....and thereby ends the tale!

“Please aunty, I promise you that I ll keep Tulsi very happy. And I ll take care of her till the last day of my life! Please try to understand.. you are killing two lives!”... pleaded Mihir!

“No, you tell me why did you lie bout your caste!” .. asked her mom

“Have you ever loved someone aunty?? Ever?? And when you love someone so much that you want to spend your entire life with her…. What is it that you fear the most? It’s the fear of losing her! And I knew from the beginning that you guys were caste conscious! Tulsi always said that my mom wants me to marry a fair, rich , well settled Brahmin guy ! And that would scare me off! So I couldn’t tell her the truth, at the first instance.. I was afraid I would lose the only one I loved!! But I didn’t lie aunty. Do you remember the day when I came alone, travelled 200kms just to meet you and tell you that I wanted to marry your daughter! And the same evening when I returned back, Tulsi gave me a call and said that my mom wants to know your caste! And it was then that i told her, and I conveyed the same to you too! I did not hide it.. nor did I lie!”

I still remember how happy Tulsi was on that day! She and her dad both texted me that you went all alone to meet her mom, that too on the eve of your final exams! Boy..we re proud of you!
But sadly with time, things re forgotten! She forgot that with high grade fever I ran in the rain to get her that novel that she wanted to read! And came back drenched but happy! Sat for hours at the bus stop waiting for her , was always there before time lest I miss her! That cute lil gal in blue salwar slowly making her way to the bus stop, and me trying to catch a glance at her for the first time… well that’s how it all started! Mihir had to pinch himself to get back to reality!

Cough.. cough.. and Tulsi s mom was at it again. Our innumerable meets always ended in agony for me. I knew that I was not rich, just had a single room apartment on the outskirts of Mumbai , didn’t ve any household help! But all of it would change with time.. things would get better! But people listen to what they want to hear and say what they want you to understand!
“Look boy, we do not believe in caste and creed! We are not casteists, but all im asking is .. if you guys do get married tomorrow what will the children write when they re asked their caste?”

For someone who claims not to believe, what was the significance of this question? Mihir s head went into a spin
**************************************************************************


5 years back mihir had joined the hospital of his dreams. night or day,you would always find Mihir working hard!!! Residency in the heaviest hospital in terms of workload was always going to be tough! But he liked it, the pain and tireless work would help in getting a few hours of sombre sleep every night. Inspite of being coaxed by his roomie that this is the time to flirt and date gals, he would say no to every gal who asked him out! This went on for 5 yrs… all exams were cleared, entrances done in 1st attempts and then one fine day………….

Mihir was returning from the College office when he saw this sweet lil gal in the blue salwar. She was trying her best to face the wind fluttering against her dupatta as she made her way to the bus stop. And something bout her gave him that weird feeling [that flutterwala feeling dumbo! Not the sinking one!] And then when he subtly bumped into her at the bus stop and she glanced at him and said… “Hi , you re the guy in cardiology right??” Well, that’s how it all started! [meeting Robin was always legendary… as the saying goes!haha]

***********************************************************************

Tulsi s mom resentment always grew stronger. Mihir s Unit Head went to meet her once to convince her that the guy was good and decent. But she would not budge.. according to her the guy was a liar and a dishonest , abusive guy. Sadly Tulsi stood beside her mom through the whole conversation but did not refute any of her statements. His unit head came back and said.. atleast she could ve supported you, but why didn’t she do it?

Mihir was quite broken that day [understandably so] and texted her at night..

I thing I am fu@#ing my life. Your mom doesn’t want to understand. She s trying every trick in the book. I have apologised to her even for no fault of mine. Met her umpteen times. I cant do this anymore.. im just bugged. I feel let down in this moment when I need you the most..

Cmon dude, don’t you think its affecting me too?

I understand but you are in an easy profession vis a vis mine . I deal with hearts and one mistake can be fatal for the patient. And I almost made one today! Its affecting my work Tulsi!

Oh wow, so now you re demeaning my profession. And making me feel inferior. My mom was so right bout you! And with this she showed these texts to her mom,and the lady replied-he s such an ill mannered abusive guy, didnt i tell you this?

###################################################################

To cut a long story short…and since Mihir would not want me to write more on it…
Its difficult to get back something at times. All your efforts can go in vain. You may be the best person to the world , but for that special one… rather let me rephrase it as..
For that person who is the most special and closest to you, you may be a villain in her eyes[ or her mom s eyes]. You cannot achieve a relationship single handedly. Two hands make a clap! And once someone is brainwashed into believing that you re bad , no matter how much you try.. sometimes you just cant do it! And Mihir realised it eventually that if there s no trust between two partners, it doesn’t work out!

And that’s how it ended…………

But as they say life doesnt end ...

If life can remove someone
you never dreamed of losing,

It can replace them with someone
you never dreamt of having!!!

and what happened next ...will definately bring a smile on your faces! but thats another story... you gotta wait for that....

Jaane bhi do yaaron....

I was observing the RMO take consent the other day for a vascular procedure.

Name of the procedure- arteriovenus fitsula. ...she wrote

She forgot to mention the name of the consultant doing the procedure (and wrote her name instead) and did not fill the column which states that the consent was explained in xyz language. On asking her about the procedure (the way she spelt it I was sure she hadn’t heard of it before) she stated that it’s done somewhere in the rectum or anal canal (she wasn’t very sure but said it’s a 50:50 between the two sites). I was amazed coz today I knew who was referring anal fistula pts to my opd for av fistula surgery.. initially I thought the pts had got to the wrong room coz the colorectal guy sits one room to my left in the opd complex. But no..this was the secret I didn’t know bout!

Frankly,I am really flustered by this rich new breed of mbbs students passing out every year from the rich private colleges from this part of the world. On paper they re qualified to practise medicine. And with 65000 mbbs seats this was bound to happen. You may ve not studied seriously ..may not know a word bout most of the diseases ..but you ve been made to pass the exam.. thanks to some help from somewhere.

I asked her.. we ll play Q n A .. just gimme a few answers..
-What’s philadelphia chromosome?
No answer...some chromosome discovered there.. she mumbled at last. (I’m happy she didn’t say it s a fossil discovered in philadelphia)

-What is varicose vein?
She answered it promptly.. dilated veins.. I was happy she did know it.. but then she went on to say ..dilated veins on the scalp.. and that it was difficult to put a veinflow in those varicose veins! (If I do commit suicide someday pls catch hold of these rmo s. .godd)

-I asked her what is Murphy s sign, de Musset sign...Rebound tenderness.. how many pages does Harrison have..and did she read Bailey and love ?
All her answers were in the negative.

Clearly these days they read just to pass exams.. ask them any concept and you will realise how hollow they are. The private classes and some colleges are indeed taking us down. Students are mugging to pass the exams.. this cannot happen in a branch that deals with the human body. No wonder we read jokes on fb about the doc explaining to his pt that his disease is from the chapter that he had left as an option during his exams!
And the saddest part is that these people re well connected. They want to become consultants and earn the same salary. And surprisingly they do get to that.

I just read what goes on with this new hospital at a twin city in our state. The hospitals guys ve just set up their new PET scanner and in a month of being operational have done 50 pet scans. That’s a huge number for a start up ! Then I hear that they ve hired a private passout medicine doc who with his wonderful knowledge of the subject doesn’t decide the cause of pyrexia, but labels it pyrexia of unknown origin and subjects the pt to a pet scan.. so amazing ain’t it!!

That is why I wonder what will happen when the seats are increased further. The way the colleges are thriving these days.. I need not say more. In the last 6 mths I haven’t seen even 2 vada pav shops come up around my hospital ..but 4 new hospitals ve been added to the list.
65000 mbbs seats and 15000 pg seats that’s how it was till now.. but now they want to increase the pg seats.. go ahead.. I would be happy if they had 35000mbbs seats and 25000 seats,but they demand 65000 pg seats, one for each!isnt that way too many? Quality is indeed getting compromised for quantity and the end result won’t be good...obviously!

I suddenly get a call as I write this write up.. it’s the same rmo .. she had a rank of 19000 plus in neet but she happily states that she has secured MD Radiology at a private college in Pune. Good.. I’m happy.. the way things re moving she ll soon join a corporate hospital as a consultant in a few years from now. And I know what to expect in the reports...expect the unexpected..ha ha!!!!

Moving away from rmo s let’s go on to the next level..

I ve this consultant who gets many referrals coz he gives referrals...err.. if you know what I mean.. he keeps his referring physicians happy.. and I ve never seen a pt treated by him happy ..but then who cares.. it’s a game of numbers.. n he s making maximum numbers in 'the maximum city'..haha! A physician referring to another substandard one just for reasons known best to him. And then the “chakravuyh” takes over.. the pt with a stomach ailment finds himself going to an ent , neuro, urologist, pulmonologist, etc for no reason. This really bugs me. And then when I see the pt with a whole bunch of radiology investigations for a condition which is diagnosed by simple clinical examination..I’m stunned! as i say this just to confirm it, my Apple manager friend calls up to say that he was suspected to have an inguinal hernia and had a sonography and mri done to confirm it, at a 5 star hospital in the suburbs.and he was so happy that he got investigated...![God who s a bigger fool...the doc or this patient?]

Next I see that a young deserving superspeciality doc being turned away by a big corporate. The reason being that she is young and has no patient base in this region. And the position is given to a mediocre guy from another regional hospital with 15 yrs practise in the region..with a big patient base. And I thought that good clinical skills and good knowledge will fetch you the job.. obviously it doesn’t work that way! But to her luck ,she was picked by another hospital and her good work has earned her a few accolades.. !

Being a guy with contacts can be really resourceful. A critical dept head has to be a senior with amazing experience. And the other day I heard a story bout a newly appointed head with no great record but good contacts..n how even one challenging case could not ve the desired result and ve always had a vertical transition..I just kept mum.

See since we all understand cricket ..the cricket crazy nation that we are.. let me use this example.
You can use your influence and money and get yourself a place in the playing team. But ultimately you will have to deliver a star performance. And then you know that you can’t cover it up for long.. it will show up and the truth will be exposed in the long run... same with the ones investing in pg seats and consultant posts in hospitals when they know they don’t deserve it. And for the people who can see this happening.. well you ve to behave like Tubelight as the new hindi movie proclaims.. coz without back up you can be easily toppled ...forget your experience, knowledge ,hardwork and degrees.. without contacts you re just a chicken waiting to be devoured by the Wolf !

We want world class options in every field.. but we don’t want to work hard to get there! After all these years we just ve 2 squash players and a handful of badminton players who have made the cut. What s wrong with billiards,table tennis, wrestling.. what happened to gymnastics after that gal put up a great show in olympics? If you expected better training and new centres ..it has not happened and in all probability won’t. .until and unless someone finds a vested interest in doing it. The current breed of cricketers joking and smiling after a brazen defeat at the hands of our arch rivals says it all..the new culture is.. leave it.. just enjoy ur life.. live carefree... once ur a name you can kick anyone out ...especially if he raises a voice bout the indiscipline and lack of commitment in the present era!
We re a country of people running around from the time we learnt to walk.. we run around in trains,buses ..run after gals.. run after money.. run after fame.. (you may be a jack ass but still want to be respected and be famous..what shit!) ...then why don’t we ve a single world class runner representing us in world championships? If you look at the runners most look undernourished and don’t ve enough muscle for the job! Then where do the crores invested (Atleast on paper) go..

I just feel sad for the soldiers martyred each day..they give up their lives for a better future ....not knowing that the future is getting exploited at the hands of non deserving rich fools.. and most don’t want to do anything bout it and remain oblivious coz it doesn’t affect them in any way.

Hope things change.. adios!!!!!!

A SARCASTIC Soul!

Its been a long time since I have penned something down. Confining myself to the walls that I have built around me, it needed a herculean effort to dig a tunnel and get on to the other side! And when I did get there, what do I see….
I see that a lot has changed.. in time..in place.. in person… in deeds.. in life!

So when Lucky and Shao dragged me to the pub after, almost eternity, and we did.. ,not drinks but, karaoke..it reminded me of the MBBS days ..the songs that we would sing aloud when we were happy.. and the songs which only your room mate would sing when he was sad, esp on that last day when he knew that he would never see her again! Reminded me of all the happiness, bliss..and the pain and angst and those tears behind..
‘ hum rahe ya na rahe kal… pal yaad aayenge yeh pal!’
That same bus stop outside gate no 4 where you would drop her off everyday to the empty road that now lay like a recluse…!!!!!!!! Life has taken us afar…
His story too shall feature on my blog.. but not today!

So then what do I write bout … well lets say ..going by my present mood...sarcasm!

Farewell MOTHERland!

We see a lot of people settled abroad, but their parents still reside in India. The other day a 80yr old lady gets wheeled in our ICU. I was checking a cardiac patient when I see her ..she doesn’t make any sound, gives a blank stare and makes no movement! I know this is Stroke, and I know it takes a while to recover. A day passed and I see her in the same state. And what surprises me is that she has no one around, esp when its this critical. On inquiring I find out that she was brought by the members of an old age home close to our hospital. I presume that she has no living kith or kin and so was a part of the old age home. What I learn the next day surprises me further! The lady has a son settled in USA and a daughter based in Australia. Both of them know that she s admitted but wont come down. Finally on the 4th day a grandson shows up[ dunno from where] . He pays the charges and disappears! The lady finally goes back to the old age home and that’s where we lose her!
Clearly this is not an exception these days. I have seen many parents sad … old age is when they act like toddlers and become dependent on their kids . when the kids do this to the parents, I don’t like it at all!

TRANSPLANT ing in time!

We see a lot of smart people coming for consultation these days! I saw a doctor couple outsmarting themselves the other day! They had a relative, a young 30yr old , with dilated cardiomyopathy with a very low pumping fraction of the heart. He was taken to a prestigious hospital in the western suburbs where the cardiologist treating him did not think at any point of time that a cardioverter-defibrillator implantation would help him, given the recent history of multiple syncopes. Moreover the fact that this guy is an ideal candidate for a transplant was never discussed! Rather he was managed in the ICU and shifted to the ward when he was a tad better! A common family friend gives me a call and says –boss don’t you think he needs a transplant! I say yes. He asks me if I can help him out. I say why not. I get in touch with my team and we tell them that we should move him straight to the transplant centre and register him! The doctor relative doesn’t call me for a week. I am busy in my work but still whatsapp him to ask –what s going on?
No answer! I get the answer!
Suddenly after 10 days the relative calls frantically! His patient has collapsed and is back in the ICU gasping with no urine output and completely altered in mentation! They want a transplant now.. stat! I like stat orders… seriously! I mean is transplant an injection that you give for fever? Abhi de do doctor saab! So I start arranging for the stuff when they say –doc can you come down and see him once. I say yes. I tell them to intubate him and preserve his higher functions to which the treating cardiologist says they don’t agree to it. So if a patient is gasping and you don’t intubate how will he make it till the transplant happens? I really don’t know what educated patient s relatives want these days! Im not surprised when I get a message in a while.. Mr ABC has peacefully passed away!
Im sad because this was a young guy who was eminently salvageable had the relatives made the decision in time! These guys had also called up another doc who probably didn’t know anything bout transplants but still gave his opinion that it wont work,blah blah. I have seen this time too many. Even if you don’t ve expertise in the subject you would still give an opinion. And because you ve gray hair , and as the indian mentality goes- gray hair/ bald guy + old age= good doctor! the people believe in your opinion and disregard the helpful ones! Chalo..koi baat nahi!

Sherlocked or SHELLSHOCKED!

I like a branch of medicine! It deals with the higher functions! Every lesion has a characteristic presentation! But you ve to look for the clues! Its like setting up a jigsaw puzzle in place! As you understand a few findings, newer ones get revealed! The same presentation may have different differentials! And you ve to put the Sherlock s cap on and then narrow it down to the final clue and present your diagnosis! obviously there are investigations that can help you through all this!but the diagnosis should be clinical and it can be supplemented through the investigations!
I know of an academic guy who loves to talk.. he goes on and on.. with his metaphors and similies and synecdoche’s …what a lovely clinician he must be! I too thought the same… until I saw the patients coming out with every possible investigation done and nil clinical diagnosis! And if someone did ask why most of the investigations were negative the reply would be—oh! I knew that it would be negative. That was just to rule out this XYZ condition!
I think people have forgotten the clinical examination part these days! Sherlock holmes is indeed sad! Also in KEM we would be taught to examine the patient thoroughly and elicit the findings , but nowadays I just see guys stand near the bed and look at the numbers on the screen, make a comment and move on! Sad…

The BIG Show!

My friend was telling me this story. There s this senior guy with him. He s a very average surgeon. Knows only the basic surgeries. But talk to him and he ll showcase his aura.. ohh when I was in USA I did 500 such surgeries, in Australia I ve done 1000 such procedures, this is how they do it in Germany.. I ve done so many of these stuff.. the list goes on and on! And when this big guy washes up for the case and its his turn to do the same thing that he claims to ve done a thousand times before….psst.. he says.. this is the second time im doing it, tell me how did you do it in your centre in south india? So basically the truth unravels, he s not done it before! But then why boast in front of others that you ve seen or done it a million times! And then opine on stuff that you ve never done or seen but talk as if you have been doing it since childhood.. just amazing!

Goof up GOOFY!

A friend of mine married a couple of years back. A poor cardiac guy that he was, I was sceptical if the gal married him just to ve a trophy hubby! Having cleared the air before marriage that he was not rich and it takes time to settle down in this difficult profession with long working hours, it was a shock a month later when the gal confided in him that she wanted to marry her BF. And the reason being that she wanted to marry her rich bf but her parents wouldn’t let her! And so she wanted to try and she how it feels to marry a good cardiac guy! But now it was clear that an easy life should be the preferred choice! The gal further added that she couldn’t say no before because all the people she spoke to gave her good reviews of the guy and so she thought lets try it once!
Clearly tripadvisor.com reviews are taken more seriously these days and NEET pattern of taking up a seat and trying it for sometime before giving it up are being tried in real life too! To her good luck the goof up goofy was allowed by the trophy guy, to leave without any hassles only to be hassled by her, later, in the courtyard of the law !

SEAT Matrix!

There was a pleasant pretty dame working as a RMO in a hospital after internship! And obviously when you have no inclination to study but at the same time wanna earn fast bucks, this is the best bet! And so when you get your not so encouraging result in NEET , you decide why struggle and study? Lets get a seat in a private college! But you ve to pay a bomb for that! So when this dame comes up and asks me what should I take up? I ask her back what do u expect from your branch?
She said -I want a branch in a good college with no emergencies with a very good pay and good quality of life!
Sums up the expectations of the new no workaholic culture these days! I wont work hard and still want the best results! Makes me sad!

FREE SERVICE to mankind!

A very common occurrence these days is a large number of extremely poor patients that we see in the clinic these days! The patient’s Audi A5 screeches to a halt and he dethrones himself! Walks to the clinic. He gets his sutures removed and just wont pay the fee. He will argue and threaten the guests relation executive that this is clearly an act of overcharging! The guy will spend 5000 bucks on his cigarettes a month, 10k on liquor, 3k on a movie ticket and popcorn, 11k for dinner with the whole family at mime and dine … but..but ..but 200 bucks for a suture removal and dressing is indeed a big deal! In contrast to this, I have a rich auto driver s wife who comes in for a consultation for her daughter. I have offered her daughter a waiver for my opd charges but still after the consultation , on her way out..she goes and offers a sum as the opd fee and asks my secretary not to reveal bout it to me! So on her next visit I ensure that I get everything done for her 3 yr old kid free thereafter. I am sad that the sweet lil one has such a complicated cardiac lesion that most ve refused to operate on her! And obviously they ve no funds.. but still are rich and beautiful.. by heart and deeds!

well i guess thats enough of sarcasm for the day... life is indeed a lil different from what it used to be! i guess getting used to it is a better deal... esp when you know you cant change much! tsk...tsk...

till next time........ adios!