Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Author: akshay

  • Losing an Ear-Tip

    “Which is the most important part of a stethoscope?” asked the Professor.
    “The diaphragm”, “the tube”, “the earplugs”, came answers from students.
    “No. The most important part of a stethoscope is the one between the two earpieces”, said the Professor with a smile. 1

    It was a regular “free” day in Orthopaedics. That means you get to eat either breakfast or lunch. I ran to ward at 8:15, after gulping down a cup of milk shook with the chocolate malt powder that my grandmother lovingly packed for me the last time I went home.

    None of the patients had absconded the night before. Which meant all of the five 70+ year olds with femur fracture where sleeping comfortably on their bed. Only those patients whose perpetual complaint of pain were awake. Even tramadol would not help them. The nurse had just arrived. And I started putting notes, as usual.

    All the patients looked alright. So, there was no need to check their pulse. I checked the blood pressure of a couple of the patients who had surgery just a few days back and entered in the respective notes. Rest of the notes would remain the same as the day before. On one side, all the organ systems would be marked normal and the limb would be marked as having active distal movements. On the other side, the advise for the day. Two antibiotics compulsorily bought from outside even if the hospital supplies the same combination. One painkiller. Paracetamol infusion SOS. And a little something to stop these drugs from punching holes in the bellies of these grandfathers.

    Before I finish putting notes for half the patients the post-graduate students would reach and start dressing. Depending on the mood of the nurse she might join in helping them dress the wounds or stay aloof lost in their own tasks. If a student nurse is found standing still for a second, they’re invariably pulled into the business of taking out “sterile” cotton using a “sterile” forceps and placing them on the “sterile” gloves of the doctor who carefully places them on the wound that has just been cleaned of all the dirty pus and other gross stuff that accumulate in wounds.

    I sometimes do seriously wonder whether it is the over-priced antibiotics and the over-done sterile dressing that help the patient or the innate immunity of the patient themselves.

    Anyhow, post dressing, there was rounds. Where each patient is seen and discussed briefly. If you are ever admitted as a patient, remember that rounds is the most important time of your hospital stay and treatment. Almost the entirety of the planning of your management happens during this brief encounter between the doctors and the patient. If there’s something that bothers you, you better keep repeating it to yourself to blurt it out during the rounds.

    During rounds some orders would be made. Ha, get another X-ray done on this knee. Get the side view. Get the distal joint. Easy enough. The patient can’t walk. Sometimes, they can’t even sit. So you would need a trolley. But they aren’t motorized yet. So you need a worker to push. And that’s the most difficult part. You have either one or two workers at your disposal. And they have to do all the work in the ward beginning from cleaning and not ending at making sure everyone’s shaved and prepared for surgery. It’s largely unknown how they set their priorities. They might help your patient get an x-ray. But that might not happen before noon. Maybe they can be bribed into getting it quickly. But should you pay or should the patient? There are no clear answers. The best way forward would be to tell them and remind them and ask someone else to remind them and then come back and confirm they’ve indeed done what you’ve pleaded them to. And that’s what I did.

    It was past lunch-time when I finished ward work. So I went to Ruchi mess for lunch. That’s the one our ortho post graduate likes. Food is really important in orthopaedics. If you don’t eat some chicken bones, you can’t fix broken bones. After food, I went back to hostel. Because there was no point going back to hospital in the afternoon anyhow. It is not like any work will get done because you are there. So you might as well go back to hostel and enjoy the rare few free hours you find.

    Going to hospital during dusk is comfortable. You don’t have to wear shoes. So you don’t have to wear the socks that haven’t been washed in weeks. You can wear jeans if you like. If you think you’ll need it, take a stethoscope. And that’s the biggest mistake I did that day.

    I took my stethoscope. And I put it in my trouser pocket. And I rode my cycle to the hospital. I was pretty sure the stethoscope was fine when I left. But when I reached, and put the stethoscope around my neck, it was missing an ear-tip. Yeah, the black round cushions at the tip of the steth that makes them wearable. I imagine these preventing a hole from forming on my tympanic membrane when I wear a stethoscope.

    So I lost an ear-tip. And there’s no wearing a steth without the ear-tip. Without a steth, you can’t measure BP. (Not really. That’s a myth intentionally spread to make interns feel good about having to measure BP. I am the only one with the steth. Only I can measure BP. I am doing valuable work.)

    I knew it was going to be a sad day. Because misfortunes do not come singly. This would be the beginning of a series. I was pretty sure there were more things waiting for me in the hospital.

    The hospital was calm. As usual. There were not many people in the ward. At least, none of the patients had a family of 20 around the bed. THat’s a good sign. Because if there’s a family, there’ll always be a family guy among them. And he will definitely have a couple of questions about “is my relative going to get better?”, “why is the pain not going down at all?”. These are questions that do have answers. But I wouldn’t want to give those answers. I would just want my work done.

    Turns out the x-rays were all done. I don’t know who paid whom. And almost everyone was “fit for surgery with low risk” from medical side. And nobody had any complaint. Nothing was wrong. That means, I can report to my seniors that everything is spot on, and go back to hostel and have a good night’s sleep.

    If only I hadn’t lost the ear-tip. Because I might not have needed the steth today, but I’ll definitely need it tomorrow. Maybe I had a couple of spare ear-tips in the box that came with the steth. Hmm, anyhow I didn’t have the energy to go to a surgical shop to buy a new set. So the spare set better be in the box. I just cycled back to the hostel.

    And on the way, just as I crossed DD Urss road, about 400 metres from the hostel, there was something black on the roadside. I stopped my cycle and took a closer look. It was an ear-tip. My ear-tip. Maybe a few cars went over it. But it’s not broken or anything. I just have to clean it with spirit and put it back on, like nothing ever happened. Happy. My stethoscope was happy. I was happy.

     1 This joke probably originated in Trivandrum Medical College because it was my dad who told me this. It’s also documented in this article in The Hindu.

  • Disillusionment

    After graduation, almost everyone I know went away to different so called “coaching centres” for getting into a preferable post graduation seat. I was uncomfortable with the way health education works at colleges and at “coaching centres”. So, I went away to Malki hoping to figure out everything.

    Daktre was waiting with a vane to fan the fruit flies away. We talked for an entire afternoon and evening (and the next day morning along with my community medicine professor).

    Several trains of thought departed at that station. Here are a few.

    Who am I?

    I am a self-described narcissist. The question though is, is my narcissism clouding my judgement about my abilities and possibilities? Is it making me go in directions that I would not want to if I were to think clearly without the pressure of having to be “me”? The “me” here is also questionable. Stereotypes are bad. If I have an idea of “me” it means that I’ve stereotyped myself into something. Stereotypes limit what we consider as possible.

    Is my “discomfort” with entrance coaching, medical education, etc stemming from my own sense of me being a person who goes against most of the mainstream things? Am I going against most mainstream things because “I go against mainstream things”?

    I think the answers to many of these questions are inseparable from the nature of reality.

    Do not mistake the horse for the cart

    But we don’t need to answer many of those questions. There are people who follow the crowd and do great things. There are people who don’t follow the crowd and do great things. There are people who follow the crowd and do meagre things. There are people who don’t follow the crowd and do meagre things.

    Doing “great things” is my cart. That’s what I want to do.

    How I do it, is just the horse.

    And it doesn’t matter which horse we are riding.

    What do I want to do?

    It is funny I haven’t defined “great things”. Because I don’t know what I want to do. I want to do good. I want to be remembered. I want to make life simpler for a lot of people. And I want to satisfy my own intellectual curiosities.

  • Bye Bye Mysore

    An incredible journey has come to its natural end. I started this blog more than 5 years back while waiting in college for my admission procedures. The things that transpired in these 2048 days, I could never have imagined.

    The journey doesn’t end here though. I am going to continue writing about the funniest things that happened during college, especially during internship. And I’ll be writing about all the new things that happen in my life as a doctor.

    Now, it’s time to move on from the hostel. Bags are packed.

  • What’s up?

    It’s been a busy 9 months of internship. So busy that I had to take a casual leave to update this blog. No, just kidding. The CL was just a coincidence. (I couldn’t finish this post on that day. I’m now writing this in the free time at psychiatry department). It is just my incredible inability to do more than one thing at a time that’s keeping me from all my extracurricular “responsibilities”.

    It has not gone waste though. I have been carefully considering the lifestyles that various specialities in medicine would afford me. Such as the busy anaesthetist surrounded by his monitors who can get an adrenaline rush by adrenalizing a collapsing patient or the pulmonologist in his roomy consultation room auscultating chest after chest after chest.

    Blessed is the radiologist who can sit on his computer all day. But imagine being an obstetrician inserting his finger into the unseen insides of strange vaginas day after day.

    I know my priorities. I want a lot of free time (which will go to the web). I also want scot-free holidays (for travelling and attending events). I don’t want a career which ties me down in a robotic routine.

    Psychiatry sounds interesting. So does community medicine. Not to forget radiology.

    But at the same time, I don’t want to settle for a comfortable routine of mediocrity. I have been led into believing that human beings are capable of doing great things.

    What if there is a future for computers in health care? What if there’s something that could be unlocked only by a doctor who understands the possibilities of programming?

    What if the next breakthrough in artificial intelligence has to come through an intimate understanding of the mind – both normal and abnormal. We could be thinking about our minds in a completely wrong way and maybe that’s why we think consciousness is a hard problem to solve.

    If I end up as a regular doctor, who will ask these questions? If someone has to ask these questions, why not me?

    Maybe I should hook myself up to the ECT machine behind me and jolt my brain into senses. Maybe I already make sense.

  • Why would Kashmir want to stay with India when they don’t even get access to internet like the rest of Indians?

    India is brutally restricting access to internet in Kashmir. And like marital rape, suppressing a citizen’s basic rights this way is legal in India.

    There are complex geopolitical issues in Kashmir. But, what wrong did internet in Kashmir do to be treated like trade with an enemy state?

    There is a class of Indians who conflates the cloud with clouds in the sky and internet with Pandora’s box. They know internet only as a replacement for their porn CDs and a medium for terrorists to coordinate their strikes. It is probably the same people who banned internet in Kashmir and keep it that way.

    Internet is a wormhole in your basement which lets you explore and experience places and cultures that you can never otherwise in your life. Internet is full of opportunities that are limited only by one’s imagination. Internet gives answers that you can find nowhere else. Internet can teach you anything from cooking to neuroscience.

    Internet is a great equalizer. It empowers the disempowered. It does not care whether you are rich or urban middle class, Muslim or atheist, gay or bi, left-winged or religious fanatic, above 18 or just lying to be; you are what you say you are. And when Twitter is down, it is down for everyone.

    Also, internet is so huge and powerful that knowing how to wield it is a skill (called “web literacy”) in itself. There are problem areas inside internet that one needs to be aware and careful of. One needs to learn a great deal while using internet to be using it effectively. Internet is not for the ones who give up easily.

    Perhaps, India has a huge bunch of web illiterates. Perhaps, that is why they think blocking internet in Kashmir can be of any good. For, little do they realize the value of the greatest innovation of mankind (after the wheel, of course) that they so comfortably withhold from Kashmir.

  • Haridwar

    This notorious place. Do anything you want, but never eat a thing from
    here. They are probably taking all their water from the E-coli filled
    dirty sacred holy river Ganga. We had no plan to eat at the bank of the
    river, but it rained and we got trapped near a place and we ate some and
    the story turns worse.
    But before that, we had some nice
    time walking by the side of the river. We had reached the Haridwar
    railway station by afternoon. And the Russian would leave for Delhi in
    the 18:15 Shatabdi Express. He was particular that he goes in an air
    conditioned train because of what had happened on our journey from Delhi
    to Dehradun. All of us had something to cover ourselves with, except
    him. We were in sleeper compartment. He went to his berth like a Russian
    and we assumed Russians were resistant to cold. Turns out they aren’t.
    They just have excellent warming systems in their place. So, the outside
    temperatures might go below zero, but inside the homes are warm. And in
    the morning all of us had woken up from a good night’s sleep except
    him. So he couldn’t miss this AC train to Delhi.

    But we
    still had some time to pass before the train would arrive. There were
    so many police officers deployed in the railway station. Turns out it
    was indeed a special occasion and we would have cursed ourselves if we
    had reached there a day later. It was going to be an ‘ardh kumbh mela’
    next day. Means a lot of devotees running to the river. Anyhow, we
    walked perpendicularly towards the river.

    The banks
    were surprisingly calm. There were a few devotee groups sitting here and
    there. People dressed like Lord Shiva kept walking by us. The river was
    mighty, filled to the brim. We walked more than a kilometer like that
    and took enough photos on the way. After all, the river is a river.

    Panorama

    We
    were walking towards a huge Shiva statue. But it was too far for us to
    walk to and it appeared to be on an island all by itself. Instead we
    decided to go to this part of the river where they would float lamps on.
    We were there, but it wasn’t time yet for the devotees to come in
    masses with the lamps. So we decided to check out the shops on the
    parallel road. This is where it rained and we got charmed into eating
    thalis and kesari from a dhaba.

    When the rain
    subsided, it was time for the Russian to leave. We dropped him back at
    the station waving him goodbye. On the way to the station we had nice
    warm tea at another shop too. And then we came back to the place where
    the lamps would float.

    The lamps had started floating.
    There was a small mandir on the bank where people would fetch these
    from. There also was a monkey on its roof trying to steal the bananas
    offered to the God there being rattled away by the priest. Then there
    was this set of people standing in the river with water up till their
    knees. They would use a piece of glass (or transparent plastic?) to look
    through the surface of the river on to the bottom and pick something
    from the bottom using their long magnetic stick. Turns out, coins. Look,
    pick, transfer. Repeat.

    We observed them and the floating
    lamps for a while and then walked around the city. There was a Chinese corner where we had noodles and soup. Night had fallen and that would be our dinner. We then walked to the riverbank again. There were cold seats to sit on. We sat with the breeze hitting us hard and the mighty river tempting me to jump into and die.

    After a while, we went back to the railway station. They had a
    waiting room upstairs. Filled with people though. We spread a newspaper
    and sat outside. Our train was coming only after midnight. I slowly drifted into sleep.

  • Mussoorie

    We reached Mussoorie around 4 o’clock. Although we saw the youth hostel
    on the way we weren’t sure if they provided accommodation and it was a
    bit far from all the places we wanted to trek to. At the bus stand an
    agent approached us asking if we wanted rooms and then led us to a
    nearby hotel where we got a large room where the 4 of us could stay. The
    Russian asked if a room warmer was available. It was, at ₹200 extra. We
    went for it and that decision was a lifesaver as you will soon come to
    know.

    By then the Sun was going to go down and we didn’t
    want to waste that day by not going anywhere. I calculated the distance
    to various places we could go to and settled on going to Everest house.
    The distance could be covered on foot in about an hour said Google Maps.
    But that hour easily stretched into two. I’ll write about how
    GPS-enabled/dependent our treks were in a later post.

    We
    did get lost once and reached a high-security hotel with dogs that
    would look like they could rip you apart. But we retraced, walked, and
    stomped our way forward. At about 800m to Sir George Everest House you
    reach this cafe called Seagreen. It was really dark by then and so we
    decided to go to the Everest House first and then go to the cafe on
    return even though we were really hungry and hadn’t had any food (I had
    promised my travel mates that there were so many restaurants on the way
    where we could eat from, but turns out the map is different from
    reality). Here, two dogs joined us on the upward climb.

    The
    climb is steep but there is a clear unpaved path upwards and although
    it was dark we had enough moonlight to see our way. The dogs – we named
    them Schwanan (Malayalam for dog) and Hillary. We were so late that the
    tiny shops on the sides which would sell soft drinks and noodles were
    closing down one by one. It was still wonderful how there were people
    running such shops everywhere. Schwanan was leading the way at times and
    at other times slowing down to catch up with Hillary who was trailing.
    But I realized that day that these were probably the descendants of
    those very same dogs which gave Sir George Everest company when he
    climbed that hill to set up his house on top.

    And then
    we reached the house, quite literally at the top of the hill and at the
    edge of the land. But to call it a house would be a mistake because all
    that remained were a few walls which have now been written over with
    names of couples inside huge ❤ symbols.

    And then there
    was a surprise. There was light! There were the Himalayan mountains far
    away glistening in red, orange, and all the colours of the setting Sun.
    The horizon was a rainbow between the starlit dark sky and the snowy
    white mountains. We were the only people there, the last trekkers of the
    day. The 4 of us and Schwanan. Hillary had gone away somewhere else.

    We
    spent only about 15 minutes on the top because we were hungry, it was
    getting cold, it was getting darker, and we had taken enough panoramas
    and selfies and timer shots. On the way back, we had to intermittently
    shine a fridge market torch one of us had to make sure there were no
    snakes or holes. And we did stop here and there to look at the stars and
    make out random constellations that didn’t even exist.

    As
    we had decided we took a break at Seagreen Cafe where we had a large
    pizza and hot coffee. More importantly they had a room warmer which
    worked on coal maybe and we took a lot of warmth from it. Working on his
    tablet was a fellow traveller who was spending some time in North India
    before flying to Scotland to meet his girlfriend. We waved him goodbye
    and walked back, trying and failing to hitchhike. On the long way back
    which felt shorter, the 3 of us who were Malayalis sang some of our boat
    racing songs to keep us going faster. When we got tired, the Russian
    taught us his marching songs too. We reached our rooms and slept
    peacefully with the warmer first on, and then off.

    This is where warmth comes from

    For
    next day, I had decided that we would trek to a “Tibetan Buddhist
    Temple” which looked good in photos on Google Maps. We woke up early,
    had breakfast and started walking. We weren’t even a kilometer down when
    it started to drizzle slightly. We walked on till the rain got heavier
    and we had to find shelter in a building on the roadside. As we stood
    there we tried to find a hike to the temple but unfortunately it was too
    early in the morning and there were no vehicles going that side. The
    rain gave in slightly and we continued to walk. checking off landmarks
    to make sure we were on the right path. But then, all of a sudden there
    was heavy downpour and our woollen clothes were absorbing all the water
    like a camel at an oasis. We tried taking cover again, but by then we
    were so wet and so close to the temple on the map that we decided to
    brave the rain.

    There was ice on the road. It was a
    hailstorm. There was water everywhere. Our shoes were wet despite our
    best attempts to not step on water. And the hail was hitting us hard
    too. Anyhow we reached the Buddhist temple. Like the rain wasn’t enough,
    the temple was closed that morning. We could not go inside, but we
    could take photos from outside and see the valley. As I was trying to
    take a picture of the temple, I realized to my horror that my fingers
    were getting so cold that I could not bend them to click. It was the
    case with everyone. We were going to die probably while still searching
    for an open cafe to buy some warmth.

    This was everywhere!

    But there was a
    saviour. The language teacher of a Tibetan school there was going to
    Chandigarh in his car. And after removing all the hailstones from his
    car’s windshield he was willing to drop us back to the city. We jumped
    in and he turned the AC on to full heat, dropped us near our hotel, and
    we ran to our rooms after thanking him and wishing him a happy journey.
    When we reached room we were drenched and shivering. The only warm thing
    in the room was the warmer and we sat around it warming our clothes and
    body in turns. The wet socks were fuming. Shoes definitely had to be
    dried. The room service brought cups of tea and we had bought some
    bananas on the way. After about an hour we were dry enough to pack up
    and leave.

    We had brunch at a nice warm restaurant just
    above the bus stand. It was still raining. The Mussoorie Library were
    Ruskin Bond is known to frequent was right next to us but we were in no
    mood for reading. The buses to Dehradun are the same buses that come
    from Dehradun. We waited for about half an hour and got our seats back
    to Dehradun.

    As soon as we reached the bus stand I
    realized there was a train about to leave from the station – the
    Dehradun Allahabad Link Express. We ran to the station and made sure the
    train hadn’t left and then ran to the ticket counter which is outside
    the platform and took tickets and ran back to the train and got in to
    the general compartment and the train started, all within a span of ten
    minutes. The compartment was full and the Russian got the taste of
    general compartment journey and we alighted at Haridwar.

  • Dehradun

    The Delhi Dehradun express stops for long time at various places and
    reaches Dehradun by 9 in the morning. We woke up by the time the train
    reached Haridwar and saw dried Ganga on the way.

    At Dehradun railway station, you can walk outside to the
    Dehradun bus stand where there are half hourly buses to Mussoorie from 6
    in the morning to 9 in the night. We walked further, had breakfast, and
    walked through the market to reach clock tower. From the clock tower a
    small bus took us to Forest Research Institute at ₹10.

    There
    were a couple of other tourists waiting in the electric cart at the
    entrance. We quickly bought entry tickets and sat on it. I was at the
    tail, looking back when the cart went forward. The straight road cut at
    right angles to several buildings, all in lush green plots.

    The
    cart dropped us at one end of a large, imperial building built of red
    bricks. This was the Forest Research Institute. Some of the corridors
    reminded us of Hogwarts.

    See?

    There were multiple
    “exhibitions” inside the building. The entry ticket would cover all of
    them. But the exhibitions were rather the various departments of the
    Forest Research Institute. For example, there was this pathology
    exhibition, in which the pathophysiology of all the plant diseases were
    shown (with pathological specimens just like our medical college).
    Siviculture exhibition was about cultivating forests and there were tiny
    models of forests showing how the trees looked at different height. In
    another room, there were cross sections of 800 year old trees showing
    tree rings that corresponded to different years in the history. One of
    these rooms, I heard about cordyceps sinensis which is a fungus
    that parasitically grows out of worms apparently more expensive than
    gold and extremely difficult to procure.

    A nearby
    school had come for picnic there and when we got outside the Institute’s
    garden was full of kids playing different games in their own little
    groups. This is also where our Russian friend saw someone posing in one
    of the classic Bollywood hero poses and imitated those himself. We
    started walking back and got on to the electric cart about a minute down
    the path. Then we took a vehicle back to the Dehradun city back to
    where we started from.

    At the bus stand, there were
    regular and frequent buses to Mussoorie. All we had to do was stand in
    queue and reserve seats in the next bus that was going up. The ride is
    just under a couple of hours but the road is winding and uphill.

  • Surgery – the rush

    Wednesday: OPD

     My first OPD.

    Showered and left early to the ward to finish work there and be at the OPD on time. It was a continuous rush of patients from 9 o’clock till the time PG asked me to go have lunch.

    There was everything – Road Traffic Accidents (RTAs), healing and non-healing wounds to be dressed, deep gaping wounds to be sutured, pain abdomen of various kinds.

    My first sutures were on the leg of a patient. Neat 3 of them (or 4?). Dr Mayank encouraged me saying “You’re a surgeon, ha?” But those were the easiest sutures that day.

    While we were incising and draining abscesses, dressing more wounds, etc. a serious RTA patient came, unconscious. The PGs took direct laryngoscope and intubated him, called up ICU duty doctors for emergency, gave a slew of drugs, gave CPR multiple times, etc. But he couldn’t be saved. I was pressing on the AMBU bag for a while and I don’t even remember when I handed it over to someone else.

    Nothing would stop more patients from coming in. The rules of work applied quite strongly here. Nobody else would do our work and we had to do them sooner or later.

    After lunch, the rush mellowed a bit. But there was still work for everyone. Students filled in holi colours needed suturing. Quite close to the eye. I was scared to touch the temporal artery. Left it to PG.

    While debriding a wound in another patient there was a bleeding artery. And the PG just ligated it in a second.

    Evening came in quite soon. We had one patient with pain abdomen and history of typhoid fever that we had to do an emergency OT for (for intestinal perforation). I went to the OT, submitted the list. There was an orthopaedic surgery going on from 3 apparently which was still going on to go on till 8. Our patient would have to wait for that to be over.

    Things like these and it was night quite soon. I stayed in the OT to watch the laparotomy and saw the surgeons closing the ileal perforation. They biopsied the edge of the perforation which I sent for evaluation. I went straight to a hotel from there to have dinner. It was 10.30 in the night by then.

    Back in the OPD there were only occasional cases coming in. By now, the casualty OT became the place for Ortho, ENT, and surgery. We had a few more road traffic accidents and assault later in the night.

    There was a child who had a scalp wound and there was a lot of blood draining and turns out you can stop bleeding and suture all in one.

    There was a goonda gang in which one person got hit by a wicket and had a wound on the scalp. I had to suture it and the scalp was pretty thick but somehow I managed to get one suture through. The rest had to be put by the PG. I would later realize that I should have been locking the needle holder every time I hold it for better control. The entire gang came in to take photos while I was dressing this guy up and I had to ask them to go outside (because they were scaring me).

    Around 12, the PGs gave us an algorithm to manage cases that come up in the night. Mostly pain abdomen. We then started taking turns to sleep. I slept from 12 – 4 in the Unit Chief’s room (where there were 3 others sleeping, including one on the table).

    After 4 there were only three patients who came in, with pain abdomen. I managed them and it was morning by then!

    Thursday: Dressing

     At 8, Abdu would come back from sleep and let me go to hostel to become fresh. I rode my cycle slowly, took a shower walking like zombie, and came back. I had to go to the endoscopy room to write down the reports. Saw the duodenal opening of stomach and ?Ca esophagus and things like that.

    Joined dressing after that.

    If I remember correctly I gave a blood transfusion today for a patient with lipoma in his forearm and low haemoglobin.

    Friday: Good Friday 

    There was no OT today because “Good Friday”. Went to JK grounds in the morning for our second match in Kreida ’16 football. The first match was on Wednesday morning which we lost 0-1 to 2k14. Today we drew 1-1 with 2k15 and our only goal was on technicality (the defender touched the ball while it was a goal kick and we kicked it into the goal and something along that line).

    Today I had two work after dressing. One was to monitor hourly the
    abdominal girth of a patient whom we are suspecting intestinal
    obstruction. And the second was to give blood transfusion to a patient
    who was losing blood in stools and had grown pale.

    The latter guy didn’t
    have any attender but I took his consent and started blood transfusion.
    The sister scolded me a lot for this because apparently if something
    happened to him the question that would be asked would be “Why did you
    do blood transfusion without having an attender? Whom did you ask before
    doing so?” etc. Apparently, patients can’t make decisions for
    themselves here. Weird world. Anyhow I’ve decided no more blood
    transfusions without permission of the entire family.

    The former guy also needed a Contrast Enhanced CT scan so we could confirm it is intestinal obstruction and figure out a cause too. I was supposed to talk to the radiology department and get it done on an emergency basis. His creatinine, urea, etc were normal so there was no contraindication for using IV contrast. But it was 1 o’clock by then and they asked me to come and convince the next day’s staff.

    Saturday

    This day from morning my work was to make sure to get the CT done. I managed to convince today’s staff even though they first said that surgeons should be bold to open the patient since the X-ray showed clear signs (multiple air-fluid levels) of obstruction. Nevertheless, they fixed 2pm as the time and asked us to be punctual or forget the CT. We got it done and there was indeed obstruction and some free fluid in the peritoneum with nothing much except these in the report.

    Sunday

    We did emergency surgery for that person today and saw that there was a perforation which led to peritonitis which led to ileus which lead to obstruction and distension of abdomen. There was a lot of suctioning of fecal matter to be done before the abdomen was closed.

    Monday, the 28th

    Major OT. Meanwhile the patient with blood in the stools got esophageal banding done in the endoscopy room. Now the esophagus can’t bleed any more. But he still has to find an exchange donor for the blood I transfused him.

    In the OT we had a lot of cases. Goiters, Thyroglossal cyst (sistrunk’s operation), the lipoma in intramuscular plane in forearm, Ca Breast, Appendicitises, Haemorrhoid, and a hernia.

    By the time I took the case sheets from the anaesthesia PG the rounds were over and there was no work left.

    In the night some of us went to Kalamandira to see this drama called “Top” (in Kannada) which nobody understood (even Kannadigas).

  • Surgery – feeling comfortable

    On the first day my PG had asked me “Hey, how do you like it here? Feeling rushed and busy?”. I replied “it’s okay”. I like rush. I like having a hundred things in my mind. But I like it only when I feel comfortable and confident about the things I have to do.

    And on day 1 I wasn’t so comfortable. I didn’t know what to do and everything had to happen in a jiffy. But over the next few days I started feeling comfortable. I had this aha-moment when I realized “Aha! It’s all about the patient. Our duty is to make life the best for our patients.” And if we think from that perspective, everything becomes easier.

    Saturday: Dressing

    Dressing is required for most patients with large wounds and especially diabetic patients. Wounds tend to get dirty with dead tissue and pus (promoting bacterial growth) and debridement ensures there is nowhere that bacteria can grow comfortably. But good debridement is a difficult skill to achieve.

    I’ll write about hydrogen peroxide, povidone iodine, spirit, sterile gauzes, pads, gloves, etc on a later day.

    Sunday: Free Day

    This is a relaxed day where we don’t have complicated cases to monitor. After rounds, the entire unit went to have tea. Back in the wards I asked my PGs whether us interns had to come back later for rounds. They said “Yes, come for evening rounds at 5.30 and night rounds at 8.30”. I asked them, “Oh, so 3 rounds in a day?” “No, there’s also another at 10.30pm. Coming for that?”

    That evening the seniors were hosting “Summer Dreams” their graduation day. It was a nice night. Dr BM Hegde was the chief guest and apparently didn’t have any eccentric thoughts that night. I missed the movie the seniors made because I was helping the Malayalis edit the audio track for their dance. And that dance was simply superb. Later I was managing the computer playing the karaokes and songs, working together with Ganesh, like all these years. Met L.I.‘s super cool mom while having the “high” tea which became the “long” tea because of the queue.

    It was during the graduation day dinner that most of us saw each other for the first time properly after internship started two days back. And that’s when I realized that we had to sign in an attendance register in the office every day morning. People who were doing night duty were sneaking in and eating while we were leaving quickly to sleep early to report for duty on time next day. Gone are the sleepless nights of student days.

    That day when I woke up I had a very weird dream. I was vomiting into a tub in which my PG had vomited already and which was actually meant for the patient whom we had just put Ryle’s tube to vomit into. Brain seems pretty absorbed.

    That night I was reading this “House officer’s survival guide” which helped me gain more confidence.

    Monday: Major OT

    In Major OT there are no local cases. So, there’s no need to give test doses. Or rather, the anaesthesiologists will take care of that part. I ran to the wards to take BP before the OT starts. Didn’t forget to sign the attendance register today (for all three days). But we still haven’t given the reporting letter that the unit chief signed on the first day to the office.

    Today there was one multinodular goiter and one pleomorphic adenoma of the parotid gland being operated. Actually there was another MNG in the list. But it was too late and this surgery was postponed. When I asked the PGs though, they said “Sir said we will do it in the ward itself. Didn’t you examine the swelling, it is a single large swelling, isn’t it? So we’ll use something called a crow’s leg and put it in between and pull the swelling”. Very funny.

    That night, Fadnis brought his brand old Yamaha RX 100 motorbike and we had one square round around the hostel wroom vroom.

    Tuesday: Wards

    Nothing special in wards. Checked BP and pulse. Then, turns out, there was an emergency surgery for a burst abdomen early this morning for a female patient. She was in surgical ICU. I had to give her a blood transfusion. Yes, that would be my first. But turns out the lady had not passed urine either. So I had to catheterize her too. I had learned how to do it, even watching a youtube video previous day, and so I did everything correctly till the actual insertion of catheter into the urethra and then I couldn’t find the urethra. Finally the sister came to my rescue finding the urethra, inserting the catheter, then filling the balloon with water, connecting urine bag, etc.

    Then I got the blood from blood bank (like I had done it previously in
    paediatrics) and the sister again  taught me how to cut the outlet,
    prick the sterile transfusion set into it, and start transfusion without
    spilling blood or making it all unsterile. Not to forget, I got the consent signed before the transfusion started. I then started monitoring the patient continuously for any signs of adverse reactions. There wasn’t any.

    Before we left, the sweet sister gave me and Abdu and even Abhishek a piece each of the kalathappam she had got as gift from a Malayali PG.