Monday, March 30, 2009

seeking some help fro GOD....

When you have limited option and you have to choose one, very sure you will find your hands shaking before choosing one. Same here…. Being a surgeon I am scared with intra-op and post-op complications. I have never come across hardware problems. Orthopedic infections being my nightmares, I always pray before holding knife with my right hand and try to stick with in the principles of sterility. But today is different, I am to operate the old lady of 80’s tomorrow and I am sweating now onwards. The frail lady with difficult fracture and preoperative morbidity including bad chest condition will rob my sleep today. The rare blood group and no blood stock in blood bank, what more is needed to warn my life much before she complicates in the theatre. And his grandson whose eyes are always searching for our faults to point out. What a deadly combination? Had I been a private practioner, I would have said sorry much earlier to them. But medical college you have to accept it and being a tertiory center where you will refer them? She is getting delayed, there is no blood, she can complicate in the ward anytime and her grandson finds us guilty for all nonsense reasons. This is the sorry state of the affairs where you find some people are born headless. Politely I can label him as one of them. Else he should be at least thankful to the hospital for keeping her better than she was.


Earlier I thought I would not be touching this case. But now the matter is different..things have already been decided I will be going to the theater tomorrow. But now I have to and I am scared if something wrong happens, relatives will make an issue out of it. Who knows? they may shout for compensation. This has become the usual trend in Nepal once the patient dies they invariably destroys the hospital property and ask for compensation. How bad the matter is taking shape. If so who will come forward to operate the patients. Because every surgery carries, some rate or mortality be it from anesthesia or surgical point of view. How and when people will understand this? Thank god, the patient who died last time immediately after induction realized the matter that, this is a known complication and they accepted despite the fact some people tried to make an issue to raise our name.


I have to operate upon her tomorrow. I was reading for it since evening and how it can be done smoothly with minimal errors and with best possible outcome. Cannot say about outcome, but one thing sure with minimal blood loss I can do it and can fix it with the implant available with us. My plan is MIS and will convert into liberal incision if I find I am struggling to fix it. Any way I can only plan what happens, happens for best and I have no control over it. Only I can do is the informed consent with maximization of mortality rate to save my skin if something happens during and after surgery. Still my mind says we need to wait for few days for her general condition to improve. But what one can do if anaesthesist says he is ready. I am little confused and praying my god for helping me in such tough situation. As always please God take me out of it smoothly as if I was not entered in this problem either. God bless my patients, bless me too.

Sunday, March 22, 2009

The beauty lies Near by my college. I dont know it cause I am a stupid....

I am not a moron but stupid for sure. I was doing my residency in AIIMS and went to south ex market after 3 months of stressful life. That day I declared myself a stupid, a mere collection of bone and flesh. Same thing happened today. I had never been to the other side of the college. Today I had an opportunity and just took a short walk. A half an hour journey of life and it showed me the real beauty of nature just besides my college. This is how I could capture it in the frame…..



The journey begins…........



Life has limited support, start journey at your own risk….......



Half we have traveled. Half left…say hi to all in same journey, no matter how busy you are. “The lesson I recently learnt from ants…..”



The tough survives and stands still. Rest follow the flow….....



Few inches away and life ends here….



Everything traverses a tough journey before freedom…… see the water how it has escaped…......



As high as deep down! Nature teaches you if you wish to learn….....



Tail lies in the viewer’s eyes.. The mysterious fish tail hiding its other fin…....



The more I think the more I sink… the majestic beauty lies 5 minutes from hospital……..


This is the beginning not the end... Will reach there before I die…..




Slow and steady wins the race.. Each step cut shorts your journey by one more step…..



Give space to all…take a side and keep walking…support your back with your own hand. Life is to travel alone……



The farther the taller….but its not the end… life is unreachable journey…ends before you finish…....



Who waits for you, not even the sun…start again tomorrow…



Not every road leads you there….decide much before you start walking…..think twice, walk two steps behind and proceed one … life is unmistakable then…...






Every little things neatly arranged add value in life.. Gives dimension to life….after all body is made up of such 206 bones……..



Children everywhere are same… they play till they are tired…so was I …...



Everybody gets confused when they have to choose one…..



Though rusted provides shelter to many….everything rusts with time…but remember value is same…....



If you have guts you stand still… no matter there are river both the side……...



Water takes its own course, no matter white water or blue water… it flows downward. Life is like water…....



Take a rest after a long journey.. How it matters, who the near by fellow is? He is an anaesthesist and me a surgeon, we don’t have case today so we are calm here…

Thursday, March 19, 2009

Delhi trip

There are occasions nobody knows what happens next in life? I am blogging from the airport that too I don’t need to log in my laptop and enable Wi-Fi to connect. I don’t need to buy the Wi-Fi coupon anymore. Thanks airtel for everything they have provided. They have installed some of the system called "internet kiosk" inside Delhi airport and here I am.

Writing about self...... No one knows why I was landed in delhi all of a sudden. But for god shake no one asked why? But all asked when? In addition, when are you leaving? Thanks god for their faith upon me. Thanks for knowing me in the form I was. And i promise I will be same.

My family knows why I was hurried to Delhi. I was suppose to attend DNB final exam.

Apart from this event and some monitory loss for plane ticket and delaying the ticket for few days, but I was blessed with many new surprises in Delhi.

Mentioning few of them, my paper was published in the "orthopaedic today" the paper I wrote long time back when I was leaving Delhi. It was a review article for the femoral stem design and its status in world. Remembering that paper, I think writing a review article has now become easy for me. Any body who reads it can judge the implant design and the result worldwide. In fact, it is a review and summary of such femoral designs world wide right from Swedish hip registry, Australian hip registry and British hip registry. I am happy for their faith and many many thanks for my prof. who have tremendous faith upon me. He did not even changed the sentence of it and allowed it to go to the print as it was written.

Another was article call by Elsevier publication. Long time back I send some article to Elsevier. Last time they send it back as they have many articles pending for publications. Now they sent me the mail stating I should write them back for that article. Very interestingly I got that mail. I was checking mail in my senior’s room and he pointed out that mail from Elsevier. "kya bat hai article call kar rahe Elsevier wale tere se" then only I checked that mail. Else I would have considered it as spam mail. Success comes in life as an installment. May be this is the way god wants and happens so.

Worth mentioning was my research paper has been accepted as a poster in Vienna Austria the 10th congress of EFORT starting from 3rd June. I wish to be there if things are favorable, else my prof will present it. During my Delhi stay, we have already finalized the slides for the poster. With in few days it will be printed.

The other being I checked my ranchi SBI account with ATM card and found some cash in some 5 digit. I never had an intuition that the increment of the internship will be forwarded in the same account. Thank god, it helped me a lot to buy my MRCS books. I was almost bankrupt in Delhi because my debit card was not working there somehow. This is the reason I prefer to carry cash. You never know when your card stops working.

Will update some more once I am back to home. It’s difficult to type while standing that too from the airport. It’s wise enough to leave this system to otherpeople who needs more to check mails. Have a good day…..got a boarding pass but not yet boarded inside the flight…..

Tuesday, March 03, 2009

God please help me:):):)

how he came to us......all bones exposed in the arm right from shoulder joint, and muscles crushed, nerves unidentified and vascular compromise. Almost dead limb difficult to look at it even with multiple bone fractures. a ray of hope to give life to it. there is nothing more than humanity, only hope that made me to work for hours and hours is the young age. he has long life to go ahead, and he has potential to heal himself if we do it in correct time and correct way. if the limb is 40% useful of its normal, and its his left limb its better than cosmetic artificail limb. keeping all things in mind i devoted myself like a donkey, not listening what others say, be it senior be it junior. i have 2 ears to listen and one mouth to talk.









we did all the experiment to make it viable, i did what i could imagine and what i could memorize. but the only hope is its immediate change of colour towards viability at the end of day. this gives me a smile in my face and finally it has gained the shape of a limb. even it cannot be salvaged, i would be happy to say myself that i left nothing for it.and the relatives know what i have sacrificied for it. hope the poor people's thanks really works for me. God please listen to him, god please listen to his parents and of course me too:):):)





Saturday, January 24, 2009

Happy me...


BEFORE WITH DISPLACED FRACTURE




COFMORTABLE CHILD.



AFTER ARM CHEST STRAP.


Life is challenging though funny many times. I am taking round alone with medical officers and interns. However, I was consultant on call earlier also but the Saturday is the first time I am on call. Saturday is holiday and the big boss of morning round is no other than me. ha ha ha.


I was proceeding and medical officer tried to give some unnecessary information to save his ass leaving the responsibility to juniors. I said whoever does, its not issue, if not you people I will do it. But, it should be done. Same time I was smiling for what he was trying to do. I memorized my residency and compared how people changes with time. Our colleague used to do same thing and consultant used to screw our ass publically.. However, I always took my responsibility and said sorry but no excuses. Today I gave them the space to face responsibility not that I scolded like hell. Let us see how people react to it. Definitely, these juniors will not put me on the topic and abuse me in tea time. If at all I will be discussed I will be discussed with reference of my parent institute. See the difference he is from AIIMS, but funny thing is same things happens in AIIMS too. ha ha ha


Was having lunch and got a call that a precious child during delivery got his arm fractured while the gynecologist was applying force to deliver him out.. These days my brain is storming with these precious child things. Went to the ER and tried doing new to him so that he suffers less and fracture takes its better shape. Immediately came to room and searched the literature. Its not a common fracture that one can say do this way and it is best. People have tried their knowledge but all have union since the kids have tremendous capacity to heal themselves be it a bone or soft tissue. Tried to give splint to the limb but found it will loosened with time once the child starts moving limbs. I was reluctant to put U slab/plaster because the child skin is so soft it peels like potato with plaster. So I wrapped the upper limb with adequate cotton to the side of chest and strapped with bandage and adhesive tapes. Got the x-ray and its fantastic. Remodeling in children is so much that small deformities are corrected with time. And our’s was a minimal deformity after strapping. Abundant cotton will keep the baby warm too.


The tragedy started after that. Gynecologist had already discharged the patient since the child was delivered yesterday . Since it was male child the pampered parents wants to go home today and celebrate with the relatives and neighbors. Feel pity for them being proud of producing male kid. The mother burst into tears that she wants to be in home for her comfort. She hates to be in hospital. I convinced stay for 2 weeks in hospital and we will discharge. But she was sure she can come after week or so. I called her after 2 weeks so that by the time it will unite. Only concern is the cotton gets loosened and deformity may progress. Hope the mom can still maintain the position so that the kid is least disturbed. Praying for the god for his best outcome with the less deformed arm. There are few moments where I feel proud of being a doctor. Its one of them……..

Saturday, January 17, 2009

Me here....

Fine and happy here. Joined as a faculty in Manipal College of Medical Sciences in pokhara. Alloted a hostel a better one and shifted fully. As i used to say it’s a beautiful place in Nepal, the most visited place in Nepal by the tourists. Life is cool and happy . I am usually free by 4:30pm everyday. Now life is so comfortable that you keep on asking over the phone and the rest will be done by the juniors. This is what they call at one level one becomes senior same thing has happened to me...... very funny though, unknowingly I have become senior. ha ha ha ha. I still remember those tough days in AIIMS, where I missed most of my dinner lunch and the day breakfast used to be irregularly irregular. Moreover those were the residency days and one has to undergo the tough situation to make him fit to bear the most untoward. That is what medical science believes,,, I guess so..

There is nothing new. I have not yet got the internet connection. I knew from the private internet provider that the college provides the broadband to the faculty that to free. "ye to chandi hai na dost mere liye, jiske pass TV nahi hai, nahi hai BIWI" :):):):):):).

My favorite time pass as usual has become to sit in the library. Though small the library meets my requirements. Books I have already, silence and clean it is but the separate study area for faculty, that's not fair. Why to bar us from sitting close by beautiful .........? ha ha ha thats entire a joke, nothing serious plz....

Tomorrow is Saturday and the national holiday or the week's end. So I may get the internet on Sunday cause it is the working day here. Hope by god's grace I would be able to get the connection the same day. If not I would be going to buy a wireless. As usual I am a moody and cannot wait long to get what I want. However I don’t want to connect with people through net but still it’s my weakness to roam at the deepest page of World Wide Web..... Most of the time I click one page and don’t know where I end too, until and unless my eyes says me "stop it please"

There is nothing more to write now. Wrote every craps saying nothing to write but leaving nothing unsaid. Eeeee Eooooo....

God bless you all. Praying for you all....

Thursday, January 15, 2009

The update....

hey friends!

I am still taking few more breaths in this Earth. Have joined MCOMS Pokhara. For the people unfamiliar to this MCOMS, it stands for meanipal college of medical sciences and located in the beautiful place of Nepal. Nepal itself is beautiful no doubt but when it comes to pokhara its simply beautiful. Not yet explored but what i see is too much. And the place i work is great.
Does not look like a medical college, looks like a corporate hospital. dont know much about the working pattern and culture but must be good, as it is able to maintain the same spirit since couple of years.


Shifted to hsotel and fully started a hostelier life once again. but the new hostel is a different. Not like a usual hostel,i was staying since last 10 years of my college life. hey people the weather is not wild like kathmandu......Anyway happy and confortable......:):):)


Will update with photographs soon.......:)

hello hello hello....... I am back....

Dated 09-01-09
All the people in Delhi I miss you all, esp S:). I reached safely. Though it was very difficult to get the returning ticket, the flight was almost empty. There were only 25 passengers though the capacity of the Boeing was 180. This reminds me why the government owned airlines collapses. People say THAI and RNAC were started on same day but see THAI and RNAC, its nowhere we can compare man. Similar was the condition of Srilankan airways, but once it was owned by AIR France it has gained momentum and it’s probably the best now in south East Asia.

Since I came home, I have become a foodie. I don’t mind if I gain wt by few kilos this time. Cause I can gain a victory over weight so its not a problem for me to reduce weight as and when required. The whole of my intestine has probably turned greenish this time. I don’t mind to have any green vegetables now, only criterion is it should be cooked.

I have just finished the medical council work. Got all the papers to practice as a bone fixer in Nepal. Paper wise I have already joined the medical college but the presence is necessary to raise my counts in meter, a meter that determines my salary. Again I have to open a bank account, wherever I go I open an account. So far, I must have so many accounts that it is difficult to remember the signature and pin code fir ATM cards. In this era of inflation and regression, I sometimes doubt why money is not safe if they are kept in home too. So why to open a bank account? But poor me what I can do if they ask a bank account. Whatever, money makes you slave and you will be ready to open even two bank accounts if required.

Will meet the nation’s best orthopaedicain on Sunday morning and discuss with him if there are chances to stay back in kathmandu. Else, I will continue with what I have done in MCOMS. One year is what I need to do what I wanted to. So MCOMS is not a bad option at this phase for me. And I know I am not a bonded labor so I am free to move wherever I am comfortable. My time, my comfort, and my expectations are the priority wherever I go.

Kathmandu is freezing day by day. The sudden exposure to cold had made me uncomfortable. Running nose and dry cough has once again troubled me. Heard that pokhara is comfortable than kathmandu climate wise. Even air ticket is cheap to pokhara :D. See you soon pokhara, wish me a good luck guys:):):)

Sunday, January 04, 2009

Few words more.....










“3W’s are never predictable” was the favorite slang during undergrad days. If I am permitted, I should explain all 3 W’s first, namely WIFE, WINE, AND WEATHER. Hey, you I am unaware of two of those. Bachelor by choice until now, never drank alcohol in any form, but more interested in weather. However, all three are interrelated. Mainly weather has more justification to both of those they say to satisfy their action. Before you could jump upon any speculation, let me clear about it. I do not want to comment upon WIFE, the novel relationship god has created. WINE I can but I don’t want because it has never attracted me. Only left is WEATHER. Moreover, my few words are incomparable to describe weather where people have tried writing pages and pages since ages.

Last night my knees were so cold that I was barely sleeping. Heater was not working, and I don’t enjoy putting clothes while sleeping. Hey hey hey! don’t say I sleep naked :D Early morning I could feel my knees as a mass of ice covered with flesh. Stiff, creaky, crunchy, and detached. What I mean to say is Delhi suddenly allowed the temperature to drop and as usual I say this winter is the worst winter. Foggy, misty, lousy, lonely, shaky and suddenly arrhythmic.

I am already on the reverse count for my stay in Delhi, better say India. I had a ticket on 4th. Though I planned to leave on 8th after attending convocation. Unfortunately, this convocation was not for us as they informed at the final moment. I cancelled just because I want to meet all who loved me and helped me during my stay. Still few are left to meet so I cancelled the ticket and got it for 7th. So, three more days to go. I feel like staying but time does not allow me. I am finally leaving on 7th. Hey people unaware of my next life, let me share my happiness that I am appointed as a consultant in a medical college in Nepal, consultant orthopaedic surgeon. The happiness is limitless. PLACE, PEOPLE AND POSTING all 3P’s are the best in the place I am going. The mini Switzerland of Nepal I should say, though I have never been there. Last night I was busy googling the pictures from POKHARA( check the pics). For a mad like me, the natural beauty is all, which makes me happy. Happy sleeping, sweet dreams((((

Thursday, January 01, 2009