Dr. Geeta Sundar

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This totally happened to me once. I remember it was the first time I was going to do an open appendectomy on my own! Damn, but I was nervous – sweaty palms inside those double gloves, heart beating a dozen a second, thinking of all the ways I could make mistakes – sepsis, fecal fistula, yank the ileum too hard, cut off the cecum, surgical site infection…and so much more. It was double duty night as a bonus and my sleep was long restricted. 

I was talking to myself, urging myself on. I knew this. I could do this. 

Patient laid on the OT table, anesthetized from the waist down, shivering and in his own complex, called out in distress. “You are scaring me! Don’t talk to yourself!”

I had not realised I was loud enough for him to hear me. There in, that moment I understood the one small thing that no one can ever teach you in medical school or residency – i.e – no matter your inner turmoil, or situation, you have to present a confident front to the patient.

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Once, there was news that buses carrying large number of people from a wedding had met with an accident and that one of the buses had overturned, with lot of fatalities. The place of this incident was around 2-3 hour drive from our referral hospital. We were informed of the triage we’d have to be prepared for that night. And boy, did we dig in deep and rush for all the excitement we expected that night. 

We called in favors, got in interns for extra duties, called up friends on sleep time, bought a lot of Red Bull, all possible caffeinated drinks. It was in its own, a splendour – a rare task where all the forces of the hospital – be it medical/surgical/juniors/seniors were all going in hands deep to help this mess, and more most of us, this was our first rodeo at a mass casualty.

The numbers were slow in the rising initially, but then they piled up, long drawn, with multiple casualties and harsh trauma. Each time we thought the patients had dwindled, and were ready to get some sleep/rest, there would be call/page and we’d rush back for another action packed event.

That night was a highlight!

OMG! This really reminds me of that one time when I had a really silly patient who just needed additional information to understand what was being advised. She was admitted with cholecystitis and we had planned her for a laparoscopic cholecystectomy. However, during surgery, due to difficult anatomy and dissection, we had to resort to an open cholecystectomy. Post-operative period was uneventful. And eventually it came for her time of discharge from the hospital. I had advised her soundly about the dressing change for the surgical site and gave instruction about diet changes, follow up etc. 

She came back 10 days later, stinking, with a smell that could be experienced 5 yards away and causing the whole OPD to shudder in repulsion. I took her immediately to the examination room and found an absolute mess of the surgical site – the old discharge day dressing was barely holding on, and the sutures had gotten partially embedded and there was cellulitis around the wound, all surrounded by sticky adhesive.

I was alarmed. When I asked her, she replied as-a-matter-of-fact “You said to take a bath, pour water on it, use a mild soap over it. I did that.” But she hadn’t removed the dressing fully and kept doing the same thing each day. It was a miracle that dressing had even stayed on. 

I realised in that minute that it’s not enough to explain to patients at your level of thinking and it usually involves a lot more than just explaining patiently whilst answering all their questions – I adopted a technique of making each patient/kin do the dressing in front of me and correcting them as they went about it. There is often a big slip between the advice and the action.

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