Feb 5, 2022
I would like to tell you an anecdote about my final surgical oral exam. I had a unique patient. While he was cooperative, there was a moment when I nearly had a heart attack!
The patient, oh I do remember him well, how could I forget him? He was a young man with Buerger’s Disease which is a rare disease of the arteries and veins in the arms and legs. It is also called thromboangiitis obliterans — the blood vessels become inflamed, swollen, and can become blocked with blood clots (thrombi). This eventually damages or destroys skin and the surrounding tissues leading to infection and gangrene. It initially manifests in the hands and feet, but it is possible that it could eventually affect larger areas of the arms and legs.
The significant point to note is that everyone ever diagnosed with Buerger’s Disease smoked or had smoked cigarettes or used other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop the progression of Buerger’s Disease. For those who don’t quit the disease progresses to cause gangrene, and sometimes amputation of all or part of a limb becomes necessary.
In my exam case, my patient’s nemesis was chewing tobacco. He had started using it since he was 10 years old when his much older cousin introduced it to him, and he had subsequently become addicted. But as he unfortunately now got to know, the consequences were ultimately grim for him.
Iqbal was a friendly, cooperative man who had already gone through the examination process the day before with another group if exam hopefuls, and still wasn’t (yet) too irritated. I was therefore able to complete his history and detailed examination quite quickly, since the case, despite the misgivings of others, was actually quite straight forward. Thereafter, I just had to wait till the professor’s examination team came to my patient’s bedside to cross examine me about the case.
While I waited for the examiners, I chatted with the patient. He told me stories about his family, how he met his fiancé, and the business he was hoping to start after he was discharged from the hospital. He added that I was the first student that knew what I was doing (with reference to his case). I was relaxed and not at all appalled by his illness. While I had the time, I tried to persuade him to stop chewing tobacco, because that was one of the reasons that he had this disease, inasmuch he should take care of himself because a young man needs his limbs desperately… Of course, he does. Amputation should never be an option if it could be prevented.
Finally, I saw that the professors had entered the far end of the ward and were two beds away, starting the viva voce of one of my friends. But my day wasn’t destined to be smooth, was it? Where was the drama? The fun? What is a perfect day without a routine dose of adrenaline? Well, just as I turned my back to check my notes, I heard a rustling sound and footsteps walking away. I swung around to see that my patient had disappeared!!! Now I was on the verge of a panic attack! I nearly fainted with the effort to slow down my breathing and my racing heart.
Surely, I’ll fail my surgery exam if my patient wasn’t there! Oh God! I’ll be good! Please make my patient come back! I don’t want my professional degree to be delayed because of a minor glitch! These words were just whizzing through my mind, making me even more anxious instead of calming me down.
I tried looking for my patient as discretely as possible, asking the passing nurses and the ward orderlies whether they had seen him. They just shrugged and continued with their jobs. Just when I was nearly at the end of my tether, lo and behold! In the last moment, I saw Iqbal hurrying towards me, weaving in and out in the aisles of the ward, trying not to bump into anyone. In one of his hands, he carried a bowl of ripe, washed grapes and in the other, a bottle of cold water. He succinctly handed them to me saying “You have been on your feet the whole day, and I didn’t see you eat or drink anything! Something suddenly compelled me to get you some food and water before your exam. I do want you to do well as you were talking so kindly to me. I thought that this would help you bring your energy levels up and concentrate on your exams”.
That was enough to render me was speechless for a moment, and of course I was touched! It was also so unprecedented! Actually, to be honest, at the time I was feeling the effects of low blood sugar since I hadn’t had any breakfast that morning, and the fruit did perk me up. Therefore, when it was my turn to be examined by the invigilators, trust me, I was alert, focused and didn’t have my usual exam anxiety. It goes without saying that I happily passed my surgery viva voce with flying colors.
Feb 3, 2022
“Live as if you were to die tomorrow. Learn as if you were to live forever.” ~ Mahatma Gandhi
College life was fun. Not only because of the pleasure we had with our extra-curricular activities, but also because we loved what we were doing. Admissions into medical colleges were and still are quite difficult. Only those students with high marks are considered for admission, and not everyone is chosen. At that period of time very few seats were reserved for women, and the competition was fierce. Thankfully, that isn’t the case anymore, and the establishing of an all-women’s medical college launched opportunities where in the past there were none. The majority of the students were happy to have been given a chance to become doctors and provide future healthcare to the people, especially to the female population of the conservative villages in the country.
Reading the history of female doctors worldwide, I did notice that in the past, women had to either disguise themselves as men to be “allowed” to study medicine, or they were consistently ridiculed for even thinking that they could be “good enough” to compete in a man’s world. One had to be strong and thick-skinned to survive. And survive they did, paving the way for the modern female physicians. It was seen quite early on those women did excel in this field, and today, all over the world the ratio of women to men medical students is steadily increasing. There is a sort of passion intertwined with kindness along with inherent medical intelligence that drives us. I definitely suppose it’s more about the patient than the paycheck (though a healthy paycheck does sweeten things). Or so I would like to believe.
When one is interested and loves what they are doing, studying doesn’t seem like work, and in the first couple of years in college, we happily used to spend hours poring over anatomy specimens and studying bones in painstaking detail. It wasn’t unusual that we even used to fall asleep with a human skull or a femur near us. You could have without any doubt found a small bone if you had put your hand in one of our pockets. That wasn’t too bad. Undoubtedly, I think that is normal for any medical students all over the world. The disgusting parts were usually when we used to eat meat in the cafeteria, and some bright spark would come up and ask how our gluteus maximus, or deltoid tasted that day….. It took me quite a while to start eating meat once again, and even then, I prefer chicken if at all.
As it is, the food served was variable in variety and quality. Sometimes we would go back for seconds and other days….
I do need to mention here that one day we were served meatballs that were so hard they bounced. My friend Laila was playing with her food, and was trying to bounce the meatballs on the table, when one of them slipped towards the entrance of the cafeteria as fast as a projectile. Coincidently, I walked in just at the right moment, fielded the meatball and handed it back to Laila with a flourish and a bow. My friends still giggle about it because at the time it was considered quite hilarious.
Once, during the summer holidays, I was able to borrow a human skull from the college and took it home to study. You see, the base of the skull is the most complicated bone in the human body. That is because it has so many openings, and we had to learn every nerve, artery, or vein that passed through a specific foramen. I really needed to study the bone intensely, as our first professional final exams were just a month away. And I definitely wanted to be proficient and have the names of the structures just flow off the tip of my tongue when I was called for my viva voce. It’s interesting to know that the commonest mistake I heard a student make while discussing the skull was that they thought the food passed through the foramen magnum… This is one of the most prominent openings on the base of the skull through which the spinal cord passes when it exits the cranial cavity. (Hey dude, did you actually study?)
Well, here I was sitting in my room at home and concentrating on studying the said skull. While reading and trying to co-relate the structures with the descriptions in the book, I had used an eraser as a fulcrum and had fitted the tip if my pencil in the front gap of the skull’s maxilla where a tooth was missing. As I continued to read, I absentmindedly moved the pencil up and down, and the skull looked as if it was nodding rhythmically. It must have looked hilarious, but I didn’t give it another thought, after all I was used to being knee deep in human remains. So here I was innocently perusing my enormous Gray’s Anatomy tome and was in my own world till dusk, when I unexpectedly heard a high-pitched scream from the corridor that startled me. It was my brother, and he had this absolutely terrified look on his face. He started to shout at me that I should be careful because the skull was moving! Of course, it was! I was the one moving it! After he took a deep and calming breath, he explained that he had walked into my room to let me know that dinner was on the table, and since the only light in the room was the island of light created by my table lamp, he was startled when he saw the skull move in the dusky gloom. Rest assured; I still tease him about it to this day.
As the days went by, and we became more proficient with our dissection skills, I started to get the impression that dissecting a human body was like working on an archeological dig site. One couldn’t just pounce on the body and extract the parts and organs that we needed to study. The nerves, veins, arteries, and muscles are bound together by fascia and fat, that are very flexible when one is alive, but stiff and paper-like when seen in a mummified body. Our most commonly used instruments for dissection were forceps and scalpels. The accepted methodology was to demarcate areas (like a dig site, isn’t it?), and to scrape the skin and fascia slowly and gently off the muscles, as well as venous, arterial, or nervous systems to identify their origins and where they were heading. If one thought about it, it was quite beautiful, like some intricate work of art. Just to see what the Creator made in the human body was so interesting and actually awe inspiring. Every little bit has its uses, and there is beauty in every part isolated. However, just a little slip or cut would be enough to spoil the whole specimen.
I remember watching a science fiction movie called Fantastic Voyage where a submarine was shrunk to microscopic size and after they were injected into the blood stream, the doctors travelled in the submarine to perform surgery on an inaccessible tumor in the brain of an important scientist. I was fascinated. The movie showed how the submarine and the scientists travelled throughout the whole body, especially the lungs, liver, heart, and the kidneys. I thought at the time that the props and mechanics were amazing. I’m not sure how I would feel if I saw the film now, but suffice to say, it addressed the working of the human body in a delightfully scientific way and it had thrilled my adolescent heart.
Obviously, we were quite clumsy as first year students, but our experienced demonstrators were able to make beautiful specimens for us to study. It goes without saying that these specimens were extremely important to educate us in the working and structures of the human body since the correlation of the systems in a real human body with the garishly colored Plaster of Paris models that we know from middle school was quite difficult.
It so happened that in our enthusiasm to excel, we started to focus on the “specimen” part of the studies rather than the “human” part once we got used to handling them. The general attitude was that if we would think that these were once upon a time, human beings, who lived and loved just like us, it would have created fanciful, even scary thoughts and a barrier to proper learning. It was no surprise at all that the specimens that were supposed to be stored in the anatomy museum, would sometimes make their way to one of the students’ rooms where group studies would take place in the dark nights like budding cults with the same creepiness and membership criteria.
Inasmuch, there were times when the specimens available to us were limited, so to compensate, a large group would crowd around a dissected body and eagerly discuss nerve pathways, organs, and muscle movements. It would be a bonus if we could get a demonstrator to help us identify the bits and pieces excavated. Sometimes, one was pushed against the body, and no one thought twice about it. That is apart from having the smell of formaldehyde coming out of every pore and every bit of clothing we owned including our underwear. As the days passed, we continued to dissect the bodies, sometimes even without gloves so that the finer structures could be felt with our more sensitive fingertips. The downside was that the skin of our hands became hard and tough. That was predominantly due to the preservative and mummification properties of the formaldehyde the morticians used in the bodies. It was an uphill task to get them to soften even with the most expensive soaps and lotions. Acne was considered normal in the first-year students, and we would know when someone just came back from a short holiday, because their faces would be glowing, smooth and pink. Our general wellbeing and sense of smell became better only when we went home for short breaks during the college holidays. It was good to feel “normal” again even for a short while.
Nevertheless, no matter what the attitude, I believe there must still be some connection with the spirit and the body especially in such unusual circumstances as ending up as an anonymous entity and being cut to a million pieces in a dissection hall of a medical college. And I have proof! I know some people might call me fanciful or strange, but I am sure that the encounter that I had one dark night showed me once again, that even though we are being taught structures and human mechanics by the bodies in the morgue, we still need to think of their humanity and thank them for being the reason that we could be taught well.
The story I am about to tell you happened one extremely busy day when we were crowding around a dissected body while an anatomy demonstrator was lecturing us about the nerve pathways in the arms leading to the thorax. Sometime during the lecture, I was suddenly pushed forward by a student who had climbed onto a stool behind me and was leaning over my shoulders to get a better view. What was more, my elbows were not very gently pushed against the torso of the poor hapless body. Obviously, I didn’t think twice of what happened, and continued to stay in that position as it gave me a better view of what the teacher was pointing out and trying to explain to us.
That night, around one AM, I was suddenly woken up by the sounds of a furious electrical storm that lead to a city-wide power outage. The sound of the wind blowing through the trees was just as frightening as a B-Grade horror movie. It was extremely dark with not even a sliver of light seen anywhere. It was oppressing, hot and quite disorienting. I felt as if I was in a dark box with no way to claw myself out. When I had suddenly woken up from my deep sleep, I felt a sharp and continuous pressure on my chest. It wasn’t painful, it just felt as if something heavy was pressing down on me. As if I was being leaned upon by someone heavy and strong. I was terrified, but even if I tried, I couldn’t utter a sound or move. I tried to look helplessly towards my sleeping roommates, but I couldn’t see anything in the absolute darkness, and I also knew that they would not be able to help me in any case. There was an intense feeling of claustrophobia, and I was sweating profusely and yet my hands and feet were ice cold. Just when I thought that I wouldn’t be able to stand it anymore, I heard a hollow voice ask me how it felt to be leaned upon. I was terrified and immediately recited a protection prayer. Then I vehemently promised the unseen voice that I would up the ante for respect of the dissected bodies in the morgue as well as those alive or dead, that I would be encountering herewith in my professional life. It was only then that I felt the pressure diminish, as if I were released from an ominous hold, and I immediately fell into a deep dreamless slumber.
This incidence disturbed me for days. I tried telling my friends, but I only encountered ridicule and skepticism. Or I was told not to scare them with my ghost stories. But I know what I felt and saw. Without doubt it was quite disconcerting. But to this day, I have kept that promise to the entity of that dark night to the best of my ability. And I actually did feel lighter and happier because of the pledge that I made, as a terrified medical student. It has created an understanding in me to underline empathy and kindness that every patient coming to a doctor for treatment, has the right to receive. I believe those two principles are the foundations of good clinical practices. Even if we prescribe the best treatment in the world, a kind word or look, a reassuring squeeze of a shoulder and a gentle demeanor is the icing on the cake towards excellent medical care.
Jan 31, 2022
As the years passed by, the gardens in the college became lusher and even more beautiful. Especially the trees that were planted by the students during the annual tree plantation drives. There were many green nooks and crannies which were ideal as cool study areas in the blistering heat. Similarly, under a cluster of the now grown trees, just near the older neem trees, there was a small Masjid (mosque) nestled under the branches and shaded by the canopy of green leaves. It seemed so serene in the shade. A blossoming magnolia tree as well as some jasmine bushes added their fragrance to the idyllic ambience.
The little Masjid was situated in one of the farthest corners of the college compound, and very few people would make their way there in the hot afternoons. The little squat single-story building had only two open airy rooms and was surrounded by a small courtyard that had a low concrete wall surrounding it. The floor was paved with the red flagstones indigenous to the area, their retention of cool temperatures making it pleasant to walk barefoot on. Yes, that little Masjid was a pleasant and cool place to sit, pray or simply meditate.
One day, deciding to have a post prandial walk, I wandered towards the area, and was intrigued by the peace as well as the shade of the luxuriant trees that I saw there. Suddenly I had a thought. This was the perfect place to study in the afternoons when the library was closed! Since I was definitely not going home for my study leave. There were too many attractions to divert me from my studies, so I had actually found the perfect place to prepare for my finals. The last exams before I could finally put the coveted prefix of Dr. in front of my name!
Medical Students usually like to pull all-nighters when they studied for their exams. The boast of the day would be how long into the night they studied and how many cups of strong tea or coffee were consumed. How much was retained, was a different story and obviously one we never got to know.
I never could stay up so late, and my concentration would wane once the sun had set, and night fell. But I had formulated a different study schedule than the others for myself. As a matter of fact, to my amusement, there was a rumour going round that I didn’t need to study (much) since my father was politically well connected. People used to speculate that was the reason why I used to sleep soundly at night while the others studied. Little did they realise that according to my timetable and set plan, I used to get up early, have a good breakfast and spend my mornings in the library, come back for a nap in the afternoon, and then study till 10pm when the library closed for the night.
Once I was back in the dorm, the sweet realm of Morpheus would claim me, and no amount of noise could wake me up. Since I ensured that I had enough sleep, I was usually quite alert and fresh while studying during the day and I rarely nodded over my books. But as the finals loomed near, I felt that the afternoon hours had to be used to study as well since I was consistently making notes of topics and subjects that I had compiled from different texts and reference books.
Consequently, the Masjid was perfect. No one disturbed me there, and the cool breeze under the trees made for a comfortable nook to study. I loved that place. Not only was I able study quite intensely there, but I also meditated, convened with nature, and basically relaxed without the stress from my colleagues who tried to psychologically intimidate everyone by bragging how far along, they were with their studies.
Sometimes, I would even take a short, half an hour power nap, and curiously, I never felt scared in that lonely place. As a matter of fact, I felt calm, (as if I were taken care of by some benevolent entity), secure, and I would always wake up quite refreshed.
One day, I dreamt of an ancient man in white clothes who came to visit me at my serene retreat. He radiated peace and tranquility, and there seemed to be a light shining from a place near where his heart was supposed to be. At the time, I was going through unprecedented stress because of a private matter and seeing this old man sort of melted away my fears and anxiety.
In my dream, he started to talk to me in a soft melodious voice. I listened attentively even though I was surprised at the vividness of the dream and the presence of the old Sufi.
He said that he had been watching over me since I was a little girl, and had bestowed some gifts on me, some of which I was already aware of, and some would be revealed to me as I grew older. He told me that I should not be afraid, he would always be there when I needed him, and that I will become a good doctor. In his soft, gentle way he also told me that I will make my mark in the world. Awesome!
One day, as I was exploring my dreamscape, the ancient one advised me to eat three dates every day. He said that the nutrients were easily absorbed by the digestive system and provided energy to all of the essential organs, especially to the brain cells, muscles, red blood cells and marrow. The dates would help me study and retain whatever I had ploughed through. He went on to say that a handful of nuts every morning, with a glass of milk were also supposed to be good for the brain.
You know, I thought that one could not mix allopathic medicine with herbal or traditional medicine. But just for a lark I did try that out, and I was surprised that I became aware of an increase in my concentration and energy levels. This created quite an impression on me. So much so that nowadays, I try to blend the good points of all forms of healing to create a well-rounded and holistic approach for my patients.
As the days went by, word got around that I was studying in the Masjid in the afternoons, some friends asked whether they could join me. I agreed on the proviso that they stayed in their own corners. This was not a place where we “group study” and caused a loud ruckus. It was a place of serenity and quiet. Anyone violating that cardinal rule had to go. Surprisingly, the peaceful ambience affected the others as well and this rule was strictly adhered to. However, in the end only four of us remained.
It was a remarkably successful “retreat” so to say. We meditated together, even started off with a short yoga session before we went to our respective corners to study. I am incredibly pleased to say that when the time came, the four of us passed our exams stress free and with flying colours.
Jan 29, 2022
Another day in the life of Sarah the Medical Student:
The miracle of birth is wonderful, that’s the only word that I can use to describe something that even after working so many years as a doctor. I still get emotional and tears of happiness well in my eyes when I watch a child come into this world. My friends keep teasing me about the tears that spill over at times. They nudge each other and smile good naturedly when they see me get emotional. But the first cry of a newborn baby is the most beautiful sound that I could ever think of.
However, I have come across some New Age healers who think that a “gentle” birth where the baby doesn’t cry immediately at birth, is good for the future psyche of the baby and will ensure a healthy and calm growth. It’s a good idea, no, it’s an amazing idea…in theory. I wish it were true. The reality is that a baby has to take a deep breath and cry at the time of birth to organically switch from its Foetal Circulation to the mature or adult type circulation of the blood.
One has to understand that during a pregnancy, the fetal circulatory system works differently than the one after birth: It is a well-known fact that the fetus is connected by the umbilical cord to the placenta. This miraculous organ is rich in blood vessels that carry nutrition and oxygen from the mother to the baby. The point is that while the baby is still in the uterus, his or her lungs are not being used to filter or oxygenate the blood. The baby’s liver is also not fully developed. So, the circulating blood bypasses the lungs and liver by flowing via different pathways and through special openings in the heart called shunts. Once the baby takes a deep breath, along with a vigorous cry, the shunts close. It is the force of this first breath and the strong cries of the baby that expand the lungs and the circulation transforms almost immediately into the adult type as we all know it. From that point onwards, the lungs start working on oxygenating the blood as they are supposed to. Quite ingenious I dare say.
The first time that I was allowed to deliver a baby is still etched in my mind. I was still a medical student and was obviously supervised by one of my teachers. I was so excited that day, because I was told that morning that the next delivery in the labor room would be mine. Since our obstetrics ward was extremely busy, and we were the nearest and largest tertiary hospital catering to a wide rural and urban area, I didn’t have to wait long.
My patient was wheeled into the birthing room and to my consternation she was a frightened 16-year-old girl, and her confused and terrified husband was only 17 years old. I think they were too young to realise the implications of what was going on and they clung to each other as if they were trying to reassure themselves by having close contact with each other.
Her age and apparent pallor were evident that this was a high-risk pregnancy. Additionally, she hadn’t had any antenatal care whatsoever, and was extremely thin and fragile looking. Her bloated, pregnant abdomen looked almost obscene on her little malnourished body. She was so delicate that one would think she would be more comfortable playing hide and seek in the fields with her friends, rather than being here with us in the hospital. In the throes of painful labor pains, wracking her immature body.
As soon as I first saw her, I was galvanized into action and immediately started to make my patient comfortable. In addition to that I had to draw blood for a spate of laboratory tests. I was utterly horrified when I saw that the results of the bedside haemoglobin reading were only 4mg/dl, whereas the normal reading at her age should have been at the very least 11-12mg/dl. Therefore, after I took the requisite detailed history and conducted a thorough external examination, (students were not allowed internal examination at that level). Once I had some initial data, I informed my attending professor about the case and the unfortunate condition of the young mother. With her consent and guidelines, I swung into action and tried to arrange an emergency blood transfusion for her. (The emphasis is on the word “tried”).
Wanting to start my patient’s treatment as soon as we could, I asked one of her parents and her husband to accompany me to the blood bank so that we could arrange the required blood. It was thought to be cheaper and obviously better quality-wise if a member of the family donated their own blood for their patients. I also told them that in cases of emergency, we could get some stored blood from the blood bank for the expectant mother. While talking to them I looked up and saw that the family had terrified expressions on their faces when I mentioned a blood transfusion! It was as if I told them that I would be performing a voodoo spell on their patient. And donate blood? No way! How can the doctors even think of sucking blood out of their body! What if they died? The family continued to adamantly refuse to purchase or donate blood, saying that they were not comfortable with infusing another person’s or a stranger’s blood into their patient. (Bad karma?)
I tried persuasion, arguing, and even firmly admonishing them desperately for a long while but with absolutely no success. Finally, after a long debate and failed persuasion techniques, the real reason was revealed…an uncle confessed that they were as I had guesses earlier, all scared! They thought that they would die a horrible death if they donated even a teaspoon of blood!
Jamila, the young mother to be, by then started to fade and was getting weaker with each contraction that was wracking her frail body. I was getting frantic. There was no way that I would let my first obstetric patient slip away from me! I had to hurry! To save time I grabbed a cross matching kit from the laboratory and cross matched her blood with mine. It was a match! Once again, I dragged the father as quickly as I could to the blood bank, and donated 500ml of my own blood. I had the process rushed and the blood prepared for immediate transfusion. You have to realise that this was the pre-AIDS prevention period, so it was easy to get the blood almost immediately. The reason I took the husband with me was that I wanted to show him that donating blood wasn’t life threatening in case we might have needed some more.
We were just in time because by the time we reached back to the labor room once more, Jamila’s contractions came to the point that she desperately felt like pushing. As soon as we could, we hooked the blood infusion and a bag of plasma to her veins through two IV cannulas in both of her arms. The slow, painful progress of her labor seemed as if it was going to be a long and painful day. Not only for Jamila, but for all of us. As it is, it usually does take a bit longer with primigravidas (first time pregnancies). While listening for the foetal heart sounds, and recording the foetal heart rate during the contractions, I asked the midwife when the last foetal heart sound was measured by either a nurse or a doctor. She confirmed that it had been a short while ago, but she wasn’t exactly sure when since she had just started her shift.
Everyone was under the impression that this was a normal run-of-the- mill delivery that had been handed over to a hysterical medical student. Remember, we didn’t have any data or findings for Saira because she hadn’t attended any of the antenatal clinics, and she had just arrived as an unbooked patient that morning. She was already in the initial stages of labor. As I mentioned before, I wasn’t allowed to examine Saira internally. That was done exclusively by the attending obstetric resident or specialist, but when I did palpate and auscultate her incongruously enormous abdomen, I felt two heartbeats resonating within instead of the expected one. To be sure, I asked the midwife to show me exactly where she heard the baby’s heartbeat, and she pointed on the right lower quadrant of the abdomen, while I auscultated the upper left side. I was right!! There were two heartbeats!
As I was just a student, I didn’t want to take things in my own hands in case there were complications, I immediately turned (once again) to my instructor. The Obstetric Resident. After a quick examination, she confirmed my suspicions and promised to monitor me during the whole delivery. I was confident that my senior would jump in in case of any perceived complications or dire emergency. I was pleased that she gently continued to coach me in the background, thus increasing my confidence.
Trust me to get the complicated cases on my first day in the labor ward and for my first ever delivery!!
Since the first baby’s head was already engaged in the pelvis, it was already too late for a c-section. In any case she was considered too anemic and weak to go through the surgical procedure. Therefore, unless it was considered an emergency, or we thought that her condition was life threatening, we just continued to monitor the delivery process very carefully. If Jamila would have had proper ante-natal care, and we had enough relevant information, we could have prepared her as well as our own selves for the risky delivery. But there was no time for recriminations, she needed our help, and we gave it to her to the best of our abilities.
After a strenuous bout of pushing, we finally saw the head of Baby A who was born surprisingly easy considering it was the mother’s first pregnancy. The baby cried immediately and lustily as soon as she was born. Baby B took her time since she decided to come out upside down. Thankfully she came quicker than expected in spite of the small build of the mother, and we didn’t have to resuscitate her or provide baby Cardio Pulmonary Resuscitation (CPR). We were so worried, because breech babies could get very easily asphyxiated, or the umbilical cord could have been wound around the neck, causing the baby to choke. That is one of the reasons why breech babies are more or less born by elective c-sections nowadays to prevent any birth injury or other serious sequalae. Two normal and healthy babies! Both beautiful girls. We were so relieved that all went well. Saira was extremely lucky. Her babies were a little small for their gestational ages, but they were born with a lust for life, and thankfully thrived well.
Going back to the dorm, I was tired but exhilarated, because those babies were the first, I had ever delivered, and they were normal and healthy. Most of all, the whole team was thankful that the mother survived despite all the odds against her. I was thrilled and didn’t come off cloud nine for quite some time. On the way to my room, I told my story to anyone who would stop and listen. I must have sounded quite annoying!
That evening, I was surprised to receive an unexpected visitor. The husband of Jamila met me at my dorm and handed me a large ornate basket filled with a cornucopia of fruits. He said that he was grateful for all I had done that day, especially that I had donated my own blood to save his wife’s life. He said he had brought me the fruit because he heard from the nurses in the ward that it was a good idea to eat fruit or anything sweet after donating blood. I was touched and thanked him but so that he wasn’t offended, I just took just one apple from the selection and told him to take the basket back to the hospital. I made him promise to feed the fruit to his wife. Having just given birth to twins she would definitely be needing the extra nutrition. Oh, at least it was nice to feel appreciated.
Another day another drama, but such a blissful feeling. THIS was why being a doctor was such a good idea! The circle of life begins here, and though we also have sad stories, the good ones outweigh the bad, and most mothers go home with their bundles of joy firmly tucked lovingly in their arms.
Jan 28, 2022
Narrated by Dr. Sarah Shah:
Besides learning about run of the mill cases in medical college, it was exciting to see and experience the weirdness of the human psyche and physiology. That was how we met Mazen who was a cocky 16-year-old when he walked into the out-patient clinic for the treatment of his chronic abdominal pain. As was usual with walk-in patients, the attending doctors would expect the students to take the detailed history and do the prelimary examination of the patients. He smiled most of the time and thought it was hilarious that so many young women in white coats were so seriously focused on him. He was very ticklish and giggled all through his baseline examination. We had to ask all the relevant questions from him…How long had he been ill? Did he have constipation? Diarrhea? What and when did he eat last? More giggles (and eye-rolls).
Well, the general history was taken, and though we tried, he did not give us any specific information about his diet or what he ate last. Yes, he did have constipation off and on. He looked a bit pale, and his pulse was a bit fast and thready, but we didn’t think it was significant at the time because he was active and very responsive.
When it was time for the professor to examine him, we all crowded around to hear what was being discussed and most of all what the professor thought about the differential diagnosis of the patient. We were interested, no were desperate to know how he was ultimately going to come to the diagnostic conclusion of Mazen’s abdominal pain. I did notice that the patient was a bit furtive and tries to avoid a few of the pertinent questions.
All of a sudden, just as he was about to be palpated by the professor on his abdomen, Mazen turns on his side, groans and vomits a projectile of fresh blood! We immediately sprang into action and put up an IV bag with saline in one arm and took a blood sample to cross match his blood for an emergency transfusion. But within 10 minutes we were performing high quality CPR (Cardio Pulmonary Resuscitation) on him. Unfortunately, our efforts were futile and he died quite soon after that.
We learnt a major lesson on how to communicate bad news to a bereaved family that day. It was even more excruciating for us since it was our first time, and the patient was so young and full of life when he came to us. How do we tell a family that a young child who walked merrily into the clinic had just died? And we could not tell them about the exact diagnosis at once. Understandably, once we had given the sad news to his family, they were very upset. They wanted to take him away to be buried immediately. But our professor was able to convince the family to have an autopsy done since he came to us with his mysterious abdominal pain followed by his vomiting of fresh blood. We needed to know what the actual diagnosis was so that it could be treated or even prevented if we came across another patient with these symptoms in the future.
Since our study group was present when he visited the clinic, we were all allowed to attend the autopsy as well. After all we wanted to know the conclusive diagnosis as much as anyone else. While waiting for the autopsy to begin, we tried to out-guess each other by tabulating the various causes of bloody vomiting, especially in his age group. We were acting like over-zealous puppies. (Nothing new). The “I know better than you” interns were also there in full force, looking at us medical students with their usual disdain. And as usual we ignored them.
Finally, the autopsy commenced and as usual, the body was opened with the thorax to abdomen Y-incision and was painstakingly examined. We realized that with our speculative pre-autopsy discussions, we had already unknowingly suspected Mazen’s diagnosis when the stomach was palpated before it was sliced open. Examining it carefully, we saw that it had unusual bruising all over it, some fresh and some in their healing phase. There were also unmistakable signs of where it hemorrhaged and most of all, it had some really strange lumps. The stomach seemed quite solid and heavy for a normal organ when it was lifted out of the abdominal cavity. However, once the wall of the stomach was incised, we saw to our morbid fascination that it was filled with sharp metal objects! Razor blades, random pieces of metal, countless needles, and even a small pocket-knife!! No wonder he was in pain and no wonder that he literally bled to death. His stomach was so full that a partial intestinal obstruction had already formed, and it was concluded that the abdominal pain was due to the strong peristalsis (movement of the gut) trying to push the blockage forward. Instead of that helping, due to the strong movements, the sharp edges of the razors had rubbed against the stomach wall where ultimately an artery was severed. That led to Mazen’s fatal hemorrhage.
Mazen had suffered from a rare form of pica, (an eating disorder characterized by a tendency to eat substances that provide no nutritive value) called Acuphagia. This is a condition where people ingest sharp objects willingly. Usually, this type of pica is found in mentally ill patients, but so-called normal people, have also been found to have this disorder.
Although very few cases of Acuphagia have been reported in the medical literature (particularly in adults), most of these suggest that those displaying the symptoms have psychological disorders, (except of course if the behavior is part of an “entertainment” act). Well from whatever information we were able to garner with our brief acquaintance with Mazen, he seemed active and alert, though he did give the impression of being an extrovert, like a class clown. It could be possible that he was showing off to his friends or he swallowed the sharp metallic items on a dare…On the other hand, it could be that he was impressed by some magician in the movies, and his quest for entertainment became his nemesis, and he ultimately died a painful death.
Moral of the story…don’t eat what you shouldn’t. It can kill you.
Jan 27, 2022
As Narrated by Inspector Tanya:
Even though we are now well into the 21st century the inclusion of women in the Pakistani police force remains low. From the overall 1% in the 70s and 80s the numbers have just increased to a minimal 1.8% today.
I have always believed that recruiting more policewomen in the force was a great step towards empowering women as well as strengthening the rule of law. One must keep in mind that having policewomen arrest those perpetrators who harass or humiliate women would not only discourage this threat but would also make Pakistan stronger and more stable.
Unfortunately, violence against women is still rampant in the country, however, NGOs and activists say the recorded cases are just the tip of the iceberg, as most cases of gender-based violence go unreported in the country. In many instances, women do not come forward and report the abuse to authorities.
One of the reasons behind this is a deep fear. Since most of Pakistan’s police force and judiciary is male-dominated, women are reluctant to interact with them. There have been reports of harassment in police stations during investigations. Having female police officers at the time gives the women a sense of comfort and the belief that a woman would be more inclined to get justice for them than a man. Therefore, many human rights groups are urging the government to establish special courts for rape trials, so that victims feel more secure. They also demand that the number of female police officers and female judges be increased in order to deal with such cases.
At the time that I undertook my training, I do admit that it was grueling and at times even humiliating, since we were trained by the men who didn’t look kindly at having female competition. We were always given tasks to set us up to fail. But our small batch of recruits were bold, but unfortunately we were also still quite rare. There was at the time and still is today to some extent a misconstrued understanding among many male colleagues that the “big” jobs should be left to the men. But to reach the zenith of a career that had to ensure that the law and order in the country was taken care of in an ethical and compassionate manner, we had to at times suffer and realise that a bruised pride, humiliation, and discrimination were often tangled up in the progression of our career. Thankfully it is now widely acknowledged that having more women in the police is crucial to building an institution that protects the rights of women and girls that facilitates, rather than hinders, their access to justice. Therefore just like the patient spiders we had to persevere.
I am happy to say that the UN has argued that policewomen and female peacekeepers are particularly valuable in establishing stability particularly in post-conflict states and crimes against women.
To sum it up, despite all the trials and tribulations that my team and I have suffered, I am proud to be a policewoman.
