Virtual Bags for Waste Disposal

The world has some parts which have a lot of resources and a lot of money to spend on those resources. Then there are some parts where both are scant. These parts are of two types - one part likes to think they have enough of resources and money, and their situation is as ideal as in the affluent parts. The other type knows it is poor and behaves accordingly.
When the hospital infection committee started functioning, I was made a member. I knew we belonged to the non affluent group, and myself preferred to behave accordingly. The chairman of the committee believed we had a plenty and wanted to behave as such. When the matter of waste disposal came up, the decision was made to follow the universal rule - black bags for household waste, red bags for biohazardous non-sharp waste, and yellow bags for body parts.
"Do we have funds for such wastage on bags?" I asked. "We might dispose off the household waste like the whole city does. Why use bags? They will not get biodegraded too."
"We have enough funds. We must follow rules."
I kept quiet. One of the big bosses even declared that the bags were biodegradable plastic. I could not confirm that despite extensive research. But they did not want my opinion. They had all three types of bags to start with. They situation was as shown below.

Then the supply and funds started running out. The servants started using one bag for another type which was not available. The nurses had innovative thinking. They put labels on the walls behind the bags as shown below, so that people would know what should be thrown into which bag. They situation was as shown below.

How the waste managers would identify the contents of the bags when the bags were taken away leaving the labels behind is beyond my imagination. Finally all supply stopped. Then they started throwing the waste in sterile plastic surgical drapes placed inside plastic drums or buckets. All bigwigs who had maintained we have everything a plenty have superannuated and gone away.  The members and enforcers of the infection committee are not to be seen around. So I cannot ask them if they still believed we had a plenty. I had resigned from the infection committee long ago because I could not live with pretense. So I don't know what is their take on the current situation. I had known I was right, but I had not wanted myself to be proved right in this way.

Structural Warning

When they repaired the old hospital building, it looked nice and shiny and everyone was happy. Usually the servants would sweep and mop my office floor to keep it looking good. But they would not clean the window sill, Oe day they sent a new servant who was temporary and wanted to make a good impression. So he cleaned the windows and the window sill.
"Sir, the outside wall is all cracked up" he said.
"Huh?" I said. The wall was not cracked up before the repairing work. How could they produce a crack in it by repairing work? Anyway I went to have a look, because if there was a crack, it had to be repaired before the warranty ran out.

There was really a big crack running pretty deep.
"Sir, do not lean on the wall here" he warned. "You might fall out of the room if the wall collapses."
He sounded so matter of fact about it that I knew he must have seen it happen. I dared not ask him when he had seen that happen, because it might have been a tragedy involving near and dear ones.
"I won't" I said. "Thamk you for bringing it to my attention."
Then I sent a letter to the chief asking for a structural audit of the newly repaired building to check if it was safe for occupation. Our civil engineer came, had a look at it, learned that there were other defects in the repair work too, and fixed up a meeting with chief, concerned heads of department, and engineer from civic head office. The said engineer came for the meeting, checked his files to see if I had certified the work as satisfactory, failed to find it, and went away with the understanding that he would come the next day and check out all problems. That was long ago. He has not come. I am thinking of putting a warning on that wall for visitors. I am not leaning on that wall. But if my blog stops being updated, one of the possible reasons might be that I forgot and leaned on the wall. :-)

Patient Dumping Trolley

I have seen dumping trucks which are used in building and construction business. They load them with sand or stones and take them to the construction site. At the desired site, the park the truck and elevate the front of the container so that the contents are dumped on the ground. It is a motorized procedure. Some of the new trolleys supplied by the contractor are innovative, seem to be built on similar principles. They were like other trolleys initially. But they evolved with time. In the new state, when the trolley is raised by pumping on a foot pedal, the head end goes up, until it is so steep that the patient slides down the trolley.

"Sir, the patients will fall down from the trolley" the House Officer said when I saw this first.
"They do not come for repairing it" the Sister in charge said :despite repeated calls."
"As it is, there is shortage of servants for shifting patients" someone said, "the patient's relatives often have to pull the trolleys."
"Perhaps someone with out of the box thinking has developed these trolleys" someone else said. One just takes the trolley to the patient's bed, and raises the head end, so that the patient slides off and gets on the bed."
That sounded sarcastic, but perhaps it was the truth.
"Don't use it that way" I advised.

Innovations in Theater Technique: Surgical Gowns

It is wonderful the human mind works. It is even more wonderful when the mind belongs to an intelligent person. I appreciated the surgical repair of a torn surgical gown achieved by one of our resident doctors. It seems it had to be done because the gown was otherwise OK, and we could not just discard it owing to a big operation list and a limited supply of sterile gowns. If they had waited for a new lot of gowns to be ready, they would have had to postpone a few operations for lack of time.

The torn portion was held at the center, and a ligature of a rolled up piece of sterile gauze was tied all around it over intact portion. It was something like burial of the stump after an appendectomy. After the operation was over, the gown was sent for repair by the tailor.

Patients in a Hurry

Life in Mumbai is always on the fast track. So it would not be surprising if the patients are in a hurry to get their treatment and do away. But one would think they would want the doctor to listen to them patiently, check them up thoroughly, and get their treatment explained properly before making a move. Well, some of them are in a greater hurry than most of the others.
I see a number of women who get on the examination table after waiting for an hour or two. They should want to spend some time with the doctor after such a long wait. But I find that when I finish with a speculum examination, put the speculum away and turn back to check them up internally, , they are already up from the examination table. Surely getting up before the doctor says he is done with the check-up is a sign of a hurry? I have seen so many such patients, that now I do not get surprised by this behavior any more.
But something happened today that would beat this hurry. We had a patient scheduled to undergo a gynecological surgical procedure. The anesthesiologist gave her a spinal block after a bit of difficulty. When he finished the administration of the block, he said with satisfaction "OK, done!" As soon as he said this, the patient got up from the operation table and started stepping down to go back to her ward. We had to stop her and put her back on the table.
"....!" the anesthesiologist said.
"We could have allowed her to walk until we found out when she could walk no more. That would have made a good case report. The vice chancellor of the health university wants us to do research or he will stop our promotions" someone said.
"....!" the anesthesiologist said.

Concealed Plumbing: Heritage Style

People define heritage in different ways, not based on which dictionary they use, but what their occupation is. The architectural consultant who planned and got executed the repair and renovation of our building possibly interpreted it as something that must be seen from the outside (what they call facade of the structure) as it was when the structure was created. Probably in order not to mar the beauty of the building in any way, he has put the drainage trap in plain view of the operation theaters, staff room, and corridors.

Probably the heritage, in his opinion, lies in what people can see from the outside rather than what the contents of the structure are in reality, both physical and traditional. I recall when one of them started leaking soon after we moved in, and the whole corridor was flooded by the waterfall - what could be termed 'heritage waterfall'. It was fixed somehow - I hope not by a bypass.

Adults Stuck in Childhood

Sigmund Freud proposed that some people get stuck in oral phase and some others in anal phase. I am no psychiatrist, but I feel with conviction that all people remain stuck in their childhood. As they grow, they just do things differently, but they think as they did as children when their guard is down. That would explain adult pranksters' pranks. That would explain adult bullies. That would also explain why some women throw tantrums when stressed, while others sulk or cry.
We had this three day workshop on research methodologies, where senior faculty were made to be students. Senior consultants were children in school again. Many ran away from class periodically - some to do child things, some to do adult things, and many to get away from boring stuff. When asked what 'statistics' was, one frankly said 'boring'. Some of them refused to sit at tables assigned to them and were absent for group activities. A few came to class in fancy dresses like six year old girls. Some of these women-girls giggled uncontrollably at times while the men-boys looked on uncomprehendingly. Some of them refused to concentrate when a session got prolonged and the lunch hour was past without any lunch. One came on the first day and disappeared for the remaining two days. One took special leave for three days, attended on the first day, declared it was toxic stuff and did not come on the second day, came back on the last day hoping the absence on the day in between would not be noticed. This one even cheated, because the special leave granted for academic work was used for having fun at home. They checked their notes when answering the post test, and they even took help from supervisors and neighbors.
I rest my case.

Ultimate Faith or Cute Thinking?

She was a young woman. She came to us with a complaint of white discharge. She had some infection, which was treated appropriately.
"Doctor, I still have some discharge" she said.
"Do you have any itching" I asked.
"No. But the discharge comes off and and on" she said.
"With respect to the beginning of the cycle, could you tell me when it is sen and when it is not?" I asked her.
"It is seen about 2 weeks from the beginning of the cycle" she said.
I checked her and found nothing wrong with her. It was physiological discharge. I had to explaint it to her.
"This discharge is natural. Ovulation takes place about 14 days after the beginning of a 28 day cycle. If the discharge is abundant and watery at this time, the sperm find it easier to travel up and fertilize the ovum. It is the arrangement made by God so that women can have babies. Who am I to try and stop God's wish and who are you to wish it stopped?" I said.
"But I have had a sterilization operation" she said. "Now I don't need the discharge."
I was speechless. She believed in God and was innocent enough to believe that God would stop the discharge when He realized that she had undergone sterilization and did not need it any more. Served me right to bring God into it, when I could have said it was the way human body was made.
"God probably cannot keep watching what every human being needs and change physiology accordingly" I told her. "Be happy there is nothing wrong with you and live happily with what He has given you."
She went away not unhappy.

Schizophrenic Wiring

I had had no occasion to examine the electric wiring done in the examination room of that ward, except that of the examination light. It had seemed OK. It came as a surprise to me when I happened to look at the back of the storage shelves. The contractor, as per the design of the architectural consultant for the heritage building, had put up an electric board with sockets behind the shelves, as shown below. The arrows indicate the vertical divider of the storage shelf.

"Sister, how do you use this electric socket?" I asked the nurse on duty. "This three-pin socket has its one hole on one side of the vertical dividing stone slab of the shelf, upper hole almost behind the divider, and the other lower hole is also behind the divider, but obliquely accessible from the other side. How do you put a three-pin plug into it?"
"We don't" she said. "We have never had occasion to use it."
"So the contractor got his payment, the consultant got 10% of that amount as his fee, and the users are without the benefit of the great work!" I said.
"It must be lack of coordination between the civil and electrical contractors" my Assistant Professor said.
"The consultant made great drawings in Autocad" I said "with precision of millimeters. The civil and electrical contractors do not need to coordinate. They just have to work according to the drawings."
"Well, then what went wrong?"
"God knows. Perhaps the consultant wanted to make the work suit the hospital environment. Perhaps he thought this was a psychiatric ward, and he put a split socket to suit the split personalities of the patients in the ward."
"Sir, he knew it was an obstetric ward."
"I know he knew" I said. "I was just joking."

Hardware with Emotions

I would not have believed it if anyone had told me this story. ‘Fibber’ I would have said if I had been a small boy and another boy had told me this. As a young adult, I would have said ‘Are you trying to be funny?’ As a mature adult (meaning old man) I would have probably ignored to story teller as a foolish person, and not said anything, because there is no point telling a fool that he is a fool. But it happened to me, and I am telling the story. So I cannot take any of these stands.

I am still using a desktop computer and the conventional hardware that goes with it. I have a mouse that has served me OK for quite some time. Then it started acting up. The left mouse button would not produce a click on clicking it, or it would click three or four times like a machine gun, producing four windows when I wanted only one. This became especially troublesome when I was using a graphics software. In place of a continuous line, I would get a segmented line. I should have got a new one, but somehow it remained to be done. One day the mouse got so bad, that the left button would not produce any effect no matter how many times I clicked and with how much force. Work stopped. I normally do not get angry with my hardware because it is inanimate. But that day I had such a rage that I lifted the mouse and slammed it on the desk surface. I half expected it to break into pieces. It did not. I tentatively clicked it a few times and it worked like a charm. That reminded me of radio sets which used to get OK with such treatment when I was small. Well, this corrected mouse worked well for a few days and then started going bad again I decided to buy a new one before it stopped totally – after all, slamming it hard might not have worked a second time. So I bought one and kept it in its box pack near the old mouse, planning to attach it the next day. I have not had to attach it for a week now, because the old mouse has started showing exemplary behavior. It does not miss a click, and does not show any confusion between right and left.

You may say it is just coincidence. But two coincidences in a row is a bit too much. I want to believe (even if it sounds irrational) that the old mouse is like a child – it behaves under threat of a beating, and behaves even better when it fears a new mouse will replace it. I am glad I am not in Norway or US, where they put Indian adults in jail for disciplining their own children. I am afraid the PETA activists might read this post and start a demonstration in front of my house tomorrow, for showing cruelty to an animal (even if it is hardware). :-)

Cesarean Section: 3 Unique Difficulties

My Resident doctors presented a seminar on difficulties in cesarean section. They did a good job, listing all possible difficulties and then giving their solutions. At the end I felt compelled to narrate three unique case reports, (not my own, but which I knew of) because I thought they should not encounter them sometime without knowing about them.
Case 1: Where is the uterine incision
They performed a lower segment cesarean section and delivered the baby. Then they started defining the lower segment incision so that it could be sutured up. There was no incision. The uterovesical fold was intact and there was no question of an incision being present underneath. It seems they called the consultant down, who gave it considerable thought and finally found the uterine incision on the posterior wall of the lower segment. The explanation was that the uterus had dextrorotated through 180 degrees, and they had not corrected it prior to making the incision. I have heard of two such cases in 32 years. Both patients made uneventful recovery.
Case 2: Where is the uterus?
A lower segment cesarean section being performed in a case of previous cesarean section. The baby was delivered. One moment the uterus was there and the next moment it was not there.
"I just looked at the multipara monitor and in that time the uterus disappeared" the consultant assisting the operation said. "Where is the uterus?"
"It is in this only" the operating surgeon replied, pointing towards the placental mass and membranes in the field.
"What did you do when I was not watching you? the consultant asked.
"I made cord traction to deliver the placenta" the operating surgeon said.
Then the consultant discovered that it was a case of iatrogenic inversion of the uterus through the lower segment incision. The uterus was not seen because it was under the placental mass. He rapidly corrected the inversion. All this happened so rapidly that there was no hemodynamic change or shock. The patient made an uneventful recovery.
Case 3: Where is the baby?
The patient was taken to the oT for an emergency cesarean section for fetal distress in advanced labot. When the made the lower segment incision and put a hand inside the uterus to deliver the baby, they found there was no baby in there.
"Where is the baby?" shouted the operating surgeon.
There was a muffled cry in response, from under the surgical drapes over the patient's thighs. Someone lifted the drapes and found the baby there. It had delivered vaginally while they were approaching the lower segment surgically. The mother and baby made uneventful recovery.
"How did that happen?" someone asked me later.
"When the cesarean section is done in advanced labor for acute fetal distress, if the obstetrician is faster than the patient, the baby is delivered by a cesarean section. If the patient is faster than the obstetrician, she delivers the baby vaginally in the OT before a cesarean section can be performed. In this case both of them must have been equally fast, such that the woman delivered vaginally while the obstetrician reached the uterine cavity to take the baby out."