Twitter Threat

I was scheduled to deliver a lecture to undergraduate students on ‘obstructed labor, uterine rupture, and other maternal injuries’. I had one hour to do it. When I sat down to make my slides, I realized it was actually 2.5 to three lectures, going by 35 A4 sized Word pages of my notes. I made three PowerPoint presentations, including over 200 slides. The last time I had delivered a lecture to the undergrads, the computer and LCD projector had not functioned at all, even if the lecture hall was the usual one and was well equipped and adequately staffed. I had written to the Dean, who had promised to take necessary action. This time they had shifted the venue to an auditorium which was actually meant for cultural programs rather than lectures. I was mentally prepared that I would not be able to show my slides. My instinct was right. They had a laptop and an LCD projector, but no one to connect them. I did not have time to connect them physically and electrically, and then make them work. “There won’t be any slides,” I told the students, “because there is no one to handle the equipment and I don’t have time enough to do that and teach you. “The positive aspect of this is that you don’t have to go through more than 200 slides. The negative aspect is that the lights will not be switched off during the lecture, and any one of you desirous of taking a nap will not be able to do so.” They laughed. The standard procedure in the event of electronic technology failure during a teaching session is to fall back on ‘blackboard and chalk’. I turned to the wall to write on the backboard. There was no board, neither black nor white. Finally I started teaching them without any visual aid, making gestures in the air, and folding papers for demonstration of body parts. One of the students proved me wrong on not being able to sleep with the lights on. Obviously he wasn’t afraid of being caught, and probably was used to a night-lamp. About 10 minutes afterwards I noticed that a student was asleep in the second row, the first row being vacant. ‘Hey, wake up!’ I said. He wouldn’t wake up. Finally the fellow sitting next to him nudged him awake. I continued my lecture. After another ten minutes or so, I happened to glance in his direction, and found him asleep again. I was surprised. “Hey, wake up,” I said. He wouldn’t. “Doesn’t wake up,” I said to no one in particular. The obliging neighboring student nudged him and woke him up. But his face showed he was still generating alpha brain waves and not beta ones. “Never in my history as a teacher has anyone gone to sleep twice during the same lecture,” I declared. “What shall we do with you?” Then I had an idea. “I shall put this up in Twitter tonight.” Both the audience (minus the said guy) and I brightened up at the prospect. “What is your name? I need it for my Twitter post”. He wouldn’t say anything. He was probably afraid of telling me his name. He probably did not know I did not tweet. Instead of the traumatic experience of asking him again, I chose to read out a random male name from the attendance sheet and looked at him expectantly. “Sir, but that is my name,” another guy said from the third row on the other side of the room. He seemed agitated that I would put his name by mistake in Twitter post. “If that is your name, what is his name?” I asked him. He hesitated briefly, and gave in. He told me the fellow’s name. “Thank you,” I said, “I actually knew the name I read out would not be his name. But would you have told me his name willingly otherwise?” I turned back to the culprit who had disturbed the flow of the lecture by sleeping twice. By now he was out of alpha waves and well into delta waves. “OK, I won’t put your name in Twitter, unless you go back to sleep a third time”. With that he seemed to settle down. I resumed by lecture. He kept nodding his head vehemently during my remaining lecture, which I thought was his attempt to reassure me that he was not only awake, but also comprehending the contents of my talk. On second thought, now I feel it might have been his method of not falling asleep again. To keep him and the others awake and interested, I told them a couple of stories related to the topics being discussed. They seemed to like them, and laughed together at the punch lines without any cue. So I told them a couple more stories, and they laughed again. Overall, it was a quite satisfying experience for all (except maybe the sleepy guy), and educational for those who wanted education.

Medical Council Inspection

We had a Medical Council inspection yesterday. It was a surprise. I have heard they have to do a surprise inspection in private medical colleges because these colleges do not regular teachers. They call teachers only on the day of the inspection so that they meet the requirements and their recognition is maintained. But to do that in our institute was wholly unnecessary, it being a prime institute not only in this country, but in the world. In fact, they keep calling our faculty to inspect all other medical colleges in the country. The inspection was just 3 days before the New Year. As a result, a large number of staff members were on leave, preparing for the New Year celebrations, finishing their leave doing work left over, or just finishing balance leave that would lapse at the end of the year. I was on casual leave to get our ration card revalidated. The ration card in this country is something like a proof of existence, not for getting ration. You need it for everything legal. All of us were called back for the inspection. We waited in chaos, because the inspection requires a set of documents for individuals as well as for departments, which cannot be prepared without prior notice. Even an IT company will not have such documents ready at all times. I had heard the inspection at another hospital in the city had continued well into the night, with the Dean requesting all to stay. Giving medical care at all times of the day and night is understandable. But carrying out inspections of office documents and staff members is not an emergency activity that should be carried out at night. Either the inspectors are nuts, or their instructions are weird. Fortunately we could finish everything and go home at 4:15 P.M. But the chaos continued today, with the inspector wanting data in new formats. When I reached the hospital after my morning half day’s casual leave taken to finish yesterday’s unfinished work, I found chaos. The inspector wanted hospital data that the medical records section should have but said it didn’t. The officer had to be threatened that the matter would be reported to the Dean, when the data was provided. The computer would not boot, the printer would not work on the other computer, and the typist was on casual leave, with all data on a CD locked in her drawer. She had to be called so that the CD could be accessed. In the meantime I held a couple of meetings, and fixed the computer myself – it was dust preventing the RAM from working. Then the thing was done and sent to the inspector. My wish-list for the coming year is as follows. 1. The Medical Council puts on its website the list of documents it requires and their formats. 2. The Medical Council instructs the inspectors to confine their inspection to office hours. 3. The Medical Council develops biometric identity cards for medical teachers all over the country, so that “teachers for inspection only” need not exist, and inspections can be done without such paranoia. 4. The Medical Council inspections are not scheduled at times a large number of staff members will be on leave, as in vacations and near year ends. 5. The institute provides good database program which can maintain the data uniformly for all departments. 6. Computer engineers are available when required, instead of us being forced to fix the computers. 7. The medical record office should not have to be threatened by staff members to get hospital data.

Attitude 10

This one is about this associate professor of ours with multiple attitudes. “Give him a thump!'' said one colleague that day. "Give him a big thump" said another colleague. “Who are you talking about” I asked. It turned out they wanted our friend with attitudes thumped for joining contributory lunches in the department and then coolly declaring that his contribution would be his presence but not any home-cooked food. They had told him to get food from a hotel, which was also flatly refused. “A thump is unlikely to change his attitude” I said. “Sir, he knows the exact schedule of the servants’ and nurses’ tea-time. He visits them every day in those locations like different wards, operation theaters, and outpatient clinic. If we happen to reach there at such times, we find him sitting amongst them, sipping free tea. But we have not seen him get anything for them even once in his 24 years of service” said the first colleague. “I even recall him refusing to contribute to the farewell functions we arrange for nurses and servants when they retire. He had said he felt the financial pinch from such contributions, If he had put away money for every cup of tea he consumed at their expense, he would have money left over after such contributions” said the other colleague. They were quite worked up. “He gets the same salary we get. How come he cannot afford to pay his dues?” The question seemed rhetorical. “How can he just take and not give?” That one also looked rhetorical. “See, this is a deep psychological thing that cannot be cured by mere logical reasoning. It needs a specialist to cure it.” That sounded like wisdom, but only theoretical wisdom. “That is right,” I said “but you cannot commit colleagues to such treatment for such small matters. They need to commit something gross and dangerous. A better option is for such persons to seek help by themselves.” “He will never go seek such help by himself” declared the first colleague. “He thinks there is nothing wrong with him but the world is doing him wrong. He thinks the whole world owes him and it is his right to collect. Perhaps as described inour philosophy, he is a creditor of us all from a past life and it is for us all to pay up and him to collect in this life". They looked at me with disbelief. They did not believe in this philosophy apparently.

Standards

About three years ago the outpatient block was renovated. The architect appointed said his design was of international standard, and we had nothing to worry about. It probably was. Since I never studied architecture, I would not know. I also don’t know of which countries he was referring to. I just had a lot of experience with the working in our setup. So I asked him if the spare parts of our fluorescent tube fittings would be available when required. I had to ask because they looked different from the regular ones. “Of course,” he said “everything is available in market and also on the municipal schedule.” Since our electrical engineers had not said anything to the contrary, I had no reason to disbelieve him. The work was somehow completed, in two years instead of the promised six month period. We ran our outpatient clinics in one of our wards without cribbing, because there was no point in cribbing. This was probably the way of life as God had meant it. The tragedy was that the architect was not totally right. The spares were available in the market, but not on municipal schedule. A number of the twin tube-lights went off, and their chokes were just not available. The room where I saw patients was in almost darkness. The electricians wouldn’t even take off chokes from other well-lit areas and put them where they were needed. Perhaps it was power-saving measure of the institute, since recently the electricity bills had shot up and there was a circular to cut down on the consumption of electricity. Finally one of my professors who saw patients in the same room on another weekday threatened not to see any patient until the tubes were made functional. That worked and those 4 tubes were made functional. The chokes are still not on municipal schedule. I wish they appoint architects who work with Indian standards in our place.

Attitudes 9

It is quite understandable that all human beings are not saints, and they will have their own dislikes. But decency expects that one does not reveal one’s dislikes openly, especially when there is no provocation. It pains me that such decency is sometimes not found even in the sacred temples of education (I mean in medical colleges). There was that meeting with one of the previous Deans, where one more head of a department was present besides me. The issue had to do with a matter concerning our departments independently and the medical council. It so happened that I had three band-aids on my right hand knuckles. No, I had not been boxing anyone’s ears. I am mild person. I had been cleaning our wheat grinder, and the knuckles had got abraded by the rough lining of the grinding chamber. The Dean politely asked me what happened to my hand. I told her it was a grinder injury. At that moment the other head of department said “Grinder? Your tendons were cut?” I noticed that there was a happy grin on her face and wishful expectancy in her voice. It was obvious there were no tendon injuries, or my hand would have been in a plaster cast and I would have been home recuperation, rather than in a meeting. I told her (regrettably) there was no tendon injury, and she barely hid her disappointment. I knew she did not like me for reasons best known to her. But she need not have shown her glee at the prospect of me having had my hand tendons cut. This attitude of hers also reminded me of another professor in my own department, who disliked me too, for reasons known to me too. I had superseded this one in seniority on merit though younger, and was scheduled to become her head of department when the current head retired. I had been suffering from repeated attacks of malaria then. I would be well for a few days and then there would be another episode. I was fed up. My morale was down, because the hospital physicians could not make a diagnosis. This professor chose to hit me when I was down. She stopped me in the corridor and asked how I was. I told her I had another attack of malaria. Then she said in the same manner as the previous professor “Perhaps you should have your HIV test done.” She had the same gleeful facial expression, the same wishful expectancy in the voice and no shadow of real concern. I told her my HIV test was negative. My fever turned out to be resistant malaria, and I was cured with Mefloquin and Artisunate. It bothers me that such learned professors wished a colleague hand tendon injuries or HIV, and disclosed it quite openly. God did not give me any of those illnesses. I do not know if God gave them anything for wishing me ill, though I know God does not punish, but only forgives. I owe it to these two professors to have shown me this form of attitude and taught me to be wary of people like them.

Quirks

We have a staff member in the institute who is funny. This member has a few quirks. One of them is that she does not carry a pen at any time. Everyday she will borrow someone's pen to sign on the muster. If there is no one around, she will patiently sit down until someone turns up. When I became head of the department, I asked her in a friendly tone “Why don't you carry a pen when you need one everyday?” She smiled sheepishly and said, “I do. But it is kept here” and pointed where some women keep private things or important things like money. I thought it was an old custom, popular with some old time women, but not a modern, professional person like her. Please don't ask me to state exactly where. I did not ask her why she would not take it out when she needed it. I also did not ask her why she carried one there if she never took it out. This happened six years ago. She still does the same thing. She has another funny habit. She does not bend forward to do something essential like opening a lock on a door. We started locking the staff toilet in the department because a lot of people visiting the department started using it while the staff members had to wait in a queue. She started calling the office servant to unlock it when she wanted to use it. Once the servant was away on an errand. So she called the typist to do the job, and shouted at her when she hesitated. The typist was right in hesitating because unlocking a toilet door was not a part of her job description. That was a few years ago. I thought it was a temporary problem of some sort, like pain in the lower back. But just the other day I found her outside departmental office getting a passerby to unlock the door. So her this habit was also persistent. Her third habit I had heard of from many people. She does not tie any of the ligatures when she performs surgery. She places the ligature, and asks her resident doctor assisting her to tie it. Actually that is a dangerous practice. If the ligature remains loose, the patient can bleed, which can become life-threatening. It must be done by the operating surgeon with responsibility. She should know this as a consultant. She probably does. After thinking on this issue for a long time, I realized this had to do with her lumbar spine or her weight. Her spine otherwise seems OK, and she does not describe she taking any treatment for it, like she does about her other problems. Sp it must be the weight. She either cannot or will not reduce her weight. A major portion of that weight being around the middle, she probably cannot bend forwards. She will not quit, probably because she can always find people who will bend for her free of charge. I might be wrong on this one. I don't want to ask her, because I feel embarrassed even if she won't be. If you have a better theory, please let me know. I might write another post on her other quirks sometime.

Attitudes 8

We had a Professor and Head of a department, who was quite peculiar. This professor resided in quarters provided by the institute. Actually she had a place of his own quite far away in the suburbs. But when she went to any meeting where traveling allowance was given, she gave the address of her home rather than her quarters, so that she gets more allowance. And the funny part is that she was not expected to be going there from home, nor from the quarters, but actually from the institute where she should have been working at that time of the day. Well, that is an attitude that does not show greatness of character. I call that an attitude of unscrupulous greediness. This same professor threw a tantrum when tea was given to her in a disposable plastic cup during one such meeting. “What do you think, I am a beggar or what?” she thundered, “give me tea in a cup and saucer properly”. But when even less tea was given to her in a thinner plastic cup in the Dean's meeting, she smilingly accepted it. I call it attitude of throwing one's weight around where one can, and becoming meek and polite when the other party has a lot more weight to throw around. We could call this lion-sheep attitude too. This professor once asked the gardener to let her water the plants in the institution's garden using the hose pipe. That was OK. One may have unfulfilled dreams from childhood which one may get to fulfill in adult life. But then she came to a meeting and bragged about what she just did. “I was just thinking about what if a reporter had been around and had snapped my picture. There it could have been in newspaper or on television, showing me watering the plants and saying “Professor and head waters plants in the institution's garden”. I failed to see any greatness in that. I could not also see how she saw this act as a great thing she did, as if doing such a lowly (!) task by a person of her stature was something that was expected to make headlines. I call it attitude of pseudo-greatness, or perhaps it is megalomania with poor perception of truly great things in life.

Attitude

Surprised it is a blank? I think it has to do with attitude of a troll..
I had worked out things such that we had standard operating procedures or SOPs for everything. They were explained to all of our resident doctors at the beginning of every term, each term being of six months. Thus in a period of about three years, every resident listened to the stuff six times. The procedures were quite logical and reasonable. Nothing was very taxing. And we now have about ten residents in each unit, as compared to three per unit when I did residency, The work load has increased, but not three times. A mature, adult person, that too a qualified doctor, should be following the SOPs without any problems. I trusted them, and did not do any policing. So there was peace. Since life was going on, I supposed work was getting done in a way. The patients were coming in, getting treated, and going away, but not the right way. Actually it came as a surprise when a colleague told me that residents were not writing admission notes on the patients' OPD papers. I checked out my own unit papers, and found that three of my Registrars and one House-officer had not written any notes on five papers, all five quite serious patients. It was understood that we being health care giant i.e. a tertiary level center, we treated most of the critically ill patients well and they went home fine. So it was not as if they died and it did not matter if their OPD papers did not have any admission time findings. When these patients went to another doctor for treatment in their next pregnancy, there would be no information available about their condition when they went in tabor in the previous pregnancy. It was a case of gross negligence. I asked the reidents why they did not write these notes. They had no answer. At least they offered none. One Registrar said he had done it for the first time in his life. I could not believe it. A first mistake is not often discovered, when there is no system of checking for mistakes routinely. I proved he was cheating, when I found another patient whom he had admitted without writing any notes. I made all of them write the notes then and there. Then I asked them what disciplinary action should be taken against them. They offered no suggestions. I left it for later, because there was more important work that needed my attention. But I am upset because I find in this generation of doctors a lack of commitment that is essential in this profession. I find that they want to cheat when they think no one is watching. I am upset because they are like rebellious kids who revolt the moment they are without any supervision. I am afraid for the country, because these are the people who will administer healthcare to future generations of people.

All-knowing General Practitioner

One of my neighbors approached me for treatment. I found that she had a uterine leiomyoma and pelvic endometriosis. She was infertile, but the main reason for that her husband had azoospermia that was not correctable. After discussing all treatment options with her, we settled for an abdominal hysterectomy. It was carried out uneventfully; she made a good recovery, and went home. Unfortunately all was not well. She probably was unhappy at having lost the prospect of a pregnancy even if she knew her husband had a problem that was not treatable. A year later she rang me up. "Doctor, I am Mrs. *****," she said, "I am unwell". I have masked the name to maintain her privacy. "What is the problem?" I asked her. I should have asked her to see me in the hospital, instead of talking to her on phone when I was home, since my hospital practice does not include treating them from my home. I did that because she was a neighbor, and also because she wanted help. "I have lost a lot of weight after my surgery and I feel very weak". I was surprised. If at all, my patients put on weight after surgery because they would not exercise. This seemed to be unusual. "I don't think the operation has caused this", I said. "But it is! Dr Mrs. XXXXX said I should have been given calcium after my hysterectomy. Because I wasn't, I have become weak." "But Dr Mrs. XXXXX is not a specialist of diseases of women", I said. She was a general practitioner near my house. "She does not know these things. I have not removed your ovaries. So your female sex hormone production is still normal, and you don't need hormones or even calcium". “But she is a specialist of women," she insisted. "What is her qualification?" I asked. "That I don't understand, but she is a specialist of diseases of women. She said so." I wanted to get angry and tell her to go get treated by that doctor. But I could not get angry. The fault was not of the patient. It was that of the doctor who was maligning a specialist just to impress her patient and increase her own practice. "I still don't think what you are saying is true," I said. But if you will come and see me in the hospital, I will find out what is the problem and treat it". She never saw me in the hospital. Perhaps I should have told her about other patients that had been misled by this doctor, such as the young woman she had referred to a gynecologist in private practice for excision of transverse vaginal septum. This woman was a mother of a child that she had delivered normally, and could not have a transverse vaginal septum. The said doctor had not even examined this patient internally. The patient did not afford to spend money on treatment in a private hospital, and came to us. All she had was discharge sticking the labia together, kept there because of poor hygiene. When my resident used a speculum, it went away. No more septum! The patient understood this, and also understood why the doctor had sent her to the consultant for an operation.

Virtual floppy drive

I was going down from the fifth floor, where the offices of the engineers and billing section are also located. I overheard the following conversation in the elevator. "They just removed the IBM machine without telling us. Now it has all our software for creating pay sheets and it has a floppy disk drive. Now I don't know what to do." "Why?" asked the other guy. "Because all our pay sheets are created in a dos-based program, and the pay sheets have to be sent on a floppy to the head office, or no one gets any salary." "Floppy?" the other guy was surprised. He was justified in being surprised. These days they make machines without floppy disk drives. Floppies are expensive. They go bad quite easily. Even brand new floppies are known to go bad from the time of purchase to your putting them in the drive. In fact, they might already be bad the time of purchase. After all, no one checks them before purchase like one checks an electric bulb or a fluorescent tube. "Yes, floppy", answered the first guy. "In modern times too! To run a dos-based program and send the document on a floppy! They won't allow pen drives because they spread viruses. As if floppies don't transfer viruses any more! It can happen only in MCGM!" It probably can happen elsewhere too, but I have not heard of any other place, nor had they. I thought of the Health University, where they belong to exactly opposite category. They ask for dissertations of resident doctors on DVD, when the largest dissertation is of about 5 to 10 megabytes. Either the decision maker there does not know the difference between a CD and DVD, or they want to use the remaining blank space on the DVDs for writing their own stuff. "And what is more, they supply modern machines with 2.66 GHz processor, 180 GB HDD, 3 GB RAM, DVD writers and what not, to do work that could be done with a low end machine (I thought of 486 machines) with cheap 1.6 GHz Atom processors and floppy disk drives. What a waste!" "But where do you get floppy disk drives?" the other guy asked. "Exactly!" the first guy said. You will wonder how I heard all this in transit downwards from 5th floor. Well, it was an elevator for cardiac patients and moved ever so slowly. Add to that time spent on each floor for discharging people and getting new ones in, and we have enough time. Before I got out on the first floor, I turned towards them and said, "Put a virtual floppy drive on you machines, and you don't have to worry about where to get floppy disk drives." They were surprised to hear something like this from an unknown person, that too from a doctor with white hair and the appearance of a professor. They did not stop me and ask from where to get it. If they don't know where to get a virtual floppy disk drive, and they don't find me to ask me again, or if they do not Google this and find out, I am giving a link below, which gives a free program of size 141 KB that does the trick. Of course they need to read my blog to get the link :-) http://webscripts.softpedia.com/script/Development-Scripts-js/Complete-applications/Virtual-Floppy-Drive-39797.html

The joy of bathing a newborn baby

I had to attend an interview for selecting the best intern in the department of preventive and social medicine (what is also known as community medicine to modern people). There were only three candidates. On inquiry I found that the interns had to apply for the award, and then they would be called for the interview if they met the selection criteria. That reminded me of the procedure for applying for some of the high, higher and highest awards in the country, including the sports awards. It seems one is not automatically given the award for being what one is, and achieving what one has achieved. It is given based on these facts all right, but only if one has applied for it. On similar lines, three interns had applied for it, and were called for the interview. Normally I request the person who is in charge of the internship programme in my department to go for this interview. But today that person was busy in the operation theater and hence I went myself. The interns were enthusiastic, but not well groomed for interviews. By modern standards, an interview is not a place for being honest. One has to give politically correct answers and get what one wants. They did not know this and gave honest answers. They had not conducted deliveries, and hence would not be able to do so after getting their degree certificates. The curriculum looks fine on paper, but the system is such that many things in the fine curriculum remain not covered despite the facilities being present. They did not have any satisfactory answer for not conducting deliveries. I don't think is possible for the staff members to find out when women are about to deliver, then find the interns and take them to the labor room to make them deliver those women. There are resident doctors on duty and qualified senior residents or lecturers to supervise their work. The students just have to be there and deliver women under supervision. I still recall my days as a student, when we used to compete with student midwives for getting a chance to deliver women. I recall holding the newborn babies in a basin of hot water to give them their first bath after I delivered them. It took some skill to hold them in the water with their heads above the water with one hand and give them a bath without dropping them in that water. It was great fun too. Now the students and interns are missing out on the essential education as well as the fun, and reading in libraries for the common entrance test which determines whether they can do postgraduation or not, and if they can, in which subject.

Attitudes 7

To rebel against authority could be a normal thing for some people. That cannot be called a wrong attitude when the act of authority is unjust or unreasonable. But to rebel when the authority is right and one is wrong is definitely an attitudinal problem. We had a wonderful Dean who was quite conscious about conserving resources and recycling things. That Dean had vision. Recycling is talked of quite a lot these days, but was quite a novelty in those days. It was the Dean’s idea to open out old envelopes, turn them inside out and stick them so that they could be used again. I had used a number of envelopes like that. She also would ask us to send her letters on a quarter or a half sheet of paper, if the letters were short. The idea was that the remaining sheets could be used for writing another time. However there was one Head of a department who took offense when he was asked by her to get his letters typed on sheets of appropriate size. He would get the letters typed on standard sized paper, and the cut off the blank parts of the sheets. But instead of keeping the blank portions for future use, he would tear them up and throw them in the dustbin. Something was seriously wrong with his attitude. I don’t know what he achieved by such behavior. He did not teach the Dean a lesson as he probably wanted to, because she never knew what he actually did. He showed himself in poor light to others who watched him do this. He set a bad example to those who did not understand what the Dean meant by her instructions and trusted him instead. He wasted resources, for which the taxpayer had paid.

Attitudes 5

IF there is anything more irritating than gross inefficiency in simple management, it is causing botheration to people by your mismanagement. I had a resident once who was dumb. Well, God makes them in all types. But this one was irritating too. She would try to reach me in my office in my working hours, and if I had just gone somewhere (like the loo), she would presume I had gone home and ring up my residence When this happened twice in two conswcutive weeks (which was too often, in my opinion) my wife got a little upset. She wanted to know where I had gone and for what purpose, when I had told her I was working. Finally I ot the said resident to ring up my wife, and explain to her that she had found me in my office 5 minutes after she called my residence both the times. You may wonder why my wife would not trust me then. It was 15 years ago, I was young, and hence perhaps in my wife's opinion ‘susceptable’ if not ‘strayable’ :-D. Anyway, that resident passed out and this trouble stopped. Now, 15 years later, at 2:30 p.m. today, when I was operating on a patient., a head of one of the departments in our college rang up my residence and asked for me, saying I was not found anywhere in the hospital. If she had rung up my office, one of the 4 persons working there would have told her I was in the operation theater. But we have two types of senior doctors - grand and not grand. She was grand. The grand type doctors get the telephone operator to find someone they want in the campus, or get one of their subordinates to do the job. When that person comes on the line, the grand persons will come on line in their own sweet time. If the telephone operator or the subordinate does not know where to look, he/she does not find the desired person. That same thing happened today. Fortunately my wife has realized by now that I am not ‘strayable’, that I actually work and enjoy it, and she also knew the nature and abilities of this particular head of department from my narration of various incidents in the hospital. It is already 3.5 hours past the time I go off duty. This particular person had some very important work with me 27.5 hours ago, for which she rang up my residence when she shouldn’t have, and now that I have been home last night, in the institute all day today, and home after that, she hasn’t bothered to ring and ask for whatever she wanted. She happens to be the same head of department who had kept my technician for nearly 2 years while she had been ‘borrowed’ for just 15 days. I had to struggle and have the technician back with me for half a day every day so that our work could be done. She is the same one who wanted to have another arrangement of the same type a year after I had finally got my technician back. Those of you who have read my previous posts will know this.

Curiosity

When I started my blog, I was just content to put my feelings about things there. Then my son, a computer wizard, told me about a service that tells me all details of visits to my blog, such as how many, when, from which part of the world and many other things. It tells me the IP addresses of people who visit my blog, but not their names. I have been studying the statistics for awhile. Now I am curious about who are those readers who visit my blog quite frequently, and who are those who visit the blog from countries where I have never been and probably will never be. I mean, I do understand that internet has no boundaries of any country, and people visit sites all over the world. But I would like to know what makes people unknown to me search on Google and find my blog. I wish they would post a comment to let me know who they were. But if they wish to remain anonymous, well, so be it.

Show Stoppers

My institute is huge, and keeping it clean and tidy is a massive job. Luckily we have a large support staff to do this work. Unluckily the support staff has an attitude and a strong union. The employees do not report on duty at required time when they don't feel like. The strong union sees to it that no disciplinary action is taken on them except when the sky falls on our heads as a result of the activity or inactivity of the cleaners. When the hospital begins its work for the day, it should already be clean and tidy. Unfortunately the cleaning often begins when the health care personnel begin their work. The cleaners start their work late because they arrive on duty late, and of the two options – getting the cleaning done late or not at all, the former is more reasonable. I was stopped by a closed gate today morning. There were two security persons standing behind the closed gate, and a sweeper was mopping the floor beyond them. I asked them to let me in, because there was something quite important to be done early morning. They looked at my face, then at the sweeper, and back to me, without making any attempt at opening the gate. I lost my patience and snapped 'open the gate.' 'The floor is being cleaned,' one of them said by way of explanation of why he would not open the gate. 'I am the head of the gynecology department,' I said, 'open up'. 'How would we know that?' he said and opened the gate. So the gate would be opened for someone important, but not for the patients who came to us for treatment! I have heard complaints from doctors who are senior but not heads of departments that they were made to wait at the gate while the floor mopping ceremony was on. That patients in the wards and operation theaters waiting for these doctors to treat them were suffering was not an important point at all. I sometimes wonder if the institute's primary function is to let the employees to earn salary, and everything else is just there to justify this aim.

Gynec Urologists

I am proud to say that we are turning out residents with good training in gynec urology. A couple of years ago I improvised instruments and started transobturator tension free tape insertion for urinary stress incontinence. The kit from reputed companies, including disposable needles attached to the tape was available for 10000 to 20000 rupees. Since our patients were often very poor and could not afford such costly material, I improvised the technique and used Shirodkar's abdominal sling needle for this purpose. The needle is reusable after sterilization by autoclaving. The polypropylene mesh tape is purchased by the patients, and the entire expense is just 800 rupees for the material. My resident doctors now do the operation through a 1 cm long incision in the vagina in less than half an hour. I learnt from others that only urologists in the city perform these operations, and very few gynecologists do it in the private setup. I am proud that my residents will be able to do this operation with confidence and expertise in their practice after leaving our institute.

Attitude 6 Part 2

The staff member with many attitudes I mentioned in my previous posts started coming in time. She has a curious habit of coughing twice on entering a room so that people noticed her. I think we can live with that, but I hope she does not put out germs that can infect others, since she does not cover her nose and mouth when she coughs. Every morning she arrives, enters the office, coughs twice and signs on the muster. Then she plops down comfortably to catch her breath. She probably needs that, since she has a lot of weight to carry around, and her car can bring her to the campus, but she has to walk to the office on her two feet, using those same old muscles, with same old lungs oxygenating her blood and throwing out the carbon dioxide generated by the effort, and the same old heart pumping the oxygenated blood to the same old muscles we just mentioned. The sad part is that she continues to rest there or in the staff room while the resident doctors and the staff members posted under her wait for her to start the ward rounds or whatever work that is scheduled that day. After making them wait for half an hour while she does nothing constructive for the institute, she gets up and starts work. Wasting time of others is a crime, because the institute pays for their time, which is wasted, and the patients keep waiting for treatment, which can be given only after our friend with an attitude sees them. She could tell them to do their work and come for the ward round after the half an hour she has to spend sitting down. But she does not do that. I think she feels that making others wait for her establishes her greatness. I think she feels insecure, and has to behave this way to prove to herself that she is indeed great. I will say that she is not alone in this world. There are a lot of people who behave the same way. One of our previous Deans used to call all heads of departments for meetings, and arrive a half-hour late. She wouldn’t even be apologetic about it. And there are the administrators higher than the Deans, who treat doctors and other junior administrators the same, calling them for meetings and making them wait for hours, after which the meeting may or may not take place. And I read in the newspapers that politicians do the same thing when in power.

Plumber gynecologist

I am posting this one only because what I did gave me a sense of having achieved something that I was not expected to achieve. Actually many of my readers will perhaps feel that I should be calling a plumber to fix leaking connectors and faucets, instead of fixing them myself. But the first time I got a plumber to fix a brand new connector to the water inlet and the newly installed flush tank, he managed to break it and the shopkeeper refused to even acknowledge that it was purchased from his shop, though I had a cash memo of the purchase made the previous day. After prolonged discussion, he did replace it, but sold me teflon tape and asked me to fix the connector over the tape rather than over a teased out string like the plumbers do. The whole experience was so traumatic, that the next time the connector between the water pipe and our geyser started leaking, I just shut off the mains, took out the connector, went to a hardware shop and purchased a heavy duty connector. I had learnt that the connectors had to be treated with gentleness, so I treated it gently, and fixed it over teflon tape wound over the female end of the joint. It actually worked! So when the faucet started leaking at both the connector end and the water outlet end yesterday, I decided to fix it myself. The connector end was like the last time, and it worked with fixing over teflon tape. The outlet was a different matter altogether. I had to figure out where it came apart. Then I was able to open it with a spanner. There was some dirt collected over the filter inside it, which was probably forcing the water out through the joint due to back pressure. I removed it and then fixed the cap over teflon tape. It worked! The first time my wife had been impressed when I had fixed the connector and stopped the leak. This time she had casually mentioned that there was water leaking, and when I told her about my achievement of fixing the leak, she took it without any element of surprise and did not praise me. I take that as a compliment, since it showed her acceptance of the fact that I would be able to do it.

Attitude 6 Part 1

Here is something more about the staff member about whom I had written in a previous post. The said staff member now arrives on time because otherwise the clerk puts a late-mark or absent sign on the muster. First she tried to make me allow her to come late, because she got stuck in the campus while trying to park her car, owing to the repair and reconstruction work in progress. I told her I did not have to power to do so. Then she tried bulldozing the clerks into not putting such marks on her name in the muster. She accused that there was favoritism, and she alone was being victimized while others got away. It was just her paranoid mind and actually there was no such favoritism or victimization. She shouted, threw tantrums, threatened to get them sacked or some such thing. They got worried and came to me with a complaint about her behavior. I called her and told her that the clerks too were our employees, that they had their rights, and she had no power to shout at them for doing their job. I told her she would face a departmental inquiry if they chose to complain to the Director in writing about her shouting at them. That seemed to cool her down a bit. All staff members reasoned with her, but failed to change her mind. She declared she would meet the Director and get her way, stating all the previous Deans and Directors had always given her a positive response. “Wonderful idea,” I said, “if you get this permission, all of us can start coming late without fear of being marked late or absent. Please do this, and tell us when you get the permission.” She tried and tried and finally one day managed to meet the Director. I saw her sitting in the staff room that day, soon after the said meeting, drying her eyes with a handkerchief. I did not know what had made her cry silently there, but refrained from asking her. The truth came out after 3 days in our departmental meeting. I asked her if she had got the permission to come late from the Director. “No.” she said, but wouldn’t elaborate. “What did he say?” I asked. Since there was no way she could avoid answering that one, she said, “He said ‘Just ignore it!’” We were amused. She could ignore the late-marks and absent-marks, but the marks would remain, and she would continue to lose her leave as per the service rules. Her behavior with the clerks on this and other issues suddenly became sweet and has remained sweet for a long time. Read more about this in the next post.

A new method to inspire resident doctors to study

It is true that sometimes we get the residents who just will not have an aptitude for operating. They have just five thumbs. On the other hand we occasionally get a resident who is wonderful with his hands. I have one such a resident now who was performing his first hysterectomy the other day. I had a gut feeling that he would be good and from a group of three resident doctors I selected him to operate that they. I was a right. All of his ligatures were tight and I did not have to tie any of them again. He held his instruments like a pro and did not know it. I asked him where he would go for his third year residency, and found that his rotation would take him out of our institute. I do not manipulate rotations of residents just as I don’t manipulate anything else while running my department. So I will not have him in my unit any longer than his current posting. On the other hand, I have two others from his batch, who will continue with me, and who have twenty thumbs together. No matter how much I try to improve them, they don’t make any efforts by themselves. Finally I had a brainwave. I plan to take their exam every week, and the resident with the highest score will get to operate. If anything will make them study and improve, this will.

The Ethics Joke

The Health Sciences University has laid down a rule that every dissertation proposal for a postgraduate degree must be approved by the institution’s ethics committee. Principally it is correct. Research on live human beings must be approved by ethics committee. Unfortunately, the ‘research’ carried out on the clinical side is often collection of data of investigations and treatment that are carried out on patients as a part of their management. The management will be carried out, whether the ethics committee will give permission for the data collection or not. Our institute has an ethics committee about which you can read here on my website. This new workload proved to be unmanageable for the existing ethics committee, which was already overworked handling the research proposals of the staff members. So they formed a sort of junior ethics committee to handle the dissertation proposals. The new members probably were quite enthusiastic with this newly found source of power over others. They scrutinized the proposals with a zeal that was not seen in the previous ethics committee’s work. Unfortunately they did not have the knowledge and maturity required of members of ethics committee. I understood this when they returned my student’s proposal with a suggestion to change the title. The original title was “Laparoscopic oophorectomy with vaginal hysterectomy”, meaning removal of the woman’s ovaries using an endoscope passed abdominally, and the uterus vaginally. They suggested “Laparoscopic abdominal vaginal hysterectomy (LAVH)”. The joke was that LAVH is a short form used for laparoscopy assisted vaginal hysterectomy, while the ethics committee was suggesting a combination of all three possible routes of hysterectomy (which was not only present anywhere in the proposal submitted, but was also unheard of world over), and calling it LAVH. I admire the guts of the committee to suggest a ridiculous correction in the title of a proposal from a student and teacher, when the teacher is a specialist of his subject, author of 23 books and 99 scientific papers, and also head of the department. I am not saying there cannot be any scope for improvement in my work, but the suggestions need not be ridiculous, made only because there is the backing of the institutional committee.

Parental support

I have to certify journals of all students as complete, even if they are not placed in my unit, and even if their teachers have checked the journals and certified them as complete. The head of the department is expected to do that by the university. I was doing that one day, when I came across a journal with a glossy brown cover. The cover was fine. Unfortunately for the student, I happened to look at from an angle reflecting light off its glossy surface. I saw 12 impressions of signature of one of our unit heads. I could think of no reason why the unit head would practice her signature 12 times on a piece of paper placed on top of this journal. But I could imagine the student doing this before making the signature himself on the journal. So I checked the signature inside the journal. It would not take a bank teller or a handwriting specialist to diagnose the forgery. I asked the unit head, and she confirmed that she had not made that signature. I called the student and asked him to see me with one of his parents or guardian. He came with his mother on the appointed day. They seemed affluent. I explained to the mother the matter of the forged signature. She seemed to have understood the situation. I asked her son why he did this. He said he had not done it. I asked her why he had done this. She had no answer. I asked her that was not likely that he had not done the work recorded in the journal, probably not done the writing himself, and she responded to that immediately. She said he was a very sincere student, and had filled the journal in front of her, and that the handwriting in the journal was his own. So I gave him a sheet of paper and asked him to write down a paragraph that I read out from his journal. He did this while the mother just waited patiently. After he was done, I compared the two hand writings, and it would not take a bank teller or a handwriting specialist to state that they were grossly different. His was childlike and beautiful in a way. The original was slanting and more mature. I held both in front of the mother for her perusal. She probably knew what she would find there. She looked at the papers. Then she put her hands on the edge of my desk and put her head, face down, on the hands. I could see the mother had written the journal for the son, probably copied from someone else's journal. What the son had been doing in the time he should have writing the journal was also probably known to her. She might have tried everything and finally found writing the journal herself was the best solution to the problem. I wonder if she had written his journals for the other subjects too. "Do you know that this is not proper education?" I asked. Neither the son nor the mother answered. "Do you know that forgery is a criminal offense?" I asked. There was no answer. "Do you realize that you are not only promoting him in his deception, but also not preventing him from doing something criminal, which could lead to perhaps greater criminal activity on his part in future? He may believe it is OK to do so." I said to the mother. She did not say anything. I had no intention of calling the police, nor stopping the student from appearing for the university examination. I am not God and I cannot take it upon myself to judge people and punish them. I got the student's teacher to take charge of him, who made him fill up his journal himself, checked it and certified it. I certified it after that and he appeared for his examination and passed it. I wonder what he is doing today. I don't know if he or his mother will thank me for what I did, or will try to put a curse on me for 'troubling' them. I wonder if the mother brings up all her children the same way she brought up this fellow if there are other children. Or perhaps I am wrong, and she did bring up this fellow properly, instilling in him values that he failed to imbibe, and her mother's heart could take it no more when his journal remained blank in face of an approaching final examination. Perhaps he signed it himself without telling her. I don't know how many other students are getting others to write their journals. I know policing is not my job and hence I do not want to make each of them write a paragraph in front of me and compare it to the handwriting in his or her journal.

How to fix a spike-buster

I fixed my spike buster today. It looked OK from outside, but would not work. Out of its three light indicators, only one light glowed, and it supplied no current to the appliances plugged into it. So I opened it up. There were no burn marks inside. I checked the completeness of the circuit before the circuit board using a multimeter that I had bought for just checking circuits, and it seemed OK. The fuse was OK. There was no current beyond the circuit board. So I removed it. Then I checked the power cord, and it did not show any continuity between two ends of individual wires. So I replaced the wire with one from another spike buster that I had discarded last week. Unfortunately this one had a green, a blue and a black wire, none red as per our standards. So I used the multimeter and found out which was the active one. The black one was active, blue neutral and green earth. I had to think long before I figured out that the active went into ‘on’ position of the switch, neutral went to the ‘off’ position of the switch, one wire went from the active to the fuse, another went from the fuse to the active of the sockets, and one from neutral of the sockets to the neutral of the switch. It took one hour, but I feel the experience was satisfying, considering that I managed the whole thing on my own, without any prior training. I am writing this so that anyone who wants to fix his spike-buster can do so, instead of throwing it away. It does not have indicators, but they did not matter if your electrical wiring is OK. Mine did not blow a fuse or cause a short circuit. It actually worked!

The repairing is simple. Most of the times the circuit board goes. If so, it is to be removed. It is a lot easier to use the spike buster without the circuit board, than buying one and replacing it. After all, it indicates the condition of one's electrical wiring, which can be checked by better means. Besides, circuit boards are not available in the market. As long as the live, neutral and earth are maintained properly, and the fuse is working, the spike buster serves its purpose. The diagram above shows a repaired spike buster without a circuit board.
 Changing the fuse is quite simple. Usually it is under a screw cap on the front surface of the spike buster. When the cap is removed, the fuse is found as a thin glass tube about 1 cm long. One has to take it out, put a new fuse in its place and screw the cap on. There is no need to make any electrical contact by joining wires.

Attitudes 4

When I became a head of my department, I decided to change a number of things for better. One of them was to teach the resident doctors. The postgraduate teaching program was practically nonexistent. There used to be four clinical meetings a month – maternal mortality audit, perinatal mortality audit, journal club and seminar. The seminar used to be more interesting than others, but not up to the mark. There was no didactic or small group teaching on a regular basis. In a questionnaire I circulated amongst them, I included some questions on their needs of education, and found out that they could not attend lectures before 4 o’clock, which was the official end of working day for the staff members. So I proposed that we teach them between 4 and 5 P.M. Working for 1 extra hour once in 16 weeks was not asking for too much, especially when we had to stay back for emergencies not infrequently. There was a group of 4 staff members, three of them professors and one associate professor, all of them junior to me by position but two of them much older than me, who used to resist every good proposal from me, and would go to the Dean or someone who had access to the Dean’s ear (figuratively) and crib about it. All of them refused to teach between 4 and 5 P.M. Two things were wrong with this refusal. We as medical teachers were expected to make all possible efforts for better education of the students. This refusal was against that principle. The other thing that was wrong was that three of them were active members of local obstetric gynecological society, which was a member body of the national obstetric gynecological society. They would participate in educational activities of the society after office hours and even on Sundays and holidays. They would accept these assignments with smiles on their faces and respectful words when their senior office bearers asked them to do that work. I had actually witnessed this polite behavior. When I asked them about this double standard, one of them told me that that was their personal interest. The education part was not the interest, the need to keep climbing the political ladder to the post of president of the society was. Nothing lasts for ever, including bad things. Over the next 6 years three of them left. One of them got transferred to another institute because the Dean started asking for too much effort from that person, after 4 P.M., at night, and even on Sundays and public holidays. Another person left because she always wanted a better paying job in a private hospital, and had been trying to find one for years. Third one left similarly for a job in a corporate hospital. The associate professor continued. When I decided to revamp the postgraduate teaching program again, I proposed this time slot again. The associate professor alone said she did not want to teach at that time, because she was against teaching the residents between 4 and 5 P.M. in principle. Boy, I have such principled persons to deal with. What I do about this situation is for a future posting on this blog.

Attitudes 3

This story is about my elder brother, my friend and I. Actually there are two stories with so much parallelism, that I have clubbed them together. In the vacation after my first year as a medical student in Mumbai, I went to see my elder brother in Pune. He was a dentist, a fine one, and I needed to have a couple of cavities in my molars filled. So we decided to combine a family reunion and my treatment. My brother was fine fellow, but had a vice that he could not give up. He smoked, often excessively, until it finally did him in one day. His theory was that one had to smoke in a medical college or a dental college. My mother used to tell him repeatedly to stop smoking, but to no avail. He had predicted to her that even I would start smoking when I went to a medical college. When I sat down on his dental chair and opened my mouth wide as per his instructions, he put in a mirror directing it to the back of my lower incisors and saying “this is where you find carbon deposits due to smoking’. Unfortunately he said that first and looked afterwards. Since I did not smoke (and still don’t), he could find no carbon. He changed the angle of the mirror and tried again, but could not find any carbon. His face was crestfallen. Finally he pointed the mirror to my molars that needed treatment, and spoke no more about smoking. Many years later, I went to my friend who was my classmate in science college before I joined a medical college and he a dental college. I needed to have a root canal done on the molar that had been filled by my brother before. My brother was no more, and anyway I would not have gone to Pune just to have a root canal done. I have a upper third molar (so called wisdom tooth) that is malaligned, so that there is a gap between it and the second molar. I am aware of the fact and make it a point to have that and any other gaps properly cleaned after every meal. My dentist friend seemed to be in an educational mood, and he put a pointed probe in that gap, making a drawing out movement and saying, ‘this is the gap that collects food which leads to dental caries’. He put the extracted end of the probe in front of our eyes, to show me the food that he had scooped out and to admire his clinical abilities himself. Unfortunately there was nothing to show. The end of the probe was clean, because the gap had been clean. His face was as crestfallen as my brother’s had been many years ago. He had put himself in a situation that he seemed unable to get out of. Finally I told him I cleaned that gap and all other teeth after every meal to prevent dental caries. Then he went about the business of doing my root canal. I don’t know why these two dentists, both of them quite close to me, had such conviction that they would be right and I wrong, when I had done nothing to provoke such a feeling. I also don’t know why they had to speak first and then look for validity of their statements. Did it have anything to do with my personality? If so, how? I do not adopt a superior attitude any time that people would like to find a flaw in me somewhere. Or do all dentists do the same thing to all their patients?

Attitudes 2

We have an associate professor in our department who is very senior. In fact, he will superannuate in a few years. He is quite knowledgeable and well read. Unfortunately he has some quirks which are detrimental to patient care. Normally we do not go to the operation theater on days allotted to other units. Once I had occasion to go there on his operation day. He arrived after I reached there. He changed into operation-theater clothes. Then he opened his locker and took out a pair of slippers for wearing into the theater. We have a perpetual shortage of theater footwear and unless you are early, you may end up barefoot in the theater. A senior person like would always be given a pair by someone, but he seemed to prefer to keep his pair in his locker, to be used by him once a week. That explained partly the shortage in the theater. I noticed something unusual on the strap of each slipper. He had made a pad of gauze covered over with white sticking plaster, and stuck it on the strap of each slipper. On the pad he had put his initials in bold letters. The sad part was that he could not get the slippers washed because the artwork would get spoilt. So he was keeping the slippers in the locker week after week, month after month, year after year (if the slippers lasted more than a year), without getting them washed at all. All the dirt collected on the bottom of the slippers carried bacteria into the theater, which explained partly the somewhat higher infection rate in our theater. The most upsetting fact was that these basic principles of microbiology are taught to a second year medical student, and he as an associate professor was definitely aware of the harm he was causing. That he should continue to do so for personal reasons was inexcusable. I talked to him about it and he readily agreed to change his ways and get his slippers cleaned every week. A month or so passed, and I had to go to the operation theater on his day. He arrived later than I, and the slippers he took out to wear were the same as before, with the bottom as dirty as before. He had not kept his promise, and his attitude had not changed. It is unlikely to change no matter how much I may explain the need to him, because the desire to change has to come from within, not by an order of a senior officer.

Attitudes

This is about attitudes. Some of the departments in my institute have a high incidence of stress. In my department the work stress is very high. In addition there are attitude problems of senior residents that I wrote about before, and that causes a lot of psychiatric disturbances in somewhat weak-minded persons. We are working on it with the help of the psychiatry department, and soon should have good results. There is another department, where the problem is said to lie with the staff members. The head of the department has a high regard for himself and his staff members, who are said to have a style statement of their own. They get resident doctors for superspecialization coming from different parts of the country. They are all intelligent doctors who have excelled in their fields of the medicine, got good marks in the common entrance test for this superspecialization, and got these coveted jobs. Some of them come from towns and villages and lack the stylish English pronunciation and the stylish clothes of the city doctors. Instead of appreciating their talent as doctors and ignoring their lack of style, this head of the department is said to look down upon them and to ridicule them at times. Some of them end up with psychological disturbances like anxiety, depression and sometimes suicidal tendencies. There was one such a resident who needed treatment for suicidal tendencies. The psychiatrist treating this resident doctor managed to get him OK. She also advised the head of that department to change his behavior with the residents so that they would not develop psychological disturbances. This head of the department went back to his department and told the staff members not to speak badly to this resident doctor or he would attempt suicide, and the blame would be put on him and his staff members. The unfortunate part of this was that he made the statement quite loudly in front of the concerned resident doctor and a lot of other people. The resident doctor was greatly humiliated instead of feeling reassured. His condition was aggravated and he needed further therapy. The treating psychiatrist was also disturbed by all this. When we discussed this issue, we concluded that the said head of the department had a problem of a wrong attitude and it was beyond repair.

Residents’ Orations

Orations are in general delivered by senior persons who have presumably done a lot of work in a specialized field. Unfortunately a number of orations arranged these days are not following this principle. They are often based ‘you-scratch-my-back-I will-scratch-yours’ principle. Or they are for paying back some obligation or to get something in return. I have disapproved of this for a long time, and always will. Perhaps this dislike was at the back of my mind when I decided to award one oration each to two of my residents. One of them I caught giving a test dose of an intramuscular iron preparation by the intradermal technique. The preparation stains the skin very badly. So a special technique has to be used while giving it deep intramuscularly, so that it does not track out and stain the skin. And here was my resident giving it directly into the skin! The other resident was found trying to make a skin incision with a stab knife using the cutting technique. The stab knife is to be stabbed in, and other knives are to be used to cut in the conventional manner. This resident was trying to make a series of linear cuts at the same site and not making a good job of it for obvious reasons. It was not as if they had not been taught what was required to be done. The injection technique was taught in the second year of their undergraduate training, and she was already into the second half of her first year of residency. The other one was doing ht second half of her second year of residency, and had observed a number of laparoscopies and done a few herself, and it was a laparoscopy in which she was cutting with a stab knife. She had made the incision at a dangerously low level too. So I decided to make them to extensive reading on these two topics, and give a talk on the respective topics for 15 minutes each. The talks would be attended by all residents in my unit and faculty. I decided to call these talks residents’ orations on the spur of the moment, probably to ridicule the current concept of orations, and also to make them feel a bit ashamed that they did not know what they should have known. They did read and did deliver the ‘orations’. SO they at least made an effort to read. They answered a lot of questions incorrectly. But we provided them with the correct answers. One resident came late, though all work had been finished. I awarded her one oration as a disciplinary action. I thing the residents got quite a bit of academic training and some in time management and discipline too. I hope there will be many more orations, and they achieve the purpose behind them.

Mindlessness

I had thought that just one example of the mindless behavior of some of the current resident doctors would be enough. But I am tempted to give another example of the same resident doctor that I described in the previous post. There was a patient who had undergone a sterilization operation after her delivery. She had been given a spinal anesthesia for the same. Some of the patients given spinal anesthesia develop a headache because of leak of cerebrospinal fluid through the puncture made in the covering of the spinal cord. This patient had a similar headache for which she was given medication by this resident doctor. The next day morning our resident proudly told that she had given tablet Lynoral to that woman because she had a spinal headache. I was aghast because Lynoral contains a synthetic estrogen that among other things suppresses lactation, and has nothing to do with their treatment of a post-spinal headache. I checked what medicine the patient had purchased, and found that it was indeed Lynoral, and she had already taken two doses of the same. I asked the resident doctor why she had given Lynoral to that the patient, since it would not cure her headache, and would suppress her lactation. She thought intensely and said that she had actually wanted to give Lanol-ER. Lanol-ER was paracetamol, which could be used for treating a headache. We stopped the medication and prescribed paracetamol. Luckily her lactation had not been suppressed by the two doses of estrogen she had already taken. One of my colleagues was this resident doctor’s examiner, and passed her in her MS examination. I pity that resident's current and future patients. P.S. : I find that this post is read quite a lot. You may like to read about this same resident at the following link HERE. You may click on it or copy and paste the following link into the address bar of your browser and press the 'Enter' key. http://shashankparulekar.blogspot.com/2009/11/selection-charade.html

Selection Charade

It is very sad that the current method of selection of resident doctors for post graduation is far from perfect. There is a common entrance test based on multiple choice questions. It does not assess how good a doctor the concerned person is. Based on the result of this test the doctors are admitted for post graduate courses. Their aptitude for the concerned subjects is not checked at all. I would like to give just one example of this deficiency. I had a resident doctor whose rank on the merit list of the entrance test was 28. This was quite good. Unfortunately this doctor was pretty dumb. There are many examples of her dumbness. I’ll tell you just one to give you an idea how dumb she was. I was assisting her to perform an abdominal hysterectomy, meaning surgical removal of the uterus by the abdominal approach. There were many large blood vessels feeding the large uterus. One of the vessels started bleeding furiously such that my surgical gown and the clothes underneath got soaked. I asked her to keep pressure on the bleeding blood vessel with a surgical mop while I went to change my gown and clothes. The pressure would stop the bleeding temporarily. I came back in less than three minutes. To my great horror I found that she was standing with a foolish grin on her face visible even through the surgical mask, pressing the mop on the top of the uterus (as during a caesarean section if one has to wait for something), far from the leading blood vessel. The vessel was spurting blood as furiously as before. There was another equally foolish resident doctor as the second assistant, also there owing to her high rank on the selection list. She was holding that tip of a suction cannula just above the spurting blood vessel so that all blood would get removed to a bottle kept at a distance keeping the surroundings clean. The bottle was a quarter full with precious blood that would not have been lost if they had compressed the bleeding vessel with a mop as I had asked them to do. I was aghast. I then took over the surgery and stopped the bleeding. Then I asked them the reason for such behavior. They had no explanation. The point is not to show how foolish and sometimes dangerous to the patients they were. The point is that there is a need for a better method for selecting candidates for postgraduate training.

Integrity? What is that?

One of our previous Deans was quite afraid of pressure from higher authorities and also from politicians. Actually the Dean’s post is a quite senior post and the Dean should be able to maintain his stand with integrity irrespective of wrongful pressures from anyone. However this particular Dean was not so. There was a scheme from the Central Government of paying out money to women belonging to scheduled casts, scheduled tribes, and those below the poverty line. It was necessary for the women to provide proof of belonging to one of the categories. We as the treating obstetricians were supposed to receive the documents and certify the women fit for receiving this money. We were quite particular in our work, as a result of which the number of patients receiving the money was quite low. The administrative office from where the money came told us to distribute money to every woman who delivered with us, so that they could show good performance on their part to the Central Government. But they would not give us written instructions to that effect. They were afraid of giving written instructions. They wanted us to be responsible for any trouble arising out of such action. So we would not do what they wanted us to do. They told our Dean that we would not do what they asked us to do. The Dean asked me why. I told him that if we certified women as eligible for the benefits of the scheme without meeting the eligibility criteria, the money paid would be recovered from us after an audit. We would not do something wrong on our own. Sadly the Dean was unable to stand by us. Instead of supporting us and telling us to maintain our right will stand, he told me that if we did not pay the money as asked by that particular office, we would be held responsible for not carrying out the Government’s scheme and be penalized anyway. We still did not succumb to the pressure and continue to perform as before. Finally the administrative office had to send us a document signed by the additional municipal commissioner telling us that there was no need of documentary support and any woman who seemed to be poor should be given the money. The point is not that we won the battle. The point is that the person who was the chief of our institute should have shown integrity and supported us in our legally correct stand, but could not do so. All employees working under him would have shows integrity following his example, but he failed us all quite miserably.

Spontaneous Cure of Hardware Errors

This is a new concept in computer hardware. I am not a computer engineer. I’m actually a doctor. But I have been using computers for ages and know a bit about hardware and software. I have observed a new phenomenon over the last many years. I call this phenomenon spontaneous cure of hardware problems. A few years ago my computer just stopped working. It had Windows XP installed on it as the operating system which would just not boot. I decided to install windows XP again but it would not work. Finally I changed the hard disk and installed Windows XP on that again. It worked. In the next vacation my son came back from college and wanted his data on the old hard disk. He was not interested in my new hard disk and its installation. So he connected the old hard disk in the computer and the computer just worked fine. The Windows was OK and it continued to work OK for the duration of his vacation. I continued to use it afterwards too. I do not know how the hard disk problem got sorted out by itself after sleeping for almost six months or if it was the Windows installation that corrected. The main thing was that this correction happened in the absence of any electrical current into the disk. At another time I had a RAM that stopped working. It wouldn’t work in spite of being cleaned with a cloth, isopropyl alcohol, and an eraser that school children use. These were the standard methods used by a computer engineer in our institute. I replaced the RAM but did not throw it away. A similar thing happened in my office and I replaced that RAM too. One day I needed RAM for another computer, and not having any spare RAM I used the ones that were not working. I was surprised to find that both of them were fully functional. How they cured themselves is beyond my ability to explain. The latest example is that of a digital pad made in China that I had purchased for 9900 INR. It worked for less than two years. One day of the pencil cells inside the pad leaked and it stopped working too. I cleaned it thoroughly myself after opening it. I replaced the batteries. I replaced the cell in the digital pen. In spite of all these measures it would not work. It could be switched on OK. I could add new pages and remove old pages from it but it would not accept any writing. Finally I packed it up and went on vacation for two weeks. After coming back I opened the pad again to give it one more try and was immensely surprised that it had started working again. I had actually written off the 9900 INR as a loss and was quite happy to see that it was not a loss. Clearly the main point of all this is that one should not throw away hardware that seems to have stopped functioning and cannot be repaired, unless there is a space crunch for storage. There is a new phenomenon that has not been described in the computer industry so far, that seems to correct hardware errors that seem resistant but sometimes cure themselves just on being kept in storage. Perhaps it is reorientation of magnetic elements in the hardware. Perhaps it is drying. Perhaps it is accumulation of some dust that joins tiny circuits that were broken. It sounds silly, I suppose, but the phenomenon exists. If my theories are amateurish and wrong, I hope some knowledgeable person explains the phenomenon scientifically. In the meantime I am keeping all the expensive hardware that seems to be irreparable though looks OK physically.

Ridiculous Decisions: Part Two

Here is another one more example of a ridiculous administrative decision. In the Radiology department of my hospital there was a ten year long problem of technicians not taking radiographs on Sunday as there was a dispute between two different unions. The patients were suffering quite a lot. The resident doctors were made to take the radiographs on Sundays. On one particular Sunday there was an argument between a radiology technicians and a resident doctor and the resident doctor was badly bashed up by the technician. There was a lot of disturbance. A police complaint was lodged. The Dean of the hospital was under tremendous pressure to resolve the issue peacefully. This was where she made a mistake. Instead of solving the problem the right way, she asked the deputy dean to ask senior consultants from clinical departments to be present round the clock on Sunday in the emergency room to see that any radiology technicians did not beat up any resident doctors. In reality this was actually the job to be done by security personnel and police. The Dean’s presumption was that the presence of senior consultants would deter the technicians from being offensive. It was a just a presumption, with no substance in it. She probably had no trust in radiology consultants to control the technicians (which they had anyway failed to do for 10 years). No provision was made for protection of the additional consultants, who were physically much less fit than the technicians who could attack them, and resident doctors who had proved to be unable to defend themselves. This was an absolutely ridiculous decision. The funny part of that was that the Dean would not sign that order. She verbally asked the deputy dean to take out that order. The deputy dean took out the order and sent it to us without his signature. I called him and asked what we were supposed to on that Sunday. He advised me to ask the Dean. I called the Dean, who got very angry and asked me to ask the deputy dean. Finally three of our consultants spent the Sunday in the emergency room doing nothing. Highly trained personnel were asked to do something they had no means of doing, for which they were not compensated in any way, and which gave them an immense degree of dissatisfaction. That Dean was known to avoid responsibility for any decision by asking subordinates to sign the concerned documents. The deputy dean did not want to be the scapegoat, and sent out an order without any signature. It was unfortunate that such things happened in an institute like ours, and such a person headed the institute and made these things happen.

Ridiculous Decisions: Part One

It is surprising that a number of quiet senior and intelligent people under pressure can be quite ridiculous in the orders they issue to their subordinates. A few years ago there was a municipal commission who was as usual an IAS officer. That year once there were very heavy rains and the entire city was flooded. The roads were blocked and no one could go anywhere. The doctors also could not move to the hospital for work and only doctors residing in the hospital were able to carry on the emergency work. They declared a two-day holiday to all municipal employees retrospectively, since they had not been able to go to work anyway. However the minister came under flak for this decision as there was a lot of work of cleaning up the city still not done. As a result he asked the commissioner to take appropriate measures, who passed an order making every municipal employee worked on everyday including Sundays. There was no point in making office workers work on Sundays, as there was no work related to flood relief. There are no patience in some parts of the hospital on Sundays, and none ever in departments like Anatomy and preclinical subjects. The actual work involved the cleaning of the mess on the roads, and treating medical disorders arising out of floods. I had no work as a gynecologist, because that part of the work in the hospital was handled by one consultant every Sunday, and was unchanged by the floods. The correct order should have been making related people work instead of calling everyone on duty, whether there was work to be done or not. There was not a single Dean in the three medical colleges who could tell the commissioner that it was a wrong order. After a few Sunday’s like this the order was canceled. The commissioner probably took it out on the people working under him, when he received flak. There was no maturity in the decision, nor any logic.

The exercise

I must say the planning of my institution's renovation is excellent. They have put my patients in two different buildings, and our offices in a third building. I must be walking about 5 kilometers every day just to see my patients. Improves coronary circulation and reduces cholesterol.

I am going on a vacation for two weeks, and will be back for more blogging.

Resident Monsters

The residents go through three years of residency. In the first year they are junior residents. They are believed to know hardly anything, and their operative abilities are also quite limited. The second year residents are senior to the first year residents, and junior to the third year residents. That I suppose is pretty obvious. But there are a few things in between lines that prompt me to state the obvious. The main thing is that the residents of each year are acutely conscious of this fact and they behave accordingly. We do not notice anything is amiss when we are working along with the residents. But when we are not around, they behave differently. A number of third year residents behave like kings and queens, and treat the juniors as underdogs. They order them around. They want to be called sir and Madam by residents who are just a year or two junior to them. They shout at them for minor or even nonexistent mistakes. The second year residents in turn treat the first year residents in the same fashion. The first year residents suffer silently and await their own turn. Unfortunately they do not get even with the seniors who treated them badly. They treat their own juniors badly. Some of the juniors cannot handle this maltreatment well. They develop anxiety neurosis, depression and some of them even attempt suicides.

Here is a short story of a couple of them. Anparna (name changed) was a first year resident. She could not adjust to residency and kept on crying and disappearing from duty. She required psychiatric help. When she joined duty after an apparent recovery, Ajyokti (name changed) was second year resident started bossing over her. An episode went somewhat like this:

“Anparna, do my two patients’ dressings,” Ajyokti said, “I am going to my room.”

“I won’t do your work” Anparna said “I still have to finish my work.”

“You won’t do my work?” Ajyokti said threateningly, “Don’t you know you have to spend two years as my junior?”

Anparna threw a fit and went to her psychiatrist again.

This same Anjyokti was treated rather badly by her senior resident Ashrukti (name changed) and another second year resident Ashrakdha (name changed). The two harassers broke open Anjyokti’s locker and removed her register containing all records of her dissertation for MS examination. Anjyokti was quite upset. Breaking open someone’s locker is a criminal offense, for which the two could have gone to jail. Unfortunately Anjyokti did not lodge a police complaint, but remained dependent on Hospital authorities to take appropriate action. They just made verbal inquiries and dropped the matter. Ashrukti had a good hold on her boss, who strongly supported her even if she was dead wrong. The boss even made a statement on Ashrukti’s explanation to the administration that the lockers were not allotted to anyone. It was a wrong statement, because e the lockers had been allotted to the residents of that unit. Today I happened to go to the unit's outpatient clinic. The boss was away as usual, and Ashrukti was the Queen. She had no idea I was there, and did not even expect that, because I was not expected to be there as the head of the department nor as a clinician (my outpatient day being different). I overheard the following dialogue.

“Anjyokti! Anjyokti!!” Ashrukti shouted. “Where are you?”

“What happened?” Anjyokti asked in a civil tone.

“Why have you not got anesthesia fitness for this previous cesarean case? Don’t you know in our unit we get fitness done at 36 weeks, so that they can undergo cesarean section again any time they need?

“But it is already done,” Anjyokti protested.

“No. You will not go off call,” Ashrukti ruled. Then she stormed out of the room they both were in, and I think she saw me then. She went away without a word. As a third year resident, Ashrukti does not have the authority to mete out punishment o a junior resident, that too without a fair inquiry. I will ask her tomorrow the reason for such behavior, but I have a gut feeling it is unlikely to improve her attitude.

Maternity Leave

There is nothing more wonderful in the life of a couple than having a baby. The woman who delivers a baby needs time to pay full attention to the needs of her newborn. I am in full agreement with this. However what is wonderful in one person’s life should not become a painful event in the lives of others. Unfortunately in the case of employees in the public sector, like government and semi-government organizations, it is so. These women get fully paid leave for three months. Recently it has been increased to six months. Many of them join it to their earned leave accumulated over a period of time, and extend the maternity leave to one year. There is nothing wrong with taking leave which is due. But that is just one part of it. No one is employed in her leave vacancy. The woman gets this leave while her coworkers have to keep doing her work while she is away. If they work in an office, they just keep her work pending, even if she remains away from work for a year. But if she is in the essential services, like healthcare administration, her work cannot be kept pending. The poor coworkers do that extra work without any compensation for the same. One can argue that they in turn will get their maternity leave when this woman will do their work. That may be true if the coworkers have babies, but some of them don’t have babies, some of them are men who do not get leave of this sort when they have babies. This in my opinion is exploitation of others. The administrators and policy makers are not concerned, because they do not get exploited in this manner. In my department a number women doctors took a job, planned to have a baby as soon as they completed the required duration of service to be eligible for maternity leave, proceeded on maternity leave at the right time, extended the leave until there wasn’t any left or further extension was not granted due to shortage of working employees, and then left. No employers was concerned because the hospital is a public sector undertaking, and the money spent is money collected from taxpayers who do not come to know what has happened and who have hardly any say in the matter anyway. I think this behavior is exhibition of selfish nature of the extreme degree.

White Lie

Infection of the lower genital tract with two organisms called Candida and Trichomonas causes distressing symptoms like itching of the private parts and white discharge. It is quite simple to cure this. One time administration of two medicines cures both of these infections. But it is not that simple to maintain the cured state if the sexual partner of the woman is not treated at the same time, as he transfers the organisms to the woman during intercourse. An understanding husband takes the treatment when explained the need for it. But a number of them don't understand the need, and refuse to take the medicines since they themselves have no symptoms. I had a patient in my last outpatient clinic that had this infection. She typically had recurrent infections, and on inquiry said that her husband would not take any treatment. “You have the disease, you take the treatment," he would say. “I have no disease. I will not take any medicines."

"Does he understand that he transmits the infection to you during sex?"

"Yes, I told him so. Still he won't take the medicines."

She needed a solution to the problem.

"Tell him there will be no sex if he does not take treatment" I suggested.

She kept quiet. That probably was not a workable solution. A lot of husbands force sex on their wives in a male dominant society. She needed some solution that was more effective in convincing him. I suddenly had an idea.

"Tell him he will keep harboring the germs if he does not take the treatment. Even if he does not have any symptoms, he can develop cancer of his organ."

Her face lit up. She understood that was not the case, but I was just trying to help her. Judging by her social and educational class, it seemed unlikely her husband. would search the net to see if this infection really caused cancer. It would be easier to swallow a couple of pills. My conscience is clear about this white lie - it was to benefit my patient and there was no personal gain.