INTERNSHIP DIARIES #4 - THE GRATITUDE CHOCOLATE

This chapter may seem a little childish to some of my readers, yet, let me tell you that if you have received "gratitude chocolates" such as this, your thoughts would resonate with mine.

When I was posted in the emergency department, a 42 year old man came with complaints of abdominal pain and distension, with loss of continuous urine stream - USG was suggestive of a ureteric calculus. I don't remember the exact details of the case, but I remember that the patient had to be shifted for a CT KUB - a computerised tomography scan of the kidneys, ureters and bladder, which would help in formulation of the management plan. The PG in charge also asked me to catheterise the patient so that his symptoms get relieved.

Now, a universal phenomenon among housesurgeons is that we get super excited when we are asked to conduct a minor procedure on our own, or even when we are asked to scrub in and assist during surgeries. Assisting would mostly include only duties that a scrub nurse is able to do, but it gives a huge sense of entitlement to hold the abdominal retractor taut or suture the surgical site, because we have always dreamt of doing those at the start of our medical studies.

I think I am an expert at inserting Foley's catheter, thanks to the training from the surgery residents. Sure enough, urine came flowing into the urobag as soon as the tube was inserted, and I proceeded to inflate the balloon. The patient was writhing in pain - frictional forces between the mucosal surface and the rubber tubing are so intense that we end up squishing the lignocaine tube for all the lubrication in the world. Removing the gloves, I reassured the patient party that this tube would drain all urine from the bladder and the abdominal distension would be gone in no time.

As I finished writing the minor procedure notes, the urobag was half filled with amber-coloured urine. I smiled to myself that there was no evidence of any blood in the urobag. The patient smiled back as I looked on - some rare moments of happy tears for me.

I asked the patient to drink lots of water as the bladder had to be full, prior to the scan. He gulped down as much as he could and told me he could hold no more. Then he was shifted to the CT room.

CT scan showed a moderately sized pelvi-ureteric junction calculus - this needed a urologist intervention which we call PCNL(percutaneous nephrolithotomy) and a stent would be placed at the site after this. Soon, he was admitted under surgery and the procedure was planned.

A week later, this patient and his wife walked up to me as I was waiting for my parcel. They both smiled at me as if they had known me for years.

"Doctor, where were you.... We didn't see you for a week...," the lady told me.

"Aunty.. My posting changed that's why you didn't see me... How are you, uncle?", I asked, concerned. After all, he was my patient too.

"Operation is over, doctor. Got discharged today. Everything is fine, ma,"he told me, smiling.

"Thank you ma, we will always remember you, and today is our child's fifth birthday. We wanted to give you this chocolate and we were searching for you since morning. We are happy and thankful to you." They gave me a Cadbury Silk chocolate - I was surprised.

I was moved to tears. What did I do for them, I am just a housesurgeon, I wondered. That chocolate in my hand, it was the first "gratitude chocolate" that was sweeter than any other chocolate I had till date.

"That simple acts of kindness reap happiness for the benefactor and beneficiary alike. That the beauty of this profession lies in the verity - we have a purpose that is beyond starvation, misery and dread of death."