Parting Note. . . . .

Life comes full circle. . . . .so does this blog.
And we must move on to bigger things. . . . . so after a brief hiatus I shall be back. . . . on WORDPRESS though!
I'm currently preparing for post-MS entrance examinations and exploring avenues and basically enjoying life.
Some posts from this blog shall be posted on the new blog by yours truly....so watch THAT space, not this one.

Coz sadly all "bad" things must come to an end. . . . . .

The doctor's rant. . . . . on CORRUPTION et al.

Read this forward..... thought I'd share it on my blog.
Dunno who the original author is..... whoever s/he is.... THANK YOU!

Guys this may take some time to read but it's worth it!..... an article by an eye surgeon on corruption in Indian Doctors:
This article is also a test of how our society tolerates the truth.
Recently read a flash news about eminent doctors taking cuts / referral fees. There cannot be any justification. But if a whole system based upon corruption, a whole society facing inflation expects only one of its components to be sane, it’s insanity.
Hence these thoughts. . . .
I apologise in advance if this hurts some feelings. This isn’t a placebo though.
For the “nautanki” people who appear so shocked to hear about corruption in the medical field, here’s the naked truth:
 There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, YOUR FIELD, and also medicine, as the doctor is a part of this very same society, not from Mars. There is corruption in every aspect of the medical field: referring a patient, lab tests, CT/MRI, Surgeries, Cross referrals, almost everything.
But as in every field, there are people who do it by choice, there are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

Think simple: why would a person with highest of merit, hardest of hard work, tendency for helping others want to become corrupt? Not by choice. No one becomes a doctor for greed (Someone might attempt, but these people drop out in the first six months or a year: Those not dedicated to a hard life cannot endure medical education in India).
Every doctor wants to do good to his patient and also live a decent life. After a lifelong meritorious career, why should he be expected to toil in villages / rural areas without any rewards for it? Why should he not want his kids to go to the best schools? Why should he not want a decent lifestyle? Why should one give up a lucrative career in the west and return to the homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?
“Someone who wants money should not become a doctor” said a dropout actor who is seen doing all immoral things (from peeing openly in a garden for press in real life to cruel crimes and revengeful murders on film, while running a show to change India to an ideal country.. I hope he and his family only use Indian things, medicines etc.). Why?
Why should a doctor not want money for a decent life? Why should he endure the humiliation of so many non-meritorious people from his class living in luxury because they chose not to be a doctor, while he chose the noble profession?
 Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating on time, not having enough time for family, why should a Doctor NOT want to earn well?
We are not supposed to refuse a case in emergency. Does the Judiciary or the Police or the Politicians behave in a similar manner?
We are fined crores for medical negligence. What if the Judge is wrong? What if the police are wrong? What if the politician is wrong? What do they pay even when proven wrong? Why the presumption that the negligent doctor’s intention was bad? Negligence is possible in all fields (reactors/ bridges/ buildings/ food/ trains/ public transport), can cost life in many, how come the doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive was profit, not saving life…?

How come the judges decide the amount of fine? In a recent case, the fine was in crores. If the patient had survived, would the court have ordered the same payment for the doctors? Doctors save millions of lives. Some through heroic / exceptional efforts, without thinking of rewards. If a young patient is saved, shall we charge according to the income he can make in his future? Then, why this criteria for fines?
The world has become a global village. People travel to the developed world often. Highly specialised doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.
But the Indian community is yet to awaken to the Doctor’s fees. An average specialist in the developed world charges between 10,000 to 30,000 INR for the first consult. Appointments are very difficult to get. They don’t work out of 8 am -4 pm slots except in emergencies (some honourable exceptions). And yet they get so many benefits from the hospitals they work at, and also from the government. THEY SEE NO FREE PATIENTS. Most doctors live in luxury in the western world.
 An Indian doctor on an average charges 200-1000 rupees for an OPD patient. Sees many free patients (almost 40-50%) everyday. Continuously has to be occupied with:
 1. Patient’s health and benefit
 2. Relative’s expectations, their anger (many think that every patient must get well irrespective of his / her health status). Many hold the doctor responsible for their illness / failure to improve/ complications.
 3. Continuous suspicion: Many patients think Doctors are out to loot! Every investigation is with an intention to get more profit out of the patient. They want the best, but like “sabji”, they want to bargain.
 4. There is also a widespread belief that pharma industry is actually serving the doctors, not patients.
 5. Google searchers who think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They eat up a lot of time, but don’t want to pay for that additional time.
 6. The very relatives who shout at the doctor seldom know what medicines the patient is taking: it is all supposed to be the doc’s responsibility.
 7. So many Toms, Dicks and Harrys coming over and threatening: this is everyday nuisance in ALL casualties in India. There is no sensible Director in Bollywood to have realised a Doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-Threatening” hero!

Next comes the seemingly innocent weapon (the secret bleeding wound in many a Doctor’s heart!!),
“But Doctor, You are like God / Next to God. The whole society respects you”
That respect is divine for us, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps us from going on and not quitting the profession for better incomes. Don’t you think we had the option of making more money had we used our talent elsewhere, especially in today’s IT world?
But that respect does not substitute for our children’s fees. Not for our rents, electricity, travel or  ANY other expense. Almost all doctors and their family members end up paying full bills for themselves at the very hospitals that they work in… with some minor exceptions. Everywhere a doctor goes, he pays the same money that any other citizen does. There isn’t a separate queue for a doctors anywhere in any office just because he / she has patients waiting. There is no pension. There is no security. I can show you some highly successful (in patient care) ethical doctors who can’t pay for their own treatment TODAY!! If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free.
 The respect does not substitute for the stress a doctor bears: of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.. as with anyone else, the DOCTOR ALSO HAS ONLY ONE LIFE… WHICH HE CHOOSES TO SPEND HELPING OTHERS.. is it a crime to be living well for such a person?
And if Doctors are next to God, very respectable, how come their mistakes become villainous immediately when something goes wrong?
As for the other side:
There are corrupt doctors, corrupt practices. But please understand, a single doctor did not create them, nor did a group plan them These developed over time as the system evolved. One had to fall in line or quit the profession for want of a better life.
 Like in every field, there are some rotten apples. They ruin the reputation of themselves as well as the doctors around them. But a single doctor cannot do anything. Those who try to change the system are boycotted, thrown away, maligned. There are some continuously fighting this.
Every doctor cannot afford to start a hospital of his own. He has to choose a speciality hospital which has all the facilities to practice his speciality. These come at a price. I appeal to the people who feel bad about investigation prices to just enquire the rates of the machines/ skills/ licences/ manpower/ maintenance required to make these facilities available. The government makes it compulsory to attend to many of its employees free / at subsidized rates, and never pays.. who will pay for them?
So hospitals have their systems. A single doctor cannot change them. Also, not all hospitals are corrupt.
The Medical councils do not have any protocol / system to protect a doctor who faces vindictive attitude from hospitals if he / she wants to argue. Many specialists DO NOT RETURN TO INDIA OR HAVE ALREADY LEFT INDIA AFTER RETURNING due to this one reason. Because specialist practice is based upon referrals, and where most of the referral system itself is corrupt, one has little hope of survival especially in a decent city / town.
Doctors who want to run their own hospitals face same bribery, same licencing scams, same corrupt government practices that any other business does. The rates are probably higher, and the regulations stricter.
Doctors are a weak vote bank., hence not on priority of any party. It is more practical for the politicians to openly criticize the doctor / profession in hope of gaining public sympathy / attention. No one wants to attend to their problems, which are many.
The medical council never protected any doctor against court cases or hospital victimising them for fighting against corruption. The regulations made are ancient, primitive. When a whole medical system is corrupt in almost every step, they have taken the approach of superficial actions against individual cases: typically populist and sensationalist. The medical councils KNOW every aspect of corruption, but have opted to fit in some screws where the whole building needs extensive repairs. One’s degree and education of fifteen years becomes meaningless in the eyes of medical council just because there is delay in renewal of licences. How can rules be applied only partially in a system? While many people practice without degrees or knowledge, the councils choose to target the qualified for not renewing their licences: a process that involves acquiring CME points, the money for most such events, travel etc. comes from pharmaceuticals, the patient pays. They do not have the online option of CME / licence renewal like most western countries, even in this advanced age! So a doctor is expected to leave his town and practice, get involved in events sponsored by pharmaceuticals, travel with help from pharma companies, stay in hotels with their money so as to renew his licence. But not online. And there is no compulsion that he has to attend the event for his specialty. So a Neurologist could attend a gynaecology event just for CME points and its okay for the renewal of his Neurology licence!! One can easily get such CME credits without attending the event! There has to be an online option, or a rethinking of this whole business. And an option to do it without involving pharmaceuticals.

Average number of books read by a specialist to get to where he is. . .

The whole Medi-claim business in India is a fraud: they don’t pay for
1. OPD consultation / investigations of a patient: even if serious.
 2. Patients with genuine illness, but without injectables or surgery.
 3. When they do not understand the diagnosis or the fact that some cases do not have a proper diagnosis.
 4. Emergency / Critical care / Specialist charges etc.
 5. Even when they pay, it is their choice how much.
This results in many a wrong practices, or the patients can't afford treatment at all.
So in a medi-claim case, no one benefits except the company: Patients, Hospitals, Doctors all lose. Still, the Medical councils do not want to do anything. In fact, they don’t have a say.
Add to these:
Incessant calls / emails/ whatsapp messages for any enquiries that pop up in the patient’s or relatives (usually the cousin in America) mind at any time of the day or night: and bitter words to follow if reply is delayed. (That doctor has advised so so… what is your opinion?... I just read on Google about stem cell therapy to improve my anger… what say? Etc. etc.).
Then there are sons and daughters who stay in US / UK etc., but leave their parents back in India. They expect the same care but at a low price, and also a daily update by the treating doctor. NO WESTERN DOCTOR GIVES OUT HIS CELLPHONE or EMAIL ID TO PATIENTS, THEY KNOW THIS, but they talk from there as if from the top of a mountain. They don’t want to come and attend to their dying parents, but vent out this guilt in the form of anger towards the treating doctor: Do everything doctor, don’t worry about the money. I am unable to come to attend to my MOM because of business meetings/ no tickets / kid’s exams etc. I lose my patience here often.
If a Judge / lawyer is ever reading this article. Your Honours, please consider these when you next fine crores to a doctor (even if insured, he has to pay huge):
A doctor should not be held negligent if
1. The patient does not follow advice as written.
2. Patient continues to drink / smoke / eat tobacco/ or does anything that the doctor has prohibited.
3. Does not follow up as directed (most patients miss their follow up dates: doctors are supposed to jump from illness to illness).
4. Does not show the same care towards his own life that the doctor is expected to take.
5. Has not given all correct information about himself / herself  and/or  his/ her illness
6. Hidden some information from the treating doctor.
7. Has lost treatment details.
8. Self medication / cross consultation without knowledge of the earlier doctor, resulting in multiple medications.
9. Has had unknown allergies / reactions in the past.
There should be a doctor’s board for each speciality which opines about every particular medico-legal case before the court makes its final decision.

I always wanted to be a good doctor, like most other colleagues I know. I have always heard the courts of justice demand that one speaks the truth. Here it is. Hope I am not punished for speaking the truth. I am not always correct, I am sure some of my friends will correct me. I will keep learning too.
A warning: If the whole medical system becomes non corrupt, patients will end up paying far higher consultation / surgical fees than what is paid now. This is inevitable. Add the legalities to everything, and many specialists will become non-affordable / non available to most. The many "phukatchands" who get free treatment now, will be denied that.
Or the next generations will see less and less specialists opting to settle in India.
I love my profession. I love my country. I love my patients too.
But I also deserve a good life. It is time I stop thinking I am God because the society has presumed so.
 May God confer best of health upon all humanity. May God guide me to always do good to my patient.

Thanatology: Death and the Doctor. . . . .My Perspective.

It was supposed to be a free weekend; one that I'd been aching for since weeks. You never expect a post double-emergency weekend to be free for a Trauma Registrar..... but, yeah, I did manage that feat in the middle of the week, thanks to people not drink-driving, falling, stabbing, hanging precariously outside locals, etc. etc. on Sunday or Monday (surprising!!!).
Anyways, today I got a call from my colleague in the wee hours of the morning that one of my patients in the Trauma ward had expired. To the best of my knowledge, I had no patient admitted under my care in the ward. So this statement raised a few eyebrows! On further probing, she was the trauma patient who I had shifted to the General ward around 2 months ago after stabilisation and had to be shifted back in view of poor general condition. Despite our best resuscitative efforts, the patient could not be revived and was declared dead.

I remember the situation around 3 months ago when this patient presented to our casualty as a case of Road Traffic Accident (RTA) with head injury. She was referred from a private hospital, intubated and on AMBU support. She definitely required a ventilator. I was the Trauma Registrar on call that day. We had no free ventilator in our Trauma Ward and I was forced to refuse the patient and asked them to take her to another public hospital where they most likely would have a ventilator available. The husband begged me to admit the patient. In such cases, we take an AMBU consent from the patient's relatives stating that they are willing to perform AMBU ventilation on their patient till the time a ventilator frees up (yes, considering it's a public hospital and with our limited resources and high volume of patients, we have to!!!). The husband appeared desperate. Apparently he had spent lakhs of rupees on her treatment in a private hospital and had run out of money and could see no results in his patient. Hence, the referral to a public hospital (a very common scenario at our hospital and hence the portrayed high "mortality-rate" despite the optimum care given).
This patient was under my care in the trauma ward for almost a month. I will not go into details of how she was resuscitated, stabilized and shifted to the ward after almost a month of being on a ventilator, being tracheostomised and then being weaned off the ventilator, undergoing a PEG (feeding procedure) etc. etc. All I can say is that I put in my best efforts to save this patient!
Shifting her to the ward after stabilisation was one of my biggest personal achievements given her co-morbid conditions as well (morbid obesity, Diabetes Mellitus, borderline hypothyroid).
To hear of her death got me thinking for a while.....

Back to this morning.......... After I heard the news, I cut the call, pondered for a while wondering what could have gone wrong and went back to sleep. Yes, that was my reaction. And, this similar non-sympathetic behaviour HAS become my reaction to the death of any of my patients! Am I heartless??? Think not.....
Death is an irreversible cessation of life- that state of the body that shows complete loss of sensibility and the ability to move..... the complete cessation of the functions of the brain, the heart and the lungs, the so-called "tripod of life" which maintain life and health. Death is a part of life and a part of my JOB. That is an unwanted reality that we as doctors have to face on a regular basis (especially in a trauma set-up). Initially, I'd be quite taken aback and found myself being emotionally involved. as a student in my MBBS days. After graduation, when I was authorised to declare death, I really couldn't bring myself to shed a few tears over someone else's loss, even if I wanted to. I gradually began to realise how and why this happened and why it mattered. As a doctor, I cannot let death take an emotional toll on my life. Yes, you may call me stone-hearted, heartless or whatever. But, I guess this is in the best interest of all the future patients that I will be treating. If I had to shed tears over every death that I have witnessed and had I let each of them shake me up emotionally, I would have given up being a doctor long ago! All I'd be thinking of were dead people! I wouldn't be able to work, to eat, to drink, to sleep..... just imagine!
Yes, I'm heartless during such situations and I have to be. I can empathise with the relatives but that's that....... I CANNOT let my emotions overcome me. And that is what my profession teaches me.......
There have been a lot many occasions like these, where I have given my all to save a patient, to see them eventually die. Frustrated, check.....Angry, check......Sad, check...... Unhappy, check. And a whole gamut of emotions- check, check and check again! Do I portray those emotions......NO! Can't get myself to either. It just dies down till I witness another death!
I can just imagine what you must be thinking but unless you're a doctor, I don't really expect you to understand.
So far, in my short surgical career (many years to go.....still), working in one of the best Trauma centres in our country, I feel as if I've seen it all. Victims of railway accidents with dismembered limbs, some carrying their own leg in their hands (YES!!!), electrocution injuries, stab victims, gun shot victims, burns with trauma, road traffic accidents with their wide gamut of presentations, month old babies falling off God-knows-what-not. (image alongside says it all, I guess. A concrete slab impacted into this young boy's skull with damage to the underlying brain matter successfully extirpated by our neurosurgery team. He was discharged, with just a scar at this site!). Lots more to see, I guess....
All I know is that those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body.
That's some food for thought, I guess. . . . . .
 

Why I think doctors deserve the money they make.....

Here's a well written piece by one of my junior colleagues.....  Sriniket. Good job, dude!
(Edited for this blog by yours truly)


     Doctor bashing seems to be the trend today. Everywhere I go, I get to hear a medical horror story about how some satanic medical practitioner had the balls to ask for 500 bucks after giving a measly injection or scribbling gibberish on a paper with his name on after asking some idiotic questions like "what did you eat on that day?"; " is it a throbbing pain or a bounding pain"(like one can make that out!) and of course the biggest sacrilege of them all "that bloody quack had the audacity to tell me where to get my xray /usg/ blood work, he must be getting a commission..... all doctors are just white coated pimps!"
         

It has been just more than a year since I have qualified to become a practicing physician but already people look at  me as if I am Ambani or at least a Birla in waiting who will very soon be driving around in a BMW bought by money which apparently we get by looting the pained, already much taxed masses. Let me make it clear at the outset when I graduated from my institute I didn't get anything other than all my SSC and HSC documents and threatening words from the office that very soon I will have become a medical officer in the govt. public health centre nearby where i will spend the rest of my days giving out malaria pills and pain killer injections to 'tatya , bandya aajibai and others' (no disrespect implied). I was told in most cases by my own batch mates we will get a princely salary of 25k. WOW!!!! I wonder which other 24 year old gets that much money at that age and then the answer came" every moron who ever graduated from college with any lame ass degree gets more than that! In fact most people who didn't bother with graduation get that". Independent sources tell me rickshaw-wallahs in Thane get more dough than that. Why should I ask for more? ALL I EVER DID WAS GET A GOOD RANK IN A HYPER COMPETITIVE EXAM AT THE THRESHOLD OF ADULTHOOD. I only gave 4 sets of freakishly subjective examinations in which my fortunes can be decided in the end by what I wore to the exam hall, my caste, my language skills, my relations with the college departments and MAYBE  by my knowledge and I haven't even begun ranting about my experiences with post graduate entrance exams!
            Let me be very clear i have nothing against any of my friends who are into any other stream, good for you guys you had the good fortune to steer away from this field by design or by accident! I am sure all of you are doing great now and you all deserve every dollar, every euro ,every pound and every rupee(for the few that still live here) that you make. Nor will i trivialize for a moment the troubles you people go through in your graduate lives. My problem here is on a whole  different level . I want to know why does the layman have a problem with a medico earning big money . of course we as medical students are also to blame here. My 66 months in Kolhapur taught me that many students are not comfortable with this idea and their ideas of success in this world come across as rather weak and limited in scope  (again a personal opinion with no disrespect implied whatsoever)  while i don't believe even for a moment that a fat pay is worth losing one's good name , I believe it's reasonable to expect reasonable remuneration for your skills , abilities , aptitude and work.
       

  Let's get the numbers straight. My information about branches other than medical and engineering is painfully limited, but i am sure that won't be a issue here. There are 18 government medical colleges in Maharashtra and around 20 private ones. Engineering- I think there were 639 in Mumbai-Thane region..... there were 620 last week and it will probably hit 700 by the end of this month. Aspirants for both fields give the same exams almost with the obvious variation being Bio and Math. Because of the sheer numbers even if i consider there are 20 great colleges in this state) that will come to a figure of at least 5000 people who end up with good quality peers , teachers , facilities and by extension good prospects. and these guys wont even be close to the best in the country. The best guys are studying in the IITs, NITs and BITS. All together this comes to around another 20 thousand students with excellent prospects. My basic point is you can expect to be Maharashtra rank 3000 and still graduate from a very good institute. What happens in the medical side of the entrance is that in Maharashtra unless your rank is within 500 you have a steep climb ahead. All those people who say all government colleges are the same and they are all good are DELUDED! The reasons are many and I won't get into them...... this write up is already too long. Somewhere around rank 700 rank you have three choices- pick up below average (read baaaad) college or take up a BDS (dentistry) seat which are even fewer and third option is give up, pick up an engineering seat which is always there or give another attempt!
My point here is that at rank 700, a medical graduate is probably studying in a very bad place where he is deprived of many facilities and opportunities. These guys are all mostly very good students,  toppers in their respective schools, cream of the milk pot that is the PCB stream. These guys are now stuck in very mediocre places for a very long time and that has an effect.. ...believe me it does!  These people are those who are within 1 percent of the state.  Even if they come out unscathed still with the fire in the belly to tackle the big monster that is PG entrances what will it lead too! Again if I consider only the popular PG choices which is about 8-10 subjects..... each has not more than 20 seats in our state....maybe 30. And again this includes the who's who of crap such as Nanded, Akola, Yavatmal and Ambejogai! To complicate matters further there are about an equal number of people arriving at the starting line from the private colleges which have hundreds of seats but all off which are auctioned to the highest bidder! People put their life savings to get their children into these courses....for what?...... private colleges where there are no patients and government colleges where there are no facilities and almost no teachers.
                 So once again, there is a cohort formed by 1 percent of the population and among these only 2 percent can move to the next level! Now you go and do the math! I am sure this is the equivalent of doing your engineering from the BIG SEVEN IITs and then wanting to get into one of the IIMs! These are the odds the very best off the PCM stream have.....each and every medical student has to go through the same odds to get even the most pathetic seat in the worst possible college. If I talk about the odds of doing the medical equivalent of a IIT + IIM. the odds get mind numbingly small!
              We as a society are so used to throwing money , " ooh he is a consultant , he did his B.E from VJTI and MBA from IIM-A ' he should obviously get 40 lakhs per annum, he deserves it!!!" What is the salary that a surgeon passing from KEM can expect.. I will be damned if it's more than 40-50 thousand and he is still not done with his studies, mind you ! And that's the best possible outcome! The guy is 28-29 years old, he hasn't slept properly for the last 4 years at least! He has cleared India's second most difficult exam (IAS tops the chart obviously) with  flying colours and he has sacrificed his whole youth. He basically smells of phenyl ! Also bear in mind that Infosys and TCS are not waiting around to hire this guy. His only option is to stick with a government seat if the decision he took as an 18 year old has to make any financial sense in the long term. When this guy finally turns 35 and decides I need to start enjoying the good things in life and enter private practice, he comes upon people saying "If you wanted to make money, you shouldn't have become a doctor(thank you very much Aamir! I am sure the next batch of people who believe you and stick to dialysis for years thinking transplant is a luxury and not a necessity in renal failure will remember you in their prayers as they hurtle towards their painful and inevitable ends!)".
             

So my appeal to all my non-medical friends.....never question a doctor's fees if you are satisfied with the outcome. You are paying remuneration for the struggles and sacrifices he makes in his youth. You are paying for the fact that he depended on his parents for basic living expenses well into his late twenties and in spite of being among the best in the state he gets treated like something that fell off a garbage truck! As for my medico friends- let's stop selling ourselves short, we are an elite bunch and it's time people realize it! Expecting to get good money for the efforts is not a bad thing. And let's be frank......the pay for interns , residents even super-specialist residents is pathetic. Let's change our outlook!
                    -DR. SRINIKET RAGHAVAN


PS: Check out this blog too..... http://doccartoon.blogspot.in/

I'll be back..... and here I am!!!

Been a long three years.....
I started this blog when I was preparing for my Post-Graduate Entrance Examinations as a distraction. Although updated infrequently, I tried to incorporate as much of my personal & professional experiences in this blog.

What have I been doing for the past 3 years?
That is another amazing journey........ which I shall share with you in due course of time.
Here's a peek: I secured admission to a branch that I love and wanted to pursue......at one of the premier medical institutions for that particular branch. I have been pursuing M.S. (General Surgery) at LTMMC & LTMGH, Mumbai a.k.a. "Sion Hospital"!

 

 

Hoping to update the blog more often......!

 

FUN FLOWCHART TO HELP YOU CHOOSE YOUR SPECIALTY !!!

So, what's your pick???

MEDICINE AS A LEARNED AND HUMANE PROFESSION

People have always asked me what it feels like to be a doctor. That "oh-so-noble" profession that everyone keeps referring to. When you introduce yourself as a doctor, people's perception about you automatically changes. It's like..... you are someone to be revered and respected; the adulation and at times, awe are all part of the package. But is this what being a doctor means??? I think not....... Read on.

Becoming a physician has meaning far beyond completing medical college. It is the entry to a way of life, the one characteristic common to every true profession. It may sound old-fashioned, but the learned professions are really "callings" from which the members cannot separate their lives. There are no "part-time professionals", at least in this profession, having accepted such a calling, one is bound to live it or leave it. A physician can also be a good spouse, a good parent and a good citizen of the community; however, the role of a spouse, parent and citizen, is inextricably intertwined with the calling of being a physician.
Medicine is not just a science, but a profession that encompasses medical science as well as personal, humanistic and professional attributes. The process of becoming a physician and being committed to lifelong learning requires that an individual possess the scientific base not only to acquire and appreciate new knowledge but also to see new ways for applying it to patient care. Every physician must delight in learning the new, correcting the old and perfecting the future. Much of what medicine now accomplishes depends on large-scale testing of procedures, interventions, vaccines and new drugs.

Being both professional and caring is an acquired skill. A physician can diagnose and prescribe in a technically correct and scientific, but insensitive way. The patient may be made better, even cured, but still feel unsatisfied with the interaction. In these cases, patients are likely to ask the questions:
1. Does my physician really care?
2. Does what happens to me matter to the physician?
3. Does my doctor show sensitivity and compassion beyond mere technical ability?
Patients want and deserve compassion and understanding. They want their doctors to be interested in them as individuals who seek advice, as well as relief from pain, disease and suffering. They want to sense that they can safely share their deepest thoughts and their most heartfelt confidences with their doctors. In short, they want to value their physician as a trusted friend. My own experiences during my rural internship have shown that a kind word is all that is needed in allaying part of the fear and anxiety associated with visiting a doctor.

Patients also expect to be kept informed while they are receiving competent professional service. As a caregiver, it is the sharing of oneself that is so very important. To some, it may seem odd to talk about caring as a learned skill, but it is just that. In studying to be a physician, one must learn both compassion and caring. Easy, supportive interaction with patients and others less fortunate, is a skill that comes readily for some and with great difficulty for others. In learning how to demonstrate compassion, Kahlil Gibran taught us: "You give but little when you give of your possessions.....it is when you give of yourself that you truly give". The giving of oneself with ease, with grace and with meaning is, for most persons, an acquired skill. Sometimes a deep sense of awakening within is required to release the innate sensitivity and compassion that perhaps have not been expressed since childhood. Nevertheless, these traits remain imperatives if the aim is to become a "complete physician".
When patients seek medical attention, they entrust their doctors with their very lives. The physician must earn such complete trust. Technical abilities and skilled treatment of disease alone do not suffice. Patients must believe that their physicians care about them as people, not just as patients. Physicians, in turn, must understand that they do far better as professionals if they err on the side of being human with their patients
A particularly difficult time comes as physicians deal with patients who become old, frail, dependent, crippled or cognitively impaired. These are circumstances from which the most sensitive among us truly learn what it means to give of ourselves. Sometimes we may find once again that our patients are the "best teachers".

On second thought, I really can't define what being a doctor encompasses..... because it is something that goes way beyond mere "definitions"..... for me, I guess, it's a way of life...... as said before, something that is inextricably intertwined with my very being.....

Adapted from: Cecil's Textbook of Medicine

!NCREDIBLE !NDIA

Amidst all the hullabaloo of the ongoing Commonwealth Games..... the corruption, the lackadaisical attitude of our authorities and the absolute debacle (that it was gonna be, but so far hasn't been.. THANKFULLY).... I thought I'd share my version on why India is truly Incredible and why we are "like this only" !


Amul, at their very best, yet again !!!

 We Indians are so cynical that, had those nincompoops (at the Commonwealth games) done at least a respectable job (at not only organising the CWG but also "hiding" the "under-the-table" business of theirs), we wouldn't have made a big deal about it as, the "supposedly brilliant" end-result is what would've mattered to us!!! Because, obviously, everyone in India knows the "what, where, why, how and when" of CORRUPTION..... we are like this only !!!
Anyways, back to my anecdote on why this country never fails to amaze me.
I'm currently preparing for my entrance exams and study at a library a l'il distance from home. The lib has a huge ground facing it and, according to my sources, there's a huge fair organised there every year during the Navratri/Dussehra festival. Currently this fair is in its "construction/organising" phase and I get a direct view of the frenetic activity happening there. Now this is your typical Indian "mela" replete with all sorts of see-saws, merry-go-rounds, giant wheels, mini-shooting range and what not. I guess you get the point....and am sure you've been to at least one such mela in your life ( the last time I went to one such mela was during my rural posting in Internship around a year ago, what fun!!!.....but that's another topic altogether ).


The Ferris-wheel in its "preparatory" phase with the "mango-people" working relentlessly 


Now getting to the point....... actually observing a mela take shape is, truly, a fulfilling experience, I must say. The amount of hard work one puts in, is truly undervalued, at least in our country. Just watching those puny little men from some remote village in north India sweating it out in the Mumbai sun, assembling that huge giant wheel and that huge "dome-of-death" ( or whatever that motorcycle-stunt thingy is called ) from scratch , piece-by-piece, WITHOUT A MACHINE...... and that too for what.....some measly 150 bucks a day..... WHO DOES THAT?.......... The "common man" in India.....the "aam-aadmi" or "mango-people" (as popularised by some Bolly movie)..... it may not be much of an experience, the way I've described it. But day in and day out watching these "invisible", "behind-the-scenes" men work really hard, so that the other "common-men and women" of our country have a great time, represents the true spirit of India for me. Despite inadequate lighting post-sun down, these men are still at it, working on that sheer monstrosity called a "giant-wheel" (which could very well be called India Eye by me, akin to the London Eye or Singapore Eye or whatever eye...have you). That is the "spirit" of this wonderful country called India.


Lo behold ! The Ferris-wheel all ready ! Also, don't miss the "dome-of-death" behind


And what astonishes me further is...... this library that I study in, is less than 50 feet away from this "site of action"..... and we are continuously exposed to the "din" outside..... and yet Indian students preparing for God-knows-which entrance exam continue to study, oblivious to that construction outside, maintaining an inner calm, not complaining..... but continuing to do what we do best..... EXCEL AT EVERYTHING WE DO WITH WHATEVER LIMITED RESOURCES WE HAVE !!!
And that's my !NCREDIBLE !NDIA for you.....
Kudos to the mango-people...... JAI HIND !

My WAVY BIRTHDAY WISHLIST !!!

Today's morning-walk along the Worli Sea-face promenade.....felt different for me. The eerie silence of the waves alternating with its humble roar, lashing against the shore..... the humid weather..... the cloudy sky...... my jogging shoe sole giving way..... yeh baat kuch hazam nahi hui.

I realized, then, I would be turning 25 tomorrow..... and, was this a hint from the one up there........ ???
I started making a wish-list of a different kind.....inspired by the waves.
Here goes.....

I wish I never again, feel like worrying and keep thinking about the lovely sea-waves which keep coming onto the shore one after another, breaking off.....but knowing that, that's the way the calm and powerful sea expresses its happiness.
I wish I never worry about the sand on the shore, which has to see so many waves being destroyed on the shore..... they are not destroyed, in fact they are totally accepted by the sand with all their characteristics, just the way they are.
I wish I never worry about the short life-span of the waves..... each moment of it, is spent with such joy, so freely.
I wish I always stay as expressive and happy as the waves, and be as calm and powerful as the sea, and get someone as firm as the shore, accepting me for who I am (I am fortunate enough to have such people in my life, already).
I wish all possible ways of running away from problems are blocked and many new avenues of solving them are opened.
I wish the coming year repeats all the happy moments of my life a thousand times over and gives me more such moments.
I wish all my dreams and aspirations are fulfilled and many more such dreams are born in my mind.
I wish myself..... a very HAPPY BIRTHDAY !

Teenage Angst: I AM VJ

I am sharing a "beautiful" poem from the book, "Chicken Soup for the Teenage Soul on Tough Stuff"..... I have modified it a little..... but the entire credit goes to the original poet, Krysteen Hernandez (I don't know who she is, but if you're reading this..... Thank you)

I read this poem when I was going through some really difficult moments in my life (more about that, on another blog-post)..... and the fact that this poem rightly described my frame of mind (at that time) in the most simplistic way, really stood out, for me.

So here goes...... I call this poem:      I AM VJ

I am a poet writing of my pain,
I am a person living a life of shame.
I am your son hiding my depression,
I am your brother making a good impression.

I am your friend acting like I'm fine,

I am a wisher wishing this life weren't mine.

I am a guy who thinks of ending his life,

I am a teenager with a lot of issues rife.

I am a student who doesn't have a clue,

I am the guy sitting next to you.

I am the one asking you to care,

I am your best friend hoping you'll be there.

My tryst with CANCER

Another day, another case.
This blog-post speaks of a man's "need"..... a need to get "diagnosed" first and then the need to get treated and the need to lead a normal healthy life..... Alas! That was not to be ! Read on.......
This patient's case is slightly peculiar because he presented with varying symptoms. I was supposed to present his case, but never got the chance to.....

The Violet Ribbon- "Support Hodgkin's Lymphoma Awareness"

This man was a poor construction-site worker from a remote village, and came to our hospital with complaints of swelling in the neck, fever, weakness, breathlessness, facial puffiness, abdominal complaints and various other non-specific complaints. He was admitted to our hospital 4 months ago to undergo a biopsy but backed out, for reasons best known to him.
Since I examined this patient in detail, I knew his clinical history..... he had multiple shotty lymph nodes all over his body (basically, a generalised lymphadenopathy). My provisional diagnosis for the case read: "Multiple enlarged lymph nodes due to ???Hodgkin's Lymphoma (possibly stage III B) with a severe degree of anemia and anasarca"
Now when I say, a severe degree of anemia.....his "Hemoglobin" levels were 3.2 gm/dl (normal level for an adult male as per Indian standards: between 12-16 gm/dl). Multiple transfusions later, he developed a cardiac overload, which he did recover from. Ideally concentrating on his primary disease, he should have undergone a "biopsy of his neck lymph nodes", but he was scared (?) of this procedure and even though I explained to him that it was a "harmless" procedure, he wasn't convinced. The patient's brother was basically running from pillar to post, just to get a "certain" diagnosis for this patient. My professors suspected a form of "Lymphoma", but a confirmatory test was required in the form of a biopsy, so that he could be referred to a centre offering "Specialised Cancer treatment" (since those facilities were unavailable at my teaching hospital). Since the patient was unwilling to get any form of procedure done on him (while his relatives were more than willing), he was asked to get "discharged". He actually did !!!
Around 2 months later, I was enjoying a "mini"-party with some close friends and just outside the venue..... this patient's brother spots me, and actually recognises me, and then addresses me as "Dr." (I was just a final year student then, but such "occasions" actually give you such a "HIGH"). I remember this patient well and I asked the relative how my patient was doing. I was in for a shock now.....
My patient had expired a week ago...... he developed a severe anaemia again and was admitted to the Rural Hospital in his village. But this time, no amount of transfusions or symptomatic treatment could help him...... his lymphoma, I guess, turned too aggressive......he died from a cardio-pulmonary arrest due to an extremely severe degree of anaemia ( I was told, his Hemoglobin was just 1.7 gm/dl !!! ).
So that party turned out to be exactly the opposite- a cause for celebration..... turned into a cause for mourning !!!
Patient deaths wouldn't affect me so often (more on that on another blog-post), but what happened here shouldn't have happened and in fact, shouldn't happen to anyone...... this man died for the lack of a diagnosis, a fear of the unknown and basically, according to me, his own foolishness (for lack of a better word).
But as my internship progressed and as my rural postings came to an end, I realised that this man's case was not an isolated instance. In fact, in the villages of India, thousands of such deaths go "undiagnosed" !
And we talk about "HEALTH FOR ALL" !!! Wow !

My tryst with HIV/AIDS

So, I am back after a "mini"-hiatus (thanks to all the "BOOKS" that have been keeping me really busy). So I read recently in the papers about a Kolhapur village "taking back" an HIV+ widow and her child (see link below). One of the causes I was actively involved in, and want to be involved with in future is PLWHA (People Living With HIV/AIDS), especially widows and children. So, here I share a detailed account of my "tryst with HIV/AIDS"....the HOW and WHY, for my association with HIV/AIDS in general.
This case is from my final year, in MBBS, when we were posted in the Department of Paediatrics, and were actively involved in Case-Discussions. This one case I distinctly remember, because I was lauded for my efforts (at case-presentation) by my Professor......and more importantly because the boy's face is etched in my mind till today.
I'm presenting it to you the way I presented it back then.....I guess it'll also give you an idea on how we present cases! It might seem BORING to some, so a WARNING at the outset.....read only if you really are keen on knowin' what happened..... details are (medically) authentic because I have retained the case-discussion notes till today! So, here goes:
(OBVIOUSLY, no personal details revealed----- patient-doc privilege, you see)

The INFORMANT in this case is my patient's GRANDFATHER.
Master V, 9 years old, residing at K village, K district, studying in the 2nd standard and 2nd issue of a third-degree consanguineous marriage presented to our hospital with:

Chief Complaints of: Cough since 8 years; fever since 1 month

The patient was apparently alright 8 yrs back. Symptoms of COUGH began at the age of 13 months.....intermittent in nature, with a crescendo-decrescendo pattern (gradually increasing and decreasing although not having completely regressed). Cough is associated with whitish expectoration about 2 teaspoonfuls in quantity. The intensity of cough increases at night. There are no relieving factors.
Since the last month, the patient has been complaining of fever which is, again, intermittent in nature. The fever is not relieved by medication and it is increased at night. Fever is not associated with chills or rigors.
There are associated complaints as follows:
1. Breathlessness (on and off), which he experiences on walking a little distance.
2. Relatives have noticed that the patient has stopped talking since the past one month, although he can hear and understand what is being said.
3. The patient has developed weakness in both his lower limbs since the last episode of fever. He walks with difficulty and with pain in both lower limbs.
4. The weight of the patient has also decreased due to loss of appetite.
5. There is a history of ear discharge since the past 4-5 months, which has stopped at present.
6. There is a history, of a vomiting episode yesterday. Vomiting was non-projectile, bilious in nature and vomitus contained only food particles.
7. There is a history of passage of loose stools (on and off) since the past one month.

There is, however, no history of:
convulsions, rash over the body, dysuria or frequent hematuria, contact with an open case of TB (Koch's disease), haemoptysis, haematemesis or e/o worms in the stools.

Other RELEVANT PAST HISTORY:
The patient is a known case of HIV infection diagnosed at the age of 13 months, and currently not on any form of ART (Anti-Retroviral Treatment). Patient has had recurrent Lower Respiratory Tract Infections and bilateral ear discharge, since then.
Both his parents have died of "UNKNOWN" causes, as per the Informant.
There is no significant history regarding any hospital admission or surgery in the past.

Family History:
The patient is a second issue of third-degree consanguineous marriage. His father died in 1999 and mother in late 2000. Patient's elder brother has no similar complaints and is non-reactive (i.e. doesn't have the HIV infection).

Birth History:
Full-term normal vaginal delivery, at HOME. Patient cried immediately after birth. Perinatal period was uneventful. There is no history of NICU (Neonatal Intensive Care Unit) admission or any major illness in the neonatal period.

Socio-Economic History:
The informant (grandfather) is the guardian of the child (both his parents are dead, as reported previously). Grandfather is literate (but has studied only till Class III). The patient lives in a pucca house; no history of over-crowding. Sanitary facilities available at home. Tap water is available from a common tap catering to around 10-12 houses in his village.

Dietary History:
The patient consumes 1150 kcal and 30.8 gms of proteins a day, during 4 meals in a day.
The expected intake is 1950 kcal and 40 gms of proteins a day.
Thus, there is a dietary deficit of 800 kcal and 9.2 gms of proteins, per day.

Anthropometric findings:
Height: 102 cms Expected: 122 cms -----Under the 3rd percentile.
Weight: 12 kgs Expected: 28.1 kgs -----Under the 3rd percentile.
The patient is severely malnourished with evidence of wasting as well as stunting.

NOW, normally I would present the examination findings, general and then system-wise examination (i.e the Cardio-Vascular System, Respiratory System, Central Nervous System and the Per/Abdomen findings)..... but that would be Greek/Latin for a majority of my blog readers.....so I'm sparing you the torture.

By now, you may guessed the "WHY" part..... the kind of "trauma" this child faced for no fault of his !

His *&%$%@#@$$@$%$$@ father went and @#$#%$% a CSW (Commercial Sex Worker) without a condom (or "protection" as its popularly known)..... then transmitted the infection to his wife who then transmitted it to this kid. Yeah, I'm playing the blame-game here and why shouldn't I ???

But after a year, I passed my MBBS examinations and was then posted as an intern, to the TB & Chest Medicine Dept. of my teaching hospital ..... and REALITY struck me in a "LIGHTENING" sort of way..... every third (or so) patient who walked into our OPD was HIV +ve and came in for DOTS treatment (Directly Observed Treatment- Short course chemotherapy)...... because Tuberculosis was (and still is) the most common opportunistic infection in our country in PLWHA..... and our government provides FREE TB treatment to our patients at government hospitals.
And now, thanks to HAART (Highly Active Anti-Retroviral Therapy)..... the life-span of PLWHA has increased..... but still, knowing that you have HIV/AIDS and yet facing the onslaught (of recurrent infections and thence ill-health), just like my innocent patient, V, did.... defines TRUE COURAGE for me. Kudos to these brave hearts.


"V" must not have lived long (no follow-up, a common patient issue), because he wasn't on HAART and his grandfather wasn't very genuinely interested in taking care of him..... coz he ( V ) was just an additional financial, emotional and SOCIAL burden on him..... (stressing on the SOCIAL-stigmata part here)..... and that is the "harsh" REALITY !!!
So that's "HOW", I got involved in a cause that is dear to me..... no details on how I actually am involved with the cause, because I don't wanna be a brag-n-tell @$$.
That's my "tryst with HIV/AIDS"..... and this article is dedicated to my aforementioned patient, "V"..... wherever you may be, my dear..... GOD BLESS YOU !

Here's hoping the HIV vaccine becomes a REALITY soon.....

LINK: http://epaper.hindustantimes.com/Publications/HT/HM/2010/08/14/INDEX.SHTML
{Read Page 8 of the e-paper}

Strange encounters with the "alcoholic" kind !

So, a long-due act was recently passed in the state of Maharashtra. The Maharashtra Medicare Service Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) Act, 2010 was passed by the Maharashtra Assembly on the 9th of April this year. What this means is that, any individual (or group, for that matter) found attacking any doctor or medicare personnel, will attract a (minimum) fine of Rs. 50,000 and imprisonment for three years and it will now be considered a non-bailable offence.

You might be wondering what the aforementioned tidbit has to do with the title of this post??? Read on.....
This happened during my Internship.....when I was posted to the Dept. of Internal Medicine. As I've (tirelessly!) mentioned earlier about the workload at this district hospital I trained at(because of the paucity of residents.....Interns work like Residents- read "bakras").....I'm not gonna delve into details (for your benefit). This was peak season for admissions (hospital-admissions, mind you) and I was handed over the Male Medical Ward as per my rotating internship programme. There were around 27 patients under my care (and only me, alone!!!) during this period. We were required to see the patients on admission, write their case-history, medicine orders (everyday that they were admitted there, that too twice a day), do blood collections and other minor procedures (like catheterization), etc etc. (hope you get the hint). All this and 27 patients to top it all, sure took its toll on me. And one day, I missed out on seeing one of the patients. After our rounds (with the Senior Consultants), I realised my folly. So, that evening I went and apologised to the aforementioned patient. Fortunately, the relatives were very understanding. As I was about to leave, I heard someone abuse me....(specifically using the word "doctor", and I was the only doc around). I didn't heed....but then the abuses went on and on....and all the patients and relatives in the ward (mind you, this was a general ward) were aghast. I turned back and went to see what the problem was. Believe you me, this patient looked like he was hardly in his senses (diagnosed with "Alcohol-Withdrawal Syndrome") and he wasn't under my care (as in, he was admitted under another Unit), so I began to walk away. But the abuses didn't stop, and now this degrading attitude of his, really began to piss me off.....after all I hadn't spent the past four and a half years studying Medicine, to listen to people like him, abuse doctors like us!!! So I asked him what his problem was, sternly. He actually had the audacity to hit me....though I ducked at the right moment and was spared of his wrath (unlike "first time in labour"). Taken aback, I called the security guard on duty.....but this delirious man wasn't in a mood to give up and went on about how "you doctors" don't give a damn about poor patients....how that patient suffered (which was absolutely untrue) and the like. All this while, his poor wife was a silent bystander to this drama and now even she tried to "console" him. But I really don't know what strength "ALCOHOL" gives people.....three security guards later and his wife holding onto him couldn't stop this guy's attempt to pounce on me. I really didn't understand the reason for his wrath against medicare personnel in general. A few seconds later, the patient's doc (Resident Doc of that particular Unit) came in. He ordered for some tranquilizers. Two shots of Diazepam didn't do the trick. Finally after a lot of attempts to pacify him and a lot of violence on the part of the Resident Doc (yup, have to do that at times), Chlorpromazine and Phenargan, both potent drugs.....did the trick. He conked off. Further probing revealed that his wife was used to this drama at home and often wound up getting beaten up. And yet, she supported her husband.....I was at a loss for words. The next day, this patient was discharged (Against Medical Advice- DAMA).....and it seems he couldn't remember anything about this "interesting" incident !!! Woah....!!!

And so this is one particular "breed of patients" we see on a regular basis at Government Hospitals..... this man hadn't realized the damage that alcohol had done to his brain, liver, kidneys, heart and virtually every organ in his body.....I hope you do, before its too late. . . . . !
P.S.: And on similar lines (as my previous "labour story"), this "man" visited me again when I was in the Surgery OPD.....with his kids having multiple abrasions and contusions, saying they had fallen while playing.....whether they had really fallen or were "made to fall" is an entirely different story.
Sordid state of affairs, I must say. . . . . !

GOLDEN YEARS at my ALMA MATER

Continuing the series on Videos......this one also has something to do with Internship.....and a whole lot more !!!
In sharp contrast to the video posted before, this one's more about the good times at my medical college......a sort of collage of photographs (and memories attached to them) with some soothing Bollywood Music in the background.
NOTE: Please excuse the gross spelling and grammatical errors in the video......coz even though I feature in it, I haven't edited it !!!
Watch, and share some of those memories with me. . . . . .

GELCO: INTERNSHIP UNCUT

This video I'm posting, is created around the life of a Medical Intern (portrayed in a very humorous light). The characters, situations and locations shown in the video are not fictitious.
Although the work that I've done during my internship, in my college-attached District Hospital is nothing like how its portrayed here (as in, it wasn't limited to blood collection, catheters etc.....but much much, much more); the video does give one, a perspective on the trials and tribulations, the red-tape and juz plain BS that an Intern deals with.......just to get that oh-so-coveted "COMPLETION" and his hard earned "measly" stipend !!!
Watch.....and you shall be enlightened (and entertained) !!!
It's not easy becoming a DOCTOR in this country.....thats all I can say !!!

BHOPAL GAS TRAGEDY: Justice Delayed.....Justice Denied !

On December 2,1984 at around midnight, there was a leak of Methyl Isocyanate (MIC) gas from the Union Carbide India Ltd. (UCIL) Pesticide Plant in Bhopal, resulting in the exposure of this toxic gas to over 5,00,000 people.....and there you have the largest industrial disaster to date!
The earliest reference to the Bhopal Gas Tragedy that I can gather, was from our Science textbooks in Secondary School. Obviously, at that time I hadn't realized the magnitude of the problem (what with the text matter limited to a few lines in our textbooks).....but now, reading various articles on the net and in the newspapers have actually opened my eyes to the great disaster that it was.
Estimates vary on the death toll; some say around 3,000 and others around 15,000. Others estimate that around 8,000 died within the first few weeks and another 8,000 have since died from gas-related ailments. And the foibles continue, what with epidemiological reports showing eye problems, respiratory difficulties, immunological disorders, neurological disorders, cardiac failure secondary to lung injury, female reproductive difficulties, etc. among those affected and birth defects among children born to affected women.
So what had happened exactly?
The UCIL factory was established in 1969 near Bhopal. It produced the pesticide "Carbaryl" (Sevin). In 1979, a "Methyl Isocyanate" production plant was added to the site. Now, MIC is an extremely toxic gas, which can cause damage by inhalation, ingestion and contact in quantities as low as 0.4 ppm. Proper care must be taken to store MIC because of its ease of exothermically polymerizing and its similar sensitivity to water. MIC, an intermediary in carbaryl production, was used instead of less hazardous but more expensive materials (other manufacturers like Bayer made carbaryl without MIC, though at greater manufacturing costs).
On the night of December 2-3, large amounts of water entered a tank containing 42 tonnes of MIC (during cleaning work; while some claim due to bad maintenance and leaking valves).....causing exothermic reactions and pressure changes leading to a release of large volumes of toxic gases into the atmosphere. The gases flooded the city of Bhopal, causing great panic as people woke up with a burning sensation in their chests. Thousands died immediately from the effects of the gas and many were trampled in the panic.
Various factors complicated the issue.....Besides the poor maintenance and various "money-saving" approaches adopted at the plant, the problem was made worse by the plant's location near a densely populated area, non-existent disaster-management plans and shortcomings in health-care and socio-economic rehabilitation.
Over two decades since the tragedy, many civil and criminal cases remain pending in US district court, Manhattan and District Court, Bhopal against UC (now owned by Dow Chemical Company) with an Indian arrest warrant also pending against Warren Anderson, CEO of UC at that time. As the UC boss, Anderson knew about a 1982 safety audit of the Bhopal plant which identified thirty major hazards. Rather than fix them in Bhopal, only the Company's identical plant in the US was fixed. Neglecting these hazards in Bhopal caused the deadly explosion.
On June 7 2010, seven former employees of UC (all Indian nationals) were convicted of causing death due to negligence and were sentenced to two years imprisonment and fined Rs. 1 lakh (approx $ 2000). All were released on bail (surety of Rs.25,000) shortly after the verdict. APPALLING, to say the least !!!
Surveys and laboratory analyses from water sources around the plant still show contamination of the ground-water (with pesticides). A recent analysis (by BBC) actually showed traces of Carbon Tetrachloride (a liver carcinogen) from a water sample taken from a hand-pump located within a 3-km radius of the plant.
And the main reason why this incident was almost completely ignored for the past two decades is because it had nothing to do with celebrities or well-known politicians or their kith & kin.....but with the "aam-aadmi" (ordinary citizen) of this country.
Kudos to us all!!!!

References: http://en.wikipedia.org/wiki/Bhopal_disaster

The Sights, Sounds and Smells of MUMBAI

NOTE: This is a blog version of my previously published article in our College Magazine. It's normally the other way around (i.e. print version of a blog), but hey.....it's my blog after all! So, here goes.....

As soon as you enter the street, a cloud of brown dust covers your face and before you have time to recover, you are toppled off your two feet. Welcome to Mumbai- a little sadness, some hardship, but loads of happiness and wonderful feelings!
Mumbai, the city where I was born, brought up and where I live. I am quite familiar with its sights, sounds and smells, if not entirely. It is the city I love: it lures me when I am not here. But I still have something to complain about- a perfect combination.
Mumbai, right from Churchgate to Virar, is a land of miracles. A land of extremes, a land of contrasts. The richest people lying on mattresses of money, live here. The poorest people lying on the muddy streets, live here. People flaunting their Versaces and Armanis, and people who only have a metre of linen to cover their body. People moving around in their chauffeur-driven Mercedes Benz rub shoulders with those (un)fortunate enough to have only their two bare feet to move around. There are people who live at Marine Drive in their ultra-modern homes and then there are those who live at Marine Drive on the pavements. Again, a land of contrasts.
The tallest of skyscrapers, the neon lights, the colour, the money, the richness of Mumbai drapes a cloth over your eye till you open your eye to the small huts; the darkness, the poverty, the hunger of Mumbai. It's all here and we all have to live with it.


There are people all around you, pushing you to the limit. They will push you and push you and push you some more, till one day your lungs cry out for space. In this city that never sleeps, even morning won't give you solace, what with the incessant honking of cars bringing you back to the real world. And when the morning paper arrives, you read nothing but bad news. Get ready to go the office, jostling for that inch of space on the packed local trains. In the evenings, come back all sticky and tired from work, wanting some peace and quietude. You expect peace at home, but then you probably haven't heard of television and the barrage of ethnic serials doing the rounds today!
But notwithstanding all this, this city has a lot to offer. If Mumbai didn't have the charm, would it attract thousands of people from all over the globe to come and try out their luck here? Mumbai has the glamour and lavishness, like a gold foil covering a stone. But even this gold foil is attractive enough to bring and more importantly, keep people here!
Mumbai might not be the best city in the world but which other city can compare with its extremes and contrasts? Mumbai might not be a New York, London, Paris or even a Shanghai, but it still is good enough to make me live in it, love it and sleep every night believing in a better dawn. . . . .

LOVE STORY OF A MEDICO !!!

This is one of those funny messages I received.....which actually sounds too good to be true! Many of my colleagues may (or may not?) have read this.....so for the benefit of my non-medico acquaintances, I am posting this.....just for laughs!

PLEASE NOTE: ANY RESEMBLANCE TO REAL-LIFE MEDICOS IS PURELY CO-INCIDENTAL.

So, here goes.....the "LOVE STORY" of a medico:

I was in Class XII
She was in Class XII

I got admission into MBBS
She got admission into B.Sc

I was still doing my MBBS
She got an M.Sc.

I was finishing my MBBS
She got a Ph.D

I completed MBBS
She got married

I was preparing for my MD entrance
She is the mother of two children

I am doing my MD
Her daughter is in Class I
I completed my MD

I opened my own Hospital
Her daughter passed Class XII

The greatest Irony: Today is my engagement
And her daughter is my fiancee!!!

THERE'S ALSO A HINDI VERSION OF THIS (though, slightly different), which I am gonna share (Please EXCUSE the Bambaiyya Hindi,you staunch "Shudh Hindi" loyalists out there):

Main 12th mein tha
Woh 12th mein thi

Main MBBS kar raha tha
Woh B.Sc kar rahi thi

Main MBBS kar raha tha
Woh M.Sc. kar rahi thi

Main MBBS kar raha tha
Woh Ph.D kar rahi thi

Main Doctor ban gaya
Woh Doctor ban gayi

Uski Shaadi ho gayi
Main PG-Entrance de raha tha

Woh do bacchon ki maa ban gayi
Main MD Gynaec kar raha tha

Bacche paanch saal ke hokar school jaane lagein
Main MD Gynaec ban gaya

Bacche tenth pass ho gaye
Maine Hospital shuru kiya

AFSOS ISS BAAT KI HAIN ke:
Aaj uski TUBECTOMY hain aur meri ENGAGEMENT

!!!

FIRST TIME IN LABOUR !!!

We, medical students, have something called "clinical postings" everyday (starting from our second year in MBBS).....where we're supposed to attend OPDs (as observers), have case-discussions, learn minor clinical procedures and observe major ones, etc etc.... So, this was the first time we were posted in the Department of Obstetrics and Gynaecology. Whilst waiting for our Professor on the first day, curiosity got the better of me and I ventured near the labour room.....(as you shall find out later, CURIOSITY does KILL the cat!).....Lo behold! What a sight.....A single intern busy working on an episiotomy suture surrounded by a bevy of screeching ladies.....and the moment he saw me, he yelled out, "Hey you, get me another pack of Catgut". The look on his face said it all....I was the proverbial "bakra" (scapegoat)! Now all this suture material lingo was Greek to me at that time. So, I yelled back, "Sir, I am a second-year student"! Miffed, he replied, "Okay, do you know how to record a patients blood pressure....go and record that lady's BP". Now, this was something we were taught very well in the first year and I thought why not put it to good use here! So I went ahead and got the sphygmomanometer and got to the aforementioned "lady's" table. She was a hefty woman in her late twenties.....lying on her back with her legs spread wide open (almost a lithotomy position, in medical parlance). I went ahead and began tying the sphygmomanometer cuff to her right arm.....(I may have tied the cuff a tad too tight!).....she winced a little.....I didn't mind.....and went ahead and began inflating the cuff. I moved towards the leg-end of the labour table, unknowingly. Meanwhile just to comfort her a little, I asked her..... (AND NEVER EVER DO THIS TO A WOMAN IN LABOUR, even out of courtesy!) in Marathi (the local language there) "बाई, तुम्हाला त्रास होतोय का?".....loosely meaning, "Lady, are you in some sort of pain?".....What happened next, completely shook me!!!.....I don't know how, but she just KICKED me in the groin.....and asked, " आता सांग तुला त्रास होतोय का?" (Translation: Now tell me if you are in some sort of pain?).....Too taken aback and with an aching groin, I just got out of there that very moment, still trying to figure out what had happened exactly. On my way out though, I did notice a snicker on the interns face and a glistening look in his eyes (As though saying, take that you incompetent @$$).....
{ PS: (UN)FORTUNATELY......during my internship, I happened to see the aforementioned "lady" again (SECOND time in LABOUR, I guess!).....although, she didn't recognize me, I made a run for the nearest exit! }

AND that is also when I decided I am never gonna specialize in OBSTETRICS!!!
A lesson learnt the hard way!