Santhosh's ramblings

A few days back in one of our social networking groups there was this discussion on “clinical examination in Medicine” – recovering a lost art. There were discussions regarding the importance of the same, at the same time the challenges of doing a full examination in the midst of very busy OPD with each doctor seeing 40 to 50 patients in an hour or so. One of the senior consultants remarked about the 6 th sense we need to develop if are to work in busy set ups, where one develops a sense of recognising patients who need full examination and evaluation. As I was participating in the discussions, I was taken back in memory to my early experiences in the art of clinical medicine under a very astute clinician. I remember, one evening as a Junior Medical officer, working up a patient for about 2 to 3 hours, and coming to a possible diagnosis of “Malabsorption Syndrome” after a full history, clinical examination and investigations. I was quite satisfied with myself, having been able to

A young man in 20’s came to us, after attempting to commit suicide. Couple of days after being on ventilator support and on the way to recovery, his story came out. Sobbing, he told us this story…. He is from the neighbouring country, and was educated till the 10 th standard. Not able to find work, he went off to Malaysia, having had paid 200,000/- NRs to a middle man for the job. The job which he was doing over the year was a 12 to 14 hours’ job, lifting heavy weights, 7 days a week with one day off every month. Physically and emotionally abused if he and his friends do not fulfil the owners’ expectations, being beaten up very frequently, and earning about 12 to 14 ,000/- per month. It came to a point that he could not go any further and he objected to this treatment. And he had to come back, but he went back to the job after paying a fine of 75,000/-. But after going back, he could not continue since the treatment worsened and he and his 3 friends came back. Having had used up

"Rather, prophetic ministry consists of offering an alternative perception of reality and in letting people see their own history in the light of God’s freedom and his will for justice. The issues of God’s freedom and his will for justice are not always and need not be expressed primarily in the big issues of the day. They can be discerned wherever people try to live together and show concern for their shared future and identity. So these dimensions of prophetic ministry arise from our study:  1. The task of prophetic ministry is to evoke an alternative community that knows it is about different things in different ways. And that alternative community has a variety of relationships with the dominant community.  2. The practice of prophetic ministry is not some special thing done two days a week. Rather, it is done in, with, and under all the acts of ministry—as much in counseling as in preaching, as much in liturgy as in education. It concerns a stance and posture or a he

A 30-year-old lady was brought to us with a “Bilateral hemiplegia”. She had a hysterectomy and appendectomy, done a week prior to this, at a private nursing home. She was running some fever prior to the same, and had completed her family. It was told to them that she needs these surgeries urgently! A week later she ended up with bilateral hemiplegia which turned out to be a Sagittal Sinus Thrombosis. She was anaemic and in severe sepsis. An unwanted surgery done which led to her cortical veins getting thrombosed. Majority of the women who come to our OPD above the age of 30 do not have a uterus.  Hysterectomy is the mode of current day contraception. When asked about contraception, they will say, bada operation ho gaya. For what? Bacha bandh karnekeliye….For contraception! Changing medical protocols in a part of our nation, when rest of the country is talking about health tourism! Cortical vein thrombosis which is supposed to be an uncommon disease is quite frequently seen in

Over last four weeks, I went through three context and care situation changes, each of which was a learning in itself, at the same time a privilege. The first, which I had the privilege to be part of for the last one year or more. Facilitating care in the context of the hospital where I am currently placed. Being part of the group of young enthusiastic junior doctors and consultants, (though I am not young chronologically!) supporting the team in facilitating care has been a great privilege. Such a facilitation is more of disengaged caring, where one is not actively engaged with hands on care, but more supporting others to provide care.  Engagement is with the care providers than the person who receives care, and to see lives being touched, by the care provided has been a great privilege. It is not always easy, but in the midst of the various challenges, I am constantly surprised how the sovereign unseen hands are working despite our challenged paradigms of thinking! I did not rea

It was two years back, we as a family had to go through demise of our mother, after a rather fast progressive dementia. The experience of releasing our mother to a fast progressing inevitable end, was tough but we learned much through that experience. For me trained as a physician, releasing to death was ingrained in my mind as failure. To realize that releasing was inevitable is the best that can happen in the given context, made the bereavement process easier. This experience did change my perspectives much. Subsequently as I practiced and taught medicine, I would advise families about releasing their loved ones. I would teach junior doctors about thinking through these issues before we communicate with the family. And i felt i had matured in my thinking. Till this week. I have been sitting beside my father who has a CRF and fracture pelvis struggling in pain. Trying various permutations and combinations of pain killers, but realising that he has lost his will to live. He has had

How did this change happen? Freedom to celebrate each other diverse as we are? This did not happen overnight or naturally nor is complete. It is an ongoing journey.  But many played key roles in this transition. (I, for most times was a silent observer!) We started off as being forcibly put together due to circumstances, as a batch of 1978. We had to live together come what may for the next 5 years at least. And so we were forced to “tolerate each other”. We formed our cliques and groups where we were more comfortable within the batch itself. For that matter, there were multiple groups and group allegiances. The dissection group was the first. That was outside our control. The rest were within our control. The political groups out of political leanings, the day scholars, the hostellers, the local paying guest groups, the Young Turks (Pre degree group), the seniors (Achayans) etc. We even had an apolitical group named as “Moofens” – not sure how this word originated! In the i