A Second Diversion...

On Fbook or should it be blogger..I think it will be worthwhile to provide links to the resource available on Net for free, at a place where people can read them..may be i shall tag them on Fbook or share them there....or should I start a second blog with this address? Appendixedmusings seems good enough for that too.....

Lessons

Missed a patient initially come for shortness of breath for the metabolic acidosis part...Even if i have been handling patients for quite some time like this, I will admit I havent come across the scenario when I missed making a diagnosis.

Bicarbonates were persistently coming low. He never gave a history of diabetes and he is an 80 year old man, too well preserved to come up with an initial Diabetic Ketoacidosis. Even if I and A were working together and its beyond doubt we make a super efficient team with our doggedness, we both did not have a time when we had tea before us and did not get time to sip it. Minds were pretty crowded and with the Medicine- Chest and T B story and me being on a backfoot because of the other units LOC rigid admission criteria, we both failed to miss it.

Always, always account for a patients metabolic acidosis. I will never make this mistake again...Because DKA doesnt come with an age tag. Today's 80 year old Bijender just showed that to me.

My first confession will be Sunita...a case of TB Meningitis who was there in my first month of posting. I will not mention the reasons for her death, but I will tell here that I am going to read about this and try to do womething better..She was a beautiful woman, newly married and had a daughter..and when she dies her mother had held on to me long after the others went. That was possibly the first day I had cried in hospital. I could not know she was developing hydrocephalus and her conjugate gaze palsy started and went on until I stopped forcing it on myself that it was not coincidence. Opposite to her was this real marasmic female with TB meningitis and DVT who survived. Suneeta never made it. I met her mother yesterday, and she came and hugged me. Women. They never forget another one they connect with.

And I will mention it when I finish with TB Meningitis. Since then I have seen very few deaths with it, except this one occasion when the man was so down with TB, that he had cutaneous TB, and of course one where we did not give ATT to a patient with SIDS with a near normal CSF..I will get back to you on this...Its a promise.

Thanks to two teachers here I have with me, who I think have faith in me, I am beginning to get my nerve back, along with the unnerved back, and I am back. The wards are beginning to seem once more like Cuttack now.

THE ART OF MEDICINE

I miss the arrogance with which PKD taught...and contrary to what people might otherwise think about me, I want to be humiliated about how less I know and with what I know how underconfident I really am about them. Today, these days, classes and situations are creeping up where that inner feeling inside me like " Ah...I know it, I have read it somewhere", keeps coming at me from time to time. About the inadequacy of our learning, and about the rampant disregard we have for facts in the way we treat. Evidence based Medicine.

When I was in undegraduation, I used to belong to one of those types who knew most answers if not all to most questions thrown at postgraduates in Medicine. And Medicine in my college was good, and we had some of the most arrogantly well read professors in our time. The biggest war after how much money one made in a month was succeeded by how many correct diagnoses one made...and it was like that...except for the excuse of those not being able to get managed being sent to AIIMS. I remember seeing those postgrads sweating and panting, of professors throwing letters and papers in their faces, and then we as undegraduates, and I in particular, with all the theoretical knowledge obtained from all books garnered from amply providing parents and the Internet used to look down upon Post Graduates thinking " How can they not know this ?"

It has turned into that. I have turned into one of those I used to look down upon. I dont have a reason, or maybe I do, but I am not staying put like this. And I will do whatever it takes beyond that point when just " Connecting with people and recognising diseases" is not enough. I have achieved that level. Now I will work with the limited expertise that should come to someone in my position. I am a physician. I will not work like a Dai. No more words, but one day at a time, and I will document deaths, mistakes that happen and as and when they happen. Before I forget to recognize them a second time it happens. Before its too late.

And thanks to one of the teachers I have over here who gives me the confidence that aggressiveness is not bad, as long as you are saying the right thing. I am aggressive no doubt. But I am not confident how right I am. And in all probabilities with whatever limited intellect I have if I work one step at a time, 3 years of post graduation will not be a difficult time. It has not been bad till now. I don't see it often, but a part back home in SCB is still here. And with my own professor giving me the confidence to give the medicine I want to, the freedom to choose, admit and refuse ( okay, none of this last part), I hope what I do makes up for the time I lost i finding my nerve back.

And I will be back with more. God bless the ones here who are trying to make a difference beyond eyewash.

Coming Back to blogger

Lots of things happened.

3-4 months passed, pain subsided, screwed the medicines, overcame the fear, rampaged facebook, slept through Inception, finally nodded at the examination, abused the internet, wrote a paper, was asked for a bribe, faced a confrontation, thoroughly disappointed with an inspiration, got back to books, started yoga, quit it, got a QWERTY keypad phone, met two great friends on social network site, loved qi gong,

Came back to write. Met this awesome blog by Dr S Venkatesan in wordpress by the same name. Amazing the way he writes. I am going to do something similar if possible.

And work harder if i have to pull through it.