Hypertrophied Mouths & Atrophied Brains

Disclaimer: The following is based on true life experience. Though it would seem like a rant, it isn't.  It is just a capture of how workplace stress can influence people and how people responding to it might in turn affect the workplace. I am too young to be writing this. Constructive criticism is always welcome.

**

A lady, of dark complexion and in her late forties, was afoot with arms folded on her protruding abdomen. She wore a white gown and a plastic white cap to her crown. While she spoke, her voice was loud and discordant and the cacophony she created seemed to fit her figure. It was my first day and as I entered ward G, her shrill piercing voice perturbed the peaceful room filled with pregnant women. My first impression on seeing her was to try my best to avoid any kind of conversation with her. But as I entered the ward, the screams stopped momentarily and then it started again. This time it was at me that she was screaming, only a bit louder.

“Who are you, doctor?” she almost yelled.

“Intern. OG – 2, Sister” I replied and managed to pull a smile.

There was discernibly no pause after I’d finished my humble introduction. She went on to tell me what the junior residents of OG – 2 had left incomplete, urging me to finish them or remind them about it. She didn't notice my gesture of reassurance. Her attention shifted to the orderlies who were on their morning routine of cleaning the wards. Relieved (temporarily), I slipped into the ward and found jobs already waiting for me.

I was in that particular ward for around 8 weeks. I tried my best not to be mindful of the people around me but went on with my business. But I couldn't help but notice the conspicuous difference when she was not on her shift. I learned that the other interns working in the ward were also pissed off with her. They even had their own version of abusive names for her. No wonder she was the most disliked person in the entire floor. I did not bother to carry any hatred or grudge against her, until one fine evening.

I was finishing my shift and was about to leave home. I was tired. I had to do an ECG for a patient. There was no ECG machine in ward so I rolled the ECG machine from the nearby ward, just some 20 meters away. As I was finished with the ECG, the ward attendant, a lady clad in pink, offered to roll the ECG machine back to ward. I had not demanded her but probably out of some compassion to a tiring soul or perhaps remembering my previous gestures of good will to her, she offered me help. Though I politely refused, she was already rolling the ECG machine back. Only to be stopped by the stout, arrogant creature sitting on a cracking old chair. “You don’t have to do what this intern orders. You are here to do this ward work and you’ll do what I say”, she yelled. I could say she was flushing with rage, but her coal dark countenance was too incompetent to reveal any signs of it.  The ward attendant was trying her best to explain. But I wasted no time. I rolled the ECG machine to the adjoining ward on my own and I left home. I was too pissed off. I did not talk back because I knew that behind her big mouth there were no brains backing her up. Any argument would be pointless. I was cursing her on my way back. But soon it slipped off my mind and I was back to my peaceful routine.

I would not say all nursing sisters were of this kind. No. While I was in the nearby OR (operating room), after the surgeries of the day were over, I came out and sat in distress in the nursing station. I was having an attack of migraine. The nurse there took out a kettle and some milk she had brought for herself. She prepared a strong cup of coffee and offered me. More than the caffeine, her care and compassion had a considerable soothing effect on my nerves.

I often wondered what made the arrogant sister of ward G so arrogant. Was it because of the increasing work place stress? Of-course, ward G was one of the busiest and hectic wards in the whole of the hospital. But there were other wards more hectic than this and not all nurses breed such air of arrogance. Maybe she was more susceptible to such stress? Maybe she had other problems which contributed to this? Whatever, she required professional help. And there’s nothing in that to be ashamed of. I sincerely feel that in such places where the work load tends to be more and work flow become hectic, the institution should provide some sort of help/assessment for their staff to keep increasing stress levels at bay. Workplace stress can bring out varied untoward behaviour of people and this only tends to affect the workplace even more adversely for the others. Though the title of this post resonates the residual amount of anger I have on her, I do feel bad at the same time. Trying to act a little more maturely, I keep thinking of changes that can be brought to the system processes at work that will help make the workplace more conducive to the health care force as well as for the patients.

**

Dengue did not kill, despair almost did !

It was during the later half of my study holidays before the pre-final MBBS university exams, the time when a sense of fear and helplessness finally motivated me to start reading. On that evening, just 3 days before the first theory exam, I found myself lying on the bed with the book, casually reading. Suddenly, I felt the room get colder. I got up and turned off the fan and lay again. I felt a little fatigued too. I didn't bother much. I kept reading. But an uncomfortable feeling soon overcame me. I thought I might be running a fever. So I touched my forehead and felt it a little warmer than usual. I didn't understand why nor did I bother to take a pill. I kept on reading and checking my mobile phone for texts, as usual. But, in a matter of few minutes, I could feel my hot breath hit my chest. I was getting heated up and my skin was now feeling like a hot pot. I was a little disturbed. I took a paracetamol tablet, kept my book aside, put off the lights and closed my eyes. I hoped that everything would be OK when I woke up. I didn't speak about it to anybody in the house. It was around 8.30 pm when I fell asleep. It probably might have been very strange for others if they'd noticed that I'd slept so early with my exams right around the corner.

Angel of Grief  by William Wetmore

I woke up at around 2-3 am. I was running a very high temperature. I put a thermometer to my mouth and it read 104 F. I knew something was wrong. It was not the usual fever that comes and leaves without much trouble. The next day, I was fully on fever medications and had intermittent spikes of fever. I had every symptom of dengue fever. Saddle back fever, extreme bone pain, retro-orbital pains and all just like it was written in the book. However, I did not want to get lab tests done or get admitted in a hospital. I knew that would be even more unbearable. However, I was also aware of the danger signs and the management of dengue fever. So I kept a check on myself for them and kept myself well hydrated. I did not take NSAIDs that might interfere with my platelet function. I treated myself the way I thought was the best !

The problem started when people close to me started accusing me of not reading for my exams, not taking responsibilities for my own health, not seeking medical attention etc. The fever also started getting worse. It made me severely myalgic and tired. I could not even stand. I even fell once when I tried to. Nausea and episodes of vomiting made the situation even worse. I ate very little. It was the most torturous period of my life. I had to read for my exam which I couldn't. Not even a bit ! I simply lay alone on my bed and slept most of the time.

As the day of the exam neared, I became more and more nervous. The fever was still the same. Death from dengue was even OK for me but flunking univs ! I couldn't even imagine what would happen if I flunked! No one was there to support me emotionally. No one who would tell me that I could get through, was close. Friends did text and sent Get well messages. But they seemed too superficial. I don't blame them. After all, they had their exams to study for !

On the day of the exam, I felt a little stronger. I was surprised cos I couldn't even stand by myself till then. I rode my bike by myself, drove up to the exam hall. I spoke with no one. (I know, speaking with people would discourage me, cos they'd be discussing the subject and I might not know). I wrote the test. But I did feel sleepy and tired most of the time. I didn't care much of what happened around me. Somehow I survived through the test. The fever and the terrible myalgia stayed with me for about 10 days in all.

The results. I did pass my exam with distinction.

But the moments of loneliness and the despair I had to go through were the most painful of all. That wasn't the direct effect of the dengue virus. Of course, the dengue viruses (the different serotypes) can attack together and can even kill. But this time though, the virus decided to run a benign course on me. But the pathological mechanisms of loneliness and despair were induced by the environment and the people around, and also by some of my own decisions. Anyway, after that painful period, when I had to play the role of a suffering patient, dengue left me a bit wiser !

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Dr. Abialbon Paul
Though my literary skill are almost non existent, I love blogging and photography.
My photopage: www.facebook.com/abialbonpaul.photos
This is my blog and is about a year old. Do feel free to roam around and communicate. Thank you.

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. 

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 !

Fun as a Final Year (True Love @ the cafe)

From my diary (random incident):

Tomorrow is my Pediatric Nephrology test. Haven't read anything till now (5.30pm already). But I did listen well during the lectures and I'm a little confident that I can finish reading for the test(over confidence, probably). But there's sure a fear gripping my troubled trembling mind. 

Whenever I have such a fear of failing miserably, I try to search for company. I dial Sakthi's number. By sheer luck, his mobile is reachable! (usually it's switched off because it's left uncharged!). He tells me that he's yet to start reading too. I feel overjoyed :-)
Neither of us have the habit of taking notes in the class. So we usually borrow some girl's notes, take xerox of it and use it as our reading material. (A very heart felt thanks to those girls who helped us!). This time, Sakthi has already got the notes from Pushkey. So Sakthi & me decide to read together all night for the test. We start at around 7 pm and keep reading (sincerely) (mostly out of fear!!)

10:00 pm - We've finished more than 40% of the syllabus !

12:30 am - We've finished almost 70% of the syllabus !

12:45 am: We decide to go to Cafe Coffee Day and have a large dose of caffeine so we can finish the rest of the syllabus and do some revision too...!!

1:00 am: We've reached Coffee Day with out notes in our hands. We order our cappuccino. We sit there at the silent lounge and start discussing & revising whatever we'd learnt.

1:15 am: Our tall glasses of coffee are ready! We decide to give our discussion on pediatric nephrology some rest and we start sipping away our coffee.

This is not our coffee. This was shot at a later date!!

As we enjoy our caffeinated drinks, we start gossiping! At first, it's about the new pairs(couples) that have been formed in our batch. We also discuss the broken up relationships. We then turn to tease each other with what we assumed were each other's crushes. 

Then the topic of what "True Love" meant, popped in. Each one of us came with the concept of what we thought was pure and appreciable form of love. We had little disagreements. So we started supporting our viewpoints with quotes and anecdotes. What started as a simple gossip was now a heated debate. The long altercations we were having was thrilling.

2:45 am: The moment we see our watches and say "SHIT"!!

3:00 am: Hurriedly we reach our hostel room.

Sakthi: "Take out the notes, we'll finish the rest 30% and go to sleep"
Me: "Dude, stop kidding. You have the notes, don't you?"

Sakthi & me (at the same time!) : Shit !!! (We had left it @ the Café)!!

I don't remember what happened after that. Probably we blamed each other for leaving the notes at the Café and soon we slept off.

What happened to the test?
We rocked it!! as usual :))

My Internship FB Updates: Top 10

Below are some of my status updates in Facebook when I was an intern.

Little things I've realised as an INTERN: Part 1
Patient oriented:
1. The morning prick we make when we take blood sometimes keeps paining till evening. So the needle bore, site of puncture should be carefully chosen and done.
2. If patients are informed about why the test has to be done, they are much relieved.
3. Spending 1 min explaining the route to a certain lab/place in the hospital saves their 1 hour of roaming around.
4. I give kids the chest piece of my steth. They themselves keep it on their chest. Less panic :)

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Things I've realised as an INTERN: Part 2
Self Oriented:
1. Many may try to belittle you..from consultants to nurses, wardboys and even patients cos you are just an INTERN. Never lose self-esteem. Be humble. Cos your heart knows what you are becoming...
2. At the end of the day, the  positive influences you'd had on others' lives make you happier than the knowledge gained. But of course, knowledge and skills are needed to bring the best in you for patient care.

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I'd successfully put an IV line for a 10 day old baby on the very FIRST attempt :-):-)    

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Please don't SCARE little children saying "I'll take you to the doctor n he'll give you an injection if you don't...." Children start yelling in fear just as they see me with my steth!! I feel miserable... 

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I'm stuck here in a hard shell...pressure from all sides, life getting harder and harder......But deep down here, I'm metamorphosing....silently and patiently...slowly and steadily.....when I fly out I'll be something beautiful :)

I'm in OG Postings :(

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Whenever I'm posted in any dept. in INTERNSHIP, I do 3 things:-)
1. Feel that the previous dept. was far better
2. Count the days for the current posting to end
3. Look forward for an easy life in the next posting :-P:-P

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I'm Dumbstruck!!
Unfortunately Actinomycin D, a chemotherapeutic drug, is currently not available in JIPMER. A 25 yr old lady, admitted in ward 16, JIPMER, is on chemo regime containing Actinomycin D. She has to buy the drug herself n single dose costs Rs.439.00
She got the first dose with her money. She later confessed to the doctors that she had no money to get other dose.
A group of Junior Residents, OG Unit 2, Jipmer have put their pocket money for her second dose..I was one of them who contributed. :)

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Best moments of life: 
Me & my co-intern were involved in the treatment of a lady diagnosed with PRES (Posterior Reversible Encephalopathy Syndrome) due to severe hypertension. Her BP was very high and her brain was affected. She was disoriented and possibly going into coma. Every 15 min we gave her drugs to bring her BP under control. After around 5-6 hours of aggressive BP control, I'd gone to check in on her. She woke up and spoke to me, "Doctor, can I drink a cup of coffee?"
I had goosebumps !!

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"BUSE for all, BUSE for all
BUSE for all d JR said.."
Not tho' the INTERN knew
Someone had blunder'd:
Theirs not to make reply,
Theirs not to reason why,
Theirs but to do and die:
Into the valley of ignorance
Rode the budding medico.

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MBBS: when it started, it appeared as a very long and tiring road....
now 5 & a half yrs gone, when it's about to end,
I wish to travel that road again with my friends....
It was fun & frolic all the way.....

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The Ethics of Love

This post is a part of my "Getting Trained for Marriage" post. I try to learn the principles of a good relationship through whatever I observe. Being a post graduate medico in Pharmacology, I was talking a class on ethics for some students. This post is a result of post-class effect (musings).

How would you react when your doctor performed an appendectomy on you and charged you when there was no actual need?

How would you react when your personal information was shared to others without your knowledge by your doctor?

Unethical aren’t they??

How would a girl react when she finds after her marriage that her husband had been a chronic smoker and has actually cheated her? (If love was true, he should have stopped smoking for his love instead of trying to cheat)

All is fair in love & marriage, they say. Is is so? Are thousand lies acceptable for establishing a lifelong relationship in marriage?

If your answer to the above questions is “yes”, just imagine yourself to be on the wronged side for a moment!!

There are certain ethical principles which every medical professional is supposed to follow. I find that these provide certain principles on how we should treat our most loved one as well. Well, isn’t this relationship more important than the doc-patient relationship!!

The Principle of Autonomy

You love a person. You propose. But you are left with a rejected proposal and a broken heart. What do you do?? Find out the reason behind the rejection. Explain your love more clearly. Show your love in action to him/her without offending the other person. Give time for the emotions of love to take root in the other heart. NEVER FORCE or ATTEMPT TO FORCE. Love never buds by force. It rather would die.

If it still doesn't work out, move away gracefully.

And just because you are united together in marriage, never force decisions or orders on your spouse. Appreciate individuality and foster autonomy.

The Principle of Beneficence/ No Harm

Ask yourself.

“What’s the purpose of this love?”

“Is your love a means by which you serve your own interest?”

Many people get this thing totally wrong. The major reason why young people seek out for relationships while at their college is peer pressure. Their main aim to show others they too have a girl/guy with them.

You are to love someone to make him/her happy. It is to sacrifice everything of yours to benefit the other. As I put in my words, “True love is like a tumour that arises in the heart And permeates your soul until you lose yourself selflessly for the other”
If you love someone for your happiness, to satisfy your ego or lust then you’re merely using them. And it equates to harming them.

But then, do you loose yourself because of love ! No ! I don't think so. But rather, in mutually trying to seek for the best of the other, a richer and fulfilling relationship will form! I hope.

The Principle of Justice & Equality

You come home late but you get angry at your partner when the meeting at her workplace took his/her time.

You rest all Sunday but you expect your partner to cook, to clean, to care the child etc..etc..

So many examples can be given in this regard.

Whatever privileges you’re allowed, your partner has them too.

Whatever law binds your partner, binds you as well.

The Principle of Confidentiality

Major relationship break ups occur because one of the members divulges information about the other to the outer world. And these social networking sites come handy in breaking relationships! Happens mostly by girls, though not exclusively. In their gossip hours, they let out certain personal info of their significant other.  This could start an unhealthy conversation about your significant other and may sow hatred in hearts. Unnecessary doubts and suspicions can be kept at bay if certain levels of confidentiality are maintained.

Have your principles right. Principles are the guiding posts to reach your purpose in life.

I do appreciate your comments as I go on with my "getting trained for my marriage" posts !