The prettiest of hemorrhoids

This is gonna be one of those light hearted stories which you may rarely come across in my career. So here goes

Again this is a story from my internship when I was probably half-way through it. I was posted in the department of general surgery for two months which includes a 15 day posting in the department of anesthesia and in the post-operative ward with the remaining 45 days spent in the regular surgery ward and in the operating room and the surgical out-patient department. 

So one afternoon that I had spent in the surgical clinic, a middle aged moderately obese man came to the clinic and i asked him what the problem was. Now this man had come with a case of hemorrhoids.

Any previous patient that I had seen with similar complaints usually described it to me in the local language in a simple way for example

"Sir my anal region hurts" or "My anal region is swollen" etc

But this one description given by my current patient was burned into my memory for all eternity, it was almost as if I had caught the legendary Pokemon version of hemorrhoid descriptions.

So I asked him what the problem was and he tells me with a straight face that when it's literally translated to English it says "Sir my asshole looks like a rose" and so my mind was running in a thousand different directions imagining or rather running away from the possibility of imagining how a person can compare his asshole to a rose. I didn't even wanna ask him whether it was a yellow rose or red rose or whatever. So now being the calm minded professional that I am (Yeahhhh righttttt!) I suppress my laughter and ask him to drop his pants and lie down to examine him, he obliges and lies on the examination bed and is lying there patiently as I put on a fresh pair of gloves to examine said rose which had somehow sprouted and blossomed forth from one of the most hostile environments known to mankind. So just as I'm about to examine  his nether regions , my chief of surgery decides to barge in and ask me what the patient's problem is and I tell her and that's when her sharp eyesight caught this white patch which was surrounding the patient's buttcheeks. Now my chief tells me that it can possibly be a fungal infection due to the fact that the climate is very humid or also a possibility that the patient's immune system was compromised to due to a possible HIV infection resulting in such an easy and widespread fungal infection there. So due to this my chief advised me to wear double gloves and not take chances. She was absolutely right and I was putting on my double gloves but she somehow had managed to slip on a double pair before me and started examining the patient, you know finger up the butthole or rather for those of you who think I'm being crude , there was active pollination of a rose going on by a bee. So as she's doing this she asks him what he does for a living and this is what unfolded after that.

Chief : What do you do for a living ? 

Patient : I'm a truck driver

Chief: I see 

*Chief slowly leans towards me and whispers* 

Chief : Look! These truck drivers and bus drivers and a lot of these guys are known get lonely on long journeys so there's a possibility that they visit prostitutes, so always ask for a thorough history of what their career entails as well because you'll never know what detail you might catch to help you support your diagnosis which can help the patient and protect you(wearing double gloves) 

Me: Yes ma'am you're right I shall be more careful in the future.

*Chief asks the patient about his sexual history trying to be as subtle as possible*

Chief : What sir? Do you have a habit of going to women? 

The patient apparently had no fucking clue about what she was asking and just said "No ma'am I have come to you for the first time"

And that was it.

I threw my gloves on the floor and ran out of the room because this is one of those kinda laughter fits that are imminent, the same kinda laughter that forces a drink up your nose and the kinda laughter that makes your knees go weak. I probably had nanoseconds before the laughter started and so I just ran to the room on the opposite side right after ramming my shoulder on the door and I fell to the ground, sat against the wall and let it all out only to realize the room that I had barged into was a wound dressing room and turns out it was already occupied by a senior post grad student and a patient who had accidentally torn his sutures which were on just above his hip. 

So seeing me laughing this post grad student just left the patient half way through the re-suturing and came squatted right in front of me taking care that his blood covered gloves aren't touching anything and kept telling me "Dude I've had a bad day so please tell me what's so funny I could use a laugh" and I had to wait a few minutes to catch my breath and for the laughter to subside before I could tell him.

So ultimately I did tell him what happened while laughing here and there in between the story and once we reached the end of the story , even he shifted from a squatting position to a sitting position laughing his ass off because he in particular didn't like the chief and now both of us are having this light hearted moment but the other person in the room overhead me and he started laughing as well and he called out to us and said "Sir it's a really funny story but every time I'm laughing there's blood oozing from this wound which you have sutured up half way only". And I see there blood literally dripping down his abdomen soiling his clothes. So I finally wore gloves again. And the post grad , the patient and I had the happiest suturing memory of all time.

Sharing is apparently caring

Hello again 

Here is another random story from my internship days. 

Alright so this happened during the 3rd month of my year long internship during my posting in general medicine. 

So I was in the first unit and was going about my usual day in the male medicine ward and finally it came down to the discharging paperwork which is usually a pain in the ass. 

But anyway as I was doing said paperwork, one of the nurses from another unit just walked up to me and asked me what the intercom number for a "code blue" is. And I replied saying "100...why?".

She picked up the phone and started dialing and I'm just wondering like "hold up...if she's dialing here that means there's something wrong here" and I look up to see one of the professors of medicine doing a CPR on one patient. Turns out the patient was under the care of another unit whose intern had gone to lunch and due to whatever reason, the patient had cardiac failure just as the professor was using this patient as a subject for the medicine class in front of bunch of junior students. 

So when he found out that the patient was unresponsive he ignored the students and started a CPR all the while screaming "where is so and so intern???" 

So he notices me there as I'm running towards him and I assist him in doing the CPR. The emergency medical team showed up in a minute and we secured an iv line, connected an ECG and saw that the heart was having an arrythmia which was also a shockable rhythm. 

So my prof and I and the EMT are trying our best to resuscitate the patient and that's when I notice the nurse who had dialled the code blue number sitting casually and eating mixture snacks out of a steel lunch box.

WTF right so I'm fuming and was about to yell at her when my prof just told me to focus and handed me the pads of the defibrillator and charged it and asked me to shock the patient.

In my head I'm like "duuuudddeee I've never done this before" but I just looked and in the next few seconds my palms are sweaty knees weak, arms are heavy and there's no vomit on his clothing already I thought it was a STEMI.

I was nervous but on the surface the pads were primed and ready to deploy shocks but I kept on forgetting do I ask someone else to do it or go yell at the nurse who was stuffing her face with snacks like fuck it! 

But yeah I apologise for the Eminem rip off 

Anyway shocks were delivered and the patient vitals were check and he was shifted to the icu after a successful resuscitation. My professor said good job and gave me a pat on my shoulder and left to continue taking the rest of his class for the juniors.

I still hadn't calmed down cuz I was about to go give that nurse a piece of my mind about her sitting and eating instead of coming and helping. It was absolutely unacceptable.

So I go and stand in front of her glaring at her stuffing her face with snacks while I'm burning with the rage of a thousand suns. She doesn't understand why I look pissed off and without a word she raises one finger like she just had got enlightenment as to why I was nanoseconds away from shouting at her. And extends her other hand forward offering me the snacks!!!!!!!!!!! 

I'm like wtf

The chronicles of Narnia 

The lion 

The witch 

And the audacity of this bitch!!!!!!

The end 

Fuck the oscars

So today one of my friends from school who is also a doctor was talking about this hospital stuff and managed to trigger another memory from my internship days 

Okay here goes

So towards the end of my internship I was posted in emergency medicine and usually emergency as the name says we see a lot of fucked up stuff 

There was an unconscious boy aged probably 14 or 15 who was brought to the emergency room by an older gentleman and a boy of a similar age! When asked what had happened they said he suddenly fell unconscious. 

So this boy was from one of the schools which was near my college and turns out the gentleman who had brought him was his hostel warden. Yes that school was a boarding school but had day scholars as well. 

So since the warden hardly knew anything about what happened, I asked the other boy about it and promised him I wouldn't tell his warden but I need the complete truth. 

So after a little convincing the young man tells me that the patient had a fight with some other senior kid over a girl the previous day and they had gotten into a physical conflict where the senior kid pushed him and this guy hit the back of his head against a wall or on a rock, I don't remember very well what it was, but he had basically sustained a head injury. They had taken him to some other hospital the previous day to do a CT of the kids brain and found nothing wrong.

Now here when I say nothing wrong I mean there was no evidence of any physical trauma that he had sustained for him to be unconscious out of nowhere.

So my work buddies and me knew it was a case of malingering.

For those of you who don't know, malingering is basically faking an illness to get away from some work or duty or to get attention.

Right so now back to what I was saying.

My classmate who was posted with me that night in the emergency is a total softie. So as the nurses were taking this kids vitals you know blood pressure, pulse, respiratory rate, checking the pupil reflex to light etc which were all normal. My friend goes up to him and keeps shaking him and says nice things to him about how he's a nice kid and should behave better, I ask the nurse to insert an IV cannula immediately. And then okay fine, I tried being nice as well trying to wake him up and make him drop his act, and again my luck is cursed so the ER suddenly started getting overwhelmed with a sudden influx of new patients. Now the time we are wasting on this kid could have been better spent by helping the others who came in. So I lost my patience and asked the nurse to go ahead with an IV line and she did as ordered. And then I asked for a 500ml bottle of normal saline which I opened and suddenly splashed on his face. Now anyone else would have flinched. But our man here is a man of focus, commitment and sheer fucking will. I once saw him delay us from treating 3 other patients with an act....with a fucking act. For those of you who get the reference, here is a high five from me. Now I connected the iv line and rushed the fluids into his bloodstream through the IV line at full speed. And as the bottle became empty. His girlfriend actually came to the emergency room. So our man somehow """"sensed"""" his woman in the room nearby by her voice obviously and thought he would finally get his attention and he would miraculously wake up due to her. Fuck that! I wasn't having any of it I just had to introduce a little anarchy.

I took the opportunity to give him an injection called lasix through the same IV line and also tightened his belt over his bladder. Lasix is a diuretic, basically it makes you pee! 

So I didn't allow her to get near him but told her she can watch him from a distance just to make sure he doesn't wake up yet. And then a few minutes later our man starts squirming on the bed. It was literally like watching his brain trying to decide between maintaining his dignity or pissing the bed in front of his woman.

Finally his mind made the right decision as he slowly got up and saw the smug look on my face and then he asked us to disconnect the iv fluids because he needs to use the washroom because he suddenly feels like peeing. 

Fuck these guys in particular I swear.

The end 

Language barrier

So this is basically an anecdote. Not gonna be too detailed like the previous posts.

Here goes 

A few months ago we had a patient in the COVID-19 ward who needed intensive care because roughly 60% of his lungs were damaged due to the viral pneumonia and this patient constantly had to be left in a prone position on his bed and also constantly needed oxygen support. Patient still had an active infection so it could start progressing to become even worse. This patient wasn't in my ward but the ward upstairs which was taken care of this new doctor who had joined as a temporary medical officer. This young guy spent his childhood in some country in South America called "Guyana". Okay I'm gonna be honest with you here. I never knew such a country existed until this new doctor had mentioned it to me. So turns out he's indian but he grew up there and also did his medical education there as well. His parents were tamilians but for some reason he didn't really have much exposure to his native language. So now back to the current scenario. The patient needed icu support hence he needed to shift him upstairs to the icu connected to an oxygen cylinder and a portable vitals monitor. But all protocol states that before we do any procedure or use any medicine that could be expensive, it is our job to inform all this to the patient's family and get their consent. So let me tell you this. Our young doctor told the nursing staff under him to explain the situation and the need for icu care to the family. 

But I'm gonna tell you something, a lot of times patient attenders can be dicks. They were the kinda people who thought the nurses don't know shit and that they weren't capable of explaining a patient's health status to them.

So they go and start yelling and saying "Why are you people telling us??? We only want the doctor to update us" and usually even I dread this because most people like this will easily eat up atleast half an hour of your work time which can be spent doing other ward work. 

But our young doctor gets up and tries his best to speak in the local language. All he wanted to say was "Please listen to me. He requires Intensive care hence I'm shifting him upstairs and the intensivist upstairs is gonna take care of him". So he says in the local language "Paarungo patient mela poporango....adhuku aprom mela irrukaravanga thaan paakamudiyom". 

And the next second I hear the attenders screaming and wailing. I thought "okay maybe the new guy had some issues so I should go check it out" and when I run upstairs and see the woman has collapsed to the ground and is wailing and crying like a banshee. And I asked the new guy what happened and he explained it to me. And I had to explain to them that he doesn't speak the native language properly and not to worry and I calm them down.

For those of you who don't understand tamil.

What our young doctor said in tamil literally translates to "Look he is gonna go up and after that only the ONE above can help him" 

And yes after I did calm them down they said they were extremely releived because it's "JUST the icu right? Wow we are releived"

Never in my career did I think I'd hear a line like that 

And I go "That doesn't mean he's out of danger yet you inbred"

FFS

A tale of two masseuses

So this is one of the non-medical stories that I would like to share.

A few years ago a couple of friends and I decided to take a road trip to Pondicherry and stay there over the weekend and party really hard.

So let's call these friends as Alpha and omega alright? 

So we started late afternoon and we have a really great drive and we reached our destination by evening. I made the big mistake of mentioning that the last time I went to Pondicherry with my friends from college , one of the guys got a Thai massage with the happy ending. So this actually hyped up both alpha and omega and they actually wanted to see if this stuff happens for real and if it does, they wanted to experience it. I'm like please let's just go get drunk and party, but no. My friends made me google some place to get a Thai massage and a happy ending, so we end up in the corner of this shady ass street and we walk into the massage parlor and I look around and see the entrance is being guarded by a couple of guys. So we walk in and there's a waiting room there with all these guys in their 50s and 60s. At the reception in the waiting room there was one morbidly obese woman who did not have an approachable/pleasant disposition , and now alpha isn't the kinda guy who's subtle. He walks up with to the reception and asks in a fairly loud tone "do you have girls?". The receptionist said "yes I do". Now here's the part that started making me uncomfortable, alpha asks the receptionist if she has North Indian girls and she says yes and my friend asks to see them. So the woman calls out like 10 names and they all come and stand at attention all lined up facing us. And trust me when I say I'm not easily disgusted but seeing the faces of those women who were barely 20 years old , you could tell that they didn't like their job and were possibly being made to do this against their will. It was one of those moments that my stomach turn seeing their plight. Now back to alpha's subtlety, he says to the receptionist immediately after noticing the mongoloid features on those young women  "I asked for North Indian not for North East indians" and I'm like "can you not be racist? That too here of all places, we might get beaten up" but alpha is unrelenting and he asks the receptionist if she doesn't have anyone else and the receptionist said she could also give him a massage if he wanted, and alpha mumbles under his breath like "yeah right who would ever come to you?" And I just tell him that I'm walking out and that I'll be outside. So leaving alpha and omega inside the building I walk out and call mutual friend of ours and tell him about what's going on and had a small laugh over it. That's when both alpha and omega come out saying that there's a 45 minute waiting period and that he gave the phone number of the friend who was on the call as a gag. So I'm like "finally let's go get drunk". Omega seemed to have lost interest by now but alpha isn't the kind who gives up easily as well so he pleaded with omega and me to go and try to search for one more place. So we did and we googled and found another which was in a more densely populated area which sounded a lot safer to me. So we go to the place and it looked like an innocent saloon with a couple of rooms in the end. At the reception there was this woman who was actually quite pretty and alpha goes and sits down in front of her and asks if there are any girls , the receptionist said they have gone for dinner and will be back soon. Alpha meanwhile is actually smitten by this woman and asked if she was a masseuse as well and she said she was. So alpha actually started flirting with her and I was amazed to see that she was actually flirting back. I mean I guess I couldn't blame her either, because she's probably working for elderly guys the whole day and my guess is that she was fairly excited seeing a younger guy come to her. So she agreed to service alpha for a 1500 rupees for the massage and a 1000 rupee tip for the happy ending. These two hit it off and were flirting so much that I actually called alpha to talk to him outside for a moment. He comes out and asks me why I'm ruining his "game and charm" and I'm like "dude you are going to pay her right?" He says "of course" and I get irritated and just kinda yelled at him saying "then what the fuck are you flirting for ? Skip the fucking foreplay and get it over with and let's go". So alpha goes in while omega and I wait in the car with a beer. Around 30 minutes later alpha gets in the car and asks "Duuuuuddddeeeee will I get AIDS?" I'm like "what the actual fuck did you do in there?" And he proceeded to tell me that there was heavy making out and after which he fingered her while she was jerking him off. And I'm like "you're paying her! Why did you finger her???" And alpha exclaimed that he "took care of it later". 

So alpha goes on and said that she wanted to have sex but he didn't so he just asked her to give him a happy ending and walked out after paying her a total of 2000 eupees.

I was puzzled and said "2k? I thought it was gonna come up to 2.5k?" 

That's when our man said "yeah but I fingered her as well so for her pleasure I gave myself a 500 buck discount otherwise there's no sense in having an MBA" and proceeded to act like he had pulled of the greatest con after oceans 11!

I swear to you considering the cast of characters I've come across in my life, there's rarely a dull outing. And no he didn't get AIDS and we did end up partying hard that night.

Till next time.

Snake bite : A story from my internship days

Okay so most of the stories you will be reading here are from my internship days. I was under rotation from department to department for a year so at the time I was basically a jack of all trades and master of none. 

And another thing I would like to highlight is the lack of people skills that most patients and healthcare workers have.

So today's memory which I would like to recall is one patient I had who was bit by a snake.

This particular man had been brought to the ER by maybe 3 or 4 friends/relatives.

The patient had apparently been working at some factory and while walking home he was bit by a snake on one of his ankles(My college is in a fairly rural area so these things happen every now and then). I was posted in the general medicine department back then but the ER interns called me to help out since they were not able to speak Tamil , I know right! what was the management thinking? Putting 6 non-Tamil speaking interns together that too in an emergency room duty in a place where Tamil is the primary language!

So anyway I go up to the patient and looked at him and saw the signature double fang marks on his ankle and now the first thing to do is identify the snake.

Now since I live in India there is a single anti-venom known as the Polyvalent antivenom which is an effective anti-venom for India's 4 most common venomous snakes. 

Which are : 

1. Russel's viper

2. Saw-scaled viper

3. Indian cobra

4. Common krait

If we find out that the snake is something other than the above listed ones we give something known as a monovalent anti-venom which is effective against the venom of one particular species of snake that it was made for.

Anyway I ask the guy "Do you know which snake it was ? Any description?"  

Now this is one of those incidents where people skills are really needed because within the next microsecond the guy shoves a polythene cover in my face and yells out "This snake sir!!!!"

And horror of horrors the polythene cover contained a dead cobra which kinda wriggled in my face due to the sudden movement made by the guy who brought it!

And i got startled and literally teleported like 10 meters away and started yelling at him about how he should have eased into the topic by saying "we have killed the snake and brought it...please take a look"  and then showed it to me.

I mean you understand right ? Things could have gone so much simpler if he was a little more discreet. So anyway the people in the ER were also petrified because someone heard me yell at the patient and only heard the part saying "The snake and brought it" so people in the vicinity thought that there was a live snake in the area and you know how it is when a group of people panic, everything becomes chaotic.

But yeah if you are wondering what happened to the patient , he recovered under our care.

Anyway that is my memory/rant for today about how sometimes people really don't know how to ease into a topic! 

First ever online rant about a patient

Most things that I will be ranting about here might seem mean and cruel but it has almost always happened to me when I am exhausted , hungry, sleep deprived , overloaded etc. I am pretty sure you know how cranky you get when you are in such a situation

So here goes

I pull 12 hour shifts at the hospital in the COVID-19 ward, usually it is heartwarming to see patients recovering and leaving the hospital while thanking you personally for your care. Sometimes it is gut wrenching to explain to the relatives/guardians over the phone or from a distance that their relative/friend/family is gonna succumb to the illness. Usually people think these are the only two things a doctor goes through. But on some days you just wanna agree with the virus.

A few weeks ago was one such day.

*Intercom rings*

Usually it is the nurses in my ward who answer the phone ...but since they were at the bedside administering drugs or checking vitals , i answered it. 

ER Nurse : Doctor is there a bed available for a new patient?

Me: There is but tell me the patient history.

ER Nurse : A young woman has come to the ER and since we are doing mandatory testing for COVID-19 i wanted to know if a bed is available in case she turns out to test positive for it.

Me: I know all that but tell me the history why is the patient in the ER in the first place ?

ER Nurse : Sir you're not gonna believe this but the patient is an 18 year old woman who attempted suicide due to some domestic issues by drinking nail polish

Me: Oh crap! what are her vitals like???

ER Nurse : Sir hear me out .... the patient drank nail polish and then a minute later she decided she didn't want to die so she drank nail polish remover as the antidote to it.

Me: ..........

So these are the kinda days when I feel I'm so done with humans and that the pandemic must run it's course.

So anyway this woman was kept under observation and treated symptomatically and she turned out to be negative and hence was discharged.

Thank you 

That is my rant for today 

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