The immortal life of Henrietta Lacks

The immortal life of Henrietta Lacks was one of the best books that I've read in many years. There are so many reasons why I enjoyed this book so much. It tells an interesting and powerful story about an ordinary woman who made a contribution to science that nobody could have ever imagined. What makes the contribution so interesting is that even though it made such a big impact, the lady behind it remained an anonymity for decades. Dr Howard Jones, a gynaecological surgeon in John Hopkins earnestly collects biopsy samples from most of his cancer patients and he did so with Henrietta's cervical specimen too. Dr George Gey, a cell biologist at Hopkins who had been persistently trying to culture cell lines and had failed, attempted to culture Henrietta's too and walked away that night only to return the next morning to see that her cells had divided and multiplied like no other. This was the first ever case of cells surviving and multiplying for a prolonged time outside the human body.
The HeLa cells travelled all over the world ( even to space!) and were utilised by scientists to discover several vaccines ( polio, hepatitis to name a few), to study cell division, to test antibiotics, HIV treatment, cloning and so on and so forth. Almost every lab in the world is a home to the HeLa cells that were extracted from Henrietta in the 1940's . Even though she passed away prematurely due to cervical cancer, her cells are multiplying and growing every minute in a test tube across the planet even today. ( and will continue to do so forever!)
I loved this book not just because it was a fascinating read about the history of her cells and their contribution to science, but also because it explored the concept of medical ethics. Even though Henrietta's family were proud of the fact that her cells had helped so many people, they were haunted by the fear that she, being an African woman in those days was exploited by white doctors who took her cells, ran tests on them and never gave her or her family the necessary credit for them. You cannot blame them as the world was considerably different in those times and the author shines light on some horror tales of exploitation of the African community by doctors in those days by giving examples of the "Tuskegee syphillis experiment". Her children had over the years struggled due to inadequate accessibility to healthcare while their mother's cells had helped medical science blossom. The story of HeLa played an important role in the development of medical ethics and "informed consent" that is the backbone of medical research today. While we use bones, ligaments, blood and organs to run tests and researches with the hope of developing science, it is essential we remember that behind the dissected fragments of the body is a face and soul of a person who is as human as any of us and we must give them the respect and dignity that they deserve whether they are dead or alive.

two metres apart

A short anecdote from my experience during the covid19 pandemic so far titled "Two metres apart "

"TWO METRES APART"
I opened the door to my flat after a tiring, long day at work. “ Babe, I’m home” I said as I entered. “How was your day?” came a voice from the living room. “It was ok, babe. I’ll tell you more in a bit” I said from the doorstep as I stood there performing what had become my evening ritual after work. First, I kept my work bag and coat in a big carry bag and pushed it into a spot at the bottom of a table. Then, I stripped from my scrubs and inserted them into a plastic bag which I then emptied into the washing machine. I would then hop into the shower, and give myself a deep clean which would result in dry, cracked skin over my arms, especially my hands which had already bone the brunt of the incessant hand-washing during the day. After a shower, I would clean my phone with wipes, wash my hand again and rub cream on them. Only after all this, I would walk towards his makeshift work table, and stand there before him asking to be hugged. He would take me in his big arms, hold me tight, pat my head and ask “ Did you have a tough day again?” This was one such day. I told him work had been weird. I had lost a patient- an elderly gentleman who passed away due to covid-19. However, I didn’t cry. He had watched me navigate through my journey in medicine. He had seen the side of me that was the easy going final year medical student and he had also seen the enthusiastic senior house officer working in the NHS. Throughout the years, what had remained constant was that I was an empathetic doctor. I will admit I wasn't the most hard working medical student nor was I the most passionate junior doctor at work. However, I can say from my heart that I felt deeply for my patients. An obvious result of this was that over the years, I had cried for several of my patients. I had become friends with many who eventually died under the care of my team. They would appear in my sleep on some nights. On one night, I had a strange dream where I sensed the body smell of a patient who I had been looking after for several weeks on the elderly care ward. She was ninety six years old and of Indian origin. Since she couldn't communicate with anyone on the ward due to language barriers, I would always offer to readily translate the food menu for her. I would also regularly make her a cup of tea which she preferred to have with six packets of sugar and sit with her and talk to her for a few minutes. She was skinny till her bones and suffered from dementia. She once held on to my hand and cried to me over her lost husband. She asked me if I was married. When I said no, she said “ You should get married...there is nobody else in this world who will be by your side as much as your husband. Look at me, I lost my husband twenty years ago. Ever since that day , It has been a sad life. The children are busy with their lives. Trust, me, nobody is truly there for you other than your life companion. Get married, ok? Good girl.”
After she passed away, I was called to the mortuary to identify the dead body and write the medical certificate of death. When the mortuary officer pulled out the body and unraveled the sheet from her face, a terrible grief overtook me and I burst into tears. A person looks so different when they are dead as compared to when they were alive.This was the first time that I had actually cried while doing this. The officer asked me if she was my relative. I said no, she wasn't, but I had gotten to know her a bit. Several days after, I could still smell her in my dreams occasionally. It wasn’t guilt as I knew she had passed away due to frailty and old age, but for some reason, my patient's death was just a difficult emotion to process for my mind and heart.
Coming back to the elderly gentleman who passed away. I felt odd. This time, I felt like somehow I had let him down although I knew I was not being reasonable, but I couldn't let go of the nagging feeling. This gentleman was already on the “end of life” pathway when I met him. This basically meant that the doctors who had looked after him had come to the realization that he was not responding to medical treatment, was very poorly and henceforth had decided to withdraw treatment. He had “end of life” medications prescribed which helped him with pain, secretions and restlessness which can cause distress to dying patients. On our ward round the previous day, we ensured he looked comfortable, adjusted his medications and moved on to the next patient. I had given a call to his son to give him an update of his condition. He was already aware of his condition as he had been involved in the discussion to provide him palliative care by the medical team . I heard a hopeless voice over the phone as he told me he had just received the death certificate for his mother too who had also passed away due to covid two days ago. The tragedy of the pandemic had affected this family badly as it claimed the lives of both their elderly parents.
A vision came to my mind of both of them being cremated side by side. In the vision, were the faces of their children shocked by what life had hit them with. And there I was, just a junior doctor feeling like I could have done more, but not knowing what. Our masks, gloves and aprons had bridged a gap between our dear patient’s hands and us doctors and nurses. We had been stripped off from the honor of even holding their hands or giving them a hug. I said a silent prayer for their soul to rest in peace as I dreaded what the next few months of this pandemic had in store for us. "Go easy on us, Mother Nature" I prayed as I tried to put my day aside and walked towards the kitchen to make a cup of tea.

- Dr Prarthana Bhat
( Stories from my experience as a frontline doctor during the covid19 pandemic)
All information has been made anonymous to preserve patient confidentiality

My experience in rural postings : KAIWARA

Lunging around my large trolley suitcase, a big duffle bag, and a backpack clad with an induction stove, a portable juicer, egg boiler, laptop,tea boxes, ready to eats, and the quintessentials of cosmopolitan life, I quite dreadfully alighted my bus and unloaded my over-packed luggage at Kaiwara, a small village in Chikballapur district of Karnataka state. I could sense the driver of the bus was giving me judgmental looks for it seemed like I was packed for a famine. At Kaiwara, you have the option of living in the beautiful ashram that is the centerpiece of tourism here, but this time, we were allotted rooms in a specific hostel for doctors. In my second year of med school, we had rooms in the ashram and I'd found it to be a serene environment away from the bustle of commercialization and since that way you live close to the ashram kitchen that serves meals four times a day, it is a clear win-win situation to live there. I was excited for these two weeks that stood in front of me. It was going to be challenging for it meant being away from the comfort of civilization. We as city dwellers are intertwined with the comfort of technology and when your food delivery apps states " sorry, we don't serve your location yet", it brings out a pit in your stomach and you want to run back to home, sweet home. Our days typically began with field visits which I thoroughly enjoyed. These meant going from house to house in a specific village, and filling out a survey book that check-listed important medical information such as antenatal care, vaccination for pediatric age group, tuberculosis symptoms, fever symptoms, and sanitation. I believe there is no work that is insignificant in the medical profession, and even little things such as these are important since they reflect if the government healthcare schemes such as ASHA workers  are working efficiently in these small coups of population. If nobody does it, these could go unaccounted for since these people are the poorest of the poor and do not have the privilege of voicing out their concerns.

I sat on this rock in silence for ten minutes and became mindful of the life here. The villagers have a simple routine that is so close to mother nature, unlike ours. Their day to day life revolves around working around plants, animals and their families, while we work around computers and cars.They wake up, work in the farm, bathe their cows and goats, cook using the produce of their own fields, and live close to their children and elders. Their needs are simple and they are truly rich in their own way as they are so content.  Villages are so small that the population is close and neighbors have your back just like family. They eat produce grown on their own land, milk from their own cows, eggs from their own poultry. This way, they are closely knit to nature and their loved ones. The air that I was breathing was so fresh unlike the smoke laden air that I'm used to and sitting in silence, I could hear the sound of at-least ten different birds and animals at the same moment. 

If this is how mornings here looked, afternoons were meant for working out of the primary health center ( PHC) here. If the medical officer was on field visits, we could attend to patients first hand. Since it is a very small set-up, it does not hold the spectrum of medication needed to cater to all the diseases of the population, but you do have useful medication to work around with such as standard drugs- paracetamol, ibuprofen, omez, domperidone, diclofenac, metformin, ORS to name a few. There is a different form of satisfaction in attending to the simple village folk who would sit in total surrender in front of you- their "doctoramma" as they lovingly address you, and they thank you -tremendously with joined hands. In one of the pediatric patients, we were fortunate to catch a heart murmur whom we referred for detailed scan at a higher center. This restored my faith that indeed the work we were doing was important if we executed it with sincerity. The highlight of my time here was getting to witness a delivery conducted solely by a community nurse with just the very basic medicines at disposal. Having studied and worked in modern hospitals that carry everything from scans, to IV lines, medications, sterilization kits, this was a unique experience. The lady was wheeled in just at the instant that her water broke. Episiotomy was conducted with a normal sterile blade ( not episiotomy scissors) without any local anesthetia, and labor proceeded much more easily than I'd ever witnessed. The baby cried immediately at birth, and the placenta separated without any delay. The uterus went back to it's position and there was no excessive blood loss. Lactation occurred , and the baby was sleeping peacefully. There was no need for continuous labor monitoring, IV fluids, blood, or anything too special. The nurse skillfully stitched the episiotomy cut in three layers. I was awestruck by the ease of it all. 

I am writing out this piece from my house in Bangalore where I've come for the weekend, but I go back to Kaiwara tomorrow as it's the beginning of Pulse Polio Programme, so I'm very excited for it and will share extensively about it in my next post  .