Curtain Falls

It has finally happened!! My ICMR Project report is out, and it says -

Wait for it!

APPROVED!!!!!!!!


 I'm so relieved!! I have had so much trouble with this whole project idea this year, I can't actually believe my eyes which read that "Approved". Yes, everyone around me told me that it was a good topic, that Diabetes is a subject that no researcher can ignore, that the effort I had taken was for real and that the authorities would see that, that I deserved to get the approval.....but, my whole experience was one big roller-coaster....I never believed that I would touch solid ground, until I did for real. Yes, I have finally touched solid ground.
From the complications that arose from our Symposium Competition and the submission of the Research proposal clashing....to the missing of the date for the Ethics Committee Meeting...to the decision of almost giving up this project, irrespective of whether the ICMR allowed me to do it or not....to that provisional certificate that was given and then revoked (after I'd completed my study)....to having been called to present my topic before the Ethics Committee (something that has never happened with ICMR projects before)....to running around behind the new Head of the Ethics Committee to give me my approval letter....to having to buy the Lipid Profile Kit for my project....to having to make the numerous trips to the lab to get things moving...to having gotten my mom to college to collect the blood of my first two patients....to getting so nauseous out of worry that I did not eat for two whole days...to coming everyday to college compulsorily to get two (and any more being called 'bonus') patients of Diabetes everyday....to having trouble with the Statistics of the project....to waiting till the last minute (after my Prelims got over) to create a report out of whatever I'd managed to find....to that final horror of a day when things got unruly at home, and I still managed to send the whole report to ICMR.....yeah, it has been quite a journey.
I made mistakes along the way, I hated my life along the way too....I made life hell for all the people close to me, friends and family included. It was tough, but it was an experience...something that I shall never forget for the rest of my life. I know what it's like to conduct research, I know the pains people take to do something that can get them something more than just plain knowledge (the feeling of having done something great, found something new)....I understand why people fall in love with their papers and hate it when they get rejected from Journals they are sent to for publication. I landed at the other end of the scale...instead of falling in love, I hated it....I thought I could've come up with something grand, and I did not. Which hurt, yes it did. But, I think it is grand now. Out of the 1000s in the country who applied for this Short-Term Studentship, they selected around 200, and out of those 200, they approved my whole research. Yes, this is a good positive feeling.
Looking back, I probably don't want to miss the Ethics Committee meeting date. That is pretty much it. I wouldn't change a thing about my experience while doing this project. I met some really good patients...I was told many good things by a lot of patients....my 70 patients, who shared a part of their life with me deserve a big thank you. I learnt a lot about talking to you, being kind, appreciating the problem you have, trying to make things better for you...as I said in the assessment of my experience, I grew as a doctor, I learnt to be a doctor and a human being. I might not be very gentle during my internship, but I do know that I have a responsibility to treat every human as human, give importance to everything the patient has to say, and always be kind, no matter what. Yes, that was my biggest lesson.
It would've been such a bummer to not have got this approval...I'd have probably been chanting all sorts of negative thoughts, hating those 4 months, wanting to have followed my heart and not wasted time in my project. But, God has been there, and been there in style :-) Thank you so much Dear God. You have no idea how much this means to me!!
So overall, yes, I hated the year. I took on a lot of things apart from plain studying-
1. The Symposium on Islet Cell Transplantation
2. The ICMR Project
3. The Seminar on Hospital-Acquired Infections
4. The Paediatrics Quiz
5. The TB Quiz
6. The Medicine Quiz
7. The Asthma Quiz
8. The load of my Final Year studies
Phew. I think I've done decently well then.
Oh yes, the reason for that 'decently well'-
My Final Year results are out....I've gotten 72.33% :-)
No distinctions though...missed the one in Paediatrics by one mark :-p
I'm 4th in College. Which is sort of cool :-)...a let-down on last year (73%, Rank 2), but after looking at that list above, I think I've done better than I thought I would have.
Results were declared on 28th February. Since I was doing that BLS and ACLS course, I'd decided not to check my result. The tentative date was always 28th Feb, so that day, I was on tenterhooks all day long. You can imagine my delight when I got a text from a friend saying that they were not going to be declared on that day, but maybe the next day. I was on Cloud 9. I've been ranting about how I don't want this result, haven't I? It was an answer to all my prayers.
I was so happy about passing my BLS examination, I updated my FB status to "I can save lives now." Turns out people took that as my status response to the results having been declared. Oops. A few phone calls down the line, I had to delete my happiness over my BLS course from FB. Weird thing is, the moment I deleted it, I got another text saying, "Results declared." Now, you would obviously think there was still some confusion over my just-deleted status. Which is what I thought and replied also. Fate had decided t play a trick on my me and my jolly mood though. Results did get declared. Hmm.
I thought I'd just check out the college list to see whether I'd passed or failed. Seeing that "PASS" against my name gave me a sigh of relief. At least there was no further exam to take 6 months down the line. Again to soothe my nerves down a bit, I called up my school friend, talked for half an hour, then decided to check my marks.
There they were- 651/900. Was I happy? Umm. Was I sad? Umm. I was actually empty on emotion. I had now gotten the tag of Dr. to my name, and I was still feeling empty. That was strange. I didn't really care about anything. I knew I hadn't topped but that did not matter...I knew I hadn't come 2nd, but somehow that did not hurt or matter either. These marks just proved that I was done. Done with this jam-packed final year forever. That gave me a calm, a serenity that did not budge for a long time (now it has, because the thought of internship scares the hell out of me). It has been that way about my results this year. I don't care. As long as I pass, that is all that matters. I feel more satisfied about my Project and my Course. Maybe that sounds strange....but it sounds good to me. And it has put my mind in a state that has come to terms with these marks much faster than ever before.
Done...now I can only look upward from here. No going back. 

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 :-)

Outside My Comfort Zone

A moment of personal victory for me was to receive an E-mail from the Moving Academy of Medicine and Biomedicine telling me that I had been selected among the 40 people from all over India to attend a Foundation Workshop of Clinical and Laboratory Medicine Research. When I initially sent my ICMR proposal to them, I did not expect to get through. It was a wonderful feeling to see that e-mail and know that I had a marvelous experience coming up in the next month. My only regret is that I won't be able to spend my birthday with the people closest to me. However, the way I'll spend my birthday this year sounds pretty great too :-))
On Saturday (4th August), members of Medical and Educational Perspective, a non-profit organisation looking to come up with low-cost innovative equipment to better the health situation in India and other developing countries, visited BJ. We interacted with them and what struck me most was that they were so seriously concerned with wanting to do something to improve Medical Science and Healthcare. There were medical students, MD students, PhD students and Bio-Medical Engineering students too...all with a common goal. It made me ask myself why I, as a budding doctor in India, should not be as concerned about the situation here and strive to do something about it.
Talking to them, I realised how differently we are brought up by the educational system in India. You are moulded to run in a particular direction. Yes, at times you may deviate a little and do something outstanding. But, ultimately, you are pushed onto that straight path with a pre-decided goal. These guys, instead, are forced to think differently and originally. They are forced to use their heads, heart and creativity and imagination. They are forced to take that path which deviates outside of normal and stay there...it is so refreshing!! I was delighted that I managed to interact with them. I was disappointed at the same time, because due to our poor timing (what with it being Final year and prelims coming up), I won't be able to really be a part of the project that they want to undertake here in India..ah well, maybe soon enough...
My Ethics Committee saga may come to an end...I'm not sure yet. I'll need an entire post to describe it. I'm just going to say that if there were ever a bunch of idiots with egos as huge as Jupiter, they were all hand-picked from the various parts of the world they lived in, and placed in BJ Medical College as the Ethics Committee.    

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 :-)

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

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 :-)      

Subconscious Priorities

When you start dreaming about your college life, it helps you put things into perspective. On the surface, there are a million things to think of; a million things to do and a million things trying to get your attention at the same time. Dreams really just line them all up, starting from the most important to the least important.

Over the past few days, I’ve been dreaming. The important point to note is that, I’ve dreamt about stuff that I have never acknowledged as stuff that has troubled me or made me uneasy when I thought of it. However, I guess I was wrong. It has affected me more than I thought it did, or should I say, more than I wanted it to.

Let’s start with the first.

A dark background all around me…I’m assuming it is night. I’m outside an unknown cabin - a wooden one like in those Cowboy movies. I’m sure I’m alone yet there are a few people with me. I have my cell phone with me, but I don’t feel like calling anybody as of now. Out of nowhere, there come a group of people – no wait, there appear to be two groups of people. I seem to recongise some faces…hell, yeah! These are my Medicine and Surgery Residents. What are they doing here?? They see me. They are shocked to say the least. The very next second, they’re holding my arms. The Medicine group gets to me first. I know I am being kidnapped but can’t really do anything about it.

The Residents start bombarding me with questions -Medicine-related questions. I can answer a few, and at the one question I can’t answer, I’m being dragged off with that group. When this happens, the other group jumps up to my rescue. Not rescue exactly, because, the moment there is a question I can't answer from their list, I'm just dragged off there! And then, I get a phone call. Again, from a surgery resident. He seems to want to tell me something, but just keeps beating about the bush. I'm scared. I can't tell him where I am. I keep wondering whether he is involved in this very operation or not. Ultimately, he doesn't end up doing much to help me. 
I did not get up with a jerk or anything. I got up with an uneasy mind and a tough day to look forward to. I know I haven't been on top of my timetable. But, such dreams are definitely going to push me onto Insomnia big time!
Moving on to the second:
Let me first give a brief background to this one. I've had two such dreams. They are both related to the ICMR project I was intent on doing a few months back. At this moment, in April, I know for a fact that I will not be able to do everything possible, and giving my time to the ICMR project is just going to spoil my chances of doing well in Final year.
The first dream basically had my to-be Guide shouting his head off at me, when I go to tell him that I don't want to do the project. This was obviously related to an incident from day before, when he told our batch off for making too much noise in an evening clinic. It was the first time I had seen him lose his head, and I think, I was a little traumatised by that experience. Hence, the dream. I just stand helpless, waiting for the dream to end, by the way.
The second dream came yesterday. After cajoling myself to at least take a look at the list of selected projects, I found that my project had been selected. So now, my dream had me walking about in college, trying to make up my mind whether to meet my Guide now or not. Out of nowhere, lots of people start coming and wishing me congratulations for having been selected. It appears on Facebook and I seem to be caught in this big trap. I want to say no, but I can't seem to say it. And nobody even wants to listen to what I have to say. Scary.
These two dreams bring me to the main worry I have. Do I want to do the project? I have a stack of points for not doing the project:
1. There is way too much to study in Final year. I know I'm not that strong. So whatever time I get to waste, I want to be able to waste it and not spend in more work.
2. My aim in doing the project was to improve my CV when it came to applying to universities abroad. I am now leaning more towards doing my PG in India, in which case it won't really matter. Also, it isn't necessary to have a project under your belt. I have my academic record and lots of certificates to which I shall add many more in the coming few months.
3. My Ethics certificate hasn't come, in which case, I shall have to wait till June. That is when my Terminals would begin. Not a great time.
4. I'm just not in the mood any more to run around looking for patients.


For doing the project, there are a few points too:
1. It has been selected. That means it is good enough and there are going to be some results which would really help the future of Medicine.
2. It will add to my CV any way, whether I like it or not.
3. I won't get another chance.


Add on, the fear of facing my to-be guide, yeah, I'm pretty screwed. I just hope he takes it nicely and helps me put my mind at ease. 


I'm doing the Inter-Disciplinary Seminar this time. The topic is 'Hospital-Acquired Infections' and I shall be dealing with the Surgery aspect of it. The reason I am so proud of this is that, I was chosen on the basis of my performance at the University Examination. Initially, there was going to be an elimination round. The Academic Committee, finally decided to just go with the Univ marks.
I'd had a conversation with a friend about our marks after the results came out. He said, it didn't really matter because nobody was going to bother about these marks later. I, on the other hand, was a big supporter of the rank system and was delighted about what all I had achieved. The selection of participants for this time's IDS, simply added weight to my argument. I feel that whatever I get, on the basis of my marks at Univ exams, I thoroughly deserve. That's 'cause I work my ass off for these exams. Thus, I am extremely proud of my selection. I wanted Surgery and I got it too. So I am pretty happy right now.
Our Medicine term-end comes up on Friday the 13th. I hope to do well there. It is going to be a busy week up ahead. Let's hope it shall start well and end well.  

Psychiatry gives me a surprise!!

The 15 day posting ended on 15th April. Haven't exactly been the mood to write since then. Today, I am.

So Psychiatry. Wow! There is something, an inherent, ever-present sentiment.....a disbelief of sorts, that these clinicians can remain Doctors, sane-headed Doctors. It is interesting to listen to the calm and off-hand manner in which the patients speak. Stories seeming to be absolutely impossible, are said with such belief, it is SCARY. These people have a weird expressionless look in their eyes. Apart from that, extremely normal. And, of course, in our posting, we learnt about :

1. Schizophrenia

2. Bipolar Affective Disorder with Psychotic signs

3. Manic Episodes

Almost every second patient seemed to suffer from some kind of auditory and visual hallucinations.

That way, a very easy case to diagnose.

The Mental Retardation cases were heart-wrenching. We had a case of two 27 yr old brothers, who were mentally reatarded in the severest way. They couldn't utter a word , only identified individuals. Their father looked so old and worn-out and tired, I couldn't get his image out of my head for a very long time (stilll can't). The world is such an unfair place. Firstly, people are financially unequal, and to top that, the lowest class of people have to suffer from such disasters. Disasters that need the financial help to run a decent course, a course that is manageable. A mentally-retarded child is loved despite everything by his parentsm probably, even more because of his condition. It is killing to imagine, being in that 60 yr old father's shoes, wondering about the future of his two children, after he may be well beyond the capacity to provide for them....to imagine how he has spent all these years having to look after two children, he could never expect himself to hate or be taken away from him, and yet at times, wish for the same. It aches so much, and I felt relief, and still do, when he mentioned that he also has another son and daughter.

This is the only part of being a doctor that I don't like. Some patients, with the baggage they bring along, touch the most sensitive part of my soul, and almost always, I wish I could run away from it all, and never feel all this stuff.

Any way, I topped in Psychiatry. 37/50!!! It a second. After having got our Gynaec journals checked, the CR told me I did amazingly well in the term-end, and that our HOU was very happy with me. Now this. I feel previleged and lucky. I'm finally making some headway, and it feels like it. So satisfying, and a confirmation that I have chosen the right field.

Our current posting is Radiology. Very interesting. The best part of it is, the posting gets over by 11 30 am. So I easily get about an hour and a half in the library. Plus, I really like it, and the branch is one of my choices for a PG in.

My ICMR project didn't get selected. Only three out of like an easy 15, got selected. I'll still be doing it. The news was saddening, but I don't want my research being wasted, and I intend to see this project through.

Thats about it. We're going to Mauritius next week. I am SO excited!!! Can't wait! And I will write before we leave... I promise myself that.

Labour, in every facet of the meaning

It started with the Seminar on Thyrotoxicosis last week, on Feb 8th. It was a wonderful experience. Standing in front of a huge audience and speaking as calmly as I did, I have to say to myself, "Kudos!!". I ended with the sentence, "Even though the thyroid gland is not essential for survival, absence of the hormones can cause physical and mental slowing and affect the quality if life." That raised up a controversy amongst the teachers sitting in the front. But, there were some who agreed with what I said, and frankly, I don't think what I said was wrong. The Thyroid doesn't decide the life and death of a person. Nor do the hormones. They make a person capable of living what is termed as a normal human life. My friends said I spoke a lot better than I had, during the rehersals. Personally, I'm glad I was able to stand up for myself at the podium, and say what i thought was right when the controversy came up. Plus, I got a certificate, which for me, is more important. You could say that I am selfish enough to participate in this kind of activity only for the certificates!!

Moving onto my next goal, after two days of running around and being tense that I might not be able to finish off with all the signatures in time, I have finally sent my Research Proposal to the Indian Council of Medical Research (ICMR). The results will be out in April. I don't care whether they choose my project or not, I'll be doing it any way. But, there is always a sense of achievement in having your project selected by such a prestigious body. Also, they choose just 500 such projects from all over the country. So, I guess, its easy to get what I'm trying to say. I just have my Ethics Committee proposal to be handed over tomorrow, and then wholly, and truly, I will be done with it all, till April.

After this, it is our Intercollegiate Competition Vedant to think about. I have to come up with my entire schedule to hold the Debate and Essay competitions. I don't know what the verdict on this time's Vedant will be after the bomb blast yesterday. But, lets remain hopeful.

Now, labour. In the field of Medicine. Overcoming my pre-construed aversion to the process of Miracle of Birth, I watched 3 normal deliveries and a Caesarien Section (CS), yesterday, during my first ever Emergency Duty (ED) of my term in Gynaecology and Obstretics. The Caesarian was a textbook operation. We've already had our clinic on the step-by-step manual of performing a CS. Yesterday, we had a practical version. The deliveries were a little gross, but the babies when taken out looked really, really cute. As luck would have it, we didn' see any girls being born. It was all male babies. Hmm, maybe next time!!

So its been eventful, this week. And I really hope, next week is a little less taxing. Ciao!!

Pressing Matters

The exams having finished, and my voice and health having returned to more or less normal (I can sing now, without flinching at the sound of my voice!), I now turn my attention to two pressing matters: The Thyrotoxicosis Seminar which will take place on the 5th of Feb and the final decision on my ICMR (Indian Council of Medical Research) Project.

We had a rehearsal of sorts on Thursday (21st Jan) for the Seminar. My presentation took 15 mins, more than 2.5 times the alloted time. I have to cut down on a lot of matter, something which I am so NOT interested in doing. I've spent ages on making the presentation just right. Lets see what my guide has to say about what we can cut down upon. But, as such the experience of standing up there and talking was brilliant. I did not have jitters. That might not be the case on the 5th, when there would easily be a huge crowd, and the venue would be the MGA. I'll be doing all that I can this week, to make sure I'm fully prepared.

The ICMR project deadline has come, and it is the 15th of Feb. Having come down to two topics, I'll hopefully be making a decision and submitting a report to the Ethics committee of our college for approval of the project. I am hell-bent on doing this project and I do hope things work out well.

Moving onto the earliest and most enjoyable event of all, we have a trek to Purandar Fort next weekend (29th, 30th, 31st). This reminds me a lot of the Lohagad trek we had last year, and I can't wait to go for another one. We will have a meeting mid-week so that we can be told of the itineary and the stuff we need to carry. But, I'm a hundred percent sure this trip will be a major fun trip for me.

The weekend was a welcome break for me, with all the remnants of my illness bearing down on me during the week. Also, we missed out on almost 17 days of our paediatric posting because of the terminal examination. So, the last week in college hasn't been a restful one, complete with 3 hrs being spent in the wards. I love paediatrics. The patients are so CUTE!!! And, I get to unleash all of my sweet side onto those patients. We have an amazing lecturer teaching us too. A Dr. Chhaya, who has a certain way with children and us too. I really wish we had been able to finish the entrie posting. It would have been an experience. But, now I do know that there's one branch I wouldn't mind specialising in.

And I saw my Micro marks. They are pretty ok. I've passed by a fair amount. It wouldn't have hurt to score a little more, bu then medicine isn't about scoring marks, it's about learning and enjoying the subject. So, that has been able to console me a bit.

This week has been fun. Hope the next one is too :-)