To Let Live or Not?

Who gets to decide whether a life is worth preserving or not? Who gets to decide the fate of a newborn who hasn't yet seen the world?

A newborn who might not be able to appreciate the beauty of life. A newborn who may forever be dependent on external support. A newborn who may never be able to fully reach his potential. 

Or who may…

Who may actually be a boon to mankind. Who may entertain millions with his talent. Who may find the cure to cancer. Who may just live a happy life. Who may survive as a fighter. Who maybe just another person LIVING.

Is it the doctor who works his best to save him/her from becoming an ‘it’? For a doctor it might just be an achievement... The 'I saved him' tag. The 'I gave him a second life' tag. But, is he going to be a part of his life forever? No.

Is it the parents who waited patiently to feel the first kick, to hear the first cry and then find out that the baby is 'defective'? Afterall, they are the ones who are going to live with the child… or maybe ‘bear’ with the child (harsh but true words). For some of them, the child maybe a 'burden'- a drain on their personal resources- time, strength and finances. But for others the child can be a pure source of joy.

I have seen the way a mother's face lights up when she sees her baby for the first time. 
I have also seen the way her eyes swell up when she hears that her child needs corrective surgery and that her child, being the tiny being he is, may not be able to survive through it. 
I have seen the way a surgeon's face lights up when the child survives the grueling surgery and the critical post-surgery days. 
But rarely have I seen a doctor getting really emotional about letting the child go. (A defense mechanism that comes with experience, to keep working and carry on with duties.)

So what happens when a neonate's fate is to be decided? What should be done when the decision is to be made? Whose decision is more important- the doctor’s or the parents’?

What should be done when a neonate goes into cardiac arrest? A doctor can save him with the CPR... But those crucial minutes of lost oxygen may render him a vegetable for life. An adult gets the option to sign a DNR (Do Not Resuscitate) to be saved from the torture of ‘hanging up there’. But a neonate? Who gets to decide for them?

What is more important? Saving a neonate from death or saving a LIFE? Giving the ability to breathe or giving a life?

The emotional turmoil of a young doctor can rarely be cleared. These questions don't really have any answers. Experience may just harden up our souls and hearts- make us indifferent to some things.

(Apologies to the Grammar Nazis for the chaotic language.)

On the way to Eradication (Feeling proud)

Today, on 13 January 2014, it has been exactly 3 years since the last case of Polio was detected in India. Continuous efforts at various levels has brought us to this landmark- India is now Polio-Free.

As a kid, I saw a case of poliomyelitis and felt sorry for the bhaiyya suffering from it. As a student, I read about polio in books and realized there is no cure- only prevention. As a fresher medical student, I saw polio cases in the hospital and saw some hope for the paralyzed victims- in the form of rehabilitation. As a senior medical student and intern, I was a part of the prevention programs. And that! That is what I can say makes me proud.

First duty. Ghonda, Delhi

My first Pulse Polio posting was in a corner of Delhi I had never heard of. When I reached the center (a government school) on the Sunday morning, I saw a long queue of kids waiting to be immunized. The awareness created for the immunization drives is one key factor making us reach this milestone today. There are prominent banners all over, loudspeakers announcing the dates, celebrities advertising on televisions and radios, schools informing people. Usually everyone knows about a ‘Pulse Polio Ravivaar’ (Sunday).

Loudspeakers announcing the Pulse Polio Ravivar. Palam, Delhi

On subsequent immunization drives, I came across the difficulties that the drive was facing- the stigma amongst the various sections of the society regarding the vaccine. The worst was the myth that the vaccine leads to infertility. (Oh! This one got me facing a mob of angry people because I gave the ‘do boond zindagi ke’ to a 5 year old Muslim boy who came unaccompanied). For some people, polio is just a disease of the poor that cannot affect their rich kids. Problems for all classes.

Health talks by medical students (in the community and at the health center). Kalyanpuri, Delhi

But, the difficulties were overcome by awareness programs, political reforms, rotary organizations, international aids and global goals. There have been huge groups of volunteers who went door to door, who sat for hours educating people, creating awareness, and putting a stop to the spread of this deadly virus.

Ice boxes being prepared for maintaining the vaccine vials. Palam, Delhi.

When we were immunizing children one at a time, none of us realized that we were being a miniscule yet vital part of this gigantic national (rather international) effort at eradicating polio. We were paid 25 rupees (50 cents) for those duties. It’s not then, but now that we have truly been paid! Paid in full with the joy of knowing that history is in the making- that polio is now going to be limited to textbooks- that no kid will be exposed to it ever again!

Child by child. Country by country. Region by region. Polio is on its way out! Cheers to that.

Modified Kubler Ross Model for Surgical Grief

 

Disclaimer:

Iam not responsible for what is following. This is a joke and in no ways meant to hurt the sentiments of any doctor/ profession/ institute/ patient/ or anybody or anything. Also, I do not take credit for this model. Iam just putting it up.

 

"Modified Kubler Ross Model for Surgical Grief"

What do surgeons do when they are confronted with a post-op patient of theirs who isn't doing as well as expected? They undergo the following stages-

1. Cursing
• !@#@$% "Why are you disturbing me? Iam tired from the long surgeries."
2. Denial
• "Who? My patient? No way... The operation went perfectly fine (read as patient came out of OT alive!) You got to be kidding me! He is fine and you are wrong (whatever it is you are trying to tell me- Iam not listening."
3. Anger (read as cursing under breath)
• #@$&*^$#
4. Bargaining
• "Listen, why don't we try to cover this up..." (actually this stage never happens. Skip to 4)
5. Acceptance
• "The operation didn't go well. Lets do some more tests and correct it before it is too late."
6. Depression
• "My spic-n-span rates are dropping... Nobody will come to me for surgeries anymore."
7. Cursing!
• !#@#@#$@ "Why did this have to happen to me?"

Read Disclaimer again!

 

Soulless??? (Scrubs Diaries 4)

Death is all around. More so in a hospital. I haven’t been in a hospital long enough to get used to death on a daily basis. I have only been a medstudent and an intern. Both are phases of a doctor wherein everything is new, exciting and adrenaline inducing. Yet… Yet, one would always remember the first death they saw, the first death they blame themselves for, the first death that could have been prevented, the first pediatric death. What is important is that one should also remember the deaths they actually prevented, the lives they actually saved. The balance of our memories is what will keep us sane. That, and of course friends (Twitter friends too) get us through.

 

Like Dr Cox says death is joked about just to distance oneself, to get by. The doctor needs to move on as soon as possible. The doctor needs to get past the emotional aspect of it in order to carry on with work, and in order to learn from it and if possible avoid the next one. Learning from every mistake is important. Mistakes in this field are fatal.

So, doctors do tend to seem soulless over time. But, that is only to preserve the soul they have.

No copyright infringement intended.

 

Gross! (Scrubs Diaries 3)

This scene from Scrubs reminds of a case I saw in the surgical emergency of Dr RML Hospital. This young guy in his late twenties comes with his index finger wrapped in a cloth. His finger apparently got stuck in a hotel food processor. And when he unwrapped the cloth- lo behold, the sight was Gross! The distal phalanx (that would be the top one-third of the finger) was exposed to the bone, covered in blood… and when he shook his finger in pain- a piece of muscle fell in front of me. Inspite of all this, he had a big smile bordering on a LOL face- I thought he was either high or being a 5-star-hotel-employee, I thought the smile was a permanent feature! Well, it wasn’t any of those, it was a mature defense mechanism that our body has, to cope with the immediate excruciating pain… (The body never ceases to marvel!) (Even in the clip, Ben seems to be fine with the nail in his hand- defense mechanism again!).

Anyways, what did I want to do when I saw that? I wanted to faint (just like JD did) but I didn’t. As an intern we see many things that would make us woozy! But, as a matter of fact- I have never seen or heard of an intern fainting at the sight of blood or exposed anatomy. Why is that?

Well, I can say this for me (and I think for most medical interns)- such things are thrilling- it may sound rude, but it is the fact. There is an adrenaline rush that gets you through it. You don’t want to miss out on the learning experience- you want to be in the spot and see how it is going to be managed. You want to be of help and be proud of it. Also, being exposed to dead cadavers and gross anatomy on the very first day of medschool helps! (There are people who faint then).

Sure, stuff like rectal examinations, or inserting a Ryle’s tube and getting vomit all over yourself, makes me want to vomit! Gross Gross Gross!!! But these urges certainly dont get in the way of finshing up our work.

No copyright infringement intended!