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.

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.

So called inspection

Nearly a week ago we were informed to make ourselves prepared for N.M.C (Nepal Medical Council) inspection & we were looking quite forward to it. Since years unknown such inspections have been taking place now and then but still hasn't been able to turn a single stone of this college.

I think this is so because they don't use the element of surprise. They happily inform the college well in advance granting then enough time to make preparations for their proper welcome. This is the time when our college sparkles up. Every department has quit a number of names in the list of the doctors working there. The actual number may be not even 1/4th but during the inspection days all the faces become visible walking around the OPD and the canteen.
I myself got introduced to few of the new faculty members on the supposed day of inspection. On my way i saw the nursing students nicely dressed, waiting for the inspection team with flower bouquets. Notice had been published earlier itself by our well reputed MS issuing orders for all of us (doctors,  interns and JR's) to look sharp and formally dressed. 

People formally dressed

So be it, i also went in wearing my best attire with a batch on my apron saying 'Dr. Sarthak Chakravarty'. Let's us also enjoy the attention sometimes. My colleges also walked in wearing formals and looked ravishing. Inspection time is kind a like a carnival in the hospital, people running up and down inquiring weather the inspection team has arrived or not, sweepers cleaning every bit of dirt from the floor, ward attendants spraying room freshener all around, all kind of patch work going on which kind a made a few corners totally unrecognizable. Mess swelling up with all kinds of delicious mouth watering recipes which gives almost the same food everyday for rest of the year. Doctors have taken on their aprons after dusting out from the almirahs. And many similar changes were seen around the campus.

People trying to look busy

"They have arrived" came in the news. Everybody trying hard to look busy, engaging themselves in something or the other. I being posted on the top floor of the OPD waited nearly 4 hours for the team to reach here. Yes i was all prepared, i knew how many faculty members were there & what their names were (all mugged up), i knew how many students were posted, what topic is being taught, what all operations are being done, yes i was ready.

The team arrives, goes upto the HOD, shakes hand. Asked the JR a question or two and that's it. It was over, done, finished..... no one asked me anything. All mugging up went in vain, down the drain. I knew i should have worn in the imported perfume but no i had to use the stupid NIKE deo! Well nothing to do now but we all were definitely happy that it was over and no more formals from tomorrow, thank God for that.
I just hope the college doesn't shuts down before i complete my internship  and hopefully not as the heads of management have masters in the art of bribery. Other than that who doesn't likes a bit of carnival mood now and then ;)

Duty begins with a blast

It's now been 2 months since i have started my Medical internship at UCMS teaching college at Bhairahaawa.

Had a super duper starting - My 1st day was emergency duty & on the very 1st day i was assigned to put sutures on a scalp of a guy who had come in about 3 hours ago after having a big fight at home because of inter familial conflicts.
Well if a man got to do his duty he's just gotta do it. I called upon Mukund my very good friend a final year student back then. He also didn't hold any experience  in this particular art of suturing. After a good boost up from the MO incharge and mukund i entered the male ward. The injured was very well prepared to sleep and was already very comfortable over bed. After getting him to position i started shaving his head over the injured region with an incision blade (no razor was available). My hand shaking & mukund cleaning of bouts of sweats over my forehead. Soon the field was clear and there i was holding the "cutting edge, piercing 3.0 curved non-traumatic needle" (yes it's that long a name) in my hand, with an artery forcep and toothed forcep the other. Oh i almost forgot the injecting Local Anesthesia part. It's actually fun, you inject the periferal skin with 'lignocain' and keep doing that while small spurts of lignocain errupt all over the place. Anyway, now i was half a way through my suture by piercing the poor guys scalp a lot of times and don't know how many times saving my finger from that needle. Now comes the tricky part... what i had learned before was how to suture a straight wound but whats this?!!! This wound was in 'Y' shape, WTH! not which side was i supposed to move?
Now kicked in my common sence, or you can say it was a combined thought from me and mukund that let's stich one side first and we'll come back for the other later (only if i had learned sewing back at home, lol)
The trick did work and at last both of us were very happy that some how we managed to stop the bleeding from that poor fellows head & then MO incharge enters the ward. 'Good Job' he said and i was just wow, patting my self in my imagination which seized with the next word from my MO - "what about the other cut?"
"What other cut?" & then we found out that there was a another linear injury next to the one we have stitched & this one had escaped our eye. 
After a long painful back aching repeate of events finally we got a victory to make that guy medically fit.
And then the events continued for the next 15days throughout my emergency posting, from snake bites to poision suicidal cases and much much more.
Over all it was fun and fun still continues coz everyday in medicine field is a new experience, something new to learn everyday and somethings to make your life more meaningful. My adventure as an intern continues.....