Random Thoughts from Day #2

1.) Sorry KBA, no “mother’s milk” (vanco/zosyn) here. Empiric antibiotic of choice is Ceftriaxone alone.

2.) India has a pay-for-performance health care system. The patients pay upfront and then then they perform the lab/procedure/imaging.

3.) The second two bus trips have not been as pleasurable as the first one.  I have never been so hot/sweaty/claustrophobic at the same time.

Another day in Pondi

Greetings all, I hope that this day has been good for all of you. We were fortunate enough today to be present on rounds in the NICU. It was definitely a different experience. The residents would present to the attending (much like the US style) but it seemed different. I didn’t think that there was as much autonomy in terms of asking “what would you like to do next….” or “why do you think that x is happening”. Instead I felt it was more of a hierarchical style in which the attending would tell them what to do and they would do them. It was definitely different.

We came across a case in which a baby was still showing signs of sepsis and had failed 1st line therapy of Anti-biotics (Ceftaz and Amikacin). Needing to change the coverage, the team opted to start Piperacillin/Tazobactam and ciprofloxacin. I felt that the choice of Ciprofloxacin was an odd one as there are no indications for fluorquinolones in the Pediatric population with the exception of multi-drug resitant UTI’s and other infections. Brian, Alicia, and I had discussed this and thought that gentamicin may have been a decent alternative however Brian wisely pointed out that to start gentamicin would mean to check levels which may take a while to come back. It was definitely interesting and something that I will need to think more about.

The rest of the day will be for more of sight-seeing as I believe that we will be going to Auroville which wikipedia has told me is a “universal town where men and women of all countries are able to live in peace and progressive harmony, above all creeds, all politics and all nationalities. The purpose of Auroville is to realize human unity”. I think that it will be fun and will let you all know what we thought of it later

And finally, some more random musings by yours truly

– I think that we look ridiculous with mustaches. I really want to shave it off but I am told by Alicia that I am not allowed to do that. There will be some penalty (of which we have not yet decided) for the first person to shave it off. For the record, my money is on Gopal to be the first one to shave it off

– No signs of Betsy today

– We all bought drums the other day. Some got the best deal (alicia), some got the one with the ornate markings (me), and some paid way too much for a really small drum (no comment)

– I have made a realization that I should not publicly bring up the beauty of Indian woman. What was meant to be a simple observation has now turned into a bride-finding mission by others (that some have termed “hopeless”). I feel that Gopal is now in search of keeping a priest on retainer to quickly get me married if someone happens to like me here….

Buffet and babies

We now have not only an official hangout for CIT2 (Coffee.com), but also an official Pondicherry buffet. We had dinner last night at the Promenade Hotel and it was very nice. The ambience was impressive with a view of the ocean and great a/c. The only thing that could have made the evening better would have been if Dr. and Mrs. Mark Collins had showed up.

We joined NICU rounds this morning. It is interesting to realize how heavily they rely on physical exam findings both for diagnosis and daily management. They have several premature infants with hyperbilirubinemia under bili lights and estimate the duration of light therapy based on the initial elevated level, then choose a stop date and check a rebound level at some point. I don’t think many of us back home would be comfortable without our TB levels at least daily. They’ve had a recent outbreak of fungal sepsis, mostly Candida, which has been concerning them greatly. They actually lost an almost month old baby to fungal sepsis just a couple days ago. The outbreak seems to be increasing the awareness of infection control and I was impressed that the attending washed his hands in between all pts and used hand sanitizer, somthing I have not see elsewhere in the hospital.