Rural Postings for Doctors : Their resistance is illogical and futile.

One of the reasons I voted for the BJP, other than of course the fact that Narendra Modi had caught my imagination (the fact that I used to be a Modi hater from 2002 to 2012 notwithstanding), was the ass-licking appeasement policies of the previous government which I felt were anti-doctors in addition to, of course, being anti national.

My world view has evolved a great deal over the course of my 5 year journey in MBBS. From being a strong supporter of socialism (perhaps that's why I took up medicine in the first place), almost being a borderline communist sympathiser at times, to recently becoming a little right leaning. A part of this transition has been the realisation that the world we live in is not ideal, ideologies falter and collapse when personal benefits come in conflict, and that a logical argument can easily be distorted to shield a particular individual or group of individual's self interests and selfish intensions in the name of larger hardships of community; which, therefore, will always continue to persist and the gaps will always ever widen. Internship, of course, was the turning point, but the process may have begun earlier.

Facebook discussions now-a-days have gone from being one liner, pull your leg-blow my trumpet comments to literally large - Long answer monologues and discourses. This may partly be a sign of our individual maturity or we may probably have learnt to use the platform for appropriate and relevant matters with age.

When the proposal for compulsory rural postings came up last year, the Gymkhana organised a debate. I was a part of the team that was "against". We were supporting not serving poor people, not giving health to the diseased, running away from responsibilities, not repaying the debt of the society. In short, being selfish, immoral and arrogant and defending it too.

But, lecture hall debates end up in lecture halls and have no more importance.

I had a end stage full blown AIDS patient in the ward. Sending his blood work would be a very frightening experience. I am not judging him or chastising him, but just the amount of precautions to be taken and the anxiety of an accidental prick would make it all the more difficult. But, it was managed. Accidents do not happen if one is careful.

Then one day there was someone who looked like a priest by the patient.  I was happy to see him. Nothing consoles a patient more than a reading from a holy scripture when he knows that his time is running out. I was more happy, that his family members had accepted him, knowing full well the social stigma associated with his disease.

As I continued with the blood collections I couldn't help but be astonished by his mutterings.

"Shaitan is ke shareer se nikal jaa. Holy spirit kehta hai iske shareer se nikal jaa!" And these were the only 2 sentences he kept on repeating for all the ten minutes that I was by his bed side. I between the feeble man would try and say "Nikal Jaa!!"

 I felt like telling him, that your CD 4 count is only 24. Is baar to shaitan nahi nikalega, agli baar shaitani mat karna! I don't judge him for an act in his past, but this is and should be unacceptable.

Was it an exorcism being performed in a hospital? I have seen discovery channel documentaries about such things being done, especially in case of rabies, trying to force feed water to a person who had lost the ability to drink. The discomfort then would, logically be extrapolated as resistance by the devil. But, in 2014?

A few years ago I had seen a patient with herpes. He had taken medicine for a week and so would obviously be cured. But his sister took him to some Baba who swept a broom over his vesicles and then when they went away she proclaimed that the Baba had cured him. So much for our Acyclovir!

A man would stand outside the KEM arthritis opd entrance with "Bhallo ka baal and Whale ki haddi". As patients would crawl out with their painful joints he would entice them, dupe them and tie a Bhalloo ka baal around their arm and a Whale ki Haddi around their throat. If only it was that easy, wouldn't all pharma companies market bear hair? All natural and no side effects.

These are instances where they only eat away our credit, at least patients take the treatment. But, there are many other instances where such beliefs prove counter productive especially in psychiatric illnesses. Psychiatric illnesses where time of patient contact is perhaps the most important determinant of successful outcome. People would rather kill their patients doing woo-doo and what not, but never take them to a psychiatrist. And it is not just the poor, but rich (cast, community, creed, colour, gender no bar) more often who engage in such hoolabaloos.

Indians are spiritual. And our spirituality is often misguided, as much as Hitler's nationalism was misguided.

Its been a year since Dr. Dabholkar, an anti superstition activist was murdered. No arrests have been done. More importantly, no anti-superstition law has been passed. Communities take to roads demanding reservations, cities come to a standstill fighting corruption, police commissioners get transferred if a rape occurs in a remote corner of their jurisdiction, but no noise is raised, rather political parties shout down a legislation that would have corrected a very wrong that is routed in the community.

"Matters of belief"  is a very wide based argument, misused often. May be reintroduce Sati, hadn't Britishers interfered with out faith then?

When I hear the argument that every Indian is Hindu, I don't feel like refuting it.Don't they walk with a mouthful of saffron and spit and colour every corner available in shades of orange to red. Perhaps, it's animal instinct, just as dogs can't let go of their affinity for car tyres.

As much as you tell a patient that he has to throw the cotton swab in the red bag, even be polite enough to point it out to them. Yet, you can always see from the corner of your eye that it goes right under their cot. Blood soaked cotton swab, the most fertile medium for the most notorious germs to grow, stocked up under 70 beds in each ward.

We raised points of unavailability of medicines, of poor security conditions (especially for our female colleagues), the fact that resident doctors go on a strike almost 4-5 times in a year because some short tempered relative vents his ire on a treating doctor. Such instances occur in civic hospitals with in-house security cops, the rural scenario is left to one's imagination. We've all had experiences with those guys with running noses demanding 'INJJESHUN'. And last, but not the least, also about bad roads and no ambulances in rural areas. 

The persistent counter from the jury was "So isn't that your responsibility? Will you run away?"

Non-medicos (except medico's parents, spouses, children and immediate kin) have unexceptionally high expectations of social service from medicos. Partly our seniors have been responsible for that. They managed to keep high moral standards when everyone around was faltering. It is expected that the police will not lodge an FIR even if a murder takes place without first taking Gandhiji's blessings. But, doctors have always sacrificed their personal lives for the sake of strangers and made their sufferings their own.

Today, these expectations have sky rocketed to unreal heights perhaps infringing into administrative and executive domains. Thinking that doctors going to the villages will bring medicines and roads is perhaps acknowledging us for more than what we can do. Dr. Dabholkar was a Medical doctor, not a Ph. D. in sociology. Forget his life, did the society stand with him in his death?

This is why I feel, that the medico's resistance to rural postings is illogical. Without the periphrenalia that we require, we will be useless. But, it may not be wrong to look at it as a year long paid vacation in the greenery and heart of nature. We have been living sleep deprived existence since we were 15, perhaps this is our gift at 24!

Its true that our opposition is because we can foresee that this exercise will be futile, that it will breed in more corruption into the field, that sending demotivated cadres will in fact be counter productive, that the nation will eventually loose its cream to the brain drain.

But, when people want only to be beaten by broom sticks, tie Bhaloo ka baal and Whale ki haddi, and look towards us a potential tool to win them elections, so be it.

So guys, just chillax!

Of Sex Education, Phone Calls and Karyakram!

The only session in "Ahem Education" that I had in school was a 1 hour lecture a few weeks after we had appeared for the Xth board exams. And, that too was held because either the Education Department or the BMC or someone else mandated it. What they spoke, even they had no clue about.I think now, that bees know more.

"What is STD?" one asked.

Being a  studious, sincere student, I proudly raised my hand (as all geeks in schools do!)
"Subscriber Trunk Dialing" I answered, with a smile grinning from ear to ear.

"No, it is Sexually Transmitted Diseases." came the reply.

And that was it. STD is Sexually Transmitted Diseases, full stop.
What? How? Where? When? You were free to figure out by yourself.

Luckily, I took up biology in college and managed to enter medicine. At least now, there is some authentic knowledge. I read about a couple of things that some advertisements in trains and a few websites proclaim. All non-sense! Unfortunate!

Somethings so bizzare as, STDs are cured with sex with virgins! That perhaps explains the society's obsession with the V word. (Poor virgins! They be plagued for life.)

The reason why I am reminded of this incidence is the current string of rapes and sexual assaults that the media is highlighting. And one of the reasons I feel that the trend will not be curbed in any foreseeable future, is because of the element of ignorance.

When educated people are ignorant, what about the already illiterate frustrated unemployed youths?

I had the fortune of studying in a boy's school and therefore there is some first hand information of the endless limits to which the adolescent boy can dream. We used to share!

The problem is less of perversion. 

What is the greatest human attribute? The ability to reproduce in any season? The opposable thumb? The discovery of fire? No, it is the ability to think.

The problem is more of curiosity. What differentiates humans from monkeys and chimpanzees and orangutans, is among other things, our curiosity.

Chimps, our closest relatives, can only think about thinking! We can actually think. Plus, we have curiosity! Added benefits!

Curiosity, not adversity, is the mother of all inventions. We are curious about the stars, the moon, the mars and also the nucleus of the atom. About life, pre-life and after-life!

We are curious of the past as also of the future. We try to satisfy our curiosity by finding answers. Where we can, we do. Where we can't we refer to the greatest invention of the human species: GOD.

(Of course, then we fight and kill over it as well.)

So, God created two humans, a male and a female. And each is curious about the other as well. And that is where the problem starts.

We have the answers to most of the querries, but somehow, God once again is forbidding disseminating them, this time via the instrument of Morality and Decency and such other things conjured out of the thin air.

About six months ago, I was doing my night shift in the casualty.
Suddenly a group of about 14 men and women entered. No big deal! Bring 'em on. But, there was no trolley, no blood, no screaming patient nor a crying mother. They all were, however, surprisingly hold battery-torches. My first impression would have otherwise been that maybe a wall had fallen on someone in the dark night. I was curious.

"Sir, these two kids ran away from the house at 6 pm." said one. Apparently, they were neighbours.
"Sir, we caught them now 10 minutes ago in a garden without clothes." He added. The time was 2.15 am.

Torches, explained!

"So, what's the problem?" I asked.

"Sir, aamhala watatay, hyaannee KARYAKRAM kela aahe! Tumhi fakt check karun sanga."

"Bol, or else the doctor will anyway find out." Said a female to the girl. I presume that it should have been her mother.

One of the benefits of internship was that one would not handle such sticky situations. So, gleefully I referred them to the senior MO on call and watched how he dealt with it.

It was a clearly medico-legal case. The kids were pretty young. And if the girl would have been under 16, and if, they had indeed performed the karyakram,  the dude would be charged with statutory rape, consensuality not withstanding.

Well, from what ever that transpired, neither parties were willing to file a police case, let alone even getting an official casualty paper issued.

The families had no objections to the fact that they were run away lovers, neither was there any sense of animosity apparent between them. There greater concerns were whether the karyakram had been conducted or no. The mothers and the aunts were sweet talking the kids to confess, the fathers and the uncles playing "the bad cops" - Confess or the Doctor will find out.

Door gaon me jab koi baccha sota nahi, to uski maa us se kehti hai, ki so jaa, nahi to Gabbar aa jaayega!  Something, on those lines.

But they went away eventually, us being unable to comply to their requests without them willing to do appropriate procedures.

The kids were lucky (pun not intended), that their families were cajoling them. A few hundred kilometers away, in Uttar Pradesh their bodies would otherwise have been found suspended from a banayan tree with a noose around their necks.

Dr. Harsh Vardhan, the current Union Health Minister is the man responsible for eradicating polio from India. I read recently, that now he tends for Kala Azar to meet the same fate. And he will succeed, undoubtedly.

But, even the views of such a visionary on "Ahem" Education are medieval. When Sunny Leone is starring as lead heroine in film after film, a simple Google Image search from even a naive fan, is bound to reveal more than he expected to see.

How more graphic could your text books get sir?

The knowledge is for dissipation! We are medical professionals and men of science. At least, such we shouldn't feel ashamed and embarrassed when discharging our duties.


Science has to replace shame, and in this scenario we are the most well equipped to do so.

Coming back to the kids in discussion, it was a shameful loss for Indian Culture, but Curiosity won!

Curiosity always wins, just that sometimes the collateral damages become unacceptable. One can't curb curiosity........ its impossible ......... but one can channel it for sure. You can't make monkeys of humans, so let the sapiens blossom.


(P. S.- Ahem in Hindi, means important)

Had the MO given in to their requests, would they have said," Mandal aaple aabhari aahe!" ?

O! What has happened of Men!

(This article features in GOSUMAG 2013)

      If you call the 2^nd year MBBS a honeymoon, call the final year a hell. The final MBBS exam, especially, is a living hell – an apt punishment for all our karmas – past, present and even the future! The dying declaration is considered to be the most truthful and as I write suffering these insufferable sulphurous fires of hell, what I say is nothing but the truth.

      Look back, just five years ago, how happy we were! Young, vibrant and enthusiastic! We were still ‘humans’, with social lives that could be measured on a Richter scale. Five years hence, we are now ‘zombies’! No pain, no emotion, no exhaustion! No sleep, no hunger, and more importantly, no joy. Generalized anhedonia now defines us.

      Is it so difficult, passing an exam? Aren’t we the cream of the intellects? Having cleared exam after exam, fortnight after fortnight, with an effort no more than required to slice a knife through a piece of butter, seasoned campaigners hardened by the toils of war. Innumerable times we’ve heard, “If you can clear this exam, you can clear any other!” However, at this time it seems more of a taunt and less of a consolation.

We have read, we have learned, we have understood, we have practiced and even rotted and mugged, but since the past few days the mind only draws a blank. All that has been constructed has just disappeared. Even when we read our revision notes, it seems something new. There is no déjà vu! It is said that one should sleep well before the exams so that one is relaxed and the mind can work at its optimum. But we’re just maniacs now, sans the excitement and the happiness that is.

Every morning we look in the mirror, and feel just that bit more ashamed. Somewhere, in another parallel universe, is another version of us, who is better, who has continued to travel on the upward trajectory, a path from which we have long deviated and fallen.

Once in school, a teacher gave me a mark less and I cried. Today they say – I will pass you because the examiner who will take your exam six months later will not!

Is this good? No. Because, we deserve better. The world deserves better. We do injustice to our capabilities, to our talents, to our capacities, the hopes that people – parents, friends and teachers – place in us. Usually, when greats retire, the fans feel saddened and it appears that the void will never fill. None of these accolades will ever come our way, though. We are way past our greatness!

Yet, we no longer feel disgraced. It hurts, but not that much. The more you think, the more immune you become. It is the oxygen in our lungs, the blood in our veins and the bile in our tummy. A Professor calls it shamelessness, I prefer the term complacency. As bad as it may sound, it is the antidote to our stresses, a necessary evil.

O! What has happened of men!

Ek Bottle Khun Ka, Kaam Mera Roj Ka!

"Kitna khun nikaloge ?" They ask.

In the earlier days of my internship, I would explain then, how much and for what. But in the due course, I realized, that not all good intentions are always reciprocated. That time and trolley, waits for no intern! That the Registrar is not interested in whether you were counselling the patient. That the patient's well being is decided by timely blood reports and not by whether you answered all his queries.

Then again, it is the human body. It comes with its daily quota of physical and emotional and mental stamina. And all that can't be drained off within the first 2 hours of the day. So, we all mature with time.

"Kitna khun nikaloge?" they ask.

"Roj nikalenge!" I answer, the soldier hardened by a year of war. This is a good answer. It keeps most of them quiet for the entirety of their ward stay. It's diplomatic as well. Man, am I good diplomat! You sort of don't answer the question, but still give a satisfactory answer.

Then again, there are those days, when your mechanisms fail. Those are called the post-emerge days. Post-emerge, post-emergency for those of you who may be interested in knowing the full forms of our medical lingo, is the day that comes once or twice in a week, when you have an emergency the previous day. An emergency is defined as a day, when you manage actual medical emergencies, and not those that your acquaintances call you up in the middle of the night for, like cough, cold and its cousins.

The beauty of a post-emerge is that, most of the times you would not have slept for about 20-22 hours at a stretch, some lucky sons of guns go on for 40-44 hours and then its day dawn for your post-emerge. So maybe, about 5-8 more hours before you can fall dead. You basically work at a spinal level as most of your higher facilities start shutting shop and dissociating from each other.

"Kitna khun nikaloge?" they ask.

"Aadha aaj nikalenge aur aadha kal!" a post-emerge me answers.

My friend (who's hooked on to weed) and I were once discussing life in general. He said he did weed, because it sent him to another world. I described to him my feelings post-emerge. He said, if only he could get such a kick! Sleep deprivation causes dis-inhibition, to be short and sweet.

In my disinhibited state, I loose my diplomacy, and as is the fervor this election season, say something detrimental, but it won't get me any votes. Definitely, if someone told me that he would take away half of my blood today and the remaining half the next day, I would run away. But sometimes, things become such a daily routine for you that you forget that they mean drastically different for others.

"Par kal bhi to liya tha. Aur isko khun kitna kaam hai!" The mother adds in. "Khun banta hi nahi iske sharir me."

"Haath seedha karo aur muthhi tight karo. Hilna mat, ek baar me nikalne ka hai, aur bahoot nikalne ka hai" say I with a smile, as I flash him a 20cc syringe, made famous by those funny scenes in the yesteryears' bollywood movies as "Haathi ka Injection". I think it may be the shock of such a huge thing penetrating their bodies or something, but they don't say anything after that. Except for the one occasion, of course, when the mother actually pulled me away when I barely had collected 5 cc screaming "Bas karo!"

"Aur isko khun kitna kaam hai!" The mother adds in. "Khun banta hi nahi iske sharir me."

"Khun chadhana hai" I answer, "is liye tapas bhej rahe hai."

"Roj ka 5-5 bottle khun nikaal nikkal ke khun khatam kar diya, abhi ek bottle chadhyenge!"

"Khun chadhana hai ki nahi?" I ask. The basic tenet of medicine is that the patient decides his course of treatment. I leave the choice to them, therefore.

My friend had an interesting encounter once, on her post-emerge day. The relative proclaimed, " I know there is syndicate here. You collect all our blood everyday ....... And sell it to the blood bank. Then you tell us to go and get a bottle of blood from them! I am going to complain to Aamir Khan."

Aamir Khan, is the de-facto highest medical authority in India, btw!

"No, I am hungry and blood is tasty and I drink all of it! " She said, in her intoxicated state.

"Khun chadhana hai ki nahi?" I ask.

"Par kal bhi chadhaya tha. "

"Kal ka report aaj nahi chalta. Khun chadhane ke liye, blood group check karna padta hai."

"To kya blood group change ho jaata hai?'

Valid question. But, there are safety mechanisms and legalities. I would have loved to explain in details to her, but for the lack of time.

She continued," Aap bolo unko, khun kam hai, aise hi dusra bottle de do."

"I don't want to go to jail. There are rules!"

"Aise kaise rules banate ho aap log?"

"Khun chadhana hai ki nahi?" I ask. The silence that follows, is an implied consent.

"Yaa Allah! Ye kya marj hai!" she shouted, as I pricked her.

"Chachi, aap ki liver pe sujaan aa gayi hai."

"Wo mujhe pata hai" she said, " Tumhe kya marj hai? Aise suiyaan chubhate rehte ho."

"Aap ke liye hi kar rahe hai." I couldn't think of anything else.

Monday, 21st April, 2014, will be the last day of my internship. For all the foreseeable future, blood collections (majority of them) will be someone else's responsibility. That poor soul will be my intern! And O! Shall I grin, from ear to ear!

What is it, that makes such an innocuous procedure seem such a hardship to the patients?

Is it fear? Fear psychosis..... Internship has been of 365 days, and it has been 365 faces of fear psychosis! Some of them our own faces, majority those of the patients.

There were days when our hands trembled, for we feared, we may hurt the patients...... There were times, our hands trembled for the fear we may hurt ourselves. There were times we dreaded contracting a deadly disease from a patient, there are times when we think and only think about the uncertainty of the future.

Why does it occur?

Is it because, we are afraid of what we do not know?

All-in-all, anxiety and uncertainty and immature psychological defense mechanism of transference makes life hell for us. Knowledge can be empowering...... but not always! Knowledge can be dissipated, but not always. There are prejudices, beliefs and misunderstandings that, do us all in.

We all face them, though, in whatever way we can. Arguing with an intern, perhaps, because somewhere in a dark corner of your mind, the brain has equated a blood collection with a disease, which has affected you, of which you are suffering, of which you know little, which has changed your priorities....... and of course, you do not know, if it will take you to the grave.

 My friend (who's hooked on to weed) and I were once discussing life in general. And he said, he did weed, cause it helped him think about things in a way, he wouldn't have otherwise.

Medicine, has made me think about things in a way, I wouldn't have otherwise.

There is a diabetic admitted in my ward. We want his fasting blood sugar levels, but he always eats something before I come.

"Monday morning ko, mai nahi aaunga tab tak kuch mat khilana!" I instructed as I prepared to leave.

"Par Sir, ye bahut weak hai! 2 din bhookha kaise rahega?"

At some point in the future, I do see myself becoming a resident medical officer. More responsibilities, more complex procedures and definitely more food for.... sorry weed for thought!

Thank you, my dear patients for a small trailer of the bigger picture to come.

Another friend of mine, did a blood collection, and handed over the bottle to the husband saying, " Isko hilao!"
She blinked, and the fellow had uncapped the bottle and was just about to feed the sample to his wife.
"Array! Ye kya kar rahe ho?" She exclaimed, in shock and surprise.
"Aap hi ne t bola, Isko PILAO!"

Uncoding Online Reviews!

"These are dark times, my friend, " said one fictional character to another....... and my friend who is a big fan of the series, kept on repeating it all day, for days on end, until one day I punched him on the face and gifted him dark times around one of his eyes.

I quote this incident, because currently I do feel that these are dark times.

I will be visiting a far off city, for the 1st time, for a couple of days, a couple of months later. And so, the preparations are in full swing and most of them "a-swing-and-a-miss". One of the things I am very worried about is my accomodation. They say the city is safer than Mumbai...... which should make it the safest city in the country, but then the true-blue Mumbaikar will not accept that claim.......

So, to be on the safe side, it's good to be assured that you have booked a good accomodation.
In the era of the internet, everything is online..... e-mails, e-payments, e-transfers. We Indians, anyway, have been making hay of the internet even before it was in its stage of genesis. For centuries we have been e-smiling at each other, talking and gossiping about the e-smooches in E-nglish e-stories converted to films, playing all sorts of e-sports, going on e-strikes and what not in our own e-special e-styles. But, all this doesn't bother me. What bothered me was my first experience of booking hotel rooms the e-way.

In the e-ra of social media, communications have broken down. In those olden days, people would inquire with friends and friends and relatives of friends for such queries. But, the confident youth of today (such as myself) more often than not, e-mpowered by the e-nternet, take things into their own hands, go to google and get all our querries answered.

So, I rub my magic lamp, and a Google comes out of it. "Hukum mere aaka! Aaj kya maangta???" As if reading my mind, it has already given search results before I have finished typing........ "You know, interrupting others is ill manners" my mother stills reprimands me, but the standards for Google are different.

Cheap hotels....... and some 200 pages and 200,000 search results in 0.0025 of a second. E-mpressive! I look up the first few results........ Click on photos for preview..... I am blown out this world into the outer e-space! Such beautiful rooms at such throw away prices!! Why rent an apartment, when staying in a hotel is profitable.

But, one must always read reviews...... So, I began reading.
Everything seemed very pink and rosy. A particular site had a good system of having classified their reviews from family to solo and business, excellent to terrible. Might as well see, what problems people had with it...... (Just to see if it's worth taking a shot)

Under terrible:
#1: No windows...... rooms nothing like the ones shown in the photos.
#2: Flush not working.
#3: The room on the ground floor has a broken window....... people from the neighbour building just kept peeping in the room all through the night...... made me very uncomfortable...... (Yeah, that's what Indians do.)
#4: Very noisy.
#5: Rude manager.
#6: The toilets were not clean.... The sofa had molds..... AC wasn't working.
#7: No maintenance. The bathroom was filled with hair of the previous visitor.....
#8: Area is surrounded by brothels...... Not good for women travelling alone!

Those under Solo and Business read
# 1:Excellent place, warm people.
# 2: will come back again.
# 3: Excellent room service.
#4: Reached there at night for a stopover on a trip to Delhi.... could have done with better sound proofing as it is located on the highway..... But, great place at this price.
#5: I've been here thrice, gets better each time.
#6: I never write any reviews, but this place is so good that I am writing it. (That was all, and indeed that user had this lone review to his credit)

Eventually, since I am going for an exam, I have decided, this is definitely not the place I want to stay at. I have gotten in touch with a couple of people who know people residing in the said city to refer me to a safe place.

By-the-by, the following review requires a special mention. Categorised under the one rating the said hotel as excellent-

Stayed here for three nights. Poor ventilation, poor room service, charged me more at checkout. But on the bright side, J.W. Marriot is bang opposite, so you can pop-out of here in the middle of the night and go there.

What do you mean???

This hasn't been my first experience reading online reviews....... A month ago, my old laptop crashed and I had to buy a new one. Read online reviews and bought a Leovo..... which crashed on day one.... Went back and exchanged it for an HP.... which was reviewed to be bad..... Has been working e-smoothly!

Conclusions:
1. When Indians write reviews, they can't be trusted. Either we don't know what we are writing or forget to include the "pun intended" in brackets.
2. It all boils down to the price..... If its cheap its e-xcellent.

Contact someone who you know personally and follow their advice.