Sexual Harassment of Men

It was a condolence meeting. As usual, people were more interested in telling their own encounters rather than grieving the loss of the deceased.
"Do you remember Madam XXX?" someone whispered to his neighbor in the row in front of me. "The one who just spoke?"
"Yes" the neighbor said. I looked at the speaker who had just paid condolences to the deceased. She had been faculty when I was a resident doctor.
"Do you know what she used to do?" the first one asked.
"What?" the neighbor asked in reply.
"She used to stand behind us guys while we were assisting an abdominal operation being performed by Sir. In order to see better, she would lean forward and put her entire front against our backs."
"......" was the neighbor's response.
'All of them together or one at a time?' I wondered.
"One at a time, of course," the first one said. I wondered how he read my thoughts, me sitting behind him and all. "But she treated all of us in turn."
'Treated?' I thought. 'That is touching students inappropriately. It is sexual harassment.'
'Did you work in her unit any time?" the first one asked.
"Yes" said the neighbor in a sort of strangled voice.
"So you know about it firsthand?"

"Yes" came the strangled reply. He actually blushed while the first one was leering. I could understand why both of them did not complain - the first one had enjoyed it, while the second one had been embarrassed and perhaps afraid too.

Rain Maker

He was supposed to be brilliant. I would not have known him but for his wife, who happened to be one of my resident doctors. They had been married before she came to work in our institute. She brought him to meet me much after her residency got over. He was PhD something from MIT or something in US. He had invented something and was making lots of money by marketing the product. I was happy for them.
One day he came to see me sans the wife. There had been some tiff and he wanted me to intervene so that she would see and follow his way.
"I have powers" he told me conversationally. "I belong to the elite few of the inner circle close to Lord Krishna."
I knew he was a devotee, but I had not known he had reached the inner circle.
"I can do things, but I do not want to use my powers on her" he said.
"Whew!" I thought.
"We of the inner circle have powers. For example, I can make it rain, and I can make it stop raining."
I looked out the window. It was a bright sunny day. I wished he would make it rain so that the heat would be bearable. He probably read my thoughts, but chose to ignore them. It did not rain.
"I love my wife. She says you are naive. Please tell her to change herself or there will be trouble" he said.
He went away. Probably he also thought I was naive. I must be naive. Every year when there is no rain, I think of him and wish he would make it rain. During the deluge on 26th July a few years ago I thought of him and wished he would make it stop raining and save lives. He could make more money hiring out his powers to governments than by selling his scientific product.
I am waiting for him to meet me again. I will request him to show me his ability to make it rain. I had not done so last time out of decency or perhaps being shell shocked after hearing about it. Now I am out of shock, and as curious as ever.

Stealing Faculty

"Did you receive my letter?" the fill in Boss asked me.
"No" I said.
"OK. I won't tell you now. Get disturbed when you get it." I got it any way.
"Um... I don;t think I will get disturbed. There is no point in it. I just want to do my job and go home" I said. Getting disturbed means having emotional attachment. I stopped having that when I realized the administrators don't care.
I got disturbed anyway. The letter was waiting for me in the department's office. Boss' Boss had sent an order temporarily shifting three of our Assistant Professors to two other civic medical college hospitals until further notice. My entire faculty was upset. Heads of Obstetrics and Gynecology departments of those two hospitals had been asking for our Assistant Professors for a long time, but we had refused because that was not civic procedure and we needed them for our recognition as teaching institute.
"This is autocratic" one person said.
"Will these two hospitals, both tertiary level centers, stop transferring patients to our institute now?" someone wondered.
"But one hospital has three qualified senior residents in each unit. An Assistant Professor just sits around" a third person said.
"And the other one has no patients. The faculty arrive at noon and go away no later than 2 P.M." another one piped.
"Many of the first hospital faculty arrive at noon or later. Don't you remember the Professor drawing salary from us but managing to get posted to work at that hospital used to take the entire unit for lunch followed by first show in cinema theaters in office hours?"
I remembered that one very vividly. She had managed to get that posting allegedly through Boss' Boss that time. There had been newspaper stories on that episode.
A couple of days later we had occasion to get even more upset. We heard from multiple sources that the Assistant Professors who had feigned shock at such transfer had themselves applied for the transfer.  There had been no apparent reason for wanting to go away. Two of them had been our own students.Not only had they done this without telling us, but had put their parent institute at risk of losing recognition by the medical council and health university.
'Ungrateful lot" someone said.
"What are we going to do about it?" someone asked.
"Nothing will reverse it" I said. "If our institute loses recognition because of this, we may have to  start looking for new jobs. You may be proactive and start doing that now."

Resident Doctors' Fast

Rapid Cervical Dilatation Difficulty

Rapid dilatation of the cervix is usually not difficult when one uses half graduated cervical dilators. It becomes even easier when the woman has been treated with 200 micrograms of misoprostol a few hours prior to the procedure. However once in a while one comes across a case in which the cervix refuses to get dilated beyond a certain size. If the intrauterine procedure planned cannot be achieved through the dilatation achieved, one is forced to try and achieve more dilatation of the cervix. What happen in such cases is as shown in 'A' of the following diagram.

With traction on the vulsellum applied to the anterior lip of the cervix (black arrow) and inward push on the cervical dilator (red arrow), the cervix tends to tear along the direction of the interrupted blue arrow, or the vulsellum cuts through the cervix and tears it at the site of its bite.
Considering the vectors at work, the only way to avoid both of these complications and achieve cervical dilatation is to apply one Allis' forceps on the anterior lip of the cervix, another on the posterior lip of the cervix, and then dilate the cervix, making traction on both of the Allis' forceps simultaneously. As shown in 'B' of the diagram above, the vectors of traction on cervix with Allis' forceps nullify each other, so that the push of the dilator acts along the cervical canal and cervix dilates without tear or cutting out of the instrument on the cervix.

Electronic Snooping and Us

I know that my email service providers read my emails. But I thought it was after I sent it. It came as quite a shock when I realized that it was read even before I sent it. I had received an email from someone. It had no content, nor was any file attached to it. I wrote back -
"There is no text in the email, nor is there any file attached to it. Perhaps it was an oversight?"
When I clicked on the send button, Gmail asked me "You have written 'file attached' but there is no file attached. Send the email anyway?"
It was rather nice and helpful of Gmail to notice something like this and ask me. It was also inadequate comprehension on the part of the electronic snooping, because I had not written I had attached a file. What was much more important was that they had read my email even before it was sent.
'What will Gmail do if I write words indicating terrorism, like bomb, gun, explosive, spy, or whatever they consider threatening in my email?" I wondered aloud. "Will they send the email, ask me to change the text, delete those words before sending the email, close my email account, or send federal agents to arrest me?"
"There was such a movement in US recently" someone told me. "The group decided to send an innocuous email containing such words scattered in the text, in large numbers to a lot of people on the same day, just to teach the electronic snoopers a lesson by throwing them into overdrive."
"What happened then? Did they send it?"
"Probably. The snoopers would not reveal what happened anyway."
"What if I send encrypted email? Will they sit and decrypt my text?" I asked.
"They might. But do you have anything important that you would like to keep from them?"
"No. I would do it because principally I would like my privacy maintained. On the other hand, thanks to these snoopers terror threats are aborted. They are doing it for all of us.I might as well help them by not encrypting my emails. They can use their time and resources thus saved on reading emails of terrorists."
"Do you know how to encrypt your emails?"
"Yes" I said. "I have Javascript code to encrypt my emails. Only after writing that code have I made a decision not to encrypt the emails, just so that no one would claim I would not do it because I did not know how."

Short Trial Of Labor

I recall learning by heart a very complicated and detailed definition of a trial of labor, when I was an undergraduate student. I read much more about it during my postgraduation, and some more subsequently. I heard a lot about a 'short trial of labor' from seniors, colleagues and juniors, but did not read about it anywhere. Considering the elaborate description of a trial of labor, there cannot exist anything like a short trial, nor a long trial. The duration of each trial is determined by a number of factors, and there are criteria about discontinuing trials, about calling them a success or a failure. Clearly a short trial of  labor exists only in a parallel obstetrics that a number of clinicians practice. Happily for them they are not called upon to write on evidence-based obstetrics. Unluckily for students, they become examiners and if the students stick to what they have learned from text books and journals, they can fail in exams at the hands of such examiners who probably believe such a thing actually exists. After all, have they not heard of it from their bosses when they were younger?
I conducted an opinion poll on 'short trial of labor'. Various answers received are listed below.

1. 'It is, um... shorter than a normal trial of labor.'
2. 'It is a trial to be terminated at the slightest indication of anything going wrong.'
3. 'It means a cesarean section is to be performed unless the gravida progresses really fast.'
4. 'If the woman does not deliver in two hours, the trial is said to have failed.'
5. '........' (this was the response of a lot of them).

My interpretation of the term is as follows.

1. It means a cesarean section is to be done based on one's personal feelings, but that does not sound right when one is in an academic institute.
2. One hopes that something will happen in the short period of the trial which will necessitate a cesarean section. On the other hand if it is God's wish that the woman delivers vaginally, she will have a rapid progress of labor and will deliver safely vaginally.

Doctors' Protection From TB

A number of Resident Doctors and Faculty in civic hospitals are reported to have got tuberculosis. The civic administration is reportedly concerned about it, if newspaper reports are anything to go by. Though we have not been told anything about it officially, I overheard a few things, and read with interest news reports.

These are not photo sketches. Any similarity to anyone's face will be purely coincidental.

Placenta: Fundal Or Previa?

“Sir, this patient is admitted for undergoing a cesarean section” my Registrar told me on ward round. “She has central placenta previa.”

“What is the gestational age?” I asked.

“Thirty seven weeks” came the answer.

“It is unusual for a central placenta previa not to bleed by this gestational age” I said. “Perhaps it is a placenta accreta, increta or percreta. Ask the sonologists to see if she has such a condition.”

“But she has had two normal deliveries before. It is unlikely she will have such a condition” piped my Assistant Professor.

“Why?” I asked.

“It is more common with a previous cesarean section” she said.

“It is not impossible that she will have one, is it?” I asked.

“Um… no” she said reluctantly.

“Is there any sensible reason not to perform an ultrasonic scan?” I asked.

“Um… no” she said reluctantly.

“Then let us do it in her interest” I said. “Another reason for doing it is that it may turn out to be a fundal placenta.”

“Fundal placenta?”

“Yes. When a novice sonographer hold the ultrasonic probe directed 180 degrees wrong, top become bottom and right becomes left. A fundal placenta becomes placenta previa and vertex becomes breech.”

There was no further argument, either because they were convinced, or because they gave up on me.

“Sir, we got the ultrasonic scan report of that patient” my Registrar told me in the afternoon. “It is fundal placenta” she smiled. She did not know how I did it. I knew how I did it. It was sheer logic and my experience with our sonographers.

“What shall we do now?” she asked.

“Send the patient home” I said. “She can deliver vaginally. Tell our Assistant Professor about this report, so that she will refrain from arguing with me in future.”

Shaving: Boss' Observations

It is almost universal truth that many high ranking officials in government and civic bodies have great wisdom, not only on topics in their field of work, but very often anything and everything anywhere and everywhere.
Our erstwhile Boss was once conducting a meeting of Heads of Departments. Somehow he started speaking on water management and the monologue veered on shaving.
"I know I should not be doing it. But when I shave, the tap is open. I have to have water running when I shave. I am sure you all do the same."
The men kept quiet. The women probably looked embarrassed. I did not look at the face of any of the women because I was thinking of my operation theater servants who kept blood soaked linen under running tap water until it got cleaned by the flow of water. No amount of counseling cured them of this habit, though there was a drought all over the state, including their home towns. So I don't know of my own knowledge that the women were embarrassed, but they must have been and the Boss must have seen the embarrassment on their faces, because he added as an afterthought,
"I mean the men present here who shave" and he made a gesture of shaving over his chin. That explained everything! I did not look at any women for fear of causing further embarrassment.
"I bet everyone does that. Who doesn't?"
I raised my hand. It was not as if I wanted him to know I kept the tap closed during shaving. I did not want all others to think I did, or to think that I was afraid to say I did not. The Boss looked at my hand, possibly the expression on my face if any, and ignored both the hand and the face.
I wonder if he still shaves with the tap open. He did not speak on this topic again until he left the institute.

Ranbeer, Deepika, and Martindale

I had written about one pharmaceutical marketing campaign taking disadvantage of goodwill of Harrison's Medicine textbook. Today they came up with another such campaign. Their representative showed me a visual about one of their products. There was a box shot of Martindale's pharmacopoeia, suggesting the entire book was devoted to this product of that company. This one was right next to the old one with Harrison's Medicine.
"You are still showing around box shots of famous books to promote your products?" I asked.
"Yes" she said in a low voice. Poor representative had to show what the bosses ordered.
"But Martindale would not help you" I said. "These young doctors sitting here in my outpatient clinic would not know what it was. If you put photos of Ranbeer and Deepika (two actors in Bollywood who are quite popular at present) and suggested they were using your medicine, you would have a great promotion of your products. Every youngster knows them."
She looked skeptical.
"I am willing to bet these young doctors won't know Martindale. If you will wait until I finish seeing these other medical sales representatives,we can ask the the doctors if they know Martindale."
She went away anyway and was nowhere to be seen soon after. I asked the doctors to write on a piece of paper who or what Martindale was. All House Officers, Registrars, one Assistant Professor (she gave a tentative correct answer after a while) and all but one Intern said they did not know who or what Martindale was. One intern wrote the name as Martin Dale. Another intern wrote it as Martin Dane and said he was a gynec researcher. I was aghast. The only Intern who answered it correctly looked quite bright.
"You are good" I told him. I don't remember seeing you during my lectures, but that does not matter."
"You would not have seen me" he said. "I am an extern."
""Ah!" I said. "Where are you from?"
"I am from B. J. Medical College, Pune."
"I have found guys from B.J. to be always good" I said. "Tell them I said so when you go back there. You will specialize in Internal Medicine, I suppose?"
He looked surprised for a moment and then said "I hope to."
I was not wrong about our crowd and I was not wrong about him either. Do I have a sixth sense or am I just experienced?"

Why They Do What They Do

We have this limited time in this life, and we should do everything that we love doing professionally. There is no point in doing things one does not like, because that does not give any sense of fulfillment, nor any happiness.
We have bright students who get into our prestigious institute after beating a lot of others in the merit list. One would believe they join medical colleges because they love becoming a doctor. Perhaps that is so. But I am yet to find all 10 out of 10 students present on the first day (and also on any of the subsequent days) of their clinical posting with us. The usual number is 5 or 6, the lowest is 0 or 1. The burning desire to learn something new is sadly nowhere to be seen. In a lecture hall, almost half the seats are empty, sometimes only 10% seats are occupied. I wonder why they do this, and what they do when they are away. I will say the girls seem much more interested than boys in attending the college.
We have postgraduates who join our institute by excelling in entrance tests. They would definitely be interested, one would think. We have quite a few who disappear, often without any intimation. Some of them do so periodically. We used to put off weddings until after postgraduation. One hears of career minded women putting off raising families so as to achieve career goals. Well, not in our line. A large number of women get married during residency, some have babies too. Their leaves for wedding extend from a few days to many weeks. The current trend seems to be 24 to 28 days. the longest reported is 41 days. The trend is reversed as compared to graduate students - more girls than boys seem to get away from residency for extended periods. One wonders why.

Coconut For Protection

A coconut is an important aspect of not only Indian diet, but also of Hindu mythology. It is believed to be God Shankar. It is put for worshiping in many households. It is offered as a gift when felicitating someone. It is also given along with an invitation to a wedding. Coconut shell is used as fuel by poor people. I thought all uses of a coconut had been exhausted. I heard of an unorthodox use when I was a student. One of our old surgery professors had alcoholic cirrhosis of the liver. He was admitted in a surgical ward. Alcohol was strictly forbidden. All visitors were watched closely, lest anyone slip him a bottle of liquor. But he was intelligent. He continued to get his supply. Before he died, it was discovered how. His friends would visit him, and bring coconut water in opened coconuts. What was believed to be coconut water used to be alcohol.
I learned of a new use of a coconut in our hospital recently.
.

There is a pointed metal spike driven into the ground near the college gate.It is probably meant for fastening the gate so that it is not swung open or closed accidentally. There is a barrier that prevents pedestrians and vehicles from passing through. It is raised for vehicles considered OK by the security guy at the gate. The pedestrians have to walk around the gate, and the spike is right in the middle of that space. In order to prevent foot injury by stepping on it, the security guys have placed an opened and empty coconut inverted over the spike. People see it, and go around or over it, but do not step on it. I have shown my 3D depiction of the spike and coconut here and not an actual photograph because taking photographs in the campus is prohibited, and making a model is far more pleasurable to me than taking a photograph anyway.

Pseudocyanosis

That woman in the postnatal ward had us all foxed. She seemed to be like any other normal woman in puerperium until our Registrar said,
"Sir, this patient has developed blueness of hands since yesterday morning."
We looked and were aghast.

Her both hands had become blue. There was a sharp line of demarcation, above which the skin color was like elsewhere on her body.
"Looks like cyanosis" I said.
"Peripheral vascular disease?" an Assistant Professor said. We checked the temperature of the affected part. It was normal. We checked the sensation and movements of the fingers. Both were normal. We checked the arterial pulse in the radial and brachial arteries. All were normal. The woman was enjoying all the attention she was getting.
"We may have to do doppler studies, though the vascularity of the limbs seems OK" I said.
"Have you got a new dress?" our Associate Professor asked the patient suddenly.
"Yes" she said and showed a new blue colored gown.
"Did your hand become blue after you washed it?"
"Yes" she said.
We all laughed the laughter of people relieved of great stress.
"Clothes of not very high quality tend to lose the dye used to color them on washing" the Associate Professor explained.
When we had another patient who had cherry red hands after a couple of months, we were not worried. We just looked at her hands, and she said "it is nothing. I got a new red dress, washed it, and it is the color of that dress on my hands."
I think the next one could be yellow or green.