I went to medical school in 1976 and have been tested innumerable times for nearly five decades to affirm a threshold of competence. The testing preceded medical school and is a subliminal part of every patient encounter. Patients have the right to be comfortable with their quality of care. Any deviation from that covenant can defile the fundamental rule of medicine; the sacred Hippocratic Oath: First, do no harm. The notion of competence seems to be in a state of disrepair, and merit is losing its relevance. We are still struggling with a parallel experiment dubbed Modern Money Theory that proclaims government can print to prosperity; it surely ignites inflation and guts the toils of hard-working. A mulish submission to magical ideology and distribution of free money to influence elections can win a battle and lose the war.
Some amongst us are fiercely determined to wreck all metrics that measure merit and underpin the nation’s upward trajectory. From high school SAT exam to dilution of academic criteria for college admission, substantially corroded by DEI requirements, to hollowed-out Next Gen bar exams and more, is a fatalistic attempt to erode America’s pre-eminence. I lack the insights of the anti-meritocracy crowd to appraise their beliefs, but I do see the precipice they are pushing the next generation to.
On top of that, many of us are firm in our convictions, hold irreconcilable differences, and stand against each other.

Let’s contrast this with the Chinese Communist Party’s vision. CPP, through a generational effort, has homogenized syllabi with an emphasis on merit and STEM. CPP has also essentially solidified most of the population in a single-minded nationalistic dedication.

The much-anticipated freedom in China as an offshoot of prosperity failed to materialize, and the Chinese society, for now, has settled in for relative prosperity against tumultuous freedom.

It’s a simple equation: ill-prepared and divided against rigorously prepared and united. The superpower stature stands shaky for us if we don’t course correct.
Job fitness has to be a universal and continuous requirement. We need a Captain Sully if the plane has to land in the Hudson River. Even Michael Jordan can’t find a berth as a player at his present age in NBA. As faculties build and strengthen from birth to adulthood, they inevitably decline in later years before eventuating in a final exit. We need fine-tuned, external, and transparent processes that measure job fitness. Most of us concur with this basic premise of fitness but can act as a judge and jury when assessing personal fitness. The self-assessment gets inherently biased because a concomitant cognitive decline with age can often cloud an impartial judgment.

On multiple occasions, I have had to carry the difficult conversation with my senior colleagues to let go of the scalpel. It’s a death-like experience akin to letting go of the car keys, but it saves lives.
Recently, I watched the senior Senator from California, with blatant evidence to the contrary, state that she is still fit for the job. I do not doubt that she believes it, mark that as exhibit one against self-assessment. We as a nation have to decide whether we let cognitively extinguished and physically impaired stubbornly demand persisting in self-service at the country’s expense. Similarly, questions abound about job fitness for a Senator from Pennsylvania and a Congressman from New York across the party lines.

We know the answer, its time we find a way to implement it.

Ageism, generally speaking, is a pejorative slur against a particular age group, like hello boomer. Irrespective of the heightened sensitivities of a specific age group, a job holder has to demonstrate the vigor and competence the job demands.

It is especially true regarding the Commander of the US military and leader of the free world, incumbent or the next. The good of the nation can not be subservient to the ambition of a few who have a hard time letting go.

If not, in the spirit of DEI and prevailing standards of merit, I want to play as the center in 4th quarter of 7th game in the NBA finals.

Merit anyone?

– Brij

Brij –

As I prepare for my new position as Chancellor of the California Community Colleges, I’ve been reflecting on my time as Chancellor of the Kern Community College District. I wanted to share this video from a speech I made last summer for Women’s Equality Day.

In it, I talk about the importance of Early College, as well as some of the issues facing women in higher education. While there has been progress since I made these remarks last August, there is still work to be done in ensuring equality and equity for our students and our leaders in education.

– sonya

It’s been a consensus cup. The world has prayed for Messi to win this one to match his laurels. Argentina, now you can cry tears of joy. The trickle on the cheeks is adorable.

But Messi isn’t just Argentina. Messie is dignity personified. Hence a Messie cup. It’s hard to imagine if, at heart, even France wasn’t rooting for the little giant.

After all, Mbappe already has a trophy. And when Mbappe walked out of his somnambulism, his genius threatened Messi’s life’s worth. I wouldn’t say I liked every goal that Mbappe scored. My emotions flowed in Messi’s veins. How do you reconcile a hat trick that ended up losing against the wish you wanted to be granted?

It’s hard to be Mbappe tonight.

But it’s great to be Messi tonight.

In due time, given enough separation, Mbappe will salute this defeat as his greatest triumph.

The world is a better place tonight.

Messi belongs to the ages.

Mbappe has ages ahead of him.

– Brij

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

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

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.