Sushruta ‘09

Clini --ChoreaCLINICAL SECTION

1

Sushruta ‘09

Index

I don't want to do my MD but what else can I do?Dr. Saranya Sridhar

Biomedical Waste Management Dr. D.K. Mendiratta

WHAT HEART HAS TO SAY!!! Neha Pandey

The Fear of rejection in a Doctor-Patient Relationship Dr. Rajnish Joshi

The Good Death Dr. Amit Bhatt

Hypnosis and CrimeDr. Vishwajit, Dr.Aloke, Dr.Sandip

Medico's Love Letter Manish Kumar Singh

HOSPITALS - A BREEDING GROUND FOR DISEASES Anupriya Singh

MICROBIOLOGY OF MEDICOS Neha Pandey

No Longer Gage!!! Nayan Chaudhari

Ig Nobel Prize Pawan Kandhari

Blunders Par Excellance!!! Aditi Jain

Why did I choose Medical Career Option? P. Keerthi Kundana

19

7

15

10

4

16

19

9

12

14

18

17

20

2

Six months back when we chose to accept this responsibility, our hearts were filled with

a feeling of fear, which today has been completely taken over by one of accomplishment and victory as we successfully present before you the Clinical section of Sushruta 2008-09.

After a lot of mind pestering, we chose to name it CLINI-CHOREA which actually denotes “A dance to play in a clinical way” as our motto.

This year we have tried to give this supposedly monotonous and serious section a “make-over”. Therefore though we had articles pouring in on a plethora of issues, we carefully excluded plain information-based ones for which we believe there is no dearth of medical books and journals. Our aim has been not to burden your minds but to lighten your moods by presenting information in an interesting manner but how far we have succeeded in our attempt is for you all to judge.

Hope you read and enjoy this special part of the magazine. We promise you that these new ideas and facts are really going to woo your minds. We thank our beloved teachers and dear friends for their generous contribution.

Our special thanks to Dr. Anshu madam for her indispensable guidance and Mr. Nayan Laxman Chaudhari for his co-operation. Hope you read and enjoy this special part of the magazine. We promise you that these new ideas and facts are really going to woo your minds. Wishing you all a pleasant time going though Clini-chorea.

- EditorsNeha PandeyAditi Jain (2005 batch)

Clini--Chorea

Sushruta ‘09 3

Sushruta ‘09

About ten years ago, I entered MGIMS to idea that I might be doing something new was a little start my MBBS degree fixated on becoming one of heady and intoxicating. I got hooked to asking the many doctors and surgeons whose heroic life- questions, which was fuelled by the next summer saving efforts in Reader's Digest inspired me to spent in the Biochemistry labs doing ELISAs, pursue this career. But over the five years of lectures measuring responses to isolated candidate vaccine and clinics, I wondered whether an MBBS antigens and mulling existential and scientific automatically meant that my next career step is an questions with PhD students. I was intrigued by the MD. I continued to half-heartedly study and write my idea of research, although I continued to post-graduate entrance exams, concentrate on learning the side-hesitatingly venturing to find effects of calcium channel blockers options beyond MS and MD. In and the treatment of pancreatic hindsight, my vacillation to break cancer. the mould and shackles of Internship made me realise expectation (my father still that I wanted a break from the clinic believes that I should have and ward and I decided to apply for become a practicing physician) some research PhD positions. I lay rooted in limited knowledge of applied to the National Institute of my options beyond the MD and Immunology (they like having MBBS MS. I am uncertain that make life- students!) for a PhD program and defining decisions aged 17 is the wrote my GRE's to apply for Masters best time to decide your career. Programs in the US. I also applied for Unfortunately, I realised this when I a scholarship during the last few was close to finishing my MBBS, months of my internship for a PhD at which was not necessarily the the University of Oxford (D.Phil as it is best time for career enlightenment. called in Oxford) which I was lucky enough to get. I am currently on a different path to the The option of going to Oxford University to do a PhD traditional MBBS- MD-MCh route, having done a PhD, and have someone else pay for it seemed like an finishing a Masters and headed for an academic opportunity too good to miss. I still harboured aims of research career. Last summer, I spent some time continuing my medical career after the PhD after with a few students back in MGIMS. It was suggested all, what else was I good for? that my experiences might help some others like me For the scholarship application, I had to who weren't entirely persuaded by the MBBS-MD identify a professor that I would like to work with and a route, although closer to 30 than I wish and currently research area of interest. I had to make a decision unemployed, you might be careful of following my about what aspect of scientific research interested lead. Most of this article is a distillation of my me and whether I would prefer to work in a lab or interaction last summer and I hope that by reaching pursue clinical area of research. I chatted with a few a wider audience it encourages people to think a seniors, realised that the options were endless and little bit more about their future by relating the variety there wasn't really a right choice, just the best one. of options that I explored after finishing my MBBS. I My options included most areas of research open to can only hope this article does not deter you from MBBS graduates whether they seek a research continuing to be a doctor, for I wish to read about career abroad or in India.you someday in Reader's Digest, but rather I do hope I was keen to work on vaccines, so I had a it deters you from asking “what else can I do after choice of departments and areas to choose from. MBBS but my MD?” My options included being part of designing and

My first steps on moving away from conducting clinical trials of malaria vaccines in pursuing my MD can be traced to the rather hot Africa and the UK, a career that would have allowed summer of 2000 when I spent many a days with my me to continue my medical training a little bit and batch mate Chandan scootering to the use my medical training. This career option might Government TB clinic in Wardha. We were collecting have resulted in pursuit of a medical career in the UK, sputum samples, which we brought back to grow on so if you wish to continue clinical work and the greenish-blue LJ media. It was the first time I was academic research early after MBBS, this is not a in a position to ask a question the answer to which bad option. The other option was to undertake didn't exist in a textbook or professors' lectures. The laboratory work in immunology primarily working on

“I don't want to do my MD but what else can I do?” SARANYA SRIDHAR, 1997 Batch

saranya.sridhar@gmail.com

4

Sushruta ‘09

samples from the human clinical trials or doing basic one of my colleagues, molecular biology work designing vaccines. Another an MBBS from India is area of interest was genetics, understanding genetic undertaking a PhD susceptibility to disease. However, most of these were project to investigate laboratory work. I did meet doctors doing many the ru ra l hea l th different things, just to give you an idea that if you are insurance system in interested in something there are ways to pursue that Karnataka to see stream. I met surgeons who worked on improving whether it works to transplant uptake, someone interested in drug improve health for development and working in a chemistry lab people.developing new drugs, doctors working to combine T h e nano-technology with drug delivery, another doctor Masters in Public who was a hiker and interested in altitude hypoxia Health (MPH) is and physiology and a few who ventured into the field a n o t h e r of behavioral psychology and psychiatry. Most of i n c r e a s i n g l y these are research based careers, which either popular career meant that you pursued a PhD and a research career path that I briefly or you incorporate research as part of your clinical considered after career. MBBS and am currently pursuing. Ten to

If you are keen to be part of medical fifteen years ago, pursuing this career path research, choosing MDs in B iochemist r y, necessitated going to the US or Europe, but Microbiology and the other basic sciences is an increasingly institutes in India are offering this course. option. A large part of your medical career is spent So, what happens after you do an MPH? Most MPH pursuing research in their field along with the added graduates might work in either government advantage of teaching and being affiliated to a departments, academic institutions as researchers or medical college. global think tanks and health organizations like the

There are other options that I briefly thought WHO, UNAIDS, Gates Foundation as program about which is especially good for those interested in managers and later program directors. As a doctor doing something different with their medical training. you are eligible for admission to the MPH program Bioinformatics is a developing field that requires either after your Post-graduate degree (post MD) or people interested in computing with a biology immediately after MBBS. You could either do this after background. This is an excellent area to work in and is MBBS and then come back to doing a MD/MS or can slowly coming to play an important role in medical do it after you finish your MD/MS which is an option technologies and pharmacology. The field has taken by many consultants. If you decide to do an mainly been populated by computer scientists but is MPH after MBBS in India, it does make it a little difficult now looking for medical professionals who enjoy for you to write your PG entrance exams. On the other compu t i ng enough to unde r s tand t he hand, if you plan to take a break to study for those computational theory and techniques involved. The exams, doing an MPH on the side is a useful long term career option is not restricted to academic qualification. There are a number of specializations in research but extends to working in pharmaceutical public health epidemiology, biostatistics, companies. The other exciting area is systems biology environmental health, occupational health, which also makes use of computing techniques to maternal and child health, nutrition, social behavior answer some very basic biological questions from a and health and the list is endless. I am currently doing different theoretical perspective. a Masters in Epidemiology with a focus on infectious

An equally exciting career option is health diseases at the University of California, Berkeley. The policy, which I briefly explored by taking a course in field of public health is too broad for me to talk about the subject. The long term career options here are to here, but one suggestion for many MBBS graduates is either become an academic in this area or part of a Clinical Epidemiology. This is especially suited for think-tank NGOs, UN organizations or working in the doctors especially those who wish to continue clinical publ ic sector evaluat ing, designing and practice and broadly speaking involves learning how implementing different health policies. This is a great to design and analyze research studies that improve area to work in, often the domain of bureaucrats and clinical decision making and feeds into the broader experts from social and public policy and needs area of Evidence based medicine. doctors who can contribute medical expertise to the The other option for those who wish to do health policy debates. This is ideally suited to doctors something different is called Clinical Research. The who says,“ I would really like to affect more people field of clinical research involves the design and than to keep treating one individual at a time”. To work conduct of clinical trials and is currently experiencing in this area, you might either pursue an MD in a boom in India. The influx of foreign pharmaceutical Community Medicine or an MPH specializing in companies and the growth of the Indian R&D sector health policy and systems. To give you an example, has increased the demands for trained workers in this

5

field. This is a natural progression for many doctors advanced degrees in science are opting for is who would like to be continued to be involved in scientific and medical publishing and journalism. It some sort of clinical work while not spending does require command over the language, but everyday at the hospital or private clinic. Medical medical professionals are naturally advantaged in professionals tuned to the Indian regulatory set up understanding medical and scientific jargon. The are highly prized and compensated in accordance. BMJ, NEJM, Lancet all require junior editors and staff Many companies, institutes and universities both in and positions of this sort while difficult to get while India and abroad offer training courses in clinical staying in India, are not impossible. One of the ways research as well as offering a Masters of Clinical to explore whether you might like such a career is to research, which then allows you to either continue in write for the Student BMJ, Student Lancet editions this career as a researcher or work for and become a student editor. This should allow you pharmaceutical companies or set up your own both the experience when you apply for such C l i n i c a l R e s e a r c h positions and the extra Organization. qualification on your CV. A

I finally chose to more recent career path is undertake laboratory-based the combination of legal research in molecular biology skills with medical expertise. and immunology working to The National Law School is develop a malaria vaccine. I Bangalore offer a Medical was advised by my seniors Law and Ethics distance t h a t a c q u i r i n g s o m e learning course which is laboratory skills might be attracting a number of extremely handy for a future medical graduates. It is an research career. Four years in interesting career for the a laboratory and I decided I future in the light of the preferred human interaction consumer protection act as part of my job description extending to the medical r a t h e r t h a n a c l o s e profession and the growth relationship to mice, which is o f l a r g e m e d i c a l why I sh i f ted to doing corporations. There is also a epidemiology. very interesting research

Most of the options I component to undertaking have outlined above allow work in this area with issues you in some way to keep in o f med ica l p r i vacy, touch with the medical field, but there are other confidentiality and informed consent in India waiting options for those who wish to make a drastic career to be explored academically.change. The IAS has become a favored destination The above list that I thought of is neither for MBBS graduates. However, in this discussion I exhaustive nor detailed for anyone to base their would submit to my more experienced batch mate decisions on. Rather, it seeks to provide a taste of the Karthik Adapa for advice on navigating this career different opportunities that exist today. The MBBS path. I understand that he would be more than degree seems to have become like any other happy to talk to students interested in pursuing this professional degree, equipping you with unique career path. expertise but also with a set of transferable skills that is

I wish to put forward another option that I valuable in a non-medical marketplace. I hope that wished I had considered when I was finishing my you make a more informed and careful decision MBBS. This is the option of working for financial about your future career, irrespective of where that consulting services like McKinsey, Monitor, and decision leads. Accenture. This is a favoured avenue for many MBA, I have often been asked whether I economics and mathematics graduates. These planned my path to where I am today, and my companies which mainly advise other financial and unabashed reply is the negative. I am currently business ventures also advise Pharmaceutical doing a Masters in Epidemiology after having spent companies on their marketing, business and four years working in a laboratory with mice getting a investment strategy and are therefore not averse to PhD and I assure you that I am still groping to find that employing medical graduates. A few companies rather elusive utopian job where every morning is not also have a global health component a a chore but an exciting challenge. The only department that is involved in working on issues difference is that I have a better idea of what I want concerning health. The competition is fierce for now than I did five years ago and that can only be a these positions, but it is a well-paying job, but involves good thing. I hope this article allows you to make working hours that would remind you of being back that decision earlier than I did. in the ward.

An option that many PhD graduates with

Sushruta ‘09 6

Sushruta ‘09

Biomedical Waste Management Dr D K MENDIRATTAOfficer In charge, Student Council,

Prof & Head, Microbiology.

Biomedical Waste or Health-care waste sanitary) , waste collection & disposal staff & general (BMW / HCW) is a by product of health care and is the public ( dumping in municipal dustbins , open Waste generated by hospitals, healthcare spaces, water bodies etc.). This potentially establishments and research facilities during the hazardous waste may cause in humans beings : diagnosis, treatment, immunization and associated HIV, Hepatitis B & C , GIT , Respiratory tract, blood research. BMW generation by region has been stream & skin infections , tetanus , intoxication and reported to be ranging from 7 - 10 kg / bed /day in N effects of radioactive substances etc, while in America to 1.4 to 2 kg / bed /day in Eastern Europe. animals & birds it may lead to choking ( plastics) & Estimates of HCW in South East Asian countries has injuries ( sharps) and chemicals such as dioxins & been reported to be 0.25 kg / bed / day in Bhutan , furans may result in serious health hazard. WHO 0.36 kg / bed / day in Sri Lanka , 1.06 kg / bed / day in estimates that a single needle stick injury from a Pakistan , 1.16 kg / bed / day in Dhaka & 1.5 kg / bed / contaminated source has the potential to case HBV day in India. With respect to source it has been infection in 30% , HCV in 1.8% & HIV in 0.3% exposed estimated to be 0 .05 - 2 kg / bed in PHC, 0.5 1.8 kg / individuals. A National surveillance (1996) on bed in district hospital , 3.1 - 4.2 kg / bed in General occupational HIV infection revealed that among the hospital to 4.1- 8.7 kg / bed in University hospital . medical personal 70% Nurses were affected and

Between 75% and 90% of the HCW the commonest mode was needle stick injury. produced by health-care providers is non-risk or Another study from India in 2003 revealed Dioxin in “general” health-care waste, comparable to the tissues of humans (170-1300 pg / domestic waste. This comes gram fat: Normal- 1-4pg/Kg), fishes mostly from the administrative chicken, goats, birds and Ganges and housekeeping functions of river dolphins. health-care establishments and In India, concern for m a y a l s o i n c l u d e w a s t e medical waste was an outcome of generated during maintenance judicial and NGO interventions. of health-care premises. The Ministry of Environment and Forests remaining 1025% of healthcare came out with the first draft rules on waste is regarded as hazardous / bio-medical waste in 1998. The risk waste and may create a Cen t ra l Gov t. no t i f i ed the variety of health risks as it contains management and handling of bio-pathogens (bacteria, viruses, medical waste in exercise of the parasites, or fungi) in sufficient powers confirmed by section 6, 8, concentration or quantity to cause 25 of the Environment (Protection) disease in susceptible hosts. Act 1986. Short title of this is “Bio-

The risk waste includes Medical Waste (Management & Handling) Sharps ( hypodermic needles, scalpels and other Rules, 1998 (envfor.nic.in/legis/hsm/biomed.html) . blades, knives, infusion sets, saws, broken glass, and This document included thirteen (1-13) rules, five (I-V) nails), Pharmaceutical waste( expired, unused, spilt Schedules, three (I-III) forms and two (I-II) annexures. and contaminated pharmaceutical products, The document was amended in 2000 & 2003. These drugs, vaccines and sera that are no longer useful.) , rules are applicable on all persons who generate , Radioactive waste(sol id, l iquid,andgaseous collect , receive , store , transport , treat , dispose or materials contaminated with radionuclide) , handle waste and on all institutions generating BMW Chemicals waste ( used in diagnostic and (Hospitals , PHC's , Nursing homes , Clinics , experimental work, and in cleaning, housekeeping Dispensaries , Veterinary hospitals , Animal houses , and disinfecting procedures.) , Infectious waste ( Research & Pathological labs , Blood bank etc). The Laboratory cultures , waste from isolation wards , law essentially wants the above mentioned persons tissues . items contaminated with blood & other & institutions to segregate ( separate in designated body fluids etc), Pathological waste ( body parts , types/groups ) waste at source , use designated blood & other body fluids), Pressurized containers & color coded containers, transport the waste in Genotoxic waste (cytotoxic drugs, genotoxic designated authorized vehicles, treat infectious chemicals). The risk waste is potentially hazardous to waste according to prescribed standards, avoid doctors & nurses, patients, hospital support staff ( incinerating plastics & use safe incineration ( if attendants, laundry, CSSD, paramedical staff, must). The rule further states that non compliance of

7

Sushruta ‘09

these rules may result in fine and / or imprisonment HCWM plan that should contain a National Action for as long as seven years. The schedules of the Plan (using for example the WHO/National guidance Government notification includes details on document), Consolidate the legal & regulatory categories of biomedical waste, color coding , frameworks, Standardize HCWM practices (edit labels for hazardous waste, label for transport of National Guidelines), Strengthen the institutional BMW container/bags, standards for incineration , capacities (human and financial resources; training, autoclaving, sewerage, deep burial and deadlines etc.), Set up waste management plans at all for implementation. A total of ten Categories relevant levels and Establish a monitoring plan.(Schedule I) of BMW have been described. They are: For efficient management there has to be Category 1: Human anatomical waste , Category 2: a team which should include Head of Hospital Animal wastes, Category 3: Microbiology and (chairperson: Occupier) , Heads of Hospital biotechnology waste, Category 4: Waste sharps: Departments , Infection Control Officer , Chief needles, syringes, scalpels, blades, glass, Category Pharmacist , Radiation Officer , 5: Discarded medicines and cytotoxic drugs, Matron (or Senior Nursing Officer), Hospital Category 6: Solid Soiled waste: items contaminated Manager (Superintendent) , Hospital Engineer and with blood, body fluids including cotton dressings, Financial Controller . A Waste Management Officer soiled plaster castes, linen, beddings, Category 7: (WMO) with overall responsibilities for the Solid wastes: waste generated from disposable development of the hospital waste management items other than the waste sharps i.e. tubing's, plan and for the subsequent day-to-day operation

catheters, IV sets, Category 8: Liquid wastes, and monitoring of the waste disposal system should Category 9: Incineration ash, Category 10: be appointed. This person will often be the infection Chemical waste control officer / nurse.

Schedule II describes the color & type of E f fec t i ve HCWM inc ludes was te containers / bags in which these categories of waste minimization, waste segregation, collection, have to be separated, stored and transported along storage, transport, treatment and disposal. Waste with methods of final disposal. In brief they are as minimization can be achieved through 3R's i.e. given in Table. Reduce , Reuse , Recycle, however the key to waste

management is segregation which means separating waste into various waste groups

Health care waste management (HCWM) according to its final treatment & disposal for is first of all a management issue before being a occupational safety and reducing cost of technical one and therefore completely depends management by separating non hazardous & on the commitment of both administrative and recyclable material from hazardous waste. It should political authorities as well as the entire staff within be carried out by waste producer & as close to the HCF's( Health care facilities ) . The 10 steps for a site of production. Segregated waste should be HCWM plan are: Raise awareness of the problem, collected daily (or as frequently as required) and especially amongst policy makers, Define a policy transported to the designated central storage site (the rational for HCWM and what one wants to which should have an impermeable floor with good achieve), Set up a strategy (which is basically stating drainage, easy to clean and disinfect, afford easy what steps must be taken to achieve the objectives access and it should be possible to lock: the area to that have been listed in the Policy), Conduct an prevent entry of unauthorized person / animal. In assessment of the current situation (using for temperate climate areas the waste could be stored example the WHO Rapid Assessment Tool), Draft a for up to 72 hours in winter and 48 hours in summer,

8

Sushruta ‘09

while in warm climates, 48 hours during the cool season and 24 hours during the hot season.The aim of treatment and disposal is to limit public health & environment impacts by transforming HCW

into non hazardous and containing it to avoid human exposure & dispersion in environment. The various treatment options recommended are Incineration, Chemical disinfection, Steam sterilization (autoclave / hydroclave / vapoclave) , Encapsulation , Micro waving etc while the Disposal options are municipal land fill, deep burial in premises and discharge in sewers.

BMW is a universal problem. We must join together to form a united front powerful enough to tackle the problem. Today, with increasing number of health care institutions and careless attitude of health personal , the job has become more challenging.

Further reading:·

····

www.solutionexchange-un.net.inwww.csuchico.edu/ehswww.noharm.org/details.cfmwww.envfor.nic.in/legis/hsm/biomed.htmlwww.latrobe.edu.au/pc/ohs

Big 'P's, so plain for all to see it is rather mids and untidy. Denote of course hypetrophy ? When infarction is severe when the the waves are tall and thin, A deepened 'Q' will appear- Cor pulmonale has set in, if the heart size doeth grow Broad and bifid then it is vital, a high 'R' one will surely show. to eliminate stenosis mitral. But in a left super charge, Ectopic foci may appear, then in both R5 and Rb are large. abnormal 'p's will make them clear If 'T to P' is nil or dismal, All points from 's' across to 'T' take care it may be proximal, should ever isoelectric be But don' t forget in nodal rhythm. If on the line they do not lie inverted 'p's may then be hidden. then querry first the blood supply, with a 'P-R' of nought point two, then there in much more the danger lies. everything will nicely do. Least distal cardiac muscle dies, But if it should be rather long. moreover at a later date, His or Kent is not too strong. An altered line an altered state, When it is short then one should fear. Then bear in mind those "drugs and ions", Ectopic focus rather near, Forgetting not the endocrines Now QRS is complicated, but following may be stated- If there exist a BBB,

WHAT HEART HAS TO SAY !!!

Neha Pandey (2005)

9

Sushruta ‘09

is not met. For example, "I must see a specialist for my ingrowing toenail right now!"

M o s t 3) Manipulative help-rejectors continually return to of us fear the surgery to report that treatment failed. Where rejection in any symptom is relieved, it is rapidly replaced by our lives, an another. For example, "None of the painkillers have e m o t i o n helped my back, I'm allergic to those other pills. Pain which begins Clinic did nothing. You've got to help me!" early in life, All these three “difficult” patient types inherently feel a n d that they have been inadequately treated by the p r o b a b l y doctor, so would present with a new set of c o n t i n u e s symptoms, demand results, or are vocal in l i f e - l o n g . expressing that previous treatments did not help. I n d i v i d u a l Doctors are never trained to handle such patients,

personalities determine the degree of such a fear, and different personalities tend to handle such patients differently.

Why do some pat ients

become difficult? A wonderful insight and the initiatives we take to overcome such a fear.

was provided by a physician, who was suffering from Traditionally a doctor-patient relationship has been

scleroderma and self confessed about being a of a provider (doctor), and a seeker (patient), where

difficult patient. The narrative from a physician the former was on a higher pedestal and probably 1explains and I quote: had to fear the least, while all the fears were for the latter. Increasingly the hierarchy in the doctor-

“ Why did I become difficult ? It wasn't my patient relationship is getting diminished, making first choice. In the physician-patient relationship, fear of rejection a greater concern for doctors as trust on the part of the patient is a consequence of a well. number of factors, including perception of the

Often doctors encounter patients who are provider's technical competence, interpersonaltermed as “difficult patients”. These patients ask skills, and ability to act in the patient's best interests.questions, demand results, and have often

In other words, the provider knows what he or she is researched about their disease. Some of them doing, treats the patient what could be described would refuse clinical history or examination by a as "nicely," and acts in a way that the patient would trainee medical student, as they very well act, given access to the same knowledge and understand the hierarchy in a teaching hospital, and information. Being difficult was my natural response are vocal in expressing their discomforts. In the

when my doctor was incompetent, rude, or clinical world, the term difficult is applied to a variety domineering. I didn't need a physician to be my of patients: the noncompliant, the rude, abusive

"perfect agent" (the phrase from health economics and manipulative, the malingering, the mentally ill, that the physician is the patient's agent). I needed a the skeptical. The antitheses of this minority are the physician to be an additional source of informationdocile and compliant patients, who are meek,

and insight to support my informed decision compliant, agreeable, non-dissenting, and hardly making. I wasn't interested in being told what to do, ever seek a clarification from the doctor. and I expected my doctors to respect my right to Understandably, we the doctors like the latter, and make truly informed choices that were consistent tend to reject the former “difficult” patients. with the way in which I wanted to intervene in my

disease and live my life…….. But being a difficult Difficult patients can be grouped in three patient is a tricky proposition. By advocating for categories-

myself, I risk incensing the person on whom I depend 1) Dependent clingers are excessively dependent for care. I tried being the "good" patient. I suppose on the doctor, desperate for reassurance but will like many young women, I was raised to please return continually with a new array of symptoms. For others. My natural inclination is to be pleasant, example, "Thank you, my back's much better but I've because, in all honesty, I want people to like me, got chest pain now." and I believed that others, including doctorsboth2) Entitled demanders are also inexhaustibly needy,

male and femaleapproached interpersonal but rather than using thanks and flattery, will use exchanges in the same way. In return for being a intimidation, devaluation and guilt against the pleasant patient, I was misdiagnosed for fourteen doctor, frequently complaining when every request

10

Sushruta ‘09

months, given scientifically unsound advice about unmet by the doctors they term such patients as treatments, and warned against having children difficult. Doctors fear difficult patients, and have a

despite limited literature on scleroderma and feeling of failure or rejection by the patient. This pregnancy………..When I finally decided to feeling is often difficult to digest or accept, so is

become a difficult patient, terminate relationships expressed as a negative reaction. To overcome with unhelpful physicians, and find like-minded fear of rejection, doctors would ignore a patient,

providers willing to inform rather than dictate my refer the patient to another provider, delay their treatment decisions, I started getting the care that I appointment requests, or overwhelm the patient

wanted and needed. Although some might label with triviality of their symptoms. Thus a fear of me as "difficult," others might callme "empowered." rejection in a provider manifests itself as a

My empowerment allowed me to accommodate tendency to reject the patient by the provider, scleroderma into my life rather than surrender my and this becomes a cyclic self-perpetuating

life to the disease. It was the difference between phenomenon. becoming a patient with What could be

scleroderma instead of done about it? Foremost is being a sc leroderma the knowledge and

patient: I came first, not my understanding among illness. I wish more providers doctors, about occurrence treated me rather than my of this rejection-

”diagnosis. phenomenon. Secondly, realizing that the art of

Patients in general medicine is based on are weak players in the communication skills, doctor-patient paradigm. something which in the Their fear of rejection forest of medical education begins even before they is left for individuals to approach a doctor. This figure out. Lastly making could result in a delay in internship as a more seeking care, and often interactive process where significant symptoms art of medicine is would be trivialized by emphasized, rather than patients themselves. This threshold of triviality learning of mundane clerical skills. Once we differs according to patient personality types, but realize that 1) most patient-symptoms would not in general when a patient musters enough fit into textbook description of diseases, and 2) courage to partially overcome this fear, and these symptoms need to be addressed time and approaches a provider the symptom is significant again without abandoning the patient, would for the patient. When such symptoms do-not probably be the first step in breaking the make sense to a treating doctor, they are termed rejection-cycle. as “non-specific” or “vague” or “miscellaneous”. Usually providers are uncomfortable with such symptoms or conditions, largely because they were never trained to deal with them. This discomfort manifests itself as patient-rejection, attitude patients realize soon. Some patients would persist with their symptoms none-the-less, Reference: and in the process would get labeled as 1. Mayer ML. On being a difficult patient, difficult, “difficult”. I will tell you what is difficult.

An element of fear operates in a difficult- Health affairs 2008; 25(8) 1416-21. patient-doctor relationship. Patients feel inadequately treated or cared for, and ask questions. When these questions or demands are

11

Sushruta ‘09

about a quick injection, an easy end. I love my daadi dearly, and that's why I might be prepared to do it. My parents are doctors. They

Dr. AMIT BHATT know what's happening; they have watched many patients die. When I discussed the issue Lecturerwith Mum, she looked at me and said, "You

Dept Of Medicine realize that I believe you would ruin her chances of eternal happiness. I don't want you even to discuss it with daadi." She's right, of

My grandfather died long course. Suicide and murder are both grievous before. What killed him was not the sins in our religion. If I were to give that painless, cancer that riddled his body and undetectable and lethal shot of potassium, wormed its excruciating way up his daadi would be barred from Heaven. Heaven spine. It was an overdose of or otherwise, the suffering here on Earth would morphine. My father, a doctor be very real. If losing a parent is hard, losing himself, had discussed the matter hope for them in the hereafter is intolerable. with the treating physician and the That could well ruin my mother, and our family knew exactly what was relationship. going on. When he passed away, In times such as these, my solution is to the matter was also laid to rest. curl up in a quiet room, take several deep There is nothing unusual or breaths and meditate. I try to divest myself of all controversial about his case; my preconceived notions of right and wrong, euthanasia was never even of loyalty and obligation, and the fetters of mentioned. He was merely given emotion and fear. I strive to see things in the ample pain relief. That the required clearest light possible, free of such hindrances. dose of painkiller became fatal Then I hope for a solution ... Nothing.w a s a n u n f o r t u n a t e y e t unavoidable side effect. Such practice still goes on today, Currently I am a practicing medical discretely and regularly. physician myself. I had an elderly doctor with

recurrent stroke and severe paralysis in my Today my grandmother is also dying. ward. With the recent controversy surrounding This time there is no cancer, but a disease euthanasia, the topic came up easily. He called multiple sclerosis, which has already left paused a moment and rubbed his prickly chin her virtually unable to talk or swallow. before proffering judgment. "It is not a Communication between her and my father is doctor's place to decide life and death. That is almost impossible, something which has for God. It is simply our place to alleviate exacerbated existing, domestic difficulties. As suffering. If, in the course of doing that, the the disease progresses, she can expect patient dies, so be it. I believe a crime against gradual paralysis. Her death will come when God for anyone, particularly a doctor, to kill."she is no longer physically able to breathe.

Originally I was dissatisfied, but as I Unlike my grandfather, she is not in any curled back up on the sofa I started to see his great physical pain. Although her osteoporotic point. God does not feature in my decision-old back does cause some discomfort, it is making, but that does not diminish the nothing compared to her fear, her perpetual significance of what he said. For the terminally cloud of depression, and to the difficulties she ill, alleviation of suffering is paramount. If an faces at home. The anti-depressants she is on earlier death is the side-effect, that's do little to hold back her tide of lament. As she acceptable, but one should never intend to becomes weaker and weaker, more and more kill. The next day, when I saw him at morning immobile, she seems to sink lower and lower. rounds, I asked about the current debate on Often she talks of wanting to die, of looking euthanasia. He was unimpressed. "You can forward to her death, and of being ready to talk all you like about building safeguards into leave this world. Occasionally I have thought

Alleviate suffering

THE

GOOD

DEATH

12

Again, I dragged my mind back to the the law and having a panel with psychiatrists and question of Daadi. She was a tough case. There is no such. It doesn't mean a thing. We went through drug that is appropriate for her to overdose on these 25 years ago with the abortion debate. We inadvertently - antidepressants just don't work that were going to have at least two doctors who had to way. However, the grieving and fear she is going be able to verify that there was sufficient medical

through now is a natural reason and all sorts of process, and one that paraphernalia. Recently I will pass. That requires read that 60 per cent of all no treatment other than abortions in India last year family support, love and were for social reasons." perhaps some therapy. Whatever your views on Eating and speech will abortion, his point is to do still be difficult, and in with the hazards of time she may even need legislation. Open the to be fed through a tube. floodgates and the waters That is part of her will come pouring out. It is condition, and she needs not hard to imagine the to work through that and situation where someone come to terms with her sick, old or an economic fate. It is important, not strain on the newly wed only for her, but also for chi ldren, might feel the grieving process of compelled to request those who will survive death. It is also not hard to her. Unfor tunate ly, make the next leap - to Daadi's depression is killing those unable to only partly related to her request , but whose illness. relatives feel it is "for the

best." In some form or another, it has been Leaving the law

lingering in the background for years, never really as it stands does not mean that we prolong resolving, but never really treated aggressively. To suffering - we should be frantically working to my mind, this is perhaps one of our greatest relieve it. It does mean that the focus is not placed transgressions. Not treating aggressively in these on killing, but on supporting, and that a patient's cases is a mistake. Everything possible should be death retains the gravity it deserves. I like to think I done to make their remaining time comfortable.had learnt a little more about my role in life.

Although I don't have a blind belief in God, I do have values. Love of life and happiness are what "When inevitable death is imminent... it count for me. Upon these you can build the same is permitted in conscience to take the decision to moral and ethical structures that have been refuse forms of treatment that would only secure preached for millennia. Whether you see it as a precarious and burdensome prolongation of following God's rules, preserving the sanctity of life, so long as the normal care due to a sick life, or just helping others find their happiness, it person in similar cases is not interrupted.comes to the same thing. Taking a life is unacceptable; accidentally losing a life in the process of bringing happiness into it is very different.

”- 1980 Declaration on Euthanasia

issued by the Sacred Congregation of the Doctrine of the Faith

Sushruta ‘09

HUMOURrrr…ours

1.Q. What are MEN? A. Multiple Endocrinal Neoplasia

2.MISS….. CONCEPTA doctor was examining a pretty young girl.“ You've got a-cute appendicitis”, He said at last. The girl sat up indignantly.“EXCUSE ME” she said.“I want to get examined, not admired”.

13

Sushruta ‘09

Many of us may remember an on-line sites are there to help in performing hypnosis.incident occurred during the beginning of this year. A woman in Nagpur had some major personal Hypnosis and crime:problem for which she sought help of a guru who Although the infrequent use of hypnosis in hypnotized her. Ultimately the lady lost a good psychiatry (medical hypnosis) is a known fact- amount of her precious ornaments in that incident generally in alleviating anxiety, depression and under her hypnotized condition. related disorders, the relation of hypnosis and crime

is a real fact of consideration.All of us have heard of similar incidents. But what exactly is hypnosis? Hypnotism as a defense to a criminal act is not

generally recognized in courts. A What is hypnosis? person cannot be hypnotized Hypnosis is a state in which against his will. Hence when he a person is relaxed and drowsy volunteers for hypnotism; he is and more suggestible than e x p e c t e d t o h a v e t h e usual. Enhanced suggestibility a n t i c i p a t i o n o f t h e leads to diminished sensitivity to consequences of the act. pain, vivid mental imagery, hallucination etc. In fact this is a A group of persons believe that sleep-like condition brought on crimes are possible by hypnosis. by artificial means. It is practice They do it by complex brain-where a connection is made washing in which the entire with the subconscious mind in personality of the individual is order to alter a pattern of thinking shattered. In medical hypnosis, or acting in order to improve a the personality of the subject is state of health, relieve pain and not hampered. But in brain or improve one's personality and washing, the subject is processed self esteem. It has generally through severe mental pressure, been observed that the subject doesn't remember often by confinement and regular stimulus of horror the activities of hypnotized state afterwards. and emotional activities. It is told that today's suicidal terrorists are products of such type of hypnosis/brain Induction of hypnosis: washing. But as it is very hard to perform hypnosis on Hypnosis can be induced in many ways, someone without his knowledge, it is not a common but the primary aspect is that the subject should be to create crime by hypnosis.willing to be hypnotized and convinced that hypnosis will occur. This means the personality or But on the other hand, hypnosis is increasingly being state of mind of the subject should be in such a utilized by police and investigators in solving crimes. position so that it can be dominated by the Well, when practically all investigation leads have hypnotizer. Most hypnotic procedures contain some been exhausted there is certainly no harm in combination of tasks to focus attention (such as exploring hypnosis as potential solution. This part watching a moving object, rhythmic monotonous comes under “Forensic Hypnosis” Authorities use instructions, and the use of a series of suggestions for hypnosis to tap into victims and witnesses, e.g. - one limb of the subject will rise, like this). Slowly, subconscious and retrieve memories that can be a Trans state appears and the subconscious mind of utilized in solving the case.the person is focused.

The first attempted use of hypnosis in the criminal Scientists have developed a hypothesis that justice system dates back to the mid 1800s and the hypnotism and hysteria are related because they second documented effort was in 1894.found that1. Phenomena observed in hysteria could be Tom Pert, a hypnotherapist said, “If we could use and produced in normal subjects by, means of hypnosis access our subconscious minds like we should be 2. The same symptoms also could be removed by able to, for would be amazed at what we have means of hypnosis. stored up there.” “Forensic hypnosis is nothing more It is interesting to inform that many people today than memory refreshing,” says detective (Dollar practice hypnosis on themselves by using the help of Police), B .J. Watkins. Hypnotically refreshed recall is CDs and DVDs as well as books for guidance. Many admissible in Texas in both criminal and civil cases.

Hypnosis and Crime Dr VG PAWAR, Dr ALOKE MAZUMDAR, Dr SANDIP BHOWATE

14

Sushruta ‘09

There were approximately 800 law enforcement officers in Texas who had received training as the Forensic Application of Hypnosis by 1986.

But although potentially handy, hypnosis cannot be relied upon for 100% truthfulness. It has several limitations like some people can mimic or simulate hypnosis and can lie willfully. Some may confabulate. During the induction of hypnosis there is a possibility of bias by the investigative hypnotizer, and also any existing preconception of any thought- may create pseudo-memories which may dominate the actual memory of any crime. All these did not allow hypnosis to be accepted in the court of law at all places.

Conclusion:-OK, enough is enough. Thank you very much for being hypnotized by us. Hope you have been hypnotized by this article.

Date : Address :

t10 Cranial'08 Graymatter/white mater

Vagus day Brain Stem Street,

Near Cerebellum,

Pontine Colony - Skull

My Love,

You are the rhythm of my cardiac muscles. Do you

remember, the first time we met? We were standing in

anatomical position with my coronal suture exactly parallel

to yours. You looked into my eyes and I looked into your

glasses.

Second time we met, you were standing in your

balcony, your right lower limb was in mid flexion and left

fore arm supine. You smiled at me, my eyes blinked, my heart thrate increased to 200/min. and 4 heart sound became

clearly audible.Third time we met, I had a cardiac arrest,

you caught my wrist, it acted like DC shock. My ventricles

revived, causing hypertension.

My dear, whenever I look at you, I develope

Isolated systolic hypertension. My love is as

pure as distilled water, you can test it by

adding hot CuSo powder. It will surely turn4

blue. I hope you will not forget me.

Clinically yours,

S.A. Node

MEDICO'S LOVE LETTER-MANISH KUMAR SINGH (2005

15

Sushruta ‘09

Escherichia coli, Klebsiella spp and Enterobacter spp. (all penicillin resistant). Another recently

discovered infection for which hospitals provide We have turned doctors into Gods and worship this special conditions enabling the causative deity by offering up our bodies and souls not to organisms to survive is Legionnaire's disease.mention our worldly Gods. And yet paradoxically, they are the most vulnerable of human beings. They Rarely the nursing and medical staff themselves are are aptly called as “wounded healers”. source of infection to patient, but streptococcal

pharyngitis, influenza and other respiratory infections This article tries to take a 'look' at one of the aspects are examples where hospital staff should take to be of medicine which is often 'overlooked'. Long before immunized against communicable diseases to the microbial nature of infection was known, reduce their chances of acting as sources of direct hospitals were regarded as places where infection to patient or to community indirect via communicable diseases could be acquired as well laboratory staff to their families and friends has as treated. The admission of a patient with a recurred in cases of tuberculosis and Hepatitis B.communicable disease into a hospital creates a potential source of infection in that hospital. Usually Medical drugs have occasionally been the vehicles the risk is minimized by nursing the patient under of infection. Intravenous fluids contaminated by isolation, but if the infectious nature of the illness is bacteria cause the most serious hazards, but are unrecognized, the danger is increased. The disease very uncommon. Eye drops have also been a may be so rare as to serve an improbable diagnosis. problem when disposed from large containers For instance small pox in Britain in 1973 which spread which become contaminated after sterilization. from an undiagnosed patient to two visitors of a Finally drugs such as pancreatic enzymes, have patient in the adjacent bed with viral hemorrhagic been known to transmit infections.fever spread to nursing and medical attendants of the index case. Any discussion of the possibility that hospitals are

breeding grounds for communicable diseases, risks Actually a communicable disease depends on the appearing as a catalogue of hazards which portrays conjugation of many factors: presence of micro- hospitals as hot-beds of infection. In developing organisms which can cause the disease, presence counties like ours much of infection that is acquired of susceptible host and a mode of transmission. In in hospital is caused by patients own colonizing the hospitals, the conjugation of these factors bacteria which take the opportunity of the illness or occurs and they are deemed to be the breading treatment to become invasive and cause infection. ground for resultant outbreaks. Nevertheless, the past history of hospitals as places,

where once infection was rife should serve to warn us Hospitals in which antibiotics are heartily used are an against becoming complacent.environment where antibiotic resistant bacteria are in effect selected for survival, such threat is posed by Staphylococci and other gram negative bacteria as

The nurse went in to check her patient in the ICU who was wearing nasal prongs. The nurse tried to talk to him, but all she could get out of him was gasping and unintelligible talk. Finally, the nurse thrust a note pad and pencil at the patient and said, “I can't understand you, sir. Please write it down.”

The patient weakly scribbled on the pad, “Get your dang foot off my oxygen tube!”

16

MICROBIOLOGY OF MEDICOS NEHA PANDEY (2005)

The microbiology of medicos is complicated and pleomorphic. Mutation is common phenomenon and requires careful study. Even after careful study the subject is difficult to be put in black and white. Here is also not an insincere attempt. HABITS AND HABITATS- A large number of them are found in boys and girls hostel, though some are found scattered in city. They are particularly sensitive to the term ''DOCTOR SAHIB.''

MORPHOLOGY-For convenience of description they are classified into 2 main groups- 1.Male organisms 2.Female organismsThe female are cocci, always arranged in groups and hence known as staphylococci contributing Brownian movements. They are multicolored, powder sprinkled and cream coated .The males are bacilli arranged in chains and called as streptobacilli. They are actively motile and highly virulent particularly to cocci. STAINING-Some of them are ward positive while others are ward negative. Ward negative bacilli are exam resistant. They usually form spores during examinations and need intermittent autoclaving in order to get rid of them. By careful observation over a long period we have recently detected the most virulent organism which is ward negative, exam resistant and 100%.nurses fast .Morbidity is high and mortality is 100%.Other commonly used stains are theatre meta chromatin ,guncha blue and elite violet .

CULTURE MEDIA -Ordinary culture media for a male organism is the college corridor and for a female organism is the girls common room. Special selective media for both of them hospital canteen, reading room egg media and college gathering agar. When both are inoculated in same liquid media (theatre at Wardha) they give uniform turbidity.

BIOCHEMICAL REACTIONS-All are "parents money fermentors" and "knowledge liberators". Ward positive organisms liberate more knowledge than ward negative. DISINFECTANT-Scientists have been able to discover only a few disinfectants even after full sweat. These disinfectants only retard the growth of microorganisms. Some of them are anatomy stages pharmacology tutorials and ward attendance. Most effective disinfectants are final year classes and postings.

TOXIN PRODUCTION-Only the male type is found to produce an exotoxin which is very powerful and is called ''theatre phoron-toxin.'

CHEMOTHERAPY-Repeated failure in 1st year MBBS used to give a radical cure. But since this therapy has been abandoned, more and more resistant strains are encountered. Subsequent failures in other exams give a palliative cure. Other important drugs recently marketed are election fight tablet and leadership injection.

COMPLICATIONS-1.Acute, sub-acute or chronic boring fever.2.Adhesion to college corridor.3.Malignancy which metastasize to girls hostel.4.Sarcomatous changes in reading room couples.5.Prescriptions for bikes.6.Particularly the ward negative may sometimes become patient killers.

Sushruta ‘09 17

Sushruta ‘09

No longer Gage - Milestone of neurology

Compiled by NAYAN CHAUDHARI (2005)

Tyanv!!! Tyanv!!! Hear the first cry of the baby! Gradually- the baby walks… talks...plays with friends… argues with friends… fights with them… faces exams in full tension... falls in love… comes under emotions and that is what we call 'behavior'.

th Till the 19 century, scientists didn't know the biological basis of behavior till the accident with Phineus P. Gage happened. On September 13, 1848, Gage was foreman of a crew of railroad construction workers who were excavating rocks to make way for the railroad track. Gage was preparing for an explosion by compacting a bore with explosive powder using a tamping iron. While he was doing this, a spark from the tamping iron ignited the powder, causing the iron to be propelled at high speed straight through Gage's skull. It entered under the left cheek bone and exited through the top of the head, and was later recovered some 30 yards from the site of the accident. Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3/4-mile ride to town. Though physicians Edward H. Williams and John Martyn Harlow found him weak from hemorrhage, he had a regular pulse and was alert and coherent. Within a few days of his accident, one of Gage's exposed brain became infected with a 'fungus', and he lapsed into a semi-comatose state. Harlow released 8 fluid ounces of pus from an abscess under Gage's scalp, which would otherwise have leaked into the brain, with fatal consequences. His family prepared a coffin for him, but Gage recovered. By 1st January 1849, Gage was leading an apparently normal life.

Harlow goes on to describe how, while examining Gage, he determined that no bone fragments remained inside the skull: “in searching to ascertain if there were other foreign bodies there, I passed in the index finger its whole length, without the least resistance, in the direction of the sound [of the hemorrhaging?] in the cheek, which received the other finger in like manner.” After the accident, but his wife and other people close to him soon began to notice dramatic changes in his personality. It wasn't until 1868 that Harlow documented the “mental manifestations” of Gage's brain injuries. His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint of advice when it conflicts with his desires, at times pertinaciously obstinent, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. In this regard, his mind was radically changed,So decidedly that his friends and acquaintances said he was “No Longer Gage.” Thus, the damage to Gage's frontal cortex had resulted in a complete loss of social inhibitions, which often led to inappropriate behavior. In effect, the tamping iron had performed a frontal lobotomy on Gage. Ferrier, an early proponent of the localization of cerebral function, used Gage's case and told that there are certain regions in the cortex to which definite functions can be assigned; and that the phenomena of cortical lesions will vary according to their seat and also to their character…removal or destruction…of the antero-frontal lobes is not followed by any definite physiological results…And yet, notwithstanding this apparent absence of physiological symptoms. Gage's case, therefore, had confirmed Ferrier's findings that damage to the prefrontal cortex could result in personality changes while leaving other neurological functions intact. Gage's case is one of the very first which provides evidence that the frontal cortex is involved in personality. Today, the role of frontal cortex in social cognition and executive function is relatively well established; however, this area of research is yet to blossom, and neuroscientists know little more about the relationship between the mind and the brain than did

ththe early neurologists of 19 century.

[Clinical Section editors of this edition urge future editors of Clinical Section to continue the thread of CASE STORY OF YEAR.]

!!!

18

CASE STORY OF THE YEAR

Sushruta ‘09

Ig Nobel Prize

The Ig Nobel Prizes are a parody of the Nobel Prizes and are given each year in early October for ten achievements that "first make people laugh, and then make them think."

The first Ig Nobels were awarded in 1991, at that time for discoveries "that cannot, or should not, be reproduced." Ten prizes are awarded each year in many categories, including the Nobel Prize categories of physics, chemistry, physiology/medicine, literature, and peace, but also other categories such as public health, engineering, biology, and interdisciplinary research.

Some of the Medicine Ig Nobel prize winning topics:

1991- Work with anti-gas liquids that prevent bloat, gassiness, discomfort and embarrassment.1992- People who think they have foot odor do, and those who don't, don't.1993- Acute Management of the Zipper-Entrapped Penis.1995- The effects of unilateral forced nostril breathing on cognition.1998- Presented to Patient Y and to his doctors for "A Man Who Pricked His Finger and Smelled Putrid for 5 Years."1999- For carefully collecting, classifying, and contemplating which kinds of containers his patients chose when submitting urine samples.2000- Magnetic Resonance Imaging of male and female genitals during coitus and female sexual arousal.2001- Injuries due to falling coconuts.2002- Scrotal asymmetry in man and in ancient sculpture.2003- The hippocampi of London taxi drivers are more highly developed than those of their fellow citizens.2004- The Effect of Country Music on Suicide.2005- Artificial replacement testicles for dogs, which are available in three sizes, and three degrees of firmness.2006- Termination of intractable hiccups with digital rectal massage.2008- Expensive placebos are more effective than inexpensive placebos.

- PAWAN KANDHARI (2008)

At an exam, a student was asked causes of absent knee jerk. He replied, 'above knee amputation.’

There was a forensic exam in which a short note on STATUTORY RAPE was asked. One student wrote 'raping a statue…. Another one wrote 'threatening a girl into standing still like a statue and then raping her.

A gynaecology viva going on.. Examiner- What will you do if a female cannot feel the thread neck of Copper-T? Student- Ma'am.. I mean Copper-T has been lost in the body and we'll give her copper chelating agents.

Examiner to student in pharmacology viva ---What is therapeutic window of a drug? Student after thinking for sometime said “Sir, It is the window through which a chemist dispences his drugs.”

Ma'am not satisfied asks further “If the patient is nulligravida and she wants a child in future, What will be your step? Student- “ADOPTION” Teacher Area to be biopsied for cervical dysplasia? Student- “The patient's neck.”

In anatomy exam, a student was given a female pelvis section. Teacher- Wat's this? (pointing towards uterus. Student- TONGUE…

BLU N DER S PAR EXCELLANCE ! ! !

Aditi Jain (2005)

19

Sushruta ‘09

declines, I can never tolerate my actions to be Why Did I Choose dictated like this by someone else. The long tenure of medical studies, struggle, and immense handwork cannot Medical Career overshadow the sweet fruits that it would bore in the long run in the form of fame, money respect, Option? responsibility with a degree. After all a common man is recognized only by his neighbours but a doctor is well known throughout his locality among all age groups.

P.KEERTHI KUNDANA (2008) Who can deny the fact that with a stetho in neck, one is dealing with best creations of

Every human being strives to become god, the jewels of nature- “Homo Sapiens” and gets “something” in life- primarily for earning the an opportunity to appreciate the wits of God.livelihood and secondarily to satisfy his taste of In keeping view with the changing interest and passion. The same is the case with me. I lifestyles of people, changing climate, increasing too wanted to create a distinct image of myself. But pollution and ascending population as well as the BIG question that blocked me was- HOW and in irrelevance of outdated medical techniques- there which field should I sprout my talent? crops up a need for quality specialists, and research It was the result of all the entrance exams scientists to innovate solutions to the prevailing that made me enter the state of dilemma. I qualified problems, and when the society is craving for these almost all of them with good scores. On one side IIT people Why should I keep myself aloof from it? From and several NITs were calling me and on the other birth till adolescence, when society has bestowed side many Govt. medical colleges were pulling me. I on me so many good things, its now my turn to pay stood on a path from where two roads diverged and the debt by providing services as a doctor. But for it was for me to decide as to travel on which road. that I need to sweat out a little more and for a longer Both the roads were equally attractive and boasted time than my counterparts of other professions but of providing safe and comfortable journey. Then my for those who wear khadi-needle of interest turned towards the medical field Doesn't matter at all.and hence I decided to move my steps on the path So I think I took the right path though of becoming a doctor. A number of factors led me it was the one less travelled by.take this tough decision. I move my steps with an aim to leave a trace behind. The professions in demand today like software engineering, law, chartered accountancy

are based more or less on temporary subjects. If computers were to disappear today software

engineers would become jobless and the new machines would replace the manual workers. But the doctors could at least never be out of work because their subjects human beings are to stay are to stay here permanently. No technology could ever replace the diagnosis and treatment done by a doctor. Thus it is one of the safest career options in today's transient world. Today half of the population is unaware of the correct lifestyle, eating habits and its nutritional values, importance of exercise etc. This invites a number of ailments and diseases and necessitates the intervention of a doctor. Thus it makes a doctor; the person must sought after today. The other white collar jobs are in for high craze and need just in big cities.Actually, the employees literally play in hands of MNCs and become the victims of their whims and fancies. They sell their freedom for mere packages of few lacs as they cannot exercise any right to retain their jobs and are fired as soon as their efficiency

20