The Missing Needle: Sweet Medicine – Bitter Coating

                Intern Dr. X was posted in Casualty (The Accidents and Emergency Department) during his internship posting in AIIMS, New Delhi. This is the same intern doctor whose adventure, ‘The Mystery of the Retained Urine’  some of you may have read earlier. http://agnipathdoctors.blogspot.in/2015/05/sweet-medicine-bitter-coating-mystery.html

A young lady came to Casualty with a needle accidentally and embedded in her foot. Dr. X independently attended the patient. He got x-rays done which showed the position of the needle inside the sole of the foot. He took the patient to the Casualty Operation Theater (OT). 

After giving local anaesthesia and making the area insensible to pain, he made a cut (incision) in the foot just above the position of the needle, as seen in x-rays and started to search for the needle.

       

     After 5 minutes he did not find the needle, but he was not worried and the patient was lying comfortably. After 15 minutes, he still had not found the needle. He started to get worried. The patient started making sound of discomfort. After 30 minutes, the needle has still not been found. 

Dr. X now became worried and beads of sweat appeared over his forehead even in the cool winter of Delhi. The patient also was now squirming, moaning in discomfort and repeatedly asking him when the procedure was going to be over. After 45 minutes, Dr. X decided, enough is enough, and it’s time to face the music.

 

            He sent a message to the Surgery Senior Resident (SR) doctor, regarding his position. The Surgery SR become very angry that he has taken up a patient with foreign body for exploration, without consulting anyone, a procedure that is even difficult for senior surgeons. Since there was great rush of patients in the Casualty, he asked Dr. X to come out and see the patients in the Casualty and Dr. Dev (fictional name) the surgery junior resident to assess and try to remove the needle. 

            Within 5 minutes, Dr. Dev sent the message that the needle was out and he was now cleaning the cut and putting stitches.

Dr. X was simply amazed. He asked Dr. Dev how he was able to find and remove the needle so fast, when he has failed after trying for 45 minutes. 

            Dr. Dev just gave a mysterious smile, made a comment regarding ‘magicians never tell’ and kept quite. Dr. X impressed, amazed, baffled, puzzled and flabbergasted and lots of other things, to say the least.

            What happened was, Dr. Dev went inside the OT, and he checked the x-rays of the patient. From this he decided the best way to approach the needle. On inspection of the patient, he found Dr. X has given the skin cut, in the best possible place, right over the needle. He started exploring the wound through the same skin opening. To wipe the blood from the wound, he started to lift the dressing pad (made of cotton and gauze cloth) from the instrument trolley placed near the patient. 

When lifting the pad, he felt a prick in his hand. To his surprise, he found the needle lying entangled in the dressing pad. 

Most likely, after giving the skin cut, some amount of bleeding is expected and must have occurred. While Dr. X was wiping the blood from the wound with the gauze pad, the needle must have got entangled in the pad. The needle got removed while lying entangled in the pad. Dr. X failed to notice that the needle was out and was searching for the needle in the wrong place in vain.

            Never undertake any intervention without informing your seniors and their advice. This may be minor operation as in this case or handling a major project in your case. 

When in doubt get help early. It is better to risk looking a fool, then to be proved a fool. Which you will look after you foul up something important. 

When you have looked in the obvious place then look in the not so obvious place. When the obvious solution is not working then think of applying something unusual. The history of science is filled with examples that thinking in different direction, people have made new discoveries, inventions, etc, when other people had reached a dead end

(Based on true incident)

— NKD

© Author. All rights reserved. 

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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The Mosquito Identity

Despite their small size, mosquitoes are a large problem in developing countries like India. There are more than three thousand different species divided into forty genera (types) of mosquitoes. Many of these mosquitoes are important from medical point of view as they transmit many diseases such as malaria and dengue. 

Different mosquitoes transmit different diseases and have unique physical features, breeding and feeding habits. These differences are important to form strategy to prevent the spread of disease transmitted by these mosquitoes. Therefore, from a Microbiologist (part of medical science dealing with the diseases causing organisms such as bacteria, viruses and parasites) identify the different types of mosquitoes is very important. 

Identifying the three commonly found types of mosquitoes, Anopheles (transmitting malaria), Culex (transmitting Filiarisis) and Aedes (transmitting Dengue) is part of the curriculum of the MBBS students from India.

Anopheles mosquitoes can be distinguished by long palps and presence of discrete blocks of black and white scales on their wings. Culex mosquitoes have short palps. Aedes mosquitoes can be distinguished by the black and white markings on their body and legs, leading to the name ‘tiger mosquito’. But indentifying these features requires close careful observation with the aid of magnifying glass.

In the Microbiology practical exam, of AIIMS, New Delhi, there was pattern of spots. Instead of the conventional practical examination pattern, the examiners have made different exam stations. At the ‘spots’ or ‘stations’ different specimens, culture medium, slides, etc are kept with printed questions besides them, such as what is this organism, what disease do they cause, etc. The students stand at different stations, read the question and write their answer in the answer-sheet. After a fixed interval, say 2-3 minutes a bell is rung and the students move to next station, and so on.

Student X was standing at one station. Being a fast examinee he finished writing the answers at his station well before it was time to move to next spot station. The next station adjoining him was vacant. Feeling bored, he glanced at the small specimen bottle, the magnifying lens kept near it to examine the specimen and the questions printed in large fonts next to it, at the adjoining empty station. A microbiology senior demonstrator was standing near him as invigilator. The spot being vacant, he did not object to Student X’s roving eyes. 

The questions at the adjoining station were: (i) Identify the type of mosquito in the bottle (ii) write the disease transmitted by this type of mosquito. 

Quick as a flash Student X correctly wrote the type of mosquito and the disease transmitted by it. On seeing this, the microbiology senior demonstrator got shocked. He demanded from Student X, ‘People require magnifying glass even when examining this tiny mosquitoes from near. Tell me, how did you correctly identified the type of mosquito from so far away?

Smiling mysterious Student X thought discretion is indicated and just kept mum even on repeated questioning from the demonstrator. 

Do you want to know the secret of Student X’s combination of telescopic and microscopic vision power?

When Student X was attending the microbiology practical class, he, like his other classmates had learned to identify the types of mosquitoes depending on their body markings, etc.

In addition, as an insurance against inability to identify the minute differences between the type of mosquitoes in exam, they have also noted and memorized that: round specimen bottle with one mosquito in it is Anopheles, round specimen bottle with two mosquito in it is Culex, rectangular bottle is of Aedes. 

So, looking at the shape of the bottle and the number of mosquitoes, Student X was able to guess the type of mosquito and correctly write it down from so far away. 

Identify and memorizing specimen bottle characteristics may lead to better marks, as long as the examiner don’t wisen up and change the bottles between the practical class and exam.

(Based on true incident)

— NKD

© Author. All rights reserved. 

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 and  Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

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