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}