Tuesday, June 12, 2018

Learning in Orthopaedics

After the cool confines of the NICU and the dengue filled Paediatric wards, it was time to bid adieu and start afresh in Orthopaedics. 

With no prior experience in suturing/ dressing/ management of Fractures, I had my trepidations regarding this rather male dominated department. Furthermore, I was now setting foot in the new hospital. That is to say, I had so far been a resident of the old hospital which houses the Paediatric Department, Obstetrics and Gynaecology Department and Psychiatry Department while the rest of the Departments, ICU, ICCU are a part of the new massive 4 floor hospital building. (What I'm trying to say is I'm yet to figure out my way through the 4-5 lifts, 4 entrances and ward rooms that all appear the same to my fresh eyes!)

The Orthopaedic department is well organized with two units. Both units function separately and have prefixed OT and OPD days. While unit 1 has specialized interest in spine surgery, unit 2 (under the involvement of the HoD) has a weekly section dedicated to CTEV correction. The Ortho Department has a Male Trauma Centre, Female Trauma Centre and Male and Female Ortho wards. Post OPD, an Ortho intern is expected in the Casualty for all cases that present with Orthopaedic complaints. 

My first day in the OPD gave me a glimpse of the work load and by the looks of it, the number of cases seen by the doctors per day is much more than the earlier department. There is also a CTEV clinic headed by the HoD weekly aiming to correct congenital deformations of the foot. Orthopaedics is about pain management. While in some cases the pain can be eliminated with the right surgery/ slab followed by appropriate exercises, sometimes the original range of movement is not obtained and there is some residual pain. Either way, an Orthopaedic surgeon has his moment when he watches the once bedridden patient taking hesitant steps on his own after the successful completion of a surgery.

It's not just about cutting up and fixing bones. A lot of work goes in before the patient makes it to the OT table. He must be evaluated for his blood counts, tested for seroviruses and often, a physician's opinion is required to rule out any cardiac comorbidities. After this comes the pre anaesthetic evaluation by the Anaesthesia department following which he is said to be 'Fit for Surgery'. In Orthopaedics, there is usage of specific implants for each kind of fracture and this must be procured by the patient prior to the surgery. Sometimes, the patient may also require blood to be transfused prior to surgery to correct anaemia or blood to be arranged in anticipation of blood loss.

My first experience in the OT involved a lot of written procedural work, consent taking and shifting the patients in the order until I was allowed to scrub in. S Sir taught me since it was my first scrub and I was treated more like a precocious kid capable of contaminating the sterile zone. My job was mostly to retract and provide adequate working area for the surgeon. But it was indeed fascinating to watch the theory come alive on the table as Sir observed his work under C arm guidance, fixed the plate, put in a drill to make holes and then put the screws to hold the once broken bones of the trimalleolar fracture in place. Later he closed up and proceeded to operate on the fracture shaft of radius.

My first day in the OT more about figuring out where it exists as the OT complex is pretty much a maze and it had me dejected at one point when I didn't know where I had changed so I thought I'd be stuck in my OT dress until forever. Luckily, I was wrong and I could have a late lunch after meeting the patients post op, giving them the standard instructions regarding NPO, limb elevation and a check XRAY to look at the handiwork of the Orthopaedics. After the rounds with Sir, he dropped us near our hostels (Yaaass) and proceeded to his clinic where a flood of patients awaited him.

Now for the part about the casualty. Having no such prior experience, my first time in the casualty was more of an observation than an action packed experience. Patients being rushed in on stretchers and wheelchairs, limping in, walking in and sometimes stumbling in after an intoxicated night. From the fairly calm atmosphere of the Paediatric wards, it took me some time to adapt to the sights (of wounds), sounds (of pain) and smell (of injuries) in the casualty. Furthermore, I still had to figure out where specific instruments and apparatus were located. What amazed me was how, in spite of all the chaos and rush, there was actually a system in place and perhaps, there was a method in the madness! 

The moment a case was brought in, there was the CMO asking for their history behind the injury (assault/RTA/self fall), a surgery intern looking at injuries in the head thorax and abdomen, a medicine intern assessing if he had any other complaints and the orthopaedic intern looking into his injuries to the back and peripheries. Depending on the severity, each injury is addressed and the patient is admitted if necessary treatment can be provided in the hospital.

As an Ortho intern, it was my duty to assess the limb affected for its movements, neurovascular status, provide wound dressing and suturing in case of lacerated wounds, ask for the XRAY of the specified part and then act accordingly (based on the instructions of our duty doctor). In case of undisplaced fractures, often a slab support is given followed by a review in OPD. Some fractures need to be operated upon such as an open fracture or one that is displaced completely hence the patient is put on a slab support and informed about the need for surgery. Cervical vertebrae fractures are usually not handled here because of its coexisting neurological involvement and they are referred to a higher centre just like cases where the vascularity of the limb is compromised requiring a vascular surgeon intervention.

I usually stay till 12AM and then walk back to the Ladies Hostel and attend to any calls between 5.30 and 8.30am (which are less or none in the early hours tbh). The maximum number of cases are between 8.30 to 11.30PM on weekends, especially post rains. As we clear each case, there are fresh ones being rolled in and so it's a constant state of flux in the casualty. The 'brothers' and sisters in the casualty are extremely helpful, especially when it comes to learning any procedure. After my first day where I made several attempts with the help of my co intern, I was eager learn suturing and sure enough, there were plenty of opportunities to learn in a day. On my next duty day, under the guidance of Basavaraj Brother, I managed to suture a lacerated wound by myself even as curious 3rd years wondered if this new person in the casualty was an Ortho PG. It's indeed a moment of joy when you look at your handiwork after unsteady hands managed to coordinate to close a gaping wound. In the course of the day, I managed to close another badly cut open wound at the shoulder with sutures thanks to the guidance of my senior Co Intern.

The next OT day proved to be interesting with me fainting with postural hypotension and then making it back to the OT to put mattress sutures on the patient posted for implant removal. All in all, each day in the Ortho Department brings forth new things to be learnt, new experiences and a sense of excitement over every tiny new thing accomplished. :)

A month in the world of little ones.

The final days of Paediatrics saw a surplus in the case load as the dengue season had kicked in. On some days we had as many as 24 admissions in a day including the ward ones in NICU, PICU, Special ward and the general paediatric wards.

One particular evening there was a case of Paraquat poisoning which was brought to us and we promptly shifted her to the PICU. Now, Paraquat, unfortunately is one of those chemicals which have no specific antidote. The chances of survival are modest when the patient is immediately given activated charcoal based elimination, hemodialysis and hemoperfusion which are just technical terms for us here since we don't have those high end facilities. While B Sir explained the bleak outcome to the family, they had their hopes pinned on a miraculous survival despite the fairly large amount consumed by the teenager over a trivial fight. However it was the following day when M Sir saw the patient and immediately made arrangements to shift the patient out to a private centre where they had some hope of receiving the specified treatment. 

Yet, it was not meant to be since the private set up only squeezed their dwindling funds and sent them packing. At this point, the whole scenario; ( the inconsolable mother, a helpless father, a girl consumed by pain from within as the chemical corroded her from within even as she was in grief over her decision, doctors having their own limitations..) had me in a state of turmoil that couldn't be explained. We sent them packing to Indira Gandhi again in a free ambulance and all I could do was sit and cry as I wrote discharge summaries of moderately sick patients. Never had I seen poverty cripple a family that they are helpless to save their child. The anguish in the father's eyes as he watched his daughter struggle with the tubes attached to her even as he knew that a government facility was the best he could give. 

In the course of my postings, I saw several other girls between 14-17 brought with a history of phenol/ organophosphorous/ calamine lotion/ Harpic consumption and what concerned me was how these children had decided to take this drastic step after any altercation/ failure/ disappointment. Perhaps it has something to do with parenting as well. If only these girls could talk to their parents about what they were going through, if only the parents had the presence of mind to gauge the emotions of a teenager and react accordingly; tomorrow's adults will be a stronger lot who face challenges head on. 

There was Hemavathi from Bangalore who stayed with us for over a week since her typhoid fever was one that did not respond to the usual antibiotics. Initially her parents voiced their concerns about the treatment but in time, they had faith in us and left in a happy state. There was also a case of caecal volvulus with the complaint of abdominal distension. Here again, there was little that we could do since it was more of a paediatrics surgical intervention that was required. It was later that it surfaced that the infant had been investigated in the past and they were aware of the child's precarious condition yet had not taken any proactive steps on it. While some parents are examples of neglect and lack of concern, others are obsessed with every action of their child and promptly notify us about the child's food/sleep/bladder and expect adequate response from us for the same.

Mohammed Fizul was another 1 month 1 week old baby brought to us with an NS1 positive report and a falling platelet count. Overnight, he received transfusion so that he shot up from 9000/microL to a respectable number in the next few days. In the midst of discharge summaries, fresh investigations, rounds and OPD, when the father comes and thanks you for your involvement, you feel a wave of happiness wash away your tiredness, you smile and get back to your work with a burst of motivation.

There was Jeevan, a 1.5 year old who came to us one evening with respiratory distress and a low oxygen saturation. His XRAY did not look good and the underlying pathology remained undiagnosed but he was put on treatment to improve his saturation and general status. His brownish tangled unkempt hair and pale look spoke of his living condition but the concern in his mother's eyes revealed how they regretted that they had neglected his illness. The following day, an ICD was inserted by the surgeon Dr B to drain what appeared to be pus and pockets of air. His condition improved and we got a CT scan done at the hospital which showed a synpneumonic effusion of infective etiology. My shift ended before his discharge but I was told that he made gradual progress in the following days. 

There was Mohammad Hamdan who was brought gasping to the OPD and immediately rushed to the PICU. HE was eventually put on the ventilator and given a dose of antiepileptics and sedatives but he remained restless through the night long ordeal. The following morning, M Sir did an LP and drained CSF which I again rushed towards the virology lab along with the usual investigations. He was extubated subsequently but it is these cases, where you don't know why a particular symptom is occurring that you are worried more because you have a list of possible etiologies to rule out.

The last days of Paediatrics were busy but memorable. Be it the short talks with my P2 professors and ma'am enquiring about my welfare and making sure I had enough food/ sleep, the friendly banter with the sisters who made sure I didn't go hungry on my last day and shared their meal, the rushed breaks and the intermittent sleep, the moments of joy as you hold a chubby little toddler in your arms and look into its innocent eyes even as it doubtfully evaluates your stethoscope to the moment when a parent says it was good to have you as our doctor, Paediatrics was a journey I hope to relive.

Sunday, May 27, 2018

Internship at Hassan 2

Fresh out of the insulated NICU, I began my stint in the Paediatric department with alternate day OPD and ward duties. This meant that I had about half a day and a night off on the ward days and alternate day night duties.

On my first OPD day I reported on time and when I was on my rounds (prior to the actual rounds with the consultants), the recently admitted patient Kishan, a 11 month old boy on ventilator had no cardia and his family attenders began mourning. We quickly did the emergency resuscitation but to no avail. We called the duty doctor who verified the same and informed the family. It was only later that I realized that it was a case of Retroviral infection also present in other family members that was the main factor leading to all other complications.

There was Umme Kulsum, a case NS1 positive Dengue fever of Unit 1 that I monitored because I saw how she progressed from throwing up over a glass of water to half an idli to a full meal. On my subsequent night duty, she had platelet counts around 40,000 , abdominal pain and hypoproteinemia leading to some edema. Over the next few days, her counts dropped further necessitating transfusion after which she made a gradual recovery. It was indeed a happy moment when this little girl gave a broad smile, a shy thank you and made her way out of the wards. The next such happy moment was when Saniya Banu (who was in the PICU for a while) and her elder sister Hiba Tehreen were also discharged upon recovery and they left after a thank you from their mother.

Dengue cases are on the rise this season and they usually present with the primary complaint of fever, sometimes associated with myalgia and vomiting. The management is not specific but mainly consisting of fluid therapy (Ringer Lactate), regular BP monitoring, daily platelet and haematocrit verification. It's when the platelet counts drop further that the crisis deepens with abdominal pain and bleeding as the next set of manifestations. But so far, the dozen or more cases admitted have all made a successful recovery.

The next case that's worth mentioning is a case of hydrocephalus and subgaleal hematoma that was brought to us for a short stay after which we referred it to NIMHANS for a VP Shunt and further neurocare. There was the standard running around for a free ambulance under NRHM (National Rural Health Mission), some reassurance to the parents that NIMHANS would provide quality medical and surgical intervention at affordable prices and Krushi baby was sent packing.

Along with Krushi came B/o Mani who was brought one afternoon after she had 4-5 episodes of convulsions the previous evening. While the mother was extremely emotional and burst into tears at the slightest question/ explanation, the father was rather demanding and expected 24*7 presence of the consultants. This otherwise adorable cherubic little one also had fever and we got a CT and EEG (Electroencephalography) done which again pointed towards a neurologist for further reference (Query: Viral Encephalitis) but then she aspirated on her feed (probably the mother's enthusiasm after a week of keeping the baby on NPO (Nil Per Oral)) and had some respiratory distress, much to the anguish of the parents. At this point, I was some kind of interface between the NICU sisters who were viewed with hostility and the parents who simply wanted to hear that everything was going to be fine; something we cannot guarantee once a child is brought to the NICU. Luckily enough, she made a satisfactory progress, was shifted to the PICU and then was sent home after she regained her active joyful state. Here's hoping she makes a remarkable progress with no recurrence.

After this came two cases of mesenteric lymphadenitis presenting with pain in the right iliac fossa and some vomiting. The management involved initial NPO, fluid therapy, antibiotics and fat free diet. There was also a case of what appeared to be paraphimosis which I promptly referred to the surgery department. Samarth was born out of a precious pregnancy and was brought for complaints of breathlessness and cough. He recovered in time but M Sir asked for an Echocardiogram which revealed TAPVC (a type of congenital heart disease) and the cardiologist contacted me citing that he needed further intervention because he was likely to go into right heart failure in the near future. He was referred to a higher centre while his family remained apprnehensive and distraught upon hearing this news. Perhaps he is now at Jayadeva receiving the right treatment. Then there was Deekshitha with multiple enlarged infraclavicular lymph nodes which slowly regressed with antibiotic therapy and Rizwanoor, a four month old with bright kajal lined eyes who had been fed 'Nandini Milk' by her foster parents who spoke nothing but Hindi and Assamese and here I was trying to communicate with them with my not so fluent Hindi. Well, it did lead to some heated moments but nevertheless, she too made a satisfactory recovery.

Probably a case I will always remember is that of Prarthana, a 4 year old from the interiors of Arsikere who was referred here for focal seizures. She presented in status and had been given a diazepam earlier. I was in the ward when she was brought in so I asked for her to be started on Eptoin stat and left to contact Sir. The seizures continued so he started her on Lorazepam and then Gardinal followed by Eptoin again. She remained disoriented after which she began feeds, small conversation and was on her feet after a few days. We got the necessary blood investigations and CT scan and somehow her progress wasn't satisfactory since she was still not completely oriented and had some motor incoordination but since they were insisting on a discharge, M Sir did a Lumbar Puncture and we sent the CSF samples to the Micro, Patho and Biochem department and the reports were not obvious but suggestive of albuminocytologic dissociation. I did tell the mother (her father had met with an accident and was admittedly elsewhere) the need for further monitoring and that she was not completely okay yet and this was only a Discharge on Request. Probably because the little girl addressed me as 'Akka' or because she actually responded to me or that the mother was expressed her gratitude that 'Jayashree Doctor' helped them, I wanted to see Prarthana back to her playful state. I sincerely hope she too makes a complete recovery. It's only upon seeing cases like her and others that I've realized the extent of poverty in the patients here. While most of the services are at very nominal rates, it is still a dent to many families. God forbid, when we tell them that the child needs further treatment at a higher centre in Bangalore, I have literally seen the fear in their eyes as they imagine the exorbitant cost of treatment in Bangalore. It requires much reasurrance and restoration of faith before they muster the courage for the next step.

Several cases not in my unit but noteworthy of a mention are a snake bite (cobra) that was promptly treated with ASV (Anti Snake Venom) and he made a complete recovery from near nil saturation and cyanosed state back to his naughty brat state, a case of Acute Flaccid Paralysis (GB Syndrome?) that presented with classic ascending paralysis, late involvement of respiratory muscles and bladder dysfunction. Their vague history and travel history from Mangalore initially created a Nipah scare that was duly dismissed and he was then referred to a higher treatment for specific treatment (IVIg) and cases of cerebral palsy that also have seizure disorder.

When I'm not prescribing drugs after (struggling and) calculating the pediatric dosage, I've given stomach wash, learning cannulation in little ones which can be especially tricky when the concerned patient is a fidgety yelling kicking toddler who will glare at you and screech at the top of his voice for hurting him. So I'm currently practising on the older variants and will hopefully work downwards. There are nights when the duty is fairly uneventful with just a few admissions giving you atleast 4 hours of undisturbed sleep  and then there are nights when every complicated case ranging from poisoning to respiratory distress to febrile seizures lands up at regular intervals making sleep an inevitable myth. 

Now, I'm in Unit 2 and I have some really good professors who are friendly and are very clear in their instructions. They also respond to all queries leaving no room for ambiguity. There is A ma'am who is approachable and always responds in case of emergency. She has an advantage with the language and hence communicates better with patients from different communities. B Sir is probably the earliest to appear in case of crisis, also responds even when he is not in charge, calm and composed in all emergencies, never takes risks when it comes to a critical case and ALWAYS makes it a point to explain the prognosis to the patient attender. M Sir is probably one of the sought after paediatricians in Hassan with people coming from far specifically to see him. His speed of consultation is actually terrifying. His ability to detect something abnormal in a short period of inspection and auscultation is truly something inspiring.

So with a week more of Paediatrics to go, I have nothing but interesting experiences to share, memories of parents gratitude, anger and frustration are things you will have to become accustomed to. When you've seen many cases with the same illness, you will know it's an uneventful prognosis but to the parent, it is the first and hopefully the last time their child is afflicted with this illness so they will need all the reassurance that in due course of time, their child will get better.

Wednesday, May 16, 2018

Internship at Hassan 1

New beginnings don't come often but when they do, make sure to make the most of it.
So here I am at Shri Chamarajendra Hospital, Hassan for the next 10 months. I'm posted in Paediatrics for now and today I finish my tenure at the NICU.

The NICU is all about details. Its about specifics, minute details, extensive workup, meticulous follow up and identifying danger signs. Is it all about oxytocin high inducing cuddly little ones? I'm afraid its anything but that. There's more of sick and malnourished neonates, febrile irritable babies, babies in respiratory distress as they gasp and grunt for every breath, yellowish jaundiced little one and sometimes a convulsing neonate who needs immediate management.

Since my first day here it has been an overwhelming experience as you watch the birth of a baby, give immediate newborn care and hand it over to the attenders even as they are sometimes overcome with emotions. Sometimes you see sick babies and admit them for further treatment and investigation and watch the troubled expression on their parents faces. Babies may often make a quick recovery necessitating their shift to the mother side and eventually a discharge but this is closely monitored to prevent any lapses.

While in the NICU, stats are everything. The birth weight, yesterday's weight and today's weight are important for growth monitoring and also for antibiotics dose calculation. We need to look for urine output, grbs and the days of life of the baby and in the hospital to decide the course of treatment and relevant investigations.

The consultants need the numbers. A fall in platelet or rise in WBC or CRP+ve implies a change from 1st line to 2nd line antibiotics or upwards. The feed for the baby is NGF or OGF and slowly DBF is introduced when the baby improves. Fluids for the baby are either 10% dextrose in the initial days and then to isolyte P based on the weight.

Part of NICU duty is baby receiving which means when the OBG intern calls you saying there is a case shifted you run to put on your OT dress, grab a tray and gloves and receive the incoming little one. Sometimes you are informed late and you run to the OT only to hear the little one giving its first cry, you trip and fall right at the OT entrance even as everyone inside gave a surprised expression and went about their work. The sheer number of cases is staggering. There are days with consecutive caesarean sections with skewed sex ratios like 7 males and 1 female in a matter of  few hours. Sometimes we rush to the labour ward (with the sister, of course) when there is weak cry or meconium aspiration. It might seem dramatic but there are times when I have rushed out of the labour ward with a baby bundled in my arms to be resuscitated in the NICU. Once the baby is inside, the trolley is rolled in and emergency intubation is done if the baby is in distress.

As this is the district hospital we get a lot of cases referred from the Government hospitals in Sakaleshpura, Belur, Holenarsipura, Alur and Chanraypatna.
The NICU is a closeted space from the rest of the hospital and it attracts a huge amount of daily visitors implying the need for strict sterile precautions.

The consultants look at the investigation reports and charts and decide the course of treatment in the morning and also have a counseling session with the parents where they tell them the present status, course of treatment and prognosis.
Later in the day there is another rounds after the reports from the morning investigations are brought back.

Sometimes we refer the babies to a higher centre (Indira Gandhi Children's Hospital) when we realize that the child may improve under different conditions. Baby of Pooja had elevated urea and creatinine continuously and we had to shift it out. We explained the same to attenders and told them about the free ambulance facility. The attenders asked me if one or both kidneys were damaged because if both were damaged they wouldn't be able to afford treatment. We tried our best to tell them about the free facilities and after some running around for an RMO sign and the ambulance, B/o Pooja was off to Bangalore. Similary B/o Gayathri came with abdominal distension from Arsikere and one look at the X Ray showed that something was not right. The surgery consult said that it was likely a case of Congenital Hypertrophic Pyloric Stenosis which would require paediatric surgical intervention. B/o Pavithra had elevated Bilirubin (20+) levels in spite of phototherapy so on one rainy evening we referred her to Indira Gandhi again.

During the course of my NICU posting, I've seen life and the beginning of life in close quarters. I've also seen the darker side, with death rearing its ugly head often in the NICU. Explaining the condition of a critical baby is always a hard time and there are times when you push back tears of your own.
Baby of Mamatha was a tiny preterm LBW baby who fought for a while until it was too laborious to breathe anymore. While sometimes the parents understand that their child hangs precariously between life and death, at other times, it is a tough moment for them to see that after 7/8 months of nursing dreams of a newborn, the little one did not make it.

Baby of Mala was also a brave little one who was lucky enough to receive surfactant (rare in supply and requires an indent), caffeine and when his Hb% decreased one evening, I even decided to arrange for 1 unit of B +ve blood that night even though his saturation was not maintaining. When the blood finally arrived, he had already desaturated and had no cardia thus leaving one unit of blood to go without use. This was also the first time I practised intubation thanks to the hyper Veena sister.

Baby of Asharani was the first of the 28week twins who lived for a day on the ventilator unlike his brother who didn't make it out alive. Baby of Pavithra is also the first twin who breathes mechanically at 27weeks. In such cases it's important to find out the underlying cause especially since in this case the mother had APH and a similar preterm pregnancy.

Perhaps its the 'perk' of being in the NICU but it is indeed a tough moment when the parents place so much faith in you and ask you to do everything you can to save their child's life. Sometimes you go back with a smile when you send a discharged patient after a long stay. Sometimes you can only tell them that you are doing everything possible in this hospital's facilities.

There were days when I didn't answer questions I ought to know, there are moments when I feel how can I have this responsibility upon me; do I know what I should know?
From the plush confines of Subbaiah to the government hostels here, its been quite a journey. Real exhaustion is when you sleep for 12 hours straight after your duty ends. Its when you eat what's in the mess without a squeak because you're too hungry to complain and your co-intern is waiting to be relieved.
Its been about 10 days here and nearly 10 months to go.

Adios Amigos.

Wednesday, April 11, 2018


Picture Imperfect.

Tell me everything I shouldn't know

The dark stains that refuse to go.
Fill me with the darkness that shall blind,
The answers to the questions on my my mind.

Beneath that fine veneer and sheen

Maybe there are unknown tales to glean.
Fall from that pedestal of glory please
Bestow that starched white with some grease.

Tell me everything I shouldn't know

Anything to let go of that halo
Fill me with dark lies so I may believe
And hope to seek an uncomfortable refuge.

Beneath that chiseled perfection I see

Maybe there are crevices and cracks unknown to me
For now that is all the reason I can live with
To believe that it is after all a delusional myth.

When I'm not swatting flies and seeing inebriated patients on night duty at the Holehonnur CHC, I'm scamming their free WiFi and attempting to relearn how to write poetry.

Working at a PHC for a month and now a CHC has been an interesting experience so far, opening your eyes to the amount of sickness and disease. It also makes you realize how the things you take for granted are privileges to someone else.

During my free time in the day, I've been doing paintings that should probably be torn up into 38372827 pieces yet I still have them probably because they are so stupid they are a little funny. :')

Oh and I'm also listening to some music after what seems like ages! :) 
  • Kajra Mohabbat Wala (Sachet Tandon)
  • You can be king again (I'm not really into anime but I should thank Medha for this!)
  • Nindaraan Diyaan (Amit Trivedi) <3
  • Your hand in mine (Explosions in the sky)
  • K (Cigarettes after sex)
  • What's my name (Rihanna) (I heard this recently after years and I couldn't believe I was a big fan of this once xD

^ A cloud walker. An individual who lives in the clouds of her own imagination or dreams. A person who doesn't abide by the rules of society, literature, or art. 

Thursday, April 5, 2018

A Billion Worlds.

We live in a world of contrasts;
A conglomeration of extremes.
While a little one utters its first cry in a grubby labour room in a village, another is already trending on social media.
While the little girl who studies at the local school dreams of becoming a teacher,
another boy juggles between cricket, guitar and the perfect grades.
While one relishes the chat by the roadside stall as a treat,
another has a brunch at the upscale resort in town.
While one lit the midnight oil in a nondescript town to bring life to those dreams,
another light up to banish those insecurities in a cloud of grey.
While one was blessed with conjugal bliss,
Another was tethered to a lucrative kiss.
While one sweats it out for the daily bread,
another plunders through wastefulness and opulence.
While one surrenders to the elements,
Another challenges them and defies death.
Between these two divides lie the great majority.
In awe of wealth, yet aware of cruel Fate's stealth.     
Cushioned from dire poverty yet embroiled in competitive vagary.
Cocooned from squalor but desirous of glamour.
We live in a world of contrasts;
A conglomeration of extremes.
With a billion stories within us we live,
With hope that some dreams shall fulfil.

Monday, March 26, 2018

Can we pretend that airplanes in the night sky are like shootin' stars?

There is something so poetically beautiful about fleeting moments of happiness even though you know they are only like drops of rain in a parched land, like an oasis in the sultry desert and maybe like a moment that isn't really yours but only a dream you know you shall be awakened from.

Yet, sunshine isn't dulled in its warmth even if lasts for only a short while in the cold North, a rainbow shall always make heads turn even if may disappear in the blink of an eye, a comet darts across the starlit sky in moments, yet that mystical scene remains etched for eternity and no matter how how brief the spectacle lasts, its one that remains close to you.

As clich├Ęd as it might sound, it is no wonder that the best literature or arts stem not from a state of euphoria or contentment but more often from that painfully beautiful state of incomplete jigsaws. 

Life is short, times change, we know not what tomorrow holds but its upto us to make the most of the Time as the clock keeps ticking. To make every moment worthwhile, to have good memories worth cherishing and to have the strength to tide over and look past the bitter memories.

Saturday, March 24, 2018

Backpacker Diaries

"Seriously?!" she asked me in surprise, "You're going alone all the way to Cochin?"

"Are you really going alone or is there something you're not telling me?" said another with a sly grin.

After my spontaneous decision to go backpacking resurfaced, it wasn't difficult to choose: Kochi or Alleppey since I wanted to travel God's Own Country.

After having a good look at the options at hand, I got the travel bookings done thanks to Abhi and BP, packed my bags for 4 odd days, borrowed some sunscreen and a good power bank and set off on yet another journey to explore!

The journey to Mangalore was a night bus and I managed to catch some shut eye despite the window sneaking in cold air as we rattled our way through the Ghats. The next morning after a quick "Wash and Brush" at the dingy bus stop and a simple breakfast, I headed to Mangalore Central, found my way to the right platform and boarded the 7:20 Ernad Express that starts from Mangalore, traverses through Kasargod, Thrissur, Kannur, Kozhikode, Cochin and Alleppey, all the way upto Tirunelveli. It was a pleasant journey with a scenic view of streams, canals, coconut fields and green fields and I reached Cochin by late evening, found myself an Uber and reached Zostel after a 45 minute drive through the city's bustling lanes, overlooking the lit up port and through the quieter neighbourhoods.

Cochin, the conglomeration of Ernakulam town, Mattancherry, Fort Kochi, Willingdon Island and a few other nearby islands, is historically famous its role as a trading centre, a thriving port town and the epicentre of cultural exchanges back in the day. The earliest visitors were probably the Chinese who are known for their most famous contribution to the city: Fishing Nets that dot the landscape of the sealine. After them, came the Arabs, followed by the Portuguese, the Dutch who brought Kochi to the international limelight as the hotspot of spice trade and a commercial hub. Lastly, the British arrived and mainly used it as a colonial settlement but not before it had made a lasting impression in the international circuit for its trade relations. 

So in retrospect, it made perfect sense to me that I had Americans, South Asians and Europeans as roommates and subsequently interacted with a diverse lot in the following day! I opted to go on a boat ride in the morning and we were joined by new travelers along the way until we reached Vaikom. 

Thampi, our guide, told us about the agenda for the day and we set off in two small boats (or canoes) through the backwaters, gently sailing through the narrower canals even as the tree lined canopy shaded us from the heat of the sun. Water snakes, washerwomen and bathing children greeted us along the way until we disembarked at one of the settlements to have a look at the spices like cardomom, clove, bay leaf and nutmeg. We had a glimpse of how coir was made (Unity is Strength was the take home message) and later had a traditional Kerala lunch on a plantain leaf.

During the course of the day, I spent time with my roomates, Gaby and her friend who were Americans working as teachers in Thailand and we shared some light moments and 'rice crackers', a crispy snack from Thailand. There was Naomi and her friend from England who were friendly and we bonded when I realized Naomi was a doctor and wanted to pursue Tropical Medicine. Then there was blue eyed Robin and his friend Yohaan from Germany who were students on a vacation and Ponya, also from Germany who had traveled across the length and breadth of our country. There was a pretty young girl, Anna also from Britain who was on a gap year after finishing high school. Coming to India was a revelation of sorts for her since this was where her parents met when they were in college. Then there was the All American couple, John and Debbie, who were pleasantly surprised to know that I was from Bangalore and not in IT. I learnt a little about the american healthcare system and also why medical tourism in India is picking up rapidly. The web designer from Paris had some stories to share about his stay in Sao Paulo and Germany while Lee, the American shared his experience and photos of the Aarthi at Varanasi. While he worked as a limousine driver for half the year, the other half was (wisely) spent in traveling across the world. 

Post the boat ride, I met another Asian, Nanthini, from Malaysia who was also on a solo trip and we watched a beautiful sunset by the beachside. I was glad to have a fellow companion as we ventured around Kochi at our pace. Perhaps it was the Asian connection or just two individuals bonding over their love for travel but either way, ai was glad to have found a comrade. In a way, Kochi was and still is, the melting pot of many cultures as it continues to attract travelers, tourists, businessmen and artists alike. 

The following day, Nanthini and I made a neat plan thanks to the folks at Zostel and we began with a visit to the Mattancherry/ Dutch palace which houses intricate murals and a lot of artefacts that detail the era of the Kerala rulers. It detailed the lineage of Raja Rama Varma, the matriarchal system, their weapons, wardrobe and a general preview of the life they lead. 

After this we took a walk down the Jew Town and shopped judiciously for curios. A customary visit to the Synagogue showed us a few paintings that explain the role of Jews in Cochin, their arrival, trials and triumphs. For lunch, we headed to Fusion Bay where Nanthini got her much awaited fish curry cooked in the traditional Kerala style with a hint of Mango while I was content with some Okra Masala and Malabar Parota. Post lunch, we rested awhile at Santa Cruz Basilica, refreshed at Zostel and then headed to Kerala Kathakali Centre. 

Kathakali is an ancient dance form originating in Kerala as a variant of Krishnanattam under the then king's support. It is known for its detailed makeup and costume efforts, intricate facial expressions, mudras (hand movements) that signify different meanings and the enactment of a story from any mythological tale such as the Ramayana or Mahabharatha with drum beats, cymbals and vocals to accompany the performance. Kathakali performances are traditionally known to last for several hours and generally involve only male artists. 

We arrived in time to watch the make up in progress which every performer applied by himself for the most part. We were taken through the basics of Kathakali before we began with the story depiction. With rhythmic drumbeats, spirited use of cymbals and intense expressions, it was a complete performance that left one wanting more. 

After dinner at a nearby cafe and bidding goodbye to my newly found friends, I struck up a conversation with my Uber driver as we made our way back to Ernakulam Junction Railway Station for the Maveli Express. A nursing student, he was surprised that someone would travel alone but I think I made some valid points in my defense and appeared to be more open to the idea by the end of the journey. 

A delayed train journey, some Ideal Gudbud for breakfast in Mangalore and a bus ride later, I was back to the comfort of my room in Shimoga with a cartload of memories and the unmistakable self confidence that comes when you know you are independent. :)

PS: Half the pictures are courtesy of Nanthini's photography skills and the rest are probably the last works of my phone as it lies on its deathbed. :P

Wednesday, February 7, 2018

Unwelcome Relief.

So here's an attempt to try and look at the brighter side of things. Perhaps the holidays are not what I had hoped for but there's a month to go and it doesn't hurt in the least to look at the glass half full. :)

The idea is to complain less and appreciate the good things. I finally got to meet Sanjana after she did the classic trick of pretending to be mad at me and pop up at my place when I least expect it! It was the most unexpected thing at probably just what I needed then. The following day, I met Pingi and we had the usual banter just that suddenly 23 seems like a bigger number than the time when we were little kids without dreams as high as the sky!

So Di and I tried building the DJ Krishnu DogBot and the gears weren't all that flexible so we tried doing the TurtleBot which was partially successful but here again we were thwarted by the gears which just don't seem to coordinate. Yet, it's interesting to put them all together and watch the wheels in motion, if only slightly when placed in sunlight/ close proximity to a 100W bulb. :)

 I think the best part is having Di urge us to try and fix the loopholes, reading the instructions herself and trying to set up the whole thing. 

Probably my most prized possession till date! <3
This is just the setting sun!
 So last week was the much awaited Super Moon/ Blue Moon/ Red Moon with the Lunar Eclipse touted to be a once in 150 year phenomenon so Di and I headed to Lalbagh along with Sahana where I was actually surprised to see people spanning all age groups in large numbers. While the Red Moon eluded us for the most part, we did see a spectacularly bright moon later which was captured appreciably in Pingi's phone. 

The Culinary Diaries:

These holidays have been spent trying to gain some experience in the culinary department, if nothing else. What began with the initial basics of Rasam, Sambar, Palya and Batter preparation has progressed to a variety I (and Di!) are interested in. 
We've dabbled in Gobi Manchuri, Palak Paneer, Alu and Gobi Parotas, Masala Puri, Pani Puri, Pav Bhaji, Godhi Biscuits, Sweet Pongal and even some lip smacking Paneer Tikka that was in short supply after increased demand. :)
Pardon the pathetic 'plating skills',
I don't have the finesse of your television chef!

The second picture, is the all too familiar Sabudhana Kheer 
which we tried with some jaggery instead.
So you might have heard of Sabudana or Tapioca Pearls which Amma needed for a craft item she was trying out and I tried out this recipe and it turned out just fine. It's basically a Maharashtrian Recipe and it made for a good evening snack. Aided of course, by Di, who helped in every stage of it's preparation. :)

 Check out the recipe here :) 

The evenings from Tuesday to Friday are spent in the art class where little ones come home to learn drawing and painting. I'm usually assigned the youngest of the lot (the ones who believe they are Baahubali, the ones who show me the gap in their toothy smile, and the ones who ask for an 'ice-cream star' for drawing neatly) so it makes for interesting evenings. :)
When he knows only Bengali and
I know only basic HIndi
The one who wants to
draw cars, ships and trains :)

So I finally caught up with Padmaavat and was rather in awe of the Rajput culture, couture and the grand set up from their glittering palaces to the intricate details in their designer wear. Not to mention the stellar expressions, the stories conveyed through mere eye contact and yes, a mention to the maniacal ruler that is Khilji. Of course, it is a movie and just that. History cannot be gleaned from the same since it is after all, an exaggeration of reality or perhaps a portrayal of a work of fiction (Padmavat was a poem by Mallik Muhammad Jayasi).

On an other note, I recently noticed the stark contrast between myself and my close(st?) relatives whom I FINALLY caught up with. Perhaps it stems from my own disinterest that has built over time, or the paucity of time during the course of the academic year or the convenient excuse to attribute it to the prevailing situation; but I find myself in the dark about civic issues. In the sense, I am aware, yet I am not pro-active in the least. While it is commendable that they are part of ECO groups, active members of the Welfare association, plant saplings in the neighborhood, initiate and conduct a fest in their area,  organize e-waste collection drives and protest against Modi's flex banners in the event of his arrival in Bangalore, I'm currently living through each day, trying to make sure Di packs her bag and gets to her van in time, making her a snack for the evening and trying HARD to get her to open her books and read. Yes, this is from the same person who once started a nature club and tried to get people to be more eco friendly. 

I really think it's about how much of an effort we make to fight and buy time for the things that matter to us. After all, everyone has a busy schedule these days with the constant struggle between work and family but perhaps we can all steal some time for anything that WE feel deserves some attention. :)

Here's hoping for a good week! Cya readers. 

As for the title? look up "caregiver burden".

Saturday, January 20, 2018


Hello there readers! Here's to the first post of 2018 and more meaningful posts to come, hopefully. This one definitely will not make the cut.

So the year began with the practicals and they were.. well, a lot of things! That thing I said about how I need to control the stress I bring to the surface? Didn't really work in reality.

Oh and I hate rats. With a passion.

Finally sweating it out in the gym and looking for imaginary biceps every other day. Feel like a boss lifting some weights and trying out all the tough stuff until I see huger people prowling around.

Joined the RoundChapathiAndDosa Squad and began taking notes to make Rice, Rasam and yeah, even my favorite Chitranna. Although I don't get the point of a lot of things. I mean why did the human race come up with the idea of slicing cabbage into tiny equal parts for a palya. I mean couldn't I just wolf the whole thing down. -_- And how there are a lot of indefinite measures in cooking. As in 'put the rest of the ingredients once the rawness is replaced by an aroma' (wut) or 'stop frying the ladies' finger once its sticky consistency is replaced by slight brownish color' or the mind boggling ratios of flour and water which I never seem to figure out. But hey, I can identify the ingredient boxes without opening the lid so maybe I'm getting better at this. B)

I think I adore little kids who come to Amma's art class and it takes a lot of self restraint not to pinch their cheeks and cuddle those cute champs who stutter and stammer as they speak. I think I might violate the Teacher-Student code of conduct at this rate. -_-

When I'm not busy with these, I'm trying my hand at another piece of art, which I really hope to do justice to. Let's seee.

And when Di comes home from school, that's the end of any 'me time' that I can claim for myself. We did come up with a partially functional Robot: DiJay Krishnu Dogbot. We finally did the visit to ISKCON so she had some one on one time with her fav. When I'm not yelling at her for being greedy/ losing her specs/ being rude/ making faces, I tell her stories and ask her not to take ICSE and put her to sleep, only to fall asleep myself mid-story, until the beginning of another busy day.

Here's to home. Here's to coming back, adapting to the changes. Picking up from where I left, which is not always easy. You've stayed away for a while, you've developed your own ways and habits but you've got to remember your roots and do what's best for the moment.

Cya Peeps.