PCPNDT Immunity

"Sir, the civic body wants to run a training course of ultrasonography in our hospital."
"So be it" I said.
"In our department. They want to give hands-on training to doctors working in peripheral civic hospitals. They are going to bring two ultrasound machines for the training."
"Huh?" I said. Being chairman of the PCPNDT Advisory Committee , I knew the PCPNDT act well. "They have to have the proposal passed by the Advisory Committee. The committee needs to see if the trainees qualify to be trained as per the act. The machines need to be registered for being brought here."
"..."
"I will speak to the concerned person" I said. That was easy, because they needed me to make arrangements locally. The officer in charge came to see me about it.
"We have to follow the act" I said. "If not, I hang, the violation of the act being done in my department."
"But there is no time, Sir" she said. "The Civic Boss wants the training done now."
"But you seal ultrasonography machines of private practitioners if they are no registered or if persons not registered under the act carry out ultrasonography. How can you commit both of those wrongs?"
"It is us who have to take that action against offenders. We will not take action against our own people" she said, appearing pained at having to explain such a simple thing to me.
I was speechless for some time. When I recovered, I said, "that is like Policemen committing crimes. They have to catch the criminals, and they will be safe if they do not catch their own. By newspaper reports, it seems such a thing happens sometimes. By the same reports, it seems there is a big stink and heads roll when this is found out. If you have to violate the PCPNDT Act, please do it elsewhere, not in my department."
After we repeated ourselves multiple times (through no fault of mine - I had to repeat myself when she repeated herself), she went to see the Boss. The Boss called me.
"Please explain the situation to me" the Boss said. The complainant sat there expecting compliance from me.
I explained the situation to the Boss. Then I said the penalty for violation of the PCPNDT Act was imprisonment and fine, and since the PCPNDT certificate was in the name of the Boss, the Boss was at risk of getting the punishment for violation of the act. That settled the issue.
"I knew there would be legal trouble when he objected to the arrangement" the Boss said, pointing at me. "We agree that this training is very important. But at the same time, we must follow the law very scrupulously. Get the necessary permissions and only then start the training."
The officer arranged an urgent meeting of the PCPNDT Advisory Committee. We got the certificate from the civic body the same day.
"That must have been the fastest permission given by the civic body in its entire history" someone said.
"No. It is the second fastest" a knowledgeable person said. "The fastest was given to the new civic hospital that was inaugurated recently by chief of the ruling party and Boss' Boss' Boss. It was given as soon as the day of inauguration was finalized, without going through the standard procedure of getting the proposal finalized and approved."
They all looked at me.
"The concerned officer told me the main Boss gave a temporary registration to that hospital, pending approval by the Advisory Committee."
"Does the act permit that? Was the proposal OK?" a principle centered person asked.
I smiled twice, once for each question, and said nothing.

Oil Can Engineering

Edible oil is available in plastic cans. We buy it in cans of capacity of 5 L. We transfer a small quantity at a time from that can to a small container, and replenish its contents as required. A problem with this system is that the oil pours out in an unruly manner. That makes the process messy, and wastes a bit of the oil too.
"See if you can fix this problem" my wife told me. I was home because I was on Diwali vacation. I was glad to have something to do. I had known the problem, having carried out the procedure myself once. I thought about it a bit, and realized that the oil poured out of the can creating a sort of empty space inside the can. The can had to suck in air before it could pour out more oil. That produced a very turbulent flow, waxing and waning, and spilling out in different directions with time. There had to be an inlet for air, so that the oil would pour out in a smooth flow. I burned two small holes in the hollow handle of the can using a heated nail. The fixed oil can looked like this (arrow on the holes).

Then I tilted the mouth of the can over the small container. The oil poured out in an even stream, spilling not one drop outside the container. After filling the small container, I put a piece of adhesive tape over the holes, so that air and bacteria would not enter it.
"That was wonderful" my wife said with a broad smile. "How did you think of it?"
"I must have remembered laws flows of fluids from school or college physics" I said. For those who have not been able to visualize what I have described, I have put the illustration below. The left part shows the unruly spill, and the right part shows the smooth flow after fixing the oil can.

Insult the Professor?

This one is about one of our Assistant Professors who left in search of greener pastures, as young people should do and do. We always train people, whether they be resident doctors or newly appointed Assistant Professors. Some of the latter are good when they come to us. Most of them are like the Resident doctors who have just passed M.S., but have not learned the nuances of the subject.
This one was OK. There were a few things that he/she* messed up a little. There was a particular operation that he/she had not understood well, and would not despite my instructions. I had a scientific article with illustrations that would be quite useful to him/her, I thought.
"Take that article from me on your pen drive and study it well" I said.
"OK" he/she said.
A month passed without any action, until the next time the same operation was attempted by him/her with similar confusion as ever. I asked him/her why he/she had not taken the article from me, despite a reminder in between.
"I am worried about virus" he/she said. "Can you not email me the article?"
"Don't worry," I said "I have AVG and Microsoft Security Essentials on my system. If your pen drive has a virus, my antivirus programs will remove it and not let my system get infected."
"Quick Heal is good" he/she said "which I have on my system." Then he/she left. He/she left the institute a few months later, without taking the article from me.
I thought about it a bit over a few days, and one day suddenly realized that he/she was worried about getting a virus from my system, not putting one into my system. I felt like one would if someone suggested that one had a dirty disease. I had built four computers from start, installed Windows innumerable times, installed antivirus software programs on multiple systems after researching on the merits and demerits of different ones, recovered data from pen drives and hard drives of people who had lost their data to viruses, and written two decision making software programs of my own in Visual Basic. After doing so much work, I thought no one would say such a thing about me. I did Google search and compared Quick Heal to the ones I was using. I was assured I was doing the right thing. I did not send him/her the comparative data I compiled, because I knew I could not improve his/her knowledge on antivirus software, just as I could not improve his/her technical knowledge and abilities. Though I have been discouraged, I have not stopped trying to help people. I would have stopped but for the sensible part of me telling me that I had to be principle centered, not people centered, as taught by late Mr. Stephen Covey (Seven Habits of Highly Effective People).
(*: I have used he/she to protect the identity of the person concerned. I cannot say he/she deserves if his/her identity is known to all, because I know I should not be judgmental and condemn anyone.)

Doctors and Strikes

It is a tradition that Resident Doctors go on strike every few years. They used to strike work every fourth year like clockwork, when the issue used to be raise in stipend. Now there are many issues and the strikes occur more often. Usually the strikes begin on Tuesday. My theory is that it takes them that long to get out of Monday morning blues. Or perhaps they believe the administrators should not be in Monday morning blues when they strike work, so that their demands will be met. Another good time to begin a strike is when the Faculty proceed on vacation. All leave including vacation gets cancelled when the strike begins. Faculty have to do their own work plus the striking doctors' work. The strikers probably believe that pressurizing the Faculty will result in Faculty pressurizing the administrators to settle matters to the satisfaction of the Resident doctors. Poor dears do not realize that no one listens to the faculty on any issue. Today they went on a token strike. It is a Thursday, not Tuesday. But it is the second day of vacation for the Faculty. So they proved my theory. What follows is graphic representation of what used to happen when I was a Resident doctor and later an Assistant Professor. I believe little has changed since.
Day -1

Collection of union membership dues prior to the strike. These days stipends get credited to bank accounts. So the dues are probably collected one time when new Residents join.
Day 0: Eve of Strike

The main activity is packing bags for going home on a fully paid long holiday.
Day 1 of Strike: Warning potential strike-breakers

I am warning you, you @#$$%&%^. If you break the strike, we will lock you up in your room when you go to sleep.
Day 2 of the strike: The stage of negotiations with the health minister.

Day 5 of the strike

It is Saturday today. Let us enjoy this Sunday and call the strike off on Monday.

Every day of the strike

Ring up the mortuary in the morning to find out if the strike is having the desired impact on the patients' health.
Day 6 of the strike

A humble request to chemists for a generous donation to the strike ... or else...
Day 6 of the strike

An appeal to the professors to donate generously for the strike, so that their ordeal ends quickly too.
Day 8 of the strike

An outpatient clinic is set up outside the hospital for the convenience of the poor patients.
Day 12 of the strike

March at 12 noon in candlelight. The purpose is to be noticed by people, not to show them light.
Day 14 of the strike: Opinions of professors on the strike

"Why do I say the strike is ethically, morally and legally justified? Because by daughter is one of the striking doctors."
Day 28 of the strike

Finding the professor doing ward-work and getting him to check and sign one's dissertation for MD examination.
Day 31 of the strike

Relay hunger strike: Location? Near the canteen, where the hunger striking doctors can rush into the canteen as soon as their 2 hour turns get over.
Day 51 of the strike

Strike breakers: "we can take those ad hoc lecturers' posts. That will not amount to breaking the strike, because we will not be resident doctors, we will be full-timers.
Day 56 of the strike

Stage of negotiations for at least granting of term and pay for the period of absence from duty during the strike.
Day 57 of the strike

Face of Victory!: "We are very proud of our struggle for justice. And we even managed to get a promise that they will not mention the strike on our post-holding certificates.
Day 1 after the strike

"God knows what the objectives of the strike were. But it gave me time to get engaged and finish my dissertation too."

Administrative Chess

I always thought that chess was a boring game. I had given it a few tries as a child and had given up as something I would not be able to master and never enjoy. Thinking of a number of moves and counter moves in advance was not my idea of having fun. If I had to stare at something for long periods, I would rather stare at an interesting book than a chess board.
I found a new type of chess in the administrative office. It was played between one staff member and the administrators. It all started with the staff member moving into a guest suite of the institute. It was actually meant for external examiners and visiting dignitaries. This person apparently moved in temporarily because his house was in need of major repairs. Days stretched into weeks and weeks into months, but he would not move out. People started talking about it.
"He will stay there permanently" one person said. "At a charge of Rs. 300 a day, it works out to Rs. 9000/- per month. Where else in this city will one find a suite with air-conditioning, television, kitchen, and no separate water and electricity bill?"
"But he has a house of his own. He must be spending on its maintenance. Why would he spend on two places? He is not known to waste any money" another person said.
"At market rate his flat will fetch a rent of Rs. 30000 to 40000 a month. After spending Rs. 9000 per month, he gets to profit by Rs. 21000 to 31000 per month. Who will leave that suite under such conditions?" a third person said.
"He has let out his flat on rent?" someone asked.
"God knows" the first one said, sounding like 'yes, of course'.
"The administrative boss was complaining that he is not leaving, not matter how many times they have told him to leave" the third person said.
"External women examiners don't like it" the first one said. Their suite is adjacent, and they have to share the bathroom and toilet."
"Hmm..." I said.
Another month passed. Then there was news.
"He has moved back to his flat" the first person said.
"What made him go?" I asked.
"The administrative boss asked him to pay Rs. 700 a day. That comes to Rs. 21000 a month. 'Who will pay that much?' he asked and moved out the same day."
"What about the tenants he was supposed to have in his flat?" someone asked.
"God knows" said the first one, sounding like 'who cares?'.
What none of them realized (or voiced if they had realized) was that this was a brilliant game of chess played between this fellow and the administrative boss, in which the administrative boss won brilliantly. This form of chess was, in my opinion, far more entertaining than conventional chess.

Blood Bank Crisis

"Sir, we have given a number of anemic patients multiple packed cell transfusions. But despite three or four unit transfusions each, their hemoglobin levels rise barely by half or 1 g%" my Registrar told me.
"But each unit of packed cell has to increase hemoglobin level by 1 g%" I said.
"Yes sir. But our patients do not show such a rise."
"Have they been bleeding?" I asked.
"A couple of them bled a bit. But most of them have not bled."
"All cannot have hookworms. And hookworms cannot drink a unit of packed cells per day" I said. "Make a list of all such patients and the dates of their pre- and post-transfusion hemoglobin estimations."
When I got the list, I got the laboratory to check their hemoglobin levels carefully. They found the results as before. I got them to check the machines, which turned out to be OK. Then I contacted the blood bank, explained the problem and asked the Professor in charge about the hemoglobin level of the packed cell units issued out by them.
"We check 1% of all blood issued out as per FDA rules. I will arrange to have more samples checked. The FDA requires a minimum hemoglobin level of 12.5 g% for acceptance of a blood donor. The hemoglobin of the packed cells issued out should be at least 12.5 g%."
I thought about it after the call. After some time I realized the error in the statement. So I called the blood bank again. The Professor was away. I got the Assistant Professor. I explained the problem.
"Please tell me the hematocrit or hemoglobin level of the blood in the bag you issue out" I said.
The Assistant Professor told me the unit should increase hemoglobin by 1 g%.
"I know" I said. "What I want to know is the hematocrit or hemoglobin level of the blood in the bag you issue out. If the donor's hemoglobin is 12.5 g%, and then you remove plasma from the blood and issue red cells, the hematocrit should be 50 to 55."
"It should increase hemoglobin by 1 g%" she said doggedly, and the connection got lost promptly. I could not get her back on the line.
Then I arranged to check the hemoglobin levels of packed cells transfused to patients. The first two results were 11 g% and 12.5 g%. The word probably reached the person concerned in the blood bank. Third sample onwards the hemoglobin levels were 17.5 g%, 18 g% and even 24 g%.
"The problem is solved" I told my people. Now our patients' hemoglobin levels will rise by 1 g% per unit transfused.
It seems the problem was solved only for my department.
"Sir, we have received a call from the medicine ward. A patient of uterine leiomyomas and anemia has been transfused 4 units of packed cells. Her hemoglobin has risen by only 1 g%. They want us to transfer the patient for that reason."
"Is she bleeding?" I asked.
"No sir."
"Then tell them the source of the problem, our solution to the problem and ask them to do what we did."
"Sir, but how can the blood bank people distinguish between different patients and issue units of different hemoglobin levels?" my Associate Professor asked me.
"I am not saying they are doing that. But someone could be doing it without knowledge of others. It is quite simple. The blood requisition slip has the unit name and ward number. Our patients can be identified easily. Specially prepared blood bags can be identified by their numbers. The rest is easy."

Lateral Myomectomy

I have developed a new concept for removal of uterine leiomyomas. I call it 'Lateral Myomectomy'. Conventionally abdominal myomectomy is performed through preferably anterior uterine wall incisions, and when that is not possible through posterior uterine wall incisions. In both of these cases, the uterine scar is exposed to the intraperitoneal structures and adhesions with bowel and/or omentum are quite likely. This risk can be reduced using barriers to cover the suture lines until the serosa heals, like hydrofloataion or oxidized cellulose cover. The best way would be to avoid a serosal incision, which I achieve by opening the broad ligament and cutting the lateral uterine wall.
This technique is applicable when there is a large leiomyoma that expands the uterus globally i.e. in all directions. That expands the lateral uterine wall too. If it is an anterior wall leiomyoma, the round ligament and anterior leaf of broad ligament are cut. The uterine incision is made anterior to the ascending uterine vessels, above the uterine artery stem. If it a posterior wall leiomyoma, the posterior leaf of broad ligament is opened in front of the attachment of the utero-ovarian ligament, and the uterine incision is made posterior to the ascending uterine vessels. In both the cases, the uterine vessels are protected as the incisions runs parallel to them. The ureter is protected because it lies below the uterine artery stem, and downward extension of the incision is avoided by application of an Allis' forceps at that end. Fallopian tube is protected by applying an Allis' forceps at the upper end of the incision to avoid an extension of the incision during removal of the leiomyoma.. Tunneling incisions can be made as required through the bed of the leiomyoma removed, so as to remove any other leiomyomas present. Closure is by conventional technique. At the end of the operation the divided round ligament is reapproximated, and broad ligament is closed. There is no scar on the serosa of the uterus.

I have put a video of this on YouTube for those who want to see it. Do write to me if you have any questions.
YouTube Link:  http://youtu.be/y1g5hPzHzw0

Trust ...What Is That?

I always trusted people. I trusted people or organizations with high ranking in society even more. I had not expected the following things to happen to me..
Episode 1
A reputable publishing house asked me to write a chapter for their book 'TeLinde's Operative Gynecology'.. I am quoting directly from their communication.

22-5-2009

….we would be delighted if you could spare a little time and add some fresh material to make the book more useful particularly for our South Asian readership……Purely for the sake of clarity, I would like to specify that you shall get authorship credit for the new material within the book. We shall also be happy to pay a one-time honorarium of Rs.10000.00 as a token of our appreciation.

Publishing Director.

Wolters Kluwer (Health) Pvt Ltd

It was a reputable book and it was an honor to contribute to it. So I accepted. I sent them the chapter on 21-6-2009. Months passed. Then years passed. My emails went unanswered. Finally I was able to get in touch with the person concerned. It appeared he could not do it because the parent company in US had not approved of his proposal. He promised the would send the honorarium anyway. It never arrived, nor is the chapter published in the book.
_____________________________________________________
Episode 2
The other story is about a chapter in another book. The communication was as follows.


It is our pleasure to announce that the Federation of Obstetric and Gynecological Societies of India (FOGSI) will be releasing the Textbooks of Obstetrics, Gynecology and Family Welfare in 2012. We would like to invite you to be one of the authors for these textbooks…… FOGSI appreciates your time, patience and efforts in contributing to the textbook. As a token of appreciation, a remuneration of Rs. 4000 (Rupees Four Thousand Only) will be made on receipt of the entire submission (text, power point presentation, multiple choice questions, short and long questions). ….Please send a reply confirming your willingness to contribute as an author by 20 February 2012 ….The submission is expected to reach us by 15 April 2012.
I accepted and sent the chapter on 15-3-12. A communication after a few months revealed there were some technical issues which had delayed the project. When the material sent became 1.5 years old and hence out of date, I wrote to the person concerned, and voiced various concerns. There was no answer. A reminder sent after a couple of weeks went unanswered too. I have understood there will be no answer. The money promised has not been sent to me too.
_____________________________________________________
That neither party paid the money promised is not so important to me as the fact that it was they who had approached me for a favor, got from me what they wanted, and did not honor their promises. Their behavior reminds me of people who avoid their creditors when they are unable to pay up. What hurts is that these people do not understand that if they violate trust so blatantly, people will not trust anyone.What hurts even more is that one of them was our student once. Now I don't know whom I can trust - or if I can trust anyone at all.

Free Intraperitoneal Cyst

A 45 years old woman presented with third degree uterine prolapse, cystocele, rectocele and lax perineum. She had had no symptoms of acute abdominal pain in the past. We performed a vaginal hysterectomy, anterior colporrhaphy, vault suspension and posterior colpoperineorrhaphy on her. After division of the uterine vessels, I noticed a dirty yellowish colored cystic structure above and behind the uterine corpus. I removed the uterus. Then I held the structure with Babcock's forceps and made traction. It delivered without any resistance. It had absolutely no attachment to any intraperitoneal structure.

It was soft, cystic, flaccid, and tended to flatten out when placed on a flat surface. The surface did not show any place where a pedicle could have necrosed and set it free in the peritoneal cavity. I inspected both the ovaries and found them to be normal. I cannot put a picture of the operative field showing the ovaries because that would show body parts which may be considered objectionable by some viewers and also by Google who gives me free space for this blog. Histopathology of the cyst showed degenerated cyst possibly of ovarian origin.
"Sir, where did it come from?" a Resident doctor asked me.
"I would have said one of the ovaries. But the ovaries are all normal. An ovarian cyst develops within an ovary, not from the surface of an ovary with a pedicle that can undergo necrosis and set the cyst free. If the ovary with a cyst in it undergoes torsion and gets detached, the cyst may become free, but it would contain the ovary too, not leave it behind. It cannot have been a broad ligament cyst, because it was above and behind the uterus. If it had been in the broad ligament, we would have seen it before clamping the uterine vessels. Broad ligament cysts do not escape into the peritoneal cavity anyway."
"Why don't you publish it in a scientific journal?" a colleague asked me.
"These days many journals ask for a lot of money to publish articles. Those which do not do so ask silly questions about the content and their reviewers pass comments which if made by exam going students would result in them being failed. Anyway the readership of my blog is large enough for me to be happy as a teacher. I know how many people read my given article in my blog, which is not what I can say about my article in a local scientific journal. After all, a blog post disseminates scientific information as much as a scientific journal, if not more. It is free too, while most journals ask money from readers too."

Migrating Leiomyomas

Birds migrate. People migrate. The human placenta migrates from lower uterine segment to upper uterine segment sometimes. But more about it some other time. This one is about migrating location of uterine leiomyomas.
That patient came to our outpatient clinic with about 9 cm diameter leiomyoma in the vagina. Since we could not reach the upper part of the leiomyoma, we could not see where the cervix was. She had an ultrasonographic report from an outside clinic showing that it was a central cervical leiomyoma arising from the anterior wall, stretching the posterior cervical wall over it. It did not disclose the location of the external os. Our people are intensely loyal to our institute. So they got a scan done by our sonographers. Their report came as a central cervical leiomyoma arising from the posterior wall, stretching the anterior cervical wall over it.
"Sir, the reports are exactly opposite of each other" my Registrar said.
"Could the origin of the leiomyoma have migrated between the two scans?" someone sniggered.
"I would tend to believe the first report, because it is done by a qualified sonologist, with some experience in private practice. The second report is by a resident doctor in training. We also have enough experience of our local people, who sometimes give mirror image locations of structures instead of their actual locations. We have to explore and remove the mass anyway, no matter where it is coming from. So relax. We will know about its location on our OT day."
It turned out to be neither. It was a polyp arising by a short pedicle from the posterior endocervix 0.5 cm above the external os. No part of the cervical canal was stretched over it."
"Our people were more right than the qualified private practitioner, though both were wrong" said someone. "How do we explain that?"
I was stumped.
"The only explanation is that he must have been one of our local people, now qualified and in private practice" someone said. Everybody laughed.
I knew it was not right to laugh. I also knew there was something that needed to be set right. But I could not do it because I was not a sonographer and did not know how.

Fixing A Key Ring

One of my acquaintances wanted to wear the key ring on a chain or a tape around the neck while working in the OT. That became essential when the pockets of the OT dress started having holes or the stitch at their bottom started coming off. The key to the OT locker would fall out of the pocket causing no end of a bother. He procured a tape of the type used to wear identity cards around the neck. He put the key ring through the loop of the tape. Unfortunately, the spiral of the key ring rotated in the reverse direction and the ring came off the tape and fell off. Needing this thing fixed and knowing my happiness at fixing things, he approached me. It would have been easy to get the engineers to weld the two ends of the ring together. But it would have been sort of irreversible. The heat of the welding would have burnt the tape too. I fixed it as follows.

I took a piece of plastic tubing of an intravenous infusion set. I heated the ends of the spiral on a flame. Then I threaded one end of the piece on one end of the spiral ring, and the other end on the other end, before the ends cooled down. This produced a continuity of the two ends such that if the ring rotated in the reverse direction, the loop of the tape would just move from one end of the spiral on to the other end, but never come off. I heated the ends of a set of pliers and squeezed the tubing over the spiral ends so that the plastic melted a little and stuck to the spiral. The plastic tubing was transparent, so that the key ring did not look odd. Who is going to notice it in the OT around the neck of a male anyway?

(It took me ten minutes to think of this idea, another ten minutes to assemble the components and tools and do it,  and one hour to prepare its 3D model on my computer.)

Hospital Corridor Puddles

It is the custom of the servants to tie the necks of waste disposal bags and leave them in the corridors of the hospital, until it is time to load them on a cart and take them to the waste collection center. It is not uncommon for the bags to break open and leak the liquid contents, if any, on the floor. Such leaks result in formation of small puddles starting under the bags and spreading centrifugally. We get to see these puddles with or without the bags, depending on whether the bags have been taken away or not at the time of the sightings. It is necessary to diagnose what the source fluid is, so that one can feel more or less miserable when one accidentally steps into a puddle. The diagnostics are based mainly on the color, though one could diagnose them by odor too, if one were foolish enough to bend down and bring one's nose close to a puddle.

Blood from a blood bag or blood soaked rag.

Povidone iodine solution from a bottle broken by an accident prone Resident Doctor.

Cough mixture from a bottle broken by an accident prone relative of a patient.

Urine of a toddler held by an elder over an open bag so that he can relieve himself, or water used by a patient's relative to gargle into the bag after lunch/dinner in the corridor. When such a puddle is seen without a source bag, it could be the result of of a toddler peeing on the floor, a careless person upturning a water bottle, or people gargling on the floor after lunch/dinner in the corridor.

May God give wisdom the people who cause such puddles, so that they won't cause them.
In case it is too much to ask, may God give conscience to suppliers of waste disposal bags so that they will not supply such poor quality bags despite charging the sky for them.

Acting Dean

It is a custom of the civic body to call an interim position holder as 'acting' position holder. 'Acting dean' and 'acting head of department' are examples of this custom.
I received a call from the personal assistant of the Acting Boss (the real Boss is on long leave) to ask if I would be available on two specified days.
"What is the occasion?" I asked.
The Acting Boss is going to be away and wants to know if you can fill in."
Acting acting-Boss? This was getting complicated. I could have said no right away, but there was no fun in it.
"Why not ask the person who is usually the Acting-Boss but is not Acting-Boss at the moment?" I asked.
"She is not available at that time" the personal assistant said.
"But why me?"
"You are the most senior person in campus" she said.
"I know. But I was the most senior person all this time when others have become Acting Boss. I am senior to the current Acting Boss too" I said. "Why am I thought of now?"
"Um... yes" was the best she could do. I knew the Boss could nominate anyone as Acting Boss, not necessarily by seniority. She must have known that too, but must have thought it prudent not to tell me so.
"I will be working on those days, but I don't want to be Acting Boss" I said.
"Huh?" she said. She probably could not understand why anyone would refuse that honor.
"If I wanted to be Boss, I would have applied to the public service commission long ago and become Boss of one of the civic medical colleges. I chose not to because I never wanted to. The principle would be defeated if I accepted to be an interim Boss for a couple of days. Besides, I am not suitable for that post. The Boss has to be politically oriented and willing to please higher ups and politicians. I cannot do that."
"But then we will have to look for another suitable person" she said miserably.
"Yes. But that is not my problem, is it?" I said.
When I recounted the story to others, the following responses were heard. I go on record that I do not endorse any of the statements made.
"I heard the Boss' secretary say that you should be the Boss. You would straighten out all that chaos and let them go home at the right time instead of keeping them until late evening" someone said.
"Good you refused. There is too much unnecessary pressure" another person said.
"You could not have made any extra money in just two days" another person said with a leer.
"But the canteen fellow supplies special food to the Boss. You missed out on that" a knowledgeable foodie said.
"Good for you. It seems for every topic there are two meetings. One is with the Boss' Boss. The proceedings of the meeting are of half an hour, but the meeting continues for two and a half hours. Then the same meeting is held by the Boss' Boss' Boss. The waiting period is two hours (spent outside the Boss' Boss' Boss' cabin} and then the meeting takes place over half an hour. You would have hated that" someone who had just attended a meeting with the Acting Boss and heard an earful said. "The Acting Boss says there is not time to work. All the time is spent on meetings."
"You mean there is no time to have a good time?" a sarcastic person said.
"You should have taken the post and made a large budgetary allocation for our department" a hopeful said.
"You should have taken the post and given memos to those nasty people" some aggrieved person said. I knew who those 'nasty' persons were.
"You should have taken the post and terminated services of my Associate Professor who is a pain in the XXX" someone said.
"You could have nominated yourself for Padmashree or BC Roy award" someone said with a grin.
"Thanks but no thanks" I said.

Gloves Over Gloves

A large majority of doctors in my department wear two pairs of gloves during an operation. I had a general idea why they did so. But these are times of precision. So I asked people who worked in the OTs their reasons for doing so. I had to use intermediaries in case of residents for fear of not getting their true answers if I asked the question myself. Some of the answers were educative and entertaining at the same time. They were as follows.

1. Hospital supply of gloves is such that one or both the gloves tear during use. When that happens, there is another one under it. That gives protection to ....(read answers 2 to 4).
2. When the outer glove tears, the inner glove protects the doctor from catching some disease from the patient's body fluids.
3. If I wear only one pair and one of the gloves tears, I get electric shock when I use electrocautery. If I have two pairs on, I don't get any shock when the outer glove tears, because the inner one electrically insulates my hand.
4. When the outer glove tears, the inner glove prevents bacteria from the surgeon's hand entering the operative field.
5. When the surgeon wears the gloves using a wrong technique, i.e. touching the outer surface of a glove with bare skin, it gets contaminated. Another glove on top of it nullifies the effect of this contamination.
6. The air conditioner in the OT is so strong! Two gloves keep my hands warm (with the air cushion in between them as insulation?).
7. After the operation, I remove the outer blood stained gloves and use the clean ones inside to apply dressing to the wound. That keeps the dressing clean.
8. When I have to get an instrument from the general trolley while assisting an operation and there is no one to give it to me, I remove my outer glove, get the instrument, and then put on the glove again. Thus I do not contaminate the general trolley.
9. I do it because the senior resident told me to do so.
10. I heard the Boss hits on the knuckles with a surgical instrument if the resident goofs up while assisting him perform an operation. Two gloves would reduce the trauma. (Would knuckle pads be more useful?)

If you wear two pairs of gloves and have any reason other than those listed here, please write to me. I will update this post with the newer answers.

Dustbin High Up

I  was leaving the ward with the unit doctors when the Sister in charge of the ward came along. She was quite upset.
"Sir, I am fed up with the relatives of patients. They eat in the corridor outside the ward, and then wash their hands and gargle in the dustbin kept here. All that dirty water leaks out and spreads on the floor. The servants have to clean it up and they are fed up too."
She had a reason to be upset. I could not blame the people who did this too. This was the way of life for them. They spat on the roads, out of their windows and wherever they went. No one had taught them different and they were not teaching their children different. This problem was permanent and expanding at the same rate the population was expanding.
"But we have to provide a dustbin. Or they will throw garbage on the floor" I said.
"That is true" she said.
I brainstormed alone for a couple of seconds and then I had that brainwave.
"Sister, put the dustbin here" I said, pointing to the wall recess near the dustbin. "Chain it to the wall so that they will not be able to take it down."
They all looked at the place I was pointing at and took in the implications of the suggestion.

That is my artistic representation of what it would look like.
"No one will jump up and gargle into the dustbin that high. Keep the edges of the dustbin dirty so that they will not bring their mouths close to it, even if they stand up on something to reach it."
The Sister and all the doctors laughed. Even the servants of the adjacent OT who were listening from a distance laughed. They were probably imagining people using slam dunk technique like a basket ball player.
"I think I deserve an award for coming up with funky ideas" I said, regretting there was no such award offered by the civic body.