Santhosh's ramblings

I was recently reviewing the stories of the patients about whom I had written, and was trying to reflect on them. As I reviewed a pattern emerged. The patients whom we had to struggle to care due to issues other than “Medical”, has been either women, elderly, or the challenged.  In other words, those whose life was less important than other issues affecting the family institution or care givers. I was left wondering; whose interest are we holding on when we care for people? For e.g., the 12-year-old girl with massive bleeding from her stomach. As we were getting ready to admit, organize blood replacement, Ultra Sound, Endoscopy etc. the mother, father and a relative got together and categorically communicated, that no way will they give blood. Anything else we want they can do, but do not ask any of them to give blood. We heard them, tried to reason, threaten, plead but with no use! They were adamant. They were not too well off, but money was nowhere in the discussions. We were he

This boy came to OPD with bleeding from gums. He was seen in Dental OPD and was brought to us to rule out any systemic issue. His clinical evaluation revealed multiple purpuras and petechial areas (bleeding spots) suggestive of a bleeding disorder. We asked for his blood parameters and while we were looking at the details, I kept asking the story. Any history of travel, any past history, any other illnesses, any drugs he is on etc – the routine screening for causes of such an illness. He had a pancytopenia – low Hb – 8gm/dl, TLC 1700 cells/cumm and Platelets of 2000 cells/cumm. And as we were trying to get his story, his mother who accompanied him was asking him, why are you not telling everything? Tell what you want to tell. I thought he was going to tell me some major past history which will give some clues to his illness. But he blurted some “inconsequential details” of some “night fall” weakness etc, which he thought was the cause of his illness. But I was not sure, if he was tell

It was a regular OPD. Not too busy, but enough patients to keep all of us occupied. As we were coming to the end of the morning clinic, this man came in to check the report of his daughter. She was an epileptic and also had hypothyroidism. He had come to collect the Thyroid function tests. Not being too complex a patient, I told him everything is fine, let her continue treatment. He got up to go and then paused for second. Will she be okay, he asked? I responded in the affirmative, yes, she should be okay, but she will have to continue drugs lifelong or at least 5 years. He again paused for a second and said, her marriage is fixed. And almost within a few minutes one of the OPD helpers walked in and said, sir, this patient’s marriage is fixed! Not too common for a patient in the middle of a busy OPD to bring up such personal issues, nor an OPD helper to get these details from a relative. We asked him to sit down, or he was already sitting down by then, and I asked him a question –

Every institution and or movements and its leaders have to ask this question – every now and then – what is our vision? What is that Big picture towards which we are steering the institution or movement towards? Unless this is consistently asked and time is set aside to pro actively reflect on this, as frequently as possible, we will lose our focus. We will lose the sense of direction and will become complacent in our daily tasks. Maintaining and running institutions and movements will become an end in itself. And this vision has to be relevant and contextual and defined and redefined based on emerging context and situations. (Clarifying vision) If the question of vision is asked and clarified, the next task is to get the staff and other stakeholders to align themselves to this greater vision. This is not an easy task. This will need a core group of leaders who understand what the vision is, and are able to articulate the same in a way every staff under him or her can understand.

I work in a context where there is always loud voices and non-physical violence (verbal violence) as part of the health care context. Yesterday morning walking into ICU – this patient has been with us for 10 days with a Chronic Meningitis and encephalopathy. There was that one particular distant relative, who has been consistently “irritating”. He would walk in and out of the wards, OPD catching you in the corridors, or any other doctor and trying to ask questions, asking for surety of success, shouting at the nurses over last 10 days. Our team had offered that the patient be referred to a higher centre, but the same person would say yes once and then turn around and decide against it. At the end of this multiple dilly dallying I decided time has come to stop and put an end to this. I called him aside and had gave him a verbal show down, whereby I asked him to make up his mind regarding taking patient off or keeping him with us. Now after 10 days, we were sending the patient home,

A few years back I had done a study on Community which continues to challenge me as I look around and observe the various communities I have been in touch with. But the more I see, the more I see comfortable communities! Not any more the boiling pots of simmering fires. May be we have grown, or is it really growth? One end of the spectrum is what i call the "Boiling Pot community." This is where there is outright conflict, each person lives for his own plans and desires. The end point is me, mine and no more. From this stage, because of various issues, the community might move to seeming peace. This is the "Simmering Fire community". Due to contextual pressures, there is a cohabitation, but an inner cold war. There is a hai, bye relationships but still the end point continues to be me. Somewhere down the line, due to a common agenda which needs to be fulfilled, people move into a "Lukewarm community" where there is peaceful coexistence for a com

The face book is full of “mothers’ day’s wishes”. And I also added my contribution to the same, by sharing a blog article which I had written when my mother was with us, in the late stages of Alzheimer’s. And I was at the same time reading the life story of Ida Scudder. The story of, how she as a young lady resisted the thought of being in India, but three events which happened the same night changed her life to consider a return to India. The rest is history. The events were – three young women in labour, dying the same night, because there was no lady to provide care for them. And Ida though requested, did not want to go, because she was untrained. Nor would the husbands allow her father the Doctor, to care for them because of their religious and cultural practices. (Dr Ida, Passing on the Torch of Life). This was in 1890’s, from an “undeveloped India”. I had been away for a few days and returned to our hospital this mid week. Walking into ICU the first patient I saw was, a