Wednesday, March 27, 2013

My overconfidence got busted ! - Doc confesses - 2

Not even 2 weeks into my internship, I was bubbling with confidence.
Overconfidence, actually.
I was posted in the dept. of Medicine and the residents were cool and they let me do many procedures. And I did them quite well for a first timer. I was already so much interested in medicine since my pre-final year and my confidence levels were sky-rocketing ! To help it all, I was free from migraine attacks.

I felt that Internal Medicine would be the area of my specialization. I actively involved myself in patient care. I tried to do more that what was required of me.

Now there was a 55 year old guy who had a 1.5 x 2 cm liver abscess. A diagnostic tap was required.
"I will get this one done", I declared. 
"This is not the first time I am doing one"

I took the patient to the procedure room and bored into his liver. I did everything correct. You can believe my word. I did do everything perfectly fine. Except for one little thing! The radiologist had surface-marked the abscess with the patient in the sitting position while I did the procedure in the lying position. I did read the radiologist's report but didn't notice this line ! And we know the liver moves significantly between the two positions and the abscess was small. My bad luck, I got 2 drops of thick pus in the aspirate and after that whatever came was dark red stuff.

Believe me, at the sight of blood, I was about to faint. My heart almost broke my rib cage. My useless double agent brain was frightening me more. "You've given your patient a hemoperitoneum, well done doc!", "I think you tore the IVC, your patient will be dead in minutes". Such thoughts came like a tornedo from nowhere and tossed my mind. 

Strangely, on the outside, I was calm. I abandoned the procedure and let the patient lie down. I kept checking his vitals every 5 minutes. The IV access was ready and fluids were all kept ready. I informed the residents.

Fortunately nothing happened to the patient. He was stable and fine. 
But me! I went through all the stages of shock and survived!

In a way, I was happy that this incident took place very early in my internship. My overconfidence got busted earlier and I maintained sanity.

The patient knew I had made a mistake. Being a terminally ill patient, he was already depressed and he didn't bother to make a big fuss out of this. Everyday I spent some time talking to him. We became friends. I came to know that he wasn't really afraid of dying. He and his wife lived alone after their children had left them long ago. His grief was in leaving his wife alone. 

Sunday, March 24, 2013

Confessions of a Medico - I

I don't have anything 'interesting' to share on these 'confessions' or 'anonymous proposal' pages that have loomed over several social networking sites recently. But this is what happened to me during my medical undergraduate training.

The day I walked into JIPMER, my medical school, I absolutely had no sense of purpose. I had no great ambitions. I wasn't sure of my choice. I had cleared the eligibility tests for JIPMER, AIEEE and wasn't sure which one to choose. And I hadn't thought of other options ! (I had been selected for the National Biology Olympiad the previous year, which stimulated my interested in Biological sciences. I probably thought learning human physiology and pathology would be great.)

Just few days into my first year and I was sure I had made a wrong decision. I badly wanted to talk with someone. I wanted to throw a tantrum and somehow leave the course. Nothing materialized. I was not performing so well in the exams (Though, I never failed one!). As I was struggling through, something happened to me that changed me a lot ! Friends ! (Not the serial, I mean my real friends).

In the university exams that marked the end of the first year of MBBS, I topped all the three subjects. (Actually top marks in two subjects and 2 marks less than the topper in one). That motivated me to move forward. I moved to second year and loved the para-clinical subjects very well. But little did I realize that I had crossed the point of no return !

Second year went on well. But the third, the fourth and the internship were hell.

There was nothing wrong with the course. I simply did not like it. Further to make things worse, there was always a pain to torment me.

I had this problem of migraine for long. For many, migraine was just another headache. But for me, it was a brainquake that occurred once on a happy week, five to six days on a worse week ! The pain's worse, and the pre & post migraine phases were no better. They made me depressed many a time. They robbed me of every little joy in my heart and strength in my muscles.

I can't describe in full how much I suffered. I wanted to run away in between but was too tired to do so. Somehow, I passed every subject with distinction and got some gold medals too.

I don't say that I would have not suffered if I had chosen some other profession. Every profession has its own troubles. It's the passion for the profession that keeps people going. I found myself having none or too little passion towards this profession. However, in all these, I kept patient care a priority. You can read about some of my patient encounters in this blog.

Till now, I have no clear idea if I have made a wrong choice. But I have no regrets. Because, in the course of my MBBS, I have learnt the following: (and probably much more, I have failed to pen down here!)

1. "If I have seen further it is by standing on the shoulders of giants.", Sir  Isaac Newton said. If I have come this far, it's because I have stood on the shoulders of my friends.

2. If there's a God, I never understand why He won't intervene and change things for the better. But now, after crossing MBBS, I strangely feel so strong. I feel I can tackle anything that comes my way. I have seen the worst and have survived. Probably God has a purpose in everything of which we have little knowledge! Or that is how we should console ourselves!

3. I have learnt to live life. One day at a time. Trying my best to live life to the maximum.

4. What matters to me at the end of the day?
It's not the knowledge gained or the awards collected. It's not the Facebook likes or the no. of blogger page visits. Wisdom. Creativity and innovation. The positive impact I create on the life of people around me. The purity of love in my relationships. These are the things that matter most to me.

5. Happiness is what we create for ourselves. Respect & Trust are what we earn for ourselves. These are certain things that can never come by force or power.

That's all for now ! Happy week ahead !

Thursday, March 14, 2013

Thank you, Google Reader, will miss you lots!

Shocked. Sad. Grieved. Disappointing. Frustrated. Angry. Helpless. Hopeless. I was all.

Ha, ha, I am not a drama queen, but I was indeed affected when I read the news. Yesterday, Google announced that it would shut down its Google Reader service from July 2013 as a part of their spring cleaning ritual. 

Now this comes as a big time disappointment for me. I've been using Google Reader to keep sync of all my RSS feeds across my devices. On my laptop, on the web and on my android mobile. I check out around 30-50 articles everyday on various topics: Photography, Android news, Technology, Inspiration, Science, etc. etc. (Now, If I read an article in my mobile, it will be marked read in my laptop also. So i don't have to go through it again. If I save an article for later reading in one device, it will be saved in all!)
Thankfully there are many other RSS readers out there. But where will I find one which will keep me synced across all the platforms I use and one which I will love? 

There has been a varied response in the internet media about this decision of Google. Some people just didn't bother. But most of them, who found it useful like me, got angry and frustrated. Some very disappointed. 
I am a little disappointed too. But still, it was a totally free service. So no one can complain, I feel. And I am so thankful to Google for giving us Google Reader till now. Will miss it a lot when it's gone.

Friday, March 8, 2013

"A doctor like you is rare to find"

"A doctor like you is rare to find. And I am so lucky to have found you"
Well, this is what my patient told me today morning. And it made my day!

Now I certainly don't say that I am a great doctor or I did something great but do read below to know how it all happened and what I learned from my own experience!

Mr. R is a 40 year old agricultural worker who attended the medicine OPD, three days back. That was when I first met him. He had come for some stomach pain. When I saw him, I felt he was a little obese and gave him a sugar test and a lipid profile as a part of my screening.
And yes, the tests proved him to have diabetes and high cholesterol levels. And that is how he became a part of my thesis.

I took him to the Clinical Pharmacology Lab. I showed him the test reports and explained it to him. I told him he requires medications. I carefully explained the cardiopulmonary exercise testing that I was about to perform on him. After getting his consent to participate in the study, I performed the test on him. After the test was over, I handed over the medicines to him and provided the necessary instructions. I also referred him to other departments for baseline investigations.

When I did all these, I was genuinely interested in the well being of my patient.  Also, I had enough time to spend with him. It took me around 45 minutes for the counselling and performing the test.

When it was time for the patient to leave, he spoke to me.  (Until then, he was just listening to whatever I said.) He spoke to me about a keloid on his chest which bothered him. He has had intra-lesional injections when it grew larger and antibiotics when it ulcerated and got infected in the past. But he was neither informed about the disease nor of its treatment or prognosis.

I was about to leave to the OPD and I was in a hurry. But strangely, when he started speaking, I could sense the anxiety in his tone. So I stopped there and listened to him. I simply listened without speaking back. He spoke to me about how it appeared, how he got treated at various places, how it embarrassed him, how it troubled him, how it gave him pain, what other people told him, etc. etc. After listening to everything he had to say, I made him understand about keloids and gave practical tips to deal with it. Seeing him get relieved, I reminded him about his diabetic medications & life style modifications (because I felt he would remember much better now as he was relieved now of what was troubling him).

And when he was about to leave, he said: "A doctor like you is rare to find. And I am so lucky to have found you. Thank you, doctor"

I did not do anything heroic! I did not give CPR and save a dying soul. I did not operate and resect a large tumor from a highly vascular bed. I did not see hundred patients and prescribe them medicines. I made a simple impact in the life of a patient and in my best capacity and I did it well. That satisfies me. However, as I ponder as to what made him say those words that brought me  joy, I find certain conclusions.

A genuine interest and a listening ear which I offered the patient, impressed him the most. Not my skill. Not my educational qualification.

However his phrase: "rare to find" makes me wonder!

Dear friends,

Cure sometimes, 
treat often, 
comfort always.

Monday, March 4, 2013

Time to Think & Reflect

Since my childhood days, I've been a very curious kid. I loved to know about everything around me and it made me wonder. Why the sky looks blue? How does the twilight glow beautiful shades of red and violet? How do some birds simply stop flapping their wings and glide in the air? How does the TV work? etc...etc... my mind was always full of such questions. I remember, I'd go to my grandpa and ask him. He was such a treasure trove of information. He seemed to know a bit about everything. When he was away, I'd frequently visit the small private library near my house. I read more of science books & non fiction that novels.

I read a lot. I thought over it. I reflected. I wondered.

Time passed. Every year, I moved to a higher class. Year by year, the amount of information I had to read increased. Initially I was loving it. I always questioned "Why" and tried my best at finding the answers even if I couldn't find them in our standard text books. I referred many books. I spoke with elders. I appreciated the beauty of it. I appreciated the practical utility of it. I thought of more ways of using the information in my day to day life. "Wow", I'd wonder, when a brilliant idea or pattern emerged out of my thinking. But as time flew, more and more had to be read, memorized and many exams to be cleared. I read a lot. (was compelled to read a lot!). There was no time to reflect on what I read. There was no time to appreciate! I reckoned that I'd fallen into a pattern of reading, memorizing and vomiting. My 5.5 years in medical school were the worst in this regard.

I felt the burden of knowing more rather than the appreciating the beauty of what I read.
I read. I wrote the exams. I forgot.
I neither took time to reflect and nor to wonder.

Well, I guess it's easier to get lost in our busy schedules that we forget to think beyond the boundaries. Creativity and imagination, wisdom and insight, have to be cultivated in the garden of our minds. And for that you need to take time to think and reflect.

My favorite spot for tilling the garden of my mind is sitting in front of a gorgeous sunrise or a sunset! :-)

Wavy sky