Hue and No Cry

I thought that once I started my post-graduation, I'd reel out tales of patients and my fellow surgeons and professors and OT gossip. But the first story to make it to my blog is one that does not concern my specialty.

On our last duty day, it was just going from drizzling to raining outside, and we were having a steady stream of patients. We got a patient with eight months of amenorrhea with pain abdomen, diagnosed with a perforated appendix with peritonitis and requiring immediate surgery. The patient was told about her chance of going into labour during the surgery and gave her informed consent for any eventuality. My seniors who were doing the surgery were ready for an on-table delivery, if needed. We had put a call for an obstetrician, who however hadn't come in time for the surgery and it had to start without her. The appendix was removed and the peritoneal lavage given, flank drains inserted. There were no signs of labour and the patient was shifted to the post-op recovery room. We monitored her vitals regularly and as soon as she gained her senses, she started complaining repeatedly of thirst and pain at the surgery site, and I was just getting a little tired of telling her the importance of staying NBM. She called me again to her side yet another time. And this time she said, 'Something's coming out!' I took a look and what do I find: the baby's head was crowning! Maybe she wasn't aware of it because of the previous anaesthesia, but the labour had advanced fairly fast for a primigravida. Me and my colleague were amazed and terrified at the same time, about having to conduct a delivery after so long. I am not really interested in OBGYN but you can't deny that delivering a new fresh soft fragile baby from a mother's womb into the world is a really happy and thrilling experience, and so long after our internship rotation, we were about to experience that again!
We got our gloves on and alerted our seniors who took over, and waited for the contractions. Only then did we realise that we did not have instruments for an episiotomy in that ward. I rushed to the emergency OT to borrow some instruments from the stern sister in there, and rushed back, to find that the obstetrician had arrived and was delivering the baby and there was no need for an episiotomy after all. With a semi-relieved semi-disappointed heart I got back to the patient's bedside. The baby was a cute pink premature baby boy, and he wasn't crying and had an APGAR of 4/4. We had absolutely no paediatric resuscitation stuff with us, no paediatric cuffs/suckers/masks/ET tubes/IV sets/catheters. Nothing. We tried to resuscitate him with thumb pressure and later the anaesthetist on call gave him oxygen directly from the pipe, trying to maintain a crude form of positive pressure ventilation. It was difficult keeping the baby warm in the cold climate and unregulated ward temperature conditions and he was turning blue. We put a call for a paediatrician and transferred him immediately to them. The lady's family was kept posted meanwhile. And we waited at our posts hoping for the best. After a long long time, we were informed that the baby was doing pretty good, and was going to recover from the respiratory distress. The mom was doing well too. We thanked our respective stars and got back to our routine again. Back to tending to our surgical patients. All in all, it was a happy ending. For our patient and her baby, and for us too. And I emerged from the experience feeling like I had been in an episode of Grey's Anatomy or ER. [Didn't get a House feel though!]
Life's so unpredictable sometimes and such surprises keep it spicy and interesting. They teach us to always be ready and keep us on our toes. And also keep us wanting more. ;)

Fear

Fear of failure is a powerful motivator.

It either makes you give it your Best.
Or
It makes you back down without even trying.

You get to choose which. And you gotta be wise while doing it.
But the question is: which of the two is the wiser choice??
What makes you think it's the first option??
There. Now there's fear of making a decision. And you start all over again.

And of course there's procrastination. In the hope that the solution will present by itself or to put it off till it's absolutely necessary.

Sometimes you have to just break the circle and do it. Abruptly. Firmly.
And you are free.

Till the next fork in the road.

Are you?

I think not! :P

FEELING GOOD!

It's a New Dawn!
It's a New Day!
It's a New Life!
(for me...)
And I'm Feeling Good. ^_^


Feeling Good - Cover by Muse (original by Nina Simone):

My announcement is coming a bit late. But...

Yay!!! I got in.
I'm a few weeks into my post-graduation course in General Surgery. (=Residency)
Woohoo! After a period of uncertainty and some amount of drama, I finally got into one of the places that I had my sights on!!
I feel happy and blessed, more than ever, as I know there are around 80,000 people out there who have taken their chances this year, along with me, but have not been as lucky.
Now it's time to de-rustify my grey matter (from all the caustic MCQ rubbish) and get ready to devour the surgery tomes, put on the gloves and wield the scalpel!

I know there's still a long way to go from here, and I'm very excited about the journey ahead and  the destination.
So, world: HERE I COME!!

[Birds flying high, you know how I feel!! :D ]

I speak Inglish

Blogger wants to know if I write in:
1. English (United Kingdom) or
2. English (United States)

The answer is: Neither.
'Cause, like a true Indian of the 21st century, I speak: 'INGLISH'!

What's Inglish, you say?
You gotta talk to one of us to understand.
It's what we speak. It's how we speak.
I can give you a few examples though:
- We Indians apologize or apologise as we wish. Or not.
- We may think colors but write colours (an old habit as a result of who was taught 'British' English at school, at least for the 90s kids).
- We add suffixes to our sentences ranging from 're' to 'man' to 'naa?' to 'ya' to 'pa' to....okay, you get it!
(Btw, I detest the widely used and variably prolonged 'yaa...aar')
- We add our own little somethings borrowed from our mother-tongues to our English conversations to spice them up.
- Everyone of us has at sometime used a direct translation of a proverb/adage of their 'mother-tongue' and passed it off as English. Also, we do accept similar such usages by our brothers and sisters from the other parts of the country, 'cause India is a socialist and secular country, you know. And we gotta protect our culture and heritage.
- You can identify which part of India someone is from by the way they greet you or scold/abuse you.
- We are very accepting of new words and frequently accommodate them in our vocabulary, without regard to which part of the world they came from originally, as long as they sound good and are catchy. And we use them with full passion. Well, the more cryptic and regal they are, the better.
All of this, not considering the multiple accents across the length and breadth of the country!

So, I've been thinking lately that this discrimination and 'colonisation' of the English language is bigoted and archaic. Just as English had evolved from Latin, I think it takes on a local tang and flavour in every country it is spoken. And every country deserves its own dialect!

So let's forget about the differences and huddle under a solitary 'English'(global) umbrella together, shall we? :)

The Perks.

I finally got around to reading The Perks of Being a Wallflower by Stephen Chbosky.
And it wasn't what I was expecting!

Based on what I had read in a review, I was kinda expecting a hipster novel, because of its cult following, or just another story about a teenager's experiments with love, drugs, etc.

I was surprised to find a sensitive portrayal of a boy who is 'different' from others around him, his struggle to fit in, how he faces everything life throws at him, good and bad, but mostly bad; and especially how he is as accepting of whatever is bad as he is appreciative of the good things.

The book reminded me of The Curious Incident of the Dog in the Night time' by Mark Haddon. (Do read it in case you haven't!) The protagonists in both books are teen-aged boys who are unconventional, have behavioural problems, and are talented in their own particular spheres (mathematics vs writing skills). Although: Christopher in 'The Curious Case..' is probably autistic, while Charlie here might have been suffering from PTSD (Post Traumatic Stress Disorder).

I'm not going to write a synopsis of 'The Perks..'; just going to pen down what impressed me most about the book.

From the beginning, Charlie has a difficult life. He loses his best friend in middle school. He is devastated because he can't understand why his best friend couldn't share his problems with him and had to commit suicide. He goes into high school alone, and is either ignored or bullied by his classmates. He makes friends with a pair of siblings, and is totally devoted to them. When he falls for Sam, one of them, he keeps loving her though he knows she might never love him back.

He is pure and selfless, like a child rather than a teenager, and in some circumstances, he acts mature beyond his years, in matters of love and understanding.

"I'd die for you; but I wouldn't live for you"

He doesn't judge people by their faults. He buys and makes such thoughtful gifts for his family and friends, it shows his untainted love. Even after the truth about his aunt comes out, he still willingly forgives her.

He has his stints with drugs, smoking and sex too. But his outlook towards life and his innocence and honesty permeate every experience he has, making it that much less mundane.

“And I guess I realized at that moment that I really did love her. Because there was nothing to gain, and that didn't matter.”

Charlie's fondness for music and habit of devouring books gives another angle to his character. He has a deep appreciation for 'the people who wrote the songs' and finds himself lost inside the books he reads. His quip that his last book is always his favourite one, I think I can relate to it sometimes.

“And all the books you've read have been read by other people. And all the songs you've loved have been heard by other people. And that girl that's pretty to you is pretty to other people. and that if you looked at these facts when you were happy, you would feel great because you are describing 'unity.”

Overall, I found Charlie's character very fascinating (which you may have realised already!). The other characters in the book too are well written and consistent. The family dynamic is very realistic and also endearing, the take on homosexuality and frustrated love, the chain of abusive relationships in Charlie's parents' families, each character's personal interests and goals in life, and how it affects everything around them, it was all interesting.

There are a lot of sentences/conversations throughout the book, that make you ponder, smile and agree quietly. Here are a few more images I found on Tumbler and Google:

Maybe the happy ending did it for me too. Charlie sticking it out till the end and taking his life into his hands, his friends and family coming together to support him. 'Cause I don't think I could have accepted a wretched fate for Charlie, after everything he had gone through. With Charlie's resilience and kindness, what could have been a frustrating depressing story turns into one of hope and acceptance, optimism and faith.

One paragraph I especially liked:

There's a lot more about the book to talk about,  but I'll leave the rest for you to read and discover.

If you want to share your thoughts on the book/movie, I'd love to hear from you!

What is the opposite of Neat?

Even if you are an Indian, or more specifically, residing in India, there's a fair chance that you haven't heard of NEET. Not unless you are a medico/ aspiring medico/ parent of any of the two or you own a medical college. And even if you have, it's definitely not the whole story.

What the complete story is, no one knows. Least of all, the students whose 'future is at stake'. And in spite of the importance it holds for the future physicians/surgeons of the country, it is extremely under-covered by the media.

Looking back at the recent history of examinations for admission into medical post-graduation courses in India, there has never been a single exam for admissions into all of the colleges/ universities in the country. Most states were admitting students through the All India PG Medical Entrance Examination, while a few states had their own State Board exams, and a few had quotas for admission through both. Added to this, some deemed universities conducted their own admission procedures.

There had been talk of a single all-encompassing exam for admission into all medical colleges through a central counselling procedure for a long time. And it has been implemented last November, by the MCI (Medical Council Of India), with a short notice of two months time. (The AIPGMEE exam is usually conducted in January). That exam was NEET. Four universities have been exempted from NEET. (AIIMS, PGI, JIPMER, NIMHANS).
[The acronym 'NEET' in another context stands for 'Not in Education, Employment or Training' which unfortunately sums up the state of the medicos of the country quite correctly.]

Owing to opposition from various private medical colleges and some universities, who'd lose their 'NRI seats' (which are paid for with staggering amounts of money), and some individuals who were concerned with the unfairness of conducting the exam in this manner, cases were filed in various local courts, which were then transferred to the apex court, the Supreme Court of India. It has been on trial ever since. The court had given interim orders to all the states and universities to conduct their own exams while it pondered over the NEET decision. Results of none of the exams are to be declared till then. And so, the aspirants have been left jobless and resentful all this time, first for having to appear for NEET without adequate preparation, then to appear in all the subsequent exams, and then to wait endlessly for the verdict.

The only difference this year was that we medicos have had to write an extra exam. The term which is supposed to start by May may be delayed, or the PGs might fall behind a few months in their course, if the decision is given after the summer vacation of the Court.
What goes on behind the scenes is known to none. Day after day, the case was listed for trial, but not contested. Later on, the hearing was started, but the arguments never seem to get over. After all it's all of the private colleges against the MCI.

This year, there are around 1 lakh MBBS doctors (100,000) vying for a meagre 14-15,000 seats, including non-clinical specialties. It's anyone's guess that yearly, a lot of medicos are left without a seat and keep re-appearing for the exam the next year. This has also led to emigration of medicos to every country on the map, from USA to Tanzania to Australia and the USSR. The stress for survival is high as it is among medicos. From parents who want their children well settled, to the students' own aspirations to specialise in the area of their choice. There is also the necessity of staying on top of the medical advances that crop up every day. In the present urban and semi-urban Indian society, no one wants to consult an MBBS degree holder, when there are specialists available. This is in direct contrast to the rural areas where even MBBS-qualified doctors are scarce to find.  To clear this disparity, compulsory rural service has been proposed in some states, but without basic infrastructure and a reasonable pay, the objective of this service wouldn't be achieved, even if it were to be implemented.

One element I don't understand is the culling at the point between graduation and specialisation. The system is the same in many other countries. My question is: why should you allow someone to invest so much time, energy and ambition into the study of Medicine, and then throw them into a pit-fire for the survival of the fittest? Wouldn't it be better to limit the number early? Why nurture their souls and then break their spirits?

A lot of medicos start out with positive hopes for their future, but are forced to eventually settle in a specialty they aren't interested in, due to financial reasons, or because they are too tired of the whole process to fight anymore. The ideal solution might be the provision of more number of PG seats and good quality education and opportunities for professional growth. It is a well known fact that 'More doctors are needed for the country' as everyone is fond of saying. So why not increase opportunities for doctors to grow instead of scaring off the coming generations from opting for a career in medicine.

Maybe the problem goes deeper than this, maybe the root of it is the population explosion, the unstable economy, the corruption rooted deep in the system, which we have come to accept as a part of life. I sincerely hope that whatever the reasons are, that the present generations remember all the anguish that they have gone through when in the future, they assume positions of power. I hope that they take righteous and honest decisions, and not succumb to feelings of either revenge or apathy. I hope for better times, brought about by people working courageously for what is right, not just what is good for them or for their clan. I hope that this past year has not embittered my fellow medicos enough to let go of their devotion to medicine and their integrity. I hope we can rise high above all else.