A day in the life of a platelet.

P.K.Ghatak.MD

 No 1.

 

A young platelet is happily floating around in the bloodstream, then suddenly he is pushed into a narrow tunnel (capillary) the wall of which is neatly lined with closely fitted glazed tiles (endothelial cells). As the platelet is looking around, he noticed a part of the wall with missing tiles and blood is oozing out. Suddenly he sees his favorite face of collagen fiber with lips colored with von Willebrand factor. He feels compelled to give a kiss on her lips (receptor protein). But lo! Now he can't separate himself from her. His lips (receptors) are stuck on her lips. He notices his body shape is changing – swelling up, arms are coming out like arms of octopus and reaching out to other nearby platelets. As more and more platelets congregate and all the platelets are trying to kiss collagen lips, they form a heap and the mass completely covered up the missing tiles (break in endothelial surface). The platelet mass seals the leak and blood loss is prevented and a white soft clot is formed. From their bodies, granular packs burst open, and the chemicals spill all over. Now, an army of bridge-building-brigade assembles at the site in response to the released chemical (cytokines). Platelets release more chemicals containing construction materials (clotting factors fibrinogen, V, VIII, etc.). And the scaffolding takes the shape of a net. The net begins to trap RBCs and WBCs as they are traveling downstream with the blood flow. This is the beginning of the formation of a red but firm clot. As time passes the platelets release a clot stabilizing factor and that turns the red clot into a hard one, and this permanently seals the wound.

This story was told to us by one of our medical college professors as a metaphor. He took the story from the Mahabharata. It goes like this:

A student named Aruni approached the principal of a residential university and applied for university admission and requested his approval. Prof. Dhaumya told him that he would give him a test the following morning and then decide. Aruni faced Prof. Dhaumya in the early morning. To test Aruni's resolve and endurance he sent him out to his rice field. Aruni went to the field and found the monsoon rain flooded the rice paddocks. There he found one paddock was losing water fast due to a break in the mud embankment. Aruni immediately went into action. He dragged up earth from a nearby spot and began repairing the break. He tried and tried but the water continued to gush out, taking the newly reinforced mud wall with it. It was getting dark, and his work was far from over. He was tired and frustrated. In desperation, he laid his body across the breach of an embankment. That stopped the water leak, but as he attempted to leave the water began to flow out again. So, Aruni stayed in the field using his body to hold back water. When the professor noticed Aruni did not return, he called all the other students and went out to find him. It was a dark night; they could not see far. He began calling him.” Aruni where are you, answer me:” Finally, Aruni heard the professor's voice and replied.” Professor, I am here. In the field, lying here.” They came, and they were surprised to see him covered with mud and shivering in the cold. Aruni related the whole story. Professor told Aruni to get up and go to dormitory, and he took Aruni as his student.

We, all of us, knew Aruni's story from reading and rereading Mahabharata

At that time Mahabharata was our social media, television and internet all rolled into one. It is the story of sacrificing one's body for the common good. That is the purpose and objective of platelets.

_______________________________________________________________

   The Ring

     P.K.Ghatak, MD

No 2.

                                               

On a Saturday Henry came home early. As he entered the foyer through the garage, he heard the telephone ringing in the living room. He picked up the phone, and answered, “hello”.
 “Hello” a female voice replied from the other end.
Henry said, “this is the doctor…, whom am I speaking with”.

The other voice replied, “don’t you recognize my voice, I am Sarah, I called you two weeks ago, did you not get my message”?

Henry said, “are you Sarah from Toronto.”

She answered, “yes, who else you know as Sarah”.

Henry replied, “I thought it was a salesperson, trying to sell me something. Why did you not give your last name”.

Sarah replied, “never mind my last name”.

Henry questioned, “where is your husband, does he know you are calling me.”

She replied, “that is what I am calling you about. I am separated.”

Henry asked, “what! What went wrong”?

She replied, “I will tell you all when you come to see me.”

He asked, “are you inviting me to come to Toronto; are you sure?”

She said, “I am still your friend, am I not? You are not married, will you not come? I need you.”
  Henry agreed.

Two weeks later, Henry took a flight to Toronto.

On the flight Henry was thinking: It seems so long ago -  he just started his medical practice. He bought a single family home in a new development in the River Forest. He was looking for things to hang on the wall in his study, when he came across a beautiful Batik painting of the famous Esala Perahera Festival Parade of Kandy, a gift from Sarah when they were in London. The painting was done on a deep red background, elephants were in black, and men were in orange color with a white dress on them. He loved the scene- the spirit and the vibrant colors. He hung the painting on the wall opposite his writing desk. He sat on the chair and tilted his head back as far as it could go and kept admiring the painting. He wished Sarah were here to see it. He wrote her a letter described his new situation and invited her to come and visit him. He included his new telephone number and asked her to call him. Several weeks went by but he did not hear from her. Now, he wished he had not written the letter; it must have made things difficult for her; and felt sorry for himself.

One day he picked up his mail from the mailbox, and then put them down on his desk; made a cup of coffee and proceeded to separate real mail from junk. Here, he saw her letter. He opened the letter with nervous shaky hands. “Dear Henry: We just returned from our honeymoon and found your redirected mail. We have moved to a larger and better..........” He put the letter face down on the table and closed his eyes in disbelief. He gathered his thoughts and concluded it must be an illusion. He read the letter again – “returned from our honeymoon”.

He was devastated, to say the least. He did not go off the bend because of his love for medical practice. The hurt of that difficult day was still with him, but the sharp edges had smoothed over with the passage of several thousand days and nights.

Sarah was waiting for him at the arrival gate. From a distance, she saw him and waved at him. Henry was stunned. Sarah went from a petite to a large size. Only her shoulder length beautiful hair remained unchanged. He stretched his arms to greet her.

She said, “don’t tell me anything about my weight; I know I am overweight. I am going to lose weight; you will see”.

They took the airport shuttle to the car rental office and got into a car. Sarah said, “take Highway 403 West, we are going to Hamilton”.

They continued their conversation as he drove. With the ease with which they inquired about each other's family members by name or relation, one would think there was not a 10 year hiatus at all. Only when Henry took his eyes off the road and looked at her, he could not find that beautiful celestial nymph as she used to be. Sarah could see Henry had a moderate size bald spot on his head and graying sideburns and lost that wondrous inquisitive luster of his eyes, replaced with the mundane look of a bank manager.

Sarah told him, “Take the exit for Plain Road.”

He followed her instruction and asked, “where are we going.”

She replied, “we are going to a beautiful rock garden. Turn left on York Road.”

The way Sarah was giving him driving directions, Henry knew she had been at this place many times before. He was smitten with jealousy.

They walked around the flower beds, came to a fishpond and then to a beautiful small English Tea shop. They got an outside table in the shade and ordered tea and snacks.

Henry asked her, “why did you leave your husband”?

She replied, “he had some behavioral problems. You know, he was my client from London. I thought I could handle him with firmness and straighten him out. But on the way, I lost the handle. He was persistent what he wanted”.

He asked, “where were you married; in Australia or Toronto?”

Sarah replied, “that was another sign I missed. As soon as I said “yes” when he proposed; he wanted to get married right away. He wanted a small wedding. No one from my side of the family came or could have come in that short time. Only my friend Rose and her husband attended; David’s mother, sister with her husband came and a few friends were invited, - altogether we were only 10 people at the wedding”.

Henry said, “why did you agree to such arrangements; after all, it was your wedding too?”

She replied, “he was always short of cash, did not learn the value of money. Anyway, it is over and done with”. Sarah continued, “my cousin from Baltimore came to visit me when we were dating. He sensed David had a problem and wrote to my brother. He advised me to be careful, but I ignored him, he was not a psychiatrist.”

“What kind of problem he had” Henry enquired.

“He was compulsive: he would read all the articles published in Sunday magazine in NY Times. Then cut the articles and stack them in different piles on the bare floor of the spare room. If I ever touched those papers, while cleaning the room, he would have a fit; he would rant all day long. When he had a tantrum, I had to shut myself in my bedroom or get out”.

Henry said, “you said you were afraid of him; do you mean he threatened you with violence?”

She replied, “that was initially”.

He asked, “will it be a messy divorce?”

She replied. “You can imagine what happens when lawyers are involved, nothing remains simple. Moreover, he is not currently employed. I may end up paying alimony to him, but that is okay.”

The waitress bought tea and placed the tray on the table. Sarah reached for the sweet snacks. Henry cracked half a smile and knew why she was unable to lose weight. He reclined back in the chair and watched her closely. Then he looked in her direction but his sight was fixed on a distant flower bed.

Sarah asked, “what are you smiling about.”

He replied, “I was reminded of our days in London.”

She said, “do not lie to me, you can never lie and get away with it, I can read your mind through your eyes.” She continued, “you don’t tell me things you think, you never show your emotions in public, at times I wonder if you really like me or not. He was quite the opposite, you know, I mean my ex. He always held on to me in public, gave me big kisses whenever he had a chance, took me to all the theaters, movies and plays. He knew all my weaknesses, used them effectively and gained my trust. I did not suspect he had an opposite side”.

Henry said, “you must have known he had bipolar disorder or similar such conditions. He must have acted out violently before.”

She looked at him then lowered her eyes and was about to say more. He reached over and put his right hand over her hands resting on the table and said, “no, don’t tell me anymore please, it is painful.”

He held on to her hands for a while and remained silent. Sarah took a ring off her finger and put it on the pinkie of his right hand and said, “this is my mother’s ring, don’t lose it. This is for you.”

He looked at the ring closely and held up his hand in the air and asked her, “how does it look on me”. Sarah replied, “it is a bit tight for you, but you can get it stretched, any good jeweler can do that. You look very distinguished with this ring”. He held his hand in front of his eyes and looked at the ring again and said, “thank you. I promise I will not lose it.”

Sarah looked happy and took a sip of tea from the cup then kept looking into Henry’s eyes.

Henry said, “you said you could read my mind through my eyes. Tell me what they say”.

Sarah looked deeply into his eyes, and then lowered her eyes and looking at the teacup, she said, “I am not telling you what I read.”

A month went by since they last met. Henry’s mind was occupied with her thoughts. He searched for that fire of passion once he knew so well. At this time, it simply was not there. He took the ring off his finger and placed that in a small jewelry box, wrote a short note and mailed it to Sarah by special delivery.

Sarah returned late in the evening from an office dinner meeting. She went to pick up her mail; the attendant at the front desk gave her a parcel. She hurried back to her apartment and opened it. She saw her mother’s ring. She took the ring out and put it back on her finger. She rubbed the ring against her dress till it sparkled. She looked at it for a few minutes, looked at the box and saw the note resting at the bottom of the box but ignored it and pushed the box away. Since her separation from David, she kept the radio on continuously. The radio was playing a popular song:

“My love is warmer than the warmest sunshine, softer than a sigh.

My love is deeper than the deepest ocean, wider than the sky. ”

She slammed the radio and shut it off and murmured. “Stop that, you fool!”

She turned around and saw fresh flowers in that beautiful Waterford crystal vase, a gift from Henry at their meeting in the rock garden; she took the flowers from the vase, placed them on the kitchen top, dumped the water in the kitchen sink and dropped the vase in a trashcan. She walked over to her liqueur chest, poured a small glass of Drambuie. She sat on her favorite chair, lifted her feet up on the coffee table, took a sip of Drambuie and mocked the radio song and sang in the same tune: 

My love is wider than widest ocean 

and has more fish than all the pebbles on shores.

https://www.youtube.com/watch?v=1i7ftGPrRis

(copy & paste on browser)

*************************************************

Haridas Returns

P.K.Ghatak, MD


No 3.

The telephone rang in the middle of the night.

“Hello,” I said.

“This is Haridas,” The voice on the other end answered.

“Oh! Haridas. Where have you been for so long? I wondered what had happened to you. Did they put you in Guantánamo prison?"  I asked.

“Well, I am in town, I will see you in the morning,” he said.

In the morning over a cup of coffee, Haridas explained his long hiatus. He said he was in demand since the Christian Right group shouted down a Hindu priest giving benediction in the Senate Chamber followed by more nasty remarks in the prints and Internet

.“What did he do”, I asked.

He spoke. “Nothing really, if people willingly remain ignorant and thereby behave foolishly, then one can only hope with a wider discussion on the subject the other voices will dominate and drown the voices of ignorant”.

“I thought you said you were busy because of the incident in the Senate Chamber,” I remarked.

“Oh, yes.” He said, and then added, “I was invited by several groups interested in the Hindu theology; they wanted to enlighten the Christian Right and wanted to know better ways to respond to this bigotry and intolerance”.

“Why people are so ignorant about Hindus”, I asked.

“They are not ignorant; in fact, they think they know it all. In school, they have learned Indians are poor, they worship cows, they have a caste systems and untouchables, and Indian streets are full of snake charmers, free roaming cows and elephants. What more one needs to know, especially if you appeal for donations on the T.V. by showing Indian destitute begging for handouts. That reinforces one's impression of India. They even do not know all Indians are not Hindus. India in their minds a waste bucket of world’s poor and cow worshipers,” Haridas said.

“How to correct that misinformation”, I asked.

Haridas said. “You do not have to look further than a dollar bill - In God we trust - printed on the dollar bills. If you want to say something profound, then print it on the money. Money is the strength. Money is power. I tell Hindus to follow the Jewish communities for inspiration. Making money - lots of money and then give a big chunk of it to politically connected groups, that was the way the Jewish people regained their place in the society. Now they dominate the world with money and power. During the 2^nd world war, people denied the holocaust, now 60 years later, anyone who dares to deny the holocaust will be prosecuted in court. That is power.”

“God is one and the same no matter what one calls Him, and no matter how you worship Him. God remains God. Why then the Christian Right is upset about the Senate benediction given by a Hindu priest,” I asked.

“Maybe it is worth here to repeat the story of a beggar and the pious old man," Haridas said.

He continued. “A pious man was about to sit down for his dinner when an old infirm beggar showed up at the door and asked for alms. The pious man invited the beggar to join him for the dinner. They sat face to face and the food was served. The beggar immediately began to eat without even taking a moment to thank God. That behavior angered the pious man. He reprimanded him for not thanking God and asked him to leave at once before he could take another mouthful. The beggar did not understand what he did wrong and left without remorse but was saddened from missing the dinner. The pious man sat silently and then reflected on the incident. He realized God had taken care of this beggar all his life even when the beggar did not thank God once. God sees all, God knows all. God is merciful. God forgives.”

Haridas continued. “Christians need not worry. God created both Christians and Hindus; Hindus came two thousand years earlier than them. God does not take sides. God is benevolent. Hindus did not pollute the Senate Chamber and the Christian heaven. The Christians will find that out when their time comes.”

“Why so much divisiveness among men in the name of religion”, I asked.

Haridas replied. “Why you think Muslims invaded India from Turkey, Persia, and Afghanistan repeatedly over a century. Certainly, they did not come for their spiritual enlightenment. They were there to loot the Indian pearls, rubies, diamonds and gold that were stashed away in temples, holy places and monasteries. Indians were happy to be poor, but temples were bulging with riches. The invaders carried away anything they could lift, the rest they burned down to the ground. If you get a chance, please visit the Vatican treasury and the museum. Thrones weighing in tons made of fine jade and other beautiful jade ornaments alone will convince you of the power of religion in attracting money. Even the poorest of the world willingly give at least a dollar a month in the name of religion. That is 6 billion dollars a month. Whoever has that money can buy a lot of Angus steaks and Russian caviar. Talking about food – I am hungry. Don’t you have any food?” he asked.

“I am sorry, I am living on crackers and coffee for the last 3 days since my social security money ran out”. I replied. I gave Haridas a few crackers on a plate. He took one cracker at a time, closed his eyes and hummed a Tagore song – “the world today is wild with the delirium of hatred…the conflict……O Serene, O Free……. wipe away all the dark stains from the heart…..” and he ate crackers with utmost delight. When all the crackers were gone, Haridas picked up the crumbs bit by bit as if they were gold nuggets and put them in his mouth and continued with the song O Serene O Free…

My eyes became misty. When I regained my composure Haridas was gone.

**********************************************************************

                                    A Doctor in a Rural Health Center.

                               

                                   P.K.Ghatak, MD
                            

                                   No 4.

 

Arun started, at the crack of dawn, from his home and took the first morning train to reach the main railway station then took another train to the next junction, changed train again to reach a railway station close to the rural hospital where he was assigned to work. At the rail station, he took a rickshaw and arrived at the hospital by then it was afternoon. The rickshaw puller dropped his luggage on the pavement and left. The office door was padlocked. Arun looked for the doctor he came to replace. But not a soul was there other than few patients in the female section of the hospital. Finally, he found one person; she said. “Doctor is on midday break; he will be back when the hot sun is down on the horizon.” She pointed to a chair in the corridor where he could wait. She was not even curious to know who he was or why he showed up in the hospital with his luggage.

Arun sat for a while; then paced the corridor; saw an empty room marked “Male Ward”. The room was crammed with broken and rusted hospital beds, metal benches, chairs and other pieces. He walked around the grounds. The health center was an H- shaped building; male and female beds were one on each side joined in the middle by the doctor’s office, outpatient clinic, pharmacy and an operating room. Behind the main building, there were two small buildings, one marked “Isolation Ward” the other “Kitchen” both were padlocked. One tubewell was on the ground. There were several small detached houses on the other side of the road. A little further away on a small barren earth mound, he could see the charred remains of a funeral pyre.

About 5 PM the doctor showed up. He said he did not know that he was coming to replace him and so he was not prepared to receive him. He was drinking a cup of tea while talking but he did not offer tea to Arun. After a discussion, they agreed that till further clarification came from the regional medical office, both of them will continue to work. Arun would look after the outpatient clinic and the other doctor would be in charge of administration and in-patients. He told Arun that there was no vacant building for him to move in but he would ask the janitor to vacate his apartment and then Arun could move in there. That would be a temporary arrangement till things were sorted out at a later time. He added that janitors were not entitled to housing, but the guy moved in because it was unoccupied. A cobra snake was spotted several times around that place and people were afraid to trespass into cobra territory.

The young janitor came and took Arun to his house. It was just a room built with brick and mortar, had a corrugated tin roof and had no ceiling. The door was functional; the windows had no shutters. There was no electricity or running water. He pointed to an outhouse at a distance near an old pipul tree. He cautioned Arun not to walk there in the dark because he said.” The snake lives there”. The janitor had next to nothing of his personal possession. He picked up his things, swept the floor clean and left.

In his bundle, Arun carried a blanket, a mosquito net, one pillow and a pair of bed sheets, and in his tin suitcase, he had a pair of paints and a few shirts and undershirts, a piece of linen as a bath towel and toiletries. He had no candles or oil lamp with him.

He sat on his suitcase and felt thirsty and hungry. He could see the sun was setting. He remembered his mother packed some snacks and sweets for him. He washed as best as he could, out in the open, drawing water from the tubewell and returned to his room. He ate snacks and sweets with utmost delight.

Sitting there in the dark he could hear in his head the welcome speech given to the entering class by his professor of Anatomy. The professor said. “I congratulate you for choosing to become a doctor, the most noble profession one can have. You will be asked to sacrifice, risk your lives but rewards will be plenty. You will be the first one to greet a new life in this world and you will be the last one to hold hands of a dying man giving him comfort and say goodbye”.
Arun thought about his mother, remembered her kindness to the poor and her faith in the goodness in mankind and her unwavering trust in him and her advice to him that by his own conduct he must prove his worth of his family name.

But there was a cobra in his vicinity. He knew snakes liked to stretch out on a cement floor in the evening. He had no way to separate himself from the snake; there was no bed and he had to sleep on the floor. Then mosquitoes began to bite him and added to his misery. He hung the mosquito net and got inside. He waited in the dark for a snake to crawl in. Nothing happened as long he was awake.

Very early in the morning, he was awakened by someone calling him.” Doctor are you still sleeping”. Arun opened his eyes and saw an old man standing outside by the window, almost touching his mosquito net. He was dressed only in a loincloth and carried a long strong bamboo walking stick in his hand. Arun realized he had no privacy; his privacy depended upon the goodwill of people not looking through the shutter-less window. His room stood next to the road and had no boundary wall. The man continued. “You are a government servant, you are paid to work, and you are on duty 24 hrs. a day, do not waste time lying in bed. Look, he continued," patients are waiting for you”. Arun looked in the direction of the health center, there was not enough daylight to see any building and he saw no one. The old man waited till Arun got up from the bed and folded the mosquito net and bed sheet and put them away. He asked Arun unceremoniously about his qualification, grade and honors and training he received at the university hospital since graduation, and at the end, he added,” If you are as good as you say why did they send you to a village”.
Arun pondered over the same question when he received his appointment letter from the State Health Department, directing him to go to the rural primary health center. He had the expectation to be placed in a teaching hospital on the basis of his academic achievements.

In the morning both old and young people came to see the new doctor. Arun was given the task of taking care of the outpatient clinic. He worked diligently and by the time he saw the last patient, it was past midday. All employees left for lunch. Arun did not know where to go for food. He had nothing to eat in the morning and had snacks the night before. There was no restaurant within a 3-mile radius. He saw a rickshaw and asked the rickshaw puller to take him to a place where he could find food. He took him to a market and pointed out a restaurant. It was just a shack, cooking was done out in the open, and people sat on long benches and ate - one bench facing the street the other facing the back wall. He was shown to the backbench. He ate alone, facing a dirty wall which was only 6 inches from his nose. Later on, he learned the backbench was a preferred sitting because the dust from the dirt road kicked up by the passing vehicles landed on plates of people sitting on the front row.

After lunch he looked for transportation to get back, there was nothing available during the hot noon hours; people looked at shelters under shades and took a break from work. He began to walk back to the health center in the hot sun. The heat was intense, and the pavement was radiating heat and he felt his face was scorching and by the time he arrived at the hospital he was drenched in sweat. But he could not get inside his room because the room felt like a hot oven. He sat under the pipul tree but remained alert in case the snake showed up.
After sunset, a few hospital employees showed up at the center, but it was more of a social get together than any significant hospital work.
That was how the first day of work ended for Arun. He, however, did not know how and from where his next meal would come. He went back to his snake infested lodging to ponder over the whole situation and started to get hungry thinking about food. He found it difficult to fall asleep on an empty stomach.
That old man showed up every morning until one day he brought his grandson to Arun. That young man was losing weight, had a low-grade fever for 2 to 3 months and now had developed shortness of breath. Arun examined him and found fluid in his right chest. He inserted a needle in his chest and drained about a liter of pleural fluid and placed him on drugs for tuberculosis. His grandson got well in a short time. Then on the old man became Arun’s cheerleader. He bought Arun mangoes, coconuts and other produce from his field. He gradually opened up to him and told him the difficulties he had faced in getting government officials' approval to locate the health center in his village and securing a piece of land from villagers. When no one gave him the land, he took over this cremation ground. He endured all kinds of bureaucratic obstructions and foot-dragging, but he prevailed in the end.

Three months had gone by, but Arun did not receive his salary. His mother was sending him money to keep him going. When inquiries led him nowhere, Arun took a few days off and went to the state health department. After several attempts, he located his" joining letter" in the file cabinet of the head clerk. He took the letter and went straight to the chief medical officer, thinking the office would admonish the clerk, Instead, the doctor told him it was Arun's fault and stated, " young man do you not know how things run in a government office, you have to grease every wheel if you want anything done" He later learned that the grease was only Rs.2/. He took the document personally to the office of accounting and gave it to the clerk responsible to grant his pay slips. Arun thought sure this time he would receive his salary. But again- this time the accountant at the disbursement office demanded" Baksis" a coded term for a bribe. This time the grease was also RS 2/. (2/5th of a dollar at that time - the exchange rate).

On a very hot day in mid June Arun was lying underneath his bed, using the bed as a shield from radiating heat coming down from the tin roof. He poured water on the floor and wrapped himself in a wet cloth. At that moment two of his medical school classmates unexpectedly showed up. His friends were appalled finding him in that wretched condition. Arun smiled nervously and said it was not as bad as it looked. His friends told him that they were leaving for the USA and they came to say goodbye. They urged Arun to make plans to go to the USA and they promised to write to him regarding the medical training in America.

A letter arrived from his friends from Connecticut in due course. In the letter, they described the medical training they were receiving at the hospital and listed various medical conferences, grand rounds, and case presentations, etc.  “It is the opportunity of a lifetime. To be most useful to your people you have to be best educated and trained,” they concluded.

Arun decided to go home and talk it over with his mother.

Six months later Arun was sitting in the airport lounge of Air India, he had in his pocket a one-way ticket to Kennedy airport in New York via London; and then on to Detroit, Michigan by Eastern airlines.
           ----------------------------------------

Crossing the Oxus River

Crossing the Oxus River

P.K.Ghatak, MD

No 5.

We are heading toward the Afghan Uzbek border. After five days of confinement in a cellar due to an armed struggle between two parties in the Afghan civil war, we are happy to leave behind Afghanistan. The Oxus River lies ahead. At present we are passing through a desert. Small sand dunes and rocky hills are all around us, and here and there soldiers with full battle gear are stationed along the road, but they are not tense; some of them waved at our UN convoy and some of them even smiled.

Allan, pointing the road ahead of us, told me, “This is the road Alexander the Great took to cross the Oxus River.” Allan is an Alexander buff. He is an Irishman, a mid-level executive of an international company, who was stationed in Paris when he volunteered.

I said, “why go north when India is to the east from here”.

He said, “that came later. Alexander was on the heels of Bessus, a confidant of the Persian King Darius. Bessus stabbed Darius and left him on the roadside to die; put the crown on his head and declared himself the emperor. When Alexander got the news, he was furious; after all, Darius was a great emperor and deserved respect even at death. At that time Alexander was in a place in Afghanistan known now as Herat. He could have gone straight east to Sogdiana where Bessus fled, that would have been a shorter distance, instead, he went south to Kandahar and then to Kabul. He crossed with his cavalry the mightily Hindu Kush Mountain during a snow blizzard; then marched through this desert and crossed the Oxus River at a place, where we now are heading for.” He added, “We call him Alexander the Great but in fact, he was a butcher. Anyone dared to put up a resistance, he attacked them with absolute brutality and after his victory, he would gather all the citizens, from royalties to the poppers and order his army to butcher them all including children and women. He spared none and left the dead and dying on the field for everyone to see. The word got around fast. Most of the rulers of this territory simply surrender to him without a fight.”

Our driver Hussein, a history teacher in Mazar before the war, was listening. He said, “two other important Amu Darya crossings took place here. (Afghans call the river by that name). Those also profoundly changed the history of this country. He continued, “in 643 AD the 2^nd Caliphate Umar ordered his trusted general, Ahnaf bin Qais, to conquer Sassanid Persian Empire. Ahnaf crossed the Amu Darya near here and defeated Emperor Yazdegerd lll and took the Khurasan province of Sassanid and converted our forefathers to Muslims from Buddhists. Yazdegerd fled to China. Balk was the capital of Khurasan; it is near Mazar which you know all too well and I bet you will never forget Mazar in your lifetime”.

I asked him, “when did the 3rd important crossing take place?”

Hussein said, “you all know that; the Soviets crossed the river here when they occupied Afghanistan. When the Soviets invaded Afghanistan there was no resistance in this region because the local commander forged an alliance with the Soviets; and when they left Afghanistan, the Soviets gave him their entire stock of Aircraft, helicopters and other war machinery and this commander became the strongest warlord in Afghanistan. And the other warlords did not dare to attack him. We did not see any fighting until this one. You have suffered a lot during these 5 days. I thought it was a miracle that all of you came out unscathed from this ordeal.”

We remained silent, and then I said, “as far as I see it, the most important crossing of the Oxus River has not happened yet: it will take place when we cross here safely”. Then I laughed and all of them joined me in a burst of hearty laughter.

We are now in the heart of fortified Hazareh Cantonment. Every building, from the roof to the front gate, is adorned with military hardware. Soldiers are serious-looking and professional. We are waiting at a checkpoint for about ½ hours. A UN official who is accompanying us and a senior member of our group has gone to pay a courtesy visit to the chief commander. They carried with them a heavy box loaded with “goodwill care packs”.  We have resumed our journey upon their return and are moving toward the Afghan-Uzbek Friendship Bridge - a gift from the Soviets to the Afghan people.

The approach road leading to the bridge is heavily fortified.  Heavy field guns, anti-aircraft guns, and concrete bunkers are placed along the road all the way to the bridge. We are now crossing the all-steel bridge without stopping. The bridge has railway tracks in the middle separating the roadway one on each side and a pedestrian walkway on one side of the roadway. We have now parked our vehicles in a parking lot which is right on the riverbank. A signpost says this part belongs to Afghanistan; Uzbekistan begins at the other end of the parking lot. The immigration/ customs office is just across the parking lot. The UN officer, after collecting our passports, visa applications, and photographs has walked over to the office building.

We are waiting in our vehicle, thinking it is just a formality to get our passport stamped and enter Termes, Uzbekistan; but we are waiting and waiting. Our vehicles are not equipped with car heaters; we are beginning to feel the chill of January cold. I got out of the vehicle and began walking briskly, then jumped around to get the chills out. Here, I can see we are at the top of a hill and the riverbed is way down. The whole valley of Mazar lies in front. The water level of the river is low; the water is flowing gently, with tiny ripples now and then, reflecting the bright golden sun rays.

The Oxus River starts her 1500 mile journey from the glaciers of the Pamir, gets a heavy load of melted snow from the Hindu Kush Mountain. It journeys west, then north/ northwest to Kyzyl Kum desert, a land between the Aral Sea and the Caspian Sea. In ancient times, it emptied in the Aral Sea. In 985 AD a massive Gurganj dam was built across the river, diverting the river water for agriculture; and the region flourished. Another tyrant, Genghis Khan, occupied this land and in 1221 AD he leveled the dam flat to teach the people a lesson. Since then, the river had not made up her mind: at times she emptied in Caspian and other times in Aural Sea.  The Soviets built a number of dams along the course of the river, vastly expanding the irrigated land and introduced large scale cotton cultivation.  Now, as the Oxus flows further north, she hardly makes any headway and dies in the sand dunes of Turkmenistan. What an inglorious death of a mighty river!

We have been detained at this cold windswept hilltop for nearly 3 hours.                

There is no trace of our UN officer. I am jogging along a grassy path, just to keep myself warm. I can see 18 feet tall 50 feet wide barbed wire fence, running along the river edge all the way as far as I can see. Several posters are nailed to the fence displaying the international symbols of live-high-voltage electric lines, landmines, and other hazards: warning people not to come near the fence.  When I went near the barrier, several pieces of clothing hanging from the barbs came to my view. I do not know how many people were blown to pieces by landmines in their attempts to cross the border, or the wind simply has blown the pieces there.

The UN officer, presently, is coming out of the building and he is waving at us.  Now, we are crossing the parking lot and entering Uzbekistan. Our crossing of the Oxus River is now complete.

************************************************************

A Page from Afghan Civil War

A page from Afghan Civil War

P.K.Ghatak, MD

No 6.

Our mission in Kunduz was new. We started with a limited supply of medicine and other medical supplies, and we were replenishing our medicine stock from Pakistan. But some recent events in Pakistan put a stop to that supply route. We were desperate for medicine. Our mission in Mazar-e-Sharif was willing to give us their stock of medicine and about the same time news came from France that a plane loaded with medical supplies and medicine was coming to the Termez airport in Uzbekistan in 2 days, a short distance away from Mazar-e-Sharif.

We left early in the morning the next day so that we would arrive at our destination before the sunset. It was considered suicidal to venture out on the streets after dark. The shortest route to Mazar went through a desert but it was a very risky road to travel because of frequent kidnappings, murders, and robberies. We took the longer route but that meant passing through the territories of two other powerful warlords. Our vehicles were bright white in color and had insignia painted in red on the sides, back and hood. A large white flag, with a red logo, was attached to the passenger side of the front fender of the lead vehicle. We carried "safe passage” documents from all the regional warlords just in case somebody stopped us. However, it did not guarantee us much because the roadside checkpoints were manned by illiterate drug happy young people. We also carried “ goodwill care packs” containing vitamin pills, aspirin, antiseptics, band-aid, etc, and dutifully gave each one of them when they approached our vehicles.

 Soon we came to the end of our warlord’s protection zone and now we were entering the enemy territories. The road became bad to worse, there were potholes of all sizes everywhere, at some places the road was cut deliberately and our car had to travel over a field.  We had strict orders not to get out of the vehicle and step on darts in order to avoid stepping on anti-personnel mines. The driver was going side to side of the road more frequently than going forward along the path. It took another hour to cross this no-man zone. Soon the checkpoint of the other side came into view and the road condition improved. The vehicle stop was indicated by a tank thread buried across the roadway. It was nearly impossible to drive a vehicle over it without a push from the soldiers. We passed the checkpoint without any incident.
We soon came to a vacant patch of land scarred with recent skirmishes involving tanks and other heavy war pieces of equipment. There were big craters on the road where shells had landed. We saw buses, packed with people two /three times the carrying capacity, with household goods piled on the roofs 4-5 feet high, chickens and goats tied to the rear of vehicles swinging side to side, advancing at a snail speed. Soon the road looked deserted, only speeding military jeeps passed us. Here and there trucks were stopped on the road, in a group of 2 to 3, by soldiers with AK 47, ready to fire; while other soldiers were busy siphoning out diesel from the fuel tanks. As we traveled further, it appeared an unnatural calm had descended on the region like the morning fog.  A chill went down my spine when we saw abandoned gun positions along the road. There were fresh marks of tank tracts in the adjacent field, soon we saw the charred remains of a tank, and it was still smoldering. We were concerned but remained silent. We came to the next checkpoint. The guard told the driver something, as he handed him the Goodwill care pack, and signaled with his hand to hurry and leave.

We reached Mazar-e Sharif as the sun was setting. We were briefed on the security situation. We were told minor clashes had broken out and four soldiers were killed. It was not clear at that moment whether it was just a clash or a prelude to bigger things to come.

In the morning, after breakfast, we had to go to the main office for a meeting. The UNHCR office kept us briefed on the security situation by ham radio. The town was calm, people were on the street and the market place was crowded. The UN staff from a local UN office invited us for a New Year party in the afternoon. I declined to go and stayed behind. One of our members, who had previously served in Mazar, filled me in on the history of the Mazar-e Sharif. The blue mosque was the main point of attraction of the town, and he mentioned non- Muslims were allowed to go inside the compound which was a rare treat in a Muslim world. He offered to take me there.
He drove a jeep. We were in the market next to the mosque when a sudden explosion shook our jeep. He looked at me and I looked at him. None of us were bleeding and we knew we were alive, that was all there to know. The busy market emptied out faster than the props changed on a stage in Broadway shows. The metal shutters of shops came down; sandbagged gun positions suddenly filled with young soldiers with pointing AK-47. Bursts of machine-gun fire were coming from all directions. Then another thunderous noise came from the corner of the mosque and black smokes were billowing out. My eyes met the eyes of a young soldier; he had no fear in his eyes. He was edgy with the excitement of an anticipated kill. Suddenly the holy place turned into a playground of devils.

My friend drove the jeep faster than it was meant to go. I thought if bullets did not kill me his driving would. I never knew the fear of death could be that deadly. Once we reached our walled compound he jumped out of the vehicle and went straight for the ham radio. He repeated coded messages several times. Soon our place filled with the rest of our people and a few others. A hasty meeting was called. We were ordered to move down the hall to a basement bomb shelter.

The shelter was about 12 x 15 feet, with a 48 inches thick wall all around. There was a small kitchen, a sink and a tap with no running water. There were cabinets on all four walls of the kitchen and they were stacked with canned food. A place about 4 feet square was used as privy but had no toilet seat, instead, had a hole in the dirt floor marked by bricks one on each side. The flimsy door had no latch and the bottom part of it had rotted away. There were blankets and sleeping bags piled up at one corner of the room. The bomb shelter was 4-5 feet underground; sandbags piled 4 bags across and 4 bags high all around. There was a dugout shallow well on the ground and we had a huge bladder of drinking water from the US army supply.

Another meeting was called. We were 14 of us in total, 6 were girls and the rest were boys. Each of us received a notebook, a pencil, a packet containing a small flashlight, a pocket knife, one sheet of metal foil for use as a thermal blanket, a few halogen tablets in a glass vial, a few aspirin tablets, a ligature, and a few bandages. People were assigned to various jobs. I was put in charge of food and sanitation. At each meeting, I had to give a report. I felt if we stayed in the bomb shelter for more than 24 hours, cockroaches, vermin, rats, and flies would take over this place.

As I looked around, I found two books, one was an official document on Kabul, the other one a paper book edition of " The Caravana" by Michael Misner. As I began reading the book, I felt I was lucky in that I was able to read an engaging drama unfolded in Afghanistan of an earlier time but the social condition of the country had remained pretty much the same. It was very interesting reading.

At night we slipped into our individual sleeping bags. We directed our heads towards the wall and feet to the center of the room. We looked like walruses on a sandy beach packed side to side without any room in between.

At about 9 PM the fireworks really began. We could hear tanks moving on the pavement, occasional loud booms of gum fire with that the windows upstairs rattled. Then clit-clit sounds of the more tank movements and loud boom - one was never sure where it would land. Then a series of machine gun fires rattled structures all around us. The ricocheting bullets from hitting the metals and shattering of window planes kept us on edge. The fire was coming from both sides of our bomb shelter, we were caught in a crossfire.
After a while, nothing bothered me, and instead of imagining what was going to happen, I wanted to be outside with the soldiers. At least my life would not be that uncertain. Staying put in a hole even with fortified walls was like a sitting duck; a direct hit from a field gun would certainly take few of us out.

Day no. 2.
 We were having a breakfast meeting when our cook showed up with a stack of fresh bread, and a cheer went up. He told us a tank drove through the home of our night watchman, narrowly missing his wife and a child. There were deaths and destruction all around our compound; our metal front gate looked like a colander; all the windows of our building were shattered. He said he had to come and find for himself those people he cared for so long made through the night or not. Then he left in a hurry.

There was a lull in the fighting the whole day. In the evening briefing, we learned the local UN office was ransacked by the soldiers. They made gun placements on the roof of the building, broke furniture to make barricades. They found the duty free liquor chest and broke it open and got drunk. When their commander found them drunk, he ordered them out of the building. But the soldiers took all the things they could carry with them including a heavy antique solid brass wood burning stove.

Day no.3
We learned the war had spread to Kunduz. The airport was bombed; 8 people were killed. They had no word about our hospital which was located in one of the airport hangers. Local Afghans who worked for us were all safe.
Late in the morning jet planes screamed past over our shelter, then we heard bombs bursting at a distance. This time the theatre of operation was toward a hill rather than the residential area. At night, the ground fighting began with gusto. It appeared one side was going to wipe out the other. Afghans do not take prisoners.

Day no. 4.
Our supply of food was almost all gone. We had biscuits, rancid butter, and tea for breakfast. At the meeting, we learned about a ground war now raging in Kunduz. We had no further information on casualties or about people who worked for our mission. An air force commander in charge of this sector was killed when his helicopter was shot down by the ground fire. They feared that a retaliatory ground offensive was underway. New gun positions and pillboxes were cropping up all around us. It was decided to move us to a safer location. The UN was trying to arrange a temporary ceasefire to evacuate us along with other groups of NGOs (non-government organizations). The looted UN office was abandoned and people were taken to the UNHCR (UN High Commissioner for Refugees) office located in a different part of the town.

The word of a temporary cease-fire came and went several times of the day. The situation around our compound was tense but quiet. I saw one or two people sneak out of the shelter and headed upstairs in search of food and gather their personal belongings. I had no change of clothing with me, my overnight bag was in another part of the town where I stayed the first night in Mazar-e Sharif. I was smelly and felt dirty. In the same predicament as mine was a young medical student from Holland. He had finished his tour of duty and was waiting for his transportation out to Paris then to Holland. He was extremely depressed. He was following me like a shadow. I told him if worse came to worse I would call home and my family would contact our State Senator. The Senators carry power and influence in the US Government. He would get the Pentagon to rescue us and take us to a safe place. I reminded him Americans would never forget their fellow countrymen in times of need. He believed me and the others believed it also when he repeated to them that I had told him. However, I did not believe a rescue was possible in that situation. But I kept my optimistic looks up.

We were totally cut off physically except the UNHCR kept us informed. We had only tea for lunch and a few lucky ones had pieces of a chocolate bar and hard candies that were retrieved from upstairs.
It was not easy to fall asleep on an empty stomach especially when intermittent bursts of machine gun fire came from behind the building. In the middle of the night, a fierce gun battle raged.

Day no.5.
The word came early in the morning that a temporary cease-fire was agreed upon. We were given just 5 minutes to board when the convoy would come. The security man showed us how to duck incoming bullets. We were ready. But the convoy did not show up. Hopes followed by despair and it wore out many of the ladies and younger men. After the third attempt, the convoy was let in. We boarded well-marked UN vehicles in a minute. With UN flags flying from both the front and rear fenders and with military escorts our convoy passed through the charred marketplace, we saw destruction all around. The situation was tense but no one took a shot at our passing vehicles. We reached the UNHCR office intact. We then headed towards the Uzbekistan border and left Afghanistan behind.

*********************************************************

Afghan Justice

Afghan Justice

P.K.Ghatak, MD

No. 7.

The administrator of the medical mission in Kunduz, Afghanistan introduced me to other members of the mission, when I arrived there, and gave me a tour of the place and pointing his finger at the stairway he said." Do not go up the stairs to the roof, you can easily see the courtyards of the adjacent houses from there. And if by chance you happen to see an uncovered face of a female member of a household that would be considered as a punishable offense because you have polluted the purity of his harem. The punishment of such offense is left to the demand made by the senior member of that household.  In some cases, you can get away with a ton of money, or they may demand your gouged out eyes, or ask you to marry the girl you saw."

Not only I never went to the roof; I never looked at anything that remotely resembled a woman; always kept my gaze down - not going up above the knee level.

One day we were going to a satellite clinic, riding in a well-marked vehicle, with a prominently displaced logo and flags. As we were passing through a roadside market when a one-horse carriage (Tonga called locally) driven by an old man was coming from the other direction. The fluttering flags might have startled the horse, and it began to run erratically. The old man lost control of the horse and Tonga hit our vehicle. A metal tip of the horse harness smashed a glass window of our vehicle and penetrated inside the vehicle narrowly missing our interpreter.
Within a minute a large crowd gathered around our vehicle. Soon a fully dressed police officer appeared and began to question our driver and the old man. And after finishing his inquiry he arrested the old man and impounded his horse and carriage.
Our interpreter told me that we could not leave the area till the court proceedings had concluded.

Court proceedings!! I asked how long that would take. He politely said Afghan justice was swift.

A crowd gathered around an elevated gazebo like structure in the central square.  A clergyman arrived and took over the proceeding as a judge. He began with an invocation followed by a short prayer, then the entire crowd joined him.

The police officer produced the old man and our driver to the judge. Each gave his side of the story; eyewitnesses were asked questions. In less than ½ hour the trial was over. The judge found the old man was responsible for the accident. The judge asked our driver how he wanted to be compensated. The driver asked for a sum of money, enough to cover the repair of the vehicle. The owner of a repair shop was present among the crowd. He gave an estimate. The judge told the old man to pay the driver that amount. And added until the full payment was made his horse and the carriage would remain impounded.

We managed to slip some money to the old man; he paid the fine and the court released the old man, his horse, and carriage.
Afghan justice is swift and final. And later I learned this was the Sharia Law.

***************************************************************