Hi friends! I am superashdoc and I have completed my internship just a few months back.I had some good experiences and some bad ones .Some happy days and some sad ones .If you are doing your internship or are about to start,I am sure there are some doubts in your minds .You can freely voice them and discuss your thoughts on this forum in this thread .I am sure some of our seniors and myself would be able to help you out .Please make yourself at home and do not hesitate!
Lots of Love
Superashdoc!
"Sweet the uses of adversity which like the toad -ugly and venomous,wears yet a jewel on its head"
My lacklustre performance at the Final MBBS examination came as a gray episode in my otherwise unblemished academic career.But using it as a stepping stone,I resolved to be more committed and launched into my internship with gusto!I breezed through surgery, learning the essentials of suturing and dressing of wounds with ease.After surgery came PSM
-rural posting Palghar;and here is where our little story begins.....
Palghar is a sleepy village about 25 km north of Virar in the Thane district.I mentioned the word sleepy because if you venture out after 8pm in the night-the entire village would be deserted.
On my first day as I alighted from the Ferozpur Janata Express,I took my first full deep breath of fresh,cool ,unpolluted air.It felt like the first few drops of sweet rain on a parched desert land!Fortified ,I purposefully strode through the tiny but busy market and within minutes reached an old building which read -'Rural Health Centre,Palghar'.
Our duties at the center were divided into
a)Subcentre and b)Maternity. Subcentre consisted of :-1.A weekly ANC opd at Palghar
2.A number of visits to various subcentres in the surrounding region to see ANC as well as General patients during the week.
I particularly remember my visit to a village called Kharekhuran.It was my first trip there and I was to reach at 2pm along with my co-intern Vishal who was staying at the hostel.However due to the low frequency of trains ,I reached Palghar station at 2.30pm.
Assuming that Vishal had gone ahead ,I looked around for a'Tum-tum".Finding it,I managed to squeeze in along with 10 other villagers and over 3 dozen fish (no kidding!) and crabs.By the way,a 'Tum-tum" is the local name for an eight-seater autorickshaw which is the main mode of transport around Palghar.
After a bumpy ride,which tested the integrity of each one of my 206 bones,I reached Kharekhuran at about 3.30pm.As I entered the small cattle shed which also doubled as a subcentre;I was amazed to see around 35-40 pregnant women seated quietly in a line.
"There you are!",thundered a voice,"Is this the time to come?These people are waiting since two hours!"I turned to see Sister Joshi's otherwise kindly face take on an angry colour which I judged to be either reddish-brown or crimson!(sorry ,I didnt give my elementary drawing exam at school.Colours always confuse me.)
I almost opened my mouth to back-answer her when my eyes fell upon a little boy holding his cheek and crying bitterly.Wordlessly,I went up to him,elicited a quick history using my charm(usually works with children and fails with girls!)and prescribed voveron and Septran.(only 7-8 drugs are available )I also wrote a reference to the Palghar Dental OPD to take appropriate measures.
I then moved into the adjoining room and meticulously examined all ANC patients -counselling them as well as clearing their doubts.I was able to diagnose a number of cases with anaemia and a PIH.I then came across a patient complaining of pain in abdomen whom I found to have a transverse lie.I then dispatched her urgently under the care of Vishal (who had arrived finally)to the maternity centre at Palghar.
Then I saw all the general patients prescribing from whatever meagre resources at my disposal.At the end of 2 hours ,my job was done.
As I made to leave,Sister Joshi said,"Doctor,I am sorry for my outburst.But even last week no one had turned up.The ladies here are very poor.They cannot afford to go to private doctors.They are totally dependent on you."
The next week,I reached Kharekhuran exactly at 2pm.As I entered the village,there were shouts of "Doctorsaheb aale, Doctorsaheb aale" (Doctor has come).I was taken aback as two men and three women,one of them carrying a baby in her arms fell at my feet.
"What is all this?" I demanded.
One of the men was an old bent man of about eighty-frail with shivering hands.He gave me a broad toothless smile and his eyes glistened with tears.
"I have become a grandfather saheb,"he said"Now I can die happily".
Baffled,I looked around and saw the woman holding the baby.She was Savita,the patient whom I had urgently sent to Palghar for a Transverse Lie.
"She had previously 3 miscarriages Sir,"said the village headman.
"Yes saheb",the old man said , "because of you ,our baby was saved.You are no ordinary mortal!"
"But all I did was to examine her and use my knowledge!"I exclaimed, moved.
The man held my hands in his coarse palms and said,"Saheb,we are farmers.With these hands we work and toil and only then grow food to sustain life."
"But your hands are special!With just a touch ,you could give life to my grandson.These hands are a part of your body but they do not belong to you!"
And then in a loud voice he proclaimed to an entire village:
hi doctor its interesting and rewarding for our profession
i am doing my final mbbs now
i am during in a private college where we dont have much exposure to common cases
so i wish to do internship in a govt. college where i will be confronting with a lot of cases and that may bring confidence for me
though i feel academically allright this clinical exposure i am lacking should be compensated ]
please suggest me the steps to get an internship in a govt college
hi doctor its interesting and rewarding for our profession
i am doing my final mbbs now
i am during in a private college where we dont have much exposure to common cases
so i wish to do internship in a govt. college where i will be confronting with a lot of cases and that may bring confidence for me
though i feel academically allright this clinical exposure i am lacking should be compensated ]
please suggest me the steps to get an internship in a govt college
Dear Vidhu.Study well for your Final MBBS.Each college has its own rule for the number of interns who will be allowed for externship.It is usually based on your marks in Final MBBS.All you have to do is give an application in your own college and the college you wish to do externship in.You also need no objection from both colleges.Also you need to submit an application and fill a form in the university .After getting an OK from the university you will be allowed to do your externship in a govt college!
Looks long drawn isnt it?It is!But the rewards are much greater!!
The maternity ward at Palghar rural health centre was far from a pretty picture.In December 2004 it consisted of an old steel cupboard,an antiquated teakwood table and a creaky chair valiantly trying to bear the weight of a well-nourished bespectacled individual.This individual is of late liked or hated(whatever may be the case)as superashdoc and dedicates quality time to a site named RXPg-you must have no doubt heard of it.
However my memory takes me back to the 31st of December 2004-my last day in maternity.
It was close to 7.30pm in the evening and I was taking my evening round of the 10 bedded ward and putting the last of my notes for the patients.The sister on duty was Mrs More and she looked almost on the verge of crying.Not that she had any special affection for me,just that she would have to now conduct the deliveries on her own.(I used to do them myself unlike others who just came in at their own convenience only to perform episiotomy suturing.)
I glanced at my wrist and cursed-I had lost my wrist watch in the train.I then took out my mobile.The time showed 7.35 pm."Only 25 minutes now and my duty would be over",I thought.It wasn't a very happy feeling.I had enjoyed my stay and my work and would miss it sorely.My eyes then drifted to the number on the mobile handset-1100.I vaguely recalled some advertisement about 'desh ka mobile' and Rajpal Yadav using it as a truck headlight saying "Raat mein bhi bhalta hain' .My thoughts were interrupted by the advent of Dr.Umesh ,Medical officer in-charge of the maternity.
"Hi champ,"he said.I merely smiled."Looks like you won't be able to go home tonight",he continued.
"Why not ?"I asked surprised.
"Well,there has been some derailment at vaitarna station and so no trains stopping here till morning."he said coolly.
"Also a patient is going to arrive at about 8pm.She called me.Full term primi .Just take care of her buddy as I won't be here.New year party you see!"
At that moment I felt like throttling him but didn't.I just nodded and went back to my chair.I then sent the boy to the hostel to summon Vishal who had gone to pack his bags.
The patient and my co-intern Vishal arrived at the stroke of eight.I did a PV exam and took a detailed history.The cervix was 3 cm loose,bag of membranes intact,vertex presentation.The FHS were normal and there were minor labour pains.I judged that the lady would be troubling us sometime close to dawn.
After dinner I did one PV exam at about 11pm .4 cm loose.I yawned and decided to call it a day.We interns had to sleep in the MO's office and lay our own bed.I had specially remembered to buy Mortein mosquito coil having advanced action MMR or some such thing.Without the coil ,the IMR(read intern mortality rate )due to mosquito bite would have the WHO and maybe the Ministry of Health interested.
We slept fitfully till about 2 am when Vishal leaped out of the room dancing like Prabhudeva.Within seconds I joined him.The cot had caught fire due to the embers of Mortein coil.The ward mama then emptied 3 buckets of water before the conflagaration was doused.
After a longish lecture about the safety parameters in mortein coil usage mama let us go and sleep on the chairs in maternity ward.I entered the ward and saw the expecting mother Leela in pain.I shifted her to the labour room and examined her.The membranes had ruptured and cervix was 6 cm loose 50% effaced.I advised her to sleep in the labour room.
At around 5am we were woken up by More sister."I think she is fully dilated "she screamed shrilly.I jumped into action.I entered the room,wore the apron and donned gloves.Vishal followed suit.Putting her in lithotomy position I examined and could see the head .
Shouting at the patient to push hard I tried to create space for the descent of the head.After 15 min of effort and alternately screaming at the woman and pleading with her,I inferred that an episiotomy would be needed.At the peak of the labour pains ,sister More gave the episiotomy;Vishal gave fundal presure and I deftly delivered the head.Rotating the head clockwise into left occipito transverse I laterally flexed the baby to deliver the anterior shoulder.The next instant the room was plunged into darkness.....................
Pandemonium ensued as I shouted for mama ,Vishal shouted for light and sister shouted for me."Light the candles",I roared.
"No candles Sir,"mama said."They got over last week".
At that very moment ,I got a brainwave.
"Vishal ,take out my mobile ,"I said calmly.The normally lazy Vishal was quick to understand.He took it out of my pocket and snapped it on.As the bright light focussed on the baby I delivered it out.Milking the cord proximally I clamped and cut it .Suctioning the mouth and slapping the baby on the back ,sister More elicited the first cry of the baby which had become slightly blue.
"Now for the placenta ,"I thought.
The placenta was out within minutes.But my difficulties were only beginning!
I just looked at the vaginal mucosa in the light of the phone torch(It was seeming dimmer now)There was not one but 4 apices.I looked at sister More who had given the episiotomy but she looked away.Leela was crying continously and bleeding too due to the vaginal mucosal lacerations.I thought of calling Dr.Umesh but realised that he might not be in his senses due to hangover of the late night party.
Summoning every ounce of my confidence I turned to Vishal.He simply nodded and focussed the mobile as best as he could.He had implicit faith in my abilities and his belief gave me strength.
I took all 4 apices in my first suture and fixed them .Then I used continuous interlocking sutures taking multiple bites in a curved fashion so as not to leave a single bleeding point.Then came the muscles and lastly SKIN .As I finished ,the bleeding had also narrowed to a trickle.I double checked to ensure there was no other tear and removed the gauze swab from the cervix.
As I removed my apron,I felt a hand on my shoulder.I turned to look into the smiling face of Dr.Umesh."Sir.when did you come?"I asked in surprise.
"Just as you were about to start your suturing",he replied.
"But why didn't you take over?"I queried.
"O ,I didn't have to son,"he said,"I knew you are the best .Even I couldn't have done it better!"
With tears in my eyes,I touched his feet.He embraced me and then feigning mock sternness he said,"Your job doesn't end here doc.Have you examined the baby?"
I turned to the small tray which held the baby-little, chubby and cute.As I touched her cheek(it was a girl),she gave me the sweetest of smiles.
"You have a way with girls,I see,"said Dr.Umesh."This is your NEW YEAR gift.Happy new year!"
Urinary catheterisation
A catheter is a thin, clean hollow tube which is usually made of soft plastic or rubber. Catheterisation means to introduce a catheter into a body cavity to inject or remove fluid. For example, people who are suffering from incontinence can use this simple procedure to empty their bladder. The whole process is called intermittent clean self- catheterisation (ICSC). It gives the person control over their bladder and thus keeps them dry. ICSC also reduces the risk of infection and kidney damage by ensuring the bladder is emptied adequately at regular intervals and the equipment doesn't prohibit or interfere with a normal sexual relationship.
Conditions that may require urinary catheterisation
Urinary catheterisation can be useful for people with bladder problems, such as urinary retention or bladder obstruction. It may be suggested for people who have longterm chronic problems that prevent them from emptying their bladder in the usual way, for example, those who have spinal cord injuries and pelvic nerve damage. It can be used on a temporary basis to help people retrain their bladders to empty. Catheterisation may also be needed after certain kinds of surgery such as trans-urethral resection. An indwelling catheter is often used for the first few days after major surgery or to monitor fluid output in patients receiving intravenous fluids.
[size=18]Medical issues to consider[/size]
ICSC can cause urinary tract infections. Even scrupulously clean equipment can introduce bacteria to the urinary tract. In many cases, the urinary tract may be colonised with bacteria but infection doesn't take place. It is important that the person be thoroughly trained in ICSC techniques and hygiene by their doctor or nurse. Patients at high risk of infection (such as those requiring long term catheterisation) may be prescribed antibiotics.
Catheterisation procedure
The four pieces of equipment needed for ICSC include a catheter, something to clean yourself with (such as a wash cloth or cotton balls), a lubricant (such as water or a water-soluble gel) and a container to hold the drained urine if you are unable to get to the toilet. There is no single 'right' way to perform ICSC. Be guided by your doctor but general suggestions include:
Have all the necessary equipment clean and ready.
Wash your hands with soap and water. Dry them thoroughly before commencing ICSC.
Clean the opening of the urethra with water using a face washer, cotton balls or moist towelettes.
Some people may like to smear the urethral opening with local anaesthetic cream.
Place one end of the catheter into the toilet or container.
Insert the lubricated catheter slowly and gently until urine starts to flow down the tube.
Do not rush the procedure. It is important to completely empty the bladder.
If urine stops flowing, try adjusting the catheter or moving your body into another position.
Slowly rotate the catheter as you remove it from the bladder.
Clean your equipment as directed after each use.
Empty your bladder at least four times a day, or as directed by your doctor or trained continence professional.
Immediately after the procedure
Many people experience an unpleasant dragging sensation as the catheter is removed from the urethra but generally, ICSC is a safe and easy procedure if performed correctly and with clean equipment. The ICSC equipment is usually cleaned straight after the catheter is removed. Sterilisation techniques vary but may include boiling the catheter, washing it in soap and water, or using disinfectant solution. Some people may prefer to bypass the cleaning stage altogether by choosing disposable single-use catheters.
Possible complications
Some of the complications of ICSC include:
Injury to the urethra caused by rough insertion of the catheter
Narrowing of the urethra caused by scar tissue
Injury to the bladder caused by incorrect insertion of the catheter
Urinary tract infections.
Taking care of yourself at home
Be guided by your doctor or continence professional but general suggestions on how to deal with common problems include:
Difficulty introducing or removing the catheter - this can result from either insufficient lubrication or spontaneous spasm of the sphincter muscles. Check that you are in a comfortable position. Take some deep breaths. Relax. As you slowly exhale, gently but firmly introduce or remove the catheter. Never force the catheter.
Infection - see your doctor immediately if you experience any sign of infection. Symptoms may include feeling unwell, fever, pain or burning sensation when passing catheter or urine, cloudy or offensive-smelling urine, needing to empty the bladder more frequently, leakage between catheterisations, and kidney pain.
Wetting between catheters - this may be caused by a change of fluid intake, such as increased caffeine or alcohol. It may mean that you need to catheterise yourself more frequently. Check for signs of infection. See your doctor if signs of infection are present or if leakage persists.
Blood in catheter or urine - increase your fluid intake. Use more lubricant or, if using water, change to a water-soluble gel. Check for signs of infection. If your urine fails to clear after a few days, contact your doctor.
No urine is passed - check that the eyelet in the catheter is not blocked with lubricant or urine sediment. The catheter may be kinked or the other end of the catheter may be higher than the bladder. Ensure that the catheter has been inserted far enough to reach the bladder or gently pull back on the catheter a short distance. Women need to check that the catheter is not in the vagina. Always clean the catheter before trying to reinsert. If unable to drain any urine, contact your doctor.
Long term outlook
In some cases, urinary catheterisation is a short-term option that can be discontinued as soon as bladder control is re-established. However, certain conditions (such as spinal injury) require the long-term use of catheters to aid urination. In some cases, catheters which stay in place for weeks at a time (chronic indwelling urinary catheters) may be used because of their convenience but these devices carry a degree of risk. For example, some studies suggest that the use of chronic indwelling urinary catheters for more than 10 years can increase the risk of bladder cancer and kidney complications. If possible, alternatives to these kinds of 'permanent' urinary catheters are preferred.
Other forms of treatment
Alternatives may include:
ICSC performed four times per day is preferable to using chronic indwelling urinary catheters because of the reduced risk of complications.
In some cases, male patients who are incontinent but not urine retentive may be able to wear a catheter attached to a condom.
Continence training can help in some cases to re-establish bladder control.
Where to get help
Your doctor
Continence specialist
Things to remember
Catheterisation means to introduce a catheter into a body cavity to inject or remove fluid.
Urinary catheterisation reduces the risk of infection and kidney damage by ensuring the bladder is emptied adequately at regular intervals.
Urinary catheterisation can cause urinary tract infections.
Urinary catheterisation
A catheter is a thin, clean hollow tube which is usually made of soft plastic or rubber. Catheterisation means to introduce a catheter into a body cavity to inject or remove fluid. For example, people who are suffering from incontinence can use this simple procedure to empty their bladder. The whole process is called intermittent clean self- catheterisation (ICSC). It gives the person control over their bladder and thus keeps them dry. ICSC also reduces the risk of infection and kidney damage by ensuring the bladder is emptied adequately at regular intervals and the equipment doesn't prohibit or interfere with a normal sexual relationship.
Conditions that may require urinary catheterisation
Urinary catheterisation can be useful for people with bladder problems, such as urinary retention or bladder obstruction. It may be suggested for people who have longterm chronic problems that prevent them from emptying their bladder in the usual way, for example, those who have spinal cord injuries and pelvic nerve damage. It can be used on a temporary basis to help people retrain their bladders to empty. Catheterisation may also be needed after certain kinds of surgery such as trans-urethral resection. An indwelling catheter is often used for the first few days after major surgery or to monitor fluid output in patients receiving intravenous fluids.
[size=18]Medical issues to consider[/size]
ICSC can cause urinary tract infections. Even scrupulously clean equipment can introduce bacteria to the urinary tract. In many cases, the urinary tract may be colonised with bacteria but infection doesn't take place. It is important that the person be thoroughly trained in ICSC techniques and hygiene by their doctor or nurse. Patients at high risk of infection (such as those requiring long term catheterisation) may be prescribed antibiotics.
Catheterisation procedure
The four pieces of equipment needed for ICSC include a catheter, something to clean yourself with (such as a wash cloth or cotton balls), a lubricant (such as water or a water-soluble gel) and a container to hold the drained urine if you are unable to get to the toilet. There is no single 'right' way to perform ICSC. Be guided by your doctor but general suggestions include:
Have all the necessary equipment clean and ready.
Wash your hands with soap and water. Dry them thoroughly before commencing ICSC.
Clean the opening of the urethra with water using a face washer, cotton balls or moist towelettes.
Some people may like to smear the urethral opening with local anaesthetic cream.
Place one end of the catheter into the toilet or container.
Insert the lubricated catheter slowly and gently until urine starts to flow down the tube.
Do not rush the procedure. It is important to completely empty the bladder.
If urine stops flowing, try adjusting the catheter or moving your body into another position.
Slowly rotate the catheter as you remove it from the bladder.
Clean your equipment as directed after each use.
Empty your bladder at least four times a day, or as directed by your doctor or trained continence professional.
Immediately after the procedure
Many people experience an unpleasant dragging sensation as the catheter is removed from the urethra but generally, ICSC is a safe and easy procedure if performed correctly and with clean equipment. The ICSC equipment is usually cleaned straight after the catheter is removed. Sterilisation techniques vary but may include boiling the catheter, washing it in soap and water, or using disinfectant solution. Some people may prefer to bypass the cleaning stage altogether by choosing disposable single-use catheters.
Possible complications
Some of the complications of ICSC include:
Injury to the urethra caused by rough insertion of the catheter
Narrowing of the urethra caused by scar tissue
Injury to the bladder caused by incorrect insertion of the catheter
Urinary tract infections.
Taking care of yourself at home
Be guided by your doctor or continence professional but general suggestions on how to deal with common problems include:
Difficulty introducing or removing the catheter - this can result from either insufficient lubrication or spontaneous spasm of the sphincter muscles. Check that you are in a comfortable position. Take some deep breaths. Relax. As you slowly exhale, gently but firmly introduce or remove the catheter. Never force the catheter.
Infection - see your doctor immediately if you experience any sign of infection. Symptoms may include feeling unwell, fever, pain or burning sensation when passing catheter or urine, cloudy or offensive-smelling urine, needing to empty the bladder more frequently, leakage between catheterisations, and kidney pain.
Wetting between catheters - this may be caused by a change of fluid intake, such as increased caffeine or alcohol. It may mean that you need to catheterise yourself more frequently. Check for signs of infection. See your doctor if signs of infection are present or if leakage persists.
Blood in catheter or urine - increase your fluid intake. Use more lubricant or, if using water, change to a water-soluble gel. Check for signs of infection. If your urine fails to clear after a few days, contact your doctor.
No urine is passed - check that the eyelet in the catheter is not blocked with lubricant or urine sediment. The catheter may be kinked or the other end of the catheter may be higher than the bladder. Ensure that the catheter has been inserted far enough to reach the bladder or gently pull back on the catheter a short distance. Women need to check that the catheter is not in the vagina. Always clean the catheter before trying to reinsert. If unable to drain any urine, contact your doctor.
Long term outlook
In some cases, urinary catheterisation is a short-term option that can be discontinued as soon as bladder control is re-established. However, certain conditions (such as spinal injury) require the long-term use of catheters to aid urination. In some cases, catheters which stay in place for weeks at a time (chronic indwelling urinary catheters) may be used because of their convenience but these devices carry a degree of risk. For example, some studies suggest that the use of chronic indwelling urinary catheters for more than 10 years can increase the risk of bladder cancer and kidney complications. If possible, alternatives to these kinds of 'permanent' urinary catheters are preferred.
Other forms of treatment
Alternatives may include:
ICSC performed four times per day is preferable to using chronic indwelling urinary catheters because of the reduced risk of complications.
In some cases, male patients who are incontinent but not urine retentive may be able to wear a catheter attached to a condom.
Continence training can help in some cases to re-establish bladder control.
Where to get help
Your doctor
Continence specialist
Things to remember
Catheterisation means to introduce a catheter into a body cavity to inject or remove fluid.
Urinary catheterisation reduces the risk of infection and kidney damage by ensuring the bladder is emptied adequately at regular intervals.
Urinary catheterisation can cause urinary tract infections.
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Topic Tags: 
I am superashdoc and I have completed my internship just a few months back.I had some good experiences 
and some bad ones 
.Some happy days 
and some sad ones 
.If you are doing your internship or are about to start,I am sure there are some doubts in your minds 
.You can freely voice them and discuss your thoughts on this forum in this thread 
.I am sure some of our seniors and myself would be able to help you out 
.Please make yourself at home and do not hesitate! 
.This is something which happened to me during my internship.If you also have something memorable to share please feel free to do so. 