May-June 1997
The days leading up to Labour Room Part two are slow and long drawn out. The excitement and anticipation that accompanied my first stint there is pretty diluted but after 14 days of the OG posting, I, along with the other 5 usual suspects, head past the Eclampsia Room and 4 or 5 heavily pregnant ladies, through the yellow double doors of Labour Room and into the action thriller that Labour Room often is with the unique all pervasive constant whiff of blood mixed with the unique smells of amniotic fluid and newborn baby, like a strange room freshener set to auto.
The Labour Room team is led by Dr Sethi, (someone I know through Shom and his gang) and also consists of three other residents who will man it from 8 to 5 every day for the next 3 months. At 5, the corresponding Duty Team which varies every day depending on the Unit on Duty will take over. Mondays-Thursdays are Units 1 to 4 and Fridays and Saturdays alternate between Units 1 and 3, and 2 and 4 respectively. Sundays are by rotation, but not for us of course.
Things start off as before with rapid allotment of beds to be monitored, deliveries to be conducted, Caesarians to assist and various forms to be filled. The space between the door and the delivery rooms is occupied by a yellow board stuck to the wall on which rests a massive register with details of every delivery and their outcomes, times of births, modes of deliveries etc. Next to this is a table with scattered bags, white coats, stethoscopes and books. A trolley with a green mattress lies next to this, at right angles and partially blocking the doors that lead directly into the OT. On the wall opposite to the heavy register is a wooden coat hanger which is perpetually occupied by green gowns, caps and masks.
In the delivery rooms, each occupied by 2 steel tables, a kind of a 2 step stool, a light fixed to the wall opposite and IV stands, lie the almost mothers. Stuck on the wall opposite each mother to be are their respective partograms. A couple of new born baby cots lie against the wall in the corridor which receive each baby for cleaning, tying the identifying wrist band and for paediatric examination if required.
There is general controlled panic as usual.
To an outsider, it seems like there are people, all dressed in green gowns, caps and masks with stethoscopes hanging from their necks, running about, shouting orders at 6 Final Years, who are moving around with controlled reluctance in varying degrees of exhaustion. That would be us. The second stint of this place is much more tiring than the first, because there is less to ogle at and fewer new things to learn. This time round, we are experienced and are supposed to just do things without much explanation. The pressures are greater, the expectations higher and the margins for ignorance and error significantly lower.
The SLR is conected to the CLR via the OT complex which consists of 2 Operating Rooms next to each other. The OT's are therefore connected to both Labour Rooms and are always occupied, especially after 2 PM when the routine cases are over and the long line of Caesarian Sections can take over. Often, in the morning, the routine OT list is interrupted by an Emergency Section and we, as Labour Room Final Years are expected to scrub and assist. This is both a chance to actually do some surgery and a hugely welcome break from the tedium of delivering babies and charting partograms.
One evening, well into the posting and resembling a walking zombie I am assaulted by the fumes of formalin in the SLR. It's stinging, pungent and very very strong. It is unbearable and I grab my mask and get out of there into a room next to the SLR where the air is more normal. Dr S (not Sethi), who is the Senior Resident for the night is running back and forth from CLR to SLR trying to figure out what's happening. He is accompanied by Suzie, who we all imagine is his future wife to be and we are frantically shifting SLR patients outside. It's quite a task moving them on to wheelchairs and trollies, all getting cramped in the smallish room just outside the SLR.
It seems that the CLR is getting fumigated, a process initiated by someone finding large colonies of Pseudomonas on the walls and in Savlon bottles and all of that formalin has made its way into the AC vents and into the shared AC system of the SLR. The CLR is vacant of course, all patients having been shifted to the SLR, but no one has bothered to realize that the bloody AC system is common.
I stand outside the SLR and take a few deep breaths, wear my mask, hold my breath and run inside. My eyes are watering and a very quick, deep breath later, I am helping to get a patient out of the bed and into another trolley to take outside this formalin hell. The others are doing the same. After a few minutes of very rapid activity, all patients are now outside a completely fumigated but totally uninhabitable Labour Room (s).
This of course does not absolve us of any monitoring or Syntocin drip administration or the like. Fortunately no one is in active labour right now but S walks over with his characteristic deliberate slow dignified walk and tells me to "keep my hand on the pulse" of a particular patient because she is at risk of a uterine rupture. If this happens, it's a catastrophe and a rapid rise in pulse rate will give us advance warning. This is frightening and I feel very responsible and scared at the same time. What if the pulse does rise and no one is around? Do I go around shouting for help?
I am stuck with this for the next 2 hours. Hand on pulse and I don't dare move from the stuffy non AC room where all the patients now find themselves. People go for dinner and come back but I stay there till I am told it's all clear.
A couple of days later and inching towards escape and freedom, I lie exhausted on one of the beds in the Duty Doctors room, opposite one of the Special Ward Rooms. They are numbered from 1 to 10 or so and the numbers are preceded by either A or B. The standing but rather stale joke is that Cancer patients are never admitted to Room B9.
3 of us lie there at 3 AM, bone tired and hoping the morning gets delayed somehow. But what does get delayed is our precious sleep. At 3 AM there is a loud knock. Naveen, who has made a hobby of assisting Caesarians, is frantic. Madam A is on her way to the OT to do an "Ectopic Pregnancy" case. And we ALL have to be there.
This has more implications than loss of sleep. Madam A will expect us to know about the case. The history, the findings, what the surgery will involve, and numerous questions will be peppered throughout this whole drama. Even if she does not physically come, she will make it a point to come around the next day and ask. In such situations, we all stand in a small circle in the CLR and hope against hope that the questions are not directed at us.
The procedure lasts for an hour and now I am too buzzed to sleep. So 2 of us head out to the shacks for tea and chat till the first hints of sunrise come on the horizon. I've never seen as many sunrises as I have in this posting and it's quite a new experience. The slow lightening of the sky, a change of colour from black to blackish-blue and finally to varying shades of orange and yellow. Birds start chirping, the air turns slightly chilly with the early morning breeze and a new line of patients, often from far away and having spent the night on the footpaths outside Jipmer, make their way towards the front gate, assembling in a disjointed line for their turn. Some of them will turn into guinea pigs for people like us.
Inside the hospital, Nurses wander from room to room with their drug trolleys and a note-book on which they have to record what medicines have to be given to whom and at what time. The cleaning people start early. Around 7, the first wave of Junior Residents come in, all fresh and alert, shaved and dressed. They make a quick trip to their respective wards to see their patients before Rounds at 8. Various other sundry people, some in the brown uniforms of the "Group C and D", some in Nurses uniforms, and some "OT Brothers" move around.
The 5 of us on the other hand look unkempt, haggard and dirty. I smell of amniotic fluid and blood. It's a a weird feeling to walk around in the hospital at 8 AM looking like that. But this is a hospital and no one really cares. Zombies like me are everywhere, post call in all specialities, all of us shuffling off to our respective bikes parked outside like wounded comrades in arms.
It's a good time to share battle stories, who said what to whom, who screwed up and who got shouted at but eventually the talk veers around to Final Year and the impending Exams.
As Labour Room draws to a close, I find myself with mixed feelings to what should be a welcome end to a gruelling 2 weeks but, in reality, is the beginning of a 4 month hurdle race to the finish line. One of the few joys of Labour Room is that one is so involved in the whole posting that all else takes a back seat. All of Medicine, Surgery, Paeds, Ortho. We are exempted from all theory classes bar OG and even here, it's a common sight to see 6 Labour Room occupants struggling to keep awake or on the odd occasion, snoring lightly.
The 14 day posting becomes a kind of refuge from the terrors of Final Year that lurk just outside the double yellow doors of the CLR.
There is much I have learnt-Conducting deliveries, monitoring pregnancy, active management of a lady in labour, assisting C Sections etc. More importantly, I have learnt how to function on adrenaline and coffee, how to ignore screwings, how to be time efficient and how to prioritise work and the value of teamwork. I have learnt that people die, some before they are born alive. And I have watched extreme grief and extreme joy-both at arm's length.
Labour Room has also, quite insidiously, introduced the concept of team dynamics. Lock up 6 similar people in a space and circumstance for 14 days and things happen. Bickering, bitching, adjustments, covering up for goof ups-all of this has happened and will continue to happen to all subsequent batches. Someone will invariably be labelled as a "suck-up", someone will get labelled as a slacker, someone else will be a stubborn SOB unwilling to exchange duties or nights off. Intentions can be misinterpreted and the mental stress of being on full alert for 14 days, 18 hours a day is only mitigated by the fact it does not last forever. I am fortunate in finishing Labour Room early but a few will finish it just 24 hours before the Send -Ups. In some ways , perhaps, that is better since there really isn't much they can do about the exams.
I think about all of this while dealing with an aching back, sore muscles and a fried brain swimming with drug doses, partograms, IV lines, OT call slips and what happened to Muniammal in her expedited 2nd stage of labour. I think of all this at 230 AM when the world is asleep but the hospital is buzzing with activity, if you know where to look.
The phone rings (again). Casualty is on the line with yet another lady in labour. The Duty Resident, who managed to get away for a quick 30 minute nap is summoned and the two of us head off to Casualty to assess the lady in question. Satya is my Resident, walks with a slight hop and limp and we hop and lumber respectively to the controlled chaos that Casualty is. It is beginning to appear that the entire hospital is in a state of controlled chaos.
Casualty is somewhere near the front of the campus, close to the Main Gate. There are rumours of a new Casualty block somewhere but no such construction has started yet. It is much needed since this one is bursting at the seams, people everywhere-patients, trolleys, doctors, interns, patients' attenders. The sounds are as varied-machine bleeps, rushing footsteps, occasional wails and screams, Residents shouting at Interns, Interns shouting at patient attenders, attenders standing quietly by the side hoping for miracles. I have seen many a Burn case here, all with stories of "the kerosene lamp was kicked by the cat" and "my saree caught fire on the stove" kind of barely believable stories. Many a poisoning case, some accidental, some suicidal. The odd patient in coma waiting to be shifted to a perpetually occupied ICU, people with fractures being plastered and X-rayed. And some polytrauma patient no one wants to takes.
I have seen this scene a number of times but always with the mission to reach our patient-the lady in labour who lies waiting in the OG Room for us.
A quick history to establish gravida and parity, a PV examination to check position and descent and we are off. One more added to an always growing list of deliveries. It feels good to be here since I can start monitoring patients from the time they arrive to the time they leave after a successful delivery.I don't have a sense of completion with this particular patient since I will be off in a few hours. Nevertheless, when I am asked to do a PV, feel the head and check dilation, I feel more like a doctor than I have ever felt in any posting before.
The Labour Room is not very busy tonight and the routine after such a Casualty visit is, time permitting, to head off to the shacks for tea, biscuits and the odd nicotine fix. It's 4 in the morning, still dark and relatively quiet but the shacks are always busy. We walk out of the main gate, see the rows of patients and attenders sleeping on the footpaths and on the median of the highway and make our way to Casino where the "Master" is making the first tea of the day. This is always the best since the same tea leaves are probably used many times and the tea gets progressively worse as the day goes on. This is a good place for some gossip with fellow Interns, some in Medicine, some in Surgery and with some juniors, who, it seems have nothing better to do than drink tea after yet another party. My white coat and steth makes me look all senior and serious and the obvious sleep deprivation just heighten the mystique that surrounds a Labour Room occupant. The shacks is also a good vantage point from where to observe the Casualty. Any Ambulance/car/auto entering the main gate is tracked to see if it turns left to the Casualty and if so, we often dash to make a quick check.
"Is it our case"?
As an aside, a tea in the shacks is also referred to as a " Casual Tea".
The clock ticks on. Dawn breaks and the hospital comes to life.
We had a small leaving party in labour Room the previous evening, with Pepsi, cakes, samosas and the like, all sponsored of course by the Labour Room Senior Resident.
The five of us-me, Narayanan, Naveen, Pakha and Pajanivel-will head off into the world again, a world with Final Year Exams and the prospect of doom and gloom written all over. I know I have to read like never before and start praying, also like never before. There are 3 more postings to go-Paeds, Medicine and Surgery and that's it.
The end of my MBBS course is near.
Exams, reading, clinics, tests, vivas, screwings, royal screwings, notes, books, despair, loneliness-the life of a Final Year student.
The days leading up to Labour Room Part two are slow and long drawn out. The excitement and anticipation that accompanied my first stint there is pretty diluted but after 14 days of the OG posting, I, along with the other 5 usual suspects, head past the Eclampsia Room and 4 or 5 heavily pregnant ladies, through the yellow double doors of Labour Room and into the action thriller that Labour Room often is with the unique all pervasive constant whiff of blood mixed with the unique smells of amniotic fluid and newborn baby, like a strange room freshener set to auto.
The Labour Room team is led by Dr Sethi, (someone I know through Shom and his gang) and also consists of three other residents who will man it from 8 to 5 every day for the next 3 months. At 5, the corresponding Duty Team which varies every day depending on the Unit on Duty will take over. Mondays-Thursdays are Units 1 to 4 and Fridays and Saturdays alternate between Units 1 and 3, and 2 and 4 respectively. Sundays are by rotation, but not for us of course.
Things start off as before with rapid allotment of beds to be monitored, deliveries to be conducted, Caesarians to assist and various forms to be filled. The space between the door and the delivery rooms is occupied by a yellow board stuck to the wall on which rests a massive register with details of every delivery and their outcomes, times of births, modes of deliveries etc. Next to this is a table with scattered bags, white coats, stethoscopes and books. A trolley with a green mattress lies next to this, at right angles and partially blocking the doors that lead directly into the OT. On the wall opposite to the heavy register is a wooden coat hanger which is perpetually occupied by green gowns, caps and masks.
In the delivery rooms, each occupied by 2 steel tables, a kind of a 2 step stool, a light fixed to the wall opposite and IV stands, lie the almost mothers. Stuck on the wall opposite each mother to be are their respective partograms. A couple of new born baby cots lie against the wall in the corridor which receive each baby for cleaning, tying the identifying wrist band and for paediatric examination if required.
There is general controlled panic as usual.
To an outsider, it seems like there are people, all dressed in green gowns, caps and masks with stethoscopes hanging from their necks, running about, shouting orders at 6 Final Years, who are moving around with controlled reluctance in varying degrees of exhaustion. That would be us. The second stint of this place is much more tiring than the first, because there is less to ogle at and fewer new things to learn. This time round, we are experienced and are supposed to just do things without much explanation. The pressures are greater, the expectations higher and the margins for ignorance and error significantly lower.
The SLR is conected to the CLR via the OT complex which consists of 2 Operating Rooms next to each other. The OT's are therefore connected to both Labour Rooms and are always occupied, especially after 2 PM when the routine cases are over and the long line of Caesarian Sections can take over. Often, in the morning, the routine OT list is interrupted by an Emergency Section and we, as Labour Room Final Years are expected to scrub and assist. This is both a chance to actually do some surgery and a hugely welcome break from the tedium of delivering babies and charting partograms.
One evening, well into the posting and resembling a walking zombie I am assaulted by the fumes of formalin in the SLR. It's stinging, pungent and very very strong. It is unbearable and I grab my mask and get out of there into a room next to the SLR where the air is more normal. Dr S (not Sethi), who is the Senior Resident for the night is running back and forth from CLR to SLR trying to figure out what's happening. He is accompanied by Suzie, who we all imagine is his future wife to be and we are frantically shifting SLR patients outside. It's quite a task moving them on to wheelchairs and trollies, all getting cramped in the smallish room just outside the SLR.
It seems that the CLR is getting fumigated, a process initiated by someone finding large colonies of Pseudomonas on the walls and in Savlon bottles and all of that formalin has made its way into the AC vents and into the shared AC system of the SLR. The CLR is vacant of course, all patients having been shifted to the SLR, but no one has bothered to realize that the bloody AC system is common.
I stand outside the SLR and take a few deep breaths, wear my mask, hold my breath and run inside. My eyes are watering and a very quick, deep breath later, I am helping to get a patient out of the bed and into another trolley to take outside this formalin hell. The others are doing the same. After a few minutes of very rapid activity, all patients are now outside a completely fumigated but totally uninhabitable Labour Room (s).
This of course does not absolve us of any monitoring or Syntocin drip administration or the like. Fortunately no one is in active labour right now but S walks over with his characteristic deliberate slow dignified walk and tells me to "keep my hand on the pulse" of a particular patient because she is at risk of a uterine rupture. If this happens, it's a catastrophe and a rapid rise in pulse rate will give us advance warning. This is frightening and I feel very responsible and scared at the same time. What if the pulse does rise and no one is around? Do I go around shouting for help?
I am stuck with this for the next 2 hours. Hand on pulse and I don't dare move from the stuffy non AC room where all the patients now find themselves. People go for dinner and come back but I stay there till I am told it's all clear.
A couple of days later and inching towards escape and freedom, I lie exhausted on one of the beds in the Duty Doctors room, opposite one of the Special Ward Rooms. They are numbered from 1 to 10 or so and the numbers are preceded by either A or B. The standing but rather stale joke is that Cancer patients are never admitted to Room B9.
3 of us lie there at 3 AM, bone tired and hoping the morning gets delayed somehow. But what does get delayed is our precious sleep. At 3 AM there is a loud knock. Naveen, who has made a hobby of assisting Caesarians, is frantic. Madam A is on her way to the OT to do an "Ectopic Pregnancy" case. And we ALL have to be there.
This has more implications than loss of sleep. Madam A will expect us to know about the case. The history, the findings, what the surgery will involve, and numerous questions will be peppered throughout this whole drama. Even if she does not physically come, she will make it a point to come around the next day and ask. In such situations, we all stand in a small circle in the CLR and hope against hope that the questions are not directed at us.
The procedure lasts for an hour and now I am too buzzed to sleep. So 2 of us head out to the shacks for tea and chat till the first hints of sunrise come on the horizon. I've never seen as many sunrises as I have in this posting and it's quite a new experience. The slow lightening of the sky, a change of colour from black to blackish-blue and finally to varying shades of orange and yellow. Birds start chirping, the air turns slightly chilly with the early morning breeze and a new line of patients, often from far away and having spent the night on the footpaths outside Jipmer, make their way towards the front gate, assembling in a disjointed line for their turn. Some of them will turn into guinea pigs for people like us.
Inside the hospital, Nurses wander from room to room with their drug trolleys and a note-book on which they have to record what medicines have to be given to whom and at what time. The cleaning people start early. Around 7, the first wave of Junior Residents come in, all fresh and alert, shaved and dressed. They make a quick trip to their respective wards to see their patients before Rounds at 8. Various other sundry people, some in the brown uniforms of the "Group C and D", some in Nurses uniforms, and some "OT Brothers" move around.
The 5 of us on the other hand look unkempt, haggard and dirty. I smell of amniotic fluid and blood. It's a a weird feeling to walk around in the hospital at 8 AM looking like that. But this is a hospital and no one really cares. Zombies like me are everywhere, post call in all specialities, all of us shuffling off to our respective bikes parked outside like wounded comrades in arms.
It's a good time to share battle stories, who said what to whom, who screwed up and who got shouted at but eventually the talk veers around to Final Year and the impending Exams.
As Labour Room draws to a close, I find myself with mixed feelings to what should be a welcome end to a gruelling 2 weeks but, in reality, is the beginning of a 4 month hurdle race to the finish line. One of the few joys of Labour Room is that one is so involved in the whole posting that all else takes a back seat. All of Medicine, Surgery, Paeds, Ortho. We are exempted from all theory classes bar OG and even here, it's a common sight to see 6 Labour Room occupants struggling to keep awake or on the odd occasion, snoring lightly.
The 14 day posting becomes a kind of refuge from the terrors of Final Year that lurk just outside the double yellow doors of the CLR.
There is much I have learnt-Conducting deliveries, monitoring pregnancy, active management of a lady in labour, assisting C Sections etc. More importantly, I have learnt how to function on adrenaline and coffee, how to ignore screwings, how to be time efficient and how to prioritise work and the value of teamwork. I have learnt that people die, some before they are born alive. And I have watched extreme grief and extreme joy-both at arm's length.
Labour Room has also, quite insidiously, introduced the concept of team dynamics. Lock up 6 similar people in a space and circumstance for 14 days and things happen. Bickering, bitching, adjustments, covering up for goof ups-all of this has happened and will continue to happen to all subsequent batches. Someone will invariably be labelled as a "suck-up", someone will get labelled as a slacker, someone else will be a stubborn SOB unwilling to exchange duties or nights off. Intentions can be misinterpreted and the mental stress of being on full alert for 14 days, 18 hours a day is only mitigated by the fact it does not last forever. I am fortunate in finishing Labour Room early but a few will finish it just 24 hours before the Send -Ups. In some ways , perhaps, that is better since there really isn't much they can do about the exams.
I think about all of this while dealing with an aching back, sore muscles and a fried brain swimming with drug doses, partograms, IV lines, OT call slips and what happened to Muniammal in her expedited 2nd stage of labour. I think of all this at 230 AM when the world is asleep but the hospital is buzzing with activity, if you know where to look.
The phone rings (again). Casualty is on the line with yet another lady in labour. The Duty Resident, who managed to get away for a quick 30 minute nap is summoned and the two of us head off to Casualty to assess the lady in question. Satya is my Resident, walks with a slight hop and limp and we hop and lumber respectively to the controlled chaos that Casualty is. It is beginning to appear that the entire hospital is in a state of controlled chaos.
Casualty is somewhere near the front of the campus, close to the Main Gate. There are rumours of a new Casualty block somewhere but no such construction has started yet. It is much needed since this one is bursting at the seams, people everywhere-patients, trolleys, doctors, interns, patients' attenders. The sounds are as varied-machine bleeps, rushing footsteps, occasional wails and screams, Residents shouting at Interns, Interns shouting at patient attenders, attenders standing quietly by the side hoping for miracles. I have seen many a Burn case here, all with stories of "the kerosene lamp was kicked by the cat" and "my saree caught fire on the stove" kind of barely believable stories. Many a poisoning case, some accidental, some suicidal. The odd patient in coma waiting to be shifted to a perpetually occupied ICU, people with fractures being plastered and X-rayed. And some polytrauma patient no one wants to takes.
I have seen this scene a number of times but always with the mission to reach our patient-the lady in labour who lies waiting in the OG Room for us.
A quick history to establish gravida and parity, a PV examination to check position and descent and we are off. One more added to an always growing list of deliveries. It feels good to be here since I can start monitoring patients from the time they arrive to the time they leave after a successful delivery.I don't have a sense of completion with this particular patient since I will be off in a few hours. Nevertheless, when I am asked to do a PV, feel the head and check dilation, I feel more like a doctor than I have ever felt in any posting before.
The Labour Room is not very busy tonight and the routine after such a Casualty visit is, time permitting, to head off to the shacks for tea, biscuits and the odd nicotine fix. It's 4 in the morning, still dark and relatively quiet but the shacks are always busy. We walk out of the main gate, see the rows of patients and attenders sleeping on the footpaths and on the median of the highway and make our way to Casino where the "Master" is making the first tea of the day. This is always the best since the same tea leaves are probably used many times and the tea gets progressively worse as the day goes on. This is a good place for some gossip with fellow Interns, some in Medicine, some in Surgery and with some juniors, who, it seems have nothing better to do than drink tea after yet another party. My white coat and steth makes me look all senior and serious and the obvious sleep deprivation just heighten the mystique that surrounds a Labour Room occupant. The shacks is also a good vantage point from where to observe the Casualty. Any Ambulance/car/auto entering the main gate is tracked to see if it turns left to the Casualty and if so, we often dash to make a quick check.
"Is it our case"?
As an aside, a tea in the shacks is also referred to as a " Casual Tea".
The clock ticks on. Dawn breaks and the hospital comes to life.
We had a small leaving party in labour Room the previous evening, with Pepsi, cakes, samosas and the like, all sponsored of course by the Labour Room Senior Resident.
The five of us-me, Narayanan, Naveen, Pakha and Pajanivel-will head off into the world again, a world with Final Year Exams and the prospect of doom and gloom written all over. I know I have to read like never before and start praying, also like never before. There are 3 more postings to go-Paeds, Medicine and Surgery and that's it.
The end of my MBBS course is near.
Exams, reading, clinics, tests, vivas, screwings, royal screwings, notes, books, despair, loneliness-the life of a Final Year student.
awesome...keep writing !
ReplyDeleteThanks...I sure will.
ReplyDeleteBloody hell, dude. That is almost lyrical - the way you have described the march of the hoi polloi into and out of the hospital in the hours of the morning. One of your best yet! Awesome, bugger .... and am stopping there with the praise 'cos I don't want your fat head getting any bigger :D
ReplyDeleteP.S. You should describe a "Night in JIPMER hospital" and all the routine (and illicit) nocturnal activities that go on there - casualty, wards, ICU, and of course behind Banting Hall ;)
This story, once it is (sadly) complete, should be standard reading for anybody interested in knowing what goes into making of a doctor. Great stuff, man.. a complete freak-out.
ReplyDeletewow!superb...keep writing!
ReplyDeleteThank uou so much kushal and "anonymous". Its been a dream writing all this and i dont think i have emjoyed doing something this much. My homage to jipmer and to all med students
ReplyDelete