Bhaja Govindam

WHOLE DUDE – WHOLE DIAGNOSIS

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THIS PORTRAIT OF ADI SHANKARA DEPICTS HIM IN PERFECT, GOOD AND POSITIVE HEALTH.  

THE LEGEND ABOUT ‘BHAJA GOVINDAM’ : 

Adi Shankara, an Indian philosopher of 8th century CE, born in the southern Indian state of Kerala is well-known for his doctrine of Advaita Vedanta which he had established using Upanishads for reference. Shankara had established the ‘SMARTHA’ tradition to which I belong. He had recommended devotion to both Shiva and Vishnu and also the worship of other gods and goddesses. His poetic composition popularly known as ‘Bhaja Govindam’ deals with issues of human existence and the problem of death. Shankara had renounced the comforts associated with materialistic existence and had become a ‘Sanyasin'( Hindu ascetic) at a very young age and had walked across the length and breadth of India on foot. He had lived by accepting the offerings(‘biksha’) given by the community which often involved walking along the streets in places where he had lived. While he had lived in the city of Kashi also known as Benares or Varanasi, the legend claims that he had composed the twelve verses of Sanskrit poetry. He was accompanied by fourteen of his disciples who had also contributed a verse each and these songs are collectively known as ‘Bhaja Govindam’. The legend describes that Shankara had encountered a man teaching the rules of Sanskrit grammar to his students. In India, the teaching technique often involves learning by rote. A phrase is repeated several times to let the students put it into memory. As this Sanskrit Grammar teacher was repeating the phrase ‘Du krun kariney’, Shankara, a man of great spiritual insight, had instantly recognized that the Sanskrit teacher was actually facing the threat of death and the teacher himself was not aware of the threat to his physical existence. Shankara who had mastered Vedas and Upanishads was aware of the many sources both external and internal that endanger human physical existence. This particular ability of Shankara to diagnose the health of an individual interests me because of my educational experience and training in the ‘Art of Diagnosis’. Unfortunately, Shankara died at the very young age of 32. A mystery surrounds his death. The place of his death is disputed. He was always followed by his disciples. Some accounts claim that he had died in Kedarnath in the Himalayan mountains of Uttaranchal State. Others claim that he had died in the southern Indian city of Kanchi. What had contributed to his premature demise is not known. His portraits always depicted him in good and positive health. 

THE ART OF DIAGNOSING GOOD HEALTH : 

To diagnose ill-health is easy. The sick person may describe his ailments. In addition to a person’s subjective symptoms, ill-health shows objective manifestations. The art of clinical diagnosis in sickness and disease involves the use of signs and symptoms attributable to specific conditions that affect the state of health of an individual. However, the mere absence of ill-health does not necessarily mean that the person is positively healthy. Health, like beauty is often a matter of subjective impression. But, while beauty is in the eyes of the beholder, the diagnosis of perfect and positive health is a verdict rendered after a carefully executed medical examination. 

The important object of medical inspection and examination of Armed Forces personnel is to ensure that they are healthy and are able to perform the tasks assigned to them. As the medical officer providing medical cover to units in the Armed Forces of India and The Sultanate of Oman where I had served, I was responsible for assessment of health of all personnel under my care. To ensure that the troops are in good health, I was required to medically inspect all personnel under my care periodically and diagnose that they were in good health. Good health demands that a person should appear well nourished. In stature and build, a person should represent an average example of his race and class. The person should not present any evidence of emotional hyper-excitability. Temperamentally, the individual should exhibit reasonable aptitude and behavior consistent with the expectations of his occupation. Most importantly, the face of the person should reflect the bloom of vigorous health. A person in good health should appear cheerful and be full of vitality. The entire individual is carefully examined to assess the health status. I had acquired the practical skills of the ‘Art of Diagnosing Good Health’ by carefully carrying out regular, periodic health inspections of all men under my care. Armed Forces insists upon Medical Inspections for a variety of reasons and individuals who are subject to the Rules and Regulations that govern Service in Uniform cannot refuse the mandatory Medical Examinations. Medical Inspection of all the men including all food handlers of the Unit is done typically once every month. In addition, men newly posted to the Unit( New Arrivals), men before proceeding on and returning from Courses of Instruction/Leave of Absence/Temporary Duty, and after Hospital Discharge are Medically Inspected. Recruits posted to the Unit after completion of Recruit Training, and men joining their Units after serving abroad are subjected to Medical Inspections. Thorough, detailed and specific Medical Examinations of military personnel is required under the following conditions : 

1. All troops proceeding on ‘active service’ or troops proceeding overseas. 2. Individuals proceeding on permanent transfer to another Unit. 3. Men desirous of an extension of service or re-engagement. 4. Troops for transfer for the Reserve Duty. 5.Officers at the time of initiation of Annual Confidential Reports, entry to Staff College, any Course of Instruction, Fitness for Special Duty. 6. Men under arrest and undergoing sentence and before disciplinary action. 7. Men posted to serve at High Altitude. 8. Special examination at the outbreak of an infectious disease. Typically, I used to examine at least twenty known contacts of each case of Malaria or Viral Hepatitis. 

Medicine is not merely the Art of Diagnosing ill-health and it is equally the Art of Diagnosing Good and Positive Health. I had perfected this skill by meticulously repeating the task of conducting Medical Inspections thousands of times during the course of my service in the Armed Forces. This had also contributed to my ability to diagnose ill-health and in the next several posts I would narrate a few specific instances when I had diagnosed an impending outcome of death during my service and there are instances when I had diagnosed Good Health and made individuals to perform their assigned tasks and did not allow them to escape from the obligations of Military Duty. Sometimes, my acute power of observation was better than that of Physicians more qualified than me. During 1973, I was admitted to Military Hospital, ROORKEE for an intestinal infection. During my hospital stay as a patient,while I was standing in the lobby of the Officers’ Ward one particular evening, I had seen a young, male patient coming into the Ward after his admission. When I had looked at him from a distance, and the manner in which he was walking, particularly his gait and the position of his right hand over the right lower quadrant of his abdomen, I had suspected his medical problem. After he came into the Ward, from his facial appearance alone, I had recognized him as the younger brother of an Officer who was then serving with me in my Unit. Both of them belonged to the Corps of Engineers. I had introduced myself and he had confirmed his relationship to the Officer who was then serving at my Unit. I had asked him about his medical ailment. He was getting treatment from the Hospital Physician( Medical Specialist) over the last several days and was
already seen by the Physician twice in the Out-Patient Clinic and was not responding to the medicines that were prescribed. I had looked up at the Hospital Admission document. He was admitted to the Military Hospital with the provisional diagnosis of Fever Not Yet Diagnosed. I told him that Fever was not the real issue and that he was suffering on account of a common well-known surgical condition called Acute Appendicitis. I had confirmed this diagnosis by performing a simple test on this young Officer patient and told him that he would need immediate surgery and that his ‘APPENDIX’ should be removed without any delay. I proceeded to contact the Duty Medical Officer who had admitted and sent this individual to the Officers’ Ward. The Duty Officer had simply admitted this man based upon the written opinion given by the Physician. The Duty Medical Officer came over to the Officers’ Ward and he repeated the test I had performed earlier and the diagnosis was very clear. He immediately called the Duty Surgeon, who came over and repeated the test I had conducted and confirmed that Appendix should be removed. The appendix was removed and the Surgeon came back and told me that the appendix was highly inflamed and was at the risk of a RUPTURE which could pose a greater threat. While, Appendicitis is a common surgical emergency among young adults, Medical Specialists are not trained to treat this condition and sometimes they may fail to look for it. I was less qualified than the Medical Specialist but I had trained myself in the Art of Diagnosis which would be of use in diagnosis if not in delivering the special treatment a medical condition requires. Whatever may be the outcome, a Good Diagnosis is as relevant as a Good and proper Treatment. Roorkee was the hometown of this Officer patient. Later his father came to the Ward to meet me and was particularly excited with this chance coincidence ; I knew his first son and then I was in Roorkee at that precise moment and intervened as his second son was arriving at the Officers’ ward.
 

BHAJA GOVINDAM – PART-I : 

While the Art of Diagnosis interests me, I constantly remind myself that Good Health is due to the GRACE and MERCY of the LORD and Indians love to identify the LORD as GOVINDA. While we exist because of MERCY, when the existence is threatened, we have no choice other than remembering the LORD. 

Bhaja Govindam, Bhaja Govindam, 

Govindam Bhaja muudha matey, 

Sampraaptey Sannihitey kaaley, 

Nahi Nahi rakshati Du krun karaney. 

Dr. R. Rudra Narasimham,

Kurnool Medical College, Kurnool, A.P., India.,

M.B.B.S., Class of April, 1970.

 

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WHOLE DUDE – WHOLE ENEMY

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Description: This micrograph depicts the histo...
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Vulpes bengalensis - Indian Fox
Vulpes bengalensis - Indian Fox and Rabies Infection.

 

Bullet shaped Rabies Virus
Bullet shaped Rabies Virus

 

Structure of Rhabdovirus that causes RABIES
Structure of Rhabdovirus that causes RABIES

 

Rabies Evidence - Negri body
Rabies Evidence - Negri body

 

Brain Inflammation - Negri bodies
Rabies Encephalitis-Brain Inflammation - Negri bodies

 

Mahajan Firing Range, Suratgarh
Mahajan Firing Range, Suratgarh, We have weapons to fight our external enemies.

 Indian Armed Forces train and conduct Military Exercises in Suratgarh region of  Rajasthan with a sense of ‘excitement’ induced by the preparation to confront the enemy. The attack by an ‘invisible’ enemy is manifested by the medical symptom of mental excitement.      

SURATGARH - A STRATEGIC POST
FIGHTING AN ENEMY - SURATGARH - A STRATEGIC POST

 

Canis aureus, Golden Jackal
Canis aureus, Golden Jackal and Rabies Virus Transmission.

 

Suratgarh-Vedic Bhumi-SARASVATI RIVER
Suratgarh-Vedic Bhumi-The Land of Legendary SARASVATI RIVER

 

SURATGARH, RAJASTHAN – THE LAND OF RIG VEDA  :      

Suratgarh is in Sri Ganganagar District of Rajasthan. Around 3,000 B.C., Suratgarh is believed to be a lush green pasture land due to the presence of Sarasvati River which is repeatedly mentioned in Rig Veda and is described as “Ambi ta mey, Nadi ta mey, Devi ta mey, Sarasvati” meaning that River Sarasvati is Best Mother, Best River, and Best Goddess.      

Fighting the Enemy – The Excitement at Suratgarh  :      

Suratgarh is of strategic importance. I had visited and camped in this area several times during the period from 1976 to 1978. It was not a picnic. My visits were mostly related to military training and exercises that would prepare me to fight the enemy in a battle. Battle preparation always induces a sense of excitement. Apart from the body, the mind would be put on an alert to accept the challenge and confront the enemy. I had never missed that feeling on any day that I had spent in Suratgarh. During 1977, I had camped at Suratgarh for three months where we had opened a ‘Desert Driving School’ to impart training to military drivers. The sandy desert terrain poses a challenge to the man aswell as the machine. The driving lessons were imparted by instructors from Army Service Corps which provides provisions(rations) and transportation in the conduct of military operations. We had established a very small camp in tents on the Suratgarh-Sri Ganganagar Road. I had set up a very modest Medical Inspection Room in a bunker to provide medical services to trainees at our School. I had posted a sign on the road near our School to encourage others to visit my Medical Inspection Room if they needed any help. I had always liked the idea of preparing for the battle. The success in actual war depends upon the skills a person acquires while training for the battle. I thought that it was important that I must learn to drive and operate all types of vehicles that Indian Army would use in the desert terrain. Like all other trainees at the School, I drove a 3- ton Lorry, the basic workhorse of Indian Army. I had successfully finished my training and was issued a Military Driver’s License. Apart from 3- ton Lorry, I also operated all other vehicles like Jeep, Jonga, and 1- ton trucks. The driving tracks included regular surface roads and plenty of cross-country driving over sand dunes and desert terrain. It was exciting to face the challenge and be prepared.      

Fighting an Invisible Enemy – A Challenge to Human Existence  :      

Fighting a visible, external enemy is easier rather than fighting an ‘invisible’ enemy. The Rhabdovirus that causes the fatal disease of RABIES is one such invisible enemy. The virus has a characteristic ‘bullet’ shape. It is described as a neurotropic virus as it chiefly attacks the central nervous tissues and causes brain inflammation. While a person is alive, the infection is always diagnosed on clinical grounds.After death, the evidence for this infection is demonstrated by the presence of microscopic, the oxyphilic inclusion bodies called the ‘Negri Bodies’ found in the cytoplasm of the brain nerve cells. The disease once manifested, has no cure and the mortality is 100 percent. The disease was eradicated in Britain and Australia, but is still prevalent in India. Rabies is primarily a disease of a variety of animals( the Canidae tribe) and man is secondarily infected. In India, furious canine rabies causes most cases of the disease in man. The virus also attacks the salivary glands and the virus is present in the saliva of the infected animal. For man, the immediate source of infection is essentially the rabid domestic, street, or pet, dogs, and cats. The infection could also spread from wild animals like Jackals and Foxes. The virus is transmitted to man either by the bite of an infected animal or by contact through the mucous membranes or breaks in the skin such as cuts, abrasions, and open injuries that get licked by the animal.The virus cannot enter the body without some trauma to the skin or mucosa. However, the virus can gain entry if it contacts intact conjunctiva of the eyes. Transmission by ‘droplets’ has also been demonstrated. Once within the body, the virus travels using nervous tissues and attacks the brain. Depending upon the site of entry into the body, the disease can manifest itself in about 10 to 90 days.      

HYDROPHOBIA – THE FEAR OF WATER : THE CHARACTERISTIC FEATURE OF RABIES :      

During the very initial phase of infection which may last from 1 to 10 days, the disease is manifested as increasing restlessness, excitement, anxiety, and irritability. After the initial period of 1 to 10 days, the symptoms and signs of Hydrophobia appear in the man. This is a characteristic feature of the disease only in man and does not occur in dogs or other animals. The fearful manifestation of Hydrophobia includes violent contractions of the diaphragm and other respiratory muscles if the individual attempts to drink water. The muscles of throat go into spasm and the victim would be unable to drink water despite extreme thirst. The sight of water or even the sound of water may precipitate these very distressing spasms and attacks of panic.Man has no natural immunity against the infection. Anti-Rabic Vaccine treatment is useful during the incubation period. The Vaccine treatment has no value if the Rabies Virus reaches the brain. Once the symptoms of the infection appear, no treatment is possible. Rabies is prevalent in India, but the incidence is very low in the Indian Armed forces. We had 59 reported cases of Rabies from 1944 to 1964, about 3 cases per year. There have been cases of Rabies transmitted by corneal grafts taken from people who had died of undiagnosed Rabies.      

THE INVISIBLE ENEMY’S ATTACK IN SURATGARH :      

While I was attending to patients at my Medical Inspection Room at the Desert Driving School, a Non-Commissioned Officer(NCO) came to our Camp to seek my assistance. He belonged to the Corps of Electrical & Mechanical Engineers(EME). He being a member of the SIKH religious community could be immediately identified by the turban that he wore and his beard. He was well-groomed and was in proper military attire and had very good physical stature and appearance. His Unit had sent a small detachment to Suratgarh area in preparation for some training event. They were camping nearby. His Unit was not affiliated to the military formation which had set up the Driving School. During that time, Suratgarh had only a Primary Healthcare Clinic.  I was the only Army Medical Officer providing services to military personnel stationed in that area. As he walked in, I could see that he was excited and I had immediately assured him that he should have no apprehension to seek my services and the Unit affiliations are of no consequence and he should totally feel free to discuss his medical problems with me. He had a very brief medical history. For some unknown reason, he was feeling restless, excited , and becoming anxious about his restlessness. He had no headache, no fever, and no other problems. He was apparently performing all his tasks very well and had no quarrels or arguments with his colleagues. I could easily see his attitude and military bearing. He was displaying a very disciplined behavior, a respectful attitude while coping with a serious and troubling condition. I could immediately rule out the possibility of overt or occult ‘Malingering’. He was a NCO who had spent some years in military service, he was very well-adjusted to his military life and had no particular problems with superiors or colleagues of his Unit. I spent time to fully medically examine him and evaluating his general condition and exploring the reasons for this sudden onset of mental restlessness in an adult who had no prior medical problems. He was not disgruntled, cynical or bitter. He was speaking and answering all of my questions in a very coherent manner. He was not expressing any bizarre ideas or thoughts. He was not hallucinating, not deluded or demented. His personal habits were good and he did not consume alcohol or any other mood altering drugs. He was not any medications. He was not experiencing a ‘STRESS’ disorder and appeared to be having good stress resistance. He had no pressing domestic concerns or problems. I could not discover any physical factors like Heat or infections like Malaria or metabolic disorders like diabetes which may explain his condition. Through careful interrogation, I could exclude Psychiatric illness or disorder. After spending some time, I could not still come to any conclusion and I was unwilling to send him away with some symptomatic treatment to relieve his anxiety.      

MEDICAL COMFORTS  AND  MEDICAL DIAGNOSIS  :      

Unlike in civil medical practice, the army medical practice gives attention to the individual and not exclusively to the disease. At Medical Inspection Rooms, we very often provide ‘Medical Comforts’, to all people who visit us, as needed. The Medical Inspection Room is entitled to draw rations like sugar, tea leaves, and milk powder and very often we serve hot, and refreshing tea while people wait at the Clinic. Suratgarh is an extremely hot place. I was drawing blocks of ice to keep my Clinic cool as there was no electricity or air-conditioning. I was also serving chilled water to all visitors and consistently encouraged everyone to consume more fluids.      

After my initial, inconclusive evaluation of my patient, I wanted to provide him some ‘Medical Comfort’ and offered to him a glass of chilled water as it was already very hot. He had declined my offer and showed no interest to drink water. He was not being rude or impolite. He was too excited and was not in a mood to relax. But, that very simple act of offering water as ‘Medical Comfort’ and his refusal made me to contemplate about his condition. It suddenly occurred to me that I could be dealing with a case of Rabies. He had no symptoms or signs that could be identified as ‘Hydrophobia’. He had no such concerns or problems at that time. However, I had decided to fully explore that possibility. I again started my interrogation to find out if he had any contact with any animal. He never had pet animals. He was never bitten by any animal. He was never licked by any animal. I carefully examined his skin and could not discover any cuts, abrasions, open wounds or healed injuries. His skin was intact and it would not be possible for Rabies Virus to enter his body through his unbroken skin. I had no other options left and I was not able to exclude the possibility of Rabies infection as the cause of his medical complaints of restlessness and anxiety. I had no choice other than acting upon my suspicion even though I had fully trusted his statements about never being licked or bitten by any animal.      

THE ROAD JOURNEY FROM SURATGARH TO ABOHAR , PUNJAB:      

I made a decision to medically evacuate my patient to a military medical facility located about 95 Kilometres away at ABOHAR, Punjab. We made no such prior plans to evacuate patients from the Desert Driving School to Abohar. I had to make that decision on my own keeping the best interests of my patient in my mind. I had also decided to transport the patient myself and to drive the 1 – ton truck ambulance.I wanted to assume the full responsibility for taking the vehicle to Abohar. As we were getting ready for this road journey, I checked and found that I had only 2 ampoules of Injection Chlorpromazine hydrochloride(LARGACTIL), a drug of choice to alleviate anxiety. It can tranquillize the patient without impairing his consciousness. Largactil has a marked sedating effect without causing stupor. However, I had only two ampoules in my Clinic. I quickly ran to Suratgarh Primary Healthcare Centre and met the doctor there to get some additional ampoules of Largactil. He had none in his dispensary. So, I prepared my patient for the road journey after administering the medicine that I had and none for the duration of the journey. The road was in a very bad shape with pot holes. My patient could not be fully sedated with the dose I had administered. While I was driving the ambulance, I had kept the partition glass window open to check on the patient. Two of my medical assistants were with the patient, and the ambulance driver was in the co-passenger seat in the front. The bumpy ride caused a bit of stress and my patient was constantly shouting from behind asking me to slow down and sometimes he was directing me to speed up. I was happy to hear his voice and finding that his condition was still stable without any worsening of symptoms. By the time we entered the Hospital at Abohar, it was already dark. I had contacted the Duty Medical Officer who had immediately sent word to the Hospital Surgeon to evaluate the patient. The Surgeon carefully examined him and there were no clinical grounds to diagnose Rabies at that hour. The possibility was there. In any case, the patient needed Hospital admission simply on account of his extremely excited condition. I gave the postal address of my Unit and obtained an assurance from the Surgeon that he would communicate to me the Medical Diagnosis of my patient. After that assurance, the patient was duly handed over, I left Abohar and returned to Suratgarh. A few days after this trip, my three months of stay at Suratgarh had concluded and I had returned to my Unit and had assumed the duties of Unit Adjutant. I had received that unfortunate Medical Diagnosis in the mail. The Surgeon wrote to me stating that the Medical Diagnosis of Rabies was confirmed after conducting an autopsy and the demonstration of ‘Negri Bodies’ in the brain nerve cells.      

BHAJA GOVINDAM – PART- V   :      

The human body is very vulnerable and could be attacked in several manners. In this particular patient, the deadly virus  might have gained its entry into his body through the conjunctiva of his eyes. The saliva, the droplets carrying the Virus from an infected animal like a Jackal or Fox could have entered his eyes while the animal was in his vicinity but escaped from being noticed by him. We camp outdoors and sometimes fail to notice an imminent threat. I would suggest to all of my readers to use protective goggles while camping outdoors and introduce its use on a regular basis while conducting military exercises and training in areas where infected animals could be present. After taking all these precautions, we still need the help, the help of our LORD, the help that a sweet name like GOVINDA could offer to protect and defend our human existence.      

Bhaja Govindam, Bhaja Govindam,      

Govindam Bhaja muudha matey,      

Sampraapte Sannihitey Kaaley,      

Nahi, Nahi Rakshati Du Krun Karaney.      

Dr. R. Rudra Narasimham,     

Kurnool Medical College, Kurnool, A.P., India.,     

M.B.B.S., Class of April, 1970.      

WHOLE DUDE – WHOLE TOXIN

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Countries with reported cases of Tetanus
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Tetanus - pathogen
The spores of Tetanus bacilli can live in soil for years. The spores can survive autoclaving instruments at 121 degrees centigrade.

 

Clostridium.tetani - The Tetanus causing bacilli.
The tetanus bacilli live in the guts of humans, cattle, and other animals.

 

Clostridium tetani
The Tetanus causing bacilli produce deadly Neurotoxin. How would you manage this case of Tetanus if you know that the bacilli are lodged in the endometrial lining of this young woman? In 1971, we had no Human Immunoglobulin. Anti Tetanus Serum is not very effective. What are your options?How would you get rid of the bacilli?

 

Clostridia and Tetanus
Clostridium.tetani bacilli cause Tetanus.This young woman reported to the Hospital very early and her condition was diagnosed promptly.If you had known that the bacilli are lodged in the endometrial lining of her uterus, would you attempt surgical debridement? Would you attempt Curettage to remove the source of neurotoxin production?What are the risks of surgical debridement? Would you recommend Hysterectomy to save her life?Conservative Treatment did not save her life. Is there a chance that she would have been living after emergency Hysterectomy?

 

Tetanus disease first manifests in the facial muscles.
Tetanus disease first manifests in the facial muscles.

 

The jaw muscles are typically involved in Tetanus.
The jaw muscles are typically involved in Tetanus.

 

Tetanus neurotoxin affects the neuro-muscular junction.
Tetanus neurotoxin affects the neuro-muscular junction.

 

Clostridium.botulinum causes Botulism, a paralysis of muscles.
Clostridium.botulinum causes Botulism, a paralysis of muscles.

 

A STORY FROM MILITARY HOSPITAL  AMBALA, HARYANA STATE, INDIA  :    

I had served at the Military Hospital, Ambala from July 1970, to September 1971. I had served in the rank of Lieutenant during the period of my twelve months Hospital Internship Training. I had narrated an earlier experience at the same Military Hospital in my blog post titled ‘Defining Indian Identity-Listen to the Heart’. I want to recount some of my experiences to understand the nature of human condition and the challenges to human existence. The challenges are many and they are so vastly different. I am choosing to narrate the stories of those individuals whose life was cut short while they had no other health issues that could undermine their ability to live. Padma Sundarji, Lt.Col.D’ Souza, and the athlete at Army Ordnance Corps Centre, Secunderabad fought to defend their existence from the threats of Cancer. I had earlier described the nature of the Immune System that defends the human body from Cancer, infections, and foreign proteins. This is the story about a very young woman whose life was shortened in tragic circumstances and I want to stress the importance; the medical profession has a duty to avoid costly mistakes while delivering routine care.    

When people walk into a government-run clinic or hospital, the usual impression is that a doctor would listen to the complaints in about a few minutes time, make a very quick evaluation, and send the patient away with a prescription. I had mentioned that in the Armed Forces, the Medical Officers would love to spend time medically examining people who have no apparent sickness as they lay emphasis upon diagnosing a person’s Good Health. I was introduced to aspects of Medical Practice in Army at Military Hospital, Ambala where I learned that writing a prescription should not be our first concern. Major. Mohan Pal Dhir, AMC, the Senior Surgical Specialist of the Hospital at that time of my service, had asked me to converse with my patients and try to know each one as an individual; as a person and not as a diseased entity. In India, we would still follow the cultural norms and do not intrude into personal lives unless the patient desires to discuss all the aspects of their medical history.    

During 1971, I was in the Hospital Medical Inspection Room around 8.30 P.M. while my friend Lt. Mohan Lal Dubey, AMC was the Orderly Medical Officer;(Dr. M L Dubey is presently Professor, Department of Parasitology, Postgraduate Institute of Medical Education & Research, Chandigarh,India). A young woman about 17 years old accompanied by her father had walked into the Clinic. Her father had earlier served in the Indian Army. They were traveling in a bus and she was feeling unwell, and they had decided to discontinue their journey. The Military Hospital, Ambala is at a short distance from the Grand Trunk Road and the father knew the Hospital and thought that it would be better to have his daughter checked up before getting back to their village. She could not contribute any further information and did not suffer from any serious illness in her life. As she walked into the Clinic, I had noticed an expression of fear on her face, and it had alerted me that there would be some underlying problem. Surprisingly, we could not detect any reason( a medical condition ) to explain her feeling of being unwell. Her temperature, pulse, respiration, heart, lungs, and abdomen were all within normal expected limits. I did not want to suggest to this young woman that she was alright. I had kept talking to her and her father to arrive at some clues about this sudden sickness that she had experienced. While speaking to her and intently looking at her face, I had noticed with a sense of alarm, that her jaw muscle known as ‘masseters’ appeared to be a lit more ‘taut’. Masseters are the primary chewing muscles. They cover the sides of the jaw just behind the cheeks. These muscles help us to clench our jaws and to grind our teeth. The stiffening of these muscles forced me to think of the possibility of Tetanus infection. Her medical history did not reveal any possibility of contacting this terrifying disease. She had no injuries of any kind. Myself and my friend Dubey, checked her again and could not find any evidence of even a minor injury. Her throat, her teeth were normal. She was not hysterical. She was not exposed to drugs or poisons. She had no concerns or experiencing any difficulty about opening her mouth. There was no stiffness of the muscles that she could experience on her own. This stiffness of jaw muscles, this involvement of facial muscles is the basis for diagnosing the disease of Tetanus. We do not need any laboratory investigations. We need not see the Tetanus bacilli to clinically diagnose this condition. The bacilli live in the intestines of humans, cattle, horses, cats, and dogs without causing any disease. The spores of the Tetanus bacilli are widely distributed in nature, especially in top soil. The spores are very resistant to heat, and chemicals like lysol and can survive for years in the dust. But, the infection is caused only when the spores enter the body through any wound, particularly like a thorn prick, or a puncture wound caused by a nail, a splinter, or an agricultural implement. The bacilli are strict anaerobes, meaning that they cannot thrive in areas receiving free oxygen. The Tetanus bacilli germinate from its spores only where there is reduced oxygen supply. Generally, a patient would be having a dirty wound or injury. The disease manifests itself very quickly in about 2 days to 2 weeks after the spores germinated in the body tissues. The stiffness of the jaw muscles is called ‘Lock Jaw’ or ‘Trismus’. We could not conclude that she was a case of Tetanus. The sign of ‘Trismus’ was hanging in the air like a ‘SWORD’. We made a decision to admit her to the Family Ward with the Provisional Diagnosis of ? TRISMUS and initiated the prophylactic treatment against Tetanus as recommended in the Standard Text Books of Surgery. During 1970s, Indian Army Hospitals had no Tetanus Human Immunoglobulin, the antitoxin that is used in the United States to neutralize the neurotoxin produced by tetanus bacilli. We were then using Tetanus Anti-Serum that is procured from horses. This Serum could cause some serious side-effects, and very high doses are not recommended unless treating established Tetanus. She was given an initial dose of 5,000 International Units with due precautions. In India during 1970s, and prior to it, the children were not routinely immunized by ‘triple vaccine’ which is very effective against Tetanus infection. As a precaution, she was also started on Penicillin antibiotic and initiated immunization against tetanus with a dose of Tetanus Toxoid injection. I went away hoping that the stiffness of jaw muscles that I had discovered on my examination would go away and that she would be alright. Next day, when I had arrived at the Hospital at about 7.00 A.M., I came to know that the suspicion of Tetanus became stronger and the patient was transferred to the Intensive Care Room at the Acute Surgical Ward. They had treated her very vigorously and she had survived this terrifying ordeal of Tetanus for five days and had lost her battle. She had received medical attention as soon as she had become ill, and yet could not be saved. We had failed because we could not discover the seat of her infection. The tetanus bacilli after entering human body do not circulate in the blood. They remain stationary at a place where they thrive. The bacilli do not directly harm the body. It is the ‘tetanospasmin’, the neurotoxin that they excrete which circulates in the blood and reaches the neuron cells of the spinal cord that inflicts the damage. It is one of the deadliest poisons known. The poison is like the poison known as ‘STRYCHNINE’ which is used to kill rats. The poison specifically acts on the synthesis and release of ‘Acetylcholine’, a chemical that has a key role in the transmission of nerve impulses throughout the body. The stimulation, the accumulation of ‘acetylcholine’ results in rigidity of muscle groups of different voluntary muscles.This toxic rigidity of muscles gradually involves face, head, neck, trunk, extremities and the muscles of respiration. This rigidity of the body is punctuated by sudden tonic spasms, and convulsions. The patient would be exhausted and dies due to respiratory failure. Patients are nursed in dark, very quiet rooms, and are not disturbed and moved without reason. If the seat of infection is known, surgery is performed to completely clean the wound and remove all dead tissue where the Tetanus bacilli multiply. In this young woman, we could not detect the seat of infection while she was treated. After her death, the Hospital conducted an autopsy to discover the problem. The Hospital Pathologist, Major B K Sharma, AMC had later informed me that he had isolated the Clostridium.tetani bacilli from the lining of her uterus or womb. She had acquired a ‘Surgical Infection’ after undergoing a simple gynaecological surgical procedure commonly known as ‘CURETTAGE’ in which the lining membrane of the uterus is gently scraped and removed. The father and the patient did not reveal this information. A sense of modesty and Cultural sensitivity could have prevented them. The operation was done in a Clinic or Hospital and we could not obtain any details. The surgical instrument that was used in this procedure was contaminated with dust that had the Tetanus spores. The spores cannot be killed by autoclave or sterilizing the instruments at 121 degrees centigrade temperature. This apparently healthy young woman might have experienced a relatively harmless disorder of her menstrual function which would not truly require a surgical treatment. But, we have no treatment for a disease called ‘GREED’. A medical practitioner sometimes performs a surgical procedure to justify charging a patient a large amount in fees to fill up his/her pockets. In the autopsy examination, we could not find any reason as to why she was subjected to this Surgical Intervention which introduced this deadly infection into her body. She had no other complications from this surgical operation and she had no gynaecological problems and our careful examination did not indicate any problem. A
s a rule, doctors do not carry out a gynaecological pelvic examination in young patients and particularly when they are not married and have no symptoms and signs of a gynaecological disease. Even if we had known, we could not have done more to save her life. She was not evaluated by the Gynaecologist at the Military Hospital, Ambala. I would not think that a Gynaecologist would have done the operation of ‘CURETTAGE’ for a second time to get rid of Tetanus bacilli from the endometrial lining of her uterus. It could pose risks of its own. An emergency hysterectomy could be life saving as it would have eliminated the source of neurotoxin production and would have given us a chance to fully neutralize the circulating neurotoxin. Tragically, she got caught up in a situation with no further escape.
    

BHAJA GOVINDAM – PART IV  :    

We exist at the mercy of our LORD. It is not always easy to defend human existence. This tiny bacillus needs no oxygen for its survival. The antibiotics that we may use may not even reach it in enough concentration. The bacillus has a cell wall coated with sugar molecules which may even prevent the antibiotic from entering the cell. A person even with exceptionally strong and well-developed muscles cannot defend himself from this poison. Only timely immunization is the best way to protect a person. During 1970, a spent a month at the Kurnool General Hospital, Kurnool doing my Internship in Medical Ward III. As an Intern at the Medical Ward, I did a neurological examination of a young male patient with well-built body. He was admitted for Spasticity of his muscles of his limbs, and the trunk. He was rigid like a board but had not experienced any muscle spasms or convulsions. I had diagnosed him as a case of Tetanus and had him transferred to the Infectious Diseases Ward as per the Hospital Policy. These were the two instances when I had made the Clinical Diagnosis of Tetanus and they are important and live in my memory and constantly remind me to seek the protection which only the LORD could provide.    

Bhaja Govindam, Bhaja Govindam,    

Govindam Bhaja muudhamatey,    

Sampraapte Sannihitey Kaaley,    

Nahi, Nahi Rakshati, Du krun karaney.    

Dr. R. Rudra Narasimham,   

Kurnool Medical College, Kurnool, A.P., India.,   

M.B.B.S., Class of April, 1970.   

WHOLE DUDE – WHOLE SHADOW

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SUNFLOWERS, HELIANTHUS ANNUUS,BELONGS TO COMPOSITAE/ASTERACEAE, THE FAMILY OF DAISY FLOWERS, NEED FULL SUN TO GROW WELL.   

 

    

 

   

  

PADMA SUNDARJI LIVED UNDER THE SHADOW OF GENERAL K S SUNDARJI
PADMA SUNDARJI LIVED UNDER THE SHADOW OF GENERAL K S SUNDARJI

 

LIVING UNDER SHADOW :   

Shadow gives us protection or shelter from external danger. In India, women before their marriage live under the shadow of their fathers. After marriage, women are expected to live under the shadow of their husbands. Indian Tradition demands that a married woman should be subjected to live under the influence or domination of her husband. Very often, women love to bask under the glory of the position, the status, and the power wielded by their husbands. But, living under shadow should not endanger the very existence of the individual who is seeking the protection. Sunflowers bloom and thrive only when exposed to full sun. These plants cannot grow well under shade or shadow. Every individual has a fundamental Right to exist. No individual should dominate or influence another individual to an extent that compromises the Right to Life.   

A PRESCRIPTION FOR DEATH :   

General Krishnaswamy Sundarrajan,PVSM ( popularly known as General Sundarji) was India’s Chief of Army Staff from February 1, 1985 to May 31, 1988. I had spoken about him in my blog post titled ‘WINNING PEACE – THE ART OF PREPARING FOR WAR’. He was married to Padma Sundarji when he was a Major serving with the MAHAR Infantry Regiment in the Army. She spent the best years of her life living with him and had kept his company throughout his various postings. I met Padma Sundarji for the first time in my life in the year 1978. At that time, General Sundarji was serving as General Officer Commanding (GOC) of First Armoured Division. It was a rare distinction of great honor for an Infantry Officer to Command an elite Armoured Division. I was serving as a Medical Officer in the rank of Major under the Command of General Sundarji.   

I had met Padma Sundarji at the General’s official residence. I went there to personally administer intramuscular injection of Streptomycin which is exclusively reserved for the treatment of Tuberculosis. Three drugs are concurrently used as first-line drugs in the Initial Phase of treatment of Tuberculosis and the daily injections of Streptomycin are used for about three months. Pulmonary Tuberculosis is a “NOTIFIABLE” Communicable Disease in the Armed Forces. Statutory legislations have been made at various levels for imposing legal obligations on all people to facilitate control actions to prevent the spread of the infection in the community. ‘OPEN’ or infectious cases of Pulmonary Tuberculosis are always treated in an ‘Isolation Ward’ of a Hospital. Padma Sundarji was getting treated at her home and hence would not be considered as an ‘open’ case. It also means that there were no Mycobacterium tuberculosis Bacilli ( Gram Positive, Acid-Fast Bacilli) in her sputum. Apparently, she was diagnosed as a case of Pulmonary Tuberculosis simply based upon an interpretation of her chest X-ray films. There was no conclusive evidence to claim that she was having Tuberculosis infection. Tuberculosis is prevalent in India but it is less common among people serving in the Armed Forces. I had mentioned in my earlier blog post that we routinely medically inspect all personnel to detect illness including infections like Tuberculosis. While she lived at the General’s residence, there was no practical chance that she would come into contact with an ‘open’ case of Tuberculosis who could transmit this infection to her. Apart from that, we routinely vaccinate all individuals to protect them from Tuberculosis. These facts were not used in establishing her medical diagnosis. She was diagnosed as a Pulmonary T.B. case by a Medical Specialist who had no special training in the diagnosis or treatment of Lung Cancer. A Medical Specialist while looking at a chest X-ray film would tend to diagnose T.B. and not Lung cancer. This Medical Specialist had misdiagnosed Padma Sundarji as a case of Pulmonary T.B. as he had no experience in the diagnosis of Lung cancer. She was given the Standard Anti- T. B. treatment and if the treatment was correct and appropriate, she would show improvement day after day. She would have felt a little better after each day of her treatment with those very powerful drugs. She had NOT shown any encouraging response to her therapy and in fact her condition was deteriorating day after day. The Medical Specialist was very convinced with his diagnosis and he had never bothered to check upon her while she was religiously taking these daily doses of intramuscular injections of Streptomycin and other drugs.   

When I first met Padma Sundarji, I had immediately diagnosed that she was not in Good Health. Her face lacked the expression that is typically associated with the vigor and bloom of Good Health. I had instinctively known that she was not responding to her Anti-T.B. treatment. I spoke to her mother Smt. Indira Rao. This elderly lady had openly expressed her disbelief in the diagnosis. She was utterly unhappy with the Anti-T.B. treatment that was being given to her daughter. She was already feeling helpless and anxious about her daughter’s life. If Padma Sundarji had been the wife of any other person, I would have immediately sent her to the Hospital and would have obtained an opinion from a different Specialist. In my previous blog post I had narrated as to how I had intervened at Military Hospital, ROORKEE and had publicly exposed the incompetence of the Medical Specialist there during 1973. Padma Sundarji was living under the shadow of her husband. If you are in someone’s shadow, you receive less attention and seem less important. I was less qualified than the Medical Specialist, and I was not in a position to convince General Sundarji to disregard the opinion and the treatment recommended by this Medical Specialist. Padma Sundarji needed urgent re-evaluation. I had asked Smt. Indira Rao to take her daughter to the All India Institute of Medical Sciences at New Delhi and obtain a second opinion. Indian Traditions stood in the way of this battle for life. Women are not expected to act on their own even if their own life is at a great risk. She could not act upon my sincere suggestion and my desire to protect the health of a person to whom I was asked to give an injection. I had administered the injections for only a short period of time and the duty was resumed by another Medical Officer. I had no further contact with her or her mother. Eventually, Padma Sundarji was transferred to Army Hospital, Delhi Cantonment. She died of Lung cancer in 1978. She was cremated in New Delhi. She never had a chance to return alive to the First Armoured Division and to her existence under the shadow of her husband, the General who later became the top Military Commander of Indian Armed Forces.   

THE BATTLE OF LIFE vs DEATH :   

In 1978, the medical community and the general public were not aware of the dangers of ‘SECOND-HAND’ tobacco smoke. People who inhale ‘second-hand’ smoke are exposed to the same cancer-causing agents as smokers. Second-hand tobacco smoke also causes Lung Cancer. By the time symptoms appear, Cancer may have begun to spread. Hence, early diagnosis of Lung Cancer is very important to improve the chances of survival of Cancer victims. I am not claiming that Padma Sundarji would have lived forever if I had admitted her to a Hospital promptly. I could have definitely helped to prolong her life by a few hours or even a few more months. General Sundarji who had repeatedly inspected and tested the Medical Unit under his Command in the First Armoured Division clearly knew that his Medical Officers at their very best could only protect and prolong the lives of his men for a few precious hours. During those precious moments, we evacuate our casualties to the nearest Hospital. If we succeed in doing so, we most certainly save some lives. In the battle of Life vs Death, a few hours makes a huge difference. Padma Sundarji who had lived under the shadow of a General did not receive the benefit that I was trained to give to the men under his Command. She was excluded and I did not evacuate her to the nearest Hospital which could have added a few more hours to her life.    

BHAJA GOVINDAM – PART – II :   

At First Armoured Division, we took pride in our training and preparedness to defend our country from the threats of external aggression. Apart from the threats posed by external enemies, human existence faces several challenges. Many times, we are not aware of the threats faced by our loved ones who live under our shelter. The Art of Diagnosis interests me,but there may be no escape from the threat and hence the ultimate refuge still remains the same, the sweet name of GOVINDA.   

Bhaja Govindam, Bhaja Govindam,   

Govindam Bhaja muudha matey,   

Sampraapte Sannihitey kaaley,   

Nahi Nahi rakshati Du krun karaney.   

http://bhavanajagat.wordpress.com   

Nyctanthes. arbor tristis,Night-flowering Jasmine, The tree of Sorrow.
Nyctanthes. arbor tristis,Night-flowering Jasmine, The tree of Sorrow.

 

Dr. R. Rudra Narasimham,  

Kurnool Medical College, Kurnool, A.P., India,  

M.B.B.S., Class of April, 1970.  

WHOLE DUDE – WHOLE REFUGE

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विद्याशंकर मंदिर (Vidyashankara temple) at Sri...
Whole Dude – Whole Refuge : Human Existence faces dangers and threats from various known and unknown directions. The Existence demands shelter, protection, and refuge to complete its journey. Image via Wikipedia
Adi Shankaracharya – Instructs us to seek the Mercy, the Compassion, and the grace of Lord Govinda to get to the Shore, to complete a Journey known as ‘Samsara’.

Human existence faces challenges from several directions. The nature of man’s existence is conditioned and man has no alternative other than that of seeking the protection of LORD God. The sweet name of Govinda is the ultimate refuge when man is checkmated and has no way to escape from dangers threatening his life.

Bhaja Govindam, Bhaja Govindam,
Govindam bhaja mudha mate,
Samprapte sannihite kale,
Nahi, Nahi rakshate ‘Du krun Karine’.

Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,

Kurnool Medical College, Kurnool, Andhra Pradesh, India,

M.B.B.S.  Class  of  April,  1970.

WHOLE DUDE – WHOLE PUJA

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Karmanye vadhikaraste Maa Phaleshu kadachana 

Maa Karma Phala hetur bhoor maate sangostwa Karmana. 

  

  

  

THE TRADITION OF “GURU” WORSHIP(PUJA) : 

Since Vedic times,in the Land of India ,teachers are held in high esteem and the reverence is reflected in the following verse.According to my uncle,Capt.R.R.Rao,”there is no ‘Mantra’ greater than this”:
 

Guru Brahma,Guru Vishnu,Guru Devo Maheswara
Guru Sakshaat ParaBrahmam,Tasmai Shri Gurave Namah.
 

 

 MY GURU : 

After joining Kurnool Medical College in 1965,I had started visualizing Lord Sri Krishna as my personal Guru.I had a pocket-size edition of BHAGAVAD GITA published in Gorakhpur,Uttar Pradesh.The book included the verses in Sanskrit with its literal meaning in English.That format had allowed me to read the verse in its original form and understand its purport through my own efforts.I had a hectic time at the School and was exposed to new information every day.Over four and half years time,I had studied Physics,Anatomy,Physiology,Biochemistry,Pharmacology,Microbiology, Pathology,
Forensic Medicine,Ear,Nose&Throat diseases,Ophthalmology,Social&Preventive Medicine,General Medicine,Surgery, and Obstetrics&Gynecology.Simultaneously,I was reading one or more chapters from Gita every day and was slowly incorporating Krishna as my Guru.I was more attracted to His teaching of ” KARMA YOGA ” and I would still consider Him as my Guru even if “GITA” is the only known contribution made by Him.My elder brother Pratap stressed about the importance of ” GURU KRUPA “( Master’s Compassion).My Guru’s Mercy is revealed to me in the fact that I am able to work seven days a week.I can very easily manage to work eighty or more hours per week on account of this Guru-Sishya relationship.I do not experience any stress or mental fatigue on account of sixteen hour work schedules.At the same time,I am mentally alert and could indulge in a bit of creative writing every now and then.Apart from this ability to work 365 days each year while I am 59 years old, the following verse shows that they are advantages in having Krishna as personal Guru :
 

Bhagavad Gitaa kimchi dhadheetaa, 

Gangaa jala lava kanikaa peetaa 

Sakrudapi yena Murari samarchaa, 

Kriyatey tasya Yamena na charchaa. 

Bhaja Govindam,Bhaja Govindam 

Govindam Bhaja muuda matey.
 

  

MY OTHER GURU : 

Adi Shankaracharya has emphatically stated that his identity is neither that of Guru nor that of a student or disciple. I am not free to describe him as my Guru and I cannot call myself his disciple. I need to reflect upon my Identity and seek that Identity to experience the Reality.

 

Fortunately,I did not spend any time and energy to search and discover the right Guru.The choice was made for me the moment I had arrived on this planet.I grew up in a family which followed the ” SMARTHA ” tradition established by Adi Sankaracharya.I had the freedom to designate SHIVA as my personal Protector.I am free to choose RAMA as my Benefactor.I seek favors from SARASWATHI in my pursuit of Pure Knowledge.I make the perilous journey across the ocean with encouragement from HANUMAN.GANESHA assures me of success in my personal endeavors.In my struggles and battle of life,Krishna guides me to find the winning strategy.If I have to defend my self,I draw courage from Bhavani.With the blessings from my other Guru,I had described my attitude about human existence as that of                            ” INDIVIDUALISM “. I love to read and memorize the beautiful verses composed by him.I would just quote a verse which my eldest brother,Prof.R.Subbarao had observed to be a very powerful thought: 

Shadamgaadi Vedo mukhe sastra vidyaa 

Kavitvaadi gadyam supadyam karoti 

Guroramghri padme manachenna lagnam 

Tatah kim, Tatah kim,Tatah kim,Tatah kim. 

Even after learning every thing that is humanly possible,we still need to desire and focus upon the lotus feet of the Master,the giver of Knowledge. 

Dr. R. Rudra Narasimham, 

Kurnool Medical College, Kurnool, A.P., India., 

M.B.B.S., Class of April, 1970 

  

 

 

 

 

 

 

WHOLE DUDE – WHOLE FEAR

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 Ullanghya Sindho salilam saleelam
Ya soka vahnim Janakaatmajaayaa
 Aadaaya te nieva dadaaha Lankaam
 Namaami tam praamjali Anjaneyam.
 In one great leap of faith,Hanuman jumps over the sea with utmost ease,whereas crossing the sea evokes only a sense of fear in my heart.I derive some hope from the legend about the land bridge built by the army of monkeys.The Sea God had promised that the rocks and boulders used for the construction of the bridge will be held in place and stay afloat.He did that to please Lord Rama.During my journey across the ocean of ‘ SAMSARA ‘,I could use the name “RAMA” and remain afloat.
 
 
 

   

  

LORD RAMA - THE MEDICINE FOR A DISEASE KNOWN AS 'SAMSARA'
In the fearful journey described as 'SAMSARA', I would use Lord Rama's name as a 'Life Jacket' and also the name serves like a Beacon of Hope and provides a sense of direction while journeying across an uncharted sea.

 

 The fear of the Lord is the beginning of Wisdom” says the Holy Bible,in The Book of Proverbs,Chapter1,verse7.For the religious traditions that originated outside of India such as Judaism,Christianity and Islam,the fear of the Lord could be a primary motivating factor to seek worship of the Lord.On the contrary,the religious traditions that originated in the land of India,do not encourage their adherents to entertain any such fear of the Lord.In the Indian traditions,the Lord or deity that Indians choose to worship would receive them with a sign that proclaims ” BE FEARLESS “.The Lord reassures them with a sign that is popularly described as ” ABHAYA HASTA “or ” ABHAYA MUDRA “.In Indian literature,countless number of images,idols,paintings and drawings,there are invariable references to a consistent message of ” ABHAYA “and naturally Indians are less concerned with ” The fear of the Lord “.  

The cultural traditions that originated in India motivate people to seek refuge or shelter at the Feet of the Lord by evoking a sense of fear and this fear is described as the fear of ” SAMSARA “.Samsara or Bhava describes the viewpoint about the human condition and deals with the problems of human existence.It contributes to a sense of apprehension and anxiety and the attitude it generates is one of intense fear and helplessness.Samsara portrays the picture of life’s journey as a tedious,difficult and challenging swim across an unknown,uncharted and treacherous ocean.Samsara is also depicted as a serious disease entity afflicting a person’s health and is referred to as ” BHAVA ROGA “.Others view Samsara as existence in a bottomless deep pit(“AGHADHA”)or that of being trapped in a deep well from where an escape would not be easy.The fear of Samsara/Bhava,the human condition,has nothing to do with physical courage.The powerful idea of Samsara inspires a sense of fear in the hearts of even the most courageous of all people.Cultural traditions that have their roots in the other parts of this planet may not be aware of this kind of fear and hence the fear of Samsara could be viewed as a feature that defines and molds the Indian Identity.Indians chant the Lord’s name as a medicine to cure this terrible disease and they seek Lord’s protection to reach the shore and complete the journey across the ocean.There are numerous references in Indian literature and some verses could be quoted to illustrate the point.  

1.SRI RAMA MANTRAM:  

  

Human existence faces challenges from several directions. The concept of Samsara is an additional and significant challenge experienced by the people of Land of India. Lord Rama during His life's journey had faced several challenges and His name gives the comfort and protection that I seek while my journey is rough and tough.

 

 Samsara sagara bhayaapaha viswa mantram  

Sakshaanmu mukshu jana sevita siddhi mantram  

Saranga hasta mukha hasta nivasa mantram  

Kaivalya mantra manesam bhaja Rama mantram.  

This verse would banish the fear generated by the ocean like Samsara.  

2.THE PRAYER TO LORD MAHA VISHNU:  

  

"VANDE VISHNUM, BHAVA BHAYA HARAM" - Salutations to Lord Vishnu, the Destroyer of the Fear of Samsara.

 

Shantaakaaram,bhujaga sayanam,padma naabham,Suresam,  

Vishwaakaaram,gagana sadrusam,megha varnam,subhangam  

Lakshmi kaantam,kamala nayanam,yogi hrudyaana gamyam  

Vande Vishnum bhava bhaya haram,sarva lokaika natham.  

The prayer would destroy the fear of bhava/Samsara.  

3.THE PRAYER TO LORD LAKSHMI NARASIMHA SWAMY:  

  

THE UPLIFTING POWER OF LORD NARASIMHA TO CONQUER THE FEAR OF SAMSARA.

 

Samsara koopa mati ghoramaghadha mulam,  

Samprapya dukha sata sarpa samaa kulasya  

Deenasya Deva krupayaa saranaagatasya  

Laksmi Nrusimha mama deeht karaavalambam.  

The verse pleads the Lord to extend His hand and physically lift the worshiper from the horrible bottomless well of Samsara.  

4.THE PRAYER TO LORD SHIVA:  

  

LORD SHIVA, THE PROTECTOR, THE DESTROYER OF ALL FEARS.

 

Praatarnamaami girisam girijaardha deham  

Sarga sthiti pralaya kaarana maadi Devam  

Visweswaram vijita viswa manobhiraamam  

Samsaara roga haranoushadha madviteeyam.  

The verse describes Lord Shiva as the root cause of creation,sustenance and eventual destruction and the Lord’s name is the matchless medicine to wipe out the disease of Samsara.  

5.A PRAYER FROM BHAJA GOVINDAM:  

  

Guru Adi Shankaracharya describes the fear of Samsara and its resolution by seeking protection from chanting the name of GOVINDA.

 

Punarapi jananam punarapi maranam  

Punarapi jananee jatare sayanam  

Eha samsaare bahu dustaare  

Krupayaa paare paahi Murare.  

This verse seeks the compassion of Vishnu to reach the shore and to get over the problem of this difficult existence which involves repeated cycles of birth,death and rebirth.  

6.KALI KALMASHA NAASANA MAHAA MANTRAM:  

  

SHODASA NAAMA MANTRAM. The Sound Energy of these 16 names would destroy all the polluting effects of our present times.

 

Hare Rama Hare Rama-Rama Rama Hare Hare  

Hare Krishna Hare Krishna-Krishna Krishna Hare Hare.  

 
This Mantra is composed with sixteen words and hence is also known as Shodasa Naama
Mahaa Mantram.Amongst all Vedas,there is no better device than this Mantra to seek
 

  

deliverance from the trappings of Samsara.The following verse from Kali Samtaranopanishad  

proves the efficacy of this Mantra.  

Eti Shodasam Naamnam,Kali kalmasha naasanam;  

 NaaTha parataropayaH, Sarva Vedeshu drusyatey.  

Human existence is beset with countless uncertainties and difficulties which may arrive without any prior warning from different directions in an unpredictable manner.It is rational to approach life with a sense of apprehension and seek the help of the Lord who graciously held His right hand in a show of compassion and receives with a greeting of “ABHAYA” and is willing to banish the fear of Samsara.  

Please also view a related blog post titled ‘Defining Indian Identity – The Land of Karma’  

http://bhavanajagat.wordpress.com/2009/09/07/defining-indian-identity-the-land-of-karma/  

Dr. R. Rudra Narasimham,  

Kurnool Medical College, Kurnool, Andhra Pradesh, India,  

M.B.B.S.,  Class of  April,  1970.