Roll the dice

Working in ER on weekends especially on friday night is something that doesn't go down easy for me. Any one working in the ER knew what I am talking about. All kinds of surprises walk,most of the times brought by EMS through the Emergency room door. I have come across multiple patients that make me think or some time scratch my head wondering why in the world this happened to them.Of all the places that I moonlight, Mena ER is interesting and stays busy all the time.Mena is one of those small towns in rural Arkansas out in middle of beautiful Quachita mountain ranges. Every time I drive from fort smith to mena which is about a good one and half hours through the winding roads of US 71 or US 59, I come across some small mud roads that leads to houses,cabins on top of the mountains or middle of the forest.I always wonder how people live in the middle of nowhere. You got to be pretty tough to live here.maybe it's the peace of mind and the nature's beauty that keeps them.

Few weeks ago, I have to cover for another physician who had an emergency and I agreed to help him out.Its on a friday night.I had a busy clinic during the day and as soon I am done seeing the patients I went home,changed cloths and spent few mins with my wife who was mad for working on friday night that I promised the week before for a movie night. I needed some caffeine in my blood to get me back to work.I filled up a big mug of freshly brewed coffee and drove off to Mena for an exciting night.After around 90 mins of driving, I finally reached Mena. All through the way while enjoying the beauty of spring blossom and lush greenery I kept thinking about how the night is going to be. Having worked on weekends before I know it's going to be a busy night,but it's the surprises that come through the door that get me thinking.By the end of the journey I am ready for whatever come through the night.as I parked the car and walked through the back door, I was hoping to see a hoard of patients charts waiting for me to be seen.

To my utter surprise there weren't any.infact the outgoing doctor has just finished admitting the patient and other transferred out.so I am here with no patients to see now. That never happened and it's a pleasant surprise I went to the doctors room and laid down for a few mins knowing my luck is going to run out soon.As expected the phone rang in 20 minutes and nurse told me that I have patient to be seen while they are fixing to bring another patient in. I went there and saw the first patient,an easy one,an elderly gentle man with abdominal pain.while waiting got the workup I saw the other patient,a small kid with an ankle injury after falling down from horse back.It started out as a trickle and within the next 2 hours the flood gates opened and I saw 8 patients.By this time,my mind is tuned to mechanical mode. I look at the chart to see why the patient is here and see him/her and order labs and medications before going to see the next one. 7 patient rooms and one trauma room are filled with patients.It continued through the night with patients coming with various complaints of chest pain, broken limbs, head injury, altered mental status, minor cough and cold and occasional one or two who just want to score some pain medication by complaining of pain somewhere and hoping that they can fool the nurses and me to believe them.

After caring to the needy and disappointing the pain medicine seekers away ,I started working on a patient who was brought in few minutes back following ATV accident. After seeing the patient and stabilizing him,I ordered imaging studies and went about to see the other patients.I grabbed a chart of room 2 and walked in to see a middle aged obese lady with artificial leg on one limb and a big wound on the other leg. After introducing myself I asked her name and other details about the gaping wound .She told me that she lives by herself in middle of a forest about 30 mins from the nearest road . She raises sheep there. She told me that couger was killing her sheep and her dog got in to fight with the couger few nights back and she went out to help the dog which was hurt by the couger. She was bitten by one of them and she didn't realize who it was as it was in middle of night.I was shell shocked listening to her casually telling me that she was bitten by a couger or her dog in the middle of night out of nowhere a week ago.I started looking at the wound on the only leg that's left. There is a gaping wound on the calf with swelling surrounding it. I asked her why it took so long for her to seek medical care. She told me that there is no one to take care of her sheep or dogs and she has been cleaning the wound and applying some antibiotic cream that she had it. She wasn't planning to come to ER,but after she noticed swelling and pus coming out of the wound two days back she decided on showing up. Its around 2 in the morning and I was with this lady with one leg thats bitten by a couger. I thought to myself why? Why in the middle of the night did she think of coming to ER after waiting for 8 days. I couldn't hold my slight anger(frustration)and asked her.Ms. So and so told me that she and her husband were seperated and that her ex husband agreed to come and bring her to ER after getting off work.

As I started working on her wound I realized that her self treatment with daily cleaning with soap,peroxide and dressing kept the wound from extending to underlying muscle.although the wound is around 5-6 cm deep,It only stayed in the subcutaneous fat that this pt has in excess all over the body. I debrided the wound and took off the dead tissue. By the end of the procedure,I was tired and sleepy .To keep myself awake I asked her why she is living in middle of nowhere as I couldnt help but notice her her language devoid of thick southern accent.She started telling me her story,while I worked on the wound dressing. She was from california and her ex husband was from Florida. They met through online dating way back in late 90's. They decided to get married and settle down. But where to settle down was an important question for them.Both wanted to settle down in a rural area away from the urban area where they grew up,but weren't sure where to go. They came up with an idea of rolling the dice on the Map of USA. She wasnt sure who got the idea and whether alcohol was involved or not. Anyways they rolled the dice and it landed in the middle of Quachita mountains. So they decided to move there.They brought 40 acres of land in middle of the forest and lived together for 15 years.They raised sheep,vegetables and other things. Unfortunately things didn't turn out well and they separated few years ago. While her husband moved out, she stayed back and continued to raise the sheep and live by her self.they still stay in touch and are good friends.

By the end of her story I was spell bound by how her life took turns,all starting after rolling a dice.I asked her if she ever thought it was right idea.With out hesitation she said "no". She said she enjoyed most of the time living like that but her recent health problems including diabetes complications leading to ampution of her left leg and having to live by herself,she doesn't think she can stay there for a longer time.I thought about her free sprit and mental strength to keep going and wondered if I ever could do that. I realized I am too accustomed to material comforts that I am complaining about seat warmer in my car.

I told the patient that she doesn't needs to be admitted but needs oral antibiotics and should follow up with her doctor in one week. She was worried and wanted to know if she needs to be admitted. Her ex husband dropped her and went back to take care of her home. After explaining her how to take care if the wound and no need to worry she agreed to go home.while she waited for her husband to drive back and pick, I started working on my trauma patient who had enough alcohol in his blood,that kept his pain well controlled.he fractured his left forearm. The last few hours of the night kept going with patients and finally at 6.30 I was able to clear the ER. I am so ready to go home and sleep. But I have another 90 mins of travel. After pouring myself another big jug of coffee, I rolled out of ER. On my way I saw on the many dirt roads and thought about rolling the dice,but my seat warmer is too comfortable for me.

What Smells do you like?

Fall Colors

Fall has come to Ann Arbor so early. Its getting chilly and the trees are changing to the fall colors.This short but sweet blossom of colors lifts up the spirits of any one after a tiring day.

Today after coming back from work, me and my roomie took some snaps of the changing fall colors.Its a scenery to behold. Guess this is final period to rejoice the surroundings before the gloomy winters takes away the fun.

Pretty Leaves
Pretty leaves are falling down,
Green, orange, yellow and brown.
Here comes one colored red,
It landed on my head.

In autumn when the trees are brown
The little leaves come tumbling down
They do not make the slightest sound
But lie so quietly on the ground
Until the wind comes puffing by
And blows them off towards the sky.

Rants

life's journeys are more fun when your moral compass hangs in front of you and swings with each step.Every one have their moments in life when they want to vent out the anger on some one who really pisses them off.

Here are my favorite things to say to some one that got on to your nerves.Its just hilarious and wondering how could people be so innovative in cussing.I haven't used any of these sentences until now and don't see an opportunity to use them in near future. I collected these artistic descriptions from various blogs.All the effort goes to the authors of these absolutely entertaining blogs like hot chicks with douche bags, passive aggressive notes etc.I just collected them from these blogs which I thought I could share with my friends.

here it goes
1)Your face is like a three day old loaf of pumpernickle rye after being urinated on by feral wolves and then masticated by a toothless billy goat.
2)You have become what you beheld, and no amount of ironic name moniker will save you from the fact you are driftwood monkey poo on a sea of crystalline narcissism and overhyped redundancies.

Who cannot laugh at yo mama jokes?here are some I collected over from twitter.
Yo momma so ugly, she make goatse cry for a unicorn chaser. (@xenijardin)
Yo momma so fat THX can't even surround her. (@mustardhamsters)
Yo momma so dumb, she went to the dentist and asked for a bluetooth.(@seanbonner)
Yo momma so stupid, she thinks the Large Hadron Collider is a gay porn film.(@xenijardin)
Yo momma's so big and ugly she lies dreaming in R'lyeh.(@Orlovsky)
Yo momma so fat she doesn't just have a low center of gravity, she has an elliptical orbit.(@seanmoriva)
Yo momma so old, she's an arguing point between Creationists and Evolutionists. (@Nightwyrm)
Yo Momma so fat, even Ralph Lauren's Photoshop team can't help her ass. (@rawkreative)
Yo momma so old she goes on carbon dates. (@sfslim)
Yo momma so dense she got her own event horizon. (@sfslim)
Yo momma so weak physicists have unified her with electromagnetism. (@sfslim)
Your momma is so fat NASA shot a rocket into her ass looking for water. (@tbias)
Yo momma so fat, she took geometry in high school just cause she heard there was gonna be some pi. (@MatthewMors)
Yo mamma so fat, China uses her to block the internet. (@thelizupdate )

This was a small effort to bring some smile on my friends faces who are going through some tense phase in life.Good luck all and every thing would be alright.

"No"

As difficult as for me to say "NO" to any thing its even more difficult for me to accept a "NO".
Alas its me and its the life.

Where are you going

Do you don't know what you don't know?

Chatting up with my friend Rajesh at work is always fun and quiet often you hear some golden quotations.Today morning he mentioned about this quote,that he read some where.The origin's of this quote really don't matter, for what we need is the awesomeness of the meaning behind these four questions. Here is the quote

"Do you know what you know?

Do you know what you don't know?

Do you don't know what you know?

Do you don't know what you don't know?"

     This quote with use of few words but with deep sense of philosophy changes the depth of the understanding of the things that happen in our life.

     I felt the last sentence "Do you don't know what you don't know?" is the most difficult of the situation one could face and realizing that what effects it had on our lives.In this age of vast amounts of knowledge and google, I am quite sure that like me ,many of us still don't know what we don't know.It does sound scary thinking of how our past deeds with our minuscule knowledge and ignorance have effected the way  our lives run.

Alas this simple quote humbles the humans  grandeur and pseudo security of how much we know and throws us to the ground from that pedestal we created, trumpeting ourselves about advancement in technology.

As an afterthought,I am still wondering what should I do to face the final question and answer it as yes.I am  pretty much sure the answer would always be no forever.Life is a big mystery and full of surprises.

Out of Mind experience

The term lazy Sunday afternoon is a metaphor for me as its that time of week when my thoughts sit down for the round table conference to discuss and argue what they want to do in my life in coming days,weeks and years.Its an intense debate among the thoughts each arguing with their past experiences and their future predictions.

Here I am watching the discussion going through twists and turns and judging them how they put up their case.They start of their debate with the best foot forward to impress me.One is asking me to keep going since it argues that if feeling down and depressed about problems being faced in life could bring an end to them,then there is a point to be sad,but its not the case. So it is asking me to face them with strong will.Then the other thought came out with the argument that a will is as strong as what the mind feels.The human mind is like a honey bee.It works hard to gather and relish the honey i.e the sweet taste of success.if the mind can not get its honey even after going through long distances and hurdles then the mind gradually starts dying from inside and starts feeling down and depressed like a honey comb with depleting honey stores.It looks normal from out side but the honey stores are getting empty.The mind gradually starts loosing its ability to generate ideas to look for the ways to gather the sweet taste of success.

Then a new thought came up with the argument that like a honey bee during difficult times when its difficult to get honey it survives by feeding on the honey in the honey comb and starts looking at different places which it never explored before.With out the honey it would not have survived to explore these areas and find new ways to get the honey.Same is the human mind,when faced with adversities in our life it gathers courage and support from the success it has achieved in life till then to replenish it self and scour further for success.The frustration and depression are like the wasps that attack the honey comb when the honey bees are weak.If the honey bees don’t feed on the honey stores in the comb,they would not have enough strength to face and repel the wasps.All the thoughts agreed to this point and I being the judge seeing the proceedings through my out of mind experience was impressed.

I gave my judgment favoring the thought of keep going and face the difficulties with strong will.My out of mind experience is over and my mind is tired after the intense debate.I am making a cup of tea with honey for my Sunday afternoon late tea.

What’s about Slumdog Millionaire?

I am an avid fan of Danny Boyle movies and his new movie Slum dog Millionaire is by far the best from Boyle.Although the movie opened early November it didn’t get much attention initially but gradually by December it won the accolades from general audience as well as critics.I watched it in December and I was really impressed by the way he depicted the story a young boy from slum in Mumbai.The audience  gave a standing ovation after the movie.

The story depicted the sad but the ground reality of the poverty and struggle for survival in one of the biggest slums in the world.The  movie’s real strength was the realistic depiction of young kids being forced in to child labor and more horrendously the way they are handicapped and thrown in to streets for begging and prostitution.It also portrayed the hope and love that triumph in the most difficult of the times.

It was destined to won many awards and I was exalted when it won four golden globe awards including the best music score by an A.R Rehman , the first Indian to win a Golden globe award.I was going  through the reviews of the movie and I came across this article that some of the Indian audiences didn’t like the portrayal of India in such a poor light exposing the underbelly of poverty that’s right next to the sprawling buildings which represent the surging  Indian economy.Even couple of my friends argued that the film showed only the negative side with out showing the positive aspects that India is experiencing.

I feel that we are missing the whole point of film making.First of all the film is based on a novel written by an Indian and Boyle did an excellent job of making a movie on that story and portraying  the reality.the story indeed is a saga of struggle, hope and love in the slums of Mumbai.The  argument that  positive aspects were not showed in the movie sounds absurd,when the whole movie is about the young boy’s  life  and his hope that carried him to meet his lady love.The movie is not some feel good movie that shows lives of people being perfect with all the happiness in their lives.A good movie can only  be made when the director makes a movie according to what the story demands rather than making a story for what the movie demands.

I feel that those who are arguing against the movie don’t realize the sad reality that these are the things that every common man faces in his life.Is it not true that children are being trafficked in to flesh trade, begging, drug business.The movie got enough media attention for highlighting the plight of the children in slums of India.This would  help in mounting pressure on  the government to tackle these issues and bring about necessary reforms and laws to eradicate this evil.Its a sad thing that,although many Indian directors showed the ugly side, they didn’t get western media attention.

The other argument that the western media portrays India in a stereotypical fashion of land of elephants, yogis and snake charmers  and poverty and this movie is no different is wrong.although it showed the poverty,the depiction of the elements of  love, hope and struggle in the lives and how  they overcome the adversities gives us enough inspiration to think about the various aspects in our lives that we take them for granted.

 

Technorati Tags: India,Movie. Slumdog Millionaire,Danny Boyle,Mumbai,A.R.Rehman.

My Sweet Simbha

She came in to our life about 2 years ago.When I first saw the sweet little thing for the first time, I fell in love right at that moment.It was the cutest pup I had ever seen.

Me and my brother thought of bringing a pet in to our family,but we were not sure how they would react to the idea of pet.But we were sure that my parents would love it once it comes in.So I took Simbha, well that was the name we kept to our Labrador puppy we bought.My brother suggested the name.

When I first brought Simbha it was 30 days old,just weaned off mother’s milk.I took a bus to my home town, the same day as I wanted to give surprise to my parents.I carried Simbha in a basket and all through the journey I kept the box on my lap.Since it was first time that Simbha was out in to outside environment,it didn’t sleep the whole night,so did I.

When my parents saw Simbha for the first time, they had mixed feelings.they liked the cute looks and when it ran towards mommy as soon I let loose her, know they are going to love it.But my mother was apprehensive how to raise it in an apartment as the Labrador breed needs lots of space to run around the house and space is a constraint.

here is the first photograph of Simbha when we got it to our home.

Since then the happiness it brought in our family was immense.The unconditional love, the way it greets us when we come back from work relieves all the tensions.

Here are some of the snaps that we took.

Now after two years of coming in to our lives, its like another human .My parents talk to it as if conversing with a person.It listens and understands what ever my parents talk.They have to talk secretly if they are planning to go out.Its crazy for car rides.Every evening when dad comes back from office, it sits near him and makes sounds asking him to take out.The way it jumps around when it sees dad picking up the car keys is one delight to watch.

When ever we call up home, my parents switches on the speaker phone and it recognizes our voice when we call her name and tries to grab the phone from their hands.

I some times feel that may be we humans are lucky to have dogs in our lives because the true love and devotion it shows makes us realize we do not come any way near to it in our relations because of our prejudices, egos and conditional affection.

I am really glad to see my parents happy and stress free,thanks to simbha it removed the lonely feeling in their lives.

 

I am a great fan of Lifehacker blog and I have been experimenting with different applications and softwares they review. I recently read about how the desktop can be customized with different applications like Rocket dock, rainmeter,yahoo widgets( especially Neon Gauges), RK Launcher, Vista OS X.


Here is my modified desktop using the above mentioned applications.

Dock- RK Launcher
Dock Icons- http://skm-industries.deviantart.com/art/Carbon-Gloss-60590949
Clock and Weather- Rainmeter configs
Neon Gauges- Yahoo widgets
OS- Vista Ultimate.

Thanks to Tom0630 from lifehacker for the amazing idea. Do let me know about your opinions with your comments.

Desktop Modification

I am a great fan of Lifehacker blog and I have been experimenting with different applications and soft wares that they review.I recently read about how the desktop can be customized with different applications like Rocket dock, rainmeter,yahoo widgets( especially Neon Gauges), RK Launcher, Vista OS X.





Here is my modified desktop using the above mentioned applications.

Dock- RK Launcher
Dock Icons- http://skm-industries.deviantart.com/art/Carbon-Gloss-60590949
Clock and Weather- Rainmeter configs
Neon Gauges- Yahoo wodgets
OS- Vista Ultimate.

Thanks to Tom0630 from lifehacker for the amazing idea.Do let me know about your opinions with your comments.

Merry Christmas and a wonderful new year.

Doctors opinion on their profession

Abject apologies

Abject apologies I just figured out I have not updated this since petrol was cheaper than a bottle of Grange!... You would not believe I spend all my time in front of a computer. I prostrate myself in sorrow and beg thy forgiveness..

I am distracted with work, commitments, just generally being of great concern to my friends, my day seems to be packed from 8am to 11pm at which point I fall asleep on the couch. I am totally exhausted. life happens.

I wish I will make more of an effort to blog more often. Honestly! No Joke!.

Divide and Rule

Its agreed that the region of Telangana has suffered because of slow pace of development.This I think can be attributed to the callous attitude of the political parties, insufficient natural resources, comparatively less arable land although two rivers flow through this region.But the notion that it suffered at the cost of other regions of Andhra pradesh is outlandish and far from truth.Everyone knows about the perennial drought like conditions in Anantapur, kurnool, Prakasham dists.Even they too lag behind in developmental parameters.Lamenting that the people of Andhra region exploited the conditions in Telangana is totally baseless and false.
I understand the desperate felling in the people of Telangana region . Its high time that the government should keep up the the developmental activities so that the backwardness in the region can disappear.

Our state was the first state to form based on linguistic basis and every one is proud of the culture,dialects we speak in different parts of the state..Its this diversity that brings people closer.This whole issue is raked up the political parties for their own gains rather than for the people.

I don't think a party like TRS which claims that it works for the Telangana people would do any good for the development of this region. When the people of this region gave the mandate to them ,what have they done? Its President Mr.KCR having been in the position of central minister has not done any job for the country or for our state.People voted for TRS to bring development to their regions,not to keep fighting among themselves about who represents Telangana. Just think how much money is wasted because of these forced elections.What is that they want to prove ?That Telnganavadham exists? Or they represent the Telanganavadham. No MLA from that party can claim that they did developmental activities to their constituencies.People are educated and know about the tactics of these political leaders and I hope the government realize the reality and strive for the development of all the backward areas in Andhra Pradesh.

The British ruled and destroyed our country because of their divide and rule policy.If this is what these political parties are doing, they would not stand the misdeeds and people of Andhra Pradesh would show them the door.

God save this country

Lazing around in the home during these forced holidays , I was reading lots of articles about the current political situation in my state and my country.Oh Boy I thought education brings wisdom and knowledge that can make an young mind in to a responsible citizen.But alas I was totally astounded by the lack of interest and laxity of the present day youth in tackling the common problems surrounding them.Why have we become so self centered, egoistic persons.

I came across a few situations where I felt, may be we are selling our souls to meet our goals or ambitions or what ever work we are doing.
Being a doctor myself I am pained to see how insensitive people are when some one needs a helping hand. The typical situation of an ambulance to reach the hospital .Since there is no rule to give way to for emergency vehicles like ambulances, no body cares to give way to these vehicles.Every precious minute lost during the transportation brings the patient nearer to death.Its a loosing battle for the doctors and other medical professionals to revive a patient beyond certain point of time.
I was so anguished at this situation that ,when ever I come across some one obstructing the way for emergency vehicles I shout at them to think themselves or their family members in that ambulance and do what they would have done.Although harsh, I guess our society understands better with a carrot and stick method rather than the usual softer stance.

The other day I went to the barber shop,which I have been going for the last 8 years. Last time after a few month in US, I went to get my hair done, when I heard from them that one of the worker met with an accident involving an electric pole falling in him. Miraculously he survived and was under going physical rehabilitation. Last time when I went there I met him and asked him about the accident. After dropping off his son's lunch box at the school , on the way back home the electricity department was cutting trees.Nobody cautioned the public traveling on the road.A falling tree fell on the electricity line pulling the electric pole ,which fell on this fellow's cycle. It missed his head by a whisker and fell in the bike. The patient was knocked of the cycle and the pole landed on the back. He started bleeding and was unable to move . The surrounding public watched mutely with no one coming forward to pull him from under the pole. Some dumbass told that they should wait for the police to come or else it would be a crime to move the person from the scene of accident.

The Patient waited for full 10 mins before some good Samaritan pulled him out and called the ambulance. It was a miracle that he survived to tell the story and able to walk after suffering a vertebral fracture.

What could be done to bring change to this society which has buried itself and stopped caring for the fellow individuals.If education cannot bring wisdom and the qualities that are needed for making a responsible citizen, probably we should realize that our educational system should be changed and a serious effort be made by the elderly to teach the values to the children.

Simbha's Snaps

My 1st Impressions

People say 1st impressions matter most in judging a new person.Although I don't agree with it in whole I do think that there is some relevance of first impression in this present materialistic world where you are a product and the sales person too wooing others.
Well in all my experiences with new people, I must say the relation ship which develops between two individuals depends more than the first impressions.It depends on the various other factors like the pre conceived notion about a particular individual, which I think we have on every one.The outcome of that particular meeting may be positive or negative on what the other person had in mind about the other before.Suppose if you r going to meet some one whom you thought was head strong,cocky but when the interaction changes your opinion I guess that would build a positive relation b/w individuals.