Bank Teller In Total Control

I trust my readers know about the famous king who built a hospital for poor patients in his kingdom. If not, please do a Google search of my blog - it will give you all the links. Today I am going to write about a bank teller in that kingdom.

The doctors in his hospital were paid salaries. But they were also given bearer cheques (checks) for doing some research out of their research grants. They would take these cheques to the bank which handled the king's business. The bank was conscientious. Though a bearer cheque was meant to allow anyone holding it to withdraw cash of the amount written on it, the bank tellers asked for identification of the bearer of the cheque, so as to protect loss of the money by the cheque falling in the hands of rogues.

One day one doctor employed by the king went to the bank with such a cheque. He believed he was actually fit to be the king himself, and behaved accordingly. Though the bank was at some distance from the hospital, he went their wearing his full sleeved white coat that told people he was a doctor.Unfortunately the fools (in his opinion) at the bank did not recognize him for what he was, and he had to stand in a queue like ordinary people. He showed he was a good sport by not showing his anger at the treatment meted out to him. When he reached the bank teller (they used to call the bank person who paid or received cash as teller even in those days), he presented his cheque and stood waiting for the cash.
"Your identity card please" the teller said.
"My identity card?" he asked incredulously. Everyone should be knowing him, he believed. This was an outrage.
"Yes, please" the teller said.
"In twelve years no one has asked me to show my identity card! (बारा वर्षांत कोणीही माझ्याकडे माझे कार्ड मागितलेले नाही)" he said loudly enough for everyone in the bank to hear. So the teller must have heard him, since the distance between the two was just one foot. Still she showed no reaction and kept waiting for the card to be shown. People who were listening understood that he had been in service for twelve years.
"Our hospital has forty lakh rupees in this bank. We use that money for research (आमचे चाळीस लाख रुपये या बॅंकेत आहेत. ते आम्ही संशोधनासाठी वापरतो)" he said, suggesting all that money was actually his. The clerk remained unmoved.
"Take this (हे घ्या)" he said angrily, extracting his identity card from his wallet. "If it is not enough, I have PAN card, election card, driving license and passport, ... Shall I show  you all of those too? (ते जर पुरले नाही तर माझ्याकडे पॅन कार्ड, निवडणूक ओळखपत्र, वाहकाचा परवाना, आणि पारपत्र पण आहे. ते सर्व दाखवू का?)"
The teller inspected the card he had shown, returned it without a word and started counting the banknotes to be given to him for the cheque.
"What a face. Even a fly is not moving from that face ( काय चेहरा आहे! चेह~यावरची माशीपण हलत नाही आहे) he said angrily about the teller, again loudly enough so that everyone would hear it. The teller showed no reaction, gave him the money for that cheque, and asked the next person in the queue to hand over his cheque or withdrawal slip. The angry doctor took the money  went away fuming.
"That teller was totally in control of her emotions" someone commented softly so that the angry doctor would not hear it and start another fight. "She has control like Lord Buddha."

Bully Bird

I had never thought birds wold be capable of emotions and behavior more than primitive ones, like grief at the loss of a young one, love for the young one, love for a mate etc. This story was an eye opener for me.

Asian Koel is a big bird. It has angry red eyes. The male is all black and the female is with brownish spots. One hot afternoon last summer I found two of them sitting on a branch of large tree opposite our house. One was a male and the other was a female. They were quiet and probably resting. There was a tiny bird sitting on a branch above them. This tiny bird was quite vocal about something. It was not singing. Actually it sounded as if it was complaining loudly. It must have been its territory and it must have disliked those two birds entering its territory. In the picture below, the black bird is on the right of the center, the spotted one is on the left of the center (white arrow), and the tiny bird is above the black bird (between yellow-outlined black arrows).

After the tiny bird had complained for a while, the big bird perched on a branch below it apparently got tired of the disturbance. It turned its head through 90 degrees and looked up. It gave the tiny bird a full glare of its angry red eye. The tiny bird shut up in a snap. The big bird turned back its head to neutral position, paying no more attention to the tiny bird.. The tiny bird did not utter a single sound until the big birds flew away after some time.

Bullying is not limited to school children. Even birds bully.

Technique Of Developing Technical Specifications

You may want to know about the hospital a King built for the poor people in his kingdom. Read all about it here and here.. This post is about the King's prescribed method of procuring equipment for his hospital.

There were a few (actually quite a few) dishonest people in his court, who would buy equipment for the hospital at inflated prices, and the difference between the market rate and the rate of purchase would be shared by them. In order to curb this, the King decided to use a process he called 'tender'. Actually there was nothing tender about it. It was quite complex. You can read all about it here. One of the steps in inviting these tenders was to lay down specific technical features of the item to be bought, so that all persons who wanted to sell that item would offer a similar product. The process of writing these specifications was entrusted to the hospital doctors and one engineer. The king did not know that doctors were not taught engineering skills, because he used to be a political appointee himself with no knowledge of either medicine or engineering. A problem with the engineer was that he would be appointed to this position by seniority in the king's service. So a garbage or sewage management engineer could get appointed to do an electronic engineer's job. The doctors would copy specifications given to them by vendors they liked. The engineer would depend on brochures of three different vendors, taking out their least common denominator. These facts resulted in preparation of technical specifications which left a lot to be desired. Sometimes different points about a single item would be opposite of each other, creating a technical impossibility.

One day the king appointed an engineer to do this job, who was different. He probably hated electronics, or perhaps hated engineering itself, like some medical students hate medicine but join a medical college under parental pressure. He used to collect files in his office until their pressure threatened to push the walls outward. All medical specialists complained that they could get no equipment because there were no specifications. No one could do anything about it, including the king, because of reasons not revealed to anyone. Fortunately almost every problem has a solution. An innovative doctor found it for the problem at hand. This doctor got specifications for seven items approved when others could not get even one. The secret was not revealed. After some time another doctor got specifications for a mega project sanctioned. It is rumored that the engineer asked this second doctor to bring along other projects too, on which he would love to work with that doctor. Though the other doctors were not very good with math, they found the least common denominator of the two doctors who had succeeded where the others had failed. The result was as follows.

The aspirant of technical specifications should have fashionably cut hair, well made up face, pleasant and a little mischievous smile, slim arms revealed by sleeveless top, fashionable dress, and willingness to have coffee.

Not A Day Above Forty

"Hello there!"
I looked up from the history I was writing on a patient's case paper. Normally I would be busy seeing patients in an examination room. But there was a shortage of resident doctors, and I was filling in. I was the unit head, and I had to see that all work was finished in time. Putting on airs would not help do that. That was how that Professor saw me while using my outpatient clinic as a thoroughfare.
"Hello" I said.
"Do you know if they increased our retirement age to 63?" she asked.
"Not yet. But I don't see any point in doing it for surgical specialties. If our hands shake like this" I said, moving my hand in a demonstration of a senile tremor, we won't be able to operate well at that age. It is not as if we have to just sit and write prescriptions."
"Oh, that won't happen. One should eat well, exercise and be fit. Look at me. I am sixty, but I don't look a day over forty."
She held her hand over her upper chest, well in front of the rib cage, as if there was something there preventing direct contact with the rib cage. What was more interesting was that she had made a statement about herself that a third party is supposed to make about a woman well above forty. She waited for me to agree with her, and when I did not, would not, or could not, or perhaps when she saw the answer in my facial expression, she turned and went away. 'Can't blame people who say she is a bit funny' I thought, and went back to my writing of the history of the patient who was sitting there, not understanding a word of what was being said.

Crows With Attitudes

We have put up a water dish for birds on our window sill. The original idea was to let all sorts of birds drink from it. But only crows have monopolized it. The sparrows are afraid of crows, and do not even look at the water dish. Pigeons keep a safe distance from the crows, possibly because crows eat non vegetarian food and are not very clean. Perhaps pigeons remember crows which stole their eggs from their nests. Other exotic birds (only robins and another type whose name I don't know) which visit our balcony garden prefer to drink water somewhere else.

Our crows are special. They do not just drink water and go away. They have attitudes. Though they look similar to me, I can identify three of them as individuals, from their cawing. They visit the water dish before retiring for the day. One of them is a gentleman. He caws as follows.
"Caw .. caw. Krrr caw Kawwaa? Kaa Caw" in a low volume, gentle voice. My interpretation is that he says "Hello, hello. How you doing? Good night." He goes away after I say good night. But it may not mean anything, because he goes away even when I say nothing. Please note that I never say "go away" to him.

The second crow looks sly. He also speaks softly. "Caw .. caw. Kra kraa ka?" My interpretation is that he says, "Hello, hello. Anything to eat?" Since we do not feed them in the evening, I usually ignore him, and he goes away quietly.

The third crow is stout, dark (I know all crows are dark, but this one is darker) and looks like a hooligan. He checks out the water dish. If it is nearly empty, he says angrily, "KRAA..KRAA..KRAA..KRAA", which I cannot put in words, because I am sure he is an illiterate (or its equivalent in crows) and cannot speak crow language. But I am sure he scolds me for letting the dish get nearly empty. A nearly empty dish in the evening means an empty dish in the morning, and he has to wait for us to wake up and fill up his dish before he can drink.

I could be wrong, but I have a strong feeling that I have met people with similar attitudes.

Obesity Caricature

This post is about someone I don't know, who handled the outpatient case paper of one of my patients without letting her know about it. I had seen her some time ago. Besides her gynecological problem, she also had obesity. There was no reason for her obesity that could be found medically. The final diagnosis (besides the gynecological diagnosis) was overeating and not exercising. After prescribing her medication, I had advised her to reduce her weight by making adjustments in her diet and walking briskly for 30-45 minutes every day. An operation would be performed after she got investigated for fitness for receiving anesthesia. When she came back for follow-up, I looked at my previous notes. There was a word that I could not understand, though the handwriting was mine. It looked like this.

I just could not make out what had made me write the word 'BESITY'. After thinking about it for some time, it dawned on me that there was a sad face behind 'BESITY', which I had not drawn. A little more thinking showed that I had actually written the following word, and someone had modified it.

I must have been a little concerned about her obesity, anticipating wound breakdown after an abdominal surgery. So I had written that word in a rather large print. Someone had been tempted to modify that 'O'.
"Who wrote something on your case paper?" I asked her.
"No one" she said. "I had gone to my native place after seeing you, and seen a doctor there because I did not feel very well."
Tracking that doctor in her native place and pulling him up for being naughty was not an easy task. So I let it go. But I did wish that he had at least cured her if he had to mess up my clinical notes.

Royalty In Halls of Academia

Once upon a time there was a Gurukul [गुरुकूल] (what is called a university in modern times) in Aryavat [आर्यावत]. The chief Guru [गुरु] (what is called a vice chancellor in modern times) was a famous Guru who was selected by the King from a handful of aspirants. This was a tenure post for 5 years, subject to reappointment if the King and his ministers were pleased by the Guru. This Guru was given a Rath [रथ] (what is called a car in modern times) for his daily commute. This Rath was no ordinary vehicle. It was special, like a sedan in modern times. The Guru was so pleased with his new status, that he got his Rath modified to his liking. This activity can be compared to renovation of residences given to ministers and such in modern times. Since the Rath belonged to the Gurukul, the Guru could not spend his own money on this renovation, and was forced to use the money in the treasury of the Gurukul. The original cost of the Rath was said to be 3000000 gold coins, and the cost of the renovation was said to be 3000000 gold coins too. A simple math shows the total cost to be 6000000 gold coins. Needless to say the Rath probably had special features like perhaps access to the Gurukul's database, the King's ear, GPS, wi-fi, SAT phone, nuclear weapons(?) or whatever. Perhaps it ran a few inches above ground, like the Rath of Udhishthir [युधिष्ठिर] in Mahabharata [महाभारत].
Once the Guru had to visit another province for an academic matter. There was a flying Rath service, which was paid for by the Gurukul, just like his own Rath was. Air travel was faster than more comfortable than that by road. So the Guru took the morning flight. But he was so used (what is called addicted in modern times) to his own Rath for travel by road, that he sent his Rath by road ahead of the flight, so that he was met at the airport by his driver in that Rath, who drove him to the place of that academic work, and drove him back to the airport after the work was over. Then the Guru took a flight back, while the driver went back by road. It is not known if he made it in time to receive the Guru at the home airport to drive him back to the Gurukul. If not, he might have been laid off and another driver might have been appointed.
The name of this Guru has been put down in Golden letters in the archives of the Gurukul for giving a Royal touch in this manner to the position of the chief Guru.
I came across this story while reading our Purana [पुराण] and have no personal knowledge of the identity of the said King, the said Guru, and the authenticity of the story. I personally do not believe this story, but I do admire the imagination of the storyteller. I have reproduced the story here so that my readers can see how fertile imagination can concoct stories which sound quite true.

Look Or See?

A senior consultant in Delhi told me this story.

A driver does not look out of the window while driving. He sees things on and around the road, which can interfere with his driving. Old doctors are like drivers when they manage things in the hospital. A lot of things are going on at the time, which are looked at by many people, but seen by a very few.
"Who has put that saline bottle on the sterile trolley?"
"It is the trainee nurse from another institute, Sir."
"Its outer surface is unsterile. Now the whole trolley is contaminated. We cannot use it for any patient. If we do, there will be infection. How come no one saw it?"
No answer.
On another occasion, "See that syringe on the trolley?"
"Yes, Sir. It is of local anesthetic solution, for an episiotomy."
"How do you know it contains local anesthetic?"
"It has a label on it."
"But labels are not sterile. So now the trolley is contaminated. Our patients deserve better, don't you think?"
"Yes, Sir."
"If they label a syringe, it must be prepared well in advance. That means there must be more of them."
Yes,Sir. There they are."
Indeed, there was a tray with twenty loaded syringes, all of them proudly bearing the label 'lignocaine'.
"How come no one notices this? Though these are meant to be used during surgery, they cannot be used for that purpose. Their outer surface is not sterile."
No answer.
One would think the eyesight starts failing as age advances. It must be paradoxical that older doctors see many things that others probably look at and forget they looked, never seeing the consequences.
Or is it life in a fast lane, with no time to see anything? But then, drivers in Formula 1 races are in very fast lanes, and still they have to see things if they have to survive. Our lanes are relatively slower, but involve many more lives than in those races.
It must be the curse of old age, when one has to see things which trouble a mind that would rather be at peace.

Did Or Might Have?

This story is from another anger management workshop, where one speaker told this as a part of the exercise set by the person conducting the workshop.
_________________________________________________________________________________
It is all in the manner of speech.
I prefer to say what I want to say or at least what I have to say. There is no hiding from it. Most of the people do the same thing. If they don't want to say something, they keep quiet. But not everyone is so. See the following example to know what I mean.
"Why did you do this?" I asked one resident doctor who had goofed up big time in patient management. Luckily we had been around and not allowed things to go wrong.
"But I did not do so" she said.
"But you did. People saw you do it" I said mildly. I have learned finally that anger harms me rather than the person who makes me angry. So now I try and not get angry.
"I did not do it intentionally. It might have just happened from me" she said.
"Ah!" I said. It looked like a case of someone using this person like a puppet. She probably could not help what happened. "But I don't think you did not know what you were doing. Would you not go to sleep in some corner of one of the wards during emergency duty, where no one could find you? You would even switch off your phone so that you would not be woken up."
'I did not sleep like that" she said indignantly. "My eyes might have shut on their own."
"And you lie to save yourself many times" I said. It troubled me saying all those things. But they were true complaints, and they caused trouble to patients and her coworkers.
"I don't lie" she said. "Some untruths might be slipping out of my mouth."
I gave up. "OK. You can go to your work" I said.
"But when ..."
"See, I have managed not to get angry because I am working on it. But now my breaking point is approaching. Go before I get angry" I said.
She turned and started going. She stopped twice in the six feet distance to the door, turned around and opened her mouth to say something, saw the look on my face and finally went away. I congratulated myself on having maintained my cool, and also thanked her mentally for the training session in anger management she had not conducted on her own, but had somehow been instrumental in its occurrence.

Threat of DNA Analysis

It was an old trick they used to get away from work.
"Sir, we have a problem. The water supply to the labor ward shuts down once or twice a week regularly" the sister in charge of the labor ward complained to me, while I was taking a round of our patients in that ward.
"That sounds familiar" I said. "Where is the problem?"
"There is enough water in the  underground tank. But the inlet of the overhead tank is shut off."
"That is usually operated by the electricians who run the water pump" I said.
"We asked them. They said they were not closing the inlets. Someone else was doing that."
"I know who is doing it" I said. "The servants in the gynecological OT used to do that on my OT day because the operation list used to be big. If they shut off the water, there would be no list. Which meant
they did not have to work. I found that out and got it sorted out. The problem has not recurred for many years. Now one or more of your servants has learned the trick. Call the senior servant. I will talk to him."
The servant was duly called.
"I understand the water supply to our labor ward is shut off by someone" I said. He kept looking at me, confident that I could do nothing to catch the culprit. "The servants in the gynecological OT used to do that on my OT day" I continued conversationally. He kept looking at me. "I fixed that problem. It did not happen again after that."
That shook him up. Fixing gynecological OT servants was no small feat. If I did that, I must be good.
"Now I am warning you and the other servants. If this happens again, I will get DNA analysis done on the inlet valve of the overhead tank. That will catch the culprit. Then I will lodge a police complaint for interfering with work of the civic hospital. You understand the nature of the complaint and the consequences, don't you?"
It seemed he understood the consequences very well. I went away.
"Sir, will you really do that?" someone in the unit asked me.
"Well, no. We do not have funds to do such a test. I have just frightened him. Knowing my academic reputation, he has believed me. They won't do that again. Actually they could have beaten the trap by wearing gloves while doing this, just as they do while cleaning the ward. But he does not know that and I am not telling him."
In the next two months, the water supply to the labor ward stopped only once, but was soon restored. It was either accidental, or they decided to do it just to try and prove that they were not totally beaten.

HIV Therapy Misinformation

One woman came to our outpatient clinic demanding a laparoscopy. This seemed unusual.
"Why do you want a laparoscopy?" I asked her.
"I want to have another baby" she said.
"But why laparoscopy?"
"When I could not conceive, that nice doctor XXXX performed a laparoscopy on me and I had a baby. Now I want another."
"OK. But I don't think you need a laparoscopy. Did he tell you to have a laparoscopy again?" I asked.
"He does not want to treat me" she said shortly.
"Why?" I asked. This was getting weirder and weirder.
"Um... I am HIV positive" she said.
I was taken aback, for a number of reasons. That a doctor should refuse to treat her because she was HIV positive was not OK. Then he had advised her a laparoscopy, when she had conceived and had a baby. So that advise was also probably not OK. The main thing was that she knew she was HIV positive, and that she could get AIDS and die some time, leaving behind children who would be orphans. The fact that she came to a civic hospital indicated that she was not well to do. How would she provide for two children?
"The risk of transmission to the baby was substantially reduced but not eliminated totally with drugs administered to the mother" I said."You have a baby Why not take good care of that baby rather than have another one, when that baby can get infected? Besides, if your disease progresses and your life is cut short, who will raise your babies?"
"The person at the therapy center  has told me that with medicines for HIV, I can have a normal life span" she told me.
"OK.Are you going to buy your own medicines?"
"No! Government gives these medicines free" she said indignantly. Poor woman did not seem to be reading the newspapers and did not know that government healthcare schemes worked at times and did not at other times. For those who do not believe me, read the following news in Times of India that appeared just two days ago. For the last one year, medicine kits given by the same agency to pelvic infection cases are not available. The medicine kit given for vaginitis by the same agency has been available for a few days and not available for most of the days in the previous year.`
Stock-out hits HIV treatment across India

"OK. It is good that you trust you will get an uninterrupted supply of the drugs you will need. I will treat you to help you get a baby. But We will not perform a laparoscopy. From your history and examination findings, I don't think that is required. It is a dangerous procedure that can cause serious complications at times. We never do it without proper indication"
She looked at me suspiciously and went away. She reappeared after half an hour with another woman who said she was a social worker in the agency that gave HIV drugs.
"Why are you not performing a laparoscopy on her?" she asked me. "She will have a normal life span with medication and raise her babies well."
"That is good. Perhaps you will tell me why patients are dying in the medical ward with AIDS?"
She just looked at me. She probably knew a few lines that she was supposed to tell patients, but not the hard facts of life in a poor country. Or was she forbidden to talk about those hard facts?
"Anyway, it is good to know that patients are doing well in your opinion. We will treat this woman's infertility, but we will not do a laparoscopy because it is not required and doing an unnecessary operation on her might pose a threat to her life. Let her follow up in our infertility clinic and we will treat whatever problem she has got."
They went away. That woman never came back. She would not believe me probably because she wanted to believe what she thought suited her best. No degree of wisdom and explanation from me would convince her otherwise.

Novel Contraception

Usually the histories of new patients are written by the resident doctors in the outpatient clinic, and then the patients go for a clinical examination to senior doctors. But there was a big queue for history taking and no patients for examination. So I went to write a few histories. There was a 24 year old patient, who had come for a check up because she had missed her menstruation by 5 days. After asking about the complaint, menstrual, obstetric, medical, surgical, and personal history, I asked her about her use of any contraception.

"Yes. My husband uses condoms" she said.

I had known that most of the couples coming to our clinic were not very regular in their use of condoms, when they used condoms at all. So I asked, "when does your husband use condoms? Does he use a condom every time?"

"No, not every time" she said. "He uses only during my menstruation."

"What does he use at the the other times?" I asked when I had recovered from the shock I experienced.

"Nothing" she said.

 Poor woman, I thought. No one has taught her that contraception is not required during menstruation. Poor woman, also because no one had taught her husband to leave her alone during her menstruation.

Chronic Adrenaline Rush

My life was quiet and peaceful when I was a kid. I managed to get the top rank in school without too much effort, and I did not feel it was a great achievement. Probably the other kids took is easy much more than I did. Even in premed it was equally peaceful. Then I joined a medical college and I changed without knowing about it. There was so much to learn and it was fun too. Thinking back, I realize it was a high that lasted throughout my graduation and postgraduation. It became a habit. I would not walk peacefully even when there was no urgency. I would hurry to wherever I had to go. If there was anything to do, I would start doing it and be at it like a man possessed until it was done. I joined as a Lecturer and progressed to Professor and Head of Department's position at that same pace. The pressure at work, some of it inevitable from the profession I had chosen, some created by administrators who could have done far better but did not know how, kept the pressure on me. It became a habit that made a slave of me even in my personal life. Even when it was exercising or going for a walk, it was always a part of the hectic schedule, to be rushed through so as to be able to go to the next chore.  Now it is 39 years since I entered a med school, and I don't remember any time when it has been different.
The other day I went out to buy a couple of things. After the first purchase, I went on looking for the other thing I needed. I could not find what I wanted. But it was a day different from the other days. The roads were less crowded. There was less noise, fewer obstacles while walking, a pleasant breeze in place of the usual heat and humidity. Walking was not just an unavoidable unpleasantness, it was refreshing. It was at that moment when I realized what I had been doing. I had been on a chronic continuous adrenaline rush, which would continue until it exhausted me. Then I would rest awhile, let the overworked system recover, and plunge right back in. I suddenly understood the meaning of those forwarded emails which told me to stop to feel the breeze, to smell a rose, to listen to a bird sing, to watch a sunset.
I hope those who read this post don't have to do what I somehow did. I understand it is difficult with the rat race on. I just hope they find a method of finding a few moments to feel the breeze, to smell a rose, to listen to a bird sing, to watch a sunset.without any other thought in those moments.

To What End

I was on my way home from the hospital. A very senior consultant boarded the bus just as it was about to leave, and sat down next to me. We chatted a little, about the same things two medical persons chat when they meet occasionally.
"Dr XXXXXX had come visiting recently" the consultant said.
"The preventive medicine person?" I asked.
"No, no. Anesthetist. She was in the same batch as you, she said."
"Oh, yes" I said. I remembered. The name had not made sense at first because I remembered her by her maiden name, while this consultant had referred to her name after marriage.
"How is she?" I asked conversationally.
"Oh, she is fine" the consultant said.
"Is she not in New Zealand?" I asked, straining my memory.
"Australia" the consultant said.
"What does she do?" I asked. There should have been no reason to ask. She should have been practicing anesthesiology. But some of the doctors I had known who had migrated to US had changed their specialties. One had gone from cardiac surgery to radiology. Another had gone from cardiac surgery to gynecology. Another had gone from gynecology to family medicine. Perhaps this one had changed her specialty too.
"She teaches in a school" the consultant said.
"Um..." I was confused. "A medical school, you mean?"
"She teaches children in a school" came the answer.
"But why?" I asked.
"She thought her child would do better in Australia than in India. She did not want to go through residency again in Australia, because she would not be able to give time to her child if she went through the residency".
I kept quiet. I thought of the 8.5 years spent on medical education, finally wasted. I thought of the national resources spent by the government so that she could get subsidized education, now wasted. I thought of loss of one more doctor for my country which needed doctors badly. I thought of the rumors of parental influence used to get her a couple of gold medals over other students who were considered more worthy then.  To what end was all that? I thought and then could not think any more.

Educational Resistance Movement

It is a new movement. You won't find it on a Google search or any other search.
I had thought students wanted education. After all, that's what students become students for. Well, a number of students apparently do not seem to think so. They probably just want to get a degree, so that they can make a lot of money to live happily ever after.
I may sound harsh when I say so. Well, I am upset at what happened. That should explain my harshness.
It was my observation that resident doctors did not read much (lack of time? Lack of energy? Lack of motivation?). When thinking about it, I had a novel idea. We publish about 10 interesting case reports every month in our journal JPGO. These articles are written well, after a good amount of research by the authors. Residents did not get to see such cases, not in any one unit they work in. They did not read the journal (lack of time? Lack of energy? Lack of motivation?). So I thought I should make them read it, which would enrich their experience and make them better doctors. I decided to put multiple choice questions at the end of each issue, based on the articles published in that issue. I coded a web form and put the questions in it, each with a radio button for each of the four options for each question. I arranged to have the residents type their names and year of residency in that web form. I arranged for a print facility so that they could print the completed answer sheet and submit them to our office. My colleagues liked the idea. We decided to give the reidents internal assessment marks based on their performance in these monthly tests. They could read the articles while then answered. It was to be like an open book examination. The idea was to just make them read.
The outcome for about 10 residents in each unit is shown below.

Unit	Activity
1	All residents answered honestly.
2	Only one resident took the test.
3	Seven of them cheated. They made one answer sheet and everyone copied it.
4	All except one resident cheated. Only one person made answer sheets for all residents in the unit. They submitted their own answer sheets.
5	All residents answered honestly.
6	Only three residents took the test. They were honest.

The cheating was easy to spot. The concerned residents had the same score, and the same answers wrong. The technique of cheating was found out by questioning. The explanation for cheating, after repeated questioning, was "Sorry, Sir. It won't happen again."

I am feeling sort of numb inside.

"Why do you insist on making them learn if they keep finding methods to avoid learning?" I was asked. "You are just making yourself unhappy."
Did I do that because I was stupid, stubborn, or a hopeless dreamer? Definitely not to trouble them, as some of them probably believed.
"I do that because I believe it is my Karma to do that" I said. I was a teacher. Was it not my Karma to teach and make them learn?

Another Virtual Oxytocin Drip

When I write about another oxytocin drip, it implies I must have written about it before. I have not called it 'virtual' when I wrote about it before, but it was indeed a virtual drip. You don't actually have to know about that one to understand today's post. But if you are curious, you can find that post at this link.
It was during a departmental meeting when I heard of this virtual oxytocin drip. It was observed in that civic hospital that the Boss' Boss publicly declared as the best of the three civic hospitals. The reason cited was that it delivered so many women, and nothing went wrong. That 'nothing went wrong' was a statement that should have been taken with not just a pinch of salt, but with a sack of salt. Anyway, someone has said 'the boss is always right'. Then the Boss' Boss must always be right, and more than right or more right, or whatever.
"We got over of this patient who was herself a lawyer" one senior senior staff member said. That hospital had a system in which they handed over all patients in the labor ward were handed over to a new unit in the morning. That way the previous unit was free to go away. "Her indoor paper said she had been on an oxytocin drip. When asked about it, she confirmed she was receiving an oxytocin drip, as she had been informed by her doctor. But there was no intravenous line, and no intravenous infusion of anything had been given to her. When asked if she knew what an oxytocin drip was, she said she did not know."
'It was a virtual oxytocin drip' I thought.
"May be she was being given oxytocin through gas' someone joked. 'Perhaps they called some doctor 'Gas' over there' I thought.
"Why did you come to this hospital?" this doctor asked her.
"To get good treatment' she said. 'She must have heard someone like the Boss' Boss' I thought.

My Virtual Twin

There is a theme used by many Hindi movies. There would be twin babies, and they would get separated in some calamity. Then they would grow up independently, and meet one day as adults. Such movies were there when I was a child, and I suppose they are there even today.
I know no such thing happened with me. But I met someone today, and I thought, 'my God, if I had a twin, she would have been like this.' I had gone to the bank. The teller asked me to wait. She was an elderly woman, thin, fair, and and with good manners. It was not this description that prompted me t think what I said I thought. While I was sitting on an adjacent bench and waiting, she said in voice that carried,
"Krapash.....Krapash ....."
Krapash came on the third call, which was louder than the first two. He was another employee of the bank.
"What?" he asked.
"Phone...." she said.
"For me?" he asked.
"Yes, for you. You think I would call you to take a call that was for me?"
I wanted to laugh out loud, but managed to stop with a grin. 'My, God, she thinks like me, and talks like me too' I thought. I finished my work, came home, and told my wife enthusiastically, "Hey, listen. There is a new teller at the bank. Elderly, thin, fair."
"What about her?" she asked.
"You know which one?" I asked.
"Yes," she said calmly, "she speaks exactly like you."
"You know that too?" I asked.
"Yes" she smiled.
"If I had a twin that got separated when we were babies, she would have been like her" I said.
"I know" she said.
 I remembered a story, which I had told my wife before. When I ask patients 'when did you get your last period or some such clinical question', some of them ask me back,'who, me?' If I am not overworked or stressed, I say 'yes, you'. But if a lot of them do it to me on a single morning session, I point to another woman standing or sitting at the other end of the waiting hall and say, 'not you. I am asking that woman over there'. Then they get the hint and do not ask 'who me' again. I remembered another story. When I get a call while working in my office and the caller actually wants some other person or place, I say 'this is not him or the place. Some of them are insistent. They ask 'then where has the call reached?' I lose my patient then and retort, 'does it matter where it has reached, when it definitely not reached the person you want?'
I know some of you out there want to advise me to take a course in having patience. I am unlikely to do so, but thanks for the suggestion anyway.

An Offer That Hurt

"Sir, I want to see you for something important. When can I?"
"Sure thing" I said. "This Wednesday would be fine." He/she was my student, who had done MD some years ago. He/she had opted for running a coaching class for aspiring college students rather than practicing Obstetrics Gynecology. He/she was doing very well, probably much better than contemporaries who had gone into private practice. I wondered what he/she wanted from me.
He/she came on the Wednesday fixed for the meeting. Preliminaries over, he/she came to the point.
"Sir, I am expanding."
"That is nice."
"I want you to help me" he/she said.
"Huh?" I was surprised. "Your business is teaching college students. How can I help you?"
"The syllabus is changing. A lot of work has to be done... teaching sets, question and answer sets... I cannot do that alone."
"But you must have assistants" I said. I had an idea where the conversation was going, and wanted it to stop before it did.
"You could do a part of the work. The money will be good."
I was speechless.
"But I must tell you, I need the work done a certain way. Professor XXXXXXXXX had joined me to do this work. But he/she could not do it the way I wanted it. So I had to tell him/her to go."
I knew about this. This professor, a superspecialist in a surgical branch of medicine, had indeed taken up that work, possibly because the money was good. I had heard it had not worked out. Now I knew one side of the story.
"Thanks for the offer" I said. "But I am afraid I cannot do this. I don't need the money. I am making enough to eat four meals a day, commute to work and back, and buy the essentials for living. But even if I did not, I would not do this. I became an Obstetrician and Gynecologist because I loved that subject. I don't want do anything else in life. Best of luck."
He/she went away. I was hurt, not because I had been insulted, but because perhaps I had failed as his/her teacher in instilling in him/her the love for the subject that I had taught, and the values I believed I instilled in all of my students.I wondered where I had appeared inadequate so that he/she believed that I would prefer to do something else to make more money as he/she had done. Or was it the wealth he/she had amassed that gave him/her the idea that he/she could make that offer to me and I would accept it, and if I did not do well, he/she could ask me to go.

The One Who Chaired Many Chairs

"You see that person?" someone murmured while I was trying to suppress my seventh yawn of the morning. We were in the middle of a meeting called by a government agency, and the time was being put to (good or bad) use by dignitaries on the dais making speeches. I looked in the direction pointed at.
"Yes. What about him?" I asked.
"You don't know him?"
"I do. But what is it that you want to say about him?"
"I don't know why he is here. But it cannot be for an academic purpose."
I knew him. I could understand why this speaker said that about him. I kept quiet.
"You know he chaired many important chairs?"
"Huh?" I said.
"Dean of this college, Director of that institute, Director of some obscure department of the university, Dean of that third institute, then chair of his specialty in a fourth institute and so on."
So that was the chairing-many-chairs business.
"That is impressive" I said.
"You must have read about the financial scandal he was in before some minister bailed him out."
I recalled reading that in a newspaper a few years ago.
"I remember a story about him. Want to hear it?"
A story seemed a lot more interesting than the repetitive speeches coming from the people on the dais.
"OK" I said.
"A number of people were called to the university for some work. Both of us were there. When the clerk asked him how he had reached the university, so that he could pay the traveling allowance, he asked the clerk what transport was permitted. The clerk said first class railway fare or taxi fare. So he said he had traveled by railway - first class. The clerk asked him for the railway ticket, to be submitted to the accounts section. That got him in a fix. He thought about it a bit and said he would not take any traveling allowance, without giving any reason for it. The clerk managed to look puzzled and I managed to look not embarrassed for my one time teacher. I knew he had no first class railway ticket, because he had not traveled by first class."
"Ah!" I said. I understood that he was trying to make some money. "What did you tall the clerk about your travel?" I asked just to avoid discussing the embarrassing topic any further.
"I said I had gone there by bus, and gave him my one rupee ticket. The clerk looked embarrassed at the idea of paying me one rupee as travelling allowance. He asked me to keep it and paid me a princely sum of fifty rupees."
The bus ticket to the university located at one end of the town costing only one rupee suggested it must have been about thirty years ago. This person asking for one rupee seemed unreal.
"That must have been thirty years ago" I said.
"Yes. In thirty years his dishonesty has increased manifold as he chaired chair after chair. I am afraid to be under the same roof as him."
Suddenly I was afraid to be on the same academic platform as him too. I managed not to say 'me too'. But it was tough.
(Note: read he/she and him/her in place of he and him respectively. That is to protect the identity of the person concerned. Normally I do it as I type. But this time I did not do it because someone told me it makes reading the article less interesting.)

Hail Those Independent Minds!

We have an outpatient case paper for women attending antenatal clinic. It is something like a printed spreadsheet. All one has to do is to fill in the blanks under appropriate headings. It makes sense to do so, because one can always check what the previous readings were, and note if there is a trend, like weight gain or increase in fundal height. A sample of that case paper is reproduced below.

It did not work out as was intended by the civic body which gets these papers printed. So I gave strict instructions that all parameters should be checked and written in respective columns. It still would not work, so I kept giving the same instruction again and again. Still I find the following variations repeatedly, involving faculty and resident doctors equally. On a given case paper, when the patient has been seen by different doctors on different days, there is utter chaos.

1. Some of them move the columns showing fetal size (by date, clinically and by USG) one column to the right. So the successive readings are not one below another.
2. A few of them move the columns showing fetal size (by date, clinically and by USG) one column to the left. So the successive readings are not one below another.
3. Some of them do not fill rows horizontally. They write the three parameters one below another in three paragraphs.
4. One of them has a unique style. There are only two readings in place of three. One is written on the left half of the paper, the other on the right half, in a huge letter size. No one has any clue about the heading of either of them. It looks like the following. It does not serve the purpose it is supposed to serve, and wastes a lot of paper too.

                                

All this stresses me out when the patient comes to me for a check-up the next time. The only solution to this problem is to stop going to the antenatal clinic, like a number of senior faculty in many hospitals did and do, or take voluntary retirement. At the moment I have chosen to take the stress and keep working, because working is what I got to do.