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Thursday, November 03, 2005

Penile Penalty...

Anyone who considers laughing at other people’s miseries distasteful may stop reading this right now…All the other’s who can afford to laugh along continue!

This happened in the morning when we were relatively free (Yes, sometimes we are free in the morning). A call came from the casualty for the on call unit (not us) for a patient in severe pain and the call book read exactly this, “C/o Rope tied around penis”. My first instinct was I’m not on call, go find the doctor who is.

As all good things are realised a little too late, my batti also jaloed after 5 mins and as expected my evil side took over and I just had to see what the hell a guy was doing with a rope around his penis? I headed over to the casualty, considering the various possibilities all the way there! Maybe this was a novel way of committing suicide…Just imagine trying to kill yourself by hanging from your penis. It’ll kill you all right!

Anyway, I reached there and started looking for a guy with a rope tied around him, but I was hugely disappointed because there wasn’t a rope in sight. All was not lost though, because I found the guy, only it wasn’t a rope, it was a very strong piece of thick thread tied securely around the base of his penis!

Now, I was bored and this seemed a nice way to pass the morning till my bosses came for rounds so I went up to the guy and started asking him the most annoying questions. What happened? How did you do this? Why did you do this? For how long? Etc etc.

This guy surprised me by giving me the most absurd explanations for my questions. He said he tied it because mosquitoes were biting his penis (hehehehe) and the thread would keep them away. I asked him how that would be achieved, would he be using the rope to lasso the mosquitoes or use it to swipe at the mosquitoes with his penis. Agreed it was very rude of me to say so but come on, you don’t lie to your doctor, especially an intelligent one!

To top it off he says he had it on for 5 days! His penis was really swollen and the thread had begun to cut through his skin so I stopped being nasty and asked the other unit to come ad take over, but not before I took a pic of the great specimen.

I was thinking of putting it up with this but I thought it would be best to wait and see how many of you really want to see such a gruesome picture so post your comments and if demanded the pic shall be uploaded!

Till later.

Tuesday, October 18, 2005

Get Laser Surgery Done Now!

I keep telling myself I shall not write degrading things about my workplace anymore but they leave me with no choice.

Before you read any further you have to take a solemn oath not to tell any health regulatory authority about this incident.

You will probably find this very very kathin to believe but I swear its true and it happened today 18th October 2005 around 12.30 in the afternoon.

Dr. Broadwalk and I were operating this case of undescended testis where one of the guys balls failed to come down to its correct location and consequently was lodged somewhere in his abdomen. What we do in such cases is usually mobilise the poor thing and try and get it back into his scrotum before he develops a tumour in it and a lemon turns into a melon!

So we open this guy’s abdomen and find a hernial sac there (which is quite common in such cases) and try and separate the sac from the cord structures (Sid and Abhi probably understand this better than the rest of u) so that we can pull his lost 'life-giver' and try and get it back down.

We’re working away trying to get it done, we open the sac, pull on the gubernaculum (this is an actual structure and it is as weird as it sounds) and find the misplaced ‘nut’ inside the deep ring (let it be…it’s just a thing we have in the abdomen) and pull it downward.

Now, we’re trying to mobilise it further because it’s come up short! Bole to, it’s just about reaching the scrotal entrance which is not good enough. So, Dr. Broadwalk tries to free some adherent structures around the gubernaculum and has to free some vessels in the process.

Unlike what you may be thinking right now, we did not end up tearing any vessel. Something much worse happened. Brace yourselves….His glasses fall right into the abdomen!!!!!!!!!!!!!!!!!!!!!

I’m not joking, lying, imagining, nothing! His spectacles are lying there on this guy’s ‘gonad’ exposed to blood and tissue. For a second or two, nobody moved or said a word.

As any good story of mine, this one is not over yet….Dr. Broadwalk (B.M.C. Employee of the year this one!) now removes his gloves, proceeds to pick up his glasses, puts them back on (Ewwwww), drops some spirit on his hands, wears a pair of new gloves and continues with the operation!

I have nothing more to say. I’m speechless. I’m flabbergasted. I’m so many things you guys will never be until you enter an operating room with this guy.

Tuesday, October 04, 2005

Midnight Walk Through The Graveyard!

OK something like this can only happen to me or with me or for me or whatever.

Dr. Shaikh and I were forced to take this patient who required an urgent CT Scan and neurosurgical reference. Now by the time we got there it was around midnight and we finished transferring the patient by about 1. The ambulance had left so it was up to us to go back and none of us wanted to spend too much money on a cab (ricks don't go upto Sion hosp.), we decided to take the train.

I think it was the last or second to last train and unfortunately for us it was going only upto Kurla so we figured we would take a rick from there. Now, when we landed at kurla, we knew we had to go east so we got a bridge and went east. This bridge was really long and it led us to this dark hutment type of area, but I thought its a bridge so it should lead to the main road so we continued further.

Then we saw an arch with lights and it was pointed towards the highway so we entered. We're walking along and suddenly as I looked to the sides I saw the one thing you don't want to see at 1 in the morning....GRAVES!!! Very quickly realisation dawned that we were in a graveyard and the inscriptions told us it was a Muslim Kabrastan! As we continued to walk along hoping for an exit to the main road we're deathly quiet (excuse the pun) and we see an old man walking towards the end where there is a white wall.

I thought there must be a gate there so I told Dr. Shaikh to follow him and maybe we could get out of here without much of a problem. By the time I finish telling him this the old guy has Vanished! No Jokes it was like he just disappeared. Suddenly a tube light comes on in a small room to our right and we can see a tomb....and after a few seconds the same old man walking around it.

Apparently he was the caretaker and we then asked him how to get to the main road. He told us that we had to go back where we came from because there was no way out from here. So we collectively held whatever little breath we had left in us and walked all the way back through the kabrastan, through the dark lane which seemed even darker now, up the bridge, back on the station and got out through the next bridge looking very carefully to see weather it leads to a road or some other dark alley!

Casualty Calamity!

Ok, not everything in my life happens in the OT. This past emergency day I was sitting in the casualty for around an extra hour, overlapping with my junior trying to teach him some surgery!

In come a bunch of cops with a drunk guy who has somehow managed to hit his head. So he's sitting there on the bed, my junior goes takes the history comes and tells me about it and we advise some stitches and injections to ease him of his pain. In the mean while, the cops are grilling him about who he is, why he was drunk and how he fell unconscious with a laceration over his scalp.

This was a particularly heavy day and there were a lot of patients in the trauma ward, mostly medicine cases but the sisters were busy, so the guy is still waiting for his injection to cure his pain and he has like 5 cops asking him all sorts of questions!

He loses it...I mean loses it, stands up on the bed, grabs the tube light off the wall and breaks it over his head and in totally bollywood style threatens to drive the half he's holding into his own stomach.

Everyone is like shocked, the cops take some 4 steps backwards and try and coax him out of his beloved tube. I'm sitting there on the Doctor's desk studying away not really concerned because it doesn't look like the guy is capable of doing anything. My junior says do something and I tell him, " Just let him be, if he stabs himself we get another case to operate upon and if he doesn't everything comes back to normal."

Mr. Drunk had other ideas...He proceeds to hurl some choice Maharashtrian French words at my junior who then snaps and puts his steth down walks up to his cot and slaps the bugger so hard in the face (twice) that the tube, the guy and the guy's brains all switch off at the same instant. Then the brave cops of Mumbai not to mention the security of the Great B.M.C. come and tie him up.

By this time we have walked out of the casualty saying there is danger to our lives and we can't work under such circumstances and wait till the C.M.O. works out this particular case and then we go back in and everything except my junior is back to normal...hehehehe

Nothing happened, he didn't stab himself, he didn't get admitted and he did basically nothing else after that but leave! Since it was a bollywood type of incident, the ending had to be just as sad as a Hindi movie na!

Tuesday, September 20, 2005

B.M.C. Rocks again!

B.M.C. Rocks again!

Accha now that everyone has recovered from the operating in Sandas incident I have to tell you about what happened on Friday.

What was supposed to be a relatively normal major operation turned out to be a complete disaster. This guy was supposed to be operated for an intra abdominal cystic swelling most probably a dermoid and was prepared and kept waiting while we finished some of the easier one's before our lecturer and other miscellaneous bosses arrived.

My lecturer, lets call him Dr. Broadwalk came in in a frenzy and said come on come on lets take him on the table we have a lot to do.
So we did. My Asso Prof Dr. Lefty comes in too and we're ready to go.

We start the operation around 11 am and its evident almost immediately that we've bitten off more than we can chew!
The cyst ? tumour is present retroperitoneally ( which for my non medico ppl is in the back compartment of the abdomen....Yes there are two compartments ) and is in a position to cause much discomfort to all standing at the table.

Its arising out of the uncinate process of the Pancreas and has grown in such a way that it has stretched out the Duodenum and head of the pancreas laterally and the superior mesentric vessels medially.

Now the head of our unit (H.O.U) walks in Dr. Black and decides that the best approach is to go through the fibrous covering of the cyst and dissect it out de novo.

Well they tried. He was wrong wasn't he. The moment they tried getting into that plane the superior mesentric vein which was stretched to a great degree starts ripping of along with the layer.

As we all know BLOOD happened in a fairly large amount and the guy's blood pressure drops to 80 / palp. This my non medico friends is not a good thing!

Then in true hindi movie style there is a mad rush for blood transfusions and platelets and fresh frozen plasma anything that will get this previously hypertensive guy out from his current state of extreme hypotension. (excuse the pun)

Blood is pouring out of his vein and we're trying to clamp the vessel and ligate it. One prolene stitch taken and the tear extends just a little beyond where the stitch is. One more and the same thing happens and the vein just strips off. My second honorary surgeon Dr. Hey comes in looks at what is going on and very suspiciously leaves almost immediately saying there is an emergency at his private operating hospital. Uhhh Hello what do you think this is...A routine day care surgery!!!

Now just for those ppl who think this is a little toooo long to read this line was meant as a break.

Remember now, I work at Rajawadi bole to BMC hosp. So our great Murphy's law comes into full force at just the opportune moment and the cautery stops working (non medicos that is what we use to coagulate the vessel so it stops bleeding). Now there is a mad rush again in true bollywood style to get another cautery machine into to OT.

We would think that this was enough... Right, right WRONG.
BMC people ---- The damn suction machine (non medicos the thing that was sucking the blood out of the operative field so we could take the stitches) stops sucking! I mean it just stops cold turkey. No power failure, no clots, no warning alarm, nothing, it just stopped!

Now we're using mops like chindi's to see whats happening.
My H.O.U is now a bag of worms and does the wise thing of eating some humble pie and calling for help. The head of the department of surgery in my hospital is called in and I quote "I am in deep trouble here can you please come quick this is an emergency"

In walks Dr. Daredevil (the reason behind the name some other blog) and uses some quick saline dissection to expose fully the tear in the vein and to make a long story short saves the day.

The patient has lost some 5 litres of blood which by the way is the entire cardiac output. He is in the ICCU and is fighting for his life. We're monitoring him 4 hourly and hoping we can get him out of this one!

Moral of the story...None. Its the freaking BMC they never learn!

Wednesday, August 24, 2005

You're too busy to call

......And people ask me why I'm sooo tired and can't call.

The last two days of my life have been spent in the operation theatre looking down on people with guarded abdomen and pain all over.

All this started on that fateful double emergency weekend when I felt a strange sense of niceness about an old man who came in holding his stomach telling me he hadn't moved his bowels in 4 days....Well normally he would have won himself an enema but something told me we should admit him and keep a watch on him.....Little did I know that at the same time my junior resident was feeling a little nice towards another person who had an abdomen as hard as an ironing board! Thik hai, it was important, nay, imperative that he be operated as soon as possible, so we set about getting his work up done so that the anaesthetists would agree to give him anaesthesia...

We did his blood count, sent his urine for examination and tried to get a chest X ray. That's when all the fun began...Our great hospital run by the great BMC with a Great Medical Superintendent and great Technicians inform us that the X ray machines are not working. After explaining to them that this is indeed an emergency and not an ordinary ward patient whose work up hasn't been completed in time, (Yes we do that sometimes) they finally agreed to get a portable X ray machine to take the X ray but also were quick to warn us, "quality ka koi bharosa nahi dete hain, jaise niklega usise kaam chalana padega" (no gaurantee on quality, you will have to make do with whatever image comes in).

It wasn't like we had a choice so we got that done. Then the anaesthetist says we're not on call, so please arrange for a private anaesthetist as its past 2.00 pm. It was a Sunday, little chance of finding a private anaesthetist who would come and work for just Rs. 200 ( that's right, that's all they get paid for coming to a BMC hospital ) but nevertheless I tried. One said I'm not going to come and waste 4 hrs on a Sunday, the other cleverly said she was busy and I should try and send the patient to Sion where there was an on call anaesthetist and the case could be done there. I called Dr. Broadwalk and asked him what to do. He says, "Its ok, transfer the patient." So I went up to the patient and told him what was decided. This dude for some reason or the other tell me that no matter what happens he wants to be in this hospital only. I warned him that his life was in danger. He tells me that he doesn't care even if he dies but he's gonna stay right here.Well he didn't die but he was sure taken to the limit.

Enter Monday and we do rounds as usual and suddenly Dr. Broadwalk says to me, "This guy needs to be opened." We rush helter skelter and get him ready for the OT. I shall spare you the nasty details but let me tell you he had a hole in the Intestine: what we call a 'Perforation' and it was leaking stools onto the insides of his abdomen so much so, that what is supposed to be pink and healthy was looking Yellow and severely diseased. We fixed him up in about 2 hrs and left him with drains on either side of the abdomen to relieve any fluid which may collect inside!

The second guy was taken with all the work up done and in him we found a perforated appendix. What that means is that he probably had multiple episodes of inflammation of his appendix and it finally gave way and punctured!!! This led to fluid in his abdomen and the hard abdomen with all the pain. He was left with just one drain on his right side.

I wish this was the end of the story but come Tuesday we had more emergencies happening with one persons umbilical hernia becoming strangulated (basically meaning that the hernia was cut off from blood supply causing obstruction to movement of the intestine and impending gangrene of the bowel). He was taken in and operated on and everything did not go smoothly. Firstly this guy was fat and I mean FAT! He had a belly girth of 48 inches. To top it off he wasn't prepared for the surgery and it showed. He passed stools in the middle of the operation and as if that wasn't enough he proceeded to Vomit on the table. This led my great BMC employed Dr. Broadwalk to exclaim, " What the hell, we are now operating in SANDAS."

The other case was this lady with a huge mass in the right side of her abdomen which needed removal. On the table it turned out that this was a huge cyst arising from her ovary which prompted the removal of her uterus, ovaries and part or her cervix.

As a result I haven't had lunch in two days, I had a migrane on the first day due to hunger which is quite common with me and am sooooo tired that I can barely talk to any of my friends on the phone and they probably think I'm being a real high nosed red assed creep who is the only one working and the only one who is busy and can't call!!!

You know what........ inspite of all this I've had to endure I loved every minute of cutting open all these people and removing some of their organs!!!!

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