ramadocblog

One of the scenes common in the black and white era was when a lady was feeling a little weak and the ‘doctor’ would hold her wrist and apparently feel for pulse! That was really ok but what used to come later was definitely shocking and hilarious!

The doctor would announce that, “Congratulations, you are pregnant!”

Of course you cannot confirm the pregnancy by measuring Pulse!

Then again this is one very important sign in many disease! In fact if you include the history and the measurement of Vital Signs; you can reach a diagnosis and define treatment more than 90 percent of the time!

Of course the concept of measuring your ‘vital’ signs has always been the routine for doctors and healers throughout history and in most civilisations but the proper differentiation and characterisation was not very uniform.

The variations in Pulse and temperature was  of course really important though these were largely ignored or not taken much seriously for documenting as a VITAL sign.

Officially with the publication of “Pulse-Watch” by Sir John Floyer in 1707 that the first scientific report pertaining to the pulse rate came to light.

Ludwig Taube published the first-ever plotted course of fever in a patient circa 1852, adding respiratory rate to the list of human vital signs trackable at the time. Subsequent improvements in the thermometer and clock solidified the heart rate, respiratory rate and body temperature as the standard vital signs monitored by medical professionals of the time.

In 1896 the first ever ‘sphygmomanometer’ (blood-pressure cuff) was introduced to the medical world, which added a fourth vital sign, arterial blood pressures, to patient monitoring procedures.

The next step in patient monitoring was to devise a system that allowed medical professionals to monitor all four vital signs (heart rate, respiratory rate, temperature, and blood pressure) at once, and over an indefinite period of time.

Now the spectrum of vital signs is much more though the basic four remain the same! You also now have blood oxygen level added which became very popular with the COVID! (popular for general public that is! Doctor’s used to measure anyways!). I still remember a duplicate Sat meter recording 100 percent oxygen! So what you say!? Well I had placed it on a pencil!

You also have Blood Glucose level as one of the chief vital ‘Signs’

Then for routine purposes the weight is one of the vital signs while in emergency we would see the PUPIL.

Remember that though they are relatively simple to measure; each one when is in the normal range then you have a very high chance of being normal! At least physically and at least for the time being since health is actually a constantly changing modality! This is what I tell my patients!

Once a patient comes back to me stating that her ear pain has come back! I looked at my notes and saw that she saw me one year back!

For one year she had no pain in the year and now she is coming back to me saying that my treatment was ineffective since it came back after one year!

You may laugh but she was serious! Laugh reminds me of the character who used to make me laugh by being serious! Our Utpal Dutt!

Now assume that your vital Signs are ok and sleep!

Shubh Ratri!

Satire and criticism have been the ways of great kings! Even one of the greatest kings King Krishnadevaraya used to listen to Tenali Raman who was not only clever but also used Humour to give great and apt suggestions!

In the modern era the realm of Humour with intelligence could be the Ignoble prize!

The Ig Nobel Prize is a satirical prize awarded annually since 1991 to celebrate ten unusual or trivial achievements in scientific research.

Its aim is to “honor achievements that first make people laugh, and then make them think.” The name of the award is a pun on the Nobel Prize, which it parodies, and on the word “ignoble”.

Organized by the scientific humor magazine Annals of Improbable Research (AIR), the Ig Nobel Prizes are presented by actual Nobel laureates in a ceremony at the Massachusetts Institute of Technology!

The Ig Nobel Prize monetary award is given in a solitary banknote for the amount of 10 trillion Zimbabwean dollars! In case you are wondering wow! That is a big amount! Well, it translates to  0.003106 USD! It may not get you a House but it is a highly priced collector’s item!

During the ceremony there is a custom of throwing paper planes!
For many years Professor Roy J. Glauber swept the stage clean of the airplanes as the official “Keeper of the Broom”.
Then in 2005 Glauber could not attend the 2005 awards because he was traveling to Stockholm to claim a genuine Nobel Prize in Physics!

Yes!
So the satire and the comic relief actually leads to development and invention and maybe progress!

Like in 2006, a study showing that one of the mosquitoes that can carry malaria (Anopheles gambiae) is attracted equally to the smell of Limburger cheese and the smell of human feet earned the Ig Nobel Prize in the area of biology!

You may laugh at that but what happened was that as a direct result of these findings, traps baited with this cheese have been placed in strategic locations to combat the epidemic of malaria in Africa!

Later on Also Sir Andre Geim, who had been awarded an Ig Nobel Prize in 2000 for levitating a frog by magnetism, was awarded a Nobel Prize in physics in 2010 for his work with the electromagnetic properties of graphene. He is the only individual, as of 2025, to have received both a Nobel and an Ig Nobel!

Then again his Ignoble research magnetic levitation of a frog, was by 2022  reportedly part of the inspiration for China’s lunar gravity research facility! Now that is very Noble indeed!

Noble and brave also was Squadron Leader Ajjamada Boppayya Devayya! This movie called the Sky Force is a remarkable ode to the legacy of this great man who sacrificed his life for our country. They used to call him mad! And like AK says in the movie, “The love for your country is madness indeed!”

Do read about him!
Jai Hind..

SHubh Ratri…

Everyone knows that the dog is the Man’s (or woman’s for that matter!) best friend!

You would be surprised to know that over the whole course of human evolution and socialisation, the only wild species which has been fully domesticated is the dog!

Of course occasionally the wild side takes over but then this is not limited to dogs! Even humans can become wild and show traits of the cave dwelling ancestors when they get, well; WILD!

But (what is a blog without a but!); did you know that if you are thinking that humans have domesticated dog, you may not be entirely true! There is a mild honey trapping involved here!

There would have been ancestors of dogs who would have realised that being with the man and guarding him or her would be more lucrative and frankly more easier than being in the wild! Since it is literally a Jungle out there! In fact even an average guard dog is just an extended door alarm who warns the human of the danger most of the time! The final confrontation of the danger has to be done by the human!

One of the tools they have thus developed are the expressions on their face and the way they move their head!

In fact it has been found that if a dog has eyes that seem to be telling you something or demanding your attention, it could be evolution’s way of manipulating your feelings!

Researchers have found that dogs have evolved muscles around their eyes, which allow them to make expressions that particularly appeal to humans!

A small facial muscle allows dog eyes to mimic an “infant-like” expression which prompts a “nurturing response”. The study says such “puppy eyes” helped domesticated dogs to bond with humans. This allows dogs to create what the researchers call “expressive eyebrows” and to “create the illusion of human-like communication”.  So when dogs make the movement, it seems to elicit a strong desire in humans to look after them! Honey trap lesson one right there!

Also did you know that the only dogs who cannot do that are the Huskies! But they also have a trick up their, well voice! They have the Honey trap lesson two with them! They can mimic a human baby’s voice!

All those reels where dogs and puppies behave like human kids and babies are only they getting you actually reeled in to take care of them!
It does not work with the cats who are mostly still wild! Of course that is a car lover’s problem not mine!

But normal people would see those Pups and get a smile and that is how they trap you! Another one with not only a smile but also a big laugh is Renuka Shahane! Her pleasant demeanour in the series Surabhi  used to make us smile and how!

Now stop those reels and sleep!

Shubh ratri!

What is the connection between Van Halen and M&M’s? This band used to ask for M&M’s in their dressing room with all brown ones removed! Crazy! Well, it was actually brilliant!

Then again you may first ask who or what is Van Halen!

Now I am sure everyone has heard the song Beat it by MJ! The guitar riff in the middle which is actually the best part of the song is by Eddie Van Halen

Shortly after its release, “Beat It” was included in the National Highway Safety Commission’s anti-drunk driving campaign, “Drinking and Driving Can Kill a Friendship”.

Also the album Thriller is actually highest selling album ever! Even now the record has not been broken and it will not be broken too soon since no one buys music albums anymore! Then again you do not get such great music albums anymore!

Michael Jackson’s Thriller, estimated to have sold 70 million copies worldwide, is the best-selling album ever! Jackson also currently has the highest number of albums on the list with five, Celine Dion has four, while the Beatles, Madonna, Whitney Houston and Pink Floyd each have three!

See the amount of side track!? Now we were with Van Halen and M&M’s!

Now Eddie and his brother drummer Alex Van Halen officially launched the  Van Halen band which consisted of Eddie Van Halen, his brother, lead vocalist David Lee Roth (will come to him later since he made the M&M demand!) and bassist Michael Anthony.

They had one of the most amazing success stories as far as the live shows and performances were concerned!

In fact Eddie is known for his Guitar intro called the eruption which is one of the best Guitar intro ever!

BUT! Let us not digress again! The blog is about M&M’s!

The show’s lead singer had a very specific request for the organisers when they used to arrange for the show! This whole incident has been described in The checklist Manifesto by Atul.

Now David Lee Roth’s notorious insistence that Van Halen’s contracts with concert promoters contain a clause specifying that a bowl of M&M’s has to be provided backstage, but with every single brown candy removed, upon pain of forfeiture of the show, with full compensation to the band!

And at least once, Van Halen followed through, peremptorily canceling a show in Colorado when Roth found some brown M&M’s in his dressing room. This turned out to be, however, not another example of the insane demands of power-mad celebrities but an ingenious ruse!

As Roth explained in his memoir, Crazy from the Heat, “Van Halen was the first band to take huge productions into tertiary, third-level markets.
We’d pull up with nine eighteen-wheeler trucks, full of gear, where the standard was three trucks, max. And there were many, many technical errors-whether it was the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through.

The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many human beings to make it function!

So just as a little test, buried somewhere in the middle of the rider, would be article 126, the no-brown-M&M’s clause!

So if the band member walks backstage and saw a brown M&M in that bowl then he would line-check the entire production!

There would be a high chance that there will be a technical error!
The mistakes for not following the whole protocol could be life-threatening!

In Colorado, the band found the local promoters had failed to read the weight requirements and the staging would have fallen through the arena floor!

The whole Idea was to make sure that the organisers have seriously gone through the list of technical specifications given to them and they have been taken seriously since a single misfire would have been catastrophic!
And like always, the non brown M&M’s saved the day!

Of course all this goes to show that even great rock legends and planners follow a checklist! Of course sometimes life does not follow a list; it is sudden like the passing away of the talented director and actor Manoj Kumar Bharathiraja…

he will be missed…

OM SHanthi…
SHUbh Ratri…

I know I bore you all with my blogs and sketches but am really happy with these two! Hope you like them too!

Story time!

We love symmetry! In fact nature is full of symmetry! In fact even in medical science as well as in nature, any asymmetry is feared!

This is really surprising because not everything has symmetry! In fact your own body is not symmetrical! You cannot divide an average human or for that matter most animals in two and expect each part to be symmetrical!

Even in primary section we have learnt that since most people are right handed, even the measure of their biceps would reveal that the right is a little bigger and possibly stronger than the left! Of course it is the opposite for a left handed person!

But for specific areas we do look for symmetry! This is when there are similar organs or central organs! Like even in the average scan we look for symmetry before anything else! In the nose and sinuses we look out for symmetry and it is the same for the ear and even the brain! These have to be similar or must have symmetry! When there is a difference then there is usually an issue!

Which is why asymmetry is actually good! It is like the pain! No one likes pain and usually you are pain free, but when you do have pain it shows that something is wrong and needs to be investigated!

Thinking of asymmetry reminds me of this clinical rounds story during our medicine posting.

There was a patient with recurrent infection sitting and minding his business but the exams were near and any patient is dear to the average final year student!

One of my seniors had remarked that he is an interesting case without mentioning what was interesting! So we all armed with our stethoscope and couple of us with the Indian ones while some had the Littman rushed towards him!

If he was not well, I am sure he would have just jumped and ran away! We were sure that he had a heart murmur! So we started with the site for the most easiest to find; Pansystolic murmur! Couple of guys ‘found’ it and we all wanted to hear it! When I placed my Indian steth all I could hear was a very faint muffled heart beat! Forget murmur! But when everyone heard it, the best option was to nod along which I did!

Our senior PG then came and saw us proudly exclaim the ‘finding’ to him! Couple of ‘guys’ and ‘gals’ even heard some rarest of the rare murmur which we simple blokes could not hear!

The PG simply said, “That’s great! You guys are better than me! I could not hear any!” With that he simply took out his steth and placed it on the right of the chest and not the left! We knew he was a very intelligent bloke! In fact he had got AIR rank and he selected our college! But to see him place the steth on the right to get a heartbeat which even a junior would know is usually on the left was shocking!

We thought maybe the stress of the PG had got him!

Then he proudly said, you can hear the heart beat here! Which we did eventually and this time it was not muffled or had any murmur!

The PG then announced that the interesting thing was that he is a case of Dextrocardia! Dextrocardia is a rare congenital condition where the heart is positioned on the right side of the chest, with its apex pointing rightward!

He was right and the heartbeat was on the right! The look which the patient gave was not very symmetrical! In fact even before the examination he had told us where to place the steth but we ‘knowledgeable’ final year students did not listen to a ‘patient’!

What would he know!?

Well, this time we could not even say, “At least his heart was in the right place!” since his “Heart was in the RIGHT place!”

Rightly places with great directors also is Quentin Jerome Tarantino!

Confirm that your heart beats a little to the left and sleep!

SHubh Ratri!

The Checklist Manifesto is an interesting book by Mr (dr) Atul Gawande. It is surprising that many surgeons like to be called by their names while physicians always prefer Dr!

That Dr Atul is a general surgeon specialising in Endocrine Cancers surgeries is something you get to know only after a couple of chapters!

On top of that, in spite of the seriously medical input in the first couple of chapters, the book is actually about increasing efficacy in your professional world!

In the introduction he tells how the age of specialisation has grown so much that one fine day you would have a doctor who has specialised in the RIGHT ear while another one in the LEFT! You can imagine the same with the eyes!

For now the average Otologist is specialised in both the ears so you are safe!
But this craze for specialisation is well, crazy!

There were times when we feel like having a coffee outside, all we need is to ask for either sugar less or normal! By the way in Bengaluru, sugar less does not mean without sugar! But with less sugar! If you do not want sugar you have to say; no sugar!

But now when I was with some friends going to the coffee shop for a well, coffee! There is nothing like just coffee! With so many choices, I never get what I want which is of course just coffee!

This complex specialisation brings about the very big problem of selection! Atul then tells about this great air competition with Boeing and the US army! One of the airplane was so complex that the pilot just could not handle it and crashed!

This is when the mandatory checklist system was introduced! You must remember that human brain though an amazing creation with amazing power is still mortal! If it has to process too many things then it gets very difficult! The solution is to have a checklist! Now you have this standard checklist before any flight which is why aviation has become so safe!  Everything starts with a simple thing which makes a big change!

Like a simple man with clear thought and true nationalism would rise to become a great freedom fighter in spite of being just a young lad less than 25 years while old blokes were making talks!

Celebrating the Shaheed diwas by remembering Shaheed Bhagat Singh…

Jai hind…

Think of detective and Sherlock and maybe Poirot come into your mind! But having read most stories of sherlock and Poirot; I have a special bias to Byomkesh dada! Of course it is because his stories are relatable for an Indian since they occur in the by lanes of India!

Unlike Sherlock or Poirot; Byomkesh was not quirky and was not exceptional! He was like the Batman of Superheroes! Mere mortal in every sense which made him more closer to the audience and readers!

One of the best stories (there are many!) is in which he meets a person in a function who happens to be a police official (If my memory serves right but that is not important!); the officer then proceeds to tell a surprising story in which they could not find the suspect who had apparently disappeared! The twist was that with a twinkle in his eye Byomkesh tells the official that “I know who is the culprit!”  The official is taken aback when he and we the audience realise that it was the official who was the culprit all along who either overestimated his own intelligence or underestimated Byomkesh! In hindi the story is called Anjaan Khooni!

Then again Byomkesh is a mortal in every sense!

In fact, like every other mortal Byomkesh gets old, gets married and has a kid! He even gets a small plot of land in Kolkata and makes a small house there like a middle class Indian!

Of course I never liked the fact that he smoked! But his love for tea was tolerable! Which again makes him a mortal!

Byomkesh never like the name detective or investigator but he called himself the seeker of truth! The original novels were written in Bengali though you can get the translated ones! Or you can watch the famous DD serial starring Rajat as Byomkesh!

So when Sharadindu Bandyopadhyay created his Satyanveshi or the seeker of truth Byomkesh Bakshi, he never thought that the character will become so famous!

In fact just like return of Sherlock Holmes after Reichenbach Falls, after a hiatus of four years he started writing Byomkesh stories again! His last story of Byomkesh was unfortunately not complete.

In an interesting twist he had predicted that  Satyabati (Byomkesh’s wife) would never own a car! In the last story she was waiting for a taxi and finally Byomkesh compromised and thought of getting a second hand car! The story was not completed since Sharadindu passed away suddenly without writing the end which is the best part of his stories! Satyabati though never got that car just like how Sharadindu predicted!

In the crowd of Sherlock and Poirot, do not forget Byomkesh! Like we do remember Sunita but let us not forget Butch Wilmore also! Here’s to Butch! Welcome home!

SHubh Ratri!

Sometimes knowledge is a tricky thing! Too many options spoil the choice! It is like when you have time during weekend and then you decide to watch a movie with the family! 

Now if it was the once a week movie in DD; you simply had no choice! All work would be done and you will promptly sit in front of the TV and watch the movie in between the ads and maybe even the news!

Now you do not have ads and the time is yours and you have a thousand movie to choose! But still you have difficulty in selecting what to see! You have more than one option but still may not be hundred percent sure which is the best!

Welcome to the state of Epistemic Ambivalence!

First you must know what is Ambivalence!

So Ambivalence  is the emotional state often arises in complex relationships, where an individual’s feelings are influenced by conflicting behaviors or traits of the other person. For example, you might like your friend but also feel frustration due to his or her annoying habits! You also respect and love your parents but know that they are not perfect since neither are you!

Epistemic Ambivalence is almost the opposite idea of what ambivalence means because to be epistemic means you know, you are sure! 

Epistemic ambivalence is when you may know the truth of a situation but cannot say which truth it is, because there is more than one option!

Confused!? Well, imagine a situation and then imagine more than one option. Or imagine a parallel universe where more than one option exists at the same time though in this universe only one of the options is true!

Epistemic Ambivalence creates a delicate interplay between uncertainty and confidence, distinguishing it from epistemic uncertainty that typically diminishes with new information. 

It’s like Schrodinger’s cat analogy where you can have both options!

Doctors face this many times since they have the option of treating a condition in more ways than one and depending on the situation every option may be different but still valid and may work! Then again you may never know which is right or wrong till you do it! Of course that is experience! In medical practice that is one of the most important factor! 

Then again Epistemic Ambivalence may just be another fancy term to confuse us all the way to space! Anyway that talk about space and you know our stranded Astronauts who had a plan of maybe some days, ended up for months so far away uncertain of the future! 

For them and in fact majority of people in the world, life needs to be simple! A routine which is a dream for many and not some fancy sounding word!

Wishing Sunita Williams and  Butch Wilmore a comfortable night’s sleep with gravity on a cozy bed on Earth!

Oh yeah! You already have that don’t you!?

shubh ratri!

Life leson time!

Next time if you are preparing to make an important decision in your life and you are troubled whether it is right or wrong then you must drink a lot of water, make the ac super cool and wait for the bladder to fill up!

Apparently you make great decision on a full bladder! Full mind, well that it not very important!

This theory which got an Ignoble award was put forward by Mirjam Tuk!

Mirjam Tuk is from the faculty of behavioural sciences at the University of Twente, Netherlands. She and her colleagues won an Ig Nobel prize in medicine for their research into the effects of controlling your bladder on your ability to control decisions in other areas. The Ig Nobels, in their 21st year, are awarded for improbable research that “first makes people laugh and then makes them think”!

Of course it is intended to be taken in proper spirit or in this case, water!

But there is research into bladder and decision making which can actually make sense and maybe get a Noble next time!

Tuk came up with the idea after drinking several cups of coffee in an attempt to stay alert during a long lecture about biological factors that have a detrimental impact on self-control.

This made her and her team to experiment on her hypothesis!

One such experiment involved asking participants either to drink five cups of water or take small sips from five cups. Forty minutes later, the average amount of time it takes water to reach the bladder, participants were asked to make eight choices that would affect whether they received a small reward immediately or a large award later on!

The researchers also found that simply thinking about urination had the same effect in similar experiments.

Does that mean we should wait until our bladders are full before deciding whether to buy that house or car, invest in a certain stock or make a marriage proposal?

Well; take a drink of water and find out!
Now of course if the decision is to be the James Gordon in Gotham then Gary Leonard Oldman is definitely a choice made in a full…ahem brain!

Now don’t try that before you sleep! Don’t drink and sleep!

Shubh ratri!

Some dress materials like the Silk and the Suits are costly! But they are actually more costly to maintain!

This is of `course because they have to be dry cleaned!

Also it was invented because of a clumsy maid!

Now everyone knows that in dry cleaning garments are placed in a large dry-cleaning machine, which uses a solvent that removes dirt and oils. While normal washing uses water to flush out dirt, the dry cleaning solvent cleans without saturating the fabric with water!

Giving clothes for laundry is such a rich thing to do! So those days it was reserved only for the clothes which were actually rich! Since they would always be returned ironed and cleaned it was like getting a new dress again!

Specially our dhoti or suits or sometimes even some high priced shirt! If you are too lazy to clean and iron and take care while throwing it in the washing machine, the best alternative is to send it for dry cleaning!

Now of course it is a mighty industry and dry cleaning is only a small part of it! They are now the stain removal experts! They of course survive on bedsheets and carpets! The history though like most history is really interesting and not at all dry!

The history of dry cleaning is associated with Jean Baptiste Jolly who worked in the clothing industry as a textile maker in France which is supposed to be the origin of dry cleaning!

The French Federation of Dyeing and Cleaning gives an account of a servant in the household of Jean-Baptiste Jolly in Paris in 1825 who spilled the contents of a lamp on a soiled tablecloth.

When the tablecloth dried, the spots had disappeared!

The liquid in the lamp was probably camphene, produced from pinene, which is the main ingredient of turpentine. Camphene was initially used as a spotting agent, but it was later used for complete cleaning by hand.

Use of volatile organic liquids to clean cloths became known as ‘French cleaning’ in Scotland and ‘chemical cleaning’ in Germany!
Eventually, such processes were called ‘dry cleaning’ because they do not involve the use of water!

A dirty cloth, a clumsy maid and broken lamp with an astute observer created a very successful modern industry of dry cleaning! A great voice and some training with real talent can create success like Alka Yagnik!

Listen to some songs by her and think about which dress to give for dry cleaning soon!

Shubh ratri!