The Pathology(cal) Inflammation

Ok, I'm sleeping in the side room while on-call. It's around 3am & I have this woman shaking my knees vigorously. "Anyplace else, any other woman", I pray half-asleep "Please let this be a part of my dream too". But, my resident doesn't find any of my mumbling funny & says, "Trace this patient's CBC & RFT report... STAT"

I've never liked this term - Stat! The only place it has any real use is in prescriptions or in nurses' orders meaning the meds have to be given immediately. But, this being a country of over-usage & customization, the term is now used as freely as a 14Fr Foley's; people have just stopped thinking. Some of the many improper uses I come across daily: 'Come back from dinner stat', 'Collect this patient's sample stat', 'Make this patient abscond stat', 'Finish reading this stat', 'the Head's coming up in 10 minutes stat' !?!

But I, as I so often do, am digressing. I slap on my shoes, put on my puppy-dog face & move to the lab which is around 300 metres away, but it sure does seem like miles. I look at the on-call technician & plead, beg, implore, beseech & request, then demand I get this report! I hate reports. That tiny piece of paper makes me want to dip into my family's savings & buy myself cell counters that I can carry around. Just imagine, patients queuing up in front of me every morning, bloody arms et al, being given STAT reports (Note the correct usage). And if I'm not tracing reports in the middle of the night, I'm definitely doing it bright and early every morning. But, my Intern Avatar is now 6 months old & I've learnt a few tricks to bypass these depressing situations altogether.

Here's a list of things to do to make sure you never get sent out to trace ever again:

1. Forge a report!
   I know this sounds kinda insane but there're times when you know the result (usually via phone) but can't get your hand on the signed report. Don't be afraid to forge it, there're plenty of desks in these labs with report sheets lying around. Better yet, call the friendly "private" path lab fellow & have him make you one instead.
   
2. Over-diagnose
   Never be afraid to write a 'killer' diagnosis. And it must be absolutely horrendous if you aren't going to go deliver the sample yourself. Here're some of the ones I frequently use:
   HIV induced encephalopathy (?Query) with past h/o STI
   Acute drug-induced Hepatitis (preferably due to ART or AKT)
   DIC
   Acute necrotizing glomerulonephritis with patient to be given Mag.Sulf (100% success rate)
   Incomplete abortion with post-curettage hemorrhage
   Septic peritonitis with hepatic encephalopathy
   ? MDR-TB
   
3. There's a budding actor in all of us:
   I usually start panting as soon as I get to the blood bank or emergency-lab, ask the technician to run the sample. I put on my sternest, most constipated face, and mumble, "Didn't even have time to write up a request form". Thank them profusely and run the hell outta there.
   
4. My newest book's title: "Letters to the the E-lab"
   Dear on-call E-lab technician,
   Kindly send reports of patient xyz in Wd.123 urgently as the patient is already being induced & we need to know the counts before we start blood transfusion. Also, the patient has developed drug toxicity requiring steroids, we could use the LFT, RFT reports as soon as you can process them.
   Thanking you,
   abc
   (Senior Resident under Dr.ABC)

Another useful piece of advice from my recent misadventures; whenever on-call, sleep in the adjacent ward. The residents are usually too lazy to go call you themselves & the cellphone reception in our hospital is horrendous to say the least (God bless broken promises by cellphone operators).

The Lab-coat Equivalence

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Life without Treason

Ever so often I come up with a title or phrase that I really like but have nothing to write about. These are usually vague references, not really translating to anything of significance at first glance. But, just to exercise my neurons, I thought maybe following the reverse path could be fun. Here's my story:

Life without treason

It was just another lazy afternoon in the hospital, patients trickling in just when he was about to get out of his seat. He'd lost track of what the patient kept mumbling, letting his pen jot down what his hand thought significant. The past few weeks had been tougher than he had anticipated, the excitement of medicine overshadowed by the bane of paperwork. But, he thought it was good fortune that he had company around him.

Just as the the day swept past, an over-powering urge to meet his old resident overcame him. As he kept walking towards the opposite wing, he slipped in a pool of blood that another intern had spilled while running from the blood bank. He woke up in the Trauma Center with a bad case of nausea and distorted vision. He didn't realize it was the lack of his glasses till someone shoved them onto his face, one lens obviously missing. He looked down upon his leg, seeing way too may rods sticking out of his leg. "Double vision", he thought, "It had to be double vision, so many damn rods!"

He asked the nurse to get the on-call surgeon so he could thank him, & the intern responsible for the blood spill; another blood spill would obviously make the world seem less unfair. His friends came from all their faculties to inquire about his health. They were obviously blind cause they couldn't see the rods, could't read his file. Still he mustered enough air to mumble, "I'm alright". Over the next few days he got terribly bored. "Hospital ceilings must have TVs installed". He asked the nurse to get a novel that lay at the doctor's table. Its title was, 'Life without Treason'

The End

"What's a libido?"

Patients have this uncanny ability to come up and surprise you. Sure, you need to go through hundreds before you can garner enough tales worthy of a blog, but this next one takes the cake. You'll find these people when you least expect them, when your brain is at its dormant best, figuratively twiddling its olfactory lobes & definitely not in a state to process what's about to present itself.

I was sitting peacefully in my OBGY clinic yesterday when a tame looking 45 year old woman was brought by her husband. It was almost lunchtime & this hubby had a look of serious concern on his face that made my heart sink; I was expecting a long history. So, he starts off & then suddenly trails, feeling uncomfortable discussing his wife's *cough*cough* reproductive prowess. My resident came by and sat herself down, telling him that he needn't be embarrassed. For my younger friends out there studying medicine, I'd rather describe the complaints in usual 'case format':

Patient, ABCD, 45 year old married female, G3P3L3A0, living in Mumbai, hailing from XYZ, was brought by her husband, who is also her informant, with chief complaints of:

• Excessive libido since 6 months
• Unusual need to experiment in bed, especially positions
• Insatiable urge to seek sexual satisfaction with other men in absence of husband
• Severe exhaustion & dehydration of husband intermittently

Patient claims, "There's nothing bothering me, it's my husband who's worrying too much". 

Husband claims psychological distress at seeing her with strange men when he comes home. 

There's no past history of heart disease (Thank God!), hypertension, diabetes, TB, asthma, psychiatric illness or surgeries

Diagnosis: Refer to psychiatry

If Rajnikanth was an Intern

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1. Rajni would never be late for rounds, rounds would be too early for Rajni
2. Rajni would not answer to residents, it would be the other way around, "Why the hell haven't you sent this bloodwork yet?"
3. Rajni would stand at one end of the ward & throw syringes like darts for blood collection
4. Rajni will never say, "Sorry, I forgot". He says, "You should have reminded me, mind it!"
5. One of Rajni's patients got a needle prick with Rajni's blood. That patient got cured of HIV
6. Rajni does not need to wash up, his skin secretes Amikacin
7. Rajni would never 'not find' a vein!
8. Rajnikanth's Arterial Blood Gas sample would never turn out to be Venous
9. Nurses would actually listen to Rajni
10. We would not get a single admission when he is on-call
11. Rajni once got in a fight with the e-Lab technician. Now, that technician is an MD Path cause he's scared of fucking up again
12. Rajni never needs lead suits during X-rays
13. Rajni does not trace reports, reports trace him
14. Rajni will finish residency before he finishes internship
15. Rajni signs the attendance muster for HODs
16. Rajni can declare an OPD holiday
17. Rajni gets urine output even he has inserted a Foley's into the cervix
18. Rajni can make the PSM Dept admit their mistake
19. Rajni will get attendance for interns' strike
20. Rajni does not need to count pills in Periphery. How many ever pills fit into his hand is the right number
21. Rajni never has to wait for the lift in the hospital
22. Rajni can put an IV in the Dorsal Vein
23. When Rajnikanth doesn't want to be disturbed, he switches off the residents' phones
24. Rajnikanth can cross-match blood looking at its colour
25. Rajnikanth can get a CBC done from a Plain Bulb
26. Rajnikanth knows who Peter Roberts is

You can't always get what you want

I've been meaning to share this since over a month. But, somehow I kept trying to come up with some deep philosophical way of penning it down. Thought this post should move the readers, make them think, ponder, introspect, want to buy me things. But, eventually I just couldn't come up with a concrete way to write this; so, I'm gonna wing it!

You can't always get what you want is one of the classics by The Rolling Stones, a band that I always knew of, but didn't really follow until I heard this song. I first heard it on a TV show, a slightly out-of-sync cover by an upcoming musician. His vocals aside, the songs struck a cord with me (excuse the pun). Eventually, I got myself the CD, the song found its way to my regular playlists & even now, I'm so enamored by it, I want the song to be played at my funeral. Sorry to sound utterly morbid, but I'm quite serious about it. When I do pass on, I'd rather have this song playing that I have chosen rather than some random stuff that's supposed to put my soul to peace. Something that I practiced and advocated should obviously occupy a central place on such a momentous day. Plus, I always find it easier to celebrate someone's life than mourn their passing. But, I digress. 

The song weaves together so many emotions & experiences; and the second line, 'But you may find that if you try sometimes, you get what you need' sums it all for me. You need to keep pushing, persevering without worrying too much about the outcome. Strive to do well, not just to check another thing off your list. 

I want an easier internship, I need my signatures, I'm gonna get a shitload of work tomorrow morning. 

Can anyone come up with a more profound analogy? 

<Lyrics can be found here>

New foray into cartooning: Perspective

Before I get any crap from my Psych buddies, there's a disclaimer: My views & opinions are based on my experiences during my clinical rotations. They derive inspiration from only specific events & people. I do not generalize or imply that an entire medical specialty may be a particular way. Obviously, I have learnt that that you don't have to be a certain 'kind' of doctor to be anal!

Could've been narrated in a "Psych" ward

People have been telling me since I was very small that I am crazy. I always ask, "How can I be crazy? I always listen to what I have to say and it always makes sense." But these people around me, I tell you, they're all much older than me, so I have to listen. I keep getting these urges. No, no, nothing like you are thinking. I feel like the entire world is this huge stage & I must perform. It's strange that I can hear cheers and applause when I'm alone. People around me are so boring, I think I bring excitement to them. Children I think are nicer, they always laugh & dance like I do. But, one day, while I was dancing, I don't know what happened, but my neighbor's daughter started bleeding. All I remember is shouting & screaming.

I woke up in this strange little hall with so many white beds & so many people in white, I thought I'd died and gone to heaven. But these people were all so ugly, I thought they can't be angels! Turns out I was in a hospital. My mother kept telling this lady with white coat, high pants & tight ponytail that I had been "like this only" since childhood. My parents had brought me to a mad persons' hospital. I asked them, "How can I be mad? Wouldn't I know it if i was?" But, they don't ever listen to me. So, I keep sitting in this room, watching these white coats move around. Sometimes, they move so fast, they leave a streak of white light behind them, full time at full speed. I think they keep running in circles. After all, how many places could they have to go? 

But, not all of them keep running. There are these few people who keep coming every morning & speak to me, asking me how I'm doing & how my mind is feeling. These people are so sweet to me. I just wish they were like that with everyone. There are these small white coats that also come that move as fast as light, I think the big coats pick on these little coats. They keep scolding and telling this and that. The small coats just keep running. Big coats tell them to bring food & write things. These poor small coats keep on listening. I think they need to dance like me to remove anger. How much can one person run? Even I used to get tired with all my dancing. But, these small coats, they run on air. Every time big coats need something, they shout out. The small coat will leave his book & come running (what a surprise!), then big coat will tell him he needs a long tube. If they need this pipe everyday, why they don't have one themselves? One day it is tube, another day it is paper. I think big coats need to run more for themselves. Maybe small coats can teach them how some day.

I think these big coats are very forgetful. They keep looking at their watch every morning. Why they keep forgetting the time? Then sometimes they shout at small coat & point at clock. The small one runs around for 10 minutes, then he just sits. Sometimes small coats are girls, they are even smaller. They keep reading big fat book, I wonder if it teaches them how to run even faster. Some days when small coats don't come, the big coat comes with a needle to take my blood. It really hurts those days. Why they don't take time & do slowly like small coats? Then, they come again with another needle on SAME day. I ask one small coat one day how much blood I have left. She just laughed & said I should not worry. How I cannot worry I ask, they never put blood in, just keep removing. This girl sleeping on the other side says these white coats are vampires & they drink our blood. I just laugh at her, because they would've bitten us directly naa? But, then again, perhaps the big coats are...

Never give up on "Strange"

Dr. Linda Freeman: Anything bothering you lately?

Charlie Harper: Well, there is this one thing, but I don't know if it's medical or psychological.
Dr. Linda Freeman: Tell me.
Charlie Harper: Lately, I've passed up a couple of opportunities to get some strange.
Dr. Linda Freeman: *Strange*?
Charlie Harper: Oh... Women with whom I have not previously been acquainted.
Dr. Linda Freeman: Oh, right, strange. Charming.

For those of you who aren't familiar with the characters, they're from Two And A Half Men. (For those who are even geekier, its Season 6 Episode 15)

I've shared this for two reasons. One, I find it incredibly funny how the character objectifies women. Two, I like "strange" too. Don't get me wrong, I'm not really referring to women here, but, I'm always one to try out new things. As a kid, I once came across this poster which read, "Between two evils, pick one you haven't tried before". Once again, I apologize for the poor choice of examples to convey my point. Apparently, Google couldn't help me find alternatives without sex and alcohol involved. 

Give yourself the "Strange" treatment! 

Enter a restaurant and instead of going through the menu, ask the attendant to get you what he feels is good. Don't fuss over the type of sauce, side-dishes etc. Try out something new for a change, what's the worst that can happen? I'm yet to ever order a drink based on what's written under its name. If the description was important, it wouldn't be in such a small font, would it? 

When out in a lounge, bar or just waiting for a table in a restaurant, strike up a conversation with the girl opposite you. No, you don't need to blast off on a romantic tangent, just talk. You'd be surprised how interesting the opposite sex seems when you take sex out of the picture. Wait, scratch that! 

Ask your friends to pick something to do & don't bother resisting their choice. I recently went to see Vagina Monologues, with a group of 5 women nonetheless (slaps forehead) & left after an hour of intense laughter. 

Something you should know about the "Strange" Treatment, it's especially good if you're lethargic. There's nothing I hate more than having to plan, co-ordinate & arrange for 'days out'. Strange does all the work for you & things work out most of the time. Though I strongly suggest those with a neo-Nazi, ultra-authoritative personality to stay away. You're one kind of strange I'd pass up on any day! Strange isn't about losing control, its about giving it up peacefully.

Cheers to another strange weekend