Laparoscopy

On this weekend, I had the opportunity to attend a workshop on Basic and Advanced Laparoscopy. We were taught everything about Laparoscopy from the very beginning - how to hold the instruments, what the instruments are, how to suture stuff inside the abdomen, working the instrument with what you see on the camera in front of you, hand-eye co-ordination, where and how to put the ports in....all the stuff that you want to know before you just plunge into Laparoscopic surgeries.
Thing is, I've always watched Laparoscopies. Easiest surgery to watch actually. It is an Air-conditioned OR (yeah, I guess I've started using a lot of American terminologies now. If I plan on doing my residency there, makes sense to use their words instead of ours), you can sit on a comfy stool to watch and you have as good a view of the organs as the operating Surgeon. It's pretty damn amazing. After all, it is tiring to watch a 5 hour surgery standing tiptoed, in a crowd, straining your neck from here to there to get a better view.
So back to the workshop. We started with the Endo Trainer. Its a plastic box with holes for the ports. They keep stuff like plates of peanuts, sugar cubes, Polo pills, match sticks and plastic gloves in it. The instruments go in through the holes. You can get really good training in picking those peanuts up, moving them from one plate to the other. The sugar cubes are a little tougher. You have to stack them on one another. The 2-D image in front of you doesn't help a lot in that. The match sticks and Polo pills are the worst. You have to pick a pill and then loop it into the match stick that's stuck down on the rubber padding. Not as easy as it looks! We also got to learn and practice intracorporeal suturing on the same. I, apparently did not have great instruments. But, wow, was that tough!
The key to good Laparoscopy is to stop working with your hands in your head. This is just my thought. I'm just a beginner. But, from what I saw and did, I realised this. When you learn a new language, for example, you always tend to think in the language you know well. And then, you translate that thought into your new language. It's only when you start thinking in that new language that you actually learn. That's the same principle with Laparoscopy too. You can't keep thinking of how you'd separate tissue or suture an incision with your bare hands and then use those methods with that instrument. You have to allow that instrument to be your hand. The needle-holder is not going to be this 20 inch long instrument that you directly hold and just plunge inside. It's going to have a long handle, a different grip and, most importantly, a really small area to move in. Unless and until you can think in terms of moving the needle holder and picture it as a part of your working hand, you can never get good with Laparoscopy. That needs patience, practice and perseverance.
I personally had a great time. I realised yet again, how much I LOVE surgery, love being inside an OR. I also learnt that I am good at this. Day to day practice and I could make myself really really proud. I like looking back at things I've done and marvel at them. I like saying stuff like, "Wow!! You go girl!". I can do that in Surgery or any surgical field. It's great to know that the love I'd felt during my Casualty posting was not a one time thing. I know I love this and I get a feeling I can get really good at it too.
I thank my luck that I had this opportunity so early on. Experiences like these help mould the clay of my confused mind into a beautiful pot. There is a long way to go, but I'm taking small steps. And, I get a feeling that the beautiful piece of art is not very far off :-)

I'm Back !!

It has been over a year since I made my last entry. Things got very busy after I came back from rural posting in Shirur. We then started with all the heavy postings - Medicine, Surgery, Ob-Gyn. That was followed by a nerve-racking USMLE Step 1, Step 2 CK and Step 2 CS preparation. Amidst all of that, I had the opportunity to complete 2 elective rotations at Yale-New Haven Hospital and Massachusetts General Hospital. I visited my Uncle in California, saw a little bit of LA for the one day that I was there for my CS examination, made a return to New York (this time with my best friend) to fall in love with it AGAIN (why do you do this to me New York?!), met some wonderful people, made some brilliant and funny friends, learnt from smashing residents and Professors, grew up a little (not so much though :-P ), carried all my baggage alone everywhere (trust me, that is my greatest achievement - you know why, because only today morning I dreamt that I left my check-in bag at the security counter at the airport. I was running across the entire length 10 mins before my flight took off, just to get my bag. Such a relief to get up and realise I was in bed, at home and that my airport story ended 3 months back!), gained weight (that was second achievement. a whole 2.5 kg!! in 2 months!) and basically wanted to come back home, but so did not at the same time!!

People do many more things in the time that I spent in the USA, than I did. But, then, looking back, I loved the relaxed life I lived there. Yes, I worked. In New Haven, I was in the hospital from 9 am to 5 pm. In Boston, I was there from 6 am to 6 pm. But, I roamed about, I read, I studied, I watched FRIENDS all over again, I developed newfound love for The Big Bang Theory, I found Chipotle (oh holy God! I loved their barbacoa so much, it hurts to remember it now. Please please take me back there now!!), I loved Boston (that's saying a lot because, frankly, I dreaded being alone in a city without any new friends) Yet my first weekend out in the city, I knew I was going to love it, with all its rain, sunshine, snow and wind. Oh yes, I experienced my first ever snow fall :-) As beautiful as it looked from inside the house, it was tough to walk out there. People may laugh saying, "So excited about snowfall of all things?!" But, hey, I live in a tropical country. The day I left for the US, the temperature here was a whopping 40 degree Celsius. If I see snowfall, I'm going to enjoy it and call it beautiful.

After my posting in Shirur, I'd realised that I don't go beserk with new surroundings. I adapt, without any complains. In fact, it takes me months to realise that I actually enjoyed the change. During my time in Shirur, I never once thought of the stay as wonderful, enjoyable or easy. I just did what I had to do. I had lots of time to ponder (oh yeah, I did, lots and lots of it. My best friends will attest to that.) It was only maybe months down the line that I looked back at that month and classified it as 'Good. I managed to live on my own.' It was the same with my US trip. During that time, I didn't really believe it was amazing or bad. I just went along with the flow, week by week, ticking things off my list. It is only now, 3 months down the line, that I look back and say "wow, I really did it. And I enjoyed every moment." That probably gives me most hope about the kind of person I shall be when I fly out of my homestead.

So what is next up for me? I have decided to go the US way. I'm currently compiling applications, putting together Personal Statements, looking up programs to apply for. If things all work out, next year, at this time, I shall be working my ass off at some wonderful hospital. If things don't, well, I think that is a story for another post. I get the feeling that I'm sounding happy and optimistic in this one. Let's keep it that way :-)

It feels so good to be back. I'm sure I'm going to spend an hour or two going through my old posts, reliving some memories, good and bad. I've missed writing so much. I'm glad I forced myself to take some time off and do this. Now, of course, I shall be itching to write my next post.

p.s. the title of this blog finally makes complete sense!! I've officially become Dr. Pranjali. I'm still not used to it. My parents have to keep reminding me to add that 'Dr.' before my name :-P


Adding a picture of my Italian Brunch In New York. A tribute to the love I developed for eating. The white stuff is the best ever cheese I've had in a long long time :-)

When You Learn

I learnt a thing or two about myself over this weekend. I don’t know whether to think it is just my thought process or whether it is human nature in general. I will be keeping it in mind now on.

About a month back, I bought a new smart phone. An HTC 8X. The thing about me and phones is, I am never too sure of which one to buy. I never narrow down on any one. My way of buying phones is – go to the shop, go through the collection, compare the prices, see which one suits my personality. 3 days later buy one. I don’t know whether this way is wrong or right. It is my way. I also end up using my phone till the very end. I manage to find every reason to keep on using the tattered-looking model as long as I can.

This year, after my results, I could have asked for a new phone straightaway. Exactly what all my friends did. I thought, my current model is good, let’s continue with it. Until, those days came, when the model started going to pieces. I started with an online screening of phones. And there it was, that HTC 8X. Standing tall in that California Blue matt finish colour, the Windows Phone tiles emitting an eerie glow, that big screen telling me to come get it…..It had everything I wanted and more. The only issue was its price.

I have never stubbornly asked for anything. I am always practical and adjusting (at least where phones are concerned :-p). This time however, I had to fight tooth and nail to get what I wanted. I wasn’t sure I was getting it, until the very last moment, when that guy finally opened the box. I still remember that moment. I fell in love. Again. With my HTC 8X. With my Blue HTC 8X.

Over the past month, I have been so careful about this phone. I wash my hands before touching it, I clean it every weekend, that screen may have gorilla glass, but I still put a scratch guard. There is a fixed place in my bedroom for it (away from dust, dirt and any danger of falling down). I can spend hours just looking at it as it gets charged. Yes, I can be passionately in love and possessive about something. That’s the first thing I learnt.

This weekend, as a part of our Annual Family Trip, we visited Della Resort in Lonavla. Wonderful place by the way….there’s an Adventure Park there and I did all that there was – Ziplining, Rock Climbing, Rapelling, High Ropes, Zorbing, Reverse Bungee Jumping, Archery and the Arcade games. Lots of fun in lots of rain…getting wet in the rain is an out-of-the-world feeling!! Everything went well, until Lunch time when my phone stopped working. It refused to start. And it kept vibrating every 40 secs. Charging did not help, it worsened the condition. And there went my awesome happy mood down the drain. All I wanted to do was get back to Pune and repair that phone. I couldn’t stop worrying about it. I couldn’t stop thinking about it. My phone was sick and I was helpless. The feeling of helplessness is the worst feeling in the world. I had thought of not taking this phone to Lonavla. I regretted not taking that thought seriously. I just wanted my phone switched on. I didn’t care about the data, I didn’t care about the formatting. I just wanted it show signs of life. Signs of being around for some time more. I couldn’t sleep for two whole nights. In fact, as the end of our trip came closer, my tension, apprehension and jitteriness increased. I don’t know how I managed to sleep through that Sunday night. I had to get to the Service Centre on Monday. Whatever happened.

They called yesterday and said that phone had been repaired. There had been water there, so my warranty period is over now. All my data is lost. But, you know what, I don’t care. I don’t care about the contacts, I don’t care about the videos, the images, the songs, those notes I keep on my phone. All I care about is seeing my phone in a working condition again.

What did I learn? You love your phone, right? Don’t test it and its tolerance capacity. I might call myself moderation personified, but when it comes to the things I desperately love, I am an Extreme. In every way. I also learnt that I can desperately love something. I can be desperately worried about something. I can be desperate about something. That scares me and makes me feel good about myself too. When you feel too much about something, you are more liable to get hurt, more liable to harbor grudges, more liable to senseless action. That is scary. But, when you feel too much about something, you are motivated to work at it, more dedicated towards it, you don’t lose yourself when things go bad. That is a part of the recipe for success.

I am more of the Moderate and the Extreme. But, I have the tendency to become an Extreme. Do I need to work to change this? Only time will tell….  

When Doctors Act Like Patients

One would think that the years of study we put in to become Doctors would make us better prepared to face any health situation that confronts us. Since the pathophysiology, the symptomology, the complications, the investigations done and the treatment needed have been encrypted into our minds, we would in fact be the most resilient and calm patients or patients' relatives. Yeah, that is just a myth. We are humans. And we have every right to create a scene and fear the worst, when our own health is concerned.

As an occupational hazard in our profession, we are capable of being exposed to anything and everything. It is our  responsibility to protect ourselves against the worst of  scenarios. The most common is, of course, the needle pricks. It has been 4 months of Internship now, and I've managed to get two already. Both experiences contributed to my post today. I feel more confident about handling such situations now, but in the spur of the moment, I acted like any non-medic person would. That is scary. That spur of the moment action or inaction.
We are taught to maintain basic precautions - gloves, covered shoes, masks, glasses, lab coats, etc. We are also told that there are certain norms to be followed to protect ourselves. One is, never recap a used needle. NEVER. More than half of the needle-pricks occur when we try to use our own heads and recap needles. Two, always push the used needle into the plastic cover on the bed. That keeps everybody out of danger. Three, wear gloves. Yeah, that's what I wrote first, but that is just so important!
I want to record my second experience here, because I learnt more from this one. I was posted in Skin (I don't know what it is, there isn't much love lost between me and the subject) and had to put an iv cath for a patient. I'd previously taken a sample of his for HIV testing, so I was wearing double gloves, a mask and doing everything I was supposed to do. While taking the cath to throw it, I felt it pierce my gloves. On removal of the gloves, I looked for any kind of injury on the skin of my palm. There was none - no blood, no inflammation, nothing. I washed my hand, there wasn't any burning either. I thought I'd caught the needle just in time.
That was a mistake - Never think there is no prick. Go to the Medicine guy responsible, immediately.
I didn't think about it too much until next morning, I saw an  inflamed spot. At 4 am in the morning. And then everything got twisted. I started  panicking. I wanted to cry and scream....I wanted to call up my resident and ask her about the patient's HIV status. Having seen the patient, I kept thinking, there was a possibility that he could be positive. And I hadn't taken that PEP dose immediately. My sleep disturbed, my mind shaken, I  spent my morning trying to decide what to do. Ultimately, it was decided, that I should go and do that patient's Tri-Dot test any way, instead of waiting for his report. Before doing that, I took the first PEP dose. That moment, when I was waiting for the lines to form on the strip, was most frightening. I could imagine more than one lines on that strip. I had prepared myself for the worst, because I was so sure that was going to be the case. When only the control line came up, the surge of relief that went through me, filled me with a new life, really. Next day, the patient's report also came as negative. Phew. Close call.
This whole episode made me think. I've learnt about HIV and HbsAg since I was in second year. I've learnt that the chances of contracting diseases like this are pretty slim, that once you take all the necessary measures, you don't need to think much. I've learnt all about the pathophysiology, the spectrum, everything there is to learn, at UG level. This is enough  to know that what I was faced with, did not put me in danger at all, especially after that Kit test. Yet, I panicked. Yet, I feared the worst. Yet, I traumatised myself and my parents and my two bestest friends. I told myself, it couldn't happen to me and yet, it was happening. What was the use of all that knowledge then? It didn't matter that I was a doctor. I could easily have been an engineer or an archeologist or a parent. My reaction was a purely human reaction - a scared person, faced with the possibility of a different life. It is like facing a tiger in the middle of a forest - in those initial seconds, it doesn't matter whether you've been researching tigers all your life or whether you're thrown in front of him by mistake. This fear, this panic....it's a part of the innate response of our body. Innate - present since birth. However trained and educated we get, this response always gets the better of us when faced with danger or death.
And at such times, doctors end up acting like patients....

Monday Blues

The title of this post is actually wrong. It hasn't been just Monday blues. It has been All-Week blues that earned a boost-up today. I was truly happy and at peace yesterday- the one Sunday when I did not have to look at the sight of that Dermatology building. Hmm...it's been a sad week.
The elective posting is supposed to be the only one in which you have a say. I had a say in it. I was so sure I wanted to take Psychiatry as my elective posting that there never seemed any two ways about it. I don't what went through my mind in those 5 minutes before I went and selected my Internship batch that made me call up a senior of mine and ask, "What should I take? Skin or Psychiatry?" And I don't know what induced her to change from her previous answer of Psychiatry to Skin. She did change her answer though. I changed my mind though. And now I regret every bit of this 15 day torture.
Maybe it is that building. The building houses Paediatrics also and we all know how much I 'enjoyed' that posting. Or maybe it is the lack of space - 2 crowded OPDs where the 6 residents barely manage to fit it (talk of fitting in, there is also an examination table, computers and stools for patients), 2 wards on the 2nd floor of the building where again they've managed to fit in 7-8 beds each for male and female patients. Or maybe it is the lighting- there's hardly any....it is so difficult to look for veins to put intracaths into in improper light. Or maybe it just the residents- they look so bored and not-so-happy with what they are doing, there isn't enough enthusiasm for us left.
I remember how my ENT posting went. When the nice guy gave us work, he gave it with a smile and positive look. We did it in the same way. When the frustrated girl gave us work, she wasn't delighted with the results. In Ophthalmology, the residents and we had a mutually happy relationship. They helped us, we helped them and ultimately patients went home happy. In here, I am just plain bored. They are bored too. I guess, in their defence, if you had to work in the place that they work in day in and day out, you'd get bored too. Still.
All the work that I do is take labs, put caths and take pus culture & sensitivity samples literally everyday. If not taking those samples, I go trace them. TRACE. I hate that word. It means having to walk all the way across the campus from one end to the other and back. On days when I have to pass by the cute resident in the Orthopaedics OPD, it seems more tolerable. But that's just two days out of the whole week. Oh yes, the whole week . That reminds me of the start of this unhappiness. We are 4 interns posted in Skin right now. There are 2 units so 2 interns in each unit. We decided we'd put a rotation for all 4 of us so that we'd have to come only 3 days each. The one person who came would complete the work for both units. The residents did not agree, so we've barely managed to put a rotation in the unit itself. My Unit is 'fantastic' though. They need both of us there. One to take the labs, the other to trace them. One to stay in the wards, the other to go hunting for a xerox shop to split their books/ xerox books/ bring some forms from the co-operative store. God, such a pain.
So, for the past week, I've been going and sitting in college. I and my co-intern alternate between the work and sitting in the library, in case they ask to see our faces. Yes, i'm finally studying and all, but this is so frustrating. I was so glad on saturday when my work was done and I could run home to a Sunday. That Sunday came and went and today, it was back to being glum, angry and in a foul mood.
July 6th, when shall thou come??

In other news, Brazil beat Spain 3-0 in the Confederation Cup 2013. An ardent Spanish Armada fan, I don't know what hurts more- that they lost, that Brazil scored 3 goals or that Spain did not even have a goal on the match sheet. Hmph.

How's The Internship Going?

This question is the most obvious and the most commonly asked of me wherever I go. Today, I have the time to ponder on the perfect answer to it.
Hmm...so, how is this internship going? One thing is for sure: I'm enjoying this phase only because I have my friends with me (and by friends I mean, people I like, call friends and who also work as much as I do). Working in a hospital can be a lonely feeling....you are working with and under residents, who you can have no choice of. Right now, thanks to the delay in the Entrance examination results, we are short of Junior Residents. That means that our Senior Residents are quite frustrated with the amount of work left for them to do and, in turn, we, the Interns suffer, because we need to work more than usual and also do all the petty jobs there are. In such a scenario, if you don't have decent people to work with you, pour out your innermost emotions to, have a laugh with and remind each other of your plight, life sucks.  That's where, I have been lucky enough.
Of course, there are people called 'cutters' in our batch too. The word is used to describe an intern who wriggles out of the work assigned, usually to study. Such a person is usually more thick-skinned than the rest of us (as interns, you have to be thick-skinned to survive the mental ordeal in SGH), has absolutely no conscience to provide a haven for guilt and loads the rest of us with extra work. In my batch, we have about 3 such people. We've been able to distance ourselves from them, but time and again, fate just plays into their hands instead of ours. Currently, there are 4 of us, who've sort of decided to stick together, because we work well together. 3 of us were together in the Orthopaedics posting and we had a blast. The fourth girl joined us during our ENT Rotation and we managed very well. We decided to do day duty during our Csualty &Trauma rotation. We've left that place with the Chief Medical Officer saying that our team of four was one of the most sincere and hardworking lot he's seen in a few years. Such a nice compliment to hear!
So, going back to the question: I shall be biased now because of the Casualty rotation. Upto the start of Casualty, internship was fine. Paediatrics was over and done with (that itself is such a liberating feeling. I realise it now when I go to the building and there is no reason why I should need to enter it), Orthopaedics was fun and signed off, Otolarhingology (ENT) created a few issues regarding the Interns' rotation but we scraped through and Ophthalmology just proved to be my favourite yet again. So far, so good. Apart from the ENT completion signatures, I had all the others and things were good. I particularly enjoyed Ophthalmology. All that I ever did was measure the vision of patients and take labs, but I'm so completely in love with the subject, I enjoyed that bit too :-)
My hate for Casualty began during Orthopaedics. On our Emergency days, the intern had to sit in the Casualty and do the preliminary of the Ortho patients. Obviously, that was NOT my favourite job. The Casualty Interns posted at that time weren't more than acquaintances of mine. Seeing them run around here and there like freaking doctors, added to my negativity about the Casualty. I used to get this helplessness sort of a thing watching them. I used every opportunity to run away to the ward. There was lab work, blood issue calls, the HIV-HbsAg testing and trips to the OT to help out the residents a little. I did not sit at all, but I got that helpless feeling out. I felt better about myself. It worked for me.
This attitude carried into the start of my Casualty posting. On day one, I did not want to start the posting at all. I wanted to run away from the place and hide myself in some tiny little corner of the world where nobody would find me. But, by the end of the day, that thought itself was hiding in some deep dark corner of the world.
Looking back, this has been my best posting till date. A 12-hour day duty, managing more than 80 patients per day (all sorts - malingerers to psychotics, chest pain+breathlessness to assualt, alcoholics to RTAs, dog bites, cat bites, pig bites, monkey bites....everything) is not a joke. We did not get time to sit. My whole diet was ruined because my ages-old routine of 4 meals a day at fixed intervals was kicked out. There was a point when I almost collapsed there due to exhaustion. But, amidst all this, I loved every moment of this duty. My fear of putting an  intravenous catheter, a Ryle's Tube, a Foley's....everything was dealt with. I'm more confident of myself now...I managed to put my CPR skills to good use (finally, the BLS, ACLS workshop can be properly thanked :-) ). But, if there is one thing I enjoyed more than anything else in the world, it was the Minor OT. We dealt with all kind of wounds....my mattress and simple suturing has flourished during these 15 days. I love doing it all. Such a constructive way of getting rid of all the frustration and anger that boils inside you when you have to listen to 10 relatives per patient asking you 10 different questions. I had realised long back that I love surgical work. In these 15 days, I have also realised that when a patient comes with complaints of chest pain+breathlessness+hypertension, I lose interest. Its so obvious that Cardiaology is so not my thing. The area of the CMO dedicated to Surgery and Orthopaedics was my home, my go-to place when things got out of hand. I could calm myself down, doing the preliminaries of those patients, setting their wounds right, giving them hope that things would become better.
We had all sorts of patients - suicidal attempts (I and a friend sutured a wound in 3 layers - the only one in these 15 days :-) ), cases of castration, hit-&-run cases, accidental machinery injuries, self-poisoning for all sorts of reasons....I got a look into the kind of life people are forced to lead. That was disheartening because, when you have all the luxury in the world, some people don't even have 10 bucks to make a case paper. Old men with BPH complaints came from afar and refused to go back, because they had no fare. Aged women travelled for 2 days to come here and be told that they should have come 2 days before or after....that part of a direct view of reality made me depressed. I will do something for such patients in the future, because, they deserve every bit of it.
The casualty is an excellent place to learn. Medicine, Surgery and Orthopaedics residents are always there and they always managed to teach us a little something. Yes, this 15-day posting was wonderful. So much so that now it is over and I have this vacant feeling. My elective posting is Dermatology and it's back to being an intern doing all the menial jobs. I'm still in that mode of activity and multi-tasking. It is going to take a long time to get back to my usual job. Ha ha ha. Check this out. On day one, I had already hated every minute of that Casualty. Now I actually miss it. He he!!
So, how's the Internship going? It's going well. I'm enjoying it and I've learned quite a bit :-)

My Go-To Comfort Food

This was my first attempt at making pasta from scratch....not scratch actually (I got ready made pasta)....but I made the sauce...and it tasted delicious...yumm.....it will always remain my go-to food....always :-)

Musings of an Insecure Mind (innate + internship-effect)

It has been almost two months since I last wrote. Internship SUCKS. And as days go by, the feeling of getting used to the whole routine doesn’t make this thought any more palatable. When I was in final year, all I wanted was to get out of it and redeem myself with that one month break between results and the end of exams. During that one month, each day, I went a step closer to the beginning of this internship. Damn, I hated that.

We’ve had Paediatrics and are currently posted in Orthopaedics. Let’s begin with Paediatrics-

If there is ever a place that can frustrate you no end, upset you to interfering with your sleep, anger you to the extent of wanting to burn the place down, exhaust you to such a degree that the mere thought of burning the place down makes you anxious about the extra work you have to do….it is Paediatrics. I did not see my home clearly. I used to leave early in the morning and come back late night only to go to sleep and start with the same routine all over again. We did not get any holidays (No Government Holidays and no Sunday Holidays either). I was pitted against the most annoying girl on earth (no, probably universe)….not just annoying, manipulative, irritating, fussy, un-accomodating and a COMPLETE BITCH, if there ever was one. Out of the four weeks that I was posted in Paediatrics she was with me in three. It started with small fights, and by the end of the month, there was a war. One more day and I swear I’d have slapped her in front of the entire ward. That would have been exhilarating. I don’t mind working long hours and learning something. We did not even do anything amazing. In the ICUs all we ever did was monitoring, until I got myself the job of taking skin and rectal swabs for new patients and making the Bubble C-Pap for the Respiratory patients. I did learn Tracheal suction. I think that was a major landmark, because after we interns started doing it, all patients on the ventilator walked out healthy. Since there was no Junior Resident posted with us, and the Senior Residents thought it below their dignity to do something like a tracheal suction, we lost a few patients to ETT blockage. That thought hurt, you know. It was our fault, after all. So, the next a patient was put on the ventilator, we all took the responsibility of ensuring that a block wasn’t the cause of death. The pride I felt when I saw that girl walk home (breathing on her own) was the highest feeling I got in that one month.

We did not do lab, all we did was, take it from the residents and send it to the concerned laboratory. That was a bad feeling. I mean, you are interns. Lab collection is what you DO. In Paediatrics, they stripped us off the one job that we usually do with a little pride. Add to all this, the stress of the Project, Poster and 25 MCQs that we have to make during that one month. I was intent on making a paper out of my project, so I had to do it properly. I don’t know how I managed it all. I haven’t been so lost to the world and its happenings as I was during that one month.

Orthopaediacs, in comparison, is a fairytale. They have allowed us rotations so ultimately, each of us needs to go and work only twice a week. Emergency days are terrifying. It is heavy and there is no question of eating or even sitting down on that day. I finished my second ED yesterday and I was dead. Completely dead. But, I get time at home….time to make my research papers, time to send them to journals, time to do all the other work I have pending (like writing this blog J ) and time to just sit and still tell myself, you shall have time to study later on.

All is currently good. But, of course, I can’t wait to finish Orthopaedics. I like studying it, but I don’t like being a part of the team. I don’t particularly enjoy the whole scene, never have.

What I really want to write about today, is something that I heard yesterday. So friend of mine messaged me yesterday saying that he may be the topper in Paediatrics in our college. The list may be out this week (or there may be a function this week) and since he isn’t here, I may have to go and check. Have I mentioned before that my Paediatrics marks hurt? I missed out on distinction by one mark (and that left me with no distinctions this year, which hurt in places that I knew it would hurt). Wost part is, I know exactly where I lost that one mark that could have given me something close to pride about my performance this year. Yesterday, he told me that he may be the topper and also that he had crossed that distinction mark (75%). I had been cherishing this tiny hope that I may be the topper of Paediatrics (because the people above my rank have all scored less than me). I was hoping that I may get at least one prize this year (since all the others are totally out of my reach). But, that doesn’t seem to be so now. This friend of mine has scored way lesser than I have. It never crossed my mind that he could get more marks than me in any subject. When I read his message yesterday, I had half a mind to not reply and half a mind to send a really rude message. Ultimately, I gave myself some time to cool down and sent a congratulatory message. Which has left me pondering over my morals-

I always give importance to the marks scored. I want those awards, all that adulation, not because it swells my pride up to the point of bursting, but because it makes me think a little better about my own capability. In the long run, nobody will give as much importance to number of distinctions I got in so many number of subjects, or the list of prizes I won for my academic excellence in college (not even at the University level), or that fact that I stood 1^st/2^nd/4^th in class. What will be more important is the research I’ve done, the papers I’ve published, the places I’ve been to, the skill I have, the knowledge I manage to use practically (all that an examination doesn’t test at all!). And yet, I go hankering after all these marks, all the ranks, all the awards I don’t get….I, even if it is for a moment, spoil all the positive relations I have with people I call ‘friends’ and wish they go rot in hell. I hate being like this. This is insecurity. Insecurity that shouldn’t even be present because time and again, I’m facing examples of people who haven’t had the kind of academic achievements I’ve been lucky to get, but are doing amazing things, getting awesome placements in the best Universities in the world.

I wish I could change myself, I really wish I could. It is a good thing to desire to achieve the best there can be. But, it comes with this sort of a mentality as an auxillary, then it isn’t worth thinking of reaching that place.

Yes, its all out now…feeling better J I have a two day off now. I hope I study J

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. 

BLS and ACLS

I thought of writing about the two most important things for me right now, together, but then it didn't really make sense. Let's have two different posts then.
I managed to complete the Basic Life Support and Advanced Cardiac Life Support Courses. I am now a certified provider of both, and man, am I so confident and happy about the two!!
Day one was really good. One of my chief problems has been talking to people. Somehow, the two years higher secondary school and the four years of college taught me everything except communication. I haven't been the kind of a person who makes friends everywhere she goes, and these experiences just added to that trait more than ever. I haven't been doing a lot of out-of-college stuff, so the chance of trying to get out of this trait never came. I was worried about the experience of doing this alone. But, you know what, I'm not that bad after all. I did meet new people and definitely made a new friend :-)
Going back to the actual course- BLS was fantastic. Initially, the task of doing 5 cycles of 30 chest compressions with an interruption of <10secs :-="" :-p="" a="" after="" aha.="" aha="" an="" and="" anything="" arm="" as="" association="" at="" been="" between="" beyond="" bls="" but="" by="" can="" cardiopulmonary="" certified="" course="" day.="" designed="" do="" end="" examination="" got="" had="" has="" heart="" helps.="" hurt="" i="" if="" in="" into="" involves="" is="" it="" learning="" man="" merican="" method="" mode.="" more="" my="" nbsp="" now="" of="" on="" over="" p="" perceived="" period="" plus="" practical="" protocol="" providers="" really="" resuscitation="" s="" see-and-learn="" session="" step-by-step="" stupid="" superb.="" teaching="" technique="" than="" the="" there="" things="" this="" time="" to="" tough.="" under="" was="" we="" well="" were="" which="" wrist="" written="">

ACLS was more taxing. The whole process was beautifully organised. We were shown videos of teams managing cases...step-by-step videos....followed by putting-it-all-together videos, so the idea of an ACLS team was put through to us via visuals than mere didactic sessions. Those videos were a class apart. I have always admired the importance of protocols and organisation given in the Healthcare system in the US. This course provided perfect evidence to my previous heard-from-others respect.

From my point of view, the ACLS was more demanding. I haven't worked in a hospital before, haven't been a part of a team that needs to save a dying patient, haven't ever needed to think fast, act fast, be on my toes all the time, manage a whole team, think of what everyone is doing and ensuring that it done well. That is exactly what this course was about. I was the youngest person there, having just completed my final year of undergrad (and not even a doctor on the first day, our results were declared that evening). I was quite taken aback, when they said that we were going to be tested on our ability to be team leaders and guide a team to perform an ACLS service. Yeah, here I was, fresh out of medical school from India (where they don't teach you anything not-theoretical)....having my own doubts about calling myself a doctor and now, I was supposed to consider myself the most experienced out of the whole team and order them around as if I knew what it was exactly I have to do. I've always had my doubts about my own capabilities, but the second day of our course, those doubts stood out like tall pillars hiding me from what I knew was to be done. The instructors kept saying that when you know the algorithms by heart, there isn't much difference between a doctor and a non-medical person. All you have to do is follow the protocol and the algorithm.
Then came the task of identifying cardiac rhythms. Have I ever mentioned how stupid I am, when it comes to cardiac rhythms? Those ECGs were never taught to our batch (our bad, and only our bad. All my friends in other batches came to final year knowing how to read ECGs). They gave me nightmares during exams (and my final university examination, luck stood by me. I got an Inferior Wall MI to identify, the only rhythm I could identify). So, when they said you have to analyse rhythmns, yes, I threw up inside of me. I'd rather do something else. What added to my stress further was that everyone else already knew the rhythms (thanks to being doctors working for years, or doctors who'd completed their internship.). I was terrified. Let alone having ever seen a defibrillator or a TCP device before, I couldn't even identify rhythms. How was I to know whether to shock the patient or not?
Day two left me a little bruised inside. I was wondering how I'd fare in the examination the next day. I was wondering whether it had been a good decision to do this course now, at the start of my internship. A lot of questions swum around in my head, as I mugged up all those algorithms and tried out all sorts of permutations and combinations of them, thinking of patients weaving out of one rhythm and going into another.
I don't know whether it was the feel of a new day or just the fact that I'd studied hard enough to finally get hold of the idea, but next day (i.e. yesterday) when we practised again, I was understanding things, thinking for myself, looking at myself as a team leader, and gaining confidence as I did it all. It helped that our instructor was very pleasant and very nice about all the doubts I had, explaining every little thing to me. So as luck would have it, my practical went really well. So well that the examiner asked me where I worked :-p Lol!! When I told him that I was yet to start with internship, he gave me this surprised+satisfied look and said, "Very Good then. I thought you were working in some institution." Such a boost. The theory was a little tough, but I managed to get the required percentage. Yay!!

So now I am a certified BLS and ACLS Provider for two years....I have the confidence to know and do exactly what I need to save a dying patient in the casualty....and yes, I feel more like a doctor now than I felt immediately after our results were declared (when I officially became one :-p)