The Romance of Introspection

I was listening to "Hotel California" by Eagles as I was reading about different types of vomit. My feet were neatly resting on the red oxide floor that my nearly half a century old house bears.

Do you remember red oxide floors? The flooring that was there in your grandparents' house probably. The ones you wrote all over with tiny pieces of chalks. The very same you rolled all over when you were 3. You'd get chided by your mother for spilling buttermilk on those floors because they left behind a nasty stain that took time to wear off. Those floors you sat on and played board games with your grandmother every summer. Sunny afternoons you spent mindlessly playing with cowries, the clunking noise they made when they kissed the ground. The floor that did bear your first foot steps and saw your shoe size grow from baby size 3 to adult size 6.  

Sometimes I wonder if we have lost the ability to see perfection in the little things around us. We have definitely lost the old world charm. And  I sorely miss it. 

Doctor Diaries : Part 1

He looked at me intently, wide eyed. No, I wasn't going to touch him if he didn't want me to. It wasn't fright or anger, mere curiosity. I didn't know what to make of it. I was trying to comprehend his mood. Suddenly, I was going back in time to the day when I first met him..... 

..... He came to us with a subconjunctival hemorrhage and a few blue patches on his back. His blood was brimming with leucocytes, cells that fight infection. Only, in his case, they were bad cells growing uncontrollably and not performing their function. In addition, they were even spilling out, fragmenting and would potentially start blocking his kidneys which could be life threatening. His hemoglobin and platelets were dwindling in the meanwhile, causing him to bleed into his skin and eyes. Under the microscope were seen blast cells, a dreaded finding for haemat-oncologists. He was suffering from a form of Acute Leukemia. The parents were shattered on learning the diagnosis. The castles they'd built in air for their family came crashing down in a few seconds. Given his age, the kind of leukemia he was suffering from was expected to be aggressive. 

He underwent his first lumbar puncture. My consultant likes to do the first lumbar puncture himself. As he says, it is extremely important to not puncture any blood vessels in the process. That would mean we have introduced the bad white cells from the blood into the CSF which cushions the brain. The procedure not only requires immense experience, but also profound faith in your own abilities.

We started immediate basic therapy for him. By evening, he had progressed from bad to worse. His cancer cells were already starting to choke his kidneys, a term we doctors like to call 'tumor lysis syndrome'. We used a drug called Rasburicase to antagonize the effect of it. Each shot of that drug costs about 15,000/- as it is a relatively new drug in the field. So much so that my consultant confessed that this was his first time as well.....

All of 8 months, he kicked and gurgled, spitting some fresh saliva into the air, and went back to sucking his thumb, completely oblivious to his disease, poor prognosis and the pain written all over his parents' faces.  

HAPPY DEEPAVALI INDEED

For the longest time I can remember, Deepavali always meant lots of savouries, free goodies, joy, crackers and new clothes. This Deepavali was a wee bit different. Of course, gifts, sweets and new clothes were a part of the festivities this year too. But this time, I celebrated mine working on all 3 days. I spent my time talking to my patients, sharing their happiness, joys and fears. I celebrated it by sharing my sweets with a cute little 3 yr old suffering from an acute form of leukemia, who has now been in the hospital for over 2 weeks. All he gets this Deepavali are beautiful visuals of the light studded sky from the window of his hospital room. 

It is sometimes frustrating that we work tirelessly day and night. Personal life, loved ones, parties, family gatherings and sometimes even important exams may take a backseat. But it disappears when you have even one person coming and thanking you, making you realise that every little minute you spent for them was worth it.

The festival this year has been extra special because we have also done an autologous bone marrow transplantation for a patient suffering from multiple myeloma. It would give her a chance to live disease free for 2-3 years. For people whose expiry date is more or less known, even one extra week makes such a difference. These procedures are huge for the hospital (also in terms of income. He he.) These people are extremely prone to infections post transplantation and have the risk of high morbidity and also mortality in about 5% of the cases. That may seem like a small percentage only. But even one patient we lose is a big loss to us and their families. Hoping that she breezes through the next 20 days safely. 

I don't know how the transition happened - dolls to people, playing doctor to being a real one, a real stethoscope replacing the toy one I used to pocket all the children in the neighbourhood. But I am glad it happened and I know I would do it all over again if I had to. 

WHERE THERE IS A WILL, THERE IS A WAY...

"I had amenorrhea for 2 years. I never bothered to pay attention to it because I was so busy taking care of my family. When I finally visited my gynaecologist, she recommended that I undergo a scan, which was suggestive of chocolate cysts, a relatively benign condition. She told me that a laparoscopic surgery can resolve my problem. The operating surgeon, on the contrary found cauliflower like growth all over. She was shocked. She immediately closed me up and informed my husband. It was 1992. I was diagnosed with stage 3 ovarian carcinoma. My girl was 10 and boy was 4. Eventually a debulking surgery was performed. I was given high doses of endoxan (a chemotherapy drug) which made me lose my hair. I fell sick often. I would endlessly retch and vomit. Those were dark days. But I was almost cured of it. I travelled all the way till Apollo Hyderabad for my follow ups. All was fine, till it resurfaced in 2001. My daughter was a medical student. My abdomen had to bear the brunt of another surgery. Coincidentally, I met the gynaecologist who had operated on me for the first time. I couldn't help but stare at the wig she was wearing. She seemed to have read my thoughts and promptly told me how she was diagnosed with breast cancer and had to undergo mastectomy. I was speechless.

Post second surgery, I went to the hospital for a follow up. That's when I learnt she went into coma and passed away in the same hospital. What a cruel twist of fate. The lady who gave me a second chance in life lay there motionless.

Soon, my daughter moved to another country and I lost my husband. I've changed a few doctors. I've had near miss events happening in my life. A lot of people and things left me, but this damn cancer doesn't seem to. But I am not going to quit fighting. I am a survivor.... "

I hope this incredible woman who has tirelessly fought cancer for the last 2 decades serves as an inspiration to every single person out there in the world because out of difficulties grow miracles!

THE POWER OF TOUCH

I have comfortably slid into my daily routine of seeing sick people and trying to nurse them back to  health all in good time. Most people look at us either as God or monsters, but the fact really is that we are human beings like everyone else .Today was a little different. Appreciation for your work makes you work harder. When it comes from your patient, it makes you realise why you got into this profession in the first place.

We have a patient who has been with us for over half a decade now. She explained to me the importance of "touch" in our profession. She explained to me how a very small thing like me patting her shoulder gave her so much of satisfaction and more importantly, courage to go about doing her daily chores.

Patients who carry the burden of a disease which is still considered stigma today are always looking for more love, in addition to care. These little things are never taught to us in med school. They are a mere reflection of our personality. She narrated to me how her previous oncologist always wore a mask face and would never answer queries, leave alone anything else. She, being a doctor herself,also spoke to me about how times and health care have drastically changed in the last 2 decades, when she was first diagnosed with cancer. 

Before I left her room, she thanked me for spending some time listening to what she had to say and did something that caught me by surprise - she held my hands and kissed them. That's when I truly understood what she was trying to say. 

...BECAUSE EVERY DAY IS A SECOND CHANCE

"According to Elizabeth Kubler-Ross, when we are dying or have suffered a catastrophic loss, we all move through five distinct stages of grief. We go into denial, because the loss is so unthinkable, we can't imagine it's true. We become angry with everyone - angry with survivors, angry with ourselves. Then we bargain. We offer everything we have. We offer up our souls in exchange for just one more day. When the bargaining has failed and the anger is too hard to maintain, we fall into depression, despair, until finally we have to accept that we have done everything we can. We let go. We let go and move into acceptance."

We take our lives way too casually. Suddenly, one day you realise you're sick. It dawns upon you that you have very little time to do everything you wished to/planned to. You wish you could freeze time. And then it's too late. And just like that, you're gone.....

Hello everyone. I work in the department of Haem-Oncology at Columbia Asia hospital. In a matter of a week, I have seen a lot of different kind of cancers, head to toe. Right from the more common breast and lung cancers to pretty rare ones like mantle cell lymphoma. Though the cancers have varied, the response to a person's diagnosis when they heard it for the first time hasn't. Sometimes it hits you that despite being a doctor, there is no way to possibly alleviate everyone's suffering. 

Back in the 90s, cancer was still unheard of. Diagnostic tests were minimal. Chemotherapy was expensive as hell. There were so many people who died even without being diagnosed. Come, the new millenium, things took a turn. Today, we have treatment for so many different types of cancers and we have new revelations and path-breaking research happening every single day. Yet, the stigma of having cancer is almost as bad as it used to be for tuberculosis if not worse. What we need to understand is that cancer is a diagnosis just like diabetes or hypertension. The number of people who die because of complications of diabetes and hypertension far outweigh those who die of cancer. Cancer does not mean the end of life. It just means that it needs to detected, treated and accepted in the right manner. We do have patients who have lived for 2 decades after initial diagnosis and who continue to maintain well. We should never stop believing in hope because miracles do happen every day! 

Today, a 50 year old lady walked in to our chemotherapy unit. She was diagnosed with early stages of breast cancer. She was shocked and then she was suddenly crying. It dawned upon me that knowledge is not the most important thing about my job. Knowing how to console a person and believing that they can come out of their illness, or training them to be mentally strong about it in terminal cases, is perhaps the single thing that differentiates a "good" doctor from a "mediocre" one.

I feel so lucky to be working in a setup where I am not only learning to effectively communicate with my patients but also learning to be a better person in general. That's my learning curve.


“The things you do for yourself are gone when you are gone, but the things you do for others remain as your legacy.” 

IN(Not So)SUR(e)ANCE: Learning the hard way

For me, hospitals have always been about work and treating sick people with all kinds of ailments. But that perspective changed when my father got admitted to the cardiac ICU at the hospital I was supposed to start work at in 2 days. I saw a whole new side to it. A side where a security guard had to permit me to let me into an ICU. What I had taken for granted before was something that came to bite me in my back. Thankfully, becoming a prospective employee and some pull got me in without much hassle for the rest of our brief stay there.
I, for the first time actually understood the proceedings of insurance and their policies. At first, I was mostly ashamed that I had no idea whatsoever about insurance policies being a health care provider. But hey, there's a first time for everyone and I am glad mine happened, albeit the hard way.

In comparison with the hospital where I imbibed the tricks of the trade (read as Davangere, a small semi urban town where you lawyers and filthy rich doctors breed), corporate hospitals are a whole new chapter. Corporate hospitals have changed the dynamics of health care. Health insurance, a thing that was almost unheard of in India in the last century is the way health care rolls these days (in an urban area of course). It has also reduced the burden of middle class fellows like us. But with the bouquets, come the brickbats. Remember, that insurance companies are very good in convincing you to buy a policy and are very happy as long as you're paying your annual premium. But when it actually comes to doling out money for your hospital expenses, they don't give in without a tough fight from their end. Query after query finally resulted in a 70% payment from their side and us getting discharged after 10 whole hours!! In a small way, I felt pretty cheated. Looking back, all of the above said about insurance companies would seem very obvious. But unfortunately I never paid heed prior to this experience. So here I am sharing my experience with you briefly so that you don't feel as lost as I did.

1. KEEP COPIES OF YOUR INSURANCE POLICIES FROM THE PREVIOUS YEARS TOO. DO NOT DISCARD THEM. (They are retards who want to see your policy from 3-4 years even though they have documentation of your loyalty to them)

2. As soon as your kin gets admitted, hunt for the insurance and billing department (I&B)of the hospital. They'll guide you with the procedure. You just fill in a form of your TPA and hand it over to the staff so they can email it to the respective TPA for approval.

3. Approval should roughly take anywhere between 2 hours - 24 hours depending on the insurance company.

4. Once you get a nod for discharge, inform the I&B department. Be nice to them and bat your eyelids to get your work done quickly. (Everybody is put off by shouting. Even though it can be frustrating, remember that they are also tending to a lot of other patient requests. Hence, be patient and dignified).

5. Insurance companies will never sanction the amount right away. They need proof for everything and will always have a gazillion queries to know how genuine the illness was. Let the staff of the hospital deal with that.

6. Also, constantly check with your insurance company the status of your submission by dialing their toll free number. A lot of times lacunae in communication may result in unwarranted delays.

7. Pray that everything gets processed fast.

8. Once the amount is sanctioned, walk out of the hospital better and happy.

(The above mentioned is merely for the cashless facility. For the reimbursement facility, I'll have to wait to learn all about it)


With changing times, sedentary lifestyles and a polluted environment, more people are falling sick. When prevention isn't an option/happening, cure is the next best thing. With more corporate hospitals and tertiary care hospitals cropping up, tiny nursing homes are disappearing. The entire nation is also aware of the rising cost of health care in our country. So my personal recommendation to everyone is to buy a health insurance policy as soon as possible. Make sure that you find a good one which fits your bill and processes claims fast. You never know when you may need one. 

My thoughts are stars I can't fathom into constellations

I had a very interesting conversation with one of my friends recently about human greed and expectations with respect to relationships. He gave me really good advice. We are forever in pursuit of, let us say, lusher pasture. It’s such a vicious cycle. But isn’t this greed the very thing that makes us so human? That makes us err and do right? That gives us enormous experience. Is there ever an end to it though? There is. It is when you decide to mature and realise that hey! I am happy with what I’ve got. It apparently happens at some time. Waiting for my turn….

Life as we know it

A few days ago, I went rafting in River Kelani, Sri Lanka. At a point of time, I jumped off the raft into the river. It was the single most LIBERATING experience of my life. Its funny I would like to term it so. It was probably symbolic of a life I was leading and didn't want to lead anymore. I initially thought I'd drown and die. But my life jacket came to my rescue. It was only minutes before I felt at ease. I swam and floated for about three quarters of a km; I could lay on my back, watch the blue skies dispersed with white clouds drift away from me and let the sparkling water push me forward. I thought of nothing. Open space and open mind.
If only we could extrapolate this to our real lives. If only we weren't scared of dying. If only we weren't so scared of living. If only....

SEX, DRAMA AND EDUCATION

The latest controversial headline doing the rounds is “Sex education should be banned”. Well, here is my 2 cents on the issue:

I was posted in the ultrasonography department during my internship. I was sitting next to my PG who was explaining the basics of identifying structures on the computer screen in front of me. He showed me a gestation sac with a tiny little creature inside. The little heart was beating on our monitor. Our patient was a 15 year old unmarried girl from a nearby village who was 3 months late according to the history she gave. She was referred from the OBGynaec department to rule out pregnancy. She was initially suspected to have severe anemia which was treated with a pint of blood (Anemia can be a common cause of missing your period). My PG, being a rather old guy, asked her if she had indulged in sexual intercourse in the recent past. She vehemently denied it. And then he posed the question to her, “Then how are you 17 wks pregnant?” She was shocked. Honestly, so was I. She looked like she was going to cry. But she was trying to be completely brave about it. She begged us not to tell her parents about it. She being a minor, and this being India, the PG said he had to inform someone about it. So, her elder sister who had accompanied her was called inside and informed. Barely 2-3 years older than her, she was at a loss of words herself. I felt so sad for the little girl. The consultant radiologist, a lady in her late 50s had nothing nice to say about it. She thought the girl had no culture and these people are hopeless. I really hope she didn’t find a well.

This incident made me believe that sex education is such an important aspect of education in a country with such a huge adolescent population. This is more so in a rural population where adolescents don’t have the knowledge or the access to internet and media, in comparison to their urban counterparts. This girl, all of 15 had no idea that she should be worried about a missed period after having sex. Had she known that, she would have probably come to us earlier when it would have been so much safer to terminate the pregnancy.

Our health minister, himself a doctor, thinks we need to weed out this western culture of pre-marital sex and extra marital affairs. Which era are you living in? When was it ever western culture? Our epics are all about pre-marital sex and multiple sexual partners. (Of course, it had its fair share of downfall) Banning sex education isn’t going to stop people from having sex. Let us face it, we are all animals. Our carnal instincts always get the better of us. The more forbidden something seems, the more you want to indulge. What can be done instead is to learn the ways to protect our adolescents from unwanted teenage pregnancies, life threatening sexually transmitted diseases and a lifetime of hell. Boys and girls are peaking by 12-13 years these days. This is why sex education should be imparted by the age of 13 – safe sexual practices, personal hygiene, the advantages of monogamy, awareness about rising incidence of cervical cancers attributable to multiple sexual partners and earlier age at the time of first coitus, and sexually transmitted diseases. It’s not just enough if sex education is being imparted. It should be imparted effectively. If teachers are shy, call upon health personnel who are ever willing to share their views uninhibited.

Our culture is such that parents also refrain from discussing these issues. I never got “the talk”. We resorted to books, peer and the internet. For the less fortunate, the government has to do something, if they want their adolescent population in safe territory. 

Dear health minister, our culture was never about monogamy. Men have always been men and indulged in what they pleased, married or not married. Uneducated women, who were barely exposed to the world never suspected anything and even if they did, put up with it to uphold traditions. But today, women are educated and hence, it’s a different story. He said, “Condoms promise safe sex, but the safest sex is through faithfulness to one's partner. Prevention is always better than cure.” Although it makes sense, trying to preach this to a million horny people is futile, I believe.

I am not suggesting the adolescents of this generation to be rabbits. But being prepared and knowing how to tackle a problem can make a difference. Disaster management demonstrates the steps to tackle situations, should disaster strike. You can’t just sit back and ask Nature to stop taking its natural course. 

CHANGING TIMES

I went to the chaat cart near my house that I've been going to since I was 11. This is the first time I went there after he introduced the disposable plates system. The vendor and I got talking when he told me that his daughter is planning to pursue a course in engineering this year. Having seen the frugal life he has led, I was pleasantly surprised and genuinely happy for this man, who had made it to my sister's wedding with a small gift about 3.5 years back. Nobody wants to be left out of the rat race anymore.

My second anecdote is about the headmistress of a government school near my house that I recently visited. A distraught looking mother came to the headmistress and told her that she wanted to take back her 13 year old daughter who was studying in that school and lived in the school hostel. On inquiring the reason behind this sudden and drastic decision, it came to light that the father was opposed to the current setup due to a financial crisis. The class teacher came with the school records and exclaimed that this child was doing extremely well in class (3rd in class) and would surely get a distinction in 10th if she pursued and worked harder. The headmistress sent the mother back saying she wouldn't permit this withdrawl from school and she would personally make sure that the child got education and accommodation free of cost. This attitude of the elderly lady I was sitting in front of, really won my heart. Education in India, especially of the women makes such a difference in the quality of the life a family leads. If there are little children willing to be educated, there are always large-hearted people who are willing to help.

In another incident, I visited a village for a diabetes awareness camp. I saw a 7 year old girl running about the place with an infectious smile. I caught hold of her and started talking to her. Found out that she loved dancing. She showed me a few good moves. She was unbelievably good for her age. She also told me that she loved going to school and wants to become a doctor like me when she grows big. The very fact that she had such a huge aspiration given her humble background is the stepping stone to achieving something in life.

Dream big, because the sky is not the limit, we ourselves are.

THE GIRL WITH NO NAME

The sky was a mosaic of colors. Grey clouds dispersed among patches of blue and red along with ribbons of gold. As it turned purple, it eventually dissolved into the darkness. Sitting on the dusty stone steps that had once seen daylight, night and more, we sat there lost in ourselves. We poured our hearts out, filling in each other with every thing we had missed out on so far to the most intimate detail. We sat and wondered how it felt like time had almost stood still, like 6 years had never happened. So much had changed, yet so much was the same. Took us back to ancient sunny afternoons when we'd bake a cake religiously after school, try all these absurd culinary stuff on each other. While some memories reminded us of how insane we were to have a girl band without people who play any instruments, some others took us back to "Girlfare awards" which we had completely rigged. Sunday morning painting classes, combined study sessions, holi celebrations with ujala water, insanely competitive bulletin board competitions, discussing crushes and eventually love lives, innumerable auto rides back home with her sitting on top of me, running up the hill clinging on to our bags, long walks and long talks and sharing our dreams paint vivid pictures on our timeline.

When I look back, I see 2 little girls happily running to school, so late, yet managing to make it just in time. I have known this girl since we were all of 3 years of age. We went to the same play school, kindergarten, primary school, middle school and high school. That's indeed a long time to know someone. And then we parted ways to chase our dreams. Today she is an architect and I am a doctor. We are back in the same city ready to renew our threads of friendship. I know for certain, that with this girl, I squared my knots right!

Are You 'Kid'ding me?

When I was born, my grandfather apparently told the family that this beautiful doe eyed child would make a fine doctor. Ever since I was 10, I wanted to be a doctor – logic or no logic. It never occurred to me that there was unchartered territory out there yet to be explored. And wanting to be a baby doctor caught my fancy early in life quite naturally influenced by my own paediatrician who I considered the modern day Midas.

There are some people out there who enter medicine unsure of how life is going to carry them forward and there are a few others who know exactly what they want to be when they grow up. For me, it was always Paediatrics. My heart did cheat on me by wandering to other specialities every now and then though. But 5.5 years later, I am back to square one – aspiring to be a paediatrician as always.

My college boasts of one of the finest Paediatrics department in the state. Every professor is better than the other. So it wasn’t surprising to see really rare textbook cases, first-hand.

I vividly remember an incident from 3^rd year of med school that I’d like to share. It was a bright Monday morning and everything about the day right from the sunrise to the breakfast was pretty perfect. I happened to take the history and examined a 10 year old girl diagnosed with type 1 diabetes with suspected Wilson’s disease. I spoke to her for a while, got chummy, and made her write out stuff in my notebook. 3 days later when I was walking in the wards, I felt someone nudging me softly. I turned around and saw this little girl, breathless, who had come running to tell me that she was getting discharged and going back home. She shook hands with me and gave me the most genuine smile I had seen in the longest time possible. I went back home, with my heart ready to burst. Such overwhelming joy!

Doctors are supposedly vaccinated against the constant emotional brunt that comes with disease and suffering. Yet, I haven’t met even a single paediatrician who doesn’t get involved with his patients and carry the burden of suffering themselves. Children are truly the hands by which we take hold of heaven.

I was so fortunate to rotate in the Neonatal Intensive Care Unit (NICU) for a month during my internship. My job was to counsel new mothers about feeding, contraception, keeping the baby warm and administering timely vaccinations for the babies. I realised that new mothers are some of the most receptive people we can ever find and for good reason. While some mothers had to be demonstrated the art of breast feeding, some others had to be coaxed into visiting their babies with cleft lips and dysmorphic features. The babies were all sick and needed constant attention and feeding. The work hours were killing but so very satisfying to go back to bed knowing that you had held a baby and tried your best for him/her.  

When I sit back and close my eyes, I distinctly hear the paroxysms of cough that a 1 year old child with pertussis had, a disease almost unheard of in the 21^st century; I hear the rumbling noise of a machine like murmur (heart sounds due to turbulent blood flow) in a 12 year old boy with a congenital condition called patent ductus arteriosus, which should have ideally been treated more than a decade ago in him; I see the rashes of Henoch Schonlein Purpura  on the thighs of a 9 year old girl; I stare into the puffy eyes and face of 2 year old Sahana (name changed) who cannot even comprehend that she is ill, leave alone having a renal condition called nephrotic syndrome; I remember the beautiful face of Mrs Geetha Parashuram’s (name changed) 10 day old baby who won my heart, the little baby girl who kept having myoclonus like jerks and went back home undiagnosed after a month because nothing we gave her made her any better and all the investigations they could afford came back clean.

We succeed sometimes and we fail sometimes. But children always push us to try the very best for them and in turn, ourselves. I am living my dream of becoming a doctor. I now begin my journey, in chase of another dream and hungry for more adventure.

THE BEGINNING OF THE END

My routine for the last few days has mainly involved rounding in the ward, saying hello to all the patients in my ward, checking blood pressures, changing dressings, cracking some flimsy jokes and trying to advise everyone regarding diet and general lifestyle. Being in orthopaedic surgery (as a good friend insists on calling) my contribution is very passive.

2 weeks back, we had a patient in our ward who was simultaneously diagnosed with depression. His main complaint more than pain was the lack of attention towards him by the nursing staff. We don’t do 5.5 years of med school to turn a deaf ear on such issues. We aren’t just taught to tackle diseases, we are trained to try and be super heroes. All I had to do was really assure him that he will be well in no time and we will take good care of him. In the sick room, ten cents’ worth human understanding equals ten dollars’ worth of medical science. A week after he was discharged, he came for a follow up visit to the OP. He came straight to me and thanked me for making him alright and wisely said that more than a doctor’s treatment, it’s the assurance that could truly make a difference, in both our lives. Hearing that from a person who is 3 times my age really made my day.

What really got me writing today is a small observation made in the wards today. As usual, I was going about my work. Surgical patients are generally retained in the wards for a longer period than medical patients. The bond patients foster with their treating personnel and co-sufferers is something purely amazing. They defy boundaries of all sorts – economic, religious and personal; and become united in suffering. What I wonder though, is if this is a rural attitude and would be wrong to extrapolate to the urban crowd.  One lady asked me about my background, my family and seemed to be in awe of me and everything I had to say and did. It is a feeling that can never be put to words. They look forward to my visits every day and the feeling is mutual, I am starting to believe. 

I am haughty enough to say that I wouldn’t miss anything about this place. As I walked the orthopaedics wards today, I knew what I would miss –Smiles in the face of adversity; the warmth, love and respect each and every patient and their attendant gave me in the last few days of my life as a junior doctor.

A STITCH IN TIME...

My mother has always had this inexplicable fascination for surgeons and their art of healing with a scalpel. So it is not surprising that I often found myself being a victim of her constant banter about what an amazing life I could lead as a surgeon, and she in turn, as the immensely proud mother of a young surgeon. But it never pushed me to like surgery more than I already did.

I vividly remember the very first surgery I observed. I was in my second year of med school. I had never seen the insides of an OR prior to that. I knew much less about the OR dress code and discipline. But that did not dent my enthusiasm even in the slightest of ways. Dressed in bottle green scrubs, we entered the OR bare foot.

It was a little intimidating at first, even though we were merely observors. In front of us, lay a 45 year old lady who was about to lose something that defined her very essence. She was scheduled for a right sided modified radical mastectomy, having been diagnosed with breast carcinoma. The psychological trauma of having her breast cut off, would probably leave her more scarred for life.

With all due respect, my unit chief was a very ordinary surgeon albeit with a fierce temper that could probably kill the patient before cancer could consume her. He began the procedure with an elliptical incision beginning on the inside of the breast. I had never seen so much blood all my life. Blood stained hands, scrubs, floors. It was mortifying. They kept suctioning all the blood and it still wouldn’t stop oozing out. I secretly thought she would bleed to death. The stench of the cautery slowly but mercilessly eating its way through the human tissue was dizzying and wasn’t helping. The surgery trudged on for what seemed like forever but lasted a good 2 hours. At the end of it, she was surely short of one breast, but the cancer? We were not sure. We could only wait and watch. And hope!

As I entered my surgical rotation for the second time in my final year of med school, I had taken a liking for it which rather surprised me. My unit chief was not just an extraordinary surgeon, he was also an extraordinary man. Watching him resect a gangrenous bowel and anastomosing it in the middle of the night was probably one of the best experiences of my lifetime. (Yes, just being a witness to it.) Its easy to fall hopelessly in love with surgery if you ever saw him playing around with vicryl and a needle holder. Deft and precise, he was everything a budding surgeon hoped to ever be. Being bold as a surgeon is the greatest gift that can be bestowed upon one. And he was gifted. In more than one way.   

Internship was an altogether different experience. I learnt slowly, but effectively (hopefully!!) basic surgical skills and techniques. I got plenty of opportunities to learn and practice with minimal adverse consequences.

Yet, the event that changed my mind about surgery came after I finished all my surgical rotations. It was during my brief stint in Anaesthesia. I was posted in the plastic surgery OT. A 55 year old man was posted for creation of an Arteriovenous fistula. He was diagnosed with diabetic nephropathy which meant his uncontrolled sugar levels had started to stunt his kidney functioning. Without dialysis on a regular basis, he would die very soon. People on dialysis undergo a procedure which involves creating an AV fistula called a Cimino fistula. Our body has two separate blood circulation systems – an arterial system (high pressure system) which contains all the good blood and oxygen that fuels the tissues of our body; and a venous system (low pressure system) carrying the bad blood away from the tissues to the heart which in turn gets filtered in the lungs and returns to the arterial system. It’s a simple cycle really. By creating an AV fistula, we are essentially connecting a small artery to a small vein thereby inducing a hyperdynamic circulation in the body.

The patient was made to lie supine and stretch out his right arm to find a vein. He was given a local anaesthetic, parts painted and draped. The plastic surgeon then got down straight to business! He made a small nick in his forearm and carefully dissected out the underlying tissues. His immense experience was testimony to him spotting the vein in no time. It was clamped. He then proceeded to find the artery adjacent to it. It was pulsating and breathing life, and hence hard to miss. It was clamped. Procedure half done. Sounds astonishingly simple doesn’t it? There is no way an amateur could do this procedure without causing some kind of damage to one of the blood vessels, The whole procedure would be totally futile even if it was only one small puncture. All along, he beautifully explained the entire procedure step by step. It was fascinating for an onlooker.

He proceeded to cut the vein and made a tiny nick on one side of the arterial wall without damaging the rest of it. (This was all of course done after clamping the vessels and obtaining a bloodless field) All he had to do was connect  one end of the cut vein to the cut side of the artery by placing sutures anteriorly and posteriorly. He used 7-0 prolene sutures which are visible to the naked eye only if you have perfect vision. Procedure completed. He released all the clamps and just like that, the now conjoint vessels sprang back to life, pulsating and pushing harder than ever. The operating surgeon let me palpate the vessels after stitching back the skin together. The mixing of the bloods had caused the blood flow to become turbulent which I could appreciate as a thrill. On auscultating, I could hear a low rumbling noise like that of a machine. It only meant one thing – it was a job beautifully done!

“The night fissured and stars rained down on me. Queen of the night, I knew love at last.”