Better – A Surgeon’s Notes on Performance by Atul Gawande

Rating - Read

I first came across Atul Gawande a few years ago when I picked up a ridiculously discounted The Best American Essays of 2003 from the Landmark sale. (A slight detour since I will never finish my growing collection of the The Best American Essays and review it here but its existence needs to be broadcast. This awesome book is released yearly and is a collection of really good essays published in various magazines and journals that particular year in the U.S. The topics can be wide in range or circle around a particular theme. Either way, the reading is great.) Gawande’s essay on learning how to be a doctor was funny and touching.

So when I happened upon this book, I promptly bought it.

It is quite interesting to read about a field which you constantly see only one side of – as a worrying patient. The fact that for doctors this is a profession and they would have professional concerns the way the rest of us do had never actively crossed my mind. The book was a wonderfully guided tour into unchartered territory.

Gawande groups his essays around three topics.

The first part, Diligence, is an eye-opener on how the small things can save millions of lives. The essay about doctors washing hands between patients, the continuous improvements that hospitals keep trying to do to get doctors to wash their hands, the historical figures who were ahead of their times in identifying the absence of handwashing as a source of spreading infection..all of this makes you think about the larger place a very simple act can have in the world.

The next part on Doing Right has essays on doctor litigations, maintaining professionalism and dignity of patients when they are naked/nearly naked and so on. The most moving essay in this part was on doctors who work in administrating the death penalty. A philosophical discussion on how as a citizen you may want some people to really be given the injection, but then as a doctor you are betraying your profession’s fundamental principles to save people. I got wondering how it felt for a normal human being to have to deliberately kill another human being.

The final part is on Ingenuity, which includes a piece on the amazing ways in which underequipped, understaffed hospitals in rural India cope with a flood of patients. From having berated government hospitals, it made me think about the few good men (and women) who do the best knowing that they cannot possibly do the theoretical best for their patients.

Tucked in somewhere was also an interesting piece on why C-sections are now used more commonly compared to the 60s in America. I thought all the arguments made perfect sense.

Infact his arguments throughout the book are well-presented, well-thought out and though-provoking. Gawande does not always have answers to questions but it is nice to hear the questions that doctors face. Besides, for a book that dwells into the complex world of people saving lives, the issues are seen logically and somewhat, gently. Not to mention, Gawande is an engaging writer.

This was probably my first unputdownable non-fiction book (not counting the masala-filled Barbarians at the Gate and similar near-fiction stuff).

The culture of fear

When the first news of the bomb blasts at Opera House, Dadar and Zaveri Bazaar hit, I faintly remember having a feeling of déjà vu. I had already gone through the motions before – of staying at home, checking where immediate family was and asking them to come home, of answering SMSes and calls from family and friends checking to see if we were OK.

It is now, much later that the impact of the blast is slowly beginning to sink in. I went to a mall to catch a movie on Saturday and took a long time to enter parking. As I was waiting for my turn at the vehicle security check, I noticed that the boot of the slightly dilapidated looking vehicle in front of me was wedged tight and the security guy was struggling to open it. For a second, I visualized the boot blowing up and releasing flames filmi-style. Of course, life continued in its ordinary course.

Or maybe I should not say ‘of course’. I should say ‘luckily’

And I absolutely hate to think that I have to say ‘luckily’.

We live in peaceful times. In a country that has no civil war going on. And which has its border fights, but nothing that threatens to turn into WWIII or even a regional war.

Yet, why do we have to live in such fear?

It seems very normal now for malls to be frisking each person and checking each bag. It seems common to walk past detectors all the time. What was confined to airports once upon a time, is now a part of daily life. It is accepted that we will go through elaborate motions of security.

For what?

The blasts have laid open the fact it is not these motions that we go through that protects its citizens. It is a whole lot more. From the press that has been going on, it is clear that the elaborate infrastructure arrangements which were promised to Mumbai in the aftermath of 26/11 never came to pass. The elite force that was created for the city’s protection, cannot be called elite given the treatment they have been given. And finally, the whole intelligence set-up apparently still cannot catch possible security targets.

Yet, we have the powers-that-be rushing to the scene (buffeted on both sides by plenty of security cars) and looking properly grim and giving the same assurances. Do they even mean what they say? Do they even care that the ordinary Mumbai citizen now walks around with fear clutching his heart?

It is a really sad state of affairs.

And I, Mumbai citizen, am very very angry.

Sea of Poppies by Amitav Ghosh

Rating - Read

For anyone who has not read Amitav Ghosh, I can confidently say ‘stop reading. Log onto a book site and order him. Resume reading’. Ghosh must be among the best writers when it comes to weaving tales backed by really strong research. Everything sounds authentic and you sink into the stories he paints for you, pulled in by the wonderfully vivid descriptions. Everytime I read Ghosh, I am transported to his scenes and often find myself startled to emerge into the here and now.

Sea of Poppies is no less. The tale is set in British India around the time opium was being grown in large belts of Bihar around the Ganges. Deeti is a high caste opium farmer, watching the days go by with her opium-addicted husband unable to provide enough to even repair the roof of their house. Zachary Reid, a free American born of a black mother and a white father finds himself raising from carpenter to second mate in a ship. Paulette, daughter of a French botanist, becomes an orphan and is taken in by a kind British burra sahib, Mr Burnham. Her Indian nanny’s son and her childhood friend, Joru is aiming to become a sailor. Burnham establishes his strong-hold on the opium and coolie business, assisted ably by his Indian advisor. Raja Ratan Halder, a zemindar comfortably ensconced in age-old traditions is beginning to realize the might of the British raj. In the midst of all this is the Ibis, having finished her time as a slave galley and now being outfitted to carry coolies to Mauritius.

Each of these threads slowly begins to come together to form the first part of the trilogy. The book jumps from one thread to the next but at no point do you feel that any thread is less interesting than the others. You greedily consume the story of Deeti but as easily move to find out what is happening with Raja Ratan Halder.

Someone had mentioned that the language of this book is tough to comprehend, and unquestioningly I had also ignored this book for a while. What a fool I was.

The book’s strongest point lies in its language. The English characters speak a version of English that generously borrows from the Hindustani language they would have dealt with at that point in time. Sample this - ‘there is a roti in your choola’, a Hindi transfiguration of the English expression ‘bun in your oven’ to suggest a character could be expecting. Even though a lot of these words would have been utterly bonafide English usage back then, knowing Hindi made the reading a lot easier. The Indian characters speak in Bhojpuri or Bengali but we get the translation of this. The lascars, the most interesting bunch of all, speak in a sea-language that draws from a whole range of languages and is utterly charming.

The characterization feels real and is an eye-opener on how people were back then. What happened when someone tried to interact with someone from another caste, how the burra-sahibs viewed Indians, how the English-speaking Indians viewed themselves and maintained their ‘caste’ while kow-towing to the British, how the British viewed themselves in relation to the opium trade. More importantly, none of the characters succumb to a caricature of how they should be. Each character is his or her own while maintaining the broader background from which he or she comes. The interactions between each of the characters also maitains this broader background.

The book sets the mood for the next book in the series, River of Smoke (which I now can’t wait to get my hands on).

If are an Amitav Ghosh fan, then you must have already read this. If not, now is a good time to start.

p.s. Thanks to Z for reminding me of this book’s existence and lending it to me.

Sleeping beauty

It was one of those intense moments of self-awareness.

Sis was telling about her work-from-home job and I eagerly asked her ‘so do you nap in the afternoons?’

The spark in my eye was discernible for a mile around.

‘No’, Sis mentioned nonchalantly, nearly causing me to fall off the chair.

‘But why?!!!! You work for someone in the U.S. You work from India. You take a short nap in the afternoon. No one is the wiser’ I worked out the logic for her.

‘Er..because I don’t like to sleep in the afternoons. Remember, you are the one who enjoys sleeping’ she replied

Voila. Just like that the truth that had been starring me in the face, was released.

I love to sleep.

Mind you, when I say I love to sleep, it does not indicate a life of sleeping-in on weekends till noon or oversleeping and waking up with a groggy head. It simply means, when it is time to sleep, I sleep.

I do not stay up too late partying or watching TV. I sleep.

Weekend afternoons are not spent cleaning the house or reading a book or watching reruns on TV. I just sleep.

I get my 8 hours of beauty sleep in the night and then an hour more in the weekend.

The evidence was visible from early on. As a baby I was apparently a pro at going off to sleep and then waking up well after the sun had risen and the birds had started twittering etc. My naïve parents were fooled into thinking that it was a cinch managing a baby and soon enough, along came Sis. Ironically, Sis turned out to be the type who would wake up at 5 a.m. and insist someone play with her.

Sometime around the age of two, I insisted on getting my own bed so I could sleep with arms outstretched, instead of being squeezed into a bed with the whole family.

From class 9 to the end of graduation, classes got over in the afternoons giving me enough time to catch an afternoon nap. If the occasional school activity kept me busy, I still managed to squeeze in forty minutes before tea time. Days when I did not manage even that, saw me surly and red-eyed.

B-School was a much bigger challenge than anything I had seen though. Most people gave up on sleep in order to get acceptable grades and still have a decent social life. It was not unusual for people to work all night and then doze in classes.

Not me. Early on, I figured out how much sleep I was willing to sacrifice for grades. The answer turned out to be ‘none’. In the first year, the compulsory courses ensured I had to skip the post-prandial siesta occasionally. But in the second year, I chose my courses wisely. In the only one that was held between 2 p.m. and 3 p.m., I nearly lose a grade point for having inadequate attendance.

As for late night studying, that was unheard of unless one meant 11 p.m. Friends soon learnt to walk past my room making as little noise as possible during these sleeptimes.

Unfortunately, since then, the precious noontime siesta has not been a part of my life except on weekends.

Come Saturday afternoon, I draw the curtains, prop up my pillows and carry a book to the bed. Then as the effect of lunch takes over and the sun becomes a hazy light beyond the curtains, I gently slide further and further down the pillows. Finally, my eyes are closed, I am drooling on the pillow and snoring like a Hippo with a flu. D usually tiptoes around me at these times, having learnt very early in our relationship that waking me was unnecessarily putting his life in peril.

Given the mounting stack of evidence, one would have thought I would have started putting down ‘sleeping’ as a hobby early in life.

Interestingly enough, no. I always assumed sleeping meant this much to everyone.

Till my sister shook me up by revealing the scandalous truth that she was rather indifferent about it.

Strangely enough, learning the truth has had quite a happy effect on me. Perhaps a younger me would have felt guilty about enjoying something as inactive and non-intellectual and unchallenging as sleep. The older and wiser me though relishes the fact that here is an activity that involves zero effort from me, is a pleasure to do and can easily fill time when bored.

Weekend naptime, here I come. Zzzzzz.

The Girl who stirred the hornet's nest by Steig Larsson

Rating - Read

The first book in the Millennium series, The Girl with the Dragon Tattoo, introduced us to the series. It was a stunning novel. Lisbeth Salander, the protagonist, is a 20 something girl, who has been under legal guardianship most of her life due to an incident from her childhood. Mikael Blomkvist is a journalist looking to lie low after his story and credibility on an investigative journalism piece are ripped apart. Enter Vanger, an aged, wealthy patriarch wanting to solve the mystery of his grand-daughter’s death from long ago. Lisbeth and Mikael paths cross each other and they become allies/friends/what you will.

The whole set up is in Sweden and the book immediately immerses you into tongue-twister names which you have rarely heard before. The pace is quick and heart thumping and the violence, unabashed in its full glory.

When I finished the first novel, I could not wait to get my hands on the next one, The Girl who Played with Fire. This book is a continuation from the next novel and dwells more into Lisbeth Salandar’s background and the reader is exposed to some stunning discoveries. In parallel, Blomkvist takes on an investigation on sex-trafficking. Given the topic of Book II, the stories are fairly heart-wrenching and stomach-revolting. The violence is more gruesome, if that is possible.

Which is why despite wanting to find out what happens in the final part of the series, I decided to take a break from the series. In retrospect, I really needn’t have.

Book III, The Girl who stirred the Hornet’s Nest, ties up loose ends without unleashing fresh bouts of violence. Most of this book goes into providing a background of Swedish law, security police, governance, parliament etc and what needs to be done with Salander. Coming from the Indian culture of accepted corruption and the casual misuse of power, I found it increasingly hard to believe that the option of the Swedish establishment punishing an old crime rather than hiding it away could even be considered in the book. The book eventually ends with the answer to the question ‘Will Lisbeth get justice’.

The series on the whole is definitely a must-read (a no-brainer given its position on best seller charts). What I liked about the series was

- set in Sweden, a country I have not seen as a backdrop in novels
- a female protagonist who is incredibly strong and quick-witted and whose character feels true despite the low probability of actually meeting someone like that in my daily life.
- plots that keep your interest going with some detailed fleshing out
- no apologies for the kind of violence that the stories narrate. Most of them are based on crime statistics.

The points all tick off well, but most importantly the mix is served neatly.

What the @#&*

Anyone watching any English channel regularly must be familiar with the censorship of ‘bad’ words that go on. The English subtitles provided in the channels all miraculously swallow up words like ‘fuck’ or replace ‘crap’ with ‘shit’ (or maybe it is the other way around).

I am most amused by this editing. Who is supposed to benefit from this I wonder?

Clearly it can’t be for kids. I certainly hope not considering some of the serials subject to this include ‘Dexter’ – a gripping tale about a serial killer who kills other serial killers. Which kid is watching this! Or for that matter which kid is watching the cynical ‘Family Guy’ or ‘How I met your Mother’ where the lead characters deal with relationship issues and one of the characters lives largely for sex.

On the other hand, surely we adults don’t need the policing.

Most times it is amusing. Like when ‘sex’ is replaced by ‘love’ in sentences like ‘It is just about sex, isn’t it?’ As you can well imagine, the whole context of the scene changes when you do the substitution.

Sometimes, it is plain annoying. Try watching a Guy Ritchie movie where the volume dips everytime an obscenity is used and your head will spin from the rapid changes in volume.

Of course, like everything else in our country that defies logic, after all this careful policing, we have five year olds singing the hit number ‘Bhaag DK Bose’.

Makes you go 'What the @#&* ' ?

Number9dream by David Mitchell

Rating - Read

Number9dream tells the story of Eiji Miyake, a nineteen year old Japanese village boy, who comes to big-city Tokyo in search of his father. Back in her youth, his mother had been the mistress of a rich man and had ended up abandoned, with twins and an allowance. Eiji and his now-dead sister Anju were brought up by their maternal grandmother, his mother being too unstable to raise kids. As he approaches his 20th birthday, Eiji decides to find who his father is.

Eiji knows practically nothing about his father and starts the search from the building occupied by the lawyer who handles his father’s affairs. As Eiji moves along in his search, he gets involved in all sorts of experiences. He gets a job and a place to stay. He gets mixed up with the Japanese mafia equivalent, Yakuza. He moves to another job. He finds a girlfriend. He experiences the kindness of part-strangers. As the book nears its end, Eiji moves towards embracing his reality as best as he can

The book by itself is a largely neat read. Eiji’s experiences take you through various aspects of Japanese society and boy is that country interesting! The book’s selling point is however not meant to be its storytelling alone but also its structure. Like its famous cousin, Cloud Atlas, this book also follows an interesting structure but does not pull it off quite as well. Each chapter in the book alternates between Eiji’s primary goal and some other event happening to Eiji in his mind or in reality. For instance, the first chapter jumps between Eiji’s imagination of how he meets his father in rather bizarre circumstances, and his actual confinement to a coffee house, too scared to even enter the building in which his father’s lawyer is located. The chapter on the mafia was my favourite, loaded with Kill Bill-style imagery.

This is one of those books where you go with the flow and let the author lead you between the various strands, enjoying each strand for its imagination.

If you are new to David Mitchell, I would strong recommend you start off with Cloud Atlas. Then, you can come back to this one. I dithered between a ‘Read’ and a ‘Read if you have the time’ rating but decided the entertainment value is adequate to give it the benefit of doubt and move it to ‘Read’.