Rosters

There is still no sign of Koby. Anne and I live in a little room in the Men’s Interns quarters that is barely enough for two. When Koby comes along we become eligible for a small house (flat) on the hospital campus. The list of those eligible is a long one and the vacant houses are few. Anyway a larger accommodation is something great to look forward to.

It’s a great work environment in pediatric surgery and I have been seeing some great cases over the past few days. There are loads of hernias for me to do, tongue tie releases and venous cut downs will be among other out patient procedures that we can do in Baripada. We had an unfortunate kid that swallowed a coin, that was stuck halfway down the esophagus on the way to the tummy – was an experience watching a senior registrar of our getting it out under a continuous X ray image intensifier!

All of us were on a roster duty a day ago – the roster system is when we have a sick child, we take turns to sit in the ICU with it, making sure all is well. The children we do rosters for are usually on a ventilator and need a little intensive monitoring, so we all rotate a couple of hours each and then the next person relieves you. The only thing is that you see stars the next day in theatre with the lack of sleep!

Anyway, once Koby turns up everyday is going to be a roster, and only the two of us to do the duty!

Keeping me in focus

Ok! OK! I am sorry, what I actually meant was that I thought that I had finished narrating what experiences in my life would make any sort of benefit to a third person reading it. 10 thousand people reading it was just an observation, not a finish marker! In the future our life will be a blur of dirty nappies, duties, a crying baby, nappies, surgery, paper readings, thesis, nappies, being a “family” – and being good parents. Do you all want to hear such mundane stuff? I will have as much a ‘story’ or ‘experiences’ as anyone else at my stage in life. Anyways – I have so begun to enjoy the blog that I’ll keep at it when I have a chance!

But in retrospect, I think this forum has helped me keep focus – when it is so easy to lose focus along the way. On some days, it was the only “useful” thing I did between throwing up and avoiding food. Imagine if I was 3 months post chemo with nothing constructive to show for the time I spent under the needle! Maybe this blog classifies under constructive? (Not that I have anything more to offer!). And I think it was also a way to keep thanking God actively and consciously, even when the going was tough – I hope that is a message this blog can teach others- because miracles do occur if only we keep our hearts ready to realize them.

Anne and I went to amma’s office in the evening; she is a pathologist and has just got a fancy new microscope! Here is a picture of Amma showing Anne a biopsy of somebody’s sweaty head!

Waiting for Koby.

Isn't it difficult to wait and wait for a good thing? Can hardly wait for Koby to pop along..... maybe if we give a little push?
My blog has crossed 10 thousand people on the counter. Thats great! Maybe it's time to pack up?

Weekend!

The exams for the final year students went off well. We were “skilled assistants”, what skill we have, I’m not sure – but it was a great experience watching how the exams were conducted. I will be taking them in another 2 years, so it was worthwhile having a taste of what to expect!
All the radiation changes have started to resolve, my skin is nearly back to normal and I am feeling better when I swallow food. It's like the picture of college hill alongside, when one phase of life hits the sunset and the new dawn breaks to life with a new purpose.
We had come back home yesterday, and are spending the weekend at home. The pediatric surgery department where I am working now went up the college hill with most of the doctors and their children. It was a nice, fun time! The pictures are from the hill climb. Anne gave the climb a miss, because she is just too close to popping to attempt a hill climb! The climb was followed by dinner in one of the consultants –Dr. Sudipta Sen’s home. (Mutton Biriyani again, my favorite!)
Appa, Amma and Tripti have gone to Madras to finalize the printing of Tripti’s wedding card. They left early this morning and Anne and I are left at home – we slept late and were just saying that once Koby comes along these small pleasures in life will go down the drain! We have just about 3 weeks for the expected date to see little Koby, maybe sooner?

Out of my cage!

Today marks another special day in this online diary of events. I have officially completed my radiation today. I met Dr. Subhashini in her out patient chamber and she looked over my x rays and decided that one extra dose of radiation would be enough (i.e Today). Went down for my last nuke with a grin on my mug! It’s great to have another chapter of this saga completed.

I have a picture of the cage I was in for the radiation, one of the technicians were nice enough to hold it for me while I took a picture of it on my PRIMUS radiation machine. I was basically strapped into this plastic cage and the lines on its surface were a guide to where I was positioned in the radiation field. From tomorrow, I have no more cages to face. Even of the mind - I think it’s easy to worry now. Questions like “Am I through it all? or will my PET scan 3 months down the line show tumour again?; there are so many doubts that can crop up, and I don’t deny that they exist. But they are not caging me in, I’m sure I’ll be given the strength to deal with it when and where the situation exists.

What’s next? Well, I guess I just sit and wait – a check CT scan in a month and a PET scan after 3 months to see if the crab is around or not!

Tomorrow I need to get up early and go as an assistant for the final year Surgery residents, as they give their practical exams. I need some rest, but I needed to blog the good news first, before I crash out!

Patient, we must all be!

The next few days will be the last of my radiation. Dr. Subhashini had asked me to continue my radiation for one more day, get an X ray of my chest and meet her in her out patient department tomorrow.

My chest is now a sort of scarlet pink, but the skin hasn’t thankfully peeled off.

Our final years are doing their final exams this Friday, and all of us from the second years will be the skilled assistants for the exam. That means making sure X-rays and instruments are ready for the practical and that the examiners are comfortable. I guess we also get a taste of what our exams will be like in a year’s time. Since I have lost time on Chemo, I give my exams 6 months later, and in some other center in the state! That’s a bit tougher, but hey I’m thinking that it’s not too bad a trade off!

I spent a while in Amma’s office today, we had a baby in theatre who was suspected to have an absent ganglion (nerve) network in her colon (Hirschprungs disease), and we needed to know an urgent biopsy to decide how much to cut off. I sat in Amma’s room while the biopsy was being done. It’s not often I see Amma, even though we are working in the same hospital!!

Anne has a presentation on cancers of the Vulva, to make this week in her department and that means I have to patiently wait my turn for the computer! As you can all see!!

Can you feel the Love?

Can you feel the love tonight?
It is where we are
It's enough for this wide-eyed wanderer, that we got this far.
And can you feel the love tonight, how it's laid to rest?
It's enough to make kings and vagabonds believe the very best.

Ya! I’m listening to Lion King. Lots of music playing in the room now, for Koby’s benefit! Today’s checkup was interesting – Anne’s obstetrician is also her consultant. So she pops into her out patient cubicle with patients for her opinion as well as in between today for her own check up! Koby is going to be a big baby we are told. I am happy, Anne groans!

I have been busy reading a really good novel. Q & A is the title – Question and Answer – Vikas Swarup. For a guy who doesn’t read much, this book kept me glued from start to finish. Great fun – It’s about a waiter who wins a quiz show for a billion bucks, just because the questions were from incidents and trivia that passed his life at various parts in his life. You could credit fate to such things, but in real life - I would like to credit a God who is great at orchestrating 'fate'.

So, this wild eyed wanderer is thrilled to be so far down a path to getting better! Appa was in the main hospital for a meeting, he came down to the radiation room with me – but it was crowded and so I decided to come back later. I met Dr. Subashini too, she will decide by tomorrow if I need the extra radiation. She could hardly believe that my course of radiation was over so fast. Neither can I. It seems like yesterday when I met the Linear accelerator for the first time. Maybe God speeds up time too?

Todays picture - My desk, in the room – with my old trusty laptop!

Changing the world!

I wonder how many of us can really change the world. Isn’t changing the world what each person wants to do? My thoughts were kicked off after I met a good friend of mine, who in college, believed that getting into the Government set up for health care, with CMC training and values would be the best way to create a social change. However today 2 years into his tryst with government health care, he does not sound as hopeful as before. Disillusioned and given up trying to make a difference.
I hope Anne’s and my plans for the future do not reach such an end. It has to be different when we are sure God had a part to play in us making our choices. There are so many reasons we can say we have had enough – poor facilities, Koby and his education, a need to study further, lack of stimulus to improve or learn new things. One of the things that has repeatedly been repeated to us during this illness, is that for those to whom much is given, much is expected. Anne, Koby and I have been given so much, I’m sure that the future will sort itself out and we can give back to both God and man.
Today is a day off from both radiation and duty. Pediatric surgery is a great specialty and I am really enjoying the time there. Anne is on call, so we will miss the music competition that the medical students are organizing in the college, buts that’s all right – we will be able to spend the day at home tomorrow, and that will be a treat.
36 G of radiation will be completed on Wednesday; Dr. Subhashini will reassess me and decide if I need the full dose of 40 G. That can mean another 2- 3 days of radiation. The end is in sight!

of Lymph nodes and trauma...

Paediatric Surgery is not as busy as I thought it would be. I missed lunch today, but that was because an intersting case started at 11 am and went on till 4 pm. Anyway, skipping a meal is a routine thing in our main Surg rotations. This ward is so full of kids, each with a different kind of illness. The great thing is there is no sub-specialization, each consultant is good at a different specialty and we get to see the entire gamete.

Today was the last day of radiation for the week. The weekend will be off and then, I will finish by next week – God willing. I have sneaked a snap of my radiation machine. The board I lie on is there, as well as a black cushion I rest my head in. The cage I am fixed into is not in the picture. Since the cage(cast), I’m fixed into is custom fit, I am going to ask if I can take mine back and keep it once I’m done! Just for memory sake!

There is a technician in the radiation room – her elder brother had large lymph nodes in the neck and I had biopsied them in the out patient last week. I think she was really worried that he had a lymphoma (she sees so many patients), but while I was doing the biopsy – I found these lymph nodes to be quite full of pus. So I had reassured her that it would probably be tuberculosis. She kept pestering me about the result for a few days, every time I went for my radiation. I finally did get the result, and lucky for him it was tuberculosis – but when I went for radiation, I was told by the others there that she had gone to be with her younger brother was in the intensive care unit after an accident on his motorcycle! Life can be so tough at times….

A day for research.

I start my next posting tomorrow, a rotation in the department of paediatric surgery. I have always loved kids and I wonder if I will enjoy this posting, which combines the joys of children and surgery. It is a great unit to work with, with some great surgeons, and I can hardly wait to get there.
I will miss the hepatobilliary unit. I really enjoyed the last 20 days there. More than the fact that it was great to be back to work, I wonder if you remember the uncertain days a few weeks ago, when I struggled to button my shirt because of the pain in my fingers. Those days, I wondered if I could really continue in surgery, with decreased sensation. But working with these people, really supportive and who gave me a lot of responsibility to shoulder - renewed my confidence in what I am doing, and I'm now more sure than ever that God needs a surgeon in Baripada.
The few of us, registrars - Arpith, Balaji, Mohan and Gregory went out for dinner last night, and it was a nice parting meal..a 'last supper', so to speak! I will miss this gang, because they made my easing into work so easy!
Today, I had taken some time off to finish the protocol writing for my Cochrane collaboration meta ananlysis. I had hoped we get most of it done today, because from tomorrow - life will become a blur and one crazy rush of work. Sadly there are more changes needed in the protocol. It's difficult to get my teeth into the exact way this research has to be tackled. Anyway, I'll keep making the corrections, and hope things fall into place. Time to get to sleep - I have to get to work tomorrow!

A God of peace.

Amma came with me for last night’s dose of radiotherapy, it was nice to show her the room and how I get caged in for the radiation. She was invited to the opening of the new conformal radiation therapy room last year as a professor of the institution; and was shown the new fancy machine – but little did she know that her baby boy would be there for 4 weeks of his life, and that too so soon.

She had so many questions, does it hurt, does it burn, and are your ulcers hurting when you eat? Anne’s parents too are so worried, and I suppose my being so casual and optimistically cool about it may give them the impression that I am having difficulties but refusing to show it.

On rounds last week, boss stopped an old lady who was the attendant of a patient from chewing tobacco and told her it was harmful for her. “It makes a difference if one in a hundred modify lifestyles from what we tell them”, he told us. “I would not wish carcinoma cheek even on my worst enemy; it’s the worst disease to have, and the treatment even more terrible than the disease.” He then said “in life it is good to live it well and then to die in peace and dignity. We must also if possible die after our parents” he added “for it is, by far the most difficult thing for parents to watch their children suffer”. He looked at me and said “I’m sure you will know”.

I never really looked at it that way. I know it has been tough on the family, both mine and Anne’s. But I’ve always thought if I show strength and a face that everything is all right (which it has been!), that they would feel easier about the entire situation. I wonder how I would feel if Koby had to face something similar, even if he said that all was well. I guess that at this point a God of peace makes perfect sense. He has to exist, because I have felt him at work in me and the entire family, despite this crazy situation.

knowing what its about

It’s been a few busy days and I have been on call for the past 3 days. It’s great to have the weekend off from radiation. The wards have been busy and keeping everything under control hasn’t been an easy task. Anne has been doing well; Koby is not being very forgiving though – lots of small pains and aches.

I hope I can get back to my regular postings this week, there will be 4 months of work to catch up on at the end of the posting, but I guess that’s a small price to pay for getting well. It’s really tough to blog though, I really thought that I would be able to get a little time to type my thoughts in but sleep always seems to be a greater priority.

Amma called today, she wants to come with me for my next dose of radiation tomorrow and see what its like. That’s great! Arpit had come last week too, but he was so tired that he fell asleep waiting outside the room! As surgeons we have no exposure to radiotherapy as part of our training. Going through it personally changes the way I look at the entire process and in future when I recommend it – I will really know what I’m talking about!

This is a view of a part of the hospital outside our ward!

Neck deep!

Life has been so incredibly busy that I just keep procrastinating writing my blog each day. I reach my room usually at some unearthly hour and the last thing I want to do is waste time booting up my computer and typing when those extra moments can be spent in sleep.

I know I am a lazy bum!

I really on cloud nine because I got to do a hepaticojejunostomy – an operation that connects the bile duct to the intestine, in this case because of a suspected cancer in the duct. Feel good about that!

Radiation is still going on as planned; I run every evening to keep the appointment at 7 O’ clock. There is just a little burning that is probably due to small ulcers due to radiation of my esophagus (food pipe), but that settles with an antacid solution I drink occasionally.

I have a great group to work with. Mohan, Gregory and Arpit are the registrars with me. These chaps are fun to work with and since we have a great time at work and we have great consultants - waking up every morning is with a sense of wanting to go to work!. This is a picture of us grabbing a Pepsi outside hospital, in a little restaurant. The picture on top is one of my ward, or should I say – second home!

Today I have some time off, we have an arrangement where Arpit does some days and I do a few. Tonight..... I sleep well!

Out of the tunnel

It’s been a great Sunday today. Last night the department of general Surgery held a dinner to bid farewell to the final year postgraduates and welcome in the new ones. It was nice - a statement that kept coming up was the final years telling our teachers that they each leave having become a part of each of them! How true! A surgeon can only learn by doing and watching small techniques that only an experienced teacher can pass down. As we learn we pick up the best from different teachers and in many ways become a bit of each one.
Arpit was on call today and so I got some time to myself today after the morning rounds. Anne and I went home for the afternoon and enjoyed a good steak that Appa made. It’s great to eat great food after a while; in hospital food itself is a luxury at times and good food even rarer!
Today I was reminded of an analogy of life that Dr. Prathap had given me when he came to meet me earlier in hospital – just before Chemo. He said he thought of life like a train ride, at times life is great and we are on the top of mountains looking at the most beautiful scenery and at times we are in beautiful planes with green fields around. But there are times we enter dark tunnels- and it’s the way we react in the tunnel makes that part of the ride enjoyable. We all have the option to crib about going into a tunnel and maybe about not having lights in the train for a short time or we can make the best of it by sharing our food with our neighbor, picking up a conversation with some one there in the train and making the best of the tunnel. I guess I’m making it out of the tunnel now and the ride has been a good one.
Good news- the Echo scan (heart) I had yesterday shows my heart is ticking allright and the engine is going well - there was a worry that my heart function had decreased post Adriamycin Chemo, but thats improved now. My hair is on it's way back! I was keen on keeping the head clean shaved, but I have neither the time nor the energy! A pic of us and bits of stubble on my head! God's been great and its another reason to say thanks!

A day off!

I am off today and it’s so great to have a few moments to myself. Getting back to an active work schedule is like jumping onto a running bus. You really have to run fast to gain momentum to jump on safely. It’s been a week since I’ve joined and this week has really been exhausting. I met my Radiotherapy doctors today, and was given an echo (heart scan) request – because there was a bit of worry about the effects that radiation could produce on my heart.
Tomorrow is the live donor liver transplant – we start at around 4.00 am, and will go on for probably the entire day. I’m posted on the team that’s working on the recipient – in this case a child. The donor of the liver is his father. It’s a great privilege to be on the case, hope it goes well for the team.
I’m really thrilled about the improvement of my fingers. I remember about a month ago, worrying about whether I would be able to operate with chemo having numbed the sensation and caused a burning of my fingers. This week I managed to do an appendix, breast cancer, opened an abdomen for a cyst and quite a few more smaller cases alone – and am now fairly confident that I can do it. 3 weeks ago buttoning my shirt was impossible because of the pain, and now I’m operating – I can only say that God has been really good.
My hair is also on its way back. I had half a mind to keep the bald head, but when 4 hours of sleep is a difficult proposition, shaving my head is the last priority on my to- do list. A post pancreas operation chap in my ward shaved his head just like mine – they say imitation is the best form of flattery….!
To end a snap of the good ole dayz!