Hibiscus - Two Flower Types on One Plant

My wife loves her potted plants garden. I love the look of the garden and the flowers that grow in it. We have a large variety of plants, which grow different types of flowers that look good. We have three types of Hibiscus. One is the common Indian red hibiscus, technically called Abelmosk: It grows large pink-red 5 petal flowers. Its pot is located on the east side. On the south side, we have two. One is white Hibiscus, which grows white flowers similar to the first one, but smaller and more delicate. The other is Hibiscus rosa-sinensis or China Rose. Its flower is layered. While the Abelmosk and white Hibiscus flowers have a single pistil and a few stamens bunched on its terminal part, the China rose has three sets of the same.
We have had the plants for a few years. They blossom regularly, without any surprises. The day before yesterday, the China Rose grew five flowers, of which three were of the regular type, while two were of five-petal type (like Abelmosk) in a single layer. The pistil was much thicker than the usual stamens of the China Rose. Shape of each petal was like the China Rose type. Both types had come from the same single plant. Here is a snap of those flowers. There are three of China Rose type in the back row and two of the variant type in the front row.

I have zoomed and put one flower of each type side by side for comparison in the following picture. 

Yesterday we had a large number of flowers from the three plants (28 to be exact), but there were no variants. Today we had six on the China Rose plant, of which 5 were the normal, usual type, and one was a variant. I took a snap of two of those to show that they actually came from the same plant. The upper one is a variant, while the lower one is the usual one.

We have not grafted another Hibiscus type one the China Rose. Since a single stem has come out of the pot and then branched out, there is no possibility of two plants growing side by side. It could not have happened without our knowledge anyway, because my wife planted a single twig which took roots and grew up in front of us. Thus it is a unique case of two different flower types growing on a single Hibiscus plant. I did an exhaustive Google search and failed to find any instance of such an occurrence. If we were not doctors, we would have perhaps called it a miracle. Being doctors, we think it is a genetic mutation. Either way we are proud that God chose to put its first occurrence in our humble home.
Update: 09-01-2014
Actually it is three flower types, not two as I had originally written. This week we had a flower that had only two rows of petals arranged concentrically, not four and not one. There was a single stamen. Its picture is shown below.

 Update: 12-02-2014
 I found an interesting variant of the China Rose, shown as B in the following picture. Flower marked A is the usual type. Usually the sepals are small and green on both the inner and outer surfaces. This variant had large sepals (though smaller than petals). These were green on the outer surface, and red like the petals on the inner surface.

Update: 10-03-2014
I found the first variant of the white Hibiscus, shown in the following photograph. The usual type shown in A has the petals overlapping the edges of the previous petal going anticlockwise. The variant shown in B has the petals overlapping the previous petal going clockwise.

Adventure Sport: Riding A City Bus

A ride on a city bus can be an adventure. One needs to run after it to catch it at times, when the driver decides to skip a bus-stop. You may want to jump off a running bus when you have some work in between two bus-stops. It is easier when it slows down while turning. You often have to ride on the foot board because the bus is so crowded that there is no place in it. If verbal sparring can be considered a sport, there it is, played with the conductor on the matter of him not returning the balance amount on excuse of not having loose change, especially when you have given him a large denomination note (what Americans call a bill).

There can be extreme adventure sport while riding a city bus. One may be pressed for time, especially with long traffic jams. So one is forced to take a bus to a spot short of one's destination, and then take another from that spot onwards, rather than wait for a bus going directly to the destination. Check out the following illustrations to understand how this extreme adventure sport is played.

One is on bus number 1, going in the direction of the blue arrow.

Bus number 2 (going in the direction of red arrow) cuts in front of bus number 1 breaking a red signal. Bus number 1 has to stop. Bus number 3 is right behind bus number 2. One notes that he needs to be on bus number 3 to reach his destination.

Bus number 1 cuts in front of bus number 3, forcing it to stop. One hops down in that split second before bus number 1 starts, and runs along the pink path and boards bus number 3. He has to be so fast that he does not get under the wheels of any of those buses, and driver of none of the buses can get to shout at him or stop him in his path.
After I decided to use public transport as a social obligation and sold off my car, the commuting to and from work has become increasingly difficult. Finally one day I got so late going home from work that I succumbed to temptation and engaged in this extreme sport. The adrenaline surge started after boarding bus number 3. I probably used up all the adrenaline in my reserves. Though it was reassuring that I had a sound heart (considering the fact that I did not get angina or worse), I decided not to test my heart again in this manner, and leave this sport to younger people.
(Warning: do not try this- you may end up with a few fractures, a head injury, or worse.)

Teetotaler Music System

This is a true story. If you are wondering if it means my other stories are not true, please read the intro on the home page of my blog.
I have a Panasonic music system, which can play CD, cassette, FM and AM radio. I have not used the cassette player part for a long time, and now it does not work. I decided to clean the playing head of the player to see if it was magnetic dust collected on the head that was the cause of the loss of function. So I took a brush, dipped it in methylated spirit (we use it to disinfect the skin prior to giving an injection to a patient) and cleaned the head of the player. My old practice was to use a piece of cloth soaked with spirit for this job, which I used on my old music system. But I disliked the smell of alcohol on my finger. So I used a brush. After that. I started the system, and it just went crazy. The CD tray would come out, wait for 2 seconds and close again. It continued to do this tirelessly, and I knew it would continue to do so till eternity or until the power was switched off, whichever was earlier. So I switched off the power. It was smarter than I thought. It went on again on its own and continued its antics. I was smarter. I switched off the mains before it could power itself. After giving it a rest for a few minutes, I powered it on again. Now luckily it did not play the CD tray trick again. But it rapidly cycled through all its commands - some of which I knew and many of which I didn't. I could read the commands it was executing on the display - CD1, CD2, CD3, CD4, CD5, AM, FM, Cassette, Normal, Movie, Bass, Treble, Sleep, Wake, Manual, Auto, Record, Eject, Hello, Goodbye, and a number of others I did not register in my amazement. It started making me dizzy. So I switched it off.
I powered it on the next morning. Its behavior was exemplary. It played like a music player should - a sane one I mean.
"What was wrong with it?" my wife asked me.
I thought it over.
"If we believed in ghosts and spirits, I would say it was possessed" I said. "If it were computerized and connected to the net, I would say a hacker had taken it over. My best guess, believe it or not, is that it was drunk."
"Drunk?" she asked incredulously.
"Drunk" I said. "I put alcohol on the head of the cassette player with a brush. It must have evaporated and spread inside the system's box. Having never been exposed to alcohol, it probably got intoxicated with that small amount. So it started its monkey tricks. After a day, it got sober. So now it is working OK."
"Oh!" she said. I knew she did not believe me. I did not believe myself. But then, there was no other explanation. In fact, I think the sound coming out of the speakers was a little gruff - like it had a hangover. (:-)

Salary Payment Through SAP

The civic employees are paid salary electronically into their bank accounts. That is a lot better than having to stand in a queue and taking cash. There is also the risk of carrying so much cash home in view of pickpockets being active. They would become even more active on the day of salary if it were paid in cash.
There are civic body administrators who always want to improve on a system that is working well. They acquired a software called SAP for all purchases and other financial transactions. That the employees could not master it was the reason the supply of a lot of things suffered. Then they decided to pay the salary through SAP. This post is about that decision.
"Sir, there is this letter asking for employees to fill up the form for receiving salary through SAP" I was informed.
"But we have filled up SAP forms twice in past, about six to eight months apart" I said.
"They want it again" I was informed.
I read the form. It was in Marathi, our state language. For the curious types, I present images of the two pages of the form.

"Why do they want to know about the state of an employee's marriage?" I exclaimed. "The marriage may be good or about to break up. Irrespective of that, he/she has to be given salary for work done by him/her."
"Not only that" said someone, "but they want to know about employment of spouse and offspring, and their monthly incomes too."
"That is collecting private data" said another person. "The civic body cannot collect such private data!"
"They are doing that" I said. "If you don't provide all the information asked for, they will stop paying your salary from first January. That is what the circular states."
"There is a gender bias" exclaimed a gender sensitive person. " The statement at the end has the verb करणे in the form for masculine gender alone. They have to give both masculine and feminine genders, and ask one to strike out inappropriate one."
"There are 11 spelling mistakes and two grammar mistakes" said a person who was well versed with Marathi language, in which this form was written, and in which all work of the civic body has to be done. In fact, each employee was expected to produce a certificate of having passed Marathi examination, or he/she would not be promoted, and without which new persons would not be even employed. "How can our employers who insist that we must know Marathi well themselves make 13 mistakes in just a 2 page form?"
I checked the form and found all the mistakes. For the curious types, I have marked them in red in the images above. If anyone finds more mistakes, please write to me. I will inform the civic body about those too.

Facial Expressions in Faculty and Resident Doctors

Some people watch other people's facial expressions during interactions, others don't. I do, because expressions tell a lot of things that mere words don't or sometimes things that are different from those implied by the words uttered. What follows is the graphical expression of various facial expressions I find in the people who work with me. Just sit back and watch.

Please write to me if you think of any expressions that I may have not included either out of oversight or because I have not encountered them yet. I will try and draw those too, to be put in the next version of this animation.

Baby Name

People name babies differently. Some name them after their parents' names. Some name them after names of Gods they worship. Some name them after their heroes. Some use nice sounding words for their babies' names, even if they don't mean a thing. These days people search the net for baby names.
That patient had it easy. She had some gynecological problem, which I looked into and started the management.
"Doctor, I have come to you because you had treated me well the last time."
I kept a smiling face, though I could not remember her."
"I had infertility. I got a baby after you treated me. I was very happy."
I broadened my smile.
"I have named my baby after you" she said. My surprise must have shown on my face. "I have given my baby your name" she explained.
I smiled genuinely.
"Has he started going to school?" I asked.
"Yes" she said.
"Is he bright?"
"Yes" she said.
"That is nice" I said. "He will do you proud."
"Yes, doctor. Thank you doctor" she said, smiled some more and went away.
This was the first time (as far as I knew) some patient had named her baby after me. This woman had made my day.

Breath Holding

People hold breath for different reasons. Swimmers hold breath while swimming underwater. Spectators hold breath when a batsman hits a high one and a fielder runs to make it to the expected spot of landing to catch the ball. A guy holds breath when he pops the question and the girl is about to answer.
In hospital, we hold breath when:

1. a baby delivers and is yet to cry.
2. someone is doing a cesarean section and is struggling hard to deliver the baby's head.
3. a Resident doctor is trying hard to pass a trocar and cannula into a patient's tummy during laparoscopy.
4. a junior anesthetist puts in a lumbar puncture needle for the nth time and everyone bends down to see if the cerebrospinal fluid escapes out of the hub of the needle.
5. we pass by the college wash room.
6. we pass by the central garbage dump.
7. we pass by a cat or dog poo on the staircase, especially when someone has already stepped on it.
8. when someone sneezes in the hospital corridor without covering his/her nose and mouth.
9. when someone coughs nearby in the hospital corridor without covering his/her nose and mouth.
10. in the elevator jammed with people, some of them going to the RNTCP center, where they treat patients with tuberculosis.
11. a Resident doctor calls in the middle of the night and keeps on talking about some patient in the past tense, but does not reach the part when something happened to the patient.

In case you cannot make out why we hold breath for any of these happenings, feel free to write to me.

Generating Work

I thought there was so much work at the hospital that no one would think of generating some. I was wrong.
"Sir, this patient with uterine leiomyomas is to be posted for abdominal hysterectomy" my Registrar said. "But the anesthetists have found hepatomegaly and splenomegaly. They have asked for opinion from hematologists and gastrointestinal surgeons."
"Let me see her" I said. I palpated her abdomen, but could not feel the liver and spleen. "Liver and spleen are not enlarged" I declared.
"Even her abdominal ultrasonography does not show any enlargement of the liver and spleen" the Registrar said.
"Let us speak to the anesthesiologists" I said. I found senior anesthesiologist and told him about this patient.
"I asked for opinions of hematologist and gastrointestinal surgeon because my House officer found hepato-splenomegaly" he said.
"But there is no hepato-splenomegaly" I said."neither on palpation nor on ultrasonography."
"It is better to take those opinions" he said. "The patient looks emaciated."
"We will take all opinions required if there is hepato-splenomegaly" I said. "We cannot increase work of those superspecialists, who are understaffed and overworked. I suggest you palpate her abdomen yourself before asking for such opinions." I should have added 'they will laugh us out when they find no hepato-splenomegaly', but decided to let it go unsaid.
Finally he palpated the patient's abdomen and said  'there is no hepato-splenomegaly. I thought the House officer was right."
"Don't trust a person blindly" I advised. "Confirm that he/she is good before you trust him/her." I wanted to add 'or we will end up doing a lot of things, some of them bad for the patients', but decided to let it go unsaid.
Lately I have been leaving a lot of things unsaid, because I have realized that though I like to state the truth, people often do not like to hear it.

Meeting at 12 P.M.

English is taught in schools. It is more advanced when it is taught as the first language and less so when it is second. The importance of the language is not emphasized then because one does not know where the student is headed for higher education. Professional courses do not have English as a subject in the curriculum. So whatever English the student has learned in school and has retained will be used by him/her whenever there is need for it.
When the person starts working in clerical capacity in an organization, like ours, he/she may have to compose letters for the Boss, who signs those letters and then those letters reach whoever they are meant for. Often the Boss just signs them after scanning them briefly. A few Bosses read the letters and correct the grammar before sending it. Most of them don't. One such letter reached me asking me to attend a meeting.
"The meeting is scheduled at 12:00 P.M." it read. I was perplexed for a few seconds. Knowing what I have described in the early part of this post, I realized what it meant.
"For a moment I thought the meeting was at midnight" I said to our clerk. "The term 'A.M.' stands for the Latin phrase 'Ante Meridiem' —which means 'before noon'—and 'P.M.' stands for 'Post M': —which means 'after noon.' 12:00 A.M. and 12:00 is wrong usage of the language. If at all, 12:00 P.M. would mean midnight. However some people do not understand that very clearly, and write 12:00 P.M. when they mean 'noon'. I was not confused in this case because generally no one schedules meetings at midnight. There was a Boss in this institute some years ago, who used to keep meetings at midnight or in the wee hours. Luckily there has not been another one like that subsequently. This sort of confusion is best avoided, and it is easy to avoid it - one should write 12:00 noon and 12:00 midnight or use 24 hour clock in which midnight is 00 hours and noon is 1200 hours."
Now I am certain that at least one clerk will not create this confusion in the civic offices.

FIGO Classification of Abnormal Uterine Bleeding

The International federation of Obstetrics and Gynecology has some pretty detailed stagings of gynecological cancers. They keep modifying these periodically. I had not thought they would go beyond that, but they did. I came across their classification of abnormal uterine bleeding (AUB) on the internet. Surprisingly it has not found its place in text books of Gynecology. I also found out that hardly anyone knew about it, though it came out in 2011. I tried to find out why. There were several reasons.

1. They had done away with the age old terminology of menorrhagia, polymenorrhea, oligomenorrhea, metrorrhagia, hypomenorrhea, cryptomenorrhea etc, and replaced them with descriptive terms. The old terms were fine, brief, precise and well accepted. They caused no confusion and there was no need to change them.
2. They had left things half way. While leiomyomas had been subclassified a lot, other lesions like polyps, adenomyosis had not been subclassified at all.
3. They had pooled endometrial hyperplasia and malignancy together. Putting benign and malignant conditions of the uterus together made no sense.
4. They had scrapped the term 'dysfunctional uterine bleeding' which was quite satisfactory.
5. The purpose of this new classification was not clear. No purpose seems to have been served in the two years after they put out the classification.
6. They put one condition - iatrogenic - in the list. They did not put any in which the patient ingested hormones on her own and caused abnormal uterine bleeding.
7. They put a 'not yet classified' category. If they brainstormed and came up with a whole new classification which was to replace the old one, the new one had to be comprehensive. Leaving a big unclassified chunk does not make sense.

"Why have they done this?" someone asked me.
"To justify their existence?" someone else suggested. That sounded like justifying a trip to the city of the meeting, all expenses paid.
"To feel good at having created something new?" a third person suggested.
"To provide material for newer editions of textbooks?" someone snickered.
"I found the following explanation on the internet" I said. "These are quotes of the committee members.

1. There has been general inconsistency in the nomenclature used to describe ...AUB in reproductive aged women, and there is a plethora of potential causes—several of which may coexist in a given individual.
2. It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research.
3. The goal of our panel was to develop an agreed pragmatic classification system with a standardized nomenclature to be used worldwide by researchers and clinicians investigating and treating women of reproductive age with AUB."

 They all were stunned.
"What does it all mean?" the first person asked.
"Does it mean anything?" the second person asked.
"It all reminds me of the preventive and social medicine text books. A lot of words, and you are blank after reading them" the third person said. I neither agreed nor disagreed with any comment.
"The concluding remarks included this line" I said. "We recommend a scheduled systematic review of the system on a regular basis by a permanent committee of an international organization such as FIGO."
"Now we know what it is all about" they said and laughed.

SVP's Test

One of my old Resident Doctors was visiting us.
"We had fun" she said. "I still remember your SVP's test. Do you still do it?"
I smiled. I used to do things which were unorthodox, but would help the Residents remember things better. This test was to demonstrate how loose a ligature was, so that they would remember to tie tighter ligatures.
"No" I said. "The fun wears out if you do the same thing over and over."
After she went away, I sat thinking of the test. I used to call it SVP's test for want of a better term, not to immortalize my name. Anyway, there was nothing wrong with naming the test after me - after all I had developed it myself. Nothing great I suppose, but effective.
After a Resident Doctor had tied all ligatures while performing a hysterectomy, I would take a curved hemostat and try to pass it gently between the pedicle tied and the ligature. If it passed through, the ligature was loose. If it did not, the ligature was tight. Then I would make him/her put a figure-of-eight ligature over the ligated pedicle to avoid postoperative bleeding from the loosely ligated pedicle. Later I made it a policy to place figure-of-eight ligatures on all ligated pedicles for safety. Then this test became superfluous. I performed the test recently because a doctor trained in another institute wanted to do away with the placement of the safety ligatures - or rather did not know about them. The results are shown in the following picture.

The hemostat is seen to have passed through the ligatures on two pedicles. The test was thus positive on both the  pedicles tested. Needless to say, I made that doctor place safety ligatures on all pedicles and advised to do so in all cases operated on subsequently.

Iatrogenic Dystocia

I was teaching my postgraduate students 'Dystocia' when I remembered this story. For those who don't know what 'Dystocia' means - 'Dystocia' is difficult labor. It can be caused by many factors in the mother and the baby. For those who don't know what 'Iatrogenic' means - 'Iatrogenic' is some problem for the patient caused by the treatment of a doctor.
Some of the students were half sleepy - poor souls who work day and night without sleep at times. I decided to tell them this story partly to educate them and partly to wake the sleepy ones up.
'This happened when I was a resident doctor. There was an honorary Professor in the department. This one had a lot of rich patients in private practice. Some of the patients were foreigners. It seems they expected the Professor to deliver them personally, for which they paid well. If the Professor was busy elsewhere and an assistant delivered them, the payment would be less. A resident doctor from my batch was working with this honorary doctor. That day they were in the OT. There was a call for this honorary doctor. I can put down only the honorary doctor's part of the conversation as heard this resident doctor, who recounted it to us later.
"Oh, she has gone in labor, huh?"
"............"
"How much is the dilatation?"
"............"
"Full?"
"..........."
"Of course she will deliver if you let her bear down."
".........."
"Ask her to breathe in and out, in and out, deeply." (That prevented the patient from bearing down or pushing the baby out, we knew). "And ask her to cross her lower limbs and hold them tightly together." (That would keep the lower end of the birth passage tightly closed and the baby would not be able to come out, no matter how much the poor woman pushed). "I am on my way to the hospital."
With that, the honorary doctor jumped into the car waiting outside and rushed off to deliver the patient.
"What must have happened to that baby?" someone asked.
"Its head must have been compressed by the patient's thighs preventing exit" I said. "That could have caused injury to the head and its contents."
"Oh!"
"Yes, oh!" I said. "Nothing bad might have happened to the baby too. I call this 'iatrogenic dystocia'. When you practice after you qualify, I advise you never to do this."
They shook their heads.

Google, Spikebuster and Me

Life is full of surprises. Here I am, a gynecologist who spends almost all working time treating women patients, and the rest managing problems of all sorts at workplace. Here I am too, spending a chunk of my private time thinking of solutions to problems, including technical nonmedical issues. One of these problems used to be spikebusters which would go 'phut' without any notice.
"They must be made in a certain country" said someone who read newspapers knew all about that country flooding Indian and also World markets with cheap products which would go 'phut' anytime. I refrain from naming that country (which that someone had named), because of two reasons - one is that my country is not flooding the markets with any products even half as good, and the other is that one should not buy these products on one hand (having a fixed ideas on their quality) and criticize them on the other. Anyway, all that is besides the point. I had a number of non-working spikebusters on my hand, which our engineers would/could not repair, and advised me to buy new ones instead. Finally I opened them, bypassed the circuit boards, reestablished electric circuits, and made them functional again. For like minded people, I drew up a diagram of their circuit boards and put it up on my blog, along with an explanation on how to repair them.
I used to get repeated hits for that article, mainly from my own country, that too mainly from Hyderabad. I was happy that my article was helping people. Today I had a surprise. I got a hit from Hewlett-Packard Company, Palo Alto, California, USA. Google search had directed that person to my blog article. I know there might be a few who will not believe me. So here goes a screenshot of the same.

There are number of issues here.

1. The hit came from a country known for its technical superiority and consumerism both. Someone there wanted to repair a spikebuster rather than throw it away and buy a new one.
2. The hit came from California, the silicon valley known for software and also hardware. They seemed not have a solution to a minor problem like this.
3. The hit came from Hewlett-Packard Company, a company known for its hardware. If the Boss knew what an employee had done, he would hit the roof, unless the Boss himself had done the search and reached my blog :-)

I thought it was funny that my article link, probably on 12th or 34th page of a Google search would be reached by anyone. Just to be sure, I did Google search thrice, using different keywords each time. Here is the biggest surprise. Google ranked my article first in all three, including my circuit board image in Google images. I know the Google search results vary from country to country. But it seemed to be doing that in Hyderabad, India and California, USA. After all this, one is left wondering about the following.

1. Has Google gone nuts, ranking a gynecologist's article on repairing a spikebuster first?
2. Is Hewlett-Packard Company so down in the dumps that the employees have to repair their spikebusters and also that they do not have the technical know-how to do it?
3. Am I going to choose a PC, laptop, or printer made by that company next time I buy one for myself or my department?

Update: 3rd December 2013
Another person working in Hewlett-Packard (making computer hardware), Europe, must be a gynecologist. Today he did an encrypted search and found my article on making a pelvitrainer. Here is proof of that.

White Noise

I had read that white noise was used as a form of labor analgesia. That was when I was an undergraduate student, and the the book was, I believe,  by Holland and Brews. I did no find it in other books during my subsequent reading. But perhaps it works. The nurses and resident doctors must not have read about it, but they seem to know all about it and they use it extensively too. When I take round of the labor ward, if one of the women is delivering at that time, I get fresh evidence of it.
"Come on, push, push, push" shouts one person.
"PUSH! PUSH! PUSH!" shouts another..
"बाई जोर कर, बाई जोर कर, बाई जोर कर" shouts a third person.
The main thing is that all three or six or whatever number of them shout their thing at the same time. The poor woman is with clenched teeth, her entire concentration on that phenomenal effort of pushing. I wonder if she hears anything in that state, and if she does, if anything registers. Even if it does, no one can make out the individual components of the white noise.
"What is the purpose of this shouting?" I asked during the ward round once.
"Encourage her to bear down" answered one Resident doctor.
"As if she can make out what they are saying" said an Assistant Professor.
"It is like the crowd cheering their hero in a game - cricket, soccer, boxing, whatever" said another Assistant Professor. "She knows all of them are on her side - are with her. That gives her strength."
"I think it is labor analgesia" I said. "The midwives have perpetuated it through all these years from time long forgotten."
"Does it work?" asked one Assistant Professor.
"God knows. It is actually causing a headache rather than relieving any pain" I said. "Perhaps that is how it works - like a counter irritant.. Causing a pain greater than the labor pain makes her forget the labor pains."

Happy Diwali

Happy Diwali


Let us be Happy this Festive Season
If we can remain so for the rest of the year...
Nothing like it
If we cannot...
At least the memories of this happiness should last
Until the next year.