Heart attack...

Myocardial Infarction[MI] or in plain english heart attack kills people....in just a 6 hours shift yesterday i came across 4 such situations..all of them referred from private physicians...unfortunately these poor people keep roaming from one practitioner to another with no treatment and finally end up here losing that precious 3 hour window period where any medical intervention perhaps will save his life.....

p.s-

am more worried about these atypical presentations[unusual symptoms] of MI...like this one guy yesterday who came with an upper abdominal pain and when i did a fresh Ecg[high suspicion coz of age and associated diabetes] turned out to be angina.....this patient could have been easily neglected as a case of gastritis and put on wrong drugs...

beginning....

1-loads and loads of OPD cases who cleverly bypass it and land up in casualty for medications...[who rarely succeed]
2-road traffic accidents...being a tertiary centre you shoud be ready for this...being a MLC[medico legal case] u shd be extra cautious regarding documenting and handling the crowd...already 2 cases in my pocket today.....
3-emotional ladies......those who are always ready to pop up a tablet for no reason and land up in casualty with their extra caring husband[read frustrated]...am talking about poisoning...from 10 to 40 yr olds female gender this is so common...this also being a MLC you in a soup if u mess up[like the husband when the wife survives].
4-staff patient....real PIA types[Pain In the Ass]....always extra demanding and try to boss u[even a chapraasi is a staff right?]....but we really don't give a damn for them.
5-real sick cases....this is the reason your posted there..do a quick triage and refer to the parent department...this s where your medical knowledge will play a role....
6-help my colleagues-any respiratory case comes am expected to

this sums up my 1st day in casualty today...

p.s-

best part is that you are your own BOSS..u can dictate terms..and also sometimes get to work with nice people :D

5 more days..

5 more days and am out of this stupid department..no ward rounds,presentations,sick cases,fights[with patient attenders] for a month...will be posted as a CMO[casualty medical officer]..cool job....just 6 hrs duties /day and post night shifts off and moreover get to met new people[read  nice interns :D].....yeah baby!!

prove it...

any case which gets dumped in your department [as PTB-Pulmonary tuberculosis] and which turns out to be not so always prove it before doing the same towards other department...

retrospection

Falling sick all of a sudden and taking a leave for the day gives you a rare much needed  opportunity for self retrospection.....

Daily routine of getting up early,OPD,ward rounds,patients sometimes doesn't give you much time for yourself.

Today i had this rare chance...a whole day for myself...where i could just be myself....relax a bit,sleep a lot,think about my past,call some old friends and relive your good old past memories......

p.s-

time for me to reschedule my things more efficiently now....frankly i must say tht poor planning and laziness are turning out to be the reasons why am not as good as expected[by myself] in my work and have to work towards them...

time factor...

when a case comes to casualty...

time taken

for history taking-15mins [with my full blown butler tamil]

for xray -30 min...yeah thats how our emergency works here....everyone here [except the docs] work at their own pace whether the patient convulses,faints or dies

for me to see that x-ray and come to a diagnosis-another 15mins....

means just for a simple cough case i spend a useless 1hr [of my life] and end up prescribing some lame tonic or tablet [cant prescribe genuine ones available outside since the patients cant afford.....they come to casualty with a 5rs/10rs note in their pocket!]

p.s-

1-another night duty yesterday-not much cases but still no decent sleep..coz i had to attend a call at 3am for a simple asthma case....

2-happy ganesha chathurthi :)

holiday....

today we have a holiday and i clearly don't know why[ compensation for some holiday which was cancelled few months back]..

OPDs are closed today and many patients [those who were previosly admitted in wards and come for routine check up] clever enough bypass it and come to ward directly and expect us to see them and prescribe some medications[any thing will do for them....they just want something to swallow]....

Actually i really pity these people for relying on our health system...lack of proper guidance/counselling regarding basic health,lack of planned facilities,the way this govn setup works[takes months for a simple CT scan]...and in a way i feel we are not even providing the basic proper care we are supposed to provide for them being a part of govn health setup......

p.s

[INDIA's population and poverty is not helping either....]

memory stunts...

'there is nothing like good and bad memory but only trained and untrained one'

-Harry lorayne

many say success in any field is 99% effort + 1%luck but i think in medical field its 99% memory and just 1% luck...coz medical science is more of fact based and the little bit of clinics u do is no where near the amount of theory u need to know.Many of our seniors[read profs] say key is to understand the things and do them practically but i think most the things u read/hear cant be seen and its impractical to expect to learn everything just by clinical knowledge.And this problem of retaining things is more so when u r preparing for competitive exams like pg,upsce etc where more than what to remember its more of how to remember.

Just think for a sec..how in gods name are u going to remember the mc se of Carbamazepine drug or the drugs causing SLE by just understanding the subject or agonist of any particular receptor..?? Either u have to study it byheart like we did during high school [even mathematical problems weren't spared then] or just use some memory techniques like acronyms,mnemonics and apply them accordingly.

Making a mnemonic or any acronym is like creating a music..its depends on your personality[like an art] and time and interest u invest in doing it....if u really want to remember anything u just have to invest accordingly and frankly there is no other short cut.

Throught my UG like [and even now] i was quite famous for this among my friends and in fact some of my mnemonics which i had made then are helping me even now for my exams..Some of them are-

rIght-right side heart murmurs Increase on inspiration..

among LAs anything with 2i is an amide...

WTF* pelcan-wimburger,tremmerfeld,franklin line and pelcan spur...scurvy radiological signs

cArbamazepine-Ataxia[mc]>Anemia[most serious]

Sulfonylureas[oral hypoglycemic] patients must be Small-so given in thin patients and metformin in obese...

Imagine a tree @ ur sacred place....Trazadone causes priaprism[painful erection]

Lamotrigine causes a line in your skin-cause Steven Johnson syndrome

Clip on your hair-doc for Hairy CL is Cladribine

key is just to use the techniques accordingly and among these the most powerful one is visual ones[like trazadone] coz what ever u hear/see is visualized inside your brain and in this way why not use it constructively and remember few things!!

p.s-

*wtf-wow thats funny

1-it may be worlds fastest rubic cube solver or some UPSCE topper..its just pure memory which helps them do things they do more efficiently...

2-talking like an expert here doesn't make me one...its just my opinion and little bit of knowledge i have gained during my medical life....

Ego/superego

id-want to go out with friends,movies etc

ego-its not the right time for worldly pleasures since many exams are fast approaching

superego-wont affect my moral consciousness though..

had an awesome psychiatry class[i mean actual classroom class not sessions] this week..just loved it...subj looks nice in the books.

p.s-

just got my net conn back..

ANy one been to inception??....

life @ new home is quite diffn...its an apartment with many children around [who scream all the time] and nosy old ladies...

one of my friends working in PHC is being transferred from his work place for his honesty...am sorry for him and have advised to be less sincere next time..

i just love this..Kangna by Dr Zueus..good old punjabi pop songs [almost extinct now days]

things i miss..

finally with the internship coming to an end [not counting the extension in ENT am doing] i would like to highlight the things which i think i liked and would miss from now on...

1-stipend-this may sound weird but frankly this is the thing i will miss the most..financially it helped and hope from now on i need not work part time till i get into a pg...

2-post duty brkfast-after 24 hrs duty this was the silver lining i was looking forward to each morning[post duty]..nothing more cherishing than a good brky[with coffee] on a post duty morning..will surely miss it [more so since most of the times pgs used to pay for it:P]

3-sisters-will miss those v rare cute sisters whom i worked with and were my good friends....

4-seminar perks-only reason we interns used to attend those boring post lunch seminars was the perk we used to get there-a simple tea/coffee and some snacks [and also a way to escape from ur ward work]

5-free samples-sometimes its tht more than the patients its the medical reps[MRs] who pester u with their products and medicines....we used to get a lot of such samples[most of which i never used] and sometimes even movie tickets!!

p.s-

thts our official pullover of the passing out batch...[brugandi color]...

graduation...

,finally having the degree....

heights of ignorance

heights of ignorance-

a private physician writing NIMHANCE instead of NIMHANS in his reference letter to us...

he doesnt deserve to live on this planet!

p.s-

bored of life/internship!!

my name is...

While working in wards[obg] i come across many people with so weird funny names...like this one lady whose name was "Akkamahadevi"...looks like her parents were too impressed with the goddess and wants to  recite it their whole life.Likewise i have seen many couples where husb's and wife's names sound so similar like Gangappa/gangamma,manjunath/manjula,Mangappa/mangamma etc....dont know whether they married for their names or changed it after marriage....

p.s-

my close friend has contracted swine flu while he was on duty...and luckily has managed to get 10 days leave with attn[that too in med]....everytime i mess him he tells me that he is fine and enjoying his life like never before...lucky dog!!

moments!!

1-today was my penultimate day in medicine...really learned a lot though it was pretty hectic...thts atropine-the "wonder drug" for op compound poisoning[most common here]
2-casualty-place where its hell for interns and heaven[?] for patients!
thts our age old ECG machine!!...

countdown

just one opd to go and 8 more days of med postings...its better to see a glass as half full;)

p.s-people now days r so stupid and careless....for just simple fever and diabetes they come to emergency in the middle of the night for medication...guess wht they do during day time.

bored,frustrated

After 4 weeks of med am totally bored,frustrated and fed up with it...apart from a docs job u also have to do that of an attender like report collection etc and on top of this we have[from this week] to do both icu and swine flu duty.Icu duty now has been extended for 12 hrs now[each shift] and apart from the work its the sound pollution[of ventilators,nurses etc] which irritates u the most and now days coz of too much work load have even lost interest in the cases i come across.Think i really need some stress management lessons right now and an appointment with docs at room 55
Next of batch students r surely gonna suffer with so many duties from the beginning itself.

p.s-
1-n95 mask given to us during swine flu duty...and unluckily 4 of them[a whole family] just isolated here have been found positive for swine flu!!...
2-room 55-psychiatry department

scissors

at 5am today[during my emergency duty] a patient walks in to the casualty and says that he is having loose stools and needs iv fluids[they just demand here].So when i asked him the frequency of the stools patient calmly replies back "150 times"!

a 2nd yr nursing student asks our pg during rounds "sir i want to know some systemic causes of Scissors?"(she meant to say Seizures)

p.s-
1-Wolverine movie really rocks guys..had been to it with my pgs last week...dont miss it!!...
2-

monday

monday has finally arrived...that means its opd day and time for night duty...!!...to be frank i dont like just sitting in opd like a duck and prescribe med to the patients instead i prefer to work in emergency and in the wards....ok then guys bye for now...happy weekday!!..:)

p.s-
no more icu duties for me from this week instead we have SWINE flu duties here in our hosp[inaugrated just yesterday]....one intern and one senior resident are posted here on a rotation basis.

Envenomation

During rounds a patient bit by a snake says to our unit prof "saar(sir) it[snake] just hissed once and i got this bite"
myself and the pgs were literally rofl on hearing this..as if via bluetooth its venom got into his body!!

DAMA

On the first day of my medicine during night duty 2 interns were talking to each other saying that 2 patients went DAMA and they have to write their case sheets...i thought then that using DAMAR[heard it so] word is such a inhuman thing [since DAMAR is a slang word for dead in Kannada] to use for any patient that too among the public there.Later i came to know that DAMA is not DAMAR but acronym for Discharge Against Medical Advice..lol

p.s-one of my friends when told on the phone by a prof that give the patient DAMA replied back "dose sir??"!!!

happy weekend...today again an icu duty till 8pm!!:(...there goes my so called sunday.