Sir Jerry

Surgery casualty was one of the postings I was looking forward to. I find Emergency Medicine (which is not available here) very interesting. Put it down to watching too much ER. Damn you, Noah Wyle. And traumatology is the main branch of the subject. In our hospital, trauma care comes under the departments of Surgery (for people who get coshed on the head, stabbed in the chest, and then have their breakfast disagree with them), Orthopaedics (for boyfriends whose limbs get broken by The Dad), OMFS (for those endearing personalities who pick fights in bars and pretty their faces) and ENT (for heavy metal fans who play their music REALLY loud). All of these can be achieved by simply getting drunk and then driving the next vehicle in sight.

We work in 3 shifts- 8AM to 11AM, 4PM to 8PM, and 8PM to 8AM. We are given these times so that we can watch TV at home with a guilty conscience during those hours.

The very first case I saw was depressing. An unconscious old man was brought to the surgery casualty- his wife said he had fallen and hit his head. The housie on duty tried to get the history of head injury (the usual projectile vomiting-convulsions routine), while the patient’s wife wailed in the background. She (the housie, not the wife) checked his pupils and breathing, and I noticed that the guy had blood tinged saliva coming out of his mouth. Then the duty MO took one look at him and yelled, 'MI, Medicine casualty stat!' We rushed him to the resuscitation room, and the Medicine PG immediately intubated him and gave him CPR. Shit, that was scary. Half the instruments wouldn’t work, the nurse couldn’t find any veins, and the PG was pumping away at his chest yelling instructions to the nurses. And then, for the first time in my life, I saw them using the defibrillator. ‘Stand back, we have to zap him.’ It was all done in a hurry, and I saw the paddles sparking. They tried it twice, but he was already gone.

I wish they would start a proper department for Emergency Medicine. It’s awful how patients need to be shuttled from one department to another because their illness encompasses many specialities.

I put 3 stitches. I hadn’t done it in more than a year, but the how started coming back once I started to stitch up a kid’s forehead. I’d forgotten how thick the scalp was, and how difficult it is to get the needle through. But I managed to finish it, and felt very satisfied. I hadn’t wanted to stitch up the wound, because the kid had vomited, and had bits of it sticking to his mouth.

Vomit and I have a very strained relationship. I can never look at it without wanting to add to it. I can resist the temptation until the smell hits me. Another repulsive body fluid is sputum. The revolting mallu habit of spitting on the roads has given me plenty of opportunity to get grossed out while crossing the road. This disgust does not a good doctor make.

Our SPM ‘study’ tour is coming up. After the heroic effort it took to convince my parents that we are going to Delhi strictly for ‘educational’ purposes, it got cancelled. We haven’t given up hope yet, though.

This is my last lax posting, and I have plenty of free time to catch up with my studies. So I spend most of my time on the Internet drooling over shoes. Strappy sandals are my best friends. We met when I was about 4, and their heels developed when I was 14. Take a look at this pair. I would cheerfully cut off my arm for them. And my other arm for these. And dear God in heaven, just look at them beauties. But I only have two arms, and they don't accept them as payment. My feet hurt from just looking at them, and my purse quit. I overheard my mom telling my dad that the internet connection wasn't such a good idea because I spend too much time on the net looking at shoes and crying. I hate my life. I think I’ll go jump from the roof or something. I’ll end up in the casualty anyway.

I am so unhappy. :(

Bones of Contention

For every patient who makes you get a little too involved, there’s always another one who will want wo convince you that patients are assholes.

We had this polytrauma case in the Orthopaedics casualty (my last one, by the way), a guy in his late teens who had the incredible luck to get hit by a bus. I think he didn’t break his little toe on his right foot, the rest of his limbs were a mangled mass of injuries. He had no head injury, so he was conscious and oriented throughout. His left leg was a sight to behold. I'm not sure how much skin he had left on it, and pieces of bone were surveying the world through numerous bleeding wounds. He had had massive haemorrhage, and we requested the blood bank to send 3 units of blood, stat. He was going into shock, and my friend and I were asked to check his BP. He was lying on a trolley, so we need two people to check blood pressure- one to hold the apparatus, and another to do the actual measuring. I held the manometer, and my friend tied the cuff round his arm. He was having fluid infused into him through every vein on his arms, so I was turning off the fluid supply so that inflating the cuff wouldn’t send blood into the fluid bag. And then my friend screamed and ran out.

Everyone stared at her, and asked her what happened, but she smiled (which looked like it was pasted on her face) and shrugged. The guy’s arm was stretched put of the trolley, and he had a leer on his bloody lips. It took me a moment to figure it out. The fucking bastard had tried to grope her. There he was, guaranteed to die without medical attention, with a good chance of becoming handicapped for life even with the best of care. No one wants his bloody gratitude, why can't he just let us do our job if he didn't want to lie in a ditch and die?

Am I supposed to feel happy about the fact that he may never walk again? Should I be ecstatic his arm will never regain complete function? Upset because he didn’t have a head injury to complicate his condition? Miserable because there was no blunt trauma to the abdomen to cause more haemorrhage? Would it make me any less a doctor if I felt any of this, or less of a woman if I did not?

I suppose I have to hold a farewell party for my humanity soon. I went to comfort my friend only after I finished checking the bastard's blood pressure. And satisfied when it started rising to near normal levels.

Resultant Happiness

I paaaaaaaassed!
That made me feel like Mushu the ‘dragon’. Anyway, the 3^rd year results are out. All of us have done pretty well. I feel like an idiot now, agonising over mere Pathology and Pharmacology.

This is my last week in Orthopaedics. I am the first (and only) girl in my batch to have set a fracture. Not one of those Amazons, but ol’ pencil arm. (Certain congenital idiots reach for my arms when they get pieces of chicken stuck between their teeth, but they are always ignored. Corpulent jackasses.) Reducing a Colles fracture is not a one-man job, you need one person to give traction, another for counter-traction, and a third one corrects the displacement. I pulled the patient’s hand (traction), and there was this sound like what is produced when you crack your knuckles. That was the bone fragments aligning themselves. It was a very rewarding experience. Which was why I kept grinning like an imbecile throughout.

I can read X ray films now. The picture on the right shows a beautiful supracondylar fracture of the humerus in a 12-year-old boy. It's a fracture that has to be reduced as soon as possible, because it goes in for dangerous complications. The major artery of the arm passes in front of the elbow, and the fractured fragment can injure it. *sigh* If only Anatomy had been taught by clinicians.

I do crazy stuff these days, like going to college on holidays. The casualty sure is addictive. I wish they offered a PG course in Emergency Medicine in India. I know what I'd sign up for. It's the only reason I'm contemplating taking the USMLE. Remind me to change the channel the next time E.R. comes on.

Today is the last day of the Intermedicos, our annual excuse to fight with the other medical colleges in the state. I’ve never attended a single one. Damn.
The first one was held in my own college. But my dad decided against my going, and had a heart attack. He always had a flair for the dramatic.
The second one was at Kottayam. I was all set to break some Achayan hearts, but they got wind of my coming, and cancelled it.
The third one. This year. Dammit. I was not given permission to go. I didn’t want to risk my dad’s heart falling to pieces, so here I am.
The last I heard, we were 30 points behind. I knew I should have gone over and intimidated become friendly with the judges. I sing, you know. Now I may have to disown my college.

My cat fooled me into thinking she had kittens. Close inspection made me think she was right, but on palpation, they were revealed to be the evil progeny of Satan and Dracula. I don’t think tetanus shots are any good against warding off evil spirits. Maybe if the constituting fluid used was garlic dissolved in Holy normal saline.

Arch wanted to watch horror movies over the weekend, and turned to us for suggestions. My scotophobia and hyperactive nocturnal imagination prevent me from watching anything scarier than the Hindu mythology serials on Doordarshan, so I couldn't help much, until horrible memories of watching the last scenes of a movie where an evil toy comes to life, resurfaced. I just couldn't remember the name of the movie, and turned to the guy sitting behind me for help. He couldn't recall the name either, and he asked his friend.
1^st guy: Da, what's that name of that movie in which one boy's toy comes alive and tries to kill him?
2^nd guy: Ayyo, I know that.
1^st guy: I do too. Something like..
2^nd guy: Got it. Playboy!

Got yet another test this week. Those SPM people seem to have nothing better to do than correct answer papers and chase mosquitoes to find out whether they are Aedes or Culex. If anyone is building a new toilet, make sure it slopes 45 degrees. That is the kind of useful stuff we learn in SPM. Clumps of my hair will be available for sale as soon as I finish reading the anti-insomniac-cum-hallucinogen known as Park’s textbook of Preventive and Social Medicine. The money will go towards the treatment and rehabilitation of former medical students suffering from delusions of being persecuted by the Department of Community Medicine. Bidding begins now! Loosen those purse strings, generous people! It's all for a good cause. And my hair is very nice- long, black (appears dark brown in bright sunlight) and wavy. So place your bid NOW!!!

The Healer of the Abyss

I am still in shock. I came out of the coma yesterday, but I haven’t yet recovered fully. Skoda is still out, with a GCS score of 4. We were the only witnesses, and I don’t think either of us could relive the experience. *shudder*

In a moment of misguided enthusiasm, we decided that we would go to the casualty after classes, on our admission day, to have a Live! experience of how patients are treated in an emergency setting. Arch and Hope, and Skoda and I trotted off to the Orthopaedics casualty. The guys in my unit are bats. Skoda and I are deer.

Our first impression on entering the Orthopaedics casualty was that we had somehow entered a men’s club by mistake. 6 of the members stared at us like we were extra terrestrials, complete with green skin, antennae, and white coats. Then they recognised us as 4^th year students, smiled and invited us in. My, what a lot of teeth you have, Grandma.

Dramatis personae
1 duty medical officer- a doctor employed by the medical college in the Department of Orthopaedics, known as Sir
4 PG students- MBBS graduates who have crossed the post graduate entrance hurdle, doing their residency in orthopaedics, known as PG Chettan
1 house surgeon- a glorified manual labourer who has passed his final year, and is allowed to be addressed as doctor to satisfy his ego, but has not yet received his MBBS degree, known as HS Chettan
2 undergraduate students- 2 sacrificial lambs who had no idea what was in store for them, known as AP and Skoda
Patients- I don’t know why they are called that, impatients would have been a better term for most of them. After a while, a few became inpatients.

Boy, was it crowded. All the old people in the area seemed to be using the bathroom only to slip and fall, while the younger ones were getting drunk and having accidents. The children, in the absence of adult supervision, climbed trees and fell from them. This is the Ortho casualty in a nutshell. Full of nuts. Not counting me, of course.

Things became really hectic, and Skoda and I got drafted. I held arms and legs while PG Chettans bandaged them. My new dress and I, both of us got covered in plaster of Paris. But we didn’t mind, because it did feel a little like we were helping, almost like we were real doctors.

It was some time before we noticed the byplays. At first we took it for some sort of tribal ritual. It then dawned on us that we were the first females to observe males in the wild, on their territory. I refuse to elaborate on the details, suffice to say that I have been scarred for life. Some might call it insights into the psychological profile of males, but it felt more like a lesson on the habits of Wild Animals, that goes by the innocuous sounding name of male bonding. Testosterone is poison.

I have informed my parents of my decision to marry a blue wildebeest called Ramu. He is an absolute darling, who occasionally has trouble controlling his temper. Nothing I can’t handle with some alfalfa and TLC.

I can say that my already considerable respect for Orthopaedics has gone up several notches. You can’t help but admire their sturdiness and perseverance. Who would have guessed that all those apparently bird boned PG Chettans had so much strength? Why is it so hot around here all of a sudden? And who on earth is Ramu?

One of the patients was a very old man; he reminded me very strongly of my grandfather. He was disoriented (Alzheimer's?) and had a fractured hip. I had to hold his legs while they drilled his bone to insert a pin for the skeletal traction. He kept calling his son, whose name just happened to be the same as my uncle’s. I rarely have trouble keeping myself detached, but he got to me. Dammit, he looked Achachan. Why can’t my heart just pump blood when I’m in the hospital?

Objectivity is an invaluable asset. How else can a neonatologist not resuscitate a child born with anencephaly (clicking on the link is strongly discouraged if your last meal was less than 6 hours ago) struggling to breathe? The parents could not afford a scan, and the developmental anomaly was detected only at birth. You can’t take pity on the mother and help her child live a little longer, the child will not survive, and you’ll only be prolonging its miserable existence. Maybe euthanasia should be legalised.

I heart the casualty, at any rate. I'm definitely going back next week, but this time they are in for a surprise. Oestrogen pills cunningly dissolved in coffee. I'm going to have a great time.