The changed world

Historically speaking, is peace an illusion or an interlude?

Is war a natural continuum?

We are at the crossroads of destruction that we hoped to circumvent through mutual assurance.

Over millennia, humans have been enslaved by the vicious and few. A systematic subjugation of proletariat thrived as a feature and not a bug. Monarchy and feudalism were never an aberration. Fear is the strongest emotion. Fear has been a failsafe tool to subdue the human spirit by the oppressors. Greater oppression versus spineless surrender was the buffet of choices on the dinner table for much of the human history. Most capitulated in the face of tyrannical forces that astronomically outweighed in power and ferocity. Human spirit was made to bend.

The defeated sometimes chose to be complicit. And the complicit displayed newfound loyalty with the zeal of convert. Violence was amplified and extortion enforced.

Glory and grace found rare and sporadic space.

Violence, intimidation, plunder, thievery, rape and murder have been the gory tools of the celebrated and victorious. Names changed, methods thrived.

Courage is a virtue we all strive for. Some excel at it, many come short. Predators know it. Enslavement can be multifaceted — physical, spiritual, material, financial and potentially transcendental.

Transcendence perpetuating through evanescence. Generations of peasants toiling namelessly, coerced to extol the virtues of the emperor of the time. The impoverished proletariat existence reduced to fertilize corrupt egos of vein and decadent rulers who often doubled as divinity.

The world has struggled to change. But the wheel was stuck in circular motions.

Stuck in moral, intellectual and physical mud, the human engine sputtered and submitted to unenviable existence. The few, the evil, the ones in cahoots with the devil ruled the helpless.

In our unencumbered weakness, in our myopic vision, in our benevolent neglect, in our intellectual lethargy and in our prostrate submission we strengthened the empowered. Unenlightened, we put to hazard, again and again, our exposed underbelly.

The kicks came in on schedule and never ceased.

The helpless fell to ruthless, living burdened with the chore of living, smothered by unbearable anguish of the prematurely dead.

The human history changed for the better with formation of the USA. Enlightenment, democracy and human empowerment replaced oppression and lawlessness. We all know that the stated virtues enshrined in the Constitution have taken centuries to reconcile with practiced reality. Still, the progress has been stunning. If there is an exodus of disappointed citizens against structural bias in this country, it has escaped my notice. We are flawed, but still the best.

The current events demand reinforcement of the founding principles of the USA. The democratic government relies on a temporary lease of power, contingent upon performance. Concentration of powers in a few autocratic tends to have the blood of many on its hands. Promotion of democracy across the world is a perilous and expensive task. But when measured against the price of indifference, it becomes prohibitively expensive and unaffordable.

The checks and balances in the power structure need to be reinforced starting at home.

If the government is not of the people, it won’t be for the people. From the engulfing fires in Europe, the vows to democracy seek renewal. It is an existential necessity to save humanity from the worst impulses of the worst among us.

Nationalism is a potent force. The virtue of patriotism is at its core but a plethora of ingredients complete this mosaic. The mosaic is always changing.

Our convictions in the inevitability of our current identity are only a part of the continuum. The farther we move the historical line, the more alike the humanity gets. Entropy, the second law of thermodynamics, is at play in human affairs, too. Do we have intellectual gravitas to defeat this law of nature and find ways to bury our hatred? Or hatred is entropy’s tool to lay waste the humanity.

Words crowd the mind and emotions erupt in the heart, as humanity is threatened by the maniac ambitions of an insatiable.

Ukraine is being bloodied and martyred as the world stands in fearful solidarity. We have to successfully navigate this mortal provocation.

Then we have to double down on democracy. Flawed as it is.

“Democracy is the worst from of government except all other forms of government that have been tried from time to time.”

Let Churchill smile in his grave.

– Brij

Education. Final Common pathway

Education is the cheap defense of nations-Edmund Burke.

Education is a formidable tool. Its virtues are not confined to the conscripted. Its a genie that unleashes life. Pursuit of fulfillment is given a path.

A commitment to education is a collaborative effort. It demands individual discipline cultivated by family, school, society and nation as a whole. 

As a fortunate recipient of a dedicated collaborative that churned out some of the wisest humans from the humblest of beginnings, I share with you my traipse in life.

I have had the privilege of a lifetime to be a cardiologist in Bakersfield for last thirty years.

Education is the ultimate equalizer. The promise of education is not zero sum, distributive or regressive. It empowers all and raises the tide.

An enlightened society or a society seeking enlightenment is best focussed on educating all. There is no better return on investment that enriches all aspects of life. An access to education demands a system that guarantees safety, health and shelter.

Such ambition can’t be dismissed as a platitude. The alternative is a collective decline.

Incarceration and recidivism don’t have a stellar record in shaping productive humans. We need to seed accountability, discipline and civic cohesion through universal education. Cohesion does not imply a communist or Nazi parallel of ingrained agendas. Here in this country, we have already established the merits of critical thinking and audacity of self belief. The entrepreneurial spirit in education undergirds  our leadership in science, finance and others.

Those wheels need to stay on the wagon.

The riddle is in universal access.

And in welcoming meritocracy, again.

A watered down math and elimination of standardized testing has aroused passions in a segment of intelligentsia. Such passions have understandably kindled hopes among our competitors that we are choreographing our failure.

We don’t win by scoring against ourselves.

A rigorous commitment to STEM syllabus is a national imperative. Math makes it mathematically impossible to have double standards.

This training wheel needs to come off.

All knowledge grows in the cradle of present, supported by past progresses.

Human bias is a constant of nature.

It pulsates with every heartbeat.

Education, discipline, conscience and moral underpinnings continually struggle to rise above the biases. Overcoming profit motive is a perennial challenge.

The exaltation of humanity, conceived in the constitution, suffered and submitted to the prevailing biases of the times.

Yet, as a first in humanity, it laid the foundation of the road for eventual emancipation and parity.

Racism of 17th, 18th, 19th and 20th century was embedded both osmotically and maliciously, in American culture.

Malice in some, osmosis in all.

Just like now.

Bias is a mountain, always uphill.

But we have walked uphill for a long while and triumphed many steep slopes. In our frustrations to reach the top we can’t disparage  the sacrifices of generations, who made today possible for us.

Cultural appropriation needs to shed its pejorative insinuations. Sharing is a thing of beauty. Its cultural evolution and is emblematic of societal integration. Cultural assimilation may better intuit the soul of camaraderie.

Trans-generational score settling is another conundrum.

Violence, plunder, pillagery, rape and murder have been a failsafe recipe for the few and powerful to decimate the rest of us.

In my part of the world, British colonialism drained millennial treasures from India.

On the way out the colonialists bestowed a partition, that killed and bloodied millions. Temptations aside, reparation is in asserting self actualization.

Education comes to mind again.

Its been said there are two kinds of illiterates. Ones who can’t read and others who can but wont.

Education may fail to lift the veil of prejudice in all, at least it can offer a choice to some.

– Brij

Merry Christmas

The long journey of Christmas from reluctant celebration in 4th century AD to current cosmopolitan, kaleidoscopic, cultural extravaganza merits a brief historical look back. The early puritans confined celebrations of Jesus of Nazareth to Easter. Even the precise date of birth was apparently kept a mystery to preempt celebration of Jesus’s birth.

Christmas was first celebrated in 4th century AD and increasingly found an enlarging audience. By middle ages Pagan celebrations were comprehensibly substituted by Christmas. There were brief periods of puritanical cancel Christmas outbursts, both in England and USA. Those outburst had the longevity of ephemeral effervescence of yesterday’s bubbly.

The legend of Santa Claus goes back to 280 AD when a monk named St. Nicholas catered to needy, sick and children. His generosity has since been immortalized in the slightly modified name of Santa Clause. He still puts smiles on children’s faces.

In 1870, Christmas was declared a federal holiday in USA.

From proximity to Winter Solstice, birth of Jesus and advent of a new year, the politically correct connotation of Holiday Season, bundles an assortment of joys. For the faithful, reasons for gratitude maybe many. But joy seems to be universal, and that we can be grateful for.

As we anxiously step out of the smothering confines of the pandemic, prayers may seek answers in the attenuated virulence of Omicron. Let it be a vaccine for the world. Thats a miracle this Christmas may well be remembered for.

Meanwhile, from my house to yours, Merry Christmas!


Cohabitating with Covid

The chaos that marked the first two years of pandemic is finally settling in to a sharpening focus. The virus is no longer novel and vulnerability no longer universal. The degree of contagiousness and severity of virulence of continually mutating virus will keep us vigilant but wont push us in to a paralysis of locked doors.

We have learned much about the virus. We know how it spreads and deep cleaning is a resource wastefulness. From the peak in hospital mortality of twenty plus percent, improved care has favorably reduced the death rate to mid single digit. We know virus lethality favors elderly, obese and those with comorbidities. We are better able to triage our efforts to those at most risk. At risk patients can significantly lower risk through out patient monoclonal antibodies.

Vaccines and boosters remain the most effective preventative tools.

Unfortunately, virus also shed light on some of our flaws. We humans think differently. Cognitive bias can lock our brains in a hermetic seal. The fat based virtue of open mindedness that welcomes persuasiveness does not stand a chance.  Facts get distorted and reason gets reduced to derision. It is what it is.

The vaccine divide whether by personal choice or barriers of access is here to stay. Issues of access are being incrementally remedied. Naturally acquired immunity also makes a “natural” ally in the fight against the virus.

Pharma, mRNA based vaccines, compliance to mitigating measures etc by many give us rising hope.

Against this background, we have to choreograph a realtime readiness as new variants morph in to the next surge. Fortunately, here we are dealing with only two variables: hospitalization rate and numbers likely to be hospitalized. We don’t have a three body problem. We can work with this modeling.

If we take only hospitalization as a metric to calibrate mitigation measures, we look at a lagging indicator and predictably doom the healthcare as a large number of newly infected will faithfully stress supply chain as time lag catches up.

The projected hospitalization rate based upon prevalence of infection and severity will lend a workable calculation on hospital occupancy two weeks hence. Current occupancy is only relevant when blended with projected peak hospital occupancy. This integrated model can lessen uncertainty and rectify future demand supply disequilibrium. A calibrated approach that guides mitigation measures is our key to unburdened health care and open businesses.

Example: lets say healthcare need to be determined in a community of 1000,000. Lets say the new variant infects 10% over a period of couple weeks(an extreme scenario). If the variant causes hospitalization in 2% of the infected, then projected cumulative demand over next 2-4 weeks will equal 2000 beds.

These numbers are not static. New infections, adoption of mitigation measures, recoveries, existing hospitalizations, length of stay in hospital, ICU occupancy etc are many variables that can be predictably modeled.

On the other hand if downstream hospitalization rate is less than 0.5% then virus essentially becomes a vaccine. Putting emphasis only on number of infections in a community is an incomplete and practically useless metric.


Fall Colors – Sept/Oct 2021

End of September and beginning of October presents possibilities of Nature’s miracles in Colorado Rockies. As the temperature looks winter-wards, the green on Aspens deepens pigments to present a dazzling spectacle of colors. From a greenish yellow to deep crimson, present a plethora of colors erupts in to a visual delight for the mesmerized eyes. Season’s first snow lends added contrast to rich colors. The colorful flora in the lap of towering, freshly snowed mountains, wows the cursory to committed.

With my family and a few very dear friends, I happened to avail Nature’s blessings, an annual ritual in this part of the world. Aspen, Snowmass and Vail are small towns with worldwide fame. Its easy to see why.

Nature speaks for them. It finds eloquence in colors, in towering height of fifty eight 14ers and lung cleansing air. The magic seeps deep in the soul.

A single day may behold whether befitting a year.

Early morning freeze, midday heat on a taxing hike, late afternoon thunderstorm with “tropical” rain shower, followed by sudden break in clouds only to be substituted by late evening snow flakes. Its a cycle that we experienced more than once in a week’s escape to the Rockies.

The long hikes at demanding inclines and challenging altitude confer long periods of absolute silence. The sense of awe finds a companion in introspection. Problems seem to find solutions.

Plagued by divisiveness, an unsettled mind yearns for an answer in nature. It strives to seek a resolution.

The changing colors tell a captivating story.

Photosynthesis is the founding miracle of nature that blends water, carbon dioxide and sunlight to yield life sustaining oxygen and energy. Trees have evolved to do it effortlessly and flawlessly with 100% efficiency. No wasted effort. No wasteful residues. As Fall temperatures plummet, days get shorter, photosynthesis splutters and leaves blush. No more worthy of photosynthesis leaves fall and fertilize the next bloom. They fall in style and breathtaking splendor.

Hate should be deciduous, love perennial they seem to say.

Hate should blush with shame and fall alike Fall leaves, to be reborn as love. That’s a cycle of life the Fall seems to inspire.

Imagine spellbinding colors of a Fall leaf drifting elegantly towards the ground, having fulfilled its obligations to support photosynthesis. Now committing to raising the generation next. Thats how nature renews its vows. Life intuitively sustaining itself.

Hate is counterintuitive to humanity. Love is the necessary glue.

The falling leaves helped me shed some of my prejudices. It was a refreshing and a necessary interlude.


Re athletes and stress.

It’s life.

All spheres of life share their burden of expectations.

I’m a radical and I confess.

Irrespective of load of unshed tears in my dry eyes and shoulder bending load on my torn rotator cuffs, my hands stay steady in service to my chosen profession, when maneuvering intricacies of damaged plumbing in human body.

Patients deserve and get the best outcome.

Now let’s say I’m physically damaged or intellectually impaired in a way that compromises patient care, then it will behoove me to back off.

It should be given a neutral acceptance of an ordinary act.

But that’s not what’s in play.

In our reactive trashing of all things White, we have sunk to the level of celebrating failure.

Biles has earned her successes.

She withstood sexual abuse and kept it together.

Thats a cause for celebration.

Nation owes her appreciation, and she has been well appreciated.

If her mental faculties stood in her way to perform her best, its her right and obligation to back off.

She did that.

And that’s noteworthy.

What’s equally noteworthy is amount of ink that has been spilled to spell heroism out of personal injury.

Failure irrespective of color is not a cause to celebrate or demean.

Somehow failed accomplishment of good intentioned athletes of color has become a surrogate rallying cry for the cause in general.

That’s new racism.

I resent all racism.


July 4

Emerald Bay, Lake Tahoe

Hello, Sonya!

The Great American Experiment began July 4th, 1776. Taxation without representation provided the initial thrust to the fueled passions, unleashing expansive dreams of human emancipation across the globe. The Declaration of Independence aimed to put human rights on a pedestal “we hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”.  Humanity had never aimed higher. That notion undergirds the nation called USA. That notion undergirds flight of freedom in human soul, irrespective of the moving lines across nations, called borders. The utopian interpretations of the nascent experiment lamentably failed to achieve immediate luminescence. The soaring rhetoric will struggle for centuries to surmount human prejudices and incrementally extend benefit to the rest. There of course is a distinction between an event and a process. For the event to deliver its promise, process is necessary. Yet a moral bar had been set.

For those who lived and died witnessing an egalitarian experiment but, were systematically denied participation, stood doubly harmed.  Only privileged could have it for generations.

Enslavement of humans while celebrating emancipation of humanity is not merely a revolting contradiction in terms. Its a sin. As It has rightfully been judged to be an original American sin.

Serial massacres of unsuspecting Indian aborigines, shredded treaties coaxed by Machiavellian promises and shady deals founded much of the wealth. These stains are abhorrent, unforgivable and will forever singe. They will compel us to remember the past.

Lest not to repeat it!

The quest continues.

Political battles whether to seek justice, impose imperial decrees, impound others wealth, spread religion by sword, engage in retributive tribal bloodbaths, romantic conquests and many other iterations, were confined in their scope.
None aspired to see beyond the confines of horizon.

Declaration of Independence raised the bar.

The proclaimed Moral Code decimated extortive monarchies and feudalism.

Profit and power will obstruct universal implementation, but law of land was set. For sure it will keep the restless busy.
Switching gears to now and tomorrow.

It’s a trifecta: a welcome unleashing of coiled energy to celebrate July 4th, Declaration of Independence and life “after” Covid. What a RELIEF!

I continue to believe 21st century will have multiple pandemics but Covid prepared us for the impending challenges. Science evolved at Warp Speed. Now we have Platform technologies that marry speed and precision.
Covid reminded us about our personal responsibilities towards health. A simple rule: no smoking, healthy diet and daily exercise equal 80% reduction in disease burden. We need to do our part. We need to weigh less.

There are many prevailing, and unfortunately, entrenched issues in our society that need a novel look. These include gerrymandering, infrastructure, accelerated climate change, renewable energy, responsible fossil fuel extraction, drying up water resources, threatened agriculture, income inequality, vocational education, desalination, planetary sustainability and educational standardization among many others.

Then there is Establishment. The arrogance of it, shallow and repulsive! Feudalism spelled with different alphabets. Ambition has developed ambidexterity in double speak. Establishment infrastructure has truncal obesity, uncontrolled diabetes and unsteady gait. We can’t lend it a shoulder to lean on. Disruptive engineering is necessary.

In closing I will like to celebrate a wounded friendship that found healing and blessed this nation. Both giants crossed the finish line and succumbed to eternity within hours, unbeknownst to each other, to mark the 50th year of Republic’s founding, July 4th 1826. Thomas Jefferson and John Adams were 2nd and 3rd presidents of the nation. They were friends who wrote Declaration of Independence. They became enemies with big egos and sparks flew. All their monumental contributions to the nation and humanity would stand diminished, if at the end, they did not renew their love. Their renewed love was an “invented accident” masterminded by another Founder and mutual friend, Benjamin Rush.

As we echo rehashed words from adversarial echo chambers in this country, it will behoove us to renew vows to the love for this country. It has given us much. We owe it back. Lets be a Benjamin Rush and bridge the gulf.

We are one!


An American Tapestry

[The following article was published as a Community Voices op-ed in the Bakersfield Californian on June 16, 2021]

Life, beyond sustainability, is a continuous quest seeking purpose, enlightenment, meaning and salvation.

Contradictions abound.

Rushing to judge others while being blissfully unaware of personal responsibility is not an uncommon occurrence.

It can be a chore to practice equitability in human affairs.

Prejudice is universal among humans. Extirpate it we can’t. Manage it we must.

Only blindness can make us colorblind.

This world is not a monochromatic experiment. It’s a chaos of colors. Colors that lend diversity and festivity. Colors that divide and bridge. Prejudice is an ultimate versatile emotion, a true chameleon. It piggybacks on color, culture, nationalism, reason, region, religion and God forbid, politics.

What distinguishes the United States of America is its virtues, which far outweigh its flaws. The pursuit continues but progress is everywhere to see. It’s the most benevolent empire the world has witnessed in human history. Amplified shrillness in the voices of fragile and wilting seem to be in a rush to throw out the baby with the bathwater.

There is a reason America has a strong pull for the driven across the world. Traditionally, it has taken the world’s finest and encouraged them to express their best in the bounty of freedom. In the process, the U.S. has thrived and made the world a better place.

Growing up in India, I was exposed to many of the same prejudices. We all realize life is nuanced and complicated. The U.S. is the crucible that nurtures the upward trajectory of humanity as it struggles to accommodate conflicting data points that seek disparate resolutions. Linear deductions can be questioned, but the essence remains unchallenged.

Closer to home, Central Cardiology in Bakersfield was founded by Americans of Sri Lankan and Japanese descent. It was soon joined by Dr. Peter Nalos, whose dad was a renowned engineer at Boeing. Dr. Bill Nyitray of East European descent joined in 1988. A year later. Dr. Peter Fung of Chinese descent joined the group. I was fortunate to join the group in 1992 and have been forever grateful.

Our group has since expanded a lot and is now a microcosm of the community and country we serve. It’s an uncommon privilege to have some of the world’s best work in harmony to achieve the goal of a healthy Kern County.

Physician scarcity is becoming a significant bottleneck in sufficiency of healthcare delivery. In the U.S., there are roughly 30,000 seats in medical schools. Simple math suggests less than one in a thousand high school graduates opts for medical school. More on that some other day.

Base prejudices do occupy the minds of a few deviants.

People across nations and ethnicities, who have embraced notion Americana, tend not to bring ideologies of places they are escaping. They emigrate to America to assimilate and become American. The people of Chinese descent in the U.S. played no part in the Wuhan Lab Leak theory. Their adoption of the USA is a declaration of their fidelity to the chosen land.

The shame belongs to Xi.

To cast slurs on east Asians based on superficial appearances is guilt by association, a manifest folly.

To shoot Sikhs at religious places is illiteracy and bigotry, a manifest folly.

To equate U.S. and Talibans by congresswoman, on the other hand, is a considered and manifest mischief. A refugee who was welcomed by the land of opportunity is busy poking in the eye of the host. As she simultaneously doubles down on antisemitism. Serial offenders should have serious consequences.

Color of skin should be no sin. Born white can’t be a crime. To relitigate the past through the prism of present is retributive and regressive.

Some four decades ago when I went to medical school, chapters on the utility of leeches in therapeutics were long deleted. I am in no position to cast aspersions on the practice of medicine in the 18th century. There is an evolution in human affairs. The focus has to be on creating an equitable present and better tomorrow.

To call a spade a spade should not be a contrived grievances-driven charade.

It will ill behoove me to insult the generosity of a country that accepted me as a citizen, allowed me to thrive and threw no systemic racism at me.

American tapestry is a work of art. It’s pockmarked. It’s uplifting. It’s liberating. It’s a work in progress. A weave runs through it.

Lets do our bit to make it a masterpiece.