A Lady, a Thief, & a Screwdriver

It looked like just another day when it started, but it was different as one of my neighbors found out. The Master of the House was away passing time of the day as he was retired and had nothing better to do. The Lady of the House was home alone, managing the daily chores. At about 10 A.M. someone knocked on their door. She went to see who it was. “Madam, I have come to repair the cable TV connection” the visitor said. He was young, thin, and wore nondescript clothes. “It is not working?” she asked him. She was old and probably did not watch the cable programs so often. “Your husband sent me. He said it is not working.” “Come in.” He went in. Under her watchful eye, he switched on the TV, disconnected and connected the cable connection, changed channels a few times, and turned towards the Lady. “Madam, do you have an electric geyser?” “Yes, it is in the bathroom” the Lady said. “Please show me”. They went to the bathroom, he following her. The instant geyser was there, apparently looking OK. “Do you have a screwdriver?” he asked. She fetched a screwdriver while he waited in the bathroom. He put the screwdriver against the body of the geyser and asked her “Will you please hold the screwdriver like this while I go check the TV connection? Don’t worry; it won’t give you any electric shock. But don’t take it off, or I may get one.” So she stood there holding the screwdriver touching the geyser, while he went to fix the cable. Minutes passed, but he wouldn’t come back. She wanted to go see what was happening, but was afraid to break the contact with the geyser lest the cable fellow got electrocuted or something. A half hour later the Man of the House returned, let himself in with his key, and after looking for the lady everywhere, found her in the bathroom holding the screwdriver. “What are you doing?” he asked her. So she told him. “But there in no one repairing the cable. Actually I sent no one” he said. “Let us go and see if everything is OK.” So they rushed to check everything. The TV and cable were OK, as they originally had been. But the cupboard was open and cash inside was stolen. The Lady’s gold bangles kept on the wardrobe were stolen too. A police complaint was lodged. The outcome was healthy entertainment of the policemen for the next few days as they recounted the story, but the thief was not found and the stolen goods were not recovered. This is an unorthodox and first-time-in-literature use of a screwdriver.

Medical Council & Us

“Did you read today’s news? The Medical Council of India chief has been arrested and put in police custody for 5 days.” One of the news buffs said. My department has a few of them. “Yes, I did” I said. “It seems he had asked for twenty million rupees for giving recognition to a medical college.” “Twenty million? Last I heard it was ten million” said a knowledge buff. We have some of those too in my department. “I would not know” I said. “I don’t go as MCI inspector anywhere.” “Why? They treat you well, five star accommodations, fine food, good money and a lot of respect” said a regular MCI inspector. We have a couple of them too. “I don’t go because I don’t want to be involved in something like what you see in today’s news” I said. “You mean the inspectors also will be pulled up?” said the professor who was all for going as inspector for the accommodation, food, money and respect. She seemed a bit worried now. “They can pull up whoever seems to be involved” said the knowledge buff. “Besides, I dislike what they are doing to our institute” I said. They have received fee for inspecting our institute for DGO in 2001. In spite of repeated reminders, they have not come for that inspection. Our residents passing DGO cannot practice outside the state though they are good, only because MCI does not recognize the institute for DGO. Why should I work for them when they won’t recognize our institute? “That must be because we did not offer 20 million rupees” said the cynic. We have one such in my department. “They have issued a show cause notice to our institute, threatening to derecognize us. Imagine derecognizing us, one of the best institutes in the country” said another professor. “Not one of the best” I said “the best!” “It seems the idea is to derecognize public institutes like ours, so that students will be forced to join private institutes. That is where they charge fortunes for admissions” said the knowledge buff. I wondered where he picked up such classified information. “That is unlikely to happen” I said. “There will be a hue and cry if public institutes close down.” They seemed to find this agreeable. I hoped it was the truth, or there would be no future to future students of this country, if they had no money for education in fancy institutes.

Deemed University

“Sir, we hear we are going to become a Deemed University”. My staff members started the topic in a departmental meeting. “I heard the same. It seems the VC asked the chief to make arrangements to make us a deemed university” I said. “So how do we benefit from this” asked one professor. “It means we do everything on our own, without involving the University of Health Sciences”. “So it is more work!” “The chief said we will improve because we can draw our curricula, syllabi, and design our own courses”. “Wow!” said a skeptic. “I heard we will run our own entrance tests and get our own students, without depending on DMER” I said. “So we can get our children in more easily, what?” asked one professor hopefully. “We will set our own questions papers for all exams”. “So our children can pass more easily, what?” said the same professor with a happy grin. “We will conduct our own postgraduate course entrance tests.” “Easy postgraduation for our children” said the professor. “Are you being sarcastic” someone asked her. “Of course I am sarcastic! You think our children will benefit from any of this? The members of the standing and health committees, additional and deputy commissioners, municipal corporators, the MLAs and MPs, and such are the people who matter. Their children will get these benefits, not ours. We have to work to give them these benefits.” I was stunned. I had not expected such insight from her. “Don’t you remember they wanted the university question paper for one such candidate last year?” People nodded. “Don’t you remember we were asked to pass that candidate?” everyone did not nod, only the concerned examiners nodded. Whether they had obliged or not was not known to me, and I did not want to know it too. “Will there be capitation fee?” someone asked. “These things are not expected to happen, because we are expected to behave with knowledge, understanding and integrity when our college becomes a deemed university” I said. They all looked at me with wonder. “Wow!” said the skeptic.

Hardware Recovery

I was quite happy for two reasons. The first reason was that my theory of spontaneous recovery of non-functioning computer hardware was proved to be correct one more time. The second reason was that I had heeded my own advice and not thrown away my pen drive which refused to be read on a number of computers I tried. I had a backup of the data on that pen drive, and everyone including netizens out there and my computer engineer son had advised me to be practical, throw away the useless pen drive and move on. Well, I was sentimental about it because I had spent good money on it and believed in my theory of spontaneous recovery of dead hardware. SO I just kept it in my drawer for more than six months. Yesterday I needed a pen drive to put my music on (meaning music owned by me, not made by me). This pen drive was the only spare one I had. So I plugged it into my computer’s USB port, and it worked! Then I thought of our department’s computer scanner that had stopped functioning, tried on multiple machines. Our engineer had advised us to condemn it as it was not reparable. I had kept it on a shelf for a few weeks, and tried to use it again. It had worked without a glitch and is still working perfectly. Friends, I strongly recommend that you keep your non-functioning hardware if storage is not a problem, and there is no physical evidence of damage on it. It may just start working again some day.

Windows Won’t Shut Down

I have experienced the problem of Windows not shutting down a few times in the past, on machines ranging from 486 to Pentium 4, running Windows 98 to XP. When everything else failed, I used to just switch off the power, and it would shut down. It did corrupt the Windows files a bit or a lot, depending on my luck, but nothing a scandisk would not fix, and if it couldn’t, I could reinstall Windows again. When it happened yesterday, I tried “start – shut down – shut down” sequence four times. It was no good. The desktop just sat there, as peaceful as a monk. I did not feel like switching off the mains, because I was in the mood of being analytical and scientific. So I launched the Windows task Manager by pressing Ctrl-Alt-Delete keys together. There was no application running that was interfering with the shutdown process. I tried to shut down through the Windows task Manager menu command. The result was the same as after standard shutdown sequence. When it failed thrice, I wondered if there was a loop being executed indefinitely, so that Windows remained busy trying to shut down. So I looked at the processes being run in the Windows task Manager. Well, it was nothing like anything I had seen before. The processes were moving up and down the queue at a pace that would not let me click on any one process so that I could stop it. There was a “signal.exe” that I had never seen before. Before I could click on it to shut it down, it would move down and some other process would take its place. There was indeed a loop and there seemed to be no way of stopping it. It could have been a virus, though unlikely since my antivirus was updated and active. Then I had an idea. I launched the Windows System restore utility and restored the system to a date 2 days ago. It was successful. Then I tried the “start – shut down – shut down” sequence, and it worked! I hope someone out there finds this useful.

One Gram Gold Coin

I was working in my office, when three smartly dressed guys turned up. They looked like med reps. “Doctor, can we take a few minutes of your time?” one of them asked politely. Actually I had some important document to study. But they had come to see me in this warm weather, and I did not have the heart to say no. “OK, please sit down” I said. They took seats. “Doctor, we have this wonderful brand of calcium” they showed me a multicolor brochure, with pie charts and bar diagrams, and tables showing comparison with other brands of calcium. It is water soluble, does not interfere with bowel movements, and does not impair absorption of iron”. “OK” I said. Every med rep said the same thing about his brand. That was the standard sales talk. “Here are some samples. Please try them and if you like them, prescribe our product.” “OK” I said, happy that they had finished and I could go back to work. I was wrong. They did not get up to go away. “Doctor, we have a scheme” the most senior rep said. He must be the manager. “If you give exclusive support to our brand, and we find that at the end of six months your prescriptions have resulted in a significant sale of the calcium, we will give you one gram pure gold coin.” I had encountered different types of med reps, but this one was a new one. I looked at them again to see if they were joking. They seemed dead serious. “No, thank you” I said. “I find many things wrong with your proposal. What you are suggesting is in my mind highly unethical. If I needed gold, I would have gone into lucrative private practice, not remained an academic in a teaching hospital. I cannot do what you want me to. But even if I wanted to, your bargain has flaws. You are making an offer with no guarantees. You are not specifying how much sale deserves that gold coin. For all one knows, you could do the disappearing trick after the sales truly go up. Or you could claim the sales had not gone to the level desired and hence no gold coin could be given. There is no quantification. A good business deal is one gram gold for a specific amount of sale, so that some doctor may earn even 10 gold coins in your six months.” I wondered if they understood the sarcasm. “Please tell me all your products in obstetrics and gynecology” I said. They rattled off six names. “I will remember these names. I used to prescribe these medicines for their merit. But I feel you have insulted me by putting me in that category in which they prescribe for gold, money, junkets and the like. I am a human being, and I feel badly when insulted. To get even, I will not prescribe any of your products hence forth.” They seemed taken aback. When they made no move to go away, I said “I have a lot of work and not enough time. Will you kindly let me do my work now?” They went away at that. A couple of months later, they came back with a new manager. I listened to their sales talk, and said “I have stopped prescribing your products because your company insulted me by offering me a gold coin in return of prescriptions.” “Doctor, the previous person made a mistake. That scheme was not meant for teaching hospital doctors. I was meant for private practicing doctors.”

Bird Language

My office is on the first floor. Just outside stands a guava tree. It is old and proportionately big. Sparing a moment to watch the squirrels and birds on that tree is a powerful stress buster. It is great fun too. Usually the birds are small and pretty. That day there were visiting birds. Three large birds of prey descended on the tree. In my opinion they were eagles. But I came across a newspaper photograph that showed a similar bird and called it a screaming kite. These kites looked fierce. They had pointed beaks and red eyes. Though they just perched on the branches of the tree doing nothing in particular, one small black bird got upset. It was probably his home and he did not like the intrusion. So he sat on a branch four feet above one of the kites and kept chattering in what sounded like an angry tone. The kite ignored it and continued to sit there elegantly. That seemed to infuriate the small bird and he chattered even more angrily. Finally the kite turned his head and looked at the small bird with his red eye. The chatter stopped instantly. The kite straightened his head and went back to sitting there elegantly. There was total silence for five minutes, until they saw me training my camera in their direction. Then they all flew away.

Which side ... which organ ... which patient?

“Sir, this patient is for diagnostic laparoscopy for chronic pelvic pain” my resident doctor informed me. She was to perform the laparoscopy and I was to assist her. The patient was already on the operation table. The anesthetists were going through the motions of getting things ready. “What is her name?” I asked. “Show me her papers.” “Her name is Parwati” said the resident as she handed me the indoor papers. “Never rely on the first name alone” I told her. “You must check the full name. Parwati is such a common name that at a given time there could be three or four women with that first name in our ward. You could get a wrong patient on the table if you stick to the first name alone.” Then I checked the patient’s name on the paper. It was Parwati Sarvate. I turned to the patient and asked “Are you Mrs. Parwati Sarvate?” “Yes” she said. “Sir, her name is written on the label put on her OT gown” my resident pointed to a square label on the front of the woman’s gown, below the left shoulder. She had a look of pride on her face, having shown me a fool-proof method of patient identification. “OK. But remember that the label is put by a nurse, and you are relying on her not to make a mistake. You can get in trouble because you are responsible for patient identity, not the nurse.” It was indeed surprising how naïve the residents could be at times. “Are you undergoing laparoscopy for chronic pelvic pain?” I asked the patient. “Yes” she answered. I confirmed all these details myself, though the resident had done all that herself before bringing the patient to the OT. It was my vicarious responsibility, even if the resident was going to perform the operation, because she was not yet qualified. “You cannot be careless in these matters, or you may end up performing a wrong operation on a wrong patient” I warned. “Yes sir,” the anesthetist agreed with me instantly “that day the surgeons took up a patient for repairing a fistula in ano. After giving anesthesia and lithotomy position, they started the operation, but could not find any fistula. After searching frantically for ten minutes, they realized that patient did not have a fistula, and he actually had a hernia. The patient with a fistula was sitting outside the OT, awaiting his turn to undergo an operation. SO they straightened his position and repaired his hernia. Lucky they had not started dissecting his tissues for repairing a fistula.” “Yes, the fellow must have been lucky” I said. “All he lost was ten minutes. Here are reports in the world literature of patients having perfectly sound limbs or organs surgically removed, while the diseased limbs or organs stayed back inside them or inside some other patients. Needless to say, the operating surgeons paid heavily in the form of compensation and disciplinary action. I remember a patient we had operated on when I was a Registrar. One day a Registrar of another unit brought her along and told me that we had performed a laparoscopic sterilization on her while she had actually wanted a diagnostic laparoscopy for finding out why she was not having a baby. She had gone to his outpatient clinic by mistake and he had found this on her discharge summary. I almost went into a shock. Sterilizing a woman by mistake when she actually wanted treatment to get pregnant was a form of criminal negligence not yet reported in the world literature. I immediately took her along to the medical records section and took out her indoor paper. Luckily it showed that she had actually undergone a diagnostic laparoscopy and not a sterilization operation. Someone had given a discharge summary of another patient.” My audience was suitably impressed. I hope they learned the importance of being careful at all stages of operative treatment of any patient.

Election Campaign Strategies

We have obstetric and Gynecological Societies all over the country, almost one in every city. They are member bodies of a central federation of societies. Every society has members in the city, and a managing committee of elected members. Being on the committee initially, an office bearer later and finally the president of the society are things considered wonderful by some members. They contest the elections. They meet the voters for promoting their cause. But with more than a thousand members, it is often not possible to meet everyone. So they send their letters of appeal to all members, requesting their valuable votes in their favor. That day I found six such appeals in my letter box. There were five men and one woman. I opened their letters and settled down to see what they had written about themselves that would appeal to the voters. Their photographs were apparently taken when they were younger. That is a usual strategy. Voters love young looking leaders. But there were more complex strategies than just presenting a good appearance. Until one becomes great enough to be quoted by others, one has to rely on famous quotes of others. So it was not surprising that these candidates had put quotes of others in their appeals. What was surprising was the innovative use of the quotes. One candidate had put his photograph and his name with credentials at the center of the top of the page. The following lines appeared in bold print right after that. The only ones amongst us who will be really happy are those who will have sought and found how to serve. – Albert Schweitzer Albert Schweitzer will never know he has apparently said such a great thing about this candidate. All potential voters who read this appeal will know anyway, which is what matters most. Another candidate found another great person to commend him. At the top of the letter of appeal was the following in bold print. “Success is achieved not just by great ideas but their effective implementation. To successfully implement you need youthful energy, utmost commitment and futuristic vision” _ Late JRD Tata. This was followed by the candidate’s photograph, and his name and credentials. Anyone who read this appeal would be out of his mind not to vote for this candidate, considering that Late JRD Tata himself seemed to be suggesting that this candidate had youthful energy, utmost commitment and futuristic vision. This candidate and the third candidate seemed to know that no matter how good they may be, most of the voters could be counted upon not to turn up for the voting on a Sunday morning at a place quite remote from the heart of the city. So they had the following quotes put in to ensure a better turn up. Candidate number 2 had quoted: “Those who stay away from the election that one vote will do no good; tis but one step more to think one vote will do no harm” – Ralf Waldo Emerson. Perhaps Emerson had said this in a different context. I disagree with Emerson in the current context. One vote can make a difference between a win and a loss. It is also not correct to think one vote will do no harm. It will definitely harm if it is the deciding vote, and the candidate is not worthy. The third candidate has quoted at the center of the bottom of the page as follows. Voting is civic sacrament – Theodore Hesburg Though I was put off a bit by a word sounding a bit like excrement, and put down a bit by his superior knowledge of someone called Theodore Hesburg, I was impressed by the strategy. Even the laziest of gynecologists would turn up and vote after knowing what Hesburg thought of those who did not vote. In the meantime in case anyone wants, I have a book on famous quotes which can be used by anyone without knowing who the people being quoted are.

Sex Education: Where Are We?

“Did you read the story in today’s newspaper on the village women?” my wife asked me over tea. “No, what is it about?” I said. “It seems more than 30% of women in villages have engaged in sexual activity before they get married.” “Times have changed” I said. With globalization, there was hardly any difference between cities and villages in attitudes and practices. “Actually the rate might be lower in the cities because they cannot get the privacy necessary for such a thing.” If there was privacy easily available, you would not find couples seeking privacy along the wall at the beach, covering their heads with Dupattas. “That may be true. But that reminds me of a patient who came to see me the other day. She was quite worried.” My wife has family practice, and women tell her a lot of things they don’t tell us in the hospital. “She is 35 and single. She works in a government office. They had gone for an office picnic. They played tug-of-war, men versus women. The women were so strong they pulled the men over the line and that too so strongly that they fell on their backs and the men fell over them. My patient was the leader i.e. the first of her team. So the leading man fell over her. She came and asked me if anything would happen to her. She was quite worried, I can tell you. So I asked her if she was injured or was hurting anywhere. She said no. So I asked her what could happen to her that was so worrying. She said all her friends were telling her she would now get pregnant. I asked her if anything else had happened between them. She said no, but that all her friends were quite convinced she would get pregnant.” “My goodness! At 35, in Mumbai, she does not know how women get pregnant?” I was aghast. She must be watching the wrong type of television soaps and movies. “Why did the government oppose sex education in schools?” “Beats me” my wife said. “The other day I had another patient who came for treatment of infertility. They were married for two years. When I asked details, I discovered all they had been doing for two years was holding each other and kissing. They did not know what else could be done so that they would be blessed with a child.” I hope the health minister reads this and gets the education minister to include sex education in school curricula.

Misoprostol Tragedy

Science makes progress all the time. There are places where the progress does not touch. There are other places where it touches with some distortion. And there are still others where dictators shoot it down with a circular. Misoprostol is a wonderful invention. It is great for facilitating ripening of the cervix for abortions and deliveries. It also manages atonic postpartum hemorrhage. After it was established in the developed countries for a long time, and we longed to have it for managing our patients for also a long time, the drug controller finally consented to have it in the market. The part of the world that had remained untouched by this invention finally got a nod to be touched. Science has its discipline, and for optimum results, the rules must be followed. Unfortunately a number of bosses refused to use it or let their juniors use it all over the city. Just like the forbidden fruit, a forbidden drug is also tempting. So without sound knowledge about the rules about the use of the drug, a large number of junior doctors started using it the way the med reps told them to use it. When they could not get the 25 mcg tablets for cervical ripening, they broke a 200 mcg tablet to get 25 mcg (a feat!) and inserted it in the birth passages of women to be delivered. Instead of every 4 hours, they inserted it every 1 or 2 hours when they were in a hurry for whatever reason. Some uteri ruptured, some women became seriously ill, and allegedly some of them died. The drug developed a bad reputation. In the meantime the government got worried about a high maternal mortality rate, which had been high even before misoprostol appeared on the scene. It asked the administrators to reduce it. The administrators asked the health department to find out the causes of maternal mortality and control them. The health department suddenly realized that they had to do this work. So it admonished all public sector hospitals for not sending copies of indoor papers of all mothers who had died in the last one year. How they analyzed the papers in a month is beyond imagination. But they took out a circular for all health posts, asking them to give calcium, iron, tetanus toxoid etc to all pregnant women, to have regular check-ups, and STOP USE OF MISOPROSTOL. They sent a copy of that circular to us too. We were stumped that health department consisting of clerical people and doctors who had minimal contact with treating patients and almost no contact with progress in science told teachers and practitioners in a tertiary lever healthcare institute to stop use of misoprostol. We stopped it, because we get salary to do our job, and the administrators decide how we should do our specialized jobs. When I met the key person who had taken out the circular, I asked the reason for stopping the use of misoprostol. The answer was because it killed women. I asked if the statement was evidence-based. She had not heard of evidence-based medicine. She said the evidence was found in the photocopies of indoor papers of women who had died in childbirth. Many had been treated with misoprostol. So much for evidence-based obstetric practice in the financial capitol of the country! the evidence in support of this statement. I asked meaning of telling the postgraduate teachers what they should not be doing. The answer was that it was not meant for us, but only for junior doctors working in periphery. I asked why they could not be trained on the proper use of the drug instead of stopping the use of the drug. There was no answer. My understanding of the situation is that the government wanted action, so some action was taken and a report to that effect was sent to the government. It was symptomatic treatment of the problem (that too highly inappropriate one) rather than radical cure. Well, we get what we deserve.

Hey Doc, No Hands: Part 3

This patient who did not want an internal examination was not in labor and did not have any clinical complaints too. But she was full term. This was her first pregnancy. I was a professor and head of department then. “Sir, this patient is refusing to get examined. We have to check her pelvic adequacy” my registrar informed me. “OK, I will see her” I told them. I prided myself in being able to perform a gentle examination so that the patients would experience little or no discomfort. I had successfully examined many patients that my residents had found uncooperative. Unfortunately this patient would not allow me to examine her. “Mrs. XXX, I need to see if your birth passage is adequate for delivery of the baby. If it is, you can deliver. If it is not, we have to perform a cesarean section on you. If you do not allow us to examine you, we will not be able to make a decision on the mode of your delivery.” “I don’t want an examination” she said adamantly. When a lot of counseling failed to change her mind, I told my residents to talk to the relatives of the patient when they arrived, and if they too could not talk sense into her, to inform the administrative medical officer and send the patient away. I went home at 4 o’clock. What transpired later was amazing. The relatives came in the visiting hours. They understood the situation, and brought more relatives. They also did not want an internal examination. They accused our doctors of troubling them on religious grounds. It looked like the beginning of a communal riot. One of my registrars was of the same religion as this patient. When she informed them of this fact, they changed their approach. They made our residents call a more senior doctor. So they called my associate professor. He saw that a riot was about to begin. So he touched her abdomen, and gravely declared that a cesarean section was required. The relatives agreed instantly because their honor was saved. The cesarean was uneventful and so was her recovery. We never understood how the woman had got pregnant in the first place if she refused all genital contact by anyone. It must have been a miracle of whichever God she believed in.

Hey Doc, No Hands: Part 2

You don’t get patients who refuse examination very often. There are those who do fall in this category, but most of them see reason when counseled and get examined. The second patient of the adamant variety I saw was a staff nurse. I was a Registrar (senior resident) then. She came to me in the outpatient clinic and told me that she was two months pregnant, had vaginal bleeding, and the lecturer had asked me to admit her. SO I admitted her in the antenatal ward. After the outpatient clinic, I went to see the newly admitted patients. She was there. I took her history, and then asked to go to the examination room for getting examined. “No, I don’t want an examination” she said. “But it is not possible for me to make a diagnosis about your condition without an examination” I said. “You may have a threatened abortion, inevitable abortion, and I hope not, but even a missed abortion or an ectopic pregnancy. The treatment for each of these conditions is different.” She should have known all this, because she was a staff nurse. In those days ultrasonography was not easily available. Nowadays, it is easily available, and often patients present with an ultrasonographic diagnosis, making a clinical examination superfluous. “I have had an abortion before, and if you examine me internally, I will have an abortion again” she said. “That is not correct” I said “a clinical examination does not cause an abortion.” “Whatever you say, I will not be examined” she said. She was an employee of our hospital, and the Matron was her boss. This situation was better than that of an outside patient. So I called the matron and explained the situation to her. She promptly arrived along with a couple of senior nurses. Together they counseled this patient. Finally they told her that she had to undergo an examination and informed me she was ready for an examination. “But if I develop and abortion, I will hold him responsible” the staff nurse said. I was experienced in the psychology of such patients who wanted to put the blame on the doctor for whatever went wrong with them. So I told them that I would do only a speculum examination first, so that only the vagina would be touched. If she was found to be aborting, I would not make a palpatory examination and would be free of any blame from the patient. I also asked the matron and the two nurses to remain present as a chaperon cum my witness. They agreed. I put in a speculum gently and found that her cervix was wide open and the products of conception were bulging out. She was aborting. I showed that to the chaperons cum witnesses, declared the same to the staff nurse and without touching her in any way took out the speculum. She got off the table. Before she could walk away to her bed, the products fell out. I heard she did claim to other nurses later that she had aborted because of me, but I had the matron and two senior nurses as my witnesses. I was glad I had examined her, because I felt she was quite capable of saying she aborted because I had not examined her properly and given appropriate treatment.

Just Do It!

I am aware this is almost a trademark of a famous sports company, But long before the company adopted it as its slogan, some of our doctors had adopted it. I recall the time laparoscopy had just come to our institute. I was a first year resident doctor. I was not allowed to have my own thoughts, and definitely not allowed to express them in case I happened to have any. I was not allowed to touch the laparoscope too. Those in command, usually honorary professors, used the laparoscope to the best of their abilities, without really worrying too much about the patients. Some of them were somewhat adventurous, and would apply their wild ideas to laparoscopy without compunction. The patients would not have known the difference even if they had not been anesthetized, because they came to the famous hospital with blind faith and were often ignorant too. On that fateful day one patient undergoing laparoscopy at the hands of an honorary professor developed a huge distortions of the stomach by gases during ventilation by the anesthetist. It was standard practice to pass a nasogastric tube and decompress a distended stomach, so that it would not be Injured during laparoscopy, But our honorary professor had a novel idea. "Let us put the trocar and cannada into the stomach to remove the gas" he said. The trocar and cannada were used to put the laparoscope into the abdomen, not for sucha purpose. But his position being that of a king or god in the hospital, no one objected, He did it, and the gas did come out through it. He was happy because he had done something new and it had worked. Unfortunately the stomach injury caused perforative peritonitis, and the patient required an exploratory laparotomy for getting it repaired. He was lucky.No one sued him. Still he was unhappy because he could not publish it in a scientific journal as an innovative use of trocar and cannada. He retired in due course, but the trend of putting nonanalytical thoughts into practice has not retired. Sometime someone does get a desire to be the first to do something new, and if the time is unfortunate, something terrible does happen. I must say the trend is on the decline, because times have changed and most of us care for the patients more, and know about the consumer protection act too.

Hey Doc, No Hands

She was from a village in North. She had no education. But she was a woman, she had her own cultural beliefs, she was pregnant, and she was in tabor. She had been seen in the Receiving Room and was admitted in the labor ward, Once she was in, her cultural and any other beliefs took over. When I went to see her to assess her progress in tabor, she flatly refused an internal examination. That was 29 years ago, I did not know what to do. I was the houseman, supposed to manage everything. I had read about court ordered examination and even cesarean sections. But I also knew about the backlog of cases in our courts, and it would probably take 20 to 30 years for getting a court order, i.e. about now. I did not have that kind of time, I did not have even 30 hours. "See, if you won't' get examined, we won't know if you are going to deliver safely?' I said. “I don't want an examination” she said flatly. “But if I don't know what is happening inside you, how do I treat you?" “I don't know that. I will not be examined." I spent quite some time counseling her, but to no avail. The nurse tried her best, but the patient remained adamant. She would not give any reason for her refusal for examination too. Just a flat 'no!’ "If you don't want examination, go to some hospital where you can get treatment without an examination” I said. I would not have sent her away, but was using the threat as a strategic move. "I am not going anywhere” she said. So much for my strategic move! I thought about what to do next and finally decided to protect my self and my hospital at least. "If you won't get examined, write that down on your case paper, and sign it" I said. she kept quiet. She was illiterate, but seemed to have a strong mind. Either she had a well worked out strategy, or it was just one of my bad days. Finally I did what I had to do. I left her alone and went to treat other women who needed me. After all, women were unattended in labor before midwives and obstetricians were created by God. God did deliver her safely, the nurse and I being His instruments in the final process. The baby was 0K. If has taken after its mother in attitude, it should be a successful negotiator.

Washbasins

“We cannot give you washbasins wherever you want” said the architect. It sounded OK, because doctors in our institute have asked for washbasins right in the middle of the rooms at times, without any thought to the water and lines. “But in a ward that theoretically takes 44 patients, and usually has 100 or more patients, if you do not provide enough washbasins, how are the doctors going to wash hands between patients? We are not asking for a luxury item. We are asking for the basic essential in healthcare administration” I said. A meeting of our heritage building renovation was in progress. “If you don’t give enough washbasins, doctors will not be able to wash hands, and infections will spread from patient to patient” our infection committee specialist said. “If we give washbasins where there are no existing drainage lines, there will be leakages. Your building has massive leakages already” the architect said. We let it go at that. But when I went to see the progress of work, I found he had not given washbasins in our offices where there had been drainage lines and washbasins before. “How come you have removed existing washbasins?” I asked. “Well, it is not good to have wash basins” said the architect’s assistant. “But the lines exist. The floor above and the floor below have washbasins in these locations. Washbasins here are not going to cause any water leaks” I protested. “But even in big corporate offices we go a long way to wash hands” said the assistant. “Corporate offices have a comfortable life, with air conditioners and desk jobs. They have all the time and energy in the world to go long distances to wash hands. Doctors are overworked, time starved, and cannot go long distances to wash hands” I said. “I will still speak to the architect” said the assistant. But it has been two months since, and there is no word on washbasins. I think the market price of washbasins must have shot up and the contractors cannot make a profit unless they delete this item.

Squirrel in Love

We were quite sad when the huge tree just outside my office fell in a storm. It was there the previous evening when we left, and it was on the ground the next morning. The green foliage used to be very soothing to the eyes, and the shade it afforded made use of blinds on the windows quite unnecessary. It took me a couple of days to get the sadness out of my system. But that was not the end of it. I opened the third window of my office which I normally kept closed for keeping dust away from my computer. I almost jumped out of my skin because there lay something that I could not have imagined ever could exist. There was a squirrel on the window ledge, packed on all sides with cotton. It did not run away because it was dead. After looking at it for some time, I realized it had been killed by the impact of a branch of the tree when it fell three days ago. The lethal branch was next to it. The cotton all around it was remarkably like that used in our adjacent ward. I thought some more about how it had landed up all around the squirrel, and then the truth him me. The squirrel’s mate had seen it was dead, and somehow refusing to accept it, it had stolen cotton from the adjacent ward and put it all around its mate, probably hoping to make it comfortable and hopefully cure it. The poor thing had not known that hospital cotton could not revive dead squirrels. Even our medicines could not have revived it, even if the mate had managed to get some. I had not realized till then how much animals love their mates, and nursing sick ones is not the monopoly of only the human beings, but animals are also good at it.

Dan Brown, Buddhism and Hinduism

Dan Brown is a great writer. I have read his books with interest and admiration. His research is good and story-telling abilities superb. It so happened that I read his “Angels and Demons” in 2010 when it was published in 2000. I wonder if anyone wrote on it before. The following quote is from his book “Angels and Demons” Hatha yoga? Langdon mused. The ancient Buddhist art of meditative stretching seemed an odd proficiency for the physicist daughter of a Catholic priest. My objection to this statement in his book is purely academic and has nothing to do with my being a Hindu. Hatha Yoga has its origin in Hindu Vedas and not in Buddhist practices. I wish Dan Brown had made an internet search for this before writing it. There are hundreds of references to be found with one mouse click. Though it does not decrease the entertainment value of the book, it is a minus point for its information value. No hard feelings Mr. Dan Brown, in case you happen to read this. I only wish you well.

Myomectomy With Rubber Tourniquet

Every uterus with fibroids is a latent challenge. You don't know exactly what you will find when you open the abdomen to perform a myomectomy. You could always do an MRI scan preoperatively to know the size and locations of the fibroids, but that is unnecessary use of costly technology, and there is no guarantee you can plan your operation accurately based on the results. It is best to be ready for whatever you may find inside, and modify your technique accordingly. That day we had this woman aged 40, single, with multiple fibroids. The uterus was 26 weeks’ size. Myomectomy would be possible, but difficult, we thought. We opened her abdomen. Was she lucky! She had a more than 20 cm diameter fibroid attached to the top of the uterus with a 2-3 diameter pedicle. She had 3 other fibroids measuring 2 cm in diameter in the front wall of the uterus and one in the left broad ligament. Curiously, she had four spots of endometriosis in the uterovesical fold on the left side but not anywhere else. I tried to deliver the large fibroid out of the abdomen, but it was too large. I did not divide the pedicle, because it would make it free to go anywhere in the abdomen, making its removal move even more difficult. There was no point in enlarging the abdominal incision. I thought for a minute and then I put an India rubber catheter around its pedicle and tied two knots. Then I put a clamp on the catheter beyond the knot so that it would not become loose. My residents were wondering what it was all about, I could see. They had not seen anything like that before. I did not blame them, because no one had done such a simple thing before. Then I proceeded to cut up the fibroid into a number of pieces until the mass became small enough to be delivered out. Thanks to the catheter tourniquet, it did not bleed a drop. Then it was back to conventional surgery to cut the pedicle and repair the defect in two layers. Then I removed the other four fibroids and cauterized the spots of endometriosis. Rubin had described placing a rubber catheter tourniquet around the uterine vessels instead of using a Bonney's myomectomy clamp to prevent bleeding during myomectomy. No one had put a tourniquet around the pedicle of a large single fibroid because such an occasion might not have come. Or perhaps such occasions might have come, but people must have either enlarged the incisions far beyond conventional length, or morcellated the fibroids accompanied by unnecessary blood loss. I must say what I did was a happy outcome for the patient and a satisfying experience for me as a surgeon.

My Hospital & My Knee

I was enjoying my leave. I had been in our armchair, reclining ¾ and reading a Dan Brown novel all afternoon today. Armchairs are different from regular chairs. The difference is not only in the comfort when sitting on it, but also while getting up. When you are on the other side of fifty and with an old knee injury, it sometimes hurts in the knee while getting up from the low position. It hurt today, and I thought of the knee injury. It was my operation-theater day. I had a long list, and it was progressing well. Between two cases, they called me to the air-handling unit for discussing some engineering matter. I was second in command of my department then, and the head was on some leave. So I went to that room. The engineers were standing in front of the running machine, and I stood on the side where there was no one. It never occurred to me that there should have been some reason why the spot was deserted. It did not occur to all those engineers to warn me. I soon found out why. A little breeze blew my OT pajama into the fan belt of the God knows how many horse power pump. The fan belt should have had a cover, but they seemed not to follow standard safety precautions. I did not know any pain at that moment, just a tremendous pull dragging me on the fan belt. They just watched me being pulled in, while I screamed someone cut off my pajama so that I would be free. Someone realized what had happened and switched off the pump. I fell to the ground. They lifted me and took me outside. I lay on the ground, my back against the wall, holding a knee that was just full of pain. I remember horrified faces of my associates. I remember the ceiling and walls moving backwards as they wheeled me to the radiology room. I remember the professor of orthopedics checking my knee and pronouncing two ligaments torn. I remember the happiness on the face of two particular staff members while I waited to go home. I refused to allow any colleague to accompany me home (foolish of me perhaps) and drove the car myself. Surprisingly the strapped knee did not hurt much while driving. But I took longer than my driving time just to climb up three floors to home. I remember my wife crying when she saw my knee, and shredded shorts suggesting the degree force I had survived. It took me two months to get OK. I remember the auditors asking for the letter stating I was to hold the charge of the department when the head was away, so that my claim of having gone to the accident site in place of the head of the department would be substantiated and they may sanction my special leave for injury on duty. I was so angry I told them every time the head of department remained absent, I had to work as the head, and if they did not sanction my leave, I would not do that work any time in future. They relented after that threat. I wanted to sue the administrators for negligence and causing grievous hurt and ask for apology and compensation. But I loved my institute and couldn’t bring myself to do so. I must not have let go completely, because occasionally the knee hurts when getting up from a low sitting position, and I relive all those events and emotions.