This has always been a tricky situation.  In the past 2 years I have seen 3 patients with clinical signs of peritonitis. They had a visibly normal looking X ray chest and Abdomen but  Ultrasound revealed moderate amount of free fluid in abdomen. On closure inspection of X ray chest all the patients had strong suspicion of free gas under left dome of diaphragm, which was distinctly separate from the fundus gas shadow. This was later confirmed on plain CT abdomen. All patients had ileal perforation as the intra-abdominal finding.

We had to start him on ionotropic support and and aspirated about 500 ml pus from the liver. Blood transfusions and the usual supportive care was given and patient showed gradual but limited improvementThe relatives kept coming in short bursts but showed no real interest.

T o be cont..

The patient’s condition deteriorated and he started having intraperitoneal bleeding and hypotension. Blood was transfused and symptomatic care was carried out but we could not revive the patient. He died in the ICU 1 week after the admission. The young boy did not flinch through all this and was very strong. he had nowhere to go after the death of his father and he told us he could not go back to the relatives.

Later we heard that he went to his grandfather in a nearby city.

Sledging and mental disintegration was an Australian thing around a year back. When Australia won the one day championship in India in September 2007, Ricky Ponting said that the attitude of Indian Players will change When they tour Australia in Dec 2007 and then they would find out how tough these Indians really were. They found that out all right. They won the test series 2-1 narrowly (If you count the Sydney test) lost their reputation and the One day series after that.

If any of us watched the IPL matches, Watson always had a word to say to even the lesser batsmen, He would get hit for a four, put in a bouncer next ball and would feel happy about it. But when Gambhir and Laxman were flaying him all over the park he had nothing but his hand to stick out.

ICC is now worried that the game is going too arrogant and they must shell out punishments. Again I agree with it but why the double standards.

Australian bowlers were having verbals with even VVS Laxman, the mildest guy in the Indian team, he had to silence them with his bat remaining unbeaten in both the innings; but Gambhir made a gesture both with his bat and elbow. Next time every bowler would think twice before sticking his hand out to a batsman attempting a run.

Anil Kumble decides to retire from international cricket today after a glorious carrier startng from 1992 in England. The decision was sudden and unexpected, It was not something he had talked about before and certainly not in the middle of a series.

He might have been speculating on continuing even after the series  had he done well. He has not been a match winner for India for a couple of series now. The hand injury and emergence of Amit MIshra as a quality leg spinner maybe has a part to play in deciding his early retirement.

It has been a great carrier for him. In the late 90s and early 2000s he along with Sachin tendulkar were the only players capable of winning matches for India. India lost badly when they failed.

Kumble at 38 retires.

1. Big surgeons make big incisions.

2. It was dry when i closed it.

3. I love to operate, you manage the post op period.

4. If you dont find something you are looking for, find harder, Everything is in books

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2. Check the instrument/sponge(atleast) after the floor nurse announces “Counts Complete”

3. While operating listen to the surgeon assisting you. He’s seeing things you cant see.

4. Respect tissue planes, take time off to tie bleeding vessels

5. Most important two words  Be patient

All this development comes at a price ofcourse, the scientists of the 19th and 20th centuries have toiled hard and some even gave their lives for their passion and work.

Marie Sk?odowska Curie (famously known as Madam Curie) died of aplastic anemia obviously unaware of the hazards of radioactivity she discovered.

In the discovery of Helicobacter Pylori, Marshall swallowed live bacteria to prove their existence and fullfill the Koch’s postulates.

Numerous dedicated doctors and scientists have worked very hard in the best years of their lives to bring medicine to the state it currently is.

But we can not sit back and enjoy the moment, still a lot of research work has to be done, New diseases like AIDS, Hepatitis C , most of the cancers have no cure. New innovations are coming up regularly and I am sure the day is not far when we have cure for the incurable.

In my 1st year as a junior resident, I was confronted by two senior residents, one was considered to be very good, the other one was just average. The 1st one was a perfectionist and liked to do things exactly as they were written in the books, the 2nd one hardly ever cared.

Then there was an assistant professor, he used to sing songs in OT when he was nervous or when extremely happy. Some of the songs were awesome and I used to add them to my playlist immediately.

Then there was my thesis guide, he was extremely well behaved with everyone in the OT and was an excellent surgeon, respected by everyone.

There was another one; just an average surgeon who thought he was the best. He used to look up frequently to see who was admiring his skill and handywok.

Later in my 2nd and 3rd year I had a unit head who had very limited or outdated knowledge and used to prefer thyroid surgeries.. He was a good speaker and initially everyone was highly impressed. Only after a few weeks you would know what a jerk he was.He used to make up OT table stories and we had to put up a straight face. The moment he left everyone used to burst into spontaneous laughter.There were evenings dedicated to him and we would just sit and talk about his stories. (He was a nice person thiough).

After My post graduation I worked a bit in Cardiac surgery unit and was confronted with two surgeons of extremely opposite nature..

To be continued

One was extremely confident and sure about the work he was doing , it was fun to work with him , the other one it seemed was highly distressed while working, he was not very proficient in his work and always used to find excuses to blame us for his mishaps.

I have already come to a conclusion in my short career, no matter how the surgeon is inside the theatre, he would always be a different person outside it.

sleep in the ward 3 hours + postoperative round 9 pm Tuesday)

At that time I didnt give this remark much attention but now I realize how right he was. How can a hospital system in which the three working residents( who havent slept for 18-24 hours ) provide effective services to their patients. Of course these things are understood by everyone concerned still no effective action is taken.

To be cont…

To continue rest of the thoughts…

Of course all our consultants know about the kind of physical and mental stress a resident has to go through, yet they choose to ignore it with the simple “We have undergone the same thing during our residency days” Point is taken but what about the patient load. Was it still the same as it was 10 years ago.

Answer is a an owerwhelming NO. You cant expect to treat patients the same was you were  doing 6-10 years ago.

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