Monday, August 10, 2009


My mum ever so often told us in our formative years, “those that work hard will never be doomed”. We grew up with that belief, until I thought I was grown up enough to stop listening to her.

And when I discovered this piece of genius on a T-shirt in our college fest, “Hard work never killed anybody, but why take a chance?” I thought, Good one, Ha-ha… wish I could afford that! This may not serve well in the field of medicine, where every minute your mind is on its toes.

During my medical school years, I looked at the senior doctors, practicing year after year, decade after decade, not tiring of doing what they do, with the same drive and zest. I would wonder, what do they run on? ‘Aviation fuel’, would be my best guess.

I got my keyhole view into the world of ‘dedicated’ docs when I worked with one, and to my great fortune, for one whole week. The experience of length of time is relative to the experience you have with the time. Every second seems an hour long when you are waiting for your date to show up, and an hour seems shorter when that is all the time you got to spend with your loved one.

Well, before I digress farther, I need to retrace. So, this week I worked with Dr. Climb (as I will refer to him), and he is one of the most experienced, knowledgeable, respected and loved Attendings in our program. There was so much I learnt from the week, more than you could fill into just seven days. This may be because I got to witness his daily schedule hour by hour. And these luxuries don’t come so often in the hustle bustle of a hospital.

Dr. Climb’s day always started before the sun. He would be at the hospital early, doing his ‘pre-round’ paperwork, dictations and discharge plans. He would then round, patiently on every patient, meet with the families and answer all their queries. I would often catch him in some corner computer room, helping out a newly recruited Attending with the nuances of ‘billing’, or discussing with a small group of med-students about ‘this interesting case’ on his service. For one, he seemed to have the time for one and all, and had so much to give others out of his day.

And then later in the afternoon, I would meet with him to discuss about a minor chunk (although a big number in itself!) of his patient’s that I was taking care of. His attention and patient care, even at the end of the day, was ‘wholesome’. We would do ‘walking’ rounds on every patient, sit down to discuss the plan, and finish off with the wisdom pearl.

Close towards evening, after seeing all the ‘follow-up’ patients (those that we have been following all week) and the ‘new’ ones, I would be exhausted. And there have been times, when the thought of rounds at the end of an already late day, sounded murderous to me. But Dr. Climb would walk in with a big smile hiding those sunken and tired eyes, and say, ‘You know, I had this interesting patient today….’ and continue the story in a velvet voice. There must be something about this man that, at the end of his story, you feel like you just drank a Redbull, and are raring to go for another round of rounds. The fatigue fatigues. You bounce back!

What is it that keeps him going? There is another doctor (heart-surgeon) I grew up in awe of, who once said, ‘Skill, is what you can teach, but what you cannot is Passion’.

So, that was the secret of Dr. Climb. It was no rocket science any more, and not aviation fuel that kept him running…(well, I confirmed that one after being around for one whole week). His work seemed to always excite him. Even after working day after day for a fortnight without a weekend, he still came to work full of life, looking forward to another day of excitement. Every patient was interesting, every diagnostic dilemma was challenging, a mystery waiting to be solved, every difficult family was a learning experience. There is something to envy and imbibe about these folks.

They ooze and enthuse with energy. He taught me a bit more than medicine… to love my work despite the vagaries of long hours and tough terrains, to care for patients unbiased and to keep going.

So what my mum said was right. So long, until we discover that passion and that purpose that charms. When you really enjoy what you do, it’s no longer work and work becomes play.

“Work fascinates me, I can watch it for hours.” -- Calvin and Hobbes

Wednesday, February 25, 2009


FREE FLOW… No, I am not talking about iodized salt to prevent goiter!! Free-Flow, that’s how I describe residency in US.

I was, like all my peers in medical college, very curious to know how It’s different! I had my own assumptions….may be they see more interesting cases… COPD, CAD, CVA, CRF, CLL…. (voh, yenn idella naav noDde irodaa??). Of course, we have seen it all (bejaan times) during our medical school years back home, and perhaps even more! The amount of clinical exposure we received in medical school was enormous, it was a boot camp! It is a foundation we built on, and I will be ever grateful for that. Yet, if I were to take sides, I would lean towards the US’ system of learning.

I recount one of my earliest cultural shocks during my interview season for residency. It was the morning rounds and one of the interns was ‘presenting a case’ to an Attending (equivalent of a ‘Professor’) and was chewing gum!! Rounds and Chewing gum, they just did not seem to fit into a single frame in my mind. I felt so unsettled, and was seconded by this other Indian co-interviewee with whom I kept exchanging flabbergasted stares. Imagine a scenario of ‘getting caught’ chewing gum in classroom during one of the lectures in medical college… well, you may as well imagine spending the rest of the afternoon outside the lecture-hall preparing your apology speech.

The next shocking episode came during the very first monthly-birthday-celebrations in residency (which included ‘My birthday! My birthday!’), when our Program Director (I might equate him to the Department head- HOD) cut the cake and served it to us. I was stunned….wha…. That’s the camaraderie that exists when you let the reins of your authority go, treat all like colleagues and work as a Team.

Casual- is how things function here, and it is good. Infact it is great, because it allows ‘free-flow’ of discussions, and knowledge. Everything in medicine is so relative, and so dynamic. You tell me what you think, I tell you what I think, and we learn. I cannot recall a single casual conversation with any of my medical college professors, and I never had a great rapport with them. Well, there was never a chance to! I recall our rounds during internship as this one-way conversation by the boss, while the minions just listened. By the way, do you have a point to make? Well good, then keep it to yourself! Don’t even try to ‘act smart’ with your addendum to the big-boss discussions. And if you ever dared to ask a question, awww….bad move….you are either melted under the lava of the volcano that you just unscrewed, or you get this little sermon of, ‘why don’t you tell me? Go and read up!’

Some of the things were FIRSTs for me in US. For the first time, I heard a resident being nonchalant about NOT knowing something about a patient’s history or blood work… an Attending being ok with accepting he learnt something from the minion… history and progress notes dint have to look like Presidential speech (Attending notes can look like this, “I underestimated the patient, he looks awesome!" "Today, the patient really tried to die on us")… and yes the big relief of dropping the ‘Sir’ before referring to a senior doctor. During my first year medical school, my Anatomy professor threw me out of exam hall for being disrespectful, because I didn’t begin the answer with a “Ma’am”. But how do I explain to her that I really had a huge respect for her, until that day.

Going by the case-load (that’s the magnitude of patients we saw back home) and clinical knowledge (=number of readings of Harrison’s / year), there is a huge difference in the way we train in India and US during a PG 's life. I can never compare with quality of the medicine PGs I worked with in B’lore, they were geniuses. So, what is it that makes medical training in US different? Well, it’s not the books, not the patients, not the rare diseases, not even those hi-fi investigations you do…. As I see it, it’s the learning, and the way it happens. You learn as you do, and you learn as you discuss. And the freedom of expression wins the gold medal!

We went out for a team-dinner last month, after finishing one busy month of floors (wards). Needless to say, it was fun! The Attending narrated the story of how (many years ago) he met his future wife on one of the hospital floors as a medical student. We laughed over the times in the past month when we had success stories, near-misses and goof-ups. Just then, I was reminded of a showdown incident from my second year medical school, when a psycho Professor had passed an uncalled-for vulgar comment for walking alongside a boy “roaming around in college shamelessly instead of going home and studying”. Well, ‘Sir’, that was a great display of manners from you right there!!

To “Freedom of expression and Freedom of knowledge” I told myself as we raised a toast and my glass clinked with my Attending’s….. “CHEERS….. to the Team”!!