Friend?

This happened some time ago. I thought of it in connection with a recent event that I do not wish to write about so as to protect identity of people concerned.
"Sir, I need to talk to you."
I looked up from my work. It was an Assistant Professor from another unit. She looked disturbed and determined at the same time. That looked like trouble.
"Please sit down" I said. "What is it?"
"Sir, my immediate superior keeps saying dirty things to me."
"Huh?" I said. "Dirty as in a man saying such things to a woman?"
"Yes" she seemed close to tears and yet brave.
"Why don't you complain against him?" I asked.
"I can. But I came to you to ask you something. He said you are his friend. He threatened to complain to you about me if I complained about him."
I was stunned. The cheek of this guy! We had never been friends. We had never talked casually at any time before or after I had taken charge of the department. The faculty knew of my opinion of this person's lack of efficiency and tendency to shirk work. That he would call me his friend just to intimidate a junior woman colleague was appalling.
"I will make this clear" I said. "I am friendly with all my colleagues in the department, because I have to run it with peace and produce good results. That does not make all of my colleagues my friends. This person is NOT a friend of mine. I don't have any dirty people as friends. But even if he were my friend, I would not shield him or harass a woman complainant for complaining against his sexually harassing her. I strongly urge you to lodge a complaint against him. We have a cell in the institute to deal with such matters and protect women employees. I will forward your complaint to the Dean , who will send it to this cell."
"I did not believe you would harass me" she said. "I just wanted to check the truth in his statement of you being his friend. I have told him today in no uncertain terms that I will complain to the Dean if he harasses me again" she said. "I will lodge a complaint if he troubles me again."
He apparently did not trouble her again. At least there was o complaint from her until she left for greener pastures a few years later.

Many Deep Breaths

Ted Mosby's wife gave wonderful advice to Robin. She said she took three deep breaths when she was overwhelmed. She said that helped her resolve all such situations. For those of you who don't know Ted Mosby - he is the central character in the famous American TV serial 'How I Met Your Mother'. I decided to try that out. Today I had plenty of scope for trying that out. This is how my day went.

Situation	Primary Action	Action After Primary Action
Gynecology OT first operation held up because operating surgeon did not turn up on time	Three deep breaths	Decided to stand in for the operating surgeon, to perform a vaginal hysterectomy
Operating surgeon arrived	Three deep breaths	Decided to allow operating surgeon to operate instead of me.
Operating surgeon likely to open bladder	Three hurried deep breaths	Helped find correct plane and corrected direction of scissors.
Operating surgeon exposed prerectal fat	Three deep breaths	Found posterior peritoneal pouch for the operating surgeon
Operating surgeon likely to clamp ureter	Three deep breaths	Corrected direction of clamp.
Loose ligature	Three deep breaths	Got a figure of eight ligature placed.
Operating surgeon broke continuous stitch near the end	Three deep breaths	Took over and prevented the entire suture line opening up.
Placed right foot in dustbin at foot end of OT table while getting up after previous step	Three deep breaths	Washed foot and OT slipper and disinfected with alcohol based antiseptic.
Cystic ovarian tumor spilled its contents on my left foot while assisting the next operation	Three deep breaths	Washed out, changed, washed left foot and OT slipper, disinfected with alcohol based antiseptic, washed up and resumed assisting.
Second assistant likely to spray aspirated peritoneal fluid on operating surgeon	Three deep breaths	Resolved without any intervention on my part.
Boss asked for urgent information on equipment in the department, while I was still assisting.	Three deep breaths	Got another professor to stand in for me.
An alcoholic boarded my bus, sat next to me, poked me in the ribs and asked what the time was.	Three deep breaths	Said I had no watch on my wrist and turned nose towards window to inhale fresh air rather than his alcohol laden breath.
Sudoku in Times seemed impossible, though it was categorized as ‘easy’	Three deep breaths	Went to sleep, though it was just 6:30 P.M.
Booted computer for work in the evening: dead.	Three deep breaths	Checked current in wall socket, opened box, reattached power cable, checked RAM and other connections, rechecked mother board connections, finally replaced mains power cord.

It was 42 deep breaths, not three. I am not sure if the deep breaths worked or my remedial actions worked primarily. One thing is sure - my body tissues got much more oxygen that they usually do.

Gravidity Parity Dilemma

One of the most basic instructions given to an undergrad is on the concept of gravidity and parity. Gravidity is the number of times a woman has got pregnant. Parity is the number of times she had delivered a viable baby. One adds abortion to the list, the number denoting the number of pregnancies that ended as abortions. If the woman is not pregnant at present, her gravidity is the sum of her parity and abortion number. If she delivers more than one fetus in a given pregnancy, her parity remains one irrespective of the number of fetuses she delivers.
The hospital nurses assign confinement number to every woman who delivers a viable baby. A tag with that number is ties around the wrist of the mother and another one with the same is tied around the wrist of the baby.
There was a curious situation the other day. The sister-in-charge of the labor ward stopped me during my ward round with a problem.
"Sir, a woman delivered a baby yesterday. Actually she had twins, but one of the babies had died in the uterus at 3 months of pregnancy. That small fetus came out after she delivered the first baby of nine months. We gave a confinement number to the first baby and the mother. We also gave the number to the other baby which had died at the gestational age of 3 months."
"You mean you tied a tape with that number around the very tiny wrist of a fetus of three months?" I asked incredulously."
"Yes" she said sheepishly.
"How did you manage that?" I asked. "That tape would have gone around the entire baby, not just its wrist."
"We managed" she said briefly. Obviously she did not want to go into the details of how they managed the feat. "What I want to know is that the Registrar told us not to give that number to that fetus. Were we right or was he?"
"He was right" I said.
She looked at me with accusing eyes. She probably did not take it well that I supported the doctor.
"By definition, if a fetus dies before the age of viability, it is called an abortion. If it is not expelled, it is called a missed abortion. So this woman with twins had a term delivery and an abortion together."
She looked at me skeptically. There must have been no such situation in their nursing books, nor in her nursing experience. My unit doctors looked like they thought I was putting them on. I assured them I was not. When I explained the logic, they were convinced.
"Now there is a problem in this" I said. "A woman pregnant for the first time in such a situation becomes Gravida 1 Para 1 Abortion 1 after her delivery of the fetuses, one being term and the other being an abortus. But the sum of her parity and abortions exceeds her gravidity. That is against the basic principle. What can be done to resolve this confusion?"
They thought about it, but had no solution. I had no solution too, mainly because I left it there and moved on with my ward round. I found the solution just now, when I reached the end of this post. It is as follows.
'The conventional teaching does not offer any solution here. No one has thought of such a situation before, though death and retention of one of twins is a known condition. We will have to accept the situation of having to call her Gravida 1 Para 1 Abortion 1, and write 'twins' in bracket.'
That sounds satisfactory to me. It is unlikely to find its way into obstetric textbooks, because I do not plan to write one, and people who write textbooks usually do not read blogs to get new ideas. :-)

State Security

There is a state run guest house at Malabar Hill, Mumbai. Ministers and high-up government officials stay there and also hold important meetings there. The security has to be very good at such a place. The health university holds a workshop on the same topic once a year at this secure place, and invites us there. It is painful listening to the same topics, the same speakers, and the same content year after year. But that is not the topic of the post today. The topic is the security at that place.
They have a tall fence with spikes at the top, so that no criminal or terrorist can climb over it. The gates are manned by multiple security guards. They look at you suspiciously. If you do not get discouraged and retreat, they open the gate and ask you what your business is. When you proffer documents to support your business there, they scrutinize them with suspicion. One wonders if they can read the documents in English. They do not move their lips when the look at the documents. Then they ask you for an identity card. If it is printed in English or Marathi, they ask which place you have come from. I am yet to know any language of printing the cards that they read and accept. If they are satisfied, they let you in. There is no checking the insides and undersides of cars which go in. The metal detectors do not work. They do not frisk you like they do at the airports.
The first time I went there, I was not prepared. I had no proof of identity with me, because the letter of invitation had not asked me to get any. I thought it was a free country and I was an important part of that country. They did not think so. The letter was not enough to get me in. They had to be sure I was who I claimed to be. I told them I would go away, and they would have to explain why I went away without attending the meeting. I could not understand what was threatening in the appearance of an elderly and frail looking doctor.
"I can recite the steps of performing a vaginal hysterectomy. That should prove I am a gynecologist" I wanted to say. But if our students did not want to hear those steps from us, these policemen would surely not be interested too, even if it was offered as proof. Finally they let me in reluctantly. At the end of the day they were not sorry they did, because no one blew up the guest house that day.
Just to prove that the security was lousy, I carried a color photocopy of my identity card in plastic lamination the next time. They looked at it gravely like they looked at everything, and let me in. They apparently did not know that terrorists and criminals carry fake IDs which are much better done than the one I carried. I have carried that same photocopy every time, and different security guards have let me in every time. I hope the people who frequent this guest house read this post and beef up the security there. Next time I plan to carry my original ID card and the photocopy, in case they will have beefed up the security. I will do that though I have serious doubts about them reading any blogs.

Man with Fixation on 'The'

English language has three articles, 'a, an, and the'. We were taught usage of articles quite early in school, and I had never thought there would be anyone who would have any problems with articles, especially of psychiatric nature. I was wrong. I met a man long ago, and continue to meet him even now. He suffers from a peculiar psychiatric condition that has not been described before. Bad usage of articles would be quite possible if the person was not educated well.  But it would not apply to a person with an MD degree and the job of a Professor and sometimes even a fill-in Dean.
'No article before a proper noun' my teacher had said and that was that. Perhaps his teacher did not say that. When he would refer to me as 'the' Parulekar, I would think of my school teacher. When he would do that to every name and surname he uttered, I would be glad my teacher was not around to feel upset (upset would be too mild a word to describe my teacher's feelings). I diagnosed his psychiatric fixation on 'the' when I realized that he never used the other articles in a similar manner. There never was 'a' Parulekar and 'an' Agashe. (Note: for people on the net who do not know Indian names and surnames - Parulekar and Agashe are surnames, or what others call second names in India.)
He asked the following question to a candidate during an interview to select a person for a job in the civic hospitals.
"What the form you the fill?"
The candidate became blank, the other interviewers who were paying attention somehow managed to keep straight faces, and those who were not paying attention deserved what they got - or rather did not get - free entertainment. I was paying attention. But I was not entertained. I got happiness because this question confirmed this was a fixation with 'the' rather than bad grammar.

Wonders of Banking

The banks, or rather the people working in the banks never fail to amaze me. There are a lot of stories to tell. May be I will write a masterly essay on this topic one day. Today I want to write about something unimaginable.
I put some money in a cumulative interest scheme for 555 days in my bank. They gave me a receipt, stating the maturity value. In a few days one of my old deposits matured. I added a little amount to it to make it equal to the recent deposit, and put it in the same scheme for the same duration. When I collected its receipt and went to put it along with the older receipt, I noticed that the maturity value of this one was less than the previous one. Though I had opted for biology and not mathematics before I went to a medical college, I remembered enough of my arithmetic to understand that the interest for a certain amount for a certain duration at a certain interest rate must remain the same irrespective of the day on which it is invested. After all, rules of arithmetic calculations do not change with the phases of the moon. I Google searched and found a site that gave compound interest result and maturity value of a deposit if you gave it the principal, interest rate and duration of the deposit. It is at http://www.allbankingsolutions.com/fdcal.htm I calculated maturity amount of my deposit, and found that the higher one of the two was accurate. I was making a loss on the second one.
I approached the bank and lodged a complaint. It took a long and repeated explanation over a period of two months, some eight visits to the bank, and a lot of frustration to finally find out what had gone wrong.
"It is the computer system. I gives different maturity values if the deposits are made on different days" the manager told me. When he realized that I would not buy that, he corrected the maturity value on my second receipt and promised to give a written answer to my complaint. Two more months have passed since then and I have not received that answer yet. In the meantime, I have to check if they have cheated me on any of my other deposits. It was sheer chance that I had two identical deposits for identical duration  and identical interest rates, or I never would have realized how they had cheated me.
I hope my readers use the link above to find out if their banks have been cheating them in a similar manner.

Weird Leave Application

It has been quite some time since, but I have not been able to forget this one. It was an application for 5 days of earned leave. The resident doctor had brought it himself/herself at about 10 A.M. The clerk had stated on it that there was no casual leave balance in the account of the applicant. The reason stated was 'personal reason'. I could sense something was amiss, but could not place it. I remembered the other time this Resident had gone on unsanctioned leave, gad come back and signed on the muster for those days. We had called it virtual presence, reprimanded him/her, and warned never to repeat that one. That did not mean this one would not try another trick. So I asked the resident why a short duration earned leave was asked for, it being against the civic body rules. I was authorized to sanction such leave only at my own discretion.
"I have personal reasons" came the answer. "I have leave due" came out an additional point after some time.
I explained that earned leave needed justification when it was to be of short duration. Finally the reason came out, which was not something that could not be stated on the application. Something was still amiss, though.
"Why have you not obtained OK from the Associate Professor, as is the policy?" I asked.
"The Associate Professor asked me to see you" came the answer. I showed my surprise. "I will be leaving for home tonight" came out reluctantly.
"But the leave is to be from tomorrow" I said, surprised. "How can you leave when you are on emergency duty?"
"Because the train is at night" came the answer. The logic was apparently solid. But it was not sound.
"But why did you book a ticket for tonight, before obtaining a sanction for your leave? It is wrong to go away from duty much before the leave starts."
"That is OK" came the answer. "I cover for the others sometimes, and they cover for me now."
This Resident Doctor had guts. Not only did he/she plan to do something wrong, but also told the Head of the Department about it, and that too quite casually.
"I shall not permit you to go away at night when you are on emergency duty until tomorrow morning" I said.
"In that case I will apply for leave for today too. I have worked up till now, but it is OK."
I was aghast. I had not met anyone before who planned to do something wrong, told me frankly what he/she planned, had no feeling that it was morally and ethically wrong too, and had the cheek to offer to take leave for the day so as to be able to go away early, sounding as if he/she was doing me and the institute a favor for having worked for a short while during the day he/she had to be on leave. I picked up my pen to sign on the leave application, held it there and asked, "Have you not learned moral and ethical values so as to be able to know what is right and what is wrong?"
There was no answer, just an angry wait until I would sign the leave application.
"Do you have any answer to that question?" I asked.
"No. I don't have any answer" he/she replied.
I hid my pain at the thought of what this future pillar of tomorrow's India was like, and signed that leave application. I have learned to recognize people I cannot change, and clearly this person was one of them.

(Note: 'he/she' is used to protect the identity of the person concerned.)

Septic Focus

There was a patient in the gynecology ward. She had a gynecological condition, for which she was being treated on indoor basis. She also had intermittent fever, which was not due to any gynecological cause. Usual causes of fever had been ruled out.
"Look for septic foci" I said. :Make references to medical, ENT, and dental departments. It does not look like septicemia, but get her blood culture done, since the medical Registrar will ask for it anyway."
The next day we saw this woman again during our ward round.
"Sir, the medical and ENT Registrars have not found any septic foci in her" I was told. "The dental Registrar has noted the call but not seen her yet."
"But does she have any dental sepsis on gross?" I asked. "We can do the basic checking ourselves." I turned to the woman and asked her to open her mouth. She did so. I bent down and peeped inside. There were two smooth gum ridges but no teeth.
"Where are the teeth?" I asked.
"There are no teeth" she said calmly.
All faculty and Resident doctors burst out laughing.
"You could have saved the dental Registrar a visit to our ward by looking at her teeth. If she has no teeth, she cannot have dental caries and periodontal disease" I said. I knew she could have it, if she had a root broken inside the tooth sockets, but she would have had pain and swelling of the gums too.
"I knew she had not teeth. I wanted the dental Registrar to look for sepsis in the gums"  the Registrar said lamely.

Sinus Closure

Sometimes an abdominal incision does not heal and it gapes open. Usually there is some infection, which needs to be cleared by local dressing with/without systemic antibiotics. When healthy granulation tissue forms on the raw surface, the wound is sutured in one layer, using simple No.1 monofilament polyamide sutures.
We had a case who developed MRSA infection. We controlled it with antibiotics. Healthy granulation tissue formed. But there was a problem. A tunnel of about 1-2 cm length had formed under the skin surface extending from the right side of the wound laterally in the subcutaneous tissue. It just would not fill up, and we could not pack it because its opening was not big enough. If we sutured just the original incision, this sinus would persist and keep discharging pus chronically. The option of laying it open by cutting healthy tissue overlying it was not very attractive, because that was healthy tissue and we did not want to disfigure the abdomen. Then I had an idea, which I have shown in the following 3D representation.

Four simple interrupted sutures of No.1 monofilament polyamide are shown. When tied, they will approximate the edges of the wound. The sinus is seen on one side, with a suture passing under it and exiting on either side of it over the skin surface. When tied, it will occlude the cavity of the sinus. Then it will heal because the granulation tissue within it will generate fibrous tissue to replace the cavity. The patient responded to this form of treatment very well.

Show Off

I have never been a show off. I believe in just doing what I do best, and let people appreciate if they feel so. I feel good if they do, and also if they don't, because my happiness also stems from achieving something.
Today I suddenly felt like showing off, when I opened my 3D models folder.

It so happened that I had developed this 3D model a long time ago, and had kept it for a blog post. But I never got around to thinking of any text which would be supplemented by it. So I thought, why not just show it off? So here it is. You know what guys? It felt good. But I wonder if this feeling is because of showing off, or because I could use the 3D model and move on?

Types of Professors

In a developed country, a college has just one Professor. All others are Associate Professors, Assistant Professors, or others. Our country has a trick. It is to offer honor and prestige, so that people feel good. Then they work well, and do not create trouble(s).
One of the things they did in this connection was to call Lecturers as Assistant Professors. Another thing they did was to create a lot of posts of Professors in medical and allied subjects. So a lot of people felt good. A few years later, they decided to increase the retirement age from 58 to 62. Suddenly Associate Professors realized that their seniors would retire 4 years later, and their own promotions would be delayed by 4 years. They resisted. They brought about political pressure to stall this move. They probably wanted the seniors to retire first, and then have this change implemented, so that they would become professors earlier and enjoy that position for 4 more years. Finally the civic body upgraded their posts to Additional Professors, and increased their salaries to those of Professors. Now there are so many professors around, that one wonders if there are any junior cadres.
Now with the next revolt, they should upgrade the following posts as shown in the right hand column. This based on the positions of Deans in Engineering Colleges, like Dean if Student Affairs, Dean of This and Dean if That :-).

Professor	Dean in Waiting
Additional Professor	Additional Dean in Waiting
Assistant Professor	Assistant Dean in Waiting
Senior Resident	Senior Professor in Waiting
Junior Resident	Junior Professor in Waiting
Intern	Sub Junior Professor in Waiting
Medical Student	Potential Professor in Waiting

Women's Day Special

She was seventeen, but looked barely twelve or thirteen. She had come to the outpatient clinic with her mother. She was in pain. She was scared, but was trying not to show it. They both looked poor, and were making no attempt to hide it. She had been diagnosed to have a hematometra and had come to us for treatment. I examined her and found that she had a hematometra and hematocolpos due to a transverse vaginal septum. She had a single kidney.
"She was to appear for her SSC exam today" the mother told me. "I brought her here because she could not stand the pain."
"So she loses a year?" I asked. "We could have stopped the pain with medicines temporarily." I looked at the wall clock. It was just 10:30. "There is time enough for her to go and appear for the exam. We will give her medicines. We can perform the operation after her exam is over."
Her mother smiled sadly. "We have come from xxxxxxxx" she said. I knew that place. It was far off. They must have traveled for a day to reach our hospital. It was sad they could not get healthcare near their home.
We got her admitted in our gynecology ward. All her tests for fitness for anesthesia gave normal results. I operated on her just 5 days after her visit to our outpatient clinic, which is usually not possible owing to a long waiting list. It was a difficult operation. She had two uteri, of which one was opening normally in the vagina, while the other was obstructed by a transverse vaginal septum. The next day morning, I found her sound asleep at 9:10 A.M., when I reached her ward for my morning ward round. We woke her up to ask her if she felt OK. She nodded with her eyes half closed. There was no pain, no anxiety, no worry about her strange surroundings or her catheter or thoughts about her future.She just knew that the doctors had solved her problem and she was free to be the child that she was. She did not know it was women's day, but I was happy that she had found happiness on this day.

Tamponing

"Sir, we are tamponing this woman" I was informed during our round of the gynecological ward.
The word 'tamponing' reminded me of the word harpooning and then of captain Nemo and his Nautilus. Then it made me think of lampooning - which is transitive form of 'to lampoon', which means 'to attack or satirize in a lampoon', a lampoon being 'a satire in verse or prose ridiculing a person'. Then I thought of 'cartooning' meaning to draw a cartoon. But there is no such verb in the dictionary. I thought of all these other words because I believed there was no such verb as 'to tampon'. I checked the dictionary to make sure, and discovered that there was indeed a verb 'to tampon', which meant 'to plug a wound or body cavity with a tampon'. a tampon being 'a plug of lint, cotton or cotton wool, inserted into a wound or body cavity to stop the flow of blood or absorb blood. It is inserted by some women into the vagina during menstruation  to absorb menstrual blood. We use it in gynecology to reduce edema of the cervix due to pelvic organ prolapse. Of course it has to be soaked with glycerine-acriflavine prior to insertion for this indication.
This Resident Doctor made me proud by correctly using a word when all people are criticizing the Resident Doctors for using abbreviations which they make on the fly.

Grab Their Attention

I delivered two lectures to the undergrads back to back the other day. One was my scheduled lecture, and the other was for a colleague who had to be elsewhere unexpectedly and there was no one else to deliver a lecture in that time slot. I did not want to lose the slot, because their education had to be completed as per scheduled plan. I tried my best to keep them awake, and entertained them with anecdotes, while continuing to impart education. But I started losing them during the second lecture. After all, there is only so much that a human mind can take. Two of them yawned independently within ten seconds of each other.
"There are two types of yawns. One is the infectious type, in which a person yawns when he/she sees someone else yawn. The other is noninfectious yawn. Just now that guy there yawned. In less than 10 seconds, that girl yawned. But she could not have seen him yawn. She is sitting in a row ahead of him. So these were the noninfectious type of yawns. The only reason for these yawns, I can see, is my lecture."
They laughed. I could teach them some more before they started losing interest again. I had to grab their attention again. So I started with a story, which had to do with a goal before starting out in life. I thought of it in connection with something that happened in class at that moment.
"I will tell you how I reached where I am now" I said. I won't tell the story here, because it will make this post too long. Perhaps some other time. Halfway through the story, I realized that they were listening with rapt attention, like people do when they watching some soap on the TV. Perhaps they thought they would hear something worth gossiping. I completed the story, advised them to fix their goals and went back to teaching. Within ten seconds they went back to their whisperings, texting and not paying any attention.
So I can say that it easy to grab their attention with anecdotes, but very difficult to keep it if you go back to teaching.

Dynamic Handling of Tocodynamometer

The well being of the baby during labor is assessed by recording the fetal heart rate and maternal uterine contractions during labor. The uterine contractions are recorded using a simple gadget called as a tocodynamometer, which is shown below.

The transducer used for this is strapped to the patient's abdomen over the upper part of the uterus. It has a disk projecting out from the middle of the maternal surface. There is a spring under the disk. When the uterus contracts, it rises forwards and compresses the spring. This mechanical energy is converted into an electrical signal, which is carried through a cable to the recorder, which writes on a moving strip of paper. The fetal heart rate is recorded on the same paper using another device.
The job of fetal heart rate monitoring is usually done by the Resident Doctors. Actually all transducers have to be strapped to the patient's abdomen, so that they do not fall down. They break if they fall down. Another reason for strapping the tocodynamometer is that the spring has to be compressed to a fixed level when the uterus is relaxed, and only then it can give an idea about the force and duration of the uterine contractions.
Once we were taking a round of the labor ward. I found a patient connected to a monitor there. The patient was holding the tocodynamometer with her hand, while the heart rate transducer was strapped with a belt. The Resident Doctor who was doing the monitoring was with another patient.
"May I ask why the transducer is not strapped to the patient's abdomen?" I asked.
She promptly replaced the patient's hand with her own. "The other transducer is strapped" she said.
I took the transducer from her and asked her if it was recording uterine contractions well. She said it was. I held the disk over the spring facing away from her and pressed it. The record immediately showed a powerful contraction which just would not go away, because I kept pressing on the disk.
"What a strong and long uterine contraction!" I said.
She looked suspiciously at my hand. "You are pressing on the disk" she said accusingly.
"Exactly" I said. "The same thing can happen when the patient gets a painful uterine contraction, or just holds the transducer tightly. She might let the grip become loose, which will result in loss of recording of the contraction. If you are holding it and someone calls you, you turn around and the hand presses the transducer on the patient's abdomen. That produces a false record of a contraction." I demonstrated what I meant. It did what I had just said it would do.
"Now I hope you understand why both the transducers should be strapped to the patient's abdomen."
I hope she understood it. I am hoping against hope she will do what I told her to do - after all there are many reasons for not following standard operating procedures.