SUSHRUTA 2016-17 · MESSAGE Dear readers, It is a pleasure to present before you the first edition of our hospital magazine SUSHRUTA 2016-17. The journey from conceiving its idea

SUSHRUTA 2016-17

Editorial TeamDr Dheeresh Dr Pulin Kr Gupta Dr Subodh Kr Mahto Dr Pratima Mishra (Left to Right)

Dr Ekta Dr Bhavika (not in pic)

Cover Designed by Dr Jeenu

MESSAGE

DR (Prof) A K Gadpayle Additional Director General of Health Services GOI Director PGIMER amp Medical Superintendent PGIMER Dr RML Hospital New Delhi-110001

I am pleased to know that PGIMER Dr RML hospital is bringing out the first edition of the hospital magazine SUSHRUTA

As the Director and MS of the hospital I am kept apprised of your enthusiasm and zeal both in academics and extracurricular activities

This magazine SUSHRUTA is a reflection of the thoughts yearnings and ideas of our medical fraternity Penning down their thoughts gives them a chance to express themselves and a learning opportunity for all of us as they represent the understanding and aspirations of a young generation who are expected to lead us in future

Write ups are the only means to preserve the wisdom of the wise and experience of ages

REVELS the first fest of our hospital has indeed served as a benchmark for the years to follow I appreciate all the organizers and the participants for putting up such an enthralling show

PGIMERDRRML Hospital New Delhi is a premier institute under Government of India established since 1932 as the Willingdon hospital initially and later got its present name The institute has one amongst the largest faculties in different specialties and super specialties streams and caters to medical care of honourable President Prime Minister Vice President and Ex-Prime Ministers of India This is apart from catering to one of the busiest OPDrsquos and emergencies in India for the general public

I would like to congratulate the president of RDA Dr Durga S Meena and other members of the RDA A special heart felt wish for the editorial team led by Dr Pulin Kr Gupta and Dr Subodh Kr Mahto for their dedication for bringing out ldquoSUSHRUTArdquo

Well done guys Keep up the spirit

Jai Hind

MESSAGE

Prof (Dr) Rajeev Sood Dean PGI MER amp Dr RML Hospital Professor Consultant and Head Department of Urology Dr RML Hospital amp PGI MER New Delhi - 110001 (India)

It is my immense pleasure to congratulate the organizing team of the First ever cultural and sport event ldquoRevels 2016rdquo held at PGIMER amp Dr RML Hospital New Delhi on 1st Dec 2016 Indeed it is laudable to know that initiative has been taken to publish the First Cultural Book ldquoSUSHRUTArdquo of PGIMER amp Dr RML Hospital New Delhi

Life of a resident is totally indebted to long working hours sheer pressure lack of social and friendly events and bonding For any hospital they constitute the true strength and pillar however only work and no play make them less efficient

Recently there has been going concern and this event was a perpetuation of the initiative in the same direction to evolve all round development of the doctors

Mr Faggan Singh Kulaste Union Minister of State Govt of India and Dr Jagdish Prasad Director General of Health Services took this cultural gala and raised the occasion with their kind words and highlighted the importance of good health of the doctor for a healthy society

Other day of the fest was also graced by Mr P P Chaudhary Union Minister of State Ministry of Law and Justice commemorating the importance of the occasion in the era of amalgamation of technology with the advancing medicine The sheer presence of the sport legends of the fame of Para-Olympic and international arena Mr Devendra Jhajharia enthused the young resident doctors for whom he emphasized the importance of physical fitness and sport medicine for medicos

The in house doctorrsquos music band and other talents dominated the cultural program which was appreciable to be recognized the hidden talents with the climax of the performance by Mr Hardy Sandhu the star Indian Singer and Actor

I hope the legacy will continue in the future with the same enthusiasm and zeal Doctors have always been a role model of the society and I am happy to find active participation of our residents in extra curriculum activities other than excellence in medicine

Hope for the best and continue to excel in life

Jai Hind

MESSAGE

Shri Arvind Kumar Registrar PGIMER Dr RML Hospital New Delhi - 110001 (India)

I am delighted to know that the first edition of ldquoSUSHRUTArdquo the hospitalrsquos magazine is planned to be rolled out in January 2017 The magazine is being followed after the institutersquos festival which was held in the last week of November 2016 It was a successful initiative by administration to rejuvenate our residents faculties and health care workers who have devoted their long hours towards the care of patients at PGIMER Dr RML Hospital

As the Registrar of the institute management committee I am apprised of your enthusiasm and zeal both in academics as well as in extracurricular activities It is a matter of satisfaction that PGIMER Dr RML Hospital is providing to be an example of our competence in the field of Medical Education borne out by your achievement

I extend my heartiest felicitation to the entire team of resident and staff of PGIMER Dr RML Hospital and wish them all the success

Jai Hind

MESSAGE

e-Mh- frac14dk fpfdRlkfrac12 lg vkpkZ frac14dk fpfdRlkfrac12 ih th vkbZ e bZ vkj] MkW- jke- e- yks- vLirky ubZ fnYyhamp110001

Post Graduate Institute of Medical Education and Research (PGIMER) Dr RML Hospital has been a leading hospital with world class facilities offered to all irrespective of caste religion race or gender Not only is the utmost patient care our motto but an empathetic attitude towards the weaker section of our society and continued medical education and research is our objectives

To fulfill this aim more than 100 postgraduates and 20 DMMCH students are passing every year in flying colours from this institution But these goals of medical education research and patient care takes its toll by causing much of mental and physical stress on the residents as well as faculties

To destress them our honourable Director Prof A K Gadpayle and Dean Prof Rajeev Sood under the companionship of honourable Director General Health Services Prof Jagdish Prasad and under flagship of honourable Cabinet Minister of Health and family welfare Sh J P Nadda Ji took this initiative to hold an annual cultural and sports event at PGIMER Dr RML Hospital

This event was celebrated like a festival and all HCPrsquos enjoyed a lot Along with this event a new initiative was taken to publish the annual cultural book of RML hospital by the name ldquoSUSHRUTArdquo The present inaugural issue of year 2017 is now available with us which contains beautiful poems review articles memorials and short stories from resident of RMLH as well as LHMC

The most beautiful aspect of this book is to see the affection of our residents towards our mother tongue Hindi The editorial board has worked really hard day and night and definitely needs an applause for that

How a small pleasurely and leisure time can bring out the artistic values of a humanrsquos personality is correctly been depicted by the quality of articles submitted to us for this book

I hope that all of you will enjoy this book and will come up with much more submission next year A lot of effort has gone into this initiative issue to see the light of the day but the success shall be if everyone in the institute finds it interesting to read Waiting to see your response

t fgUn

MESSAGE

Dear readers

It is a pleasure to present before you the first edition of our hospital magazine

SUSHRUTA 2016-17 The journey from conceiving its idea to being published was like a

bumpy hill very demanding in terms of time and thought as well as a fun filled experience

The magazine has tried to capture most of the memorable moments form our first fest

REVELSrsquo 2016

We thank all the fantastic souls for contributing their write ups and photos for the magazine

Hope you enjoy reading it as much as we had enjoyed bringing up SUSHRUTA

Suggestions for the further editions of the magazine are invited in good spirits

The editorial team (Left to Right) Dr Dheeresh PG Medicine Dr Subodh Kr Mahto SR Medicine Dr A K Gadpayle Add DGHS Director amp MS Dr Ekta Yadav PG Surgery Dr Pratima Mishra PG Ophthalmology Dr Bhavika PG Paediatrics (not in pic)

MESSAGE

Dr D S Meena President of RDA PGIMER Dr RML Hospital New Delhi-110001

It is a pleasure to present before you the 1st edition of the magazine SUSHRUTA This issue

of Sushruta is yet another example of the hidden talents of our residents My heartiest

congratulations to Dr Pulin Kumar gupta and Dr Subodh Kumar Mahto and his editorial team

for this achievement an act of co-operation perseverance and will

My good wishes to all those who have contributed to the magazine and also to those who will

read and enjoy this excellent attempt

ENGLISH SECTION INDEX

A HUMOURS 1 Bacteriology of Doctors - Dr Subodh Kr Mahto 2 Full Circle - Dr Mohd Ali 3 Google Maps Saga - Dr Dheeresh KH 4 The Dancing Girl - Dr Daljeet 5 Great Thought - Dr Ramesh Meena B PEARLS 1 Tolerance - Dr Pratima Mishra C MEMORIES 1 In Memoriam of Kanu Chatterjee - Dr Debopriyo Mondal 2 I wish it was Mutual - Unknown 3 Short Beautiful Stories - Dr Aakansh Jain 4 Memories of Dissection Hall - Dr Parteek D TRAVEL 1 Journey to the roof of the world - Dr Sameek Bhattercharya E SCIENTIFIC THOUGHT 1 The fear of rejection in doctor- patient relationship - Dr A K Gadpayle amp Dr Subodh 2 Cognitive Disorder in India - Dr Vikash amp Dr KS Anand F SOUL SOUP 1 How a password changed my life - Dr Aakansh Jain G THE NEW YEAR RESOLUTION MENU CARD

1 Making resolutions for the new year is a neat trap - Dr Aakansh Jain

H POEMS 1 The Voice - Dr Himani 2 Being a Doctor - Dr Ghazal 3 Mirror - Dr Shivangee 4 Life of an MBBS student - Dr Arjun 5 Imipramine amp Milrinone - Dr Garyll Ryan 6 Anatomy - Dr DS Meena

Sushruta 2016-17 PGIMER Dr RML Hospital New Delhi

BACTERIOLOGY OF DOCTOR

- Dr Subodh Kr Mahto

Senior Resident Medicine

Bacteriology chapter of Microbiology is very volatile complicated and pleomorphic Even

after careful study the subject is difficult to be put in black and white Here is also not an

insincere attempt

MORPHOLOGY-

For convenience of description they are classified into 2 main groups-

1 Male organisms

2 Female organisms

The male are bacilli arranged in chains and called as streptobacilli They are actively motile

and highly virulent particularly to cocci

The female are cocci always arranged in groups and hence known as staphylococci

contributing Brownian movements They are multi-coloured powder sprinkled and cream

coated

HABITS AND HABITATS-

A large number of them are found in boys and girls hostel though some are found scattered in

city They are particularly sensitive to them ldquoDOCTOR SAHIBSAHIBArdquo

STAINING-

Some of them are ward positive while others are ward negative Ward negative bacilli are exam

resistance They usually form spores during examinations and need intermittent autoclaving in

order to get rid of them By careful observation over a long period we have recently detected

the most virulent organism which is ward negative exam resistant Morbidity is high and

mortality is 100Other commonly used stains are theatre mate chromatin guncha blue and

elite violet

TOXIN PRODUCTION-

Only the male type is found to produce an exotoxin which is very powerful and is called

ldquotheatre photon toxinrdquo

BICHEMICAL REACTIONS-

All are ldquoparentsrsquo money fermentersrdquo and ldquoknowledge liberatorsrdquo Ward positive organisms

liberate more knowledge than ward negative Ward negatives have highly affinity to wine and

cigarette

CULTURE MEDIA-

Ordinary culture media for a male organisms are the hostel corridor and for the female

organisms are girls common room Special selective media for both of them is the hostel mess

and reading room When both were inoculated in same liquid media (college fest -REVELS in

RML LHMC and Pulse in AIIMS amptheatre in CP New Delhi) they gave uniform turbidity

PATHOGENESIS-

Ward negative more dangerous than ward positive Most of ward positive get good rank in

class which leads to cardiomegaly (parents are happy-dil Kush) while ward negative leads to

organ failure-redness of eye watering from eye and nose palpitation constrictive

cardiomyopathy (chhota dil-parents are unhappy)and finally increased affinity to drinking and

smoking

COMPLICATOINS-

1 Acute sub-acute or chronic boring fever

2 Prescriptions for cars

3 Adhesion to hostel and mess corridor

4 Malignancy which metastasize to girl hostel

5 Sarcomatous changes in reading room (PGIMER RR) couples

6 Ward negative may sometimes become patient killers

DISINFECTANT-

Scientists have been able to discover only a few disfectants even full sweat These disinfectants

only retard the growth of microorganism Most disinfectant are final year classes and posting

TREATMENT-

Repeated failure in 1st year MBBS and MDMS used to give a radical cure Subsequent failure

in other exams give a palliative cure

Other important drugs recently marketed are election fight tablet and leadership injection

FULL CIRCLE

- Dr Mohd Ali Medical officer Department of Medicine

Prologue

Random relative ldquoGreat you are a doctor now I have this and that and what and not What is the treatmentrdquo

ldquoI just entered MBBS am not a full-fledged doctor yet Anyway take this rantac and b-complex and go to a proper doctorrdquo

MBBS 1styear

ldquoYou there what is the origin and insertion of musculusobscuriusrdquo

ltBewildered lookgt

ldquoSir erhellipummmhellipit originates from tuberculusinvisibilus and attaches to the lateral border of Palestinerdquo

ldquoYou donrsquot know this You failrdquo

ldquoPuhleeez sirhelliprdquo

ldquoDescribe Krebrsquos cyclerdquo

ldquoUhhellipit has tubeless tyres thirteen gears and shock-absorbersrdquo

ltGleefullygt ldquoCome after 6 monthsrdquo

MBBS 2nd year

ldquoWhat do you see in this slide in high power magnificationrdquo

ldquoOil-on-canvas Picasso 1936rdquo

ldquoGet lost before I find a specimen jar for your brainrdquo

ldquoWhat is the interaction of acetyl polysilly acid with green mangoes when taken at 7rsquoo clock in the evening of Thanksgivingrdquo

ldquoErrrhellipit causes blue rings of smoke to emanate from the ears and makes the alchemy book turn to page 329rdquo

ltExaminerrsquos slipper flies across the roomgt

MBBS 3rd year

ldquoIf the incidence of funniosis is 90 per year and the temperature of the arctic is minus twenty degrees in the winter what is the probability of India winning the quidditch world cuprdquo

ldquoSir I think if the wind blows in the northwest direction in Preet Vihar then there is a good chancerdquo

ldquoRubbish Go drown yourself in the septic tankrdquo

MBBS 4th year

ldquoIf a patient comes with tingling sensation in the middle one-third of the inferior half of the medial aspect of the lower phalanx of the little finger what treatment will you give to his father-in-lawrdquo

ldquoSir hard rock music for 43 minutes and application of toothpaste to the rim of the rear back tyre of his tractorrdquo

ldquoLeave it dimwit Tell me what do you hear on auscultationrdquo

ldquoLub dup lub dup whoosh whooshrdquo

ltStudent flies out the windowgt

Internship

ldquoGo put a cannula rylersquos tube foleyrsquos central line also take his blood sample urine sample stool sample also get his urgent ultrasound x-ray CT scan MRI liver biopsy haircut manicure foot massage also get clearance from cardiology neurology CBI CIA defence ministry and the Income-tax department And donrsquot you dare come back without any of thisrdquo

ldquoSir but how to examine diagnose and managerdquo

ltCold stare translating to ldquoI have no idea buddyrdquogt

PG 1st year

ldquoWelcome to the first season of the walking dead Henceforth thou shalt not sleep eat drink or make merry Thou shalt work work and work till thou can work no more Thence thou shalt attain true zombiehoodrdquo

ldquoSir will I at least get a weekly offrdquo

ltRound book lands on PGrsquos headgt

PG 2nd year

ldquoExamine this patient and tell me your findingsrdquo

ldquoSir he has pallor and hepatosplenomegalyrdquo

ldquoReally What about the fact that he has three hair in the left nostril a mole between his left 3rd and 4th toes a half-eaten biscuit in his left pocket and three thousand rupees in his bank accountrdquo

ltAwkward silencegt

ldquoSir he also looks like Justin Bieberrdquo

ltPatient slaps a billion-dollar lawsuitgt

PG 3rdyear

ldquoSo what is your diagnosisrdquo

ldquoThis patient has Diseasus Uncommonus based on these twenty three features and here are my possible ninety differential diagnoses and 927 investigations for confirmation ldquo

ldquoGreat Now you have truly qualified to practice Go forth and sit in the OPDrdquo

Epilogue

ldquoDoctor saab I have this and that and what and not What should I dordquo

ldquoBah Take this rantac and b complex

THE GOOGLE MAPS SAGA

- Dr Dheeresh K H (Supposedly) Post Graduate resident in Medicine

To begin with google maps is an amazing application It has helped me through my exams by

guiding me to those elusive exam centres which were allotted in galaxy far away Over the

period of time I have leaned heavily on the maps to show me the path towards my destiny

shunning all possible human interaction on the way The joy of discovering the location

successfully marked by red dot on the map is huge (as if I have reached South Pole) without

asking for help

I am heaping praises over this app because my experience with it has been wonderful Until

It all started with demonetisation In order to activate online transactions on my card I was

asked to register my mobile number with the bankrsquos own precious particular ATMI searched

for it on the map(as the wise guy I am)It showed on two locations one in Barkhamba road and

one in some place called Minto bridge colony Apparently both of them were lsquoequidistantrsquo from

my location in RMLI chose to go to the Barakhamba road ATM as it was in CP I went there

stood in the perilous line for half hour inserted my card forgot my pin punched wrong twice

couldnrsquot register my number Then I decided to come out and question the decisions taken by

me in my life when the adventurous side of me caught hold I remembered my pin by now

decided to try the lsquoother ATMrsquo in my vicinity rather than stand again from the back in that

awful line The other ATM according to the map was lsquo12kmrsquo and lsquo15minrsquo away

Well as you have guessed I started following that blue dotted line towards my goal The air

was crisp going to an unknown territory always brings a sense of thrill and warmth to the mind

I dodged the vehicles crossed those infernal roads The map said ETA 10min I was getting

excited lsquoI am going to see my ATM in 10 minrsquo oh sweet

As I proceeded guided by my faithful map the lanes got narrower darker But I reached a

railway station by then The station was surprisingly cleaner than I expected Praising our PM

at the back of my mind for the swacch bharath I continued along the path of my fate laid down

by the blue dots I had to doubt by now as the map was showing a swanky restaurant nearby

but all I could see was a cluster of houses (but I didnrsquot doubt because where the fun in that is)

None the less I continued along my predestined path to the lsquotreasurersquo dodging the vehicles

and crossing the road

ldquoYou have arrived at your destinationrdquo declared the map ldquoAh thatrsquos it I have discovered

Antarcticardquo I said to myself and raised my head (I was looking at the screen of course) to have

a look at the result of my treasure hunt To my shock all I could see was a compound wall

painted delicately by the artistic red paanbeeda and a small house beside it I started looking

here and there when a boy looking at my puzzled face asked what happened I asked him about

my precious ATMrdquo You followed google maps to come hererdquo he asked ldquoyesrdquo said I ldquowell

its wrong go to CPrdquo said hersquo Oh god why Why mersquo Said I in my head I thanked him

retraced my steps hastily to the previous ATM dodging the vehicles and crossing the road

Now I again stood in that never ending line which the whole country now is standing at one or

other place inserted my card remembered the pin correctly registered my number and finally

emerged victorious even though people behind me were gawking at me as I didnrsquot get the cash

Now feeling like the legendary Bhaghiratha from Mahabharath I realised that leaning too much

on the google map may be good 99 of the time but always have a 1 doubt in your mind I

have now realised the value of human interaction

(FOOTNOTE I reported the error to the google map but it now says lsquoyour edit canrsquot be

verifiedrsquo Well fheads I have been to that place and seen no ATM unlike you sitting in

some plush office in BangaloreUS and typing such messages)

The Dancing Girl (in messaging lingo)

- Dr Daljeet Singh Post graduate Department of Anesthesiology

Last yr at NRVANAs aw a girl dancing awkwardly (yet in an adorable way)with bunch of my

seniors CUPID struk yet AGAIN Thought of testing my luck did naagin dance close to her

group which brought smile on her face Ab to pakka kuch karna thagot to knw dat she z an

extern nd d best partv belonged to d SAME cast (yes I was making long term plans) FB

came to my rescue We had 10 mutual friends (all seniors of course) didnrsquot want to look despo

so didnrsquot send friend request but i had to do something Used age old trick-Maam book MARK

She said ok I took out HARRISON She-Mathews nai hai kya Me-nai maammain saari

standard books hi padta hoon

Yes I lied but who cares she was impressed

Just on the pretence of getting my book marked I met with her three times

Still i had neither asked for her number nor had sent a friend request I had made a resolution

that I would not befriend her till i clear my exams (a BAD BAD decision)but i used to

follow(stalk)her activities via FB

Suddenly she disappeared from the face of SJH kuch pata hi nai chala ki kahan gayi Fb pe bhi

kuch nai tha

Then i got busy wid my proffs fir result aaya pappu pass ho gaya

I had not forgotten my resolution with trembling hands went to her profile Cover pic was

different from the last time She was looking fab all dressed up in pink saari and heavy

jewellery I thought my mother would be proud of my choice Then a saw man standing beside

her in d pic

BHAI HOGA-was my first thought But comments on the pic told a different story She had

been MARRIED

Feeling of eternal doom took over me abey internship mein shaadi kaun krta hai

Once again my true() love was lost but koi ni Chicken nd internship helped me overcome

her I had learnt the hard waypatience is good but you should not confuse it with inaction

Take risks follow your heart and do speak up

Ps-previously i had written this piece anonymously i donno whybut now i am glad to share

this with you all

GREAT THOUGHTS FROM GREATER MINDS

Dr Ramesh Meena

Senior Resident of medicine

The greatest folly -getting admission in MDMS

The greatest crippler -study

The ultimate joy -scoring 50

The greatest triumph -passing MDMS

The unbelievable miracle -passing 1st attempt

The most unwanted book -Attendance register

The most expensive thing -girl friend

The best game -love

The greatest loss -hair loss

The satisfying through -of food

The most cherished work -sleeping

The most immobile thing -mobile holder

Doctorrsquos secret Hand shake

Cardiologist -Left hand on your wrist feeling pulse

Dermatologist -Wears latex gloves

Gynaecologist -Index and middle fingers extended

Paediatrician -Thumb extended

Psychiatrist -Grasps his own hand

TOLERANCE

- Dr Pratima Mishra

PG Resident ophthalmology

Itrsquos a natural attitude and the attitude of nature

It forms the best behaviour and is the best form of behaviour

It characterises the cream of society and is the cream of social character

It dwells in the heart to make life a hearty dwelling

It is an enlightened emotion that leads to emotional enlightenment

It is a faithful foundation that makes the foundations of faith

It generates glory and glorifies our generation

It is a humane habit that helps human habitation

It is an important inducement that induces importance

It joins everyone with joy

It is a kind of knowledge that knows kindness

It is a lovely lead that leads to love

It matters in most matters

It is a nice necessity and a necessary nicety

It observes really with openness and opens up real observation

It provides peace and a peaceful providence

It is a question less quietude and an unquestionable qualification

It reaps reciprocal reactions

It is the seventh sense that sobers the other six senses

It causes total tranquillity and tranquil totality

It unifies humanity and helps humane unity

It is vital virtue and virtuous vitality

It works wise wonders and is workable wonderful wisdom

It causes X-axial compatibility

It yields high dividends and you too yield to it

It zeros the differences and indifferences are zeroed

And where there is this tolerance there is harmony and unity

IN MEMORIAM

Remembering Kanu Chatterjee A Gentle Giant of Cardiology (Born1934 Passed away 2015)

Debopriyo Mondal MD Medicine DRRMLH DM Cardiology resident ((SCTIMST))

Kamalendu Chatterjee a beloved physician cardiologist healer teacher and charismatic

mentor was one of our very own Indian origin super-talent who made it to being one of the

most renowned cardiologists of all times Better known as Dr Kanu Chatterjee he had

contributed to many pioneering work related to the field of cardiology in the 1970s when much

of the modern knowledge of cardiology was beginning to surface Born in Bangladesh in 1934

he used to live in a refugee camp in Calcutta Against all odds he received his formal medical

degree from the prestigious RG Kar Medical College Calcutta Later on he moved on to

London UK for completing his training in medicine where he also pursued higher

qualification in cardiology In the year 1970 he migrated to the United States and joined

cardiology division at Cedars-Sinai Medical Centre in Los Angeles to direct the coronary care

unit and the Myocardial Infarction Research Unit (the MIRU sponsored by the National

Institutes of Health)Until 2009 he had dedicated himself in clinical teaching and contributed

phenomenally to ascertain the role of vasodilators in heart failure(which was much before the

era of RAAS) The last few years of his life after his retirement from UCSF he had worked

at the University of Iowa he continued his teaching clinical work and writing as the first

University of Iowa Kanu and Docey Edwards Chatterjee Chair in Cardiovascular

Medicine(Docey Edwards Chatterjee was his wife) He passed away on Mar 4 at the age of

81 after suffering from pancreatic cancer to be remembered by his wife Docey of almost 40

years his children and huge number of students and well-wishers This great man had been an

integral part of the modern day cardiovascular practice who by his hard work and brilliant

teaching skills had tailored giants in todayrsquos world of modern cardiology practice Here is some

of the milestones and achievements just to write a few of them

1964 moved to England to complete his training in internal medicine and cardiology at St

Georgersquos Hospital and the Royal Brompton Hospital earning membership in the Royal

College of Physicians of Edinburgh and London

1970 Joined Cedars-Sinai Medical Center USA Division of Cardiology and eventually ran

the coronary care unit and the National Institutes of Healthndashsponsored Myocardial

Infarction Research Unit

1970-1975 Around that time the Swan-Ganz catheter was introduced into clinical medicine

and Dr Kanu published several seminal papers on the hemodynamic spectrum in acute

myocardial infarction and heart failure He did pioneering work in the role of iv sodium

nitroprusside and nitroglycerine in severe mitral regurgitation and heart failure

1975 moved onto University of California San Francisco (UCSF)Eventually The Chatterjee

Center for Cardiac Research and the Kanu Chatterjee Resident Education Center at UCSF

Medical Center were named after him

1990 ldquoGifted teacher awardrdquo from the ACC

2014 Receive the prestigious ldquoHerrick Awardrdquo (Highest Honour) from the American Heart

Association

2015 Presidential Honor for Excellence from the ACC (posthumously)

Apart from these he has to his credit more than 300 papers edited 6 books and received

numerous other awards His distinguished clinical teaching and investigative career at UCSF

earned numerous accolades for his role as a bedside teacher and skilled clinician gentle bedside

manner together with phenomenal skill in examining the patient taught the house staff about

the critical information one can obtain from a well-directed history and superb physical

examination He had an uncanny knack of gently leading the presenting physician to a correct

diagnosis and treatment plan He will always be remembered as a dedicated and one of the

greatest figure in Cardiology and cardiovascular sciences

I WISH IT WAS MUTUAL

-unknown

It had all started with you staring at me

Managing your phone number was a herculean task With a mind flushed with extremes of

thoughts I texted you over whatsapp with no name and a lengthy message trust me this

required more courage than asking people for your number I was glad over my decision to

start a conversation as it took our mere acquaintance a step further

Every day I would get up hoping to see you around and nothing more The very sight of you

was a treat to my eyes it was likelike the dark green leaves after the rain had washed them

There was nothing more than just waving hello or smiling at each other still some feelings

kept pace no matter how hard I tried stopping them

You were a well sorted gentleman with priorities where I fitted nowhere But how could this

silly heart accept it But then one day you told me that you had a life before I had come and

that I was nowhere a part of your future Days following this conversation were not very happy

I hadnrsquot any option but to be fine with it

I continued texting you as I used to do probably you were too occupied handling your life that

you took me in a way I never meant You became rude to me reasons known to you You had

even stopped replying back to me Finally it was the day when you spokespoke to me as if I

was to be blamed for everything bad that happens

A month had passed we hadnrsquot talked had ignored each other with best of our skills I was

alright busy with my life and duties had deleted your number (this I generally do when I donrsquot

like that person) Then one day I get a message from an unknown number asking me how I

was And guess what it had all come back to the way it was a month earlier but this time with

more laughter and understanding

The seasons were passing by and all that I hoped for was to see to you every day and nothing

more You would look at me and smile and that was all that I needed to make my day Life

continued as usual

Eventually it was time when you would be leaving soon I came offering you chocolates

because it was my birthday the other day You had already started packing your stuff although

there was still a month before you would have left

This time something was different your smile was more warming than ever As I gave you a

chocolate you gave me hug that feeling I cannot describe I came back to my room and texted

you ldquoif I give you more chocolates would I get another hugrdquo to my surprise your answer was

a yes Without wasting any time I came back to your room You hugged me again and

whispered in my ears that ldquoit takes courage to be happyrdquo Trust me you couldnrsquot have gauzed

my happiness at this moment

Now whenever I would see you instead of a smile I chuckle Things continued between us in

the most serene way possible with certain boundaries because some things are just not meant

to be And those things not meant to be better stay out of the way for things destined to be

You vacated your room We still met on and off in our premises

Finally you have left this place I so much miss you and I keep letting you know this over our

occasional chats Either I donrsquot entertain people or they become an integral part of my life

(courtesy my zodiac)

When I walk across the streets of our premises today (filtered street lights through the leaves

the gentle wind the winter silence all adding to my misery) I remember everything starting

from you wrongly guessing the fragrance I wear walking together and talking getting angry

with you midway while going for an ice cream lending you my umbrella telling you my birth

date at least five times (which I know you still donrsquot remember) You making fun of my future

plans the smell of your hair those sleepy eyes I so much wanted to embrace you when I

handed you a cake on your birthday that day I just couldnrsquot gather the courage and I wished

you had stopped me

You now have everything you need For me the next time I see you I just hope that the moment

pauses forever and the world comes to a halt

I have already started disliking this place it makes me miss you even more

Because the words will never be enough else I would have told you how much you mean to me

SHORT BEAUTIFUL STORIES

- Dr Aakansh Jain Post graduate in surgery

1) Those who had coins enjoyed in the rain Those who had notes were busy looking for

shelter

2) Man and God both met somewhere Both exclaimed-My creator

3) He asked are you-Hindu or Muslim Response came- I am hungry

4) The fool didnt know it was impossible-So he did it

5) Wrong number Said a familiar voice

6) What if God asks you after you die-So how was heaven

7) They told me that to make her fall in love I had to make her laugh But every time she

laughs I am the one who falls in love

8) We dont make friends anymore We add them

MEMORIES OF THE DISSECTION HALL

Dr Prateek Srivastava Junior Resident Dept of Psychiatry

Hiking along the path right from the creaky wooden benches of the Lecture Theatre to the dark

indoors of the Dept of Anatomy we used to reach the Dissection Hall after three lengthy sleep

inducing lectures which used to test our patience to the fullest If we were to start dissecting

the Abdomen that day then as per my teachers say Irsquod to give the initial few pages of

Cunningham the dissection manual a read

Itrsquod been three months and by now wersquod grown quite friendly with my co-students on the

dissection table with a few table parties and lots of truth and dares and dumb charades which

we played when extreme dissection started to piss us off We celebrated our birth days or

success in any part completion test partying out hard Also we grew quite familiar with our

female cadaver who probably heard almost everything we discussed in secret Altogether our

dissection table including me had 3 guys and 7 girls with surprisingly all genius minds If there

was a test a scholarship programme a sports event or any academic enterprise one of the

participants had to be from my dissection table

I remember the first few days of dissection

lsquoHERE THE DEAD ENLIGHTENS THE LIVINGrsquo said a rusty yellow iron board outside

Dissection Hall at its entrance Facing a dead human body right in front of you was always a

haunt Before joining Medical College dissection was one of my worst fears as Irsquod seen Munna

Bhai faint out of frenzy on holding the scalpel in his hand like a pen The first day when we

were allotted our table and lockers the bodies had their shrouds on We were gradually

mentally prepared for the big task ahead-that of dissection of course The other day I almost

had a goosersquos skin when the shrouds were jerked off the bodies to reveal what it carried inside-

a dead fat human female in her mid fifties with all four limbs intact un-dissected and fresh

As months would roll by she would gradually impart to us what the anatomies of the human

body were and eventually get dismantled limb after limb organ after organ The memory I

have of her this day four years post dissection is merely that of a limbless torso skull sawed

and brain removed chest cage ripped apart at the breast bone and the heart and lungs

dismembered leaving a gaping cavern Her face is another undying memory with her jaw half

open revealing a neat line of teeth with two or three missing members the skin of her face

drawn tight against the underlying facial bones giving her a curious grinning expression There

were ten bodies for a hundred of us being assigned ten to one per table

All the cadavers had been duly processed before being provided to us for dissection and the

processing had left them no different from the bunch of roses left to dry under the sun - Black

Stiff Motionless and Hideous

The daze of seeing the cadaver for the first time was distracted by the harsh pompous voice of

Dr Rohatagi who wanted to get done with taking the roll call of a hundred freshers number by

number We were expecting to be guided about the maiden approach towards studying the

cadavers but we were in for a major misunderstanding lsquoAllopen your Cunninghams

manualsstart reading Page one to sixrsquo was all we were worthy of according to Dr Rohatagi

on our first day in medical college

But it was an experience Five students on each side of the cadaver not being able to raise our

heads and look around to evaluate the equally scared peers as to have a good look at the still

bodies on the cold steel table before us Yet gradually one by one by referring from the books

we got the real first glimpse of the inside of our cadavers making us even more inquisitive

And I must confess that the first three pages of the manual were the toughest comprehension

passages I had ever read Medial Sagital Coronal Axial were all as Latin or German in

pronunciation as in comprehension The description of movements as Abduction Adduction

Flexion Circumduction and Extension added to the mounting tension Surely reading the first

few pages was treacherous for someone who had just eighty two percent in English in the

twelfth standard

If you thought that the dissection began from the head and completed with the toe you are

wrong We started with the lower limb proceeded to the upper and then to the Thorax and

Breast-all in a disorderly order

The first few days we wore rubber gloves which we got from Dispensary Road Dehradun but

they were either too large or too small and since our seniors hadnrsquot been using them in 15 years

we too decided to go bare handed

The funda of doing well in dissection was simple-pay attention in class read the dissection

from Cunningham before handed and keep your patience till you finally search what you

wanted

As we dissected the palm we were expected to identify the Palmer Aponeurosis the Fascia

Reticularis the Median Nerve and many other bigger tongue twisters Thus seeing or imagining

the structures that were being dissected I found myself staring at peoples palms in all public

places-the Daily Needs shop the Library the Royal Mess and even Nescafe But the next week

when the time table on the notice board said lsquoDissection-The Breastrsquo I was rather scared

Imagine staring at lemons oranges and water melons in public

No medical student can ever recall a dissection theatre without the pervasive formalin It is this

acrid liquid that caused a lot of trouble in the initial days Our cadaver was extra fatty so fat

and formalin formed a really deadly pungent combo and we could smell it everywhere-during

food during writing or even playing Table Tennis

However looking back today I realize there were so many untaught but naturally learnt

lessons in those ten months of dissection Dissection taught me perseverance We had to

understand the intricacies of the human body before getting down to dissecting it

Understanding the greater sac and lesser sac arguing about the cornea and sclera and

discussing the formation of the arches-all contributed to cracking the mystery of the body bit

by bit If the concept was not clear then any amount of dissection could not show us what we

wanted to see THE EYES DO NOT SEE WHAT THE MIND DOES NOT KNOW

And the greatest most important lesson for the life of a doctor- respect for the human body

We owe it to those corpses who lay patiently tutoring us the marvels of the Creation the beauty

of the architecture and reverence to the most awe inspiring creation of God-the Human body

JOURNEY TO THE ROOF OF THE WORLD

Dr Sameek Bhattacharya

We were on an early morning flight to Leh and I had dozed off Suddenly I woke up to find

that we were flying over the Himalayas and the weather absolutely clear We were gliding over

the snow caped peaks and glaciers It was an awesome sight Only other way have such view

is to climb these unscalable heights While descending we followed the Indus river We landed

in Kushok Bakula Rinpoche airport in Leh The airport is situated at an wooping of 10682ft

one of the highest in the world and is surrounded by craggy mountains On disembarking we

were greeted by strong icy wind at the tarmac Walking to the arrival terminal was enough to

make us fell that we are above 10000 ft Our lungs were craving out for precious O2 in the

rarified atmosphere Our first station was Karoo about 14 km from Leh The road from Leh to

Karoo was along Indus River meandering in a wide valley This great trans-Himalyan river has

an astounding course of 2900 Km and has witnessed and nurtured numerous civilizations The

arid valley was flanked by craggy snow covered Ladakh range of mountain with a band of

green on either banks of the river On the way we saw Sindhu Ghat where Sindhu Darshan

festival is held every year from 1 to 3rd June showcasing the cultural heritage of the

country Participants from different parts of the country bring water from the river of their

state in earthen pots and immerse these pots in the Indus River This mingling of water

symbolizes the multicultural identity of our country Driving further down on the eastern bank

of Indus perched on a sheer cliff was Shey Palace Built in 16th century by the first king of

Ladakh Lhachen Palgyigon Most of the palace fortress was in ruins but notable sights were

the gold-topped victory stupa and the 12 m high statue of Maitryee Buddha Two kilometers

down the road was the spectacular Thiksey Monastery This six storey monastery is 600 years

old is one of the largest and is the finest illustration of Ladakhi architecture The monastery

complex housed numerous stupas statues Thangkas wall paintings swords and a large pillar

engraved with the Buddhas teachings Further down bang on the west bank of Indus we saw

another monastery perched on small pyramidal hillock This was Stakna (means tiger nose)

monastery which was so named because the hill looked like a tiger nose This was offered to

the great scholar saint of Bhutan called Chosje Jamyang Palkar in about 1580 AD by the

Dharmaraja Jamyang Namgial who had invited him to Ladakh The monastery housed the

image of the sacred Arya Avaloketesvara from Kamrup (Assam) Finally we reached Karoo

which housed an important army camp straddling the Leh-Manali Highway and was the access

to Hemis Monastary and Pangong lake The next 48 hours we kept ourselves indoors to

acclimatize to high altitude

Our first outing after the mandatory confinement was to Hemis monastery which was barely 3

km form our pad in Karu on the west bank of Indus Atop a green hill and surrounded by

spectacular mountains Hemis was well secluded and not visible form the road The road was

dotted with white stupas and neat heaps of stones with engraving of Buddist prayer in Ladakhi

script Series of multicolored Buddhist prayer flags fluttered with the strong chilly wind adding

color to otherwise drab surroundings Hemis is the biggest and most richly endowed monastery

of Ladakh Built in 1630 it belongs to the red sect Borkpa The massive stone building was

painted white with numerous ornate red windows dotting the walls We entered through a large

wooden gate leading to big courtyard On the right there was a four storey building housing a

temple and an assembly hall and on the left was the museum The museum had an impressive

collection of Tibetan styles books Thangkas gold statues and Stupas embedded with precious

stones Every year Hemis festival is held here in June-july commemorating the birth

anniversary of Guru Padmasambhava During the festival time various rituals and mask dances

are performed in this courtyard

After the monatery hopping our next agenda was to see Nubra valley and the two beautiful

lakes Pangong Tso and Tso Moriri The problem was there was no road recorded in the map

connecting Nubra valley and Pangon Tso Normally one has to come back to Leh after visiting

each of them We decided to find out about the road connectivity between these sites from

Border Road Organization We were informed that a new road was under construction but there

were stretches of mud tract and two river crossing with no bridge We decided to take the

chance At dawn we started off in a Mahindra Xylo with Phunsook our guide cum driver at

wheel He was ex-subedar of Ladakh Scout The Ladakh Scouts also known as the Snow

Warriors or Snow Tigers is an infantry regiment of the Indian Army specializing in mountain

warfare He was an expert hill driver and knew the roads of Ladakh like back of his hand Our

first destination was Nubra valley The gate way to Nubra was the formidable Khardong La

pass At 18379ft it is the highest motorable road in the world and historically the caravan route

from Leh to Kashgar in Central Asia Today the pass is of immense strategic importance as it

lies on the supply route to Siachen Glacier The pass had one-way traffic 9am to 1 pm Leh to

Nubra and 1pm to 5 pm on the opposite direction The climb to the pass was both nerve

wrecking and bone rattling The narrow road was just a ledge on the sheer cliff was non-

metaled with loose rocks and snow on it Hair-pin bends made matter worse In short it had the

entire recipe for both disaster and adrenaline rush On reaching the top the view was

spectacular We could see Ladakh range on one side and Karakoram ranges on the other side

of the pass But we were advice not stay long at the top as we had gained 7000 ft in two hours

and the oxygen level was very low and the weather chilling While descending we saw many

Yaks grazing in the slopes Shortly we reached Khalsar where road followed the Shyok river

Nubra valley was at the confluence of Shyok and Shiachen river separating the Ladakh range

from the Karakoram range This was a unique landscape A wide valley with azure blue river

meandering through it the flat land had both desert with undulating sand dunes and fertile

green areas and all surrounded by lofty peaks Another distinction to Nubra was that it was the

habitat for the double humped Bactrian camels We avoided a ride as it was a pain to see the

animals being ill-treated by their handlers These camels were originally inhabitants of steppes

of Central Asia and were important part of the caravan of the ancient silk route which passed

through the valley The valley is also known as the Orchard of Ladakh and was originally called

Ldumra which meant the valley of flowers We stayed over night in Hundar village in the

valley Next day we proceeded to see the Diskit monastery Changzem Tserab Zangpo founded

the Diskit monastery in the 14th centuryAs we climbed the monastery which was built on a

mountain slope we had a panoramic view of the Nubra valley the sand dunes the serpentine

course of Shyok river and the surrounding mountains Overlooking the valley was a 33-meter

tall statue of Maitrey Buddha Inside the monastery there was mummified hand and head of a

Mongol invader After this we hit the road for Pangong lake This road was not marked in any

tourist map It followed eastward following Shyok river from Khalsar Agaam Shyokand

Dubruk It was an excuse of a road and absolutely desolate with no habitation or traffic The

track had only the big boulders removed and loose rocks on it made the drive painfully slow

and bumpy The worst was when one of the tyres got locked between two rocks We would

have been marooned there but had timely help from some BRO men working there Further

down we had to cross two streams which had no bridge over them Adrenaline was at its peak

and the view was spectacular Shyok River sparkled with midday sunshine the sky was deep

blue and clear and the arid mountains had varied hue with their pinnacle snow covered We

reached Tangtse a small village on the road to Pangong and had break The road from Tangtse

to PangongTso passed through a sandy flat land flanked on either side by spectacular

mountains Although the mountains were bare and devoid of any vegetation their different

shades and hues gave a surreal color to the arid panorama On the way we noticed Tibetan Wild

Asses also known as Kiang grazing the almost nonexistent vegetation on rocky plains These

are the largest of the wild asses and the adults are 7 feet long and 4 to 5 feet high They are

inhabitants of Tibet Ladakh some parts of Nepal Kiangs had luxuriant dark brown coat with

dark mane long tail and white legs and belly While driving down the winding road we noticed

a deep blue streak in the gap between two mountains Phunsook declared that was the beautiful

PangongTso It was looking as if a giant clams concealing a precious jewel As we drove closer

to the destination we were mesmerized by the view In front of us was a huge azure blue water

body with undulating mountains in the background the sky deep blue with wooly white clouds

floating The water still like mirror with perfect reflection of the mountains A strong wind

brought gentle ripples on the surface wiping off the reflections The mountain ringing the lake

was equally captivating Its light brown shade marbled by streaks of grey blue and pink like

an artistrsquos brush strokes The bank on which we were standing had light grey sand and rocks

A large tongue of land projected into the lake A group of gulls with bright red bills were sitting

in a single file on this steak of land their reflection falling on the lake The water was so clear

that we could see the rock at the bottom near the bank Suddenly we realized that we were

freezing and reasonably short of breath It was no wonder as we were at 14270 ft PangongTso

is a salt water lake which is 134 km long sitting on the Sino-India border with 60 of the lake

in China The name aptly means ldquolong narrow enchanted lakerdquo in Tibetan We went back to

the warmth of our car and drove along Pangong to our cottage on the bank in village Spangmik

The Spartan plyboard cabin was a pad of luxury in the barren freezing country Through the

window we saw the color of the lake changing every hour After sundown the clear sky lit up

with a thick blanket of stars The day ended on a high with a traditional Tibetan dinner Next

morning we started off for Tso Moriri The best part of the route was that we drove along the

whole length of Indian part of Pangong Tso till it turned northwards into China This part of

the drive was quite close to the border with Indian post on the hilltops We left the lake and

turned south at Kakstal and drove for hours through flat rocky and absolutely barren flat land

with mountains ringing the horizon It was easy to lose our way as the terrain looked the same

in all directions The only indication of the road was the tyre marks Only sound was the

whoosh of chilling dry wind There was no sign of life not even a wisp of grass so deserted it

was we felt marooned in an alien planet After about three hours of drive we spotted an Indian

Army post perched on a sheer cliff We could immediately realize and empathize with the harsh

life of the brave-hearts on vigil Phunsook our driver declared that we were approaching

Chushul where the battle of Rezeng-la was fought This battle is fondly remembered for the

heroic resistance offered by Major Shaitan Singh and his jawans of 13th Kumaon Battalion to

repeated Chinese offensive and intensive artillery barrage during the Sino-Indian conflict of

1962 In the action Kumaonis lost 114 men but inflicted over 1000 casualties on the Chinese

Following this the Chinese did not push further in Chushul After the war was over the body

of Major Shaitan Singh was found at the same place It was flown to Jodhpur and cremated

with full military honors and later posthumously awarded Param Veer Chakra Shortly we

reached the 13 Kumaon Rezang-La Memorial erected in memory and honor of these brave-

hearts Engraving on the memorial headstone read

How can a Man die Better than facing Fearful Odds For the Ashes of His Fathers and the

Temples of His Gods

We solemnly stood in the desolate cold land feeling the warmth of pride of being with our

fallen brave brothers we felt fortunate to be here We continued with our journey and shortly

we were driving along Indus with a flock of Bar-headed Geese floating on it They were our

first encounter with life forms in the whole day These birds migrate from Central Asia and are

among the highest-flying birds in the world as they cross the mighty Himalayas We crossed

Indus at Mahe bridge and encountered a large group of ldquochangrardquo ndash goats (the source of

ldquopashmina shawlsrdquo) Now we were driving through patches of grasslands and came across a

small lake Tso Kayger Phunsook told us that this was the trailer of the ldquogrand show of

TsoMoririrdquo And how right he was We approached Tso Moriri with awe in our eyes all

tiredness vanishing from our travel rattled bodies The still sapphire blue water mirrored the

snow caped mountains of the background The foreground of the lake had light green grassland

lending another color to the canvas The setting sun casted an auburn hue to the artistically

patterned mountains Situated at 15075 ft Tso Moriri is 28 Km long and 8 Km wide We stayed

overnight in Karzok village in a small guesthouse overlooking the lake The next day we started

our return journey to wards Karoo On the way we saw another high altitude salt lake Tso Kar

It had heaps of salt deposits on its banks Gradually we started our assent towards Tanglala

Pass (the second highest motorable road) We crossed over the snow covered pass and

descended towards Rumtse Upshi and finally to Karoo

This expedition was a great experience and the sole credit went to our driver Phunsook But

the real heroes were my wife Dr Manjula and my two little daughters Sameeksha and Vidisha

who stoically faced the harsh conditions of the journey

THE FEAR OF REJECTION IN A DOCTOR-PATIENT

RELATIONSHIP

DR(Prof) A KGadpayle Dr Subodh Kr Mahto

Additional Director General Senior Resident of Medicine

of Health Services GOI

Director PGIMER amp

Medical Superintendent

PGIMER DRRMLH New Delhi

Patients in general are weak players in the doctor-patient paradigm Their fear of rejection

begins even before they approach to a doctor Most of us fear rejection in our lives an emotion

which begins early in life and probably continues lifelong Personalities determine the degree

of such a fear and the initiatives we take to overcome such fear

Often doctors encounter patients who are termed as difficult patients In the clinical word the

term difficult is applied to a variety of patients like the noncompliant the rude abusive and

manipulative the malingering the mentally ill the sceptical etc

Why did it become difficult

In the physician-patient relationship trust on the part of the patient is a consequence of a

number of factors including perception of the providerrsquos technical competence interpersonal

skills and ability to act in the patientrsquos best interests In other words the provider knows what

he or she is doing treats the patient what could be described as ldquonicelyrdquo and acts in a way that

the patient would act given access to the same knowledge and information

Trust may lessen when doctor is incompetent rude or domineering Physician may need an

additional source of information and insight to support informed decision making Doctor to

respect patientrsquos right to make truly informed choices that were consistent with the way in

which patient wanted to intervene in his disease and live Some time it is difficult being patient

may not cooperate

Some patient try to be of being the ldquogoodrdquo patient They try to please others In all honesty

within a patient to disclose all his illness is must Approached interpersonal exchanges in the

same way build up trust in doctor patients relationship

Patient may become a difficult one terminate relationships with physicians and find faults

with Doctors They dictate treatment decisions started getting the care as they wanted and

needed They feel proud in doing so which is against ethical practice

Proper communication with patient is not made by doctor regarding disease condition

progress complication medical errors and adverse reaction of drug therapy Due to chronic

condition of disease patient get frustrated and slowly looses trust with doctor Feeling of

avoidance by doctor is also a major factor for this relationship

One of the most critical problems inherent in managed care for the doctorndashpatient relationship

is overlapping interest of both Patients correctly wonder if doctors are caring for them the

plan or their own jobs or incomes (the latter is equally problematic in fee-for-service care)

This ambiguity erodes trust promotes adversarial relationships and inhibits patientndashcentred

care The recent controversy over gag rules has only confirmed this set of fears in the mind of

the public As illustrated below (Figure 1) the interests of patients plans and doctors can

overlap to a greater or lesser extent Professional ethics dictate that physicians attempt as

individuals and as a profession to ensure that their interests and those of their patients are

congruent in clinical practice Plan interests however can pull physicians away from this goal

as the organizations values and their implementation inevitably influence attitudes behaviour

and experiences Alternatively plans could promote patient-centred care by trying to maximize

the extent to which patient doctor and plan interests overlap For example promoting

continuity communication and prevention can further all three interests so long as value (and

not cost alone) is seen as the plans product Similarly resource stewardship can be honestly

promoted as a way to ensure that quality care is available for future patients(2)

Figure 1

doctor plans

patients

Overlapping and conflicting interests The interests of patients (top circle) A doctors (left

circle) B and health plans (right circle) C-may overlap to a greater or lesser degree depending

on the actors and the circumstances

Difficult patients can be grouped in three categories-

1 Dependent clingers are excessively dependent on the doctor desperate for reassurance but

will return continuity with a new array of symptoms eg-ldquoThank you my back is much better

but I have a chest pain nowrdquo

2 Entitled demanders are also inexhaustibly needy but rather than using thanks and flattery

will use intimidation devaluation and guilt against the doctor Frequently complaining when

every request is not met eg- I must see a specialist for my in growing toe nail right now

3 Manipulative help-rejectors continually return to the surgery to report that treatment failed

What could be done about it

Foremost is knowledge and understanding among doctors about occurrence of this rejection-

phenomenon Secondly realizing that the art of medicine is based on communication skills

something which in the forest of medical education is left for individuals to figure out Lastly

making internship more of an interactive process where the art of medicine should be

emphasized rather than learning of mundane clerical skills

Most patient-symptoms would not fit into text book description of disease

These symptoms need to be addressed time and again without abandoning the patient would

probably be the first step in breaking the rejection-cycle

Expression of sympathy towards patients full disclosures of all events related to disease and

prognosis and medication corrective measures for mistakes accepting responsibility for

patients Discussing the treatments plan with colleagues Decrease the fatigue and stress of

doctors from reducing workload Maintaining dates of commitment for building the trust with

patient(3)

References

1 Michelle L Mayer- Health Affairs On Being A Difficult Patient2751416 27 no5

(2008)1416-1421

2 Susan Dorr Goold MD MHSA MA1 and Mack Lipkin Jr MD2 The DoctorndashPatient

Relationship Challenges Opportunities and Strategies- J Gen Intern Med 1999 Jan

14(Suppl 1) S26ndashS33 doi 101046j1525-1497199900267x

3 David wallube ndash text book of medical errors and adverse reaction- managing the

aftermath -2011 page 89-91- httpsbooksgooglecoinbooksisbn=1462846580

COGNITIVE NEUROLOGY IN INDIA

Vikas Dhikav amp Kuljeet Singh Anand

Department of Neurology PGIMER amp

Dr RML Hospital New Delhi INDIA 110001

corresponding email vikasdhikavhotmailcom

What is cognition

Grossly spoken cognition is the mental action or process of acquiring knowledge and

understanding through thought experience and the senses So it is the combination of

attention memory language perception and thinking Together these processes constitute

lsquocognitive psychologyrsquo

What is dementia

Dementia is a disease of the elderly and is usually characterized by slow and progressive loss

of memory There is disturbance in other mental faculties such as language judgment and

planning impairment of daily activities and deficiency in social interaction etc making

dementia a neuro-cognitive disorder

Dementia affects personal family and societal life of the affected individual and reduces life

span Caregivers strain1-2 at family level is quite high It puts a huge strain on health care

facilities and on national income It is preceded by a phase of mild cognitive decline called as

mild cognitive impairment (MCI)3 Treatment is challenging until done early and use of drugs

of complementary and alternative system CAM) is common4

Recognizing dementia

In Indian forgetfulness in the elderly is often recognized as normal variation of aging ldquosathiya

janardquo Consequently milder cognitive impairment may remain unrecognized By the time

dementia is recognized it is often in moderate to severe stages Activities such as shopping

office work banking gets affected In the advanced phase even taking bath going to washroom

becomes challenging

Burden of dementia1-2

The caregivers have to bear the brunt of the dementia patients and majority of patients develop

behavioural and psychological manifestations of dementia (BPSD) Women are major

caregivers and could be wives daughters and daughters-in-law etc The principal sources of

caregiver strain are BPSD and incontinence Gross dis-inhibition can be quite troublesome5

Strain is exacerbated by the lack of supportive response from local health services and of family

support resulting from adverse behaviours from other family members and they suffer

significant mental strains indicating clear need for support and more education

Dementia situation in India

Burden of dementia will be increasing in developing countries like India due to increase in

longevity and increasing prevalence of risk factors such as hypertension diabetes depression

and stroke and lifestyle changes eg physical inactivity Though India currently has around 10

million cases of dementia in the world 5 million are being added every year

World situation

The World Health Organization (WHO) predicts that by next less than 10 years about 75 of

the estimated 12 billion people aged 60 years and older will reside in developing countries It

is estimated that the number of people living with dementia will almost double every 20 years

to 423 million in 2020 and 811 million in 2040 The rate of growth will be the highest (gt

300) in India and China The growth will be lowest (100) in developed regions Now

dementia is among the leading causes of disability with increasing lifespan

It has been shown that community-based interventions have considerable potential to improve

the quality of life of the caregivers and the subjects with dementia However there are training

gaps among medical professions for diagnosis and treatment of dementia Department of

Neurology PGIMER amp Dr RML Hospital maintains a neurology clinic on Thursday at 2PM

in room number 16

Cognitive neurology in India

Knowledge gaps

India lacks much information such as incidenceprevalence of many types of dementia which

are avoidable by preventing stroke and controlling risk factors such hypertension diabetes

smoking and dyslipidemia etc In the last 25 years the biological groundwork of AD has been

unravelled but no disease-modifying agent has been discovered6 Therefore the focus should

be on increasing education and awareness about dementia and its manifestations both among

the public and medical professionals

Societies

Alzheimerrsquos amp Disease Related Society of India (ARDSI) Society for Alzheimerrsquos amp Ageing

Research and Dementia Society of India are some of the professional bodies involved in

dementia education awarenessor research

Education amp Research in cognitive neurology needed

Fellowship programs in cognitive neurology are urgently needed These programs have been a

matter of routine in the west but not so forthcoming in India It has been appreciated that long-

term research plan to identify the protective factors and subsequent research application in

animals and human should be urgently undertaken

Memory clinics6

Memory clinics are specialized clinics the concept of which started around 25 years ago This

is a place where experts who specialize in memory disorders like cognitive neurologists

neuropsychologists psychiatrists are sitting at one place This makes evaluation of such

patients much easier Dementia care nurses are appeared in the last decade or so Memory

clinics have been accepted worldwide as a tool to improve practice of dementia

Society for Alzheimerrsquos amp Ageing Research (SAAR)

SAAR started in 2012 with the aim of promoting education and awareness in dementia and

provide impetus to dementia research in India Since 2012 the society has published a journal

Asian Journal of Cognitive Neurology (wwwajcnin) which is a biannual peer reviewed

international journal Dozens of major publications have come out in last by its members A

book of clinical neuropsychopharmacology is under publication as well Dozens of meetings

for caregivers have been conducted and three seminars for doctors have been held The society

has a website wwwsaarin and has an interactive inter-phase for membership

HOW A PASSWORD CHANGED MY LIFE

- Dr Aakansh Jain

Post graduate in surgery

I was having a great morning until I sat down in front of my office computer ldquoyour password

has expiredrdquo a server message flashed on my screen with instructions for changing itIn my

company we have to change password monthly I was deeply depressed after my recent

divorce Disbelief over what she had done to me was what I thought all day

I remembered a tip Irsquod heard from my former boss Hersquod said ldquoIrsquom going to use a password

that is going to change my liferdquo I couldnrsquot focus on getting things done in my current mood

My password reminded me that I shouldnrsquot let myself be a victim of my recent breakup and

that I was strong enough to do something about it

I made my password ndash Forgiveher I had to type this password several times every day each

time my computer would lock Each time I came back from lunch I wrote forgive her

The simple action changed the way I looked at my ex-wife That constant reminder of

reconciliation led me to accept the way things happened and helped me deal with my

depression By the time the server prompted me to change my password following month I

felt free

The next time I had to change my password I thought about the next thing that I had to get

done My password became Quitsmoking4ever

It motivated me to follow my goal and I was able to quit smoking

One month later my password became Save4tripeurope and in three months I was able to

visit Europe

Reminders helped me materialize my goals kept me motivated and excited

Its sometimes difficult to come up with your next goal keeping at it brings great results

After a few months my password was

lifeisbeauTful

Life is going to change again

MAKING RESOLUTIONS FOR THE NEW YEAR IS A NEAT TRAP

- Dr Aakansh Jain

You know you are going to break most of them and feel terrible about it for the rest of the

Instead I suggest you make a wish list It is like a buffet spread-you can eat all or eat nothing-

it depends on how hungry you are

Here is a wish list which can provide the required magic to life It is like a beautiful spread on

a Sunday afternoon

Starters (pick any 2)

1 I will try to get up early (you can accomplish 30 more during 5 am to 10 am)

2 I will exercise at least for 30 minutes 4 times a week (you have no choice on this)

3 I will meditate pray visualize positive things do yoga for 30 minutes every day

Main course (pick any 5)

1) I will invest in best clothes I can afford-along with good shoes (It has been proved that

better dressed people earn 15 more-all things being equal)

2) Will outsource everything which is not my core competence (Wonrsquot waste time on

improving my weakness)

3) Will reduce my mobile bills by 30 (Mobile phones are the biggest time waster in

India)

4) I will not call my employees on weekends or when they are on vacations (They will

respect me for that)

5) I will at least take one risky decision which I was always scared to take (I donrsquot want

to die of boredom-do you)

6) I will train my brain to think creatively every day I will try to do different things to

exercise my brain muscles- try new style amp color of clothes go to new restaurants visit

zoo listen to different music visit toy shop to observe children buying toys

Dessert (pick all)

1 I will take 2 vacations in a year

2 I will devote at least one day (Sunday) for myself only No business calls no laptops

Does not matter how big my businessposition is

3 I will smile at everyone I meet (Even to the liftmancabbiepeon)

4 I will laugh often

5 I will watch one movie in a cinema hall every month (it is therapy for the soul)

6 I will read at least 2 books in a year

7 I will do one thing which I was always fearful about

8 I will call two old friends whom I have not spoken for years

9 I will do one thing which makes me truly happy

10 I have got only 52 weekends I will not let anybody spoil them

Let the coming year be the best year of your life

Let the force be with you

THE VOICE

HIMANI AHALAWAT

3rd Sem LHMC

Ya itrsquos weird I know

Calling u all day long

Your voice is cute

Enters straight into hearts route

Its seems like offensive irritating n rude

But it just it keeps me- smiling n trued

Its over u said I remember those words well as that

It takes over night n days to forget those ways

People laugh n I m still proud witnessing the same by the shining cloud

Oh yes I feel you is what all I need

But I cant get- your love n my regret

Only words I can dope creating your voice like my hope

Your 2 words- just hello makes my heartbeats high n low

I m sorry if I m asking u more than a bit

Your voice is something - makes me Addict

Being A Doctor - Duty Not a Job

- Dr Ghazal Tansir

(PG III Medicine)

Medicine has no room for arrogance

We dont just cure disease

We cure humans

The human body does always not go by the books weve read or

the algorithms weve memorised

The human body does not know

how famous we are how much we earn

The human body presents to us

and places in our hands its life

and trusts us with all it has

to solve its puzzles

Bizarre puzzles really

Sometimes so easy to piece together

Sometimes turning more puzzling with

our attempts at deciphering

the meaning of the riddles it throws at us

Sometimes a novice may solve them

Irritating some egos but medicine

has no room for ego either

One cant be a doctor without

Selflessness one cant be a healer

Without having ones feet planted

firmly on the ground and the strength to

know that one can be wrong and the

ability to question ones own reasoning

And it isnt something were taught

Its something we build everyday by

Failing fumbling blundering finally learning

thats how the art of healing we acquire

which is why medicine isnt just a job-

It is a way of life

MIRROR

Shivangee Gupta

MBBS (IInd Proff)

Lady Hardinge Medical College

A single surface yet

So deep you can spend your life in its depth

So silent yet says everything

So honest doesnrsquot even leave a lsquoqueenrsquohellip

So transparent hides no flaws

So accomplished on no quest to make you happysad

So triumphant has an endless life

So fair holds no grudges for one and all

So friendly buries all secrets

So forgiving doesnrsquot remind of the past

So optimistic holds no aversions for future

So encouraging shows beauty and perfections

So peaceful contemplates in his own meditations

So dutiful does his work even if lsquobrokenrsquo

So fearless shines brilliantly

Sparkling shimmering spectacular indeed

Life of an MBBS student

Dr Arjun M B

LHMC ampDRRMLH

Department of medicine

Today Im a doctor

It all started in october

Wen I woke up with dreams of cadaver

My school friends called me psycho

Wen I was stuck with physio

Family friends I left al of them

To slog tis never ending biochem

Today Im a doctor to make ur life happier

And then came memory card full of photos

Filled with insane slides of patho

My sleep was spoilt by micro

So i always sat in the last row

My body went numb n I turned a cynic

Wen I entered dept of forensic

Huge List of drugs made me maniac

Just to clear tat crazy pharmac

Here Im a doctor to make ur life healthier

Eyes ears nose throat

Everything destroyed my years of youth

Along with the great book which got me

beheaded

Filled with impossible crap of commed

Today Im a doctor

ur health ambassador

Inspired by george matthew never opened

harrison

Only god knows how I cleared medicine

Choked on my food while eating in bakery

As I never wanted to miss a chance in

surgery

Saw Birth and death both in agony

On those countless duties in obs amp gyne

I did learn some magic tricks

Wen I was Into pediatrics

Today Im a doctor who can save ur

daughter

MEDICAL LIFE )

Dr Arjun M B

LHMC ampDRRMLH

Oath of a first year pg in game of throne style

Patients gather And now my watch begins

It shall not end till i get my degree

I shall take no bribe hold no chambers date no intern

I shall wear no suits and win no awards

I shall live and fight death at my post

I am the sword to the illness

I am the watcher in the wards

I am the fire that burns against sickness

The light that brings upon health

The horn that wakes up the nurses

The shield that guards the life of men

I pledge my life and honor to the patients watch

For this night and all the nights to come

IMIPRAMINE

Better to soak in bliss

Albeit transitory in nature

Concocted but hard to dismiss

The dark put out to pasture

How can we play the game

When fate is pre-determined

Dexterity put to shame

Even on the sand no imprint

Chasing after the gleam of Amaal

Placed further than sight perceives

No longer lucid in the interval

Pride arrives unseen and leaves

The pain overcomes felicity

Spurned another new suitor

The damned almost always dizzy

Anything but a lack of vigor

Announce the arrival- Moonshooter

MILRINONE

Fatigued at the end of the day

Burned and bruised beaten and taken

Immersion into the inferno bay

Anything else but heartbroken

While gazing out into nothingness

A spark erupts for a tiny second

It was everything - I confess

A jolt meant to be reckoned

Run and fight I tell myself

So close nothing else matters

Fully loaded expecting to find oneself

The facade not the glass shatters

Chasing Pride I run myself down

Away from the light

- Dr Garyll Ryan

(Resident Medicine)

ANATOMY

Dr DS Meena

Senior Resident

Ortho Department

Bone muscle and ligaments

This is what anatomy is about

It is said to be a good doctor

You need to know it all without doubt

Which nerve comes from here there

Which vessel then passes through

Who knew the sciatic came down till the knee

And then just divides into two

Hip knee and ankle joint

While walking they do their part

The number of attachments in one tarsal

Is more complicated than even the heart

The abductors kidnap and take away

The word sesamoid actually means seed

This is just the lower limb here

There are another two chaurasias to read

HINDI SECTION

Pranshu Mehta

Jr Dr RML Hospital

द पण

कोई कऻता ऻ म भला कोई कऻता ऻ तॐ बॏरा ककॎ न घोकित ककया खॏद को मऻान

कोई बटोरता रठता क रमाण

ककॎ को ऻ फलता का घमड

यॐ ऻॎ चलता रऻता पाखड

बमबारॎ गोलाबारॎ का शोर कऻॎ भॏखमरॎ कॏ पोिण ऻ घोर कऻॎ कशषा मॎलो दॐ र कपड़ो क कारखानो म

छॎन कलया ऻ बचपन धन कॎ दॏकानो न

जो कनधधन था रऻा दा कनराश

धकन का धन छॐ गया आकाश

जॐझता कोई दो मय कॎ रोटॎ कमल जाय

यथध ऻो जाता भोजन कऻॎ कबना पलक झपकाए

उ मा का या जो चाऻतॎ थॎ बटॎ पालना अनकऻॎ रऻ गयॎ उकॎ किडबना कॏ चल कदया जाता ऻ अपनॎ ऻॎ तान को कोख म

शमध झॏक जातॎ ऻ मानिता शोक म

या कट म ऻ यता या मात ऻो गयॎ मानिता या कमलगॎ इ अनत रकगतान म पानॎ कॎ भॎख

नऻॎ या कमलॎ मानि को अपन अतॎत ॎख नऻॎ

ार कॎ चकाच ध क बॎच गॏम ऻ यो कब तॏझ मझ म आएगा लॏपत ऻो गया ककन यथध कामो म

जॎिन जायगा बॎत

पचाताप भॎ न कर पायगा

कॏ छ षण क कलए ऻॎ ऻॎ अपन को शॎश म दख ल एक बार मानि

तॏझ तर रो का उतर कमल जायगा जब तॐ अपन को लय भटका पायगा तब नऻॎ ऻ पायगा खॏद कॎ ॐरत

अपन ऻॎ दपधण पर तॏझ तर आएगा

चाऻ कजतनॎ भॎ पररततकथ जकटल ऻो जाय

चाऻ ककतन ऻॎ कट क बदल छाए

ऐ लोग दा आएग

जो पॏप क दयध म आनद पाएग

जो क जायग ऻाथ बटान

कजनकॎ मॏकराऻट लगगा ार जगमगान

कप कर ऻम जब तक मय ऻ

मानिता को कफर जगाएग

जब कर पाएग थाकपत शाकत

शायद खॏद को षमा कर पाएग

ड मोऻमद अलॎ कचककसा अकधकारॎ काय कचककसा किभाग

रतदान जीशनदान

बत कम ऐा ऻख़ता ऻ

जब ज़िदगी म ज़की क ज़दन ऐा आता ऻ

मऻव ज़िदगी कातब मझ म आता ऻ

जब डटर न उ ज़दन ररख़ प थमाई थी तख़ ब थम गया था

लगा मानख़ ज़िदगी का ार

एक ऻी ल म ज़म गया था

बत कम ऐा आ की शऻ रख़यी थी र उ ज़दन आ न थम थ

जब डटर न

मरी दख़त कख़ कर बताया था

बचना ज़जम लगभग अभश था

इज़लए लगा ब ओर ध आ-ध आ-ा उका ररशार था उक भरख़ बत ज़िमदारी थी मा का इलाज बकाया और बऻन की षादी थी

घर जब शा लग़ी बन छा था ज़क-ब क छ ठीक तख़ ऻ

अनी यथा ज़छात झ उन बख़ला था राि मन म ऻी रखा न खख़ला था

डटरख़ न कऻा ज़क भती ऻख़ जाओ

अना इलाि कराओ

इ र भती भी ऻख़ गयी थी रत डटर न

अब मा कख़ बता ज़दया था ज़दन बीत रऻ घज़िया बीती जा रऻी थी उकी बीमारी उ खाए जा रऻी थी आखखरी बार उकी मा बात ई थी तख़ कऻा था- मा बऻन का खयाल रखनाषादी ध मधाम

करना और दशाई लत रऻना

रख़ना नऻी दीाशली आ रऻी ऻ ऻख़ क तख़ ख ष

रऻना र मरा इतिार न करना

मा कख़ तब आखखरी बार षायद दख रऻी थी रख़त ज़शला करत

और ज़िर डटर उ ल गए

जब आख खख़ली उन

तख़ नया ार दखती ऻ

क यऻ जीशनदान ज़मला यऻी छती रऻी मरा नऻी उ यखत का ष ज़ियादा करख़ ज़जन रतदान ज़कया ऻ

और त ह एक नया जीशन ज़दया ऻ

डटर न कऻा यऻ था कऻा ऻ शऻ रीमान

ज़मल कती ह उन

कग़न जन ऻ शऻ

उक शाल थ

ता नऻी कख़ई म लमान था डटर की बात कख़ कात शऻ बख़ली अर यऻ या कऻत ऻख़

ज़क बात कख़ कऻा जख़ित ऻख़

उक बाद शऻ यखत कभी नऻी ज़मला था चाऻ शऻ जख़ था ज़ऻद या म लमान

म झ िकप नऻी िता जख़ भी यखत शऻ था अछा था उक ज़लए िररता था जीशनदान द ज़दया गया था मऻादान कर गया था उ ऻी नऻी र ररशार कख़ ख ज़षया द गया था चाऻ उक ज़लए शऻ ज़िप मामली-ा रतदान

था र च उक ज़लए शरदान था

Kalpana Kumari Nursing Officer

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