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doc2doc interviews... Matiram Pun
What made you want to be a doctor?
Medicine was not close to me (my family, village, district, province and not even anyone I knew distantly). In my early school, I loved Sanskrit (language), Physics, English and Biology the most. I got more and more interested in science and wanted to pursue it but nearly went for Mathematics and English in College as there was no science stream in the province. Luckily, a new college opened and offered scholarship…couldn’t be happier!!!
I had near-death-experience falling from a huge cliff with a massive bundle of woods when I was in early teens dropping out of school (for four years) to help family in the farm. But this hardly comes to my mind and it is not the motivation for going into medicine.
When I was in the final years of higher secondary, my mother got seriously ill. She was anaemic and cachectic. I donated blood so did my brother. Doctors in the district told it could be blood cancer. My dad and I took her to the capital city which was my first visit to the city. On the third day afternoon, a group of white apron wearing people came and talk in different language. I and my dad were put aside. They painted mom’s chest, took out a big needle and bored into the sternum holding her. I saw my mom in agony. The needle was pushed so hard that it went all the way down (I could see resistance and then suddenly needle going deep other side) and they aspirated full syringe of blood. My mother was biting teeth and throwing legs with pain. They discarded that blood. They punctured again and aspirated little bit of whitish fluid which the put in the glass slides they had taken. By then, my mother was motionless and they started reviving her (did central paging for consultants) with chest compression and all the drugs pushing. They pushed me and dad further away down the corridor. It did not take long time to declare death. I just could see fluid going too fast while doing chest compression. The death certificate wrote ‘Asystole’ somewhere there. My dad was distraught! I was clueless in new city; no known persons and nobody to ask for anything. There were no phones connected back home to my family. I talked to my dad and we decided to cremate mom by the side of Holy River and Hindu Temple (Pashupatinath) as we are Buddhist lineage and Hindu influence. Hence we took her there and finished cremation (turning to ashes) late night. We headed home…and family knew on the third day! With all these, I thought strongly I will go to medical school but I will be responsible, will do home work and preparation before I handle the patients, will have common sense and will practice good medicine.
When I was undergraduate at university, my maternal aunt had diarrhea and was severely dehydrated. In the far flung village, the auxillary health worker could not access the vein for fluid resuscitation. She died of dehydration. While I was in medical school, my brother got kids and they inherited hemophilia. When I was in internship, my sister in law developed breast cancer at the age of 36 and it was already in axilla. She is under Tamoxifen and she already has one episode of fracture!
Why did you choose your specialty?
People say they are not surprised when I say I do mountain medicine and high altitude physiology. This is simply because I’m from Nepal. I think that is myth. I like hiking in the mountains (Nepal Himalayas), studying altitude illnesses and working with local people. Then I was mentored by Dr Buddha Basnyat, world renowned mountain medicine and travel medicine expert, in medical school. Having a good mentor makes a lot of difference in shaping your interest.
What’s the most interesting thing about your speciality/job?
Basically, it is hypoxia, mountains, altitude illness, field study and some researches; the blend that have fascinated me. I like challenges from the field and adverse environment besides from controlled and well equipped hospital settings. What could be more peaceful and fun than being in the mountains and fields to practice medicine or carry out researches!
Funny enough, hypoxia is in tumor biology, intensive care units, sleep disorders, many other conditions we see everyday e.g. chronic obstructive pulmonary disease (COPD) and of course in high up cool mountains! This is what I find most interesting and broadness about my topic.
What has been your best moment in medicine?
In one of those weekends, I was in duty in OBGYN; at around 9.00 AM a lady was brought into us. She was in her late teens, had delivered a baby at home two days prior but her bleeding did not stop and rather increased. She was pale and was jaundiced. She did not have any ante-natal checkups and no supplementation.
On further examination and investigation, she was found to be Hepatitis E positive (that’s why she had jaundice). On all attempts to stop bleeding, we failed. Whole OBGYN department was informed and all on-call consultants and head of the department came. Bleeding per vagina was scary! I have never seen such. Residents, house officers and interns all rushed and did the best to arrange bloods, consultations and connect with patient. She had to be incubated in the late afternoon. Surgery was even riskier. We tried to pack up and mitigate bleeding as much as we could. Ultimately bleeding subsided with medical intervention. She was admitted in ICU.
She was transferred out after 17 days in ICU and discharged on 21st day smiling and walking. The poor and illiterate teenager with no antenatal checkups and supplementation, Hepatitis E positive and home delivery…..handling a case in first hand and following the recovery. I felt good.
And your worst?
While doing house officer job in emergency department, I got an elderly lady with severe chest pain (she had acute myocardial infarction). She was diagnosed case of COPD as well. In an attempt of alleviating her pain with Morphine, she went into respiratory depression! It was messy and busy ER and an MI patient going into respiratory depression was a nightmare. She was intubated and transferred to ICU. I am still nervous about this case.
What advice would you give prospective doctors?
Well, first thing is first; one must love his/her profession. If one does not, he/she must change it. In medical profession, one should be sensible, responsible and have common sense…one should enjoy working and doing duties/treating patients.
Irritable, arrogant and material driven attitude can not only spoil oneself but also can tarnish the profession.
What’s been your favourite doc2doc discussion of all time?
What do you do when you are not being a doctor?
I like hiking and photography. I play cricket and soccer (both amateur level) little bit. I like listening to people especially senior citizens (this is my childhood hobby and I learn a lot from them).