The Ideal Co-Intern

Now, I'm not one of them hippocrates who passes judgments on residents while leaving my colleagues alone. The Ideal Co-Intern is, in a lot of ways, more important than The Cool Resident. You share responsibilities instead of having them dumped onto you like a car parked underneath an aviary. You go through the same grueling routine, have the same rights, the same work timings. For that month of rotation, you're like Siamese twins, except with fewer awkward bathroom moments (Can't elaborate, you need to have been there, or maybe you'd rather not!). 

T'was two years back with a senior friend when the concept of the Ideal Co-Intern (ICI from now) took shape. He explained how it's not always beneficial to have a friend working with you during internship as the relationship sours over time, neither is it easy to have a total stranger who you don't have any pull on. He explained that delegation of duties is as important as showing up at all; and that you can't really survive without good people around. Here're the qualities of an ICI:

1. The ICI shows up, preferably on time, all the time. You two should have the SAME work timings, unless of course you're taking turns while on-call. 
2. The ICI gives two days prior notice for remaining absent, even if it's for an acute medical emergency. 48 hours are a bare minimum to finish crying and cribbing about the work you'll have to do alone. 
3. The ICI never tells the residents you haven't shown up. "He's off tracing histo-path reports", or the classic "The professor gave him some personal work" never gets old
4. The ICI let's you alternate shifts with that hot new extern who you've been meaning to talk to since before you knew her.
5. If you're surgically inclined, the ICI agrees to take care of the world outside while you're scrubbed in. 
6. The ICI always has backup lists of everything, so if you lose yours, no harm, no foul
7. The ICI shows up when it's not his turn, even when he has a hangover, because he knows you HAVE to show up hungover yourself. Wasn't that sweet?
8. The ICI does not entertain friends, relatives, strangers during on-call days. It's not cool to go visit your uncle, aunt, father, niece, fiance and spend ages in the cafeteria while your co-intern is slogging it out
9. The ICI never forgets to make it clear to the residents that you live extremely far away & that it you must cross mountain ranges, rivers and landslides to get to work on time
10. The ICI always calls at dinner time to make sure you've eaten
11. The ICI always has that elusive EDTA bulb when you need one
12. While on that point: the ICI is a thief! Their bag is littered with an awesome collection of syringes, needles, varied catheters, urosac bags, central lines, micropore tapes, labels & a phone charger! The ICI doesn't mind you raiding his/her bag ever so often
13. If you're romantically involved, you share those all-too-corny cinematic moments when one of you has only syringes and the other, needles
14. The ICI always starts work in the morning without waiting for you to show up
15. The ICI is always courteous and offers you the chance to doze off first while on-call
16. The ICI is NOT a sexist prick! Cause all women are more than capable of performing their internship duties with flair, and men shouldn't have problems getting basic work done by the ancillary staff just because they don't have the right type of 'pair'

P.S: I know the difference between Hippocrates & hypocrite. Do you? Or did you miss that altogether? Good job either way

Who kidnapped good 'ol Humour?

It may come as a surprise to many, but I was once a child. In my early formative years, I made friends with a chap called Humour. Humour was always there to protect me from bullies, unfair critique, and even some relationship issues I'd got myself into. Humour made me believe that as long as I had him by my side, nothing could go wrong; or at least if it did, it didn't seem so bad. Humour didn't ask for much in return, except to humour him when he was friends with other people. Humour explained, being able to take stick well is just as important as being able to dole it out with class. Sadly, it seems Humour didn't make too many friends over time. I pray to the mighty Bearded One each night that others discover my friend as I did, open their hearts to his awesomeness. 

Why am I ranting about personified abstract ideas? Well, because there's way too much "Real" out in the real world. It seems that somewhere between illustrating the Kama Sutra and humming along to Kolaveri Di, we Indians lost our sense of humour! Here's what you need to know:

• Top Gear, one of my favorite shows of all time is lambasted for making a documentary about a road trip across our great country which showed us as quirky, eccentric people in the lightest vein without being judgmental; but importantly, they were honest about it unlike a certain movie which the world lapped up. I'm pretty sure the presenters and producers steered  clear of the usual Indian stereotypes, creating new ones along the way. I thought the show was amazing, but hey, I'm friends with Humour. What do I know? More info here
• Jay Leno recently cracked a joke about Mitt Romney's wealth by showing a picture of the Golden Temple, saying it was Romney's summer home. Where he insulted the Indian community, I have no idea, but people aren't having any more of it, I tell you! Read this. Was it racist? No. Was it derogatory to a holy shrine? In my view, derogatory is a very strong term. The joke may not be in good taste, but is definitely not derogatory. I'm not trying to start a war here, but this doesn't even come close to the sort of insult and 'derogation' that other deities have faced in the past. One wrong doesn't justify another or make it bearable. But, one really has to look at it from the writer's point of view. Type in "Golden" in Google Images and and the first picture resembling a building is that of the Golden Temple. More than anything, the joke reflects the writer's ignorance. 

We're the land of a thousand cultures, a billion people from a million backgrounds, and yet we lack a single funny bone. Hey, it's a free world. People have the right to crack jokes and people have the right to be offended & lodge protests. But, I equally have the right to brush aside those protests because they seem to be stemming from what I can only imagine is a 10 year old cranky child quite pissed cause he dropped his ice-cream. Grow up for God's sake! 

There's this line in The Inscrutable Americans, "We Indians are extremely arrogant, without much to be arrogant about". I can only imagine how these borderline-hardliner protests make us look to the international community. I know the BBC refused to apologize for TopGear and I can't really see Leno doing anything else. Where does that leave the Indian High Commission in both these matters? Yes, looking like a child whose ice-cream just fell to the floor! 

Of Growing Up

You're all 'growed up' in medicine when:

• You enter the college library and can't recognize a single face
• You head to the cafeteria and can call out any attendant/waiter by first name
• Its worse when they know the order before you say a word
• You head to the common rooms and see the young 'uns completing their journals. You peek in to find you don't recognize any of the crap they've written or horribly drawn
• You have your own "Tab" in the canteens
• You know all the makeout spots in college. Been there, done that
• You know all the residents walking past and their food habits; "He's a strict vegetarian", "She's a heavy drinker", "He starves himself to make himself more attractive to that Dermat resident", "She never pays for the food bill!"
• The people you so sheepishly ragged when you turned into a 'super' senior ask you for advice on tackling first years
• You rub your face so often while brooding that your hands get beard-burn
• Your friends are categorized into: Still in college, passing out, passed out
• You have an utter dislike for all things un-medicine. Blood feuds with MBAs & engineers are not infrequent
• You can shoot down at least half the exam questions that're asked by juniors to leave only the bare essentials 
• Worse, you're called in to supervise their exams
• You use phrases like "Back then when...", "End of an era", "Time flies", & "Which rat bastard stole my steth this time?!?" 
• You begin to believe in the power of multi-vitamins in curing everything from fibromyalgia to pancreatic cancer

The Cool Resident

Woah! I think it's been ages since I last blogged. Partially cause I was out holidaying for New Year's and then I was detoxing from New Year's. Anyhow, I still had my awesome phone on me where I jotted down all the other itsy-bitsy ideas that I wanted to write about. So, if you were taken aback by my December Delirium, January, or what's left of it, should be a good ride.

"The cool resident" was born when I was interning in Internal Medicine. My first and third year residents were extremely likable, efficient, friendly, & respectful, while the second year was none of the above. As usual, I was spending the on-call evening with friends (sadly also on-call) in the canteen, sipping tea, discussing resident horror stories where we just labelled our senior colleagues as cool or idiotic. What better judge of residents could there be than a bunch of nosy fresh interns, right? Anyway, the concept of the cool resident evolved over time and rotations and here's what we've come down to:

1. The Cool Resident realizes that blood collection, hematology, histopathology is a part of a resident's job description and the intern is merely helping them out, NOT the other way around. He/she promptly starts work in the morning without ringing the interns if they're late, thinking that their oh-so-sexy-morning-voice is enough motivation to be on time for the "morning chores"
2. The Cool Resident  takes full responsibility for errors on the interns' behalf. Vicarious Responsibility is a reality, not a theory! 
3. The Cool Resident gives full credit to the intern for any clinical cues picked up. I hated my senior resident who told the professor he'd diagnosed a patient with Cheyne-stokes when it was I who had pointed it out! (angry fists flying!)
4. The Cool Resident never allows the intern to pick up the bill. I know this is kinda silly, but hey, I'm yet to meet a resident I like who left the food bill to me
5. The Cool Resident  chooses to order the awesomest chicken tikkas and ice-creams when on-call & makes sure the intern eats with the residents in spite of the workload at the time
6. The Cool Resident protects the interns from the nurses and the ancillary staff
7. The Cool Resident preferably plays a musical instrument or sings, even if its terrible. I can't tell you how the sound of crappy old Hindi songs just lifts you up after a night on-call
8. The Cool Resident has a tattoo. I'm just partial to them, period.
9. The Cool Resident allows the interns to perform procedures and offers full guidance during the same. Conversely, after enough practice, he/she lets the intern loose on patients.
10. The Cool Resident trusts the interns' clinical judgement when no resident is around
11. The Cool Resident takes the interns out drinking, because they did a good job
12. The Cool Resident rings up the interns months after their rotations have ended to bitch about their current interns. Its fun getting nostalgic together
13. The Cool Resident speaks to the interns with respect and realizes they wouldn't be where they are today without a solid foundation. They offer the same to their interns.
14. The Cool Resident protects the interns from the professors, associate professors and lecturers, and fights for the interns' rights as stated above
15. The Cool Resident offers to teach every step of the way, even if it means making the intern sweat for the carrot. Give & take. 
16. The Cool Resident makes you go, "Sigh, when I'm all grown up, I'll be just like him"

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?"