THE DOCTOR'S FEES !!!

Working as a doctor in the community, u get used to recieving all sorts of  'fees' for ur services, be it a bunch of  fresh drumsticks or a big carton of  mangoes or the 4 members of the fowl family that run around in the backyard of my home, taunting my dog with their constant clucking and waking me up at 4am by being my live alarm. i soon learnt that it is a lot easier to accept these strange and unique gifts that are bestowed to you than to refuse and have to explain your reasons to all 100 villagers time and again, like why i refused to accept the cow that Mani so sweetly gave me in gratitude for having delivered his first baby boy after four girls, like it was the hands conducting the delivary  that determined the child's sex...

But of all the different 'fees' that iv been offered the one that struck the deepest cord in my heart was a couple of years ago...i was 24, for the first time i was in charge of the antenatal ward in my community hospital when a lady nearly at term walked into hospital.. barely 21 yrs old, this was her 3rd pregnancy and she seemed more anxious and worried than even a primi, she was constantly surrounded by relatives yaking nonstop while she barely muttered a word. Between my  patient load n her relatives,though i really wanted to speak to her and comfort her, i never managed to get beyond saying her baby was fine after a routinue  check up everyday at morning rounds.

It was december 20th.. a dark, cold friday morning, low lying fog surrounded us as she went into labour.. The mother had some bleeding and the baby's heart rate was dropping, we were all worried about the situation but after some struggle and an assisted delivary, a beautiful baby was born, loudly protesting at the uncermoniuos way that we had welcomed her into the world..

After ensuring that the mother n child were doing fine, I handed the baby over to the nurse instructing her to initiate feeding and left..

That evening when i met the new mother i was surprised to see her quite low..I asked her what they had named the little darling, for which one of the relatives rather disinterestedly informed me, that they hadn't decided yet  and asked if i could suggest one.. I named the little one 'lakshmi' explainig to the family that since she was born on a friday she would bring properity to the house..

The next day, i found the mother weeping her head off, my first instinct was to check to make sure the baby was ok and i was happy to find her peacefully asleep.. For the first time since her arrival, there was no relatives surrounding her and i slowly asked her what the problem was.. In response all i got was another fresh burst of tears.. Nothing i seemed to say or do seemed to help, finally after about an hour i left making a mental note to myself to call one of my psych friends and gather info on post partum depression and if it could present like this.

The situation din't improve over the next few days, till i finally told the nurse to inform me the minute any of her relatives turn up as i had to speak to them urgently..
Around noon i walked into the ward where the young lady sat with a women who from the family resemblance i infered to be her mother. I asked to have a word privately with the older women, and that is how i came to realize the issue.. it was a GIRL.."It's her third girl child" said the grandmother, "her in-laws are not happy about it, they are still deciding weather to take her home or not "..
"Doctor can you please take this child, vl just pretend it was never born, anyways if it grows up with u, it l have a good life.. let it be ur fees"

I had heard of people having such notions but had never really seen it, my idea of discrimination was at the level of how can you let him travel alone but not me simply cause im a girl, that in itself was way too much discrimination for me to accept.. I was shocked, dumbstuck.. 

I heard myself saying "Im a girl, im a doctor, i earn as much as any guy, i support my parents, wat makes you think its bad to be a girl" I knew they weren't saying anything against me, but instinctively i felt it sting like a personal insult.. So many years after independance, education, fight for equality... my glass house was shattered, i realized how much improvement  my country needed, how much the mindset of people had to change..

I did all i could for that little girl, i called in the husband and in-laws and spoke to them,counseled them for days.. I don't know what happened to that family after they left the hospital... I would like to believe that i changed the mindset of  atleast one of the million families, atleast for the sake of little Lakshmi...

HOSPITAL RELATIONSHIPS !!!

In a hospital as an intern, you tend to spend a lot of time with your patients, and interesting relationships develop that probably won’t be understood by many..


Probably one such patient who Il never forget, is Mr.X..

One day after finishing a busy Surgery OPD, Iñ  headed to the private ward, to find Mr.X admitted with a large insicional Hernia. No one had any idea who admitted him as his surgery was not scheduled for next 20 days. As our Head Of Department(surgery)  wasn’t in town and none of us were sure about what to do and since he was a private patient, which meant no one was willing to upset him and end up facing the music from the management, we decided to make him as comfortable as possible and do routinue pre operative workup.

“Ok you, work up the patient, you have to present the case to sir tomorrow”, the final words my PG uttered as he left the ward.

I looked at the big ward clock, 11 PM, probably not the best time to disturb a patient but my other choice was 5 AM which din’t seem any better..

With a huge sigh, I got up from the nurse’s desk and headed to the patient’s room, he was sound asleep, which after almost a year of internship was no longer a deterrent, I put on my, im the busy doctor expression, and knocked the door, rather loudly twice, before entering.

Mr.X stirred sleepily while his bystander got up rather hurriedly and greeted me. For a millisecond I felt bad about my insensitivity at waking up a patient when it wasn’t at all necessary medically, the thought of leaving the room entered my head for a very very brief moment but it was almost instantaneously replaced by other frivolous thoughts like pending discharge summaries.

After convincing myself that my patient was awake enough to answer me, I started to elicit the history of his ailment. I usually prided myself on taking elaborate histories but today I wasn’t really up to it.. I just wanted to finish the work, go back and hit the bed, but my patient had other plans. Now that he was finally awake, he seemed to find it a rather good time to chat, and wanted to talk about everything under the sun expect his medical problem ..

As I half paid attention to him, while battling the irresistible urge to shut my eyes and my mind wondered about how the private room mattresses are nice and springy, I realized the futility of this attempt.. After 15 mins the only relevant information I had was his name, occupation, and I also had had a quick update on all the newsworthy events in the world.

I left the room with a polite goodnight to enjoy my 4 hours of sleep.

The next day wasn’t much better off, with Mr.X veering off the topic every 2 seconds, but somehow with great difficulty I managed to elicit the required information.. I managed to present the case, not the best iv presented but considering the circumstances, it was ok..

Since Mr.X had some insurance issues, we decided to prepone his surgery and keep him admitted till then. This meant that over the next 15 days I visited his room atleast 7 – 8 times daily, and with each passing visit I got increasingly irritated with him… don’t get me wrong, he was a nice old man, although he may have been suffering from hypomania as one of our medical students diagnosed after her brief conversation with him, but my main concern was the 30 – 45 min extra that I had to spend each visit which I could have used to do a million better things…

This cycle continued of me trying to politely escape from the room while he continued to chat upon every issue ranging from American politics to his daughter’s marriage to marine geography in the same breath, till that one fateful day…

I had been on call for 4 continuous days and was now suffering from what I can only call somnambulism (sleep walking), and after answering my bleep for the umpteenth time I decided to get a head start on the day and do my morning rounds at 4 AM, yes, ur right, in my zombie state I totally forgot that my patients are still human and may be asleep..

So I headed to the ward and started to check my patients, when I reached Mr.X’s room it was around 4.30.. I entered the room, Mr. X was awake and he smiled broadly at me, I smiled back while all the time thinking at the back of my mind, how long is this going to take.. “you are up early” said Mr.X , “ Im on call so I din’t actually sleep Sir” I replied , “ ur on call again, u have been on call the whole week now, right ?” asked Mr.X , I was too surprised to answer, I never knew patients actually followed duty rosters of their doctor… I silently nodded my head, learnt some new information on football, finished checking vitals and dressing and left the room.

The following day was grand rounds, our entire team entered Mr.X’s room, he greeted us all brightly and then to my greatest surprise decided that his topic of discussion today would be ME.. He started by telling my unit head about how polite I was, how nicely I spoke to him, and efficiently did my work, and finished with praising me for doing such long hours without complaining.. With every word he spoke I felt more and more guilty, till by the time he finished I was drowning in a big pool of guilt…

He continued to speak about how doctors were doing the best possible work in the world cause what they did was not just a job, how they were God’s gift to mankind, and how much he appreciated them.

As I heard him speak, I felt all the love I had for medicine return, I was reminded that these were the reasons I took medicine in the first place, to help people, and it din’t matter how tired I was or how long my patient spoke unnecessary things, it was part of who I was to listen and serve...

Mr.X continued to stay for another 10 days and during this time he continued to chat incessantly each day I visited him, he shared with me many wonderful experiences and knowledge that he had gained with age, and this time I listened.. :) :) 

MY FIRST DELIVERY

As I scrubbed up yesterday, with my friend, screaming at me to hurry up, for what was my umpteenth delivery, I heard myself saying , ‘oh plz , wat’s the big deal, the baby will come anyways …’
As I thought about it later I was stunned to realize how much things have changed…

My first delivery, it seems like ages ago now…

It was a rainy weekday evening , in final year of Medicine, and a bunch of us students had just about managed to drag our sorry selves to the Hospital for 2nd day of labour room posting. Only one thought filled all minds, hope the PostGraduate (PG) is sweet and lets us go after giving attendance but unfortunately for us that day, like a true OBGian, our PG was in a cranky mood, so that meant we would have to stay till 8.30 at least and witness the miracle called childbirth, unless of course one of the guys managed to sweet talk her into letting us go early, but with this bunch of guys, I dint have much hope.

So it started, the screaming, the anguished wails, the hand breaking grip (its true, never let a woman in labour hold your hand, I realized that the hard way), the gory and nauseating sight and smell of blood, faeces, urine, just about any bodily secretion everywhere, this is how I saw it happen, the so called happiest event in a person’s life..

I think every girl decided then and there never to have a child and every guy thanked the gods that he was XY.

After watching 2 more of these shows, true style, I decided since im forced to see this, why don’t I at least make use of it. So I went up to the PG and told her, ‘Maam please can I conduct the next delivery?’ this question was followed by a piercing stare from my entire unit, that basically said, which planet are u from n what sin did we commit that u landed up in our unit?? and a silent assessment of me by the PG , after which she gave me a curt nod for OK.. as an after thought she added, do u know how to do it? I think il assist u anyways..

So I got all set up, washed my hands as cleanly as I cud, wore a plastic gown and gloves, and sat watching a perineum, silently, while everyone around encouraged, or to rightly put it, screamed at the poor patient to bear down.

Ah, finally the head’s coming.. oops sorry, went back in, not crowned yet, please continue screaming at the woman for her pathetic efforts, tell her “its cause of u that your baby will have difficulty breathing, don’t u want a healthy baby???”.. I mean seriously why do we believe these are the golden words of encouragement, I don’t know, but it’s d same words in every hospital…

So anyways after some 15 – 20 min the head did pop out, I think the PG supported the perineum, I was stunned into inaction at the sight, then I heard a voice screaming in the distance, wait for external rotation, now pull down, ok ok enough, pull up pull up, what r u doing???
As I blindly followed these instructions, all I remember thinking is ITS so warm, like a cake ..
The baby wailed its head off, someone cut the cord, and I managed to hand the slippery eel to the pediatrician without dropping it..
What happened to the placenta or the 2nd or 3rd degree perineal tear , I have no clue….

All I could think was its so warm, so alive, so full of life and I brought it into this world

A RIDE TO REMEMBER !!!

As a part of our community medicine posting during internship, we have to do a week being the transfer intern- this intern has the privilege to ride with the referred patients from the secondary care hospital to our tertiary hospital.. My first day as transfer intern was surprisingly light, i had only 4 transfers, all of them were pregnant women, with previous LSCS or PIH or some other minor condition, and though i went for each of these transfers paranoid that one of these panting ladies might just give a big push and i would be forced to conduct a delivery with my (then) nonexistent knowledge of childbirth, thankfully the day went of without a hitch. So on day 2, when i received the summons, i cooly walked into casualty with a smile on my faceto the sound of "oh good, transfer intern is here, Patient is having chest pain, here's the ECG.. I have spoken to chest pain unit (CPU).. They'll be expecting u there.. NOW GO !!!" The smile faltered a little as i asked , " do i need to take anything or be prepared for anything?" " No, no the patient is stable, jut put him Oxygen though" was the reassuring reply from my senior.So with the smile back in place i waited as we shifted the patient into the ambulance, only then i realized the patient had no bystander, i was going to be alone on this ride... i don't know why but i felt a few 100 ml of gastric secretions pour into my stomach at the thought.. The ride started.. 2 min into the ride my patient looked like he'd fallen asleep... 'i called his name, ayya yenna aachu?' no response.... my heart started to race, for no better reason than that i dint know what else to do, i checked his pulse and auscultated his chest.. was i picking up a pulse or was it my heart hammering ???i screamed at the driver "anna, lights and siren please.. we have to go fast, really really fast." While i massaged his chest, wondering how and what and if i should do anything at all, the patient twitched.. ah, he's alive.. relief flooded my body.. till he twitched again, jerked, had tonic spasms... oh shit.. its a seizure.. no pulse.. hypoxemic seizure... I started CPR ( Cardiopulmonary Resuscitation).. With no proper equipment, no help,

 in a vehicle that was now going full speed such that i was thrown across the ambulance every few seconds, i figured il just increase Oxygen to maximum and hope for the best, I started chest compressions.. he had occasional spontaneous breaths, my only sign of him being alive. The ambulance took a u-turn, i was thrown on the floor, the patient fell on me, as i scrambled out from under him, i realized he was 90 kgs, i din't even try to put him back, i continued Chest compressions, kneeling on the floor beside him...he had hit his forehead when he fell, small abrasion with some bleeding.. last of my concerns.. every second felt like a year, here i was, knowing that i was the only one who could keep him alive, and i wasn't even sure if what i was doing was correct and enough.. Finally we reached the hospital, CCU.. the ambulance doors open, im still on the floor giving cardiac compressions.. a few nursing staff are standing there... "Sister i need help, im not getting a pulse on him"one of them said "sorry, duty doctor has gone for lunch, we cant accept the patient" i was shocked, i was still on the floor, exhausted from the effort of giving compressions for so long and the last thing i expected was this.. i had no words, no response... The driver said," doctor shall we take him to casualty?" "yes" i screamed, all i cud think was yes please go somewhere, please, where real doctors would come and do something, please don't let him die like this, with me.... We went to casualty, where they continued compressions, intubated him, gave adrenaline, atropine, shocked him 4 times and finally got a pulse on him... I stood around, wondering want to do, a part of me wanted to ask if he would die cause i wasn't good enough, d other part of me din't want to know the answer to that EVER.. Finally, when the patient was stabilized, a registrar walked upto me and said " u did a good job, if u hadn't started compressions, we would have declared him brought dead. U can go back, we'll take over" I left casualty.. i learnt the next day that he'd arrested again 8 hours later, and died. i know i had done my best, i had done everything i could but sometimes i can't help but wonder, was my best just not good enough... maybe someday il know the answer.