August-Sep 1997
Having successfully laboured through an exhausting OG posting, complete with Labour Room part Deux, loads of history takings, abdominal palpations and foetal heart sounds, I find myself in the middle of a Ward Leaving which is a breeze. Gynaecology, the focus of this particular posting, is easy, even fun. The only tricky part is Dysfunctional Uterine Bleeding which has hormonal balance, prostaglandins and such things in it and because it is an Exam case, I make an extra effort to get my head around it. But I can't.
I'll just hope I don't get it for exams. The other cases are fine. Cancer Cervix and Endomterium. Uterine Prolapse. Fibroid. Ovarian masses. They are a bit like a surgical case and there is some logic to them.
Apart from the Labour Room stuff and cases, exams also consist of Instrument vivas, an Operative surgery section, X-Rays, surgical specimens and a general Viva. In OG, the major instruments are Doyen's retractors which are used extensively and I have used it in a C Section. Then there are the forceps.
Long and curved, I have seen babies being pulled out with these. The head is held between the forceps and good old fashioned pulling does the trick. Sometimes a vacuum pump is used where the baby is literally vacuumed out. I am told there will be a tray with all these (and many more) instruments kept for us. I'll cross that bridge when it comes.
Of course, no OG posting is complete without a complete knowledge of how a baby is actually born. In detail. There is a long pnemoic for it which goes starts with Engagement of the head and has components of Flexion, Extension, Internal Rotation, Restitution etc with baby descent occuring throughout. Theis descent bit is is the most important and a stuck head will warrant a vacuum or forceps or sometimes, a C Section.
When the baby is born the other way round, it becomes a breech. Here, sometimes a foot is the first thing to come out and then it becomes a Footling.
Sometimes the face comes out and then it's a Face Presentation.
On many occassions, where it is vital to just attend something, like a marriage or a party or anything, that appearance is also called a Face Presentation.
If the baby lies transversely and can't come down, it's all upto the OT guys to do their C Section magic.
Armed with all this knowledge and sailing through the Ward Leaving, 16 of us move on to our next posting-Paeds.
I dislike Paeds. At first sight. The Ward is on the 1st floor, right in front of the staircase and is Ward 21. It seems overcrowded at first, till it dawns on me that each kid is obviously accompanied by his/her mother. The Ward consists of small cot like beds with railings and is divided into 2 sections, the first 8 or so cots nearest to the door harbouring the sicker kids.
There are all kinds-Heart disease, TB, pneumonias and bronchitis, abdominal masses, sometimes malignant, febrile rashes and of course, the scourge of all babies-malnutrition and diarrhea.
Just outside the Ward is an examination bed with an overhead lamp where babies brought as Emergencies can be seen quickly. How anyone can examine a baby or a toddler is still a source of constant amazement to me. Everything is so small, delicate. And of course, the kid can give no reliable history.
In Paeds, starting an IV Line is an art and the Pediatricians are called from everywhere to start IV Lines. They are the kid specialists for this kind of thing, better than the Anaesthetists who would like to claim this skill all to themselves.
I can't take sick kids. Many of these will get better but some will not. I have been told that in the process of becoming and practicing as a doctor, one gets detached, sometimes immune to the suffering one has studied so hard to try to alleviate. I hope this does not happen to me, that patients-kids or adults, remain kids and adults and not turn into "Stroke" or "RHD, MS, MR" or "Leukemia" etc. I know it will happen and has already started to happen.
I cannot recall a single patient's name that I have examined. I do recall, however, what condition they had and what the findings were.
The Dept is headed by Chinu-a Senior Professor, immensely knowledgeable and who commands the respect of his entire team. His main penchant seems to be a massive emphasis on breast feeding and there are posters in the Ward reminding us about this. Dr VB is a small, cutish guy, also Senior and is a Neonatologist, a very suitable job description for him at first glance. Dr N is the Second in command, looks very scholarly and is very tall. The Dept is rounded off by DR AB and Dr M but most of our classes are taken by Senior Residents, one of whom is Somya, a lovely lady who takes great classes to boot.
I struggle through Paeds. The subject is similar to Medicine but I have to mug up all the Milestones-when babies smile, walk, turn, run, draw triangles and squares, say da-da and ma-ma and how they grow-head and arm measurements, weights, heights.
Paeds is memorable only for the times I scoot across the corridor to the Duty Doctors Room which has the biggest bathroom in the entire hospital. Closing the door behind me, I light a tar filled nicotine bomb, close my eyes and contemplate the purpose of my current existence for the few minutes. I don't do this often, for the Room is also used for classes and the smell can be pervasive but at times, I need to run out of a Ward full of sick kids and just be alone. One time, Chinu is taking a class when I emerge from a pale blue cloud of smoke and our eyes meet, but I dash out with not a word. Nothing came out of that thankfully.
Having successfully laboured through an exhausting OG posting, complete with Labour Room part Deux, loads of history takings, abdominal palpations and foetal heart sounds, I find myself in the middle of a Ward Leaving which is a breeze. Gynaecology, the focus of this particular posting, is easy, even fun. The only tricky part is Dysfunctional Uterine Bleeding which has hormonal balance, prostaglandins and such things in it and because it is an Exam case, I make an extra effort to get my head around it. But I can't.
I'll just hope I don't get it for exams. The other cases are fine. Cancer Cervix and Endomterium. Uterine Prolapse. Fibroid. Ovarian masses. They are a bit like a surgical case and there is some logic to them.
Apart from the Labour Room stuff and cases, exams also consist of Instrument vivas, an Operative surgery section, X-Rays, surgical specimens and a general Viva. In OG, the major instruments are Doyen's retractors which are used extensively and I have used it in a C Section. Then there are the forceps.
Long and curved, I have seen babies being pulled out with these. The head is held between the forceps and good old fashioned pulling does the trick. Sometimes a vacuum pump is used where the baby is literally vacuumed out. I am told there will be a tray with all these (and many more) instruments kept for us. I'll cross that bridge when it comes.
Of course, no OG posting is complete without a complete knowledge of how a baby is actually born. In detail. There is a long pnemoic for it which goes starts with Engagement of the head and has components of Flexion, Extension, Internal Rotation, Restitution etc with baby descent occuring throughout. Theis descent bit is is the most important and a stuck head will warrant a vacuum or forceps or sometimes, a C Section.
When the baby is born the other way round, it becomes a breech. Here, sometimes a foot is the first thing to come out and then it becomes a Footling.
Sometimes the face comes out and then it's a Face Presentation.
On many occassions, where it is vital to just attend something, like a marriage or a party or anything, that appearance is also called a Face Presentation.
If the baby lies transversely and can't come down, it's all upto the OT guys to do their C Section magic.
Armed with all this knowledge and sailing through the Ward Leaving, 16 of us move on to our next posting-Paeds.
I dislike Paeds. At first sight. The Ward is on the 1st floor, right in front of the staircase and is Ward 21. It seems overcrowded at first, till it dawns on me that each kid is obviously accompanied by his/her mother. The Ward consists of small cot like beds with railings and is divided into 2 sections, the first 8 or so cots nearest to the door harbouring the sicker kids.
There are all kinds-Heart disease, TB, pneumonias and bronchitis, abdominal masses, sometimes malignant, febrile rashes and of course, the scourge of all babies-malnutrition and diarrhea.
Just outside the Ward is an examination bed with an overhead lamp where babies brought as Emergencies can be seen quickly. How anyone can examine a baby or a toddler is still a source of constant amazement to me. Everything is so small, delicate. And of course, the kid can give no reliable history.
In Paeds, starting an IV Line is an art and the Pediatricians are called from everywhere to start IV Lines. They are the kid specialists for this kind of thing, better than the Anaesthetists who would like to claim this skill all to themselves.
I can't take sick kids. Many of these will get better but some will not. I have been told that in the process of becoming and practicing as a doctor, one gets detached, sometimes immune to the suffering one has studied so hard to try to alleviate. I hope this does not happen to me, that patients-kids or adults, remain kids and adults and not turn into "Stroke" or "RHD, MS, MR" or "Leukemia" etc. I know it will happen and has already started to happen.
I cannot recall a single patient's name that I have examined. I do recall, however, what condition they had and what the findings were.
The Dept is headed by Chinu-a Senior Professor, immensely knowledgeable and who commands the respect of his entire team. His main penchant seems to be a massive emphasis on breast feeding and there are posters in the Ward reminding us about this. Dr VB is a small, cutish guy, also Senior and is a Neonatologist, a very suitable job description for him at first glance. Dr N is the Second in command, looks very scholarly and is very tall. The Dept is rounded off by DR AB and Dr M but most of our classes are taken by Senior Residents, one of whom is Somya, a lovely lady who takes great classes to boot.
I struggle through Paeds. The subject is similar to Medicine but I have to mug up all the Milestones-when babies smile, walk, turn, run, draw triangles and squares, say da-da and ma-ma and how they grow-head and arm measurements, weights, heights.
Paeds is memorable only for the times I scoot across the corridor to the Duty Doctors Room which has the biggest bathroom in the entire hospital. Closing the door behind me, I light a tar filled nicotine bomb, close my eyes and contemplate the purpose of my current existence for the few minutes. I don't do this often, for the Room is also used for classes and the smell can be pervasive but at times, I need to run out of a Ward full of sick kids and just be alone. One time, Chinu is taking a class when I emerge from a pale blue cloud of smoke and our eyes meet, but I dash out with not a word. Nothing came out of that thankfully.
'the kid can give no reliable history'
ReplyDelete:-)
- a trait that often carries into adulthood