WARD DUTIES – It’s the beginning of real tough work.

Part 1- The cardiac ward:

( The cardiac ward offers the best view in the campus)

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2nd October 2013.

Not even a single person in our batch of 100, will forget what is perhaps the most significant day of our lives. I was 17 – young, shy, and a very much pampered, sensitive girl, who would definitely get lost, when left to herself, even with GPS (If you are curious, I still get lost without GPS! Well, I definitely call that an improvement). It was this girl who was enrolled in a Med school some 300 kms from her hometown, with the only aim – to pursue medical education.

It’s been a really long but an absolutely memorable journey, of what we call as the best time of our lives:

• Six birthdays,
• Five and a half years of medical education,
• Four university exams (24 papers),
• Three years of clinical postings, two phases (one as a student and the other as an Intern) and everything towards the
• One final degree “Bachelor of Medicine and Bachelor of Surgery(M.B.B.S)” only after which we get to call ourselves as “DOCTORS”.

Now, coming back to 2018. It is the beginning of my ward duties. As expected, I was feeling the excitement of the new duty in store for me.

My first ward was the cardiac ward, the one where the people with heart diseases are admitted. Little did I know that this ward will give me so many memories. So, here we go.

Once you get to learn and understand a subject at a deeper level by reading all the big really-difficult-to-carry- but not-so-difficult-to-understand books, the complexities become really simple. It is the same with the diseases of the cardiovascular system which involves the heart, the arteries and the veins (the hollow muscular elastic tubes which carry pure and impure blood; from and to the heart respectively). At the beginning of the final year of MBBS, we had a quiz on cardiovascular system, so it was the first topic I read in great detail and from that day this specialty occupies a special corner of my heart.

Once you get to learn and understand a subject at a deeper level by reading all the big really-difficult-to-carry- but not-so-difficult-to-understand books, the complexities become really simple.

We all have a pump, a four chambered, untiring, muscular one, fitted with valves (4, all of which are leak proof) to prevent the blood pumped out from flowing back.

This pump is placed in a very safe place, protected by a bony cage formed by the ribs, separated from the abdominal cavity, which has very different pressure from the thoracic cavity, the separating structure being the diaphragm, and it goes on pumping from the day it was formed, sometime in an embryonic stage, the pumping triggered at the required rate and rhythm by electrical activity which is spontaneous and the energy for pumping provided by ATP. The cause of all woes – the poor heart.

Well, that’s a teeny bit of cardiology. It is a universally known fact that cardiovascular diseases are rampant in the developed world and the incidence is increasing exponentially in the developing world as they move towards the developed state with the adoption of similar dietary and lifestyle practices.

One day, only one day at the cardiology department will make you witness and lament on the actual extent of this really serious issue. The number of people who present with cardiac arrest to the ER, the people getting admitted to cardiac critical care unit, the number requiring interventions and the number ending up in open heart surgery and the number coming for routine checkups to the OPD are all really very huge numbers. And so are sudden deaths due to cardiac arrest.

When we have ward duties we are supposed to receive the handover from the previous interns who were posted there. CRRI stands for “Compulsory Rotatory Residential Internship”. That’s what we are. We are rotated between departments.

Even the handover from the previous interns posted there regarding the patients in cardiac ward made me feel dizzy. The cardiac unit in our institution is one of the busiest and to think that my ward duties started there, I was elated.

The handover details include the reason for the admission, diagnosis, pending investigations, the course in the hospital, specialist consultations and pending discharge summaries of every single patient.

We receive the patients from the Out-patient department (run by highly qualified cardiologists), most of whom are admitted for coronary angiogram (the procedure where dye is injected into the arteries of the heart, through an access attained through one of the arteries either in the arm or in the leg in order to find out the number, location and degree of block in the arteries supplying the heart which will be done by the interventional cardiologists). It is only after this that it is decided whether placement of one or two stents are adequate or they need an open-heart surgery (which will need a cardiothoracic surgeon).

All the workups for these procedures are the duties of the interns and that includes getting appointments for all the scans and shifting the patients back and forth. We get to learn a lot from every single problem which arises during the process and that’s how it adds to our experience.

Paperwork. You just can’t imagine the amount of paperwork us interns are supposed to do. (The nursing staff have even more paperwork!). Each and every single detail of the course treatment the patient has undergone during his period of admission in the hospital is documented by us and is maintained by the Medical Records Department. Well, as students we were not given even a tiny clue about the paperwork that was in store for us. In the current era of growing medico-legal issues, I guess paperwork is inevitable. It might really save you someday.

Paperwork. You just can’t imagine the amount of paperwork us interns are supposed to do.

This one particular kid will be really hard for me to forget. He was a 17 year old. One look at him and you will guess his age as anything not more than 12. His body did not have the robust development expected of a teenager, on the contrary, his physique was a skeleton covered by skin, all his ribs standing out and his chest wall showing visible pulsations.

His face was pale, and showed great distress as he was finding it difficult to breathe. It was really easy, looking at him to say that there was something seriously wrong with this boy. Merely placing the stethoscope, the hearing aid which has been exclusively customized for our needs, on his chest wall, I could make out harsh and loud sounds, with which we are very much acquainted with. This boy was having cardiac murmurs. He was a child with classical Rheumatic Heart Disease(RHD) with leaky valves, one of the very many diseases specifically haunting the developing countries.

Merely placing the stethoscope, the hearing aid which has been exclusively customized for our needs, on his chest wall, I could make out harsh and loud sounds, with which we are very much acquainted with.

I was angry, really angry, because here was a child who was sick enough to have discontinued school but still the parents did not bother to take him to a hospital till his condition worsened to such a critical state. My anger turned to pity after one look at his mother. It was plain ignorance. She used to bring me pineapples every day because I monitored his blood transfusion. It’s the best gift I have received so far.

My anger turned to pity after one look at his mother. It was plain ignorance.

Before internship, when we read that the duration of antibiotic therapy, for example – infective endocarditis is 6 weeks, we didn’t think anything beyond that. But now, during internship, 6 weeks antibiotics= 6×7 days of around this much expense only for antibiotics. Will this patient be able to afford it? What antibiotic should we choose? A thousand thoughts….

Now, everything we think revolves around the patient undergoing treatment for the particular condition.

When you are a student, it’s really simple: You learn, you gain knowledge and skills, you pass out with flying colors, and if you don’t you fail. But, the working field is not as simple as that. A senior consultant admits a patient, he comes to your ward, then there is a big chain of events involved and if it’s gets stuck somewhere, you are getting nowhere. From being a book worm to have to actually fight in the field. It’s interesting.

In the end the handgrip with teary eyes and the word “Thank You” which comes deep from the heart is worth all the pain.

It is still a long way to reach the position as a consultant where he gets to do ward rounds with a bunch of interns and PGs tagging along him eager to learn from every single word he says, a feel of awe at the amount of knowledge and experience he has and the respect he gets from every single patient.

It is what exactly every intern ( including the enthusiastic me) hopes of becoming someday.