Phases of Junior doctoring - Part 1

‘How’s bond going?’ asked a senior of mine.

‘Pretty good, I’m busy, learning and doing lots of things!’ I replied, as I launched into an exhaustive list of all the things I was getting confident in doing day by day.

‘That’s great!’ he answered. ‘But what happens when you know everything? Will you still feel as eager when you’ve learnt what there is to learn, or when this time next year all your classmates are preparing hard for NEET and you’re still doing the same things? The newness of it might wear off… How has this experience changed you?’

I was stumped. What will I do when the newness wears off? I was already beginning to feel it, and this conversation made me think about the past 6 months. Was I any different from when I started? Was I supposed to be? As any good product of the system would answer this question, I have set out to categorize the various phases of Junior Doctoring I’ve gone through. Sometimes Dr Jekyll and at other times, Mr Hyde!

Phase 1 - The Enthusiastic Learner.

We all start this way, young, idealistic, fresh from college, raring to go, and new to everything. The enthusiastic learner is awed by everything from a baby sucking it’s thumb on ultrasound, to the neat squaring of a suture knot, to the remarkable slipperiness of amniotic fluid covered gloves when delivering a baby (what if I drop it?!) This learner is not scared of asking questions or making mistakes and says yes to everything. She even claims to enjoy the mess food, seldom complains, always agrees to play with the campus kids, calls the consultant for everything from a common cold to ‘Ma’am, do you have a broom?’, desaturates when the patient is gasping, hyperventilates in the presence of tachycardia and sleeps with one eye open during on calls for fear of sleeping through them, but sleeps through them anyway.

Dear Enthusiastic learner, please don’t lose your sense of wonder.

Phase 2 - The Dizzy Learner.

It has been one month and the learner you met earlier is in the thick of things slowly but surely taking on more responsibility. Skin one day, Rectus the next, Uterus, Baby out. She has gotten a sense of the routine, and figured out alternate paths to avoid the onslaught of the kids after a long day at work. She is busy and has no time to do her laundry, call her mum or look at the pretty blue skies, smell the flowers or admire the red litchis – it’s okay! I’m learning. But one day while in the operation theatre, she feels dizzy and has to step out and sit down. ‘Darn this sign of weakness!’ she scolds herself. It happens again, and again, till she starts dreading the embarrassment of stepping out each time and prays as she scrubs – no fainting this time. It still happens. Advise pours in – ‘don’t be scared of blood!’, ‘it’s postural hypotension’, ‘get more sleep’, ‘arey, just wiggle your toes!’ Many deep breaths, toe wiggling sessions, prayers and dizzy OT exits later, it stops, just as suddenly as it started.

Dear Dizzy Learner, when you feel like giving up, reconsider. And, always, ALWAYS stop to admire the sky.

Phase 3 - The Late-comer.

The learner is getting tired and is faced with the same tasks over and over again. The learner has also figured out ways of accumulating ‘loose change’ sleep and her friend procrastination has come to visit. Together, they are persistently late. They are running against time, stumbling into rounds, moving around bleary eyed and staying up when they should be asleep. For example right now, she should be asleep.
Dear Late-comer, please don’t tell me you’re here to stay!

And in keeping with my promise to be up on time tomorrow morning (It’s Monday after all!) I will introduce you to ‘The Unmarried-Loner’, ‘The OPD Monster’, ‘The Weight Gainer’ and ‘The Jack of all Trades’ tomorrow.

Signing off,

The Junior Doctor.

Life in Madhepura Christian Hospital– A JMO's Point of View

‘I want a career in which I never have to sit at a desk for too long, or stare at a computer for days on end, a job where no two days are the same. I want to be useful!’ 

These were the big ambitious wishes of the young teenage me. It’s been a few years since then and my wishes have been more than fulfilled through my placement at Madhepura Christian Hospital.

When I first arrived at the airport, I was greeted by Manju bhaiya, a very happy man, who is the face of Madhepura Christian Hospital to all newcomers to the hospital. As we got closer to Madhepura the road got bumpier and the weather got cooler. Instead of seeing plump turban wearing uncles and the yellow mustard fields of Punjab, I now saw pineapple fields, paan chewing bhaiyas and the vast fertile land of Bihar with its flowing rivers and greenery. Our campus is a small haven in midst of the cramped town of Madhepura – with a collection of different fruit trees (Litchies, Mangoes, Chikus, Mulberries et al), full-fledged organic farming and nature study, spear headed by Arpita ma’am doctor/mother/homeschooler/organic farmer and her three home schooled kids in tow.

A typical day here leaves me breathless! We kick start the day with devotion, followed by General ward, ICU and NICU rounds, quickly completing discharges and rushing to OPD where patients are already waiting to see you and the cards begin piling up.

OPD consists of an USG room and two airy rooms with plenty of sunlight. The area where the doctors sit is separated by a curtain from the area where the patients wait – expectant mothers, crying babies, old and wrinkled grandpas and concerned relatives. It is a bustling hub of activity – the nurses screening patients, taking vitals, giving directions, ‘Char number – Billing! Aath number – Dawayi! Satra number – Lab!’

On the other side, Dr Timothy (our SAO and radiologist) hustles in and out, going back and forth, doing USGs, handling office work and overseeing construction. Everyday in OPD, USG probe in hand, he opens my eyes to the wonders of the developing fetus, physics, radiology and life, with a sprinkle of PG entrance MCQs and well timed jokes. What was once a blur of greys, whites and jargon now makes perfect sense thanks to him enabling me to learn how to do USGs. As a senior one would expect him to be strict and up tight, he on the other hand, is approachable and humble – no where else have I seen the JMO and MS alternating calls.

Dr Ilango, our Anesthesist sees medicine and paediatrics, patiently explaining and listening to what troubles the patients. The ICU where bleeping alarms of falling saturation often rattle my nerves, he once coolly sauntered in and asked me to intubate a patient absolutely unruffled by the cacophony that surrounds him or my feeble protest of, ‘But I’ve never done it!’

Dr Pradeep, a Paediatric Surgeon works part time at Madhepura Christian hospital and the rest teaching at government hospitals in Bihar. The days he’s here are packed with surgeries. From something as small as an Incision and drainage or cutdown to Hydrocoele repairs, Hypospadias repair, Hernioplastys, Laparotomies, Cholecystectomies and even a Hemiglossectomy – he takes equal effort to explain them all. With his kind smile and gentle touch he soon wins the trust of his patients.

Dr Bina, our Gynaec-ALL-ologist, is always multitasking - busy seeing Antenatal patients, and pretty much every other kind of patient as well. And here lies the remarkable speciality of working here – you get to see everything!

As the sole JMO in this 35 bedded hospital every on call night provides an opportunity to see and manage cases from all specialities – Ob-gynae, Paediatrics, Surgery, Medicine, Derm, Psychiatry, ENT, Community health. I have learnt more in the last two months than I ever did in my 5.5 years of college. MCH is small, but makes a significant contribution towards mending lives in the state of Bihar.
In the midst of the hullabaloo of OPD, we have patients coming into the Emergency Room adjoining OPD. Some are dramatic - Snake bites, Organophosphorus poisonings, Eclampsia, Ruptured Uteruses, Severe Anemia, Dehydration and Malnutrition, mothers in second stage of labour – in which case we drop all and rush to OT/ICU, some unique and others relatively docile – Common cold (the treatment of which is really an art!)

On an average we have 2-3 Caesarean sections a day, and a busy labour room – all managed single handedly by Dr Bina and the team of nurses headed by Sister Ancy. From never having done a PV on my first day here, to doing independent C-sections two months after, my learning curve has shot up steeply thanks to her patient instruction and excellent example. On many a busy nights we’ve groggily made our way back from OT after our third CS of the night, bleary eyed and low on sleep, but the next morning however tired she is, she’ll greet you with a twinkle in her eye, a pat on the back, her easy smile and yummy dosas for breakfast.

Some days are free, some insanely busy, some days I worry about how I don’t get time to study for PG, some days I realise I’m learning things that form the basis of my practise, some days patients fight, some days they walk out hale and hearty, some days are lonely, some days filled with the company of really wonderful people. This brings me to the sprightly youngsters of MCH – An animated troop of seven campus kids who make sure you never have a dull moment. From climbing trees, playing with guinea pigs, running behind chickens and reading story books to making me jump on the trampoline (‘Because it’s good for your lymphatic circulation, Preeti didi!’) they add colour to life.

I have learnt that in a mission hospital there is nothing that is ‘not your job’, there is no job description, you learn to juggle multiple roles and manage your time (or at least you try to!)

I have learnt that well trained nurses are the backbone, the hands, the feet, the circulatory system (or whatever simile you’d like to use) of an effective mission hospital.

I have learnt that if you keep an open mind there is something valuable to be learnt from everyone, the sweeper, the staff, the OT technician, the patients, the relative, the doctors and the nurses. You learn integrity, dedication, hard work, humility, compassion and you see a side of India which we often choose to ignore. For how long can we ignore the elephant in the room?

It is impossible not to be downcast at some of the things we see, to not get angry at the injustice meted out to those who can’t fight for themselves, but this is the stuff of reality. In working here I truly feel useful in my small way, and I am glad I’m able to be of service to the one who looks after the greater scheme of things. When one hears of Bihar it always brings to mind images of derelict women and children, extreme poverty and illiteracy. Clearly, the harvest is plenty, but the workers are very few.