Monk in a Merc: Moksha in a Material World with All Its Perks

PREFACE

A few years ago, a brilliant young banker from Hong Kong visited me to enquire about his health. He had graduated from top colleges, worked at the finest banks, had made a fortune for himself and his family. I clearly remember this instance because of what he asked me at the end of his appointment. He said, ‘I still don’t feel the happiness I thought I would when I started out. What went wrong, Doctor?’

This was not the first time I had encountered this question, nor was it the only occasion when I had attempted to understand what brings us joy and suffering. But this was one of the earlier instances of when I felt I could draw on my own experiences and expertise to help people lead a more meaningful and purpose-driven life.

I have practised neurology for over 40 years and have seen the miracles of life and the burden of death from very close quarters. During this time, I have served more than a million patients. These include a garden variety of the rich and the not-so-rich. One of the themes that has remained constant is the search for ways to find liberation from things that trouble us every day and attain the elusive yet ultimate goal of happiness. This book is my attempt at answering this dilemma.

My fascination with the makings of a good life began when I became a student of neurology. I was curious about the inner workings of the brain and the potential for tapping into its resourcefulness for health, longevity and happiness. This curiosity turned into a life-long passion to master the practice of mindful living. That involved ways and methods to use the brain’s strengths, overcome its weaknesses and harness its underlying power. All this while accepting genetic constraints and circumstances of birth, which I allude to as the role of luck and chance in our lives later in the book. The old adage rings true here: great men are made, not born. God may well have been the creator, but the brain is definitely the modulator.

Fortunately, to master or train your mind, you don’t necessarily have to leave your household comforts and take refuge in the hills, as many monks do. Our modern culture very often perpetuates this myth of a constant positive relationship between the renunciation of material wealth and a high degree of contentment. Sure, our world has zoomed ahead at an unbelievably rapid pace, demanding much more from us—physically, mentally and emotionally. But as I argue in this book, it is possible to pursue material goals while achieving a state of happiness and mental peace. That you can attain moksha while continuing to aspire for more wealth and success. Essentially, you can become a monk in a Mercedes.

I have tried to cultivate a framework for life based on my life experiences, modern science and Indian philosophy. It led to a strong desire to share these ideas and approaches because I felt some readers would be able to apply the lessons in the book to better deal with the vicissitudes of life. If that happens, I will be content in my thoughts that I achieved the goal I set while writing this book.

1

Bread, Butter and Brain

Of Angels and Demons

The jangling cry of the phone tore through the calm of the room where I was sipping on freshly brewed tea, having yawned out of my Sunday siesta moments before. My eyes veered off the fine china and instinctively zoomed in on the wall clock. It was late in the afternoon. For a while, the clamouring intrusion was engaged in a duel with my patience, but eventually I gave in to the mechanical shrieks and decided to end the agony for both parties.

It was my colleague, also a man of medicine. ‘Sir, you need to be here.’ There was a sense of foreboding in his voice. ‘And, this one is a challenge!’ The next few minutes were spent in an urgent conversation to get me up to date on a matter of life and death, the head of a family of 100 members who happened to be a thriving wool merchant. The junior resident, who had called, lived across his sprawling haveli in old Jaipur within lofty gates of limestone and wood that have been standing guard to the city since it was under the rule of the monarchs.

My colleague told them the case looked hopeless, but there was a new specialist in neurology whom they could consult. They were eager. The place where the case was unfolding was a furlong from the iconic Hawa Mahal. My colleague exhorted me not to decline: ‘Please do not refuse the home visit.’

I was barely 32, fresh out of a two-year super speciality course in neurology from the prestigious Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Being the first qualified neurologist in Rajasthan, I was beginning to be appreciated as a doctor of medicine and a man of science. In that moment, when I replaced the receiver in its holder, my tryst with a miracle—of science and spaces beyond its construct—was about to transpire in the most unlikely of places. This was something that would end up shaping my practice as a doctor and seed my curious mind with the primordial questions of life and death.

The case, the way it was described, was indeed a challenge. I responded with unusual agility and headed out in no time. The sun was in spring, but was showing its summer colours. My colleague was already waiting at the entrance of the imposing haveli when I arrived there. Together we entered the spacious chowk that could put the lobby of a five-star hotel to shame and was now a gloomy patio of bereaved mourners. Amid the chanting of mantras and the wails of the grieving kin, I approached the patient and took a closer look. There was no visible movement in the rawboned elder lying in front of me. Family members informed me his breathing had stopped and the doctor before me had found no pulse on him.

A distinguished professor of medicine and my senior at the SMS Medical College of Jaipur had examined the patient moments ago and had pronounced him dead. Upon his departure, the family had begun the last rites of the elderly man who was promptly carried from his cot and laid down on the floor. A priest, squatted next to his inanimate frame, was reading out from the Garuda Purana, a Hindu text that covers a range of topics such as the question of good versus evil, ethics, karma and rebirth, etc.

In that moment of profound loss, surrounded by the kin discussing rituals for the deceased, I found the chest of the old man moving. It was a shallow heaving and upon a good, second look I immediately asked them to stop the final rites and proceeded, in a shock reversal of my senior colleague’s assessment, to declare him alive. ‘You must lift him off the floor!’ I told them. A sudden eerie silence descended on the chowk, which was expectedly chaotic. For a moment, I felt like the proverbial clown in the ring with the audience, the priest and the mourners peering at me incredulously and waiting to call out the prank. Only, it was not.

I helped them put the patient’s body on the cot. The pulse was weak, but back on the patient. After a quick examination, I deduced he was suffering from Cheyne–Stokes breathing, which is symptomatic of an abrupt stalling of respiratory process that, in rare cases, does tend to resume after a break. When the previous doctor had checked him, the patient’s breathing must have temporarily halted. As a doctor to the chief minister of Rajasthan and other dignitaries, he, of course, was short on time and had exited upon finding no peripheral pulse. However, the patient’s breathing resumed upon my arrival.

Cheyne–Stokes breathing is a terminal respiratory disease. The patient is symptomatic of abnormal breathing replete with sudden jerks, like that of a train when its sputtering engine is killed at its last halt with the deft push of a mechanical lever. The engine of the 73-year-old man, however, quite miraculously, and in time, revived that day.

The stifled breathing had triggered a severe case of CO2 narcosis in the patient. Put simply, it means carbon dioxide retention goes up in the body and the oxygen level drops alarmingly. This resulted in the shutting down of the brain and the patient becoming unconscious. Without wasting time, we put him on vasopressor and oxygen support, injected glucose and put in on saline drips to correct the metabolic factors and stabilise him by getting his pulse rate and blood pressure up.

Then, I proceeded to pinch the patient to induce pain and imitate a process of hyperventilation. Pain receptors stimulate the respiratory centre in the brain, which is why when we are hurting our breathing accelerates and, in extreme cases, we end up gasping for air. The brain, which had begun to revive by then, triggered a bout of hyperventilation in the patient’s respiratory system upon receiving the pain stimuli and supported by Positive End-expiratory Pressure (PEEP) therapy, flushed out the carbon dioxide trapped in his lungs and ended the vicious cycle of CO2 narcosis. The elderly man would go on to live for seven more years and would visit the revered Govind Devji temple, of which he was an ardent follower, on foot every day for his extended stay.

The near-death experience of my patient was remarkable for its rarity as was his return to life. While it was indeed a marvel of science that saved him, the true miracle was in the chance presented to him by the universe in the first place. I saw life and death in the same frame as did many others who were present in the courtyard that day. I was told later that people were looking up to me like an angel, preventing the demons from taking away a life.

I carried that day with me for the rest of my life. From the point where I attempted to revive a man presumed dead, I, unlike others who saw me as a medium of divine intervention, was visualising myself as a child under the mentorship of his father.

Three Brothers, Three Destinies

The surge of nostalgia was overpowering like a hungry tornado tearing down a sleepy town. I found myself whisked away to the familiar territory of my childhood where I stood at the beginning of my long and fruitful career. I was barely 10 springs old and had not really weathered any storms that cross our paths in adulthood.

We were a band of three brothers born to a low-income and high value-based family. I was the guy in the middle, younger by two years to the eldest and separated by the same period from the youngest. We would go to the same school, covering a distance of 10 kilometres on foot every weekday of our student lives. I was in Grade 6, while the other two were enrolled in Grades 8 and 4, respectively.

The day was terribly mundane and didn’t betray any hint of excitement. We had returned from school and had just wrapped up our lunch when our father summoned us to the living room. My father, a government servant, was the first to edit a popular newspaper from Rajasthan titled Lokvani. This was also his ticket to participating in the freedom movement under the stewardship of its founder and freedom fighter Siddharaj Dhadda.

After India had wrested its freedom from the British, he consciously chose public service through administration over an understandable foray by a freedom fighter into the political arena. Familial duties were instrumental in his decision to work for the government, an idea he upheld as a badge of honour until he drew his last breath.

We realised early in our lives that he was a stickler for rules and bore no tolerance towards any extravagance or extracurricular use of government property. This included three free telephone calls he was granted every day and a vehicle at his disposal that we never remember taking out for a spin. We could not even muster the courage to ask for a drop at school by the sarkari gaadi.

That balmy noon, he took to counselling the three of us on what our preferred life choices could be. His engagement was unexpected, but was not a complete surprise. Our mother was not literate and was indisposed to tutoring us in the formal set up of regimented schooling. She made up for it with her robust common sense and incisive knowledge of religious verses and ancient texts, introducing us to the wise who walked among us and exposing us to the philosophical realm of existence. This would help me unravel the key to a wholesome life years later.

If she gave us clarity of thought and revealed to us the righteous way of life, our father trained us to walk that path. He was a man on a mission. Unlike most of our batchmates, whose fathers were content commentating on the batting skills of their sons and daughters on the sidelines of a match, our father would get down to the pitch and practice with us at the nets every day all through our school days. He took it upon himself to coach the three of us for the big game.

He was testing our general knowledge much before quiz master Siddhartha Basu, whose masterpiece Kaun Banega Crorepati, a roaring success even in its Season 12, aired on television with his buzzer-happy rapid-fire question round. Our father was curating quiz papers and evaluating our intelligence quotient through a series of progressive tests every day after his work hours.

We were educating ourselves all the time about country capitals and cities, heads of states and flags rather than keeping track of how the celebrities from the movie world were doing, unlike our friends. Our father would make us debate with each other, push our oratory skills to the level we never knew existed and service our brain with exercises to hone our mental faculties.

The net practice led the Panagariya brothers to open the debate for their respective houses at school competitions. Quite enviably, my younger brother would end up debating me on the same topic while representing his house at the school. We would be pitching our opposing views, swinging the best arguments in our favour and winning over the audience of teachers and students well before the winning team was declared. It was only much later when we were old enough to understand what it took to have such parenting skills that we appreciated the zeal with which our father contributed to our academic pursuits.

We stood there before him that day speculating over the impromptu huddle he had pushed us into. He started with the eldest. ‘You,’ he said, ‘should start preparing for engineering because you can think logically.’ He turned to me and suggested I take up medicine as my profession. ‘You are sensitive and guided by emotions. Becoming a doctor would help you serve people and, in turn, serve your own cause.’ For the youngest one, he recommended a course of action that placed him in the role of a teacher or a bureaucrat based on his argumentative reasoning.

The effect was similar to that of the Sorting Hat of Albus Dumbledore, the legendary headmaster of the Hogwarts School of Witchcraft and Wizardry, which would go about choosing the houses for Harry Potter and other young magicians in their first year. The traits corresponding to their houses would shape for them a career in wizardry when they passed out of the institution. Our father donned the role of the hat that noon as he went about placing us in moulds that would, when the cast was complete, shape our thinking and our professional lives in the years to follow.

It was an insightful discourse where the observations he made ended up placing us like pieces on the chessboard, chaperoning me to the day where I would find myself in a position to bring a man back from the dead, 20 years hence.

Evening had made its way home before me. As I plonked on the sofa and resumed my appreciation of a languid Sunday sprawl, my mind returned to my father who would with his life-changing monologue, seated at the very same place, make his move on us before life attempted to place us under check.

However, his gifted clarity about my abilities and that of my brothers isn’t why I keep going back to the conversation he had with us. When he was educating us on our inherent strengths, something stirred inside me. My impressionable mind was taken aback by the stark differences among the three brothers he had laid bare. Until then, I would look at them as siblings born to the same set of biological parents. After that day, I started realising we were strikingly different individuals despite accidental similarities in our birth, circumstances and the environment, the confluence of which we address as destiny.

My father had unknowingly facilitated my mindset for this noble profession in service of humanity with that talk, as he did for my brothers. I went on to successfully join one of the most prestigious medical colleges of the country, the Sawai Man Singh Medical College in Jaipur, not realising at that time that I would have the rare privilege to head the same institution—first as a director and then its vice chancellor. My eldest brother went on to retire as the head of a public sector undertaking, engineering being his stepping stone to professional triumph just as my father had laid it out. My younger brother became a successful economist-cum-academician and has since assisted state heads in India and the US, facilitating the bureaucracy with his arguments for a market-based economy.

If anything, Panagariya Senior as a Sorting Hat was more effective than Dumbledore. He came terrifyingly close to predicting our journeys that worked on us like a fabled magician’s inescapable charm. However, more than that, he taught us anyone can be a Harry Potter, provided they can find a mentor to first identify the prodigy within and then help unleash it. We had, through some blessed intervention of destiny, found ours in the man who was responsible for bringing us into the world.

The ‘Think’ Tank

The lion, the monkeys, the bees and the birds—they are all striving to survive on planet earth. When seen from the perspective of life on this planet, they are, like us, a species governed by the same laws of reproduction, life and death. What is it then that makes us different from them? Like everyone else, I was long aware of humans turning out different as a species from the countless others who have made earth their home. We are separated from the rest, not just in the evolved making of our limbs, including the thumb’s unique positioning that so beautifully facilitates our easy grasp of things, but also in the manner in which we appreciate our surroundings and alter them to our purpose and understanding.

At the medical college, I was fascinated looking at the brain in the anatomy dissection hall. The unmistakable walnut-like appearance is the first to register in the mind of a medical student. When I was made familiar with the two distinct lobes of the brain with their defined areas of operation that control our body movements, I deduced that the other organs, however vital to our functioning, were at the end of the day slaving for it.

Learning about the sensory areas responsible for our simplest of reflexes such as touch and pain and the special sensory area that lends us our abilities of smell, vision and hearing made me appreciate this organ more than others. Every aspect of our neurocircuitry was so breathtakingly intertwined with the cognitive areas of the brain that it resulted in the choreographed evolution of an ape into the Homo sapien or ‘the wise one’.

The study of the brain started to mystify me. I was looking at the change agent that was content sitting in the shadows away from the limelight of the sensory receptors, making us the most evolved among all mammals in a diligent, almost godly, way. It held the answers to questions we have been asking ourselves. We are, like all species, born with an instinct that triggers a limited set of responses to our primal urges for survival. But we walked a different path of evolution over millions of years to come loaded with something the other species didn’t have—intellect.

The human brain, unlike others, is conditioned to not just be guided by instinct and draw from the environment, but also to employ the sensory faculties and alter the environment to better the chances of survival. The difference is stark. It is what separates us from other living beings in the animal kingdom. Where other species migrate in search of water, we build dams and continue to live and grow in the same habitat. Others urged by their instinct fan out in search of life-supporting resources. We, guided by our intellect, alter our surroundings to fetch resources that are necessary to sustain lives.

The brain, I was quick to realise, is at the heart of our intellect. It is the treasure trove of thoughts and actions that is single-handedly responsible for our dominance over other species. The more I delved into its incredible machinations, the more my excitement started turning into love for this marvel of creation.

In 1976, I was invited to join as a senior health officer in England. However, destiny, as I was foretold by a person with extrasensory perception (ESP), had other plans for me that rested within the shores of my country and not beyond. While I was still celebrating my selection for clinical attachment in England, I got admission in the department of neurology at the All India Institute of Medical Sciences in New Delhi. I was, of course, elated, but neither of them was going to be my career path.

That same year, around the same time, I aced the interview of the faculty central selection committee and was offered the assistant professor’s job in the institution where I was introduced to and tutored in the science and art of medicine. I took my time, but I made my choice. Over the course of the next five years (1976–1980), as a faculty with the SMS Medical College in Jaipur, I started to consult on cases that were considered difficult or remained undiagnosed. I offered my services to such patients free of charge. It was my own way of gathering answers to questions about the brain that piqued my curiosity.

Soon, I started getting calls about patients who were critically ill or remained, for lack of funds or access, without a formal diagnosis. I ended up reaching out to them irrespective of the distance or their financial worthiness. I would take out my bicycle, ride pillion with my junior residents or medical students to arrive at the doorstep of those who needed consultation. The referring individual would usually accompany us while we assessed the patient and accepted the challenge. My refusal to accept any fee and my quick assessment, coupled with successful healing, established my hard work and set me on the course to a fulfilling livelihood.

By 1982, I was qualified as a doctor of medicine in neurology, having passed out of the haloed medical institution in Chandigarh where I had enrolled