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"?