Bible Of Blasphemy

Recently needed to see a doctor for a strange persistent cough that has lasted well over a month. Apollo a bit of a drive, so called a local hospital to see if I could walk in for a consult. Lady asks if I want a “normal doctor” or a “special doctor.” “ENT will be great but that’ll take an appointment, right?” “Yes sir, you can get an appointment for 4:00 PM tomorrow. If you want a normal doctor, you can walk in anytime.” “Yeah I think regular should be fine for now. Am coming in now then. It’s just a cold, any MBBS should be able to handle it.” “Sorry sir, for an MBBS you’ll need to come with appointment.” “What? Then what do you mean by normal doctor?” “BAMS.” I hung up without a word. I don’t know how common it is to call BAMS quacks doctors now but it’s a dangerous downgrade of India’s medical ecosystem.

According to some senior doctors-postgraduate doctors learn more: - During 14-hour daily duties - In a toxic environment - Amid violence at the workplace - When seniors hurl abuses for not completing work - When you don’t take any holidays for years - When you have to pay for the entire department’s food every day - When you are humiliated in front of patients daily for missing even minor tasks - When even ward boys taunt you for not finishing work - When you are not allowed to take lunch or dinner on time Some doctors expect you to learn in an environment where you are struggling just to survive.

Left ventricular compliance and diastolic function using a simple analogy: 🔴 Normal Left Ventricle (Top) ▪︎ Represented by a soft rubber balloon ▪︎ Highly compliant → fills easily with low pressure ▪︎ Active relaxation (ATP-dependent) in early diastole creates a suction effect, helping blood flow from the left atrium into the LV ▪︎ Results in efficient filling with normal left atrial pressure. ⚽ Stiff Left Ventricle – HFpEF (Bottom) ▪︎ Represented by a football (soccer ball). ▪︎ Low compliance (stiff ventricle) → difficult to fill. ▪︎ Requires higher pressure (like using an air pump) to achieve filling. ▪︎ Impaired relaxation → loss of suction effect Leads to: ↑ Left atrial pressure Pulmonary congestion & pulmonary hypertension ↓ LV end-diastolic volume → ↓ stroke volume. 🔑 Key Concept ▪︎ Normal LV = suction + easy filling ▪︎ Stiff LV = pressure-dependent filling → congestion. 💡 Clinical Pearl This explains symptoms in heart failure with preserved ejection fraction (HFpEF): 👉 Normal EF but diastolic dysfunction → elevated filling pressures → dyspnea