Blame Transfer & ' Scapegoating'

When Rahul Saxena (name changed) died recently of liver cirrhosis due to excessive drinking for 20 years, the family blamed the doctors and the hospital for his death. His parents did not blame themselves or their son for drinking away his health. A fleeting mention of his wife for not doing enough to stop him earlier or his friends who gave him company every evening for booze, paled away in the face of the hospital and the doctors who they considered responsible for the tragic outcome. That Rahul was brought to hospital in a critical state having vomited 2 litres of blood did not mitigate their fury. The 10 minutes of delay in the doctor’s attending to Rahul and the one hour time lag for procuring blood for transfusion, they were convinced, caused Rahul’s death and all their problems!

In blame transfer or scapegoating, feelings of guilt, blame and suffering are transferred away from a person or group so as to fulfill an unconscious drive to resolve or avoid such bad feelings. This is done by the displacement of responsibility and blame to another who serves as a target for blame both for the scapegoater and his supporters.

In this case, Rahul’s family, by shifting the entire onus of his death on to the doctor and hospital, unconsciously shifted their own sense of blame and helplessness on to others. Also, in the process, by identifying one external scapegoat, the family members found a way of remaining united emotionally.Scapegoating therefore can be seen as the perpetrator's defense mechanism against unacceptable emotions such as shame and guilt.

Blame transfer or scapegoating is something we do almost everyday without quite realizing. When a smoker develops lung cancer after years of heavy smoking, it is the tobacco lobby at fault. If the cancer, when detected is at an advanced stage, the fault is of the 1^st doctor who ignored that nagging cough and did not ask for a bronchoscopy. If he finally succumbs to his disease, then the cancer specialist and hospital are guilty for not being able to achieve a cure. Everyone is guilty, except the smoker himself or his family, the people who really allowed all this to happen.

Studies have shown that scapegoating increases as the importance of religion or faith declines in our lives. It is no longer God’s will or destiny. Happiness has become our right and if we are prevented from achieving it, someone must be responsible. And as often happens in matters of health and life, doctors are the favoured scapegoats. It is a lot easier at parties to blame someone rather than ourselves if something has gone awfully wrong in our lives or our families.

Doctors need to understand this unique need of desperately distressed patients and their relatives to want to paradoxically blame them instead of thanking them for their efforts. It is not logic but compassion that these blamers seek. And doctors need to be generous to them.

 As published in HT City ( Hindustan Times) dated 30 January,2011.

AMBULANCES and Emergencies

As we Indians refuse to really believe that emergencies could strike our homes and us, we are caught horribly off-guard and unprepared when a sudden crisis does strike. Most of us, for instance, may not know what number to call in case of a fire or a medical emergency. One might argue that there is no point remembering numbers that we are convinced would work, and we rely on our skills of “jugaar” as the best way out.

Efficient ambulance services, by quickly bringing people who have suddenly taken critically ill, to medical attention, have indeed saved many lives. The London Ambulance Service, started since 1897, is one of the most efficient with 400 ambulances and 4500 strong staff parked in different parts of the city, poised to rush in. A telephone call to a central command and control center evokes a quick response. The service is not merely of transportation of sick person to a hospital but also provides resuscitaion, preliminary care, oxygen, life support and so on.

The quickness of response may make all the difference between life and death especially in the case of a sudden heart attack. The Emergency Medical Services of Seattle serves as a world model. A single phone call makes fire-fighters (yes, firefighters!) rush to the spot in less than 7 minutes. This time is critical as brain death occurs if blood circulation to the brain has stopped for 5 minutes or more. The fire fighters, who are trained and equipped, can resuscitate patients, provide cardiac massage, defibrillate a stopped heart, give oxygen, start intravenous drugs, and transport the patient to the nearest equipped hospital. With this strategy, 40% of their patients with cardiac arrest survive compared to 20% in other American cities that have longer response times.

What about our Indian cities? A web search shows around 15 hospitals in Lucknow to offer ambulance services. Most however is only on paper (or net). Few private diagnostic centres arrange ambulance pick-up and drop for patients who undertake expensive tests such as CT or MRI scans with them.

One trust (Dr Akhilesh Das Gupta Charitable Trust) provides a semblance of a true ambulance service in the city. They have a central control room (numbers 0522-3911222, 0522-6560000) that responds promptly, have 7 ambulances parked in 6 parts of the city to respond quickly ( 20-30 minutes), offer transportation to any hospital of the patient’s choice, and is free of charge (you need not worry about money in the middle of the night). The ambulance however has only a driver, and does not have any additional staff or facilities for resuscitation or cardiac revival.

As they say, “A wise man knows his neighbours”, a wise citizen should know how best to seek help in his city in an emergency. 

As published in HT City( Hindustan Times) dated 23 January, 2011. 

DE-STRESS YOURSELF

Is chronic stress wearing you down, making you anxious or irritable, giving you frequent headaches and preventing you from concentrating? Do you feel exhausted easily, have lost your appetite for food or sex?  If so, you've got stress. It is not difficult to recognize, although many people who are obviously stressed tend to deny it to themselves, fearing it as an admission of weakness, in their subconscious mind.

Stress is internal, which explains why it can wreak havoc on your health. It feels awful...it's the sense that you're not in control. The easiest way to mitigate its effect is to take charge of the one and only thing you have the power to control...YOU, and let go of what you can't control.

Here are few steps to destress:

Laugh. Laughter really is the best medicine. It is proven to lower tension, and at the same time, improves blood flow and the health of your heart. Rent a funny movie or hang out with that wannabe-comedian pal, and forget about your worries for a while. Joining a laughter club can be transforming.

Socialize. Spending time with friends and family who give you a sense of belonging, purpose, and fun may provide all the stress relief you need. Avoid discussing your woes all the time. It becomes a habit and tyhe mind gets stuck on negative issues.

Get some fresh air. If you are cooped up inside all day, take a few minutes to get outside and see the sun. A little time in the great outdoors can improve your mood and help you relax.

Take a (virtual) vacation: "I close my eyes and visualize being on the mountains in Garhwal," says one of my patients,. "I feel the cool air and hear the distant chyming of temple bells."  Day-dreaming at times can be relaxing.  It helps to get away from the constant nagging stress of life once in a while.

Music: Listen to soothing music. Choose anything that triggers a positive image or is soothing. Remember that your brain may have the imprint of the “lori” your mother sang to relax you and put you to sleep when you were small.

Develop hobbies: When I write “Health Adda” for instance, I forget my departmental and hospital woes for a while and see health a larger picture of well being.

Breathe deeply and slowly. When we are stressed we tend to take quick and shallow breaths. Ifyou cotrol your breathing, make it deep and slow, it destresses your body. Tat is why “Pranayam” is so helpful and so widely recommended.

Be thankful. Gratitude is a beautiful virtue. Recognize all the wonderful things that you have got, rather than couting those that you did not.

Meditate:  As all energy comes from The Boss, connecting with Him periodically can be the best way to recharge yourself.

 As published in HT City ( Hindustan Times) dated 16 january, 2011.

Which Exercise For Me, Doc?

“Which is the best exercise for me, doc?” is a frequently asked question I find difficult to answer and that I often return with “ Which one do you like best?”

If you thought docs always had the perfect lives and answers, this personal recount will tell you how very human and vulnerable we are. Having been a sports enthusiast in my younger days, weight had never been a problem till my 40s, as a daily dose of soccer, cricket or shuttle with young colleagues kept me trim. Games further added that “enetrtainment value” that is so unique about them.

Things changed when forgetting may age, I tried a scissor shot on the soccer field, landed with a thud, broke my bone, and realized that soccer had now become a game to be only watched on TV screens. In a few months, when I grew  a paunch, a senior colleague suggested tennis. It was a refreshing change and provided the much needed pauses between points during which my vintage colleagues and I could catch our breath.Ten years rolled pleasantly by except for the seasonal gain of 3-4 Kg of  body weight during the monsoon months that we struggled and shed when the rains left.

When I developed a “tennis elbow” a few months ago (my friends laughed that I got it in my left one!) and had to discontinue tennis, my family insisted that I try walks. I had never been a steady walker and considered this lengthy exercise of crossing suspiciousy looking dogs and men, monotonous and flat. I soon gave up.

When my son, worried about my lack of stamina, dragged me to the gym one evening, my initial fascination with the treadmill turned to horror when the calorie-meter showed that I had burnt only 46 Kcal, about half that of a nice sized chapati,.after having spent 10 endless minutes on the machine.

There is really no such thing as the best exercise that fits all. We need to move our bodies (that is aerobics), for around 30-40 minutes, should rave up your heart rate and breathing, and should do it with regularity. While I continue my search for what is best for me, you could try some of these websites to find out what appeals to you.

The website www.stronglifts.com provides you all information on how to build muscles, lose weight and shape up. If running appeals to you visit www.completerunning.com and learn how you can maximize your gains and make the jog interesting. If yoga appeals to you, go to www.itsallaboutyoga.com and discover which ‘asanas’ are best for you. And if you fancy dancing your weight down try www.zumba.com and enjoy the experience with Latin beats and tunes.

If you want to enjoy all the wonderful foods this world has to offer, you need to burn calories so that you don’t bulge when you savour them. So find out your best exercise and get started.

As published in HT City( Hindustan Times) dated 9 january, 2011.

TEN LIFESTYLE CHANGES FOR 2011

The New Year is a good time to make resolutions, and with life-style diseases having emerged as the major threat to our lives, it is time we usher in changes that would ensure health and happiness in the times ahead.

1.    Weight watch. Once the new year partying gets over, check your weight and calculate your Body Mass Index (BMI). You can find a calculator on the website www.gastroindia.net. Make sure you keep your BMI between 20 and 23.5.

2.     Exercise. Regular exercise of atleast 30 minutes a day has emerged as a key factor to good health. Draw up a routine that lets you achieve that through walking, cycling, running, swimming or dancing. Small measures like taking the stairs at the mall or office rather than the escalator, parking a little distance and walking the rest of the way could be simple supplementary measures.

3.     Eat right. Cut down on fast foods to no more than once a week and soft drinks to not more than 3 times a week. Avoid red meat, fried and greasy food, sweets and ice creams. Make sure you have green veggies and fruits atleast 3 times a day (WHO recommends 5 portions of fruits a day!). Add a dash of fibre to your daily diet.

4.     Road safety. Switch off your mobile while driving and make it a habit to wear your helmet or seat belt. Make sure your children wear helmets while riding 2 wheelers. Many precious lives were lost in 2010 due to this oversight.

5.     De-stress your self. Periodic destressing is essential if you wish to forge ahead in life. A car that is not serviced and tuned periodically does not run long. Try meditating for 10 minutes a day this year.

6.     Music. A daily diet of soothing music could do wonders to your mood, attitude, concentration and performance. Make sure you get enough of oit this year. (see related article on the blog)

7.    Hobbies.  Develop atleast 2 hobbies this year. Hobbies protect you from getting obsessed and weighed down with worries of home, children, work and finance.

8.    Family and Friends. Connect with old friends and relatives and spend qulaity time with them. In the daily hustle we often forget those who matter most in our lives and fail to renew our emotional energy from them.

9.    Quit tobacco.. Tobacco causes too many health problems for which you have to pay a heavy price later on. If atleast 5 Bollywood biggies could quit smoking in 2010, why can’t you? If you need help see the related article on the blog.

10.  Overcome negative emotions. They really weigh us down. Like birds let us leave behind what we don’t need to carry – grudges, sadness, pain, fear and regrets. Let us enter the New Year with positive feelings.

For previous articles by the author, visit the blog www.healthaddaindia.blogspot.com.

As published in HT City (Hindustan Times) dated 2 January 2011.