Crow's Nest...

It is a strange day today. I got to sleep for 3 hours in the night with minimal interruptions. That is not usually the way it happens on call. I was really groggy in the morning and missed Farmingham risk score on the rounds. So not very impressive rounds. Then I cleaned up my post call work. It was almost one by the time I was done. Then I sat in the resident's lounge and watched the Viking's game which they lost by the way. Its four in the evening and I don't feel like sleeping at all. Strange very strange!

I was in a family meeting today. Part of my job definition as a doctor also means that when situation so demands I have to provide a complete and essential update to the family members of my patients. This becomes more important and tough in patients who are sedated or who are complex and do not have a definite diagnosis. But we have to do whatever is necessary to involve the family according to the wishes of our patients. It makes them feel empowered and respected and helps us run the show as a complete working team. Anyhoo I do not mean to write about these meetings today. It is not my intent to do so because the intent of today's meeting was to determine withdrawal of care for one of my patients and the result was a not always desired one _ death. We as doctors have great respect for numbers. Numbers determine our course of action. Numbers determine our prognosis. Numbers determine our treatment. Numbers dictate our proficiency as good doctors. We are so dependent on n...

I have been up and awake for almost 18 hours now. I did one of my better shifts in the ED last night. By the time I was done there was no transport to take me back hom eso I had to sit and wait in the resident lounge. Tried to sleep the time off but it gets kind of difficult to go to sleep in all the lights around you. Missed the first bus and had to sit and wait for the next one for 40 minutes. Anyways I am here to talk about the kind devil in disguise that I have had to learn to operate and handle in the last 3 weeks. It is the all encompassing health care management system used in our hospital and in most of the hospitals in the US, with paperless working. It is essentially a programme that keeps track of everything that goes on with the patient and the related entities from every health care provider's point of view. When a patient comes to the hospital he/she comes in contact with a diverse number of providers. There are the doctors, there are the nurses, there are the...

As sensational as this title might seem to many it is just another term that doctors have to come across very often in this day of overwhelming technology. It is something that clutters your EPIC inbox but you can't do anything about. But the title of the folder "Delinquent Encounters" is dreadful enough to have prompted an inquiry from my, otherwise lazy, brain. I think that it if there is a true link between typing and CTS then all doctors who are looking to make money in their lifetime should opt for a speciality that gives them ample training in recognizing and treating this ailment. It will be little wonder to see almost 99% of the doctor population afflicted with CTS in about 20 years from now. The amount of typing that I do every day today surpasses the total amount of typing that i might have done in my lifetime. Damn you EPIC!

I am moving a bit ahead of the actual time frame on this blog. My orientation officially ended today. I am on one of the so called non-call months in ED. It therefore was not part of my duty at the end of the day to get the sign off from the senior G1s. I left the place earlier than most of my fellow interns. ED begins tomorrow and there is said to be a tnesion between the my parent department and ED bunch. And we are therefore relegated to seemingly trash work. But lets see what happens once I begin ED.

The orientation week is almost over. Just a few nitty gritty stuff left to do and then I am all set to go and launch in the world of medicine. Looking forward to the coming Monday. The system here is pretty different and that is something not very unexpected. But its all the technology that is taking it away. The system is paperless and thus very new for me. I am used to our very own and old tried and tested way of writing down everything about the patient on the paper and then making sure there are a million copies of each thing floating around in the air. Kind of messy but that's something I am used to back home. Here everything has to be done through computers or if possible at all through COWs (Computers on Wheels). These cows do not moo but move and this is something unlike all the cows we know of back in Pakistan. Anyhoo I am starting my rotation in ED and that should be fun to work in.

I have finally been able to match for a post graduate training position here. It has been a long winding road with a seemingly good end. I have to thank Allah for all His infinite mercy. Thank you for all the valuable prayers. My 'Where did I match?" question will be answered soon enough now. Infact these statistics will be announced on March 20th at 12 noon EST. I will have to take quick note and try and get my contract delivered at my present address. If this happens then my process will be expediated and help me secure a visa eventually. Residency Training will mean a huge change in my life and quite a welcome change after a long long time. Some of my friends have not been able to secure a position in the match. I hope and pray that tomorrow brings good news for them too. This process is so uncertain that the little the better and the shorter the time period the better. I think it is more a test of emotional and psychological endurance than actual meaningful testing o...

Fidel Castro has officially stepped aside from the seat of power that he so diligently clung onto for the past half century. His name has been so maligned by the western media that any mention of Cuba provokes an unwelcome image of Fidel with it in everyone's mind. We forget to see a country but instead are forced to see a man - who we are made to believe is - a dictator. But finally Fidel Castro is a thing of the past. He is behind the curtain and Cuba has something new to celebrate for - a new leader. Raul can not be termed a new face as he has been hanging around his brother, lurking in the power corridors, since the revolution in 1959 . He personally saw to the execution of anti revolution people in the years ensuing the revolution. But for that matter change is welcome as that is the only permanent thing to go around uninterrupted in this world and in this cosmos. My concern is the change in the relationship between Pakistan and Cuba. Cuba was one of the first count...

Certain strains of Bird Flu have been detected in the poultry farms in Southern Pakistan. H5N1 strain has been identified in a family in Karachi . The news has brought back the fear and scare in the minds of the ordinary people who consume poultry meat regularly. The news has also affected the poultry business by bringing down the sales and damages to the poultry crops in the poultry farms. There is a lot of confusion about bird flu in the common man. Little information is shared by the official channels and people are, largely, unaware of the precautions they need to take when such outbreaks of bird flu occur in the area. The results are often chaotic and the resulting confusion adds to the management problems that the officials have to face, while handling such situations. In the following posts i will try to talk about bird flu from both medical perspective and common man's perspective but mostly concentrate on enlightening the common man. So, bird flu or avian influenza a...

A J McMichael and colleagues in their recent article in BMJ discuss the impact of global environment change and its impact on the helth status of population. They argue that human health is not an independent variable but dependent on the larger scale environmental changes that take place on earth. Doctors should be more sensitive to the global changes in environmental conditions as most of the time they are irreversible and cause greater damage than those hazazrds that are confined to a smaller area. The authors argue that the millinium development goals of UN do not take into full account the impact the environment change has on the human health. It is therefore possible that we may not be able to realize the goals if environment destruction continues. The millennium development goals are: Eradicate extreme poverty and hunger. Achieve univeral primary education. promote gender equality and empower women. reduce child mortality. improve maternal health. Combat HIV/AIDS, malaria a...

Aisha Siddiqua tells us about the approximate net worth of the dictator cum tyrant who recently left one of the posts that he was so hanging on to. It makes an interesting read as she tells us that the net worth of the plots that he owns is around 440 million to 500 million Rupees. His pension is around 45,000 to 50,000 a month and he is eligible for three to four servants all expenses paid courtesy of the Govt. of Pakistan. He is at the same time allowed to import one luxury car from anywhere in the world and is eligible for a home anywhere in Pakistan. All this money is what he gets free and fair from the Govt. of Pakistan. The money that he must have usurped during eight years of his rule through corruption must be 100 times more than his stated worth. Read the article on BBC Urdu .

Man has earned his right to live in this world through evolution over a million years. The bacteria, the viruses and the fungi that inhabit this planet in numbers far exceeding ours have had to give us this right to co-inhabit this planet with them. They have allowed us the so called piece of the cake. But all this has not come easily to the human race. As H G Wells so beautifully expresses in his book 'War of the Worlds', we have had to earn this status through natural selection and constant struggle. But sometimes our defences do fail us and we fall victim to slimiest of creatures that live around us. Maggots form just one part of this spectrum of dread. Just the other day i Saw a patient with pyogenic meningitis who was carrying truck load of these worms in her facial sinuses. The patient had ended up in my ward because her lumber puncture revealed a grim picture of pyogenic meningitis and she was very sick. Initially my efforts circled around getting her out of imme...

This week has been busy at the hospital. Most of the house officers have left the ward as their rotations have finished and only five of us are left. Of us five not many are inclined towards working and that leaves me and one of my fellow officers with all the work burden. I have been doing alternate day calls this week and it becomes very tough when one has to deal with all the slime and shit the trainees throw at you. Power, they say, corrupts. And this stands true for the Pakistani people more than anyone else. My senior colleagues who are hardly one or two year senior than i am sometimes start believing, by virtue of their, modest seniority that that they somehow have gained control over me and try and force orders unto me. And as we know authority of this kind irks me more than anything in this world. But even then i try and maintain a straight face just because this is the Holy moth of Ramadan and I don't want to sour the relationship. Not all of them are the same but ...

It is such an ironic and unfortunate thing that trainee doctors in Pakistan are treated in the most humiliating and degrading manner. And in turn when these doctors come out of this low level training they do the same with their younger colleagues. A trainee doctor in the federal hospital is paid a mere Rs. 10,000 in form a stipend. This amount is insufficient for anyone, let alone a doctor, who has to earn for his/her family and support them. Even a street hawker earns more than his every month. To top this all when doctors try to raise their concern about the issue they are shot down by their very own senior colleagues who are in administrative power and have by this time filled their pockets with money and are satiated. The doctors at Pakistan Institute of Medical Sciences let their voice out last week. All they did was stage a token protest in front of the emergency ward for 30 minutes. Lo and behold the tyrant Executive Director appears on the scene and very shamelessly tr...

I have been on a blog vacation because of various reasons. After my last post about MQM on this blog my access to blogger was blocked. I wasn't able to sign in till today. Then i have been working the work that i have been trained to work. I am doing my house job at Pakistan Institute of Medical Sciences (PIMS). It has been, so far, the worst experience in my life as a doctor. The experience is so bad that last night i was on call and all the time i was wondering on my luck and how it had spiralled down so badly over the past years. I was hoping that something would happen and i would die instead of being tortured again ad again and again, relentlessly. The IQ level of this nation, especially the people at the helm of affairs, is so low and pathetic that it puts me to shame and makes me wonder, when will i die! It is my firm belief that the DHQ Hospital Jhang is a much better place both in terms of learning experiences and efficiency in terms of the hospital, when we put both...

Medical Representatives make a real fool out of doctors. Just today a medical rep accompanied me all along the length of my clinic. His deal was that if i prescribe his medicine to the patient he will provide the patients with free first two doses of the medicine. I didn't prescribe his medicine to any of my patients of my own free will. He was selling piroxicam a potent analgesic and anti inflammatory agent. The drug is prohibitively expensive at 8 rupees for a single tablet. Yet he was adamant that it was a very very cheap alternative to many of the drugs available in the market. I have been trained to doubt all medical representative authority. But all is not lost on this front. Medical representatives are human beings too. True they want to sell their drugs and do so by any means possible but still most of them do things that is very classifiable as human compassionate behaviour. they know that the free samples that they leave on the tables do not go to waste but are ...

The MS at our hospital has changed. The old one is gone and forgotten and the new one is taking charge and being praised. Strange attitudes of the people here! Being a junior doctor who takes little interests in people around him i was not aware of the change up until today when the new MS made a surprise visit to my clinic. So ignorant was i that my doctor in charge had to inform me ' nai MS sahib'. I am thankful to him for telling me or else i barely stand up to greet anyone. He being my boss deserved that i dismantled my routine and get up from my very comfortable chair to shake hands and share a word or two with him. The guy himself was not interested in meeting a junior doctor rather he was somewhat surprised that this hospital had doctors doing house jobs.( sometimes i am surprised too!). I was noticing for the past two days that my senior doctors were arriving in the hospital earlier than me and clinics were starting at 8 in the morning instead of the normal 10...

I have never actually blogged about my house job in DHQ Jhang. It is an interesting story and needs a lot of time to be told in detail. It has almost been a month since i started my house job at District Headquarters Hospital Jhang. This is the main hospital in the district for a population of around 2 million people. It supposedly has all the facilities that a tertiary care hospital should have. But that is not the case. My hospital is a 300 bed hospital located on the busiest road of the city. It employs almost all the doctors taht live in this city. I am one of them. The building of the hospital is very old and about to fall on itself. The plaster is crusting and the sewerage is busting out of its civilized limits. There is no waste disposal for the hospital and most of the waste is sold to crooked buyers who sit right across the road. There are a million medical stores right across the road and the life in there is busy with patients and patient relatives buying and selli...

I have journeyed across a whole continent, overnight, and am now in New york for my interview. I took a red eye flight out of San Jose into JFK. This time around the check in was complicated because the air line tagged me and thus i had to undergo special security checks. It cost me an extra 5 minutes but nothing much. The flight itself was very uncomfortable on Jet Blue . The check in clerk changed my seat from the exit row to the one in front of it. Jet Blue is a paranoid airline and thus their actions. I had to spend my whole journey crammed in a seat that had minimum leg space and did not recline. It was horrible. And since my boarding pass was tagged i could not complain. Otherwise the journey went well. We landed in New york early in the morning and were welcomed by wind chill temperatures of 19 degrees Fahrenheit. I took the Air train out to the Howard Beach Station and then the A train to 168th street. After this it took me 2 block walk to my very pleasant hosts, FC and AJ. I h...

I am going for my interview at the Brookdale University Hospital on the 31st of this month. I have just received the email from the coordinator. Let us see what happens on this interview. The weather in Brooklyn is very very cold and i will be carrying with me some extra clothing to prevent myself from sheer freezing. the forecast for the week though is better and on the interview day it is supposed to be sunny and not runny. The weather here in Santa Clara has been unusually dry and i haven't seen the better part of rain for quite some time. But there is hope in the air and rain on its way. The preparation for the exam is going good i guess. Today was a better day where i was able to accomplish more and do better on the tests. But overall the exam requires some honest time to sit and study. I am trying to do that and will continue to do so inshaAllah. I have my exam scheduled for the 8th and 9th of February 2007. The hope spring is eternal.