March-April 1997
Life is not all work and no play, although at times that is what it should be. Some of my seniors developed the routine of studying 5 hours daily after class Monday to Friday and relax on Saturday. This is not a routine I'm going to ever develop but the pace is increasing. So are the tension levels.
Normally a specialist in night-outs and last second cramming, I am getting into the habit of daily reading though this still has to reach the levels my more accomplished classmates have been at for some time now. If it were just a matter of mugging up a book and facts, that could have been easy. But of course it's not.
There are 3 distinct separate areas to study-Clinical Examination methods (with which I should have become thorough by now, but am not), Clinical Cases themselves and the theory. The Clinical cases deal with a lot of stuff that won't be asked in a typical theory paper but constitute the more important, or sometimes the more exotic types of diseases and their associated findings. The theory paper usually has things one can't really assess in a Clinical setting like long questions on Acute Upper GI Bleed or Management of a Cardiac Arrest, Management of Antepartum Bleeding etc.
Most of the time, since there is little overlap between the core theory and the Clinical topics and since one can fail the exam in either component, I'm having a hard time juggling between studying boring topics like Hypertension and more exciting stuff like "Approach to a patient with Chest Pain", or "Approach to a Patient with Splenomegaly" etc.
The traditional approach to exams, one that has been honed to fine art by many batches of Jipmerites is to read all the case related books and notes and leave the core theory for later. Who am I to go against the grain?
Many of these Clinical Case notes and "Approaches" are in the form of notes passed down to us from seniors and although they are undoubdtedly excellent, I have one major problem with them.
Which is thus.
In an exam, faced with a patient about whom one knows nothing, how will an "Approach to a patient with Splenomegaly possibly help me. How, in Heaven's name, will I know this patient has Splenomegaly or whatever (and thus have the correct approach) before I examine him with that particular approach. It's a Catch 22 situation and I get very depressed thinking about it. I'm sure I'm missing something important but I suppose I'll figure it out sometime in the next few months. One set of circulating notes has been written by Vinci, 4 years senior and it helps that he's written them in excellent writing-big letters, lovely cursive, good material. There are also some notes written by Amouchou, 3 years senior, and soon all I am doing is building a great collection of beautifully written, still unread, heavily xeroxed notes.
There are also other things besides notes and books. For Guillan Barre Syndrome, which will come as a case, there is an article in the New England Journal of Medicine which everyone reads. So I make copies of this too.
I'm trying hard to read PJ Mehta, a Medicine Clinical Exam book which basically lists out causes for everything. 10 causes each for the 5 differnt types of pulses, 20 causes of breathlessness etc. The various causes of raised jugular venous pressures and so on. It's a good book to read while in the Medicine posting but it's very painful to read. Shom tells me that it gets better as one's Medicine knowledge improves, so I suppose I'll take his word for it.
There is Golwalla, which I have no intention of reading. Just the name puts me off. I wish I had time to read the whole of Harrison's which has to be the most comprehensive Medicine book I have ever seen. Davidson, our core text book is dry as hell but I am assured that every time one reads it, new information is uncovered. I don't know. I haven't even read half if it.
Sid, a year senior and crazy about going to the US, recommends a book called Lionel HOP which apparently describes cardiac drugs very well. After a while, I finally see it with someone and discover it is actually Lionel H. Opie. I don't read it.
Some topics are better covered in Paediatric texts. The description of heart murmurs in OP Ghai, a Paed text is excellent. The rest of Paeds is a big blur.
Das, the Surgery equivalent of PJ Mehta, is considerably better and is vital to know. It describes the clinical methods for examining all the cases in Surgery from lumps to ulcers to breast masses and thyroid swellings. Masses in the abdomen and how to distinguish kidney swellings from splenic enlargements, the difference between transmitted and expansile pulsations, varicose veins....everything.
There are also 17 types of ulcers for starters and The 15 points to know when looking at a swelling,(The pnemonic is SSSSSCFTRIPPP, and of course, hernias and hydroceles.
Hernias are a problem. They are considered among the ABC's of Surgery, and in an exam, even the slightest of fumbles can signal impending doom. I hate hernias, especially when one has to undress a patient and get him to cough and watch his hernia become bigger. I can tell they don't really love it either, and who would, with 15 eager students looking on. It's worse if it is combined with a hydrocele, but such is the lot of the poor Govt Hospital patient. On the other hand, we have a ton of cases to see and I could not ask for more variety.
After the incompetence of Ortho and the vastness of Medicine, Surgery comes as a welcome, logical relief. I like this subject. It has definite examination methods, is logical and one can see things like swellings and ulcers. Medicine is all inside and requires some imagination.
Surgery, however, also is a strict Department populated by personality laden characters. The Head, Prof AK, is a super stylish man and has a great surgical and academic reputation. He teaches like no one else. He walks with a slight sway which also oozes style and wears horn rimmed glasses that seem to suit him perfectly.
He is also known to be lenient with attendance shortages. I hope he hasn't changed.
He is called "Chief". He doesn't have a nickname. A sign of respect I suppose.
Another Consultant is nicknamed supposedly after his dog, Benjy although I have never seen the dog. Unit 3 is the most colourful with 2 consultants we are all terrified of. Dr J and Dr P's classes are full of witty sarcasm and I am always a bit scared going into them. Dr P is also known as Uncle.
Unit 2 has one of the nicest Consultants I know. Always smiling and known to be a gifted surgeon, people queue up to go see him operate. He, however, is also of the "fair in exams" variety and I hope that he does not come for our exams.
Some of our Ward classes are taken by Senior Residents, people who have finished the Masters degree but have to spend 3 years working as SR's before becoming eligible for a Consultant position. Sonal, the senior in whose room I spent that fateful Hasmukh Lal night comes on occasions. He takes excellent classes. He takes a class on Gastric Outlet Obstruction and I quiz him for a few minutes after on the types of gastric drainage procedures. This is probably not really necessary at our level but he gamely explains the whole thing.
Dr K, the 2nd Consultant after Chief in Unit 1, and to whom I lost a Badminton match once (mainly because I ran out of breath), is earnest and mild and can take a great class. He is sometimes hampered by not knowing when to stop teaching us poor MBBS students, so one of his Breast Cancer classes goes like this:
"You can do this also, or that also for this stage. 1 +1 may not be 2, sometimes it is 3 and sometimes it is 4". And ends with a "Is it not"?
At our level, I need to know what to do for each stage of a Cancer Breast. Knowing many options is not really helpful. And it is a hugely important case.
Our Surgery textbook is called "A Short Practice of Surgery" and is written by Messrs. Bailey and Love. I would love to see who came up with this name since there seems to be nothing short about this 1200 page double columned monster. It's not as bad as say Harrison's, which is in 2 volumes and needs a microscope to read properly but then Harrisons is not essential reading. This is.
However, like any good British book, it's easy to read and the edition that my seniors have is widely considered the most readable and well written. The current edition has been expanded and the book has become wider and according to some, Bailey has "lost its charm". When medical tomes become "charming", you know you're doomed. The Ortho section of Bailey is supposed to be well written but that time has passed for me. I should have read an Ortho book called Maheshwari then but I was too petrified of Ortho and exams were too far away for me to bother. Most of Surgery is occupied by the Gastro-Intestinal system and it's millions of diseases. Then there is Urology, whose lectures will start soon; Neurosurgery, whose lectures may be in the past without me knowing; Breast;Thyroid etc etc.
In the meantime, quite apart from clinics, our lectures are continuing at full speed and I am making desparate attempts to attend them. The attendance for all Final Year subjects-Medicine, Surgery and OG is counted only at the end of Final Year and so for 2 years, one is usually very blase about the whole thing. It's only in Final Year that nirvana happens and one realizes that unless one starts attending class "sharp sharp", one will "get screwed" or "happiness will get taken/raped".
However, in the ultimate analysis it's the clinics that will decide pass/fail and so most attention is paid to the 9AM-1 PM clinical sessions. I'm a bit scared of presenting a case, perhaps because of language issues and I manage to get through most of the posting with 1 short case and 1 long case presentation. The Ward Leaving will come and go. Fate has taken over and I just hope I've done some good karma in the past. There is not much karma happening now.
The evenings, however, provide some respite. Rahul, who is now an Intern, has been posted to our Rural Health Centre, 25 km away in a village, and he is rarely seen. I spend my evenings mostly with my comrade in arms-Vinay, and sometimes Plaha and Shom join in. Plaha is reading hard for the Jipmer Entrance Exam and Shom pops in now and then, usually on the way back from the hospital. He is married after all, so his time is not really his anymore.
Many evenings are spent in Snappy getting bored. There really shouldn't be any time for boredom but some habits, like endless tea and mindless gossip are hard to break. We miss Rahul and his company and curse his Ramanathpuram posting, a 6 week rural adventure which by all accounts everyone loves.
Plaha is getting bored too. He, along with Reddy and a few other guys from his class used to go upto Auroville in the middle of the night on their bikes and ride around, sometimes with all bike lights off. This can be a magical thing to do- with no external lighting at all the sky really lights up. They used to do this often till one of the residents there got up and let a bunch of dogs loose on them.
I have hardly gone to Auroville even in the day and a night trip with loose dogs running after us does not appeal to me. Ramanathpuram, though, does. I have been here 2 or 3 times before on class trips with the PSM Department. We had a small tour of the Heath Centre, were briefed on the workings of a typical Rural outpost and back we came. Plaha wants me and Vinay to come with him on a joyride there and we're quite happy to oblige. It's 1130 at night, we have nothing better to do and I love riding my bike anyway. The weather is cool, no rain and it will be a pleasant 20 minute ride. We can meet Rahul, have some tea in a roadside shack, gossip and generally end another fruitless day.
Ramanathpuram, here we come.
Life is not all work and no play, although at times that is what it should be. Some of my seniors developed the routine of studying 5 hours daily after class Monday to Friday and relax on Saturday. This is not a routine I'm going to ever develop but the pace is increasing. So are the tension levels.
Normally a specialist in night-outs and last second cramming, I am getting into the habit of daily reading though this still has to reach the levels my more accomplished classmates have been at for some time now. If it were just a matter of mugging up a book and facts, that could have been easy. But of course it's not.
There are 3 distinct separate areas to study-Clinical Examination methods (with which I should have become thorough by now, but am not), Clinical Cases themselves and the theory. The Clinical cases deal with a lot of stuff that won't be asked in a typical theory paper but constitute the more important, or sometimes the more exotic types of diseases and their associated findings. The theory paper usually has things one can't really assess in a Clinical setting like long questions on Acute Upper GI Bleed or Management of a Cardiac Arrest, Management of Antepartum Bleeding etc.
Most of the time, since there is little overlap between the core theory and the Clinical topics and since one can fail the exam in either component, I'm having a hard time juggling between studying boring topics like Hypertension and more exciting stuff like "Approach to a patient with Chest Pain", or "Approach to a Patient with Splenomegaly" etc.
The traditional approach to exams, one that has been honed to fine art by many batches of Jipmerites is to read all the case related books and notes and leave the core theory for later. Who am I to go against the grain?
Many of these Clinical Case notes and "Approaches" are in the form of notes passed down to us from seniors and although they are undoubdtedly excellent, I have one major problem with them.
Which is thus.
In an exam, faced with a patient about whom one knows nothing, how will an "Approach to a patient with Splenomegaly possibly help me. How, in Heaven's name, will I know this patient has Splenomegaly or whatever (and thus have the correct approach) before I examine him with that particular approach. It's a Catch 22 situation and I get very depressed thinking about it. I'm sure I'm missing something important but I suppose I'll figure it out sometime in the next few months. One set of circulating notes has been written by Vinci, 4 years senior and it helps that he's written them in excellent writing-big letters, lovely cursive, good material. There are also some notes written by Amouchou, 3 years senior, and soon all I am doing is building a great collection of beautifully written, still unread, heavily xeroxed notes.
There are also other things besides notes and books. For Guillan Barre Syndrome, which will come as a case, there is an article in the New England Journal of Medicine which everyone reads. So I make copies of this too.
I'm trying hard to read PJ Mehta, a Medicine Clinical Exam book which basically lists out causes for everything. 10 causes each for the 5 differnt types of pulses, 20 causes of breathlessness etc. The various causes of raised jugular venous pressures and so on. It's a good book to read while in the Medicine posting but it's very painful to read. Shom tells me that it gets better as one's Medicine knowledge improves, so I suppose I'll take his word for it.
There is Golwalla, which I have no intention of reading. Just the name puts me off. I wish I had time to read the whole of Harrison's which has to be the most comprehensive Medicine book I have ever seen. Davidson, our core text book is dry as hell but I am assured that every time one reads it, new information is uncovered. I don't know. I haven't even read half if it.
Sid, a year senior and crazy about going to the US, recommends a book called Lionel HOP which apparently describes cardiac drugs very well. After a while, I finally see it with someone and discover it is actually Lionel H. Opie. I don't read it.
Some topics are better covered in Paediatric texts. The description of heart murmurs in OP Ghai, a Paed text is excellent. The rest of Paeds is a big blur.
Das, the Surgery equivalent of PJ Mehta, is considerably better and is vital to know. It describes the clinical methods for examining all the cases in Surgery from lumps to ulcers to breast masses and thyroid swellings. Masses in the abdomen and how to distinguish kidney swellings from splenic enlargements, the difference between transmitted and expansile pulsations, varicose veins....everything.
There are also 17 types of ulcers for starters and The 15 points to know when looking at a swelling,(The pnemonic is SSSSSCFTRIPPP, and of course, hernias and hydroceles.
Hernias are a problem. They are considered among the ABC's of Surgery, and in an exam, even the slightest of fumbles can signal impending doom. I hate hernias, especially when one has to undress a patient and get him to cough and watch his hernia become bigger. I can tell they don't really love it either, and who would, with 15 eager students looking on. It's worse if it is combined with a hydrocele, but such is the lot of the poor Govt Hospital patient. On the other hand, we have a ton of cases to see and I could not ask for more variety.
After the incompetence of Ortho and the vastness of Medicine, Surgery comes as a welcome, logical relief. I like this subject. It has definite examination methods, is logical and one can see things like swellings and ulcers. Medicine is all inside and requires some imagination.
Surgery, however, also is a strict Department populated by personality laden characters. The Head, Prof AK, is a super stylish man and has a great surgical and academic reputation. He teaches like no one else. He walks with a slight sway which also oozes style and wears horn rimmed glasses that seem to suit him perfectly.
He is also known to be lenient with attendance shortages. I hope he hasn't changed.
He is called "Chief". He doesn't have a nickname. A sign of respect I suppose.
Another Consultant is nicknamed supposedly after his dog, Benjy although I have never seen the dog. Unit 3 is the most colourful with 2 consultants we are all terrified of. Dr J and Dr P's classes are full of witty sarcasm and I am always a bit scared going into them. Dr P is also known as Uncle.
Unit 2 has one of the nicest Consultants I know. Always smiling and known to be a gifted surgeon, people queue up to go see him operate. He, however, is also of the "fair in exams" variety and I hope that he does not come for our exams.
Some of our Ward classes are taken by Senior Residents, people who have finished the Masters degree but have to spend 3 years working as SR's before becoming eligible for a Consultant position. Sonal, the senior in whose room I spent that fateful Hasmukh Lal night comes on occasions. He takes excellent classes. He takes a class on Gastric Outlet Obstruction and I quiz him for a few minutes after on the types of gastric drainage procedures. This is probably not really necessary at our level but he gamely explains the whole thing.
Dr K, the 2nd Consultant after Chief in Unit 1, and to whom I lost a Badminton match once (mainly because I ran out of breath), is earnest and mild and can take a great class. He is sometimes hampered by not knowing when to stop teaching us poor MBBS students, so one of his Breast Cancer classes goes like this:
"You can do this also, or that also for this stage. 1 +1 may not be 2, sometimes it is 3 and sometimes it is 4". And ends with a "Is it not"?
At our level, I need to know what to do for each stage of a Cancer Breast. Knowing many options is not really helpful. And it is a hugely important case.
Our Surgery textbook is called "A Short Practice of Surgery" and is written by Messrs. Bailey and Love. I would love to see who came up with this name since there seems to be nothing short about this 1200 page double columned monster. It's not as bad as say Harrison's, which is in 2 volumes and needs a microscope to read properly but then Harrisons is not essential reading. This is.
However, like any good British book, it's easy to read and the edition that my seniors have is widely considered the most readable and well written. The current edition has been expanded and the book has become wider and according to some, Bailey has "lost its charm". When medical tomes become "charming", you know you're doomed. The Ortho section of Bailey is supposed to be well written but that time has passed for me. I should have read an Ortho book called Maheshwari then but I was too petrified of Ortho and exams were too far away for me to bother. Most of Surgery is occupied by the Gastro-Intestinal system and it's millions of diseases. Then there is Urology, whose lectures will start soon; Neurosurgery, whose lectures may be in the past without me knowing; Breast;Thyroid etc etc.
In the meantime, quite apart from clinics, our lectures are continuing at full speed and I am making desparate attempts to attend them. The attendance for all Final Year subjects-Medicine, Surgery and OG is counted only at the end of Final Year and so for 2 years, one is usually very blase about the whole thing. It's only in Final Year that nirvana happens and one realizes that unless one starts attending class "sharp sharp", one will "get screwed" or "happiness will get taken/raped".
However, in the ultimate analysis it's the clinics that will decide pass/fail and so most attention is paid to the 9AM-1 PM clinical sessions. I'm a bit scared of presenting a case, perhaps because of language issues and I manage to get through most of the posting with 1 short case and 1 long case presentation. The Ward Leaving will come and go. Fate has taken over and I just hope I've done some good karma in the past. There is not much karma happening now.
The evenings, however, provide some respite. Rahul, who is now an Intern, has been posted to our Rural Health Centre, 25 km away in a village, and he is rarely seen. I spend my evenings mostly with my comrade in arms-Vinay, and sometimes Plaha and Shom join in. Plaha is reading hard for the Jipmer Entrance Exam and Shom pops in now and then, usually on the way back from the hospital. He is married after all, so his time is not really his anymore.
Many evenings are spent in Snappy getting bored. There really shouldn't be any time for boredom but some habits, like endless tea and mindless gossip are hard to break. We miss Rahul and his company and curse his Ramanathpuram posting, a 6 week rural adventure which by all accounts everyone loves.
Plaha is getting bored too. He, along with Reddy and a few other guys from his class used to go upto Auroville in the middle of the night on their bikes and ride around, sometimes with all bike lights off. This can be a magical thing to do- with no external lighting at all the sky really lights up. They used to do this often till one of the residents there got up and let a bunch of dogs loose on them.
I have hardly gone to Auroville even in the day and a night trip with loose dogs running after us does not appeal to me. Ramanathpuram, though, does. I have been here 2 or 3 times before on class trips with the PSM Department. We had a small tour of the Heath Centre, were briefed on the workings of a typical Rural outpost and back we came. Plaha wants me and Vinay to come with him on a joyride there and we're quite happy to oblige. It's 1130 at night, we have nothing better to do and I love riding my bike anyway. The weather is cool, no rain and it will be a pleasant 20 minute ride. We can meet Rahul, have some tea in a roadside shack, gossip and generally end another fruitless day.
Ramanathpuram, here we come.
Hi dear.. why am I getting the unpleasant thought that you are rushing it a bit and soon the tale will be all over..
ReplyDeleteNo No Kushal! I'm not rushing it! I don't want it to finish either!!!
ReplyDelete