Everyday at the night duty at the Day Care Center where three Suspected swine Flu patients with ARDS are kept in Ventilator I usually sit up with the Emergency room where each unit goes on charge per routine...I usually manage to chatter with the Second year Post Grad or the Final year Post Grad and time goes by easily....until today...
The unit I am supposed to be in for the next 2 and half years is on duty....And I am worried about where to find a place to sit...
Wednesday, December 30, 2009
Sunday, December 27, 2009
Final
Got the first taste of what it actually means to say you are f***** and not mean it. Especially when it carries some meaning.
Units got fixed....Sometimes you can and yet cannot question the system. Whats to become of life will be seen. Lets just take one step at a time.
Beginning..Now.
Units got fixed....Sometimes you can and yet cannot question the system. Whats to become of life will be seen. Lets just take one step at a time.
Beginning..Now.
Sunday, December 20, 2009
To know it....
To know you don't have much time. To know that beyond that throbbing heart with a soaring pulse and a fever that refuses to die down...the moments gradually converge to those few painful, insipid days spent in an ordinary Indian hospital with a voice that slowly gives way to a willowy whisper, all taste buds going to sleep one after the other with a promise never to come back. The pulse continues its monstrous overtones with a vengeance...And you know, behind all those cells that are gushing through the veins laden with at that instant with all those poisons that your body manufactured for itself...you know, that your time has come. You are suffering from Acute Myeloid Leukemia.
And this time, it wont retrace its steps; this time around it will refuse to give you more time.
How much time is enough for a seventeen year old? Who decides that he has had enough in his life? He has faithfully laid himself to the scrutiny and awe of at least 5 batches of students tottering on the brink of their graduation to the point he told them answers to the questions the examiner would ask. The first day I saw him was a warm day in August when I was in rotation in Unit 3 and we were holding this prefinal examination...He moved from his side to mine, with the complaint that he did not like to lie with other women patients and that there was " too much sun". He had Petechiae then. He told me he had cancer when I was telling the nervous examinee the D/Ds of Petechiae. Beside him stood his elder brother, not a year over 22..with angelic kind eyes. They made a fun pair. And I was insistent he leave the bed he was occupying on "my side' for "my patient" as soon as the exam was over. They did.
He had stayed for quite some time now. And I learnt from them that I love being told "Good morning Mam", instead of a "namaste doctorsaab". They perched on the bed next to the sister's common room and I always saw them first thing I entered the ward. Both the boys always had that smile.
Next he came under me in the month of October as his status went further down. His brother did every thing for him, still does. Not once have I seen this guy of seventeen cry, or whine or mourn...He is stylish, he likes to sleep on the bed with his shoes on, he gives me a flashing smile each time I see him, and I love those two always wishing me a " Good morning mam.." For once, I feel good to be 27.
Deepak quit studies when he was in 10th. His brother is doing a Bachelor's degree in Arts. Together, these two live in the hearts of most sisters in the ward. I have never seen any of the sisters ever delaying or being rude to them. And I have never seen them ever coming back to complain or crib about anyone or any thing. They stay in their ward, they smile, joke like two buddies, they are both smart and into the times. Often I have seen Deepak reading newspapers.
Deepak will go. Its a fact, and its this time. He has 90 % blasts in his peripheral smear. This time no amount of blood or platelets or chemotherapy will save his life. His tongue is white, he persistently runs a fever, and his mouth has begun to smell that bovine stench I first noticed in Omraj, my first leukemia Patient. I ordered Listerine asap.
Today his brother came back to me to ask if they would take him back because anyhow the end was explained. Unit I is running through a double emergency so it is me more or less who goes there once or twice to talk to him. I told him it was entirely up to him...He was explained that despite being on Augmentin, Levoflox and Magnova if he runs a fever, it doesn't indicate a good thing. His brother looked me in the eye, and asked me " Is this the end?"
"Yes", I told him. "Keep him happy. Give him whatever he wants to eat, whatever he wants to do"
" I will", he said, with a smile that did not quite reach his eyes. " Good night mam ."
I see this guy with his kid brother and I wonder just how people manage to take their own lives with their own hands...not very far from him lies another guy who has multiple Pyogenic Liver Abscess because of his own callousness. There is not one moment when he doesnt abuse his sister-in-law, his only attendant..He doesnt take medicines, doesn't take fluids, doesn't get nebulized, and whenever I ask him if he has any more pain, he replies, 'I am perfectly okay', in such a manner that makes me want to slap his living sardonic trait off his brains for good...but you get these two...both of them heading perhaps to the same end, albeit through different paths. But I see Deepak smiling, chatting, being happy even while he knows how its going to end. And I see this man, who will perhaps survive..but to be honest, he does nothing any single day of his living life to deserve the moments he is having.
I love this kid and his brother. I pray his brother lives a long prosperous life. Because he is a good soul. As for Deepak, I don't know what to say. I hope whatever it takes, how much time, or energy or care, he should be happy till the end.....He deserves more life than anybody else present in Ward 3 PGIMS, Rohatk. And I know he knows it. But he doesn't complain.
Thats what makes him so special. The ultimate Mam's kind of guy.
And this time, it wont retrace its steps; this time around it will refuse to give you more time.
How much time is enough for a seventeen year old? Who decides that he has had enough in his life? He has faithfully laid himself to the scrutiny and awe of at least 5 batches of students tottering on the brink of their graduation to the point he told them answers to the questions the examiner would ask. The first day I saw him was a warm day in August when I was in rotation in Unit 3 and we were holding this prefinal examination...He moved from his side to mine, with the complaint that he did not like to lie with other women patients and that there was " too much sun". He had Petechiae then. He told me he had cancer when I was telling the nervous examinee the D/Ds of Petechiae. Beside him stood his elder brother, not a year over 22..with angelic kind eyes. They made a fun pair. And I was insistent he leave the bed he was occupying on "my side' for "my patient" as soon as the exam was over. They did.
He had stayed for quite some time now. And I learnt from them that I love being told "Good morning Mam", instead of a "namaste doctorsaab". They perched on the bed next to the sister's common room and I always saw them first thing I entered the ward. Both the boys always had that smile.
Next he came under me in the month of October as his status went further down. His brother did every thing for him, still does. Not once have I seen this guy of seventeen cry, or whine or mourn...He is stylish, he likes to sleep on the bed with his shoes on, he gives me a flashing smile each time I see him, and I love those two always wishing me a " Good morning mam.." For once, I feel good to be 27.
Deepak quit studies when he was in 10th. His brother is doing a Bachelor's degree in Arts. Together, these two live in the hearts of most sisters in the ward. I have never seen any of the sisters ever delaying or being rude to them. And I have never seen them ever coming back to complain or crib about anyone or any thing. They stay in their ward, they smile, joke like two buddies, they are both smart and into the times. Often I have seen Deepak reading newspapers.
Deepak will go. Its a fact, and its this time. He has 90 % blasts in his peripheral smear. This time no amount of blood or platelets or chemotherapy will save his life. His tongue is white, he persistently runs a fever, and his mouth has begun to smell that bovine stench I first noticed in Omraj, my first leukemia Patient. I ordered Listerine asap.
Today his brother came back to me to ask if they would take him back because anyhow the end was explained. Unit I is running through a double emergency so it is me more or less who goes there once or twice to talk to him. I told him it was entirely up to him...He was explained that despite being on Augmentin, Levoflox and Magnova if he runs a fever, it doesn't indicate a good thing. His brother looked me in the eye, and asked me " Is this the end?"
"Yes", I told him. "Keep him happy. Give him whatever he wants to eat, whatever he wants to do"
" I will", he said, with a smile that did not quite reach his eyes. " Good night mam ."
I see this guy with his kid brother and I wonder just how people manage to take their own lives with their own hands...not very far from him lies another guy who has multiple Pyogenic Liver Abscess because of his own callousness. There is not one moment when he doesnt abuse his sister-in-law, his only attendant..He doesnt take medicines, doesn't take fluids, doesn't get nebulized, and whenever I ask him if he has any more pain, he replies, 'I am perfectly okay', in such a manner that makes me want to slap his living sardonic trait off his brains for good...but you get these two...both of them heading perhaps to the same end, albeit through different paths. But I see Deepak smiling, chatting, being happy even while he knows how its going to end. And I see this man, who will perhaps survive..but to be honest, he does nothing any single day of his living life to deserve the moments he is having.
I love this kid and his brother. I pray his brother lives a long prosperous life. Because he is a good soul. As for Deepak, I don't know what to say. I hope whatever it takes, how much time, or energy or care, he should be happy till the end.....He deserves more life than anybody else present in Ward 3 PGIMS, Rohatk. And I know he knows it. But he doesn't complain.
Thats what makes him so special. The ultimate Mam's kind of guy.
Wednesday, December 16, 2009
Upon Reading:
What I wrote 3 years back was way too long. But except the "th" in place of the "the" and the i's, I think I wrote better...
Something has died inside me. I doubt if I can write with those individual bursts of passion I then had. And I feel like a hypocrite to talk about making the most about the small happinesses.
When my turn came, I refused and refused ...It took three years to lose the wounds, but the scars run deep and are sort of embossed on the signature one gets when I one sees me.
I am a hard task master, an exacting physician, an inglorious realist, an angry failure at happiness....True, I am good at my work,my juniors adore me, my interns thank me profusely for the generosity, my patients worship me but are somewhat intimidated by me. And I don't think they love me. I walk away every time a woman patient has tried to hug me. If I stayed I would cry. I don't know why this happens.
But I am not a coward. I accept the fact that I am not happy, that I am not interested. I am honest with the people I deal with. And I have gradually secluded myself from the general fun part of it all....I am into the internet, into cinema, into computers, into books and literature....
I am only not into one thing. Into me.
Know what this is called?
At 27, I am a 27 year OLD. Adjectives are immaterial.
Something has died inside me. I doubt if I can write with those individual bursts of passion I then had. And I feel like a hypocrite to talk about making the most about the small happinesses.
When my turn came, I refused and refused ...It took three years to lose the wounds, but the scars run deep and are sort of embossed on the signature one gets when I one sees me.
I am a hard task master, an exacting physician, an inglorious realist, an angry failure at happiness....True, I am good at my work,my juniors adore me, my interns thank me profusely for the generosity, my patients worship me but are somewhat intimidated by me. And I don't think they love me. I walk away every time a woman patient has tried to hug me. If I stayed I would cry. I don't know why this happens.
But I am not a coward. I accept the fact that I am not happy, that I am not interested. I am honest with the people I deal with. And I have gradually secluded myself from the general fun part of it all....I am into the internet, into cinema, into computers, into books and literature....
I am only not into one thing. Into me.
Know what this is called?
At 27, I am a 27 year OLD. Adjectives are immaterial.
WHITEWASHED RAINBOWS.....
This is what I had written close to 3 years back that had started it all. There have been innumerable, unmentionable changes in me as a person, as a doctor, I think I would be hypocritical if I said I can speak about life with the same anger and passion as I then used to have; neverthless, I publish this for two reasons;
1> No matter where I go, or what I become, some part of me will be alive that will always have this battle cry against life's ways, no matter how stifled it may be.
2> There was a moment in life when I wrote like a mad woman. I never wrote that good, I never saw what I wrote, I mostly vomited all the hate and scum that choked my soul....I never wanted to be a writer, I wanted to write. But somehow, when people have madnesses like this without a foundation, without any conviction, it usually goes caput. It happened. I remember that morning conversation with Goli when I said I would be burning my blog with 150 odd entries...he continued talking to me from Bangalore but started saving all the blogs he could....till I hit the Delete button in Cuttack....
Dust to dust to thus to thus.
I restart this blog with none and a lot of intentions, most small, some a little bigger than the small ones. And a huge thanks to this very nice man for keeping that one post that mattered so much....Next time I lose track, I will come back to it. I know I will still vituperate, I will still spill forth once I get into this madness...But I hope this time it will have some method in it....
I give you WHITEWASHED RAINBOWS, my dear Me...And this will complete the circle my heart was aching to watch:
( originally written in 2005, reproduced with permission from my very dear friend, Goli...Its unedited, and contains a lot of trash..almost comical my metaphors and all, but anyways thats how I thought and wrote then. some changes were made as an afterthought, ostly involving a lot of snipping...)
Something happened last year during my outdoor duty at the Department Of Ophthalmology that I must mention.A hastily gathered group of 20 odd students collect everyday around 9: 30 am to see patients that would help them in knowing the subject better and in a more practical sense of the term, help them sail through the 3rd professional exams.We had been caught up in this frenzied state of being ever since Clinicals have started where we learnt to see patients to get a proper hold on our subject which actually translated to learning up hundreds of diseases and their associated clinical conditions, differential diagnoses and so on...Whatever the case,that morning 26 of us gathered in the outdoor department of the Department of Ophthalmology eager to learn and see some new cases.
The teacher we were allotted that day was Dr Madan Mohapatra, a very efficient doctor and a really nice person . And that morning he was his usual incisive yet gentle self, teaching us the nuances of Ophthalmology that we could handle at that stage. The crowd was beginning to warm up as the day progressed and we were shuffling about in the small room all craning our necks together at the same time trying to look into the pupil of one patient who just had a new lens fitted or to see the pattern of injury caused by an iron foreign body in the other. Perched as I was, at the side of Sir with the plan of having a better view of the individual pathologies, I was indulging myself...Nothing seemed to be out of the ordinary, at least until then....
The next patient was a young boy, no more than 7 years at the most. He came holding this father’s hands and sat on the stool. He was wearing a yellow T-shirt and black pants and had on a pair of black glasses the kind of which you get in hospitals. ...I did some quick Spot the diagnosis.
Appearance-Healthy.
Attitude- Rather Cheerful.
Gait- Normal, no deformities.
Skin and Hair condition- Healthy, no evidence of malnutrition.
Injuries-None observed except the eye area which hid behind the glasses.
Most probable diagnosis- Hmmm...Childhood cataract operated and patient has come for a routine check up after lens implantation.
As my mind was doing this the boy was running his hand across the edge of the table. He was turning his head from where he supposed his father must be to the other side probably trying to find him out. Nothing about him to suggest he could not have been a boy straight from the fair, who had made his father buy him the goggles from a vendor. All he lacked was perhaps a red balloon; and I could half imagine him clutching one in his left hand. Or was there a lack that didn't meet the eye? Only time would tell that. And in a few seconds it did.
I smiled at him when he turned his head towards me, and was waiting for him to smile back when far echoes of a familiar voice cut my imagination...'A very unfortunate case..' , Madan Sir was saying. I was confused, "Did the cataract operation not go well ?" Things were not making sense. I wanted to know what had happened...I waited for the father to take the child’s glasses off half wishing to do it myself. Madan Sir turned towards the boy who was now smiling at him stretching his hands possibly with the hope of shaking it. “And now there is nothing that can be done”, he said and took his glasses off. There was a single collective gasp.I was by the side of the boy so I bent forward to see wondering what could have moved even the stiffest students to flinch. And my jaw dropped at what I saw.
There was a fleshy crater in place of where his left eye should have been. At least 2 fingers deep and as wide and extending right to the back of the orbit where the bare remains of what should have been the optic nerve stood out like a stubbed cigarette butt. Across the back of the orbit were the stitches that had tagged the sclera into the roof. The black silk stitches were put there to prevent infection from spreading intra cranially. The right eye was there but it was possibly worse than the other. The cornea looked like a glob of pudding that had fallen into his eyes.
We call that clinical condition Keratomalacia. A blinding disease caused by the dietary deficiency of Vitamin A, which causes blindness and makes the skin flaky.In layman's terms it simply melts the eyes. But its not something people need not buy expensive capsules to treat or prevent; it is found in abundance in all green leafy vegetables and if one even ate the papaya that grows in abundance in our state one will never get that condition. However what was shocking was that someone who looked so healthy and had no other manifestations of a deficiency should suffer from it; weird to explain. His skin looked pretty healthy and it was hard to imagine what amount of depravation he must have faced before this happened to his eyes. And I wondered what his parents were doing till then instead of getting him to a hospital sooner. And the only thought I could possibly have that time was which was worse to have- a hole on the left with the lids sinking into it or a non-functioning eye on the right that the lids could not close.
The right eye was beyond repair was what we heard from sir, and so the inevitable re-operation a few weeks after to take his right eye out to prevent him from dying because once the cornea on the right melted and dislodged, the right eye would become a nidus of infection that would gnaw into his brains and kill him within a week. I was feeling suffocated, and I wanted an explanation for the fact that such injustice be done to someone so young and what were we doing at all if we could not save vision even in one of his eyes with all our unbridled pride for saving people's lives.. I wondered what sort of life we were sending him back to. Sooner or later he will be relegated to begging on the streets and hating the fact that he was alive. And then if we were claiming to make so many advances in medicine why we could not do something that was so widespread in a country like ours where 10\% of the children born suffer from avoidable blindness so if we have a 10\% of a billion odd population it makes 10 crore of children under the age of 5 out of which at least 10 percent lose their sight in any eventuality..which amounts to 10000000 blind kids in the country and growing every second. I was confused and embittered about what I felt to be the handiwork of poverty that can stifle so many lives and literally take the light out of any meaning in it.
“But surely Sir there must be some way, at least a cornea transplant; couldn’t that be done?”, I had blurted out just as he was about to resign this patient because the wound on his left was healing appropriately. All heads turned at me, known as I am for my abruptness and candour. Madan Sir looked at me and I began to wonder if I had blurted out something stupid.My classmates looked as blank as the whitewashed walls. At times a white can be a dark as black.
“Good question”, he said. “But do you think we can consider that possibility here?”, he asked me.
“May be Sir”, I struggled with the ineffectual abilities of an amateur at the science. “His entire cornea is sloughed so there will be no rim to place it “,I was thinking inside.
“Maybe Sir if we could find a big cornea from a donater”, I blurted because I already knew there being no supportive tissue in the boy’s eyes to support it, it would be just a matter of days before the graft would slough off. For a moment Sir regarded my suggestion. But whatever there was he started to say “Even if we consider a transplant we will at least have to see if it will be effectual even if its grafted into it”. “And for that “, he said and looked around hopin to receive an answer which at that instant was not forthcoming from anyone including me, “We need to see if he has any PR and PL because otherwise we do such a huge surgery and find his eye melts right after 2 weeks,and its just not worth it”.
Madan Sir took a torch and put directly into his eye and asked him if he felt or saw anything.He didn’t.“No PL”, “Bad sign. Lets hope at least the PR remains”, he said and took the torch to all the 4 quadrants asking the boy if he ever felt something coming from somewhere he should say from which side he felt it was coming from. Notice he used the terms "something", and "feeling" instead of "light" and "looking" because the boy had no idea what light is all about.He had the condition ever since he was a kid until his eyes finally gave way like molten wax. The boy immediately took a fancy for what he thought was a game. As sir showed the torch from all sides he giggled and tried to catch the torch each time.For 15 seconds the room was filled with 20 nauseated students, an expressionless father, a doctor assessing a patient if he could do something more other than taking his eyes out, and the blissfully innocent giggles of a kid who had possibly no idea what vision is all about so something in place of the nothing he saw or rather felt made him think life was beautiful.
And he played a good game.PR was lost in 1 quadrant. So in short there was some hope of a graft working in theory. Sir told had circumstances been a little more beneficial they would have even risked the benefit of doubt to a graft and see how the body responded. Sometimes the human body responds in ways no one can explain and miracles can happen. So who knew. But in this case “Where is the money to go on about it?”, Sir said as he looked at me.“The father had to be convinced the first time if we didn’t operate his son would be dead within a week. The hospital is going to do the second enucleation for free” . There was my half nodding and a half lipped smile as I understood what he was saying through his eyes. This is the language people of a profession share when they talk about the impotence of a situation that cannot be helped. This is also the language a doctor buries in his heart and his lowered head when his family members disconnect the lines and take away their patient because they cannot afford the healthcare costs and if they put the patient in the hospital they will be dead before long because they haven’t eaten for last 4 days.
Something started to sting my eyes.And mostly it was guilt. Guilt at having an intact life; having resources to sustain and indeed enjoy that intactness at times even abusing it; and guilt at the injustice I was doing to the vastness of possibilities in my existence weighed against my own protestations of the injustices I felt were done to me for every mundanely unimportant thing that had upset me so far. Gulit at the privilege; and guilt at what I was doing about the responsibilities bestowed with the endowments. And disgust mostly at myself for my procrastination of happiness because of my own weird reasons that at this time seemed corrupt with selfishness.
And disgust.A lot more of disgust actually.Disgust that someone like me could make myself so miserable about things that seemed nothing in comparison to this blind boy in front of me who has never seen a ray of light in his life and worse, he has no idea what he is stepping into.And disgust at him for being happy in a situation like that.Its weird to explain. But I could not like him. I hated him because he was missing something he didn’t know. I hated him for what was going to happen to him. And I hated him for not questioning for his being the way he was. For being happy with his losses. I was despising his happiness.
What struck me much later for his appearance that belied his condition is a fact that most patients in our state think going to a hospital is a special occasion, much akin to going to the house of a relation, so its not unusual to see ladies bedecked in jewellery and pata sarees even if its only to open the petticoat and lie down crumpling all those folds for a pelvic examination.So in all possibilities he was probably dressed in a fresh pair of clothes borrowed from someone and thoroughly oiled and groomed by his mother for his hospital visit.
Whatever it was, he was bade away.
I cant lay more expression to what I was feeling for my ability to express falls way short of my feelings at that time. And I most certainly didn’t want to look up and see what my friends were growing through.Summarily the case was dismissed as the next patient came to have his 5 minutes of fame with our audience. And the Boy from the Fair was forgotten for the time being.
But what I remember most at this time after 2 years is not my angst and frustration or revolt against things way beyond my powers to modify. In some weird way that cant be explained. I only preserve within the confines of my memory the realization that day of a human’s capacity for happiness. In the little we have from life its just that it takes just us and only us to make us feel the way we want to. And for that, I feel proud I met that boy who showed me that one should not waste life in misery thinking about what the morrow will bring because anyways a person has no idea about that..and to waste time thinking about the darkest of possibilities and in turn being sad for something one has no idea of, life is too short to indulge in this way.
The world of nothingness from which the boy came that day and into which he disappeared was in ways way more colourful than all our starched white formalin sprayed existences. A rainbow sht forth that day in OPD2; and still blooms in my mind when I think of him after so long. Against a whitewashed silent blackness, its a rainbow hued smile that inspires you to rise up and to try to be better at what you are doing..Because people like him need things from this world. And people like us need to do it for the world.
And that completes a circle. The seven colours of rainbow, mix, mingle and unite...into an eternal whiteness.
God bless him wherever he might be.
1> No matter where I go, or what I become, some part of me will be alive that will always have this battle cry against life's ways, no matter how stifled it may be.
2> There was a moment in life when I wrote like a mad woman. I never wrote that good, I never saw what I wrote, I mostly vomited all the hate and scum that choked my soul....I never wanted to be a writer, I wanted to write. But somehow, when people have madnesses like this without a foundation, without any conviction, it usually goes caput. It happened. I remember that morning conversation with Goli when I said I would be burning my blog with 150 odd entries...he continued talking to me from Bangalore but started saving all the blogs he could....till I hit the Delete button in Cuttack....
Dust to dust to thus to thus.
I restart this blog with none and a lot of intentions, most small, some a little bigger than the small ones. And a huge thanks to this very nice man for keeping that one post that mattered so much....Next time I lose track, I will come back to it. I know I will still vituperate, I will still spill forth once I get into this madness...But I hope this time it will have some method in it....
I give you WHITEWASHED RAINBOWS, my dear Me...And this will complete the circle my heart was aching to watch:
( originally written in 2005, reproduced with permission from my very dear friend, Goli...Its unedited, and contains a lot of trash..almost comical my metaphors and all, but anyways thats how I thought and wrote then. some changes were made as an afterthought, ostly involving a lot of snipping...)
Something happened last year during my outdoor duty at the Department Of Ophthalmology that I must mention.A hastily gathered group of 20 odd students collect everyday around 9: 30 am to see patients that would help them in knowing the subject better and in a more practical sense of the term, help them sail through the 3rd professional exams.We had been caught up in this frenzied state of being ever since Clinicals have started where we learnt to see patients to get a proper hold on our subject which actually translated to learning up hundreds of diseases and their associated clinical conditions, differential diagnoses and so on...Whatever the case,that morning 26 of us gathered in the outdoor department of the Department of Ophthalmology eager to learn and see some new cases.
The teacher we were allotted that day was Dr Madan Mohapatra, a very efficient doctor and a really nice person . And that morning he was his usual incisive yet gentle self, teaching us the nuances of Ophthalmology that we could handle at that stage. The crowd was beginning to warm up as the day progressed and we were shuffling about in the small room all craning our necks together at the same time trying to look into the pupil of one patient who just had a new lens fitted or to see the pattern of injury caused by an iron foreign body in the other. Perched as I was, at the side of Sir with the plan of having a better view of the individual pathologies, I was indulging myself...Nothing seemed to be out of the ordinary, at least until then....
The next patient was a young boy, no more than 7 years at the most. He came holding this father’s hands and sat on the stool. He was wearing a yellow T-shirt and black pants and had on a pair of black glasses the kind of which you get in hospitals. ...I did some quick Spot the diagnosis.
Appearance-Healthy.
Attitude- Rather Cheerful.
Gait- Normal, no deformities.
Skin and Hair condition- Healthy, no evidence of malnutrition.
Injuries-None observed except the eye area which hid behind the glasses.
Most probable diagnosis- Hmmm...Childhood cataract operated and patient has come for a routine check up after lens implantation.
As my mind was doing this the boy was running his hand across the edge of the table. He was turning his head from where he supposed his father must be to the other side probably trying to find him out. Nothing about him to suggest he could not have been a boy straight from the fair, who had made his father buy him the goggles from a vendor. All he lacked was perhaps a red balloon; and I could half imagine him clutching one in his left hand. Or was there a lack that didn't meet the eye? Only time would tell that. And in a few seconds it did.
I smiled at him when he turned his head towards me, and was waiting for him to smile back when far echoes of a familiar voice cut my imagination...'A very unfortunate case..' , Madan Sir was saying. I was confused, "Did the cataract operation not go well ?" Things were not making sense. I wanted to know what had happened...I waited for the father to take the child’s glasses off half wishing to do it myself. Madan Sir turned towards the boy who was now smiling at him stretching his hands possibly with the hope of shaking it. “And now there is nothing that can be done”, he said and took his glasses off. There was a single collective gasp.I was by the side of the boy so I bent forward to see wondering what could have moved even the stiffest students to flinch. And my jaw dropped at what I saw.
There was a fleshy crater in place of where his left eye should have been. At least 2 fingers deep and as wide and extending right to the back of the orbit where the bare remains of what should have been the optic nerve stood out like a stubbed cigarette butt. Across the back of the orbit were the stitches that had tagged the sclera into the roof. The black silk stitches were put there to prevent infection from spreading intra cranially. The right eye was there but it was possibly worse than the other. The cornea looked like a glob of pudding that had fallen into his eyes.
We call that clinical condition Keratomalacia. A blinding disease caused by the dietary deficiency of Vitamin A, which causes blindness and makes the skin flaky.In layman's terms it simply melts the eyes. But its not something people need not buy expensive capsules to treat or prevent; it is found in abundance in all green leafy vegetables and if one even ate the papaya that grows in abundance in our state one will never get that condition. However what was shocking was that someone who looked so healthy and had no other manifestations of a deficiency should suffer from it; weird to explain. His skin looked pretty healthy and it was hard to imagine what amount of depravation he must have faced before this happened to his eyes. And I wondered what his parents were doing till then instead of getting him to a hospital sooner. And the only thought I could possibly have that time was which was worse to have- a hole on the left with the lids sinking into it or a non-functioning eye on the right that the lids could not close.
The right eye was beyond repair was what we heard from sir, and so the inevitable re-operation a few weeks after to take his right eye out to prevent him from dying because once the cornea on the right melted and dislodged, the right eye would become a nidus of infection that would gnaw into his brains and kill him within a week. I was feeling suffocated, and I wanted an explanation for the fact that such injustice be done to someone so young and what were we doing at all if we could not save vision even in one of his eyes with all our unbridled pride for saving people's lives.. I wondered what sort of life we were sending him back to. Sooner or later he will be relegated to begging on the streets and hating the fact that he was alive. And then if we were claiming to make so many advances in medicine why we could not do something that was so widespread in a country like ours where 10\% of the children born suffer from avoidable blindness so if we have a 10\% of a billion odd population it makes 10 crore of children under the age of 5 out of which at least 10 percent lose their sight in any eventuality..which amounts to 10000000 blind kids in the country and growing every second. I was confused and embittered about what I felt to be the handiwork of poverty that can stifle so many lives and literally take the light out of any meaning in it.
“But surely Sir there must be some way, at least a cornea transplant; couldn’t that be done?”, I had blurted out just as he was about to resign this patient because the wound on his left was healing appropriately. All heads turned at me, known as I am for my abruptness and candour. Madan Sir looked at me and I began to wonder if I had blurted out something stupid.My classmates looked as blank as the whitewashed walls. At times a white can be a dark as black.
“Good question”, he said. “But do you think we can consider that possibility here?”, he asked me.
“May be Sir”, I struggled with the ineffectual abilities of an amateur at the science. “His entire cornea is sloughed so there will be no rim to place it “,I was thinking inside.
“Maybe Sir if we could find a big cornea from a donater”, I blurted because I already knew there being no supportive tissue in the boy’s eyes to support it, it would be just a matter of days before the graft would slough off. For a moment Sir regarded my suggestion. But whatever there was he started to say “Even if we consider a transplant we will at least have to see if it will be effectual even if its grafted into it”. “And for that “, he said and looked around hopin to receive an answer which at that instant was not forthcoming from anyone including me, “We need to see if he has any PR and PL because otherwise we do such a huge surgery and find his eye melts right after 2 weeks,and its just not worth it”.
Madan Sir took a torch and put directly into his eye and asked him if he felt or saw anything.He didn’t.“No PL”, “Bad sign. Lets hope at least the PR remains”, he said and took the torch to all the 4 quadrants asking the boy if he ever felt something coming from somewhere he should say from which side he felt it was coming from. Notice he used the terms "something", and "feeling" instead of "light" and "looking" because the boy had no idea what light is all about.He had the condition ever since he was a kid until his eyes finally gave way like molten wax. The boy immediately took a fancy for what he thought was a game. As sir showed the torch from all sides he giggled and tried to catch the torch each time.For 15 seconds the room was filled with 20 nauseated students, an expressionless father, a doctor assessing a patient if he could do something more other than taking his eyes out, and the blissfully innocent giggles of a kid who had possibly no idea what vision is all about so something in place of the nothing he saw or rather felt made him think life was beautiful.
And he played a good game.PR was lost in 1 quadrant. So in short there was some hope of a graft working in theory. Sir told had circumstances been a little more beneficial they would have even risked the benefit of doubt to a graft and see how the body responded. Sometimes the human body responds in ways no one can explain and miracles can happen. So who knew. But in this case “Where is the money to go on about it?”, Sir said as he looked at me.“The father had to be convinced the first time if we didn’t operate his son would be dead within a week. The hospital is going to do the second enucleation for free” . There was my half nodding and a half lipped smile as I understood what he was saying through his eyes. This is the language people of a profession share when they talk about the impotence of a situation that cannot be helped. This is also the language a doctor buries in his heart and his lowered head when his family members disconnect the lines and take away their patient because they cannot afford the healthcare costs and if they put the patient in the hospital they will be dead before long because they haven’t eaten for last 4 days.
Something started to sting my eyes.And mostly it was guilt. Guilt at having an intact life; having resources to sustain and indeed enjoy that intactness at times even abusing it; and guilt at the injustice I was doing to the vastness of possibilities in my existence weighed against my own protestations of the injustices I felt were done to me for every mundanely unimportant thing that had upset me so far. Gulit at the privilege; and guilt at what I was doing about the responsibilities bestowed with the endowments. And disgust mostly at myself for my procrastination of happiness because of my own weird reasons that at this time seemed corrupt with selfishness.
And disgust.A lot more of disgust actually.Disgust that someone like me could make myself so miserable about things that seemed nothing in comparison to this blind boy in front of me who has never seen a ray of light in his life and worse, he has no idea what he is stepping into.And disgust at him for being happy in a situation like that.Its weird to explain. But I could not like him. I hated him because he was missing something he didn’t know. I hated him for what was going to happen to him. And I hated him for not questioning for his being the way he was. For being happy with his losses. I was despising his happiness.
What struck me much later for his appearance that belied his condition is a fact that most patients in our state think going to a hospital is a special occasion, much akin to going to the house of a relation, so its not unusual to see ladies bedecked in jewellery and pata sarees even if its only to open the petticoat and lie down crumpling all those folds for a pelvic examination.So in all possibilities he was probably dressed in a fresh pair of clothes borrowed from someone and thoroughly oiled and groomed by his mother for his hospital visit.
Whatever it was, he was bade away.
I cant lay more expression to what I was feeling for my ability to express falls way short of my feelings at that time. And I most certainly didn’t want to look up and see what my friends were growing through.Summarily the case was dismissed as the next patient came to have his 5 minutes of fame with our audience. And the Boy from the Fair was forgotten for the time being.
But what I remember most at this time after 2 years is not my angst and frustration or revolt against things way beyond my powers to modify. In some weird way that cant be explained. I only preserve within the confines of my memory the realization that day of a human’s capacity for happiness. In the little we have from life its just that it takes just us and only us to make us feel the way we want to. And for that, I feel proud I met that boy who showed me that one should not waste life in misery thinking about what the morrow will bring because anyways a person has no idea about that..and to waste time thinking about the darkest of possibilities and in turn being sad for something one has no idea of, life is too short to indulge in this way.
The world of nothingness from which the boy came that day and into which he disappeared was in ways way more colourful than all our starched white formalin sprayed existences. A rainbow sht forth that day in OPD2; and still blooms in my mind when I think of him after so long. Against a whitewashed silent blackness, its a rainbow hued smile that inspires you to rise up and to try to be better at what you are doing..Because people like him need things from this world. And people like us need to do it for the world.
And that completes a circle. The seven colours of rainbow, mix, mingle and unite...into an eternal whiteness.
God bless him wherever he might be.
Tuesday, December 15, 2009
ARRRRGHHHHH!!!!!!
When I have been working nights in an emergency, and dealing with patients the best way I can, the worst thing that pisses me off is a patient's attendant calling me a sister ( universal slang for nurse) and asking me to change the "GULCOZE bottle"....
Its amazing how much power that single bottle of sodium chloride and sucrose holds over these people that they literally count the last 1000 odd drops of the vanishing elixir and come running to ensure the uninterrupted supply when the previous bottle has been downed....
Normally I handle the "Sister" tag and the war of worlds over the IV Fluids very well...but especially on a Post Emergency day, especially when I haven't slept the night ( I don't like it when I get time to sleep, I sleep almost 3 hours in this present unit, and I don't like it when I do so) , and am surviving on my sole adrenaline rush arising from the fact that I managed the chaotic night not too badly, this innocuous inquiry of patients' attendants adds just that spark to the bundle of withered dynamite....
And do I erupt....Sometimes I feel sorry about the way, but then I cannot hold back, especially because after the shower is over people do not nag me about being a sister for another week...System is chaotic here because, nurses wear almost the same uniform here as doctors, the blue salwar kameez being hidden beneath the white apron...In SCB, nurses always wore that blue salwar kameez or a saree, and a cap...I miss that latter...it looked beautiful on young students coming to do their ward rounds. Sure girls here are prettier, rosier and almost angelic just that the scene of about fifteen odd white caps bobbong up and down in unison to the head matron's ministrations looked good to me then....
Here I am always in an apron, and the code we ( myself and my Co-PG have devised to deal with our ordeal sometimes turns the table back on us...So imagine my consternation when Payal my Co-PG sends an attendant to find a "Sister is in a blue dress" and the hapless man literally comes panting to my side to ask me to change the IV line....I was wearing a blue kurta that day...
For a change, I had smiled.
Its amazing how much power that single bottle of sodium chloride and sucrose holds over these people that they literally count the last 1000 odd drops of the vanishing elixir and come running to ensure the uninterrupted supply when the previous bottle has been downed....
Normally I handle the "Sister" tag and the war of worlds over the IV Fluids very well...but especially on a Post Emergency day, especially when I haven't slept the night ( I don't like it when I get time to sleep, I sleep almost 3 hours in this present unit, and I don't like it when I do so) , and am surviving on my sole adrenaline rush arising from the fact that I managed the chaotic night not too badly, this innocuous inquiry of patients' attendants adds just that spark to the bundle of withered dynamite....
And do I erupt....Sometimes I feel sorry about the way, but then I cannot hold back, especially because after the shower is over people do not nag me about being a sister for another week...System is chaotic here because, nurses wear almost the same uniform here as doctors, the blue salwar kameez being hidden beneath the white apron...In SCB, nurses always wore that blue salwar kameez or a saree, and a cap...I miss that latter...it looked beautiful on young students coming to do their ward rounds. Sure girls here are prettier, rosier and almost angelic just that the scene of about fifteen odd white caps bobbong up and down in unison to the head matron's ministrations looked good to me then....
Here I am always in an apron, and the code we ( myself and my Co-PG have devised to deal with our ordeal sometimes turns the table back on us...So imagine my consternation when Payal my Co-PG sends an attendant to find a "Sister is in a blue dress" and the hapless man literally comes panting to my side to ask me to change the IV line....I was wearing a blue kurta that day...
For a change, I had smiled.
A Little unconvincing...
Suddenly our family has been thrown into a bucket of frenzied activity....The truth has to finally sink in...I am still at a loss what to say...For so long we had got so used to each other, growing old together seemed like an all inclusive, complete in itself thing. Now suddenly this turn of events, I do not quite know how to put it, and I will take time to react to it, and then perhaps respond to it, and the whole concept of that being a fractured continuum seems lost to me..
I am not disliking it, but I have yet not grown to like it.
May be with our independences and eccentricities the four of us have set higher standards for ourselves than would be required to redeem ourselves. Now its not just Maa, Paa, Apa and I...
And I am not disliking it, but i have yet not grown to like it.
I am not disliking it, but I have yet not grown to like it.
May be with our independences and eccentricities the four of us have set higher standards for ourselves than would be required to redeem ourselves. Now its not just Maa, Paa, Apa and I...
And I am not disliking it, but i have yet not grown to like it.
Monday, December 14, 2009
The Last Leaf
Its like that story by O' Henry where a young girl has severe pneumonia in a bitter winter and somehow comes to believe that once the last leaf of the fast withering small sapling drops she would die too...And a failed artist creates a miniature leaf on the stem of the plant in the ice cold winter night when the last leaf does fall down. And the girl hoping to see the bare stem in the morning cannot believe her eyes when she sees the same leaf still standing on the stem after the harsh winter storm...It gives her a new lease of life, she lives through her illness and comes out of it.
Do brain dead people see? Do they hear, feel and react? Do they feel the necessity of leaving their loved ones once they realize the love that they initially held for their own has been put to test by the endless chores their resilient unmoving body heaves on the hapless attendants, sons, daughters, brothers? The humdrum of suctioning, of bedsores, of cleaning grime in thigh creases of overweight bodies, of tracheostomy wounds, of periodically deflating and inflating the cuffs, of putting 'body' in left lateral, feeding in sitting, reclining with head end elevation, putting Ryle's tube in flexed head position...and so on... ?Do they also like to metamorphose and leave their present decaying bodies for a better, more ethereal, more eternal continuum that spares their attendants that inaudible sigh of relief they exhale when this person, with an IC Bleed, Left Internal Capsule, with extension into the lateral ventricles and an associated midline shift of 1.5 cm to the right, finally decides to give up the breaths she has been struggling to take.
It surprises me, then to see how the story actually unfolds; from the first day, when the attendants are, by turns, demanding, threatening, cajoling, waiting for that once hair raise from the doctor, when they are prepared to do 'anything', absolutely anything for their patient...they spread the sheets, they complain about leaking iv lines, about dead iv fluid bottles and about suctioning not being done well enough....and ithey are willing too, to get the ABG reports at 2 : 40 in the morning, and show it to the sleep infested doctor on duty...
Equations change...with time, the zeal to do 'anything, absolutely anything' is tested by roughly 5 visits to the pharmacy, 15 visits to the emergency lab, position change, suctioning ( an act, the responsibility of which which by now the doctor has relinquished on the attendants), and not to mention that occasional outburst from their screwed up doctor, who in an attempt to overshadow her own irate temperament at seeing that unmoving body day after day without any progress, or deterioration, and having told their attendants roughly 900 times she wont make it, decides to unleash her anger in more unscrupulous ways....She gives them a BGA at 3 20 in the morning, asking them to collect the report and show it to her in the morning..and watches the attendant bundle past her with shuffling steps on a bitter cold emergency night at Rohtak, a small, dimensionless city in North India....
She (the doctor) changes as well, the lady was a grossly obese 36 year old with 3 kids and a out of job husband...the attendants are, in order of their willingness and love for the patient, respectively the Brother, the Son, and the Bahu. She takes a look at the pallid skin, the toneless chapeless heap into which the body has been confined, the rhythmic swell of her breasts through which the heart sounds seem so faint she confuses if the heart is beating at all....the bed sore on her left butt, that unhealing patch of yellow, red and pink that still doesnt give her fever but that which has festered all this time...She asks about how much they have spent till date on her, and the Son gives a rough estimation: 25,000....with tears in his eyes...
25,000...thats a small number. Going by Haryana's standards, it may even be called negligible, a quick mental mathematics suggests her it could not be so much, with 2 CT Scans and some medications....but there is still a possibility...Her stance softens...She gradually introduces the topic of the famous DOR...Discharge On Request, partly with a guilt ridden heart...She backtracks in the middle...Her ethics don't support her...She once again gives the example of Life support systems and its use in America...She assures the they can, and then, they must take more time to decide....she would tell the medications...the rest in the line of care she would tell them....The guilt pang hits home again...she asks them to stay for 2-3 days more...and walks back to the resident room.
Thirty minutes later, the Brother, the decision maker comes to her...they would leave the next day, he says...she is shaken..'No, no, I don't want you guys to leave, I was only telling this because you guys told me just how difficult it had become to feed your hungry mouths...stay here for as long as you want..' , and then with new found insolence in the voice, talk to my seniors, they will tell you....
40 odd minutes, that dead body, listening to their conversation decides to die...She performs an average CPR, takes an ECG out of a machine that only traces flat lines, and declares her dead...None of the relatives make a sound, they are complying almost, they listen silently to her condolence of how her period of torture was fortunately cut short, they ask to keep the body in the hospital for the night, and they move with lightning efficiency to clear the bed and do the necessary.
The only tears are hastily shed by the son, who then moves on too, and a transport certificate ends that 10 day relationship she and her family had come to establish as the IC Bleed patient that was 'still alive'...
Do brain dead people see? Do they hear, feel and react? Do they feel the necessity of leaving their loved ones once they realize the love that they initially held for their own has been put to test by the endless chores their resilient unmoving body heaves on the hapless attendants, sons, daughters, brothers? The humdrum of suctioning, of bedsores, of cleaning grime in thigh creases of overweight bodies, of tracheostomy wounds, of periodically deflating and inflating the cuffs, of putting 'body' in left lateral, feeding in sitting, reclining with head end elevation, putting Ryle's tube in flexed head position...and so on... ?Do they also like to metamorphose and leave their present decaying bodies for a better, more ethereal, more eternal continuum that spares their attendants that inaudible sigh of relief they exhale when this person, with an IC Bleed, Left Internal Capsule, with extension into the lateral ventricles and an associated midline shift of 1.5 cm to the right, finally decides to give up the breaths she has been struggling to take.
It surprises me, then to see how the story actually unfolds; from the first day, when the attendants are, by turns, demanding, threatening, cajoling, waiting for that once hair raise from the doctor, when they are prepared to do 'anything', absolutely anything for their patient...they spread the sheets, they complain about leaking iv lines, about dead iv fluid bottles and about suctioning not being done well enough....and ithey are willing too, to get the ABG reports at 2 : 40 in the morning, and show it to the sleep infested doctor on duty...
Equations change...with time, the zeal to do 'anything, absolutely anything' is tested by roughly 5 visits to the pharmacy, 15 visits to the emergency lab, position change, suctioning ( an act, the responsibility of which which by now the doctor has relinquished on the attendants), and not to mention that occasional outburst from their screwed up doctor, who in an attempt to overshadow her own irate temperament at seeing that unmoving body day after day without any progress, or deterioration, and having told their attendants roughly 900 times she wont make it, decides to unleash her anger in more unscrupulous ways....She gives them a BGA at 3 20 in the morning, asking them to collect the report and show it to her in the morning..and watches the attendant bundle past her with shuffling steps on a bitter cold emergency night at Rohtak, a small, dimensionless city in North India....
She (the doctor) changes as well, the lady was a grossly obese 36 year old with 3 kids and a out of job husband...the attendants are, in order of their willingness and love for the patient, respectively the Brother, the Son, and the Bahu. She takes a look at the pallid skin, the toneless chapeless heap into which the body has been confined, the rhythmic swell of her breasts through which the heart sounds seem so faint she confuses if the heart is beating at all....the bed sore on her left butt, that unhealing patch of yellow, red and pink that still doesnt give her fever but that which has festered all this time...She asks about how much they have spent till date on her, and the Son gives a rough estimation: 25,000....with tears in his eyes...
25,000...thats a small number. Going by Haryana's standards, it may even be called negligible, a quick mental mathematics suggests her it could not be so much, with 2 CT Scans and some medications....but there is still a possibility...Her stance softens...She gradually introduces the topic of the famous DOR...Discharge On Request, partly with a guilt ridden heart...She backtracks in the middle...Her ethics don't support her...She once again gives the example of Life support systems and its use in America...She assures the they can, and then, they must take more time to decide....she would tell the medications...the rest in the line of care she would tell them....The guilt pang hits home again...she asks them to stay for 2-3 days more...and walks back to the resident room.
Thirty minutes later, the Brother, the decision maker comes to her...they would leave the next day, he says...she is shaken..'No, no, I don't want you guys to leave, I was only telling this because you guys told me just how difficult it had become to feed your hungry mouths...stay here for as long as you want..' , and then with new found insolence in the voice, talk to my seniors, they will tell you....
40 odd minutes, that dead body, listening to their conversation decides to die...She performs an average CPR, takes an ECG out of a machine that only traces flat lines, and declares her dead...None of the relatives make a sound, they are complying almost, they listen silently to her condolence of how her period of torture was fortunately cut short, they ask to keep the body in the hospital for the night, and they move with lightning efficiency to clear the bed and do the necessary.
The only tears are hastily shed by the son, who then moves on too, and a transport certificate ends that 10 day relationship she and her family had come to establish as the IC Bleed patient that was 'still alive'...
Saturday, December 12, 2009
Jesus!!! Google Chrome sucks!!!
I decided to yet gain tamper with my browser that I decided to give up my Firefox for good and installed Google chrome on my ailing 248 MB RAM Compaq Presario C500. Though Google chrome promises to be faster than Firefox, I was disappointed to see the interface, its simplistic, set in rather large letters that makes you think you are running it in safe mode, doesn't have Google homepage incorporated into it. So that makes the onus of typing in Google every time you want to look something up....And this doesn't suit me who opens browser chiefly for looking things up on the net.
Browser speed is claimed to be fast in Chrome but to be honest I did not find it appealing. I remember using Firefox six years back from Internet Explorer on the insistence of my computer mechanic and falling in love with it the very first time I used it.. Now though we have 8 to 10 browsers all consuming some space in the market, almost none of them are a big departure from the earlier standards. I opened Orkut in Firefox and then in Chrome, it opened in a jiffy in Firefox. Plus the restoring previous sessions option in Firefox is a boon for those unwanted crashes when Firefox stops functioning. Even if a site doesn't open, or Firefox takes some time to load a page, the green rectangles somehow look good at the bottom of the screen. The same cant be said of Chrome. It looks like a single simple web browser with no extra features.
Am now downloading Apple Safari in Chrome and lets see how does it do...Morale of the story...Firefox is powerful, relatively hassle free, fast web browser with very satisfactory download and browser speeds with good anti virus protection and lots of add ons that make viewing, downloading and sharing fun. If you want to change it you should have good reasons for it....
And if you still use Internet Explorer, the next thing you should do is get Firefox....
I decided to yet gain tamper with my browser that I decided to give up my Firefox for good and installed Google chrome on my ailing 248 MB RAM Compaq Presario C500. Though Google chrome promises to be faster than Firefox, I was disappointed to see the interface, its simplistic, set in rather large letters that makes you think you are running it in safe mode, doesn't have Google homepage incorporated into it. So that makes the onus of typing in Google every time you want to look something up....And this doesn't suit me who opens browser chiefly for looking things up on the net.
Browser speed is claimed to be fast in Chrome but to be honest I did not find it appealing. I remember using Firefox six years back from Internet Explorer on the insistence of my computer mechanic and falling in love with it the very first time I used it.. Now though we have 8 to 10 browsers all consuming some space in the market, almost none of them are a big departure from the earlier standards. I opened Orkut in Firefox and then in Chrome, it opened in a jiffy in Firefox. Plus the restoring previous sessions option in Firefox is a boon for those unwanted crashes when Firefox stops functioning. Even if a site doesn't open, or Firefox takes some time to load a page, the green rectangles somehow look good at the bottom of the screen. The same cant be said of Chrome. It looks like a single simple web browser with no extra features.
Am now downloading Apple Safari in Chrome and lets see how does it do...Morale of the story...Firefox is powerful, relatively hassle free, fast web browser with very satisfactory download and browser speeds with good anti virus protection and lots of add ons that make viewing, downloading and sharing fun. If you want to change it you should have good reasons for it....
And if you still use Internet Explorer, the next thing you should do is get Firefox....
Wednesday, December 9, 2009
Indian Point Of View....
Having a hands on experience for the last 6 months in one of the busiest hospitals in the country, and one where the cost to benefit ratio for a patient would be undoubtedly be pegged the most favourable, the experience of working under the Haryana Government Post Graduate Institute of Medical Sciences has been both rewarding and frustrating. And the virtues do outshine the vices.
Foremost is the facilities that Rohtak has included to be given free or at negligible costs. So we have Lab tests like ANA, CRP, D Dimer, FDP, HBA1C, RA Factor, HbF, Osmotic fragility, Coomb's, Trop I, CPK-MB and so on... and to include CDs to be incorporated soon. None of these are done in any state medical college...And are charged every cent even in a college like PGI Chandigarh...To get these tests done here, in the batting of an eye lid, for every single patient, regardless of his/her income, is awesome...The sheer number of patients getting treated and followed up in this manner has been pegged to be the highest in the country, in AIIMS treatment is restricted to a limited number of people, in other state colleges, people are lost to follow up.
In terms of therapeutics, the scene is better. Government servants, be it a Primary school teacher, or a university Professor are given 100% insurance coverage...So we have Multiple Myeloma patients receiving bortezomib every 4th day and a patient of panhypopituitarism receiving somatotropin, not to talk about IFN-gamma, and CSFs and what not occuring on a daily basis. The work that the government is doing in this regard is undoubtedly, commendable and aweinspiring. The amount of traffic in terms of medications procured and dispensed, the system of follow up is easier than a central institute chiefly because the beneficiaries are a state popuation and in terms of a state, Haryana is cosy, small and neatly packaged between Punjab and Delhi...So transport is easier, people are more aware of their rights and status than perhaps any other state. Hence its heartwarming to see patients actually coming with a BPL card and asking the investigations and medications to be made poor free....And, even when these people do come from a BPL background, their affordability VIS A VIS the rest of the country, is quite favourable.
In conclusion, I feel every state machinery, if it functions as efficiently as this one state, could bring about a paradigm shift in the way health care is disbursed in India. I shall deal with it in subsequent articles. To be honest, as of now I am beginning to get my language correct and frame of reference more analytical than emotional....The rest, learning from this set-up where I work presently, upto the point where I shall make the best use of all resources, will be a journey I shall grow wiser with.
Trouble with other state systems is manifold and unique. I am not aware of the functioning of states like Maharastra yet, and what I have heard upto now about the way healthcare functions in Maharastra scores pretty high, though the private system like Seven Seas, Breach Candy and others there yields more power. But when I compare PGIMS, Rohtak with SCBMCP, Cuttack, the diferences loom large and outline for each individual institutes' advantages and disadvantages.
( to be continued....)
Foremost is the facilities that Rohtak has included to be given free or at negligible costs. So we have Lab tests like ANA, CRP, D Dimer, FDP, HBA1C, RA Factor, HbF, Osmotic fragility, Coomb's, Trop I, CPK-MB and so on... and to include CDs to be incorporated soon. None of these are done in any state medical college...And are charged every cent even in a college like PGI Chandigarh...To get these tests done here, in the batting of an eye lid, for every single patient, regardless of his/her income, is awesome...The sheer number of patients getting treated and followed up in this manner has been pegged to be the highest in the country, in AIIMS treatment is restricted to a limited number of people, in other state colleges, people are lost to follow up.
In terms of therapeutics, the scene is better. Government servants, be it a Primary school teacher, or a university Professor are given 100% insurance coverage...So we have Multiple Myeloma patients receiving bortezomib every 4th day and a patient of panhypopituitarism receiving somatotropin, not to talk about IFN-gamma, and CSFs and what not occuring on a daily basis. The work that the government is doing in this regard is undoubtedly, commendable and aweinspiring. The amount of traffic in terms of medications procured and dispensed, the system of follow up is easier than a central institute chiefly because the beneficiaries are a state popuation and in terms of a state, Haryana is cosy, small and neatly packaged between Punjab and Delhi...So transport is easier, people are more aware of their rights and status than perhaps any other state. Hence its heartwarming to see patients actually coming with a BPL card and asking the investigations and medications to be made poor free....And, even when these people do come from a BPL background, their affordability VIS A VIS the rest of the country, is quite favourable.
In conclusion, I feel every state machinery, if it functions as efficiently as this one state, could bring about a paradigm shift in the way health care is disbursed in India. I shall deal with it in subsequent articles. To be honest, as of now I am beginning to get my language correct and frame of reference more analytical than emotional....The rest, learning from this set-up where I work presently, upto the point where I shall make the best use of all resources, will be a journey I shall grow wiser with.
Trouble with other state systems is manifold and unique. I am not aware of the functioning of states like Maharastra yet, and what I have heard upto now about the way healthcare functions in Maharastra scores pretty high, though the private system like Seven Seas, Breach Candy and others there yields more power. But when I compare PGIMS, Rohtak with SCBMCP, Cuttack, the diferences loom large and outline for each individual institutes' advantages and disadvantages.
( to be continued....)
Saturday, December 5, 2009
I AM
A woman....in every sense of the word.
Out of plans for life, where its gonna take me, whats gonna become...
Someone who has dualities in everything...I contradict myself the self same way I convince myself...
Not aspiring to be the best doctor on this planet, I merely want to do good work and save some lives when everything else seems to fail.
Tired of Hindi movies with mindless plots involving drop dead gorgeous male and female stars...give them a chance....
Still crying at the softest movie spots with a little bit of emotion...(so I dont watch good movies with other people, I watch them alone)
Planning to stay sane.
Have been and perhaps will be, always hopeless and hopelessly in Love.
A survivor. I have come out of it...yes...if not with flying colours, then not with a pallid face either..
Planning to be a great cook...
Hoping that one day I will be able to type with 10 fingers without having to look down at the keyboard....
Hoping that if I stay single all my life, at least I dont become bitter like all those loony women I have seen.
Hoping I will end up not so bad.
Hoping I will write a book...2 books or more actually...some on academics, and only one personal that I hope I will publish before I die, not caring whether it sells or not...
Collecting ecgs and hoping I learn to read those lines decently well...
Hoping that I go all over India, with a nice companion, and take a lot of time out...not in a pricey way but just like average normal people go about....
Learn to read fundus, MRI, CT Scan and ECG.
Hoping that even if I may not fall in love again, I should not make others think Love doesn't exist.
Hoping someday to be a mother.
Hoping to start a helpline or web page to tackle some health related issue on a regular basis.
Hoping to lose all those flab I have gained.
Hoping to be fit at forty.
Hoping to be there for my momma and dad when the time really comes for it...Lotsa times, life doesn't give you that much time.
Planning to own a Blackberry in the next 5 years.
Build a web site in the next 3 years....
Collect medical trivia...
Read all the computer books I have collected...
Learn to make chocolate-rum cake....
Watch meaningful cinema...not movies...
Stop watching every Hindi movie for time-pass...write instead...
Go to meet those very few people I did not meet when it was needed...
Have nil expectations from others....
Have nil expectation from life....
Learn to play the Hotel California on a Spanish...
Get a second hand car and learn to ride it before I stash it for a good, clean new one.
Own a golden haired Labrador....Call him Lui, again.
Hoping to be able to appreciate Bach and Subbulaxmi the same way as I do, Pink Floyd, or Kishore.
Planning not to burn down this blog again..but write better articles....
Dedicate this blog to the same child with a yellow t-shirt and black glasses on.
Hoping I am not wrong in thinking that if a person is right, he/she always ends up well...
Only hoping that all the time there is to be had, once its been had, I should still be smiling at the end of it...
Yes, I am
Me.
Out of plans for life, where its gonna take me, whats gonna become...
Someone who has dualities in everything...I contradict myself the self same way I convince myself...
Not aspiring to be the best doctor on this planet, I merely want to do good work and save some lives when everything else seems to fail.
Tired of Hindi movies with mindless plots involving drop dead gorgeous male and female stars...give them a chance....
Still crying at the softest movie spots with a little bit of emotion...(so I dont watch good movies with other people, I watch them alone)
Planning to stay sane.
Have been and perhaps will be, always hopeless and hopelessly in Love.
A survivor. I have come out of it...yes...if not with flying colours, then not with a pallid face either..
Planning to be a great cook...
Hoping that one day I will be able to type with 10 fingers without having to look down at the keyboard....
Hoping that if I stay single all my life, at least I dont become bitter like all those loony women I have seen.
Hoping I will end up not so bad.
Hoping I will write a book...2 books or more actually...some on academics, and only one personal that I hope I will publish before I die, not caring whether it sells or not...
Collecting ecgs and hoping I learn to read those lines decently well...
Hoping that I go all over India, with a nice companion, and take a lot of time out...not in a pricey way but just like average normal people go about....
Learn to read fundus, MRI, CT Scan and ECG.
Hoping that even if I may not fall in love again, I should not make others think Love doesn't exist.
Hoping someday to be a mother.
Hoping to start a helpline or web page to tackle some health related issue on a regular basis.
Hoping to lose all those flab I have gained.
Hoping to be fit at forty.
Hoping to be there for my momma and dad when the time really comes for it...Lotsa times, life doesn't give you that much time.
Planning to own a Blackberry in the next 5 years.
Build a web site in the next 3 years....
Collect medical trivia...
Read all the computer books I have collected...
Learn to make chocolate-rum cake....
Watch meaningful cinema...not movies...
Stop watching every Hindi movie for time-pass...write instead...
Go to meet those very few people I did not meet when it was needed...
Have nil expectations from others....
Have nil expectation from life....
Learn to play the Hotel California on a Spanish...
Get a second hand car and learn to ride it before I stash it for a good, clean new one.
Own a golden haired Labrador....Call him Lui, again.
Hoping to be able to appreciate Bach and Subbulaxmi the same way as I do, Pink Floyd, or Kishore.
Planning not to burn down this blog again..but write better articles....
Dedicate this blog to the same child with a yellow t-shirt and black glasses on.
Hoping I am not wrong in thinking that if a person is right, he/she always ends up well...
Only hoping that all the time there is to be had, once its been had, I should still be smiling at the end of it...
Yes, I am
Me.
Always...
What is it about relationships that don't last ? A lot think in the protocol mode of starting on with a new one to save one self from the sorrow of the one that did not work out...but to be honest, does it work that ways?
Any of the relations that i have been through..friendships, love, partnerships, which did not turn out quite the way I would have liked them to, each have seemed to have taken away a piece of my soul with them when they went...I ascribe every single one of them to be unique in their own ways, though not completing me, yet in that moment while they lasted, they almost neared that definition...so that, now that when I don't have them, I feel a lot of those lumps having been taken away from me....
But that doesn't make me a bitter individual..only it makes me more cautious...
Thing is, I still think it is better to be bitter...the soft underbelly persists in that person but is somewhat dead in one who never prepares to trust another person or accord another individual the same status in her/his life as the previous ones where he/she was so unjustifiably not requited.
Any of the relations that i have been through..friendships, love, partnerships, which did not turn out quite the way I would have liked them to, each have seemed to have taken away a piece of my soul with them when they went...I ascribe every single one of them to be unique in their own ways, though not completing me, yet in that moment while they lasted, they almost neared that definition...so that, now that when I don't have them, I feel a lot of those lumps having been taken away from me....
But that doesn't make me a bitter individual..only it makes me more cautious...
Thing is, I still think it is better to be bitter...the soft underbelly persists in that person but is somewhat dead in one who never prepares to trust another person or accord another individual the same status in her/his life as the previous ones where he/she was so unjustifiably not requited.
Tuesday, December 1, 2009
Tomorrow you will be free
I have begun to fear these words more than anything now.my morbidity tracker shot up through the sky and sailed in free air on its way to glory as I entered my 4th month of residency in Unit 10/II, the most feared of all units because of the Godzilla of a Unit Head it has. True, I did not take up the Male Emergency cabin any single day, but to be honest there was no such thing as a male emergency cabin.....sick patients were every where, and that one month, we had more people coming with CVA's than anything else. To my credit, I handled 80 percent of all the deaths in that unit that month.....
And every single CVA patient who had come, and trust me these are so difficult to give nursing care to, with bed sores and thrombophlebtis...was taking a toll. I remember this one female with a large IC bleed in her Right Frontotemporoparietal region, with a midline shift of 1.8 com to her left who somehow managed to open her eyes and accept food....I looked after her day and night, and her 2 sisters and mother were very cooperative as well. To the point that she was even managing to do some active physiotherapy herself. I was happy with the result..I hadn't seen so many managing to so much as breathe properly on their own with an IC bleed.
Life was hectic those days, I used to reach ward before 8 in the morning, and it would be often that I would return after dinner to work there till 12 in the night as well. Somehow, she went through the first week and though her thrombophlebitis was beginning to show, her vitals remained stable and she was passing stool normally. Slowly that week dragged on and I had a crazy night at emergency with over 37 admissions...The next week it wasn't possible to be ther everytime her sister called me. Often, I would tell her that I would come but then go away as something or the other always kept me. They did not complain much, seeing how busy we always were. She started runinng a brief fever but that went down after sometime...I honestly did not think too much about it.
On her 14 th day of admission, Professor finally decided to discharge her withh advice for physiotherapy and follow up. That night, I told her sisters " Tomorrow you will be free." Her sister asked me some trivial question about her ryles tube and I came back, not paying much attention.
Next day morning, with packed bags, she arrested.
Bottomline is: How many IC Bleeds can actually make it? I havent yet managed to find time to go through the literature. Neurosurgeons had ruled out any surgical intervention as a possibility. She had extensions into the ventricles as well. Then apart from Decongestants and Physiotherapy is there no other treatment for these people?
None of the IC bleeds I have seen so far has survived. They always collapsed. And it totally saps the energy of the resident managing them because they take so much time, planning fluids and ensuring physiotherapy and that terrible smell of unclean mouths....
Lesson of the day: Never encourage attendants into believing the patient will be back to normal. In our setting, with our pitiable nursing care, and limited resourses for personalized care, where the resident doctor has bags under his/her eyes catering to these people, its more sensible to keep watching without commenting much on future aspects.
And every single CVA patient who had come, and trust me these are so difficult to give nursing care to, with bed sores and thrombophlebtis...was taking a toll. I remember this one female with a large IC bleed in her Right Frontotemporoparietal region, with a midline shift of 1.8 com to her left who somehow managed to open her eyes and accept food....I looked after her day and night, and her 2 sisters and mother were very cooperative as well. To the point that she was even managing to do some active physiotherapy herself. I was happy with the result..I hadn't seen so many managing to so much as breathe properly on their own with an IC bleed.
Life was hectic those days, I used to reach ward before 8 in the morning, and it would be often that I would return after dinner to work there till 12 in the night as well. Somehow, she went through the first week and though her thrombophlebitis was beginning to show, her vitals remained stable and she was passing stool normally. Slowly that week dragged on and I had a crazy night at emergency with over 37 admissions...The next week it wasn't possible to be ther everytime her sister called me. Often, I would tell her that I would come but then go away as something or the other always kept me. They did not complain much, seeing how busy we always were. She started runinng a brief fever but that went down after sometime...I honestly did not think too much about it.
On her 14 th day of admission, Professor finally decided to discharge her withh advice for physiotherapy and follow up. That night, I told her sisters " Tomorrow you will be free." Her sister asked me some trivial question about her ryles tube and I came back, not paying much attention.
Next day morning, with packed bags, she arrested.
Bottomline is: How many IC Bleeds can actually make it? I havent yet managed to find time to go through the literature. Neurosurgeons had ruled out any surgical intervention as a possibility. She had extensions into the ventricles as well. Then apart from Decongestants and Physiotherapy is there no other treatment for these people?
None of the IC bleeds I have seen so far has survived. They always collapsed. And it totally saps the energy of the resident managing them because they take so much time, planning fluids and ensuring physiotherapy and that terrible smell of unclean mouths....
Lesson of the day: Never encourage attendants into believing the patient will be back to normal. In our setting, with our pitiable nursing care, and limited resourses for personalized care, where the resident doctor has bags under his/her eyes catering to these people, its more sensible to keep watching without commenting much on future aspects.
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