Welcome to the second part of our interview with Dr. Aditi Sinha, where we will delve into her DNB training under the guidance of Padma Shri Dr. Sandra Desa Souza, her thesis selection process, and her valuable experiences during internships and work in various hospitals.

Arpita Meher: My name is Arpita Meher, and I'm a final-year medical student. I have a question regarding the latest trend of ear candling. We frequently observe people purchasing these sticks from Amazon and using them to remove earwax. I would like to know if this is considered a good practice and what the pros and cons are associated with it. I would appreciate your insights on this matter.

Dr. Aditi Sinha: You tell me what you think about it first. I want to know from you before I can answer this question.

Arpita Meher: Ma'am, to be frank, I have never used the product, but I've come across videos where earwax appears on the paper after it has burned to the marked level and is then removed. It seems somewhat suspicious to me. I'm curious about whether ear candling is a safe practice.

In India, many people may be hesitant to visit a doctor for earwax removal due to the perceived cost, even if it's just a nominal fee of five hundred rupees. Instead, they might watch these videos and opt to purchase ear candling kits from Amazon to perform the procedure themselves or on family members. I'd like to understand if this practice is safe and effective.

Dr. Aditi Sinha: If you were to ask me, and if you delve into extensive online resources such as reputable websites like WebMD or similar sources, you'll find that ear candling is often regarded as one of the worst methods for ear cleaning. However, it's essential to understand the perspective of patients in India who are highly cost-conscious. In their view, paying, let's say, 500 rupees for a doctor's consultation and potentially an additional 500 to 1000 rupees for a procedure that seems to involve merely removing some "dirt" from their ears might not seem justified.

But here's the crux of the matter: we need to weigh the trade-offs and risks. Especially for less educated individuals who may not be well-informed about the potential dangers, they might resort to roadside ear cleaners who use sharp tools or brass scoops, often causing harm while attempting to remove wax. Moreover, in addition to ear candling, there are various other devices available, such as rotary wax brushes and suction kits, resembling thermometers that people use to attempt wax removal.

While ear candling might provide temporary relief and yield visible results on the candle, it's essential to understand that it likely does not remove all the earwax. Furthermore, it offers no insight into potential damage or the introduction of infections. The safety and efficacy of these practices are not supported by scientific evidence, and they are generally considered unsafe and non-recommended worldwide.

Arpita Meher: The next question is, since your DNB qualification was obtained under the guidance of Padma Shri Dr. Sandra Desa, how do you believe her mentorship has influenced your career or your surgical approach in life?

Dr. Aditi Sinha: In my view, I consider myself fortunate to have had Padma Shri Dr. Sandra Desa as my postgraduate teacher and guide during my DNB training. Our group was relatively small, consisting of just two students initially, in contrast to the larger groups typically seen in MS programs. This allowed us to receive a significant amount of individual attention.

Beyond her impressive surgical skills, Dr. Sandra Desa is also a pioneer in the field of cochlear implants in India, making her an exceptional mentor. Working alongside her has completely transformed my perspective on ENT (Ear, Nose, and Throat) medicine. Rather than viewing it solely in terms of issues like ear perforations, ear discharge, tympanoplasty, tonsil and adenoid procedures, or sinus allergies, I now see it as a way to change lives.

Through our work, we encountered deaf children who were congenitally deaf and born into impoverished families in rural Maharashtra. Some had contracted meningitis at a young age, and their parents only realized their hearing impairment around the age of two. We initiated a funding program, supported by a charitable trust, to help these children. Witnessing their journey from non-responsiveness to sound to being implanted with cochlear devices, undergoing programming and speech therapy sessions, and eventually beginning to hear was nothing short of miraculous.

Imagine the profound impact of that first switch-on moment for a cochlear implant recipient. The child hears a sound, turns towards it, and the mother calls them—it's a moment of pure magic. It's akin to providing someone with a bionic ear after a lifetime of silence. This experience has profoundly changed my life and how I perceive my role as a medical professional.

Arpita Meher: We know that while doing DNB, making a thesis is a very important thing and there have been several cases. I mean, they're mostly unreported here, and because of this thesis pressure, these medical students have committed suicide in some states of India. So how did you decide to take up such a thesis on pediatric implants? If you could give some tips to the future medical students so that, we could decide on making a thesis easily or taking up any topics.

Dr. Aditi Sinha: To be completely honest, when I was a fresh MBBS graduate, joining the DNB program without any career gap, the idea of doing a thesis on cochlear implants seemed almost crazy. It felt like a daunting task, and I even thought of it as a potential academic suicide. My guide, who happened to be my teacher, played a crucial role in the decision. She said, "Aditi, this is the future."

She advised against choosing a thesis topic like tympanoplasty or mastoidectomy, which had been extensively studied. She pointed out that there were numerous studies on common procedures like septoplasty or adenoid surgeries. So, to my shock, she suggested focusing on cochlear implants. At the time, I had never even seen a cochlear implant in person, and my exposure to advanced digital hearing technology was limited because I studied in a government-run BMC college.

Adding to the challenge, she set a deadline of three years for completing the thesis.

She reassured me that we could collect data gradually, even doing one case every week. In two years, we could easily accumulate 50 cases, or maybe even 100. It seemed like a daunting task, but she had experience with numerous cochlear implant surgeries and data to back it up.

Completing my thesis became one of my most significant challenges. I knew I could pass the DNB exams, but the thesis work was a different beast. In retrospect, it turned out to be the best decision of my life. Choosing a specialized topic like pediatric cochlear implants set me apart from other students who opted for more common subjects.

I want to address the concerns of many students who fear they won't gather enough data or complete their thesis on time. It's disheartening to hear that some believe medical students aren't adept at mathematics or statistics. My guide had an essential piece of advice: "Don't worry about the specific results you'll get. Collect your data honestly and thoroughly. Even if you find no correlation or get unexpected results, that's okay. The key is to engage in genuine research."

Arpita Meher: Working in several hospitals like Jaslok, KB Babha, PD Hinduja, Apollo Spectra, and all these hospitals, you might have seen several cases throughout, when working there. You might have encountered several challenging cases. So how did you approach them and did you ever feel, seeing those cases that, no, I cannot go ahead with this one? The patient has to be referred to a different hospital. Has it ever happened?

Dr. Aditi Sinha: I want to share a story that I've never shared before. It dates back to my very first day of MBBS. On that day, when I walked into the dissection room for our first anatomy lecture, I felt incredibly confident. I thought, "This is what medicine is all about." However, what happened next was quite unexpected. In a room filled with a hundred fellow students, I was the only one who fainted upon seeing the cadaver.

It was a strange experience because I had never fainted before in my life. In that large hall, where everyone was initially focused on the cadaver, they suddenly heard a thud. People turned their attention away from the cadaver and realized that a student had fainted. I still remember my anatomy professor initially thought that the cadaver had somehow fallen off the table due to the loud thud.

I had a substantial bump on my head, and my peers rushed to help, even bringing me a cold drink and applying ice, though somewhat panicked. When I went home and recounted the incident, my parents expressed concerns about my ability to pursue a medical career. They questioned whether I was cut out for it, considering that I had fainted on the very first day in front of a hundred new students and professors. I, too, felt a sense of shame and doubt. I had given up engineering and architecture seats for this, and now I had made a fool of myself.

But it's a story of courage, isn't it? The next day, I returned to college, and everyone had a good laugh about it. I had a noticeable bump on my head for about a week, and people would say, "Oh, she's the one who fainted on the first day." However, it taught me a valuable lesson. In the grand scheme of things, such incidents don't matter. What truly matters is having the courage to face challenges and believe in yourself. We all can overcome our fears and doubts.

Throughout my career, I have worked in various hospitals, including KB Bhabha, where we were on duty 24 hours a day. We encountered all sorts of patients, including those with strangulation injuries and cutthroat wounds. It was a government hospital with a wide range of cases, including police cases that required immediate attention. Being on call, we were answerable, and relatives were often present, demanding answers.

I've also worked in private hospitals where the atmosphere is more controlled, and patients' relatives are generally more cooperative. It's a different stratum of patients altogether. Nevertheless, even in private hospitals, there have been times when I felt out of my depth. It's a feeling that many good doctors can relate to. You encounter cases that make you think, "I don't know how to handle this." In such situations, there's no harm in admitting that a case is beyond your expertise or resources. The patient's well-being should always come first.

I believe it's crucial to recognize your limits and not hesitate to refer a patient to a higher center or a specialist when necessary. This is especially important in peripheral centers or smaller hospitals that may lack certain critical resources.

I recall a case involving a young girl, just 16 years old, who had been involved in a dispute. Another individual had slashed her throat. When she arrived at the hospital, her windpipe was hanging out, just dangling. I looked at it and thought, "Can I do this?" "What do I do?" But she was a young girl, and I knew I had to try. So, I gathered all the courage I had, called in every resource I could, and we managed to repair her injuries. She survived, recovered well, and even came to visit me every year. This experience taught me that in medicine, you win some and lose some, but you must always be prepared to confront your fears and accept that there will be times when you face challenges beyond your immediate capabilities.

Priya Bairagi: There was a recent study in which they showed that female surgeons are better and more meticulous.

Dr. Aditi Sinha: That news story went viral, but it's essential to understand that while that study is accurate, the daily reality we face as women in the medical field is quite different. Gender biases persist, and they manifest in various ways. I've encountered situations where I've booked an operating room on time, only to have a male surgeon assume it's okay for me to wait. They won't vacate their outpatient department (OPD) on schedule because a woman is waiting, and they think it's acceptable for her to wait.

In my department, I've had occasions where male ENT doctors refused to cover my locum when I needed to take leave. Their reasoning? "You're going on leave; you can figure it out." This situation forced me to rely on my female colleague for locum coverage because we knew that others wouldn't stand up for us. There should be no reason for this disparity, especially considering that women often exhibit care and compassion in patient care, and studies have shown they can be excellent surgeons.

Yet, there's intense competition, as mentioned earlier. Whether it's suturing a patient or performing a specific procedure, there can be territorial disputes. I've witnessed cases where two residents are fighting, even to the point of one angrily switching off the OT lights during a procedure because they disagreed about whose patient it was or who should perform it. It's essential to remember that the patient should not suffer due to these disputes.

Once you're someone's junior in college, you remain that way indefinitely. In contrast, other professions tend to treat colleagues as equals once they're working. If you've ever seen engineers or professionals outside the medical field being treated as juniors indefinitely, it's rare.

If you find yourself in a situation where you're not getting enough surgical experience during your residency due to a shortage of patients and an abundance of students, you can consider working as a resident in hospitals after completing your degree. Many of us have done so, dedicating a few years to learning different procedures we might not have had the chance to experience during our formal training.

In the medical profession, you're a lifelong student, constantly learning and evolving. There are numerous procedures that I, as an experienced surgeon, still haven't mastered, and I continue to learn from my juniors. When they graduated and introduced new procedures, I reached out to them to learn and improve my skills. The essence of medicine lies in continuous learning and growth.

Stay tuned for Part 3, in which Dr. Aditi will debunk common ear myths and discuss the diseases observed in both private and government hospitals. She will also explain how doctors stay updated with the latest advancements and trends in the field of medicine.

(Transcription/Arpita Meher)