Back after break

It doesn't exactly feel great to be back to Nepal, but one has to do what one has to do.
Joining medicine ward duty from Sunday.

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FMGE

due to the impending foreign medical graduate exams (FMGE) we had in late september, our internship had taken a back seat for a few months.

these exams are now compulsory for all foreign medical graduates (FMGs) planning to enter the Indian medical system. 2 papers or 150 MCQs each, is all you have to clear to get a pass and qualify for registration in the indian medical register.

thank god! i passed. got 174 out of 300. was expecting a borderline result. thank god, seriously, cause the preparation was crap and the 1st attempt seemed dodgy, as we had no idea what to expect.

unfortunately, a few of my close friends did not clear. they will have to sit for it again in march next year now. its shitty to think of giving the exam again. spoils your self esteem and pushes your plans for the future on the back seat.

it was a great sense of relief i felt when i realised i had passed. relief that a big hurdle is cleared, that too in the first go.

now its back to future planning and internship.

P.S. good luck to all those who give it again in march, pray you clear.

Paediatrics

my oh my!

i was looking through my last blog post, and realised that i had started posting for paeds on the 1st day of duty. my plan was to update with cute baby pics daily.

what paeds turned out to be, i was totally unprepared for!

this was one of the busiest duties i have done. i knew it was to be busy, friends had warned. what i didnt know, was how busy your emotional senses are going to be!

it was a whirlwind 2 weeks, highs and lows, saved lives and lost lives, cute kids and ugly kids, kind nurses and devilish ones! all in 2 weeks.

what i learned in 2 weeks i could never learn in 6 months of commed posting ! (we only have 3 months)

there was this one particular day, we lost two kids! one of them was from the NICU and i was on duty with ankur then. it was a sad sad day for me. that day mansi was in the ward and she lost a kid under her too. we shared our sorrow, and it helped.

that very day, i had seen our MO dr.shankar help save a life in the ER performing resuscitation. i saw it all - flat line on the ECG, CPR, Defibrillation and all. for over half an hour, guys worked on him and he survived! it was a rewarding feeling just witnessing that!

when i came back to the NICU, i discovered to my shock, that one of the sick twins had died!!

i couldnt hold my tears looking through its file, the notes i had entered, the charts i had filled. this was too sudden for me. how quickly the kid died. i imagined the twin who still lived, he would grow up to discover his brother died . terrible terrible feeling.

somehow i got through the night. trying to hide the hurt i was feeling inside. you cant help but get attached to these children you look after. they seem like your own. it is terrible when the die. it is.

soon, i overcame and moved on to ward duty. 1 week was up and 1 to go. sambhav seemed so dogged by ward duty, it wasnt what he made it out to be. and surprisingly he was so carefree during his NICU, which wasnt so slack when i was there. weird. but that is sam's middle name.

anyway, worked with mansi and ankur in the ward too, lovely people to work with. couldnt have asked for better! they work with the right spirit, which i have to say, is scarce nowadays.

it came up to 3-4 kids per intern to manage, as a lot more juniors joined and made our life easy.

i learned how to catheterise a vein in a neonate! managed it in the 1st shot!! :) and talking about 1st shots, i did a Lumbar Puncture yesterday (that is putting a needle through the gap in the vertebrae and collecting the fluid that comes out for study), and got it in the 1st shot as well! thankyou :) . thanks to dr. Deepak who offered me to do it, otherwise i was quite sad i would have missed out.

i learned the neonatal resuscitation in routine newborns as soon as they are born! I've put a nasogastric tube in one newborn too!

overall satisfied by the skill-acquisition.

thank god it was only 2 weeks, how much can one take?! yesterday was my last night duty and we had 8 admissions!!!

so much work! phew, did it, its over. yehhhhhhh :)

thank you paediatrics. did learn quite a lot. it definitely broadened my horizon.

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the NICU

Image via Wikipedia

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!

Image via Wikipedia

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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