Saturday, September 29, 2012

The last few days.

The last few days have been hectic.The last but one day to my off week I was hit by an onslaught of cardiac patients.If you were to ask me I love cardiology.It is my favourite subject.I have managed so many cardiac patient's in my life and yet when it comes to managing patients here one likes to follow the local protocol.So fondiparanex comes into the picture.I remember ,during the herbertpur days ,there was a medical representative who used to drive us up the wall trying to promote fondiparanex.The moment we used to see him we used to run off .
So our patients rarely got fondiparenex,thanks to the MR.
I am hand writing each and every protocol into a notebook even as I come to it.I think it is basically following everything to the book since every type of investigation is available.
Today I wrote minutest details about paracetamol poisoning.
I got a local mobile sim for myself.Washed a whole pile of clothes,went downtown and watched basildon enjoying a saturday in the town centre,went in for a cold drink into a restaurant and decided to order coke float.I seriously thought we had invented coke float in one of the ice-cream shops in Bankura during our medical college days,almost more than fifteen years ago and lo here it was in a restaurant menu.I had to take a snap and the owner turned out to be a Guju from Nairobi.As soon as he heard that I was from India he offered to refill my glass with coke.I thanked him but declined the offer of extra coke but requested him to take the snap nevertheless.I am beginning to think Basildon is filled with Gujaratis.Every stone throw away I meet one of them. The closest I  have been to meeting so many gujaratis in a row was when I boarded the early morning train from Dehradun to Delhi.Ten minutes after the train reached Delhi,yours truly woke up.I was struggling to drag my battered suitcase across the train corridor when I realised it was a hopeless case.A whole file of extra healthy men and women in shorts,dragging in expensive looking suitcases,smelling of money were standing in the corridor all the way to the door.The train was Gujarat bound.Nobody lifted a finger to help me but reluctantly made way for me to deboard since there was a locked-in situation.
This gentleman however went out of his way to be nice and helpful.

Precious scraps in my purse.

Am I a wee bit sentimental or what ! I have moved houses ,lost my

purse ,have been through various phases in my life, taken most things under

my stride by God's grace ,but somethings have gone along with me.I keep

chucking old papers,spending old money,wearing out old clothes,even

walked past a lot of people in my life but somethings I hold on to and it

keeps passing the chucking test.

One such precious item is a 10 pound scottish note which has been in my

purse for the better part of the decade.It was the winter of 2006,November

to be exact and I was visiting England for my ERS fellowship

.Christmas was around the bend and I was at the Bink's in


I received my first post in England that year and it was a christmas card

from Scotland fromDr Anne Urquat.This ten pound note was neatly folded

within the card .

I had met Dr Anne Urquat briefly when she visited Satbarwa years after she

left India.I was deeply touched by the thought that went behind that act.I put

that note in my purse and it survived my time in England,moving in and out

of two hospitals and it is here in my purse,a mute statement of a

commitment that was brought forward again this year when during the CMF

meet the host remembered her time as an elective in Kacchwa hospital and

the first name she mentioned was Anne Urquat.My heart was filled with

deep joy and a side of me wanted to fish out that ten pound scottish note

from my purse but instead I just said yes ,I knew her.
I have a few thing with me which have survived the chucking test,I can

perhaps write about them in time.

A week into it.

Gotta get used to the way things are done here.Predictability factor is missing.Every day you are on to something new.I have never been in a situation where you actually get a week off after five days of ten hours week.It is like as though someone is saying ,'have a life!'So it is a lazy saturday morning.I put in my clothes for laundry.Recieved a note from Anu asking me whether she should come by to pick me up for the week-end.
Got to get a few things in order.
I am shifting room this week-end for one.I am trying to get my debit card working.Have not decided whether I want to go to South-end on sea for a day or two just to be away.
One good news was after one and half weeks of sharing a flat ,yesterday I came to know that two of my flatmates are good believers.Got talking to one of them but the other one I must have seen and said hello to her once.She was on night call the first week I came and has been on a holiday eversince.
All believers who live in the campus visit the baptist church round the corner.I was blessed the last week I went for the service.One of my flat-mates apparently attends the bible studies there.
I look forward to meeting her once she gets back.
Otherwise I have a lot of fellow countrymen around me.
A Gujju lady lives next doors.Another Gujju gentleman lives in the oppositte flat and a tamilian srilankan lady lives upstairs....and the list goes on.


Thursday, September 27, 2012

The crucifix.

C has alzheimers.She must be atleast eighty five.She accidentally consumed her husband's medicine and was brought to the A&E.Her husband looked more frail than her, was stone deaf and had to be wheel chaired around but he would never fail to chuckle aloud whenever he guessed that C wasn't talking sense.Sixtyfive years of marriage ,onslaught of debility and the alzheimers to boot had not diminished their deep love for each other.I asked her my usual bout of memory questions.Did she know who the monarch was?She did.She further added 'and here ,next to me is Prince Philip'.Her husband gave another chuckle.In between,I helped her with her tea cup as she was struggling to drink from it.They immediately warmed up and the next thing I knew, her husband wanted me to help her put back her crucifix chain that the doctor had asked her to remove during a procedure.
I was extremely touched by the sense of trust and camaderie and suddenly C started telling me about how much her church meant to her and how she had loved to be part of the choir and how the church was now planning to get back to using latin during the service.
We extended our hands towards each other, the crucifix sealed the deal.
I was touched even as C was oblivious to what was happening.

Tuesday, September 25, 2012

Is what we are doing enough?

The quality of lab services we provide has to go beyond the rhetorics.The backbone of every hospital and clinical pratice is the laboratory .We have to admit that lab services remain one of our weakest points.When it remains weak,slowly the quality of medical services provided become more provisional and we remain limited in the range of medical services we can provide well. We can never think of improving our lab service till by some miracle some specialist pops into our hospital,decides to stay back and the hospital gives it the necessary backing.

It is extremely mandatory that each lab personal undergo one to one evaluation at a regular interval.That keeps one on their toes.

Apart form the quality control measures which apparently has been introduced in all the hospitals ,the lab continues to be a problem area.One time generalised training and workshop for the personals DO NOT HELP.After attending umpteen number of seminars and workshops they go back to the same way of working.One is yet to see a definate change take place.

This same rule goes for every other personal working in the mission hospital.When I decided to come to England for a year of acute medicine ,one constant line I often heard was 'What one learns in England will be of no use for the mission hospitals we go back to.'

I found these statements highly irritating for one,but did not bother to correct them .But the more medicine I learn here ,the more I wonder if I have done justice to my patients in the hospital I have worked in.With the limited facilities available we have done our best but at the end of the day we are talking about equitable health-care.Unless we know what the patients in the first world get, how are we going to strive towards getting as much for the least of us.

We are serving in the name of the King of Kings but we often serve and take pride in the fact that we don't act like it.

Abstinence on a personal front is commendable but not JUST when we are abstemious towards the service of those very people who give us the identity we so seem to covet.The poor deserve the best ,especially when we claim to do it in the name of Him,who is the end of quality,beyond compare.Our utmost for His highest! Do we stand?

Another day in the UK.

Today has been a challenging day.Saw a patient with a florid ulcerative colites flare,a man apart from the steroids the doctor had put him on, was on steroids for body buiding.His bowels were giving him a hard time and he was having rectal bleed with serious discomfort in the abdomen.His CRP was normal and his X-ray abdomen did not show features of toxic megacolon ,stools were sent for routine and Cl.difficile toxins.We referred the patient to gastro on VTE prophylaxis.
The second patient I saw through was a patient on CAPD with CKD grade 5.
She told me that she had been anuric for the better part of one and half years and was on dialysis every night for nine hours.She had come to the regular clinic but had been sent to the A and E because she looked unwell.Her blood gasses and the electrolytes were fine.Her renal parameters looked unbelievable.She had bilateral wheezes with no evidence of fluid over-load.She did have a short history of cough with yellow phlegm for which she had been prescribed Amoxycillin by her GP.The renal consultant came over and took over the patient.
The third gentleman came in with DVT of the lower limb with sudden onset of pleuritic chest pain which was radiating all the way to the back.His troponins were normal.ECG showed LAD with Q3T3.Heart rate of 77/min on beta blockers for HTN.D-dimers were over 4000 and the CTPA showed bilateral filling defects of the pulmonary artery.Well's score for clinical probability of PE was high(9).His ABG showed low oxygen levels.
So a diagnosis of PE was made and the patient put on treatment dosage of LMW heparin(1.5mg/KG) with overlapping dose of Warfarin and the patient was simultaneously referred to the anticoagulation clinic.
Running after and settling three patients is enough work for one day.
I finished work well after my take was over but I felt satisfied,even as I bid my last patient of PE goodnight after a word or two of reassurance.He had been in the army,had seen the coronation of Queen Elizabeth first hand.I get amazed by the elderly.They come through with diseases one cannot even think of and yet even then they are more concerned about making life easier for us.He reminded me of my father.


Sunday, September 23, 2012

The napkin

Today is sunday.The weather forecast says that it is going to rain and it did.I have run out of groceries so I had to pop down to the market to get some supplies.Tescoes-I never fail to get what I want.Even managed a chilli paste.
A senior has offered to take me to a church today at six in the evening.My first in the UK.The weekends seem quite deserted in the hospital corridors.I had my breakfast in the canteen.Five items of hot cooked meal,I chose sausages,tomatoes,a fry made of potatoes and onions,I thought it looked a little over the top but I managed to eat it without getting sick.
Met an old lady on a walker,who swore like a fisherman but was dressed to the hilt,quite spirited I must say.
It did rain as was forecasted.Was waiting for my transport so I sat down at the Wimpy's to catch a hot chocolate with cream and the napkin caught my fancy.


I spent the saturday yesterday with Dr Samuel and family.Had a lovely indian lunch and then drove to Dansbury to attend a CMF meet.Met a lot of people with old mission connections,heard what Julian had to say about what CMF is doing ,spent the afternoon talking about the bees and the weather,had wads of lovely tea which Maggie kept rustling.
By the time it was all over,it was around six in the evening.Saw some cooking apples on the trees,a lovely compound with a garden,lawn tennis court,tree house and what not.Walked around a bit but the chill was unbeatable.There was fire in the hearth.Some more tea.
It was time to say goodbye.
Not the usual way we do our meetings back home.

Friday, September 21, 2012

Have a good weekend Mrs X.

It's been less than a week since I have started working in London.Slowly but surely, the Lord's teaching me step by step,ways to settle down.I have started doing the ward works inspite of the access to the trust clinical hub coming through only on Monday.It was a full day today.Working on the ground.
The first day or two were the days of just watching the world go by.Apart from the system one has to get familiar with,there is a whole line of abbreviations one has to interpret,one can call it the Basildon lingo.The commercial names of the drugs used is the other thing .I run around quite a bit asking questions which is normal for me,my sister often says I take people's trip interviewing them.
It amazes me to see the patient's who come in.Most of them are elderly citizens,amazingly perky with the wisdom of the age who are unusually kind.There are many extremely fragile,like kids,who look at you with lovely innocent eyes.Mrs X turns her head each time someone walks past her door.Yesterday when I saw her it was her daughter she was on the lookout for.Each time someone walked past she would hopefully ask,'Is that you Doris?'Today the question had changed to 'Is that you Paul',and then she further asked me ,'did you see my son?'
I happened to walk past her ward so I just dropped in to say hi.Seeing me with my bag,she asked me are you going home now?I said yes.She has dementia and was brought in yesterday.She was found face down in her house by her daughter.
Even as I bid Mrs X a goodbye for the weekend,I see her comfortably settle down to another bout of expectations,I am not sure who.

Monday, September 17, 2012

Getting to know myself!

Today was my first day of work at Basildon Hospital.
I got my security card made,applied for the e-access,rebooted my bank account,got the feel of the work I was to do in the coming days.
Saw a case of florid sub-arachnoid haemorhage Hunter and Hess scale-grade 3,another case of multiple sclerosis with eye defects(reminded me of a little child paramjit had brought to me with similar symptoms,she completely recovered at that time but my guess is she has MS(although she has presented with the symptoms only on one occassion ),a case of oesophageal diverticulum and the  usual medical cases.
Acute medical ward is an ideal place for reviewing and updating  one's medicine without the stress of A and E or the prolonged management of chronic diseases.
It is also about doing things in an orderly manner,following protocols and a chance to revise medicine.The only thing that appalled me was the one week break we are liable to get every twenty one days.This is the first month and I almost asked my consultant aloud,'what am I going to do for one week?'May be I will have answers for it by and by,but I will really have to learn to face myself instead of trying to hide  behind work and whatever else I hide myself behind.
This time in England should be able to give me some answers to a lot of questions I have about myself.

Sunday, September 16, 2012

The Sanctuary..

Sanctuary is the place you go to,to enter rest.
Basildon has a sanctuary located almost close to the reception ,next to the canteen where counselling takes place.It has been labelled 'all faith room'.
I entered the sanctuary just to have a look around and my eyes fell on the board which had post-cards pinned to the wall with 'messages to God'.It is meant to be the prayer needs.
One read-Dear Lord please help me with my hip surgery and please be with my little son who is going to be at home away from his mother for the first time.Please bless him'
Love K,
Another letter read-Dear God ,please help my grand dad come through this sickness this time round.Help him to hear us and understand us and please look after him whereever he is.
Love E,
Dear Jesus,
Please be with my husband even as he goes through this tough time.
Love Em,
One more read-
Dear Jesus,
Please look after A,B ,C and D even as they have gone to be with you.
I love you.
I sat down in the sanctuary and started my letter to Him as well.

Reading about freemasonry

"...How can we fail to pronounce Freemasonry an anti-Christian institution? .. Its morality is unchristian, ... its oath-bound secrecy is unchristian, .. taking of its oaths are unchristian, ... Masonic oaths pledge its members to commit most unlawful and unchristian acts, deliver each other from difficulty whether right or wrong, favor Masonry in political action and business transactions, sworn to retaliated, to persecute unto death the violators of Masonic obligations, ...its oaths are profane, the taking of the name of God in vain, ...the penalties of these oaths are barbarous and even savage, ...its teachings are false and profane, ...its design is partial and selfish, is an enormous falsehood.

"Every local branch of the Church of Christ is bound to examine this subject, and pronounce upon this institution, according to the best light they can get. God does not allow individuals, or churches, (or pastors), to withhold action, and the expression of the opinion, until other churches are as enlightened as themselves.

"If churches who are known to have examined the subject withhold their testimony; if they continue to receive persistent and intelligent Freemasons; if they leave the public to infer that they see nothing in Freemasonry inconsistent with a creditable profession of the Christian religion, it will be justly inferred by other branches of the church, and by the world, that there is nothing in it so bad, so dangerous and unchristian as to call for their examination, action, and testimony.

"It is almost universally conceded that persistent Freemasons, who continued to adhere and cooperate with them, ought not to be admitted to Christian churches."


I have crossed half the world to come over to the UK but it is like I have never left my childhood behind.There is my family from all the world over on skype watching me,talking to me and making sure I am comfortable.My brother skyped me from Mangan,spoke to my parents,saw them after almost a month or so.Next was my sister from Delhi with my neice and my brother in law.My sister and brother -in law from Sydney were next, called in to check if I was allright on the way to the church.Muani called from Germany,caught up with her for around five minutes.
Early next morning I had but opened my eyes and there was a bleep again.This time it was my cousin from New Zealand,another from Darwin and my sister in Delhi in a group chat pulling me in.
This is the thing about family.The last time I was in a space like this was when the earthquake in Sikkim happened.We laughed the disaster through with all sorts of comic stuff that was going around even while the houses crumbled,people died,sad things happened.All of us stayed in touch.
Suddenly my cousin in New zealand remembered an incident which occured when we were kids.My dad used to take us to the boarding school in a blue city bus when we were kids.This was a public transport.After plying quite a distance my father realised he had forgotten to carry some papers.So he stopped the bus and decided to hike it home the shortest way.He went,collected his papers and came back after half an hour.
In the mean time the bus just waited for him,the public happily chatting  and simply enjoying themselves.This was Mangan!This actually happened and it's amazing how my cousin took it out from the archives of her memory this morning.These sort of memories take you back into time.

Friday, September 14, 2012

off to London to see the queen!

A week before the trip to London was a mixed bag.My sister was given a MCQ to solve by my older sister.Is she excited about the journey or is she nervous?she opted for the latter which is not quite true but I surprised myself with the number of health issues that actually came through the last week.
After starting the trip I was into it,and had no time to reflect at all.
Emirates was a pleasant surprise especially the service.Airports look all the same,Dubai was no different.
Landed in London in the morning.Worked my way to Elizabeth's house.Rested,showered,lunched  and it was off to RCP and GMC.Naa noi,who has been communicating with me thus far was a surprise.Her name sounded oriental but it was a beautiful black lady,as compassionate as she sounded in her communication who greeted me,guided me and looked after my luggage even as I went to the GMC for my id check.
Londoners get full points in the art of helping strangers.I had all sorts of people lugging my 30kg suitcase though the underground,et al.Some of them looked wee smaller then myself but were I guess stronger.
Reached Basildon at around five in the evenng.
Providence had my accomodation ready.I couldn't wait to hit the bed.After a quick dinner I was off to the dreamland sleeping off my jet lag.
The next day I worked through the personals and I join work on Monday.
Met a few people from dear India.Put faces to the names I had been communicating with.
As soon as the communication got through received letters from Dr Binks,Dr Richard.
Dr Richard and Anne are planning a trip through Essex..I look forward to meeting them.He had also copied out a bible study site on revelations for me.
Dr Binks was meticulous in the detailed directions and organising he had done .It struck me afresh how good a clinician he was because of this quality.His two paged letter was better than any guidebook one can lay hold of.
Tomorrow I guess I would have to go church hunting although Dr Binks has already connected me to a CMF i/
Like I told Naa,..'I'll find my way..Naa,..don't worry....I always do..!
I will  or  to be exact  'God will!'-He always does.


Sunday, September 9, 2012

Half the sky-how to change the world!

This past fortnight even as I have waited for the last minute paper works to proceed I have devoured books at the rate of two to three per day.My neice who keeps squeezing in time to spend with me in between her preparation for her half yearly exams keeps a count of it regularly.We also take time out in between to slip in a few cookery shows,a hollywood movie 'wanted' and ofcourse mikado,she beats me to it almost every time.It is good for my concentration and a time out for her even as she revises her french and hindi.
Two heart-warming books were easily-'half the sky'-How to change the world by Nicholas D Kristof and Sheryl Wudunn and 'for one more day' by Mitch Albom.
I had read 'Tuesdays with Morris .'some years back and so the theme of 'One more day' is similar but if I were to put in a line that touched me the most it was-'My mother had she been alive,might have found away through to me because she was always good at that,taking my arm and sayng,'Come on Charley,what's the story?'.But she wasn't around,and that's the thing when your parents die,you feel like instead of going into every fight with a back up,you are going into every fight alone.That I guess summed up the book for me.
The other book 'Half the sky' is iconic in that it writes about the other half who owns the sky but do not get their due-'The woman".It's extreme in it's potrayel of abuse,neglect and exploitation,whereas subtly it happens all the time in all the places,culture....and it is not just woman ,it is the weak...who are exploited,abused and neglected..........isn't it the way of the world!?
Yet Christ said 'Be in the world and Not of it!' The question is are we??

Thursday, September 6, 2012

Jesus said,'I give you life and life abundantly....'

Today is teacher's day.My mother all of seventy five years is celebrating the reconstruction of her school.They have a function in school organised by her ex- students.
My mother started teaching toddlers in the church premises more than thirty five years ago when there was no concept of nursery teaching in my region.All of us have passed through that school in the church and were carted off to boarding schools early in life because there were no good schools in the region.Now when we look back we get amazed to see the array of lives that have passed through that school..foundations laid,blossomed and have moved on in life.
The fondest memories of my teachers start with my mom.There was always an element of surprise in the lessons she sprung on us and guided us through.I remember the beautiful garden,the flower arrangements,etiquettes she was so particular about,the bible stories,the nudge towards all things altruistic...our first taste of alphabets......somehow none of us siblings ever out-grew our mother...she has remained our beautifully unpredictable but stable friend.
My nursery teacher was a cheerfull lady who looked like an 'O'.A short plump doll-like lady who loved dancing to the nursery rhymes along with us.I remember her best prancing to 'I am a musician I come from fairy land i can play with my big drum...dungdumaa...dungdumaa...dungdumaa dungdumaa...'
 I remember time amd again being called out to perform 'I had a little pony'before every guest that visited the school.
My first grade teacher was Mrs Gurung.She introduced me to the vowels and double promoted me.i never attended grade two.I remember growing a bean plant ,in a tin ,in the biology class even as we learnt the basics of botany.
My sister met her more than three decades after she taught me.She was pathologically losing her memory and was disabled...and then she suddenly blurted out,'Chering Choden was an intelligent child.'My sister was startled and touched.She was quick to pass it on to me.
The first principal of the school I was in was Mr Madhusudhan Singh.He was the kindest gentleman who took our sketches seriously enough to put them in the school magazine(annual)which went on to win an award in the national scene.My picture of 'sunflower and me'... with my caricature bigger than the mountains...spoke a lot about what had been put into me as a child.
My childhood in the boarding schools are memories of sunshine,cherry trees, ...lawns,blue skies beyond the green hills,Kanchendzonga coated with snow in the sun..a palate of gold,silver and myraid of hues ,my principal with his camerra ,smiling.greeting us a good morning...driving us to impromptu picnics with milk shakes and pop-corns....the TNA way....those were happy memories.
They came and they went,teachers in all shapes and sizes.One with am-meters in their pockets...,nature lovers,dreamers,striaghtjackets,ones who would talk to the plants,blackboards,...walls,some who would affirm us to embarrasment,who would take time to push us out of our comfort zones..they came ,they challenged...they watched us with curiosity...affirmed us at different times in different ways....they shared of their experiences ,they left us lessons for life..they were there for us....they showed us examples of alternative lifestyle and then most importantly they gave us room to grow.....they gave us life...
My prayer is that the Lord will make me a teacher who gives life.