Blissful Life

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

Author: akshay

  • Surgery – fitting in

    On 18th, we made mental calculations about which surgery unit we would be posted to, when they would have OT, etc. and then reached surgery office around 9. There was a table full of dates written against our names according to which the first half would have general surgery straightaway, being divided into units in order (A,B,C,D,E,F,A,B,C,D,E). The first half of the other half would be in Anesthesia. 3 of the remaining people would be in pediatric surgery and the last 3 would be posted in neurosurgery or plastic surgery. As expected, me and Abdu were in C unit of general surgery (headed by Dr Madhu). (After all the diarrhea cases we took together in pediatrics, one more joint venture for us).

    Right next to the postings matrix were the wards displayed. I saw that our unit had the wards 10 & 15. I headed to 10th ward and there on a chart paper was displayed prominently what days were what for our unit – “…Friday – OT…” it read. And we ran to the operation theatre.

    Friday: Minor OT

    I quickly changed into  OT scrubs and went inside where the PGs were preparing cases and waiting. I introduced myself and was asked to first report to our HoU. By then Abdu came and we saw the anesthesia interns sitting and writing letters to their HoD and we wrote a letter each too. When Dr Madhu came in, he congratulated us on passing and asked us to work hard and signed our letters saying we did report on 18th.

    Then the OT work started. Our main work in the OT is to enter surgery details in the OT register, send specimens for histopathological examination, give test dose of local anesthetic (patients come directly from OPD to minor OT to get minor swellings, etc removed), watch surgeries and try to learn, and be around and be helpful (help surgeons scrub in, get vicryl, spirit swab, etc, bring tablets, injections, etc from the patient’s attenders outside, collect case sheets, attend phone calls for the surgeons, etc).

    I knew how to open vicryl without making it unsterile. And that’s all I knew. One of our nice PGs, Dr Pradeep, taught us everything else.

    First, we get a plastic container from the patients’ attenders to put their specimen in. We also get the ubiquitously useful Transpore™ (which is a surgical tape that you can tear with your hands). Then, as soon as a thyroid nodule, appendix, cyst, or swelling is out, we take them in this container, add formalin to it and label it. Subsequently, we fill the “histopathology requisition form” with the details of the patient, the specimen, the preservative used, etc. and brief history which we give the patient’s attenders outside along with the specimen so they can take it to the pathology department for evaluation.

    For patients coming from OPD to get their swellings removed under local anesthesia, we need to give a test dose of the local anesthetic to ensure they don’t have an allergy against that. I saw Dr Pradeep doing 5 of these in less than 2 minutes and I did the next 2 in 2 minutes each. Spirit, 0.5mL in syringe, push intradermal, withdraw, throw the syringe and needle. Repeat.

    Inside the OT that day we had a laparoscopic appendicectomy, some thyroid swellings, and many swellings here and there. I was too dazed that day to remember anything. But I do remember assisting in excising a cyst in the arm of a person. Mopping up blood, cutting suture thread.

    After OT, the PGs made sure we ate puffs before running back to our wards to do a quick round. Around each bed the faculties would be on the right side of the patient, the PGs on the left, and us interns and nurses at the foot of the bed. The senior PGs briefly present the patient’s condition and the unit chief gives orders on what to do for the day for each patient. One patient was just being shifted from OT and I was asked to put a Ryle’s tube for that patient! I was stunned but the PGs told me they would help. Then we went to the female ward and the PGs put Ryle’s tube for a patient there (which she kind of aspirated first).

    At the end of the rounds, the unit chief asked us interns to split ourselves in between our two wards and exchange after 15 days. I decided to stay in the male ward where I waited for the PGs who disappeared to put the Ryle’s tube for my patient. They were surprised to see me waiting when they returned and put the tube swiftly. Then, I was about to be asked to put a urinary catheter, but that patient didn’t need it.

    The PG then told me that the primary duty of house surgeons is two things – BP & BT (Checking blood pressure, and making blood transfusions happen.) I was supposed to go to hospital by 8.20 next morning to check the BP of all patients.

    That day was only the first day I started skipping lunch. Maybe the energy and enthusiasm that first day brings, I didn’t even go to Aroma bakery for an egg roll. Back at hostel I realized that I would be scared of not knowing how to do catheterization, how to give blood transfusion, etc that I better do it quickly and be comfortable about doing it again. I would soon get a chance to do both.

  • Rules of Work

    I had one day of internship under my belt before the actual beginning date of internship on 18th March. This, thanks to my senior who had to prepare for his fantastic dance item for their graduation day on Friday (19th).

    Even before that, on 12th, when the final years organized a “summer slam” fun event for seniors, I got one hour in paediatrics emergency (receiving) ward alone (with PGs). That is when the PGs taught me how to manage fever, cold, diarrhea (+dehydration), etc; with dose conversions for pediatrics. In there, though, an intern’s main task is to monitor the children continuously. Check their SpO2, check their BP, check their pulse, check their respiratory rate and make sure they are all healthy. When checking for SpO2, if the fingers are too small or the child is too wobbly, you can use the toes. I wrote down all numbers in case sheets and it took more than the hour I was supposed to stay there.

    But then, on 17th, when I was in the same ward from 11 o’clock till evening, things were much more fun.

    Thalassemia. There were two major children that day. I had to fill their case sheet up, making sure to not miss an enlarged spleen while doing the per abdomen. The PG collected 4 blood samples each from them. Apart from cross matching sample and complete haemogram (+peripheral smear) sample which they needed every month when they come for transfusion, that day we took a sample each for ICTC and HBsAg – because they are at risk because of frequent transfusions. After despatching the parents with the samples (especially to the blood bank with a requisition letter indicating the blood group), I had to fill up the thalassemia registers – one to just note down every patient who comes with thalassemia (to track down thalassemia), and one with dedicated pages for each patient (to track down the patient).

    By then the patients would have returned with the requisition approved from the blood bank so I can go and collect the blood. And they have a thalassemia register too (apart from the normal blood register and requisition register). In essence, everything is written down everywhere. The blood bags will be readied with name of the patient, blood group, donor number, and so many other details. I have to carefully enter those details in all registers checking they are all right. But, first thing to remember is, remove your shoes while entering the blood bank.

    Back at the hospital the blood must reach ambient room temperature before being given to the patient and if it takes a long time before you can start transfusion put it in the fridge like I did. One of my patients didn’t have a IV catheter yet and I didn’t know how to put one yet and so I had to wait for my seniors to reach at 4 before starting transfusion. But, as you will read in the below paragraphs, it didn’t start at 4 as planned.

    Mantoux test. This one is simple. Take an intradermal syringe (insulin syringe?), take the tuberculin from the refrigerator. 5 TU (tuberculin units) (0.1mL) is all we need. Give it intradermally to get a small raised area. Draw a circle around that with a pen so there’s no need to hunt for it when reading the reading between 48 and 72 hours.

    Sedation. Kids who need MRI scan can bob their heads in all directions to confuse MRI machines. To prevent them from moving you inevitably have to put them to sleep. Either do this naturally or with lorazepam. Pushing drugs is tricky. First you block the backflow through the catheter by holding firmly at the wrist. Then you open the catheter and attach your lorazepam syringe. Then you unblock the vein at the wrist and push the lorazepam slowly. Then block again while you remove the lorazepam syringe and attach the saline syringe. Push the saline so that the lorazepam goes inside all the way and not stay at the catheter. Finally, you close the cap while the kid slowly goes to sleep. All this is wasted if the kid wakes up by the time they are inside MRI machine. And that happened to my patient thrice that day.

    Death. I was learning how to put a venous catheter from the senior intern who came at 4. And then, this baby came with “difficulty in breathing”. And while I was putting the pulse oximeter on the toes I realized it won’t show anything because the senior put the stethoscope on the cardia and there was no activity. They then threw torchlight into the eyes and there was no pupillary reaction. All I had to do was stay back while my senior asked all the relatives to go out and called in a male relative to whom he broke the news. But the whole family knew within minutes and there were some cries but I was lost in writing thalassemia registers by then.

    Work. It was getting late and I was staying longer than I had to, so I just reminded my senior who was taking over about the blood transfusion and slowly left and that’s when a parent whose child wasn’t sleeping under MRI machine came to ask for a doctor to accompany and give sedation. My senior asked me to leave nevertheless saying it’s not my duty time. And just as I was outside, I was called by the intern I was replacing because he was called by the PG to accompany the patient and give sedation. And there goes rule #1:

    Do not run from work, it will come behind you.

     So I went back. Filled syringes with lorazepam (the senior intern filled this and I’m still confused about the dilution) and saline. And went with the parent to reach the radiology department. And there the mother was waiting with the baby sleeping on her and she broke the news as soon as we reached “the baby slept and we took MRI”. So, corollary to rule #1.

    Sometimes, if you delay work just long enough, you might not have to do it.

     But I realized over the next week the rule #2

    Do not let work get piled up. Do them as soon as you can.

     My actual first posting is to surgery department. I will write about it in the next post.

  • Disclaimers

    I have been thinking a lot about the legalities of posting about my hospital work in this blog. As I think about it there are several problems that arise by me writing. But, I cannot not write and lose these posts forever. So, the following disclaimers apply for any post on this blog or any article I link to.

    1. What is written here will not be substitute for medical advice. I might cook up crazy hypotheses and write here. If you follow them and die, do make sure I won’t be held responsible
    2. By I, I mean, I, my college, my friends, my teachers, my seniors, my juniors, my textbooks, my websites, my linked articles, their authors, and so on. Nobody shall be held responsible for what happens to you because you read this blog.
    3. The thoughts on this blog are entirely mine and even if I’m writing about others’ thoughts, it is my thoughts on what I think are others’ thoughts and therefore still my thoughts.
    4. Do not think you can use any work in this blog to sue me or my college or my friends, my teachers, my seniors, my juniors, or anyone I mention or miss in this blog. I could be writing things that never happened. For all you know, all this work is fiction and if they bear any resemblance to real life events, they are only coincidences.
    5. I might change any writing on this blog at any time (including these disclaimers). 
    6. No, we can’t have established a physician-patient relationship because you read this blog.
    7. Basically, if you use this blog as a part of any argument (including but not restricted to legal fights), that argument shall stand invalid.

    Now, about patient confidentiality. I will make sure no patient identity is revealed, leave that to me.

    Let’s just hope this goes alright.

  • Agra

    We took the 19’666′ Udaipur-Khajuraho express to Agra from Gandhinagar railway station Jaipur. It came right behind the double decker express to Delhi. We took general tickets and later upgraded to sleeper tickets from the train and got allotted the same empty seats we were sleeping in after getting on.

    Outside Agra Cantonment railway station, there was government approved sightseeing packages with small cabs at ₹750 for half day. We had only one place to visit, actually – the Taj Mahal.

    Taj is large and Agra is small (like Mysore palace and Mysuru). There are multiple gates to the Taj. We took the one near the red fort. (The red fort of Agra is not the red fort of Delhi as I used to believe. At least, that explains how Shah Jahan could see the Taj Mahal from his prison in red fort where he was put by his son). The crowd of rickshaw riders, camel riders, vendors, guides, and photographers who approach you here is larger than you would expect. We fought our way through to the Taj, yet falling for buying some shoe covers.

    There is tight security at the entrance. Bags are checked and so are people. The entry ticket was a QR code printed on a rectangular piece of paper. It was scanned at the entrance.

    Once inside, we got a guide for ₹100 which was cheaper than all the guides outside and also stupid because he didn’t “guide” us for more than 10 minutes and also led us into a photographer’s ambit. More about that later.

    There is a row of houses just opposite to the grant entrance gate of Taj Mahal which supposedly belong to the descendants of the sculptors who built the Taj Mahal. The story that Shah Jahan cut the hands of the workers so they wouldn’t build another Taj Mahal is most probably a myth. I was imagining how cool their address would be – “House 21, Taj Mahal”.

    The design of Taj Mahal complex is mostly symmetric. For every building on the left, there’s a similar building on the right. The Taj Mahal itself looks the same from all four sides. The only asymmetry for us was that when we went, two diagonally opposite minarets were being cleaned because of all the color they’ve been losing and these were draped in metal stands so the workers could sit on them while scrubbing the white turned yellow marbles with some ancient technology of scientific restoration. The entire Taj seems to have turned as yellow as my teeth and I’m sure the next time I go, it’ll be the central dome that is being cleaned like this.

    There were giant writings on all walls, especially at the darwaza (door). The first look at Taj Mahal from front through this door is quite a moment. The monument is very large, larger than what you would expect from photos. And it just stays there. White. Stone.

    Just inside there is a large number of photographers telling you how the mobile camera is not as good as their professional camera in capturing both your faces and Taj Mahal’s simultaneously. Our guide, at this point, told us the story of how Shah Jahan wanted to build a black Taj behind the white across Yamuna (which is a myth and a fantasy created by a writer later, according to wikipedia) and about how the minarets are inclined by 5 degrees outwards so that in the event of an earthquake they won’t fall on the dome, and then he led us to a photographer who would waste our time and vice versa. First, he tells ₹25 per photo. Then he tells, only hard copies. What would one do with printouts? He said he can give soft copies too. We took so many photos. Then we chose 4 photos and he said he can’t “waste” a CD for just 4 photos. So we chose to get hard copy of just one group photo and then he got so angry and deleted all the photos he took. I had started walking towards the Taj with one of my friends while this drama was happening because after all, people enjoyed Taj even before photography was invented.

    There is a long and narrow garden and pool in front of Taj which is well maintained. At just about the right spot for photographs there is an elevated platform. When you walk right from right below the Taj, you reach the free shoe racks to keep your shoes. We turned in all our shoes. Even those of us who had shoe covers. For a moment we thought the shoe cover is a shoe made of cloth to be worn on naked foot, but just as we moved away from the racks we saw others wearing the shoe cover over their shoes. I was walking barefoot anyhow, because I wanted to feel the marble. All of us walked barefoot.

    There are two paths everywhere. One for general tickets, one for VIP tickets. I assume the VIPs are those foreigners who are forced to pay ₹500 and above. The general entrance is towards the right again. We get to enter the Taj from behind. There are two buildings just flanking the minarets. One of these is a mosque. Among the other buildings in the complex is a VIP guest house where ministers and others can stay when they come to Agra.

    The marble was cold even though it was around noon when the skin of our feet touched it. Like I said, the general ticket holders enter via the backside and so we saw the Yamuna first. The river flows parallel to the backside of the Taj. There is a garden on the exact opposite bank and nobody can be blamed for thinking Shah Jahan wanted to build a black Taj Mahal for himself there.

    Once you climb on the platform where the minarets are, you can no longer see the dome and therefore the Taj Mahal becomes so unlike what you know from all the pictures. The symmetry of the construction is mathematical. Yet there is an entrance at the front wall, the marble sides of which are carved with flowers and other designs. The entrance directly leads to the dimly lit tombs of Mumtaj and Shah Jahan. There was a tunnel to go underground where the actual tombs are, but it remains closed now and we can only see representations in the top. The marble here is translucent, as demonstrated in the transilluminence test at a corner by me and many others. There are glass doors everywhere with small round glass arranged like honeycomb on them. People trying to write their name on this glass had broken several of the comb compartments already.

    We came outside and sat on the marble and under the shade of the marble mausoleum for a while. Yamuna brought breeze. After collecting our shoes and calculating how much money the shoe keeper would get as “happiness allowance”, we walked through the less busy side road into the Taj Museum.

    The museum welcomes you with a read board that describes what it exhibits – coins, maps, letters, pictures, stones. The center piece is this map of the entire Taj Mahal complex which definitely didn’t include a black Taj. My hypothesis is that Shah Jahan wanted to build a small house for himself on the other bank where he could sit and watch the Taj Mahal till his death. (Remember Aurangzeb put him in the nearby Red Fort (which is not the Red Fort of Delhi) which had a similar view, probably on his request)

    We went to the toilets in one corner which is free for foreigners (payback for paying so much to enter) and well maintained. Displayed on the wall outside till the exit, are pictures of various monuments in India pretty many of which I’m yet to see. While exiting, I couldn’t fail to notice the awe and wonder on the face of people who were entering then and getting their first glimpse of the Taj. Once outside we had to rush to our car escaping from the e-carts, rickshaws, and camels. And then through the waste-filled gullies of Agra to the inter state bus terminal where we would catch a fast bus that plies on the Yamuna express way to Noida.

  • And we begin

    I had begun calling myself a doctor from the moment I finished the last practical viva. When I was traveling all last month I could only think of going back to hospital and starting work as an intern. But when on Sunday the result was announced, I had to triple check it wasn't a computer error.

    I probably have the lowest mark in my batch. At least, in Obstetrics & Gynecology I have the lowest possible mark in theory. And that too I wouldn't be through had it not been for the theory viva which gets added to the written papers.

    But that doesn't matter now. Because now I get hands-on. I will have "my patients". I can be workaholic. I can do as I learn. I can write the original case sheet now. I can make a difference.

    The excitement reminds me of the first week of dissection. Eagerly waiting around the cadaver to bring the scalpel out and slice through the skin. That feels like yesterday. Time flies. And this next year won't be any different. And I don't plan on missing out on any moment of it.

  • Pink City

    Jaisalmer Delhi express reaches Jaipur by 5 in the morning. Even if it is late at Jodhpur Junction by an hour. Maybe we were too fascinated by the consummation of train 14660 (ours) by 14662 (Malani express) to think about how trains can run fast and catch up on lost time. It works like this. Our train reaches platform 2 of Jodhpur Junction by around 11. We can then get down and go to platform 1 to have tea and refreshments. That is when you can realize your worst fear of seeing your train move forward with your luggage but without you. Soon, our train comes to our platform, in reverse, as if it remembered you and came back to pick you up. But it has actually come to pick up the coaches from Malani express which has been waiting there. And since this has to happen necessarily, railways will reschedule the departure for you to have your tea without worries even if the arrival was late.

    So, how do you wake up on time even though your alarms were scheduled an hour late? Enter North Indian aunties. They talk lovingly to each other at decibels higher than our alarms. And fortunately we had a double family next to our berths. They woke their children up and explained how Jaipur is coming up in half an hour and all I had to do was wake up and listen.

    First thing you notice when you are on the roads of Jaipur is how wide, clean, and organized (straight) they are. We would later hear in the lights and sound show at the Amber fort that Jaipur is the first planned city in India, as we guessed.

    At Jaipur, we stayed at the guest house of my friend's uncle's institution. We got some more sleep, then got up, dressed like summer, and set out in the car that was arranged for us. 

    We were traveling through Jawaharlal Nehru Marg  when I found out all interesting things on either side of the road with the maps.me app on my phone. Most interesting of these was the ruins of a fort just over the white Birla Mandir. This fort apparently has a temple which opens only once in an year and that's the only time public can go there. Actually, good for the fort because it looked dilapidated.

    Then, Sawai Mansingh (SMS) Medical College, the government medical college of Jaipur that is the counterpart of our college in Mysore, by appearance, location, importance, and even the fact that the hospital and college are on either side of the road like in MMC. Must be endearing, there is a small crowd of MMC undergraduates doing post graduation here, including one of our Malayali seniors who came to meet us when we were shopping in the Jaipur market later that night.

    The only association I had with Jaipur apart from it being the capital of Rajasthan and being called the Pink City was that Hawa Mahal is an important attraction here. But apparently Hawa Mahal is just the windows of an otherwise unremarkable building. And we literally didn't even step out of the car to take photos.

    But right behind Hawa Mahal are the interesting places we spent time till lunch. (One good thing to note here is that there is a composite ticket for many places available and there is even a student discount if you carry your identity card.) First, the City Palace. At the entrance to this place was sitting a snake charmer and his two hypnotized cobras posing for photos with foreigners. The gate he was sitting in front of was so elaborate we took some photos there, even including the police officer who was standing guard. The City Palace is a fairly large place and we saw the numbering of audio guide spots in the wrong order so there is a definite chance we missed seeing many things. But we definitely saw many interesting leftovers of the royal past. Two giant vessels with tiny wheels, used for carrying water while the king was traveling, made out of melted silver coins. Among other armory, a special kind of dagger you can play with wearing it like Wolverine claws and when you pull on the bar with your curled fingers, the covering sheath of it would slide away to both sides pushing out the knife within. Totally oversized clothes of kings, pyjamas that could accommodate an elephant (probably belonging to Madhosingh who was that large according to sources). Pashmina carpets. Huge chandeliers above the hall where royal proceedings used to happen – surrounded by the portraits and brief history of all the kings that ruled there and the wall paintings of Krishna. (The wikipedia article on the palace describes even more things which I should have read when it mattered)

    Right outside is Jantar Mantar – the collection of astronomical instruments that are large enough to climb on. We went in the reverse order as usual, and without a guide, so we didn't have to learn any broken science that the guides were feeding the foreigners. Most of the instruments I could figure out did one of the two things – tell time, find the declination or azimuth of an astronomical structure. The largest sundial gave the most accurate timing (local time off by up to two seconds) because that's the way shadows work. We were not allowed to go near the markings of the large sundial and so we couldn't read the small markings. The large markings were visible from far away yet we couldn't find out the time correctly. It was around 1 when we were there but the shadow had crossed more than 2 markings. The local time could definitely not be off by more than half an hour from IST. Something was wrong, yet we took some photos climbing on the walls opposite and still being unable to get the whole dial inside frame. There were smaller dials facing different directions next to the large dial. These would be useful in different seasons when Sun moves around. After passing through many more instruments clueless we reached the dial which was shaped cylindrical with two flat ends facing North and South and sloped in the angle of the slope of the Earth's equator. This dial had the 24 hour markings in addition to the markings that didn't add up earlier. That is when the search pages started loading and I confirmed my hunch that the unit of time for the users of these instruments was gatis and palas, and not hours. One day would be divided into ghatis and then into palas and so on. And that would explain everything.

    Having figured it out we came outside, had mutka kulfis, and went towards our next destination – forts. On the way we saw from the road the Jal Mahal which is a palace in the middle of a lake. Didn't see any boats to reach there, though.

    The Jaigarh fort and the Amber fort are adjacent to each other. In fact, the right way to visit them both would be to reach one and travel through the ancient path into the other. There were military personnel on the way and there seems to be some kind of Indian Air Force activity happening here. 

    We reached Jaigarh fort first. Jaivana, the largest cannon in the world was right in front of us and we thought that was all there is to this fort. We walked around looking at holes in the ground figuring out which of them are tunnels and which are water ways. There were also holes in the walls in the characteristic shape of fort wall holes with large opening inside and small opening outside. And there were monkeys and pigeons everywhere. We were hungry and there was a restaurant inside the fort which didn't exactly look attractive. So we decided to go back down the hill but I curiously went to the other end of the courtyard and saw a board showing directions to a lot of places inside the fort. We had missed almost the entirety of the fort. The King's palace, the Queen's place, the giant courtyard where the soldiers would line up, the large water tank. The dining rooms where there were fully dressed up mannequins dining rubber chappathis, green grass in green gardens. 

    As soon as we entered a guard there self appointed himself as our guide insisting that he be not paid if we aren't happy – an offer that is difficult to refuse. He led us into the above places and more. The Jaigarh fort is located higher on the hill than the Amber fort. Jaigarh fort housed soldiers while Amber fort housed the King and Queen. When the King is with the soldiers preparing for war, the Queen might decide to pay a visit. Then, she is transported in pallaquin from Amber fort to Jaigarh fort. At the entrance of the Jaigarh fort from that side is an elaborate Bhool Bulaiya (maze) of pathways which is designed to confuse enemies. We saw the path to Amber fort, the gardens and courtyards inside it, and identified even some locations where Jodha Akbar was shot from the balconies (or watch houses) of the Jaigarh fort.

    The balconies also gave a splendid view of Jaipur city between the hills surrounding it. And the water system that was in place for the forts. There was a small lake at the base of the hill. Rainwater would be collected in this river which is then carried up by elephants into water tanks high above. The tanks have outlets connected to the irrigation system and the gardens below are watered with the same. 

    There was a gallery in the central courtyard of Jaigarh fort with photographs of the army and Kings in various moments of twentieth century. Turns out, even after independence, the kings had formidable power for a while. On the opposite side there was a gallery of armors in which the most interesting exhibit was a "time bomb" which looked more like a large cracker with a long safe thread to burn.

    Next we went to Amber fort, having in mind some spots discovered earlier in the aerial view. We had some nice tea at the entrance of this fort. There were writings about the structures in the front yard and we didn't take a guide. The large front courtyard was where the public could come to meet the king. Around the courtyard there were toilets (which were vertical holes on the ground), massage parlors, baths, and balconies. The paths everywhere were highly interconnected – you could directly go to many rooms from wherever you were standing. 

    Amber fort might be the more beautiful of the two. Fountains dripping water in front of a palace full of mirrors, pigeons taking bath in them. Gardens, facing a marble stage where dance and entertainment could take place. Better view points and more photogenic spots, especially when you climb up on either sides to the roof. All you have to be careful is not to tear your jeans by running faster than the high steps allow you to.

    At the exit there are gift shops some playing nice Rajasthani music. There are also independent vendors who sell expensive, so called hand drawn, paintings (the same paintings which we found out in the hands of another vendor later after lights and sound show), cheap fancy earrings, key chains, and bangles.

    We were hungry by then and went down to the city below to have some nice cheap kulchas and pachoris. We were eating right outside the lower gate of the Amber fort from which we could go to the lights and sound show. There are two shows everyday – English first, Hindi next. We chose English but we were running through the long stony route to reach the spot on time. The show hadn't begun but we didn't take tickets from the counter below, rather choosing to pay the ticket checker directly since he said that will be better than going down and taking the tickets now that the show was about to start. But this might have cost us dearly as we paid ₹200 per head whereas wikitravel says there's discount for Indians and students. What made me not doubt the cost was the website which showed the costs and a phone call to the enquiry desk which both said the fee was ₹200. 

    Anyhow, the lights and the sounds were all realistic. Different parts of the forts would be lit in different colors and the lights would dance in perfect synchronization with the sounds – of battles, feuds, celebrations, marriages, Kings, soldiers, horses, swords, just, unjust – of history. At the end of it I was cold because of the night and calm because of the happy ending after all the tumult. There was a road till the place from the other side and we didn't have to run to the place on the way there, we were told by that same ticket collector. On the way out, we went to the toilet where, unusually, the gents had a queue and the ladies didn't. Then we got into our car right there, no walking, no running.

    We had some time left to go shopping in Jaipur market. Jaipur must be famous for cotton saris because we bought some 5 saris among ourselves. Our train was early morning next day so we hit the sacks early after packing all new things.

  • Golden City

    The Jodhpur Jaisalmer express is perfect for traveling from Jodhpur to Jaisalmer (duh) overnight. It leaves from Jodhpur junction itself which is large, colorfully lit, and has an escalator. And you reach Jaisalmer railway station around 6 in the morning which is cold enough to warrant monkey cap, gloves, jacket, and shoes to be worn while going to sleep in winter.

    We had booked stay in Oasis Sam desert camp through goibibo.com and it was very cheap for us because of all the credits my friend’s brother had saved up. The camp people themselves helped us hire a Bolero jeep to travel. But the check-in time wasn’t till 3. So, we went checked in at a hotel near railway station, slept a little, had some nice tea, and freshened up till it was warm enough to go outside.

    First, we had breakfast at a restaurant nearby. Chola bhattura, parathas, some more nice tea. They played some Rajasthani folk music in the background on request. And the golden Jaisalmer fort was right outside so we took some selfies.

    While still adjusting to the golden glow on the buildings that the limestone gives off on morning sunlight, we reached at the bottom of Gadi Sagar lake. There’s a small walk to the waterfront which is filled with colorful Rajasthani clothes, handiwork, embroidery, etc. That is also where I noticed the animals – dogs, goats – all of which had thick fur, acclimatized to the lazy cold weather of the desert land.

    Colourful, no?

    There is a small temple on the bank of the lake, golden in color as you would have guessed. You can remove your shoes and walk inside. I stayed outside looking at the man who was sitting at the entrance dressed like a sadhu welcoming people with “Jai Shriram” and other mantras (like Mickey Mouse figures in Disney world). There are what look like extensions of the temple in the lake, popping up from the water like somebody built a large temple and then the lake flooded it till just below the top. These were fully occupied by pigeons and the floor with their shit. The water was home to catfish so large that they probably could eat the pigeons if one of them fell into the water. These fishes were being fed dough by some people at the shore. That’s apparently one of the main activities here apart from boating. And taking photos, of course.

    Next, we went to the Jaisalmer fort. We were swamped by guides as soon as we reached. They do have ID cards but they do charge a lot if you don’t bargain. We didn’t take a guide till we walked about 200 metres from the parking spot to just inside the entrance of the fort. It’s actually a good idea to do impulse control and see around for more before you pay money anywhere in Rajasthan, more so in Delhi. Although, if you take this to the extreme you will also find very cheap guides who also don’t tell you a lot of things – like we found at Taj Mahal later.

    The Jaisalmer fort is a live city surrounded by three layers of walls. A quarter of the population of Jaisalmer live inside the fort in their golden houses. The inhabitants are the descendants of the same people who lived in the fort in the past. A part of the fort was for the Warriors (who eat non-vegetarian), another for the Brahmins (who eat vegetarian), and a third part for the Royals (who ate “mixed vegetables” in the words of our guide). Now, many parts have been taken over by restaurants who sell the same kinds of foods.

    There are two palaces inside the fort – King’s palace and Queen’s palace. You see a lot of armors in the King’s palace. Everything ranging from bows and arrows to guns. And then the short heighted bed which the King would sleep in (so that he doesn’t get killed by anyone hiding under it), the halls where he would listen to people, and many other rooms with a lot of architecture. At one place our guide told us that the fort was built with limestone mostly but there’s one more kind of stone used rarely – “fossil” stones (I think that’s what he told), and it had magical properties like “being able to turn milk into curd overnight”.

    At the roof of the palace you can see all around Jaisalmer. We had some masala chai and turned 360 degrees again and again listening to the guide and seeing the desert, the Pakistan border, the roads, the houses, the desert, and more of the desert. After getting down we found the route to the large canon on the other side of the fort. The canon was also at a height letting us watch the city and our jeep and five guides converging on new groups that arrive. We sat there for more than 15 minutes taking photos and enjoying the breeze.

    Back near the parking spot we had some chole kulchas which were the best. And then we set forth for Sam.

    Sam is around 40 km from Jaisalmer and I slept through most of the wind turbines and sand. The place is full of desert camps, camel safari, and other desert adventures. We reached our camp just after noon and we were the only people there then.

    The tents are surprisingly well furnished. The beds, blankets, and carpets look just like any hotel. But the walls are made of layers of clothes. The door is just another cloth with ropes on the sides allowing you to tie it to the wall around (if you want to “lock” the room). The windows are improvised curtains which can be folded up by pulling the ropes on their sides and unfolded by pulling the ropes in the reverse direction. Another door on the far wall leads you to the bathroom which has solid walls on the other three sides and cloth roof. The floor was tiles. The water was salty. The bathroom was roomy, but I didn’t take bath because it was very cold and I didn’t wake up in time for the geyser next day.

    There were about 50 tents like these arranged in a quadrilateral in our camp. The tents on one edge were actually solid rooms unlike our Swiss tents. In the middle there was a platform surrounded by chairs where the cultural programs would happen at the night. The common dining hall was at one corner.

    We sat enjoying the architecture of our tents and putting socks and towels to dry on the guy ropes while others, mostly families, started filling up other tents one by one.

    An hour before sunset it was time for us to move to the dunes at the opposite side of the road. The camp had arranged tickets for us in the ship of the desert to travel to the sunset point. We had 4 camels – Michael Jackson, Lucky, Bubloo, and Salman Khan. I was sitting on Lucky with my friend. Getting on a camel is easy since it lies down with its legs folded and you can climb like you climb on a bike. But once you’re seated, the camel gets up to its full height – hind legs first – and you have to hold on like Titanic is sinking head first. Pretty much the same when getting down or when walking down a sand dune. At all other times you can actually swing your hips with the camel’s and dance in that rhythm without holding anywhere.

    Not posing

    The ride was fun so we paid them extra to take us a bit farther to the “old Pakistan border” where we saw an old bunker and a wire fence and more sand. We saw the sunset on a “private dune”, playing with the sand and running barefoot from dune to dune. After sunset it got cold very fast and the sounds of cultural programs could be heard. So we returned to the camp where we were greeted in traditional Rajasthani style by a lady in Rajasthani clothes putting tilak on our forehead.

    The cultural programs had started on the platform in the middle of the camp. People were seated around in chairs, and on the platform on diwans with masand. We drank some hot tea and ate some snacks sitting down. There were two singers, and drummers, and kartal players, and dancers. The songs were in Hindi and Rajasthani. The main singer also sang some shayariyas in Hindi which were really funny when translated to English for me. The dancers did Rajasthani folk with characteristic hip movements. They also did a few tricks by picking up notes and stones from the floor bending over back with their mouth and eyes, respectively. The lead singer then took over the kartals and did a wonderful performance along with the dolak. Rajasthani kartal is very simple – two flat wooden planks slightly longer than an iPhone 6+. You hit these together very fast, at various sound levels and you get music that sounds almost like tap dance. In fact, the performer was moving in such a way that it appeared like he was dancing with his hands and corresponding music came from in between his fingers. There was also a man who played with fire – swallowing it, blowing fire from his mouth, etc.

    People started dancing from the beginning and every time someone would get up to dance the singers would ask them to sit down and wait for their chance at the end. Something that irked me was when people used to give the performers money while they were performing. For example, when the lead dancer was dancing with pots on her head and balancing on glasses at the foot, people would come and put money which she would hold between her teeth. After all professional performances, they put random songs and everyone started dancing while some, including us, went to the dining hall for dinner. The dinner was nice buffet. And there were many curries whose names I don’t know.

    After dinner we went and danced till it was too cold and we went to our tents and sat talking.

    Towards the night the welcome hosts came with tea and sent us off to the night desert. We walked up to the dunes, this time against colder breezes. At the top of a dune, we just lied down on the sand watching the stars (also crossing it off the bucket list of one of us). I stared into the Pakistan side thinking of soldiers at Siachen glacier for a while with the breeze making that eerie sound you hear in mountains. We then went back to our tents, had more tea, and slept. The hosts couldn’t arrange camp fire because nobody else was interested and the guy who promised he would arrange it if we wanted slept by the time we went back.

    The blankets kept us in the bed for longer than we wanted to. We woke up when our jeep driver came looking for us so he could catch his next riders. After having a quick delicious breakfast we packed our bags back to Jaisalmer. This time going back I was awake to see all the wind turbines. Apparently these provide a lot of electricity in Jaisalmer.

    We went back to the same hotel as last day, and stay put till noon rearranging clothes, munching snacks, settling accounts. We divided into two then and the first pack including me went shopping in the Jaisalmer market – carpets, clothes, and so on. The second pack joined us outside patwa ki haveli. We had bhelpuri and went inside. The entry fee to the building was ₹100 and so we didn’t go inside, rather took photos from outside. We then had to run for our train to Jaipur, so we got some food parcel and ran.

  • Blue City

    Jodhpur Express left Bangalore City Junction at ten to ten in the night of 27th. It would take about 43 hours to reach Bhagat Ki Kothi (which is to Jodhpur Junction what Yeshwantpur railway station is to SBC.)

    When I woke up in the morning, we were near Hubli. And when I woke up again, we were still near Hubli. That’s when I decided Karnataka was too large and went back to sleep.

    The men were playing a card game called ‘Mongoose’ which is just another name for ‘Donkey’. The way they distributed the cards was different though. Instead of dealing cards one by one to each person, there was an open deal in which each person pulled out a card to their hand in turns. If the card is one higher than the topmost card of any other player’s hand, it could be placed on that other player’s hand instead of our own. Thus distribution of cards itself became a game.

    We bought two decks of card that night and played mongoose, bluff, and even that card trick about “387 years ago there lived A Queen who was 64 years old and had 2 children – Jack and King who were 10+9 and 5 years old respectively”.

    We had home food packaged and ready to eat, everywhere. So all we had to buy from outside was local specialties. Aloo samosa and Bhaji from Gujarat and Rabdi.

    Rabdi was from Abu Road railway station (which is where you get down to go to Mount Abu). Rabdi is a sweet which you get by concentrating all the goodness of a Litre of milk into an ounce.

    We reached Mumbai a couple of hours before midnight. And the widely popular Mumbai local trains were plying along ours with a hundred people hanging from its doors.

    Rajasthan was as green as any other state. Acres of farms on either side of the rail line. Crops which I have no idea as to what they are.

    The train went at 95 km per hour for around 3 hours straight going into Jodhpur. And we reached just in time for baraat.

    Before going to baraat, one has to wear the pagadi which is a colorful turban. If untied and unfurled the pagadi will be perhaps as long as a sari and as difficult to tie back into shape (which I realized when I removed it posing for a photo later in the night and had to wear it like a shawl ever after).

    Dressed up, the groom and his party leave for the bride’s place. The groom on a horse with a sword by his belt while everyone else dancing in front, between the music and lights walking around. The actual marriage was in the wee hours of the next day which we slept through at the hotel so we could explore the city in the morning.

    Umaid Bhawan Palace. That’s where the auto drivers took us first. Umaid Singh had this palace inaugurated by 1944. Speaking of Umaid Singh, he was the chief scout of Marwar state, King of the same, and also died of appendicitis shortly after independence. He built the rail lines to Jodhpur to bring marbles and other materials for the palace and that’s how Jodhpur got its train lines. He built the airport in Jodhpur because he was an aviation enthusiast.

    Neat place to live in, huh?

    And he also made me wonder whether development can come in a democracy, whether autocratic rulers are a necessary evil to get things done. Maybe back when machines weren’t as plenty as today and all construction had to be done by human labor (along with animal labor), Kings, dictators and their unjust rules would make sure some work gets done, but today machines can replace human effort and therefore it must be possible even in an egalitarian society to build huge structures.

    The palace is now divided into three. The museum open to public which we visited, the Taj hotel (which contains the swimming pool) and that part where the royal family resides. The museum too is closed to public when the royal family celebrates birthday. North India hits your head with the fact that birth privilege based hierarchical society is not a distant past.

    Inside the palace museum is the architecture, paintings, wood work, etc. There are photographs showing various political moments in the history, Jodhpur Polo team and their trophies, and so many details of the history. Then there is a dining room where many high profile people dined and where the menu was exotic. Also is a room full of clocks (time pieces) embedded on small scale replicas of all sorts of things – ships, submarines, guns, buildings.

    Outside there is a garden which we can’t walk over and this collection of old luxury cars. So many Rolls Royce cars that the Mercedes Benz car at the end felt like market car. Most of these cars look long and large with their wheels very far apart towards the ends of the body unlike in today’s cars.

    We had kesar kulfi and koffee on the way out. Funny it was served by the same person who was guiding us in the palace with nobody asking him to. In fact, when we had told him that we didn’t need a guide he said in Hindi, “If you are happy at the end, give me some money, otherwise I’m just happily helping you here for free”, a refrain we heard throughout Rajasthan.

    Then the waiting autos took us to Mehrangarh Fort. This was one of the many forts we would visit in the next few days. There was a lot of intricate designs in phool ki mahal, sheesh ki mahal, and moti ki mahal (palace of flowers, mirrors, and pearls, respectively) but not very memorable. In between, near the palace of the Queen, we found a large closed door with some steps leading to it where we sat and took some pictures.

    On the way back from the fort, there was this small lake and marble temple where the King was worshiped. And in the courtyard a man in typical Rajasthani costume was playing the Ravanahatha which is a stringed instrument (violin, cello, etc having been inspired from this) that now fills all the forts with an ambient music.

    Hungry, we had to go to Gypsy restaurant which was the first recommendation by at least two people. But it was too late for lunch and too early for dinner and so we went to another place the rickshaw drivers suggested and had chola bhattura, golgoppa, etc.

    The Jodhpur market was on the same road. Clothes, spices, and other things to buy that reminded me of DD Urss road back at Mysore. Except Jodhpur has a colorful clock tower at the spicy end of the road. We also went to ‘On The Rocks’ which was a nice, though slightly expensive place to hang out, to waste some time till our train to Jaisalmer.

  • Why Do Children Fall Ill?

    I had lunch and finished packing my bags at 3. Then I spent 5 minutes saying goodbye to my roommate which is when I told him that I'm going to North India for a trip. Of course I had to tell him at the last moment, because apparently last month he had gone to the same places I'm going towards the end of this trip. That must give a good idea about how much I talk with people in general.

    The railway station is 15 minutes away by walk. And I had to walk. After all, if I miss the 3.30 train there's another at 4. Walking to railway station is important. Once you board the train, you are a different person. And it is this walk that helps me transition. With a large bag on my back containing all clothes and a small bag in my front containing all the books and miscellaneous stuff, people would surely think I'm a seasoned traveler. And that gives me a false confidence.

    Maybe I'll be a traveler after this trip. Maybe I won't. That's why I'm going, you see? I'm giving it a fair chance. One month of moving around all over the offline maps I've downloaded should either make me love traveling or hate it. Either way, it will make up a nice activity for this month before my MBBS result is announced.

    I didn't miss the 3.30 train. It was a full five minutes after I sat down in the general compartment that the train started moving. It was in those five minutes that this young mother sat in front of me with her son who must be 1 and a half years old judging by his fragile movements and short vocabulary.

    When I woke up from my nap at Maddur station, she had just woken the boy up. And the Maddur vade vendors were all over the compartment. She bought one. And so did many others. (Some even bought five of them parcel.) But the boy wanted tea. And the tea vendor had just walked by into the next compartment. There was a coffee vendor around. So she bought a cup of coffee. She asked for another cup, an empty one to pour the hot coffee back and forth and make it tepid. But the coffee vendor wouldn't give her one.

    Why would he? The number of coffees he can sell is limited by the number of coffee cups he has. One cup less is one coffee less sold. That is why he told the men surrounding the lady who asked him repeatedly to give her an empty cup this: "What will happen if I give a cup? Nothing will happen. Nothing will happen to you people who talk. It is I who sell the coffee. Those who talk can keep talking. I have to sell my coffee"

    The old lady next to me gave her a small steel cup. And then everyone started talking. Everyone except me and another lady in the corner near the window.

    The boy's father had gone to Bangalore in the morning, with their two-month old child, after a fight. And she was going to get the child back from her husband's house in Bangalore. She only vaguely remembers where his house is. But she knows for sure that her mother in law and sister in law can't take care of her child like she can. And that is why she was on train with this stubborn boy who threw half the vade down and would not drink the coffee either, instead choosing to cry and flutter his legs incessantly.

    Everyone around was trying to distract their mind from her story by trying their best to stop the boy from whining. But of course they could not. The old lady gave them some tomato rice she had and the middle aged lady a chappathi, knowing very well that the boy wouldn't eat but the mother should. The men could not refrain from giving advice, "You should be humble and not create a reason for a fight." They themselves admit, "Of course, he drinks as alcohol all that he earns as a PWD worker and alcoholics don't need any reason for starting a fight." Yet they want her to change her ways.

    They want her to go live with her husband in his house. To work in nearby houses. Earn some money. Buy a small house in Mysore. And by then the kids would be grown up so it won't matter how her husband behaves with her.

    I didn't speak a word. What can I, a feminist, a social media activist, and a future health care worker, tell her?

    When she was talking she mentioned that she had given a bottle of milk to her husband that morning. Probably so he would feed the child at least.

    They say bottle feeding is bad for infants. So, in a few weeks this child might end up with diarrhea in the pediatrics ward of Bangalore Medical College. And the third year students there will ask her "Why did you feed the child with bottle?" And she might choose not to tell them the story of how children fall ill.

  • OBG practical and Internship Dreams

    Woohoo. Finally.

    I already wrote about the first three practical exams.

    OBG was a breeze. Went early to the special (examination) ward. Had a 24 year old lady with a previous Caesarean section as my Obstetrics case. And a 65 year old with procidentia uterus as the gynaecology case.

    I told the examiners that the reason for previous Caesarean was respiratory distress (instead of telling fetal distress) and I had to tell everything about fetal distress, all the things that are monitored, and what management to go with, and in VBAC-TOL how to manage first, second, and third stage; whether to cut-short second stage or not. It was more like they were testing if I could go work in the labour room tomorrow.

    Same thing followed in Gynaecology. My patient had decubitus ulcer and I had to explain how to manage it (and how to manage the “corresponding” ulcer in surgery (which happens to be venous ulcer)).

    Viva had 4 stations.

    Station 1: Ultrasound and x-rays. Luckily I got X-ray because I knew nothing about ultrasound. And the X-ray of pelvis showed a bent Copper T being assessed by a uterine sound? I had to tell the long term side effects of Copper T too.

    Station 2: Specimens. There were some 5 specimens and I could only recognize the anencephaly kid and so I chose it. I had to tell how I recognized it, that it is a neural tube defect, other examples of NTD

    Station 3: Instruments. I identified a manual vacuum aspiration syringe (Girls also had to pull it against vacuum to prove that they have the strength to do it) and a ventouse. Then I got a CuT and was asked how it is inserted the keyword I had to say being “withdrawal technique” which I didn’t.

    Station 4: Pelvis. Had to show bispinous diameter and give the common value. Then, I was asked to identify what was obturator foramen; followed by “what is its clinical significance?” which apparently was asked to many of my friends and nobody got the correct answer to.

    We came out and none of us could believe that it was all over. In just 4 (gruelling) days that went by like a quick cold shower, we had gone from students to doctors.

    Well, I say doctors because since yesterday I am addressing all my friends “Doctor” and dreaming of all the hospital work to follow. The only thing between Akshay and Dr Akshay now is RGUHS announcing the result with PASS return next to my name.

    And so am I reading through the thousand medical posts in Polite Dissent which I discovered by searching for that House scenario I talked about in the last post. And through so many nice posts in the underwear drawer.

    That is also why I got scared reading this horror story of a first year PG getting beaten up last week for the death of an accident victim and even read Hippocratic oath and MCI code of ethics.

    I can’t wait to finish Harrison’s now 😀

    Acronyms used in this post:
    OBG – Obstetrics and Gynaecology
    VBAC-TOL – Vaginal Birth After Caesarean – Trial of Labour
    NTD – Neural Tube Defect
    CuT – Copper T
    RGUHS – Rajiv Gandhi University of Health Sciences