Twenty years back and forth

         Human life is so short. Homosapiens has been on earth for last 2 lakh years and we have a decent understanding of history only of last 2000 years. And the science tell there is no significant difference between the thinking and understanding capability of humans then and now. So what were those people doing before 2000 years? What miracle occurred which made this rapid progress in human race.
        
        Some times it occur to me that all humans have one spirit and they are recycled. What they make during their life time stays and make their life better for the next cycle. Any big corporate in the world with a long history has been started by a single or group of persons. The story of how they changed hands between generations while the establishment stays and grows is fascinating. Take the case of a castle or an old church. How many generations have lived and prayed there. The walls of church witness baptism, marriage and death ceremony of the same person. The dirt I stand on has been here on earth, millions of years before me.

        There is an out flow of emphatic emotional turbulence when I visit an old fort or museum. The forts and castles that has been build half a millennium ago. What all incidents they must have witnessed. The power of the empire who built it, the people who built it, the wars they have seen, the victory, glory, violence, blood and gore. And now in this twenty first century I am standing on it. The sand on which all this has happened.

       Another thing that is in total contrast with all this development is that still babies are born on streets, eat to stay alive and die of the same disease that killed people 2000 years back. Some people are unfortunate that, even with the fortune they have, there is no cure for what they suffer from. I don't think life was any different for a slave who worked to make an Egyptian pyramid and a immigrant manual labourer who works for a contract builder in a metropolitan city.

       I don't think there is going to be any difference in this cycle of events. Every one has to live his life one way or another. I was thinking what was I doing twenty years back, I was six years old, studying in first standard, some good memories, but school life was always an entrapment. Twenty years has passed and I am still trapped in another place. Where will be I, after another twenty years. How uncertain human life is! Now I am writing this in a laptop, Who knows what technology I will use to write, twenty years from now.

 

Dull winter days

          Grown up in a warm sunny place,  I was not prepared for the winter life. Be specific, the Delhi climate. Delhi has got a climate which swings from one extreme of temperature to other like a pendulum. It is dull, gloomy and grey for a tertile from November and burning red hot for a semester from April.

         The first time when I landed in Delhi, I tried to enjoy the winter, walking with hands tucked in , vapours coming out with each breath and new fashion clothes in the streets. But the enjoyment did not last long. It was difficult even to touch the floor bare foot, the water is ice chilled, the food is cold in two minutes and I cannot live without wearing two layers of clothes.

        This is my third winter in Delhi. I know what to expect. The key in winter is to keep yourself warm. Wear sweater all the time, cover the peripheral parts while driving, change damp clothes as soon as possible, have extra petrol in the bike and a warmer in the room. Rather than the temperature, it is the dampness and humidity that makes life difficult. It is very easy to get respiratory tract and enteritis easily during this vulnerable time.

        More over today I am not feeling out, may be due to last night's duty. But still I felt I has to note this strange moodiness associated with winters. And I miss my Mom's food.

Entero cutaneous fistulas and stomas....

         Today morning rounds was going fine till that bad news came, the patient who underwent resection anastomosis developed an entero-atmospheric fistula. This young guy had undergone 3-4 laparotomies in the past and came to us with multiple entero-cutaneous fistulas. Adding to that his histopathology report has come positive for cancer with positive margins.

        Another young lady, who is the mother of two small kids has got inoperable rectal cancer with rectovaginal fistula, she underwent chemotherapy, radiotherapy, and we did a diverting colostomy for her.

        For some people, normal life is never meant. This is the raw truth of life. A visit to pediatric surgery or oncology ward can make one depressed. They just get crushed before they know what life is like. But these young people, they have tasted the life, they have just grown up and started their independent life and then suddenly it is all shattered.

       Well, seeing patients with stomas and fistulas daily had started to make me think, that it is not that difficult to live with it. But two days of severe gastro enteritis made me realize how tough it is. The embarrassment they has to go through every day. Compelled to live with the smell of stool from unnatural sites and the incontinence, make life tough for the patients and the near ones.

      So what can I do? Direct them to stoma clinic and advice on proper stoma care. Give them motivation and comfort. Try to create good stomas. Yes, there are so many things these patients teach us during these years of residency. 

Working up for a bike trip in extreme weather and first visit to snow

      This idea of bike trip to a snow capped mountain ranges has been revolving around my head recently. I have never seen real snow in my life. Residing in Delhi, I think I should not miss a chance to perform such a trip now.
      My searches has pin pointed me to Shimla, But there are stories written by bikers riding up to Spiti valley in the extreme weather. The beauty of the place in their snaps are really tempting for me. It will take around 2oo km till the base of the high ranges, and 600 km more to reach there. I hope if everything works well, I can finish the journey in 5 days. Any way I have arranged my duties accordingly so that, I hope to get 6 days unofficial leave at the end of this year.
     I have to collect items for my journey, equipment which can protect me while riding in winter. Good thermal gloves and rain coat will be on top of the list. I think I will have to carry an extra bottle for gasoline as reserve while passing through the ranges.
              

to be continued ...

'The happenings' : Defining an arbitrary confidence interval for '-ish'

              An interesting event occurred in the internet history last month which led me to name the title. Anyway I am not going to talk about that in this ellevenish hour. Adding '-ish' to any thing is an interesting slang I got from my colleague. It is a word which provides confidence to the user and listener. But actually it is a usage which denotes uncertainty. Yeah, each time I use it, I am reminded of how uncertain and inaccurate I can with respect to what I am talking about. Now I just googled it.... See what I found in Dictionary.com

ish¹                                                              

1.

a suffix used to form adjectives from nouns, with the sense of “belonging to” ( British; Danish; English; Spanish); “after the manner of,” “having the characteristics of,” “like” ( babyish; girlish; mulish); “addicted to,” “inclined or tending to” ( bookish; freakish); “near or about” ( fiftyish; sevenish).

2.

a suffix used to form adjectives from other adjectives, with the sense of “somewhat,” “rather” ( oldish; reddish; sweetish).

 

              Now I think should add a confidence interval to the uncertainty provided by it. The limit of the security provided for the speaker should not be compromised by putting the interval too short. The same time the listener also should not feel like walking on water. Taking these factors into consideration I would put an arbitrary value of 83% acuity. A confidence level of 17% up or down.

             

              For example when I say I checked the blood pressure of the patient at fivish, the listener can assume I checked it some where between 17% of 24 hours up and down. That will be 4 hours up or below. 

             Well, this is open for discussion.

 

 

The Dalhousie

          So I had my next lone long bike trip. It was more like a retreat from the boring routines in Trauma Center. By the end of three months I was fed up. I was feeling fatigued and brain drained. Although I don't know why. I wanted to run away to a distant place. I wanted to feel the freedom. May be the fact that I am going back to my ward posting has fired up my thirst for freedom.

          When I was doing the wound care of the last patient on my list, I was determined that I am not coming next day. That night I could not sleep well. Next day I woke up at 1200 pm, perplexed what to do, then I saw the email reply from my Madam. She had asked me to explain about the family emergency which I have to attend. So I thought of my imaginary uncle who was traveling to North India suddenly got Acute Cholecystitis and got admitted at Ludhiana. So the destination was decided. I packed my back pack and got on my bike at 2:30pm. It took about one hour to get out of Delhi. Then straight to Ludhiana on the Grand Trunk Road.

        
          My camera will tell the rest of story.

A review of life at Jammu.

       I am twenty five years old now. What have I achieved in my life. Have I done anything out of expected? Have I done anything to become what I really want? How much do I grade myself on my self development ? Have I grown out of my shell? Have I undergone the metamorphosis?

      So many things are undone. Only achievement in my life, something I value to be part of my portfolio is that I am in the course of becoming a surgeon. But thats not the end of it. I want to be different. I dont want to become just a part of swarm of surgeons. I want to identify myself.
 
   I want to be that guy, the one who has seen the world, the content one, the guy with depth in his eyes, the silent guy who sees through, the man who is not owned by anyone. I havent done anything for that.

       I want to do surgery for people who cannot afford the herd of surgeons who operate for a living. I want to do surgery for their cure. I want to do surgery not for my enrichment, but for their life.

      I have took some decisions. After MS, it is either DNB Thoracic surgery or just surgery. I will not marry for fortune but I will not say no fortune either. I dont want to sit in a corner desk and live the life. I want to live young and hard, slow and royale. I want to plunge in to the world. I want to be the man who do.

           In the end I should be able to say ' I had a heck of a life, Lets call it a day'.

Surgical residents, anger management and drinking habits

I have entered my second half of my surgical residency and I think I am mature enough to make my own opinion about the well-known issues of a resident in surgery. In my knowledge, the working environment of residents in any of the surgical speciality is similar. The striking difference between a surgical and non-surgical speciality is the fact that, the surgeons has to perform a well-planned, time consuming procedure  on the patient as the part of treatment while, the treatment by latter specialities mainly comprise of brainstorming, discussions and logical conclusions.

Time consuming is the word that I like to stress here. The usual routine of a surgery unit includes two or three operation days in a week in addition to whatever common things like outpatient day, grand rounds day and special clinics. In a teaching institution the responsibility of working up the patients for surgery naturally lies on the resident, starting from the lowest line of hierarchy. I will never criticize this working model, because it is an inevitable part of surgical training. In my personnel experience, I have found out that the more we talk with the patients, the more beneficial it is.

 Most of the time the residents will not be able to cover the academic topics in a fruitful manner along with the stressful working hours resulting in some mistakes her and there and eventually scolding during operation theatre proceedings or ward rounds. The residents get intimidated by the patients as well. Some patients may consider them inefficient, inexperienced young doctors experimenting on them, while some others over bear them with disrespectful dialogues. The nursing and supporting staff may also sometimes act like residents are invisible.

Getting into a resident ship in a reputable institution under merit is the fruit of long focussed hard training. The UG course itself is a long journey of five and half years. The fresh pass out from a medical school is considered naïve and the chance for a rewarding permanent job is minimal. The same time the friends from precollege times who chose a nonmedical field would have started earning. 

 Anyway my point is that the result of these inevitable pressure put on the residents in surgical specialty has a major influence on their character development as a doctor. The main change is that the threshold for anger come down. But the vent for frustration release is often small. Most of the time the ignorant patient or a newly joined nursing staff will be the prey for unexpected anger venting. The senior staff are usually experienced enough and seen so many residents grow up in front of them. So most of them are resistant to it. From one bad experience the resident will also understand that going into a bull fight with a senior nursing staff is not healthy.

Numerous times I have regretted for getting enraged with patients or patient attendants. The stimulating issue will be something silly. The patient might have forgot to bring an investigation report, might not have responded to my call etc. I get furious when such negligent acts occur before me when I am frustrated, especially after some scolding from consultant or senior, or during a long busy duty. ‘This doctor is talking to us as if we are animals’- I have heard one bystander of a patient make a comment about me in ED. It is not actually true from my point of view, and it is a well-known fact that the patient bystanders try to provoke staff with all kinds of offending remarks when they don’t get what they expect.

What can be done to prevent clumsy conversations and keep ourselves under control? The first point is that one should voluntarily train and keep some artificiality in conversation and action in front of patients and their attenders. This comes from practice. Speaking with true emotions out of heart may not be advantageous to patient or doctor either. I have seen senior consultants managing difficult situations with versatility of language. This is also known as ‘Soft skills’. Some may have this innate quality. But most of has to develop it.

Dramatization is the key word in learning communication. Start with a facial expression that might communicate the situation beforehand. Spending two minutes on a CAT film as if you are studying it thoroughly, running through the referral letters even if they have written blunders, pulling your lips apart laterally creating a smiling face before conveying a normal result or good result will help more than telling it plainly. Make a sad face or face of desperation before conveying a bad report or death. Try to look at the face of person while talking and get the feedback. Try to be clear and loud enough. Be a good actor.

Try to think for a second before raising the voice. Get the help of nursing staff or guard to raise the voice than getting our own pressure high. If something wrong has been found with the nursing staff never ever raise the voice, smile and make a joke of it. Politely make them know that you will convey the mistakes to the consultant or their seniors if they keep on repeating it. The permanent staff is afraid only of their own superiors and consultants. Better idea is to keep a friendly relationship with all supporting staff and never go on to a straight fight with them.

There are so many surgeons who do not drink. But an equal number of them take alcoholic beverages. From my experience, having a Beer party once or twice a month with resident colleagues is a great reliever of stress. Sharing the experiences, feeling loose and free and good food is actually a necessity for healthy survival in this profession. Not only drinking, having a coffee break with a colleague is also refreshing. Actually it is usual that one get addicted to coffee in residency. Anyone who has done residency cannot forget the freshness of after rounds coffee. It is lucky to have non egoistic down to earth, freely communicable colleague to share the work and fun.

'I am enjoying life'

          [7:58PM, 10/07/2014] My friend: I was pondering over your earlier question...

          [7:58PM, 10/07/2014] My friend: What do u think is enjoying life

          [8:01PM, 10/07/2014] My friend: I think being with friends I love and the man I love...and going for trips and exploring new places...wud be enjoyment for me...

          [8:02PM, 10/07/2014] My friend: Being able to take unplanned leave from work is enjoyment for me...

          [8:02PM, 10/07/2014] My friend: Being able to curl up with a book with nice fried snacks is enjoyment for me...

         [8:05PM, 10/07/2014] My friend: Having couple of drinks and becoming euphoric and dancing a bit wud    be  enjoyment for me...

         [8:13PM, 10/07/2014] Me: Its strange u never mentioned having kids and growing them....

         [8:13PM, 10/07/2014] My friend: How does that come under enjoyment 

         [8:14PM, 10/07/2014] My friend: That wud come under inevitable stress and torture!

Well, I frequently make that above statement in my diary. I want to remember the good times in my life. May be this statement is a sign that I fear that something bad will happen in my life. This is like counterattack thinking. Thinking the opposite possibility of whatever topic. More fruitful would be a lateral thinking. Anyway that is not of my interest now.

The above conversation was made with one of my best friends. I saved it because, it is like an ideal answer to the question. May be later in life I will review this answer. It is fun to see how things, ideas and views change as the years pass by.

 

The value of normalcy

              

Normalcy- It is a difficult term to define. It is a deceptive term. It is as complicated as simple it appears. Actually it took a little time for the mankind to understand the value of normalcy.
Earlier it was the values of king and religion that was considered normal. Then it was the values of general public that was considered normal. Then came the century of enlightment. Philosophers started to think what the meaning of being normal is. The statisticians came with idea of 'curve of normalcy' and standard deviations. So now the modern scientific generation believes anything that is between two standard deviations from median can be considered normal.

                But normal man cannot be satisfied by the normalcy. Everyone aim towards the idealism. The minority. The social elites. Defining normalcy in every realm of life will be a herculean task. So I will like to tell about normalcy which is germane to my field of my interest. WHO could come with a definition for 'health' only after years of brainstorming. The standards of wellbeing varies widely.

For a mechanic with lost little finger, it may not be a problem. But for a craftsman even that tip of little finger may cost much, and for a pianist it is invaluable. For a young man with an amputated leg as a result of an accident, ambulation will be a blessing. But for a diabetic patient, the healing of a chronic ulcer on the foot will be a thing for hope. People with no disease want to have ideal body shape, body that resembles a film star. People become anorexic and bulimic to fit in to that perfect dress.

 For a person with a temporary diverting colostomy, a successful reversal surgery is the day of his life. But a patient with colostomy made as a part of cancer treatment prays his disease never come back. He is totally denied of the dream of colostomy reversal. A good stoma without any complications and discomfort is defined as normal for him. For a person with peripheral vascular disease, pain is a part of life. If his pain is reduced to an affordable level, it is considered normal for him. A woman undergoing mastectomy for cancer, any kind of reconstruction which might feel disastrous, if applied on a healthy woman may be considered normal. Same time a small scar on the neck may be disabling for a teenage girl. A young lady may not feel complete until she gets an augmentation surgery on her perfectly healthy breast.

The values of normalcy can change from one end of a scale to the other end in matter of minutes. A doctor who is rushing to the ED to attend a patient may slip and get a serious head injury. That is fate. It is an inevitable unpredictable issue. And the normalcy is a complement factor of fate.

Two movies back to back

Lol.... this month was awesome. I got to watch two blockbuster action thrillers. Both of them were so good that I want to mention in my notes.

I haven't heard of these guys before, but after watching the movie I became a fan, especially the Rocket. Awesome movie, good screenplay and clarity of action sequences in 3D. The comedy makes the difference. Eagerly waiting for the Tony Stark to join the group.

Oh, Stallone the 68 year old Rocky, Statham...the Transporter, the movie is already a treat for eyes and ears. But Expendables 3 has got all the action heros together in a platter. So much for fun. Loved it. Here is a fan of Expendables series. 

How to cut down your body into what you wish

Having a healthy physique is a result of hard work. Except for some exomorphic persons, maintaining the BMI and waist hip ratio in healthy range is a challenge. Most of us doesn't care much about fitness either due to lack of time or patience. Every person in good shape will have a story of dedication and hard work to share.

Let us breakdown the term ‘overweight’. Whatever we consider as ‘overweight’ is actually the weight of excess fat stored in the body. The pot belly is the result of fat deposition both inside and outside the abdomen with some loosening of muscles. As a surgeon I have seen how much thick the fat layer can be. In obese persons, the fat layer just under the skin may measure half foot in depth.

So why does this happen. It is due to the action of ‘thrifty genes’. These genes are supposed to store available excess energy during the seasons of harvest and good weather, so that this stored energy can be used during the time of famine and food scarcity. These subcutaneous fat act as a long term storage facility for energy. In these modern times we don’t have famines or seasons of food scarcity anymore. So the stored energy in the body does not get an opportunity to get out of the system.

This explains the answer to the question, how to lose a major chunk of weight from the body? Make use of the ‘thrifty genes’. Cut down the calories to minimum or nil for a short period of time. Create an artificial environment of food scarcity. Human body has got a wonderful phenomenon called ‘homeostasis.’ It is like auto weather control in air conditioning system. It will make use of the available resources and maintain the inner supply of energy even if the intake from outside is zero.

The basic method to limit energy intake is restriction of carbohydrate and fat in the diet. Proteins and vitamins along with minerals have to be supplemented. Protein supplement is necessary to compensate for the muscle mass loss. But a little loss in muscle mass can be gained later by having a little excess protein and workouts. Usual carbohydrate in diet comes from the grains and their products. Sugar juices and soft drinks also add to it.

Let us see what is left in diet after removing carbohydrate and fat. Fruits and vegetables. Fruits contain sugar which is fructose and vegetables have very less caloric value. Among fruits itself the ones with more juice are the best, like orange, pomegranate, grape and watermelon. Among vegetables what we like to have is cucumber like things and green leaves. Tubers e.g.: potato, are high energy sources which has to be totally avoided.

So a model diet will go like, one to one and half kilos of orange a day as and when hungry, 2-3 cucumbers with lemon juice, salt and chilli. Watermelon or some other melons, 3-4 pomegranates, one full papaya, 5-6 apples are other choices. Boiled or grilled chicken wings or legs once in a week. Try to avoid banana.

Hydration is the key point in any dieting regime. Drink lots of water. One has to take minimum 3 litres per day. Juicy fruits and vegetables can contribute to hydration. The idea is basically to starve the body. The fruits and vegetables are just to fill up the stomach and keep the digestive system running smoothly. Taste buds will also need to be satisfied while dieting. Also having a fruitarian diet may make one feel cold. So to satisfy the taste buds and to keep the core fire alive, one will have to add some salt and spice of choice to the fruits or vegetables as necessary. 

Workout is also a part of this regimen. Minimum half an hour of aerobic exercise will accentuate the weight loss. Rather it will act as a benchmark for your performance. Normally this dieting regimen will not be a hindrance for the energy level one need for half an hour running or elliptical trainer. But feeling constantly deficient in energy level for minimum workout calls for relook into the dieting regimen and halt if necessary.

A major side effect of having a fruitarian diet depicted in literature is pancreatitis ( usually a self-limited  inflammation of pancreas associated with excruciating mid abdominal pain that may prolong up to one week, but needs hospitalisation for diagnosis and early treatment). Actual incidence is not sure, but not in my experience. Another minor but frequent problem is tooth related issues. The fruits contain lot of acids that can easily cause teeth damage. So mouth washing and brushing will be of utmost importance while following a fruitarian diet.

The results are seen within two days of starting a strict diet plan. Loss of weight can be expected up to 3-4 kilograms in a week. After a rapid fall of 10-12 kilogram, there may be a plateau. But maintaining the course will ensure further loss. Aim for two kilos more than the required target line. Once that is attained gradually change to normal diet. Do not overfeed. The change in your habitus will be pronounced and easily notable, that people start to recognise the difference. The appreciation you receive and the improved confidence about self-image will be sufficient to make sure you don't over feed.  Reading on how your favourite film stars and models maintain their shape can also be motivating.

Binge eating or partying once in a fortnight is also recommended with this regime. It can also be avoided if you think it is a hindrance to the divine course of dieting. But in my opinion this will help to be in control and make sure that you can resist the pressure of over feeding once the target line is touched. Once the excess fat has been churned out of the system, you can start pumping in muscles with some extra protein supplements. Still one has to make sure that the carbohydrate and fat intake is not out of the limit.

This article has contents which may be described as ‘pro-anaemic’ or ‘pro-bulimic’. Most of the film stars and models who maintain a great physique had followed at least a part of this regimen. Nobody is born with muscles defined to each fibre or body shape for size zero. This is a choice to be made, a choice that can change your life. Before I finish I have to remind that having a great body is not a reason for ultimate happiness nor defines a successful life.  It is all about the person and how much good at heart you are.

The phone that never hangs

            Mobile phone has been a sincere companion of human being since the beginning of 21st century. Earlier it could be afforded by billionaires only, later millionaires, middle class people, students and eventually all class of people. This transition took place in a period of 10 years. No other product of modern mankind have percolated so fast through all layers of social strata.

           My first encounter with a real color screen phone was in 2003 when my classmate brought it. My family got a phone within next few months which was a gift from my uncle abroad. Two years later when I joined for Medicine, my brother who was a senior in same college gifted me a phone on my Birthday, My first personal phone. It was a Nokia 1600 with basic  functions.

           I had to wait two more years, the two years which has seen the fastest acceleration in releasing new model phones, development of phone as a multimedia personal companion than just a phone. The 'N series' by Nokia was viral. They got a new model with some new features every fortnight. I requested my Dad and he bought me my second phone and my first smartphone 'N73',with a Symbian software.

            With smartphones came the new issue. The more features it had, the slower it was. Not to mention the added effect of internet viral infections. Although the phone could do magic with its peanut sized brain and memory, gradually it became old. But I loved that phone so much. It is still functional with my Dad while I am writing this. He could not throw away what he got with his hard earned 16 grants.

             After two years came the Android era. It was the solution for the 'Quest for phone that never hangs'. One year later I also changed to the new stream. It was magical. Superfast phones with unbelievable free softwares. A software for anything in the world. And the phone froze at a rate of once a year only. It was the days of Samsung.

          It is now almost three years since I started using Android. It still works fine, but the hanging rate has increased and one has to get a new phone with bigger processor to keep up in the front line. The Nokia is now playing both cards, Windows and Android. Samsung is almost done with innovations except for releasing phones with bigger RAM at a cost of Fifty grands and the Chinese phone companies are now infecting the market virally with their cheaper and 150 percent cost benefit phones.

          What probed me to writing this happened two days back in our OT changing room. The Anaesthetist was telling he is going to get a Windows phone. I asked why. He replied "Thats the only thing that never hang these days"

Roads in life

             When i have titled this 'Roads in life', I mean in literally. Its a  wonderful thing how important the roads and streets in your life. Everybody has memories attached to streets and lanes they know. There is always a specific street or junction or an avenue where someone feels secure, free, emotionally full or happy. Nobody can forget the places where they spent their childhood.

              Whenever I hit my home, I like to ride cycle or bike or take a bus to the place where I spent my childhood and school years. I know every nook and corner of those roads. Even the footpath slab seems familiar. Its also a fact that when you are small you can see them closely and moreover you have the time to watch them especially if you were walking holding the hand of your mom.
             
                Also during school days nothing is better than having a bicycle of your own and the free will to roam around. You will be familiar with almost all places around including the dead ends. I have my own favourite coffee shop, sweet shop, park, garden all well clear in my memories.
Also I have noted that all your bizarre, weird and normal seeming dreams are located in some of the familiar streets or places most of the time. There is nothing that can signify nostalgia than going to a place where you lived and sit there and ponder.

                A rather interesting thing which prompted me to write this is that how new roads and lanes become part of your current or new life. The feeling when places that were totally alien, streets that were totally confusing, roads with unknown bearing become part of daily life. The feeling when you start loving the  same roads which you cursed for making you unable to reach the home. The sign boards which you strained to read becomes familiar that you never mind it. The growing knowledge of shops and stores around these streets makes you feel confident.

                Although we all know there is only one sun and moon, actually there is a different sun and moon for all places. When you live in a new place you don't know them. You don't know which direction they rise from and which direction they go, how bad sun is going to warm you. So you cannot find that friendly guy whom you could look for directions when you are lost. Instead there will be always a strange new sun staring at you thinking who is this new guy? But later as you get familiar they also became friendly and start helping you. In the congested dyspgenic streets of Delhi I see the moon very rarely.

         There are also streets where you want to be at least once in a lifetime and never in a lifetime. I dream of that avenue where I am going to have my dream home. More roads are waiting for me ahead which will enter as a strangers and going to be family.

The most wonderful thing in this world 17/7/14

I think this gift by God to the living beings is the most wonderful. The gift of ‘good sleep’. I am writing this at 4 am in the morning after a straight 8 hours sleep and I have got two more full hours left. I have been so strained and sleep deprived the day before. So right now I feel fresh and full of energy.

Till now nobody has been able to decipher the sleep and dreams. Somebody has tried to correlate it with something, but the true meaning is still a mystery. What a weird dreams we have during sleep. Sometimes I can think of recently happened events or thoughts which has led to those dreams. But the way a dream progress is really unpredictable and most of the time it contains unconventional thought process and actions. Maybe that was supposed to be the natural course of action.

Anyway I am not interested in deducing the meaning of dreams. Trauma centre posting is going on. Done with dressings and the attitude of consultants there.

This is not a holiday destination

                    Life was going awesome in CTVS. For the first two weeks I took leave for my cousin’s marriage. The net two weeks I went to the department. But the welcome was rather cold. There was more than enough people in the OT room since it was the vacation time. I got to assist the cases twice or thrice, but most of the other time I was an observer.

                   Then I stopped going to department. That’s when life was awesome. Wake up late, regular gym, FIFA at night, reading Sabiston and above all I got a new keyboard. Then one day I got that uninvited call which I was expecting. A memo from the HOD of CTVS for the missing residents.

                   So as usual we went to meet HOD. He was really infuriated. That’s when he asked “Do you think this is a holiday destination?”

FIFA world cup and life

           There are various thoughts on how the life of a person is staged. Some says life is divided in intervals of 7 years, the climacterics. But according to Rajnikanth it is 8 year segments. But for me and most of the People who are FIFA world cup lovers it is four years.

        

                  Like many others I am a football fan who expresses it only during the world cup. Football is a beautiful game. It is a sport which demonstrates skill, stamina, group work, tactics and hard work. The game extends for a convenient one and half hours. But the best part is if you can get three four guys and a football, you can play it anywhere. Such a universal game.

               

                   So the point is that, the FIFA world cup is associated with a lot of memories. Each time I have been at different places during last five world cups. So when I see a world cup it induces a nostalgia, and at the same time a chance for look back into last four years.

The election results 2014

                I am not a keen follower of politics. But we cannot live without knowing some basic things. Even if I try to avoid these basic things, something will be instilled to mind forcefully by the media and daily personnel conversations.

                Sri Narendra Modi has won the parliament election unanimously and the NDA government will rule the country for next five years. It gives me a mixed feeling of hope, joy and respect with a pinch of fear. The way he won the election with a monstrous majority and his determination earned my respect. The fact that India is able to coordinate and conduct such a big election brings my joy. Last ten years of UPA government was good, but lacked some spirit. They had enough time to change the country. But there was no out of bounds progress. I hope the next government will do something about it. Lastly the reason for fear is related to religion. Even though the government may uphold secularism there is a chance for religion based riots. I hope the inner peace of our country will be maintained and we may forward through the path of progress with this new government. 

Boiled spicy chicken wings

              Recently I have been experimenting with cooking. This is an easy way to prepare chicken wings 100% oil free. Things required are listed here.

     1. chicken wings 500g (9 piece)
     2. ginger garlic paste
     3. chilli powder
     4. turmeric powder (very little)
     5. pepper powder
     6. salt
     7. sliced onion and green chilli (optional)

  Mix all these add ingredients half a teaspoon each for 500g chicken , keep for half hour, then add 250 ml water and boil for 25 min on medium flame. Add more water if it gets dry.

(at 600w if induction cooker). 

Transporting cycle on a flight in India

               Here I would like to share my experience of transporting a cycle with me in a domestic flight in India. I traveled from Kochi to Delhi. I tried to dismantle my cycle ( Hercules Act 110) as much as possible so that the luggage will not be over sized. Anyway I always had the backup plan of sending it in train if the flight authorities deny.

               I got a cardboard box and two extra axles from a cycle shop. After dismantling the cycle, I cut the extra space of the box. After packing the size was about 130 x 70 x 30 cm and weighed 18 kg. The Air India airport staff were kind enough to give concession for that extra 3 kg. Also they gave extra care to the package on my requisition and applied a ' Fragile' label on it. Fortunately there was no damage during transportation. 

The package

The Fragile label for extra care

Side view

Security checked

Parts brown taped to prevent rolling around

Out of the box

Tire off rims to decrease box height. 

       Tires were removed from rim so as to decrease the height of the box. Also the tires were placed at sides of the frame inside the box for extra cushioning.Some extra foam was also kept inside the box over sharp parts and rear derailleur.

         Front and rear forks were fixed with extra axles to prevent distortion. All of this dismantling can be done with minimal tools. 15 no spanner and L keys of two sizes. A star shape screwdriver is optional and I used a flat screw driver for fixing tires over rim.

                                                                    

 

Minimal tools 

Final product 

The Prodigal son

 

This is an inspired painting. I am not so proud to say that, because the painting is very amateur and the inspiration is not a good one either.

We live in a congested area filled with apartments. There is an old lady living across our room. Her room have one door and window opening to the street. There is a wooden chair covered with old cushions and pillow in front of the room. Her relatives live on first floor. There is no much contact between them. Usually she spends her day sitting on that chair if the climate is good.

She has a son, a prodigal son. He is a drunkard, probably with psychiatric disturbances. Nobody knows what he does for a living. He wears shaggy clothes, sometimes a jacket. He comes in the evening and bills gates his mother. This may go till next day morning. Whenever he start abusing her, she gets into the home and shut the door and window from inside.

Rarely have I seen them talking amiably. Even then she will try to keep the distance. He will sit on her chair and she will sit inside the room. She may serve some tea and biscuit through the window. Then he will have his tea and talk to her through the window.

I never understood why is he infuriated against her and I never tried to. Also one day when he was yelling at her, my roommate who was trying to study then, went to him and shouted in some strange language. To my surprise he left the place. And the roommate never explained what he told him in spite of my repeated requisition.

The prodigal son

The Wikipedia doctor meets the Wikipedia patient

In these modern days in which everything is available on internet, the case of medical knowledge is also not different. Even me, a resident who is supposed to read original literature from big fat books find it easy to Google it.

I am not ashamed to say it, but I have become a big fan of Wikipedia. Even though I am not sure about its accuracy, it is easy it get a superficial idea about a subject from it. But I have to assure you that it is just literature. The real skill of a doctor comes from practice and not by literature alone. So definitely it is not going to be a substitute for doctor for treating illness.

Sometimes you get irritated by patients who come to you saying” Doctor, I read in Wikipedia that the medicine you prescribed is effective in only 5 percent of cases” or “the treatment option you suggest is a failure in fifty percent cases”.

Once a father of a boy asked me to comfort his boy suffering from hydrocephalus who was being taken to operation theatre for a shunt placement. It was his third surgery as previous two eventually got blocked.

So I asked him “why are you so worried? You have already undergone two surgeries and you know the usual procedures.”

He said to me “I know. But I read in Wikipedia that this surgery is associated with fifty percent chance of getting permanently paralysed.”

But he was smiling. I thought to myself “brave boy”. He recovered uneventfully from surgery that time.

Another time a young gentleman came to me when I was in Emergency room. He was having some intermittent pain or burning sensation in penis or sometimes in abdomen at some nonspecific points. All this started in two months and only factor I could pick out is his marriage was fixed around the same time. He has already undergone ultrasounds of abdomen, scrotum, urine cultures, microscopic examinations and NCCT abdomen, which were all normal. Then I assured him, “don’t worry, you don’t have any serious illness.”

Still he kept on asking “What is the reason for this, there must be some reason for these symptoms.”

The only thing that came to my mind then was “You can try searching in Wikipedia”

Relationship status " committed"

This is a typical example of how a man changes when he is engaged. This is my friend and roommate, a doctor and physician in making. We are also partners in crime, if downloading with torrent is considered illegal in your region.

Before his engagement whenever we opened his UTorrent app, we could see hundreds of hard core porn queued. But after his engagement with this beautiful girl, who is also a doctor by profession, he was most of the time glued to his phone and seemed to forget his laptop.

One day I found him with working with his laptop again. Curiously I peeked, you know what I saw; “one hundred heart touching romantic songs” being downloaded and all the porn were gone.

Dietary advices to avoid recurrence…

 

         This happened few days back. A college girl and her boyfriend came to Emergency Room. She was having nausea, vomiting with bloating and stomach disturbances. Just to mention she had her periods recently, regular and normal. She had taken food from a street vendor some hours before the onset of symptoms. Most likely diagnosis of an Acute Gastritis was put forward and she was treated accordingly. She got relieved after some time.

While prescribing some oral medications the senior resident told her “Please avoid food from outside. Try to stick to home-made food and purified or boiled water.”

Next question from her boyfriend was “Can she take some ‘Fanta’ now?”

Senior resident “!”

Sunny Leone and Mangoes

 Now a days, I cannot live a day without hearing about these two. No news media is complete without Sunny’s name it. What to say, Sunny Leone has achieved 2^nd rank in Times Celebex in April 14. A giant leap from previous position over so many hot girls of B town, including Deepika.








            Mangoes, this is the season of it. But the news is that European Union has banned import of mangoes due to some quality problem. This may be in effect till 2015. The result is mangoes are now available in local market for far much less price than usual. Media is also celebrating it, the various ways to make use of mangoes. Some even think it’s a sign of victory for AAP in ongoing elections. (Mango people party)

Back to Sunny Leone, the latest news spread is that she has performed a strip dance for 4 million rupees in a private party. Pictures are also available for proof. I have no enmity to her. But what makes her so expensive. Yes, the culture, the mere fact that it is difficult to find a similar woman who is daring to do such tasks. So I think Sunny should be thankful to rest of the ladies in India for making her popular.

The simple principle of Economics: Decrease in availability in market will increase the price and vice versa.

Anaesthetist vs. Pathologist

 

Today an Anaesthetist came to review one of my patients. I have to say, she was so hot! When I look back, I can remember so many Surgeons pairing up with Anaesthetists. It may be due to the mere fact that there is more chance of meeting between these two specialties.

Once my senior resident told me. “It’s better for a Surgeon to stay away from an Anaesthetist. Because if a patient sucks up on theatre table, you can blame on Anaesthetist. But if you marry a Pathologist, she will always cover for your resection specimens. Secondly the nonclinical doctor will have more free time for you.”