Santhosh's ramblings

Working in health care, in rural India, one is used to casualties, sudden medical crisis that are brought into emergency where the team gets together to stabilize the patient before deciding what to do next. Some go on into an acute care ward or ICU, some go into a low-end care or high dependency unit, as the situation may be. Some even go home after the initial stabilization. Most of the casualties that come in are crises that has been waiting to happen. There was a festering wound, a lingering illness, an ignored symptom or disease. Ignored for months together by either the patient or those who are responsible for to take care. And by the time they decide to come in, many are beyond help. They have ignored it so long that the illness is beyond cure. Some have been fooled by practitioners who had promised them a cure but was using their illness for making a fast buck, while the illness is progressing. By the time the patient or his or her family realizes the mistake, it would be t...

As one ages having worked years in institutions and living through much experiences, one faces many dangers. The major one is the danger of institutional frameworks that limits thinking.  Working in institutions for decades one ends up having an institutional mindset and behaviour. “Institutional behaviors could refer to any behavior that is more common among individuals within an institution than those not in the institution. ... “ Usually the term "institutional behavior" is used for prisons, mental hospitals, orphanages, large corporations, and government bureaucracies.” But this affects people from all institutions.  We end up expecting a certain type of behaviour, following rules and regulations, policies and processes etc. These might be important but these  become behaviour traits and limits our thinking. Affecting our ability to think out of the box, the ability to innovate and be flexible keeping impact as the overarching direction. And if behavi...

The last couple of decades has been a happening one in health care. Having had graduated in Medicine, 35 odd years back, my generation had the opportunity to be part of these happenings and taste both worlds. The world of health care of yester years and new world that is fast emerging around us. There are innumerable “happenings” that have transformed health care, but I am reflecting on four happenings or in one sense, transitions. Transiting from one way of functioning to another. Transitions that has brought much celebrations for some, but a nostalgia for some others – me being one with nostalgia's! May be like the Jews who were on a journey from Egypt to the Promised Land, still carving for the meat and the food of the country that they had left, some of us still craving for the yester years! We are promised a new face and system of health care, in the new emerging India, but some of us still yearning for the context of old times…. One such transition is from Medicine ...

It was in 2015, when the Medical team saw this lady. She was in severe pain. Pain due to blood supply to her hands compromised. Couple of fingers were already blue, showing signs of early gangrene. She also was running high fever, with swollen joints, and most of her hair gone. Her blood tests revealed moderate renal failure too. The medical team had come to a diagnosis of an “immunological disorder” – Systemic Lupus Erythematosus, with multiple organ system dysfunctions, and was trying to communicate to her in laws, the need for immediate intervention with drugs to suppress her immune system, and the need for a life long treatment. She was from a lower socio-economic back ground and had no way of supporting herself. The in-laws didn’t seem interested. They had only one concern – how many days and how much money would it take. She must get home as soon as possible and take of her children and the house. She had four kids and her husband (their son) was away. After much negotiatio...

It was yet another regular Monday morning in Duncan. I, walking about with the young and excellent consultants in Medicine, Anesthesia/Critical care and Pead’s, me, not doing much but just being around.  As we walked into casualty, there was this 50-year, obese male, in encephalopathy and taking very shallow breaths. A classic and clear patient with Obstructive airways disease and possibly an additional Obesity hypoventilation syndrome in respiratory failure. Some surgeon in a nearby nursing home had taken the risk of doing a cholecystectomy on such a high-risk patient and now he had come in with respiratory failure. His complex blood gases started of a series of conversations. Should we intubate and ventilate, if we ventilate, would he ever come out, or should we wait on NIV alone? If he does not come out of ventilation what would the next step be? Finally, after much consideration, the Anesthetist turned critical care specialist, dec ided for NIV only. We walked into t...

We see quite a bit a new Hansen’s Disease (Leprosy) at the hospital where we are. Three to four new cases a day, for a disease supposedly “eliminated” in India and across the world! We see new pauci-bacillary, many multi bacillary, and very many with severe reactions. We come across many partially treated, some possibly resistant ones too! For an old disease we hardly have any new answers. The same old treatment since a few decades. Well the purpose of this blog was not to complain about the “neglected tropical disease” but to make another point!   But I couldn’t control my habit of being a complainer when it comes to diseases of poverty! The most difficult decision which I find in treating leprosy is to decide, if the patient still needs treatment or is it a burnt-out case. People come after having taken treatment for a few months, with no bacteria detected in the smear, or broken bacteria seen – are we dealing with a partially treated case or a fully treated “burnt out” ca...

It was some time in 1990-91. Working as a junior faculty in the division of Nephrology, I was busy. Setting up a new Nephrology unit with just one senior person supporting, most of my days and night were spend in the dialysis unit, much to the irritation of my wife! Busy with the job of setting up systems of the unit, seeing 8 to 10 patients on dialysis a day, seeing that their vascular access is in place, and decisions for dialysis are taken, there was not much time left over. Very minimal to listen or communicate to patients or families. Calls from casualty or other units of Medicine, where we would go see, diagnose renal failure, look out for indications for dialysis, have a quick chat with the family regarding the need for dialysis, and then rest was all standardized protocols.   Patient comes into the unit, vascular access is put, 2 hours session 1, 4 hours session 2 onward, in between assessment will be done on the long-term plans and rest will be communicated over next few...