Happy Thanksgiving

Challenges of the moment now and moment next consume the life out of both. Thanksgiving originates in the fabled story of harvest, Divine blessings, and pilgrims, among others. The celebration of the day of Thanksgiving has only added to its allure. Today is a “carve out”; when we take time away from complaints and live IN the moment.

It’s a privileged day.

Rejoice.

Share.

Let this day remind us that we can live the moment now, the moment next, and build a chain of moments that becomes a life of happiness.

We can triumph over challenges and yet be happy.

To all the multitaskers…

Cheers

– Bhambi Family

Rajiv

This day 11/22/22, marks the 31st anniversary of my brother’s death.

On Nov 20th, we left LAX to attend his wedding in 1991. Times were on the precipice of change for the better. My father had lived through me to be a cardiologist. I had lived my dream to be an interventional cardiologist at Cedars. I had taken the Cardiology boards. Rajiv had lived a discovery in life that finally achieved aspirational beginnings. Rajiv had achieved academic success and a bureaucratic pedestal and was marrying into a desirable family. The Bhambi family was on the mend.

To backfill, I left home when I was less than four, soon after Rajiv was born.

I never had enough of him.

I fondly anticipated our brief togetherness during sweltering summers.

Never enough, though.

Life throws curve balls and near misses hurt forever.

This one was a strikeout. Rajiv died when we were on the plane to attend his wedding.

I didn’t attend either; the wedding or the funeral. I would have preferred the wedding. It’s a forever miss that stays unsettled.

With him gone, the unfulfillable vacuum sought magical relief in his avatar that continues to dominate my dreams.

Almost tangible, almost here. Yet perishes on touch.

A lot had to do with proximity to mom.

It was his turn to be next to mom.

The pain eased a bit when mom joined him on 10/12/2018.

Dreams continue to be wayward.

My mind is at ease.

Mom is with Rajiv.

I’m also at ease that beyond personal failures and fortune’s weave, I raised a good family.

Family is the unit. I would die a million times to bring Rajiv back.

Emotions aside, emotions undergird the infrastructure that holds commonsense astride.

The kinship in the family has to lay the foundation of camaraderie around.

To Rajiv.

To love.

Let’s live in love. Death is forever.

Sibling love is a rare blessing.

Cherish and behold.

-Brij

Summer Stories-Post Harvest Pickings

Returning home for a summer vacation in my early childhood was the best time of the year for me. I missed my mom and younger brother constantly away from home.

The dreaded summer heat of North-Western India never succeeded in keeping us indoors. We played field hockey with sticks made of tree branches. Rags rolled into spheroids, stitched together by a neighborhood “gramma” substituted as hockey balls. The homemade sports equipment easily exceeded my athletic gifts. But the uneven, dusty grounds fielded endless joy for the little kids’ ages 7-8.

When the sports equipment reached the end of life, some half an hour into the game, we seamlessly switched the sports.

Kabaddi is a game that requires no equipment, just a mud field. It’s a game of strength, speed, and endurance. An equal number of players occupy their half of the field. A single player runs into the opposing team’s field murmuring kabaddi kabaddi, intending to tag one person of the opposing team in a single breath to score. The opposing team tries to circle and hold down the player till he runs out of breath and loses a point when compelled to breathe again. It’s a sport of mud, sweat, and guts but completely enthralling.

The outdoor adventures would leave us yearning for ice cream. A hawker from a nearby village carried ice cream in an earthen pot and bartered it for potatoes and other vegetables. The afternoon toils to gather potatoes was an absolute must. Barefooted, we would scrounge the harvested potato fields looking for leftovers. The thorny needles often punctured bare feet. Gramma would skillfully retrieve the buried thorns with her sewing needle. The minor out-patient surgery often corrected the hobble in walking instantly.

Most days, we succeeded in collecting enough leftovers to barter for a slice of heavenly ice cream, a delicious end, capping a day of joy.

– Brij

Vaccinated. Boosted. And infected.

Brij –

I read your piece on August 5 in The Bakersfield Californian. It’s one of the best pieces I’ve seen framing where we are with COVID-19 and what our response should be today.

I’m sharing your words below – thank you for this service to our community:

– Sonya

***

The wheel has come full circle, but revolutions continue. COVID-19 has lost its novelty but has loaded up on contagiousness. The virus, fortified with more than 50 mutations in its current iteration, has perfected the art of cognito invasion. The magnitude of the infection in public with fading immunity gives the virus a vast petri dish to continually reinvent itself. Yet, the virus may hit an evolutionary ceiling in its cat and mouse game with acquired immunity and pale into manageable irrelevance.

For now, the infections continue to rage with considered disregard to prior immunity with one important caveat: the hospitalization rate among the vaccinated and under the age of 60 is much less than 1 in 1,000. The mortality rate is even lower. As a society, we have paid the bulk of the price for the pandemic’s ravages and made peace with now an insidious enemy.

The tamed does not equal timid of the virus. It can inflict a broad spectrum of clinical severity on the afflicted with an apparent disregard for personal invincibility. I have seen 98-year-olds with multiple co-morbidities barely notice the infection, while a young 18-year-old may agonize with severe muscle pain, fever, chills and unshakable lethargy.

I suffered a mild sore throat and muscle pains that took me out of in-person patient care for a week. The muscle pains were rather interesting. I was reminded of post-marathon torture without the benefit of a medal.

The isolation compelled introspection, and these are my thoughts for the building tool kit to deal with this chameleon of a pathogen.

In the wee hours of the pandemic, Japan ascribed its success to adherence to the strategy of avoiding 3C’s (closed spaces, crowded places and close contact). When infection positivity rises in a community, at-risk populations may benefit from avoiding the 3C’s. The dose-response curve is eminently relevant in infectious diseases. The elderly and immunocompromised should benefit from masking and distancing amid micro flare-ups.

The infected should have comfort in the attenuated virulence of the virus and available therapeutics. For people under 60 with prior vaccination (and likely prior infection), the treatment is rest and Tylenol.

Of course, we still need the discipline to take us out of circulation for a week or so to minimize the infectious spread.

For the elderly, immunocompromised or unvaccinated/COVID virgins with severe symptoms, an out-patient antibody infusion is an available miracle.

Paxlovid is an enigma, though. It has all the hype, overuse and cost. Paxlovid is helpful in a narrow segment of the afflicted: elderly, unvaccinated, and sick. The current indiscriminate use lays waste its utility in the needy and opens the possibility of drug resistance, a menace we face on the antibiotic side. There is no evidence that Paxlovid lowers the long-haul symptoms. There is as yet an inadequately quantified rebound rate after Paxlovid. We need to restrict Paxlovid usage to the small population who have been demonstrated to benefit from it.

From a public health perspective, we must address the correctable risk factors that exacerbated COVID and non-COVID mortality. Obesity, diabetes and hypertension have been significant determinants of adverse outcomes in people infected with COVID.

Obesity is a complex and expanding metabolic problem. Obesity-related diabetes, dubbed diabesity, is the number one cause of preventable blindness. The corrupt corporate culture that has promoted simple carbohydrates and processed foods has a foundational role in the obesity epidemic. The calorie-dense, addictive and nutritionally vacant foods stimulate a spike in insulin that helps park calories in fat tissue while starving energy needs. The body becomes a victim of insatiability and expanding girth. Healthy food choices are imperative, both at individual and corporate levels.

Healthy food, regular exercise and not smoking have been demonstrated to lower all diseases by 80 percent. We all need to take ownership of our health.

As far as COVID is concerned, I’m back to work, aware that the next round is likely a few months away. But COVID computations don’t crowd out attention necessary for my day job.

The pandemic has passed.

The Cosmos

Image from NASA’s James Webb Space Telescope

The Cosmos is a rebellion against gravity. Gravity is a self-reinforcing force that can reduce all matter into a space less than an atom. Gravity is a self-imploding force that gets stronger as the size gets smaller. At an atomic level, Pauli’s exclusion principle precludes atoms from getting too close. When stellar furnaces go quiet, and gravitation overtakes the centripetal forces, the exclusion principle barriers further gravitational collapse.

The mass governs the hard stop.

The gravitational force happens to be the off shoot of the mass.

When larger stars run out of fuel and go supernova, the residual mass exceeds the repulsive forces of Pauli’s exclusion principle at the electron level. Atoms draw down their last defense at neutron level and settle into hugely potent, and incredibly dense neutron stars.

Still larger stars, at the end of their lifecycle, submit to gravitation, where Pauli’s exclusion principle is humbled at the neutron level. The neutrons can’t repel neutrons. Instead, they succumb to mutual obliteration and agree to exist only as a matter-less gravitational point, aka Black Hole.

Black Holes anchor galaxies and swing stars around them. So much for seeking enlightenment, when sheer darkness swings around distant points of light.

Our medium-sized star, our Sun, takes a leisurely 250 million years to make an orbit around the Black Hole that anchors our Milky Way. The Dinosaurs are still aboard the last ride.

The fission that lights the stars eventually exhausts its fires. The centrifugal forces, after a stubborn resistance to yield, fall prey to the almighty gravity. A White dwarf, a neutron star, or a Black Hole, Gravity claims them all.

The elephant in the room still begs an answer, why did Big Bang have to reverse the gravitational powers and re-engineer the Cosmos.

We are glad that the question exists, and we exist with it.

Yet, the immense, inexhaustible power of gravity that keeps satellites afloat, lunar orbit in a predictable trajectory, planets predictably around the Sun and Sun around the anchoring Black Hole taunt us as a source of energy all around us, and we not able to solve the riddle. The turbines around Earth’s orbit will never experience dearth of water for their rotational force.

Forget about Mars.

Let’s capitalize the Earth.

– Brij

Our only home

Perilous threats, from ill-conceived human misadventures in Ukraine to elevating climate tantrums threatening our Earthly abode, have energized the urge to seek alternatives.

Often the proximate challenges constrict our horizons.

Thomas J. Watson, the president of IBM in the 1940s, famously proclaimed, “I think there is a world market for about five computers.”

Bill Gates, in 1980, was way more prescient. He wrote, “A computer on every desk and in every home.”

Thank God for Elon Musk. The man is magic and mania, all in one. The man creates miracles and hubris at the speed of dodge coin.

The myth makes and unmakes.

The mavericks have overleaping optimism that compels reality to catch up. Serial failure is part of the bargain.

Musk may have failed in his quest for timely delivery of self-driven cars or human landing on Mars by 2026. He unabashedly accepts “punctuality is not my strong suit.” The same can be said about his aspirational goal of a “self-sustaining city powered by hydroponic farms” on Mars. A two-way ticket to Mars, starting at a purported rate of $500,000 in 2020 dollars, may not be prohibitively deterrent to the rich and daring. Mr. Musk’s candid observation — “some astronauts will probably die en route to Mars” — may similarly deter only “girlie men.”

Beyond the rhetoric and aspirations, we need to reconcile the stubborn facts.

The quest for an alternative planet is provocative, admirable and unachievable. A thing called Einstein’s theory of general relativity precludes it. Our interstellar and intergalactic travel comes with built-in breaks, the speed limit of light.

At the speed of light, we can travel back and forth from earth to the moon in three seconds with more than a half-second to spare. The same trip to our sun, theoretically, will take 16 minutes. Incineration will reduce it to less than eight minutes on a one-way journey.

Furthering the thought experiment, a trip to our nearest star system, Alpha Centauri, will take roughly nine years at light speed.

Let’s try to insert thought into the “thought experiment.” The speed of light is an unattainable goal, precluded by the laws of physics. The fastest rockets so far have achieved is less than 0.05 percent of the speed of light. At that inconceivably blinding speed, a round trip to Alpha Centauri will take roughly 16,000 years.

Ridiculousness starts aggregating astronomically.

Closer to home, Mars has captured the fancy from the romantic to enterprising. At least, the “ease” of travel makes it a plausible option. The Martian “terraforming” exudes boundless enthusiasm.

Then the stubborn reality knocks mercilessly at the recklessness of illogic. Why did Mars go barren and turn hostile to life?

Perhaps it lost the electromagnetic shield from the lethal solar radiation early in its genesis.

Mars is a terrestrial planet that mirrors Earth in its crustiness. Mars is the second smallest planet but has Earth-like potential in Goldilocks’ scenario (aka “habitable zone,” between 90 million to 140 million miles away from a medium-sized star, like our sun). Mars is 143 million miles away from sun. Mars is similarly tilted along its rotational axis and has most Earth-like seasons, albeit the Martian year is twice as long as ours. The surface temperature, however, has a wide variation from minus 166 degrees F to 95 degrees F. Water flowed on the Martian surface some four billion years ago. Life may have had a passing rendezvous at a microorganism level. There is no confirmation, but it’s an entertaining hypothesis.

The Martian soil, however, has salt perchlorate in concentrations that are toxic to humans. The atmospheric pressure at merely 1 percent of Earth’s comparison precludes liquid water on the Martian surface. The Martian atmosphere contains 96 percent carbon dioxide and only traces of oxygen. Martian gravity at 38 percent relative to Earth will be corrosive to musculoskeletal health. An unprotected human will smother instantaneously as the blood boils due to nearly absent atmospheric pressure. A vast infrastructure has to be in place before humans successfully colonize Mars. The work has to be outsourced to alien immigrants. Homo sapiens dare not be first and homeless on Mars.

It’s no San Francisco.

Beyond the romantic lure, the presence of life has never been confirmed on Mars. The conditions for life have only been worsened over billions of years. Be it as it may, Mars is furiously more hostile to life than the raging expanse of deserts and vast oceans on Earth. At least the air is breathable, and water can be desalinated.

The romantic tug for Mars may yet eventuate scientific advances with terra firma utilities.

But the next Earth is the Earth we are on.

Let’s be part of the solution. Humans are carbon-intensive. We can’t die to save the planet. Let’s suspend magical thinking. Fossil fuel is the bridge to renewables. The USA has the most climate-friendly fossil fuel extraction rules. Where is the lesson? Which petroleum shock is going to awaken us from our drunken slumber? Extract the oil. Build Keystone. Build fission-based nuclear plants. Our sun continually reminds us that we have the solution we willfully elect to ignore. In fission lies the future.

Drought is correctable. It’s a distribution problem. An interconnected subterranean network of water-carrying tunnels can resolve it for good. A national bond can cover the costs.

Lets shine the light on solutions.

The planet Earth is a blessing we persevere to preserve.

It’s an inheritance that belongs to our children. We are just carrying the baton.

Let’s not drop it.

– Brij

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!

-Brij