Oh well...

Kala died last week... was too rushed and too bummed about it to blog. The moment she became "bad" her mother ran to the male ward and I had Mahesh watching me and moaning in the background while I administered CPR. Not fun.

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December 25th Casualty wasn't too bad. The next couple of days were though. However, my best buddy is in SL and I met up with her on Saturday, which was really really good. Let's see how the January 1st Casualty goes... fingers crossed!

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Happy New Year, all! And remember, if you drink, drive and crash your car, you will end up in my ward and I will not be amused. So beware! Don't get behind the wheel unless you're sober! :)

Cheers!

A

Dammit!

My last pair of work shoes broke this morning... I am now faced with the choice of going to work in
a) broken shoes
b) rubber slippers
c) hooker heels

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I'm sorry my last post came out all whiny and self pitying. I'm not the first or the only one to go through this... everyone does it. My Colleague M went home to Mathara today after 5 weeks (and was entirely cheerful about handing over her ward to me).

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So I'm now handling the female ward. Slightly lesser number of patients but full of old achchi's suffering from APR (athe-paye rudha/ anga-patha ridenawa) . Since I've been suffering from APR. meself, I'm a bit more sympathetic than I would have been otherwise. The ward also has Kala*.

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Kala is a 19 year old with a 43% kerosene oil burn - accidental, she claims but the pattern of the burn injury makes us question that. She has a 2 year old daughter and was pregnant with her second child when she was admitted. Her husband Janaka is in my old ward with a "rescue burn"... he has essentially burnt the skin off both hands trying to save her.

Janaka looks a real rasthiyaadu type... dirty teeth, silver earling, breath smelling of stale ciagarettes. He drives a three-wheeler and lives near the place Kala was boarded at a couple of years ago while working at a garment factory. Romance blossommed between the brash sinhala youth and the shy tamil girl. His family was ok with the match... hers opposed it. So they eloped and in true Sri Lankan style, all differences were settled when little Tharushi was born. Kala's family came from Trinco and were living in a house paid for by Janaka.

Janaka had tears in his eyes when he told me how Kala made him tea and stroked his hair untill he fell asleep that fateful night. He was woken up by her screams of agony and had rushed to the kitchen to find her blazing like a torch. He carried Kala with his burnt hands into the threewheeler and then to the Accident Service.

Two days ago Kala developed labour pains and was rushed to DMH where she prematurely gave birth to their second child. She's back in NHSL while the kid is in the PBU.

In Sri Lanka, anything more than a 30% burn injury carried a pretty poor prognosis... i.e. 99% die. Kala has an inhalational injury as well... her lungs have been burn from inside by the kerosene fumes. We're pumping in fluids and plasma and high protien food... but the truth is that she can die any minute.

She scares the daylights out of me.

She's conscious and rational.... her breathing pattern sucks and she knows it. She asks me if she's going to die. Janaka asks me if she's going to die. Her mother asks me if she's going to die. I don't have much to say.

Everytime I leave the ward, I leave in grim anticipation of the call "Doctor, Kala has become bad".

Would appreciate any positive energy you guys can spare to be sent her way.

Last day off...

Literally...

Until sometime after the 7th of January...

I will be working everyday and be on-call every night till then... every weekend and every public holiday too..

Life sucks.

My feet hurt and I have got fairly large, possibly infected callosities on both feet. It hurts to walk. Sometimes I get pains in my feet that make me feel as if they are on fire. They only last a few seconds but sometimes it's difficult to stop from going "ouch" out loud. Maybe I'm getting some kind of neuropathy... maybe it's just that they need a rest.

Three of the guys who were admitted to the last casualty came with the complaint "pain in the big toe". It was hard not to be exasperated... they were eating up time that could have been spent on patients who were much more ill. The Consultant didn't play around... all were sent home with instructions to attend the clinic and get a routine date for surgery, if needed.

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I need new shoes. I started off this job with 6 pairs (2 different designs each in black, white and brown) and now am down to one (ONE!) because the others have all worn out / broken.

I need new clothes because everyday on call = 14 outfits a week. I don't have that many clothes and I can't see myself doing the laundry (or, to be honest, bugging Darling to do the laundry) more than once a week.

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Not much time to surf/blog... you may have noticed fewer and fewer posts... by the time I get home, I'm usually too tired to get Darlings laptop out and trawl the net. All I want to do is to sleep.

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The "season" is upon us and am not really feeling very festive. I'll be doing a casualty on December 25th and on January 1st... :( Did I mention that it's been a year since Darling and I tied the knot? Our first anniversary pic has me in a dressing gown and Darling in his vest, cutting a one pound chocolate cake sent by Brother... the messy kitchen of our apartment is in the background, making me feel guilty whenever I see it.

It wasn't bad... we went to the hotel for dinner and the following weekend (my last off-weekend incidentally) we went out of Colombo (not very far) and just chilled. (details in a post to come...)

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Anyway, I'm just feeling really depressed at the moment.

Sigh...

Luck

There was once this guy, a victim of a blast, not too long ago.

As the fatal explosion occurred, shrapnel entered his body, like it did to others around him. Others died.

The biggest piece that entered his body was a bullet casing that went in through his chest, missed the heart and lungs, missed the great vessels carrying his life-blood, missed the gullet and the windpipe and lodged at the back of his throat.

And all the doctors had to do was to make a small slit and remove it from there.

Two ball bearings also hit his face, neatly entering on either side of his right eye and getting stuck in the skull, leaving his eye - and his vision - intact.

Luck? Good karma?

I don't know... do you?

Have I ever...

Tagged by Sachintha... (though I'm not sure whether it was a I have never or a have I ever tag....) This may turn out to be long and boring but anywez...

Have I ever...

Felt utterly sick and thrown up after drinking 2 sips of peach vodka...

Climbed the Dambadeniya rock using ropes, in the pouring rain and wondered why the heck I was doing so...

Had undiluted passion fruit cordial poured down my bra...

Had my strapless bra come loose somehow and had the cups sticking out under the waist band of my dress like a couple of weird tumours...

Fallen into a swimming pool and nearly drowned (aged 2) and still can't swim...

Learnt Bharatha Natyam (aged 3-5) and then forgotten everything about it (aged 6 to date)...

Run away from home... (aged 11)

Faked a fainting fit in order to attract attention...

Developed meningitis, spent 11 days in a painful red delirium and emerged partially deaf (aged 15)...

Got kissed by a random drunk guy at a party and then slapped him, only to have my hand slither off his sweaty face... (cringe)

Given this totally gorgeous Chilean guy a long and intimate backrub in his hotel room... (Portugal, aged 18)

Got so mad when an A'level exam invigilator criticized the way I was sitting, that I went to her room after the exam and cursed her and her children, that they may never become achievers in life and never know happiness... (it was the Zoology paper, and I got an A)

Had a bunch of dudes in a three wheeler snatch my cap off... then run after the three wheeler, catch up, kick at the rear lights, tear out branches of the pathetic x'mas tree tied to its roof and when they stopped out of sheer desperation, swear at them in a fairly fruity combination of sinhala and english... (Unawatuna, aged 18) (ok, I have anger issues...)

Been so desperately crushing that I'd walk up and down my room, chanting his name over and over like a manthra, willing myself not to call him on a day to day basis because it would look pathetic...

Kissed the same guy while in a moving three wheeler and opened my eyes to wonder how come the Beira Lake looked so dazzlingly blue...

Married the same guy and spent a significant part of the (ahem) first night is a sheer white slip, with my bridal headdress perched on top of my head, jumping up and down saying "I'm married... you married me... we're married...." etc.

Okie... this is turning out to be far too personal.... that's all for now folks! I won't be tagging anyone because everyone and his aunt seem to be tagged already...

Cheers!

Physician, heal thyself...

I managed to leave the ward by about 5.30pm during last week's post casualty. Post casualty on-calls always suck... the ward is full, half of the patients are after surgery and invariably the number of patients exceeds the number of beds.

Anyway, it was a quick break - rush to the flat, welcome wash and then grab a bite to eat, a banana and a piece of cheese, as it happened. 15 minutes later I felt a horrible burning sensation around and inside my mouth... rushing to the mirror, I saw horrible ugly red wheals form on my lips and tongue... eeeek!

Okie... food allergy (but to bananas and cheese??) Horrible pictures started swimming through my head. Things like angioedema and Stevens-Johnsen syndrome start off like this. There was no one at home, so, mildly panicked, I rushed off to the OPD with the vague uncomfortable knowledge at the back of my head that whatever this was, it could kill me.

The OPD doctor took one look at me and said "admit!!". So there I was, jittery as hell, clutching the admission sheet while my name was being jotted down into the admission book of a medical ward. The doctor there - an intern like myself, let's call him R - took my history, my blood pressure, listened to my lungs and said with interest that the taste buds on my tongue were so swollen that he could count every single one of them.

And then we ran into a problem. One of the drugs I needed, promethazine (also known as phenargen) would knock me out completely - and I was on-call that night! A brief argument ensued. I had every intention of going "LAMA" (leaving against medical advice) after getting the shots I needed. There were a hundred things to do in my ward... there were at least 2 patients who were "bad". Dr. R said in that case, there was no way he would give me the promethazine because then he would have to restrain me in his ward - I would be in no condition to do an on-call.

After a few minutes of roundabout conversation "but I have to go"... "then I can't give you phenargen"... "but I need the phenargen" we reached a compromise. I would get the non sedating drugs and wait in the ward. He would go and have a quiet cup of tea. We would decide on what to do once he came back.

My symptoms improved somewhat, my BP continued to be stable and the horrible itching didn't spread beyond my face. So about an hour later I signed myself out of that ward. I cajoled the nurses into letting me keep the cannula - after all, if I collapsed, there would be a handy pathway for nurses in my ward to give me the phenargen or whatever.

So there I was, doing a ward round, cannula on my hand as large as life and patients giving me odd looks and asking "Doc what happened to you?" Happily my Registrar took a firm stand and said he'd be on-call instead of me so that I could go home and get a good night's rest.

Which brings me to the hypocrisy of it all.

Had it been someone else asking my advice, I would have snapped that they needed in-patient treatment and that the universe will survive for one night without them. But no, doctors are the worst type of patients. They are stubborn, idiotic and know-it-all. As a general rule they take poor care of themselves - irregular meals, inadequate water intake, erratic sleep patterns and not enough quality time with loved ones/family. In short, they (i.e. we) are hypocrites of the worst sort.

Sigh... looks like I fit pretty neatly into the stereotype!

Rain...

I'm not sure I like the rain anymore.

Yesterday, I forgot to take my umbrella, had to take a trishaw to the flat and then got frickckin' wet anyway, because my neighbour had a lorry parked down the lane and the trishaw couldn't negotiate the last 100 yards home.

I was wearing a red saree.

I discovered that the afore mentioned saree is not colour-fast.

I ended up trailing pinkish streams of water all the way along the living room, past the pantry and into the bedroom.

In an absolutely foul mood, soaked through, I tear off the offending saree and dump it in the laundry basket... failing to notice that two of Darlings light coloured office shirts are in it.

Saree has been banished from wardrobe.

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On the positive side, the flat is no longer like an oven when I get home from work.

And heavy rains means we get less admissions. Of course it does mean that those who do come are the dead-or-dying. Sigh. Oh yeah, it also means that those who don't have a dry place to sleep in also get admitted. So no real difference in number of admissions... :S

The hospital corridors flood too... and I always get paranoid about worm infections and take vermox "just in case". It's not very nice squelching along, with damp hem of saree sticking to ankles. The lift guy advised me to keep my umbrella up even when walking the corridors "because Nona, the roofs were built only to keep the sun out, not the rain".

Yup, I think that settles it. I don't like the rainy season.

Tired....

Sigh.... joints and muscles I wasn't even aware I had have been aching for ages. I have been working the night on 6 of the last 9 days. Of course, this is after working the day shift as well. Even Darling got tired of me coming home well after 10pm, but to be honest, on most occasions I chose to stay back... I couldn't leave the ward until I was sure that X's BP was stable and Y was out of pain, and Z had stopped vomiting blood.

I'm not a saint. I did it not for the love of humankind. X is 90 years old and is in absolute suffering with a dozen medical problems that will push him to the grave sooner rather than later. Y had crashed his bike while drunk, killing someone, and Z is a wife-beating drunkard.

Ideally, I should not care less. Yet they are my patients, under my care, in my ward. They are my responsibility. It would be wrong if because of a lack of something on my part, someone should die a little sooner or that someone else spend a sleepless night due to pain.

This is my job. It is my responsibility and it's not a very comfortable one. It's a horrible feeling to come in the morning and realise that someone has had unnecessary pain because the morphine had been prescribed 8 hourly instead of 6 hourly. Lapses do happen, because in spite of everything, I am human, and I'm just an intern. And when they do happen, I am so very very sorry.

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Ouch, ouch, ouch. Achy muscles suck.

It's also that time of the month.

Since panadine is the strongest painkiller I use, drug-relief is minimal. What I really need is a hot bath and a good foot rub. I shall have to settle for a cold shower.

I've got lots of comments to reply to... thanks to all who took the trouble, your input is appreciated. Will update when less crazy-busy.

Work again tomorrow. Tomorrow's a new day - a new week.

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3 and a 1/2 months down... 8 and a 1/2 more...

Daily ditties

Sri Lankans frustrate me in general.

Those in my ward are frustrate me in particular.

But they are my daily fare.... my bread and butter, so to speak. Every day I ask patients about their bowel movements and whether they are peeing comfortably. I stick my finger up innumerable back-sides. I poke and prod and tap and listen. I feel sweaty and uncomfortable and sick at times. These days, dehydration is almost a by word. And still, in spite of doing our best, patients don't do what's best for themselves... why do people have so much trouble in taking responsibility for their own health?

Take the guy in bed X for instance. After devoutly fasting for 20 days, he decides to prematurely break-fast by going on an alcoholic binge.... which lasted till sunrise. He then lands in our ward with a ruptured stomach ulcer, bleeding like mad and has to be rushed into emergency surgery. After days of being kept nil by mouth, we cautiously asked him to drink water - and water only - not exceeding 30ml an hour. The next thing you know the guy is found with a huge buriyani in hand! Aaarrrgh!!!

Then there's the fellow who stabbed himself in the stomach with a bread knife. He seems to have wriggled it around a bit also because his bowels were cut and torn in multiple places and he needed 6 hours of surgery in the wee hours of the night, ICU care and constant monitoring after that. After looking disgruntled for a day or two, he starts yelling at the doctors accusing them of starving him to death. After frustrated conversation and repeated explanations that food will kill him if taken too early, our only conclusion was that next time, he should aim slightly higher and to the left. Hmmmph!

My last casualty saw three admissions with bad diabetic foot ulcers. All three patients had delayed coming to hospital by at least 2 weeks after developing what was initially a small sore. This is in spite of repeated verbal and written information by doctors, nurses and medical and nursing students of the importance of foot care and getting early treatment. One foot ulcer was actually swarming with maggots!! (Eeeeuw!!!) They all turned up after 11pm in the night and all had to undergo amputation. Depressing.

Come to think of it, our countrymen and women seem to have a particular affinity for coming to hospitals in the middle of the night for quite routine complaints. I guess they finish up the house work, sort out their accounts and bills and feed the poor and hungry before they come. Almost every casualty has an admission or two where the patient has been constipated for days... sometimes weeks... who then decides that they want to move their bowel at 2 o'clock in the morning! Honestly, if they came at a decent hour that day... they would have got prompt treatment, a date for endoscopy and been sent home quite comfortable... instead of having to sleep on the floor because there are no beds. And probably wouldn't have had a sleepy doctor (virtual pitchfork threatening alarmingly) getting irritated at their complacence.

Finally there's the guy in bed Z... the bane of my existence. He has multiple anal abscesses caused by constipation, caused by his not taking his thyroxine for 3 frikkin years. The abscesses are oozing pus (eeeuw... why am I in this profession?) and the area needs to be kept meticulously clean with frequent dousings of salt water. And he refuses to wash. Instead he asks for more tablets and pills and injections. Jeez... he frikkin refuses to wash!! (Did I say that already?) And he refuses to go to the toilet - which is the root of all the evil in the first place. The only thing that finally got him to the bathroom was my dark prediction (said out loud and to the ward in general) that unless he does so, his bottom will completely rot and fall off.

Well, that's all for now, folks. I have to go early to the ward tomorrow... there are more back sides that need examining.

Sigh...

Dr. Lakshmi Indunil... a tribute

I never knew of your existence
Until you ceased to exist on this earthly plane

Your memory blazes like a torch in the hearts of all those you served
Blessed are the many who felt your healing touch


I did not know you, sister...
Yet even in your death, you teach me much

May you attain the supreme bliss of Nibbana

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Words by those who did knew her...

"...she was incredibly kind, if someone was ill, she'd get on the bicycle of the messenger and go to attend to that patient..."

"...when she requested a transfer because of this fellow's threats, the respectable people in the village - the grama niladari, principal etc. - petitioned for her to stay..."

"... I can't imagine anyone shooting her... shooting her is like shooting a butterfly..."

Occupational hazards

I think I'm going to quit medicine - it's becoming bad for my health.

Apart from the minor heart attacks and nervous breakdowns caused by patients, the getting-yelled-at by the relatives because we hadn't given the patient soup or papaw or something (dude - this is a government hospital. All we can afford to give is rice and curry for all 3 meals.. be thankful!) and the occasional romantic overtures from the more inebriated, hospital life can become a threat to safety, peace of mind and even life.

A friend of mine had her chain snatched a few months ago. She was leaning over to examine a patient who ripped off her chain (causing deep cuts around her neck) and run out of the ward. He was subsequently caught and found to have swallowed it. X-rays showed the chain and pendent - close to 2 sovereigns of gold - lying there as large as life in his bowels. So he was given laxatives... and everyone patiently waited for the chain to pass. Eeeeuw. The chain didn't come out, the patient was taken in to remand, and that will be the last my friend hears about her necklace. Honestly, if it had been me, all ethics would have been put aside and the patient would have been sliced open on the operating table the very next day!

As a precaution, I don't wear any jewelery to work. Not my wedding rings. Not even a necklace or a pair of earrings, unless a particularly festive mood calls for a pair of imitation danglers. Rings interfere with the scrubbing at theatre, and it's difficult to pull on a pair of gloves in an emergency. Earrings get caught in theatre masks and caps. Chains get snatched. I sometimes walk home alone, down a couple of poorly lit streets. Who knows what type of desperate weirdo will accost me?

The there was the murder.

Lady doctor shot dead in Hambanthota. She was a group mate of some of my colleagues and the atmosphere in the ward yesterday was one of deep shock and distress. She had been a lovely girl, they said. Quiet and unassuming and totally unlikely to get embroiled in arguments.

Apparently there had been a disagreement with an army soldier and this guy had stalked her for months, tracked her down to her quarters and shot her in front of her father.

OMG!

We treat many personnel from the armed forces on a daily basis, some for routine surgery and some from the front lines who come for specialized trauma care. There are plenty of stories, some heartbreaking, some shining examples of courage that I don't blog about, simply because I don't want my posts to raise any unnecessary red flags.

My point is that even though we're very kind and give them priority at every point, sometimes we have to be firm. Many's the time I had to tell patients (or the bystanders) off for not following medical instructions. Sometimes information needs to be repeatedly yelled out before it can penetrate the thick Sri Lankan skulls. Goodness knows how many of them walk out of the ward bearing a grudge and even now may be plotting to kill some medical officer or the other.

It's not just the forces personnel. This is a nation of twisted, violent and ignorant people and at hospital we deal with the scum - drug addicts and dealers, mafia hitmen, government hitmen, kassippu brewers, pimps.

Eeeek!

I think I want a nice, safe job... with set working hours, in a comfortable air conditioned environment among people who are not sick.

A moment of weakness

Phone conversation recently, a couple of hours after I got to work.

Angel : darling, I just made an impulse buy...

Darling : oh? And how much did this little impulse cost you?

A : ummmm... Rs. 2,500/-

D : huh? It's your money, but what could you have bought that cost so much?

A : mumble mumble, darling

D : what?

A : (sheepishly) an eye make up set...

D : (bewildered) but I thought you were at the OT today... how did you manage to acquire something like that?

A : (even more sheepishly) a male nurse sold it to me while I was at the theater

D : .....

D : .....

A : Honey?

D : I am truly speechless... we will talk in the evening.





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Those who have read my earlier posts may notice a trend....

The death of rats...

With apologies to Terry Pratchett


Picture from here.

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I'm tired.

A casualty to handle, a week end on-call, and personal emotional turmoil.

But all that's besides the point of this post.

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I walked into a medical ward yesterday... sat down near the house officer (an old friend) and started a random chat. I can't explain the difference I felt... was the air somehow heavier in this ward? Was there somehow less light than the one I worked in, or was it just the generally overcast day?

These musings at the back of my mind were cut short by wails and screams of agony. Over and over again... now high pitched, now low... different voices... different levels of torture ripping through souls. At times a confused babbling.... at times just incoherent moans. Over and over again...

I listen for a full minute, mouth agape... "what is that?" I ask, horrified. My friend looks glum. "Them? They're the lepto patients..."

Leptospirosis.

The farmers call it mee una (rat fever). The spiral like bacteria lives in the kidneys of rats... and when they pee, get passed into drains and canals and paddy fields. Unwary farmers go sloshing around... and get infected through the cuts and scrapes on their feet. The fever sets in and chills shake the bodies of these young, strong, healthy males. Blinding headaches. Uncontrollable vomiting. Delirium. And the complications are killers : inflammation of the heart and brain, liver failure, kidney failure, relentless bleeding tendencies.

It is "Lepto season" again in Sri Lanka. There is an epidemic going on... but I don't have the statistics or the numbers yet. Many many are transferred to Colombo... from all over the country and they die like flies... young men, reduced to moaning shells of their former selves. Women die too... young and old... some who have only stepped into the paddy field to help a friend during the sowing.

There is hardly enough space in the dialysis unit for patients with chronic kidney disease. The unit is full of lepto cases, their blood being fed into machines in a desperate attempt to clean out the toxins that are poisoning them. The wards overflow with the infection... the systematic removal of bodies is only matched by the relentless inflow of even more patients.

Antibiotics can cure... if given early. As soon as there is even a faint suspicion of the presence of Leptospira. Before the complications set in. I believe there's an island wide awareness programme going on. Cut off as I am from newspapers, TV and other mass media that is available to the normal population, I haven't a clue as to what they're saying. But please listen, and take care.

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It was close to 9 pm as I walked to the flat, the full moon radiant overhead. I bump into another friend, moodily making her way to the canteen.

"Heavy weekend eh?"

"You have NO idea. Three early morning arrests today"
(cardiac arrests... not good, obviously)

"How many survived?"

"None."

"Damn! Poor you... hope the rest of your day was better..."

She looks at me... tiredness, and something else I can't define seeming to ooze out of her very being.

"I got a call from the dialysis unit at about 10, a patient had arrested during dialysis. While giving CPR, I got a call from the ward... another arrest."

I didn't have much to say after that. Obviously her weekend was a helluva lot more shitty than mine. I only had one question.

"All lepto?"

"Yup, all lepto."

Going home

Last week, we sent a man home to die.

Cancer had ravaged his body. His abdomen was swollen with fluid, taut and tense and shiny. Each day he became a little more breathless. Each day he would eat less... finally able only to take water, squeezed into his mouth from a soaked piece of cotton wool. Each day we would infuse albumin, plasma and blood, trying desperately to replace the proteins being leached out of his system. Each day a large needle would be inserted through the abdominal wall as we tried to drain out the malignant collection of fluid. 4 liters on the first day, 2 1/2 on the second.... after about a week, less than 1 liter coming out as the fluid started clotting in the tubing system.

He was a farmer, from a rural area far away from Colombo. His relatives traveled long distances to see him. Father to 5 children, many expenses were met by the employer of his eldest child. They were a devoted family... someone was at his side 24/7, medical instructions were meticulously followed, some sign of recovery anxiously awaited.

Tissue taken from the ugly mass in his abdomen was examined by pathologists. High grade sarcoma... a particularly aggressive liver tumour. Surgery was not possible. Chemotherapy and radiotherapy have not been shown to work much. The plan was to refer to an oncologist, and then transfer to the Cancer Institute, Maharagama. That would take a few days... the patient was deteriorating day by day, slowly dying.

We spoke to the relatives, to his wife and her sister, to the sons and daughters. Gently we told them not to expect too much. How can you ask a fellow human being not to hope? Yet we cannot falsely reassure...

They came to us one day, tears brimming in their eyes. Could we transfer him to M..........., a base hospital close to their home? They were prepared to arrange a vehicle... a van would cost them 5 thousand rupees... a hearse would cost 50 grand. Is it not pathetic? Can you imagine what was going through their minds as they made that request? I stifled my own tears while my colleague assured them that we would try our best.

Permission was granted by those at the top - yes, transfer to local hospital on humanitarian grounds. We may not be able to relieve their emotional distress, but maybe we could ease their financial burden. The patient was in no condition to travel in an ordinary van. The rules are such that to transfer a patient from NHSL for such a purpose, we need to wait for an ambulance from the relevant hospital to come to Colombo. An ambulance from M.......... would take days, if not weeks to come. This patient didn't have that long.

Private ambulance services were called up... the tab was Rs. 10,000/-. The family was seen outside the ward, pooling and counting the money from their purses. Orange notes and blue ones. Not many green notes to be seen. Dr. E then had his brainwave... could we not ask the Director to authorize an ambulance for this patient? The letter was carefully composed, highlighting the desperate situation. The authorization came in less than an hour and before evening, the patient was on his way home. His young son called later that night to say they had reached the local hospital safely.

The second call came the following morning. Our patient had stopped breathing... the end had come. That 18 year old boy who had watched his father die could not stop his sobs as he spoke over the phone. He understood that we are all destined to live a certain span of years and that when the ayusha (life force) runs out, we all have to leave. His last words before he returned to the sad duties of last rites and burials were "Doctor, waattuwe hamotama godak pin. Budu saranai".

A postscipt to the last...

A patient grabbed my bottom yesterday.

To be fair, at that time, I was grasping his penis (while inserting a urinary catheter).

When I slapped his hand away, he yelled "you dirty bastard" with quite unnecessary vim.

In his defense, he's 83 years old, confused and probably thought he was being molested.

Ah well... c'est la vie! My life, at least...

The penis factor...

...is something I don't think I'll ever understand. I mean, I understand the concept of the penis... and it's biological and ...um... pleasurable necessity. But seriously, isn't it rather disturbing to have an independent appendage that dominates your thoughts and actions and perhaps even your life the way it tends to do?

My first unpleasant encounter was about 5 years ago, during my first clinical appointment. I was examining this guy for varicose veins, and he kept asking weird questions such as whether his VVs had been caused by too much sex, whether the surgery would affect his sex life and how he was very active in that department and how much his wife complained. Engrossed as I was with trying to figure out where exactly the incompetent veins were, I merely made several soothing comments such as "don't worry, no of course not" etc. My clinical train of thought was rudely interrupted when his erection became so obvious that I couldn't possibly miss it. Eeeeuw. Utterly flustered, I snapped "get your clothes back on" and fled the ward.

Since then I've been resigned to the fact that as a female in the medical profession I'm likely to have the random patient drop his pants / raise his sarong in the ward, in the clinic and occasionally even on the corridor, usually accompanied by the words "nona meka poddak balanna" (Ma'm, have a look at this). Last week though was more trying than usual, hence this post.

A well known drunkard from the outskirts of Colombo was in our ward, after being assaulted by a gang of equally inebriated fellow drinkers. So there he was, on a bed, trying to look pathetic and failing miserably... and everytime a female went by his bed, this guy would reach under his sarong and start wanking away. Now, since our ward has 3 lady doctors, 5 nurses and about half a dozen student nurses walking around, this would happen every 10 minutes or so. Finally, after the poor nurse who was giving him injections came back looking absolutely nauseated, I asked a couple of attendants to tie his hands to the bars of the bed. Soon afterwards, his family requested that he be transferred to a health facility close to his home and we were only too happy to comply. Good riddance!

The casualty also saw this guy who for some unexplained reason had tied what looked suspiciously like a pirith noola around his penis! By the time he came, that ridiculous piece of thread had been there for a couple of weeks and the organ was swollen, rotting and stinking to high heaven. Our conversation went something like this...

Me : why did you tie that piece of thread?

Patient : I just felt like it Nona

Me : were you trying to sustain an erection?

Patient : no no, I don't do those bad things Nona

Me : why didn't you come any sooner??

Patient : only now it began to hurt Nona

Me : (silent scream of frustration)

The Registrar took one look and said we'd have to amputate, but as the patient was not fasting, we were told to just take him to the OT and cut the thread off, and prepare for surgery the following day. The pleasant task of breaking the news to the patient and getting consent for amputation of the penis was allocated to me. The thread duly came off and P. Nonis, as he jokingly became known as to the senior doctors, (read - No Penis - pathetic medical joke but it did sound funny at that time), was told to be ready for surgery the next day. Morning dawned and the patient was missing from the ward. Much hullabaloo, calls to the hospital police post and paper work to be sent to the Director's office. Goodness knows what happened to the poor fellow. Hopefully, that thing would fall off because if it stays attached for much longer, he'd get blood poisoning and die.

Finally, a 17 year old kid was admitted in the wee hours of the morning, complaining of pain in his weewee. I came to the ward, bleary eyed and started clerking. Apparently he had had sex with his 16 year old girlfriend 2 days ago, forgotten to pull back the foreskin and was now having pain and swelling "down there". Of course, he had to wait till 2.30am to come to hospital. I was more concerned about the girl. Had they used a condom? No. Did he have any idea what part of the cycle she was in? No. Could she be pregnant? Shrug. Apparently "she is a poor girl and has lots of family problems... that's why I was with her". I failed to understand how a possible pregnancy would improve this girl's prospects.

Getting his foreskin back in place was no picnic. Liberal amounts of anaesthetic gel were used... he thrashed around, arms and legs flailing... reinforcements were called... but in a few minutes, things were back to normal. I waited till morning to give that boy a large and nasty piece of my mind. If he thinks he's old enough to screw around, then he's old enough to be responsible about it.

Hopefully, next week will be more routine and have less ickyness all around. All in all, even you guys out there must admit that I have some justification for my rants! :)

Casualty days... casualty nights...

The next casualty will be my baby. 24 hours from 7am Thursday to 7am Friday, I will handle all the emergency surgical admissions (wince...). It doesn't end there though... I do the post casualty round on Friday morning, and if I'm lucky, get off around 3 or 4 pm to snooze and recharge as I will also be doing the weekend.

The last casualty I did saw 48 admissions in 24 hours...average for NHSL, and thankfully most were not critically ill. It's usually the uncontrolled diabetic with a foot infection, the uncontrolled alcoholic with gastritis/pancreatitis/withdrawal or someone with kidney-stone colic. The latter is the only category I really feel sorry for, as the others, IMHO, ask for it.

Recently, there was this guy (let's call him P, for patient) who was admitted with a painful hernia... something that an ice pack cured. He was asked not to eat and drink and we inserted a nasal tube... just in case. He was doing fine that night, snoozing peacefully, and doing fine when the consultant saw him the next morning. There was just one x-ray that was faintly dodgy... nothing clear cut, but when we looked at one area... it just didn't seem right... it looked as if there was air in the abdominal cavity. Now, air has no business being in there, unless it is in a loop of bowel, i.e. bowel gas. What we saw could be just a bowel loop... and that's what I thought it was. Others just thought it was dodgy.

P suddenly started to deteriorate at about 8.30 in the morning... pulse shot up, BP kept dropping at an alarming rate in spite of the IV drips. Yet he was conscious and rational and talking fine. There was no abdominal pain even though 4-5 doctors of varying experience kept prodding him. He didn't vomit and wasn't running a fever. Blood counts were absolutely normal. The consultant however was taking no chances and P was rushed to the casualty theatre with delay only to order blood and plasma.

"Explaratory laparotomy" is pretty self-explanatory. That's what we do when we have no idea what the heck is going on and open up to have a look. So we opened up and I just couldn't help gasp in horror. What looked like the entirety of what P had for breakfast, lunch and dinner the previous day was inside his abdominal cavity... obviously, part of his bowel had perforated. There's something a little surreal about seeing bits of carrot, kankun and half digested karapincha floating around the liver and sticking to bowel loops.

We sucked nearly 2 liters of intestinal contents out of his abdominal cavity before locating the part of the bowel with the hole in it. A very suspicious lumpy area (? cancer) was resected out and the two free ends were sewn together. And then the washing began... warm saline was poured in and the surgeons patiently washed and rubbed loop after loop of bowel, in a way faintly reminiscent of a Sunlight ad. Thankfully there was an ICU bed available and he was getting the best care available to someone with such a condition. Unfortunately, I guess the stress of the surgery, the infection and the pathology inside his bowel was too much for his system. P went into cardiac arrest yesterday, and could not be resuscitated.

What surprises me was that even with such a lot of muck inside the normally sterile abdominal cavity, this guy was not in pain, had no fever and even joked with the doctors while on the operating table before being anaesthetised. I guess this underlines the fact that in a really old person (ok, he wasn't that old, 67 years), going purely by clinical signs can be misleading and a really high index of suspicion is needed.

It's terrible when we loose a patient... but somehow, it seems less bad when it happens in the ICU. The death happens in spite of the best in critical care, 24 hour one to one medical and nursing care and the monitors and the fancy drugs... there is some sense of inevitability. When it happens in the ward in the middle of the night... there's always sick underlying feeling that something more could have been done... even if the circumstances are such that nothing really could be done.

Mea Culpa...

The other day was my turn at the theater and I was in "civvies" and not the usual saree. I rather liked my blouse, a sort of wrap thingie, mostly in white lace that looked very soft and feminine. The ward round went smoothly but Dr. P, the registrar, seemed somewhat distracted. Several times he asked "what was that again?" which was most uncharacteristic.

After the round, I was at the nurses station filling up some forms when Nurse W (possibly my favourite of them all) came running at me brandishing a large pin as if it were the Sword of Omens. "Look at you child!" she hissed, "Even I am embarrassed... that poor man, who knows what he will cut off when he gets to the theater!!"

I glanced down to realise with shock that the outer flap of my blouse had got ...um... displaced... and that I had done the ward round with the right side of my bosom, (bright purple inner-wear and all) sticking out like a traffic light!

BLUSH

Oh dear... I guess wardrobe malfunctions happen even to the best of us!

5 weeks down

... and 47 to go.

I really don't like this intern business... and apologise to all my readers because this blog is turning into a long drawn out "I don't like my job" whine. Sigh...

A patient almost died on me the other day. The night on-call was seemingly uneventful, I had high hopes of finishing a little early and catching a bit of the Olympics on TV back at the flat. I was almost at the last bed when one of the nurses cam running "Doctor, bed 13 patient A is bad".

Now A was admitted to the last casualty with non specific abdominal pains and had been doing fine so far. The problem was that he was foreign, understood no English or Sinhala and had a "smattering" of Tamil. History was taken using one or two words, lots of arm and leg movements and he was treated on the findings of the physical examination and blood tests. He was a round, jolly looking fellow, eager to tell his story and apparently unfazed that none of us could understand a word he was saying. When I had examined him 30 minutes ago, his tummy was soft but his lungs were a little noisy. Discussed with my senior, who also examined his lungs and we decided to add an antibiotic. What could possibly go wrong in 20 minutes?

I reach the bed to see patient A wheezing, with his chest heaving in the most laboured respirations I had ever seen. Sweat was pouring down his body in streams, his eyes were blood shot and his whole body shaking as he desperately fought to get air into his system. The nurses had got out the nebulizer and the oxygen and we gave him a shot of steroids while I felt for a pulse. Damn... no pulse to be felt on either arm... blood pressure could not be recorded and frantic groping at his neck revealed only a faint carotid pulse. Phew, I thought... this means he at least has a BP of 60. Lungs where full of rales and wheezes.... and his tongue was blue with cyanosis.

A million things were running through my mind... acute severe asthma, ok, we were doing everything required, 20 minutes now, why wasn't he improving? And in the background of the cold clinical reasonings, the desperate voice of a panicked child, please please please, don't let anything bad happen, please don't die.

To make things worse, we don't have a cardiac monitor in our ward. The pulse oxymeter (which is usually held together with a piece of plaster) refused to work. I ran to the next ward to borrow theirs... and before I talked my way through the red tape, an attendant called out that a few good thumps had cause our machine to start working. The readings positively chilled me. Pulse was 210/minute and oxygen saturation was 88%. One look at that and I ran to phone the medical Registrar on call... the patient was dying in front of me and the condition wasn't something I could handle on my own. Dr. N answered the page... and listened patiently as I almost wailed down the line at him. Added one more drug as advised, but the message was "keep doing what you are doing, I will be there soon". My own racing heart slowed down a notch.

Dr. N turned up soon, by then 40 minutes since the attack had started. Patient A was still distressed, still gasping, but his saturation was up to 95% and his heart rate had slowed somewhat. We stood in front of the bed, debating whether to give mag-sulphate or not. This wasn't too safe given the absence of a proper cardiac monitor... but the other options hadn't made much of a difference. Then slowly, slowly, the saturation rose to 100%, his breathing slowed down and A started looking more himself. One hour and 15 minutes after the onset, he was back to his jovial, voluble (but totally unintelligible) self.

Dr. N wrote out what to do next and left instructions that if an attack occurs again, to rush the patient over to the medical casualty ward. Once he left, I went to the lecture room, locked the door and had a mini breakdown. After the dry retching had finished and my shaking hands had settled a bit, I washed my face and went to complete the rest of the ward round.

I didn't sleep that night. My mind was churning, trying to find out possible causes and I kept looking at my phone every 10 minutes just in case I had gone suddenly deaf and missed a call from the ward. I think I fell into an uneasy doze around 3 in the morning.

The next day the nurse told me that the attack had come soon after she had given the antibiotic. I went next to patient A (who was, thank goodness, looking hale and hearty) and after waving my hands about and yelling "penicillin ooshi" at him several times he started nodding and said that penicillin was "bad" for him.

OMG!!! The drug we gave him wasn't penicillin (only distantly related) but it easily could have been. If it had been penicillin, he would probably have died within minutes in spite of our best efforts. What I had dealt with was anaphylaxis, a retrospective diagnosis that gave absolutely no comfort. I should have given adrenaline but I didn't know his allergic history and for all intents and purposes what he had seemed like acute severe asthma. All that would have been inexcusable, to my own conscience if not anyone else, had the worst happened.

All in all, I'm really really happy that I'm not on-call this weekend. I think I need a little break.

Update

Greetings, gentle readers, after more than a month of silence, and sparse blogging before that. Not much time today, either - but just enough for a quick update. :) The past four weeks were hectic... many things going on... some nice, some nasty.

1. My blog turned one year old last April. And I didn't even notice, till early July and couldn't blog about it till now. Happy Birthday Angel - my alter ego, my stress buster, and the only means I have of actually putting my thoughts down.
   
   
2. Darling and I got a place of our own - sort of. We've officially moved from the nest, taking clothes, furniture and the 3 rice cookers we got (each a different size, as you never know when or how many guests you'll have to dinner). To be honest, it's not that much of a change, except that now I have to think up of innovative dinner ideas. So far we've been alternating between noodles and pasta. And bread, when I don't feel like boiling the said noodles / pasta. promises to darling of Darwin like cooking have not been fullfilled, yet!
   
   
3. I started the dreaded internship... eeek! Day after day I question why the heck I'm in this field of work. I'm in the ward by 6.30am, sometimes don't get home till past 10pm. I feel constantly sleep deprived. My feet developed blisters, which cracked and bled, in spite of me wearing what I thought were my most comfortable shoes.
   
   It's not that the work's not enjoyable... it is. But it's different from a clinical problem in a textbook that can be leisurely analyzed and solved. We work with living, breathing human beings, in a dynamic state of flux, who develop different, unique and occasionally mind boggling problems every day. It's also coupled with the horrible feeling knowing that you're responsible for someone else's life. Being responsible for one's own is bad enough. To be honest, it's not really a happy job. the "oh but you're making people better" argument is inherently weak as people who get better will do so anyway (natural history), and the people who don't, suffer unbelievably and then die. :(
   
   I did my first solo casualty last week and got through it safely (with all patients alive and ticking, phew!) It doesn't seem so scary now, but still do feel apprehensive as the next one looms up.
   
   The last 24 hours were like a scene from ER... with about half the staff and none of the fancy equipment. Three (three!!) emergency laparotomies, and rushing a patient to a theatre to be ventilated because there were no ICU beds available. Hours of running around organising blood and plasma and platelets and fancy drugs. The emotionless announcement that there had been a death at one ICU and that we had first booking for that bed. How pathetic. One man's death opens the door to life for another. One family's bereavement is the source of relief to another family.
   
   
4. Theatre. The surgical type. At least 10 days of the 28 spent in icy cold, sterile surroundings, wearing draughty green scrubs, face hidden behind a mask that smells a little weird. The stench of the diathermy device as it cuts through tissue and fat. This is why I don't like BBQs... the smell reminds me of burning human flesh. Yech!
   
   
5. Bad news. Something I hate to deliver. Over the last 4 weeks I had to tell 5 families that the situation of their loved one was serious and that while we were doing our best, chances are slim. I watched their eyes tear up, watched grown men cry and rant and rave. I had a lady 15 years older than me kneel at my feet and beg me to somehow save her father. I felt like yelling "there's nothing I can do... I'm only a house officer, the most ignorant and incompetent of the team... even the seniors have done all they can, I cannot do anything more, I am not God!". I felt like kneeling on the floor next to her with my my arms around her shaking shoulders and reassuring her, however untrue and hollow those reassurances would be. I didn't do either. Just followed the protocol we had been trained to follow : asked her kindly, yet clinically, to calm down, wash her face and not to let the patient see her distress.
   
   I wrote out a death certificate for the first time that week. Not a nice experience.
   
   
6. Off day. Much anticipated opportunity to put feet up and consider something other than bread and an omlette for dinner. Darling convinced me that Kung Fu Panda was worth the effort of dragging self out of bed. Totally loved the movie... cuteness re-defined! Cheese kottu from Pilawoo's and early to bed. Bliss!
   

I guess I can't complain that my life is uneventful... stay tuned for more rants... and take care, all!

Kiddies!

I'm not very good with kids. Sometimes I don't like them much either. But these two munchkins are too adorable for words!! In addition, we get along surprisingly well... :)

Culture shock of sorts...

Okie... me I'm a simple girl. Mildly goday if you like (though not in the league of the estimable DDA.) For the last few years my time was spent mostly ambling around the National Hospital, the rest of the time in bed saying "amme, how my feet are aching!"

Ok, there were good times too. I had a great gang of girlfriends to gossip, go shopping and do the "girl-stuff" with. My boyfriend turned up regularly to sweeten my life with cream buns and by taking me "out". We'd go check out the clubbing scene occasionally - even though the last time we did that we ended up in a brothel. (Long story). Money was always in short supply - text books, equipment and stationary are quite pricy, shoes get worn out fast, clothes get gunk on them and need replacement and there were unforseen expenses like having to replace the earpieces on the stethoscope because a kid in the ward had eaten them.

So my point is, whenever there was a wedding or a party or a big do, I'd just wash my hair, slap on a bit of powder, drape a saree around myself and rush off. Getting dressed and primped and all pweety at a saloon was an alien experience until my wedding day. And it was a wonderful experience... I had so many people fussing over me and even my fingers were made-up!

So the season has dawned again, and there's a big family wedding next week. Having splurged on a fancy saree and a stylish jacket, me wanted to go the whole nine yards, so called a nearby saloon (a moderately famous one) for an appointment - hair, saree and makeup.

"That will be Rs. 2500/-, Madam" twitters the young lady, as if it were pocket change. I try very hard to swallow and inquire in a nonchalant manner "how much for a hairstyle ony?" "Rs. 850/-, Madam."

Holy macaroni.

How much does a Doctor charge for a consultation? A consultant? Rs. 350/-? Rs. 450/-? This is with 6 hellish and un-fun years as an undergrad, gruelling training in the wards for PG, exams and more exams arguably described as the hardest in the world. Painstaking setting up of a practice and essentially working 2 jobs.

Damn, I'm in the wrong profession! In a 15 minute appointment, with absolutely no responsibility whatsoever for my client's life and well being, with no exhaustive thought process or analysis of symptoms, with merely an aesthetic appraisal of the shape of the face, type of hair etc., I could have earned double the money doctors 15 frikkin' years senior to me are earning.

I'd have time to take care of myself, get regular pedicures and possibly have a more fun and interesting life. I'd be around carefree people instead of stressed co-house officers and patients. I'd not get calls in the middle of the night that so-and-so was seriously ill, or requests to go see someone's, someone's, someone in hospital. I'd have time for my loved ones... and for myself

Anyway... I thanked the saloon lady politely and put down the receiver. I think I'll just wash my hair, slap on a bit of powder, drape a saree around myself and rush off.

:)

Tag time, again!

Tagged again, this time by Chaarmax, Pink Mist, Samanalee and Charmed... feeling a deep and comforting sense of belonging in blogosphere (mad grin!). Will not be posting any rules or tagging at the end, because everyone else I know seems to be tagged already!

Okie, here they are.

1. Needles terrify me. Whether I'm on the giving end or the recieving end. Not good, when it comes to my line of work.

2. I love kiddie parties. The stuffed eggs and cheese bouchees, the rainbow sandwiches, baby cutlets and homemade birthday cake. Ok, ok, I just like the food, the kiddies are optional.

3. I used to (and still can) bite my toenails too! And so can my best friend. What is this, a national past time?

4. I'm mostly deaf in my right ear. This makes conversations difficult when the other person is to my right. It also provides an interesting answer when senior doctors bellow "are you deaf???"

5. The first day of my honeymoon was spent shopping... Odel, Romafour, Wildflower etc.

6. I won't say I'm an animal lover but I can't stand to see animals die. This includes fishing ants out of teacups, blowing at mosquitoes (and stopping others from slapping them) and rescuing spiders from the toilet.

7. I read books that I love over and over again, the Anne series, Bridget Jones, books by Terry Prattchet and James Herriot, Pride and Predjudice and Pollyanna. I can quote entire paragraphs at a stretch.

Well... that's it. Not terribly interesting, but hey, it's me!

Monthus Horribillius...

...or is it mensus horribillius? Pardon my Latin.

Anyway, that's what the coming month is promising to be. Hot on the heels of the car crash, my poor father falls ill and needs to be hospitalised. Severe respiratory infection with a suspicion of low cortisol response. Icy cold peripheries, dehydration, fever at 104F and low BP. Dispropotionately low pulse (low 60's). All this had Mums and I scratching our heads and trotting back and forth between the ward and the lab. Happily, the drugs worked and he's back at home and on the mend. Phew!

Yesterday was another scare as around 7.15 am Brother's girlfriend calls to say there's been a bomb in the train she was travelling in! She was thankfully unhurt but quite naturally shocked... and was now walking along Galle road, avoiding crowds and she felt jumpy whenever there were more than a few people around her. A few hours after dropping her home, I read Dinidu's post on the subject... and got to thinking of how many people were nervous about loved ones... real panic beats on the edge of your mind while another part of you keeps chanting "okay, it's going to be okay..." over and over again like same manthra.

And now, the Ministry of Health announces that Internship will be starting on the 1st of July. Now, this means we get an overlap and save 3 1/2 months of waiting but aaaaarrrrgh! I've gotten used to this cushy lifestyle and I don't wanna go! Clinical oriented though I am, the thought of doing casualties, clinics, ward rounds and on calls bloody sux! :(

I need comfort food.

Crash!

Oh dear!

Darling was involved in a car crash last wednesday... with one of those famous white vans that was speeding in order to get a couple of foreigners to the airport. Thank goodness no one was hurt... all Darling has is a bit of neck and shoulder stiffness and a bump on his side. (Phew!) And thankfully, a motorcyclist narrowly avoided being squished by the two skidding vehicles.

I shudder at the thought of what could have happened.

Brother was called out, and Mums went with him... I stayed at home getting jitterier with each passing minute. It was past 2am when they towed the car home - pretty much wrecked on the right side. Bonnet dented, doors crumpled, radiator broken, tires busted, front and rear lamps smashed... :S And we only bought it a few months ago...

So now the car is in the garage and the saga of haggling with the insurance company continues.

Darling has come out of the whole thing rather like a Highland yoghurt - shaken, but not stirred.

Marriage has taught me...

Well, it has been six months yesterday since Darling and I tied the proverbial knot and stepped into the murky and shark infested waters of married life. Continuing in the same vein, Daling has been the proverbial tower of strength during the panic attacks, tantrums moods and moments with which I responded to the minor crises we faced.

During this period, I have gathered many pebbles of wisdom. Many more are scattered around the boggy shores. Some may make those who are further down this beaten path shake their heads in nostalgia / frustration. They may serve as a heads up for those who wish to step in, and serve as more fodder for thought for those who are patently anti-matrimony. Here goes.

(Ahem) Marriage has taught me...

... that being cuddled to sleep is a luxurious experience, subconciously missed since childhood

... that the limbs of a sleeping male are incredibly heavy. A carelessly flung out arm could easily lead to suffocation

... that there is absolutely no underlying satisfaction in washing your husbands dirty socks

... that no matter when or where you decide to be intimate, it is always a good idea to double check if the door is locked

... that time for self is low priority and dwindles down close to zero

... that it is possible to develop an allergy to gold only on the 4th finger of your left hand

... that the once abbhored period can become a welcome beacon of successful family planing

... that you cannot eat so much as an extra cutlet without the aunty brigade wondering aloud if you're pregnant

...and the list goes on. Stay tuned for more!

Tagged!

Wow...I've been tagged! For the first time ever!! By both Chaar and Santhoshi!! I feel absurdly pleased about this! Okie..., in no particular order, here are 10 random things that make me happy...

• Food!! Potato salad, strawberry milkshakes and licking half melted toblerone.
  
• When Darling gives me a foot rub.... sigh.... sheer bliss!
  
• My parents, especially have fun when we sit together at meals and just talk...
  
• Being cuddled, can't get enough of that...
  
• Photographing weddings. I must be having over 4000 photos of various people getting married.
  
• Teaching... maybe the kick comes from telling people what to do! (grin!)
  
• Talking to Brother, few people get to know of his wit and sense of humour.
  
• Drawing. Haven't drawn a picture in years. What happened?
  
• Bubble baths. Lotsa bubbles!
  
• Movies with happy endings! :)
  

Well... that actually took a surprisingly long time. Now if it were ten bad things, I would have had much to say about Thai journal editors who give impossible deadlines.

Hmmm... who to tag?

Nisadas and Agni... you're it!

Hmmmm....

So I'm back...

After weeks...

After being crazy busy at work, and feeling quite exploited about it...

After ignoring good buddies, missing birthdays and feeling like a crappy friend... (still feel bad :( actually)

After forgetting the password that gives me access to this particular typepad...

After running around as if my tail was on fire, looking for the little bit of paper with the password written on it...


Watch out world!

- - - But don't hold your breath!! :)

Oh gosh!

(Warning : medical gobbledygook ahead)


I recently met a senior colleague of mine who is attached to the ETU (Emergency Treatment Unit, a.k.a. A&E) of a big hospital in Colombo. Little beads of sweat dotted my forehead as I listened to his experiences there. The trauma scenarios he described were horrifying, even though I have had a decent training at NHSL.

A few weeks ago, a youngish guy had been admitted following a road traffic accident (RTA)... a nasty collision with a train during the wee hours of the morning. While the rest of the body was ok, he had severe injuries to the head, including facial fractures that were a combination of Le Fort II and III. In other words, his facial bones were in 4 fragments... (shudder).

My friend and his team had been trying disparately to intubate the patient, as that was the only way to secure the airway and ensure he didn't aspirate from the torrential bleeding. Every time they tried to insert the ET tube, part of the face would move forward or backwards or sideways....making the task next to impossible.

That's when they decided on a radical approach, one I had never heard of before. They created an emergency tracheostomy and inserted the guide-wire of a CVP line upwards through the larynx and out of the mouth and then guided the ET tube down the wire!! I was open mouthed with admiration at whoever came up with this maneuver. Thanks to their quick action, they were able to get the patient stabilized on a ventilator.

I'm not sure what happened to the poor guy, but I hope he survived.

My applause goes to all innovative doctors out there.... for their clear headedness in the face of the seemingly impossible - a trait that saves lives.

Bus rides and perverts

Ok, I admit that public transport is not something I brave very often these days. Mind you, when I was in school and during the first uni. years I used to travel all over Colombo by bus. Then chronic laziness set in.

Anyway, last week, there I was, sitting on the aisle seat of a 176, minding my own business and mentally preparing exactly what I was going to say to Mr. R at the meeting. The guy next to me - a gaunt, middle aged fellow - kept shifting around with the parcel on his lap, and what do you know... less than two minutes into the ride, the guy is fumbling around my leg. Just below the femoral triangle.

Eeuw...

I scowled at him and moved myself away. Wondered whether to start yelling but felt doubtful. Maybe it was an accident and he was just fumbling with his parcel... Hmmmp... Anyway, he didn't try any more monkey business and I kept quiet as my halt was quite close.

What are the odds of something like that happening on the way back? Pretty high as it turned out. This time it was the guy standing near my seat, ignoring the practically empty bus area in front of him and oblivious to the conductor yelling "issarahata yanna, issarahata yanna" into his ear. Perv #2 was having fun rubbing his crotch against my shoulder... and getting harder by the minute!

YUCK...!

I scowled up at him... stale breath courtesy of a poor quality distillary wafted all over me. After trying unsuccessfuly to move away (the guy kept moving with me) I finally elbowed him out of the way, got up and moved to the front of the bus.

The fact that Sri Lankan public transport reeks with maggots like these does not surprise me. What surprised me was my reaction - or rather, my lack of any. I was shocked, disgusted and felt dirty and violated. I like to think of myself as a strong person. When faced with such a situation, I had always expected myself to be very vocal, yell and make a big scene etc. Instead I just felt bad about myself. Not blaming myself but just generally icky.

Couldn't wait to go home and shower!

Chuti Junior?

Last Sunday, Brother reported a strange creature in his sock drawer. I went to investigate and found what looked like an oversized hoona (gecko) lying amidst the shredded remnants of half a dozen socks and what was once a rather dashing blue tie.

Yup, you guessed it. One tiny baby squirrel (even smaller than Chuti when I found him) that probably got the shock of his short life when faced with my searching fingers. I just sat down and groaned "not again...". The thought of going through that saga once more, only to have another innocent die in my hands was not a bright one.

Since neither of us actually touched it, and therefore hopefully not transferred our scent, we kept the doors, windows and the cupboard open hoping that mummy-squirrel would show up. The little fellow kept squeaking hungrily the whole day and it was all I could do to harden my heart and not give a few drops of milk. Happily around 4.00 pm darling noticed what looked like a streak of brown furry lightning scampering up the stairs, which reappeared shortly afterwards as the mum, grasping the baby by the scruff of his neck. Much relieved, we promptly closed all portals... and cleaned out the sock drawer. :)

Only one question remains... why reproducing rodents find Brother's room so attractive...

Chuti.... my first pet... and only

I guess many of you know about the life and death of this cute little critter. I still can't help feeling guilty that he died... even though numerous people have told me that baby squirrels are notoriously difficult to raise. Darling points out that if I hadn't adopted him, no one would have even known it existed until Brother started wondering why his room was more odiferous than usual.

I always used gloves to handle him... forgive me, oh, ye animal lovers. I am merely an animal liker and anyway, my precautions were justified when the little blighter pee-ed on my hand. He was the most adorable creature and always running around after me, squeaking his opinion on the little obstacle courses I'd place for him on the floor so that he could learn to climb. Field visits to the garden meant scaling mango trees and he had just about learnt to jump from one branch to another the weekend before he fell ill.

He'd keep me company when I'd have trouble staying awake, waiting for Darling to come home. When his box was open, he'd stand on hind legs and poke his head out to inspect all four sides before deciding to come out. When he'd spot me, he'd be on his hind legs again, fore-paws held out, begging to be taken into my hands. Maybe this is a common thing to people who have had pets... but it seemed wonderfully loving to me.

Funnily enough, he never accepted anything but milk. I tried banana mush, but it was disdainfully rejected. Ditto for bread and cream crackers. When the bread was soaked in milk, he just sucked up the milk and squeaked hungrily for more. Whenever I'd murmur "Chuti-Chuti" he'd always wake up and scramble around his box, eagerly anticipating the feed...never drinking more than 3/4 tblsp... maybe that was all his little belly could hold.



Even when he was sick, he managed to hold up his head and look interested when the milk came. Sigh... and he choked on it... died with milk flooding his lungs. I guess I just pushed the plunger of the feeding tube too fast. :(

I really have to thank Aunty Chandrani who looked after him when I was at work, setting the alarm so that she could feed him on time... even during the busy hours in the lab. Also Dr. Tharanga and Dr. Mangala who looked at him and recommended treatment, Pets V Care for advising me over the phone (one the day I found him) on how to feed baby squirrels, and for treating him when he fell ill and Dr. Kodikara (2-853087) for trying so hard to save him that last day. (Yup, Chuti was shown to 4 vets... I was so worried). Im really grateful to Al Juhara for having the numbers of the vet surgeons on her blog... that helped me when I was desparate.

I guess this is a final farewell to Chuti. He's buried under a tree near our front gate. I wanted to do something like give away some packets of rice 7 days later... but things didn't workout. I know people will call me silly, but I do transfer merit to him when possible. Afterall, it's because of the lack of it that he was born an animal and died young and in pain.

Thnaks all, for your comforting comments and apologies for the long and tragedy queen type posts of late.

The lowest ebb

I know a young lady, K, who works as a secretary in a government institution. She's charming and intelligent and never failed to help me on the occasions I toddled over to her office to get something done.

Her cheerful manner masked many problems at home. The rising cost of living was taking its toll on her family, just like millions of others in the country. The biggest problem, however, was the inability to conceive, even after 5 years of marriage. They had gone down the usual paths, timing the cycle, ovarian stimulation, IVF. The tension was driving a wedge between K and her husband. Then, when they had almost given up hope, the pregnancy test came up positive. Her quiet glow of happiness was beautiful to behold. Parents, in-laws and relatives fussed over her, her husband became the doting lover of years gone by and life was good.

A couple of months later, her husband P wasn't feeling well. Their little world came crashing down around them... at barely 40 years, he was diagnosed with rectal cancer. The malignancy had already invaded the surrounding tissues and his liver was dotted with secondary deposits. Surgery was performed as soon as possible, leaving P with a permanent colostomy. K held him close and comforted him through all the pain and distress of surgery, chemo and radiotherapy.

A few weeks went by and suddenly K felt a sharp pain deep inside her. To her horror, her water bag broke shortly afterwards and life blood started to drain out from their precious baby. She was rushed to hospital and with the medication, rest and perhaps the prayers of her loved ones, the miscarriage was averted.

Since then she has been lying on a bed in a gynae ward... doctors had warned against any unnecessary activity or mental stress. Just relax and take it easy, they told her. Her friends and relatives visited daily. Little gifts were always near her bedside. Bottles of Horlicks. A fluffy new towel. A pink bed-jacket trimmed with dainty ribbons. Her mother kept a watchful eye on her, seeing to her every need.

Aunty (K's mum) wasn't too well herself. Poorly controlled diabetes topped the list. Maybe she didn't have the time or energy to care for herself. Maybe it was the stress. Maybe it was just meant to be. Aunty woke up one day and found that she could only mumble. She could barely lift herself off the bed and her limbs on one side felt useless... she had suffered a stroke. Another admission, this time to the stroke unit.

P was meanwhile in and out of hospitals. Maharagama, NHSL and back. He was stick thin and getting weaker by the day. He worried about his unborn child, about K, her mum and their deteriorating finances. Worsening bouts of pain would rack his body, seemingly unaffected by morphine. When I saw him 2 days ago he was lying crumpled on a bed, his entire body twitching due to low serum calcium (tetany). He stared dimly at me with sunken eyes. I spoke his name, but not an eyelid flickered in response.

P died early this morning.

K, devastated by grief insisted on going home. I cannot even begin to imagine the pain and sadness she is experiencing. I continue to pray for her unborn child. I dread meeting her at the funeral tomorrow... my own inadequacy to comfort a sorrowing fellow human being shames me.

Bad things all too often happen to good people.

Why?

Terrible weeks... one truly terrible month

Hello world...

Apologies for the long silence over here at Angel's pad. As the title hints (ahem) the past few weeks have been one big suckfest. And I can't even blog about most of the things that happened. Sigh. I warn my gentle readers... this is NOT going to be a very happy post...

At least today I came home at a decent hour after submitting the newsletter (1 week late - what's the point of a March newsletter that comes out in mid-April?) but thankfully didn't have to take any more flak than was my due. Tomorrow may be another story as I'm having a lecture in the morning (eeek, have prepared nothing!) and then MedEx duty... with an estimated crowd of close to 20,000! Feet, please forgive me... pedicure and foot massage, soon... I promise!

Last week is hazy... what happened? I remember being yelled at. Oh yeah, I've f**ked up big time and lost a load of invoices from our last workshop. Worth about 15,000/- .... which I will probably have to fork out of my own (meagre) pocket. Last week was spent running around like my tail was on fire going damn! damn!! damn!!! while I went through every single bloody file in the office... TWICE!!! The annoying thing is that I remember thinking, "Girl, if you lose this, you're in deep shit" after I had pasted, labled and stamped the invoices with the Director's seal. So anyway, I gathered up my courage and told the big guy... and his response was more or less, Angel, it's your baby... deal with it" Sigh... If I find the congenitally syphylitic cretin who stole my file I swear I'll chop him up into little pieces and feed him to the snakes in the herpetarium.

The week before that was slightly better with only the SLMA sessions on the calendar. Of course these HAD to be scheduled for the 20th, 21st and 22nd... the LONG WEEKEND! AAArrrrrghh! For once, Darling was off-work on a public holiday but I had to be stuck at frickkin' sessions. In saree. Dealing with irate (and scary) judges, annoyed participants and a hotel management that charged the earth for a couple of photocopies. The food sucked too... and since I repeatedly lost the tiny little chitty with "tea" and an ugly picture of a teacup on it, I had to go without the said tea several times, in spite of the large red tag saying "staff" that was around my neck like a noose.

The worst part was that I missed almost all the sessions I wanted to attend, including the ones on Parkinson's disease, Wilson disease and a symposium on patient safety. This was because some judging session or the other was ongoing and the powers that be wanted the marks entered, tables added up and classified immediately! Unlike Darwin I find powerpoints on topics with long names quite interesting... and these were some top notch international researchers and clinicians. Sigh...

The week before that, my pet died. My first and only pet, unless you count the 2 goldfish I briefly owned when I was 8. Chuti was an abandoned baby squirrel that I rescued and fed on milk for 6 weeks. The fellow was on the cold hard tiles of Brother's room and was found by self while sweeping... and immediately tipped into a shoebox when discovered to be alive. I didn't realise how attached I was to him... feeding him with carefully prepared milk, first thing in the morning... every two hours... last thing at night. He'd run around the box, squeaking with joy when I brought the milk and would follow me in little leaps and bounds around the room or in the garden. The horrible thing is that I think I killed him. He was off his food for a couple of days so I used the feeding tube given by the vet to alternatively give him saline, dextrose and milk. I think the milk went in too fast, because he asphyxiated... he gasped for breath on my palm while we rushed him to the vet and then writhed in terrible pain and died. I've watched people gasp like that... I've seen babies with birth asphyxia... but at least then I could do something other than watch helplessly while waves of guilt crashed over me. Chuti deserves a post of his own... so now you know what the next one will be.

The same week was the quality asurance programme in our faculty. This is a process that takes place once a year in every medical faculty in SL to ensure the curriculum is upto par. Reviewers from the UGC and other faculties spend about a week going through papers and books and files and getting all worked up if something was missing. I was somehow convinced to be a "coordinator" and I had to take an incredible amount of flak for things I wasn't responsible for. I had to dive into mountains of never-before-seen files and come up with specific documents, I had to call up departments for lists of this and that, I'd get defensive when things were criticized, then criticized for getting defensive. There were others who ran around with me... but I for my sins, was the one to get yelled at. Honestly, those reviewers were really rude sometimes, though honey-sweet when the senior staff were around. I have to totally thank my workmate M for covering for me when I had to go off taking Chuti to the vet. But they somehow found about him and made fun of that too... the sickos.

This is just a taste of what the past few days/weeks have been like. The days were occasionally punctuated by visits to blogosphere. I find Half-Doc, my articulate colleague has been compelled to delete his blog for merely stating his thoughts about a drunken party. E-mail has piled up since the connection is mind numbingly slow at office. I suspect it's because some nerds at the CAL lab are downloading flicks.

Anyway I feel too drained to type anymore. Adios, amigos. To Dinesh, Justin, Azrael, Priyanga and the many others who expressed help and support to Samitha, I profusely apologise for the delay in communication and will be in touch as soon as possible.

An update : Samitha Samanmali

Samitha is now in a ward at the accident service of the NHSL. She lies on the bed, her lower body motionless, and gazes out of the window. Blue skies with fluffy clouds. Mara trees bedecked with red and yellow flowers. Crows wheeling across her field of vision.

Friends hover around her, trying to anticipate and meet every need. Major trauma, major surgery and major change of life... in the face of these, Samitha remains cheerful. Tutes are brought to her bedside and she courageously turns pages and refers notes, determined not to fall behind.

What now? The next step is a wheelchair. At present, Samitha can only be "propped up" i.e. kept semi recumbent with the aid of pillows. The injury is at the 5th thoracic spinal level, which means she has poor control over the muscles of her trunk (these are antigravity muscles that help us keep upright). Obviously, a generic wheelchair, purchased from Union Chemists for instance, will be useless. She needs a special, custom-made wheelchair that will help support her comfortably. An electric wheelchair will be ideal as she will then have a degree of independence. Overseas rehabilitation is needed next. There are a couple of wonderful units in Singapore and the UK that offer facilities far far beyond what is available in SL.

Many thanks to all who contributed and continue to contribute to her rehabilitation fund. As yet, only a fraction of the funds needed have been raised, but I feel fairly confident that we may be able to collect the required sum. Things are yet to be streamlined. Arrangements are being made to get her cause registered as a charity. Not only will that give an added incentive for the corporate sector to donate (tax relief!) it will also allow the funds to be handled in the best possible way.

Many friends and well wishers from abroad have contacted us. They're not financial giants... many are students who work part time to pay for their own university education. yet they all want to donate something and this is where we hit a snag. What's the best way. Wire transfer is horribly expensive and not practical for small sums. Cheques run the risk of processing problems when issued by a bank overseas. Someone suggested a demand draft from the bank, but I wonder if this requires a minimum sum. Another friend suggested a paypal account.

Dinesh has kindly offered to develop a website for her cause. Untill he mentioned it, I hadn't realised that there was no official information available online. Maybe the paypal account can be linked to this website. Does anyone know how that works?

Once more, thanks to all for your good wishes and contributions. Will continue with the updates.

Please help...

The mood is gloomy around campus these days. Samitha, a third year medical student was injured about ten days ago as she accompanied her batch on a site visit to the BMICH. This was in order to scope out the place for the up-coming (and now postponed) medical exhibition. The Deyata Kirula stalls were still there and a sudden downpour forced them to seek shelter under the sheds.

Horrifyingly, one of the sheds collapsed on a group of students... two managed to make it out... two, including Samitha were trapped beneath the rubble. The other student escaped with minor injuries, Samitha however was not so lucky. Another student described how a metal support pole hit her head, and as she fell, how another pole landed on her back... She sustained severe injuries, skull fractures, bleeding in her chest cavity (haemothorax) and tragically, a spinal cord injury at midchest level. X-rays and MRI scans showed shattered spinal vertebrae... a grim sign of what spinal surgery would later reveal.

Samitha underwent a 20 hour surgery last Tuesday, to stabilise the spinal column. Apparently, the surgeons had discovered that the spinal cord wasn't completely cut, as feared... but was however severely crushed. The implications? Well... the worst is that there is very little chance that Samitha will regain the ability to walk.

Right now, she's in the NSICU, battling the stress effects of her injury as well as the surgery. Batchmates and other friends are keeping vigil at the accident service, combing the internet, phoning contacts and trying to find out any possible treatment method that may offer some hope. There is talk of stem cell therapy, that maybe they may differentiate into nervecells and bridge the gap. There are other treatments, mostly experimental that slow the rate of fibrous tissue formation, leaving room for whatever nerves that have survived to recover.

None of these are available in Sri Lanka. Few have shown scientifically sound, proven results... but any glimmer of hope is worth striving for. Unless a miracle happens (and believe me, there are hundreds of us in temples and churches holding bodhi pooja and other religeous services, silently offering up prayers to whatever diety we believe in that such a miracle will happen) she will need complete and long term support, physically, psychologically and socially... with proper rehabilitation to help her adjust to the consequences of her injury.

Money is scarce. Her father unfortunately passed away when she was young and her mother too is ill and has just had major surgery. Her sister, a teacher, has been supporting the family. The estimated cost for Samitha's treatment and rehabilitation is between 10 - 15 million rupees. :(

I don't know Samitha very well. I've seen her in campus, talking to friends, clutching books while running to one lecture or the other... full of hopes and dreams. Her friends describe her as being fun loving and hard working. that she faced the many hardships life threw at her with courage and determination. After days of tears, she seems to have found her inner strength again.... as she told a friend, "I am ready to face anything". She smiles up at those who visit her... and lives in hope that she will have a chance to regain at least part of her former independence.

The Sunday Times ran an article about her yesterday. More details can be provided on request. If you, or anyone you know would like to help, please call Aravinda Kamaladasa on 0773-017183 or contribute to the student rehabilitation fund started by the faculty.

Thank you.