DREAMER

Quotable quote #21

2010-12-14T10:38:00.000+05:30

My mother, my fiance and I (both of us are doctors and are still studying) went out for shopping yesterday evening in my brother's car. Near majestic, I saw a maruti 800 with a sticker on it's glass reading, "Mom's Gift."

I told, "The owner of the car must be a doctor then!"

What do you know about sunscreens?

2010-09-11T21:45:00.006+05:30

Who doesn't want to look good and be fair?! And when the demand being more than half the population of the world, who will not take the advantage of it?

Today, I attended a dermatology class as a part of my pg entrance preparation and the dermatologist told a few things about UV rays and sunscreens. I came home and searched in wiki and a few other websites and below are few things about the sunscreens.

Ultra-violet rays:
There are 3 types of UV rays: UVA, UVB and UVC. Of these, UVA is concerned with photoaging (wrinkling, sagging, leathering etc) and UVB is implicated in causing sunburns.

Natural defence against UV rays:
Melanin - UVA increase the amount of the melanin pigment in the melanocytes and increases the release of melanin from the cell. UVB increases the synthesis of melanocytes.
Melanin absorbs the harmful UV rays and dissipates it as heat.

Difference between sunblock and sunscreen:
Sunblock is opaque and is stronger than sunscreen since it is able to block a majority of the UVA/UVB rays and radiation from the sun, thus not having to be reapplied several times a day. Titanium dioxide and zinc oxide are two of the important ingredients in sunblock.

Sunscreens are more transparent and protect mainly against UVB and not against UVA. The newer, broad spectrum sunscreen have at least three active ingredients: They are PABA derivatives, salicylates, and/or cinnamates (octylmethoxycinnamate and cinoxate) for UVB absorption; benzophenones (such as oxybenzone and sulisobenzone) for shorter-wavelength UVA protection; and avobenzone, ecamsule, titanium dioxide, or zinc oxide for the remaining UVA spectrum.

What is SPF?
SPF — or Sun Protection Factor — is a measure of a sunscreen's ability to prevent UVB from damaging the skin. Here's how it works: If it takes 20 minutes for your unprotected skin to start turning red, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer — about five hours. So it's mainly concerned only with the duration of the block, not the actual strength of the block.
The strength of block also increases as the SPF number increases but no sunscreen is 100% effective and more importantly, the brands availabe in the market might not actually contain in them, the ingredients printed on the pack.

Now coming to the actual practical utilization:

1. Sunscreens are effective only after they are organised into a thin coat on the surface of the skin that binds to the skin and hence need to be applied half an hour before going out in sun; those applied before 2 hours are also ineffective.

2. Reapplication every 2 hours is required irrespective of the SPF used as the sunscreens are broken down quickly after exposure to sunlight. There is also no use if the sunscreen is applied just before going out in the sun because the sunscreen breaks down before binding to the skin, releasing reactive oxygen species.

3. The amount that needs to be applied is 4 times more than the amount one generally applies for other fairness creams etc. Generally, nobody applies enough of the sunscreen to be enough.

4. Only UVB is blocked by most of the sunscreens and only sunburn can be prevented in sunburn prone individuals. The incidence of Squamous cell carcinoma and basal cell carcinoma might decrease if applied in the right quantity and duration, but the UVA associated malignant melanoma and photoaging go unrestrained.

5. Most importantly, sunscreens release ‘reactive oxygen species’ which are being implicated in all the diseases in the body, including cancers (Free radical injury). The sunscreens penetrate into the skin in 30 minutes to an hour and start releasing the free radicals, which increase in concentration after an hour. Hence, the sunscreens applied just before going out in the sun and those which are not reapplied do more harm than good.

6. Whether it is summer, winter or cloudy, UV rays penetrate the atmosphere all the time and reach the earth’s surface. So it doesn’t mean that you don’t need sunscreen if there’s no hot sun.

7. There are concerns about vitamin D deficiency in countries where people don’t spend much time in the sun and those who spend, use sunscreen all the time (sunlight is essential for the skin to synthesise the precursors of active vitamin D). Of course, this doesn’t hold good for our country.

Coming to the most important question: Who needs a sunscreen?

When Indians have such a good natural protection of melanin, why bother about sunscreen?! Well, to keep oneself fair, you've to apply the sunscreen as mentioned above and then only it'll be a 'little' useful; because all persons don't react equally to the sunscreen. For one person's skin, it might be very effective (the sunscreen might bind well to that particular skin) and for another, it might be useless. Also, too much sweating and washing face with plain water will wash away the sunscreen. Water resistant ones have also been developed but it's not in the market much and can't rely upon whatever is written on the label.

I think the people who actually need sunscreen are the very fair skinned people who have less of the natural sunprotector -melanin, people living at high altitudes, people living in cold countries where snow reflects the sun's light and more UV rays hits the face and for people who are inherently more prone for sunburn. For these people, I think sunblock is more essential than just applying a sunscreen; but for Indians, sunscreens are either not effective because of improper application or are not necessary at all. And if used improperly, it might do more harm than being useful. Beware!

Sources:

https://secure.wikimedia.org/wikipedia/en/wiki/Sunscreen

http://www.skincancer.org/Sunscreen/

A 'contract'

2010-08-27T14:51:00.003+05:30

I attended a wedding reception yesterday evening and was asked to sit at the reception to give arishina, kunkuma and rose to all the invitees as they entered the hall. There was already one beautiful girl wearing a saree, sitting there silently and I went and sat next to her. After a few minutes, I asked if she's from the bride's side and she told yes. We didn't speak for the next five minutes and to break the silence, I asked her what is she studying and where does she stay. . She told she is studying in 1st PUC and stays at Magadi Road, Bangalore. The bride's side was from Tamil Nadu and Kerala and I realised she was a girl who had come there as a part of some contract (Nowadays, catering, decoration and photographer can be booked together and we don't have to take the trouble searching for them separately) . I asked her about why she was there and she told they are called from the catering head - they're a group of 4 girls, one sits at the reception, the other to serve the soup, the 3rd and 4th to give Tambula (coconut, betel leaf and betel nut in a bag on which the bride and the groom's name are printed). I asked if it doesn't disturb her studies and she told they don't have to do this work daily, it's only once in a week or less and they've to stay at the reception only from 7pm to 10pm. When asked more about her family, she told her father is retired from business and mother is a housewife and there are 7 children! A brother who is married and has a kid, one sister working at a call centre, another doing nursing etc. She and her sister attend wedding receptions and they are paid Rs.250 each per reception.

Gone are the days when there used to be a bunch of small kids decked up in nice colourful dresses, happily roaming around in the wedding hall, getting their cheeks pinched by the elders, standing outside in turns and welcoming people; now there are less kids in a family and even if they are there, they have to stay near to their parents, socialising with adults, looking and behaving more dignified than adults. Offering arishina-kunkuma and flowers has become an undignified job which can also be done by the girls meant for that who are a part of the catering contract.

More surprise was waiting for me. . Two 40 year old ladies entered the hall, dressed up neatly in traditional silk saree and gold jewellery and I stood up and offered them arishina and kunkuma. The ladies glimpsed at me, gave an artificial smile and told 'No Thanks!' and went inside! By the time this happened, it was time for me to have dinner with my family and come back home. The contract girl stayed there and hardly anybody entering the hall saw her. When I went to the dinner, there was one girl in saree (all 4 wore an orange colour saree, as a part of the dress code) serving soup and the other two at the end of all the stalls, giving coconut. When I left the hall, I waved her bye and she smiled back and continued with her job. Now there were one or two near her, as Tambula was kept even is this counter, for those who forgot to take it after the dinner.

The test of time

2010-05-25T14:22:00.005+05:30

I happened to visit my blog unintentionally today! And realised it's 8 months since I have posted anything! I read some of my old posts and wondered if I really wrote all those. So many things have changed over the last 8 months. . I'm preparing for All India PG entrance which is on jan 9th, 2011. I'm no longer employed, my internship is over, I can call myself as a doctor now; all the skills I acquired during internship are collecting dust, brain is not working at it's full speed, there's no enthusiasm and motivation to study and mind is rusted. [I was chatting with my friend while typing this post and told my mind is rusted; and the reply came immediately, 'Don't use the word rusted, it doesn't suit you.']

I was fine till internship got over, the hospital work kept me occupied, there was change everyday, I was jumping from one department to another and there was enthusiasm to learn. It's only 2.5 months since it is over but it feels like 2.5 years. Sitting at home from morning to evening is so distressing, I'm fully cut off from the college community, friends, reading room and hospital. . First I tried to utilize time well and studied well for a few days, then everyday became a routine and my study hours decreased, slowly I deteriorated. I never thought I would deteriorate so soon; atleast I'm realising it now. It's time to get back to track, study well and make my future. I will start going to college reading room again and will try to get into the mood of studying again. Will also try to continue blogging, it's so refreshing to blog again.

Getting "used to"

2009-09-19T10:49:00.004+05:30

I've been thinking about "change" - change in the lifestyle and the choice of foods. How my veg classmates started eating non-veg, how people start drinking, smoking etc. The choice is theirs and I'm not commenting about it but just thinking how it all starts. The first and a major influence is the company, friends. Initially, you see people around you eat non veg and drink at gatherings (conferences, parties sponsored by medical representatives, birthday parties etc). First you feel bad, then neglect it thinking it's their choice, then you get 'used to' seeing people eat non veg and drink, then you observe them, then you feel like knowing what it is and how it might be; when the will to taste it exceeds the will of not to do so, you finally taste non veg/ have a drink. That is the start. Then you feel it weird, then in the next party you feel as if you are missing out something and you would have forgotten the taste, so you taste it again, it tastes better this time, not too weird. You feel a bit guilty but then, you get 'used to' it. You promise yourself that you won't get into the habit only to break it yourself.

Next comes the change of attitude. You start thinking why eating non veg and drinking are bad. Animals are of course some entity of life, plants too. Why can't you kill them if you can root out plants just to satisfy your hunger? Plants are also a form of life. (I get this explanation from every non vegetarian)
The attitude about drinks also undergoes a change. There's lot of stress in life, what's wrong in social drinking, many do that anyway, why shouldn't I drink at social gatherings? Initially that was tasting weird, now starts feeling good, then it tastes like coca cola, then it becomes sprite, and gradually, it becomes as easy to drink it as water. You get 'used to' it.

A milder form of getting 'used to': When I was at bhadravathi, the only thing I used to eat outside was pani puri/masal puri, only when I came to high school. There were a row of stalls next to discussion class (where many students used to gather and study, I'll write a post about it later) and we used to go and eat pani puri only when a test/ exam got over, very occasionally. All our energy and concentration was focused on studies and nothing else and there was no temptation and motivation to go out and have pani puri frequently. After we completed 2nd PUC, CET exams and all other exams, the number of visits to pani puri stalls increased. We used to gather at discussion class, chat for sometime, have pani puri and go home; there was no better work to do (there was a long gap of 4 months between our CET exams and the start of MBBS/BE courses). My friends took me to a stall which offered 'gobi,' that was the first time I saw gobi. It appeared like a non veg dish to me and I refused it. The second time we went together, many ordered for it and I tasted one piece, it tasted weird and oily. By that time, classes started and I came to Bangalore. In the hostel, gobi was made once or twice in a month and I started having it. And whenever the food was bad at hostel, Divya (my friend and senior at hostel) and I used to go to VVH canteen. She used to order fried rice and sometimes gobi; I tasted fried rice for the first time there and after that, I've had fried rice and gobi many times at VVH! Got 'used to' it. :-)

PS: I'm a vegetarian, non alcoholic and non smoker. When I had been to ENT fresher's party, I was the only one who ate veg, all others were eating non veg and that was when I felt I'll write a post on my blog about 'getting used to.'

The choice about being a veg/non-veg is not entirely ours. It's about how well we are brain washed during our childhood. My parents are veg, and I'm veg. If my mom had cooked non-veg, I would be a non-vegetarian. I can have non-veg but my brain feels that killing animals is unethical and hence I don't have the temptation to taste non-veg. And I'm not 'used to' it. I used to feel nauseating at the sight and smell of non-veg; now I can see people eat non-veg but still feel nauseating when I see them eat the muscle fibres and the bone marrow.
I can just cut and suture muscle fibres in the operating field or cut a bone with a gigely wire during amputation, but I can't imagine eating them.

Quotable quote #20

2009-09-17T12:10:00.001+05:30

I told my brother today that I've joined car driving class. He remarked, "Unlike video games, there's no restart. Be careful."

Quotable quote #19

2009-09-10T12:55:00.002+05:30

A post in my brother's blog:

"A wise woman once said about three ways that people end up screwing up their lives:

1. Cannot forget about the past.
2. Can't live the present.
3. And can't stop being worried about the future."

My views on it:

"Live the present as if there's no tomorrow. Life is beautiful."

Irreparable loss :-(

2009-08-26T19:10:00.002+05:30

I go to the beauty parlour only 2-3 times a year, just to get a very simple straight cut done. But this time (I don’t know why I got this disastrous idea), I thought of acquiring a different hair style and went to the parlour today. The lady there did something called ‘layers with step.’ The end result was that I was looking miserable and she charged me Rs.150 for that (she told it’s cheap!) which is a day’s hard earned money for me. :-( Moreover, it's an irreparable loss :-( and I just hope my hairs grow back soon.

If I had a barber’s scissors in my hand instead of a surgeon’s knife, I think I would be minting money by now!

Smart patients!

2009-08-19T23:28:00.001+05:30

Most of the cases in the Orthopaedics OPD are HPD syndrome (haata, paava dard syndrome!), osteoarthritis, fractures and lot others. The standard treatment for HPD syndrome followed by us is diclo+rantac and paracetamol for osteoarthritis (only analgesic action of paracetamol is enough as there’s no inflammation in osteoarthritis).

A case of osteoarthritis came and the PG examined the lady and prescribed her paracetamol. After 10 minutes, she came back with the paracetamol tablets provided by the hospital and asked the PG, “Ye bukhar ki goliyan hai, is se dard kaise kam hoga?!” (You’ve prescribed me tables for fever, how will pain come down by it?) The PG frowned, tried to explain her that paracetamol was enough for her illness and I don’t think she was convinced by it.

What would have happened to we doctors if all the patients of Victoria and especially Vani Vilas Hospital were well educated?! Most of our energy would be spent on trying to communicate with the patient than actually treating them. Thankfully, majority of the patients still listen to what we tell and we try our best to help them.

Updates

2009-08-19T23:24:00.004+05:30

Now in orthopaedics postings. I’m allotted only female ward, emergency and special ward and the number of patients there are quite less; and even after one and a half week of postings, I’ve not done a single wound dressing! Ortho is much better than ophthal/ENT postings (where I didn’t have any work but had to just stay there doing nothing) and it’s going on smoothly. I' m mostly doing pre-op work up of patients and casualty duties.

I read a couple of novels by Robin Cook and found it just ok ok. The biggest flaw in “Coma” is Susan Wheeler (the intelligent doctor in the novel) telling all her discoveries to the director of the institute which is obviously unintelligent and stupid.
Read Michael Crichton’s Jurassic Park, another wonderful fiction; very much different from the movie.

After the news of ‘Swine Flu’ spread like flu through the media, my male counterparts (interns) seem to be happy seeing some pretty ladies roam around in the Victoria Hospital campus, asking directions every 100 meters to whoever they find in white coat, to the swine flu ward!

The swine flu screening centre is just next to our duty room now! Hope we get resistance to all the infectious diseases prevalent in our hospital and hope the flu ends soon.

PS: Victoria hospital was visited only by poor people who were ill. Now that swine flu screening is done only at certain institutes, even the rich people and all healthy ones are visiting Victoria hospital.

The anthropomorphic phenomena

2009-08-01T17:00:00.002+05:30

When the movie Koi Mil Gaya was released, it was stated in a newspaper review that the producer has spent some crores on the creation of the character 'Jadoo' (an extra terrestrial life in the movie) and lots of big minds have spent a couple of years creating it. There was also a picture of it and my mom saw that and told, "It's again just a modification of a human, what's so special in it?" Recently, I read the novel 'Sphere' and started thinking why an ET is always human-like.

“You see,” Norman said, “at first I thought the Anthropomorphic Problem—the fact that we can only conceive of extraterrestrial life as basically human—I thought it was a failure of imagination. Man is man, all he knows is man, and all he can think of is what he knows. Yet, as you can see, that’s not true. We can think of plenty of other things. But we don’t. So there must be another reason why we only conceive of extraterrestrials as humans. And I think the answer is that we are, in reality, terribly frail animals. And we don’t like to be reminded of how frail we are—how delicate the balances are inside our own bodies, how short our stay on Earth, and how easily it is ended. So we imagine other life forms as being like us, so we don’t have to think of the real threat—the terrifying threat—they may represent, without ever intending to.”

-From the "Sphere" by Michael Crichton.

The below three creations in the movies related to extraterrestrial life substantiates the above reasoning. Master yoda in Star Wars, The ET, Jaadu in koi Mil Gaya; all that they could imagine were a head, a body, a ribcage, two legs, two ears and two eyes.

What else can we imagine? If they had created an extra terrestrial life resembling an umbrella, it would look like a jelly fish;

if they had imagined a muscular structure with tentacles, it would look like an octopus.

An organism like a ball of thorns would look like a sea urchin;

an organism with wide wings would look like a bat.

Can't we imagine anything else? Our imagination is only limited to what we know. We can't imagine what we don't know/ what we can't perceive. There's a good reasoning in 'Sphere' - We can only imagine a life in 3 dimensions or maximum 4. And whatever we can imagine is a permutation combination of what we already know. What if there's a 5th dimension? Or a 6th and 7th dimension? We will never know as we can't perceive it.

Also, only human-like forms will appeal to humans. Hence, to make the ET appealing, it has to have the basic mind of a human. An ET like the jelly fish/sea urchin won't be interesting as we know that a jelly fish/sea urchin can't speak or interact with a human (Again, that is all that we know of). Hence, the component of 'emotion' is invariably associated with whatever we imagine; which means our imagination can't expand beyond what we already know.

Quotable quote #18

2009-07-30T07:40:00.002+05:30

"Don’t do just because I tell you to do like that; always think why you are doing it and then do."

- A Surgery PG.

During internship, our job is to follow our seniors (post graduate students, staff) and to learn as much as clinical stuff from them; and gradually learn to perform independently. I was first posted to surgery and I had to do suture removal at Minor OT one day. A PG told me to wipe the wound with spirit first and then start cutting the sutures. He asked why I should put spirit first for a healthy wound, I told it’s to make the area sterile but I couldn’t tell the exact reason because the job was just to cut the suture and remove it. Then he told it has to be sterile because a part of the suture material will go inside the wound and come out. He told, "Don’t do just because I tell you to do like that; always think why you are doing it and then do."

It was a simple thing but a very good lesson. From then, I’ve been asking ‘why’ for most of the things I do; and have also avoided just blindly following what my seniors order me. I learnt a lot in Surgery, Anesthesia and OBG postings but Ophthalmology and ENT are too boring as interns don’t get to do any doctor’s work at all. I hope I get to learn something in the coming postings.

Lead kindly light

2009-07-23T15:12:00.002+05:30

I took an old female patient from Minto Ophthalmic Hospital to Victoria Hospital to obtain fitness for surgery by the physician. I took her twice, walked less than a kilometre (to and fro) each time and everytime I went, I waited there till the physician saw her. While coming back yesterday, she thrust 30 rupees into my hand and told I should have some coffee/tea. I denied it and told I won't take it. Then she started telling I've helped her a lot as she's too old and couldn't have done the job herself and hence I 'should' take the money as a token of love and that I'm like her grand daughter! She just refused to take the money back.
Today, I kept the money back on her bed and she started crying! She took it but just kept crying, told people pity her that she's poor after she has lost both her sons in different mishaps. Also added that her daughter in law takes good care of her; I hope she gets treated soon (a few laser spots for retinal detachment; done free of cost at our hospital and a cataract surgery).

There's no end to poverty and I'm glad the Minto Regional Institute of Ophthalmology is doing great job by helping as many patients as they can. An eye camp is arranged at urban and rural areas in and around Bangalore 4 times a week and patients with loss of vision due to cataract are brought to hospital where they are treated free of cost. Nothing is charged for the admission, food, surgery or the intra-ocular lens; and the poor old patients can see the world again.

Pattern matching

2009-07-23T14:56:00.004+05:30

The best thing about internship is that I don't have to write exams. :) So I can spend a lot of time on reading novels. The below is just my observation. I wish I could read my text books as fast as I read novels!
I read Tell Me Your Dreams by Sidney Sheldon a week back, and I read it in 5-6 hours. It was a small book with adequately spaced letters and lines and I felt I did read it all. But I also felt 6 hours was still less to read the whole book in detail, word by word.
Do we read each and every word when we read a newspaper or a novel? (I take lot of time to read my mbbs text books) Or do we do “Pattern Matching?” Once you get the plot and know where it is heading to, it’s easier to skip (just look at it, but don’t actually ‘read’ it) words such as I, we, are, there etc and many more small words. And hence I feel it’s always faster and easier to read a story than read a science text book. I think you would take a week to read a newspaper if you would ‘read’ each and every word of it.

My favourite text books

2009-07-21T15:06:00.006+05:30

This post is for medicos. Every year, I took a lot of time in finding out which book to study and the below is a list of my favourite ones. I'm just writing about them on my blog so that somebody might find it useful.

1) Review of medical physiology, Ganong: I took some time to get accustomed to the language and the way facts were presented in the book, but it was worth reading it. It’s very compact and contains no unnecessary facts. A must read in 1st year, not just an 'entrance' book.

2) Lippincott’s Biochemistry: It's a beautiful book. It helped me a lot as I could retain the photographic memory. You can picture the colourful pages and flow charts in your mind when you need.

3) Robbins’ pathology: This book needs no explanation. What everybody forgets is to watch the CD given along with the book; it has lot of stuff which is not present in the hard copy of the book.

4) Goljan’s Pathology: Great book, too good. I read it in 3^rd year. A must read irrespective of whether you’re writing MLE or not.

5) Lange Pharmacology: Another great book, very compact but has all the information.

6) Lange Microbiology: I loved this book. I bought this book just 2 months before the exam and read around 80% of it.

7) Harrison's principles of internal medicine: Unfortunately, I couldn't read this book during 4th year and now I'm not enough motivated to read it. It's the bible of medicine but I found it too lengthy. Anyway, I've to start reading it, don't know from when!

Your destiny decider

2009-07-09T12:19:00.007+05:30

This the labor room clock.

As soon as a baby is born, we document the time with the help of this. How accurate this is, I don't know; do they cross check and reset this periodically, that also I don't know. A baby's horoscope is written based on this and it's fate is also decided by the nurse who has recorded this. The question is, do you record it as soon as the head comes out or do you record it when the whole body is out? (there's no significant difference in a cephalic presentation); or, do you record it when the legs are out or wait till the head is also out? (in breech presentation, head comes last)

That's just a funny argument. The 'paada' of the horoscope might change frequently, sometimes, the 'star' can also change by just a minute's difference. So never blindly believe your horoscopes, birth stars etc., they all don't make much sense to me.

My brain!

2009-07-07T10:57:00.004+05:30

I don't have the good habit of reading newspaper. My mom marks only the important columns and I read them. Yesterday, I was sitting next to her and she read out aloud, "Britain celebrated Queen Elizabeth's reign of 57 years and her 83rd birthday and Pratibha Patil was invited; in the history of Britain, nobody else except the royal family has been invited for a function of the royal family." The news was something like that, I don't remember the exact words.

I asked instantaneously, "Who is Pratibha Patil?" Then I bit my lips, it flashed to me the next moment who she is. I have become so busy with home, hospital and work that the name 'Pratibha Patil' hadn't registered well in my brain. :-(

Doctor/ Sister?

2009-07-06T15:14:00.004+05:30

One thing which makes me furious - when my patients call me "SISTER." If they call sister to a lady doctor when they first enter the hospital, out of ignorance, it's fine. When they call me sister the second time or even after a day's stay at the ward, I'm furious. (Patients make out who's a doctor easily, a stethoscope around the neck is the trademark of a doctor; the one who's in white dress with tied hairs and powder on the face and also overweight, is a sister. The ones who are shabbily dressed, wearing coloured dresses and a dirty apron with blood stains here and there and who are in great hurry to finish their work are the doctors.)

Whenever patients call me sister even when they know I'm a doctor, I point to the sister and tell, "'sister' is there." Then the patients tell, "No Doctor!, I want to talk to you only." I politely reply back - "You asked for sister and sister is there, go consult her." That's the end, I don't speak to them unless it's very necessary. If they irritate me more, then my intern friend in the next ward can hear my voice.

PS: No offense at the sisters. They are one of the most important part of health care. It's just the patients' attitude that irritates me. Patients don't value a doctor at a government hospital, they should learn to do that.

Quotable quote #17

2009-07-04T16:00:00.001+05:30

Everybody used to highlight in class and clinics that Anencephaly is more common in female than male fetuses.

And yesterday, I read that the 'X' that is deleted in Turner's syndrome is the paternal X and it's the only cytogenetic syndrome in which the person's IQ is normal.

Quotable quote #16

2009-07-02T11:35:00.001+05:30

A part of the message I received on Doctor’s day (yesterday) which I found funny:

Biggest mystery of maths:

1000s of years passed,
millions of theorems derived,
crores of formulas made,
but still X is unknown.

Babies, babies and babies

2009-06-12T18:58:00.002+05:30

I had labor postings for a month and it was too busy. I ended up catching around 100+ babies in one month. I had 15 days of night duty and the day night reversal broke my circadian rhythm and I had to resort to a proton pump inhibitor to decrease the acid in my stomach. Now I'm getting some rest and getting time to blog. Labor room was fun, we used to manage everything on our own; it was a great experience. The maximum number of babies born in a 12 hour period was 24, which meant a PG, my co-intern and myself had to work for 12 hours continuously without a break.

Here is a photo of my friend placing a just born baby in the warmer.

Tulips

2009-06-12T18:22:00.002+05:30

Nothing can beat nature.

Photo courtesy: My brother.

Quotable quote #15

2009-05-22T09:43:00.002+05:30

My friend (my co-intern at labor ward) was describing a wedding he attended. He said, "How much jewelery the boy was wearing you know.... He was wearing two thick cords* in his neck, so much gold he was wearing!"

A pg and I couldn't stop laughing. He was so much influenced by labor ward duty that he forgot to just tell, "The boy was wearing thick gold chains."

(* Some babies are born with umbilical cord around the neck)

A gloomy weekend

2009-05-19T09:56:00.003+05:30

Clouds which masked the sunrise over the queen of hills, Mussourie.

There was a heavy downpour this sunday evening and I enjoyed watching it through the window. After it stopped raining, I switched on tv. Though there are hundred tv channels, nothing good pops up when you sit in front of tv to watch it. I thought I would watch a movie on computer but I had watched all the movies I had on dvds. I thought I would blog but the internet connection was slow. Then I thought of calling my brother and my best friend who left to US recently and I realized they would be sleeping. I thought of calling up my friends but then it flashed to me that most of them would be busy at that time (my doctor friends would be working on sunday too and my engineering friends would be enjoying the weekend or would've gone to their native). I got the feeling that I've everything but nothing. I came out of it soon and I slept off.
Now I'm thinking of pursuing my lost loves in my free time, painting and sketching. It's long since I did any painting.

Quotable quote #14

2009-05-09T14:18:00.002+05:30

"That which we must learn to do, we learn by doing."
- Aristotle (Nicomachean Ethics II)

When I was posted to anesthesia, I asked a PG and got the chance to give spinal anesthesia for a case on the second day (Profs had told me to just stand and observe for the first 4 days). Another intern kept quiet for the first few days, followed what profs had told and waited till they gave him the chance. Whenever he wore the OT gown and was ready to give anesthesia, a prof used to ask him, “Have you given any spinal? You observe me giving spinal carefully this time, next time you can do it.” The same thing went on for 3 or 4 times and he lost those many chances. When he finally felt he wanted to do it, he went near the patient’s spine holding the spinal needle and the prof came and told, “Your hands are shivering and the patient’s intervertebral space is narrow and hence I’ll give spinal this time too, you watch.” And the intern ended up giving just one or two spinal in two weeks.

Medicine is all about gaining practical experience. We might have watched a procedure hundred times, but we cannot do it by ourselves unless we do it ourselves. I’m spending some extra time at wards, OT etc (which means I’m not studying as much as my friends are studying for entrance) but I’m learning as much practical work as possible. Any amount of practical work is just not enough, each case is different.

DVT

2009-05-09T14:13:00.002+05:30

Stalin: ‘One death is a tragedy, a million deaths is a statistic.’

Among the many deaths at our hospital, this looked quite tragic to me.

Most of you would’ve heard of economy class syndrome. Due to prolonged immobility, blood gets clotted in the large veins of the leg, and if the clot embolises to your lung, you get breathlessness and you die. The below is a case of DVT.

I went to hospital on 6^th May at 8.50am (I usually go at 8, our work starts officially at 9) and was in no hurry to start doing my work. PG asked if I saw the patients in the female ward and I said no. I went there after 5 minutes and saw the PG giving chest compressions to a patient to keep the patient alive.

She was a 22 year old lady who had delivered a baby 3 months back, had suffered from DVT (deep vein thrombosis, post-partum) a month back, was treated by 4^th unit surgery at out hospital and had again developed pain in the left leg and pain abdomen. She was admitted on Saturday and the lecturer had treated her (we were on strike), he had put a requisition for ultrasound scan of the abdomen and the radiologist had fixed a date and time for it 3 days later, the scan was fixed on 6^th May 09 at 9.30am. I saw the case day before yesterday (after resuming work) and asked the patient’s relative why they couldn’t get it done early at a private lab, they told they can’t afford for that at a private lab. I sent another requisition for venous and arterial Doppler of the left leg to our hospital and again they were given a date. Anyway, she was already on warfarin treatment and I sent for PT, INR to see if warfarin was less or high. I saw that she looked pale but most of the patients are anemic at our hospital and hence didn’t pay too much attention to it. She complained of hematuria (blood in urine) too and told it was not much; I listed that in the case sheet.

When we saw her the next day, she had breathlessness and gasping; her mom told she had lot of hematuria at the night. We put her on oxygen and asked the sister if adrenaline and atropine were there. To our surprise, she told yes (we have got supply of lot of drugs after the strike). We started more iv lines, injected adrenaline, atropine, Vit K, Soda bicarb, Hydrocortisone etc; she picked up respiration but it weakened again. She passed away at 9.30 am on 6^th May. I think she had pulmonary embolism alone or DIC too. I have seen many deaths in the hospital but this looked quite tragic to me. I went to the ward again after two hours and that bed was empty.

Quotable quote # 13

2009-05-06T06:39:00.005+05:30

My friend: “Do you have water?”

I: “No Stock.”

No Stock is the punch line now. Our dean cum director has filed an affidavit at high court on Monday that we had all the emergency drugs and all facilities at the hospital. We have filed an affidavit yesterday that there was deficiency of many drugs, blood and basic facilities etc at hospital (that was the first reason for our strike). The court asked us to file a much more detailed affidavit stating which drugs and facilities were deficient and have given us 2 day time to file it. The main proof for that are the indent book and the investigations that were not done at our hospital and many other things. When we need a drug that is not there in the wards, we write a requisition in the indent book, they send the indent book to the store everyday. If the stock is there, they give us what we want; if we don’t have, they write “NS” (NO STOCK) and send it back. I’ve myself put indents for 5% Aminoven, Intralipid and Celemix etc and they have replied as NS. Medicine people keep asking for basic drugs and even they get a same reply. I don’t know what will happen at the court further but when my friend asked for drinking water, I replied “No Stock” and laughter burst out.

It also seems that the Interim order in writing did not contain any punishment to the PGs and House Surgeons! The court had said it verbally but it did not appear in writing.

Don't become a doctor, you have no value here

2009-05-05T07:05:00.003+05:30

MMC was on strike since april 23^rdasking for more security at the hospital campus when a patient’s relatives attacked a doctor. We (BMCRI, Bangalore) started strike on may 1^st. Our demands were the improvement of basic facilities at the hospital, strengthening the security, making the emergency drugs available all the time, hike in stipend (Interns are getting Rs.6000/m and PGs are getting Rs.11,000/m). It was organized by KSJDA – Karnataka State Junior Doctors’ Association, comprising of 1400 doctors all over the state (BMCRI, Bangalore; MMCRI, Mysore; VIMS, Bellary; KIMS, Hubli). The strike went on peacefully for 2 days. On Sunday, the dean cum director of our college, the superintendents and the additional secretary came on site to negotiate; they again gave verbal assurances and we told we won’t call off the strike. Yesterday, everything was at its peak when the high court passed a sou motu order stating that doctors can’t go on strike. It also passed an interim order which stated that the MBBS degrees of all the post graduate students have been barred and the house surgeons get an extension of 6 months without pay.

Yesterday evening, the police force arrived at our campus and told they’ll arrest us if we don’t call off the strike. First we thought its ok, let them arrest and it won’t be a problem. But then our friends who had been to the chief justice’s house (it was a holiday yesterday) told they were showed a court order which was passed around 3 months back which stated that KSJDA can’t go on strike which meant our strike itself meant a contempt of court, it was a complete surprise to us. We also got a show cause notice from the dean of our college for not attending our duty for the past 4 days. It was too sad that we had to call off the strike. Today, we have to first challenge the interim order and get our degrees back. If it is not over-ruled, all the 1400 doctors will no more be doctors and we’ll have to change our profession and start a new beginning! I think we have to start studying for CET again and become techies!

AIIMS doctors go on strike whenever their demands are not met, and the government agrees to it. Kerala doctors went on strike in December and their stipend was hiked in January. It’s only in Karnataka that doctors don’t have any value; there’s no support from the government, there’s no support from the law, there’s no public sympathy.

My sincere advice to all those who are writing CET this year – Don’t do the mistake of taking up medicine in Karnataka.

Where's the place for doctors?

2009-04-29T16:45:00.000+05:30

I had a look at my blogger profile now. Under 'Work,' there were two sub headings, Industry and Occupation. I had selected 'student' for Industry so far, I thought of changing it to Doctor or Medicine. I clicked on it and found the following options:

Not specified, accounting, advertising, agriculture, architecture, arts, automotive, banking, biotech, business services, chemicals, communications or media, construction, consulting, education, engineering, environment, fashion, government, human resources, internet, investment banking, law, law enforcement or security, manufacturing, maritime, marketing, military, museums or libraries, non-profit, publishing, real estate, religion, science, sports or recreation, student, technology, telecommunications, tourism, transportation.

Where's the place for doctors and the medical field?! Do we come under "Not specified?"

A few updates

2009-04-29T16:10:00.003+05:30

My grandpa who was 90 passed away last week. He had stroke 2 weeks back and passed away a week later. I just saw him (on my birthday) when he was at the hospital, I didn't go to see him after his death. The saddest thing about seeing a dead person is that you will know that you're not going to see him again; it's a sense of loss that makes it painful.

My anesthesia posting got over and I started enjoying it at the end when they allowed me to handle a table on my own; that day I gave 3 spinal and replaced a PG who went to emergency OT. I gave 8 spinal in total and wanted to give one or two epidural anesthesias but didn't get the chance. I am back to surgery now and enjoying it.

Though I'm learning work, my studies have suffered. Should get back to studies soon.

The art of balancing

2009-04-09T13:48:00.006+05:30

I've been posted to Anesthesia from yesterday. Today, I gave spinal anesthesia -- put a needle into a patient's back and injected the anesthetic drug; the first attempt was successful. :-) Quite a good day today, enjoying internship; I've some good work in my hands now.

I was monitoring general anesthesia for a patient, got a glimpse of what Anesthesia is. It's an art of balancing. A gas inhalation to make the patient unconscious, a muscle relaxant to make him immobile, top up injections to maintain everything, a central venous vein through neck for a major surgery -- all these to keep the patient alive, yet unconscious. Too much anesthesia is bad and too less is of no use; so just to keep balancing with all the drugs available.

The good thing during my Anesthesia postings is that elective OTs don't work on government holidays and sundays and hence I've two holidays during my postings and two sundays. :-) Looking forward to get some good rest after a month of hectic surgery postings.

Quotable quote #12

2009-04-07T16:44:00.002+05:30

Beware! Your cell phone might go mobile!

- This was put up near the entrance of the operation theatre of our hospital.

Work first, sleep later.

2009-04-01T12:31:00.004+05:30

We had OPD both on saturday and sunday this time (28th to 30th of March). I went to work at 8 am on saturday and my work got over at 2 pm on monday! I worked continuously for 54 hours with a total of 4.5 hours sleep (with an effective sleep of 2 hours). Now when I look back at it, I wonder how I could do it. But it was a good experience.

On saturday night, there were two mass casuatlites. 10 criminals were brought by police for first aid and to book them as a medico-legal case. Those people had murdered their opposite gang leader the previous day at Azad Nagar, Mysore Road. The hands and feet of all the 10 were swollen, I think the bones had broken inside due to police treatment; but they didn't complain of anything. They were instructed like that by the police I think. The police just wanted to book the case, they were in a hurry to produce them to the court at 10.40pm; the fractures could be treated later! By the time I wrote the 5th OPD slip with all the details of the crime, I knew the case by heart. Only one had a few cuts on leg which was sutured by my colleague.

The second mass casualty was quite bad. A Muslim family had come with broken head. One person had hit a whole family with stone while they were sleeping. (They were his relatives but there was some quarrel between them). There were 2 kids with scalp lacerations (tears in the head), another kid with lacerations on the face, and one more with a black eye. There were two or 3 adults with multiple cuts on the head.
The person who had hit was inturn injured by some and had sustained a stab injury to the abdomen. His gut was out, that required an emergency OT. And his pregnant wife also had 2 cuts on her head (later I came to know her husband only injured her head). By the time we finished stitching all the tears of all those people, it was early morning. So couldn't sleep at all.

Sunday morning was ok, I slept for half an hour. At night, the press reporter Gauri Lankesh had come with a pedestrian hit case or something, some accident case. There was panic in her eyes, she appeared frightened; I felt that was not how a journalist had to be in such a situation. The case was just a minor one without any head injury with all the work up done at NIMHANS. I just admitted the patient to head injury ward.

That was the first time I did a double duty, for 2.5 days, both day and night. Thankfully, the next double duty is on the day after our surgery posting ends. :-) Anyway, it was a great experience. I'm learning a lot. Very importantly, I'm learning how to be tough and I'm very happy with my work. :-)

My internship diary

2009-03-20T19:40:00.003+05:30

Two weeks of internship and I've lost one kilo! It's quite hectic and there is a lot of work to do. I found thursdays very tiring as I've to keep running around to shift patients to OT or just stand holding the retractor while surgery is going on; I've to just stand all the time (from 9 am to 2 pm approx.).

Saturdays are even more tiring -- OPD, Emergency duty at night and then the regular duty on Sunday; 36 hours duty in total !! Last saturday, I got up at 6 am, went to work at 8 am; kept working till 12 pm on Sunday and then went home and slept at 1 pm! I was awake for 31 hours continuously and worked at hospital for 28 hours without any sleep! The same thing to be repeated tomorrow and day after, God save me! Bye.

Shark cutting trhough water

2009-03-11T14:06:00.001+05:30

I invite comments for this photo: http://lakshmibk.blogspot.com/2009/03/shark-cutting-through-water.html

Take a closer look at it.

My first day as an intern :-)

2009-03-09T15:41:00.002+05:30

I've been posted to 6th unit, Department of Surgery, Victoria Hospital. It seems to be good. While studying MBBS, we always concentrated on cases that would appear for exams, remember every minute detail about it, mug it up and be ready to diagnose a similar case on the day of exam.

Now, there's no such tension of exams, we can work coolly and need not remember too many details. Feeling good. I hope one year of internship will go on smoothly.

Sunset

2009-03-07T09:00:00.002+05:30

All the birds are pigeons, not crows!

A few photographs of sunset at Birla Mandir, Jaipur.

Golden clouds:

The beauty of marble - Part I

2009-03-06T09:00:00.002+05:30

I had just seen marble flooring and a few small Jain temples at Bangalore which are built in marble; but felt that it's used like cement in Rajasthan and Agra. All structures are built in marble, there's marble everywhere! Makhrana is the second largest marble mine in the world (the first being Italy) and hence marble is in abundance in North India.

Why is marble so special? Take a look at the photos below. They are photos of a model of Taj at UP handloom, Agra. The white marble appears white in normal light, yellow at sunrise, bright white at noon, red at sunset and blue in moonlight. The below images just give an idea of how The Taj will look in different lighting conditions, the real beauty of it has to be caught by the eyes in real. To watch the Taj at moonlight, you've to inform the authorities 15 days prior and you've to pay Rs.750.

Taj at normal light:
Taj at sunrise:

Taj in moonlight:

White marble appearing yellow to golden at sunset (At Agra fort) :

My holiday diary

2009-03-05T09:00:00.002+05:30

This has been my busiest holiday ever. My exams got over on Jan 20th, but I've not got enough time to sleep properly. Soon after the exam got over, I went on a Bhadravathi - Thirthalli - Shimoga trip and spent a week there. After coming back, I got busy with my friend's father's consultation, investigations and surgery.

Then was one of the happiest times of my life, the North India tour, from Feb 10th to 22nd. It was great, I forgot about studies, exams and results completely. We had been to North India at the right time, it was neither cold nor sunny. Food was great as there was a cook accompanying us as it was a package tour.

From two days, I'm roaming around Bangalore. Visited my friends' places, had been for shopping, had breakfast at MTR and had coffee served in silver cup at MTR. In short, this has been my best holiday ever. :-) I'm now very reluctant to get back to work from monday. :-(

Shark cutting through water

2009-03-04T09:40:00.002+05:30

I found this rare photo at Discovery Photogallery. The shark is cutting through the water creating no ripples at all. The sun is shining from above and the water is so clear.

Doctor, I think I've some disease!

2009-02-28T09:00:00.003+05:30

A lady presented to the surgery out patient departement at Bowring and Lady Curzon hospital, around 5 months back.

Doctor (a post graduate): What is your problem?
Lady: I was watching a health program on tv. They told dark lines on the skin of the neck signifies cancer. I have noticed that my neck skin is a bit dark here and there and I feel that the hyperpigmentation is increasing. Hence, I'm always worried that I've cancer.
Doctor: No, it is also seen in normal individuals, it need not necessarily be a cancer; you don't seem to have a cancer.
Lady: No sir, I think I'm not alright. I am always anxious and the pigmentation is increasing.

The male post graduate referred the case to me and I had a tough time convincing her that it's not a sign of cancer. She actually had slight pigmentation due to contact dermatitis (because of her neck chain) and hence I referred the case to dermatology department.

It's lucky for me!

2009-02-27T10:05:00.003+05:30

We had 7 theory exams with just 2 day gap in between. In the exam hall, I noticed that Roll number 4, 5, 6 and 51 were wearing the same dress every day, for 7 days! I again noticed them in same dresses during clinical exams! I also remember seeing roll number 5 in the same dress from I MBBS!!

Later, I came to know that they wear it because they consider the dress "lucky." My guess is that they are doing the same since 2nd PUC and CET exams.
Doctors and superstitions go hand in hand most of the times. It's true! Most of the doctors are either firm believers of God or are crazy about things that they consider lucky.

Quotable quote #11

2009-02-27T09:00:00.001+05:30

The greatest cardiologist in the world measured pulse for 2 minutes; our young cardiologists of BMC measure pulse for 15 seconds. - A prof told in a theory class.

We are supposed to measure pulse (the thing that doctors feel when they hold your wrist) for one full minute but most of us don't do it. Instead, we measure it for 15 seconds and multiply it by 4. But to detect an abnormality in the rhythm of the pulse (to detect arrhythmias) we have to feel the pulse for atleast a minute, which we don't do!

Vote for the BMJ Group Lifetime Achievement Award

2009-02-26T15:50:00.002+05:30

Here's your chance to vote for Dr. Sudarshan Hanumappa who has been nominated for the BMJ Group Award for Lifetime Achievement. Just click on this and vote.

"Dr Sudarshan has spent his career improving the health of rural and tribal people in India. He developed a public-private partnership model of primary health care with the Karuna Trust, a charitable trust based in Bangalore that he set up 10 years ago. Since then, the trust has set up primary health centres in three states, providing health care to more than 600,000 people in rural India. The Karuna Trust primary health centres provide around the clock emergency and casualty services, outpatient facilities on six days a week, a small five to 10 bed inpatient department, and 24 hour obstetric facilities. Dr Sudarshan is firmly committed to state provision of health care, but set up the trust when it became clear that many primary health centres in rural India were providing very poor services, with insufficient staff and poor access to drugs. The trust’s aim is to set up primary healthcare centres that provide models to improve the working of other government funded clinics in the area. To achieve this, he has introduced a range of innovations, including community health insurance, telemedicine, and the integration of mental health into primary care. Dr Sudarshan has also served on several government committees working to improve public health, as well as working as a government appointed ombudsman to reduce corruption in health care."

Consult the right doctor, develop health awareness

2009-02-26T15:15:00.003+05:30

This is a must read. Don't neglect.

When you encounter a serious health problem in life, do not hesitate to take advice from the people you know. Sit and analyse which is best, discuss the treatment options with a reliable doctor and then go ahead. A blind step might cost you your life.

When I had been to Bhadravathi 3 weeks back, I heard that my friend's dad "had" cancer inside the mouth and I was instructed not to speak about it as the family would feel bad. I went to their house, I waited till they spoke about it and listened to them patiently. My friend's dad said that he is feeling some mass in the neck. I panicked. I was told that the cancer was inside the mouth but he was complaining of neck masses! (metastatic lymph nodes) I asked them to give complete details and then they opened up.

Here is the case history: My friend's dad noticed a whitish patch on the inside of his left cheek which didn't go off even after good mouth wash and an attempt at scraping it. When they consulted a surgeon at Bhadravathi, they were told that it's nothing and not to worry. Next time, they consulted a dentist! and he referred them to Manipal hospital (Udupi) and told biopsy was required. At Manipal, biopsy was done badly and the patch started growing rapidly and started bleeding. The report came out as squamous cell carcinoma (quite a malignant one, usually fatal if not treated aggressively). The doctors at Manipal told he needs a big surgery and he might not survive it. Scared of that, they came back. They went to another hospital at Shimoga (I don't want to name it) where they were told he just needed a small surgery. Convinced, they consented for it, totally unaware that they were digging their own grave. The surgeon there did wide excision of the white patch, cleared just a little bit of soft tissue around and put a skin graft!! No neck dissection was done, no advice was given to the patient and he was sent back with the assurance that it's cured and he need not come back, not even for follow up.

But he noticed a white patch in his mouth again just behind the operated area and started finding it very difficult to open his mouth. (He has mild trismus even after active exercise) When he consulted the surgeon who had operated on him, he was told the white patch was nothing and he was finding it difficult to open his mouth because of the skin graft (it was actually because of the cancer spreading inside and which was fixed to the pterygoid muscle; luckily, bone was still not involved). He also noticed small neck masses a couple of weeks later, consulted the surgeon again and he was sent back with antibiotics!!
This was the situation when I saw him. It was scary. He was slowly dying and everybody was unaware of it. I forced them to come to Bangalore, they agreed after seeing me panic so much.

We consulted an oncosurgeon here, surgery was done on 7th february and he's free of cancer now. Histopathology reports said that the lymph nodes had reactive hyperplasia without any signs of metastasis, one more news to be happy about. He is now back to Bhadravathi, leading a normal life as before. He can even return to work after a month.

I repeat again, "DON'T hesitate to take multiple opinions, find a reliable source of information, consult the right doctor, get treated properly."

Lakshmi.B.K to Dr.Lakshmi.B.K. :-)

2009-02-24T19:14:00.002+05:30

It's time to celebrate, I've passed 4th year MBBS with a score of 70.57%. :-)
Quite happy. :-)

Exams, exams and exams........Tired

2009-01-15T08:48:00.004+05:30

My final year theory exams got over day before yesterday. This is the only time I knew answers for all the questions in all the papers (7 papers, 700 marks). I'll comfortably pass in theory. But the sad thing is that practicals are advanced from 19th to 16th and 16th is tomorrow! 4 days of exams from morning to evening, I just hope everything will be fine.

Update: Practicals wasn't so fine, will be relieved and happy only when I see "Pass" on my marks card.

Sketch of the week

2008-12-22T09:00:00.000+05:30

Quotable quote #10

2008-12-17T09:00:00.003+05:30

"Change is one thing that is constant in life."

-Anonymous.

Sketch of the week

2008-12-15T09:00:00.000+05:30

Evolution of AIDS

2008-12-13T09:00:00.001+05:30

Another post by my brother:

Recently I was watching the PBS program on evolution where they were discussing how AIDS evolves. The program was discussing one particular feature of the evolution of the virus that puzzled doctors. When a patient was treated for AIDS, the HIV developed resistance. The story
of how it develops resistance is well known (the copying mechanism is faulty, so by chance one of them is better, the rest are killed, now the better one survives). What made the doctors take an interest is that when a patient was taken off the medication, after about a month, the virus was again susceptible to drugs. The reason given in the program was that the wild type was better at replicating, so in the absence of any selection pressure, it increased in number. But somehow
that doesn't convince me because the drug-resistant strain is not necessarily paying a price in replication. What I think (with my extensive experience in armchair explanations of evolution) is
happening is that, since the replication mechanism is faulty, whenever the drug-resistant strain mutates, it loses the drug-resistant property. In the absence of drugs, all those can also replicate. In the end, we will end up with a population full of non-drug-resistant HIV. This kind of reason is obvious for anyone who has done optimization. The surest way to know that you have climbed the hill (i.e., at a maximum) is that if the height falls if you take a step in any direction. So, in the absence of climbing back up the hill (or falling of and dieing), any step from the maximum point will take you to a sub-optimal point i.e., downhill. That is exactly what I think is happening in the HIV case. Since there are more ways of being dead than alive (quote from one of Richard Dawkins' book) i.e., more ways of losing height than gaining, it is only natural that left to itself,
the virus will lose the drug-resistance.

The program also makes an important point about why we are seeing increasing drug-resistance these days. It claims that half of all the antibiotic prescriptions in the US are unnecessary or irrelevant. But since the antibiotics are being fed to animals and humans without thought, all the non-drug-resistant pathogens are being killed, leaving us to fight with the drug-resistant ones.

Quotable quote #9

2008-12-11T09:00:00.005+05:30

"Rest is a weapon, never forget it. "

- The Bourne Identity by Robert Ludlum.

My friend slept for only two hours before the day of microbiology exam in 2nd year. In the exam hall, she was very drowsy and couldn't answer all the questions though she knew it. She answered only for 75 marks out of 100. She passed comfortably but, only her overall percentage suffered.

Capturing rays

2008-12-11T08:57:00.003+05:30

Road map to wisdom

2008-12-10T09:51:00.003+05:30

I picked this up from an anatomy lecture by Dr.Marian Diamond, Univ of Berkeley, California. The basic structural and functional unit of our nervous system are called neurons. The cell body of a neuron has multiple projections (to receive and forward information) called dendrites (the lines in the above picture). It has been found that the dendrites keep growing throughout our life. First order dendrite gives rise to second, second to third and so on. It grows upto 6th order.

As we acquire knowledge and other traits, the dendrites grow (I'm not saying that, medical science is saying). The first order dendrite grows as we acquire knowledge. It branches when we acquire idealism and creativity; it again branches when we acquire courage, intuition and reasoning; later we acquire generosity, love and dedication; and at the end, the 6th order dendrites give us wisdom. These are the stages of our neurons and the stages of our lives.

I seem to be still around 2nd or 3rd order neuron; my brother and few others seem to be at a level higher; and I find my parents in the 6th order. That's why, we should listen to elders; they would've gained 'WISDOM.'

Total recall

2008-12-09T09:00:00.007+05:30

I was second for the state in class tenth. Hence, most of the state and the local newspapers featured an article on me along with my photo.

One day morning, I had been to a sports shop in Bhadravathi (i was in Bhadravathi then), to buy a pack of shuttlecocks. The shopkeeper was busy reading the newspaper. I asked him that I wanted a few shuttlecocks but he didn't hear me; I again asked. He looked up, stared at me and then went inside the shop to get me a pack of shuttlecocks. I noticed that he was still staring at me. I paid for my purchase and when I was about to leave, he asked me if I was the same girl as the one in the newspaper! I hadn't seen the newspaper yet and after seeing it, I said yes. I still can't forget the expression on his face.

Bhadravathi was a small town. The town required a traffic signal for the first time in 2004. I really miss that place. Since it was a small town and social life was good, there were hardly any unfamiliar faces when I went out for a walk or for shopping. In Bangalore, I'm lost in the crowd, I'm just a nobody here. It took some time for me to adjust to live like a 'nobody.'

Sketch of the week

2008-12-08T09:00:00.000+05:30

This is one of the simplest sketches I've done so far. Create a homogenous dark background and use an eraser to clear off the shade to get your desired design.

Right and left brain: Part 2

2008-12-05T09:00:00.002+05:30

This is a sequel to the post 'Right and left brain' authored by my brother:

Recently I wrote about my experiences about the differences between the left brain and the right brain. Today I will show some more examples of it.

Recently I was watching TED talks (http://www.ted.com/tedtalks/) and came across this talk from Michael Shermer. He is the founder/publisher of Skeptic Magazine. In his talk, he shows how priming the brain can have enormous effects on what we hear/see/perceive. Here is the assignment. Go to http://www.ted.com/tedtalks/tedtalksplayer.cfm?key=m_shermer and watch his talk. Go on. Don't worry, I won't go away. I will just wait for you here.

(waiting patiently...)

Did you see it?

Now, did you notice the gorilla? If not, then you were really paying attention and were patted on the back by your favorite school teacher back in school for your attentiveness. If you did, then you were probably patted a little harder (possibly quite a bit harder) on the back by your favorite school teacher for being a spoil sport when she was trying to teach something interesting by engaging the other kids. The point is that what your eyes see is not what is in front of them, but what your brain tells them. Your eyes probably saw the gorilla and the few cells in the visual cortex probably staged a minor rally to get the majority to see, quite literally, the views of the minority as well, but as happens always, the majority vote overruled the minority vote and without the possibility of appeal.

There is a reason why I like movies by the Zucker brothers and Jim Abrahams such as Top Secret!, Naked Gun (1, 2 1/2, 33 1/3), Hot Shots!, Hot Shots! Part Deux, Airplane! etc. A small fraction of the scenes in these movies are quite disgusting, but if you close your eyes during those parts just like you would close your nose while walking past a public toilet in India, you will actually enjoy the movie. The main reason is that they test and question your assumptions about normality (or rather the assumptions about normality that your brain - specifically left brain - has). This usually comes out as a visual joke and is often quite funny. Let me give you a couple of
examples. In the movie Top Secret! (Val Kilmer's first movie), a German messenger delivers a message to a General and just before doing so, he removes his hat. But the strap of the hat that went around his face still remains on his face. This develops a conflict in your brain. Your left brain is telling you that what you really saw was not correct, but your right brain is telling you that what your eyes saw was the truth. If you are not used to watching such movies, it takes a few seconds to get the joke. Similarly, later on in the movie Val Kilmer crawls through a fence (of a German prison where a scientist is kept whom they are trying to save) and sees two boots. Suddenly the music changes and you expect that he will be arrested. The camera moves up and reveals that they just a pair of boots and not a soldier standing guard. Such hijacking of our thought process is what makes these movies funny. (Note carefully that this is just one step away from being complete nonsense. One example that has crossed that line is post-modernism philosophy).

Coming back to the woman in a gorilla suit, I didn't notice her. Later I spent a lot of time exclaiming I missed that!. This makes me both happy and sad. Happy because when someone wanted my undivided attention, I was able to give them that, sad because I let my own views interfere with objective judgment. There is a way to consciously work to wards increasing the concentration. That is by Meditation[1]. When one tries to meditate, one is trying to rid his/her brain of all thought. This is not possible because of evolutionary reasons. If one of our ancestors forgot about the body (not counting the involuntary actions), then there was a real danger of him/her being eaten [2]. This is also more like having an init process that can spawn all other thought processes in the brain. You can cut down all conscious thought but not less than 1. You need at least one thought to get back and start thinking again. This is a sort of watchdog process. As you might have probably guessed, in meditation you are asked to think about God. The whole point is that, if you wish so, you can consciously work to wards eliminating all stray thoughts until only one thought is left in your brain. This is tremendously advantageous in the modern world when you want to concentrate on a particular thing, such as studies or work or chess or anything. Most religions have some form of meditation or the other. In particular Brahmans meditate during their prayer, which is called Sandhyavandane [3]. And when you meditate, regardless of the God you are thinking of, you are increasing your capacity to have clear thoughts. And when you think clearly without distractions, you get wise. Thus, by praying to God everyday, you are learning to think clearly and in turn getting wise. Although I generally don't like people imposing their religious views on me, I like it (religion in general, not the part where people are imposing their views on me) because of these reasons. If you know what is going on and, more importantly, why, then it can be quite interesting. This is one of the reasons why I am religious.

Before I get into trouble by telling something stupid about religion let me get back to my brain. If seeing what is in front of you important, why is that we have evolved overriding it? The reason can be found in the difficulty that current robotic vision experts face. When the robots see with their stereoscopic cameras, they see what is in front of them, but they can't make any sense out of it. They have to consciously try very hard to detect the edges between objects and put a name to them. Unless they do this, they can't avoid obstacles when they want to move. Similarly, unless our ancestors detected the edge around the nice black and yellow stripes and knew that it
represented an object of terror and ran away in the opposite direction very fast, instead of looking at saying "nice pussy", they wouldn't have survived. In addition to this, recognizing patterns is essential to ignore a lot of the unchanging surrounding around us. When we are taking a leisurely stroll in the Savannah, unless we ignore the foliage, vegetation, sky, clouds etc. and concentrate on the saber tooth, we are not going to survive. And to ignore anything, we first have to see them, label them and then decide that they represent no threat. You might conceivably ask that if the vegetation is so unimportant, why do we even bother to notice it? The reason is that food or danger can take on any form and come from anywhere and until you have experimented by putting your finger in the live plug of the universe and gotten surprising results, you wouldn't know. Pattern recognition also helps social behavior a lot. You need pattern
recognition for recognizing people, their mood and the level of interaction you plan to have with them.

I think that's enough about the brain. Now it's time for me to rest both parts of my brain.

[1] It is likely that whatever I have to say about my experiences of meditation has already been said by others. If you read the wikipedia article on meditation, you will probably find all those. But the important distinction is that I don't have to take any of those things completely on faith as I can verify the results by comparing them with my own.

[2] This is one reason why we experience Hypnic jerks. When our ancestor was tired at the end of the day (because of all the females he tried to copulate with) and wanted to go to sleep, the jerk kept him alert so that he could find a safe place away from precarious boughs and predators.

[3] Karnataka State Board announces "ranks" of the top 20 scorers in the 10th and 12th exams. When I was in 8th standard, we went to see an Astrologer. I am not sure if we gave him the details of my academic history or not, but he said that if I did Sandhyavandane every day, I have the "yoga" to get a rank in 10th standard. In hindsight it seems that what he was effectively telling me was that if I did Sandhyavandane (praying to God at three junctions of the day - morning, afternoon and evening. Sandhya = junction, meeting point and vandane = greetings, salutation (which means pray here)) everyday, which involves meditation in it, I would gain enough concentration to focus on preparing for the exam that I would have a chance of being in the top 20 scorers (of course, the number of people getting the same score is a lot and it increases as the rank # increases). As it happened, I got 93.92% (587/625) in the exam and missed the 20th rank by 2 points. (You would think that it doesn't matter now, but in the
month just after the results were announced, it did).

Quotable quote #8

2008-12-03T09:00:00.008+05:30

"The best thing about telling truth always is that you don't have to remember what you had told."

- Anonymous

Painting of the week

2008-12-01T09:00:00.001+05:30

I could paint the bigger one symmetrically, but the two smaller ones are not symmetrical.

Conquering nature

2008-11-29T10:06:00.000+05:30

After a couple of decades, consider that you or your loved one has a damaged heart which cannot pump efficiently. Solution: Go to a hospital and get a battery of tests done; donate some blood or allow the doctors to aspirate some bone marrow cells. Then go home, return after a couple of months. Doctors will have a gift for you -- a new heart! Get a surgery done and get the heart fixed. You're young again.

Recipe to grow a heart: A few stem cells from the blood or bone marrow, a cup of enzymatic solution which is replaced regularly, one square inch of a muscle taken from your body, a pipette full of endothelial cells to form blood vessels, a cup of protein soup, a pinch of salt to provide sodium and chloride ions which are required for the heart to pump and a stove set at required temperature to incubate a growing heart - Perfect! The dish is ready.

Such a day is not too far. Efforts have been going on since a few decades for growing new organs. By the time we are old, I think organ culture and stem cell therapy will be the first choice of treatment for terminal illnesses and more importantly, they'll be affordable. This is something similar to the theme of the movie The Island, in which clones are created just to donate organs to the original ones.

Result: Our lives are prolonged, every family is happy, there's marked decline in death rate. In short, the nature's law of life and death is disturbed.

The more and more humans invent and the more we try to conquer nature, the more problem we create. When the field of medicine grew and found out treatment for all the known diseases, a new set of diseases arose from nowhere -- AIDS and the prion diseases.

Either weapons of mass destruction or epidemics of deadly diseases will eradicate humans. Einstein told half a century back, "I do not know what the third world war will be fought with, but the fourth world war will be fought with sticks and stones."

Background:
Doctors have given a woman a new windpipe with tissue engineered from her own stem cells in what experts have hailed as a "milestone in medicine." The breakthrough allowed Claudia Castillo, 30, to receive a new section of trachea -- an airway essential for breathing -- without the risk that her body would reject the transplant.

Castillo was given the stem cell surgery, the controversial branch of medicine that some say could lead to human cloning, after suffering a severe lung collapse. The condition, caused by long-term tuberculosis left Castillo, a Colombian now living in Barcelona, unable to carry out simple domestic duties or care for her two children. The only conventional option was a major operation to remove her left lung, a risky procedure with a high mortality rate.

A team from the universities of Barcelona, Spain; Bristol, England; and Padua and Milan, Italy, decided instead to replace Castillo's lower trachea and bronchial tube to her left lung with a lab-grown airway. The operation reported in the British medical journal The Lancet, has been hailed as a major leap for medicine that could offer new hope for patients suffering from serious illness.

To create the new windpipe, the team took a seven-centimeter (2.75-inch) segment of trachea from a 51-year-old who had died. Over a six-week period, the team then removed all the cells from the donor trachea, because those cells could lead to rejection of the organ after transplant.

All that remained of the donor's stripped-down trachea was a matrix of collagen, a sort of scaffolding onto which the team then put Castillo's own stem cells -- along with cells taken from a healthy part of her trachea. Birchall had already taken Castillo's stem cells from her bone marrow and grown them into a large population in his Bristol lab.

Four days after putting Castillo's stem cells into the donor trachea, the team was able to perform the transplant operation at the Hospital Clinic in Barcelona. Castillo had no complications from the operation and was discharged from the hospital 10 days later.

"We think that this first experience represents a milestone in medicine and hope that it will unlock the door for a safe and recipient-tailored transplantation of the airway in adults and children," the authors said in their report.

Text courtesy: CNN http://edition.cnn.com/2008/HEALTH/11/19/windpipe.transplant/index.html#cnnSTCText

Right brain and left brain

2008-11-26T11:26:00.004+05:30

My brother used to blog and wrote this entry a couple of years back. It is reproduced here for your reading pleasure.

===Start of post===

I have always wondered how some people can write things that are so funny or can have an imagination that is so ridiculous and more importantly, why I can't think up something stupid and funny (intentionally that is). Whenever I read Terry Pratchett's Discworld series books, I imagine myself trying to think up something that is so obviously not possible (a flat world carried on the backs of four elephants which are themselves standing on a giant turtle). And I find myself constantly censoring my thoughts whenever they leave the realmof reality. That is why it is hard to write fiction. First you have to think up something that is not there and second, to make it interesting fiction, you have to let go of the rules of normality and reality. I think I found the answer when I was reading the book Drawing for the Terrified by Richard Box. Specifically, he quotes from the book Drawing on the Right Side of the Brain by Betty Edwards, but the essence of the argument is that our left brain is logical (conceptual) and our right brain is perceptual.

Some background. I recently started pursuing one of my lost loves, drawing and painting, which I had not done for about ten years now. I started drawing when I was about five and continued it till I wasabout 15. By then, I had reached high-school (the grades are in Indian scale) and stopped my art work to spend more time on studies. This did show up as high scores and continued until I started reading a lot of fiction starting with the last year of my undergrad. Since left brain is responsible for all the logical thinking, this was just as well. This is also probably why I had problems making up a story for my SOP. Whatever the reasons for this lopsidedness, I am starting to correct it now.

First, drawing is hard because most people override what their rightbrain sees, by their left brain. As long as they don't know they are drawing a face, they are OK but as soon as they know what they are drawing is a face, then they stop because their left brain has just told them that they can't draw faces. Our right brain only sees lines of varying widths and lengths, but it is our left brain that puts a name to a collection of them such as eye, face etc. Same is the case with hearing (so much so that we only hear what our brain tells us, not what our ear drum senses). You see where this is going. You try to think up something that is ridiculous and you can't because as soon as you start thinking that is non-sense, your left brain barges in like an angry matron who has just caught you doing a naughty thing and stops all the absurd thinking. Drawing actually is helping me develop my right brain as what I draw is necessarily what I see and not what Ithink I see.

When asked the questions how do you create such a master piece, artists usually say I just draw what I see. While this answer may seem arrogant and even obvious, it is not. Similarly, when the same question was asked to an (old and famous, but I forget his name now) Indian sculptor, he said "I just take away the bits of rock that are not God and what remains is the statue of God". I think I know what artists and sculptors mean by that. Unless one develops the habit of seeing what is actually in front of their eyes instead of seeing what their brain tells them, one can't draw.

There are exceptions to the rule, as usual. Cartoons work great because our left brain does the interpretation of what our eyes see. If we go around actually seeing what is actually in front of our eyes instead of the interpretation of what is in front our eyes, then half the comics wouldn't be funny. And each comic is uniquely funny to every individual because the interpretation filled in by the brain is unique to that person's experiences. So, to draw cartoons, you not only need to know what to draw but how to interpret it as well.

While I am saying I have neglected my right side of the brain, I don't want to be completely on that side. There are disadvantages to both sides. On one side you get people who hate each other for using different versions of emacs and on the other side you get people who praise a "modern art" painting which was drawn by the dog of the artist when, in its eternal quest to please its master, it decided to have a go at painting and ended up waggling its tail all over the paper with a vaguely ocher colored paint on it. But the advantage of being trained in optimization and control (admittedly of process systems, but still control) is that I can now decide how much time to spend in each part of the brain. How much time I spend seeing exactly what is in front of my eyes and how much time I spend doing pattern matching. It is a great feeling listening to the two halves of thebrain talking to each other.

Now comes the advantage of technology. I recently bought a Nikon D50 and now I can use it to learn art. How? When Isee a scene and want to draw it, I have to first see exactly what is there and I have to convert it to black and white manually in my head so that I can draw it (remember, drawing is nothing more than drawing what you see) and get the tones right. So my shortcut to all this is to take a photo with my camera, convert it to black and white in my computer so that I can study the tones. I like this logic, it is useful.

===End of post===

This is also the reason why I have not been able to draw and paint without a source. The two paintings that I've posted in my blog under 'Painting of the week' were printed on greeting cards, I just saw them and copied. So far, I've not done too much of creative work.

Painting of the week

2008-11-25T10:53:00.000+05:30

Quotable quote #7

2008-11-22T13:57:00.007+05:30

Waves strike the shore with the promise of leaving behind a pearl in a shell; what they leave behind after receding are the broken empty shells.

Photo courtesy: My brother.

Quotable quote #6

2008-11-21T09:17:00.001+05:30

'Don't use your lateral rectus!'

-An invigilator told this before our orthopaedics theory internals started. (Lateral rectus is a muscle in the eye which is required to see sideways)

Predicting my unpredictable future

2008-11-20T10:43:00.005+05:30

Which subject do you want to take up for your post graduation? --This is one question that most people ask me; mainly my relatives and my parents' acquaintances. For a few, I said I still haven't decided which subject to choose for my pg and for others, I said some subject that flashed in my mind when they asked. See the reaction..

When I say I don't know what to specialize in, they tell: "Why don't you know that yet? You must be interested in some subject. How can you just keep studying without knowing what you want to study further? You should have some goal in life. You should know where you are heading to etc."
First, they doubt my skills. Next, they advice me (though most of them are non medicos). They tell -- You should take up ophthalmology, you can give light to many; you've skilled hands, you should take up surgery; you're a girl, you should take up obstetrics and gynaecology!; one even suggested me to take up OBG so that I could marry a paediatrician and run a maternity and child health centre later!!

Bored of getting free advices, I later started telling that I liked some subject. I told I would like to take up OBG, a lady told I shouldn't consider OBG for my post graduation as I would've to attend emergencies throughout my life. I told I would like to do pg in General Medicine, somebody told not to take it as I would have to do a DM after MD (DM is a speciality, like neurology and cardiology). I told I want to be a surgeon, they told that's not for girls! My plan was a flop.

Again bored, I started telling I like para clinical subjects like Pathology, Microbiology and Pharmacology. You know what they told? They told I should take up some clinical subject so that I can serve people directly. One even said that my life is not worth if I'm not a clinician.

No matter what I said, people didn't stop imposing their views on me.That's the mentality of most of the people. They just want to outsmart others. Nobody wanted to listen to me; nobody wanted to know why I made my choices, they just knew to give free advice.

It's very good when people of my own profession give good advices, explain about the bright side and the flip side of it; but I get irritated when non medicos try to impose their views on me.
This world would be a better place if people were more interested in listening than speaking.

Happy patients = Happy doctors

2008-11-19T09:52:00.000+05:30

It was quite a tiring day yesterday. I spent 3 hours in editing my friend's project report and then went with her to Chamrajpet to get 3 copies of it. By the time we finished the job we were very tired and hungry. We went to a small hotel to have some food. We spotted a medicine pg and an intern there. Also, there was a professor from the plastic surgery department! The prof gave a coffee treat for all of us. Though I don't drink coffee/tea, I gulped it. The prof had finished a surgery in a private nursing home nearby and was returning home (Doesn't his wife cook at home?!).

He told he gets a very warm reception at Vidyarthi Bhavana (a hotel in Gandhi Bazaar) as he has operated on the owner of that hotel! He also told he avoids going there as they don't charge him.

When I was working in Orthopaedics department to do my project, a minister's wife came to consult my guide for a calcaneal spur (she had pain in the heel, there was some extra growth of bone). Before leaving, she told the doc that he can ask any favour he wants as her husband is a minister!
There are lot of doctors in our college who have such rich influential patients. Just a phone call to them and the doctor's work is done. A biochemistry lecturer who was transferred to MMC, Mysore was back to BMC in just 3 months. And I've not seen any lecturers in the clinical departments getting transferred to other colleges. Well, doctors are influential, what about medical students?

Earlier, if students wore apron, traffic police never fined them if they violated traffic rules. Even if they stopped the students to ask why they violated, the students would say that they've got a call from the emergency and escape! Now if we jump a signal, police catch hold of us. They're smart enough to know that we're not put on emergency duty until we're interns!

Apart from having a great amount of knowledge and skills, it just requires a good smile, a few kind words and a little bit of patience for a doctor to retain his/her patients. Happy patients implies happy doctors!
I think I can earn quite a good fortune in the future. :-)

Technology and medicine: Part III

2008-11-18T11:06:00.000+05:30

In 1st MBBS, lecturers used a black board to teach us. They wrote diagrams on board, scribbled the salient points on the board with a piece of chalk while teaching, they wrote flow charts to explain the topic.

In 2nd MBBS, the same continued but by the end of 2nd year, the pathology lecture hall was renovated; it got a new projector and lecturers possessed laptops by then. They started preparing power point presentations.

In 3rd MBBS, we had some good classes where videos of surgeries were shown.

In 4th MBBS, all the lecturers had upgraded to laptops and they started putting more and more information on each power point slide. The focus was on stuffing as much information as they could; they forgot that a power point presentation was just a tool to highlight the salient points. Power point made their job easy. They asked post graduate students to prepare presentations for them. They found it very easy to teach, they just read out the matter that the post graduates typed. They didn't have to come prepared for the class, they didn't have to draw line diagrams on the board, they could just copy a presentation onto their laptop and read it out in the class. By the time we could write one line on the paper, the teacher could read out 5 slides on ppt. We could never assimilate whatever they told. In short, teaching lost its meaning, students lost interest in attending classes. The points on the slides lost their power.

Painting of the week

2008-11-17T11:06:00.001+05:30

Technology and medicine: Part II

2008-11-17T10:08:00.000+05:30

Wondering how technology and medicine are inter-related?

Look at the requirements of a medical student or a medical professional:

1) A cell phone: We work in different wards in the hospital; if we want to know what case is there in which wards, we call up our colleagues. To know at what time we have theory class, there's My Today or BMCB to assist us. The class representative types the message on the internet and our mobiles beep.

2) A camera phone or a digital camera: Most of the students have camera phones. Earlier, we had no visual documentation of the specimens kept in the pathology lab or the microbiology lab. We would've to identify the specimens in the exam which we had seen at the start of the academic year and forgotten. Our seniors revolutionised our practical exams. With the help of camera on their phones or with a digicam, they shot each and every specimen. Hence, before my 2nd year and 3rd year exams, I just had a look at the photos and did not have any problem in identifying the specimens.

3) Digital cameras: Post graduates need this to document their studies. Whenever they find a rare case, they document it. Some lecturers also use it for follow up of their cases.

4) Handycams: While I was in ENT, a professor did a repair of the broken cribriform plate in the nose and documented the complete surgery. In orthopaedics, another professor documented a knee replacement surgery.

5) Laptops: Medicos have provided a great market for laptops. Almost everybody has a laptop nowadays. To prepare a powerpoint presentation for their seminars, to document the photos and case details, to prepare their thesis etc., they need a laptop.

6) A broadband connection: This has proved extremely helpful in the retrieval of medical literature online. RGUHS spends around 7 lac/year on a few journals. (That's just not enough actually)

7) Medical equipments: A stethoscope, an operating microscope, a laparoscope, an endoscope, the operation table, a good light source, an optical fibre head light for ENT, prostheses such as knee replacement and hip replacement prostheses, titanium rods to join broken bones, silicone oil to fill the vitreous humor in the eye, laser treatment for eye, X ray units, gamma cameras, artificial heart valves etc., the list will never end -- all need advanced technology.

8) Satellites and telemedicine: BMC has the telemedicine set up. A doctor here can listen to a case history of a patient in a village and can advice the doctor in that remote place as to how to treat that case. ISRO launched a satellite for this purpose.
We had telemedicine conferences too. Doctors at CMC, Vellore, Delhi and Mumbai conducted interactive talks.

9) The iPhone: This is the latest that I know of. It supports MIMvista. Medicos can now store data online, we need not worry about the size of the memory cards.

In short, medicine and technology are very much inter-connected. The medical field is the one which requires more and more modern technology.

Further reading: http://thegunnybag.wordpress.com/

Quotable quote #5

2008-11-16T14:39:00.001+05:30

"After you've released the book, 'The Fundamentals of Physics,' we've become jobless." -- This was what many physics teachers told the authors of the book, Robert Resnick and David Halliday when the book was first released.

- Picked up from David Halliday's talk at IIT Madras (more than 6 years back, I don't remember the exact year).

Lame marketing

2008-11-15T15:57:00.000+05:30

Yesterday, my mom's mobile started ringing. She received the call, a male voice (let me address him as XY) spoke.

Mom: "Hello."
Mr.XY: "Good evening ma'm, could I speak to Mr. Krishnamurthy?" (that's my dad)
Mom: "Who are you? You can speak with me."
Mr.XY: "I want to speak to Mr.Krishnamurthy ma'm."
Mom (She got angry): "Ok, go on, speak." (She handed over the phone to dad)
Mr.XY wanted to promote the Reliance Automatic Investment Plan and started detailing my dad on it. The line got cut, but he kept calling. It again got cut and we thought he got bored of calling us.

Today morning, my mom received a call. This time, a female voice (let me address her as Ms.XX) spoke.
Mom: "Hello."
Ms.XX: "Good morning ma'm, could I please speak to Mr.Krishnamurthy?"
Needless to say, my mom was furious. Since my dad was not at home, she asked the lady to speak with her. The lady told she wanted to educate my dad about an investment plan. My mom asked where their office was and told she would come to her office. The lady was happy. She told my mom need not take the trouble to come to her and she would only come to our house. Today afternoon, Mr.XY and Ms.XX came to my house to promote their fabulous investment plan. They introduced themselves as 'relationship managers.'

Mom to Mr.XY and Ms.XX: "I called you to let you know your mistakes. How could you both assume that I'm a housewife who doesn't know the abcd of finance? Almost in every house, it's the lady of the house who's in charge of finance. Generally, no financial plan is approved by a husband without his wife's consent. Never underestimate anybody. Go and market your great financial plan to somebody else, I'm not the right customer for you."

Mr.XY and Ms.XX asked sorry to my mom and left!

Technology and medicine: Part I

2008-11-15T15:54:00.001+05:30

We are posted to different departments every month and this month, we were posted to OBG. Yesterday, 3 units had clinical internals in OBG (Our class is divided into 4 batches and each batch is again divided into units). We had the clinical internal assessment today. 9 of us assembled in the wards at 9am to take case (to make notes of the patients). One of my unitmate told he has taken the case already, I was surprised. Then he told he had taken photos of the case sheet written by one of those who had internals yesterday and hence the case was ready!!

After taking the photo, he transferred it to his computer, made a note of it neatly and by today morning, he was well prepared with a neat case sheet! This is how technology assists medicine. :-) I'll write another post on this topic later.

I'm back :-)

2008-11-15T15:52:00.000+05:30

I'm back :-). In the past 3 weeks, I have done nothing except studying and writing internals. It was too tiring and boring. There's one more left, it's on 22nd and it's a week away. I've turned to blogging for some change.

Blog hibernated

2008-09-30T13:39:00.000+05:30

Looks like the coin trick has worked well from Sholay to The Dark Knight. But in real life, there's no director who will assure you that the scene is going to be as scheduled and there's no coin with heads on both the sides to turn every chance into your favour.

I'll hibernate this blog for the next 4 months so that I get more time to turn the odds into my favour. If head, then I pass 4th year with a good score; if tail, then I pass 4th year with a decent score. Wish me good luck, I'm going to need a lot of it in the following months.

The Short Term Studentship award :)

2008-09-20T16:51:00.000+05:30

I received the much awaited certificate from The Indian Council of Medical Research, New Delhi confirming that my research was found to be satisfactory. I had spent 6 months on this project and finally got the result :)

Quotable quote #4

2008-09-09T16:24:00.001+05:30

"A neurologist learns the subject stroke by stroke."

- had heard it in one of the telemedicine programmes conducted in our college last year, the talk was by a neurologist from CMC, Vellore.

Enter the dragon

2008-09-09T16:20:00.000+05:30

I watched the movie enter the dragon on saturday. The climax of the movie is wonderful. Bruce lee and the villain fight in a chamber in which all the walls have mirrors, multiple mirrors. And there are few more walls inside the chamber, again with mirrors. It is based on this concept - When a surface becomes so smooth that it reflects all the incident rays so that the surface itself becomes invisible and all the reflected light forms an image, it is called a mirror (Ref- Parson's diseases of the eye).
Hence when multiple mirrors are placed opposite to each other, you can't identify whether it is the person or the image as you can't spot the mirrors (they are themselves invisible).

Habits costing death

2008-09-09T16:04:00.000+05:30

It's medicine postings now. I saw a case of cerebellar infarction today but the patient had already recovered and hence couldn't find much on examination. After that I approached a female patient to write down a case in my book. When asked about her problems, she just said that she had weakness and that she has changed 3 hospitals so far. She didn't tell any other complaints. I came to know that it was a case of alcoholic liver disease only after seeing the case sheet. (As soon as a patient is admitted, an intern writes the details of the case in a file, we call it a case sheet).

Alcoholism is so rampant among the lower socio economic strata in our country. I had earlier thought that majority of the drunkards in our country are males but a significant number of females also drink. There are so many female alcoholic liver disease cases in Victoria and Bowring hospitals. Though there's no food to eat, the poor people here drink country liquor and die.

BMC, the cream of the state!!!

2008-09-01T15:22:00.001+05:30

We were supposed to go to the neonatal intensive care unit today but we were waiting for our unit's post graduate student to mark the attendence in the wards. The pg who had to mark the attendence didn't come, but a pg from NICU came and started shouting on us:
What are you people doing in wards? Don't you know you're supposed to be in NICU by now? At what time do you come, you people come later than us, or is there any rule that pg and lecturers should come earlier than you and wait for you? Being in BMC, is this the attitude you people have? You're the cream...Are you the cream or the scum? The floating thing can be both the cream and the scum. You all decide which one you are. Now get lost from the ward and head towards NICU."

Oooooh.. We all left the ward and as soon as we went out laughter errupted. He's a pg in paediatrics who has done his undergraduation from MMC (Mysore Medical College). Whenever he gets the opportunity, he shouts on undergraduates. I don't know why he's so fond of scolding BMC students. But he taught us really well today, on normal newborn. One of the best classes we had in this year's paediatric postings.

Even in exams, the externals who come from different colleges to torture us scold in the same way. 'Being a BMC student you don't know the answer for a simple question, very bad.' We are all bored of hearing the same thing every year. I don't know what's so special in BMC. Here, self learning is more than spoon feeding. Private college students get a lot better teaching than us. Also, they complete the whole syllabus in a short period of time. They get more study holidays than us before the exam. In our college, there are a lot of patients, but it's only helpful if we're taught well. Only a few teach us well, BMC won't improve unless every lecturer/professor teaches well.

Trendy!

2008-08-26T15:03:00.001+05:30

Lots of functions going on. Weddings, engagement and house warming ceremonies. I attended a few of them. Earlier, people use to name their newly built houses with God's names, their kids' or parents' names. But the trend has changed now, money is floating everywhere, people have prospered and people are naming their houses differently. Example: Kalpavriksha, Kanasu, Sampada, Samrudhi, Vaikunta etc. Here is what they mean:
Kalpavriksha - the tree which gives whatever you want
Kanasu - dream
Sampada - richness, prosperity
Samrudhi - prosperity, all the needs of life are in excess.
Vaikunta - Mythologically,it's the abode of Lord Vishnu.

Are these people so prosperous that they have everything they want? Good health, wealth and fame? Aren't they fearless of the future? Will that richness remain forever or will keep increasing?!! I don't know.
I personally feel that health and wealth keep fluctuating.

PS: I've just voiced my thoughts; the owners of the above houses need not feel otherwise. I heartily wish them good luck for all the endeavours in life.

How are blacks different?

2008-08-26T14:59:00.000+05:30

In the men's 100m final, all the participants were blacks, Usain bolt thundered with a great finish and a world record. Why couldn't any white make it to the final? What sets the black apart?

Babies, kids and adolescents

2008-08-25T16:00:00.000+05:30

It's paediatrics for a month. It's fun to be with kids, but sad that it's in a hospital ward. There are lots of diseases that are troubling those innocent wonderful kids - congenital heart disease, mucopolysaccharidosis, malnutrition, pneumonia, diarrhoea, rickets, down's syndrome, meningitis, hepatitis, leukemia and many more.

The kids are witty. When I went near a 3 yr old boy to hear the breath sounds, he started crying to avoid me, but there were no tears. He thought I'll go off, but I didn't leave his bed. Annoyed, he created more drama and started shouting. I started laughing seeing his tricks; more annoyed now, he started crying with real tears in his eyes. Poor boy, I examined him and went on to check another kid.

Olympics and more olympics

2008-08-25T15:29:00.000+05:30

2008 Beijing Olympics finally came to an end yesterday. Every 4 years, a city gets ready to host it. The whole city comes to life, a new airport is built, railways and subways are renovated, a magnificient stadium is built, millions of people work for it, flats are built to accomodate the athletes, the stage is set for the events - pools, tennis court, volley ball, basket ball courts, tracks and a lot more, industries are re-located to decrease air pollution, odd and even number cars are allowed on alternate days in the city, clouds are also dispersed so that it doesn't rain during the magnificient opening and closing ceremonies..

I wonder why all these are necessary every 4 years? Though it's good and setting a good stage for the athletes according to international standards is necessary, such olympian efforts to deliver a extravagant opening and closing ceremony seem unnecessary.

Lessons from my brother

2008-08-16T12:19:00.000+05:30

Three things that I learnt from my brother:

1) When you get bored of studying some topic, don't take a break to watch tv or roam around. Instead, change the subject and start reading a different topic. A lot of time is thus saved. When he was preparing for IIT-JEE, he kept shifting from one subject to other and studied for long hours together, never took long breaks in between.

2) If you find a subject difficult, just turn a few pages every day for 15 minutes and keep revising. That'll make the difficult easy.

3) When you've a computer in your hand, experiment with it. I never had any computer education at school,never attended any classes though my friends did. Before leaving to US, my brother installed a computer in the house, with a dial up bsnl connection. He taught me these things- how to press the on button in the cpu, how to connect to net, how to open my yahoo account, how to click on the sign out option and how to click on the shut down option. :) He told I should learn the rest of the things myself and left.

When I got the computer into my hands, the first and the good thing I did was to learn typing with the help of typist tutor installed in linux. Later was the time to experiment, installed all the softwares that he had got from IIT, and started getting acquainted with them. Meanwhile, the great computer had too many loose connections and troubled me frequently. Explored the inside of the cpu and I was able to locate and fix most of the problems. Recently, the computer went into coma, I discarded the old parts and bought a new processor, motherboard and ram. In relative terms, I'm still a computer illiterate, but I now know enough things to help me in my medical education.

How to locate shops in Bangalore?

2008-08-13T11:58:00.001+05:30

Do you want to know what's where in Bangalore? Make use of this wonderful service. Dial 080-30111111 and you'll get you know the addresses and phone numbers of most of the shops in Bangalore. It's very helpful for those who don't have access to internet.

I'm lucky :)

2008-08-13T11:58:00.000+05:30

I had been to Kamat bugle rock hotel yesterday. While I was having food, an elderly male, 60+ years old, holding a plate of idli in his hand came and sat in front of me. He asked me whether I'm working/studying, what my parents do, which is my native place, where do I stay here etc. By the time I anwered to all those, he finished his food and started sipping coffee. When he stood up to leave, he wished me good luck and told, "You're very lucky to stay with your parents and your parents are also lucky to have you with them. Both my children live abroad and me and my wife live alone in Bangalore." I felt sorry for the old man.

There are lot such parents in Bangalore living alone without their kids. Either the children should take their parents along to wherever they go or they should come back to India after their studies/work etc.

The ever elusive 'gold medal'

2008-08-12T12:25:00.000+05:30

As soon as I woke up, I caught hold of today's newspapers, I was waiting to see how the headlines and the matter would be. There was a photo of Abhinav Bindra with the gold medal and next to it was a box which displayed what state has announced what price for the achiever.

When an Indian wins, he's a " Nation's Pride," when he loses, he's a "Nation's Disappointment." Who knew the name of Rajyavardhan Singh Rathore before he won the silver at Athens 2004? But he was the flag bearer in the Beijing Olympics this time. And when I switched on tv today, the only news apart from Abhinav's gold was about the disappointing show by Rathore so far, in Beijing. He stood at 15,but only 6 will qualify. This is the attitude of the media and Indians about a sportsperson. If he wins, he's a hero; if not, a zero. People and the governments forget that all the Indians participating at the Olympics are heroes. Winning is one's hard work, 'luck' and confidence become 100% simultaneously. But only the winner gets all the name, fame, money and encouragement. Others don't get 'anything.' That's the reason why many struggle in sports and fear to take up sports as a full time profession in India.

P T Usha needed a job to sustain herself and the Indian Railways offered her a job and also gave as much as holidays she wanted whenever she had to attend any sporting event. I've seen only one ad featuring her, it's for a 'tender coconut drink.' Whereas all cricketers can earn their livelihood by just featuring in ads for pepsi and coca cola.

If an Indian child goes out to play and falls, the whole family panics. Even trivial injuries will be treated as life threatening ones. Children here are the apple of their parents' eyes. To know what a Chinese child is for its parents, watch the video below (link at the end). Parents here see to it that their child is happy and safe without working hard. Everyone wants an easy life. If you take up sports as a profession, you've to practice daily, keep yourself fit, pay for a coach, tolerate the country's politics in sports, beg for a chance, prove yourself, get a sponser, appoint a sports medicine doctor to look after your injuries and face a lot more problems. Also, an athlete can't remain in form for a long time. They can remain in their best state of physical and mental health for not more than 10 years, they can just participate in 2 olympics and a few other games. In that, chances of winning is agian doubtful, if they don't win, they're not recognised, no name,fame,money. It's a risky profession.

The poor attention of the government towards non-cricket sports, no spirit in Indians to be a nation's pride, no interest to do hard work, no encouragement and facilities to those who are interested in sports - all these have made India to lag behind in Olympics and in all International sports.

To know why Chinese win so many golds, silvers and bronzes, follow the link and watch this video: http://in.youtube.com/watch?v=c7NZ97gekZk&feature=related. Also watch the other videos in the series.
Also take a look at Abhinav Bindra's blog.

A temple or a food mall?

2008-08-05T16:19:00.000+05:30

I had been to ISKCON, Rajajinagar, Bangalore on sunday to attend my friend's brother's wedding (There are two marriage/function halls in Iskcon called Dwarakapuri and Mathura). After the wedding, my friends Usha, Siri and I went to the temple.

I don't know what Iskcon is, a temple or a shopping and food mall? People were more busy in shopping and eating than in praying God. All kinds of things are there for sale- T shirts, kurtas, photos and paintings of Gods, pooja items, lamps, plastic garlands, incense sticks, books, cassettes and cds, eatables etc etc.. Eatables deserve special attention; pakoda, gobi manchurian, pizza, burger, fruit salad, ice cream, chips, vadas, cakes, paneer rolls, rasgulla, jilebi, jamoon, peda and many more are available. This was the busiest place in Iskcon.

The next time you plan to go to Iskcon, you can fast overnight. Also, don't forget to get fasting blood sugar and post-prandial blood sugar tested!

What's a balanced diet? Learn it from McD!

2008-08-05T16:08:00.000+05:30

I have been in Bangalore from 4 years, but I hadn't been to brigade road, Forum mall and McDonald's till last month! It was my friend's birthday and a few of us had been to Corner House in Residency Road, ice cream was just ok there; and from there we went to Mc Donald's in Brigade Road. That what when I ate a burger for the first time in my life. Ate it for the second time in Forum last month. While I was eating, my attention was fixed on the tray in which the burger was self served. It contained this:

I was surprised to see this in McD! McD advicing its customers on balanced diet, how the family food should be, what it should contain and how active people should be! More surprising was this:

Burger is a balanced diet! It contains carbohydrates, fibres, proteins and fat, each ingredient balanced and thus making it a balanced diet. So people, when you're hungry next time, try the balanced food in McD and please don't eat other junk foods. Also, offer your kids the McD's balanced diet when they're hungry.
The significant number of child population in McDonald's worried me. Bangalore kids live on junk foods. To make use of the opportunity, I can think of becoming a diabetologist in future!

A drug used as drug!

2008-08-05T14:45:00.000+05:30

Last week, I had been to my dad's cousin's house in Srinagar, Bangalore and there my 70+ year old uncle asked me what's the safest analgesic. I started telling that no analgesic is 'safe' etc etc and then he asked what he wanted to ask. He told he thinks 'PROXYVON' is safe and is marketed by WOKHARDT. Since it's the trade name that he told, I told I'll check the content of that drug and inform him later. When I ran a search, this is the first article that popped up:
http://www.burmalibrary.org/reg.burma/archives/200006/msg00075.html
" The Centre has taken serious note of the alleged involvement of licensed opium poppy growers with drug traffickers in the country and the deteriorating drug abuse situation in the North-east states. In this regard it is considering a ban on proxyvon in pharmaceuticalmarkets of the region, especially in Mizoram, as it is increasingly being used as a substitute for heroin."

Well, proxyvon is the trade-name for dextro-propoxyphene, a synthetic opioid, which relieves pain (an analgesic); it's a WOKHARDT'S POWER BRAND. But it's increasingly been used by drug addicts as it's cheaper than heroin and is manufactured locally. Though proxyvon is to be supplied only with the prescription of a registered medical practitioner, the drug is available over-the-counter illegally.

The article also says this: "A recent report of the International Narcotic Control Board (INCB), in which India is also one of the six representing nations, noted that the area of cultivation of opium has increased from 23,811 hectares in 1986 to 29,700 hectares in 2000 with the percentage of consumption increasing from 82.6per cent to 115.8 per cent during the same period. But more than 60 percent of farmers engaged in the illicit cultivation of opium during the 1998-99 crop-year failed to meet the minimum qualifying yield per hectare as established by the government.The other nations are Bangladesh, Bhutan, Maldives, Nepal and Sri Lanka."
A drug used as drug!

I miss Maths

2008-08-02T12:02:00.000+05:30

Read this: http://nonstopgoli.blogspot.com/2008/07/making-teaching-simpler.html
And read this: Lockhart's Lament.

I always loved mathematics. Got 100/100 in 7th, 10th and 12th board exams, and in most of the school exams. I managed to clear state level NTSE with a very good MAT score (Mental Ability Test), but couldn't clear national level as my social science knowledge was very poor (I studied under Karnataka State board, which is just around 40% syllabus of CBSE or ICSE). I also got 55+ on 60 in K-CET,the score was the highest among all the four subjects (Physics, Chemistry, Maths, Biology). But now I'm in medicine and studies have been never great as it was during my school days. Now, I feel that my brain is not as sharp as it was before. I see only letters and words and drug dosages in my books. Having good memory and developing an analytical approach towards every case and its treatment are the only two things required in medicine, apart from having a great deal of commom sense. I miss maths. I feel that studying maths and solving problems is very essential to sharpen one's brain.

Did you know?

2008-07-14T12:33:00.000+05:30

All of you must have watched movies in PVR, Forum and must have been to S.P.Road to purchase electronic goods, atleast in your student days when funding came from parents. Do you know what's PVR and what's 'S P'?

It's Priya Village Roadside and Saadara Patrappa Road!

Happy doctor's day!

2008-07-01T13:13:00.000+05:30

It's Doctor's Day today. Once upon a time, a doctor was next to God, a healing hand, a person who freed thousands of patients from their sufferings, both rich and poor. He was the cream of the society, medicine was the highest profession in the society. And money came to him, he did not have to ask for money or charge his patients much. Even a GP (a general practitioner) was respected and feared by people. Medicine was the most satisfactory profession.
But now, when I meet my friends and relatives in functions, they ask - "Why did you take up medicine? It's just hard work and no money. At what age will you settle? You'll become old by the time you start earning. What will you do by just an mbbs degree? You've to do a pg and it's very difficult. You should've thought about all this before joining mbbs. See my family, I made both my son and daughter join engineering and they've already started earning. He owns a house and a couple of cars and when I'm ill, I get treated at Apollo because his company funds my medical bills. etc etc." This is what all people say in Bangalore. But when their heart is weak, they want the best cardiologist to treat them, when their lungs are weak, they want the best pulmonologist to treat them, when their kidneys stop working, they want the best urologist and his team to transplant a healthy kidney to their diseased body. Everybody want the best doctor to treat them, but nobody want their son/daughter to become a doctor. Now from where do these 'best' come from? They don't fall from heaven, they are the people who have worked hard in their life, spending day and night in the hospital to save as many lives as possible, studying well and updating their knowledge throughout their life so that no patient is lost by their ignorance; they are the people who have dedicated their whole life in the service of the humanity. I wish all my colleagues a happy Doctor's day and wish them success in every step of their life.
When coming to commercialization in this noble field, it's because of the 'fathers' as in this incident, who are ready to buy the doctors and the system of medicine. Another sad thing is the people buying undergraduate and postgraduate seats in medicine with the power of their money when their knowledge is sparse, and more depressing are the goverment policies that have introduced a variety of reservations in the system of medicine. General merit has become a minority now and the readers can understand the consequences. The future is both promising and scary.

Necessity is the mother of all inventions

2008-06-18T14:04:00.000+05:30

A post in my brother's online journal (he has closed it now):
"When they (whoever they might be) say Necessity is the mother of all Inventions, they are only saying the short form of the more complete genealogy. Desperation is the father, Confusion is the paternal grandfather, Panic is the paternal grandmother, Funding Program Manager is the maternal grandfather and Peer Pressure is the maternal grandmother."

I'm having self pity for getting this family for free in 4th year mbbs. :( Many internals lined up for the next couple of months and there's a necessity to study; I'm desparate to study all the books and all the photocopied notes but I'm not able to complete even a single book in the specified time limit; Confusion about which subject to study and which book to study; Panic that half of 4th year is already over; the term fee is announced, have to pay it soon; constant pressure to study and perform well this time. So, it's time to invent some plan to get rid of this family of worries and to study calmly. Will get back to planning and studying. :) Bye.

God or no God?

2008-06-05T10:27:00.001+05:30

When I had been for a walk at 6 am in the morning a few days back, I found a person offering flowers and praying in front of the small Ganesha idol in the Venlakh hospital, near my house in Chamrajpet, Bangalore. That reminded me of a line told by Dr.Devi Shetty in one of his speeches at a medical college, "Believe in God so that you can blame someone when things go wrong." I presume that the middle aged man was also doing the same thing, blaming God why his near and dear one has got a disease and also praying God in a hope that his family member would recover from the illness soon. I have seen similar incidents in the temples inside the Victoria and Bowring hospitals. Every hospital has a temple, and many of them also have an idol of Jesus.
And yesterday, I read The Religion War by Scott Adams. I liked the flow of thoughts presented in that book very much, esp the chapter in which the Avatar is under interrogation. The question about God's existence doesn't concern me; but the belief that God exists comforts a lot of patients and their family members in the hospitals who are fighting between life and death. This supports this - 'The majority believe in the usefulness of their beliefs—an earthly and practical utility—but they do not believe in theunderlying reality.' -a line from God's Debris by Scott Adams.

'I want to be a doctor'

2008-05-28T07:26:00.000+05:30

I had been to one of my relatives' house to see a newborn child. The mother had come to her mother's house for her puerperal care. The granny introduced me to the family members telling that I'm a doctor. She then turned to the child and told that it should also become a doctor as there are no doctors in their family. I was shocked, did not know whether to laugh or cry. I got a sense of pity on that kid, seeing the ambition of its parents and grandparents. If it takes up medicine after 18 years, how much it has to study! The 1200+ pages of Robbins pathology would have become 3,000+. The 3,000+ pages of Harrison's Internal Medicine would have become 6,000+. Schwartz would contain 5,000+ pages by then. The number of undergraduate medical seats would be increased disproportionately to the number of post graduate seats. And after 18 years, one might need to do under graduation, post graduation and super specialization and super super specialization and what not. Also, financially, doing medicine which is a multi lakh business now would have become a multi crore business by the next 18 years. There will not be any place for general merit students in India. America, Canada and Australia would have taken the path of UK and would stop taking IMG (International medical graduates). Only the rich sons and daughters of rich people in India would be able to do medicine by the time the kid grows up and enters the race. The poor granny has absolutely no clue about all this and heartily wishes that her grand child should become a 'DOCTOR.'

The mother told that the baby was born in The Nest, a branch of Wokhardt. The granny added that the kid's father wanted the baby to be born at Wokhardt only. The parents didn't know the background of the doctor who delivered the kid, but they wanted the child to be born in that hospital just because it was 'Wokhardt.' Such is the effect of the 'branded' hospitals on general public. Later, the granny told the child was delivered by Caesarean section and also told there are hardly any normal deliveries conducted nowadays as the doctors come to know that their clients get reimbursement form the firm in which they are working and hence can afford for Caesarean surgery! This was the second shock of the day!

One week later, I saw a hoarding in Gandhi Bazaar, it was the ad of The Nest with a nice photograph of a mother and a child. It read like this: 'The Nest, Wokhardt... Every time a child is born, a mother is born.'

Well, every time a child is born, a mother is born, a doctor is born, a hospital is born, an administrative officer is born, a maternity welfare wing is born in the firm in which the mother is working, an insurance wing is born in the father/mother's firm to reimburse the money spent on the Caesarean section.

Updates: I heard that a 'Normal' delivery in The Cradle (a maternity hospital near South end circle, Jayanagar) costs around Rs.58,000, and middle class people also want to get the baby delivered in that particular hospital at the cost of getting into debt, as giving birth to a baby is a lifetime event!

Quotable quote #3

2008-05-28T07:16:00.001+05:30

"Do not waste a moment of your time while you're at BMC, or you'll regret for the rest of your life not having taken advantage of all this college has to offer. A fool leaves BMC with only a degree, a wise man with enough knowledge to face whatever life throws at him. Sieze every opportunity that's offered to you. Do not be frightened of any new challenge, and should you fail, there's no reason to be ashamed. You'll learn far more from your mistakes than from your triumphs. Challenge every wit, and let it not be said of you, I walked a path but never left an imprint."

Quotable quote #2

2008-05-27T12:21:00.001+05:30

"It is better to be fortunate than wise."

- An age old saying, but very true.

Neighbourhood stories

2008-05-27T11:57:00.000+05:30

A couple of days back, smoke filled my house which in the first floor, at around 8 pm in the night. I told mom that it is smelling like that of smoke emitted while performing homa (a Hindu ritual in which plant twigs, ghee and many other things are burnt on an altar). It subsided after sometime. The next day, when I went out, I saw the house next to me decorated with lights. The smoke that I had smelled was indeed that of a homa. It was 'Grihapravesha' (house warming ceremony) that was going on. And we the immediate neighbours didn't know and were not invited!

Last week, my mom had bought butter and had kept it on the lighted stove for it to melt and become ghee. My neighbour's son who is studying in 9th class asked his mom why he's smelling a peculiar odour. That boy in the middle of the second decade of his life didn't know how butter smells when it melts! Later, his mom came and told that the boy doesn't know that butter can be melt into ghee as they've never bought butter!

Observation

2008-04-04T11:49:00.000+05:30

I found this in Apley's System of Orthopaedics, 8th edition. The author quotes the conversation given below to stress upon the importance of inspection during examination of a patient. The consversation is from A case of identity:

Watson: "You appeared to read a good deal upon (your client) which was quite invisible to me."

Holmes: "Not invisible but unnoticed, Watson."