Uh, no, you got the wrong number. This is 9-1…2.

Goof ups are universal- like so many I have seen here in the last couple of weeks. People need to collect and acknowledge them and say, perhaps in the larger perspective, 'guys, today is the first day of the rest of our lives', lets get on.Unfortunately someone has to be fall guy and take blame- coz if there is no one to blame, who gets praise, how does the company improve. Corporate humbug.

Oh...how I wish suckers kept to sucking and did not mechanize every bit of life, air, aerosol into stochastic pigeonhole slots.

Anyways ........ am on Tamiflu....as PEP. This is my fifth PEP session. I have had 2 forHIV, one for HepB, one for rabies- and by far the most expensive one here. If I count the countless tabs of Doxy that i gulped down while leptospirae squished along in the lungs of the chappaled mumbai gentry, this would be my sixth.

Medecines do not affect me in the way they might affect many others. I am so convinced about placebo effect and destiny-epiphenomenon axis being major outcome influencing variables that I can challenge a RCT on me and me clones of any whatchamacallitumab drug compared with M and Ms. Nocebo effect you may call that. But the PLOS metaanalysis of antidepressants makes me wonder- why should it not be ethical to prescribe placebo medications just to make someone 'feel better'

Take away your medicines, and what are you? Omniscient nomojo. So despite the fact that you know that they really don't work, you continue to give Paxil and Abilify - why? You are practising placebo medicine aren't you? Do you know you are?

There's so far to go to even realise that there's so much you do not even know. It is a good habit to learn KCP's stylish deflection " I have treated to as much I know, now it it up to HIM"

DD Ads from the 80s

Have a look. These are the ads we grew up on DD.

Tubaah: Ads by Prahlad Kakkar

Ration card

The PDS system in India has the 'ration card' system so well entrenched- it is a form of identity proof. I do not think it exists any other country.


"--A hospital bed is a parked taxi with the meter running"- Groucho Marx


Read this article about health rationing in the US.

The PDS system in India has the 'ration card' system so well entrenched- it is a form of identity proof. I do not think this exists any other country.It is something we have grown up with, our few liters of kerosene and few bags of rice to keep it going. Then we had gas stoves and microwaves.

To hear the R word in American commontalk is ironical in this land of the HOV meaning 2 people in a car.For all the talk of having access to the best health care in the world, where it gets spent is apparent to see- 1/2 of all the healthcare you have in your life is in your last year of life. In this year of life, on the day that you die, your average life expectancy would have read out as 6 months more, and so the extra spoon of salt tipped your CHF over, or the strain of jumping over the parapet wall increased myocardial oxygen demand > oxygen supply and infarcted the jeopardized myocardium, and you had a heart attack.


Atherosclerosis started in teenage- after that you are just playing a game of hide and seek. That one will not die, or should not die is an insult to the rules that apply. You cannot fool with Insulin pens and Tarceva and play Tweedledee tweedledum with telomerases that build up as you age.


I come from a different type of healthcare system, and to see young patients die of infectious disease illness, for lack of access to good critical care, while Octreotide is being pumped in day in and out to decrease fistula output in a multiinfarct dementia patient makes me sneer sometimes in irony at the refrain, " whats a life worth"

I would mention-we need to ration moneys all over the world- the apalling disparities are out of sight, out of mind for the ones that demand FULL CODE.

Think of a flu pandemic with acute respiratory illnesses overwhelming the number of ICU beds available.I would think of lives saved, then QAL saved than QALY saved.when deciding who needed to come to the ICU when beds are less.

I found this hard to explain to a foreign medical student who was visiting during my residency in India- we aren't Gods who mete and dole, no one is losing his dignity in being told that it is the end of the road for him and that we do not have anything to offer, or to eat and sleep well and not worry about advanced HIV/AIDS which will kill him one day, for buying medicines for that is 10 times more expensive than his monthly income. My intentions are as noble as Bill Gates', but I don't have a fraction of his chauffeur's fortune.

If I have 10 syringes and 20 pts- I have to decide who needs a test and who does not. If I have 200 syringes and ten patients i decide how many different tests I can run on each patient as 'work up", If I have 20 syringes and 10 patients ( and were in America) I will decide which 3-4 pts need all the "work up", whereas if I were in Canada i will be racking my brain deciding what 2 tests to do in the 10 pts.

She got the drift of it.


Image from original article

What are the chances.......

That this daily run of the mill random patient that you  see in the ER with all the pattern of symptoms that have become second nature to you to slot and eal with, is an initial manifestation of a rare syndrome that you existed only in the small paragraphs of the end of the chapter in Harrison that you never read? 

That would depend on the questions you ask I guess. No one comes to the doctor saying I have Langerhans cell histiocytosis or MELAS. You could be very comfortable treating these guys as "COPD exacerbation" or "young stroke with negative work up" and never know for once whats going on. It runs well with your spiel of things- protocol done, rehab worked out, patient feels well, D/C to nursing home. 

You could very well put it the other way around and ask, well......WHAT ARE the  chances?

Well.....it all depends on the questions you ask.

Full code

Some day the old guy with multiinfarct dementia with PEG tubes pumping tasteless Jevity 1.5 into his stomach, trach to breathe, multiple aspirations of garden variety flora , MRSA in his maniacal decubiti, VRE in his pee and shit thats C difficult to solidify, will wake up and live his life.

The life where he could get out and smoke some hash , sell some Percocet on the street to add to his income from disability /social security checks , get mugged/shot/stabbed walking home with the booty- all this while battling his chest pain that someone told was from the coke- bah those guys, its the itch from his sternotomy sutures, nothing more- and making occasional visits to the dialysis center, suffering for some stupid genes that his ancestors handled him besides plus size jeans thats family heirloom , battling the stupid BiPAP machine at night when sweet love slept with her own.

That life beckons to him - he craves to get up and move on. It is more than just a sexually transmitted disease, or an accidental collision between sperm and ovum with randomness of Heisenberg or phylogenetic boohah.

You can choose life, choose a job, choose career, Choose a family. Choose a fucking big television, choose washing machines, cars, compact disc players and electrical tin openers. Choose good health, low cholesterol, and dental insurance. Choose fixed interest mortgage repayments. Choose a starter home. Choose your friends.

Or you can choose to live life this way and never die.Because them guys told em all "to do everything."
Just as he did everything man.

Italicised material by Mark Renton from Trainspotting

I am.........

Mulling over lots of things...........,

Waiting to get some time to myself.........,

Checking lab values on my CCU patients, half guilty to be on Mozilla and Azyxxi at the same time....,

Eating Graham's crackers and snack biscuits with Sumatra coffee to keep me awake...,

Thinking about points of no return and then thinking maybe it is all relative to which direction you are pointed to initially...........,

Wondering where my reading habits went....,

Trying to read end of life care from the UMMC website, arguing with microcerebrate ER nurses, correcting Calcium,Mag,phos on phone-wondering about whether it really matters in the end to have pristine numbers on your metabolic facebook page......,

Still getting a hang of: - living amidst the panicogens of C diff-MRSA-VRE-ESBL than Kochs ; Percocet- Dilaudid-Darvon than Fortwin-Phenergan........,

Waiting for warmer weather, longer days........,

Moving, or trying to...from laissez-faire mode to hitch hiking mode.....,

Wishful I had my own books here, planning my MRCP, also wanting to do a part time masters, struggling to keep up with my research modules..........,

Flipped out at how someone can have a Minnesota tube shoved in for 2 days, have 30 pRBCs and countless FFPs transfused, still bleed like a tap at endo, and finally be made comfort care, never awaken and die......,

mulling over a lot of things..........,


Essentially.

The rest of ......being.....or not being

Quite as much as I sometimes regret not learning Shakespeare and English poetry from tatha while he was alive- I was weak in maths and needed my dose of Hall and Knight to kindle my left brain too , I also am thankful to some of my teachers who chose to rush through the State board books so that they could teach us some' real stuff'.

I have never met Ms Ramaswamy later, but the pains she took to etch Othello's soliloquy " It is the cause, It is the cause, my soul......" into my memory, or the para by para pauses she took while we painfully trundled through Wilkie Collins' Chandraphattar, or when she let me do my stuff when I differed from what she advised- and ended up hopelessly wrong, all, quite make her the best teacher I have had.

Was reading the rest of the lines after the most quoted lines of Hamlet. We were taught just the first four lines....and I thought that was it. I figured out that the rest was too heavy on existentialist stuff...too much for 8th graders. But then for blogPOST- erity, here goes:

To be, or not to be, that is the question:
Whether 'tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them. To die—to sleep,
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to: 'tis a consummation
Devoutly to be wish'd. To die, to sleep;
To sleep, perchance to dream—ay, there's the rub:
For in that sleep of death what dreams may come,
When we have shuffled off this mortal coil,
Must give us pause—there's the respect
That makes calamity of so long life.
For who would bear the whips and scorns of time,
Th'oppressor's wrong, the proud man's contumely,
The pangs of dispriz'd love, the law's delay,
The insolence of office, and the spurns
That patient merit of th'unworthy takes,
When he himself might his quietus make
With a bare bodkin? Who would fardels bear,
To grunt and sweat under a weary life,
But that the dread of something after death,
The undiscovere'd country, from whose bourn
No traveller returns, puzzles the will,
And makes us rather bear those ills we have
Than fly to others that we know not of?
Thus conscience does make cowards of us all,
And thus the native hue of resolution
Is sicklied o'er with the pale cast of thought,
And enterprises of great pitch and moment
With this regard their currents turn awry
And lose the name of action.