The last of the trees of my neighborhood.

The last tree in my street was axed today,
In a matter of minutes, she was brought to the ground.
By an electric saw that ripped across her broad trunk,
The tree that saw me through my childhood breathed it's last.

The tree that welcomed me 16 years ago into this quaint neighborhood,
Was a royal Gulmohar that bloomed every season.
A carpet of red draped the roads,
Even as families of birds perched above.
The morning melody of their chirps
Will only be a thing of the forgotten past.

She lived older than I will ever live,
And humbly gave herself as a home
To myriad creatures aplenty
But she also gave shelter to a little girl's dream,
Even as I sat underneath her broad trunk with a million thoughts agleam.


In fond memory of the Gulmohar trees that were successively put down over the years.

Limitless Love .

Wrinkled with the fine lines of their ripe age,
Peppered with the ills that poverty bring,
Bereft of the love and care of their offspring,
They arrived with savings of their meagre wage.

Immobilized by disease, she lay bedridden
Yet beneath the pain, a coy smile was hidden,
Aged yet agile, he rallied around for her care,
Her infected foot, he vowed to repair.

He pleaded and prodded all day long,
Until even the hardest heart melted at his adoration,
His relentless efforts would make her strong,
She regained her colour with his dedication.

A love so pure they shared,
That crossed boundaries of age and ill health,
Others often watched and admired
That their attachment was their one true wealth.

An ode to Mrs. S and her husband whom I had the opportunity to meet during my surgery postings at Hassan.

Skills with the Scalpel and Beyond.

January began with the excitement of nearing the end of our internship. After the debacle that was the NEET PG exam, I began with my stint in the Department of Anaesthesiology.

While most of the time, I was involved in having a look at the Pre Anaesthetic Evaluation of the patient, shifting the patient to the OT and monitoring the vitals, there was also the opportunity to intubate the patients either in the OT or in the ICU and also in giving spinal block to patients being posted for LSCS. Less often, there were also epidural anaesthesias given and Central Lines inserted. The 15 days in the Department involved elective OT, Emergency OT (which was followed by a day off) and ICU duty.

Another thing about the Anaesthesiologists in the Department was how they were always so full of questions! I particularly had an interesting time discussing with Dr C as well as Dr H who were open to all kind of answers and also provided interesting points to ponder upon.


Following this stint in Anaesthesia, it was time to get my hands dirty in surgery! And literally so; With diabetic foot debridements aplenty and the casualty bustling with head injuries, there was never a dull moment in this Department.

Although I was initially very apprehensive about my non existent surgical skills, I was extremely fortunate to be in what I would consider the best unit in surgery. Headed by Dr K who had a huge patient pull (never a day passed without patients turning up saying they were related to him and thus demanded VIP care) and with Dr N and Dr V  who were good spirited and encouraging to the interns, it made for a moderately busy unit with good surgical exposure for an intern. Particular credit must be given to Dr V who almost ALWAYS made it a point to involve the interns in any decision making and gave ample opportunity to do the procedure (skin to skin). At a time when our incisions are still unsteady and prone to fishmouthing, Sir had the confidence to give us a chance to learn. We initially had Dr K as our JR who was well informed and guided us in the casualty for critical cases and later we had Dr P who was also a friendly guide in the wards and the casualty.

As a surgeon, While Hernioplasty, Lap. Cholecystectomy, mastectomy, BK/AK amputation, Trendelenburg Procedure (for patients with Varicose Veins) and cyst excisions remain the elective bread and butter, the emergencies like acute appendicitis/rupture, hollow viscus perforations are the emergency cases which would require early preparation of the patient and an operation at the earliest. Of course, there are a host of local procedures which also come under the jurisdiction of surgeons such as local cyst excisions, incision and drainage of abscesses, suprapubic catheterization, foreign body removals, excision of ingrown toe nails and many many more! Basically a general surgeon has a lot on his plate!

One of the important things I learnt in surgery is that the operation per se is only one part of the treatment provided by the surgeon. The pre operative care as well as post operative care are as important as the procedure itself and goes a long way in deciding the prognosis of the patient.

There were patients who had fairly uneventful surgeries but developed complications post operatively owing to their preoperative comorbidities such as COPD or uncontrolled Diabetes.

A particular patient I will remember is the HBsAg positive Mr. GN who came to the casualty with pain abdomen at night. When his USG happened only the next day afternoon, it revealed a case of intussusception which was operated upon the following day after ensuring he had received some nebulisation in view of his chronic smoking history. While the patient recovered quickly post operatively, he returned soon enough with abdominal wound dehiscence and swab cultures showed sensitivity only to colistin.

Mrs. S was another long term occupant in the Female S/D ward who only had her old and wrinkled husband caring for her relentlessly. Day in and day out he followed us until we made arrangements for free blood transfusion for her, until we had posted her for a below knee amputation that eventually gave her some relief.

Being a part of her OT was another memorable experience altogether with the Gigli saw!

There were a few interesting cases such as a pancreatic cancer in advanced stages. She presented with obstructive jaundice so a Triple Bypass surgery was done with a palliative perspective. There was the patient with open skull fracture who came to our casualty one evening. The contents of the cranium were clearly visible and were palpable. The patient was surprisingly stable so a quick wash and some stay sutures later, we had him rushed to NIMHANS but I had my doubts on his prognosis. Imagine my happiness when I returned after a few days leave and saw the same patient referred back from NIMHANS after an anterior cranial fossa repair and moving around normally!

Thus, after 2months of learning in the Department of Surgery, after even giving a seminar on post operative management of a surgical patient, with some wonderful memories with my co intern Sanjana, with the new junior interns, it was time to bid adieu to the last leg of my internship at Sri Chamarajendra Hospital, Hassan.

Summer Child..

The mere memory of you in me
Once had words flowing in a fervent breeze
You remain etched within my soul
Irreplaceably firm from the roots.

I often wondered what had I lost
That words failed me when I needed them most.
Empty and hollow were the echoes of my musings,
Quietly I sheltered myself from my own bruises.

Like the sea that goes back to the sands in vain,
I burn bright in this self inflicted pain,
I smile at the cost of my sanity
And for the fleeting moments of unreality.

Observations in OBG: The joy of bringing babies to life!

As always, with a hint of excitement and ladles of nervousness, we reported to the Department of Obstetrics and Gynaecology just about two months ago. As we were shuffled into the 3 units A, B and C (each withits own unique reputation), Labour room and Casualty, some had Lady Luck on their side while some others knew they had a few more hurdles to cross than the rest.

The Department is one of the busiest at HIMS, notorious for its hectic schedule which reflected upon the interns and staff alike. I was posted in B Unit which initially had the all-male staff of Dr. Rajashekhar Sir (Unit Chief), Dr. Shridhar Sir and Dr. Raghupathi Sir. Later Dr. Nishitha ma'am joined the Unit. On my first OPD day, I learnt the main steps of taking and ANC case including the examination. Now these were things that I could learn well only with time so initially it would take me some time to localize the Fetal Heart Sound (FHS) but slowly, over the weeks, my ears began to get trained to recognize the familiar rhythmic beating, to make an estimate of the gestational age by the abdominal examination and also to assess about the progression of labour based on the PV examination.

A typical duty day involved a quick prerounds of the Post Natal Wards, Immediate and Late Post Operative Wards, Special Ward, ICU and Gynaec Wards after which we had the ANC rounds with the staff and the rounds and follow up of all of the wards as advised by the professors during their rounds. After this we hurried to the ANC OPD to clear the cases and give admission to those in labour. Any emergency case would be taken up for LSCS once all the investigations were in place. By 4PM, there would be rounds by the duty doctor of all the ANC cases admitted during which he/she would decide the course of action: Watch for Progress/ Shift to Labor Room/ Prepare for LSCS or maybe even discharge in case they were not in active labor.

Following this was the tedious process of writing the case sheet (which was later marginally simplified by a book which we had to fill up) looking at any loopholes, any deranged laboratory values or medical / surgical comorbidities. Usually there would be few cases taken up for Emergency LSCS where we were required to assist and close up. The common indications were Meconium Stained Liqour with Foetal Distress, Cephalopelvic Disproportion, Previous LSCS, AntePartum haemorrhage, Pregnancy Induced Hypertension(PIH), Abnormal Lie/Presentation among others. Along with the usual ANC cases, there were several cases of spontaneous/ threatened/ missed abortion or cases who came for MTP or HIV/HbsAg positive which were dealt with in the Septic Labor Room. Cases required strict monitoring of vitals were shifted to the High Dependency Unit (HDU) where PIH, Ecclampsia, Pre eclampsia and GDM cases were monitored by the labor room interns and staff.

One notable incident that occurred when on duty was the case of the 'Tubectomy Meningitis' as I'd like to call it. Two patients who had been operated earlier in the morning, developed restlessness and became disoriented later in the evening even as their vitals remained normal and their laboratory investigations revealed no obvious imbalance. While we monitored the patients all night long in the ICU, the patient attenders were increasingly impatient and we even had to deal with the mob and media attention. They were referred to NIMHANS the following morning where they were said to have 'Bupivacaine Induced Aseptic Meningitis'. Now the patients made a complete recovery but it brought about a lot of changes in the OT and the Post Operative Care of the patient to prevent such instances.

What began with hesitation and reluctance towards this subject gradually changed into respect for this demanding yet equally fulfilling career choice. From the first LSCS assisted to the first baby delivered via normal vaginal delivery, there was a definite surge in my interest and respect towards this department. From bullying irresponsible and intoxicated patient attenders to arrange for blood for their anaemic patient in labour to holding the hand of the sobbing woman who had just had an IUD (intrauterine death) in her first pregnancy, there was something to learn in everyday of OBG.

The Gynaec Ward had its own set of patients who needed to be operated upon for commonly a Fibroid Uterus or  a Uterovaginal Prolapse but I also got to see a gigantic mucinous cystadenoma of Ovary in an otherwise frail woman of 70years operated upon successfully. There were plenty of ruptured ectopic that came our way, especially on the C unit duty days but as Dr. R said it, a "quick in, quick out" approach works best to handle these cases. Be it with the interaction with patients or their attenders or sometimes with the professors, nursing staff and even our colleagues, there has been some real high voltage drama we've witnessed/been a part of.

Towards the end of two months, I did feel relieved that it had passed with no major mishap but more importantly, I also felt like I was actually doing something. Perhaps the posting where I definitely had *some* relevance to the Department even though we were mostly treated otherwise. :')

Labour Room with the Roomie!

Of course, the completion did not pan out as expected and it definitely was a disappointment but nevertheless, irrespective of the outcome of my derailed completion/erroneous extension I will be thankful for everything I have learnt from the professors and nursing staff during my 2 month stint in the Department of Obstetrics and Gynaecology at SCH, Hassan.