Generals Lead Inadvertantly

The assistant civic chief was to visit and see the grand spectre of the repaired and renovated building we work in. The work was by no means over. But the contractor pushed all the clutter into rooms to clear the corridors and locked up the doors. The corridors started looking like those in Western hospitals- clean, nice and empty. He cleared the rubble and tools of repair from the yard beyond a stone's throw, hoping the elderly administrator would not be wearing bifocals in public. I was advised to be available at the time of the scheduled visit. I was not on the welcome committee, probably because I could not be trusted to be politically correct, or could perhaps be trusted to be truthful. So I remained in my office, and conducted a brain-storming session of senior staff members on our educational plans for our post-graduate students. I learned later that the civic boss inspected the premises and went away, without needing my presence. "How did they go up to the third floor without the elevator" I asked the two fellows who were working on the new elevator which had not been made functional yet. "We took them in the elevator" the senior one of the two said. "Is the elevator ready?" I asked. I was climbing up and down all day. A ride in the elevator would help in some of the trips at least. "No, it is not ready. There are two inspections yet to be carried out by two different authorities." "So it was the first run?" "Yes" he said simply. "Something like a trial run?" I asked. "Yes" he said. "The civic boss and our boss went up in the elevator together in a trial run?" "Yes" he said. "Had something gone wrong, we would have lost two brilliant people in one go!" I shuddered. They don't fly all generals in the same plane for that very reason. But the elevator guy did not know that. "Did they know it was a trial run?" "Um … probably not" he admitted. So the generals had led the army inadvertently.

First Blood

We almost had our first casualty after the reoccupation of our repaired building. “You know what happened?” one of our senior professors said while I was trying to finish the paperwork. “What?” I asked. “One of the twin tube-lights almost fell on my head while I was working in the office upstairs.” “How?” I asked. “These tube-lights are suspended from the ceiling by two rods. One of the rods gave way. The tube-light was hanging down from the other rod, its end an inch above my head. I never knew such a thing had happened. Another professor was passing by, when she noticed it and warned me. I moved away quickly.” “Thank God you were not hit by it” I said. “Call the contractor and get it repaired.” “It is done already. I came over just to tell you what happened.” “One of the ceiling fans fell almost on the head of one of the department heads before the repair and renovation work” I said. “It was a moving fan. Even if he was not hit directly, he could have lost a limb or even his life by the moving blades. Now we must watch the tube-lights too.” She went away. I looked up at the ceiling and noticed with dread that they have fitted eight tube-lights on my tiny ceiling in place of the two I had before the repair and renovation. ‘Are they out to get us?’ I thought.

Old Scanner

I have a computer scanner that is not supported by versions of Windows beyond Windows 98. When I installed Windows XP, I tried to use this scanner, but a driver to run it could not be found on its software disc, nor on the net. I kept it in the cupboard. When Windows Vista came along, I tried to run it on that OS, but it would not work. I hoped against hope that Windows 7 would support it, but it did not too. People advised me to throw it away and get another one. Well, I had already got another one when Windows XP would not run it. But I could not get myself to throw it away. Then suddenly I had an idea. I installed a virtual machine on the PC with Windows Vista as the OS. Then I installed Windows 98 in that virtual machine. Then I connected the scanner to the PC while in the Windows 98 environment and installed the drivers for the scanner. I was happy to find that the scanner worked like the purring engine of a Merc, even better than my newer scanner. I think 'innovate and keep' is a more satisfying strategy than the 'use and throw' strategy.

April Fool

I never thought I would be able to fool anyone with that one. But it was the first of April, and I had to try it. I was nearly through my morning round of the wards. The undergrdauate students had joined the round one by one, so that while there had been none with us when we started in the first ward, there were five of them at the end of three quarters of an hour in the fifth ward. I had just read about the failure of the education department’s plan of passing all students in school so that they would learn without pressure and fear of failure. They had not studied at all since they would not fail in exams. When I saw our undergraduate students who behaved like those school-children, I had an idea that I could not resist acting on. “The health university has sent our a circular that states the undergraduate students will not have any exams until the last year of their 4.5 years’ course. They will be automatically passed. They just have to pass one exam at the end of the entire course.” The students watched me warily. They have learned to be wary of me for reasons unknown. I kept a straight face, but I am not sure it did not look over-straight. It probably did. Two of my Assistant Professors grinned slightly. “Have you finished your third-first term” I asked. “Yes” they said. Third-first meant third year part one course, which covered ENT-Ophthal, PSM, Psychiatry, Dermat etc. “So you don’t benefit from this scheme” I said. They managed to look sad. “But your juniors will benefit. Now they can study with a mind free of tensions, free of fear of failure. They will learn their subjects better. At least that is what the university believes. It is on the website of the university. Go check it out.” My residents looked sad that they had not had this opportunity when they were undergraduate students. We proceeded to see the patients in the last ward. Then the students went for a bedside clinic, while I was called to sort out some issue by the building contractor’s carpenter. The next day there was a discussion on education of medical students, when my Associate Professor said indignantly, “The university does not help either. Now with this business of passing every one in all the duration of the undergraduate training until the one and only examination at the end is going to make matters even worse.” I was speechless. After a few seconds of silence, I managed to say, “I am sorry. It was my effort at fooling the students, it being the first of April. I planned to tell you that it was an April-Fool. But I was dragged away. I never thought it would fool you. The Associate Professor kept quiet. She probably resolved to be careful the next year.

Retrograde Postero-anterior Hysterectomy

We had a patient diagnosed to have placenta previa percreta on ultrasonography at 24 weeks. She had had a cesarean section in the past. I had asked our residents to get an MRI scan done on her to see if it was truly placenta percreta, so that we could plan her management in advance. The MRI showed central placenta previa percreta invading the bladder. She presented at 34 weeks with painless bleeding per vaginum. Two of our Assistant Professors performed an upper segment cesarean section on her under the supervision of our Associate Professor. They left the placenta undisturbed. The patient did well postoperatively until the next day, when she started bleeding vaginally again. The only interventional radiology unit in the civic hospitals is in our hospital (I am proud to say). But it was not available then because some part inside was broken and could not be replaced for lack of maintenance contract or some such thing (I am not proud to say). We were forced to perform an obstetric hysterectomy, with a urologist ready to help with resection of a part of the bladder and repair, with or without ureteric reimplantation if required. I really had planned to help out with the critical part and then let them continue with the operation, but I was forced to operate on her by my people, who washed up before I could, and promptly occupied positions of first and second assistants. When I offered to assist, the offer was politely but firmly declined. I carefully dissected between the uterus and the bladder. The tissue was edematous, loose, and the separation was easy except where the previous uterine scar was adherent to the bladder. I was reluctant to dissect the ballooned up lower segment and cervix right down to the bladder neck. So I decided to do something new – a retrograde postero-anterior hysterectomy. When one side adnexa is a mass of inflammatory origin such that cornuals and uterine pedicles cannot be secured during an abdominal hysterectomy, one has to cut and ligate all pedicles on the other side first, cut across the vagina to the affected side, and then divide and ligate the pedicles from below upwards – i.e. uterosacral-cardinal ligaments, uterine vessels, and cornuals in that order. This is called retrograde lateral hysterectomy. In this case the problem was anteriorly placed. So I divided and ligated the uterosacrals first. The posterior vagina was soft and friable, and opened transversely during upward traction on the uterus before I could cut across it. I cut the lateral vagina next, and the anterior vagina above the cervix last. Then I dissected the bladder away from the front of the cervix from below upwards. I had not known it before completing the dissection, but there was no placenta percreta right down to the pelvic floor level. The MRI people had goofed. If the diagnosis had been correct, my separation of the bladder from below upwards would have proved to be more useful, since the nor-percreta area below the percreta area would have been freed before the torrential bleeding started. I also feel that the dissection was easier than blind dissection downwards, not knowing what lay beyond.

Workshop Wonders

I had this wonderful opportunity to attend a workshop at a government guest house organized by the health university. I reached the venue five minutes before time, only to find the gates closed. “There is probably no meeting today” said the gun-toting security fellow on the other side of the gate. A couple of other people came and went away. Ask the receptionist inside and tell us too.” I went in and met the girl at the reception counter. “We have no word from the university” she said. “But we hear rumors that it is postponed.” I waited for a while and left. Luckily it was in my home town, and all I lost was a half working day. People had come from all over the state and had to go back. Many of them used this break to catch up with old acquaintances in town. It was a boon in disguise. A month went by and the invitation came again. Since it was an advice to our boss to nominate me to attend, I was obliged to have the pleasure to go to the same place again. I went without prior sanction of special leave, thinking I would apply for leave only if the event took place. Otherwise I had to make two efforts, one at obtaining a sanction, and then another at cancelling the leave. “Do you have any identity proof?” the gun-toting security fellow asked me at the gate. I had been let in the previous time without any ID check. But there was no point in telling him so. After all, the previous time may have been a mistake. “No, I said. “The invitation letter does not say I have to carry an ID proof.” He read my invitation letter, or at least glanced at it long enough to appear to have read it. “But it is required” he said. I thought this was a free country. I could go where I wanted except in secure areas. A guest house was hardly a secure or sensitive area. “My work is my identity” I almost said. But I realized in time that he was unlikely to have known about my work in Obstetrics and Gynecology. So I tried another trick. “I shall go away happily if you won’t let me in” I said and almost turned away to go. “Go in” he said hastily. After all, an elderly (and I think scholarly) looking fellow with an accent of an Indian Professor would not blow up the guest house, especially when the only thing he seemed to be carrying was the invitation letter. It was a grand workshop. They had a spread of Punjabi samosas, sandwiches, some exotic sweets and tea right insdie the entrance. I thought of the breakfast I had had at home, the free radicals and cholesterol in that food, and refrained from eating anything. I had a cup of tea. The breakfast lasted for another hour. Then the dignitaries arrived. A beautiful looking girl (at my age, without wearing glasses for distant vision, all girls look beautiful from a distance) invited them on the dais. All were asked to rise for the university song. All did that and the song was duly sung. Thus I learned there was a song of the university. Then she proceeded to invite the dignitaries to speak their minds, and thanked them for their words of wisdom, their inspiring words, their precious time, their enlightening ideas etc. They must have a small book containing such phrases. A huge camera was rolling, capturing all those precious moments. One of the speakers was the elder sister of one of our retired bosses, speaking with the same style and voice. I had believed I had forgotten the trauma inflicted on us by that boss and moved on. Well I had moved on, but the trauma caught up with me. I sat through a half hour of the ghost of that tormenter torturing me vocally. After the talks were over, the dignitaries left. Then the academic function began, an hour behind schedule. The pretty young thing handed over the mic to a middle aged associate professor. They had given us a pad and a pen to write. I had to appear interested, so I jotted down a few sentences. They were as follows. “To conduct whole workshop may not be able to possible.” “It is also very very important…” “The module is very very clear.” “Another important thing we are there is …” “We are supposed to have monitoring should be done.” “There is a chapter full on anemia.” She was not alone in use of such grammatically perfect English. Other speakers also contributed. Read the following lines. “I feel very proud to see you people talking to you people.” “Whatever we have done in the last ten twenty years …” “…………………………………………………..” (The lines I typed got the spelling and grammar checker in convusions. I had no option but to put periods in place of the alphabets.) At the end they gave a post-test which was identical to the pre-test. I noted with interest that they had asked us to state if we were doctor, postgraduate, professor, associate professor, lecturer, administrator in both the per- and post-test. Since I had not changed my designation in the wonderful few hours I had spent there, I selected the same option in the post-test too. I gained the following in this workshop. 1. A bag: I could put my laptop in it. 2. A pad and a pen: I drew a few cartoons in the time between speeches. 3. Lunch: with some heartburn and cholesterol in my vessels. 4. Tea: added to the heartburn, but the fault was mine. I should not have drunk it. 5. New ideas for my cartoons. 6. A sense of wonder: I dared not ask them why they had called me, an obstetrician to attend this workshop, when it was for management of children. All other obstetricians seemed to know why they were there, and I dared not show my confusion in front of such an august audience (the audience was august – either the pretty young girl or some speaker had said so).

Tripod Jinx

I had a tripod once, which had belonged to my father. He had been deeply interested in photography. But my brother took it away before I got into medicine, and long before I started doing medical photography. All my medical videos are done with a handycam, and the field keeps moving sometimes quite annoyingly. I have been planning to buy a tripod, but never got around to do it. The readers will recall the story when our clerk-cum-typist asked for a loan of ‘camera for a tripod’ from the Artist department of the hospital, when I had actually asked for ‘tripod for a camera’. They were reluctant to loan it, and the boss had finally consented, provided only I would handle it. That had made me wonder. Handling a tripod was no great thing that only the head of the department could do. Finally it dawned on me that there was a goof-up. I clarified that I needed a tripod and not a camera. Then they were all smiles. But I decided then and there to buy one of our own. So I went to the leading shop in the market that evening and asked for a quotation. “It will cost Rs. 2900/- and better one will cost Rs. 4500/-“ the shopkeeper said. The prices were higher than reasonable. So I went to the neighboring shop and asked the prices. “Rs, 1100/- for the standard one and Rs. 2600/- for the better one” the salesman said. “Please give me a quotation. My hospital will buy it” I said. “But we cannot give a quotation for the Rs. 1100/- tripod. It is the one we sell without receipt” whispered another salesman in my salesman’s ear. I heard it anyway. “Please meet the boss for a quotation” the salesman said, suddenly adopting an evasive maneuver. The boss was even more evasive. He kept chatting with a visitor rather than attend to me. Finally he asked the salesman to show me high-end tripods, rather than the ones he had shown me. “I am content with these” I said. “My handicam does not require a heavy tripod.” “No, no” the boss said. “Nothing but the best for a costly thing like a handicam. Give him a quotation for the tripods.” Salesman number one disappeared into the inner room to make a quotation. He appeared after some time and asked for detailed name and address of my hospital. Then he disappeared again and would not come out. After 20 minutes of waiting I told the other guy to cancel the request for quotation, and left. He appeared quite relieved. They seemd to have a thriving business of non-receipt sales – smuggled goods perhaps? While I was waiting, he had shown a couple of cameras costing Rs. 32000/- and 29000/- to a buyer, saying ‘no receipt’ firmly when asked about it. Finally I reached the third store in that area. It was somewhat crowded. I waited. When the elderly salesman who was looking quite harassed asked me what I wanted, I told him I wanted a tripod. He turned to the showcases behind him, thought awhile, and was finally distracted by a disgruntled customer. After dealing with him, he just stood there breathing deeply, probably to relieve stress. I kept waiting patiently, looking at him steadily. He came to after some time, found me waiting, and asked, “What was it you wanted?” “I don’t know” I heard myself say in a wondering sort of voice. “It has been so long that I have now forgotten what it was that I wanted.” He looked starteled. Then he searched my face for guile, probably found none, and smiled. “I want a tripod” I said. “We have only this” he said and produced a baby tripod. If I mounted my handycam on it and shot operation videos, I would be recording the underside of the OT table, and drawing suspicious stares from people in the operation theater. “I am afraid I need something taller” I said. “Thanks.” My purchase of a tripod seems to be jinxed. I am waiting until an inner voice tells me ‘it is all clear, go ahead and buy one’.

Pedema

We were conducting a maternal mortality audit. My Registrar was presenting a case of a maternal death. She had had severe preeclampsia with a lot of complications. “Her general condition was poor” he said. “Her pulse rate was 110 per minute, respiratory rate was 32 per minute, and blood pressure 180/120 mm Hg. She had moderate pallor and moderate pedema.” Pedema? That was a new one. I have known many generations of resident doctors and generally I can guess what they mean. It was just that I had not anticipated such a word. “Do you mean pedal edema?” I asked. “Yes, Sir. She had moderate pedal edema.” I could see he was tense. His fingers had tremors which I could see from a distance even without wearing mu bifocals. “OK. Relax. Take a couple of deep breaths. Don’t worry. No one is going to hang you.We know you did not kill that woman.” He smiled, took a couple of deep breaths and then continued his presentation. He did not use any unknown words thereafter that day. A month later, we were conducting another maternal mortality audit. A Registrar of another unit was presenting a case of preeclampsia. “…. And she had pedema….” She said. I did not interrupt her. I knew what pedema was. Her hands were trembling too. It must be the tension of presenting a case in front of a large audience, or perhaps grief at the death of a woman. When I narrated the story to my wife, she said “they must be using that word when they SMS one another.” That sounded quite likely. So I asked my Registrar if they SMSed one another about the cases admitted when they were on emergency duty. “No, Sir. We call one another on our mobile phones.” These two Registrars are not sibs. Otherwise I could have put the use of the same word as a family practice. Now I have to speak to the other unit Registrar how she used the word ‘pedema’. I talked to both the Registrars independently. They confirmed that they did not SMS anyone about pedal edema, that they had not heard the word before from anyone else and also from themselves, and they had uttered it when tense. Some linguist can work on this to advance some theory on origin of words.

Z-shaped Screw

I don’t know if they make z-shaped screw. They probably don’t because the market for such screws would be extremely limited. I tried to find one in the hardware stores around my house, but could not. You will wonder why I would need one shaped like Z. I would have thought the same until today morning. It so happened that we got a new mirror for the dressing table. It had to be fitted in such a manner that the drawer above it would open without having to take the mirror down. But the mirror manufacturer had thought differently, and had put the slot for hanging the mirror 1.5” from the edge. So the upper edge of the mirror would overlap the door of the drawer. If only I could fit the screw at the right place and the head of the screw would be 1.5” lower! As I thought this, I got the idea that a Z-shaped screw would do the trick. So I went on round of the stores and failed to find one. I am not beaten that easily. If they don’t make such screws, I will modify one into that shape, I thought. Then I found a long screw of appropriate size of the head. I used two pliers to hold it and bent it with a twisting force for the first bend and a hammer for the second bend. It turned out to be OK, but could not be fitted with a screw driver. I used pliers to hold it end on and screwed it in. Now the mirror stands there proudly. I wonder if I could have found a carpenter to visit us for fitting one screw, and more important, to design a screw like that.

Smoke Alarm

They have made our department quite different from what it was in the past. The people are the same, and the work done is the same, but the building is different. One example is the smoke alarms everywhere. There are those smart-looking white square boxes emitting red flashes periodically. They look quite impressive. We were in the middle of a maternal mortality audit (not another one, the same one I wrote about last time) when there was a persistent faint siren-like noise. I put my ear close to the laptop and the LCD projector, but the noise was not coming from either of the two. We went on with the meeting. The next day my Associate Professor told me that the noise was the smoke alarm. “What caused it to go off?” I asked. “I don’t know.” “Does anybody know what set off the alarm?” I asked. No one knew. “Perhaps they were testing it” I said. “They should tell us if they test it. Or there can be panic.” That was right. But these people are known to do wrong things by choice too. “Perhaps some worker took a smoke break.” “They are not allowed to smoke by the contractor.” “Perhaps our OT servant smoked. Their room used to be a smoke room before repair and renovation.” That was probably the right reason, but my people were not satisfied. “Perhaps it was our Profess XX XXXX’s perfume” I said. The whole second floor corridor was thick with that musk just before the meeting. I must warn against its use.” They seemed to like that one.