The never ending sleep

 

I don’t know what to put as a title for what I am going to write. Today morning I was greeted with the death news of one of our patients who was admitted in the ICU. He was a young guy who just touched twenty. An undergraduate student. He was having a normal life till one and a half year back, when he started having bowel symptoms predominantly constipation. Sad to say, none could treat his illness nor find what it is. He died without a diagnosis. He had underwent multiple laboratory and painful tests in this period and finally he ended up in our casualty with complete bowel obstruction.

***scene 1 ***

While trying hard to approximate and close the laparostomy wound on his soulless body, I glanced at his face. He was looking peaceful. It made me recount my first encounter with him while he was alive. He was in agony, he wanted to get rid of the giant nasogastric tube stuffed in his nose. His abdomen was hugely distended and I could see his bowel creating ripples on it.

***scene 2***

“Why can’t you help me to clean this bowl? Whom do you think you are…?” my senior colleague was shouting at the nursing staff, he was at the brim of a breakdown, taking part in surgery after continuous 48 hrs strenuous duty. The male nurse refused to help him with the big bowl which was overflowing with stool removed from our patient. His large intestine was the size of a trumpet and completely filled with semisolid and solid stools which had to be removed. The staff wanted the orderly to come to clean up the mess.

After taking part in his first surgery, I was happy that I chose to become a surgeon. We has made a diverting stoma which we believed to help him out of obstruction and agony. I was proud that we could give him the relief from symptoms, which he could not get from any physician. I was confident in explaining what had we done to him and how it is going to help him after the surgery to his sister. His sister was a well-educated girl. She cared so much for him.

***scene 3***

My colleague who was in charge of his bed for most of the time, told me, that his sister was grabbing his hand and not letting him go after her brother’s death. She was accusing us for doing those procedures, which ultimately relieved him from this world. His father was crying, he was recounting how dearly he looked after his son. The second surgery was done when his abdominal drain started showing pus, which was not expected. On second exploration, we found he had developed perforation of bowel at another site. But his body system had already been crashed that, he never made it to the normal physiological mode after second surgery.

There are things which are hard to explain. Like the loss to that family. The way his dreams were crushed. His eyes were vivid, it said he wanted to live. He wanted to enjoy life. He never have thought that it was his last journey from home, when he left to the hospital that morning. His sister had hope. She believed we could save her brother. But what happened was not expected. But somewhere in my mind I can recollect his face, after the first surgery, telling me he is feeling better.

The surgeon

         My friend and colleague who was actually fond of medicine, but now in the profession of cutting, always tell me that surgeon is an extended physician. A step forward which makes them eligible to cut open and repair the living body. Two years has passed since I joined for surgical training. As I stand at this point, celebrating the new year, somewhere I felt a little pride to be a surgeon.
      
        Surgeon is bestowed upon the permission to operate on human beings and relieve them of their suffering. Well it is not right to say that surgeon treats the disease or eliminates it. What he do facilitates the natural process of healing to take place. Basic principle of surgery whether it be small or big is, removing the dead or diseased part and realign the rest, so that they can stick together by nature's way. Even though man has been able to go to moon and come back alive,  he has not been able to understand the life force. There is no wonder, the people thought life is a power or spirit which is invisible. Even now, when I watch a patient die, I feel that some force or invisible spirit gets evaporated. Like the flickering of a dying flame.

     Surgery is an art when it comes to operating. It includes well planning, judicious selection of patients, procedure and instruments. Like a well trained and talented orchestra, it flows out like a symphony in the operation room. But what makes a surgeon is the follow up. The experience and analysis of the operated patients adds invisible power to the surgeons clinical skill.

     Surgery is medicine when treating patients. The surgeon has the access to all the medicines to keep his patients free of symptoms. But some times patient does not get symptom relief just by medicine and the radiological eye gets blurred that they cannot find a cause to reason the symptom. Then comes the call for surgeon, to open and see what is happening inside. Some times surgery is the answer.

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.