You Look!

You look heavenly “he said”.

I gushed with estrogen.

You look old “he said”.

I gushed with epinephrine.

You look constipated “he said”.

I gushed with less thyroid hormones.

You look Pale “he said”.

I gushed with RBC’s lacking Iron.

You look worried “he said”.

I gushed with less serotonin.

You look expressionless “he said”.

I guessed I had Parkinson’s.

You look like Angelina Jolie “he said”.

I gushed with excess histamine release from an anaphylactic shock.

You look like you have a butterfly on your face “he said”.

I gushed with excess auto antibodies from SLE.

You look  hot, hot, hot, “he said”.

I guessed this was the last time I see him. He will never know what I took! ( Hint: Atropine OD)

The list is endless folks! As medical science is not limited and so is my poetry. Hope you guys liked it!

Case A

Ever since I got the opportunity to work in the ER, I have decided to save the interesting cases on my blog for future references. Here’s one case that needs further discussion.

Case A

Female around her mid thirties presented to the ER with a three day history of acute watery diarrhea with multiple episodes of non-projectile vomiting. She was admitted in a local hospital where she received IV fluids and her routine labs showed increased Creatinine level with normal urea counts. On the third day, she started to develop rashes which where mostly predominant on the feet and legs and had a distal to proximal presentation. The rash was papule like, non-tender and not itchy. Her drug history showed that she denied any medication in the previous hospital. She is non-diabetic and non-hypertensive and no use of any drugs with the exception of omeprazole. No history of alcohol abuse and smoking. She is Multigravida with normal menstrual cycles and LMP was few weeks prior to consult. On Examination she was anemic with IV Canula in Situ. Her systemic findings were unremarkable. Her current urine output and input could not be assessed as she had no proper recording prior. Her diarrhea frequencies has decreased and now she had concerns about the rash. Her labs were sent and found that she had a low platelet count, around thirty thousand in amount with normal TLC counts. She was also positive for antibodies to Dengue, APPT was prolonged with a normal INR and creatinine levels were increasing since the last lab reports. Her routine urine examination showed plenty erythrocytes with Pus cells amounting to be less than 2/HUFF. Her D-Dimer was positive with a increase to around 1.7 mg/L. Her serology was negative.

A) What is your Plan?

B) What can be done to prevent further platelet fall?

10355380_10152350235491906_6406720956607796328_nC) What is your probable Diagnosis?

Medical Officer Diaries

“Can’t you stay back in Dhaka?” An old patient asked me during my Ophthalmology rotation when I was in medical school. I politely answered, “I have so much work to do in my country.” While sitting on a chair in my two-bedded room in Dhaka, I had always dreamt about working in Nepal and making a difference for my people. Ever since my arrival in April, I have been trying to make that dream come true. It is very easy to give other people advice or write about how one can make a difference but it is indeed very challenging to implement your values and principles.

We, humans, are subject to greed, comfort and leisure and that pushes us back at a time when we have to make radical decisions in life. When one wants to jump into a road never taken before, one has to think about a whole lot of things, and usually, one comes to a conclusion that life is better when you have loved ones around you. Why leave the comfort zone?

The work is the exact directory of what we were taught in medical school but it comes with politeness and behavior. It requires you to show your dedication on a daily basis and it rewards you accordingly. The shortage of Medical officers is a new uncharted topic that most people never touch upon. It is hard to find people who decide to work after completing their medical school. It is a huge commitment plan that doctors make on the basis of various statistical data and family pressure. Earning a degree and not working is considered worthless in the eyes of the society. A medical officer learns how to follow a consultant and how to stay in a boundary. There comes a point within a month and year when a medical officer starts rejecting the peers of being the third in line to treat a patient.

How can a hospital tap a medical officers potential? Well it depends on the institute they work for. Medical college hospitals try  as much to utilize the capability of their medical officers whereas private hospitals just make them their mediators between patients and consultants. Education wise you need a specialization to survive and avoid any insecurity about what and how you can make a difference.

Competitive examinations carried out in Nepal are not sufficient for the larger majorities of graduates. With just hundred seats in IOM and five thousand applicants it is less likely you will be hitting the jackpot with insufficient studying capacity. The learning curve studied in com med class is not helpful at all as it keeps reminding you to learn at a tender age before its too late or is it? When my senior suggested that he worked as a MO for four years before he tapped a major examination is worth reconsidering. Writing has always pushed me to become a better person and yet this is might push me achieve the dream that I evolved over five years.

What To Do Next? Part -I


“The best time to plant a tree is always twenty years ago. If for some reason, you did not plant it then, the next best time to plant a tree is now”.

I had involuntarily shared my interest to become a doctor to Kitty. She was a replica of Anne Frank diary. Most people obtain habits from influences with human relationships; I made my influences limited to books and novels. I tried to be regular at it, but often had to apologize to Kitty when I exceed a week or two.

This winter break when I got the opportunity to flip through those pages again, I realized that at 16, I had decided what my next 20 years would be like. At 16, I was locked in the boundaries of Saudi Arabia. Inspirations were showered through the Indian system of knowledge and I thought I would attain the highest attainable degree in the world like most of my friends, who discussed and shared their higher level of thinking in the lunch hour.

Two years after I departed from Saudi Arabia to finish my junior school, I was lost. I was not sure what I wanted in life. My dreams were fading and I was drifting. My dreams were not nurtured and motivated to that level. Then by the grace of the Nepalese Government, we decided to move to Dhaka. “Med school is cheap in Dhaka”, is what they said. People around me motivated me after that, they helped me to map out my dreams and they enhanced it with “pride” and called it a “great respect for our family” if I decided to go to a med school.

Plans are meant to be thought, processed, assimilated, digested and beaten up until something new emerges. That’s called life. You can’t map out your life like a building block but, you should have the courage to dream big, no matter what people have to say to you. Dreaming is your right and no one should rob you of that.

Turning into a general physician was my goal and after nearly two decades of unknowingly what life direction I would go, I completed it. But even after completing one goal, I am hungry for more. Life right now seems so undirected. I need a goal and a new direction. Where would I go, what would I do?

I cannot limit myself to just a “general physician.” I want more! Most people decide to choose London or Canada for under graduation. But I choose Bangladesh with full cooperation and with hundred percent certainty that my life would be different, if I choose to stay in a third world country. I would turn out to be humble and I would stay ground to earth if I choose to feel the pain and suffering of the normal people. I still remember how I had to convince my parents that leaving me in Bangladesh would one day make them proud parents. “Let me suffer today” I said and later on, I can get all the happiness in the world. Plant your dream today, who knows ?,it, might come true. I don’t write to Kitty anymore but she played a very crucial role in my life.

Overrated junior doctors!

There was no hesitation when I decided to do MBBS, nearly five and half years back. I just left what normal kids do during my age, giving SATs, applying colleges abroad but “No” I was so fixated to one and only goal to get a better GPA and proceed to a med school. Little did I know that life would change forever after finishing that degree! Professional wise, I am still a needle in haystack, a junior, a learner but yet the society gives it a highest accord available. Society overrates junior doctors!

No, I am not an almighty! If prescribing simple over the counter medicines makes me get the same status as of a god then I decline to get that decree. I am as normal as most people, at least, I try to show that I am normal. There are days when I am painstaking waiting for the clock to strike to two thirty and leave from work.

Education wise, I may have proved myself but the professionalism attached to being a doctor has still not gotten in my veins. Being a doctor is pretty similar to business men of any kind. The only difference is that businessmen would sell merchandise of any sort and doctors sell medicine and treatment to save lives.

Things like what it means to be a doctor aren’t taught in med school. Factors like how you treat patients are not taught in med school, which makes us come to the conclusion that the personality that you had or developed over the years becomes the highlight of your career. Since med school caters less to what most med students are like, those that have the objectively unsuitable personlaity do not get filtered in the process.

Personality is cumulative of what parents teach at home and how they confidently project it to the society. There were several days, when I struggled to be people friendly. It was not a smooth teenage hood, cracking out of the self made delusion of being the superior individual was the first step. The following steps involved, engaging with everyone in an event, including those people that you always thought were mean to you and the last is the art of pleasing people instantly.

So how did a people pleasing person have doubts about being perfect for the job?  Every day is an event, every minute is a gala event now-and-then there are moments, when I completely want to forget that I can be an instant charmer. It’s stressful as it is and communication is another factor which detaches me from making a connection.

Five and half years of med school has made us to excel at collecting information and storing  them in our memory but it fails to produce quality doctors. Med schools cannot make there student’s realize what it means to be “practicing”. The power to execute a decision, actual duty hours, and endless patients to please are not as easy as they show in television sitcoms.

Med school should filter student’s worth of the job of empathy and should introduce actual internship related job earlier than the course offers (for this, my organization Health Nepal Foundation, will be focusing in the upcoming years), otherwise countries will produce doctors with the highest record of burnout physicians!

Parents, Patriotism, Point!

I am a student!

student is a learner, or someone who attends an educational institution. I am a student, have been since four. My parents graciously allowed me to be a student..I am so lucky to be literate and be able to decide what I want to be. So what makes me write this? Its 2:30 AM when I am fighting with sleep and memorization, I ask myself “Who am I?” I could easily answer by saying my name, my address, my father’s name but at that instant the words that were uttered were ” I am a Student ..a Medical student.”

This phase that we have before assuming our responsibilities is what many people called the most amazing time of  life. Some of them say “we had a blast in college  …the craziest time of my life,’ etc. Many medical students answer by saying “It was full of countless days of sleeplessness and stress”. I am not bragging about the stress that we go through but just to prove a point that we lead a very abnormal life.

While some of us enjoy as much as we can, there are some of us who are busy  in actually utilizing their youth towards their countries development and some of us are busy writing articles like this one. If I am correct, 80% of the youth are interested to have fun and 20% actually do something substantial for their country and for themselves. I don’t mean to imply that the majority lack love for their country but they are not ready to carry the burden of being patriotic. Ask me which group I fall into? I would say neither. Can you see a wingless bird fly in the sky; well let’s say I am one of them. By the time I realized what patriotism was, my wings were clipped off, but luckily I can grow them back.

Lack of proper motivation from home and from college is the real culprit. To motivate a person, you require attraction, a worthy leader to guide you and finally assure them that a reward is waiting. What most parents do is break this chain and give them the reward beforehand. That doesn’t make them the culprit either; it just proves that they want more for their child, more than what they had when they were young. This overwhelming love is satisfaction for them but a downfall for their children.

We all have our own experiences and good memories about college and high school. We gather knowledge on how to survive and be independent. We learn hard facts about life and mature accordingly. I accept that we are “Nobody” right now, don’t have a bank balance, we eat cheap food available in the menu, wear the same clothes over and over again. We walk more and travel in the local bus. At the end of the day when you finish your dad’s money and get broke, you ask yourself “why didn’t I save that extra money?” and often do more “window shopping” and dream of buying everything in that store one day.



Motherhood South-East Asia

I recently had my twenty four hour work shift, it went well, if you asked. The very idea of nurses calling me up in the middle of the night several times was quite annoying to a certain extent but then I knew this was the price of getting into MBBS.

I had the opportunity of being the keen observer of the hospital, starting off with various wards, which I have not been posted, yet. The very striking ward was the antenatal ward, where most pregnant women, who are close to their due dates, were getting admitted. The ward is over loaded with women and it seems that Bangladesh is a baby producing factory.

As I was being an intern and checking the vitals (that basically sums up my work), I came across a lady, she was in her early forties and she was happy to be pregnant, when enquired about her choice to conceive a baby at such an old age, she gleefully said that it was “Allah” given. Similarly, I attended a patient who will be receiving chemotherapy for cervical cancer, (she has seven children), and she gives a very similar answer.

There is no control of birth; unmet need for family planning has made things worse for those that want to keep the maternal health status high up. The maternal health condition in Bangladesh is well versed than in Nepal even though things like birth spacing and use of contraceptives when husband is away are easily missed by women.

Most women are not familiar with the term of antenatal check up. Although, WHO has made it mandatory for pregnant women to take at least minimum 3 check ups, women are still not aware of such polices, instead, they seek medical attention when their due date arrives. What is the reason for policy making when health education is in limbo?

The process of pregnancy is a very important decision that equally both partners have a say in, but most women that I have encountered were either pressurized by their family or the husband himself or the hypocritical silent society that we are a part of.  Educating pregnant women about the birth process or informing her about how her body will change as pregnancy advances are keynote targets to save the extra patient load that most government institutions clearly fail to show interest.

Healthcare policy making is just a tool for the government to show that it abides by WHO, there are still patients who never get any antennal check up done, even if they did claim to get checked, its by a quack, when asked if she has done the basic investigations, she declines and even further she cannot even recall taking any iron pills!

This is the situation in hand, we live in the 21st century where neighboring countries are becoming super-giants in arms and ammunition and yet a primary care general physician has to face “Death of the patient- severe blood loss (Post-partum hemorrhage)!”