Santhosh's ramblings

This 75 year old lady was brought into our hospital a month back with distension of abdomen. Distension usually being of surgical cause, she ended up in the surgical ward. The next day, our senior surgeon recognized that she had a Renal problem and asked some of us to review. We saw that the lady had a chronic kidney failure with a creatinine of 2.9 – indicating that she has lost almost 60 to 75% of her renal function. An US examination confirmed our doubt. Being of elderly age, and not having options for renal replacement therapy – (Dialysis or Transplant) we did the best we could. We gave her drugs to control her blood pressure, electrolyte abnormalities and prepared the family for a palliative care at home. But the family was very insistent. Somehow she has to be made well, and they wanted to take her to a higher center. Being insistent, and having little trust in our “Diagnosis” and advice, the best we could do was to give them a referral letter. We did not hear from them for

It is a time of fasting for the Muslim communities all over the world. Large numbers of patients who come to us, are from this community, and every day the discussions with patients and families in the ward has been, how can we get them out of the hospital as soon as possible since the fast is on, the festival is coming up. Staying on in the hospital is not something they want to during such a time like this. Someone recently send me a message – why are you not blogging – I did not realize that it has been a week since I wrote – I told that person – It is a season of fast, I am fasting from activities I enjoy, but I did also communicate that this was not an intentional fast from blogging but a forced upon fast due to confusion from too many issues I am hearing each day, but not sure what are behind these issues…Needed time for the confused brain to ramble… Though the fast I talked about in the communities around is physical, what we are observing in our practice of health care

“Suffered in the hands of many physicians” – is what we read in the good book. For the lady with bleeding, who approached Jesus, she would have spent all her money and resources going from one physician to another, but not finding cure in their hands. Today health care in India is about “suffering in the hands of many physicians”.  There was this lady who came with an Ultra sound report to me yesterday. She has had an US which showed a dilated GB, and diagnosed as Cholecystitis and was referred by a well-meaning physician for urgent surgery. She already had been planning for IV fluids, admission surgery etc and had spent money on preparations. Some thing which was not indicated or required at all. Suffered because of ignorance of lack of knowledge – may be? I started talking to her and she said – she is on treatment for giddiness from Patna. This is common here. Treatment for Diabetes from Patna, TB from Government and Asthma from our hospital. I asked another patient recently

The husband walked in with his wife. He said, I have been taking her to many places for these skin lesions on the face, have spend quite a bit of money and  in one sense "Suffered in the hands of many physicians" - can you do some thing for her. I looked at her - her face and body was full of "Pappular eruptions" what we call in medical terms as PPE. I asked a few relevant questions to her about the illness and send her to the examining bed to do a full physical. Then I turned attention to the husband. Asked him about his job - he was a migrant laborer, and I was sure that he would have had some "extra marital affair" and started asking about his way of life, habits, contacts etc. He was polite but clear and articulate - though he was illiterate - I do not do any such things. I go out for  a living, others might but I have my standards! I was quietly reprimanded about my own attitude of seeing beyond what was there. I still was not sure, and I wanted to pr

Adam and Eve’s sin is an interesting incident to reflect on. The pattern of behavior has not changed much from what happened in the Garden of Eden to the current modern age! God had told clearly that these are the limits and a life of submission, within which they are expected to live. And the limits were put by an all knowing God, who knew that the finite human that they were, their faculties of intellect and reasoning, apart from God, will lead them astray! What was told clearly by God, was doubted by humans. Did God really say – was the question Satan raised. Eve knew the facts – God had told. But Serpent had a way of explaining away or turning Gods word into what was acceptable for human reasoning and desire! Trying to turn word into something which fulfills the physical desires, emotional fulfillment and intellectual reasoning – (good for food, pleasing to eye and desirable for gaining wisdom). This rational explanation of the word of God and responding based on that, led

The man had some mild chest pain. He was accompanied by about 15 people, all walking around trying to show their importance and prominence. The Junior Doctor got the ECG done which was inconclusive. She send the ECG to me and I over phone asked her to shift the man to ICU and then get a repeat ECG and some blood tests. It was about 12 mid AM at night when all this was going on. Since a repeat ECG would any way come to me, I thought instead of it being sent, I could go to ICU and be there, see the ECG settle in the patient and come back. Which was not what the JD wanted, I did not know that the relatives had been pushing her to call the consultant and was trying to make life tough for her. She was not too keen to disturb me. Walking into ICU, a group followed me in. Questions followed. What about repeat ECG. What about blood test? Then dropping some names of prominent people and places where he has been treated etc. ECG, Blood tests all being inconclusive, morning itself they were off,

The context in which we are living now, every day multiple issues come up related to "Shame" and "honor" which affects clinical management of patients. A girl admitted with suicide attempt on a ventilator tried communicating to us, writing on a paper - first note - please save my life, second note - please adopt me. The father seemed to be keen for her to be treated and looking forward to her recovery, but was not taking any efforts to pay the bills, or support in decision making, though they seemed to have the resources to support her treatment. The shame of having a daughter (though she is doing her BA) who has tried to commit suicide, was that why the father was aloof? Did the girl know that the honor of her family was at stake and that is why she did not want to go home? Parents (both mother and father) when asked about the number of children they have - would blissfully say - 2 "bacha" and when asked again, how many girls you have, they will say