Spotlight!

A friend of mine recently underwent the resection of a benign pituitary cyst. When I had first told about trans-sphenoidal surgeries (endoscopic surgeries through the nose), he was completely incredulous. I followed him through his various states of disbelief, from diagnosis to post-resection. Two weeks after his operation, I was glad to see him perfectly hale and hearty. We had a good laugh as he described what went through his mind on the day of the surgery. It is hard to be a patient, I guess. My father underwent a cholecystectomy (gall bladder removal) a few months back. He removes at least 4-5 gall bladders a week. According to his surgeon, he had 20 suggestions, till the anesthesia knocked him off! I wonder what Dad was thinking. I bet thought of everybody ..from Kocher to Gall!This is what M was thinking..

As he lay waiting for his surgery in the oh-so-severe sterile light of the waiting room, M was thinking of lots of things. Dr. K had returned from a wonderful vacation at Europe. What if...what if... he left his skill at the golden sands of the French Riviera? Just hypothetical, but what if? What if he comes, drapes him, sticks the endoscope up his nose, and says he does not feel like doing it today? Will he lie down here another day, thinking of hypothetical situations again? Will insurance cover this day? What about the drugs? He has to take leave again... Oh no...that would mean no more PTO, no India trip this year..Oh well.. lets think a little differently. California is so prone to earthquakes. What if just when the snare grabs his cyst, there is an earthquake measuring 9 on the Richter's scale? And the fateful shake of Dr. K's hand pulls out half his brain. May be one fourth.. well more than required, what function am I going to lose? Is everybody going to leave the room after the earthquake with the endoscope sticking out of my nose? What if the anesthesia wears out? What if they give me too much of it? What if they cant take out the tumor and they have to drill through my skull? Where would they break my head? With what ? Chisel and hammer?? Oh Gawd... electric saw? How would they cut the scalp? Will I have incisions like Aamir Khan in Ghajini? What about Short Term Memory loss? What if I forget things? What if I don't remember things? What is my wife doing? What about the actual things that Dr. K said that could actually could happen. I am reasonably sure he cannot predict earthquakes. Blood transfusions? Why?? Will I be on hormone replacement for life? What if it grows back? Another surgery??

Well here's my turn! White lights, big white lights. When I close my eyes I can see UFOs. Open eyes. Big white lights. Close eyes. UFOs. Yes, I am M. How am I doing?? What do you think Ms. Nurse? How would you be doing if you know they are going to pull a piece of your brain through your nose? Oh that's the anesthesiologist. I hope he knows what he is doing. Has he done this before? How many times? What's that white stuff in the syringe. OH MY GOD! That what Michael Jackson died of. Is that what it is? What did the New York times say about that drug? Something with P, I think. Did he just say that we are going to put you to sleep? Wait a minute. May be I should ask him whether the drug is safe. Is there any substitute? Billie Jean... Home... My wife... little sleepy...

*%$#! The pain! My head! Its screaming. The lights are a little bright, recovery room I think. I better close my eyes. Am I going to puke? Oh yes I am. Stop slapping me, you.stupid nurse.... I am alive and slapping me is just not going to anyway help. Yes I am M. Where am I? Is this the time for this? Somebody get me something to vomit into. I will just lie still. And please, somebody make this nurse shut up. The time? How audacious. Can't she just see the clock? She wants me to tell here the time? 3-4 in the afternoon I guess.........aaah,< puke puke ..puke>... Good God! My head! .... I want to sleep.. when do u get me out of here... Clearly, not now.

It took him a week to feel better. Walking to the bathroom was like climbing Mt. Shasta! He took painkillers with morbid fear. Dr. K. had almost convinced him that more than 2 tablets and he will need a liver transplant! It had taken some amount of explanation that he needn't writhe in pain for the fear of a liver transplant! He feels fine now and has started working almost as hard as ever, to his wife's dismay. He had new views on the need for health care reforms. The cost of the surgery was S132,000 which he is still not able able to believe. Thank goodness for insurance!

The Unbearable Inertia of Being

There is an inertia in everything I do. For starters, when I get up in the morning, irrespective of the time I slept, I need 5 minutes more (more often than not 5 minutes here can be up to 30 minutes; depends whether it is a weekend or not). There is different kind of inertia when I comes to write blogs. It can always wait for 5 minutes more (more often than not 5 minutes here can be up to 6 months!). Does that mean that now that I am writing this post, I will tend to write it for a long time? Maybe not.

The inertia of rest is what is unbearable these days and dominates my life. The presence of inertia of motion has not yet been detected, though there is definite sense of yearning. There is lot of peace in doing nothing. I am trying to wonder aloud: what happened? Where was it that I went wrong? There used to be a time; where there was a need for 10 things to be done at one time, a need for anarchy. These things often included 10 chapters to be finished from 10 different subjects! Nowadays I have deadline, but I can't study. I have stopped seeing the awesomeness in random trivia. It does not interest me anymore, that the technical word for hiccups is singultus. Heck! why bother, I will never use it anyway.

This blog is now a therapeutic effort to revert back to normal; an effort to see awesomeness in totally random things again, an effort to get back that anarchy I used to call life :)

P.S. Gawd! I miss the hospital !

Delhi 6

I lived in Delhi 18, went to schools in Delhi 58 and Delhi 22, hospital in Delhi 1 and still do most of my shopping in Delhi 1 and 27. However, I had never before referred to Vikaspuri, Janakpuri, R.K. Puram, Connaught Place and Rajouri garden by their pin codes. I saw Dilli-6 yesterday, where everybody referred to Chandni Chowk as Dilli 6. I think if I tell the auto-wallah to take me to Delhi 6, I think he d say “O Maaaadam, naye ho kya…kaunsi jagah jaana hai ..Sonia Cinema? (O Madam, Are you new here? Where exactly do you want to go …Sonia Cinema?)”!!!

Before the onslaught of multiplexes in Delhi, the innumerable PVRs, we used to have normal theatres: Sonia, Payal, Priya, Anupam etc. , all of them are now PVR. But the auto-wallah, the bus driver and the rickshaw- wallah will still call them by their original names. Near PVR Naraina, the bus stop still says Payal. Similarly Connaught Place is still called by its erstwhile name and not Rajiv Chowk. RML hospital is Wellington, LNJP Hospital is Irwin and AIIMS is Simply Medical. But Chandni Chowk has never been Dilli -6!

Delhi-6 to me meant a yearly excursion to Chandni Chowk for my textbooks. Little shops, I think just about the size of the kitchen in this studio apartment line ‘Nai Sadak’, a famed by- lane of Chandni Chowk where you can find every medical book printed in English (at least). Nai Sadak literally means ‘The New Road’. The new book is however just one of Nai Sadak’s specialties. Books that have exchanged hands once, twice, thrice to those that have been around for a few decades are all here. So are Xerox copies, pirated copies and cut-and-bound copies! I once saw an old, but well-loved copy of Boyd’s “Pathology of Internal Disease.” It was a 1940-something edition. That’s where he would have written “Rheumatic Heart disease licks the joints and bites the heart”, something even the dumbest medical student in India knows. I guess Boyd had two great loves: English and things that “blew life’s little candle”!

It would appear that the shops at The Book Market have no walls. The shelves that line the wall would be packed with books, vertically and horizontally and somewhere there would be a ladder that would lead to an attic. The attic I believe has floors to store hundreds of volumes on medical sub-specialties. That is where one would find Kaplan’s Cardiac Anaesthesia, William’s Endocrinology and the likes. The shop typically has the owner, who probably graduated in commerce (through correspondence), his aging father (who bequeathed the shop to him) and a couple of shop boys. Any boy, who works in any shop in Delhi, is called Chotu. Chotu 1 stays up in the attic. And let us say you ask for Rook, and lo behold as if by magic four huge volumes of dermatology would descend from the attic, into the owner’s perfect grasp. The standard digests of the medical student, the Ganongs, Harpers, Robbins and Shaws, were generally within his reach. And if by chance he doesn’t have a book you asked for Chotu 2 will run around and just find it from somewhere. Then, you would need to ask around in a few shops, to get a general idea about how much you can bargain for, bargain a lot and finally strike a deal after you get at least a 30 percent discount from the original price.

The Lange books got bigger and more colorful with every passing year. Katzung’s pharmacology changed editions so fast in my 5 and ½ yrs of college that I wondered how many drugs they added in these years. Coming to think of it, my edition did not have Nevirapine :). The pages of Harrisons’ got gossamer thin, and Bailey and Love was bluer than ever. The last book I bought there was First Aid to Step 2 CS for Rs. 350 ( after 20 minutes of good bargaining; to get the price down by Rs. 150) . It retails at $ 38 at the UCSF book store (and you cannot bargain there)!

Trips to Chandni Chowk before the Metro were arduous. As soon as you enter Delhi Gate, one of the gates of the Walled City, traffic just inches, as if jinxed. After almost two hours, at least two scratches on our car and after my Dad has used every expletive in his substantial dictionary, we would reach the sprawling parking lots of Red Fort. Finding parking is just a minor ordeal. Chandni Chowk has one main road and numerous by-lanes form a giant maze around it. Only a talented old Delhi cycle rickshaw wallah is the Theseus who can take us to our Minotaur!! Every by-lane (gali) has its speciality: Nai Sadak for books, Parathe Waali Gali for hot, fried parathe, there is one that sells clothes and one that prints wedding cards. My father’s destination is the one that sells surgical instruments. Every retractor, speculum, needle-holder and forceps ever created; catheters, cannulas, vacutainers, needles and syringes; trolleys and trays; tables and lights; they have it all. This is the only place where my Dad shops with the same fervor that I have at Macy’s before Christmas. Once, my Dad’s Maryland dissector refused to open its jaws. He went to find a replacement and came back with a few trays, an autoclave drum, an array of forceps and retractors and even green and blue linen. He was totally in the mood that day. He had this faint smile as forceps closed and ratchets made that sound that generally meant “secure” in his OT. That is when I managed to convince him to get me the maroon Littman :).

10 Stupid Things I did in college

1. Cried myself sore and stayed back in room, after I flunked the Physiology "Part Completion Test" (also known as PCT...duh) and thereby missed "The Grand Opening of the skull". (seriously how many times in your life do you open a skull with a chisel and hammer? Plus, I never had or will have intentions of becoming a neurosurgeon, or perhaps an African witch doctor!)
2. Fell in love with Biochemistry ( its okay if you roll up your eyes). It was just infatuation!
3. Hid from Dr. Venkatratnamma whenever I wore jeans.
4. Came (first), saw, and conquered the varicose veins case....totally uncalled for...all the tourniquets we tied and removed we could never figure out where the perforator was.
I even got him tomato bhaat from canteen.
5. Took notes in Dr. Srikantaya's class.....
6. Tried to study pediatrics from Nelson ( so uncalled for..) . My only achievement in pediatrics probably was mugging up and retaining fluid-electrolyte management. Considering I hoped to pass pediatrics with my internal medicine knowledge, Nelson was so not required.
7. Probably drank 8-10 cups of bitter, strong coffee everyday. Coming to think of it I drank more coffee than water and spend a small fortune on it.
8. Wore those ridiculous dresses just because I did not have to iron them !!!
9. Tried to have intelligent conversation in a Community Medicine class....(so hopeless).
10. College trips I undertook: to be counted amongst the most embarassing mistakes of my life.

The Dissection of Anatomy.

This is the most paradigmatic anatomy diagram. It would be in the back cover of 'foreign' anatomy books. There were a handful who tried to even read them, most sane people giving up in a month. In my opinion though, the most appropriate use for them would be weight lifting. 'Gray's Anatomy' is the most celebrated anatomy text. For those of you who are thinking when was the book on Meredith and Derek's romance released, Gray's Anatomy is a big fat boring book. Its a GR-A-Y and not GR-E-Y. if it is of any help. The height of hotness in the book is 'The Vitruvian Man' not McDreamy. In med school, no prof looks like McDreamy, most of the are more Nazi than Bailey. And inspite of poring through books all day and night, no one knows answers in rounds (unlike Yang and Izzie, who in four seasons have never studied, they have very laborious love-lives though)

The text which I studied and almost all medical students in India have studied is B. D. Chaurasia's Textbook of Anatomy. Small red volumes, three of them, just giving you what is important. I used to still mark the very important and when time is too short, very very important questions and read them. I would have never been Henry Gray's favorite pupil. Heck! anatomy didn't even impress me. For most medical students, anatomy is the First Year. Physiology (in my opinion a more conceptual subject) was a mere appendage and Biochemistry a distant cousin. Everybody loved anatomy; I loved a certain boy in my high school bus. Everybody has problems, I guess. Girls in particular ( always if the characteristics involved are weird, it must be associated to a girl). In my hostel, girls used to read anatomy in the morning, pre-prandial, post prandial, in evening and at night. There was no time in the day, girls in junior hostel would be found to be indulging in any mundane activity. The erudite lot studied anatomy, making Henry Gray twist and turn in his grave. My attention span with Anatomy was forty five minutes, and retention power was one day. why bother cramming so much, if I am going to anyway forget it anyway.

The cardinal part of Anatomy instruction is Dissection. We used to have two hours of Dissection everyday, after lunch, at two o'clock. At that time of the day, interest in education was grossly depreciated and what was required was a good siesta. The dissection hall didn't have stools, we stood all the time trying to read Cunningham's Manual. All volumes of the book should be included in non-pharmacological treatment of insomniacs. May be they should start a cohort study with the new batch. All of us were a persevering lot, always looking into the book, though never registering anything. The art of dissection was practiced in beginning of chapters. We used to dissect so wonderfully, that nothing was left to study, no nerves, no arteries, no veins. Gradually, love stories blossomed and idle talk increased, interest in dissection as a process became sporadic (very much like my posts). There were academic high points though: study of the mammary tissue (distributed to all tables with male bodies, like gurudware ka langar), study of the eye (cow's eyes provided for better understanding; likened to my friend Divya's eyes); the grand opening of the skull (which I missed, because I was crying in my room when I flunked physiology. Hey! even I am a girl) and maybe study of the male external genitalia (somebody stole a testis; as if he could attach it!).

I somehow passed Anatomy, by making 'colorful diagrams' in theory and by blinking rapidly and occasionally making an intelligent statement in the viva. I do not have to go to Anatomy class in future, I fervently hope.

PROLOGUE

There are various ways to begin a paragraph: in an essay, review, speech or any of those write-ups which were common place in school. I am writing an article or any sort after a very long time (my unfortunate readers would thank God for minor miracles!). When I was in kindergarten the writing assignments invariably were to the likes of 'The Cow' and 'Our Country India'. The common beginnings therefore were: 'The cow is a mammal.' and 'India is a beautiful country',respectively. One of my teachers, being in retrospection, rather Laloo- esque, even made us write " The Cow is our holy Mother." My Mother was not very pleased as this intrusion into her motherly duties. It resulted in the change my primary school.

As we grew older and as I adopted my new missionary school ways, beginnings of essays changed substantially, but changed into a different cliche. Class 4- 8 was the era of quotes. ' No man is an island entire of himself.'( I used it so many times that John Donne would have twisted and turned in his grave). 'The quality of mercy is not strained.' But I showed no mercy: quotes, cliches, aphorisms galore. The ten mark essay would yield at least a seven. The English teacher would be impressed. She would make me read my essay in class. My peers (also known as competitors, sworn enemies, currently known as old friends) would snub. One would say his 'Dream the impossible dream ' was far better than my 'Hold fast to your dreams'. The other would take answer sheets for comparison. We used to just write eight letter words. Then we started speaking in eight letter words. One of my classmates had started saying 'Greetings' instead of 'Hi' as it had nine letters. He would then take our permission ' to inflict his company' on us. (Sigh!!) Our teachers would talk in the staff room about the 'healthy' atmosphere of competition in class. 'Constructive criticism' was a commonly used phrase.

Ninth and tenth were different. We developed our own styles of writing. Plagiarism was common. But, we all had distinctive styles. Eleventh and Twelveth: ready to experiment, more mature in expression, puns and euphemisms being the latest fad. Unfortunately (fortunately, for the English teacher), nobody had the time or the inclination to write. Time passed, creative writing started getting restricted to those answers in theory papers in Medical School. In my final year of medicine, creative writing in exam papers had reached its pinnacle. My three page answer on pelvic injuries had captured my imagination, would also have enraptured the examiner. Fortunately, I passed all years. My achievements in creative writing were minuscule as compared to those visionaries who showed applaudable originality in answers on Iceberg Phenomenon ( ice is melting-sea levels ) and Sexual asphyxia ( will leave it to your fertile imagination).

I wield my pen again and as I would have said in Class seven: I put on my thinking cap. This time there is no English teacher to impress, no bleary eyed audience to 'inflict' my speech on, no classmate to eclipse (damn!). This is just succor of my VEXED!!! mind. May be I ' ll throw in a quote or two. (Heck) 'Life itself is a quotation.' ( Jorge Luis Borges ) Blastoff! [;)]