Archive for the ‘My Musings’ Category

What to do in Postings?

I never thought I’d be writing something on this subject. Believe me, I’m the last person that should be writing something like this. I’m taking about clinical postings in hospitals which happen every morning for 3-4 hours since coming to second year. Two and a half years have passed since these things started and I wonder what have I done all that time. Now that I’m in final year, when we really need to utilise this time as there will be a practical exam in this, I realise that I’ve been wasting almost every morning of college by not doing anything all this time. What could have been the problem you ask?

Well firstly, the impulse every morning was not to go to the hospital as “nothing much happens” and “there is no use going”. Attendance was also not that important. Now I realise that these were just excuses and I wouldn’t have made them if I didn’t want to do something else. The same time could be spent watching some cool show or movie or do some or the other more interesting thing. Anyhow, I didn’t let this affect me much. I convinced myself every time that there is a proper time for everything and that even is you learn one thing today in the hospital then you’ve done a good job. So overall, my attendance was low but not very low, better than the average. I just used to go a little late every time, without missing anything important.

The second thing- after reaching the hospital, not being proactive in the wards. Now, we were lucky to study in a college where there is no shortage of patients. Each student could see any number of cases he wanted. Even with all this, I couldn’t make much use of it. I’ve never found History-taking a very interesting nor a very useful thing. I always thought of it as unnecessary troubling of the patient. Any good student or teacher would be agitated if he reads this. Yeah it’s true that it’s important, but only when it’s done in the right way. And the only right way to do it was to know why you’re doing it and what is the relevance of every question that you trouble the patient with. Coming to Clinical Examination, that needs even more knowledge of the subject. There were two problems in this- either we didn’t know properly what are we supposed to do and why or there were so many students examining a single patient that it was hard to do it properly or just plain not worth the trouble. Now I wonder why did we all crowd around a single  patient? Probably because we were afraid to take a case alone as we don’t know much. Probably our combined knowledge will help us get through. Furthermore, even though patients are plenty, those with classical presentation or those with conditions which are academically relevant to us are not so common.

Was there no one to teach you? – you ask. Well that’s the third problem. I do feel that we students are the one being wronged here. It’s that no one in the departments care about you. Hardly anyone is interested in teaching you. There was no proper schedule of teaching nor fixed teachers to teach a subject. I don’t know whether this is the condition of only our college or in others too. For a college that is supposed to be (or at least was, in the recent past), the best college in the state, the condition shouldn’t have been like this. Anyhow, we managed somehow most of the times. You can try and find someone who’ll teach you.

So now that I’ve told about all the problems I had, it’s time to decide what to do, if you want to avoid the earlier mistakes and make the most of what remaining time you have. Here are a few things I learnt from my experience:

  • Get up, dress up and show up every day, regardless of what is happening or what will happen. It’s important to be right in principle. They say its better to regret something you did rather than regret something you didn’t do.
  • As clichéd or impractical it sounds, read and be prepared for whatever case you’re going to take BEFORE you take it. The ideal situation would be to become perfect in a particular case and then see the patient. Of course, we are not perfect. All we can do is try to strike the right balance between the patient and the book. A little bit of both here and there. It’ll enable you to properly take the case and also reinforce what you have read by seeing it live in a patient.
  • You need to “practice” everything. That is – do it repeatedly. As much as you get the chance to do. For example, eliciting a reflex looks so simple when you see people doing it, but you’ll realise what it is when you try. (Btw I only recently came to know that you’re supposed to look at the muscle twitch in a tendon reflex, not the movement of the limb).
  • Find someone to answer your questions, probably show you some procedures, and present the case to the person. Bear the torture of a hundred mistakes getting pointed out in your presentation. Just bear it. Due to some reason, they think that while pointing out mistakes, they are teaching you. But the difference lies in the way it’s done. Most of the times it appears like they’re discouraging the student without them knowing it. Anyhow, forgive the teachers if they’re being rude. They probably don’t understand a student’s psychology and are probably just doing their teaching job unwillingly as a compulsion.If you were an ideal student and had read before taking the case then it will help you a lot at this stage.
  • Take notes of whatever is being told. Try to write everything that you can, as neatly and systematically as possible in a notebook that you’ll not throw away somewhere but will see again. This stuff is not usually given as such in the textbooks but it is very useful in viva, theory as well as answering other professors’ questions. Think of it as a secret book that all the professors have, from which book alone they accept answers, but students have no way of accessing it except in a few instances where the professors use it for teaching.
  • Don’t tell yourself that I’ll go home and read all about it. It is irrelevant whether you’ll read it later or not. Your job is to utilise this time as much as possible. It’s best to assume that you won’t be able to, so finish whatever you can here and now.
  • Discuss stuff with your fellow students. You’re lucky if you have someone with you who knows more than you. This is a much simpler and much more effective way of learning things than doing that from a book. It’s like the difference between eating and digesting something (reading) or just taking IV glucose (learning from others). They have processed everything for you.

This post became quite long. I didn’t plan to write this, it was just an impulse. As someone said- “I write to know what I think.” (Joan Didion). Hope this makes things clear for me as well as help you the reader. Writing makes an exact man they say (Francis Bacon). I sure hope to be so.

A Year in Review

This is one of my least favourite things to do, writing about myself. Yet I do it anyhow as I have nothing else to do plus I kinda need to put something on this blog.

Why am I writing this? Well, if only we knew exactly why we do everything we do. One reason might be that I may be interested in reading this myself a few months or years from now. Another may be that some reader destined to stumble upon this blog may like it or benefit from it somehow.

The year 2013. Well, I have to say it was one hell of a year. (for me, that is). It started with the gloomy exam season. Why gloomy, you ask? Well it actually shouldn’t have been gloomy but it was. Those were the Second MBBS exams, the final exams after around 17 months of studying Pharmacology, Pathology, Microbiology and Forensic Medicine. You can remove 12 months from that easily, and possibly a few more as those were not spent studying anything at all. The huge amount of work to be done coupled with the abysmal previous performances in Internals and Pre-finals, all these have a tendency to produce a kind of depression, you know. Anyhow, finals were held and the results arrived. They were not that bad (by the grace of God), but it really had more to do with the God’s grace part than my work. Yet, technically, that was the worst result I’ve ever gotten in my career. And I was not happy with it (and am still not happy). In first year, I had put in some extra effort and managed to get a much more respectable score but this time the effort was missing and the scores clearly reflected it.

As a result, Third year (or more accurately Final MBBS Part-I) was started with great enthusiasm. We have to start studying. Then the not so exciting reality hit us. Hardly any classes being taken in college and postings, haphazard and disorganised as usual. The excitement and enthusiasm diminished as fast as they had risen. The subjects either looked small (ENT, Ophthalmology) or not interesting (SPM). 

A natural question anyone would ask on hearing this is- what were you doing if not studying? Well, the problem with me is that I have so, so many methods of time-pass available that studies fall behind badly in gaining my attention. Especially cursed are people like me, the ones with a healthy PC & a swift Internet connection and a knowledge of how to properly use them.

Now I don’t know about others but at least for me, these things- movies, TV shows, random internet surfing, chatting, Facebooking- can entertain you only for so long. And only when you are in a certain mood. That is why I have always been involved in some or the other “project” that can keep your mind engaged, and probably involve the use of some of the skills you have. An example of such a project is this blog. However, there are quite a few other online projects that I was involved with, a few with a potential of earning actual money. Another offline, though tech-related, project was the editing of a short movie made by a group of my classmates. I now realise it did eat up a lot of time. I must have worked for it for around 3-4 months.

Life was going fine. The short movie was quite a success. More important than that, we were happy with our work. The other two projects were going real smooth. Then it happened. A call on my mobile. Such an outdated traditional means of communication. One of the online projects, it had to go. But not before causing a sh*tload of distress and worry and emotional trauma and paranoia and what not. Such unprofessional, backward these Indian companies are, in both mentality and their understanding of technology. Thankfully, the problem went away. The only disappointment I had was that the people benefitting from it would be disappointed. A few days of calm and then another blow. An email. The other project was gone too. Well almost. This problem  was a little bit milder but it was unfair, based on a mistake I had committed so long back that I hardly even remembered it. Anyhow it’s temporary but temporary for a long time and it’s kinda hard to see so much of your work stagnated in uncertainty.

What I got to learn is that the Internet is not much different from real life. There are setbacks and failures and all kinds of stuff. I am happy now with how I handled it. Yet here I am, left with both my big projects gone and exams on my head. I kinda tried convincing myself that it was probably for the best, that now you should concentrate on studies, and if needed, use just this blog as a distraction. And also, may be, concentrate on real life a little more, realising that the only few things you are interested in always have to be behind a computer screen.

Now aside from the cryptic stuff I wrote above, that few people will understand, there were quite a few other things that happened this year. I regularly attended a few classes at a hospital / academy being taught by successful practising doctors, got to learn quite a lot from them. May not be much of the subject, but definitely a lot about their attitude, approach, priorities, basically what kind of personality they have, that may have played a role in their becoming a successful doctor. Great TV shows were discovered – Breaking Bad, Homeland, Dexter,Suits and more, Forrest Gump, an excellent movie, quite a few other good ones – The Call, The Internship, The Bling Ring, jOBS, Moulin Rouge, To Kill a Mockingbird, a few good Hindi ones – The Dirty Picture, Ishquiya, Chennai Express. Offline activities – a lot of time was spent hanging out with friends. Probably the highest, cumulatively, in any year of my life – consequence of a care-free college life along with an old friend circle. That was kinda nice actually.

So goodbye 2013. You were a good year. No hard feelings. Hope 2014 is good. And also 2015, 2016 and all coming years, in this calendar or any other calendar that exists.

Hello world!

I’m back with this blog. I had almost given up on blogging after an earlier fiasco but I ran into a backup I had of my previous blog. I managed to get most of the  articles I had written (though the dates are messed up). And I had started to miss blogging too. So now I’m back and hopefully start a fresh new blogging journey 🙂

Check out my about page for more info!

Terms, Terms and Terms

Abductor pollicis longus
Extensor pollicis brevis
Talocalcaneonavicular joint
Substantia gelatinosa Rolandii
Corticopontocerebellar pathway
Tubuloglomerular feedback
Slow reacting substance of Anaphylaxis

These terms have nothing in common, but are capable of producing the same effect- terms like these can make even the brightest of students think-“Did I make the right choice in choosing MBBS?” Being introduced to these terms adds to the horror of a new student who is already bewildered by the strange new college environment. It is a source of wonder for non-medical people how we can say and remember such difficult names. It is true that this ability is something worth admiring, but it usually is not achieved easily. There are many ways in which a student copes with this problem. One that happens with everyone inevitably over time is that they get “used to” it. It is wonderful how many difficult situations man can adapt to. Over time, each new term causes slightly less fear than the previous one and over some time he gets literally immune to it. It takes quite a while till his sub-conscious also realises that it’s no big deal, these terms are not as big problems as he once thought they were. In fact we get used to these technical terms so much that we even start using them in our daily lives, even at times when they are not at all needed, for instance, asking each other- “Hey, how to study? Retrograde or anterograde?” or saying “The whole of my peroneal compartment is paining after that match” or even a student saying to the other a few hours before examination “Hey dude! I’m feeling palpitation! One also realises over the course of time that the usage of terms is inevitable. We just can’t do without these technical terms. It only for this reason that their use was started in the first place and still continues. One can’t use words from common language for everything. If that was the case, then a psychiatrist would be using only one word – mad! For many things we want to refer, words don’t exist in common language. One also realises that the good old Greek and Latin names are simply the best names that could have been. These names are also quite intuitive when one learns how they have been derived. Knowing the derivations can make things very easy. One can easily learn quite a bit of Greek and Latin from seeing the derivations of these terms alone. For example the word “pons”, meaning “bridge”, for that part of the brain is quite apt as it looks just like a bridge and more or less functions like one. The modern trend is to keep English names but their use has also caused a little inconvenience in that they are usually too long and unwieldy. For example, “growth hormone” for somatotropin looks okay but “growth hormone releasing hormone” or “growth hormone inhibiting hormone” look rather unwieldy when compared to “somatocrinin” and “somatostatin”. One can also use abbreviations but they are simply not intuitive and look like a meaningless bunch of letters.

At the same time it is not necessary that one shouldn’t try to do something and blindly memorise things even which he finds very difficult. One can always make an effort and try to make it easy. Sometimes we can dispose off unnecessary Greek and Latin and make things surprisingly easy, like the margo obtutus of the heart can be called the obtuse margin and the incisura angularis of the stomach can be called angular notch or arteria pancreatica magna as great artery of pancreas. These are commonly found in Western textbooks and atlases but have not yet entered much into books by Indian authors.

There is another category of terms, terms like-

Parkinson’s disease
Tetrology of Fallot
Fascia of denon Villiers
Hepatopancreatic ampulla of Vater
Korotkoff’s sounds
Lobry de Bruyn van Ekenstein isomerisation
Queckenstedt’s test

These terms actually called “eponyms” but commonly known as “named” things are a real nightmare for students. There seems to be no way around these. There was a highly successful ad campaign by some company – “The name is enough”. So successful in fact that all the teachers seem to be following it. If one knows the name then it is assumed that the student knows completely about it. However, the names are important as confusion between two will completely change the disease! One should also realise that these too are not bad names. Since a disease has more than one symptom, calling it by one symptom will leave a totally incomplete picture. Instead if one creates a picture of all the symptoms and gives it a single name, it may help in a more intuitive understanding. The same may be applied to the name of a special anatomical structure or a set of chemical reactions. Also it is not required that we remember a lot of such names, remembering only a few common or significant ones will do.

It is more because of these terms than the actual subject that makes the science we study look rather complicated. But even if a slight effort is made, things can become surprisingly easy. In the end, we all need to follow what is being strongly advocated in the ads of Tata Docomo- the principle of KISS- Keep it Simple, Stupid!

[This article will also be found in my college magazine – Insignia 2011, but here it is in it’s original form without all the undesirable editing they have done]

iCame, iSaw, iConquered: Steve Jobs

You might be wondering what is Steve Jobs doing in a blog that revolves around Medicine and such things. One reason is that personally I happen to be greatly inspired by this man and another more important reason is that we’re not gonna talk much about computers and gadgets here but about the kind of person he was, how he was different and how he made a difference to the world.

Steve Jobs for Dummies

First let’s get a little idea about the achievements of Steve Jobs. You’ll find many websites that list his achievements but here I’ll try to write such that people who don’t know much about computers can also appreciate it.

1. Founded Apple

Apple Inc. is richer than the government of USA. The company doesn’t need any introduction. It is the personification of “brand following”. Millions of people buy their products simply because “Hey, it’s an Apple product.” This image was not formed overnight. No one had more job in this than Steve Jobs.
2. Invented the Computer

Though this is gross exaggeration, it is almost as if he did it. Computers before him were just big IBM machines used only professionally in big institutions. It can be said that he played “the” major role in making the computer a “personal computer” (though he never used that name and this name became famous as a rival to his Macintosh)

3. Founded Pixar Animation Studios

These people make a lot of animated movies we enjoy.

4. iPod

There were portable music players earlier but they weren’t good enough. It wasn’t a runaway success and people started criticising him, but soon they knew that it was after all Steve Jobs, we all know whether any other music player is as popular as the iPod.

5. Invented the touch-screen smartphone

This too is exaggeration, there were touch-screen phones and also smartphones earlier but they were as good as not being there at all. The day he announced the iPhone, he changed the mobile phone industry.

6. Invented the Tablet PC

This is the perfect example of his innovation. Again he showed the world what was good for them. This product (the iPad) was highly criticised. Everyone said that it was nothing but a giant smartphone. They saw it again. A whole new segment of electronics took birth. While other companies were releasing or just developing their first tablets, Apple was releasing it’s second version.

So, What’s the big deal about him?

Steve Jobs doesn’t remind me of a person who toils hard to achieve a bit of success, he reminds me of an artist who took pleasure in his work. He made his customers happy and simply took his money. He thought out of the box, did things people would find ridiculous. He didn’t let anything get in his way, he had to leave the very company he founded, he didn’t give up complaining but made himself such that the company itself called him back. He not only made new products but made them beautiful. He started the trend in everything like using graphics instead of boring DOS commands, beautiful fonts on computer screens, good looking and colourful computers and laptops. The rivalry between Apple and Microsoft is famous but he didn’t let it get in his way. When Apple was at a huge low and he needed to do something, he called up Bill Gates and made a deal with Microsoft.

I personally don’t use any Apple product simply because I’ve never felt the need or been able to afford one. I won’t buy one even if I have the money. I know that the brand name adds to the cost and for a geek like me, something that works so easily and effortlessly would be devastatingly boring! But it is the person Steve Jobs was that inspired me so much.

His speech at Stanford was one of the best I ever heard, his keynotes can be watched even for the sake of entertainment! And no one will be able to forget his “One more thing…”

Steve Jobs’ Medical Condition

Okay, so as this blog is more about medicine, I feel obliged to pay some attention to this aspect too. Though I never knew much about it, after some research I found it quite intriguing. Jobs has not been very open with the media about his health (and rightly so). One funny fact is that a newspaper actually published his obituary when he was alive! It had actually been prepared in advance as there were rumors about his bad health.

In his Stanford speech, Jobs says that he was diagnosed with some “extremely rare form of pancreatic cancer”. He was actually speaking about a neuro-endocrine cancer of the pancreas. As you know, the pancreas is predominantly exocrine with the endocrine part (Islets of Langerhans) constituting only 2% of the mass of pancreas. Rather than exocrine cancer, for which survival rate is very low and which is the fourth largest killing cancer in the world, Jobs had the cancer of the endocrine part. Cancers of neural or endocrine structures are together called “neuro-endocrine” cancers which are mostly benign and constitute only 5% of pancreatic cancer cases (remaining 95% cases being cancer of the exocrine part). He preferred a treatment by alternative medicine in the beginning. Fortunately, the need for chemotherapy or radiation therapy never arose (which have terrible side-effects you know).

In July 2004, Jobs underwent a surgery to remove the cancerous part called “Whipple’s procedure” or pancreatico-duodenectomy in which, as the name suggests, the head of pancreas is removed along with the duodenum. The duodenum has to be removed in spite of being so important because the pancreas head and duodenum are supplied by the same gastro-duodenal artery and the removal of only pancreas’ head would stop the blood supply to the duodenum and cause its necrosis. After Jobs underwent this procedure, he started to look quite frail which is obvious because the duodenum, in which major part of digestion of food takes place, is lost.

His body may have adapted itself to this as he later became healthy. In April 2009, he had a liver transplant but I can’t see any connection of this with his earlier health problems, which makes one suspect alcohol abuse leading to liver damage.

In January 2011, he again took medical leave and then resigned as CEO and passed away “peacefully, surrounded by his family” nine months later. The reason for his death hasn’t been explicitly mentioned. From the available hints, one can suspect nothing but a relapse of his cancer.


Every soul has to taste death one day, yet a few continue to live in spite of going away. Steve Jobs will not live only in the name of his company and it’s products, but also in the minds of many whom he inspired and motivated to follow his footsteps.

As a final tribute, I would like you to watch this video which very fittingly attributes to the life of Steve Jobs, in the mesmerising voice of Carl Segan.

Here’s to the crazy ones. The misfits. The rebels. The troublemakers.
The round pegs in the square holes

The ones who see things differently. They’re not fond of rules.
And they have no respect for the status quo.
You can quote them, disagree with them, glorify or vilify them.

About the only thing you can’t do is ignore them.
Because they change things.
They invent. They imagine. They heal. They explore. They create. They inspire.
They push the human race forward.

Maybe they have to be crazy.
How else can you stare at an empty canvas and see a work of art?
Or sit in silence and hear a song that’s never been written?
Or gaze at a red planet and see a laboratory on wheels?

We make tools for these kinds of people.
While some see them as the crazy ones, we see genius.
Because the people who are crazy enough to think they can change the world, are the ones who do.

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