Indian Medic

Prologue

I think I finally get what’s going wrong with my life. Look at the picture.

I have an HP all-in-one printer that is a boon in itself, for about two years now. I have used it to print countless documents, mostly formal letters for my mother’s use, scan a million photographs and copy a lot of stuff. It’s very special to me.

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As is expected, the black cartridge gives way sooner than the color cartridge does. And broke as I am I can’t afford to buy new ones (they are pretty pricey!). So I usually get them refilled at a local stationary store for a nominal amount. Apparently, this is a perfectly acceptable thing to do. So the black printer cartridge has been refilled for about 4-5 times.

Sometime last year, there was a short-circuit in our apartment’s electricity supply and it blew my desktop’s power supply box and took down the printer as well. So many things went wrong with my already ailing desktop that it would be cheaper to buy a spanking new PC than get it repaired. Meanwhile I had bought my notebook, so it obviated the immediate need for a Family Desktop PC. But the printer was very much a needed thing, so I got it repaired.

The people at the HP customer service (after a weeks wait!) informed me that my dear printer was beyond repair and that they would replace it. And they did it for free, I am very thankful for that, coz the warranty period had already expired. But after a couple of months of ‘happily-ever-after’ the not-so-new replaced printer conked out as well. It didn’t completely break down, but works on its own whims and fancies. I tuned into its tantrums and wheedled out as much work as I could. Meanwhile, the color printer blanked out and I got it refilled as well.

Our flat is on the seventh floor and my bedroom faces the road. Consequentially, there is a lot of dust coming in through the windows, which is good neither for my darling Notebook and printer nor for my Allergic rhinitis. Try as I might to protect the dust sensitive gadgets, some particles always manage to find their way into the printer and settle on the cartridges. I try my best to clean them as well as possible, as per the instruction manual. I don’t claim to be tech savvy, but I can find my around and fix basic practical problems.

But the problem has only got worse. Nowadays, even though I know the cartridges are full, the pages come out blank, even though the contraption makes all the noises and motions of giving a perfect print. Today trying to print out an important letter, and receiving a beautiful blank white sheet in return, I got really pissed. I pulled out the dog- eared manual, which I thought I knew by heart and went over the troubleshooting pages for the umpteenth time. I even took out the cartridges and cleaned them with ‘a lint-free cloth, dipped in bottled water after squeezing out the excess water’ as said in the manual. No luck.

Then almost by divine intervention, I chanced to glance upon the illustration. It would be an understatement to say I did a double take. I read the circled lines a dozen times. If I didn’t know better I would have thought that there was some sinister force in play that had changed the instructions.

All these months I had been cleaning the cartridges, the other way around, meticulously wiping the nozzle and carefully avoiding the contacts.

Yes, I am embarrassed as hell. But this thing brought into sharp focus many things in my life, in the past couple of years, that have gone wrong. My studies for instance. I put in a lot of effort into my preparation for my entrance exams but haven’t succeeded. I am not saying that I totally misunderstand, misread, misconstrue, misapprehend or misconceive the stuff in the textbooks. Its like, I do not see the big picture while reading the fine print. Or maybe it’s the other way around…I am not sure. I am not focusing enough; I am just going through the motions of it all. Worried about my own career and future, I have neglected my family and friends. There are many more pressing things that need to be taken care of, but I ignore them.

Now I have totally stopped making sense. I can see a lot of thoughts floating in the reader’s head, “how did someone like this become a doctor?”. For the record, let me state that I am a decent doctor trying to become a good one, and I know I eventually will.

Meanwhile, I can’t live life missing the forest for the tree, or something to that effect. Nor can I read the whole manual and not note the important detail. It’s a balance, everyone needs to achieve for a complete life. And I am going to try my level best henceforth.

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Epilogue

I took out the cartridges and cleaned them. This time carefully avoiding the Nozzle and gently cleansing out the Contacts with ‘a lint-free cloth, dipped in bottled water after squeezing out the excess water’. (That is exactly what the manual says!!!)

It still does not work.

Maybe its time I got new print cartridges. Or a new printer…

It is true that one thing that your heart wants more than anything else, eludes you the most. For me it is a chance to make a successful career. For which as I have expounded before, I need to get admission to a Post - Graduation course of my choice in a reasonable good institution.
But this year too, destiny has wielded a fatal blow to my aspirations of achieving any of the above. The results of the few entrance exams I appeared for are out and I did not make the cut.

I am terribly disappointed, yes. But there is no time to mourn. I have to plan what I will be doing next. The options are, but few. I wait it out for another year and strike again. Meanwhile I do a plain post job somewhere, which will give me time to study.

Or I could appear for DNB (Diplomate of National board) which is a degree equivalent to MD/MS, but is done in private hospitals and is a tad more difficult to finally emerge from, I hear. This may be a done deal in six months, but I am unsure as how to go about doing it. Of course there is another entrance exam I need to get out of the way for entering DNB!!!

The whole deal sucks. No wonder many of my colleagues are escaping this almost tyrannical system of my country to study and practice in countries like the US and UK where you are what you are worth! But I am sure there is a whole other side to that coin, I have no idea about.
I am sorry if I sound bitter. But 2007 was supposed to be my year. Well now it doesn’t look like it is meant to be.

Well but I know this not the end of the story here. If anything, my resolution is only firmer still. I will crack the damned exam and set forth on the career course I have charted for myself, if that’s the last thing I do.

I am not superstitious, hell, I am not even devout. Neither do I believe in stuff like ‘Karm’(Karma). But I believe in something that’s above everything else - HOPE. And I know in my heart ‘This too shall pass…’

Being a doctor means shouldering many fold responsibilities - to your patients, to the community, to your family and to yourself. What happens if a doctor falls sick? It is a tenet in medicine that doctors make the worst patients. Is it because they know too much and know what questions to ask the treating physician? Because they know too much and consequentially are more scared? Or maybe because they know too much and are well aware that the best of doctors can make mistakes? The bottom line is that doctors make poor patients because they know too much.

When does a doctor seek medical help (from someone else)? How much is too much? All doctors practice some form of self-medication or the other. The degree they hold gives them the right to. But what differs is the scale in which they prescribe to themselves. That I assume, depends on their level of specialization and experience. For instance, being a non-specialized plain MBBS doctor my self-medication spectrum ranges from paracetamol to Cetrizine to simple broad spectrum antibiotics. No anxiolytics, no sedatives or such other drugs. Luckily enough I have ever needed more than that. But I know a few peers who do prescribe stronger stuff like Tramadol and Alprazolam to themselves when needed.

And as far as seeking outside medical help is concerned, mostly doctors approach others only when they have extinguished their quiver of arrows. Or when the symptoms are dramatic enough to warrant it. But if it can be avoided doctors tend to avoid it. This is speaking from experience.

As a kid, I never had any major health issues, except for chickenpox and the occasional cut needing stitches. A couple of years into medical college, which was in a place that faces extremes of all climates, I developed Allergic rhinitis. Allergic tendencies run in my family, my grandma is an asthmatic. But considering that I had never been sick before, I was overwhelmed with this simple but taxing affliction. I used to sneeze, I used to sneeze, and I used to sneeze all day long. The first thing I did on waking up was sneeze uncontrollably 20-30 times. My eyes would go red, my head would start aching and it would feel like my nose was on fire. It was like having a cold forever. The slightest of temperature changes or breezes or dust could bring on a massive paroxysm of sneezing. A senior med student gave me some Antihistaminics, which did help but also made me rather drowsy. I spent the whole of six months in this manner, and if I was a nuisance to my friends and roommates, they sure didn’t say anything.

Then one day my nose started hurting. The lightest of touches would send searing shots of pain into my head. I took all manner of over the counter analgesics but to no avail. The sneezing only escalated in frequency and it seemed like my perpetual cold was getting worse from not being able to smell anything. After a fortnight of suffering, I visited the ENT department. It was not just the pain that pushed me to do so, I was scared. We were studying ENT that semester, and I was scared that I would develop Atrophic rhinitis. It’s a condition where all the nasal mucosa and turbinates shrink and undergo atrophy, leaving a very roomy nasal cavity with permanent loss of smell. The treatment was a procedure called Young’s operation; it consisted of closing away one or both nostrils with skin flaps I admit, it seems like classic Medical student syndrome (a form of hypochondriasis) but the pain was for real.

That’s when I was officially diagnosed with allergic rhinitis, and the nose pain was from vestibulitis, an infection of the outer and lower part of the nose. A course of antibiotics and some serious nasal douching later I was back to normal in a week. You would have thought that I learnt my lesson with that. Nay….

Later that very year, I came down with a serious case of tonsillitis. It went off, only to return in a month’s time. Summers are excruciating in that part of the country and we were heavily into chilled drinks and ice creams to keep cool. Even though it is a myth that drinking or eating cold foodstuff causes cold, URI (upper respiratory tract infection) is aggravated by cold foodstuff, because they lower the temperature in the oral cavity allowing the bacteria to thrive. So my tonsillitis returned with a vengeance every time I went on an ice-cream binge. The odynophagia (pain during swallowing) it caused however was something that was amenable to NSAIDs and I ploughed on.

When I came home for the holidays that year my mom made me visit an ENT specialist, who tagged me with the diagnosis of Chronic follicular tonsillitis. Though she didn’t suggest that I get my tonsils removed, she did advise that I steer clear of cold stuff, something my mom made me swear to do.

Now that I am a registered medical practitioner, I know how to handle my idiosyncratic afflictions. Though occasionally I do indulge myself with some ice cream, I manage to have not more than four attacks of Acute on chronic tonsillitis in a year, as that then would become an indicator for tonsillectomy. My mom, though, keeps haranguing me to get it done.
But tonsillectomy, with General anesthesia, with the ET tube down my nose…no way… I can’t even begin to count all the things that could possibly go wrong there. So as a doctor if I am a poor patient that’s because I know what to be scared of.

My ‘illness’ is a very simple matter, I chose to write about it because I can be subjective and truthful about it. But I do know of a few colleagues who in spite of having a lot of dangerous symptoms didn’t seek help till it was too late.

One of them had abnormal menstrual cycles with occasional abdominal pains which kept getting worse. One day she collapsed during rounds and was diagnosed with twisted ovarian cyst. She had to go under the knife for that one.

Another friends had been passing blood in stools for a while. He thought he had piles and was embarrassed to get help, but turns out it was a fissure, which had progressed to a stage where it had to be excised.

Agreed, the above two conditions are about potentially embarrassing situations. My friend in Med school had occasional shooting pains in her right arm for a really long time. We kept telling her to get it seen. She was in the habit of writing out stuff to memorize it, she over did herself before our second year exams. She could hardly hold her pen straight on the first paper because of the pain. An x ray taken that evening revealed a cervical rib. Luckily enough she managed to scrape through in that paper and did not have to lose six months.

I have a few more of such examples, but the gist has been given. Most doctors are narcissistic, they have super egos, but they are still human. Physically they are as vulnerable as everyone else is. But does having first hand knowledge of the ways of the human body and the millions of things that could go wrong with it, in a way hinder their willingness to seek medical help for themselves?

Yesterday, I happened to read a very interesting post on one of the most popular medical blogs around, Fingers and Tubes in every orifice. I myself am a huge fan of that particular blog and of the author’s excellent style of writing; he can make you feel like you were present at the spot when things are happening. In his latest post A. McGyver, MD he enthralls us with an occurrence where he was forced to improvise in the face of lacking medical supplies to treat a case of Pneumothorax. A particular point where he says there was only one single sterile glove available, brought back memories of an incident during my OB/GY posting in internship, which was one of the first emergencies I had to face on my own. Even though it occurred well over two years back in my internship, one would think that the details would be a bit hazy, but I remember everything as if it happened yesterday. I suppose, it is one of those things you remember for a lifetime.
Here is the tale…


As Angry medic succinctly put it in his comment to my previous post ‘India IS after all one of the most densely populated countries in the world, and it's only natural that health problems are going to arise from that’, it is understandable that OB/GYN in any hospital is one of the most overworked departments. For an intern, it was the most taxing rotation; one and a half months of sheer exhaustion. We used to work over 100 hours a week including two 36 hr shifts. Social lives spiraled down to nil and any available time was spent in catching up with sleep. It would be easy to spot an intern currently posted in OB/GYN from his/her zombie like looks.

I was never particularly interested in OB/GYN as a career choice, as I did not want to spend the rest of my life ‘wicket keeping’ (as in Cricket!)for other people’s babies, as it was known in the intern world. But a couple of days into the posting and I was hooked! The sheer pace and activity of the place was like a drug that got me high. There was always something or the other to do, never a dull moment, it seemed like there was Adrenaline rushing through me 24x7 and the experience was totally hands on and invaluable. Considering that there was, as always, a staff shortage, interns got a lot of practical things to do, other than just scut work. We could assist in surgeries, mostly Cesarians sections and conduct uncomplicated deliveries under supervision. But what transfixed me the most was witnessing the birth of life. The babies who made it, came in all sizes from healthy 3kg ones to tiny 1.5 kg ones. And it gave me immense pleasure to see the rows of tiny human beings bundled up in the nursery. I was so hooked with the rotation, it was all I thought about and talked about and even dreamt about every night.

There were roughly around 40-50 deliveries conducted in our labor room in a 24-hour period and around 7-8 of them would be by LSCS or Lower section Cesarian sections. Our Unit comprised of one senior resident, 4 junior residents and 3 interns. However, our unit was famous for the number of ‘Cesars’ performed which were invariably double of what other units managed on their worst days, rouchly 12-15. Our Senior resident or Lecturer, I feel, did not believe much in the concept of Trial of Labor. Though she was an astute diagnostician and good surgeon, she had a penchant for sending patients to the OR for Cesarians for the slightest holdups in the delivery. The indications more often than not used to be from the ‘relative’ indications listed in the textbook. She would breeze into the labor room, conduct quick exams on all patients, and decide which ones could deliver on their own and which ones needed to be operated upon. Consequentially there used be a line of surgeries occurring in quick succession through out the day and by dinnertime, the labor room would be almost empty, which was a good thing. Residents operated and Interns assisted. We used to take turns assisting, but invariably the one who went into the OR wound up assisting 2-3 Cesareans at a stretch. Each surgery used to last for 45 minutes to an hour but if it were the lecturer performing the C-section, it would all be over in under half hour. She holds the record for the quickest LSCS conducted in our hospital, a mind numbing 21 minutes, from the incision to the final suture.

My tale happened on one such on-call nights. The labor room was virtually empty except for half dozen ladies, part of the late nite crowd who stagger into labor room after dinner around eleven PM and weren’t expected to deliver until dawn. It was around 2.30 AM the leanest time, activity wise. We had one on call room with two beds where all the female residents crashed including the lecturer. We interns managed to sleep where we could, including on tabletops and gurneys.

That shift, it was my turn to stay up in the later part of the night to monitor fetal heart sounds at half an hour intervals of the 6 odd patients who were scattered in the 4 delivery rooms in the labor ward. The Resident who had pulled the short straw was dozing behind nurses’ counter. It had been a hard day for me and after having assisted in a record 7 cesarian sections back to back in the afternoon I could barely stand straight on my feet. That was why I had opted to rest for a couple of hours in the earlier part of the night. Sleep, though, was out of question with the cacaphony of the labor room winding down for the night.

But at 2.30 AM there was a still silence in the ward occasionally broken by a moaning patient or a newborn whimper from the adjoining nursery. It was a calm between two storms. I walked around checking on the patients, taking vitals and checking the FHS (fetal heart sounds). After writing notes I sat down behind the nurses counter and put my head on my arm. Just when I was about to doze off I was abruptly woken up. For a second I thought I had heard some noise. But the deep silence prevailed. Though I told myself to relax, I decided to check the patients out. Maybe it was intuition or maybe I had heard a sound after all, I walked to the delivery room farthest down the corridor. One look into the room and all my tiredness and exhaustion vanished.

The lone occupant of the room was a 34 year old female G3P2L2, i.e she was there to have her third child. Just about ten minutes ago, I had left her comfortably sleeping on the standard issue metal bed with a U shaped cut at the foot end, after having ascertained a good strong FHS. But now she was perched at the edge of the table, her face contorted in pain, her brow glistening with sweat, still not making any sound but obviously experiencing a massive contraction. One look under her dress and my worst fears were confirmed. The Baby was crowning.

“Somebody, get in here”, I yelled into the corridor.

What followed after that, seems like it was played out in ultra slow motion with dramatic music in the background, or maybe it was only my heart thumping wildly in my chest.

Dismissing the routine of wearing a plastic apron over my dress, I rushed forward to the supplies side table and opened the metal bin to get a pair of gloves. But to my chagrin, there were none. Another look at the patient and I could see that the labor was progressing very rapidly - the baby’s head was out. Going to another room for a pair of gloves was out of question I rapidly decided, just when I saw a rolled up glove in the corner of the table wedged under a kidney tray. I snatched it up and jerked it open…it was single. Another glance at the patient…the baby’s torso was half out…and I made the decision in the next split second.

I dropped the glove and lunged for the patient. I was not a second sooner. The baby was out followed by a gush of amniotic fluid, which spattered all over my dress and feet. I caught the baby in mid air with my bare hands, centimeters before it hit the metal bucket placed under the foot end of the table to collect the afterbirth. However, the split second in which the baby had hung by the umbilical cord had torn it and blood started gushing out from the torn ends.

Somehow I managed to hold on to the slippery baby with one hand and pinched the baby’s end of the umbilical cord between thumb and forefinger to stem the bleed. There was not a sound from the baby, but it was not fully flaccid either nor was it cyanotic.

By then people had come into the room and miraculously all of them were gloved. The Baby tray emerged from somewhere and I carefully placed the newborn on it, still holding onto the cord while the nurse tied it with a sterile string. While one resident waited to deliver the placenta, another took the baby to the nursery to resuscitate it.

What followed next does seem a bit hazy to me now, like a dream. The baby was resuscitated with partial success and transferred to the NICU. The neonatologist was saying something about it having lost some blood. Personally I feared I might have caused it some injury while handling it - Erb’s or Klumpke’s palsy, but that was not the case. Since the disaster had been averted, no blame games were being played but I received a few slaps of kudos on my back. It was only when someone pointed it out, that I realized that my dress was soaked in amniotic fluid and my shoes were making sloppy noises as I walked. We didn’t have scrubs in the labor room, and I wasn’t given permission to go back to my dorm to change. I had to spend the remaining four hours of my duty wearing the amniotic fluid soaked dress, which I had tried to rinse of as best as I could, and which later dried to form a stiff canvas. Luckily enough the amniotic fluid was not meconium stained (that’s fetal poop!) But I didn’t mind, after all I had saved a life that night. Nevertheless, it was the most thankful shower I ever had, when I finally got around to it the next morning.

As I said, no blame games were played, but the story of how I caught a baby with my bare hands and got showered with amniotic fluid in the process, spread all over the campus. I checked in on the baby about half a dozen times the next day in the NICU. Though he was severely anemic, underweight and struggling to breathe, he seemed to be improving; I even got to name him. His mom was all gratitude for my having saved her little boy. I named him Aditya, which means ‘Sun’ in Sanskrit. However, it soon became clear that little Aditya was fighting a losing battle. The third morning, on my way to work when I went to the NICU, I was told that he had died of respiratory failure in the night. I said a quick prayer for his soul and went off to bury my sorrow in work. The tears did come though, later that night.

I hold this experience close to my heart, coz I not only had faced my first emergency but also had lost my first patient in essence.

As I strongly feel that Indian Doctors are underrepresented in the blogging community, I am trying to list them all under one directory - Don't know how far I'll succeed. But there is no harm in trying.

So if you are an Indian and you have a blog even remotely related to health or medicine and if want to list it here, please leave its link in the comment's section or email it to me directly at indianmedic@gmail.com

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The Indian Med Blogs Directory

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

A rookie doc's rants and raves

A Nice place - A thought is an awareness... Awareness is knowledge...
Knowledge is power... All begins with a thought.

A Medico's diary

All sounds to silence come

A(n)nals Of An Idle Mind - Rambles of an intellectually constipated mind.

Arvind Poswal's blog

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B

Break free - hey its all about idiosyncrasies...scientific crap...read at ur own risk...criticize do whatever u want! well but I will not stop this even if u find it pakau coz its my blog---n I' l do what I think-- it's rite to (w)rite...right?

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C

Cochin blogs

CoNFessioNs oF ConFuseD ConFuCiuS - cudn care less though...

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R

Random rambling

Reflections - Doctor Bruno's Blog. This is my little world.

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S

Scan man’s notes- random noise, nebulous views & artifacts

Shrinked Immaculate

Spot Diagnosis - Radiology images, cases, quizzes and other relevant radiology information

Sumer's Radiology Site

Sundae with Shiva... Blog by an Intern. With a Difference.

Simply Ridiculous - “What distinguishes modern art from the art of other ages is criticism.” -Octavio Paz

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T

Tejas's space

The mystery of the missing person

The Singularity

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Y

You just gotta keep livin' man, L-I-V-I-N - From almost law school to poker player to Medical Student. What an interesting road its been. If your here for the first time I'd recommend reading this from the beginning, not only will some of it make you laugh but you might end up learning a little bit about poker as well.

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