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! 

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//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!//.

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