Crest and Trough.

Aches and pains that grew by the day,

A pill to ease fatigue, they gave in hope,

Alas, it backfired and he had much more agony coming his way.

The teenage boy now began sliding down a fatal slope.

He came to us, anxious and in despair,

Routinely we worked towards a methodical repair,

Yet some jigsaw puzzles only fit together at the last

And this was a picture we saw only after the mortal die had been cast.

Rallied around by silent supporters,

His was a case familiar to all,

A breathless bout and a hypertensive heart,

His breathing was now by a machine falling apart.

Out of the grim ordeal he emerged one day,

If it was light at the end of the tunnel one couldn't say,

Yet it was a small victory to see the boy breathe,

But one could say he was still ill at ease.

Ravaged on the inside by the viruses unseen,

It was a battle brewing in his own bloodstream.

His anxious parents watched his tumultous path

And wondered why he had incurred medicine's fatal wrath.

At long last, the sun set on the young man's life,

His parents watched as he struggled with multiple wires and tubes in strife,

His doctors wondered what else could they have done

While the virus wreaked havoc, yet seen by none..

 A teenage boy from the nearby taluk referred to Cheluvamba Hospital. He had a history of fever and myalgia for which he had been prescribed Nimesulide ( a banned painkiller) at a local PHC (Primary health Centre where the grassroots of medicine begin). Karthik developed an adverse reaction to the drug the form of severe rashes and itching, swelling of his face and some breathing difficulty.

He was stabilized here and his angioedema subsided over the course of a week but his fever and myalgia were persistent. When we worked up for the cause of fever, Dengue serology came positive. One night he developed high blood pressure and breathing difficulty and was shifted to the PICU. The following morning, his respiratory efforts were strained and he was electively put on mechanical ventilator.

From then on, his issues multiplied and he developed myocarditis, intrinsic renal failure, convulsions  rhabdomyolysis and even a form of polyradiculoneuropathy as sequelae of Dengue. Suspecting something else to be acting in sync with this, we also tested him for Covid Antibodies which also turned out to be positive (although he was RTPCR negative). As this could be a case of the recently emerging Post Covid Illness (MIS-C) among paediatric population, he was given steroids and immunoglobulins in hope of improvement.

He did show some promise and was extubated from ventilator but then he took a downhill course after that. Multiple attempts failed to revive him and after almost 2 weeks of hospitalization, it was the end.

Puzzles to Decipher!

It's been almost 6 months in Mysore and every month has brought about changes. From the first 3 months in a PG and working in NICU and SBW to the transition to living at home with my parents and sister and working in General Paediatrics, every month has had new stories, new lessons to be learnt and new patients to bring a smile.

When in the Newborn side, the hours were long and there was a lot of procedural work like cannulation, blood draws and UVCs along with intubations. There was also the need to monitor much more closely since these little ones often deteriorated rapidly if not recognised at the right moment.

The night duties allowed for some breathing space in the day but either way, I would be pretty drained out towards the end of my shift.

While in General Paediatrics, the variety of cases was baffling, the uncommon presentation of common cases was intriguing and sometimes, some scenarios had most of us scratching our heads for a diagnosis. General Paediatrics involved a lot more interaction with the staff and required us to read up more for the rounds.

Emergency ward was where we get the maximum exposure of immediate management of a case and requires prompt initiation of treatment of every case after taking relevant history and doing a proper examination. Case sheet writing would often take upto midnight for slowpokes like me and December was a particularly busy month given the absence of colleagues.

But the best part was not rushing back home at 11.30 PM racing against the chilly wind; it was the simple joy of watching a once sick child recuperating, or the wave of relief wash across the parents after the critical phase had passed or the subtle satisfaction after learning a procedure.

General Paediatrics made us more acutely aware of how a child was actually "feeling" rather than just the investigations and values. It also sensitised us to the other factors contributing to a child's physical, mental and emotional well being such as the environmental socioeconomic factors.

In the midst of all this, we've had to look into statistics for the wards we are posted in, present a few cases and attend online seminars as and when time permitted. Although the pandemic has largely affected the way we learn in a classroom, these sessions provided an orientation to the kind of reading expected.

While most children made a slow but steady recovery, there were always some, who presented late or deteriorated faster than the resources could handle here.  It is always painful to deal with loss, more so when it is of little ones. We could only offer words of comfort and advice on seeking medical care sooner in future.

On the whole, every day has taught a new way to look at the cases, interact better with patients and their attenders and learn a bit more of the concerned diseases. 

Here's to a new year with lot more challenges and uncertainty ahead and memories to cherish.

Smiling In The Rain.

 Behind the veil of innocence,

Lies a heart of steel and resilience.

Behind the tantrums and tears,

Is a child facing its worst fears.

Innumerable pricks from labs,

A childhood scarred with needles and jabs,

Alien to the scientific terms of the specialist,

Yet human enough to understand the grave tone of a realist.

Some children have ambitious dreams and reach for the stars,

While some wish for a healthier day and infrequent scars.

Childhood is all fun and frolick,

Unless it's a little one who has to endure being sick.

Smiling through the rain.

Working with children over the past few months has been an experience unparalleled. Every child has a story and a lesson to be learnt in management of a condition.

But there are also times when you realize that some children will have to live with their condition all their life, be it Thalassemia or Diabetes Mellitus or Chronic Kidney Disease, to name a few. 

It made me realize how their childhood is never the same as others, more often spent in between hospital visits, affecting their education and social life, more often than not.

Yet, these children come and go with a smile on most days, aware of the reality and facing it with as much courage as they can muster.

Little Treasures.

 

If there was, perhaps, a way to measure
The love of a parent for their little one,
Their wellness is the only treasure,
And in this pursuit, they would stop at none.

Amidst barriers big and small,
No length too far for a sign of hope,
Wishing for recovery in the long haul,
Sometimes clutching at the ends of a thin rope.

To watch the joy in their eyes at last,
When the critical phase has been surpassed,
To watch the smiles of the family intact,
Makes every busy moment, immensely memorable, in fact.

Loss.

A tiny miracle that grew within her,

Nursed with all the love and care she could muster

Arrived earlier than anticipated on a monsoon night,

Yet she knew, it did not feel right.

A little too soon, they told her and whisked the little one away.

Amidst beeping monitors and mangled wires he lay.

While artificial warmth and breathing tubes were applied,

Out of the comfort of her womb, he struggled to cope with the outside.

One evening, he forgot to take his breath,

They say when you're born to soon, that's bound to occur,

As he was hooked on to a bigger machine in a blur,

Perhaps she realized he was inching closer to death.

She prayed for his strength, a tiny miracle,

But to aid his breath, his lungs were atypical.

They said they tried, with all the clinical care they could provide,

But none could hold back as the young mother cried.

Tiny Steps Forward.

It's been over a week now since I've started off and it's been very very interesting so far. Everyday had been about learning new things, meeting a few people and getting adapted to how things work around here.

Just like every other government hospital, KR and Cheluvamba Hospital receive a heavy patient load from the nearby taluks. At present, along with a moderate patient load, part of the workforce has also been deviated towards Covid duties. Separate wards have been made in most departments to treat the Covid-19 suspects and once the test reports arrive, they are either sent to the District Hospital (solely dedicated to treating Covid patients at present) or shifted to non Covid wards here to continue their treatment.

One of the oldest medical institutions in Karnataka (1924), it bears a facade that retains its old royal glory. I've never been one to marvel architecture as such, but there is regal look to these buildings that slowly unravel once inside. While I'm yet to discover the hospital complex for the most part, it seems to be a blend of the old and new and a touch of royalty in contrast to the common folk that throng the premises.

My first day began a little later in the day after reporting to the HOD in the department. I was initially posted to the Recovery ward where the senior began guiding me on the basics. The cases here were all with non Covid related symptoms and they had to be worked up as well as monitored regularly.

Currently we are told not to go to those wards where suspect cases are being treated but we will eventually work there as well. We were told to take utmost precautions at work. Currently the ward wise work is not being followed due to Covid so we will probably get a fixed roster after the state PGs also arrive. Ma'am has finished second year (now in 3rd year) and she guided me throughout the day. I observed ma'am with cannulation and tried one myself. It is an art to put cannulas on minimum tries and also be unfazed by the babies crying at the top of their voice. 😅

Ma'am told me about the cases in the ward and the workup for them. We had a baby I of 10months with convulsions due to low Calcium. Cannulating her was a real challenge since she was a chubby roly poly baby but at long last it was done in the PICU. Just a short while later, she again developed convulsions so we gave lorazepam and then started her on IV Calcium gluconate (to be given very slowly under monitoring since sometimes the heart rate can drop).

There was also a case of a girl with palpable purpura and joint pains and h/o fever (and history of snake bite 10days, treated with AntiSnake Venom) so several possibilities were being considered for a probable diagnosis such as late serum sickness. There was a case of Henoch Schonlein Purpura who had the symptoms of pain abdomen, palpable purpuras and also joint pains. There was also an adolescent girl who presented with convulsions but detailed investigation and observation suggested it was more likely to be a case of malingering than the stereotypical seizures.

By evening ma'am got us some snacks and after 7.30, I was told I could leave for the day and come back by 8.30 tomorrow.

The next day brought about some new things to learn in the wards. We learnt some basics of acute diarrhoeal disease, its presentation and management since it is one of the most common cases here and it is There was a case of Wilson's disease who had come for his followup. He had initially presented with an unusual complaint: bleeding from the umbilical stump. And Ultrasound of the Abdomen had revealed a cirrhotic liver. This had led to portal hypertension and esophageal varices too. Further workup pointed in the direction of Wilson's and a 24Hr urine Copper estimation made it a definitive working diagnosis. Though better seen on slit lamp, he also had Kayser Fleischer rings in his eyes. A bright young boy, he was updated about all his blood tests! So the plan was to start him on oral Penicillamine but the side effects and adverse reactions were also being considered before starting with the treatment.

There was also little Y, a nervous young boy of 6 with Type 1 Diabetes Mellitus. He had poor glycaemic control so he was admitted to monitor his GRBS and fix the dose accordingly. Faithfully the little one withstood the regular pricks of GRBS and jabs of insulin but he would cry even if his mother disappeared for a few seconds!

So after 2 and a half days in the wards, a few successful blood draws and maybe one or two cannulations with assistance, I was asked to shift to the NICU. The NICU is basically for all the inborns at Cheluvamba Hospital while the Sick Baby Ward is for the outborns that are referred here (from nearby taluks) and for inborns that have been discharged and sent home. I was initially apprehensive since I was slowly beginning to settle down in the Recovery wards when this shift happened but the NICU has been another overwhelming yet exciting experience in itself so far! 

With tiny babies brought straight out of the labour ward, there is always the joy of a new life, the resilience to fight against the odds and the strange shortness of life when you realize the available resources you are working with. But despite the deficiencies, there are fighters who make it out, against all odds. That's the silver lining, at the end of the day.

Clinical Correlations.

Everyday is a part of a learning curve and I'm beginning to realise this as I see new cases everyday and attempt to understand how to workup a case. It also gives me the opportunity to interact with consultants, formally and informally and learn a lot about their practice and approach towards patients.

Take the case of Mr L, a 60year old man with uncontrolled Diabetes who presented with cough with expectoration and fever. Suspecting a Right Lower Lobe Pneumonia, he was treated with antibiotics initially but when he did not improve, he was treated in isolation as a Covid Suspect (which thankfully turned out to be negative). The CECT showed that it was a case of necrotizing pneumonia of the Right Middle and and Lower Lobes with partial collapse. The Pleural fluid analysis revealed it to be a exudative fluid and the cell type and ADA helped to exclude Tuberculosis. Furthermore, considering the site of pleural fluid being as high up as the apex of the lung, he was not a suitable candidate for ICD insertion (Intercostal Drain, he was taken up for surgery ( Thoracotomy + Decortication and Right Middle Lobectomy). Several findings could be elicited on examining him such as pedal edema, clubbing, decreased air entry on the right side, woody dullness on percussion and  vesicular breath sounds on auscultation.

Another Patient Mrs K with a pre-existing heart condition (including a valve closure surgery) was admitted for pneumonia and she too was tested for Covid-19. Luckily, her reports too were negative and the following day, I was off in an ambulance (with siren and all) towards Fortis in North Bengaluru where the patient was being transferred to be treated under own cardiologist and team. 

Sometimes, when you're the first point of contact for the patient presenting in the hospital ( either in the OPD or in the ER), you tend to follow up closely, to know how they are doing. Take the case of Mr A, an elderly active gentleman who was brought with history of giddiness and on examination, had elevated BP. He had been having hyponatremia for a while now, although he remained asymptomatic. It was thought to be drug induced by previously seen clinicians. His renal excretion of Na+ was elevated. He was also on the Anti-arrhythmic Amiodarone for "ectopic beats", but a Holter monitor (24hr ECG) revealed that he, infact had Sick Sinus Syndrome. He was suggested for a pacemaker in future, in case of syncopal attacks and his elevated TSH showed that the probable cause for his (euvolemic) hyponatremia  was taken to be his untreated Hypothyroidism. Ideally, he would require to be reviewed periodically if his hyponatremia resolves with the appropriate dose of Thyroxine; if it does not, then SIADH (Syndrome of Inappropriate ADH secretion) would be the alternative cause for his hyponatremia.

Causes of Hyponatremia as per Harrison

Sometimes, there are situations where you really cannot do much. Mrs S, a young woman with a daughter in her 20s, came with complaints of decreased appetite and weight loss. Her abdominal distension due to ascites made it more evident that there was an underlying malignancy. The initial blood work revealed elevated CA-125 and a CT scan showed an ovarian carcinoma but the report ( thickening of the stomach wall) also prompted for an Upper GI Endoscopy which revealed the original Carcinoma of Stomach which had metastasized as Krukenberg Tumour. I did an ascitic tap to drain nearly 2.5Litres of fluid, we started her on multivitamins and other supportive (palliative measures). The late stage of detection did not help either, so neither chemo or surgery were options which would guarantee an improved quality of life.

An interesting case that we saw in the OPD was of Mrs. P, who had been having cough for over 6 months(!). With no co-morbidities like Diabetes or Pre-existing COPD, she was taken through a battery of investigations and had completed courses of antibiotics, none of which, had yielded any answers. She tested negative for Tuberculosis and a bronchoscopy guided biopsy got some specimens which were faintly suggestive of a neoplasm (a second Pathologist opinion only gave an "acute on chronic inflammatory changes"). A PET-CT report said it was a hypermetabolic lesion with SUV 4.5 (Still a bit lesser than the cut-off to consider it a malignancy). Here, the radiologist picked up what could possibly be the "Finger in Glove" appearance of ABPA (Allergic BronchoPulmonary Aspergillosis). While the fungal cultures from Bronchoscopy had not yielded any Aspergillus, it could have been narrowly missed considered how quick the bronchoscopy has to be (extremely uncomfortable for the patient) so she has been started empirically on Voriconazole. Further work up would, in fact, be necessary and this led to a discussion on whether a CT guided Biopsy or Endobronchial Utrasound Transbronchial Needle Aspiration (EBUS-TBNA) would yield better results. D Ma'am then asked to read up on the approach to non - resolving pneumonias and it showed that a step-wise protocol is followed. We also read an article from UpToDate for possible etiologies of non-resolving pneumonia and the differences in their presentation. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644829/

Mrs A, presented with cough without expectoration and with massive pleural effusion seen radiologically. With a history of pulmonary TB in her primary contact, it was not hard to find the cause of her (pleural) Tuberculosis (this is STILL EXTRA-Pulmonary!). But  the conundrum was that her Pleural Fluid analysis from GeneXpert showed "Indeterminate" for Rifampicin. Rifampicin is one of the crucial drugs in the regimen of Tuberculosis treatment as per RNTCP and Resistance to this would mean that it would be considered as MDR-TB (MultiDrug Resistant Tuberculosis). So we inserted an ICD, sent pleural fluid again for analysis (this time LPA too). Only after verifying the resistance would she be started on the whole line of drugs that come under MDR TB treatment, until then she would be expected to continue on the HRZE regimen itself.

There was also the case of Mrs N who was brought to the ER with severe breathlessness. She had grade 4 pedal edema, raised JVP and on further examination, her right lung had decreased/absent air entry compared to left and she had a loud P2 as well. Looking through her previous reports, we gathered she had a history of Tuberculosis as a teenager which has caused the Right Destroyed Lung/Fibrothorax evident on X-Ray, overtime, the increased load on the single functional Left lung leading to Congestive Cardiac Failure. She was immediately put on BiPAP to reduce the carbon dioxide load as shown by an immediate ABG. The sudden need to be put on oxygen, the medications to manage her CCF and her sudden immobility did take her by surprise but we tried our best to boost her morale and give her confidence that she would improve.

Right Fibrothorax/Destroyed Lung

Apart from the battery of pulmonology cases, there have been stroke patients, chemo cases coming in for day care and a Carcinoma stomach operated (for the second time) and almost discharged when he had serosanguinous discharge at the operative site so he was re-admitted and taken up for Emergency OT for Burst Abdomen. There was also a patient who presented with renal colic and was almost shifted to OT for URSL and DJ stenting but backed out in the last minute after his pain was relieved (I'm still not very sure which is the ideal analgesic). There have been cases to ponder over and cases to work up to reach a diagnosis and the availability of the facilities is a big plus of a private setup.

Nevertheless, talking to the consultants here has, in itself, been a great experience. Dr M, an reknowned orthopaedic surgeon who practices here as well as outside the country spoke about the need for ethical practice, operate only when absolutely necessary and to earn the respect of the patients by not indulging in fraudulent practices. Sometimes, it is easy to get carried away by the herd, but it takes resilience to go against the tide and stick to our ethics. Here's hoping that these words will mean as much to me in the coming years as well. D ma'am shared her experience of PG days and suggested how important it is to read everyday, even if, only just for a short while. It's important to have a good rapport with your colleagues and seniors even if it isn't always a pleasant work environment (especially if you will need to get chances for any procedures!). Dr S3 picked up that I was nervous early on and asked me the reason. When I said that it was because I was afraid I would make mistakes at my first workplace, he said that I would definitely make mistakes at some point or the other but I'll have to learn from them, as time goes by. It was indeed reassuring to hear this!

Watching the burden of ill-health from close quarters is often worrying. One cannot escape old age but one can hope to live it with dignity. One cannot keep diseases at bay forever but one can definitely lead a healthy lifestyle and prevent illness to a large extent. Beyond this, medical science has made progress to alleviate the pain, decrease the progress of a condition or sometimes, remove the causal factor of the disease. Some other times, what we do, is probably buy more time. 

The terrace door has been locked for some reason. I don't think anyone would have spotted me on the CCTV. :P

Doctoring Days

Contrary to my initial plans for the year, I've begun working at a nearby hospital until the seat allotment is finalized. While last year, the PG courses began by May 1st, this year has been unpredictable for the most part. I thought it would be a good change to get back into the hospital atmosphere and clinical set up since I've mostly spent the whole of last year on building my theoretical knowledge. The process of applying was fairly simple thanks to the resume building skills provided by my friend Dr. Sanjana! I also realized that even with just an MBBS Degree, it IS possible to get some employment, and that too on a temporary basis!

Chitra and I

After I found out that Chitra was also looking for a similar opportunity, we teamed up and applied together. After an interview with the HR and Dr S, we were formally given a position. Our first day was more of an introduction-orientation of sorts. We were taken around the hospitals, across the various departments and we also met several consultants. Most of them were very friendly and asked us about our plans ahead. They also advised us to take all precautions while examining the patients and briefed us on the existing protocols in place. Since we were working 9-5 on our first day, we spent the day taking histories of the in-patients and filling any details in the case-sheets. Finally, some amazing Corner House Ice-cream with the enthu cutlet genius Chitra brought an end to an interesting day with new beginnings! 

The next day, I got to meet Dr D, a pulmonologist with vast experience and also had a short interaction with Dr A, a budding nephrologist and she told me about the pros and cons of specializing post and MD as well as the increased number of super specialists in a big city like Bangalore. (Fangirl alert!) Day 3 was the morning shift and after the initial lull, cases began to trickle in steadily ranging from COPD cases, asthma exacerbations to anaemia under evaluation. The ward cases had several in the onco department, a psychiatry case, a few ortho post-ops and even an AKI (Acute Kidney Injury) due to ?Connective Tissue Disorder. A visit to the ICU with Dr S revealed a grim scenario. Communicating to a patient's attenders about a poor prognosis and end of life care is never easy and sometimes we must consider all clinical as well as non clinical aspects before taking any decision. Truly, an overwhelming situation for both the one delivering and receiving such information but such is the profession..

We soon got N95 Masks, Face Shields and ID Cards to induct us formally into the setup and glad though I am to have received some protective gear, it is certainly not a pleasant experience to have the masks tightly fitted for the entire duration of the shift and move around too. I also got to see cases in the OPD with Dr S, most patients have been coming to her since the last few years and she has an eye for detail which helps her spot uncommon presentations. There were cases of sarcoidosis, hemoptysis under evaluation, respiratory failure as well as Obstructive Sleep Apnoea presenting in the OPD which were all worked up as required and subsequently treated. There was also the case of young Ms D, born with bicuspid aortic valve, resulting in Aortic Stenosis which prompted a Balloon Valvuloplasty about 9 years ago. She also had anemia and GERD. The patient had new complaints of breathlessness and severe fatigue. After considering her clinical features as well as the laboratory correlation, the cardiologists in the hospital suspected that it coule be a case of Infective Endocarditis and decided that she must be referred to a higher centre and did the needful soon. 

Terrace views. :)

While the evening shift of 2-8 might initially seem to be "free", cases do keep popping in and out, a call from the wards or sometimes the ER too. Be it the case of obstructed ventral hernia that was taken up for surgery on Sunday evening or the post robotic surgery (for prostate cancer) patient who came for a hormonal injection (Degarelix), there is definitely a wide range of cases (baring ObG and Paeds). 

One that I will probably remember for a long time is of Mrs UK who was diagnosed with carcinoma of the gall bladder about six months ago and underwent cholecystectomy and a course or chemotherapy as well. But statistics do not favour the gall bladder cancer which is usually diagnosed only in the late stages and has an aggressive course. While we started a blood transfusion and albumin infusion to correct the anaemia and hypoproteinemia, the renal function was also compromised because of some of the chemotherapeutic drugs and the liver function, too, was deranged. Midway through the transfusion, her breathing became laborious since the ascitic fluid was obstructing her normal breathing. After we explained the situation to the patient's son, we shifted her to the ICU to monitor her vitals continuously and drained the ascitic fluid under USG guidance. While I was familiar with the procedure from internship days, a year's gap made me nervous to handle the "3-way" but I was guided patiently by Dr S2.

While it's important to know procedures, it is more crucial to know when to implement them and using the best techniques (when available). It also made think about how vastly different any theory is from the realities or clinical practice. Often, our clinical findings take precedence to make decisions over what the laboratory values might suggest. Ultimately, there is a cohesion between what we read, how we percieve and diagnose a case and how we explain the condition, treatment and progress to the patient's attenders. All these are three completely different skills to be developed over time in order to provide the best possible care, as a doctor, or should I say, to be a "successful" doctor. I'm also in the process of understanding how the government setup and private set up differ in some of their protocols and standard of care. There is probably no system which is completely without flaws but we must try and do the best we can in the set up we are in. 

It's been a week here and I'm not sure what's in the coming weeks/months but I'm trying to go with the flow and take this as yet another experience. There is always a take-away from everything we attempt and to be honest, my reasons for joining work were also to have a change from home so I'll just take things as they come, for now. :)

Covid Conversations.

Day 1.
Although the lockdown officially began all over India at 9pm on March 24th, I've been mostly indoors, only stepping out for any essentials since March 16th.

Staying indoor isn't something new to me; I spent most of last year either in an AC lecture hall or inside my room, preparing for PG. In fact, I was just beginning to go on long walks to another area, play badminton in nearby courts, attend gym amd aerobics when slowly but surely, a clamp down was enforced, across the city, state and eventually the entire country.

Covid-19 is something none of us planned for, none of us had any leeway for in our airtight plans for life, so it does come as a sudden displacement of all our carefully crafted plans. Promotions, retirements are postponed, competitive exams; the great way of determining the path to be taken by Indian students have been derailed indefinitely and so has every other plan that people have made for themselves. For once, we are at the mercy of a microscopic entity that scientists once fought over as being living or non-living; a Virus.

It makes you wonder, how fragile life really is. But it also makes you realize that life does go on, through deviations, detours and sometimes roadblocks. That's the beauty of creation.
Countries rebuild themselves, economies will slowly but surely rise and families will tide over the crisis with strength of the human spirit.

Until then, things are changing, yes, but this too shall pass. :')

Day 3.

So how are families as a unit coping with the lockdown ? While it's easy for individuals to busy themselves in social media challenges/ workout sessions and other ways of productivity, when you look at the entire family being together for extended periods of time, you'll begin to realize that it requires a team effort for smooth functioning of day to day activities. We also begin to realize how we depend on so many individuals for our day to day activities; be it the milk man, flower seller, vegetable vendor and pourakarmikas. 

Yes, there is a lot of uncertainty over when things will get back to "normal" again but it's also a time to reflect on how much "In control" we really are. Mankind has always believed in progress and we believe that as the superior species, we have tamed the forces of nature, but clearly, we were mistaken, as is evidenced by the raging spread of this nanomolecular virus.

As I walk across the now empty park to get some milk, I see the growing carpet of dry leaves on the pavement, a layer of flowers lies untended across the park while birds seem to have made a comeback with their daily chirping. While one species grapples with this virus,the rest of the planet, is strangely, re-emerging from the shadows that we've pushed them to. Perhaps, this is a wake up call to care more for the planet that has given us everything.

Another interesting thing is the amount of conspiracy theories, memes and forwards that are bombarding the internet these days. I think my dad has successfully completed a course from WhatsApp University.

And lastly, the Painting that I began almost 3 months ago is finally completed in a way (there are a few more things but that'll have to wait until the lockdown has ended...) and I'm filled with relief, more than anything else. I'd still recommend anyone interested in Tanjore Painting to learn it from a teacher, rather than on YouTube, because all said and done, there's nothing like learning the finer details from someone experienced.

Day 30.

It's been a month of lockdown and we're nowhere near the end of this. While the US and Europe have had larger numbers to grapple with, the economic price we'll have to pay for this extended quarantine isn't hard to imagine. While I sit at home and think about what activity to engage myself in, many others (including my dad), are figuring out how to keep the business running with minimal contact and travel. This hits hard especially on the industries that require human interactions, on factories that depend on manpower and any sector that involves travel and social interaction. 

Nevertheless, "learn as you go" kind of process as most countries learn by trial and error and each others' mistakes while trying to establish an evolving protocol. While the Spanish Flu of 1918 (coincidentally, I also found a reference to this in the British period drama Downton Abbey) surprisingly affected the younger population more, it was also partly overshadowed by the military activities of World War I. The name Spanish Flu does not refer to its Spanish origin but it was more prominently publicized in the Spanish media, since Spain was a neutral party in the ongoing war.

The foreseeable future will probably have us cautiously walking back towards normalcy, at every step, taking precautions that we don't create a resurgence of the untamed virus. Perhaps, this signifies that our efforts need to be better channelized; medical research over nuclear policies, vaccine development over artificial intelligence and affordable healthcare over high-end medical facilities. 

For now, we only know that the curve must be flattened in order to reach a manageable state. Surely, these times too shall pass and we shall look back and wonder how we made it. :)

Day 63

Honestly didn't expect that the lockdown would be extended as far as this but to be honest, is this really a "lockdown"? Most stores are reopening with "maximum safety measures", buses are operating on supposed limited capacity and flights have resumed amidst chaos on the ground! Not far from all this,patients are multiplying everyday while the government resources are being stretched and the private hospitals are charging exorbitant rates to provide a standard level care. Does every individual have a fair chance of surviving the pandemic? The answer is, an uncomfortable but resounding NO!

Why?

Because I've realized not everyone can afford the highest level of care provided by the best corporate hospitals. 

Which would leave a disproportionate number seeking the facilities of the government set up. 

Which obviously is not equipped with sufficient ventilators or support staff to help every sick patient. 

Which would mean they would use their limited resources only upon those that are likely to recover earlier, thanks to their younger age and absence of comorbidities. 

Which leaves an uncomfortable silence about the rest.

The way forward is uncertain but we've got to bounce back, one way or the other. We can't wish the virus away, but we can take caution in our social interactions. In a way, it puts into perspective how "cohesive" our social structure actually is. So bringing about this distancing on a longer term,is a challenge but perhaps we will find innovative solutions to connect despite the distance. :)

The Walk Home.

My father said we were to pack up soon,

A long walk; because I wasn't born with a silver spoon.

I asked if I could bring my bat and ball,

But he said I would get one when they would reopen the mall.

I waved goodbye to my friends at the site,

The construction workers with whom I spent every night.

The mother carried the heaviest load among us,

After all, didn't she carry bricks without a fuss?

My father said we were to walk home to the village,

Yet my blistered feet did not give much mileage.

He said we would work in the fields and harvest,

But I was hungry and in need of rest.

My mother says a virus is here to stay,

To remain indoors is the only way,

But my father asks, what about our monthly pay,

And so I'm walking; to a place far away.

Musings of May

The Time Machine.

To travel back in time, how I yearn!

Ancient scripts and hieroglyphics to discern,

For glimpses of dynasties and an era gone by,

I'd hop onto a time machine and fly!

Amidst the aristocratic royals at the Promenade,

Perhaps a British earl to serenade,

Beyond the Iron Curtain in an oriental landscape,

Living in exotic castles with trapdoors to escape.

With zest and zeal, I join the Industrial Revolution,

While the world grapples with illnesses having no solution.

The rise of modern era, the decline of an Empire,

Enslaved nations begin to rebel and aspire.

Through the freedom struggles, I stride,

As a new nation is born, I watch with pride.

Through riots, wars, poverty and disease we emerge,

At the dawn of the millenium, we surge.

As I pass through stamped post cards and ringing telephones,

I pause and reflect at this moment of peace,

If only this instant, I could capture and seize;

And not go back to a virus spreading with ease!

Dreaming of cherry blossoms in Japan,

While looking at rotations of my fan.

Scrolling through meadows and mountains afar,

As dust gathers on our unused car.

Building castles in the air,

About when I could go out without a care!

An Ode To Imagination.

On flying chariots and winged unicorns I travel,

Even as spell binding tales of wizards and witches unravel,

On broomsticks and carpets I fly into the starry night,

Or perhaps shuttle across the galaxy, hold tight!

With birds and beasts as companions, I explore,

Unknown lands and mystic folklore,

On other days, I live in a futuristic universe,

With gadgets and gizmos that speak in verse.

They say we lack magic and superpower,

But have you ever stopped to marvel at the mind,

Spinning yarns of places you could never find,

Of creatures and creations beyond our kind?

Neither the past or future we hold,

We can only watch as history shall unfold,

Yet, Imagination, with no threshold,

Is perhaps worth its weight in gold! 

.

//To the creativity of every fantasy book you've read, sci-fi thriller you've watched or the latest imaginative series you're bingeing on!//.

.

Attempts of April.

I'm probably not going to find a lot of support in this but I'm managing to get through the lockdown without any frustration. 'Is that even normal?' is a valid question at this point but all I'm saying is, I like how I'm getting this time to do everything I've wanted to do.

• I've watched The Office, Money Heist, (most of) Downton Abbey, Pushpavalli, a few good movies here and there. 
• I've been trying to practice some music everyday and it's great to revisit all the songs I learnt more than 10 years ago. 
• There's also some time for art that I have the freedom to attempt thanks to my mom's supplies. I'm also tinkering around in the kitchen these days and the results aren't too bad. 
• After a year of sitting in front of a study table piled with books and being absolutely inactive, it's a great feeling to get some workout within the comfort of my own home, thanks to Cult! (never thought I'd join the cult of Cult followers but there it is! This has really been a boon during this lockdown) 
• The icing on the cake is the new entrant; the Quarantine Quizzing sessions every night that I've joined since the last fortnight. Although the questions are mostly very difficult and my scores are abysmally low, it's a lot like the quizzes I would attend back in school and there's always some interesting trivia to take away from these. 

I've tried to pick up on my reading habit but its a lot slower these days to be honest and that's probably because of my attention span.

• Tell Me Your Dreams : Sidney Sheldon (A book I had wanted to read for a long time now. Unlikely murders, a mental illness and a courtroom drama)
• Nothing Ventured : Jeffrey Archer (The usual tale of twists and turns about a detective out to expose a suave fraudster)
• Fragile Lives: Professor Stephen Westaby (A British Cardiac Surgeon's experience over the years in his profession)
• A Doctor's Chronicles: Dr. Bharath Reddy (A paediatrician sharing is diverse experience of working with kids)
• The Girl On The Train: Paula Hawkins (This is still in progress but it appears to be a thriller set in Britain. As you can see, it hasn't reached the point of being a page-turner yet.)

I've also tried to write, after what seems like ages and although it's far from perfect, I'm really happy with myself for making a start! After drowning in writer's block for ages, this is a breath of fresh air and I'm happy to be making these imperfect attempts at poetry. :)

What would you be?

If you were the wind wafting across the flowers,

Would you caress the flowers, leaving them quivering?

If you were the sturdy tree in the woods,

Would you give a lost soul a humble dwelling?

If you were the ripples in the blue sea,

Would you clutch at the grains of sands anyway?

If you were the raindrops falling from the sky,

Would you sit gently and shimmer on the cobwebs?

If you were the warm crackling fire,

Would your embers give solace to the hillside vagrant?

If you could just be yourself in this world,

Wouldn't it make a difference in the Universe?

The Procrastinating Bibliophile.

To all the books that lie unread,

Purchased once with eagerness,

Yet overlooked for another book instead,

Know that I still love you no less.

To all the books that wait their turn,

Patiently lined up in my shelf,

For a sleek Kindle, I shall never spurn,

Next time, I always tell my lazy self.

To all my books, eager to be read,

Yet, tossed away for a shiny new find,

One fine day, in your path I shall tread,

Until that time, don't you ever mind!

To The White Army.

To my brethren that bleeds elsewhere,

Know that you are precious and rare.

To my comrades without their armour,

Our battles are not one but plenty.

To heal and help we began our journey,

In your recovery, we found our reflected glory.

The nights spent over patients aplenty,

Were worthwhile when they walked out healthy.

While we take on a microscopic enemy,

'Keep Us Safe' being our only plea,

Yet today we stand aghast and helpless,

For mankind can be violent and ruthless.

To my brethren that bleeds elsewhere,

Perhaps not all is lost in despair,

We shall live to see better days,

Humanity shall get through this dark phase.

Jaychu's Kitchen :)

 
 

 

Artistic Attempts :P

 

So that's all for now. Perhaps, there shall be something more interesting coming up in the next blogposts. ;)

Marching through the month.

To the places you've always wanted to see,
To the person you want to be,
To the castles you've built in the air,
Have you given a moment to spare?

What if you wake up and want differently one day?
What if Life chooses another way?
Carefully crafted plans in disarray.
No dreamy castles but a cottage to stay.

Would you find joy in Life's voyage?
Or perhaps muster all your courage,
And go forth in search of belonging?
With us, our dreams constantly evolving.

What Summer Was, Once Upon A Time.

On cycles chasing rainbows,
Calling out through the windows,
The summer of my childhood,
Spent running round the neighborhood.

On strangers' rooftops and trees we climbed,
Setting up camp with new kids we could find,
Games of our kind, rules to put others in a bind,
Not knowing what was 'peace of mind'.

Picnics and silly pranks at the park, 
Ludo and other board games after it grew dark;
Rasna and candies on the good days,
Ice-creams for the occasional Sundays.

Tinkles and Champaks surprised us every fortnight,
Summer specials were our only birthright!
Penpals and other strange experiments under the sun.
We never realised that it was truly fun.

New Arrivals.

Hope and mischief in their eyes,
They're here to explore the world,
With unsteady feet planted on the ground,
These toddlers are blissfully unconcerned.

With a heart filled with pure love,
Babbling in their own native tongue,
They're here to grow on this Earth
Where humanity is in dearth.

Perhaps we shall awaken at last,
Maybe we can change the bleak forecast,
May we work together for better days,
May we leave this world as a better place.



March has been a rollercoaster for literally everyone across the globe. What began with morning gym, afternoon badminton and evening walks or aerobics was also accompanied by spontaneous attempts at cooking and art. There was the college visiting session of IG, BMC and MMC.

Here are a few samples of my creations this month.

  

  

 

 Times are changing as we speak and the pandemic gripping the world will go down in the annals of history. It's essential that we take the precautions seriously, not panic and remain hopeful.
The next 3 weeks shall feature posts on life in times of a pandemic as it happens. Here's hoping that we emerge unscathed and stronger at the end of this.

Cheers,
J

The Journey through NEET PG 2020

This post is solely for those who are targeting the upcoming PG Entrance exams and this is only about my experience so far. Many others might have used better methods to crack the exam and get ranks in the top 100 or top 1000 but I hope this will help someone starting out to reach their goal.

Background: I did my MBBS in a private college via a General Merit Seat. Academics were given importance and we did participate in quizzes at intra-college and inter-college level. The patient load was just adequate and much lesser than your average medical college. For my internship, I worked at Hassan District Hospital for 10 months under all the departments (minus the stipend though) where there was significant workload and opportunity to do procedures, assist in surgeries and conduct deliveries (due to the absence of PGs in most branches).

After this, I joined DBMCI, Bangalore for the regular classes on weekends. I was also a Plan C User of Marrow. The classes were well organized with the best faculties conducting the classes from 8 to 8 or likewise. Each subject class was followed by a few days gap and a test on the same subject in the next week after which we began the next subject. I attended VIBE and found it to be extremely useful for an Image Based revision.

After the classes got over around September, I began my revision as per a timetable and tried to complete 3 revisions. I attended the Central Institute exams as well and tried to improve after exam. I got 192 in NIMHANS, 2338 in AIIMS, 935 in JIPMER and 2093 in NEET PG.

So, here’s the deal:

I’m pretty much an average student and I think my memory fails me more often than I like to admit. But that meant I had to figure out ways to overcome this.

My father and I sat down and worked out the ranks required for the branches I’m interested in and the marks that correspond to it. I had a target to score above 800 in order to make it under 2000.

1.       Do your research.

Please sit down and look at the cut-offs for the colleges your branch of interest based on the last two years. Now look at the marks scored for these ranks. Essentially 800+ is needed for something in 2000 and under. If you are looking at Radio/ Dermat at a top college, you might have to push it a notch higher.

2.       Follow a Time table.

Be it DBMCI/ DAMS or Marrow, follow the test schedule religiously. Plan to finish that subject in the time period given and also revise it once on the last day. Take your tests seriously.

3.       Notes are important.

I cannot emphasize the important of good notes. You will thank yourself for writing things neatly, legibly and in a way that you can understand even 6-8 months later. If you missed something/ fail to understand something, make sure to clarify it in the same session or during the break. If you are one who remembers by examples and similes used by the teacher, don’t hesitate to write those down in your notes. It always made things simpler for me when I was reading the subject after a long gap.

4.       Go back and read. The same day.

This is probably the single most important suggestion given to me by a senior. I found this very hard but I tried to follow it. No matter what time your class gets over or begins, it’s important to go back and read the day’s topics and even solve MCQs on it, if possible. During the gap, read slowly and try to make sure the idea is clear in your head. If needed, refer a different source for an explanation. If there are some IMPORTANT topics left out (which are usually very few to none), add it to your notes in a few words. I solved MCQs from a few Subject books and also from Marrow QBank.

5.       Take GTs.

Now this may seem like a controversial point but I think it would be an early exposure to the length and pattern. I began taking GTs for AIIMs in April and the NEET Pattern from May using both Bhatia and Marrow as my sources. My initial scores were very low but I plotted a graph that showed my growth over the months. This graph can be a boon or bane. I Initially saw good progress but after August, the growth rate was much slower (I was stuck at getting 180-190 qs right) and also fluctuated often. Nevertheless, use it as a reminder to show yourself that you’ve come this far and to motivate yourself to go further.

6.       Read well, revise more.

Again, you might wonder why do people stress this point so much, because it’s 100000% true! It’s easy to read something once but when asked to recall it when asked in a twisted manner 6 months later, you realize what they mean. Focus on revising in between your subjects, taking GTs as a way of testing yourself. Revision should not be a passive process: It would be more effective when it is retrieval of already encoded information rather than creating a new memory of the same. 

What does that mean? 

Say you read Amino Acid Metabolism in April. One way to revise it in June would be to sit and recall whatever you can from One carbon Metabolism to Phenylketonuria to the polarity of the amino acids. When you actually sit and recall, you find gaps in your memory and then you fill it up by revising the entire chapter but at a slightly faster speed.

Personally, I found this very, very hard. I found it more convenient to just read the whole thing again but it was only few months later that I realized how important this was and began to do this, even if it meant more time. I used a white board where I started recalling everything I knew on that subject. Initially, this really affected my confidence but I realized it was the only way I would test myself before the exam.

7.       Sources are plenty, trust your own.

The truth is, there are plenty of sources for the same content. Stick to what you have and go by it. Don’t dwell on controversies. I chose Bhatia Faculty and many of the teachers overlapped with the Marrow teachers. I personally found them to be relevant, concept oriented and very helpful. I think other institutes are also equally good at what they do so just believe in what you’ve joined. I referred the Marrow videos when I had doubts in my notes in a few areas. Of course, there are going to be new points in every source you read, but you’ll have to draw a line somewhere and decide how much of it can you actually remember at the end of the year.

8.       Schedule

For the average student, a good plan is essential to get through the maze of preparation. Target the AIIMS exam. Believe me, it isn’t as hard as you think it to be. You can target your revision such that you have given a good first revision by AIIMS. Practical knowledge and common sense are two things you should remember to carry with you on the day of the exam! Plan every single day before hand, plan for the upcoming exam such that you have a few days leeway to revise high yielding points in the last 3-4 days. Make sure you’ve gone through the previous year papers well because the central institutes always have a few repeats or similar questions which you wouldn’t want to miss.

9.       Traps.

Stay on your own path, don’t dwell on comparisons with your friends or random Telegram groups. Don’t get discouraged by plateauing scores; identify where and why you are going wrong. I categorized my mistakes into 3:

·         New topic,

·         Known topic but did not read properly (reduce these by clearing the concept such that any way it is asked, you don’t fumble)

·         Known topic and silly mistake (work on eliminating these)

Don’t go chasing different sources. Keep to yourself and keep the morale high. Rejuvenate yourself with good music. A regular 15-minute walk can get you some fresh air and a change from being indoors all day. Track the number of hours, if it helps. Some days are good, some are not so good. Don’t dwell and hate yourself for the bad days but try to make the next day a better one. It's equally important to have a good support system. I'm grateful my parents stood by me through the year and for the friends who helped in making it seem less daunting. I often felt we were all in this boat together, going through the rough seas.

10.   Belief.

At the end of the day, it’s a long and tough journey. You’re running a marathon and you will need refreshments along the way to stay hydrated. You can’t afford to burn out towards the end, in fact, you need to have the ‘josh’ to push yourself even more towards the end. You need to remind yourself EVERY SINGLE DAY that you want this, and work on making the most of THAT DAY. An important line by a topper that remained with me is that if you want to score a century, you don’t think about that all the time, instead, you focus on each ball that is being bowled at you. Likewise, get down from the lofty dreams and focus on making the most of EACH DAY. At the end of the day, when you go to bed, you need to try to have the satisfaction that you made the most of that day and tried to use it as effectively as possible. Don’t look at the gap year as a struggle, but as a chance to a create a better life for yourself and your family. I am forever indebted to Dr. Thameem Sir and Dr. Apurv Mehra for their motivation and never-give up attitude.

At the end of the day, give it your best. If you can afford to prepare full time for PG, please do so. Give it everything in you. Whatever be the result, prepare such that you had no regrets or ‘what if I had read a bit more’.

Best wishes to everyone beginning this journey.