You have 4 more weeks to live...........

Way back in  nineties I was appearing for my second M.B.B.S. exams.One fine morning I woke up with a high grade fever .I popped a tablet of paracetamol and 2 tablespoon of sulphonamide syrup ( which I had taken in past as well with no side effects).Within few hours I started feeling a  severe difficulty in breathing.My head was reeling badly and my joints were swollen and body was full of rashes.I had a very bad reaction with sulpha drug.It almost looked like serum sickness.I was alone in my hostel room and was just two days away from my Microbiology exam.It seemed the end was near.And suddenly someone knocked at my door.I gathered my strength ,opened the door and was surprised to see my mother who had come to see me from Patna to Gaya,as she felt that something was wrong with me.(I don't know whether it was just a coincidence or some supernatural help but fact of the matter was that she was there with me).It gave me immense confidence and after 7 to 8 hours I was still miserable but wasn't deteriorating any further.

Two days later I appeared for my Microbiology exam though it was a very painful experience as I was short of breath and was barely able to speak with very painful joints.Somehow I managed and with my mom I left for Patna ,where my parents used to live then.

Slowly I started feeling better but my swollen joints got worse.My brother who at that time was undergoing his postgraduate training in internal Medicine took me to his assistant professor who had returned from UK with a MRCP degree to his credit and was considered quite knowledgeable and smart.He listened to my whole history and advised CBC and Rheumatoid factor to be checked.

When I along with my mom went to the pathology lab to collect my reports,the technician asked us to wait as the pathologist wished to see the person whose blood had been tested.When he saw me, his looked visibly sad and gloomy.He forwarded the test report to me and said that he would like to perform a repeat test on me.
One look at the report and I knew the reason of his expression.My myelocytes and Myeloblasts were in very high numbers and my total leukocyte count was very very low.Myelocytes  and blasts are present in the blood of patients having blood cancer.My mom asked anxiously to the pathologist , 'what is wrong in the report'?
Before he could reply,I said mom he suspects that I have leukemia.He was shocked and asked me that how could I read the report.I told him that I was a medical student and that made him visibly more restless.I could sense his anguish with the idea of a young life which will be lost soon.He repeated my tests and same were the findings.He suggested a bone marrow test to confirm the findings.

In the mean time I got in touch with the Physician.He announced - you have atypical leukemia as the total counts are low rather than high.Visibly scared I asked him the prognosis expecting a comforting reply.He told me in a matter of fact tone,you are a medico,you know it that you don't have more than 4 weeks to live.(Not playing Chinese whisper here,actually these were his words)Ask your parents to arrange for money to take you to USA for a bone marrow transfer.

I contested,Sir to me it looks like ,that due to the drug reaction I had a bone marrow suppression and that explains my swollen joints.Total count is low,which again goes in favour of this.And a high myelocytes and blasts show that my body is trying to overcome this suppression.He looked at me and said .not at all!!I told you, you have leukemia .There was a tone of finality in his voice.He was an MRCP and I was just a second year medical student who was talking theory read in microbiology and pathology.My logic stood no chance.

I was scared.I didn't want to die at 17.My parents were upset and so was my brother.Life came to a stand still.I went for my bone marrow test.My sternum was pierced with a thick needle and then had to wait for 48 hours to get the report.It looked as if I was waiting for my death sentence.All the time I was measuring my temperature,as in Leukemia one can have fever.And with stress i did develop low grade fever.

I was again and again looking at my skin to see any purpura( blue spots) seen in leukemia.My mom was at Hanuman mandir and so was I.Death was very very near.My parents could not have afforded a treatment in USA.

Finally the wait was over.My brother had to collect the report but he just sat down hiding his face behind the news paper.May be he was crying.Ultimately after 10 to 12 visits to washrooms my dad gathered the courage to go and collect the report.

He came back,looking all relieved.There was no evidence of cancer.So ultimately my logic was the right diagnosis.I gave a victorious call to the physician,who sounded disappointed as his diagnosis had gone wrong.

That incident taught me empathy.whole throughout these years when ever I remember this incident I just wish if that Physician was little more compassionate and thank God that it was just a bone marrow suppression and I am still alive to share this story with you!!

General Insurers Public Sector Association (GIPSA) and it's effects

Since last few months GIPSA packages have been implemented and my hospital is also allowing cashless facility for GIPSA  patients.
As per this GIPSA package whether a patient has paid premium for a triple sharing room(thus a lower premium) or a single sharing room(higher premium)they are entitled to same amount of money being released by their insurance company to the hospitals for a particular procedure.Fore example whether a patient delivers in in shared room or a single room ,hospital and doctor will get a total of Rs 35000,which includes bed charges,medicines,disposables,surgeons charge and all other expenses.At the moment most of the time hospital ends up spending more than what they get ultimately from these packages.Even for doctors the payout has gone down drastically.Now to cut costs,we have to compromise somewhere and so will the patients.We have to be particular to use minimal possible consumables which will ultimately reflect in patient care.
Whether it is conventional open hysterectomy or advanced laparoscopic TLH GIPSA package will pay only 73000 all inclusive to the hospital.While in an open hysterectomy you don't need costly instruments neither as much skill as a laparoscopic procedure,the payout to hospital and doctor will be same.Even if it is a very small uterus or the most difficult of Hysterectomy again the payout is same.Agreed that Hospitals and doctors will suffer badly but what about the patients?Despite paying huge amount of premium they will be deprived of good services.For a total laparoscopic hysterectomy one needs disposable items like harmonic,morcellators etc,the cost of which runs into several thousand.So if the hospital isn't paid for the instruments used how can it provide the services to the patients?So even if a patient could have had a laparoscopic hysterectomy will end up with open surgeries because of these rules.
God forbid if during delivery a lady has any unforseen complication like Post partum haemorrhage,it isn't covered by GIPSA and whatever the extra cost patient ends up paying from the pocket.Insurance copanies do say that incase a doctor tells these special circumstances,the bills will be taken care of,but in my daily practice till date I have seen patients paying it from their own pocket as their claims are denied by insurance companies.
Who will gain out of it?surely the insurance companies.These kind of packages will also increase unethical practices.Don't know what the future holds but it seems quite complicated at the moment.
Imagine......every year the house rent goes up ny 10%,driver's salary has gone up from 10 k to 15k,quarterly school fees of the child has gone from 28 k to 45 k........and if the earning of a doctor is coming down year by year it isn't fair.But then who said life is fair ?????

Meconium Aspiration Syndrome (MAS)

Meconium is the stool which baby passes inside the mother's womb.It usually happens when baby is in distress,getting reduced oxygen which leads to dilatation of anus and thus passage of stool.All cases of
Meconium don't need a caesarean section but at the same time it isn't a very easy situation for the obstetrician.As the meconium starts to thicken baby can aspirate it in the lung with problems of various severity.
Last month only I did manage to deliver two ladies with thin meconium vaginally,but yes I do get stressed while waiting.It is no win situation for the doctor.If you say it calls for caesarean patients don't like it.If you wait and baby's aspirates it(no one can predict beforehand whether baby will or won't)then it is the doctor who gets all the beating.
In last two days I came across two ladies who are second time pregnant and both had bad experiences due to MAS in 1st pregnancy.First one lost her new born child and the second one has a child with Cerebral palsy.MRI of this Child done at the time of birth is suggestive of lack of oxygen during labour.Both of them were understandably sad and blamed their Gynaecologists.While as a neutral person I couldn't find fault in management of either of the doctor.It was sheer bad luck both for the doctor and the patient.
We need to understand that doctors are no God.They can try their best but after some point there is a supreme power who decides all our fates.
And after these two incidents which I came across this week,my threshold for performing caesarean following passage of meconium would be much less.

Prevention is better...........

How many of you have been for a preventive health check up?Many of you have been and most of you have not been for one.At least till date I haven't got a preventive health check up done.Some of us think that'' I don't need it.These deadly diseases affect others not me", while others are too scared to go for it.What if there is something wrong?I belong to the second category.
But not any more.Have decided to go for a Preventive health check up soon.Even if there is a disease it can be detected early and can be fixed.
Someone close in family was detected with a breast cancer recently.Luckily for her it was still very early and hopefully she has many more years in front of her to live and enjoy life.But she is just like you and me,who enjoys life,young with young kids and no symptoms at all .About a week back she was oblivious of even her condition and celebrating life.A week later she has been operated for her cancer.It is shocking.I have been asking myself a question,if it could be her why it can't be me?Of course it can be me and you too.
Plan your Preventive health check up if it is due. And all the best .Wish you many more years of healthy and happy life.

Vaginal Delivery ,has it got anything to do with doctor's skills?

What do you think of a gynaecologist whose patients have more of vaginal delivery?That she is honest,ethical, has patience,considerate,compassionate.But has it ever crossed your mind that it needs something more than that as well.....'SKILL'.Somehow we don't associate a vaginal delivery with doctor's skills.Majority of normal deliveries are surely about being honest,ethical,having patience,considerate,compassionate but not all of them.During the course of labour there are many stages when it is very crucial how skillfully your doctor takes a decision.If baby has passed stool inside the womb,does it mean performing a caesarean section or wait for couple of hours.........it takes science,art and skill and of course experience.
When a lady is fully dilated and still not able to deliver a child and your doctor helps you out with Vacuum or forceps without causing any harm to you or the baby it needs immense amount of skill.
I have got lot many compliments for conducting vaginal deliveries but the one compliment which I still have to hear is 'Doc you are skilled'.I am awaiting to hear that.Maybe it will be you,who says so :) !! 

Role reversal

I think I can be a potential astrologer.In fact many Obstetrician have already donned that cap.
Don't get surprised..........!!I Thought not to comment anything on Poor Aishwarya Rai and her Pregnancy but the way whole media(you can still forgive them),astrologers and even well known Gynaecologists of well known Institutions have been issuing statements ,I feel deep sympathy for the Lady.Agreed she is a celebrity and open to public scrutiny but so much so that you talk about her Pregnancy and looks and bodily changes in such great detail that it is in poor taste.
As per a National daily,an astrologer has commented that she would need to drink milk in her pregnancy.Great..........I tell that to all my patients.So you see ,I have the potential to be an astrologer.Some one said she will have most likely a Cesarean.For that matter I can predict it much better,so is that astrology?
Now Obstetricians are predicting if it is an IVF pregnancy or normal conception.Someone  is predicting her trimester of pregnancy.That's is what is called role reversal..........Doctors doing predictions and astrologers giving medical advise.
Just wondering how commercial and stupid we have become.

Babymoon and maternity spa

The old adage ,patients are the best teachers  for doctors holds very true.Recently two of my patients informed me of two new concepts of modern day pregnancy and delivery.It is all about celebrating motherhood.None of them is directly related to medical aspect of Pregnancy care but I guess are surely interesting and good concept.

BABYMOON i.e, your honeymoon prior to arrival of your baby after which life would be busy for a while.Couples take time out in third trimester to be together away from the routine humdrum of life.I googled further and realised that there are various hotel groups all over the world who have 'special' babymoon packages.Maybe this could be something which can be an add on on your Pregnancy wish list.

Then came a lady who wished to know if there were any delegated maternity spa.Now again a new concept for me.And after googling and with help of another patient of mine came to know of a place marketed by Mahindra retails ( mom and me chain of stores) who have two such places in India ,one in Delhi and another in Bangalore which has hired a group of non medical professionals like a reiki expert,counsellor,massage specialist etc who conduct antenatal Lamaze classes .They have special tables where mothers can lie on their belly and get pamper.Interesting.In fact this concept has started arousing a businesswoman in me.Still an untapped area in India and we know there are many couples in India who don't mind paying a price for all the pampering they can get along with some useful information regarding pregnancy which probably increases chances of normal delivery as well.I think I can be a good brand ambassador for such a concept:)).What say friends?