Thursday, 7 April 2011

Joe the "less verbose one" all the days since day 1

We started doing clinical "work" on Monday of this week.  The overall schedule goes something like this: breakfast, take the vikrem to Doon hospital, spend a few hours in the ophtho clinic, go back to our homestay for lunch, chill for a few hours, then take an auto to City Heart Centre from 6-8:30 for some ER/cardiology time.

The ophtho clinic is pretty unreal.  We usually spend about 3 hours there a day, and our preceptor is a really awesome guy who loves to teach.  Patients stream in and out of his obscenely small office, which is directly open to the waiting room. Essentially, it seems that whoever is able to shove their way to the front  of the line gets the next facetime.  That being said, even with one patient in the room, others will just come in and start talking to the doctor (and that's totally appropriate).  HIPAA is non-existant in India -- and it's slightly refreshing.  We've seen some pretty ridiculous cases come through:

(1) A type-1 diabetic girl, looks 8 yo but is actually 14, with a cataract in her left eye.  Her other eye had already been operated on. We got to see her operation on Wednesday.  The doctor thought her diminutive and cachectic appearance was secondary to underlying nephropathy.  SAD.

(2) An extremely pleasant older lady that had recently been operated on for cataracts.  She had a hypopyon (pus in the anterior chamber of the eye), which is something I've never seen before.  Also, when looking at her hands, we were completely taken aback.  They were mangled and deformed with digits fused together and auto-amputated (it looked like a plastic hand that had been melted together).  The three of us (steph, anjoli, and me) tried to guess what it was.  Bad rheumatoid arthritis?  Burn injury?  When she left the doctor turned to us and said, "she has Hansen's..."  That sparked a very rusty lightbulb in my brain, but it took a few seconds for it to register...  Hansen's = Leprosy.  Holy cow.  I will not see this again in my lifetime.

(3) The "operation theater" is sweet. The doctor did 24 cataract cases in one day.  While we were physically there, he did 7 in one hour -- puts us in America to shame.  Moreover, the operation only costs 750 rupees.  Less than 20 dollars.    Everyone pays out of pocket.  We really got fix shit in the US.

I have mixed feelings about our time with Dr. Gandhi in the ER.  He's an amazing man; he single-handedly runs 24 beds, including an ICU, while keeping his door open for walk-in appointments.  By ICU, I don't mean pressors and vents -- that doesn't exist here, but there are somewhat sick patients.  On the first day there, (after taking off my shoes to walk into the ICU ... WTF?), I looked at a few of the cardiac monitors for some of the patients there.  Active ST depressions in leads II/III/AVF for the patient in bed 3; afib with RVR for the patient in bed 12; a man with massive ST depression on his rhythm strip in bed 5.  Is cardiac cath in their future? Nope, try again.  Dr. Gandhi would promptly tell us that all these patients are doing better than when they came in. Really? Because I was pretty sure that their hearts' were bleeding in disagreement.

If that didn't make me somewhat skeptical of Dr. Gandhi's management, the story I heard from steph about how he handled a patient with R upper lobe infiltrate and ipsilateral hilar adenopathy pretty much sealed the deal.  After putting the patient on a cephalosporin, a beta-lactamase inhibitor, and clarithromycin, the fact that the lesions didn't get bigger signified that there wasn't TB.  Right.

Time outside of the clinics is pretty swell.  Our homestay lady is a fantastic cook and we get fed 2-3 of our meals by her.  Initially, I was quite concerned, since everything was vegetarian and we don't have access to alcohol.  I wondered to myself, if I go through delirium tremens, will it be meat-DTs or alcohol-DTs?   I bet most people would place their money on the latter, knowing the affection I have for the 'occasional' drink.  But they would be wrong.  I don't want to go into too much detail about the pseudo wet-dreams I've been having about St. Elmos ... but yeah.

I finished reading Survivor by Chuck Palahniuk -- freaking awesome book.  I recommend it to everyone.  Unfortunately, I finished that book in under 3 days, so I knew I would need a more substantial book to bide my time.  So I picked up Atlas Shrugged yesterday.  I'm only 75 pages into it so far, but I can tell that this is going to be a mindbending read.

Last of all -- I wanted to throw a shout-out to my man, Merv.  He's the loyal friend who sits on the wall of our room, a silent guardian 247 -- or at least he would be if he wasn't a 6-inch lizard.  Honestly though, I look forward to seeing him every day.  And yes, I'm an expert at figuring the sex of lizards.


  1. Joe - I love the blog! I am curious to hear more about the food you're enjoying over there. Also, I read Survivor about two years ago and also loved it. Big surprise. :-)


  2. I want to call my operating room "The operation theater" that is awesome. Miss you

  3. I imagine you'll like Atlas Shrugged - I picked it up for reading on the airplanes during interviews and thoroughly enjoyed it.