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Do you know what’s 42!?

If you do not know the significance of 42 then you are definitely not a nerd, nor have you read the novel by author Douglas Adams written in 1979 called “The Hitchhiker’s Guide to the Galaxy”, the first in a series of five!

For now if you are worried that this will be a spoiler, well then it is not! The novel is actually a guide within the guide about how to Hitchhike to the Galaxy! Of course the Earth gets destroyed in the novel just so you know!

Now; towards the end of the book, the supercomputer Deep Thought reveals that the answer to the “Great Question” of “Life, the Universe and Everything” is “forty-two.”

Deep Thought takes 7.5 million years to calculate the answer to the ultimate question!

The characters tasked with getting that answer are disappointed because it is not very useful. Yet, as the computer points out, the question itself was vaguely formulated. To find the correct statement of the query whose answer is 42, the computer will have to build a new version of itself. That, too, will take time. The new version of the computer is Earth!

Now Douglas Adams did not think too much when he wrote the number 42 as the  answer but this number is now a part of the GEEK culture with so many theories!

Like even now if you ask your search engine or AI variations of the question “What is the answer to everything?” it will most likely answer “42.”!

The number 42 also appears in different forms in the film Spider-Man: Into the Spider-Verse.

In ancient Egyptian mythology, during the judgment of souls, the dead had to declare before 42 judges that they had not committed any of 42 sins!

The marathon distance of 42.195 kilometers corresponds to the legend of how far the ancient Greek messenger Pheidippides traveled between Marathon and Athens to announce victory over the Persians in 490 B.C. (The fact that the kilometer had not yet been defined at that time only makes the connection all the more astonishing!)

In Mathematics the special thing about this is that it is a Pronic number in that it’s the product of two consecutive integers (6 x 7)!

In the ASCII character set, 42 is the code for the asterisk (*), a wildcard character that can represent any other character or string of characters!

Some even propose that it was chosen because 42 is 101010 in binary code, others have pointed out that light refracts through a water surface by 42 degrees to create a rainbow, and others have commented that light requires 10−42 seconds to cross the diameter of a proton!

Another common theory is that 42 refers to the number of laws in cricket, a recurring theme of the books!

But it must be remembered that these are all simple analysis! It could simply have been the number of girls who had broken Douglas Adam’s heart! Then again; let us wait for some million years to find out the next answer! Just hope it is not 84 though! Or 52! Which is the age of the one with that legendary reverberating voice Kailash Kher!

Listen to his Koun Hain vo and sleep!

Shubh Ratri!

Do you know who was General Andrew Jackson? Now do not tell that he was the son of Jack!

The aim of this blog is communication! You will eventually see how!

So General Andrew Jackson was a prominent figure, leading American forces to victory in several key battles, most notably the Battle of New Orleans. His military successes, particularly against the Creek Indians and the British, earned him the nickname “Old Hickory” and solidified his reputation as a war hero!

All this happened during the American-Brit war of 1812.

In fact Jackson led troops against the Creek Nation, achieving decisive victories at the battles of Tallushatchee, Talladega, and Horseshoe Bend.

But the battle of New Orleans which was in January 1815, Jackson’s forces decisively defeated a larger British army at New Orleans! It was a great victory and moral boosting exercise for his troop!

Jackson’s leadership and resilience during the campaign in Mississippi and Louisiana earned him the nickname “Old Hickory”.

BUT! (You expected that didn’t ya!)

Around two thousand people were lost in that battle of New Orleans! The victory came at a price! Sweet but still..

Now, wars do have causality! There is nothing different about this one!

Except the fact that at the time of war, they were no longer at war!

There was a treaty called the treaty of Ghent which was signed before this particular fight! Essentially Americans and Brits had already signed the peace treaty and they were no longer officially fighting! Jackson and the other side did not know this and kept on fighting!

A simple lack of communication led to the death of over two thousand!

This is what lack of communication can do! Be it war or even day to day life! Communication is the most important thing! If you do not communicate properly and on time then it will definitely wreck havoc and create chaos! Lack of proper communication is also the cause most problems in any relationship today! Be it between two partners or even two countries!

Now every time you want to convey a message make sure that you do it properly, clearly and on time! Most importantly make sure your message or communication has been communicated properly to the recipient and he or she has understood the communication!

Simply whispering to yourself will not do! Like in kanthara, make a loud noise and make sure he or she gets it! Which reminds me of Prasanth aka Rishabh shetty!

Now listen to varaha roopam from Kanthara and sleep!
Shubh ratri!

DNB examination especially the practical one is a horror festival! Of course most such examination in a good medical set up is tough and high on nerves but the DNB is specially difficult since it is conducted not in your college or hospital where you have learnt the ropes!

It is conducted in some other place and hospital! In my case it was conducted in a different city and state! None of the professors or teachers may know you and you do not have any familiarity!

Expect sleepless nights to prepare for the unexpected!

The examination pattern is called objective structured clinical examination or OSCE!
Sometimes you will have a healthy patient and all you have to do is ask for history! And if you forget to ask an important point then it’s gone! You are expected to do procedures like AUDIOMETRY test and not believe the technician to do it!

You may be evaluated on how you actually talk to the patient! Getting the diagnosis is a done deal! This goes above and beyond that! How you behave, which instrument you take first, how you assess the patient and how you conduct tests is what is ‘tested’!

The only way to prepare apart from all the theory knowledge is to attend as many mock tests as possible! These tests prepare you to a certain extent!
The tests are usually stations with time interval. Sometimes you need to identify, while in some you need to perform. In many stations you are supposed to simply see and recognize the findings and then answer the questions in the next station!

Rest assured, you can expect questions based on the latest guidelines and trend! During my time we had the SARS pandemic and though it was not direct ENT; we were still asked everything about the SARS virus!

Sometimes the patient is real, while sometimes it is simply a student who has been ‘instructed’ to answer your specific questions! If you ask the correct and proper question, he or she will give you the answer! You not only have to get the answer but also must know the proper question to ask! All when the time is ticking and the situation is super tense!

One such mock test was going on and this station had a CT Scan film! Of course we knew it top to bottom! Being trained in a premier institute, CT PNS or the scan of the sinuses was like child’s play for us! We could get a mine load of info from just a limited coronal cut! And this one had all views!

This film had Sinusitis, mucous collection, a deviation septum and narrow meatus and what not! We could also find stuff like concha and some other cells which one of our faculty used to call the IDK and IDC cells! It means I don’t know and I don’t care! Of course he was an international faculty and he did not have to know or care! But we knew even that!  We did not miss anything! Wrote everything on a piece of paper to answer the questions on the next station based on the CT!

The next station based on the findings of the CT SCAN was of ten vital marks! At the top of my mind I could already imagine more than ten findings! Add the management and further investigation and you have material for even a hundred marks! Let the challenge begin!

There were unfortunately only two questions!

The first was; WHAT WAS THE NAME OF THE PATIENT!? and the second
WHAT WAS HIS AGE?!!

That was the biggest lesson I have ever learnt in a mock test! The raw fact is that you are not just reading a scan! You are treating a patient! A human! He is not just a finding for you! He is a person who has come for getting a treatment!

Even the age is important as far as any issue is concerned! In fact they are the two most important factors in treatment!

Now this was a mock test so it was ok to score a dud which we did! But some experiences are remembered for life! So next time you read a report; first read the name and age of the patient!

Of course if you are calm and peaceful then any exam is easy! Then again not everyone can be as calm and peaceful as the Holy Dalai Lama!

Shubh ratri!

Back in my days!

My son usually makes some cute and great jokes with this!


“you call those text back in my day we just talk”

“you call that flash light back in my day we call that portable super nova!”

“you call that a microphone nah back in my day we called those portable cave echoes”

Of course all those are creative jokes but this is one of the most scary beginning of speech for any youngster!

If these words scare you then rest assured you are young! Or at least younger that the person starting with the words, Back in my Day!

Why do people start the back in my days prologue!?

Well; when everything is gone the only thing that remains is the memory!

Memory is like that sweet smell of incense stick or the smell of charcoal after a puja or a yagna which lingers days after the event giving you a sweet nascent reminder of the event!

Every generation gets the Back in my days lecture from the previous generation! The new generation has now made it a MEME!

With all the happening in the world there comes a time when you realize that you have done this and done that but there is no one to listen!

Many old timers only need a listening ear! All you have to do is nod along and listen. Maybe put a smile and in between act surprised or pleased as the case may be!

I had a patient the other day and his by stander was his father who was an intelligent and accomplished person. Unfortunately it was peak time and time is, well most precious! I knew that after the preliminary introduction and treatment of the patient, he would start the BACK IN MY DAY or BIMD soon!

So the patient explained his issues in less than a minute and my examination was done in less than five! As predicted though, the BIMD began! It was long and frankly if I had time, very interesting! Since I like history, I do not mind listening to historical stuff! The issue here is that once the movie begins, it is very difficult to stop! A fine balancing act has to be made!

The person delivering the BIMD must be content that his BIMD has been delivered at least to some extent while the person getting the BIMD must balance the time! One way you know that the time is over is when the BIMD incidents get repeated! The moment he or she starts telling the same thing you know that you can put a pause to the delivery! Even putting a pause or even end is a tricky thing which takes experience and patience! You have to use all your composure and talent to slowly stop the BIMD! It is like driving a car on the Highway! You cannot stop suddenly! It will topple or skid or hit some other vehicle! You have to slowly decelerate and then stop!

The deceleration is by slowly turning the attention to another person or to the time or the fact that there are other people waiting for the BIMD delivery! You must also remember that you cannot simply nod! You must repeat some stuff from the BIMD delivery so that the person delivering the BIMD is satisfied to at least pause the delivery for now!

Most importantly though the chief reason why you must accept the BIMD delivery once in a while is because at some point in the future you may be the one doing the delivery!

For surgeons and clinicians and I guess in most profession, the BIMD is routine! Of course when it becomes too much or too long, it becomes a pain! Still when someone is giving his or her BIMD; just hope that it is good and short!

Short and stout but extremely talented though was Shail Chaturvedi  ji! Not much of BIMD there!

Now Back in my days we used to sleep on time! Do that when you wish!

Shubh Ratri!

Nocere is the Latin word for hurt or harm!

One of the first things we learn in medical education has this word at the top!

The term is “Primum non nocere”!

This is the dictum and the first and foremost rule for any medical practitioner!

This Latin phrase means “first, do no harm”.

It’s a fundamental principle in medical ethics, emphasizing the importance of avoiding actions that could cause harm to a patient, even if those actions are intended to help. This principle is a cornerstone of medical training and practice worldwide.

Nocere also comes again in our medical education in the form of Nociceptors which were discovered by Charles Scott Sherrington in 1906.

A nociceptor (“pain receptor”) is a sensory neuron that responds to damaging stimuli by sending “possible threat” signals to the spinal cord and the brain. The brain creates the sensation of pain to direct attention to the body part, so the threat can be mitigated; this process is called nociception!

It is surprising that even though the brain perceives pain, the brain as such is painless! There have been times when there have been huge affliction to the brain with no pain! This is really sad since your biggest friend is pain! Pain is the brake to your speeding body!

If you ask a driver, how fast his or her vehicle can go then an experienced driver would tell that the speed does not depend on the engine power or the road! But it depends on the power of the brake! This is what the pain does to your body!

In simple terms when you have pain, it’s the best thing that can happen to you!
Most of the problems of the body lead to pain which is one of the first indicator of the underlying issue! The pain is also the first symptom we ask to any patient! The elicitation of pain on your body is called eliciting ‘Tenderness’! This is one of the most important clinical examinations in medical practice.

Most of the time all you need to know is to ask the site and severity and duration of the pain to make your diagnosis and treat! The frequency and factors which increase of decrease the pain also further make our diagnosis as well as management more efficient.

In some conditions you do not have pain which is really bad like those with diabetes  which is why it is an issue.

One of the most distressing pains is the pain of Migraine which is actually the body’s reaction to either a skipped meal or a disturbed sleep! In fact the history of pain in migraine is the cornerstone in its treatment in which the most important factor is to avoid the trigger of migraine or pain!

So remember that pain is thus your irritating but actually helpful alarm which is waking you up to face the danger! So next time you have pain, try to find the cause before popping that pill And  reduce stress maybe by watching an old movie!

My recommendation is Mayabazaar especially the scene and song called Vivaha Bhojanambu starring Samarla Venkata Ranga Rao!

It’s a laugh riot!

Have a painless Sleep!
Shubh ratri!

When someone said that life is a race; he or she was not kidding!

It is definitely a race!

It starts the moment you get up! It is a race to get ready, have breakfast, beat the traffic and race to reach your work on time!

Then you have the race to finish the work on time and rush back to home to finish the pile of work at home!

The pile of clothes to be cleaned and folded! Your kid’s home work and assignments to be completed! The bills to be paid, the food to be cooked and the house to be cleaned!

Even if you have loads of money and help to do all these, there is still a race to keep the money flowing! You have to race to catch a flight or to catch an important client!

The race never leaves you! Even in the end; lying down on your bed, all weak and unable to move; you have the final race; against TIME!

In fact the actual term is Rat race!

The term “rat race” refers to an endless, self-defeating, and often stressful pursuit of success, typically in a competitive environment. It is called a rat race because it evokes the image of rats frantically scurrying in a maze for a piece of cheese, a pointless and exhausting exercise that ultimately leads nowhere.

It is a miracle how with all this racing around, many people are so successful! They do so much and continue to shine! Of course that also is a matter of time! The champion of today will be forgotten the moment you have a new one!

So once in a while, just STOP! Take a breath! Take a break! The engine needs an overhaul! Your body also needs rest! Let the time run! Turn off the phone and take a look around! Recharge yourself and get ready to race again!

Luckily we humans can take a break from the race! Nature is not so kind!

A gazelle is given the gift of nature to be consistent. To run for long and to run fast but it normally has a slow start! It is always thus racing!

A cheetah can run fast and be quick! It’s chief power is the element of surprise! The sudden attack and the quick start! But if the chase continues then it stops since it cannot maintain the speed! That’s why the gazelle does not give hope though in the end the one gazelle which does not run that fast or is not persistent or is a little slower than the other gets eliminated! The Cheetah is in the race for food while the Gazelle is in a race for his or her life!

Remember the most famous race of the animal kingdom? Well it is the race between the tortoise and the hare! But the story is not so simple! The tortoise can be slow since it has a hard body! There is less danger! The hare on the other hand has no defense whatsoever! Which is why it has to be fast! As a story you may think how the tortoise won! But in the wild, the hare has to win always! When he or she does not win the race; well that is end game! Now that is a HARE (hair!) raising race!

So stop for a while and breath!

Let the race begin tomorrow! Today just listen to Amit Kumar and relax!!

Shubh Ratri!

History is historical! and sometimes Hysterical! Most of the time though it is simply a point of view!

Now if you read the story of the invention of Telegraph (read Samuel Morse!) and how the first message was transmitted you would get goosebumps!

The first message was “What hath God wrought?”

Not to mention how SOS is now an amazing acronym to Save our soul!

All in bliss! Which is Ignorance!

By the way, that was not the first message! SOS does not have that acronym and more importantly Morse did not single handedly invent the telegraph!

I know! What would the quiz masters say! Now please do not shoot the messenger! If you want you can shoot the actual messenger! That is Bill Bryson who mentioned all this in his novel Made in America!

Now do not get me wrong (See if I care! actually I do!); the telegraph is an amazing invention!

The telegraph’s introduction had a profound impact on the media. Prior to the telegraph, news traveled slowly and relied on physical transportation methods, such as mail and messenger services. With the advent of the telegraph, journalists could send and receive news across long distances almost instantly.

The telegraph also gave rise to the concept of wire services. Agencies like the Associated Press and Reuters collected news stories from reporters and transmitted them to subscribing newspapers via telegraph wires!

The telegraph led news agencies to develop a concise and efficient writing style to convey information quickly and effectively. The inverted pyramid, where the most important information comes first and the additional details follow, became a standard. Journalists still use this writing style today! Of course whether they use it for telling the truth no one would know!

But (!!); the fact of the matter is that Mr Morse’s genius (or luck!) was is being at the right place at the right time!

In the early 19th century, he teamed up with Leonard D. Gale and Alfred Vail, a skilled machinist, to develop the electric telegraph. While Gale, a chemistry professor, advised Morse on the technical aspects, Vail financed the patents and helped improve the machine.

At the heart of the telegraph system was Morse code, which enabled efficient transmission of telegraph messages. Vail also helped Morse develop this system, which assigned a unique combination of dots and dashes to each letter and number! So even the code which bears his name was a joint effort!

Then you must know about joseph henry of Princeton the amazingly talented engineer! He mentored and developed the whole idea about the cables and the system! He even guided Morse on the theory and practical aspects of the transmission! He also stole a magnet crucial to long distance telegraphy invented by Louis Breguet!

Unfortunately after achieving success, Morse conveniently forgot about them! And so did the rest of the world! Until now that is!

The glorification of history (read distortion!) does not end here! The first words to be telegraphed were not “What hath God wrought?”

But it was actually ‘Everything worked well”! This was actually both practical and believable!

Then again he was taken down from the top of the communication pedestal soon enough by a BELL! Of course that is a spicy story for another blog!

Oh yeah! The SOS does not mean anything! It was practical!
The nine strokes which consists of three dots three dash and three dots were the most simple to learn and transmit! Now that’s just gold! Golden also is the prefix associated with Ganesh! His Mungaru Male is the GOAT!

Listen to anisutide and sleep!

–. — — -.. ……. -. .. –. …. – or da-da-dit da-da-dah da-da-dah da-di-dit di-di-di-di-di-di-dit da-dit di-dit da-da-dit di-di-di-dit dah

That’s good night in morse code!

We all know that the middle finger (don’t worry; it is not going the PG18 WAY!); is the longest of all the fingers! It is not the first finger and not even the second! But it is the longest! This is normal!

But (ah! the return of the but!); as far as the toes are concerned, the big toe is not only the biggest, it is also the longest! In majority of course! In many people though the big toe is shorter than the second toe!

Those ‘rare’ people are supposed to be more beautiful and ‘lucky’!

The Ortho doc may not agree though! Well, then you can show him or her the Statue of Liberty!

Did you know that the Statue of Liberty has a longer second toe; sculptor Frederic Bartholdi studied Greek and Roman sculptures, modeling the statue’s feet to define her heritage from the earliest days of civilization!

The anatomical, political and ethnic logic for classic artists starts and ends with the presence of longer second toes in a portion of the population.

In fact, many Roman statues have this!
Dudley Joy Morton first evaluated a second longer toe as a medical condition in 1927, calling it “Metatarsus Atavicus.” or in simple terms Morton’s toe or Greek toe! It is thought to be a divine trait though it can cause more toe problems!

In many cases, Morton’s foot is asymptomatic. However, the altered weight distribution can lead to increased pressure on the second metatarsal, causing pain, calluses, and other issues like Morton’s neuroma or bunions!

You may think is is rare but it is not that rare! Morton’s foot is estimated to affect a significant portion of the population, with estimates ranging from 4% to 30%!

This foot shape, was seen in classical art and architecture, particularly sculptures like the Venus de Milo, as a symbol of beauty, creativity, and the Golden Ratio.
Ancient Greeks, known for their appreciation of beauty and mathematical harmony, associated the longer second toe with ideals of aesthetic perfection!

They believed this foot shape reflected the Golden Ratio, a mathematical proportion considered to embody ideal beauty and balance. The presence of “Greek toes” in famous sculptures like the Venus de Milo and Michelangelo’s David further solidified its association with classical ideals; not to mention the statue of Liberty!

Morton’s foot is associated with conditions like metatarsalgia (pain in the ball of the foot), increased risk of stress fractures in the second metatarsal, and potential for over-pronation. So if you do have a longer toe then do meet your doctor after you have done admiring its beauty!

But do pay for his or her consultation since only then you will get a good treatment that works! If it is free then it is not going to work! Even a token amount would do! Though not everyone can be like the ten rupee doctor Dr T A Kanagarathinam!

Shubh ratri…
Happy doctor’s day dear friends… and a big thanks to those who wished us…

So you forget once in a while!

That is ok!

Then again you forget that you forgot! That is not ok!

This double forgeting is the lifestyle of a parrot!

When you have a busy life then automation sets in! You may think that you forgot to lock the car but in fact you have forgotten something else!

You may forget that you have locked the car!

It is the same with examination for us clinicians! The examination is routine for us ENT. I always start with the nose then the throat and then the ears and finally the chest! Whatever the complaint may be! In fact most of the times the patient would be wondering that he or she told me that his or her right EAR is paining but this doctor is checking the nose and the throat! “Guess this ENT must get his hearing tested!”

Then I would explain that all are linked so I need to examine everything!

Suddenly though after full examination of when I would be writing the prescription he or she would ask, “Doctor how is my chest? or how is my nose!?”

Now of course we would have examined all but we would have forgotten that!

This is because unless there is a finding or something different, you would not resgiter a ‘normal’ ear or nose! A senior doctor would simply claim that everything is ok! I normally examine the part again so that both of us would be more satisfied!

This is also important since even the patient would have ‘forgotten’ that even though he or she had specific complains, I did in fact examine everything else! Many times he or she would even forget that I had examined the other normal ear!

Now listen about the kākāpō!

The kākāpō, also known as owl parrot, is a species of large, flightless, nocturnal, ground-dwelling parrot!

According to the evolutionary biologist Douglas Adams, these birds have wings but with such a stout and fat body, they really can’t fly!

Apparently their ancestors could but these birds have forgotten that! Which means that at one time their great great grandfathers used to fly but then decided that it is not necessary! Or worth the effort!

The more interesting thing about this is that they have forgotten that they have forgotten to fly!

So once in a while they jump down from a tree to soar up in the sky only to fall down on the bushy grass like a brick! And get up with whatever pride they have left till the Amnesia strikes again! Or they reach a tree or cliff which is high with a view great for a flight!

Flight assessment needs physics and who else to remember by that other than C N R Rao!

Now don’t forget to place the alarm before you sleep!

Shubh ratri!

There was a famous GB Shaw joke!

A beautiful woman once told George Bernard Shaw ‘Wouldn’t it be great if we got married and had a child with my beauty and your brains?’

Shaw, who let us just say that was not a very good looking man, replied: ‘That would be wonderful indeed, but what if our child had my beauty and your brains?’

It is funny but there seems to be some practicality in the combination!

Children are in fact a mixture of their parents and then some!

How every parent states his or her child acts or looks like him or her!

Then gain what if you have this ability of selecting the best of both parents and making the perfect combination? It is like an RPG where you get a character and you can mix and match his or her qualities! Some strength, some speed, some magical ability and voila; a perfect match!

Ethically though it cannot (officially at least!) be done in humans but this is a universal appeal in the animal industry!

Which is why you have the prized bull or the prized stud! In fact this is why you had the donkey in the first place! A donkey is a hard working horse without the attitude! What is you have an intelligent donkey! Well that’s a mule!

In fact the equine industry is full of such mix and match!

A mule is the offspring of a male donkey (jack) and a female horse (mare). Horses and donkeys are different species, with different numbers of chromosomes. Of the two first-generation hybrids between these two species, a mule is easier to obtain than a hinny, which is the offspring of a female donkey (jenny) and a male horse (stallion)!

The size of a mule and work to which it is put depend largely on the breeding of the mule’s mother (dam). Mules can be lightweight, medium weight, or when produced from draft mares, of moderately heavy weight.

Mules are more patient, hardy, and long-lived than horses, and are described as less obstinate and more intelligent than donkeys!

So if you are someone who has the horse as parent; don’t try to be another horse! Try to be a mule

Then again if you run like Pilavullakandi Thekkeparambil Usha then horse is your choice!

Shubh Ratri!