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 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"?

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.

 

"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.

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

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

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

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

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

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

There are still many more things I got to learn.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctors: The Origins

So, how do people decide that they will become Doctors? Do they even decide that at all? What drives them, what inspires them? Ever wondered? I'll tell you how.

When you first thought about becoming a doctor, you must have been a bespectacled (or not) school kid bent under the weight of your school bag, who wrote an essay about "What do I want to become when I grow up?" (Obviously, everyone wrote that they wanted to become a doctor, it was the noblest profession of all, and the teachers and parents loved it!). However you may have ended up being one of the few who actually remember that essay from your school notebook, and then actually follow it in real life. You actually tried to become a Doctor after you got out of school. You remembered what you'd written.

Or you may have been a teenager who had lots doctors in the family, and it was always understood and assumed that you would carry on the tradition. Hell, you don't even have to think about it! It's in your genes. And, if your family's rich enough, you don't even have to get the marks for it! One way, or another, you find your way into a medical college.

It could have been your parents' biggest dream, you've heard them say, all your life: "Mera beta bada hoke Doctor banega" -  to the neighbour, to the relatives in the U.S., to your Daadima,  to the postman, to the God in that tiny roadside temple, to your friends' mothers, and anyone else who happened to listen. After hearing it being repeated to you for umpteen times everyday for 17 years of your life, how could you even have thought of anything else but to be a Doctor?

Another scenario would be that you had a life altering experience. Your loved one, a family member, a friend, or even a perfect stranger, could have suffered from a disease, borne a loss, could have died. You watched them go through it. There was nothing you could do. You decided, that day, you would change the world. You would not let that happen to someone else. You would become a Doctor.

It could have been that you were sailing through your life, carefree and clueless, as to where you were headed, you know, just enjoying the ride. One fine day, someone (could be absolutely anyone) happened to mention: "Hey, why don't you become a Doctor?" and you sat and wondered, "Yeah, why not?" And so you went about becoming a Doctor.

You could have been one of those hardworking, sincere competitive people. The ones who gave all the exams that came their way, because they loved to. It was their birthright to give exams. So, they ended up giving the entrance test for MBBS, and voila, they got admission (coincidentally or not), and then they puffed out their chests, and proudly, went on to become Doctors, and gave loads and loads more of exams.

Then there are some who are just plain masochistic. They see someone who's a doctor, slogging, working hard all the time, buried in books and patients, with no signs of a life, and they think: "I want that! Looks like so much fun! I'll torture myself, and one day I'll become a Doctor, and it will be awesome!" There goes.

Others get drawn in by the glamour. Their Doctor charges in four digit numbers for a 15 minute consultation, lives in a duplex flat, has bungalows in all the nearby hill stations, plays golf on the weekend, hob-nobs all across the world like he's taking an evening walk, and drives sports cars. Hell, who wouldn't want that?  So they decided to become a Doctor, and get that.

And then there are the few who actually develop an interest in science and medicine, they wonder about the sound of the heart beating through the stethoscope, the feel of the pulse thumping under their fingertips, the cold handle of the scalpel on their palm, the mystery of the shapes they see on the X-ray. They wanted to know more, they wanted to learn more. They were curious, and eager, and excited, and passionate. So, they became Doctors.

These stories are how most Doctors originate, that's how take birth. And then, provided they have the IQ, or the monetary power, they enter a medical college, and begin their journey.

What is my story? Well, I was a confused teenager, who didn't seem to have any particular interest in any vocation. My mom said, "You're intelligent, you should become a Doctor" (like all Moms should tell their kids). A Vocational Guidance Counsellor told me, "You're a lazy bum, incapable of studying for 8-10 hours a day, and slogging. I strongly advise you against becoming a Doctor." I looked at her with hatred, joined coaching classes for the medical entrance test, made it through with difficulty (the difficult part was altering my 'I never study' lifestyle) and managed to get admission into a medical college.

And then, all hell broke loose! But that story is for another post...

So. If you're reading this, and if you're a Doctor, tell me your story. How did you end up becoming a Doctor? What was your origin? Do you know other interesting stories I may have missed out? Or do you not agree that this is how Doctors are born? Let me know.
If you're not a Doctor, tell me what do you think about this. Is this why people should become Doctors? Or are these reasons not good enough? What's your opinion? Let me know.

Till later.