Cross you heart and say it.

I vividly remember my first day as an on-call resident in the department of Psychiatry. As on-call doctors, we were in- charge of the psychiatry emergency services which usually saw patients at risk of harm to self (suicide, neglect of self), harm to others (extremely violent and agitated) and we usually were given less than a few minutes to decide their capacity to consent, restrain them physically or chemically (using injections)!

 

I often thought we were given a responsibility that was far from what we asked for or deserved. Who I am to take away an individual’s personal freedom? Even God doesn’t intrude on free will, does He?

 

I remember my days in school about a subject called Moral Science being taught to us young kids about what is right and wrong. By adolescence, I came to terms that right and wrong can be easily known by just placing my hand on my heart and asking my inner voice for an answer. The answer usually is something on the lines of anything that doesn’t harm someone or does well to you in the long-term. For some reason, lives got busier, the inner voice slowly faded away and the questions got tougher.

 

These questions now range from informed consent, surrogate mothering, genetic manipulation of fetuses, status of unused frozen embryos, abortion, homosexuality, euthanasia, experimentation on animals, pre- marital sex, suicide, disclosure about STD to partners, doctor- patient confidentiality etcetera. To make things worse, neither law nor or the Holy religious texts have been sufficiency been updated to help us out. Also, answers on moral, ethical and professional grounds are often not the same lines and even changing with time. For example, say suicide. Indian penal code until the recent Mental Healthcare act 2017 considered suicide as a punishable offense. Indian law now treats the same act as requiring medical attention. Religions including Islam, Judaism, Christianity, and Hinduism condemn suicide while several epics and folklore glorified suicides as well. Hippocratic Oath condemns administering poison to a person but now situations often demand doctors to carry out executions or even talk about euthanasia.

 

So at the end of each of the above questions, there are more questions left to answer. What is right or wrong? Good or bad? What is the best or advantageous? Is the decision close to the truth? To whom will it benefit? To whom will it harm? How much harm is reasonable or acceptable?

 

To help us answer such questions is the subject Bioethics established for humanity, by humanity in order to provide an ethical framework for the resolution of physician- patient conflicts. It lays down the basic pillars/ ethical principles that have to be weighed- respect for autonomy (informed consent, privacy and confidentiality), justice (fairness and equity) and beneficence, non- maleficence (appropriate risk- benefit ratio).

 

Bioethics is very interesting than thought otherwise. In an era where scientific advances are constantly on the focus, it’s even more important to think of the fundamentals of Medicine- when NOT to intervene, ‘do no harm’ and where do we draw the lines while we continue to chase the diagnosis! Perhaps, it does a little good to stop looking at those laboratory values on the computer screen, ponder about ethics and and try listening to the inner voice once in a while.

 

This has been published as part of Lexicon’s 20th edition dedicated to ETHICONdecoding medical ethics.

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Lexicon’s guide to SEX

I comfortably sat in the referral OPD where we screen patients referred to Psychiatry from other departments of ‘real‘ Medicine and refer them to our Mental (read Mind) Health Center where we perform our Soul surgeries (not lobotomies) in secret.

My first referral came from Hepatology. A middle aged icteric man walked in trembling with his swollen parotids. An Alcoholic, of course! Though stable for now, the challenge would be finding out the reason why he chose alcohol (a depressant) to keep him happy. Referred.

The second referral came from Neurology. It was a young female having fainting spells whenever she faces ‘stress’. Looks like a seizure but not a seizure! Multiple ElectroEncephaloGrams were also normal. Hmm, Conversion Disorder. Needs time to delve into the subconscious. Referred to the mental health center, again.

The third referral came from Medicine. A young couple that recently got married walked in anxiously but seemed hesitant to talk about their problems. And just before we judged that they need help to save their marriage going, she nudged him, making him to whisper, “Doctor Saab, there is a small problem. We recently got married and when we’re trying, you know, it just happens too quickly. She is very upset with me doctor and her family wants her to divorce me. I came here on my wife’s insistence. I do love her, please help me doctor! Please.”

When I signed up for Psychiatry to study the mysteries of the mind, little did I realize that Sex would take such a huge place in it’s understanding. Well, we all know that Freud was a bit too obsessed about Sex but seriously, I did not expect to have encounters with successful otherwise healthy young men and women, shattered and broken asking me to fix their sex lives.

Marriages in conservative societies like India take a strange place. Marriage is well understood as a physical, emotional and sexual contract between two individuals but the challenges to ensure this comes in several forms.

First of all, since most marriages are arranged, the families involved at best can only make superficial guesses at how much the contract will be satisfied. Asking about a groom’s sexual health is a sure way to end the relationship even before it begins! Since most brides and grooms are virgins at the time of marriage, they themselves wouldn’t be aware of their sexual problems. Even after engagement, premarital sex isn’t remotely acceptable. So, please stop reflecting to your friends about the wisdom of ‘would you buy a car without test driving it?’

With this ignorance and building up anxiety, the young couple is expected to perform their best on their celebrated first night itself often on a white bed sheet as a proof of consummation. And if things don’t turn out well, sometimes, hell breaks loose with families’ involvement adding to the pressure and hot divorce notices being served the next day.

 

Therefore, lovely readers of Lexicon!

I present to you- Sexual dysfunction for dummies

 

Sex is one of the most intense physical and emotional reactions experienced by all living organisms. It is natural and need not really be taught.

It is okay to talk to your married friends, friends of opposite gender, friends in relationship and your partner regarding your anxieties as they too might be experiencing the same. Please confirm if you haven’t understood something well. It isn’t healthy to develop sexual myths/ misconceptions. We, Psychiatrists even diagnosis them and treat them!

Real sex isn’t remotely close to what you watch on TV or the other so-called sex educational films. Most pornographic videos are unreal, taken after a lot of preparation, makeup, medications involving a wide variety and often violate individual rights. Also, Asian men ejaculate faster than Caucasian and African men who mostly make the porn industry making us feel inferior.

It helps a little to get you a bit oriented about the basic sexual anatomy and physiology though theory alone is often insufficient. Even doctors who regular perform genital examinations report difficulty the first time they did it. There are several online resources that might be useful.

Not just books alone, it helps if you eat healthy, exercise regularly (especially Kegel’s pelvic floor exercises) , cut down on alcohol and have your Diabetes etc. under control. Even masturbation (especially an hour before sex) also helps.

All right now, before we get to work, make sure you and your partner are comfortable, have your private space and know about each other’s preferences. Performance anxiety and embarrassment of being found during the act also result in premature ejaculation and behavioral conditioning.

Foreplay cannot be emphasized enough. It is very important for adequate excitement and a great orgasm especially for the ladies. Take your sweet time to find the sensitive areas= erotic zones.

It is also common that for the first few times, things don’t happen the best way, (happened too early, parter isn’t satisfied or didn’t happen at all). Getting anxious about it only worsens it the next time. So, stay cool. Don’t make a fuss about it. It’s not that uncommon after all.

If things aren’t still working out even the next few times, don’t lash out. Ask your partner how you can help. Use a topical anesthetic cream or a double condom (avoid worry about unwanted pregnancy) to decrease the sensitivity. Change positions often and avoid positions that excessively stimulate the glans penis (Missionary puts more pressure than Woman on top). Taking a deep breath, pulling testes down before the ejaculatory reflex, distracting with lesser stimulating thoughts or mindfulness are other techniques!

Spontaneous erections not in intercourse settings, morning erections, good erections with masturbation or with other partners generally imply that his sex machinery is intact but may be because of psychological issues that need to be addressed.

It is informative to know that it is not just men alone but women too can suffer from sexual dysfunction such as not able to achieve orgasms or severe pain during sex.

If you have done everything for your end, don’t lose hope and find professional help (Andrologist/ Gynaecologist/ Psychiatrist). The doctor usually will maintain confidence, express empathy and will take a non- judgmental stance. He/ she will often be able to identify the problem that missed your eye and will help you address it without medicines initially usually though a PLISSIT model. Some couples find help with marriage counselors especially when the sexual problems are due to their troubled marriage.

Even if all of this fails, science has run far too ahead and has come up with pills such as to increase blood flow to the penis (Sildenafil, Tadalafil), increase the happy hormone Seratonin (antidepressants such as Dapoxetine, Sertraline), vacuum pumps, prostaglandin injections, testosterone boosters, surgical penile implants and African surgeons who have started penile transplants!

After all, with a greater percentages of sexual problems reported by magazines like India Today each year (More than 1 in every 10 Indian males is impotent), Infertility centers sprouting every nook and corner, it is important for us all to know to find simple solutions and try not run behind unrealistic sexual expectations.

 

Yours friendly spiritual- sexologist,

Raviteja.

p.s. Do check out pornastherapy and Pea web app.

 

This article has been published in Lexicon’s 19th edition- SEXicon

LexiStory- A Sequel to ‘The Origins’

 

Dedicated to its founders- Drs. Suranjana, Abhijeeth Sharma and Sakhi Shah

 

“It’s our baby. How can we abandon it?!,” said Sakshi trembling on the phone. I could feel the goosebumps on her skin as they fought the chilly winds of Mumbai. It was December 2013, almost 1 year since we delivered Lexicon and exactly that time of every year where we have exhausted our funds, and with exams steaming at us are thrown into this eternal dilemma of shutting down our exiting little venture- Lexicon or just holding a little longer. After that conversation, we continued on this journey and produced HUMANAE VITAE- a fine anniversary edition.

 

It is really hard to believe that it’s been 3 years since that day and we Lexiconians continue to hold our reigns tight. What is the right word to describe Lexicon, I wonder. Passion? Intellect? Medical literature? Or just a getaway? Lexicon, I realize as I write this, isn’t just about a magazine but that fire in that belly. Lexicon is a way of life. Lexicon continues to find it’s time between our busy night shifts, steals a thought or two while we wipe the tears of our patients, makes our hearts skip a beat as we create a piece of literary art and read it each time in the magazine.

 

Our biggest achievement, which I’m sure our founding fathers and mothers would agree, was when we found a few grey hair on Abhijeeth’s head an year ago. This followed a rigorous pan-India talent search that brought us Saniya and her magnificent team. We found the same fire in this younger, innovative and enthusiastic bunch. What followed was a series of interviews, script scrutiny, elections, workshop and handing over of Lexicon.

 

Under this dynamic leadership, Lexicon continued to produce some of it’s finest editions in the last year- The Code War, Love Sex And Adolscence, A Game Of Hormones, Madness, Emergency!, Parallax and Just Kidding (from birth to reality) and had covered its fair share of events with growing numbers reading Lexicon.

 

To the young Lexiconians- Let Lexicon remain another thing that wakes you up everyday, something interesting that you can brag to your friends about, that magazine gig that you can use as a conversation breaker as you proudly announce that you work for Lexicon and can broadcast medical literature and art to the rest of the world!

Hail Lexicon.

As always,

Raviteja.

 

This has been published as part of Lexicon’s 4th anniversary edition.

 

 

 

 

 

 

 

 

Lexicon anchored at the banks of river Mandovi in Goa.

 

 

Which doctor? Witch doctor?

“The world looks yellow to a jaundiced eye.”

 

Privatization of health care in India has grown by leaps and bounds far exceeding the expectations of the then Republic India. This privatization, essentially focused around urban areas have put tremendous pressure for generation of Specialists and super- specialists who are now expected to clear their final exam answering to a single question that carries a hundred marks, meaning to declare that they know everything that can be known in that specialty. However, unlike the UK’s NHS where a general physician has to be consulted, who alone can refer to a specialist; in India, owing to the out-of-the pocket health care system, most of the now educated India access Google first and decide their specialist doctor next!

 

Let’s have a look at the already complicated scenario filled with pre- mature diagnosis and treatment demands made by the patients even prior to their consult. Let’s take a look at the myriad of most commonly presented symptoms to the clinics such as headache, abdominal pain, chest pain, fever, loose stools, vomiting etcetera etcetera and pull out one amongst them. Say, chest pain, shall we?

 

Chest and pain are known entities to all. Chest for a medical doctor will include all the anatomical structures it carries. Pain again categorized according to different criteria, say quality- dull, sharp, tearing, twisting, burning, pleuritic, twisting ectcetera. Based on these and other characteristics such as mode of onset (acute, chronic), duration, location and associated predisposing, precipitating and perpetuating factors, the doctor can then be expected to act on an emergency or refer to a specialist for further management, if required.

 

However, if the same chest pain were directly presented to a Cardiologist, inevitably owing to the several cases that he sees, Angina pectoris would be the first on his mind. Heart burn would be the first on a Gastroenterologist’s. Cervical disc disease on an Orthopedician’s and Neurologist. Panic attacks or other supratentorial lesions on a Psychiatrist’s mind. Owing to this confusion, a lot of unnecessary investigations follow that further add to the burden of the already tedious health care system.

 

Therefore, a much needed holistic is possible only with the mutual cooperation of both the patient and the doctor. Otherwise, each of us contributes to the so-called deteriorating health care losing human touch with each day. Let which doctor not turn into witch doctor, please.

 

This article has been published in Lexicon’s 14th edition- PARALLAX

 

 

 

Dear Woman,

 

You are beautiful. You are intense. You are life. You are Yin. You are absolute.

History perhaps would call this a love letter, like every other letter written by a man to a woman but I wouldn’t call it so.

 

I wonder why Adam came first before Eve. Shouldn’t it be the other way round? Or why God is a loving father than a mother? Oh boy! Aren’t we a paternalistic society? Biology tells us that every infant in the mother’s womb is a female first before the Testosterone kicks in for the outcome to be a male. When I shout, they may call me anti- social? When you do, you are labeled histrionic and borderline! When you check someone out, you are a slut and when I do, I am a macho. When I fart, its physiology but if you do, it’s disgraceful?!

 

Yours is the labor and the fruit gets my name. You are the inspiration but you leave the credit to me. You take the pain away and spare the sweetness for me. You star the movie but my name appears first. You wed me but I get the gifts and the bride. You have always outlived me- both physically and metaphorically.

 

This Woman’s day, as I celebrate you and your achievements, I promise to lend my hand to you. I promise to speak for you. I promise to appreciate you. I promise to #pledge for parity!

 

I do not know why they call you a WOman. You know, my dear, you don’t have to woo me for I have already fallen for you.

For ever and ever,

 

Man.

 

This article has been published as part of Lexicon’s edition on women health- Edition 14- DOUBLE X

LOVE

 

“Love is such a tissue of paradoxes, and exists in such an endless variety of forms and shades, that you may say almost anything about it that you please, and it is likely to be correct.”

-H. T. Finck (1902)

 

 

 

Dear Kamadeva, Venus and Cupid,

 

 

What is left to write of Love? Isn’t its tale, too long, too stale, fantastic and a fantasy? But what is that I know of love? Did I ever feel love? If love is that intense surge of hormones, pumping my heart, swelling my mind and cracking my voice, so be it, but is that so?

 

Was it the time when I was pushed into the world and my mother pulled me into her warm bosom that I first felt love? Was it the time when my friend in school took the cane for me that I thought of love? Was it the time when I narrowly missed the accident and the doctor spoke of God’s love? Will it be when she would call me three times a day and run her hand through my hair every night that I shall feel love? Or will it be when I will have to let her go?

 

As we grow older, we develop a sense of who we are. We develop our likes, dislikes and our personality traits, and as social creatures, we find the need for affiliation with other Carbon based life forms! Which of these close relations and liking finally evolve to love? Psychology explains to us that love is a qualitatively different psychological state than mere liking. If I may, broadly there are two types of it- passionate or romantic love and compassionate love.

 

Passionate love is the Romeo and Juliet kind of love. This is what makes ordinary men, poets and poets, insane. This is the kind of love that makes colors look brighter, hearts beat faster and gives intense desire for each other. It happens when an intense physiological arousal occurs together with situational cues that label this feeling as LOVE! This intense physiological arousal could even be anger or jealousy explaining the bad choice of our heroines who fall for eve teasing heroes who somehow manage to label these feelings as love!

 

Compassionate love is the more frequent and steadfast type. This is one that is less electrifying, relatively stable and binds best friends, siblings, parents and children. There is deep caring, happiness for the partner, reliability and emotional trust. Sometimes, best friends can become lovers and vice versa. It’s easy for ex- lovers to remain friends if they had compassionate love before cooking it into passionate love!

 

Sternberg’s love triangle beautifully brings out the faces of love by arguing that Love is composed of three components: intimacy (liking), passion (infatuation or physical closeness or “love at first sight”) and empty love (decision/ commitment to maintain love). The types from these combinations being:

  1. Romantic love: Intimacy + Passion e.g. Layla and Majnun
  2. Compassionate love: Intimacy + Commitment e.g. Veeru and Jai of Sholay
  3. Fatuous love: Passion + Commitment e.g. Friends with benefits
  4. Consummate love: Intimacy + Passion + Commitment e.g. Happiness by Guy de Maupassant, marriages into old age till death parts them apart!

 

 

In 1958, Nobel laureate John Steinbeck in a letter to his eldest son Thom writes on the subject of Love-

“There are several kinds of love. One is a selfish, mean, grasping, egotistical thing, which uses love for self-importance. This is the ugly and crippling kind.

The other is an outpouring of everything good in you — of kindness and consideration and respect — not only the social respect of manners but the greater respect which is recognition of another person as unique and valuable. The first kind can make you sick and small and weak but the second can release in you strength, and courage and goodness and even wisdom you didn’t know you had.”

 

Surprisingly, in several cultures, love in not particularly an important concept or a necessity for lasting bonds. Not surprisingly, the concept of love is relatively a recent phenomenon. The ancient Greeks saw love as a ‘form of madness’ and until the middle ages the current concept of love didn’t even exist! Labeling feelings as love also depends upon whether the culture we live understands, appreciates and communicates these concepts explaining us the controversy of ‘Kiss Of Love’ campaign or extremists on Valentines Day across India.

 

Apparently, The NewYork Times article To Fall in Love With Anyone, Do This, helps you find love with the help of Dr. Aron’s 36 questions! Perhaps, it’s the license test for Cupid’s golden arrow.

 

In such endless forms it exists that I wonder if it exists at all. In so many signs and no form, I am lost with labels to tag. May be I will never know love or show me if you will?

 

So long,

 

Embodiment of Love,

 

Raviteja Innamuri.

 

This article has been published in LEXICON Edition 11

 

 

 

 

Diary of an Emergency Psychiatrist

Sunny day of 21st May, 2016

6PM

I just wind up a busy OPD

 

6:15 PM

Bleep goes off. I run to the acute care room to see 4 men holding down a half- naked priest with vibudi smeared all over his body. I ask him the problem. He replies as if it was obvious why. “They are coming with swords to kill my family. I can hear their voices like someone is talking to me on the phone. Please switch off your phones. Please!”

I do a quick examination and take a brief history to rule out organic etiology. Acute Psychosis. I promise him safety, to take those voices away. I give him Lorazepam and start him on anti- psychotics. His wife weeps on seeing him going to sleep after 2 days. “It’ll be a peaceful day tomorrow”, I whisper.

 

7PM

Bleep cries as if mourning. I get back on my feet. A 24-year-old young female, consumed approximately 200 tablets of Paracetamol. Detoxified, stabilized and shifted from Emergency Casualty in view of persisting active suicidal ideation. I quickly run through the charts. I talk to her heart- broken parents only to get a clean history. No known precipitating events. A topper in class, no history of ‘love failures’ and not a worry in the whole wide world. I talk to her friends in her hostel who give a 3-week history of being locked in her room with crying spells and suicidal ideas. Her broken spirit and body was dragged to a Psychiatrist’s office, who started her on anti- depressants for Severe Depression. They began to notice change in her in less than 2 weeks, she now had more energy than before, enough to kill her self. I continue her on anti- depressants, take suicidal precautions and shake on a ‘no- suicide’ contract. Just two more weeks and I know that she will enjoy the Sunrise again.

 

9:30PM

I hear my stomach growl. I sit down for dinner. Bleep screams again.

A 35-year-old married clerk at the Government office trying to free him self from the chains that bind him as he continues to sing loudly. I immediately instruct them to remove the chains. They comply hesitantly. He jumps at once and runs around dancing to his song. His 7-year-old boy erupted in a shrilling cry seeing his father so happy.

His other clerk friends tell me the story of his 8-lakh losses in the stock market, 10 days ago. Since then he began to behave abnormally. He borrowed more. He invested more. People thought he was only making up for the loss. He got arrested as went to meet the collector. He slapped the Sub Inspector and claimed to be the brother of Rajnikanth. He spoke of his non- existent company in Singapore in broken English. He didn’t need sleep or food anymore. He was Manic.

I sedate him. I send his labs and start him on Lithium and anti- psychotics. “We’ll stabilize his mood and he’ll be fine”, I reassured. His friends and family looked dazed at the prospect of a treatment available. I smile with assurance and walk away leaving a little happiness, this time with them as well.

 

11PM

Sleep pulls down my eyelids. The bleep growls again. I drag myself back to the emergency room. I see a woman slapping a man. Not the best sight in the middle of the night. As I go nearer, the smell of alcohol hits me hard. Hmm, someone was partying tonight, I joke to myself. His eyes were yellow, cheeks were swollen, he shivered as he tried to greet me and almost fell down trying to reach my hand. He was picking paper off the ground and I didn’t need to ask more. Alcohol Dependence Syndrome- Complicated withdrawal- Delirium tremens. Neurovitamins and tapering schedule of Benzodiazepines. Well, we might have saved his life for now but the job is not done until his de-addiction and rehabilitation are done. I patiently explained his tearful wife for whom this was hope enough.

 

11:45PM

I wake up with a startle. The nurse shouts at me to hurry. I run down to see a mother holding an infant in her hands wanting to thrash it’s tiny head to pieces! We knock her down with parenteral instead. Post- partum Psychosis. Few days and then she will nurse the same baby with all the love in this world.

 

 

12AM

I collapse on the chair at the nursing station, exhausted. As I slowly brush through the orders, I hear the Manics in the ward starting to play antakshari! Another psychotic at the corner pretending to hit a sixer as one of the manics spontaneously takes up bowling for him!

My phone now jumps to a romantic ringtone. “So, how is the call going?”, she curiously asks. A strange smile wipes across my face. “Nothing much, the usual”, I reply.

 

This article has been published in Lexicon’s 16th edition- EMERGENCY!