Chapter 75-The best years of our lives

Jan-April 1998

Neil Diamond, the man with that incomparable voice, has grown on me since Vikrant introduced him to me 3 years ago when life still had exams and tests, attendance was always an issue and wing parties were just a conversation away.
And Vikrant was still around.

That evening, as on so many other evenings, as the light faded and the corridor tubelights came on, I found myself leaning against the corridor parapet right outside Vikrant's closed room, cigarette in hand and making plans for dinner with Rahul, Bong and Shom with strains of Neil Diamond coming from within. As the clock struck 730, signalling the start of dinner in the Mess, he came out  and the Neil Diamond turned from background music to full blown rock, if you can call it that. Neil defies genre.
That was the start of my Neil Diamond education. The song was called "The Best Years of Our Lives", the title song off the album and had rousing choruses of "Oh Yeah" interspersed with guitar riffs and of course Neil's voice.
What a voice.

I kept that tape with me after Vikrant died, his name scribbled on the inside front cover and if you ever feel down, I suggest this song. It kept me from slipping into depression before many an exam, a deluding escape from reality and impending doom.
"Impending doom" is probably the most consistent emotion an MBBS student experiences.

3 years on and the doom has passed. I am an Intern, making plans to play tennis with Prashant and drink afterwards. Vinay is our partner in this latter activity and while he prefers to make an ass of himself on the basketball court, Prash and I go about exploring the tennis court.
It turns out that there is a coach here, or rather someone called a "marker", in charge of maintaining the court, the nets and the lines. With Prash on his moped and me on my occasionally sputtering Yamaha, we find his house, a small flat 5 minutes away.
Once the Chief Secretary angle is explained, Natarajan (or Nattu, as he came to be known), is all smiles and more than eager to help. More than anything, I think he was thrilled that his uselessly but meticulously maintained court would finally be played on.

We put up the net, make sure the lines are regular and Nattu supplies balls. We start at 430 every evening, mainly singles matches with Nattu and Prash and carry on till nearly 9 PM, with the court bathed in artificial floodlight. Short breaks are taken for "moseys" (defined as a short, lazy walk) and they turn into "smoseys" (short lazy walks with smokes). Prash is a good player, having played for his school in Delhi but I am no slouch and the matches are intense, competitive and fully deserves the drinking sessions in Fillo, Urvasi and Seagulls that last from 930 PM till whenever they decide to chase us out.
Nattu is very good too and it give me great satisfaction to beat him on occassion. He seems less than thrilled but is always sporting. He is off on Sundays and is kind enough to leave the keys of the locker where the net is rolled up and stored, so on a Sunday, Prash and I do the net unrolling and tying ourselves. Nothing, except for the odd rain shower, stops us.

Prash's parents are very accomodating and it is a joy to eat the mini dosas and sundry stuff his cook dishes up when the two of us, all muddied and sweaty after 4 hours on a red clay court, land up. It turns out that my father's elder brother and Prash's father are batchmates. although in different services and the world shrinks a little more.
Then we discover Scotland Yard.

The board game has been lying in Vinay's room for a while but we have never seen reason to play it before. Now, there are 3 of us and the game is brought over from the hostel to the outhouse at the back of Prash's house where the three of us take turns playing "Mr X", sipping whisky and abusing the hell out of each other. Ram joins us sometimes and games go on till 2 AM at the very least.
Ramanthpuram in the day, tennis in the evenings, whisky after, Scotland Yard to round off the day. It's not a bad existence.

Routine, however, can be a game changer and in our case, literally so. After a month of Mr X being chased all over London strictly by the rules of the game, Scotland Yard changes into something MB should seriously consider looking at.
There are helicopters, motorboats, double crosses, aeroplanes and hidden routes. London becomes a city ten times more exciting as with every game that is played, new rules are made, old rules are modified and the game starts resembling a high speed chase around Central London rather than the staid turn by turn game it was originally meant to be.
Vinay is bad at Mr X. His mannerisms are a dead giveaway. When the detectives (me and Prash and sometimes Ram) are far away, he'll lean back with a smug expression and say "IllTakeATaxi"...
When we are hot on his heels, he'll lean forward, no expression on his face, stare at the board and with one hand extended, an urgent voice will say "Golu, pass a cigarette".
It's so predictable that soon enough we tell him and then he tries to bluff us, which is something he's quite bad at as well.

Ramanthpuram, meanwhile is coming to a close. I have spent a few glorious weeks here, watching sunsets by the dam, biking and walking all over the countryside, getting initiated to toddy and of course, getting a small taste of what a real doctor feels and does. This posting in particular will mean different things to different people and already I have seen a few grumble about the relative isolation from civilization, the ennui that can strike when there is truly nothing to do and many other things, from the ultra spicy food Karunanidhi specializes in to the small, cramped bathrooms. I, thankfully, have happier memories.
Our 6 week posting draws to a close and I leave with mixed feelings. This will probably be my most cherished posting but there is a lot to look forward to, professionally and personally.

Our next posting is in the Urban Health Centre of Kurchikuppam, a small well stocked outreach kind of clinic near the beach. I soon discover that while Ramanthpuram was perfect for nursing the soul after the battles of Final Year, Kurchi is best enjoyed when the scars of Internship have begun to show, not now when I'm sinking slowly into sloth and gluttony.
For starters, we are back in the hostels, back to the mess food and back to Jipmer. Our day starts at 9 or so when we make the 15 minute ride to Kurchi, and ends by 12 PM when the options include sweets in Mithai Mandir or beers in Seagulls or, on many occassions, both.
Kurchi is headed by a Chief Medical Officer and has a whole table to himself while we sit on benches and conduct an OPD similar in nature to the Ramanthpuram one. It's simple enough-the odd painkiller, stomach infections, anemias, vaccines and the like. But the similarities end there. There is no village, no green fields to soothe tired eyes and no back roads to explore. It's in the middle of Pondicherry and the ride to and fro, although pleasant and fast enough, is full of autos, cycles and the ubiquitious lord of the road-the pedestrian completely oblivious to anything not on 2 feet.

Free afternoons and evenings, of course are a major perk and there is much sleep to catch up on and much tennis to be played, rounded off as always by dosas in Prash's hoouse and the rapidly evolving Scotland Yard that now almost bears no resemblance to how it was designed to be played.
Sometime in early April, Prash strains his shoulder and that is the end of 3 glorious months of tennis on the red clay courts of Indira Nagar-our version of Roland Garros in the erstwhile French Pondicherry.
The days pass by rapidly, the relative speed at which each day passes increasing as the the Sun turns westwards. Time flies when one is having fun and there is more fun to be had playing tennis than vaccinating kids in Kurchi.

If tennis is what we play, then cricket is what we watch on TV and when India is playing Australia in Sharjah with a semifinal berth at stake, I run over and Prash and I make a dash for the nearest bar with a TV-Fillo. Fillo is dark and slightly smoky and might be termed seedy by some. However, seedy is normal and we grab the chairs nearest to the TV and proceed to watch the start of the Indian chase. 2 vodkas and 2 sprites are ordered and they come in 4 similar glasses. As Ganguly starts proceedings with a beautiful trademark flick to fine leg for four, I mix the drinks and discover that I have no vodka in my drink. Prash, on the other hand, has no sprite in his and much mixing and remixing follows while Ganguly hits a few more and then gets out.

And then the Fillo management, in all their wisdom decide that it's closing time and shut the TV.
There is no time to waste. Bills are paid and we run (literally) with a quick bathroom stop enroute to the bike and I then gun the bike in full race mode to Ajantha, the seaside place whose rooftop we have frequented on occassion.
The whole process, from bill paying to reaching Ajantha takes about 5-6 minutes and after convincing a somewhat bewildered Receptionist that we MUST see the TV, we see the rest of the match sitting on a sofa in Ajantha.

They are the "Best Years of My Life" . But however good they are or seem to be, it will be sad if this is as good as it gets.
It's strange that when one is unfortunate enough to lose someone close to them, certain things and memories attach much more strongly and more specifically to them than any other. For me and Vikrant, it is this song, this album and that evening outside his room 3 years ago.

The Best Years of Life may be happening, but I hope the Best Years lie ahead.

Chapter 74-The Arrival of Prashant

Jan-April 1998

Pondicherry-a mad medley of bikes, scooters, cycles, the odd car and the all-important-pedestrian. A town of crazy traffic, duty free alcohol, ambrosiac food and an old world charm that refuses to be cowed down by the chaos and randomness of a growing, pulsating, alive seaside city. A town steeped in French heritage, a town of dosas and sausages, toddy and Bordeaux (often in the same shop), where names are still spelt as Anandakirouchanane and Latchoumibady and where you can get to the Romain Rolland Library via Ellaipillaichavady and Mission St.
I have another 10-11 months to go in this town and in this College and I now feel that I am a part of this place. Pondicherry-with all it's sights, sounds and that intangible feel, is now much more familiar to me than Chandigarh has ever been. For me Pondicherry has become a person-a city with a soul, a city, that, even when I am sober, I imagine welcoming me back every time I return from a trip back home.

The RHC posting, with it's siesta afternoons and lazy evening bike rides gives me ample opportunities to be contemplative and dreamy. I know that this phase will end soon, in April to be precise, when I will enter the real world Internship of Medicine with it's endless night duties, torturous ward rounds and a daily grind spent largely in collecting X-Rays and blood reports. For the time being though, Ashley and I spend many evenings wandering aimlessly in the areas around the Jipmer campus around Indira Nagar, and just beyond, in the wide empty spaces and fields still untouched by the growing house construction phenomenon that's becoming increasingly apparent over what were once verdant, untouched pieces of land.
Indira Nagar is a small housing colony just opposite to Jipmer campus and consists of pristine, well-kept double story independent houses resident to the bureuacratic machinery that governs Pondicherry. The name plates read like a Who's Who in Pondy Administration and at the end of this small lane lies the biggest house of them all, earmarked for the Chief Secretary of Pondicherry.
Just off this lane is a well maintained Tennis court, ostensibly used only by the Indira Nagar VIP residents and therefore, not at all. It is made of red clay and just begs to be played on. There is a net, the lines are well marked and the clay is well swept, but the gate is locked and I've never seen anyone play here. I am a keen tennis player and last year, in a fit of optimism and a fleeting desire for fitness, I had asked Dr Thapa, the Head of Dermat, if he could please get my tennis racket with him on his way back from a Conference in Chandigarh. And he had kindly obliged.
My racket-a beautiful, Wilson Pro Staff 95, 6.1 SI, was lying untouched in it's black case and here was this pristine tennis court lying unused with no one to play with, a court apparently reserved for the VIP's of Indira Nagar.

It was here, in the Chief Secretary's House, that I had lunched with Rahul 2 days prior to joining Jipmer  and it was here, one late evening as I was staring at the tennis court, that I found myself face to face with a thin unkempt looking, moped driving, very familiar guy coming out of the gate. He had a bluish-green bag slung over his shoulder, sandals on his feet and a beard that needed a good trimming.
This was Prashant-the son of the current CS of Pondicherry and someone I had met briefly last year through Rahul.

We exchange startled abuse laden greetings. Prashant is a graduate of the Jamia Millia Mass Comm Institute and is here trying to make some sort of a documentary in Auroville. Every morning, he mopeds off to Auroville, does his stuff and mopeds back. He knows no one here and over the course of a conversation conducted perched on a Yamaha and a moped, I discover that he is a keen tennis player too. Add the fact that his father happens to be the de facto head of the Pondicherry Govt and the locked gates of the tennis court open magically.

Prashant is like no one I've ever met. Of course, all my acquaintainces thus far have been variants of book toting, trivia spouting, occassional partying medical students so Prash, as he likes to be called, is a complete breath of fresh air. He talks wisely, has his fundas clear. Apart from making his documentary, which I discover is just an excuse for him to visit Pondicherry, he is doing nothing and has nothing planned. He is single and loving it. He just goes with the flow.

And he plays tennis.

What can be better?

Chapter 73-Bonds and Vagabonds Part 2

Jan-Feb 1998

We've been in the RHC for 2 weeks and it's time for the Pulse Polio Programme.  Held every year, this essentially consists of catching every under-5 kid and making them drink a few drops of hopefully properly cold-chained Oral Polio vaccines. This serves a very important purpose of course since in many parts of India, where shit mixes with the great outdoors, the ingested vaccine is also  excreted. This is then transferred by whoever eats the food contaminated with this vaccinated shit and they get immunity in turn. This can be massive, reaching many villages and areas within a reasonable radius. This is called "herd immunity" and is a concept that has been drilled into us during the course.
Essentially, if you can't improve the sanitation, flood the shit with polio vaccine. Polio will be eradicated by eating shit-that's the national strategy- and judging from the results coming in from various surveys, it seems to be working remarkably well.

It's good fun and all for a great cause. Polio is usually a mild illness but of course it can turn lethal and cause paralysis. Over the course of two nationally designated days, camps are set up in schools and villages and Health Centres, kids are identified in buses, trains and in houses and are given these drops to swallow down. Many people, from us Interns to family physicians, GP's, nurses, Health workers and all and sundry are involved in this process and it's a huge co-ordinated attack on the polio virus. The drops themselves are tasteless, and since the virus, although live, has been weakened just enough to provide immunity but not an actual infection, are safe enough. It does provide excellent community immunity and is a much more cost effective way of doing things. There are logistical issues related to the transport of the vaccine since the drops have to be kept at a certain temperature throughout the whole process from manufacturing to administration and great care is (usually) taken to see that this happens.
As Community Medicine Interns, we are allotted a village each and one Sunday, we make our way to these places where we find a school or a camp set up. I bike down to Thondamanatham and spend a pleasant day chatting with the school and health staff, vaccinating huge lines of kids and getting a first hand experience of a National Immunization Programme in action. The only hitch in this whole affair is that it also happens to coincide with an India-Pakistan cricket match being played in Dhaka, Bangladesh and I hop onto the bike and zip down to the RHC every hour to catch the score. It's a day/night match so by the time the crowds are dwindling and the sun is setting, Pakistan have racked up an impressive 300+ score. This is depressing so I stay put in the school for a while putting 3-4 drops of the vaccine into small open mouths but around 730, when it's dark and the camp is readying for pack-up, I give up and whizz back.

India are rocking the chase. It's a tense affair. The other Interns are also back and some are standing on the table chewing their nails to bits, shouting the choicest abuses, going into fits of ecstasy at every four or six and sinking into doom and gloom at every dot ball or wicket. Everyone is an armchair cricketer. Beers are passed around, smokes are brought in from somewhere, Karunanidhi is sent to make more Chilly Chicken. Finally, when no one can shout anymore, Badrinath hits the winning runs.
The place goes crazy.
Just a typical India-Pak cricket match. But a very atypical Indian chase. Very satisfying.

A few days later, the Dept of PSM arrives in a van and informs us of a cholera outbreak in the vicinity. We need to identify the source of this problem and that will mean going from door to door in the neighbouring villages and asking the residents if they have passed rice water stool recently. Shyam and I team up and are sent to Kodapakkam, the village with the booze shop. There will be 2 other teams with us and we divide the village between ourselves.
Kodapakkam is not a big place and Shyam and I find that our particular area has a few pukka houses and stretches of empty space in the middle. And with most of the residents of these houses away on work it's a piece of cake. Our interviews take less than an hour and while the others are sweating it out, we chill out drinking Mazaa Mango under a tree, killing time and convincing ourselves we've done our bit. Sure enough, the source turns out to be a water pump in the same village and we feel proud to have contributed to the general health of this area. A job well done.

In the evenings, we often walk around the village and I usually wear a white kurta-pajama-my standard night dress. One evening, while walking on the road in front of the RHC, a few villagers spot us, snigger a bit and say "Payee Payee". I understand that this translates to "Ghost" although I am pretty sure real ghosts wear other colours also. There is a strong ghost belief running through here.
We are also invited to the village chief's house for Pongal and head out there with the whole PSM Dept in charge. The hosts are very gracious and the food is quite good. There is a pooja and some general banter, none of which I catch because it's all in colloquial Tamil.

Once every few days, I am on call. This is more of a pain than anything because I can't stray away from the RHC and have to attend to every patient who lands up after OPD Hours with any complaint whatsoever, at whatever time. Most of the time, it's cuts that need sutures or aches and pains that drag me from the Dorm to the OPD  where I take a quick history, perform a quick check-up and spend a few minutes rummaging through the medicine cabinet for something suitable.
Suturing is fun. It actually feels like I'm doing something useful. It's a whole process of cleaning and draping, debriding the wound, opening appropriate sutures from their sterile packages and actually putting needle to numbed skin and forming loops around a needle holder and then finally knotting the suture neatly. The end results look OK and get better with every subsequent wound.
Most of these patients also require a Tetanus Shot since no one can recall when they last got a booster. The TT (Tetanus Toxoid) vials are kept in a fridge in one of the rooms and each room in this OPD Block has a separate key. This means that when one is called to the OPD to attend a patient, there is a bunch of keys to contend with. One night, I suture a wound and open a few rooms to get to the fridge and the vial. I find a syringe and a needle and take the 0.5 cc needed. I replace the vial in the fridge but after I finish, send the patient off and am ready to lock up and get back to sleep, I discover that the keys are missing. It's 2 AM and this is extremely irritating. I then spend the next 15 minutes hunting for the stupid keys and finally locate them inside the fridge.

There is a lot of debate amongst us Interns as to which sequence of postings in Internship is the best in terms of opportunities to study. Alas, passing Final Year and slogging one's balls off in Internship is no excuse for the protracted, painful drama of PG Entrance Exams still to come. We have started with PSM, inarguably the posting with the most free time and will move on to Medicine, Surgery and OG in that order-each very busy postings with killer night duties and hard taskmasters. Batch A, which starts with Medicine and will get to Community Medicine only in September think they have it good because all that free time will arrive just in time when they really get serious about the Exams.
Frankly, I don't care. I'm still basking in the glory of passing Final Year. But even though these exams are a year away, they are completely unavoidable and will decide what one does for the rest of one's career. Each exam is taken by about 5000 aspirants, all fighting for a grand total of 50 PG seats on offer. The catch is that, for any given individual, only 5-6 seats will be of real interest. I know of seniors who got great ranks in the exams but did not get a seat and subject of their choice. It can take more than a few attempts to get it right.

I thought Final Year was the end. It's not even close.

Chapter 72-Bonds and Vagabonds Part One

Note: The following descriptions may require a map of sorts for better readability of this post. 
Below you will find a map of the layout of the RHC. 

I am working on a map of the general area and that will be up soon. 

Jan 1998

This is a good time of the year to be posted in Ramanathpuram. While Pondicherry is usually quite a hot and humid seaside town, the 2-3 months of winter are much more pleasant, helped no doubt by the rains that the retreating monsoons bring to the region at this time. On the odd occasion, cyclones pop up and we had one particularly furious one a few years ago when the Jipmer campus briefly resembled the set of a Jumanji movie.
The mid-afternoon sun, however, continues to be as hot as ever and most of these are spent hiding in the Dorms, getting a much needed siesta after after a tough morning OPD spent in vaccinating kids and gossiping with the village folk. The dorms themselves are pretty plain and functional. The area is notionally divided into 2 sections by a wall that doesn't quite reach the middle and each section has 4 of the iron beds and green mattresses that seem to be the norm in Jipmer MBBS residences. Next to the head end of each cot, above which is a small grilled window, is a smallish 3 section wall cupboard with a single wooden rod for hanging clothes and stethoscopes. Each shelf is occupied by sundry personal stuff and in many cases, cigarettes and quarter bottles of Ramanthpuram's finest spirits. The roof of this building is made of asbestos and gets very, very hot in the day. We suspect this is a deliberate ploy to keep us Interns away from the rooms in the afternoon when all we really want to do is catch our well deserved siesta.

The evenings are a different story.Our main source of entertainment in the evenings is driving around the region with 2 principal aims:
1. To explore the place and check out the surroundings
2. To hunt around for essential supplies, the definition of "essential" varying considerably.

Driving around one day, we come across a big partially dried up river bed, the result of a small dam holding back a lake of sorts. Lake is probably a generous description of the smallish water body formed as a result of this dam but this time of the year, it's full of water. Getting here is a 10 minute drive from the RHC with the last 100 feet or so on a muddy tree lined narrow path. This leads into a clearing from where one can choose to sit and see the sunset across the river with a few beers or go down some rocks and splash in the probably full-of-fungus expanse of water.
We head out one day and spend the evening in this lake and I can feel slime and mud under my feet. I don't know what else I am feeling since the water is really murky but it's good fun and we get back as it's getting dark. The next day I discover that I am not the only one to have grown bits of fungi and everyone seems to be scratching around various body parts. The place is still however, an excellent spot to just sit and chill out. 

Our kitchen runs exclusively on supplies managed and arranged by us. Essentials like eggs, bread and milk can be found here or in the nearby villages but for mostly anything else, the designated Mess Secretary and anyone who's interested board the weekly shopping Van and head off to Pondy. I, on the other hand,head off from the RHC in spirited pursuit of paper wrapped nicotine sticks. Now, the brand that one has got used to is often a vital determinant of success and failure in such matters and I hunt for Gold Flakes (King Size). On leaving the gate, I turn Right and about 100 feet later at a T junction I find a small shack selling tea and Gold Flakes (not King Size). This shop shuts by 7 PM, a point duly noted. I then turn Right and find myself on the main road where a Right turn will lead me to the Pathukannu bridge but to the Left lies the village of Thondamantham. I turn towards the latter and discover a small general store where volia!, I find the treasured sticks. A vital discovery. This is Thondamanatham's only claim to fame.

There are no bars in this place and finding any shop which sells something drinkable is the next mission. On more than a few occassions, some grateful villager has brought some toddy which we have equally gratefully accepted. We also learn, through trial and error that toddy is best consumed in the morning when it's fresh. Not when it has had time to ferment in the fridge. It tastes different, not too bad and makes for a great alternative to the morning tea. Toddy solves the morning issues but stocks have to procured for the evening. So, from Thondamanatham, still in search of a "Wine and Beer Shop", I turn around and head towards the Pathukannu V junction where instead of turning Left towards Ousteri, I take the other arm of the V formed at the junction here and about 500 m down, on the left, spot a sign for another village, Kodapakkam. Just off the road is a shop which sells some alcohol. Nothing fancy, but enough to satisfy underworked Interns too lazy to go shopping in Pondy.
We learn, sometimes the hard way, that it is vital to be aware of the opening and closing times of these shops and shacks. One can, of course, head back to Pondy to stock up at any time of the day or night to stock up but one does cut a rather desperate figure hunting for cigarettes this way and like all smokers in denial, when the stocks run out, we abandon the pretence of the "brand" and get along with whatever is on offer, filter or not. Gold Flakes (not King Size) or Wills or even Charminar will do.
We often travel back and forth from Jipmer, since even barely employed Interns need clean clothes and a change of scenery. However, the traditional route to Ramanthpuram via Ousteri Lake, while very well defined and used, is best avoided at night, especially if one is alone. There have been tales of villagers and farmers stringing lines of wire and rope across the road beside Ousteri lake, a particularly lonely and dark stretch, with the intention of tripping over unsuspecting motorcyclists. This can also be dangerous since the wire/rope can be at head level and may result in serious injury. I have not personally experienced this and I know of no one who has, but it's still not worth the risk. We therefore hunt for alternatives.

It turns out that there are many ways to get to Ramanthpuram. Shyam and I start from Jipmer one evening and turn Right on the main Tindivanam highway. The road is trafficked and single laned, dotted with the odd building and lined by many trees. A few kilometres down, there is a left turn which we duly take and then the road winds around many isolated green fields and patches of barren land before joining the original road just before it hits Ousteri. This is a very pleasant drive, with no traffic at all and just a couple of roadside factories interrupting an otherwise endless view of rural Pondicherry.  Alternatively, one can also turn Right at one spot and then a much smaller back road winds around Ousteri and enters Thondamanatham from the other side. This route, we think is also probably not a good idea at night and this is confirmed one late evening when a tyre punctures and it takes half an hour of hunting to locate a puncture repair shop. Being a Sunday just complicated matters. 
Back at the Ramanthpuram end of things, one exits the RHC and after a short hop across a small canal one reaches the Pathukannu bridge where the road diverges into a V.  The left arm of the V is the road around Ousteri while the right one goes past the village of Kodapakkam and it's booze joint and joins Vilianur, a small village which some massive temples. From here one can take the State Highway, with it's constant traffic and unmarked speedbreakers, or zig-zag through Vilianur and enter Pondy at one end of the 100 feet road at the other end of which lies Muruga Theatre. This Vilianur route is a favoured one when returning at night although on more than a few occassions, I forget the potential dangers of head high wires and ropes and go via Ousteri anyway.
This other arm of the V, past Kodapakkam, is a lovely completely unlit stretch of road and on this road at night, my heart starts beating just slightly faster than normal. It's a deserted but a very cool and silent road and just driving at night under a brilliant rural sky, with only the sound of my 2 stroke Yamaha for company is chicken soup for my soul. After exactly 2-3 minutes, a  small yellow light appears, getting bigger and bigger as I approach Kodapakkam and the Pathukannu bridge. 

This whole area, largely devoid of traffic, noise and shops is only 15 minutes from Pondy but it seems like a completely different world-a world I am blissfully happy to be in.

One night, driving back along this Vilianur Road, with Ravi my co-Intern as pillion, my bike sputters a few times and then stops. My bike, a 2 Stroke Yamaha RXG, is barely 18 months old, has enough petrol and has never given me trouble before and so, standing in the dark, with the RHC at least 10 minutes away and with no way to contact anyone, I can do nothing except try to kick it back to life. Amidst growing uncertainty and the seed of panic, I kick and kick and 50 kicks later, the engine comes back to life. We rush to the RHC before something similar happens and no one there can shed any light as to what might have happened.
The next day Ashley, my ex-room mate decides to drop in and discover that he is also a victim of this unique bike problem no one else seems to know about. He, however has a solution.
When the bike engine stops, take the key out of the ignition, open the petrol tank, count to 3, close it, insert the key back and turn it on. Then kick the starter and it will come back to life. All of this is done while the bike is moving.
The bike problem still happens on and off but Ashley's solution works beautifully and I almost forget that the bike actually does have a problem I should let a mechanic check out.

The Dept of PSM, with it's Senior Residents and Consultants pop in regularly and organize some village meet-ups and projects to keep us occupied. One of these is a reported Cholera/Typhoid outbreak in the area and we will be tasked to find out the point source.
The Pulse Polio program will be starting in a few days and we will be designated to various villages as the drop administrators.
Pongal is approaching and by tradition, the Batch posted at Pongal time will be invited over to the Village Chief's house for dinner.
Dr Rajan, our CMO drops in to the Dorm with some food and a chess board. He finds Reddy for company while we sit around just doing nothing.
A patient walks over and one of us on Call saunter across, unlock the OPD and do whatever needs to be done.
My first salary, all of Rs 2340, is due on the 31st.

6 of us are forming bonds that will be strongest here and will, unfortunately, become looser with time, space and distance.

It's a peaceful existence. But Internship is just starting.

Chapter 71-Rural Ramblings

Jan 1998

Note: RHC-Rural Health Centre
Below is a hand drawn sketch of what the layout of the RHC was in 1998. This may have changed a bit. 

Ramanthpuram is about 20 minutes away by bike (or van or ambulance) and is separated from Pondy town by a medium sized lake called Ousteri, expanses of barren red mud, and other greener expanses of well cultivated fields. These 20 minutes of driving, from a bustling coastal town to a quiet, peaceful, serene village, is something I have wanted to do many times over the last few years. However,  I have managed to visit this place all of twice, once on a Dept trip and once to scare the bejeezus out of Rahul who was posted here last year.

Our briefing over, the Dept has organized a Van to take us to the RHC, get organized and settled there and will return in the evening. We get back to the hostel to pack and get ready for 6 weeks of residential rural bliss. Of course, we will come back to campus off and on during the posting but it is strongly encouraged to be in residence as much as possible. It is supposed to be residential posting after all, but a few choose to live on campus and  make the commute to and fro the campus every day, a journey that in my mind defeats the purpose of the posting.
The route to Ramanthpuram is fairly standard and we get on our bikes and head off, following the PSM Van as it makes it's way past the many factories lining the main road, past and around Ousteri lake, taking a Right turn at the Pathukannu bridge towards Thondamanatham and then a final Left turn into Ramanathpuram and the RHC. It's quite remarkable how suddenly the scenery changes from the hustle of a coastal town with it's traffic and noise, transitioning through quieter roads with a few factories and their blue shirted workers heading to or from work on cycles, to just scattered collections of thatched huts, bales of straw, random animals and vast green fields that characterize the rural surroundings we find ourselves in 10 minutes into our carefree journey. There are no hoardings or horns here. Just a gentle breeze coming across Ousteri lake with a huge banyan tree just before the Pathakannu bridge, the junction itself hosting a typical tea shack with a few casual tea drinking village inhabitants whiling away yet another day. And as we reach the RHC, always a few curious onlookers waiting to see the fresh batch of excited, fairly incompetent Interns who will become their points of reference for all matters medical.

It is a normal, ordinary village-green fields, quiet back roads, starry skies. Semi naked kids running around, dogs chasing these kids, cows munching away in the middle of the road. It has a few thatched houses and a couple of cemented ones belonging to the village chief. There are a few scattered shops and one of the early priorities is to figure out which ones sell the booze and Gold Flakes (King Size). We are taken on a quick tour of the campus, a large squarish walled compound. There is the Main OPD Block which also has 2 or 3 beds for Emergencies. There are various rooms inside this Complex for dressings, injections and also a Delivery Room in the rare but extremely exciting scenario of a lady in Labour, usually brought on a bullock cart, who cannot make the journey to Jipmer in time. There are the usual Nurses and Social workers, many of whom have been here for a very long time and know some of the village inhabitants very well indeed.
We walk along a red brick path to our Quarters and look around. The Male and Female Dorms are housed in one asbestos roofed single storeyed building, guraded by a flimsy barbed wire fence and accessed through a creaky iron gate. 3 steps lead into a small common landing and we turn Right to our Dorm. Off to the left is the Dining room with a TV, a few chairs and a table, a fridge and an Aquaguard set-up. Leading on from here is the Female Dorm, which, of course, is out of bounds. Karunanidhi, the resident cook, and his protege, Ganesha, greet us and they promise to make anything we desire.
This place is truly our own. Once a week, we will take turns to go into town and shop for supplies-vegetables, groceries, booze, fish-anything that can be bought on our budget and stored in the fridge. After 4 and half years, we decide what we will eat and how we will eat it. When we will eat it. And with what we will wash it down.

The perks of passing Final Year don't end with working in a hospital.

On one side of the Dorm building is the CMO quarters, the haunt of many a haunting. The RHC has a reputation of ghost sightings and unexplained door bangings and things going bump in the night and even though the PSM Department, at the insistence of the village wise men, had organized a pooja of sorts, we are convinced that all is not solved. We actually look forward to some supernatural excitement.
There are large empty spaces in front which are hosts of impromptu cricket matches and a newly acquired net strung between 2 lamp posts signals the start of a wind affected badminton game. A tall water tank stands proudly off to one side and a few rooms for Karunanidhi and his protege, the ever smiling morning-tea-bringing Ganesha completes the campus.

The CMO (Chief Medical Officer) drops in once in a while to check on things. He will always be in-charge of the OPD sessions which is a good thing since I am sure, that we, swimming in a vast sea of newly acquired knowledge and eager to show off will end up misdiagnosing things like simple headaches for brain aneurysms or perhaps, and more importantly, missing one. Kids come here for vaccinations, village elders come to gossip, chronic headaches and body aches land up at 3 in the morning and on the odd occassion, when all is quiet and the mood is complacent and mellow, someone will land up with a badly lacerated head or hand or in shock or in Labour. The pattern is of mostly peaceful and quiet days and nights with unforseen excitement right around the corner. Jipmer is a phone call and a 20 minute Ambulance ride away, but one has to account for missing Telephone operators, unavailable Ambulances and the prospect of a life in your relatively untrained hands.

I am in Ramanthpuram. In my first few days of my last year in Jipmer.

Chapter 70-Ramanthpuram! Here I come

Jan 1998

1st Jan arrives and with that, I start Internship. We have to complete 365 days of Internship-a missing day, for whatever reason, will result in an extension for the required number of days. The end of Internship makes one a full fledged Registered Doctor but that doesn't really count for much in the real world. An MBBS degree merely makes one eligible to take the Post Graduate Entrance Exams, which, by all accounts are very painful and frustrating experiences.
One of these is the PGI Entrance Exam held in Chandigarh in June and December. I will be eligible for the December version but only if I finish Internship on the 31st of December. Chandigarh happens to be my hometown and I would love to do my PG there but if Internship carries over to the next year one is ineligible for that PGI Session. Which means that I cant afford any extensions. Which is rather frustrating.

Out of the 75 who joined Jipmer in 1993, about 45 of us have made it as Interns on time. Some failed in the 1st year exams and went into the Additional Batch and 23 were casualties of  Final Year Exams.
In practical terms this means more work per Intern and more frequent calls and duties. More stress and more hassle. Depending on how one looks at it, it is also a chance to get more chances to do procedures, operate and be more actively involved.

We have been divided into 4 batches and each batch will start a different posting. The sequence is Medicine, Surgery, OG and Community Medicine, each for 12 weeks. We also get a 4 week Elective posting where we are free to choose from the specialties available. Some, especially those destined for the US or the UK choose Psychiatry, while the lazy bums choose more benign ones like Forensic Medicine. I start with PSM-Community Medicine. This consists of 12 weeks of bliss, split between the Rural Health Centre in Ramanathpuram and the Urban Centre in town in a place called Kurchikuppam. This will then be followed by the Elective, which I have not decided on yet and the 3 major postings, finishing with OG in December.

In many Colleges, Internship is treated as a preparation ground for PG Entrance Exams. Coming to work is largely notional. Reading for PG Exams at the expense of Internship time is actively encouraged. But not here.Life as an Intern here is very very busy and I will just have to squeeze time in to read for PG Entrance. Internship here is all about learning basic hospital functioning by becoming a part of the system. It is being a Doctor in every sense, but since we are the bottom of the barrel, so to speak, our responsibilities and liabilities, while very real, are grounded largely in terms of personal ethics. In the ultimate analysis Interns are not responsible for any screw-up that might happen. We are in training after all. We aren't even registered licensed doctors.
There is always a choice. One can scoot off from work,  massage a few egos and goof off, scurry off to read for PG Exams or just bunk. One can shirk work and make excuses. One can extend vacation time for no proper reason and leave Co-Interns high and dry. One can "forget" to do things and make the 1st or 2nd Yr PG suffer the consequences.
There are no impressions to make, no exams to conquer.
But Jipmer has a culture and an ethos. Most people do their respective Internships sincerely because that's how it's done here and always has been. It's one of the many small things about Jipmer that make me glad I came here.

There are 6 of us who will start Internship in the RHC. We troop in to the Department at 10 AM and are given a briefing on what they expect from us and what we can expect from this posting. In a nutshell, we are expected to be residents in the RHC for the next 6 weeks and indeed, there is a fully functional Dorm with a cook, satellite TV and Aquaguard water to take care of us.
We will conduct an OPD in the morning and the Dept may organize some field trips to nearby villages etc  for Community Heath Camps. The Pulse Polio programme will be starting in 15 days and we will be expected to be an active part of it. We will be essentially the only doctors for Ramanthpuram and surrounding villages and that is a slightly scary thought.

But for the most part, though the PSM Dept does not see it that way,  it will be about spending 6 joyous carefree weeks in an idyllic rural hamlet away from books and the hospital. I have been looking forward to this day for a very long time and now it's here.

And I think I deserve it.

Chapter 69-The God of the Small people

Dec 1997-Jan1998

My journey home this time is the most carefree it's ever been. I am in the best of both worlds-If I fail, I'll return in a month's time, attend some clinics and classes and retake the failed exam in April. No big deal.
If I pass, well. I will become an Intern-the last year of Medical School, a year spent working in Hospital and my first year in a paid job.

One day in Dec at home: 
I get a call from Rahul. The results are out.
He starts by not talking about the result and I play along. A few minutes of this and a few choice abuses later, he starts by telling me of the people who failed. People who were above and below me in the Attendance name list.
And then he says "But you passed (fill in a suitable abuse of your choice here). Congratulations!"

I PASS!
23 other classmates, however, have not made it. 19 of them are in Surgery, all from the second day. 19 out of 24 who took the exam that day. Jipmer has never had a result this skewed.
This is a significant dampener in proceedings. Even though it's true that they will retake the exam and all that jazz, it is always a personal blow to not make it with the rest of the class. I experienced this when I was stopped for attendance, and 23 of my classmates, some of them better students than me, will go through a period of denial, anger, adjustment and eventually salvation.
I have been there. It's not pretty.

But. I am an Intern now. The juniormost hospital functionary but the Seniormost amongst all the Medical students here. Medicine is funny that way. One starts at the bottom as a Medical Student and climbs through the ranks to become a Intern where one discovers that once again, the climb starts from the bottom towards a PG Residency and eventually a Consultant.

But for the moment, I am a God among the students. An Intern.

The God of the Small People.

Chapter 68-Freedom

Dec 1997

If it possible to be delirious with joy and relief, and numb at the same time, then that is what I am. 3 days ago, at the same time,  as the sun set with a new day 12 hours away, I was in the throes of terror mixed with depression, with some minor bursts of hope and optimism thrown in.
Anup and Condom come back from their respective exams. The others slowly troop back. Some may have failed but no one can tell. Passing and failing is almost an afterthought, what matters is that the scariest, most unpredictable and stressful set of exams a medical student will ever face is now over.

I call my parents and tell them. I can tell that they have been as stressed as I have been, largely because I have been feeding them stories of Final Year and explaining how normal it is to fail, so that if I actually do, the blow will be softened. Failing really is no big deal. One retakes the failed subjects in 6 months-all that is lost is some time. There is no loss of face because it can happen to the best of us.
I close the door of my room and look around at the mess on the floor, on the bed and the table. Over the past few days, life has been a blur. I have hardly eaten a proper meal for the last 15 days. My shorts, once tight, are in danger of slipping unless I wear a belt. My eyes are red.
And I am really tired.
And in major withdrawal.
I am in study withdrawal. For the best part of the last 11 months, I have done hardly anything except study. Classes, tests, Labour Room, Ward Leavings, exams-it has been one non stop ride. My head is still swimming with Medicine, Surgery and OG and as I look at the mess of books, I pick one up and start reading something at random. I can't help it. It's like quitting cold turkey.
It is the pinnacle of intensity and stress followed by absolute nothingness. The swings are extreme.

The suddenness and intensity with which Final Year ends does not give one any time to actually consider that 4 and half years of student life-the ragging, the tests, the exams, attendance issues-all over. That will take some time to sink in.
I have a long, relaxed shower-my first in a long time (the relaxed bit, that is-I had, of course showered regularly), change and go to Snappy. And for the first time in 4 and half years, since that August in 1993, I sit there with nothing to do except just sit there.

I can sit here as long as I like.

If I pass, I will be an Intern from the 1st of January. But that can wait.

I am free.

Chapter 67-The Final Climb

Dec 1997

I've finished 2 days of exams. I think I've done well enough to pass though one can never say. Unfortunately the news is that many people on the 2nd of Surgery seem to have run into trouble and are not expecting to pass. That's the problem with Final Year. Together with the study load and the nature of the exams, the indescribable stress and the narrow margins for error combine to make a heady mix of disasters waiting to happen. Internal Examiners try to smoothen wayward vivas and rampaging Externals but too much attempted smoothening can also backfire. The Internal Examiners often walk a tightrope and it must be a tough job.
It's also a fact that for Undergraduates, most lecturers/Consultants/Professors are known not by how good they are in class but how they behave in exams. Some are out-of -the-way helpful, some are brutally fair, some are too junior to make a difference. Some are downright nasty, though thankfully there aren't too many of those.
Many an exam story is laced with "....And I passed even though So-and-so came for the exams"...Respect for seniors goes up when such an examiner falls in the brutally honest or nasty category.
Some of the time between Send-Ups and Univs is spent praying for a particular set of examiners to arrive.

The morning comes. This is it-my last exam and I hope that for the next few hours, I can keep it together and get through this nightmare. OG is a logical, less demanding subject though again, small slip ups are plentiful and there have been numerous anecdotes from previous years to keep me honest.
There are 2 cases-one from Obstetrics and one from Gynae and we will take them one after the other, presenting each to a different set of examiners.
Our exam is in Ward 12-the Obs ward. We troop in there at 8 and are shunted off to the Procedure Room-one of the small rooms in the corridor leading to the Ward. Rajeev meets us here and takes one last, very quick revision class on basic instruments and some vital Labour Room type questions. This kind of thing can be either deflating or confidence inspiring and thankfully, I'm OK.

We're off. There are 12 Obs and Gynae patients lying opposite each other. Naveen and I are together. He starts with Gynae and me with Obs and half an hour later, we shift cases. One hour later, I'm done.

I start with my Obs viva. I remember to wish the patient, get a screen, drape the patient and warm up my stethoscope. I follow protocol exactly and ask all the proper questions in hsitory. I take an accurate fundal height. I'm asked to demonstrate grips and this goes off well too, making sure to not follow the order of grips described in Dutta, which for the Dept's purposes, are incorrect.
The usual questions on Labour Room management follow-Partograms, Oxytocin drip maintainance, episiotomy suturing etc and apart from a few minor hiccups, it goes off quite smoothly.

Then, it's Gynae time. I get a UV Prolapse and sit in front of Dr GR and an external who looks benign but starts off with all kinds of questions I find myself struggling to answer. The viva continues like this. I'm asked a question-Dr GR gives me a hint and I answer. Then GR asks me a question and the External gives me a hint and I answer. And this goes on for the next half hour, punctuated by expressions of profound exasperations that Madam GR is known for.

Then. It's over.
Except for the afternoon viva. And this time it really is in the afternoon.
We start by 3. There are vivas on Instruments and X-Rays and one on Deliveries with a dummy baby and pelvis. One more on contraception methods.

In my Send-Ups, I had been given a pair of Obstetric forceps. These are long, gently curved blades designed to hold a baby's head if it's got slightly stuck. The blades articulate in the middle but I'm given 2 blades which are not.
I'm told to articulate them. I spend the next 5 minutes desperately trying to get these 2 blades to slot but all I manage is a non stop sound of steel hitting steel. And then suddenly, after 5 minutes of rattling, the blades slot. Just like that. I'm asked a few questions and then told to disarticulate them and leave.
But the blades won't budge. So after 5 very awkward minutes of trying to disengage them, a frustrated GR asks me to leave anyway.

This time I'm ready.

The vivas are fine. Instruments is benign as is Contraception and the dummy delivery. Then the last Viva of my MBBS life. X-Rays.

We have seen the usual X-Rays that can come. There is a stock of these and we have had a revision class so that all of us can identify them at a glance. Of course, one is expected to actually read an X-Ray the proper way with the type of X-Ray, the view etc. My turn comes. The X-Ray is displayed on one of the viewboxes and I look at it for a second and turn to face the examiners.
"Yes?"
"Sir, it's anencephaly"

Now, I had spent a second looking at that X-Ray and I knew what it was. But the external is not happy.
"You looked at that for ONE second! You cheated. You have been told the diagnosis!"

Oh God! This is not what I need, not now. So I deny any cheating. Then I'm told to go and look at the X-Ray properly and come back. So I make this big show of taking 2 minutes and really looking at an obvious anencephaly. And I come back and say all the right things.

Just like that, it's over.

It's all over. All of it.

I get back to the room. It's 4 PM and only our group has finished the exam. The Medicine and Surgery boys are still in the exam.
I'm like a zombie. There are no thoughts, no feelings, no emotion. I stare at empty space while I lean against the ledge. I am still in my white coat with my steth around my shoulders and I stand like that for a long time. Then I get my chair and sit like that for some more time.
 I had imagined so many things for this moment- the moment that pass or fail, all of us had been waiting for many months, dreaming about it, just willing it to come.
I had imagined I'd get beers and go lie on the beach and just sit there all night. I'd imagined I'd be in Ramanathpuram under a starry sky. I'd imagined getting drunk stupid. Shouting. Screaming. Going crazy.
But nothing happens.

More than anything I feel like crying. Maybe this is what it feels like when you finally achieve something that has consumed your existence for so long. Just an emptiness. A vacuum.

Freedom.

Chapter 66-Clinics Part Two

Dec 1997

There is no way I can read anything at 1030 PM after a long, tiring, very stressful day. I have, however, another two equally stressful exams coming up and I hope they won't be as long as Surgery.
I am up by 6. There is no point in doing a night-out for Clinics. The syllabus is too vast and too vague and I need to be on full alert the whole day. Anything can go wrong in a matter of seconds-a missed point in history, a missed clinical sign, an inexplicable diagnosis, a screw up in the management. Medicine is a bit of a weak point with me and if I manage to get through today, I will have gone a long way in passing these exams.
I start with Cardio-heart murmurs and their pathogenesis. OP Ghai to the rescue here. Quick brush up of trivia, like causes of raised JVP and types of pulses-all from PJ Mehta. Then I tackle Neurology. Root values of reflexes, all the dermatomes and muscle examination. Aphasias and GBS. Strokes and Spinal cord anatomy. Muscle tone grading. Moving on to Respiratory and this is where I hope God will come to my rescue. I hate the RS. The breath sounds all sound the same, the signs are very subtle and if the lesions are bilateral, things can get extremely sticky.

All I can do is to make sure I have all my instruments with me. I reach as usual by 745 and we are sent to Ward 46 for our cases. The pattern will be similar to Surgery- a long case, one short case, one Paeds case and 2 spotters.
I start with my Short Case. A 31 year old guy. Lots of edema. Nephrotic syndrome. Not very common in adults but still, there it is. I do a quick examination and my examiners arrive. Dr Dilip Mathai from CMC Vellore and TKD. The Viva is bedside and is going well when suddenly:
"Dr Mathai, he missed a Bitot spot".
Oh damn! I did. A small brown spot on the eye signalling Vitamin A defeciency. Fortunately, there is no immediate adverse consequence and we proceed to discuss the examination findings and some pathology and we are done.
The examiners lead me to my spotters. It's like a walking viva where I see a patient with some skin lesion and am asked to diagnose. And another one.
There isn't much scope for a viva here because both of my spotters are wrong.
2 more cases to go.

Paeds is next. I'm led to another part of the Ward by Somya, (a fantastic PG who had taken some fantastic classes for us) where kids have been brought over from the Paeds Ward for the exam. We walk past a few and stop at my "case". A 10 year old boy who turns out to have RHD with MS. A very standard case. No complications, no hassles.
Phew.

And then it's the long case. Things are happening fairly quickly today with both Short and Long Cases going on simultaneously in the Ward. It's about 12 PM and I'm nearly done. The problem is that even after one has taken the Long Case, the wait for the viva can be very long with each Viva taking 45 minutes or so.
I start. 15 minutes later, with the clock ticking, all I have been able to gather from the patient is that he is a bit breathless at times and has fallen off his bicycle once because he fainted. That's it.
Panic sets in. I still have to figure out if this is a RS Case or a Cardiac Case or whatever. I put my steth on the chest-usually done at the end of a case and hear multiple whooshes and murmurs. It's Cardiac!
From here the history is focussed and I do the usual examination. However, when it comes to actually finding what valves are involved, the situation becomes dicey. Murmurs are everywhere. Systolic, diastolic, pansystolic, mid-diastolic. Everything is a murmur.
I'm done after the allotted 45 minutes and have been waiting bedside for another 20 when AKD walks by and asks if anyone is free for the Viva before they break for lunch. I grab this opportunity and we start. I can't wait for a Viva for the next hour. I'm hungry too.
The Viva starts reasonably. AKD listens to my history, nodding vigorously and muttering "Yesh Yesh", "Very Good, Very Good" at regular intervals. Then he turns to the externals and says
"See Sir, he's a good boy, I know. Very Good"

I have no idea why I'm "very good" or what I'm doing that deserves such commendation. But here we are and I'm not complaining.
I start talking about the murmurs. When I say "Pulmonic Stenosis" there is a frown. I'm asked to check again-a signal for "better get it right this time". So I imagine another murmur and they agree.
This happens three times.

And then the viva is over.
Wow. Did I pass? No idea.

Many of us are still left for the Viva when I finish. I'm told to come back later, by 6 or so for the Evening Viva and I do so.
We're there till about 8 waiting.
The Evening Viva is a series of quick vivas on ECG's, X-Rays, some drugs in vials and questions on them, some haemat slides and a theory viva. All this makes up part of the Theory marks and is mostly a formality.

I'm dead on feet now. I stagger back at 1030 again.

2 down. 1 to go.

Chapter 65-The Clinical Exam Day One

Dec 1997

I get up early. It's still dark when I'm up but with every passing minute I am closer to starting the toughest set of exams I have encountered so far.
I take my Das, switch on my table lamp and read up Hernias and Hydroceles. I am still not very confident of these two topics, not because they are difficult, but because we are expected to know everything about them-from the intricacies of the Anatomy, to the many variations that exist and the operative details for each. Hernias are the bread and butter of any aspiring Surgeon and gaps in knowledge will not be taken well.
Soon I find that I am down to my last cigarette. This is a small miscalculation and instead of getting some the previous night, I had convinced myself that my stock would be enough to get me through the morning. At 630 AM, with 90 minutes to go, this has turned out not to be the case.
It's just about getting light when I get on my bike and go out to the shacks, 2 or 3 of which always have a running 24 hour stock. Or so I thought. I have never seen these shacks shut but this morning, of all mornings, there is a grey tarpaulin sheet covering them and not a soul around. Everything is closed, from the tea shops to the pharmacy to Casino-Johny's tea shop and to my favourite coffee/cigarette shop next to Johny's.
I, of course, am a veteran of shop locations by now, so I gun the bike and head down the road. The closest shop is on the road where Joy lives. This is a right turn off the main road about a kilometer down and I reach there by 645, with the minutes ticking by and a small panicky feeling starting to surface. The shop is also shut. Shutters down.
My next target are the 2-3 shops at the Muruga theatre junction next to a mosque and I turn the bike. If not there, I'll head back.
Then, while still trying to get back on the main road,  my bike runs out of petrol.

I am, however, barely 50 meters away from Joy's house and I push the bike to his house, run up the stairs and ring the bell. It's 650 AM and a startled, barely awake Joy opens the door.
I explain the situation. Joy takes it in his stride and we ride back on his Yamaha, back to a campus now buzzing with activity, with the shacks still shut. I then sit on the steps of Osler House for the next 10-15 minutes, flipping through my Das and avoiding the curious looks of all and sundry. Then Joy brings me some cigarettes from somewhere.
An eventful start to the morning. And I haven't even started the exams.

745 AM: 
I am ready. In any case, there is little more I can do. This is it. White coat, stethoscope, measuring tape, rolled up X-Ray film (scrotoscope), pens. Roll number plate.
All done.
I have read up some of the theory paper questions I had screwed up since they tend be asked in the Viva. The answer sheets would have been corrected over the weekend and sometimes, especially when a viva is not going great, the examiners ask some of the theory questions. The idea is to check if we bothered to go back and read up. On top of a slipping viva, not answering these questions will probably not be good news.
23 of us have Surgery today. We are divided into 2 groups and 12 of us head off to Ward 34 for the Short Cases and Ortho. I am in the other group and we troop off to Ward 36, where our Long Cases await. It is general belief that doing well in the Long Case will go a long way in passing the exam since it carries half of the marks for the Clinics. In a way, it's good that I'll get it over with early. Assuming it goes well.

Every Ward is set at right angles from the main corridor. Smaller corridors lead off to the Wards from here and at the Entrance of Wards 34 and 36, there is a green screen with a chart paper stuck on it. It reads "SILENCE PLEASE. EXAM IN PROGRESS".
These smaller corridors leading to the Wards are lined with various other Rooms-Duty Doctor's rooms, a Store Room, Treatment Room, Bathroom etc and we are escorted to one of these by Shetty, a Final Year PG in Surgery who has been allotted Exam Duty. We spread our books and bags on the two beds and wait.
Some read, some stare at the walls, some chat. Mostly though, there is nervous silence.

At 8, Dr Kate comes in. He is a Prof in Surgery, not an examiner, and he calls for my Roll Number. Just me. Without a hint of why I am being singled out, I follow him to the Ward where I am taken to a large table across which sit Prof AK and the External. The exam has not yet started and no one is taking a case yet. Without preamble, Prof AK asks
" Did you write the Surgery theory paper"?
The obvious conclusion is that this is somehow related to my Urinary Diversion debacle. But they don't go there.
Me: "Yes Sir".
Prof AK: "Did you write Section B in Paper 2"? "Because we can't find it"

I look at the table. Answer sheets lie scattered all over the table. They have been hunting for my Section B Paper 2 for the last ten minutes and can't find it. I join the hunt and 2 minutes later, it's in my hands. It's the Diversion section. So, they ask me
"Why is your paper not in order? Why is not after 4417537 since your roll number is 38"?
..and so, 5 minutes before my Final Year Surgery Long Case I explain to my examiners how I was short of attendance in Pharmacology and wrote 5 papers because I was stopped from that particular exam and how that is the reason my Roll number had been pushed to the back and was not in order.

What a great start. But no mention of getting caught trying to copy.

I get back and 5 minutes later Shetty comes and calls 6 numbers. They will start the Long Cases first while we wait. They will get 45 minutes and then Shetty will come back for more. 45 minutes later, it's my turn.
The Ward has 3 sections divided by large glass partitions and our set of 6 patients lie in the middle. I am taken to one and Shetty leaves me.
I start. The complaints are early satiety, epigastric pain, constipation. I see the patients nails and find that one is broken. This apparently happened when a rice beater or something hit his nail. I take a good history and examine the 13 areas of the abdomen and quickly write it up. It's a case of DU with GOO. Duodenual Ulcer with Gastric Outlet Obstruction-a case I love.

The 6 of us finish and sit in line waiting for our Vivas. This takes some time since each candidate is examined for almost 35-40 minutes and almost 2 hours of waiting later, it's my turn. I hand over my case sheet and proceed to make my most awesome presentation ever. I even explain the reasons for the broken nail at which point I'm told to "Carry On" rather impatiently. My findings are spot on, my history is perfect. It's beautiful. There are no interruptions at all.
I am careful with the diagnosis-Gastric Outlet Obstruction MOST LIKELY due to Duodenal Ulcer, as we have been taught. From there, the Viva is predictable. Upper GI Endoscopy, differences between malignant and benign ulcers. I am asked about the Electrolyte abnormalities and I leave out Paradoxical Aciduria because even though I know it happens, I've forgotten the mechanism, which will be the next obvious question.
Some questions on surgery-Vagotomy types and Drainage procedures and I am dying to talk about Billroth procedures and Gastrojejunostomies but they are happy with TV with GJ. And that's it. My viva is over.

Wow. I think I have not been reported for Diversion after all.
The exam is not over, however. I still have Ortho and Short cases left. The 12 of us are escorted to Ward 34 where the other 12 are still being examined. We are put in a Room again-no food and we stay there for the next 3 hours. The afternoon Sun comes in through the window and it is really, really hot. We stay like this for the next 3 hours, some dozing and happy to have done the Long Case well.
The wait is too long though and after 3 hours, when the first 12 have all finished and have been taken to Ward 36 for their turn at the Long Cases, all of us troop out.
It's now 5 PM and I start with Ortho. I am allotted my case.

My patient's leg is bent in an impossible shape. His leg is bent at right angles and then there is another right angle to the foot. I know this is a case of Pseudoarthrosis of the Tibia because I have seen it once but that won't help me. I proceed to try to measure some distances between some bony points and do some haphazard examination but I'm a bit flustered and things do not go well. The Viva is so-so and I hope that I won't set a record and be the first to fail Ortho. Dr DKP is cool, unflabbable as usual and gives away nothing.

It's dark outside by the time I am led to the Short Cases. There are 6 sets of cases, each consisting of two patients. I have 20 minutes to examine and present, this time without a case sheet to help organize my thoughts. I am standing directly opposite the Examining table and I see Dr J sitting next to an old  huge, bearded man who looks all business. My time starts.
My first case is a Cancer of the Lip who has undergone Radiotherapy. Essentially, an ulcer examination. So I get the gloves and do my thing and shift over to the next one. This is a case of Undescended Testis and it's straightforward too. So far so good.

About half an hour later, it's my turn. I sit and present the first case. Dr Mahendran is the External, from Chennai and is senior to Prof AK also. This might mean that in case of a pass/fail issue, he can override Prof AK. By this time, I am also very tired and hypoglycemic and deprived of nicotine. I am asked
"What will be the fractional dose of Radiation for this patient if divided into fractions over 5 days/week for 6 weeks assuming a total of 6000 rads"?

Maths is the last thing my brain can do right now so I take my time and finally cough up the answer. Some more standard questions on cancers and ulcers and we are on my second case. I present this one well enough and then Dr J asks
"What is the function of the Oblique Muscles of the Abdomen"

I stare at him blank for a few seconds. Then I mutter something. And he asks
"What do you do in the morning"?
I have no idea where this is going and all I can come up with is
"Umm...Sir, I wake up, brush...."
...at which point, Dr J leans over and staring through his thick lenses and black plastic frame with his trademark frown, shouts (and very loudly)
"YOU SHIT"!

...and then it hits me

..."Sir, the action is to help in straining" ....
Dr J: " OK Man, Go".
My Viva is over. I am stunned. But also very dehydrated and hungry. And I have no idea if I passed.

But....the day is not over. It's now 8 PM and I get back to Snappy to find eager juniors asking "How Was It"...I shrug and say "OK" and an hour later I am Back in the Ward for the theory vivas.

I now have to face a set of 4-5 quick vivas on Operative Surgery, Surgical Specimens, Instruments and X-Rays. About 5-10 minutes each in quick succession. The marks for these will be counted against the Theory and so it's not that much of a pressure cooker now.
I do OK in the X-Rays, Operative Surgery and Instruments and have Specimens as my last Viva. These are taken from the Path Museum and are surgical specimens preserved in formalin. They are also labeleld with a strip of white paper across the bottom and we have been told that one can sometimes read the label if done surreptiously enough. In any case, I don't need to resort to any shenanigans and I finish.

I'm done. It's 1030 PM.

I am exhausted. Any thought of reading for Medicine tomorow is a no-go.

2 more days to go.

Chapter 64-In Limbo

Dec 1997

5 days of exhausting, stressful theory papers over and I feel like I'm done with the exams. If only that were true.
I come back from the OG exam and crash out. I'm too spaced out to read anything and I spend the evening goofing around, mingling with the others around the staircase, exchanging notes and getting some gyaan from seniors on their way up or down. It's established fact that in the entire population of MBBS students we are the ones with the most knowledge, courtesy of back breaking reading over the past year but because there is just so much to read, I feel like I'm a jack of all trades, with big holes here and there just waiting to be exposed. Medical reading at this stage is very extensive, spread over many books, notes and manuals with some areas that also require very intensive detailed reading. The trick is to know what those areas are and hope the others are not asked in detail.
Exceptions like Urinary Diversion exist and it's things like this that make Univs such a profound headache. I learn that out of the 70 people writing the exam, only 2 had actually read Diversion before the exam. A few more managed it during the exam. One got caught-me.
A lot of the Clinics boils down to luck and presence of mind. Reading reduces the effects of luck but on the whole, I have to admit, sheer knowledge alone cannot get one through.

The sad truth is that even if one manages to top the class in theory and generally do spectacularly well, a small misstep on any of the 3 Clinics Days can mean a Fail grade.
I will start with Surgery on Monday, sharp at 8. This consists of a Long Case-Breast, Thyroid, Abdominal masses (which can be anywhere and be anything), varicose veins, hernias etc. We get 45 minutes to take a history and examine. This has to be written in a Case Sheet which, in the viva, is handed over to the examiners. The presentation has to be smooth and very accurate. Seemingly small errors-like a missed lymph node in Ca Breast or an inaccurate assessment of a mass will probably mean failure. The spoken history and examination has to tie in completely with what's on the paper otherwise one is asked questions like "Did you do this test" or "Did you ask that question" which is a signal that all is not well.

The diagnosis has to be reasonable. Not necessarily the correct one, but the key is that it should be deducible and defendable from the history and examination.

The ultimate warning signal is when one is asked to "go back and check" whatever examination finding one has blurted out. Chances are good that one is wrong and in the one minute or so that one is given, in that pressure cooker atmosphere, one better find something that the examiners want.

Star students have been reduced to dust in these exams.

If one gets through all of this, the viva moves on to Management. At this stage, disaster can still strike though most of the minefield has been crossed. The exceptions are in the basics like Hernias where Operative Details of Herniorraphy or the intricacies of the Liechtenstein repair are fair game. I have pages and pages of old notes and loose sheets with all the wisdom imparted to us over the past 3 years, stuff that can't be found in any standard surgical text book and will likely be asked in exams. This is why attending Clinics is so vital.
Short cases, 2 in number will be up next. I will get 20 minutes to see both, examine them and present them verbatim, without a case sheet. This calls for rapid mental organization and clarity of thought and knowledge. And the short cases can sometimes be the killer. Anything-any ulcer, mass, anything at all can be a short case.
And then there is Ortho. My nemesis. I have heard no one fails in Ortho but there can always be a first time. A malunion or a nonunion, some joint deformity maybe. Who knows what will come. Here it's examination principles and techniques that are tested and Dr DKP, the Head, with his thin rimmed rounded spectacles and an expression of amused tolerance will be our Examiner.

Examiners are a hot topic. A lot of time is wasted in discussing the pros and cons of which 2 examiners will come for the vivas and what to do and not do with them. Prof AK and Dr J will be our Internals. I don't yet know who the 2 externals will be and because in the exam, the Internals usually keep quiet ad let the Externals do the talking, I hope they will be reasonable. The Internals are supposed to steer an awkward viva to more friendly waters. Some do and some don't.

The weekend is spent reading here and there. There isn't that much that can be done now and I spend the 2 days looking at some manuals, answering mock vivas and mugging up the more vital Must Know things.
Saturday evening arrives and with it, a couple of Residents in Medicine and Surgery pop up with a long tabular list of names and diagnoses. These are supposed to be the cases currently in the Ward and therefore might turn up in the exam. This sounds like a boon but is a very sharp double edged sword. In many an exam, a candidate has failed because he/she knew the diagnosis but could not demonstrate the signs needed to make the diagnosis or back it up with the proper history. In some cases it's not even possible to make that diagnosis purely on clinical grounds.
4 years ago, someone, a potential Gold Medallist in Medicine knew that his case was a Syphilitic Aortic Regurgitation (AR)-a very rare case in these times. He took a great history and did the proper examination and when asked the diagnosis, said "Syphilitic AR". That diagnosis cannot be made without investigations for syphilis and he failed.
One or two major stars will fail in every exam. Such is life.

I take a quick look at the list and then forget it. There is no point.

Sunday evening: 
I'm all set. Clinics are very taxing and can go on pretty late each day, so I make sure to get organized and get some rest. I take some last looks at Das, the Surgical Manual and leave Hernias and Hydroceles for tomorrow morning. I lay out my white coat, washed and pressed after ages, check my stethoscope and scrotoscope, pens and pencils and lay them on the table.
My heart is pounding and sleep will be tough.

My last 3 days of exams are starting.

Chapter 63-Theoretical disasters

Nov-Dec 1997

I am up early. I haven't really slept all that much. They say that "Rest before Test is Best" but that is a luxury I don't have. Today is the first of our five theory papers. Today and tomorrow are the two Medicine papers Paper 1 has a 40 mark section on General Medicine and a 40 mark section on Peadiatrics. Paper 2 has another 40 mark section on Medicine and a 40 mark section covering the Allied Specialties of Dermatology, Psychiatry and the like-topics I've barely seen and now don't have the time to. They were scheduled for Day 7 or something of the study leave and that day came and went while I was still stuck on the topics for Day 2.

Today is D-Day and I need to have breakfast. During exams at least, breakfast has been a constant feature. Normally I never have breakfast. There simply is no time. In exam time, when I have already been awake for hours before 730 AM-breakfast time- it gives me an opportunity to take a break, head down to the mess and eat puris/dosas/grub and just mentally delay the inevitable-more reading. Its a relaxing break where I shut down and just eat and gossip. The end of breakfast signals the last hour of reading and from about 8 to 9, I sit with some tea and read some last minute obscurities. I never cease to be amazed at how much information one can imbibe in the last dying seconds. Pages fly, points and tables stick and I feel more confident with every passing second. Of course, such last minute reading doesn't stay for a long time but I only need to remember it for the next 3 hours.
By 9 AM, I'm done. I relax, shut the door and blast some good Rock on my system. This is a ritual I have followed religiously in every exam. It relaxes me and puts a full stop to reading and tension. A stress buster. (Till I discover my Hall Ticket has disappeared again).

I make the 5 minute bike ride to Banting Hall, ditch the book outside, take a deep breath and walk in. Banting has blue tables and chairs which are foldable and made of iron. Some guys hold on to books till the last possible second and are the last to take their seats. I've never done that. For me usually, the reading ends when I leave for the exam venue, leaving my fate to my own karma, which I can only hope I've generated enough of.
The chairs in Banting Hall have been arranged in neat rows with enough spacing between them to prevent "cooperation".  My roll number is 4417538 so I should be between 537 and 539 but I find that I'm placed at the end, after the entire class and with some of the guys who are rewriting the exam from last year. This has happened as a result of some reshuffling when I had to write the 5 papers of Pharm, Path and Micro last year and so I find myself in the last row to the right. It doesn't really matter where I sit.
Invigilators are sourced from various Departments and answer books are given out-a long 20 page booklet which will be followed by 4 sided smaller booklets whenever someone raises their hands and says "Sir, sheet".
The papers are given and at 930 we are off.

One dictum in an exam is to write SOMETHING. Anything. A blank answer gets no marks. A wrong answer may also get no marks but then something may be right about it. Over the last few years here I have also learnt the fine art of filling up pages with text that borders on correct without actually knowing much. In Jipmer lingo this is known as "farting". Farting is an art essential to passing.
Another dictum is to make sure that for each question, whether a 4 marker or the long 16 marker, one writes enough to get atleast 50% of the marks for that question. If that can be achieved, then by definition one passes the paper.
Time is of the essence. I start, like I always do, by jotting down approximate finish times for each section on the question paper. I should finish 30 marks or so of the paper per hour and I time myself accordingly.
The Medicine paper is unique in that it has 8 fill-in-the-blanks questions and these are must get marks. It's always a race and by the time the clock strikes 1230 my wrist hurts and my writing has become an illegible scrawl. Sheets lie here and there and 5 minutes before time we are told to gather them up and tie them together with the supplied pieces of thread.

Lunch is always a postmortem of the paper. The juniors want to see what questions came, the Interns always proclaim how easy it all is. I ignore all of this and get back up and crash out for the next 3 hours.
The routine is the same. Get up and start reading till the wee hours. Sleep for 3-4 hours, up by 630 and then it's time to Rock and Roll. Paper 2 is also reasonable. Paeds thankfully was pretty general and I get through it. I think.

Surgery is up next-2 papers again. The first has General Surgery and Ortho, each for 40 marks and the next has General Surgery again followed by 40 marks of Related Specialities. This is where things can get tricky. Each section has a 16 mark long question followed by some 4 mark short answers. The 16 marker can be a killer if not known.
My routine now is set. I sleep till 5 PM or so and a quick tea later I'm back reading outside my room, first by the setting sun and gradually, under the tubelight.
Ortho is still something that confuses me. All the fractures seem to be treated the same way and my head is swimming with Internal Fixations and Joint Replacements. The first Surgery paper is fine and is actually my strong suit. This goes off well also.
3 down, 2 to go.
By this time I am half surviving on adrenaline and coffee. I can't afford to sleep off and I read my Bailey well into the night, flipping through GI Bleeds, thyroid lumps, Pancreatitis and Oschner-Scherren regimens. I flip through some Urology notes of the classes I managed to attend, glance at Head injuries and Cardiac valve surgery and that's it. I am pooped.
I pray that we don't get a bomb like one of our senior batches "Describe the Management of a patient who has a cardiac arrest while undergoing surgery under General Anaesthesia". This was a 16 marker and was asked under Anaesthesia, a "Related Speciality". I have managed to read up some drugs and that is it for me and Anaesthesia.

I walk in as usual, dump my Bailey just outside the door and take my place. The clock strikes 930 and papers are given out. Section One has a 16 marker on Upper GI Bleed management. This is a sitter. The other questions are fine.
I flip to Section Two and continue looking in growing horror at the questions unfolding in front of me. I glance around and find that everyone else is glancing around too, expressions of barely concealed panic and bemusement.
We get a 16 marker on "Describe the Indications, Techniques and Complications of Urinary Diversion".
This is followed by 4 markers on "Diathermy", "Cryotherapy", "Digital Subtraction Angiography" and 3 more equally obscure, vague questions. 40 marks down the drain. No one has read "Urinary Diversion". This is the first time in my life I'm hearing of such a thing.

5 minutes into the exam, still reeling from the shock, I see someone get up and get permission to go to the loo outside. 2 minutes later, someone else goes. It doesn't take a genius to figure out what is happening. These 2 students are good students and it is obvious that this time, desperate measures are being resorted to.
I see something peculiar happening on the far side, in the first two rows. Soon after the first guy comes back from the loo, there is some hasty scribbling on a small piece of paper which is then casually thrown on the ground and picked up by someone else. There is more hasty scribbling. The crumpled small paper is tossed again and for the next 2 minutes, I sit and watch a small piece of paper flying around, presumably with Urinary Diversion scribbled all over it. This is unique. I'm impressed but I'm at the wrong end of the action.
It's time to take matters into my own hands. The problem is that even if I manage to get my hands on a Bailey, I won't even know where to look. I've never heard of Urinary Diversion before so I'm panicking like crazy.
I get up, get permission to go and walk out. A few Baileys are scattered on the floor and as soon as I am out, I grab one, run to the loo, frantically open the Urology section and start hunting. I'm standing with the book wide open, having found the answer 30 seconds ago and am doing a massively fast scan through it when I look up and see my invigilator staring at me.

I troop back with him right behind me. I am sunk. I sit down. He says
" Come on, write the rest of the paper. I am going to complain to the Chief Invigilator".

I mutter a sorry and probably very red in the face, I sit sown and turn my attention to Upper GI Bleed, a question I can answer almost by reflex. It takes me 30 minutes to fill up 20 sides of the answer sheet, right from History to Sengstaken tubes to Sclerotherapy and finally to Orthotopic and Heterotopic Liver Transplants. The entire time, my invigilator is standing next to me muttering how he's going to complain and get me debarred. After watching me write reams and reams of stuff, he smirks and walks away.
In the 30 seconds that I got for Diversion, I manage to pick up enough to scribble one page of barely readable rubbish. I draw some uereters and bladders, divert them here and there and create some complications. Something has to written after all.

The 4 markers are equally vague. I draw a rough sketch of a table and a man on it with some wires leading off to a machine with some dials. I label them as "Patient", and "Cautery". I know there is a Monopolar and Bipolar type so I write that. That's it.
Then I draw the exact same figure for Cryo but label the "Cautery" as a "Cryo".
I scribble some stuff for DSA and the others. It's an unmitigated disaster.
I walk out at 1230 not knowing if I have been reported.

It is of little solace that at lunch, everyone agrees that it was a real bastard of a paper.

That is however, already in the past. OG is up next. There isn't anything I can do about what happened today so I continue to crash out till 5 PM and read till 3 AM, brushing up on all of Dutta and Shaw in one massive speed reading session. My eyes are watering and I am very sleep deprived, but this is the last paper and I make a final push.
OG is a relief. Antepartum Haemorraghe is the long question and is very expected. It is really really long though and by the time it's 1225, I am racing to finish, my writing hardly decipherable and I am left with one 4 marker-"Complications of Oral Contraceptives". My fuzzy mind reads this as "Indications of Oral Contraceptives" and as I finish writing, I realize that I've written the wrong thing. I cut it out, write a "Please Omit" across it and the clock strikes 1230.

The theory papers are over. One big blur spread over 5 days where the days blended into the nights and the distinctions have gone unnoticed. One long 120 hour day.

And of course, as we have been told many many times, the theory is "OK man". It's the Clinics that will make or break you."
Clinics are a different ball game altogether. They have to be passed separately. They start on Monday.

For now, I'm going to crash out.

Chapter 62-Study Leave

Nov 1997

12 days. That's what we have. And I am seething. Our senior batches had got nearly 3 weeks of study leave before their Final Univs and here I am, sitting alone in my room, surrounded by books, notes and papers, staring blankly at a calendar and a date 12 days from now that will signal the beginning of the end of my MBBS course. Pass of fail, the course will definitely be over, and right now, all I want is for these 12 days to get over and somehow,magically, read all that I simply have to.

Wise men come and give counsel. 12 days, they say, is "cool". After all, one has, or is supposed to have, studied for this exam over the past three years-in clinics, in classes, over Ward Leavings and even in Snappy sessions. One has made, or is supposed to have made, extensive notes on all the possible cases that can come, cross-referenced the countless books in Medicine, Surgery and OG, spent hours in the library and in the room studying and therefore, in theory, one is well prepared. These 12 days should be about quick revisions, final touches and a rapid integration of all that has been taught over the last 4 years.

But it doesn't work that way. The stress is on a slow burn, not yet the adrenaline fuelled panic that will soon start, but I can feel it. I keep it at bay on the first day by making a plan and organizing the Himalayan climb to come.

Medicine-Davidson, Harrison, PJ Mehta, clinics and class notes.
Surgery-Bailey, Das, notes
OG-Dutta, Shaw, Labour Room notes, class notes

This totals up to about 10000 pages and I am already depressed. This takes up 2 of the precious 12 days I have and the plan has to be revised even as it is finalised.

I feel like I'm back to square one. I have this bad habit of needing to look through everything at least once, even if it means a one second glance at a page or a set of notes. Also, many things had been read months ago and are long forgotten and need to be refreshed. Some things look downright new. There are classifications, signs, symptoms, approaches to diseases, management issues etc, and anything right from Anatomy to Pharmacology to core Medicine and Surgery is fair game. This is the culmination of 4 years of work, not just this past year, and it is now weighing on me. Sometimes, in my darkest times, I wish I had studied a bit more regularly. Not more necessarily, but just steadily. Sigh.

November here is a quiet month. All batches have exams but we, the Final Years have special status. I stick a notice outside the door-" Shut Up. Reading", or words to that effect. The room of a Final Year exam going student is hallowed ground and no one will enter unless it's another Final Year or unless it's something vital. Casual conversations, unless self initiated, are strongly discouraged and not entertained. Gossip sessions on the staircase are sometimes interrupted by loud "Shut up buggers, I'm studying". Snappy sessions are very brief and often just an excuse to get out of the room for a minute or two.

Harry, the sole Sardar in the whole MBBS course and my classmate is a few doors down and pops in, equally spooked. He however, has managed to learn fluent Tamil and although I can now manage conversant Tamil fairly well, there are still large lacunae that I hope won't suddenly pop up in the exam. That's the last thing I need. He is also reading on his board perched on his chair outside his room. Anup is locked up inside his, probably still making notes and underlining endlessly. Condom and Vinod are usually in the Library or Curie, reading with their partners in happy bliss. It's a quiet corridor and there are no distractions.

This is serious business.

Three years ago, when in 2nd year, we had had nearly a month to study for Anatomy and Physiology. At that time, I had changed my entire sleep schedule and was effectively in a Mid-Atlantic Time zone, reading at night and sleeping in the daytime. This was great but nearly got me screwed towards the end when I had to tell my body to start waking up on time as the exams approached. I was effectively very jet-lagged. I can't afford that now, not with just 10 days.

So, I start early. The plan is to read all day till about 12 or 1 at night and then re-start. The problem is knowing where to start. I should be reading a lot of Medicine, a subject I think I'm weakest in but I start with Surgery, my strong point. Human nature. I take my wooden chair outside to the corridor and put the rectangular wooden board on the arm rests. A Bailey sits on the board. A pen and a marker lie on the side. Some notes to cross reference leave little space for my elbows to rest.
The start first involves an alteration of the time table since I have invariably overestimated my reading capacity and underestimated the reading required. This is followed by a half hour thoughtful reflective self-flagellation session, usually accompanied by nicotine and tea while being perched on my chair, elbows on my reading board, and, lying untouched by my side,perched precariously on the board, the book of the moment.
The corridor of my room faces East, and in the early morning a lovely cross-ventilation breeze blows through, especially if I leave the doors open. It feels good to wake up this early without worrying about an 8 AM class. I take my time and savour the cool breeze, the greenery in front of me and the sights and sounds of the morning.
Sitting and thinking with the puff of smoke that accompanies me everywhere these days I see some guys heading for breakfast to the mess, inevitably some inedible glob except on Sundays when we all wait endlessly for the promised Masala Dosa. Some guys wait in the middle of the InterHostel road near the Iron Man who is working his magic. Bikes start up and whizz past, either towards the hospital or out of the gate, perhaps for a tea in the shacks. Lots of young doctors or Interns, in white coats and stethoscopes zooming off for work. The sound of rushing feet, chatter and shouts signalling people getting late for class or perhaps, for an exam. Shouts of "All the best" and equivalents. An hour of noise and activity from 730-830 AM.
And then it's quiet again. And I'm all alone with my books, all day, every day. I sit and mope, wonder if I will pass and generally kill precious ticking minutes before reality kicks in and then every second of the day is squeezed out- reading, getting mentally ready for reading, taking a post reading smoke/tea break, planning and making time tables, altering time tables.....rescheduling the schedule, finding notes, books and long lost papers....Snappy...

Snappy. My saviour from the drudgery, but it does not open till evening and so my source of tea and smokes are the shacks outside. Harry is not much of a tea drinker but even he needs a break, so one afternoon, three days into the study leave, he saunters in and says "LGFT"? This apparently means "Let's go for tea". There are two responses for this:
a. Get up and go
b. Say "NFO", which means NO, F Off

Mostly I get up and go. More than needing tea, it is good for the soul to get away from the books and notes. Even though I study mostly outside in the corridors, I am gripped by fleeting moments of panic where I can feel walls closing in, pulse rates rising, blood pressures spiking and a general feeling of inevitable impending doom spoiling an otherwise lovely day.

Harry and I walk down the four floors of stairs, all books left behind in all forms-physical and mental. Jokes, chatter, gossip-anything except studies and books. As we walk down, some other similarly afflicted figures meet us-Reddy-a study in concentration, nose to the books and wondering what on earth we are up to. Deepak, as usual, pacing up and down the corridor, book in hand and mumbling loudly, Condom, zooming off on his trusted Bajaj Chetak towards Curie or, on occasion, returning from there. But mostly it's just Harry and me out for some fresh air and stale tea, recharging for another assault on the books.
The shacks take 15 minutes and then we are back up, back to the books and waiting for the next break.

Harry is not my only source of welcome interruptions. There is Shom, now a 2nd year PG in ENT who has shifted out of the campus and lives with Sirisha, his wife, in one of those apartments behind the Police Grounds so popular with Jipmerites. I have spent many evenings there, mainly to kill time and chat and also to taste some home food I have been deprived of for so long. Shom has moved on from his bike to a Red Maruti and often honks from below when getting back home after work. That's a signal for tea and I never fail to oblige.
This also happens at all hours of the night when he is on call and provides more welcome breaks from the stagnation that can set in when surrounded by a mountain of Medicine.

Many evenings were spent in his house and with no means to confirm if he would be at home, I often went across only to find the house locked. In the many instances that it wasn't, time was spent in home comfort with some whisky and food and idle chatter. He cribs about the politics of his Department, Sirisha about hers and I listen patiently, just chilling and killing time, precious minutes ticking away.

One particular evening, Shom and I went for a drive in his car and found a newly opened Burger joint on the corner of the road opposite the Pondy Railway station. Burger joints were not common here, so I went and promptly ordered a couple of Chicken burgers. 45 minutes later and with no sign of the burgers, Shom asked me to go and enquire if we should come and get them the next day.
The answer was "Yes Sir, no problem".

Joy has also moved out of the hostel and is now a PG in Ophthal. He lives on the first floor of a house, situated down the road about a kilometer away. He is now married to Anju, a PG in Pharmacology whom he met when she came to write the Jipmer Entrance Exam in March.  In fact, in the same Exam, Manoj also found his future wife, both Anju and she being friends of Sirisha from Delhi.

The days tick by. The pace is increasing as is the tension and stress. Our regular tea breaks in the shacks continue but are faster and quieter. My room is getting messier by the minute and many minutes are wasted in trying to find notes that I MUST read now or books that have mysteriously disappeared. Many of us zoom off to the hospital in the evenings to see cases in the wards but I don't have time. There is so much to cover that I am overwhelmed and at times, terrified at the ordeal to come.
I have been told that this is normal for a Final Year exam but it is of little solace.

Our time table is released. The exams start on a Monday. Two theory papers each in Medicine and Surgery and one in OG. Monday to Friday, from 930-1230 in Banting Hall, that pseudo-auditorium with horrendous acoustics. The clinics are after the weekend. The whole batch, all 70 or so of us have been divided into 3 batches and I am in Batch B. I will get Surgery first, followed by Medicine and then OG. Monday to Wednesday, back to back.
And that will be it. Passing and failing, by this point in time, is a secondary, incidental outcome. All I want is for these exams to finish.

Finally, after 12 days of misery and torture, 12 days of hope alternating with despair, 12 days of optimism and doom and many many teas and smokes, I start my Final set of exams tomorrow.

I have managed to read almost all of Bailey, except for some obsure Urology bits that I am sure won't come and some Ortho bits, that although very well presented, are best read from Maheshwari, the recommended Ortho book. I have gone through past papers and brushed up on the clinical cases. I have even been to the library to look up a book called Rutherford that describes the tourniquet system of examining varicose veins so wonderfully. I had missed that class and have never seen a case so I do detailed research on this topic and finally feel equipped to rock and roll, albeit with instruments that are slightly out of tune.

I have gone through Dutta and Shaw and now am quite confident with OG. Owing to the nature of the Department and it's inhabitants, I had also paid particular attention in OG Clinics and Labour Room and so a lot of OG is familiar and easy to deal with. There are the usual painful topics like DUB and the like but it's largely an OK subject.
Medicine and Paeds are a different ball game. I have made serious efforts at reading Davidson, the core book, but with less than 24 hours to go before the opening whistle, I feel like I know and remember nothing. I spend most of the Sunday before the start staring at a Davidson, my mind getting increasingly numb, nothing seeming to stay in my head and I'm feeling increasingly helpless. I am looking at Hypertension-a pretty important topic by all accounts, but now even the basics are looking like Greek and Latin. I flip pages, sometimes to Endocrine-some Adrenals perhaps?, then quickly over to Sarcoidosis-a minute there and over to arrythmias, bouncing across nephrology, strokes, epilepsy, infections......There is just too much. Nothing stays in, it's like I'm reading everything for the first time.

It's around 8 PM when the first visitors come in. Well wishers- juniors and seniors, coming to wish the gladiator before the lions come marching in. Mishra comes in and finds me in disarray-books all over the place, the sole table lamp casting depressing shadows , me hunched over with a blank expressionless  face and very happy to see him, simply because it's an excuse for me to get up and chat for a while.
Mishra however, says a quick "Best of Luck Golu" and leaves. I was hoping for an extended break-anything to get away from my claustrophobic room, even an inane pointless chat about anything, anything to go in the corridor, smoke a smoke and forget about exams for ten minutes. But they won't let me. I get a constant stream of people for the next half hour and then I take matters in my own hands, thank everyone, then tell them to buzz off while I get back to my table with the lamp throwing depressing shadows around a room that feels like a refugee camp offering no refuge from the terrors in my head.

I have dinner and spend some time trying to find my Hall Ticket, well buried under some books. I locate my bike keys and hope it has enough petrol to get me to Banting Hall tomorrow. I check for some pens and keep all of this stuff on the table, ready for me to take the next morning. I go out for tea to the shacks. I have made peace with my exams and now it's all fate, or whatever one calls it when matters are out of one's hands.
I climb the 18 or steps to Osler Rooftop and spend some quiet minutes alone in the cool night breeze, staring at the night sky but at nothing in particular.
I have a headache from trying too hard, a feeling of doom that is normal under the circumstances but won't go away but at the same time a feeling of immense relief that exams are finally here.
For the doomed man, the torture is in the waiting. My wait is over.

Exams at 930 AM tomorrow.