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The Ambulance

My work in the Emergency Department involves meeting and interacting with many ‘Ambulance Doctors’ on a daily basis who come to transfer patients from some medical facility to our tertiary care hospital. Here is a report of my observation over the years. (Trust me every word of it is true and from real life scenarios)

1) Most ambulances always drive with their sirens on even if there is no patient inside. You will seldom come across an ambulance moving at a normal driving speed. While few motorists use this opportunity to drive bumper to bumper with the ambulance to beat the traffic (I do that often :p), I've seen young crack heads trying a stint of street racing with the ambulance too.

2) MOST doctors that are hired in this ‘money minting’ ambulance business are BUMS, BAMS and BHMS ie. Ayurvedic and Homeopathy ‘Doctors’ who have no/very little knowledge of modern medicines they use during the journey.
Note: There are centers across the country running a 6 month PGDEMS (Post Graduate Diploma in Emergency Medical Services) course that makes it easier for them to get jobs in such ambulances and a license to kill (Wow…they become qualified Emergency Physicians...why will MBBS people persue a 3 year MD/DNB Emergency Medicine degree then ?)

3) Their sole aim is to ‘dump an alive patient’ at the receiving hospital. Patients with no recordable blood pressure (but with a pulse), patients who have an oxygen saturation of above 85 % (with or without oxygen) and many such patients with life threatening vitals are STABLE FOR THEM. The vital parameters of the patient (Pulse, Blood Pressure, Saturation and Respiratory rate) are always stable during the journey, as reported by them and change as soon as the patient enters the hospital door, when we measure them.

4) One of their primary objectives is to get their hands back on the ‘patient transferring sheet’, (the one used to shift patients from their stretcher to the hospital bed). They make the uncomfortable patient roll right and left as soon as the patient is brought in (arre chain ki saans toh lene do patient ko). The doctor too is more interested in helping his attendants pull it out than briefing us what is wrong with the patient in the 1st place. The money can wait for 15 minutes, but the patient transferring sheet is the real treasure.

5) The oxygen mask used for patients during transit is reused for an unlimited time till the elastic straps on the side of the mask become loose or break. Even if they bring a patient with TB or pneumonia, they always want the mask back, as it’s the only one they have. (My hospital infection control nurse would surely kill them!!)

6) With the dressing sense and grooming of a few ambulance doctors, it can at times become difficult for us to recognize the doctor among the 3 people who wheel the patient in (the ambulance driver, the attendant and the real ‘fake’ doctor) until we see a stethoscope hanging in 1 someone’s neck.

7) The accompanying doctor’s are exceptionally good with ONLY 2 drugs.a) Dopamine – to increase the blood pressure. b) Nitroglycerine (NTG) to make the blood pressure fall.

Depending on what the reading shows on the monitor in the moving ambulance, they don’t even bother to manually check the BP and play with the infusion rates as they like.

8) Any patient who is irritated, non cooperative, moving about, there is a high probability that he/she will be injected with Midazolam/ Fortwin and Phenagan which puts the patient to a good sleep. The relatives feel that the doctor has done something, the doctor feel that the journey will now be uneventful. But the catch here is that with a wrong extra dosing, the patient can go into respiratory arrest developing hypoxia and carbon dioxide narcosis. Next step: Intubation in a moving ambulance --- damaged vocal cords --- a bathroom singer for life, if the patient survives.

9) Rarely does an ambulance doctor declare a patient dead at home and are more than happy to rush a patient who has been dead for more than 1-2 hours on AMBU (even a layman can tell that when the body is cold, pupils completely dilated, body is stiff- rigor mortis that the person is a goner) giving false hopes to the family of a miraculous recovery or securing a Death Certificate from the hospital the patient is taken to (both of which never happen).

My motive of the above article was not to disrespect any of my fellow medico colleagues, but was to highlight the plight of a very essential and ‘life altering’ (I say altering as it really can change the outcome of the patient, the future of the family members) service - The Ambulance.

It really is disappointing to see such practice and I really wish we could have better standards of care one day and may be an EMS services like 911 in our country too.

"Aamir Khan has grown from a trusted liar to have empathy with all chakna buyer", say doctors.

Mumbai: In a major setback for Aamir Khan who is currently in the news for the new season of his show ‘Satyamev Jayate’, media pundits have revealed that he is gradually becoming the new laughing stock like Rahul Gandhi and Alia Bhatt after the 1st episode which featured those shameless people who do not drink but always finish the 'Chakna'.

It has been seen that the popular show which features not-so-true dramatizations with its sensational pauses, exaggerated viewpoints and pointless rounds of applause on topics mostly pertaining to discrepancies in the healthcare industry has finally come of age and has become bold enough to address the real issues plaguing the society.

Our Gupt Sutra spoke to Dr. Pranshul Kamdar, a famous columnist for a leading health magazine who said, “It is bad to drink on an empty stomach. The Moong Dal, Masala Peanuts, Sev Bhujia, boiled Chana, etc aid in digestion and helps counteract the female hormones in alcohol, which after drinking, make men talk unnecessarily, become emotional, drive badly, stop thinking and fight for nothing. The show is really a boon to society for highlighting the sorry plight of people fed up of their non drinker friends who blatantly finish the Chakna.”

The changed mood of doctors towards the actor is in sharp contrast to the previous view of the fraternity which felt that the show with its just 12th pass host Aamir Khan was biased and targeted the health care industry by showing doctors (who spent half their life studying) in bad light. It also never mentioned about the dark side of Bollywood including the casting couch, the unspoken infidelity of actors, Aamir’s illegitimate child with British reporter Jessica Hines, etc.

Our sources have revealed that the next episode on the show will feature life in college hostels and how a friend with weed, is the true friend indeed.

Man 'retired hurt' while booking for IRCTC's retiring room online.

Mumbai: A day after Indian Railway Catering and Tourism Corporation (IRCTC) launched an online booking facility for retiring rooms at railway stations, a man from Mumbai, Chukchuk Prasad ‘retired hurt’ with pain in his fingers, neck, back and bums after sitting for 10 hours continuously in front of his laptop, but yet failing to book his accommodation through the IRCTC website.

The news which has spread like wild fire among the already angry railway passengers owing to the slow website server during Tatkal bookings and unproved allegations of IRCTC’s setting with agents, has exposed another lie of the Indian railways that tech-savvy railway passengers could find accommodation in retiring rooms at the click of a button.

The ‘retired hurt’ passenger was taken to the emergency department of the Quackdoc Multi-Specialty Hospital where a medico-legal case (MLC) was filed against IRCTC and the patient was admitted in the ICU for observation where he is said to be stable. The police department has meanwhile started investigations, but they are not too hopeful as Mr. Prasad couldn't come up with any details except for how many times IRCTC returned “Service Unavailable” error.

In a statement to our Faking News Samwadata, Chukchup Prasad said, “The website claimed that any railway passenger with a PNR of a confirmed or RAC ticket can make an online booking of a retiring Room. I was somehow successful to get a confirmed ticket from Borivali to Churchgate, but when I made the payment of Rs. 20 for my 24 hour stay in the retiring room at CST, I never got my confirmation receipt even after trying multiple times for almost 10 hours. I wonder if I will ever get back my refund.”

There seems to be no break through in sight as there is now a dispute over whether the case falls under the jurisdiction of local police or the Railway police.

The American Dream

@ Washington DC: This is not an article…this is not a diary entry…For me this post is a documentation of one of the distant dreams of my father, who for many years often spoke about sending me to the US for further education.

“When I finished my engineering in Kanpur in 1978, I neither had the family support, nor the money to even go along with my college friends to the graduation celebration trip they had planned to Mumbai and Goa… But I’m there for you”, he said. (That father-son moment seemed like a scene from the movie Dilwale Dulhaniya Le Jayenge when Anupam Kher tells Shah Rukh Khan, “Ja…tu ab meri jawani jeeke aa”.)

I had kept this post for my last day in DC, had planned to write it while sitting on one of the benches at The National Mall, but I leave for New York tomorrow…don’t know if I will ever get that precious time. So here I’m at 2.50 am, with no sleep in my eyes penning down some random thoughts as I relive the last 4 weeks of my stay here.

Washington has surely been the most beautiful city that I have lived in or travelled to till now. I have always believed that you really have to stay in a city for a few days, walk around in the neighborhoods, wander (not be a tourist), get lost (I actually did when after being misguided by a local, ended up being the lone cyclist on a busy Georgetown Highway with cars whizzing past at 60-80 miles per hour and drivers hurling some really good American abuses at me), talk to native people to appreciate its true beauty.

From the awe inspiring 2.3 mile National Mall with the Capitol building on one side, the Lincoln Memorial on the other & the National Monument standing tall in between, to the countless world class free memorials & Smithsonian museums, gardens and parks, the access into federal buildings even while at work, beautiful old row houses of the 1800 and 1900s (there are no skyscrapers in DC), visit to the unique International Spy Museum and the Newseum, friendliness and good nature of the people (not to mention their manners), first time couch surfing experience (Thank You Mihir Pathare for that idea), cleanliness all around, almost zero traffic 24 hours (compared to Mumbai), etc made me fall in love with this city.

It was such a good experience meeting and interacting with doctors and medical students from all over the world. One thing I realized it that here people think and talk a lot about Global Health, research & publications, actually coming up with their own medical ‘apps’ and websites or writing a book, working in war stricken countries, etc while most young doctors in India are worried about getting married !!

There is so much I can write but I’d prefer the photos do all the talking (my eyes are drooping). Here is the link: The Wanderer - USA

Well I guess, all good things come to an end. But this surely is not the end, a new city…a new dream awaits me tomorrow…and this is just the beginning...Looking forward to my actual 10 day extended vacation (I have not taken my paid leaves in the last 4 months to accumulate them).

I conclude with this thought. Life’s calling, where are you ?? (Inspired by the Smirnoff tagline :p)

Fun at Work

It is fun to be witty / sarcastic with patients in the Emergency Department at times.

A 30 year old 'Fattu' male, had come with complaints of chest pain and palpitation around midnight 4 days back. We did a complete work up on him including ECG, Cardiac Enzymes, 2 D Echo which were all normal, a Cardiologist's consultation was taken and patient was then discharged.

He presented again yesterday. Here is the interaction.

Patient: "Doctor, I'm really worried...I think I'm having a heart attack...I'm feeling Uneasy."
Me: "We got your entire work up done 3 days back...your heart is fine. Don't worry".

Patient: "Doctor, is there a way I can still be sure my heart is normal?"
Me: "If you are still worried about it, you can get a CT Coronary Angio done for yourself. It will tell us about the arteries supplying the heart if they have any blockages."

Patient: "Doctor, if that CT Angio comes out normal too, is there a way we can still be sure my heart is fine?"
Me: "Then you can go for further investigations, get a Cardiac MRI done."

Patient: "Doctor, if that Cardiac MRI comes out normal too, can we be still sure my heart is fine?"
Me (Irritated by now) : "Yes, then the only way is to do an Autopsy (Post Mortem) on you to see if your heart WAS fine."

Total Silence......and his brother gives me a High Five.

But it doesn't end there...
Patient (Just before going out)- "Doctor, what were the 2 tests you told?"

Doctors go on a strike after Alia Bhatt stops colleague's car.

Mumbai: In a major embarrassment for Alia Bhatt, the 2nd in command to Rahul Gandhi for being 'The Dumbest Indian Internet Sensation', doctors across the country went on a flash strike today after she force stopped a doctor's car mistaking him for a snake charmer.

The incident happened in the wee hours of the morning when Alia who was returning from an IQ improvement class saw a car whiz past which had a sticker of 2 snakes on the wind shied and a black snake like object on the dashboard. She immediately called up the 'velle' media persons and animal right activists who were quick to reach the scene as she successfully chased down and force stopped the car. The driver (identity withheld) was later found to be a medical intern who was getting tea-biscuits for his Registrar and Houseman, and the snake like object was only a stethoscope.

In an exclusive interview with Faking News: Doctor's Lounge, the meaning of which we are still trying to decipher, Alia said, "When Doctor Fix -It can be a wall putty, Teachers can be a whiskey brand, why can't a car with a sticker of 2 snakes on it be that of a snake charmer. My intentions were not at all wrong. I respect doctors. Even when I have to go for a blood 'Test', like engineering students, I too start studying 1 day in advance."

Meanwhile, our gupt sutra Sunita Soni has found out that Alia has already filed a petition with the President of India, 'Prithviraj Chavan' to change the current universal doctor's sign to that of Aamir Khan (The 'dood ka dhula hua' Mr. Perfectionist who shot to limelight with his Anti-doctor episodes on Satyamev Jayate) wearing a stethoscope.

Patients who self diagnose from Google search will be prescribed medicine after Google search.

Dr. Google - The world's most famous Quack?

Mumbai: In a decision which could further disrupt healthcare in the country, the Medical Council of India (MCI) has issued an official notification today directing all polyclinic and hospital’s entrance to publicly display – “When you can pay for extra butter and sambhar in a restaurant, patients with doubts from Google will also be charged extra.” The historic decision has been taken following complaints from doctors that most consultations have become annoying due to the patient's self diagnosis off the internet.

Over the last few years, the number of ‘net savvy’ patients suffering from minor symptoms with 100 % mortality presenting to the clinic has increased. Also, many panicked patients are visiting the emergency department during silent hours after ‘googling’ their vague symptoms and finding out that they are suffering from Stage 4 Cancer or AIDS, and have only 2 weeks to live. Such patients usually exaggerate their symptoms and are convinced that their situation is much worse than it actually is.

In an exclusive interview with the Quackdoses, Dr. Fees-de, a famous Mumbai based GP, said, “In today's times, patients usually visit doctors to lighten their wallet only after the ‘gharelu nuskhe’ have failed,  and not before openly & loudly updating their concerned relative on phone, “Saala doctor bahut paise charge karta hai”. Earlier patients would come to us with their lab and radiology reports. But now, patients come to us with a pile of print-outs from the online research they’ve done or a list of possible reasons for their ailments, and after making their own amateur medical opinion. The moment a patient says, ‘I read somewhere’, we know he/she has already consulted ‘Dr. Google’ and such patients will be charged double consultation fees."

Many patients have voiced their opinion on social media claiming that it is wrong for doctors to think that they know everything and that patient’s can’t know anything useful. 

The notification further states that patients who diagnose themselves after searching on google will be prescribed medicine by the doctor after searching on google.

Major setback for Congress ahead of elections, doctors file copyright infringement case.

Mumbai: In a major setback to the already demotivated Congress party under the leadership of the dumb Rahul Gandhi, an alumni of doctors from Mumbai's Lokmanya Tilak Municipal Medical College have filed a copyright infringement case with the Election Commission against the party's tagline "Har hath shakti, har hath tarakki" yesterday.

The doctors claimed that they had coined the saying "Apna hath Jagannath" one night in their hostel room 18 years back due to the frustration of having to study 24 X 7, not getting girlfriends in medical college during their conservative era, and the Congress party has now stolen it from there.

Faking News: Doctor's Lounge got in touch with Dr. Deepak Kumar Singh, a famous city based Surgeon who filed the case. "I personally remember writing 'Apna hath Jagannath' above the 1st urinal in the college library during my final year of MBBS 18 years back.The Congress has simply lifted my 'eye opening, inspiring' words from there, similar to how Anu Malik lifts tunes from other musicians, and made subtle modifications to it. Jagannath and Shakti, both symbolize power - of the hand here." he said.

"However, we have no issues with the 2nd part of their tagline 'Har hath tarakki' as it doesn't even rhyme well or make sense. I'm sure that it really was Rahul Baba's original idea", Dr.Singh added further.

In a hurriedly called press conference today to rebut the claim, Rahul Gandhi said, "I'm a 43 year old unmarried youth icon. My mummy is not at all worried about my marriage. I have always believed and propagated the power of the hand- 'Har hath shakti' since last 30 years. How can these doctors claim copyright on it? Dadi se seekha hun, maza chakhaunga unhe". The statement was immediately applauded by Digvijay Singh and Kapil Sibbal.

Whether or not the Congress Party changes their election punch line, only time will tell. But a section of party workers seen shouting "Abki baar Pappu Sarkar" on the streets of Mumbai surely reflect lack of insightful ideas and tough days ahead for the Congress party.

My Resentment

Its 3.50 am in the morning and I’m not sleepy at all. It has been a busy last 46 hours. Started off with morning lectures 2 days back followed by an afternoon plus night double shift, again morning lectures and again an afternoon plus night shift…expected myself to be dead tired by now considering I have slept only for 4 hours in the last 2 days.
                                                               *
Its been more than 2.5 hours that I finished taking my rounds which included 6 new admissions today but the constant sound of the ventilator, monitor and infusion pump alarms along with the hustle and bustle outside makes it difficult to sleep….also the small sized couch isn't so comfortable at all.
                                                               *
All I can do at this point is to look back and retrospect about how difficult this journey has been to be a doctor. It was 2003 that 1st year of junior college ended and the slogging for the 12th Board exam and the medical entrance exam began…and 11 years later after working extremely hard all throughout, I’m still stuck with a lifestyle, 95 % of which includes doing a hectic job (with odd working hours, grossly altered sleepy cycle, working on Sundays and public holidays), studying, eating and sleeping, and surviving on a stipend which does not even meet my annual fees and monthly expense. There is very little time now for leisure, family, friends, and health or to pursue any hobbies and at this juncture in life that is taking quite a toll on my mental health now.
                                                               *
The best years of my life (age 17-29 years ) were/will be spent ONLY studying (Read as ‘Life wasted’ - No alcohol/smoking/drugs/girlfriends) and all I can do is drag on with life and wait for the day my existence in society really matters. Right now, I’m nobody except for the people who know I’m pursuing medicine and to those who come to me for free consultation (and a few others who really piss me off by expecting me to collect their reports from the hospital I’m working in….bloody morons). It really is so damn frustrating.
                                                               *
I've realized now that I’m a mediocre, hardworking person…Medicine is only for those gifted, brilliant minds who along with the hard, monotonous, long student life years have the patience to spend more than half their existence struggling, 1st to complete their studies and come up to a level of becoming a consultant (age 37-40 years) and then become so busy again to lead an unhealthy lifestyle with little time for themselves or their family.
                                                               *
Gone are those days when doctors used to be respected and looked upon as demi-God. Healthcare now has become a purely commercialized business with cut throat competition and infighting for the survival of the fittest. Also doctors have become easy targets- can be sued, implicated in false allegations to extort money, beaten with ‘lathis’ and sticks by the police, be slapped by patient’s relatives, threatened by the government to have their license cancelled and be thrown out of the resident doctors quarters for raising their voice.

                                                               *
I really wish now that I wouldn't have listened to my parents 12-13 years back and their wish to see both their children as doctors, a dream which eventually came true. I still remember the conversation I had with my mother telling her that I wanted to be an Air Force Pilot. All the creativity, passion, aspirations and dreams are slowly fast fading and I really can’t wait to come out of this busy, hectic student life and finally be free of all these books and studying….another 1.5 years to go…desperate to 'actually' starting earning and become independent at the age of 29....feeling like a caged beast now.

Front row - corner seat couple found 'actually watching' the movie, theater authorities refer them for psychiatric evaluation.

Mumbai: In a rare occurrence which can be seen only on children channels like Pogo and Cartoon Network, a college couple who bunked their lectures to watch an early morning show of the movie 'Heartless', actually watched it in spite of sitting alone on the corner seats of the entire 3rd row from the screen.

It is a well known fact that ever since hotels have started demanding an identity card to rent a room or patrolling policemen suddenly shining torchlight in cars, young college couples have flocked to movie theaters to get to know each other better.

Our Samwadata Dr.Tharki Jasus with his 8 years of experience staying single in medical college and studying such couples said, "Usually the boyfriend takes the girl out on the days Vodafone and Loop Mobile offer a 1 plus 1 scheme. No sooner the lights go off after the national anthem, the heads of the couple which can be seen from the back seats usually disappear and can be visible only when the girl demands a popcorn bucket during the intermission. I wonder what the reason would be in this particular case, but I'm not fully convinced as eyewitness did not report anything about their hands."

The theater authorities citing moral responsibility, forcefully referred them for a psychiatric evaluation to the nearby Faking News: Doctor's Lounge Hospital, even getting their 30% referral cut.

The news drew sharp criticism from other college couples who now demanded broad, reclining club seats (like in the last 2 rows) in the front 3-4 row-corner seats too.

Sab Bakwass Hai...

Congress ka Hath, Dagi Netaon ko laat
Mumbai k footpath, India shining ki Baat
Sab bakwaas hai !!

Badti mehngayi, Kadki hai chayi
Politicians ki kali kamai, jane kahan se ayi
Sab Bakwaas hai !!

Career banane pe zor, Paise kamane ki Hod
Bikau padhai, Placement k liye ladai
Sab Bakwaas hai !!

Media ki paid news, opinion poll pe views
Bollywood linkups k jod, Asli news tod marod
Sab Bakwaas hai !!

Relationships mein love, dead relatives watching from above
Extra marrital affair ka dhoka, Mauke pe Chauka
Sab Bakwaas hai !!

Facebook k poke, Alok Nath pe joke
Rahul Gandhi k bol, Petrol rates on a roll
Sab Bakwaas hai !!