Healthcare Workers and Election Duty

"Sir, can they call us, laboratory technicians, for election duty, can they?" the person in charge of the lab asked me.
"You have already been called, I read in the newspapers today" I said. "The election commission is a constitutionally established federal authority. It is autonomous. It can do whatever it wants as far as conducting elections is concerned. If its order is refused, it can jail people. Its chief draws salary like the judge of the supreme court of India, I hear."
"But how will we do lab tests for patients if we have to go on election duty?"
"I understand it is judicial or quasi judicial. Don't you know that law is blind. It is evident from lady justice wearing a blindfold, as shown in court scenes of our Hindi movies . That blindness must prevent the people in the commission from seeing that healthcare is more important to people, especially poor people who seem to make a major part of the population, than the election process." someone said.
"But how will we run laboratory services on those four days our technicians go on election duty?" the lab person asked desperately.
"Well, you obviously cannot. The newspapers have strongly criticized the decision to call lab persons for this duty. If that decision is not revoked by the election commission, you will have to stop laboratory services on those days."
"But our patients will suffer."
"I know" I said. "But I have no power to do anything to resolve the problem."
A week passed after the initial call was sent out, and they did not revoke the order. The lab person was right. The patients did suffer. The tragedy was that no one seemed to care. Social activists, NGOs, media, and even politicians remained silent on that issue. It seemed like the poor people had lost the will to protest, or even to survive. Others probably had other things on their minds.
"The next thing will be doctors being called for election duty" I said to the Boss during a meeting.
"They have already been called" the Boss said.
"What has the biggest democracy in the world come to?" said that someone who had criticized this decision so vehemently just a week ago.
No one answered the question, because it was a rhetorical question.

Good Riddance

This happened awhile ago. It has stayed in my mind ever since.
"We hear Dr XXXX is leaving the department" a colleague remarked.
"Yeah!" another one said with a very happy expression.
""Why, you sound almost happy about it" the first one said.
"Of course I am happy. It is good riddance!"
"When Dr XXXXXXXXXXXX retired, it was a great relief. Then Dr XXXXXXXX left. It was good riddance. This was follows by Dr XXXXX and Dr XXXX. We felt the same about them too. Now when this person goes, we will be OK."
"Are we being negative about it?" I asked.
"No. A lot of others left. We were very sad when Dr XXX left. We still miss all those who made working in the department a pleasure. But among them all, these few have been really troublesome. If only they had done their own job without bothering others, we would not have felt so about them."
'Maybe bothering others is the job of some people' I thought.
"What do you think" someone asked me.
"I know one cannot please everyone. A few will criticize one no matter how hard one tries. But most people should want one to stay on, even when it is time for one to go. Some people may feel neither good nor bad when one leaves. It is OK. If majority feel it is good riddance when one leaves, one has failed."
"But how would one know what they feel? Everyone says good things about the person who is leaving at the time of the farewell."
"You can read it in their eyes" I said.

Tactile Diagnosis of Septate Uterus

Congenital malformations of the uterus can be diagnosed by imaging techniques like ultrasonography, CT or MRI. Ultrasonography is noninvasive and economical. So it is often done as one of the many tests done for gynecological disorders. CT and MRI are used only if some anatomical abnormality is suspected and cannot be diagnosed accurately by using ultrasonography.. So uterine malformations may not be diagnosed when a woman presents with infertility and her clinical findings are normal. Such patients are subjected to hysteroscopy and laparoscopy to detect causes of infertility. Hysteroscopy detects uterine septa and bicornuate uteri coincidentally, the conditions not being responsible for the infertility. Laparoscopy detects bicurnuate uteri and may help suspect presence of a septate uterus.
We had one such patient. Hysteroscopy was done by a junior resident and a junior consultant. They could not visualize the uterine cavity very well owing to failure to achieve a good distension of the uterine cavity. Then they performed a laparoscopy on her. When I looked at the screen of the endoscopy monitor, I remarked,
"That looks like a septate uterus. The two parts of the uterus are seen separated by a groove running between them in the sagittal plane."
"....." they were not totally convinced. But one does not usually disagree with the boss, I suppose. It looked like the following model, except that the groove was a little less pronounced.

"I cannot put in a hysteroscope now. You did not have good distension, and hence you did not even connect the camera to the endoscope. So I may not get satisfactory distension too. Besides there will be some bleeding from endometrial trauma by the uterine manipulator that you are using. That will make the fluid turbid and obscure vision. Now we have to feel the inside of the fundus with a curette when you curette out the endometrium."
The junior consultant tried that after chromopertubation test was done and was found to be positive.
"The contour of the funds is smooth" he said. "There is no septum inside."
I was convinced there would be a septum in there. So I took over. I put the curette in the left cornual area, and slowly moved it along the inside of the fundus towards the right cornu. It dipped in the midline and then traveled up again to the right cornu. The path was as shown below.

"There is a septum in there" I said. "Watch the movement of the handle of the curette that is seen from the outside."
They watched intently. The handle did move as the tip moved inside the uterine cavity.
"Yes, there is a septum" they agreed.
"This is the tactile method of diagnosing a septate or bicornuate uterus" I said.

Therapy Cats

Ours is the first place in the healthcare world where therapy cats exist. We do not get credit for developing or promoting the idea, but we do get some credit for their existence. After all, if they were not allowed to get fed in hospital pantries and to breed in hospital corridors or corners, would they exist and function as therapy cats?
There used to be black and white cats and kittens. Then either there was a mutation or a ginger cat took over the territory. Now there are ginger kittens. When they are not finding food or drink (milk) in the pantries, and are not dozing some place, they are amid patients and their relatives. They especially work best with babies whose mothers are in the wards either delivering more babies, or getting treated for gynecological ailments. The babies love them. They forget the pain of separation from their mothers playing with the kittens. Once I saw a toddler pick up a kitten held by the end of its tail. The poor kitten did not utter a single meow until we made the toddler put it down and told him not to do such a thing again. There are children watching kittens with rapt attention play or hide in inaccessible spots. There are children talking to the kittens. There are those who air touch them, meaning they reach out to touch them but do not do so actually. They are totally happy doing even that.
Therapy cats work even on adults. I have seen guys making kittens jump at their rolled up newspapers. That day I saw a ginger kitten perched on one knee of a guy in the crowd outside the labor ward. I have seen patients watch the kittens fondly sitting in their food lockers. I have seen kittens sleeping in patients' beds.
I just wish they would devour mice and rats in the hospital. That would reduce cases of rat bites, leptospirosis, and equipment malfunctions from chewed up electrical wires.

True At Least To Work?

There are people who are principle-centered. they are true to everything in their lives. Then there are those who tolerate no hanky panky business where their work is concerned, but will take the remaining part of their lives quite lightly. Finally there are those who are not true to any part of their lives. One would expect a doctor to belong to the first or at least the second type.
We had this senior person in the department, whom no one really understood. Having been trained in a prestigious medical college like ours, one would expect him/her to have knowledge and integrity. Having spent quite some time in a prestigious foreign university hospital, one would expect from him/her discipline too. I was never concerned with private lives of any of the people working for us, because that had nothing to do with us. But I liked them to be true to their profession. This one person stumped me.
Once I was passing by the obstetric operation theater, when I saw this person standing in the corridor outside the operation theater wearing theater scrub suit and footwear. He/she was gazing into the distance at something.
"Dr. XXXX, what are you doing outside the OT in scrub suit and OT footwear? The clothes and especially the footwear will carry germs into the OT and contaminate the theater environment. That will increase our postoperative infection rate. As Associate Professor, you not only have to know this, but also teach it to your students."
"It was ... I was just ... I will go back inside" he/she said and went into the OT, wearing the same contaminated clothes and footwear.
Two weeks passed. I was passing along the same corridor at the same time of the day as the last time, on my way to the postoperative ward to take ward round. He/she was in the same spot as the last time, clad the same way, wearing OT footwear, gazing into the distance at some far off spot.
"What are you doing?" I said. "Just two weeks ago I asked you not to do this, explaining the reasons for the same, though you should not need anyone to explain them to you. Don't you care even a little bit about the well being of our patients?"
He/she mumbled something, turned, and went back into the OT, wearing the same contaminated clothes and footwear.
I knew this person would not improve, because he/she did not care. I knew he/she was in the wrong profession, and also that he/she would always be in the wrong profession no matter which profession he/she chose.
I am writing this blog post not to bring up those memories which bring up strong negative feelings and hurt myself again. I am writing this to request my readers to be true at least to their profession at all times.

Tarpaulin Roof Garden

Fancy places like starred hotels have equally fancy roofs which are water proofed. They have roof gardens and roof swimming pools. I had not thought it would be possible for us. But our people managed a roof garden. In fact, to the best of my knowledge, it is the first of its kind in the world.

Monsoon and water leakages through the roofs and walls go together in this city, from the best places to the worst, more so in the case of the latter. Water proofing is an expensive method of dealing with the problem, and may not be possible for some, while it may be possible and be actually done too in civic and government institutes (but may not work due to certain reasons often alleged in the media or any other reasons unknown to me). A faster and more economic alternative is to cover the said area with tarpaulin, for the duration the monsoon. That is what they did for one of the buildings in campus. It would be impossible for an individual to spend that kind of money for such a large area, but the civic body is flush with money, I guess.

As the monsoon progressed, there grew a garden on top of the tarpaulin roof. It must have grown in dust which had got there during a dry spell by air currents blowing it up from the ground. It is bordering on a miracle that shrubs grew in just dust collected there. I have no idea if the roots penetrated tarpaulin and went down, through which water might have leaked on the terrace below.

In the meantime, it is heard that they are not interested in getting the name of the institute in the book of world records for being the first to have a tarpaulin roof garden.

Compile-Comply-Whatever

Doctors are perhaps too busy to pay attention to new words - new meaning what they had not learned in their student lives, not 'new' words. Then they hear something, register something else, and then use the words incorrectly. It was a coincidence that two different doctors committed the same error and I saw it in the span of one week.
I received an article for publication in our journal JPGO. The following sentence was found in the text of the article, which was a case report. "After compiling the preoperative requirements, corrective surgery was performed on the patient."
A couple of days later, I was scrutinizing a report made by a medical officer of the civic body. This officer was in charge of the healthcare of an entire civic ward, the entire city being divided into areas called wards from A to P, and each one into North and South or East and West. It was about an inspection performed by him after a doctor answered a show-cause notice served to him by the civic body. There was the following sentence in the report, and I was expected to offer my remarks on it as the chairman of the PCPNDT committee of the civic body. "It was found during the inspection that the doctor had compiled the deficiencies pointed out..."
In both the instances, they meant to use the verb 'comply' and not the verb 'compile'. In case one or both of these words are new to any reader (I sincerely hope not), the dictionary meanings of these two words are as shown below, acknowledging the copyright of the respective dictionaries and thanking them for educational use of their meanings in this article.

Word	Meaning
	Oxford dictionary	Macmillan dictionary
Comply	meet specified standards	to obey a rule or law, or to do what someone asks you to do.
Compile	Produce (something, especially a list, report, or book) by assembling information collected from other sources.	to make something such as a list or book by bringing together information from many different places.

I corrected the word in the scientific article and informed the author about it, because it was a good article and I wanted it for our journal. I could not do so in the report I read in the PCPNDT committee meetng because it was a legal document and I had to respond to it. So I wrote,
"Since the respondent has just only 'compiled' the deficiencies, we are unable to offer any remarks on the further course of action to be taken."

Something hilarious happened the next day, which was in the same vein, though the word was different. There was a meeting of big bosses of the major civic hospitals in the office of the Boss' Boss. Heads of various departments in the hospitals, lawyers and NGOs were present too (by invitation). A new form was being discussed, which was a modification of the forms issued by the central government and state government. The additions had made this new form quite exhaustive and hence quite big too. There was a consultant wearing a necktie and all. He offered his opinion as follows.
"The form needs to be shortlisted."
Everyone just kept quiet. Perhaps it was a slip of tongue. After five minutes, he said again, "the form needs to be shortlisted." People's response to this was the same as the first time.
Perhaps he had heard the word 'shortlist' from someone, and liked it, and thought it was a more distinguished way of saying 'shorten'.
For those who think this is a new word, the meaning of the word in the Oxford dictionary is as follows, (acknowledging its copyright and thanking the editors for the use of the meaning for educational purposes):
'Put (someone or something) on a short list. An example is offered, as follows: the novel was short-listed for the Booker Prize'.

Music Sharing: New Method

There are many forms of music sharing. Sharing music on the internet is called piracy, and is punishable by law. People borrow someone's CD or DVD and listen to music. I suppose that is not piracy, because one is not making illegal copies of anything. It is somewhat like borrowing a book from a library, and returning it after one has read it, or finds it awful and does not want to read it further. Public sharing of music is what happens in festivals. The organizers put music on loud speakers so that the entire population of that area is forced to hear it. It may be called forced sharing of music. Today we are going to see yet another form of music sharing.
I was commuting on a city bus on my way to the hospital. Two young girls were sitting on the seat just in front of me. I noticed something unusual about them. They seemed to be connected by thin wires between their heads. After a while I realized they had thin white wires coming out of their adjacent ears. The two wires joined with each other, and a single wire passed downwards somewhere, probably to a hand of one of them. They were speaking to each other periodically, and then going back into forward gazing stance. After a while a realized that they had earphones in their adjacent ears (meaning right ear of the girl on the left, and left ear of the girl on the right). Then it dawned on me that they were listening to the same music emanating from a single phone or iPod. Since their other ears were open, they could hear each other too, when they decided to talk. What a wonderful bond of friendship, and what a wonderful method of sharing music. It was perfectly legal too.

What is shown above is my artwork showing this phenomenon. I have shown them sitting on a bed rather than on a seat of a city bus, because in case of the latter I would have to draw the complex interior of a bus and a lot of people in it. This was easier, and quite adequate for giving the idea to the reader.

Uni-English

One usually has heard of American English, Queen's English, and Hindi English (also known as Hinglish). Uni-English is a new type of English. It is actually quite old, but this is the first time it is being described.
The University conducts a workshop every year, always on the same topic, and invites heads of certain departments from medical colleges in the city as delegates to learn the stuff they teach every time. The topics are the same, and the contents are the same. The speakers are also the same, and usually their English is also same as at the previous times. After all they do not see any reason to improve something that they believe is superb, and what is applauded every time. I jotted down the following sentences from the speeches in one of the workshops, and then forgot all about it. I was sorting out my drawer today, and got hold of it. I thought I must share this stuff with you, because I believe in sharing fun. I could compile different sentences uttered in successive workshops, but I think the samples should suffice.

1. To conduct whole workshop may not be able to possible.
2. Another important thing we are there is ...
3. There is a chapter full on anemia.
4. I feel very proud to see you people talking to you people.
5. Whatever we have done in the last ten twenty years.
6. It is also very very important.
7. The module is very very clear.

We shall call this Uni-English. It is spoken by enthusiasts in University Workshops. Uni is short for University, and has nothing to do with the 'uni' one uses to imply one. The last three examples border on Hinglish (check out the bold letters to know why).

The Stories of Mitral Stenosis - 4 (The Last Straw)

The patients who undergo operative treatment are seen by many doctors before the operation. They are examined by the House Officer and Registrar. This examination is comprehensive, including general, systemic and gynecologic examination. They are seen by a gynecologic consultant, who checks gynecologic aspects. They are seen by anesthesiologists thrice - once in anesthesiology outpatient clinic, then preoperatively in the ward on the day prior to the operation, and finally prior to induction of anesthesia for the operation. If there is any doubt about clinical findings of any particular system, they are seen by senior consultants and specialists of the respective illnesses.
All operated patients are examined by the House Officer and Registrar in the gynecology ward postoperatively. They are seen by a consultant the morning after the operation. I was examining such operated patients once. I had not seen them preoperatively, and someone else had operated on them. They were all OK, I had been told by the resident doctors. When I put my stethoscope on the chest of one of them, I had a sudden sinking feeling in my heart. She had the classical murmur of mitral stenosis. She had been given a spinal anesthesia and a vaginal hysterectomy had been performed. No one had known that she had a mitral stenosis - neither the gynecologists nor the anesthesiologists. Luckily she seemed to have a well compensated heart and the breath sounds were OK too. I advised the residents to get a cardiologist to see her. The very next patient gave me the sinking feeling again. She had the classical murmur of a ventricular septal defect. She had undergone a vaginal hysterectomy under spinal anesthesia, and no one had known about her cardiac condition until I saw her. Luckily her cardiac function was well compensated too. I asked the residents to get a cardiologist to see her too. I told the senior anesthesiologist to sort out the problem of the juniors missing the diagnosis. I decided to give my resident doctors my software to learn cardiac auscultation. If the diagnosis had been made, the two patients would have been seen by a cardiologist and all sorts of preparations would have been made which were not made for patients with normal hearts. The following day I saw the two patients again. They were OK.
"What did the cardiology resident doctor say about this patient?" I asked, pointing at the patient with mitral stenosis.
"He said she had a pansystolic murmur. He has advised 2D echo for her" the Registrar told me.
I was aghast. That was the last straw. A cardiologist in training had mistaken a middiastolic rough murmur for a pansystolic murmur. Perhaps the time had come for throwing away stethoscopes and embracing 2D echo technology for daily work.

The Stories of Mitral Stenosis - 3

The stories on mitral stenosis get more and more interesting. The Resident Doctors have their own assessment of their seniors. They believe that they can categorize their seniors into different types, and that they are predictable. They think the seniors have their own (irrational?) whims and fancies. They tell each other and their juniors what their bosses like and dislike, and what they will say and do in different situations. It is something like the students tell the future batches what jokes certain teachers will tell in lectures on certain topics. It is no wonder that they categorized me too. I don't blame them. How would they know I was different? In fact, they probably believed nobody was different.
This story took place about a year after the last one. That day I saw a pregnant woman with a left parasternal pansystolic murmur in her heart. It was due to a congenital hole in the septum between her cardiac ventricles, what is known as ventricular septal defect. I wanted my resident doctors to learn and also wanted to see which of them were good. So I took the woman's permission,  called them one by one and asked them to auscultate her heart. Their answers were as follows.

Doctor	Diagnosis
First year resident doctor 1	Normal heart sounds
First year resident doctor 2	Mitral stenosis
First year resident doctor 3	Some murmur
Second year resident doctor 1	Mitral stenosis
Second year resident doctor 2	Mitral stenosis
Second year resident doctor 3	Ejection systolic murmur
Third year resident doctor 1	Mitral stenosis
Third year resident doctor 2	Mitral stenosis
Third year resident doctor 3	Mitral stenosis

Out of nine resident doctors, six diagnosed it as mitral stenosis. The only reason for them to mistake a loud, clear murmur that lasted throughout the systole for a milder, rough murmur that lasted mainly in the middle part of the diastole, could be that they had been primed by their seniors. They had been told that some time I would call them for auscultating a woman's heart, and that it would be mitral stenosis.
It was a double whammy for me. The first one was that they were not good with the murmur business. The second was that they believed they could successfully predict what I would do, implying I was one with stereotype thinking, and they were infinitely more smart than I.

The Stories of Mitral Stenosis - 2

Times have changed. We had to rely on our clinical acumen using conventional instruments like a stethoscope to make a diagnosis of a heart disease. I recall listening to recorded cassettes of heart sounds to learn this skill. With advances in instrumentation, people started relying on tests like 2D Echocardiography to make this diagnosis. Then the students started feeling great if they just detected a murmur in the heart, not if they diagnosed the type of the murmur and the nature of the heart disease. When they became resident doctors in our department, they continued the same trend. I felt this practice was quite dangerous, as one would not have access to such technology at all times in any institute, and at all in many parts of the world. Without a diagnosis, even a tentative one, one could not treat a patient. So I decided to test the acumen of the resident doctors once in a while, just to see which ones were good and also to motivate the rest to study better. One day a pregnant woman came to the antenatal clinic. She was asymptomatic, but had a tight mitral stenosis. For hose of my readers who don't know about it, mitral stenosis produces quite characteristic heart sounds and murmur, nd can be diagnosed quite easily and accurately by cardiac auscultation. I called the resident doctors and lecturers one at a time and asked them to diagnose her heart condition by auscultation. The results of their test are shown in the following table.

Doctor	Diagnosis
First year resident doctor 1	Normal heart
First year resident doctor 2	Normal heart
First year resident doctor 3	Some murmur
Second year resident doctor 1	Normal heart
Second year resident doctor 2	Mitral stenosis
Second year resident doctor 3	Ejection systolic murmur
Third year resident doctor 1	Normal heart
Third year resident doctor 2	Chest is clear
Third year resident doctor 3	Some murmur
Lecturer 1	Normal heart
Lecturer 2	Ejection systolic murmur
Lecturer 3	Some murmur

I did not know whether to be aghast that three junior consultants and eight out of nine resident doctors were wrong, or to be ecstatic that at least one of them got the diagnosis correct. The one who had said the chest was clear went on to become a lecturer in due course (which illustrates the point I made in the beginning. I did the test the next year, and the results were similar.

The Stories of Mitral Stenosis - 1

Mitral stenosis is a form of rheumatic heart disease that seems to plague patients even today. It happens to be the most common form of such illnesses. It is also the subject of a number of stories that I have yet to tell. This post is the first one in the series.
In my early days after qualification, I was posted as a Lecturer at a peripheral hospital briefly. There used to be a great shortage of anesthesiologists then, which has only increased manifold over the years. We had to give local anesthesia and sedation to our patients scheduled to undergo minor procedures. I used to do that regularly. We had a complex of operation theaters, in which there were tables for Obstetrics and Gynecology, General Surgery and ENT. The other specialty Resident Doctors had heard of me giving local anesthesia and sedation to my patients. One day the House Officer from the  General Surgery department came to me in the OT and said,
"Will you please give spinal anesthesia to my patient? He is a young fellow with a hydrocele."
"Let me have a look" I said. He took me to the patient who was lying down on the operation table in the surgical OT. I asked his history and auscultated his heart and lungs.
"Hey, he has got a mitral stenosis" I said. "Did you not know about it?"
"No" he said and gave me a look.
"Auscultate his heart" I said. "He has a classical middiastolic murmur with presystolic accentuation."
"So will you anesthetize him or not?" he asked me. I was aghast.
"Sorry, no" I said. Get him checked up by a cardiologist and anesthesiologist. He requires proper anesthesia by a specialist. You should examine your patients before posting them for surgery, or one day you will lose a patient. That will also get you into deep trouble."
He did not seem to like my advise. He took the patient out of the OT anyway. I was worried that he would not improve. So I warned his Lecturer about this. He also gave me a look, but at least promised to talk to the House Officer. I don't know what happened to either of them, and what they are doing today. I only hope their patients and they are OK. This happened thirty years ago. There are new players, but mitral stenosis continues to be ignored. We shall see different aspects of this in the subsequent posts.

"Call My Children" She Said

She came to us in a bad shape. The family resided in the city, but had gone to their native place in North India. She was carrying her third child then. She had a fall, and they found out that the baby was dead in her womb. They got a D & C done there, and came to us after 15 days. She was literally pouring out pus from her uterus, and was having high fever too. We gave her high antibiotics, then switched to higher antibiotics, but there was no improvement. Her sonography did not reveal any abnormality. But I had a feeling that there was a major problem on the left side of her uterus, where a lot of pus must have collected. So I asked for a CT scan, and it showed a huge collection of pus inside her. In the meantime, she kept lying down in her bed looking very sick, and her husband kept meeting me, asking me to do something to cure her. I got the surgeons to drain out the pus, and she started improving. The next day she was sitting up, all smiles.
"Now you will be OK" I told her. "But I would advise you not to have another baby. There is a hole in your uterus, through which the pus was entering the uterus. It will most probably remain unhealed. Your uterus may rupture at that site during the next pregnancy, and it may even prove fatal. I will speak to your husband about it too."
Her husband came to see me when he heard of this. I explained everything to him.
"How did that happen?" he asked me.
"Her uterus was probably perforated during the D & C" I said, "which caused a lot of bleeding inside, and it got infected."
"I know why that happened" he said. "I had sent her to a good hospital 65 km away from our place. It was expensive but good. She came back without getting treated there. She wanted it done by a woman near our house. This woman used to work as an assistant in a nursing home. Now she thinks she is a doctor, has set up a nursing home, and does these things herself. She has messed up a number of patients.  She has no medical degree. Even the nursing home she runs is not licensed."
"Oh!" I said.
"Doctor, you saved her. Two days ago, she probably realized she was slipping away. So she said,'call my children. I want to see them once...'."
"....." I just looked at his tearful eyes, unable to say anything.
"Even I thought she would not make it. That was why I kept meeting you and asking you do something more."
"She was fortunate she came to this hospital" I said. "That saved her."
"I will stop that evil woman who did this to my wife and many other women" he said with passion. "I will complain to police. Is there any other body I can complain to?"
"Perhaps the state medical council can help" I said. "But it regulates doctors. This woman is not a doctor, you said."
"I will do something" he promised.
"Be careful" I said. "From what I read in the newspapers about your native place, that person may pay some hooligans to beat you up if you make any trouble. If they do away with you, your wife will have no husband, and your children will become orphans."
"I will do it from here" he said, thanked me profusely again and went away.
It has been a few days since, but I still think of the mother who somehow knew she would not make it and wanted to see her children once before the inevitable happened. I was glad her husband had not told me this while I was working on the management decisions for getting her well, because perhaps the pressure would have made the detached analytical process difficult.

What People Want To Read On My Blog

I write a blog because I want to express my thoughts and feelings on things that happen around me, and I feel that others will benefit from knowing about them. I usually do not check who reads what. But Google keeps a meticulous record of all traffic to my blog. I have written 941 articles so far. I happened to see that some of the articles had an unusually large number of hits. So I checked out which ones had more hits than others. I have Usually each of my article has 30 to 40 hits. I have selected the topics which got more than 70 hits each, as shown in the following table.

Topic	Hits
Vaginal myomectomy: new technique	1085
Single uterus, two cervixes	1077
Uterine perforation by copper T	997
How to fix spike buster	941
Dengue pronunciation	910
Copper T and weight gain	699
Abbreviations	471
How to make a pelvitrainer	447
Mindlessness	316
Cyst in the uterus	308
Clinical methods AEBE	295
Placenta previa on ultrasonography	257
Vesical lymph nodes?	257
Partogram	237
Biometrics and us	237
Who was I?	230
Myomectomy with rubber tourniquet	227
3D instruments in Obstetrics and Gynecology	205
Vacation arrangement for watering plants	191
Iatrogenic hypoprolactinemia	172
Elective clinical pelvimetry	158
Shashank Parulekar Who?	158
Kissing ovaries	147
Uterine rupture and misoprostol	116
Liquid paraffin dressing	106
Fothergill story	106
Innovations in theater technique, surgical gown	98
Pedema	98
Adults stuck in childhood	93
Patients as writing boards	93
Retrograde hysterectomy	92
Fimbrial prolapse: diagnostic test	87
Condolences	83
Puerperal purpura	83
Mistrust	82
Burst Abdomen without sepsis	79
Making of a medical teacher	76
Fundal pressure	74
Delayed vasovagal attack	72

I am proud that my new operative technique of vaginal myomectomy was read by 1085 people. I am surprised to note that people (mainly from USA) are so curious about an uncommon congenital malformation of a single cervix and two uteri. I also see that a lot of people are worried about uterine perforation by copper T, and also false fear of copper T causing weight gain. I don't know how people know that the way dengue is pronounced is not correct, and they search the net to find out the right way. And I am amused that 230 people wanted to read an article 'Who was I?' and 158 people wanted to read the article 'Shashank Parulekar Who?'