The Break

Did I take a break? Not really. So, after the exams, I had to complete and send my research project to the ICMR, clean up my room, clean up  the house, get some decent sleep, just get away from studying for a few days. Unfortunately, that did not exactly happen. I couldn't do everything and when time came to get away to Mahabaleshwar for the weekend, I had spent an entire night trying to get my project done and was carrying all my work with me.
It is such a pain the ass to do something like that. I haven't been to Mahabaleshwar in a decade. I was really excited about roaming around there. Having the incomplete project hovering about in my thoughts did help much. Mahabaleshwar was wonderful....cool, windy and very friendly. On Saturday, we enjoyed our hotel completely. We were staying at Evershine Keys. Nice hotel :-) lovely food :-) Yesterday, we visited all the "Points" in Mahabaleshwar. My favourite had to be Kate's Point. It overlooked a river...the water was crystal blue, and it reminded of the Pacific Ocean for some reason. The scenery all over Mahabaleshwar is so pretty!! I simply love to places like that, so I've been one happy person over the weekend. Knowing that I have to start studying from today males me cringe, especially after reliving all those wonderful memories of the weekend.
The market in Mahabaleshwar was so inviting!! There were shops after shops of footwear of all kinds, purses, handbags, hats, artificial jewellery and the pride of Mahabaleshwar - Strawberry with Cream :-)) Mom and I went crazy with all that footwear...we bought so many!! Over all, I had a wonderful time.
What makes me relaxed even more today, is that I managed to finish writing my report yesterday night and sent to the ICMR. I was worried that there may be a lotof load on the site (after all, today is the last day of submission). But, sending a report at 2 am in the morning always eases the load a little :-p
My experince with this project has been enriching. It wasn't enjoyable. I remember that initial period. It was all new, the hunting for patients, talking to them, convincing them to take the required tests, interactions with the lab personnel, getting the statistics done, getting my ethics certificate...and the most difficult of the lot, trying to get my Guide to talk to me for a few minutes. Getting into the groove and setting a time table that I could follow was a task. Juggling my studies, exams with the time that went into this was an even bigger ask. I've already given up hope that I'll match my own standards of the last two years. I just want to do well enough to be proud of myself and this year...
Lets see how everything pans out. I hope they accept my report. The four months have been tough and I don't want any more trouble related to this project. Best of luck to me for the next one month :-)

FREAKS

My wish for a smooth journey regarding the Ethics Committee certificate has been anything but heard. This journey actually has put into perspective every single notion I had about "for every good that happens, there is equal amount of bad". Because here, there has been bad, worse and worst.
As you already know, it started 3 days before my exams. I had to present my topic in front of an Ethics Committee, and they had a lot to say about it. Particularly, it was on gentleman from PSM, whom I took an instant dislike to. He wanted newly diagnosed cases. He felt there was nothing that could come out my project. Yet another gentleman wanted me to decide the severity of the disease using Glycosylated haemoglobin. I had enough trouble getting a simple Lipid Profile done. Where could I manage the Glycosylated Haemoglobin? Another issue was that I had already taken my cases. And I was NOT going to take new ones. A nagging thought during all this process was, "Why have they asked me to present my project any way? They never do it for the ICMR!" At that time I decided that I'd just listen to whatever they said and go back and study.
Part 2 of this saga began on Friday (30th June) when I was told that I needed to make the changes or I wouldn't get the certificate. I talked to a teacher on the Committee, told her that my project had been selected as it was, and I had already done most of the work. She told me to meet the HoD (although I wasn't aware that this guy had become the HoD. The previous HoD had been transferred which I did not know). This new HoD was on Medical Leave. I decided to go and try on Tuesday. When I found out that even on Tuesday, he was still on Medical Leave, I decided to go and let my Guide know what all had happened. He told me to give him a copy of my proposal and told me he'd talk to the concerned people and let me know. I felt that things would get into motion now.
Part 3 of the saga occurred today. I got a call from the Pharmac Department office. On going there, I was told that I had been asked to call the new HoD. The lady told me that he and my Guide had talked to each other, and now I was supposed to talk to him. When I did talk to him, I was shocked and shattered. With anger, frustration, depression and unhappiness. He had the following things to say:
1. Why did you present your topic if it was an ICMR one?
Sir, I was told by the lady in your office that I had to. I told her that I hadn't heard of this happening to anybody before. She told me she had been told to ask me to, and she was just passing on the message.
2. You should've objected then.
How could I, Sir? You are all Professors. I thought the whole Committee had looked into my project and decided that I needed to present it. How I refuse or even object to it? Wouldn't that have been rude?
3. You have already started your work, it seems.
Yes Sir, I got a Provisional Certificate before. So I started.
4. You got a certificate before the meeting? That is not right. It is illegal to get a certificate before the meeting gets through.
Sir, I had missed the previous date of your meeting. So I asked my Guide and even in the office here, and they said I could get such a certificate. And the previous HoD went through my proposal and then issued a certificate.
5. How can one person issue such a certificate on behalf of the whole committee without even talking to them?
I do not know that, Sir. Since he said that there was no problem with getting such a certificate, I started with the work as soon as I got it.
He laughs...."This is not right. I don't understand what lengths you people go to. Look I don't have a problem with your project, but Dr. R--- does. I just don't like that provisional certificate."
What should I do then, Sir? What should I do with the project and my cases?
He laughs again...I'll talk to your Guide and let you know.

I just can't understand how unlucky this project is. Every single step that I've taken has been wrought with trouble and complications. It is so amazing that a person like me can get involved in so many issues. This HoD knows my parents, has taught them in fact. In my second year, I went to him to get some advice on how to study for the PG Entrance exams....at that time he talked as if I had already started classes with him. I didn't go back again. Is that why he's creating these problems? Did I hurt his ego? And seriously, if the previous Head gave me a certificate, big deal!! Why can't he just not let this newfound 'I'm-the HoD' ego not create problems for students? And for heavens sake, the ICMR selected this project. The INDIAN COUNCIL OF MEDICAL RESEARCH. A body that controls and encourages research from all over the COUNTRY. If they did not have a problem, what problem do these people have? May be this HoD was right. I shouldn't have presented my project only. I'd have invited their anger at the beginning only and not had to go through all this drama.
FREAKS. All of them. FREAKS. 

Finish at the Start

The terminals got over. Four days of disaster. And weeks of disaster before that. After things get done, I can't believe that I actually went through it all when I look back.
A week back, I was telling myself, "One week from now and you shall be done!! You'll then be able to let the demons of exam stress rest a bit." Then the realisation that time doesn't go at lightning speed dawned on me. I knew I had to get through the whole week, being aware of each and every moment and what I did at each single time. The whole process has been exhausting. This should seem unfair because last year, at this time of the year, we were taking exams in Medicine, Surgery, Obs-Gynae, Paediatrics, Ophthalmology, ENT and PSM with practicals in 4 of those subjects. That was supposed to be the exhausting one. It lasted two whole weeks and seemed like a lifetime. At the end of it, I was happy that I got through it, almost unhurt :-)
This year, however, these 4 days have been torturous. Since the time May dawned, I have realised that I do take stress. And that eats into my sleep. Big time. I may go to sleep around 11, but I shall always get up between 3:30 and 4:30 pm. I don't even need an alarm. It just happens. And these few days during the exams, I have had to deal with just that. By the time my last paper came (Paediatrics), I wasn't even in the mood to study during the time I was awake, let alone get up early. I managed it, however. Telling myself that this was the last paper played a huge role in this endeavour. When those last three hours came, I couldn't write fast enough to get it all over with. When it actually did, realisation of the end swept into me. I had lots of things to look forward to. All my cousins, uncle and aunt are in India, and now, in their last week of stay, I finally have time to spend with them. My eldest cousin left for the US yesterday, so once the paper got over, I spent the evening catching up with him. Everyone appreciated how I still had the energy to have a kick in my step and bounce around everywhere when I came back home.
A few hours later though, the consequences of my escapades of the past few days started creeping in. I was tired. And now I felt it. My dinner was as good as not eaten and I just wanted to get into bed and sleep. Maybe hibernate for a few days. When we came back home from the restuarant, I couldn't even get my self to change. It felt like now that I had the time to just sit and not think, my mind decided to react to the pain and injury inflicted by the tedious examination timetable. When you get a swollen knee or something, as long as you ignore it, it doesn't affect you. The moment your attention wanders towards it, it gives you that first stab of pain and then follows the saga of injury. I went through the same thing.
Even today, 2 days after the exams have gotten over, I'm feeling the stress and the exhaustion. I had lots of things planned. I have to meet up with my friends, get my room cleaned, make a timetable for the next three months, start with my project work, spend some quality time with my grandparents, write my diary (haven't written in months). But, I can only sit in one place and stare (mostly into the TV). I don't feel like getting up and taking a bath either. It is the one thing I have to push myself in every way and do.
Talking about my To-Do list reminds me, my project just doesn't stop giving me problems. Three days before my examination began, I had to present my topic before the Ethics Committee of our College. I was sorely pissed. I was way behind my timetable and I did not have a minute to spare. They expected me to spare 2 whole hours for that stupid meeting. And then, they had so many comments to make, and so many changes to suggest, I felt like I had been asked to come there to provide them with some academic entertainment. At that time, the result was the least of my worries. I just wanted to go and study. Yesterday, I had to go to college to get my brother's Admission brochure. I thought I'd go and ask about the status of my certificate. They told me I should get the changes done to get it certified with the committee. I told that Professor that it wasn't possible for me to do that. It had been selected for the ICMR just the way that it was, and I had to it that way itself. And, since I had already got a provisional certificate from the committee, I had already begun the work. I just had to get it all done in the way I had presented it. She told me that I had to go and talk to the Head of the Committee.
I can't believe how 'lucky' I am. Since the very start of this project, I have had nothing but problems. It is amazing how much trouble you can have with a 2 month research project in your own college. You end up wondering if it all is even worth it! And, if the ICMR selected this project out of the many entries they got from all over the country, I'm sure they thought it was worth whatever I had written. That body is way more deeply into research than an Ethics Committee in any college. If they didn't have a problem, why should these people? I guess Monday will tell now. Lets hope I get a solution out of this whole mess..    

When A Patient Said...

Outside of all the frustrations involved in being a Medical student in a GMC, what I really like about this profession, is the respect that certain patients give Doctors. Yes, times have changed. Today, Doctors are no longer considered Gods. Thanks to Mr. Amir Khan and his celebrated coverage of this field, we have managed to unearth some of the evils that are present all around us. That does diminish the nobleness of this field.
Having said that though, the smile on a patient's face after having gotten cured, is the greatest gift a doctor can ever get. Any doctor will vouch for this. And any doctor will tell you, that he strives to attain this very prize.
Yesterday, I took the case of an 86-yr old man. He has undergone a Below-Knee amputation, is not very oriented to his surroundings at times, suffers from Diabetes, has lost quite a bit of weight and overall is very weak. Yet, the smile on his face was evident. The happiness he had got after having undergone that surgery to remove his gangrenous foot, was shining on his face immensely.

"If I can have a sip of water from your hand, my life will be blessed."

As I normally do for all patients, I asked him how he was feeling now. Initially he was a little disoriented. he thought I was one of his relatives. When his daughter told him that I was a doctor, he took hold of my hand and thanked me for having gotten rid of his pain. He said, " If  I can have just a sip of water from your hand, my life will be blessed." Imagine this. An 85-yr old bed-ridden man, older than my grandfather, telling me (young enough to be his granddaughter, or even great-granddaughter) that his life would be blessed if I gave him some water! It should've been the other way round.
It is moments like this that make me realise that I want to do this so much. Yes, final year is horrible, the college sucks quite a bit, the profession is demanding, it is a long obstacle-laden journey. But, during this wonderful journey, there are going to be such moments...when somebody says something...somebody does something...it leaves such an impact. I know that those words are going to echo in my life for a long time. Those words were not meant for me. They were meant for the doctors who actually treated him. But, in a way, they were meant for me, as a doctor. Over the past months, I've struggled to find reasons to want to do all this, to want to still be in this field after my Internship get over in 2014. I've struggled to find love among all my subjects, desire to excel in them and the determination to do the hard work required. I've questioned my intentions a lot of times. When I heard those words though, I knew exactly why I liked this field; why I had taken it up.
I may not recommend the field with 100% gusto. But, I do know that there is a reason why I got into it. When I get into that real world (with the Designation of 'Doctor'), I know exactly what I'm going to strive for. It is that smile and that hope that somewhere some patient of mine will be satisfied enough to say the same thing to another Medical student and show him the light to the path that he was looking for :-)

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 :-)