Gauge of Reason

Raw Medicine

2012-11-24T09:31:00.000-08:00

Why is it that Doctors have it so bad? Right from the day we joined Med School through the days when we graduate and continue into Residency, life is anything but a bed of roses.... the whole world had warned us, I mean those who are in the system already, but then, I wanted to help humanity....

I'm actually completing an old draft that I started writing a few months ago, but left it incomplete. Now that I am in Clinical Medicine, I get to see, how my juniors, colleagues and seniors work hard and are living a life of constant fatigue, on the verge of burnout, most of them. Most of the conversations are about, how bad the last call was, how busy the wards are, how complex and how very ill the patients on the current list are etc. etc. Is this how life is meant to be? I mean as a Doctor? I was given to understand that as a Doctor you will be a blessing to others, and hence you should be in some kind of bliss. But, the reality seemed to be far from it.

I got permission from my team boss for an early day off the other day (for the first time, since I've now mustered enough courage and confidence to ask for such a thing), as my daughter was down with stomach flu, and guess what, since the list was really short I got off right after my rounds, and as I was walking out, the scene outside really gave me an opportunity to see the reality that I always knew existed, but had not really witnessed. I always knew that we Doctors start work really early, but I had not actually seen this in a long time.... When I am almost done with a substantial part of my routine, the rest of the world is only beginning to wake up.... and getting ready for the day! And our work does not seem to end even when the rest of the world is back home watching their fav soaps etc. judging by the bits and pieces of conversations that fall on my ear drums the next day....

The world thinks, the minute they hear I am a Doctor, that I am earning a fortune and living in some condominium, while the reality is as a junior doctor, (a lowly MO) I spend most of my waking hours in the wards and have to plan attend my daughter's pre-school events months in advance and I actually live in a humble apartment close enough for me so that it is easy for me to travel to the hospital and close enough to my daughter's Child Care Centre.

Calls. The value of sleep, and the value of food. Calls are those very real and tangible hours when you really really contemplate as to whether you did the right thing by choosing Medicine over Information Science/Electronics and Communications/Automobile Engineering or even Law/Pure Sciences, all of which were other options available to me when I was at the cross-roads. Why can't I have a normal job where I can just work 9-5 and sleep like a normal human being and not be worried if anyone is going to die while I am at work. It is the feeling when you are responsible for a particular sector of the hospital and you are just hoping no one's going to desaturate, go hypotensive etc, in short, hoping that no one's going to die while under your care.... That is a terrible feeling even when you're covering a fairly so-called stable sector. You don't want to be initiating ACLS protocols and activating the Air-way Team while you're on call.... All this while you're thirsty, hungry, sleep-deprived sometimes with a distended bladder which has been awaiting an opportunity to be decompressed.

Medicine is not easy. But, someone has to do it. IMHO, the reason why we doctors, have it so bad is, that someone has to do this job else who is going to do it? All of us who chose Medicine when we did, for whatever reason did not know what was in store for us, even though there were a lot of other things that we could have done, and excelled at. Some people would have warned us, but we never cared, we just thought "saving lives" is what we wanted to do. Destiny has it that we have been chosen for this life. All of us know someone who has quit Med School or after graduating quit Clinical Medicine for something easier, lighter, something "normal". But some of us continue to remain in this field for whatever reasons; we have been chosen for Medicine, and we did not chose Medicine. This is the reason for an indefinite duration of time to come, in spite of whatever might happen to Medicine, as long as Doctors remain responsible for the lives of people, so there will be appreciation, prayers and blessings of the people we care for, and hence respect and gratitude. And that I believe is the strength from where we derive our drive to continue to push forward, and that is the strength that is hidden in the tiny thread that hold us to the system we are all a part of.

An update that is long due

2012-11-05T23:55:00.000-08:00

Finally I feel like blogging again since April 2009. Since then, I traveled thousands of kilometers; first in suburban and remote rural south India and then flew across to another country chasing my dreams. It was a long and challenging war that followed my exit from the so-called Corporate Clinical Medicine into Public Health and finally back to Clinical Medicine. The war is far from being over.

The decision to transition to Clinical Medicine:

Public health generally speaking is Medicine "wholesale" and Clinical Medicine is its "retail" counterpart. But often in the practice of Public Health by organizations I came across bosses dealing with mundane statistics and numbers, taking decisions based on assumptions the credibility of which can be questioned many a times; and very generally speaking in my opinion you do not need to be a medically trained person in the first place to analyse incidence and prevalence of illnesses and the social determinants affecting the same, at least you need not necessarily be a Physician to do this. But when a medical doctor with a sound clinical background is "running the show" (which I got to witness during my Rural Stint after med school), things are different, since he has the perspective of a clinician. And to develop this perspective it is necessary to have undergone rigorous training. Hence the need for further training in clinical medicine; or else there is no much difference in the perspective of a Doctor or a Lawyer interested in Public Health. And of course, the joy of dealing with individuals, talking to them, going through the complex process of diagnosing and coming up with a treatment plan is something I could not trade off with Public Health.

Training in Clinical Medicine in the First World Versus the Third World:

I tried as much as I could or probably lesser than what I was capable of to get into a specialty training program in India itself, but as the prevailing circumstances at the time would have it, I had to choose between a high paying job overseas with a possibility of entering specialty training Vs the prospect of spending another year and most of my waking hours poring over books, spending my father's money for not only my expense but also that of my young and growing family..... all of this to get into a training program which will pay me pittance and make me work so hard, that at the end of it I will probably not recognize myself in the mirror. I was stilling willing to face the prospect of taking up a job in India itself while I still try my luck at the Indian exams, but some of my friends convinced me to give the other option a try at the very least. And very soon I was on a flight to Singapore, and before I knew I was already doing ward rounds in Geriatric Medicine with a COW (Computer-on-wheels). It was probably the biggest change that I had ever experienced so far, moving out into another country. Never before had I ordered as many CT and MRI scans like I did, giving Pipericillin/Tazobactam and Carbapenems. This was the first time I am working in a proper tertiary care setup since my internship days. I spent most of my waking hours in the hospital and finally, I applied for the Internal Medicine Residency and was blessed to have been accepted into it. Thank God I did not stay back in India to pursue specialty training or Public Health.

Inspired by the sheer number of online accounts and portals for me to log in and document my improvement during the course of my residency, I decided that I will start blogging again, as a sort of parallel log. So I hope to keep this blog more active until the foreseeable future at least....

Some of God's greatest gifts are his unanswered prayers.

Corporate Medicine

2009-04-28T00:06:00.000-07:00

I haven't been liking 'Corporate Medicine' at all, I think it is a contradiction in terms.... insofar as Medicine is being considered as a lucrative option for Investors. I believe that Medicine is essentially Sacred, and somehow, Corporate Medicine is making a sacrilegious alliance between Medicine and Business .... in the process eroding the ethics of some of the finest doctors intoxicated with the lure of Money for their services. Medicine is a special God-ordained Healing Ministry in which we are only mere insignificant instruments, however much important we'd like to believe our knowledge and interventions are, and to charge exorbitantly for our 'insignificant role', while compared to the Creator's or even worse to lust after that kind of money, I consider blasphemous.
It is possible to provide high quality service (including digital medical records and modernized labs with electronic reports etc) at affordable rates to everyone, including those who need it the most, (there are examples in other nations), if our policy makers make up their minds and use their brains, and the prices not artificially kept high with the sole intention of making profit. When did the 'Patient' become a 'Customer'? And the 'Doctor' a sophisticated 'Businessman'. I might sound like 'old-school' but I'll stick to my stand that Medicine is not just a glorified Hospitality Industry, it never was. It is and will remain Sacred, as long as it deals with life and death and everything in between that matters to physical/mental well-being....
Can't wait to get outta here, though I like the work that's hardly there; it is really comfortable being a doctor here, but... My heart isn't here....

Mechanics of Thought

2009-04-27T07:48:00.000-07:00

Words often play traitor when the mind is trying to quantify and capture in measurable terms the goings-on of the Universe. It really is fascinating to know how we are made up of elements, molecules and compounds, interacting with each other producing this phenomenon called 'thought'. What really makes me happy or sad or angry is a little bit of interaction of those neurotransmitters with the receptors further triggering a chain of events inside the cell itself leading to the final event of perception and processing of stimuli - tactile, gustatory, visual, auditory, and olfactory, and how different stimuli can lead to different responses in different individuals within a species or between species and genuses. And to give those stimuli different characters and sounds in over a thousand different forms used by more than a thousand times over a thousand people.... Words, can never be able to describe accurately this truly marvelous phenomenon. It is just as marvelous as those stars in those constellations some of which have ceased to exist....

Scribes in Sincere Pursuit of Infamy

2009-04-11T03:49:00.000-07:00

Looks like the new-age journalists are beginning to find Shoes mightier than the Sword. Or at least that they would love to believe that were true. By engaging in such absolutely unprofessional behavior the Scribes betray their incompetence at Effective Communication through the print... Gone are the days when Words would move people to revolt, to bring about change in Society and the World albeit in a civilized way and not by mudslinging or throwing shoes at each other...
Thankfully a majority of journalists still consider giving more importance to writing skills than at aiming at people with their footwear. Good sense continues to prevail though there are some who take what they think is the Straight-line to Celebrity but end up in Infamy.

Sensational Vs Sensationalist

2009-03-21T06:09:00.000-07:00

It is really unsurprising that some of our TV News Channels have really high TRP than you would normally expect. Reporting News which is unbiased and not sensensational is almost a rarity these days. One has to really be careful when listening to any Indian News Channel in not getting misinformed. Consider these Headlines, " War on Bangalore", "Papacy a Disaster", "India caught with its Pants Down" etc. These kind of arresting sensationalist headlines do not make facts however emphatic and dramatic they might sound. Looks like our Media people are only glorified, high-profile, gossip-mongers, who unwittingly deliver some news in their whole process of gossiping and getting people of rival ideologies to fight.
Until I started following our Media, I used to think it is only our Political Leaders who are ill-mannered and uncivil. But out Media people are more sophisticated than them. They know how to bring out the best from our Netas.
Popular Debate Shows being far from any Intellectual Exercise in a Democratic System, they have become cheap source of genuine entertainment for the Middle-Classes of India. The Moderators always try and get the People involved in these "discussions" to make provocative statements and then ask the other person involved to "respond to that quickly since we're running out of time." What a sublime intellectual exercise! Stay tuned for more from India's Infotainment Industry...

Why I didn't write all these days

2009-03-04T22:58:00.000-08:00

From as far back in time as I can remember, reading and writing have always been my favorite activities. Besides of course playing basketball and making music. But as doctors we give up many things we would rather love to do and are forced to sit with books reading medical trivia of herculean magnitude.... at least here in India in order get admitted to an Institution to pursue your real passion..... We are busy studying not the right things but, studying to avoid choosing the wrong serotype of the correct organism causing a disease... and umpteen other things more stupid than that..... But then that's the system, we've got to live with it.
Now that I've had a paradigm shift in the way my next few months are going to go... hopefully, this blog is going to be more active than it was until so far.

A Defense of the Voiceless

2008-08-15T10:53:00.000-07:00

"Is there a thing of which it is said,"See, this is new"? It has been there ages before us" - Ecclesiastes 1:10

I fail to understand why people in this day and age cannot understand that it is a crime to kill unborn children. It is one of the biggest crimes to take away a person's life, while this is understood by many (except a few crazy fanatics who justify other atrocities too in the name of God) I find it most disappointing that many people still think it is alright to kill unborn children. A child is a human person just like you and me; just because technology has advanced to the extent that it is possible to artificially concieve life in a test tube, it is no less a human being than anyone of us; single-celled may be at one time, but having the potential to become one of us.

Life begins at conception, and not at 20 weeks or 26 weeks or at term or at delivery, neither is it in the capacity of any government, organisation, society or individual to claim a point in time during gestation as the origin of 'life' or 'being'. Zygote, embryo, fetus etc are medical terms used to describe one thing which is 'the unborn child'. To say 'Zygote is single-celled therefore is not a human person', or 'Embryo is not yet a child' are pointless arguments which selfish people put forward to justify abortion which is same as murder.

The argument that children detected with birth defects need not be born is one of the most selfish and mean ways of handling the situation. So Helen Keller, Beethoven and a host of other known and unknown geniuses with apparent and unapparent congenital defects, disabilities etc should not have been born? As human beings we are blessed with Will and Intellect to overcome difficult situations and to find solutions when there are none. We are called to learn and discover ways of living with children born with disorders, and pursue the ways of alleviating their problems; Killing is not only a selfish, evil and wicked alternative to Life, but it also amounts to cowardice in the face of adversity, it is another face of Savagery.

What we all strive for is a better World, a world with fewer diseases, more vaccines for more diseases, with new advances in Surgery, Anesthesia, Radio diagnosis, Neonatology, Immunology, Pharmacology, Biotechnology etc not to be used as a means to kill but to reduce Neonatal Mortality, Infant Mortality, Maternal Mortality and to raise the Average Life Expectancy, Physical Quality of Life etc to preserve and prolong life. We should work towards a World where every human life conceived should be nurtured and welcomed. This World is not a inheritance from our ancestors but a lease from our descendants. We did not choose our ancestors, but we are grateful to them for the gift of life, the same way we cannot deny a child's right to be born, once it is conceived. To deny that is simply Inhuman.