What The Frail Old Man Taught Me On Love

It was on a mundane afternoon, one that I so vividly remember. It was one of those rare days in medical training (Internship) when nothing throws a surprise on you. Everything went well since that morning and all I had left with was a chronic disease OPD to attend after which I would walk back to my hostel room and enjoy the rest of the day absolutely doing nothing.

I was sitting in the female side of the OPD. All I had to do was to take blood pressure measurements, check blood reports of old people with diseases like diabetes and hypertension and re-write the medicines previously prescribed for them if everything was normal. I was doing it fast eager to finish it off.

An old woman come and sit at my table. When I enquired her, she did not respond. She made a few facial movements but made no voice. Instead, an old, should be 75+, frail looking man, standing nearby her side, was the one who did the talking.

I didn't listen to him. I was waiting for scream from the OPD nurse. That's what she does when any male enters the female OPD. (She does this on junior male doctors too at times :-p). I was waiting for this guy to be thrown out. I glanced sideways at the nurse. She was looking at us and beaming a broad smile. Strange!

This old man was cleanly dressed and was carrying two heavy bags. He spoke very softly and his voice indicated his frailty. With his little voice he was informing me what his wife's problems were and what medications she was on. He seemed to know the names of all the medicines and the dosage strengths and he was almost instructing me not to forget anything in a very polite manner.

(Normally it would irritate me when a lay person instructs me to prescribe, what's the point of me spending 5.5 torturous years in a med school then, I would think.) He was quite worried that I might miss out something from a big list of different medicines she was on. Probably, it has happened before that some junior doctor in a hurry forgot to write something or wrote something wrong. If that happens, his wife would have no tablets to take of that particular medicine for the next 2 weeks. So his behaviour was quite acceptable and I did my best to measure her blood pressure, check her reports and write her all the medications she required.

After I was done, the old man lifted his two heavy bags on one hand, held his wife's hand with the other and slowly walked her out of the OPD.

The nurse told me later that this particular old man brings his wife twice a month, every month from his village. His wife is hard of hearing and she has a high blood pressure and diabetes. It's a long journey from his village to JIPMER so he brings everything that would be required for her including, food, towels etc. and waits till the afternoon for the chronic disease OPD. He makes her sit in a bench and he waits in a long queue for her. He meets the doctors, gets the medications written, stands in another long queue for getting the tablets from the pharmacy and finally takes her back home.

When the sister had told me all this, I had a big smile on my face and a little tear on my eyes.

That frail old man made a statement so strong that penetrated my heart. I saw what true love was all about. The commitment, the care this old man had, simply melted my heart. He showed a commitment time nor tide would never fade.

Dear old man, I thank God for bringing you there to inspire me. I promise you, that when I hold the hands of my queen, I would remember the lesson you thought me that day.

And sure it does. Every once in a while in the middle of an ordinary life... Love gives you a fairy tale!

Iatrogenic Fear

What is the most common iatrogenic disease/morbidity?

Ask me and I'll tell you it's fear/anxiety.

You may laugh at it. You may either think it's not a morbidity or you may feel it's not so prevalent. Either way, I feel, is a wrong opinion.

So to prove my point I did a little experiment. I did this with goodwill hoping it would change someone reading this. I set out and randomly meet patients admitted in different wards during my Clinical Pharmacology posting. They ranged from simple cases of fever to cancer patients. I went to them and introduced myself as a student doctor. I spoke with them patiently and built a rapport with them.

As I was conversing with them, I came to understand that none of them were aware of what was going on to them, neither their diagnosis nor their treatment. Leave alone their prognosis. I could feel their anxiety. They were worried and were fearful of worse things that could happen to them. Some were even worried because a fellow patient with similar complaints was investigated with bone marrow aspiration (a invasive procedure). They were afraid that anytime their resident doctor would come and drill their hip bones too.

As I was still talking with them, they started bringing to me all the test reports that they had got done. They took out the X rays and CT films. They took out the big files containing all sorts of blood reports which were done in the private hospitals they visited before the came to JIPMER. They wanted me to tell them the diagnosis and the course of treatment.
(However their records were long and further I did not want to say anything to the patient that would hinder/disrupt their relationship with their treating physician)

And as positive controls I went and spoke with some patients in wards where I knew the patients were quite well informed. I could indeed feel a drastic difference.
Those with good prognosis were eagerly waiting to go home. Those with poorer prognosis were, of course, sad & worried. However they were well informed and they kept their hope alive.

Good communication is a strong foundation for any relationship and the doctor-patient relationship is no exception. It is even more important in relieving the patient of his unnecessary fears. Clinical rounds are conducted on a t.i.d basis in some wards (once by the final Yr resident, once by the SR and then by the consultant) but sadly very little information is passed on to the patient. Most often it is the resident doctor who keeps running around all day for patient care. However the patient is more impressed with the nurse who gives him/her the medicines (No..no the big-mouthed yelling sisters, I mean the sweeter ones:) because in communicating with her the patient finds care and compassion.

Cure occasionally, Relieve often, Console & Comfort always! - Anon
Thank you for patient reading.

Commitment to Quality

You might be knowing that in any hospital, the waste is segregated at the collection point. i.e. there are different coloured garbage bags in which different types of wastes are to be put in. For eg, in JIPMER, I've seen three different coloured bags which are kept in all wards, operating rooms, procedure rooms etc. for different kinds of wastes. So if I have to discard an used needle, I'll have to destroy it and throw it in a BLUE bag only. So for the whole system to work efficiently and for the purpose to be fulfilled requires a lot of commitment and motivation from each and every person inside the hospital including the patients.

Now, I was posted in Medicine dept. for two weeks and so I was in one of the the medicine wards. There in a corner was kept an YELLOW coloured garbage bag. Just above it, on the wall, was written " Keep BLUE BAGS only ". That particular corner was near the injection trolley and hence more waste sharps will be generated there. So it would be easy for people to throw them into the BLUE bag if it was kept there. But an YELLOW bag was kept there by mistake and people were throwing wastes which had to be thrown into BLUE bags!
I called the nursing sister in-charge of that ward and showed this to her. To my utter surprise, she just laughed at it and went away. She thought I was making fun of it and she enjoyed the joke!

A week later, I'm in Christian Medical College, Vellore for a workshop on Therapeutic Drug Monitoring and HPLC. During my visit there, I saw that in CMC there were five different coloured bags kept at waste collection sites. (in JIPMER we have three). And there were also many posters at different places displaying information on which type of waste had to be disposed in each of the coloured garbage bags.

We were receiving hands-on training with the HPLC operations in their labs. Once I was using the pipettes and doing some drug extraction. After pipetting, I removed my gloves and I was searching for a RED bag to throw it into. (as per their protocol, PPE* had to be thrown into RED bags). But somehow I didn't find any red bag nearby. Considering the fact that my gloves didn't come into contact with any infective material while pipetting, I threw the gloves into the GREEN bag nearby. The senior lab in-charge came and she asked me where I'd disposed my gloves. She probably asked this cause she expected that I would't have noticed the RED bag under the cover of an instrument. So when she asked me, I pointed to the GREEN bag. Without any hesitation, she wore a glove, put her hand into the garbage bag, removed the gloves I'd thrown into and put them into the RED bag. I was appalled by what she did. She was the senior-most yet she didn't order anyone else to do it. And she didn't ignore it as well.

I'm not saying CMC is better than JIPMER. NO. That is not what this post has  to convey. But what is the level of commitment we have? Are we motivated to contribute to the success of the system in a positive way? Doesn't that make a difference?

I'll leave you here....with a synapticspark !
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*PPE - Personal Protective Equipment