Armor Plating in Hospitals

"Sir, the new lockers unit is broken" I was told.
"Broken? How?" I could not see how a brand new steel unit of six lockers could be broken by anybody.
"Its one side has come, Sir."
"Let us see" I said, skeptical such a thing could be done by anybody. So we went to the lockers unit in the OT. Its one vertical face on left side had indeed come off. There was a big dent on the side, as happens on bodies of cars in vehicular accidents. I looked at carefully and knew what it was.
"The person who shifts patients on a trolley has banged the side of the unit with the trolley. The patient must have been on it, considering the amount of force that would be required to achieve it. Who was the servant on duty when this happened?" I asked.
"Um... ar... ah..."
They are afraid of naming the culprits, probably afraid of their labor union.
"Send it to the workshop and get it repaired" I said. There would be no point in asking manufacturer to repair it, because the warranty would be void when the damage was not due to manufacturing defect, but negligent use. The engineers kept the unit for a month and wanted us to condemn it.
"I condemn the act that achieved this damage" I said "but I cannot condemn the unit. It is new. If they do not know how to repair it, ask them if it is OK if I get it repaired by an outside agency."
That did the trick. They drilled holes in the side and fixed it to the main body with nuts and bolts.
The following week, there was another occurrence of similar nature. The brand new refrigerator in the labor ward developed three dents. On inspection, it was evident it was caused by patient shifting trolleys colliding against it.
"Perhaps we should shift the refrigerator elsewhere and keep an old one in its place" one staff member suggested.
"We don't need another refrigerator" I said. "We need armor plating for our cupboards, lockers, and refrigerators."

Afterthoughts

She was a middle aged patient. The Resident Doctors called me to see her.
"She has complaints suggestive of urinary stress incontinence" the Registrar said.
"OK" I said. The patient was already on the examination table. "When I ask you to cough, I want you to cough twice" I told the patient. "Please cover your nose and mouth with a handkerchief when you cough."
"Yes. doctor" she said.
I took up the examiner's seat and said "Please cough".
She coughed twice as instructed, but did not cover her mouth despite instructions. My facial expression must have showed my feelings, because she covered her nose and mouth after the act was long over. I had a sudden thought.
"May I know what is your husband's occupation?" I askd her.
"He drives a taxi" she said.
"Ah!" I said.
"What did you mean by that 'Ah!' Sir?" my Assistant Professor asked me after she went away.
"A taxi driver cuts the lane and comes into your lane without a signal. When you honk in protest, he puts out a hand to give the signal that indicates he will enter your lane ahead of you. He does that to show that he has gone through the motion, and you should be satisfied. His wife was like that. She covered her mouth and nose after coughing, only to satisfy me. Both of them either did not understand that doing those things after the harm was already done by their primary acts was no good, or they thought we were dumb enough to be satisfied with what they did as an afterthought, or did not care what we thought. They seem to be made for each other."
He laughed and then said "Sir, but how do you know her husband does that when he drives?"
"Yeah, you have a point there" I said. "He may be the type who cuts into your lane without a signal and makes no response when you honk in protest."

Eloquent One Word Explanation

A part of my job is to forward leave applications of employees in my department to the head of the institute. I have to check the validity of the reason given for asking for leave. Then I have to write my remarks and send it for sanction. There was one such application asking for leave for one day. There was just one word scribbled on the three lines offered for giving the reason for application for leave. It was 'Children'. It was an extremely eloquent word. I did not need any words before or after that word. No verbs, adjectives and punctuation marks were necessary. Even mental visualization of the usually tired and harassed looking face of that applicant was not required. I wrote 'Recommended' without any hesitation and signed on that leave application.

The High - The Crash

I was on my way home after a day at work. I had just got out of the gate of the institute, when I saw a couple of boys riding a bicycle. They were coming hurtling down the single lane left after the monorail work had occupied half the width of the road. The thing was that both of them were on a high. They had wide grins on their faces, their hands were off the handle or any other support, held high in the air. They would have looked good in a bicycle stunt show. What is shown below is my computer aided reproduction of my memory of the duo.

They went about 40 feet and crashed where the monorail pillar had reduced the single lane from the side too. I ran to see if they needed help. By the time I reached them, a crowd had collected around them. One of them had dragged his friend and then the cycle5to the side of the road. The fellow who had been so dragged was sitting on the edge of the pavement, wincing in pain. Nothing seemed to be broken. A couple of policemen happened to come by on a bike. One of them advised the fellow to call his mother on a phone. The other advised him to site on the pavement away from the road. Elderly women criticized them for reckless riding of the bicycle, and blamed their mothers for them being what they were.
They just needed time to recover their morale. So I went my way. On the way I was thinking of what had happened to them just outside our compound, and something similar that had happened recently to someone inside our compound - an intense ride on a high and then a crash.

Dangerous Obstetric Forceps Applications:

A correct cephalic application of the obstetric forceps leaves no mark on the baby's face, because the blades do not touch the face. If the application is correct pelvic when the rotation is not complete, it can produce such marks on the baby's face. In my years of study of such applications done by some people, I have reached the following classification. The red marks in the following diagrams are the positions of the marks left on the babies by the application of the forceps.
Nose sparing application

It is an occipitofrontal application, the anterior blade missing the nose of the baby.
Eye sparing application 1

It is a brow-mastoid application. The rim of the anterior forceps blade stops short of the baby's eye.
Eye sparing application 2

It is a brow-mastoid application. The anterior forceps blade encircles the baby's eye.
I can say two things about these.

1. God be praised for sparing the nose and eyes of the babies.
2. God help the babies if these forceps applications cause intracranial hemorrhages in the babies.

Intercom Abuse

The telephone is an instrument for communication. If it is put to that use, life would be simple. However human nature wants complexities, most often for unreasonable gain.
I remember once our office peon complained to me about one such thing.
"Sir, some of the staff members call on the intercom and say they have reached the campus and request us not to put a cross on their names in the muster."
"So?" I asked.
"Sir, with the new intercom system, one has to dial the intercom number after the exchange code - 2410, and one is connected from any land line or mobile phone. It is no proof that those people are actually in campus."
"OK, We will state that being in campus is not enough, that they have to sign on the muster before the deadline."
That put a stop to it. The person who used to do that finally left the institute for greener pastures, where such problems were not permitted to crop up, I hear.
Then there was another one. I called that staff member in OT on the intercom. Another staff member took the call and said the staff member was teaching the students outside the OT, and had no access to an intercom. I was told that she would contact me when she came to the OT. I realized that this was a lie. The said staff member had not reached the institute, and was being covered by the other one. She had no business being outside the OT, because the students had to be inside the OT, learning operative procedures. I let is go at that, because I do not believe in correcting people who know very well that they are wrong. I got the expected call quite late, by which time the work that I wanted to assign to her was already done by someone else. The covering staff member left the institute later, and the covered one has to be in the OT now, there being no one to cover for her absence.

Tuberculosis Leave

It goes without saying that tuberculosis is a terrible disease (as most diseases are, from the patients' point of view). The government and civic bodies give none month's leave to their employees suffering from tuberculosis. No substitute employee is provided to do the work of these employees on leave. It either taxes the healthy employees who keep working, or the work is compromised. As doctors, we compensate for the absence of all doctors away from work, because patients' health is our primary job, and it cannot be deferred. But we expect that those on such sick leave should not abuse the system and their coworkers while they get well.
We had one lecturer who developed tuberculosis of lymph nodes. She started therapy and went on tuberculosis leave. She had no functional disability. In fact, she looked the picture of health while her overworked colleagues looked sick. However she remained on leave for the duration of therapy. "I got the disease in the hospital. Now the hospital has to give me leave, as a part of compensation." Her argument was flawed. She could have got the disease anywhere, not necessarily in the hospital. Furthermore, she must have got it long before she joined the hospital, considering the latent period and the duration of her service. Anyway, I did not argue the point, because she was sick. After joining, she asked for three more months of leave, citing ill health of some not very close relative, whom she wanted to nurse. 'She must be practicing privately' people said 'and this must be an excuse to get time for it while retaining the security of a permanent job to which she can return should the attempt at private practice fail.' This leave was not sanctioned by the administration She resigned, without compensating for the efforts of her colleagues who had done her work in her absence.
We had one senior staff member, who developed tuberculosis and went on leave for nine months, in one month increments. Modern therapy of tuberculosis is shorter, but the leave is still up to nine months. Ill health was cited as the reason for extension of the leave every month. This person put up an application for special leave to go to a foreign country for a conference while on tuberculosis leave. It was rejected by administration as per rules. Then this person put up an application for sick leave for going to the conference. It was even stated that change of atmosphere would help recovery from tuberculosis (even if the duration was less than a week). I am not aware of what happened, because this person has not joined duty from ongoing sick leave yet and we are not in communication. But what troubles me is that a person is too sick to work, but not for going to conferences, while colleagues are overworked.
The system permits such abuse and conscience is overcome by need for self satisfaction. As a result such occurrences will continue. It reminds me of a story of a Lecturer who was taking sick leave for one month at a time, for 'speedy recovery' from prolapsed intervertebral disc. After three months of leave were over, she applied for fourth month of leave. The day after she sent in this application, she was seen running around the Shirdi, a holy place for devotees of Saibaba. When she saw the Lecturer who saw her in pink of health, she ran away at a speed that would not be possible for any patient of a painful disease of the spine. The matter was duly reported to the administration. I heard an inquiry was initiated, but am not aware of the result of the same.

Green Show in Obstetrics

When you search this term on Google, you find 2540000 hits that deal with shows which are in theaters, fashion industry, television, and shows related to being eco-friendly. In all these hits, there is not a single one related to obstetrics. After I complete this post, there will be one.
For those of my readers who do not know what is 'show' in obstetrics, I will explain. It is the vaginal discharge that is found in a woman who has gone into labor. It is the cervical mucus plug along with a  little blood that comes out when the plug comes off the cervix. It is one of the signs of onset of labor. Every student of obstetrics knows this. There is another term that may not be understood. It is 'meconium'. It is the stool passed by the fetus while in the mother's uterus. It is green in color, and its presence often indicates fetal distress, which may lead to fetal death if it is not delivered soon. Every student of obstetrics must know this, and every Resident Doctor knows this. At least that is what I believed until the other day.
I am on vacation. However someone got so upset with something that happened in my department, that he/she sent me an email. It was about a Resident Doctor'.
'This girl noted that a woman in labor had meconium in the vaginal discharge. She did not document it on the patient's case paper. When it was discovered by the Registrar a few hours later, and when she asked this Resident Doctor why she had not done anything about it, she answered that she thought it was 'green show' and hence she did not do anything about it. The Registrar was aghast.'
When I read the email, even I was aghast,
"This Resident Doctor is doing her fourth house post. How could she not diagnose meconium?" I asked someone.
"Beats me" was the answer.
"And Green Show?" I said. "Show is always red, never green. There is nothing called 'Green Show' in Obstetrics."
"That Resident Doctor is making history" was the reply. "She seems to be original."
"You are being sarcastic" I said.
"Of course. This doctor must have known all along that it was meconium.  She must have been very lazy, and decided to ignore it so that she would not have to treat that complication."
"But that jeopardized the fetal well being" I said.
"She must have been very selfish too. Nothing must have mattered more than her personal comfort."
"And what if she genuinely thought it was 'Green Show'?" I asked.
"Then her future would be very dark. She does not seem fit to practice obstetrics."
I will say that was an honest and frank opinion. I will find out the truth only after I join duty.

Fashion Statements for Patients?

These two patients were admitted in two different wards and had two different nurses looking after them. What they had in common was that both of them were to undergo an operation in our OT that day. One was scheduled to undergo a diagnostic laparoscopy while the other was to have an emergency cesarean section. The standard procedure is that the nurse prepares the patient for OT, including confirming removal of undergarments and ornaments, putting a name tag on the patient's dress, covering her hair with a cap and giving her premedication.The House Officer is supposed to confirm that the preparation is as expected. I was to assist the House Officer perform laparoscopy. The patient was anesthetized, and lithotomy position was given. Then I suddenly realized that the patient had her um... upper undergarment on, so far covered by the OT dress but not partly exposed. The nurse had goofed up, and the House Officer had been too busy or lazy to do her job. The anesthetists had also goofed up. They had inserted the chest leads of ECG under that garment, probably happy that they would be held in place by the tight garment and would not come off due to poor adhesive.
"Have we started leaving the undergarments on when patient go to OT?" I asked.
"Arrey, the patient's bra is still there" my Registrar declared. She did not feel awkward to say that word aloud in OT. Houseman, remove it."
"It should not be worn because it is a tight garment and may restrict ventillatory movements under anesthesia" I said. I don't know how they managed to remove the garment while the patient had chest leads, IV line and pulse oxymeter attached. I was to embarrassed to watch.
The other patient was sent from the labor room. She had no hospital dress. Instead she was wearing an OT gown, which covered her full height all right, but was open along the entire front. It was held in place by three strings, one at the upper end, one in the middle, and one a little lower down. The poor woman was clutching it around herself, trying to cover her modesty desperately despite labor pains. I called the ward and spoke to the nurse.

"Why did you send the patient without a hospital dress?" I asked her.
"I asked the doctor" she said "who said it was OK."
"The doctor says she asked you to give the patient hospital dress" I said. "The poor woman is almost naked., that too in front of all people in OT."
"I am new in this ward" she said.
"So what?" I was getting quite angry by then. "You must know hospital routine - giving a dress to a patient is the most basic of nursing care."
"OK. I am sorry" she said.
"But what about the patient on the OT table? She is still almost naked" I said.
"I said sorry, did I not?" she retorted.
I knew I could not improve things any way. After all, I was not involved in the selection process of the employees, nor were they answerable to me. I could just wonder at the coincidence, one patient being unduly clothed and the other hardly at all. Perhaps there was a cruel balance there, positive and negative nullifying errors due to extremes in each other.

Strategic Applications

There is a curious tendency for my staff members to apply for leave when I am on vacation or leave myself. On the first day of my last vacation, the Assistant Professor who had joined duty after six months of earned leave just the day before put up her notice of resignation and application for leave without pay for a month, to which she was not entitled because no such leave is granted in vacations, when the hospital is working with 50% staff members. The idea was to avoid the deposit being confiscated by the institute for resigning without any notice, and still not work for a single day after a six months' leave. She knew I would not sanction it. My next in command promptly sanctioned it, claiming ignorance of rules.
The day after I went on vacation this time, my Assistant Professor put up notice of resignation. I wonder why he was afraid to do so in my presence. I would not hold back anyone - not that I could if I wanted to. He was working during vacation anyway. I think they discuss strategies amongst themselves, and apply a strategy at inappropriate times.
That reminded me of two of my staff members, both Professors at that time. One would put up long leave application when I was away, and get the other Professor's signature on that application. The other one had put up an application for permission to publish about ten scientific papers, none of them ready anyway. It was just a list. It was dispatched just the day before I took charge as Head of the Department. It was probably fear that I would not forward the application.
Only a person who knows he or she is wrong and still wants to do that wrong behaves in such a manner. I wish they had read Stephen Covey's masterpiece - 'Seven Habits of Highly Effective People'.

In House Litigations

When I was placed first on the selection list of Lecturers, I was placed at the most peripheral place, while people lower down, including Dr ^^^ was placed at the most prestigious place. This rule was not made applicable to all specialties, probably because it did not suit some privileged candidates in some other specialties. My representation to the civic boss in charge of this affair fell on deaf ears. If I had sued, I would have won the case. I did not. I got a letter from the University that the place where I was posted was not a teaching institute, and got transferred to the place where I have worked for 27 years.
However everyone has not been as tolerant of injustice, real or imaginary, as I was. There was Dr. ***, a Registrar, who was unhappy that someone two years her senior was selected to be a Lecturer ahead of her, though she was MD while *** was not. She got a stay on that appointment. That post stayed vacant forever and was wasted. In due course, both of them became Lecturers in another institute.

^^^ did not do much academically and *** went ahead of her, though three years her junior. ^^^ did not sue. But Dr. @@@ sued *** for being selected ahead of him, despite he being two years her senior. He lost the case.
A civic boss decided to place one Dr. $$$ as the Boss of Dr ###, only because $$$ was a full timer, while ### was an honorary doctor. ### threatened to sue, because he had been Professor while $$$ had been his resident doctor. The civic body transferred him elsewhere as assistant to a very senior Professor to avoid litigation. Later, $$$ resigned for reasons not known to me. ### was transferred back as head of his original unit, because they did not want to give him a unit chief's position at the prestigious institute where he had been transferred. This time ^^^ sued him for not being given the position despite being a full timer while he was honorary doctor. He was upset. He said he could have got her services terminated because he had proof that she was engaged in private practice though she was not permitted to do so. He did not do so. He fought the case and won.
I heard the story from ###, not an old man, but still quite upset with what had happened so long ago.
Just the other day, a doctor in service of the civic body sued the civic body for being denied permission to appear for an interview of selection as an Assistant Professor, and later for being not given the post though selected for it. She won and is now working as an Assistant Professor.
A person has a right to fight for his or her rights, and it is reassuring that people can exercise that right. What is not reassuring is that there are occasions of injustice which need never arise. For every unjust act that is taken to court, there must be a score of others which do not reach the court for various reasons, like mine did not, and that hurts.

Gossipmongers

It makes no difference whether a person is a doctor or an engineer, or anything else that is recognized as something important. It makes no difference whether the person is a man or a woman. At ground level, everyone is a human being, and most human beings will do things that other human beings will gossip about.

“Thanks for doing everything you did for my patient” the guy said. He was an engineer working for the civic body. “By the way, you stay at ***?”

I agreed that I did stay at the place he mentioned.

“You know Madam **** stays nearby?”

He was talking about a specialist in our hospital. I agreed that I had heard so, but not seen her myself anytime.

“I was there the other day” he said. “I was parking my car, when I saw this driver in the uniform of a driver of the civic body. He was the Boss’ driver. He said, ‘Sahib is gone up there to Madam’s house’ and pointed to an adjacent building. So I asked, ‘so what?’ Then he said, ‘So nothing, I am just saying Sahib is gone to Madam’s house.’ Then he kept looking at me.” He sniggered.

“He was trying to gossip with you” I said mildly, and kept quiet. I had no desire to gossip on that or any other issue.

“Well, thanks again, doctor” he said and went away. As he was going away, I remembered what one of our woman staff members had said about this specialist doctor and the Boss in front of a number of staff members in our staff room - “I heard her say ‘the air conditioner in Sir’s bedroom is so good you know!’ It was so … um,,, so …vulgar.” There was a smile on her lips and a wicked glint in her eyes as she said this.

“Huh?” I had said and left it at that.

I wonder if the gossipmongers gossip because they are inferior to those that they gossip about and by demeaning them they prove to themselves that they are actually superior to their subjects.