The First Step : Realisation

I have talked to about 35-40 odd patients in the course of my project. They have all come from various spheres of life. The majority have come from the lower and the middle class. After all, in a tertiary care centre like SGH, this is exactly the kind of patients you get. The experience has been very enriching. I have learnt a lot about the lives of these people.

It is said that Medicine ensures that you remain in contact with your own soul- the soul that understands pain, fear, joy, love, anger, frustration and every other emotion that we have to deal with. The human touch remains. You come to know about the kind of problems that people have to deal with. The Common Man is still common. He still has to face the regular stress and strains of life. The patients who come to Sassoon, have to catch buses early in the morning to get here, have to wait here in line to get their case papers made, have to run around in all directions to go the one place they need to get to. We, doctors, add onto their troubles by not spending enough time with them, acting as if they are not important to us. Aged patients come to get their monthly or weekly medications. Instead of treating them with the respect that is their due, the Residents scream loudly at them because they can’t hear properly. Is it their fault that age has finally got to them? Patients are considered to be our God. We, as doctors, learn from them. We need to behave properly with them. There was a time when patients were given decent care. That has suddenly changed in the past few years. The dearth of doctors at Government institutes and the politics has led to the decline of humanity in this noble field.

Do you know what most of these patients have told me? They have given me their blessings, simply for spending 20 minutes talking to them; for touching them, examining them; for doing small things like measuring their height and weight. They say it feels satisfying that a doctor at least talks to them. Most of the doctors just come, write in their files and go. There is no patient-doctor communication. We are taught about the Doctor-Patient relationship in PSM (we even have a question on it in our examinations). There doesn’t seem to be any relationship in SGH today. I was so surprised the first time I heard a patient say these things to me. When a number of patients told me the same thing thereafter, I realised that there, indeed, is something lacking in today’s students.

In our first clinical posting, we are taught the importance of History-Taking. We are taught the individual importance of the Name of patient, his age, sex, address, occupation, etc. Along with this, we are also told that we need to talk to the patient. Talk, not just about his symptoms, but also about his feelings, his thoughts, his needs…all this to just create a rapport. ‘A patient needs to feel comfortable with his doctor’ is a line repeated a lot of times in that first posting. It is seldom remembered later on. Students become very busy trying to extract the symptoms and signs that they know of, from the patient. He doesn’t remain human anymore. He becomes an object of interest. An object to use when required and throw away when finished.

Today, I met a patient who’s case I had taken about 10 days  back. I had liked her a lot at that time. She was happy, friendly, chatty. It was a delight to examine her. She told me that she had to have an angiography done, for which she would probably be re-admitted. She seemed amused by the fact that her Diabetes had gotten her into the hospital. That was then. Today, she was a whole different person altogether! Her appointment yesterday had been cancelled because none of her relatives had been able to come. She had been told to stay Nil By Mouth today, because the Angiography could take place today. The nurse had told her that if no relative came today, her appointment would have to be cancelled again. She was on the verge of tears, this lady. She wanted to go and get her angiography done all by herself. “What is the need of relatives?”, she asked me exasperatedly. I tried to explain that in case anything happened to her in during the procedure, somebody should be around. “If I die, let them just throw me in a corner! I don’t mind that. I just want to get this done. None of my relatives are coming. I had told them, but nobody has come yet…” and she started crying. It was heart-wrenching. I tried to calm her down by telling her that things would get better….that I’d talk to the people concerned and see what could be done…that she shouldn’t just lose hope. She took my hand and kissed it. That is all that she had needed. She had just needed a little bit of talking. She had needed somebody to just stand there and talk.

I haven’t stopped thinking about the whole case. What are we turning into? We all need a little bit of love and care. It may not be possible to give the best care in SGH. But, it is a hospital for heaven’s sake! The patients here should at least be given the basic care that they all require. It is tough being a Resident, I understand. They have to study, look after patients, keep a tab on the whims and fancies of their guides and manage to get some sleep too. But, I think, as doctors, it should be a part of their case-taking to just spend a few minutes with each patient and ask about their problems. Or just spend a few minutes talking to the patient about random things. That is all.

If there is one thing I have learnt from my experience as a student in Sassoon, it is humanity and consideration for others. I have had a good childhood. I was given everything I asked for. My parents put me into a great school, allowed me to go for parties, took me on holidays and did everything possible to ensure that I have a bright future. Somewhere deep inside, I know they had to take a lot of trouble raising me and my brother. They have managed to rise out of nothing to something. I was always aware of that. Yet, they ensured that I did not have any difficulty in living my life the way I wanted to. But, not all people, in this world, are like me. There are people who grow up in difficult situations and stay in such situations all their lives. There are people for whom a 10 rupee bus ticket is expensive…people who have to fight over water and bathing facilities every morning…people who live on a single meal daily. These people need the same, if not better, treatment than a person like me, if they end up in the hospital. They require that consideration and love that a Doctor is supposed to show. I have learnt to show this consideration. I have learnt that we are supposed to heal the wounds of the patients, and alongside, heal the wounded soul of the patient too. It is our duty to ensure that every patient discharged from under our care, goes home, a better person. It is my duty that when I finish my interaction with a patient, he feels healed mentally. I may not be able to do anything to reduce the pain or other symptoms of the patient. I should, however, be able to make a difference to the mental state of the patient- make him satisfied that he has been examined…assure him that he will get better.

Today, I felt the whole purpose of this field was put in front of me, in the form of those tears. My parents keep talking about patients being thankful to them for saving their lives. I never understood the real meaning of that line. Today, I think I did. I felt the hurt of that patient. I know that if her angiography has been done today, tomorrow, I shall feel the happiness too. I’ll know that she won’t be shedding more tears and will be happier. Isn’t that the ultimate aim of a Doctor? Cure the patient physically, mentally and socially?

Jill, I think you took an important step today…you saw yourself as a doctor who shall look after her patients with proper care. There shall be just a few more steps and you will reach that goal – A Good Doctor :-)

We Are Young

I have become hooked to this song. It really speaks to me right now, at this very moment. I think it is probably because it mirrors the things happening in my life. Feels amazing to scream it out and let some steam out :-)

Holy Crap

As the month of June creeps closer and closer, the nervousness regarding my forthcoming examinations and the frustration over unfinished work is reaching new heights.

I haven’t been in the best of moods. The sudden realization that:

1.       I am very far from my target of 50 cases for the ICMR project.

2.       Residents vary in their desire to help me get on with my project work.

3.       I am very far from finishing my Surgery portion as I wanted to.

4.       I haven’t even started with the other subjects yet.

5.       I am not able to get whole days to myself when I can just study from start to end.

6.       I don’t really remember everything after doing it just once.

7.       College is just a big waste of time.

8.       Journals keep piling up – first to write, then to get the signatures.

Has made me melancholic. I haven’t yet reached the stage where I start thinking negative about my situation. I may be on the way though. I know for a fact that I have been taking about 8-10 cases over the past 3 weeks I think. I should have 30 cases, right? I am stuck at 24 and 25. The imminent arrival of my Guide on 27^th is also making me a little uncomfortable. I have to show him my cases…it will be very disappointing if he points out mistakes. Please, please let him not.

Talking about studies itself is frustrating. The subjects this year were supposed to be interesting. Somehow, my interest in them has vanished. I don’t feel the desire to go on and on with my studying. Instead, I’m just waiting for those little breaks, which eventually span out into larger breaks than they are supposed to be.

Maybe it is the idea of me running around for that project, while seeing my friends study, which is eating me from inside. Maybe it is the idea of me studying that is eating me from inside. In all, final year is testing a lot of me. I also get the feeling that this is just the beginning. There is a lot more to come. We’ll see…I look back to that one week…to those two days when I had totally lost hope…those two days when I had to deal with one shock after another…I got through that. There is no reason why I can’t get through the studying then J

Reflection

I’m not a social person. I have very strict ideas about the kind of parties I like and the kind I don’t. I have my own circle of close friends whom I regularly meet. We talk a LOT and catch up on each other’s lives. There is no drinking involved, no needless gossip, no dressing up…just some good old friends having a good time, laughing and sharing their desires and thoughts.

I met a couple of my school friends day before yesterday for dinner. They are both doing Engineering. One of them has a dual degree with Economics, and the other has a dual degree with Biology. So, practically speaking, each of us is in our own world professionally. They say, don’t they, the grass is always greener on the other side. However, having conversations with them, has made me wonder whether it is really worth it to do what I am doing.

Frankly speaking, the only reason I decided that Medicine was my field was because I sucked at Physics and Mathematics decided to abandon me during the year I needed it the most. By mid-12^th grade, my prophecy from 10^th grade (I want to do Chemical Engineering from IIT Powai) had all but eaten dust. My strength was Chemistry and Biology. I decided to do the practical thing, choose the lesser of the two evils. Instead of forcing myself to succeed in two subjects I sucked at (Physics and Maths), I forced myself to manage just Physics and enjoy Chemistry and Biology. I ended up making the right decision, since I got into BJMC in my first attempt itself, in the first round itself. I could not have asked for more.

Today, however, I wonder whether I have done what I had thought I would do as a medical student or not? I wonder whether it really is worth it to put in as much of effort and pressure as we do. Medicine is a tough choice for a profession. You need to have the push and the desire to give. You need to feel that insane urge to serve people. You need to feel that you just have to make your patients ok. I agree that in the past 3.5 years, I have formed an idea of what I will be doing in the future. I do want to give back to people. I want to make this world a better place. I just wonder why it is so difficult to want to do such things.

Final year is supposed to be crazy. It is crazy. It hasn’t treated me very well either. I am not particularly enjoying it. But, even then, I’m not a sulky sort of person. I love myself and life too much to really sulk about it. The fact that I am sulking about this year, means there is something wrong. Maybe I am taking that project too much to heart. But, even then, the rest of the year isn’t all that great.

I am wondering today whether I really want to get out into the world and treat patients. Do I really want to put myself through all the torture that being a doctor brings with itself? This year will get over. Then there shall be the internship, the PG entrance, the residency, the super-specialisation, the start of my private practice. I’m already tired thinking about it. On the other hand, my friends are excited about their internships and have nothing to really worry about. Work from Monday-Friday…weekends off…a good pay…their life is pretty much set.

I’m just a little disillusioned, I guess, by the working of my college and our lives as medical students. I know I am being extreme in my reaction…but life could be so much better for us, even with all the studying. Lectures, teachers, patients…it all sounds so interesting from an onlooker’s point of view. I wish it were really the case…

Any way, I think I’ll get over this feeling soon…it was pretty refreshing to get out of college life and meet up with my friends. It is such a blessing when your friends are from different fields. You can just lock out all your frustrations and sorrows and have a great time with them. You talk about different things, reminisce about old times…you end up bringing back some spice into your life…and that is all I really need J

A Letter

Dear Mom,

I want to say all this to your face, but the sensitive little coward that I am, I’ll probably just end up crying and not say anything at all. Maybe someday, I will pluck the courage to say all these things standing in front of you.

You are my Hero, Mom. There is a long list of things that I have learnt from you- by just watching you everyday. What has left an impact on me most, is how you fight against all the odds and still mange to emerge victorious.  Life isn’t easy, is it? But, you have managed to make me realize that one can work through this difficult maze and come out to rejoice.

You gave birth to me 21 years ago. I was the first child, so I just hope I didn’t give you much trouble coming out. If I did, I’m really sorry. I don’t remember the first few years of my life, mom, but I know from the stories told, that you were always there. God knows how tough it must have been to study and look after a baby at the same time. You did it though, and looking at myself today, I know you did a great job. I don’t remember what my first words were, or where and when I took my first steps. I do know this, mom, that the day I said, “Aai”, was a momentous one for you, and for me too.

My childhood is scattered with lots of great memories. I particularly remember the time I was seven. I had suddenly gotten into the phase, when I used to miss you in school, and would end up crying a lot. It went to such an extent, that you had to give me a photo of yours. You told me that every time I missed you, I should just look at that photo and you would be there, right next to me. I don’t think I ever told you this, Mom, but looking at that picture made me cry even more.

When I was eight, our class had been punished and we were spanked. You had been there for me at that time. You, along with our class teacher and a few other parents, had protested against this incident. You may not consider it that important, but it left a mark on me.

Throughout my childhood, there were times when you were busy; times when you went away for training. I did not really miss you at those times, simply because I knew you were doing for us, and that when I needed you, you would always be there for me. When you went for that GSE exchange program, I was just nine. I wasn’t in the mental state to express how I felt. Today, I look back and I feel such pride watching you go. You had achieved something truly outstanding, and my chest was bursting with joy and pride that you were MY mom.

Teenage is supposed to give mothers a lot of headache. I think I gave you some headache too. I do hope I didn’t give you too much of headache, though. I think, somewhere, deep inside, I always knew what you were trying to tell me during those conversations we had. I knew what you were telling me was right. I may have disagreed with you on the surface, but I always ended up agreeing with you subconsciously. When I got into Std 12, you decided to take some matters into your hand, and look into my studies for the entrance exams. You know, mom, I’m glad you did.

You might say that I am very logical and clear in the head, but at that time, I wasn’t. I needed somebody to listen to me, and take some decisions for me. You did that, and I really thank you for it all. After that CET examination, I knew maybe I had failed you somewhere. If I had taken efforts, you had taken double those efforts. The end result did not reflect that, and I was a little disappointed on that fateful day (8^th May, 2008). When I told you that getting a score worth BJMC was out of question, I did not like the look on your face. The disappointment was evident. I wish I had done more. The merit list, however, had different plans. That wonderful day, when I got into BJMC (18^th July, 2008), those tears in your eyes- I felt so happy for being able to give you those tears of joy. As a daughter, I believe that my ultimate goal in life is to make you happy. That day, I had fulfilled that goal. I was proud of it. Even today, I am.

You have been my solid support always. You and Dad have always had my back. It is something special, to know that I have such a wonderful mother, waiting for me, urging me to great things.  In fits of anger, you may call yourself a lot of ugly things, but the truth is, you are an awesome mother. You lead by example. There is nothing more special than to see you up on stage, receiving prizes for your achievements. There is nothing more inspiring to see you work against all sorts of odds, to watch you fight against injustice done to you. You are a dynamite, and to see you in the red of your spirit is just incredible.

It hurts to see you upset or in pain, Mom. If there is anything that I can’t stand, it is a tear in your eyes or a wrinkle of tension on your forehead. I want you to be happy and at peace all your life. I’ll do anything to make sure that happens. At times, I feel so helpless when I just have to stand in the background watching you manage your troubles. I want to help you, Mom, and it hurts that I can’t. You have dealt with a lot in your life. Despite that, I hope you have been happy. I just wish, now that I have grown up, I can be that shield that will protect you from any further trouble.

I want you to share your troubles with me, Mom. It always helps when you talk. If you can calm me down, I sure can try to do the same. I’ll do anything I can, to never see you unhappy, to never see a tear. You are precious, Mom. I’m nothing without you. You and Dad are my whole life, and I can’t see you two upset or unhappy about anything.

You are the most wonderful gift God had given me. I love watching you smile, love watching you sing and dance. When you smile, the whole room brightens up. When you calm me down, I know nothing in the world will trouble me. When you give me that Mom’s hug, I become that small child again, who just wants to sit by you forever.

You are the bestest Mom in the Universe. I hope I can be a good daughter to you all my life.
Love you loads, Mom. Thank you for always being there. You are the foundation of my life. There is nothing I can’t do, with you supporting me.

Love you Mom,

Jill

Reality

I just have to write. I have my Paediatrics term end tomorrow, so ideally, I should be studying. However, out of curiosity, I went through my last post and the urge to write erupted through me. The past two-three weeks have been such huge reality checks. I think I have almost hit rock-bottom, but somehow, managed to wriggle out with something to cherish.
I remember writing a month back that my ICMR Selection list was out, and that my project had been selected. I wrote a lot of reasons why I decided I would not do the project. However, a little coaxing from my mother ( she showed the wonderful things I would get if I had this project under my belt.) and I decided that I would do the project. The more-than-just-happy approval from my Guide gave me all the more reason to go ahead with it. Neither of them told me what I was in for, though.
Everyone says the first few days of any project are hard. You are somehow just getting into the rhythm, trying to work out some kind of schedule, arranging and rearranging your work, meeting the concerned people. Lots of things just tend to happen together. You end up hating those first few days. I went through just more than hating them. Being a student at a Government Medical College, I should have realised this a long time back - You can never walk straight in here. You just HAVE to take turns to reach something that can resemble a destination. My Guide told me that doing the Lipid Profiles of patients would be a very easy thing to do. That has ended up being the most dreadful thing to do. It takes quite an effort to coax patients into talking to you. An even bigger effort is required to bring these very people to you the next morning to take the blood samples. Add to that, the fact that Lipid Profiles are NOT done regularly in our hospital, got me freaked out majorly. I now also had to provide the kit to do the test. Still, it was ok. I went to the Diabetic OPD on Day 1 of my project, and managed to take some cases. Next, I had to go and tell the Lab Director that the kit would arrive there soon. When I told him that, he dropped the next bombshell - " I don't have the manpower to do the tests. You'll have to do them yourself. I'll teach you." That was it! I have my term exams coming up in June, and now I have to perform Lipid profile testing of patients!
I am going to take a few words here to talk about my temperament. I'm cool. I get nervous before an exam or a Viva. I just talk to myself at that time, say stuff like, "You're being stupid! You've studied. It is going to go great. Come on, be yourself!", and go back to being cool again. I don't freak out. I don't stop eating or lose sleep or dream of scary scenarios related to anything. I'm just not that kind of a person. I switch on and off pretty easily.
Those two days, I did exactly the opposite of what I've written above. I kept thinking about the project, the time that was going to be wasted, the patients whose blood I would have to take, the ignorance of my Guide for having put me through all this (although the Lipids may have been the reason why the project got selected in the first place), the sadistic happiness that the Director was getting (again, although, he might have been telling me the truth), my term end exams, my univ exams (yes, I went to the extent of planning out my schedule for the repeat year). I stopped eating, I couldn't sleep. I became an insomniac within a day!
Being who I am, I couldn't share this with anybody. My Mom, bless her soul, saw right through me, and gave me a boost up the next morning. The fact that two patients came that day, and I could finally say that I had started my project, made me a little settled.
Since then, however, I've been trying to find the right rhythm. The insomnia has sort of remained. I still get up  at 5 in the morning and manage to study a little. Going to the Diabetic OPD is something I have come to dread. The compliance of patients is 50%, so now, I've decided not to go there at all. I'll just hunt down patients in the wards. That way, the irritating bug (Wednesday Diabetic OPD awaits you. HAHAHA!!!!) that keeps haunting me all through the week, will disappear. I am trying to just divide my day into parts. 8-9:30 am will be dedicated to looking for cases. Thereafter, posting. The afternoon onward will be my study time. Exams are coming up next month, and I need to score. That means I need to study, HARD.
I do panic. There are loads of moments. But, I'm trying to manage. Journals have added to the tension. The to-do list never seems to reduce! My brother (in the 12th grade now) had his entrance exams. My Mom had gotten really nervous. I sat with her throughout the day for company. During that time, I finished writing two journals. The trick is always multi-tasking. I have never been good at it. I've chosen an awful time to learn it, but I can give it a shot, right?
Right now, everything else in on the back burner. I had had the idea of applying to a few universities abroad for some courses after my Univ exams. I've decided to chuck those plans. There is no way I can do everything and succeed in it all. I got past the IDS, that is enough. Now I'm just going to concentrate on my studies and the project. I can't wait for the Surgery posting to begin. I can almost feel the fresh rejuvenation already :-)
Life sucks. A lot. Having to deal with so many people now, I've realised that. It isn't all rosy, this growing up. When you are a medical student in the GMC, the word doesn't even fit into your dictionary of life. I have gotten really low over the past few weeks. There were times, when I thought I should to take some medication to shut out the many thoughts swimming around at Olympic-record time in my head, so that I could concentrate on a single one. But, I got past all that, and am still standing ok. Yeah, I lost weight, and the radiance of my face (according to my Mom). Point is, I got through it. I still dread going to hunt for cases, but I still manage to end up doing it all. I'm far back in my studies, but i know and hope I can do it in time. I'm shit scared and nervous about the next month, but I can still smile and crack jokes right now.
This is reality- not easy, but easy enough to give you a chance to make it so :-)
Best of luck for Paeds, Jill!! Do well :-)      

Love

Have I ever talked about love before? Over the past decade or so, I've made up lots of definitions of 'love'. They were related to different things - food, book, colour, boys, sports, style, song, chords, etc, etc. The one thing that was common in all of them was constancy - the constancy of my feelings for all those things. So I have come to the conclusion that love is what is enduring and unchanging. Feelings that change over time are not "love". Yes, Jill, wonderful discovery!! You've really got out some new information! The path of the whole world is about to change!! (I hope that sounds sarcastic enough:-p)
I'm not going to take names obviously. As a teenager, I had my share of crushes and great loves. Every new crush was supposed to last forever, be that "special someone". It was good while the feeling lasted. Then, one fine day, I would get up in the morning and ask myself what I even saw in that guy!! But, it was during this time that I found I was better at being in love with broader things- like certain food, cricket, tennis, Westlife songs. Yes, I felt that zoom in my stomach every time one of those came into the picture. And it has remained unchanged over a long time.
Day before my Dad and I went for the IPL match between Pune Warriors and Mumbai Indians. Before I start gushing about the whole experience, let me give you a background about my mental state.
I AM CRAZY ABOUT CRICKET! I am obsessed with it. The obsession started in 2003 and has continued till date. I used to just list cricket as my favourite game before that year. I can watch any game of cricket involving any team. I obviously prefer my faourite teams, but I'd still watch a match just for the love of the game. Before I entered Medical school, I knew the names and faces of all the international cricketers, their coaches, the Physios and the Umpires. Since, entering Medical school, I can't boast upto that extent, but hey, I'm pretty much a walking encyclopedia about the current players. I love reading autobiographies of cricketers. My ultimate dream is to go on a cricket-nations tour and visit all the cricket grounds in those countries, reliving my favourite matches in each of those stadiums. As every other fan, I would do anything to talk to my favourite cricketers.

The Subrata Roy Sahara Stadium

Go ahead, call me stupid. But, the game is my release. This and Harry Potter are two things that get my mind off everything else on earth. Oh yes, also a Rafa match. But, I'm drifting away. I love cricket and I love me for loving it.
So, we went to Gahunje, and my first reaction on seeing that field was, "OH MY GOD!! WOOOOOWWWW!!" A circular field, velvety green, surrounded by the stands with no pillars, the grass all fresh and inviting, it was beautiful!! I think the Wanderers or MCG or SCG will obviously be more inviting because of the history attached to them. But the Subrato Roy Stadium was simply stunning!!
The match was good too :-) After all, Pune did bowl well. It was disappointing to see us lose by that one run. But, hey, that's cricket :-) I was excited that I finally got to saw Michael Clarke (especially the dancing Michael Clarke) and Steve Smith for real. I think that really made my day. I realised that my passion for the game and its players and its teams is for real. When I was sitting there, my mind was off everything else. I heard news that would have, at another time, gotten me pissed. There, it made no difference. It felt so refreshing to be in that state of mind.

Dad and Me Cheering Our Team On :-))

Over the past few months, I've been wondering why I seem to drift away from things and not feel passionate or in love about anything. The game made me realise that my thoughts aren't right. I do have the passion. If I'm not feeling passionate about something, I'm just not into it. Its time to throw all that stuff away. As usual, it has been cricket to my rescue again :-)
Come on, man Pune, get back to your winning ways!!
Our Inter-disciplinary Seminar on Hospital-Acquired Infections was held today. It was a success in every way :-) We all spoke well, and since the topic and the way we handled it ( we went infection-wise rather than subject-wise) were different from the usual line, the crowd was kept interested. Over all, it was a great experience. I loved being on stage (as usual :-)). I was very disappointed with some of the teachers sitting right in front and yawning right through our presentations. As teachers, they are not expected to do that. We, students, spend a lot of time and energy creating these presentations and running behind these very teachers asking for their help. In return, we get a lot of attitude and high-handedness. The least they could do, is on the day of the real thing, be mentally and physically present and supportive.
It has been a tiring week. I don't feel all that great about it. But, I have my awesome presentation to look at and World Laughter Day (6th May) coming up, to brighten my mood a little. Come on girl, lets stand straight and face the next week with your head held high!!