its over

my internship is over, and i am sorry for the almost 3 month long hiatus in updating my blog!

my life was very busy on the personal front, which i am very happy about :)

my last posting was in surgery. had a nice time working in it. orthopaedics was a part - my last week in it wasnt so great :P

but orthopaedics is one posting where they let you participate in surgeries a lot.

anesthesia was interesting too, got to perform lumbar puncture and try my hand at intubating a patient's throat before giving him anesthesia!

eye posting was quite lame, as after almost 2 years of studying eye interns dont remember what was taught, so basically didnt learn much. did a few syringing of eyes and tonometry though.

ent posting was a similar experience like eye. i got to remove a nasal pack. child's play basically. mainly what inters had to do was write discharges :P

the only thing i missed is getting a chance at a surgery. lucky ones did get.

once the internship was over, i went around thanking the doctors who were kind to me and whom i appreciated. asked for blessings.

mainly missing the company of my best friends now. and the settled life that we had for 5.5 years in pokhara!

its time for a new beginning but waiting for my old mates and my soulmate to join me soon.

wish me luck.

Yesterday

the university exams have begun and so the interns on exam duty scramble around doing their best to help.

rebecca, tsering and prashanna here. tim is just an onlooker, while sambhav is not in the pic.

on my duty night yesterday in post-op room. i saw this cute scene where this kid was touching the mum's cheek :)

mum underwent a laparoscopic cholecystectomy (removal of gall stones via a scope)

Image via Wikipedia

yesterday was my last night duty in surgery ward posting. been 5 weeks and had 5 duties!

was a tiring experience. this is my last week. and then i'm relatively more free !

looking forward to more sleep.

3 tough weeks

after my ortho posting, i had neurosurgery for 3 weeks.

in one line, i would say i did not enjoy the experience i had, unfortunately it wasn't due to anything related to the field or the work, but rather related to the experience with colleagues and seniors, which sucked.

i realised the potential harm Facebook can do to your work life. i realised that not everyone thinks like you and you have to accept that fact and work around it not against it. i realised that people can be paranoid and will use their authority to any means, even if it means threatening you or personal attacks on you. i realised that some friends are not really there for you when you need them, even after they know that you need them. sad facts.

the stories are very long and not worth mentioning here. not merely because its a public forum, but yeah i have learnt that its very important you be careful what or who you talk about on Facebook!

despite all the negativity, i did manage to enjoy my 1st week there with nitesh. when we start off, the 1st day of neuro, the PG / MO are strict. mainly the idea is to show that here at neuro, you cant be a slacker.

stuff you will face on the 1st few days on the job:

• you'll already be scared of all the stories and all you hear and come.
• the PG / MO wont greet you with a smile on the 1st day, they will be tough!
• you will need to know about all the patients details, mainly their GCS and pupils daily and their diagnosis / CT scan findings
• the best way you can do that is keep a diary and note down all the patient details, and during rounds keep that page open where the patient's details are, they will help answer quick questions shot at you from cherian sir or the PG / MO.
• do not talk during rounds
• do not keep the file on the patient's bed
• do not sit or take support on the patient's bed
• do not be over smart
• keep a torch
• you have to run to the OPD before cherian sir gets there after the rounds
• you have to be at the neuro icu by 7.45am
• do not skip rounds or duty without permission or without informing PG / MO
• there will be an initial round by PG/MO and then we all wait for cherian sir to arrive at their own time. usually he comes by 10am and we have another round.
• try to avoid clubbing ER duty with ward as usually it will get too hectic to handle!
• you will be asked to read aloud the rules posted on the notice board in the neuro icu in front of everyone!

i cant think of other stuff. but basically you need to just take it all in. later on, things get much easier and as u get familiar with the attitude and work environment it wont be tough at all.

try to keep things professional, getting personal with the seniors can fire back.

the only thing regrettable about neuro is that, you don't get many opportunities to learn anything new or do anything exciting. all i did was see a brain surgery and that it. i didn't get to participate. you might get sutures to do at the end of the operation, but that's the best i guess.

the instruments they use in the OT are exciting though! :P

Dr cherian is a very dedicated man and his passion is beyond any other consultant i have seen so far. Impressive appearance and a nice guy to talk to, he might seem unapproachable, but he isn't really. talks to you with slangs like 'bugger', 'balls' and other stuff we all know :P, makes you feel at ease.

plus he answers questions and explains things if you care to ask.

the sisters are supposed to be the best, most sweet of the lot and i got a glimpse of that when i had my night in the icu. they offer so much to eat and the tea at night is awesome.

the best part about neuro was that you see the same patients for over 3 weeks and you get to know them and see how well they respond to treatment. some paralysed ones started walking in front of my eyes and it was a blessing to witness that! the true blessing is what the surgeon probably felt as he had seen them at the paralyzed stage. from his expressions we could tell, what a wonderful feeling it must be to help these people and watch them come back!

the OT was alright, i just got one chance when i was on call and there was a head injury case. the guy had a temporal contusion on the left side and it had to be removed. he was taken up to the OT and i was all excited that i might get to do something.

All i got was to catheterize him (put a pipe up his penis to help him pee into a bag and not on the table). that too i was yelled at for not doing it already in the ER! and in the end, i got to put a few of the scalp sutures. not very satisfying to an intern at this stage !

cherian sir at his stuff! the PG looks on.

the craniotome, it makes holes into the skull like a drill would.

this thingy is where the mechanical energy for the instruments like craniotome comes from. it has a motor attached to it.

the brother, a genuinely nice guy, works at his table of instruments!

playing around in the neuro icu. this was at happier times, during the 1st week i guess.

the neuro icu. a brother at work.

ask sambhav about this particular patient on the right of the picture and he'll give you a hilarious anecdote!
these are the rules! to be read aloud by every new bugger joining! lol

the most well known patient of our time in the neuro icu since a months already! a 10 year old girl! :S in a comatose state, dunno how long she'll take!

the interns hanging around waiting for the rounds to start.

the view from the neuro icu balcony. one site which would calm your mind when things arent going your way at work or private life.

I'm satisfied my 3 weeks of neuro are over in one stretch now. cherian sir was a gem, signed my completion with a very good too! good bye, I've moved on to friendlier pastures :P

the best OT yet!

woweee!!!

i had the best OT experience so far! simply because i participated almost as much as the surgeon did!

this guy had both his wrists fractured (colles' fracture) so we had to sedate him under general anesthesia and put metal pins (K-wires) in his wrist to fix the fractured bone. on one hand, the surgeon showed me how to do it, how to hold the wrist under traction, how to locate the site to insert the pin, how to use the drill, etc!

me and prashanna got to do it on the other hand!! all by ourselves ! :)

using the drill was pretty fun! and then we had to bend the extra pin and cut it off, later we applied a plaster cast over the arm too.

overall a fun experience learning to do something in the OT!

2 new skills :)

just yesterday i got a chance to try my hand on Ascitic tapping and Pleural tapping.
Ascitic tapping means draining the fluid accumulated in the abdominal cavity, where as pleural tapping is the same for the pleural space (outside the lungs).
did them satisfactorily, although i think we removed a little too much fluid from one guy and he started coughing suddenly. he's stable now, but it was kinda unnerving.

dealing with COPD in MEDICINE WARD

its been 3 weeks already in the Medicine ward and i couldnt come up to write another post.

basically was distracted. now that i got a few pics clicked, i thought its time.

Medicine ward, i thought would really give me an experience in dealing with the majority of common illnesses, unfortunately though, the way we interns work there makes it unlikely.

but since no one wants to work more than absolutely needed to, this system ends up fixed in place.

the way it works is, that each intern is assigned a room in the ward, and as the room gets filled up, the intern gets more work with managing his patients.

understandably the ward has some rooms, which hardly get used, and some which are always full. dont ask me why! there are lots of reasons.

and also because we get so comfortable handling our room, we dont want to change halfway either. so i got COPD room (female) and i have been seeing only COPD (lung disease with chronic cough) cases these 2 something weeks. :P

and since my room has oxygen supply, any other case needing oxygen is shifted here as well. so once in a while i do see a variety.

otherwise, i would say medicine ward is the easiest and most slack of all the wards in our hospital, mainly because when you are on call and its your night duty, in medicine you are not expected to attend calls in the ER. the PGs are supposed to do that! so you are practically only handling the emergencies in the ward itself, which hardly occur.

yet, just yesterday i had my night. and one of ritwika's patients developed hemoptysis (coughing blood) . and let me tell you, i havent seen so much blood being coughed out ever! and the lady was in her mid 20s!! poor girl had such a hard night. she must have coughed out almost 1 litre of blood by morning, despite medicines to stop the bleeding! we had to monitor her overnight, hoping that she doesnt collapse after losing so much blood! luckily she had a healthy haemoglobin of 12 and her blood pressure wasnt too high/low either. today she must have gone for bronchoscopy (scope to view the lungs) to find out where and what is bleeding. dunno the result. will ask ritwika about it.

on the other hand a lovely incident i had in the ward, in my own room! this patient, a 70 yr old lady with COPD, still there in the ward, has been lying there for 15 days already. she was there when i arrived and basically she was on antibiotics to remove the infection in her lungs.

somehow, she kept on coughing and coughing and you could hear the phlegm inside her lungs. but the chest seemed pretty clear to the stethoscope!! so somehow, one day "chest physiotherapy" came to my mind. and i remembered i saw someone do it in paediatrics ward on a patient with pneumonia. it apparently helps to remove tough and sticky phlegm from the lungs by loosening it!

during the rounds i asked the PG (srijana) if we could do that? she seemed to like the idea and i got a hint she was surprised not to have thought of it herself. i, too, wondered why she didnt think of it herself! anyway, she asked if i knew how, i said no, she asked others, sambhav knew how! he taught me how to do it on the patient. we did it for like 10 mins. basically you have to use cupped hands to hit the chest gently from down-up.

the next day, the patient's son and his brother were so happy! they thanked me for doing that, apparently what medicines couldnt do, this little step did! its removed a lot of phlegm and she slept so much better at night after a long time! they also told me she felt so much better now.

they obviously showed how much they appreciated it. and i felt so good! i tried my best to convey in nepali that it was my pleasure. and i was happy for them.

they went on to ask me where i was from, what will i be doing after this, why couldnt i stay in nepal. how sweet! i told them i have to go back to my country :)

the son learned it from me and i guess he helps his mom out now! i was so proud that i came up with something useful, and it actually helped my patient. small things do matter!

another interesting thing happened recently, one intern and one PG got beaten up in the ER by family and friends of a patient who died under mysterious circumstances!

for two days the hospital remained closed, no new cases were seen in most departments as they were holding meetings with the management for better security.

this is how meetings are held, Nepal-style ... open air! fish market!

what do we care, we enjoyed the break from work!