(IM)PRACTICAL EXAMS – A GUIDE ON HOW TO EMERGE UNSCATHED

Tick tock, my watch ticks furiously as I wait in line to be guillotined (metaphorically) at the hands of the executioner in sheep’s clothing- the examiner.
My classmate asks me what the accommodation pathway is, but his voice is drowned out by the rhythmic, nauseating ‘ping’ of the many machines attached to the patient two beds away and the quiet sobs of the guy who forgot to study CVS but unfortunately picked that case for the practical exam.
Sweat beads on my forehead and plops down to my already disgusting apron which I forgot to throw in the laundry. But luckily, the examiner can’t see that because the wards here are only partially lit by sunlight and two 17th century lightbulbs.
I curse my luck for it must’ve played a major role in my picking the hemiplegia case and I curse (albeit silently) at the residents who won’t tell me the level of the lesion because “the CT results aren’t back”.

SHIT.
He’s walking towards me. And he looks pissed. Like he ate bad biryani for lunch and on top of that he had to listen to students falter when asked where the pons was. (It is in the brain right? I’m positive) If I do survive this tsunami of questions, condescension and humiliation, I promise I will go to church every Sunday mom, I promise. I will even feed stray dogs, or volunteer at a soup kitchen or.. or.. donate my clothes instead of hoarding them. I promise! Dear God let me just live this one out. I can’t bear to study for another six months if I fail this. And..
//lights suddenly start blinking//
//ominous music plays//
//sound of glasses crashing//

There is rubble everywhere. Papers with meticulously written case histories including the ‘mmHg’ after blood pressure readings, rubber tubings with which everyone contemplated faking their own death, punctuated with sphygmomanometers and the occasional mangled stethoscope.
It is a horrible sight, a disaster like you’ve never seen. “Survivors are unlikely” says one passer-by to another who nods his head mournfully.
I fight against all odds (of the patient having aphasia and not just refusing to talk to me) and emerge out emotionally and physically drained but I made it. I MADE IT!

I am now the leader of all the survival guides, because even if you abandon me in a hospital full of hydroceles which WILL NOT show transillumination and patients with rheumatic heart disease who have physically willed themselves into not having ANY of the Jones’ criteria, I will diagnose them and present the case unlike Bear Grylls who will wither because he cannot tell the difference between alkaptonuria and coca cola. So it is only fitting that my final exam experience is shared with complete strangers on the internet along with survival tips because let’s face it, without me none of you would know that there are actual human beings out there who expect you to hold back tears as they scold you for not knowing the cellular mechanics of how aminophylline works. It’s true, I was there. (I cried)

So the most frequently asked question is, what is a good look for practical exams? Neutral makeup with nude lipstick or dewy with a nice shiny lip gloss?
The answer is – None of the above. Aim for cadaveric.
Try to look as deflated as possible, but alert, so they won’t catch you with your palms sweaty, knees weak, arms are heavy. There’s vomit on your sweater already- mom’s spaghetti. Actually it was idli. Same thing.

Coming to the actual exam format, first you must go to the ‘spotters’ section where you need to look at that guy sitting there and diagnose him on the spot without asking any questions. Why, you ask? It is a little known fact, but this was one of the torture techniques used in the Middle Ages to segregate the people based on their knowledge of “why do you think he has jaundice just because his sclera are yellow”. The ones that knew that bilirubin is an uninvited guest at the eye ‘Ball’ (get it? hahaha! If you’re reading this please be friends with me I have none) got to go to med school and the smart ones that didn’t know the answer went on to professions that did not make them acquire TB at any point in their long, happy, needle prick injury free life.

You must then walk quietly to the patient assigned to you where you need to take the case history, do a full general and local examination – that is if you can localise the system that’s affected. I chose solar system because if you think about it, if the solar system did not exist, I wouldn’t be here taking this case. But I decided against it because percussion of the moon was a bit time taking and a tad impossible. Although my best bet remains that the note is stony dull.
Unfortunately your diagnosis cannot be “patient is sick”, believe me, I tried. You need to say something fancy like ‘complete right sided hemiplegia with UMN type of facial paralysis’. But we both know that I wouldn’t know a UMN facial palsy if it hit me in the face *wink*

Your examiner will now walk over to your assigned bed and he will do it like he hates you and he hates his job (which is true). Recite all your findings to him and don’t forget to include that the patient is cooperative even though minutes ago he tried to stab you in the spleen with the biopsy needle. Now comes the fun part where you are asked to demonstrate reflexes. When you swing the knee hammer, the movement needs to be at the wrist, just like when you play badminton instead of studying the root value of the triceps jerk.
Don’t worry if you can’t elicit the biceps jerk. Try again, this time hit your thumb hard. The patient will flex his bicep in pity looking at you wince in pain.

You made it so far! We only have the toughest and the most avoidable part now. The part where you face off with the four horsemen of the apocalypse. A section each for drugs, instruments, x-rays and the part where we pretend like we’re on Dr. House.

Walk in to the first cabin, trembling as you do and take a seat in front of two people who would kill to be literally anywhere else right now. One guy has a huge tray full of vials of drugs, half of which you do not know and the other half is paracetamol. Surprisingly laughter isn’t on the tray. It must not be the best medicine as per general claims. I prayed for an easy drug like aspirin or penicillin. I would’ve been happy even with those cockamamie homeopathy sugar pills. They would’ve actually helped me with my hypoglycaemia. But alas. I was given aminophylline and I got an asthma attack. So my advice is, be prepared for the worst. If they ask you what propanolol is, say you have chest pain.

When it comes to instruments, try to hide a foleys in your pocket so when you are asked to pick an instrument you know to talk about, you can produce one with sleight of hand. But this never works because you are not Houdini, so you must face the dilemma of picking the lumbar puncture needle (and having to demonstrate the procedure of lumbar puncture on yourself because the examiner is never satisfied with any answer) or the other ones which are impossible to hold in the correct position because according to the textbook you are supposed to not hold the instrument at all but instead make it levitate mid air. You can never win.

Listen to me carefully. All x-rays in medicine are of pleural effusions and all x-rays in surgery are inevitably barium meals. So when handed an x-ray to read, confidently say it is pleural effusion. Unless it is not the chest and actually the skull, don’t say thalassemia because you see crew cut appearance. That is actually a picture of the examiner and he wants your opinion on his newest hairdo. Most x-rays used for exam purposes are super old anyway and they look like photographs from WW2 so nobody will be able to identify anything.

Next is my favourite part, the Dr House section. Here they just give you a card with a bunch of information and you need to connect it all and make a diagnosis.
For example : young female, anxious, palpitations, diarrhoea.
See this one is tricky because I know most of us would love to blurt out “THIS IS ME RIGHT NOW ACTUALLY” when faced with a case card like this, but you must think about more common conditions like hyperthyroidism.
After finishing every section, and surviving till the evening without a sip of water or a morsel of food, you can finally drive home and faint at the wheel. You might even crash into someone but hey, it was worth it since your demonstration of ankle clonus was A1.

In conclusion, I wish I could tell you that it was easy, that you will overcome, but it wasn’t and I have nightmares even today. Nevertheless I survived. I finished med school.
I hope I did because if I don’t pass in all the subjects I am quitting this to pursue a life in a monastery away from the mitral stenoses and the hydroceles that orbited me for the past month.

THE FAULT IN OUR SEMESTERS

I am in my final semester of med school. 5 months left. I can’t believe it. It feels just like yesterday I was a fresh faced 1st year, trying to memorise all the muscles of the flexor compartment of the forearm and trying to get through each day without dying from the sheer stress of studying anatomy. Now I’m in final year and
~I don’t even study 1/4th of how much I did back then
~I forgot what the flexors of the forearm are. One of them is flexor digitorum I guess?
~I should be knowing the flexors of the forearm though because I have my orthopaedics rotation now and it sucks.

I have 5 months left and I feel like I know nothing. I only know how to jump across spit puddles and used syringes expertly but that isn’t going to help me for my final exams. I feel like I need to go into a cycle of panicking and panic-studying but I still don’t feel as stressed as I was in first year. I mean who would be stressed? When you know that one of these days the ortho guys are going to drop one of those huge ass drills on your head and kill you, you’re not going to need to give finals. Right? Or maybe my professor would summon me from the afterlife to quiz me on CTEV. I need to be ouija immune. Are there antibodies for that?

 

So 5 months away from the biggest exams yet and I am still lazing around being complacent enough to take afternoon naps. Am I crazy? I might be. (note to self: read classification of antipsychotics)
First six months of rotations I didn’t do anything except sulk about waking up at 8 am and having to drive back home at a time comfortable for me and having no labs or classes back at college. I lead a tough life what can I say? Looking back at the last 6 months, I can only remember doing the following (apart from taking too many naps)

 

1. Gynaecology and obstetric rotations were a complete blur. I remember doing a 12 hour shift in the labour room and seeing a woman frantically pacing despite being told many times to lie down. She gave birth standing up and my resident had to catch the baby mid air in a sick, almost superman-ish swoop. It was amazing to watch, except I had to help the lady drenched in amniotic fluid and blood back up on the stretcher because I was supposed to remove her placenta. My shoes had placenta and amniotic fluid stuck everywhere. I incinerated them.

2. I went to medicine rotation everyday only to take hemiplegia case history everyday. One day our resident said he’d surprise us with a new case. Guess what it was? Quadriplegia.. WITH TB. Fml.

3. All Ortho surgeries make my head spin because its like carpentry but instead sawdust here is replaced by blood and bone bits? I was brushing my hair out after a knee replacement surgery one day (they made me scrub in just so I could take pictures for them) and I found enough bone bits in my hair to make a small voodoo doll out of them.

4. Even though I was the most enthusiastic about my general surgery rotation, I don’t remember what I did. I know I starved everyday because all the hydroceles and inguinal hernias and the oral cancers put me off any solid food. I think I also cried every time my professor asked me weird ass questions like “Why is the X-ray called the X-ray” or “ Why are you shaking so much examine the massive hydrocele case” and my favourite “Why do you think super specialists are better than general surgeons”
Excuse me while I deal with my PTSD in one dark corner of my room

5. My friend just reminded me I have a paediatrics exam in 10 days and all I know in paediatrics is that ‘growth’ and ‘development’ are two different things.
I mean they’re tiny humans, aren’t they supposed to be LESS complicated? ‘I must start freaking out at this stage because I haven’t even looked at the other chapters’- said she while breathing into a bag because of excessive CO2 washout during hyperventilation and hysteria.

6. I have noticed this more than I have noticed green sputum produced by TB patients, but it is so useless to wear make up on OR days?
I feel like the surgical mask manufacturers wanted to double them as makeup removers, because I try and do my makeup early in the morning so I don’t look anaemic and cadaveric when I go to hospital, but whats the point when post-surgery I take my mask off and with it comes my foundation, lipstick, and somehow even my mascara and that weird body glitter I was obsessed with when I was 12. So despite my herculean makeup efforts, I end up looking even more anaemic and cadaveric than usual because someone accidentally threw a used mop on me. I have blood on me but it wont help my anaemia. The irony.

7. I feel like you need to carry 2-3 pairs of shoes any time you go to a hospital attached to mine, more so if it is a ob/gyn hospital, because I feel like instead of land mines and booby traps we have placenta traps. Here instead of being blown to bits and dying in an explosion, you fall into a sea of placenta and clamped umbilical cords, which is 10 times worse.
Or the other danger is running into a pregnant woman who thinks theres something wrong with her (which is 98% of them). They will physically drain you of your energy and extinguish you of your glycogen stores even after you show them that all their tests AND the repeat ultrasound is normal. Carry some candy along with those extra pairs of shoes or you will go into a hypoglycaemic coma from answering all their questions.

8. Its been a year since my horrible experience with orthopaedics and I still hate orthopaedics? I know surgical subjects are supposed to be interesting but orthopaedics is so repetitive and lumberjack-esque. And I’m pretty sure the C-arm is giving me cancer.
And also it’s cute when orthopaedic surgeons are taking a class and they have to explain something medical, and they’re just like “uhhh yeah so fuck that, we need to insert an intramedullary nail and thats all you need to know”. It’s very comforting to know that someone else is just as bad in medicine as I am.

9. I have become an expert in coordinating the time of my hospital entry to the time they mop the floors because otherwise I have to make faces and skip around puddles and run away from stray cats which sounds relatively benign but is extremely hard when you have to do it in corridors with no lighting (both artificial and natural) and you’re wearing heels.
Tbh running in a hospital corridor while simultaneously dodging stray cats which want to give you cat scratch disease and not stepping on used gauze or syringes should be an Olympic sport. Like an obstacle course, but even harder and even more deadly because MRSA is not an easy hurdle to jump. (cue nervous sweating)

10. Instead of learning important things for exams, like obstructed labour and stuff like that, during my obs rotation, I learnt that I have to rap battle the nurses for oxytocin. I tell them I need oxytocin for a patient and they will spit verses back at me telling me they are running on a short supply. Well i guess we won’t deliver this baby today then?
Its safe to say I won’t be pursuing gynaecology or obstetrics in my residency.

Study up kids. Don’t be like me. Or do. You could be an olympian one day. If the olympic committee makes hazardous obstacle race an event. Thank me later losers.