Natural colours!

The four dragonflies That I discovered today during my evening walk bring a rich blend of colours and design! I am not tired of dragon flies, as I seldom come across the same ones! Every time I spot a new one,  I track it till it settles down somewhere. 

I wonder whether fashion designers look at this natural spread and combination of colours in dragon flies for them to use such a combination in their work!

There are light coloured dragon flies. They also look pretty if we can get the right light setting to click them!

I am confused whether I like the design or the colour! Either way, they are distinct.

I have a sense that they are clean insects with good aesthetic sense because their body and wings look fresh and crisp!

We are surrounded by good things in nature! They are like a sensor of clean environment!  

I spoke to a farmer about them today while on the walk. He mentioned that it usually takes a few months for them to reappear after spraying insecticides on the plants. That was a shocking news. We do not think of innocent insects when we use pesticides! 

M.C.Mathew(text and photo)

A boat on the road!

This boat placed on the median of a road turning off to Ernakulum from Alwaye town has caught my attention. I have found  a similar boat on the road in Kalady junction, following which I keep looking for it in other towns. 

There is a close association between Kerala and boats. The state of Kerala is a riverine state, which ahas annual boat races, during the post monsoon season. There are house boats for tourists. The fishermen use boats for fishing in the sea. Boats are used to transport people and goods. An dit is the boats which are used extensively during flooding for rescue operations. About 1200 boats were recently used during the flood in August 2018 for rescue and relief.

A boat is central in the cultural milieu of Kerala. In any handicraft exhibition or in shops, boats are the commonest item on display. 

A boat symbolises safety, protection and a sense of being carried. 

What a blessed experience it is to grow in the consciousness of being carried by God, while we sail in the ocean of life!

M.C.Mathew(text and photo)

Helmet use!

I stopped at a traffic junction in Thiruvella town to watch how two wheel riders use helmets.

The above pictures tell a lot about the irresponsibility with which the two wheel riders take risk on the road. The enforcement authorities do not take enough care except when there is an accident and they enforce wearing the helmets for a while. 

It is not common for the pinion riders to use the helmets. There are some like in the first picture hang their helmets on the handle bar of the two heeler only to use it when there is a traffic police in sight!

This is a reality in 'god's own country', a place where there are better health care standards except in road traffic accidents. 

If we can reverse the drunken driving and lack of helmet use, we would have done better!

M.C.Mathew(text and photo)

Watchfullness !

I watched this migrant bird beside a pool of water in a waterbody, staying vigilant for it to spot a fish. Its readiness and alertness was explicit in its body posture!

Yesterday, I came across a family who visited me a few times for consultation recently. During the first visit when I usually do a detailed clinical examination, I search for neuro-cutaneous markers. I ask the parents for any pigmentary changes they noticed on the skin of their child and complete the examination by looking for them. One child who has recurrent convulsions who came for follow up yesterday needed a review of the diagnosis and audit of the treatment. It was during this exercise that I went through with a detailed inspection of the skin. To my surprise tI found some neuro-cutaneous markers.  My colleague reminded me that I asked the parents during the previous visits about any colour change on the skin, but did not strip him to examine. With other colleagues in the room I might have avoided examining a pre-adolescent boy in public and went by the word of parents.

It was a costly omission. This finding of neurocutsneous market gives a different diagnosis, and a revised approach to understand his recurrent seizures.

I have been generally vigilant in clinical examination so much so my colleagues wondered whether all the details I look for everyone are necessary at all! Yesterday's example was a lesson for all of us. There is no short cut or assumption in clinical examination- everything has to be factual, observation based and evidence supported. 

It is now forty-five years since I have been in clinical practice, out of which thirty five years have been in the specialty of developmental neurology. I have avoided being interrupted by telephone calls, visitors or any other interruption when I am with a child and family during a consultation. That is one way of staying focussed. What is even more important is to think through the differential diagnosis while history is being taken and the clinical examination is being conducted. There is a need to cross check at the end of the clinical examination, when there is an ambiguity of diagnosis. 

The bird in the picture is a symbol of vigilance !

I take home the message: Stay vigilant during a clinical examination. 

The other lesson: repeat the clinical examination when in doubt 

A third lesson: refer to a colleague with a request to examine and offer any new thoughts. When this child was seen by a dermatologist yesterday after our clinical suspicion of a dermatological condition being a probable cause for the intractable seizure, the dermatologist concurred with the suspicion and proposed another dermatological condition different from what we thought of. We are looking into that now with more investigation.

Some of us in the practice of clinical medicine need to be willing to go that extra mile to rely on our experience as well as follow the protocol and process of clinical examination without taking any short cut! Sometimes it calls for doing al these ourselves rather than only depend on our younger colleagues. It reinforces and demonstrates the primacy of clinical examination to our younger colleagues.  

M.C.Mathew(text and photo)

More to come!

I have had some meaningful conversations with medical students of different years in their course in the recent weeks. I met a friend yesterday who finished his junior residency and is now preparing for his post graduate entrance test. He spoke about the good days of studentship. 

One theme of the conversation with some students has been the the attitude during the student days: 'Are we just medical students or doctors in training'! 

The undergraduate medical education syllabus is being revised now after 20 or so. Looking at a glance, one gets the feeling that there is considerable emphasis in the new curriculum on enhancing skills, attitude, communication, ethics, behaviour, etc. This inclusive approach to integrate knowledge, skills and values seem to be an appropriate way forward. 

The temptation of students is to look at their counter parts in science and arts colleges and replicate the  orientation to life, arts, sports, activities, which while are valuable assets in the learning and growing process, seem to be dominated by fun, pleasure, achievements, competition, etc. The medical students  can feel tempted to have the first two or three years to live and behave equivalent to what their counter parts do in the arts and science college, without necessarily being conscious of the option they choose to be 'doctors in training'. 

When one choose to be a doctor in training, there is a value based commitment we are called to make which is consistent with the 'noble practices' in the practice of medicine: to value others, to learn and acquire skills in the art and science of practice of medicine, conduct and behaviour rooted in honesty and integrity, embrace a way of life where service and altruism become the inner orientation, living the vocation of self giving and team work, etc.   

I have considerable admiration for the students in the MOSC Medical college, because they have a visible expression of their consciousness of the needs of the less privileged through the different activities they do through their social service programme. It is highly commendable. 

At the same I feel concerned by the way they make their learning 'mundane' or 'casual' with a subscription to read 'small' books and 'condense their study' to the immediate period before the examination. Now the exit examination does not decide their merit for post graduate entrance, but   the NEET which is decisive, I wonder whether teachers and students would collaborate to make learning 'intense', regular, and aspirational!

One practice that might install this orientation is to have students attached to the clinical and preclinical departments as 'shadow learners' by being involved in all the activities of the clinical and para-clinical services. I wonder whether it is the right time to think of bringing the 'tutorial system' when students are attached to a clinician for a few weeks during which period, the learning focus transcends the requirement of preparation for the examinations! The emphasis is not even to prepare for students just for he NEET, but make them learning motivated that the self directed learning inherent with study and practice of medicine would get incorporated as the 'mind set' among students and teachers. 

I watched this bunch of bananas in our garden shown in the above photographs, from the time it first appeared in the plant. Over three weeks the full bunch of bananas appeared from out its wrappings. As I wait another two months it would be fully ready to be a bunch of fruit.  From the time a banana plant is  planted till it gives its fruit, it is about 15 months which is the gestation time a farmer would offer for the plant to grow and bear fruit. 

Remember, there is something more in the wrapping of the banana when the first row of banana appears outside. 

This to me is the metaphor with which we are called to view medical students. They grow under the watch of the teachers and the institution where they study and the hostels where they live ! There is 'more to come' in their lives if only we have planned individualised programme for their personal formation!

A student becomes a doctor not just studying subjects but becoming a person oriented to seek the welfare of wellness of others. This is FORMATION of a doctor in training!

M.C.Mathew (text and photo)

Biography-20 :Being still, a journey of thirty five years !

I watched this Damselfly staying on this leaf for thirty minutes, while I was beside the stream watching the mason build the compound wall.

When I reached home I noticed a dragon fly on a flower bunch staying there still for  longer time. 

These sights brought back memories of the first experience, when lat Dr Hans Burki, introduced us during a one month retreat, to the exercise of becoming still in body and mind !

Dr Burki started with an exercise at the beginning of the retreat by helping us to stay still in the body and count the number of thoughts, ideas or imageries passing through our mind in one minute. He referred to this 'traffic' in the mind needing direction and attention. Our thoughts seek our attention. 

He then helped us to pay attention to our thoughts by offering to return to them little later. When there was a welcome and attendance to the thoughts, it was a surprise to find how the frequency of thoughts reduced and in about ten minutes the mind was free from the traffic. I remember how Anna and I felt towards the end of the month that it could be possible to stay still for about 20 minutes in body and mind. The feeling to itch or change the posture was also a thought that the body was calling attention to. Once, we became familiar with the thoughts of the body and mind, then we are free to move on to another realm of consciousness. 

That is the level of 'heyschia' or rest when we become still in body and mind. It is during such time of  rest, we become open to another level of consciousness of realities. Dr Burki would use a Bible passage at the end of ten minutes of 'becoming  quiet', to prepare us for this level of consciousness by reading a passage from the Bible to let it 'fall in our inner soil' made ready in quietness. I remember how although the initial experiences were rather dry and did not take us beyond just the exercise, another level of consciousness of being open to receive grew within us gradually. It was during such periods of openness when we are free from our own thoughts,  the seed of the scripture can generate within us thoughts which are not our own. Staying still to receive those thoughts or experiences is a patient inner activity, because, such occasions are preparation for the visitation of God of the Scripture.

In fact this exercise of ancient desert fathers of waiting for God to visit in interior stillness is not a common practice we follow in our personal or corporate prayer times. 

For me, this growing experience in interior silence has had multiple effects upon my life, living and learning.

The scripture brings freshness and renewal when I read after the exercise of preparing for interior stillness. There is a quietness in mind that removes the cloudy feeling and congestion of thoughts. The transition times between activities when accompanied by quietness for three minutes help to 'leave behind what is over' and prepare to 'welcome the next event'. This becomes a personal reality in my work. Between consultations of children, I am used to having an in between time to 'let go' of what is over and 'usher in' what is to come. This is a way of becoming fully present freed from an addiction to stay preoccupied. When there are anxious moments, or angry prone thoughts, such a short season of inner stillness brings a change in orientation. In fact, I have watched some who talk with pauses between sentences and some of them are people who have few seconds of inner quietness to receive the words inside before they talk. It is evident when we listen to them that they are speaking what they listen from within. It was obvious to me every time I had an interview with late Dr Paul Brand that the words he spoke 'fell' within me with an inner movement of increased awareness to be attentive to receive more. He spoke to communicate to experience communion with the listener.

My experience in this tradition has been interrupted often, although it has been my desire to have periods of silence during the day and a prolonged periods at the end of a week or month.

To be with oneself is not a practice we are normally inclined to follow. We are with our phone, TV, book, music, friends, family, work, etc most of the time.  We live occupied and preoccupied. 

When we let ourselves to be alone, all the thoughts would return to us in a gush. To sit quiet and jot down those thoughts would be a good way of beginning to have a longer period of stillness. Once we listened to ourselves, we become ready to listen to God, who is waiting within our soul to speak. Prophet Samuel heard his name being called three times and thought it to be Eli calling him, till Eli himself found an excuse to avoid Samuel coming to him one more time interrupting his sleep and told him to say, next time if he were to hear the call, 'here am I" ! That made all the difference in his life, when God made Himself known to him.

The level of living, with the consciousness, 'Here am I" is what liberates ourselves from ourselves. It frees us form the litany of disappointments, complaints or reactions. In that position of becoming and being present to the One, who is beyond and yet present within us is a life transforming experience.  It is when we become open to 'listen' we receive a new colour and orientation to our lives. 

I struggled with a sense of purposelessness in the year 1991. I was not sure whether I was engaged in what was the best way of spending my time. I was in Chennai exploring through ASHIRVAD Child Development Centre if there can be a meaningful way to bring a consciousness about the needs of special children among the professionals. A lot had happened in ten years since 1983, with considerable openness among medical professionals and school authorities. And yet I knew that there was something more to life. The inner restless grew and I began to sense a loss of wellness within. 

It was the time when Late Mr Johny Samuel, the sessions clerk of St Andrew's church invited me to be an elder in the church. I was invited to be in the chair of the work among special need children in the church through partnership with ASHIRVAD. I was asked if I would move to INTERSERVE to be fully involved in its leadership role. I was not ready for any of these at that time. I was the member of  international committee of INTERSERVE and was requested to discontinue as they wanted to bring someone else from India to it. I had just then discontinued going to the Christian Fellowship Hospital, Oddanchatram once a month, which I was doing for five or more years. The work we were responsible to initiate at Nagpur had become self sufficient that Mrs Pushpa Waghmare was ready to carry it forward. It was a crowded time with opportunities and closures of some. I felt weary and uncertain. 

Such times are difficult times. Our children were growing up and needed full attention. I could not afford to slip into my world of preoccupation or detachment. 

I set apart a fortnight of reduced activities and taking more time to 'listen'. There was an invitation from the local Epilepsy association to give a lecture on childhood epilepsy on the national epilepsy day. Prof. C.U.Velmurugendran, the director of the Institute of neurology  chaired that meeting. At the end of the meeting he turned to me to complement me for my talk and asked more about me. He invited me to visit him in his office on the next day, which was when he offered me a position at the Institute of Neurology to register for a clinical PhD programme in Neurology. 

It was that opportunity to be at the Institute of Neurology in training for three years leading to the award of the PhD, which filled a void and resorted purposefulness to continue in Developmental paediatrics. It was this inner restoration of wellness which gave us the confidence to go to CMC Vellore in 1997 to start the first developmental paediatrics unit in any medical college in India in partnership with ASHIRVAD. 

All the other good things that followed thereafter in this 'pilgrim journey' came out of turning purposelessness to quietening my life to listen to what was beyond the ordinary. When I knew later that the offer to do PhD was usually offered only to a faculty member in the Institute of Neurology, I knew it to be a something special that came into my life unasked for. 'What is that we have except what is given "!

It is now, 25 years later, I sense how seminal and defining was that experience of being at the institute of Neurology for three years! Among many tangible outcomes, one person out of the four registered for PhD when I was in the Developmental paediatrics unit at CMC Vellore, Reeba Roshan, received her award of PhD at the convocation a few days back. She might be the first one to have obtained a PhD in Developmental psychology in india. Thus a formal specialty is born and Reeba can take this specialty forward by training others !

It was during a season of purposelessness or weariness or a 'burnout' experience, the invitation to do training in Neurology was offered and out of it came something more than what I could ever imagine- to be a guide for PhD at the TN MGR Medical university and Pondicherry University!

The interior stillness is the way of discerning time and season. The decision to return to live in Kerala when my mother was ailing was a decision which involved considerable stress and adjustment. Having lived away from Kerala for forty years, and Anna having been born and brought up in Maharashtra, the decision was difficult that I resisted it for at least three years.

Now after six years, it seemed to have been the right decision for our wellness and growth. We feel restored by getting connected with our roots. There are many tangible benefits such as the beginning of the student research activity under the ICMR with the initiative from Anna and the starting of the department of developmental paediatrics and child neurology, both at MOSC Medical College, Kolenchery. Far from what we could have planned for! Both of these happened because we WERE enabled to consent to go through the journey of living with an interior sense of moving one step at one time! We faltered many times and had to resume our journey through departures and detours. It was not a linear journey towards the direction of the destination.

All these experiences have had their roots in inner experiences of stillness when we were made ready to let go of our preferences or choices and embrace that we did not entertain! The journey into the unknown became a means for our wellness and gladness. 

It continues to a journey with ups and downs, but it is tempered by a growing consciousness that we are being accompanied by the One, who joined the two people walking towards Emmaus two thousand years ago !  

M.C.Mathew (text and photo)

Shades of Black!

It was a surprise to me to find during a walk four dragonflies in different hues of black in their wings. 

They appeared different, which is why I traced them, even after they flew away probably disturbed by my presence!

All colours have different shades and they are distinct.  Although the shades of a colour still represent the original colour and belong to the family of a particular colour, it is worth pondering over this because of its significance. 

The green, white and the saffron in the National Flag of India have to be of particular hue, because there is a meaning attributed to each of them. 

So hues of colours are often distinct with a meaning or a message. 

I am not surprised by this because, each of these four dragon flies behaved differently. The first one remained still in one place all through my time beside the stream.The second one intermittently flew away only to return to the same place of its earlier location. The third one was a frequent 'flier' but returned to the vicinity of its earlier location but changed it landing place every time it returned. The fourth one was an explorer and took a while to reappear. It reappeared in other adjacent places. 

Although this behaviour might have nothing in common with the different hues of black, it nevertheless conveys a message: the dragon flies have distinct behaviours. We notice the difference first in the hue of the colour and later in their behaviour. 

Their appearance and some features make them different from each other. Still they are dragon flies! They are not more or less!

It is this identity crisis that we are weighed down with in India now. Some people project their identity based on language, ethnicity, religion, social class, etc. 

We are humans and fraternal beings. To me that alone matters!

M.C.Mathew(text and photo)