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. :)