I'l tell you what's up

Hey!  We're 3 hours away from calling curtains to what has been a most enlightening year. A lot has happened, so much so, that when someone asks me about it, simply gathering up my thoughts takes ages; by which time my audience has usually moved on to more interesting people with less retarded responses. At home, I watch as my brother spouts tale after entertaining tale on his life as a software engineer in Bangalore, and when its my turn to answer the 'so whats up with you?' , all I can come up with is,"well......., I'm still in the wards.... Rainy season is over.... so thats pretty good.. hmmm... oh, and I have an intern, so cheers!"...    After a 2 second pause, they turn to Srinath and ask him if he still jams with his friends in his apartment with his band mates.

The truth is, in a hospital, there's always something happening. in every corner of the place. Every single patient in my ward is a story. And each tiny incident that happens with that patient, which as doctors, we might not even notice, is possibly life-changing to that family. And to be a part of so many life-changing events, constantly, does something to your perspective. I'm not sure if its a good or bad thing, but I do know that it is inevitable and necessary. 

This post is for my family, as an attempt to basically tell them what's up.. 

So lets see. I joined this place on 1st May, (not sure that was a good move to begin with, the jury's till out on that one), and was immediately put in the MICU. In retrospect, that was a brilliant move, as since nobody has a clue what to do in that place anyway, why not add freshers into the mix. Here's the protocol in an ICU. Strap the patient to the bed, put a tube through every hole in his body, attach him to a monitor, and stare at the blinking numbers. Now and then, junior residents must suction the tubes, else his passage towards the light will be interrupted by choking. If by some mistake/miracle , he makes it, despite the nosocomial infections, MDR bugs, blocked ET tubes, and aspiration pneumonia, you label him as the one that got away, and send him back to the ward, where other clueless freshers await.

My first week in the wards was pure heaven, relatively. It was amazing how the simplest things in life can make you so happy, like not having to hear a dozen beeping monitors  in your every waking, and most of your sleeping, minutes. Also, the fact that except for a couple of days of the week, when you're on emergency call duty, you have actual free time, was a very welcome surprise. And finally, I met the first of  my two good friends that week. Sanat sir, it's been an absolute pleasure talking nonsense with you, without which I'd have been bored senseless. We'r still on for Madras cafe tonight, right?

Time went by a lot quicker from then on, and I've changed wards, and units, thrice since then. And all the events that have occurred during this time, have merged together in my head. Now when I look back, all I see is me, standing still in the middle of my ward, and all around is hectic activity going on in fast forward motion. Patients, their relatives, nurses, servants, all moving about in chaotic randomness, their faces changing every millisecond; beds being rearranged; blood collections, paperwork, clinics, rounds, lumbar punctures, taps, central lines, counselling, intubations, resuscitations... and forever as a backdrop, death and it's consequences. Its difficult to keep hold of your normal perspective on life when faced with events of such magnitude on such a routine daily basis. It's difficult to remember your priorities and whims, when there are more obviously important things happening. And most difficult of all, is keeping intact your sense of humour. And that's where friends come in.

Fifteen other idiots had joined as first-years, and I'm glad to say that they're a great bunch to work with. The pleasure of random on-the-spot  movie and dinner plans is unmatched, and when a a bunch of your co-housemen storm into your ward, and force you to accompany them because you need to be 'rescued' from your work, you'r bound to enjoy it even more. Even more so, when after the movie, they all come back with you to the ward and help you finish things up. All sixteen of us have been through this, and that forms a unique sort of bond.
Ms.V, thanks for being the accidental discovery that made my year. Both the company and the conversations have been awesome.

To be continued, again. Sucheta, sorry about this. The ward beckons.

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(A few days later.. )

Here's a thought. We spend long periods of our childhood dreaming about growing up, and even longer periods of adulthood wishing we were kids again. And the reason for this is finally clear to me. There is a phase in between, that noone talks about, and therefore, leaves you completely unprepared for it; the phase of first contact with reality. And this is where the magic dies, and childhood ends. You are no longer protected by the system, not insulated by your family, and most importantly, you no longer give yourself that extra break. As a medico, 1st year of residency is that phase, and atleast so far, I haven't given up on the dreaming. But struggling to safeguard your childhood is far more tiring than giving in and being grown up. Choice.

On a different note, it really helps to not struggle, with life in the ward. Somehow in the midst of all the chaos, if you can find a space that lets you work at your own pace, whilst dealing with the hundred tiny issues that keep cropping up, then you're saved. Else, it remains ridiculously easy to go on a shouting spree on everything that moves or makes a noise. Imagine walking into your ward at 5 in the evening, after getting your 1st hour of sleep in 2 days, and immediately being surrounded by 50-odd relatives (I'm not exaggerating), demanding things ranging from changing a patients's IV lines, to changing their beds because it's too close to the washrooms; complaining of things like vague pain since 20 years(!) to 'my patients stopped breathing an hour back, now what?'. You can try and triage all you want, ultimately, the list is over-whelming. And the relatives grumble on.

Relatives! I cant seem to tire of writing about them, and they cant seem to be getting enough of me. I've always been fond of psychology, but this year has been an eye-opener of enormous proportions. Everyone talks about patient psychology, their behavior in sickness and recovery etc. But I doubt anyone has studied the relatives, and boy, should they. Relatives come in all shapes and sizes, and in a government hospital, most are illiterate. They are all in a hurry for you to do something, anything, to their patient, whether needed or otherwise, and they all think that the other patients are wasting their doctor's time. I've had relatives coming to me, actually prodding me, when I'm in the middle of some emergency procedure, to ask me if their patient can have apple juice. Or when will the nurse give them their next shot. Or whether the world was really going to end in 2012.. (I wouldn't know, I stopped listening some time back).

Explaining poor prognosis to the relatives is, quite often, the most useful part of your treatment. The reality must be made very clear, and all false hopes firmly extinguished. Its brutal at times, but unbelievably necessary. Even inspite of all the acceptance, there is so much emotion involved; it takes very little for it to get channelized into anger. A lot of times, your message doesn't even penetrate their wall of denial.
Of course, you can take it too far; a friend of mine is such a believer in explaining poor prognosis, he does with every patient, (sometimes without even looking at the diagnosis!) ; literally goes from bed to bed telling relatives how things are not looking good, and how he cant promise anything; apparently now all the relatives in his ward are either waiting for the inevitable, or feeling extremely grateful that their patient has recovered from such a life-threatening cough and cold.
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As for life outside the ward, it remains a transient patch of breathing space. Most of my friends from school, junior college, and JJ have left the city for jobs/studies. Half have left the country. I hate that, and knowing it's a phase that we all have to go through doesn't comfort me much, when I have time for a movie, and noone I can call. Avin, Rupin, Dhrumin, Nishi, Varada, Swapna, Prathamesh, Neil, Kuldeep, Urvi, Madhur, Ramnika... get back here, we have unfinished conversations.
(P.S. Su, Alice.. glad you guys decided to stay/couldn't manage a way out)

Rupin, you poor fellow, congrats on the wedding. And good luck with that.
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And that leaves Smriti. There aren't too many ways or words that will do justice to everything that we've been through; but as a major under-statement, the last 8 years have been fun, and here's looking forward to whatever comes next.

I think that just about wraps it up. Cheers to 2013, everyone. Ciao.