Taking stock, post-NEET

It's been 16 weeks since I gave the NEET. 112 days. Almost one third of a year. No signs of the results coming out anytime soon. Seems surreal to sit and take stock of the number of days that have gone by and the number of useless things one has done with them.

And to think that an entire batch of medical graduates around the nation has been in the same state as me for the past three months; first robbed of a good two months of studying by the preponement of exams, then subjected to a torturous wait for results which have been indefinitely postponed, and an endless series of dates in the Supreme Court with no verdict in sight. I've been happily living in oblivion for the most part, but its finally getting to me. And with each day one steeps a little deeper into self-doubt and misery.

And of course the flow of well-meaning questions from people never stops, always reaching the same exact point: "And what are you doing these days?". Sigh.

To all you well-meaning people: I don't have the energy to answer and explain to you the complicated status of my professional life at the moment. And I don't need to see the judgmental look on your face at the end of my answer.

Anyways, what have I been doing?

Rediscovering myself. Making myself happy. Taking a vacation. Overdosing on romance. (Only in literature and movies, of course. Real-life romance still remains a daydream). Working, and quitting. Sleeping till noon. Earning money. Exploring new music. Shopping. Devouring novel after novel. Forcing myself to watch TV. Learning Paediatrics. Getting better. Getting fitter. Watching Hindi daily soaps.

Living the good life, apparently.

Seems I don't have much to complain about. Clearly the past few months haven't been a total waste. But I think there's only so much time a medical student can go without studying and without sleep deprived nights.

There, I said it.

In the past 6 years I've trained myself, against my will, to live and breathe in all those tomes of medical textbooks all the time. To keep giving exams on repeat. To have my head swimming with diseases all the time. To never have too much time on hand. To never have nothing to do.

So, being suddenly faced with months of nothingness, is downright absurd. The past three months have been weird. Anomalous. There's a strong undercurrent of unease. Like something's about to go terribly wrong. Like this isn't what I am supposed to be doing. That this will all turn out to be a huge prank and then disaster will strike.

Because this isn't how my life was supposed to be. No, not yet. I can't digest so much happiness and so much laziness. Too much of a good thing can kill you. So I'm pretty sure I'm dying soon if the results don't come out.

Never thought I'd say this, but I'm actually starting to miss those textbooks.

Oh, well. 

Let me know what's happening to the rest of you, in the comments.

Source: here

Conversations from Psychiatry

I have only a short post for you, since I only attended parts of my already short Psychiatry rotation.Other than that, do let me know what you all have been up to, how are your rotations going, and for my co-interns, how bad is the exam fever?
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An ongoing discussion about various ways in which funds can be used by the department.

J: Sir, we can get carrom boards in the wards for indoor patients, some entertainment for them. Both the side rooms are empty only most of the time. We can keep it there.
Y: Yes, that's a good idea, but who will take responsibility for taking care of the carrom boards, that is the question.
P: Oh yes, always good to entertain the patients. Tell me, is the TV in our ward working?
J: Yes sir, the one in the male ward is working, the one in the female ward isn't.
P: Okay, don't you people want to install a treadmill in the ward? Let's get a treadmill. All you junior doctors can work out on it, patients can work out on it, good for everyone.
J: <Says nothing>
J: (trying again) We should get some games for the patients to play and pass time. We can get something like playing cards.
P: Yes, let's get them Tarot cards.
Me: <mouth hanging open>
J: Sir, the psychotic patients will make predictions with the Tarot cards and become even more psychotic.
P: Yes, that should be great.
J: (looks at where I am sitting) All you interns, please go sit in the next room.

{J=Junior Doc
Y=Unknown in pyramid
P=Senior doc
Me=Bottom of pyramid}
-----------------------------

Intern: (Shouting in the ward for a patient) ABC, ABC... ABC kaun hai?
X: Haan ji, yahaan hoon.
Intern: Aapka khoon nikalna hai, chalo so jao.
<proceeds to collect blood>
Intern: <handing over a bulb> Issme Urine collect karke table pe rakh dena.
X: Theek hai Doctor sahab.

<Intern goes and starts studying>

<After some time>

Sister: INTERN, INTERN!!!

<Everyone gets scared and looks at each other>

Intern: <bravely gets up and goes out> Yes, sister. Kya hua?
Sister: <gives murderous look>Why did you collect the patient's relative's blood? And Urine also!!!
Intern: But, but, I was calling for the patient, and he came!
Sister: But, don't you know admitted patients are in hospital clothes?
Intern: But...
Sister: But what?
Intern: <shuts up and goes to collect the patient's blood now>

{Yeah, this story wasn't even related to psychiatry. But it happened during my Psyche rotation. You will have to just grin and bear it.}
-------------------------

I have had this love-hate relationship with Psychiatry since I joined MBBS. As a subject, it has always fascinated and intrigued me to no end. All the oppurtunities the field brings, to people-watch, and psychoanalyze, and counsel (which very ironically I think I would be good at, believe me or not!) had me in this excited state for a couple of years, and I seriously thought that this is what I would get into. But then, my family explicitly forbade me to even consider this an option, and gradually I realised the field is very sidelined in India, with most people looking down upon Psychiatrists as well as their patients.

But then, I was faced with an even bigger problem. I could not find a single Psychiatrist who would command some respect, in the professional sense, and in the way they conducted themselves. I found no one I could look up to. And I looked. But all of them seemed to have issues. When they came and conducted lectures for us, the lectures were huge embarrassments. None of them seemed to treat their own profession with respect and/or like a science. Disheartened, I gave up.

I know, I'm probably sounding like a demented snob right now. But I have nothing else to blabber about so bear with me. I eventually decided Psychiatry would not be a good career choice for me.

But then, during this rotation, I think I may have finally come across a sane Psychiatrist who commands some respect. Not too sure though. Let's see.

Tearing through the night (Part II)

Tearing through the night (Part I)

The new nurse panics and requests Dr M for a referral or to at least call the senior in-charge. Both are politely denied. Another dose of Nifedipine goes in, and the increase in duration and frequency of contractions is reassuring. Dr M at this point consults his colleagues. But he has already decided to accelerate the events of labor. He thinks about artificially rupturing the membranes but then decides against it and is fixed on only stripping them for now. He starts creating a partograph of the data he has gathered. Graph makes it obvious that the labor is progressing normally, but what bothers Dr M is that it will take another 2-3 hours at this rate. By 9:45pm, the cervix is fully dilated. Dr M now approaches the relatives, explains the high risk and the chances of poor prognosis to them, and that referral is required urgently. Of course, he knows very well that they will not agree to it, now that she is so close to delivering, no matter how near the referral centre is or how the grave the patient can become. The same was presented in writing and without hesitation they signed the high risk/poor prognosis write up. A grin appears on Dr M's face, it grows in size as he turns away from the relatives and walks towards the patient. Dr M is now getting all the action he hoped for at the start of the night.

Dr M swabs the perineum, albeit not liberally on account of limited betadiene that is left, introduces two fingers and gleefully strips the membranes off the lower uterine segment.

Back at his table, Dr M is approached by the peon who offers him food from his own house. By the time Dr M realized it was time for food, everything around had closed down, so he had been prepared to fight the MMC that would eventually come to trouble him. But of course Dr M couldn't turn down such an offer, so he agreed to eat with the peon. They were joined by the nurse and another assistant. During dinner conversations it became known that the assistant was asked to come over by the nurse as she had been present in a number of deliveries at the centre. Dr M didn't mind. He was open to any help he could get, but none that would interfere with his autonomy.

After dinner, Dr M goes out to get others and himself a bottle of Pepsi. The general store is a 5 min walk, but has closed down by then. The shopkeeper is there however, and recognizes Dr M. Turns out he had come in the late afternoon that same day with his son who may or may not have swallowed a coin, to the centre. He opens the shop; Dr M buys two bottles of Pepsi, a liter each. As Dr M walks towards the health center, he is greeted by many who invite him into their homes. It is an auspicious night, a night of celebrations. That is another reason why Dr M wants to hasten the delivery, besides him being bored of repeated observations of course. The fetus could be born on this auspicious night if his efforts are successful. Not that he cares when it is born. Yes, Dr M referred to fetuses as 'it'.

Back at the centre, he can't find anyone. He grabs his stethoscope and rushes to the labor room. Stripping has worked. Labor pains have accelerated, membranes have ruptured and liquor is clear. She is getting contractions every 2 minutes lasting half to a full minute. Prior PV exams had confirmed vertex presentation in occipitolateral postition. On PV now, head is well flexed and internal rotation has occurred. Her contractions and efforts to bear down forcibly are disproportionate to the outlet provided by the perineum, as a result of which caput is evident over the occiput even before crowning. The assistant starts applying fundal pressure. Dr M instructs her to stop, but she continues anyway. The mother was getting exhausted and crowning wasn't occurring. She had already taken many a hit from the peon and assistant. Dr M, though violent by nature himself, contributed nothing to that. On the contrary, he asks them to stop hitting her. They slowed down. Dr M at this point expresses his concern that an episiotomy will be required. The nurse remarks that they aren't ready for it and that nobody has ever performed an episiotomy over there. So the labor continues in the same way and forcible crowning is achieved after which the neonate is delivered.

No cord cutting scissors or cord clamp is available. With a suture cutting scissors, the cord is cut and ligated with two ties. A female neonate is delivered at 10:30pm weighing 2.6kg with caput and acrocyanosis. APGAR at 1 and 5 mins were 10. Placenta was delivered 15 minutes later and it was evident that a segment of it was retained. Dr M inserts his hand inside the uterus and removes the retained placenta, and whatever clots he can discern. Bleeding still doesn’t stop.

He orders 4 misoprostol tabs and gives them orally to the patient. There are no other oxytocics available. Half an hour later, the bleeding still continues. Dr M once again introduces his hand to inspect for clots or placenta, none found. The uterus is well contracted and hard to feel on PA exam. Dr M now starts swabbing the vaginal walls to inspect for tears. Swabbing is done with cotton, as gauze is not available; this leads to strands of cotton fibers being stuck everywhere, on the vaginal vault, on the instruments, on the gloves, all mixed with blood. It is difficult to work in the bloody mess, but Dr M manages somehow.

Vaginal walls seemed intact after inspection. Only plausible option now was the cervix. What worries Dr M is the possibility of coagulopathy. There is nothing he can do for that and from what he has heard, the referral unit doesn't send help after 10pm, another thing that he had been informed of and had ignored earlier. When Dr M asks for speculums and retractors, the staff looks at him as if he had spoken in an alien language. He instructs them to get all the instruments they have along with a veinflow, RL and Foley's. They return with two instrument trays, a scalp vein, DNS and nothing instead of a Foley’s. Apparently those are all the obstetric instruments they have. Dr M searches for an RL and startsa pint. He inserts a Sim’s and an AV wall retractor and can now see the cervix. He tries to teach the nurse and assistant how to hold them, and fails. With great difficulty the cervix is held with a sponge holding forceps and a single volsellum. There is no other atraumatic instrument available. Small tears are found on the anterior and posterior cervical walls. On swabbing them, none bleed actively. Dr M starts walking around the cervix with the sponge holder and is shocked to his core with what he finds over there.

Tearing through the night (Part III)

Tearing through the night

Today I present to you a medical tale, in three parts, which was sent to me yesterday via email by someone who calls himself Dr M, in response to my call for guest posts. He sent me a short profile about himself when I requested it:

Dr M is a medical intern at a Government hospital in a metropolitan city of India. He is slightly obsessed with all things medicine, and socially inept otherwise. He loves taking risks and is known to frequently take leave of rational thinking. He often seems to lack a sense of self-preservation. He used to sketch well in his childhood, but later gave up on sketching as he thinks no one in this world is worth sketching anymore. He also feels that the need for love and the need for food are complementary to each other, so he stuffs himself with a lot of food in order to balance out his need for love.

After enjoying reading the story he sent me so much, I was more than eager to publish it. The story will be published in three parts, one part each day, starting from today.

Warning: People outside the medical fraternity, read this story with caution. It is full of difficult medical terminology and gore, and might scare you off doctors for life.

Tearing through the night: Part I (by Dr M)

At a distant peripheral health center in an Indian village, it’s 6 in the PM and Dr M is in-charge tonight, alone. Desperately hoping for some action in the seemingly boring night shift ahead of him, he happens to overhear the staff talking about a woman admitted in labor. He doesn't say anything, finishes off with his dull patients and quickly checks on the patient in the labor room without the knowledge of the nurse. A 25yr old, second gravida with contractions 30 minutes apart in no distress at all. With this brief information, he says to himself "There is still a lot of time to while away".

He goes back to his chair - a comfortable blue reclining chair with adjustable height which also rotates. He plays with the height and rotation, changes his moment of inertia, observing the change in angular velocity. His thoughts jump to the unification of electromagnetic and weak forces and how it was explained on the basis of energies at different speeds of rotation. These flights of thought are interrupted by patients, again. Routine injury cases, nothing to do. Reassuring them that their injuries are nothing serious never worked, and eventually he was forced to yield to their perceived need for a parenteral analgesic.

He looks behind him, realizes that the patient will be pricked by a used needle, sterilized only by dipping in spirit for the amount of time allowed between two patients asking for the same drug. He also realizes that there is nothing more he can do. The patients know for a fact that Dr M is here only for this one night, and their tone of voice reflects the confidence in their demands and the lack of trust in Dr M. Maybe they will realize their mistake when they contract HIV and the source is unknown, he thinks with a shrug. Unlikely even then, he knows. Dr M prescribes with a heavy hand, going against his principles, and calls the next patient to the chair.

Amidst all this the nurse comes in and takes the sphygmomanometer and walks away, Dr M knows why, or at least he thinks he knows. The nurse comes back, keeps the apparatus in place and goes back to her chair, but then comes back once again in half a minute and in a low voice says "Sir, a patient has been admitted, she is in labor. At admission her BP was 160/80 and it is still the same. What should we do? "

Dr M raises both his eyebrows, wrinkling his forehead to give a look of concern, one that shows him looking startled. The forehead gradually clears as his eyes close, and all that can be seen through his glasses are closed eyelids that appear smaller than they actually are without any activity underneath. He is listing in his mind the problems the patient could have, and what he is supposed to do, as he gets up from his chair and approaches the patient. The thought process continues as he grabs the BP apparatus and walks hastily with the nurse towards the labor room, while the other hand supports the stethoscope hanging around his neck. Some would not even call this patient a patient, thinks Dr M. They would argue that pregnancy is a part of normal physiology and not a deviation from it. Well, for all those, the pregnancy in question was no more normal, and she was now a patient by all definitions, Dr M thought to himself with satisfaction.

As he nears the patient and starts securing the BP cuff around the patient's right arm, he hopes the BP would be actually elevated and not an error on the nurse's part. The mercury is at 170 when he starts hearing the taps. Dr M is delightfully distressed even before the taps; he had already felt the pulse even as the mercury rose to 160. He informs the nurse, in a pseudo-forced tone, a tone that would not divulge his joy, that the BP was 170 over 100 millimeters of mercury. Dr M asked the nurse if there was any Aldomet or Nifedipine available. On receiving a negative response, he went back to his desk and wrote a prescription for Nifedipine 10mg. The patient's husband took the prescription in his hand and tried to read what appeared to be something scribbled in a flow. Dr M explained to him why that drug was required and its urgency. Also scribbled in the prescription was Hydralazine and MgSO4, which Dr M explained the husband, had to be checked about for availability only, and not to be purchased as of now. Dr M then goes back to the patient, this time with a full formed set of questions in his head.

After about 10 minutes, the husband returns. By now he has gathered that the patient has conceived after 11 years and has had no antenatal care till date, with her first delivery being at home. She had an uneventful current pregnancy except for the bilateral swelling of feet that comes and goes with various factors  that the patient hadn’t paid attention to. Dr M is told that there are no sterile, packed needles available when he asks for them, and is told to use ‘autoclaved’ ones instead. Dr M lets out a sigh on hearing this, not because of the non-availability of sterile needles, which he had expected, but because he hears about the so-called ‘autoclaved’ needles. He uses an 'autoclaved' needle and places the capsule under the patient's tongue, instructing her not to swallow it as a whole, all the while hoping his instructions weren’t going to vain. He checks his wrist watch, the two arms of his watch were apart by 2/8ths of a circle and the hour was 6th. He wore this same watch all the time, felt incomplete without it, and yet he maintained it poorly.  Dr M elevates his right arm to visualize his watch again, this time noting the FHS, as, unsurprisingly, the Fetal Doppler at the facility isn’t working.

Dr M informs the nurse that the FHS is 130, and tells her that he wishes to do a PV exam. 2FT/O/engaged/intact is what he jots down on the paper over which he decides to record his findings throughout the course of labor. The nurse seems tense, and informs Dr M about a referral center that has dedicated labor services and an obstetrician, 10 minutes away from their centre. Dr M had already anticipated a concern for referral and was prepared with a confident explanation against the same. He wilily imparts only selected information to the nurse about the implications of the case, so as to ensure she does not bother him too much. She then asks if the senior in-charge should be informed, and is quickly dismissed once more by Dr M. Finally she asks if Dr M had conducted a delivery before and if he could handle this one. On hearing an affirmative reply to the last question, the nurse informs Dr M that she will be leaving and another nurse will come for change of duties.

It is 7:15pm now; the new nurse comes in and informs Dr M that she has had very little experience in delivering. She walks with Dr M as he enters the labor room again; he records the BP and renews his faith in medicine on noting that BP is 130/80, FHS 120, P 90. As the nurse tries to monitor the patient, Dr M soon realizes that she doesn’t even know how to record BP, and has no idea what the normal range for BP is. And here he had been thinking that he would learn from her the palpatory method of recording BP that he had always wanted to master, since she seemed to know it well, at first glance. Now Dr M can feel his hopes getting crushed. He then takes over the apparatus with resignation and operates it, all the while explaining to her how to record BP.

Another PV exam record reads 2FL/1/engaged/intact in Dr M's paper with a BP of 130 systolic. He goes back and orders slow sips of water to the patient. Between half hourly exams Dr M fiddles with his cell phone, browsing the net, chatting, and getting advice for further events which were to be expected. In fact his phone was irreplaceable to him and he had gone great lengths to get it back. This was, as he understood, the reason for his sanity over the past few weeks given one of his vitals was not available to him. A repeat exam at 8:45 gives him a scare. BP is 150/100.

Tearing through the night (Part II)
Tearing through the night (Part III)

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.

The Glorious Things Interns Do

1. Clean cupboards.
2. Bring tea, coffee, food for the senior docs.
3. Take senior doctors' family members to the dentist.
4. Basically, make senior doctors' family members feel important, show them around, do their work for them, so that your senior looks good.
5. Go to the bank and finish your seniors' work for them.
6. Fill forms. Tons and tons. Since seniors are too high and mighty to fill theirs themselves.
7. Accompany patients everywhere. Since they will otherwise get lost and some time will be wasted. An intern's time on the other hand is obviously worthless.
8. Beg all the time. For X-rays to be done, USGs to be done, investigations to be done, reports to be given, appointments to be given. Beg for syringes, needles, bulbs, gloves. Beg, haggle, fight, steal, scream, weep. Whatever it takes to get the job done quickly. (Though of course, all this should actually be getting done all by itself, as a basic requirement for any hospital to function).
9. Suck up to everyone, from the mama to the sweeper to the nurse to the resident doctors to the HOUs to the Dean.
10. Put up with flirting and ogling housies (exclusive to female interns).
11. Arrange for alcohol etc. for your residents (exclusive to male interns).
12. Trace reports. Although they should never require tracing in a fully functional hospital. 
13. Make phone calls from your cellphone for your seniors' work.
14. Scan books and textbooks for your seniors.
15. Check and tally the department's accounts for your seniors.
16. Find the X-rays or files or reports your seniors lost. 
17. Never learn a thing.
18. Never treat a patient.
19. Never question your seniors.
20. Put up with the sisters being mean to you all the time (I confess there have been occasions when they've left me close to tears with their unnecessary and uncalled for meanness).

From mkk:
21. Shoot and develop X-rays.
22. Forge prescriptions under some other Dept HOD's name.
23. Find pillow for the lecturer to rest on.
24. Help the medical instruments supplier extract money from BMC so that they get few thousand rupees of commission.
25. Take night ward rounds and write CM notes as the housemen are too busy (read lazy) to take themselves.
26. Get the tube lights fixed!
27. Renewal of medical registration.

From Tangled up...:
28. Pick up the housie's laundry and deposit it in her room.
29. Count the number of functioning and non-functioning ventilators in the ICU and write down the names of the companies as well as who donated the money needed to buy them.
30. Go to the new hospital building from the old to call the registrar because the intercom wasn't working (God forbid, they actually have to use their mobile phones!)
31. Count the number of tables and chairs in three wards.
32. Pick up lunch order from a restaurant because the restaurant had no one to deliver it.
33. Spread a bed sheet on the bed in the doctor's room in the Emergency so the lecturer can sleep on it.

All this donkey work we do isn't going to help us in any way as a doctor, or as an individual. Our seniors aren't even going to thank us for it, or acknowledge our existence once we've finished doing their work. It's just going to be time we wasted in our life. Zero benefit. The only way it helps is that they HAVE to give us the sign on the log book at the end of your posting. Since we did all their donkey work. Interns just want the sign, seniors just want their work done. So no one complains.

Some people seem to think that the PG doctors are so overworked, it's no crime if they shed some of their workload onto the interns. But I beg to differ. As PG students, they worked hard, got admission into college, and are now going to spend the next three years becoming doctors. This is a part of their deal. They're getting paid for this. It's part of their job profiles, and it will help their patients. (Yes, the very ones they actually get to treat). Their seniors will teach them, and help them in their careers, if they do their jobs well. And they better do it well! But is it really a part of an intern's job profile to do their seniors' donkey work?

As medical interns in a government hospital, we're supposed to get a hands-on experience in treating patients, and improving our medical knowledge, we're supposed to be developing skills, not doing our seniors' work for them so that their lives are easier (while they never give a thought to our lives).

Frankly, dear seniors, we don't even mind doing your donkey work, since we are the junior most in the hierarchy, but at least we should be taught something once in a while. Don't look at us like hungry leeches, with the only thought in your head when you see an intern being how to extract the most from them and get the highest amount of dumb work done from them. We've finished medical school, the least you can do is treat us with some respect. Like, maybe remember we are now your colleagues? Ever heard of the words 'please', and 'thank you'? If you're asking us to do your personal work, at least ask politely! Ever thought that you should maybe do your job once in a while which includes teaching us something? Rather than just thinking hard and inventing work for the intern every time you see one sitting ideal? Hope you get the message someday. Till then I'll just go back to living the frustrating life of an intern.

P.S. My ongoing orthopedics rotation is turning out to be a nightmare. Though this post may seem a bit extreme to some, I swear all of it is true, especially as far as this one rotation is concerned.

P.P.S. Feel free to add to my list of 'The Glorious Things Interns Do'. I will be updating the list as your comments come in.

"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.

"Always use your own clinical judgement..."

Here's a story of how I learnt a good lesson in the practice of medicine recently.

There was this patient who'd been coming to my hospital's Casualty OPD since the day I joined. He'd turn up every couple of days, at different times of the day, complaining of pain in his right knee joint.

He would walk in with this bandage tied around his knee and complain of unbearable pain. And then ask for painkillers. My senior told me he's been coming like this for quite some time, has been evaluated by many Doctors, who all say there's nothing wrong with his knee. He'd probably gotten addicted to the pain killers, or that's what everyone thought was the case. He would never go to the regular morning OPD, he just came to the Casualty OPD everyday.

So over the next month, I watched him come in multiple times. Sometimes we just gave him the drugs, sometimes we told him there's nothing wrong with him and shooed him off, sometimes we gave him placebos. But always, he would be back for more pills.

Of course, there's no such protocol followed like counseling such a patient or giving him a psychiatry reference. No one thinks it is necessary or advisable to do such things. Hell, no one even gets such ideas.

Pretty soon all the interns, all the Doctors, and all the staff started recognizing him well. Most refused to give him any treatment whenever he turned up.

One time I saw a Doctor tell him that he should wait outside quietly, come in only when he saw that particular Doctor (himself) over there, only during his shift, and then he would get the pills he needed. The Doctor then proceeded to prescribe Diazepam to him. Was that some kind of weaning tactic? I don't know. I didn't ask. We don't generally question our supervisors about their prescriptions, or about anything for that matter.

Then, after a month or so of this, he now came in during one of my night shifts and started complaining of pain in his left knee joint. Of course no one batted an eyelid or probably even noticed the difference. He came in  with three people carrying him, complaining of severe pain.

I told the on-call Medical Officer that he's been coming with similar histories all month long, since he (the MO) didn't seem to recognize him. Even the nurse recognized him, and the tons of prescriptions he had with him showed the same thing. The MO still listened to him, elicited his history. The patient mentioned that he had had a fall 4 days back, and since then developed severe pain in his left knee. This ticked something off in my mind since I clearly remembered him with a bandage over his right knee in the past.

The MO then examined him, and noticed there was a slight swelling over the knee joint. That, combined with the history, was enough to convince him. He sent him for an X-ray, and called the orthopaedician on-call to have a look. It was 12.30 am at that time.

The Orthopaedician on-call came in, took one look at the patient, got livid and started shouting at him. The patient it seems, had been coming in two-three times per day, everyday, for the last three days, complaining of pain in his left knee. But every one knew that he was a so-called addict so they just ignored him, or just gave him pain-killers and sent him off. The orthopaedician was furious that he had been called at midnight once again for that patient.

In the meanwhile, his X-Ray came. It showed a fracture lower end femur, with increased joint space, probably due to ligament tears. This man had been walking around with a fracture for four days now and no one had thought about evaluating him. In his defense, the Orthopaedician said that the patient had not given any history of trauma or fall before that particular day, so he had not thought about getting an X-ray.

Even after his diagnosis, the patient didn't want to get treated as he didn't have any money. He kept asking for some pills so it would be alright. When we asked him about addictions while taking his history, he confessed that his only 'addiction' was that he needed to take pills at night to sleep.

Finally, the patient was advised to temporarily get a cast, and arrange for more money for further surgical management, or go to a bigger hospital where a Trust Fund could be used to pay for his treatment. After he left, the MO on-call told me: "You see now what a good thing it was that I sent for that patient's X-ray? You should always use your own clinical judgement rather than listen to what others tell you. That's called practising good medicine. I saw that he had a swelling over his knee, so I sent him for an X-ray."

And that was one of the best lessons I have learnt in a long, long time.

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.