the NICU

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the neonatal intensive care unit (NICU) is where i will be posted for this week.

today was my first day on the job. met dr. deepak who is a sweet guy, explained the expectations from us interns.

there are like 8-9 kids in the NICU. basically this unit is for sick kids who are really really young. they are in their 1st month of life!

most of them are just born and sent to this place.

it is equipped with lots of incubators to heat 'em up! :P

plus there are a couple of Phototherapy machines, they emit white/blue light and help reduce the jaundice that some kids develop in early life.

some premature kids look quite like sick skinny monkeys! while others are normal healthy cute ones!!

i hope i can learn how to take blood and intubate them! it is apparently really tough to get the vein in those tiny limbs !

i am also supposed to collect reports and update their files every morning. unfortunately i couldnt do the updating today as i am new, and the MOs' handwriting is PATHETIC!

sambhav is with me in paediatrics and he is in the general ward, he is having a hard time decoding the handwriting in the files. :S

anyway, some ppl might join me in the duties in a few days, i have my night on-call on 25th, that is day after! and then every 3rd day from then on.

lets hope all goes well. tomorrow we officially meet the HOD and start paeds.

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Greener Pastures?

Finally, Green Pastures Hospital (GPH) posting is over!

I regret to say, but the place where my colleagues used to go to and come back saying it is the most worthwhile posting, isnt the same anymore !

we were posted there for 3 full weeks, and i can hardly call what i did there, worthwhile!
well, some may say, we hardly stayed there and ran away mostly. but the truth is, we would have stayed if the situation there wasnt so morose!
the first week itself made a sorry impression. no one paid us any attention! roaming around during the ward rounds, not being explained anything.

not only that, it matters who your company is as well. if you are stuck with a bunch of bunkers, you cant help but bunk yourself.
yet, we did go quite a lot and mostly sat there in the OPD doing our Mudit Khannas preparing for FMGE later in september.

I totally stand for the Dermatology Clinic though! it was the only thing impressive. there were loads of patients pouring in. and you get to see a lot of diseases.
unfortunately, it so happened, i got to see only one day of it, in 3 weeks.
it isnt held every day of the week though. just wednesdays i guess.

one day, Dr bhattarai made it clear that he's not interested in teaching the interns anymore as they dont seem interested in learning. i guess he must have had a bad experience with the previous groups of interns posted there. But still, that is not something you demand! just teach man, who knows, maybe u can ignite interest in us!

he was a disappointment though, cause i only heard praises for him before going to GPH. but when i went he kept himself busy with paperwork most of the time. he is supposed to be an excellent teacher.

there are minor operations held as well, which interns sometimes get to assist in, and guess what we got to do, NADA!
we hardly knew when the OTs happened.

anyway, i dont want to rant, GPH is a good posting and i hope they get back to their previous ways. if they continue like this, i would say its a waste of 3 weeks, just have people go for the Dermat clinics.

sadly, now i have medicine posting and dr alurkar has scrapped dermat posting completely from the intern schedule for indian interns!! his reason: no one attends and you get a 1 week holiday!

so my chance of dermatology experience seems gone!

medicine and facebook!

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http://content.nejm.org/cgi/content/full/361/7/649

i read this article, and realised how relevant the issues brought up in it were in our lives as upcoming doctors!

in my personal case, i havent started practising yet, still interning, so my friend circle in fb is still the original personal group of friends.

but i am one hefty user of social networking! and load up a lot of stuff and perform a lot of activities which i believe from my patient's point of view, would be objectionable in a doctor!

how far are we as doctors allowed to live our original lifestyles and still continue to practise unaffected by the repercussions it might have on the perception of us in our patients' minds?!

should i remove content from my facebook account, like old photos and comments which as an average youth one is expected of, but as a doctor is unacceptable ?

or should i avoid befriending clients/patients ?

or should i simply use the PRIVACY SETTINGS more critically?!

these are some things which have gone through my mind, and its not the first time either, but undeniably now more than ever! now that it is being discussed officially in journals and all!

as doctors / medical professionals using these networking sites and blog services, often discuss our inefficiencies and learning experiences, including often our mistakes and shortcomings in patient care! they are all on a personal recollection level!

patients coming across them might feel uncomfortable or doubt the adequacy of our skill/education or even approach towards our career.

the problems might arise when they assume inefficiency on our part when they dont know the true scenario through which students/doctors go through during their medical education.

so its definitely a very relevant issue of discussion, not merely at the prefessional level.

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Night Emergency Duty

so yesterday night was my night ER (emergency room) with samiyah saeed ahmed.

she is one of the hard workers, so i was pretty relaxed about it.

it wasn't very rush-rush in the beginning, around 8pm there were like 3-4 cases at max.

there was an old hemiplegic guy with bedsores! samiyah taught me how to do dressing on that, she's been through surgery posting and i havent yet.

some middle aged lady came with chest pain and breathlessness. had to rule out heart attack and pneumothorax. apparently she was just exhausted coz her relative was delivering a baby in the OBG ward and she was running around a lot for a few days without rest.

her condition was pretty stable and her ECG was normal. yet i just sent cardiac enzymes to rule it out further. according to the consultant, i shouldnt have as it costs NPR 500. not cheap!

some guy from Bhopal, India was touring muktinath in nepal, when he felt dizzy and fell unconscious, was brought later at night. his fellows thinking it was a heart attack, gave him sorbitrate . which was a smart move as a layman, in my opinion! but here, he apparently wasnt having a heart attack and it just lowered his BP and heart rate further! making him even dizzier and faint! :P

he was later shifted to the ICU. i was awake till 4 am and i couldnt take it anymore, so i left to sleep. the doctor's room in the ER is a shit hole! smells constantly of smoke! i dunno how they sleep there!

anyway i left my number and came to my room. next thing i know, i woke up at 12pm next morning :P

i just hope samiyah, who went to sleep earlier handled the morning well.

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Invigilation

4 Days of community medicine exam!

i was on duty in the department on all 4 days.

the 1st 2 days i had ken and vishesh, and the last 2 days i had geetanjali and amitanshu.

we were briefed by rashmi ma'am, who was in-charge of conducting the exams.

basically, from scouting for patients for the examinees to take history from, to organising and managing the rotation of all the students to all the examiners.

basically it was a challenging job demanding decent management skills as well, and i would like to believe we aced it!

we were literally on our toes, running around, helping students, helping patients, helping examiners, from 8am to 3pm! everyday!

i have to say, the help i got on the last two days was much much more than what i got on the 1st two. vishesh was always late and ken was always on the phone!

i was surprised how helpful amitanshu proved to be, and geetanjali turned out an asset for the students!

it was a nice experience overall, feels so great when the students you helped come back to you and thank you from their hearts!

just like i felt for my seniors who were there to help me during my exam days!

thanks to them, i am able to carry forward the karma!

geetanjali and me on the last afternoon of exams, feeling a sense of accomplishment!

rituparno striking a pose, just before his spotters, while sharmila cant help but 'peep' from the background! :P

sharmila couldn't stop singing nitesh singh's praises! apparently nitesh did a great job when he was on duty during their pre-lims.

examinees doing the spotters!

nandu the peon and the cleaning lady chat after the exams are done!

sharmila was never happy with the help she got! she wants more! :P

short stint in the ER

yesterday i learned to suture a scalp laceration!!
yehhhhhhh. did alright.

poor lady fell and hit her head against something and on her forehead she got a nasty 7-9cm long cut and the skull below could be seen! it was that deep!

she got 7 stitches!
prolene 000 suture material.

done with GONESA

done with gonesa after 2 weeks there.

GONESA is basically an italian-funded NGO working for young children in nepal among other things.

this is their little classroom for little kids .

how well behaved, right ?

the clinic at gonesa, with 2 dedicated sisters treating the sick.

this is where i got to do my job. i.e. sit and get bored.

:P

not really, i did see a few ill kids and gave them some medicine.

you see the old one on the right?

MAN, does she talk! :P