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Wednesday, June 27, 2007

Pav Bhaji and No OT

Lots of things happened today which ensured that nothing much would happen in the future. It shall soon become clear.

We were not posting cases in the OT since we needed to keep the cases for U.G. exams but little did we know that we might not get to operate on these people at all. Apparently the M.S. (Superintendent) of our hospital decided to handle our complaints about not getting enough operating tables with some action. he declared that all routine cases be stopped for 2 weeks or until we got new clothes in the OT. Brilliant, except that the problem wasn't no clothes, it was clothes not coming back from the laundry and sterilizer in time. So, we now have no OT to do for the next 2 weeks and we have some 15-20 cases admitted with the promise of an operation because that was the only way they would agree to stay in the hospital and let undergrads examine them all the time.

The evening then was relatively free as there were no clothes for emergencies as well (only life threatening cases must be taken, the rest transfered to a higher centre). So, Nasa and I decided to go out for dinner. We meet the great social worker Brother Ni on the road. He insists on chatting up with us and taking us to this road side pav bhaji stall that his father had help set up. The owner of the stall is now deceased and his son treats Brother Ni like a God for obvious reasons. So, we sit for dinner eating all the E. Coli we can get our dirty fingernails on and he starts telling us about stories about his 28 years of association with the hospital and how much power he has but doesn't show. Now, to give him credit he usually does his thing pretty quietly and he does do a lot of good for the hospital but everyone brags and so does he.
Apparently he used to smoke 10 packets of cigarettes a day and have a half bottle of alcohol daily till he got his heart attack. Alcohol I can think of believing but the cigarettes would have to be in his mouth even when he brushed his teeth for him to complete 10 packs a day. The next story was about him flying 20 feet in the air after a motorcycle accident and coming out of that without a scratch and riding to the hospital on the same bike. Nasa is intermittently looking into his phone possibly for the hope of a phone call that can take him away from all this, I'm messaging my ppl here and there, playing hangman in the meanwhile and the next story comes. now, we're talking about dogs - Labs, German shepherds, dobermen etc. I used to be a doctor dude!!!!
Anyway we finish with dinner and about 2 hours later i'm finally ready to go and we get on the bike to get back to the hospital and it starts pouring.

Lots of talk, lots of activity, end result - No Work!!
You get it all in a Municipal set up I tell you.

P.S. Looking forward to writing about the exam i'm going to conduct on my b'day. Another perk of working with the BMC. They pick the best dates for exams.

Thursday, June 07, 2007

The Importance of OT MAMA's

Summer vacation is about to end.

The only problem is that in this hospital the vacation will only end when the mama's of the ot start coming back to work.

During the summer the various ot assistants were on leave. I believe them to be the masters at resource management because they all had planned their vacation so beautifully that at no point in time was more than one operating table allowed to work amongst 3 departments. Which basically meant they controlled us while not even being there.

We were constantly arguing about whether OB/GYN or ENT or Surgery gets preference for the table and I'm not talking only about routine ot's but even emergencies.

A time came when one of our emergencies was made to get up off the table because the gynaec people came in with a ceasarian section to be done immediately and there was no staff or other table available for that patient.

Lesson learnt: The OT in our hospital is not controlled by Doctor's, Nurses or even the administration.....Its the OT MAMA's who rule the roost.

Hence the mama shall now be given preference to all when it comes to maska maroing!!

Monday, March 26, 2007

Alternative Medicine? Boon or Bust!

I know there are a lot of supporters for homeopathy and ayurveda but there is a time and place for everything.

This patient who came to the casualty on sat. had been transferred from a pvt hosp with all investigations done with a diagnosis of multiple liver abscesses. Now the thing with this is that one person had reported them as abscesses and the other as cancer spread.

The lady got admitted and as things would have it she got a little better but she started getting jaundice. Now this could be because of hepatitis, hepatocellular failure (liver failure)or the cancer spreading.

Some godforsaken well wishers told her that jaundice can be definetely cured with some ayurvedic medicine available in her village.

This morning she decided to take a discharge against medical advice and go there to get ayurvedic treatment.

The problem is that if this is a cancer there is nothing that ayurveda, homeopathy or even allopathy can do to cure it. What ppl must understand is that there are many causes of jaundice and some can be cured easily and others can't. Generally viral jaundice will clear in two weeks even without treatment and that sometimes is attributed to a miracle cure to alternative medicine because they give it for 15 days.

I have no problem with alternative medicine but please think about this lady who will probably die of cancer spread in two months where she could have lived for upto 2 years with the proper supportive medical treatment. So, I'm not exactly sure if I can be satisfied with my knowledge of healing if I can't break through traditional belief's that friends and relatives will give better advice than you're Doctor!

This might be a little more clear to medicos but I will be happy to answer questions if they do come up from non-medicos!

Nasogastric Tube or Abdominal Drain?

Before I begin this post, let me, for the benefit of non-medicos, explain what a NG tube and an Abd Drain is. NG tube is used to decompress the stomach by simply acting as a tube with holes through which stomach contents come out through the nose. Its used routinely for obstruction in the abdomen.
Abdominal Drain is a tube which is left in the abdomen and comes out through the skin and is used to remove pus or fluid from the abd cavity to a bag outside usually after a surgery.

Now that my title makes sense, let me take you into the abdomen of this old lady who came to us after being operated at a pvt hosp some 14 days prior to coming to us. She had stones in her pancreas and was operated and a major procedure was done which involved joining two pieces of intestine and draining the pancreas.

When she came she had a NG tube through the nose and an abd drain in her already as she wasn't recovering. The drain was draining some amount of pus and the NG tube was draining an abnormally large amount of fluid.

To cut things short she wasn't doing well and we suspected that the intestinal anastomosis (joining the two) was leaking so we decided to re open her up.

What we saw at the table shocked even my rather cool Dr. Lefty. The NG tube which is supposed to be in the stomach had somehow come right through the stomach wall and was lying in the abdomen. The fluid that was being drained by it was actually the abdominal cavity and it was frank pus.

Speculation was that there were two possibilities:
1.) The stomach wall had died and given way and the NG tube was therefore in the abd.
2.) The NG tube perforated and basically tore through the stomach wall.

Anyway, the tear was stitched and the drains replaced and the previous anastomosis was alright so nothing else could be done.

The lady passed away in the ICU. It was a very very strange occurence and till date no one knows how that tube came out of the stomach. For once it was not a Municipal Hospital at fault.

Spinal Anaesthesia Can Break Your Back!

Ok this is late so its going to be short.

We give spinal anaesthesia to numb the lower half of the body when we want to operate in that region.

So, this young fellow who was to undergo a hernia surgery came to the ot and was made to sit on the operating table so we could give him anaesthesia. The anaesthetist managed to find the space and administered the drug. As soon as this is done the patient is made to lie down quickly so that the drug concentrates at the lower part of the body and doesn't track upwards.This guy is made to lie down in a hurry and suddenly we hear a loud CRASH.

The ot table broke into two and the head end of the patient went down taking the poor fellow with it. Now remember that this guy is paralysed waist down because of the anaesthesia. So we jump in there to catch him before he hits the ground and the whole room is in Shock!

Just one point to highlight...What if this happened when the surgeon had applied a knife to the patient? Just imagine what could get cut by mistake!!!

P.S. This happened on the 27th of Jan. The table has since gone for repairs and hasn't yet returned.

Friday, January 12, 2007

Cruel diseases to kill your heart

This is the same day as the two abdominal injuries and stuff happened last emerg.
We had this female child around 6 yrs or so with a huge swelling around her R armpit.
She had been diagnosed with Full blown Tuberculosis which was resistant to treatment. She had taken treatment for 6 months with no improvement and was here with us because of the abscess.
She also was malnourished (Grade II PEM) with just skin and bones and a cry that was so sad it isn't even funny. To complete the setup her mom is dead and she is being taken care of by ber grandmother who also looks after her 3 healthy siblings (get the point)

We took her in the ot and she wept so much begging her grandmother to just keep her hand on the child's face so she could get some support since she could not be given anaesthesia as her lungs were fired and would not stand the anaesthetic. We drained the abscess under local coverage and she wept and begged for it to stop and we could do nothing since it was necessary to get this done. Oh and by the way Tubercular abscess once incised rarely ever heal but its still done anyway as there is no other option

At the end my registrar said something that will stay with me forever, "Its better if she dies"
The family is too poor to affort her treatment. She most probably will fall ill many times again since she is malnourished. Since she will fall ill her nutrition will never improve. She goes to the 2nd standard. And she's cute as a button.....

Its heartbreaking, its tough but its what we face almost everyday at this shithole of a hospital I work in. I guess its all a part of learning but all I felt at that point was that if she was my daughter and was suffering like this I wouldn't be able to take it.

I give that old grandmother credit for somehow managing to get 10 Rs for the paper she needed to come to the hospital. I give her credit for making that child smile in the ward inspite of the illness. I give her credit for being stronger than I ever will be.

New Unit New Issues

Hello hello.
I am back and I wish I could say new and improved but lets just stick with new for now.
I was transferred to another unit as a temporary measure since they have a shortage there.

Emerg yesterday got this intresting case to us in the morning around 11 with a moderate head injury, he was unconscious, with haemothorax (blood in his chest) and ? Haemoperitoneum (blood in his abdomen) on USG.

Now our USG dept failed to mention which organ they thought was bleeding with the result that there was major confusion regarding whether we should open up this patient or not. He seemed to be haemodynamically stable so we decided to conserve him but we had to do a CT for his head to refer him to neurosurgery.
Dr. Cellular (my junior colleague) calls me and tells me that I have to take the patient for a CT and transfer. I plainly refused saying that he was out of his mind if he thought that I would take a transfer of a patient after completing 4 posts against his 1...After all I am the senior resident.

Anyway the transfer didn't happen in the morning because we tapped his abdomen and got blood to confirm the USG and then it was a matter of stabilising his pulse and BP so that he could live and probably open him up in case he did not improve.
At this point let me add that the lecturer in this unit didn't really help by asking for a CT Abdomen. This pt was an unknown and to get money for the CT abdomen would be really difficult. The evening passed with minor ot which will be another blog after this but at night I was instructed to write to the administration for the money while there was another patient being operated for a stab wound in the abdomen to check if he too was bleeding inside ( I tell you its hectic doing emergencies but ppl refuse to believe)

Anyway that pt was fine and we closed him up and got the news that I was called by the AMO (Administration) for the sweet note I had put down on paper regarding the CT

He quite blew it and couldn't think of how to respond since our poor box fund is just that POOR
There was no money in it for the unknown pt and he couldn't admit that cause this was a medicolegal case and if anything happened to the pt it would be the admin's fault for not doing a CT.
He advised us to transfer the pt to Maike (Larger Hosp) and we told him that when we tried calling them they refused to take the pt if the abdomen was not looked into. He called the head of our unit and asked him what to do and was promptly told to make arrangements for the transfer as he could not be managed here.
So the AMO calls Maike and gets the royal boot from the CMO Amo and TR (Trauma Reg) and finally manages to con them into accepting the patient which my colleague had to take at 1.30 in the morning.

Moral of the story - Don't ever go to a municipal hospital if you have a choice!

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