Pseudo Neuro Surgery

I’m going to suck your brains out took on a whole new meaning yesterday!
We had this really bad railway traffic accident who reached the casualty around 11 pm with his eye almost hanging out, his scalp forming a nice flap and fractures all over the skull…I mean all over which will be apparent soon

IV lines are taken, catheters are put, and a nasogastric tube is inserted to suction out his gastric contents so that he doesn’t aspirate and choke on himself. However, it got blocked and we had to put it in again.

This time a colleague from another unit, let’s call him the Dr. Mole, puts it in and it goes in smoothly. He aspirates and gets fluid and is quite content with it. Now, the patient is transferred to Maike and a CT Scan is done. The doc doing the CT suddenly yells, "Where is the doctor that managed to do this” The intern accompanying the patient almost has a fit…..The nasogastric tube which was supposed to drain the stomach was in the skull into the BRAIN!!!!

Apparently there was a fracture of the cribriform plate and the tube had somehow gone through the skull into the brain where there was a clot of blood which was miraculously drained by the tube.

The patient survived somehow and all of us just couldn’t believe what had happened. I still don’t, hence the need to write this to find out just how believable it really is.

Laparoscopic Gastric Banding

Dr. Pitamaha always says that there is too much aggression in the field of surgery today. Unfortunately, its always Dr. Broadwalk who proves him right!

Dr. Broadwalk has been transferred to another hospital but something in him made him want to do his first Lap. Gastric Banding (Surgery for morbid obesity where the stomach is banded to make you thin) at our hospital itself. So, he takes permission from the M.S., arranges and ICU bed, calls two surgeons from outside along with their private anaesthetists and sends us a 140 kg 5 ft 1" 40 something lady to be admitted in the ICU as a gift. Each of her legs were like two of mine combined and lets not even get started on the abdomen.

She was taken in the OT at 2 pm and the procedure started with the inroduction of the scope. Immediately, there were obvious problems.... They failed to take into account the weight of her liver which seemed to be large enough to cover everything else in the abdomen. As a result they were unable to get a correct plane to apply the gastric band and ended up struggling. When I say struggling I mean Dr. Boss Man, Dr. Lefty and Dr. Chopper (Head of dept of surgery) all came, saw, waited, saw some more, and left at varying intervals. Oh I might mention at this point that we are some 5 hours into the operation by now and all they've managed to do is tear a bit of the liver and make a small gap in the plane behind the stomach.

Now I don't mean to be cynical but Mom told me that they shouldn't try such a surgery in a setup as great as the B.M.C. and warned me of the problems that may arise. Sometimes the ego of a surgeon is all that matters and the two pvt docs were hell bent on proving everyone wrong. They failed!

The case was converted to an open surgery, took some 6 & 1/2 hours to do (routine 2 hrs) and was more traumatic for that 140 kg lady than walking with those two feet would ever be.

If I wasn't bound to protect identity I would have posted the photo of the lady but let me see if I can find one with just her legs...Just being a HUGE understatement, of course.
140 kgs....wow

Oh another thing (sorry shanky) but the bariatric surgeon mentioned to Dr. Shanky that if he doesn't control his eating he would be next on the list!!

An Emerg To Remember

Wednesday's are supposed to be light.
The OPD was light. We finished by 11.30 took rounds and settled in. I had the day shift for the casualty and it started.
Some corporator decided he knew whats best for one of the patients and sent him to the hosp with R hemiplegia (R side paralysis) Uncontrolled Diabetes and a nasty yellow dripping foot abscess/cellulitis with great toe gangrene. I have seen this yellow colour once before in my life and I was willing to bet this was Madura Mycosis / Actinomycosis. Since I knew my seniors would never allow a debridement with an uncontrolled blood sugar level, I advised him to go in for hyperbaric O2 therapy but the AMO intervened and had him admitted into the Medical Ward.
Well, this guy was bad and he died today with counts of 37,500 (too high). The clincher - When I gave the patient the option of hyperbaric he was only too willing to go and get it done at Kasturba (we don't have a hyperbaric chamber) but the AMO forced him to get admitted because he had a corporators letter and couldn't be turned away....never mind the well being of the patient.

The other thing was a perforation that came in in the evening. His timing was so great that just at that time Dr. Big Boss Man's patient collapsed in the ward and her relative panicked and called him directly. He lost it, I mean LOST it. He called Dr. Shanky and let him have it. I was sitting some 6 feet away and I could see Dr. Shanky replying but couldn't hear a word he said...After the call he was in a state of shock! To top it off he had also told him that he was sending another patient, active tuberculosis with a ? Perforation. Now everyone started to panic cause no one wants to see the Boss Man in a bad mood. He's viscious. We were all tracking progress, getting Xrays and putting tubes whereever possible.
When the X ray of the TB patient came we all almost fell over. He had lesions all over and we had to find his lung in there. We knew at that instant that this was trouble since no one would induce him there so we couldn't operate. We were told to sit on him and the other fellow.

Today morning we finally got the go ahead for the normal fellow and he was taken up in the afternoon. As soon as we finished him we get a call that the TB fellow is bad and getting worse. We tried reasoning with the anaesthetist but there was no way he was getting induced so we had to transfer him to Maike!(higher centre)
So, we've actually finished yesterday's emerg tonight at 10 and I'm exhausted beyond words...

Oh and somewhere in between all this we got another of the Boss' cases with a Hb of 3.3 Normal being 12 so he's weak beyond repair....sheesh and I have a double weekend coming up

Helppppppppppppp

We Lost Broadwalk

Its a sad day in the history of our hospital. Dr. Broadwalk has got a promotion and has made assistant professor, but this comes with a catch. He will be transferred to another hospital and we now have no lecturer. This means no more free hands with cutting, no more nice guy to save us when we make blunders and no more mishaps (ok that may be good).

The most touching moment for me was when he walked up to Pitamaha and informed him of his transfer and joining the other hospital and before he left he touched his feet.

This coming from a man who jokes about everything and generally disagreed with Pitamaha's tactics regarding surgery. I was impressed and glad to know the amount of respect Pitamaha commands from his inferiors.

All the best Dr. Broadwalk We're really glad for your promotion but we will miss you terribly in the unit.

Till later

Humbled into submission.

You know the sayings, "Everyone Makes Mistakes" "Don't point a finger" "Overconfidence is no confidence" etc etc. I believe all of them now.

I made a mistake, a huge one, some people say it was justified but I don't think it was. I'm not going to get into the details but I've learnt from it and I will not let it happen again.

The only thing is that it could have cost someone her life and I don't know what I would be writing then, but, I guess God decided to give me another chance at improvment and I intend to take it with both hands.

Also, the saying "The greater the man the calmer his demeanor" I believe completely, now that I had to inform Dr. Lefty and he took it with a pinch of salt and just calmly taught me what to do in such situations. Thanks Doc.

Till later

Review of all the people I work with

My latest registrar : Dr. Chicken in Minutes
My former lecturer: Dr. Broadwalk
My super skilled A.P: Dr. Lefty
My Asst. Honorary: Dr. Big Boss Man
My Head of Unit: Dr. Black
My Guide: Dr. Pitamaha
My Head of Dept.: Dr. Chopper

My Colleagues:
Dr. Hypermart
Dr. Avibaby
Dr. Shanky
Dr. Jajhav (translate in marathi)
Dr. Matka
Dr. DJ (Myself)

Sheesh I work with too many people.

Monsoon Breeds Worms.

Hello hello,

Yes it has been a long time but that can entirely be blamed on strikes and allied postings and the fact that I took it upon myself to use this extra time to read and be prepared for my return.

Let's get on with it then...

This kid aged about 15 yrs comes to the casualty with severe abdominal pain accompanied with fever and vomiting since the past two days. He says he has had this type of episode in the past and is looking really sick. One touch to the right iliac fossa and he yelps in agony.

'Appendicitis' we all shout in unision. So, he's admitted, blood samples are sent and Dr. Broadwalk is called to set up the surgery. Yay I say, I get to do one more appendicectomy and take my tally over 10.

So, we take the kid in and remove his appendix. Simple right. Yeah Sure!

The kid isn't in the recovery room for five minutes that he starts writhing in pain and says he wants to vomit. Blame it on the anaesthetist right. Yeah Sure! Just as we go to take a look at him and tell him everything is alright, our kid taking the perfect cue decides this would be the perfect time to vomit out his feelings. Just to make us look like idiots!

This immediately reminds me of my paediatric practical exams in final year medical college where i was examining a newborn, had to pick him up to test a few reflexes and he reflexively SHAT on my hands.

Anyway, as I was saying 'Idiots', the kid doesn't throw up some ordinary vomit, its bile and within the pool of bile is one bouncing squirming honest to goodness live worm.

The kid's problem was not appendicitis but a severe case of round worms crowding his intestines. Like I said 'Idiots'. However, I am told that worms blocking the intestine usually present like appendicitis so we're ok.

Moral of the story : Don't chew your fingernails; you could get your appendix taken out by me.
(I'm sure this point is well taken by specific persons)

Till later

HOSPITALS ARE BETTER THAN PRISON!

With the whole Rahul Mahajan saga dominating the news channels, I was reminded of something so simple that it is overlooked in most hospitals across the country.

Almost every hospital has harboured a law breaker at some point of its existence.

Sometime last year, one of my bosses called and informed us that he was sending a patient who was to be admitted in our ward (let me just remind you that it’s a Surgical Ward) for treatment.

The patient arrives in the casualty and is referred to us, since he came with a reference letter, and we promptly admit him. Just one problem, he has liver disease, a Medical problem not a surgical one.

We admit him, work him up for all usual investigations, keep him well fed and later find out, through some hard questioning, (nobody is comfortable hiding from a Doctor) that he was to be arrested that evening, but if he stays for three days with us his bail will be approved and he will be out roaming the streets.

Now, let me clarify that he indeed had a disease, but it was not one that warranted admission to a hospital.

Point number two, he was send to a Municipal Hospital, not our bosses private set up because there could have been trouble there.

Anyway, this guy stays for exactly three days, gets up on his feet on the third morning and demands a discharge. He has just been informed on his cell phone that his bail has come through.

So goes the medical set up in our country. Jai Hind!

Electrifying!

Electric News!

I’ve been in Allied postings nowadays and that’s probably why its taken me so long to get a story out of my hospital but this one’s a doosey!!!

I’m currently in Anaesthesia and was called upon to induce a case for cystoscopy (where you put in a scope to view the bladder ) for a guy who had come with complaints of hematuria ( blood in urine. ) I was also shown the Xray which blew me to pieces!!!!

Let’s get straight to the point. This guy had a huge bladder stone 22mm X 25mm ( Sid, get this ) sitting around in his bladder which had to be removed suprapubically.

The case was induced, cystoscopy completed, stone visualised and removed by supra pubic incision. The stone was really that big and hard. That’s when I got the full story.

The X ray showed that this stone was no ordinary stone, in fact it was one I’ve not seen yet! It had formed around a foreign body in the bladder. The kicker is this……the foreign body was


A METAL WIRE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

The history given : Two ppl held this guy and shoved the wire up his urinary tract ( for fear of using graphic terms )

The Actual Story ( Obtained after much probing and frightening ): This guy was pleasuring himself and had shoved the wire up his own urethra for reasons only he understands. Hehehehehehe I am still dumbfounded as to how he got it all the way in?!?!?!?!

So being the good Doctors that we are we proceeded to break the stone to get to the core of the issue ( excuse the pun ). After breaking it, we found that this was ELECTRIC WIRE…the insulated kind. Apparently it had lost all insulating potential.

I’m telling you…There is no place like Mumbai to see the weirdest cases!!!

Till later

Right To Strike?

I'm tired of reading letters from people saying things like the Government has in principle agreed to all the demands of the doctors except that of the stipend. On what basis are people making this assumption? Also talking about how we should not sort to extreme measures just because of some irate relatives is just not right.

Let me clarify a few things

1.) If we did not care about patients, there was no reason for us to spend a good 8-10 years of our lives studying to become doctors.

2.) The Government has agreed to improve our living conditions in principle so many times before that its now time to question those same principles!

3.) Most Importantly, are we really prepared to wait till someone gets stabbed or beaten black and blue before addressing the question of security???

I have personally had a patient who stood up on the bed in the casualty, grabbed a tube light off the wall, broke it and threatned to stab himself...in the prescence of ONE security guard who could do nothing but watch. Would our demands be fair if either he or one of the doctors attending to him would have gotten stabbed!!

Just to make a point, it was two doctors and not the security guard who finally got that patient to calm down and saved his (and maybe our) life.

With respect I remain.

Strike Strike Strike

Where have we heard this before!

The overworked, underpaid, underprivileged, slum dwelling, unrespected ( I know its not a word) resident doctors of all government and municipal hospitals are on strike....Again!

Only this time I think something has to give.

The story so far... In two separate incidents, resident doctor's working at KEM Hospital and Bandra Bhabha hospital were assaulted by relatives of patients. One of these was a lady doctor who simply told the mother of an expecting mother not to enter the labour ward with shoes on and she was slapped!

We've heard of doctor's being slapped around for far too long now and this time the entire Maharashtra Association of Resident Doctors (MARD) has extended support with Doctor's from all corners lobbying for support.

The Government has issued termination notices and threatened to evacuate hostels which now becomes the no 1 demand to be taken back.

In the meanwhile, we're enjoying a break doing things we didn't have time to do, studying as much as we can and hoping for a speedy end to all this.

One thing to smile about though...Our lecturers, the replacements offered by the Govt (Naval and Armed forces Docs) will now realize how much work we do in conditions where I'm sure they will not survive more than a week or two!

Hoping for the best.