Tuesday, November 30, 2010

More observations on the Medical Floor

I have been going to the medical floor regularly. Yesterday was the emergency admission day. Most patients were brought in half-dead. They have about a 10 to 15% mortality rate on the medical floor. A few days back I attended the mortality conference of the pediatric department. Practically all the deaths were in the first 48 hours of admission, most within 24 hours. So I guess the half-dead patients somehow survive and are discharged. Those who are admitted three-quarters dead do not survive.

I can only imagine the conditions at the government hospitals outside of Delhi. They send their sickest patients to this hospital. I have seen all kinds of mismanagement of patients before they arrive at the Casualty here. One patient had epilepsy. Prior treatment had been Valium, etc and smelling salt. I am sure it made her worse. Another patient was brought in today. She had C. Section followed by acute kidney failure. It looks like they gave her the wrong blood and she had a transfusion reaction. Another patient had AIDS diagnosed at another peripheral hospital three months back. He was not prescribed any anti-AIDS medicines.

Enough sad stories. Now the good news. I had applied to get my medical licence renewed in Delhi. I had a valid licence to practice medicine here in 1972-1973. Today after about three weeks of applying I received my Delhi licence. Now I can officially treat patients in state of Delhi. So now I can open a long distance allergy clinic here in Delhi and see patients on Skype, sitting in La Canada. Just a thought :)

Monday, November 29, 2010

Chairs chairs everywhere.....

This is the chair I sat on for about an hour and a half. Now I am not going to complain if some chair in the USA is not so comfortable!

This is the chair that the Professor and Head of the Department of Medicine sits on! So I guess my chair was not that bad, considering that I am nobody here :)

Sunday, November 28, 2010

A chair in the Cyber Cafe

You have to admire the ingenuity that went into making this a soft padded, reinforced chair.

Editorial in Indian Newspaper

This is the editorial by The Pundit in the daily newspaper The Hindustan Times. It is one of the largest newspapers in India. Since it is hard to read, I have downloaded the text from its web site. Here is the text.

She's Dubya's double
Geography and politics are not Sarah Palin's strength
This could be a boon for nations like N Korea & Pakistan

"The geographically-challenged Sarah Palin is always good for a few laughs. But when she mixes up a nuclear-armed rogue North Korea with America's ally South Korea, people should be afraid, very afraid. In the recent trouble between the Koreas, our Sarah made no bones about how the US should stand with its North Korean allies. When corrected, she amended it to, "And we're also bound by prudence to stand by our South Korean allies, yes."

 Not just the Americans, but the North Koreans must be terrified of Sarah becoming the main woman in the US and mistaking their beloved leader Kim Jong-Il for Kim Cattrall of Sex and the City. Anything is possible with a woman who could call feminists a cackle of rads and who called upon peaceful Muslims to "refudiate".

But we must be thankful that she has taken up where Dubya left off. We wonder why she did not get the Korean issue right by making notes on her palm as she has done before big speeches in the past. We can only assume that the breadth of her vision could be comfortably encapsulated in that space. In fact, to justify her palm propensities, she quotes God as justifying this in a passage in the Bible. Imagine if she were to drop by here when and if she become prez. She might well ask why we are not wearing feathers in our hair and brandishing tomahawks.

Her celebration of ignorance might prove a boon to countries like North Korea and Pakistan. "Asif, who are these people with strange, ticking steel devices strapped to themselves?" Old Zardari would answer, "Oh, they are part of our meteorological team out to record the ambient air quality." To which Sarah might respond that this is a skill sorely lacking in America. Meanwhile, let us hope that Sarah with her telescope vision is looking beyond Russia which she can see clearly from her window in Alaska and keeping an eye on North Korea, sorry South Korea, oh, okay, someplace out there."

Things we take for granted

The other day, early morning, the water stopped. I almost went into a panic. I had to go number two. How was I going to wash my hands! Fortunately the water flow was restored after a few minutes. I remember the old days when the water would stop for hours at a time, almost on a daily basis. We used to have buckets of water stored, as soon as water was available, in case the water stopped. Now we are so spoiled by running water that we take it for granted.

My laptop crashed really badly. I reinstalled Windows 7. It took me a whole day. It crashed again. Then I realized how we take computers for granted when they are working fine. I called the tech support and reinstalled Windows again. I am being very careful with the laptop. I am using it more or less as a desktop. There is some problem with the USB-internet modem and the laptop going into hibernation. The USB modem does not like it.

Saturday, November 27, 2010

A couple

During my time in Medical School, if there was a couple walking or talking, everybody would stare at them.
 I guess staring must have worked!! 
Now there are couples everywhere!!!

Corruption in India

The extent of corruption in India has to be seen to be believed. The cabinet level people take such open and outlandish bribes that they would put President Noriega of Nicaragua and President Marcos of the Phillipines to shame. I always beleived that once you have a billion dollars or so, why would you want more since you cannot spend it no matter how hard you try. I was so wrong. These people have billions of dollars and they still want more.

I saw the documents containing the "smoking gun" with my own eyes and now I believe that the current top most Indian leaders are the most corrupt in India's history.

The smoking gun I saw relates to the ambulances you see in the photo above. They were purchased by the Delhi Government (DG) for the Commonwealth Games, that were held in Delhi in October 2010. The amblulances have advanced life support equipment including Automatic External Defibrillators (AED). DG invited tenders for the AEDs. I saw the tender notice and the requirements to be considered an "approved vendor." Several companies applied. DG rejected some of the most well known companies including Phillips Electronics as not meeting the "approved vendor" requirements. Phillips Electronics sent letter after letter showing that they had met all of the qualifications. Then the tender from an unknown vendor was accepted to supply the AEDs for Rs. 310,000. There was another company that protested in writing that they have a long history and better reputation then the company whose tender was accepted. This company had bid Rs 125,000 for each AED! Their bid was rejected.

These ambulances were ordered in a hurry because a lot of money was to be made by the officers of DG. They had no plan for the ambulances after the Commonwealth Games. So these ambulances are sitting in a parking place with nothing to do. Even if they are pressed into service by DG, what are they going to do? They can take the patient to a hospital but the hosptial has no equipement for advanced life support!

I have been working with Arvind Kejriwal, who along with some others, has been fighting the corruption. I spent several days working on draft of a model law to appoint an anti-corruption agency that would be free of political appointees. I think I have done what I can do, there is not much else for me to do.

Friday, November 26, 2010

The Mobile Phone

This is a MOBILE PHONE! This guy can pedal his phones to any place and offer passers-by a way to make inexpensive local and long distance calls. He was pretty busy when I saw him in front of the hospital. He had three desktop looking phones on his counter. The charge posted was Rs 2/- per call, i.e. 5 cents.

Ashoka Pillar and Headache Conference

I made another visit to the "Magnificant Discovery". The ticket booth was not yet open and the guard was not there either. I wanted to see the Ashoka Pillar up close. It is surrounded by a tough looking fence. I circled all round and could see some garbage inside the enclosure so I knew people had been inside recently. I tried to force open the locks, but had no success. After another circle I found that one of the rods in the fence was missing. There was enough room for me to squeeze in. I went all the way to the base of the pillar. It has plaster all over it except the bottom ten feet. The plaster had fine writing covering the pillar. There must be over a thousand lines of text. I was looking at the oldest written law of the land. King Ashoka had written his teachings, which were basically the law of the land. I read that there were graffiti on the column too. One graffiti was an inscription about the local king winning a battle in 1213!

On the way back I could not find the entrance/exit door. Here I was lost inside of the ruins. I found out that it is no fun if you are forced to stay in a place, even if it is a beautiful place. After another long walk to the pillar, I retraced my steps and got out.

When I returned, there was all this commotion in front of the medical school. So I made my way over and found out that they were hosting a headache conference! The whole place was beautifully made up! Once you were inside of that place, it was like you could forget all the realities outside of the medical school. The whole thing is being paid for by the drug companies.

 There were more drug representatives then the doctors attending the meeting.

I went to the registration booth and asked to be registered so I could eat at their lunch buffet. The food arrangement, as you can see, looked superb. The registration clerk took out the brochure and said the registration fee was Rs 4000/- (about $100). I was in no mood to pay $100, after having saved 12.5 cents on the entrance to the magnificant monument. I picked up one of the registration kits of some other doctor who had not shown up and told the clerk that I will use that, and if the doctor shows up, to call me and I will return his registration. She was not buying it. I gave up and moved on. Maybe I could just show up there at lunch time?

Thursday, November 25, 2010

Amit Banerjee

I have been wanting to write about Banerjee. But he is reading my blog so I have been hesitant to write about him. He is one of my classmates from medical school. In medical school, he was well known to all of us, not always in the best light. His most memorable feat was publishing a year book. It was a beautiful book, full of photos and writings. However, the rumor was that he went way over budget and the editors were not able to publish any year books for the next two years because the school was still paying for our year book!

Another Banerjee coup: One of our professors used to give a lecture from 12 Noon to 1:00 PM. We would get hungry by 1:00 PM and this professor would go on and on in his monotone voice, way past 1:00 PM. He was the most boring professor. One day at exactly 1:00 PM a loud alarm clock went off in the back of the room. The professor left the lecture hall in a hurry and after that never stayed past 1:00 PM. I thanked Banerjee for that. Anyway that was forty years ago.

Today he is the Medical Superintendent of Irwin Hospital. That would be like the CEO of USC-County Medical Center. He was head of Cardio-thoracic surgery before this. He told me that he took the job because it was such a challenge. His family was already used to an absent dad, so the new job with long hours would not make any change for them.

I have talked to several people and have seen him at work. It is a hard and thankless job. But there is so much possiblity of doing good for a large number of people. He works ten to twelve hours a day. This is in sharp contrast to most Professors who regularly work five to six hours a day in government hospitals.

There is one or the other crisis every week here in Delhi. A few weeks ago, two foreign tourists were shot by terrorists. The tourists were brought in to Irwin Hospital. Banerjee had to here day and night, with all the media and the political leaders coming in.

During the past week it was something else. A seven story illegally and poorly built building collapsed killing 50 to 100 people, and injuring several dozens. About forty bodies were brought to Irwin Hospital. About a dozen seriously injured patients were also brought in. This was front page news in all the Indian newspapers for three to four days. Naturally all the politicians would come to Irwin Hospital to show their "concern". Their main concern was that they would miss the media attention if they did not come! Banerjee had to be there to meet them and show them the excellent care that the injured were getting. He did make sure that everyone got the best possible care. This was after all front page news.

Then he had to do the very sad and difficult job of dealing with the bodies. Every body had to be identified. This was no easy task, since most Indians do not have photo ID. Some bodies had no claimants since these were migrant workers from Bihar and Bengal. Some were Moslems and others were Hindus. The bodies have to be treated differently. The railway ministry offered to transport the bodies to Bihar and Bengal in special refrigerated coaches. But the heat was not going to make it easy for them. The bodies might decompose. So the bodies had to be embalmed. Not an easy task in Delhi where only two mortuaries have the ability to embalm.

Then came the greedy ones. The relatives and neighbours realized the value of the bodies. The government was going to give compensation of seven hundred thousand rupees to each of the families of the deceased. Now several bodies had several claimants each. Some families did not speak Hindi. Several families were from Bengal and spoke Bengali. Now Banerjee was himself talking in Bengali to the families, trying to identify who were legit and who were not. By the time the whole task was done it was over a week and Banerjee had been in hospital twelve hours a day everyday!

I do have a complain against him. He has not invited me for lunch, let alone a dinner. One day while walking we stopped at Medical School Cafeteria and Banerjee ordered a tomato sandwich. I shared that with him. The bill was Rs 12/-. I think he did it so he can say that we have "broken bread" together!

I have nothing but high praise for the man. If we had more of him, India would take its rightful place in this world.

Silver Lining in the Clouds

I was talking politics with the auto-rickshawalla, on my way to my favorite place for lunch -- "Haldiram" in Connaught Place. There were elections in the state of Bihar and the results were declared yesterday. Bihar is one of the poorest of the Indian states and it has the second highest population. It was ruled by the party of Laloo Prasad for about 15 years. He was very arrogant and incompetent. The auto-rickshawalla told me that Laloo's slogan was:

"So long as Samosas have Aloo
Bihar State will have Laloo!"

Five years ago the people booted him out but his followers kept a good chunk of legislative seats. The new Chief Minister was Nitish Kumar. The newspapers could not say enough good things about him. How hard working and incorruptible he was. He worked twelwe hours a day and made good on his promises. So now the people have voted for his party and associated parties. They have 84% of the seats in the legislature!

I guess Laloo will have to make his own samosas now, without Aloo!

The Auto-Rickshawalla

 The Auto-Rickshawallas are one step above Rickshawallas. They work half as hard, and make three times as much money. But there is nothing wrong with that, since Ann has been telling me that about my job! This fellow's name is Pawan Kumar. He is forty-eight years old. Unlike a lot of other labourers he is not from Bihar. He had a small shop in a government owned building. The building was converted into some other offices and he lost his shop. So for the past two years he has been driving an auto-rickshaw. He rents the vehicle for Rs. 400/- a day and has to pay about Rs. 80-100/- a day for gas. He works twelve hours a day seven days a week and takes home about Rs. 15,000/- a month. He has one daughter and two sons. His foremost desire in his life is to educate his children so they can get some decent job. His daughter has just finished her B.A. and his sons are in high school. His daughter is looking for a job. His biggest complaint with the world is that he has to face so much corruption. He cannot buy an autorickshaw because of the inflated price and corruption in the licence department. He says his daughter can not find a job because he does not have any relative in a high position and he can not afford to pay a bribe needed to get her a government job.

The auto-rickshaws are everywhere. In Thialand they are called Tuk-Tuk, a very appropriate name, considering the sound they make. 

Outside of Delhi these are used as passenger vans. I saw this one and counted tweleve people in there.

A little further up I saw this one buldging with people on both sides. 

So I asked my car driver to pull up close to the auto-ricksaw and counted twenty people in there.

Tuesday, November 23, 2010

The Ragpickers

The charity group IFA has given me the task of keeping in contact with Pramod Kumar, who is helping the ragpickers. I am supposed to talk to him every month, to encourage him to keep on going and to get an idea of how he is working. First I took the Metro to a place very far from the center of the city. There Pramod came to the Metro station and gave me a ride on his motorbike. After about half a mile, we drove next to this open canal. It was stinking so much, like someone poking needles in your nose. The bank of the stinking canal was littered with garbage. It went on for about three miles. By now I could not smell anything! We arrived at their slum. It was pretty far from the canal. It almost smelled good. I think the smell is a matter of relativity. Their slums were not smelling as bad as the canal.

These people are from Bihar just like the Rickshawallas. There have no marketable skills. They go thru the garbage and pick out anything that can be sold to recycle companies. They pick rags, plastic bottles, plastic bags, styrofoam pieces, human hair, metals and even discarded wrappers. They bundle everything and sell their finds to people who process these things. In the photo above you see their living place. They work and live in the same place.

They even pick women's hair from discarded household waste and sell it. The photo on the right shows piles of hair they have painstakingly separated from the other waste. I was told that human hair is very good for business since they sell it for good money. (Note to Kristina: Next time you use your comb and get some hair, save it, we will give it to them for recycling!)

These rags were just brought in. They will be separated by color and fabric and will be rebundled and sold. There was another room where they burn styrofoam waste. It produces a horrendous toxic smoke. The styrofoam then turns into black gooey stuff which they also sell. They collect polythene and other used bags and burn them for heat in the winter.
They use the same, all year round to cook on. I gave them a long talk about the dangers of burning polythene. Pramod Kumar knew it was detrimental to the environment but he was taken aback by my description of it. I said that burning polythene produces dioxin and that one drop of dioxin on your skin for one minute can kill you! It is kind of true. Dioxin is the name for a group of chemicals. Burning polythene does produce dioxin. The nerve gas, US Army has, is a kind of Dioxin and one drop of it on your skin will kill you in one minute. You do not even have to inhale or ingest it! Anyway Pramod is going to talk to some people in Delhi government to see if they can find some place to dispose of the plastic bags and find some alternative fuel for the ragpickers to cook on.

A Magnificent Discovery

Well that title could be "the discovery of a magnificent fort" right next to my medical school. I have been looking for a good place to take a long morning walk. So I tried going south, west and north of my place here in Delhi. However the problem was that I could not go in any of the three directions for three-four blocks without the bad smell. I could not go east because the door on east side was always locked in the mornings. Yesterday I found that there is another door on the east side just a little north of the locked one. So I went east today. There is a very wide road next to the medical school. It is about four lanes wide in each direction. On the other side there were always some ruins about a hundred yards from the road. I went in the direction of the ruins.

The ruins were guarded by a policeman, who wanted me to buy a ticket for Rs 5. That is why the place was empty! It needs a ticket to get in! I was happy to spend the 12.5 cents that was the price of the ticket. But the ticket window was closed, since it was too early. So I bullied the guard on my way in, without paying the 12.5 cents!

I went in and what magnificent ruins these were. I was seeing them for the first time! This fort was built by Kotla, one of earliest Islamic Kings of India. This would have been about year 1315 AD. The fort goes on and on towards the east. From the ruins you could imagine what it would have been during its glory days. It is pretty large, about twice the size of Rose Bowl with all the parking area included. The walls are about three feet thick with a lot of narrow slits for the archers. There are ruins of a lot of rooms inside. The fort also has an Ashoka Pillar. This was a total surprise for me. I had read during the Grand Gupta Tour of India that there was an Ashoka Pillar in Delhi. But I had no idea it was within walking distance from my medical school where I had spent six years.

The Ashoka pillars have a grand history. They were erected by King Ashoka about 300 B.C. This one was brought from a distant city and erected by Kotla when he constructed the fort. Ashoka ruled from Pakistan to Thailand. He has come to be regarded as one of the most exemplary rulers in world history. He erected numerous such pillars all around his empire. His teachings are inscribed on the pillars. There are only about seven left now. I think I am going to go there every day for a morning walk, preferably before the ticket window opens!

Saturday, November 20, 2010

Be ready for what is coming next!

An old medical school classmate invited CM Goel and me to lunch at his home today. He and his wife both have M.D. degrees with specializations in different medical fields. There was a poster of an old man in the dining area and so I asked who the person was. The wife replied that it was Lord Brahma. I have seen several depictions of Lord Brahma but had never seen him shown as an ordinary old man. She explained to me that she and her husband belong to the Brahma Kumaris Spiritual University. She described in great detail how we are in the tail end of a period called the Kalayuga (It is called Iron Age by BKSU, a more appropriate translation would be age of darkness, it has nothing to do with the Iron Age, Bronze Age etc.).

This age will end one hundred years from now and then the Golden Age will dawn. But only 900,000 souls will enter the Golden Age. There are a total of 6,000,000,000 human souls in the universe. (Goel wanted to know about the souls in the dogs! They explained that animals have different souls. Only human souls are reborn in human form again and again.) So the extra human souls will be in a kind of limbo for the next 12,500 years. Then the Silver Age will begin. Only through meditation and learning to respect your soul, can you assure that your soul will be one of the 900,000 chosen to go on to the Golden Age.

Indian Swastika
This is the Indian Swastika. It depicts the four periods, each lasting 12,500 years. The top vertical arm shows time going to the Golden Age. The upper right hand square is the area of the Golden Age. It describes the deterioration of human beings as they lose their virtues. As you go clockwise you will see that  human souls are losing the virtues. We are almost at the transition. The green area is all the time left between now and the apocalypse that will signal the start of the Golden Age.

This is the depiction of the three worlds. On the bottom is the physical world, consisting of our solar system with us in it. On the top is the soul world. The Supreme Soul is on the top and below Him are the souls of all others. Human and animal souls are all there. The souls go through the subtle world to come to the physical world. Here you are born again and again till you merge with the Supreme Soul.

Friday, November 19, 2010

Indian Head Nod

Ann has told me from time to time that sometimes I do the Indian Head Nod. I thought she was crazy, there is no such thing as Indian Head Nod.    I hate to admit it, but I was wrong. 

Different cultures have different ways of saying yes or no, with their heads. 
Americans nod up and down for yes and side to side for no. 
Indian are more complicated. They say yes and no both by side to side movement. Straight side to side means no. But side to side with a little tilt means okay, all right or yes. Watch me and see if you can do it!

Wednesday, November 17, 2010

World Diabetes Day

Today is World Diabetes Day. All the monuments are lit in blue light. There are posters here and there. Diabetes has increased a lot in India. I saw several patients with diabetes in the Medical OPD.

I wonder why diabetes has increased so much. One reason is that some Indians are eating too much!! That is too much for an Indian person. Still a lot less then a Texan .

The second reason in that the “SINK TEST’ has been replaced by an easy mechanical blood strip test. This needs some explanation. When I was an intern here in this hospital, we used a special test called a sink test to see if a patient was diabetic or not. We would collect the patient’s urine and take it to the lab. There we would throw the urine in a sink and look at the splatter pattern. Based upon the splatter, we would write down that there was no glucose in the urine. And lord behold, everyone was negative for diabetes! Therefore, the incidence of diabetes in India was low at that time!

Before you get on your high horse and condemn me and my fellow interns you should know the reasons for the sink test. (By the way we employed the sink test for other tests too, like blood test for anemia. More on that later.) To test the urine for glucose we had to heat the urine in a test tube until it came to a boil. Then we added a chemical called ferrous sulphate. After five minutes of boiling, if the color changed from blue to orange the test was considered positive. We could do only one test tube at a time. Try doing that on fifteen patients. At ten minutes per patient, it would take a person two and half hours. Then we were supposed to test for protein and specific gravity of urine and then do some blood tests. Did I mention that we had to see patients, take and record histories, order treatment, draw blood, and start I/Vs?

One day during rounds, a professor examined my patient. He looked in the eyes of the patient. The patient was pale in color and was obviously anemic. The professor asked me what the patient's hemoglobin was. I said very confidently that the hemoglobin was 8.5 gm% (Normal being 14-16, the lower the number the more anemic you are). The professor said, “To me it looks like it is 7 gm%.”  I said, “Professor I used the same test as you did, and the result came out a little different!”

Monday, November 15, 2010

Anti-Corruption Rally

Arvind was organizing an anti-corruption rally and march. He got a call from this religious guru offering his support. His name is Baba Ramdev. He teaches yoga and meditation on his own TV channel. He has a huge following. He had started a crusade against corruption about six weeks back and now wants to join forces with Arvind.

I took an auto-rickshaw to the Jantar-Mantar, an area near Connaught Place, the main drag of Delhi. When I was about to get out, the rickshaw driver asked me if I was going to the rally of Baba Ramdev! I knew it was going to be big if the rickshawalla knows about it.

There was a sea of people. I estimated the crowd to be about 15,000. They had come to see and hear Babaji. The rally was good. It was quite an experience to see people in bright colors, waving placards and shouting slogans.

There were about seven or eight speakers. All of the speakers were good. They had the Head of the Islam Society as well as the Bishop of Delhi. It was first time the Bishop had come out in any political rally. The Muslim (Moslem) leader was a firebrand speaker. He got the most applause. Babaji was a very good speaker as well.

Looks like the anti-corruption crusade is moving forward. The corruption in the Common Wealth Games (CWG) was so rampant that I think it is possible that some effective anti-corruption legislation might get passed.

Saturday, November 13, 2010

Public Causes Research Foundation

PCRF is a foundation started by Arvind Kejriwal. The purpose of the organization is to do research in all matters that help the public. At the present time, the emphasis is on implementation of the Right to Information Act. I had the opportunity to visit the PCRF office and talk to a few of the young men and women working there. I am writing about them to give you an idea of what kind of people are working there, and why. Not everyone is included here. My apologies to those that I did not have time to talk to with.

Neeraj Kumar

Neeraj is the veteran and has worked with Arvind for about nine years. He has M.Com degree from Benaras Hindu University. He came to Delhi to take an examination for some job but met Arvind and began studying the Public Distribution System. He knew he had to do something about that. You can find out about RTI and its use in improving the Public Distribution System by googling it. He recently got married. I asked him what his plans are for the future now that he is married. How is he going to support a family on the meager salaries being handed out at PCRF? He said he had not given it much thought.

Debjani Basu

Debjani finished her post graduate in political science from JN University and started working at PCRF about four months back. She is currently involved in the analysis of CIC decisions. She says she has great job satisfaction here and is not working for money. Her monthly salary is Rs 10,000.

Ramlal Rai

Ramlal obtained a Master of Philosephy degree from JN University and started working for the Punjab Government at Rs. 23,000 a month. He came to PCRF and started working here about one month back. He does not know what his salary is going to be as he has not discussed the salary yet. He can read Kannada since he is originally from Karnatka. He is analyzing the decisions of SCI of Karnatka. These decisions are in Kannada. Ramlal analyzes them and translates some of them into English. He said he loves working here because no one can do what he does.
Firoz Khan

Firoz is a graduate of Delhi University with a B. Com. He worked in a private bank and got fed up with corruption in the private banking system. He started working for PCRF about two years back. He was a volunteer for Parivartan for about six years.

The Casualty

The Casualty in a Delhi hospital is what an Emergency Room (ER) is in a Glendale hospital. Patients walk into casualty if they are too sick to go to the OPD or if the OPD is closed. Doctors in Casualty treat some, refer some to OPD, and those who need to stay are sent to either Medical or Surgical Emergency. The patients are treated in Medical Emergency and then either sent home or more commonly transferred to the Medical Floor the next day.

If you want to see the widest variety of cases there is no better place then the Casualty of Irwin Hospital. But you need a strong stomach. I was in Casualty only for about three hours. A patient was brought in with tetanus. I do not remember ever having seen tetanus in my life. Her whole body was rigid like a wooden board. I could hardly bend her elbow or knee. She gave a history of a splinter in her hand. After about two weeks she developed difficulty in opening and closing her mouth (lockjaw). She came to the hospital about five days after  the start of tetanus. By now her body was stiff like a board. You could hold her leg and lift the whole body.

I had read about tetanus in books. The tetanus organism grows in untreated wounds. The bacteria releases a toxin that causes muscle spasm. Even if the bacterial infection is cured by antibiotics there is no way to remove the toxin which is already bound to cells. But in my heart I did not believe that a small splinter could cause that kind of wound for the bacteria to grow. Now I know better. In future I will treat splinters with respect. Even without a splinter I will get, and give to my patients, that tetanus booster every ten years!

Another young woman came in with wild movements of her head. She brought back memories of seeing other patients with conversion reactions (called hysteria in the past). You never see such gross/obvious conversion reactions in USA. There patients, under similar stress, develop Munchausen Syndrome or other disorder (Please do not quote me on this, I am not sure about the psychopathology of these disorders).

There were times when it made me very sad to see some of the deficiencies of simple equipment, like wheelchairs and stretchers.

Satish – Is he American or Indian?

In response to my blog on “Medical Emergency” and others, I heard that there have been comments like, “Satish, he grew up here. He worked on these floors. How can he say things like that?” and I have received emails saying, “Are you not trashing India?”

In response to the first comment, I plead guilty. I grew up here in India, but I spent only five years of my adult life in India and have spent thirty-seven years of my adult life in USA. If one is not influenced by his environment in thirty-seven years, he is not normal. I remember working here in Irwin Hospital. The more I stay here the more the memories are coming back. I am sure if I stay here a year or two, I will see it the way I used to see it. But right now, I am just writing what I see and feel.

Trashing India is not the right description of my blogging. India is so big, there are aspects of India that are admirable and others that are deplorable. If you read the blog carefully you will find that I have never said anything derogatory about people. I love the people here and that is why I am here. But when some conditions are pathetic, I write about them the way I see them.

Friday, November 12, 2010

The Medical Floor Revisited

Today I went back to the medical floor that I described on my November 3rd post, titled “Jump in the Ocean.” Most of the patients had been admitted on Monday, that being the emergency day for this unit (patients are admitted to the various units in rotation). Today being Friday, a lot of the patients have been discharged. So many of the rooms now have only one patient per bed. Oh what a difference it makes. It looks like a new place, calm and serene!

I remembered some of the patients I had seen on Monday, described in my “The Medical Emergency” post. The middle age patient with an acute heart attack had survived. He was transferred to the Coronary Care Unit the next day, even though he did not have any money. It was so nice to hear that.

There was another patient with viral encephalitis I had seen last week. He was comatose and in catatonic state. I had given him no chance of survival. He appeared better today. He still has ways to go. Another patient with cirrhosis and vomiting of blood looked good enough to be discharged today. There was a patient with hemorrhage in his brain. He looked a lot better. It is amazing how resilient human beings are. With whatever meager resources they had, the resident doctors had made the patients well and got a lot of them discharged. I was told that two patients had died. That was a lot less then what I was expecting.

Wednesday, November 10, 2010

The Medical Emergency

I headed to the Medical Emergency ward on the fourth floor. The signs on the fourth floor were non-existent. So I wandered into a patient care area. The stench was piercing. This was different then the usual stench of human excreta in the streets. I knew the smell but could not identify it at first. I sniffed and sniffed. Yes the old memory cells woke up. It was smell when there is copious flow of pus. I had entered the surgical floor.

The medical floor was flooded with human beings. I could see some harried resident doctors working. The residents had worked all the previous day and the previous night too. Their tired faces had total resignation written all over them. I asked them to ignore me and carry on with their work.
They were eager to do that. I just stood there near the nurse’s station and watched. Patients were wheeled in by relatives on stretchers. The stretchers were the same I had used here in this hospital about forty years ago. The paint was chipped. The wheels never went where you wanted them to go. The steel bed was as uncomfortable as it could be. Most patients had I/V bags attached. The relatives were holding the I/V bags by hand. Their hands were tired at times. The I/V bag would go down and blood would flow from the patient to the I/V tubing.

The I/V stands were also the same I had used forty years ago. The stands were on wheels. The base was very heavy to prevent tipping. The wheels were crooked, small and had lost lubrication. Some stands had six I/V bags hanging on one stand. The bags were going to two or three patients. One patient fell out of bed and tipped a stand over. There were six bags on the floor. Some I/V lines came out of patients’ arms. There was I/V fluid all over the floor. I can just visualize the poor intern starting the I/Vs again. That part of internship is still fresh in my memory. Starting I/V in an emaciated and dehydrated patient is no piece of cake. You stick the needle again and again. The patient is cringing in pain and you have gone thru and thru again.

A middle-aged man came in clinging to his chest. I was told he had acute chest pain starting about two hours back. The EKG showed acute myocardial infarction. The resident doctor hurried to give him everything this place had. Oxygen was ordered but the orderly could not start it. Morphine was given promptly. He was to be started on streptokinase. After fifteen minutes the patient was still in severe pain. If the patient was rich he would have been in cardiac cath lab. But if he was rich he would not have come to this hospital. Even if he wandered in here by mistake, he would have been transferred to an intensive cardiac care unit.

There was a shouting match going on between a doctor and an orderly. The doctor had asked that oxygen be started and the orderly had ignored the request. There was not much the doctor could do but to scream. The orderly shouted back.

The evening rounds by the attending physician started. The attending went over each patient quickly. The attending told me he felt he was keeping the residents from taking care of the patients, so he wanted to spend the least amount of time on rounds. I left the floor with the attending. We headed to a roadside shack for a cup of tea. I was exhausted. I had spent only two hours in the medical emergency and had done nothing.

Monday, November 8, 2010

The Medical OPD

The day started with a visit to the medical OPD (Out Patient Department). Anyone can walk in there to see a doctor. The waiting area was wall-to-wall people, pushing and shoving. A sick person had no business being there! The Delhi Police was busy guarding Obama, who is in town today. They were needed in the waiting area. A few street-smart dogs had also taken residence here.

The patients then enter the doctor’s consultation room. It was about twenty feet by fifteen feet. There were five doctors seeing patients. There were about thirty other people in the same room. The mobile phones (cell phones) were producing different musical melodies from Bollywood. People had selected the melodies as ring tones. Sometimes they belonged to the patients sometimes to the doctors. Everybody answered their phones and carried on.

There were no signs of any nursing personnel in the neighborhood. There was a guard at the door. There may have been another orderly. The doctors took patients' blood pressure only when needed. There was no thermometer anywhere that I could see. There was a six by eight foot room in the back with a bed. A patient could be examined there in privacy. That room was not used during my stay in the area.

Business was brisk. Doctors would ask four to ten questions and would prescribe something or the other. Several patients were sent for lab or X-ray. The average time per patient was under five minutes. The doctors had spent the previous night in the Emergency Medical Ward. To say that the doctors were tired would be a gross understatement.

In a back room senior doctors were seeing patients. The pace here was a little slower. Only patients from the front room, who needed a second opinion or other special patients were seen here.

A well-built patient (that means he must be at least middle or upper middle class), in his fifties was next. He was complaining of lower backache. The doctor inquired about his back and then started asking about the rest of the body systems. The patient had severe symptoms of prostate enlargement, had difficulty in breathing on exertion, bronchitis off and on for years and significant recent weight gain. I am glad the doctor stopped asking questions at this time otherwise the patient would need a whole body transplant!

Drug representatives with huge backpacks also came in to pitch their wares. They handed out their cards and drug information but did not hand out any goodies. The doctor patiently listened. The girl you see standing with a backpack graduated from university two months back. She has a bachelor's degree in Medical Technology. She started working as a drug rep right away. After one month of training she was pushing her stuff flawlessly. American corporates ideas had arrived in the medical OPD!

Cyber Cafe

This hole in the wall is called a cyber-cafe because it is next to an internet cafe. The internet cafe has no food only the internet. This place has food but no internet. It is owned and operated by four brothers. They grew up in Raniket, an area in the foothills of  the Himalayas. Their father is a farmer. There was not enough land for the brothers to farm. All of the four went to school. Some finished high school. The oldest came to Delhi and soon the rest  followed. They all work in the café. One of them is always there. The work starts at 4:00 AM with a visit to the market for vegetables. They finish after 11:00 PM with the cleaning of the kitchen. They all are married and have either one or two kids. They live together in a small house.

The restaurant employs five others. Most of them are migrants from other states. The rent for the space is Rs. 7000 per month and the electric bill is about the same. The workers make between Rs. 3000 to 4500 per month. The restaurant used to be very busy with people waiting in line at lunchtime. But now the hospital has opened two other eating-places. These are government run and subsidized canteens. They have taken a lot of business away from the Cyber Café. For the past six months the café is merely breaking even.

It took me a while to feel comfortable there. Everything looks awfully dirty. They clean everything every day, but it is all very old, broken, stained, and rusted! After eating a few times I realized that my stomach was not complaining. There was no Delhi belly. So now I feel okay in there. The bread is fresh out of oven and is very tasty. Today I saw the oven and took some photos. I wish I had not seen how they make it! It is not going to taste that good anymore.

I am on a crusade to teach the cook how to cook. My omelet was plain. So I asked him to sauté some onion. When the omelet came I could not see any onions. He had chopped the onions so fine, it was like onion powder! So the next day I went into the kitchen and chopped some onions and bell peppers myself. I told him to sauté it before putting it in the eggs. He threw the stuff in a pan, with some oil, and turned on the burner so high that the flames were going all around the thirteen-inch pan! No wonder he burns everything. Maybe that is why I have not had any Delhi belly so far. After appropriate instructions he made a decent omelet. Tomorrow I must teach him how to make scrambled eggs.

For photos of café click here.

Friday, November 5, 2010


Dewali is to India like Christmas is to USA. People decorate their houses, give gifts to others, light firecrackers and of course everybody overeats.

I took the Metro to a station close to Amar Nath’s place and Mukesh came and picked me up. His house was full of children as usual. After prayers we ate. By this time it was getting dark and people were using firecrackers outside. Amar Nath told me that because of education by the government, people are not using as many firecrackers as they used to. It was still too loud for me. This started at about eight o'clock and went past midnight. There was never more then two minute’s reprieve. I took some video of people lighting firecrackers. I am sure, the day after Dewali, everybody in Delhi is deaf!

The houses on the street were decorated in lights, just like Christmas in US, only more so. It looked like everyone was participating in a game called “I can do it better then you.” It was very festive. The adults were having as much fun as the kids.

Next day I took the metro back to my place. I decided to take some photos of the metro. I took some photos from outside the station. Then I went inside and took one photo of the information counter and map. There was no one inside this counter. All of a sudden a Sikh policeman appeared from nowhere. He yelled, “What are you doing, Sahib?” I was a little taken aback. I told him I was taking a photo of the map. He took my by my arm, very gently, and showed me a signboard far away. The signboard said that photography was strictly prohibited. Then he took me to another information counter. He asked the employee inside for a map. He took map and gave it to me. Then he asked if I could delete the photo I had taken. I deleted the photo. That was it. What is going on in India? Another government employee who is doing a good job!

Since I told everybody two things that I do not like about the metro, I must tell two things that I really like about the metro. First is the signage. The signs are as clear as they can be. Inside the train they have a drawing of that particular metro line with all the stations marked. There is a little light that tells you which station you are on and which is the next station. The second great thing about the metro is the loudspeaker system. You can understand every word of the announcements. Try that in a New York subway.

Later in the day I took the metro to Goel’s place. I had nice time there. Lucky for me, it was the time and day for Kapil to call. He called exactly on time on Skype. It was nice to talk to him.

Thursday, November 4, 2010

Pre-Dewali Day

Today is the day before Dewali. There should be little work being done today. Everybody is looking forward to tomorrow.

In the morning I paid another visit to the Delhi Medical Council. If you remember, this is the place where I sat down in the reception area and stared at everyone, daring them to make eye-contact with me! (see blog of Day Four – Busy day) This time I walked straight up to the receptionist and interrupted whatever she was doing!

After making me wait two minutes, she took my application, looked it over, and consulted with her colleague to see if the passport photos I had brought were too large or not. Then she handed me a computer-generated receipt for the application fee of Rs. 1,000/-, and told me that my registration will take about a month. She said I could come back and pick it up or they can mail it to me. That was it. No hassle, no hint at any hanky-panky, the whole thing was not what it was supposed to be. It was an Indian Government office. They were supposed to hassle, find some problem with my application for sure and offer to expedite if I was nice to them. Nothing like that happened. I am disappointed!

Then I went over to the hospital OPD (Out Patient Department). I passed by the medical clinic; it was chaos in there. I went to the ENT clinic and walked right into the room of the senior most doctor. No one asked me why I was there. It is surprising what you can do, if you are dressed right and appear confident. The senior ENT surgeon was seeing patients and I was observing. After all the patients were finished, all the junior doctors came in for a mini-meeting. I asked them how they treated ENT patients who had nasal and sinus problems due to allergies, after there was no response to sinus surgery. The chief doctor explained that there is no cure for allergies and that allergy tests and allergy shots are useless since they do not work. He said he tells his patients to live with it since it is not going to cause any serious complications. He said sometimes he sends them to Yoga, and Yoga works much better then allergy shots. Well, well, well, all my life’s work was trashed in two minutes.

In the afternoon I went over to Suneeta and then the two of us went shopping for sweets in Chandani Chowk. This is the main bazaar in front of the Red Fort of Delhi. The bazaar has been in continuous operation for almost a thousand years. There are descriptions of the bazaar in many old books. It was wall-to-wall people,  all of them moving in some Brownian fashion. As Meenu explained, they have moving sidewalks in Chandani Chowk. Just get in the right place in the crowd and crowd propels you forward, without any effort on your part!

I bought sweets at Haldiram’s shop. When I walked out with a bag of sweets I felt what athletes must feel on winning gold medals. I had triumphed.

Wednesday, November 3, 2010

Jump in the ocean!

I am glad I had a day of rest yesterday. I needed it today. Just watching the other doctors do their jobs made me tired. Dr. Richa Dewan, the head of the Department of Medicine, told me that I was welcome to jump in the ocean. There was so much sickness that everybody was welcome to do what they wanted to do, in terms of learning medicine and/or providing medical care. It was like jumping in the ocean. You could do all the swimming you wanted to do. After a round of the medical floor I understood.

First Dr. Dewan introduced me to her staff of residents. Here they call them post-graduate students. The senior resident is someone who had finished post-graduate. The medical floor was divided into cubicles. Some had four beds others had six. The beds were slightly smaller then a typical American single bed.

The senior resident took me on a round of the floor. The first bed had a very sick looking patient with a diagnosis of new onset of paralysis of all four extremities. He was improving so there was hope that it was some kind of self-limited demyelinating disorder. There were about three to four people on or near that and every other bed. I was about to move to the next bed when the resident interrupted me to talk about a person who was sitting on the bed of the patient. I thought he was a relative of the patient. No, he was another patient! He was very sick too, with pneumonia on top of his underlying chronic bronchitis. He was on oxygen. Then I remembered that Dr. Dewan had told me that there were two patients to every bed. It does not sink in, until you see it.  I wonder how they sleep. Do they take turns sleeping one by one?

Every patient had one family member staying with him or her. The family members provided most of the nursing care. There were family members everywhere. Since some patients are from out of town, the family sleeps in the courtyard areas. They take turns one by one, staying with the patient. Only one family member is allowed inside the medical floor at any one time. The nurses were there just to dispense medicines and take vital signs. The nurses were overwhelmed as was everybody else. There were more doctors working on the floor then nurses. There were no nursing assistants. Without a family member you are really out of luck. Thankfully, meals are provided by the hospital. I saw a child who was a ward of state. The state had provided for a caregiver for him. This caregiver was taking care of the child in a very professional manner. That kid was getting the best care on the floor.

We got to another patient who had hypokalaemic periodic paralysis. He was getting potassium by I/V infusion. It is a very rare disorder but fortunately I knew a little bit about HPP. I had seen one patient in Chicago in 1975. I asked the senior resident why the patient was getting potassium. She said since the patient had low potassium, he was getting potassium. I persisted but why give him potassium, is it going to clear up his paralysis? She did not fall for the trap. Very calmly she replied that there is no good evidence that giving potassium will help the paralysis. She had passed the test!

I was relieved that the residents did not ask me any medical questions!

Tuesday, November 2, 2010

Day Ten

In the Bible it says “and then he rested on the seventh day.” In my case it was the tenth day.

I had a delicious lunch with Kamal Goel, another classmate of mine, from my medical school days.

In the evening, Suneeta brought me a home made dinner. I had a good time with Suneeta and Mahesh sitting in my room. They sat, talked and watched while I ate dinner. They were going to go home and eat. They eat dinner at 10:30 to 11:00 PM (which is normal for Indians).

Monday, November 1, 2010

Just another day

In the morning I met Dr. Hira. He is head of the Respiratory Medicine Department at Irwin Hospital. He showed me around his pulmonary lab, which included a sleep lab, a spirometry suite and a bronchoscopy room. He performed two bronchoscopies while I watched and video recorded one of them.

He said he used to do allergy skin tests but two patients had anaphylactic shock from the testing so he stopped doing them. We made a quick tour of the Respiratory Intensive Care Unit. It has about twelve beds. One patient had acute intermittent porphyria and could go into respiratory failure at any time. She had an oxygen monitor hooked up to her. It displayed the blood oxygen saturation on the monitor next to her. I asked Dr. Hira if there was a central station to monitor her oxygen level. He pointed to the medical residents and said they were his central monitoring stations!

The staircase going to the medical ward is lined with tiles. At strategic locations they have four decorative tiles, one showing Christ, the next one a Hindu deity, another one is a Moslem symbol, and finally one for the Sikhs. Dr. Hira explained that people had been spitting on the tiles. So they put up these tiles and now no one spits here (you cannot spit on Gods, after all). Unique problems call for unique solutions.

In the afternoon I visited office of Public Citizen Research Foundation. It is run by Arvind. The office was humming with the sounds of computers and people. There were about a dozen people, mostly in their twenties. I interviewed about seven of them and took their photos. I want to write a photo essay of the office. I belong to a group called the India Friends Association (IFA). This group supports some of the people recommended by Arvind. So I want to show IFA what the organization PCRF is like.

I don’t like two things about the Delhi Metro. First, they frisk you when you go there. A guy dressed as a security officer runs his hands all over you. There is a women policeperson to frisk the ladies. I do not like getting frisked by men. Second, is that on two occasions when I was travelling, young men offered me their seats. A sign above the seats said, “Please offer your seats to the old and disabled.”