THIS CAN HAPPEN: VOLUME XXX & XXXI
Dr. Gangadhar Sahoo
This can Happen vol.XXX - (My Postgraduate Examination)
Dr. Gangadhar Sahoo.
I completed my internship from SCB Medical in June 1976. The entrance test for Postgraduate studies was conducted for the first time in Odisha that year. I had qualified in Obstetrics and Gynecology and posted in VSS Medical College Burla, around 300 km from Cuttack. I joined there in July without any break. Three years of hectic and strenuous life of a postgraduate course came to an end with submission of thesis and notification for the final MD examination from the Sambalpur University. We were three postgraduate students in our batch. Appearing for the postgraduate examination was a nightmare for the examinees at that time. The sword of Damocles of failure was hanging on the neck of every examinee. Failure was the rule.
Theory examination was held in the month of May. The last paper was going on. There was a short note on CRAYO SURGERY IN GYNECOLOGY. I had no idea about it. I had read all Gynecology books, journals and recent advances during my PG career but never came across such a term.On my right side was seated my friend Ramesh Mohapatra (Chaki : his nickname. Chaki in Odia means grinder. He was a professional grinder in his studies. He had the habit of grinding any difficult subject, drinking the potion and digesting everything. He was the encyclopedia of medical science. ). I just asked him if he had heard about CRYOSURGERY. Within a few seconds he narrated about the history, principle and its uses in Ophthalmology. I just copied and pasted what I heard, deleting Ophthalmology and related things and replacing it with Gynecology and gynecological conditions. Out of the three candidates I was the only candidate who had answered all questions.
Thanks Professor Ramesh Mohapatra for his timely help.
Really a friend in need.
After oral examination was over, we had rigorous practice sessions in clinical and practical Obstetrics and Gynecology. Oral clinical examination date was fixed with a gap of 2 weeks . Professor Dawn, the legendary gynecologist from Kolkata (then Calcutta) and another stalwart, Professor Shahay Madam from Ranchi were my externals.
As usual I was very nervous. Shedding all nervousness, leaving everything for the Almighty and accumulating courage I reached the department at 7.45 am, 15 minutes before time. I was in a situation just like a soldier sitting on the train and moving to the war field without knowing his fate if he can return successfully or not.
The lottery for case distribution was drawn exactly at 8am under the direct supervision of Dr. M.D.Raut, senior most assistant professor. Two long cases (one Obstetrics and one Gynecology) were given to each candidate. All cases were strictly new cases, no chance for the candidate to smell the diagnosis of the patients. Confidentiality of the patients was strictly maintained. Except Dr. Raut no faculty had the chance of knowing about the case. I had worked in Dr. Raut's unit for a maximum period of time. I was happy to see him in charge of the clinical examination. I had a difficult gynae case . She was a 30 year old nulliparous lady with pain abdomen. On examination she had a tender, solid mass in the left adnexa 7cm×7cm. I was confused about the diagnosis. It could be a twisted ovarian, endometriosis, tubo ovarian mass or chronic ectopic pregnancy. I just asked Dr. Raut to help me out. I was expecting some help from him as I was his favorite student. But to my utter surprise he frowned at me and said, "This is a university examination. Are you asking for help? I will inform the examiners. "Other faculty members pacified him and came to my rescue. I got a life. I controlled my nerves and decided not to write the diagnosis rather I would discuss this case. That worked wonders. When I faced the examiners I did that and discussed the differential diagnosis of unilateral tender pelvic mass. Prof. Nanda, my interna , was a silent observer. Two externals were bombarding questions after questions. At last I got a pat on my back from Prof. Dawn.
The examination which had started at 8am sharp ended at about 9pm. It was summer at its best at Burla. There was neither an air conditioner or air cooler. Only method of cooling was the evaporation of the sweat. When my examination was over, I was completely exhausted. When I was coming out of the department, I heard someone calling, " Gangadhar! Gangadhar! Wait.Wait...." I saw Sindhu Madam almost running towards me. She said that she was carrying one special message from the team of examiners to convey to you. She was too ecstatic to hide her emotions. She said, "The examiners have sent their best wishes and advised you to join medical college at the earliest for the best interest of the future generation."
I got my result. At the same time I got the most valuable certificate of my life. The readers are the best judges if I have done justice to my Guru Prof. Nanda's advice.
This can Happen vol.XXXI (Empathy:Where are you?)
Dr. Gangadhar Sahoo
This is an anecdote related to one of my good friends. After resigning from army he started his private practice in the capital city of Bhubaneswar. By nature he is down to earth, well-behaved and committed. Professionally he is sound, ethical and empathetic. He got attached to one private nursing home and still continuing there till date. Besides this he has his own clinic at his residence which is open 24×7. He earned a good name within a short period of time and became an established and popular private practitioner. From our MBBS carrier I had marked his hidden talent in dealing patients with extraordinary quality of public relationship.
I was the dean IMS and SUM Hospital, Bhubaneswar from April 2016 to May 2022. Once I am established in Bhubaneswar, both of us get closer to each other. By the bye I came to know that he is eligible to be a professor, General Medicine in medical colleges. I gave him this offer if he can join my medical college. He was in a dilemma. Between the fight of "Yes"& "No" he dragged almost a year or more and at last joined in my college.
When he joined in medical college as Professor in the department of General Medicine, he became the 4th member of our SCB-70 batch. Every day after the routine works were over , we four ( myself, Prof Mohapatra of Ophthalmology, Prof Mishra of Pharmacology and Prof Kar, the newly joined Professor of General Medicine) used to meet in my chamber at around 1.30 pm . Over a cup of tea we discuss everything except official matter starting from spirituality to politics. That was the most enjoyable period of our life . That period of one hour was the antidote of stress. Life was going smoothly. Prof Kar was getting acclimatized slowly to the new environment. At his age coming from autonomous private practice to a duty bound medical college as difficult. But it did not make any difference to my friend.
He is diabetic under self treatment. During routine investigation his routine Hb% came to be 11gm%, ophthamoscopy revealed some macular changes suspected to be a complication of diabetes. He took oral iron tablets and intraretinal injection every four weeks for 24 weeks. Those injections were too costly for an ordinary man to purchase. Because he was a retired army officer it was easily reimbursed. After 24 wks repeat evaluation of Hb% and ophthamoscopy showed the same findings. The treating ophthalmologist (specialized in retinal diseases) referred him to L V Prasad eye hospital for second opinion.
In the LV Hospital a young ophthalmologist Dr. Behera , a student of Prof Mohapatra examined Prof Kar and opined that the retinal changes were not due to diabetes. The cause might be something else and categorically he suggested to exclude certain abnormal protein metabolism. Prof. Kar consulted Dr. Priyanka, our hematology Professor and necessary investigations were done. For abnormal protein the blood sample was sent to outside and the report came after one week.
Prof Kar after receiving the report, called me over phone, "Ganga! I got the warrant from Yama Raj. My days are numbered. I am going to meet Priyanka. "His voice was sobbing. He couldn't control himself. He was crying while switching off the phone. I could read his mental state.
The diagnosis of Multiple Myloma was confirmed. PET scan showed multiple bonny lesions throughout the skeletal system. In between , we four friends were chatting in my chamber. We discussed how lucky was our friend Prof. Kar! At the earliest the disease was diagnosed. Moreover multiple myloma is treatable and curable. This was possible because of Dr. Behera, the young ophthalmologist who could suspect the lesion. All four friends wrote a few lines of appreciation and posted it in the WhatsApp number of Dr. Behera. Decision to start first line chemotherapy was taken.
It was decided that Prof. Kar will receive chemotherapy in the hospital as an indoor patient. It was done. It was a relief both for Dr. Kar and his family. First course was uneventful. In the second course he was discharged after the intraveinous medicines given as per the protocol were finished. After two days he developed certain abnormal symptoms at home which compelled his wife to call me over phone and requested me to hospitalize him .Fortunately I was in the office. I could guess the situation and without delay made necessary arrangements for admission and sent the ambulance to his residence. He was reluctant to come. But I forced him to follow my instructions not only as a friend but also as the dean.
At last he was hospitalized. He was disoriented, dyspnoec, incoherent and had high fever. He was in a state of shock. God saved him. With treatment he improved. The opinion of the treating physician was that Prof. Kar had developed the complications due to chemotherapy. The first line chemotherapy was discontinued and the decision was taken to start the second line chemotherapy.The second line chemotherapy was too costly (more than lakhs per course) and was not available. He arranged to take it in army hospital Kolkata free of cost. It was well tolerated. So he completed the full course of chemotherapy and at present in maintenance therapy.
He had a long standing problem with his vision both eyes , compromising his day to day activities like reading, climbing up and down the steps, driving etc. He consulted one renowned ophthalmologist who happens to be his relative. After detailed examination and investigation it came out to be a cataract left eye and retinal pathology with cataract right eye. His consultant decided to take up the plain cataract left eye first subject to the evaluation of retina both eyes by the concerned specialist.
Prof. Kar took appointment to consult the retinal expert of that institution. Day after next day at 9.30 am was fixed for his consultation. Prof. Kar reached the eye hospital at around 10 am. By that time 9 patients were enrolled. The receptionist said, "Sorry Sir! You are late. Already 2 cases had been examined. Your revised serial number is 11. Please wait for your turn."
Prof. Kar told, "Please convey to the consultant Madam that Dr. Kar, retired professor of General Medicine also a post chemotherapy patient is waiting on the line."
"OK! Sir."
Conveying the message of Prof. Kar to Madam, the receptionist returned and communicated to Prof. Kar, "Sir! Madam told to wait."
Prof. Kar had no other option but to wait.
Prof. Kar entered into the chamber when his number came. Madam examined thoroughly and put down her expert opinion, "Left eye shows plain matured cataract without any retinal pathology. Right eye has retinal pathology due to multiple myloma and diabetes. Cataract surgery on right eye should be deferred. "
Prof. Kar: " Madam! Is there any treatment for the retinal pathology? "
Consultant Madam: "You can take the intra ocular injection for 6 wks and re-evaluate."
Prof. Kar: "Madam! I have taken many injections. I have felt no objective or subjective improvement. Why should I take this costly pain again? "
Madam sarcastically replied, "As a medicine professor, are you not advising dialysis in your CKD cases, knowing fully well the outcome of it?"
Prof. Kar was stunned. He was never expecting such a bulnt reply from a consultant of her stature. He simply prayed," Oh! God. You can only save this noble profession."
Here I felt," Are the consultants of today are so much mechanical and superficial? Was there any need to hurt a senior professional colleague with such rude comment?
Have they forgotten the ethics of medical practice and human values? "
I felt so sorry for my friend.
As per the decision the date for cataract operation was fixed. Before the operation the OT manager displayed the different kinds of lenses:
German lense-Rs.48,000.00
British lense- Rs. 45,000.00
Indian lense- Rs. 33 ,000.00
"Sir ! Please choose one", said the manager.
Prof. Kar was confused and asked the manager to call the surgeon for help. The surgeon who is a distant relative of Prof Kar, came and said, " For few days why waste money on foreign lense? Indian lense will do."
The words "FOR FEW DAYS" hurt Prof. Kar very much. He was speechless, almost cried before going to OT. He consoled himself and got operated successfully.
Here the surgeon could have told in different ways. When he said "for few days" it was automatically understood that the days are numbered for Dr. Kar. Casually uttering these types of words to any ailing patient is quite demoralizing and shocking. This is totally unwarranted and uncalled for.
This shows the poor communication skill by the modern consultants. They have forgotten the oath they had taken at the entry of this prestigious profession. They are commercialised. They have no feelings, no human touch and what to speak of empathy!
ONLY THE ALMIGHTY CAN SAVE THIS PROFESSION.
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