10

 Dr.Shankara Raman K took extra care to ensure his patients were taken by his post graduate students .In his unit, interns and pgs were supposed to take night rounds and write down details in a log book .They were supposed to inform him over the phone .He asked about specific details of patients who were critically ill. Although a pg and professor did their job. He wanted to ensure nobody cheats up on case details causing inconvenience to his patients. There was a roster made and an intern had to do his or her job.

One such night Avani was checking her patient in the intensive care unit, she came across Dr.Venkateshwara RC who was her brothers classmate.

Dr.Mahendra MG was Dr.Avani's brother. He studied his MBBS from SJR Medical College where Dr.Venkateshwara RC was his classmate. He went to puruse his masters in Surgery from Sullia Medical College while Dr.Venkateshwara RC continued his masters in medicine at SJR.

"So how is Dr.Mahendra M G related to you?" asked Dr.Venkateshwara. Avani said "He is my brother"

"His name is Dr.Mahendra MG and you are Dr.Avani Narasimhan.." uttered Dr.Venkateshwara confused over how siblings can have different surnames

"My mother and his mother are siblings "explained Avani

In Hinduism,we believe that souls are given by the father and bodies are given by mother.So Mothers sisters children are considered as own siblings .However Mother's brother's children are technically are not considered siblings.

"Oh..that way .Are you in Dr.SRK sirs unit?" ."quipped Dr.Venkateshwara.

"Yes.Today is my night rounds" said Avani

"Ok." said Dr.Venkateshwara.

Their conversation ended as briefly as that.Dr.Avani informed her unit chief and returned home.

9

 As the sun set, their OPD hours came to an end . Avani was trying to figure out her duties after OPD .The assistant professors joined their HOD Dr.Shankara Raman K to go to the wards for the evening rounds which started from the emergency.

A part of their unit which included an Assistant professor, Post graduate student and an intern were posted at the emergency during the OPD hours. They would evaluate the patients referred from casualties to their department of medicine and admit them or refer them as per patient’s requirement. 

The Interns job at SJR hospital was very clerical. They had to evaluate ,write down case sheets and collect lab reports manually from the microbiology and pathology labs. They had to follow up cases in the respective wards. More than clinical evaluation ,they had to just manually check pulse and blood pressure of their patients. SJR Medical college was a private medical college .It was mostly their post graduate students who could do learn being doctors. Interns had to tasks as mentioned above. It was assumed that they would do their post graduation. Hence their clinical acumen was less than their counterpart government college students.

Although SJR Medical College was a private medical school funded by generous donations by management quota students, the infrastructure was very inadequate. There were no proper duty rooms for doctors. There was a small room meant for junior doctors which was more of a partition than a room with no toilets. It had no separate rooms for ladies .ECG technicians and other hospital staff used it Hence female doctors avoided it during their night duties and used it only chat with colleagues during intervals in daytime. 

Later Avani learnt from Romilla that there were rooms which could be used by doctors near nurses station. As accommodation was limited ,lady interns had minor tiffs over finding room if their numbers exceeded. Avani's house was close to SJR hospital. Although it was walkable ,she had to use her car at night for safety.

SJR Medical College and hospital were on two different locations.SJR Medical College was faraway from Avani 's home .Only final year students and interns did not visit the premises of medical college as their classes were taken at hospital premises. Avani was gifted a car by her mother during her second year MBBS. She had an accident with her two wheeler in her first year which made her reluctant to use it although she tried to overcome her fear by driving it again. This made her resort to using buses or auto. Avani was from a wealthy family. Her mother ensured she had her driving lessons when she reached 18 years and had gifted her a car.

Avani's parents cared a lot for their daughter .Her father waited near the steps of hospital mortuary awaiting her arrival during night duties to escort her safely back home .(Thankfully ,The hospital mortuary was usually empty as SJR Hospital did not have inhumane rules of keeping patients bodies till their attendants paid up fees.)Her mother also stayed awake during such nights to ensure Avani ate her dinner properly and did not sleep on empty stomach.

 Avani realised that if she persuaded a clinical career ,night duties would be a big burden for her parents as well. Hence she was thinking of not pursuing her second year MBBS dreams of being a unit chief like Dr.Shankar Raman sir and conducting grand rounds leading professors and students parading inside wards and icus.

It wasn't just her parents sacrificing their lives that deterred her ,Avani was a person of mild disposition. The amount of everyday politics and struggles a post graduate student endured made her feel she wasn't fit for the job. She felt she should have taken up another career to suit her personality

8

It was 10 am .Avani was tensed .Romilla could sense it and tried to easen her up saying “Don’t worry Avani, I am there to help you out. I know how are you feeling right now. Its ok, we all get used to this” “Thank you di” replied Avani following her senior as she moved past the wards.

They moved towards the bridge that connected wards to the outpatient department. Romilla di went to the OPD of their Head of the department Dr.SRK asking Avani to sit in whichever cubicle interns place was empty. She sat in  the chamber shared by two assistant professors at the table of Dr.Chandrahas sir .He had taught them when they were students. Dr.SriRam K was a new addition to their college whom she wasn’t familiar with.

Dr.Chandrahas was examining the patient with Fever and cough. On examination, he found that the patient had crepitations on auscultation. So he signalled his interns to listen. He asked Dr.Avani to recognise them. She listened intently. The patient had Velcro crepitations. She told her findings to her  professor. He was impressed. They then ordered for a complete blood count with X-ray for the patient.

Then a lot of patients walked in as the Sun rose up in the sky. Avani was feeling hungry. Thankfully it was lunch time. The OPD was forced shut for half an hour as receptionists explained to patients that doctors were humans who needed to eat. Sometimes patients weren’t understanding that doctors weren’t some sort of machines. They had to understand that even machines need to be filled with fuel.

7

Avani went along with Romilla to the office of Dr.Shankara Raman K whom they fondly referred to as SRK.This office was right in front of their hospital ramp.Three more pg students and four other interns waited outside.As they walked along the ramp Romilla explained how busy it would be that day as it is their OPD day with 36 hour duty. Avani was really scared. She hadn't really thought interns would be having such duty hours. She thought it was only post graduate students. So she had planned not to pursue her post graduation.It was her first day of internship. She hadn't really planned for it . Romilla looked at Avani s anxiety. She said "Don't worry. I understand. It's your first day.I shall help you. Just listen. Don't blabber without asking me as there are a lot of Kamchors in my unit who would use you up.Call me Romilla di from now on.i shall help you "Avani agreed.

Dr.Shankara Raman came at sharp 9 AM. All the post graduate students who were at ease moments ago were all alert. "Do we still have patients in emergency ward ? Are there any new admissions? "He asked."No Sir, none so far.Dr.Rashmika informed us ." said Dr.Ibrahim Khan.
"So , we shall start our rounds with ICU then" said Dr.Raman
Dr.Shankar Raman then led the rounds followed by 2 of his associate professors Dr.Eshwar Chandra, Dr.Keshavan.They were followed by two assistant professors Dr.SriRam K and Dr.Chandrahas D.They were followed by 3 other post graduate students who were followed by 6 interns which included Dr.Avani, Dr.Romilla, Dr.Sana, Dr.Abdul and Dr.Anwesh.They were followed by 12 medical students.This was how grand rounds began on an OPD day.It was almost a procession wherein students dreamed to lead it like Dr.Shankara Raman one day.Dr.Avani had such dreams earlier. However looking at the number of hours of duty and number of years which would take to achieve it.,she was beginning to have other plans.

6

March 3 ,2012,

It was their dream come true day for all those who aspired to be doctors. It was the first day of internship for Avani and her friends. They wore their new aprons with stethoscope around their neck instead of being in their pockets as students. Their name batches had changed .It had become black letters on white background instead of white letters on black background with affix Dr. written across. Dr.Avani Narasimhan, Dr.Ananya Horatti, Dr.Pooja M U,Dr.Abdul Mirza beamed with smile while they walked towards the main hall to look at notice board to view their allotted postings.
Avani was posted to Medicine while her friends were posted to Surgery, Paediatrics and Gynaecology.
As Avani entered Medicine first unit, she was welcomed by the smiling face of her senior Dr.Romilla Das.She congratulated and welcomed them."Hi !I am Dr.Romilla Das ,your senior. Congratulations, welcome to internship. I hope your smile stays like this even next year as mine seems to be fading very soon".Avani did not understand what her senior said. She knew how hierarchy was always respected in Medicine as she said "Hi Ma'am! I am Avani, new intern posted to first unit."
"Hey, you have passed your final year successfully Dr.Avani. From now on always address yourself as doctor with your full name.A lot of doctors will not like it if you say your name like this .Now, come on tell me what is your name from now on "said Dr.Romilla Das.
Avani gleamed at her and said "OK ma'am.Here I go.I am Dr.Avani Narasimhan posted as Intern to first unit Medicine. "
"That's good .Ok come soon, we have to go meet our head of the department Dr.Shankara Raman K, before he begins his rounds at his office.Otherwise he 'll be angry. "

5

The last one month of final year medicine postings was getting over.It was time for third practical internals.Avani and her friends prepared diligently for the next day's practicals.
As usual students made a note of diagnosis of patients admitted in their unit.Then they asked their postgraduate students which of these patients would be alloted to them for examination. It was not just history taking and getting the clinical details that made the students pass their examination. It was their ability to answer questions asked during viva by the examiner and convince their examiner about their "deep" knowledge that got them through. In Avani's angle it was just by God's grace as she landed up with a patient suffering from hemiplegia wherein she had to know details of elaborate examination of central nervous system and know the pathways of the reflexes next day they were being alloted their cases for examination. 
Everyone hoped that don't land up getting a stroke patient who had recovering  in the ward as they felt the testing of nervous system  was the most elaborate and difficult. They had to pick up the chits showing patients bed numbers.As one predicted, Avani ended up getting the examination of nervous system. Dr.Venkateshwara R C was given the responsibility to show the students their bed numbers and give the question papers asking them to examine a particular system. Avani walked towards bed number 32 having a feeling of doom as she read 'Examination of Nervous system '.Dr.Venkateshwara came close to her and whispered "Don't worry. Even I got CNS examination ."He strolled away before she could react.
Dr.Mahesh Murthy was absent that day.So Dr.Yashasvini examined Avani on his behalf.
'Avani why aren't you dressed as usual' asked Dr.Yashasvini.That reminded her that she hadn't put her kajal and lip gloss as she was in a hurry that day.All she did was to dab on some sunscreen as her mother fed her breakfast. 'Oh madam .I was in a hurry this morningshe blurted.She wondered if it was appropriate for her to have blurted to the examiner.
She then clearly answered Dr.Yashasvini and passed her exams.

4

The next day ,Avani and her friends came to their Medicine postings without any preparations as it was seminar by Medicine PG Dr.Venkateshwara R C. As they headed towards seminar hall of unit 5,they were greeted by Dr.Kawatra who smiled at them slyly as he announced 'Guys the seminar has been  cancelled and you are supposed to present a COPD case instead.Bed no 67.'Pooja,Mirza,Ananya and Avani looked at each other as to who is going to present a case for which they haven't studied in detail the previous night.Mirza ventured to ask as to why the seminar has been cancelled. It was told that Dr.Venkateshwara had created a seminar with 80 slides which hadn't gone well with the unit head who wanted a short brief seminar with 30 slides.
Everyone headed to bed no 67 cursing Dr.VRC in their minds.'Now who is going to present an unprepared case to Professor Mahesh Murthy with whom they had difficulty in presenting the cases for which they had prepared the previous night.Everyone looked at Avani pleading her .Avani understood.'Ok guys stop looking at me.I am ready to be the bakra.'said Avani. 'Thank you Avani ' said Mirza.'Thank god we have you in our team' blurted Ananya. 'Ok people, stop making me a bigger bakra.let us start taking the case before Prof Murthy blasts us'said Avani.
Then , they started taking their COPD case.They examined and started writing. Then as Avani realised that she had forgotten to take Smoking history, Prof Murthy walked in with PG student Dr.Venkateshwara.
'Since we have constraints for the day, we shall finish discussion of history with ten minutes and go ahead with discussion on examination with next fifteen minutes. Avani began presenting praying that the smoking history would not be asked. As she finished family history presentation, Dr.Venkateshwara standing behind her told Dr.Murthy 'Sir we have just ten minutes more left.U wanted me to remind you to start discussion on examination ''Thank you Venkateshwara, let us go ahead with examination. 'said Dr.Murthy. Avani and her friends couldn't believe that people could be so time conscious. They actually saw both their Professor and The PG student as weird people.However it was a welcome relief for Avani who had not taken the smoking history. Presenting a COPD case without smoking history sounded ridiculous. God saved the day for her she thought.As they were packing up, she looked at Dr.VRC who stood expressionless. She was happy that he had weirdly stopped the history. She couldn't thank him as she felt he was not such a friendly person. As she sat in the bus 'Did he do it on purpose? she thought.Hmm..she would never know.