CUT ME OPEN – The story of a clinical rotation in general surgery as told by an aspiring physician.

 

I look down at my blood stained hands. My mind races, thinking about the possibilities of how I got blood on them. Did I murder someone? Unlikely. I must’ve hurt myself. But I don’t see any cuts or bruises. How could a seemingly innocent person have blood on their hands? Doesn’t it seem mysterious? I could be tested for DNA, or worse, be thrown into jail for it, if the person that this blood belongs to is dead.

//deep breaths//
I’m okay. I shouldn’t panic. I haven’t done anything wrong. I trace back my steps to this morning.
Okay so I woke up, begrudgingly, at 6.30 am, showered and set off for the day by 8. Then someone asked me for the reports to an abdominal CT. I pretend not to hear them and walk towards the cafeteria because I didn’t have time to drink my morning coffee. A second person came up to me and asked me to write a discharge. This seems like white noise at this point, blaring in the background; mixed voices echoing about ceftriaxone and betadine and non healing ulcers.
I close my eyes for a second and look up at the ceiling. When I look down I find my hands stuck inside a patients abdominal cavity while the singe of flesh triggers my sensitive gag reflex. I am not in a super awesome mystery about an unsolved murder. The reality is that I am a surgical intern and I have to pretend like poop doesn’t smell every time my attending does an exploratory laparotomy (which is everyday). Also plot twist : that was poop on my hands not blood.

You know, my father is a surgeon, as are many relatives in the family. Surgeons pride on being surgeons. My father once said he doesn’t need my mother to sew on a button for him because he is a surgeon and he could (most possibly) do a much better job than she could. He always wanted for me to be a surgeon. My initiation ritual was to observe a radical nephrectomy at the young age of 13. It was spectacular in a way that it changed my life. I was never the same again.
What my first surgical experience did was, it taught me about vasovagal triggers. But the first five seconds before I fainted were definitely spectacular.

So I, being a bunch of vasovagal triggers to multiple things like the smell of a freshly excised segment of necrotic bowel, or a 10 blade, or any patient that lists main complaint as “pain abdomen” am forced to intern in general surgery. What’s worse is the surgical unit I am in-
1. Makes me dislike surgery even more.
2. Does not realise the difference between abdominal pain and constipation (inside joke.  Sorry if you don’t get it)
3. I would not trust one of them to even cut my toast in half.

How does one navigate this cat-piss ridden, foul-smelling, manic-depression inducing rotation without one turning into a foul smelling, cat piss soaked, manic depressive? They elect not to do surgery of course! But if you have impaired decision making ability, or are forced into a bonded contract of humiliation by multiple people with God-complexes, you can follow my guide to refusal of informed consent to the procedure (definitely an ex-lap).

1. Remember these words – Conservative management. They’re going to be your best friends. If at all someone mentions conservative management for treatment, jump on it and campaign for it. Because if that guy is posted for surgery, YOU will have to beg the anaesthesiologists to give him anaesthesia because there is no time for 700 chest X rays. YOU will have to face the attending if the case is postponed and he will scream at YOU because he thinks anaesthesiologists are incompetent even though you tell him you will never be an anaesthesiologist and agree to curse 10 generations in your family so nobody can dream of being an anaesthesiologist.

2. If you are a nervous fool like I am, don’t stand next to anything important or anyone important. If you do, you will be asked to do a million things like foley the guy or ‘reassure him’ while they’re DJ-ing his insides. Just be a fly on the wall. I once thought standing in the corner was a good idea so nobody would notice me. But as my terrible luck had it, I was asked to stand right next to the operating surgeon with the fumes of the cautery finding their way ONLY to my nostrils. I am perpetually put off by barbecues now thanks to that day. The other time I was standing behind everyone dry-heaving at the granulation tissue they casually minced, I was asked to adjust the lights so many times that I have permanent vertigo now.
I tried to run out of the OR but my semicircular canals failed me. I am trapped. Send help when you see me blink twice. If I blink once it means adjust the lights.

3. Chart everything. I mean everything. How much is the patient peeing, what’s his pain like, how many florals is he wearing for Spring-Summer ’18. Surgeons never care about charting but they love dissecting interns about not using a comma while writing an 8 part novel about the patient’s post-op condition.
I don’t even know half of the things they want me to chart. And they bark orders all the time, so I don’t understand what they’re trying to tell me either. This one time I saw the previous day’s rounds included “serous output” which was written horribly (because all surgeons use the pen like they’re welding a scalpel. The papers are filled with incision like pen marks). So OBVIOUSLY I thought serous output was actually ‘serious output’ and I spent half a day charting how the patient passes urine.
250 ml- serious
300 ml – happy
100 ml – crying about the indwelling foley’s.

4. Look around you. The surgical department is a treasure chest of knowledge and resources. All those blades strewn around? You could use them to chop someones appendix off. Or, you could use them to chop some beerakaya (bottle gourd?). Get creative! Your resident wants you to do the dressing while he gets to drink chai? Dress the patient up as an anaesthesiologist, complete with a constant ‘no’ for every question and the occasional ‘how much is his hemoglobin’. That will spook your resident into never making you do anything for him ever again.

5. Try not to answer anything on rounds. I don’t know about the other surgical units, but the one I’m in absolutely hates it when an intern answers a question. Almost as if the whole point of doing medicine is to never learn anything.
If you do have the answer to something weird, say “why is nystatin not a statin” then they will bring their claws out. Or 10 blades, same thing.
I once knew the answer to a question about gall bladders and my attending followed up with “what was the size of Emil Theodore Kocher’s gall bladder” just to mattress suture my lips shut.

6. What is a consult? A consult is an elaborate ritual in which surgeons find the smallest thing wrong with the patient like hemoglobin being 10.9 instead of 11 and try to shuttle them off to other departments because they’re so tired of doing wound dressings and meshing hernias.
Here are some reasons to turf patients to other innocent departments.
Does the patient have a headache? Page neuro stat. Every headache is a subarachnoid haemorrhage to them so they won’t ignore you. Easy peesy.
Turfing the patient to ortho is a tad difficult as they are also always looking for reasons to completely empty their wards so they can make castles out of POP. If you have any non-emergent, geriatric patients, ortho will be more than happy to replace all of their replaceable joints with their shiny, new toys.
One of my patients said he was so in love that he was “blinded” by it and I called ophthalmology in a heartbeat because love is blind, and this kind might just be curable.

7. Do you want to impress your surgical residents/attendings? Do you want to turn their constant frown into an occasional half-smile? Follow these simple steps!

~Mention on rounds that at least two patients’ BP is over 130. They will convulse at the thought of sending them over to internal med for hypertension and having two less dressings to do.
~Always have some betadine on you. Surgeons love betadine. They even drink betadine flavoured energy drinks to keep them awake between wound debridements. One surgeon I know even threw a betadine themed party for his kid.
~Spend some time on mastering the ‘snap’ every time you wear gloves. This will both intimidate and impress your residents. “She’s one of us” they will whisper to each other as their noses pick up the unbeatable smell of glove powder.
~All that work and no pee breaks giving you kidney stones? Refer yourself to urology first, that’s one less intern off the hands of gen surg. Then beg your urologist about letting you keep your kidney stones. He might think you’re weird, as most gen surg interns are, but will most likely comply.
Then proceed to use your kidney stone in a ring to propose to your future husband/wife/10 blade. If there’s a surgical resident around, he’d most definitely let out a half-smile at your dedication.

8. If you want to survive general surgery you need to put up with diarrhea every single day. You see all surgeons hate cafeteria food and they frown upon vegetables and essential nutrients, stuff like that. They love eating food that’s from questionable places with questionable looking meat. Somehow none of the surgical residents get diarrhea. Maybe because they tag team with the patient for metrogyl. They love metrogyl. It’s like they play the ‘he loves me, he loves me not’ game but with metrogyl. ‘Patient gets 500 ml, I get 500 ml’.

9. Casual misogyny is always welcome in gen surg. There are so many wonderful female surgeons, but male surgeons love to make the occasional sexist remark to compensate for their imperfect suture technique. Here are some phrases to get you started with your misogyny 101.
“Of course I won’t be a surgeon! I’m too delicate and weak. I’d rather do something tailored for my gender like family medicine or dermatology”
“Yes I absolutely agree that all female interns MUST wear sarees. We can even get navy blue saree scrubs and spend 7 hours pre-op perfecting the pleats”

10. Surgeons are very serious about contamination. My father even complains about an extra LED light contaminating the cricket field. So it is in your best interest to be proactive about not contaminating anything and everything in addition to the surgical field.
You can’t be friends with radiologists because according to surgeons, they will contaminate your young mind with fancy MRIs and CTs.
You can’t cry during surgery because the OR lights hitting your retinas are making your eyes bleed. Because that will contaminate the patient’s clean-contaminated wound.
You can’t even eat a salad for dinner because that’s too clean and you need to contaminate it.
You can never win.

Hope this unhelpful guide helps you on your gen surg rotation, and hope I take my own advice for the rest of my rotation because I advised myself a head CT and some bed rest. And a repeat hemoglobin (because of anaesthesia).

HOW TO SURVIVE INTERNSHIP 101

My mother waited eagerly for me to get home on the first day of my internship, after I successfully (but seriously idk how) passed my final exams. But I didn’t come home. She calls multiple times so I pull out my phone from the pockets on my scrubs mid NG tube insertion and try to answer the call. She hears multiple shrieks, some of them my own and she frantically asks if I’m okay. My voice breaks (because the network coverage at my hospital is shit) and I hang up. The patient vomits all over me.
I get home the next day, a complete zombie, depleted of all my ATP from every single source. Even from essential protein. I am a skeleton now.
My mother screams in terror and runs for her life.

That, is the story of how my first on call went. I was so exhausted that while doing CPR on a patient, my own heart betrayed me and went into asystole and my colleague had to CPR me. Kind of like a CPR-inception. Anyway, you know how I’ve been complaining about med school all these years? To give you a better understanding, if med school was a problem, it would be a first world problem like not getting an uber on time. Internship is like welding metal yourself and making your own car AND drilling the ground and extracting petrol for said car AND making it to hospital at 4.30 am when you are actually required to go at 9 am.

So obviously I gave myself 6 months to recover from the malnutrition and nightmares and the panic attacks before I could sort through all those memories and write a survival guide on how to survive internship. I think a better title would be ‘how not to die a violent and painful death during internship’ but we’ll keep this one because it’s more aesthetically pleasing.

1. As soon as you enter the wards, scope out the glucometer and the sphygmomanometer and protect them with your life because your dumb resident doesn’t understand that a patient who is alive and well and sitting upright while voluntarily ripping his IV line off for fun isn’t hypotensive, and the hypertension patient on anti-hypertensive medications isn’t hypertensive anymore. She will give you mindless orders like “check the BP of every person in the entire world”. And we have manual sphygmomanometers, the ones that you have to inflate BY HAND. Both my hands have contractures now.Also she wants you to check everyone’s random blood sugar because she is completely jealous they got to eat a proper meal last night and she only ate McDonald’s. Boohoo.

2. Whatever you do, don’t be over eager to do stuff in the first days of your internship. Because blood hungry residents are on the constant lookout for interns who can work overtime for/instead of them. I live in constant fear and clutch my phone while saying a prayer that it won’t ring. Because 10 years from now when I’m dropping my kids off at school, I’m scared my resident will call me and scream at me for not adjusting the drip rate on a patient’s IV from 10 drops to 12 drops.

3. Be mentally and physically prepared for rounds. I suggest lifting weights and becoming a world heavyweight lifting champion would help, because you have to carry all the case files of every patient admitted since 1947 while on rounds. Because you being the intern are obviously the mule to carry things for everyone else. And by being mentally prepared, I mean you should be able to shout out diagnoses for any patient/scenario that the attending asks for. For example:
Attending : Hyperglycaemia and fruity breath?
Me: DKA

Attending : Hemiplegia and deviation of mouth?
Me: Stroke

Attending : The sun is shining brightly today
Me : PUO

Attending : That wasn’t a question. Did you know the Aquaman movie is coming out soon?
Me : Aquaman? Must be Diabetes insipidus.

4. Call your local human rights advocate because when you ask your attending about your working hours he will smile and say “you only have to work 80 hours PER DAY. And I suggest self catheterisation so you don’t waste 5 minutes for pee breaks”. If you start crying or get apprehensive about this, your attending will tell you stories of how he had to walk 800 km to his hospital as an intern and how he performed 53 emergency appendectomies before morning rounds even though he was interning in dermatology at that point. He also claims he discovered the life cycle of the scabies mite in his lunch breaks when he was an intern.
Pro tip: Don’t ever shake your attending’s hand.

5. If you’re an intern working in orthopaedics my thoughts and prayers are with you because you will need new joints after your residents and attending wear them out making you run around for consults. I suggest laying down some ground rules like
But Dr. X! Having a pulse doesn’t mean the patient needs a cardio consult!
The guy with the fracture neck of femur has a headache because his wife keeps nagging him. I don’t think a neurosurgery call is necessary.
We don’t need an Internal Medicine consult because this patient is allergic to strawberries.
Do we really need a dermatology consult just because you can’t spell ‘Stevens-Johnson syndrome’?

6. Working in ob-gyn automatically qualifies you for a lifetime achievement award. You can’t even cry about how much work there is to do in one day as an ob-gyn intern because your sobs are drowned out by only 7000 ladies in active labour forming a weird scream-acapella group. But somehow your resident screams even louder asking you to deliver 10 babies in a row while she drinks her placenta flavoured coffee. Swimming underwater and against current is a good skill set to have because it is a little known fact, but the word ‘tsunami’ was actually coined for when an amniotic sac breaks and floods the whole country in neck deep fluid.

7. If you can’t remember what medications the patient is on, don’t waste time sifting through stacks of papers of case files. Because most residents seem to remember what drugs and doses their patients need, it’s easier to pester them instead.
This has the potential to backfire though, because once I told my resident that I’m stuck in traffic and the roads are congested and he asked me to “give 40mg lasix IV”.

8. You’re going to have to deal with all kinds of patients and their families, whose sole purpose of being in the hospital next to the patient is to ask you questions and make snide remarks until your shift is done. Then they will do it to the incoming intern all over again.
There are the kind of patients who think the most appropriate time for them to cough violently is when you lean in to auscultate.
Or the ones that pester you to send bloods for ALL the labs possible but you have to explain to them that they have pancreatitis and a full body scan or complete DNA sequencing is highly unnecessary.
There are also patients who have ripped out their intravenous catheter every single time and the only vein left to cath is probably the superior thyroid vein.

The survival list is exhaustive but I can only write so much as my PTSD is kicking in. So my dear fellow interns, don’t forget to play hide and seek with your residents at all times and most importantly, don’t forget to transfuse one unit of 5% dextrose to yourself. You’ll need it.

(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.

Man Vs Second Year

A COMPREHENSIVE GUIDE TO SURVIVING SECOND YEAR
(Sound of a chopper droning away into the distance, 2 random guys materialise in front of you)
“Hi there! My name is Robbins, and this is Cotran and we’ll be your guide in 2nd year. Why are you making that face? You’ll need us you nerdy loser. You thought passing Anatomy was tough? Let us tell you what second year is like; It’s like walking the whole 5,500,000 square kilometers of muddy slush in the Amazon Rainforest. With a pulled hamstring. AND it’s completely dark.
Oh you had to pee? What’s that? It hurts when you pee? Add schistosomiasis to the list. Thats a pretty accurate description of what the next 3 semesters is going to be like”.

A very disheveled and sleep deprived second year med student opens a survival guide. He obviously doesn’t know what to do. Robbins and Cotran try to ask him his name, try to loosen him up, but all he can say is the Kreb’s cycle. Robbins keeps telling the kid that the origin of Iliopsoas doesn’t matter, that all you need to know in biochem was how to spell s-u-g-a-r-s.

It’s interesting to see the kid go through all the five Kubler-Ross stages of grief really quick, because he had to psych himself into studying more useless crap for second year- like the death receptor signalling pathway in Fas ligand mediated model of apoptosis.

“Here’s the survival guide, kid. We’re out.”
The following are the survival tips found in the guide, here’s hoping fresh first year graduate survives it. Will he make it? Won’t he? Stay tuned to find out.
1. Use your pathology textbook as a weight. This way you can bench press a few sets so your muscles won’t atrophy in the next five months.
No seriously, it’s not like you have any physical activity sans sifting through dusty copies of Forensic Med textbooks. For real though, who needs a textbook for Forensic Med when you have CSI?

2. That bitch lab assistant in Microbiology gave you the Albert’s stain?
No problem. Drop that slide really close to her face.
Who you tryna give Diphtheria to, you punk?
Not me that’s who. (drop microscope for effect)

3. Walk the fuck away from every resident who’s trying to push an NG tube into a wailing infant’s nose. The resident will make you do it and what’s worse is he’ll patronise you because he thinks it’s a ‘teaching experience.’
Re-read above point for Foleys too.

4. Don’t bitch and moan about how long the lab diagnosis of TB is. When you finally get to studying parasitology, just the word Diphyllobothrium latum will give you nightmares.
On the off chance you don’t read TB (because it’s too long and you think you already have it and your silence is taken as tacit agreement) write ‘green coloured sputum’ in delicate, cursive handwriting with curlicues a couple of times and that’s all you need to know about lab diagnosis.

5. Scrunching your nose during autopsy class in Forensic Med is a huge no no.
You don’t want to end up being asked only about unnatural sexual offences in the viva.
Don’t think you can file a sexual harassment suit. It’s in the fucking textbook. (Cue evil music)

6. Relationships? Bitch please.
That cute boy in class keeps asking to “borrow your notes on clear cell carcinoma”? Sucker punch him. He wants to go out with you.
Did that hottie just text you saying she wants to chill? Block her on Facebook, Twitter and Instagram. And Tumblr, if you’re one of those people.
The time you will spend making out and holding hands is time you could’ve spent sucking up to everyone in the pharmacology department because so help me God, I have no fucking idea why a normal person would know what the mechanism of action of Denileukin diftitox is. I did a quadruple take just to check if i spelt that right.

7. The trick to giving your best in exams is sleeping in the library the night before, so you don’t waste time in doing peasantly things like waking up and showering.
Contraindication to this is sleeping with all your textbooks on your lap. We know you think embracing them in a cherishing hug will help you remember better through osmosis. But this will only give you neuropraxia.

Therefore running to the examination hall with neuropraxia will lead to tripping and falling and ACL tearing. You have to remember to man the fuck up and take that exam because even if you walk with a limp for the rest of your life, you can tell everyone the story about how you passed pathology inspite of passing out from the pain. (Cue bitch hair flip)

8. Make an important promise to yourself. If you ever have a baby, you will never love it more than how much you love your notes right now.
Your notes won’t scream and bawl in the middle of the night. Your notes wont say fuck off when you ask it why it’s texting that boy who’s stuck in junior year of high school since 11 years. Your daughter might ask you for a sweet 16 for which you need to sell a kidney and then some spare change, your notes won’t even contain the number 16. Only 15+1. It’s never 16 causes of hypertension in children. It’s 15 causes , plus one unnumbered cause scribbled at the margin.

9. It’s my birthday! Shots for everybody! (Quietly review Wernicke-Korsakoff syndrome)
Merry Christmas! (Now’s the best time to memorise drugs used for Type-2 Diabetes)
Happy New Year! (You currently have a GCS of 3. Note to self: Study up GCS)
Exam week! (Quiz time : How much REM sleep do you need to juuuust avoid seizures?)
It’s results day! (Memorise flowchart of treatment of Status Epilepticus)
You passed pathology! (Note to self : Research opioid effect of passing on a stressed brain)
You barely made it in microbiology! (At least you passed. Drop a few more microscopes to celebrate)
Did you pass pharmacology? (2nd generation cephalosporins – cefaclor, cefoxitin, cefprozil….)
Step away from the books and enjoy sleep for the first time in a year and a half.
Forensic Med! (I can make your murder look like an accident)

10. Tell everyone you’re going to fail every exam even though you know you’re going to pass.
This ensures that everyone around you has really low expectations of you and when you finally do pass, you will seem like a huge dick.
Hey, being a dick is better than repeating 2nd year again.
So don’t mess with your mojo.
Repeat after me- “Dude my exam tanked. I’m going to fail for sure. Hold on I’m looking at Mc Donald’s hiring requisites.”
After your results are out, your friends asked you how you missed top mark by 1 point, you say -“The trick is writing ‘green coloured sputum’ really neatly. Bitches (pathologists) love green coloured sputum.”

Oh and for fresh first year graduate, he passed second year. Only because he stuck to the rules in the survival handbook.
Man Vs Second Year, now in a store near you.