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.

Expiry Date

Intravenous fluids cannot be given at any speed one feels like, especially if some medicines have been added to them. Even if there are no such additions, the infusion rate has to be controlled in case the patient has a disease of the heart or kidneys, or overloading of fluid may harm or even kill the patient. Our resident doctors must know this, since it is part of their education as undergraduates. Unfortunately what they learn for passing an examination and what they remember at the time of treating their patients are sometimes poles apart. That day I found such an example on my morning round of the labor ward. There was a patient who was in need of being delivered for obstetric reasons. Unfortunately she was not getting any labor pains. My residents had started an intravenous infusion of saline with oxytocin - a medicine to cause labor pains. She still was not getting any pains. I glanced at the chamber of the infusion set and found that the infusion was going at top speed. Actually oxytocin can make very powerful contractions of the uterus, and make it rupture if it is given fast.

"Why are we giving her oxytocin infusion at such a top speed?" I asked. There was no answer. If I had asked them to slow it, they would have done so and moved on, only to repeat the same mistake some time later.

I had to make an impression on their minds so that they would remember it.

"Are you giving the fluid so fast because its expiry date is today? I asked. There was momentary silence, and when the meaning of what I had asked dawned on them, they laughed. It is a common practice to use up medicines whose expiry date is approaching because they cannot be used safely after that date. However saline need not be used fast even if it is going to expire on that day, since a bottle gets over in a few hours even if it given very slowly. There cannot be any need to rush through it on these grounds. A little sarcasm achieved what a lot of shouting or scolding would not have achieved. They did not give intravenous fluids at such rapid rates without reason again.

Thank the Lord

It is probably known to everyone in this institute that the heritage building of the hospital is scheduled to be repaired, and the work has already begun. I thank the lord for the following things.

1. The building is eighty years old. It is very likely that it will collapse on our heads any time. Now the repair will let us live a little longer unless something else calls us away.
2. The water leaking will stop. That will save a lot of water which is incidentally fresh water. We all know the city has had very poor rainfall and we need to conserve all the water we can save.
3. We have been asked to keep all our patients from seven wards in one and 2/3 ward. That has taught us crowd management.
4. We have been asked to move to ward 24, which was given over only partly by concerned heads of departments. That has taught us to be satisfied with what little is given unto us.
5. The concerned heads of departments have retained sections of the ward which were badly needed by our patients, only because they had made commitments to companies with whose money the sections had been made. That has taught us to respect money.
6. One head of department refused to let us use their space which was not used by them on a regular basis, because they had developed that area with funds raised through donations, and our staff members would make that area dirty. That has taught us the value of maintaining cleanliness of the environment. Actually it was a very eco-friendly statement, though not a friendly statement.
7. One head of department refused to give us one room because all of their rooms had junk in them and he could not get rid of the junk for years. When I offered to help him get rid of the junk so that we could get that room, he declared he would get the junk out by my method and then retain that room to new junk rather than give it to us. That taught me how to make good use of other people's ideas, even if not for helping out others.
8. One area in charge avoided me so that she would not have to give us a room. Finally I tracked her down, when she asked for another secure room for her in exchange of the room she would give me. That taught me maneuvering and negotiations.
9. I had to go around looking for space which actually should have been arranged by the institute. That taught me to know how beggars feel.
10. We were told that nobody would get offices. So now my staff members, all MD qualified, will learn how to hang around wherever they can, like canteen, katta or any other similar place when not actually treating patients.

The Lord knows the names of all people involved. Those others who wish to get to know such people who have done us a world of good may get in touch with me. When not actually treating patients, I could be hanging around somewhere.