Ha Ha

Anaesthesiologist (Age 73 years),  Patient (Age 60 years). Ages of the surgeon, surgical residents and the anaesthesiology resident do not matter

A: Aunty, open your eyes, the surgery is over
No response from "aunty"

After a lot of waiting, and adequate pharmacological reversal of anaesthetic agents we gave up and sent her to the ICU with the tube in....

If I was Mrs. M I too would have kept sleeping.....

Catharsis

Sue knew she was a brave woman. Her tummy hurt from the stitches, but she was OK as long as she didn't have to turn. She looked slowly at all the faces around her...her mother, her sister and her husband. All of them were weeping shamelessly. But she felt like she was in some sort of a trance. Like she was watching some movie. She scanned the place. No, these were not her clothes, not her bed, not even her room. Not her carefully selected upholstery, not her jug of water......but the book was hers, yes, it was her book indeed. Chicken Soup for The Expectant Mother's Soul......and the rest of the room blurred in front of her eyes. Tears finally streamed down her face as she wept for her new born who had just died. 

The Mourning

Being an anesthesiology resident in the Obstetrics and Gynaecology OT at Nair Hospital was no mean job. There was the routine OT list, the emergencies and the cranky surgeons and sometimes even crazy seniors to handle. But the job has to be done, right and that too with a smile, and we did it.


December 2009, while the routine OT is still on, we get a call, 'Emergency Laparotomy for an unruptured ectopic gestation in the fallopian tube' which means an emergency surgical exploration of a lady who had conceived, but unfortunately the fetus was outside the uterus in the fallopian tube. Fallopian tubes are the tubes which transport ovum or the embryo from the ovary to the uterus. I went to the waiting area to see this lady pre operatively. She looked distraught and strangely familiar. I could not place her, but she was familiar nonetheless. She was past 35 years, and had undergone a tubal recanalisation surgery few months ago. I noted down the rest of her medical history, did a quick physical examination and explained the surgery and anesthesia to her. She knew her baby could not be salvaged, being in a place where there is neither nutrition nor enough place for her baby to grow. The whole point of the surgery was to save her life, lest the tube rupture.


After taking her consent I did something I had never done before, I asked her a question that was too personal-- the reason why she had undergone a recanalisation surgery, or a surgery that involves reversal of a tubal ligation. The answer was obvious... she had undergone a tubal ligation which is, for all practical purposes, a permanent method of contraception. Then for some reason, she wanted to have a child again so late in her life. I was curious to know the reason.


"I lost my son to brain cancer" she said with a few tears in her eyes.


I was starting to figure out why I knew her.... still I persisted


"Where was your son admitted and how long ago did he die?"


"He was here, at the same hospital... He passed away last November"


"His name was Aditya?  I asked her to which she did not reply but broke down into tears instead. I did not pacify her, I broke down with her too into a discreet few tears.


I remembered Aditya very well. He was a 10 year old boy operated for a malignant brain tumour and had died in the ICU a few months after the surgery. He had died while I was posted in the ICU and was on duty. And he was probably the only patient whose death and the suffering prior to that had affected me so deeply,  probably because of his tender age. I remember having shed a few tears for him after seeing his grandmother break down once in the ICU. She was the one who mainly cared for him, with his sister and mother visiting on and off.  While I cried for him when he lived, I somehow did not mourn his death when he died in my arms, in front of my eyes. And I mourned for him the day I met his mother once again, a year after his death.


Being doctors who see death and suffering so often does make us tough but some incidents like these do break our tough outer layers and touch our hearts and make us cry. 


Disclaimer: The kid was not named Aditya. The name has been changed to protect the identity of the child and his family.



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This Precious Life....

On Thursday night, A called his wife M from office, and told her he will be home late. Few hours later in the middle of the night a stranger called M and told her that he had admitted A, to the hospital with multiple injuries. Few hour later, in the morning, doctors declared to M that they could not save A and he was no more....
 Life is so unpredictable.... In the 3 years of their married life, A and M would have made so many plans for their future. A name for their child not yet conceived,  the dream car to buy from their funds saved, so that A can use a car to travel to work instead of his bike, the place where they want to build their retirement home. She had probably cooked his favorite dinner that night. But he never came home to relish it. Fate had some other plans for them.....


Life gives you cruel surprises. I guess, we must live each day like its probably the last day of life. Never leave home or go away from your loved ones with a frown or some harsh words...lest you never return to make amends.

Randomness

Currently posted in ECT...that is for the past 2 weeks and two more weeks I shall be providing short General Anaesthesia (Short GA) or TIVA (Total Intravenous Anaesthesia) to patients undergoing ECT or Electro convulsive therapy, the so called "shock therapy"

No, shock therapy is NOT as scary, greusome as shown in films and soaps on TV.
1) The patient is well sedated, rather anaesthetised and doesn't remember that he underwent shock therapy

2) He/She is relaxed and does not convulse like "oh-my-god-he's-going-to-die"

3) After the procedure, in 5 minutes flat, te patient walks out of the ECT room to his bed, on his own

Ward 1 is our Psychiatry ward. Secluded from the rest of the hospital, this ward has a mix of patients. The ward (thankfully) has staff who is EXCELLENT.....all in caps. Patient with their patients, efficient, with a decent amout of sense of humour...all that you need to survive in a ward of so called "mad" people (Its a CRIME to call them that)

There's a girl who's violent, one who is so quiet that it hurts, one who sings aloud and dances all over the ward, when she is not crying for her "mummy", two schizophrenic brothers......They all make me wish I had taken up psychiatry as my field of specialisation. Though I'm not too sure I would have been able to digest their sorrow, heal their pain, face the fact that I may never be able to treat them and live peacefully inspite of and amidst all that.......


Whatever.....


Came across a nice blog of an Anaesthesiologist from Boston.... Notes of an Anesthesioboist.

Inspired by her old post I too would love to make a list of what I would have loved to be if I wasn't an Anaesthesiologist (read studying to be an anaesthesiologist)

1. Psychiatrist
2. Ophthalmologist
3. Pastry Chef
4. Own a Coffee shop
5. Classical Music Performer
10. Stage Actor
20. Preprimay teacher
50. General Surgeon
100. Dentist
5,000. General Practitioner
1,00,000. Spiritual Guru (Heh heh, suggest me a good name)
3,99,999. Ob Gy
4,00,000. House wife

The Finger

I spot her in the crowd...run to her.
"Kitni umar hain bacche ki?"
No reply....she just showed me the finger.

I spot him in the crowd. His eyes meet mine...he nods...and shows me the finger.


Ahh....thats how the days are in the life of a "Pulse Polio" intern.

[For the uninitiated, any kid who has recieved the Polio vaccine on the immunisation day gets a mark on his little finger, to identify the unvaccinated ones.]

Mixed Bag

Long time since I wrote a blog..so a lot of topics in this MIXED BAG....

Happy Diwali
Wishing everyone a Happy, Prosperous and Safe Diwali. Happy New year to all celebrating it. My new year will be in March..

Names
Had a fun time with funny/non funny names of late.

Today in the blood bank
Me: Aapka naam..?
Donor: Basudebh Das
So I started filling it in the form. B A S U D E B....
Donor:Basudebh mein B nahin...BHEE
Me: Ok. So I added the missing H, slightly confused
Donor: B nahee BHEE, BHEE.......'S', 'T', 'U', 'BHEE'

Then once at Oshiwara Maternity Home there was a lady called Photu, no jokes. The nurses had a fun time calling out to her....."Photudeveeeee" the way all B.Com ladies are addressed. Well here B.Com stands for "Bihari Community" and not Bachelor of Commerce (No offence to the Bihari's or Commercies). Photudevi's name was the talk of the town...(ok,just of OMH). One day at breakfast table with 2 neonatologists..

Neo 1: Arey postpartum ward mein ek patient ka naam hain Photu...what a name..heh heh
Neo 2:Uska Husband hoga Camera....aur unka surname studio...hah hah hah
Neo 1:(In his slightly pansy style) What funny names people call their kids.Sweety, Dolly!! I know a 60 yr old dadima called Sweety.......imagine calling a lady that old Sweety...
Neo 2: Arey par usko Sweety bulanewaley dadaji bhi utne hi old honge naa......

Nanhi Kalee
I wonder when Indians will get over their craze for a male child. Tired of seeing women with 2 or 3 daughters getting pregnant, hoping for a son.....relatives pulling a face "ladki huee"....women refusing to feed their new born baby girls.....Of men treating their wives like a "Baby producing factory".....of women with 3 girls going for a copper T, when advised permanent sterilisation saying "Ladke ka lalach hain thoda doctorsaab"

Fevicol Ad
Liked the new fevicol ad...which combines the words Diwali in English and Id in Urdu..its a hoarding. Tried to find a picture of it online...in vain. But very nice.

Amusing and Musing

Mid Day Boy
There is a boy I often see on the train who sells Mid-Day. He hops on the train, shouts "Mi de Mi De, tsk tsk"....."Mi de, Mi de..tsk tsk". He has a 'eager+ forlorn+ anxious to jump out of the First Class ASAP' expression on his face. Suddenly I got an urge to buy Mid day from him (Mid Day is something I buy only on impulse, or unless my Ajji (gran) is home. She HAS to have the crossword or she gets bored sitting at home all day). So he got in at Khar and I took a paper...started hunting my wallet for change. The train was about to leave and TC was on the train. So the guy said,
"Baad me sandaas me akey dena..."

I said "Huh, aye ruk...." He had long left the train, and the train had left the station. I keep feeling bad for not having paid the fellow, and befuddled by the toilet bit till Santa Cruz arrived and I realised I heard him wrong. He had said..."Santa Cruz mein main ayega to dena...."

Professional Secrecy
Now I know why professional secrecy is such an important legal issue in Medicine. Today in the Gyn OPD came a patient whose name I will obviously not mention. She was married and in Gyn you have to ask the patient a lot of personal questions...like time since marriage, about miscarriages, contraceptive use and so on. The lady started giving her history by telling me that she had been married since 5 years but her in laws had cheated them so she and her husband had had no physical relationship whatsoever. In her words, he had still not 'broken into her'. I was shocked. Not as much by that fact as much by the realisation that without having known me at all that lady had confided a very personal, a very serious matter in me. I am still dazed.....

Musings.....

At present I am posted in Gyn/Ob department of KEM. And 10 more days to go. And I remembered Dr.MSVK Rajoo, my psychiatry HOD from my alma mater in Loni. Now what's the connection you would ask. I will come to that, at the risk of being bashed up by all the feminists and probably my non feminist gal pals too. But I take the risk anyways. This has been bothering me for a few days now and finally I decided to put my feelings into words. Not only have I been busy but have also learnt that when you post too frequently the number of comments you get on your older posts reduces.....:)

Coming back to Dr. Rajoo. He is one of my professors I have adored. And who have inspired me. After one Dr. Abhang Prabhu who inspired me to take up MBBS, Dr. Rajoo was the one because of who my interest in Psychiatry deepened. Then one day he made a statement in class, "A woman's biggest enemy is another woman." And God was I scandalised!! He clarified, saying visit the maternity ward to know more, to see how one woman treats another. And I forgot all about it till I joined here. He wasn't too wrong. Here I see many gy/ob PGs......all females themselves treating their patients very badly. Those coming in the middle of the night to the labour ward are the ones treated the worst, "Arey if your tummy hurts, but you are not ready to deliver your baby, I can't admit you. Admit karke kya pooja karu tumahi?" Now thats not very consoling to the lady who's just 7 months pregnant, worried she's in labour too soon. Ok, you are overworked, your unit has in all about 100 patients, your diurnal rhythm is screwed for life and you don't remember when was it that you last slept. But is that the fault of the distressed patient sitting in front of you? Didn't you know before taking up this field that all your patients are going to be women coming in unannounced, in multiples and they are going to be anxious!! As a fellow woman can you not understand their anxiety! And when you start your private practice...will you still shout at each and every female who comes in at 4 am with labour pains?

I still do not completely agree with Dr. Rajoo but what he said wasn't too far from the truth....I am sad...

The Great Indian Habit

Jara sa or little bit is such a popular word of the Indian man's jargon. Like when they cook, they always put jara sa hing or haldi or whatever. My jara sa never matches with that golden standard jara sa I feel, hence when I cook, the haldi hing and salt are either jara sa excess or jara sa less..or maybe jara sa more would be fine....huh


Or when I miss meeting the head of the unit for the coveted signature and posting completion I am always jara sa late.


The other day in the casualty at around 2 am came a patient with a nasty laterated wound on the scalp, outcome of a fall.
I am not going to translate the rest, won't be as much fun....

Me, "Vomitting vagera hua?"

"Haan, jara sa."

Me, "Chakkar aya kay?"

"Haan, jara sa."

Me, "Kahi aur laga kya?"

"Haan idhar udhar jara sa laga"

Me, "Behosh hua tha kya?"

"Haan, jara saa hua....."

Me, "AREY, JARA SA BEHOSH KYA HOTA HAIN??!!!....HUA KI NAHIN??"

"Haan matlab hua........"

Russian Tonsillectomy

So today while I was sitting in the side room of the OT, killing time and worrying like mad about many things including PG exam, my preparation (or rather the lack of it...why would I worry otherwise?) the sick AMO of Cooper etc Dr. Hindolkar, unit head of surgery walked in with his gang. And after the usual talking about PG exams, reservations, etc he started telling us all and Dr. Bhargava about people removing appendices via the stomach for people who want no scars on their abdomen. Or removal of thyroid by laparoscopic techniques and more such fascinating surgical developments. Dr. Samir Bhargava is a famous ENT surgeon who has also written a text book I used for ENT in final MBBS. So while Dr. Hindolkar was amazing us with these facts Dr. Bhargava chipped in,

"In Russia they remove the tonsils via the rectal approach........
............as you are not allowed to open your mouth in Russia!!!"


For the uninitaited....tonsils lie inside your mouth....open your mouth...stick out the tongue...aahhh there they are!


Erratica!!....it was Dr. Kamat who we were talking to....not Dr. Hindolkar. Since I have never seen both before I mistook one for the other

The Poor Man's Blood

Story Courtesy: Dr. Meena Galliara

Post 11/7 blasts in Mumbai each and every Mumbaikar wanted to do something for the injured who need help. This feeling is intense amongst people who were not present at the site and may not have been able to help in any way. And not all of us have the cash resources but we readily donate one thing we all can...some thing that cannot be replaced..that is Blood.

NMIMS had organised a blood donation camp at the college for student volunteers and anyone else who wished to donate for the noble cause. Dr. Galliara and her department was actively involved in this campaign. The student turnover was awesome and probably more than they anticipated or even were prepared to handle.

A frail looking poor man turned up there. He was so poor that he didn't even have anything to wear in his feet. And the organisers knew from his looks that he couldn't possibly qualify for the donation as he was certainly less than the mandatory 50 kgs. When asked how he had learnt of the camp he said,
"I saw your board outside and came over to donate blood. I lost my brother and bhabhi in the blasts. They were my only kin in this world. Now I have no one in this world and I don't wish to live. Government has promised compensation for the kin of the dead. But whats the use of all the money? If I come into too much of money, some long lost relatives might turn up like leeches and run away once they get what they wish. So please take all the blood you wish from my body......1 bottle, or 2 or even 3 if you need."

Sad but true.......

The poor man had to go back without donating a single pint of blood as he weighed only 45 kg.

Silly me.......

Interns in any hospital are, according to the patients, modern day vampires. They come to you every other morning (or every morning if you are unlucky to be a diabetic, have kidney failure or some disease which wasn't enough of a headache for you by itself) armed with a swab, syringe and a needle and suck the blood from your veins. Patients' reactions to this painful rituals are different...

Some scream, shout or make any sort of sound a person in pain would (blood collection is a slightly painful procedure..however when done repeatedly the site too gets tender and the procedure a more traumatic and painful one. Lack of skill on the part of some just adds to the woes)

Some complain...."You will finish all the blood in my body....." or "What do you do with so much blood?".....I prefer ignoring these types

Some like to ask why the blood is being taken . These are the ones with some basic idea about their disease or the ones who want to pacify their minds with "This is being done for my good". To them you explain in the little time you have 'Kidney kaa tapaas-- renal function test' or 'Liver ki jaanch--liver function test' or 'HIV ki jaanch' and so on..in simple short words. (Interns are always short of time.....too many collections, shortage of equipments and the rush to arrange for more, or just in a plain hurry to scoot home or to the library)

So once I had to collect the sample of a lady who was posted for a 'Serum lipid profile' meaning a test for cholesterol, triglycerides, etc in blood....in short the 'fats' in her blood. She was of the 3rd category mentioned above and she asked me,

"Aaj kaunsa tapaas karna hain?"

My plain reply, " Cholesterol, lipids ki jaanch"

"Matlab?"

In my hurry to finish my work on time I could not think what I should tell her. (Plus never before had I explained to a patient about a lipid profile so didn't have a reply ready in my head). So I said to her the easiest non technical reply that came to my head....which I didn't even bother to replay in my head..

"Khun mein kitni charbee hain uskaa jaanch karna hain!!!"


To the uninitiated: Charbee is Mumbai Slang for 'attitude' or 'masti'.

Some More Funny patients

Once a fellow intern was posted in a PHC (Primary Healthcare Centre) and he had been staying there. One night a patient's relative came him and woke him up..in the middle of the night. He asked what was wrong and the fellow said
"Keeda chavlaa.." meaning that an insect has bit the patient.
Bhavin cooly got out of his bed thinking why people come to the centre with silly complaints like that.....Thinking on his way isko painkiller aur Avil deke bhagaa deta hu he went to the waiting room.
"So which insect bit you?"
Relative, "I got it killed with me...here it is...." and saying so he opened a polythene bag to show a three feet long snake!!!

Aruna..................

When I read about one Terry Wallis who got out of his semicoma of 19 years after an overwhelming head injury...I pray to God that such rare luck befall Aruna Shanbhag too................

Yesterday wasn't the only time I remembered Aruna Shanbhag again. When I was posted for a short while in Ward 4 of KEM, my co-intern who is a graduate from there told me,


"You know that Aruna Staff?? She is in one of the side rooms here in this ward. She has been in this semi comatose state for almost 2 decades now. The staff (short for staff nurses) of Ward 4 take care of her."

Me, "Oh..Aruna......oh THAT Aruna staff........"

Pritee, "Yes, she is almost 50 now...she is very fair...and must have looked pretty in her youth."


Then on some other occassion I went to the nursing station of the ward looking for the keys to the staff restroom of ward 4. There I saw a cylindrical box with a label made of sticking plaster reading 'Aruna's Keys'. That was the other occassion when I remembered her.

Aruna was a staff nurse at KEM hospital Mumbai. During her work there she had came across a sweeper Sohanlal who worked in the animal laboratory. She had found him mistreating the animals and warned him against doing that. (The other version of this story I had heard says that she had warned the fellow since she had found him stealing medicines and BMC supplies from the ward. I really don't know which is the true version of the story). So this fellow out of venegance strangled her with a dog chain and raped her brutally. The strangulation caused reduction in oxygen supply to her brain and caused what is called 'hypoxic brain damage'. As a result Aruna is now in her semi comatose state, unable to speak or move. She just responds to stimuli. Apparently she screams and laughs too sometimes.

At the time of this incident Aruna was engaged to be married to one doctor. Needless to say the doctor married some other lady later on. And apparently took no interest in caring for Aruna. I don't know how much her family is involved in caring for her. But the staff nurses at KEM take care of her....Upholding the oath they take in the name of Florence Nightingale.


Sometimes I wonder what will happen to me should such a state befall me. I know my mother will care for me as long as she can. Will my brother be able to care for me apart from his family callings? My fiance?? Some day out of social/familial pressures and the will to move on with life he will get married to someone......thats what even I would want him to do. But will he still look after me.....for how long? How long will his wife and children allow him to? Aruna has fellow nurses to look after her....but if something like this befalls me during my stint as an intern.....certainly I don't expect any interns to care for me........

I use this opportunity to say that should I become a vegetable at any stage of time, please give me my right to die....don't keep me alive just to make me a burden on the future......

Of Women and Cut Wrists- Part I

In the past week I saw two women with neat and deep cuts on their wrists....allegedly accidental. And there is a lot I learnt from them in the 15 minutes I spent with them

Girl # 1 came in the evening, well dressed, young. 18 according to her case sheet. Brought by neighbours.
When we asked her how she managed to get her wrist cut, she said that she fell on a sheet of metal!! However she didn't have a single scratch on her body, nor any other injury a person who falls from a height would sustain.....how miraculous for her.
"You didn't try and commit suicide, did you?"
"No nothing like that"
"Sure?"
"No no......."

We accepted her story and took her to the table for suturing her injury. Since it was a visible area on her wrist, to save her from an unsightly scar we made her buy a fine suture material which costs around Rs.120/. Otherwise the BMC provides suture material of a slightly thicker diameter for any patient who comes to the Minor Operation theatre. The girl was eager to watch what I was doing and at the same time would wince the moment I took the needle near her skin. Local anaesthesia had been given and all was just fine.

"Baghu nakos ga!"
(Don't look here)
"Nahi mala baghaychay tumhi kay karta tey"
(No, I want to watch what you do)

She said she worked at a private practitioner's clinic at Cotton green and that she was used to all that.
"Kay kartes tithe?"
(What do you do there)

"Sagla karte...takey ghete, dressing karte, ECG kadhtey, injection dete......."
(I do everything...suture wounds, wound dressing, take ECGs, give injections....)

"Kay shikli ga tu?" The OT assistant asked her
(What are your qualifications?)

"Dahavi fail"
(Flunked 10th standard)

After I had taken some 6 stitches she asked me how many more I would be taking. The wound was a good 6-7 cms long and I told her that I can't really say.

"Andajey sanga naa...."
(Make an estimate)

"Tuch kar naa...takey ghetes na tu pan"
(Why don't you make one....you too do suturing, right)

"Tumhi javal javal ghetlet na takey......amhi khup lamb gheyo.....me he kam don-teen takyat kele astey"
(You have taken knots at a very small distance....I would have done this in only 2 or 3 knots)

She continued "Amhi patientla vicharto..kiti takey gheu..karan ek taka ghyayla doctor 100 rupaye ghetat"
(Actually we ask patients how many stitches should be taken as doctor charges Rs.100 per knot taken)

We all asked the girl to continue her education..take a second attempt at English, the subject she had failed in. But she was the sole breadwinner of her family and further education was out of question. Her older sister was shorter than her and was denied any job at any place.

"Pan mi mazya dhaktya bhavala shikavnarach ahey"
(But I am going to see to it that my younger brother gets educated)


I sincerely hope her younger brother remembers his sister's sacrifice for him and the family and takes care of her in the future when she needs it. And that the unethical doctor is brought to the book ASAP! Both seem like remote possibilities to me

Part II will follow later ...tired of typing anymore

Funny Patients

When you sit in the emergency medical services...better known as EMS or Ward 20 of KEM, many funny incidents take place there. Let me get myself clear..Here I do not intend to make fun of the patients or their ilnesses but somethings they do and say are just too funny to be left in some corner of my brain and forgotten.

RAT MAN #1
On any given day, during any given shift there are atleast 2-3 cases of poisoning, mostly suicidal, in the EMS. So one fine day (actually one fine evening) came a man who consumed rat poison for some reason. Now unlike some poisons, rat poison has no specific antidote. The treatment is mainly removal of unabsorbed poison from the stomach by emesis that is, forced vomitting by giving the patient extremely salty water....

So the staff nurse gave him a bin to vomit in and a jug of super salty water. The fellow had a glass of the concoction and puked a bit. Then he stopped having it at all. We all were instructing him to have more. He pulled a face and yelled out to the staff nurse,
"Thoda namak kam dalte the to chalta thaa..."
(Putting a little less salt wouldn't hurt)

Pat came the reply from the seasoned lady,
"Yeh kya nimbu paani hain kyaa?....namak shakkar ki bat karta hain"
(You think I am giving you lemon juice?)

The patient was told to get admitted but after having just a glass of the solution he ran away and didn't get admitted.

AMBA-BAI #2

One girl was brought to the EMS at night by her friend. The girl said she had consumed a bottle of baygon. A naso-gastric tube (a tube to empty the stomach, put via nostril) was put in and gastric lavage was performed (stomach wash). The gastric contents did not smell of Baygon AT ALL...infact they looked strangely yellow. On asking her if she really had taken any poison, she replied she had had one whole bottle of Baygon worth Rs.90.
"Why do you stomach contents look so yellow then?"

She replied,
"Maine socha....khali pet davai kaise khaneki..to pehle maine do aam khaye aur phir Baygon Piya"
(I thought, how can I take any poison on an empty stomach, so I first had two mangoes and then I drank the poison)