Carrie the Surgeon

Vadecome! After another long day in Vellore, I have at last managed to secure a relatively decent computer, where both the Internet, automatic re-start and letter "w" are working. I attempted to fix the difficulty reading my blog- whenever I look at it as an Internet user or signed in it looked fine, but for the convenience of all it is adjusted. Please let me know if further modifications are necessary. Also, I spent more time than I had for the convenience of others to figure out how to enable unnamed comments, so again, please let me know if you have need of adjustments. It is essential to understand that I have less than 1 hour per day to spend on Internet with extremely slow Internet with issues that make me think I have returned to the dark ages of computers in the 90's. Yesterday, my day was from 5:30am to 12am non-stop. Our standard work day is from 5:30am wake up, to a quick shower (being careful to keep my mouth closed) since a shower is absolutely necessary each day, to 6:30am breakfast, to catching the bus at 7am, making it to clinical rotations by 7:30am, working in a rotation until around 10:30am when the universally upheld coffee break is initiated, continuing until 12:30pm when lunch occurs, and ending the clinical around 4:30pm. We then catch the bus at 4:45pm, get back to Bagayam in time for discussion groups and lectures with our teacher Ardith, having dinner around 7pm immediately following, and around 7:30pm I head to Gault Library to attempt to communicate with y'all, and with computer problems and library closures looming, I leave around 8:30pm or 9, and go to bed by around 10pm, to repeat it all again. This whole schedule, I should inform you is of course by Indian time, meaning it is subject to much change, and much fluidity, and it is almost impossible to stake your life on something occurring at a particular time. It has been fascinating to get to know CMC a little better. The nurses all wear white saris with old fashioned, plastic nurse caps. They are all called sister, and report directly to one lady, who no one can interfere with. The nurses are not even allowed to criticize the nurses unless they go to her first, so westerners (doctors) get in trouble with her when they say "nurse!" instead of sister, and then yell at them. They learn quickly. It is neat how protective and family like the nurse staff is. Our clinical this week have been very interesting. I believe I mentioned I was in pediatrics for the first two days this week, while other groups were sent to other departments such as community health, surgery, emergency, mental health, rehabilitation, and a couple of others. Our supervisor, Rema, arranged for the 4 of us sent to peds to spend half of each day at a different ward, so the first day our assistant teacher Barb's daughter, named Becky, and I were assigned to the medical ward in pediatrics and the surgery recovery ward in pediatrics. Yesterday, Becky and I went to oncology first in peds, then pediatric ICU. In the medical ward, we were given an extensive orientation about pediatrics in general, then were given a facility tour. The hospital is very unimpressive in general, and seems to lack basic sanitation that is much expected in the US. The beds are close together, and protective barriers are of limited use. Equipment is cleaned and re-stocked, and there is a lot of dust, as with the rest of India. As you get to know the hospital better, initial shock becomes admiration, as we learned that there are few diseases obtained by stay in hospitals, and it is purposely not remodeled as often as rich Americans take on to keep costs low and fees affordable. Supplies are well maintained and carefully re-cleaned so that large fees would not be used on equipment, where recycled materials do fine. Waste is limited, costs are reduced, and the care really is world class. Who says a building has to be pretty, as long as it is maintained? I still see some practices used that make me cringe, like bare hands on sterile procedures, but they clean their hands well, and are much more motivated to keep their personal space sterile without extra barriers. It is a very different concept, but it seems to work! Anyway, we saw the ward, which has about 30 beds. In pediatrics, a parent or guardian is required to be present at all times, so dads take time off work, or moms leave their other kids in someone else's care and come stay for days, weeks or months with their child, either sleeping on the floor under the bed, or in the bed with the child. They don't seem at all put out by it, and it is very apparent that family takes great ownership in their child's care. The hospital does not often provide food- there is a kitchen that the parents are able to use to cook food for their children. If special dietary restrictions exist, the nursing staff gives them appropriate recipes. The parents help give medicine, and a whole bunch of other stuff. So, to visit a child, look for an adult as well. The kids were sleeping, so our nurse, Lovely, talked to us about care, and when we exhausted that topic, turned to arranged marriages, and the ease with which nurses can transfer their knowledge of Tamil to Hindi and other Indian languages, as there are many, and all of India comes to that hospital (one man Barb met came on a 10 day train ride for care), so even within India the nurses must deal with diversity. It kind of sounds the the US! After lunch, we went to the surgery ward, and Lovely was again our nurse. She introduced us to several children recovering from burns. Most burns seem to happen when children spill burning oil lamps all over themselves, in the night in particular, or when they have to carry oil lamps on their heads up mountains in the middle of the night. Apparently it happens. Other burns happen when mothers leave children alone in the kitchen, which is simply a burner on the floor with a big cooking pot, and the child touches the burner or fall into the "soup". One little 2 year old girl fell into the "soup", and was burning, so her 3 or 4 year old older brother dived in after her and rescued her. They were both admitted together, and the nurses were all amazed that the brother had the sense to pull her out. Rather than covering them with bandages, the nurses recycle portions of the products of giving birth, retrieved from the department where babies are born, and cleaned for this purpose. It is apparently a good way to recycle and keep the burn sterile. Again, we ran out of things to do, so Lovely talked to us for about 2 hours about India. She told us many things, such as: the buildings are brightly colored just because the people get board of the color, so it changes to a new bright color every couple of years. Hero worship is a major problem in India, as famous movie stars become "hero's". The poor and unemployed will become full time fans, and throw huge celebrations on their birthday, or spend all day watching movies featuring them. Many politicians are movie stars who are elected because they have a strong fan club. They become gods, in fact, and the fans will set up big cardboard cut-outs of them under a shelter and poor milk (a ritual done for gods) all over them, and cover them with flower garlands. One famous movie star died a few years ago, and Lovely tells us 20 people seriously died of shock, and another 70 committed suicide. Though it is not always this dramatic, hard-core devotion is not uncommon. She also told us of another woman who a few years ago nearly convinced the government to give her a castle because she was so convincing at claiming she was a famous India princess from 4000 years ago who had been reincarnated in her body. Many people were convinced, like the Anestassia myths. Marriages are still often arranged, but since she is a Christan, she has more freedom and is unmarried because no one "is to her liking". She told us a shot history of their government, and some of the local myths etc. She is quite a lady, and very young! They start nursing school by age 17, so are well into the field by the time US nurses are graduating. This is just a fact, by the way, not an opinion. Talking to Lovely has probably been the most insightful part of my trip to India so far. Yesterday, we started at Oncology. We received a brief course in Oncology nursing basics, then were assigned to follow a nurse, and watch her give chemotherapy treatment, medication and treat medication side affects in each of her patients. Then, we watched a doctor do her rounds, and I got to talk to 2 male nurses who are just starting. It was very interesting. There are few male nurses in India, because the women are protecting it as their "thing" and not encouraging males, and males in general look down on nursing as a profession. Nurses, after all, are much more like the nurses of old, who do everything from cleaning the building, to doing CNA work (they do not have a CNA position) to passing meds, and doing the advanced work known to Americans. It is also not payed as well as American nurses, though they are just as qualified. One of the male nurses was forced to become one by his family, who were all nurses, and whose uncle was one of the first male nurses in the hospital. His family is Christian, and he comes from a long line of missionaries. I think one is even a missionary to the US. Don't quote me though- his accent is much different from mine. In the evening, we went to the PICU. It is much different from the rest of the hospital, as it is air-conditioned, and much more sterile. You have to change your shoes to go in. There is a lot of suffering, and most of the babies won't survive very long. Many suffered from fever, and we could see their heart slowing before our eyes. We mostly just watched and observed, but looking at them was very self-explanatory. Toward the end of our shift, a little boy was brought in with a bandaged head and a neck brace. I found out later that another girl in our class (Heidi, who is an RN) saw him come into emergency. He was in a bus accident (which made it into the news) and was tossed out of the window to avoid burning, and cracked his skull open, and his brains were coming out when she saw him. It was very distressing for her. When he came into PICU, he was doing much better and was conscious. Heidi was in PICU (Pediatric Intensive Care Unit) today, and got to see him, and says he is much improving. People from our group saw several hard cases that day, including an incident where CPR was required, but I don't think the patient survived. Today, I was in the surgery department! It was a unique experience like would be very hard to find in America, or most other places in the world. We got to put on scrubs, hair nets and face masks and shoe covers, and were given absolutely no supervision. Be warned, the next paragraph may be graphic. We were allowed to go wherever we wanted, read anything, go into any surgery at will, and even take pictures! I was with a girl named Dayl. At first we went to a surgery where a gall bladder was being removed. They made an incision and inserted a tube, which they used to manipulate the scapulae etc, and watched what they were doing through a camera monitor. When the gall bladder came out, they dissected it in front of us and I could see all the bile. It was so fascinating! The next surgery was a mastectomy, which was in progress. One of the surgeon assistants was a girl from Germany that I became friends with at the International tea at Bagayum a few days ago. I sat by her at dinner at a nice restaurant in Vellore as part of Darling's Residency where we went after our late lecture to again meet with international students/workers doing a short term stay at Vellore. She is named Katha, and is defiantly a kindred spirit. Anyway, she was helping with the surgery, and we watched them pull out all of the tissue and stitch it back up. I am nearly certain the US surgery are more sterile, but then I decided that the US may be over cautious with the constant threats of fine, and these surgeries seem to work out ok with lower standards, though I do defend that it is often better to be safe than sorry. I just don't want to give the impression that they are not doing quality surgery, but their technique for touching things, removing gloves and gowns, throwing body parts across the room and into the trash etc could probably not hurt for some assistance. Then, we watched her get all cleaned up and sent to recovery. It was an excellent surgery, I must say, and I am impressed by the quality they are able to do with limited resources. Next, we watched another mastectomy all the way through, and saw the first incision to the last stitch. When all of the tissue was removed, the doctor had us come over and look at the muscles underneath, so we got to brush up on anatomy, and where certain muscles, arteries, bones and such were. It was a live dissection, and that part of anatomy finally made sense! I doubt I will have many opportunities to see that kind of thing again! The anesthesiologist also gave us a brief crash course in the little meter next to the bed that monitors vitals, so by the end of the surgery I was able to press a couple of easy buttons on my own volition, with the blessing of the doctor. Our next surgery was a bypass surgery of some sort on a leg, but we left soon after to see a little boy brought into a room near by that had an obvious case of hyper-extension of the knees, so we watched them make some incisions, and I helped the doctor tie up his sterile green outer gown, and they sliced a couple of tendons/ligaments (not sure which- no one was explaining) and it looked terrifyingly like the poor child would never be able to walk again at that rate, with his muscle attachments all severed. We were not able to see how that surgery concluded, as by then it was time to leave, and I had to get to the fort to pick up my tailored Saree and get back to Bagayum in time to listen to a lecture by the man in charge of emergency. He had been to America for a few months so understood our culture shock, and was there to clarify misconceptions and give advice about Indian culture. Since he was a Christian, it was very interesting to hear what he had to say. So, I got to see a lot of blood and live dissecting, and some blood spurting everywhere, and it was pretty cool. I think I will be back in that area tomorrow.

I did not end up getting my Saree today after all, as the tailor lost my measurements, and went missing today, so I have to wait until tomorrow and hope it is done, even though it was due in yesterday but I was gone all day so couldn't get it, and pay for another ride in a tuck-tuck, and wrangle with the people there over what went wrong, and hope the correct measurements were found. I had the young man at the desk call the shop this evening to make sure it would be there, by Ardie's suggestion, and I was glad he called as he can deal with the Tamil, and knew how to dial the phone number, as there is some local area code I was struggling with. He is very nice, and has been such kind help to us all in so many ways.

Health in general seems to be improving among our group, though this afternoon it was suddenly apparent that Barb had a case of laryngitis, so she has no voice. I have a mildly scratchy throat and took some air born, but I think it is mostly because I am tired. I was up until midnight doing "homework" by writing in my journal, which the teacher will grade this weekend, and had to wake up around 5:30am. Water and rest will hopefully cure that. No one has had the runs yet.

I briefly read some of Neil's posts, and am sorry he had the revenge... that sounds no fun t'all.

Just as a warning, it is rumored that Internet connection is much worse where we are going in Chennai than here, so I cannot guarantee the frequency of posts next week, and this weekend I am going to be gone on a rafting/safari adventure, so will also be out of touch. Hopefully I can borrow a computer once in a while next week and go to an Internet cafe. The schedule there sounds very different, so it will be like starting a new trip!

It was good to see a few new faces on my blog comments!

Meeka Nandree!