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Thursday, April 6, 2017

Losing an Ear-Tip

"Which is the most important part of a stethoscope?" asked the Professor.
"The diaphragm", "the tube", "the earplugs", came answers from students.
"No. The most important part of a stethoscope is the one between the two earpieces", said the Professor with a smile. 1

It was a regular "free" day in Orthopaedics. That means you get to eat either breakfast or lunch. I ran to ward at 8:15, after gulping down a cup of milk shook with the chocolate malt powder that my grandmother lovingly packed for me the last time I went home.

None of the patients had absconded the night before. Which meant all of the five 70+ year olds with femur fracture where sleeping comfortably on their bed. Only those patients whose perpetual complaint of pain were awake. Even tramadol would not help them. The nurse had just arrived. And I started putting notes, as usual.

All the patients looked alright. So, there was no need to check their pulse. I checked the blood pressure of a couple of the patients who had surgery just a few days back and entered in the respective notes. Rest of the notes would remain the same as the day before. On one side, all the organ systems would be marked normal and the limb would be marked as having active distal movements. On the other side, the advise for the day. Two antibiotics compulsorily bought from outside even if the hospital supplies the same combination. One painkiller. Paracetamol infusion SOS. And a little something to stop these drugs from punching holes in the bellies of these grandfathers.

Before I finish putting notes for half the patients the post-graduate students would reach and start dressing. Depending on the mood of the nurse she might join in helping them dress the wounds or stay aloof lost in their own tasks. If a student nurse is found standing still for a second, they're invariably pulled into the business of taking out "sterile" cotton using a "sterile" forceps and placing them on the "sterile" gloves of the doctor who carefully places them on the wound that has just been cleaned of all the dirty pus and other gross stuff that accumulate in wounds.

I sometimes do seriously wonder whether it is the over-priced antibiotics and the over-done sterile dressing that help the patient or the innate immunity of the patient themselves.

Anyhow, post dressing, there was rounds. Where each patient is seen and discussed briefly. If you are ever admitted as a patient, remember that rounds is the most important time of your hospital stay and treatment. Almost the entirety of the planning of your management happens during this brief encounter between the doctors and the patient. If there's something that bothers you, you better keep repeating it to yourself to blurt it out during the rounds.

During rounds some orders would be made. Ha, get another X-ray done on this knee. Get the side view. Get the distal joint. Easy enough. The patient can't walk. Sometimes, they can't even sit. So you would need a trolley. But they aren't motorized yet. So you need a worker to push. And that's the most difficult part. You have either one or two workers at your disposal. And they have to do all the work in the ward beginning from cleaning and not ending at making sure everyone's shaved and prepared for surgery. It's largely unknown how they set their priorities. They might help your patient get an x-ray. But that might not happen before noon. Maybe they can be bribed into getting it quickly. But should you pay or should the patient? There are no clear answers. The best way forward would be to tell them and remind them and ask someone else to remind them and then come back and confirm they've indeed done what you've pleaded them to. And that's what I did.

It was past lunch-time when I finished ward work. So I went to Ruchi mess for lunch. That's the one our ortho post graduate likes. Food is really important in orthopaedics. If you don't eat some chicken bones, you can't fix broken bones. After food, I went back to hostel. Because there was no point going back to hospital in the afternoon anyhow. It is not like any work will get done because you are there. So you might as well go back to hostel and enjoy the rare few free hours you find.

Going to hospital during dusk is comfortable. You don't have to wear shoes. So you don't have to wear the socks that haven't been washed in weeks. You can wear jeans if you like. If you think you'll need it, take a stethoscope. And that's the biggest mistake I did that day.

I took my stethoscope. And I put it in my trouser pocket. And I rode my cycle to the hospital. I was pretty sure the stethoscope was fine when I left. But when I reached, and put the stethoscope around my neck, it was missing an ear-tip. Yeah, the black round cushions at the tip of the steth that makes them wearable. I imagine these preventing a hole from forming on my tympanic membrane when I wear a stethoscope.

So I lost an ear-tip. And there's no wearing a steth without the ear-tip. Without a steth, you can't measure BP. (Not really. That's a myth intentionally spread to make interns feel good about having to measure BP. I am the only one with the steth. Only I can measure BP. I am doing valuable work.)

I knew it was going to be a sad day. Because misfortunes do not come singly. This would be the beginning of a series. I was pretty sure there were more things waiting for me in the hospital.

The hospital was calm. As usual. There were not many people in the ward. At least, none of the patients had a family of 20 around the bed. THat's a good sign. Because if there's a family, there'll always be a family guy among them. And he will definitely have a couple of questions about "is my relative going to get better?", "why is the pain not going down at all?". These are questions that do have answers. But I wouldn't want to give those answers. I would just want my work done.

Turns out the x-rays were all done. I don't know who paid whom. And almost everyone was "fit for surgery with low risk" from medical side. And nobody had any complaint. Nothing was wrong. That means, I can report to my seniors that everything is spot on, and go back to hostel and have a good night's sleep.

If only I hadn't lost the ear-tip. Because I might not have needed the steth today, but I'll definitely need it tomorrow. Maybe I had a couple of spare ear-tips in the box that came with the steth. Hmm, anyhow I didn't have the energy to go to a surgical shop to buy a new set. So the spare set better be in the box. I just cycled back to the hostel.

And on the way, just as I crossed DD Urss road, about 400 metres from the hostel, there was something black on the roadside. I stopped my cycle and took a closer look. It was an ear-tip. My ear-tip. Maybe a few cars went over it. But it's not broken or anything. I just have to clean it with spirit and put it back on, like nothing ever happened. Happy. My stethoscope was happy. I was happy.

 1 This joke probably originated in Trivandrum Medical College because it was my dad who told me this. It's also documented in this article in The Hindu.

Wednesday, April 5, 2017


After graduation, almost everyone I know went away to different so called "coaching centres" for getting into a preferable post graduation seat. I was uncomfortable with the way health education works at colleges and at "coaching centres". So, I went away to Malki hoping to figure out everything.

Daktre was waiting with a vane to fan the fruit flies away. We talked for an entire afternoon and evening (and the next day morning along with my community medicine professor).

Several trains of thought departed at that station. Here are a few.

Who am I?

I am a self-described narcissist. The question though is, is my narcissism clouding my judgement about my abilities and possibilities? Is it making me go in directions that I would not want to if I were to think clearly without the pressure of having to be "me"? The "me" here is also questionable. Stereotypes are bad. If I have an idea of "me" it means that I've stereotyped myself into something. Stereotypes limit what we consider as possible.

Is my "discomfort" with entrance coaching, medical education, etc stemming from my own sense of me being a person who goes against most of the mainstream things? Am I going against most mainstream things because "I go against mainstream things"?

I think the answers to many of these questions are inseparable from the nature of reality.

Do not mistake the horse for the cart

But we don't need to answer many of those questions. There are people who follow the crowd and do great things. There are people who don't follow the crowd and do great things. There are people who follow the crowd and do meagre things. There are people who don't follow the crowd and do meagre things.

Doing "great things" is my cart. That's what I want to do.

How I do it, is just the horse.

And it doesn't matter which horse we are riding.

What do I want to do?

It is funny I haven't defined "great things". Because I don't know what I want to do. I want to do good. I want to be remembered. I want to make life simpler for a lot of people. And I want to satisfy my own intellectual curiosities.