DOCTOR FIRST AND FOREMOST -THE BLACK SHEEP OF OUR FAMILY.

After passing out my M.B.B.S examination I had to do Rotatory internship in each department of Surgery,Gynecology and Obstetrics and Medicine .I learnt a lot by remaining in the wards constantly on admission days,by giving evening rounds in addition to morning rounds.Here I learnt to respect a patient,hear out what he says patiently and believe in him .......well almost,rarely the patient may create melodrama and spin unnecessary tales.And you must be able to assimilate what he says and take out only those things needed for diagnosis.

And never disbelieve the patient,what he says may be true and you might be able to arrive at a diagnosis by that. Some pioneer surgeon said "if you don't put your finger in the rectum,you may put your foot on it".Hence I learnt that per rectal examination is very important for diagnosis. So this internship period was very happily spent by me.

And then came house staff placement.. I was fascinated by Surgery always and luckily I could get house staffship in surgery. This was a happy period too.I was even allowed to do surgery in the theatres and emergency theatres under the guidance of senior surgeons.

After completing house staffship in surgery, I had spare time before appearing for my post graduate examinations, so I decided to do a stint in the Gynecology and Obstetrics department.That is where I met these two ladies, the Registrar and Resident medical officer (RMO).
I have changed the original names. So let us call them Mandira Di and Bharathi Di. Di is short for Didi which is a form of respect given to seniors. 

I really do not know how these two got promoted to a senior position.And since I came from the Surgery department, Mandira Di had an aversion for me and always used to taunt me about this. Here I am going to tell you about three  incidents concerning this pair, of which the whole hospital knew.

The first incident was when I was doing duty in the Labor room. Here about six to eight labor tables were laid and women in various stages of labor used to lie on them, with both legs folded and attached to the table in "Lithotomy" position (knees bent and feet abducted and elevated)

MODERN LABOR TABLE.

What we actually had was much more primitive and with a semicircular opening in the bottom part to facilitate delivering a baby.Well it served the purpose well. 

Well our labor room had about seven to eight such tables with a labor patient in each of them/.Since it was a government hospital, the number of patients was huge. And we house staffs had to do duty in the labor room by rotation.

Well as I told you,the women on the tables were in different stages of labor. So we medical officers had to keep a vigilant watch to see which baby is coming out . And imagine,the very first baby I delivered had "Anencephaly" which translates to an absent skull ,well partially at least.The baby did not survive.I felt bad ,but consoled myself saying that I am going to be a surgeon,not a Gynecologist.

BABY BEING DELIVERED IN LITHOTOMY POSITION

Once when I was on duty and after finishing the necessary P/V "Per vaginal " examinations in each case.Some of the patients were catheterised (a tube to drain urine was kept in the urethra to drain out urine and keep the urinary bladder empty)A full bladder containing urine would hamper the passage of the baby.

URINARY CATHETER WITH BULB FILLED WITH DISTILLED WATER.

There are two tubes at the bottom,one inlet for filling water in bulb and another, outlet for letting out urine.The outlet is connected to a receptacle in which urine is collected.Depending on the surgery and depending on the gender distilled water is filled in the balloon. In females about 20 ml water is filled in the balloon. The bulb impinges in the internal urethra and prevents the catheter from coming out. So when you do an internal examination, the catheter bulb is felt through the bladder wall  as a round shaped swelling.

When I was on duty in the labor room these women ,the Registrar and the RMO ,  came to the labor room. Despite my telling her that I have already done a P/V or per vaginal examination , Mandira di strided to a patient and started an internal examination just to spite me. All of a sudden she shouted at me saying "What sort of training did they give you in the Surgery department? Did you not see that there is a very large tumour in the vagina ?"I was surprised and implored her to let me do an internal examination again. She would not let me and by this time and by this time more medics and paramedics came into the room and I was feeling very ashamed. 

And then the RMO came over and did another internal examination to spite me a little bit more. After she did a P/V her face reddened and she told Mandira di " hey this looks like a catheter baloon probably filled with a little more water. ".

And I was lucky that the labor room was crowded now with my friends and people who had come to see the fun. Thus vanquished, the duo left the room silently.

But this is not a common mistake. Once or twice I have been called by Gynecologists to exclude a "tumour" while performing Hysterectomies.So there are people and people. 

Well now on to the second incident. This was more frightening. Mandira di and Bharathi di were doing a Caesarian section to deliver a first born child to a young mother one night.

 It is believed that Julius Caesar was born by this operation which was a  fatal surgery till the beginning of the 20th century.The surgery is done by a lower horizontal abdominal incision and delivering the baby by cutting the uterus in the same manner and then suturing up the uterus in three layers before closing the abdomen.

INCISION OVER THE LOWER ABDOMEN

BABY BEING DELIVERED.

UTERUS STITCHED IN LAYERS.

A WELL HEALED INCISION.

 A junior doctor was assisting  in the operation which was being done by Mandira di and Bharathi di. Let us call him Deboo (his nick name).I was in the operation room as an audience. 

The duo damaged a major  artery and there was torrential bleeding. Somehow they placed a tight pack to stop bleeding and directed me to call a senior Professor whose private clinics were nearby. The senior doctor did come after about half an hour . He opened the wound and found out that there was severe damage to the coverings of the uterus. So very sadly the uterus had to be removed. AND A DEAD BABY WAS DELIVERED. Imagine a first born baby delivered dead and the uterus removed ....a very sad thing to happen.

 I felt awful and angry.It was at that time I decided that I will be a careful and meticulous surgeon and pray to God before every operation ,to make the patient alright. Nowadays, expert Gynecologists in India and  throughout the world are performing this surgery in a safe and effective manner within a  half an hour duration. 

Even after this incident which was hushed up, the famous duo remained in their posts. The third incident I am going to narrate was still more worse. A multi gravida (a woman who has borne multiple children in her womb),had come to the gynecology casualty. I was the admitting officer. After three or four days  of labor in a rural set up she had been transferred to the hospital with a hand prolapse (one hand sticking out of the uterus) ,a very very difficult delivery to perform. There was no heart beat in the foetus .Well I admitted her and then my duty was off,so I went to our hostel for resting. 

A long time passed and out of curiosity, I called a friend of mine. The famous duo of Mandira and Bharati  had tried several methods like Forceps delivery (delivering a baby with special forceps), Evisceration ....Evisceration is one of the rarest destructive operations. Evisceration consists of removal of abdominal or thoracic content with the aim of reducing the fetal bulk so that fetus can be delivered vaginally.

And they tried  Craniotomy....It is an operation to make a perforation on the fetal head , to evacuate the contents  followed by extraction of the fetus for conducting a successful vaginal delivery.

CRANIOTOMY FORCEPS FOR CRUSHING THE SKULL OF A DEAD FETUS.

All techniques failed and the uterus of the patient got perforated and damaged. So ultimately they had to plan a caesarean section to remove the baby. And since I was in my hostel, I was not aware of what was happening in the operation room. We came to know about everything that happened in the theatre the day after .Here again Deboo was the assistant and the whole team of junior medical officers came to know about this from Deboo.

What he told us was absurdity to the extreme. While doing the surgery which was naturally a very complicated one ( they could easily have contacted a senior consultant,but they did not), 
Bharathi di found the ureter which is a smooth tube which can be rolled with the fingers, and remarked to Mandira di " Hey Mandira this looks like the ureter". And the great Mandira replied , " let us cut it and see ".So the ureter was cut and the ends retreated to regions beyond their knowledge.

 

And after threatening Deboo that they will tamper with his certificates if he told anyone about it , the duo closed the abdomen with the ureter open and spilling urine into the abdominal cavity .

The patient was admitted under an expert and senior consultant who was very short tempered and strict ,and he was on leave. His patients were being managed by another senior lady consultant who was stricter.

When she came on rounds the next day ,she found a distended abdomen. But after such extensive procedures, there is a bit of gas formation and the peristaltic sounds return late.
So she was not overly worried. But we knew what was happening inside.

Obviously Deboo was under mental stress.The next day ,he caught both my hands and almost cried.He asked me what to do? I told him " if I were in your position ,I would have informed the consultant the next day itself.Please do so now immediately.Regarding your certificates,we will fight if needed .Leave every thing to God and inform the authorities immediately."

And he took my advice and informed the consultant.She came rushing to the hospital, and arranged for a consultation with a Urologist immediately.The next day was a Sunday .Despite that surgery was performed on the woman and the ureter ends were reunited.  But the middle aged woman, who had borne several babies in her womb, succumbed after three days.

After this incident the duo was transferred to a remote health centre. 

All this happened a very long time ago. When there were minimum facilities in government hospitals. And the duo were the blackest of black sheep in our doctor family.

But doctors are really caring and work hard even in government hospitals. I know because I have worked in several hospitals. Do not think ill of our family because of these stray incidents.

I have been keeping it in my heart for a long time and feeling very bad about these incidents. Suddenly today I felt like telling you people what happened during that black time in our otherwise super hospital. I am very glad that the duo got their due punishments.

Human life is very valuable and when a patient submits himself/herself in our hands,believing that he/she will be saved, it is our duty as doctors to handle the patient with love and utmost care. Praying to god , I am feeling light after publishing this.