Tuesday, June 22, 2010

Boot ka sattu!!

Nine year old Ashok Bhuiya was brought into the outpatient gasping for breath.There was a history of snake-bite and he was unconcious.As soon as he entered the ACU we intubated him and put him on the ventilator and then went on to treat his snake-bite symptoms.Normally snake-bite with neurotoxic features respond quite fast to rapid resuscitation,so much so that after the bolus doses of ASV and the support drugs they often get up instantly and throw off the endotracheal tubes-I have seen quite a few of these cases.Ashok Bhuiya however was an abberation.His vitals were holding ,he was delirious and his sats were not too good.
Even after the full dose of ASV ,he continued to struggle for breath so we kept him on the ventilator,overnight.The next day in the morning i noticed his level of conciousness was good but he still did not have his breathing back.After disconnecting the ventilator for a while and encouraging him to breath on his own,after ten breaths or so he asked to be connected back-I did so with a strict instruction to the ACU nurse to start weaning him off the support.The third day in the morning he was off the ventilator,extubated but still had ptosis.He was a portly nine year old .I made him sit up on the bed and gave him a glass of water and asked him lightly what he would like to eat for breakfast!
His response was-'boot ka sattu'!Needless to say I was taken aback by his specifics.When I visited him during lunch time I asked him what he had ultimately got for breakfast and he gayly answered channae ka sattu!I was a little amused and was gently teasing him as to how he had not got what he wanted...he gave me a blank look.That was when someone informed me 'boot' was a synonym for channa.
Eversince his response of'boot ka sattu 'has been haunting me .All power to little Ashok Bhuiya!

Saturday, June 19, 2010

I pray for you Palaumu!

Today the boys on their daily round of the blocks for tuberculosis work were narrating an incident of cold murder in bright daylight.Apparently an old score had to be settled and so a young man was tied up with a rope at all angles and dragged across the tough Manatu road behind a motor cycle-the man apparently died!I thought such things only happened in hindi movies.By the time they reached the place the area was infested with police personals.
This is a tough world in tough times.This is Palaumu for you living up to it's reputation of being the 'bloodiest district in India'.
Eight years ago when I was posted to Tumbagara that was how I had been introduced to my destination of work.That was the only information I had about the place peppered with heavy advices to decline the offer.Much to the chagrin of all involved my leading was clear.I don't regret my decision one bit even as I get ready to say adieu to the place and all the memories I have of the place.
I would have become a lesser person had Tumbagara not happened to me.
I pray for you Palaumu!

Photographs and memories!

Grace,Vikram,Angel and joshua are here in the campus for a day.
What a joy it is to have your old friends around.
Everyone is as we were -more mature perhaps but exactly the same.
We sat,we talked ,we bullied each other to high heavens and we did what we are best at 'just being friends!'

Friday, June 18, 2010

An awakening!!

Deep from the recesses of my mind I dig back fourteen years in the retrospect,a medico trying to make sense of a culture so foreign to the one I was brought up in.It was the days of intense heat,mosquitoes,ghugnis,rickshaws and manjula the maid who was forever on the tree-top.Sitting out on metal beds to get that whiff of a gale that frittered past ,watching,waiting,chatting,living a life so different and yet so enlightening.
The smell of formalin reeking through the perspiration of the fifty heads poring over a dead body,pulling a muscle here,a nerve there,memorising,agonising over some nameless body parts.
An illiac bone used as a sun-shade,femur a support.....it went on...it never seemed to end.The day I could chuck the bones was the happiest day of my life and the night before the anatomy exams the most harrowing.
What kept me going were those poetry sessions that could flourish where-else but bengal-it was a life-line indeed.Nothing was spared,not the mosquitoes,not the rickshawpuller,not even the dead bodies that lay on the dissection table!
I remember Deepak Vohra,the kindly breakfast show host in Doordarshan, which then had monopoly over the television rites, reading my poem out in the national television.I just loved the man .The last I heard ,he was in news for some diplomatic wrangle at the airport!
The poem was titled'Awakening' and it was about mosquitoes!
Now I seem to have lost the words -I have those diaries somewhere-a part of my growing up years.

Thursday, June 17, 2010

INTENSE PALAUMU??

i was just chatting on the net with my sister when she asked me what's with you these days! i found myself subconciously answering her-'nothing much!just relishing the last few days of 'intense Palaumu'!.
Intense Palaumu!!-why did i write that?
That has sure set me thinking.I need to mull over it a bit.

TIME CHANGE!!

Went to visit a lawyer in the courts in Daltonganj-Layers and layers of papers and people -jampacked in a room where every other person can eaves-drop on what is discussed.The black-coated entities chatting,watching-beady eyed,chewing paan(I dread this!),writing the clerical languages in pile after pile of worn-out files.
The case in hand was discussed ,even as I started dissecting the case and putting forward the relevant points,he kept butting in to say'that is what I am going to argue in court!'
I wondered if I should fight the case myself!
The case against the institution seemed extremely flimsy,the opponent hardly one,but a case nevertheless!
Somewhere in the process of getting things clarified ,it struck me that three years in the administration had indeed changed me.Who would have thought i would be so comfortable discussing a case in a court-house with a room full of beady-eyed,pan chewing babus watching your every move !
My father would be surprised!

The Rain.

The monsoons came two days too late this year.
I looked up to the skies in desperation for that flurry of dark clouds that precede rain...
There were patches every where-we would but gear up for the rains at night and a gale would blow it away.
We started praying...and we looked up to the skies in expectation...the first day...the second day ,we the officers did a cooperate prayer...no rains still....the third day we prevailed in prayer and left it to the lord...the rain came and oh it came....eversince there has been continuos mercy falling in gallons...steadily...cleaning the skies,trees,ground and our thirst parched souls.I actually cannot get enough of it.Even at the middle of the night I find myself cocking my ears to make sure that the sound I hear is that of the water on the roof...steadily hitting the roof,....falling ,falling,falling!
I put my sleepy head back on the pillow satisfied that it is raining.
Oh the simple joys of answered prayers!

Sunday, June 13, 2010

It's hot ,it's dry.....and we haven't even prayed for rains.

It's touching 48degrees and there is no sign of rain.We saw the clouds gathering in the distance ,a gale came and blew it away-it rained cats and dogs an hour away in Latehar-Palaumu remains hot and dry to the hilt....we hear theories and more theories-even Delhi had cooled down to 26 degrees when I last left it.The cut off date normally is the 15th of June ,the thirteenth is over ......today Muani was telling me how dizzy she felt in the church.I did too in my house,i did not dare venture out,not even to the church.I was feeling hot even as I poured cold water over myself...I tried to lull myself into sleep to tide over the day because there actually was nothing I could possibly do in that weather-the pillows were dripping wet with sweat-the floor immediately after a cold water swap was radiating heat at all angles-having pulled the curtains down,I couldn't put the lights on because that would have meant more heat!
The congregation hasn't even prayed for the rains yet!strange I must say!

Thursday, June 10, 2010

Doctor,have you had a knife on your person ever?

I had never had a surgery in my life.
I have done plenty of it inspite of my not choosing it for my speciality.
I have enjoyed doing them.It gives clinicians a certain high-just the feel of.......being in control...having the ability to open up a patient and setting things right...and closing them and presto! they actually walk out of the hospital almost normal!
This time God was kind enough to put me on the other side of the knife.
I went through the entire procedure but somewhere along the time when I was moving towards full recuperation I felt a strange sense of humiliation-my grouche was-when God had made me perfect in his image,why was there a need for man to put a knife on my body?I never knew such a feeling even existed-it was a revelation,a step towards empathising better with my patients and understanding Isaiah 53:5 better.
When one of my relatives had an attack of appendicites ,he hesistated a lot at the prospect of going under the knife I overheard him say'but I have never had a knife on my body before'.
I found myself telling him ,there is a thing or two left for you to learn -go through it ,it is a growing process!
However he is not a doctor.

Lead me home...!

Its but a month more and I am out of this place called Tumbagara in Jharkhand-now the reality of it is beginning to strike me.I look at ordinary people I have worked with every day,people I have struggled with,people I have lived with every day of my life and I feel a strange sense of sadness ,their lives have cut into my life deeper than I actually thought possible.It's been nine years of actually growing up to the realities of life like responsibilities,work,struggles,joys,friendships,pain,faith,companionship,sickness,healing and even a surgical scar!
I have connected to the people ,to the ministry of the place and yet I am certain I am to move on now-inspite of the pain I feel at the thought of leaving all the people I have, by God's grace, learnt to love- there is a strange sense of peace and a certainity that it is time...
'Precious Lord take my hand lead me home...'

Sunday, June 6, 2010

The Check-list Manifesto!

Over the last few months,my mind has constantly dwelled on the quality of work we do.
I find myself perpetually pressed, trying to barely manage or make do with the kind of work I have no interest or a knack for.For all practical purposes it works...things run and life goes on...most people are happy except me ,I find myself getting a bit restless.
I find myself increasingly cautioning my juniors against cutting corners while doing procedures and things,because one fine day you wake up to realise that while doing so, we have compromised on quality as well.Classical example is making diagnosis in rural hospitals without relying on investigations being done in the laboratories,because for whatever reason we find the results are not reliable,the diagnosis is fine patients get better but the juniors who work with you begin to think that it is the norm.
Atul Gawande's'The checklist Manifesto' comes as a breather.
It talks about using checklist for the most simple medical procedures and has datas to support the difference it makes in the patient management out-come.
I am not exactly a check-list kind of person-however I agree with Gawande when he says,the idea of having a checklist is to get the mundane out of the way so that we can concentrate on other abberations that might occur.
It looks like an ideal way of minimising all the iatrogenic complications that pop out when we do our audits.I liked the book.

Friday, June 4, 2010

The language that I cry in!

Tehelka,where my brother-in-law edits the print had carried a story on a naga lady who is cut an album which went on to win a lot of accolades in the music scene.This is a lady based in new-york and the album has some lovely numbers which reek of home sickness.Apart from a number titled 'Kohima',there is a number called 'the language that I cry in' which has the naga traditional wailings for the prelude.
My sister was just sharing with me about how when she gave birth to her litle one in Sydney,at the height of her birth pangs,she found that she had reverted to her mother tongue while expressing her distress.
In all of us is an impending deep longing to find our way back home.The question is how many of us actually do?-for wasn't it St Augustine who said and I quote-'"God, you have made us for yourself, and our hearts are restless till they find their rest in you."

Thursday, June 3, 2010

Hey -What's going on?

My brother-in law was in town.He made a trip to Lukhnow and La-Mart's.He has some good news.The school has been declared a world heritage site and heavy repairs are on in the campus.I am glad it is happening.
Jammed up at a good friend of my sister's(Asenla Jamir) in Delhi yesterday night-felt strange-had seen her when I must have been around seven or so and she remembered every detail of those days-had a lovely dinner with the lovely lady-who sang to us a lovely rendition of 'hey what's going on'by Non-Blondes.They all seem so much in it although their whole batch is touching fifty in a couple of years time.So much for lasting friendships and beautiful people!-They are like good wine maturing and more priceless with age!
In the mean time I still have not got over the Uttraula haze-People come and people go but they leave behind a portion of themselves with us -there is a trend with the Uttraula public.Everyone wants to conceive-God knows why?Couples pushing fifty come into the OPD requesting to be treated for secondary infertility.If you ask them about the number of alive issues without batting their eyelids they will say 'none'-Read-seven girls but no boys!
Girls do not count as issues here and this is UP-the highest populated state in India.Family planning programmes fall flat on the face -this is frightening by any standards!I still mantain that UP has the highest number of elites in the Indian scenario yet each time I get a chance to have a look at the health scenario in the state I shudder to think of the impending crisis the state is running into -and the spill overs one can expect from it!Jharkhand with all it's poverty ,political problems and novelty of being a new state seems so much more in control!