The Hungry Resident Doctor

 

The operation theater (OT) in AIIMS, New Delhi used to run non-stop from 8.00 am in the morning till 4.00 pm afternoon. The surgery professor was operating and two junior residents were assisting him. One of the junior resident doctors had just joined the surgery department and it was his first day in the operation theater. 

Midway through the operation, the new junior resident asked the professor, “Sir, it is 2.00 p.m. and I am feeling hungry. Can I go to the hostel and have my lunch?” 

On hearing this all movements stopped in the OT. Everyone stared at the new junior resident in astonishment. The surgery residents used to work non-stop when the OT was running and the junior most residents used to not even get time to go to the hospital canteen adjoining the OT let alone the hostel mess.

The surgery professor looked up icily at the new resident and replied, “You can go and have your meal today. But next time either don’t come to the OT or don’t ask to go for lunch during OT time.”

The junior resident went for lunch that day but never again was seen leaving the OT for food after that day.

In the same operation theater, while the operations were going in full swing, the anesthesia professor who was supervising two operation theaters entered that OT and asked the anesthesia assistant professor, “Is the patient stable? Is there any problem?” The assistant professor replied, “No ma’am, there is no problem. Everything is going smoothly.” 

The professor further asked, “How many residents are there in this OT?” The assistant professor replied, there are two junior residents and one senior resident posted here with me.” The professor asked, “Did you all have tea and something to eat with it?” No, ma’am” replied the assistant professor, “None of us had eaten anything since the morning after the OT started.”

The professor exclaimed, “What! It is nearly 1 O’clock and none of you had something to eat. Send the junior residents and then the senior resident one by one to have tea and eat something immediately. Once the senior resident has returned then you also go and have something to eat. The senior resident may call me if needed in your absence.”

It was clear that, unlike the anesthesia professor, the surgery professor had not heard ‘An army marches on its stomach’ a saying attributed to Napoleon Bonaparte and Frederick the Great. It means that soldiers cannot function properly unless they are well-fed. To be effective the army has to be supplied with good and enough food.

Thankfully, in the corporate world, there is now growing awareness and many companies are providing lavish and free food for their staff in their office campus with proper breaks in between as a means to increase employees' productivity and work satisfaction.

Some other points from the anesthesia professor’s instructions: She made sure that the junior residents were sent first for refreshments and the assistant professor last. It happens in many places where the seniors can take a break and have something while the junior most staff keep on working. When the anesthesia junior residents went on the food break, their work had to be shared by the senior resident and the assistant professor. This may be resented by them and they may not allow them to go.  

This used to happen in the surgery department also when the final year junior residents were able to take time off to go the canteen while making the first-year junior residents work non-stop without giving them even time to drink water in between cases. 

Also, the anesthesia professor took on the responsibilities and duties of the assistant professor, while she went on her tea break. It is the duty of the top management to ensure that the junior most staff get the much-deserved break even if at the cost of working in their place.

Making sure that your employees, subordinates or juniors are well-fed is good human resource management and not weak leadership.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

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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. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient and students as foremost and according to NMC and other Board norms. 

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Another AIIMS Delhi Ward Boy

 

As explained in the previous post, ward boys are the least educationally qualified and lowest level of workers in the hospital.

https://agnipathdoctors.blogspot.com/2022/05/the-aiims-delhi-ward-boy.html 

In the Cardio-thoracic (CTVS) operation theater (OT) of AIIMS, New Delhi there was an extremely intelligent ward boy. This exceptionally bright ward boy learned to operate the heart-lung machine and started working as the perfusionist in Dr. Bhaba Nanda Das’s OT. Now there are various official courses, from 2 to 4 years, to become a perfusionist even in India. But at that time there was no official course and in most cases, the person become trained on the job, while working.

For non-medicos: During cardiac (heart) surgery such as CABG or ‘bypass grafting’ the heart is stopped and the blood is sent from the body to the ‘Heart-Lung Machine’ which functions as both the heart and lung of the patient. This is very demanding work, both physically and mentally, with the perfusionist having to constantly monitor and take action according to the patient’s blood pressure, oxygen saturation, what is the stage of surgery, and even feedback from the anesthesiologist.

Dr. Bhaba Das was a perfectionist and a world-class surgeon who expected the same level of expertise from his supportive staff. Not many could work at the standard desired by him. But this ward boy by his expert management during the cardiac surgeries become his preferred perfusionist. Although he was working as a perfusionist the ward boy was receiving a salary the same as other ward boys.

Sometime later, Dr. Bhaba Das received an offer from a private hospital chain to join their Delhi hospital. Dr. Bhaba Das left AIIMS, New Delhi, and took his entire OT team with him, such as the nursing staff and this ward boy to work as his perfusionist in the private hospital.

Along with Dr. Bhaba Das, this perfusionist also received a handsome package. His new monthly salary was now four times what he was receiving in AIIMS Delhi. In fact, his new salary was more than an assistant professor working in AIIMS.

This incident demonstrates some very important points:

On-the-job learning: The ward boy started at the lowest post in the hospital, yet with his intelligence and passion to learn something new he learned to operate the ‘heart-lung machine’ and become a highly skilled perfusionist.

Keep on giving your best no matter what is the immediate reward: The ward boy received just a ward boy’s salary while he was at AIIMS Delhi, yet he kept on working as the perfusionist that too as a good one, who could satisfy even Dr. Bhaba Das.

In the government organization or setup, all persons get the same pay for the same post, even though some of them could be much more proficient or doing a much higher level of work. This difference between the government and private sector is partially responsible for the lackluster performance of many government employees.

When you get a better opportunity take it. The perfusionist along with the nursing staff left AIIMS and joined the new place and got a much-increased salary.

Like Dr. Bhaba Das, take your entire team with you when joining a new place, company, or organization. This way there are fewer things to adjust in the new setup.

Negotiate an increased package not just for you but also for each member of your team. They are then more likely to follow you leaving their old job. This will also increase their work satisfaction and loyalty to you.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

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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. 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 NMC and other Board norms.

Why read when I can see?

 

A common misconception is prevalent among many students and trainees that they can learn by just seeing something. In their day-to-day work/training since they are getting exposed to a variety of situations, they will learn passively by just seeing these things. One example is a surgical trainee assuming that if he/she will watch his professor operate on a patient, he/she will automatically understand and learn to do that operation. Or, if see your superior making a sales pitch you will understand and learn all the subtle psychological tricks/techniques he is employing. If you see your boss negotiating a deal you will pick up the fine points of negotiation skills.

  By the way, almost all of us are trainees no matter how old or experienced we are. There is always room for learning something new and improving ourselves.

These trainees and students forget that experience is not what happens to you; it is what you learn from what happens to you. With the same incident, two different persons may learn in different quantities or qualities of things. And one of the reasons for this is:

The Eyes Only Sees What the Mind Knows

It is only the most gifted among us who can see something and comprehend what exactly is happening. What we observe, understand, and learn is dependent on our background knowledge and information already in our brain. This may be clear from the following examples:

A junior resident doctor in AIIMS, New Delhi was doing an operation of inguinal hernia repair under the guidance of Dr. Dev (fictional name) who was a senior resident at that time. Suddenly the patient’s inferior epigastric artery got injured and started to bleed profusely. Dr. Dev quickly took an artery forceps and clamped the bleed point. Taking a surgical suture he quickly tied off the bleeding part thus controlling the bleeding. 

Once everything was under control, Dr. Dev asked the junior resident what had happened? The junior resident replied that there was some bleeding which is now controlled. 

Injury and bleeding from the inferior epigastric artery is a known complication of the inguinal hernia and if not controlled can cause serious complications to the patient. But since the junior resident had not read about it, he was not able to recognize it and understand the disaster that has been averted. So even thou he was actively involved in the operation yet because of a lack of background knowledge he did not learn to recognize and deal with the complication of that surgery.

Another time a young lady came with a large lump in the breast which needs to be taken out (excised) by operation. It is a simple task to make a cut (incision) in the skin over the lump, separate/dissect it from surrounding tissue, and stitch the wound. But the ugly scar remaining after the surgery is a problem for such young ladies. Dr. Dev decided to do a different approach (the Gillard Thomas approach) for this particular lady. In this approach instead of making a cut on the front of the breast, a cut/incision is made below at the junction of the breast with the chest wall and the surgeon goes behind the breast and removes the lump from behind. The scar of this cut is hidden below the breast.

Dr. Dev started the operation. The final year junior resident (JR) assisting him watched with interest as he had not seen this method of doing operation before. After the operation was over, the resident was impressed with the well-hidden scar with this approach.

A few days later, Dr. Dev saw the same junior resident operating on a patient with a breast lump while being assisted by another consultant. Dr. Dev’s interest was piqued when he saw the resident had made the same Gillard Thomas incision/cut instead of the usual skin cut. Dr. Dev. went to the adjoining operation theatre (OT) where he had a surgery scheduled. After he finished that operation, he came back to see what is happening in the JR’s OT. He found that the JR was still struggling to get to the lump. With quite some time and lots of struggle, he was able to get the lump out.

The problem arise that the junior resident had never read about that particular operation before and therefore he was not able to observe and note that Dr. Dev with the Gillard Thomas approach had first gone up and behind the breast and then removed the lump. So although he had seen and assisted in the operation, he was not able to learn the proper technique because of his lack of background knowledge. 

These are not isolated incidences. Time and again whether it is examining patients in wards or OPDs or assisting in the operation theater, students and resident doctors fail to observe and notice important points because they did not know what to look for as they have not studied about it before coming to the ward or operation theater. 

So before assisting in an operation, procedure, important deal, sales pitch, or even before your routine lectures and classes, study about it one day beforehand either by books or through internet videos and resources and make a note of what you should try to observe and learn from that lecture, class, negotiation, deal, operation, procedure or occurrence so that you actively learn and achieve your maximum potential.

Once again, remember first prepare your mind before seeing something new so as to turn your looking into observation and learning experience as:

The Eyes Only Sees What the Mind Knows

— ND

(Based on allegedly true incidents.)

© Author. All rights reserved. 

 Tit-Bits — Theodore Gaillard Thomas, misspelled ‘Gillard’, who described this incision was a gynecologist and not general surgeon.

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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. 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 NMC and other Board norms.

The 'Pushpa' CTVS Surgeon

Recently the movie ‘Pushpa’ was creating waves in India. One of the famous scenes in the movie is when the protagonist/hero of the movie vehemently declares that he will not bend. His dialogue reminds me of a great cardiac surgeon who was in AIIMS, New Delhi.

While doing his junior residency in MS General Surgery at AIIMS, New Delhi, Dr. Dev (fictional name) was posted in the Cardio-Thoracic-Vascular Surgery (CTVS) department on rotational posting during. Once, he was assisting in the operation of CABG, cardiac bypass grafting, in which the vein of the leg was taken and attached as a bypass graft between the Aorta and the heart arteries for blockage of the heart arteries. While the chief surgeon was busy doing the main part of the operation in the chest region, Dr. Dev was suturing the skin and subcutaneous tissue in the leg. 

As the leg was at a lower level than the chest, Dr. Dev bent at his waist level and was stitching the wound. Dr. Murli (fictional name) who was his batchmate and was posted in the adjoining operation theater (OT) came to see what was going on in that theatre.

On seeing Dr. Dev bending while applying the stitches, he remarked, ‘Dr. Dev you are lucky that you are not posted in my OT with Professor Sampath Kumar. Dr. Sampath is very particular in having a good posture while working in OT. According to him a surgeon should always stand straight and never bend while performing surgery. If he sees some trainee surgeon take a stitch while bending, he will ask the trainee to remove the stitch and apply it once again while standing in the correct posture.’

Not just for surgeons but poor posture at work if ignored and not actively avoided can lead to chronic pain, fatigue, poor performance, and productivity. This is so important that a branch of science, Ergonomics is devoted to the study of people in their working environment to improve safety and reduce chances of injury. 

Some recommendations for people working for a prolonged period while sitting at their desk are:

Choose a chair with good lower back support.

The chair should be adequate width and depth with proper padding. There should be a gap of around 2 inches between the edge of the chair and the back of your knees.

The chair should have an adjustable armrest so that your arms rest gently on them with your shoulders in a relaxed neutral position.

While sitting, the thighs should be parallel or slightly inclined upwards so that your knees are at the level or slightly higher than your hips. Your feet should rest flat on the floor. The height of the chair should be adjusted or use a footrest. You can use other items such as a small stool, empty boxes, etc. if a proper footrest is not available. 

Keep routinely used objects such as your telephone, mouse, highlighters, stapler, etc. close to you to minimize twisting, bending, or overstretching to reach them.

Use a speakerphone or headset to use the phone while working. Avoid cradling the phone between your head and neck.

The monitor should be directly in front of your eyes, around 2 to 2½ feet from you. The top of the screen should be slightly below your eye level as our eyes are most comfortable position while seeing objects 10-15 degrees below the eye level. 

The monitor and the keyboard should be in a straight line.

The keyboard should be about an inch above elbow level.

The mouse should be close to you and on the same level as the keyboard. Try to learn using the mouse with both hands and alternate between them.

There should be adequate space under the desk for your knees, thighs, and legs. The legs can be easily moved and stretched.

🎯 Be aware of your posture while working. Avoid bad posture even if it is easy in the short term. Learn and practice good posture so that it becomes a habit. Take the service of a physiotherapist or ergonomist to get professional advice if needed. You can also search on the internet for specific advice for your particular job or working condition.

 Lastly, if Pushpa was the resident of Dr. Sampath Kumar he might have said something like this: 

Professor Sampath is my Guru's name

This disciple will not bend

 NB: This is not a scientific article. Please verify the facts yourself before trying anything.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

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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. 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 NMC and other Board norms.

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NB: This is not a scientific article. Please verify the facts yourself before trying anything.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

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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. 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 NMC and other Board norms.