Three Candidates Fit To Head Institute

"I can see three persons in the institute who are fit to head the institute, should the current head decide to give up the position" I said.
"Who?" the professor sitting on the other side of the table in the staff room asked. "I believe the current head is staying, and you are making this statement to start telling us about these three people?"
"Yes and yes" I said to the two statements. "The first person is that professor who shouts at the current Boss, Boss' Boss, and Boss' Boss' Boss equally recklessly. This is the professor who knows he/she has all the knowledge and know-how to be the BOSS."
"Got it. Who is the second person?"
"That resident doctor in the department, who argues with all bosses, who knows that she/he is right at all times, who does not understand why the world cannot understand things which are so clear to her/him" I said.
"Got it. Who is the third?"
The head clerk in the office in the college building, who is rude to the rest of the people in the institute, who makes rules that have nothing to do with civic body rules, who does things that the Boss also does not seem able to control, and whose immediate boss is afraid of trying to control her/him like a hen/cock-pecked boss."
"Got it. "What do you propose to do about it?"
"If I could, I would introduce the three to one another, put them on a common platform, and let them slug it out to win the position of Boss. I know that cannot happen, but the dream gives me a very satisfying feeling that cannot be described in words."
"I understand" the professor said. I realized this professor had had the pleasure of interacting with all of the three candidates whom the God had probably made for that one post.

How To Repair A Tap

The most common serious problem with a tap is wearing out of the threads of the gland nut shown below. As a result, the gland does not push down the jumper and the washer over the distal part of the jumper firmly, but keeps rotating through 360 degrees. The washer does not make firm contact with its bed and shut off flow of water. Then water keeps leaking even when the tap is closed. The only solution plumbers offer to this problem is to replace the tap with a new one. That is what we always did all my parents' life and all my life too, until I decided to experiment with it.
The following 3D image of an old-fashioned, conventional tap shows the tap in a dismantled state, with the shield removed. I opened the irreparable (as diagnosed by the plumber) tap in our house, and removed the jumper with the washer mounted on it. Then I put another washer over the tip of the jumper, so that there were two washers, one below the other. That is shown in the second illustration.

Then I put the jumper-washers assembly back and reassembled the tap. Voila! The tap was fully functional. It has been quite a few days, and the tap is still working fine.
I have another solution to this problem too. It is to increase the height of the jumper. I could do it by fixing a rigid plastic tube of proper size (to be decided by experimenting, or by trial and error) over its upper end. Then the lower end of the jumper-washer assembly will be lower than usual, and the washer would shut off the flow of water before the turns of the gland nut reach the worn out part.
I wish I had thought of all this years ago. Then we would not have had to throw away perfectly reparable taps and buy new ones which had no guarantee of lasting long.

Communication Skills Videos

There are two types of work. The first type is an isolated effort, which works that one time. The other is a creation that will work time and again. I prefer the second type, because it keeps doing good until there is time for a modification or upgrading. We made communication skills videos for Resident Doctors with the second type in mind. Communication skills is an area of medical curriculum that has been introduced in only the last few years, probably because everyone was concerned in teaching known aspects of medicine, developing new aspects, and in general making progress. Still the concept of faith healing has also been known from ancient times. Patients of some doctors get better faster than of some other doctors, even if they prescribe the same medicines. This is related to better communication with patients. Doctors who inspire hope and confidence in their patients achieve better results because they communicate with their patients better. Doctors who speak well with their patients have more prosperous practice as compared to equally or even more knowledgeable doctors, only because they talk to their patients better. The modern times have a change in one scenario as compared to old times. The doctor is no more in God position. The patients and their relatives do not trust the doctors blindly. They have suspicion that the medical practice of modern times is commercial rather than of dedication to healing others. They often question the actions of doctors, when the result of therapy is not as expected. The modern doctor, who does not the time and patience to communicate with the patients well has distanced himself from the patients. But his curt statement, sometimes rude behavior, and an attitude that he is always right and no one can touch him is resented by dissatisfied patients. This is the root cause of assaults on doctors, and police complaints, malpractice suits, complaints in medical councils and human rights commissions against doctors. A doctor often does not remember that the patient has gone to him because he is ailing and needs relief. He forgets that the patient needs as much emotional support as medical treatment. He forgets that the patient is a human being with emotions, feelings, self respect, and pride. He forgets that that he has to communicate with the patient the same way or even better than he communicates with those near and dear to him. When the patient realizes that he is helpless against the superior position of the doctor by virtue of his medical knowledge and expertise, he finds ways that are available to him, like physical violence, peer pressure, political pressure, administrative pressure and legal recourse. A vast majority of these events are totally avoidable by just communicating well with the patient.
In a busy public hospital, the resident doctors are overworked because there are too many patients, of whom many require critical care. The doctors get little time to eat, drink and sleep. There are pressures from patients for satisfactory results, from seniors for meticulous working, from personal point of view to complete studies with good grades. The happiness of working sometimes gets lost somewhere down the line, and the doctors become irritable, curt, rude, and distant. Their communication with even colleagues from other departments often leaves much to be desired when an event occurs that implies more work for the tired doctors. Such things happen when patients are transferred to their institutes from other hospitals. They also occur when the patient suffers from an illness that they feel should be treated by doctors from other specialties. They do not realize that their poor communication is hurtful to the patient whom they are striving to heal. They do not realize that they are hurting themselves, not only by what the patients can do to them when dissatisfied, but by their own altered emotionality. They do not realize that they are anyway required to accept the patients they would rather not treat, and it is done far better by avoiding angry outbursts and resentments. The work would get over faster if they did not spend time on arguments. It would be a much more pleasant experience for everyone if they were nice, polite and respectful.
This set of videos was made after years of experience of poor communications between doctors and others, after seeing a lot of unhappy patients, dissatisfied colleagues, and furious politicians and administrators. They were made after a few doctors were assaulted by relatives of dissatisfied patients. I had been toying with this idea for a long time. When I voiced it to a couple of resident doctors, they loved it. They called like minded other resident doctors and some faculty. Their enthusiasm was catching. The planning of the videos was not difficult - we saw miscommunication every day. But they were innovative. They designed costumes out of locally available things, like a lawyer's collar and a nurse's cap out of paper and micropore tape. They achieved traditional appearance of clothes out of a few turns of a dupatta over the head and around the shoulders. They acted no less superbly than some of the professionals on the silver screen. They dubbed the movies not in a studio, but a regular office, the only precautions taken being closing the windows, switching the phones off, and disconnecting the intercom. We directed one another. We praised one another and criticized healthily. I manned the camera for two reasons - the first was that it was mine and the other was that I had had a lot more experience shooting operative videos. Making movies was challenging, which made it all the more enjoyable. I remember the struggle in synchronization of audio with lip movements. I remember the struggle at enhancing the audio volume. The experiments done to achieve the end result taught us so much that we would not have learned by doing a course in some academy. The spirit of working together on the project made us forget the difference in our ages as faculty and resident doctors. It made us equal which we would never have thought possible. These videos gave us happiness because we had created something that we believed was good and would be useful for training of generations of new doctors who joined our premier institute.
We had a premier, attended by faculty and resident doctors. It was enjoyed by all. We held our first session for the new batch of resident doctors this week. It was liked by every one. I hope they communicate well with every one, at least for the duration of their tenure in our department. I hope they communicate well with every one all their lives, for their own sake.

DIC Dilemma

"Sir, this patient came to us with placental abruption early morning" the Registrar informed me during the round of the labor ward. "She had DIC. She delivered two hours ago."
"So what did you do?" I asked. DIC is short for disseminated intravascular coagulation. It is a serious condition in which the patient's blood does not clot and she bleeds profusely, sometimes to death unless treated in time.
"We are going to transfuse her with six units of fresh frozen plasma."
"You are going to? You mean she delivered without correction of her DIC?" I asked.
"Yes, Sir. There was some problem with getting fresh frozen plasma. But now we will get it."
"But she did not bleed after delivery?" I asked.
"No, Sir. The uterus is well contracted and retracted. There is no bleeding at all."
"If she has not bled for two hours after delivery, she is not going to bleed now. Her body will correct whatever coagulopathy she has got, if any. She does not require and treatment" I said. "The diagnosis was probably wrong. She did not have any DIC."
"Sir, her PT-INR was 1.72, and plasma fibrinogen was 56 mg%."
"That sounds terrible. But believe me, she is OK. Where did you get the tests done?"
"In the private lab outside the hospital, except PT-INR which was done in the hospital's emergency lab" the Registrar said.
"Sir, I think we should treat her" the Associate Professor said. "She could bleed later."
"But the uterine vessels must have thrombosed by now. How will she bleed?" I asked.
"Suppose she does?"
"Yes, medicolegally that could pose a problem" I agreed. "Treat her."
At that time I saw doctors of another unit in the labor ward, taking round of their patients. I had an idea. I stopped their chief and said, "Can I ask you an academic question?"
"Yes."
So I explained the situation and asked, "Will you give such a patient fresh frozen plasma even if she has not bled for 2 hours after delivery?"
"Yes. She could bleed elsewhere, say in the brain?"
"Hmm...." I said.
"What are you going to do?"
"We will treat her because we do not medicolegal claim of negligence. But if I were that patient, I would not take this treatment myself." I said.
Our Registrar had send that patient's DIC tests again that morning, before starting treatment, but after she had delivered and not bled. These tests were sent to our routine lab in the hospital.
"I want to see the results of those tests" I told the Registrar" I said, "because I am sure there is an error in the diagnosis."
I was shown the results the next day and they were as shown below.

Parameter	Before delivery, before treatment	After delivery, before treatment
Plasma Fibrinogen	56 mg%	220 mg%
PT-INR	1.72	0.98
D-dimer	More than 10	0 – 5
aPTT	44/28 (Patient/control)	30.5/28.5 (Patient/control)

"The reports after delivery are normal, which cannot happen in two hours. She had no DIC" I said. "The private lab has given you wrong reports, and you believed them, rather than the clinical evidence that she had no bleeding problem. I hope you learn to believe what you find in a patient clinically rather than what some laboratory says."

Mock Viva

Education is no more about getting knowledge. It is about getting an edge over others so that one gets more marks in exams and gets a head start over others in life, or so the students seem to believe. I thought it was an effect of the competitiveness of today's world. Today I heard something that made me think there were other reasons too for this deterioration.
"There was that mock viva for postgraduates" someone said conversationally. "The one conducted by the Ob Gyn Society."
There are local Ob Gyn societies in the country, which have their own elections, office bearers, policies and activities. One of the activities is to hold mock vivas for postgraduates, so that they get practice for their final exams. Examiners are invited from faculty of medical colleges and other important members of the Ob Gyn society. I had never seen any need for any mock vivas as a student nor as a teacher, because I believed that if one knew everything that was there to know, one could answer any question in exam. A mock viva could not improve on that performance in any way.
"Hmm ..." I said.
"I had finished my session as an examiner, and was sitting there, watching the proceedings. Then Professor XXX came as examiner, along with an Associate Professor from another institute. He/she said something right at the beginning, which upset me so much that I walked away in disgust."
"What did he/she say?" I asked. I knew Professor XXX and what he/she was capable of. I had not heard of anyone walking away in disgust after hearing this professor so far. Well, there is always a first of everything. I was curious to know what this one was.
"He/she said to the candidate 'see how shabbily you are dressed! Look at these other candidates. If you dress like this, how will you get good marks?'"
"Was the candidate a girl?" I asked. I smelled a sexist attitude in that statement.
"No. It was a boy. The issue is that this mock viva is an academic exercise. This sort of statement is not what one expects academically. How could he/she say so as the very first thing? This is the reason our academic residents get less marks in viva, while residents in lesser institutes get more marks. Such examiners make that happen." I knew our residents used to top in theory, while they did not get good marks in vivas, despite excellent clinical work. Each college conducted its own viva for the final postgraduate exams, and there was no uniformity or gold standard in assessment of students.
"When you put such people in such high positions, they come to believe they must be good having reached there, and then this sort of thing happens" I explained. "It is a curse of the system, and we have to live with it, because the system is made by no other than the people of our country."

Beats Me

I believed I usually knew why people did what they did. Now I am not so sure.
We have resident doctors who join for a three year postgraduate degree course. A part of their training is to do some research and write a dissertation. The health university has laid down deadlines for all stages of the dissertation preparation, such as one for sending the topic to the university after getting approval from institutional ethics committee, one for starting work, one for submitting the finished dissertation to the university after getting approval from the teacher. The students are supposed to work on the topic for 2.5 years. What I have noticed is that a vast majority of them do not submit a topic to the university by the deadline. In fact, there are a few who have not submitted the topic yet, while they are expected to submit the finished dissertation in another 3 months and 10 days. The teachers are after them to do the work, but it just does not happen. I know of residents who take three months to respond to each letter from the ethics committee. The health university had been tolerating all the delay. But it has sent a notice recently that the residents will have to put in extra terms to work on the dissertations, if they do not do the work in time. Even that does not seem to have worked.
"Why do they do this?"one of my colleagues asked.
"They must be very busy working" someone said.
"There are eleven residents in a unit where there used to be three in the past" someone else said, "and still there would not be such delay in the past."
"They procrastinate" someone said.
"Yes. We are wondering why they procrastinate" the first person said patiently.
"They think it is not important" someone said. "They know they will finish it somehow, and the university will not object."
There appeared to be some truth in it.
"Some of them are stinking rich. They don't care" a knowledgeable person said. "They just need a degree to go back to their ready nursing homes."
"But such persons are few" someone else said.
"Why do you think they do this?" someone asked me.
"Perhaps their priorities are different. Perhaps they are distracted by other things." Then I said something I had never said before, "my most honest answer is 'Beats me!'".

Lights Please

I have been used to working in the OT with less than optimum illumination. We had ancient OT lights, which had been repaired by the local electrical engineer so many times, that none of them had any of the original parts left, except the base plates and suspending rods. Sometimes they would blink off. Sometimes they would show some spark followed by smoke and then go off. Sometimes they would blink off and on when the domes were moved to change the position of the spot. When I became head of the department, I decided I had had enough. I processed double-dome lights, one for each operation table. It took me five years of struggle to complete the process, which was like a hurdles race. Finally we got the new lights. Unfortunately, I had to be happy with only one dome per table in one OT, because we were forced to keep two OT tables in one OT (where there was not enough space to put two lights) and keep the other OT vacant, to be made into a modular OT. But that is another story. The lights were good, and even one dome was sufficient for each table. Sometimes we added another small spot light to it when we were performing vaginal surgery.
I had to wash up to help in a vaginal operation today. When I started operating, I thought the light was less. They already had the small spot light on, and still the illumination was less. I asked for more light twice, and the attendant juggled the inclination of the dome to try and improve the illumination. It did not work.
"Is something wrong with my vision?" I said. "I hear the vision becomes dark with retinal detachment."
No one assured me I did no have any such condition. But no one agreed that the light was less too. I think they were so tired that they just wanted the case to get over so that they could wash out. I finished the difficult part and handed the case back to the original operating surgeon. When I washed out, I happened to wander to the wall switch and look at it. It looked like this.

"Hey, look at this" I said. "Someone has reduced the illumination of dome 2 to half." The indicator for dome 1 showed full illumination, which was for the other table. Only half the LEDs for dome 2 were lit.
They looked. No one offered any explanation or agreed that he/she had done it. We increased the illumination to full, and suddenly the operative field glowed with light.
"Perhaps you had a fight with the attendant sometime" I said to the operating surgeon, "who reduced the light to get even?"
There was no answer.

Smell of Pseudomonas

I started as a medical student in 1975, knowing little about the health hazards I would face in the profession. Unfortunately ignorance is no protection from acquiring infections in the hospital. A few years passed by, and my minor skin cuts and scratches that used to heal in a couple of days started getting infected on a regular basis, and would require antiseptic dressings. Then I realized my skin had probably got colonized by hospital strains of pathogens, which were causing this problem. Then came the respiratory infections. Like anybody else, I would get upper respiratory infection in the form of a cold or cough once a year. That used to get well without any antibiotic in less than a week, probably because that would be viral. A few years later, the mucus coming from the nose or throat started developing a yellow or greenish color after 3 to 4 days of the viral infection, and would not go away until I took an antibiotic. I realized that it was secondary bacterial infection, caused by inhalation of hospital pathogens in the dust and air currents.
There is a transit ICU of sorts, which takes critically ill patients presenting in the emergency. It is a small temporary place, to be used while the regular ICU is being repaired and renovated. There is a strong offensive smell in it and in the corridor outside it. I thought it was probably caused by the dirt the patients and their relatives brought in, they being from the extremely poor communities. Now I realize the smell goes with a lot of hospital pathogens that are resistant to a lot of antibiotics. This wisdom came after a viral sore throat I caught from some careless citizen coughing without covering his mouth and nose, progressed after 4 days to a serious lower respiratory tract infection. This progression occurred two days after I visited the transit ICU to see a patient, and inhaled a generous dose of that foul air. It took two courses of heavy antibiotics, some cough mixtures, and a bronchodilator course to get rid of the infection. I had got the sputum tested for pathogens, and to my great horror, it grew Pseudomonas, a notorious deadly pathogen coming from hospitals.
Now I know first hand how patients feel when they acquire hospital infections.
Now I feel perhaps I should not have pursued my first passion - medicine - and should have become an engineer. I would not have been exposed to these deadly microbes as a professional hazard then.
Now I am afraid of visiting that transit ICU and similar smelling areas, and breathing in air that reeks of Pseudomonas. My Microbiology colleagues might tell me that smell is caused by other pathogens, and Pseudomonas has a fruity smell. Whatever it may be. I have written this so that young people who want to be doctors will know this aspect of the profession too, before they make a decision.

How To Remove IT PDF File Password

The Income Tax department sends the tax payers PDF files about acknowledgement of IT return, intimations, and form of TDS and advance tax credited. They are password protected, which is a good thing in case the file reaches wrong people. But when it reaches the rightful recipient, the password becomes a bother. Every time you have to open the file, you have to type in the password, and sometimes it is a combination of your PAN and birth date, while in case of the last one, it is the birth date in a peculiar format. I prefer to remove the password when I store the file on my hard disk or pen drive. There are two perfectly legal methods of doing so.

1. I open the file in PDFXchange viewer, which is a free PDF reader. It asks for the password, which I type in. When the file is open, I go to file -> Document Properties -> Security, and remove the security in the form of password to open the file. Alternatively, one can just print the file using a PDF driver - I use Primo PDF, a freeware. The new PDF file does not have a password.
2. When the security is such that changing security is disabled, I use the print as PDF option and the new PDF does not have the password.

This should help those who are bothered by having to type in passwords to open PDF files which are their own.

Bed-Cum-Slide

Our maternity wards have sturdy steel cots. They used to elevate the foot end of the cots in certain obstetric situations in the past, most of which are not considered valid indications for giving a head-low position in modern times. They used to put wooden blocks under the legs of the cots to achieve this. If the wooden blocks were kept vertical, the head-low used to be steep. If they were kept sideways, it used to be mild. We do have special situations in which a head-low position is still required, such as hemorrhagic shock and fetal umbilical cord prolapse. We have special cots for this purpose, which have mechanical arrangement to give head-low position. A steep head low position using wooden blocks is shown in the following 3D model I made to illustrate the point..

We have one consultant who still uses this old time arrangement, for the old time indications. The nurses have not thrown away the old wooden blocks, and they prove useful to this consultant. This position is so uncomfortable, that the patients dislike it intensely, and resort to some other use of the arrangement as is evident from the following comments made by different faculty members after looking at such cots.
"Look at that woman. She is sleeping in head-high position. The Boss' round must be over. Or she would not have dared put her head at the foot end of the cot" I heard on one such occasion.
"Perhaps he/she has prescribed this position to accelerate labor, reverse of head-low position to control preterm labor" someone sniggered.
"Where is the patient on this full-block head-low cot?" I heard on another occasion.
"She is sleeping on the adjacent vacant cot" someone answered with a smile.
"Oh, look at that child enjoying itself on a slide" I heard on a third occasion. Everyone looked. A small child was climbing at the foot end of the cot, and sliding down the length of the cot over the smooth McIntosh that was placed over the mattress. Its mother was sitting on an adjacent cot, watching her child with love.
"I bet the child loves visiting its mother in the hospital more than going to the garden. Here it gets the company of the mother and a slide all to itself" someone said. That actually seemed to be the case.

So Predictable

When the Boss goes away for whatever period, someone else is appointed as Boss-in-charge, whom we shall call Bic for convenience. The Boss' position is so coveted by people who hunger for power, that the first thing they want to do when they sit in the Boss' chair is to let others of importance know that they (the Bics) are more important than the others. And what better method to achieve this than by summoning someone to the Boss' chamber, making that person stand there while the Bic sits in that stuffed chair, and telling that person a thing or two? In past the Bosses were perhaps more balanced or more mature, and so were the Bics. I do not recall this phenomenon from the past. But times change.
The first time I encountered this was a few years ago. The Boss had sent out a circular, asking all faculty to submit their self assessment forms before a certain date. On the last day of that submission, all my staff members but one had submitted theirs. This one didn't, wouldn't, probably couldn't (reasons not known). I asked that person to submit that in an hour's time, which was in my opinion more than sufficient time to fill up that form. Instead of doing that, this person went to meet someone, who in turn spoke to the Bic of that day. I got a call from that Bic.
"There is a very serious complaint from one of your faculty. Come to my office now" the Bic said.
It was 12:30 P.M. It was a very hot day. I had a lot of work to wind up before the summer vacation began the next day. But Bic had Boss' power for that day. So I went. The Bic could not or would not explain to me why it was a serious matter, though it was a time-bound activity as decided by the Boss. I agreed to let that person fill up her/his self assessment form whenever she/he wanted because the Bic directed me to do so, and left. I could not see then why this could not have been said on phone, instead of dragging a department head to the Boss' office on that hot, uncomfortable day. Now I understand it was to show off one's power by demeaning others.
This Bic went on to become a sort of very prolonged Bic after a few years. Now when this prolonged Bic went on leave, they appointed another person as Bic. They had asked me, because I was the most senior person. I refused politely, saying I did not like it. One day I needed to ask the Boss something, and discovered there was a Bic in position. So I called on phone.
"Why talk on phone?" the Bic said with great satisfaction. "Come right over." The Bic made it sound like it was an invitation to dinner, while it was actually a walk to the other end of the campus leaving all work.
"I am sorry I cannot" I said. "I am stuck in the OT. I just need a point clarified." The Bic clarified that he/she did not know the answer and recommended I should ask the Boss when the Boss resumed duty.
Another time there was an important appointment that was not kept by a person. The work had to be done in my office, on my PC, under my guidance. This person had sent no word that he/she could not keep the appointment. I called and found out that this person was Bic that day. So I called Boss' office and spoke to that person. I asked when we could finish that job.
"Come right over" said this person. Being Bic had made this person forget that I was in charge of that job, not him/her.
"Uh ... I cannot get the whole desktop computer to the Boss' office" I said. "We have to look at the document I have made and make changes as required."
"Bring a printout" the Bic suggested with great satisfaction. Being Bic must give one a giddy feeling, I thought.
"I think we better do that in my office after you stop being Bic" I said. "I don't have time to make corrections on a printout and then make the changes on a computer, that too in Marathi."
"OK" the Bic said with some reluctance.
Now with age and maturity, I understand that people who become Bic think it is not about governance, but about feeling good by making contemporaries feel inferior, and in general having a good time by basking in the feeling of superiority, even if it is just for a day or two.
The Bics have become predictable.

A Mother's Grief

She was a very young woman. She was admitted in the hospital because her very first pregnancy had ended in a missed abortion. A missed abortion is one in which an early pregnancy dies and the dead fetus is retained in the uterus. This is not a text book definition, but it will do. She was to be subjected to an operation called D&C, for evacuation of the dead products of conception. When we reached her during the ward round, she was sitting on her cot, her head down. Her mother or mother-in-law was standing near her.
"Sir, this patient is a primigravida ...."
While my Registrar was telling us about this patient, I happened to see what the patient was doing. She had her ultrasonography plate in her hand, and she was looking at the plate very intently. She was so engrossed with it that she did not even notice us.
"See what she is doing" I whispered to our Associate Professor.
"She is looking at the picture of her unborn baby that is no more" the Associate Professor murmured.
I developed a lump in my throat and could not trust myself to say anything right then.

Elective Deaths

We received a circular from the Boss' Boss about maintaining operation theater data in each OT. It said it was sent as per instructions of Boss' Boss' Boss, i.e. Boss of the sender of the circular. A format for the maintenance of the data was attached in the form of a table. The first row of the table (containing the headings of the columns or data fields) is reproduced here as an image.

There were instructions that information should also be included on how many operations were done by each employee. The data was to be reviewed by heads of departments and Deans, and corrective steps were to be taken as required. It seemed the Big Boss had started something really commendable. Knowing the reasons why operations got postponed, one could take measures to prevent such an occurrence. Knowing which employees did a lot work did not help those employees in the form of a raise or bonus, but knowing which ones were drawing salary without actually doing much work would help putting them to work. The Big Boss had given good instructions. But while preparing the table, someone had goofed up.
There was a heading 'Elective Deaths' which stumped us all.
I called the  Boss' secretary and said the circular was not clear to us.
"It has come from the office of the Boss' Boss" I was told by way of an explanation. "I will call that office and get an explanation." I got an answering email in the afternoon. The heading 'elective deaths' was as it was before. I called a meeting of all faculty.
"Can deaths be elective?" someone mused.
"Euthanasia is not legal in our country" a second person said.
"Even if it were legal, one would not operate to give death to the patient. There would be no guarantee that the patient would die due to the operation" a third person said.
"A doctor saves lives. We all do. Even non-doctors understand that. Who would have thought doctors in the civic hospitals handed out elective deaths to their patients?" the first person said.
"The Big Boss must be IAS. The Boss' Boss is not a medico" a fourth person told us, though we knew that already.
"IAS persons would not make such a mistake" I said. "I have talked to the Big Boss in a meeting. He is just brilliant and very capable. Perhaps it was the clerk who goofed up?"
"That may be so" a wise one said.
I wrote to the Boss "I have not understood the meaning of 'elective deaths'. Some of our operated patients sometimes die. But none of the deaths are elective. Kindly obtain an explanation.'" I am yet to receive an explanation.

Muster Management Integrity

Normally a clerk looks after the maintenance of the muster, in which all people employed in the department sign. I am in charge of everything in the department including the muster, because I am the head of the department. But that does not mean I stand by the muster and keep checking who comes exactly at what time. After all, I am supposed to treat patients on arrival in the hospital, not while away my time doing a clerk's job. No other department head wastes time standing by the muster, unless there is any specific problem employee who has any specific problem with the muster. It is handled by a clerk in every department.
We have a senior employee in the department, who sometimes holds charge of the department when I am on leave. This person takes a great pleasure in harassing employees. She/he stands by the muster, and puts crosses (indicating absence) the moment it is 10 minutes past the expected time of arrival i.e. at 9:10 A.M. Even if there is a line of employees standing there to sign, having arrived five seconds late, she/he does not let them sign, but continues to put crosses. Her/his own work in the department remains not done all this time, but that does not detract her/him.
This behavior reached a new low when she/he started to stand by the muster and watch it even when I was present and very much in charge. She/he would urge the clerk to put crosses, because she/he was powerless to do so herself/himself at that time. This behavior reached a new low, lower than the previous one, when she/he started questioning their practice of writing the time-in as 9:10 A.M. when they had arrived after 9:10 A.M., and telling the 'late by a few seconds' employees to put crosses on their own names for having come late. They ignored her/him, but that is besides the point. That these employees often stayed working well beyond the standard end of the day at 4:00 P.M., but this person was not concerned about it. After all, the motive for this exercise was to trouble others and show her/his importance.
So the next day I sat in that office on one side and kept watching. At 9:10 A.M., this person barged in, looked at the muster and people around it venomously, signed in it, and then took a stance by its side. Then she/he noticed me through the corner of her/his eye, was taken aback duly, thought it over awhile, and went away.
I sat in my office the next day, looking at the door of this office across the corridor, and went there when this person arrived in a hurry at 9:14 A.M. A lot of other people were watching her/him too. She/he signed and went away without a word. When we checked the time below her/his signature, it was 9:10 A.M.!
"Where is her/his integrity? She/he should have signed and put the time as 9:14 A.M." one person said.
"She/he should have put a cross on her/his name for having arrived later than 9:10 A.M." said another person who had been advised to do so the previous day by this person."
"But she/he always does so when she/he arrives late" a third person said. "I have seen that happen a few times."
I knew that was true, because I had seen that happen too. But I knew that harassing people for being late by a couple of minutes just discouraged them from putting their hearts into their wok. So I never harassed anyone for being a couple of minutes late.
"And this person just goes and sits in her/his cabin for 45 minutes or one hour after arrival, instead of going to work" complained another person. "All the work is done by others whom she/he keeps criticizing."
"This person suffers from a personality disorder, and I heard from a famous psychiatrist that there is no treatment for such disorders" another person said.
I knew that was true too, because that very senior psychiatrist had told me this about this very person once. The disorder could be cured only by self improvement, and such people never want to change themselves for better.

Double Whammy for Gynecology OT

"Sir, the intercom telephone connection in the Gynec OT is dead" a staff member complained to me.
"I know" I said. "I have been communicating with the electrical engineer for more than two months. He cannot do it."
"Then who can?"
"He said he would have to call the contractor who did the job" I said "and he seems unable to do so."
"But how do we communicate with the blood bank, intensive care units, wards, and other specialty doctors when there is an urgent need?" that person asked. "We have to change into street clothes to go out and make the phone calls."
"I can see some patient getting seriously ill or worse, because of this delay" I said.
"They have banned the use of mobile phones in OTs, or we could have used our mobile phones" that person said. It was true. Boss' Boss had taken out a circular to that effect, so that people would concentrate on work rather than talk on mobiles. Someone had said that time that they should make the intercom system functional before implementing such a rule. Well, policymakers will be policymakers (like they say boys will be boys).
"So no intercom, and no mobile phones!" that person exclaimed in frustration.
"It reminds me of a saying in Marathi" I said. "आई जेवायला वाढेना, आणि बाप भीक मागू देईना. Its free translation into English would be: mother does not feed us, and father does not allow us to beg for food. So be it. I have written a complaint against the electrical engineer to the Boss, explaining the whole situation, and suggesting getting outside help if the work cannot be done in house" I said.
"So what happened?"
"The Boss had referred the matter to the same electrical engineer for doing the needful."
"Huh?"
"Yeah!" I said.