Physician par excellence

This book helps in preparing its reader to face death calmly even as it instructs him in the history of medicine and the joys of music.

I t is a unique feature of this book, written by a physician par excellence, that page after page it plunges the reader into thought and forces him to ponder and reflect. It is, in a sense, a successor to his earlier work Man and Medicine : A History , published by Oxford University Press in 2000. As that work had taught us to expect, the author’s knowledge and range of interest go far beyond those of a physician, no matter how accomplished. Nor must I fail to mention The Forgotten Art of Healing and Other Essays (2009).

Dr Farokh Erach Udwadia is a truly educated and civilised person. He is steeped in the humanities, history—far beyond the history of medicine—and music, to which he is passionately dedicated. The last chapter on death brings out the best in him—a reflective disposition, freedom from conventional wisdom and a humanity that informs this work as it did the earlier ones.

The author writes from the perspective of a physician. But his insights are not limited by that discipline. The first essay in this volume is revealingly entitled “A Knowledge of the Humanities and History Makes a Better Physician”.

At the outset, he states his fundamental belief with crystal clarity. “I believe that a knowledge of the humanities and history makes a better physician; it is a concept that is close to my heart. I passionately believe so....

“There is no greater saga in the history of mankind than the epic of medicine. Medicine emerged out of the mists of magical and empirical beliefs of the ancient civilisations. The trail of medicine has witnessed several twists and turns, victories and defeats, scintillating light and sombre darkness. Over five thousand years of history, medicine has evolved into a powerful force, an art, a science, a profession that has taken a quantum leap into the twenty-first century.”

There are of course limits to medicine as there are, indeed, to most sciences. As Edmund Burke remarked: “The law sharpens the mind—by narrowing it.” Although few lawyers will admit that, a physician does not impair his faculties by widening the areas of his interests. On the contrary, he widens them.

Dr Udwadia writes felicitous prose with ease. What he writes of medicine is true of other professions as well, especially the law, whose practitioners tend, not seldom, to be cocky.

The book has essays on other specialised subjects like “The Fight Against Infection: The Microbes Hunters” and “War and Medicine” (an important topic on which one wishes Dr Udwadia had drawn on the Geneva Conventions also) and medicine and healing in India.

Faith as a healer

The essay “Tabiyat: Medicine and Healing in India”, which gives the book its name, provides a good introduction to the Unani and Ayurvedic systems of medicines. They rose high. The author traces Ayurveda’s history and draws on its philosophy. This brings us to the doctor’s comments on faith as a healer. “Faith in the healing power of prayer stretches back to antiquity. Let me quote from the scriptures [Avesta] of the ancient Persian civilisation, ‘Of all the healers, Oh Spitama Zarathustra, mainly those who heal with the knife, with herbs, and with sacred incantation, the last one is the most potent as he heals from the very source of disease.’ Indeed, even today, there are many like me who believe that ‘More things are wrought by prayer than this world dreams of’.

“In the doctor-patient relationship, faith in the doctor unquestionably helps in healing, particularly in a critical illness. Any doctor practising any system of medicine for a significant length of time will vouch for this fact. How does faith act? Faith acts through the mind-body complex. Though there is a great deal of research going on in relation to the mind-body complex, there is very little we know and much to be learnt.”

After 1000 C.E., especially since the latter half of the 18th century, Ayurveda declined because its teachers lacked the spirit of scientific inquiry. The book is studded with moving passages, such as this: “I cannot help feeling that the average Indian, the Indian in rural areas, the Indian living in slums of large cities, the poor, the marginalised, or even the middle-class Indian, deserves a better deal with regard to his health. I just cannot imagine how the deprived Indian bears his lot with such indomitable courage, fortitude and philosophical equanimity. Perhaps it is due to his religious faith, his belief and trust in God, his belief in Karma or in the immortality of his soul that enables him to do so.” The passage occurs appropriately in the chapter “Tabiyat: Medicine and Healing in India”. Nor is Florence Nightingale ignored. She also was moved by faith.

Music & mind

To this reviewer, the most arresting chapters are on music and death. Music is far more closely related to tabiyat (health) and healing (that is, restoration to health). The chapter on music is entitled “Music, the Mind and Medicine” and it begins with this quote from William P. Neville: “There is nothing in the world so much like prayer as music is.” India is rich in the practice of religious devotion through music. A BBC journalist who heard Muslims saying their morning prayers in Kashmir thought that the rendering was close to Buddhist chants. The author’s views invite not only respect, they compel acceptance. “Of all the art forms in our world, in my opinion, music is the greatest. I speak of great music— music which penetrates into the very depth of a human being, transcendental music, music which enables one to commune with God.”

His essay proceeds with some thoughts on the origin, evolution and the mystery of music, followed by the effects of music on the mind, its inherent power and its relation to medicine. It concludes with a brief description on its nature and significance. He writes chiefly with reference to Western music. “Though familiar with all forms of Western music, my special interest is Western classical music.” He is also familiar, but to a lesser extent, with Indian classical music. His remarks that follow apply in general to all music.

Western music arouses his greatest admiration. But he does not neglect devotional music like bhajans in temples and qawwali . Evidently, he has not been exposed to the singing of what passes for qawwali in the increasingly degenerate city of Mumbai. Its predecessor Bombay mercilessly mocks at its utter lack of taste. Delhi hosts “Sufi Kathak” performances to the delight of its nouveau riche . No wonder Old Delhi, with its culture and fabulous cuisine, despises New Delhi.

What is the impact of music on the patient who is impatiently awaiting full recovery? Music can assist him a lot. “It is not just Western classical music that exerts this effect. In can be any form of music, from any part of the world, so long as it is soothing and has a special appeal for the listener. It is important to ask the patient to concentrate deeply on the music that he or she hears, to listen to every note, to shut out noises from the mind and to banish every thought that may arise in the mind’s eye, as promptly as possible. The more intense the focus on the music, the greater the effect. For those who appreciate Indian music, I recommend soothing ragas played on the sitar by Ravi Shankar or his daughter Anoushka Shankar, the melodious shehnai of Ustad Bismillah Khan, or the rhythmic slow ragas of the santoor played by Pandit Shivkumar Sharma. Equally great, and to many even greater, are the beautifully melodious, heart-rending qawwali s sung in Urdu or Persian by the Sufis—followers of the mystical Sufi strain of Islam. These qawwali s are paeans of devotion and love to the old Sufi saints, to the Prophet Mohammed, but above all to God, music assuredly being the only way to evoke him. Listeners sway, clap and lose themselves in the ecstasy of God.”

Music is related to the spirit more than to the senses. In one of the finest passages he has written, the author says: “I have often wondered when listening to great music, be it Western or Indian, what does it all mean, what is its purpose, its significance? Music makes me believe that there is a world beyond the world we inhabit, that the spirit , the self, within us is birthless, deathless, and infinite. Music allows us to commune with our inner stream of consciousness and with the Supreme Being. In doing so, music gives meaning to life, a transcendental blessing that enriches, enhances and ennobles the human spirit.”

Death experience

The chapter on death is rich with deep insights. Humans dread death. This is where Dr Udwadia brings to bear his experience as a physician. “In over fifty years of practice as a physician, I have seen so many patients—young and old—who have met death with courage and stoicism, with grace and equanimity, without a trace of manifest fear. Among other features I shall touch upon later, it is the empathy, compassion and the doctor-patient bond that helps to condition a dying patient to accept without undue fear the inevitability of death. Modern medicine is hopelessly tied upon the way of complex machines and sophisticated gadgetry. The physician of today, exposed to the glittering brilliance and capability of modern medicine, concentrates on treating organ systems and ignores or relegates to the background the patient as a whole. I see him stay away from a deathbed, impatient to get to the next bed where he feels he could be of better use. After all, what can the doctor do when death sits at the bedside waiting to take over? I rarely see a doctor holding the hand of a dying patient, sitting by his side, talking to him, consoling him, listening to him, and fortifying him or her gently for what lies ahead. The art and science involving the care of the dying is unfortunately not taught and is learnt and practised by just a few, yet it is one of the core purposes of medicine.”

Whatever the advance in medicine, death will triumph. It is a common failing among professionals to ignore anything that lies beyond the narrow field of their discipline. Businessmen are worse. What uplifts Dr Udwadia and this work, perhaps his best, is his repealed recall of what lies beyond. The physician must not only heal the patient’s ailing body; he must also tend to the pain in his heart and the anxieties in his mind. This can be done only if he has good bedside manners.

Now, read this: “As a physician, I have noted quite a few near-death experiences of patients who survived to relate their experiences. The commonest near-death experience recounted by patients who have survived a cardiac arrest is that of travelling at speed through a very dark tunnel and then seeing a light at the very end of the tunnel. The light is first just a point, but it enlarges so they are ultimately totally enveloped within it. I have heard it described as a blinding light of great beauty. One patient, I remember, mentioned that during his passage through the tunnel he witnessed a review of his whole life and life incidents. The experience may last just a few minutes in real time but is described as elaborative, rich and uplifting. The next most common experience recounted is the ‘out-of-body experience’.”

The author cites the case of one Mr D who recovered from an illness that brought him close to death. “During the time when he very nearly died, he felt that one Mr D was lying on the bed and another Mr D was floating around close to the upper region of a large window. He noticed that after a time his ‘double’ began to approach him and ultimately merged with his body lying in bed. It was then that he realised that he had recovered. This was my first encounter with an out-of-body experience, and I have had a few similar experiences reported to me by critically ill patients who were near death and who fortunately recovered. Some experience an inner feeling of tranquillity and peace, devoid of body sensation, insensate, without fear or pain, and surrounded by unconditional love. There was one individual who saw a world of supernatural beauty, beautiful landscapes filled with heavenly music. He felt reluctant to return to the world from which he seemed to have escaped.

“There comes to my mind one patient who reported that he was running at fascinating speed over a beautiful meadow towards his dead grandmother to whom he had been very attached, and who was standing immobile in the far distance. When he came close, the grandmother put her hand out as if asking him to stop—as if to say not now, later. He stopped dead in his track and found himself going back at lightning speed to return to the world.

“Does the mind always relate to the body when a person is believed to be dying? Not necessarily so. At times, a patient appears to be dying, and seems to be physically suffering great agony and torment. On recovery, he may relate that he did not feel any agony, distress, or pain, only a pleasant floating sensation of peace and tranquillity.”

This book helps a lot in preparing its reader to face death calmly even as it instructs him superbly in the history of medicine and the joys of music. It is a peerless work.