The general environment was a very favourable one for clinical teaching. After their hectic schedule of the day, all postgraduates would go from one ward to another in the evenings as well in order to examine cases with findings and discuss these amongst themselves. I would often visit my esteemed seniors Dr Shariq Masoodi and Dr Fayaz Kanjwal to examine the cases admitted to their respective wards. One day I went to ward 3 of SMHS hospital to see some case.
“Ibrahim, examine the patient admitted on bed 3 in the main ward. I will be joining you,” said Dr Fayaz Kanjwal, while he was preparing the discharge summary of an admitted patient in the house officer’s room of the unit. I went to examine the patient and found a heart murmur but could not time it at all. When he got there, he said: “Ibrahim, let’s put our stethoscopes on him together and when I hear the murmur I will raise my finger. Then you start timing it.” I did exactly that, and only then I could I understand that murmur. It was an excellent example of “peer teaching” as is described in modern medical education. On many occasions our immediate seniors and postgraduates would teach us on the ward, and demonstrate the clinical findings.
“Friends, I saw classical case of Pancost tumor with Horner’s syndrome5 in the Chest disease hospital in Srinagar”, one of our group mates told us after his clinical rotation in the said hospital. Going to that hospital used to be all fun and games, and when we were there, we would visit Dal Lake and at sometimes go on a trip to Shankar Achariya hill6. That evening, a group of students went to see that interesting patient, and later we had a tour of Dal Lake7. As there were no internet or mobile facilities, we would often communicate in this manner about interesting cases admitted to the associated hospitals of the college. For what modern medical education now describes as “self-study” our self-study was of course self-study with limited resources but many practical examples.
During our medical training the most fascinating posting used to be the “Maternity posting” month at Lala Ded Hospital in Srinagar. A group of 16 students used to stay for 24×7 hours in the hospital for the whole month. As I recall, no sooner were we allotted the few rooms in the vicinity of the labor room, we dropped our bags and headed towards the stage-1 labor room. The clinical round led by the Registrar on duty was in progress, and we joined her round.
“Bring the Doppler to check the fetal heart of this patient’s baby”, said the house officer to one of the maternity students. The patient was tossing and turning with her labor pains and intermittently squeezing the hand of her nearby mother. She was prescribed medication to ease her pain and fasten the progress of her delivery.
“We will give her a trial of medication and in the event that her labor doesn’t progress well, or there is some emergency, she will be operated” said the registrar on duty to her anxious mother.
“Doctor, please do something to relieve me of this terrible pain!” the patient kept on begging, with tears in her eyes. “I will never ever get pregnant again”, she added. From time to time we could hear her screaming with pain. Hours later she was transferred to the room for the 2nd stage of labor, and the midwife started to try and boost her morale, knitting her eye brows in between her pains, and finally, in the dead of the night she delivered a baby. The cry of her newborn baby helped her to forget her pain – suddenly she was a mother! She could not keep her eyes off her newborn baby, even though they were falling closed with extreme tiredness after the birth. In the meantime, the baby’s birth was being celebrated by the family.
The days went by, and slowly we were all learning the art of delivery and its management. One day, having gone out to buy some groceries, we saw an ambulance arriving in the hospital compound. Its windowpanes were smeared with dust. The driver jumped down from his seat and pulled the back door of the ambulance open, while extinguishing his cigarette with his left hand. We saw a pregnant woman lying on a stretcher, comatose, connected to an oxygen cylinder. She was accompanied by five or six anxious attendants, and was hurriedly rushed to emergency room of the hospital. After a quick examination in the emergency room, the house officer quickly shifted her to the eclampsia room.
“Monitor her blood pressure, and also the fetal heart”, ordered the consultant on duty. Two maternity students were allotted the job, and we made a chart. Her blood pressure was quite high, and she was bloated. The clinical diagnosis of preeclampsia was reached, and the necessary treatment was started in the room, which was kept only partially illuminated, lest the dazzling light should trigger convulsions in the patient, a feared complication of the disease.
Next day at sunset I found I could not detect the beating of the fetal heart with the Doppler. I immediately rushed off to find the nearby Intern on duty. She came immediately, and almost tripped on her heels on the way, but neither could she hear the fetal heartbeat in the patient’s womb.
“Ama (mother), I’m so sorry, but the fetal heart has stopped. It seems that the angel of death has kissed the baby in the womb. We need to take it out of the mother. I’m so sorry we could not save the child, but let us try and help the mother of the baby now”, said the registrar on duty to patient’s mother.
The tears started falling in the mother of the patient as she gave consent for labor to be induced in her unconscious daughter. A dead baby was delivered hours later. The patient’s condition started improving, and gradually she reached consciousness again. We were all happy that she had come out of her coma but sad about the death of her baby.
The next morning the patient wanted to know when she had been hospitalized and where her baby was. Yes, the mother was in search of her child, and unfortunately none of us in the team knew what to say – we were speechless. The consultant on call during the morning rounds glanced at her and affectionately touched her forehead. “Shift her to the ward in the afternoon,” she said. “I am late for the operating theater; the list is long and I need to go” the consultant said, and she asked the registrar to continue the rest of the round.
On another occasion during this posting, Mr. Iqbal Fatekhan our batchmate was singing in his melodious voice very famous Kashmiri song in the restroom” —Gachhi nai saaf dil, detie laaf saasa …..(unless your heart gets cleaned whatever you boost of, it is all meaningless). Another friend had brought a big tape recorder of around 2 feet long which must have been 7-8kgs in weight, and the session was being recorded. While this was going on, someone knocked on the door. We all stopped singing, and some students slipped under their blankets. A few even pretended to be snoring. One of the students opened the door, and yes, the intern on duty was standing there. “I need two of you accompany a patient to the operating theater as I need to have a discussion with the anesthetist on call. One of the ladies has to undergo an emergency cesarean section due to fetal distress,” she explained and then left, the door behind her closing with a bang. At around 2 am the patient was operated on, and her newborn was sent for observation to the pediatric intensive care department in the adjacent Children’s Hospital. I was asked to monitor the mother’s vitals in the recovery room.
“Doc, please tell me where my baby is,” she mumbled while I was tying a blood pressure cuff on her arm in order to measure her blood pressure.
“Your baby is in the pediatric hospital next door for observation. Otherwise she’s fine,” said I.
Oh no Doc – another girl child! How will I go home with a third daughter in row?” and she burst into tears, her voice breaking, and a stream of tears starting from her eyes.
“But it is not your fault at all,” I tried to explain to her. “You have no control over the gender of any of your children.
In fact, it is the Y chromosome of the father, your husband, that determines whether the newborn is male or female, and not you.” I tried my best to explain this to her, but without success.
…..to be continued
Excerpt from the Book Bumby Roads authored by Dr. Ibrahim Masoodi.He can be mailed at ibrahimmasoodi@yahoo.co.in
