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A few weeks ago I happened to hear a bunch of residents going back and forth about Hopkins, a new TV show with underlying themes similar to most medical TV shows: trauma and drama. Although I groaned after I realized it was also a glorifying advertisement for the institution, the characters in this series prevented me from outright disliking it. They include Herman Singh Bagga, a fourth-year medical student at the time of shooting. ABC proudly displays his synopsis on its site: “He says being a Sikh puts a special responsibility on him because he may be the only member of his group an outsider meets. He views wearing a turban as an advantage because it makes him easy to remember.”

Born and reared in Erie, Pennsylvania, Herman is now at UCSF for his internship and residency. Awesome to see the Sikh identity intact and its representation held strong and celebrated in full force from schools, hospitals, resident banter, and TV screens coast to coast.

Vinay Chakravarthy represented a common cause that engulfed my spirit and traversed the universe of blogdom. I was saddened to learn that Vinay passed away early yesterday morning. May we continue to fight his battle and carry his courage and strength through our own endeavors.

Update: A message from his family and friends with memorial service information if you’re in Boston.

Some people trace their past through memorable events: birthdays, graduations, taking Amrit, changing jobs. I use sounds to form a timeline: certain shabads remind me of road trips taken with family and friends; I can map nearly all my years in school through songs released during the same time. Some sounds have become Pavlovian: hearing Mil Mere Preetama Jio makes me feel like walking against a crisp wind through a quiet tree-lined neighborhood. The urge to run on a beach and build sandcastles comes on strong when I hear Paul Simon’s “If You Be My Bodyguard.”

When I hear a single solitary beep followed by a 1.5 second pause on an overhead speaker in a hospital, however, the Pavlovian reflex is entirely distressing. A woman’s voice follows the pause and usually asks for an illegally parked car to be moved or for an employee to return a page. Yet, sometimes the calm and soothing nature of the voice is all but deceiving.

I was near the end of discussing my plan for a very sick patient yesterday on rounds. “So, in terms of GI (gastrointestinal system), the differential includes Clostridium difficile colitis, ischemic bowel, or toxic megacolon. We continued fluid resuscitation and started broad-spectrum antibiotics. Surgery just came by to see the patient but is waiting for imaging studies. Mr. A finished his contrast and was rolled down to CT roughly 30 minutes ago. Pending the scan we’ll decide on a total colectomy versus medical management.” The resident flipped through his papers while the attending scribbled his note. “Very good,” the attending replied. “Anything else?”

A single solitary beep came through the overhead speaker followed by a 1.5 second pause.
[My Pavlovian connection kicked in: Stomach drops. Heart skips a beat.]
A woman’s voice followed. “Code Blue, Radiology CT.”
[Gasp.]
“Code Blue.”
[Hold onto everything in your pockets and bolt towards Radiology.]
“Radiology CT.”
[Crap, it’s Mr. A! We just sent him down there!]
“Repeat.”
[Fly down 4 flights of stairs.]
“Code”
[Keep running.]
“Blue.”
[Turn the corner and keep running.]

The room was packed with frantic nurses and technicians trying to recount what had happened. The other intern and I grabbed gowns and gloves and pushed our way through to the patient lying on the table and covered in his own bloody vomitus. Being that the man barely made the weight requirement for the CT scanner, I jumped on a stool and compressed his chest with all my might. The sounds of the room and the voice leading the code suddenly became soft and muffled. All I could hear were crunching noises of broken ribs that transmitted beneath my hands. I couldn’t help but look in his eyes while I kept count of my compressions. Strange, I thought, he’s looking back me. But how? Did he have enough blood perfusing his brain that he was still “alive?” Was he really looking back and communicating through his eyes?

“Hold compressions!” screamed the resident.

I stopped and caught my breath. We had been at it for 20 minutes and there was still no heart rhythm. His eyes rolled to the side. Perhaps I was witnessing a soul in the process of departing. Oh, Waheguru.

He was pronounced dead 2 minutes later.

Later that day, I passed by the room that was once assigned to Mr. A. It was being disinfected and prepared for another patient: a woman, Mrs. E, who had given birth 6 hours earlier but had an unsteady blood pressure and was still bleeding. My ears picked up a familiar sound in the distance. Playing on the TV in the corner was one of my favorite tunes of recent: Orba Squara’s “Sunshine.” As I listened thoughts of warm, sunny days full of love, life and cute pigs came racing in. Spirits, both inanimate and of organism, were being reborn.

In Japji of Guru Nanak there is a phrase that refers to a cosmic phenomenon that takes place when the disciple gets embedded in his soul-consciousness– nucleus of the life of the spirit, small as a mustard grain, bright as a point of fire. The disciple lives inspired of it, and is sustained by it as the mother is by the child, the artist by beauty, the opium-eater by his dose, the Majnun of his Leili. The disciple dies when this spark of life is extinguished. His lungs breathe the moral spirit of the spiritual universe, and his eyes see what those around him do not see.*

One can only utter Waheguru when learning that the baby was born at roughly the same time Mr. A. had passed away. The spirit of the limitless one breathed life into another. Mrs E. is now thriving in the same hospital room where Mr. A spent his last few moments. The same room where “Sunshine” played before she arrived.

Death, renewal, and spiritual reincarnation are inevitably linked. Just like sounds and memories, both pleasant and anxiety-inducing, both past and newly formed. Thank you, Waheguru, for your constant watch, guidance and protection and this kind reminder.

*Spirit Born People, Puran Singh

It was my first day off as a newbie intern on the wards, and I was in a daze. I decided to walk it off by becoming more familiar with the new town I had moved into. As I strolled along the street among the crowds and enjoyed the warmth of the sun on my face I stumbled into a bunch of young folk my age with clipboards in hand huddled in front of an Indian restaurant.

Although my activist spirit usually burns bright, the daze was in full effect and apathy had crept in for the day. I had hoped to not get stopped and questioned, but one of the volunteers locked her eyes with mine.

Darn it.

“Have you joined the bone marrow donor registry?” she asked.

Selfish thoughts ran through my head: Are you serious? It’s my first day off after an arduous 10 days. Please. I don’t want to think or hear about anything related to medicine. The blood bank already calls me every other week.

Thankfully, I didn’t allow my foggy head to do the talking.

“I’ve donated blood, but no, I’m not on the registry to donate stem cells. What’s going on?”

The friendly volunteer explained she was part of a larger force trying to find a match for their dear friend. Their South Asian friend, Vinay Chakravarthy. Their South Asian friend, Vinay Chakravarthy, who’s 28 years old. Their South Asian friend, Vinay Chakravarthy, who’s 28 years old and a resident in Orthopedic Surgery at Boston Medical Center. Their South Asian friend, Vinay Chakravarthy, just 28 years old, an Ortho resident at BMC, and recently diagnosed with Acute Myelogenous Leukemia.

Watch the start of Vinay’s journey in the PBS documentary “The Truth About Cancer.”

Whoa. The similarities hit me hard. His family members were definitely screened for a potential match, I thought, but they must have been found to be inappropriate as donors. Which means he’s relying on those who are genetically similar to him for a cure. Only problem is that South Asians account for nearly nothing (only 1% compared to 69% for Caucasians) in the bone marrow registry.

Gurmukho! Wake up!

As I swabbed the sides of my cheeks I wondered if the cells collecting onto the 4 different cotton tips might have all the antigens that made up Vinay’s cells. I wondered how many South Asians afflicted with cancer were waiting for a phone call from the registry with words of hope and renewal: that a match has been found, that the potential for a cure exists.

Vinay received a transplant last summer.

Unfortunately, Vinay relapsed a few weeks ago. He just finished a new chemotherapy treatment, however, and appears to be doing well.

Whether South Asian, Sikh, African-American, or Christian, you may be the hope someone is looking for. You may be able to infuse the spirit and energy you have been blessed with into someone else. The South Asian Marrow Association of Recruiters, led by Vikramjit Chhabra and Roopjyot Kaur in Boston, has done a wonderful job educating minorities to enter the registry. I’m looking at my donor ID card right now; are you? Become a part of the National Marrow Donor Registry, stay committed if you get a phone call, and save a life.

Sikhswim helped spread the word about the Khalsa Health Fair held in Richmond Hill, New York last weekend. Volunteers with the Khalsa Health Foundation, in collaboration with Queens Hospital, provided primary health care screenings and services to the local community.

Hmm, that person in the orange looks strangely familiar, but I digress.

A broad spectrum of people were seen: from young mothers and fathers to undocumented and uninsured sevadars. I was afraid that we would be walking into a pool of rampant uncontrolled hypertension and diabetes, but fortunately, pre-hypertension seemed to be the diagnosis of the day. It was difficult to provide education on improving cardiovascular health in 60 seconds (especially when super salty langar with jalebis and mithai were being freely served downstairs), but attempts were made to connect folks to the surrounding health care system.

It was awesome to see so many young Sikhs spending their weekend helping out as well– definitely a powerful reminder that the Sikh youth are not apathetic but leaders in the making. All in all, the rhythm and pulse of compassionate Sikhs were in sync making for a wonderful day of seva and spirited efforts. Hooray for health fairs!

Status quo. Acceptance. Rediscovering yourself and your faith. Finding the path to inner piece.

I would say those are reasonable and cool themes to explore in a movie.

But throw in a Sikh transplant surgeon and a love story and you got the makings of Ocean of Pearls, a very-soon-to-be Hollywood release.

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Sarab Singh Neelam, director and co-writer of the film, founder of Lightpost Pictures, Toronto-ian, and gastroenterologist, will debut Ocean of Pearls at the Miami International Film Festival on March 2nd.

Although our protagonist, Amrit Singh, is a surgeon, his story is common to many Sikhs outside of medicine as well. I have seen one too many brother and sister struggle with adapting to western standards while compromising their Sikh identity. I would be lying if I didn’t admit to feeling the pressure myself from time to time.

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Although the film centers around issues of Sikh heritage and principles, the director adds a healthy reminder of the realities and complexities faced by most in our current health care system. In an interview he commented “most Americans do not realize that even if you have health insurance and earn good money, an accident or a health crisis can bankrupt you.”

oop3.jpg

Awesome to see folks like Sarab Singh Neelam pursue change for the community though diverse creative outlets. To see our experiences translated through characters such as Amrit Singh and the medium of film, art, and music is a beautiful gift I hope both our community and the general public will appreciate.

Check it out.

A pain assessment usually begins with the following question: on a scale of 0 to 10, how would you rate your current level of pain? During a long day of asking people to describe and illustrate their pain through words I tried to find a bit of humor by imagining whether this scoring system could be adapted and applied elsewhere…

Twenty-five years ago, when Kanwaljeet Anand was a medical resident in a neonatal intensive care unit, his tiny patients, many of them preterm infants, were often wheeled out of the ward and into an operating room.

The journey of a Sikh and his career is described in a main article in this Sunday’s Times magazine. Wow. +3 points.

Known to all as Sunny, Anand is a soft-spoken man who wears the turban and beard of his Sikh faith.

The author highlights the physical emblems of our faith. +2 points. Yet, what did this comment add to the article? -1 point. I wonder why Singh was omitted from his name. -1 point.

Anand says he does not oppose abortion in all circumstances but says decisions should be made on a case-by-case basis.

How do Sikhs approach the issue of abortion? Is all life, no matter whether he will be born with defects or endanger his mother, entrenched with a blessed spirit? How do we feel about aggressive medical care for those nearing the end of their lives? Is this in some way meddling with Waheguru’s plan for our destiny? +5 points for getting us to think about this.

In the push to pass fetal-pain legislation, Anand’s name has been invoked at every turn; he has become a favorite expert of the anti-abortion movement precisely because of his credentials. “This Oxford- and Harvard-trained neonatal pediatrician had some jarring testimony about the subject of fetal pain,” announced the Republican congressman Mike Pence to the House of Representatives in 2004, “and it is truly made more astonishing when one considers the fact that Dr. Anand is not a stereotypical Bible-thumping pro-lifer.” Anand maintains that doctors performing abortions at 20 weeks or later should take steps to prevent or relieve fetal pain.

My, what an observation. He is not a stereotypical Bible-thumping pro-lifer. -0.5 point.

Total: 7.5 points. A considerable amount of pain on a scale of 0 to 10, but not bad on my imaginary scale of a good read that raises awareness of our community and promotes open discourse on important issues that are often pushed aside.

Correction Appended

Reseachers at the NYU/Bellevue Program for Survivors of Torture published a study titled “The Effects of Torture-Related Injuries on Long-Term Psychological Distress in a Punjabi Sikh Sample” to determine whether “physical injury moderates or mediates the relationship between torture and major depressive episodes (MDE) or post-traumatic stress disorder (PTSD) among survivors of political persecution in India.” Translation: do physical injuries in the setting of torture manifest themselves through mental disease? Major conclusions of the study included that “the diagnosis of MDE was not associated with torture, although depression was associated with chronic injuries” and “injury mediates the effect of torture on longterm PTSD.” Translation: it wasn’t the torture experience itself that led to MDE or PTSD in the sample of Sikhs studied, but rather the “traumatic cues” or reminders of being tortured through the chronic injuries one sustained that led to the manifestation of psychiatric illness.

Some bloggers have noted it was upsetting to not see Sikh physicians associated with the study. Although I agree to some extent, this is where it gets a bit fuzzy for me. It would be inspirational to see Sikhs in the medical world document the physical and psychological toll of human rights abuses in Punjab. Yet, these bloggers are setting a dangerous precedent by narrowing the population to be served to Sikhs alone. We, the Sikh Panth, are a nation defined by an insignia: we must maintain our miri and piri and protect our own spiritual and political sovereignty yet embrace the circular symbol of oneness and our duty to humanity by fighting all injustices and actions of oppression. The atrocities in Punjab have most certainly not been brought to an appropriate scale of attention, and we should use that frustration to motivate us. We must, however, make sure we do not remain blind to our current state of affairs. Genocides are going on right now in Kenya, Sudan, Chechnya, Palestine, and Burma. Right now. Yes, I’ll say it again: genocides are happening right now. In fact, we can broaden the list a bit further: when an individual is denied access to healthcare or medications a human rights violation is committed. Which means I’ve indited nearly every country on the planet, including the U.S. and Canada. Our frustration should not only be with the dearth of Sikhs within the field of human rights but with the number of spirited Sikhs enraged by the brutality currently being enforced on our brothers and sisters. Let us start by reading and getting up to speed with current national and world events and then ask questions, get linked into organizations such as Human Rights Watch or Physicians for Human Rights, sign petitions, blog our thoughts, write letters to the editor, go into the field, march in the streets, shout from the rooftops… okay, I’ll end before I start calling for total anarchy. But you get my drift, I hope.

Correction: February 1, 2007

There is an erroneous statement above, and it has been striked. The blogger did not place limits on the population to be served.

Many like to joke that mini-Punjabs exist in some Canadian cities. It’s understandable when you review the stats: of the roughly 64,000 South Asians in Brampton, Ontario, 34,000 speak Punjabi. According to census data, 135,000 Sikhs reside in Vancouver alone. Sikhism also constitutes the largest religion in Surrey, Vancouver, making up 16.3 percent of the population. Numbers alone, however, aren’t enough to attract influence. The growing Canadian Sikh community garners significant political support because it is able to organize effectively, raise substantial funds, and contribute to its local and national economy.

In 2005, it was announced that a new hospital, the William Osler Health Center, would be built for the Brampton community. Under the public private partnership (P3) funding formula used to build the new hospital, Bramptonites were required to raise 30% of the building’s total cost of $536 million. Canadian Sikhs, along with local Hindu and Muslim communities, eagerly came together to show their commitment to the future of local health care. Canadian Sikhs generously pledged $10 million for the hospital. A “Better Health Radiothon” broadcast on Punjabi radio stations raised more than $3 million (nearly $1 million in the first 90 minutes!). The Sikh community in particular was recognized when officials announced the name of the Emergency Department as Guru Nanak Emergency Services Department. The Guru Nanak Emergency Services Department greeted its first patient in July 2007.

It appears that Guru Nanak Dev Ji is causing a stir not only in Brampton but in hospitals across the land of the maple leaf. The Guru Nanak Healing Garden, at the University of Alberta Hospital in Edmonton, occupies the fourth floor of the Alberta Heart Center.* Two weeks ago, Surrey Memorial Hospital in Vancouver, British Columbia announced that Guru Nanak Dev Ji’s name “will adorn the main entrance of the new emergency centre in recognition of the importance of Surrey’s South Asian community and its support of hospital fundraising efforts.” “By naming the entrance of this Surrey Memorial Hospital centre after Guru Nanak Dev Ji, we are saying this is a place for everyone,” said Premier Gordon Campbell after making the announcement.

Which hospital in the United States will be the first to jump onto the movement? A better question may be which proactive American Sikh community can foster enough support on the outside and camaraderie from within to move forward with such a proposal.

*Note comments below.

Working in the Intensive Care Unit (ICU) absorbs me both mind and soul. The ICU is not only a sanctuary for those who are critically ill; it is my tent within the camp of caring for others. It has propagated my desire to capture the spirit of Khalsa: to be selfless, noble, and brave while in constant meditation of Waheguru. I am a strong, spirited and optimistic soldier protecting the sick. My ego, however, is tamed as I see Waheguru’s expression in every thought, decision, and action that is made by both myself and others. Although my attending may believe otherwise, I kindly obey the orders of my guru to assist in both the processes of restoration and death.

The ICU can be terrifying and stressful to both young doctors and patients alike, yet it is a place where miracles often happen and it always manages to tug at my Sikhi strings without fail. I feel the rhythm of Khalsa enrapture my senses when I enter the unit. I hear it bounding against me as I make my rounds through each patient’s room. I hear it in the beeps of the telemetry monitors and ventilators. I hear it permeate through the chaotic motions of a resuscitation. I hear it softly emerge behind conversations of end-of-life care. I hear it shout gloriously when a person leaves the ICU alive and well.

“When the Khalsa runs, he is in trance. On the bed of thorns, he lies on roses. Outside is immaterial; it is the aim of life that matters. The Khalsa is he who has found the centre of life and has enshrined God in the temple of his heart. The Khalsa looks at the world from a supreme height, blessing all, helping all, loving all, with his beautiful looks from the inner self of all life.”1

I often yearn to leave my Sahajdhari status and live as a Khalsa, and it usually reaches its zenith when I’m in the ICU. Recently, however, I have noticed the rhythm of Khalsa pulsating within my consciousness even when I’m outside of the ICU. I remember singing “we are the Khalsa, mighty mighty Khalsa” when I was a child and wondering whether a modern Sikh could truly invoke Khalsa and live in a similar fashion. Funny how opinions change over time. Perhaps feeling the rhythm inside oneself is the first step to realization of its possibility.

1 Creation and the Purpose of Khalsa, Puran Singh