India's 'Everywoman'

More than a decade ago I read an article of the same title in the Hindu Newspaper. I was a little girl then and an avid collector of interesting articles. I would cut out things from the newspaper and stick them in my scrapbook; everything from Harry Potter trivia to Calvin and Hobbes cartoons. This particular article spoke about an old widow who’d worked as a domestic help all her life laying alone in a hospital bed. ‘She did not how old she was,’ it said. This was very hard for my young mind to comprehend, it was almost silly to me – how could one not know when they were born? How could one not know their age?! How on earth would you celebrate your birthday? How would you know how many candles to stick on a birthday cake? Where did such ladies live? Did the maid at my home also not know her age? I decided that this lady needed my prayers and instead of sticking the article in my scrap book I folded it and slipped it in my Bible. Someday if when I met such ladies I would try to help them. And with that I tucked her away in one corner of my mind.

I’ve passed through years of school and college since then. Recently I started working at a rural hospital and I meet her often these days.

On Monday I met, Ruby Devi.

 ‘Aap ki umar kya hai?’
‘Yahin kuch bis, pachees.’
‘Kitne bacche?’
‘Teen ladki.

 She had three girl children. She had gotten married at the age of fourteen and had her first child about seven years after that and that child is now 12 years old. She claimed she was 20/25 years old, and yet she looked like she was at least 35.

‘I hadn’t even started getting my period when I got married,’ she giggled, tugging the edge of her sari pallu across her face and nervously chewing on the edge as I not-so-subtly gawked in surprise. ‘You see I’m one of six sisters and two brothers, my mother had no choice but to marry me off. My father died when I was twelve and I was just a liability.’

On Tuesday I met, Jhuniya.

She was pregnant for the eighth time. She fit the textbook description of bad obstetric history, having had six recurrent abortions in the first three to four months of each pregnancy. Only her first baby had made it to full term – ironically, a girl, who is now 7 years old. Five of these aborted babies had been boys, and every aborted boy had been a blow to the family. Each year she conceived and each year she aborted. She lived in one room with her mother in law, brother in law and his wife, who had already borne three boys making her the jewel of the family. Along the way she had visited several pandits, witch doctors, expensive private clinics, contracted Hepatitis B and received numerous blood tranfusions on account of anemia. Finally she came to us. We told her that we would put a stitch at opening of her uterus to prevent the baby from aborting, we warned her it may or may not work, but it’s the best we could do. A few weeks later, she came to us frantic, ‘I can’t feel the baby moving!’ Fearing the worst, we did a scan to find that this time too, the foetus has not made it. She lashed out in anger and then she broke down and cried. A tiny gold nose ring adorned her tear streaked face, with two mis-matched earrings. The chain around her neck held six lockets with a little child depicted on each to keep away the bad luck of the children she had lost. Her hair was in disarray and her eyes pleaded to hear a different diagnosis. Through her sobs she said her husband was going to leave her if she didn’t produce a boy child. ‘He’s already chosen another bride for himself.’ On her left stood her little 7 year old, ignored. And on her right, her sister in law with her boys, a constant reminder of what she failed to achieve.

On Wednesday I met Bina Devi.

She arrived at 2am, in labour, her belly was funnily shaped with two symmetrical bumps as though a heart. On per vaginal examination where I had expected to feel the comfort of a solid foetal skull, I felt something soft and squishy pulsating against my finger, surely not – the cord! Although not very well versed in obstetrics my sleep hazed mind was jerked awake as it shouted – CORD PROLAPSE PREETI! In simple words, it’s the mother of all obstetric emergencies, most babies don’t survive it – it’s like slowly but surely tightening a noose. We rushed her to OT, and prepared for an emergency Caesarean. We separated the rectus muscle (popularly known as abs) and were looking straight at a very weird uterus. It was heart shaped, with two horns instead of one. ‘It’s uterus bicornuous unicollis,’ said Bina ma’am calmly. And visions of my first year anatomy class came flying back, as she asked, ‘Remember the paramesonephric ducts?’ It struck me as odd that I should be surprised at encountering a uterine anomaly in a lady from a village, as though deviation from normal anatomy is something that happens only in embryology textbooks. Her baby did not survive, but she did. She recovered phenomenally well, was very thankful for it and to this day does not understand why I felt the need to repeated explain to her that, ‘Aapke bachadani ka aakar alag hai.’ (The shape of your uterus is different.)

On Thursday, Baby of Laxmi was born.

This was Laxmi’s third pregnancy, she had two girls previously, both by Caesarean section. This was the third and last time she would be able to carry a child, because further pregnancy in someone who has undergone so many Caesareans is dangerous. The third baby was born at 4am, a healthy pink cute baby girl. Her face fell when we showed her. At 6am we got called by the sister in ward, ‘Ma’am, Laxmi’s baby is turning blue and is not able to breathe.’ Her mother had tried to smother her to death, and had been caught just in time. The baby was rushed to the Neonatal ICU, given Oxygen, resuscitated and slowly regained colour. Her small chest was heaving, she was breathing too fast, and there was a slight depression on her chest when it had been pressed. For days she hung by a thread like this, while I tried desperately to figure out what kind of pressures could push a mother to take such an extreme measures in a moment of weakness. The parents agreed to put her up for adoption. Baby of Laxmi stayed with us a long time, she got better, started feeding and breathing alright. She became an instant favourite with all the hospital staff. A real fighter, just like her mother, who returned a week later to take her home, determined to provide her a safe future.

 On Friday I met, Nilam Devi.

Referred from the government hospital, she was pregnant, past the nine months, and her baby had been dead for the past 2 days. She startled easily every time we came close to examine or speak to her. Her husband didn’t know what to do. He stood with his hands splayed open facing the ceiling and just asked us to do something, anything. He had been all the way to Patna to get a scan worth Rs 4000 to determine the sex of the baby. They had told them it was a boy, elated to have a boy at last they returned to Madhepura. When it was past her due date, she was taken to a government hospital where she was administered Oxytocin to initiate pains; when that didn’t help, four-five nurses pushed down on her pregnant belly to force the baby out (the infamous ‘fundal’). After all this pushing and pulling, the baby ceased to move and with the baby jammed in her pelvis she was sent to us. She hadn’t passed urine in 2 days as it was obstructed labour. She delivered a still born baby boy weighing 4 kilos. She was dehydrated, exhausted and mentally traumatised by the experience. She got better after a few weeks of hospital stay and she returns often, just to chat.

On Saturday, I met Sukhmayar.

It was dramatic, it was scary, it was such a shame. She had been in labour for 2 days, the pains had once more been induced with Oxytocin artificially. She’d gotten many scans and investigations done in the past, but had not been able to deliver the baby. Somewhere during that time the baby had died, and she had started bleeding profusely. As I moved my hand to touch her abdomen she screamed even before I got within a few centimeters of her. Ultrasound showed a ruptured uterus, and a baby with a very larger than normal head full of fluid. I snatched back the scans they’d shown, read and re-read them. Not one scan mentioned the fact that the baby had an anomalous head - that it was too big to deliver normally. Not one of those scans was signed by doctor. Each said boldly, ‘Not valid for medicolegal purposes.’ It was a crime, murder in broad daylight, to not detect so obvious and significant a finding. She was taken up for surgery, and stayed many days in the ICU. She left early and never came back for follow up.

On Sunday, I’m off duty and I sit around scrolling down my Facebook newsfeed, to see what everyone else has been up to. It tells me loudly about what a celebrity wore on the red carpet at Cannes, or who the next feminist face of India is, or that we are progressing by leaps and bounds. Yes, urban India is changing, but what of the other rural 70% that knows, cares and profits nothing of this ‘progress’?

This is the original Hindu Article from which the title is derived.

Falling sick

What sort of people go to hospitals? 

Sick people. 

But what happens if the hospital falls sick?

I was confronted with this unfathomable concept a few months back. Two of our consultant specialists had to leave our hospital due to unignorably urgent needs back home. Suddenly there was a murmur going around the hospital and everyone from the sweeper to the staff where talking about it in hushed tones. Our hospital was going to become a ‘sick unit’ they said, ‘Salary time se nahi milega! Patients ka load decrease ho jayega!’ And from the way it was talked about, it was awful thing to be. I had never heard of this terminology before, but then again I hadn’t been working in a mission hospital for very long. 

I turned to a few sources to ask them what in their opinion a sick unit was. Google baba went first and said, ‘Sick (industrial) unit is defined as a unit or a company which is found at the end of the financial year to have incurred accumulated losses equal to or exceeding its net worth.’ I spoke to a few seniors - some say it is a term essentially describing the financial status of the hospital – ‘Used to refer to a hospital which is not doing well financially, usually in debt.’ Others said, and I quote, ‘I believe it is the state of the people in the unit rather than the infrastructure or finances or human resources of the unit. If the people in the unit are ‘alive’ the by-products like infrastructure and finance cannot be far behind.’ 

A lot our patients believe in ‘tatkal ilaaj (treatment for the time being)’ and we seem to have taken to the concept quite happily ourselves. Our current medical practise is very happy to treat symptomatically. Very happy to put some micropore on the tap but not fix the leak in the tank. Very happy to prune the hedge but not water the roots. Very happy to treat the X-ray or the raised counts but not look for the cause, take a detailed history and dig out the pathology. 

When filling out a death report there is always a direct cause, something acute which led to the person’s death. However, there is always an underlying cause, something vague and long standing that we refuse to make the effort to hammer out and treat. Because as we all know such causes take time, effort, consistency and some amount of hit and trial to figure out. The same analogy can be extended to hospitals which are considered sick. Maybe something acute (consultants leaving) may lead to death (shutting down a hospital) but what is the underlying morbidity? 

This brings up two questions, both of which I have very inadequate answers for. Firstly, Why does this happen? And secondly what do we do about it?

Is it enough just to have doctors fill an empty OPD chair every two years? Is it enough to ensure than there is someone manning emergency every night? Is it enough to downscale and lay low till things get better? When does one make the decision to pull the plug? Or do we keep running on ventilatory support and inotropes? 

During student years we hear of how one person started a one man clinic and turned it slowly into a hundred or two hundred bedded hospital. How the dedication of a few, changed the lives of many. We place these people on a pedestal and expect to find such powerhouses fuelling missions in India. Then we actually start working and get a close look at the real challenges Christian missions in India faces today. For how long can lone people charge and run a hospital? For how long and indefinitely can a few people surrender all, while others watch? In the end we find ourselves inadequate, inept and unwilling even to consider that the same could come of our efforts. 

Someone asked me a very apt question recently, what is the purpose of what you are doing? It took me a while to form a coherent thought on that. Why is that? Are we just working without a specific end or goal or vision? Or have we along the way, lost sight of it? 

What determines the ‘health’ of a hospital? Is the number of surgeries we do? Is the number of beds we have? The doctor to patient ratio? The amount of money we make? Is being able to pay salaries on time? Is it having more modern equipment? Or, is the happiness of the people who work there? Is it the impact we have on the community? Is it the transformation we see in our own hearts and lives? Is it kinder doctors, nurses and staff who live together with a common goal?

In the end I have many questions, and very few answers. 

30 days of Verbal Diarrhoea

'Don't get stressed about your stress buster.'

A wise friend of mine told me this when I told him I like writing, but dislike how I don't do it often enough. He loves to bike and recently completed a 30 day biking challenge where he rode 1000kms in 30 days. I marveled at how he managed to do it! And it also got me thinking about doing my own variation of a  30 day challenge.

But why?

Because,
a) I could do with a distraction.
b) I have so much to say with very few people to listen to me.
c) Bihar can be really happening and people need to know about the state of our country.
d) I'm bored.
e) I'm a great at starting things but terrible at finishing them. This blog is fine example of that. So here's to trying to complete something for once!

What are the rules?

a) Write daily.
b) A minimum of 500 words.
c) About a preselected topic, picked at random from a box full of chits listing things I've learnt, seen, experienced, eaten, visited, done, wish to do and thought about in life.

So here's to 30 days of Verbal Diarrhoea. 30 days of chatter. 30 days of writing.

Until tomorrow!

Radiology Revelations

A physiologist in the quiet blackness of the night observes how bats navigate in complete darkness.

A Physicist invents a transducer using sound waves to detect ice bergs after the sinking of the Titanic.

A neurologist uses it to detect brain tumours in Russia.

Students in the last bench of a Physics class stare dreamily at the professor talking about the properties of sound waves.

A Philanthropist donates a large sum of money to a Mission hospital.

A teenage girl feels a lump in her breast.

A company produces medical equipment in Japan.

An elderly gentleman visits the anaesthetist to get clearance for his cataract surgery.

A little baby with a very large head and recurrent episodes of vomiting gets admitted to the ICU.

A college going boy is brought to the emergency room with abdominal injury after ramming his car in a drunken haze.

A first time mother 24 weeks pregnant visits an obstetrician.

An unborn baby floats in her womb swallowing amniotic fluid and wiggling its tiny fingers.

An obstetrician palpates her abdomen and writes out an investigation to rule out anomalies.

A recent MBBS graduate starts her first day at a mission hospital.

A radiologist turns to his third ultrasound of the morning.

An ultrasound machine unites them all.

A world of greys and blacks and whites. Of shadows and densities. Of depth and gain. Of flow and colour. Of angles and pressure. A real time wonder of physics.

Its language is completely different, and to describe what one sees therein takes years of practise and reporting. That single transducer, as it makes contact with the abdomen, opens a portal to another world, the unseen, is demystified for us to see in plain sight. A little angulation of the probe, slight variation in pressure as you glide your probe across the slippery jelly, leads you through various cross sections and fleeting glimpses of human anatomy. You can pick up gallstones, ovarian cysts, free fluid in the abdomen, aqueduct stenosis, breast lumps, a calcified valve, and ejection fraction – just a few simple examples of its varied use in the medical field.

But as is the case with all good things, examples of its misuse are also very prevalent. It is shrouded in litigation over prenatal sex diagnosis, with sonologists levying large sums of money to dish out illegal sex determination, greeting the prospective parents with a ‘Jai Mata Di!’ if it’s a girl and a ‘Jai Shri Ram!’ if it’s a boy. I wonder, why that shifts the blame entirely on the sonologist for female foeticide, since the sex ratio in our country has been bad, even after - implementation of the PNDT act and even before – the advent of prenatal sex diagnosis.

In recent months I have seen many antenatal ultrasounds with developing foetuses at different gestations. It fills me with awe and wonder to see little fingers moving, a foetus swallowing amniotic fluid, the circle of willis twinkling colourfully in the Doppler, the four chambered heart thumping energetically, valves flapping open and shut in lively rhythm, the spine from cauda equina to the craniovertebral junction and the continuity of skin along it, developing eye balls, the infantile nasal bone, a little human taking shape and form so rapidly and with such organisation that it puzzles me how anyone thinks all this doesn’t have a creative maker behind it. I realise the great significance of a normal scan when we encounter a baby having anencephaly with everything else in perfect order, when a patient with bleeding per vaginum for the last week is told that she’s had an abortion, or when you don’t hear the foetal heart on auscultation and rush hurriedly to the USG room only to encounter intrauterine fetal demise - an ominously still heart.

The USG is an unsung hero, the little overlooked brother of the more glamourous and imposing CT, MRI (Not that they aren’t mighty useful and fascinating!), very modest and very helpful when in the right hands.

The oft heard dictum which stands true when peeping into the monitor of an ultrasound is this –

‘The eyes cannot see, what the mind does not know’. 

They called her Devi

She walked gingerly into the emergency room, her eyes looked tired, her saree was old and worn out, the once vibrant colours now tattered at the edges. She was pregnant with her third child – her tummy looking disproportionately large as compared to her tiny malnourished frame. She was white as a sheet, holding her hands to her back and clearly in labour pain. She smelt musty, a mixture of sweat, blood and neglect met my nostrils as I reached out to examine her. She was burning with a fever, and when I asked her what was wrong unable to answer she turned to her husband. He too was a tiny man, his big eyes shown with hopelessness as he spread his calloused hands and proceeded to explain what had happened. She was pregnant with her third child, the first one had been delivered by Caesarean section only 4 years ago, the next one was a normal delivery at home, and this was her third. She had been to a few ‘doctors’ before us where multiple unsterile per vaginal examinations had been performed and the last one had indiscriminately administered Oxytocin to induce labour. When the labour did not progress they referred her to a higher center. She had been bleeding for a few days, her urine was blood tinged, her pulse was racing, her blood pressure was unrecordable, and even after giving her fluids was dangerously low. She had ceased to feel her child moving for the last 2 days and on doing an ultrasound we found that her baby was dead.

Her haemoglobin was very low, her white cell counts very high, her fever never seemed to subside, they had no relatives to donate blood, and no money to pay for the surgery she most urgently needed. In the operation theatre, on opening her abdomen we found that her uterus had ruptured from the pressure of contracting against resistance for days, the torn ends were sealed by a huge clots of blood, the anatomy was hard to make out, her baby was lying in one corner of the abdomen, a perfectly healthy baby which would’ve had a 100% chance of thriving had the Caesarean been done electively before the pain started. Lower down we saw the bulb of the urinary catheter sticking out through a huge rent in the wall of the bladder, it had also burst. This explained why her urine was blood tinged. The bladder and uterus were repaired and her abdomen closed. She was stable, for now.

Over and over, we tried to measure her blood pressure, at the most optimistic of times the reading was still very low. In the ICU her condition worsened, and still no blood. Her husband sat next to her bed on a little wooden stool staring at the moniter beeping loudly, and the alarms going off as her vitals destabilized. She lay on the bed with multiple supports going through veins which we had struggled to cannulise before the surgery and as I stood there looking at the moniter I felt the sinking feeling that she wouldn’t make it. I thought back to the time before the surgery when we had shifted her to the operation table and tried to distract her from the pain of the IV cannula pricking her. I remember asking her why she didn’t go to a hospital earlier, and she just laughed and said, ‘Humko kya pata’ (How was I to know?). She had laughed completely oblivious to the fact that those would be her last words. Like she rightly said, how was she to know? Even when she did go to a so-called doctor, she was given grossly faulty treatment all in the name of ‘normal delivery’. ‘Do no harm’ a dictum from the Hippocratic oath, isn’t said without good reason. She died that night, without resistance, without a fight. A result of incorrect medical treatment. When the very people you trust to fix you are so grossly out of line, who does one turn to?

I checked her pupils – dilated and fixed. No pulse, no heart rate, no breath sounds. A fresh JMO, I went over the motions of confirming her death once, twice and a third time, and turned to tell her husband. He shook his head and thanked me for all our efforts. He explained that he was a daily wage worker, he and his wife were both orphans with no close relatives to support them. ‘I wish I’d known what to do,’ he said, and with that he left.

Her name was Phekni Devi, doomed from the day she was born, her very name shows us that. Phek meaning thrown away. Abandoned. Unwanted. A fate a large number of girl children in rural India meet. Devi, referring to a goddess. A surname every woman adopts once she is married. In a country which worships female goddesses like Kali, Sita, Laxmi while mourns the birth of every girl child, it seems to me, like the worst kind of hypocrisy and the cruellest contradiction, for nothing could be farther than the truth. When I stepped out of the ICU I heard devotional songs blaring through the loudspeakers all over our little town of Madhepura.

Ironically, Bihar was celebrating Saraswati puja. 

The C-Section

Scrubbed in for the first time.
I was sweating like a pig.
Everything looked too clean,
a forest of humans clad in green.

Tips of fingers to top of elbow,
under nails, and back again.
Washed in Iodine for ten minutes,
touched the tap, had to do it again.

Got blood on my feet and OT chappals.
Watched the incision in horror and awe.
Put my hand in another's abdomen.
Helped pull the rectus apart.

Found out my glove size is 6.5
and the size of my brain minuscule.
I smelt blood. Suctioned it.
Got up to my wrists in it.

I saw life emerge, like a little rag doll.
Saw a baby pulled out,
pulled out with (force)ps.
And heard it make the most awesome sound.

Clamped the cord. And cut it.
Felt giddy as I did my first suture.
Felt nauseous. Had to step out.
Came back. Had to sit down.

Found a person to look up to.
Found a peace to hold on to.
Felt excitement like never before.
Confirmation of purpose and the promise of more.

More to learn. More to feel.
More of his glory will be revealed.
More to hear. \
Try to get over all fear.

So much to know...
Oh there is so much!
Felt inadequate. Small.
Humbled. In awe.

In awe of creation.
In awe of anesthesia.
In awe of absorb-able sutures,
and of negative airway pressure.

In awe of the fact that, yet,
anything can go wrong.
Or, that everything will go just fine,
as has been since Adam's day.

I Study in Med School

What I’m writing about is no different from what most of us have probably realized at some point or the other while having stayed here, in a Medical College. It is not a new, sudden or remarkable realization, different from anything that has ever been thought. Here, is a leaf out of an non-descript medical students life, 9 days after joining and almost 2 years after having joined. 

9^th August 2011: A Bone in the Common Room                         Written by, The NAÏVE First Year

My hostel room consists of a few oddities, a bag of bones, scalpels, forceps, and surgical gloves, all of which I am very proud. As of now the bag of bones is sitting next to me on my bed. I am alone in my room, my roommate is out for dinner, yet the bag of bones is now sitting next to me on my bed. The remains of another human being, are sitting next to me. A human, a person, maybe a father, mother, sister, friend, flesh and bone, ligament, tendon, fascia and periosteum, vascular supply and nerve fibres, once upon a time innervated and gave life to these set of bones. Yet here they are in the hands of a first year medical student, as tools of learning, all 17 of them; fibula, tibia, femur, vertebrae, radius, ulna, humerus etc. I got them on loan for Rs 700. The remaining legacy of a person(s) who once lived, who was conceived and born, who lived and grew, who spoke a language, who had beliefs, for Rs 700.

I received my ‘bones’ in the Dissection Hall today. It’s a long white tiled hall, with metal stretchers arranged across its length. The tube lights are a bit too bright, like you’ve walked into an incandescent, florescent world. There are skeletons hanging in each corner, like morbid watch guards. It’s funny, I thought it was morbid the first day, but that’s also the only thing that’ll be left of me once I’m dead and gone. Maybe I will end up being an unclaimed body which ends up hanging on one of those hinges. Life is so transient. Life, a word I have come to reconsider in the last 2 weeks. A cement washbasin lines the wall, the dull grayish hue of the mosaic pattern, giving it a primal bare aura. Add to the whiteness of the room, our newly bought, well ironed, and spotless lab coats and you realize with a jolt to the gut that you’re in Medical College. Mind you, it’s been way different from what I thought it would be, like discovering the little asterix saying ‘conditions apply’ on a clearance sale poster. And that brings me back to the very ‘odd topic of this discourse, the bone in the common room.

Yesterday I was making maggi with my friend in the common room. It’s this room with a hot plate and a wash basin. Oh, and it has a dustbin. Pretty much. While cooking the maggi I started shuffling the stuff on the counter around, uncooked dal, long expired black pepper powder, used greasy pans and dismal looking rags, I was thinking about how people could be that dirty when I saw it. The bone. The scapula. In the common room. On a basin. Probably long forgotten by a medical student very much like me. Maybe I shouldn’t think it unusual to find a scapula just lying around the place, but I did. And I’m writing this down because when I’m a year into this course and I forget the awe that overtook me every time I thought about where I am and what I’m responsible to accomplish, I would read this.

24^th February 2013: The Babaji                                      Written by, the still NAÏVE Third Year

Talk about getting demoralized. If ever someone needs a check on their bloated egos, they don’t need to go any further than, Clinics. And I mean this not only for the poor student, but also for that ‘patient’ patient (pun intended) whose dignity and pride is slowly bartered off to all of us aspiring ‘doctors’ willing to percuss and prod him. I wonder where all those lofty ideals of ‘treating the patient as though they were your loved ones’ went.

I think my version of today is so very vastly different from what it’s supposed to be. Today I met a babaji, Ajaib Singh in Ward 2. He was a man slight in demeanor, with jolly twinkly eyes and laugh wrinkles on the edges of his eyes, like crinkled up butter paper. He had on an orange turban, a clean crisp off-white kurta and sheet pulled up to his waist. As I approached him I noticed under his bed a series of urine sample bottles and by his side was sitting his wife, knitting and chatting away with great agility at express speed. As I proceeded to get a ‘good’ history and find some of the ‘findings’ which always seem to elude me, he told me about how he’d been a shopkeeper till ‘peshap mein problem ho gaya’… his wife gave me an incessant backup of the details about how life changed after ‘peshap mein problem ho gaya’. I think I spent close to 40 minutes chatting with them completely forgetting to go and present my case, and therein lay the problem. Needless to say, I stuttered and stammered through the whole ordeal once I did get back to class, and received mirth-filled looks from the rest of my class mates, for the show had begun.

Now if I’d done things the way I was supposed to have, my day would’ve consisted of having worked up a patient, Ajaib Singh, male, 60 years old from Ludhiana who was apparently well till 5 days ago when he came to OPD with complaints of frequent and painful urination. End of story- teacher happy, student happy and patient? Well, who really cares right?

Note: Although the incidents may seem unrelated, and well, not that big a deal, slowly, ever so slowly, our consciences are getting blunted out and shaped. At the end of the day, it’s still in each of our hands to decide what shape that’s going to be.