.. to be uploaded
Friday, November 13, 2009
Wednesday, September 9, 2009
Wednesday, August 26, 2009
Surgical exposure of the median nerve: cadaver dissection video
Cadaver dissection video of
Wednesday, July 8, 2009
Tuesday, July 7, 2009
Hancock's confession
Dear sir,
There is nothing official about this letter and is not through the usual "proper channels". Its just a personal letter conveying the sentiments of one John Hancock. You will know him if you have watched that movie by the same name.
Let me tell you a story...
Before I do that, let us meet the characters...
Hancock: He is essentially a drunkard, now reformed, with superhuman powers. He has the ability to stop speeding trains dead on its tracks or stop an avalanche. Yet, even with great powers, he is just a human, with human failings, ego, whims and fancies.
The child: Found by his foster parents, naughty and playful, always had to be under adult supervision lest he should fall into the hands of mortal danger.
Parents: Takes good care of the child, but ever so often, they keep wondering whose child it is. It could even be Hancock's if not their rich neighbour's. Parents, technically foster parents, have built a house by the foot of the mountain. This house has no compund wall and has only a few rooms. This week they had guests too.
The Boulder: A huge one, precariously placed at the foot of the mountain. When the earth quakes, it can roll down and crush the child.
The child's rich uncle: Could afford to build a beautiful house with strong compound walls that can slow the boulder down while the guards call for help. At house warming, he had promised his neighbours that he will take care of children when the earth quakes and boulders come tumbling down.
The story...
It was an unusually tumultuous weekend. The child kept playing by the foot of the mountain where death lurked. Parents were afraid of the danger of falling rocks. They called up to Hancock to fly out there and see if the boulder would fall. Hancock flew in there, and thought for a moment "Shall I flick this rock off?" ... Yet he thought... this child should be safe within closed doors or may be within the compound walls of his rich uncle's house. He flew off saying: "just call me if that boulder fall and Ill take care"
Parents took the child to their rich neighbour and asked for shelter. But the rich uncle told: " let that Hancock fly there and throw the rock away. I'm telling you, that rock is about to fall". Then he left for town. Hancock heard this and thought: "What does this man know about falling rocks? Has he ever stopped one?"
Next day, Hancock took the child with his parents for lunch at the uncle's house. The lady of the house felt pity and let the child stay for the weekend. He played there for two days safe and sound. Hancock thought he did fine and went back to stopping trains and avalanches saying:
"just call me if that boulder falls and Ill take care"
When the child's uncle came home, he was furious to see the child playing in his house. Swiftly, the child found himself in his parents' house with no compound walls and no guards. The guest rooms were all occupied. Hancock's house too was a crowded mess as usual and it was anyway not a place for kids to play.
In the dead of night, the child did go out and play at the foot of the mountain. Parents slept sound, his uncle was asleep, and Hancock did the same after a hard day at work. The boulder came crashing down ever so silently and swiflty, crushing the child. No one called for help. Hancock heard nothing. No one heard anything.
The next morning, at the funeral by the river, it was the custom of the community to cut the cake of responsibility and drink the wine of regret.
Hancock found himself gulping down wine by the bottle and his dry throat managed to swallow three pieces out of five, when he cut the cake. One piece was left for the parents and a slightly larger piece was left for the rich uncle.
From,
MS Gopalakrishnan.
There is nothing official about this letter and is not through the usual "proper channels". Its just a personal letter conveying the sentiments of one John Hancock. You will know him if you have watched that movie by the same name.
Let me tell you a story...
Before I do that, let us meet the characters...
Hancock: He is essentially a drunkard, now reformed, with superhuman powers. He has the ability to stop speeding trains dead on its tracks or stop an avalanche. Yet, even with great powers, he is just a human, with human failings, ego, whims and fancies.
The child: Found by his foster parents, naughty and playful, always had to be under adult supervision lest he should fall into the hands of mortal danger.
Parents: Takes good care of the child, but ever so often, they keep wondering whose child it is. It could even be Hancock's if not their rich neighbour's. Parents, technically foster parents, have built a house by the foot of the mountain. This house has no compund wall and has only a few rooms. This week they had guests too.
The Boulder: A huge one, precariously placed at the foot of the mountain. When the earth quakes, it can roll down and crush the child.
The child's rich uncle: Could afford to build a beautiful house with strong compound walls that can slow the boulder down while the guards call for help. At house warming, he had promised his neighbours that he will take care of children when the earth quakes and boulders come tumbling down.
The story...
It was an unusually tumultuous weekend. The child kept playing by the foot of the mountain where death lurked. Parents were afraid of the danger of falling rocks. They called up to Hancock to fly out there and see if the boulder would fall. Hancock flew in there, and thought for a moment "Shall I flick this rock off?" ... Yet he thought... this child should be safe within closed doors or may be within the compound walls of his rich uncle's house. He flew off saying: "just call me if that boulder fall and Ill take care"
Parents took the child to their rich neighbour and asked for shelter. But the rich uncle told: " let that Hancock fly there and throw the rock away. I'm telling you, that rock is about to fall". Then he left for town. Hancock heard this and thought: "What does this man know about falling rocks? Has he ever stopped one?"
Next day, Hancock took the child with his parents for lunch at the uncle's house. The lady of the house felt pity and let the child stay for the weekend. He played there for two days safe and sound. Hancock thought he did fine and went back to stopping trains and avalanches saying:
"just call me if that boulder falls and Ill take care"
When the child's uncle came home, he was furious to see the child playing in his house. Swiftly, the child found himself in his parents' house with no compound walls and no guards. The guest rooms were all occupied. Hancock's house too was a crowded mess as usual and it was anyway not a place for kids to play.
In the dead of night, the child did go out and play at the foot of the mountain. Parents slept sound, his uncle was asleep, and Hancock did the same after a hard day at work. The boulder came crashing down ever so silently and swiflty, crushing the child. No one called for help. Hancock heard nothing. No one heard anything.
The next morning, at the funeral by the river, it was the custom of the community to cut the cake of responsibility and drink the wine of regret.
Hancock found himself gulping down wine by the bottle and his dry throat managed to swallow three pieces out of five, when he cut the cake. One piece was left for the parents and a slightly larger piece was left for the rich uncle.
From,
MS Gopalakrishnan.
Sunday, July 5, 2009
The cup is full
Not everyone panics when your room fills with beer...
Canon A 95, no flash. Reflection on a window by the sea. Le Soleil, Pondicherry
Wednesday, June 24, 2009
How can I become a neurosurgeon? Should I take up General surgery first?
How can I become a neurosurgeon? Should I take up General surgery first?
This is the exact same words that an MBBS student asked me the other day. He didnt tell me why he wanted to take up neurosurgery. He said he didn’t have any particular reason. Or maybe he didn’t want to tell me. In any case, it didn’t matter to me. Rational thought and expressed reasoning are not for everyone. For some it’s a calling and that’s fine. That's legit.
More importantly, we have to answer the second question: Should he take up general surgery first? If one has decided on taking neurosurgery as the end speciality, does one really need to go through three years of general surgical training before going through another round of entrance test and three more years of dedicated neurosurgery MCh training?
Lets break this question up…
Why is neurosurgery different from any other surgical field?
I feel that it is because the surgical motor skill that is required is quite different. It is unlike any of the catching-a-bleeder-tying-it-and-dissecting sort of thing that you do in general surgery.
Joints and muscles maketh the man!
May I take the liberty to propose a ‘Motor classification of surgeons” depending on the movements that are required at various joints?
1. If you are a ‘’shoulder-surgeon”, you are a good orthopedician
2. If you are an “elbow-surgeon”, take up general surgery, surgical gastro or cardiothoracic surgery
3. If you are a “wrist-surgeon”, its plastic surgery for you.
4. If you are good with fine finger generated surgical movements, neurosurgery and microvascular surgical fields may be good for you. You are basically restricted to metacarphalangeal and interphalangeal joints and rest of the joints are better stabilized and rested.
Neurosurgery is also not for the claustrophobic and the impatient. Expect narrow corridors and long hours on the operating microscope.
Neurosurgery is not for the morbidity-phobic surgeon either. It’s a fact that despite all the care one takes, one might end up injuring a patient forever… and many patients in a career. This happens in neurosurgery more than any other surgical field, mainly because of the density of functional tissue in the operative field.
Again back to the second question, does one really have to prime oneself with general surgery before taking up neurosurgery?
I believe that it is not necessary. If you have really decided on taking up neurosurgery, why not plunge straight in and save at least one year and be more focused on the subjects that matter – neurology, neuroradiology and operative neuroanatomy.
I am sure that many of you will not agree with me. What about ‘the broader outlook’ to patient management that a post MS general surgery resident is supposed to possess? May be there is a difference. May be you are better off managing a multiply injured patient. But how often has one managed a patient with blunt abdominal trauma and head injury and how often have you operated on a blunt injury patient while managing head injury? May be one can better diagnose the condtion and manage shock and resuscitate better. But does this really require three years of learning hernioraphy, mastectomy and abdominoperineal resection?
But there are caveats. It’s possible that a person who is post MBBS may have deep, nagging doubts throughout the five years whether the decision he has taken was too brave and whether he is up to it. And in the unlikely and unfortunate event of dropping out of the course, one will have nothing but MBBS left even if you have spent many years in the course. Yet, once he has completed the course he might be more focused on the subject and will have saved one year.
Skill, of course depends on the resident.
Lets see another angle to this question.
What type of residents do consultants prefer? For example, Sree chitra [SCTMST] favours post MS candidates of late. I’m not sure of the reasons. May be someone can enlighten on this point.
This is the exact same words that an MBBS student asked me the other day. He didnt tell me why he wanted to take up neurosurgery. He said he didn’t have any particular reason. Or maybe he didn’t want to tell me. In any case, it didn’t matter to me. Rational thought and expressed reasoning are not for everyone. For some it’s a calling and that’s fine. That's legit.
More importantly, we have to answer the second question: Should he take up general surgery first? If one has decided on taking neurosurgery as the end speciality, does one really need to go through three years of general surgical training before going through another round of entrance test and three more years of dedicated neurosurgery MCh training?
Lets break this question up…
Why is neurosurgery different from any other surgical field?
I feel that it is because the surgical motor skill that is required is quite different. It is unlike any of the catching-a-bleeder-tying-it-and-dissecting sort of thing that you do in general surgery.
Joints and muscles maketh the man!
May I take the liberty to propose a ‘Motor classification of surgeons” depending on the movements that are required at various joints?
1. If you are a ‘’shoulder-surgeon”, you are a good orthopedician
2. If you are an “elbow-surgeon”, take up general surgery, surgical gastro or cardiothoracic surgery
3. If you are a “wrist-surgeon”, its plastic surgery for you.
4. If you are good with fine finger generated surgical movements, neurosurgery and microvascular surgical fields may be good for you. You are basically restricted to metacarphalangeal and interphalangeal joints and rest of the joints are better stabilized and rested.
Neurosurgery is also not for the claustrophobic and the impatient. Expect narrow corridors and long hours on the operating microscope.
Neurosurgery is not for the morbidity-phobic surgeon either. It’s a fact that despite all the care one takes, one might end up injuring a patient forever… and many patients in a career. This happens in neurosurgery more than any other surgical field, mainly because of the density of functional tissue in the operative field.
Again back to the second question, does one really have to prime oneself with general surgery before taking up neurosurgery?
I believe that it is not necessary. If you have really decided on taking up neurosurgery, why not plunge straight in and save at least one year and be more focused on the subjects that matter – neurology, neuroradiology and operative neuroanatomy.
I am sure that many of you will not agree with me. What about ‘the broader outlook’ to patient management that a post MS general surgery resident is supposed to possess? May be there is a difference. May be you are better off managing a multiply injured patient. But how often has one managed a patient with blunt abdominal trauma and head injury and how often have you operated on a blunt injury patient while managing head injury? May be one can better diagnose the condtion and manage shock and resuscitate better. But does this really require three years of learning hernioraphy, mastectomy and abdominoperineal resection?
But there are caveats. It’s possible that a person who is post MBBS may have deep, nagging doubts throughout the five years whether the decision he has taken was too brave and whether he is up to it. And in the unlikely and unfortunate event of dropping out of the course, one will have nothing but MBBS left even if you have spent many years in the course. Yet, once he has completed the course he might be more focused on the subject and will have saved one year.
Skill, of course depends on the resident.
Lets see another angle to this question.
What type of residents do consultants prefer? For example, Sree chitra [SCTMST] favours post MS candidates of late. I’m not sure of the reasons. May be someone can enlighten on this point.
Monday, May 11, 2009
Friday, March 20, 2009
Tuesday, March 17, 2009
Saturday, March 14, 2009
Sun God
He looked up into the sky and watched the sun till it blinded him. His was a happy family in a burgeoning community. Lots of food for everybody's greed! They fermented with merry and were truly workaholic. But he knew this was too good to be true. He believed in the stories of people being taken away and left under the searing sun for the rest of their lives. Some came back half dead. Most believed that this sun god was kind and infinitely benevolent. They ridiculed his paranoia. Good times were here to stay. No more of hard survival near the garbage dump. The warmth of this palace of glass which their ancestors had found, had magical powers. Sugar would rain down day and night and no one slept hungry.
He suspected a pattern of pervasive planning. Life cannot be this easy! There must be a diabolic twist latent in all the goodness. Infinite goodness has only source – pure evil. This, he strived to prove.
So he and his friend dug through tons of sugar and let it dry. They made huge glaciers of sugary glass lenses that would catch the sun god on the ground. It would take a lifetime of futile effort – his elders thought. But in the end he succeeded.
The bacterial community couldn't believe what they saw. There was no mistaking the black silhouette of the microscope watching over them while blinding them with light.
A new religion was born…
They worked harder in sad silence ever after.
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