Respect

“Sir, we would like you to give us certificates that we are working as residents in this department” four of the resident doctors in the department came to me with this request. “But such certificates are issued by the Dean” I said. “Sir, we are planning to go to the national conference, where they want a certificate from the head of department” they said. I knew about it. The federation of gynecologists held conferences, charging fancy delegate fees. They offered a discount to resident doctors, provided they got a certificate from their heads of departments. “Sir, we have got the certificates printed” they showed me the printouts. “You just have to sign on them.” I took one of the four printouts, and read through. There was standard stuff there, telling whoever it may concern that so and so was a resident doctor working in my department, and that the certificate was issued for the purpose of the said conference. But there was one objectionable point. ‘“Respected Sir/Madam’ it said at the beginning, just after the line ‘To Whomsoever It May Concern’. I always respect people, but I want to know whom I am offering the respect. “If the concerned party is unknown, as you make clear in the beginning, I cannot say I respect that person. I would dislike calling someone respected if that person is not respectable.” Besides that, there is ‘Sir/Madam’ which is signifying respect. So why do you want to put the word ‘respected’, when you want me to sign the document? They did not have an answer to that question. “If the concerned person is not respectable, he/she will not accept a letter addressed to a ‘respected’ person. You stand to lose an opportunity if they do not accept this letter as one not addressed to them” I said. They looked at my face trying to make out if I was serious. “We could print all these certificates again, after removing the word ‘respected’. But should we be wasting paper which is not a ‘green’ thing to do. Let us put whitener on that word.” One resident doctor went to an adjacent office and procured a bottle of whitener, a substance used by clerks to remove unwanted words from a printout. They covered that word with white paint in all four certificates. I signed the certificates and said, “putting whitener on that word has a greater impact than not having printed that word at all.” They got that one and grinned.

Rescue of the Chair

Certain universities have chairs of medical specialties. Those are the positions of heads of the concerned specialties. In that vein we can say we have a chair of Obstetrics and Gynecology in our institute, if the post of professor and head can be considered as the chair of obstetrics gynecology. That chair was not under any threat and did not need to be rescued. This story is of the chair the head of obstetrics and gynecology used to sit on before the repair and renovation work started. It was a nice chair, with cushioned red seat and back, comfortable arm rests, wheels mo make it mobile, and rotation mechanism so that it could revolve. The hospital would never provide a comfortable chair, it being considered the privilege of the boss alone. So we had found a donation and purchased six such chairs, which were actually laboratory chairs. Since I headed the laboratory too as an administrator, I got one of them. Life was good sitting in that chair when I could find the time to sit down, which was not very often. Good things don’t last, they say. This comfort did not last. They ordered us into transit area when they decided to repair the building. When we moved, I moved this chair to the transit area we were to use as staff room. I got a number of other chairs there for the other staff members to sit on. During the first couple of weeks they respected my chair and kept it vacant for me. But who does not like comfort? Perhaps Hindu Sadhus and Yogis don’t. But many of my staff members did. They sat on that chair in my absence, and later on even in my presence. I did not have the heart to make them get up. After all, I had not brought it from my home. But one day disaster struck. One of the heavyweights in my department sat on it and the base of the chair broke into two. After all, it was not designed for such people. Some of the chairs in the laboratory had been broken similarly by laboratory heavyweights. It almost broke my heart. I had the base replaced, and spoke to all the heavyweights requesting them to use wooden chairs so that they would not fall down by breakage of the chairs. However the story did not end there. There is a fellow in my department who in his opinion should have been the Dean, and if not, at least the head of the department. It is evident in the tantrums he throws (though the Dean and head of department don’t throw tantrums themselves), his frequent sentences like ‘I will not permit this’ when he has no authority to permit anything at department level, summoning juniors for explanations, authoritative criticism of others, which he has probably seen some department heads and Deans do in the past. He started sitting on the chair and continued to occupy it very regularly, as if he had brought it from his home. In the meantime, I was sitting on wooden a chair in my table space in the bill section. When the building repair work went on for one year (instead of projected period of six months) and had no signs of nearing completion, and this fellow started being rude to me (without any reason, though I cannot see how he could do that even with a reason), I thought sitting on that chair was giving him ideas. So I got it shifted to the bill section, where the bill clerk is content to sit on his wooden chair with a cushion, and hopefully will not sit on my chair. I am back to my sitting pleasure while I work.

Noun, Adjective or Adverb?

"Sir, she came to emergency room fully" my Registrar said during the morning round. 'Fully' is a Marathi word which means X in English. But this Registrar was speaking English, and though resident of Maharashtra at present, came from east India and would not use a Marathi word while speaking English. 'Fully' was an old word used by the recent few batches of resident doctors in place of 'fully dilated' to describe the condition of the cervix during labor. They wanted to stress the point that the woman had entered the second stage of labor and delivery was expected soon. I wondered what drove them to omit 'dilated' and just say 'Fully'. Laziness? That was a possibility. A stronger possibility was the habit of using SMS Script. If you could write U instead of 'You' and get away with it, why not? I recalled one of our residents in her first post writing a patient's marital history as 'the patient and her husband staying 2gether' on the patient's case paper. 2gether meant together. Even if she had written 'staying together', it was not very good English. She would have done better writing 'cohabiting'. I had heard that 'fully' business too long. They could not continue like that. They would say the same thing in their final exam, and also when they went abroad, and bring shame on their teachers. "Is that 'fully' a noun, an adjective, or an adverb?" I asked. "Adjective" she answered after thinking for awhile. "Adjective of what?" I prodded. "Adjective of 'dilated' " she answered after thinking some more. "What is adjective of an adjective called?" I asked. I would have made a terrible teacher of grammar, I thought. "Or is 'dilated a noun?" She was used to my method of questioning. "It is an adverb" she said and grinned. She has not said 'fully' in front of me since then.

Queue To Beat Terror

I reached the hospital early, partly by accident, and partly because of the entry level hurdles placed for preventing terror attacks on the hospital. It was good I was early. I found a new hurdle. They had put barricades in a row, so that the ingoing human traffic had to move in single file, under scrutiny of the security guards strolling around or standing nonchalantly. I joined the queue which was moving rather slowly. There were about thirty people ahead of me. I did a rapid mental calculation to see if I would be able to make it to the signing in machine before time, and then go see my patients. Then an elderly guard came along, who had brought patients to me in the past for treatment. He recognized me and took me along to the head of the queue and let me in. He said the queue was not for people like me. I think they got the idea of making a queue by going for Ganesha Darshan in the recent Ganesha festival in the city. I have realized that I have to reach the hospital a half hour early every day if I have to sign in in time and then treat my patients in time. I wonder why they cannot start separate queues for staff members and hospital employees, patients and their relatives, and terrorists.

Cutting Technology

Cutting was a term I first heard of when I became a resident doctor. All operative work was called cutting. I suppose it had to do with the use of scissors and knife in the operative work. Odd that the use of sutures and ligatures was not included in the nomenclature. Vocabulary of youngsters changes over time. What was cool once is awesome now. But this term – cutting – has persisted in its full glory. The term has not only persisted, but it has become the principal driving force in the lives of resident doctors in specialties with operative work. It is not enough to know what, it is more important to have a hands-on training of how to (operate). With residents not interested in the subject primarily, the what part of it is no more. It is only how to. When one gets into residency not for the love of the subject but because one can get it based on one’s score in the entrance test, the concepts are not clear. Only the desire to operate and master the technique remains. Then the operative steps go wrong, and one does not even realize that they have gone wrong. That resident was performing a vaginal hysterectomy. The uterosacral-cardinal ligaments and the uterine vessels had been clamped, cut and ligated. The cornual structures could not be accessed because the uterine corpus was enlarged. So the uterus was bisected. Now the cornual structures were accessible and she started to put a clamp on them. But the anatomical concepts were not clear, and only the habit of putting a clamp holding the hand so was the guiding force. So she placed the clamp held in that particular direction as usual, but across the bisected half of the uterus instead of lateral to it over the cornual structures. I wanted the thing documented, but none of the residents would oblige by taking a snap as I requested. Finally I had to threaten them that I would stop their further ‘cutting’, when they obliged. I can post that picture if I get requests for the same. I stopped the resident in her endeavours and got the clamp placed the right way in the patient’s interest. She further proved her lack of anatomical knowledge when she caught the bladder fascial plate between the anterior vagina and the divided uterovesical fold of peritoneum,and told me it was the uterovesical peritoneal fold itself. When I said it was not, she said it was paraurethral tissue. Though she is that bad, I am sure she will go through life operating on her patients, without she or the patients knowing that something is amiss. That reminded of another resident who was my Houseman when I was a Registrar. I was assisting him perform a vaginal hysterectomy. We had two operations going on on two adjacent tables, and I was supervising the other one too, because my bosses were too busy with their private practice to go to our OT in the general hospital. The fellow had clamped the cornual structures, when the resident on the other table asked me for some advice. I turned around and sorted out the problem in a minute or so. When I turned back to see what the fellow was doing, he had cut the cornual structures and showed me the result quite proudly. Unfortunately, he had cut them lateral to the clamp, leaving it attached to the uterus. I was aghast. Luckily the divided structures were not bleeding, nor had they receded beyond reach. I caught them with two Allis’ forceps and got them ligated. He was totally lost. He could just not understand what he had done wrong. He had entered residency without any love for the subject. He did not know that the clamp was to prevent bleeding when the pedicles were cut, and had to be on the vessels until they were ligated. He had become a technician to whom it did not matter much on which side of the clamp he cut. I hear that fellow is a consultant gynecologist in the USA now.

Terror Threat to My Hospital

Three days ago someone sent a threat email to our hospital, threatening to blow it up. We read about it in the newspaper. It was supposedly because some woman in a veil (Burqua) was allegedly insulted in the hospital. The first security measure they took was to close two gates. When we reached the gate with our luggage and were in a hurry to meet the entry deadline and start working, we were discouraged by closed gate and no explanation. We managed to find an open gate and went in. They must have thought that closing two gates was adequate for security. So all entry points into the hospital building had near zero security. The metal detectors were nowhere to be seen. A couple of days went by. Today we reached the usual entrance to the building with our luggage and were in a hurry to meet the entry deadline and start working, we were discouraged by closed entrance. There was no notice stating the act, nor the reason for the same. I talked to the time keeper in the adjacent office through his open window and requested him to find out what the matter was. He rang up the security office and discovered that the gate would be open only between 7:00 and 8:00 A.M. So we were expected to reach it before 8:00 A.M. to get in even if our duty started at 9:00 A.M., or go around and through the crowded emergency area to reach our workplace. I had to choose the latter, because I could not go back in time. I found eight to ten (could not spend time counting) around the main gate, doing nothing because there was n work for so many of them. I asked them why such a thing was done without any information to anyone. The senior guard said the Boss had said the circular was sent three days ago. I told him the circulars reached destinations always a couple of months later. He smiled. He seemed to know that already. I found my way through the crowded emergency area. No one checked my bag, nor anyone else’s bag for bombs or whatever the terrorists use. The security guards must not have seen the great movie “A Wednesday” where Nasiruddin Shah had shown very well how it is done. If they knew about it, they hid their knowledge well, waiting for the BOSS to tell them. The biometric attendance system did not work in the emergency area as it never did. We had to go back to the banks of the attendance machines, log in, and then go to work. “Why do they not tell us what they plan to do?” someone asked no one in particular.. “They don’t want to put out circulars because the terrorists will read those and know the security measures adopted” someone answered. “They want us to discover the measures ourselves. If they tell us about those, the fun of discovery will be lost” said someone else. “They must not have the time to tell us, with so much to do to maintain security” someone offered. “They probably do not think it is necessary to tell us” another person said. “People who deserve to be told must have already been told. We should just keep working and take whatever is dished out to us, because we get salary for that.” This person sounded rather unhappy with the treatment received in the hospital. “What difference would it make if we were told?” someone asked. “Are they going to take our suggestions and improve the security measures?” “I have a good suggestion” a bright person said. “Every ward should have at least 20% of the patients of the community that has been insulted. Then they will not blow up the hospital.”

Bramhakamal - Cactus

My wife loves plants. She has a terrace garden. She got a plant called "Bramhakamal", which in my opinion is a cactus with flat leaves. You have to put one leaf in the ground, and it grows from it. The plant does not look exciting at all. But then it grew a flower one night, and I changed my mind. It was awesome. Have a look.

Ovarian Tumor Dilemma

We had two patients with ovarian tumors last month. What was unusual was that both were adolescent girls. One had a solid ovarian tumor. The other had a partly cystic and partly solid tumor. Both presented with pain in abdomen, and on examination were suspected to have torsion of the tumors. Tumor markers like alpha fetoprotein, human chorionic gonadotropin, carcinoembryonic antigen, and CA125 were in the normal range. We performed laparotomy in each case, and found a torsion of the tumor. The tumor was excised. There was no metastatic disease. Histoapathological examination revealed hemorrhagic necrotic mass, with no tissue type identifiable. We were left with a dilemma. We had strong suspicion of a germ cell tumor based on the age and the nature of the tumor in both the cases. But there was no supportive evidence, since the disease was nonmetastatic and the primary tumor was destroyed by necrosis due to torsion. The patients might develop a recurrence of the tumor at a later date, and they will need a close follow up examination to detect and treat the recurrence. It is possible that the disease was benign. Since it is not possible to state so with any degree of accuracy, both of the patients are left with the worry of a possible malignant disease that may haunt them at a later date.

Chronic Pelvic Pain

Chronic Pelvic Pain is a not uncommon complaint of patients attending our outpatient clinic. When there are no pelvic masses, but definite pelvic tenderness, we consider them to have pelvic infection and treat them with a course of a combination of Doxycycline and metronidazole. If they get well with that, we counsel them about prevention of such infections and advise them to follow up in case there is a recurrence of the symptoms. If the symptoms persist, we offer them a course of another antibiotic or a laparoscopy to find out the cause of the pain and treat it appropriately. If they opt for another antibiotic, we give them amoxycillin and clavalunate combination. If that fails to cure them, we perform a laparoscopy. In about 60% cases it turns out to be pelvic infection. If there is any fluid in the pelvis, we aspirate it and perform microbiologic studies on it. If there is no fluid, we wash the pelvic peritoneum with normal saline, aspirate it and perform microbiologic studies on it. Based on the report, we give them appropriate antibiotic therapy. In 35% cases it turns out to be pelvic endometriosis in the form of scattered lesions. We cauterize the lesions with bipolar electrocautery. That cures their symptoms. If they are infertile, we treat any other factors responsible for the infertility too. About 70% of them conceive with this treatment. We do not find any cause of chronic pelvic pain in 5% patients. We get psychiatric consultation for suspected somatoform pain in these patients, and they do well with that.

The Marathi Issue: 2

It is indeed commendable that in this Marathi state, the doctors in hospitals are required to know Marathi so that they can understand their patients and their patients can understand them well. That would ensure proper communication between them so that the treatment would be satisfactory. It must be with this in mind that the politicians and administrators have insisted on employing only those who have passed SSC with higher Marathi. But what beats me is that we take resident doctors from all over the country without any such prerequisite. They do not have any knowledge of Marathi. Resident doctors are the first line of doctors treating the patients. In the emergency hours they are the only doctors who primarily treat patients. There are Assistant Professors too, but they are not present to act as interpreters for the residents. They function only to manage high risk cases and to operate or supervise operations performed by the resident doctors. The resident doctors are selected for the job based on their common entrance test score, and that exam has no questions on Marathi. Have the politicians and the DMER not realized this issue?

Orderlies?

Resident doctors are registered with us for their postgraduate studies. They have a teacher each. That teacher decides what operative work they get. That teacher signs their leave applications, their exam forms, their post completion certificates, their dissertations. That teacher is in total control of their educational process. This God-like control gives some teachers ideas. Here are some of the sentences uttered by some teachers addressed to their residents. “Just take my bag and put it in the staff room.” “take this key and bring my laptop from my locker.” “Prepare slides for me. I have to give a talk in the annual conference.” “Type out these pages for me.” “This doctor is arriving by the evening flight. Go receive him at the airport and take him to this hotel.” “Call the servant.” “Hold my mobiles. If anyone calls, tell them to call later.” “Write a chapter on this topic in 2000 words. I will make you my co-author in a book that I have been invited to write this chapter in.” “Go to the cancer institute and get reports of my relative.” “Get tea for me from the canteen.” The residents usually do all this and do not complain because they have to get that degree and they cannot afford to displease the teacher. Sometimes they revolt when it becomes too much, and they have solid backing. It happened in two other institutes in the city. Senior teachers were subjected to official inquiries. After a lot of mental anguish, things were settled. That order for getting tea was allegedly given to an intern many times, and finally he threatened to commit suicide. It was in all the newspapers. It was settled after counseling, I hear. I had warned all staff members not to give any resident any private work. I did not want something like those inquiries to happen in my institute. Those highly qualified doctors were not to be treated like orderlies. I make it a point to carry my own stuff even if I am tired and someone offers to carry it for me. I write my own scientific articles and books. I make my own slides and do my own personal work myself. But setting a good example does not seem to work. They probably think I am a fool not to get work done by others without having to pay for it. I still see some things like that happen or hear about them. I hear that the two teachers who had been subjected to those inquiries are also back to their old habits, wherever they are. In my department, unless the doctors complain, I cannot initiate action on their behalf.

Times and Titles

Times change and titles change with times. In our institute, who used to be assistant Dean became Deputy Dean; who used to be senior AMO became Assistant Dean; who used to be junior AMO became senior AMO, probably who used to be a nobody became junior AMO. The job descriptions did not change, but there was a feel-good effect, which was probably supposed to improve efficiency and work output. In the medical council business, who used to be Inspector became Assessor. The job description did not change. Many of these individuals continued to feel like and behave like creatures of a far superior race, throwing their weight around, forgetting what they were in real life when they were not Assessors. Perhaps it was their turn to treat others badly to get even with the world for the abuses they had received in their lives. That reminds of one memorable inspection in our institute in the past. There was this assessor fellow who was said to be a terror. The team arrived late. Then they ordered all staff members and residents to assemble in the main auditorium for a roll call, as if the hospital was without any patients to treat at 11 A.M. When this guy was told that all persons could not reach for the roll call, because they were in theaters operating, he said rudely time would tell if they were in theaters or homes. “Resident doctors in homes at 11 A.M.? Sir, it is a joke, but he did not look like a joker.” Said one staff member. After the roll call he visited places, with senior staff members in tow. “When he found wards containing eighty patients where allotted beds were forrty, but there were eight beds kept vacant for new admissions, he counted vacant beds as eight out of forty, discounting all other occupied beds because they were not numbered. He is simply out of this world” said another staff member. No comment was warranted. So I kept quiet. “Sir, when he saw our OT, he said it looked like a godown and wondered if any cases were actually done there. If cases were not done in our hospital, were they being done in his hospital and flown back to us for postoperative care?” This staff member sounded quite angry, and I sympathized with her. I would have felt the same way myself. “ He was the limit. He asked the overworked resident in the emergency services to connect an Ambu bag to oxygen source and ventilate a baby who was being given nebulization for respiratory distress. Did he think it was a mannequin or what” another one reported. That sounded high handed to me too. It was not an inspection of the troops on parade ground. It was a battleground where doctors were battling to save lives. “When he saw that oxygen tube would not connect to Ambu bag in the labor ward neonatal area, he said babies were not resuscitated in that labor ward and were probably taken elsewhere for resuscitation. Sir, even a medical student would know babies could not be taken elsewhere for resuscitation, or they would die or develop severe asphyxial complications. To think he was said to be a specialist who was said to be treating babies where he came from!” This colleague of mine was right. Even our servants would have known that. “Sir, he insulted our eclampsia room, which we had to put up because the council insisted we must have one or they would derecognize us. He remarked it was so horrible patients would actually get eclampsia there if they did not have it. Isn’t it ridiculous? If a patient did not have eclampsia, why would she be in that room? And did he not know at the council that eclamptics were not recommended to be kept in separate rooms? Could he not keep with science?” This staff member had good reason to be upset. He had wrongly criticized our set up. “Perhaps they keep sticking to rules copied from old books by Babus in council service or on contract” suggested an associate professor. “Then he did something funny. He barged into the Ethics Committee office and told them a couple of wise things about Ethics. I did not mind that one very much. There must have been God’s hand behind this act of his, telling the Ethics wise guys a thing or two, when their entire life seems to be dedicated to telling everyone else off.” This staff member must have been burnt by the Ethics Committee of the institute. This was one good thing I had heard about him. “Sir, something is seriously wrong with his attitude. I pity his mental state and feel distinctly sorry for his subordinates, wife assuming he has one and she had not left him, and children, if any.” This associate professor of ours was known for her emotional thinking and her comments were commensurate with her personality. “Sir, he was not a neutral assessor. He had come with an agenda.” I did not know how to agree or disagree with that statement. I could not condemn him. Perhaps he did not know what was wrong with him.

Biochemical Wonder

We have an automated biochemistry laboratory. I am no expert on it, but I know that you have to put the blood sample in it, load the reagents, and press a button. Bingo, you get a report of all the tests you asked for. They write the reports manually instead of getting a print out, probably to save paper and ink. That is an eco friendly move. We have a composite form, in which you just have to fill the patient’s details, such as the name, age, sex, registration number, and tick mark the tests you want done from a big list. Theoretically if you tick mark all, you get all. But we are not very theoretical people. We are practical. Or perhaps the autoanalyzer is smart. If the blood urea nitrogen level is normal, often the serum creatinine report does not come. The machine must have a fuzzy logic (perhaps the logic is not called fuzzy, but I like that word) which determines that serum creatinine level need not be checked because the blood urea nitrogen level is normal. The machine also sees if the serum is clear or yellowish. If it is clear serum bilirubin levels are not assayed. The report is given as ‘nonicteric’. These practices are there for so long, I have forgotten exactly how long they have been prevalent. It must have been 25 or thirty years. It is remarkable that all the new machines they got in this time have the same fuzzy logic, and the working does not change. I think ours must be the first and the only laboratory with such smart machines.

Divine Justice?

I was brought up to believe in God and in Divine justice. I was a firm believer that truth would always prevail and merit would always triumph. We had this examiner for my MD exam, who gave me a low score on the first day when I knew my all answers were correct. The supervisor told me to be less arrogant so as not to displease her further. Then I learned that giving confident answers was being arrogant. I was pushed down to third rank. The first two were students from that examiner’s college. I don’t know what she got by depriving me of what I deserved by merit. I don’t know what divine justice has been meted out to her… no one knows where she is. Perhaps she is in retirement, in US or some such place, with her children. We had this head of department who used to dislike me even if I had had no contact with him. I was a Registrar in another unit, which had nothing to do with him. He tried to get me out of corporation hospitals by giving me zero marks in the interview for selection of lecturers. I still topped the list because the others gave me marks I deserved. He died soon after retirement, was terribly sick before that. But would that be divine justice? Was it not punishment to his family rather than to him? There was that additional commissioner who placed me at the most peripheral hospital when I had topped the list of lecturers selected in the interview I just mentioned. He had placed other specialty toppers in the topmost institute, but not those who had been interviewed after a dividing point arbitrarily fixed by him. That was because he wanted his niece to be in the topmost institute where I should have gone, and some other influential person wanted some topper in the topmost institute. For this injustice, the said additional commissioner was not meted out any Divine punishment. He continued to be on committees after retirement, drawing fancy remuneration for God knows what services rendered. There was that additional commissioner who promoted an associate professor to the vacant post of a professor in our institute, and placed her to work in the institute where she wanted to continue despite refusal to permit such an arrangement by all of us. I did not see any divine justice meted out to this additional commissioner, nor to that associate professor for unethical maneuvering using means best known to her. There was that Dean who troubled every Head of Department in the institute with whimsical behavior and irrational decisions. That Dean went on to occupy higher positions after retirement. I am yet to seen any Divine justice in that case too. I continue to see people in position of power all around us twisting the system to get what they want. They all continue merrily, while those hurt by their maneuvers continue to remain hurt or be hurt further. There is no divine justice apparently in all those cases. I believe in Stephen Covey (the guy who wrote ‘seven habits of highly effective people) and try to be principle centered in what I do, trying to do the right thing always. Covey did not mention anything about Divine justice, because he is a practical man. Perhaps I should forget that Divine justice and do as Covey says, knowing there will be times when I will encounter people who will be bad, and that I should continue to do my thing rather than follow their example, because I have to be comfortable with myself at the end of the day and at the end of life.

Security Deposit

I am glad I was born at a time which saw to it that I passed MD exam and could take a job of a lecturer at a time when they were not strong on security. I appeared for an interview, they selected me, gave me an appointment letter, and I joined duty. That process was not so simple as it sounds in this one sentence. But they did not make me pay a security deposit by a demand draft. If hey kept a part of my salary as a deposit, I don’t remember it. But it must have been small, or I would have remembered it. It seems everyone who takes a job in the corporation hospitals as a lecturer has to keep a hefty sum of fifty thousand six hundred rupees as security deposit before joining duty. There is a police clearance to be done too. Things have changed indeed. I don’t see anything wrong with either procedure in principle. But to get a security deposit in advance so that one can get a job is a bit too much. Perhaps people who have a lot of money even before they start earning will be able to do it. But what about people who become doctors taking education loan? What about those who become doctors because they love it, not because they can afford to? These young boys and girls, if coming from a middle class or lower middle class, may find it difficult to put up that amount up front, just so that they can start earning. It might be easier if they were asked to join duty, made to work and that amount was cut from their salary of the first two months. I know I have no means of changing that policy (come to think of it, any policy). I know it would be difficult to change the policy even if I had the means, because the attitude of people does not support the change in that direction. One should spend money, they say, without thinking if people have that money. I recall talking to the secretary of the Ethics Committee once. I wa discussing the issue of spending money while preparing and submitting Ethics Committee proposals. That time they wanted a patient information sheet in Marathi, when typing in Marathi was not easily available, and it used to cost ten times ty ping inEnglish did. We had meagre salaries, and the research had to be done using our own money, not fancy grants from pharma companies. Then they wanted five copies of the proposals in plastic folders. I asked if the Marathi part could be done in legible hand rather than typed, since it cost so much. The secretary said” “No!. It has to be typed. You should spend money.” I learned that in order to be academic you should spend money, not just be scientific. Now I learn you have to cough up dough to get a job, even if you have the merit and the will to serve the poor at monthly salaries that you would make in a couple of days in private practice.

Zero Tolerance?

I thought I had managed to control my temper reasonably well. I was wrong. I blew my top twice in a matter of two days. Perhaps it was because I had bottled it up for too long. The dispatch clerk had been acting up for quite some time. He would refuse to take our files for dispatch to other hospitals, telling us to ssend our own servant to do it. I had to ask him why he and his servant received salary from the hospital. That did the trick, and he took the files. I trust he sent them to the right places and did not send them for disposal in black bags used by the hospital for household waste. But he deteriorated suddenly. Or perhaps there was new guy. I couldn’t tell, because they had similar surnames, and similar if not worse behavior. He sent back a file in the hands of the servant who took the file to him. No remarks, no reasons. One month and a few days later I found the file on my desk without anything written in it after my last entry. I had to scold our RA (record assistant) not to keep such files in the cupboard but to take appropriate action. So she called him, and convinced him to send the file by dispatch. I hope the concerned people were not greatly unconvinced by the delay caused by that fellow. The next day he sent back another file similarly. The RA was apparently more afraid of me than of him. She called him, asked for an explanation, heard that the dispatch peon had returned it, not the clerk. He took that file finally. The very next day he returned the third file in a row. They call it a hat trick, I hear. It was past 4:00 P.M., past my departure time. My RA complained to me. We called the fellow, but he would not pick up the phone. I got bugged and I decided to settle the issue permanently. So I asked the peon to go with me to see the dispatch clerk and we went to see him. He gave me a new reason. He said there was no blank paper attached after my remarks for anyone to write anything on. My voice rose. That drew his head clerk to protect him. She made even more astonishing observations like I had not written any remarks on the file. I had to help her find my remarks made that same day - she seemed special with different needs perhaps. My voice had risen some more. That drew the administrative officer there, to pacify me perhaps. I asked them how they must be treating the general public if this was the way they treated senior officers of the institute. I wondered if they realized how much damage they were causing by delaying movement of papers to the next place of action. Finally I threatened to go to the Director himself the next time this happened. Then I left before my blood pressure shot up and caused a bleed somewhere in my CNS. Today the anesthetists tried my patience beyond limit. We have two of them in charge of anesthesia personnel in our theaters. I often see them in street clothes entering the theaters at least an hour after the juniors arrive. I don’t complain because the juniors induce cases. The older lot used to keep us waiting until their seniors arrived. These two insist on giving spinal anesthesia for our patients undergoing laparoscopy. The patients are uncomfortable, often in pain. When the situation becomes unbearable, they give additional general anesthesia. I suppose it must be personal comfort. One does not have to keep ventilating a patient under spinal anesthesia as under general anesthesia. I accepted that too, because I could not do anything much about it. If the patients developed any complications because of this practice, the anesthetists would hang. Many of the anesthetists, junior as well as senior, have poor concept of asepsis and antisepsis. Their masks hang below their noses. They wipe their wet hands and forearms on the sterile gowns they are going to wear after scrubbing. They wear surgical gloves touching their outer surfaces with skin surfaces. They order breakfasts in our theaters and throw half eaten stuff around so that the theater stinks and rats abound. They talk incessantly such that we cannot hear ourselves give instructions to assistants during surgery. They declare patients fit for anesthesia, and find something to declare them unfit when they (the patients) reach the operation table. They take their time reversing the last patient, or observing the patient on the OT table (if reversal of anesthesia is not an issue as with spinal anesthesia) beyond the induction time permitted for the last case of the day, so that they don’t have to do one more case and can be free at 1:00 P.M. instead of working up to 3:30 P.M. Today they refused to induce two patients on two tables at the same time. They would induce only one patient at a time. My associate professor heard this and walked away in disgust and frustration. I asked he reason for this, and discovered that they had only one co2 monitor, not two. We had another one in the next room, which they would not move to our theater, even if it was not needed where it was. I had a big OT list, and could not postpone any of it. Patients make a lot of arrangements at home, spouses’ workplaces, and also of their finances. That cannot be wasted because of silly reasons. I had to argue with them, and they kept arguing back. I lost my patience. My voice rose and kept rising, though I could have said everything with cold logic, which I was doing any way (I mean logically, not coolly). I finally got them to call their head of department, who advised them to get the equipment from the next OT and do the job. Even then they kept grumbling and passing remarks on how unfair my remarks were. I wonder if people take up jobs in institutes like ours to have freedom to work only as much as one pleases, drawing a good salary, and having security of a confirmed job, rather than to do good for the poor patients who have no other place to go to because they have little or no money. Have I reached the stage of zero tolerance?

Special Teacher or Special Student

Perhaps she genuinely thought I was a good teacher. But I had my suspicions. She was my student, now working in another unit, scheduled to come back to my unit in the next post, and to continue for three posts. The Teacher’s Day card another resident in a similar predicament and she gave me probably had more to do with that fact than their liking of the teacher. Not when I had revealed by displeasure every time they had messed up, and expressed my anguish that they would come back to my unit. It had been part acting, trying to improve them, but I was afraid somewhere inside. “I thank you for your wishes, but I prefer not to take a card from you. I have no place to keep cards. If you have not put my name on it, please give it to another teacher” I said. I did not mean to be unkind or snobbish. I always made it clear that I did not like them to spend their money giving me cards and flowers. Words would be enough. “Sir, please!” she said, “The message!” She wanted me to take the card because it had a message she had chosen with great care. So I took the card and thanked them again. The card read as follows. For A Special Teacher (I hope the ‘special’ was not as in ‘special children’.) You have always been a role model and helped me set high standards, by simply following your example. You have given me the strength and courage To do my best, And most of all, I thank you for teaching me never to be scared of obstacles and hard work. “That is a wonderful thing you have there” I said. “I hope you have managed to do all that.” They smiled and went away. That all happened two days ago. Today this student of mine turned up and asked me to sign her letter of submission of the topic of dissertation to the university. I signed it as her teacher as well as the head of the department. Then I recalled there had been a lot of dilly dally in the process of sending it to the university. I got her to give me the dates of various events that took place in that process, and here are the details. Event Deadline Date of occurrence Joining the college 2nd May 2009 Allotment of topic by me June 2009 First week of June 2009 Submission of protocol to September 2009 November 2009 ethics committee by her Receiving queries from December 2009 December 2009 ethics committee Approaching teacher Immediately after March 2010 with queries receiving them Submission of revised Within one of March 2010 protocol to ethics committee receiving queries Receipt of approval April 2010 April 2010 from ethics committee Submission of topic November 2009 September 2010 to university I was stunned. There seemed to be gaps of a few months between successive steps when there should have been none. “Why did you spend months in between successive steps?” I asked her. She kept quiet. “You had the permission in April 2010. But you waited till September just to send it to the university. Why?” I was genuinely curious. She kept quiet. “Did they keep you so busy that you could not fill up a simple form and send it along with the permission letter?” The question did not warrant an affirmative answer. She kept quet anyway. Finally I got tired and let her go. She went away with great alacrity. I wish she had shown that alacrity while handling the process of sending a topic of dissertation to the university. Anyway, the Teacher’s Day card was now explained. Poor girl probably hoped that I would not be mad at her for her procrastination if she appeased me by giving me a card saying I was a special teacher. I have started thinking that actually she is a ‘special’ student.

D-Dimer Dilemma

A patient came to our hospital with warfarin toxicity. She had been taking warfarin without supervision and any sort of monitoring. Her PT was 120 sec while the PT INR was not measurable (i.e. Above 6). She had intraperitoneal hemorrhage due to ruptured corpus luteum hematoma. She was a high risk case for surgical management even after possible control of the deranged PT INR, because she had had abdominal tuberculosis and was likely to have intense intraperitoneal adhesions. The problem was that the hematoma would continue to bleed even after correction of the coagulation problem because the bleeding vessels could remain open. In that case she would require a laparotomy. My associate professor had advised accordingly. Our hospital being a multispecialty hospital, we had hematology services available. So we made a hematological reference. We had asked the hematologist for advice on correction of the warfarin toxicity. They had a new lecturer after ages. This lecturer saw this patient and advised a host of investigations. By the time all those tests were done, the patient would either have recovered by herself (miraculously) or died (if treatment was withheld awaiting the test results). The said lecturer had been quite rude to our associate professor and the plan of management proposed, though it was beyond me to understand how she would know gynecology more than my associate professor. I finally called her myself. “Is that the hematology lecturer?” I asked. “Yes?” she said. I could not understand the question mark, but I had more important issues to understand from her. So I let it go. “I am the head of obstetrics and gynecology department. You have seen our patient who has warfarin toxicity and hemoperitoneum due to rupture of a corpus luteum hematoma.” “Yes?” she said. Perhaps they put a question mark after 'yes' in the part of the country that she came from. “I want to know why you have advised her to have D-dimer level tested.” “That is for diagnosing DIC” she sniggered. She must be looking down upon us obstetricians for our poor knowledge of hematology. I could not blame her. I had had similar experiences from some superspecialists in the past. “I understand” I said. “What I don't understand is why you think she could have DIC when she has warfarin toxicity, which is due to unmonitored warfarin consumption.” There was profound silence at the other end of the telephone line. She perhaps understood that she had goofed. “You may not do that test” she said “or you may do it later on.” She disconnected the line after I thanked her for her advice.

Improving Medical Education

There seems to be a strong opinion that medical education needs to be improved. The medical council is holding meetings in different cities, inviting elite doctors and even students to express their opinions. I had been directed to one such meeting a few weeks ago. When I reached there, I discovered that my name was not on the invitees' list. Then I discovered that there was another fellow there who had come from another city for this meeting, and his name was not on the list too. He was furious. “Please write down my name as one who came here, so that my boss knows I went as asked. Then I will go away. I have my OT to attend this meeting” I said this, hoping they would let me go. They wouldn't. They wrote my name down in the invitees' list and sent me into the auditorium. Gradually it became apparent that the list was indeed incomplete, and a lot many people turned up without their names being in the list. They all attended the meeting, and finally there was no place to seat them all. They invited people to speak one by one. People started coming up with suggestions that were wide in scope and not at all organized. Finally they announced that the meeting was just to decide which one of the three proposed structures the medical council should have. Other suggestions would be discussed perhaps in another meeting. They served lunch after the choice was decided upon. The lunch was sponsored by a company making suture materials, which must be a perfectly ethical thing, since it had to do with the medical council. The afternoon session was canceled, as the elite people had to move on. It seems last Sunday they held another meeting, sponsored by a rich company in India. Doctors and students attended and expressed their opinions. I was not elite enough to be invited, thank God! Some opinions expressed in the two meetings were as follows. Those allegedly expressed in the second meeting may be disregarded as hearsay stuff. 'More medical colleges should be started, as more doctors are required.' 'Endoscopic surgery should be routinely taught in all colleges.' 'Medical council should get a set of powerpoint slides made on all topics and distribute them to all medical colleges, so that the same teaching will take place everywhere.' 'Powerpoint slides should be banned during teaching.' 'Research must be made compulsory.' 'Six months must be spent on teaching psychology and communication skills before letting the medical students learn medical subjects.' 'We must not follow western methods. Our doctors are praised quite a lot when they go to US.' The list was endless. I cannot continue because it makes me dizzy and a little nauseated. I had not made any comment during the first meeting because they wanted no more opinions after the initial few. I wasn't present in the next meeting. I hope they read my blog to get my opinions, which are as follows. 1.There must be an organized effort when improvement is planned. The areas to be improved must be classified, and suggestions obtained on each one separately. 2.A team of educationists should be involved prominently. The persons planning the improvement have no training in these areas, and their attempts may turn out to be amateurish. 3.Rather that holding meetings of people by invitation, letters should be sent to all medical colleges, and their staff members should work on the issues concerned, sending the final draft to the medical council through their chief of the institute. Meetings are few, random, and the invitees tend to be those who are not necessarily good educationists.

Stop? No way!

It was our morning round as usual. The Registrar was presenting cases. We were discussing the important aspects of each patient's management before moving on. We were about halfway through. I had a thought and I wanted to ask an academic question related to the condition the patient had that the Registrar had finished telling me about. I was facing her, while she was facing the direction of the remaining part of the ward yet to be visited. I held out my hand, palm forwards, gesturing her to stop. She saw my hand, decided I did not want her to pass in that direction, and turned abruptly to go around me. So I moved my hand in her path, in front of her new position, and held it there signifying I would like her to stop. Seeing that there was obstruction in that direction, she abruptly turned back to the first direction and tried to proceed forward to continue the round. I must say her dodging maneuvers were quite remarkable. “Wait” I said, “I am trying to stop you to ask you a question.” She stopped in the middle of her escape attempts, looking surprised. For a couple of moments she could not understand what the matter was. Then she understood that she could not decide when we were finished with a given patient and we could move on. She smiled, and said “Yes sir. What is the question.” “Let it be” I said “I will ask that some other time. I thank you for giving me something funny post on my blog.”

Photocopied Books

“Sir, the students said your book is not available in the medical book stall. They have to buy photocopies of that book” one of my colleagues told me. “The owner of the bookstall opposite our main gate has purchased the whole edition from my publisher” I said. “He should have enough copies. If they had run out of stock, the publisher would have told me they had to reprint, if I did not want to bring out a new edition of the book. Thanks for telling me. I will check it out.” The said book0stall owner had sold some copies of another book I had written and he had published, but had not given me the royalty for the same. We had had some discussion on that issue, and he still did not pay, though he could not give any reason for doing so. I had stopped communication with him subsequently, because I did not like being cheated. So I requested my lecturer to check out if he had any copies left. The book-stall was just across the road, on his way home. Two days later he informed me the book was available in all book-stalls in the vicinity of the institute. “Sir, the students buy ready photocopies of different books from a shop near the hospital. Your books’ photocopies are also available there” another lecturer told me. “I know they buy photocopies” I said. “A lecturer appointed in our department a few years ago came to see me in my office once. She saw a copy of this book on my desk and asked me if it was a new edition of the book. It was. I asked her if she had read it. She said she had read a photocopy of the previous edition. She thought it was a perfectly natural thing to buy photocopies. She did not even want to hide that fact from me, the author of the book, who was denied the royalty of that sale by her act. Buying photocopies saves some money. My book we are talking about has three hundred pages. Its price after discount is two hundred and forty rupees. A photocopy costs one hundred and fifty rupees. One saves ninety rupees.” “But then you lose your royalty” she said. “That is true. But that is not all. The publisher invests a lot of money in printing and distributing the book. Piracy of books deprives him of income that is rightfully his. I myself don’t mind so much if I don’t get the royalty. I wrote books because I wanted the knowledge I had acquired to reach students. Even if they use pirated copies of my book, the purpose is served. Their indulgence in a little piracy for the sake of getting educated is definitely bad and illegal too, but it is far better than using pirated music CDs, movie DVDs and computer games. At least the purpose is noble.

Open Book Examination

A supervisor caught ten students copying during the internal assessment examination of obstetrics and gynecology. The normal course followed by all departments is to stop their copying, warn them not to do that again and carry on with the examination. But she was from another institute and did not know the routine. “It was so shocking” she said in the departmental office. “The students in this prestigious institute should be copying! We could not get admission here because we had less marks in the common entrance test. Why should people more intelligent than us have to copy?” “It is no good just talking about it” advised one staff member who really had nothing to do with it. “Put up a written complaint to the head of department.” The supervisor took that advice and put up a complaint to me. I could not just throw the complaint away after calling the students and warning them in a stern voice, because people could say I hushed up the matter for reasons best known to me. The website of the university had no instructions on handling such a complaint. So I sent the complaint to the academic committee, hoping they would get advice from the university on how to handle such a complaint. They did not ask the university. It was decided by them to appoint a subcommittee to decide how to deal with copying during internal assessment examination. They were apparently told by the boss to call the students and their parents and speak to them in strict tones (fire them was the literal translation). Two months and ten days passed before the meeting of the committee members and students and their parents took place today. The secretary of the committee had apparently sworn she would get the boss to attend. But the boss had other work, and he asked a senior professor to chair the proceedings. The accused with sullen faces and their parents with indignant faces sat on one side of a conference table. The committee members sat on the other side. The head of the supervising unit, the complaint adviser and the head of the complaining department (me) sat behind the committee members. The secretary of the committee spoke at length about the copying episode, how painful it was, how wrong it was, and added a bit of philosophy. Then she asked the chairperson to say anything she wished. “Do you have anything to say?” asked the acting chairman. Her hair appeared not to have been washed for the last five years. I had second thoughts about it and looked more closely. I could have been wrong. It might have been six years. “I forwarded the complaint asking the academic committee to tell us what to do. What more can I say?” “Problems like this in my department are sorted out locally by us and not sent to the academic committee” the chairperson said. I knew she probably resented having had to come to the institute at the ungodly hour of 10:00 A.M and then do some boring work like attending a silly meeting on something that had nothing to do with her department. She asked a parent to say something, and he said his daughter was innocent, that mere possession of a book during examination was not copying. “The whole class had books” said another. “Why single out only ten students?” “Is the complaining supervisor here?” asked the chairperson. “No” I said. “She should have come” said the chairperson. “She has left the institute. This copying took place two months ten days ago” I said in tone implying the committee should not have remain inactive for that long. “Was there any other complaint?” asked the chairperson. She reminded me of a not so smart policeman asking questions about a robbery in an old TV serial. “Were there any other books?” asked the policeman … er … the chairperson. I got irritated at that point. “Please give her the letter of complaint to read” I said in a loud and clear voice. “I have seen the complaint” she snapped. The manner was that of snake whose tail had been stepped over by someone. But I think she got the message and stopped asking intelligent-sounding questions. Then a lot of committee members spoke, tlling how it was wrong, and how copying was wrong, and why the students should be good and not indulge in such behavior. Finally someone asked the students to admit if they had copied. “I copied” said one fellow. “I copied too” said two others simultaneously. No student got up and said he/she had not copied. “Why did you copy?” asked one committee member. “We had been told by senior batch students that these internal assessment examinations were ‘open book’ examinations. So we opened our books and copied. The committee members were stunned. Another student got up and repeated the same statement. The committee members were not stunned, because they had already been stunned to the maximum degree. “If they want open-book examinations, I will let them have those. I will set the papers so tough, they cannot find the answers in their books” I told my neighboring committee member. I had no plan of doing so, but the concept was unsettling, and I had to say something to let off steam. “I copied because everyone else was copying, and if I did not copy, they would get more marks than I” said another one. “I copied only one answer” said one. “Only one.” “I had not heard of the open-book business” said another student. “The exam was at a time when it was not possible to be prepared fully. I had to copy.” “Yes, we had no time to prepare” said many of them. I had had enough by that time. I had spent one hour talking to the entire class of students about their poor attendance in lectures two weeks ago. I had the statistics with me. “I know why they copy” I said. “Normally I don’t bother the parents with such matters because it would hurt them. But some parents communicated with us that their wards were excellent students and were exemplary in behavior and would never copy in examinations. Please listen to their attendance records. They have to have 75% attendance during their theory lectures.” Then I read out the names of the ten students and their attendance figures, which ranged between 12.5% and 34.5%. “Do you realize that none of them can appear for the university examination because of this? Did they tell you parents what I told them in this connection over a period of one hour? Do you know what they do when they don’t attend lectures? They are in canteen, on the katta, outside library, or home. I would not mind if they studied to topics by themselves the same day as they were taught in their absence. But they don’t. They cannot be ready for exams if they have not learned those things. The parent who is home has to know that something is seriously wrong if the son/daughter is home during college hours. If the parent does not do anything about it, the parent is as responsible as the student for whatever happens. We are kind people and we are holding extra lectures for them so that they can fulfill the requirement of attendance and be able to appear for exam. I suggest that the parents do something about the matter though. It is not too late. This may be their final year in this college, but they have their lives ahead of them. Make them learn the right values. There cannot be any shortcuts in life, because they always backfire or misfire.” Neither the students and parents nor the committee members had anything to say after that.

Viewing Gallery

“Sir, they want us to fill up the details of all of our operation theaters in this format and return the documents by tomorrow morning” my lecturer told me while I was operating on an ovarian tumor. I realized it was for the inspection by the medical council. “Send it to the office, and get our professor in charge of medical council work to look at it. I will go there after the operations get over.” I called the office when I got free. The professor was working on the form. “What is it like?” “Usual stuff” she said. “I am filling up the columns as required. They want to know if we have various things, and the answer is affirmative for most of the questions.” Most? Not all? “What do we not have?” “First of all, we are in a transit OT. All the rooms required do not exist.” “No problem” I said. “I will show them the architect’s drawings, which only he can read. I will point out various rooms on those charts, and I will bring a magnifying lens from home so that the medical council assessor can see them. Any other problem?” “They want to know if we have a viewing gallery in each OT.” Once there was a viewing gallery in the emergency surgical OT in our hospital. It ran all round the OT. There was a cute staircase leading to it. One could view the OT table and the people from there. Needless to say the operation could not be appreciated from that distance, since binoculars or telescopes were not provided. I recall some guys used to go up there and watch the pretty anesthetists to their hearts’ content. When they repaired the OT, they closed off the gallery and put a galse ceiling for air-conditioning purpose. Now we are in the same OT using it as transit OT. But we cannot show that viewing gallery to the medical council assessors and claim to have fulfilled that requirement. “We have to state we do not have viewing galleries” I said. “If they ask me the reason, I will tell them the hospital is in a heritage building, and it is not possible to change the structure in any way, or we would have built viewing galleries in all OTs.” That was the truth, at least partly. The architect who called himself a consultant had pulled down existing toilets, so that the OT personnel would have to wait till they went home to visit a loo, or use the corridors like the cats and dogs did. That consultant would have a fit (serve him right) if he was asked to build viewing galleries within OTs. The part of my statement that was not true was that we would not have built such galleries even if it was possible. In modern times, one watches an operation on a closed circuit TV, not from a viewing gallery as if watching an opera.

Axxhole? No smartxxx

We have this professor who can be very sweet when he chooses to be, and the opposite when he does not want to be. He can switch these roles when he wants, like one switches a light on and off. A very remarkable ability, I must say. “I have come to request you to send my fourth year resident back to my unit” he said sweetly. “All the four lecturers you have given me are new. There is no one who knows my unit’s working. The unit’s work is greatly disturbed.” We had received seventeen new lecturers, when at one time they had shown inability to give us more than one. We had held a meeting just to decide their placement, and had placed them in all units maintaining an even distribution of qualified doctors, after reaching a consensus on the issue. That was eight days ago. He had met me four days ago asking for a change, and I had explained everything to him, asking him not to disturb the placements. He had had four more days to rethink on that issue, and now here he was, wanting to change that placement. “But the unit has you, and your associate professor, who are old hands” I said. “And one of your lecturers has been with you for almost a month. She has worked in this department for six months prior to that appointment.” “But she is new in my unit. I want someone who knows our protocols.” “If I shift someone, there will be shortage in that unit. We must not favor some people and trouble others” I said. “We can take out a lecturer from the last unit headed by a mere associate professor” he said. “She need not have as many working staff members. Surely I deserve to have more as a professor.” “I am sorry” I said “but it has nothing to do with the seniority of unit heads. Patients go equally to units held by a professors and an associate professor. I want all units to have adequate number of people to treat the patients.” “But units junior to mine have more qualified doctors” he said and named a few names. “They are DGO diploma holders, who are not considered to be quat par with degree holders” our expert on medical council rules said. “They are registrars, both by appointment and by placement in their units.” “I agree” I said. “DGO is a qualification, for your information” he said. “They are considered as nonqualified residents and are not allowed to make decisions, both by MCI and by us as decided together” I said. “If you feel you cannot give me my fourth year resident back, don’t give” he said. “But tell me,” I said, “do you really think your unit has collapsed because you don’t have a fourth year resident, when you have one professor, one associate professor, four lecturers, two registrars and five junior residents?” “I never said it has collapsed. Its function is disturbed” he said. “Give one lecturer from the last unit to the unit which has this resident and give him back to me.” I had had enough with this democracy business. I was too democratic. Even in model democracy, persons elected were allowed to hold office for five years. In our departmental democracy started and nurtured by me, the senior members wanted to change their own intelligently made decisions in less than ten days. “We made that decision jointly last week. I had taken everyone’s opinion, including yours. You had agreed to do what we did. Now that is final. There will be no change, because there is no valid reason to change anything.” The meeting ended there. The next day a few staff members got together and got around to discussing the previous day’s non-issue. “I cannot understand how such a senior professor cannot understand simple things, and how he cannot honor past and present decisions” one person said. “No. It is not that he does not understand. He understands everything very well. Today he fired the registrar of the last unit for some trivial thing, and asked her why she could not manage things when there were so many qualified doctors in that unit. It is not an issue of getting his fourth year resident back. He is getting back at the head of that unit.“ “He is not an axxhole, he is a smartaxx” a knowledgeable staff member concluded. (Note: x is printed in place of another alphabet so as to maintain a certain standard of writing, even if the standard of the department is greatly lowered by such petty fights.)

The “Bee” Business

A few years ago, there was quite a bit of unrest in the institute. The Boss was being troublesome when there was no call for any trouble. Heads of departments were harassed for the sake of being harassed. Others were troubled when the department heads were troubled. Lower cadre staff members were encouraged to revolt against superiors if they so wished, and many of them wished. Letters important to department heads were lost when sent to the boss. Appointment orders of new staff members were inexplicably lost from the Boss’ office. The clerical and administrative staff were asked to do unreasonable things using strange methods, at strange times, repeatedly. I recall having to conduct lecturer selection interviews at 10:00 P.M., when all support staff were present, and so were Deans of two other institutes. That could have been done in office hours. After all, the vacant posts had been vacant for ages, and this nocturnal interview did not solve the problem any faster than if conducted during the day time. The Boss even recruited a few favorites who joined in the fun of troubling others. There were a lot of dissatisfied persons in the institute. There was a poet amongst them. He started writing poetry on the happenings around. We came to know about it when he started sending them to all email account holders on the institute’s mail server. We received those poems regularly like clockwork. That person was really good; quite intelligent in fact. The poems were hilarious. No names were mentioned, but the descriptions were such that the reader had no trouble identifying the subjects of the poems. No one knew who the poet was, because the mails came from an email account without an identifiable name. Speculation was rife about the identity of the poet. It came as a shock when someone said they suspected me to be the poet. I had written a large number of books on obstetrics and gynecology, and a novel in Marathi, but no poetry. Even in school, I had to resort to guides to understand what the poet meant in his/her poem. But they said the sense of humor of the poet was like mine. Well, I had read those fun poems and admired that poet quite a lot. I would have loved to be that person, but unfortunately was not. After about six or seven poems, the fellow either got tired and stopped writing, retired and left the institute or just died. We will never know. But I know that long before that I received three emails, one into my account in my own name, one in my obligatory account as head of my department, and one in the obligatory account of my clerk cum typist. The message was the same in all three: “We know you are writing the Bee mails. Stop before someone gets really hurt.” I could have to the police for receiving threats of physical injury, but I did not. A coward who sends anonymous mail cannot really harm anyone, I believed then and I do so even now. I knew who had sent those three mails. Only one person could have known I would have access to all the three accounts, and had sent mails to all three accounts to ensure that I would definitely get at least one of them. I don’t know if the coward sent this mail to other suspects in the institute too. I thought of the ‘Bee business’ yesterday when the documentary maker said I was the Bee poet as she had read on my blog, which was untrue. She had been told so by the same person who had sent me those three threat mails, possibly hoping to bait me and get a confession out of me. It is indeed surprising that consultants have time for such foolish games in a prestigious institute like ours.

Documentary

More than a year ago, I was called to attend a meeting on a proposed documentary on our hospital. Some elderly person with loads of money wanted to do one. I was reluctant to attend, but they pushed me. I listened to whatever they were saying, but kept to myself. “What is your opinion, doctor?” she asked me. “I don’t think the documentary will serve any purpose from point of view of our hospital” I said. “It will be watched by an elite few, while it is the masses who come to our hospital and get treated. They will not get to see it. Even if they do, what does it matter to them? They want treatment, without knowing anything about it.” “Anyway, we want to do it. The Director wants it launched on the Independence day.” I knew the Director set deadlines of nearest auspicious days, so that concerned people worked hard and hopefully met those deadlines. I also knew they often did not, but that was besides the point. Since I did not see any point in the whole exercise, I had no suggestions. Two independence days passed, and still there was no documentary. I wondered about it sometimes, because I dislike loose ends, and this was a loose end. Yesterday she came back to our office and said she wanted to talk to me. “No, the documentary is not ready” she told me. “We want to interview you for that documentary.” “You don’t want me” I told her. “We want you” she said. “Believe me, you don’t want me” I repeated. “I cannot say politically correct things if they are not actually correct.” “We want such people” she said. Then I had no argument to offer any more. We fixed for that afternoon slot that both of had free. She came along with her crew, saw my transit office chair and table space, with the plaster off the wall behind me, and got enthusiastic. I think she wanted to show all negative aspects I would tell her about. Her crew arranged Everything, and we started. “So we begin, angry man of the hospital” she began. She did not add ‘young’ in that description, because I was with a lot of grey hair and ditto moustache. She had been primed by someone. Otherwise she had no business calling me angry. “I don’t think the description fits” I said. “I run courses on anger management for my people. I couldn’t if I were angry myself.” She was taken aback by that. The primer had not told her about this apparently. The interview continued. She asked this and that. She tried to get my angry opinions on her presumed poor condition of our building, state of maintenance of equipment, my boss and such things. I think she expected me to take the baits and spill my guts in front of the camera. Unfortunately I told her things that were not only politically correct, but also actually correct. There was no material to spice up her documentary. She asked me about myself, my son, and what I did in my free time. I told her the truth: there was no free time in the hospital. At home I worked preparing for the next day at the hospital, fixed things that needed fixing, wrote articles, did some computer programming etc. The primers had not told her all this. But they had told her something else. “I also understand you have some fun sometimes” she said. “You had nick named someone ‘Queen Bee’ …” “I had not done any such thing” I said, suddenly alert. Something strange was afoot. I knew the Queen Bee business of a few years ago. “Where did you pick up this information?” “I read it on your blog” she said brightly. “I googled and found your blog during my research.” “That is incorrect” I said. “There is no mention of any such thing on my blog.” She dropped that subject. I did not press it any further. I knew the source of her wisdom. Two persons were likely. One was the professor who had called me initially to meet her. The other was an ex-professor, in whose office she had been sitting when some students came along and she had interviewed them too, she said. Both of them had tried to trouble me in the past without reason, and had allegedly stated in presence of the others that I was the poet who wrote the ‘Bee’ poetry. The ‘Bee’ poetry is a topic for another post.