Weird dreams and some retro

               After a very hectic week came the day I was expecting for last 3 months, I am going to my home and I am writing this sitting at the waiting lounge in the airport. Need to mention in this last week, I dreamt twice of missing my flight home. At the first instance I was late and by the time I reached the gate of airport, the plane was locked and ready to fly. The second time was stranger. Hanging with my work colleague, I reached the airport late, only to know that the flight was cancelled because there was a fire in the plane. So ridiculous are these dreams.

               Left with nothing to do, other than staring at other people waiting with me for the flight, some childhood memories just passed through. How joining the medical field gave me some new light on some misinterpreted facts of past.

 

                There was a physical education teacher in our class when I was nine. She was a well-built lady with more than average height. The catching feature was her left arm was bulkier than the other. She used to take us to the ground and teach us warm up exercises and Physical training drills. I and my friends believed that her arm is bulkier due to the extra exercise she does with that arm.  I still remember those days when it used to rain outside, we had to sit inside the class room pondering at her big arm. May be memories are getting fader, or I am adding extra tones to it, but she used to look dull and may be depressed.

                A year or later she disappeared. I had already moved to Upper primary and we had another Physical education teacher, although her absence on PT ground used to strike me. Some more years later, the news waved through the school that she passed away. She was suffering from cancer. Now looking back, I guess she must have already been operated for breast cancer years back and was having lymphedema which we misinterpreted as a muscular arm.

"If you want to have a sound sleep at night......"

      "If you want to have a good sleep at night......" This is a very common idiom used by surgeons when they advice a colleague or teach juniors. Usually this is completed by something like "...you have to doubly ligate the vessel" or "....you have to over sew the staple line."

       So what is this that is going to impair the sleep at night? The fear. Surgeons' sleep is crippled by many things other than just fear of medico-legal issues. My Senior consultant often says that he could not sleep well before the day of a complicated surgery planning and thinking on how to tackle it most effectively. Since I haven't started doing any major surgery under my own responsibility I never had gone through such situation.

       When some big shots get admitted, sleep is deprived for all the persons on duty irrespective of hierarchy. Because big shots come big responsibility and every five minutes some one will call either to know about progress or some trivial things. Another stressful situation is when some relatives or people from our own regional area get admitted. We are influenced by so many things and we want to make them feel contend.


         But the one I have felt is when we operate a patient and his or recovery gets deviated from the normal course. This is the most difficult situation. It get worse when the recovery depends on time and the clinical findings are such a way that everything is inconclusive and you don't know whether to operate and over treat or watchfully wait. This is time where one wish there was a  person to advice. I have got my senior consultants now and I feel protected. But when they get similar problems, they get their equally experienced colleagues to involve and help them. This is the time when a surgeon ask for opinion from every one, including the juniors, residents on some input that could be useful. The time for some one to support. Sleepless nights become a common story then.

        I know that this is a risk associated with surgical field. A plastic surgeon may be worried of the flap viability,  A vascular surgeon may be worried of the leak, A thoracic surgeon may be worried of a broncho-pleural fistula, A gastro surgeon may be worried of a anastomotic leak. But as a part of training, the surgeons will acquire the acuity to ensure things that has to be done are done during surgery, so that they don't have a problem sleeping at night.
      

Knowledge do not come free

       "You have to earn bread with the sweat on your forehead"

 

 

              Recently our department conducted a one day work shop on thoracic surgery. It was a very useful program especially for residents. Since our unit was the main pillar of the program I was in charge of the audio visual co-ordination on stage. Well the nothing but collect the power point presentation from the presenters before hand and load it to the main computer ( that's my Angelina Lignocaine ..lol ) and maintain the continuity of program.

 

 

             So after the symposium residents were approaching me to copy the presentation. I have also done the same thing so many times, copying and saving stage presentations. But the when I think back, these thinks seldom become useful. Most of the time they get pushed back and back to some corner of the computer and never ever opened.

 

            Even if some of the presentations are opened and read they wont add much to the knowledge. It is actually the knowledge of the presenter that is imparted to the audience and the presentation as such does not give any advantage. Only time when a Power point presentation has helped me is when I prepare it. Then I know what the resources are and the idea conveyed in each slide.   

 

 

        So when I see this people roaming around collecting Power points, It comes to my mind

"Knowledge has to be earned with the sweat on forehead" There is no way to acquire knowledge other than the hard way and knowledge is converted to wisdom by experience.

 

        In this occasion I also remember how I started my presentations. The first one was in the anatomy hall, with hand drawn charts. By the second year we used to have Projectors and OHPs. And gradually came the era of computer presentations, bulky projectors and power points. After all I still feel the control you have when you present with a marker in the hand on a white board is the best one.

Habits

           I don't believe and I haven't met any person who loves to come to a hospital, whether as a patient or a staff. Even as a doctor, I am not attracted to hospital. Given a choice I would prefer to stay away from all those sufferings and be in a place where people come for peace and fun. It is true that there is always a heaviness in the heart while going to the hospital and feeling of lightness while coming back.

          There are two ways to reach the hospital building in our campus, one is straight ahead to the hospital building and the other passes between the library and auditorium. Somehow it has become a habit to go through the one straight to the hospital while going for duty and coming back through the other one. I thought it was just me, But no. Once the passage in front of the library was closed, and my senior colleague was looking slightly sad while going back. I asked why, then he said he also prefers to do the same.

       After all it might be just a display of predisposition for Common Wealth nation citizens to keep left on road.

The way straight to hospital complex

The way before library

Delhi has a weird winter!
 

 

Ego - The inevitable evil

           What I am going to share is something, everyone who has done a government job will understand. Not just a government job, any job for which you are paid without any feedback from the clients or any job which is not paid but done on compulsion. The ego, it is an inevitable part of human nature. It can be observed from the lowest level of hierarchy to the highest.

          Now a days I sit along with my consultant in the Out Patient examination room. I take history , examine the patient and discuss with him and take decisions. He is a very cool reasonable and experienced surgeon. More than just being a good doctor, he also have good observation skills and he has a great knowledge of human nature.

        One day a patient came to our room, he had a long standing perianal abscess, left untreated, it had become a painful collection. He needed a drainage of the collection. When we see patients who need minor surgical procedures on the same day, my consultant advices me to do it myself after the OP time. Other wise there are residents junior to me in the Minor OT to do these procedures.

       So I asked this patient to wait outside the room till the OP ends. It would take at least two hours for the OP to finish. But you know, patients are the most impatient. His wife came twice, to ask me how long they have to wait. I told them to wait till the OP ends. The third time she came, I was seeing the last few patients. Again I told her that they have to wait. Then she asked, whether I am going to one more hour? I didn't give a clear answer.( I was thinking, It is their problem to get drainage done, How they dare to ask me time?, Why cant she just see that OP patients are still waiting outside the room) I asked her to wait till I finish ( not in a soft voice). But after five minutes I was done with the patients and came out, but they were not there, I waited for another ten minutes. But they did not appear.

        After a moment I was feeling bad. This happens a lot of time. Why couldn't I speak a little more soft to that patient, why do I expect people to wait for me, without an explanation. Why do we take it granted that, as a doctor we can act bossy over the patient. It is not just the doctors, any employee in the hospital has this attitude except for very few. If the person sitting at the counter is playing 'candy crush' on phone, he will make the patient wait till that level is over. If the patient take an appointment for ten and reaches the counter at time, his card will take another half an hour to move and reach the doctors table.

        I don't think this is an easy thing to change this nature. To have control over ones ego and keep tight, not to loose the cool is a great character achievement. But this knowledge of human nature is essential. If you ask a office clerk 'can this be done', the first reply will be 'no'. But first 'no' is never the final answer. You have to probe again, why not, who does it, why you want to get it done etc. Then you will get a tip to how to start moving things for it. Now this is one thing I learnt being on both sides of the table.

 

"Sir, Please operate me" - We operated and then...

          
         Last time I mentioned about a young lady who desperately wanted to get operated. Our senior consultant was withholding the surgery in view that her imaging findings were too trivial to cause such severe pain, and we calculated that the dearth of surgery would be more painful than what she is suffering from now. Any way she was persistent and finally got operated.

          What we removed was a capsulated collection of thick paste like a dermoid, of size of a thumb attached along the chest wall, we also had to remove a small piece of rib to allow proper access to chest cavity. It was also noted that it was attached to a thin cord like structure, doubtful whether an entrapped nerve or just a thickened parietal pleura.

         The bottom line is she is happy now. Every day we ask her one question, "how is your pain?" and she says, she does not feel that kind of pain she suffered earlier, but just the pain of surgery. She seems very reasonable and she says she can feel difference between both kind of pain.

         It is difficult to generalise, but sometimes patient is the guide, and one has to believe blindly and hope for the best. I remember my zoology professor who used to instil in our mind that biology is the science where 'there is an exception for everything' is the rule.