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!

"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.

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.

A day in the life of an intern in cricket-crazy India

On 30th March, 2011 India and Pakistan played a crucial semi-final match for the Cricket World Cup 2011.
The entire nation was worked up into a mad frenzy, and almost everyone was gathered with friends, or family, or strangers, somewhere, watching the match, eating, drinking, shouting, cussing, and cheering.

I was working on my night shift at the hospital, from 8:00 pm to 8:00 am.

Don't feel sorry for me, I really didn't care much about the match anyways, except for an hourly update on the score. (Yeah, every Indian I ever knew is going to disown me after reading this). I didn't even watch too much of the first half of the match, though I was at home. (Now they'll never want to see my face again and will probably refuse to acknowledge my existence till the end of time).

8:05 pm: After having taken an exceptionally empty local train, to the hospital, I start my shift.

The first couple of  hours of the shift were normal, pretty much the same. I can't even say that there were lesser patients than usual. Of course there was this excitement in the air, and this eagerness in all the patients to go home real quick. And there was the match commentary running in the background from someone's radio, where we worked, in the Casualty Department.

9:00pm: A case of poisoning came in. The young man, in his mid-twenties, had tried to commit suicide by consuming about 250ml of a pesticide an hour back. When he came in he was conscious, with no visible adverse reactions having developed as yet. We put in a Ryle's tube and started the gastric lavage immediately. Over the next one hour, however, he worsened considerably, and vomited 4-5 times.
After all the initial management, he was to be transferred to a higher centre for further specialised care, since the hospital I work at is quite small and not well-equipped to handle such cases. And being the intern, I was given the job of accompanying the patient in the ambulance.

10:00 pm: The patient is in the ambulance, everyone's getting ready to go. The patient seemed to be in some kind of stupor, quite disoriented and languid. He was just lying there on his trolley and groaning. We hear the first firecrackers of the night. No one paid much attention, of course, except the patient. He, on the other hand, woke up from his stuporous sleep, and said slowly, but clearly: "India jeet gaya, phatake phod rahe hain. India jeet gaya!" ("India has won, they're bursting the crackers!")

I just stared at him dumbfounded. Then I quickly checked the score on my phone. Pakistan was something like 160/6 at 36 overs. Yep, India was definitely winning. But the match was far from over. Anything could happen. But obviously, some zealots had already started the after - party with the crackers.

So yeah, I let him think his happy thoughts of India's win the for rest of the trip. Would probably give him a reason to live and recover or something. He remained awake after that for the entire trip, talking about the match, and even telling us why he had tried to commit suicide (unemployment).

10:40 pm: We've reached the bigger hospital since the roads were all empty, handed him over and are now returning. Pakistan was 8 wickets down and the last few overs of the game were being played. The ambulance driver and his assistant just couldn't resist stopping at a roadside TV store to watch the match, though we are obviously not allowed to do such things, and then once they made sure we were winning, they even treated all of us to ice-creams as celebration!

10.45 pm: On the way back, we see hundreds of people dancing, and cheering for India, it's like a big festival. Even though I've lived in India all my life, and am used to all the cricket mania, I'm still surprised. The unadulterated happiness on the people's faces is infectious. Firecrackers are bursting everywhere, children are dancing, men are shouting: "Indiaaaa, Indiaaa!!" For the first time in my life, I think I truly understand what cricket means to the masses. It's beautiful.

11.05 pm: We're back. Within the next hour, a flurry of patients turn up. Some of them were just waiting for the match to get over, now they can go to the Doctor. A whole lot of young men come in, covered in gulaal. Many are drunk. A couple of them got into a fight, smashed each other's heads. Part of one's scalp got avulsed with a tin roof while he was running around celebrating India's victory. Two-three bumped their head with something or the other. Many of them were slightly drunk. And, none of them cared the least about their injuries. Their wives and mothers just hauled them to the hospital. They're sitting in this group inside the Casualty, and as each new patient comes in, they examine his injury, ooh-aah over it, and go back to discussing the match. And their tons of relatives wait outside the Casualty and create a din.
I try my best to suppress my laughter, because it's a hilarious sight, and we give them all their injections and dressings as fast as we can, just to get rid of all the noise and commotion.

11.30 pm: An 80 year old granny comes in. She was watching the match with her family all cooped up in their living room, and some one got excited when India took a wicket, thumped her on the thigh, and wham! Something broke. She comes in on a wheelchair, smiling even, we get an X-ray, and there's a fracture neck femur.

1.30 am: Finally the patients seem to be lessening. Now, the more drunk ones start turning up though. One patient comes in with an IT fracture, with about 10 people accompanying him, one of them being some kind of local goon. They say they were playing cricket when he got hurt. (At 1.30 am they were playing cricket!) The on-call orthopaedician is not available at that time to see the patient. He doesn't turn up for the next hour. In the meanwhile, we take X-rays, give him painkillers. The local goon, who is of course drunk, creates a ruckus and threatens: "Main ye akkhha hospital phod doonga!" ("I'm going to smash this entire hospital to pieces!"). Security comes in, the CMO comes in, the orthopaedician is still nowhere to be found.

2.30 am: Orthopaedician turns up, swings his arm over the local goon's shoulder and then it's like they're long lost friends. Pretty soon things calm down and all is forgotten. After the orthopaedician leaves, everyone stays up to bitch about him for a while. I have to admit, it wasn't entirely uncalled for (the bitching).

3.30 am: I try to go to sleep. I spend 15 minutes applying Odomos and finding a clean bedsheet. As soon I settle down, a patient comes in. I give up on the sleeping when patients keep turning up at 15-20 minute intervals. I start writing this post in my mind in the meanwhile.

The rest of the morning goes by as usual. I leave at 7.55 am from the hospital, drink a bottle of Sprite, since the water at the hospital can't be trusted to be safe, hop onto a train and head home.

9:25 am: I've had breakfast. I fall asleep while trying to write this post on the computer.

6.00 pm today: I wake up, hog for an hour. Then write this. Have one more meal, before finally posting it, right now.

Now I'm ready to go back to sleep. You've read all about a day in the life of an intern in cricket-crazy India.

How was your day? Tell me about it.

Kathakali show

All photos clicked at a Kathakali show in Thekkady, Kerala.
I just loved the dancer with his face painted green.
Click on the sideshow to view photos in the album.

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

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

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

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

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

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

There are still many more things I got to learn.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I Know I'll Go Crazy If I Don't Go Crazy Tonight.

...there's a part of me in the chaos that's quiet...
and there's a part of you that wants me to riot....

...is it true that perfect love drives out all fear?
The right to appear ridiculous is something I hold dear...

...listen for me, I'll be shouting,
shouting to the darkness, squeeze out sparks of light...

- (All quotes from) I'll go crazy if I don't go crazy tonight , U2.

(This song has the most fabulous lyrics ever.)

So, I'm supposed to write somthing for this blog. I have the ideas, I can visualise the articles, I just don't have the energy to write them. Yet.

Internship is exhausting.

Maybe tommorow.

Till then, I have these photos for you.

About the photos: Clicked at the most memorable and most mesmerizing bonfire ever.
12 am. Friends. Long holiday. The perfect weather. Camera. Tripod. Hammock. Bollywood songs. Too stuffed to eat. Too tired to move. A night to remember.