Bliss.

Bliss.

Tuesday, March 31, 2015

The Ultimate Nightmare.

Here's to a day that's taught me many things.
Here's to day that made realize many things.
Here's to the friends who make you feel good about yourself, who fill you with inspiration, motivation and a solid dose of advice that makes you look at things in a different perspective.
Here's to the friends who want you to do well, who will lend a hand and make sure you avoid the pitfalls.
Here's to that rare set of friends who will be there for you no matter how far they are, who will have faith in you and who will believe in you in those times when you doubt yourself.
Here's to the friend who takes the time off and convinces you that you are no less than anybody else.
Here's my thank you to you. (Because I'm pretty sure you won't be seeing this. ;) )
Wish there were more such people!

Lately, it had occurred to me that I am probably not extremely competitive. I would describe myself as moderately competitive. No the cut-throat, obsessed kind. My driving factor has most often been the urge to do well and not the desire to be No.1. Yes, it might seem strange, but what I mean is, I do it out my interest, not out of the desire to beat X/Y/Z and get to the top. But I'd been pondering if this was the right attitude because when I see X/Y/Z, it is this competitive spirit that enables them to get to the top.

But the truth is, this is irrelevant. The goal has nothing to do with X/Y/Z. In medicine, the ultimate nightmare is having a patient in front of you and being unable to diagnose/treat them appropriately. Watching the patient suffer while you fumble and falter with your concepts is the most horrifying idea. It's THIS imagery that should prompt any medico to give their 100% and work towards excellence. Yes, it's important to know where you stand relatively because in today's world, you are judged based on how you're better than the one beside you. But that isn't the sole criterion. The most important factor is to keep the Ultimate Nightmare in mind and study so that you will not fail in alleviating the suffering of the patient.

Thursday, March 26, 2015

Res Ipsa Loquitur

"Res Ipsa Loquitur" is Latin for "The thing speaks for itself". With respect to Forensic Medicine it means that the nature of the injury itself suggests the negligence of the defendant and thus requires no further proof. Sometimes, somethings require no further proof, validation or explanation because it speaks for itself. 

Our life is not measured by the highs and lows but by our adaptations to change. Change is inevitable and one can never predict what changes each day will bring. We are defined by our ability to cope with the Wild card that Life throws at us. 

Our post-dinner ward visits have resumed and every day we look at a few new cases and try to learn something new. (and try to remember what we've seen earlier) Recently we got the chance to see:
  • Abdominal Aortic Aneurysm (thrill could be palpated, atherosclerotic plaques clearly seen in the Scan via the dye injected)
  • Follicular variant of Papillary Carcinoma of Thyroid gland 
  • Capsuloganglionic hematoma of the right side (this was clearly seen in the CT Scan) leading to hemiparesis and decreased visual field of the left side.
  • Carcinoma of Breast (BIRADS Type 4)
Last weekend I'd been home after about 2 months (for a very short duration: 50hours) and it felt good to spend time with family. I also got time to catch up with Mani after a long time and listening to the medical stories at BGSGIMS, I felt slightly relieved. Maybe it's the pressures of the profession that drives people to be the way they are. But after exchanging stories of our respective colleges, it felt as though we're both in the same ocean, heading in the same direction, just in different boats. 

On Tuesday (24th March), we got to see our first surgery in the OT (ENT). 

The Patient presented with 
  • extensive deafness
  • discharge (mucoid to mucopurulent, without blood) from ear (exacerbated by head bath, relieved on medication)
  • post nasal drip 
  • facial nerve dehiscence
Previous history of CSOM (Chronic Suppurative Otitis Media) in left ear. Granulation tissue is present. 

It began as an exploratory procedure as Cortical Mastoidectomy and then they opted for Modified Radical Mastoidectomy because they had to delve even more extensively to locate the cause of dehiscence. After finding a cotton piece at the centre of the granulation tissue, Dr Harish performed Type 3 tympanoplasty (by making changes to the incus and re-attaching it and this was followed by autograft of Temporal fascia of the patient) and meatoplasty (to widen the canal). After this, he completed the procedure with inverse suture using catgut.

To read more about this procedure: http://med.stanford.edu/ohns/earinstitute/otology-neurotology/resources/chronic_otitis_media_cholesteatoma.html

Procedures:
  • Modified Radical Mastoidectomy
  • Meatoplasty
  • Type 3 Tympanoplasty
Cotton piece found, granulation tissue around this cotton piece which was causing compression near geniculate ganglion.

Pre Anaesthetic Medication: Xylocaine Adrenaline infusion

Post Operative Medication: MonoCef (antimicrobial-Ceftriaxone), Periset (Antiemetic-Ondansetron) and Dynapar (NSAID)

Distribution of Facial Nerve. Compression of the nerve can lead to altered facial
expression since the nerve supplies the muscles of face.
So this was our first OT and we were super excited. It was indeed a deja vu moment that reminded me of Grey's Anatomy when Harish Sir scrubbed up and elbowed his way into the Operation Theatre. 
All Scrubbed Up.
So it was indeed a test of endurance since the procedure lasted for a good 4 hours. Here's hoping that we get to see many more surgeries! We (Abhi and I) saw the patient in the MICU during our night visit (where we happened to meet Harish Sir again) and her smile was normalized now as was her ability to close and open her eyes.

Us! :P
Pharmacology and MicroB tests are coming up in the month of April as is the much awaited Medical Conference DEMEDCON at SDUMC, Kolar. ENT Postings are coming to an end and we will then begin Community Medicine. Hopefully we will have a few field visits and rather than merely giving attendance and walking out.

Songs update:
  • Heroes: Alesso Ft Tove Lo
  • Tere Bin Nahin Lage Jiya
  • Love Me Like You Do: Ellie Goulding 
  • Meeti Boliyan
  • Yeno Yeno Agide (All the songs are awesome actually)
Seeya :)

Wednesday, March 11, 2015

Tripping scenes. :D

Hello there!
So 8th March 2015 was our class trip to Manipal, Udupi, St Mary’s Island and Maple Beach (after much debating, planning and procrastination)!

On Saturday, we went out to the city after what seemed like forever and when we came back, the college was a riot of colours! Yes, half the students from both the hostels were out on the roads enjoying Holi. It was virtually impossible to recognize anybody given that everybody was caked in different shades and drenched in water (possibly sourced from the lake beside our college) and we faced the imminent threat of also being smeared with colours so we decamped to the mess and then watched the proceedings from a vantage point.

Post dinner, the excitement was in the air and the localites had arrived to stay overnight since we would be leaving early in the morning. At midnight, there was a bonfire organized at the girls’ hostel (but I happened to walk in when the embers were dying down) as a run-up to all the excitement that awaited us.

We left the campus gates by 4am by chanting praises of Mr Y (BP’s idea) and for a substantial part of the journey, we sang songs and had an Antakshari of sorts. This was our first such trip and for many people, it was the first such journey with friends.

At the crack of dawn we got out for a short break and soak in the wilderness of the Ghat section but we were shooed inside after being threatened that tigers roamed this region.  (-_-) We halted at Manipal for breakfast and then proceeded towards the Museum of Anatomy and Pathology which has a wide variety of specimens that makes for a great viewing. Post this, we chilled for a while at their food court (Govi’s treat. For? Errr. First year mbbs result :P)and then we set of towards the harbour. Prior to this there was another stop where most of the people had lunch (i.e savoured some sea food) whereas Abhi, BP and I clowned around on a random street. (That includes waving at random passers-by, striking the Titanic pose at the middle of the road and so on.. Don’t bother judging me, I do it myself all the time anyway!) We took the ferry ride to St Mary’s Island which was pleasant given that it wasn’t sunny at all.

Abhi and I at Manipal :)
On the island we (Kundur and I) went on the jet ski which was not scary as it was touted to be. After this, we were on a Spree! A photo-clicking spree at every possible place, in every possible angle, with and w/o shades, with and w/o the hats and so on! Just like DJ night, Kundu and I were the perfect team for the Island leg of the trip! Nevertheless, we had a good time and enjoyed the serenity of the place.

Some Cliche' Photoshoot :P

After this, we went to Malpe Beach were a considerable amount of time was spent in pondering whether or not we should get into the water, whether or not we should go for some of the rides and walking around (with difficulty) on the sand. But soon, we were walking on the beach, enjoying the waves, the setting sun and the cool breeze that provided a respite from the glaring heat during the day.
Kundur and I
We halted again at Manipal for Dinner and most people chose from the three options: KFC, Pizza Hut and Dominoes. It was time for another treat (from AVM, for clearing the 1st mbbs exams) and it was rather fun. (Despite the fact that I had almost shut down after all the excitement)

The journey back to college was mostly uneventful except when the driver put on some blaring music (that is still ringing in my ears like persistent tinnitus) and switched on the lights to ward off sleep. But soon, that too came to an end and we found ourselves at the gates of SIMS at 3:30am. It was all over. Our much awaited class trip had come to an end!

The hardest part was getting up at 7am the next day and attending the theory classes at 8am and ENT postings for another 3 hours.

Initially I was reluctant and had assumed the worst possible outcome of the trip but as Icabo, Makshi and Gimpi had predicted, everything turned out just fine. True, half the people were with their “better half” and everybody moved in close knit gangs but it didn’t matter anyway (I had feared that it would). You need to go with the flow and not cling on to your comfort zone. That’s how you’ll find happiness irrespective of who you’re with.


Thursday, March 5, 2015

Of What Is Dead And Buried.

Apologies. (in case you were waiting)
  • February, the month of sports, cultural events and college day has passed. It's back to the routine of classes, postings and practicals for a while now. Except that the class trip is coming up over this weekend. :D
Saana Kundu and Mee. :)
  • Restarted jogging (or rather, brisk walking) for the simple reason that it helps me remain active and for the rest of the day, not to mention that I need to remain fit.
  • Bibliophile Updates:
    • Chasing Tomorrow by Tilly Bagshawe (thanks to Anu! :D )
    • Best Kept Secret by Jeffrey Archer (thanks to Likki! :D )
    • Be Careful What You Wish For by Jeffrey Archer
  • We're currently in our ENT postings. By the end of these postings we would have seen several endoscopies and Indirect Laryngoscopies (fingers crossed for chance to see a Tympanoplasty in the OT. After 3 days of maám, Ballal Sir taught us today! (rather he extracted answers out of us and tested our Anatomy by going into the specifics. The thing is, we tend to mumble the answers (right or wrong) to ourselves and the teachers either lose interest in us or demand to know what is it that we're whispering to ourselves. Although it was a HIGHLY embarrassing session where we realized how much we've forgotten, it was interactive and fun as well. :)
  • We finished our OBG Postings which was majorly a theoretical session where we learnt about Pre Ecclampsia, Gestational DM, Ante-Partum and Post partum Hemorrhage, Labor, Cesarean Section and several other topics. What rankled us is the fact that the next batch is getting to watch procedures in the OT while we never did. :(
  • Professors respond based on the kind of interaction they receive from the students. An interactive session encourages the teacher and they share more information because they know the students are receptive. This is a probable explanation why each batch is treated differently in the postings.
  • Communal violence in Shimoga town prompted the authorities to declare holidays and impose curfew and Section 144 in the surroundings. Normalcy has returned and the Section will be lifted post Holi.
  • Pathology has started to worry me because I realize that my brain does not want to accept, process or retain anything related to Leukemia. Being insulted by Mr.Y has become a regular affair and you develop some tolerance to it but the worrying fact is that there is actually truth in what he says. Sarcasm from Mr.V is nothing new but the fact that he is actually being honest is rather depressing. What kind of clinicians will we become? What kind of diagnosis will we do? What sort of Examination will we do on our patients? What kind of studying is this if it doesn't help you treat your patient?
  • I don't know if it's a good thing that I keep reverting to the past and tend to look at it as a guiding light to what lies ahead. In some ways, I miss the excitement of first year, the rush to go take our place in the dissection hall (lest some other hyper excited idiot starts off dissecting by getting their hands on the dissection box), the little preparation we did before dissection (because RK wouldn't spare us if we failed to answer or atleast made a decent attempt) and our involvement in the whole process. Have things changed? Has the excitement dwindled? Or does it depend on whether the lecturer is engaging enough?
  • Patching up has its advantages. You feel lighter and a load seems to have lifted off your chest. You no longer carry the burden of misunderstandings that continues to grow rapidly with time like a malignant tumor. Sometimes, you've got to leave your ego behind you and make the first move. Everything else will sort itself out. :)
  • Too many things have been going on lately. Too much confusion and way too much nonsense. And that brings me to the point I'd like to stress upon in this post: Me-time. The idea of personal time seems to have completely vanished. The idea of having time for oneself has become extinct and everything is either a joint effort or a collaboration and I'm beginning to realize how much I've become dependent on this collaboration. Now, I've always been comfortable with the idea of being "solo", more than that, I've actually enjoyed the clarity of thought and peace that it gives, even if the rest of the world interprets it as anti-social.
  • Certain decisions ought to be taken in the near future. Neither is the perfect solution but one must decide which is more viable and which is the closest solution to what I need.
  • Of late, I've been gripped by a persistent dilemma. About the future. Have I really chosen the right thing? Is this career suited for me? Will I be able to do justice to it? I seem to have elapsed into a vortex of passivity and rarely do I emerge and interact productively. Added to this is the misery of having forgotten Anat, Physio and Biochem which the professors take joy in pointing out with great scorn and sarcasm. This makes me question myself, are my methods wrong? Is my approach wrong? Do I need to revise more often? Or am I not cut out for this? This is the profession I have chosen for myself. Will I be successful with the same rate of effort? My weakness is that I evade, avoid and detest explaining any concept. I'm slowly beginning to realize how important it is to be able to describe a process, a condition or a mechanism with simplicity. This quality is one of the foremost prerequisites of a medico, not just the ability to fill endless pages of information. Painful as it seems, the distinction that I worked for means nothing. Every other day, I question myself as to how I've passed first year of MBBS. Have I cheated myself more than anybody else by passing?
  • Very often, one is tempted to join the herd. When even those closest to you, it doesn't seem so bad after all. But then, it's at these moments that you should stick to your principles and do what is right.


  • I am strongly tempted to Delete (Not Just Deactivate or Uninstall) WhatsApp, Facebook, Instagram, Snapchat and Hike (yes, even silly Hike) but such temptations have become a regular thing. Rarely do I "succumb" to them.
  • Plans to meet MaPaDi have once again been postponed. It might be another month before we meet. Bheemi has exams coming up, I have ENT, She'll have her results and then hopefully I can meet them all. Nidhz is busy with boards (for an entire month. Phew!) so it will be a while before I meet them as well. It's been I while since I spoke to Ajji-Bajji, I should probably call her today.
  • Check out the Prognosis App on Google Play Store. An interesting app where you've got to diagnose a case based on the given input, investigate with relevance and treat accordingly. You score based on your performance and you get a detailed explanation regarding the diagnosis and course of treatment and why the other options are less appropriate in the case concerned. 
  • OH AND BY THE WAY, I've completely forgotten to mention about my May Plans!! This may be a little hard to believe (you might even be tempted to Roll On The Floor and Laugh but it's true). I intend to travel by myself to Mumbai and meet Bhopieeeeeeeeeeeeeeeeeeee for a few days. (I can do cool stuff in life too)
  • I'm currently writing another story. Let's hope I persevere and finish it. :D
  • Musicophilia:
    • It's Empty (The Click Five) [Song courtesy: Annlee! :D]
    • Yun Hi Chala (Swadesh)
    • Jeena Jeena (Atif <3)
  • Quote Factory:
    • "Anyone can be a good winner. The sign of a great man is how you handle defeat." -Jeffrey Archer (Best Kept Secret)
    • "Sneham Mathram Puchikaruthu (Malayalam) - Never Belittle Love."-Preethi Shenoy (Life Is What You Make It)
    • “You’re so bossy.” “Why is a woman always described as bossy, when if a man did the same thing he’d be thought of as decisive, commanding and displaying qualities of leadership?” -Jeffrey Archer (Be Careful What You Wish For)
                                        
Seeya Later Folks! (Sedative Hypnotics awaits! BTW Did you know that Sedatives technically are not for insomnia but for producing a calming effect and decreasing irritability? Hypnotics are the ones used in those cases to induce sleep. Sounds confusing? Read this.
Awwwww.