Days 31 and 32:
6/19 & 6/20

Today and yesterday were both spent on the outpatient unit. It’s interesting because the doctor sees mostly elderly patients and even though she’s providing treatment and advice, most of the appointments end up being counseling sessions. Patients are stubborn and won’t exercise to lessen the effects of their diabetes. Or they live alone and spend all day thinking about what would happen if their cancer from five years ago returned, instead of finding activities to occupy their mind. And so the doctor spend the majority of the appointment hearing about their lives, their complaints, and trying to counsel them to listen or fix things in their life. Definitely interesting, although I think I would prefer something with a little more variety.

We didn’t have to be at work until noon today, so I decided to see whether I could visit the disability school associated with the hospital (they’re both funded by Rotary). I could, and spent several hours with the Autism unit observing their outdoor exercise/play time and then classroom time. The school has about 150 kids, all with a variety of physical and mental disabilities and varied ages.

Also, a short note about doing internships: do not bring your little sister to work just because she’s 15, kindasortofmaybe wants to be a doctor but really thinks she wants to be a vet. It’s just awkward for everyone involved. I may or may not have had experience with this awkwardness today (and no, it was not my sister because she’s in the states and wants to be an actress!!).

Day 30:

Today we were on the OPD (outpatient) unit. I didn’t realize RMH offered so many specialties, but there was a board listing them all- probably at least 15 different types. However, being such a small hospital, I think each specialty only has one or two rooms each. The doctor we were shadowing, for example, had one room with a desk for herself, chairs for the patients, and an examining table with a curtain. This doctor was a general practitioner specializing in diabetes care. We basically just sat in the room and listened to her talk with patients for three hours. It was interesting, but being here definitely emphasizes the language barrier once again. I feel like I’m in my own world for the majority of the appointment just kind of zoning out, until either the patient speaks a little English or the doctor would explain what was going on. It was also interesting because I felt like the patients I saw today were much more put together- dressed nicer, maybe cleaner, less hardened by work- than past patients I’ve seen. I’m not really sure why this would be the case, but it was interesting to notice. I’ll have to try to ask again.

Tonight we made ourselves a paneer dish with roti, with mangoes for dessert!! We also tried and failed at opening a coconut, although found some pretty hilarious videos in the process of trying to figure out how to eat one!

Days 28 & 29:
(6/16 & 6/17)

This weekend was pretty relaxing and I spent a lot of time just doing nothing, which was nice. Today was great because I was able to meet up with one of Anna’s friends from her trip to Delhi….it truly is a small world! We rode the metro (my first time, one of the cleanest parts of the city I think!) on the way to Corner House, an awesome little ice cream place! Other than that, it was just nice to talk to get to know her better.

Also Happy Father’s Day to the best dad ever!! I wish I could be there to celebrate, but I hope you have a great day! J

Day 27:
(6/15/12)

Yesterday was another great day in OB! I got to watch all the babies get baths and vaccinations. So adorable (baths, not vaccines)!! I also got to watch another birth right after I arrived! Later in the afternoon, I went with the nurses to this lecture about cleanliness in the hospital. From what I understand they have these classes every Tuesday and Thursday for all units of the hospital…but it was Friday, so I think this one was an exception. Kind of boring, but still interesting to learn about the procedures. And we got food, which was a bonus! I stayed at the hospital a little later hoping I might get to see one final birth, but the mom was not progressing fast enough, it was going to be at least a couple more hours, and it was getting late, so I left.

Nursery
But not actually equipped to handle high-risk babies. The isolates are only used for warming.

Labor and Delivery room
Moms are transferred here once in active labor and stay a couple hours after delivering before being transferred back to the ward.

Day 26:

Today was an awesome day, and definitely made up for the lack of business in ICU! I was on the OB unit, and it was CRAZY!! The kid who crashed my internship got kicked off the unit because the women didn’t want him observing, so I had the whole day to myself without anyone tagging along! At first I felt a little out of place because the unit didn’t seem prepared to have interns/observers at all. The doctors were preoccupied with all the patients, and told me repeatedly they were sorry they didn’t have time to explain anything. So instead, I just wandered around the ward talking to the patients. I eventually ended up rocking this adorable two-day-old baby girl to sleep while talking to her mom and grandma. They were so nice! And they actually let me participate in this little traditional ceremony (or rather, told me that I was going to do this without any choice). There was a little bit of a language barrier, but apparently it’s customary to let newborns suck on sugar water (off your finger) so that they’ll like you, and I guess I was the first to do this for the baby! A pretty big honor, if you ask me! They also told me that I needed to give them baby name ideas by tomorrow, so if anyone has any let me know! Ha

After all the baby cuteness, I decided to try and watch some procedures, and ended up getting to watch the anesthesiologist place several epidurals. It’s done almost exactly the same in India and the US, but still cool to see!

And finally, the highlight of the day, I got to watch a baby being born! I was literally standing right next to the mom and got to watch everything, something that would never happen in the states! C-sections are neat, but natural births are even better! Sure makes you appreciate life, although after seeing all that pain (and an episiotomy), watching a birth would make anyone not want to ever have kids. It’s probably good most patients don’t actually know what goes on during procedures (like during the eye surgery or a birth) because guaranteed nobody would ever follow through!! I have to say though, births in India are a very lonely affair. From what I observed, once moms receive epidurals (or are far enough along) they’re transferred out of the main ward into a delivery room. However, they are there all alone. This particular mom labored by herself for at least an hour or hour and a half while the nurses just did their work all around her. And even when it came time to actually give birth, it was just the doctors and nurses. No mom, no husband, no relatives. That’s actually true for the main ward as well. Most of the women had a female relative with them, but there just isn’t room for entire families to visit. Another thing is that the OB ward is almost entirely female-dominated (as in, all the doctors and nurses are women), which is a nice change from the very male-dominated wards in the rest of the hospital, and which could be why most of the husbands weren’t even present.

Such an adorable baby!

Proud grandma

Happy momma

Day 25:

Today was another long day on the unit. There was practically nothing going on all day, which is great for the patients but really dull for us when we want to see stuff! It was nice, though, when the woman doctor I mentioned yesterday arrived. It’s amazing how some people are just natural teachers…one of the patients was having irregular heart rates and she was looking at the monitor, which led to an impromptu lesson about heart rates and pulse ox’s. Basically you know there are arrhythmias if the peaks on both the pulse and oxygen saturation don’t line up, and above all machines only aid in care, and you as the doctor are ultimately the one who needs to understand and be able to interpret the science behind the machine. It’s interesting because I never would’ve thought to ask about the machine because I know its general function; however, once she started explaining, I ended up asking a lot more questions! This doctor also helped us interpret an x-ray (it showed fluid in the lungs) and explained deep vein thrombosis (the reason why people wear those really tight socks after surgery). So it ended up being a decent afternoon, and we’re onto OB tomorrow!

Dinner at Moledina's on Monday

ICU

X-ray machine

Days 23 & 24:
(6/11, 6/12)

The first part of the week we’ve spent in the ICU unit, and it has been much different than I expected. The unit is extremely small- only 8 beds- and is much less busy compared to US hospitals. Yesterday there were two patients in the unit and then they both got moved to the wards. And then today there were two more patients and a third arrived late in the afternoon. The unit is eerily quiet, and the machines don’t really even make noise, which is also different from what I remember from the states. Since RMH is a pretty small hospital, it doesn’t get many major traumas, so the ICU’s main source of patients is surgery. The first 24-30 hours after surgery are the most critical, and all patients are required to spend those hours in ICU being closely monitored before being moved to the wards.

Our time in ICU has actually been pretty boring. At least from what I’ve seen, most of the work is just maintaining the patients’ condition. One of the doctors told me she thinks ICU is one of the easiest fields because it’s common sense and just about regaining and maintaining homeostasis- what’s wrong, what’s causing the problem, and what can be done to fix it? So far that has been nothing more than monitoring airways, extubating, taking blood pressure, cleaning wounds, and setting up IV’s. This stuff is so basic that I don’t even have that many questions, making it hard to connect with the nurses/doctors and difficult to know what to ask them. I would never wish sickness upon someone, but I guess in some way I do wish there would be a little more action on the unit. But such is the ebb and flow of a hospital; last week it was crazy, this week is quiet, and probably it’ll be crazy again next week.

Aside from the long boring days, I did have a really nice chat with one of the women doctors this morning. We ended up talking about the unequal gender ratios in India and how infanticide is a now-illegal but still very common practice. We were also talking about how many times doctors in villages are seen and treated as God, but that in hospitals it is different; in hospitals, patients expect to be cured when in all reality mistakes do happen. Homeopathic medicine is also an issue because while it is usually harmless and can supplement actual care, many homeopathic-trained people also practice allopathic medicine (without actual training), leading to a whole range of problems. Patients then find their way back to allopathic doctors, expect to be cured, and get angry when there are issues. Finally, we talked about how a lot of times in India doctors may withhold information or make certain decisions for the patients, but that the doctors in ICU (and this doctor specifically) are making a concerted effort to give patients and their families all information available, and then allow them to make treatment decisions based on that information. This doctor shared a quote, and we both agreed it is the way doctors should handle themselves:

“From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art, and cleverness before common sense; from treating patients as cases, and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.”

~Sir Robert Hutchison