Saturday 29 February 2020

The Onco-Surgeon


Non Medicos version
After passing his Master of Surgery (MS) exam from AIIMS, New Delhi, Dr. SV (Fictional Name) surprised everyone by joining the newly started cancer center at AIIMS. 

This surprise among his colleagues was based on multiple reasons. As the work was still going on in the under-construction cancer center, the operation theatre (OT) was not ready and was not likely to be operational for a few months. There may be many months before the first major operation will be done. 

Most surgeons are an embodiment of the adage, ‘choose a work you like and you may not have to work again in your life’. For the diehard surgeons operating on patients is a pleasure and not work. Many surgeons feel unhappy if they have to go without doing some operation for some time. This dose of pleasure will be missing for some time in the new cancer center. 

Further, being a cancer center, only cancer-related surgery will be done in the new center. Surgical oncology (Treatment of cancer by surgery) was not a recognized / well established separate field at that time. There was skepticism that what new things they will be able to do in the cancer center as good cancer surgery was already being done in the general surgery department of AIIMS, New Delhi. 

Despite these facts, Dr. SV made the move to surgical oncology in the new cancer center. 

As expected the operation theatre was under construction and Dr. SV was free on the OT days. Instead of wasting his time, he used the time to practice endoscopy, which was available in the new center. He became an endoscopist as skilled as any gastroenterologist (a doctor super-specializing in the diseases of liver and bowel). 

When the OT was ready, they started doing regular operations in addition to endoscopic procedures. As time went, the field of surgical oncology and the cancer center become well established with Dr. SV earning national and international fame as a cancer surgeon.

An opening of a new division, unit, center, department or field may present an opportunity to make a leap in your career. Shifting to a new field/division may turn out to be very rewarding in the future. 

Don’t judge a thing by its immediate or near-future potential but by its long term potential. Dr. SV realized the long term potential of specialization in cancer surgery and made the career-enhancing move.

In the initial phase of a new beginning or even in the middle of your career, there may be time periods when you may be relatively free. Instead of wasting this free time, use this time to improve your skills, join a course, practice something new, read, research or even just build up a network of contacts.

 (Based on allegedly true incidents)
— ND

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms. 

Thursday 20 February 2020

The Sambar Curry Lesson


Non Medicos version
Dr. Dev (Fictional Name) joined as a junior resident in the Department of Surgery, AIIMS, New Delhi. One of the duties of the junior resident was to assist the faculty members, such as the Professor, in the operation theatre. 

The senior surgeons were not satisfied by the level of assistance of Dr. Dev. Dr. Dev wanted to be a good assistant but did not know how to improve his performance.

Professor (Dr.) Rajinder Prashad, was an Assistant Professor in the surgery department when Dr. Dev joined there as a junior resident. Seeing that Dev did not have a clue about what he was doing wrong and how to improve himself, he took pity on Dev and gave him an example to illustrate his point.

Dr. Rajinder told, ‘Listen, Dev, you must have gone to restaurants and ordered and eaten a Masala Dosa (south Indian dish) with Sambar (a liquid curry accompaniment) there?’

(Masala Dosa is a south Indian dish eaten with Sambar, a liquid curry accompaniment to the Dosa)

 ‘Yes sir’ replied Dr. Dev, wondering what eating Masala Dosa has to do with surgery.

‘Frequently the sambar runs out before the dosa is finished’ said Dr. Rajinder. ‘With some waiters, you have to call them, and then ask them to refill the sambar. You have to stop eating and wait while the waiter gives your order in the kitchen and then bring the sambar after some time, spoiling your mood by the break.’

‘In contrast, some waiters keep a careful watch on your table, continued Dr. Rajinder. They notice that you sambar is about to run out and they bring the extra sambar before you can call them. They anticipate your need and fulfill it without you saying anything. You are able to enjoy your food without interruption with this type of waiter,’

‘You are going to appreciate the second type of waiter and are more likely to visit the place in the future and even leave a larger tip to the second type of waiter.’

‘Similarly, when assisting in the Operation theatre, observe carefully what the operating surgeon is doing, anticipate his next step and be ready to help him appropriately and promptly.’ 

Dr. Rajinder further explained, ‘For example, the surgeon is going to hold a bleeding vessel with an artery forceps. You know the next step is that he will tie the end of the vessel with a suture (thread) to stop the bleeding. While is the surgeon is holding the vessel, the vigilant assistant keeps ready the suture in his hand and hands it to the surgeon before he even asks for it. 

After tying the suture, the next step is to trim the ends of the thread. Again the vigilant assistant takes the scissor in his hand while the surgeon is still tying the thread, and cuts the end promptly as soon as the surgeon finishes tying the end, without any delay.’ 

‘This intelligent observation, anticipation, and preparation of the next step, and prompt action without making the operating surgeon wait, is the hallmark of a good assistant.’

As expounded by Professor Rajinder Prashad, intelligently observe your superior/boss/head/senior, anticipate his/her next step or need and be ready to fulfill it before he asks you to create a good impression and open the path of success for you. 

Life lessons and good practices can be seen and learned from anywhere and anyone and can be applied everywhere. For example, the behavior of a waiter, a low education qualification job in a restaurant can be applied to the surgical practice of the highly qualified surgeons in the operation theatre of AIIMS. 

So observe carefully the people around you with an open mind regardless of their job and educational qualification to learn something new or good that can be applied to your job or situation.

(Based on an allegedly true incident)
— ND
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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms. 

Sunday 16 February 2020

The Juicy Blunder


Non Medicos version
Dr. Jolting (Fictional Name) was taking the ward round. He approached the bed-side of a patient who had been operated two days ago for removal of appendix. The patient had been advised to take nothing by mouth since the operation to give rest to the intestines. As the patient was operated in emergency, Dr. Jolting had not seen the patient in detail previously and was not aware of the full details of the patient. 

After examining the patient, Dr. Jolting, found the patient’s condition satisfactory and he instructed the patient’s relative to start giving the patient water and juice from now onwards. 

The surprised relative asked Dr. Jolting, ‘Sir, do you really want us to give juice to the patient as he is diabetic?’

Dr. Jolting did not know the patient was diabetic. High sugar containing juices should be generally avoided in diabetes. As he had already spoken it was essential to justify his suggestion. Thinking quickly, Dr. Jolting replied, ‘Oh, I meant, ‘Lauki’ and ‘Karela’ vegetable juices and not fruit juices!’ 

            Please note: ‘Lauki’ and ‘Karela’ are traditional Indian vegetables, which had been described to be useful in controlling blood sugar levels in Ayurveda.

(Based on allegedly true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms.

Saturday 8 February 2020

The Hernia Operation Timing


A patient was to undergo an operation in AIIMS, New Delhi, by Dr. Anupam Sharma (Fictional Name), for his groin hernia. 

The patient asked Dr. Anupam, ‘What will be the duration of the operation? 

Dr. Anupam replied, ‘Just 30 minutes’ in a general way of speaking and to assure the patient that the operation is minor and nothing to get anxious about. 

The operation started, with the patient fully conscious, but with an injection in his back to make him pain-free in the lower half of the body (Spinal Anesthesia). There was a sterile curtain, separating and hiding his lower body, blocking his view of the surgical team members and the area where he was being operated upon.  

Unfortunately, the case turned out to be more complicated than normal. Thirty minutes had passed and the operation was not even half over. Forty-five minutes had passed and the operation had not been finished. One hour had passed and still, the operation was continuing. 

The patient got agitated and starting asking the anaethetist, ‘Who is operating on me?’ ‘Is Dr. Anupam not operating on me? He had told me the operation will be over in just half an hour. Why is the operation taking so long time? Is there any complication? Call Dr. Anupam Sharma, I want to talk to him?’

Whether surgery or other tasks, we frequently under-estimate the time taken to complete a given task and over-estimate over speed. This may lead us to give assurances which may be difficult to fulfill. Observe the small things in life and time them with a watch. Keep an objective record of the time taken by you to complete a given job. Do not take just a guess. This will save many embarrassing situations. 

While giving a time estimate for completing a task, it is better to give the higher range, and give a pleasant surprise to your patients/clients/customer by finishing it before the estimated time. For example, if an operation is going to take 2 to 2½ hours, give an estimate time of 3 hours and surprise them by completing the operation in 2 hours. If a project will take 5 to 7 days to complete, give the estimate of 7 to 8 days and then amaze your clients by giving them the completed project on day 6.

 (Based on an allegedly true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms. 

Friday 7 February 2020

The Female Surgery Resident


An academic JR left soon after joining the Surgery department of AIIMS, New Delhi, leaving his seat vacant. This increased the workload of the other JRs. They approached the unit head who got the post of locum resident sanctioned against the vacant academic PG JR post but there was no hope of anyone joining it due to the heavy time-consuming schedule of the surgery department.

For Non-Medicos, A little background: After doing the basic graduation in medical sciences, MBBS, the young doctors usually opt for further studies in the form of Post-Graduation (PG) in various branches of medicine and surgery. The admission to the PG courses is through an entrance exam. During the PG course, the MBBS doctors study and also do the various patient and academic work and are known as academic junior residents (JR). 

If the number of JRs is less as compared to the workload or if some seat remains vacant in the department then some MBBS doctors may be hired to work against the vacant seat, to do the departmental work and are known as a locum or non-academic JRs. They get salary equal to the academic JRs but do not have academic work. 

Those MBBS doctors, who do not get selected in the PG courses, join this non-academic post to earn some money while they are preparing for the next PG entrance exam. As their main target is to secure a good rank in the next PG entrance exam, they generally choose to do locum resident jobs in non-clinical or other departments, such as laboratory medicine, etc., where the workload minimal with limited timing, leaving them plenty of time to study.

To everyone’s surprise, a female MBBS doctor joined as the surgery locum resident. On her first day in the AIIMS surgery ward, the new female JR got the shock of her life. 

The female JR was from an all-girls/women MBBS college. The hospital attached to their college was also an all-woman hospital. The situation has much changed now, but earlier there was very less number of female surgical patients in general. The all-female surgery ward in her hospital was usually half empty, with limited work for the interns and resident doctors working there. Also, there was a difference in the complexity of cases being operated in AIIMS, which was further increasing the AIIMS workload.

Since she had already joined, she decided to give it a try to work in AIIMS. After the morning round, on finishing the work allotted to her she went home. 

The next day, the senior resident, asked where she had disappeared after the morning round. The JR replied that she had left for home after completing the morning round work. The senior resident told her, as she was getting a salary equal to other residents, she has to work like other residents and not to get any special treatment. He asked her to stay in the ward and go only after completing the ward work after the evening round. (The evening rounds used to start around 6.00 p.m. but end in the night at around 8.30 p.m.)

The female JR became crestfallen. There was the problem of staying in the ward the entire day and then completing the evening ward round work which used end in the night and then going back home in the night alone as a security risk. 

With almost tears in her eyes, the JR pleaded with the senior resident, that she has to study for the PG entrance exam and there is the risk of traveling alone in the night. She made the counteroffer of staying in the ward in the day and attending any call while the other unit doctors were busy in Operation theatre or OPD but be relieved in the evening.

The senior resident got adamant that she has to work like other junior residents and to make arrangements to stay and work after the evening round from the next day.

The female junior resident did not turn up for work the next day and left the job at AIIMS.

On hearing this, the senior resident responded, ‘The trouble with female residents in surgery is that if you handle them roughly they cry, and if you handle them softly, they make you cry’. 

(Not my personal feeling and counterpoint is given below.)

The same position in name can have vastly different workloads, responsibilities, timing, etc. depending on the organization/company/institution. Before joining/taking any new position/job/responsibility, please find out the actual working conditions, timings, expectations, etc. 

And vice versa, before hiring someone, give him or her, an idea about the job, the hours of work, responsibilities, etc., explicitly and not just assume that they have the knowledge as they have applied for the job. This will avoid surprises and disappointments on both sides.

How someone work is just not based on his/her salary but his future plan. The academic JR course is of three years after which they have to appear in an exam, on passing which they get their PG degree. The academic JRs generally work far beyond normal workers, as they want to get maximum experience by doing maximum work which will help them in becoming a better specialist in the future. There is also the factor that the department’s faculty gets to decide who passes or fails in the final exam, so creating a good impression by hard work is important to secure a good rank in the exams. 

So if a person is planning on staying in the same field or subject and wants to create a good impression on his superior, then his motivation is going to be much more than otherwise. This was the primary reason between the difference in work of the normal surgery residents and the locum resident and not her being female, as erroneously assumed by the senior resident. There had been very good, hard-working female junior residents in surgery, like Dr. Jayanthy, who had come for the 3 years MS Surgery course.

When someone new joins your organization, think of the cold swimming pool or bath situation. When faced with the prospect of swimming in a pool filled with cold water or taking a bath with un-heated, cold water, people usually adopt two different approaches. 

Some take the slow gradual approach, first dip or wet their feet, then immerse of wet their legs, then thigh, pause in between, then start once again and dip/wet their lower body, upper body and finally their head. This approach may be slower and gradual but safer.

In contrast, some just brace themselves and jump quickly in the pool, dipping them completely in a single go. This approach is faster, exciting and impressive, but may sometime cause cardiac (heart) shock and even death due to sudden exposure to the cold temperature.

Similarly, if someone new joins your organization, you may give them the full workload in one go or increase their workload gradually. The full, sudden shock approach is suitable if there are other candidates waiting to take the job if the present person leaves. The sudden shock approach will show you whether the candidate can survive and bloom in your setup or force him/her to leave quickly, allowing you to search and fill with a more suitable person.

The gradual approach is more suitable and sometimes necessary if there is no other candidate waiting to take the job if the present one leaves. Remember, a half worker may be better than no worker.

If the senior resident had agreed to the reduced work hour and responsibilities of the female junior resident, she would have stayed and relieved at least some work from the other unity doctors. Some people consider this approach, especially if someone other, in this case, the government, is paying the salary.

 (Based on an allegedly true incident)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms. 

Tuesday 4 February 2020

The Jim Corbett Park Trip


Around Christmas time there were many stories, films, shows, etc. centered on the Christmas spirit and miracles. Well, I don’t have a Christmas story to share, but I will like to share a story that is nothing short of a miracle which happened to one of the faculty members of AIIMS, New Delhi. 

Dr. Sameer Chandler (Fictional Name) was a surgeon in the Department of Surgery, in AIIMS, New Delhi. 

He, along with his family members went to visit Jim Corbett national park in the foothills of Himalayas mountain, by self-driving in his car. The Jim Corbett Park is situated at a distance around 260 kilometers (approx. 160 miles) from Delhi. As frequently happens while traveling, he happened to spend the money much beyond his budget and had only just enough money to drive back to Delhi. 

Please Note: This was the days before credit cards, e-wallets, mobile and internet banking and cell phones. Even to call from one city to another was not easy and not possible from many remote places. If the money in your pocket is exhausted there was no way you could get any money in an emergency. Even out of city cheques used to take 4-5 days to get the money deposited in your account.

Unfortunately, his car developed some mechanical problems on the way back and he had to stop at a car repair shop to get his car checked. The mechanic at the repair shop within minutes almost dismantled the car saying that this and that part are not working properly and gave him a large estimated bill to get his car repaired. 

On seeing the amount, Dr. Sameer got stunned as the amount was far beyond the money that was with him. Standing dazed and thinking of how to pay for the repair of his car, a man walked up to him. 

The stranger asked Dr. Sameer, ‘Are you a doctor?’ Though, surprised at why a stranger was asking him this Dr. Sameer replied, ‘Yes, I am.’ 

The stranger then asked, ‘Are you a surgeon in AIIMS?’ (At that time there was only one AIIMS in the world.) Getting more amazed at the stranger’s question, Dr. Sameer replied, ‘Yes, I am indeed a surgeon in AIIMS.’ 

‘But why are you asking me these things?’ enquired Dr. Sameer.

The man lifted up his shirt to show a long midline scar in his abdomen, characteristic of exploratory laparotomy, a major abdomen operation, done in AIIMS. Pointing at his scar, the man said, ‘Sir, you had operated on me in AIIMS, a few years ago and saved my life. Since some time had passed from the operation I just wanted to confirm if it was indeed you.’ 

The man then asked why Dr. Sameer was standing there. When he came to know about the car repair bill, he lent Dr. Sameer the money to pay for the repair of his car so that he can continue on his journey back to AIIMS, New Delhi.  

I am not saying that if you do your work well, serve the patients and society, a ‘stranger’ will turn up and help you whenever you are in trouble. A patient who was operated in AIIMS, New Delhi, turning up on the way to Jim Corbett park at the exact time and place where Dr. Sameer was facing difficulty is nothing sort of rare miracle. But this is just a reminder that miracles do occur to good people even this modern time.

On a mundane plane, the actual expenses on a trip may turn out to be one and a half to double the estimated amount. Arrange at least 50% more money than expected before proceeding on a trip.

Always keep some money in reserve for unexpected emergencies while traveling and do not spend it in any condition except in true emergencies.

Have a support system to call for help in an emergency.  One businessman from Kota went on a European holiday trip and even his expenses escalated beyond his estimated target. The balance in his international debit card almost become zero. He then called his younger brother who then quickly deposited the extra money in his bank account in their home town linked with his travel card, tiding his crisis.

(Based on allegedly true incidents)
— ND
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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norms. 

Sunday 2 February 2020

The End of Trouble


A man was suffering from cancer, but his relatives and doctor had not told him the expected outcome. 

When he lay dying he called his doctor and asked him, “Doctor, six months ago you had told me that my troubles were going to end soon. But here I am dying.”

 The doctor replied, “I had told you that your trouble will end and not that you are going to be cured. If you die, won’t your trouble also end?”

(Fictional)
— ND
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DISCLAIMER: This article is intended only for fun purpose and not belittle or make fun of doctors or cancer patients. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost.