Santhosh's ramblings

I just returned as a marked man.   Having been marked by the mark of democracy – ink poured over left index finger. I was one of a few hundred lining up for hour and half or more from 7.00 AM in the morning at a polling booth of about 5 dingy dark rooms and a courtyard of about 400 sq ft. There was these few 100s in 6 – 8 serpiginous queues, waiting in the summer heat, patiently to get themselves marked. But this is where democracy lives. Not in corridors of power of Delhi or state capitals. In the small villages, slums and residential colonies of our nation! Having the privilege of having a say in how I feel the country should be governed. As I waited in the queue at the polling station - there was that feeling of being part of a vibrant grass root democracy – where in the midst of a very caste conscious and divided society, the well off and the poor, the educated and the uneducated, the upper caste and the lower castes, the majority community and the minority communities...

Today was a day of sad stories. A 1 day old girl was brought in Neonatal sepsis. The family was feeding her cows milk since the mother had to do the housework. This was the second girl and the father was palpably angry with his wife for perpetrating this crime. When we said the baby needed admission, he flatly refused. There was no point wasting money on this girl he said. He would take her home to die. And he herded his family into their sedan and drove away. All pleas and threats including calling the police fell on deaf ears. And the baby was not really sick and would've surely made it.....  Then just now a 16 year old girl was brought dead to the casualty. She was 8 months pregnant. She had gone to the government hospital in the morning for breathlessness. From there she was told to go to a private clinic. She visited all the private clinics in M spending an hour or so and a good deal of money in each until she finally reached here. But she had expired on the way, just 10 minut...

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...