Thursday, March 31, 2011

A day in the life of an intern in cricket-crazy India

On 30th March, 2011 India and Pakistan played a crucial semi-final match for the Cricket World Cup 2011.
The entire nation was worked up into a mad frenzy, and almost everyone was gathered with friends, or family, or strangers, somewhere, watching the match, eating, drinking, shouting, cussing, and cheering.

I was working on my night shift at the hospital, from 8:00 pm to 8:00 am.

Don't feel sorry for me, I really didn't care much about the match anyways, except for an hourly update on the score. (Yeah, every Indian I ever knew is going to disown me after reading this). I didn't even watch too much of the first half of the match, though I was at home. (Now they'll never want to see my face again and will probably refuse to acknowledge my existence till the end of time).

8:05 pm: After having taken an exceptionally empty local train, to the hospital, I start my shift.

The first couple of  hours of the shift were normal, pretty much the same. I can't even say that there were lesser patients than usual. Of course there was this excitement in the air, and this eagerness in all the patients to go home real quick. And there was the match commentary running in the background from someone's radio, where we worked, in the Casualty Department.

9:00pm: A case of poisoning came in. The young man, in his mid-twenties, had tried to commit suicide by consuming about 250ml of a pesticide an hour back. When he came in he was conscious, with no visible adverse reactions having developed as yet. We put in a Ryle's tube and started the gastric lavage immediately. Over the next one hour, however, he worsened considerably, and vomited 4-5 times.
After all the initial management, he was to be transferred to a higher centre for further specialised care, since the hospital I work at is quite small and not well-equipped to handle such cases. And being the intern, I was given the job of accompanying the patient in the ambulance.

10:00 pm: The patient is in the ambulance, everyone's getting ready to go. The patient seemed to be in some kind of stupor, quite disoriented and languid. He was just lying there on his trolley and groaning. We hear the first firecrackers of the night. No one paid much attention, of course, except the patient. He, on the other hand, woke up from his stuporous sleep, and said slowly, but clearly: "India jeet gaya, phatake phod rahe hain. India jeet gaya!" ("India has won, they're bursting the crackers!")

I just stared at him dumbfounded. Then I quickly checked the score on my phone. Pakistan was something like 160/6 at 36 overs. Yep, India was definitely winning. But the match was far from over. Anything could happen. But obviously, some zealots had already started the after - party with the crackers.

So yeah, I let him think his happy thoughts of India's win the for rest of the trip. Would probably give him a reason to live and recover or something. He remained awake after that for the entire trip, talking about the match, and even telling us why he had tried to commit suicide (unemployment).

10:40 pm: We've reached the bigger hospital since the roads were all empty, handed him over and are now returning. Pakistan was 8 wickets down and the last few overs of the game were being played. The ambulance driver and his assistant just couldn't resist stopping at a roadside TV store to watch the match, though we are obviously not allowed to do such things, and then once they made sure we were winning, they even treated all of us to ice-creams as celebration!

10.45 pm: On the way back, we see hundreds of people dancing, and cheering for India, it's like a big festival. Even though I've lived in India all my life, and am used to all the cricket mania, I'm still surprised. The unadulterated happiness on the people's faces is infectious. Firecrackers are bursting everywhere, children are dancing, men are shouting: "Indiaaaa, Indiaaa!!" For the first time in my life, I think I truly understand what cricket means to the masses. It's beautiful.

11.05 pm: We're back. Within the next hour, a flurry of patients turn up. Some of them were just waiting for the match to get over, now they can go to the Doctor. A whole lot of young men come in, covered in gulaal. Many are drunk. A couple of them got into a fight, smashed each other's heads. Part of one's scalp got avulsed with a tin roof while he was running around celebrating India's victory. Two-three bumped their head with something or the other. Many of them were slightly drunk. And, none of them cared the least about their injuries. Their wives and mothers just hauled them to the hospital. They're sitting in this group inside the Casualty, and as each new patient comes in, they examine his injury, ooh-aah over it, and go back to discussing the match. And their tons of relatives wait outside the Casualty and create a din.
I try my best to suppress my laughter, because it's a hilarious sight, and we give them all their injections and dressings as fast as we can, just to get rid of all the noise and commotion.

11.30 pm: An 80 year old granny comes in. She was watching the match with her family all cooped up in their living room, and some one got excited when India took a wicket, thumped her on the thigh, and wham! Something broke. She comes in on a wheelchair, smiling even, we get an X-ray, and there's a fracture neck femur.

1.30 am: Finally the patients seem to be lessening. Now, the more drunk ones start turning up though. One patient comes in with an IT fracture, with about 10 people accompanying him, one of them being some kind of local goon. They say they were playing cricket when he got hurt. (At 1.30 am they were playing cricket!) The on-call orthopaedician is not available at that time to see the patient. He doesn't turn up for the next hour. In the meanwhile, we take X-rays, give him painkillers. The local goon, who is of course drunk, creates a ruckus and threatens: "Main ye akkhha hospital phod doonga!" ("I'm going to smash this entire hospital to pieces!"). Security comes in, the CMO comes in, the orthopaedician is still nowhere to be found.

2.30 am: Orthopaedician turns up, swings his arm over the local goon's shoulder and then it's like they're long lost friends. Pretty soon things calm down and all is forgotten. After the orthopaedician leaves, everyone stays up to bitch about him for a while. I have to admit, it wasn't entirely uncalled for (the bitching).

3.30 am: I try to go to sleep. I spend 15 minutes applying Odomos and finding a clean bedsheet. As soon I settle down, a patient comes in. I give up on the sleeping when patients keep turning up at 15-20 minute intervals. I start writing this post in my mind in the meanwhile.

The rest of the morning goes by as usual. I leave at 7.55 am from the hospital, drink a bottle of Sprite, since the water at the hospital can't be trusted to be safe, hop onto a train and head home.

9:25 am: I've had breakfast. I fall asleep while trying to write this post on the computer.

6.00 pm today: I wake up, hog for an hour. Then write this. Have one more meal, before finally posting it, right now.

Now I'm ready to go back to sleep. You've read all about a day in the life of an intern in cricket-crazy India.

How was your day? Tell me about it.

Sunday, March 27, 2011

Kathakali show

All photos clicked at a Kathakali show in Thekkady, Kerala.
I just loved the dancer with his face painted green.
Click on the sideshow to view photos in the album.

Thursday, March 17, 2011

I've got many doctors, I need a teacher.

So, it's been about 10 days since I started with internship.

I've been posted at a peripheral hospital in Mumbai for 2 months. From what I hear, this is probably the only place we get to actually do some medical work during our internship. The rest of the time, we interns just do mama-work (a peon's work).
(For any non-Hindi knowing readers, Mama is what we call the male helpers employed in the hospital to do all the non--medical work such as transferring patients, managing crowded OPDs, helping the doctors, etc. More often than not, they are the wisest and most experienced people in the institution. Mama is not slang, it's just referring to someone as 'my mother's brother'. It is a way to respectfully address a stranger who is elder to you.)

So far, it's been a good learning experience. Except, of course, no-one really teaches you anything. It's all self- taught. Trial and error. But then, nowhere in the Indian Medical Education System have I ever come across anyone who feels the need to teach us anything. That's totally unheard of. So how absurd of me to expect someone to do something like teaching, right?

So I have looked up youtube videos of all kinds of procedures: how to give I.M./I.V. injections/how to collect blood/how to give salbutamol nebulizations, etc. Sounds crazy, right? Well I did that because I'm just too scared thinking about what procedure I may have to do in the Casualty tommorow, and how bad it would be if I didn't know how to do it.

The nurses taught me how to collect blood, and give I.M. injections, how to start I.V. lines. Some were sweet and patient about it. Others just treated me like shit. But I just hovered over them till I learned.

There are still many more things I got to learn.

Today, for example, I was sent to do blood collections for the very first time. I knew it theoretically, had seen the youtube videos showing it, had observed someone do it long back in college, but had never practically done it.

The end result: A totally freaked out me, alternating between forcing myself to give it one more try on the poor patient and giving up and begging the pissed-off nurse to do it for me.

By the end of it, we had a wardful of patients with multiple pricks on their arms, and, thankfully, with the sisters' and the mama's help, all the blood ready to be sent for the tests.

Only one time did I manage to collect a patient's blood perfectly, at one shot, and I almost let out a huge cry of victory, in a wardful of sleeping and/or being tortured patients at 6A.M.

I'm sure this kind of scenario can work only in India. An intern who doesn't know how to collect blood is sent off to do it for an entire ward, and is expected to know how to do it, of course, miraculously, and no-one, absolutely no-one, even thinks about the patients for one moment. Thankfully, the patients also don't protest. They definitely didn't when I was pricking away multiple times at their ante-cubital veins (or what I thought looked like their ante-cubital veins).

I don't think they have such an option anyways. I mean they do have the option, but it's not really there, you know? Mostly, patients in Indian Government hospitals are treated like shit. There are exceptions of course, but in general, this is the impression I've got after all these years. Patients in these hospitals are treated like shit, just because they come from a not-so-privileged and not-so-educated background. I'll be writing more on this later.

For now, let's focus on the teaching part, or the lack of it.

I learnt how to give my first stitches from the mama, on an 8 year old with a CLW (Contused Lacerated Wound) on her scalp. It was, of course, a very messy job. But no-one cared. The mama tried his best to teach me well.

The actual medical officer who should have taught me, sat outside and read the newspaper.

That's the way things work. Everyone learns to deal with the system. And everyone gets moulded by the system, to become a part of it in the future. No-one tries to change it much.

The Professors berate us for not being hardworking and sincere, for not wanting to learn. But I beg to differ. I know there are quite a few professors who want to teach, and even try to. Very often, they don't know how to. But mostly, it's the PG students who teach the UGs, and that too because it gives them practice and helps them with their studies. And maybe because they know what it's like for the UGs. They've been there, done that.

The senior and highly qualified doctors, the ones who get paid to teach us, they hardly ever teach. It's a shame, because all their years of experience just goes to waste.

I'd like to add over here that, in these 4 and half years, I have also come across some fabulous teachers, who love their profession and who love teaching, who have scaled impressive heights in their fields and who still don't look down upon students. They've taught me, and they've taught me well. They have been great inspirations, and I hope to be like them someday.

So, here's my promise. If ever I'm in a position which requires me to teach, during my medical career, I solemnly vow to actually teach, to the best of my abilities.

For now, I just wish someone would teach me how to collect blood, insert scalp veins, take sutures, drain abscesses, write correct prescriptions, resuscitate dying patients etc. Because without that, I'm just scared all the time.

And I don't see how that can make me a good doctor.

P.S: Also, I still haven't heard the Eminem song from which my title for this post was inspired. I hope it's a good song.

Tuesday, March 15, 2011

I Know I'll Go Crazy If I Don't Go Crazy Tonight.

...there's a part of me in the chaos that's quiet...
and there's a part of you that wants me to riot

 it true that perfect love drives out all fear?
The right to appear ridiculous is something I hold dear...

...listen for me, I'll be shouting,
shouting to the darkness, squeeze out sparks of light...

- (All quotes from) I'll go crazy if I don't go crazy tonight , U2.
(This song has the most fabulous lyrics ever.)

So, I'm supposed to write somthing for this blog. I have the ideas, I can visualise the articles, I just don't have the energy to write them. Yet.

Internship is exhausting.

Maybe tommorow.

Till then, I have these photos for you.

About the photos: Clicked at the most memorable and most mesmerizing bonfire ever.
12 am. Friends. Long holiday. The perfect weather. Camera. Tripod. Hammock. Bollywood songs. Too stuffed to eat. Too tired to move. A night to remember.

Monday, March 7, 2011

Caught in the undertow

" She lives by golden rules that don't apply"
 - Mr. Big, Undertow. 

About this photo: Well, it's one of my most favourite shots. 
No special story, just a knot on a rope on a ferry boat on a safari one foggy morning in the Periyar Wildlife Sanctuary. 
I feel like I am caught in the undertow right now, hence the title and the quote. 

Saturday, March 5, 2011

On the mark...get set...go!!!

So, my Final Year MBBS results came out, and I have passed. Yayyy!!! :D
Couldn't post anything earlier since a virus ate up my hard disk. I would have new photos for you, except my data's still getting recovered :(

I've already finished with the first week of internship, and it's been fun. I've been thinking about what's coming in this next year, making plans, just getting into a rhythm.

So here's what I wish next year would look like:
1. All I do is complete my internship sincerely, enjoy the process, learn well, and study about whatever I learn in the hospitals everyday.
2. Post frequently on this blog, so that it takes me places.
3. Regale you (my dear readers) with lots of fabulous tales and stories from my internship.
4. Click a whole lot of photos with Troy (my camera).
5. Keep up with my friends and family.
6. Thoroughly enjoy my sisters big fat Indian wedding.
7. Watch all the great movies that will be coming out this year.
8. Write. A lot.
9. Read. A lot. Of non-medical books.
10. Just have a life.

Sigh. Whatever. A girl can dream, right?

Anyhow, here's what next year is actually going to look like, in all probability (basically it's a repeat of what last year was for me, except instead of college I will now have internship):
1. I'll be trying to do as little work in my internship as possible, so that I can study for my entrance exams in all the remaining time. There will be absolutely no need to learn anything not asked in the entrance exams.
2. Post infrequently on this blog, and gradually, I'll just end up totally deserting it.
3. "Stories? What stories? Go away, I need to solve this MCQ."
4. Troy (my camera) will be buried under a sea of books, and won't see the light of day for months.
5. I'll be avoiding all calls from all friends, and will answer everyone I know with one single phrase: "No I'm studying."
6. Develop super-powers and still keep studying as much during the big fat Indian wedding as otherwise.
7. Watch zero movies (Though I did watch a few of the good ones last year).
8. Will write some crappy articles over here to vent my frustration.
9. Won't read a single novel all year.
10. Just get admission into a PG course, somehow, somewhere.
     (Please, please, please dear God. Do you hear me?)

I hope I can strike a balance between the two scenarios I've described above.
And judging from the PG entrance results in every batch and my capacity to study, the chances of me getting admission in the first attempt after doing all of the above for the next one year, are still pretty dismal. So, it's probably at least 2 more years of this for me. Sigh.
For now, I've decided it's high time I start studying seriously. 
Let's just see how this goes, shall we?

Here I come, 2011.

On the mark...
Get set...