Uncategorized

Looking For My Mother…. Look No Further..

Mother's Day, Mother's Day for dead mother, orphan's mother's day, Uncategorized /

37 years had passed by, but even today my mother continues to inspire me. When I spent the last days with my mother, I was young, excited and, naïve in my mid 20s when I just got the visa to my dreamland, the United States of America.  I was scared to death, still I was so excited at the prospect of setting foot in my dreamland. My last day with her was at the dilapidated airfield, in Chittagong, Bangladesh, at the farthest shores of the Bay of Bengal, the same place that has been used by the British and the allied forces to launch the counter offensive against the occupying Japanese army in Burma frontier, where first leg of my journey to US began. Before I was boarding a small airplane at the time of departure, little did I know that this was the last time for me to see my mother. I didn’t know it myself but perhaps my subconscious knew it.  Perhaps that was the reason I fell onto her feet and asked for her forgiveness for all the troubles I had caused her while growing up.  Coming to America and looking for new opportunities wasn’t an easy path. For few weeks, my daily sustenance was two pieces of bread and peanut butter. I couldn’t have even eaten those unless my mother gave me the $23 in the Chittagong airport with which I landed in USA. I remember in the airport she asked me, “Son how much money do you have with you?” “What are you talking about mom? I’m going to the richest country in the world, they are flushed with money everywhere!”, I retorted with all my naivety and ignorance of young age.  My mother just smiled and looked at me directly into my eyes and said, “Don’t be crazy my son, you always need some money in your pocket.” Then she took me to the foreign currency counter right across the waiting room and poured out all the notes and changes she had in her purse, which translated into total of $23 in the US currency. She tucked in those currencies in my front pocket of my shirt. With that money in pocket, I started my journey to the United States. Needless to say, I was naive to say the least and it took a long time for me to grow up and to understand the realities of America. I am now settled in my American life with a comfortable profession and a number of rewarding avocations. As a gastroenterologist, in my day-to-day practice I listen to lots of stories of people and their families. In the pursuit of my profession, I have become a communicator and lots of my patients know me for many years to an intimate degree. The other day one patient told me, “Doctor Meah, you work really hard”. I looked at her and told “Really?” I was not surprised though; this is not the first time I was told that I work “hard”. I consider this as a characteristic of being an American, a quality Americans have been endowed with as part of their culture. However, this time my mind wandered back to an introspection: I wonder if I truly work hard, how do I do it, what is my inspiration? It didn’t take long for me but few seconds to realize that my inspiration comes from my mother. My mother worked as a schoolteacher outside home and inside home she worked as a homemaker.  In addition to me I have eight siblings. She did full time work as a teacher and at the same time almost every other year she gave birth to a child, total nine of them. I have never seen her complaining about her work as a teacher or at home. And I have learned a lot from just watching her after her school job doing cooking for us and feeding us and then supervising us doing our homework.  She even found time to sew our clothes and even doing crochet to make sweaters for us during the winter time.  One particular memory etched in my mind is about our home electrical breaker going off frequently as a result of which we used to lose electricity. The fuse needed to be replaced. In those days in Bangladesh the electrical fuses were not automatic and enclosed as we see today. One really had to open the main electric box, pull out the ceramic device out and replace the thin copper wires in it manually which acted to complete the circuit. So, this was a big and potentially dangerous chore, and most of the times people would call an electrician to do this. However, that meant long waiting time could be even more than 24 hours. So, one day as our main breaker went off, my mother said, “We are not going to wait for the electricians anymore, we are going to do it ourselves.” She gathered the screwdriver and a plier and handed these to me to work as her assistant. I stood by her on the floor to hand her the tools as she got up on the chair to reach the breaker and handed her the tools as she called for it. I watched her as she pulled out the ceramic switch, replaced the burnt-out old copper wires and replaced it with the new ones with her dexter hands. A little later after she had put everything in its position, she closed the lid of the master breaker and turned it on.  Voila the electricity was restored in our little two-bedroom house. I looked at her with awe; it was a tremendously empowering experience. In addition to cognitive learning, reading, and writing these are other things that I have learned from her consciously and subconsciously. As a result, I have developed an immense respect for handiwork and to stay busy. This has probably inspired me to my hobby of working as a rancher and doing little carpentry work whenever I

Looking For My Mother…. Look No Further.. Read More »

March is Colon Cancer Prevention Awareness Month

Colon Cancer Prevention, Uncategorized /

Colon cancer is one of the leading causes of cancer deaths in the world, but the good news is that it can be prevented through a combination of lifestyle changes and early detection. In this post, we will discuss some effective ways to prevent colon cancer. First and foremost, it is essential to maintain a healthy diet and healthy lifestyle. A diet that is balanced and rich in fruits, vegetables, and whole grains can lower the risk of colon cancer, while consuming excessive red and processed meats, fried foods, and sugar can increase the risk. Additionally, it’s recommended to limit alcohol consumption and maintain a healthy weight. Regular exercise is also an important factor in preventing colon cancer. Physical activity has been shown to reduce the risk of developing the disease to a surprisingly high degree, and it’s recommended to get at least 30 minutes of moderate exercise every day. There is not one single mechanism that people develop colon cancer. Like any other cancers, it is a very complicated process and many factors including genetic changes predispose humans to develop colon cancer. All of them may not be totally preventable even by using all available means of good healthcare practices. Therefore, another important aspect of colon cancer prevention is early detection. Screening tests such as a colonoscopy, stool tests, based on both occult blood detection and detection of abnormal DNA or mutation of DNA can help detect colon cancer in its early stages, when it is most treatable. Screening is usually recommended for people over the age of 45, or earlier if there is a family history of colon cancer. Screening colonoscopy plays a critical role in the prevention of colon cancer. During a colonoscopy, a physician inserts a long, flexible tube with a camera attached into the rectum and colon to examine the entire colon. This test allows the physician to detect polyps, which are small growths on the colon wall that can develop into cancer over time. If polyps are found during a colonoscopy, they can be removed immediately, preventing them from developing into cancer. In addition, colonoscopies can detect early signs of colon cancer, which can be treated more effectively when caught early. Screening colonoscopies are recommended for individuals over the age of 45, or earlier if there is a family history of colon cancer. Regular colonoscopies can reduce the risk of developing colon cancer by detecting and removing polyps before they become cancerous. In this way, screening colonoscopies play a crucial role in the prevention of colon cancer. Finally, it is important to quit smoking, as it has been linked to an increased risk of colon cancer. If you are a smoker, quitting can help lower your risk, and if you’ve never smoked, avoiding exposure to secondhand smoke can also help reduce your risk. In conclusion, preventing colon cancer requires a combination of lifestyle changes, such as maintaining a healthy diet, regular exercise, and avoiding tobacco, and early detection through screening tests. By following these tips, you can reduce your risk of colon cancer and increase your chances of living a healthy and disease-free life.

March is Colon Cancer Prevention Awareness Month Read More »

A Very Short Story Of US FED OR Federal Reserve Banking System

Social & Financial, Uncategorized, writer's blog /

A Very Short Story of US FED or Federal Reserve Banking System Nizam M. Meah, MD This year’s Nobel Prize in economics was issued to three US professionals who specialized on Bank Runs; i.e. when customers are on an economic panic thinking that their bank is about to fail and lose trust in banking system. These economists also explored the role of US Federal Reserve Bank or simply FED in such a situation and their conclusion is very positive for the FED. But the history of FED is nothing short of stormy and bitter rivalry in the United States: our founding fathers in general were vigorously against a central banking system since in the pre-independence era, Colonial Power Britain tried to impose control over the colonies by Bank of England, yes, the same famed BOE that you hear about regarding the financial crisis of current UK. After independence of the USA the First Bank of US was created in 1791 charter signed by our first President George Washington, the charter of which expired in 1811 and Congress did not renew it, so the First Bank of USA died. In 1816 Second Bank of US was chartered and Andrew Jackson was elected President in 1829 who called this Bank as “the den of serpents and corruption”. Jackson embroiled himself in a bitter political fight with other leaders and Congress leaders on this issue and this ultimately killed the Second Bank of US in 1836.  Then came the Era of “Free Banking” in the USA: 1836-1862- we had no central dollar bill, no real treasury notes, many banks had their own bills and own money, and anyone could do anything in short although many States chartered their own bank and there was NO NATIONAL BANK. Then came the Civil War and in 1863 and effort was underway to create another Central Banking System due to mainly from the need of Civil War: need for a uniform currency and need for Bond or treasury to fund the Civil War. In 1907 there was another severe economic crisis in US and at that time it was understood that there will lot more economic crisis which could be even worse than this. This realization led to a foundation of a primitive FED system and this concept matured through lots of complex interplay of politics, First World War, and other events and in trying to balance the interest of wealthy corporations, farmers, and other lobbies. Finally in 1913, current FED or Federal Reserve took shape which was given authority by US Congress to “create or destroy money” as it needed.  So today what happened to President Andrew Jackson who destroyed the early FED system in USA? He is memorialized and celebrated in our all-important $20 Dollar Bills. What happened to Bank Of England which our Founding Fathers hated? Over time BOE became the little poodle of US FED system almost running and copying everything from its big brother USA and its vast economic success. Sweet revenge indeed!

A Very Short Story Of US FED OR Federal Reserve Banking System Read More »

Boro Amma- The Great Mother & Story of Motherhood

9 Comments / Uncategorized /

Morning of October 1942, Chittagong, British Colonial India  Chittagong was a sleepy, largely agrarian town, still languishing in the backwaters of the British East Indian Colony. As the early winter fog was still hesitantly floating in the air, sudden howling of aerial attack sirens rang out from the nearby British and Allied military barracks. Soon, waves of Japanese Bombers started dropping the payloads over the town. The Japanese air-attack was instantly followed by thuds of anti-aircraft batteries fired from the British bases as they engaged the attackers from this Air-Naval base.  On this same day of October 27, 1942, shrill cries of children and relatives rang out in the unison in the household of Antoo Miyan Chowdhury and Pori Roksar Begum. The gathered elders and men of the family started chanting “La ilaha il-lal-la-No God but Allah”, their collective voice took on the gravitas of gnostic melody, as Pori’s body laid motionlessly on her bed. Someone pulled the white shroud over her body soon covering her pale bloodless face. As the cacophony of mourning voices of men, women and children merged together like an operatic performance, one was the most distinct with mournful timbre in that bamboo thicket house with a corrugated tin roof.“Pori? Why did you leave before me? How could you go before me?” The mourning and melancholy of the voice gave her identity away: only a mother could be so sad, she was none other than of Sabeda Khatun, Pori’s mother. Chittagong, being in a far-flung corner of the British Indian Colony bordering Burma (Myanmar in the present days), was still almost unknown to the world and was still hidden away from the limelight of the constant World War II news reports which were only busy with the reports of European frontlines. Almost nothing was reported from this area in what was the mainstream media of that time, although the ferocity and atrocities of the war were no less than the European frontlines. But lying in the hinterland of Indian subcontinent provided no respite to my ancestral hometown of Chittagong from the devastation of World War II. It quickly became a hub of frantic military staging operations for the British Army. By this time the Japanese Imperial Army had occupied large part of Burma with the cooperation of local Burmese and had posed a direct threat to what was the territory of Indian Colony itself.  At this time, British Major General Wilfrid Lewis Lloyd was commanding the battle to recover from what was until then a humiliating defeat of the Allied armies at the hands of the Japanese Imperial Army in the Burma Front. Chittagong Nestled by the shores of the Bay of Bengal, with continuous and contiguous Burmese shorelines, Chittagong still defines the transition of India-South East Asia with Indochina or with Far East Asia. It was the perfect geographic and strategic fit for the advance military supply base that could be reinforced from the sea and the air routes in Burma Campaign. The Americans also provided significant logistical support via Chittagong as British Allied fighters assembled for the fight in Arakan, the westernmost Burmese province adjacent to Chittagong. The assembled troops were diverse and included conscripts, soldiers, and other personnel from all parts of India, and as far as West Africa. The first reported Japanese bombing of Chittagong was on August 9, 1942, which, intensified during the subsequent months and by October it was so intense that my grandmother Pori’s burial had to be delayed on October 27, 1942. Pori & Antoo Miyan Chowdhury Pori Roksar Begum was my maternal grandmother whom we call “Nani” in local Chittagong dialect. She was the oldest of four children of Sabeda, and Ahmed Kabir (Sabeda’s husband). Pori had died when my mother was barely ten, we never had a chance to meet her in person.  Her parents had named her Pori, meaning Angel, for the angelic beauty and mild manner she showed from her childhood onward, according to family’s history. But little did they know then while naming her that she would turn out to be physically fragile all her life as well. As was customary in the society of the then, Pori, in her mid-teenage years, married my maternal grandfather, Antoo Miyan Chowdhury, my “Nana“. He was one of the first Muslim graduates in Chittagong with a BA degree at a time when the Muslims from the Indian subcontinent had just begun their struggle to regain their rights to get an education and enter the job markets after a long period of marginalization and discrimination, both at the hands of the British colonialists who wrestled the power away from the Muslim dynasties and later at the hands of the Hindu majority who more closely allied themselves with the British before the Muslims could accept and reconcile with the new reality of being the losers and the underdogs in the wake of a new power structure. Nana was a government servant of the British Raj, a position commanding considerable social respect and financial security. His homelife flourished as well, as during their married life of ten years, Nana and Nani Pori had seven children. Each pregnancy happened before she could fully recuperate form the previous childbirth and left her weaker and sicker than ever. Her seventh child, a boy, was born in 1942 through a difficult delivery at home. And so, it seemed that by this time, Pori’s young body had produced enough children and could not give birth anymore. Although the newborn was healthy after the long birthing process, Pori never regained her place in her world. All her seven deliveries were at home under the care of her mother and local elderly women (midwives) who lacked any formal medical training. Hospitalization for childbirth was not ever heard of in those days in this society. The midwives and elder women who supervised the childbirths of Pori at her home were at a loss to explain her deteriorating condition. They told she had chutabai, a basket term in the local Chittagong

Boro Amma- The Great Mother & Story of Motherhood Read More »

bosnian genocide

Bosnian Genocide in Medical Practice

2 Comments / Uncategorized /

Yesterday I visited Emete, he was paralyzed, seated in a wheel chair accompanied by his wife who brought him to my office. I have known this man since the early days of my practice: he is a refugee from Bosnia, one of the Bosnian Muslims. Over 100,000 Bosnian Muslim men and boys were systematically massacred by Serbian army and paramilitary who are predominantly Christians in the heart of Europe in the mid 90s as part of a brutal campaign for ethno-religious cleansing and elimination of a people from the heart of Europe. I was in my fellowship training in those dreadful days as we watched and read the news with horror with graphic images as the Serb forces day after day slaughtered tens and hundreds of Bosnian Muslims. But that was hardly the end of the story- women had to absorb the most brutal part of this violence. Thousands of them were raped and made pregnant by their Serbian captors and were held as hostages. They were used as the ultimate tool of message of domination over the Muslims. There are reports that when raped women were let go, they were held until the pregnancy was at an advanced stage to ensure that they could not abort the fetus. This child, born of Serbian rape, was supposed to serve as the ultimate symbol of Serbian domination over Muslims who are really no different than them ethnically but only differed in religious belief. After finishing my gastroenterology fellowship training in Detroit I started my practice in Houston Texas. I was surprised to have Emete as one of my first patients! I have always been an avid news consumer and a history junky, characteristics of my atavistic origin, passed down from my parents and families who had the same passion. I felt an immediate connection with him. I was not only interested in him as patient, but I was more interested in him as a human- to me he was the symbol of human survival against all odds, he was standing tall as a surviving member of a people who experienced genocide in our times. His personal history of survival was not surprising at all: to survive he lived in the forests of Bosnia with family members for several months drinking only from snowmelt water and foraging on wild plants and tree barks. His own Serbian neighbors who were once his friends and he had social interaction with, now turned into enemies. They are the ones who pointed out the Muslims to be hunted down living among them to the Serbian Army and Paramilitaries. Sometimes even the civilian neighbors turned into brutal persecutors, butchers of innocent Muslims. And exactly this is the fate met by Emete’s family. Emete and his family were already on high alert knowing that the killing, raping and looting had began targeting the Muslim communities all over in Bosnia. Majority of the grown up men and boys of his village were already in hiding. They knew that one of the belief the Serbians had was that if they could eliminate all the Muslim men, there will be no one left among Muslims to procreate and support the family. The helpless women will now be only low hanging fruits for the Serbians. Thus elimination of Muslims will be attained while at the same time it will be swell of a time in enjoying and using Muslim women as womb machines to produce more Serbians. Believing that women and little children were relatively safer at home than living in the forests exposed to the elements without any amenities of living were too much of a hardship for them, Emete and other male members of his village left the infants and their mothers at home while they escaped in the deep forests, only occasionally visiting them in the midst of nights or small hours of the mornings so they could evade the enemies. Even before the war broke out, Serbian Christians organized regular patrol and recruited paramilitary forces from all over the territory. It was a routine for them to be driving around the neighborhoods and villages with Muslim population in open backed trucks with gun-toting and hurling insults at the Muslims. One morning such a Serbian paramilitary patrol truck stopped right in front of Emete’s house. Eight or ten armed people jumped out of the back of the truck and entered the house simply kicking and breaking the door without any knock. They looted the house and stripped it of anything of value and loaded up the loot in their truck. Emette’s wife, the only adult left at home with two children was kind of expecting it. She heard rumors from other villages that this is taking place regularly, she thought to herself it was a matter of time but still she was hopeful for the impossible, that perhaps she and her family might luck out and escape the worst fate. Once her house was looted and everything was loaded in the green truck, feeling a strange sad relief she though her nightmare was over, at least no bodily harm had befallen upon them. Before even she could take a deep breath of relief from the horror, she heard the Serbian men coming back. But she sensed right away, this time they turned more sinister. The pleasureful glee the Serbian men had during looting demonstrating that they had enjoyed the act as entertainment just few minutes ago had this time seemed to have evaporated. She sensed something more fearful than ever before in the wind. With her fearful glance, Emete’s wife could see the young men’s stern face with deep furrows on their foreheads, their eyes seemed exuding fire, they looked more like pack of wolves in pursuit of hunt, not humans. They walked through the house, pulling down and then throwing her head cover on the floor and grabbing her by her long hair. Then they pushed the mortified little girl standing by the side of the mother

Bosnian Genocide in Medical Practice Read More »

Connecting with Patients, Humans

Featured, Uncategorized /

I was in a phone consult yesterday, a phenomenon that had taken shape in the Covid era. Many of our patients prefer to “visit” us over phone or over FaceTime or Google or some other platforms. She was a new patient in our practice and this was our first encounter. My patient on the other side of the line was a healthy 51 year old who needed a preventive or Screening Colonoscopy. She had never seen me before, and naturally she had some reservation. Colonoscopy is also an invasive procedure and any normal person would have some concern related to any such medical procedure. After the initial standard greetings and mutual introduction, I went to the part of gathering questions which in medical science or in medical practice craft we call “Family History”. It turns out that she lost both of her parents quite early in her life. As soon she told me this story, it reminded me of my own family history that I lost my mother when she was only 54. My brother, who was youngest of the nine of us was only a teenager at that time. This memory is something that works on my background all the times, 24/7/365. I have adjusted to it, but I mourn it everyday. Instead of holding it, I decided to share this with my patient, openly and in elaborate details. I told her how I feel everyday from this loss, the melancholy that is always in the background. I shared with her my own pains, pangs, angsts and my own vulnerabilities. Her anxiety, fear and reservation melted like a piece of icicle held inside the fist melting with the body heat right away. I could feel even over the phone line that she had developed a picture of mine in her own mind. Her guarding was totally gone. We truly saw us, each other as doctor and patient, in our mutual story even before seeing each other physically. We are totally connected at the human level. From here on, rendering care for her, and earning her trust in my care had no resistance, our flow of human connection was a spontaneous waterfall that had crossed and overcame all the barriers of boulders and mountains. I have always found storytelling and story listening to be the best tools for a physician in the art of the craft, craft of practicing medicine. Nothing connects us as human being than for a patient to hear our own stories of vulnerabilities, anxieties and emotions. For last several years I have been arguing with my medical school faculties to change the terminology of teaching “History and Physical Exam” to “Story and Physical Exam”. History is something objective after multiple source verification and verifying with, counseling with many experts. In doctor patient interaction, we are interested in personal perspective, a very personal story, not a history. We are not looking for dissertation of a pundit, which is history, we are looking for a details coming out of our own patient’s heart and mind. And it is not a one way street, it is a two way street to connect. Story listening works best when we, medical providers are also willing to share our own storytelling. Words to have meaning and in this day and age, for medical practitioners to serve we need to the level of humanity not in the pedestal of medical jargon.

Connecting with Patients, Humans Read More »

My Story

Uncategorized /

I am a physician, a gastroenterologist. What I do is take care of the patients who are suffering from Gastrointestinal or digestive problems. Someone might come to be for reflux problems, someone for ulcer pain, and someone for diarrhea or constipation. Or someone might come to me just because they are perfectly healthy and need a screening for colon cancer or prevention of colon cancer. But my story began much earlier, beyond the shores of the Atlantic or the Pacific. You see I was born in Bangladesh, well the then East Pakistan in a town nestled by the remote shores of the Bay of Bengal. Both of my parents were teachers, supporting a family of nine children with their meager salary. It is their sacrifice and inspiration that made me into what I am today. I always wanted to be an architect! After the college exam, I traveled across the country and visited colleges and universities and spent time with relatives in capital Dhaka and other places. Soon after this trip I was ready to enroll in the professional school. One sweltering night we gathered for our supper, which was around nine or ten at night since back in the old country we are used to taking evening snack with English tea and biscuits, or cookies in American terminology. For our supper we used to squat on the kitchen floor, in a six by ten feet space; all of us used to huddle next to each other with our bottom on a six inch wooden tool locally called as “piri” , our both knees straight upright with our stomach squeezed. In addition to her regular job as a teacher and hundreds of chores, my mother used to cook fresh on earthen stove burning firewood that we used to collect from the jungles. She would serve us while keeping the items warm with the glowing fire, she would never eat until we are done. She had no options either, this was the 1970s in the old country, we had no refrigerator, meals had to be cooked for every meal and finished shortly before it goes bad. As I was slurping the rice and curry from the plate this night and so as everyone else, my mother asked, “So son, you have visited the universities and colleges, what have you decided?” “Apply in School of Architecture, mother” seemingly confident and eager I was. The overcrowded kitchen with nine siblings, a father and a mother, all of them with a plate of food in front of the glowing inferno of the burning firewood went silent; all I could hear was slurping of the curry and cracking and hissing of the firewood burning in the stove as the last bit of wood oil tries to escape from the end of the charred wood. My father’s voice this time triumphed over the burning wood, “Son, we want you to be a doctor”. And then another brief silence to be only broken by arrhythmic cracking of the firewood, and this time I gathered all my inner logic and rebutted, “But my older sister is in med school, she is going to be a doctor”. My sister is our oldest sibling and by this time she was in the first year of medical school. Without taking out much time this time my mother forwarded, “Son, your sister is her own, she will be married off and make her home with her in laws, you are for us!” Her statement although I did not fully agree with or comprehend totally was reflective of deep thinking and cultural norm of Bangladesh that girls will be serving their husbands and I as the oldest son I had my own responsibility towards my family; it was my job to lift up rest of the siblings. This is how, societies in scarcity work, parents invest while they can in the first few children, and these older children lift rest of the family. This is why a son is so important in a developing country. The kitchen fell silent again, I did not agree neither did I protest, but, I must have been convinced, because the next thing I discovered in months to come was that I had enrolled in the medical school. In the medical school, I was not a happy camper; I was a frustrated student, for two reasons: I had like to be an architect first and secondly, I had always dreamed of being in America and part of this great nation since my 6th grade. Just about that time all my relatives and friends who were well to do got admitted in America and I was left behind knowing all well that I am from a lower middle class family and to be enrolled in an American school was beyond my parent’s means. This was further escalated by the grueling basic science syllabus of first two years of med school. The very first day, we were locked in the Anatomy Dissection Room with the formalin preserved cadavers, the rancid smell was unbearable let alone overcoming the shock of seeing and cutting into a dead body lying on the table right before us. The other subjects like Biochemistry were equally boring if not tormenting. In those days, they did not allow med students to start working in the clinic with real human beings for first years. In spite of all of these, I could pass and got promoted in the Third Year when I could go to the “Ward” in our British system of education, interacting with real patients. And in no time, I had a new birth of my soul knowing for the first time that every human was a story, even every disease had a story of its own, in medicine we call it “Natural history of a disease”. My life changed overnight and I started working hard and feeling good about it. I always liked story, story is primal, story is our essence. Liking story, is

My Story Read More »

Saying Thank You to Patients

8 Comments / American Dream, Bangladesh, book blog, book publishing, Chittagong, detroit, Detroit VA, doctor, Father's Day, gastroenterologist, healing and storytelling, healing through storytelling, hospital, love, Mentor, patient, publish, short story, Teacher, Uncategorized, Wayne State Medical School /

The year was 1990. I was in Detroit, Michigan working as a resident physician in Internal Medicine. Detroit was dilapidated, its old structures were crumbling, boarded up unkempt houses in neighborhoods once humming with life were now empty, desolated, overgrown with weeds. Brick walls of the old houses, once rock-solid were now fragile and cracked, in some of which parasitic plant lives had found foothold telling the story of once mighty Motor City. A drive through such neighborhoods evoked an unknown anxiety and fear that was only interrupted by sight of an occasional industrial park, equally gloomy, in disrepair, hauntingly desolate, behemoth brick buildings with broken glass windows and ragged pitched roofs still oozing melted snow, as if only kept alive in this state of coma by some unknown force just to remind people of the old industrial glory of Detroit. Coming from Bangladesh, an overpopulated country of 2000 people per square miles, it was terribly lonely for me not to see any people on the streets and neighborhoods deserted whereas in my home country it was hard to see an inch of empty spot devoid of humans. I was struggling in my conscious and subconscious to reconcile and digest the contrast. Loneliness that I found impossible in Bangladesh, now in Detroit was over abundant and almost overwhelming. Demand of residency training, both physical and mental vigor that is called for from a young trainee doctor, kept me busy and had distracted me somewhat, perhaps even protected me from the malady of loneliness. Working in a large urban medical school training program I needed to rotate through many different hospitals. Allen Park Veterans Administration Hospital and Medical Center was one such a place. Allen Park, twenty minute South and West of Detroit was a small working class community of Downriver area. Houses were small but neat, yards were tiny yet tidy. The imposing structure other than nearby shopping mall was the VA Hospital. As I drove the very first day of internship towards this hospital, the first sight of the sprawling red-brick building stuck right next to the freeway, with its multi-floored structure and hundreds of small panes of glass windows on all sides seemed like I was being watched by a giant alien with hundreds of eyes looking out over the plains. The sight was overpowering. As I approached the building close, the billowing cloud of smoke from the smoking veterans on both sides of the entrance outside greeted me with an aura of Burmese Opium Den. But time is a great healer; distance is the halcyon; work is the opium; my old familiar sights and sounds from the home country of Bangladesh faded gradually, and soon realities and demands of current surroundings took the center stage. Curious part of my brain sprang back into action again, perhaps I subconsciously realized it to be a healthy distraction from the monotonous grueling work of patient care at the VA Hospital. Often in call nights, I would look through the cracks and crannies of the old hospital building noticing the fine color difference of the two buildings put together, the subtle difference of the pinkish bricks, the variation of the poured concrete, the rusted iron rods sticking out as if I was driven by an impulse to find an old skeleton hidden somewhere. There are times at night I would circumnavigate the old buildings as if I were the Columbus on a mission to discover America. The reason behind as to why the Federal government put this huge hospital in such a place outside the city limits of Detroit was simply another Henry Ford story. In the dark days of Great Depression of the 1930s, the Ford family had donated 38 acres of land to the federal government in Allen Park, MI, as an inducement to set up this VA hospital. The construction work began in 1937. At the end of Second World War as the rank of Midwestern veterans swelled, the hospital was expanded in phases to accommodate the increasing demand. The architects in charge of these renovations never wanted to hide this fact perhaps, because any observant set of eyeballs could easily still tell each additions of the hospital separately. This VA Hospital was gem of a place to learn for any aspiring medical student. Veterans and the teaching faculties were always easy going compared with elite private hospitals and sophisticated patients therein. Veterans on the other hand, did not have any special demand upon the trainees. VA Patients were always compliant and unabashed at the request of physical examination and as of yet, neither there was the looming threat of malpractice law suits, nor there was any pressure from the administration to discharge anyone early to save the hospital money. In fact the pressure was opposite: to keep patients in the hospital for any reason as long as one can, medical to social. It was not unusual to keep someone for days even weeks in the inpatient hospital service because the veteran had no taxicab fare or bus ride to go home. Apparently each individual VA Hospitals used to get budgeted money allocation according to the census of the hospital. The more patients each hospital had in its rolls the more money were to be allocated. I remember one day, the chief of the hospital came in our morning round and told us to “keep as many patients in hospital as you can so our census goes up since the budget allocation time is coming up”! Inside the mammoth building it was gloomy dark with old fixtures. The walls were old and bare, as if the building was missing the touch of a woman and truly it was devoid of women at that time. In my whole time of service over several years, I only got to see two or three female veterans in this hospital. The whole hospital building was made for only men by men. The rare female veterans who were to be admitted were

Saying Thank You to Patients Read More »

Age of TeleMedicine

5 Comments / doctor, gastroenterologist, healing and storytelling, healing through storytelling, hospital, patient, publish, Uncategorized, writer's blog /

With the Coronavirus Crisis, we are enduring the modern Plaque of our times. Here in the United States, 30 of the 50 States have declared strict social distancing as of this date of writing. This order stopped all work of outpatient surgical facilities and also stopped the regular patient visits to the doctors’ offices making the the nation increasingly dependent on tele-medicine, or remote medicine by using video or other chat technologies. Studies on US patients show that even in normal times a significant percentage of patients are unhappy with the encounter experiences. With the introduction of computer technologies and EHR, some feel increasing impersonal and mechanical atmosphere of the sacred doctor-patient relationship, the basis of which is so personal in nature. This feeling now will accentuate to a higher degree given the providers and the patients are not even in the vicinity of each other. In absence of direct eye contact and touch of physicians or providers, I am afraid the dissatisfaction will sky-rocket. At the same time, we should not discount the advantages of remote medicine and look for ways to mitigate the disadvantages of such remote encounters. Remote medicine is a great way to reduce one of the main complaints of American patients: waiting time. Since patients are in their own environment either at their own homes or offices, doing what they normally do, this is an area we can see immediate improvement. We also have to look at favorably the productivity of the patient by not spending time in the physician offices or hospitals. In addition, exposure to infectious and contagious diseases will be minimized by remote medicine. With respect to mitigation of lack of physical exam and touch and feel of the physician, there is no true replacement and serious patients must still be examined by the provider. But one way to mitigate the disadvantages of remote medicine is physicians have to better story listeners and better storytellers. Each patient is an open storybook. Physicians just have to read it. I am an advocate of replacing the age old medical school slogan of “History and physical” to “Storytelling and Story Listening”. The reason storytelling is important because in my experience I find that physician has his/her own story to tell first to make the patient comfortable. This is a great signal to a vulnerable individual that physician/ provider is a human and it is the best reassurance and encouragement for patients to open up about her/his own story. In my own remote or person to person encounter, after initial introduction, I often start the interview by an open ended question, “Tell me your story……..” And this gives the patient on the other side of the line or sitting on the other chair to start with whatever they want. And often times people will start with something that is important to them or something that is bothering them the most. As the conversation starts, I find something of my personal life to share with them….. thus a patient’s story becomes one with a doctor’s story and it becomes a human story. By the time it ends, we both have an insight to our mutual connections as our doctor-patient relationship solidifies and a satisfactory treatment plan is built upon this solid foundation. In my experience, patient satisfaction and compliance is far superior in this way. But this is also a self-service for the provider. Self-service because as providers we also need to feel content and satisfied about what we do and by doing it better. So this is a way to derive fulfillment about our own job. Most importantly, the intangible benefit a physician derives by connecting with her/his patients is immense, far beyond what money can buy. So in the days of remote medicine and artificial intelligence, provider communities have to be far better storytellers and story listeners. Followings are few examples how my patients told their own stories and at times even gave me away the diagnosis. In 100 percent of times though, they gave me an opening to their lives and a great way to connect: A 48 year old woman; “How anxious I am to learn what is causing my pain. I have been on a liquid diet for more than a week, afraid of having another painful episode and returning to the ER”. This is in the background of upper abdominal pain. A 66 year old woman: “I am getting too many chicken eggs!” This is after successful treatment of blockage of the esophagus. A 59 year old female: “That my mother had a stroke in a catheterization lab and this procedures scares me because of that. But due to my faith, I believe that I’m going to be fine and back at my house eating chicken burgers, BBQ ribs, green beans etc!” This is in the perspective of a colonoscopy exam. A 56 year male: “Get up in the middle of night with panic attacks when I can’t breathe. Using Wal-four Nasal Spray all day long”. This is in the background of an upper abdominal pain. A 65 year old male: “My favorite color is blue, I love my wife more than life itself and my children are my strength. I need to exercise and eat better, I want to live as long as my great grand parents did at 103 and 105 years of age. I love life and believe in Jesus Christ who is with me today as I go through this procedure of life….. This is in the background of bleeding from colon. A 18 year old male: “I like spicy food” This is in the background of reflux and upper abdominal pain.

Age of TeleMedicine Read More »

Discover the Human Within