synapse

Tumor

2009-12-16T11:45:00.000-08:00

I think I'm a jolly kind of person, but when it comes to blogging all that I can remember are the sad sad stories!
There was this cute little girl of 15 yrs. we'd admitted her for an interval appendicectomy.
A simple in and out case with no complications. She had two ultrasounds saying that her abdomen was fine.Her appendix was removed through a small incision on her right side. During the procedure something touched the surgeons hand while it was inside the incision. Something that should not have been there. After discussing with the parents the procedure was converted to a full exploratory surgery via a midline abdominal incision. We found a large tumor arising from the right ovary, which was adherent to most of her abdominal organs. Cancer was most likely, so the surgeon removed the right ovary and fallopian tube.The tumor was sent to pathology for examination.
I try to see it from the parents point of view. They'd been told it was a simple procedure and that their daughter would be out of hospital in a few days. Suddenly these people in scrubs come up to you saying that there has been a complication. The surgery that was supposed to last less than an hour, lasts 3. Bags of blood are carried in to the theatre.Finally the surgeon comes out and gives them the mind numbing news- that the tumor is most probably malignant and that their child may need chemotherapy.
We discharged her after a few days, to review when the pathology report came..It came as an aggressive malignancy. We hand her over to oncology. Our work is over.
Its been almost a month now, I wonder how the girl is standing up to her chemo? How the family is coping?

On ventilator

2008-09-04T10:36:00.001-07:00

I saw this cute little 3½ year old yesterday.He was lying in a bed in our neurosurgery ICU, attached to a ventilator. He had been travelling in the front seat of a car when he stuck his head out of the window. An auto passing by, hit his head. His skull fractured and a piece of his skull was driven into his brain. he was unconscious when he reached pediatric casualty where he stopped breathing. He was intubated and resuscitated and transferred to neurosurgery ICU and hooked to a ventilator.A CT scan was done which revealed that the piece of bone was driven in to the brain to a depth of about 1.5-2 cm with some bleeding below it.The boy was immediately shifted to the OT. The surgery lasted 3½ hours, the fractured bone pieces were removed and the underlying damaged brain tissue was removed and the bone pieces were fixed in their normal position.

The child is now in the critical care unit, still on a ventilator. We hope he will gain consciousness soon. No one can say what damage has been done to his brain. But children's brain in enormously plastic. The function of the damaged area can be taken up by surrounding area. But no one knows how complete his recovery will be, if he recovers at all.

It is at times like this when i feel grateful for my body that i take for granted. To stand on my own two legs, see through my eyes, and have an unclouded mind to enjoy the world.

PS: now you know why they say in buses to not stick your arms of head outside. Be safe.

Express Delivery

2008-07-28T09:09:00.000-07:00

Recently i came across this and was reminded of my own experiences delivering babies. My first delivery during house surgeoncy happened while i was posted in gen surgery.
There was this young lady who was admitted with about 50% burns to her body and she was about 7 months pregnant. About 2-3 days after her admission she complained of vague abdominal pains. An O&G consultation was sent and the obstetrician examined her and was of the opinion that the abdominal pain was not related to the pregnancy.
That night I was the house surgeon on duty and at about 11pm the duty nurse called me up informing me that the lady was in full blown labour. Now the last time i'd taken a delivery was way back in 4th year! So i gathered up my wits, called the house surgeon from the next ward and went to the patient.

On examination i found that the baby was already crowning. Things happened very fast and i found myself holding this tiny baby! It wasn't moving or breathing. I hadn't expected a baby this preterm to survive. I clamped and cut the cord, kept the baby on the bed and turned back to the mother to deliver the placenta when suddenly I heard a noise and turned to find the baby struggling to breathe. I asked the nurse for a suction catheter to clear the airway. Since it was an adult ward there were no small sized suction catheters and the one I got wouldn't fit the tiny baby's nostril.

At that point i realised that if the baby was to survive i would have to get it to the NICU. So i handed the mother over to the other house surgeon, bundled up the baby in a sterile towel and ran. Our O&G and pediatric depts were in another building across a road from the med and surgery building. I ran about 200 metres with the kid's father following me and handed over my precious cargo to the neonatologist in the NICU, where they successfully resuscitated him. I collapsed in to a chair and couldn't speak for 10 minutes, at which point my fatigue was replaced by a warm glow of success. My first unsupervised delivery as a house surgeon was a success!

Resuscitation

2008-07-25T04:14:00.000-07:00

Large Bore cannulae in both arms

Saline infusions started on both cannulae

Inj Atropine iv stat

Inj Adrenaline iv stat

Checking airway

Head tilt, chin lift, jaw thrust

Positioning larygoscope

Suctioning airway

Inserting no.8 endotracheal tube.

checking air entry

ET cuff inflated, ET tube fixed

AMBU ventilation commenced

chest compressions started

Defibrillation at 200J

Defibrillation at 300J.

Defibrillation at 360J.

Sinus rhythm

BP recordable

This blog has been successfully resuscitated.

A series of unfortunate events

2007-03-11T21:35:00.000-07:00

With all the stress of the PG entrance exams behind us, a bunch of us decided to get together at a friend’s house for a well deserved break. On the second day evening two of my friends S and K were supposed to catch a train to Delhi.

S: “come on guys we’ve to get goin by 4.45, the train’s at 5.25.n I’ve to go to the ATM too”
F: “arre yaar we’ll get there don’t worry!”
K: “yeah the station’s nearby, just 3-4 km”
So basically all of us ended up lyin around till 5pm
S: “come on guys we’re getin late!”
F: “Arre yaar pahunch jaayenge!”
So F, K, S and me piled in to F’s car n set off for the railway station. F drove a t a brisk pace n had covered about half the distance when we ran in to a procession!
F: “No problem, we’ll go by the other way!”
S: “Let’s go directly to the station, needn’t go to the ATM”
F: “arre yaar don’t worry I know these roads like the back of my hand, I’ll get you to both with time to spare!”
Unfortunately alternate pathway 1 was jammed at the railway crossing! The gates had just opened n all the cars trying to cross had jammed it! Had to wait there for about ten minutes, while the jam cleared!
F: “arre yaar don’t worry I’ll still get u there in time”
Then the road jammed again! And F took alt road 2 which also was jammed halfway thru. Unfortunately for us alt road 3 ran thru the busiest wholesale market with dozens of truck being unloaded on the road!
To cut a long adrenaline filled story short, we ran on to the platform to see the yellow painted X on the back of the train recede in to the distance!

S: well OK! You know what; there is only a single track for the next hundred kilometers! So there’s a chance the train may have to wait somewhere for a train from the opposite direction!”
So we decided to try to catch the train from the third station about 50 km away as the next station was too close for us to catch up!

So we set out on an ill fated journey
F: “the tank is almost dry we need to get petrol”
The first pump was too busy, the second pump was dug up, but we managed to get petrol from the third pump.
A bridge on the highway was under construction, we needed to take a deviation via side roads.
What followed was a high speed chase on narrow roads with several near misses!
By then we managed to call up a guy on the train n he informed us that the train was way past our destination! So we turned back. After about 1 km we realized that by the time we reached back the reservation counter would have closed, so we wouldn’t be able to cancel the tickets or buy new ones. So we turned back n went to station 2 only to find out they had never heard of things like computerized reservation! So following their advice had to go station 3 anyway. Got there half an hour before closing time and the booking clerk tells us an important rule they forgot to mention at the other station! – Once a train leaves, you can only cancel the ticket at the journey start point! And you don’t need a reservation counter for that! Any counter would do! So we dragged ourselves back to the car and drove 50 km back, cancelled the tickets, got a bottle of Romanov n drowned our sorrows!
N you bet we reached the station early for the next days train! And F hasn’t used the term arre yaar after that!

Reminiscence 2

2007-02-03T06:33:00.000-08:00

This is a continuation from my previous post.

On the D day, landed up in front of the imposing college building admission letter in hand, parents in tow. It was a proper zoo with people standing in a line moving from table to table, feeding the creatures assorted certificates and various fees. Behind certain tables sat dreadful creatures referred to as house surgeons who sized us up and made occasional circles around names in a copy of the admission list which they had somehow managed to acquire.

The admission formalities completed, the principal gave his 'you are the best of the best' speech, no doubt under the influence of watching too many American commando movies, followed by assignment of hostels. One guy was mistakenly assigned to a ladies hostel leading to queries of how one may accomplish that!
However the list was soon corrected much to our disappointment!

With our first night in the hostel we became acquainted with the hierarchy of medical student life

House surgeon/intern - can leap tall buildings in a single bound
Final year - can clear medium buildings with a running start and favorable winds
Third years - can scale a compound wall
Second year - can jump over puddles
First years - can crawl on fours

The first couple of days were rather hectic, with the seniors aka chettanmar conducting Interviews late in to the night, displaying extreme interest in our prior love life, our knowledge of swear words, porn, human anatomy, politics and so on. If our knowledge was found to be lacking in any sphere they were only too happy to augment it from there own extensive database. Needless to say, those early sessions were extremely informative and we soon got to refer to seniors with various colorful epithets among ourselves. The chettanmar however displayed their superior cunningness by getting a short fellow from amongst themselves to pretend to be a late admission and come to us. our conversation soon turned to ragging and the fellow asked in an oh-so-innocent voice "how are the seniors here?" one guy unable to curb his enthusiasm blurted out " they are all f***ing b*****ds!" the rest as they say, was history. I'll just add that the fellow was seen coming for dinner at the mess with his underwear on his head!

On the whole I'll add, to the credit of my seniors, they exercised restraint, there was almost no physical violence, or exposure to various drugs, the abuse of which we'd assumed would have been widespread on the campus. And it was a great way to get friendly with the chettans and broke the ice with our own batch mates!

Reminiscence 1

2007-01-26T23:42:00.000-08:00

Not long ago, in a city not far from here, there was this boy who wasn't sure what he wanted to do with his life. So he went with the flow, joined all the tuitions and signed up for all the correspondence courses. When it was finally entrance exam season, the boy decided to keep his options open till the last by applying for all the exams for which he could find applications forms for.

In case you haven't guessed by now, that boy was me. I can still remember writing IIT JEE. Well not exactly writing, shading bubbles at random and staring at the ceiling! Kerala CEE was much better with questions like 'whats the national bird of india?' Then the Gods decided that i should qualify for both engineering and medicine, therby landing me in a quandary
Option 1 - join engineering and be with my old school buddies or
Option 2 - join med and be part of a select few.
Finally after much head scratching, my old adversary trignometry made up my mind for me. See, it even has the words 'no me try' in it! :D So without further ado, went and joined MBBS.
Was on cloud 9 for a few weeks till the course started. Was flooded with requests from my school teachers and parent's colleagues to 'advise' their children on how to ace the entrance. So i sat down and made up a few fake dos n donts like
'study what u are taught the same day itself.'
'cut down on tv, newspapers and magazines'
'buy humungous books with 25000 MCQs' n so on.
Received a request from a pretty junior of mine that she wanted the books of a correspondence course that i had taken, so pulled out the brand new books from the as yet unopened postal covers, went crazy with a highlighter and a pen, marking out 'important points' n trying in general to give the books a well used look before handing them over! After all i have an image to maintain!
If any of the above mentioned people are reading this, i beg their forgiveness for atleast temporarily screwing their studies!

Whats with guys and black!

2006-12-23T06:06:00.000-08:00

Walk up to any guy on the road, and ask his favourite colour is and chances are that you will hear all the shades of the rainbow, but ask him what he would like to be seen wearing, chances are black will figure in the top three!
Women, probably due to genetic reasons, don't seem to be able to understand this and attempt to attire there menfolk in colours lifted from a revlon lipcolor shade card! What they dont seem to understand is that colour is used by males as a form of nonverbal communication.
Imagine Mr. Alpha Male walking in to his fav hangout wearing his new, girl friend bought, yellow T shirt... Its only a matter of minutes before he is dethroned from the post of alpha male by his gang of black clad mates, but not before he is guffawed at, photographed and mmsed all over town, and our poor ex alpha has to go back home and explain why he can't wear that shirt- ever!

The trend probably started when the first caveman killed his first black bear, skinned it, wore its pelt, walked over to the nearest stream and put some water in his hair for that wet look and said "woah, do i look cool or what!" At which point the cave woman was probably thinking a deer skin would have been so much more cuter!
Our caveman soon found out that he just had to get up in the morning, shake out his pelt and he was ready to go! and since he only wore black, no one would be the wiser about how many suits he actually owned!

Perhaps the black clothes gave him a survival advantage while escaping in to the dusk after a quickie with his neighbours cavewoman. Which probably led to there being an explosion in the number of kids with a prediliction for wearing black, multiply that in to a thousand generations and you'll see how almost every male prefers black now. The same chain of events probably also led to the two words 'black' and 'sexy' being inseparably linked together.

After the discovery of black clothing, coolness languished in the dark ages with hardly any progress until the 19th century, at which time an inventive genius polished two round black pieces of glass, fixed them in a wire frame in front of his eyes and looked in the mirror and
said "Woah, do i look cool or what!"
with that men were able to lounge about in their black tees and shades! and there is nothing females can do to change that!

this post was inspired by this and the fact that my gf gifted me a formal pink shirt, which i'm being made to wear in public :(
and no, my gf doesnt know i've started blogging! :)

hi all

2006-12-06T02:17:00.000-08:00

just created an account on blogger . the posts will come soon enough.