Thursday, 11 February 2016

Glittering lights in that house...(Story of a silent humanist)



Suddenly heavens opened up that evening. The Professor was totally unprepared. Rains were torrential and his consulting hours had just ended. He had just got ready to go home and the rains started to pour down in sheets. He waited for some time, his car-driver too was reluctant due to poor visibility and water-logging that was expected. Once the fury of the rains eased a bit the professor asked his car-driver “Shall we go?” Reluctantly the driver agreed. Hardly had they gone five minutes in the failing light that the old car went conk. Stranded in the middle of the road, without any umbrella to protect him from these unforeseen rains; he came out of the car briskly to take protection under the awning of a closed shop nearby. He was hoping to catch a taxi to be driven home. The fury of the rains intensified once again.  He tried to call some numbers through his mobile but nothing seemed to be working. He was obviously distraught.


Distraught

Always very upright, trained in England from where he got his FRCOG, he served a full-term at the local government Medical College before he retired as Professor and Head of the Obgyn department. He then started his own small consulting room in a rented premise admitting his patients in different hospitals.



Rains showed no respite and no taxi was stopping by. The professor watched helplessly as other private vehicles arrogantly passed by caring a damn for people around and splashing water all over. He had been stranded thus for an hour so. Suddenly a white Mercedes that had driven ahead screeched to a halt. It reversed and came close to where he stood. The owner in the backseat waited as his car-driver hurried with an umbrella to where the professor was standing. He said “Sir, please come with me. My master has requested you to come.” The professor was obviously confused. But with this being the best alternative available at that moment, he got under the cover and got into the car.

As he settled in the backseat and wiped his drenched face, he saw a well-dressed gentleman next to him. He was “the master” of the car-driver. He folded his hands to the Professor saying “Namaskaar, Sir”. The Professor responded appropriately but was completely confused about the identity of this Good Samaritan. He was about to tell his address to the driver when the owner said “The driver knows Sir. I have told him where you are to be taken. I will come to reach you home”. The Professor was all the more confused. He, however, remained silent and as some music started playing on the music system of the car he just closed his eyes. Too tired, he had no energy to think.

After about 20 minutes of the drive he heard the owner addressing him: “Sir, do you see that house there?” The Professor opened his eyes and immediately realized he was in one of the most affluent residential areas of the metropolis. On his way to work he passed through this area every day. The car had stopped and the rains too had ceased. “Sir I live there.” “You see the lights in there sir?” The Professor nodded. “Sir those lights are glittering because of you” This left him now completely perplexed. “Who are you, babu?” He asked most humbly. As the owner smiled he told his chauffeur to drive on the car to The Professor’s home. “I will see sir off”. He then turned to his professor to answer the question.

“Sir, I am Dr. Nripen Banerjee”. Oh! So this is Dr. Nripen Banerjee – the most famous cardiothoracic surgeon of his city – The Nripen Banerjee! So much had been heard about him, his fame, his surgical skills and what not. The Professor felt a little intimidated but he quickly regained his composure. “Hello!” he said folding his hands in a Namaskaar. Dr. Banerjee immediately caught hold of his hands and said “No sir, you are my teacher. You are not supposed to say Namaskaar to me. I owe you obeisance”.
Obeisance

As the car rolled on Dr. Banerjee explained: “Sir this is a story of more than three decades. I was a young lad – son of a priest from Bolpur. My father just managed to make his ends meet by performing rituals for people. I got admission in the medical college where you taught. But funds were a huge problem for me. Within a few months in medical college, my measly resources ran dry. My father used to visit me occasionally. But I knew that he was making up the smile on his face vainly trying to boost my morale. I knew he was trying but was not succeeding in getting help for me. Things came to a head when I had to buy my textbooks. Copies in the library were always scarce. The two pairs of clothes that my parents had got stitched anew were also wearing off as the new term began. Now I did not have money to even pay up my fees for the hostel and mess bill. At my wits end, I decided to call quits. I confided for the first time in my roommate, told him of my condition and that I would be leaving in a day or two.”
Disappointed and helpless
“Next evening as I returned to my hostel room completely helpless, disappointed and in tears, I got a huge shock. My entire wardrobe was full of decent looking pairs of new but not costly clothes. I suddenly felt a warmth within. Something good was happening. On my reading table lay neatly stacked new editions of my textbooks for that year. I saw under the base of the reading-lamp a wad of receipts of payments made for my college fees, hostel fees and mess bills all - outstanding as well as for the entire I MBBS course that was remaining. I was too stunned now to react. I just crashed in the chair and let the feeling sink in. Obviously, someone had silently helped me and saved my career. As I collected myself I ran in search of my room-mate. He was the only person who knew about my penury. He didn’t tell much. There is someone is all that he said. I can’t tell you the name. Every year your fees and living expenses will be paid till you complete your MBBS.”


Benevolence

“Sir, thanks to this critical support, I stuck on. I worked very hard and emerged consistently a topper in my class. I then after joined general surgery for my post-graduation and topped there too. But the fact that someone had silently saved my career and probably my life never left me. At the end of my post-graduation, I won a scholarship to do my super-specialization in cardiothoracic surgery abroad. Before I left I traced that erstwhile roommate of mine who was doing general practice in the city now. After a long plea, he revealed your name with a promise that I will not approach you to thank you. That he said was his stiff but strict condition. For decades, he said you would anonymously help students out of such crisis. You were that messiah who has saved so many” 


Glittering lights in a posh house

“Sir I know this for nearly 25 years now. Today the lights that you saw in my house are your lights. You illuminated those decades ago and we live under their glitter, lest I would have left and gone to do priesthood in Bolpur. I even considered committing suicide – you saved me that day. But I have not forgotten you even for a moment. Sir, my wife and I have established a system which supports students like me anonymously without any obligation on the recipient. We do not tell this to anyone. You are the first one I am sharing this with”.

“Sir, such numerous lights in so many houses glitter today because of you and your inspiration. Thank you, sir” 
Thank You Sir!


Sunday, 8 February 2015

Oxygen, Metamorphosis and Preeclampsia: Amazing Nature

Amazing Nature

In our perception when someone talks of amazing nature, the reader almost always feels it must be something with natural scenic beauty around us. However being in the field of research and academics for three decades now, I have found natural beauty in each and every natural phenomenon, live tissues, cells and sub-cellular particles. One such natural beauty which for an average onlooker can appear, ugly, is the phenomenon of Obstetric Vasculopathy. Amongst all obstetric vasculopathies, preeclampsia is the one which is most studied and gives us time to go into its depth.

Oxygen Molecule


Oxygen:
Oxygen is rightly called “Pranvayu” in local vernacular or life-giving air. It is basic to sustenance of all life on this planet. Following this rule the fetal system needs to arrange for a robust and sustained supply of oxygen for its survival and growth. Trophoblasts have been assigned this responsibility. As is well known the cytotrophoblasts undergo a rapid proliferation as soon as implantation occurs. They invade into the maternal tissues to establish the system of oxygenation. This invasion has many other functions too but for the sake of this writing we shall confine to the function of oxygenation. Normally the cytotrophoblasts invade relatively large bore arteries along the decidual wall. These vessels are well-oxygenated. In most of the pregnancies this invasion suffices for establishing the robust and incessant supply of oxygen to the fetus.
In normal ongoing healthy pregnancy, the oxygen pressure in the intervillous space is estimated to be approximately 40 mm of Hg at 8 to 10 weeks gestation. Afterwards at midtrimester when the trophoblastic proliferation and invasion of the endovascular space is complete, the pressure is as high as 90 to 100 mm of Hg. This shows that the invading trophoblasts seek oxygen. Success of these trophoblasts in establishing the oxygen supply decides the success of the pregnancy.
For studying a physiology well, it is sometimes necessary in biological sciences to study the pathological processes. This is true in the current context also. The trophoblasts seek a well oxygenated blood supply which is obtained from large bore spiral arterioles at the decidual surface. In subjects with preeclampsia it has been found that the trophoblasts face a relatively hypoxic environment. As a result they try to invade deeper and even small bore vessels. Again if the oxygen supply gets established, one will find preeclampsia restricted in fury and limited in devastation. However in situations where this supply remains unsatisfactory, the invasion occurs even in much smaller vessels and clinically results in severe forms of obstetric vasculopathies like severe preeclampsia.
There is one vital step remaining in-between, if one is to understand the entire process of etiopathogenesis of preeclampsia. That step is the step of generation of dead-spaces. Incomplete and incompetent invasion by trophoblasts in hypoxic environment at the level of fetomaternal interface leads to generation of dead spaces. It is in these dead spaces that the entire mischief of occurrence of vasculopathy finds its source. However it is beyond the scope of this write-up and so we shall leave it at that.
(For interested readers, please read Obstetric Vasculopathies: http://www.jaypeedigital.com/bookdetails.aspx?id=9789350904510&sr=1.  For details of this book click on:  http://blessedexistence-blessed.blogspot.in/2013/01/obstetric-vasculopathies-latest-best.html)
The oxygen gradients in the vascular channels that the trophoblasts are invading into are great drivers of the invasion process. It is believed that the sensors in the trophoblasts can sense the suboptimal oxygenation. At the same time this sub-optimal oxygen itself too can drive the proliferation and invasion activity. This means both are responsible – the trophoblasts themselves as well as the oxygenation in the vessels that they are proliferating and invading into. Both are apparently interdependent as judged by different studies of antigenic expression and functioning of certain molecules like Matrix Metalloproteinase.
This entire process of trophoblastic activity goes on well into II trimester and is critical in the understanding the physiology of a healthy pregnancy at the cellular level as well as the etiopathogenesis of when and how things can go wrong.

Process of metamorphosis in nature


The Metamorphosis:

Concurrently occurring with this process of establishing a well oxygenated supply mechanism for the fetus is a complex but wonderful process of metamorphosis. This transformation occurs in the trophoblasts that go into the spiral arterioles. As is well known, the spiral arterioles though are essentially endometrial vessels but are distinct in the fact that they are lose their muscular wall and as decidual vessels generate a low-resistance vascular bed. This low-resistance blood pool at the fetomaternal interface is critical component of a healthy well-oxygenated supply chain to the fetus.  
It is simply wonderful to study and know that the cytotrophoblasts transform themselves into the characteristics of the maternal spiral arterioles which they are invading. If this does not occur the spiral arterioles would cease to function as maternal vascular channels and instead get clogged up. It answers the oft asked question: How do the spiral arterioles remain patent when the solid columns of cytotrophoblastic cells are invading them? The metamorphosis of cytotrophoblasts and acquisition of phenotypic characteristic of spiral arterioles keeps the vessel patent and perfused.
This linkup of the fetus and the mother should be proper at the fetomaternal interface. If this linkage is suboptimal, the result will be obstetric vasculopathy. Interestingly this linkage should occur at both, the placental component as well as the maternal component. If the cytotrophoblasts fail to differentiate and assume maternal phenotypic vascular function early, they result in spontaneous missed abortion. (This term is now replaced by embryonic or fetal demise as per the duration of pregnancy.) This is the earliest manifestation of obstetric vasculopathy.
Such an intricate, well-planned and competently executed natural process occurring away from our eyes but is critical in healthy pregnancy outcome is bound to make an inquisitive scientist awestruck and amazed: Amazing nature indeed!
Amazing pregnancy intricacies


Saturday, 1 March 2014

A Teacher In Life.....A Teacher In Death

A Guru - A teacher

There was a complete chaos in the classroom. It was our second MBBS undergraduate lecture room. As we waited for the teacher to arrive and start the lecture expected disorder, fun, frolic, noise and mischief ruled. Absolutely neglecting the fact that there was a classroom adjoining ours, the entire class of more than hundred students was having a free for all. 

Chaos in the class

Suddenly all this turned into a hushed silence. Everything suddenly became orderly. Students sitting on the desks suddenly re-positioned themselves no one was uttering a sound and all seemed to be so disciplined. No the lecturer had not yet arrived – but there at the entrance stood a forty-plus, nearly 6 feet tall Professor, very handsome and immaculately dressed but with a stern and disciplined demeanor. He was just standing there without a single word uttered, in a commanding silence. His presence was enough. No word was spoken, no rebuke, no warning. He was apparently taking a class in the adjoining lecture hall and was disturbed by our melee.  He was indeed the no-nonsense teacher in obstetrics and gynecology about whom we all had heard a lot but had never seen him before. His personality and power of character of controlling the class by his mere presence at the entrance simply floored all of us. I was impressed.
In just over a year I could realize why he was so respected, loved and popular. He taught divinely. In his first lecture with us he had brought his personal laptop and showed us with the help of videos and pictures a power-point presentation through a LCD projector. It was a big novelty in those days. We could completely understand the mechanics of normal child-birth (the most difficult to understand) easily and thoroughly. I was aware that there were no laptops or LCD projectors with the college at that time. At best, mechanical slide projectors were the teaching aids available. 

At the end of the class, while we were leaving, I saw from the corner of my eyes, The Professor walking up to an unknown person whom I had noticed was also sitting in the classroom. He paid that stranger Rs. 1000. I overheard him telling that man in a low voice: “Children could understand this difficult subject. How does a thousand bucks matter?” Obviously he had hired the projection facility from his own resources. It dawned on me then that there are many who teach but there are very few teachers. I saw a teacher!     
As luck would have it I did my post-graduation in obstetrics and gynecology. While I worked in the unit of some other professor he headed some other unit. Once when I was doing my senior residency having successfully cleared my MD exam, on a big festival all consultants wanted leave. Seeing everyone tense, he volunteered to be "on first-call" meaning he was to be called first as soon as a complicated case is received. This was very unusual for a Professor to be on first-call that too on the day of the biggest festival. This was furthermore amazing as he was to do emergency in our unit to which he was not attached. Night was expectedly rough. There were five critical and complicated patients. They all needed major obstetric surgeries; he was present in all of them. However in all five he stood on the left side of the operating table. This meant that the postgraduate student stands on the right. One who stands on the right operates. All surgeries which with his expertise could have been over in 25-30 minutes, he patiently waited and made the students do them even in the middle of the night taking much more time.

At the end of five surgeries, sick and tired

The climax came when I saw him perspiring as he came out of the last surgery. I straight confronted him “Sir what is your temperature”. He obviously had fever. Under the effects of antipyretics he was attending someone else’s emergency and that too making students do surgeries. His only response to my question was “Don’t tell the students whom I have made to operate. They will feel indebted. I don’t like that”. “But Sir, why didn't you finish up the surgeries yourself?’. The answer was an eye-opener. “What fault of the students if I have fever? They won’t get such complicated surgeries again to learn. I was just doing my duty”. Tired he just crashed into the chair outside the operation theater. He made one request “Can you please drive me home? I can’t drive now”. As the New-year day broke, I saw sitting next to me in the car, with his eyes closed, a teacher in a medical college for whom his own debility was not as important as his duty to teach.
Prophets are not without honors....

He retired from service to a quiet life. As expected the department or the institution never gave him a farewell or even said a “Thank you” inspite of unparalleled selfless contributions and changes that he had affected. I had expected it. Words echoed in my mind: “Prophets are not without honors, but they never get it from their own city”.  Like me, many of his students are still very close to him.
The other day he rang me up. “Can you come down at my residence this evening?” The voice was as usual commanding but loving to which the answer “no” was never an alternative. When I went I realized that it was his seventieth birthday. There were a small group that had collected – two three of his old students, close contacts, some family members and a common lawyer friend. “I am making my will today and you are my witnesses”. I knew he was a full-timer in Medical College. What all assets must he have accumulated as a full-timer? But there must be something special, lest he wouldn't have called me. As the prepared will was being read most of us were least interested in knowing about his assets. But the last paragraph instantly stirred all of us up. “On my death, I pledge my body to Medical College, where I studied and taught all throughout my life. Like my life, let my body also be of use to the students of my medical college. It will be the responsibility of all my students who are present here and have signed below as witnesses that this wish of mine be followed in letter and spirit”. I could not hold my tears back as the lawyer looked very meaningfully at me. I barely managed to sign. As soon as I signed I left. I know he noted that I had become emotional. He did not stop me.


He pledged his body for donation to Medical College
As I walked towards my car, I imagined a picture after decades of the anatomy teaching- hall where some demonstrator would be teaching on a human brain or a kidney or some other organ, well-preserved in a jar. Knowledge-thirsty students I pictured crowded around the specimen. 

Amongst them would be future neurophysicians or world-class urologists of tomorrow some of whom may not even have been born today. Their seeds of basic knowledge would be sown on the body organs of a professor in that same medical college who had taught there decades ago. There was he - The Professor sitting in that jar in anatomy department teaching generations to follow even after his death. There he was indeed: “A Teacher in Life….A Teacher in death”.    


Saturday, 8 February 2014

Recurrent Spontaneous Miscarriages:latest BEST SELLER in Obgyn





About the book:

New and latest edition of this best-selling book titled Recurrent Spontaneous Miscarriages has just been published and has already been declared The Best Seller in obgyn. Extensively overhauled, profusely illustrated and interlaced with clinical case studies, this new edition covers all aspects of recurrent miscarriages up-to-date. This second edition has many nuances incorporated within. Aspects of Obstetric vasculopathies in reference to recurrent miscarriages have been specially handled. Special attention has been given to recent advances in immunology and ultrasonography in approach to a subject with recurrent miscarriages. Frequently asked questions regarding the use of heparin, progesterone, HCG and other supplements have been refreshed in the light of latest literature. Literature review has been stretched to include references upto December 2013. Evidence-based practice in recurrent miscarriages with practical tips to the management of these cases has been continuously kept in mind while preparing this new edition. Profusely illustrated with pictures, tables and laced extensively with clinical case-studies this book will make the students and clinicians best equipped to approach the problem of recurrent miscarriages in the most modern way. With references reviewed right upto December 2013, this monogram becomes a must for reference for all consultants, teachers and students of the subject. It has been very attractively priced so that it is easily accessible to as many obgyn practitioners as possible.


About the Author:

Dr. Pankaj Desai


Dr. Pankaj Desai is one of the best known academicians and teachers in obstetrics and gynecology in India. All his ten books have proved to be best-sellers, one of which was awarded the best book award in the subject. A prolific writer, he has contributed 39 chapters to different text books internationally and nationally. His outstanding academic contributions in the subject have been acknowledged and honored with 7 gold medals and 52 orations. An extremely popular teacher that he is, he has delivered 616 guest lectures in different parts of India and the world at the time of this book going for print. He has published 104 research papers till date, 9 of which have been awarded best research paper prizes. His website www.drpankajdesai.com has become an extremely popular portal for students and practitioners of the subject seeking references and up-to-date knowledge of the subject. It has invited nearly 1, 70,000 hits by the time of this publication. His blogs on different academic and non-academic aspects being published on the net as Dr. Pankaj Desai's blogs have also become very popular inviting more than 27,000 reads as of now.

Contents:
1.      Introduction to Recurrent Spontaneous Miscarriages: An Overview
2.      Ultrasonographic Features of Fetal Demise
•         Terminology
•         Gestational Sac Features
•         Subchorionic Hemorrhage
•         Fetal Cardiac Activity (CA)
•         Yolk Sac
•         Doppler Findings
3.      Anatomical Causes of Recurrent Spontaneous Miscarriages
•         Investigations
•         Congenital Uterine Anomalies
•         Acquired Uterine Anomalies
•         Cervical Incompetence
4.      Immunology of Recurrent Pregnancy Miscarriage
•         What Protects the Fetus?
•         Partner Specificity in Miscarriages
•         Autoimmunity in Recurrent Pregnancy Loss
•         What is Spontaneous Resolution?
•         The Miracle of Paradox
•         Laboratory Evaluation
•         Treatment
5.      Genetics of Recurrent Miscarriages and Other Pregnancy Losses
•         Etiology
•         Blighted Ovum and Missed Abortion
•         Syndromes
•         Chromosomal Abnormalities and Fetal Malformations
6.      Endocrinal Causes of Recurrent Spontaneous Miscarriages
•         Diabetes and Recurrent Spontaneous Miscarriages
•         Thyroid Abnormalities and Recurrent Spontaneous Miscarriages
•         Progesterone and Recurrent Spontaneous Miscarriages
•         Luteinizing Hormone Endocrinopathy and Recurrent Spontaneous Miscarriages
•         PCOS–Insulin Resistance and Recurrent Pregnancy Loss
7.      Endometriosis and Recurrent Spontaneous Miscarriages
•         Endometriosis and Pregnancy Loss—Examining the Evidence
•         Possible Causes of Endometriosis and Pregnancy Loss
8.      Infections and Recurrent Spontaneous Miscarriages
•         How do Infections Cause Recurrent Miscarriages if at All?
•         Essentials of Lab Diagnosis for Proving the Association Between
•         Specific Organism and Recurrent Miscarriages
•         Specific Infections and Recurrent Spontaneous Miscarriages
•         Are Antiphospholipid Antibodies Originating In Infections?
9.      Psychological Bearings of Recurrent Spontaneous Miscarriages
•         Immunology, Psychology and recurrent miscarriages
•         Providing Psychological Support to Subjects with recurrent miscarriages
•         Components of Support Giving that may be Helpful
10.  Evidence-based Practice in Recurrent Spontaneous Miscarriages
11. Approach to a Subject with Recurrent Spontaneous Miscarriages

You can obtain a copy from:

Jaypee Ahmedabad Phone: +91-079-26926233, +91-079-32988717
Jaypee Bengaluru     Phone: +91-80-22285971, +91-80-22382956,+91-80-32714073
Jaypee Chennai         Phone: +91-44-28193265, +91-44-28194897, +91-44-32972089
Jaypee Hyderabad    Phone: +91-40-66610020, +91-40-24758498, +91-40-32940929
Jaypee Kochi             Phone: +91-0484-4036109
Jaypee Kolkata          Phone: +91-33-22651926, +91-33-22276404/15, +91-33-32901926
Jaypee Lucknow       Phone: 0522-3293848, 0522-3293847, 0522-4108504
Jaypee Mumbai         Phone: +91-22-24124863, +91-22-24104532, +91-22-32926896
Jaypee Nagpur          Phone: +91-712-3245220

OR

Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com

Tuesday, 28 January 2014

Blood Relatives…WHO?



“Sir there is a rupture uterus. She is looking very pale. We are arranging for blood. The anesthetists have been called” – it was a typical call from one of the junior doctor on duty from the labor room in the middle of the night. Such calls instantly awaken and put the consultant-on-duty in alert mode.  As I accelerated my car on the nearly deserted roads in the middle of the night, I did a mental rehearsal of what all complications and challenges I was likely to face and what all should be done. No wonder rupture uterus is called “electric emergency in obstetrics”. It is a potentially catastrophic event during childbirth by which the integrity of the uterus is breached. It is a life-threatening event for mother and baby.
Rupture uterus: Baby dead, mother endangered
As I was racing up the stairs to the labor room operation theater, I passed a junior doctor. He was obviously breathless hurrying back from the blood-bank carrying two units of blood in his hands. It must be for that patient in shock. I asked him “Why did you go personally?” The reply as expected: “Sir, all relatives have disappeared as soon as we told them to replace blood. The helping staff in the operation theater is very busy helping the doctors as this patient is critically bad. So I went personally. She may die, sir!” (We had a system in the hospital for patients requiring blood transfusion wherein relatives were encouraged to replace blood.)
Blood bag

Once in surgery, I quickly did what was to be done and the patient stabilized. As I looked up from the surgical field, I saw two units of blood running fast into her veins. I could also see two more units of blood ready to be transfused once these got over. I inquired “Who amongst you gave blood for this since the relatives have disappeared?” As expected two were donated by the junior doctors who were actually assisting the surgery and two others were from undergraduate M.B.B.S students who were watching the surgery. Such a routine scenario! We all had a knowing smile on our faces.

Blood donor's smile

Surgery successfully over, I came out of the operation theater and while I was descrubbing I requested the nursing staff to call the relatives of the patient. I wanted to brief them about the condition of the patient. The nurse meekly said: “Sir she has no relatives”. I could guess that she must have seen the picture of no one coming forward as a relative of the patient when blood replacement must have been asked for surgery. I smiled cryptically. I went to the area where relatives of patients wait and just announced: “Who all are the relatives of Mrs. X (Name hidden)? She is out of danger now!” and like a miracle 15 to 20 apparently healthy and young people sprung up: “Sir we all”! I briefed them. Then I said “She will require two more units of blood. She has lost blood considerably”. Immediately most in the group stepped back. From the corner of my eyes I could see some of them actually leaving. Only two remained who immediately blurted in chorus: “Sir we are not her blood-relatives. We are just neighbors”. “Who is her blood relative then?” An absolutely frail looking old woman was forwarded by them “She sir, only she”. “No other blood relatives?” I smilingly asked. Their eyes went blank and as if aimlessly they started looking at the junior doctors who were standing with me!
Ironical smile

As I started my car to go back home I couldn't help wondering: who were her relatives – her husband? her brothers? sisters? uncles? aunts? parents? or the doctors who rushed to save her life with their own blood - donated blood for her, came and assisted in surgery and will now take care of her all throughout till she goes home?  This idea just looped in my mind again and again that night “Blood relatives who?”

    

Monday, 14 October 2013

A Loaf Of Bread (A Human Story)

Bleeding Emergency

She was rushed down to the obstetric emergency rooms with advanced pregnancy, increased blood pressure and heavy bleeding. Almost immediately she delivered. Her baby was a stillborn. It did not stop at that. Because of raised blood pressure and bleeding for a long time before she could reach the hospital, her kidneys failed.  This was indeed a bad condition to have. Thankfully her kidney failure appeared to be of the type where recovery was possible. But in the mean time she needed dialysis. As luck would have it, all the three dialysis units at the hospital were dysfunctional and so she had to be shifted to another government hospital in a still bigger city about a 100 miles away.

Hospital Transfer Ambulance
Obviously she was in no position to spend for her transport but the hospital had the facility to transfer her free in its ambulance. Though the main part of the dialysis at the government hospital was free, each cycle of dialysis would still be costing her nearly 2000 to 3000 rupees. Even if by a conservative expectation of five to seven cycles, the cost would not be less than twenty thousand rupees. The referring doctors knew this. They sent one of their resident junior doctors in the ambulance stuffing his pockets with about twenty five thousand rupees. This money was to be handed over to the doctor on duty in the kidney hospital with clear instructions not to reveal to the patient from where the assistance came. All was arranged and was going well. She started recovering.

Dialysis Unit
After sometime I had an opportunity to go to that city for some academic engagement. Out of concern and wanting to make the patient feel cared-for I visited the hospital to meet her and her relatives. In a typical Indian tradition she and her husband folded their hands in a “Namaskaar” and she had a smile on her face. She was obviously looking frail recovering from a major sickness. What intrigued me was that her husband looked haggard and weak. They were obviously happy at her recovery and had all blessings for the hospitals. But the look of her husband, all worn out and hungry was disturbing.    

On my way out I took her husband with me out of the hospital ward and inquired about his well-being. “What is the matter? Are you okay?” I asked. “Everything is okay, Sir” he replied with a forced smile. I was not convinced. “What is the matter? Your wife is recovering. She has been treated very well. Everything seems to be good to me”. “Yes sir” he sighed. All did not seem to be well. I persisted as I wanted to know what was paining this man. Finally he said: “Sir, I am here in a totally unknown city. My wife has been admitted for last ten days. In these ten days I have not earned a penny. As such at our village too I work as a laborer with a near hand to mouth existence. Whatever little money I had could pull me on for five six days. Now all that money is over and I am not able to get enough food. I get to sleep in the hospital corner. But Sir, Food? My wife gets her hospital diet. She shares something with me. Since then I am not getting enough food to eat. That is the only problem Sir. Lest all is well” and again came the forced smile.


Tears welled-up

Tears welled-up in my eyes at the paradox: Here was a man for whose wife we arranged for free dialysis of nearly hundred thousand rupees but for him we could not arrange - a loaf of bread!




Sunday, 22 September 2013

A Child’s “Thank You” [Human Story]




Medical college hospitals have some very interesting routines. One of them is The Grand Round. Though its structure and name may vary from one hospital to another, in the obgyn department where I worked it was on the day on which we had our minor OT. On this day surgeries which did not need major anesthesia were performed. The chief of the unit would take the round with all other junior consultants and all postgraduate students. It was a spectacle – the chief walking cot by cot surrounded by his entourage of his subordinates and nursing staff.

One fine morning in one such grand round, the chief stopped by a patient who had choriocarcinoma (a quick-growing form of cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta). Choriocarcinoma occurs in young subjects in their reproductive age. Thankfully it is very responsive to treatment. The subject in question was being administered chemotherapy (medicines for treating cancer). While the chief was being briefed about the medical details of the patient’s condition by his juniors an intriguing happening occurred. The small child of the patient in question climbed up her mother’s cot and started touching the chief’s spotless white apron with its dirty hands. 

Child reaching out


The chief looked at the child with loving eyes and patted its cheek. Both communicated with each other with no words spoken. The assistants however were not very happy. “How could this dirty and shabbily dressed kid touch and soil the apron of their boss?” It is said that the kettle is always warmer than the tea it holds. After the round was over two assistants walked up to the mother and instructed her to ensure that this is not repeated.  All seemed to have been forgotten till another grand round – a couple of days after.



Again the same spectacle recurred. While the chief was being briefed about the latest condition of the patient, the child climbed up its mother’s cot. It boldly reached its hand out to the chief and touched it. Prominent stains of dirt were seen on the spotless white apron where the child had reached the chief. Again the chief looked at the child with loving eyes and patted its cheek. Both communicated with each other with no words spoken. He talked a word or two of reassurance to its mother and moved on. But the juniors were now livid. As soon as the chief left the ward, all of them rushed to the patient reprimanding her for her child’s “misdemeanor”.

The week that followed saw the same spectacle – the grand round visit of the chief, the mother with an intravenous line of chemotherapy and the child climbing up her mother’s cot and reaching out to the chief soiling his spotless white apron. The chief as kindhearted and gentle as ever patted the child lovingly, smiled at the patient reassuringly and moved on. But this time he didn't leave the ward. As soon as he reached the gate of the ward, from the edge of his eyes he watched his juniors making an angry rush to the patient’s room. He quickly turned around and called all of them. What followed was something very tender.

The hospital being a government public hospital could not provide free cancer chemotherapy treatment. The patient in question was in no position to buy these drugs from her resources as she was financially challenged. The chief seemed to have sensed this. As he had done with many of his patients in the past, he anonymously arranged for the costly drugs from his personal resources. He had clearly instructed the chief-resident through whom the chemotherapy was arranged, not to reveal this to anybody. In his exuberance it seemed the chief resident had told the patient from where the money for her treatment had come. However other consultants and junior doctors were oblivious of this. Apparently the husband and wife were very thankful and had discussed their relief amongst each other in presence of this small child. Their child was sensitive enough to sense that it was the “big” doctor (the chief) who had done “something” for its mother. The happiness of the parents was sensed by the child. The brilliant chief had picked this up.

             
A sensitive heart

               The chief told his assistants and students, “When the child is trying to reach me and make some physical contact all that it is doing is telling a thank you. It doesn't have words. It is not erudite enough to speak. But it has a sensitive heart”. The child was making attempts to reach this man who gave happiness to its parents. Little did it know what that happiness was. It knew no language but the language of touch. So it was trying to touch the chief. “Her child is simply telling us Thank You. Just listen to the unspoken words of the child. Just feel the words in the touch of the child. It is saying….Thank you!”