Chapter 50-From Semesters to Trimesters

Jan 1997

1st of Jan arrives and a few minutes are spent wishing "Happy New Year" to anyone I see, receiving reciprocal wishes and well meant but mildly sinister sounding refrains of "Start reading bugger".
It's Final Year after all. In keeping with the tone for the year, the daily time table for the year is also no-nonsense. An hour of lectures to start the day, followed by 4 hours of intensive clinics and then 3 hours of classes, with a brief one hour lunch break.
Over the years, I have seen Final Years troop into the mess with white coats and stethoscopes between 1 and 2 PM, discussing the cases for the day and rushing back for their respective classes. There isn't much scope to dawdle and goof around, 2 things I have become an expert at, so apart from anything else, Final Year also involves a lifestyle and mindset change. The Final Years are also looked upon with a new respect from the juniors, as if some mountain of knowledge has suddenly descended upon them. It feels good to be in the mess as an exalted Final Year, but only Final Years know the truth.

The class is divided into 4 batches and I have been in Batch C since Clinics started. This means that I will start with OG first, moving on to Ortho, Medicine and ending with Surgery before the 15 day Summer Break. This pattern will repeat after the Summer Break, with the Send-Ups starting 2 days after the last posting ends.
OG is fine, it's a subject that seems quite systematic, is straightforward and the Department is populated by people eager to teach and therefore, quite good at it. I have had the least amount of Tamil trouble in OG mainly because the questions are specific, easy to ask and get straight answers.
The only hitch is the Labour Room posting, where I will be banished to in 10 days time.

We start at 9. Final Years are given special status in the OPD and Wards. There is usually a First Clinical Year batch also posted at the same time and I notice how we are always given priority in case allotment and even teacher allotment. Our classes are taken by Senior Residents, people who have finished their PG degrees, or by Consultants while many of our First Clinical classes were handled by PG Residents.
We troop into the OPD. 6 of us have already disappeared into the bowels of the Labour Room and there they will stay for the next 10 days, emerging only for the Ward Class at 12 PM. They are excused from every other class and when they do appear, looking as sleep deprived as anyone with a massive hangover, we all rush to catch the happenings of Labour Room and what life is like in that mysterious place whose reputation perhaps precedes one's actual posting in it.

The OPD is crowded, of course. I spend my mornings taking histories and palpating abdomens. It's quite a thrill to listen to foetal hearts and feel foetal feet and heads. The history in OG, thankfully is very systematic with specific questions for each of the three trimesters. We are immediately clued into the eccentricities of the Department.
"Always ask for name, age and address".
"Never say someone is so many years OLD. It's always so many YEARS OF AGE".
" Know why you are asking for age, address and name".
" Always introduce yourself".
In a viva, one can get stuck even at this point it seems.

Obs is easy. The questions are standard and so is the examination protocol. There are 4 "grips" for feeling a pregnant abdomen and in Dutta, our book, the 2nd and 3rd grips need to be interchanged when presenting a case. That is how the Department wants it, and that is that.

I see Pap smears, cervical examinations, do them as well, and listen to countless heart sounds. I learn to calculate Delivery Dates, Fundal heights and look for signs of pre-eclampsia. I take a good history and get screwed for missing many important points. The usual stuff.
After about 2 hours of this, we head over to see some Ultrasounds which are all black and white smudges  but everytime I am shown a real live foetus, complete with head, spine and feet, my heart skips a beat. It's an unreal feeling. For a while, that is. And such is the curse of medicine that even the most fascinating thing becomes routine and yawn inducing after a while, and that's what happens to me.

By the time the 12 PM class rolls around, we have been standing for 3 hours straight and some of us have taken a case to present. I manage to scoot off for a quick tea and nicotine break in the middle but return in time for class.
There are 2 wards in OG. Ward 12 is for Obs and Ward 16 for Gynae, each directly opposite the Labour Rooms. Some days we take a case in both wards and others, it's either. In any case, the pattern is the same.We are joined by our 6 classmates, released from Labour Room for the class and 15 of us stand around a patient, presenting the history of her pregnancy and what we have managed to learn about her unborn child (or children, if twins).
This is the routine every day. Every passing day brings me closer to the day I will enter Labour Room. It's a whole new ball game.


"Name, age, address"
"Last Menstrual Period"..(Hurried calculations for EDD).
" Did you take drugs during pregnancy" (Drugs=medicines, sometimes lost in translation)
" Vomiting?"
"When did you first feel movements"?
etc etc...

That's a bit of what I ask in the first trimester. I also quickly learn about what drugs can cause foetal defects and how to measure fundal heights. I learn that "twins" and "breech" (bums first) are exam cases. And I start reading Dutta in earnest.
One morning, waiting for someone to come and take class in the Wards, we hear that the Head will come. The chage in atmosphere is obvious. White coats appear from nowhere, dirty coats are hidden out of sight and fresh clean white coats are begged, borrowed and stolen from unsuspecting or helpful newbie First Cliical Years, histories are mugged up ready for presentation and the tension level rises exponentially.
This brings me to the topic of "impressions".

"Impressions" has been drilled into me from the day I joined College. One is supposed to be in the good books of the teachers, or atleast potential examiners (who will be the senior Consultants), and at the very least, one should never be in their bad books. Getting into good books is straightforward. Attend classes, do well consistently in exams and tests, ask questions in class, sit in the front benches, look interested. Above all, wish. Getting into bad books is the opposite but it does take some effort. Bunked classes, failed exams (failed tests are routine and do not count) are a good way to get there.
Being neutral is what most of us aspire to be and the general view is that it is best to remain as inconspicuous as possible without failing exams and attending atleast minimal classes to avoid getting noticed. I vow to remain neutral. That will actually mean I will be on the upswing since I have already had an attendance disaster and even though most people will be unaware of that, and perhaps not care at all, standing with my more sincere classmates in that Ward, I can sense judgemental eyes upon me from all directions. In short, it's my first week in Final Year and I am already spooked.

In Final Year, the ante is upped a bit. In OG, especially, it's the Labour Room that can make or break you. Do well here and one is rewarded. Slack off, and the word spreads. One does not take chances. Hence the white coats, the sincere expressions and the jangled nerves. The Head does not ask difficult questions, but those questions cannot go unanswered.
This spices up the OG posting by leaps and bounds. The Department is on the Ground Floor, straight down the corridor from the Main Entrance and even as I enter this corridor, I can feel my pulse quicken just slightly and my eyes darting sideways to catch a glimpse of the powers that be before they see me.

The Head of the Dept is also the Head of Unit One and when on rounds, a long line of white coats follows her from Ward to Ward. It's quite a sight. When this army reaches the huddle that we have formed around a patient, she makes sure to ask how we are doing, who is coming for class and whether we have any problems. She is supposed to be scary but looks rather sweet. She also has a short, giggly laugh which can mean anything from a shared joke to code for impending doom. It's best not to laugh with her. As an Undergraduate Final Year student, one does not share jokes with Heads of Departments.

She is not the only one in this rather big Department of course. .
The Unit 3 Head is perhaps the most personality filled Consultant I have come across yet. She can walk the walk and talk the talk. And boy, when she talks, her command of English and her sarcastic, cutting down to size comments are a sight to behold. When one is not on the receiving end, it can be the highlight of the day. When one is, however, it is still something to ponder over a few hours later, perhaps with a drink and a quiet chuckle. She is sharp, witty and very approachable. She was the Cultural Advisor when we organized Spandan.
She has already taken a few classes for us in the Lecture Theatres. She has a unique style. Her lectures start by calling someone at random to start jotting down the previous class's notes on the balckboard while she starts that day's lecture. This goes on, she is talking, and behind her, some poor soul is frantically trying to recall what she talked about in the last class (which could have been last week), back turned to us, but desperately stealing the odd glance at the front benchers for prompts and clues. Glances which must not be caught.
In between, questions are asked and for some reason, most of the questions are put to the girls, who by a strange tradition always sit on the right of the class. When a question is unanswered, or answered incorrectly, that person is sent to an isolated section of the class, soon to be joined by 2 or 3 more hapless students.
In one class, she selected Ashley to be the blackboard writer. He started well, writing the first 2 lines but then slowly started petering off and even frantic hand signals and rolling eyes were not helping him carry on. Stuck for knowledge and inspiration, he still had to write something and then, the chalk decided to betray him.
In a quiet class, a squealing white chalk on a clean blackboard can be quite a sound. Loud, screechy squeal. A slow motion head turn found Ash standing motionless holding the chalk near his head, obviously having run out of things to write.
It was one of her best performances. Ash was reduced to dust. We had a ball.

Back in the Wards, I am ready to present a Case. OG has a standard question format and the class goes off OK. I manage to answer the basics and demonstarte the grips and we are done. The Head aka Madam calls me by name. In fact, she calls all of us by name and that is another thing. She knows everyone's name. That makes it even more scary because if one can put names to faces, one's misdeeds cannot be hidden anymore. She has that. I have seen seniors, long passed out, coming to say Hello. And I have seen Madam A greeting them by name, sometimes 15 years after she has seen them last, without any hesitation.

I have to be on my guard. The "good boy" days are here.