(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.

A FINAL YEAR MED STUDENT GUIDE TO PERFORMING A PHYSICAL EXAMINATION AND CASE TAKING

A good physical examination, as repeatedly told by my professors from the first ever clinical rotation I attended, is the biggest clue to diagnosing a patient. But when I got to the hospital after a close encounter with death at the entrance i.e., physically wringing out of the grip of a patient who wants to leave AMA , I was only shown a few clinical signs and watched as my professors sized up the patient and told me his diagnosis. So as a naive second year med student eager to absorb clinical knowledge like a sponge after being released from the clutches of cadavers, dissection hall and the biochemistry lab, I thought all I needed to know was how to read a CT/MRI/X-ray/ECG.

I wasn’t wrong, but I definitely wasn’t right. We were taught how to write case histories and recite them to our professors who paid irritating attention to details like negative history of every condition ever known to mankind and measuring the JVP which I’m sure is only a myth and no man has ever measured the JVP before, much like how no man has ever seen the loch ness monster or the bigfoot. The people who tell you they’ve measured the JVP, and worse told you about how clear the Kussmaul sign is in the patient in bed 3, are LIARS and conspiracy theorists.

So this, my fellow batchmates and underclassmen, is a guide on how to perform a good physical exam, and simultaneously impress your professor while also learning about the complete sham that is JVP examination (seriously, I stopped using a scale back when I was in 5th grade. What makes Hutchinson think I have TWO scales at my dispense and the time to cry my eyes out every time the JVP is normal/ definitely NOT raised/ invisible in every right heart failure patient)

시작합니다 – That’s Korean for let’s begin. Physical examination is hella confusing so what’s one more notch on the confusion scale amirite?

GENERAL DETAILS:
Ask the patient his
1. Name : don’t be a dick and call him ‘that mitral prolapse guy’ every time you need to address him.
2. Age : Definitely going to be lied to about this. Tell him you’re not here for a rishta and this is not a Swayamvar. You don’t care if he did his MS in the USA at only 23 years of age.
3. Address : So you can tell his mom when he sneaks out in the night.
You can then ask for additional details like – does he have a dog? What kind? What’s his name? Is he a good boy? Is he a very good boy? Who’s a very good doggie?
Sorry I get carried away but this is 100% the best way to impress your examiner from the very start. Show him pictures of cute dogs.

PRESENTING ILLNESS :
Start by asking him when he first started noticing the symptoms. He will definitely give you a ball park range, for example :
Me : So when did you first notice the cough?
Patient : When I was 3 years old.
Me : But.. you’re 37 years old now.
Patient : Baba Ramdev said I can cure this with deep breathing.
Me : …
Patient : *Starts deep breathing out of one nostril*

After writing everything in chronological order, and describing the fever in 782 different ways like low grade in the morning, high grade at 8.37 pm and now in a hectic picket fence pattern, move on to asking about negative history, which means asking questions to rule out other conditions. Ask about trauma, weight loss, blood in sputum, syncopal attacks etc. You can also ask who will kill Cersei Lannister in the next season and why you keep watching GoT when you have so much to study.

PAST ILLNESS : Same as above, but like in the past. Before that guy got that cough when he was 3 years old.

FAMILY HISTORY : Does the disease run in the family? Does the father also show extreme displeasure while being asked for medical history by undergrads? Why was the saasuma (mother in law) fuming at the bahu (daughter in law). Stay tuned to find out.

 

VITALS : Is the pulse even present? Okay good. The patient is alive. Makes it easier to diagnose this way. Did you count for a full minute or just for 15 seconds and multiplied it by 4? Is it pulsus paradoxus or pulsus bigeminus or pulsus tardus et parvus? You need a minute to read about those for the first time? Cool. You’ll need a crash course on Latin for that. Good luck.
The respiratory rate is always 17/min even though he is tachypneic, bradypneic or apneic.
Just like how the BP is always 120/80 mm Hg even in someone with severe hypotension. As long as you write mm Hg, you’re good.
Temperature – afebrile/febrile/ you’re hot then you’re cold, you’re yes then you’re no, you’re in and you’re out, you’re up and you’re down – as described by Dr. Katy Perry.

GENERAL EXAMINATION :
This is supposed to be a head-to-toe examination so you don’t miss anything in addition to the disease you’re trying really hard to diagnose without looking at the patient’s case file.
Did you check for PICKLE? I mean did you check if the patient is carrying any pickles on him? I’m starving and I could use some, thanks.
But don’t miss the clubbing on the chain smoker’s fingers. Don’t accept his invitation to go clubbing either. No thanks, second hand smoke.
Look at his gait. Is it wobbly/trendelenburg/ moon-walk? He might secretly be Michael Jackson. Oh wait..

INSPECTION : You’re supposed to look at the patient and ‘inspect’ him before touching. Does anyone do this anymore?
Imagine staring at him until you check off all the boxes under inspection.
Scars – check
Sinuses – check
Swellings – check
Engorged veins – check
Mild awkwardness progressing to extreme awkwardness – CHECK.

PALPATION : Did you touch the patient with your ice cold, nervous, quaking hands? Good job, you’re one of us now. This is your patients encounter with frost bite #1. Spend the next five minutes playing tag with the patient around the hospital because he doesn’t want to be touched by you ever again.
Did you feel for thrills/apex beat/tactile vocal fremitus? Feel for organomegaly – close to impossible, but your professor will always say “There’s massive splenomegaly! Look! Feel right here”, to which you will say “yes yes there is massive splenomegaly” while jabbing the poor patient with your cold hands and finding that there is actually NO splenomegaly. There might not be a spleen present too. This is all an act.
Run away whenever someone mentions Murphy’s sign.

PERCUSSION : Percussion is by far the hardest thing I have ever done and I have helped a woman give birth on the floor while she screamed and yelled at me. What is the note you hear when you percuss the lungs? Resonant/hyper- resonant/ dull/ stony dull/ emo/ very emo. Talk about how you heard a resonant note when you don’t even know what the ‘pleximeter’ is.
If everyone in your class cooperates, all of you could play a song out just with percussion.

 

AUSCULTATION:
Your patient’s encounter with frostbite #2 – the harsh, sub-zero temperature of your stethoscope diaphragm.
Did you listen for the first and second heart sounds? I have finished at least a million clinical rotations and I still say “lub-dub” out loud to differentiate the first heart sound from the second. The heart is weird man. It murmurs and stuff too. You have to then grade the murmur. Grade 1 – very faint to Grade 6 – very loud, very Arnab Goswami, very tantrum-throwing teenager-ish.
If you hear a gallop sound its best to bribe a resident with some food and actually confirm because everything sounds like a pathology to your underprepared, over enthusiastic ears.
To complicate things even further, there are some signs that combine the already complicated auscultation with other things – like the liver scratch test where the patient tells you his skin itches and you have to scratch him or he won’t let you examine, or the puddle’s sign which is impossible to perform and has joined the leagues of the JVP and the loch ness monster.

After finishing your case taking and examination, you must arrive at a diagnosis.
To summarise my case,
“37 y/o male patient who did his MS from the USA, a resident of Westeros, who sneaks out regularly in the night through the left window on the second floor, has a dog named snickers who is the cutest, won’t stop doing yoga (consult psychiatry), won’t tell me who will kill Cersei, never walks, only moonwalks (consult ortho), has invited me to go clubbing with him, has a grade 6 murmur yelling at me from across the room, most definitely a case needed to be taken up by Dr House”

*drops mic*

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.

FAQ : HOW IS FOURTH YEAR?

How is fourth year?

Can you perform surgeries now?

Why are you wearing block heels to hospital?

Why is your makeup so blended?

Where did you get time to buy that outfit?

Hello friends, remember me? The mopey third year? I am in final year now. Which means I am invincible and I have all the time in the world to watch Captain America : Civil War TWICE. That’s right, twice. Can any other med student perform this staggering feat? I don’t think so.

To answer all the questions above, yes I look amazing because I get enough sleep and I have all the time in the world because fourth year is like all hospital and no classes. I don’t have to shuttle back and forth from the hospital to classes in sweltering heat. I finally have a life!

But I know that even though I say I am free, I really am not. I’m supposed to be reading Bailey and Love/ Davidson but I guess I’ll stick to my method of panic-reading everything before my semester exams and crying about how little time I have. Up until now I’ve only had my medicine and general surgery rotation and even though I’ve hated them they were really comfortable and I got to go home early and sleep 🙂

I first had my surgery rotation which was a breeze (not). Instead of rollin’ into the surgical wards at 10.30 am like the other kids, I had to go at 9 am because my attending was a little cray cray and he got a kick out of seeing students being punctual. So my daily routine in the 6 weeks of general surgery was something like this,

Walk into da club (general surgery male pre-op ward) at 9 am and look at wound dressings being done.
Study about hernia/hydrocele
Present a case of hernia/hydrocele
Listen to general surgeons talk about how they’re better than super- specialists while they’re teaching a hernia/hydrocele class
Being the official discarder of used wound dressing materials. Mostly suture dressing after hernia/hydrocele surgery.

But I am a surgery fan so it was bearable for me. In medicine all we do is cry about getting TB because even the CVA guy has TB and I can’t escape it.

So here are some of the frequently asked I (or any other med student) face. I will answer them once and for all, so please don’t trouble us.

1. (Q) All my relatives : Can you treat me now? You’ve been studying for the past decade.
(A) No I can’t treat you. I can tell you the procedure of gram staining and I can give you a band aid. Do you want some aspirin?
Also that one cousin, you cannot have a prescription for medical marijuana sorry.

2. (Q) My boyfriend : Why are you always studying? Do you like have an exam or something?
(A) Do I have an exam or something? DO I HAVE AN EXAM OR SOMETHING? I only know that my paediatrics textbook is lying somewhere and they’ve finished teaching half of whatever it is they teach in paeds.
So no, I do not have an exam. I am just catatonic I will fail this year and forever be stuck in a loop of trying to look for my book and failing ❤

3. (Q) All my non-medical friends : Why are you throwing up?
(A) From the stress of a pancreatic pseudocyst rupturing and the weird green liquid spilling all over my brand new scrubs in the OR.

4. (Q) My mom : Why do you only eat foods with absolutely no nutritive value? You read about nutrition in community medicine right?
(A)Because I am training my body for surgery finals. Also, what even is nutrition 🙂 ?

5. (Q) Also my boyfriend : Why don’t you emote?
(A) I was forced to watch 15 episiotomies non stop pls don’t do this to me I can only take so much.

6. (Q) Everyone at the hospital : Why do you park like you’re a blind fruit bat?
(A) I never learnt how to park properly because I was learning the urea cycle.

7. (Q) Patient : Sister. Excuse me. Ma’am. Lady. Lady in the white coat. Nurse.. (basically everything except doctor) Why won’t you turn the fan on for me? While you’re at it, can I have the menu for dinner?
(A)This… this is not a hotel!

8. (Q) Professor : What did the author of this textbook say in the preface about his take on the meaning of the Hippocratic oath?
(A) *wiping tear from cheek* I can recite the steps of hernioplasty. Will that do?

9. (Q) My classmates : Why did you go on a holiday and then cry about not being able to study gynaecology?
(A) You fools I know what menstrual cycle means I think that’s enough to master gynaecology.

10. (Q) Underclassmen : How are you so calm when you have massive subjects this year to study?
(A) Water-proof mascara, concealer, caffeine, a lot of waking up at 4 am and panic-reading, and a boyfriend who thinks IV antibiotics are stage 4 antibiotics and who also offsets your psychosis.

THIRD WORLD MED STUDENT PROBLEMS PART-2

Picture this. It’s summer in the tropics, which means it’s pretty fucking hot, say 41 degrees C. You are forced to go to a hospital 4789236 kilometres away from home. You park your car in the crumbling semblance of a shed, bump your car around a few other frustrated drivers, trees bang in the middle of the road, and obvious manholes laced in between the intricate one-car lanes.

You are extremely tired and it’s only 9 am. Delightful. Then you have to do a 100m sprint from the parking to the hospital building and while doing so you have to dodge a few birds trying to take a shit on your white apron. You are basically an Usain Bolt who also does relay-runs. Why do you need to run you ask? The professor comes in at 11.45 am, but he will enquire when the students came in because he is trying his very best to invent new ways to torture us. Poor guy, A+ for trying.

Then you are barraged with questions, as soon as you can catch your breath. Mostly from residents because they are in a constant fight for power in the food chain. You try to answer whatever you can while also experiencing grade 4 dyspnoea. But tough luck, you trip on a bum tile and fall down in a tub of used gauze. Ha-ha. You laugh awkwardly. But inside you are dying.

Welcome to one day in my life.

In my previous post of third world med student problems, I made a lot of people laugh (sure, go ahead, laugh at my misery), but i spoke da real 100% truth. Though I might have left a few points behind, because you can’t really describe a third world hospital. It’s a museum, a zoo, a dustbin, a movie set and maybe sometimes, a hospital.

Third world hospitals are like a parallel universe. It’s like stepping into Narnia, only the white witch is Tuberculosis. In this strange world, we have endangered art work such as “Jai Telangana” splattered across walls, the ritualistic outdated surgeries using instruments John Hunter himself forged out of rusting metal. And how can I forget, the mesmerising sing-song voice of the nurses saying ‘pakkaku jaragandiiiiiii’ (translation : GTFO) . It’s all fun and games until your professor makes you examine a hydrocele case sans gloves. Why? Because it makes him inexplicably happy and don’t whine, it’s *practical knowledge*. It must be my damn birthday because the icing on the cake was that the hydrocele guy had TB too. Ha-ha-ha (crying slowly turning to tears) I want to switch places with the coma guy.

But I have left behind my snobbish ways of wanting cleanliness and wanting to NOT die from fright every time I trip on the ghoulish winding staircases with no lighting whatsoever. From my last post on third world hospitals, up until now, I have come to realise that,
a) I cannot change anything
b) All pigeons are going to want to poop on me
c) I need to get waterproof makeup because I cry a lot whenever I am confronted with a patient and his family who all have a coughing contest on me.
d) My professors expect me to love this hospital and worship the ground they walk on. Which I cannot because it is inevitably covered in dust/pus/blood/urine of animals or humans/all of the above

So while I cannot change the fact that I have probably stepped already on someones urine and/or blood, I can at least help you, if you ever have the misfortune of going to a hospital in India. You must first remember that bravery is key.
You cannot run like a pansy when you see poor med students being harassed and asked to feel for axillary lymph nodes in someone who has not showered in 10 days and is sweating like an Indian bride on the day of her arranged marriage .

You must instead give them moral support and stay with them till they regain consciousness. Okay here is your survival kit : Updated

1.How is your hospital back in the west with your beautiful shiny, expensive things and your spotless scrubs? All good? I thought so too.
While you lead a life of rampant luxury, we fight gladiator-style for the last pair of OT shoes . It’s cool 🙂
Also, must be nice to have a hospital stocked with ESSENTIAL things like hand sanitiser and soap and surgical masks.
You know the last time I walked into an OR and I forgot to bring my own surgical mask, I had to run around the entire hospital asking in each department if they could spare a mask for a poor child like me.
One nurse in the medicine department finally took pity on me seeing how I was close to tears.
I am free.
Master gave Dobby a sock.

2. Where do you go for your summer vacation? The theme park? Or probably the beach?
I go to the hospital.
When it is dangerously hot outside, it’s even hotter in the hospital. Because we have maybe about 10 ceiling fans and 2 out of them work on a good day.
So you are sweating half of your body weight and finally faint and fall into a puddle of your own sweat out of sheer dehydration. Only to be rudely woken up by the colossally inexperienced interns poking you with IVs, who can’t find a vein if it slapped them in the face.

3. There are a few words you need to know to get out of any situation in each department.
Surgery – ‘Pain and suffering’
For example,
Professor : What are the symptoms of acute appendicitis?
Me : Pain.. and suffering.
Professor : Ok. What are the symptoms of hernia?
Me : Pain. Maybe suffering too. Definitely pain though.
Professor : (Impressed) Good job. You can assist on the next surgery.
Me : OMG THANK YOU!! Which one?
Professor : Lateral anal sphincterotomy
*cue PAIN AND SUFFERING*
Likewise, the important word for internal medicine is ‘hypoxia’, or basically any word with a ‘hypo-’ prefix. It will give your attending little shivers of excitement.
For Ob-Gyn it is obviously ‘emergency C-section’, or if they’re feeling particularly risqué, ‘Bladder injuries’, ‘I-thought-the-ureter-was-the-fallopian-ha-ha’
For paediatrics you just wail along with the other children.

4. Why study about symptoms when you can demonstrate them on yourself?
Do you want to know what hypoxia is you silly child? Run from the OR to the blood bank because your attending surgeon wants to *make sure* you have enough blood, and then back to the OR from the blood bank because the blood bank lady won’t give one unit of blood to the patient. Try explaining to her that it’s redundant to call it a blood bank when they REFUSE to sanction blood to patients. She barks at you without ever breaking eye-contact.
What you feel right now is dyspnoea, hypoxia and pain and suffering.

What is the puddle’s sign? You don’t need a textbook for that! You’re already constantly in the knee-elbow position to prevent the blood-thirsty residents from seeing you sobbing because you got told off for showing slight displeasure at doing all those per-rectal examinations actually to be done by them.

5. When you see case files for the patient’s case history, don’t stroke out if you only see three words in the chief complaint, present and past history, combined.
Our precious residents and interns have other major things to do, like drink chai 792 times a day, always borrowing your stethoscope, and asking you to “man up” when you have an MI because you almost stepped on the maze made out of discarded needles.
So if you see something like “pain in chest”, assume immediately you will have to say drug names like ‘metoprolol’ without stammering even once, or you will be thrown to the wolves, i.e, casualty department.

 

YOU THINK YOU’RE COOLER THAN ME?

Everyone thinks they’re cool, right? People who work out are cool, people who act and sing in Broadway, people who spend 167357 hours a day studying because they are in medical school and don’t want to fail are cool. It’s true. We all think we are cool despite the monumental lack of coolness or any redeemable cool factor. You know who’s cool? I think Alexander Fleming was cool. He had the most unsanitary lab while he grew deadly bacteria on unsterilised plates and he didn’t give a fuck. What he did give all of us was the Christmas present that is Penicillin. Ugh I wish I was as cool as that guy.

So coming back to normal people, I feel like some communities feel like they’re cooler than the rest. Everyone will agree with me when I say this, but the art community think they’re the coolest. What you splish splash some paints around and suddenly you’re cool? Okay maybe they are, I’m just hating. Other communities include pilots, chefs, IT guys, heck even dentists are cool. Everyone except doctors. We are at the bottom of the cool chain, the plankton of the cool ocean party. So where am I in the cool ocean party? I am a tiny plankton that you can’t even see with your naked eye because I’m always indoors, studying for community medicine, nurturing a dangerous Vit D deficiency.

Because us plankton tend to feel bad a lot about sharks and dolphins having a great time, we need to justify it. And that’s where I, and my twisted sense of justification come to the rescue. If you’re a doctor, welcome to the plankton family. If you’re literally anyone else, whatevs, enjoy that mojito before you get cirrhosis.

All the ways doctors are cooler than anybody else. (An autobiography of a bored med student double thinking her career choice)

1. Everyone goes to parties, we go to HOSPITAL wohooooo!!
I’m not missing out on dancing with strangers, because I’m too busy dancing around patients who blame me for not getting better.
While you guys are socialising and drinking fancy cocktails, I am getting fecal samples and drinking yesterday’s chai. You know why? Because it was the only edible thing and I am malnourished.
Take that cool people. Hah

2. Don’t you hate it when you ask people what they do to pass time and they say something overly pretentious like “Oh I go parasailing whenever I can. It’s a stress buster.” or “I love cooking gourmet French food. It’s so relaxing.”
And you can’t tell them your pass time activities because they include going to the pathology lab and being forced to test someones evidently yellow urine for bile salts, BUT then again you are screamed at for using too much reagent and voila what do we have here? You have spilt urine on your self, again. At least it tested positive. You go, nerd.

You cannot tell them the above. So you just say “Ah nothing much I like chilling with my friends Robbins and Harrison” *wink*

3. All cool people have an interesting story to tell. Like that one time he went to Mexico by himself or last year when she got an aztec inspired tattoo.
I have an interesting story to tell too.
Long long ago a med student was trying to finish her ophthalmology rotation. Just when she did, she realised that her next rotation is orthopaedics, the land of unknown, because nobody really goes to that department. She was intrigued, and made the stupid decision of attending the rotation all alone. She walked past the hundreds of cabins of male doctors who were all surprisingly bald/balding. Her attending had less personality than the average flea. He hated everyone, he hated her, he barked orders and everyone shook in fear. She thought to herself “if I wanted Ursula to teach me, I’d have done marine biology” and slaved through the rest of ortho like a zombie while crying internally 24×7. The end.

4. Cool people follow the most recent trends. Crop tops, pencil skirts, whatever.
You know what we follow? The tailor who is supposed to alter my scrubs so I don’t drown in them.

5. Every time a cute bistro or a cafe opens anywhere in the city, cool people are the first to get there and give a snobby review about it.
Us? We don’t have that kind of time.
You know what med students do instead? They go to the coolest radiology labs with the newest MRI machine and the smug faces of radiologists taking perpetual naps and breaks.

While cool people will keep doing their thing, I will keep hating orthopaedics and pretending to have a social life.
*Phone rings*
“Hello?”
“Oh hey Robbins. I’ll see you in 5”
*wink*

THIRD WORLD MED STUDENT PROBLEMS

I see a lot of first world people complaining about their health care system and about how long they have to wait till their doctors see them. *cough (entitled) cough* What amazes me is that someone finds a reason to complain inspite of having hospitals with sparkly floors with their shiny steel instruments and electronic charts and the (expensive) miracle that is the da Vinci surgical robot. So naturally first world med students have no idea what we go through in da hood.
Third world countries are said to be colourful and lively. More so if you’re in India. We have our gutkha chewing Mukeshs’ (Sorry bro) who very artistically paint our walls red, and the famous couple Munna and Shalini who very considerately scribble their names enclosed in a heart on every tree, brick and train window. And we have our excellent ‘Health Care for None’ policy which very vehemently supports going to ‘Brindavan Bone-Setting Centar’ if you are ever faced with the misfortune of a comminuted femoral shaft fracture. So cool when the guy setting your bone in place tells you about the amazing healing power of Tulsi leaves and shit no?

I don’t know what it feels like to be on the receiving end of Health Care for None, but I do know what it is to work in a hospital where we body surf atop patients who just want to get some gul-cose. So while I know I’m complaining about a hospital that’s over 150 years old (and crumbling). I am fully aware that I will always find a corner painted red at every turn with chewing tobacco and I will always have to stand in the NICU full of wailing babies with no AC, heck with no fans even. I will even have to step on someones urine/spit/sputum while walking up the stairs to get screamed at by my attending because he’s having a hard day dealing with 20 medical students staring at his balding head in his royal cabin.

But I know I will be out of the hospital Hunger Games in another two years, so I intend to paint a (not so) pretty picture for all the underclassmen after me and I in turn get a free venting session for no reform measures in return. It’s a win-win. While this being a product of my borderline obsessive-compulsiveness, it’s also going to be an eye opener to that puddle of urine in the middle of the surgical ward. Watch out!

1. Everyone might not know this, but our (government) hospitals are practically petting zoos.
Have you ever been to a petting zoo? You know the place where they charge you to pet and feed animals and immediately makes you feel like you’re an animal person?
Hospitals in the third world have an added bonus of being breeding grounds for many generations of dogs, cats and even pigeons. The animals even establish territorial authority, because I see the alpha male dog always sitting on a bed reserved for a patient in the ward.
Hey you want some free Rabies with that atypical pneumonia? C’mon don’t say no. It’s as easy as drinking a glass of water. *wink*

2. After dodging a dog and a few kittens, you’ll need to know how to navigate the hospital. Here’s a basic navigation plan for our hospital :
You enter the main door, feeling happy about not stepping in pigeon poop which carpets the walk from the parking space to the entrance.
Quickly dodge patient #1 and #2 when they ask you why they aren’t getting any gul-cose (glucose) . Leap out of the sea of family of patients because all they want to know is why your eyeliner is so perfect and not their son’s lungs.
Good, you’re safe for now. But don’t ever let your guard down. You almost stepped on that gauze soaked in pus. Whew. No thanks, MRSA.
Assess your patient’s condition from 10 feet away. If he’s very sick and the nurses haven’t gotten around to giving him his meds yet, you’ll be drenched in bilious vomiting (No bed pans because we’re ghetto like that). And you’ll be forever waiting for the day when Alexander McQueen makes gowns in ‘bile vomit yellow’ to justify all your clothes being permanently stained.

3. If you have your paeds rotation avoid going to the paeds hospital at all. If you’re a paeds resident, quit your job. If you’re a paeds attending, seriously, why are your life choices completely mental?
Those kids are never EVER well behaved. They kick and scream every time they see someone in a white coat because they think everyone is out to poke and prod them with injections. Most of the kids I saw shut up only when their parents gave them money. Actual money. They’re so fucking gangsta, I can’t even.

4. There are a million dialects and at least 5,000 languages you need to be fluent in. Because people from every region here say things differently.
As soon as you learn how to say ‘jumma’ for Friday, your other patient can’t wait because ‘doctor eda undu’. (Where the fuck is the doctor)
So you end up not knowing any one language perfectly and sadly you sound like a dyslexic 5 year old.
But unlike the other doctors, I’ve learnt to say “Arey hato amma” (step aside, fresh meat coming through) pretty well.

5. You finally get to class at 1pm, prime sun-blazing time. So your perfect mascara is runny and your hair decides to stick to your face.
Everyone around the world has AC classrooms, but we have a huge gallery, low lit for weird classmates to catcall and boys and girls to look at each other amorously like its one huge mating ritual.
Half of the time there’s no electricity and the other half of the time one half of the fans don’t work.
So imagine paying attention in class when it’s 40 degrees inside (actually only 27 outside. It’s hot inside because everyone is on heat.)

6. You have a 640 slice CT, we have an X-ray
What’s your complaint? Doesn’t matter, order an X-ray.
Sorry but you have an aortic dissection. Yo did you get an X-ray though?

7. If you’re the patient, then God help you.
Apart from being the patient and getting treated at the hospital, you have to run around to get tests done. AND collect the reports from the respective departments.
At the end of a patients hospital stay he becomes a habitual multitasker and he will be able to recite his own history, because no electronic charts remember?

8. We take PDA to the next level, I mean to the hospital.
Everyone drinks fevicol as an attempt to prove to their parents that their love is eternal.
a) Fevicol won’t kill them.
b) Fuck you arranged marriage I want a Taj Mahal too.

9. My damn phone doesn’t have 4G like the rest of the world.
So imagine trying to frantically search the internet on your phone ON 2G for the answer to “what’s the second decimal point in the T3 level in Sub-clinical Hyperthyroidism” in my practical exam.

10. Here’s everything else that irritates me :
Someone always borrows your steth.
Most girls wear the most disgusting maternity gown-ish things instead of scrubs. Idk I think they think it’s the closest thing to a saree or whatever.
Most boys think making eyes at patients is okay. Wtf, no!
Why are all the nurses so mean? Or is it just a 3rd world problem?
TB patients make it a point to cough on you. Have to keep the XDR alive and teeming no?
(My friend thinks I talk about TB too much but it’s only because TB is the boss and I’m secretly scared I have it)
I’m on vacation right now so I’m enjoying the lack of TB patients around me and everyone asking me to pull out their IV line so they can leave AMA.
I wish the residents would stop hitting on the undergrads because I personally don’t want to get married in Shilparamam brother, chill.
The floors are never clean.
We have surgical spirit instead of hand sanitiser. That shit smells so malignant, like it might melt your hands off.
Derm rotations are a joy because there’s a 9 in 10 chance you’ll get taenia.

I hope you’re reading this using your 4G data in your air conditioned galleries while your professor glares at you over his teak wood desk while talking about the expensive miracle that is the da Vinci surgical bot.
That’s all from the ghetto. Peace.