Year : 2009 | Volume
: 25 | Issue : 2 | Page : 228--229
Diary of a trainee urologist in SGPGI
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow-226 014, Uttar Pradesh, India
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow-226 014, Uttar Pradesh
|How to cite this article:|
Mandhani A. Diary of a trainee urologist in SGPGI.Indian J Urol 2009;25:228-229
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Mandhani A. Diary of a trainee urologist in SGPGI. Indian J Urol [serial online] 2009 [cited 2020 Aug 13 ];25:228-229
Available from: http://www.indianjurol.com/text.asp?2009/25/2/228/52929
It has been more than a decade since I got my training in Urology. Writing a diary was my passion as no other hobby gives one a closer look into how 'the most intelligent creature on earth' spent a life in the hospital. I share some of the excerpts which, I hope, would be of interest to our residents of current generation.
Yoga Helped Me Getting into the Urology Program !
Before coming to the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), I was working in Sir Ganga Ram Hospital in New Delhi and used to live in a Yoga Ashram leading the life of an ascetic! When I appeared for my interview, the Chief of Urology asked me, 'What is the use of Yoga in Urology?' I did not expect such a question. Thank God for my collateral thinking, I quipped; 'Sir, it helps in improving sexual function!' The chairman got excited and after seeing the glow on his face, I explained the role of an asana called 'bandh' to exercise the perineal musculature that prolong the ejaculation! And I got selected!
It was a dream come true to get into SGPGIMS, which provide the most prestigious clinical training program in the country. After getting selected, I went to see the Chairman of Urology. I could not have imagined a better welcome than I got from the Chief, who invited me inside the operating room and, over a cup of tea, had a chat about the program and the way I should be working in the department.
Freedom of Thought and Accessibility to the Faculty
The hierarchal system in Indian medicine has its positives and negatives. Work culture in the medical arena is often person oriented rather than system oriented, as most of the clinical decision-making in postgraduate surgical training is based on level 4 evidence. Things were different in our institute where I did my Urology training. I was influenced by the accessibility of the faculty and the way no one felt offended when presented with counterpoints backed by evidence. This freedom of thought and action imparted during the training period was useful in evolving and implementing new ideas that made medicine more relevant to the needs of patients in our own milieu.
Mentorship and Intellectual Challenge to the Seniors
Most of the time, surgical training is imparted by Chief Residents. Surgical skill percolates from the Consultant to Junior Residents through the Chief Resident. One patient presented with renal failure with creatinine of 12 mg% and bilateral hydroureteronephrosis with bilateral, large (more than 3 cm) radio-opaque shadows in the line of upper ureter on KUB X-ray. He had bilateral nephrostomies and, once creatinine stabilized, the decision was taken to remove both stones by a lumbotomy approach. When the Chief Resident was about to start the surgery, one of the junior residents said, 'Why don't we do a nephrostogram before giving an incision'. The Chief Resident agreed and, to our surprise, on one side the radio-opaque shadow was not in the ureter (could have been a calcified lymph node); instead, the patient had a megaureter on that side. This incident left an indelible impression on my mind that I should always listen to the 'lesser mortals' when it comes to making a critical decision.
Holistic Approach to Treat a Patient
Medicine is not only a science but an art too. And being artistic means one has to be humane! A patient was pestering me for admission during my ward posting and was denied admission due to non-availability of beds, despite having a valid appointment. This denial of admission occurred when patients overstayed due to various reasons. I lost my temper, which was very unusual for me, and scolded him! This was the first and last incidence of misbehaving with patients as I got a long discourse from my Chief to be polite and understanding to the patients. This lesson remains ingrained in my mind till today.
The message given to me was that a patient, like a customer, is always right. A patient comes to us with full faith; he/she is giving their whole self to us without even thinking that one stroke of negligence on our part may jeopardize their whole life! If he is giving us his whole self then we, too, have to give him our whole selves. Howsoever skilled a surgeon I may be, without a humane face I would never become a 'great' surgeon. Instilling human touch with scientific teaching was the best part of my training, a practice emphasized at our unique institute.
My First Publication in a Journal !
Another aspect of the training was a compulsory publication prior to examination. I remember a patient who was given silver nitrate instillation on both sides simultaneously for Chyluria in another hospital. She had acute renal failure initially, and later presented with bilateral multiple ureteric strictures for which she had ileal replacement and developed septicemia. She went into multiorgan failure and could not survive. I felt very bad that a life was lost due to negligence by someone who had not used his discretion. This case was later reported by me in the British Journal of Urology. I was very elated in getting my first publication in an international indexed journal! A moment of personal glory at the cost of someone's life!
A Bitter Pill
Does diagnosing a treatable malignancy become like passing a death sentence? I saw a three-year-old child with Wilm's tumor. I counseled the father for surgical treatment and the need for possible radiation and chemotherapy, which would involve frequent visits to the hospital and a lot of money. There was no system to give him the complete treatment free of cost. I was shocked to listen to his reasoning that it was much easier for him to beget another child rather than spend so much of money! I advised him to seek help from the State but then I realized that his decision was probably correct. A philosophical acceptance of life and death is a 'samskara' percolated from our Vedas and helps in alleviating the pain of loss of our beloved ones!
Influence of Technology
I witnessed two major changes during my training period. One was the introduction of newer sophisticated instruments and the other was the use of computers in case presentation.
My first surgery as an assistant was a transurethral resection of the prostate (TURP)! I read all related books on it and went ahead with excitement. I was really thrilled to see the veru montanum and beautiful parts of urethra with ridges and furrows. As the only beam splitter available in the department was out of order, I could only assess the procedure by seeing the color of urine and expressions of the operating surgeon. Hence, until we got our new video-endoscope, I learnt about TURP from hearing the grunts and moans of the surgeon at the time of opening up of a venous sinuses and using different modalities of traction needed to control bleeding.
Thanks to the computer, we lost another useful indication of 'ethyl alcohol' which was used for cleaning transparencies for slide presentations. It used to be fun borrowing transparencies from fellow residents, helping to clean them and sharing writing pens and ideas too! Ours was the only institute where basic courses are organized to impart training on statistics, scientific writing, and powerpoint presentation.
Virtual Surgery on a Patient
Giving an independent surgery to the trainee requires a lot of courage on the part of the faculty. This I realized only when I became a faculty member myself. So when the stakes are high, a minute deviation from the step can change the outcome of a surgery. Hence independent surgery was given only when faculty thought that resident could complete the surgery without messing up. One thing I used to do was to read all steps carefully before scrubbing for a case and do a virtual surgical procedure in my mind, asking the surgeon about the anatomy, and foreseeing the next step. I never did a transvaginal repair independently, but I did assist on four cases during my training period. Immediately after my training I was appointed as an Assistant Professor in Sri Venkateswara Institute of Medical Sciences (SVIMS), which was devoid of urology faculty at that time. I had to do everything on my own. I did vesico-vaginal fistula (VVF) repair with vivid memory of cases I had assisted, and thus could complete the surgery with success.
A Parting Thought
I have witnessed a gamut of changes in every facet of professional life, reflecting changes in technology and glamour. With the emergence of corporate hospitals, the allure of big bucks in the very near future obviously influences a trainee to concentrate on common procedures that are profitable. Residents are the backbone of any program and they should be motivated to maintain the best traditions and academic life of an institute, even after leaving, by not letting commerce supersede medical ethics.
I thank Dr. Lalit Mohan Aga for providing useful inputs for this manuscript.