Welcome back

It’s been a while. Since I wrote on this platform. The only writing I have done in the past three years is scientific jargon, some of which I myself don’t understand till date. When I entered super specialty training, I was hit by the term “Evidence based medicine”. Suddenly I realized, I cannot just “say” things. I need to find people who have studied it, proven it, published it and then only can I make heroic attempts to make some statements. I need to be able to quote who has studied it at a moments notice. Every time I sat down to write a scientific paper, the edits would come with big red marks saying “Quote reference”. My brain constantly struggled to remember how I knew a certain fact. Where did I read it? It was not just enough to merely know. You had to know why you know.

While this rigorous process is absolutely necessary in science, especially medicine, the creative part of my brain, one which could sit down and start writing paragraphs to express what I was feeling at any point slowly regressed to a corner. Day in and day out, it watched its big brother, the scientific brain, obsessively open twenty tabs and read 40 papers to be able to write one paragraph. Whenever the creative brain tried to put a sentence or opinion in, big brother hollered “REFERENCE!” and little brother went scampering into the corner.

The training is over. The papers are published and accolades received. The degree is in hand. But something is missing.

We are in midst of a raging second wave of a pandemic. Humanity is experiencing a myriad range of emotions. There is anxiety, grief, terror and uncertainty. The young, old, new and experienced, all are in uncharted territory. And the brain and heart need an outlet. No amount of scientific data makes dealing with the uncertainty any easier. This is where art in any form steps in. And this where the scientific brain reluctantly steps aside. I need the creative brain. Not everything can be expressed in ratios, proportions and P values. Not everything can be validated by a third person. Some things are raw and unedited. Welcome back, my creative brain. Don’t leave me this time.

A Start

After an unpleasant conversation which could hardly be termed as a conversation, early in the morning with a random man at the Jaipur junction after dropping my darling mother, I sat in the auto speeding through the open roads. I have rarely been on the roads at six in the morning. It has either been the hospital or my hostel. Needless to say, Jaipur is and will be a very pretty city.

But while on the road, I counted a minimum of five people happily giving into the call of nature in complete public view. This is not a very uncommon site while exiting from the railway stations in most cities. But somehow one thinks that the main arterial roads of the capital of Rajasthan would have been spared. Once I unfortunately started paying attention, I realized the primary population on the roads were the homeless. Every shape, size and colour. Walking aimlessly in whichever direction they fancied today. I felt guilty. For wearing clean clothes. For being fussy about the amount of salt in my hostel mess. For being upset because I couldn’t find the required chudidaar I needed to exactly match my kurta. What have I done differently that I am on the other side of the fence? Being in government health services, and mostly in close contact with the rural population, I know that most of them are victims of their circumstances. The ones on the road often spiral downhill by squandering whatever money they earn by begging or selling scraps,  on cheap alcohol or drugs which are easily available on the roads. But then, it is easy to judge when we have a roof on our heads and a head full of sensible advice and education. Who is to say what we would have done if god forbid, we were born to the emaciated 16 year old girl in rags on the corner of the road.

My mood started going south when I realized there was a long line of the homeless sitting at the side of the road, all with smiles on their faces and chatting and munching. Upon following that line, I realized it started with two men on the  side of the road with two boxes who were distributing kachoris( Fried local snack) and tea to the party. I would have loved to get off and ask them what motivated them to do this but my auto driver didn’t seem too keen on stopping anywhere other than the destination. But witnessing this simple act of kindness early in the morning made my day. There are many such people who carry out simple acts of kindness for the less fortunate. Everybody doesn’t need to get a Nobel peace prize or come on the front page. But if one tummy was filled today morning because of which someone didn’t reach for the extra bottle of cheap liquor, it’s a day well started.

He stopped breathing.

“Boss we have just shifted a young man to the ICU.” I groggily held the phone to my ears as my first year excitedly repeated the case history.

“23 year old, married man,a guard, no addictions, lives alone in a room, was found by his landlord as he stumbled out of his room at night with slurred speech followed by rapid onset loss of consciousness as the landlord rushed with him to the hospital. He was not breathing in the ward but his heart was functioning normally.”

Mildly puzzled, I reached the ICU to evaluate the case. A quick examination later revealed the exact same history and finding. The young man was on the ventilator with obvious signs of brain damage due to lack of oxygen supply to his brain and I was at a complete loss as to what could have been the reason. His family was yet to arrive and the poor landlord was running from pillar to post.

We proceeded to treat him for multiple differential diagnosis although at the back of our minds, we knew very well that damage was already done and this was a lost cause. Next day his family arrived, aghast at the news. He had a young wife who was living in the village with their boy who was a mere 3 year old beautiful child who had no idea why papa was connected to weird contraptions in the big white ICU room. Despite their lack of understanding of modern science, the family took the grave news very maturely while praying for his miraculous recovery every day.

Our search for the cause of his illness continued. All his tests came back normal. Everything in his body was working fine except he needed assistance for breathing and his brain was damaged. On day 3, during rounds, while conversing with the family, his brother said that they thought there might have been some “pudiyas” or drug packets in his house. Sensing some light at the end of the tunnel, I immediately ordered them to go and inspect the house in great detail . ( No, doctors don’t go to patients house for such work, unlike House MD. we have better things to do)

Next day, they came back with some disturbing news and a disturbing gift for me. A snake, which they found below his bed, which wouldn’t leave the room despite all efforts. They decided to box it up and get it to the hospital for Madam. Suddenly things started falling in place. Ofcourse, that is it! A paralysing snake bite would explain everything! The slurring of speech followed by paralysis of his muscles of respiration. The diagnostician in me felt happy that atleast we had some semblance of a diagnosis though the humanitarian in me felt angry. Which God plays such a cruel trick on a young man. A forensic medicine consult confirmed the snake to be a Krait, a highly poisonous neuroparalytic snake thereby roughly confirming our diagnosis.

We proceeded to treat him accordingly though we knew it didn’t change his prognosis much. My daily rounds continued in the ICU. Facing the young man was a old man who was admitted for a stroke and was conscious and improving. We were hoping we would have him out of the ICU in a week while my snake bite boy showed absolutely no signs of improvement. The family simultaneously started their own brand of traditional treatment with ash and what not. ( I really don’t know in detail).

On day 30 since his admission, I walked in the ICU as usual and saw my patients brother leaning towards him and whispering. Thinking nothing of it, I proceeded to pick up my files when I saw a sight which made me stand dumbstruck. The brother wasn’t just whispering to an unconscious, brain dead man, he was whispering to an awake man who was nodding his head in understanding. My jaw dropped open. The attendants laughed when they saw me. The came and said ” Madam, kal raat se baat kar raha hai. Humne kissiko nai bola. Socha aapko bataye seedha. ( Maam he has been talking since last night. We didn’t tell anyone because we wanted to let you know directly)

A quick examination and my apparently written off brain dead patient was completely awake and responsive; albeit completely paralysed and still in need of a  ventilator. On the contrary, my old man, who was improving chose to start deteriorating that very day.

My unit head declared that there is a god when he saw the young patient. A miracle! Everyone cried. In the following days, there was rapid recovery of the boy while my old man died peacefully in his sleep a few days later.

2 weeks later, my snake bite patient walked out of the ward on crutches holding his discharge card. As I watched him walk out, all I could think of was, yes, there are miracles. How he recovered is beyond me. Was it medical science? Was it the traditional medicine? Was it a young wife’s earnest prayers or a sons plea to have his father back? Did the old man choose to maintain the balance in the universe by letting go? Or is there a God somewhere?

All I know is that sometimes, the universe actually conspires to give you miracles and I have been fortunate enough to be witness to one.

A Month

It has been a month. I am exhausted. As I look back, I realize so much has happened.

Patient’s husband,who is equivalent to my grandfathers age, touching my feet crying because his wife improved.

Patient’s husband and patient party cornering me in the ward because his wife vomited blood and aspirated and died when I had left the ward for half an hour after not having eaten since last night’s dinner.

A small girl who had Scrub Typhus and came back from the brink of death, coming back to the ward after a week of getting discharged just to say  “ Thank You Didi” and ask for my number.

A young mother with a 30 day old girl, dying because I made a small mistake.

Patient insisting they want to come only to my chamber and no one else’s despite me explaining to them that I don’t have one.

Being speechless in front of a family  whose 14 year old daughter died suddenly and inexplicably and not being able to answer their questions which will haunt me for a while to come.

Walking away without showing emotions when the son of a 35 year old mother, who was absolutely fine a week back died, howls and wails.

If someone asks me what I’ve learnt,  I would say, Life is a Bitch. 

When will it change?

I am very annoyed. Ask me why? Secretly wonder when she will stop complaining? Yeah well, not now.

I missed one of my closest friend’s sister’s wedding tonight. Why? Oh, I could not find a free friend with a car/chaperone/driver to take me and get me back from the wedding at night. And going alone? Hey, I would not let my own daughter ( if I had one) venture out in this city alone at night decked up, so I don’t blame my folks for having an issue.

The point here is not missing the wedding. I realize not everyone can attend every function however much their heart desires. But the sheer concept that in this blasted city, a girl cannot even imagine travelling alone beyond eleven in the night, is outrageous and obnoxious AND if she does, she risks eve teasing, molestation, harassment, rape or murder. Quite a mood dampener isn’t it? Eleven is being ambitious. My parents will gasp if they knew that I was even contemplating travelling till 11 PM alone. Stop being alone on the road after eight or nine and maybe you’ll avoid the night time shift of the rapists.

Should it be like this in a free and fair country? Just because of my god forsaken ovaries and uterus, my freedom beyond sundown is severely restricted unless a kind friend with a car, offers to drive me home at night. And the kind friend has to be male. A female in a car is probably as vulnerable as a female in public transport late at night. Actually, after the Nirbhaya incident, it is evident that having male friends to protect us at night, actually may not be as foolproof as we think.

I am a young woman in the twenties. As are so many. We work, we travel, we like to hang out. But for everything, we need the constant support and protection from others? Plan our lives around someone else’s availability. I  know many women who do travel alone at odd hours because they have to but only they and their families know, the fear and dread with which they travel.  What sort of warped  freedom is this? I am not going to be naïve and say I should be able to walk naked on the road. Actually, in a utopian world, I should be. But I won’t. I will not even walk in shorts or skirts or a strapless top. In fact I am not going to be walking alone on the streets at night at all. Even if my brain’s bursting with anger. Even if I miss my friend’s sister’s wedding. Even if I miss out on some job opportunities because they require me to travel late at night. Or just missing some harmless fun beyond ten.  No, I must adjust MY life so that my mere presence  does not tempt every man’s raging libido on the road. Every time I step out of my house and am a little late, my poor parents must go bonkers worrying because they unfortunately gave birth to a girl.

I realize there are bigger problems in the world. Also, I realize there are girls and women far less fortunate than I. Those who are not allowed to leave their houses at any hour. My heart goes out to them. And this in no way compares to their troubles. And, also I realize talking about this in a blog post which is accessible only to the educated community serves no purpose other than to add to the already growing resentment. But this is my problem currently and I wish to throw a tantrum about it.

I usually like to end my posts on a positive note. But unfortunately, I am unable to find anything positive in this situation. I do not foresee any significant change in safety of women in the capital or in the country for that matter.  Yes, I know I must travel sensibly, carry a pepper spray, learn self defence, never be alone on the road. I have done all that. And I still don’t feel safe when I am in a bus full of drunken men leering at me hungrily when I go home from the metro station at night. The worst outcome of this oppressive atmosphere in the city is that I, or most women, have developed a deep distrust of unknown people. We have lost the ability to casually talk to the next passenger on the metro, or discuss the book, the person on the next table in the café is reading.  The poor men who actually are the good ones have to suffer because of the bad apples in the lot.  I have not seen other countries in this world but I sure hope, the situation is different there.

Anyone with any suggestions that one can adopt at a personal level to change the situation?

Notes to self before starting Post Graduation

Develop a layer of alligator skin. Covered with a layer of crocodile skin. Throw on some elephant hide as well. Because you will always be wrong.  Even if you are right. That doesn’t sound right, does it? Well, you’re wrong.

Bid goodbye to the marriage you developed with sleep. Taking it for granted. Expecting it to come to you every night. Stay till the morning. Now it’s just going to be an elusive mistress. Not under your control.

Forget that shiny things exist in the world. Shiny floors, shiny instruments, shiny beds, shiny windows, shiny chairs.

Things are going to get dirty and filthy. In fact, they will already be filthy by the time you arrive. And no one will care about it or want to clean it. Nor will you get the supplies to clean it yourself if the desire to do so suddenly overcomes you. It will be best if you slowly accept the filth as part of your existence.

Remember that every patient is a scared person with an even more scared family depending on you to do your work well, even if it is a simple blood draw. However tired you may be, don’t skimp on the details or do a half hearted job. You wouldn’t want any doctor to treat your family like that.

Books are your  friends.  When a long, dirty, bad day gets over, (The dirt is really bothering me, isn’t it? )on most days,  you will have to go home and convince yourself that Harrison is a better use of time than the bed.

Your seniors and consultant are humans. They may appear tough, they may say things to you which you will not repeat to yourself ever again. But don’t take it to heart. They’ve been there, done that and they are training you so that a decade down the line, you will be able to say “Been there, done that.”

Occasionally while walking the atrocious corridors of the hospital after a 36 hour duty, pretend you’re in Grey’s Anatomy. And that, there is some romance in the torture. Or pretend you’re in Scrubs if you will and dance amongst balloons in your head. 🙂

Always carry Combiflam, Crocin and Meftal Spas with you. ( The list may vary from person to person. 🙂 )

Drink water, try eat some food. Sometimes good food. Maybe even learn to cook something. Who knows, Nigella Lawson went from being a journalist to a cook.

Stay in touch with all your friends. Call parents regularly. Otherwise, they will suspect the hospital threw you in a dungeon somewhere. Read some regular books, watch some movies, sing and dance around sometimes. Pretend to lead a normal life.

The next three years are dedicated to your subject. Utilize it well. Don’t be scared to work some more, read some more, ask some more, demand some more. You will never get the opportunity again.

This is what you worked for and dreamt about. Savour the fruits of your labour. There is some time again before you find something else to work towards .

Enjoy the next three years. 🙂

Open invite to all for more suggestions. These are just some things I have to make an attempt to keep in mind before entering the battlefield. Whether I follow them through will be another post for six months later. 😉

Someone stop the Baby!

Ask any med student about some of the most traumatic memories from med school, and 90% will recall the day they were forced to watch a delivery for the first time. I know I know, it’s god’s miracle, it’s beautiful, every woman wants to go through it but SERIOUSLY, those people have NOT seen a delivery. There is not a single person in the labour room during a labour, who thinks it is beautiful including the woman. But somehow when the show’s over, the screams subside and there is a baby amidst everyone, it is an unspoken rule that when one exits the labour room, one must pretend that this was the best day of their life.

With all due respect to the labouring women everywhere, I’d like to talk about my traumatic memory.

I was in my 4^th semester of MBBS and we used to get posted in all major departments for 1-2 months. The much dreaded OBGyn (Obstetrics and Gynaecology) posting which I had been tracking since the beginning of the semester arrived. We had to observe ten deliveries that year. And everyday I prayed that women all over chose to go the feminist way and adopt  or atleast not deliver in my hospital. Alas, god or the labour committee chose not to listen. “Sujata! Lets run, there’s a lady in the initial stages. We can observe.”  Damn my heart rate. Reluctantly I followed my over enthusiastic, fearless  friends. ( Because they had attended one before, I’m not THAT big a sissy).

As I entered the Labour Room, I do not know who was more scared that day, the pregnant lady about to undergo the most painful few hours of her life, or the terrified 20 year old hiding under the white coat. What followed thereafter was not medicine or healing, it was just.. harassment.( With all due respect to my budding Obstetrician friends :p )

I can still hear the echoes of the doctor yelling “bikki bikki amma” ( Kannada for Push) and ‘lovingly’ slapping the patient’s legs and the patient protesting weakly. I could hear my heart pounding in my head which was louder than the lady’s or the OBGYn’s screaming while I surveyed the mess and chaos in front of me.

And suddenly, there it was, the blood sodden hairy head. “Look students, crowning of the head!” The professor  declared triumphantly. Everyone enthusiastically leaned forward to catch a glimpse of this miracle while I hid behind my roommate and simultaneously tried leaning forward and lo behold, the dreaded wave of nausea took over.  The newborn’s head suddenly turned upside down and I was alarmed till I realized the entire room was slowly turning.

“Deep breaths. Try again. Remember you will be a doctor. Lean again.” I slowly talked myself into trying again when. “ Oh shit, back off! Back off before you bathe the new baby in your vomit. Someone stop the baby from coming out!”

By then my brain was screaming “ This is NOT right!  Whoever engineered this got the sizes and proportions all wrong. This baby is never ever going to come out! This is all a conspiracy against women kind!”

I fled to the Ultrasound room and I am ashamed to admit, barfed a tiny bit in the sink and desperately called my mother. She was in a car with three other friends who heard my sob story on loudspeaker and… LAUGHED. She just could not be convinced that my trauma of watching a delivery was worse than her trauma of giving birth to me! Frustrated with all of women kind in general, I walked back into the labour room convinced that I will handle myself with dignity and poise, saw the OBGyn taking the placenta out and silently walked out of the room before I barfed all over the placenta again.

It has been five years since. And I am pleased to inform you that I have assisted in deliveries successfully without having some sort of syncopal attack. But I am also slightly ashamed to inform you that I still have a small phobia of anything OBGyn which I am hoping will never be a problem again since I’ve chosen to move away from OBG unless of course.. I choose to change my orientation. 😛

With all said and done, a child birth is indeed, a god’s miracle. 😉

Do you have a similar story from Medical school or otherwise? 😉 I’d love to know!

The Journey where it all started- A flashback

( Since I am about to undertake a journey similar to the one I took 7 years back, I thought a bit of reminiscing was required. 🙂 )

When I shifted to Manipal, Karnataka, little did I know how important would buses be in my life. Coming from Delhi, a city where the fashionable and the barely fashionable, glide in and out of the airports as if they were free rides, the thought of taking 10 hour bus journeys was new and a bit daunting.

My first visit to my college town 7 years back was when I was shifting there. I had had a nerve wracking 3 hour flight which got extended to a 6.5 hour flight with no food and water. Firmly convinced that this was a bad omen, I boarded the rather huge Volvo bus from the Majestic bus stand in Bangalore for Manipal. It was a seater AC bus and we boarded around noon. I settled down to a long eight hour journey, feverishly praying that the disastrous flight was not in any way, an indication of the bus journey and my MBBS life to come.

As we wove through the crazy noon traffic of Bangalore, my mind wove itself through the millions of thoughts that kept pouring in. I had taken medicine despite everyone warning me against it. Every aunty and uncle on the road and off it, doctors or not, had this expression of foreboding when I mentioned my future plans. In their head, they already checked me off from all future weddings, social gatherings, marriage proposals and normal life. But I knew nothing else except the desire to learn medicine.

Then came the minefield of entrance exams, one which I navigated just about barely, quite akin to how my bus driver seemed to do on the road. Suddenly, the bus braked throwing us all forward. I hurriedly leaned out to see two auto walas do road gymnastics with their autos, barely paying any heed to their near death experience. I was to get used to this driving in the years to come.

After settling down, my mind went back to the last few months. The exams , the results, the final decision to come to Manipal. My parent’s faces when they realized that the first of the brood was going to leave the nest. My attempt to maintain a brave façade while being terrified inside as to how I would handle life without  mommy’s embrace and  daddy’s pearls of wisdom. I fought another onslaught of tears while I looked out and realized that we had left Bangalore. Looking to my right, I saw my parents were half asleep already.

I looked up and saw a flock of birds flying in the sky. They flew in formation never leaving the other’s side. They reminded me of my childhood friends with whom I had grown up and shared my school life. Suddenly they seemed so far away, like the flock of birds.

Feeling slightly sad and apprehensive, I succumbed to the sedative effects of the anti emetic pill and dozed off.

After a  few hours of fitful, nightmare laden sleep, I suddenly woke up for no apparent reason. And I gasped when I looked outside. Nothing in Delhi, nor any hill station ,compared to the spectacle I was seeing outside. It was like Switzerland -meet- India.  Or atleast how I visualize Switzerland in my head :P.  There was an explosion of green everywhere. Trees, valleys, bushes, grass, forests.. it was breathtaking. It had started drizzling and the black pregnant clouds hung low over the valley in one end while starting to clear out from the other, giving way to dazzling green. Our apparently inefficient on city roads driver was driving very efficiently through the capricious hilly roads. My heart soared . How can this be a bad omen? I am going to live and study in the very lap of nature. As we neared Manipal, the greenery never stopped. We crossed small villages, whose names are a tongue twister till date. Finally we drove through the bustling markets of Udupi and broke through the crowd  onto the uphill Manipal approach road which is now  all too familiar. I could see the rise of the building interspersed with the fantastic scenery in the background and in my heart, I knew I found my second home and that buses would always be something which take me closer to my homes.

P.S- If you haven’t, you must visit Karnataka and the various small towns, cities and beaches in it besides Bangalore.

“ This post is also an entry for Momentum of Moments contest of www.redbus.in “

What are your first memories of moving to a new city for college or work? Do let me know in the comments section. 🙂

Letting go and a fresh start

There is a way  to torture doctors. AND THEN there is THE way to torture doctors. Hit them at their weakest spot. So that they are reduced from being the “ know-it-all insufferable, I can save your life/ pretend to cure your cold nerds”  to “please let me go, I didn’t do anything wrong” blubbering, snot running from nose, bullied 5th graders.

And who knows how to do this better than the all encompassing Indian Government and the legal system. My friends will sigh listening to this story again. But now that the horror show is over, the admissions are about to start and with it, another era, I want to make use of this brief interlude to express my anger and sadness just one last time before I let it go.

(For the uninitiated, I gave an entrance exam for Post Graduate studies in Nov-Dec 2012. This exam was initially scheduled for January and was preponed to November with a two month notice. This is a horrific thing to do for something which requires intensive study of 19 subjects. Then the exam got caught in a legal tangle and results were withheld till the Supreme Court released the stay in May 2013. Med Students live in a small world, I understand 😉 )

My last 8 months have been spent in a way, no 25 year old should go through. I should have been at the high of my life, travelling, meeting new people, seeing new things… oh wait, I am confusing my make believe world with my real world :p. OK,  I get that that is sort of impossible at this stage for any newbie doctor. But atleast, furthering my career ? Not sitting and staring at  rotten worthless entrance books, or the supreme court website, slowly losing faith in myself, my knowledge, my ability  as a doctor, my faith and love for my country. Everything!

Our profession is a highly demanding one. It demands high standards in terms of knowledge, hands on skills, ability to control your emotions, ability to withstand sheer physical torture. Such an unscheduled break in our training is devastating. Our knowledge is still fresh, our skills are only in the bare initial stages. If it is not cemented soon, it will erode away.

But then they say.. or as Phil Dunphy says, “When life gives you lemonade, make lemons. Life will be all like, WHAAAAT?”. 😉 I utilized this time to read  wonderful books, learn about the rich history of Delhi, watch a stand up comedy which I had been meaning to watch since ages, visit the breathtaking heritage sites in Delhi, drink endless cups of coffee in Costa and of course watch soaps in such monstrous amounts which I doubt I’ll ever get the time for again in my life.

And now, the wait is OVER!  It’s time to move on. I am very soon going to enter my first love, the hospital again. The dingy corridors, the smell of disinfectants, the rounds, the discussion and most of all, the patients, each with their own stories, each with so  much to teach me. After a long ordeal, in exactly a day, I will get to know where I will begin the next phase of my life and start my next long journey in becoming MD .

How did you guys (I mean my fellow doctors) utilize this time? 🙂 Do let me know in the comments section!