Showing posts with label Cardiology. Show all posts
Showing posts with label Cardiology. Show all posts

Thursday, 11 July 2019

The Brahmin, the Cow and the Cardiologist


There is an ancient story of the Brahmin and the old cow. The Brahmin had a lovely garden which he had designed, constructed and took care with great love and labor. He used to proudly show his handiwork to the people who used to come from faraway places to view his garden. 

Once an old cow entered the garden and started eating plants. The Brahmin on noticing this got enraged and started beating the cow with a stick. The old sick collapsed from the beating and died. Once the fit of rage had passed the Brahmin realized his mistake and got guilt-ridden. 

There was an uproar when the villagers learned of the cow’s death, considered a holy creature. The Brahmin being a learned person thought of a way put the death of the cow on someone else. 

When the villagers gathered to punish the Brahmin for his crime of killing the holy creature, the Brahmin explained, ‘Lord Indra (Hindu God) is the deity presiding over the hands. The cow died due to Indra’s fault as he was the controller of my hand. So Lord Indra should be blamed for the cow’s death and not me.’ 

The villagers got convinced by the brahmin’s argument and the news spread like wildfire that Lord Indra was responsible for the cow’s death.

When the news reached Lord Indra ear, he was mortified to be blamed for the holy cow’s death. Taking the form of a traveler he reached the brahmin’s village. 

On reaching the brahmin’s garden, he asked him to show him the garden of which he had heard so much praise.  The disguised Indra asked, ‘Who had designed this garden?’ the brahmin proudly replied, ‘I did.” When they reached the lovely flower beds the disguised Indra asked, ‘who had planted these lovely flowers?’ The Brahmin proudly replied, ‘I did.’ When Indira asked, ‘who had planted these tall trees? The Brahmin again proudly replied, ‘I did.’ 

Similarly when Indira asked, who had watered the garden, removed the weeds, constructed the flower beds the Brahmin proudly replied ‘I did!’ to all these questions. 

Reaching the spot where the cow had died, the disguised Indra asked, ‘Who had killed the cow at this spot?’ The Brahmin caught at this sudden twist in the questioning replied, ‘Err, Indira killed the cow.’

Showing his true form, Lord Indira asked the Brahmin, ‘When you take personal credit for the construction and upkeep of this lovely garden, how can you blame me for killing the cow?’ ‘The praise and blame are both yours alone,’ saying this Lord Indira vanished.

Now let’s come back to the present times. I was visiting a friend admitted to a large multi-specialty hospital. I noticed an old lady sitting with tears in her eyes and prayer on her lips in front of the angiography cath lab. It appeared that her husband was undergoing emergency angioplasty procedure to restore the blood supply to the heart after a severe heart attack (MI – Myocardial Infarction). 

Shortly afterward, the door of the cath lab opened. The cardiologist who was performing the angioplasty procedure walked out with a swagger and style which would have been difficult for even Salman Khan or Shahrukh Khan to copy. Putting his hand over the lady’s shoulder like a God bestowing a boon on a supplicant, he said, “Don’t worry Amma (old lady). I had done an excellent operation and saved your husband’s life.” The woman gave a look of gratitude and effusively thanked the cardiologist. 

But mishaps can happen, and if perhaps the woman’s husband had not recovered and died in the hospital, would the same cardiologist have come and said, ‘I had botched the operation and killed your husband?’ 

In the above story, we see how the Brahmin wanted to take all the credit for himself but in the case of accusation, he didn’t want to accept it and he wanted to blame others. This is a perfect representation of our nature.

Doctors today are quick to take credit for a patient’s recovery, perhaps as; compensation for the long hard work they do, pride in their skill and knowledge acquired through years of hard work and study, to satisfy their egos or to justify their hospital charges.


 The patient’s general condition and immunity, the disease stage, facilities available in the hospital and the city, the help and effort of the other staff members and even the patient’s relatives, and if you are so inclined then God’s grace or luck factor should be also routinely given credit for patient’s recovery so that the public become conditioned that the outcome of patient’s treatment is not due to the doctor’s treatment alone. Other factors may play a more important part in the death or recovery of patient.

If a patient’s death cannot be blamed on the doctor alone, likewise his recovery cannot be credited to the doctor alone.

 (Based on an allegedly true incident)
— ND
© Author. All rights reserved. 
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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 of the information herein is at you 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 of the information herein is at you 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 norm. 

Thursday, 3 May 2018

The Heart Sound Quandary

Dr. Jitender Kumar (Fictional Name) was appearing for his final MD (Medicine) exam in AIIMS, New Delhi. Being a brilliant student he was the favourite resident of the Head of Department (HOD) of Medicine.

In the MD (Medicine) practical exam. Dr. Jitender Kumar was allotted a patient suffering from damaged heart valve.

For Non-Medicos: There are four heart valves, two each on right and left side. Abnormality of this valves can produce abnormal heart sound know as murmurs which can be heard with the use of a stethoscope (the Y-shaped tube like thing which doctors put in their ear to listen to your heart and lung). Murmurs produced when the heart is pumping out blood are known as systolic murmurs. Murmurs produced when the heart is filling with blood is known as diastolic murmur. Knowing if a murmur is systolic and diastolic and whether on right or left side of the heart the physician can diagnosis which heart valve is damaged even without other investigations such echo-cardiography.

The Head of Department of Medicine, AIIMS, New Delhi and another examiner, the external examiner, from a different medical college were jointly taking the viva in the practical exam.

When it was Dr. Jitender Kumar’s turn to present his case; the discussion reached to what type of murmur the patient was having? Dr. Jitender Kumar replied, “Sir, the patient is having a systolic murmur.”

The external examiner listened to the patient’s heart sound with his stethoscope and raised his head in amazement. “What are you saying?” inquired the external examiner, “the patient is clearly having a diastolic murmur!” Turning to the HOD Medicine he requested, “Sir, Kindly listen to the patient’s heart and confirm it is a diastolic murmur.”

The HOD – Medicine was in a quandary. A systolic murmur is as different from a diastolic murmur as sunrise is from sunset. If he confirms it is to be a diastolic murmur, it will be difficult to justify passing his favourite resident in front of the external examiner after committing such a blunder.

The HOD – Medicine applied his stethoscope to the patient’s chest, listened for few minutes and gave his verdict, “It is a systolic murmur.”

The external examiner was surprised, to say the least, “Listen again carefully, Sir,” he demanded, “It is a diastolic murmur, not a systolic murmur.”

The HOD – Medicine looked at the external examiner and said, “You and I have become old. Our hearing is not what it used to be. If the candidate is saying it is a systolic murmur, then it must be a systolic murmur. But if you are having any doubt then let us call the cardiologist to find out what type of murmur it is.”

So a message was sent to the cardiologist on call with the instruction, ‘Come and listen to the patient’s heart and whatever the murmur is, say it is a systolic murmur!’

So teachers go to extreme length to protect their favourite students. Lucky are the students who get such teachers. Having a good relationship and creating a good impression on your teacher can prove quite beneficial in the exam.

 (Based on a true incident)

— ND

© Author. All rights reserved. 

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour illustrated here or claim it to be useful. Use of the information herein is at you 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 behaviour illustrated here or claim it to be useful. Use of the information herein is at you 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 norm. 

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Monday, 7 August 2017

The MUGA Scan appointment



A patient with an interesting surgical disease was admitted to a Surgery Unit III in AIIMS, New Delhi. On checkup for fitness for anesthesia, he was found to be suffering from heart disease. The cardiologist (heart doctor) reviewed the patient and advised MUGA scan to further evaluate the patient’s risk for surgery. 

In MUGA scan a small amount of radioactive material is injected in the patient’s vein. Using a special device (camera) the amount of radioactivity coming from the pooled blood in the patient’s heart is recorded. This gives an estimate of the blood pumping power of the heart.

The trouble with MUGA scan was that due to the over-burdened cardiology department of AIIMS, New Delhi, there was minimum waiting period of 10 to 15 days before this MUGA scan can be done.
The Surgery Department of AIIMS, New Delhi, was also over-burdened and it was not possible to keep the patient admitted in the ward for 10 to 15 days while waiting for the MUGA scan. The patient was from a distant place and it would have cost the patient a good amount of time and money for him to go back to his home and come back to AIIMS for the MUGA scan.
The head of unit, Prof. Tarun Kumar Chaturji (fictional name) also did not want to send the patient home, as it was a surgically challenging case. There was the possibility that the patient may not come back to AIIMS, or may get re-admitted in a different unit.
The senior resident of the unit asked to Dr. Dev (fictional name) solve this problem. Dr. Dev studied the problem and came up with a plan of action.
Professor (Dr.) Umesh Kaul (fictional name) was the acting HOD of the Department of Cardiology in AIIMS, New Delhi, at that time. Dr. Kaul was learned person, master of his field, with a busy schedule. Even high ranking officials and politicians had to take appointment to meet.
When Dr. Dev reached the Cardiology centre of AIIMS, New Delhi, instead of going to the MUGA scan lab, he made his way directly to Professor Kaul’s Office. Without stopping to talk and take permission from his receptionist, just barged straight in his office.
Dr. Kaul, who was having some meeting in his office looked at Dr. Dev with amazement and anger at his rude interruption. Perhaps, the adage ‘Fools rush in where angels fear to tread’ (walk) must have crossed his mind.
Before he can be unceremoniously thrown out of Prof. Kaul’s office, Dr. Dev blurted, “Sir, I am a junior resident from surgery unit III and we have a patient who requires a MUGA scan on priority.”
Dr. Kaul looked at Dr. Dev with exasperation and barked at him, “Why have you come to disturb me for this?” “Go and talk to the reception at the MUGA lab.”
Bowing obsequiously, Dr. Dev replied, “I am extremely sorry to disturb you. I will go the MUGA lab as instructed by you” and hurried out of Dr. Kaul’s office, breaking out in smile as soon as he was out of the office.
When Dr. Dev reached the MUGA Scan lab, instead of going to the clerk giving appointment for the scan, he sauntered to the Lab in-charge and said, “I am coming from Dr. Kaul’s office. He has told me to get the MUGA scan done of this patient on priority.”
The in-charge was surprised that Dr. Kaul himself was instructing about some patient’s MUGA Scan.
He queried Dr. Dev, “Professor Kaul himself?”
“Yes”, replied Dr. Dev truthfully, “Professor Kaul personally instructed me to get the MUGA scan done.”
Still amazed the Lab in-charge asked, “Is the patient some relative of Dr. Kaul?”
Leaning toward the Lab in-charge, Dr. Dev lowered his voice as if he was afraid someone will over hear him and whispered conspiratorially, “I am also not sure, but I think he may be either some distant relative or close family friend.”
The in-charge looked at Dr. Dev helplessly, “It is already past noon and we have many patients waiting for the MUGA scan today. Will it be alright if we do the scan on this patient as first case coming morning?” he pleaded.
“Okay” answered Dr. Dev, “It had been better if the scan would have been today, but we will adjust even if done tomorrow.”
The MUGA scan was indeed done the next day; patient operated on soon after and went home hale and hearty.

(Based on true incident)
— ND
© Author. All rights reserved. 

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

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 of the information herein is at you 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. 

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