Santhosh's ramblings

I do not consider myself to be an expert in pain management, but I do manage the same on a regular basis. Not only have I been managing pain, I have been helping others to manage the pain. By teaching, helping in planning treatment for the patients admitted to our wards. I have used the WHO ladder, pain ruler etc. to teach and build capacity of JMOs to learn how to manage pain. But all this have been a based on a professional assessment and fairly detached and logical management of pain. We have had multiple discussions on rounds on how best to manage pain, why the PRN (as and when required - Pro Re Nata) never works. And PRN can be read as “personal responsibility mitigated” by writing an order and passing it on to the nurses, who generally never give the drugs because the patient neither complaints nor relatives ask for it. Because in our culture we are expected to tolerate pain. “Ethana dard to hoga, sahana padega….!” The principle with which we doctors practice. But...

I see organization and movements as man-made structures. There is only one organization or movement God established – that is the Church. (Not the one that we see today, that might be part of it!) All the rest are man-made. But definitely many of these might have been established out of God enabling and giving vision to people, fulfil a particular task which is in line with His Kingdom purposes. The structure of the institution or movement is not “God given” but man-made based on the then socio-cultural and political requirements. Which bring the issue that, all man-made structures bring with it the fallenness of humanity and all its failures and weaknesses. But like all fallen systems and individuals, they have the potential of redemption and being in line with the Kingdom purposes and holding on to the values of the Kingdom. This alignment is the role of the leadership. Not the supreme leader or CEO alone. The leadership of any organization, movement or institution has to co...

Fruitfulness is result of rootedness – the river was able to facilitate fruits because “river originates from the sanctuary”. It is our rootedness in the source that facilitates fruits in our lives and our ability to facilitate fruits in others’ lives. Not our skills, talents, hard work or striving. A river does not strive to facilitate fruits, it naturally does it because the it keeps itself connected to the source. Daniel and his friends, protected their rootedness in their God. Daniel from the initial days itself, even at the cost of life saw that that relationship with his God was kept alive and active though the context was challenging. How many times have we limited our fruitfulness by blocking our lives from the source or focussing on our abilities, talents and work more than rootedness? Limitedness of our influence comes out of we taking control of our life planning - A river flows where ever it finds space and as it flows it widens, deepens and facilitate life all a...

I just finished (along with a friend) editing a small write up which my father wrote. He was asked to write some memories of his time in a parish he pastored in mid-1980’s. Being in his late 80’s of age now, 89 to be precise, he is losing some of his memory. But he managed to put down a few key highlights of his time there. Reading through that, one thing became clear. Towards the latter part of his life, about 30 odd years after he left the place, it is the memory of “relationships he cherished” that remains most prominent in his mind. I do know that he had innovated much during his time there, but in his memoirs, all what he has done, only find a passing mention. We were recently sitting with a young boy and his family who have been with us for more than 2 months. He went through more than 2 weeks of ventilator support, suffered multiple cardio respiratory arrests, and almost of month of rehab and was going home. In his broken Hindi, (they are more comfortable in Bhojpuri) the f...

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 wer...

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 –...