Telephone Manners and Fun

As my favorite author late Mr Stephen Covey said, a telephone is a time waster. You could be in the middle of something very important. Then the telephone rings and you cannot overcome the urge to pick it up, because it could be something even more important. Most often it is not, but you cannot take chances. Depending on your network, it could be sometimes or often a wrong number. There are polite people who apologize when you inform them it is a wrong number. There are impolite ones who abuse verbally when they hear it is a wrong number. There are less impolite ones who just bang the phone down, without saying anything. The last week I had two episodes of wrong numbers which were different from those described above.

I was discussing a patient's management with another professor, when the phone rang. I picked it up.

"Ward 42?" a woman's voice asked.

"No. It is a wrong number" I said and put the phone down. No sooner than I had put it down, it rang again. This person must have hit the redial button, I thought.

"Ha....lo..." I said in a voice that was in my opinion rougher than my regular voice, so that the caller would not identify it.

"Hello" said the same woman. "Is it ..."

"No" I interrupted. "It is still not ward 42" and put the phone down.

"That was a nice one" said the professor. I grinned. The caller did not hit the redial button again, nor did she dial the number again.

A couple of days later, someone called when I was studying a complex document that had arrived in dispatch.

"Is it ward 21?"

"No, it is not" I said. I should have put the phone down and continued with the study of that document. But the guy on the phone was faster than I.

"If it is not ward 21, then what place is it?" he asked. This irritated me.

"You want ward 21. This is not ward 21. How does it matter what place is it?" I asked. I knew I should have realized he was a little simple or something and not got irritated with him. But anyway I had said it before thinking all that. I bet he kept thinking about that long after I put the phone down. I hope he does not ask that question the next time he gets a wrong number.

Lucky to Have Ignorant Employees

"This clerk" one department head told me conversationally "was in my department. We had collected all the information and she/he had filled all the forms required for inspection by the medical council. It was saved on our computer. Then one day she/he got transferred to another department. She/he came back and deleted the file from the computer. We had no backup."
"Huh" I said, for both deletion of the file by the clerk and not having a backup by the department. Perhaps they trusted her/him. "Then what did you do?"
"When the file disappeared following her/his visit to the department, I checked the recycle bin. I found the file there. I restored it. The inspection could be carried out without any trouble."
Perhaps the clerk had been unhappy working in that department, I thought. But that did not justify deletion of the file. It was lucky that the clerk did not know about deleting a file bypassing the recycle bin, or emptying the recycle bin. It was even luckier that she/he did not know about permanently deleting a file so that it could not be restored using special software. Perhaps she knew about it, but did not have time to do it, or did not have the software installed there. My personal impression was that the reason was ignorance.
"Count this as your blessing" I said.
"Yes" said the department head with a happy grin.
(Note: the use of 'she/he' is to protect the identity of the person concerned.)

Red Wine in Gynecology

Some Resident Doctors were presenting a seminar on 'Scar Endometriosis'. They were following the standard sequence of a presentation. There was a speaker who was talking on the historical aspect. A part of the slide he/she presented is shown below. The red oval has been added by me to draw attention of the readers to the area of interest.

"Red Wine described this phenomenon first" he/she said. A lot of people suddenly moved from a phase of drowsiness to one of alertness.
"Where did you get this information?" one Professor asked.
"The internet" came an honest answer.
"Are you sure it was 'Red Wine'?" another Professor asked.
"Yes."
"But the internet is not a reliable source of information" I said. "Anyone can write anything on the inetrnet, without any accountability about the validity of the statements made. Perhaps someone put this stuff there to pull a lot of people's legs at one go. I myself have not heard of any Gynecologist called Red Wine."
He/she looked genuinely hurt at all the criticism. I decided to find out the truth of it. So when I had some free time in the evening, I did a Google search and found that Dr Redwine, a person who had dedicated his whole life to the study of endometriosis, had done pioneering work on this subject. He had passed away in 2012. So it was Dr Redwine and not Dr Red Wine. I spoke to the concerned Resident Doctor the next day, borrowed his slide, and looked at the reference he/she showed me on his/her mobile phone. It was 'Redwine' and not 'Red Wine' even there. I pointed that out to him/her. In the next academic meeting in the department, I made this announcement.
"For those who heard our young friend here state that Dr. Red Wine described scar endometriosis first, I wish to announce that a Google search showed me that it was Dr Redwine and not Dr Red Wine."
"It was a typo" he/she said.
"No, it wasn't" I said. "In a typo, one does not press the space bar and make the first letter of the next word capital. It was probably an expression of your romantic nature."

Managing Files Without Extension

Our administrative office sent me an email with an attachment, which had been received by that office from a government office. It had to do with some healthcare related matter, since it was sent by a healthcare related agency of the government. I downloaded the file and tried to open it. Windows informed me that the file was of an unknown type and Windows did not know how to open it. So I checked the properties of the file. The file type was 'File'. It had no extension.
I informed our administrative office that the attachment could not be opened. But I could not let it go just like that. I could not believe that the government office people could make 'File' type of files that they expected doctors to read. So I gave it '.doc' extension by renaming it. Then I tried to open it in Microsoft Word. Word expressed an inability to open it. So I changed the extension to '.pdf' by renaming it again. My PDF reader opened it promptly.
As luck would have it, there was a goof up by the government office. They had not called me to the meeting at all. They had called the head of another medical college Obstetrics Gynecology department, but had written the address of the college as 'Parel', which was where my institute was located. We could call it a double-goof up, something on lines of a 'double-whammy'. One was sending the invitation to a wrong person, and the other was to remove the extension of their file, so that no one could read it. I could read it, only because I could read the mindset of the people who made that file and knew what they would do, though this was the first instance of it in my life.

New Indications For LSCS

LSCS is short for lower segment cesarean section (for those who are not medicos who have not undergone one or have undergone one but don't know what it is called) The list of indications was quite limited about 50 years ago. With advances in maternal-fetal medicine, the list has got quite exhaustive. When we were discussing this issue once, I came to know about some other indications that have not been put down in text books and journals yet.
"Did you know what XXX used to do?" asked someone. "It was a modification of 'failure of induction of labor' as an indication for an LSCS." XXX was a person who worked in our hospital as a unit head, who left for greener pastures some time ago.
"What?"
"Once I saw a patient of that person in the labor ward. She was a staff nurse with a prior LSCS. She was receiving an oxytocin infusion for induction of labor. We both reached the patient simultaneously. I noticed that the oxytocin drip was running like a tap."
"Huh?" I said. "That would cause fetal death or uterine rupture."
"Exactly. I drew attention of XXX to the drip rate. Instead of promptly reducing the drip rate, he/she merely smiled. You know what it means."
"What?"
"There was no oxytocin in the infusion bottle. It was plain 5% dextrose."
"Huh?"
"Yes. The plan was to do an LSCS. But the drip was given to make the patient think that all efforts were made to achieve a vaginal delivery before LSCS was done when induction of labor failed."
"...." I was speechless.
"I heard this was not a one time occurrence. XXX must have made the resident doctors privy to this plan too, since the drip is always prepared, administered and monitored by the resident doctors."
"....: I was still speechless.
"This was subtle" said another person. "ZZZ was more direct." ZZZ was another unit head who joined another institute some time back, for many reasons including a greener pasture.
"How?" asked the person who had told the first story.
"He/she would subject all staff nurses registered with that unit to LSCS. It had got so that when anyone asked about the indication for LSCS in any given case, the Associate Professor in the unit would say 'staff nurse'. Of course the patient herself would be told some other reason."
"But why? Why not treat them like any other patients?" I asked.
"Your guess is as good as mine" I was told.
(Note: XXX, ZZZ, and he/she have been used to protect the identity of persons concerned. This note is superfluous anyway, when you read the warning at the bottom of the page, which reads 'All characters except me and all places and incidents described are fictitious and any resemblance to actual persons, places or incidents will be entirely accidental or coincidental.')

What A Modification

A special feature of many people around us is their desire to change something to their satisfaction. Some of them do it so brilliantly that one cannot even begin to fathom the thought process behind it. Here is an example of this.
We were working in the OT. There was a patient who had an intrauterine device, whose strings had gone missing. It could not be removed in the outpatient clinic. It was scheduled to be removed under anesthesia. A special instrument used for this purpose is IUD removing hook. Another instrument used for this purpose is Shirodkar's intrauterine prosthesis removing device, which is shown below. The part 'A' is as it is seen, and part 'B' is close up view of its terminal portion that goes into the uterus to hook out the IUD.

We asked for this instrument while operating on that patient. The nurse gave us one which looked as follows.

"Who changed its shape like this?" I asked with amazement.
"Is it changed?" the nurse asked me. "It has been of this shape ever since I have been posted in this OT two months ago."
"I could attempt to straighten it" I said. "But it is likely to break at the new bend. Please send it to the engineer."
"Right away" she said.
"Not right away. Please wait until we take its photograph. One comes across a modification like this but once in a lifetime, if at all."
That instrument could not have been passed into any woman's uterus in any way. I fervently wish I meet that person to know the working of his/her mind.

Advanced Speech Therapy

We have one resident doctor who spoke without any breaks for commas or full stops. Despite telling him/her not do so over two years and one month, there was no change. Here is what happened during one of the ward rounds.

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpaininabdomenlastmenstrualperiodnotknownwithacutepaininabdomennohistoryofbleedingpervaginum”

“Hey, wait. I cannot make it out what you are saying” I said. “Say it all again with pauses between words, and wherever you would place commas and full stops.”

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpainin” he/she said.

“Stop!” I said. “Say it again with pauses as I told you”.

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpainin”

There was no improvement. If he/she did this in MS examination, the examiner would surely fail him/her, I thought.

“Stop” I commanded. “You have to start again and say it all again until you do it right. I will spend the whole morning listen to you, if I have to, until you do it right. Now start again.”

“This is gravida three para two withninemonthsamenorrheaandpainin”

“Stop. Start over again” I said.

“This is gravida three para two with nine months amenorrhea and pain in abdomen. Last menstrual period notknownwithactepaininabdo.”

“Stop. Start again” I said.

“This is gravida three para two with nine months amenorrhea and pain in abdomen. Last menstrual period not known, with acute pain in abdomen. No history of bleeding per vaginum.”

“That is good. Now tell me more about her” I said. The improvement lasted that day and for two more days afterwards. He/she has understood that I will make him/her go through that again if he/she reverts to his/her old style of speaking.

I wish I had thought of this speech therapy two years ago.
(Note: 'He/she' is used to protect the identity of the person concerned.) 

Innovations In Intravenous Fluids Management

We usually administer intravenous fluids to a patient for 24 hours after a cesarean section. Since cesarean sections are performed at all times, there are patients who have received intravenous fluids for 0 to 24 hours in the postoperative ward at any given time. We often find that a patient is without any fluid going into her vein even if it has been a short time after the cesarean section. The nurses offer different reasons for the same, some of which are as follows, and all of which I trust are true.

1. I was going to start the next bottle of fluid just now.
2. I disconnected the fluid infusion because the servant was changing the patient's dirty gown.
3. I have just come on the duty, and learned that IV fluid is to be given to this patient. I will do it right away.
4. The nurse who has to do it has gone somewhere on duty. I will do it right away.

Despite clear instructions, the Resident Doctors are unable to enforce continued administration of IV fluids, because the disconnection usually happens when they have gone away from the ward. That day I found a patient with an intravenous cannula in place, but no fluid bottle connected to it through an infusion set. There were three infusion bottles hung on an IV stand as shown in my 3D model below. It had been just 11 hours since the patient had undergone a cesarean section.

"Where is her IV infusion?" I asked. The Registrar put on a confused expression and said nothing.
"Are all of these bottles for this patient?" I asked. Someone called the nurse, who declared,
"Yes. We have her remaining fluid bottles ready on the stand. We will give them to her one after another."
"Keeping all bottles opened will result in contamination of their external surface, and those bacteria will enter the bottles when the bottles are pierced with the end of the infusion set" I said.
"Um..." the nurse said. I took it to mean she had understood it and would not do so again.
"There is no infusion tube between any of the bottles and the intravenous cannula" I pointed out. "Is the connection WiFi?"
The Associate Professor laughed. I think the others either did not get the joke or were to scared to laugh.

Reason To Occupy The Top Spot

"I am thinking of giving up my top spot in the organization" a CEO of one public sector organization told me as a friend.
"Why" I asked.
"It is too much headache. Too much pressure to do wrong things. Too much internal politics. Too much external political intervention. Bosses ignore you even when you are right, and you cannot do anything about it. They take away your resources and you cannot even complain much."
"I understand" I said. "It is one reason I never thought of such a position for myself. I remained happy with Head of Department's position. But you seem to manage things well. You should not give up."
"Why should I continue if it troubles my conscience?"
"For one thing, it will make you think you were defeated by those people who trouble you" I said. "The other, and more important reason is that if you give up, some idXXt* will occupy that position and ruin everything, and trouble you too."
"Huh?" this seemed to be a new thought to the CEO.
"Yes. I have seen some capable CEOs. I have also seen what many other CEOs were capable of. You should continue to keep doing whatever good work you can, keeping away idXXts* from that position."
I hope that CEO takes my advice and stays put for the sake of the organization and the people it serves.
(Note: * read vowels in places of X).

Styles in Soccer and Gynecology

The Times had an article on 'Soccer Stars and Their Superstitions' on 10th June 2014. A number of soccer stars featured in it. There were photos showing what some of them did while playing soccer. There was a picture of Frank Lampard of England, pointing a finger towards the sky, and the description was that he pointed a finger in this way after scoring a goal. It looked somewhat like this (only the posture, not the physical details).

We had a meeting the same afternoon, where one resident doctor suggested a topic for their seminar. It was 'OT behavior of gynecologists'. It was rejected because it was not an academic topic. But that got me thinking about how a gynecologist would react after removing a uterus in a difficult case, if he/she were to follow the soccer players. I came up with this one.

In case you have seen better ones, please write to me or email pictures of such interesting poses.

Amazing Filing Styles

Every patient attending the outpatient clinic is urged to file her case papers in a file of her own, so that the documents are better preserved, and are available during her subsequent visits in a better condition. This is done purely in her own interest. Not all the patients are literate, and not all of the illiterate ones have someone literate to help them with filing the documents the right side up. So we get to see a lot of ways in which these documents are filed. First we will see a 3D image of a representative file, only because I took great pains to create a 3D model of the same.

The standard way to file the documents is shown below, like the pages of a book.

Here is one in which the patient files the documents upside down, so that we have to turn the file upside down to read the contents.

Here is one in which she files the pages on the wrong side of the file. I suppose there might be people who print and bind books in such a way that one has to turn pages of books from left to right. Anyway it is unlikely these women belong to that group, because they are not capable of reading anything.

Here is a variation of the previous one, in which the documents are filed upside down, in addition to being filed for turning the pages from left to right.

Here we have one which has the documents filed on the correct side of the file, but the backside to the front.

Here we have one which has the documents filed on the correct side of the file, but upside down and the backside to the front.

Here is a variation in which a folded sheet is filed with its folded edge out and free edges in the spine. One has to remove the pages and open them for reading the contents, and then one files them properly because of habit.
Then there are those who want a life rich with variety, or the are ardent followers of the chaos theory. They use different combinations of these techniques in the same file.
The psychiatrists could use these files to test the ability of people to maintain their sanity under extreme conditions.

Connectivity - A New Problem

We get broadband Internet connection in the office. It is a PPPoE connection. Everyone has a unique login name and password. The network administrator is a little quirky. He shuts down an account if the user does not change his default password to a new one. There are other quirks too. For example he changed to Windows 2003 server suddenly (long ago, but it still rankles) so that all our systems stopped getting Internet connection. We took two months to work out that the server did not support our operating system (Windows 98 at that time). We spent a lot of money to upgrade our systems just so as to be able to connect to the Internet. So anything goes wrong with our network, we presume it is the network administrator's doing until proved otherwise.
This time my Internet connection started going off every 6 to 10 minutes, so that I had to log in again and again. That happened if I was not actively browsing. I called the service engineer who logged in himself, and was promptly cut off like I was. So it proved that I was not singled out for this punishment as I had suspected. We both recalled that the Network Administrator had revealed a plan to log off a user if inactive for more than 5 minutes. Perhaps he had done that. He changed the patch cord, but it did not achieve anything. He advised me to try another PC or laptop on the same connection and went away. I did that and found out that the connection was maintained on it. So the problem was with the PC, not the network. I went home with that knowledge.
The next day I had a shock. The desktop looked alien when I booted the PC. All my files, folders and shortcuts on the desktop had gone. The logging in problem was persistent. I called computer service engineer, who found my files and folders in another location, while the desktop remained clean. He could not solve the logging in problem too. He advised me to call the authorized service agency, which I did. The agency promised to send someone whenever someone would be in our area. That was not very encouraging. I checked the PC for viruses and malware. There was no virus. Seven malware threats were found and removed. But the problems persisted. In fact, now I could not log in at all. Then I had an idea. I checked the device manager. Under the network adapters, I found seven corrupt drivers above the standard one of the PC. They all were for ISATAP adapter, with different multidigit serial numbers. They had never been there before. They were for IPV6 protocol, which is not yet implemented.. I deleted them one by one, and suddenly the Internet connected and kept working smoothly. I then rebooted the system, and they reappeared. Finally I had to disable the IPV6 protocol, and then they did not reappear after rebooting.
So it was probably some malware which had created a new desktop location for my PC and put seven corrupt drivers for ISATAP network adapter by enabling IPV6 protocol, when none was required. The new drivers were preventing the PC from connecting to Internet using the actual Ethernet adapter.
Update: 12-06-2014
I found out that all this did not solve the problem. The computer engineers found this problem on all PCs in my department, and with different persons logged in. It turned out to be the network administrator's itch to trouble us, by switching off a user if he did not show activity for a few minutes. My previous internet service provider (ISP) at home used to do that, to stop us from putting a file for download at night and going to sleep. Once we were logged off, the internet usage would be zero, and ISP would save money (we having an unlimited plan). I used a trick that time to overcome this problem. I used the same trick on our network administrator and now I remain logged on, even if I do not browse the net. I won't write about that trick here, because this fellow might read it and do something else to trouble me. In case you are interested in finding out what it is, please email me.

Unique Reason For Divorce

History repeats itself.
There was a patient referred to a hospital by a court for an examination by a gynecologist. It was a case for divorce, in which the husband had claimed that the wife did not have normal external sex organs. The court wanted a gynecologist to examine and state if that was true. That was not true, as was found out by local gynecologist. I wondered how any lawyer would advise a client to seek a divorce on these false grounds, which can be verified easily by a gynecologist. Or perhaps the husband stuck to his claim and the lawyer represented him, just as he/she would represent any client, outcome not guaranteed.
That reminded me of a case that had been referred for the same reason thirty one years ago, when I was a Resident Doctor. It came for hearing when I had become a Lecturer. I stated that the wife was normal. The husband's lawyer said "I charge that you have colluded with the defendant". I put on a bored expression and looked at the clouds in the distance through a window. The judge got irritated by the lawyer and asked me if that was true. I politely said that it was not true. The court seemed to accept my statement about my findings.
I wonder if the human race is evolving, or we are stuck where we were thirty one years ago.

Brain Picking and Blind Trust

I always believed that if someone asked for help, and if I could help, I should. And I did. I did not think that I would ask for any reciprocation from the persons I helped. But I also believed that if I needed help from any of these people and they could help, they would. The main thing I can help with is knowledge or at least knowledge of sources of knowledge that I can refer to and find answers for others. Some of them call me and ask for academic help. Some of them email me and ask for help. I help. I never thought I would need help from them and I did manage on my own. Until recently.
There is this journal JPGO that my department has started. We have published six issues so far. We have got indexing from four indexing bodies. It is open access and totally free. I emailed all colleagues to contribute to it. I dug out addresses from my inbox of people I had helped and emailed them to write for our journal. No one did. A few of them promised they would, most of them did not even answer the emails. I have had calls from people asking for academic help after all this. One person called from London and asked my critical opinion on some operation. A classmate and colleague called and asked about interpretation of some modern tests that a pathologist did for his patient. It was not the first time either of them had asked for and got help from me. I spent time for both and sent them extensive replies. At the end of the answers I wrote, 'I strongly urge you to write an article for our journal. It is totally free.' Both of them thanked me profusely for helping them. Neither mentioned anything about any article for the journal. There has been no communication from them subsequently. When I told my co-editor about this, the co-editor said,
"Sir, they just want to pick on your brains for nothing in return, even if it costs them not a dime. You should not trust people blindly."
I have always trusted people blindly until I have been burnt, which has been most of the times. I wonder if I have lived a life based on wrong values. I wonder if I can change at this stage of my life. And even as I wonder, I think the answer to both of these questions is 'no'. But if the answer is 'no', what has gone wrong and where has it gone wrong?

The Welcome

I was on vacation for three weeks. The hospital work continued in my absence, as all doctors did not go on vacation at the same time. A few days before the end of the vacation, I had to go to the hospital because the medical council held an inspection of the department. Everyone had to go to the hospital that day, whether on vacation or not, because if adequate number of doctors were not found, they would remove recognition of the institute. I had to be there not only for being count as present, but to tell the medical council inspector all about my department, answer all questions, and show her around the institute. One of the places to be shown was my Gynecology ward. When I entered the ward with the inspectors, all the beds were occupied. The patients were lying down. When they saw me, a number of them sat up. A few of them started waving at me enthusiastically. I had not thought the patients would remember me and be so happy to see me when they least expected to do so. After all, it was a civic general hospital with a lot of doctors, and someone or the other would treat them anyway.
"Now now" I said. "I am here for some other work. Be with you in four more days."
They stopped waving, but seemed reassured. All these days I probably had believed I was doing a job mainly for my job satisfaction. Now I realized I was doing a job mainly for their satisfaction, even if I had not known that.