The Nairite's guide to rural posting

1. Attend your rural posting at Ganeshpuri. Take those twenty days off from your year of internship and whatever it is that you're doing with it, to attend this posting. It really won't make any difference in your entrance exams, but it will make a lot of difference in your lives.
2. Pray that you have great batchmates. You'll be living with them for twenty days, and not having a good batch sucks. That said, it is very easy to bond with almost anyone, including the weirdest alien in your class, during these 20 days of your rural post. So give it a shot. You may just acquire a brand new set of friends.
3. Don't run home on the weekends. Takes out all the fun from the posting!
4. Go for early morning walks, to make the most of the best weather in the day and the fog. Though I wasn't posted there in the summers, so I can't say how the weather will be in summer (from what I hear it's unbearably hot in the daytime during summers).
5. Every night, climb up to the terrace and watch the stars. If you're a girl, throw the guys out of their hostel so as to get access to the terrace.
6. Places to visit: Usgaon dam, river nearby, bridge in the market, Vajreshwari temple, hot water springs, Akloli kund, Gorad village for Warli painting, Great Escape water park near Parole, and Mount Mandagni if you have suicidal tendencies.The village is a great place to buy some Warli merchandise.
7. In the midst of all this, do not forget to attend your postings.
8. While at Ganeshpuri you will experience a new high in the quality of drugs available, at Parole you will experience a new low in the quality of drugs as well as medical care available. Experience both.
9. You will get a chance to sit in the ART OPD, I think this is the only time you get this opportunity in internship. You get to see follow-up cases of HIV patients, deal with their complaints, learn about the side-effect profiles if various anti-retroviral drugs. 
10. If a certain pan-chewing MO asks you to take off your apron (female interns) tell him to take a hike.
11. You will get many opportunities to learn a lot of new things, don't waste them.
12. Cook often, if you posses any culinary skills. Otherwise, eat at the local restaurants.
13. Go snake spotting. Also revise how to treat snake bites before you do the same.
14. Go with the mobile unit for medical camps to obscure, untouched villages.
15. Experience personally the Indian people's belief in black magic, till date, as a working cure to all disease.
16. Learn the way of life in a village. Wait for hours for ST buses, stuff yourself into share-e-rickshaws, have random conversations with old ladies you are very likely to meet, and do everything slowly and without a care in the world. Forget that you live in an instant age, for once.
17. Ride the bicycle everywhere, if, unlike me, you do know how to ride one. Easiest and best mode of transport you are likely to find.
18. Do not try to find cake or cheese or butter in the village. All attempts will be unsuccessful. Ice cream, though, you are likely to find.
19. Do not forget to look for fireflies. You will definitely find one. Or tons of them. Depending on your luck.
20. Go with old friends for this trip, or make new friends. Either ways, it will be a memorable affair, that, I promise you.

Nasbandi and Indian Chemists and... other stuff...

I have been setting aside a LOT of stuff inside my head with the tag "has got to go down on blog" for such a long time, that I've started forgetting all those stories and the details that go with them. So, without further delay, I'm just going to try and put it all down in this post. Here goes.

Location: Casualty Department, Tertiary Hospital in Mumbai.

A young man walks in, almost runs in, then sits down, panting, and and tells us: "Mujhe nas bandhi ka operation karwana hai". We all stare at him, pretty amazed (at least I was). I turn around, to check with the MO, and confirm whether he really does mean what I think he does (that he wants to get a vasectomy done!). The MO asks him, "Are you married?" He says no. Then the MO asks him, "Who told you to get this operation done?" He says he figured it out by himself, after watching the Govt. ads on TV, which said that you get paid by the Govt. if you volunteer to undergo a vasectomy. He said his sister was very ill, admitted to a private hospital, and he was falling short of Rs. 900/- for her treatment. She was his only sister, he wanted to save her, so he decided that undergoing a vasectomy would be a good solution. I don't think the ad explains the actual implications of the surgery. Anyone seen the ad? Then tell me what it shows because I haven't seen it. Embedded below is an ironic as well as hilarious video regarding nasbandi that I found while trying to search for a government ad video on the internet.

Anyways, the man didn't seem to realize that undergoing this surgery meant that he would not be able to have a child in the future. He just seemed concerned with the monetary compensation he would get. We sent him away, telling him this wasn't an option for him and that he should probably get his sister treated at a government institution if he wanted to save some money.

Location: Casualty Department, Tertiary Hospital in Mumbai.

An old lady is brought in on a wheelchair, transferred from a peripheral private hospital. She comes with reports of deranged RFTs and S. Creat at 8.3. She gives a history of irregular, unsupervised intake of NSAIDs and other Ayurvedic medications over the past two years, to treat her joint pains and some form of arthritis she supposedly had. The medicine registrar on call cites her chronic intake of NSAIDS as the cause for her renal failure. Makes me think about the tons of patients we subscribe NSAIDs to rampantly, everyday, with or without indications, and without thinking about the dangers of a situation where a patient may start self prescribing and abusing those very same NSAIDs. After all, how difficult can it be to read a drug name, ask the drug dispenser what it is used for, and, upon hearing the magic words 'pain relief' start popping it as and when your fancy arises after obtaining it from your friendly local chemist!

Location: Ob/Gyn OT, Tertiary Hospital in Mumbai.

A patient is taken up for an emergency LSCS, she was already in labour when she came to the hospital...I was posted in anesthesia and I just cannot remember what the indication for her LSCS was. Sorry about that. So anyways, she was wailing and screaming loudly the entire time inside the OT, everyone there was distracted because of her, and this while another surgery was going on in the same room. She had to be given her spinal, twice by the housie, I think the first time it was unsuccessful, thanks in no small part to her screaming and thrashing around. Then, when she didn't stop screaming at all, even after two attempts at a spinal, the senior anesthetist came and asked them to give it for a third time before starting the surgery, just to be safe. Inspite of this, the patient continued her voracious wails of "Aaaaaaa....owwww....majhyaa aai la bolva...aaaaaaeeeeeee" ("Owww....get me my mother...please...aaaaaeeeeeee") at a shocking volume, and atleast 20 people gathered to watch the spectacle. Finally, the obs people started the surgery in all this confusion, it was an emergency after all.

About 10 mins into the surgery, the patient seemed to be calmer, and had taken to just calling out for her aai in a normal voice as opposed to screaming. Now the much-more-visibly-relieved-looking-anaesthetist asked the patient, hopefully: "Aata tumhala dard kami jhala na?" ("Has your pain reduced now?") to which the patient (whose uterus was about to be cut open, may I remind you!) who had so far not given up on her incessant wailing, replied: "Ho, aata jara kami aahe, pan tari pan majhya aai la bolva!" ("Yes, now my pain is relieved, but you must still get me my mother!") At this, the 20 people who were inside the OT spontaneously burst out laughing at the same time, many of them shaking their heads in disbelief. I suppose the wonders which mothers can make happen in this world have no bounds! And I am sure that was the noisiest day ever in the history of that particular OT.

Location: ANC OPD, Peripheral urban health centre, Mumbai.

A young handicapped pregnant patient comes in. She seems to have a deformity in both lower limbs. She doesn't even use a wheelchair, she crawls in with the support of her hands and knees. Her mother accompanies her. We find out that she is unmarried and is now about 8 months pregnant. The patient refuses to take anyone's help to get onto the examination table, and shouts at the doctor for trying to help her. When after several attempts she's unsuccessful, her mother and the doctor try to help her, but it's still not possible to lift her onto the high set examination table. Finally we get her to agree to lie down on the floor of the room and get examined. When asked why she didn't get married, we find out that the father of the child is also handicapped, and he is also unemployed and doesn't have any family to look after him. So they chose not to get married. The patient's family is currently looking after both of them. And it is understood that they will have to look after the baby as well. When advised a visit to an obstetrician in a proper hospital, since this was just a health centre, the mother says she cannot afford to take her daughter by a taxi to any hospital, and the daughter being disabled cannot travel by any other modes of transport available in this city. The patient then crawls out, after telling the doctor haughtily that she need not prescribe any medications because she wouldn't be taking them, and then bursts into tears while leaving. Her mother plans to conduct her delivery at home itself with some local woman's help. I cannot even begin to imagine what it would feel like to be in that patient's place. The entire episode left me pretty dumbstruck.

Her one story just seemed to highlight so many issues in the country - lack of proper rehabilitation or a support system for handicapped people... the handicap-unfriendly public transport system... societal bias against handicapped people... poor reach of healthcare services to the people who need them the most... unemployment... motherhood outside marriage... and I don't know what else!

I'm still reeling from the shock of this story here.

Okay, I have forgotten the rest of the stories. Yes, there were more.

Anyways.

On another note, today's feature in HT Cafe 'Is your chemist the drug-peddler?' was quite interesting, informative and amusing. Being all three at the same time is definitely an achievement. Reading that article reminded me of when, about four years back, I was suffering from some kind of a UTI, and had already taken two courses of medications from my family doctor, with no great relief. I was a lost kid in my 2nd year MBBS at that time. So then, the third time I went to the doctor, he got irritated by me I think.

He wrote my prescriptions, and told me to get one particular drug from the chemist and sent me off with a wide smile. I went directly to the chemists' from there, and gave him the prescription. The chemist read it, gave me a long stare, then got the meds for me. He asked me whether he could keep the prescription. I was mildly surprised, but didn't think too much, gave it to him, and went home. At home, I opened up my brand new, hitherto-untouched pharmacology textbook, and looked up the drug the doc had prescribed. It was a tricyclic antidepressant! With embarrassment I now realised why the chemist had wanted my prescription. I felt angry and insulted, and got up and threw the entire strip, untouched, into the dustbin, and vowed never to go back to that particular doctor! Thankfully, my UTI resolved soon enough so I didn't need to either ways. But this reminds me that the chemist at that time was a good one, who did his job well. And he probably thought I was a teenager with issues. Oh well.

On yet another note, being posted in PSM (Preventive and Social Medicine) is taking its toll. I thought that working in the branch would actually involve practicing some preventive and social medicine. But I am starting to doubt whether the PSM people even practice medicine at all. They just seem to occupy themselves with being lazy, supervising the interns, making us run the dispensary and do all sorts of other clerical work, being humongous pains regarding attendance and (god-forbid!) dropped tablets, and incorrectly treating patients. Let's just hope this trend isn't really as generalized as it is appearing to be.

So. I think that was about enough to make a blog post. Entertaining or not, you tell me.

I will now head off to bed. And to yet another day of new stories to tell you people.

Catching up. And deaf culture.

I know.

Long time, no see.

I was just going through a hide - underground phase. Didn't feel like writing much. Now I'm back. And I'm rusty.

Anywho. Internship's been going on pretty much as usual and as expected. But most times I really enjoy the contact with various kinds of people it brings for me.

Now just during my last 15 day Ophthalmology posting, all I did was check the visual acuity of the patients in the OPDs. Very boring, you might think? Yeah. I guess. But you know, not really.

It's just fun coming across so many people and all their idiosyncrasies and wondering about their back stories.

And I just love it when a patient comes and wishes me "Good morning Doctor" with a really excited smile. It makes my day.

So, ophthal brought me tons of kids who thought reading out the visual acuity chart correctly was like passing in a school test, old ladies who forced their life stories upon me instead of getting tested, the relatives who tried to prompt to the patients whenever they wouldn't read correctly, the little kid who tried to cheat by peeking through her good eye every single time I asked her to read anything, the proud uncles who were too embarrassed to admit they couldn't see, and the pros who were so used to the testing they just told me up to which line they could read. And of course, the occasional lecherous old men. But yeah.

I pretty much enjoyed the experience. 

But there's one story I'm unlikely to forget. A 17 year old kid came in one day along with his father. He was thin, lanky, and otherwise looked non-descript. Once he took his seat his father informed me that he was deaf. I was mildly surprised, but didn't react. Instead I was pretty much in awe.

*More info required here* So, of late, I have taken to watching a new series called 'Switched at birth'. One of the two protagonists on the show is deaf, and the show also has a lot of other hearing-impaired characters. The show has vastly improved my knowledge and education regarding the community of deaf/hearing-impaired people, acquainted me with the kind of lives they live, and helped me develop an immense respect and greater awareness about them. It also introduced me to what is known as deaf culture, as well as to the ongoing debate in the community regarding cochlear implants.

I have never ever met a deaf /hearing-impaired person earlier in my life. So when I came across this kid, I looked at him in wonder. I know that some deaf people talk aloud, and some don't. He was one who didn't talk aloud. His dad pretty much talked for him. I also noticed that neither of them used sign language, quite unlike what I saw on the show. Neither did the kid seem to know lip-reading. But then again, this was India. So then their problems and the way they live over here and how they deal with it would be totally different. I probably still need a lot more education in this area.

Anyhow, so, back to the story. The kid sat there, a bit confused about how to proceed. I immediately got up, and started pointing out to the boxes I wanted him to read, and he immediately responded by gesturing the answers with his fingers. He looked sad when he couldn't read beyond two lines with one eye, and nothing with the other. That meant even his vision was poor.

When I glanced at his papers, his history said that he had been diagnosed with a cancer in his lymph nodes a couple of years back and was still undergoing treatment for the same. And now, from the looks of it, even his vision was receding. he didn't wear spectacles, so it had to be a recent development.

After knowing all this, I couldn't  bear to ask his father anything else. About whether he was hearing impaired since birth, since when and why was his vision receding, and how was he dealing with the cancer. How can one person have to deal with so many problems and that too so early on in their lives?

It scared the shit out of me. So I acted like a coward. I was too scared to find out what his life was like. I didn't want to know. I wouldn't have been able to bear it. So I didn't ask. I just politely sent him his way.

Hopefully I will learn better. But I have thought about him often after that.Which has obviously led to this post.

Then just a few days after that incident, I came across this quote put up in a frame inside my ENT department:

"I am just as deaf as I am blind. The problems of deafness are deeper and more complex, if not more important than those of blindness. Deafness is a much worse misfortune. For it means the loss of the most vital stimulus-- the sound of the voice that brings language, sets thoughts astir, and keeps us in the intellectual company of man.

Blindness separates us from things but deafness separates us from people."

- Hellen Keller.

While I had heard of Hellen Keller before this, I didn't really know her story very well. Researching that thought-provoking quote led me to read more about her. I am so glad that happened. Her story was one of the few truly inspiring ones I have read.

It also made me realize that the Hindi movie 'Black' must be inspired by her story. I just wish it hadn't starred Amitabh Bachchan (Yeah, I don't like him too much). Just watch this trailer and you'll see how similar the two movies must be if you've seen Black. Now I am going to watch the original movie.

Anyhow, so I am going to correct my lack of knowledge about hearing disabled people. Hopefully my post will make you want to do the same.

I guess I'll leave you now with all this food for thought. End of post.

Good night and good bye.

Not yet forgotten

About this photo: Dug this one up from some of my old shots. This was clicked with my first camera, a film SLR, Nikon F55. Clicked in a tiny village in Punjab, about three years back, this little girl was staring sullenly at us, while we roamed around like the quintessential city tourists who seemed to have landed up in the village by mistake. :)

Now I wish I had spoken to her at that time. I wonder what was her name, and what was her story? Guess I will never know.

Random photographs and scratches

These are my spectacles. Can you see the huge scratch on one of the lenses? Well I got that while trying to catheterize a patients bladder at 2 am during my last emergency shift, from banging into a bedpost or something. Obviously, I was half asleep.

"The hospital experience"

I'm in love with hospitals! That's what I realized yesterday. I, love hospitals! I love almost everything about them. And I haven't even worked at or been to any of the high-end ones with modern, state-of-the-art facilities.

Hospitals are these huge systems, they're giant, well-coordinated machines. They work on well-oiled practices developed over the years. There's this camaraderie, this working relationship - friendly, good-natured, gossipy, but never invading others' privacy (well, at least not too much!), amongst everyone. From the doctors, the nurses, the patients, to the mamas, the canteen-wallas, the pharmacist, the store owners, there's this shared aura around everyone of having lived what I call, "the hospital experience".

There's glamor in almost anything associated with a hospital. At least to my mind's eye, there is. Though, I do understand that many of you might be disgusted by most of the things in a hospital. But I'm still at the stage where I feel like I'm an over-excited kid with his shiny new remote-controlled car (which for me is my hospital). There's this high I get from walking into a ward, and knowing I belong there, even if all I do is collect blood. As a student, I still wasn't quite part of the hospital, I was part of my college. So this is like a brand new world I've entered as an intern. And oh, it is so damn brilliant.

There are all these tiny little things that you can come across only in a hospital. There are beds in all the wards for the doctors and nurses to sleep in on their night shifts, and there are stoves to make chai in the mornings. Which other workplace has that? Then there are these washbasins with soap everywhere, because that becomes a basic necessity. There's a canteen/mess with all these doctors having meals at all odd hours of the day, either stuffing food before work, or tiredly gobbling something after. There are these humongous, slow-mo lifts, which are almost always overstuffed with patients. And there's always, always a temple in the complex. And it hosts poojas at regular intervals and every person on the premises gets prasad! Then there are always tons of forms to be filled everywhere, by both doctors, and patients. And yes, there is always, always, someone awake all night in a hospital!

I guess these are all the things I can remember right now. But there are more, I know. You can leave the ones you think of in the comments.

And then, of course, there are the patients. They're the biggest part of "the hospital experience". They come in all kinds and ages and varieties, each with his/her own story. They're fascinating, to say the least. If you take time to stop and notice them. Almost everyday, there's a great new story in the hospital.

I often imagine all the waiters and delivery boys in hotels surrounding any hospital would know it in and out, since they probably get tons of orders from the hungry people who are working at the hospital, especially in the night. Now imagine, you're a delivery boy working at a hotel, delivering food to people's boring doorsteps everyday, and then, one fine day you get an order for "Dr. So and So, Trauma Ward, OPD building, XYZ Hospital". Then you would go, apprehensively, with your parcel, and after much difficulty, when you reach the trauma ward, what do you find? A ward full of patients in various states of consciousness, blood spilled on the floor, most patients with lots of tubes attached to them, a lot of hustle and bustle and a lot of white all over the place...no one has the time or energy to even notice you. After few minutes of waiting, you would finally call out for the Doctor, and then he would materialize out of nowhere, in scrubs or in a white coat, and take the parcel from you. Now tell me, wouldn't you (the delivery boy) be in awe? Wouldn't you? I totally would. I would go home and tell my family this brilliant story, it would be the highlight of my day. I would have been part of "the hospital experience", even if for a few minutes.

In hospitals, there's always an unspoken protocol to be followed. Hospitals work, no, thrive, on hierarchy. Everyone is answerable to someone, everyone has someone whose orders they have to blindly follow, no questions asked. The interns are, of course, on the lowest rung of the hierarchy. We do the most menial and the least skilled medical work, have to suck up to everyone else, listen to and/or laugh at their mostly bad jokes, and tread carefully everywhere we go. Insult a senior, and you're doomed. Insult a nurse, and you're beyond doomed. That's the way things work. Don't disturb your senior unless it's an emergency. Don't order the nurse around. Don't shout at the mama. Wish them all good morning with a smile when you come in, and your day should go by noticeably smoother, trust me.

As you can see, living "the hospital experience" teaches you a lot of things, both medical and non-medical.

Well, this post has basically become a prolonged, disconnected, ramble. Suffice to say, I am living and loving my "hospital experience" to the fullest these days, and I have developed a writers' block as well. But I needed to post this. Maybe I will rework it later on.

As of now, I hereby end it abruptly.

Do let me know how you are living up your "hospital experience"?

Photos from Day 5

He's Dr. Sagar Kolhe, been on hunger strike since 5 days now. Was admitted to the hospital and then discharged.

The list of all the Doctors who went on hunger strike.

These are the Doctors admitted for treatment after their health deteriorated.

Registering our protest outside the Mantralaya, after the Government refused to initiate negotiations even on day 5.

Interns being detained by the police.

Inside the police van. Over 400 medical interns were detained at Azad Maidan for many hours after the protests outside the Mantralaya. ASMI has decided to continue the strike, in view of the dismal response by the State Government.

Day 4 of Medical Interns' hunger strike in Maharashtra

Medical interns all over the state of Maharashtra went on a hunger strike from 2nd of May, 2011. Today is Day 4 of the strike. What started off with 24 medical interns and students on hunger strike from various medical colleges across the state, has intensified to now include about 114 interns on strike, of which 20 have been hospitalized.

The demands? An increase in the monthly stipend of interns from the current Rs. 2550, to Rs. 13000. Maharashtra is the state in the country with the lowest interns' stipend, with other states offering much higher stipends (West Bengal - Rs. 14000, Jharkhand - Rs. 9000, Delhi - Rs. 13000, Assam - Rs.12500, UP and Bihar - Rs. 7000).

Any person with even the slightest common sense would see that paying an intern Rs. 2550
 as monthly stipend is a joke. Yes, agreed internship is a part of our medical education. But why the disparity in stipends across various states? Should we suffer because we chose to live/study in Maharashtra? The Government officials say that since medical education is sponsored by the Government, we cannot expect them to pay us a good stipend as well. But if we compare the fees during MBBS in every state, fees in Maharashtra are on the higher side, while the stipend is the lowest in the country.

So if other State Governments can afford to educate their medical students and pay them a good stipend as well, are they suggesting that Maharashtra is the poorest state in the country that can't even support it's own health professionals? We know that cannot be true.

As medical students we have studied for so many years, while our peers have started working and supporting their families, and now when we finally start working, at ages of 23-24, we still can't sustain ourselves with the measly pay we get (Rs. 85/day). In a city like Mumbai, where I live, that wouldn't even get me three square meals per day. And most of us still have years of studying ahead of us.

Seeing the state apathy towards the well-being of it's Doctors, there will be no wonder if the quality of health care services goes down the drain, if it hasn't already reached there.

After repeated failed attempts to make the Government sit up and take notice these past few months, the interns were forced to go on a hunger strike. Even after that, the Government continues it's apathetic attitude.

Since the last 4 days, interns have been sitting inside a pandal at the Kamgar Maidan opposite KEM hospital in Mumbai, on a hunger strike. No-one has even batted an eyelid. Media coverage has been lukewarm, political response has been almost non-existent, negotiations with the Government have yet to begin, and the interns who are not going hungry are so relieved to get a few days off from work that they don't even come to the grounds to show their support.

Every evening, we are told that tomorrow there will be a meeting, and the issues will be resolved. Every evening means one more hungry night.

I cannot even begin to think what the people who are going hungry must be going through.
Today I am ashamed to be an Indian and a Maharashtrian, and disgusted and appalled by this state of affairs.

To all my co-interns who haven't shown up to support the strike - You may not want these demands to be fulfilled, it may not matter to you, there may be more important things going on in your life, but many of your co-interns really need this change. An increase in the stipend would make a world of change to them, and to their families back home where they live in the villages of Maharashtra. If they can go hungry for days altogether to fight for what they deserve, can't you just show up and extend your support? If and when the stipend increases, are you not going to accept your increased monthly salary? Are you going to refuse the increased stipend, like you're now refusing to show up and fight for this cause? Is it not your duty towards your classmates and friends to support them in their cause?

To the government officials - Well, I am sure none of them will be reading this, even if they are, I refuse to say anything to them. The strike should have spoken volumes, but since they haven't heard anything till now, I'm sure they're deaf.

To the media - Please, just don't ignore us. Don't write a tiny article hidden inside your newspaper just mentioning our strike somewhere.We are not asking you to support our cause blindly, but go ahead, do your research, dig out the facts, and after that, if and when you realize that we deserve what we're asking for, then you can help us by creating awareness and increasing political pressure.

The outcome of this strike will say a lot about this Government, and it will affect the state of health services in Maharashtra in the future, but more than that, more than anything else, the outcome of this strike will affect my faith and belief in my Nation and it's Democracy. Let's see where that goes from here.

 

Looking back on April

Song of the month: 

I have two songs to share.

Athlete, with Wires,
(I don't want to risk saying anything about this song and spoiling it)

and

Jessie J, with Who You Are,
(A song with beautiful lyrics and vocals that will haunt you for days)

You should definitely go hear both the songs. Right now.



Book of the month:

Room, by Emma Donoghue.

One of the best books I have read of late.

Breaking various stereotypes, including genre, lead characters, and style of narration, it makes for excellent reading. There's no love story, no detective thriller fiction, nothing supernatural either. Written from the perspective of a five-year-old, who has not left his house (referred to as 'Room') since birth, and is the only world he knows of, with his mother, and 'Old Nick' being the only two living people he's ever met, this is a story that is both engrossing and moving. A great change from the usual crime fiction, chick-lit, Indian lit, fantasy, and Jeffery Archer which crowd Indian bookstores everywhere.Go read it, and tell me whether you like it.



Movie of the month:

Pan's labyrinth.

It's a Spanish movie. I downloaded it thanks to my endless appetite for all things magical and supernatural, though it turned out to be more like horror/war cinema/drama/psychologic thriller, along with it's share of fantasy, of course.
So yeah, that's a whole lot of genres. You may find the movie a tad long, but it was engrossing.

My scariest scene (only one which elicited any sort-of-freaked-out reaction from me) was when a man had to suture up his own cheek which had been cut and lacerated. I own up, I couldn't stand watching it, and I shut my eyes during that scene.

(Yeah, that's what my nightmares as an intern are made up of. Having to suture myself  up someday. I am petrified of the pain caused to patients while I suture them, the displeasure making me try hard to steer away from any suturing responsibilities I might have. Though I know these tactics aren't going to last long. Sigh. I guess, as of now, Surgery as a PG option is definitely out for me!)

I love Pan's character and I love the child actress. I am too lazy to tell you about the story etc. Go Google it if you're so interested. I definitely did not regret watching this movie, that's all I'm going to say.

P.S. As you can make out from this post, I obviously did not get much studying done this last month. Let's see if May can change that.

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.

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.

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.

I miss the beach

"Do you know where your heart is?

Do you think you can find it?

Or did you trade it for something somewhere
Better just to have it..."

- OneRepublic, Say (All I Need).

About this photo: Clicked on a crowded evening at Kovalam beach, Kerala, India, just before sunset.

These ladies were having a great time, the beach seemed to be crowded with them and their white sarees and their golden borders wherever I looked...probably a group visiting from somewhere...

Initially I was irritated with them because there was hardly any breathing space on the beach, but then the waves and the sunset finally did have their effect on me.

I calmed down quite a bit and started smiling aimlessly and staring at people unabashedly (top favourite hobby).

In this photo, I was happy to capture the pensive look on the face of the woman who's closest to camera... (hope you can make out which one I am talking about, she's sort of in the middle). She inspired the quote which goes with the photo (though I am pretty sure she wasn't thinking of any such things;).

EDIT: Okay, I am adding more photos to this post, because they're there, and they're nice.

This shows a close-up of the pensive lady, my muse, though not as pensive in this shot. Extreme left (or outermost) in the photo.

She was happy, laughing and dancing in the water, very child-like. Don't you see her laughing?