My two years in the capital: Learning to move and move on

 

Posting to Delhi, happened to me more as a default after 25years of service rather than by influencing the powers that be to get there. Having been in my alma mater as a faculty for 5years, actively involved in teaching undergraduate and post graduate students, I had spent some wonderful moments in the college, enriching myself professionally, and inculcating healthy lifestyle amongst the young students and faculty. Starting the AFMC Marathoners’ club in the college and getting the kids bitten by the Running bug, I felt was an effective way to instill a sense of self-discipline and work-ethic amongst them in their formative years.

Posting to the hospital in Delhi, which boasted of one of the largest patient loads, and a challenging mix of secondary and tertiary care medical practice, I knew that I had to change my mode of working to more of foot soldiering with patient care focusing both on general medicine and my own specialty of Endocrinology, the department which was unattended since my predecessor had left a few months ago. 

There was a DNB program in General Medicine running, with three residents per year, who formed the active ground level workforce in the department, who worked as first level contact in emergencies and the out-patient department, as well as managing the in-patient workload. While this was a great set up to gain practical experience in managing all kinds of cases pertaining to the subject, I sincerely felt that thrust on academics was lacking, and a formal training program existed only on paper. Having come from AFMC to this extremely busy hospital, I did realize that any effort to introduce a formal training program would be seen not only an as infringement on the regular work culture but also a sign of attempt at establishing my style of functioning without understanding the key role of this hospital, which was patient care. Although I agreed to its primary role being patient care in principal, I tried to emphasize amongst the faculty and the residents, the need to club academics with work, to get best results both in our work as well as in the exams which was an inevitable goal for every resident working in the hospital. I tried to exhort every faculty about their responsibility to reciprocate the work done by the residents in the hospital, by teaching them something in the process and contributing to their growth as physicians. While this added to their work hours and efforts, and was shown some reluctance and resistance by most residents and a few of the faculty alike, gradually its importance was understood. The performance of the first batch that passed out in the next few months of my joining and their testimonials of experiences at the final exams on how our teaching program had helped them, made it easier to continue with our work with the subsequent batches. Soon, teaching sessions 3-4 times per week, ward rounds and other training activities gathered momentum and became seamless part of the otherwise busy work schedule.

Thanks to regular training program, and faculty-student interaction, the quality of clinical work improved too and was visible in the way it was being documented. Better case sheet writing, referral notes and discharge summaries was emphasized on, and results were soon evident.

Endocrinology department had a large outpatient attendance of 100-150 twice a week, mainly of patients with diabetes and thyroid disorders amongst others requiring more specialized endocrinology management. Maintaining quality super-specialty service with such a workload was not possible. Hence, in an attempt to improve quality, OPD attendance was restricted to 80 to maximum 100 per day, and patients were seen on non-OPD days as well, and a separate day for officers was scheduled on Saturdays. On this day, those having 5-day week schedules, students, teachers and patients with complex endocrine disorders requiring more time to evaluate were seen by appointment. This helped improve clientele satisfaction as well as quality of my work. To enhance services being provided, Bone mineral density scan by DEXA was made more formalized with a better protocol, twice a week, with reports being given along with consultation for treatment based on the reports on the same day. Radio-immunoassay laboratory for hormone assays, which was lying defunct due to administrative reasons, was made functional and patients were given their reports from the in-house lab, with appropriate treatment advice. This not only made the management of most conditions comprehensive, but also enhanced the quality of services and clientele satisfaction.

During the same period, active efforts were made to introduce newer techniques, drugs and equipments like better insulins, flash glucose monitoring system (Freestyle Libre Pro) and Insulin pump for better management of patients and enhancing patient care with state-of-the-art services. This helped build the reputation of the hospital as a premier tertiary care endocrine centre at par with other service and corporate hospitals in the city.

Management of focused groups requiring closer monitoring and follow up, like type 1 diabetes and gestational diabetes patients was ensured using active utilization of Whatsapp and other media. Insulin dose titration based on their self-monitored blood glucose levels was done telephonically, to help real-time management, and avoid unnecessary visits to the hospital by these patients. This not only helped them attain better metabolic control in a shorter time frame, it also reduced their stress levels by avoiding cumbersome visits to the hospital and having a feel of constantly being looked after by the health care services. Being accessible to their primary caregiver 24x7 for troubleshooting, was seen by the patients and their kin as a great help. Results of such remote follow ups and insulin dose titration were soon visible with better glycemic control amongst the patients and steep fall in hospitalization for hyperglycemic emergencies like diabetic ketoacidosis especially amongst the children with type 1 DM. Even women with gestational DM were managed at home for glycemic control through regular remote follow up, avoiding unnecessary hospitalization in most cases.

This further helped immensely in maintaining the continuity of follow up and good metabolic control during the periods of lockdown and travel restrictions from March to July 2020 and thereafter. We could manage most of our type 1 diabetes and gestational diabetes patients by tele-consults and held a few web-meetings for group therapy. We could manage a Type 1 diabetic lady on Insulin pump successfully through her pregnancy with few hospital visits.

After the first year in Delhi, I was surprised by an unsolicited transfer to another appointment within the city itself, with an added responsibility of continuing to work in my specialty in my hospital. Although it was a welcome feeling to continue doing my professional work, it did bring in some dilemma administratively, as it often became a balancing act between two different bosses in organizations with different roles.

I am glad, I could continue managing both my responsibilities along with focus on my passion of running marathons. While it was tough to transition to Delhi, a city of extreme weather conditions and polluted air, rather unfriendly to the runners, especially after having run in Pune for the past 5 years, a city with salubrious climate and healthy running culture, it was heartening to have trained well enough to qualify for the Boston marathon and run its virtual format in Sep 2020, and also run the Chicago and Berlin marathons over the past two years, in addition to other major domestic events. Active support and encouragement by the senior colleagues at work and professional assistance by sports medicine fraternity in Delhi helped a great deal.  

These two years in Delhi, while occupied with work in a busy institution, with my multiple roles, I also made trips to family who had stayed back in Pune. This ensured adequate breaks from the hectic schedule as well as the torrid climes of Delhi and much needed recovery from solitude.

Onset of 2020, just after the first 2 months, brought in COVID and all the changes that came with it. Lockdown, quarantines and travel restrictions, social distancing and mask had become part of the new normal. The year that followed involved a change of roles to handling covid patients in the hospital which became a dedicated center for managing this pandemic for its clientele in the capital. With the department of endocrinology now lying buried within the containment zone created for the Covid management, my role was restricted to handling patients mostly in the general medical OPD and through tele-medicine, which was effectively done, thanks to most patients on my contact list, or in communication with me since the earlier times.

In addition, two trips into the Covid zone as the physician in charge, once in June and later in August’20, was a great learning experience which has been described in my earlier blogs on these.  

With such a varied exposure professionally, continuing pursuit of improvement in my chosen sport of Marathon running and balancing my personal responsibilities, I realize that I have kept myself largely aloof in the social circuit and have hardly engaged in meeting friends I knew from before now settled in Delhi, or have managed to make any new friends. In this power-city, where most people wish to have “contacts” and make “friends with benefits”, I think all I did was enrich myself with better professional and personal experiences. The only personal interactions and friendships developed were those with immediate colleagues, staff and workforce in the residential area to maintain a harmonious work-life balance and help those in need in these difficult times.

The organization where I have worked all these years and gained all that I could, is now a place where it is becoming a challenge to stay true to one’s work and passion without being affected by what is happening around. One sees blatant disregard for regulations by individuals, frequent political, bureaucratic and legal interventions in matters of official importance. Personal contacts are often being used to infringe on professional workspace for manipulating what otherwise are official protocols. Professional skills and other performance measures, which should be the only means to grade individuals in an organization is being openly flouted, with people with no contacts or strength/intention to take on a legal recourse being condemned to follow the default mode, which is often one of anonymity and untold hardships.

In the near future, I look forward to enhancing my professional capabilities and get into better avenues, in places where I can put my skills with patients, people and my sport to better use for the betterment of myself, and others in whose lives I can make a difference. This will need some changes in my work environment and focus, where I can balance the work with life and sport smoothly. Looking forward to a better 2021.