And then there was 4!

Dear Anya,

Another year rolls around and with it, another RSNA for me to spend it in Chicago. As always, here is the annual summary. I wonder if I am getting old or just plain old forgetful as it gets harder to put the year in perspective!

Health-wise, it has been a good one. No hospitalizations and we have put you on some regular medications for your reactive airways disease. So no big flare ups. The milk allergy unfortunately continues but you have adapted well to soy milk. There are moments when others consume milk containing products that you ask about it. Nevertheless, you manage it with a certain stoic calm of someone much older than you actually are. We all hope that in time, this too will pass.

It’s been an exciting change in school as in February, you became a “Cathedralite”! One of the “privileged few” as school puts it to be selected for the pre primary section. As best we can see, you enjoy school and are coping well car pooling with two boys who have off late been ganging up on you. Looks like you can deal with a brother without having one.

As far as we can tell, you really enjoy school. Your special likes are music and dancing, which I will get to more in detail later. Ms. Billimoria is your music teacher and from what I gather there is significant mutual admiration for eachother. always nice.

School has interesting projects which you have been a part of. The first term was all about Earth and the second about Children of the World. It was quite amazing to see how much you learnt through these. I am honestly quite excited about these new ways in which you are getting integrated learning.

Music has off late been a big thing for you, with things really taking off from some Gujarati CD’s that Nayanafoi sent you. As a result of this we at home are constantly exposed to such wonderful hits as “Mein ek biladi pali chhe” (I have a pet cat), “mara prabhu to nana chhe” (My God is small), “Pappa nu pet chhe fandalu” (My father has a fat belly)! The trouble for all of us is that we have to hear these sung by someone in an incredibly irritating nasal voice from 5-7 PM on most days. The advantage of course is that we get to watch you dance while you sing these!

Your tastes fortunately are quite varied, with Nanu downstairs exposing you to old hindi film songs, which you now enjoy and listening to jazz and rock upstairs with us. In addition, the thing I find most entertaining is the way you sing “Wonderful World”.

We of course get to see traces of Ms. Billimoria in you when you sit at your little grand piano at home. The typical routine is asking me to repeat the words of the song after you in syllables you create yourself. “A wayi naman ger, nocr ibfor abed”. Once this is learnt, we must sing to the music and you start playing the piano. As soon as I am about to start singing, you stop me and say “Wait, introduction!” Then, I must wait for your cue once the introductory music is over before we can start singing. This completely cracks me up!

In order to try and get you more formally involved in music, we have recently started you off at the Mehli Mehta academy for music appreciation and hopefully more. I can comfortably say you are enjoying yourself.

Unfortunately, we are in an era where kids must go to classes to stay occupied. Even though we don’t like it, we do send you to some. So far, it includes a “gym class” twice a week (God knows your parents need it more than you!), music class and Gujarati class once a week. Other than that, it’s once a week at least to your cousins nearby and once a week to the park nearby. The much promised swim trips haven’t quite materialized as often as one would like.

Your best friends continue to be Nani, whose energy seems to multiply by the minute when she is with you and quickly wanes when you leave! Long chats about the kids in her class and complicated exchanges of opinion are as always fascinating. The other wonderful figure in your life right now is Sangeeta, who looks after you when we are not around or if we are busy. The two of you have such a wonderful synergy and of course it helps that you can bully her into letting you paint and draw at will! I hope you pick up on her meticulousness and artistic sense.

Sarla Ba manages to keep you occupied for some time so long as you have crayons. I hope you have the chance to spend more time with her in future. What fraction of creativity we have is in many ways thanks to her.

Skype continues to be the bridge between you and our North American family with especially regular chats with fi-fi and fu-fu. As I travel too, the phone seems to fade away with your insistence on video conferencing. Well, c’est la vie, we must adapt and as usual you are adapting to a changing world with remarkable ease.

For us as usual, it has been a fabulous year and we can only look forward to more. Keep doing what you are doing, it seems to be working!

Lots of love,

Mama & Papa

The Mumbai Haad Sena: Community Radiology Education for a city – Part II

Following up on the previous blog, which primarily relates to setting up a successful, regular teaching program, this post will focus on expansion.

Having got this activity up and running with good support from faculty and residents, we feel comfortable that we are not politically aligned and are open to working with the best teachers in the area to come and speak to the group. This has been done at a minimal cost with maximum benefit to a large number of residents. At this time, the radiology department at the central institution takes on the responsibility of booking an auditorium and visiting faculty come by their own volition and cost. The only cost we take on is that of photocopying the feedback forms. It is important that we align with the radiology departments in the city as we are looking for their support and guidance as we grow.

The next obvious step in this activity is growth. While the success of our initial foray might enthuse us to dive headlong into many other projects, one must exercise caution to prevent dilution of ones energies. At present, it is our feeling that although residents want more and we are becoming increasingly popular we must only take on what we can deliver. A simple rule of thumb that we have taken is that we only start a new activity once the previous has existed for a reasonable amount of time (6-8 months) and is functioning on it’s own. At the same time, one must continue to malke efforts to ensure seamless running of the previous efforts by incorporating a few more enthusiastic members.

Our feedback shows that residents are interested in a weekly educational activity. Finding faculty is the challenge! Based on available resources, we have proceeded to add to this, the stepchild “non-bone club” which deals with confusing or less well taught/understood topics. Over the last two months, we have had two very successful sessions; one on radiographic evaluation of the oesophagus another on the temporal bone. We plan to add to this, topics such as neonatal chest, mammography, nuclear medicine, neck spaces etc. It seems this too will be on its way.

These sessions have been developed slightly differently from the bone radiology sessions. As sometimes faculty may find it difficult to get a talk together, we requested them to involve their residents. In this case, the residents developed and delivered the talks with guidance from the supervising faculty. This allows residents access to an expert in the field as well as an opportunity to speak in a public forum. In our brief experience, residents have performed extremely well and learnt a tremendous amount from these experiences.

An additional area that seems to be under-served by our educational system is that of radiology/imaging physics. Our next and most ambitious plan is to foray into imaging physics in 12 monthly sessions. We are hoping to teach the basics of x ray and CT physics in about 4-5 sessions, ultrasound in 3 sessions and MRI in about 4 sessions. Obviously, finding faculty willing to take on this challenge is difficult but I am sure it is doable. Furthermore, as we have committed ourselves to quality, we are not keen to start something before we are sure we can do a good job with it.

If anyone has suggestions or wants to become involved with the Mumbai Haad Sena (literally translated Mumbai Bone Army), please feel free to e-mail mumbaihaadsena@gmail.com.

I hope all of you work on developing your own little armies. The way imaging is growing we need a good strong one for the future!

The Mumbai Haad Sena: Community Radiology Education for a city – Part I

The best way to learn anything is in small sessions that are focused. Ones that highlight important things rather than rambling details and ones that are delivered in an entertaining manner. Most everything else contributes constructively to the sleep cycle!

I am proud to inform you that through a group of dedicated radiologists I am part of a regular monthly radiology education programme in the city of Mumbai. I am also happy to say that its simplicity is probably the cause for its success. What I am about to share with you is top secret and a little dedication will enable you to develop a similar programme in your city and ramp up the quality of radiology education nationwide.

The piece is written in two parts, the first that focuses on the actual setup and the second on early and future plans for development.

So what is this success story and what are its ingredients?

1. The core group: To start, the activity requires a small group of like-minded radiologists (residents and/or faculty) who agree to give a small amount of time on a regular basis towards education. It is important that the group be small, cohesive and bereft of ego hassles. Furthermore, it is good if everyone is from different institutions. The group must have the common goal of delivering the best possible education to residents irrespective of where they come from and preferably at no cost. In our case, most of our core faculty consists of 2-4 people at any given time, 33-36 years of age and everyone comes from a different institution.

2. Advisors: Make sure this group is small too. It should consist of ego free dedicated educators in your area. Specially ones who are not at loggerheads with other heads of departments in the city. One should also include any other faculty that wishes to be involved but is unable to dedicate time regularly. The senior advisors add legitimacy to the group while others provide suggestions for topics, space and feedback (which the core group filters as needed). In our case, we have one prominent head of department, one former head of department and a whole horde of radiology colleagues who encourage us and provide support as and when they can. They have helped us with lectures, cases, space, feedback and new ideas amongst many other useful things. They also serve as the word of mouth to inform residents about the existence of the entity.

3. Curriculum: This is probably the most important aspect of what one sets out to do. We figured it was impossible to deliver all information at these conferences and so decided what we would focus on is providing a basic platform from which residents could build a more detailed knowledge base. We also decided to pick a less emphasized subspecialty (musculoskeletal radiology) as the focus of the conference. Initially, we began in a haphazard manner by just deciding to show cases and teach residents to take them interactively but eventually, we decided to move to a more structured approach. Presently, we have a 45-60 minute didactic session followed by an interactive case session. We have also decided to structure the curriculum into core topics (eg: approach to plain film trauma, arthritis, tumours, hardware, infection) which we will repeat every year in the first six months and advanced topics (MRI, US) which we will vary annually.

4. Timing, regularity and location: It is important to find a time, place and frequency that allows maximum attendance. We figured 6 PM on Thursdays at a centrally located institution (in our case Parel) is perfect. Most people are done with work by 5 PM, which gives them enough time to make it. Thursday is far enough from the weekend that it does not eat into vacation. Central location allows everyone to come. A monthly session allows faculty and residents to recuperate, be fresh and prepared for each session.

5. Session monitoring and feedback: This is where the core group plays an important role. Every session must be monitored for quality of content, delivery and resident satisfaction. Feedback forms are also important. They should be handed out at the beginning of the session and collected at the end. Space should be kept for resident suggestions and e-mail addresses so a mailing list can be developed. If you listen to the audience, it comes back. It is also a good idea to document feedback for future developments and retrospection. We found that suggestions were important in our selection of topics, improving image quality and changing our location. Our own experience with electronic feedback has been quite poor!

6. Finding teachers: Every institution is blessed with their knight in shining armour and it is through residents and fellow radiologists that we get to know who they are. Dr. A at Hospital X teaches temporal bone well and Dr. B at hospital Y is a master of neck spaces while Dr. C at hospital Z is superb at bone tumors. This is how we find them. In addition, we all happen to have friends who are radiologists overseas who need to see their families in India. When they make the fatal mistake of telling me they are in town, they are gagged, kicking and screaming and asked to deliver their best to the group! Most of them love to speak on their pet topics and are always open to ways in which to deliver information. We have found that requesting them for a nice 45-60 minute lecture followed by 10-12 interactive cases to drive home the salient aspects works well. We stress on emphasizing important practical points and spending less time on inane details and long lists of syndromes. In some cases, we’ve requested them to get their residents. Involved and residents have delivered excellent lectures with guidance from these teachers. The results have been fabulous.

7. Follow up: It is always important to follow up each session with a brief note that summarizes the salient points. I sometimes find things listed in a structured manner in a textbook make it difficult for me to figure out what is important and what is not. This is what the note should do. We make it a point NOT to distribute the lectures (power points) through this medium. Lectures are the work of the person preparing them and given the little respect that most people seem to have for intellectual property, we let the lecturer decide on how they would like their information to be shared.

Our experience in the first four months was quite varied. The first session had 60-80 residents, the next had 20, the third 12 and fourth had 25. After that, we consistently see 60-80 residents. We even have a few residents who come regularly from Pune, which is quite nice. This makes sure we have our conferences as planned as we can’t let their trips go waste!

Of loss and reflection: 25 years on

Dear Anya,

Today I write about my father. Someone you never knew and will never meet but I think it is important that you know about him. He’s a part of your genetic make up and knowing him may give you that additional window into yourself.

Many who knew him can scarcely believe that it’s been 25 years since my father passed away. For me, I was just ten and memories are vivid, but few. Mostly in photographs that my father took of us, and my mother maintained for us in an album till I was about ten.

He was born in 1944 in Jamnagar, Gujarat and then quickly moved to Colombo, Sri Lanka where his parents lived at the time. The latter will always haunt you for any time the country’s name is taken you will feel a strange attachment to it. My grandparents lived there for a good many years and although I never went there, I heard so much about it growing up I almost feel like I did. Trust me, you cannot be easily de-linked from it. The home they lived in hosted so many guests and had so many memories associated with it that even now when anyone from the family visits they will try and find the address just to say a quick hello to the current residents of a large building that I believe has replaced a small and cozy home!

His childhood was as best I know was mostly uneventful. He was a good student with an active interest in sports, especially table tennis and cricket and apparently quite unlike the rest of us quiet, graceful and well mannered. There is however a major childhood event which involves a sleepwalking incident where he almost took a walk into a lake (was not so lucky another time as you will see). The other large negative that his sister will point to is that during his school days he somehow always managed to stand by her shabbily dressed and embarrass her. From what little I know of him, this could not have been intentional.

As a child, from what I recall, he had fascinating interests. He seems to have preserved everything in pristine order. I distinctly recall sitting one afternoon and building and painting a plastic ship from a Spanish armada that was one of his toys as a child! I know he enjoyed photography because he had so many great pictures of us and I still keep and cherish his old Asahi Pentax camera. In addition to this, there is a great picture he took of Pandit Jawaharlal Nehru while he was on tour to Sri Lanka. Finally and most curiously he collected autographs and as a result of this I (and thus you) have inherited a wonderful collection of autographs. I started collecting them too briefly, but didn’t quite have the persistence.

Following schooling in Colombo, he moved for his inter-science (standards 11 and 12) to Baroda (Vadodra) and after doing quite well there found his way into one of the earliest batches of the Indian Institute of Technology (IIT) in Powai, Mumbai. After spending four years at this bastion of technologic education in India, he moved to do his masters in mechanical engineering at Oklahoma State University, worked for a bit in Logan, Ohio (from which came his nickname by a boisterous cousin; “Logan no Jogan”).

After four years in the US, he returned for a trip to India only to be smitten by my mother and they were married amidst the blackout and fireworks of the India-Pakistan war in December 1972. My mother never wanted to move to the US and within the next four years, your aunt and I were on the scene and so he never returned to the US.

He worked for years at Voltas and all I recall is that the last few years that he worked there, he was in a section called “Marine Products”. I don’t believe the Jain in him could take it and so he marched on to an entrepreneurial career helping my grandmother build a stuffed toy manufacturing business. Unfortunately, his time was up and the sleepwalking came back to haunt him a day before he was to officially start his life as an entrepreneur and he was taken from us in an accident from our balcony.

My own memories though are wonderful. I recall spending time with him on weekends tinkering around with things as he made it a point to religiously document our development through photographs. He had picked up tennis in the US and regularly went to play at the Bombay Gymkhana. I duly followed as an appendage, thus beginning my destiny with this establishment that you similarly take advantage of. For years, I held on to a maroon pimple faced Dunlop Barnard table tennis racquet and a couple of warped Wilson tennis racquets with their wooden frames to prevent them from warping.

His tastes in music were very varied and the old Magnavox record player with the Sony amplifier and spool player are etched in my memory. We spent hours listening to everything from Sesame Street to Mantovani (his favourite) and Silsila (his favourite Hindi music track) to Michael Jackson (Thriller!). I am not a music connoisseur but certainly like listening to a lot of different music. I hope I can pass some of this on to you.

We took regular family vacations to interesting places. I recall a road trip to Mandavgarh, Ujjain and Indore via Makrana and numerous trips to Mahabaleshwar, Lonavala, Madh Island and Nargol. I recall a time when on one of these trips, out of curiosity he decided to smoke a pipe for the first time after he came back from the US.

I’m not so good at remembering his food habits, but I do recall he liked his “bhinda” crispy (we never got it at home). He also liked the occasional drink. I recall the beer mugs my parents picked up on a trip to Sri Lanka in the 70’s that we have inherited and spending many hours going through the phenomenal collection of miniature drink bottles he had and learning to be the bar tender at parties (mixing lemonade). Speaking of the miniatures, so proud was I of his collection that I insisted on showing it off in great detail them to a visiting elderly aunt. This of course resulted in her believing my father was an alcoholic and making him promise he would never touch alcohol again in his life!

My first ten years are quite like the last 25, rowdy and undisciplined; I always remember his patience in dealing with me and cannot recall an instance of him losing his temper with me. I try to be the same with you. In the few years that I had with him, he offered me such a wide variety of experiences; many that I still apply to my every day life, and yours. If I can be half the father he was for at least twice as long, I’ll be really thankful and I hope you will be too.

Love always,

Papa

The Saving Grace

I consider myself fortunate to be a physician today. Despite my borderline grades I somehow managed to get just about enough to make it to the next level in the merit category (into Jai Hind in the third list, D. Y. Patil on the last few merit seats). Something apparently clicked in the medical environment and I had some academic success during my first MBBS and then forgot all about it in second MBBS (where all of a sudden it seemed important to take a week long hiking trip to the Himalayas in the two week break between the theory and practical examinations). Anyways, no harm done; I made it safely to third MBBS (a certain cousin’s words: “once you’re in medicine, you have to get out sometime” were now seeming increasingly true).

But then again, life isn’t all that simple is it. I saw it coming during second MBBS and my thoughts were confirmed during third MBBS. There was this thing called Obstetrics and Gynaecology. Something that  I found it incredibly hard to be even remotely interested in. Despite many friends suggesting excellent graphic books with very few words and one that had a bright red cover (I think designed to keep you awake while you read it) it was just something that was going to elude me.

Every cloud must have its silver lining and I found mine in a book by an author who shared the same last name as me. The lining was not so much in the book though, as the person as you will soon see. At the time, I knew this person, more as an uncle, probably a fairly serious physician with an academic background and I wondered if a borderline student like me should approach him for advice. Well, such is the joy of a foolish youth that such things don’t really bother you that much. And so, off I went to visit and see if I could get through this Obstetric and Gynaecologic hurdle armed with ignorance and a hope that if not anyone else, a blood relative could help.

The conversation as I recall began quite seriously with some discussion of different books to read, wards to visit and procedures to see. My vision was getting blurry and a sinking feeling was setting in. I nervously asked “why the hell do they have so many different words for different parts of labour….isn’t the thing complicated enough?”

Little did I know that this was the line that would open up a whole new world as far as me and Obs/Gyn went. The next thing I knew, we were in the labour and delivery area of his hospital; he had grasped one of the recently born babies, turned it upside down and demonstrated to me the entire process of labour and delivery in real time and for the first time it actually made sense to me. For good measure he threw in a few funny medical school stories and I chipped in with the only thing funny I knew; bawdy jokes and just like that the deal was made. I was to spend my Saturdays with him learning Obs/Gyn (never really opened a book after that) and in return I was to drink tea and tell him bad jokes. The year flew by and I never thought much more about Obs/Gyn and looked forward to my Saturday tea and joke session (where unknown to me I was acquiring an education too!).

Life went on, the third MBBS exams came. I was asked by one of my examiners during the viva if I wanted to do Obstetrics and Gynaecology. The answer was the obvious “No way!” and I went on to do radiology (and am admittedly bad with fetal sonography!) and further specialized in bone and joint imaging.

The point of the story though is that there are many hurdles in the life of a medical student and we seldom come across people who recall their own years as students. Making the effort to find some areas of common interest are so important in catching the attention of the student and using unorthodox methods that deliver concepts rather than details are what great teachers are about. I hope I can deliver something similar as an academician and still look forward to having tea and cracking jokes with students even if they don’t go into radiology. I know as the student I still enjoy doing this with my uncle.

Thanks very much it’s been more about life than about Obstetrics and Gynaecology. Most great teachers seem to get it…why can’t more of us?