!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. . . . . .