Temptation

They asked me if I would like to go on the Asian Pacific Edition of TeLinde's operative Gynecology Advisor list. I agreed. So they sent me two copies of the book. I went through the book. A month later, someone from the Delhi asked me to send them my suggestions to improve the book. So I sent them a long list of suggestions for changes or inclusions in the next edition. That must have pleased them. One day I got a call from Delhi asking me if I would like to write a whole new chapter in the book. I agreed. They promised to pay me Rs. 10000/- for my troubles. It was not any trouble. Actually it was a pleasure. So I wrote a chapter, formatted it to look like the other chapters in the book and sent it to that fellow by email. Months passed, but there was no progress. There would be no answer to my emails. When one of their marketing managers met me for sales promotion, I asked if this fellow had left the company. He hadn't. So I sent a verbal reminder through that manager. I got an email promising me a cheque of Rs. 10000/- in 10 days, and the chapter in the book whenever they printed the book again. Months have passed since, and neither promise has been fulfilled. In the meantime, they used my email address to make me an offer. If I promoted TeLinde's book to my residents, and it resulted in the sale of a given number of copies of that book that they would verify with the bookseller, they would give me a free copy of some other book. I felt sort of violated by the insinuation. Did they honestly think professors were like that? Or did they think we made so little money that we would fall to such low levels? I wrote back it was unethical to ask me to do so. They did not answer my mail. But they did not make any such suggestion in their future emails for sales promotion. That reminded me of the offer of a Tanishq gold coin, to be given to me if I prescribed a certain calcium brand so much that at the end of six months they would find a great increase in sales that they could verify at the chemist's shop across the road. I had politely but firmly asked them to get lost. Perhaps all corporates believe professors need money badly and would do anything to get it.

Census

It is believed that the census is a very important national activity. We had gone through that exercise a few months ago. The method is to make school teachers and government and municipal employees leave their usual work and do this work. For each family, they have one or two huge sheets to be filled. But they do not seem to fill all the blank spaces. Right now the second phase of the census is going on. Today a young girl visited us for census work. So they work Sundays too, probably for families where everyone is away working during the week days. She had a huge sheet to fill for our family. she asked names, education and date of birth of all family members, which the previous person had done too. Then she carefully asked our religion. When I answered that, she got up to go. "Is that all?" I asked. "Yes" she said. "But why is there a second phase of the census?" I asked. "This one is to get in depth information" she said. "OK" I said. She went away. The last time the census person had spent a half hour getting all sorts of information from me. This time she repeated three of the previous questions, asked only one new question, and for that the nation has pulled away people compromising their work like education of school going children or administration of healthcare. An additional loss is the number of trees they must have cut to make all that paper for printing those forms. I wish they had included the religion part in the last form.

Relaxation therapy

"Sir, this patient came with preterm labor. We treated her with nifedipine to control it and betamethasone to enhance maturation of fetal lungs. Now she is relaxed." I wondered how the woman relaxed with these drugs. Probably the Registrar meant the uterus was relaxed or that the preterm labor was controlled. All the residents in my department were in that habit. The patient's problem seemed to be solved. So I continued with our ward round without asking any question. After seeing two more patients, we had another patient with a similar outcome. "Sir, this patient came with preterm labor. We treated her with nifedipine to control it and betamethasone to enhance maturation of fetal lungs. Now she is relaxed" the Registrar said. "Is the preterm labor controlled?" I asked. "Yes" she said, with a look on her face which seemed to say 'that is what I just said'. "Good. You must be very good in relieving stress of people. Two women treated by you have relaxed so well. I think I should ask for your help when I am stressed. I want to relax like these two women." She kept quiet. "What did you give them which relaxed them?" I asked. "I might take the same medication for relaxation." She kept quiet. "Nifedipine! I recall you treated them with Nifedipine. No. I cannot take it for relaxation" I said. She still kept quiet. "Next time say that the uterus is relaxed, not the woman. The woman may relax too because the uterus is relaxed, but we are more interested in the uterine relaxation" I said. "Yes sir" she said.

Cut - but where?

The junior community in surgical lines has a word to describe operative work - "cutting". It means the process of operating. It has to do with the process of using scalpel and scissors. Sadly it implies that they are concerned with the technical process of operating experience, rather than treating a patient who is a live human being. Sadly it also implies that they want to cut, not suture, or rather cut, not heal. That is life! That day I was assisting my Registrar perform a vaginal hysterectomy. She was to go on exam leave soon after. That meant she was as good as a consultant, should she pass that final exam. She had clamped, cut and ligated both of the uterosacral-cardinal ligament complexes. While I was telling the nurse about some suture material we would require next, she applied her clamp to the uterine vessels on the left side, cut and ligated them. Then I realized she had taken the previous uterosacral pedicle along with it. The stump was attached to the uterus, with its holding polyglactin 910 thread hanging from it. There was nothing on the lateral wall where the pedicle should have been. I was stumped. I had never seen anything like that before. I kept a cool head because that is what being a head of unit is about. I asked her to proceed with the operation, planning to put a figure-of-eight suture on the raw area later. She clamped, cut, and ligated the other side uterine vessels satisfactorily and clamped the left side cornual structures. To my amazement, she proceeded to cut it lateral to the clamp. I stopped her just in time. Within a matter of five minutes, she was committing another grave error, not realizing that it would defeat the purpose of the clamp which was to prevent the cut vessels from bleeding until they were tied. That patient did well postoperatively and went home fine. I recall assisting my houseman similarly, when I was a Registrar. I was actually supervising another resident on the other table at the same time, giving advice as asked. While I was looking the other way, this houseman started cutting the left cornual pedicle that he had clamped while I had been watching him. When I turned my attention to him again, I found him starting to cut the pedicle lateral to the clamp. I stopped him just in time. That patient also did well postoperatively. This fellow is in USA somewhere practicing obstetrics gynecology. One can draw many conclusions from all this. 1. They tend to commit this mistake on the left side. 2. They do things mechanically without knowing why they do it, and that leads to mistakes. 3. Perhaps they take such people in the USA, where they do well. This last conclusion will be valid if my current Registrar goes to USA.

Attitude 14

"Sir, there is call for you from Dr. XXXX" my Registrar told me in our busy antenatal clinic. That was the head of department of a superspecialty. I took the call. "Is that the head of obstetrics gynecology?" asked a woman's voice, which was clearly of not the person whose call it was supposed to be. "Yes" I said. "Dr XXXX would like to talk to you" she said and put me on hold. I waited. A minute passed, then two. The same silly music continued. Finally I put down the phone and went back to work. After a couple of minutes the woman called again. "Hello" I said. "Is that the head of obstetrics gynecology?" she asked. "Yes" I said. "Dr XXXX would like to talk to you" she said and put me on hold again. This time the said person arrived in a minute. "Sorry I detained you" said the said head of department, "I want you to see a patient. When shall I send her?" "Send her to my outpatient clinic next Monday" I said. "Fine. Thank you." Two Mondays have passed since. No such patient has come to see me. In the meantime I told this story to a couple of our staff members. "For his own work he keeps you on hold?" said one "You should have put him on hold yourself." "I could not. Perhaps it was some important work." "You should have got an intern to hold the phone until he came. Then the intern would have called you." "I could never get myself to get other people to something for me like this" I said. "If he wants to appear to be grand, let him. It is his problem, not mine. Next time he repeats this stunt, I will disconnect the line until he calls me myself."

Meaning of Happiness

“There are two types of people. One type gives you happiness. The other type teaches you what is happiness.” This was a little deep. I am not all that into philosophy. But when a staff member junior to me comes with something like this, I cannot just let it go. “What do you mean? Do people who give you happiness not teach you the meaning of happiness too?” I asked. “No! They are two entirely different things.” “could you give any examples?” I asked. “Oh, sure. The resident doctor who works like a master gives you happiness. The resident doctor who is nothing but trouble teaches you what is happiness – it is that feeling that you are entirely missing out on with this person around.” That sounded great. That explained why I understood what happiness was every time one of the four pain-in-the-backside staff members went away one by one, and when my troublesome Registrars went on exam leave, not to come back again.

Lord-Like Attitude

It is wonderful to have people working for you who have capabilities of a Lord. We have someone who perhaps does not have the capabilities, but has the attitude. When we decide to get some new equipment, this person comes up with a great suggestion, like so and so equipment made by so and so company is wonderful, and let us get it. When I say we could get something more economical, this person counters saying it is far better to get what that person has suggested. So I ask that person to get me the details, like the address, telephone number of the vendor and the technical specifications of the equipment. That is where the enthusiasm dies. After patiently waiting for a week or so, I remind that person to get me the details asked for and settle down to wait some more. The answer never comes. By now I have learned not to rely on this person and process the purchase, or we would never get anything. Our 'Lord in attitude' person is meant for things like making suggestions and get others, including higher ranking officers to work out the details which mere mortals should be doing anyway. When I was a student, the psychiatry professors used to call such behavior as megalomania. I wonder if they would still call it the same.

Touch me not

I recall one of my lecturers when I was a house officer. A decent person, really! Perhaps her command on grammar was not very good. One day there was a case of eclampsia, and I was performing a central venous cut down on her. It was my first house post, and I was still learning. She found that I was not finding the vein very easily. So she took over and made me into an assistant. Being senior, she perhaps believed she did not have to wash up, wear sterile gown and gloves. She she just donned a pair of sterile gloves and started. I was mopping any blood that collected in the operative field. She also had some difficulty finding the vein. So she was a bit irritated. My gauze probably touched her bare forearm some time. Suddenly she said, "Hey, don't keep touching me everywhere." I knew I had not touched her anywhere. I also knew the degree of her command on the English language. So Inderstood what she meant and did not let the gauze touch any of her bare skin of the upper limb again. When I recounted the story to a couple of my women colleagues recently, they were amused. Then they themselves had a couple of things to say. "Sir, do you know what Dr. X Y ZZZZ does?" "What?" I asked. "He keeps touching women colleagues inappropriately. He had put his hand on my shoulder once. the next time he started doing that, another woman professor warned him with her eyes not to try it with me. After that he did not bother me." "Huh!" I said. It is not appropriate in our culture to touch women like this. "He did something even worse to me" the other one said. "We were taking ward round. Suddenly he came along with his unit, stopped and tickled me on the neck." I was stunned. "He puts his arms around women residents too." "Why do you women not tell him firmly that you do not like it and he may please refrain from such touching?" I asked. They did not answer me. Perhaps they are reluctant to offend a senior person. Perhaps they do not want to create a situation. Perhaps it is their modesty that keeps him assured that he can continue to do this and no one will object. I remembered having heard of his activities like thin in the institute he came from, and warning him not try those things in our institute. He probably believed he knew better than I did, or he was so addicted to it that he could not stop.

Wider Readership

I wrote a book for postgraduate students called 'Practical Gynecology and Obstetrics'. It has gone through four editions. Today I had a pleasant surprise. I had finished the session in the OT and was on my way to the office. Two guys were sitting on the table (they sit anywhere!) just outside the OT. They were going through a copy of this book I wrote about. They were young, but not doctors. They looked more like relatives of patients in the OT, or relatives or friends of servants working in the OT. I asked them why they were reading that book. They immediately withdrew, saying they had nothing to do with that book. So I opened the book and checked whose name was written inside. It belonged to one Dr. XXXX YYYY. I asked around, and found that this doctor was probably an intern who had forgotten that book in the OT, and the residents would read it sometimes, when they needed a ready reference and could not go to their rooms. I also recalled that our houseman had not read how to do a laparoscopy and was asked to read it in the OT by our Associate Professor. So the question was what those two guys found so interesting in that book. In a couple of seconds the answer dawned on me. They found a photograph of an old woman with a huge abdominal tumor on the front page, which attracted them to that book. They found diagrams which had to do with women, so they kept looking, hoping to find something more interesting. I wonder how they hoped so looking at sketches of instruments and operations that I had made myself (meaning not by a professional artist). I think one lives on hope more than on reality.

Silence zone

A lot of construction work is going on in the campus. But the stage of pressure piling was over a long time ago for all the ongoing projects. The rhythmic ear-drum-shattering noise suggested pressure piling which had no business being in the campus. After some time the screaming started. It sounded just like the sounds in the labor ward, where women labored in natural childbirth process. The timbre was a little deeper and the words were not clear. But the overall effect was similar. I could not understand how the sounds from the labor ward could be heard a block away as clearly as if they were coming from the next room. Then suddenly the sounds stopped, and someone announced “thank you. That was XXXXX singing for you. Now let us hear YYYYY, with ZZZZZ on the drums and QQQQQ on guitar.” “What is with all this noise?” I asked the clerk in our office. “It is the annual function of the students” she answered. So it was a talent show or a competition of some sort. “Can you make out the words of the singer?” I asked. “No” she smiled. “I thought you young people would know what they were singing” I said. “I wish they knew it was a silence zone, this being a hospital.” “The silence zone is around the hospital, not inside it” a professor volunteered. Well, in that case all that noise must be OK.

Leaving their mark

We had this annual all India conference of some sorts of surgeons in our campus. It was indeed a grand show. Early morning I found them in their warm business clothes in the lobby, having coffee. I did not pass by at noon, but the activity must have indeed been equally festive in the area set up on the lush lawn for their lunch. I went home the other way and missed the scene in the evening. But the fine surgeons did leave their mark behind. The next morning I went to work and found the lawn and adjacent path littered with styrofoam mugs. Probably the same surgeons must be throwing their hemostats on OT walls when they don't work in their institutes. When the coffee mugs did not yield any more coffee, the best thing to do must have been to throw them away. Luckily the third morning the area was clean again. Probably one leaves an ever lasting mark these days.