Eye Am Back

It is time, folks.


Ophthalmology review posting.

And yes, that is hordeolum internum. I can distinguish it from a chalazion, so yay.

Pissed Happy Children

“These children know nothing about PHCs!”
“You are right, they think it stands for Personal Holding Company.”
“Deplorable!”
“Let’s show them!”

And thus it came to be, that the Pancreas and her friends were released from the torture chamber at the Department of Community Medicine, and sent to live in a village.

The Pancreas, having experienced rustic village life previously, knew exactly what to do. She packed her whole room into a bag, and added the kitchen sink too, for good measure. There wasn’t much space left for clothes, but this did not worry her. She had been informed that the most she would be able to do at the end of the day would be to crawl into bed with a prayer of thanks.
“3 days, 2 dresses, and the one I’m wearing. This will be more than adequate.”
In retrospect, that was an extremely stupid notion.

The Pancreas could not lift her bag. But her friends could, and did. (She loves them all very much, and will be eternally grateful to Skoda, the A and Scarhead.)

The Pancreas was bewildered. Was this the village? The rural village on top of a hill in the middle of nowhere that they were posted in? But it had a shop that actually sold shampoo. Real shampoo, with Sunsilk written on the bottle in big, bold letters.

The Pancreas went to the PHC. She was surprised to see actual, honest-to-goodness patients there, and her eyeballs popped out and did a tango when she saw in-patients.

The Pancreas met some of the villagers. She went into their homes, and saw old ladies watching Ente Manasa Puthri [My Insane Daughter] on Asianet.
“Shampoo and mega serials on cable, this must be a city.”

The Pancreas made her way back to the convent they were going to stay in. This time, the tiles on the floor did not raise her eyebrows, but the toilet did. She nearly wept with joy when she saw that the toilet was better equipped than her own toilet back home.

The Pancreas flourished under the excellent food provided by the nuns. She was very happy, and decided to stay there forever.

The Pancreas had a teacher, known as Dr. Wick. Dr. Wick wanted the Pancreas and all her friends to become experts in SPM. Dr. Wick was loads of fun, and they all loved him, and so they decided to work. And how they worked! They conducted surveys among the people of the ‘village’, they interviewed patients in the PHC, they talked to doctors and nurses and pharmacists and drivers, they formulated health programmes and held discussions about the merits and demerits of immunisation programmes; they ate, slept and thought SPM. And it was fun. For the first time in their lives, they realised how SPM worked, and they were happy.

We had joy, we had fun
We held surveys in the sun.
But the hills that we climbed
Were so steep I had a fall*.

The Pancreas and her friends worked hard, and Dr. Wick was pleased with them.
“I shall take you to a lion safari park on our way back,” he said, and there was much rejoicing.

The Pancreas saw a lion, and four lionesses. The lion saw the Pancreas, and he smiled at her. The lionesses growled, and the lion returned to his den. She told her friends waiting in line about it, and they laughed at her.
“You checked the sex too?” and there was much guffawing. They returned subdued, because they hadn’t realised that lions had manes, and lionesses did not.

The Pancreas returned home, tired, but happy, and kissed her cat, and got scratched on her nose.

P.S: Some people think PHC stands for Primary Health Centre.
P.P.S: I hate Medical Entomology. I don't know, or care about, the species of mosquito feeding on my blood. I will zap them all with my AllOut mosquito repellent, and that's it. Gah.

*Almost.

Happy Vishu

I am finally beginning to like SPM. Before the whole lot of you disown me for crimes against medicos, let me tell you the reason. We have one professor (just one, mind you) in the entire department who is genuinely interested in the subject and can successfully impart his enthusiasm to students. SPM can be interesting, provided your teacher has enough imagination to transform something as boring as the national tuberculosis control programme into something a medico in stage IV NREM sleep can relate to. I have enough of gumption to be horrified the thought of specialising in SPM, but that might have something to do with the way internal medicine calls to me, to use a corny phrase.

The Department of Community Medicine is one of the few departments that owns a LCD projector, and so we are now slowly succumbing to that bane of the corporate world- Death by PowerPoint. Every single one of us is required to present a previously assigned topic. This means that in addition to my own, I am also ‘requested’ to make presentations for some of the hosteller girls, since they are ‘not computer literate anyway’, leaving me with plenty of free time. I made at least five presentations for the clinico pathological correlation classes in (duh!) Pathology last year, for people I barely know, and from the look of it, I think history is about to repeat itself. It is a pleasure to help out only people like Eli, who doesn’t wear a gloating smile, thinking “Sucker!” while I agonise over design templates.

Next weekend will be spent at the primary health centre in some rural area. I am so looking forward to SPM lectures at eleven in the night. (Yes, yes, that was sarcastic.) The department has also promised an Exciting! Trip! to apprehend mosquitoes, cultivated in the campus specifically for this purpose. Dengue haemorrhagic fever, here I come!

The bag I carry to college these days can hold an elephant, and still have space left over for the kitchen sink. I am expected to take the Park, and the freakin’ heavy SPM record everyday. My back is going on strike from Thursday. I wonder what they’ll say to that.

My senior, Vanilla Chechi* got engaged last week. She was one of the house surgeons we chummed up with during the third year Medicine postings. There is something about inserting a nasogastric tube at three in the morning into a patient who is screaming at the top of his voice that we are trying to kill him that cannot but make friends of the brave (and sleep-deprived) souls who are involved in the matter. She was radiantly happy, and we got to see many of our seniors we hadn’t met in a long time. And also her husband to be. Who seemed very nice. I hope you’ll be very happy together.

I googled my friend’s name (a long lost one), and I find her picture on the internet IN THE NEWS, people. Jealous Curious, I googled my own name, and found something about Henoch-Schönlein purpura. I didn’t know that I had done a research paper on HSP, or that I had tuberculosis. I eventually concluded (with a heavy heart) that it probably wasn’t me. This highly talented doctor from Delhi also seems to write poetry, and then moonlights as a nuclear physicist in her spare time. Just to cheer myself up, I googled Adorable Pancreas, and found that four of the ten results on the first page were about me. Ah, fame.

This google train of thought led me to the ‘peculiar google searches’ station. It’s been a while since I did that, don’t you think? No? All right, if you don’t want to know about “medico – long underwear” and “perineum impalement torture” (OWWW!) I won’t force you. Still no? Not even for “the technition did not have gloves on while looking for vains”? Perhaps “written sex stories by medicos” will do the trick. That one got me a number of hits. No? Well, your loss, I say.

Happy Vishu, all! I’m off to set the Vishukkani. Which means I will stand around making uselesssuggestions while Amma arranges the vegetables and gold in front of a picture of Krishna. My role cannot be trivialised. And I shall get lots of money tomorrow. Yay!

*It’s considered disrespectful to address older people by their name. Chechi is the term of address for someone old enough to be a sister, and original older sisters. We Indians have strong ideas regarding respect.

Composting. And Also, Happy Birthday To Me.

I got a phone call from Skoda. She's brilliant, you know. She's the "another distinction here, please" type, topped the Ophthalmology exam (I scraped through, and I consider that a major miracle) and all. She wanted me (please note the point, me) to tell her the dose of salbutamol used for nebulisation. I felt like a real doctor then, and was very happy. (And also, a confidence trickster, but don't you worry about that.) And then I used my brain (what? I have one, complete with 2 cerebral hemispheres and a medulla oblongata.) and concluded that she was too upset to think.

Community medicine posting, also known as composting, is what I go through these days, where they do their best to put me into a coma. Apart form trying to kill me from shock (“YOU THERE, SLEEPING GIRL, TELL ME, WHAT IS THE DIFFERENCE BETWEEN A RANDOMISED CONTROL TRIAL AND A COHORT STUDY?” directly into my left ear while I *ahem* meditate about life in class), they are also doing their best to show me up as an idiot by making me present seminars (or whatever those things are called) on leptospirosis. It’s on Tuesday*, I think. And I have a zillion pages to fill up in my record, and learn statistics. Logistic regression and standard effing deviation. And I joined medicine because I hated maths. Aargh! SPM, I hate you.

The point of this post, peoples, is to tell you that I am very busy these days. When I am not sleeping in class studying statistics and acting as a senior consultant, I am busy staring at my new dress, which is the BEST DRESS ever. Um, did I mention that I am having a birthday? No? Well, uh, I turn the inconvenient age of twenty two next week. I feel like a septuagenarian staring death in the face. Then again, I get gifts, and I’m pretty sure they won’t be dentures, so I guess it’s not such a bad deal after all.

Like all mallus, I have two birthdays, and they rarely fall on the same day. My nakshathram (star) was last week, and I got payasam and a sadya. I also got one of the best birthday presents ever. If The KGB is reading this, it's you I am talking about. It was awesome! So, tell me about Sharon Stone. ;)

I need to go complete that stupid SPM record now. Damn!

*The D-day. Or B-day, which sounds really stupid.

PS: You can send me gifts if you like. Anything to take the sting out of the two twos. :)

Frightened Out of My Skin

When I started my itchy scratchy Dermatology posting, I hoped I could bunk classes and sleep at home, instead of in class. And then they announced that we have an end posting exam, and attendance is compulsory, blah blah blah. Damn!

This unit I am in, SUCKS. I am stuck with some of the most unfriendly kids in my class. They pretend that the rest of the world does not exist, and ignore a lost, lonely, unhappy medico* whose friends were all put in another unit. They are intolerable, and I should not really count this as a loss, but I hate being a stranger in a strange land.

And then one day Bandit (the unit representative) told me it was my turn to present the case. Having absolutely no idea how to examine a examine a patient with skin disease, I objected, but then the words ‘end posting’ and ‘long case’ were casually dropped, and I suddenly found myself eager to broaden my understanding of the most boring subject on earth Dermatology. Bandit led me to the patient, a man completely covered by a blanket, except for his head.

Do you know how pus smells? It has to be the most unbearable smell in the world. This guy’s whole body was covered with ruptured, infected blisters, and the smell would have put the Orthopaedics and Surgery (the gangrene headquarters) wards to shame.

By a superhuman effort, I managed not to wrinkle my nose or display any other external signs of the presence of The Smell, and wrote down the patient’s history, and examined him. His wife removed the blanket covering him, and I’ll just say that the sight more or less scarred me for life.

While I was performing all these trivial activities, the others (my beloved unit, all 22 of them) stood around chatting and giggling. The sound was driving me crazy, I tell you. I still couldn’t come up with a diagnosis, what had caused the blisters in the first place. I was going to go with SJS, but decided to peek into his case record before I committed it to paper. It was actually a variant of pemphigus, an autoimmune condition where the upper layers of the skin become separated from the lower layers. Armed with this information, I confidently proceeded to present the case before teacher. And then, get this, Bandit (the SLIME) had shown me the wrong patient. I wanted to STAB him. I got a ‘poor presentation’ and ‘this is not the way to present a case’ for the first time in my life. Gah.

I bought a Dermatology textbook that very evening. I was looking through the pictures (I do that with all my books- Ophthal is the worst, I think) and I came across a photograph that changed my life. The nail on my little finger has had a small, dark coloured band for about 4 years now, and I never thought much of it. The picture in the book looked exactly like my nail, and it had the highly encouraging caption ‘Subungual melanoma- a rare variant of malignant melanoma’ beneath it. The prognosis is pretty poor, apparently. I will be seeing a doctor on Monday.

I haven’t stopped shaking yet. Oh, God, please, please let it be benign.

*Me, in case you didn't get it.

NAIL UPDATE:
Considering the alternative, I guess this is just a slap on the wrist.

Monday came. I had spent a sleepless night tossing and turning in bed, with dreams of my finger getting chopped off and my career ending with a bald me (courtesy of the chemotherapy) saying goodbye to all my friends and then going home to slash my neck (much quicker than the wrist, apparently) when I did manage to sleep. The funereal atmosphere at home did not help much (I couldn't stop myself from crying on my mom's shoulder) and left for the hospital with a feeling of dread. I did not want my parents around when I received my death sentence.

I consulted my Dermatology professor, told him I had had it for four years, and that a couple of other nails have similar dark lines on them. He took one look at the nail, and diagnosed onychymycosis. (Yeesh. I went through all that self torture for a fungal infection? was the only coherent thought I had then.) I was asked to get a nail clipping test done, and to get back to him with the result in two days' time. I looked at the prescription only after I was out of his room. That's when I noticed a question mark against the diagnosis. It could still be melanoma...

Scene 2: The Dermatology laboratory.
"Oh, nail clipping? Come here."

She put on gloves. Her assistant got two bottles ready, and then placed a glass slide on the table. She wiped my nail with saline, and fitted a new blade onto the scalpel, while I watched with increasing apprehension.
She took hold of my finger and placed it on the slide. The blade gleamed in the sunlight streaming in through the window. She was going to chop my nail off! Noooo....

She began to scrape away the nail surface. The shavings fell on the slide. She showed no signs of stopping even when it looked (to me) like there was just a millimetre before she reached the nail bed. Then she stopped, and I heaved a sigh of relief, which I soon learnt was premature, because she immediately put all the 'clippings' into one bottle. I closed my eyes while she began scraping my nail again...

Scene 3: Today
I got the results.
"No fungus found."
I was sweating bullets when I went back to my professor with the result. And then he told me that I probably have nail psoriasis.

I was told that it was not a serious condition, that it usually remains confined to the nails, that I had nothing to worry about and to please stop looking so horrified. All I could think was, "Psoriasis. I am going to end up looking like this." while everyone around me comforted me.

I do not have family history of psoriasis, I have no skin lesions, I have never had an autoimmune disease. It felt unreal, somehow.

I start steroids tonight. Some lotion that I have to cover my nail with after food, twice a day.

Anyway, I feel much better about the whole thing now. It really is rather trivial (I looked it up), and it should go away soon.

SPM exam on Saturday. And ObG on Monday. See y'all after. Thanks for sticking by me. :)

At Sixes and Sevens

My friends are back from Delhi. While I sat at home and held heated internal debates over which portion of my anatomy to scratch, they held heated debates over whether to go paragliding or white water rafting. *headdesk* Being a stoic, uncomplaining and dutiful daughter, I did not sit around moping, so my parents took me to our home town in the interest of their sanity as a reward. It had been months since my last visit, and I spent a few days dropping in on my relatives. Really, I don’t have a family tree, I have a family jungle. I won’t go into the family scandals of the last 100 years; my head is still spinning. The highlights of trip include three new pairs of shoes, my aunt’s world famous crab curry, and the train journey. A couple of Italian ladies sat next to us on the train, and they wanted to take my picture because I was “very beautiful.” I swear I am not making this up. And then they proceeded to snap pictures of my hair. Just the hair. So much for my stunning beauty. *sigh*

Since the excitement of excoriation is more than I can handle, I thought I would do a meme. Two, actually. Ziah wanted seven random and/or weird things, and ~nm asked for six non-important quirks. The rules state that I’m supposed to tag other unassuming souls, but I'm feeling rebellious. If you want to take it up, I won’t stop you. Being the Maths genius that I am, you get 6.5 non-important weird things about me. I can see you rubbing your hands in glee. I know I am going to bore you to tears. *muahahaha*

Sunshine.
Unlike John Denver, sunshine almost never makes me high. What it does is, make me seriously mad at the world, and give me a raging headache. Two minutes of exposure and my migraine kicks in for the rest of the day. I would live in Noah’s times if I could. I am one of the loons who actually sing in the rain. And dance. And then catch a cold and spend the rest of the day in bed watching the rain from my window. The only season (Kerala has two seasons- hot, and wet) I look forward to is the monsoon.

Touched. Not.
This was discovered by my mother, while she was giving her precious, precious second born a bath. My laughter was not due to the pleasurable sensation of having the grime scrubbed away. Let’s just say my cutaneous nerve endings are hypersensitive to tactile stimuli. Currently this trait is so well developed that it is unnecessary to touch me to make me giggle hysterically. Perhaps because of my ticklish nature, I do not like being touched deliberately, and thus, I refuse to have my eyebrows plucked. (Also: straitjackets are not standard equipment in most places that practice this form of torture.)

Obligate carnivore.
My mother prudently decided to raise me as a vegetarian, and kept me away from meat for months after I was weaned. Unfortunately for her, my ayah was unaware of her intentions and proceeded to feed me fish with my rice, at the tender age of eleven months. And the rest, as they say, is history. Hell would be a place that serves idli and sambar for eternity. The ironic part is that I am mildly allergic to seafood.

Chocolatophobia.
We have a strained relationship, at best. My mother introduced us when I was about 4 years old. I took this to be a sign of parental approval, and fell for his pretty golden skin. I was young and innocent, and was captivated by his sweet words. We retired to my room, where he proceeded to show me the wonders of sinning. I did not pay much attention when the swelling began, but soon it got really bad, with me gasping for breath. That put a quick end to any designs he might have had on making me a poster child for childhood obesity. (Yeah, right.) We reconciled after a few years, but he proved that he was indeed as dark as his heart. I was deceived again, and spent the day in bed, vomiting and screaming in pain. These days, the smell of chocolate can induce migraine. Don’t you wish you were me? I still eat lots of chocolate, though.

The Highwayman.

The wind was a torrent of darkness among the gusty trees,
The moon was a ghostly galleon tossed upon cloudy seas,
The road was a ribbon of moonlight, over the purple moor,
And the highwayman came riding-
Riding-riding-
The highwayman came riding, up to the old inn-door.

I cannot emphasise this enough. I. Hate. Poetry. The sight of a verse is guaranteed to make me run faster than a Ferrari on steroids. That bald guy shaking his spears can beg all he wants, I will not read his ‘stories’ unless he rewrites them in prose. The same goes for that albatross guy. And even the funny guys. Sorry, Ogden.

The Idiot Box.
I am not a big fan of the TV. In fact, I don’t even like the TV. But don’t tell my parents this unless you want to see people die laughing. And I warn you, this can, and has, happened. Remember that episode of South- Uh, never mind.

The Blue Umbrella.
I hate black umbrellas and refuse to use one. They are ugly. Mine is blue- it's pretty! And it weighs next to nothing.

That should make 6.5 points. This is just the tip of the iceberg that the SPM creeps are constantly telling us about. I actually like Apocalyptica. See?

All you Famous Five fans (alliteration!) can now rejoice (not the shampoo). It used to make me angry even then I was a crazy 8 year old who couldn’t get enough of Enid Blyton. Come to think of it, I still like Enid Blyton. Arrested development?

Now all of you head over to humor-blogs.com and… Just sort of look around. You know, so I can be famous and all.

Wherein I Have Nothing To Say

We have no classes for the next couple of weeks. Everyone is in Delhi for our 'study' tour. Except for me, of course. Because the pater is not exactly in the pink of health. It seems his heart has not been beating for the last three years. * abort panic attack*

I have run out of topics to blog about, so here comes another of those ready made posts for lazy bloggers like me: weird google search keywords. Ah, the price of fame.

1. andhra pradesh mbbs first year exams preponed

What do Andhra Pradesh and I have in common? Both of our names can be abbreviated as AP. If anyone finds the word 'prepone' in the dictionary, let me know. One of my pet peeves, that. Pity about the exams, though.

2. divorced my fat

What happened to your 'true love' and 'till death do us part'? One minute you were inseparable, the next you're paying alimony and eating celery. Sad.

3. brachial plexus honeymoon phase

Medicine is truly a fascinating field. You are always learning new things, and there is no telling where you'll do it. So the brachial plexus also has a honeymoon phase, apart from the innumerable roots, trunks, divisions, cords and branches that I memorised back in first year. Henry Gray, go hang your head in shame!

4. corneal ulcer picture

Why do people come to my blog looking for Ophthalmology images? Just because my uncle is an ophthalmologist does not mean it runs in the family. No, I will not give you a picture of a corneal ulcer. Google it. Oh.

5. cannot find a good vein to administer drugs

You can have my Dad's veins. His veins are ginormous. GINORMOUS, I tell you. Just looking at them will make you want to give him an i.v. The only thing stopping me from doing that is the absence of syringes at home. Remind me to nick some from the ward next time.

6. surgery sitting down

Sorry, we insist on patients lying down (preferably knocked out and oblivious to the foodie conversation amongst the operating team) during surgery. No such restriction is placed on the surgeon.

7. case discussion on mitral stenosis for pg students

PG students read my blog for medical information? I must know more stuff than I think. Or maybe they were just dumb. In which case, stay away from them. They know less about mitral stenosis than ignoramus of the millennium me.

8. gave an im injection into vein by mistake

Why is this ending up at my blog? I've screwed up, and screwed up bad, but not this bad. This is why we withdraw the plunger before we give intramuscular injections. And what are you googling that for? Oh, I know, misery loves company. You won't find it here. Careless jackass.

9. masini skoda lissing

I speak English, Malayalam and Hindi. I can understand written French. I can handle spoken Tamil reasonably well. For other languages, I use Babelfish. I strongly recommend that you click on that link and then come back. I might be able to help you then. Or not.

10. diplopia ruining my life

Ophthalmology again! Why me? Oh, lord, why me?

11. medical students are arrogant

Where did you get an idea like that? We most certainly are not. How dare you, scum of the earth? Now where did I keep that vial containing the Ebola virus?

12. muscae volitantes and stress

*pretends to be deaf*

13. uterus hepatitis

Remember what I said earlier about learning new stuff everyday? The uterus can get hepatitis! I always assumed hepatitis had something to do with the liver. Silly me.

14. dissection diaries of dead people

Dead people who are being dissected keep diaries? Should be interesting. "Today that incompetent nincompoop of a medical student cut took out my kidney. This would have bothered me if he hadn't already removed my bladder. Oh, wait. I'm dead."

15. tall cornea

*whistles*

16. blogspot stretched assholes

You're still around? After that tongue lashing I gave you last time? Ooh, looky, I have a loyal reader! Woo hoo!

17. i hate anatomy

Welcome to the club. Feel free to use the gym. We use Gray's Anatomy textbooks as dumbbells, and we have a punching bag bearing Cunningham's dissections manuals. be careful and don't strain any of those muscles with weird names. Please place flowers on the grave of the cadaver you dissected on your way out.

I read an awesome short story today. Check it out. Also, Harper-Collins is publishing Neil Gaiman's American Gods online for free! It's open only for a month, so make sure you get there fast. Also, pleease click on the humor-blogs.com link on the sidebar to up my standing. Please? Pretty please? Thanks!