Saturday, June 27, 2009

D. E. Knuth and his phd

I am always amazed by the story of how D. E. Knuth got his phd. Knowing many friends who have done or are trying to do a doctoral degree completed, it is just amazing how he did it. Here is the ACM interview where he talks about it.

I got a listing from a guy at Princeton who had just computed 32 solutions to a problem that I had been looking at for a homework problem in my combinatorics class. I was riding up on the elevator with Olga Todd, one of our professors, and I said, "Mrs. Todd, I think I'm going to have a theorem in an hour. I am going to psyche out the rule that explains why there happen to be 32 of each kind." Sure enough, an hour later I had seen how to get from each solution on the first page to the solution on the second page. I showed this to Marshall Hall. He said, "Don, that's your thesis. Don't worry about this block design with squ.gif=2 business. Write this up instead and get out of here." So that became my thesis. And it is a good thing, because since then only one more design with squ.gif=2 has been discovered in the history of the world. I might still be working on my thesis if I had stuck to that problem. But I felt a little guilty that I had solved my Ph.D. problem in one hour, so I dressed it up with a few other chapters of stuff.

Thursday, June 18, 2009

Atleast UP police redeems itself

Few minutes after I wrote this post about the UP police, they have managed to eliminate the dacoit.  Now only if WB police also can do something, I would be happy.

IPL, Fatigue and Mccullum

Indian cricket team's coach mentioned that IP fatigue could be one of the reasons of the team's pathetic show in WT20. Everybody seems to have pounced upon him. I believe what he says does have sense. There never seemed to be any sense of coordination in the team, most of the people were not 100% fit and both of these were major reasons of our defeat and could be caused by IPL's excessing cricket too close to the world cup.

Anyway, people may agree or disagree with the coach but the interesting comment came back from Mccullum. He said that the fatigue theory is rubbish. I can understand that. Only those people would be fatigued who were doing hardword. Mccullum, who lead KKR actually were passengers so for them it was really a jolly ride and that is probably one of the reasons he believes that fatigue can't be the reason of team's bad performance.

India's tryst with deflation

So the inflation numbers reported for this week stand at -1.61%. Technically that is deflation. I hope now my home loan rate would come down.

Pathetic police work -- Two examples

So today I saw two examples of pathetic police work in two different states of the country. The first one being the UP police which engaged in an encounter a single dacoit Ghanshyam Kewat alias Nanhu with 400 police personnel for overl 47 hours and finally he managed to escape.
"Company commander PAC Beni Madhav Singh and constables Shamim and Iqbal were killed in the encounter while IG, PAC VK Gupta, DIG Chitrakoot SK Singh and four others -- Navendra Singh and Akram of STF, Dileep Kumar Tiwari and Rajendra Singh -- were injured," the officer said on Wednesday.

The second incident is the incident in Lalgarh involving local administration and Maoists.  This seems to be total breakdown of any kind of administration in that place. Everybody is doing whatever they want.
Maoist gunmen on Wednesday emerged from their stronghold in jungles along the Bengal-Jharkhand border for an audacious strike near Jhargram town, killing a local CPM leader and two activists in full public glare. As Trinamool Congress activists and Maoists have battled to capture turf from weakened CPM cadres, nearly 25 people have been killed, mostly CPM workers and supporters. At many places, the anti-CPM forces have been supported by locals who see the CPM as a receding force in the face of Mamata Banerjee's electoral surge.

Atleast one news paper claimed that in the past police just outsourced the security to local CPM cadre and finally maoists just had enough and when the came the police, already having abdicated, was nowhere to save them.
The murders today underline how administrative institutions, systematically subverted over the years by the CPM, collapse when there’s threat of a power-shift reducing party cadres to sitting ducks. Nothing illustrates this better than the story of those who were killed: 27-year-old Tinku Mahato; Anil Mahato, 48, the branch committee secretary of the CPM, and 23-year-old college student Abhijit Mahato.

An MA in Sanskrit from Vidyasagar University, Tinku was recently employed as a “para-teacher” in the village primary school. But Tinku Mahato was also the secretary of a “security syndicate” that employed nearly 200 youths of the village as security guards. The other two killed, Anil Mahato and Abhijit, were also key members of this syndicate. Their job: to provide security cover to vehicles on National Highway 6 as they passed the vulnerable Lodhasuli forest stretch where armed robbery is common.

This should have been the job of the Jhargram police but they had, in effect, “outsourced” this responsibility to this syndicate largely comprising CPM supporters. Routinely, armed robbers deflate tyres of vehicles on this stretch by littering the road with “improvised nails” and loot passengers. The police asked Tinku Mahato’s team to take over.

Seems to have another disaster in the making.

Friday, June 12, 2009

Calorie Burning modern style

I stay in an apartment complex where the clubhouse is located some 100mtrs from the residential block. As usual the clubhouse provider a decent gym and many people make use of it. Here are some interesting things that I observed that make life interesting.

  • A significant percent of clubhouse users actually drive in their cars from residence parking to clubhouse parking. As I have mentioned earlier, this distance is no more than 100 mtrs. In this distance these gentlemen (ladies) floor the accelerators of their cars, start honking when they are atleast 50mtrs from the clubhouse so that the security opens the gate and then don't have to slow down. Makes for a sight more thrilling then a F1 race start. Only doubt I have that most probably the car is burning more calories then the users of the gym.

  • Even though lockers have been provided for people to put stuff when they are using gym equipment, it is not uncommon to see a IT style conference call going on while people are running on treadmill.

Anyway, all this makes walking to clubhouse really interesting.

Friday, June 5, 2009

New age five star hospital

Off late many new age five star type hospitals have started opening all over the place. I have always wondered whether the quality of healthcare delivered by these hospital is also in line with the shiny interiors and well dressed receptionists. My own experiences in Wockhardt hospital in Bangalore have not really been great. But since there is little most of us understand about medicine, one assumes that may be we are unduly worried. Here is someody's experience from Wockhardt which kinds of points in the same direction. Please make your own conclusions. I have just received this email through friends that I can not vouch for the accuracy of events or assumptions.
Rashmi's Story

My name is Rashmi B.T. I am 35 years old, married to an air force officer, Vivek, and have a four year old son, Dhruv, delivered by emergency Caeserean section in 2004. On March 4th, 2009, my life was changed unalterably. I lost a baby that I had carried inside me, completely healthy, for a full 41 weeks.

I understand that doctors are human, that mistakes happen. However, I have come to believe that what happened to me could have been prevented if the doctor and the hospital had provided the most basic level of care and expertise. What's worse, they refuse to take steps to prevent someone else going through the same nightmare, simply because they want to protect
themselves from the possibility of litigation - something I am not interested in unless it is the only way to force them to change their protocols.

The Beginning

In June 2008, Vivek and I learnt that we were expecting our second child. The pregnancy was uneventful. I was healthy and fit. Every prenatal visit and test showed that the baby was healthy and developing well. During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt's Bannerghatta Road maternity facility to see me through the rest of my pregnancy.

Despite the fact that I had already undergone a C-section, she urged me to opt for a V-BAC (Vaginal Birth After Cesarean Section) or in layman's terms, a normal delivery. She brushed aside my concerns, telling me that a second C-section would be six times more risky and assuring me that a V-BAC would be less risky and almost pain-free.

My due date was estimated as 26 Feb 2009. I visited Dr. Latha on 28 Feb. She wrote on my record: "delivery will be attended by Dr. Latha/Dr. Prabha." Since I had neither met, heard of, nor been examined by Dr. Prabha before, I was concerned. Dr. Latha explained that Dr. Prabha Ramakrishna is another consultant at Wockhardt, and that it was a hospital requirement for her to write both their names down as possible attending doctors for my labor/delivery. However, she assured me that it was just a formality, and that she would be the one to attend to me when I went into labor.

On 3 March, I visited Dr. Latha again. Since I was so far past my due date, I requested that a scan be done to check on the baby.

When I called her to read out the results of the report, she did not want to know anything other than the liquor content, though I specifically asked her if there was any other information she would require from the scan. She told me I could either wait for labor to start or choose a day to come in and have my labor induced.

The Nightmare Begins
I went into labor at 2am on 4 March, and got admitted to the hospital at 5.15am.

By 7.45 am, I was experiencing contractions less than a minute apart. Dr. Latha came and did a quick examination. I was shifted to the labor ward at 8am where I remained until 1.50p.m., under the sole care of nurse Savitha. Dr. Latha was not present at all.

A junior doctor, Dr. Shirley, was available intermittently. She spent most of the time on her cell phone, talking to her husband. She was keen to see him before he left on an 11-day vacation. A Dr. Chetna substituted for her while when she went to see her husband off.

There was no other doctor present. Dr. Prabha was called each time the fetal heart rate fell (this happened a couple of times). She was seeing outpatients and attending two other deliveries simultaneously, so she was only able to come to the labor ward to see me four times, for less than 5 minutes each time.

At 10am, I was given Syntocinon, a drug used to enhance labor; the dosage was increased at 10.45am. At 12.30, there was vaginal bleeding, and the nurse phoned Dr. Prabha, who advised her to "keep a watch". The bleeding reduced, but I began to feel pain of increasing intensity during contractions. Dr. Shirley reappeared at 1.00 p.m., examined me vaginally and announced that I was almost fully dilated and would deliver by 1.30pm. I complained several times of excruciating pain but was told that it was
normal. At 1.30pm, Dr. Prabha came in and was told by Dr. Shirley that I was fully dilated and would deliver any minute. Despite that, Dr. Prabha breezed off to visit another patient in the OPD.

I felt no urge whatsoever to push, yet was asked to do so. The stirrup on the delivery table kept breaking off - I was told that this is a recurring problem that "needed attention". At 1.50 pm, the fetal heart rate dropped to 80 beats per minute. Dr. Prabha was called again. She checked the fetal heart rate on the CTG, explained that this was normal when the baby
was passing through the birth canal, and asked me to hold my breath and push hard. I felt no sensation in my cervical area, but felt intense pain tearing my stomach apart. I felt like my baby had rolled into my stomach and could see its body pushing up against my ribcage. I was screaming, pointing at my stomach, and telling them that my stomach was hurting, and there was no urge to push. But she told me to "push, push harder". I then heard Dr. Prabha saying "Get the OT ready". She told my husband that she was going to attempt to deliver by forceps - if that was unsuccessful, she'd have to do a Caesarian.

The OT wasn't on standby, wasn't ready. I was numb with pain. They wanted me to get up and move to the operation table. I couldn't move. They eventually slid something under my back and I pushed myself on to the OT table, as there was no transfer stretcher available. I complained of severe shoulder and chest pain. No one paid me any attention; everyone was busy
preparing the OT, and the anesthetist was attempting to top up my epidural.
The fetal heart rate was never monitored in the OT. Dr.. Prabha unsuccessfully attempted a forceps delivery at 2.20 p.m., and then cut me open. I heard a deafening sucking sound, after which I must have passed out.

Later, I learnt that my uterus had ruptured along the scar of my previous Caeserian section. My baby was found floating in my abdomen. He had no heartbeat and he wasn't breathing. He had been deprived of oxygen for a long time - 43 minutes. They "resuscitated" my son and put him on a ventilator.

When I opened my eyes I saw Dr. Latha leave, followed by Dr. Prabha. Dr. Shirley was suturing me while laughing and talking with another nurse. I felt reassured that my baby was okay, even though I had neither seen nor
heard him. "Don't Worry, You Can Conceive Again"

At 3.30pm, a nurse struggled to take my BP reading; the BP apparatus wasn't working and had to be replaced. Dr. Latha met Vivek at the NICU and told him that the baby was doing fine and had to be kept under observation.
She also told him that my scar had ruptured, but said that I was okay. At 4.30 pm, my husband repeatedly begged the nurses to give me pain relief. I was then shifted to the ward.

At 9.30 pm the neonatologist told Vivek that the baby had been deprived of oxygen for over 40 minutes, possibly resulting in "some extent" of brain damage. This was the first inkling we had that something had gone wrong.

The next morning, I was given a sponge bath at 6am. I then lay unattended until 2.30 p.m., when Dr. Prabha, Dr. Latha, and Dr. Prakash (the neonatologist) saw me for the first time after the operation. Dr. Latha unceremoniously ripped the dressing off my wound without using any gel or spirit, and pronounced the wound clean.

We were told that our baby would be kept under observation for another 24 hours. Later that night Dr. Latha came in at 9.50pm. Her only words to me: "Don't worry, you can conceive again. Your uterus is intact." "Do Japa and Tapa To Get Better""
None of the consultants saw me on 6 March. That night, my milk came in, and my breasts became swollen and painful. I asked in vain for assistance. After repeatedly begging for help, I sent Dr. Latha a text message at noon on 7 March. At 4pm, a nurse told me that the doctor had instructed them to use a breast pump to relieve my pain - however, since the hospital didn't have one, I would have to go and buy one.

Dr. Latha finally visited me at 7.30 pm. She confessed that she was unaware that there had been a 43 minute delay in performing my C-section. She also admitted that instructions delivered over the phone could never substitute for personal supervision. She said, and again I quote, "Do some pranayama, japa, and tapa to help you get better."

Throughout my stay, nurses didn't know what medication I had been prescribed. They kept asking me what medication I was to be given. They had to be repeatedly reminded to give me medication.

For the next 13 days, Arnav was in the NICU on a ventilator. Throughout that time, he was completely reliant on ventilator support, his eyes were dilated and non-responsive to light, and there was no sign of movement. After a week, the neonatologist asked me to express milk and said they would feed the baby with a pipe inserted from his nose to the stomach. I did this for the next six days.

On 16 March, we decided to let Arnav go. We requested that he be removed from life support.

"We Would Do Exactly The Same For The Next Patient Who Walks In"
Vivek and I wanted to learn what had gone wrong with such a healthy pregnancy. Basic reading indicated that scar rupture is a well-known risk when you attempt to deliver vaginally after a first C-section, and must therefore be monitored very closely by a doctor if attempted at all.

We met with the hospital administration and the doctors. All we wanted was an explanation. To hear the words, "I made an error in judgment". Instead, we were met with a wall of defensiveness. Dr. Latha said that despite knowing the outcome, she would take exactly the same steps with the next patient who walked through her door.

I decided to get a second opinion. And then a third, and a fourth, and a fifth. Three of Bangalore's best-known gynaecologists (and other doctors too) categorically stated that given my age (35), the estimated weight of the baby (> 4 kilos), and the duration of gestation (>40 weeks), a vaginal birth should never have been attempted, and scar rupture was a logical, obvious outcome.

All reading I have done has backed this up. Even a layperson's book like "What to expect when you are expecting" (pages 363-364) says that abdominal pain during a V-BAC indicates a scar rupture and outlines the procedure for safe delivery of the baby. Given that I was complaining of excruciating abdominal pain, shoulder pain and chest pain, the doctor should have known my scar was rupturing. I should never have been asked to push; it exacerbated the rupture. Nor should I have been given a drug that intensified my contractions. By Dr. Prabha's own admission, she did not know about the rupture until she opened me up.

Several doctors have also told us that keeping Arnav on the ventilator for 13 days was an exercise in futility from the first. At no point were we told that he would never survive if taken off the ventilator - had we known that, we would never have subjected him, or ourselves to two weeks of anguish. All we were told was that he "might be" brain damaged to "some extent" but they couldn't predict how bad it would be.

A Brick Wall of Defensiveness; Discrepancies Galore

When I attempted to engage with the hospital to ask them to change their protocol of treatment based on an unbiased review conducted with the inputs of external gynecologists, I was met with a brick wall of defensiveness. They refused to conduct a fair, transparent investigation, claiming that their internal investigation showed that they had done everything right and that losing the baby was "my destiny". Dr. Latha went so far as to say that since I am educated, I should have been better informed about the procedure.

I don't want to sue them for money. I just want them to change their policies and protocols so that this doesn't happen to someone else. I have been hitting a brick wall for two months, and feel that the only way to make them pay attention is to tell my story to people.

There are many discrepancies and attempts to cover up the hospital's inefficiency (to name a few: baby's weight recorded as 3Kg despite the fact that he was never weighed; post-facto note of fetal heart rate as 180bpm despite the fact that the heart rate was never monitored in the OT; discharge summary says "live term baby extracted" even though Arnav had no heartbeat or respiration at birth; half-hour discrepancy between CTG trace and labor room clock). I asked questions to which I was given ludicrous answers (Eg: Our pediatrician is very experienced, so he can guess the weight of any baby just by looking at it).

We were charged approximately Rs. 2,20,000 by Wockhardt. Of this, we found over Rs. 7000 billed for things that had never been done (spinal anesthetic, an extra day of room rent, food not consumed). We subsequently found more extraneous charges, amongst them an amount billed for tests that were performed on 18 March, two days after Arnav's death.

My Story Has Just Begun...
My uterus is still healing. My back still hurts from the trauma. And my heart aches for Arnav, the baby I will never hold.

More than that, I am filled with the fear that this will happen again. After all, Dr. Latha says she would "do exactly the same again" even though she knows the outcome. And the hospital agrees that she - and they - did everything right.

Wockhardt delivers approximately 80 babies each month. With BP machines that don't work, a delivery room stirrup that's falling off and that has "needed to be fixed for a while", nurses who don't know what medication they are supposed to administer, and one (yes ONE) OT dedicated to emergency deliveries. That OT wasn't ready when I needed it. What guarantee do you have that it will be ready when you need it? Sure, they claim to have nine other OTs in the hospital - but if they are all as woefully unprepared as the one I was in, my story could be yours.

I want them to change their policies, and I won't give up until they do.

Thank you for reading.