The Antardhwani Saga: Resounding Conviction, Resonanting Possibilities

"There is a voice inside of you that whispers all day long, I feel this is right for me, I know that this is wrong. No teacher, preacher, parent, friend or wise man can decide what's right for you: just listen to the voice that speaks inside.” 

― Shel Silverstein, legendary writer, cartoonist, poet, and playwright (1930-1999)

As a practising oncologist, both in US and India, Dr. B. S. Ajaikumar has long pondered over the umpteen ills, evils, pretences, and prejudices that plague our society at large. Even after four decades of earnest observation and deep introspection, he is the first to confess he knows so little about them, given  their multifarious mutations across the globe, more so in India. He sensed the need for a stellar movement aimed at nurturing and nourishing the cocoon of our priceless individuality without getting bogged down by the societal pressures that numb our intellect and intuition. We all know casteism and social discrimination is the worst evil thrust upon us from time immemorial. Yet, we knowingly or unknowingly uphold the status quo; worse, even our silence becomes a wilful endorsement of these absurd social and political diktats. 

In the search for lasting solutions, he strongly felt, it was high time activism became magnanimously philanthropic, not merely charitable. Thus was born Antardhwani, the proverbial and powerful inner voice of people, a call for conscious change, a potent and purposeful platform to probe beneath the venerated fabric of our culture and conventions, as also orchestrate a solution-centric collaboration of like-minded activists from different walks of life to work towards institutionalizing social equality and economic prosperity in India. The goal may have been overwhelming, but he set about the mission with inimitable grit and gumption, with the robust support of two selfless activists of a notably eventful journalistic background. 

The Antardhwani story is incomplete without an elaboration of its genesis, which can be best appreciated in the freewheeling words of the two co-founders Seethalakshmi S and Rahul Nandan.  

                                 

 

Seethalakshmi S

“As he walked to his car, he turned, raised his thumb, and exclaimed, ‘Think Tank!’ I responded, ‘Yes, on board with you.”

The year was 2017. I was in the midst of yet another busy newsroom day when I got a call from Dr Ajai. “Seethalakshmi, can we catch up for coffee tomorrow? ', he asked in his inimitably polite voice. He was attending  a press meet on MG Road, close to my The Times of India office. The reporter in me jumped at the invitation of meeting one of the best oncologists in India, having set up a chain of cancer hospitals in India and abroad. “Yes Dr Ajai,” I said instantly, praying no major news breaks would happen the next day, which would have made it difficult for me to step out. Fortunately, the next day was peaceful. After wrapping my morning news meet, and readying the day’s news list, I headed for the Cafe Coffee Day on MG Road. I had earlier interviewed Dr Ajai for the phenomenal CyberKnife treatment he brought to India as also following any breakthrough surgeries at his hospital. However, those were pure business meetings for both of us. This coffee rendezvous was different. Well known for his punctuality, he was at the coffee shop ahead of the slated time. I greeted him and as we settled with a cappuccino, he leaned back and said: “You know Seethalakshmi, I am bored… I want to do something more. As an oncologist, I have seen the ills in society, and I feel helpless that we as citizens do nothing about it. I want to set up a think tank.''

My first reaction was that of shock and bewilderment. An accomplished doctor owning a chain of hospitals is bored and wants to do more… after doing yeomen service in cancer care for over four decades. But what changed the entire conversation was a strong inclination lurking inside me since a few years.  That I must change my career path. And Dr Ajai was the first person I confided in. I blurted: “I am bored too doctor. Often, I feel that a media job is powerful, yet it is at times mindless. Day after day, we chase deadlines and bring out a newspaper. But barely anything changes on the ground.  As a city editor, I feel helpless too. Even I want to be an integral part of some change. Can I join you?”

There was epic silence for a few moments which seemed like ages to me. Finally, Dr Ajai burst into his emblematic laughter. “Are you sure you are bored? I cannot believe this. You are in a good position in India's number one newspaper. Why would you leave all of that and join a cancer hospital?  I insisted that I will build something for him which will at least attempt to realise his vision. The next 30 minutes, Dr Ajai and I talked about the sheer helplessness amongst citizens, the need to start demanding accountability, how a tiny percentage of people in India pay taxes and the big sharks get away. As he walked to his car, he turned, raised his thumb and exclaimed, “Think Tank!” I responded, “Yes, on board with you.”

Dr Ajai then left for the US but regularly kept in touch. At this point, I told him it is not just me, a colleague from The Times of India Delhi, Rahul Nandan, is also keen to embark on this journey. That CCD meet with Dr Ajai was followed by one more, and it was sealed. The time had come to give up what I had done all my life with absolute passion. I loved my job and was happy every single day for sixteen years. I joined TOI as a trainee journalist and rose to become a city editor, won awards and fellowships for excellence in journalism, and wrote over 4,000 news articles. I told myself: Now I must start work in a different sector where I have no experience. The inner voice in me (we named the think tank Antardhwani later) told me I must take the plunge. I signed the offer letter.  And that was the boldest thing I had done in many years. With no regrets of course!

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Rahul Nandan

“I found Dr Ajai extremely passionate about his thoughts and crystal clear about how he wanted to pursue them.”

My thoughts on different aspects of life and work were largely shaped by my formal initiation in journalism in the coveted Indian Institute of Mass Communication, as also in different editorial capacities in national newspapers in Delhi and Bengaluru including The Statesman, The Indian Express and The Times of India. They gradually prepared me for what I am doing now. 

I feel the daily stream of news in the newsroom and the way they are handled with considerable degree of detachment was making me numb to the things happening around. Making sense of something that has happened far from where you are is what an editor does day in day out, with little room to actually relate to the people or the epicentre of action. It often left me with an urge to find a way that will aid establish a closer connection with my subjects. 

After a decade of a flourishing stint in Delhi, mostly in The Times of India where I was an editor with the paper’s special projects team, I moved to Bangalore in 2016 albeit in the same organization, in a similar role. Seetha was among my earliest acquaintances. We shared a deep desire to do something more meaningful and relevant at the grassroots level, using our years of learnings as journalists. When Dr Ajai expressed his wish to do something similar, as Seetha has already enumerated, things started to fall in place in quick succession. 

In my first meeting itself I found Dr Ajai extremely passionate about his thoughts and crystal clear about how he wanted to pursue them. His ideas seamlessly amalgamated with ours. Six months later, Antardhwani – The Inner Voice was born on June 8, 2018 as a think tank focused on prevailing issues in healthcare, education, livelihood, and governance. 

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Antardhwani: Key Milestones

Helping Tobacco Farmers Grow Alternative Crops

·   Dr Ajai’s single-minded focus on curbing tobacco use in India led Antardhwani to study, explore and set a model for reducing tobacco cultivation by helping farmers grow financially and ethically viable alternative crops. As its flagship intervention, Antardhwani launched the country’s first-of-its-kind alternative farming project in Karnataka’s Mysuru district, the state’s tobacco growing hub. The project involves 50 tobacco farmers who grow sandalwood besides other seasonal fruits in 1 acre of their respective agricultural land, putting the project size to a total of 50 acres in the first phase. More than 15,000 high grade saplings of sandalwood and over 8,000 saplings of lucrative seasonal fruits have been supplied to the farmers free of cost under the project. 

·   Antardhwani is working with agronomists, ecologists, medical practitioners, and other relevant experts to guide decision-making at every step of the process. Willing to switch, tobacco growers in Karnataka have been unable to do so in the absence of an economically viable alternative plan. There has long been the need to identify crops which can be grown instead of tobacco in regions of different climatic and soil conditions, assure market guarantee of the produce, at the same time sensitize the farmers about the ill effects of growing tobacco on health and environment (deforestation) - a fact they are largely unaware of.

·   Antardhwani is also documenting the entire stages of the transformation of our tobacco farmers from planting, harvesting, and selling the produce. “Butting Out Tobacco” a documentary film that will showcase the entire lifecycle of a cigarette – from grower to consumer – is also under production. The initiative has since garnered support from other tobacco farmers in the region and is considered as a unique success model in preventing tobacco growing and use. 

 

Education Cess Accountability

Antardhwani has urged the government to take corrective action regarding the non-utilization of Secondary & Higher Education Cess worth thousands of crores for a decade after being introduced. Through a public interest litigation, it seeks fixing of accountability and liability for non-allocation of the cess money collected from every citizen of this country when it could have been used for improving the learning levels and quality teaching in classrooms, recruiting more teachers to improve the pupil-teacher ratio, and paying more to teachers, and largely improving and putting in place the right infrastructure, especially in rural areas.

Antardhwani Conversations 

Antardhwani Conversations is a unique platform that aims to bring together experts from diverse backgrounds to share their thoughts and opinions on contemporary issues and create effective discourse around them. The purpose is to have a meaningful conversation to figure out how each one having distinct understanding and opinion perceives a particular issue or a situation, most importantly learn from each other’s experiences. The inaugural edition of Antardhwani Conversations in March 2020 had meaningful deliberation on global poverty and its possible solutions. Antardhwani Conversations has since become an extremely admired and successful model of conversations on diverse topical issues. The next three editions have touched issues including Evolution of Democracy in India and the World; Voice of the Vote; and Making Tax Less Taxing and More Paying. 

Voice of the Vote Campaign

Changing the way people vote is a colossal and formidable challenge in India, a country where the majority of voters hail from rural and remote areas and hence are largely uneducated and ignorant. Initiating and fostering a purposeful discourse with them about Voting the right way calls for a painstakingly focused and sustained approach. Antardhwani has initiated focused rural campaigns to sensitize rural voters on why caste, creed, religion, momentary gains, and freebies should not be the basis of their invaluable votes. Persuasive and persistent effort is required to help them internalize the fact that citizen votes must be necessarily cast based on key issues towards electing genuine candidates with clean records and clear conscience, rather than placing faith in people with shady pasts and suspect motives for five long years, only to lament in hindsight.

It is time to shift focus on the women of rural India to make them the vehicles of community-wide change. It is important to identify competent and conscientious women leaders from among rural households and make them aware about political accountability, as also their voting rights and responsibilities. An informed and transformed woman can change the perception of the entire family, as also the community. A growing talent pool of rural women leaders will also pave the way for more women candidates contesting polls going forward.

India has around 6.5 lakh villages and about 2,50,000 gram panchayats, so it becomes imperative to focus on them to bring any political and democratic reform in real sense. A serious effort to document the voting pattern, issues and candidates in panchayat elections will go a long way in bringing positive behavioural changes in rural voters, which will eventually influence the voting pattern of the districts, states, and the entire country. We need to follow the 'rural to urban' model for a widespread impact.

Antardhwani Papers

The first paper of its research-based paper series called Antardhwani Papers – The Roadmap to Universal Healthcare in India – has six chapters that deals with various facets of the state of healthcare in India, the need for universal healthcare coverage, imminent reforms in medical education, public-private partnership in healthcare, leadership protocol of Covid times and Covid-19 in perspective. The chapters written by experts from diverse fields examine the issues in India’s healthcare logically and suggest practical reforms. 

The paper also carried heartfelt experiences and learnings of Covid survivors including a doctor, a journalist and acclaimed woman business leader Kiran Mazumdar Shaw (Biocon Chairperson).  

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 Antardhwani - The Way Forward

Antardhwani will continue to work on all fronts - involving taxpayers in decision making, empowering citizens to proactively demand what they deserve, strengthening India’s tax administration, creating a single credible source of all tax-related law and data and enhancing disclosure standards of the government.

Endgame Tobacco: Vision of Complete Eradication of Tobacco in India by 2050. Taking the fight against tobacco from control and prevention to absolute eradication, Antardhwani will investigate all aspects of tobacco, from cultivation, production to consumption and prepare a Vision Document for Eradication of Tobacco from India in the next 25 years. An authoritative research-based document will be a guiding light for the government and the courts for tobacco-related decision making. 

Antardhwani will bring doctors and healthcare practitioners across India as a single collective voice against tobacco, for the first time ever.

Antardhwani is also working at different levels to make a panchayat in Periyapatna (Mysore) tobacco free by next year.

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When the celebrated Santoor maestro Pandit Shivkumar Sharma was asked about his profound creation – a deeply contemplative raga he christened Antardhwani – he gave a very intuitive elaboration. He said, “During a practice session at home, I was changing the jodi from one raga to other raga when I found that a few notes when repeated took me inward. So, I decided to call it Antardhwani. Dr. Ajaikumar and his two comrades have done something similar, shifting from one thought to another, and innately tuning into a reverberating call for conscious change, which they named Antardhwani. They couldn’t have found a more apt Sanskrit name: a Visarg sandhi that makes the prefix अन्तर् (अन्तः ) meet the noun ध्वनि at a transformative junction. It implies ‘inner voice’ in English, but it represents something more profound than what the English connotations can convey. 

Visit Antardhwani at https://antardhwani-theinnervoice.org/ 

Oasis: Freewheeling conversations with Dr. Vishal Rao - III

“There is no cure for birth and death save to enjoy the interval.” 

― George Santayana

 

All clinical cases that thrive on the cusp of life and death invariably give birth to perplexing questions: Different stakeholders – whether patients, family members, and acquaintances or doctors, nurses, and medical staff - have to deal with life and death situations where the outcome can (and at times does) turn towards either end in the unlikeliest of ways. In the third edition of “Oasis”, we probe deeper into this critical issue, which is needlessly made to appear dark and sinister in conventional conversations.

The proposition of accepting death when life seems futile is largely controversial given its ethical, legal, scientific, and spiritual connotations. The legal perspective is the most furiously debated, centered on the difficult question: should we allow active euthanasia or not? In the Indian legal system, only passive euthanasia is permissible, which implies easing the process of death for a person with no will to live by discontinuing active medical intervention. Active euthanasia on the other hand means accelerating the process of death through lethal injectables, which is not legally permissible due to social complexities, systemic loopholes, as also given the likelihood of criminal motives. This conversation is not about euthanasia but given its interconnectedness, but it does touch upon it before addressing the multi-hued aspects surrounding life and death. 

Here it is pertinent to note that Dr. Vishal’s  recounting of baffling cases consciously steers clear of the unknowing urge to color them with conjectures and conclusions, neither making divine proclamations, nor dismissing the unexpected outcomes as too-good-to-be-true exceptions. He suspends judgement of every kind and humbly bows down before the celestial forces that work from the mists of the unknown, while mere mortals do what they can in their limited capacities.

 

 Here goes…

 When, according to you, does death become a better solution? 

That’s a good question to kick-off our conversations. You mentioned euthanasia above. A lot of our terminally ill patients wish for passive euthanasia as they find resuscitation meaningless at the point of no return, which they may have internally sensed. They may have had a knock at the door like in the movie “Meet Joe Black”, where Brad Pitt meticulously leads Anthony Hopkins to ask the primordial question, “Am I going to die?”

Death at that point seems inevitable and imminent, and any intervention clearly does not add to the quality of life, although it may or may not add to the quantity of life. More importantly, resisting death also proves infeasible from the financial perspective which is an integral part of the treatment and often proves prohibitive. In many such cases, death becomes a better solution than life, not as a meek surrender but as a conscious embrace.

What has been your personal experience on this front, as a surgical oncologist?    

In my evolution as an oncologist, I have grappled with many fundamental questions, especially during the formative years: why do a few good cancers go bad when the doctors assumed a recovery track in due course? Conversely, why do a few bad cancers miraculously transform into good cancers saving lives when all clinical hope had been abandoned. When I did not find credible and consistent answers from all likely sources, I turned to the Bhagwad Geeta to help me address these existential questions. I cannot say I found the answers in the sacred text, but I definitely understand the questions better than before.

You are an agnostic, right?

Yes! As an agnostic, neither a believer nor a non-believer, I respect all religions and deities. Being a man of science, beliefs for me are nothing but hard facts. Like for instance, I see sun and the moon every day and hence I know they exist, I do not have to force myself into a belief without knowing it to be true. I find God and spirituality synonymous with science as natural laws deriving their fundamentals from a blend of facts and hypotheses, which have been accepted as truths. Having said that, as we probe deeper into things, our assumptions of truths change. And that is where we should ideally seek refuge in the Socratic truth: “the only thing I know is that I know nothing.”  

How do assumptions of truth change in the course of the treatment?

As physicians, we encounter death on a daily basis, complete with the suffering and misery that it invariably triggers. At the same time, we also experience mystical U-turns where a patient comes back from the point of no return. Imminent death can have an aspect of life hovering around it and vice versa. During such transcendent experiences, the doctor is venturing into uncharted territories. I have a long list of absolutely baffling cases: some have left me emotionally drained; others have given me dollops of joy, hope, and inspiration, a few have lent me deep insights into the play of life and death, while many others have forced me to re-examine some of the assumptions that I held dear till that point.

Let us take a closer look at all these cases in your words, for the benefit of the reader:

I met Dr. Stanley Wetschler, former director of the Bradfordwoods Medical Centre, through sheer serendipity. Save for a common acquaintance between us, we were as good as strangers, and yet he graciously decided to host me at his lavish Pittsburgh residence when I moved from San Francisco on a Pittsburgh University stint. During one of our heartfelt conversations, he casually shared his medical report with me and asked for my opinion. It was a case of stage four colon cancer; the tumour was clearly not responding to chemotherapy. I could barely convey my helplessness to him as any intervention at that stage seemed pointless. He smiled and showed me the date of the report, which was ten years back in time. I was flabbergasted when I realized that the good doctor had not just outlived the six months his doctors had then given him, he was in the pink of health leading a perfectly normal life.

***

A 67-year-old lady patient came to me in 2015 with an aggressive cancer of the mouth, a sarcomatous carcinoma of the maxilla. Post an eight-hour successful surgery, when she came back in a month’s time for radiation and chemo, the tumour had recurred both in the lungs and local area. The patient was now in a wheelchair, unable to walk on her own. 

 

Notwithstanding the seeming futility of further treatment given the poor prognosis, I briefed the patient about metronomic chemotherapy – a low-dose chemo variant founded on the simple premise that if you cannot demolish a building at one go, try to remove one block at a time, akin to the brick removal in the film ‘Shawshank Redemption.’ 

 

I gave her the needful tablets and requested her to keep me updated through regular follow ups.  One and a half years later, when she came back, she was doing fine and was back to normal life. A PET scan showed no tumour this time around.  I was overjoyed to see our prediction going wrong; we had given her not more than a month after she had first come for radiation and chemo, and here she was, urging me for a cosmetic correction to set her face right with the vigour and vitality of a young woman.

***

Another patient of mine, a cancer survivor, was having her stiches removed post-surgery. She seemed incredibly happy and upbeat, thanking me for helping her conquer the disease. I reassured her and asked her to return in a week’s time for routine follow up. She happily bade me goodbye and went to the washroom to freshen up. Then and there, she suffered a massive cardiac arrest that claimed her life on the spot.  

***

A 65-year-old lady was doing well after surgery, but a minor infection delayed her overall recovery by five days. During that time, I came to know that none of her children wanted her back home as they saw her more of a burden. She seemed extremely depressed despite the recovery. At night, she passed away in sleep but just before that, she called the nurse and narrated a beautiful scenario that she was visualizing, that she is in her hometown, laughing in the fields, enjoying the bliss of mother nature with gay abandon. After the narration, she had a hearty laugh before she closed her eyes forever.

***

On one my routine ICU rounds, a lady approached me, the daughter of an old patient of mine whose condition was deteriorating by the minute. She requested me to give a courtesy visit to her mom in the ICU. Having undergone tracheostomy, the patient was breathing though a hole in the throat and feeding through a stomach pipe, while her bladder was being emptied through a catheter. The tumour had spread all over her body and she was in discernibly bad shape. She wrote a note asking me: ‘how much time do I have?’ I told her instinctively that I was not sure, but it was not more than a day or two. I vividly remember the bright smile that adorned her dull face. She was overjoyed and wrote another lovely note to me, thanking me for telling her the truth when everybody around her was busy giving her false hopes. She moved on with a deep sense of solace writ on her dying face.

***

A cancer patient of mine, a young and dynamic sports journalist, was known to me since long. I had even played a part in arranging for his matrimony. Since he had lost his voice box, his marriage seemed a difficult proposition although the girl loved him. I convinced the parents on both sides to let the wedding happen given the deep love between the couple. The girl’s family asked me bluntly about his life span: I asked them a counter question: what about your life span? Can you make a prediction? Just because he is a cancer survivor does not mean we can predict his impending death. So go with the flow and who knows, he may outlive you, I told them. 

Ten years later, his tumour recurred and spread to the lungs. We managed to stop the profuse bleeding for a while but after a few days, he was again critical. Soon after, I got a call that one of last wishes was to talk to me. When I went to his room, he was about to be put on the ventilator. The medical team briefly reversed the sedation, and he gave me a thumbs up for a goodbye. 

I was examining his reports while the medical team informed me that all that could be done had been done. Yet, I decided to make one last attempt of manually putting pressure on the concerned area. The next morning, I was told that the bleeding had stopped. The week after, the ventilator was removed as he was showing signs of waking up. Three days later, he was looking in much better shape and was shifted back to his room. As per his wish, he was allowed to spend time with his three-year old daughter and also complete his unfinished book on cricket. 

Not only did he complete the book, but he also hosted a grand book release function. His normal life resumed for a while, but sadly the tumour came back with a vengeance. When he met me again in my OPD, he was visibly depressed. Amid his worsening condition, he was also forced to face the onslaught of the constant bickering between his mom and wife. 

Being helpless and hapless, I intuitively decided to employ humour to cheer him up. I told him “Even Lord Shiva and Lord Vishnu failed to resolve this sticky familial challenge, why do you grieve unless you feel you are above these gods?”  I was happy to see the smile back on his handsome face. I told him to go back home and send me a clean-shaven snap. He sent me the snap and also conveyed that he felt better after talking to me. He passed away few months later. 

***

A patient from the Northeast was due for discharge in a week’s time. All of a sudden, he suffered a severe psychiatric attack with no history of similar episodes. He became violent to the extent of physically attacking our hospital staff on duty. Metabolically, the psychosis could have the outcome of carbon di oxide retention or tobacco withdrawal, but the exact cause remains unknown. When he collapsed in a breathless state, he was immediately taken for resuscitation. After the tracheostomy, his breathing resumed but his pulse and cardiac rates remained unstable, and his ejection fractions were not strong. On an impulse, I touched the patient and made a silent prayer. All I asked for was the right guidance from above as I did not know what was best for him. As I walked towards the next ICU bed, I saw the wife of this patient, understandably distraught and broken down. Something inside me urged me to talk to her. I told her about his deteriorating condition and asked her to let go. I told her every therapy has failed, his body has given up, and we are forcing him to come back. About three hours later, I came to know that he had moved on. But, after a few hours, I was duly informed that he had reclaimed his life from the jaws of death. I will never know what exactly transpired in those wee hours, but this patient fully recovered and went back home smiling.

 

 

What explains such miraculous recoveries and relapses?      This question has no answer, but it should not deter one from analyzing these statistical outliers to guide future therapies, as also study life and death from all the perspectives discussed above -   ethical, legal, scientific, and spiritual.   When a stage IV cancer patient asks me, “Am I going to die?”, my answer is that we did not choose the day we were born, likewise, we cannot decide the day and time of our death. What we have at our disposal is the time and space in between. In this space, there is science, there are facts and truths beyond which there are assumptions of truths. As clinicians, we have to operate within this spectrum which is why you must have your Intelligence Quotient, Emotional Quotient, and Spiritual Quotient tightly coupled with each other. All three have their own ways and means to guide you and you cannot ignore any of them.    A lot of the times, death has a few emotional entanglements and how it chooses its way out is too intricate for human understanding, whether you call it Karma or anything else. It is easy to seek refuge in the good karma -bad karma theory, but I feel, sometimes, many good people absorb the negativity around them in the form of cancer afflictions and move on to make the world a better place than before. Little children are known to do this from time to time, in the capacity of little angels.   What should be the surgeon’s approach, outlook, and priorities during such extreme encounters – both favorable and fatal.  A clinician cannot predict the time of death. But it is important to explain his or her understanding of death to patients and their kin. My understanding as an agnostic oncologist is that people die to move on and again come back to the universe to interact with each other in differing relationships. During this difficult time when life is ebbing, patients should get as much good sleep as possible. They must also be urged to have food to the extent possible, and all effort must be made to remove their physical and psychological pain, again to the extent possible. Beyond this, nothing is in our control as to what course the cancer will take.  Sadly, doctors bear the brunt of undesirable outcomes many a times, as the grieving families finds an easy target to take out their deep frustration and disappointment at having lost their near and dear ones. This eventuality is an integral part of our fraternity. Barring exceptions, no doctor would consciously push a patient towards death. He or she will leave no stone unturned to save a life.  It is imperative to communicate with the patient’s family in timely fashion, informing them about the circumstances surrounding the demise. I have set up a bereavement team which swings into action in cohesive fashion every time there is a demise, helping the patient’s family cope with the tragedy, informing relatives, calling for the ambulance, facilitating the last rites and prayers, and attending to paperwork and other formalities.   Sadly, a surgeon cannot but escape a ghastly predicament: “How do I go and convey bad news to the family who are hoping against hope?” it is easy to explain the umpteen challenges of life and survival to a patient’s relatives, but it is exceedingly difficult to explain death and its mysterious ways to them. A lot of the time doctors find it difficult to accept their failures or the fatalities of nature. It is difficult to confront death saying that ‘this is beyond me’. It is annoying and over consuming.  Do you find it difficult to overcome grief following a tragic event?  Yes, I have experienced many such difficult moments. Contrary to popular notion, even oncologists need to undergo a catharsis of evolved processes to overcome the grief that stems from the sheer helplessness in trying to rescue the patient from the jaws of death. My family has helped me burn this catharsis from time to time. Every time I experience a tragic event, they help me to come out of it. Sometimes, a doctor may even need the help of a psychologist to come out of the shock and move on.  At times, when I am supposedly counselling the deceased’s family, I have found them reassuring me instead. Many of them have shown extreme forbearance in expressing their gratitude for the attention and care I had shown for the patient even in their moment of grief.  Any parting thoughts? A spiritual master once told me, “There are hundreds of people waiting for you outside your cabin. Their blessings and prayers have given you the healing touch. This is not some intrinsic power bestowed upon few individuals by the almighty; it is an elemental power that emanates from the blessings of these common people.  This power is not meant to benefit you, it is meant to benefit people. So, make it a point to touch your patients and pave the way for the healing to happen. When you touch them, you offer a silent prayer for their wellbeing.”  Ever since, I never forget to touch the patient and offer a silent prayer even if the case is hopelessly critical, like I did in the case of the patient who suffered the sudden psychiatric episode. Even when a patient is unconscious, the soul is supposed to be awake, and it communicates in strange ways. I place my faith in this assumption of truth as a conscious choice.

The {Glasnostic} Diagnostician from Dublin

 

The Irish literary genius James Augustine Aloysius Joyce makes an enlightening observation in his seminal short story collection “Dubliners”: “I wanted real adventures to happen to myself. But real adventures, I reflected, do not happen to people who remain at home: they must be sought abroad.” 

 

One Russian prodigy would have certainly made Joyce immensely proud for sharing his passion for real adventures on foreign soil, a non-conformist who found his calling in Dublin through a long winding route that was well worth every effort that went into the relocation. He travelled from Moscow to Kiev, Ukraine where he was interviewed for a vocation following which he came back to Moscow and applied for a working visa to Ireland, a welcoming arrangement that allowed an aspirant to change jobs subsequent to the debut job, unlike in many other nations where losing your employment meant the end of the road (and a forced homecoming). 

 

So he came to Dublin and found his comfort zone – a sweet home and a thriving workspace - among the friendly and non-interfering Irish people. If a lot can happen over coffee, a lot can more can happen over an Irish coffee! 

 

Meet Dmitry Vostokov, the globally renowned software diagnostics expert, educator, scientist, inventor, speaker and author. When it comes to diagnostics across different spheres and sectors, we have several practitioners doing exactly the opposite of what Sir William Osler, father of modern medicine, earnestly advised: “To confess ignorance is often wiser than to beat about the bush with a hypothetical diagnosis.”

 

It is indeed heartening to note that we have commited crusaders like Dmitry who have raised the bar for software diagnostics to such a level that it now stands to benefit other pivotal spheres like medical diagnostics. The story of his inspiring life and phenomenal work knows no bounds, and one is really at a loss to decide where to begin the tete-a-tete, and on what note to conclude the conversation. But a beginning needs to be made, for the guiding light of Dmitry’s insights undoubtedly helps the world decipher trends and make meaning out of the metaphorical patterns of different hues, colours, shapes, and contours. So, here is a tiny window – small enough to arouse interest and wide enough to cover the essence.      

 

 

Q & A with Dmitry Vostokov 

 

How was life during your formative years in the Soviet Union? 

 

Life was really calm in that era than what it is today; those were the late Soviet Union years, the late 1970s, and early 1980s, which were blessed by stability in some sense. Prior to the mid-1970s, my grandfather held the highest technical position  (CTO in modern terminology) in a large mechanical factory, and he was also an inventor. I vividly remember my parents taking me out every summer for at least 2 months of travel. I visited all Soviet Union republics, their museums, and tourist hubs, including Central Asia. My favorite cities were Samarkand, Bukhara, and Hiva. Having had no siblings, I spent most of my time reading, including popular medical magazines from a very early age. Perhaps that habit subconsciously influenced me towards diagnostics. I was also fond of reading science fiction and adventure books. At age 10, I read Hobbit and liked it very much. I read an anthology on the history of the European Middle Ages several times, from cover to cover, even before we studied about that epoch-making era at school. I also wrote a long epic poem. Of course, all this reading happened prior to my deep affinity with Chemistry which got me hooked to Chemistry books, including university-level textbooks. I also attended a musical school for many years playing mostly cello with elements of piano (cello classes was several times cost-effective than the piano ones, hence my obsession with cello!). I became an ardent fan of Johann Sebastian Bach although I, methodically, on my own, learned to play a few fragments from the Well-Tempered Clavier. So, by the end of school, I had the choice to pursue higher education in either Music or Chemistry. I chose Chemistry based on my success in several Olympic Competitions at the regional, republic, and Soviet Union levels.

 

Lego modeling: the epicenter of Dimitry’s continued preoccupation 

 

Your affinity with Chemistry at age 12 seems very intriguing, almost as if there was something predestined about this choice. 

 

I think abstraction played a key role in this affinity. I saw aromatic compounds drawn on a blackboard, which sparked my interest. So I asked my parents to bring me Chemistry school books to study, which I devoured in a month. In the same way, many years later, I saw a category theory book cover in a bookshop and was positively intrigued. Now I have written my books on these subjects. At school, I also read many books on the history of Chemistry. And when I study a new subject, I always try to read a book on its history. But I think my intrinsic curiosity about abstraction dates back much earlier. I recall I was intrigued about complex contour integral notation at preschool age (before I learned to read) after seeing it in some math book. Such integrals certainly stood out from the surrounding cloud of letters. Only much later, I had an aha moment having seen them again in a complex analysis book 

 

Again, there seems something serendipitous about your tryst with computational chemistry. How did this come about? 

 

I read a popular book on quantum chemistry at school, and again, abstraction played a role: all those quantum operators and wave functions. I learned calculus on my own from the first volume of The Feynman Lectures and jumped straight to the final volumes on quantum mechanics. Dirac notation was not alien to me. When learning linear algebra on my own, I got the idea of representing chemical formulas as vector spaces. I even attempted to learn quantum electrodynamics just before being accepted to University. So, I wanted to become a theoretical (organic) chemist. But, at the University, I almost immediately got involved with programming (and I had already learned a large part of University-level chemistry at school and, therefore, had extra free time) and gradually put Chemistry aside. Accidentally, in the first year, I was put into a special learning group with additional computational subjects, and this sparked my interest in programming because I knew nothing about it at all. The Russian Algorithmic Language was like a pseudocode: you could execute all instructions on paper. And it was all in the Russian language. We all studied it at school, but my school didn't have a computer to practice.  

 

Your early success with Fortran was quite exemplary...

 

The FORTRAN language is quite simple, you can guess from its name FORmular TRANslation, and it could also be easily translated to machine language by hand. I was in love with the PDP-11 assembly language at that time. So, I gave it a try.

I worked in a computational chemistry laboratory as a student by the end of the 1980s. The whole country worked for the Buran space shuttle project, as did my supervisor. I saw that one of the PDP-11 computers (Polish or Soviet clone) was always busy running something, even at night. I was told it was a program that calculated fuel properties for weeks, saving intermediary results to a file so it could be restarted. Knowing that the FORTRAN compiler could have generated more optimal code, I suggested manually rewriting some or all parts. I also had an additional goal to get more computer time for programming practice, which sometimes took some effort to obtain. The head of the laboratory agreed. And so, I translated 800 lines of FORTRAN code to approx. 2500 lines of PDP-11 assembly language code, including file and console output. It also tested well; it produced the same intermediate output on input. And it was 25% faster, which could have saved a week of calculations if run for a month. The result was very satisfactory to me and got me a very good positive feedback loop. I also printed it on paper, and my fellow students were amused :-)

 

Treading on three careers in the same breath - software engineering, tech support and writing and publishing - while your natural affinity for the first two is amply clear, how did the third happen?  Were you naturally adept in it too or did you cultivate it over the course of time?

 

When I joined one of my previous companies in Ireland, I was asked to train technical support engineers in code reading. I initially hesitated, but my manager told me he would reassign that to someone else if I couldn't do it, so I gave it a try. I liked teaching a group of engineers, especially imparting foundational knowledge. I also learned a lot from it. It was an enduring success, resulting in at least 5 books written later. However, publishing was a steep learning curve as I wanted to do everything myself, and I took the difficult route of doing the activities of a traditional publisher. 

 

How did your relocation to Ireland happen? Was it a conscious choice or an outcome of circumstances?

 

Moving to Ireland was a chain of coincidences; I was looking for additional jobs in Moscow for extra income, and suddenly, an Irish job came in, and the recruiters and the company were very keen to bring me in as I had the skills very few people had at that time in Russia. Although I was very hesitant to follow suit, I finally gave in, primarily to learn English. Also, another contributing factor was that my employment was not tied to an employer, like in the USA, which proved handy in turbulent post-dot com crash times. I could easily change employers if I wanted or needed. 

 

 

Early days in Ireland, 2001

 

You found software narratology when you were contemplating an analysis of software logs. Can you provide a detailed elaboration for the uninitiated? 

 

Earlier in 2009, I was trying to make sense of software trace analysis. I had to analyze very complex software logs with millions of events from dozens of processes, hundreds of components, and threads. There was no time to learn millions of source code lines. If in memory dumps, a problem was often immediately visible to me due to numerous patterns, it was not in software logs. So, I started discerning patterns to help me with trace analysis. However, I came to a pattern language-writing block as I could see only a few obviously discernible product-independent patterns. Because my wife studied Russian philology and related subjects at that time, I noticed books on literary theory and criticism which mentioned the notion of a narrative. I started reading them. So, all that information came to my mind, and I explained software tracing as stories of computation. After that, I came up with the first definition of software narratology as an application of narratology to software traces and logs. Some subsequent product-independent trace analysis patterns were discerned using this narratological perspective. 

 

As an example of the application of narratology to software traces and logs, compare these two narratives; the first (in italics) is a tale split by events:

 

A long search 

A Hero found a castle 

The Hero tried to open the castle gate 

The gate was closed 

The Hero needed a key

 

After a long computation, Component ABC tried to save the computed results to a file. Access denied. The Component needed to have certain rights.

 

The 4^th edition of my trace and log analysis patterns reference is hence titled "Trace, Log, Text, Narrative."

 

You have stressed on the need to talk about software pathology along with data pathology. An elaboration will help students of data science immensely.  

 

Data pathology is well-known to data scientists and engineers (think about data cleansing). But I found the need to extend the analogy and metaphors between medical and software diagnostics to pathology. And in the name "pathology," I see patterns of "path" and "log." This approach may also shed new light on data pathology since the same pattern-oriented approach to trace and log analysis can be applied to data in general, be it textual or structural. The 5^th edition of my trace and log analysis patterns reference, to be published earlier next year, will have the new title "Trace, Log, Text, Narrative, Data."

 

When did the Software Diagnostics Institute come into being? Is it a commercial venture? How do you interact with your target audience and clients?

 

Initially, it was just the Crash Dump Analysis Portal, since 2006 or so. While accumulating the material and its interdisciplinary connections, I realized that what I was doing needed a shorter name, so I looked for different names and coined some new ones. In 2012 I realized that what I was doing was called just diagnostics. And I wanted something that sounded scientific. I spent 12 years in various laboratories at University, either studying or doing part-time paid jobs, and I saw science inside out. Since I single-handedly wrote so much on software diagnostics and being completely self-sufficient, I thought it should merit the name of the research institution. Hence the name Software Diagnostics Institute. I was doing novel research anyway. This is not a commercial venture, although it markets my training courses and other reference books and has links to the Software Diagnostics Library (my previous blog), which is now a large collection of diagnostic analysis patterns. In edited form, they are included in my reference books, but, as one reader told me years ago, why should someone buy the book if its content is free, albeit in unpolished form? Clients find me via search, social media, and bookshops. I need some form of monetary reward to continue my research which I own, and buy books and hardware/software for it  But most of my recent theoretical articles can be accessed at https://www.dumpanalysis.org/

 

 

Reading Windows Internals and doing crash dump analysis, 2003

 

How do you look back (and ahead) on your software strides. What is your view on the open source movement? What do you make of the talk around metaverse?

 

I flow where software is flowing. For me, the software makes sense only when it has problems, and I don't mind problems as I like to put my mind on them. The more complex software and its environment become, the more I relish it. We see how many medical professionals we have now, the medical diagnostics is getting complex by the day. Contrary to the popular opinion that in the future, debugging will not be necessary, I think we will need more software diagnostics and debugging, especially when AI/ML (mind) and the required infrastructure (body) become more and more complex. Regarding OSS, I have been catching up for the last 5 years, after having spent the earlier time exclusively on Windows platforms with infrequent excursions to Mac OS X and Linux. Metaverse looks very distant to me, I haven't tried it yet, but I believe it will need diagnostics too 

 

 

What innovations would you rate among your most satisfying breakthroughs - those that deeply satisfied the thinker and innovator in you?

 

I would rank my work in Trace and Log Analysis Patterns and Theoretical Software Diagnostics above others.

 

As I wrote elsewhere, the famous Soviet mathematician Gelfand considered himself the Mozart of Mathematics according to the memoirs of Edward Frenkel:

 

"Most composers are remembered for particular pieces they wrote," he said. "But in the case of Mozart, that's not so. It's the totality of his work that makes him a genius." He paused and continued: "The same goes for my mathematical work." (Love and Math: The Heart of Hidden Reality, page 67)

 

To repeat the pattern, the same goes for my software diagnostics work. Also, one of the deeply satisfying inventions was the new way to represent chemical formulas using baseplate and Lego bricks. I could finally do something in Chemistry after I left the discipline and switched to programming.

 

Naturally, all memory dump analysis work had some influence on my philosophical aspirations. I made a philosophical discovery that Universe is Memory in the tradition of presocratic philosophy.

 

I also applied crash dump analysis patterns to project failures, resulting in me being sandwiched between Voltaire and Weber in the references section in one of the management research papers  The paper is called "Sherlock Holmes and the adventure of the rational manager: organizational reason and its discontents." It is in open access. You can easily find it.

 

Also, I'm proud that my foundational memory dump analysis work is referenced in the Debugging Wikipedia article.

 

An accomplished diagnostician, 2012

 

Your current areas of interest are phenomenally exhaustive: spanning theoretical software diagnostics and its mathematical and computer science foundations, application of formal logic, artificial intelligence, machine learning and data mining to diagnostics and anomaly detection, software diagnostics engineering and diagnostics-driven development, diagnostics workflow and interaction, cloud native computing, security, automation, functional programming, and applications of category theory to software development and big data. Phew that’s quite a list!

 

In a lighter vein, I would say this list is essentially a compilation with search engines in mind  On a serious note, these are areas of interest where I try to read, evaluate, and adapt to the discipline of software diagnostics, especially to the theoretical part of it. I'm more interested in deep concepts there. For example, recently, I transformed my diagnostic analysis patterns to native cloud computing. Regarding AI, I devised a general architecture of analysis pattern networks. On category theory, I have proposed a categorical definition of debugging. For diagnostic workflow and interaction, I proposed a novel approach using gestures. The list is a continuum. It goes on expanding by the day.  

 

Magical moments in the company of remarkable cats, 2022. 

{No wonder, cats are the favorite pets of category theorists}

 

 

Your command over mathematical concepts seems ripe with sunrise possibilities…

 

I view and use mathematics as a conceptual tool for theoretical software diagnostics. Many analysis patterns got their inspiration from mathematical analogies, especially from modern and contemporary mathematics. So it's rather a worldview. But, again, as I said, I love abstraction, and hence the preoccupation with mathematics. 

 

You have been a serial entrepreneur and founder of a string of corporate entities -  Syndromatix, Anolog.io, BriteTrace, DiaThings, Logtellect, OpenTask Iterative and Incremental Publishing, Software Diagnostics Technology and Services , and Software Prognostics. 

 

Some of the listed projects are related to diagnostics automation, they are not necessarily software-related. Most of these are essentially projects I have worked on for years towards making them fruitful. They are not corporate entities, and most of them are registered business names that I fancied, with the publishing and training businesses being the most successful of them all. However, a few more priorities that are uppermost in my mind do not find mention in this list. They are under wraps as yet! 

 

What are your aspirations and goals going forward?

 

I want to read a few interesting books I bought recently. I also wish continue working on the "Writing Bad Code" book, which I will probably start as a training course early next year. I will finish the remaining CoParts 4 – 7 of Visual Category Theory, and the 15^th volume of Memory Dump Analysis Anthology (Diagnomicon). 

 

I also have in the publishing pipeline many new and updated training courses and reference books related to software diagnostics. Also, I want to learn more about n-Category Theory next year. more the abstraction, the better! Finally, a stealth project will be revealed around New Year's Eve when I have some leisure time to work on its initial phase, including new Visual books on functional programming, category theory, and a few mathematical topics I learned recently.

 

Some people have suggested I write an autobiography because I have lived and worked during interesting times spanning different countries and political systems. So, I'm also working on that. But, here, the book needs to be interesting not only to me but also to my readers. So, I came out with one particular format that should attract different readers even if they are not interested in me. More to be revealed once I accumulate sufficient material. As an additional preparation, I'm also reading books about autobiographies. 