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!

its been long

i know its been long since my posting started and i havent updated.
been busy. will come soon with a few pics!!

Back after break

It doesn't exactly feel great to be back to Nepal, but one has to do what one has to do.
Joining medicine ward duty from Sunday.

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FMGE

due to the impending foreign medical graduate exams (FMGE) we had in late september, our internship had taken a back seat for a few months.

these exams are now compulsory for all foreign medical graduates (FMGs) planning to enter the Indian medical system. 2 papers or 150 MCQs each, is all you have to clear to get a pass and qualify for registration in the indian medical register.

thank god! i passed. got 174 out of 300. was expecting a borderline result. thank god, seriously, cause the preparation was crap and the 1st attempt seemed dodgy, as we had no idea what to expect.

unfortunately, a few of my close friends did not clear. they will have to sit for it again in march next year now. its shitty to think of giving the exam again. spoils your self esteem and pushes your plans for the future on the back seat.

it was a great sense of relief i felt when i realised i had passed. relief that a big hurdle is cleared, that too in the first go.

now its back to future planning and internship.

P.S. good luck to all those who give it again in march, pray you clear.

Paediatrics

my oh my!

i was looking through my last blog post, and realised that i had started posting for paeds on the 1st day of duty. my plan was to update with cute baby pics daily.

what paeds turned out to be, i was totally unprepared for!

this was one of the busiest duties i have done. i knew it was to be busy, friends had warned. what i didnt know, was how busy your emotional senses are going to be!

it was a whirlwind 2 weeks, highs and lows, saved lives and lost lives, cute kids and ugly kids, kind nurses and devilish ones! all in 2 weeks.

what i learned in 2 weeks i could never learn in 6 months of commed posting ! (we only have 3 months)

there was this one particular day, we lost two kids! one of them was from the NICU and i was on duty with ankur then. it was a sad sad day for me. that day mansi was in the ward and she lost a kid under her too. we shared our sorrow, and it helped.

that very day, i had seen our MO dr.shankar help save a life in the ER performing resuscitation. i saw it all - flat line on the ECG, CPR, Defibrillation and all. for over half an hour, guys worked on him and he survived! it was a rewarding feeling just witnessing that!

when i came back to the NICU, i discovered to my shock, that one of the sick twins had died!!

i couldnt hold my tears looking through its file, the notes i had entered, the charts i had filled. this was too sudden for me. how quickly the kid died. i imagined the twin who still lived, he would grow up to discover his brother died . terrible terrible feeling.

somehow i got through the night. trying to hide the hurt i was feeling inside. you cant help but get attached to these children you look after. they seem like your own. it is terrible when the die. it is.

soon, i overcame and moved on to ward duty. 1 week was up and 1 to go. sambhav seemed so dogged by ward duty, it wasnt what he made it out to be. and surprisingly he was so carefree during his NICU, which wasnt so slack when i was there. weird. but that is sam's middle name.

anyway, worked with mansi and ankur in the ward too, lovely people to work with. couldnt have asked for better! they work with the right spirit, which i have to say, is scarce nowadays.

it came up to 3-4 kids per intern to manage, as a lot more juniors joined and made our life easy.

i learned how to catheterise a vein in a neonate! managed it in the 1st shot!! :) and talking about 1st shots, i did a Lumbar Puncture yesterday (that is putting a needle through the gap in the vertebrae and collecting the fluid that comes out for study), and got it in the 1st shot as well! thankyou :) . thanks to dr. Deepak who offered me to do it, otherwise i was quite sad i would have missed out.

i learned the neonatal resuscitation in routine newborns as soon as they are born! I've put a nasogastric tube in one newborn too!

overall satisfied by the skill-acquisition.

thank god it was only 2 weeks, how much can one take?! yesterday was my last night duty and we had 8 admissions!!!

so much work! phew, did it, its over. yehhhhhhh :)

thank you paediatrics. did learn quite a lot. it definitely broadened my horizon.

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the NICU

Image via Wikipedia

the neonatal intensive care unit (NICU) is where i will be posted for this week.

today was my first day on the job. met dr. deepak who is a sweet guy, explained the expectations from us interns.

there are like 8-9 kids in the NICU. basically this unit is for sick kids who are really really young. they are in their 1st month of life!

most of them are just born and sent to this place.

it is equipped with lots of incubators to heat 'em up! :P

plus there are a couple of Phototherapy machines, they emit white/blue light and help reduce the jaundice that some kids develop in early life.

some premature kids look quite like sick skinny monkeys! while others are normal healthy cute ones!!

i hope i can learn how to take blood and intubate them! it is apparently really tough to get the vein in those tiny limbs !

i am also supposed to collect reports and update their files every morning. unfortunately i couldnt do the updating today as i am new, and the MOs' handwriting is PATHETIC!

sambhav is with me in paediatrics and he is in the general ward, he is having a hard time decoding the handwriting in the files. :S

anyway, some ppl might join me in the duties in a few days, i have my night on-call on 25th, that is day after! and then every 3rd day from then on.

lets hope all goes well. tomorrow we officially meet the HOD and start paeds.

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Greener Pastures?

Finally, Green Pastures Hospital (GPH) posting is over!

I regret to say, but the place where my colleagues used to go to and come back saying it is the most worthwhile posting, isnt the same anymore !

we were posted there for 3 full weeks, and i can hardly call what i did there, worthwhile!
well, some may say, we hardly stayed there and ran away mostly. but the truth is, we would have stayed if the situation there wasnt so morose!
the first week itself made a sorry impression. no one paid us any attention! roaming around during the ward rounds, not being explained anything.

not only that, it matters who your company is as well. if you are stuck with a bunch of bunkers, you cant help but bunk yourself.
yet, we did go quite a lot and mostly sat there in the OPD doing our Mudit Khannas preparing for FMGE later in september.

I totally stand for the Dermatology Clinic though! it was the only thing impressive. there were loads of patients pouring in. and you get to see a lot of diseases.
unfortunately, it so happened, i got to see only one day of it, in 3 weeks.
it isnt held every day of the week though. just wednesdays i guess.

one day, Dr bhattarai made it clear that he's not interested in teaching the interns anymore as they dont seem interested in learning. i guess he must have had a bad experience with the previous groups of interns posted there. But still, that is not something you demand! just teach man, who knows, maybe u can ignite interest in us!

he was a disappointment though, cause i only heard praises for him before going to GPH. but when i went he kept himself busy with paperwork most of the time. he is supposed to be an excellent teacher.

there are minor operations held as well, which interns sometimes get to assist in, and guess what we got to do, NADA!
we hardly knew when the OTs happened.

anyway, i dont want to rant, GPH is a good posting and i hope they get back to their previous ways. if they continue like this, i would say its a waste of 3 weeks, just have people go for the Dermat clinics.

sadly, now i have medicine posting and dr alurkar has scrapped dermat posting completely from the intern schedule for indian interns!! his reason: no one attends and you get a 1 week holiday!

so my chance of dermatology experience seems gone!

medicine and facebook!

Image via Wikipedia

http://content.nejm.org/cgi/content/full/361/7/649

i read this article, and realised how relevant the issues brought up in it were in our lives as upcoming doctors!

in my personal case, i havent started practising yet, still interning, so my friend circle in fb is still the original personal group of friends.

but i am one hefty user of social networking! and load up a lot of stuff and perform a lot of activities which i believe from my patient's point of view, would be objectionable in a doctor!

how far are we as doctors allowed to live our original lifestyles and still continue to practise unaffected by the repercussions it might have on the perception of us in our patients' minds?!

should i remove content from my facebook account, like old photos and comments which as an average youth one is expected of, but as a doctor is unacceptable ?

or should i avoid befriending clients/patients ?

or should i simply use the PRIVACY SETTINGS more critically?!

these are some things which have gone through my mind, and its not the first time either, but undeniably now more than ever! now that it is being discussed officially in journals and all!

as doctors / medical professionals using these networking sites and blog services, often discuss our inefficiencies and learning experiences, including often our mistakes and shortcomings in patient care! they are all on a personal recollection level!

patients coming across them might feel uncomfortable or doubt the adequacy of our skill/education or even approach towards our career.

the problems might arise when they assume inefficiency on our part when they dont know the true scenario through which students/doctors go through during their medical education.

so its definitely a very relevant issue of discussion, not merely at the prefessional level.

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Night Emergency Duty

so yesterday night was my night ER (emergency room) with samiyah saeed ahmed.

she is one of the hard workers, so i was pretty relaxed about it.

it wasn't very rush-rush in the beginning, around 8pm there were like 3-4 cases at max.

there was an old hemiplegic guy with bedsores! samiyah taught me how to do dressing on that, she's been through surgery posting and i havent yet.

some middle aged lady came with chest pain and breathlessness. had to rule out heart attack and pneumothorax. apparently she was just exhausted coz her relative was delivering a baby in the OBG ward and she was running around a lot for a few days without rest.

her condition was pretty stable and her ECG was normal. yet i just sent cardiac enzymes to rule it out further. according to the consultant, i shouldnt have as it costs NPR 500. not cheap!

some guy from Bhopal, India was touring muktinath in nepal, when he felt dizzy and fell unconscious, was brought later at night. his fellows thinking it was a heart attack, gave him sorbitrate . which was a smart move as a layman, in my opinion! but here, he apparently wasnt having a heart attack and it just lowered his BP and heart rate further! making him even dizzier and faint! :P

he was later shifted to the ICU. i was awake till 4 am and i couldnt take it anymore, so i left to sleep. the doctor's room in the ER is a shit hole! smells constantly of smoke! i dunno how they sleep there!

anyway i left my number and came to my room. next thing i know, i woke up at 12pm next morning :P

i just hope samiyah, who went to sleep earlier handled the morning well.

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Invigilation

4 Days of community medicine exam!

i was on duty in the department on all 4 days.

the 1st 2 days i had ken and vishesh, and the last 2 days i had geetanjali and amitanshu.

we were briefed by rashmi ma'am, who was in-charge of conducting the exams.

basically, from scouting for patients for the examinees to take history from, to organising and managing the rotation of all the students to all the examiners.

basically it was a challenging job demanding decent management skills as well, and i would like to believe we aced it!

we were literally on our toes, running around, helping students, helping patients, helping examiners, from 8am to 3pm! everyday!

i have to say, the help i got on the last two days was much much more than what i got on the 1st two. vishesh was always late and ken was always on the phone!

i was surprised how helpful amitanshu proved to be, and geetanjali turned out an asset for the students!

it was a nice experience overall, feels so great when the students you helped come back to you and thank you from their hearts!

just like i felt for my seniors who were there to help me during my exam days!

thanks to them, i am able to carry forward the karma!

geetanjali and me on the last afternoon of exams, feeling a sense of accomplishment!

rituparno striking a pose, just before his spotters, while sharmila cant help but 'peep' from the background! :P

sharmila couldn't stop singing nitesh singh's praises! apparently nitesh did a great job when he was on duty during their pre-lims.

examinees doing the spotters!

nandu the peon and the cleaning lady chat after the exams are done!

sharmila was never happy with the help she got! she wants more! :P

short stint in the ER

yesterday i learned to suture a scalp laceration!!
yehhhhhhh. did alright.

poor lady fell and hit her head against something and on her forehead she got a nasty 7-9cm long cut and the skull below could be seen! it was that deep!

she got 7 stitches!
prolene 000 suture material.

done with GONESA

done with gonesa after 2 weeks there.

GONESA is basically an italian-funded NGO working for young children in nepal among other things.

this is their little classroom for little kids .

how well behaved, right ?

the clinic at gonesa, with 2 dedicated sisters treating the sick.

this is where i got to do my job. i.e. sit and get bored.

:P

not really, i did see a few ill kids and gave them some medicine.

you see the old one on the right?

MAN, does she talk! :P

Gonesa?

really? seriously? Gonesa (GOod NEighbour Service Association) is a waste of time!?

its been 5 days of posting, there is no protocol for what one has to do there. those people hardly talk to anyone who visits. no instructions about the job, or where to sit or what to do.
its like a complete waste of time. from the people who have already been there, information came that we have to treat sick kids there. but i didnt see any sick kids neither did i see them treat anyone.
weird posting. useless.

galem camp

tough, young men were chosen for the trip to the small village of galem in syangja, nepal.

tough and young because the journey was arduous, and men because the journey was arduous (this sexist bias was the department of community medicine's doing, not mine).

challenge #1 : getting up early in the morning, before the usual time, to leave the college by 7.30am.

challenge #2 : having a quick breakfast before leaving and packing something for the trip, which could last the whole day!

challenge #3 : surviving the winding roads up and down the hills. sitting all cramped up in the tiny back seats of mahindra for 2 hours with a bad bout of nausea.

challenge #4 : trekking up the path, extremely narrow at some parts for an hour plus.

prashanna standing for the picture at a turn on our trekking path to galem village, where a medical camp was organised.


a particularly picturesque spot on the way. a lot of pics were taken here.
we reached the village school all sweaty and sticky. but the pleasant welcome was quite unexpected.

dr. milan is in the picture, an MO from the ER.
all the children were lined up patiently waiting for our arrival. we had a team of 6 doctors from manipal (including 3 interns, and 3 doctors) and a group of people working for GONESA (which is an NGO) who arranged and sponsored the trip.

the garland welcome :)
maoist? :P
how cute is that ?! :) its been so long since i saw kids lining up like in kindergarten!!

an amazingly beautiful setting for the school but very inaccessible !

the path looked like this, a brilliant red colour.

overall, it seemed more of a formality than actually helping out the people. because half the guys who went were not interested, and were reluctant in the first place. i was disappointed because i couldnt take much part myself in the examining and clerking the patients as i was unable to express myself in the nepali language well enough to get through to the patients. so i simply joined team with another guy and watched him do the work, meanwhile trying to check a few kids myself.

the lunch we had was pretty good though. was worried that i ate too much and might have to go poop sometime on the way . lucky enough it didnt happen.

the main time spent was the journey! 3-4 hours one way! we reached home by 7.30pm! 12 hours out! and there was no telephone network!!

but it was lovely to see the villagers all happy and pleased to see us visit! we got nice tokens of appreciation (a hand woven bag) in the end.

the only thing i missed was my earphones, which due to the hurry i forgot to pack. if only i had those the journey would have been really enjoyable.

in the ER

started the community medicine ER shift. so basically i along with rashika, prashanna and anindita go to the ER in the morning and stay till the afternoon.
today i learned how to use that ECG machine they have at our hospital. sadly, these people dont keep any training sessions for new doctors, and neither can you find any instruction manuals anywhere. so its a chore to actually get yourself to learn anything new. but i did it and went around taking the ecgs of 3 patients in the ER today. :) so happy overall for learning something new today.

more babies from the OBG ward

from the nose you can guess this is dr.abhishek's son.
really cute one !



for nan and ma! :)
zat is it for tonite.