Just When They Thought They Are Smarter

Sometime back, I told you how some people deserve to get their asses incinerated.

Now this guy, an extern, thinks he’s very rich. Obviously, this does not mean that he can do whatever he wishes to. He comes to the OPD at 11.30 am, a good 2.5 hours late. After that, he has the cheek to ask me if there was too much work, with a sly idiotic smile. I care a damn, you bag of urine.

He joined with us on Monday. He didn’t report for the first two days, came on the third day for 10 – 15 minutes and today, as I said, this dog comes at his own ease thinking that he is some showstopper. I don’t care about the work, it’s hardly something. Besides, crooks like him don’t even deserve to serve patients. But the fact that bugs me is his attitude – totally not bothered. As if he is some gift to mankind. He is undiluted bullshit, crow-shit and shit of many other wild pigs mixed together.

She is no less. She thinks that she is a super-babe. In fact, she belongs to that category of pseudo-babes whom you wouldn’t want to meet. She looks like a plague-afflicted rat and her mouth doesn’t shut up. Just like him, she feels that just because she has paid some twenty-five thousand bucks to the BMC, she owns it. Sucker…

My batch-mates had to tolerate them for 3 days while I was posted in other sections of the department. They told me about how these two pieces of faeces had frustrated them too. Today, I got the opportunity of taking revenge. I don’t indulge in such things normally, never; I prefer to stay away and do my own work. I have a relatively high threshold. But I had to teach these Scylla and Charybdis a lesson. They need to understand that they are responsible if a patient has to suffer some inconvenience.

So, in the morning, when they presented their macerated faces in the OPD, they had to face nice music from the registrar (with whom I teamed up). The two maggots were marked absent – this must have surely set their bum on fire. From tomorrow, if they don’t improve, they surely deserve worse – like falling into a manhole full of methane and getting asphyxiated. Assholes falling into manholes – how cool is it.

This is what all people who don’t do their part of work deserve. Many people have a tendency to take too many things for granted, not realising how it can create unnecessary problems and inconvenience for others in need of help.

Hiccups

One of the most non-specific conditions for a physician to treat is hiccups (singultus). They usually have a very obscure cause and at times can underlie serious diseases.

A young man (non-diabetic/non-hypertensive) diagnosed with malaria presented with tiring non-stop hiccups. He was investigated three days back and the peripheral blood smear demonstrated vivax parasites. He was on artesunate along with other supportive care. He came at 11pm in the casualty and complained that his hiccups were non-stop, present since afternoon (post-lunch) and had caused him considerable exhaustion. He had no other complaints.

Luckily, he responded to injectable metaclopromide within minutes.

Another patient presented with features of gastric acid reflux disease and exhausting hiccups. However, his chief complaint was acidity, from which he wanted immediate relief. An intramuscular injection of rantidine allayed his acidity, but hiccups continued. This man was otherwise normal. I thought of giving him dispersible domperidone tablets; his hiccups stopped 10 minutes after keeping the tablet under his tongue.

I read up few papers on hiccups, their cause and treatment. Most of the literature has treatment based on trial and error; others consist of success stories (such as mine) without much backing. There is hardly any paper which does not mention remedies put forth by folk medicine. In fact, this adds spice to the otherwise boring allopathic life.

Folk medicine has described various home-remedies to get rid of hiccups – from ‘gulp down two teaspoons of sugar’ to ‘have someone startle you with a loud boo!’ Indian folk medicine also prescribes various techniques such as drinking ice cold water or pressing one’s eyeballs gently. Pulling one’s tongue has been suggested as a good alternative. They probably have a scientific basis (like pressing one’s eyeballs stimulates vagal activity).

Good old Harrison does not have much information on treatment of hiccups. Adam’s & Victor’s Principles of Neurology (8th edition) mentions baclofen for persistent cases. Bradley Neurology in Clinical Practice does not mention anything specific. Goetz textbook of Clinical Neurology (3rd edition) has arguably the best line of management:

1. Chlorpromazine 25 – 50 mg IV or 50 mg per orally
2. Metaclopromide 10 mg IV or 10 mg per orally TID

Some published papers provide excellent views (historical and current medical) on hiccups. There are charts on various drugs that are effective (including atropine) and many authors have given protocols for treating intractable kind of hiccups. A case study is the most interesting of the lot – it’s about a man who was instantly relieved from persistent hiccups after a sexual intercourse!

Suggested reading:
1. A paper from British Medical Journal – ‘Management of Intractable Hiccups’.
2. A historical note on hiccups.
3. A paper describing various causes of hiccups.
4. A case report describing sexual intercourse as a potential cure for intractable hiccups (wow!).