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.

A fatal kiss

Our small two bedded casualty was full to capacity, on one bed a pregnant lady in labour pains twisted fitfully surrounded by concerned relatives as sisters  while a curtain separated her from a middle aged  as lady who’d received an electric shock and lay comparatively still while her ECG was done. The moniter bleeped confident rhythmic heart rates and displayed reassuring oxygen saturations. I surveyed the scene with some satisfaction - investigations were underway, plans for treatment had been made, relatives spoken to. Now I could return to a busy OPD and all the waiting patients there.

The moment I sat down to see the next patient, Sister ran up to me, ‘Ma’am, snake bite aaya hai!’, I asked with trepidation, ‘Ptosis hai?’ to which she replied, ‘Haan ma’am, hai toh!’ The next half an hour played out like a dramatic episode in what could be called an Indian version of the popular American medical saga Grays Anatomy (minus McDreamy). She was brought in to casualty with each arm draped loosely around the shoulders of two men who were struggling to support the dead weight of a person who is fast losing consciousness. Her bindi was askew to one corner of her forehead, and her sweaty face caked with what appeared to be and smelt like, a combination of atta and chuna (lime stone powder) most probably smeared by a ‘faith healer’. She had on a bright stripped orange cotton saree with a parrot green blouse, against which her heaving chest was straining as she gasped for breath. But by far the most striking thing about her appearance was the ominous manner in which her eyelids were half closed, and her swollen upper lip.

I told her to open her eyes, but no matter how hard she tried she couldn’t – this is ptosis (a small but characteristically alarming sign). I tapped her on the shoulder and asked her what happened – the syllables came out slurred, and her tongue kept falling back as she tried hard to swallow back spit. But she couldn’t. She was quickly laid on a trolley for lack of room and hooked to the moniter which bleeped uncertainly as her saturation dropped – 95… 90… 87… 82… 79% she was slowly going to stop breathing on her own. She was rushed to the ICU, cannulised, and given Anti Snake Venom along with antihistamines to prevent a reaction. We breathed a sigh of relief as that was done and prepared to intubate and put her on the ventilator. Even as I gazed at her I saw her slowly blowing up like a red balloon, and I’m not exaggerating one bit. Her lips, eyelids and cheeks were puffy and rashes erupted across her arms and legs. It took me a minute to realize she had developed a reaction to ASV. I was boggled by the irony of it, but there was no option but to continue the ASV and deal with the reaction. Once more there was a scramble for adrenaline and rapid intubation.

Once intubated and stabilized, I had a chance to speak with the relatives. A snake had bitten her on her upper lip (which is why it was swollen) in her sleep at 12pm last night, and she had only been brought to us about 10 hours after the bite. Why did it take so long? I asked. A chorus of answers erupted, ‘We took her to johla chaap (village doctor)!’, ‘…Jhadphook ke liye le gaye the madam (we took her to the witch doctor)’, ‘sarkari aspataal mein bhi gaye (and to the government hospital as well)’. When I asked them for some receipt or prescription they produced a small pitiful piece of paper with an assortment of drugs listed including antibiotics, steroids and every variety of IV fluid. Clearly they’d been swindled of their money and better sense.

In a community which is so steeped in superstition it is extremely hard for us to expect an immediate trust in hospitals which offer ‘angrezi ilaaj (western treatment)’. There are many barriers, cultural, social, religious and definitely financial which need to be overcome in order for such patients to reach us. And by then it’s often too late. Most often it is the poorest of the poor who get bitten by poisonous snakes, either while tilling their maize or rice fields, or while going into the forest to relieve themselves as most villages lack toilets. Yet they can’t afford to get bitten by a snake. The antidote alone costs anywhere from Rs 600-1000 a vial, and we give 10 vials – Rs 6000-10000 for Anti venom alone! Not to mention the cost of transport, ICU admission, moniters, oxygen, ventilation. In which land is this a fair plight? To me it seems like a cruel joke that to those who need it the most, care is not accessible or affordable.

The picture above is from one of the times a patient decided to bring us the culprit himself to see if it was poisonous or not!

From the Frying pan into the Fire

Imagine how a blob of butter (me) fresh out the cosy cool fridge (Kodaikanal) feels when it’s dumped onto the hot pan (Med school) and then mixed with coconut from Kerala, mustard from Punjab, curry leaves from Tamilnadu and other random ingredients from the gulf, metropolitan Indian cities and Mizoram, which by the way, are all originally from Kerala (Sanadors – Batch of ’11). The ingredients are tossed and sautéed together for a while (five and half years, no less), with the heat varying from a slight simmer in summer (college fests and class trips) to high flame (profs) till finally you are presented with a dish so delectable, where the ingredients have blended and infused so well together that you couldn’t tell them apart (except for a few exceptions, like the clove or tez patta which is always going to taste terrible if you bite into just that!) Then, of course the heat is turned off and the dish is left to cool (internship) and then transferred to a serving bowl. Well, this is where the simile ends, because in my version the entire dish falls bang into the fire (bond). And this isn’t a tame home kitchen burner, it’s the road side burning furnace which rises with tongues of heat to devour and blacken the bottom of the kadai.

Whether you’re from a family full of doctors or a first generation medico, nothing, let me repeat, NOTHING prepares you for what medical school has in store for you. Swimming through the sea of syllabus we triumphantly arrived at the shores of MBBS only to find ourselves marooned on an island full of unforeseen monsters which, Physics, Chemistry and Biology never prepared you tackle, namely – Anatomy et al. But one must never lose hope, as my good friend once said, ‘God got us in and He will definitely get us out!’ They say time flies when you’re having fun, and sure enough, these years have flown by in a blur. I wouldn’t be exaggerating if I said that these were some of the best days of our lives! Finishing college and leaving my safe bubble in CMC Ludhiana was one of the saddest things I’ve gone through.

After five and a half years of studying with the same people and living within the protected confines of a teaching hospital one is not prepared or willing to voluntarily ‘jump from the frying pan into the fire’ so to speak.

It was like learning how to swim, being unceremoniously pushed into the deep end, except instead of a swimming pool this was a vast swirling whirlpool of real life, with its troubled deep blue waters, complete with rollicking crests, humbling troughs and spaces of inexplicably calming, still, beautiful waters reflecting the brilliant fire in the sunsets above. In one word this is called – Adulting. Suddenly I was using words like independent and earning in sentences to describe myself. While such glamourous words do describe my new life the stark reality is that now I have to wash my own bathroom (no hostel), manage my money, treat patients, manage the emergency, do on call duties, talk to Biharis, keep my ID cards and certificates safely and think about whether I need a maid (this is my mother’s job, I tell you!). I also have a PF, I mean come on, that is the stuff of LIC ads!

Another thing about being a completed dish is that soon it is not good enough on it’s own, you need to garnish it (PG seat) and serve it with an accompaniment (husband). My facebook newsfeed is now filled with either pre wedding photo shoots or stories of which PG course my friends are getting into. You know when you start a blog, you have to select a template, and all your articles, pictures and links are laid out according to that template. Many tutorials on how to have an amazing blog say that it should be thematic, which is disappointing because everything I have to say is random and scattered. But sometimes, I feel like I’m stuck in a thematic template.
I feel like a food blog.

Cooking time: 24 years.

Ingredients: Versatile genes, Years of study, lovely people, beautiful places and mostly God’s grace.

Recipe: Refer to the rant above!

Serves: I guess this part makes the difference. The serving part. How many will I serve? And who will those people be? And how will that experience be? No one cooks without a reason, and the same goes for us. We weren’t created without a reason.

Maybe I will be the curry leaves which reminds someone of home.

Or maybe, I’ll be the clove which soothes someone’s aching tooth.

Maybe I will be the butter which fattens a malnourished child.

Maybe I will be a tava roti which when thrown onto the fire, becomes light and fluffy, soft and cooked to perfection. Ready and willing. To serve. Of course in the process you might get eaten up, but who would want to be a rotting chapatti?

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!