Chinese Torture vs Indian Torture

I had read about Chinese water torture as a child. In this form of torture, the victims was tied so that he could not move. Then cold water was dripped slowly on his head. The victim would go crazy waiting for the next drop to fall, perhaps imagining that the drip would make a hollow in his head like it does on a stone with a drip of water.
India and China being neighbors, I compared the Indian torture to this Chinese torture. In Indian torture the victims are not tied down, because they have nowhere to go where there would be no torture. Loud discordant noise (some call it music) is made, using instruments like huge drums, trumpets, electric banjos. The sound is amplified thousandfold using gigawatt speakers, sometimes banks of them. The sound is made while festive processions go along roads. The victims go crazy waiting for the procession to move on, which it doesn't. The noise vibrated violently not only the eardrums, but the rib cage and chordae tendinae in the heart too. I have put the processes down graphically here. Putting down the tactile part of the Chinese torture and auditory auditory part of the Indian torture is beyond the scope of the current Internet technology.

The Chinese torture is shown on the left, while the Indian torture is shown on the right. A comparative table is as follows.

Variable	Chine torture	Indian torture
Number of victims	One at a time	Thousands
Cost	Inexpensive	Expensive
Onset of effect	Slow	Immediate
Nature of effect	Psychological	Physical and psychological
Intention	Revenge Extract information Extract cooperation	Sadistic pleasure? Ignorant pleasure? Herd mentality?

My comments: I am one of the victims. You can guess my comments. I say 'no comments' because there is a report in the newspapers today, of an activist being thrashed by police because he went to complain against sound pollution caused by such noisy revelry.

Best Employee Award

The Institute celebrates its foundation day religiously every year. One part of the celebrations is to award best xxxx awards. There are best doctors, best residents, best office workers, best servants, and dome more. Some of them get the award more than once, I heard. The process is that the head of that section makes a recommendation. Then different committees presumably deliberate over the nominations and choose one each. Selection of committee members is by an unknown process. Selection criteria are best known to the committee members, I presume. The best xxxx people fill half the auditorium.
I was forced to attend one such function once, because a donor was to give an endoscopy camera to my department, and he wanted to give it in front of all people and immortalize the even with photographs. While I was waiting, I happened to see a servant sitting in the group of award winners. I was stunned.
"See that fellow" I said to my Assistant Professor, who was keeping me company. "he was in our department. He would be drunk on duty."
"He seems to be drunk even now. His eyes are red."
"He would disappear from the department every now and then. He would take people to different outpatient clinics, claim they were his relatives and get them preferential treatment. They would then take him to the canteen, or perhaps please him some other way. We got him transferred elsewhere because they would not terminate him and we wanted someone who actually worked. he pleaded with us, but we did not take him back. He managed to come back after a couple of years when someone retired from a light job and there was a vacancy. After some time we got him sent elsewhere again, because he had not changed his ways.. He pleaded again, with similar results as the last time. Now he is here to receive the best servant's award."
"How?"
"His section chief must have recommended his name, or his section chief must head the selection committee or be on the committee" I said.
"Perhaps he is just sitting there, and does not get an award."
That was just wishful thinking. His name was called and he got the award.
"This is how they do these things?"
"This is how they do these things" I said.
After we returned to the department, a laboratory technician who got an award came to see me. His name was recommended because he was to retire soon after and he had not done anything wrong while he served.
Sir, look at my certificate" he said.
I looked at it. It was a printed certificate, with blanks filled in.
"They have not even cancelled Mrs from the 'Mr/Mrs/Ms' part!" I said. "They could not do even that?"
'Yes" he said sadly and went away.

Medical Violence

The most common place of violence is in the movies. It is both general violence and violence against women. Going by media coverage and social media anger, the most common place for the violence against women would be Delhi and Mumbai, though by crime records it is anywhere in certain states in the country.
No one has talked about medical violence yet. That does not mean it does not exist. There is that occasional doctor who threatens to slap a woman screaming in pain in labor, unless she stops screaming. There was that House Officer a few years ago who had touched a woman's nose with the scissors he was holding while conducting childbirth, and said,
"Stop screaming or I will cut off your nose." She stopped, saved her nose, and now he is somewhere in UK. I trust he does not indulge in such practices there, or they would have deported him minus his nose long ago.
I have heard of House Officers who have slapped patients' thighs to stop non co-operation during childbirth.
"She was absolutely hysterical." the explanation would be given. "When I slapped her thigh (the only part nearby) she suddenly became co-operative and the delivery took place safely."
I had been aghast whenever I heard these stories. I thought nothing could be worse. I was wrong. Just the other day I heard another one that would beat any other story.
"He was Registrar when I was A House Officer" the story teller said. "He was quite rough on patients, many times abusive and at times violent. I remember two patients in particular. He had dislocated a patient's jaw once by slapping her face. The other one was given a broken finger. The reason was that they became hysterical with labor pains."
"Huh?" I was aghast again, this time more than at the previous times. "What does he do these days?" I thought he would have been stopped from practicing by some patient who went to a court against him.
"He is still around, practicing obstetrics and gynecology."
Lucky fellow and unlucky patients!

Anecdotes In Medical Teaching

I used to love my books when I was a student and I still do. I loved all books of Obstetrics and Gynecology, because I loved that subject. But I loved two more than others - Operative Gynecology by Munro-Kerr and Practical Obstetric Problems by Ian Donald. They were masterpieces like many others, no doubt. But what made them more enjoyable was that there were stories in them - what people call anecdotes - which left a lasting impression on the reader's mind. I enjoyed anecdotes told by my teachers too.  When I became a clinician and a teacher, I started telling my own stories when I taught, and believed they enjoyed my teaching more because of the stories. I even recall an undergrad who had told me that lectures were boring, and teachers should be taught how to make their lectures interesting. So anecdotes must be good for students' learning.
I was teaching the undergrads ectopic pregnancy. I told them a couple of stories, one of which was in my opinion particularly moving and the lesson it taught was very important. It was about a 28 years old woman who was being operated on by the Registrar when I was a Lecturer. She had an unruptured ectopic pregnancy. There was no endoscopic surgery in those days. When he was holding the ectopic pregnancy and the ovary in his hand and was about to remove them both, I told him "remove only the tube, not the ovary." That was important because she needed her ovaries for the hormones they produced.
"Remove the ovary" instructed the Boss, who I believe did it to spite me rather than for any scientific reason.
"Where is the other ovary?" I asked.
"The other side is buried under adhesions. The ovary should be in there somewhere" the Registrar said.
"Remove the ovary" the boss repeated. Since they both wanted to remove the ovary and the Boss had passed her decision to do so, I kept quiet. When we were taking a ward round the next day and reached this patient, the Registrar told us,
"She brought her old case papers. She had undergone an exploration in the past for an ectopic pregnancy, at which time the other tube and ovary had been removed."
There was silence for a few seconds. Then I broke it.
"You have given her surgical menopause at the age of 28 years" I said. The Boss said nothing. The Boss did not learn to take my valid suggestions and continued to act in exactly opposite way for years afterwards, which hurt me because it hurt a lot of patients.
I told the students to remember never to remove the ovary in a case of tubal ectopic pregnancy. It had been in a class of 180 students. I did not know how many of my clinical posting students were present that day. So I asked them the next week if they had attended the lecture. Most of them were noncommittal. Some looked doubtful. So I asked them to tell me the story I had told them during the lecture. Then 4 out of 10 admitted they had been absent, three maintained they were present but did not remember the story, one remembered another thing that happened to him during the lecture, and only one said the story was something about removal of an ovary.
That destroyed my belief that anecdotes made students remember things taught in lectures better.

Chloasma - Radical Cure

She was a young woman in her second pregnancy. She was one among many in our outpatient clinic. But she was different. There was something distinctly unusual about her face.

"What happened to you?" I asked her, looking at her face.
"Doctor, I had this blackish pigmentation on my cheek bones. My husband went to a chemist, who gave him a cream that he said would cure me. I applied it to the pigmented area" she said.
"Ah!" I said.
"The skin just came off the next day. Then I went to the skin specialist in this hospital. He prescribed me some cream. Now I am much better after using that."
"That's good" I said. She had chloasma, and thanks to the chemist, she had no skin where there had been chloasma. There was just a raw pink area. It was a chemical burn, which was now thankfully healing.
"Will it remain like this?" she asked. I knew she must have asked the same question to the dermatologist too.
"It will heal" I said, avoiding to say what percentage of the original skin texture would be restored. "Did you not have such pigmentation in your first pregnancy?" I was wondering why she had tried such treatment only in her second pregnancy. After all, it occurred in susceptible women in successive pregnancies, and also with the use of combination type of oral contraceptive pills.
"No" she said. I thought there was some regret in her voice, though she did not voice the reason for that regret. She went away. Her experience reminded me of a popular skin preparation in market in my younger days. There used to be ads of that in the newspapers, claiming it cured all skin maladies.
"It removes all skin lesions" our dermatology professor had told us. It removes all skin it is applied to. naturally there is no skin disease left behind. Then we have to work on restoring the skin when the patient reaches us." Now I did not see such ads, but that or a similar product seemed to be in market.

DNR and DNCP

'Do not resuscitate' is an order that is given to the doctors and paramedics by a patient, before he/she reaches the stage that would require resuscitation. It is done by some people who have lived (in their opinion) enough, and do not wish to be traumatized to be kept alive at all costs. Perhaps it is given by some who have a terminal illness and do not want to live a life with handicaps after resuscitation. It is signed by the patient and his/her physician. I suppose there is some legality too, such as a witness and a magistrate to sign it. The medical power of attorney is given to a relative in some cases. The ethical and social aspects of DNR are not under discussion at this moment. I just wanted it defined for comparison to something I call DNCP.

Once there was a condolence meeting in our institute, after the death of an eminent consultant who had retired long ago. The family members were called. A number of past faculty turned up. Some office bearers of medical political bodies turned up too. The highlights were as follows.

1. Many of them spoke, some briefly, some until they were stopped by others.
2. Some of them spoke good things about the deceased.
3. Most of them spoke about themselves more than about the deceased.
4. Some of them spoke exclusively about themselves, making brief references to the deceased.
5. Someone said "he was wonderful. He learned from me, his student!"
6. Someone said "we had such a grand time drinking together. He would love his glass of wxxxxy.".
7. Someone said "we were watching him perform a tubal reconstructive surgery. We were amazed he just knocked off the tubes!"
8. Some of them told funny anecdotes and a lot of people laughed, the speakers before the audience.
9. Some others said a few things I cannot bear to put in print.
10. All of these things were said while the bereaved family members sat there and listened.

I could not bear it and wanted to go away. But I could not because it would have hurt the family members further. But I decided to initiate a move in my department called DNCP - short for 'Do Not Condole Publicly'. Those staff members not wishing such indignity on themselves posthumously under the guise of condolence may fill up the prescribed form (which we still have to develop) and keep that in the DNCP file. In such cases we will just pay our respects by standing in silence for five minutes.

Adhesive in Obstetrics

We have a few fetal heart rate monitors. We unfortunately have problems related to their use which outnumber them in a ratio of 2:1 to 3:1. The problems are not related to the hardware. They are related to the end users.
We were seeing our patients in the labor ward. On my way out, I saw a resident doctor who saw me at the same time, stopped in her tracks and ran back to the labor room. My sixth sense me go to the labor room, while I was wondering what I expected to see there. I found that there was a single patient in labor. Her fetal heart sounds were being monitored by this resident using a monitor. The transducer for fetal heart rate was held manually on her tummy by the resident, instead of being strapped with a nylon belt. I realized what the sixth sense had sensed. I had reason to worry about the transducer, because the quartz crystal inside breaks when the transducer falls down. It cannot be glued back. Replacing it takes a few thousand rupees, and a lot more number of months (not in thousands) going by the speed of work of the civic body workers.
"Who was holding the transducer in place?" I asked the resident. There was no answer.
"Was the patient holding it herself, was God's hand holding it, or the conducting jelly holding it?" I asked.
She did quick mental calculations, decided not to drag God into it, not lie since I was known to verify such answers by asking the patient about it, and said "The jelly was holding it".
"You have worked in my unit for 6 months. I think we both have failed in getting proper education for you. Or you would not do such a thing, knowing full well how to do it, how not to do it, and the financial and management reasons behind the method of using the monitor." I did not wait  for the conventional 'Sorry, Sir' and went away, because there was more work to be done, and no degree of training seemed to work on her.
The next day found me taking a round of the same ward. There was another patient there, and another resident doctor. The fetal monitor was next to the patient, not in use at that moment. I picked up the transducer out of habit, and inspected it. It was covered by the conducting jelly, instead of being wiped clean as was the requirement.
"Did the doctor check you with this machine just now?" I asked the patient.
"Yes" she said and indicated the doctor concerned.
"Doctor, why have you not wiped the jelly off the transducer after using it?" I asked, though I knew the answer. The answer was she did not care or she was too lazy to do it. She knew I knew the answer. She just picked up a piece of gauze and proceeded to wipe the jelly.
"If the jelly dries on the transducer, it does not work well" I told her. "The manufacturer says that it must be wiped away after use. Which post are you doing?"
"Third" she answered briefly. She did not enjoy conversing with me, I thought.
"If you have not picked this up after one year and three months, the chances seem small that you ever will" I said and turned away because there seemed no point in stressing myself over an impossible situation. On my way out, I saw the resident doctor who had let the jelly do her job the previous day. My right brain had an idea and I called her to accompany me back to the labor ward. We reached the resident doctor who had left the jelly behind.
"Please put you mask down so that she can see your face" I requested the resident doctor in the ward. She did so, confused. "Dxxxxa, meet Nxxa" I said to the yesterday's resident doctor. "Nxxa, this is Dxxxxa" I said conversationally. Nxxa looked as if I was off my rocker. If both of them were from the same batch, obviously they knew each other. I should have known that. If she had known me, she would not have been so confused, I thought.
"I know you must have met before" I said. "I am introducing you to each other for a new quality that connects you together. Dxxxxa left the transducer on a patient's tummy yesterday, held there by jelly alone. You left jelly on a transducer today to let it become a sticky stuff, so that for Dxxxxa, some other doctor, or you yourself can leave the transducer on the next patient's tummy without anything like a belt or anyone holding it safely."
If they cannot remember the procedure of fetal heart rate monitoring despite clear and repeated instructions, perhaps a dose of sarcasm will make them remember it. Even as I thought so, I knew I was hoping against hope.

Stroking Self

"The Boss was stroking herself" a Professor reported.
I thought I had heard it wrong. A vision of a Kadak Laksmi (कडक लक्ष्मी, from Indian mythology) flashed before my eyes. The vision was something like this.

Then I thought the Professor meant something else. Perhaps it was 'giving herself strokes?'
"What do you mean?" I asked, worried I would hear the unthinkable.
"I had gone to meet the Boss on a matter of some importance. One thing led to another, and the Boss started talking about self. In the story I heard, the following lines were said. "I am very focused."; "My priorities are quite right. I know exactly what must be done."; "I am not influenced by anyone."; and some more in the same theme."
So it was psychological strokes, like one strokes a cat. I had read about it in transactional analysis.
"Why would the Boss do that?" I asked.
"Well, everyone wants strokes. If no one else would give them, one has to give them to oneself" came the answer with a grin.

Attitudes - 15

A pharmaceutical company's marketing executive and his boss were promoting their products to me.
"This is our preparation of calcium and vitamin D" the boss said as the executive held open his promotional catalog for me to admire. "It is useful for treating normal pregnant women, menopausal women and women with pregnancy induced hypertension."
I was surprised at the last indication. I checked what they had printed on the catalog. They had listed that as an indication in colorful print.
"It cannot be used to treat pregnancy induced hypertension" I said. "If you had said for prevention of this condition, I would have accepted it. But to treat? No way!"
"Of course it is" the boss said.
"Show me some evidence" I said "in the form of a scientific study published in a scientific journal."
"We will show you" he said. "Give me your mobile number and I will get it sent to you immediately."
"No. I prefer you show me the paper in print."
"That will take time" he said "to get it from Delhi to here".
"I can wait" I said. "What if you do not produce any evidence in one week?"
"Then you do not prescribe this product" he said.
"I will not prescribe this product for that indication anyway" I said, "because I know it is wrong. What I will do is write about you and your product on my blog for the whole world to be put wise. I could complain to appropriate authority about unethical marketing by giving wrong information. But I prefer not to waste my time on that."
He looked concerned. Then he decided to reason it out with me. "Do you at least agree that there is something called pregnancy induced hypertension?" he asked as the first step of the reasoning process.
It was at this point that I lost my patience. "Are you an obstetrician?" I asked him.
"No" he said.
"Then you are not qualified to discuss this issue with me. Come back with evidence in one week."
It has been 11 days since, and there is still no evidence produced by that company. I refrain from writing the name of the product. If the company retains this fellow, it deserves what it will get in the form of loss of sales. It deserves that anyway for wrongful promotion of its product. In the meantime I stay amazed that a marketing manager can have such poor skills and knowledge, and an even worse attitude.

Top Leadership Qualities - 1

There are a lot of 'leadership' self improvement books out there. There is the famous cartoon strip - 'Dilbert' that tells how it might not be. This is the first one in my series that might one day end up as an ebook on leadership.

Projectile Gloves

I was delivering a lecture to an assorted group. There were doctors, nurses, microbiologists and personnel from an NGO. The topic was 'hand washing, surgical scrub, and wearing surgical gown and gloves'. It was an unplanned lecture. I had to deliver that lecture with 15 minutes for preparation, because the organizers had not contacted the speaker I had suggested from my department, and there was no one to give it. So I had no slides. The NGOs offered me their slides. I declined because the slides did not say or show what I wanted. The other reason for not using their slides was that to me using slides made by someone else was like using someone else's toothbrush or clothes. So I spoke with plenty of demonstrations and miming and a few stories.
"Are there any questions?" I asked at the end.
"How do you remove gloves after an operation?" a young woman asked.
"I put my fingers under the edge of the glove at the back of my wrist, the least soiled part. Then I pull it out. I do the same on the other side. Since I wear two pair of gloves, I remove the other pair the same way as the first one. This way there is no risk of any contact between my skin and the blood and body fluids on my gloves." Then I had an idea. "One should not dispose off the gloves like this" I said and started my demonstration. The gloves I had on were sterile, used only for that demonstration.

"That is what gashing young surgeons used to do when I was a student. If the glove fell in the bucket, he was in his opinion a fine surgeon. I prefer to throw them in a red bag for disposal of biohazardous waste."
The microbiologists nodded approvingly.
(Note: I tried very hard to make my GIF animation above loop only once. I tried a number of software programs. None of them works when I put it in Google blog.)

Obstetrician Swordsmen

I had not thought there would be any confusion about operative steps that have been described in books. Now I realize time and again that I was wrong. The steps are often not learnt from text books, but from what a senior resident teaches the juniors. It is a chain in which one link goes out at the end of residency, and another one enters at the beginning. The knowledge base of the chain is carried forward, sometimes changed like Chinese whispers. When some of these residents become faculty, the science of Obstetrics and Gynecology changes.
The most recent example of this is as follows. A woman was undergoing an endocervical curettage and cervical biopsy under paracervical block. I had taught them how to administer that block, and I was secure in that knowledge. Unfortunately it had not been learned at all or had been unlearned. The woman was grimacing and moaning and was in pain. I investigated the cause and found that they had administered only half the dose and that too at not very appropriate place. I got the problem corrected and she settled down. That prompted me to conduct an in OT survey of how all of my people administered a paracervical block. The results are shown below.

Position of doctor	Volume	Position of injection	Depth of injection
1st year 1	10	4 and 8 o’ clock	2 cm
1st year 2	10	4 and 8 o’clock	2-3 cm
1st year 3	10	4 and 8 o’clock	2
2nd year 1	10	4 and 8 o’clock	Up to just below pelvic peritoneum
2nd year 2	10	4 and 8 o’clock	2-3 cm
2nd year 3	10	3 and 9 o’clock	2-3 cm
3rd year 1	10	3, 6, 9, 12 o’clock	2-3 cm
3rd year 2	10	4 and 8 o’clock	2-3 cm
Assistant Professor 1	10	4 and 8 o’clock	By judgment, varying from case to case, finally committed to 2-3 cm on forcing the answer.
Assistant Professor 2	20	4 and 8 o’clock	2.5 cm

All of them used 1% lignocaine, which was OK.  Only one Assistant Professor used 20 ml, all other fell short by 50%, which was not OK. Only one person used correctly 3 and 9 o'clock position. Why the others were stuck on 4 and 8 o'clock positions is explained by my theory elaborated at the beginning of this post. One was set on covering all bases and injected the drug at 12 and 6 o'clock too. All of them thrust the needle like swordsmen, deep enough to make a good job of it. Luckily no one thrust it right up to the hilt. I asked the same question to another resident doctor from another unit, to make sure that it was a phenomenon restricted to people in my unit. Her answer was similar, except that she thrust the needle for half its length.
"So it will be half an inch if the needle is 1 inch long, and 6 inches if the needle is 1 foot long" I said.
She made a face and settled on 2-3 cm.
"The right answer is1% lignocaine, 10 ml each at 3 and 9 o'clock positions, or 5 ml each at 4, 5, 7, and 8 o'clock positions, at a depth of 2-3 mm under the vaginal mucosa of the lateral fornix. Less drug or wrong position would not stop the pain, more than 3 mm depth would possibly puncture the uterine vessels and cause local bleeding and/or intravascular injection and complications like cardiac arrhythmia" I told them.

Waste Disposal: A Cat's Take

Though our hospital is meant for humans, it is flexible and it permits cats and dogs to roam its insides freely. Well, perhaps not so freely. I have not seen any in the intensive care units and operation theaters. But the rest of the areas seem open to them. Sometimes fun things happen with them around. One day I saw a toddler stalking a kitten just outside the postpartum sterilization ward. When I finished seeing patients in that ward and was going out, I found he had managed to catch the kitten by its tail, and lifted it in the air by the tail. The parent of the toddler rescued the kitten before catastrophe occurred.
I found the same kitten grown into a cat, sleeping in a wash basin that had been defunct for quite some time.

It was sleeping on a black bag that is meant to be used for disposal of household waste. Someone working in the ward had put the bag there so that the patients would not use the basin. When we reached the patient next to the basin, the cat woke up and looked at us with curiosity.

It decided we were harmless. It probably also decided to put on its cute expression for us.

I was impressed not so much by its expression, as much by its choice of the waste disposal bag. It knew sleeping on a red bag or a yellow bag would lead it to incineration. The black one was safe.
I thank our Associate Professor who took these snaps for me.

One Fetus Per Week

The sonologists had a busy time.
"Sir, this patient has undergone an ultrasonic scan three weeks ago. There was a single intrauterine fetus 5 weeks old" I was told.
"OK" I said. I sensed there was more, but could not guess what it was.
"They could not see the fetal pole that time. So they performed another scan after a week. That time they found two fetuses in the uterine cavity."
"Huh?"
"Yes, sir. Then they asked the patient to undergo another scan another week later, just to confirm which of the two sonologists was right. They took some time, argued a bit. The final verdict was three fetuses in the uterine cavity."
I was stunned. I had not known fetuses could multiply so late, and that too serially. :-)
"Now what?" I asked.
"Not the patient has refused to undergo another scan at the hands of those people. She thinks their technique or their machine or both together are causing her fetuses to multiply."
"In her place anybody would be scared. This must be the first case in the world literature. Why don't we publish it in a scientific journal?"
They had worked with me long enough to know when I said something that actually meant the opposite. They just grinned.

Why Students Fail

There was a debate on in the staff room. The topic was 'why postgraduate students fail'.
"Students fail because they do not study" one person said.
"Some of the failures are due to that" said another one.
"Some fail because the examiner wants them to fail" someone said bitterly. I had known about that. Some examiners were said to fail students of their presumed or actual rivals.
"In the last exam a few students failed because the examiners said their answers were absolutely wrong" complained one, "while actually the students were right. The statements were made as per latest postgraduate text books."
"Huh?" said the first person.
"Yes. These students read for three months to prepare themselves for their exams. Which examiner studies even for three days prior to conducting the exams?"
I knew that was true.
"The students should show the examiners the references" suggested someone.
"That is a sure way of inviting the wrath of the examiner" retorted the person who had made this claim.
"Is there no solution to this?" someone asked.
"The solution is to record the entire proceedings of the practical examination" I said. "Then there can be a third examiner who can review the proceedings and reassess the student. The student can even go to court against an unfair marking causing him to fail."
The examiners suddenly became quiet.

Impossible Situation

A young woman came to our outpatient clinic.
"Doctor, I think I may be pregnant" she said. "I performed a urine pregnancy test at home. But I am not sure of the result."
"What makes you think so?" I asked.
"There was one distinct line, and one faint line." she said and showed me the strip.
"It has two distinct lines" I said looking at the strip. "When did the faint line become distinct?"
"I don't know. May be I did it wrong."
I checked her up. The pregnancy was too early to detect by clinical examination.
"OK, we will perform the test again" I said. We got another pregnancy test kit, performed the test and asked her to wait. In the meantime another patient came for a similar complaint.
"Please get the test kit and come back" I told her. "We will perform the test."
She went away. After sometime she came back, with a test performed. It was a mess. Instead of three drops of urine, there was a flood of urine on the strip.
"Did you do the test yourself?" I asked her.
"No. The person in the lab gave me the kit and asked me to get it done by personnel here."
"Show me who did it" I said. She took me to the waiting area and showed me who had done it. It was our first patient. I was incredulous.
"Did you perform the test for this patient?" I asked her.
"Yes" she said. "She said she did not know how, so I did it for her."
Every time I believe I have seen it all, along comes someone who proves me wrong, and how!