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.


 E. RAJKUMAR
 BATCH OF 2008
 GANDHI MEDICAL COLLEGE

Tuesday, February 18, 2014

Elsevier Clinical Learning



Hi

Here is a great opportunity to use the "Clinical Learning" Tool designed by ELSEVIER on a FREE TRIAL Basis. "Clinical Learning" consists of instructionally designed modules with appropriate use of videos, animations, interactions, illustrations, professional voice over and self-assessment features. It accommodates different learning styles, provides opportunities for repetitive practice, encourages interaction of students with teachers and peers, and promotes active learning.

You can register here for a free one month trial !

https://www.clinicallearning.com/university/addtrialuser.php

When you register, please do choose my name "Rajkumar Elanjeran" as the referring Elsevier Student Ambassador.

Do not miss out on this exceptional Learning tool!

Thanks

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,

Hyderabad.

Wednesday, February 20, 2013

OB/GYN SPECIMENS


RUPTURED UTERUS












SEROUS CYSTADENOMA









CARCINOMA CERVIX





Red degeneration specimen (view from opposite side)

Monday, February 18, 2013

SURGERY : RADIOGRAPHS

PNEUMOPERITONEUM









































BOWEL OBSTRUCTION







STAGHORN CALCULUS




HYDRONEPHROSIS (CLUBBING OF CALYCES)





PYLORIC STENOSIS SECONDARY TO CHRONIC DUODENAL ULCER




ACHALASIA CARDIA





VESICULAR CALCULUS




TO BE UPDATED


Surgical Instrument : Miscellaneous

KELLYS ANAL SPECULUM









Surgical Instruments : Tubes

CUFFED ENDOTRACHEAL TUBE




GUEDEL'S AIRWAY (NASOPHARYNGEAL AIRWAY)




RYLES NASOGASTRIC TUBE


MALECOT'S SELF RETAINING URINARY CATHETER








FOLEYS SELF RETAINING URINARY CATHETER (inflated)

 For tracheostomy tubes , see ENT Instruments