Are you an Indian? enough?!

I was really hurt today when i saw saw my fellow INDIANS not standing upto the National Anthem.
Spending my last few days of internship in Nepal and then it's a good bye forever & so have been doing some crazy stuff lately. No, i won't go into the details ;)
So i went to this early morning show on saturday of the latest relese "MARRY KOM" which is an amazing movie by the way and you should probably go and see it.
At the end of this movie they play the Indian National Anthem and an onscreen message appears that 'Please stand to respect the National Anthem', and so i did which comes so naturally if you come from India, isn't it? For me it's like sugar to my ears (since i'm a sweet crazy) i will even stand if someone whistles or hums the National Anthem. But there inside the movie hall i was really surprised to see that other than me and my friend no one else stood during the anthem. OK fine i was in Nepal and i don't expect them to stand but where is the National spirit of the Indians present inside that hall, my fellow interns, college students none rose to pay respect, and thats really saad. What is happening to our country?! Has the education level become so low that they are not even able  to teach the students to stand up during the National Anthem, pay some respect to mother INDIA. For we have been taught and brought up in such a manner that we'll even stand to honour if some other country's national anthem is being played. That's how it should be, that's how you pay respect, that's how you make relationships and not by being selfish jerk. C'mon have some respect for your beautiful country which is RICH in every possible way, you just need to have eyes to see that. This is INDIA and i'm proud of it's rich heritage.

I love my country.
That's all i had to say.... this place has thought me a lot and this was one of the biggest lessons that i got is, if you can't respect your country your country will not respect you. People like you deserve to stand i line, people like you deserve to be drained out by corruption and people like you should end up having a poor and miserable life because the riches of our land was not inherited for you. Jai Hind!

A small day

Waking up at 8 already shortened up my day by an hour that day. I knew i only had a small number of cases in the ward, 1 to be exact. As the day progressed the sun came out of the foggy sky shining in our medicine opd. "I'll be back soon, till then you stay in the OPD" my supervising Doctor said. And after a short interval he was back with a tall, fair athletic built man with blonde hair and golden beard and next to him was a lady matching his height and built. He was wearing a sea weed green cargo with a royal blue T-shirt and she was in casuals. Both of them having typical features of englishmen were in fact really from U.K.
"They are from 'The Discovery channel' to shoot my interview about the smallest man in the World" sir tried to answer my question marked face.

World's Smallest man

Followed them the SMALLEST man in the world in a wheel chair driven by his brothers. This was a man with height of not more than a feet and  a age of 72 years. He couldn't walk around attributing to his extra fragile bones since his childhood.

Discovery Crew

I tried to make conversation with the Discovery people and came to know they are shooting 10 different & unique stories around the world and each will be shown as a 1 hour show in the near future on air. I was assigned to help them around and meet their requirements of background people and different locations for the shoot. Small did i know then that this will turn out to be something outstanding. Once the interview of my supervising doctor was over he left and next shoot was done at another location about how investigations were performed on the smallest person alive.
After all this one of crew member walks up to me and starts talking in a very casual mode "Yeah, almost every thing is over, we have all that we needed. We got his checked, got all the investigations done. Now we are just left with the last part which is we gifting him a hearing aid and we need you to put it on him while we shoot it."

Discovery crew

"WHAT!" - they took me in by a huge surprise, i continued "No i can't do it, i'm not even a audiometrist. I'm nervous" But alas they didn't listen and 5 mins later i was being pictured putting a hearing aid in the smallest man in the worlds ear. He was very happy after that and was listening very clearly. Then with a warm friendly handshake they all left thanking me for all the help and company.
The day was small indeed, a small stay with a small man and a small role made it Large, Xtra Large i'd rather say. I played a part in a show which is soon to be aired on the international television around the world was all i needed to know for a sound sleep that night without worrying about it to be small or big. I don't know if they will keep me or edit me out but i have lived that day that moment - no matter how small it was, the memory of that feeling makes it immortal.

Close to Nature

Adventurous New year begins with our last minute plan to "CHITWAN National Park Reserve". On the eve of new year a spontaneous decision making ends up with 7 of us in a van to Chitwan on the very 1st day of the year.

The sky was clear and river was calm when we reached for boating after having a mouthful at the local restaurant. Unknown of what was about to come we sat in the low, single rowed canoe. 10 of  us and a boatman. So slowly we start off having a adventurous beginning of the new year into the deeps and very soon we were frozen below the sun with the sight of a 8 feet alligator at not more than a distance of 30 feet from us. It laid there like a statue at the shore warming it's cold blood under the sun. We could tell it was real and not a statue when it snapped its mouth with us crossing by.

That ecstatic view automatically made us reach our cameras and seal down the moment for ever. Ans then for the next 30 minutes it kept on coming... first 8, then 9, 10 and so on. Largest we would have ever seen so closely, it's a different issue on the TV. And then there were the small ones also, it was a croc pit. On one hand we were shit scared that why no one warned us beforehand and on the other the Adrenaline rush made it quite a fun trip. Maybe reaching the land was the best part of the trip but then again we couldn't wait to go back in again.
From there we reached our next tour point - 'Elephant Ride' in the jungle. 4 of us on the back of a girl elephant (i know girl for the mahavat told me) and then through the jungle ducking our heads at branches and seeing no more than the common jungle deer and the spotted deer but it was equally fun. Not lucky enough to see the famous "One horned Rhino" has surely planned out a next trip of the jungle very soon. The hot summer when the Rhino comes to drink at the pond. It will be a night well spend at the mid jungle tree house also a good treat for the bird spotters.

Chitwan was truly remarkable a day and tired of all day's journey we had a quite time on our way back in the van but all of us were glad that we made this plan. Looking forward to a adventure filled year ahead.

A Happy Day 1st Jan 2014

ECG has to be done

I was confident today that i will take out the ECG perfectly after i had done it wrong the last 3 times. I pressed the button and the ECG started rolling. The 'first lead' came out good, the second was also nice, by the time i reached the third it stopped. "It must have run out of paper" with these words the nurse put to me in a ease.
               I was looking at the 'BPL' logo on the ECG machine and in my head 'Next i'll press this button and then that....' when suddenly my name rings in my ear breaking my analogue thought stream "Sarthak! Sarthak! come here fast". My duty time was already over nearly half an hour ago and next shift interns had already come in. I stayed behind only to do that ECG so that i'd be able  to handle things in states of emergency and no hands to help around. Dr. Durgesh had joined the institution as a MO just one month earlier to me and we get along pretty well. He taught me suturing, bandaging, NG insertion, catheterisation and pretty much all the basics of emergency medicine. Just like any other profession that needs team work Emergency Medicine also gets very interesting if co-ordination between partners click off.
                                       Same is with me and Dr. Durgesh who was calling my name at that moment just next bed from where i was standing. A young man of 38-40 had come in about an hour ago with loss of consciousness and alcohol withdrawal effects.We have had the the necessary and the patient's condition were stable. When suddenly Dr. Durgesh noticed 'NOTHING'. Nothing here means a lot, nothing to a militant is Safe, nothing to a teacher is a quite class, nothing to engineer means no errors in calculation, or simply nothing is nothing at all for anyone else but nothing for a doctor is a lot of things because none of the symptoms were present over that patient and we could see no movement of chest or limbs, absolutely NOTHING.

CPR

                             Without wasting any further time i reached the bed and immediately understood what Dr. Durgesh was calling me for. Within seconds my left palm was over my right which was placed over the sternum (mid point of the chest) of the patient. I was giving CPR (Cardiopulmonary resuscitation). "Get me the AMBU bag" - i cried for help to one of the replacing interns who immediately fetched me a over sized egg shaped self inflating air balloon which is used to push in extra air into the lungs of a person who is unable to breath or so. From the other side of the bed nurse was being directed by Dr. Durgesh to push in 1-1 ampule of atropine and adrenaline into the veins of the patient. With every five compression of the chest Dr. Durgesh will punch in a gush of air from the AMBU bag into the patients lungs. The power needed for the surge was so great that each time my body would rise from the floor while doing so, so at last i climbed onto the bed and started again with better stability.

Different age group AMBU bag

                                             I knew climbing on to the bed was a good idea from this morning where almost a similar situation had taken hold it's grounds and with a similar scenario setup i was doing CPR and Dr. Durgesh was pumping the AMBU. This man was 73 years old, heavily Diabetic and was brought in by his daughter with a hypoglycemic shock. Our profound measures to resuscitate him were going in vain and at last when there was NOTHING we decided to go in for CPR. After giving in all our heart we failed to start their hearts. This followed in the hardest part - Declaring the death of the person to the family.
                                     I was relaxed for i was sure i wouldn't have to do that but did wanted to watch and learn how to do so for my future references when it suddenly struck me 'The MO's were not declaring that person as dead. But WHY?!' This was something new & interesting to me. I knew the man was dead, the MO's knew he was dead, even the family was sure that the person was no more with them but then why was not he being declared dead? What did i missed from the scene? Was there still some hope? All these questions running inside my head and no answers were appearing i decided to ask Dr. Durgesh my only faithful companion in front of whom i could do silly mistakes and expect him to understand.
"Sir, what is going on and why isn't he being handed over to the family?" i inquired eagerly.
"The ECG has to be done yet" he answered  simply
"Why to waist ECG when we already know he's dead?"
"We'll it's our clinical proof & we can declare him dead only when the ECG turns flat" He understood my  confusion and cleared it out.

Flat ECG

                 But not for long was i satisfied - The ECG wasn't flat. Did that meant there is still chance??? And my very thought was answered by Dr. Krishna who explained the situation to the patient party since they were in a hurry to take the body with them. ECG will turn flat after sometime once the effect of atropine and adrenaline as well as CPR wears off. So until the CPR turns flat the body will not be handed over, death certificate will not be issued and the person will not be declared DEAD! During which so many mixed emotions turned up at the gates where the family is being consoled by the neighbors or by each other. Wives and daughters crying their lungs out and dehydrating themselves up. The only way to neglect all that is to make yourself useful again in saving other lives.
                                     The only humorous incident that happened that i had a bad stiff neck this morning but all the heavy exercise kind of did me good and i could move my neck in all directions again by the end of the day.

I want to see a Physician

My working days in the hospital as a intern has taught and showed me a lot of things in the past 3 months. So many recoveries, so many miracles, so many happy faces and equal number of deaths. People die in front of my eyes everyday, no matter how hard we try, their death somehow seems evident. Medicine saves lives but can't bring back the dead. Our life is in our own hands to cherish & nourish it.

                Everyday nearly 2-3 cases of poisoning reaches the emergency department who tried to commit suicide or moreover should i say tried to scare their family by making a drama. Drama because none of them take enough amount of poison that will kill them. They just make it hard for them selves and for the poor family members. Once during my duty hours they bring  in a patient who himself was accepting of having taken 'sulfas' a potent poison with 100% mortality rate. It's very rare when people survive after taking SULFAS. However this guy seemed alright except for looking drowsy. His family had made him drink soap water and make him vomit thrice on the way reaching here. Unless and until you know what poison has been taken it's very difficult to decide the antidote. We treated him according to the symptoms which clearly indicated some other poisoning. He had pulled this drama just to scare his family and to show them that he's a serious man who can even commit a coward thing like suicide. Each day number of such cases are being reported in our parts of the world.

Death comes as the end

                 Similarly a lot of other cases show up at the end stage of the disease. People keep on avoiding their problems and try out their home remedies to take relief. And when thing finally move out of hand that is when they remember a doctor. At this point it's difficult for us as well, people then not to reckon that. And over that they expect us to magically make the person fit in moments. We are doctors not magicians. Today with our advance life style and fast food fashion we invite a lot of unwanted and serious health problems. Surveys have shown even small children as low as age of 14 are having hypertension. People are now dying at an early age with Heart Attack being the most common cause. Every second person is having diabetes and every third is having arthritis or gout.
                 "What's the solution you ask?" The answer is simple - "Healthy Lifestyle". A complete self controlled and simple way of living promises you a long and disease free life. With the help of Lifestyle channels and the Internet people are well aware of what's good and what's not. To avoid the very common tormentors of life like hypertension, gout, angina etc. you should keep a check on what you EAT, the main culprit to all that is happening to your body. And the point where you have done your part comes in the role of a General Physician.

General Physician

                  A General Physician (GP) is your personal trainer to a healthy body, your coach to kick of diseases & your guide to a beautiful  ailment free life. A GP is your first step to the medical  world. He's the station master who directs you to specialists when required. Whenever we fall ill we shot for specialists which is not the very best idea. One should go to his family physician first as he knows you well, knows your medical history, knows your allergies and he is as good as a specialist when it's just a fever or stomach ache. He'll examine you and when things are out of his reach it's then when he refers you to a specialist. Going directly to a specialist has it's own merits and demerits like he will treat you in the same line of drug as GP if it doesn't require any special treatment. Also he'll charge double the physician's fee. It's hard to get a specialist's appointment and above all he can only treat and think in the direction of his specialization and none other.

ENT Specialist

Eye Specialist

Child Specialist

                
                                     For example a Cardiologist will keep on looking for something wrong with the heart and will not treat for any stomach related disorders and vice versa. Whereas a GP will look in general the whole body and it's different parts instead of referring to different persons for each part. A GP can treat from diabetes, migraine, jaundice, malaria, dengue, tuberculosis, hypertension, gout, arthritis, peptic ulcer, gastritis, psychosis, etc. to hypochondria, suturing minor cuts, fungal infections, psoriasis, alopecia, menstrual disorders etc. To sum up almost anything as long as it doesn't requires surgery or micro specialty like cardiomyopathies and nephrology etc.

                    
                               Sadly lack of this knowledge among the commoners is leading to a shortage of GP's in our country. As people shot for specialists in every medical emergency GP's tend to do specialization and are able to charge more. We can only help improve the health services in our country by demanding GP's and reducing the overall medical cost. The fist thing is you to have yourself a family physician whom you can reach over the phone or call home at time of emergencies, whom you can visit all year round and get your selves regular health check ups. Your GP can direct you to all the test you are to get done regularly instead of wasting your money on a big amount of tests which are not even necessary. He'll tell you what to eat and what not to if you have diabetes or gout. What to do or what not to when you have tonsillitis or hernia, and endlessly so many things. 
                   My 3 years of internship has taught me a lot of things but it has lead me to become a MD GP. MD because people slaves to their nature, will look for a specialist when ill and GP because what they actually need is a GP. Know more and help yourself, help the society or stay ignorant and witness the downfall.

A night at ICU

          My eye opened to a knock on the door. I checked my watch, it said 5:30 a.m just 2 hours since i hit the bed in the ICU doctors chamber. I could hear ventilator buzzers and nebulizers. I opened the gate and sister was standing mumbling something about a patient complaining about dizziness and blurring of vision. I knew what to do since i had attended her before going to bed. 

               Only last night i had joined the anesthesia department  which runs the ICU under it. It was my first day as well as first night. I got acquainted about the cases present there through the files. I being the only intern present there a anesthesia JR was to help me out. Out of 7 cases in the ICU 2 cases were in a very critical state and after instructing me how to handle them he left for OT at around 8 in the night. There i was all alone with two sisters to assist me and my only help was my knowledge.

     

Monitoring of the patients

                            I was supposed to monitor for patients Blood pressure changes, heart rate, SpO2 (measure of oxygen level in the blood) and a few other medical standard measures like pulse, temp. etc. I took a round and sat in my seat with the idea in my mind that they are all peacefully sleeping (or more likely unconscious) and i will sit for a few hours and leave at around 12 o'clock. But little did i know i would be working for the next 18 hours.
                           As soon as i sat down the sister calls for help. "Doctor! please open the vein of the patient at bed number 8, it's very feeble & i can't find it". If you couldn't how would i?! i thought to myself but still went in for the challenge and after a series of pricks and blood drops all over the bed sheet i achieved success. After wiping the sweat from my forehead i was just about to sit down then suddenly patient party of bed number 4 starts panicking as the cardiac monitor was not showing SpO2 readings. They thought that patient was gone but only the SpO2 probe wasn't working properly & i asked the ward boy to change the probe and things were back to normal again.
           "Doctor! BT Note" requested the sister. BT note stands for blood transfusion note which is a formality before transfusing blood to a required patient in which we write the transfusion details asking to stop immediately if any such transfusion reaction occurs. BT note was not a big deal for me, i had done that before also. But this time i realized i was the only doctor around and if some reaction does occurs i will only have to take care of the patient. My worst fear had  come true and patient did showed signs of transfusion reaction. Thankfully it was only high grade fever and not any other fatal reaction which i feared. "Stop the transfusion and give her paracetamol" i asked the sister.

Nurses Station

             While waiting for her temperature to come down BOOM! comes in another case from emergency medicine. Case of alcoholic liver diseases who also was suffering from withdrawal symptoms. Withdrawal symptoms are something that occurs in an addictive patient weather alcohol, smoking or drugs when it is stopped suddenly. The patient becomes heavily agitated and same was the condition over here. Patient was tied down to the bed and was screaming incomprehensibly. I called upon the JR for help. After few minutes of his arrival we were fixing canula in the patients hand. I was holding the patients hand with all of my body weight other wise the needle may break inside his body and will create messy situation for us. We succeeded eventually some how saving me from the patient who tried to bite me. "Give him a combo of Phenargan and Serenec (heavy sedatives) and he will sleep now" the JR directed me and left after reviewing the critical cases once again. But those heavy sedatives also didn't do us much help. The patient was still very hyperactive and free himself from the bondage 3 times. We again and again with the help of the ward boy tied him down and increased the dose of sedatives uptill 12 o'clock.
                                          Then rises yet another challenge for me when the SpO2 of the patient  decreased suddenly and immediate oxygen supply was required. I asked the ward boy to open the oxygen cylinder and started pumping oxygen through the Endotracheal tube directly into the lungs while the sister started suction on the bronchial secretions. After a desperate attempt for 10 minutes and heavy backache i could bring back the patient's blood oxygen to a satisfactory level. Her secretions had become very thick and i had to change her NG tube (naso gastric tube that is put through nose upto stomach, also known as Ryle's tube) which was again a very tricky job the patient being unconscious. How ever i had a good practice of this when i was posted in emergency medicine so without much difficulty i could change her NG tube.
                            After the last vital check ups of all patients i checked my watch - it was 3 am. I sat down at the nurses station and was surfing the my phone for any pending messages when a patient party approaches me "Doctor please tell me will my son live or not?!". "What?!" i said surprised getting up from my seat and looking for the patient if something just happened. "I don't care about the money, i have already spent 4 laks and i can spend more. I'll sell all my fields. Just tell me what to do?" I understood the patient party was emotionally exhausted. I tried to calm them down and give them hope, but there is not much hope left when the prognosis is negative. Their 4 year old child was struck with Gullien Bar disease in which their is very very minute chance of survival.

Nurses Station, Old man keeping
watch over his son's heart rate

                          Another case was of a young teenager who tried to commit suicide and  was brought in as a case of unknown poisoning. He was having sleep bradycardia and each time he falls asleep his heart beat will drop massively. His attendant his poor old father had to stay awake all night and kept waking him up each time his heart beat will fall below 40. That old man kept staring at the cardiac monitor. I asked the sister to inject 1 ampule of atropine so that the old man could also get some sleep and the boy's heart rate would stay stable for some time.
                              I looked at my watch it was 3 a.m and it was getting very hard for me to keep my eyes open. "Doctor, go and have some sleep. we'll manage now" the nice sister told me and i went to bed. In the morning things looked very different. How funny when you experience some trouble with your computer of bike and you take it to the service center it works just fine. Similarly when the JR's from anesthesia, medicine, pediatrics and surgery arrived in the morning all the patients were stable and looked good. I completed the daily S.O.A.P note (subjective and objective assessment plan) of the patients and left the ICU at 9:30 in the morning when releaving intern came in.
                                I helped my self to the anesthesia department for my attendance to the HOD where i was caught to attend the daily presentations. I sat there for next 1 hour with my eye half open and thinking of the event of the night. How every patient had to be looked upon, the mental status of the  patient parties, someone is ready to spend laks, some one is unable to understand the critical condition, some one wants to take the patient to higher centers. I sat there and thought of the life waiting for me in the future, the life which is not mine anymore but for the betterment of the mankind. To help the poor, the needy and most important of all to save a life. I returned to my room in the hostel at around 11 in the noon and within no time was fast asleep into my dreamworld.

Roofies for Rookies

A message on my phone read as follows :-

"A woman at a nightclub (Mumbai) on Saturday night was taken by 5 men,

who according to hospital and police reports,

gang raped her before dumping her at a Busstand in Mumbai.

Unable to remember the events of the evening,
tests later confirmed the repeat rapes along with traces of rohypnol in her blood. ...

Rohypnol,
date rape drug is an essentially a small sterilization pill.

The drug is now being used by rapists at parties to rape AND sterilize their victims.

All they have to do is drop it into the girl's drink.

The girl can't remember a thing the next morning,
of all that had taken place the night before.

Rohypnol,

Not able to remember your rape is even more horrifying

which dissolves in drinks just as easily, is such that the victim doesn't conceive from the rape and the rapist needn't worry about having a paternity test identifying him months later.

The Drug's affects ARE NOT TEMPORARY -
they are PERMANENT.

Any female that takes it WILL NEVER BE ABLE TO CONCEIVE.

The weasels can get this drug from anyone who is in the vet school or any university.

It's that easy,
and Rohypnol is about to break out big on campuses everywhere.

Believe it or not,
there are even sites on the Internet telling people how to use it.

Please forward this to everyone you know,
especially girls.

Girls,
be careful when you're out and don't leave your drink unattended.

(added - Buy your own drinks, ensure bottles or cans received are unopened or sealed;
don't even taste someone else's drink)

There has already been a report in Singapore of girls drink been Spiked by Rohypnol.

Please make the effort to forward this to everyone you know.

For guys - Pls inform all your female friends and relatives."
This is imp message pls spend some time to read it completely...n pass it to all.

------------------------------------------------------------------------------------------------------------
So i thought of throwing some light on the article as well as the product. Rohypnol is just a trade name and the real name is Flunitrazepam. Which is used by psychiatrist on mania patients to calm them down and provide them sleep. They use benzodiazepam grouop of drugs.

But perticularly fluniterazepam has a adverse effect that it can cause retrograde amnesia i.e. the patient wont remember ample details. Other facts are true in the above message. But there is no effect of it causing infertility. Victim will still conceive and in future also she can achieve pregnancy. It can only cause harm to the fetus only if victim is already pregnant.
Fluniterazepam's most dreadful adverse effect is that is may cause coma or even death if given in higher dose and it's action become stronger if taken with alcohol, which is the case mostly. But then again let me assure you guys that this drug Rohypnol or roofies is not easily available. it can only be obtained on prescription that too in 1mg dose. Also rarely used in india. It has been banned in most posts of the world and is classfied as scheduled class 'A' drug and possessing it without proper medical prescription is illegal. It is common in Singapore, south Afrika,  norway etc but not that much in India. For more details check out yourself Date Rape Drugs or  Rohypnol

Know more and be safe or be ignorant and suffer the consequences. It's completely your choice.