A story of a bottle: Meet the powerful yet destructive alcohol

A few days back, I was silently sitting on the shelf of a bottle shop and waiting for my turn to be picked up by some admirer of mine. I waited for a month or two, and then there came a twenty-year-old in the shop. Desperately, the young man picked me and went to the counter to pay the bill and rushed outside to open me. He was sweating and shivering, and I knew he was craving for me right then. “Stop” shouted the self-control of the boy. “You haven’t touched a bottle for the last 48 hours, then why now you ran away to buy alcohol so urgently?” I chuckled sensing with the perplexity of the war of mind and body to consume me or throw me away. The dilemma inside the boy crushed him entirely as his brain cells wanted alcohol to function, and his body was showing signs of doom. Despite all the effort of giving up drinking, the craving creeps over, and the boy starts engulfing me quickly to calm down his nerves.

Now, he looks drunk from the outside world as I start capturing his brain cells to slow down and affect memory, consciousness, and alertness.
He tried to get up, but he couldn’t, and he aggressively started shouting and then abusing people on the road. Soon after, police intervened and asked him to stand up. This time, I let him stand up and asked him to walk in an unsteady and staggering gait. After all, he needs to go to the police station for his abusive behaviour in a public place. “Why you are so insensitive, Mr Alcohol?” cried the heart. “Why are you wrecking us and please go away ?” pleaded the brain.

The struggle of the boy is nothing unusual for me; I witnessed so many influential people crumbling under my influence. Come and meet me; I am the most powerful and destructive substance popularly known as alcohol.

I realised I need to clarify everyone, so I narrated –
Did I come into the body by myself? Absolutely no. Who bought me here in the first place. Perhaps, you should enquire why am I been glamorised by adults so much. People around the world hold me in glasses to socialise and to spend some quality time with friends. But why can’t they understand that my nature is addictive? The brain receptor needs me daily in increasing amount to have the same effect because I develop the tolerance. Yes! I don’t start affecting anyone on fist occasion, and mild drinking habit doesn’t bother many. However, the problem began when a person indulges in me excessively. Here it is important to analyse why people start drinking me at an unrestrained level.   Is it lack knowledge about my effect on the body, or is it something to do with the community attitude? My destruction nor be dealt with will power alone, neither medical management in isolation can bring the desired changed. To curb the storm created by me needs the systematic effort of person,  family and the community. Without incorporating more substantial community portion,  I would undoubtedly emerge as a ruler of young generation destruction .
When someone pours me in a glass little did they realised that I could impact their career, family, health and reputation. I may be legally available in the market, but that doesn’t mean that I am harmless. Perhaps, my glossy labels and bright colour create an illusion of being non-toxic. However, let me clarify how sparkling I may emerge from outside, I am addictive to an individual, destructive for the family and catastrophic for a community.
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Parenting challenges while nurturing little creative brains

I could never realise that dealing with a writer adolescent could be tedious and jeopardise dynamics of household relationship; until I met Nancy, a 14-year-old, class eight student.

Nancy was an obedient and topper student until her sixth grade. Her loving and caring doctor parents gifted her logical mindset, which helped her to put her thoughts on paper analytically. Consequently, she start expressing her self through poetry. Naturally, with her persistent efforts towards poetry, her skills were at a much higher level than her age group; hence, she was continuously appreciated for the craft.
However, her ability leads her to the world of dream and desire of publishing books.
Dreaming out of one’s age group indeed leads to criticism. Perhaps, the adolescent mind is somehow unable to see themselves in restraint and wants to rebel for their dream and purpose. Unfortunately, Nancy couldn’t be able to withstand the criticism and start showing a sudden decline in her exam scorecards. Her world shattered and she cocooned with her thoughts, believing that she is not good in studies. But her dream of writing doesn’t leave her and always inspired her to write more. The teachers and parents negatively take such headstrong behaviour. Also reaches to a point where she had been poorly humiliated in front of her class.

While meeting on the first visit at a doctors office, her writing patterns and thought process gives the impression of schizophrenia. Probably, her high-level collection of English poems confuses practitioner with some hidden meaning thought process. As a result , her aspiration and creativity labelled her stubborn, eccentric and grandiose.
Nancy paid the price-of the inability to accommodate highly creative children in our regular school curriculum. When asked who taught you how to write so efficiently? “I did it by reading books and increasing my vocabulary “-she proudly smiled.

Undoubtedly, if a person invests time in learning a language, he/she must be cutting downtime in another subject. However, it shouldn’t be tagging her failure in another topic. One must understand such child work double harder than others. They do homework for the school and simultaneously, growing their creative sides. Should parents not understand the dilemma of the creative mind than who else should? Perhaps, our education system needs to fit in the gifted children rather than making them a scapegoat.

Overall, the tremendous courage of the parents required to assist a creative little brain in conquering the world.

What is motherhood?

Since the time of ancient human civilization, one thing about humans has been constant so far: temperament of the motherhood. The overarching term of motherhood involves several skill sets such as supervision and providing care to a child. However, the core element of motherhood consists of the role of a provider with unconditional love. The navigation of the abundant affection to create a sensible boy or girl is the expertise of the parenthood.
Perhaps, providing shelter, books and food is not enough to craft a rational human being. The manuscript of an analytical and wise individual is carefully crafted with the chisel of warmth and devotion of motherhood. The pattern of values and ethics often highlighted with consistent feedback technique of motherhood; that may involve guiding a child to distinguish between virtue and crime.
Overall, a child is the most invested painting of motherhood that needs immense patience and abundant yet balanced affection of a mother.

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Same problem at the same channel at the same frequency: that’s life

At the cusps of midlife, one often look back and reflect; perhaps, to approach future cautiously but with elements of optimism. Of course, the sense of guilt blanket often covers us more than the proud moment. Usually, own accomplishments underestimated, and failures blow out of proportion. Isn’t that human nature to self-sabotage for every action which doesn’t produce result from a social yardstick.
Perhaps, creating ‘a clone ‘of a prosperous and economically stable human being is the goal. However, the speed breakers or the collapses of life plans nourishes us to develop as a unique individual on planet earth. Presumably, midlife is the most suitable time to go back and unfold pages of the early teens and twenties. Interestingly, often new generation approach midlife couples for pieces of advice and guiding their decision . Conceivably, moments of providing encouragements to the younger generation can give you a sense of Deja vu. Unquestionably, naïve elements  and the high energy level of the early twenties lead anyone to take up more risk in life.
Along with the risk-taking comes the chapter of achievement and failure. This achievement can be in personal life such as marriage and having kids or professional fulfilment of career goals. However, it is the unfulfilled targets in personal and professional life, which we tend to classify in broad umbrella  term of failure. However, explore more about these failures; one could realise these are a little learning experience which is necessary to navigate life in a much more meaningful way. Reasonably, at the cusp of midlife, every triumph and defeat blends far away as blue sky merges with the sparkling blue river.

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What a cup of coffee holds?

When the historians of the future era would explore the characteristics of middle age adults of twenty nineteen (2019), they would undoubtedly mention a revolution in the connectivity of people around the globe with social networking. The FB would perhaps top the chart for providing a safe venue for meeting people after work. Probably, the current communication mode of speaking would primarily be taken over with typed words and emoji expression. Unquestionably, social media gathering have been inextricably woven with our generation, and we start forgetting our skill of meeting people with flesh and blood.
Getting out of comfort zone to explore a day with your besties is hard for a variety of pre-committed reasons such as busy schedule at work and home.

For women, a larger goal is to conquer the work-life balance and for a man sailing the boat in the hope of the two ends meet.

Isn’t to create a perfect life-illusion, our generation designed a castle built with layers of emotional detachment and isolation? We all need a break from our ideal self-image and indulge more with childhood buddies. The technique of rewinding may not need a luxury party or an expensive holiday destination. Perhaps a cup of coffee in the company of a good friend can restore our faith in the supportive environment of social architecture. Hence, reach out and explore more.

coffee cup

 

Checking identification is saving life in blood transfusion

As the dawn filter the shimmering rays of sun through the hospital window, newly joined interns, Tara and Arun looked at the clock.
Tara whispered -“Only one more hour to go, and then we finished with our first day posting of obstetrics and gynaecology, it is undoubtedly a stringent department to work. Isn’t it ?”
Arun nodded -“look at the amount of work we still need to finish, just one hour, can we hurry up. Please!”.
It was a massive night shift for everyone in the unit as there were cases of two emergency caesarean section for preeclampsia and abruptio placentae along with instances of complicated breech delivery and prolonged labour.
Monitoring BP, putting IV line, sending the sample to the laboratory and writing notes on a patients file seems a tedious task for the newly joined interns. But they wonder how there Senior resident Ananya, is so efficient and yet calm in such a tense situation.
Meanwhile, Ananya stepped inside the ward and asked Arun -“Have you able to arrange the blood for the pregnant patient who is suffering from anaemia.”
With a conquering smile, Arun  replied: “Yes Mam, just now I have collected it from blood bank “.
“That’s great, would you both like to learn today about the correct procedure for transfusion” ,Ananya encouraged Tara and Arun .
“We learnt it last week from our friends Mam, “Tara said excitedly.
“Oh! so tell me the first and basic step ” inquired Ananya
“Mam, we need to connect blood with iv line and then we need to monitor”-said Arun and explained necessary textbook procedure about blood transfusion.
“Do you miss something basic Arun, think more carefully what you need to do first ?”-probed Anaya
Tara moaned “Can’t think of anything else mam, that’s what all written in the textbook .”
Well, transfusion of blood is one of the most dangerous events in the hospital if not done carefully. Hence, the first and most crucial step is to check the name and date of birth of the patient. Usually, in ideal setup patient is provided with a wrist band where a unique identification number is provided. Always match the name, date of birth and unique identification with the blood bag. Always make sure to double check the blood group written on the blood bag with the patient’s blood group on the notes. ” -explained Ananya.
With little bewilderment, Arun muttered-” why so many checks for patients name and blood bag.”
Ananya smile and clarified-” Arun you need to understand while working in the Indian set up that everything would not be as structured as you read in a textbook. We need to practice more cautiously in India for a variety of reason. First, the patient can be from low socio-economic status and can be illiterate. Perhaps, cannot provide information spontaneously; hence, you should develop art to extract information. Additionally, there can be a possibility of not having a unique identification number in the hospital, and many times, there are two patients of the same gender and age can be present in a hospital ward. Thus, to overcome this barrier, you need to adopt extra vigilant skill in your practice. “
Tara mumbled” There is so much to learn and we thought we nailed it last week only ”
“Try to have another person with you at the time of checking names and labels to reduce the morbidity and mortality due to human error” -Advice Ananya.
“Now, let’s go and learn the useful bits together”Ananya directed. Three of them headed towards the patient bed for the blood transfusion.

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Sparkling monster and frontal lobe nuggets

Hi Mr XY,
I am your frontal lobe of the brain, and I feel annoyed while discussing my damage in you. My current terrible condition would perhaps unable to depict the glorious time of past I traveled with you . While working during your childhood I found that you were academically brilliant and one well behaved boy . Oh! Those were the days , when as young handsome man your charisma, articulation skill and swiftness were the talk of the town .I was fully functioning on those days and helped you to invigorate intelligence and calmness . Then I recall a phase, where homesickness and loneliness creep in, and you start drinking for social lubrication. I acknowledge how naive you were to think that occasional alcohol drinking will not make you habituated. But keen to admit,  I get uncomfortable with your growing daily consumption, as my responses went sluggish. Remembering  the night when I want to send a signal to the foot, and he disobeys me, and you smashed another car. Horrible night, isn’t it? Hospital, police and court all mess done in one night. But, perhaps, I can’t remember everything now as my damages lead to memory impairment also.

Despite so many difficulties in life, you keep on dissolving me in gallons of alcohol. I do understand it was not your fault as you were biologically dependent on alcohol, and your tolerance increased several folds. I was not aware at that time , what the term tolerance means . But realised the change in you that there was an increased need of the same substance at the higher quantity to get the same effect. I can’t blame you as I started dissolving and you had little insight into the changes that have occurred to you.
I don’t say that you never tried to give up, you sincerely tried to get rid of alcohol on several occasions. But, I hate alcohol withdrawal, which made everything so difficult to conquer. I dislike the tremor, weakness, nausea vomiting after abstinence from alcohol for a day or two. Strong tremors after withdrawal were worst than the feeling of the earthquake and craving resolve only after alcohol consumption. I still repent nobody told us there were hospital de-addiction methods available to lower down the symptom of alcohol tremor. Or maybe some white coat or loved one said, perhaps we forgot to follow anyone instruction or showed some anti-social behaviour.
Life could have been a blessing if this toxic drop does not infuse in me slowly and daily. I had been crushed and turned into a shrinking piece sitting like wreckage in your skull. I am watching and waiting for you to say goodbye to your fame, fortune, family and fullest life for a sparkling monster whose favourite food is frontal lobe nuggets with liver chips and heart dips.
Yours truly
Frontal Lobe

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Twinkle Twinkle, no more star please!

Have you ever noticed the concept of placing stars for hotels and home appliances has evolved into the idea for creating a tailored star rating for health provider with a photograph? There are numerous websites which claim to provide an authentic review about a health practitioner with there glittering stars and extensive comment section. The number of a star attached to a health provider name perhaps depicts a negative story on first glance but never allows the public to view the real picture of that particular branch or case.
For instance, obstetric and gynaecology field deals with their patients nearly in an emergency, and it’s almost impossible to predict the outcome till the last minute. Looking at a case scenario, a husband rated an eminent obstetrician of the town as one star and wrote a lengthy criticism for performing caesarian delivery in spite of the initial assurance of a normal delivery. While reading these reviews, it is sometimes puzzling how can emergency branches expect 100 % outcome. Above it, the significant question for medical fraternity would be: are we suppose to fall in the trap of star rating? Is it essential for us to expose ourselves in the toxic domain of star rating? Can as individualised practice, we ever able to equate ourselves to a flourishing hotel business or perhaps with a brand of a washing machine or plasma TV.
Along with all the negative aspect of star rating, the element of ethics somewhere conflicts with a star rating of health providers.
Overall, star rating may sound an astonishing suggestion for other industry; however, for the health sector, it has no apparent benefit. Instead, it helps to create a sense of confusion among practitioners and the public.

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Who to blame: the soft target of health system

Ironically, the incident of asking a bunch of questions to a health provider is similar to scolding a teenager for poverty, over crowdedness and unhygienic condition of the house. The child, perhaps with courage, could mutter some words that the father is a chronic alcoholic and mother was beaten by the father and now admitted to a nearby hospital. Hence, he needs to take care of his three siblings and trying his level best to perform the duty in a crisis, with the best possible way. The best possible way perhaps doesn’t matches with the drawing room condition of an average household, but there is no other alternative available for him at this point of time.
Instead of looking for causes of the cause, anyone can raise their voice and start abusing and blaming the child for all the mess in the house. Somehow medical science in a developing country is facing the dilemma of the teenager. The fatherly figure authorities who should mentor and help the young health providers to deal with a crisis, suddenly start showing arrogant behaviour and ask them to manage everything of their own. Moreover, in the name of the hierarchical system, there is no question of questioning anyone. As a result, young health provider often forgets to realise how much responsibility is he supposed to take and what is the right method to overcome the chaos.
How many of us have seen a volunteer involvement from the community for the government sector? Perhaps, none of us can boast that we have stakeholders from the community who works in collaboration with health providers to deal with the mass management in a crisis. Even doctors and nurses need to understand that it is almost impossible to run a government hospital without the support of ordinary people participation.
Undoubtedly, crowded hospital and two to three patients per bed can give a chaotic picture; however, unable to provide the complete picture and the story.
Causes need to acknowledge if it is lack of cultural, legal, political or therapeutic infrastructure. Specific inadequacies should be dealt from inside medical administration and from outside -the political arena and the participation of the public.
There are methods available to systemically analyse the current scenario, such as a simplified acronym SWOT analysis, which involves looking at the internal and external component of strength, weakness, opportunity and threat. The positive side includes power and opportunity and negative areas incorporate elements of weakness and threat to a system . Indisputability; easy accessibility is the strength of any regional medical hospital. However, lack of resources and workforce is the significant ‘weakness’ of a government hospital. In the middle of all chaos, it cannot be overemphasised that blaming of budding doctors and nurses is the core ‘threat’ to the system — these threats not limited from outside such violence towards doctors. But, also comes from inside, such as instead of providing a friendly team environment by higher authorities, there is a tendency for promoting a negative culture of marginalising and shaming young doctors.
Overall, acquiring medical degrees can help us to become an excellent health practitioner; however, getting skill set of communication and getting connected with the public and politics can help us to evolve as better health providers.

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The cob-web of disease, doctors, patients, relatives, community, and violence

 

The term ‘de-escalation technique’ is often used in emergency and psychiatry settings for the management of violent patients. The term helps clinicians to understand the underpinning philosophy of aggression and its management. These methods work effectively in a tertiary setup due to presence of efficient security staffs and trained health providers. In an ideal emergency setting, when a patient becomes aggressive and abusive ,the team of security officers are called to help health providers for further management. Unfortunately, the current violence against health providers in India shows a sickening trend of collective vandalism which includes hundreds of people. Would any health researcher, throughout the world, be able to explain the beating of a medical college intern by a mob of more than 200? Well, the magnitude of the problem can be defined as ‘medical negligence’ (a term which has been a consistent cacophony of the national media after the case was telecast).

Usually, textbooks from the Western world state the treatment protocol involves a triangle, consisting of the doctor, patient, and the disease. But in a collective society, treatment resembles a cobweb: a doctor, a patient, illness, and a mob consisting of the patient’s relatives, friends, village, suburb. Ironically, no Western textbook or research paper has yet tried to show the interrelationship of the health sector and the anger of the crowd, which is directly proportionate to the vandalism in the community.

Undoubtedly, health providers in metro pockets need to introspect the burden of the patients they are carrying while assessing the resources. The vast patient influx in a government setup is nothing new for health providers. However, there should be a reasonable ratio for a medical unit to see a patient in a day. The inbuilt problem of medicine units is accommodating hundreds of patients in a day—without the support of a manager who can assign appointment systems or case managers who can take care of the patient during the treatment process.

Moreover, the junior staff of health sciences often mistakenly takes up the role of a manager, which he or she is not trained for, and becomes overburdened with the unnecessary pressure of work.

The health providers need to understand a core concept; if one cannot cater efficiently, then there is no need to create a crowd outside OPD and emergency. Here, it is significant to emphasise that the group that stands outside are the people who come with the hope that all of them will be seen in justified time. Waiting to see a patient for approximately two hours and then talking for 5–10 minutes could frustrate anyone.

To top it all, hooligans and antisocial elements are in the perfect environment to show their destructive power. The agenda is clear for vandals: abuse and beatings with approval of a crowd result in nothing less than feeling like Robin Hood for a day. Unfortunately, the medical fraternity cannot do much to curb these antisocial elements without the support of law enforcement agencies and the people within society. However, health providers can do a lot to improve their surroundings by reducing the number of visitors present at any time in the hospital grounds. 

Perhaps an efficient call centre where patients could book their appointments, online or the provision of a standardised triage system, would help to address these issues. Together with these ideas, an effective security system could help to reduce the amount of aggression that is being shown towards the medical staff.

Overall, violence against health providers is an unacceptable phenomenon that is rampant in India nowadays. The prevention of such antisocial activities is the need of the hour and requires understanding and effort from both sides. For better outcomes in the health sector of India, the patients should be cared for ethically, and health providers should be treated at least as humanely.

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