March 30, 2008

First hand experience of Pinhole/keyhole/laprascopic/thoracoscopic surgery

I will go thru the phases and stages of the events that ultimately is leading me to the hospital for the thoracoscopic surgery on 3rd of April. It wasn't a good experience and I am hoping that it comes to a satisfactory end with this surgery. I am hoping to recover fast and come back to post on my blog again soon around 15th of April.
It was September of 2006 and I went to Raffles hospital for medical checkup as part of pre employment check up. I went to thru a series of test as part of medical tests to confirm my fitness to be able to discharge my duties in good health that included chest X-Ray. I was called next day to collect the X-Ray report and to meet up with the doctor to do some other tests so that doctor could write up my fitness report. Next day upon arrival I was being asked to go for detailed chest X-ray as the radiologist is not able to make decision based on the previous X-ray and wants to re-affirm his suspicision based on this round of X-ray. I went thru another round of chest X-Ray. My appointment with the general physician who was supposed to write my fitness report was cancelled as general physician now needed a advice from thoracic expert and cardiologist. I was referred to Glen Eagles Hospital for expert advice from thoracic experts and cardiologist. In the absence of immediate dates I will have to see them 2 weeks later that's when I was able to get an appointment.
At this time I was in Bangalore[India] for a 2 week vacation. With this news My planned vacation had turned into series of marathons to multiple departments and doctors of Manipal Hospital in Bangalore. In the family there was a bit of palpable tension and every one wanted to get a 2nd advice from doctors in India too. I got an appointment with Thoracic expert. She adviced for CT scan. Next day CT scan was scheduled, this has to be done empty stomach. Day after tomorrow I will have consultation session with the specialist with the CT Scan report. She suspected the dreaded diseases TB[Tuberculosis] as the CT scan were showing 2-3 small scars not just one around that area and probabley in lungs. She adviced for montu[Mantoux test]. Me and family was having a night mare. I am so very normal and fine without any external symptoms. What all is there with in me hiding and waiting to explode. I cam back for next session with the Montu test. It was showing negative. She referred me to surgery section of Thoracic department for advice. There the thoracic surgeon adviced for endoscopy. Oh God!!!! another test next day morning - empty stomach. Next day morning I came back for the endoscopy. It was scheduled at 11 O'clock but for some emeregency that this surgeon had to attend to, I had to wait till 5 in evening. At about 5 PM I went for the endoscopy. It's not a nice experince at all with tubes going down your throat and all. After 2 hours of observation because of the mild anaesthesia during the endoscopy procedure I returned back home. Next appointment was next day noon with the reports of the endoscopy.
After all these tests thoracic sourgeon told that - there is some benign growth beside the food pipe adjacent to the heart. It's about a little less than a inch in length and width. It isn't harmful and you need to keep monitoring it's growth over time. May be you should get endoscopy done every 12 to 18 months where ever you are. In case there is any problem while swallowing food or whomitting or pain around that area get check up done immediately. You can also consider surgery to get it removed. Surgery will be advisable in case there is any further growth in the size. There are very little chances of it becoming malignant[cancerous] or it getting infected. How ever in case this happens it would be critical and immediate surgery would be required because of the proximity to heart and food pipe.
I was back to Singapore for work. I was at Glen Eagles Hospital for expert advice from thoracic experts and cardiologist regarding my fitness to take up the new appointment. Seeing these detailed test reports and finally the advice from the thoracic surgeon I was cleared fit to take up new appointment. How ever they adviced to go for endoscopy every 6-12 months instead of every 12-18 months.
I went for next Endoscopy in August 2007 to Glen Eagles Hospital and they referred me to NUH. No growth was reported and growth was still homogenous and smooth suggesting it's was not malignant. How ever I decided to go for the surgery as it was very frightening and uncomfortable to go for the endoscopy and wait for the results. It was like a bomb waiting to explode. There were some thoughts that at times body automatically absorbs these abnomral growth and it had not happened in my case so it was better to get it cleared thru surgical way. No more tension of this growth turning malignant or getting infected and affecting other body organs near by.

Note: Please also take a look at post titled Going for pin hole heart surgery. Above post is inspired by this post. Though there is no logical relation between both the posts.

Keywords: Some of these fairly technical. Each of them is an hyper link which will help you to learn and know more about it.
Laparoscopic surgery - Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

Chest X-ray - A chest X-ray, commonly abbreviated CXR, is a projection radiograph (X-ray), taken by a radiographer, of the thorax which is used to diagnose problems with that area.

CT Scan - Computed tomography (CT) is a medical imaging method employing tomography. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphein (to write).

TB[Tuberculosis] - Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect healthy adults.

Mantoux test - The Mantoux test (or Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or PPD test for Purified Protein Derivative) is a diagnostic tool for tuberculosis. The Mantoux test is used in Australia, Canada, The Netherlands, Portugal, and the United States, it is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). It was also used in the USSR, and now most ex-USSR countries. Multiple puncture tests such as the Tine test are not recommended. The Mantoux test is one of the two major tuberculin skin tests for tuberculosis used in the world. Until 2005, the Heaf test was used in the United Kingdom but the Mantoux test is now used.

Is everything okay at my workplace !!! (Part 2)

Note: This is continuation of the post titled Is everything okay at my workplace !!! (Part 1). Recommended to read it before continuing with this post.

In the mean time our departments previous director had been pulling key staff from our department into the NAIT unit. There he was in charge of setting up a new department. Though the working model for this department was pre established but there were no people as NAIT has moved it's operations in America to a cheaper location from LA. Most of the staff had chosen not to move out of LA to the new cheaper locale for personal and family reasons. He was virtually setting it up from scratch. This was another canabalism on going but I guess it was acceptable as these brilliant team workers moving to NAIT unit from our department would have left anyway after the gruelling frustrations over last 1 and 1/2 years that each and every one in the department is going thru. On top of this some other people had moved to other departments in ASIAIT as the work wise movement were certainly more comfortable and a relief for them. These people also were hell bent on taking their pound of flesh from a crumbling department as I guess they too had felt the pain in the daprtment for about a year or so after the re-org that ASIAIT had gone thru. More ever new directors[one outgoing person was replaced by two] who have been imported from NAIT unit to resurrect our department did not had the chemistry, charishma and connections to rein in the people in other departments. More ever they were also while elephants because of the expat benefits they were entitled to for having moved to ASIAIT unit in Singapore from NAIT in LA.
Mostly two kind of work gets done in the department. First is BAU work - this ensures that production line keeps running with minimum glitch. There is minimal impact to the external customers and problems if any are addressed in a timely manner. Second is new project role out - this is like putting new things on to the production line once the user test, quality test and all checks have been performed. How ever no amount of checks and test can simulate the actual production environment. As I had mentioned our department is an IT shop which works on INTERNET channel. It ensures that biz critical fucntions are available 24*7 to external customers on internet. Department's job is to upgrade and launch new function on the INTERNET channel to our customers. So in this line of biz no amount of load test and checks can simulate the actual production load and pattern. BAU is so important and vital for the entire company which is now being compromised by the new MDs/EDs and unit head. I really fail to understand how can these people be so short sighted. I can't imagine if something like what is happening to British Airways newly opened T5 at heathrow happens on internet channel of our company. Apart from monetary loss it will be severe loss in terms of good will and reputation. Our customers are with us because of the reputation that has been built over years. New customers join because of brand name that is associated with our organization. I think the financial regulators thru out the world will be so severe on the penalty and punishment for the pain/losses that customers will face when the smooth function of the system will be disrupted. Department is involved for taking care of the INTERNET channel across the globe except for North America. Anyways I think the reason for our MDs/EDs and new ASIAIT unit head not focusing on the BAU is that they don't get visibility for this. No visibility means no promotion and no good bonus. Some thing is definitely wrong in the benefits and compensation policy and correction is required. Like I had mentioned in Part-1[previous post] all new roleout go with more than 100% schedule slippage and between 200% to 300% cost over run. In spite of these over runs and slippage each and every launch is done with fanfare and celebrations. I am also part of the celebrations but still at back of my mind it keeps ticking that the department is on the brink of collapse. Process is definitely on the back seat. Thought of ensuring that newly launched product need to serviced well during BAU phase is not in anyone's mind in this team. It's BAU team's headache - why to loose sleep pondering over this.
New EDs/MDs and even quite a few of the VPs/AVPs are senile fellows. They just want to ensure that they have another place to pass about 1/5 of their life out side thier cozy home. They are content with monthly pay package and are least bothered with what is going on around them in the department and impact it will have on the company and brand name. Any thing wrong is promptly passed to their sub-ordinates. Any thing good invokes a steriotypical "Thank You TEAM" note with a wide distrubtion list. In fact in our department like other departments such a population always existed but then the problem that happened now is that they are all sitting at the hot seats and supposedly responsible for bring things back to track. This is making things worse as of now. I always think it's best to cull them during once every 2/3 year trimming that happens in the name of cost cutting in form of golden handshake[Pink slips]. Hardly 5% of the staffs are old timers[This is where entire knowledge base is] and I think most of them including me are running thin on patienece now. Mind is always cluttered with the thaught that should I start looking out and move out of the department and may be move out of the organization as well all together. Every day is fire fighting on new set of problems threatening to bring down entire production line. Work hours have been streched to 14 hrs per day for more than 9 months now. Percentage of sick leave utilization in the department has shot up sharply because of this. Our senile EDs/MDs and VP have made we 5%[old timers] as in charge of BAU as well new product role outs with BAU as main responsibility. Entire team working under us has no knowledge of the systems and processes. There is no time to think of long term view for BAU as time has to be devoted to new role out as each of these are always escalated to highest level and they keep waiting for our time. They remain quite only when they see some thing critical happening on BAU side.
In four days from now I am going for the pin hole surgery and there after it's likely that I will start looking out. Please send a prayer for me and my department.

March 28, 2008

Is everything okay at my workplace !!! (Part 1)

It's almost end of the day and I have not been able to think how to convey the things and activities [which can be least but called chaotic] at my work place. It would be a little difficult to comprehend for a reader if you have not faced, heard or gone thru it before at your work place.
It all begin about 2 years back then it was being managed fine by set of people who can be described as mediocore but were passionate about work and hungry to succeed. I would not be taking any names as world is a small place and specially so in the IT[Information technology] world. The guy leading the organization about 2 years back was some one who had joined the organization as the smallest ranked soldier and had grown up there after as the department had grown over time. This department had grown really fast and with it few people grew very very fast and most of the guys who were there at the inception too grew considerably. Now for last 1+ yrs there has been no growth in real sense. He joined the organization when it was being conceived. It was started with about 5-6 people then nearly 5 and 1/2 yrs back. I joined the department when it was about 25 people team in the begining of year 2003. He was leading the department in background even before formally being announced as the director of our department in year 2005. He was not a junior person in terms of experience but since it was a new department just formed he had hands on experince with all the jobs that is done in the department even today on day to day and regular basis. This allowed him to feel each and every movement in veins and nerves, he was able to feel the pulse of the department as it was growing. He along with his direct reports use to tweak the governance model of the department as required based on the need of the department and the environemnt in which department was serving the bigger behemoth conglomorate. This is a place where intra department cannabalism is rampant. This means if the guy steering the department is not alert entire department would vanish in few months. Talking about present - there wouldn't have been the problems that the department is facing if same team would have continued to manage the department or at least a slow transition in the departments management team.
Before I get into present state of sad affairs of the department and I guess I will be more critical about the present mainly because I am not a person who believes in making castles from thin air. Let me tell a bit more about the set of people who were running the department earlier. They were not master planners and had not charted the course for the department for too many years or even months in future. Most of the decisions taken by them were improptu based on the prevailing circumstances. And as per me 70% of these were turning out as winning decisions. As I had mentioned the work place is such, if you draw long term plans your existence is at stake. Investment into anything for each dollar is counted on paper and yes on paper only. If you present a solid plan which shows that any of the project executed by the department would be delayed by 2 more month and it will need XXX $$$s. You[Department] are out of the project. Another team will promise that delivery would be done 2 months before need date and at lower $$$s. This attitude and behavior has led to projects over running twice of the estimated schedule and cost over running 3 times at places[2 times was the norm]. So this team leading this department too had mastered this art of over promising as this was I think the key to survival for the entire depatment. I guess some where higher up[2/3 ladders up] cost and schedule was still being met or may be exceeding their expectation. Anyways what was the result of this environemnt - this had led to no documentation of the any of the things that was being done on a day to day basis. It was all in the minds/actions of the person on job. Every time a new member joining the department had to learn things when the problem[mishap for non techies] had happened and he/she would fire fight to resolve it and in the process learn about it. Even in the good days days a team of people were always on stand-by for the fire fighting.
Things changed when entire organization I mean the "behemoth conglomerate" faced credit crunch. Stocks of the company listed in the US started plunging. Board started questioning the day to day operations of the company. Rising operating cost but falling revenue generation comparted to operating cost. This all was the state when the entire world economy was sanguine and ASIA in particular was shining bright with China and India leading the pack. What did this do the department where I work - Some one up[CIO of the conglomerate] decided to change the way the department was operating and align it in as per new line of thought. Reasoning was that this mehod had worked well in the NA[North America] region for years. These biggies[CIO/MDs/EDs] could not see that the conglomerate is in poor financial health because of poor performance of the NA region. They decided to split the department including other departments in the conglomerate in ASPAC[Asia Pacific] region on the same lines as the setup is in NAIT unit. Director of our department was adamant and against this move. He was given the marching order and as I had told resource canabalism is rampant in this conglomerate. Competition with in the conglomerate is so strong and stiff that social responsibilities and ethical professional behavior can take a walk when work is on mind of the people. These things comes to mind of executives and managers only when they are not working together. Ya so our director was immediately gobbled up by NAIT[North America Information Technology] unit along with a promotion to MD[Managing Director]. I guess the main reason for this was that NAIT and our department had worked very closely in past and NAIT guys had seen the managerial acumen of our director. In the mean time not just our department but entire ASIAIT unit had started falling apart. CIO had resigned and moved on leaving the mesh behind in ASIA which he had exported from America. I guess main reason that this model had failed in ASIAIT is because of the cultural difference between NA and ASIA. I strongly feel that cultures affect the behavior of the people at work too. A working model and setup has to suit the culture and the environment in which it is being applied else it is bound to fail in absence of proper conditioning while moving to a new model. For ASIAIT unit new model had been forcibly thrust upon. New CIO had been appointed in Newyork. There was a big time shuffle between MDs/EDs by this new CIO. He had made a young guy in charge of the entire ASIAIT unit. This guy[new ASIAIT unit head] was no one but previous director of our department who had a meteioric rise because of the success that our department had achieved. He had left the department long back in good hands of the new director who had recently moved to NAIT unit.
Many of the old timers in the department like me are familiar with this old wine[our new ASIAIT unit head] in new pack. He is such a good marketing guy and has so much focus on the financial numbers. He only thinks of present and TODAY and for him TOMORROW NEVER COMES. It is widely believed by many of the us[department old timers] that under the great package in which our department was presented to all when he was moving out things were not very rosey in the department in terms of day to day operation. Thanks to our new director that he had taken charge unofficially and things had started to fall in place. I guess it takes different traits for starting/setting up a shop and running a shop when it's of significant size. Our current ASIAIT unit head[old wine] is very good at starting things but does not seem equally adept at running a bigger unit smoothly. He still is hell bent on meeting his financial numbers and may be in doing so there will be no ASIAIT unit. It might be broken up and packaged to individual Biz units at country level. It is just a question of time when entire company will come to know of and demand it if the purpose for which the department was created will not be met. This time our man[ASIAIT unit head] has taken over some thing which is already has rust and if not handled carefully will certainly fall apart.

Note: It's becoming too long. Continuation of this post can be read by clicking on Is everything okay at my workplace !!! (Part 2)

March 27, 2008

Going for pin hole heart surgery

I have finished my pre admission test to get admitted into NUH[National University Hospital]. NUH is one of the well known hospital in Singapore. Next week I would be under going a surgery to preempt possible infection or chances of turning a benign muscular growth malignant. Thanks to advancement in medical science that it will not be an open surgery. It will be done using a technology what is called as "Pin hole surgery". As per surgeons this allows the patient to heel and recover faster as the wound[cut from surgery] is smaller. There are lesser chances of any infection as the area exposed to open air is much smaller given the smaller cut.
I have to go for this surgery to remove some muscular growth between food pipe, arota[this is the main artery coming out of heart] and heart. To explain a little more arteries are the blood vessels in we humans which carry blood from heart to all other body parts. Hearing of such a surgery to your known ones sounds a bit scary. My parents, well-wishers, wife, kids, friends and colleagues are all a bit worried. They are all putting prayers for me before God for fast re-ceovery and every thing gets done smoothly as per surgeons plan. Some not so close people who are aware of it are giving a kind of sympathetic look.
As of even today I hardly feel worried/tense about the major invasion surgeons would be doing on me beside such an in important body organ[Heart]. Anyone looks up with ear focussed and searching for the words to hear about any talk of heart surgery. I have been thinking and trying to analyze why it is so that I am not at all worried about it.
I have taken leave from my work 10 calendar days before the surgery so that my immune system becomes strong to recover and cope up with the additional demand surgery will exert on the body's immune system. I will be on 5-6 weeks of leave after the surgery as well. This will include about 2 week of stay in hospital. I am still happy with the thought of not attending office for such a long period of time.
I think the office has been draining me so much that I don't feel at all worried about going through surgery. In stead I am happy that I will not have to attend office. If this is how other colleagues in office feel, what holds for the future of my department at work place. We will talk about it next writeup.
All reader, please pray and wish for my department as there are about 150 souls suffering with no doctor/surgeon to attend to. After this do pray for my personal physical well being.