Sunday, February 7, 2016

Ragging - Emotional Abuse bordering on Physical Abuse

Ragging is rampant and it's not going away anytime soon, at least in this part of the world. Ragging or Hazing is a form emotional abuse bordering on physical abuse. Let's not hide from reality of abuse and torment that entails every incidence of Ragging and call a spade a spade - Ragging Is Abuse. That said, what I'm going to talk about is based on my personal experiences at Gandhi medical college, Hyderabad. There's so many people, even on Quora, to my utter disappointment and bewilderment, who have built a wall of defense around ragging calling it a socializing tool only to hide their abusive personalities. There are several layers to this debate and I'm going to try and break it down, point by point.
My Personal ordeal - Ragging, an apparent Initiation to become a true "Gandhian", began right after regular classes had begun in Gandhi Medical College. I was forcibly taken to the hostel, stripped, slapped and humiliated in front of several seniors from various Batches and also in front of my own class mates. This was compounded by the fact that I am a native of Tamil Nadu, an "Aravam". My ragging was a combination of racism, body shaming and name calling. Me, being a day scholar, returned home and swore never to go back to college. That changed soon after a lot of self introspection and learning to fight back. My friends pointed out that I was an easy target because I was submissive and eager to please the people around me. They were right and I eventually learnt to resist any ragging attempts. This has led me to being completely averse to the idea of ragging ever since and this article is a reflection of that very thought process.
The Psychology of the Abuser - Like I said earlier, Ragging is Abuse and that is what I will call it through the remainder of this article. The abuse here though is shrouded under the guise of a false sense of justification by the abuser that he is out to teach, but this is actually a hallmark of every abusive personality - putting you down by shattering your self esteem so as to project himself as someone you can look up to. It is fair to say that most abusers , especially in the setting of ragging/hazing have a narcissistic personality bordering on self love and the constant need to feel superior. Like many bullies, an abuser uses physical threats or actions when feeling impotent, frustrated. Let me talk about the several instances of abuse I've seen at my college and the way I understand it. As simple and as harmless as they might seem, there' always more to ragging than meets the eye.
1. Physical abuse - This can be direct physical hurt, but can also entail physical restraint of the abused. There are gruesome incidences, but I won't dwell into the specifics because this answer is not a shock tactic. Physical abuse is more common in a hostel setting when freshers spend most of their time held up in dormitories as they are ragged and abused by one senior followed by another. The fear of standing up to this abuse in itself manifests as a more incapacitating form of self abuse, when the victim becomes emotionally restrained and emasculated. This form of abuse is commonly seen in violent cults where the victims, despite their desire to leave, are overwhelmed by a sense of foreboding and stay in the cult and continue to suffer through the abuse. This is most evident from the fact the freshers staying in the hostel go from room to room "requesting" to be ragged. The abuser succeeds time and again in instilling a fear of dire consequences and he does so by reminding the victim of the several years he will spend in college in the company of the abuser. The abuser will threaten the victim with social boycott, academic setbacks and he will succeed every step of the way in keep the victim chained in invisible shackles.
2. Destroying self esteem - "Don't smile and don't you dare laugh", "Look down when you're talking to me", "Fold your hands", "Call me SIR", are things we've all been told and may seem pretty harmless. Every time you obey such commands, you spiral down a regressive path which eventually ends with you as the bottom feeder looking up at the abuser, who now places himself at the top of the ladder of social hierarchy. This is a clever technique to reinforce Structural inequality in educational institutions and only asserts oppression that some are superior to others. More often that not this bias can take the form of Casteist harassment with certain sections of students facing more difficulties than the other.
There are several incidents where I've been put down, time and again, because I've always been outspoken and not one to shy away from a difference of opinion. A more systematic form of institutionalized oppression is evident from how Juniors are virtually banned from the library, reading room and canteen areas for the first few months of entering college, or how juniors are ordered to vacate chairs in the library so seniors can sit in their favorite places.
3. Ragging and Servitude - Most seniors treat their favorite (most obliging i.e.) juniors as their personal slaves often using them as their personal shopping assistants, for running errands and for writing their records. Some may justify this as just seeking help, but that argument is invalid because help which entails a sense of superiority and the risk of "dire consequences" isn't help at all. That is just abuse in the form a master - slave dynamic parading as seeking favors. If it really is help, it should work both ways and no, ragging a junior to make him understand how college life works doesn't qualify as help!
An ideal Senior - junior relationship is that which is built on the foundation of friendship and not one with forced respect and superiority. I've never ragged a junior and always treated them with respect. Some of my juniors are the closest friends I have and I know they've never ragged a junior themselves. It is evident from my personal experience that some regressive attitudes are inherited undiluted and the abused becomes the abuser. This continues to be passed down one from generation to the next, but on the bright side, so are progressive junior senior relationship equations which do not involve abuse. The one common defense I hear when I talk about ragging is that it forges long lasting friendships. My opinion is that long lasting friendships can be forged without necessitating the component of ragging. There is a growing distaste towards abuse in these relationships but ragging is still a deeply rooted problem endemic to colleges in India. Understanding that ragging is not acceptable and that it should be done away with as a socializing tool can go a long way in eradicating abuse completely.

Sunday, December 14, 2014

A Commitment Beyond Academics

Before I begin, I must convey my thanks and best wishes to the Batch of 2010 for bringing to life, Gandhi’s first online journal - one that, true to its definition, chronicles life at Gandhi. To members of the general public who are reading this, here is a disclaimer – the term “Gandhi” isn’t a reference to the Mahatma, but a proud reference to my Alma mater – Gandhi Medical College.

At the outset, here is my stand on this subject –The Internship I pursued at Gandhi Hospital is one of the most rewarding experiences of my life so far, and one that I miss dearly. Far too many interns have been misled into believing that internship is nothing but a waste of valuable time which can otherwise be spent in preparing for post graduate medical entrances. I hope that at the end of this article, you will ridicule this contrived advice as a farce. I hope that I am successful in quelling any and every misconceptions you have, and that you don’t pay heed to any individual who attempts to downplay the importance of internship.

Before I stepped into the wards of Gandhi hospital as an intern, I, like everyone else, heard contrasting opinions on the experience of being a house surgeon. Some seniors labelled interns as glorified ward boys/girls, and some others called them the life line that our hospital runs on. I can assure you that the truth lies in the latter, because only these people have done their internship with dedication and honesty. How can one count on the opinion of an individual who couldn’t even muster up enough strength and heart to finish 12 months of internship? For all you know, that person is probably downplaying the importance of the internship only to satisfy his guilt.

The experiences of internship are unique to every house surgeon, and these are experiences that one can never expect to re-live.  Every intern has special moments. The memories of these moments kept us going in the face of adversity.  I am going to tell you two special moments which continue to inspire me when I am down. I was posted in the department of obstetrics and gynecology for the first two months of internship and this is where I learnt the bare essential skills I needed as a house surgeon.  I was posted to pediatrics after my two months in Ob-gyn and this particular incident happened when I was in the pediatrics OP seeing patients. I was seated right opposite my Unit chief and sitting adjacent to me was the pediatrics PG.  A mother carrying her infant walks into the room and sits on the stool next to my chair. Before I could ask her what is wrong with the child, she says out loud “Doctor sir, I do not know if you remember me, but you were the one who conducted my delivery a month ago. I am here to thank you once again and seek your blessings for the child”. My unit chief looks at me and smiles, and the PG, I can see is trying hard to control himself from teasing me.  But I knew instantly, that what she said will become a memory I will cherish for years to come. It may not seem much to you or any other doctor for that matter.

Every intern conducts countless number of deliveries during his time in the labour room and it was something of a routine to all of us. But what never struck me was how much of an impact we make on patients lives. We interact with thousands of people in the course of the year and at some point, they stop being people and start becoming merely a number. This woman reminded me of how consumed I was with the pace of the internship and stopped valuing these memories but only cared about getting the job done.

The second incident happened when I was posted in the department of Orthopedics. I am 36 hrs into the duty day having slept for only 4 hrs and the PG and I are preparing the list of cases to be posted for Surgery tomorrow.  The list is ready and we are rechecking the case sheets when we realize one of the patients hasn’t had a single investigation done.  What this basically means is that the anesthetist coming for the pre anesthetic check up (PAC)is going to laugh at my plight and the orthoPG quite the opposite. So me being the PAC in charge this particular day, have less than 3 hrs to get all his investigations done and make sure this man has his surgery tomorrow. So I set out with the patient and take him to get his ECG done first, then to the emergency lab to beg the in charge to give me the reports in an hour, and then to the radiology department for his chest X-ray. It’s almost 12 now and I take all the reports and run to the medicine OP to get a fitness approval for the patient. Everything goes according to plan, and the anesthetist and the PG are happy and so am I.  So I go to the patient and start explaining the pre operative advice when he suddenly pulls out a Rs. 20 note and says “Sir, you seem  to be very tired. Please get yourself a tea”. I am shocked and overwhelmed, not sure how to react. I obviously declined to accept and told him I am only doing my job. This is one of those rare incidents when the patient empathizes with you and understands the hard work you are doing to help his treatment.

Empathy is a very special trait expected out of doctors. One that forms the basis of a doctor patient relationship and this is probably the only instance where I have seen it work both ways.  But empathy is also the crux of the relationship you share with your colleague. Internship is team work , where your workload only decreases when your co interns are willing to work together and share the burden.  When even a single intern is absent, you will have to deal with twice the amount of work and twice the number of patients.  To all my classmates who felt it was ok to bunk duties or not even report to postings because you were bored or didn’t find the postings interesting or whatever selfish reason ;When you decided to abandon ship, not only did you disown your friends, you also let sink your honor and respect. I wish I can say this subtly but there is no easy way to put in words my frustration at the situation that me and my fellow interns faced when more than 30 of our batch mates decided to skip internship for good. For those of you who intend to skip their internship in the near future, there is no greater act of negligence than what you are now contemplating.

Putting the hard work aside, there are so many fun moments when you just give in and enjoy yourself in spite of all the work load. There are times when you try hard to reason with the patient suffering from alcohol withdrawal syndrome, but realize your efforts are futile and load him up with haloperidol just so that he stops abusing you.  The evening breaks in the Doctor’s canteen and Amul parlour bring back livid memories where all we do is talk about the goof ups of some hapless transfer intern. My favorite one is the Transfer intern who inserted the IV cannula in the opposite direction.  But let’s be nice, how can you expect an MBBS graduate to know the direction of venous blood flow. That’s some serious super speciality stuff right there. There was also this famous photograph of a casuality requisition which went “patient complains of stomach pain in the right groin”.

And how can I forget the task of getting your log books signed. In the immortal words of King Boromir , One does not simply – get his log book signed.  And Dear Govt. of Telangana, you still owe me 5 months of my stipend. One gets to bond with some really hardworking and inspiring Post graduates through random conversations and dinner treats. You will be made to run around for the silliest of reasons, but sometimes you’re running because in your hands is the blood for a patient who is bleeding out on the OT table and your praying that this blood reaches him before its too late. You will find that your co-intern chose to come to a duty drunk or hung over and yet feel helpless at their immorality and how things are taken for granted. You will find endless corruption, you will find people who try to monetize human misery. You will find heroes amongst you who put up a tremendous fight against the prying eyes of Media to protect the Identity of a helpless 5 year old girl who was molested.You will be appalled at the gross deprivation of basic human rights that HIV positive patients suffer from and you will be moved to take a stand against this stigma.

Internship is a test of your personality, a character building exercise of sorts. This is when you will realize what kind of a doctor you will become and what kind of a doctor you want to become. There will be sleepless nights, but there will also be nights of heroics and tremendous achievements.

Everyday in your internship is a first – the first time you performed a surgery on your own;  the first time you successfully resuscitated a patient, brought him back from the dead;  the first time you declared a patient's death to grieving relatives;  the first time you went  48 hours without a minute of sleep;  the first time you know what needs to be done to save a patient's life but your hands are tied for lack of facilities; the first time you hold a person's hand telling him everything is going to be fine, even in the final moments of his life; and the first time you realize you are now a person who can walk out of this hospital and save lives all on your own.

 BATCH OF 2008

Tuesday, February 18, 2014

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Friday, December 27, 2013

The Business of Saving Lives

Here I am, 8 months into my internship, waking up every day to new challenges, challenges where peoples lives are at stake, challenges which are a test of my personality. Have I risen to these Challenges? I believe i have. The work I do has  never failed to excite me and I think its my enthusiasm coupled with a  borderline impulsive/obsessive attitude that keeps me going, day after day after day. I am a small but essential part of Gandhi Hospital and it is an opportunity that I have rightfully earned for myself. I take great pride in being in the position that I am in now  , a feeling that gets reinforced every time I interact with  a patient. And these challenges I keep mentioning - they teach me new things about myself every day. So what else could I want more?, seems right about perfect doesn't it? Well if you thought so, then you're certainly not part of this profession, but if you're grinning to yourself thinking "yeah, right!", then wipe that smirk off your face because you, my friend, are in the same rickety  boat as I am.

I try to shut off the pain and worries and just live the moment as it presents itself.  I have many passions which I have adamantly refused to let go off and still actively indulge myself in. I think it's fine to live in the now, but the thing  about now is, there’s  another one tomorrow. I need  to start making them count. I’ve never been the guy who has had life handed to him on a silver platter, and I consider myself fortunate for that.  We chose the path less travelled  and that obviously has consequences. But what compounds these, making them worse than they ever were,  are the times we live in. If you are an outsider who believes doctors are duty-bound to serve in the downtrodden villages of this country, then you, Sir, are gravely mistaken. As a matter of fact, you’ll be surprised to note that our “Duties” are no different from yours. I hate to break it to you, but we aren’t the miracle virgin births. You see, we are born into the same kind of families you were born into and have the same responsibility towards them that you do. It would be foolish to argue otherwise.

A couple of months from now, I will be joining a rat race, for the second time in my life and certainly not the last time. This scenario does not include all my colleagues though, as some of them are lucky and smart enough to get out of this system and there’s the other rotten kind who have paid their way into the profession right from  the very beginning. I have a mouthful for the latter, but personal ideologies aside, I am here to talk about the crisis that the vast majority of us are facing now. Borrowing from the “Save the Doctors” Campaign, I want to talk to you about the crisis that will determine our future as a country. After about 6 rigorous years of medical college, We compete with 38,000 other medical students for a meager  12,000 post graduate seats, a quarter of which I am eligible for and about 1 percent of which remotely interest me.  What this means is that for every single post graduate seat that is available , a thousand young hopeful doctors will walk away empty handed, their efforts amounting to nothing. We will now spend the next year, or two years or even three years in a coaching class room or a dusty library, preparing for another chance at fulfilling our dreams. Some of us will never see this dream come true, and we will accept defeat.  As I write this, I feel overwhelmed by a fear of failure and  I feel stranded. I feel let down by my country, the country I stand to serve for the rest of my life.  This is the cost of ambition. These are the times we live in.

E. Rajkumar,


Wednesday, February 20, 2013





Red degeneration specimen (view from opposite side)

Monday, February 18, 2013










Surgical Instrument : Miscellaneous