more babies from the OBG ward

from the nose you can guess this is dr.abhishek's son.
really cute one !



for nan and ma! :)
zat is it for tonite.

some more baby pictures :)

since the OBG ward is one of the best places to view newborns, i get a great opportunity to take pictures while i am posted here.

this is an old picture, been 2 months i guess since 'the crisis' . anindita conducting the delivery and i was assisting!

she's basically suturing the episiotomy wound there, the baby was out already.

these are latest pictures :

holding the mic! gonna be a singer?

urmila karki (didi from the deep canteen), gave birth recently by cesarean section, unfortunately the wound did not heal probably because of obesity. so today she went for a re-suturing!

same baby :) sleeping soundly

baby of anju kafle (a patient with ASD - heart disease) 

someone's kid, forgot whom :P

bye.

wards

i am in the ward duty since a week or more now, and it just seems so exhausting!
totally unlike OPD duty where it was like a 9-5 job, you left the office fresh to enjoy the evening. here in the wards, you have to report for rounds in the morning at 8.30am, although they hardly ever start on time, cause the consultants arrive around half to an hour late.

you gotta take notes of what to do with the patients that day (ie basically either send/collect reports of various investigations or monitor the vital signs or discharge or dressings etc)
plus, you are not under direct observation and guidance of the consultants unlike in the OPD , so you have further stress to be able to assess any sudden emergency case or deterioration in a patient's health. which adds to the stress of work. and i just have a 3 intern group, so its one short of expected, and thus more work on each pair of shoulders.

the long hours is just irritating. you have to stay overnight as well, but i dont, i come back for a late night snack around 2-3am and sleep in my room till 6am.
the next morning you have to do your rounds first to determine how each patient in the ward is doing, and later wait for the consultant on call to arrive for the official rounds.

after the rounds is over i can leave, while the next batch of interns take over! the worst thing is the mismanagement of meals, i usually end up missing them and have to take them outside, instead of at the mess, and at odd hours.

worse still, you are so exhausted by the next day that even though you are off, you cant enjoy the day, all you can do is sleep !!
today was such a day, i slept all day and now am awake at night! :S

annoying

so, vijay sir is going crazy over the duty rosters!

he has done it again! changed the schedules.

now he went an annoying extra step, and changed our groups too, so i dont have the people whom i want to work with now.

plus, my ward duty had to start on 23rd, he changed that and now its starting on 20th itself. so extra ward (which is the worst)!

so the opd duty, which i kinda liked is cut short now :S

anyway, it'll soon all be over and we will be in community medicine department after this.

oh i totally forgot about the Log Books we have to maintain!!

we have to write about interesting cases that we have seen ... time consuming work!

a day at the emergency room

yesterday was my ER duty along with sambhav, from 8 am to 8 pm.

totally unready for what to do and what are the expectations from interns in ER, we just left after having breakfast.

sambhav was there earlier, coz thats him, he likes to be present everywhere earlier than the others. so when i got there there were a few cases only, some old man with COPD on nebulisation and a lady with abdominal pain who was waiting for the surgical consultant to arrive.

we started chitchatting and introduced us to the nurses and the MO on call.

then some patients started to come.

what we realised by evening is that patients come in hoards, and when its empty its empty, you hardly have one or two patients ever, its either 6 or none! :P weird isnt it ?

and all we had to do is do the forms, follow instructions from the MO / consults.

we had to make calls to the dept.s to send consults. we had to collect lab reports. we had to take history and do general examination and fill up the file with relevant data.

we could help the nurses with procedures but we were new, so they let us watch first.

i did my first PR exam on this old guy with urinary retention (big prostate felt!!)

(PR = per rectal exam, basically shoving your finger up the anus)

tried to cannulate a patient but didnt get the vein, so the nurse took over. next time might get it right! :)

by the time it was 7.30pm a load of patients arrived! one guy with serious head injury and bleeding came in moribund condition. i checked his pulse, carotid pulse was palpable, i checked his pupils , non-reactive !!

rushed to fill his forms, ran with him to CT scan his head. he had a big fracture and hematoma.

his brainstem had bleeding so when the neurosurgeon arrived he said, this patient will not survive!

we had to leave coz our time was over, when we left we hadn't seen anyone die under us! thank god!

we heard that this patient didnt survive as expected.

there was another patient yesterday, she was suspected of heart attack / acute pancreatitis. she was shifted to ICU, heard today that she died too!

sad!

got to learn so much in emergency duty!

this woman came with 3 kids. the girl in pink held in the mother's arms had a greenstick fracture to her right forearm .

assisted in her plastering.

sanumaya sister from the OBG ward. time passing down here with us early in the morning when the load was less.

she is a very nice fun lady. very helpful, very knowledgeable, knows who are keen and who arent and helps those who are to learn a lot.

sambhav was really good in handling the phone calls and taking the history and all.

didnt expect so much, impressed me to some level.

we might be able to do more and do better in our next ER duty i hope.

feeling the cervix

did the PV and PS examinations on a particular lady today with dr.talitha's help.

PS/PV is basically vaginal examinations using your fingers or an instrument.

felt a retroverted uterus and appreciated the 'retroversion' part of it.

HOD gave me and ken a job to fill in a long pending birth register. and this register is humongous!
we ended up doing that the whole day and it is still not done!

tomorrow i have my emergency duty with sambhav from 8am to 8pm.
lets see what happens, totally unprepared for emergency duty !

the slack days are gone.

yes, they are gone.

the slack days are when you are posted in OBG-miscellaneous duty.

you will just have to go to the OT and that too, not everyday, only on occasion when your name is on the list. surprisingly, mine was only there for like 3-4 times in the whole month!

i used this time mostly taking part in the expressions!

was one of the MCs the 1st day, then had a western dance on the 2nd day and an eastern dance on the 3rd day!

in the fete, i took part in the sack race and the 3-legged race and won 2nd prize in both! lol. was surprised myself that i won!

now tomorrow starts my OPD duty (ie, out patient department)

i'm with ken, tsering and sambhav. 

opd duty is also pretty cool. you dont have odd hours like in ward duty, you are off by 4.30 pm and you get 2 days off for 1 day of duty!

this is to accommodate all the interns in the dept, coz we are a lot of em!

lets see how tomorrow goes.

i have some idea about what to do, like receive patients and take their history (a big chore, coz i hardly understand what they say in nepali!).

then you have to present it to the consultants, and they will instruct you to either prepare them for examination or to send for some investigations.

you have to fill in the investigation forms, or in the other case, do the general examination.