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The Paradoxical Commandments

by Kent M. Keith

People are illogical, unreasonable, and self-centered.
Love them anyway.

If you do good, people will accuse you of selfish ulterior motives.
Do good anyway.

If you are successful, you will win false friends and true enemies.
Succeed anyway.

The good you do today will be forgotten tomorrow.
Do good anyway.

Honesty and frankness make you vulnerable.
Be honest and frank anyway.

The biggest men and women with the biggest ideas can be shot down by the smallest men and women with the smallest minds.
Think big anyway.

People favor underdogs but follow only top dogs.
Fight for a few underdogs anyway.

What you spend years building may be destroyed overnight.
Build anyway.

People really need help but may attack you if you do help them.
Help people anyway.

Give the world the best you have and you’ll get kicked in the teeth.
Give the world the best you have anyway.

 

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Filed under Death, honest, Inspiration, life, love, Opinion, paradox, people, poem, poetry, secret, success

Anesthesia Vs. Anaesthesia: Does It Really Matter?

Ashish Khanna, 1998 batch

Connections-May 2013 (Volume 10, Issue 2) 

The Oxford dictionary definition of Anaesthesia is “insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations”. The Merriam-Webster dictionary defines Anesthesia as “loss of sensation and usually of consciousness without loss of vital functions artificially produced by the administration of one or more agents that block the passage of pain impulses along nerve pathways to the brain” Synonymous: yes?

Anyone would agree that the difference between Anaesthesia (British English) versus Anesthesia  (American English) is above and beyond the addition of a single alphabet of the English language. I started my journey as an anesthesia resident in a country where Anaesthesia was the correctly spelt version of the branch of medicine that dealt with this specialty. Today, three years after re-training the art and re-learning Anaesthesia to be spelt as Anesthesia in the United States, it is time to look back and ponder on the finer points.
The decision to leave your own country after finishing a residency always comes with a pinch of salt. As you look to expand your clinical and academic training beyond the horizon, you are faced with the uncertainty of the unexpected. The challenge is a system of medicine distinctly different from your home country and a culture to healthcare that demands considerable understanding. A question that I am very often faced with when I make my frequent trips back home is “What is different about Anesthesia practice in the United States?” It might come as a surprise to a lot of people if I say “nothing at all” in reply. Well, what is different is not Anesthesia or Anaesthesia, only the fine print!! The other very frequent question that is thrown at me is the almost rhetorical “Is it better there?” Let me step back today and say let’s keep all this better – worse talk aside. It never was and it will never be fair to compare two vastly different systems of medicine. As I direct this piece of writing to those friends of mine who are faced with doubts and internal struggles before they leave the comfort of their own homes I would like to emphasize one singular fact: forget about quality of medicine or quality of life and remember the biggest challenge is the ability to train to re-train or put
in more simple words another residency program after a prior residency in your home country. Starting a residency program in Anesthesia under the Accreditation Council for Graduate Medical Education (ACGME) at the Cleveland Clinic Foundation, I realized early on that the essence of getting the most out of this education is to wipe my slate clean and restart again. Tell the world that you are trained in your specialty in your own country and you are capable of doing your thing does provide you with the much-needed independence of clinical work at times, but can be your worst
enemy if you want to acquire new knowledge. It is important to understand that there will be days where the attending will hold your hand when you are doing a procedure that you have done so many times before or might tell you that “this is the way it is done here”. Days, when you need to keep you’re your ego at home. Days when you will feel your neurons are struggling to cope with erasing old skills and acquiring new skills for the same procedures again. But, hey did you want to  do things the way you were doing them in your own country? That said, what is the reason you
made this trip across 4000+ miles half way across the planet? The answer to these questions will help you understand that unless you let your guard down in a foreign land and show that you are an open book you will never learn anything new and in essence never grow as a clinician. Medicine is repetitive science; it is very easy to be lulled into a false sense of satisfaction practicing the same
things over and over again, the same very way every day. The only way to appropriately imbibe your area of expertise and to mature as a clinician is to step out and see what else can be done differently and is being done differently. My message here is not to train in the United States after training in India, but to train at different places and in that process acquire a new set of skills all the time.
Going further, another area of distress for the physician from India as he or she steps onto alien soil is the cultural aspect of medicine. The interaction between peer groups as resident doctors and patient physicians as healthcare providers is different to say the least. As you move away from the “yes sir/ma’am” policy to “yes Dr. XYZ” even when that Dr. XYZ might be your department chair, you will quickly realize that you have to prove your worth as a resident by the sheer quality of your work and not the weight of your courtesy and multiple salutations directed to your staff. Decision making for the betterment of your patient is another area where the young resident here is thrown into the deep end every single day. An ICU attending will ask you for your plan, and so will your anesthesia attending in the operating room. And yes, your plan will be plan that will be executed as long as you can justify it. And that holds true for every provider from the lowest level of an intern to upwards.
Protecting patient privacy and respecting that the patient is the true owner of his or her healthcare information is another moot point here. Not to discuss patients with names or anything that could identify them, not to talk about them in the hospital corridors or the escalators is a habit that is difficult to get rid of. The tendency to try to force your decision as a clinician on the patient or the patient’s family is also something that we live by all the time in India. The patient is the master of his/her own destiny here and whether it be morbid obesity, chronic smoking in a vasculopath or narcotic abuse in a chronic pain patient, your job will be to ask them whether they feel they can change theirlifestyleand not to enforce that change on them. Difficult times will also revolve around “End-of-Life” decisions in the ICU and DNR (Do Not Resuscitate) statuses. The ability of families here to think very practically for their dying loved ones and to let go of them when there is point of futility, is commonplace. Another challenge that is
beyond the understanding of anesthesia and different from back home, and is something that you
have to deal with on a regular basis.
How can I forget to include in my set of challenges also, the change from using pharmaceuticals as brand names versus names of salts back home. Or the different abbreviations that come inherent with another healthcare system. Yes, I gave my senior resident a quizzical look when he said “Did you tube your patient” ( a.k.a intubation) or “Can you do the A-line first?” ( a.k.a arterial line) or “ Is he off the vent ?” (weaning from the ventilator) or “When is your ICU patient going to the sniff?” (a.k.a skilled nursing facility). There are numerous more such which define the distinct cultural differences in healthcare here in the United States.
As I look back today, I know that things have evolved for me as a clinician but also more importantly as a human being. I look at medicine differently; I look and understand a patient’s emotions differently. That to me is the pivotal change. For all those fellow friends who are getting ready to step out on this often-treaded path of training in another country after training as a specialist in India, I hope this writing will give a better idea of what to expect. All said and done, the
difference is not in quality of healthcare or the quality of life that you can expect to live, but in what you can assimilate from the new system of medicine.

In the end, it is not Anesthesia versus Anaesthesia, and it really does not matter!

Dr.Khanna

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Filed under Anesthesia, attitude, GMCH, health, humor, life, Residency, USMLE

BSNL-Bechara Sanchar Nigam……………………

                                                                                BID ADIEU BSNL

broadband

BSNL

It was company which probably had longest association with me and my family.Right from the days of trunk calling,when STD rates used to get half by  10 pm,I had been a part of BSNL family.But not from now on………

It was probably the decision which I took a very long time to take.It had been a year since I have had problems with the company’s broadband connection and due to  callous  and ignorant attitude of the company officials I had to take this connection off.

My connection would switch off on its own sweet will.I even brought up a new modem wondering if there was some problem with the modem but to no avail…. Regular calling for complaints got me same answer there was some technical problem but no one knew where the problem was ,and no one seemed interested in finding or solving it.

The funniest reply i got from their worker at Sector 51 area was that his cycle had been stolen twice ,so he was going walking whole of the sector to attend the complaints,as a result of which he had come after so many days to attend my complaint.

And to add nail to coffin was that connection got disrupted an hour after he left.He explained me how hard it was for him to walk through the area and he had grown old as a result of which he was attending one complaint on daily basis.

I was wondering if he had gone nuts or was because of attitude of people like him that most people have lost in BSNL.He also explained me if senior official had some problem with his attitude,he can take  leave for whole of the month,and who would take up the complaints then…………..

Perhaps this is the reason why there are no regular jobs these days even in the government sector .

So fed up with BSNL I switched to Airtel today and to amusement they set up connection within a day of my calling and actually shows the speeds it promised. I wonder if BSNL subscribers would see such days in near future………………

I think in the present state the day is not far when company would be dis-invested by government ,citing reasons for great losses it is causing to exchequer……

They should probably rename the company as

 “BECHARA  SANCHAR  NIGAM  LIMITED

Where bechara( HELPLESS) is the subscriber who takes its connection and gets caught in it …………….

U gain with internet………….

The last picture captures how internet has got into our lives and has its pros and cons…………..

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Filed under attitude, life, negligence, WORK

Inspiration

Look at Image Carefully and then read below

LOOK at the camels first and then read the message below.
This is a picture taken from directly above these camels in the desert at sunset. It is considered to be one of the best pictures of the year. When you look closely, you can see that the camels are the little white lines in the picture.
The black images you see are just the shadows!

Sometimes, our “problems” seem to be as big as the shadows…but they are little. Have a lovely day!
LOOK ONCE MORE. YOU CANNOT BELIEVE IT, RIGHT?

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Filed under attitude, chandigarh, Inspiration, life, mind

“Life is what happens to you while you’re busy making other plans”

The most characteristic nature of life happens to be uncertainty surrounding us,even the next moment is unknown and that makes it even more wonderful .

A small moment can change and define a persons life. It may be a moment of victory, which may define new horizons and may set a new beginning.It may bring a new ray of hope, a light which may transcend in one life and may even inspire a full generation.  How can we forget famous 1983 world cup victory in cricket  had set some unprecedented history in game of cricket turning India into  a cricket crazy nation.

I’ll tell you a secret. Something they don’t teach you in your temple. The Gods envy us. They envy us because we’re mortal, because any moment might be our last. Everything is more beautiful because we’re doomed. You will never be lovelier than you are now. We will never be here again……….

Achilles

Probably the beauty of this life lies in uncertainty and maybe we all humans should understand to live with it. It may sound difficult but it is something we need to cherish and enjoy. There may be moments where this may seem awkward,bizarre or funny but that’s how life goes on………….

The quicker we understand and learn to adjust the more we will cherish our stay on this planet .After all say an average life of 60-70 years ,more than half is spent in learning  new things and rest in coming terms with reality .

Nature has its own ways to make a man learn and it gives beautiful gifts to man .We need  learn to cherish them and enjoy every moment of our life and just remember that:

Life is what happens to you ,while you are busy making other plans ”  🙂

tree

Tree of Life

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Filed under life, mind, precious moments, WORK

A session with Dr.Navneet Majhail (’91 Batch)

majhail

Dr Majhail

YOU MAKE FRIENDS IN MBBS AND COLLEAGUES REST OF YOUR LIFE
These were words in which Dr Navneet Majhail summed the wonderful years of MBBS course and how much he misses his campus days.

I got an opportunity to meet our most famous senior and pioneer of GMCCOSA who has literally connected everyone from GMCH right from 91 batch to 2009 batch.
He held a talk on USMLE this evening at GMCH Sarai building and guided students on various aspects of it.
It was a great opportunity to meet the man behind the GMCCOSA and i did make most of it like many of my friends from various batches.
Well the talk was immensely helpful on the kinds of problems one faces in USMLE, monetary constraints and visa issues in the process .

DRK(Divyanshu) had prepared an exhaustive presentation and Dr Majhail presented with excerpts from his vast experience of the same.

And best part was queries after the session which ranged from different perspectives from second year medicine grad to post MBBS graduates.
He probably answered every query in the room along with inputs from DRK ,Dushyant 2k4,Akash 2k4 and other recent takers in audience on the recent trends and session did stretch about 3 long hours.

It was really great on his part to come to campus and address students on career issues and help them making decisions .

He probably lent an ear to everyone in room and personally answered each of their queries which probably required tremendous amount of patience on his part.

KIDA “was word with which he described his passion for GMCCOSA and his work for same
I express my gratitude to contributors at GMCCOSA and Dr Majhail ,DRK and Anuj 2k7 for the wonderful talk and enlightening the GMCH students.

“A life isn’t significant
except for its impact on other lives.”

Robinson

gmch chandigarh

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Filed under chandigarh, college, GMCCOSA, GMCH, precious moments, WORK

Attitude ??

f**k you

that’s what i call attitude

Yes some have inbuilt in them and word is attitude

well this guy has too much i suppose wonder what did his radiologist advise him ???

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