Ganapatibappa Morya

May Ganapatibappa bless you all.
The following movie may take some time to load, but that would be a very small fraction of the time I took to make it. Please be patient.

There is another one I made using a different technology. Take a look. It is bigger in size and may take a little longer to load.

I will appreciate your feedback.

Barefoot Babies

We were taking round of our antenatal ward. Suddenly a small girl started walking between two rows of beds. She was barely two years old. We all were amused because she was wearing her mother's slippers, the right slipper on the left foot and the left slipper on the right foot. Her mother was admitted with another consultant and was lying on her bed in another row. She saw us watching her daughter, got up hurriedly, picked up her daughter and took her to her bed. I do not carry a camera around on ward rounds. So I could not capture that moment. Later I had some time to think about what had happened, and it suddenly dawned on me that the poor woman had no money to buy any footwear for her daughter. The daughter had a strong desire to walk wearing some footwear, found her mother's slippers near her bed, and made the best of the opportunity.
A few years passed. I was on my way to the outpatient clinic the other day, when I passed by a mother and her toddler standing outside the OT.
"Here, take mine" the mother said, in response to something the child had said. I looked at them. She was taking off her slippers and offering them to her child.
"But will they fit me?" the child asked her.
"Yes, of course" she said. "They will fit you perfectly."

He trusted her. He slipped his tiny feet into the slippers which seemed huge on his feet and started walking. His mother noticed me looking at him and smiled, proud of her son. I smiled back showing that I liked her son, and walked on. Actually I was moved by the mother's love for her child, her child's intelligence in judging the disparity in the size of his feet and the slippers, and his total trust in his mother which overrode his logical reasoning. At the same time I was upset that there was so much poverty that small children had to walk barefoot. I did not have a camera with me that time too; and even if I had one, I could not have snapped a picture without hurting that mother. The image shown above is my 3D graphics effort at reproducing what I saw that day.

Compulsory Attendance Woes

The health university makes 80% attendance for practical training sessions compulsory for medical students. It goes without saying that 100% attendance is expected of the teachers. The students often attend because of the compulsion rather than out of a burning desire to acquire knowledge. Since attendance is marked based on their physical presence, irrespective of the time of arrival on the scene, they arrive as shown in the following animation I made specially for this post. Green clothes indicate the students are being taught in the operation theater, in between two operations, so that they can understand what they see during performance of the operations after the teaching session.
(Note: I had placed a GIF animation here, but it does not loop as required, because of image resizing issue of Google. Finally I settled for posting individual images instead, to be viewed in sequence.)

Please note the time, correlate it with the number of students, and the total number reached towards the end of the teaching session, never exceeding 7 or 8 out of 10. The word 'woes' in the title is about the woes of the students for having to attend the teaching sessions, and woes of teachers resulting from the disinterest shown by the students.

Installation of Remote Switch

We have a number of fans in our house. None of them is with a remote switch, because I had not known we could get those. But sometimes one needs to put the fan on or off (depending on the weather) in the middle of the night. It is a pain to get up to do so, and it is also risky, because when one goes out of the mosquito net, mosquitoes go into it. Then they have a field day (or night?) until morning, unless one gets up, puts on the lights and kills them in the net. So we decided to put a remote switch on the fan in the bedroom. I asked in all the electrical stores near our house, and they all said it did not exist. I had given up hope, until I got an ad in my inbox. It was people who felt too lazy to get up and switch electrical appliances on or off. I promptly bought one. Unfortunately it had no instructions on its installation. I checked the net, and found a video on Youtube, It was for the same model as the one I had bought. But it did not explain how to do it clearly. The fellow would have done well if he had shown a circuit diagram. I consulted the electricians whose wives and daughters I had been treating all these years.They explained the principles to me. They even offered to do it for me, which I declined. I said I wanted to feel good by doing it myself. I thought it was a piece of cake to do it. Well, it was not.
I got home. The Youtube fellow had stressed that the first step was to switch off the main electric supply so that one would not get electrocuted. I did that. It was quite easy. Then I opened the board with all those sockets and switches. The trouble started there. It looked so much different from what they had described. Wires went everywhere. There was not much of a color code. I had to study the contents far longer than I study the inside of a patient's abdomen during a laparotomy. I was sweating, but could not switch on the fan because the electric current was switched off. Finally I worked out the connections, and worked out a plan, which I want to document here, so that anyone else who wants to do it himself/herself but has no training of doing so can do it. The principles of the procedure are as follows.
(For amateurs only)

1. The second one (the first one is switching off the current, remember?) is to draw a clear diagram of how the connections are. This is important because if what one does in there does not work out, one should be able to undo the damage and go back to the initial state.
2. The third one is to draw a diagram of how one wants the connections. I have shown the two diagrams above, 'A' being the starting position, and 'B' being the end position desired.
3. The fourth one is to disconnect the wire ends that have to be disconnected.
4. The last one is to connect the ends as per one's circuit diagram, seal the joints with duct tape, put the lid back on the box, switch on the electric current and test your work.

(Note: it is better to have someone around who knows how to administer cardiopulmonary resuscitation and call the fire department in case things go horribly wrong. They probably won't if one follows all steps correctly. :-) Ah! Nothing happens if you switch off the mains before starting, and if you have a tripper for when you try out what you have done.)
The remote switch has two sets of wires coming out. One is for giving it electric supply from the mains, and complete the circuit by joining it to the neutral of the mains. The other set is for running appliances. I have shown only one such wire, but my device has three such wires, which means I can run three devices using that switch. The steps are as follows.

1. As shown in the diagram, one disconnects the wire between the switch of the fan and its regulator.
2. The wire for supplying electric current to the remote switch is connected to the empty place on the switch.
3. The wire of the remote switch for connecting to a device (a fan in our case) is connected to the now free end of the input wire of the regulator.
4. The wire of the remote switch for connecting to neutral is connected to the neutral wire of the mains.
5. I am not clear about the function of the antenna (marked as A in diagram 'B'). I suggest leaving it out where the remote control can sense it, in case that is its purpose.

It works like a charm.

Conferences and Us

We have a huge main lecture hall that can accommodate 300 people. A number of conferences are hosted there. They get pharma and instruments manufacturers to keep stalls outside the lecture hall and make a bit of money from that. The pharma and instruments companies are there to make sales to the delegates. They want to attract the buyers. So they make the stalls and surroundings look posh.
This conference seemed to be grander than usual. I could tell that the moment I stepped into the quadrangle in front of the lecture theater on my way to the department. Look at the following images (3D, not actual photographs) of the appearance before and after the conference people moved in.
Before

After

Normally two stray dogs sleep there near the left side wall all day. The conference guys drove them out, and put posh looking carpets on the floor. Later on they put their stalls over the carpets along both right and left walls. The poor dogs looked miserable standing outside what they considered to be their home.
The other posh thing about the conference was the pleasant smell of air freshener one could smell in the exhaust while passing along the corridor behind the toilet block, where one normally smelled ammoniacal smells in varying strengths. They had probably put so much of the air freshener there that the cost of that would have fed a family of five (below poverty line, of course) for a month.
The only thing that was not different was the people who attended the conference. On my way home in the evening, I saw plastic cups of mineral water thrown in pots of plants in the garden near the entrance. Praise the lord that they had not discarded the lunch dishes there too.

Who Educated Me?

It was a rare case and the operation planned for it was something I had never done or seen before, only because no patient with that condition had reached my unit before. That patient had a chronic total inversion of the uterus. She.went to another consultant in our hospital. One day I got a call from that colleague while I was working in another OT. That patient was anesthetized and in position for vaginal correction of the inversion, and would I go help? Would I! I left word to inform me if there was any problem in the management of any of our patients, who were fortunately scheduled to undergo routine, minor operations. I reached that OT. I washed up and started helping out. A lot of people had gathered to see that operation. An enthusiastic resident doctor was video recording the operation on her mobile phone. The operation was tricky. When the last critical part could not be managed by the operating surgeon, I took over when requested and reduced the inversion. I was happy because I got to see and partly do a case that one gets may be once in a lifetime if one is lucky. I was also happy because there was a video of it with someone.
"Let me see the video when you transfer it to a PC" I requested and left. I got the video after a couple of weeks.
"Oh! This video is shot sideways" I said. It was running at an angle of 90 degrees.
"It is like that in parts" came the answer, and so it was. The resident had been rotating the camera periodically, and the video had turned through 90 degrees in parts.
"We cannot expect viewers to turn their heads through 90 degrees while they watch the video" I said.
"True."
"So we have to cut the video into parts, those which are straight and those which are turned through 90 degrees."
"Um..." It looked like I had to do it or at least tell how to do it. I had a free video cutter, but it refused to recognize the mp4 file that the resident's phone camera had produced. So I finally resorted to Google search. I found a software called MooO, which was excellent for purpose (and free too). It was unbelievably fast and precise. The next step was to rotate the videos. I was skeptical I would find software to do it, but a Google search helped again. I discovered that VLC player, the media player that I use did this work. I used it and found that it was unbelievably fast, but put a scrolling tape looking like candy cane one third distance up the bottom. I searched again, and found another software which did the job, but put the frames vertically.
I realized that after a lifetime of watching movies and videos in which the frame is a horizontal rectangle, one could not adjust to a vertical rectangle, and definitely not to part horizontal and part vertical frame movies.

I was angry with the resident for creating all this trouble and pleased at the same for making me learn something new. When I went home and had some time to think things over, I wonder who had educated me in this process. I came up with the following possibles.

1. The resident doctor who created the need.
2. Google, who gave me the links to the solutions.
3. People who posted those solutions on the internet.
4. People who created the situations (like shooting videos through 90 degrees  (or any other angle) rotations, prompting other tech savvy people to find solution to that problem.
5. Software developers who developed solutions for these needs, like cutting videos, rotating videos, joining videos.
6. I myself, by thinking of what needed to be done, searching for solutions and implementing them.
7. All these factors jointly.

I would prefer my readers cast the vote in favor of option 6, while I know deep inside that it is option 7.

Thermal Protection to Vaccine

Some vaccines have to be maintained in a cold state, from the time of manufacture to administration, so that they do not lose their potency. When vaccination is done on a mass scale, it is not practical to keep the vaccine in a refrigerator and take it out for every person who is to be administered the vaccine. So they have an ice pack, which is made of a polymer like plastic, and has a coolant fluid inside it. It is to kept inside a refrigerator for cooling. Then it is used in place of ice to keep the vaccine cold during transportation or when it is kept on a table during mass vaccinations. It has a socket to contain the vaccine bottle.
That day I was taking round of the postnatal ward. On my way out after the round, I found a couple of pediatrics resident doctors sitting at the table, waiting for mothers to bring their babies for oral polio vaccination. The vaccine was kept on the top of an ice gel pack as shown below.

I was somewhat surprised at the arrangement. So I stopped and asked the doctor, "is the area of contact between the bottom of the vaccine bottle and the ice pack enough to keep the vaccine cool?"
She looked at it, thought for a couple of seconds, lifted the vaccine bottle, inverted the ice pack so that its sockets faced up, and placed the vaccine bottle in one of the sockets. Now the vaccine was totally surrounded by the cold coolant. It looked like this.

"That is nice" I said. "Sorry to have bothered you."
I wonder if she caught my sarcasm, and if she did, if it did any good. I wonder how many babies had been administered not cooled vaccine by her and by others like her all over the country. I made a note of the event, planning to talk to the pediatrics professor after the round to advise his resident doctors on this issue.

Nuances of Feedback

Feedback is a process meant to bring about an improvement in performance. We take feedback from delegates who attend continuing medical education programs (CME) conducted by us. Then the speakers know if they lacked somewhere, and can strive to do better. The feedback forms are kept anonymous, so that the feedback can be given without any inhibition.
Recently we conducted a CME on breastfeeding, for faculty and resident doctors. All senior faculty in the department delivered lectures as well as attended as delegates. The same program was conducted on two different days, so that all faculty and all resident doctors in the department could attend. When I looked at the feedback forms, I noticed that some speakers had been graded occasionally as below average, a few as average, and others above that. Then I also noticed that these speakers had also been graded as good, very good, and excellent by a large number of delegates. So I compiled statistics for a senior, good speaker. The result is shown graphically in the illustration below.

The contents of all the speeches were from standard modules distributed by the Breastfeeding Promotion Association of the country. I found out that this speaker, like many others, had added content from the books provided by WHO and Wellstart International (two excellent resources). If the lectures were considered below average and average by a couple of delegates, there had to be some reason for it. Different reasons came to my mind. I have listed them below.

1. The content was truly poor. In that case we have to communicate with Breastfeeding Promotion Association, WHO and Wellstart International, and ask them to do better. I personally feel this is not the likely cause for the poor grading in the feedback. The general trend was similar on both the days, which confirms that the speaker was truly good, and the reason was bad scores was something else.
2. The speaker was disliked by a couple of delegates who were faculty. That is possible as intradepartmental rivalry, jealousies, and bad blood are universal, and sadly, my department is not an exception.
3. The speaker was disliked by a couple of residents. This is likely, because faculty do discipline resident doctors, criticize them at times, and the resident doctors may interpret that as intentional harassment. In that case this sort of feedback is good, because that lets out pent up anger, gives them a sense of satisfaction at having got even, and then they can move on in life more easily.

Door Stopper

A door stopper prevents a door from closing. Our operation theaters have automatic door closers, which keep the doors closed when no one is passing through. It makes moving about inconvenient to theater personnel, who open a door fully and tie its handle with a string to something unyielding on or near the wall. This is a door stopper of sorts. It causes stretching of the spring in the door closer permanently after a while, so that it does not function ever again. They do not know what their actions do, and they don't care when they are told what their actions do. They want the door open and they get the door open and keep it open. Period.
On the other hand, we need door stoppers in the house so that the doors remain open and don't bang closed with strong winds, especially in the monsoon. We have wooden stoppers fitted to the door frames, which wedge in the angle between the frame and the open door. Unfortunately their hinges become loose and it is a hassle to get a carpenter to repair them - carpenters want to be hired for the whole day, not just for a small job. I wonder if any doctors do that to anyone, especially to carpenters - get hired for the whole day, not just for removal of an appendix in half an hour or a toenail in five minutes. Anyway, getting a carpenter not being an option, I had to fix a door stopper somehow. Initially I tried putting folded pieces of thick card between the door and the floor. It worked until the card-wedge got thinner due to continued use, or the maid servant swept it away into trash. Then I had an idea. I use a lot of ballpoint pens to write patients' notes, do office work etc. The pens are use-and-throw type. I saved a cap of one such pen, heated its open end over a gas flame, and compressed it with pliers. Thus it turned into a wedge. It stayed put between the door and the floor when wedged there. It did not get soggy when the maid servant cleaned and she was smart enough to know it was not trash, especially after we told her so. Now it functions as a good door stopper. The following picture shows it in a 3D form from two different angles (A and B).

I could make as many of them as the OT personnel want, but won't because I care for the automatic door closers in the OTs.

Image Resolution

I am not sure if image resolution is all that important when images are to be used as web graphics. I think it is important when one wants to print the image on paper. But if one has to look at it on the web, then it probably does not matter. I also feel Google compresses images to make them suitable for web display. For resolving this issue, I am putting two images in this post.

The images are actually the same photograph, but differ in that one is a screen capture image of the other one seen in Windows image viewer. They seem identical. If anyone can make out any differences, please email me. Thanks if you do, and no hard feelings if you don't.

Shashank Parulekar Who?

This fellow came to my office, with a broad smile on his face and his right hand extended forward to shake mine, like a friend who had come visiting me after ages. I was not taken in, because he came to see me only when he needed something from me, and always behaved like that at those times.
"We need cases to operate on in our live operative conference" he said. "Do you have any?"
"Not matching your exact requirements" I said. He had told me about this a few days ago and then repeatedly periodically since then.
"Now I will take 30 of your residents free" he said.
"But you were going to charge them 1000 INR each two days ago" I said.
"We have lots of funds" he said. "Why not do something for our own students?"
"You did not have funds two days ago" I said with surprise in my voice.
"I have lots of funds" he said. "Now about giving us cases to operate on ..."
So the offer was in exchange of patients to operate on, so that the delegates could see the operations they wanted to show in the conference!
"Will you charge these patients?" I asked.
"Of course not" he said with force.
"But you did, during the last such conference you held at Xxssxxx hospital. One nurse who had gone there as a patient for the workshop came away because you charged. The others paid the fancy five star hospital fees."
He ignored that one.
"I want you to be there as faculty on all days" he said grandly.
"But you have not put my name in the list of faculty on the brochure" I said. "You have put names of a lot of others who are not even good in the subject covered by your conference."
"I must have forgotten" he said. "Don't worry, I will tell everyone attending that you are faculty."
I ignored that one.
"Who is this Dr. XXXXX XXXXX in your department?" he asked
"She/he is head of a unit" I said. "One of our alumni."
"Then she/he should know me. When I called her/him and said I was Dr XXXX, she/he said 'Dr XXXX who?"" he sounded hurt.
"Well, when the nurse who went as a patient to your last conference after my referral as per you request, met you over the payment issue and told you Dr Shashank Parulekar had sent her, you asked her 'Dr Shashank Parulekar who?"
"I said so?" he said. He tried to look surprised, presumably at the content of the matter said rather than at the bad grammar.
"Yes" I said. "That happens. People forget things sometimes. You should not be upset our Dr XXXXX XXXXX asked you that question." Mentally I applauded Dr XXXXX XXXXX for doing something I would have loved to do, but could not because decency prevented me from doing so.

Students' Conference

We have a famous saying in Marathi, 'बाळाचे पाय पाळण्यात दिसतात'. Its literal translation into English would sound quite weird. But it means a small child shows all signs of what it will be and do when grown up. That was true about our undergrad students.
They hosted a national conference of all medical students. I was first approached by one girl. "We are hosting a conference" she said. 'We need help from you".
"How can I help you?" I asked.
"We want you to give us money for the conference" she said.
"From my salary?" I asked. Giving money to someone else's child for going to a conference was something I could not fathom. Did their parents know what their children were doing? Did their parents not make enough money to give to their children for this purpose?
"If not, you can give us money from the departmental developmental fund" she said. "Our chairman madam, an Assistant Professor in another department said so."
"Uh!" I said. "We collect money in that fund for development of the department. It cannot be used for students' conference."
"But we need money" she said.
"Well, you must have thought about it before you planned the conference" I said.
"We did. We thought we would get money from pharmaceutical companies."
"Well, I wish you all the best. But think of ethics before you take money from pharmaceutical companies" I said.
So getting money from others was OK? Taking money from Pharmaceutical companies (who give it for marketing) was OK? They seemed to be doing what the qualified doctors were doing in their conferences, no matter what the public opinion was about it, or what the government regulatory body said about it.
The next time one of them came to me was to ask me to allow them to remain absent from their clinical postings, so that they could attend the conference. The Boss had given them an OK for it. But when I started getting copies of that same permission letter every second or third day, and different students approaching me for it, I lost my patience. One day one girl walked into my office while I was trying to do multitasking (or the work would never get over), seated herself, and gave me a copy of the same letter again.
"OK. Give me a list of all who will attend the conference. I will instruct the heads of units to allow them to remain absent" I said.
"But there are too many" she said. "How can we make a list of them?"
"There are six units" I said. "Out of ten students in each unit, how many will go?"
"About six" she said.
"So it will be about thirty six students. Writing down thirty six names is no big deal. Get the letter signed by the chairman of the conference, that Assistant Professor, and give it to my clerk."
She went away with an uncertain look on her face. The next day I received a letter with three names on it, and there was no signature on it.
They seemed to be doing what their seniors (in age and qualification) seemed to be doing.
Finally the conference started. When I entered the gate and started going to the hospital building, I started seeing a lot of young guys wearing smart suits, hurrying about briskly in that sweltering heat. It was such a contrast to their informal clothes and usual no-hurry-to-go-anywhere gait, that I thought of their seniors who held their conferences in five star hotels, wore suits, and looked important. I thought of that Marathi saying I have quoted above.

No Problem Is The Problem

She was a woman in the first half of the reproductive age. She came to the gynecology outpatient clinic.
"What are your complaints?" I asked her.
"Doctor, I have not had any problem this month" she said.
"So what is the problem?" I asked her. "It is a good thing that you have no problems."
"But doctor, how can you say that? I must have the problem every month" she said with hurt in her voice in the first sentence, and conviction in the second sentence."
"Every month?" this seemed something familiar. Women have something every month. Did she mean menstruation?
"Yes doctor, if I don't get the problem, I feel all bloated up and get this dull pain in the lower abdomen" she said. Surely she meant menstruation?
"What do you mean by problem? There are many types of problems in one's life. Do you mean menstrual flow?" I said.
"Yes, doctor" she said, looking all around to see if anyone had heard that word. Her facial expression clearly showed her displeasure at the use of that word. 'Ugh! Gross!' she seemed to say without actually uttering the words.
"But why do you call it 'problem'?" I asked her out of curiosity.
"That is what it is called" she said, surprised that I did not know that.
"Do you use the word 'problem' in place of the word 'menstruation'?" I asked the other patients sitting in a queue, and the women doctors around us. They all shook their heads.
I wanted to ask her who had taught her to use that word, her school teacher, mother, or friends in childhood. But I refrained from doing so. The need of the hour was to get her the problem she wanted, not finding out the source of her health education.

Superspecialty Focus

"Doctor, they have sent me to you from the cancer hospital" the patient said. I was surprised. Usually we sent them patients for management. This seemed to be an exception.
"What is the problem?" I asked.
"I have white discharge and pain in lower abdomen" she said. It looked like pelvic infection and vaginitis.
"Do you have itching of the private parts?" I asked. It may seem like a little too personal question. But it is essential with the symptom of white discharge, and no patient of ours has found it embarrassing.
"Yes" she said.
So it looked like I was right. I examined her and confirmed that she had both of those conditions. I gave her appropriate advise and prescribed her specific medicines to cure her conditions.
"Why did you go to the cancer hospital?" I asked her.
"I had this white discharge, and my local doctor said it could be cancer" She said.
"Show me the reports from the cancer hospital" I said. She did so. They had checked her Pap smear, done a test for Human Papilloma Virus, and performed a cervical biopsy. Thus they had ruled out cervical cancer and referred her to a gynecologist. They had spent a lot of money, specialist time (clinician and pathologist included) both of which were wholly unnecessary. All of their and the patient's troubles would have been avoided if she had gone to a gynecologist primarily.
When I narrated this story to a friend, he asked "why did this happen?"
"That happened because a superspecialist is very focused on his work, and cannot see beyond. Then he misses out a lot of things that a specialist or even a family physician would pick up more easily."

Administration Par Excellence?

I was asked to conduct a preliminary inquiry of someone by civic administration. A part of an inquiry process is to call witnesses to the event under consideration and take their statements. When the witnesses are working in some department or a section, inquiry officer has to write to the head of that department or section, and ask him/her to send the witnesses for making statements. For that inquiry, I needed to get the casualty medical officers (CMOs) as witnesses. So I wrote to their head, whom we will call Deputy Boss.
"Ring up casualty and tell them to come for the inquiry, in addition to sending this letter" I told our clerk-cum-typist (CCT). The inquiry had to be postponed because the health university sent people for an inspection of the institute on that very day. Se I sent another letter to Deputy Boss and got the CCT to ring up casualty again, informing them of the new date and time of the inquiry. The CMOs came at the appointed time, and the inquiry was conducted. A month passed. Then both of my letters came back.
"Joint Chief Personnel Officer - do the needful" was the instruction scribbled on each letter by Deputy Boss. The Joint Chief Personnel Officer had returned the first paper with the remark, "this does not concern my office", and had returned the other paper without any remarks. Someone had remarked 'file' on the first paper at the end, which probably meant 'put it on file'. Both papers had been put in the box of my department, from where our servant had brought them back to me.
When I had to see Boss for some urgent work, I took these papers along and showed them to Boss and said, "Deputy Boss does not understand that he/she had to instruct the CMOs working under him to attend the inquiry. He/she sent the papers to a third person, who had nothing to do with it."
It so happened that Deputy Boss walked into the Boss' chamber just then.
"Dr. XXXXX, you have to instruct the CMOs to attend this inquiry, as is written in this letter" the Boss said. "You have delayed the inquiry by your action. Now instruct them to attend the inquiry."
Deputy Boss looked blank.
"The inquiry is over" I told Boss. "We called the CMOs and they came to make statements. I have shown you these papers just to make you aware of how things are done in the civic offices, affecting smooth functioning and causing undue delays."
"Next time do things properly" the Boss told Deputy Boss.
Deputy Boss kept looking blank.
'The future looks bleak', I thought, 'if there will be a future at all.'

Uniform For Ward Round

It was a warm day, like most days are in our part of the world. We were taking ward rounds. The women in the antenatal ward were looking very uncomfortable despite the ceiling fans going at top speed.
"Why are they so uncomfortable?" I wondered aloud.
"Because they are wearing hospital gowns over their own clothes" the Associate Professor said.
"Huh?" I said.
"Sir, they are wearing the hospital gowns made of hick white cloth over their own gowns, because we are taking ward round."
"Why?"
"Because the nurse has told them to wear the hospital gowns when the doctors take rounds."
"That so?" I asked the nurse.
"Yes" she said.
I looked around the ward. All patients except our unit patients were wearing their own colorful gowns. No other unit doctors were taking ward round.
"Perhaps the nurse does not have enough gowns. So these patients may be removing their hospital gowns after our round and giving them to the patients of other units when their doctors come for round" I said.
"We have given hospital gowns to all the patients" the nurse said. "They keep them nicely folded. They wear them only when the doctors come for round."
"But why wear their own clothes? The hospital gowns are clean and not at all torn as they used to be some time ago" I said.
"They are made of very thick cloth. They feel very warm wearing those gowns."
"Ah!" I said. Just then doctors of another unit came along for taking a round of their patients. I watched them and said, "but look. Patients of that unit are not wearing hospital gowns."
"That must be because doctors of that unit do not wear doctor coats during ward rounds" someone said.
I looked at the doctors in street clothes and said, "perhaps Dr House of the famous TV serial 'House MD' is their role model."