Indian Writing

Via email from Revathy Gopal’s husband, and posted here with his concurrence, the text of an article by him which first appeared in HT Cafe on 10 April. It is posted here with the hope that more awareness can help save lives.

MEDICAL LESSONS FROM THE DEATH OF A POET- REVATHY GOPAL

by V.S.Gopalakrishnan

That Revathy Gopal, Bombay-based poet, writer and columnist, passed away on 7 March 2007, after a brave battle with cancer, has already been covered in tribute-rendering reports and articles in print and elsewhere. She was my wife and life partner for 38 years, and died untimely at 59 years of age. The story of her illness has lessons for everybody who values his or her own life and others’ lives, by spreading awareness in the matter.

She was imbued with very good health at all times that lent strength to her beautiful and attractive appearance. Like any widely read person, she was attentive about health and nutrition and was familiar with modern-day diseases and afflictions and preventive practices.

It was in April 2006 that she, during self-examination, suspected a lump on her left breast. She quickly underwent a mammography which confirmed her suspicions. One of the prominent hospitals in Bombay was immediately contacted. A top breast surgeon - let us call him Dr.X - came on the scene and within a week the small cancerous lump was removed. The lump was less than a centimetre in dimension. An adjoining lymph node, under the arm-pit, was also removed as a precautionary step. The breast-surgeon assured us that that was all and there was nothing more to worry. Some radiation was prescribed. A tablet was to be taken daily that would prevent oestrogen formation in the body. So far so good.

Later in May 2006, Revathy underwent an ultrasound procedure for abdomen and pelvis as she was ’spotting’. This was at another hospital and the report showed unusual endometrial thickness of the uterus. Armed with this report, we met the breast-surgeon who did the lumpectomy, as a first step. The mortal mistake he made was that he did not refer the matter to a gynaec-surgeon in the next cabin. On the otherhand he assured Revathy that the unusual endometrial thickness must be due to oestrogen deposit and could vanish soon due to the post-lumpectomy non-oestrogen forming pill prescribed and being taken by her already.

That was a welcome assurance for Revathy. She had planned a trip to England in July to see her son, over three weeks. Could she go, she asked the said Doctor X, in keen anticipation. Yes, indeed, was what the doctor said. This pleased Revathy immensely. The doctor said that after her return from England she could have another look at her uterus. He further said that even if something wrong turned out with the uterus, that would not be life threatening.

Imagine a breast-surgeon of great eminence assuming the mantle of a gynaec-surgeon! Sure enough my wife Revathy went to England, had a great time, and returned by mid-August by which time spotting had turned into bleeding. A fresh ultra-sound was done from a nearby place and the report showed that the condition of the uterus was much worse. The original unusual thickness f the endometrium detected in May had doubled in thickness by mid-August.

So, we again, as a first step, rushed to Dr.X, the eminent breast specialist. Seeing this report he got a real shock. He led Revathy at once to a gynaec-surgeon in the next cabin for the first time for further procedures. We had lost two precious months in this process!

After a Dilatation and Curettage procedure, it was revealed in the biopsy that there was carcinoma of the uterus. Post-procedure, Revathy was prescribed anti-biotics and pain-killer for five days. The pain-killer cum anti-inflammatory was ‘combiflam’, taken three times a day. After the fourth day, Revathy developed severe drug-induced gastritis said to be thanks to combiflam, that lasted a month during which time she could hardly eat. So, my wife lost one more month before she could undergo a CT scan of the abdomen and pelvis.

The CT scan (in the latter part of September) revealed extensive metastasis (secondary disease of cancer) in the abdomen, pelvis and thorax areas. There was now no point in removing the uterus. The whole system had to be treated. Hence, chemotherapy treatment to be done intravenously in six cycles, was immediately commenced by a very competent oncologist. The sixth cycle ended in mid-January of 2007. Revathy had hardly any side- effects barring loss of hair and some loss of weight. We thought that she had survived and the worst was over.

That was not to be. She developed some pain on the back. An MRI of the spine was then done. (Could it not have been done long ago as a part of a thorough diagnostic assessment?) It was found that four vertebrae showed lesions. Then followed radiation of the vertebrae. A little later Revathy suddenly found her left leg going limp. Then followed an MRI scan of the brain. That showed two secondaries in the right section of the brain. (When the world-famous cycling champion Lance Armstrong was detected with testicular cancer in the USA, every part of his body was scanned at once including the brain which showed two secondaries that were surgically removed right away and as luck would have it, they were found to be necrotic, meaning already dead !). Revathy’s MRI scan showed two secondaries in the right lobe. Then further complications followed in her case and she passed away peacefully and painlessly in that famous hospital on 7 March 2007.

Another interesting part of this tragedy is that the oncologist at no time suggested to me on his own the use of monoclonal antibodies (MAB) which are part of the recent medical developments and which attack the cancerous cells only and do not harm the normal cells. MAB is very expensive with one injection priced at a lakh of rupees. The oncologist perhaps presumes that if you are not an Ambani, you cannot afford a course of four MAB injections. Due to my extensive readings, it was I who suggested to him sometime in January 2007 or so about the administration of MAB to Revathy. It was ultimately done on 3 March, just four days before she passed away!

I do not intend to point my fingers now at any of these eminent doctors. I am just raising some issues so that the readers are enlightened and could save their lives and others’ lives. The issues that arise from Revathy’s case are as follows:

1. Can a breast specialist, however eminent, take over the role of a gynaec specialist? Revathy may not have had the secondaries if those two months had not been lost. I would now recommend to the readers the importance of a second opinion.

2. Are drugs like combiflam which many people do not tolerate require to be prescribed for our patients? Revathy lost a month before her CT scan due to drug-induced severe gastritis.

3. Why do our doctors go for scanning piece-meal depending on any symptoms of the patients which can occur possibly very late? In the USA they do scanning head to foot at one go right at the beginning.

4. Why did not the oncologist suggest treatment with monoclonal antibodies (possibly together with chemos) at the beginning of the treatment? This could have been a surer way of saving a life.

Finally I have taken consolation in the theory of karma. The only thing is that the erring doctors’ karma apparently sealed Revathy’s fate.

I know everyone’s tired of shaadi news, but this one is really sweet.

This five-year old child has been diagnosed with Acute Lymphoblastic Leukemia. His parents have made an appeal for help to pay for a bone marrow transplant. Please consider helping if you can, and please spread the word.

Saw this bizarre news item… does anyone know anything more about this? I haven’t been able to find anything else…

A milkman was beheaded in front of his wife and three children — all under 12 — because he had been late to milk a Bokaro Steel Plant officer’s cows.

Neighbours watched in mute horror last night as Jaiprakash Singh, the security officer, held Upendra Yadav down and ordered his sons to chop off the 32-year-old’s head. While younger son Chhotu, 22, helped his father hold the ailing milkman who had been dragged out of bed, the older Kaushal, 26, brought the sword down.

The mob surrounded the local police station, demanding that Kaushal be handed over to them for justice. The police and administration officials struggled to keep the protest from spinning out of control. By afternoon, the mob appeared to have given up the demand for Kaushal and were only asking for a job and compensation for Meena.

Its multiple facets - pen and ink drawings by Manohar Devadoss. Lovely, and so is the text accompanying the sketches:

When I was an adolescent, a small miscellaneous group of my school-mates and I, belonging to different castes, communities and faiths became very close friends. One of the boys in our close-knit group was Satagopan, hailing from an orthodox, middle class Iyengar Brahmin family. His parents were so old-fashioned that they solemnised the wedding of his sister, Jeyamma even before she completed her schooling. Unfortunately, her husband was drowned soon after in a railway accident caused by a swollen river. She was a teenager and was expecting when she became a widow. Back then in Tamil Nadu, Brahmin widows belonging to traditional families were made to suffer the harshest of punishments. Our group of friends was justifiably apprehensive. Would so young and beautiful a girl be forced to take on a widow’s mantle: shaven head, coarse off-white saree, isolation, ostracism et al? On the contrary, her parents moved away from these cruel customs, one step at a time. They shifted to another town and put her through college. She passed her bachelors’ degree examination, winning the first rank in the state. They returned to Madurai to enable her to pursue her master’s degree. At this stage, our friends and I were spending a fair share of our time in Satagopan’s house. His parents could perceive that we tacitly followed a code of not looking at our friends’ sisters with amorous eyes. They allowed Jeyamma to roam around with us, as long as Satagopan too was in the group. In those days it was not an everyday event for a comely well-dressed young woman to go out with a group of indifferently dressed somewhat unruly young men. People stared at us indelicately, be we happily ignored them. In this drawing, finished in February 1988 I have tried to recapture a scene belonging to the early 1960s.

Jeyamma went on to pursue her higher studies, remarried and recently retired as a professor in California University at Davis.

The whole collection of extracts from The Hindu Magazine, here.

On seeing this post about Mrinal Sen’s film Bhuvan Shome (which was also cinematographer KK Mahajan’s first film) Praba Mahajan sends me these paragraphs about KK in Mrinal Sen’s words:

In the mid-sixties, when the wind started shifting and I smelt a certain madness in the air, I like some of my colleagues and fellow travelers felt an irresistible urge for a change. I thought it was a good enough time for me to launch a breakaway from the existing convention and try my hand at creating a new one…

That was the time when I had accidentally run into a minor work by K.K. Mahajan—a diploma film of the Institute directed by his batch-mate Kumar Shahani, and photographed by K.K. I saw the class-room exercise and loved it immediately. I loved it for a different reason…for venturing to shoot in adverse conditions. Soon after, I met him. I was at the Film Institute, and the triumvirate-Mani Kaul, Kumar Shahani and K.K. walked in. I spoke to him, I spoke a lot as I always do, and he answered my questions, quite a few of them, mostly in
mono-syllabic yes’s and no’s. And that was our first meeting, way back in 1966.

Two years later, in 1968, I got a loan from the then Film Finance Corporation, and happily there were no strings attached. I formed a team, almost all having very little or nothing of “commercial” content and having an abundant measure of verve and courage. I asked K.K. if he would do the photography as a sort of love’s labour, so to say. K.K. readily agreed and perhaps beamed inwardly.

That was the beginning of a journey, a long one, which perhaps in just two cases, that too under unforeseen circumstances, never broke. K.K. and I, we worked together, starting from BHUVAN SHOME and continued unabated, once a year, in various places, various languages, and interestingly, in diverse situations. In the process, I learnt a lot and so, I believe, did he and we have been growing together steadily, happily, clumsily. True, we had initial problems to understand each other but neither he nor I took unreasonable time to get to know ourselves and then coming out of one film and walking into another, year after year, we became, as was expected, almost one inseparable entity.

We are still growing strong, even at my age, and he with his seventy-fifth film. The last thing about K.K: Success, till this moment, has not gone into his head, which is what has kept his body and soul together and which, every time I think of him, gives me the impression that he has remained the same, delightfully the same, as he was in 1966,the year of our first meeting, -shy but confident.

And as a postscript: K.K. is still mono-syllabic in his articulations except, however when he is made to speak on occasions such as the Convocation Address at the Film Institute of India where he, along with his batch-mates, was groomed wonderfully, deliciously, inspiringly.

****

KK Mahajan went on to work on over 80 films across four decades. Praba tells me that he is very ill at present. My thoughts are with her and the family. This post is for KK, wishing him a speedy recovery.

Lesson: it’s better to be rich, of course, but if you must be poor then at least make sure you’re interning for a stockbroking job while pounding the pavements.

Bah. It may be based on a true story but this movie certainly isn’t the whole truth.

The latest issue of Frontline has this article on the plight of Kerala’s elephants. It begins with this quote from one of Basheer’s stories:

If he is displeased in any way at the manner in which the world is being run, he will kill an elephant keeper. For this reason, Kochunarayanan Namboodiripad, the head of the Chathangeri Mana, has stocked a number of elephant keepers.

Here is a translation of the Basheer story.

Here is Kipling’s story The Killing of Hatim Tai.

Image H.Vibhu/Frontline.

Rajan has some lovely pictures from Thanjavur.

(via Blogbharti)

In my hometown, Patna, there is a general consensus that culture, like the surrounding economy, lies in ruins. And yet a visit to the Khudabaksh Library reveals another world, distant from the cramped, dusty streets outside filled with rickshaws and cars with loud, blasting horns. A librarian, his right hand shaky, pulls out a book on medicine that was written two thousand years ago. The book is titled Kitab-ul-Hashaish. The edition the librarian holds in his hands is from the thirteenth century A.D. The book was translated from Greek to Arabic by the order of Haroun-ul-Rashid; it carries beautiful illustrations painted with herbal and mineral colours that still appear clean and bright. The librarian is old; his spectacles sit crookedly over his bulging eyes. He wants to show you ancient paintings of war scenes where, he says, “No two faces are alike.” He keeps using the phrase “hidden treasures.” There are 22000 handwritten books in his library; about five thousand to seven thousand of them are rare manuscripts.

While Amitava reads from his book in New York, I have been rereading it here in Bombay.

Here is a poem by Nikki Giovanni about librarians, “My First Memory (Of Librarians)”:

This is my first memory:
A big room with heavy wooden tables that sat on a creaky
wood floor
A line of green shades—bankers’ lights—down the center
Heavy oak chairs that were too low or maybe I was simply
too short
For me to sit in and read
So my first book was always big

The whole thing here.

Here is an interesting article about the Khudabaksh Library.

Calcutta, Pujo 2006.

Here. (Thanks Abi for the link!)

And here, lots of Labs…

And one more:

Atul Gawande writing about an aging society:

Decline remains our fate; death will come. But, until that last backup system inside each of us fails, decline can occur in two ways. One is early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. The other way is more gradual, preserving, for as long as possible, your ability to control your own life.

Finally, at eighty-two, he had to retire. The problem wasn’t his health; it was that of his wife, Bella. They’d been married for more than sixty years. Felix had met Bella when he was an intern and she was a dietitian at Kings County Hospital, in Brooklyn. They brought up two sons in Flatbush. When the boys left home, Bella got her teaching certification and began working with children who had learning disabilities. In her seventies, however, retinal disease diminished her vision, and she had to stop working. A decade later, she became almost completely blind. Felix no longer felt safe leaving her at home alone, and in 2001 he gave up his practice. They moved to Orchard Cove, a retirement community in Canton, Massachusetts, outside Boston, where they could be closer to their sons.

“I didn’t think I would survive the change,” Felix said. He’d observed in his patients how difficult the transitions of age could be. Examining his last patient, packing up his home, he felt that he was about to die. “I was taking apart my life as well as the house,” he recalled. “It was terrible.”

… Her blindness and recent memory troubles have made her deeply dependent. Without him, I suspect, she would probably be in a nursing home. He helps her dress. He administers her medicines. He makes her breakfast and lunch. He takes her on walks and to doctors’ appointments. “She is my purpose now,” he said. Bella doesn’t always like his way of doing things. “We argue constantly—we’re at each other about a lot of things,” Felix said. “But we’re also very forgiving.”

He does not feel this responsibility to be a burden. With the narrowing of his own life, his ability to look after Bella has become his main source of self-worth. “I am exclusively her caregiver,” he said. “I am glad to be.” And this role has heightened his sense that he must be attentive to the changes in his own capabilities; he is no good to her if he isn’t honest with himself about what he can and can’t do.

The whole thing here.

Self-portrait with mother and father. Satyajit Ray, 1935.

That morning, some upper-caste Brahmin and Bania youth aggressively blocked his path to the temple, threatening him if he returned to worship there. They taunted him, “What business do low-caste people like you have in our temple? Just stand at a far distance and join your hands.”

It is difficult to explain exactly what transpired at that moment. But a lifetime, indeed generations of uncomplaining acquiescence to multitudes of degradations and humiliation of caste, just cracked within him. Rarely had Bhanwar seen his father so agitated than when he returned home that day. He broke his silence some days later, to announce his decision to his stunned family. “I will build my own temple. It will be bigger and better than anything that the people of this village have seen. Let us see who can stop us from worshipping then?”

Yesterday was Equal Pay for Women Day, a step to mark the wage gap between men and women. According to this Ms Magazine report:

In 1963, women earned 59 cents for every dollar men earned. Although earnings for women have increased, the wage gap persists today. Among full-time, year-round workers, women now earn 77 cents, on average, for every dollar that men earn. Behind the Pay Gap, a report released Monday by the American Association of University Women (AAUW) Educational Foundation, exposes the disparity in wages between college-educated women and men. The report analyzed data from the US Department of Education on nearly 20,000 college graduates from the years 1992-93 and 1999-2000 and found that women earn 80 percent of what men make just one year after college — a gap that widens to 69 percent after ten years.

Additionally, the report shows that the wage gap persists despite women’s educational achievement. In college, women maintained higher grade point averages and outperformed men academically in all subjects, including science and math…

Appuswamy had always been harboring a small, unambitious desire – to operate an ATM machine using his wife Seetha’s card and count the crisp currency notes. Seetha knew it for certain that Appuswamy, in his early seventies, was unfit even to gently tap an electric switch and drive away the darkness and an ATM machine for him would be as unintelligible as Aero Dynamics. To keep Appuswamy’s attempts at bay, Seetha always carried a small pouch and the ATM card inside it and like Mary’s lamb, it remained inseparable from her.

Mahadevan writes an Appuswamy-Seetha Patti story.

Also check out his paean to the Jhangiri, Emperor of Tamil sweets:

Jhangiri enjoys a social status in the south. For the man who is adept at preparing Jhangiri, Mysore Pak or Laddu is too primitive, like a club player to a World Cup wonder. As Jhangiri is generally served on arrival of the bridegroom’s party at the marriage hall on the eve of the marriage in Tamilian marriages, its quality can make or mar a marriage. What more, mere absence of Jhangiri in a marriage, mellows down the merriment. If the Jhangiri is a little pliable, the groom’s granny in her nineties would start grumbling. If it is too crisp, his young aunt would resort to her taunts. If it is too sweet, the diabetic brigade ( I am an humble soldier in this brigade) would start its diatribe and if the level of sugar is low, it would be relegated to the last serve…

The lives of migrant workers:

About 200 million migrants from different countries are scattered across the globe, supporting a population back home that is as big if not bigger. Were these half-billion or so people to constitute a state — migration nation — it would rank as the world’s third-largest…

About half the world’s migrants are women, many of whom care for children abroad while leaving their own children home. “Your loved ones across that ocean . . . ,” Nadine Sarreal, a Filipina poet in Singapore, warns:

Will sit at breakfast and try not to gaze
Where you would sit at the table.
Meals now divided by five
Instead of six, don’t feed an emptiness.

Yesterday was Shakespeare’s anniversary, marked as World Book Day. Here is a group of child labourers at a rally for the right to education, at College Square near the statue of Ishwar Chandra Vidyasagar. Picture by Amit Datta, from The Telegraph.

I love this poster.

Here is the man who created it.

Fortunately that gun manages not to kill anything. Lovely film.

Seven construction workers and their family members died in this car accident on Bandra’s Carter Road last November. The young man who had been driving the car got a six-month prison term. The High Court has, however, reopened the case.

Meanwhile, apart from the lives lost, there were others whose daily struggles for survival became even harder (see here). In the impoverished region of Mahbubnagar, over 800 km away from Mumbai, is an old woman who lost her son and pregnant daughter-in-law, and who now does odd jobs in the fields in exchange for food. Another old woman who must care for her orphaned 11-year old grandson. And a man who lies paralysed on one side of his body, still traumatised by the fear that a speeding car might kill him:

All the victims were Pindi’s friends and family. He had migrated with them, as thousands of young folk have done in this dirt-poor area, to Mumbai for six months every year for the past 18 years. Six of the seven who died were from Mahbubnagar, where about 40 per cent of the population joins the great, faceless migration to Mumbai every year. They live either in slums or on pavements and power the metropolis’ construction boom — building roads, apartment blocks, flyovers, railways and other infrastructure…

Pindi’s right side is paralysed. He cannot work. He has medical bills to repay. He has five children between the ages of 3 and 13, and a wife who is furious at the verdict. “Those rich fellows have gotten away with murder,” she said. “I have to take care of my husband. He’s like a child now since he cannot even bathe on his own. I have children. Should I work or sit at home and look after them?”