Medical Couples

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[UN]Reality TV: Part 2

Grey's Anatomy, now this one show which raised my expectations like none other. The doctors were all so good-looking, Katherine Heigl was a lead protagonist & I don't have to explain how much she excited me. The men on the show were real men, surgeons who held life by the balls & made it dole out what they wanted it to. The hospital was never short of exciting cases, brilliant procedures. Everyone was free to do what they saw fit. Importantly, I can't recall a single episode where an intern collected blood. Ah, those were the days. 

I went through around 3 seasons in 2 months time. And in the span of some 40 episodes, they'd found a bomb in a body, almost killed a patient and brought him back because Heigl was in love with him & they'd got to scrub in on cardiac surgeries! Yes, Cardiac! The hope of an intern scrubbing in on those is even more perverse than Dr. Chase actually coming to a surgical diagnosis on House MD. 

I remember reading an article that when House MD was pitched to the network executives by the creator David Shore, he promised them a medical drama which wouldn't be all about white coats talking in corridors; a show where the diagnosis would be the lead character. Imagine the exact opposite & you've got Grey's! The show revolves more around relationships than even The Bachelor. Everyone's more concerned about who they're gonna wake up in bed next to than their own careers! 

Dear aspiring doctors, because I'm your friend, I'm going to tell you the harsh truth. While you may find time for a relationship while studying medicine, it's by no means the way its portrayed in movies/tv shows. They want you to believe that you're so stressed with your practice & studies that you just crave quickies for venting frustration. They're WRONG!! Medicine is that bitch which holds your life by the crotch and steers you around in meaningless circles till either your social skills die or your libido does; you decide which one is worse. Most people you'll find are so intensely career oriented that they that you can literally smell tyres burning before you ask them out on a date. Here, time is short, unfortunately tempers are too. So, if you planning to join us in this worldwide social experiment, ask the professionals; stop watching TV shows. Ironically, at the end of five years of training, I can't say I'd like to date anyone apart from a doctor myself. Am I just a glutton for punishment or a perverse sociopath? Medicine's a bitch that also screws with your mind. Did I say that already? Well, now you know. 

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[UN]Reality TV: Part 1

OK, if we could only go back a few years when I was busy prepping for Med School, I'd tell you that Scrubs and House were my favorite shows. I spent the better part of my free time away from books admiring Sarah Chalke and wondering why Jennifer Morrison couldn't be the same. Anyhow, my basic presumptions about med school, medicine in general, and the work environment were so freakishly flawed by these shows, I wonder how I adapted to reality in the first place. And that's not it! One of my friends got me started on Grey's anatomy right after I knew I was gonna get into med school. It took her 2 full months before college began to realize that the show is named after the book, not the other way around! 

So, I'll be sharing my breakdown of the top UNREAL medical shows on TV over the next few days. Here's presenting House M.D:

House M.D revolves around the life of an egotistical, ingenious, ACDC listening, vintage t-shirt wearing, bike-riding, sadistic prick, who would rather get jailed than listen to a patient. Everything on this show is done STAT. You need a f-MRI with PET Scan at 2am, no problems. You want a lap dance at noon, why not? You want to diagnose a never before discovered condition quickly, because you have a dinner reservation. Why not? After all, the show is only 1 hour long.. Oops, 40 minutes without the ads! 

The general surgeon on the team excels in micro-vascular surgery, neurosurgery, urosurgery, ophthalmology & of course, Internal Medicine. That's right, the Genral Surgeon!!

Lisa, I miss you!

The Rheumatologist tries in vain to prove every case is an SLE. The Neurologist looks like he's getting head under the table at all times, cause he fails to react to any outlandish theory that comes up. But, here's why I watched the show: Lisa Edelstein, the sinfully adorable chief of medicine, who I learn has recently left the show.

I'd end this rant by adding that there is no such thing as a department of Diagnostic Medicine in my hospital, regular patients are not that interesting & the doctors are seriously not that good looking, well at least most of them aren't.

Timing, my dear boy

I'm a punctual person. I always have been. I'm made fun off for always arriving on time for dinners and lunches, while everyone else believes it's important to add the :30 at the end of whatever time they've been told. I'm also anal about getting to work on time. Its more peaceful to wake up a few minutes early, than seeing a constipated face shout at you early morning. So, since I'm so considerate of those around me at work, I expect they be the same with me. I ask only to be left on time. 

For the sake of anonymity, I can't really reveal where I'm currently working, but it's a magical place. As long as I arrive on time, finish my work, I can leave on time. I haven't yet been asked to wait "in case a patient shows up", as asked to twiddle my thumbs. I finally have defined work timings, unlike the other clinical rotations I've had! Some of you may give me some shit about how a doctor isn't supposed to have proper timings & we're supposed to report whenever required. Yeah! When was the last time you lost out on sleep, missed a close friend's engagement, drove 20 kms directly from work to reach a birthday, only to realize you're too late!

We  need to let people go home in this country. The concept off being on-call 24x7 doesn't work with the patient loads we deal with. Accountability suffers in the present scenario. There've been patients who have been taken for surgery without viral markers being in time, only to find out after the surgery that the patient was sero-positive. And I can't imagine how difficult it must be for the first year residents themselves. Even if you live a stone's throw away from the hospital, you still can't go home more than once a month. Someone really needs to stop this madness.. STAT!

Red Suede Shoes

I spent the better part of last week figuring out what was wrong with me the past month. Was I demented? Was I color blind, or just plain sleep deprived? Or was it someone else's mischief at work? How in god's name did my shoes all get so much blood all over them? Ok, for at least one pair, I had the answer; I was a little hasty and overzealous with a central line insertion. But, for the others, no idea! Even my brand new Nike Classics! Hmph

Now left wondering how I go about fixing this mess. The regular shoe laundry isn't taking any calls. And I'm far too lazy to take care of things myself. Maybe I should just get a spray gun and coin the term "Red Suede Shoes" instead. This entire episode got me thinking about how I badly need a new pair of sneakers for use restricted within the hospital. Or maybe I could borrow those nifty plastic shoe covers we use in the OTs when we have a seropositive patient. Will walking around the entire day like I'm avoiding the flood be a bit too funny? Anyway, finally decided on a cool pair of sneakers to buy. It's not so much about fighting the blood now as it is about flaunting it 

Nothing Routine About It

Ok, so I worked tirelessly in my I.Med rotation & it still wasn't enough to finish off all my blood work in time. If I wasn't sending the samples, I was busy procuring bulbs, tubes, bottles & media to send them in! The dreaded "Trolley System" is enough to strike a fear into any intern's heart. For those who don't know, the labs send faceless, nameless & humorless drones with elaborate trolleys neatly marked, into wards at set times during the day to whisk away samples. Time & the trolley men wait for no one! I've had quite a few productive runs tracing the trolley men up and down elevators before they disappeared into their secret passageways.

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While I couldn't really blame my professors and senior residents for demanding a lot of investigations in I.Med, I can't say the same about surgeons. Ever heard the old adage, "Physicians know everything and do nothing, Surgeons know nothing and do everything"? There're so few things a physician can do, that I think they keep ordering crap for interns to get done because they feel an HRCT for a cold could reveal bronchiectasis! Surgeons on the other hand shouldn't need that many investigations, at least that's what my logic told me. So, last month, either my logic failed or my luck did. The unit where I was posted decided it would be great if they could conjure up not one, but two "All-routine" days every week. These were days of joy, laughter & melancholy where I would have to send each & every damn patient's CBC, renal & liver function tests, FBS & PLBS! Ah, what fun! It didn't matter if the patient was a comatose case of polytrauma, or if he just had an abscess drained. The non-discriminatory intern would swoop to their hematological rescue. 

Over time, I grew quite tired of the entire "All Routine" routine, more so with the explanations I had to give patients. They were obviously not willing to give blood for no good reason so often & half my time went in counselling them. Some I could have a good laugh with, others I had to be a tad serious around. There was this one particular chap, who was quite paranoid. Every time he would come up with a new excuse like giddiness, pain in the arms, feeling just about ok & sometimes he wouldn't even grace me with an excuse. On my last day, all I could muster was, "You know what? This hospital pays me crap. How am I supposed to make money on the side if I don't sell blood?" 

How To Tackle "Mindless" Residents

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P.S: Do not question how my drawing skills have improved!

Dear Med Student

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So there I was, minding my own business one day during rounds, when a pack of med students suddenly came up behind us. It's extremely funny to think you were one of them not so long ago, but one can't help but be critical of what they do. Circle of life I suppose. Big fish gets to criticize little fish, make it cry & then eat it.

There were all in their second year, in the first surgical rotation. It was so cute how they didn't know what to do. "Should we talk to the professor? Should we tell the resident to teach us? Should we have a look at the patients while the rounds start? When can we leave? Would they notice we're gone?"

Ah, nostalgia, why're you such a bitch?! Couldn't you make me reminisce without making me feel senile?

Anyhow, these guys walk upto me and ask which cases are worth discussing. I skillfully and effortlessly shot off patients that I knew would be too difficult for them, narrowing down on two cases. Seeing that I had to stay in the wards for the next one hour, I kept wondering if I should try my hand at teaching these noobs. Before I could utter another word, they had disappeared. One thing you have to appreciate about med students is, no matter how large a group they are, they can effortlessly appear and disappear!

So, my bungling batch of eager students, here're my tips on how to have fun, learn along the way & not make an ass out of yourself in the final year exams:

1. Study. I'm gonna sound like an ass, but yeah, you came to med school. You're not an arts student. So, stop asking when's the last day you can afford to start studying for exams!
   
   
2. Ask. It's wonderful what you can extract from your teachers with a simple, "Where? How? Why? What?" If you never ask, you'll never know.
    
3. Stop acting like an ass at rounds. You may not realize this, but the hospital does not revolve around students. You contribute zilch. So, if you're attending rounds, you will be respectful to those who are working and pay attention, or at least not grab our attention
   
   
4. Don't EVER reveal you're a student. A lot of patients in government hospitals already have a mortal fear that they're entrusting their lives at a substandard medical center. And then we have students who keep talking in Hindi & Marathi, asking each other questions, discussing crap, displaying their ineptitude, acting casually with the patient. There is nothing casual about fifteen people discussing your illness while you're lying alone on a bed in a strange place. Act like you know what you're doing even if you have no idea! Be confident, read beforehand, think about questions you'd like to ask and what physical exam you'd like to perform. Don't just show up, read the diagnosis on the chart, and then happily poke and palpate away.
   
   
5. Do not be a critic. You will come across a lot of teachers over time that could do little more to grab your attention; worse, you could meet people who are hell-bent on teaching treatments that you could lift off any TV show depicting a witch-doctor. When you're being taught, you must be grateful. The next time that person is arranging a clinic, ask yourself if you learned anything the last time & decide whether its worth attending. Run around, follow, stalk, bully & pass on death threats to good teachers! Get them to teach you anyhow! Learn from them, emulate them.
   
   
6. Teach. I can't give enough credit to my senior friends who taught me so well over the years. It was their clinical acumen, patience & support that pulled me through the exams. Medicine is all about passing on one's knowledge, whether it's to a colleague or a subordinate. Teach because you want to be taught. Circle of life. 

Inspired By A True Story

Checklists and then some

There've been some omissions on my part. Sue me! 

Find the odds & ends on my Facebook page

Was that you or me?

I've been mulling over whether I should write about this for the past few weeks, simply because it doesn't show my clinical skills in the best light. Some may even say I need to go back to first year and work out my problems.

Since the blog is somewhat anonymous, I thought I'd share anyway. 

So, I've been told I have a nice high volume pulse, and I'm a thin guy. It just so happens there're times during ABGs when I need to concentrate real hard to avoid picking up on my own pulse in my fingertips. So, a couple of weeks ago, I had a couple of polytrauma patients who weren't doing so well. They required daily blood tests, so it had become a routine for me to get blood via the femoral vessels; God forbid I try to extract it from the central lines and mess up the Dopa-drips.

Was just another morning, me with my needle and syringe, hunting for a femoral pulse that I knew is usually feeble seeing how critical the patient is. I was just about to prick him, when an anesthesiologist asked what I was doing. "I need to run some tests". "He's gone. Didn't you know?". I was just left standing there, wondering what needed to be done next; a little befuddled and upset at thinking I'd found the patient's pulse. And when all the thoughts of my stupidity had ceased, the flatline pulse oxymeter, the ominously still functioning ventilator made me feel sorry for the man who'd just passed. 

My obsession with "Anal People"

Worry not, this isn't a rant about how I like to deal with difficult people, I don't! It just hit me yesterday when I was going through my posts from August, that I've been using this label for my posts a lot. So, what's changed?

Have I just become unluckier with my colleagues? Am I an "Anal People" magnet? Do Aliens really exist? Have I grown spiteful & vengeful with time? Who killed Michael Jackson? Is internship turning me miserable?

The answers to these and many more questions will be coming up in future posts. For now, at least, I hope to write a few cheerful posts, get back to those notes I took during surgery & give those ideas some life & of course get back to cartooning. I can't believe I gave up on that mid-way. Maybe it's because I only happen to know how to work Paint on my computer. Photoshop is like a Whipple's to me; I'm eager to try it but don't know shit about it! 

Someone come forward and help poor SS out.

& sorry, but this post will also have to be labelled with... You guessed it!

The Dilution Disparity

So, I've been working under the most difficult head, once again! Is it just me, or am I really turning into a bad superiors magnet? Remember what happened in Pediatrics? Tsk Tsk, a recap: here, here & here. Thinking back about it, those losers inspired my best work. Thank you fuckers, sincerely thanks.

So, there was this one particular day on-call, didn't get a wink of sleep, finished off everyone else's work because people were too busy in surgery or were out sick, skipped breakfast for rounds & am then abused by the head about how this one nonsensical clerical job, that wasn't mine to begin with, wasn't done & that he'd told me the previous morning! 

*Blink *Blink.. Did I hear that right? Am I asleep? Did he really shoot down all that I had managed to do over the past thirty hours because of that?!? This wasn't the end of it, "Things usually get done NO thanks to YOU. When I say something, I expect them to be taken care of before I happen to ask. If you can't even manage such a thing, someone ought to remove you from the hospital!" 

I can't even describe how I felt at that point. It was a sad mixture of desperation, irritation, PMS, aggression & surrender. I had my senior resident gesturing vociferously behind the head's back for me to not say anything further. And not surprisingly, I'm handed another piece of work, that isn't mine to start off with, isn't in any way related to surgery, or medicine, or the hospital! Somehow I manage to get this piece of crap outta my way, only to be shown false concern by the asshole. How selfish can you get?!? 

Spoke to my resident about how crappy all this made made me feel. He could only introduce me to what he calls "The Trickle-Down Effect". Apparently, since an intern is at the bottom of the medical pyramid, all the crap, bullshit, nonsense that anyone generates above him trickles down to him eventually. Sadly, there's noone below him/her to vent out this frustration. Thank fucking god I have a blog!

So, here's my corollary to the Trickle-Down Effect: The Dilution Disparity

No matter how much an intern works, the efforts and accomplishments get progressively diluted until the news reaches the top of the pyramid; so much so, that eventually the head just acknowledges the presence of this sad soul!

What was his name again?

I'm this close (holding index finger and thumb 0.5mm apart) to calling up my nerdy engineering friends & having them calculate the probability of what I'm about to say. My surgical unit has the worst luck with patients, they all have the same freaking names! I mean all of them. You may wonder what difference that may make to me, but it really does. Leads to a bucket load of problems with their paperwork & guess who gets blamed. 

There were two ABCs when I joined and this last night on-call, another one joined in. The worst part, I had no idea about their diagnoses, so I had no idea whose files I kept looking at. Next thing I know, I happen to wander into the female ward & there're two PQRs there too. Haven't ever been so relieved to see someone's discharge card being filled; one less confusion to deal with. 

But this next one just had to take the cake. We have two guys with severe head injuries currently on ventilators in the ICU on adjacent beds. Both were brought in by the police, without any relatives, so were labelled "Unknown" until someone came forth to claim them. Thankfully, a couple of days in, Unknown #1's family showed up and changed his name in the papers to XYZ. And considering the ongoing trend in my unit, not surprisingly, Unknown #2's name also turns out to be XYZ!! 

So, back to square one. "Excuse me, which head injury was this one again?"

Sister or Sistah ?!?

Dear Nurse,

I hope this letter of mine reaches you in the best of health and happiness as the same deserts me here. You may have seen me around the hospital. I'm the friendly guy with the friendly face, with friendly words. I'm usually too harrowed to worry about the blood on my hands, running from pillar to post to get work done on time. I'm also the one who asks with a smile and ends with a "Thanks". Remember me now?

I've worked in this place (and others) for long enough to get a vague understanding of where everyone stands and how things work; everything except for the nurses. You go from being kind and gentle to fire-breathing dragons within seconds. I have to listen to long lectures at the end of which I have no idea what the mistake was. I've been told I speak disrespectfully by people who should be shown the "NO HONKING" signs outside hospitals. I mean, if you had to PMS so often, why join medicine at all? And while I'm at it, I need you to know, I don't run a private practice of my own. Those syringes, needles, blood bulbs, catheters in my pocket aren't brought back home. Neither do I sell them in the black market. I carry crap around in my coat because it saves me time and effort. By far the heaviest thing I've been lugging around is this rude nurse who follows me wherever in the ward, making sure I don't pocket anything that's the hospital's property. I never knew I needed a security guard. Can you please look into what this nice nurse does other than stalk me? 

I know I'm a hindrance to your work, maybe I come in your way at times. But, honestly I don't think I can be that irritating! If I ask for help, it's because I need it and you happened to be around. What about all the times that I helped out and taught those nursing trainees? And what about when you come to me in the clinics asking what this drug does and which resident is good to consult? Let's accept it, you didn't want me to become a doctor. I swear, if I was in media instead, I would've come up with a sizzling hot rap video with all the nurses scantily dressed, teasing doctors, shaking booty and what not! Sing with me "I need you Sistah!"

Melodiously yours,

Rap Master S.S.

Disclaimer: I know I'm gonna get crap about this post, but, once again this isn't me generalizing. Been having a torrid time with a couple of people at work and this is addressed only to them. I've been lucky to have met some great nurses in my rotations, the best at my sister-hospital. I miss them terribly, now more than ever! That being said, that music video idea wasn't half-bad was it?!

Indecision Conundrum

"He's the best of the lot. He sees things others don't or at least things that others ignore & takes the final call." I heard a resident speak of a junior surgeon in my hospital the other day. He also commented on how others are scared of committing themselves to a line of treatment. Fellow interns, how many times have you gone through a file and read, "Dr.ABC has assessed the patient and suggested continuing conservative line of management with review if any change in condition"? It's definitely easier on the surgeon, it's easier on the relatives, but most importantly, quite often it's easier for the disease. 

Every few weeks, each hospital holds a Mortality & Morbidity meeting, to reassess what went wrong with the selected cases for review & offers advice on how to best manage similar situations in the future. I am yet to attend such a meeting, but have been told that every care is taken to be sympathetic to the state of the presenting doctor & avoid such terms as "accuse" and "blame". People die, that's the harsh reality of our profession, it's worse when they die due to human error; and mistakes do occur regularly. The worst errors are those of omission. But, sadly these are seldom discussed at these meetings. Not operating is often the easiest choice that a surgeon makes. This is most true when a problem is often complex and survival considered bleak. His morality rates are kept in check, he goes on perform surgeries where the prognosis is optimistic and everybody goes home happy, including the patient, albeit not for long. 

From what I can see, some of these surgeons ought to grow a pair. If they were so interested in watching from the sidelines, they should've become physicians instead. There's no sense of discovery, no enthusiasm of finding the unknown. What's so great about opening a patient for an appendectomy & finding an inflamed appendix? Nothing! Ever been in a massive surgery where they operated for something else instead? It's magical. You hope for a fruit and find a fruit tree instead; every surgeon's dream, or at least I used to think so. And while I'm at it, people need to stop treating the pancreas like it's the fucking plague. I agree it's insanely difficult, the protocols aren't well-defined & predicting a prognosis is often more difficult than the surgery itself; But, still! I'm sick of hearing people go on about what "should have" been done two, three weeks ago and how how the patient is now inoperable. This rant is dedicated this awesome surgeon who joined us at rounds today. I wish he'd come 10 days earlier, I would've witnessed one awesome surgery!

The Boy Who Cried, "Doctor!"

n a land far far away, but not so different than ours, there lived a young boy. Moving through the streets around his home, he gathered tiresome looks from those who knew him; this boy was not the most popular chap around. Wearing the most smug look, prancing around with his friends he created trouble wherever he went. 

While other boys his age would be considered naughty or hyperactive or be diagnosed his ADHD, "Royal pain in the ass" wouldn't not be on the differential list! He would beat down other kids & act like he was the victim. The minutest of scrapes while playing would be advertised as a life-threatening disorder to the others around him. He craved this attention, loved having his family pamper him, loved the idea of missing school, loved blaming others for his mistakes & loved the idea of getting away with it all!

He would run off to the Doctor for every cough, sneeze or burp. It started with body aches, moved on to migraines, escalated to visual disturbances & toned down to tasting problems. The doctor lent him a patient ear, and tried hard to arrive at a diagnosis. Finally, as the boy walked out of the casualty, he asked his parents if anything was bothering him at home. Met with a curt "No", he made a mental note of all that went on. The next day this boy came with another bout of abdominal pain. The doctor examined the boy thoroughly & after he was sure the boy didn't have any signs of pathology, he wrote down a long list of tests. "There has to be a reason that these pains keep coming back", he said, "We badly need to investigate because it could be systemic seeing his history. This is a necessary evil, but, wouldn't you want to be sure your child is healthy?". His parents could do nothing but nod in unison. That night they questioned the boy, "Are you sure you're ill? These tests are very expensive". The boy could not have his lie exposed so late in the game & rather demanded the tests, foolhardily saying something will surely be revealed. And so the cycle of lengthy, expensive tests began. A few days, pockets full of cash, many tubes in many orifices later, each paper read, "All findings within normal limits".

These papers were shown back to their Doctor who could do little to justify his happiness at being vindicated other than saying, "This is great news, your son is perfectly healthy!" And so the parents finally understood what  was actually wrong with the boy. Over the next year, not another day of school was missed; scrapes were not treated & dressed like battle wounds; & a fever would be deemed a fever only if the thermometer said so! But, this wasn't because of a lack of effort on the boy's part. There were still that many headaches, stomach cramps & flatulence, except that it usually disappeared after an hour at school or if the family so decided to eat out or take a trip.

One fine day, the boy noticed a pain in the right abdomen, radiating to his navel. He promptly brought this to his mother's attention, who brushed it aside like the million other times. The child's abdomen kept swelling, it kept aching, until finally he fell unconscious.  Expect the child wasn't faking anymore.

In Sickness & In Health

I am a good doctor. I give my patients enough time to understand their complaints. When I feel my skills fall short, I readily refer them to a specialist. 

I am a good doctor. I give it my all to counsel my patients when they feel the world & their health is against them. I try hard to to get to the root cause of their complaints; even if it means I must dig myself a hole. 

I am a good doctor. I do not ask why they made a particular mistake; nor do I make them feel guilty about their present state. I am not their mother. I merely help & heal, that is what I am here for. 

I am a good doctor. I wake up at odd hours in the night for any complaint, ranging from life-threatening heart attacks to an itching finger. I do not discriminate against complaints.  I am like Sauron from Lord of the Rings, I see everyone & everything.

I am a good doctor. I do not complain about my workload to my patients, they have enough worries as it is. But when I'm in the middle of a 200+ clinic, without much help, at my wit's end with so many patients, and someone comes in to just say they're feeling "healthy & alright" after their meds... I am not a good doctor. I'd like to refer them to Surgery instead

Sleeping etiquette?

I'm usually quite courteous & polite. I hold open doors, wait for people to finish their sentences & try extremely hard not to slurp my drink when I'm in company. But, for all my collective awesomeness, I can't ever figure out what's proper sleeping etiquette (not what you're thinking, I have that one mastered like an art). You see I'm over half way through my internship. I've done my fair share of night shifts & no matter where I am, who I'm working with, I hate it when 2am comes around! That's usually when the patients stop trickling in, the nurses start to go off to bed & the senior residents decide to run away without telling you, leaving you in despair, in silent need to slit their throats for loading you with the responsibility of any serious cases that may come by; but, I digress.

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Do I go sleep in the on-call room? If so, should I latch the door? Should I change outta my scrubs? There's this nice empty bed next to that patient, would he mind if I slept there? Or would he wake up all startled? Should I go off to bed before my resident? Should I ask him if there's any more work? How long will it take for me to go sneak into the ICU & sleep in there with those comfy beds & awesome airconditioning riddled with multi-antibiotic resistant bugs? Would I ever wake up from the ICU? Would the nurses mind if I hogged one entire end of the table, because for them, I'm almost an alien? Should I just stay awake? If I take off my coat, am I still on-call? Do these idiots even have my number? Could I just drive home right now? Wouldn't that be just perfect? And why God, why, can't You ever have a hot extern work with me during the night?

So many questions... Any answers? Seriously? I'm waiting

HTMKK

Nobody likes a faker! Not one bit! Not in bed, not at the workplace, unless those two happen to coincide. What's the most irritating part of a faker? That they continue to "act out" even when they've been "found out". They will just refuse to give up; talking about a good-for-nothing idiot persevering (wrong place, wrong time)! But, what angers me most is that I can't label my patients - Fakers. It seems someone came up with a cool term - Malingering. So, I'll have to run with that since using outdated terminology is frowned upon in medical circles. Look at what happened to the Ayurvedic doctor who said he was practicing Voodoo! 

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There're a lot of malingering patients I see regularly, we call them "chronic cases", we know their entire past medical history, family history, bowel time-table & even what they had for dinner last night, simply because we see them "chronically", at times more often than I see my family. Their papers read like the what's what in medical symptoms. Not a single organ system is missed, there're always gonna be multiple complaints & usually they come back within a day, "because the meds don't work".

Modern medicine has thrown in everything to try to describe this "condition". They deem it to be a serious disorder that "handicaps" a large section of the population. I, being the young medical marvel that I am, see it for what it is. I don't go around labeling patients, "Systemic Candidiasis Syndrome", "Fibromyalgia", "Chronic Fatigue Syndrome" or some other Voodoo, sorry, ayurvedic crap like that! Sometimes, a pussy is just a pussy! Surprised?

You can't show up in my clinic every other day with tingling & aches & a general feeling of unwell and have the balls to demand a diagnosis. I've run my tests, I've given you a head-to-toe examination, & yet, you have the nerve to question my medical knowledge? I've filled out your entire case history, written out the prescription for body pain & THEN, you remember you've got chest pain? Guess what? Fakers often tend to forget which symptom is to be given top priority, they're not too bright. They heave when they see me, but when they're with the nurses, their breathing normalizes. They come with a BP of 140/90 & say they have "Chronic Low BP". You know what? I should probably just immortalize my name in medical textbooks by creating criteria for a new condition "Pseudo-hypotensive hypertension syndrome". First 100 doctors to make that diagnosis will get a 1000 referrals & a pen from me!

To all these people who have the tolerance level of a fish outta water, watch the next video & Harden The Fuck Up (courtesy of MDOD): 

I have an old friend, extremely laid back & couldn't care less about any damning news you may have to give him. He came up with HTMKK, short for "Haan, to main kya karu?" for whenever someone shares some shitty info he doesn't give a crap about. For those not fluent in Hindi, its literal translation is, "So, what I am supposed to do"; But, when used correctly, it means, "I don't really give a fuck!"

So, don't be surprised to see FSD, HTFU, & HTMKK on your prescription the next time you see your doc

Quick! To the Laboratory, I've got Magic Hands!!

Me: So, how're you feeling today?
Patient: Doc, I've got this irritating cough & nasty high fever which just refuses to go down.
(I feel the patient's forehead & arm, definitely not running a fever)
Patient: (within a second) Seriously, I think it must've just gone down just now
Me: (mentally slapping forehead)

Eons ago, when I hadn't ruptured my internship's metaphorical hymen, I never really bothered with such patients. There was nothing I could do but take what they said at face value & move on. But, as time wore on, I kept noticing a pattern. I was the only person who kept seeing these patients. And according to ALL of them, "My fever JUST subsided".

This kept me awake at nights, wondering what it was that made my patients seem spontaneously healthy in my presence. I asked myself a lot of questions:

• Is my skin insensitive to high temperatures?
• Am I running a temperature, so I can't figure out if someone else is?
• Is there a Higher power at play?
• Am I exuding some sort of magic pheramone that makes people alright?

The first just wasn't possible, I had myself tested. Ditto for the second one too. I even asked God why he was playing tricks with me; I did not get an answer *cough typical cough*. What does that leave then? Magic Hands? Of course, that must be true! Off to the lab, I dare say... Let's take some biopsies, run a battery of tests, hook me up to monitors all day long, draw some blood, urine, stool, saliva, semen even. Run me dry! Bring me a slew of fever patients, let me cure them all. Perhaps I should start to grow a beard, wear a turban & be named "Fever Baba" instead. No wait... that's too primitive! I'll call myself Dr.Paracetamol™ ! I'll even trademark my name! Doesn't that sound like a plan?

What's the other option? Saying my patients are lying, that they're cases of Fibro or FSD? How dare you?!?

The Screenplay: Good Resident, Bad Resident

So, I mentioned I was writing something completely stupid & new in my earlier post. Believe me, it didn't  take two days to write the damn thing, I just wanted to build up suspense. In case you can't see the entirely oh-so-cool retro effect I've given the post with the font, you'll find it here. So, here's my first attempt at writing a screenplay:

Good Resident, Bad Resident

By

Scalpel Sculptor

Inspired by a true story narrated by

Helpless intern

Fade in. Interns, running around in a medical ward. Suddenly, the sound of shattering glass. Everyone moves towards sound. Fat Man at back starts roaring. Audible nonsense becomes less clear with time. The gathered start walking away. Fade out.

Fade in. Canteen. DAY. Interns chatting among themselves over lunch. Pan camera to door, residents move in. Cue stupidly dramatic music. Fat Man waves to interns to come over. Pan camera back to table, zoom in on girl’s eye filling up with anger. Pan camera back to residents’ table.

Interns told they need to do double shifts. Fat Man stops looking at interns. Interns stand still. He waves them goodbye. One of them gestures he would call to another resident [Friendly Resident]. Fat Man sees this through corner of his fat eye. Fade out.

Hospital Ward, evening. Intern on his way to meet Friendly Resident; “Don’t worry, I’ll take care of everything”. Intern breathes sigh of relief, removes his cellphone, dials co-intern’s number. Intern smiling while talking on phone, walking out of ward. Fade out.

Hospital Ward, morning. Interns called again by all residents together. No chairs left for interns to sit. Residents look constipated, interns feel nervous diarrhoea coming on. Camera zooms, shows jaw twitching, pans, shows fists forming. Fat man roars, “There is nothing you can do. Don’t try to go over my head. Eventually I’m the one you deal with. Know the consequences of antagonizing me”. Intern thinks, “Antagonize? Too big a word for fat man to know. He must’ve been told this speech”. He looks over to Friendly Resident. Change camera to Friendly Resident’s vision. He does not look at interns at all. ZOOM OUT. FACE TO BLACK.

Residents’Quarters. Night. Darkness. Glass breaks. Bed rumbles. The light from passing cars’ headlights shines through: shows intern with needle, he has pricked fat man’s head. All the hot air from his head is now leaving him. Gradually inaudible whistling sound fills the room. Another light shines through, Fat Man has now taken form of Friendly Resident. Metallic clink of needle falling on floor. Light shines on horrified intern's face!

CUT TO BLACK.

CREDITS.

END.

Good Resident, Bad Resident

Ever seen an old American movie about cops or even a bad recent one? There's usually a scene where the protagonist is taken into police custody, made to sit alone in a room for ages with the police watching him/her through a one-way mirror. With a loud bang, the door opens and two policemen walk in. One invariably looks better than the other, cause the latter looks like a rabid dog! The decent looking chap starts asking the questions, explaining how it'd be nice if they'd cooperate. Every now and again, the mean cop would shout, scream & finally threaten. The hapless convict feels safer with the decent cop & eventually does what he says, even though that isn't in his best interest. This entire charade is called the "Good Cop, Bad Cop" routine. Neither one of the cops is actually good (at least in the movie), and they pull this off in unison after having discussed how the interrogation should play out. The entire idea revolves around the fact that when you're in a fix, you take whatever help you get, whoever you get it from! Hey, at least it's not the cheesy third degree that you find in Indian movies!

Now imagine this entire scenario with an intern in the midst of a lot of residents. Incredibly bad residents are  generally difficult to find. Those that fall in the gray zone are a dime a dozen! Off late, I've kinda been a magnet for the most ghastly ones. Most of the times, these 'gray' and 'dark black' residents move around in packs, with an obvious pack leader. Now, I could've used a more glamorous metaphor like a "pride" of bad residents (like the lion) or even the modest term "herd", but I was too lazy to google what a group of Hyenas is! But, there's no better comparison out there; hyenas are cunning, generally disliked, move around in groups that seem strong, but the moment one is alone, they're easy to kill! 

You can learn more about hyena behavior here: (And just for fun, let's imagine I'm Mufasa)

What did you expect? The Discovery Channel?

So, it was a few weeks back that I realized one of the residents who I trusted turned out to be this other asshole's personal bitch! Imagine the shock and surprise! Turns out she was nice to us to get us to open up about everything that's going on, only to go squeal on us to her seniors. So, did you get the "Good Cop, Bad Cop" analogy? It's like being conned in your own backyard! 

Imagine how low one needs to be to actually get into an argument about when I could take a holiday because I wasn't feeling well! I'll take it whenever I damn well please, fucker! You've already dictated a lotta crap to me, but you're not gonna dictate my damn biology!

I recently borrowed my friend's copy of The Shawshank Redemption Screenplay. Easy to say I was bored to bits, but it kinda gave me an idea for my next post. You'll know what I'm talking about when you see it.

DISCLAIMER: To my actual friends who are pursuing residency (old ones as well as recent), I sincerely  have great respect for the work you all do & am in no way trying to take a jab at you. But, just like you sometimes come across bad interns, I've come across some bad residents. If you'd like to share bad intern stories (stories about bad interns, not bad stories about interns!), write to me or comment here. I'd love to have you as a guest blogger with the tables turned!

FYI: A group of hyenas is called a cackle!

Social Medicine

We're all currently being carried on along a "social" wave, and recently, I saw this ridiculous TV advert by Vodafone about Facebook, click at your own risk:

Apart from the fact that the ad made me incredibly nauseated, it got me wondering what the hell ever happened to Orkut!

Sure, I was one of the earlier adopters to Facebook, but now I'm wondering how I can get back those hyperbole-studded testimonials that people wrote for me! Yes, I'm THAT self-obsessed!
Eventually, it hit me that I'm 4 social generations old. How?

And three of those generations have come during the lifetime of my medical course. As if it wasn't enough that other people gawk at the length of my degree, now even I've gotten in on the cynical fun!

How many social generations have you passed by? 

I did not need to know that!

What is it about us studying medicine that makes everyone we know want to come up to us and tell us their medical problems? Wait, let me rephrase that! 

'What is it about us studying medicine that makes everyone we know want to come up to us and tell us things we don't ever want to know?!'

It freaks me out!!

Now, as interns, we come across a lot of people everyday, narrating things that they wouldn't want anyone other than their doctors to know. They're usually secretive & hush-hush about things concerning even the upper half of their bodies. God forbid they have to utter words like penis and vagina! But, we're forced to be sensitive to their issues & speak about their problems in the same soft tones, use the same mindless lingo for their genitals & breasts & never ever ask more than 3 questions about their sex lives:

"1. Do you have sex?

2. Have you ever had sex with a prostitute?

3. Any infections?

That will be all. Thank you"

We're quick and discrete during our practice, because every normal human being would be uncomfortable divulging way too much information (I'd rather not get into the details of how our entire social structure is anti-medical history cause noone wants to tell us shit anyways!). So, I have to ask again -  Why are so many people I know coming up to me and asking me these things? Because my logic tells me that they should be embarrassed outta their pants (no pun!). Maybe they're just plain dumb! You can't ask me what the side-effects of a single dose of Fluconazole are without me figuring out you've got fungal vaginitis! Don't show me medicines I do not want to know about & ask me names of diseases that aren't really code words that your doctor invented. Turns out, I know what they mean too! Or even worse, I may know how you got it! I need not know what sort of discharge you've got coming out from which orifice, how your bowel habits have been altered by which medication & please don't ask me if Ayurvedic medication can help you sexually. Give it a shot and let me know. I'm just as curious about those ads in local trains. 

Maybe it's because interns are in this twilight zone, where everyone thinks we're eager to learn, good enough to guide & yet not learned enough to deduce their dirty deeds effectively. Or maybe it's cause I happen to be around & I don't charge a penny. What's the going rate of a half-decent medical intern's consult these days?

To everyone I know: Keep it in your pants, within your head & don't let it outta your mouth. I couldn't care less!

Anonymosity?

If you haven't yet figured out the title of the post, the rest should stump you as well. I started this blog because I felt I would have a lot to share over the course of internship. I love to write, it comes easily; though it's more taxing compared to when I'm just rambling to myself. I wanted others to see the humor in the strangest situations. But, sadly, over the past month or so, I haven't been able to see a lot of the humor myself. Much like the monsoon, it's been a gloomy, dark & wet past month, with all my "worst case scenarios" coming true.

I have this idea about people I deal with professionally, I always like to imagine the "worst case scenario". Basically, if I'm sure that the "horned" one (note how I used 'ed' instead of 'y') cannot make my life more hellish, I do whatever the hell I want. This usually involves me acting like the uncaring intern I can be for dumbass residents, not intent on learning stupid things & refusing to do things that infringe on my human rights. I work more efficiently, such that I don't need to move about too much. I have learned that that the best way to fix a dumb resident is to twiddle your thumbs in plain sight.

But, I haven't yet mentioned how and why I coined the term above.

Anonymous + animosity = ?

C'mon, even my peds patients could solve that one now! So, yeah. While I've found that my last rhyme which had a healthy topping of expletives turned out to be one of my popular posts, I didn't really start the blog to vent my frustrations about a few talented individuals, brilliant suited to making me feel like crap. Maybe, one day when they read my work, they'll realize they've faltered; or maybe they'll just get worse. The best thing is, I won't be around them much longer to find out.

So, ardent readers, it's back to the basics for me. Eagerly looking forward to my next rotation. Write to you soon

Technologically Savaged

Medical Student:

I'm in love with my phone. It does everything I want it to do & then some. I have cool apps like MedScape & Epocrates on it, they help me look up things on the go; I don't have to feel stupid in the clinics anymore. It's got a hardcore camera so I can take a picture of whatever new I come across during rotations. 

I love the browser, I love looking up conditions in Wikipedia. It has all my music so I can unwind & I keep up with the news when I'm on the move. I can't imagine life without it.

Intern:

I have an awesome phone. It does all the things I want it to do, but only when I've taken out the Sim Card. 

I don't really have time to look things up, which is good cause hardly anyone asks me to anymore.

I use MedScape a lot, but only when I'm alone running a peripheral clinic & I'm stumped; I feel like a good ol' fool checking my phone in front of the patient. 

I don't really take any clinical photographs anymore, what's the point? 

My memory is loaded with music I hardly have the energy to listen to anymore. Yes, I need to have some energy to appreciate music, else I'm just hearing noise. 

And yes, I hate that my phone vibrates & rings. I get a pre-ictal aura every time my damn phone rings & I'm sure I get absence seizures when I see its an unknown number, though I can't really recall. Maybe that's the point of absence seizures, remind me to look it up on MedScape. "I should cut the call, who cares? But, then again, maybe I should just let it ring, I'll say it was on vibrate & I didn't feel it through my coat. To hell with it, I might as well pick it up, I'm screwed either ways."

I can't think of what an interns' life must've been like before cellphones became rampant as STDs. Even now when I'm dispatched for a chore, I get called in repeatedly to ask about its progress, why it's going so slow yada yada yada! 

If there was a day to yearn for the simpler times, this is it!

P.S: I hope you liked the typewriter font. The idea hit me and I just kinda ran with it

Not A Nursery Rhyme For Kids

Prequel to this rhyme: What rhymes with blood?

The calendar's page finally turned,

And so the cycle of blood also adjourned.

For children needed much steadier hands,

And for blood, his help they'd never demand.

Little people, he thought, would be easy to handle,

Not realizing he'd be walking into a stupid scandal.

The residents weren't humans, they were wolves, I dare say,

They made him hop, skip and jump through hoops all day.

"How dare he sit by the corner, twiddle his thumbs in full view?

He'll wish he'd never been born, when I'm through."

And so the residents acted like an ass and a witch,

To over-compensate for their obvious gonadal glitch!

"Run here, get that, fetch this useless thing right now, 

and let me plump myself up to be a useless fat cow!"

He craved for the feeling of a syringe back in hand,

And the queue of endless patients, slowly expand. 

"What am I thinking? Didn't I hate blood collection?"
But compared to the present, it seemed like a vacation.
"Ah, those were the days, they taught everyday,
Now, collections seem like a small price to pay"

He looked around the ward & saw others like him,

No spring in their step, faces gloomy & grim.

Mumbling, "This time too will pass", he kept his hopes up,

But these residents wanted to tie a leash around their pup.

The phone kept ringing, with requests not making sense,

He ran their errands at his dignity's expense. 

He dreamed of of a day he could give them the finger,

In that damn ward, not a moment longer he'd linger.

A pity to see such potential turn crass,

How great they'd be, without a fist up their ass!

Poor boy did all that these idiots demanded,

In a sea of blood, he wish he'd been stranded.

"How naive could I be, dismissing my red-handed chores?

That was nothing compared to working under these whores!"

First Impressions?

Ever so often, I come across someone (mostly at work) who I've spoken to for just a few seconds & yet, that's all the time in the world to realize what assholes they are! Its amazing how these people have this vibe, it keeps screaming out, "I'm a dork!", "I'm a douche", "I'm your worst nightmare", "I have insecurity issues", "I'm usually incontinent" !!

Someone needs to tell this people how you can bare your teeth for a grin, not just a growl. They're usually people who believe in 'end of world-this, end of world-that'! Everything is needed STAT! They're rude & generally dislike interns. It's also weird cause these assholes (Yes, I do not have to use weird syntax to hide my abuses on my blog) have never done their internships well. They've usually been cocooned at home, taken cosy externships or paid their way through. They have no right to expect from us what they've never given. Then, there's the other variety who've been tortured through their lives & wish to pass it onto us a part of their general ego hassles & sexual inadequacies.

This is the end of my rant. For those who're reading this blog for the first time still generating their first impressions of it, read the older posts... STAT!

From elbow-deep in a uterus to neck-deep in crap!

My family wants me to become an obstetrician. Bringing life into this world, they say, is the most noble thing a doctor can do. Some of my friends want me to do the same, they're shit scared of going to unknown doctors; the remaining ones say they won't let me ever come within a 100 yards of them! Me? I'd love to take up the science, it's an exciting line. There's a deep appreciation one can gain for the process of childbirth when you're elbow deep in someone's uterus, as I found myself to be on several occasions over the past month.

Yesterday was my last day in my OBGY rotation. I think my eyes should be tearing up right now (cue soft dramatic music), because this past month was an unexpected revelation. I still remember wincing when I got to know who I'm going to be working under, tales of their stern attitude had seeped through already. It seems the past interns in this unit had created quite a ruckus & the next batch would pay for their foolhardiness. The first thing that I was told when I started work, "I hope you interns will not cause us grief like the past batch. Work hard! We're gonna make them pay & if you bother us, we won't treat you any different." Gulp! And so we commenced what was expected to be a long month ahead, treading carefully, not wanting to step on anyone's toes. It took around ten days to realize that we're quite adept at what we we're doing, the junior residents were fun, even the seniors shared a few laughs. There wasn't any sense of terror that we'd anticipated. Instead, everyone just let us be. Scratch that, everyone pushed us to do more!

Every now & again, you'd hear someone shout out at you, asking you to wash up for the next surgery. They went out of their way to make sure our surgical skills were honed. It took them a few days to realize one needs basic skills in the first place to hone them! But, they were patient nonetheless. Eyes glued to the organs laid bare, there'd be a running commentary on what needed to be done next, why it was being done, why in that particular way. It made me wish everyone I'd worked for earlier had taken the same amount of enthusiasm. They need to be eager to teach to deserve an eager intern!

The most surprising aspect of this rotation though, was the women! Their beliefs, attitude & noncompliance were legendary! The humor in it all wasn't lost on any of us:

(Patient refusing a vaginal exam inspite of being 9cms dilated)

Patient: No, no, don't do that, it hurts, I want to go home!

Doc: Woman, how can I check if your baby is alright if you won't let me examine you? Don't you know where babies come from?

Patient: No!

Doc: Look, I beg you to please let me examine you, the baby will suffer otherwise

Patient: But, I'm scared

Doc: (whispers into her ears) You know something? So am I !

Patient: Look here doctor, its hurting too much

Doc: Listen, you're going through childbirth, we've already started your drip. This isn't your first delivery, you ought to know it's gonna hurt a bit.

Patient: It never hurt as much as it does right now! What should I do to make you give me a C-section? Should I get a pooja plate & pray to you?!

(Patient in labour since 12 hours, demanding a C-section, also since 12 hours, by far the loudest female we have in that room. Doc approaches to do a vaginal exam)

Patient: Ooooooh, Aaaaaargh! Doc, remove your hands, it's hurting

Doc: Why're you screaming so much? I haven't even touched you yet!

Patient: Oh, alright, I thought you had!

(The vaginal exam is completed, the patient doesn't squirm or scream)

Doc: Wasn't that bad now, was it?
Patient: But, you haven't even done anything yet.

Doc: Yes, I did. I'm done with the exam

Patient: Ooooooh, Aaaaaargh!

P.S: I almost forgot to explain the second part of my title - I start with my Pediatrics rotation tomorrow!