Sunday, May 15, 2011

"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"?

Saturday, May 7, 2011

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.



Thursday, May 5, 2011

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.


 



Sunday, May 1, 2011

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.



Tuesday, April 26, 2011

Bamboo Madness


With my building having some construction and repair work going on, it's surrounded on all four sides by bamboo suspension bridges. One evening of boredom and a walk around the building later, I realised the bridges made for great photos. This is also the first time I took a photo walk, albeit a very, very tiny one, the whole purpose of which was to click photos and nothing else. Here are the products of that evening.

All the grey goo you see over the white tiles is cement used in the construction work.
 



This makeshift shack is what the construction workers have built for themselves to live in, in our backyard, while they work. They've been living there for four months now. 



*sigh*


There are two Gulmohar trees, one jamun tree, one cotton tree, and one mango tree in and around my building. I love the Gulmohars best. Both are yellow ones, I wish I had a red one nearby as well.

We used to have a red shoeflower tree in our backyard for many years. It used to have loads of blossoms every morning, and I remember collecting them and playing with them for hours and offering them in the Jain temple I went to.

Recently it was cut down to build an ornamental garden and the white tiled courtyard you see in the first photo. I miss my shoeflower blossoms :( Plus it would have made for beautiful photos!































































Sunday, April 17, 2011

"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.

Sunday, April 10, 2011

To lost friends


"Where did I go wrong, I lost a friend
Somewhere along in the bitterness..."
- How to save a life, The Fray.


To all the friends I have managed to lose, along the way.

We used to be close, once upon a time. Then life happened, we grew up, we drifted apart, we hurt each other too bad, we changed as people, or we were just too lazy to continue being the friends that we were in the past. We lost each other.

But I still remember you. And I hope we meet again sometime, along the way.