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Thursday, December 27, 2018

De Quervain's like Pain After CPR

Yesterday I was demonstrating CPR in a life support workshop. Today, I have pain in the left radial styloid process area.

What could it be? Searching took me to two pages of interest. One is AAFP's page on diagnosis wrist pain. This page talks about many things including Finkelstein's test which is grasping the thumb with other fingers and then ulnar deviation of wrist. It was negative for me, and I definitely did not have De Quervain's tendonitis.

But it could be the same tendons. What are the tendons involved in de Quervain's? The extensor policis brevis and the abductor policis longus which both go through the groove lateral to the radial styloid process. Maybe there was some microtrauma?

The other article was about wrist injuries in emergency service providers. It does not look like I have a scapholunate ligament injury. So I decided to read more about de Quervain's.

I found an article - Walsh and Miller: Pain about the Styloid Process - which beautifully captures the history of Fritz de Quervain's initial case descriptions and then Finkelstein's reviews and so on. The original articles by de Quervain are probably in German (Because Google Translate detects the title so. I initially thought they were in French because I had once enrolled to learn French in Alliance Francaise and it looked similar to what I was learning then). You can, though, read translations in English if you, like me, can't tell between French and German - references 1-4 on this article.

Especially the one "on a form of chronic tendovaginitis". When you read this you find out how chronic inflammations of tendon sheath were "rightly, increasingly being seen as tubercular". And then de Quervain going on to describe a chronic inflammation due to repeated use. The people who see beyond what they are taught to see indeed get diseases named after them.

Wait a second, where did "vagina" come into picture? Why is it tendovaginitis? Well, as it turns out, vagina means sheath in latin (and the sword (gladius) is kept inside) and since the inflammation here is on the sheath around the tendons, de Quervain (who obviously is a master of language) named it tendovaginitis. In fact, I see all reference of tendovaginitis going back to de Quervain's disease. [Side note: Do you still want to use the word vagina to refer to vagina? Are you sure you are talking about vagina, and not labia or vulva?]

After all that research, now I am now thinking it is the skin over the forearm that is giving me pain as the pain increases when I am softly rubbing over the skin. Maybe it is just a friction burn I got when handling my bag?

Sunday, December 9, 2018

A Letter to the Disillusioned Intern (or Medical Student)

Disillusionment. It happens to the best among us. It has happened to you? Welcome to the club.

After all, who wouldn't be disappointed? You could have become anyone - an architect, an engineer, a teacher, a scientist, a mathematician. Yet you chose to become a doctor. Of course it was your calculated choice. What a fantastic profession is it, after all? When a doctor talks to a patient, she is a teacher, an artist; when a doctor is diagnosing an illness, she is a detective, a scientist; when a doctor is communicating, she is a writer; when managing an emergency, she is a leader; in her career, she becomes an administrator, a guide, a policy analyst, a visionary. A doctor's profession is an incredible melting point of careers. Unique, interesting. And above all, serves humankind like nobody else.

And what did it all come to? Running around like a dog completing errands passed down to you in the strictest hierarchy ever. (It is called dog work, did you know?) Maybe learning a bit of medicine here and there, but if it is up to me, can I really handle a pregnant lady with eclampsia? Or a polytrauma? Will I be able to diagnose appendicitis in time? Am I doing the right thing even? What am I doing to patients? Does this hospital have anything? Are patients really being treated like shit or am I feeling so because I am treated like shit? What about IAS after internship? If this is how it is going to be, why would I even think of a post-graduation in medicine? Ah, I wish I could be in my bed. When did I last sleep? Should I really have taken an ECG on that guy before putting an NG tube like my PG asked me to and killing him? What salary do people in other states get when they do compulsory rural service? Heck, do they even do compulsory rural service? Will I ever get laid? If I eat this biriyani, will I be able to lose the weight after internship? Dude these 5th term students suck. They answer everything. Where did I keep that guy's X-ray? What is the point of this education system? Am I mad? Is this life? Please stop this.

It is the system. The horrible horrible system. It needs to change. People need to change. India will never improve. Horrible corruption. There are only 20,000 PG seats for 65,000 graduates every year. And then there are foreign graduates too. Life is going to be a rat race. Everyone is behind money. Have doctors always been like this? "Noble profession" it seems. LOL. When there are so many patients, there is no way things can be better. Patient load has to decrease. Examination system has to change. It is just this one year of internship. If I survive this somehow, that would be the end of all pain. Well, maybe 3 years of PG also. But why do PG? What is the point? Does it stop anywhere? They say MD Pediatrics is not enough because "it is saturated field". Super specialization. Super super specialization. And to do what? Or like my friend, I should also try to go outside the country. They say Australia has too few doctors for their population. One thing is for sure. This system sucks. I don't want to be anywhere near it.

Woah, woah! Hold on for a moment. I thought this letter is going to be an answer to my confusion. I know what the problems are. Do you have an answer? If no, please ***k off so I can move on with my ***king life.


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Dear Intern (or medical student),

Hang in there. You have done so well. You will keep doing well. Don't forget, you have a gift - you think!

Let me quote you Kabir.

सुखिया सब संसार है खाए अरु सोवै।
दुखिया दास कबीर है जागे अरु रोवै।।

Now I don't know what Kabir meant by it. But what I read is this: "The entire world is happy - ate well and slept; but Kabir (you) is sad - up and crying"

Woken up and crying. That's what you are. And guess what? That's the first step of enlightenment. Gautama Buddha was a happy prince in a palace till one day he went out and saw suffering in his kingdom; Gandhi was sitting in first-class before he got kicked out; Greta Thunberg should have been in school this Friday, but she saw wildfire in Sweden this summer.

Woken up. Different people get woken up at different times in their lives. Devi Shetty apparently after meeting Mother Teresa. Steve Jobs had Zen Buddhism on LSD. Some don't wake up in their entire lives. So what if you are in medical school? You have been woken up. And now there is no going back to sleep either.

I have got some very good news for you.

The first good news is that you are at the lowest point in your life. How is that good news? Well, because the only direction you can go from here is "up". And that is where you are going to go.

The second good news is that you are not alone. There are not many people like you, but there are people like you. They are variably called as "crazy", "whack ass", "visionary", "odd", "interesting. hmm.", "crazy", and so on (depending on who is talking about them). There is no easy way to find them though. They could be in your batch, in your college, among your professors, in a forest, sitting at home, they could be anywhere. They could even be writing blog posts to their juniors.

It is difficult to find them, but if you find them, you are family! There is very little need to talk about what you are going through, because they know what you are talking about. And they can feel your pain. And they want you out of it as soon as possible. And out you will be, shortly. Because there is a better world out there.

A world where you can spread your wings and thrive. One in which patients are people and doctors are people and a consultation is a life long relationship. One in which knowledge is not just consumed but also synthesised. One in which a doctor is more than just a doctor. A world where you are revered not for specializations but for being a human. A world in which you can realize your true potential without worrying about hierarchies. A world of endless possibilities.

So stop crying. And buckle up, for, there are things to be done, systems to be fixed, patients to be treated, lives to be made, and doctors to be delivered safely into the new world. And yes, you have earned yourself an invitation. Reach out to the undersigned and we start our journey right now.

Take care,
Someone who was you a while back

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