When you write a paper and publish it but find the same thing and the same treatment has been published years before with the same taglines almost.
My professor is a very sad man. None of our papers are getting published either because the stuff we are reporting is outdated or because of insufficient reports or workup, or because we are speaking the truth and not putting in too much fabrication. Plus with his penchant for speed I have a feeling, we are lacking out on content ( thats a personal opinion). Hence, our papers are going everywhere and coming back.
I have taken one case report but I am sitting on it for the time being. And collecting all things I can get on it for free. Once I am done with it, I will perhaps realize that there is not much new to report in this case. The condition is at least diagnosed, and very few have been reported so far. Hence, I will perhaps try not to do what Indians do best, collate stuff and then twist the truth to arrive at a conclusion.
Summarily expresses what some of my old colleagues used to say when I was at AIIMS. So much fund being given for research, AIIMS has virtually produced no meaningful research in the last 50 years since its inception.
When AIIMS could not do that, what can we say about PGIMS?
Lol.
Monday, May 31, 2010
Saturday, May 29, 2010
I wonder if it is the same for everyone. I am so drained when I come from the Emergency. Life is like an empty blur and I feel sapped of life and energy. Sometimes the days are good, sometimes the days are not so good. Today there were 4 casualty deaths. For some inexplicable reason there is a sinking feeling coming from somewhere deep within me. I have narrowed down the choices to one or two. But I have no clue. This used to happen some time back. But for quite some time now it had gone. A claustrophobia of sorts. That was most evident when I intubated the patient wrongly. Dr B came and put it right. No one had attended the patient since the day. And since she was an old case Koch's with Cor Pulmonale, nothing much could be done apparently. I tried intubating her twice. But each time it went into the oesophagus. By the time Dr B came, she was long since gone.
There was another death with a CVA, one with poisoning, one with something else I don't remember. Walking back was a drag. As if something is going to happen. But I just can't put my hands on it what it is. Maybe its the pre 28 year old phenomenon I am feeling. Its in my bones. Starts from today.
Convincing yourself about the choices you make is not a difficult thing to do. But sticking on to the promise is the most trying part. I am just letting myself sip it in. Gradually I will think about this and choose what I must.
Reading up on ECGs and stuff from today. I leave for home on 11th June. Before that I plan to finish Hashimoto's Encephalopathy and CVT. A lot of time has gone by. Getting back on track will take time. Lets hope for the best.
There was another death with a CVA, one with poisoning, one with something else I don't remember. Walking back was a drag. As if something is going to happen. But I just can't put my hands on it what it is. Maybe its the pre 28 year old phenomenon I am feeling. Its in my bones. Starts from today.
Convincing yourself about the choices you make is not a difficult thing to do. But sticking on to the promise is the most trying part. I am just letting myself sip it in. Gradually I will think about this and choose what I must.
Reading up on ECGs and stuff from today. I leave for home on 11th June. Before that I plan to finish Hashimoto's Encephalopathy and CVT. A lot of time has gone by. Getting back on track will take time. Lets hope for the best.
Friday, May 28, 2010
Random Jottings....
I start from you
from the morning of the last
until the dusk of the first.
From the haze of the barren clouds
that sift over salty shores.
To move over the wet rocks,
upon a light house,
with a broken beacon,
a limp falcon
flying above a prey,
clawing with
ineffective snatches, the time
that went by, when
the weather was good.
and things then stood
and she stood by
till a point in magenta
by a dusty sink
disappeared into the
democracies of jobs,
sobs, subjects, choices.
And stood there by
a mahogany table,
half cracked open, by its owner
while she walked
with sores on her feet,
her blood's fate sealed at a number
and the shadows watched
as the times happily
disappeared by.
'Happy Birthday' spoken
into the phone awaiting a response
from behind a wooden door
long since shut.
twenty and eight
Stay happy and tight.
with choices that were never difficult
to make
over causes that one
could not take.
And questions that were
best left unanswered.
from the morning of the last
until the dusk of the first.
From the haze of the barren clouds
that sift over salty shores.
To move over the wet rocks,
upon a light house,
with a broken beacon,
a limp falcon
flying above a prey,
clawing with
ineffective snatches, the time
that went by, when
the weather was good.
and things then stood
and she stood by
till a point in magenta
by a dusty sink
disappeared into the
democracies of jobs,
sobs, subjects, choices.
And stood there by
a mahogany table,
half cracked open, by its owner
while she walked
with sores on her feet,
her blood's fate sealed at a number
and the shadows watched
as the times happily
disappeared by.
'Happy Birthday' spoken
into the phone awaiting a response
from behind a wooden door
long since shut.
twenty and eight
Stay happy and tight.
with choices that were never difficult
to make
over causes that one
could not take.
And questions that were
best left unanswered.
Thursday, May 27, 2010
GOPAL - II
Today that old patient of mine I wrote about last month came walking to me.
You can read about him here
I am happy for this man as much as I can be. And I feel as proud of this man as much as I can allow myself to be. And this makes me promise to myself not to waste time on things and people who will never give you a chance in life, or understand your motives or intentions. 3 odd months back, we had an alcoholic who had seizures persistently who we took to be Rum Fits. Associated with an undeniable unconscious urge to let these patients be, we offered him the usual for delirium tremens. Somehow, somewhere, he did not recover and was transferred from bed 13 to bed 49 and given more than a cautionary glance than subconsciously reserved for these people. Somehow somewhere, it did not look like he had an ordinary problem most young alcoholics face. We did a CT Scan. Big Subarachnoid hemorrhage..and something something more... Something was missing. My SR Dr P suggested we start him on Low Molecular Heparin despite there being a hemorrhage. We got a MR Venography done. His CT Scan and MRI concurred. He had those bleeds with infarcts spread over 70 odd percent of his brain area dotting it like full cherries on a cake. He had loss of flow void in the sagittal veins and an empty delta sign. Diagnosis: Cortical Vein Thrombosis. To see it with alcohol was a rare condition. Only 3 patients have been reported so far the world over. Why he had it, what predisposing factors he had to have it, we havent managed to find any.
He was bed ridden, aspirated, fetid bed sores oozing serum from all over his body. I dare say he was being treated correctly but not being looked after correctly. His mother was a woman who would not listen to any advice. We have no nursing care in our hospital. Its not possible, to have them, with the number of admissions and the precarious work distribution we have. That was when I took over. I am not bragging about my achievement but I just want to say that proper instruction to attendants about basic hygiene and physiotherapy...these two are cornerstones of management of any neurosurgical patient. Life and Haryana have hardened me into an indomitable woman, unafraid of anything. I went after the parents, his pyorrhoea I ensured went with at least two Listerine scrubbings. I howled at the mother when she fed him water without lifting his head up increasing chances of aspiration, took care so he did not smell of pee that he did despite the catheter.Mostly i shouted at his parents, day in and day out. I could not do these things, looking after 20 odd patients lying any time. So I made sure my 'orders were obeyed'. In short, I did become what I hate being called the most...A Sister...the Staff Nurse. And a most angry one at that. Fortunately his parents got scared and did what I tole them to do. He would lie for days on one side of his body being able to move nothing but his mouth and eyes. His hands were clasped tight, and he almost always had his wrists clenched.
He recovered. His bed sores stopped oozing and started to dry. He stopped passing loose stools that continuously soiled his undersides. I remember the way I used to ask him everyday if he could move his hand. He used to sat Tch Tch in a way I cannot forget. There was a dogged way about him, a different light in his eyes. I never asked why he went binge drinking for three continuous days at a friend's marriage party. Earlier, he drank almost everyday. But he did not smoke. His father was a very docile man who was literally bent twice from the burden of his son's disease. He always had a sad smile on his face. His mother graduated, under my rather uncomfortable and voluble appraisals of her inefficiency as a mother to someone who started on his physiotherapy vigorously.
Last time I wrote that previous blog he continued to lie down in bed and was massaged by his entire family all the time. I asked him if he could sit. He said no. I ordered him to sit. Slowly he sat for the first time which you can see in that picture I took of him. That was the first time he sat in three months he said. I asked him why he did not do it earlier. To which he said he did not do it because no one had ordered him to sit so far.
What have I become.
Yesterday he came walking to the OPD. Meanwhile his father during the process of taking care of him suffered a left basal ganglia bleed. And barely recognizes his son he used to look after. But Gopal came walking in full glory today. He is a handsome man, with a beautiful daughter. And very very proud. Something about him doesn't look ordinary, commonplace. I don't know what it is. He doesn't drink anymore, and is about to start work as a photographer. His mother came upto me and ran her hands on my head blessing me yesterday.
I will take his snap next time to show what a remarkable man he has become. I am not talking about a case of Cortical venous Thrombosis we are trying to get published with minimal homework and preparation. I am talking about the human effort and kindness. About faith and hope, and how such lives get transformed after a tragedy if taken in the right way.
With Gopal, I learn few things. And one saying by Einstein rings loudest in my ears. I am clueless what sort of a person I will become tomorrow, especially with the iron fist I am developing sans any feminine streak, almost like a man. But I hope I will at least preserve the humanity in me. And that I become a good doctor. That is the most I will be happy with.
The secret to happiness lies in attaching oneself to something, not someone.
You can read about him here
I am happy for this man as much as I can be. And I feel as proud of this man as much as I can allow myself to be. And this makes me promise to myself not to waste time on things and people who will never give you a chance in life, or understand your motives or intentions. 3 odd months back, we had an alcoholic who had seizures persistently who we took to be Rum Fits. Associated with an undeniable unconscious urge to let these patients be, we offered him the usual for delirium tremens. Somehow, somewhere, he did not recover and was transferred from bed 13 to bed 49 and given more than a cautionary glance than subconsciously reserved for these people. Somehow somewhere, it did not look like he had an ordinary problem most young alcoholics face. We did a CT Scan. Big Subarachnoid hemorrhage..and something something more... Something was missing. My SR Dr P suggested we start him on Low Molecular Heparin despite there being a hemorrhage. We got a MR Venography done. His CT Scan and MRI concurred. He had those bleeds with infarcts spread over 70 odd percent of his brain area dotting it like full cherries on a cake. He had loss of flow void in the sagittal veins and an empty delta sign. Diagnosis: Cortical Vein Thrombosis. To see it with alcohol was a rare condition. Only 3 patients have been reported so far the world over. Why he had it, what predisposing factors he had to have it, we havent managed to find any.
He was bed ridden, aspirated, fetid bed sores oozing serum from all over his body. I dare say he was being treated correctly but not being looked after correctly. His mother was a woman who would not listen to any advice. We have no nursing care in our hospital. Its not possible, to have them, with the number of admissions and the precarious work distribution we have. That was when I took over. I am not bragging about my achievement but I just want to say that proper instruction to attendants about basic hygiene and physiotherapy...these two are cornerstones of management of any neurosurgical patient. Life and Haryana have hardened me into an indomitable woman, unafraid of anything. I went after the parents, his pyorrhoea I ensured went with at least two Listerine scrubbings. I howled at the mother when she fed him water without lifting his head up increasing chances of aspiration, took care so he did not smell of pee that he did despite the catheter.Mostly i shouted at his parents, day in and day out. I could not do these things, looking after 20 odd patients lying any time. So I made sure my 'orders were obeyed'. In short, I did become what I hate being called the most...A Sister...the Staff Nurse. And a most angry one at that. Fortunately his parents got scared and did what I tole them to do. He would lie for days on one side of his body being able to move nothing but his mouth and eyes. His hands were clasped tight, and he almost always had his wrists clenched.
He recovered. His bed sores stopped oozing and started to dry. He stopped passing loose stools that continuously soiled his undersides. I remember the way I used to ask him everyday if he could move his hand. He used to sat Tch Tch in a way I cannot forget. There was a dogged way about him, a different light in his eyes. I never asked why he went binge drinking for three continuous days at a friend's marriage party. Earlier, he drank almost everyday. But he did not smoke. His father was a very docile man who was literally bent twice from the burden of his son's disease. He always had a sad smile on his face. His mother graduated, under my rather uncomfortable and voluble appraisals of her inefficiency as a mother to someone who started on his physiotherapy vigorously.
Last time I wrote that previous blog he continued to lie down in bed and was massaged by his entire family all the time. I asked him if he could sit. He said no. I ordered him to sit. Slowly he sat for the first time which you can see in that picture I took of him. That was the first time he sat in three months he said. I asked him why he did not do it earlier. To which he said he did not do it because no one had ordered him to sit so far.
What have I become.
Yesterday he came walking to the OPD. Meanwhile his father during the process of taking care of him suffered a left basal ganglia bleed. And barely recognizes his son he used to look after. But Gopal came walking in full glory today. He is a handsome man, with a beautiful daughter. And very very proud. Something about him doesn't look ordinary, commonplace. I don't know what it is. He doesn't drink anymore, and is about to start work as a photographer. His mother came upto me and ran her hands on my head blessing me yesterday.
I will take his snap next time to show what a remarkable man he has become. I am not talking about a case of Cortical venous Thrombosis we are trying to get published with minimal homework and preparation. I am talking about the human effort and kindness. About faith and hope, and how such lives get transformed after a tragedy if taken in the right way.
With Gopal, I learn few things. And one saying by Einstein rings loudest in my ears. I am clueless what sort of a person I will become tomorrow, especially with the iron fist I am developing sans any feminine streak, almost like a man. But I hope I will at least preserve the humanity in me. And that I become a good doctor. That is the most I will be happy with.
The secret to happiness lies in attaching oneself to something, not someone.
Monday, May 24, 2010
Starting Rotation
We got together to start the Rotation. By a stroke of luck when 7 of us gather inside the HOD's office, in comes in most daring and my most lauded of them all. Proff D. That made things half as easier. He changes the air around him when he comes in. And most of all, he is not scared.
The worst part is the thesis. How to complete and when to submit. We have been asked to submit a roster on how to do it. I hope we do it.
If this does not pull through, we are even then going to get rotated in ICU. Thats an understanding between Proff D and my Proff H, childhood friends, buddies. Its heartening to just see these two walk together in the campus. You get a feeling all is well. Even when they bicker about a case.
No second thoughts. Will visit Cuttack to finish a chapter. And come back and start a new life.
I hope I have the physical stamina to match it. And the capacity to block certain things out of my life. I am a doctor. It would be enough for me to be able to do justification to just that.
The worst part is the thesis. How to complete and when to submit. We have been asked to submit a roster on how to do it. I hope we do it.
If this does not pull through, we are even then going to get rotated in ICU. Thats an understanding between Proff D and my Proff H, childhood friends, buddies. Its heartening to just see these two walk together in the campus. You get a feeling all is well. Even when they bicker about a case.
No second thoughts. Will visit Cuttack to finish a chapter. And come back and start a new life.
I hope I have the physical stamina to match it. And the capacity to block certain things out of my life. I am a doctor. It would be enough for me to be able to do justification to just that.
Saturday, May 22, 2010
Start...Turn Off...Shutting Down....
How easy it must have been,
to keep a promise, to hide
under the veiled attempts of humor,
the tears inside.
I sleep-wake-work-sleep
in an endless loop, the insides of that blackened
hearth, in a damp swamp,
of disgust, of hope all misplaced, misattempts at
claiming that happiness I thought
I deserved.
It takes a second to say,
needlessly,
it wasn't so difficult to forget, or get over.
A dream that we three would be together,
and he will finally say to her,
how much he loved her, treasured her,
yet he ran away, and stayed away.
And she, uremic with happiness,
will draw her knobbed hands, knitting
sweaters for laborers, baskets for
orphans,
will draw that semi orphan,that rickety
chap into her parched bosom.
And things would be in a shape,
neither too happy, nor too sad,
but just okay, when she would herself return,
limping from Work, she would find him sitting
and thinking,
And he would look up and smile,
and a thousand fireflies would light
the room, filled with dark secrets of the night.
Till the rains of that overdunged,
underdrained city will drown,
every tear, every fear, into a heap of
rotten river marsh,
which she buried her head into,
when he had asked her,
if she felt like killing herself
because of him,
like his mother.
And she could not explain, why this
why that. She would wait, she thought
For time to come.
It never did.
There was always a Dad.
A lifetime, of not fitting into,
anything else, because, for her,
there was a situation, she
couldn't explain, couldn't fight
until the night when she bent her head,
at the altar of The Over.
Bent her shadow, that she had left
to hover over that luckless widow,
and her lonely son,
and she took it and put it into
her wretched soul,
to be slammed down to 'tiresome'
in the name of propriety.
Because, now
the swallows had flown, taken a new look
of Sky Blue skins rubbing across,
a grey western shore...claiming
dreams to be shined, on the altar of
The Forever.
to keep a promise, to hide
under the veiled attempts of humor,
the tears inside.
I sleep-wake-work-sleep
in an endless loop, the insides of that blackened
hearth, in a damp swamp,
of disgust, of hope all misplaced, misattempts at
claiming that happiness I thought
I deserved.
It takes a second to say,
needlessly,
it wasn't so difficult to forget, or get over.
A dream that we three would be together,
and he will finally say to her,
how much he loved her, treasured her,
yet he ran away, and stayed away.
And she, uremic with happiness,
will draw her knobbed hands, knitting
sweaters for laborers, baskets for
orphans,
will draw that semi orphan,that rickety
chap into her parched bosom.
And things would be in a shape,
neither too happy, nor too sad,
but just okay, when she would herself return,
limping from Work, she would find him sitting
and thinking,
And he would look up and smile,
and a thousand fireflies would light
the room, filled with dark secrets of the night.
Till the rains of that overdunged,
underdrained city will drown,
every tear, every fear, into a heap of
rotten river marsh,
which she buried her head into,
when he had asked her,
if she felt like killing herself
because of him,
like his mother.
And she could not explain, why this
why that. She would wait, she thought
For time to come.
It never did.
There was always a Dad.
A lifetime, of not fitting into,
anything else, because, for her,
there was a situation, she
couldn't explain, couldn't fight
until the night when she bent her head,
at the altar of The Over.
Bent her shadow, that she had left
to hover over that luckless widow,
and her lonely son,
and she took it and put it into
her wretched soul,
to be slammed down to 'tiresome'
in the name of propriety.
Because, now
the swallows had flown, taken a new look
of Sky Blue skins rubbing across,
a grey western shore...claiming
dreams to be shined, on the altar of
The Forever.
Thursday, May 20, 2010
For Whom The Bell Doesn't toll....
Endless bickering with staff, doctors and the 'System'. For a moment when I get these people I treat for sometime in a flashback, I wonder what I have been doing. I am not saying I do more, but I give all the percentage of my capacity to my job. I am passionate about a proper and systematic workup, and months of doing Emergency duty have now taught me some rude truths about Indian System of Medicine. But I am not going to speak about that now. I want to talk about the 'Me' that has sunk down somewhere behind the 'Madam' and 'Docsaab' business.
When I work for whatever length of time, and I return, I don't know but I am drained. Not physically but mentally. The hagglings behind a family who decide to do nothing about a sick child, the Blood Bank attendant refusing to give blood to 'Non emergency patients'...the typical example of who sent that day were 2 patients with Refractory Heart Failure secondary to severe Anemia, a patient who had to be dialyzed the next day...and a patient of Hydrocephalus to be operated the next day. I was picking cudgels against a 50 year old man at the other end of the line talking in a tone my friends would never know existed in me. Thats normally the aggressive animal i turn into when I treat patients. I am fast, swift, but angry. And sometimes its required to keep attendants on their toes. Whatever.
After threatening these people of things like sending a written complaint forwarded by my Professor ( I use his name unabashedly in places like this where I feel a moral code of conduct is violated...I don't know if he would approve...but that day all 4 of them got their BTs..I was feeling almost physically abusive towards the doctor who denied Blood transfusions to these patients saying Blood Bank had issued precise instructions not to do 'Routine' Blood Transfusions after 2 pm. I asked that man to define what 'Routine Blood Transfusions meant' and was it similar to the 'Routine urine and Blood examinations that were done in Central Laboratory'. He kept blabbering. I told him the precise indications of all 4 patients for whom I had requisitioned a B.T. And then I asked him to point out which one he thought was routine. He started about telling how the new Dr in Charge of the Blood bank was the one to decide this and now that she had gone out to the emergency and could not receive a call so that the onus of everything fell on him. Next I asked him with all the anger that was bursting through my lungs.
'What is your name uncle ji? I will personally come to visit you and Dr N in thirty minutes with a letter from my Professor.'
'Madamji, send the requisitions again. I will see what I can do about them'
In 2 hours, all my patients had BTs and were as usual bickering with the sisters about the drop count.'
Life is that pathetic here. And it takes someone to pick up the cudgel to show these people to be aware if not at least be sensitive to the needs of such a population that comes under our care. And I tell you...its not easy. You go too far with this anger bubbling in your veins and you are more likely than not to have someone coming at you. You have to stay careful of these people.
Change in this group of people is not possible from bringing it about within them. Because its nearly impossible to be that sharp and beat so many people taking an aim at you. Change can more rationally be bought by being above them, ad being withing them. Something like the 'chadmavesh' the incognito principle of all kings in the past. But I am not sure if principles remain the same once you reach up there. The higher you go, the tighter the snare gets.
I love that pounding thing in my head when I manage to bring these ridiculous fools to their knees. But what saddens me is that I am speaking to a 50 year old man who is tied by a similar snare, though from a difficult angle. I would have no personal enmity with him. But I would always remember his voice. And he would always remember my name. I hate myself then, for what we become to bring about some change.
I am drained by these conflicts. When I walk home I am usually happy about some patient or the other. I don't know if the picture I am projecting is that of a dictator. My Professor is just the opposite. And he doesn't know how I am cleaning the system under him. I don't know if he will approve. I am quite clear that only those people who cannot do without an admission on an emergency day will be admitted. A cent-percent diagnosis in at least 80 percent is my target. More importantly, a 70 percent full treatment. No fuss treatment, rigid adherence to therapy. Almost disciplined. ( What a pity none of my juniors have a good handwriting...I cant tolerate dirty treatment charts...)
What does that make me? What has that made me? And what have I lost in the process of getting this..The answers to this are beyond me. I just promise this to myself. That I will be honest to the core. And fearless. And that no situation should arise when my greed for something will overpower my resolve to act on these lines.
I am striving to make my unit as organized as possible. Some people tend to believe I am against admissions and work up. To a big extent I appreciate intuitive clinical acumen over the test oriented, investigation backed, analytical one. I am also against the idea of mooting for the diagnosis so that by the time we are patting each other's backs over a diagnosis we made, the patent's family have spent every cent of their earning on the tests we order and have none left for treatment. to this extent, I would ask for a B12 challenge with followup rather than an investigation sent for vitB12 and Folic acid to some lab...In any case..we are treating nutritional anemia...My Professor does this wherever he can and its something I will take to my graves.
Dont make the treatment sicker than the disease. And I am ready to go to any extent to safeguard these people when it comes to a situation when people either by commission or omission of an act, do these things that hurts people more than it heals them. Be it as a knack for 'following the trend' or be it to stand up against 'This is the irrefutable diagnosis'. And if I am right ( and that will require acquiring knowledge), I will speak in a similar note of highheadedness to anyone placed anywhere in the system. And be ready to face the consequences.
Similar was a day when I returned home in a happy mood after thinking I had broken the ice with someone. I wont go into details how hectic those 3 hours turned out to be. But basically, my adrenaline was pumping. Checked room, checked computer screen. A mail was staring. With some links on it for writing a thesis plan. " Unless you want to wallow in self pity or slather yourself with the latter, check these links." Later I learnt it was meant to be in humor. But I was not in a mood for it. Maybe the evening had been scheming all along. It brought back some memories. And then everything fell apart. But in the process the vision got clearer...
I am a little surefooted today. I make reasonably good diagnosis. And today I say this that leaving other things apart, if I manage to become even half the doctor I think I should be, I will be happy not to get anything else in my life I have wanted. These people who drain me, this profession that put me on a backfoot every time a chance came where I should have accorded priority to my life, I better get good at this.
Today an incredibly sweet woman hugged me before leaving the Emergency. I was reeling from fatigue from having slept 5 hours in the last 72 hours. My personal life is like the fragments of a shell that has burst, oozing fresh wounds everywhere. Some where then, I did not automatically forward these blessings to the address I normally send them to whenever someone blesses me in a way that I appreciate. I kept that thing to myself. And tried to feel what it feels to be a little selfish about blessings.
And you know, I felt sadder than before.
Maybe I got to think about this 'Wallow' part....
Smiles....
When I work for whatever length of time, and I return, I don't know but I am drained. Not physically but mentally. The hagglings behind a family who decide to do nothing about a sick child, the Blood Bank attendant refusing to give blood to 'Non emergency patients'...the typical example of who sent that day were 2 patients with Refractory Heart Failure secondary to severe Anemia, a patient who had to be dialyzed the next day...and a patient of Hydrocephalus to be operated the next day. I was picking cudgels against a 50 year old man at the other end of the line talking in a tone my friends would never know existed in me. Thats normally the aggressive animal i turn into when I treat patients. I am fast, swift, but angry. And sometimes its required to keep attendants on their toes. Whatever.
After threatening these people of things like sending a written complaint forwarded by my Professor ( I use his name unabashedly in places like this where I feel a moral code of conduct is violated...I don't know if he would approve...but that day all 4 of them got their BTs..I was feeling almost physically abusive towards the doctor who denied Blood transfusions to these patients saying Blood Bank had issued precise instructions not to do 'Routine' Blood Transfusions after 2 pm. I asked that man to define what 'Routine Blood Transfusions meant' and was it similar to the 'Routine urine and Blood examinations that were done in Central Laboratory'. He kept blabbering. I told him the precise indications of all 4 patients for whom I had requisitioned a B.T. And then I asked him to point out which one he thought was routine. He started about telling how the new Dr in Charge of the Blood bank was the one to decide this and now that she had gone out to the emergency and could not receive a call so that the onus of everything fell on him. Next I asked him with all the anger that was bursting through my lungs.
'What is your name uncle ji? I will personally come to visit you and Dr N in thirty minutes with a letter from my Professor.'
'Madamji, send the requisitions again. I will see what I can do about them'
In 2 hours, all my patients had BTs and were as usual bickering with the sisters about the drop count.'
Life is that pathetic here. And it takes someone to pick up the cudgel to show these people to be aware if not at least be sensitive to the needs of such a population that comes under our care. And I tell you...its not easy. You go too far with this anger bubbling in your veins and you are more likely than not to have someone coming at you. You have to stay careful of these people.
Change in this group of people is not possible from bringing it about within them. Because its nearly impossible to be that sharp and beat so many people taking an aim at you. Change can more rationally be bought by being above them, ad being withing them. Something like the 'chadmavesh' the incognito principle of all kings in the past. But I am not sure if principles remain the same once you reach up there. The higher you go, the tighter the snare gets.
I love that pounding thing in my head when I manage to bring these ridiculous fools to their knees. But what saddens me is that I am speaking to a 50 year old man who is tied by a similar snare, though from a difficult angle. I would have no personal enmity with him. But I would always remember his voice. And he would always remember my name. I hate myself then, for what we become to bring about some change.
I am drained by these conflicts. When I walk home I am usually happy about some patient or the other. I don't know if the picture I am projecting is that of a dictator. My Professor is just the opposite. And he doesn't know how I am cleaning the system under him. I don't know if he will approve. I am quite clear that only those people who cannot do without an admission on an emergency day will be admitted. A cent-percent diagnosis in at least 80 percent is my target. More importantly, a 70 percent full treatment. No fuss treatment, rigid adherence to therapy. Almost disciplined. ( What a pity none of my juniors have a good handwriting...I cant tolerate dirty treatment charts...)
What does that make me? What has that made me? And what have I lost in the process of getting this..The answers to this are beyond me. I just promise this to myself. That I will be honest to the core. And fearless. And that no situation should arise when my greed for something will overpower my resolve to act on these lines.
I am striving to make my unit as organized as possible. Some people tend to believe I am against admissions and work up. To a big extent I appreciate intuitive clinical acumen over the test oriented, investigation backed, analytical one. I am also against the idea of mooting for the diagnosis so that by the time we are patting each other's backs over a diagnosis we made, the patent's family have spent every cent of their earning on the tests we order and have none left for treatment. to this extent, I would ask for a B12 challenge with followup rather than an investigation sent for vitB12 and Folic acid to some lab...In any case..we are treating nutritional anemia...My Professor does this wherever he can and its something I will take to my graves.
Dont make the treatment sicker than the disease. And I am ready to go to any extent to safeguard these people when it comes to a situation when people either by commission or omission of an act, do these things that hurts people more than it heals them. Be it as a knack for 'following the trend' or be it to stand up against 'This is the irrefutable diagnosis'. And if I am right ( and that will require acquiring knowledge), I will speak in a similar note of highheadedness to anyone placed anywhere in the system. And be ready to face the consequences.
Similar was a day when I returned home in a happy mood after thinking I had broken the ice with someone. I wont go into details how hectic those 3 hours turned out to be. But basically, my adrenaline was pumping. Checked room, checked computer screen. A mail was staring. With some links on it for writing a thesis plan. " Unless you want to wallow in self pity or slather yourself with the latter, check these links." Later I learnt it was meant to be in humor. But I was not in a mood for it. Maybe the evening had been scheming all along. It brought back some memories. And then everything fell apart. But in the process the vision got clearer...
I am a little surefooted today. I make reasonably good diagnosis. And today I say this that leaving other things apart, if I manage to become even half the doctor I think I should be, I will be happy not to get anything else in my life I have wanted. These people who drain me, this profession that put me on a backfoot every time a chance came where I should have accorded priority to my life, I better get good at this.
Today an incredibly sweet woman hugged me before leaving the Emergency. I was reeling from fatigue from having slept 5 hours in the last 72 hours. My personal life is like the fragments of a shell that has burst, oozing fresh wounds everywhere. Some where then, I did not automatically forward these blessings to the address I normally send them to whenever someone blesses me in a way that I appreciate. I kept that thing to myself. And tried to feel what it feels to be a little selfish about blessings.
And you know, I felt sadder than before.
Maybe I got to think about this 'Wallow' part....
Smiles....
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