Friday, May 24, 2013

Infectious Doctors: The stethoscope and the white coat



Should we really wear stethoscopes around our neck while on street? There are sufficient infectious agents looming about in our premises (in different forms, indeed, some walk, others fly, some inanimate); so is there a need to drag extra ones from the road? I think it would be better to avoid stethoscopes while you walk to a bus stop, or the Indian Coffee House!
With regard to the white coat, opinions vary though! More than serving as a source of infection, the thick white status symbol drenches poor docs in sweat in our mostly-non-air conditioned hospital. But it definitely is a blunder to wear a white coat all the way from home to the hospital, or whenever you are out of the hospital, be it a walk from the college building to the hospital. The public, I feel, have every right to question any medic or paramedic they find on road wearing a white coat. We are already part of a heavily compromised set up. Why should a doctor (or a paramedic) stroll around, ‘imbibe’ all the dust on to his coat and walk into the hospital?

Here's an excerpt from a BMJ article: 

History of the white coat

Doctors adopted the white coat in the mid-19th century to restore credibility to a profession that had been damaged by scientists, who had proved that many doctors’ remedies were worthless. Looking to associate themselves with science, doctors adopted the lab coat as a sign that they could be trusted to provide cures that were effective and backed up by the latest empirical thinking. Although lab coats were originally beige, doctors decided to choose white because it represented purity, holiness, and cleanliness. Hospitals were becoming places of healing rather than places that people went to die, and the white coat symbolized this.


References: 

Microbial flora on doctors' white coats http://www.ncbi.nlm.nih.gov/pubmed/1773186


Saturday, February 16, 2013

The Lady who killed a Crab

(Sobhanacharitham Onnam Khandam)




Amma wins her battle against cancer, at last. 1.5 years of distress ends (at least transiently). Thanks to God, Dr. V. P. Gangadharan and his Team at Lakeshore (hugs to Dr. Anupama ma’am, high-five with Dr. Arun Sir).

I still remember the moment when Amma rang me up and said, ‘’Da the report says M Band present…is that something to worry about?”. I said with all the courage left, “No Amma, nothing serious.” The diagnosis of Multiple Myeloma changed the entire course of our life.  What followed was a marathon of agony and depression. Being a doctor, being a son, being a bystander…never before had I struggled so much. Amma was determined to fight this crab off her body. She learned the A to Z of her disease; nothing could be hidden or manipulated. But she did ask me a couple of times, “Da will I live long enough to watch you grow? I don’t want to die before your marriage…” I would joke, “Kollam…avasanam thonnooru vayasuvare okke jeevichirunnu menakkedavallu” (Great. You’d live long...better don’t make it over 90 or 100!!!). The real answer however was, ‘I don’t know amma’.



She is one hell of a fighter. When the doctor drilled her bones and asked, “Does it hurt too much?” she said, “No, it is okay”. At times when I miserably failed and reached the nadir of depression, she’d try sitting up, pat my head and say, “Illeda, enikkonnum pattilla. Nee dhairyamai iri” (Don’t worry dear, I’ll be alright).


Achan was a silent listener. He never talked with doctors or asked doubts. Behind his mask of iron will and courage, he was just a child weeping all the time. He would ask me secretly, whether things went well. Sometimes I said ‘yes’, at other times ‘no’. He was in charge of Amma all the time; I have barely seen him sleep adequately during the past two years. He took charge of the kitchen; never let me hire a home nurse. During stays at the hospital he would always ignore the expensive hospital canteen for himself, but never let me or Amma do that.


The initial days following diagnosis were the worst. I repeatedly cursed the physician who misdiagnosed Amma’s illness, for not having taken a simple plain X-ray that would have allowed an early diagnosis. I would stay inside the hospital room with my parents, I would then get a call. I would sneak out of the room, start explaining Amma’s condition like a recorded message. By the time the call ended, my face would be wet, eyes red. Then I would walk searching for tap water, clear my nose, face and return to the room as if nothing happened. Nightmares became a part of my life. So often did I see my Amma lying motionless in dreams that I finally began to fear falling asleep.


Bad news kept on walking in at every point of treatment. The orthopaedist referred her to the Dept. of Oncology, Medical College. I hoped that the Pathologist would confirm it to be a cancer in its initial stage. But things were always bad. Radiological studies and pathology reports revealed that had we delayed further Amma would’ve lost the power of her legs. My Aunt, a Radiotherapist, rushed to do what was required to prevent a vertebral compression. Chemotherapy was initiated after discussion with the Regional Cancer Centre Trivandrum. But all drugs, based on the latest protocols, failed to bring her cancer into remission. The result of every serial bone marrow study turned out to be painful.


Days of admission at the Medical College were tiring and stressful. The diagnosis, admission at the pay ward, doses of radiation, initial confusion...all of these happened while I was doing my internship. I would run panting like a dog searching for wheel chairs, fight and shout at Nurses-in-charge for securing bone marrow biopsy sets (strange but true). There were times when I hid my stethoscope inside my pocket to avoid insulting it; for I would be pushing a handicapped wheel chair through the verandas, drenched in sweat. Sometimes we had to run through extra floors when one of the usual lifts were damaged or jammed (often done purposefully by lazy operators). I realised how tough it was for normal people (meaning who don’t work at that hospital as Doctors) to stay at the medical college as  patients or bystanders. There were hardly two nurses for two three floors of pay wards.

The RCC was no different. I climbed stairs up and down, ran hither and thither between labs. There were instances when various labs even mixed up results. These would have gone unnoticed if I was not a part of the medical fraternity (the non-medicos, beware).


The unnecessary and unwarranted procrastination and confusion at the RCC that drove in at the most unexpected times made matters worse. Amma’s condition worsened despite an initial breeze of hope. The imported-much touted revolutionary drugs (that saved lakhs of people) admitted their failure in Amma’s case. The expert Oncologist who was in charge of Amma all the time, explained to me the poor prognosis. I was shattered. He said it was time to switch to a new regimen. A question that he asked afterwards electrocuted my brain, “How is the patient related to you?” May be his patient load was too high for him to remember that it was my mother. I could no more leave my Amma’s life in his hands. Moreover, when you hear that your mother doesn’t have much time left, your thinking pathways fail.


I defied my Aunt who still clung on to the decision of RCC. My other relatives trusted me though. I managed to get an appointment with Dr. V. P. Gangadharan, and rushed to Tripunithura, Ernakulam. He flipped through the reports. After minutes of thought he broke the silence. “Nithin. The disease doesn’t have a complete cure, as you already know. But bring her, we’ll try all that we can."


I didn’t wait any further. Got Amma admitted at Lakeshore Hospital (Ernakulam). Reassessment was done. I did expect a miracle in the biopsy report since it was not repeated at the RCC during the past visit. ‘Bone marrow report will only be revealed tomorrow’, said the nurse. I used my contacts to know what the result was (Dr. Maya ma’am who had taught me Paediatrics at Medical College is currently doing her DNB in Gastroenterology at this hospital). What I heard was grave. Amma and Achan were eagerly waiting at the room in Oncology ward, the fifth floor of the building.   I climbed down the stairs, walked to the car parking lot, moved to a dark corner and cried like an infant. I checked a mirror thrice to see if my face was clear, and walked back to the room and said results are not ready yet.


Amma surprised me again when she calmly took the news (was terribly depressed though) from Dr. Arun. Dr. V. P Gangadharan (I’ll say Dr.VPG from now on) took control of her mind very well afterwards. The counselling he gave had a mesmerising effect. He smoothly eased the tension that we had. Never did he give us any false hopes. For the first time in my life I saw a new side of Medical practice, something that was beyond Pharmocology. The three of us did not have any tension about the disease afterwards. Even Amma’s diabetes and hypertension came under control. All that was left to be taken care of were the finances. With more than forty lakhs of rupees converted to medications and investigations, things were never good. We lacked any kind of health insurance coverage.


I actively entered clinical duties at a local hospital at Kollam and worked for more than 16 hours per day. Felt sad initially, since most of my pals were working hard at post graduate entrance coaching institutes. I missed the chance; skipped many of the examinations that I had registered for. But soon my concepts about life changed. I began to enjoy clinical practice to the utmost. Let me not expand this part of the story at this point of time and space (for it is cumbersome).


Months rolled on. The new drug regimen (different from what the RCC recommended) was physically energy consuming. Amma lost her hair (tiny news for me, but more painful than biopsies for Amma. Her previous medications did not have this side effect). One of the medications was to be infused continuously for four days through her veins. Meaning she had to confine herself to bed all the time (yeah, Amma was much better, could walk on her own, could do her personal stuffs all by herself this time). One of her peripheral veins (the ones in her hands) was literally burnt by the medications! This forced the Doctors to stab her neck (well, medically it’s called placing Central Venous Lines, i.e. using veins in the neck. Fewer side effects). By the end of six cycles of the new regimen, her biopsy yielded clean reports. She was almost free of cancer.


She was rewarded with a sixteen days long confinement in an isolation room. Despite the cost, the difficulty and risks involved, we were all happy to accept the final part of the treatment. All these were part of the only definitive procedure that could gift Amma a longer disease-free period of time. Amma, Achan and two staffs were sequestered in the highly sterile Bone Marrow Transplantation (BMT) room. They could never walk out of the room; newspaper, magazines and TV soaps like ‘Kumkumapoovu’ let them cope with stress!!! Stem cell transplantation is a process that technically replaces your immune system with a healthier one. The rejuvenating procedure involves risks such as fatal infections, since during the period of treatment the patient’s immunity would be near zero. I shuttled between hospital verandas and a relative’s house at Tripunithura, Ernakulam. My life was similar to that of what Tom Hanks depicted in Terminal. I spent most of the time at the hospital reception, reading a copy of ‘The Immortal Life of Henrietta Lacks’.


Arranging people for blood donation (in Amma’s case, stuffs were more complicated, her group was O negative. Blood is collected using a process called apheresis, different from the normal donation technique. This one takes more than an hour, requires healthier donors with prominent veins!) was tiring initially. Amma’s blood counts frequently crashed dangerously, requiring frequent transfusions. Timely help from a couple of pals and relatives eased the difficulty. One of the first donors was my own classmate, Manu Vincent. I also happened to meet a number of good souls who were willing to travel long, postponing their engagements. The 51 years old professor of Economics (Dr. Ajith Kumar) who donated blood for an eighty second time in his life was the biggest awe-factor during the week.


Blood Counts stabilized by the fourteenth day. She was shifted out of the ‘dark room’ (in her own words!) yesterday. My heart is lighter these days. Breathes fine. Feeling happy. Now I’ll have to deal with my other self. She was always there at the other side with her phone’s receiver, listening to me. Situations never permitted her to be with me in person throughout.


I wonder how long this happiness will last. Cancer is one villainous rascal who can spread its fangs anytime and return with vengeance. The Emperor of all Maladies has however been defeated by Amma, for now, or maybe forever. There were moments that made me believe in fate, in God (once again), and in the goodness of humanity. Responsibility, which was a heavy burden on my shoulders, now became a strange kind of fun. I rediscovered myself.

The ‘Sobhana, 56 years old patient, stage 3 Multiple Myeloma’ tag has anyway finally lost most of its validity.

Image courtesy: https://supermomdecoded.files.wordpress.com/2012/01/superwoman-blog-illustration3.jpg

Saturday, January 19, 2013

Nostalgia


Was refreshing memories, walking along my college verandas. Suddenly someone was calling me as I neared the Dept. of Anatomy . I turned back.

"Lecture hallil ninnu mungi nadakkuvanno?" [Sneaking out of the lecture hall?]

Felt so happy hearing that :) :)

I couldn't recollect the name of this ma'am...but felt nice,
"Ayyo...njan pandu mungeetha ma'am...njan 2k5 batcharrnu..." [Ehh..had done that long back ma'am...I belong to the class of 2005]
We chatted for a while...

Friday, January 11, 2013

Mammooty,Kajol, Lotus and Internet



It was 6.30 am, and I was sleepy. It was unusual for me to wake that early, for it's vacation. I rode my bicycle to the computer centre where I had been a part of vacation classes that were supposed to teach me Lotus 123 and a new program called Excel. The day was special, our tutor had promised to show us a magic.

Every eyes focussed on the monitor. A browser opened up, he typed in mammootty.com on the address bar. We waited for five minutes; a black and white hour glass was right in front of us. Then a page loaded up, it had pictures of Mammootty. The tutor then proclaimed with pride, "well I don't know these Malayalam actors much". He then typed in Kajol, and voila!...we were now looking at wedding pictures of Kajol.

"So children, this is Internet"
Next he showed us an e-mail. It had an 'attachment', a game that needed him to catch a giant fly on the computer screen with his mouse pointer.

I returned home, thrilled to have seen a 'web page', and yeah, Mammooty had one! (I was always a fan of this guy. Mammooty-Mohanlal fan clashes were common in our class room). I kept thinking about the advances that ride in so fast. 'Things have changed, why do they teach me windows 3.1 anymore at school?', I thought.


Well that was in April, some year...may be 1999 ( yeah, at school we were still being shown windows 3.1).

Tuesday, January 8, 2013

The death sentence



Some people are unlucky to live long enough to suffer all the tragedy that life can hold. 'A life sans health is not really worth living', I often hear this from my patients.

I was notified about the arrival of this patient as soon as the ambulance started from his home. The hospital staff knew him as a regular inpatient. Everyone knew that he had suffered enough. His relatives were convinced that only death could save him. He had presented now with a failing heart. His medical history revealed too long a list of ailments that a mortal can suffer. Yet I found it hard to keep him at the emergency room and do nothing, watch him die. He was gasping, loud. Someone else within me walked towards his son and said, "his condition is bad, and I know your situation; but I can't let him stay here and await his death. I am taking him to the I.C.U". After thinking for a moment, he said in a depressed tone, " do whatever is needed". He returned to his mother, an old lady with a mask like face.

All the life saving procedures were done as per protocol, and he improved. By dawn he was stable. Before signing off my duty hours, I enquired the I.C.U staff about his status. The news, that he was coping well, did not gift me the satisfaction that I normally get when I hear that someone was saved. Did I err by extending his period of suffering on earth? He lived, to die another day.

(Image credit: Blaklyon)

Sunday, January 6, 2013

The Magic Lamp


Something's terribly wrong with the world and I'm perfect.
The world's perfect and something's terribly wrong with me.

The possibility of one of these statements turning out to be true equals my chance of getting satisfied with a rather challenging yet prosaic life. I wonder if it is normal for a guy who is as old as twenty five or some one like me, as young as twenty five to search the night sky for answers when he is aware of the fact that it has nothing more than asterisks to offer.

Now isn't that a lamp? Holy cow! The famous magic lamp!
I rubbed it hard, real hard...Rubbed it again.
Finally, here's the Jinn.
Jin: "Aye Master...one answer, that's all that I'll give"
I : "When will the world end?"
Jin: "Oh! Man is not supposed to know that. Something else?"
I : "Nothing's working for me these days. Feeling screwed up, absolutely screwed up. So how do I fix things?"

Jin thinks for a moment.
Jin: I'd better tell you when the world would end...now that'll be a secret okay? Shhhhhhhh