Hiatus

I have been neglecting the blog for quite some while now (umm.. over three months!). While I apologize for it, I would also like to tell y'all the couple of excuses that I have lined up for the neglect :P

1. Microblogging: Twitter has taken over my blogging (for now). Now days, anything remotely interesting that happens in life is reported instantly on Twitter, rather than waiting to write on the blog later. Even things that I am wondering about, missing, enjoying or need to decide on are posted on Twitter for instant decisions.
Must say, I've met quite a few fantastic (and some not-so-fantastic-yet-interesting) people via the microblogging site. :)
I tweet as @drarps by the way.

2. Laziness: Yes, I've admitted to this before and I'll say it again-- I am a lazy blogger. (I still have the Birthday post to finish -- which I can't actually do for another couple of months since I don't have the clues with me as I travel)

Which brings us to point three:
3. Travel: I have been traveling quite a bit in the past two months. If you think it would provide quite some fodder for the blog, you are correct!
I've had my share of mishaps and incidents, (been lost in a strange city, seen some amazing places, spent more than the average person's share at the airport, traveled in a bus where a physical fight broke out at 3 in the night! etc.) but I've seriously been pretty busy planning out the routes and flights, to keep up with the blog.
Again, all these incidents were taken out of my system by ranting on twitter.

4. Exam-lessness: As is natural, the quantity of blogging ideas (and will to publish them), is inversely proportional to the amount of time on hand. Therefore, I blog most often when I am preparing for an exam and am constantly stuck with books.
Technically, I have an exam to prepare for even now, but I haven't been studying for it (why: see point #3). So, I guess for me, no exam= no blogging.


Well, my excuse list ends here. I agree these are pretty lame, but this is all I have for now. Maybe one day I'll become more responsible towards the blog and write more often. Till then I leave you with these pictures that show how I've been the past three months--

(Keep praying for me. Okay?)

And where have I been? Here mostly.

Also, while I end the excuse post, I'll leave you to read the pick of posts on the blog-
Making of a Doctor - First post after the first day of clinical posting.
Best-est teacher in the world - (Clearly it wasn't one of my English teachers! :P)
Test-imony- One of the most hilarious stories I heard in med school! (<--MUST READ!!) Also in line, mono-phonic thinking!

Brutal Assault

A black day was written in the history of Dr. S.N. Medical College last night when scores of students and doctors were brutally assaulted by the police/jawans. These residents of the UG boys hostel were victimized in their own home, as police barged inside the hostel and beat them up.

_________________________________________________________
Penned by Telly, here is a summary of what happened:

Scheme of Events, (4th-5th Sept. 2010)

• Trauma Centre – Two injured brought in, Resident Doctor attends. Lots of attendants with the injured, who end up in a verbal tussle with the Doctor. Doctor stops treatment. Returns to treat the injured after talks.

Room broken in

• Trauma Centre – The gang which assaulted the injured rushes in. Start violence. Doctor informs the colleagues to swarm in. Policemen come, and start hitting anyone, and everyone with Lathis. Resident Doctors beaten up.

• Trauma Centre – In the meanwhile, Interns come for rescue. Police kick start their jeeps, and drive at break-neck speeds at Interns. Interns forced to run to their hostels.

Blood on the Terrace

• Boys Hostel – Policemen run and lathi-charge the few students there. Students start pelting stones on them.

• Boys Hostel – Huge number of policemen called in. 200 policemen, including RAC jawans stationed outside the Hostel. Students are called for. They are asked to come outside.

• Boys Hostel – Policemen and RAC jawans rush in the hostels, indeterminate hitting by Lathis. Innocent students studying quietly in rooms, Sleeping, are hit with lathis. Doors are broken open. Coolers dismantled. Even students cooperating to come out are beaten like criminals.

• Each step you take on the staircase, you receive one hit. Hit on head. Run behind a student till the terrace, loses balance, and falls down.

• Mass looting by the policemen, money, mobiles. Laptops thrashed on the floor, on purpose. 

Meeting for calling a strike

• Post-massacre – Immense political pressure to not let the senior doctors go on strike. Threatened in different ways.
  

Mono-phonic Thinking

Another one from Dr. N. [This is the first one. And its hilarious!]

After examining a case of suspected infectious mononucleosis, Dr. N and the student on call were discussing the diagnosis and management.

Dr.N: "The heterophile test might not always be positive in the early course of the disease.. So, what other test can you use for diagnosis?"

Student: "Give the patient amoxicillin. And watch if he develops a rash.."

(This one cracked me up. Believe me, it might sound like me, but I wasn't the student here!)

Test-imony

Here's a true story I heard the other day from Dr. N while I was ordering labs for what looked like a girl with a sexually transmitted disease.

Dr. N is a Pediatrician, practicing in a small town in USA.

[Writing the anecdote in her words.]

I was working in the clinic one day, when I saw a 8 year old girl with urinary problems. I ordered labs on her. When her labs came back, I was shocked to see Trichomonas in he urine. Now, with a STD in such a young child, it automatically becomes a case of child-abuse. I had to call the Child Protection Services. But before I did that, I had to inform the mother, and try to find out the culprit. This woman was a single mom.

Dr. N: "Mrs. So&So, does the child go to stay with her father sometimes?"

Mrs. So&So: "She's doesn't stay with him. Why she hasn't met him in a while"

Dr. N: "Do you have a boyfriend?"

Mrs. So&So: "Not really, why?"

Dr. N: "Well we did some tests on her, and her lab results show that she has trichomoniasis, a STD. We suspect that your child is being sexually abused, and so I'm going to call the CPS."

Mrs. So&So: " No it can't be.. "

Dr. N: "Well, her urine culture results are right there.."

Mrs. So&So: "Ohh.. then she doesn't have the disease.."

*goes crimson red*

Dr. N: "Wha..??"

Mrs. So&So: "Well, yesterday when I took her for giving the specimen, I took her to the restroom. I waited and waited and waited... but she wouldn't pee. So I just took some of my own pee, and sent it.."

Dr. N: "Well in that case, I suggest you set up an appointment with *your* doctor as soon as possible! You have a STD!"

Image: http://www.pasozyty.net.pl/rzesistek-pochwowy/

Annd score!!

Yes. Its been twenty one days since that fateful day in October.
Had been waiting anxiously for my score sice the past two weeks, and it arrived fifteen minutes before the scheduled time.

I got that elusive 99.

Happiness.

Yay! Yay!

The past three weeks have been hell emotionally.

I've cried over wrong answers.

Brooded over the difficuilt questions.

Rationalised some ethics questions.

Decided on alternate career options.

And what not!*

I wish the NBME people would post the scores earlier. Whoever heard of the scores of an online exam delayed by atleast three weeks. (Even the state Pre-PG exams results are faster!- However crappy the quality of questions might be! :p) But seriously, some of the questions were maddening. Have never come across such questions, ever!

And even more frustrating was that I remembered a lot of them post-exam!

And now after the results, I feel I could've done a tad better had I not taken the exam as the 'most-important-exam-of-my-life'.

The exam period was spent in extremes. At one hand I was anxious during the early blocks. Lost confidence in the middle. And became complacent in the end-- just wanted to get over with it.

Anyway,

All that is past now.

With a good score, I can hapily leave Step1 behind and move on.

Bring on the next step!!

*All my apologies to Papa, Ritz, D, Kau, Navy, Avi, AnkC, Dibs and others who have had to deal with my depressed mood the past three weeks. I still blame the NBME for the tough test!

Occupational Exposure

Once again one of Pi's posts got me recollecting another one of my stories.

(This may not be exactly the same thing- themewise. But the context is the same--Med Students.)

------
A couple of days ago an intern (let's call him S) was assisting in a laceration repair in the Surgery Mini-Op Theatre (MOT, for us)
He was standing there, helping out the resident working on the wound. When all of a sudden there was a gush of blood and he felt a searing pain.
The resident had placed a scalpel cut on one of his fingers.
There was severe bleeding.

The scalpel had punctured through the gloves and cut over the PIP joint of one of his fingers.
While everyne rushed to help him out and bandage the wound, the bleeding continued for a whole fifteen minutes.
It stopped eventually.
He came back to the hostel.

After he was back and settled for once, did it dawn on him that he had been in contact with potentially contagious fluid.

He called up some friends to check-on what to do. He talked to some doctors.

He visited the hospital again to get details of the patient. But to his horror-it being a OPD patient, just the mention of the name and colony was found in the records.

Apparently, the patient was supposed to return three days later to get the stitches off.

He visited the ART incharge next.He was counselled and given a box of post-exposure prophylaxis, to be taken for about a month.
He starteed the meds, hoping that the patient would come back three days later for removal of stitches.

Three days later:
No sign of the patient. Apparently she decided to get the stitches removed someplace else!

Seven days later:
S stopped taking the meds coz of the horrible horrible side effects! Fever, abdominal pain, nausea, vomiting!
Twelve days later:
(ie today.)
S's absolutely fine just now. And I'm sincerely hoping it stays that way till an antibody test is done six months from now.

Things that I realised:
1. This entire episode, occured at a hospital full of doctors, residents and nurses. no one realised that it was a contact with potentially infectious fluid, and an assay of the patient was required.

(This was one case where the student at least bothered to go the ART centre and find out about the pros and cons of meds. There are hundreds of instances where the ever busy residents come in contact, and don't even bother to get the patient tested even though he's right there!!)

2. The concept of universal precautions- is not something that is very much followed here.

Heck, in the labour room, the residents have just one plastic apron to protect them from any kind of fluid. I've heard of instances where the resident came in contact with the patient's fluid in the form of spurts hitting the face and eyes!
(And oh, PPTCT is optional for the women!!)

3. Doctors in general, tend to consider such a contact as a minor thing, and therefore tend to give you an option to take meds or not.

(Maybe its because they've been in contact with blood and all kinds of fluids since eons, and nothing's ever happened to them!)

4. Being a medico/doctor does nothing to improve your compliance for meds.

Its always the side-effects that win in the end.

On a lighter note:

*Thanks to CartoonStock!

4 & A Half Years... Still A Novice!

Okay! So I'm getting into that chilly zone of exams again. With Pre-Univs round the corner & Univs lined up as a Happy 2009 gift in early Jan, its high time that I start studying seriously.

But the so-called 'Final Year' that was supposed to be the toughest (yeah!I know it IS!!!) & the most exhaustive period of Med College, somehow flew by! I wonder if I actually got to learn anything new this year!

I still cannot differentiate between a bronchial & vesicular breath sound.

I still get my vertex & breeches mixed up!

I still see a nothing more than a tiny scrawl while reading an ECG. (Okay, maybe I can tell you where a ST elevation is, but that's only when I'm told beforehand that its a MI ECG)

I still don't know the the Glasgow coma scale.

I still can't get an IV line in!

I still can't auscultate & recognise a heart murmur on my own!

Although there are some things that I can do, too (tho they're really numbered):

I can tell you what a 'strawberry tongue' is.

I know a lot of things eponymous with 'Charcot' in medicine :)

I know the triad of congenital rubella syndrome.

I know what 'Battle's sign' stands for.

I might not know the exact components of Brown-Sequard syndrome, but I do know how it was discovered :P

I know what Pickwickian syndrome is.

I know the story behind Ondine's curse.

I know what a Keel operation is for. (It may be obselete, but who cares. The examiner will pop the question anyway!)

[One thing that I realised this year is that somehow, I'm good at just one thing. Eponymous syndromes & signs!! & the rarer the better. :) Of course, these aren't gonna come in use in any time during my medicine career. But then, these are about the only things I can learn with low input. Wonder if someonw would hire me where I just have to tell the components of named syndromes. Man, I would love that job! :D ]

I know for sure that however much may I love Med College, I ain't no match for "FINAL YEAR"! It calls for continuous studying, with lo-ooong hours of cramming & rote. Well, my butts aren't prepared for that kind of sitting! So then, I might face a tough time just trying to pass some of the subjects. * Do pray for me!!*

& know the final year's almost ended, with me just worrying about finishing the syllabus. With the exams at a really scary distance, I'm still not one with even the first read of books! Haven't even purchased Psychiatry & Anesthesia ki books! :(

Well at this point of time, it seems kinda stupid for me to be still sitting here moping about the epic-course & my tiny pool of knowledge, when I should be studying surgery. But hey, this was a great way to let off steam.

Right, I might as well get back to reading how to amputate a limb now. :/

*Plus one more thing on my mind right now: I HATE OBS!!!!!

So done with the OnG posting..

We-eh-ell..
Finished up with the 7th sem Gynae posting...and yes! like I've said before, this was the first time I actually went for the damn thing!!
Amazingly, I actually enjoyed the posting this time on... Maybe it was because I was posted with a really good Unit in the Dept... but whatever.. made the most of it and basically liked it all!! :)


Here are some things I learnt during the month:
1. Donning gloves is not all that tough :P
2. How to identify a full bladder and catheterize a female.
3. The boys in our Unit don't care a shit to come and attend the classes.
4. Some male gynecologists are actually good at teaching! (hats off to CP Sir)
5. AJ's long locks are noticable to all. ;)
6. You can never find the teacher if u're late on 'free days'!!
7. If u go into the OT, when some resident has done their first op, you get to eat sweets! :)
8. AIDS counselling for pregnant ladies is NOT compulsory!!! So... beware, when u're taking those deliveries in the labour room.
9. Giving birth to a baby is TOUGH on the mom... more so for a primipara!!
10. A woman CAN have a 10 month old baby and *still* be 7 months pregnant.
11. Gynaecologists in general... love eating! [prem-vilas ke samose] ;)
12. You must get your attendance registered on the same day...or they'll mark you absent.
13. While doing the 2nd Pelvic Grip, the ulnar border of the hand should rest on the pubic symphysis of the patient.
14. There's a room next to the PV room, that is exclusively meant for students to study!!
15. Most couples don't believe in birth control!
16. There's a LOT to learn.
17. Fourth Unit rocks!!

*Next Surgery*


- AL (VII Semester)

My First Time At Labour Room

Yesterday was the first time I set foot into the Ummed Hospital labour room, which by the way caters to the huge population of the entire Jodhpur district & more for conducting deliveries...(:see the PSM works here!!!)

First of all, let me clear up one thing for fellow medics who’ve actually bothered to linger around for so long at the blog (this is barring aside ritz, of course!).

You must be wondering WHY did I have to wait till the 7th sem to go to the labour room for the first time..!!??!! Well, the fact here is that I was seriously apprehensive of what was there to see in there. The thought of seeing even a “normal delivery” was kind of scary & I kept putting it off……..

& vaise we haven’t been posted as much in the O&G dept as such (the 3rd sem posting, well we kindof bunked; & the 5th sem posting, was missed coz of the univ exams!!!)…

So there I was at the Labour room yesterday…standing with D & Urmila (who had been to the area previously & seen deliveries!!).

Well.. while standing there, the first thing I got to see was the removal of the placenta…. Frankly, the sight was pretty nauseating at first—seeing all the blood... but made through that & while I was revelling in the feat--- that was seeing the process,---- a lady was brought in wherein the crowning had already occurred & was abt to deliver!! Boss, gave a quick episiotomy incision, & what started to come out was a dirty, black thingie…I thought for a moment that the baby was dead & macerated….

But the “black thingie” turned out to be the baby’s head & as boss externally rotated & pulled on the trunk, I wondered if she was trying to decapitate the kid. But then, out came the trunk & the legs… & a li’l boy was born!!! He cried at once to announce his safe arrival!

He was gross!!!! Covered in fluids & blood… Not a pretty sight… But as the nurse took him to the incubator & cleaned him up, he started gaining a bit of colour. As he was weighed, he got active & started moving out hands & feet. Looked amazing now!!!

It took hardly two minutes for him to come out of the womb, all filthy & transform into this b’ful little human being!!!

Now, I realize why its called “the miracle of birth”…..

As we were watching this baby, another one was born…. It was a if it was raining kids that day!!!

This one was a girl & had her cord tied round her ankle…It was cyanosed… As boss untangled the cord, the foot became normal & we heard her first cry!!

Another one was a breech presentation…

There was one who refused to cry & had to have the paeditrician come & do a check up!!

Now then, amidst all the deliveries, we also got to see some sutures done & got to administer oxygen to this girl who was cyanosed, & administer methergine injection to the iv line…

Basically, after seeing all these deliveries, I’ve found the Labour Room a pretty interesting place to be…& maybe you’re reading the blog of a “future Obstetrician” right now… :) (vaise lemme clear up one thing here…that my future plans change with every other posting…… so it might not be long before you get to hear from a “future Surgeon” too!!!) ;)

Anyways, I just need to write this down coz my fellow “A-batchmates” (except D, who was with me all the time) would’nt even listen to my labour room stories…… So I decided to drop the bomb on YOU!!!!

Cheers!

The Making Of A Doctor

The beginning of third semester at college is marked by a lot many changes—the most prominent & exciting being the commencement of clinical ward postings—which is basically what this piece of paper is filled with…

Now, just the idea of going to “The Hospital”, in sparkling white aprons- with steths around the neck to complete the picture- is enough to make you feel like half-a-doctor.
And add to that, the sense of freedom which comes with the posting-timings!!! You already feel high, as if on dope!!
The friends, the bikes, the open roads of Sardarpura….
Finally, a whole new world of juice shops and cafes opens up around you. The city becomes your canteen and hanging around these joints a routine.

So then, after a hearty celebration of this new-found independence over a cold shake & a samosa, you decide to head for the hospital !!

As you reach about an hour late for the clinic; you realize that the hospital is no joke & finding your way to the department is a Herculean task in itself.
And oh! Amidst all this confusion, when you yourself are lost in the buzzing activity of the hospital with stretchers being hurled around & people pushing you all over the place, you are stopped by a couple of attendants (or sometimes, an occasional patient), asking you the directions to the “orthopedics department” or else whereabouts of a certain physician who seems to have gone on a long vacation !!
This is where a sense of helplessness creeps in, & you try to explain to them that you are as new to the surroundings as they are. The attendants leave, giving you a look of disgust—as if saying-- “Why the hell carry that steth around, when you haven’t a clue!!”

Well, crossing all obstacles & evading any further enquiries, you finally make it to the ward. There you see about a dozen of your classmates, almost as dazed as you are.

You are then asked to go and “take the history” of a case who has been admitted & confined to the ward for days together; & is already irritable with ‘pseudo-docs’ like you trying to comprehend his disease. After a few minutes of inspection and a bit of palpation, he hushes you off by pin-pointing his exact disease & the drugs that he is on. You lap-up all this information happily, feeling like the brightest medical student there ever was…with a smile of contentment brightening up your face.

You decide to present the so-called ‘history’ to the doctor, when to your disgust, you find that it is the in-house resident who will listen to it (‘C’mon.. my first history deserves nothing less than the HOD’, you think!!)

Anyway, as you start presenting the history, you are stopped on the very first line & mocked at… ‘Is this how you present a history…Even a fresher can do better than that!!’,the resident exclaims.
Oh! The humiliation!
‘It’ll be okay!’, you think, & decide to move on. As you read out the words on the paper, you realize what sub-standard crap you have penned down-- & feel like the smallest creature on the planet.
Every word and line seems like a blunder & you wish you had never gone to that patient for the history!
Somehow, you manage to finish through & by the end what remains of the three page ‘history’, which you had so proudly put on paper, is merely a few pronouns and prepositions.

All the mockery done with, you are told to go study a-bit, “or else you’ll never pass MBBS!!” With this, as the resident leaves, the patient gives you a sly smile, as if he knew all along what kind of a quack you were.
You decide on your honour to never ever take a history again, let alone present it in front of everyone.

Finally, the grueling time comes to end with you registering your attendance & rushing back to college for the scheduled practical class, all the while thinking…..
“Will I ever make a doctor??”


- AL (III- semester)