Making of a Doctor
The nephrology and urology departments were
housed in the basement. The nephrology part was not so bad; It housed a
heterogeneous collection of enormous (swollen with fluid) patients of both
sexes. Most of them had chronic renal
failure for varying reasons. The ones who had acute renal failure either died
or recovered quickly with dialysis. The chronic cases were given
medications as they awaited kidney transplant. Those were early days,
relatives were coerced into donating kidneys, there were no “rackets” and the
success rate was low. Steroids were the mainstay of therapy, and across the
board (male, female, young ,old) they were moon faced and hairy.
The other section was filled with men, most
of them old with prostrate problems. Some came with acute retention of urine,
crying as their bladders painfully filled up with urine they could not void. The
whole place smelled like some one had emptied a can of urine on the floor. Most of the girls did not enjoy their posting
there. Personally if I was not obsessive- compulsive about attendance, I would
have gladly have cut the posting altogether.
The urologists, (almost universally male),
were want to crack jokes which were so far below the belt that they were
practically on the floor.
“Why do antibiotics not work for
vesicovaginal fistula?”
(Women sometimes unfortunately developed
this injury in childbirth. A communication developed between the vagina and the
bladder and they dribbled urine all the time. They also developed frequent
urinary tract infections. This had to be repaired surgically. The success rate
was low and repeated surgery was often required.)
The correct answer to the question was “Because
there is a tigress living there (resistant bacteria).”
“Why did it rain in the circus tent?
Because the trapeze artist had a watering can perineum.” (A urethra with
multiple perforations)
Why is the prostrate enlarged? Not getting enough
sex!”
We were also forced to watch a torturous
procedure called “trans urethral resection of the prostrate (TURP). It was done
through the penis, no one except the surgeon knew what is happening, but we had
to stand around in the air-conditioned, anaesthesia gas leaking theatre for
hours on end. It made me sleepy and sometimes I wheezed. A few of my class mates
ran away to the “surgeons lounge” and slept there. Some ran away altogether and
indulged in caroms and cards in the rest rooms.
Anyway we survived. Since it was not a
separate subject in MBBS examinations (it was a part of surgery), a rudimentary
knowledge was enough. Or so I thought ( a big mistake!)
When I reached internship, we were posted in a
surgical unit with a deaf, misogynist bachelor, a frustrated urologist. He
insisted that every male patient admitted for any surgical procedure have an
evaluation of his post-void urine volume and then a phenol injection into his
prostrate through the perineum if the volume was more than 100 ml. The whole
procedure was disgusting to say the least. The patients were not subsequently
followed up, so no one really knew if they recovered, developed atrophied
prostrates, cancer or died from the sheer pain of the injection.
“We are doing a service to mankind”, he
explained, “these people will not develop benign prostatic hypertrophy (BPH) as
they age. They will not need surgery in the urology department later in life.
(That seemed to be a major incentive.)
This was before the time of proper medical studies
double blind with 10-15 year followup. He was a famous surgeon and his word was law. None of us questioned his
logic. We did not read up about it either. There was no internet. Questioning
his order meant a long trek to the library, a request to the librarian for
journals, a few days wait and then reading relevant or irrelevant data. After
which, the lion had to be faced in his den.
Many years later I did look it up. Apparently, it affects 90% of men by the time
they are eighty. The risk increased with obesity, diabetes and decreased
physical activity. The risk factors seem
to describe most of the middle aged men
in India, so perhaps the injections were a good thing. Maybe there really was a dip in the surgery
rate for BPH for the next 10 years and now that no one is going around
injecting prostrates, there is a resurgence?
The rest of the posting involved mundane
procedures like surgical repairs of hernia and hydrocele. There was also the
occasional adult male circumcision. (The children went to paediatric surgery).
We were allowed to do these procedures as they were considered “minor,” and
they were sent home within a day. There is nothing really minor about any
surgical procedure. Also, no one really told us how much skin is cut off during
a circumcision. The ones my batch did
showed varying grades. (Some had no skin a left at all, others had plenty). An
enthusiastic classmate even nicked off a bit of the tip of the penis. The
patient returned after surgery to enquire about this, and was told that that
was what the surgery was meant to be!
We got away with many things, but I guess
“hands on” is the only way to learn!
Dr. Gita Mathai
The writer is a paediatrician
with a family practice at Vellore.
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