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Gosumag 2008... Patients and the lessons of life

July 1, 2008.

Time: 9.05 am

Place: Pediatric Ward, KEM Hospital

Background score: A baby crying at the end of the ward. Sister-in-charge shouting at the mother “Apna ghar bhi itna ganda rakhte ho kya? Yeh saaf karo!” Houseman running around and screaming “Aye intern, iska form bhara kya? Kab bharega?

Perfect chaos. Perfect morning at the Pediatrics ward where we were posted.

Two of us had reached the ward early. It wasn’t that we were too sincere but it was just the typical GS attitude-let’s take the best cases before anybody else from the batch. So we went on to savor the fresh cases (sorry for the sarcasm) from the previous day’s emergency.

There was a boy named Nayan Shah…walking around in the ward, with a tan and like a pregnant lady. We told him to sleep on the bed and asked him why he had come to KEM. “I have to take blood every month” he said. Perfect, we thought. Its must be thal and he’s got H-S-megaly. Let’s take this ‘thal-case’. The thing about children is that they will not allow you to examine them unless you divert their attention. I gave two chocolates to Nayan so that he would let us examine his abdomen without fuss. While palpating his massive spleen, to indulge in some idle talk so as to divert his attention, I asked him, “Why don’t you eat these chocolates now?” He said, “I have kept these for my two younger brothers. They are coming here after their school.”

And that was lesson number one for the day from the thal-case…No, from Nayan. While Nayan, for whom chocolates are a luxury, wanted to save the two chocolates for his younger siblings, we still take pride in having khoof clinics. There are hundreds of cases everyday in the wards, and we students still have tiffs about who would take the best case. Or two ‘friends’ who won’t talk to each other for a week because ‘she put the Foley’s when it was my turn to do so’. Or another two who start a cold war when the one auscultates a case of PDA before the other.

The truth is that the environment that we doctors thrive in is constantly testing us while teaching us the way to live life. The situations that arise test the character that we are made of. The patients keep reminding us to forget our petty frustrations and see the larger picture of life. The suffering we see around helps us appreciate the little moments of happiness and togetherness we have with our family and friends. Like a friend, who after seeing her first case of normal labour went home with a present for her mother and thanked her for giving birth to her.

We moved on to the next cot…Sagar’s cot, but walked ahead after a minute. He was a eight-month boy who had been in the ward for almost a month now. Everyday we would see his mother either holding him in her lap trying to make him go to sleep, changing his diaper and feeding milk to him from a wati. Nothing new…all mothers do that! But in this case, sometimes we would see his mother just keeping on holding his hand as it went into phases of jitteriness or feed him one spoon after another of medicine syrups or just wait while a group of ten doctors came to the bed and discussed something and moved on. Then she would move on to her next task-of taking care of her child.

Sagar was a case of cerebral atrophy, and as we saw him in the ward, he seemed to have no emotions at all. He would just lie on his bed staring…no where. He would hardly cry and would never smile. Even then his mother would religiously keep on doing something for him. There wasn’t any conviction on her face, the way it is described in inspirational writings. There was no helplessness in her manner. There were no tears that we saw. I don’t know whether she knew that the prognosis was bleak, but her efforts were unmovable. She knew that she had to take care of her child and the results then were not in her hands.

Many of us throughout our life have fretted thinking about ‘why did he get two marks more than me?’ or ‘how did he get the first rank in class? Why am I always second…I had worked so hard for this exam.’ And then some of us get frustrated…‘What is the point of studying, I am not going to get good marks’. But really, the results are not in our hands. The only thing that we can do is put in constant efforts like Sagar’s mother. While she probably knew that her son may not improve, we still have the hope that our efforts will prove to be fruitful.

Place: Back to Pediatric ward

Time: 9.45 AM

The unit we were posted in began the post-emergency rounds and we joined in. The whole group of twelve-odd people moved from one cot to another. The registrar was presenting the case, the Professor confirming whether a certain investigation was done and yearning the juniors to come up with more differential diagnosis on each case. We glided along with them, straining our ears to hear each word and trying to jot down all the ‘important’ bits of information. Till suddenly, while at one bed, a mother started shouting at the whole group of knowledgeable, white-coat doctors, “Why don’t you tell me what is wrong with my child? Nobody around here tells me what I have to do? You just come here and stand for five minutes, discussing God-knows-what and move on. Who will tell me what’s wrong with my child? When will she get better?”

While we students hover around the ‘teachers’ urging them to take a clinic, we often forget to learn to talk to patient. We ask them questions about their symptoms, their family history, past medical & surgical history, ask them since how long this particular sign has been present…That’s it. But do we ever talk to the human being whose ‘case’ we are taking? Do we ever go to the ward the next day after the case has been presented to ask the patient how he is doing now?

A professor once narrated to us the incident of a surgery practical examination where there was a case of right iliac fossa lump. One of the students taking the case made efforts to be nice to the patient and developed a good rapport with him during the exam. When he was almost done with the examination, the patient pointed out to his left groin saying, “Sir, please check this. The examiner had shouted at the previous candidate who was almost crying and told him to examine this.” The patient had an incidental finding of a left sided inguinal hernia which was missed by the previous candidate who failed, but our hero here had managed to present it in his findings and was saved.

Talking to patients about their ailment plays rich dividends. When the patient asks you “Doctor, when will I become better?” we students come to know that this is the patient’s concern and we must actively search for this answer when we are reading about their disease in the text books. But emotionally too, it helps. Like a patient of Rh-issoimmunization told me the next day when I went to see her again, “Hi, I was waiting for you. I had some questions that I wanted to ask you. Could you please explain to me…” And that felt good. Somehow I had alleviated some of her worries, though by a very small amount. I hadn’t done anything about her ailment since that’s really not in my hands but she wasn’t as worried as she was before.

The rounds were almost over. The senior teachers were on their way to their offices and the registrars back to the ward work. Just as everyone was about to disperse a little boy came with a yellow rose in his hand. The registrar whispered that he had been admitted some time back in the ward. He came over to the Professor and gave the rose to him and said “Happy Doctors’ day” and ran off to his father waiting outside the ward. The Professor later told us in the OPD “I may be fifty. But everyone likes to be appreciated once in a while, even if it is by a small boy.”

Time: 4.30 PM

Place: Medicine Ward

That evening a friend posted in medicine dragged me along with her to take a CNS case for presentation the next day. After searching through the register, we found names of four patients of hemiplegia. Perfect (again)…now we can pick and choose what case we want. So did a survey of the entire ward. There was one old patient with aphasia and no relatives around so that case was out. The other one was sleeping. We still had option 3 and 4. Both of these patients were lying on adjacent beds. One of them was a man who looked to be in the early forties with thick black hair and black moustache & beard with two females sitting beside him, probably his relatives. He had a very rugged look on his face. His face was away from the side his two relatives were sitting. We tried to ask him his name. But he just turned away and said nothing at all. We went to next bed. The other man seemed ‘less dangerous’.

We started taking the case of the old friendly man. He was telling us about the stroke had struck him when suddenly the young man with hemiplegia on the bed next to us started crying. Now, it is quite a site to see a young man who could well pass off as a bully crying before you. He couldn’t speak. But he just kept on crying. He tried to say something to one of the relatives who was trying to placate him. We stood there transfixed, not knowing what to do. Did we do something? Did we say something that we shouldn’t have? What do we do now?

We asked the relative what the man was trying to say. She said “he is crying because you doctors are not coming and treating him. You went to the other patient, why don’t you do something about him?” I enquired further. The patient used to drink alcohol and smoke regularly and then this young man getting a stroke didn’t seem surprising at all.

There are times when the toughest of us…may have to cry. Situations make the most fortunate of us to lose something. So it is very important to treasure each moment of life in the present, every bit of happiness and health that we have today.

Time: 5.30 PM

Place: Borivali local train

Tired after the day’s activities and cursing final year and its taxing schedule, I sat down wearily as the train moved at a snail’s pace toward Borivali. Along came a little girl in her school uniform with her grandmother. I made her sit on the fourth seat beside me. Nothing special about the girl except that she had Down’s syndrome. I tried to talk to her but she only replied back in monosyllables and a smile. She was probably shy of the stranger trying to talk to her. When she was about to get down I said bye to her and she waved her hand as she gave me the most lovely and uninhibited smile that I have ever seen in my life. A smile that reflected content, a smile that said that she was happy. How many of us with our silly problems of life are able to give such a smile?

Crossing over... the main story of Gosumag 07

Introduction to the Main Story:
Beyond mere scalpels, ills and pills…

Should it be something to do with us, our stages of our life in a medical college? Oh, but then, that’s for the college and hospital life section, isn’t it?

Or maybe the things doctors have done for the improvement of the lives of the destitute, unfortunate ones… Stop! Are we going into the Miss.India-answer-mode… But, I wanted to add ‘for world peace’.

That happened in between thinking about the themes that we could have had for the main story, and we did this thinking in the most random places… while looking blankly out of the moving local train or while browsing through he fresh pages of Park or the behenji-bitching sessions on the katta… Then someone came up with the Eureka moment…why don’t we have the theme that doctors can have fun too.

Okay, so we all know that…what now???

This is the (seemingly) frivolous account of how we came about with the main story.

But that’s a fast-forward too fast. Lets go back in time a little bit…

It wasn’t long ago that whispers in the class went by, “There are only six months left now, and we don’t even have an ECG (that’s Editor-in-Chief of Gosumag, by the way, for those who only browse through the photos in the magazine like six-year olds…but, you guys wouldn’t be reading this anyways, so why bother explaining).”

This, I think, came from feelings of guilt (for not studying like the ghasoos for so many days in a row), a constant need to focus on academics…and hence a majority of the class were skeptical to put away their Hutchinsons’, stethoscopes and khoof-clinics (even the regular clinics, actually) and shift focus to Microsoft word & Page Editor. But some of us did put a brave face forward and volunteered. Even then, we had our moments of doubts… why am I writing this when my batch-mates are lapping up another ten pages of Park. Another trip to Hinduja for a measly five hundred rupees; I’d rather attend the surgery seminar. If this was not enough, our earnest efforts to ask for articles were turned away, not bluntly, but by friends who were so concerned about us, “Do you know Shraddha, the day after Gosumag is released, I have a whole stack of them lying down my corridor of my hostel room, near the dustbin. You are wasting your time doing this. ”

Really, I thought, am I wasting time?

That was the flashback.

Reality-check. While doing the research for the magazine (again, wasting time doing ‘research’ for which we are not going get a scholarship), we realized that there are a number of doctors who have gone off the beaten track, they followed their hearts and pursed a plethora of activities…some sailing, cartooning, painting, writing and the works. When we met them, we realized that they had fun doing what they wanted to in medical college and today, for them, is no different; the show still goes on, strong as ever, the fun is still as immeasurable as then… And this only strengthened our resolve, we are making a magazine because we like doing it, actually, we love doing it.

In this section, we bring to you interviews and profiles of doctors who are names to reckon with in their chosen professions. An Olympian sailor, an internationally acclaimed painter, a multi-talented singer (are you in euphoria already?), a fashion-designer (who had auditioned for a fashion-show in our LCR!), a cartoonist who is a household name; and to sum it up, a columnist doing what he does best-writing (that’s beside reading radiographs).
{Put in an intro for Bhavin Jhankaria before his article, that will solve the problem of not having a writer}

Further on, we have our own peers, the students of GS waging battles against some clichéd beliefs coming down the ages; the ones that tell us to study, the ones that tell us that its ok not it, once in while… As Akshay is hard-pressed for time balancing internship and his books, Sasha justifies doing-it-all. Natasha is cynical about the bland life that medicine offers to her, but Dr. Henal believes that medicine offers the highest level of inspiration that a profession can. The talented, free-bird Vivek has a line-or two to add about the life of ghasoos of our class, but ghasoo Saumya does have her share of washing the dirty linen in public (we had to have some sugar, spice and sarcasm to make it exciting!).

Realistically, we, the team had experiences we had not bargained for…making someone pay for coffee in a five-star hotel, being awe-struck by a pop-star as we tried to concentrate on the interview, learning that a top medical journalist in the US is of Indian origin, or that a Gosumec is making movies in Hollywood. This while we each discovered within us, and our teammates, abilities that needed just some polishing and shone amongst us (I should start writing more I think).

Maybe, going on in this way, in future, we too would have the liberty of saying something on the lines of what the playwright-physician Anton Chekhov, in 1988 wrote to his publisher: ''I have two professions and not one. Medicine is my lawful wife and literature is my mistress. When I get tired of one, I spend the night with the other. Though it's disorderly, it's not so dull and besides, neither loses anything through my infidelity.''

Maybe, as Vivek puts it, that will happen when the performers watch and we, the spectators perform.

To sum it up, it was a lot of fun putting together this story. Hope you enjoy as much, reading it.

Unspoken Words…

Lets start by posting what I have already written.

Gosumag 2006 article
“How much to the airport?” “Two hundred rupees”, said the autorickshaw driver, appearing as indifferent as he could, continuing to chew the betel nut in his mouth. Though she knew that this was nothing shot of daylight robbery, and it was quite evident by the disgusted look on her face, Sanjana agreed and started loading her suitcases into the small sized vehicle. Holding an umbrella that barely protected her from the rain, in one hand, somehow she managed to stuff her belongings and squeezed inside with her legs almost dangling outside. Even in this uncomfortable posture, she was only too happy to be heading towards Delhi Airport.

Sanjana was an oncosurgeon in a leading hospital in Mumbai. As a part of her ongoing education, she had to attend a workshop. The last four days in Delhi had been nothing short of a nightmare. Like all bad things, her arrival and departure were marked auspiciously by heavy rains. To add to her woes, she had to live in a dingy room with a creaking fan (at least it worked!), in a place that was so scary that she couldn’t get sleep at night.

All this could have been tolerable, but even the workshop was a mess with their star- trainer out on an emergency sick- leave. Without him being there, there was nothing new for Sanjana to learn. In short, every circumstance in Delhi made Sanjana only too anxious to return home to Mumbai.

The good old warm comfort of her home and the welcoming eyes of Avinash were just four hours away now. Avinash, an oncosurgeon was Sanjana’s husband of three years. It was a typical arranged marriage. Soon after her marriage, Sanjana realized that she had found the perfect man. Avinash, the name itself, mere thought of him brought a smile to her face. Together they had created a magical world, that of love in their house and excellence in the hospital where they worked together.

Now on her way back, in the rickshaw, Sanjana had to battle the tiny water drops that somehow found a way to her. The tiny, miniscule droplets that were so innocent themselves had managed to drench her clothes. Shivering, she got into the airport only to realize that all the flights had been delayed indefinitely due to bad weather. This meant endless hours waiting helplessly without knowing how many more to go.

Once she had checked-in, she found herself a comfortable seat in the waiting- area, which proved to be perfect for sight-seeing. There was a fat man wearing a suit that barely fitted him, and was sleeping with his mouth open. Surely, the poor man hadn’t had lunch and was waiting for a mosquito to be his first bite. In another corner, there was a rather lanky guy wearing bright orange coloured ill- fitting cargos and an orange cap to go with it. Huge earphones adorned his temporal area and a pair of weird sunglasses covered his entire face, apparently protecting him from the obvious glares of those around him. And then there was….

The unkempt hair, the infectious smile, a walk that was so distinct that it stood out in a crowd. But was it really him? It couldn’t. He was in Chennai, as Sanjana had heard from an old friend some years ago. But it still was him. It still was Rohit…

At the other end of the room, Rohit was wondering where he had seen such a beautiful face before. “Should I go and talk to her? No, that would be very silly of me and besides I’m too lazy to get up from my seat right now.”

Then it struck him, it was in medical college. The entire group of friends had gone to the beach for the evening to celebrate a friend’s birthday. While everyone sat in a circle singing random songs, their merry- making was interrupted by a drizzle that made every run for the closest shed. While Rohit joined the bandwagon and was safe in a jiffy, there was a girl who was in no hurry. Slowly, with a spring in her steps, she walked towards them. It was unique in the way that while everyone seemed to run away, this carefree soul enjoyed the moment as it was, without any pretence.

Keeping company to the raindrops a little longer than them, she joined the others in the shed. Rohit stood bewildered, staring at the careless strands of wet hair that played around the angelic face. This majestic face which was now illuminated by the rays of light from the only bulb in the shed seemed to be created to perfection, one which he had sketched so many times on papers and that had been etched forever in his mind. Yet that day he couldn’t muster enough courage to tell her how beautiful she looked.

Today, at the airport, he had seen the same artistry. “Is she looking at me? Is that a smile on her face? Oh! Forget it. I am just imagining things.” And then Rohit realized…it was Sanjana, sitting there, looking just like she had ten years ago. He had seen her last on the graduation day. After that, he completed his studies in Chennai and was now a neurosurgeon there. Years had gone by and being engrossed in his own work, he had lost touch with his old friends. In few months, he was going to get married to Shymala, who now lived in Delhi. He had come to meet her and it had only been ten hours since he proposed to her. Now he was going back home relieved that at least this time he had expressed what he felt.

Sanjana on the other hand had no trouble placing Rohit in her memory lane. Rohit was a colleague, a classmate at medical school. Actually, he was more than just a colleague. At least she thought so and had hoped that he thought the same way.

There were moments that she shared with him that made her laugh and some that brought tears to her eyes. There was a time, just an hour before their first PSM written examination, when Rohit and Sanjana decided that they had tortured their brains enough. While every student seemed to be engrossed in their ‘Park’ as if they were utterly delighted to read such profound material, they set out to terrorize everyone. They hopped around from one nervous freak to another, apparently asking doubts. “Have you read about the WPWS Syndrome or, have you memorized the combined immunization for tetanus. Seniors have told me that it is very ‘IMP’”. This left the poor chaps frantically searching for names that were in some corner of Robbins or Anathnarayan. In an hour their victim toll had reached 65 panicked heads.

What was undefined between Rohit and Sanjana was unsurprising because it was so natural. Both of them instinctively reached out for each others company. In the evenings after classes, they had long discussions in the canteen that eventually turned into disagreements between two opposing teams, but often ended in comfortable compromises. Often a sweat- trickling game of basketball ensued. They took part in debates together. While one convinced the judges with her pleasant and sympathetic manner, that exuded a moral earnestness; the other had the audience enthralled with an array of humourous one- liners and refuted with precise interjections in a persuasive manner.

Sanjana had a smile of admiration in her eyes whenever Rohit spoke. She relished his every casual utterance and often had a flattering comment to add. Those three months went by very fast and before anyone could fathom they both drifted apart. Probably because he had found the company of certain other people to be ‘politically correct’, while she gave her time to people who helped her with her studies that certainly seemed to be lagging behind.

It was only later when she saw his picture in the college magazine and thought about him that she felt that he had tried to tell her something by the way that he lurked around the dissection hall when everybody else had left and she was all alone there still dissecting the remains. By the way he offered to go with her for the movie no one else wanted to see. By the way he seemed to be so concerned about how her exam had been, or what her plans were for the vacations.

Sitting there all alone in the waiting-room with hundreds of people around her she wondered, “Did I not interpret his actions, or I failed to understand the words he hadn’t spoken? Or should I have told him how I felt? Then probably things would have been… well, different. So, I should go talk to him now. But what if he doesn’t remember me? It will destroy all those memories that I have today. I’d rather not… ”

Sanjana kept wondering, as she relived the trivia from the past, the trivia that made memories for today. It brought a smile to her face, a smile, so pure that previously it was brought about by only another name. She kept looking in random directions so that she could catch a glimpse of Rohit, who was now sitting, in deep thought. “Should I introduce myself to her? Maybe, she’ll remember me. But what if she doesn’t know that I ever existed? What if she cannot recollect that one person who has etched her in his memory, who thinks about her everyday for the past ten years? What if…” The questions and apprehensions in his mind went on and on. “But did I just see her glance here.”

Four hours went by. Then came the announcement on Delhi airport that flights had resumed and passengers should proceed towards their respective exit- gates. Sanjana and Rohit got up, both quite hesitant since their gates were on the other side of the room. As they walked down, Sanjana, just like the day at the beach and Rohit, with his gait that Sanjana so distinctly remembered; their paths crossed each other. Both of them realized, as their eyes met for a second, that there was a moment of silence, a moment of acknowledgement. But they kept walking ahead, wishing that the other would turn around and say…something. This time again, no feelings were conveyed, no words were spoken…and both of them kept walking, waiting for the day their paths would cross again.