Being Mortal by Atul Gawande

Sri.Nagaraja Shastri was a musician and dramatist, well-known and respected in his youth. Because of intermarriages between cousins, which is quite common in south India, he was uncle to three generations - my husband's grandmother's, my father-in-law’s and ours. When he and our aunt became too old, they moved to our village so they could be cared for by his daughter. While the village did not have top-notch medical facilities, the old couple didn't seem to need them either, as they were still quite independent and healthy in spite of their age.

The first (and only) sign of problem we saw was many months later, when Nagaraja mama felt easily out of breath. He was taken to a doctor in the next village, who said that he couldn't do anything as he had bradycardia, and he had to go to Bangalore if he wanted treatment. Nagaraja Mama was eighty-six years old and had never been admitted in a hospital. After much deliberation, we brought him to Bangalore and admitted him to a hospital to see what the doctors could do.

It was very clear that he was diminishing by the hour. That didn't prevent the ICU doctors and nurses from putting him on intravenous medication right away, for bringing the heart rate up. He was trying to pull the IV needles out, so they bandaged his fingers together so he wouldn't have an opposing thumb to pull the needles with. He was angry and with his slurring and incomprehensible speech he was scolding the nurses for taking away his freedom. After multiple tests the doctors came to the conclusion that the only way to keep him alive would be to put him on a pacemaker.

Our aunt, on consulting about this, was clear that she didn't want her husband to go through any more pain, and wanted to let him be. Without a pacemaker, he died on the hospital bed a day later, with only the ICU nurses around him. A question that was gnawing at my heart for a long time, was whether we made a mistake in not opting for a pacemaker. Secondly and more importantly, I was thinking whether we made a mistake in bringing him to the hospital at all.

We are confronted with choices all the time. We seem to perpetually hit the forks that diverge on yellow woods, and the path we take makes all the difference. In medicine, they are choices that decide life and death, or Scylla and Charybdis. With the modern medical technologies available, life could be Scylla. It is these hard choices that Dr Atul Gawande talks about in his book “Being Mortal”. Through many case studies and personal experiences, he tries to educate patients and their loved ones about the questions they would need to ask and get answers to, before consenting to treatments that can wreak havoc on the quality of their lives.

Reading this book required courage from me. I have been brought up in a culture where death can but be the next step to liberation; however, talking about my own death is inauspicious. To read this book, I had to confront my own probable sickness and eventual mortality. Through the course of the book, I had to ask myself tough questions - what would I do, what would I have to do if I were in the patient's shoes, or God forbid, in the caregivers’ shoes?

I have been a fan of Dr Gawande’s writing for years. Even if it is not a subject I am not frightfully interested in, (Obamacare vs Trumpcare, for instance), his writing is capable of grabbing and sustaining attention. Being Mortal is about medical facilities of today that let terminal patients live out the remainder of their lives in peace without subjecting their bodies to more pain, especially if the pain is not going to bring about any improvement in the quality of their lives later.

Consider another case. My granddad had had a paralytic stroke at a very young age, probably due to an infection. He had regained the use of his arms and legs later and was active for a long time. However, he had a second stroke which was debilitating. He survived that too with treatment. When he had a third stroke a few years later, the doctor gave up. He asked my parents to take care of him as well as they could for the rest of his life. A few months later, my taata passed away in his own house, with his family around him.

Dr. Gawande cites statistical studies to prove that providing hospice care to terminally ill patients significantly improved their quality of life. For instance, hospice patients who stopped chemotherapy treatment lived 25% longer and had far more fulfilling lives than the ones who underwent chemo. He analyses the fact that 25% of insurance spending goes for 5% of people who are already on their deathbed. Why not divert it to hospice care which will probably be more helpful for patients than more needles and scalpels and isolation?

Of course, everything is a challenge, especially in our country.  The first problem is that of greedy hospitals. There have been instances of hospitals performing surgeries on dead bodies to milk insurance money. How do we even get these hospitals on board for something like hospice care?

The second and equally difficult challenge would be to confront the concept of mortality. We have not learnt that, in spite of studying scriptures day in and day out. But if we don't take the first step, who will?
 

Thoughts Before a Medical Examination

I have my origin in the big town of Bellary, now a city. Life used to be simple back then. We went to a nearby school. We used to be vaccinated regularly too. When we were sick, mostly my grandfather used to give medicines and we would be alright. Taata was a medical practitioner and treated people with Homeopathic and Ayurvedic medicines.

I have professed my interest in the Medical field elsewhere on this blog. This interest probably came from seeing my grandfather treating his patients day in and day out. The medicines were usually kept secret from the patients, the reason being that many of the ingredients that went to form the medicines were used almost daily in the kitchen. (I knew them, since I was the privileged helper.) The aura of mystery, and more importantly, total belief in the doctor and the medicines probably helped recovery. From simple diseases like gastritis and menstrual cramps to scorpion bites and jaundice - I have seen him restore the health of many people. And when he was baffled or was unwell himself, he went to another doctor, Ananth, who visited weekly. This was my earliest experience with healthcare - simple, fairly dependable and very affordable. Taata and Dr.Ananth did not prescribe any fees for their services. They accepted whatever the patient gave. My grandmother recounts instances where my taata himself gave some money to the patient, because he/she was so poor. His technique was also simple. He used to feel the pulse of the patient. That information along with the symptoms were, almost always, enough to give him an idea of what ailed the person. Dr.V.S.Ramachandran, in his ‘Phantoms in the Brain’,  recounts of an instance when his professor told him to observe the nails of the patient. A change in the angle between the nail bed and the finger would always mean the onset of malignant lung cancer. This simple, noninvasive diagnosis could be made far before more serious symptoms appeared. Diseases like typhoid and Rubella can, apparently, be diagnosed by their characteristic smells, and Parkinson’s by the gait of the patient.

Things ceased to be this simple in the medical field, long ago. Gone are the days when doctors used to feel the pulse of the patient routinely. A doctor is always seen with a stethoscope, one of the first and most useful medical instruments. What with the heart monitors and EKGs and oxygen monitors and a zillion other instruments available today, reading pulses and diagnosing illnesses by smelling or hearing a person walk, is an art that might well be preserved by doctors stranded in remote  islands.

Heart monitors and oxygen monitors are just the beginning. We now have electronic instruments for measuring almost any bodily function. Good old steam inhalation now has electronic measurement of temperature, and pressure and what not. (A humorous aside - my son then about four years old, a gadget-freak, looked at the nebulizing unit at a hospital and said with a wide smile "Amma, I want to be a doctor who can uset that machine"). We have ventilators and pacemakers that were unheard of in older times. While it is indeed heartening that we have now reined in technology to be on our side in our fight against disease, it is really disturbing that in this fight, we subject our bodies to great torture and never learn to let go.

In the olden days, certain illnesses were just accepted. When my granddad had a stroke, he took some strength-giving medicines but did not get his blood pressure checked or take beta blockers. My grandmother says proudly that she has never undergone any tests - just took an injection (she forgets which) while pregnant with my Father, that's all. Now, at 86, she is fairly healthy and fairly strong for her age.

Things have changed for our generation. We are more aware, healthier but also very scared. I suppose that scare can actually be justified. Take iodine, for example. The deficiency of iodine causes some irreversible problems. When iodine is lacking in a child's / pregnant lady's diet, there are high chances that that child will develop mental retardation. Goitre is a well-known illness, also caused by iodine deficiency. To prevent these diseases, salt companies started adding iodine to salt. This has gone on for a while now, resulting in another side-effect, that of a non-functioning thyroid. Unfortunately, this can also be rather dangerous if undetected, as thyroxin is required for each and every function in the body. An under-working thyroid might be the cause of an enlarged heart or obesity or just any condition we can think of. Now, if the solution is as simple as getting a blood test done and taking thyroxin everyday, why not do it? Why rely on your intuition only, when you have a foolproof, if only more invasive and expensive method to diagnose a problematic thyroid? Removing iodine from salt is definitely not an answer, so the mandatory checking of thyroxin levels is.

That was just one example. Many doctors now recommend taking the HbA1C test, instead of / in addition to the traditional fasting + post-prandial blood sugar test. For people over thirty five, annual treadmill tests are mandatory. Multivitamins and multiminerals are prescribed regularly. After a certain age, Aspirin in your prescription is considered normal. But wait, this is for well-adult check-ups; taking those tests do not demand much of our time and energy, and one should not have any complaints. However, suppose one goes to the hospital with high blood pressure and is unfortunate enough to get admitted (it is a damned-if-you-do-damned-if-you-don’t-do situation, really), he/she is started immediately on medicines like Atorvastatin and Sorbitrate, even when they are quite unnecessary (and are likely to cause complications).

But the most unwanted involvement of medicine has to be in the childbirth area. Three of my cousins were born at home, two delivered by my grandmother. They are hale and healthy and doing very well. A fourth cousin was delivered (at the insistence of my uncle's family) at a hospital. He is doing fine, too. The point is that being born at home was not bad for my cousins. These days, as soon as one gets pregnant, they start thinking about c-sections and epidurals. (I am ashamed to say that I did, too). Heck, even for 'normal' deliveries, episiotomy is routine here in India. As are oxytocin shots. While these are established as safe, they take away the feeling that birth is a natural process.  

I am certainly not denying the advantages of high-tech medicine. In olden days, giving birth used to be called 'punarjanma' for women. And it has to be accepted that the reason for the high life expectancy that we see now is solely because of the advances in medicine. But my grouse is that these days the tendency is to pop a pill rather than go for daily walks and eat healthy.

Gawande, in one of his articles titled ‘...Insurance Imbroglio...”, talks about a hospital where the nurses regularly went on house-visits to check on the child asthma patients admitted to their hospital, and thus reduced the readmission percentage considerably. This left many of the hospital beds empty and reduced the hospital profits! As Gawande says, it is not easy to work out a mutually beneficial (beneficial to both doctors and patients) solution.

So what is the solution? According to a recent poll, the top issue for Americans is healthcare. What they mean by healthcare is obviously high quality diagnosis and treatment that's also affordable. Unfortunately with medicine becoming another corporate industry, this looks difficult to accomplish.

The Eternal Battle

The other day, my six-year-old Sunshine told me about the eating habits of his friend. This other child was a non-vegetarian, and apparently, he described his food with a lot of enthusiasm. I saw that my son's eyes were shining, and asked him if he would like to eat that too. He replied with a nod and a bright smile.
At that moment, you could have felled me with a fork. Raised in a family of strict vegetarians and married into one, it has never occurred to me to eat anything other than vegetarian. When we were young, the "Eww" factor kept us from eating NV. During college days, I used to try to convert non-vegetarians to vegetarianism. But later, with more reading, I learned to be tolerant of, and accept others eating that kind of food.

Actually, non-vegetarianism is not new to sanātana dharma, and from old texts, it does not look like it was forbidden for Brahmins, either. In the famous story of sage Agastya getting rid of vātāpi, it is evident that he ate vAtApi, in the form of a goat. In the kathāsaritsāgara, there is the story of a Brahmin, a servant in a merchant's house, who desired to eat meat -aamisha, and it is just one such example in our literature (On an aside, people who constantly complain that the learned brahmins sitting on high horses kept others away from knowledge should spare a look at classics like kathāsaritsāgara to get a more real and complete picture - but that should be a topic for a separate post). In fact, a story from the same classic explicitly mentions that sanātana dharma endorsed violence and therefore bauddha-dharma was better because it preached peace and non-violence. If one wants examples from sacred texts themselves, it is very clear that animals were used in various yajñas (horse during aśvamedha and goat during somayāga), until religious leaders like Madhvācārya advocated the use of images of animals made of flour (piṣṭa-paśu).In fact, the manusmṛti says the following about eating animals for food -
'pravṛttireṣa bhūtānāṃ nivṛttistu mahāphalā' |, meaning that this was the tendency of living beings, but abstinence would be greatly beneficial.

Having said all this, this is my view of vegetarianism. Even if all the śāstras of the universe espoused non-vegetarianism, I would not eat non-vegetarian food. For the simple fact that I would be taking the life of another animal to satisfy not just my hunger but also my palate. Our ancestors had a simple reason to resort to eating animals - that of non-availability of food. When people did not know how to grow their own food, it made sense to eat the animals they got by hunting. This reason does not hold during the present time and age. As R says, you can eat an animal if you can kill it. If you can stomach the killing, you can stomach the kill.

Secondly, the animals in the feedlot are treated in a very inhuman way. Not just in crowded ranches abroad, but even in our non-violent country. Chickens, still alive, are often seen packed in metal boxes, with no space to stretch their wings. It is not a rare sight to see live chickens dangling from the handlebars of bicycles. I am sure the situation is no better for other animals in feedlots. Cows in dairy farms are probably treated better, but apparently, they are also fed hormones so that more milk is produced. Also, there was this news about artificial insemination for cows. The question is, for how long can we get away with this kind of cruelty to animals?

The third issue is that of resources. Non-vegetarian food consumes a lot of resources. It makes collective economic sense to become vegetarian, or at least, reduce the consumption of non-vegetarian food. Not to mention the health benefits. Other factors being equal, a vegetarian is less likely to develop heart disease than his/her non-vegetarian counterpart. If this is not reason enough for continuing to being a vegetarian, I do not know what else is.

To come back to my Sunshine, I told him that non-vegetarian food was not really healthy and that we did not make it at home. Luckily, that evening, there was this program on Discovery, about catching sharks for their fins (shark-fin soup is apparently a delicacy). It was a bloody (sorry!) gruesome sight - the way the shark was caught, its fins were cut off, and it was thrown back into the water to die (if it was not dead already). My son was watching this too - and R asked him if he would like to do that to any animal. The shocked child replied "No", while I turned away, grinning. For a few more years, we parents can still influence him, at least in the matter of food.

Bhai-Bhai

The other day, we went to a nearby park with little Biyadiya. This one, near my house, is frequented by all nearby kids, including kids from nearby construction sites who do not know any language other than Tamil. It is a great experience to watch all these kids treating one another as just playmates, no strings attached.

That evening, there were two kids, who were evidently Muslims. The boy was young, five or six years old, with a skullcap on. The girl was slightly older, and wearing a worked-on red churidar. Both of them were conversing in Urdu. Now there are three slides in the park, one for big kids and two that are more toddler-friendly. While my little one is not scared of slides, he is usually reluctant to actually slide. This girl held him while he slid down, like the protective elder sister. The boy then tried to climb up the slide, but his big toe got stuck in a hole on the slide (did I mention that this park is maintained by the BDA?). He started crying. R tried to take his toe out, but it was stuck tight. The girl then cried "arey, Allah ka naam le ke nikaalo, aa jayega!". After some struggle, the toe came out, and everybody was happy.

I was amazed at the girl's maturity. She was helping kids onto swings and merry-go-rounds, held on to little Biyadiya because he was not comfortable sliding down the slide. She was but only slightly older than the boy, but had already taken on the role of a nurturer, a person who was capable of comforting others. One may say that girls are wired that way, but this one was extraordinary. She was far too intelligent, nay, mature for her age. What would she grow up to be? Would she grow up to be a Benazir Bhutto or a Taslima Nasreen? I wondered about the boy, too. Would he look up to his sister as he did now? And the other kids - would they (including my son) treat these two kids as somehow different when they grew up? I, an adult with reasonable sensitivity and intelligence, was thinking so much about the girl just because she was a muslim. This, in spite of knowing about cases of women-abuse in my own community!

Now, before people start accusing me of looking at people with colored glasses, let me make it clear that I have had, and still have muslim friends. And I think that it was much easier for us to befriend people from other religions, than it is for today's kids. Some boundaries are vanishing, but other, more unsurpassable boundaries are rising.

The truth hit me hard when we listened to some older children (probably 10-12 years old) talking in another park. One was asking another "Hey, what caste is yours?". When we were young, we were taught that asking about another's caste was wrong. I am definitely going to teach my children the same thing, but with so many divisive forces around us, is it possible?

Animal Rights? Who Cares?

I have long been an advocate of animal rights. Probably even to the extent of Menaka Gandhi. When we were young, my sister and I used to take butterflies with broken wings and place them on flowers, childishly hoping that they would drink nectar from them. Now that I am an adult, I do not indulge in such things, but my concern for animals remains.

Yesterday, an eagle got shocked from the live wire near my window at work. A colleague and I called the Animal Rights Fund. We saw good advertisements about it on the web. And boy, was it a mistake! I had to leave early yesterday, and my poor colleague was at our workplace when the guys from ARF came. Apparently, they were rude and horribly uncaring about the bird. The details are too gory for me to go into them again, but the bird finally got scared and fell from the stairs and died.

Are all "non-profit" organizations like this? I am just writing this to get the anger out of my system. Okay, we do not expect them to be perfect gentlemen, but they should at least have a little concern about the creatures they have made their mission to save!

You Are Free... You're Not...

Years ago, when I had fancied myself to be a right-winger and slightly authoritarian, I took an online test that assessed my political inclination. I was a little surprised at the results. I was a right-winger, but so much to the center that it did not matter; and I was a libertarian!

I am all for law and order and discipline. People need a physically, mentally and spiritually safe place to live. But it is wrong for anybody to assume that to make other people feel good, one has to keep bending over backwards and accede to every wish of the other party. This is true in all cases, whether it is the case of travelers in a train shutting up because a co-traveler takes unkindly to their conversation, or the case of Vande Mataram not being sung in schools because a certain group of people is not comfortable with it. A compromise has to be worked out, but it is a crime against oneself if he/she genuinely believes that others matter more than oneself.

I am a huge fan of Ayn Rand and her philosophy. I believe that one exists and needs to exist for oneself only. Even if we avow that we are doing something to please somebody, finally it is our own gratification that will result out of it. Indeed, the line "आत्मनस्तु कामाय सर्वं प्रियं भवति" from the BrihadAraNyakopaniShat can be construed to mean that. And to take it further, if an action brings unhappiness to oneself, it is wrong. Oh, yes, you will be called 'selfish' if you ascribe to this philosophy, but in the end you will end up being much better, and of much value to the society.

I know I am treading controversial ground here. For eons, we have been taught to be accommodating. But how right is it to ask people to give up their comforts for others' sake? Consider this scenario. Suppose I am a pianist, and a writer lives next-door. The writer complained everytime I started playing the piano? Should I give in each and every time and let him write? In some situations it is easy to draw a solid line and say that it is trespassing on the liberty of the other person if that line is crossed. Al Qaeda's recent statement that it is their legitimate right to attack Delhi and Moscow, belongs to this category. In umpteen other situations, very fine lines divide liberty from lawlessness and discipline from oppression.

During the French Revolution, the oppressed lower classes of the society revolted against the aristocracy, and put many of their oppressors to death by guillotine. The royal family, aristocrats and supporters of the aristocrats alike were killed. But the revolters became bloodthirsty after that and started killing for flimsy reasons (the whole revolution is superbly described by Charles Dickens in 'A Tale of Two Cities'). What started out as a fight for liberty became lawlessness and chaos. And I think that the reason for this was the failure to see liberty as it was, as a right as well as a responsibility.

As with all things, liberty also comes with certain costs and some responsibilities. As one becomes more and more independent, far less people tend to guide him. He is on his own, and must rely on his own experience to wade through the ocean of life. And of course, he should be responsible enough to not topple others' boats while enjoying his swim. And it will be better for others, if he takes up the additional responsibility of helping others sail, if not swim like him...

Really, are we free?

Drums and Camphor, Rice and ...

I was eating a peaceful lunch in the lunch room today, talking about mundane things that afflict employees everywhere. It was then that I heard the sound of drums beating in a simple rhythm. I did not give much thought to it, until the drum-beating crowd sounded like they had made a stop right in front of our office. I walked to the window to see what it was. There was an open lorry, with the icon of a Goddess, bedecked with jewels and adorned with flowers. A couple of people were holding umbrellas above Her head. I thought that it was the traditional aarati, and I was instantly reminded of my days in Madras. Every now and then, processions of Gods used to be taken on our road. There used to be naagaswaram playing beautifully. The house-fronts would be cleaned, and adorned with rangolis. We used to take camphor, fruit and coconuts and perform pooja. But this procession wasn't just that.

There was a water tank leading the lorry. God's path has to be clean, so these guys had ingeniously brought a tank along, with its faucet open. Drums were beating loudly and rhythmically. A couple of youngsters were dancing and looked like they were drunk. A man spread banana leaves side by side on the ground, right in front of the lorry. A couple of women served rice and some more dishes on them. A girl removed agarbattis from the wrapper, handed them to the chief priestess (?) and threw the wrapper on the roadside. I remained watching, mainly to see whether these guys would clean up as they left. On hindsight, I think that was too much of an expectation.

Agarbattis were burnt. Camphor was lit. There was real devotion and seriousness on the faces of the people standing around the lorry. The drum-beating then reached a feverish tempo. Two sheep were dragged in front of the lorry. That was the limit for me. I could not stomach it anymore. I just walked back to my seat. A while later, the beating of the drums stopped.

I have spent quite some time in small and large towns of Karnataka. Every year, in B__, there used to be the annual festival of the Mother Goddess, and animal sacrifice used to be a regular part of the proceedings. I do not know if it continues, though. During my tenth standard I lived in H___, another town. And exactly before my exams, cholera broke out. The folks there thought that it was because the Mother Goddess was angry. Therefore, to propitiate her, a festival was organized. Some thirty buffaloes, a lot of sheep and innumerable chicken were sacrificed. The devotees were not at all worried about cholera spreading even more because of their unhygenic practices.

Is there a law that bans animal sacrifice? Yes!

Sacrifice vs. Righteousness

Concern for fellow-beings sets apart sajjanas from others. As a Sanskrit proverb goes,
मृदुलं नवनीतमीरितं नवनीतादपि सज्जनस्य हृत् ।
यदिदं द्रवते स्वतापनात् परतापात् सतां पुनः ॥
"Butter is said to be soft, but the sajjana's heart is softer. Butter melts only when it is heated, but the heart of the sajjana melts (even) when others are in
difficulty".

Years ago, there was a very short story in the Kannada magazine, Mayura (I think). The protagonist was a poet, very poor but large-hearted man, like the sajjana in the above shloka. His child was ill, and the whole family was clothed in rags. Our poet was at the end of his wits. At this juncture, he received an unexpected sum of money as a fee (as far as I remember). Then there was a knock on his door. A poor man had come to ask him for help; he wanted to get his daughter married and did not have the money. Our poet gave him all the money he had, and he walked away happily. The poet then told his wife, "What could I do? I have a poet's heart!" ("ನಾನೇನು ಮಾಡಲಿ? ನನ್ನದು ಕವಿಹೃದಯ"). The wife accepted his decision.

Even back then, I had a question. How could the heart that melted at the plight of the poor man, not melt at the sight of his own sick child?

A few days ago, December Stud said in a comment, that all of us are selfish, or should at least be selfish to a certain degree. That struck me as being true, and I got thinking about the various stories of self-sacrifice that appear so often in our mythology and literature. I then realized that I have never liked the extreme self-sacrifice that is, as a rule, praised to the Heavens.

What Jimutavaahana did, was against dharma, in my opinion. As the king, his duty was to protect all his subjects, but he chose to protect Shankhachuda alone, because he was there at the right time and place. His sacrifice had a good result, in that Garuda stopped harming naagas any further, but suppose it had gone unnoticed? True, Jimutavahana was a vidyaadhara and a bodhisattva. But I think I would have had far more respect for him if he had fought and subdued Garuda like a true Kshatriya. (I did not like naagaanandam, the play written by Harsha, either... Well, that's the topic for a separate post).

We have a more realistic view of sacrifice and kshatriyadharma in the Mahabharata. When Kunti offered to send Bhima with the food for Bakasura, even Yudhishthira, the epitome of righteousness, did not approve of the act (as far as I remember). However, this had a good result too; Bhima killed Baka. What appealed to me here was the "down-to-earth-ness" of Yudhishthira.

Sometimes, the idea that self-sacrifice always brings about good results, is comforting. At other times it is disturbing. Finally, it all comes down to doing the right thing, and not just sacrificing. But just how can we decide if what we are doing is right?

Corporate responsibility

I do not watch serials on TV, but recently I happened to watch a few minutes of the kannada serial 'Minchu', directed by T.N. Seetharam.

What was going on was this. X, the managing director of a company, has an assistant Y. Now, there is another person Z, who is in need of money for her daughter's wedding, and approaches the finance department of the company for assistance. Z has already taken a housing loan and is still repaying it. Because of that, the finance department agrees to loan only a small amount of money. Z approaches Y, who takes her case to the MD and convinces the MD to increase the loan amount.

Okay, this was just an instance in a TV serial. But it was directed by Seetharam, and we can be sure that he thought it out well, before bringing it on screen. No one can deny that a company is responsible for its employees. But there is only so much anybody can do for anybody else. Even when it is possible, it is not right to cross those limits. What if all the employees of the company (or even half of them, for that matter), ask for loans, for genuine reasons? What would X have done?

Being complacent that someone higher-up is going to bail one out of all difficulties is bad. Unfortunately, I guess that is how we humans are wired (I sometimes wonder if it is just an Indian trait!). Some people always expect that rich companies help mend the bad roads, help government-run schools, and generally donate money generously for all causes.

Recently, I read an article that I received by email, written by Ravi Belagere. It was an open letter to Sudha Murthy. I respect Ravi Belagere a lot for his views, but this article struck me as very odd. Apparently M.P. Prakash, our erstwhile Dy. Chief minister, told Ravi Belagere that he asked all the IT majors to donate money for the development of infrastructure and various other things, and apparently all of them replied that "they would get back on this issue", but have not gotten back since then.

That is not all. Belagere rants about how all flyovers are near the IT offices, how the rich IT companies do not care about the necessities of the farmer whose land was destroyed by floods and about poor children who do not have access to education, how Bangalore became so very costly because of the IT companies.

To an extent, what he says is true. There is too much immigration from other parts of India to Bangalore. Cost of living is escalating. Rents have touched an all-time high. The traffic-situation is abysmal. Rather than spend evenings quietly with books, the youth prefer to hang out at malls. Ask any highschool kid, he/she wants to be a software engineer and nothing else. It is like they do not have any rolemodel in any other field. Good teachers, scientists and the like are hardly to be found. These developments are not good.

But how wise is it to blame the IT industry for everything? Businesses are there because they are in demand. An IT company exists because there are sponsors and shareholders and customers. And people work for IT companies because they pay them enough money to give good education to their kids and build bigger houses. Even IT companies get tax subsidies from the government because they generate revenue and create more wealth. Engineering colleges hiked their fees because of the high salaries the students may get once they finish their education.

And it is not like the IT companies do not do anything for the society. At R's company, there was this quarterly event where each person of the team was paired with a kid from a nearby government school. At the end of the event, R gave him his phone number, and asked him to call if he needed any help. True, such events are few and far between, but that is a start, and a good one at that. RSS has a few orphanages and schools ('anaatha shishu nivaasa', 'aruna chetana', etc) that thrive on donations by 'Professionals in Seva'. The Infosys Foundation has also done a lot of social work.

As harsh as it may sound, companies are answerable to their shareholders, and that is how their policies are made. M.P Prakash cannot complain against global companies without plugging the corrupt holes in his own ministry.

'Complications' by Atul Gawande

Writing about books has two positive results and one negative. The positive results first. One -I never run out of subjects provided I keep on reading new books, and two - suppose I want to remind myself of this book, say a few years later, I can just read this review of mine. I have often felt the need for the latter. The negative result - I will be writing about things I have not experienced personally. Many of the ideas will not be my own. But I am willing to take that risk. Henceforth I plan to write about all the interesting books I read. I hope to intersperse the "book-review posts" with other subjects, but let that be for now.

The latest book I read, 'Complications' written by Atul Gawande, was very, very interesting, and it is an understatement. I have been interested in the medical field for as long as I remember. When I go to the doctor either as a patient or as the patient's relative, I am informed. I usually have a fair idea of the side effects of the medicines prescribed. However, after reading 'Complications', I realized how inadequate all that was. It was an epiphany. I trust a couple of doctors implicitly, and the fact that they too can be fallible, is scary, but true. The book talks about mistakes that even good doctors might make, and that wee bit of extra cautiousness that has often saved patients' lives.

Gawande writes with the clinical precision and detachment capable only of a surgeon. And yet there is humanity, there are the intense emotions that even doctors experience. There is not a dull chapter, or even a dull sentence in the book. It could be called delightful, if the subject were not so morbid and serious.

I remember freaking out when I went to the hospital at an unearthly hour and saw the young, inexperienced duty doctor instead of my usual gynecologist. One cannot deny that more experience makes better doctors. And age does matter. Most people I have met are more comfortable with old, experienced doctors than younger doctors with sophisticated degrees. Gawande states an instance where experience came in real handy. A patient came in with a reddened and swollen leg. All the indications were pointing toward cellulitis, a common but treatable infection. But just weeks ago, Gawande had lost one of his patients to necrotizing fasciitis, a rare and fatal bacterial infection that can be treated surgically, only in the very initial stage. (These bacteria, usually strains of streptococcus A, can enter the body through a "wound" as small as a pinprick.) His experience made him order a biopsy and his fears were indeed true. The patient had most of the tissue removed from her leg, but she survived. What would have happened to her if the doctor did not have this kind of an experience earlier? Would the warning bells have sounded even then? It is really hard to say!

There is also this matter of statistics. Cellulitis is a common infection. And about 5% of the cases, thought to be cellulitis at first, turn out to be necrotizing faciitis. Does this help the doctor make a decision on whether the patient in front of him right then has one or the other? Can a good doctor assume that exactly 5 out of a hundred cellulitis-patients that see him have the flesh-eating bacteria? No! Statistics are there to just comfort and/or caution, but they can never be used as a guideline.

From the days of Hippocrates and our own Sushruta, Medical Science has been improving. But newer technology has its own costs. I remember feeling elated when I read about "laparoscopic cholesystectomy" in my high school days. I thought of all the lives that would be saved because of the new technology. The thought that never came to me till I read "Complications" was the learning curve of the doctors. Gawande describes a laparoscopic cholesystectomy (the removal of the gall bladder) that he performed. Only after reading that did I realize how complicated it was, how difficult it was to learn new techniques. Doctors, like all others, take time to learn. But unlike us engineers, their experiments are with life; the stakes are high. One mistake, just half a second of haziness while wielding the scalpel can kill. Okay, I may be exaggerating, but the point is that doctors are responsible for the most precious things in this world.

And they deserve that responsibility. Risks have to be taken if lives are to be saved. Gawande talks about an unusual surgery, the gastric bypass surgery. (There was a report about this surgery in this week's 'Health' supplement of the Indian Express). In this surgery, the stomach is stapled, thereby reducing its size, and about a metre of the small intestine is bypassed, so that less food is absorbed. This is the best cure now available for morbid obesity. I mean, just think of the capability of one four-hour surgery! Many people are leading healthy and happy lives because of the surgery. So, at some point, a decision has to be made. For doctors, however, difficult decisions have to be made all the time.

In the Indian tradition, we say that one should trust the doctor completely. Indeed, it is said that the result is proportional to our trust. From a psychological perspective, this makes complete sense. Though *all* our illnesses are not rooted in the mind, many of them are. Therefore, trusting the doctor is important. But how far do we go? Ultimately it is our own body we are talking about. In Kannada they say 'ಹೊಸ ವೈದ್ಯರಿಗಿಂತ ಹಳೆ ರೋಗಿಯೇ ಮೇಲು', which is true to some extent (My grandma used to do this. She had diabetes, and whenever she ate an extra sweet, she would take a little more of her diabetes medication, without consulting the doctor!). There should be a sort of a compromise between the doctor and the patient as to who listens to whom, to what extent.

'Complications' got me started on thinking about a related thing. There are happy endings and sad endings. But, isn't 'Life' mysterious? A person who has four heart attacks may survive and thrive, whereas another may die of a pinprick. A pacemaker can help an ailing heart, a ventilator can substitute the lungs and a dialysis machine, the kidneys. What is the nature of that "one thing" that keeps all these and more working together in so much harmony that if one organ fails, all the others gradually fail, too. I am delving into Philosophy here, but isn't that a question worth considering?

The story of King Kusha

Love is wonderful. No, I am not moonstruck, but pondering as usual. The thing is, I was cleaning up some stuff, and happened to see the Amar Chitra Katha comic version of the story of King Kusha. The story triggered some thoughts, and here I am.

For people not in the know, here is the story. It is taken from the Jataka tales. King Okkaka was heirless. Indra granted him two sons as a boon, one wise but ugly and the other handsome but foolish. Sheelavati, the queen asked for the wise one to be born first, and so King Kusha was born. Later, Jayampati, the beautiful child, was born.

Kusha finished his learning quite soon. When his parents asked him to get married, he thought that no princess would agree to get married to a ugly youth like him, and hit upon a ruse to ward off the impending proposals and refusals. He carved a beautiful image of a woman, and asked his parents to find somebody who looked exactly like her. He was confident that they would not be able to find a woman as beautiful as his carving. But he was mistaken. Padmavati, the daughter of Sagala was found and married to Kusha on one condition - the new couple were not to see each other for some time. Padmavati loved to hear him play the veena, and imagined that he had an artist's handsome face.

Kusha could not hide his face long from Padmavati. As soon as she found out that her husband was not the handsome prince she had hoped for, she left for her parents' house. Thither followed Kusha. He became a potter's apprentice, made a beautiful pot with Padmavati's picture on it, and sent it to her. She recognized his work and threw the pot away. He then became the royal wicker-worker's apprentice and sent his work to her, but she rejected that too. He then became a cook at the palace, with the hope that he could at least see her often. She was unrelenting, but Kusha toiled in the royal kitchen, waiting for her to accept him.

Finally, Indra decided to help him. He sent a message to seven different kings in Sagala's name, saying that since his daughter (hey, Indra was a great forger!) had left Kusha, he would marry her off to them. Seven kings with seven armies came to Madda (that was the kingdom of Padmavati). Padmavati's father was now alarmed. Giving Padmavati to any one king would mean war with the other six, and he was just not prepared for it. Padmavati now saw the situation she was in, and appealed to Kusha to help her. Kusha settled matters by offering his seven sisters-in-law to the seven kings. Kusha and Padmavati lived happily ever after.

Now, that was the story. I have a question. I am sure some women, in their vanity, do not consider not-so-good-looking men as worthy of companionship, in spite of their other virtues. But would any man do so much for a woman who has scorned him repeatedly? I have read of men and women who do anything and everything to get to their loved ones back. Rama fought the entire army of Ravana to win Seeta back. In Kalidasa's drama, vikramorvasheeyam, Pururava performed penance for winning Urvashi. One can find umpteen instances like that in other cultures also. In Greek mythology, we have the search for Cupid by Psyche and the pining of Penelope for Ulysses. But in all such stories there is this one common thing - of mutual love that is nourished by longing and even by separation.

Well, I do not want to dissect the story any further and play spoilsport. Do let me know if you liked it :)

Of Poverty, Perseverance and Dharavi

It is not uncommon to see people seeking alms in Bangalore. Today, while coming to work, I saw a woman with a child in her arms, begging at a traffic signal. It was not a pretty sight. The baby, probably about six months old, was blissfully asleep in its mother's arms. I usually do not give money as alms, but this time I gave what small change I had, knowing well that what I gave was not sufficient even for one meal of the baby.

Did the Mother have a choice? I tried to give her the benefit of doubt. Hers was probably a genuine case. She was probably not skilled in anything, and had the burden of the child to bear. But I have this feeling that there are always jobs available for the industrious and those who really want to work to make ends meet. Why, then, do people resort to begging? I am inclined to think that it is the "man-with-the-twisted-lip -syndrome", as harsh and insensitive as it may sound.

There was a time when 'ಕರತಲಭಿಕ್ಷಾ ತರುತಲವಾಸ:' was regarded highly, when poverty in terms of food, clothes and money was almost synonymous with the richness of the mind and intellect. But this is not that kind of a time. If one is reasonably intelligent and industrious, he/she can find a job (much better than begging), that might fetch enough to ward away hunger. In the olden days, one-sixth of honestly-earned money was supposed to be given off as charity. True, giving money away as charity is good for the giver, but does it not make one section of the society totally dependent on the favors of another? Won't that breed class distinction and class-wars?

I contrasted my experience with this article on Sepia Mutiny, about the Dharavi slum. I had read about the Dharavi slum a couple of years ago in the Kannada magazine, Taranga. And the picture I got from that was that of a dirty slum filled with frustrated people, as one sees in some movies. But this article was a real eye-opener for me. The slum is dirty alright, but the people are industrious, and becoming prosperous. The reason for this is their enthusiasm and spirit, that enable them to fight against all odds.

Apparently there are more than five-thousand one-room factories and many cottage industries in the two sq. km. area of Dharavi, whose collective annual turnover is a whopping 1 billion dollars! If that is not amazing, I don't know what is! Apparently they still do not pay taxes properly, but let us not think about it for now. 85% of the households have a television and 56% have a gas stove... A funny thing, as an aside - do 29% of the slum-dwellers think that the TV is more necessary than a gas stove? Oh, and 21% of the people own telephones. A really good number for a shantytown!

I can give other examples too. A lady used to work as a domestic help in my Grandmother's house. She worked in a few houses everyday for a few years and got her children (two boys), educated. Both of them did their B.E. The younger one lived in Canada for some time and made a lot of money. Now they all live in their own, big house with cars and other luxuries. One can say that Lady Luck was on their side, that the sons were intelligent and all that, but would they have become so successful if they did not have that strong desire to succeed, and if they had not worked so hard? To reiterate a point I feel very strongly about - if one really wants something (and perseveres), the whole universe will conspire in helping him achieve it.

The work-hard-and-sell-hard concept worked for the residents of Dharavi. Will it work for this woman and her child I met? And so many other men, women and children who have to beg for their living? Or rather, will they let it work for them? I fervently hope so, in spite of having a man like this at the helm.

'The Alchemist' By Paulo Coelho

Just today, I finished reading 'The Alchemist' by Paulo Coelho. The book has garnered a lot of praise from all over the world as life-changing and illuminating. I partly bought the book because I wanted some illumination, and partly to see if it really deserved so much praise. After reading it, I must say that I did find that the praise was well-deserved, and that it was really a book that I could learn from.

'The Alchemist' is the story of Santiago, a shepherd and his quest for a treasure he dreamt about. The book is about following one's dreams, both literally and figuratively. The alchemist guides the boy towards the realization of his dream, and teaches him quite a few things on the way, the most important lessons being perseverance and faith (reminds me of shraddha and saburi).

When I started reading through the book, I was unimpressed. There were, of course, precious nuggets thrown about liberally even from the beginning, the most memorable one for me being "When you really want something, the whole universe conspires in helping you achieve it". But the story itself seemed a bit weird. It felt like of those stories which seem to happen in another dimension altogether, much like Voltaire's "Princess of Babylon". And at times, I felt that I was reading a cross of Stephen Covey and Kahlil Gibran. But gradually, as I read on, I was appreciating the book more and more. I could see myself looking at the sand in the vast expanse of the desert, feeling the wind whisper to me about my dreams.

The boy's name is mentioned only once in the entire novel. Except for that one time, he is always referred to as "the boy". I think that that was because Coelho wanted to make it everybody's book. We are all like the boy; we dream of treasures. But we are not as daring, in that we are content with just dreaming and doing nothing about it. And though Santiago was more a youth than a boy, he is referred to as the boy because he was willing to be guided, without any hesitation. Though he had the help of the decision-making stones, he made his own decisions. This combination of two qualities - the eagerness to be taught and the ability to make decisions, was the reason for the boy's success.

As I do often, I could not help comparing the world-view of Coelho with that of Vedanta. More than once, it struck me that the "Soul of the World" was parabrahma, from where everything originates and to which everything goes in the end. Though Coelho is a practising Catholic, his thoughts about the "Soul of the World" appear distinctly advaitic in nature, when he says "he realized that his Soul was the Soul of the world". Most of his insights seem to stem from his own experiences. In his twenties, Coelho encountered a stranger who first appeared to him in a vision, and then in real life. This had a powerful effect on him, and he then wrote 'The Alchemist', which has a profound effect on us.

There is one very insightful story in the book that I really liked. A boy once went to a wise man to learn the secret of happiness. The wise man gave him a spoon with two drops of oil, and asked him to look around his beautiful castle. When the boy returned, he asked him whether he saw how beautiful his castle was. The boy replied that he could not, because he did not want to spill the oil in the spoon. The wise man asked him to go again and admire the castle and its grounds. The boy did what he was told, and came back, full of admiration for the beauty of the castle. But now, he was so engrossed in looking outside, that the oil was gone! The wise man then told him "The secret of happiness is to see all the marvels of the world, and never to forget the drops of oil on the spoon". I liked this concept very much. It is the middle-path that is always the best. I am reminded of DVG's poem, one of my favorites.

ಎದೆ ಮಾರುವೋಗದೊಡೆ ಕಣ್ ಸೊಬಗನುಂಡರೇಂ
ಹೃದಯ ಮುಯ್ ಕೇಳದೊಡೆ ನಲಿವ ಸೂಸಿದರೇಂ |
ಕದಡದಿರ್ದೊಡೆ ಮನವ, ತನು ಸೊಗವ ಸವಿದರೇಂ
ಮುದ ತಾನೆ ತಪ್ಪಲ್ಲ ಮಂಕುತಿಮ್ಮ ||

For people who care to learn something from the book, it gives one that much-needed gentle nudge towards one's goals. And the hope that even if we make mistakes searching for our guide like the boy did initially, we will find our alchemist waiting for us somewhere...

Public Transport

I love taking public transport. Even in the US, though it was extremely time-consuming, I used to love taking the local bus to school. To get to know a place, one has to take the public transport and walk in busy roads. One gets to see a lot of different kinds of people, and the experience is just great (of course, when you have the time).

I had made friends with a jazz musician and a bus driver, of name Ron ___. He was a Christian American, but of middle-eastern descent. And the point was that he had visited India and Bangalore. I still cherish my long talks with him. We used to discuss Politics, Religion, culture and what not. The local transit in the Bay Area has a service for senior citizens, called VTA Paratransit or something. One day, I asked Ron what that was. He could not hear me properly in the din, and asked me excitedly - "Are you asking me about Paramahamsa Yogananda?". He had actually read 'Autobiography of a Yogi' and said he would lend it to me. Now I was flat. It was really amazing. When we left the US for good, he gave me a CD of 'Yonder Tree' by Gino Vanelli.

I remember the time when I explained the meaning of the red dot on my forehead to an American. Another time, early in the morning, a drunk lady took my book (Oppenheim and Schafer) from me, turned the pages, and remarked - "Do you really understand all this? You must be very smart", and then pointing to her husband/boyfriend, also drunk, said "He has been to college... he might understand this", and then turning to him, said "Don't you, ____?". I was scared! I have not seen many drunk people, and this was like, totally unexpected! I mean, it was early in the morning, and these people were fully drunk! It was nice when they returned my book and said "Good luck", though.

Public transport is not always pleasurable. I have had my share of bad experiences. But sometimes, one can think about the bad experiences later and laugh at them.

One day I was taking 32 to school. Most of us in the bus were foreigners - South Asians and Chinese and Vietnamese. The driver was black. Now a blonde lady got in. Once she settled in her seat, she started mouthing expletives towards people of other races. It was *bad*. The driver got very irritated and told her that if she did not stop, she'd have to get off the bus. Well, she did not, and was made to get off the bus.

Public transport in Bangalore is a wholly different sort of experience. A few days ago I took a BMTC bus to my place of work. A couple of women with a framed photograph of the Mother Goddess, were in the bus. These women are, for all practical purposes, beggars. They show the Goddess's photograph to people and say "give something to please Her". The women did not have money to buy the tickets. The poor conductor was demanding ticket-money from them, and a young girl shouted at him "ರೊಕ್ಕ ಇಲ್ಲ ಅಂದರೆ ಏನ್ ಮಾಡಕ್ಕಾಗತ್ತೆ? ಗೊತ್ತಾಗಾಕಿಲ್ವ ನಿಂಗೆ?"I had half a mind to pay for their ticket, but the other half prevented me from doing so. Finally the conductor exempted them from buying tickets. Or, rather, he was forced to.

It takes all sorts to make a world!

Thoughts on Valentine's day

It is Valentine's day today and many millions of couples and wannabe couples are expressing their love for each other in many millions of creative ways. I, for one, do not believe in "celebrating" Valentine's day... I see its promotion by card-companies as a well-planned marketing strategy. I am not against it, either. If people want to express their love on a specific day, then so be it! If they want to celebrate their love all year-round, then let them!

Sepia Mutiny gives an interesting information. Apparently the perennial trouble-mongers, the Shiv Sainiks, want to marry off the couples that are seen together on V. day, if they are Hindu!. I could not contain my laughter for some time! When will they understand that Afghanistan should not be the model for our country? I am all for social health, but to have a healthy society, I think that it is necessary to have some minimum level of open-ness and personal freedom. (In the same article on Sepia Mutiny, there was another, more hilarious bit about some women's organizations working to thwart the sainiks in their attempts to disturb lovers, but let's not go there.)

Near my house, almost daily I see couples (I am sure they are not "just friends") standing and talking for hours together.. Once a policeman shooed a couple away, saying "ಏನು ನಿಮ್ಮ ಮನೆಯಲ್ಲಿ ಕಾಸು ಕೊಟ್ಟು ಕಾಲೇಜಿಗೆ ಕಳಿಸೋದು ಇದಕ್ಕೇನಾ?".. I had mixed feelings about this incident. On one hand, I felt that the kids did not need to be shooed away so rudely.. As long as they are not in the way of law and order, it is fine.. But, on the other hand, at 15-16 years of age, one usually does not find lasting loves. Gullible and insecure girls may become victims of malicious people, even if only emotionally. In that sense, it is good to have a sort of moral policing (how I hate the term!). At any rate, I am sure that the parents of the two kids would be grateful for the policeman, for giving them a good talking-to.

I think that a good way to solve this problem would be to accept dating as a fact of a teen's life (grrrr! To think that we returned from the US because we thought it was easier to bring up kids here!). Parents should keep track of who their children are talking to, and should set the limits for their kids, and most of all, believe in them. Yeah, yeah, I know this sounds too simple to be of any practical use, but we have to do something like this to keep our kids safe and our society healthy. Clandestine affairs have not done a lot of good to anyone.

I am worried about little biyadiya...

Joonu and civic sense

Indians do not have civic sense! Sorry, I have to correct that. Indians do not have civic sense when they (I mean we) are in India. That is just a plain and simple fact. Outside our country, we are the best-behaved people.

I want to relate an experience I had a few years ago. I was travelling with a marriage party from Bangalore to Mysore. My aunt had prepared snacks and put them in small plastic covers for all of us to eat on the way. All of us ate them, and I saw that everybody was throwing the plastic covers out of the window of the moving bus. Now, I was and still am, conscious about such things. One reason is that it is dirty, and I will presently relate the second reason.

We were two neighbours in a not-so-populated place in Bangalore. There were two puppies of a dog, and both of us adopted each. After a while, our neighbour stopped keeping the dog in their house because they thought that it was somewhat dirty. Now, I am fond of all kinds of animals (a bit scared of them initially, though). I used to visit my place in Bangalore every few days, from Madras. Our dog and this dog (Joonu was his name) used to rush to welcome me when they saw me at the corner of the street. Once, when I came home, I realized that nobody was home and that everybody had gone to a relatives house. All this time, Joonu was with me. He was already kicked out of his owners' house and had nowhere to go. He walked with me while I was looking for an auto. All stray dogs were picking fights with him and he would respond to them. He desisted only when I called him off. I was feeling very sorry at his state. The breaking point was when I got the auto. He tried to get in. I told him to go away, and gave him some bread. Nevertheless, he still wanted to come with me. All he wanted was some company! Unfortunately, I could not, or thought I could not take him in an auto to my relatives' house! It is one instance when I have felt very emotional. Anyways, sometime after this, Joonu died because he ate a plastic cover thrown by somebody.

I was planning to make this a blog about civic sense, but look what I did! Anyway, getting back to where I deviated. I saw people throwing plastic covers, and collected them. Then I had an argument with this person, an educated and well-to-do man. He asked me why I was doing what I was doing. I told him that it was not right to throw plastic everywhere and that I would collect them all and dump them in a dustbin when we stopped. Then, my shortsightedness made me tell him that a dear dog of mine died because he ate plastic, and that many cows die every year because of the same reason. Then he said, "Look, it was the dog's karma that made him eat the plastic. Why should you worry about it?"...!! I did not know what to say. Now I can think of at least ten retorts, but I was just tongue-tied then!

We stopped at a place some two hours from Bangalore. I, with all the collected plastic covers and with a great sense of achievement, went to dispose of them in the way they were intended to. But I could not find a dustbin! There just was no dustbin! I just had to dump them on a garbage pile next to the road.

The question is whether we start collecting plastic, or arrange for dustbins first. If there are dustbins, people will dump garbage in the bins. But on the other hand, unless people start collecting plastic, there is no reason to have a dustbin! It is the chicken-and-egg problem.

Means and Ends

I am a big fan of the comedy show 'The Simpsons'. Though it is a comedy show intended to make you laugh, sometimes the antics of Bart and the stupidity of Homer evoke some pretty serious thoughts in me. This is one such instance.

When Moe persuades an inexperienced H. to fight the heavyweight champion Dederick Tatum in a boxing match, he (Moe) says to H. "Look, Homer, you can win, all you have gotta do is visualise". Homer visualizes alright, not the fighting techniques, but the picture where he has defeated Tatum and is receiving the prize! Of course, that is the typical Homer Simpson. What scared me, was that I could see that I was also like him ! I am working on my Master's thesis right now. I am at the fag-end of the work. When I say to myself that I have to visualize and plan, the picture that comes to my mind is that of me submitting my completed thesis, getting a "Good work" certificate from my professor, telling all my relatives and friends about my work, etc. Rarely have I visualized working my butt off, though I think I do that!