Thursday, August 27, 2009

Overcoming fear of failing as a doctor

I have been practising as a pediatrician for over 22 years now, but whenever I come across a very sick child with complications and so on, I am afraid that I am going to go wrong somewhere and miss either the diagnosis or the management and lose the child for ever. I know that my fear is not irrational because every doctor, during his/her professional life, makes some errors of judgment, not all of which are going to kill his/her patient(s). This is because medicine is a very complicated science, and in some respects, it is not even a science, but an art that one learns throughout life. It is not even just an art, but also an act of faith: faith in one's own self as a doctor, faith in the abiding sea of knowledge that a doctor draws upon, faith in experience being a bigger teacher than books, and ultimately, faith in the Almighty: the most agnostic doctor will look to the skies for divine help when his patient fails to improve under his treatment.

I thought about all this for the last six days as I struggled (and am still struggling) to save the life of a newborn who is under my care. While there is a secular trend towards improvement, the child keeps having episodes of worsening which leads me to believe that, through her, the Almighty is testing my faith. I am happy to report that the baby is now showing improvement.

Such is life, and such is the tension in the mind of a clinician.

Monday, August 24, 2009

A little bit of this and a little bit of that

Sounds quite crummy as a blog title, doesn't it? Well, I don't have anything momentous to say right now, so I decided to go with smaller stuff that can add up to something readable ... or so I hope.

... I want to say that of the many things that really encourage me, the most encouraging of all is the smile that my patients give me as they improve and recover from whatever illness has put them under the weather.

... I want to say that even if a patient pays me less than what I deserve, I am satisfied if the patient or his/her parents extend a hand of friendship and cooperate with the treatment plan properly.

... I want to say that I love to eat street food: this may be one of the reasons why I seldom fall ill with gastrointestinal problems as my gut flora is used to being abused.

... I want to say that I don't subscribe to the patients and parents' oft repeated worry that eating bananas and curd will make their child ill and suffer from cough and cold. In fact, I don't mind if the child even has an ice-cream, as long as he/she is also taking medicines properly.

... I want to say that I think my parents are now really, really old, as they hardly leave the house, fall ill often, and my dad gets breathless even if he has to utter a few sentences in a row, and my mom suffers from cardiac anxiety and is always scared to venture out of the house.

... I want to say that I enjoy eating. So much so that I know that even if I skip lunch every single day during Ramadan (the month of fasting), I am not going to lose any weight. Underline the word "any". In fact, don't be surprised if I actually gain weight.

... I want to say that Pediatric practice is a very flucutating form of medical practice. The climate decides if the pediatrician is gonna be busy or not in his office. Right now, with swine flu raging around us (more as a media hype than actual pandemic), practice is really good. I am not complaining.

Sunday, August 23, 2009

Swine flu, Illness, and now, Ramadan

I think there has been a big gap in my blog, and I will try and make up for it today with a lot of snippets of what, essentially, has been going on with my life.

Well, for one thing, Swine flu (novel H1N1) hit India towards the end of the first week of August, 2009. Cases in Pune were the first to be discovered, and India saw its first death from swine flu in a std 1xth Muslim girl from there. The disease then reared its head in Mumbai, Pune, and so on, affecting many of the larger cities from India. The Government of India, and the Mahrashtra govt swung into action pretty soon, and we had a state of near panic and Pune got touted as the swine-flu capital of India. Masks became the commodity most sought after, and a black market in masks soon became active, with masks costing Re. 1 or 2 now costing Rs. 20 a piece, and the N 95 masks costing about Rs. 80-100 costing more than Rs. 450 a piece.

As the cases climbed, so did the few who succumbed to the illness. In what can be termed a knee-jerk response, Mumbai closed its multiplexes, schools and so on for a period of 3-7 days. Knowing that swine flu is here to stay, this kind of temporary closure did allay anxiety and the hoi polloi got the impression that the government was abreast of things and not dilly dallying, but this was senseless. Reports from WHO and so on tell us that the entire life cycle of this illness may last from anywhere between 1-3 years, so that short term actions will, essentially, be useless.

Swine flu attacks will continue periodically, and over the next year or three, it will affect at least 50-60% of Indian citizens (that's over 600 million individuals). Even if 1% die, we are talking of about 5-6 million people dying from this disease. The expectation is that this may not happen if the organism continues to display the same level of aggressiveness that it does as of today, but there are scientists who are saying that the disease severity may, in fact, increase, as the virus will continue to undergo antigenic changes and turn more virulent (= aggressive).

Okay, so with this swine flu, doctors had a very busy fortnight indeed, as we battled to allay the anxiety of parents who brought their offspring no sooner than they had had a little fever or cough. Speaking for myself, I think I had the best 15 days of practice in a long, long time. In fact, the rush of patients reminded me of a similar panic that had gripped Mumbai a decade ago when there was a scare of plague following an epidemic of plague in Surat a town that lies in Gujarat (a neighbouring state of Maharashtra). At that time, though, the panic remained for just three days. I remember how Surat then underwent a magical transformation from being a filthy city to becoming one of the cleanest cities of India under a new city commissioner.

Anyway, this handling of so many children with respiratory complaints had its inevitable side effect on me, and last week, I came down with flu like symptoms - cough, cold, fever, and body-aches. I did not go in for a confirmatory test for swine flu (incidentally, the municipality and the govt. have set up about 15-odd centers in Mumbai for swine flu testing), as swine flu or not, this illness was not going to kill me, and would be all right in a week to ten days' time. Today is the sixth day of this illness, and though I still have a bad cough, I am able to eat, move and have no fever, so I can see that I will be all right in another few days.

Ramadan is upon us. For Bohras, it started on Friday, and today was day 3, but for the sunni Muslims, it began today, and will run its course as usual. I performed the fasts on the first two days, but gave it a slip today as my cough has turned a lot more serious and I did not fancy bearing this for an entire day. Tomorrow, I do plan to fast, of course.

In other news, everything is going on as usual. Hospital admissions are modest, clinic practice is returning to normal, parents are all right (mom is fasting, dad isn't), Inas is fasting, Hannah isn't, and life goes on.

Tuesday, August 04, 2009

Taxing times

It has been my observation that when it does not rain enough, times become tough for every one; for the farmer, it means a reduced time window for sowing seeds that ripen and bloom in the coming year and yield crop and hence, reduced annual crop yield and reduced income; for the townie, it means reduced freight (transportation) of the harvested grain to be taken to the big city; for big cities, it means reduced amount of grain and vegetables in the markets, and higher prices of the same; for the stock markets, it is a period of gloom as a good monsoon spells positive news for India, which is, by and large, an agrarian economy; for politicians, it means an era of broken promises; for the housemaker, it is a time of shortages and delicately balancing the market purchases against a fixed household income; for corporates, it means tightening the money belt, with reduced ad spends, reduced allocation to the company's wages account, and so on.

We had good rains in the third and half of the fourth weeks of July, but after this, the rains have played truant. Almost none so far since the 25th of July.

Let's wait and see.