Why I feel did I realize this so late ?
This can be such a good tool to reflect upon things, to bring back the pinch of gravity I had had.
Thus realizing, I await my exams though and feel studying is the thing to be done for now.
Sunday, September 20
Saturday, August 29
Friday, March 27
Informed Consent - High Risk
Case - a 35 year old male, presented in the ER at 9.30 PM with head injury and multiple trauma following a fall while he was working, referred to MTH from WRH. I had just came out from the OT finished assisting a case of Extradural Hematoma, and i got the message “Neuro intern, in the ER in 10 mins” and there I go. The Surgery resident, a good guy, but he had planned to go for dinner before he knew about the case. So he explains to me how to assess a case of trauma and informs me “i am going to eat something, so assess the patient and phone me, and if you think the patients condition is critical call me STAT”
I headed towards the ER, saw the patient and to be honest i don’t have any first impression. Like a newbie, who I m; I just jumped on to history and stuff and then serially examining things which i had been told about. He had a “tender abdomen, painful left elbow and right forearm and pelvic compression test positive”. Within no time i had asked for a series of X-rays for all regions i was suspecting any trauma. My conscience hit me- can they afford this. This question was forgotten in the hustle bustle of the ER, and i headed to call the Resisdent.
I told him everything I could assess, he asked me were bowel sounds present, and I was mum, why shouldn’t I be. I had not checked for it. Hell; I realized how important was it, because if it were not present – indicates something very critical in the abdomen. I shut the phone and checked for it. My stethoscope on his abdominal wall, and I hear some gurgling at adequate interval. Good I said to myself. Within a few seconds the resident was there.
Back in the ER we now have the surgery consultant , the radiologist has to atleast oblige now. He does oblige and prepares the machine by the time the patient comes from the X-ray dept. What the surgery consultant was worried about was Hemoperitoneum, so he was asking if there was any free fluid in his abdomen. The patient lying on the trolley, radiologist placed the USG probe on his abdominal wall. As soon as the radiologist says ‘minimal free fluid’ the surgery consultant left. The room was now left with the radiologist, the patient, and...........of course ME. My conscience was hitting me – aren’t we missing a Abdominal CT for him. I got back to ER, and this patient got orders to be transferred to Neuro ICU, with conservative management and neuro observation until tomorrow.
A day later, in the morning patient was complaining of severe abdominal pain. O/E abdomen was tense, tender, with guarding and rigidity. The resident asked for a surgery consultation. During the day I came to know that Dept of Surgery had asked for an Abdominal CT Scan; plain. I was busy the whole day in the ward, and in the evening when I was coming for the rounds I saw the patient going upstairs using the elevator. I wondered what took him so long for a so urgent CT Scan. I was taken to thoughts when I was told that because of money constraints they were not able to clear the bill for the CT. They had gone to village then collected money from all the people and had returned to pay.
Scan reveals – massive free fluid in the abdomen and puemo peritoneum. No wonder the abdomen was so tense. The surgeons immediately asked the patient to be shifted for an emergency laprotomy. The MO wrote the high risk consent, it explained the operative procedure and mentioned that the patient has chances to die on table while operating. The resident took it to the patient party for signing.
I was totally taken aback to see the plight of these poor people. When asked the reason for his hesitancy in signing the consent, he revealed in a broken pitch ‘sir the patient is going to die without operation, but if you say the patient also is going to die on the table, then I don’t know why to sign. Too add up we also don’t have enough money. The resident very calmly explains ‘if he’s not operated he’s going to die 100 %, but the chances of dying while operating are only 5 – 10 %. So don’t delay things further and make a decision quickly. While the conversation was going on, the surgeon got a little irritated and said call me when they sign. Just a moment later the elder brother nodded. And the paper was signed. The surgeon went towards OT saying I am getting ready, send him immediately. The signatory broke down into tears the next moment. The patient still was not shifted to OT for may be another 30 – 40 minutes till I was there, the OT bill master was not cleared. I left the ICU.
This was my first experience with plight of patients with poverty, I was thinking about this for a long time after I came back to room. Later I realized, this is just the beginning and maybe there is another patient worse off than this in stored for me tomorrow. Only thing I am worried about is – I should not get used to, else it’ll make the job emotionless.
I headed towards the ER, saw the patient and to be honest i don’t have any first impression. Like a newbie, who I m; I just jumped on to history and stuff and then serially examining things which i had been told about. He had a “tender abdomen, painful left elbow and right forearm and pelvic compression test positive”. Within no time i had asked for a series of X-rays for all regions i was suspecting any trauma. My conscience hit me- can they afford this. This question was forgotten in the hustle bustle of the ER, and i headed to call the Resisdent.
I told him everything I could assess, he asked me were bowel sounds present, and I was mum, why shouldn’t I be. I had not checked for it. Hell; I realized how important was it, because if it were not present – indicates something very critical in the abdomen. I shut the phone and checked for it. My stethoscope on his abdominal wall, and I hear some gurgling at adequate interval. Good I said to myself. Within a few seconds the resident was there.
His first impression, the patient appears PALE. And he orders for a fast NS to be given to him. His assessment does not further add to things which I had assessed. But he also asks for an Abdominal Ultrasound urgently. I was angry with myself for not being prompt. ER intern calls the Radiologist on call; this guy has a peculiarity, he does not come to perform any emergency investigation unless he is been called by any consultant. So now we call the surgery consultant too. In the mean time I catheterise the patient. And then we go to Neuro Surgeons residence to show him the CT Scan head – fronto parietal contusion, with frontal depressed fracture.
Back in the ER we now have the surgery consultant , the radiologist has to atleast oblige now. He does oblige and prepares the machine by the time the patient comes from the X-ray dept. What the surgery consultant was worried about was Hemoperitoneum, so he was asking if there was any free fluid in his abdomen. The patient lying on the trolley, radiologist placed the USG probe on his abdominal wall. As soon as the radiologist says ‘minimal free fluid’ the surgery consultant left. The room was now left with the radiologist, the patient, and...........of course ME. My conscience was hitting me – aren’t we missing a Abdominal CT for him. I got back to ER, and this patient got orders to be transferred to Neuro ICU, with conservative management and neuro observation until tomorrow.
A day later, in the morning patient was complaining of severe abdominal pain. O/E abdomen was tense, tender, with guarding and rigidity. The resident asked for a surgery consultation. During the day I came to know that Dept of Surgery had asked for an Abdominal CT Scan; plain. I was busy the whole day in the ward, and in the evening when I was coming for the rounds I saw the patient going upstairs using the elevator. I wondered what took him so long for a so urgent CT Scan. I was taken to thoughts when I was told that because of money constraints they were not able to clear the bill for the CT. They had gone to village then collected money from all the people and had returned to pay.
Scan reveals – massive free fluid in the abdomen and puemo peritoneum. No wonder the abdomen was so tense. The surgeons immediately asked the patient to be shifted for an emergency laprotomy. The MO wrote the high risk consent, it explained the operative procedure and mentioned that the patient has chances to die on table while operating. The resident took it to the patient party for signing.
I was totally taken aback to see the plight of these poor people. When asked the reason for his hesitancy in signing the consent, he revealed in a broken pitch ‘sir the patient is going to die without operation, but if you say the patient also is going to die on the table, then I don’t know why to sign. Too add up we also don’t have enough money. The resident very calmly explains ‘if he’s not operated he’s going to die 100 %, but the chances of dying while operating are only 5 – 10 %. So don’t delay things further and make a decision quickly. While the conversation was going on, the surgeon got a little irritated and said call me when they sign. Just a moment later the elder brother nodded. And the paper was signed. The surgeon went towards OT saying I am getting ready, send him immediately. The signatory broke down into tears the next moment. The patient still was not shifted to OT for may be another 30 – 40 minutes till I was there, the OT bill master was not cleared. I left the ICU.
This was my first experience with plight of patients with poverty, I was thinking about this for a long time after I came back to room. Later I realized, this is just the beginning and maybe there is another patient worse off than this in stored for me tomorrow. Only thing I am worried about is – I should not get used to, else it’ll make the job emotionless.
Saturday, March 21
Getting Serious.
With my internship started a month ago,what i am feeling is that all peolpe though working under the same roof and staying just a meter away does not seem to cross roads. Blogging and scripting things down seemed to me a good alternative to waiting for people to jump in my arena and share a talk.
Lets see what can I come up with.
Lets see what can I come up with.
Saturday, July 5
The beauty of Mathematics
"To those who do not know mathematics it is difficult to get across a real feeling as to the beauty, the deepest beauty, of nature ... If you want to learn about nature, to appreciate nature, it is necessary to understand the language that she speaks in"
Richard Feynman
Mathematics, rightly viewed, possesses not only truth, but supreme beauty — a beauty cold and austere, like that of sculpture, without appeal to any part of our weaker nature, without the gorgeous trappings of painting or music, yet sublimely pure, and capable of a stern perfection such as only the greatest art can show. The true spirit of delight, the exaltation, the sense of being more than Man, which is the touchstone of the highest excellence, is to be found in mathematics as surely as poetry. (The Study of Mathematics, in Mysticism and Logic, and Other Essays, ch. 4, London: Longmans, Green, 1918.)
The beauty of numbers!
1 x 8 + 1 = 9
12 x 8 + 2 = 98
123 x 8 + 3 = 987
1234 x 8 + 4 = 9876
12345 x 8 + 5 = 98765
123456 x 8 + 6 = 987654
1234567 x 8 + 7 = 9876543
12345678 x 8 + 8 = 98765432
123456789 x 8 + 9 = 987654321
1 x 9 + 2 = 11
12 x 9 + 3 = 111
123 x 9 + 4 = 1111
1234 x 9 + 5 = 11111
12345 x 9 + 6 = 111111
123456 x 9 + 7 = 1111111
1234567 x 9 + 8 = 11111111
12345678 x 9 + 9 = 111111111
123456789 x 9 +10= 1111111111
9 x 9 + 7 = 88
98 x 9 + 6 = 888
987 x 9 + 5 = 8888
9876 x 9 + 4 = 88888
98765 x 9 + 3 = 888888
987654 x 9 + 2 = 8888888
9876543 x 9 + 1 = 88888888
98765432 x 9 + 0 = 888888888
1 x 1 = 1
11 x 11 = 121
111 x 111 = 12321
1111 x 1111 = 1234321
11111 x 11111 = 123454321
111111 x 111111 = 12345654321
1111111 x 1111111 = 1234567654321
11111111 x 11111111 = 123456787654321
111111111 x 111111111 = 12345678987654321
101%
From a strictly mathematical viewpoint: What Equals 100%?What does it mean to give MORE than 100%?Ever wonder about those people who say they are giving more than 100%?We have all been in situations where someone wants you to GIVE OVER 100%. How about ACHIEVING 101%? What equals 100% in life?
Here's a little mathematical formula that might helpanswer these questions:
If:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
is represented as
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
If:
H-A-R-D-W-O- R- K
8+1+18+4+23+ 15+18+11 = 98%
And:
K-N-O-W-L-E- D-G-E
11+14+15+23+ 12+5+4+7+ 5 = 96%
But:
A-T-T-I-T-U- D-E
1+20+20+9+20+ 21+4+5 = 100%
THEN, look how far the love of God will take you:
L-O-V-E-O-F- G-O-D
12+15+22+5+15+ 6+7+15+4 = 101%
Therefore, one can conclude with mathematical certainty that:
While Hard Work and Knowledge will get you close, and Attitude willget you there, It's the Love of God that will put you over the top!
Hare Krishna
Richard Feynman
Mathematics, rightly viewed, possesses not only truth, but supreme beauty — a beauty cold and austere, like that of sculpture, without appeal to any part of our weaker nature, without the gorgeous trappings of painting or music, yet sublimely pure, and capable of a stern perfection such as only the greatest art can show. The true spirit of delight, the exaltation, the sense of being more than Man, which is the touchstone of the highest excellence, is to be found in mathematics as surely as poetry. (The Study of Mathematics, in Mysticism and Logic, and Other Essays, ch. 4, London: Longmans, Green, 1918.)
The beauty of numbers!
1 x 8 + 1 = 9
12 x 8 + 2 = 98
123 x 8 + 3 = 987
1234 x 8 + 4 = 9876
12345 x 8 + 5 = 98765
123456 x 8 + 6 = 987654
1234567 x 8 + 7 = 9876543
12345678 x 8 + 8 = 98765432
123456789 x 8 + 9 = 987654321
1 x 9 + 2 = 11
12 x 9 + 3 = 111
123 x 9 + 4 = 1111
1234 x 9 + 5 = 11111
12345 x 9 + 6 = 111111
123456 x 9 + 7 = 1111111
1234567 x 9 + 8 = 11111111
12345678 x 9 + 9 = 111111111
123456789 x 9 +10= 1111111111
9 x 9 + 7 = 88
98 x 9 + 6 = 888
987 x 9 + 5 = 8888
9876 x 9 + 4 = 88888
98765 x 9 + 3 = 888888
987654 x 9 + 2 = 8888888
9876543 x 9 + 1 = 88888888
98765432 x 9 + 0 = 888888888
1 x 1 = 1
11 x 11 = 121
111 x 111 = 12321
1111 x 1111 = 1234321
11111 x 11111 = 123454321
111111 x 111111 = 12345654321
1111111 x 1111111 = 1234567654321
11111111 x 11111111 = 123456787654321
111111111 x 111111111 = 12345678987654321
101%
From a strictly mathematical viewpoint: What Equals 100%?What does it mean to give MORE than 100%?Ever wonder about those people who say they are giving more than 100%?We have all been in situations where someone wants you to GIVE OVER 100%. How about ACHIEVING 101%? What equals 100% in life?
Here's a little mathematical formula that might helpanswer these questions:
If:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
is represented as
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
If:
H-A-R-D-W-O- R- K
8+1+18+4+23+ 15+18+11 = 98%
And:
K-N-O-W-L-E- D-G-E
11+14+15+23+ 12+5+4+7+ 5 = 96%
But:
A-T-T-I-T-U- D-E
1+20+20+9+20+ 21+4+5 = 100%
THEN, look how far the love of God will take you:
L-O-V-E-O-F- G-O-D
12+15+22+5+15+ 6+7+15+4 = 101%
Therefore, one can conclude with mathematical certainty that:
While Hard Work and Knowledge will get you close, and Attitude willget you there, It's the Love of God that will put you over the top!
Hare Krishna
Tuesday, June 3
AP View
Hey !!!
Just trying my hand out in the blog world...i know i'm not going to be a frequent blogger, but occasionally for sure,just to keep my family in touch with the on goings in my life !
Why X Rayed Vision ?
well i just saw an X Ray lying next to my PC,next thing in my mind was this title !
so lets start "X Raying"
(well AP View stands for Antero-posterior view, its a type of x ray often asked for by clinicians...for them who are new to X Raying)
Just trying my hand out in the blog world...i know i'm not going to be a frequent blogger, but occasionally for sure,just to keep my family in touch with the on goings in my life !
Why X Rayed Vision ?
well i just saw an X Ray lying next to my PC,next thing in my mind was this title !
so lets start "X Raying"
(well AP View stands for Antero-posterior view, its a type of x ray often asked for by clinicians...for them who are new to X Raying)
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