Monday, March 21, 2011

Gentleness And Patience While Dealing With Pain

A recent visit to a hospital brought home once more the importance of gentleness and patience while dealing with pain.  I was sitting quietly in a corner of the hospital room when a head peered through the chinks of a curtain and I saw the frightened looking face of a young woman.  She asked me if I had been through various procedures and what the process would be etc. and I did my best to reassure and amuse her until the nurses appeared and the curtain was pulled back into place.  Soon I could hear her crying aloud a little from time to time as she went through the preparatory stages for her examinations, which are not really particularly painful. I guessed she had just worked herself up into a state, but even when I felt she could not be subjected to anything very painful, my nerves jangled at every sound.  I suppose it is a reflex action; every association with pain - be it images or sounds, even if not directly concerning us, bring about a kind of wincing from within.  Anyway, after a few minutes she began to complain that she was bored, so maybe she was a habitual complainer or perhaps she was looking for reassurance or attention at a deeper level.

At the next bed lay another woman who was being given some injections that she had never taken before.  She asked the nurse about side effects and the nurse reeled out the list - nausea, headaches, vomitting...  The lady, in a burst of positivity (or defiance?) said that she usually didn't have side reactions with most medication and the nurse replied in a matter of fact way that the woman would only know after taking the injections!  Undoubtedly logical but certainly not reassuring.

At this stage I switched off and actively attempted to relax.  At this time, my mind wandered occasionally to incidents of pain or discomfort that I had felt, how I had dealt with it and what it taught me.

Physical pain compels us to focus on our bodies, diminishing temporarily the importance of everything else that might be unfolding around us.  In this way, it also limits our thoughts, actions and affects emotions.  During moments of intense physical pain, I find it useful to remember that pain is not our natural state, that it will pass one way or another, that is is caused by muscles, blood vessels and nerves being out of gear.  In many conditions (except very extreme ones) this pain generally responds favourably to a gentle and reassuring touch, be it ours or someone else's.

Mental pain is often rooted in an apprehension or lack of trust of the future, sometimes a replaying of past trauma.  It begins (as most things do, I think) from a lack of wellness in the spirit that reveals itself in the mind and trickles down to the body.  In most natural situations (not extreme or exceptional ones), the solution, therefore lies within ourselves.  I find it almost futile to attempt to negate this pain when I am caught up in it.  It is generally helpful to try and switch the mind, if necessary by picking up a cheerful book or watching a relaxing film.  When the mind threatens to swing back to its old pattern I try and pull it back to the present as much as possible.  The present rarely contains pain; an emptiness perhaps, sometimes physical problems but those can be tackled differently.  I also find that practicing some aspects of yoga (especially those involving focussing on the breath), consciously relaxing and affirming positive statements at periodic intervals during the day and being out in the fresh air amidst nature reduces a build up of negativity.  Ignoring rather than fighting seems a more effective way to deal with this kind of condition.

Pain is a very real and troubling aspect of lives, not just of people but of other creatures as well.  I end with an excerpt from James Herriot's book 'All Things Bright and Beautiful' that reminds us that we must not lose hope in the natural healing power within us, which may be eclipsed during moments of great pain.

"And as I walked back up the field a message was tapping in my brain.  I had discovered something, discovered something by accident.  That ewe's life had been saved not by medicinal therapy but simply by stopping her pain and allowing nature to do its own job of healing.  It was a lesson I have never forgotten; that animals confronted with severe continuous pain and the terror and shock that goes with it will often retreat even into death, and if you can remove that pain amazing things can happen.  It is difficult to explain rationally but I know that it is so."

Wednesday, March 16, 2011

My Morning Walk

Spring has barely arrived and already it threatens to depart in a blaze of heat.  The cultivated beds are still full of flowers but the vibrance of winter has gone.  With the trees, however, it is a different story.  They are now filled with colour and life - birds and insects flutter in and out of them and noisy squirrels run along the branches, squeaking excitedly.  The morning walks in the park close to my house continue and I can now discern a pattern in the early hours that the park witnesses.

A stout man and his wife often come out to walk soon after sunrise.  They are joined by another man, well clad, who goes about sprinkling some powders at the base of each tree.  Then there appears a large, looming lady whose clothes smell of old cupboards and mothballs and who brings seed for the birds and strews it all over the lawn.  Pigeons flutter down soon after her arrival and approach the grass greedily.

About a quarter of an hour later, an elderly, athletic lady comes to do the rounds dressed in a smart 'Patiala Polo Club' jacket.  She nods pleasantly and thanks us for giving her way as she strides briskly along, her arms swinging in an uneven fashion, bent perhaps due to arthiritis or injury.  I wonder if she has ever played polo.  She looks sporty (and aristocratic) enough to have done so in years gone by.

A couple of maids arrive, plastic packets in hand, and bend over the earth picking up some tiny green stalk-like objects.  Today I decide to ask one of them what they are doing.  The lady stands up and smiles, explains that they are picking tender buds of the manga tree (a tree that is presently covered with beautiful white flowers), these makes a delicious vegetable, she adds and gives the recipe.  I smile and she bends down again, resumes her work painstakingly.  I notice that they never shake any buds off the tree, just gather whatever they find on the ground.

The sun is up now and it is almost time to go home. On the last round I see the maid who walks a pet beagle each morning and evening.  They pass by silently, stopping at the stretch of bottlebrushes and I always feel a twinge of sadness when I see that the beagle's eyes are perpetually closed.  Can he see?  What happened to him?  I'm afraid to ask.  But he seems to be protected and well taken care of.

And so I leave them and turn homewards, also leaving behind me the chirping sparrows and the solitary kite that makes an occasional circuit of the sky.  All is as it should be in the park this morning- at least that's what I like to think.

Saturday, March 12, 2011

Shopping In Shankar Market

Shankar Market is an old, well laid out, consumer friendly market that lies sprawled in the heart of Delhi.  This market specializes in textiles and everything revolving around clothes. The shops are arranged numerically in contiguous little blocks and are identified by their numbers rather than their names.  They are run by the owners themselves along with a motley group of salesmen. Everyone knows everyone else and everyone expresses their opinions in a frank but polite manner.  This makes shopping there a completely different experience from visiting the more modern stores.

Indeed, I  have almost stopped buying ready made clothes from retail stores because apart from the fact that tailored clothes last longer, it's just so much fun selecting materials, mixing and matching, choosing the accessories (dupattas in matching or contrasting shades, all kinds of buttons, threads for embroidery - there's a need and a shop for all such things).  The shopkeepers here can be extremely persuasive and it is interesting to see them in action, especially the older ones who remain unmatched in courtesy and skill.

Then, laden with all my shopping, I stop at the tailor's- an elderly, slightly built, cheerful man who has evidently come from across the border (during partition).  He still writes in Urdu though he speaks a kind of Hindi-Punjabi as do many such people.  He always likes to have a little chat, asking me about my husband, my in laws, what I do, Yoga tips for insomnia and so on.  The topics are varied and he listens, head tilted a little, eyes bright and shrewd, looking like a small bird.  He is an adept women's tailor and I have heard his clients having the most amazing conversations with him about changes in their anatomy while he just stands there, nods understandingly and scribbles little notes in his measurement pad.

Women's outfits are deceptively simple, they often require quite a lot of work before they are ready to be worn.  The appropriate salwars and dupattas have to be selected for every kameez or kurta.  Each saree has to have its edges hemmed, a slender strip of cloth (a 'fall') to be attached behind the bottom end of the saree to ensure that it falls properly and then there's the inevitable question of getting the blouses.  Blouses, ideally, must match at least one of the colours of the saree and must fit perfectly - they can be tight, but they must never be loose!  I, of course, often appear in loose fitting blouses (incurring the wrath of my relatives) as I'm too lazy to get the measurements changed each time my dimensions change.  There is also the critical question of how revealing or screening the blouses should be and each woman (and her tailor) have different views on this!

With all these essential (and difficult) decisions to be taken, who can question the need for markets such as Shankar Market?  It is here that every query can (and will) be answered by a multitude of well wishers - should I buy this material or the other, more expensive one?  Can't I get a closer match?  Will this shrink or run?  And, of course, the most crucial of all - do you think this suits me?!

(A picture from a recent family wedding showing the change in styles over two generations.)

Thursday, March 10, 2011

Perceiving Pain

In response to my blog on the anti-placebo effect (as I called it), a friend sent a link to a recent report on how our expectation (positive or negative) affects our perception.

 An experiment using specific drugs to alter pain levels showed that people's perception of pain changed according to what they were given to believe. The interesting aspect here was that the doctors took into account 'negative expectation' or the fact that patients (especially those with chronic problems) may develop a negative conditioning which prevents them from responding to specific drugs.

I experienced some form of 'positive conditioning' recently when I visited my dentist.  I had to get a difficult filling done and he had said he would be giving me an injection for it.  So I went in, expecting no pain except for a needle prick.  But once he actually looked at the tooth, he seemed to change his mind and went straight ahead and drilled into it.  The procedure lasted for just a few minutes and, while I wasn't comfortable, I didn't feel traumatized or particularly disturbed.  Of course, this was not just because I had gone in feeling comfortable, but because of the faith I have in my dentist, developed painstakingly over decades.

I know that he is swift, sure, alert and extremely competent.  He avoids unnecessary intervention and excess medication.  He has a good idea of my pain threshold.  All these facts came together to provide a cover of reassurance while I was sitting in that chair with my jaws prised open.

And so I feel that one's response to the medicine depends not just on what one is told about it, but also on who is doing the talking. Apart from this, people are more likely to be open to taking medicines if they know that doctors are willing to listen to them should any side reactions occur, and more importantly, to modulate the treatment if it is causing sufficient discomfort.  This process can only work optimally if both the doctor and the patient are reasonable and balanced in their views.  Doctors are what they are, we can only do our best to select one who best suits our needs, but as patients, we can certainly alter our conditioning (especially negative conditioning) to a great extent to help ourselves- but that's another story!

Wednesday, March 9, 2011

Meaty Matters

Markets have changed so much in the past few years.  This morning we parked outside a shop that had originally been a department store and was now a fancy food store.  There were signs outside advertising imported meats from France, Italy, Germany etc.  My driver and I were intrigued, for different reasons.  I was, of course, surprised that there should be sufficient demand for such  special shops in a local market.  My driver was asking me what it all meant.

"I've heard of meat from goats, sheep, pigs," he said, "But what is this meat from France, Italy, Germany?"  I struggled a little while trying to explain the concept of cold cuts, of why people might prefer those to freshly cut meat, of how the flavour of the meat was different depending on how the animals were reared and why people might prefer frozen or preserved meat which had a particular taste to fresh, local produce.

He understood but I'm sure he has no desire to taste any of it.  My driver is a hill person and a fairly good cook.  For him, the best way to eat meat would be to buy the fresh meat of a mountain goat and let it simmer with plenty of onions over a wood fire until it was tender. A satisfying no-fuss meal.

As we reached home, I realized that there were many other things I had missed telling him - the existence of turkeys, sausages and other meaty tales.  That will need another (very) long drive.

Saturday, March 5, 2011

The Anti Placebo Dilemma

At the outset I should say that my views reflect a peculiar set of circumstances that I was exposed to and are not to be generalized.  However, I feel that if the current forces of pharmaceutical industry and modern medical practice continue in an unthinking or unfeeling fashion, many others may find themselves facing the kind of dilemma that I did.

For conditions that doctors do not completely understand, patient are often showered with a torrent of medicine when a trickle might suffice.  While wading through the list, one may come across medicines which are considered beneficial in a supplementary way and so one agrees to take them.  But in my case, one of these generally benevolent chemicals produced a stomach irritation, which, I discovered, was a common side effect.  But I was urged to continue with it.  "Why?  What does it do for me?" I enquired, and the answers were quite vague.  Answers like "Because you need it", "It has a host of other benefits" and "For your purposes you may think of it as a kind of protein," did not satisfy my scientific curiosity.

I met my old, erudite doctor, who is quite familiar with this medication, having used it himself for other reasons.  He cautiously agreed that there appeared to be no reason for me to take this, though subtly reminding me, with a smile in his voice, that he was no longer treating me.

I turned to the internet.  Not to the open discussion forum, but the medical reviews and original research papers, several of which are fortunately accessible to the public.  I could find no compelling evidence to indicate that this medicine would be useful for me.  Most authors agreed that it wouldn't be harmful (except for the small side effects).  Certain specialists seemed to say the same thing on their web sites, but for every specific statement there were five vague statements about how this had now become a common part of certain prescriptions.  Statistics (I had no idea how they were generated but they made me think) indicated that much of the time the medicine was prescribed because other doctors were using it and there were no follow ups to ascertain whether it was actually benefitting people.  Perhaps there were no easy ways to check as no specific biochemical functions were being considered.  There was also, therefore, no clear dosage regulation, a standard dose was prescribed for everyone.  And so on.

Eventually I used my gut feeling, which of course, told me that it was important for me to go on enjoying my food, and to be able to digest and metabolize it properly.  So I stopped the medicine and now I feel fine from inside. It continues, however, to be listed in the long list of prescribed tablets, and my doctor feels fine.  This is as conducive a situation as any, to allow healing to take place of its own accord, from within.

Wednesday, March 2, 2011


Today is Mahashivaratri, a celebration of the union of consciousness and creative energy as symbolized by Shiva and Shakti.  There are various rituals associated with this festival, a celebration of austerity and purity but for many yogis, it is a night of uninterrupted meditation.  The fourteenth night of the waning moon of this month is dedicated to the Adi Yogi or Prime Yogi, Shiva.  It is believed that the mind slips easily into a conducive meditative state on this day and thus everyone can attempt to overcome negative mental patterns and blocks if they choose to, on this night.

Of all the gods, I find Shiva the most elusive and fascinating - living the life of an ascetic atop Mount Kailash.  He of the matted locks adorned by a crescent moon, who holds a trident in one hand and a drum (he is also the Lord of Dance) in the other.  He rides the mythological bull Nandi and has a fiery temper.  His temples are present at the peak of every mountain especially in the north. 

Although this is how he is often worshipped (symbolized by a linga in temples), I prefer to think of him as an embodiment of all the wisdom of yoga and knowledge contained within the soul.
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