Sep-Oct 1997
August is a month of mixed emotions. I want to see Interclass, see Spandan in all it's glory, bask in my filthy room and get awarded for it again, and like the rest of the campus, just take a break from the drudgery.
Instead, the spectre of exams is haunting me in my dreams and it's a race to the finish line, with no real guarantee that the race will be over.
Paeds drags on-kids with chests to be auscultated, abdomens to be palpated and developmental milestones to be mugged. OP Ghai, my standard issue Paeds book is completely unmarked and unread except for the section on heart murmurs which I read in Medicine, not here. My classmates discuss what's good in the book and what's better in Nelson (a huge Post Graduate book) making me feel decidedly incompetent and inadequate since I can't contribute to the discussion at all. At this level, a lot of Paeds is like Medicine for kids and I figure that by reading some Medicine, I can get by with Paeds in the exam.
The ward leaving comes and goes and we move to Medicine.
The Medical wards are on the top floor of the hospital. I've climbed the steps to this floor countless times, at times stopping briefly at each landing to admire the painting on the walls, all signed by a "PK Patra", all done in the '60's. The stairs open in front of Ward 41 across which is the Dialysis Room. Leading left is a long corridor with all the other wards-43 being the subject of much debate in particular. This ward, which is now a CCU, started life as a RICU (Respiratory Intensive Care Unit) which promptly got the Chest Diseases Dept to stake a claim on it. The RICU was a brainchild of the Anaesthesia Dept however, and so they renamed it and now it's their sole baby.
I've been here once and it looks pretty state of the art. Last year, while reading for my marathon 5 paper exam, Vij, a PG on Obs/Gyn had asked me to donate some blood for one of his patients admitted there. It was 3 AM, I was bored stiff and I willingly obliged. I went to see the patient here that time and there she was, lying alone in the quiet pale blue light with tubes and wires, monitors beeping, sedated, or probably, unconscious. She had DIC and her chances were slim.
She died a day or two later and it affected me a for a while before life, and I, moved on.
The rest of the wards, like all in the hospital are numbered in sequence and on this floor, the Ward at the end and to the left is occupied by the Plastic Surgery Dept. Manned by Dr KA (whose wife is a Consultant in Medicine and specializes in long, silent, uncomfortable stares after asking a question) and Dr P, this Dept is almost like a hospital in itself. It has it's own Record filing system, meticulously kept and religiously maintained complete with pre-op and post-op photographs. Dr KA has a reputation of being an excellent surgeon, specializing in cleft lips and palates. I've often seen the couple walk around the campus at night and I'll be dealing with Dr AA, his wife in the coming weeks.
Dr AKD is a gem. He is the Head and is a short, sweet guy although I hear that he can be hard on his Residents when needed. By all accounts, he is a boon in exams and we all start praying he comes as examiner.
The posting is like any other. We start in the OPD, move on to the Ward where a case or two are allotted and we take turns to present these to the designated Consultant/Resident. This varies from day to day depending on the Unit that is in charge of the case. Like Surgery and OG, Medicine has 4 Units and each Unit takes turns to allot and take class for us.
This drags on-heart lesions, lots of TB and pleural effusions, ascites and fluid thrills, pulsating abdominal masses, enlarged livers and spleens, strokes and facial palsies. It's a very long list and we are told that really, there is no defined case list at all. Anything can come, it's just vital to examine systematically and arrive at a working diagnosis. As long as that can be justified based on history and findings (which must be accurate of course), the odds of passing improve dramatically.
This sounds simple in concept but there are many, many roadblocks. I hear of a someone, a topper, who found a lymph node and made a diagnosis that could have only been made with prior knowledge of the case. His history and examination were top notch, but he failed. My hearing has become selective. Instead of hearing success stories, all I can think about is who failed in previous exams, why they failed, how they got unlucky, which examiners were "lousy" (or "bastards"), how tough the exam is and how exotic some of the questions can be.
Pondicherry is an alcohol haven and once, while driving to the bus stand at 7AM to book tickets, I saw an open booze shop and a lone cyclist, probably a worker in one of the many factories, cycle along to the shop, order a peg, gulp it down and speed off, all while still on the bike. It is no surprise, therefore to find so many cases of cirrhotic livers and distended abdomens, enlarged livers and bleeding varices.
I have thought about my own liver occassionally but the standing joke is that one must get the liver enzymes to work regularly by imbibing enough lest they fall into disuse atrophy. And I have kept them busy.
It's an uneventful posting. Nothing has changed from the last time. Dr RP with his "Diagnosis Doctor!!", preceded by a long diatribe in incomprehensible Tamil, his shotgun approach to Medicine, Dr KRS with his stern, professorial looks and fantastic diagnostic acumen, Dr TKD with his reputation of being fair and impartial in exams and Dr AA with her silent, uncomfortable pauses between questions. Classmates reading fervently, me looking a little lost, patients being examined multiple times and probably suffering in silence, the usual feeling of doom and gloom and the odd panic attack.
The subject is so vast that I really don't know where to start. Some have called Medicine "Intellectual Masturbation" but I don't feel particularly intellectual right now. Reading has to be done however, so I read Davidson, mug up the thousands of signs and symptoms in PJ Mehta, read all the notes I can and listen to all the classes in earnest. These are the last few classes of my MBBS days and each one can make a difference.
The days pass by. Interclass and Spandan whizz past. I hardly see anything and in the few events that I do manage to see, I feel guilty after half an hour and go back to read. Spandan will be back next year, when I will hopefully be an Intern and I can devote all my attention to it then.
For now it will have to wait.
October 1997
It's all come down to this. My last 4 weeks as a Medical student. Surgery is my last posting and will finish 2 days before my Send-Ups, the full scale dress rehearsal Exam before the Univs. By this time, all I am doing is reading. The reading, of course, is punctuated by lunch, dinner, classes and the odd Snappy excursion but it's all about reading now. I feel comfortable with OG and most of Surgery but Medicine and Paeds remains a problem,especially the theory simply because of the size of the subject. I have to focus now on Surgery however, in these last 4 weeks of my student life.
Surgery has logic. There are visible things to examine-ulcers, swellings, breast and thyroid lumps, abdominal masses, varicose veins, hernias and hydroceles. There are well defined points in the examination of each of these and at the Undergraduate level, fairly structured treatment plans and options that we need to know. I like Surgery even though the smell of infected ulcers and cancers of the penis can drive one straight to the loo. Surgery, however, does not like me. About a week into our posting, some of us are called into Prof AK's Office. There are about 6 of us and we are called in separately. When the first guy goes in and comes out with a worried look, some rapid, urgent questioning reveals the problem. It's attendance.
Sigh.
I'll never come to terms with attendance. The college requires 75% and this can be condoned to 65% with a fine. Except for Pharmacology where I landed up with 64.6% and therefore 1 class short, getting stopped from writing the exam in the process, I have managed to make it through each attendance related potential disaster. I have even done well in exams so far aggregating about 69% in the Univs. I hate attendance as a criteria for writing an exam but rules are rules and I am probably short again in Surgery.
I walk in. It's a fairly bland office with the usual cupboard of books and journals, some furniture, a tubelight and an examination bed and green screen.
Prof AK, with his ultra-dignified looks and horn rimmed glasses perched on the bridge of his nose, peers down at me, standing nervously 6 feet away.
I have imagined this scenario happening to me. In previous years, it has happened to a few of my seniors and they gave me this wonderful piece of advice:
If told that you are short of attendance, tell Prof AK that you will make it up by attending Casualty posting during your study break.
This worked for them and they were allowed to write the exams.
Prof AK is serious. He has a paper open in front of him and quotes exact figures of my theory and Clinics attendances over the past 3 years. They are not flattering but not that bad either. I am both a bit amazed that I attended so much and a bit upset at myself for not attending enough.
So I quote Shom's gospel.
"Sir, I am truly sorry but I promise to make it up by attending Casualty posting in my study leave. I 'll go every day for however long you want me to go"
Prof AK gives me long look, no smile and in a firm, even, almost fatherly tone, says
"Look man. If you attend classes in the 14 days of study leave you have, both your numerator and denominator will increase. Your attendance percentage will hardly increase. So there's no point doing that. I can't allow you to write the exam".
I come out. I've given up now. I don't care about the exam itself. What I'm worried about is how I'll convey this news to my parents. They took it well the last time and I wiped that memory off with my best performance in the subsequent 5 paper exam. That was then and I am now in the same situation. It's frustrating and depressing. Of course, I have only myself to blame.
5 months earlier, a notice had been put up stating that all of us needed to pay the 400 Rs or so of tuition fees for the year by a certain date. I read it, saw that the date was a month or two away and forgot about it. The deadline passed, another reminder, complete with warnings about "Name removal from the Register" came and went and my fees remained unpaid because I forgot to tell my parents.
In class a few days after the second deadline, my name is not called in Attendance. Thinking this has to be an oversight, I walk up and find that my name has been witheld owing to unpaid fees. To make matters worse, the College has sent a letter stating exactly this to my parents who, I imagine, would have been less than amused to read about their son, in a far away land, not paying the token fees simply because he forgot and has got his name removed from the Register.
The matter is remedied quickly after an awkward phone call home. Now another much more awkward call may be required.
There is still hope. Historically, no one has been stopped from exams in Surgery because of attendance. The fall-out of my one-on-one meeting with Prof AK is that he now knows me quite well and is well aware that I have attendance issues. This has put extra pressure on me to do well in the upcoming Send-Ups and I HAVE to pass this. I get the feeling that if I fail, I won't be writing the exams.
The posting drags on. I haven't yet seen a Varicose veins case and I'm worried. Varicose Veins involves tying tourniquets at defined points on the leg to see which veins fill and which don't. The idea is to locate the perforators and see which are patent. It sounds simple enough but I know that unless I see it, or better still, actually do it myself, it will be very difficult to suddenly do an accurate examination in the pressure cooker atmosphere of the exam.
There is a Cancer of the male breast somewhere in the Wards and we make a beeline to see it since it is rare and so will definitely be kept in the exams. The problem with Breast Cancer is that the treatment for each stage is unclear. We have been told many different things for each stage and it's very confusing. We approach Prof AK for a class, having been told that he often takes lecture classes right at the end to clear up really tricky issues.
The class is wonderful. Breast Cancer has never been clearer. He even explains Estrogen Receptor measurements (in fmoles/L), takes time to answer all our questions and just demystifies it completely.
Then, this happens...
Normally after a class, the teacher calls out attendance by name which is entered into the register as either an "A" or a "P". Some of them choose to pass this register around and we mark ourselves. This is rare however.
Prof AK passes the register. This has happened with senior batches and Prof has a reason. The register starts from the bottom row where the front benchers sit. The register has the entire attendance from the start of 1st Clinics. In theory, all the "A's can be overwritten to "P" and for the first two rows, the register passes quickly, first because Prof AK is 2 feet away and second, because this group of people probably do not have attendance issues anyway.
The drama starts after that. The register is passed very slowly, each guy taking time to overwrite as much as possible while desperately trying to hide this from Prof, standing and waiting for the return of the register. There is much tension because we know that at any time he can call for the register and some of us might get left behind. The register is almost snatched from one another and by the time it reaches me, I barely have time to overwrite as much as I can, and to anyone it will be quite obvious what has happened. After a while, bored of waiting Prof AK calls for the register and walks off.
There is an audible sigh of relief.
We later learn that he does this for every batch for whom he takes a last effort class. We had been warned
"Bugger, he will circulate the register. Make sure you get your hands on it"
A few days later, with the posting nearly over, the Dept posts the Attendance list. I am at 82%. I know that not of all this increase is because of me and the register.
He didn't have to do this, but he did, knowing that exams are round the corner and that's the best place to expose knowledge lacunae.
Send-Ups:
2 days. 2 days in which to revise nearly the whole of the last 4 years. There will be a theory paper in Medicine, Surgery and OG. This will be followed by Clinics in those subjects with a short case in Paeds and Ortho as part of the Medicine and Surgery exams respectively.
The structure is thus:
Medicine:
1 Long case-45 minutes to examine and write a case sheet
1 Short Case-15 minutes for examination
1 Paeds case-20 minutes for examination
A bedside viva in each
This is followed by 2 spotter diagnosis and viva on them, a viva on microscope slides, instruments and ECG and a drug viva.
Surgery:
1 Long Case-again 45 minutes
2 Short Cases-20 minutes total
1 Ortho case-20 minutes
A bedside viva in each
This is followed by vivas on Operative surgery, surgical specimens, instruments and X-Rays and general theory viva.
OG:
1 Obs Case-30 minutes
1 Gyn Case-30 minutes
A viva for each case.
This is followed by vivas on Insruments, X-Rays and a Normal Delivery demonstration with a dummy baby and pelvis.
The real killer is the Long Case. It carries 75 marks out of 150 and in 45 minutes, we have to take a detailed history, examine completely, get a diagnosis and then write all of it down. In the case presentation, whatever we say is matched with whatever is written. If something is not written, it is assumed it has not been done. It's vital to write a good case sheet.
The short cases do not need a case sheet. But that makes it trickier because one must then present logically from memory. Examination findings are key here.
In general, if one does well in the cases, the later vivas do not really decide the Pass/Fail result. However, one has to pass separately in Theory and Clinics to pass overall.
My Send-Ups do not start well. The Medicine paper, as expected is not good. The rest I manage well. I am particularly nervous about Surgery Clinics. I need to pass this because even after all the attendance register shenanigans, I'm not sure I'm out of the woods yet. The Long Case has a hard mass in the umbilical area and I don't know what it is. Dr Benjy, my examiner kind of half nods, half shakes when I venture "Ca Stomach" and I walk out not knowing what just happened.
Prof A, the head of OG comes for my OG Viva. This can be make or break time especially if she decides to come for our University exams as well. She is sweet, the vivas are great and I walk out feeling much better about life.
The results are announced. I fail Medicine. I get 75/150 in Surgery. I pass!
OG is a breeze.
Surgery puts up the final atendance list on the notice board. I am at 82%. No one in the class is short.
I'm nearly there. My study leave starts now. Univs are in 12 days.
August is a month of mixed emotions. I want to see Interclass, see Spandan in all it's glory, bask in my filthy room and get awarded for it again, and like the rest of the campus, just take a break from the drudgery.
Instead, the spectre of exams is haunting me in my dreams and it's a race to the finish line, with no real guarantee that the race will be over.
Paeds drags on-kids with chests to be auscultated, abdomens to be palpated and developmental milestones to be mugged. OP Ghai, my standard issue Paeds book is completely unmarked and unread except for the section on heart murmurs which I read in Medicine, not here. My classmates discuss what's good in the book and what's better in Nelson (a huge Post Graduate book) making me feel decidedly incompetent and inadequate since I can't contribute to the discussion at all. At this level, a lot of Paeds is like Medicine for kids and I figure that by reading some Medicine, I can get by with Paeds in the exam.
The ward leaving comes and goes and we move to Medicine.
The Medical wards are on the top floor of the hospital. I've climbed the steps to this floor countless times, at times stopping briefly at each landing to admire the painting on the walls, all signed by a "PK Patra", all done in the '60's. The stairs open in front of Ward 41 across which is the Dialysis Room. Leading left is a long corridor with all the other wards-43 being the subject of much debate in particular. This ward, which is now a CCU, started life as a RICU (Respiratory Intensive Care Unit) which promptly got the Chest Diseases Dept to stake a claim on it. The RICU was a brainchild of the Anaesthesia Dept however, and so they renamed it and now it's their sole baby.
I've been here once and it looks pretty state of the art. Last year, while reading for my marathon 5 paper exam, Vij, a PG on Obs/Gyn had asked me to donate some blood for one of his patients admitted there. It was 3 AM, I was bored stiff and I willingly obliged. I went to see the patient here that time and there she was, lying alone in the quiet pale blue light with tubes and wires, monitors beeping, sedated, or probably, unconscious. She had DIC and her chances were slim.
She died a day or two later and it affected me a for a while before life, and I, moved on.
The rest of the wards, like all in the hospital are numbered in sequence and on this floor, the Ward at the end and to the left is occupied by the Plastic Surgery Dept. Manned by Dr KA (whose wife is a Consultant in Medicine and specializes in long, silent, uncomfortable stares after asking a question) and Dr P, this Dept is almost like a hospital in itself. It has it's own Record filing system, meticulously kept and religiously maintained complete with pre-op and post-op photographs. Dr KA has a reputation of being an excellent surgeon, specializing in cleft lips and palates. I've often seen the couple walk around the campus at night and I'll be dealing with Dr AA, his wife in the coming weeks.
Dr AKD is a gem. He is the Head and is a short, sweet guy although I hear that he can be hard on his Residents when needed. By all accounts, he is a boon in exams and we all start praying he comes as examiner.
The posting is like any other. We start in the OPD, move on to the Ward where a case or two are allotted and we take turns to present these to the designated Consultant/Resident. This varies from day to day depending on the Unit that is in charge of the case. Like Surgery and OG, Medicine has 4 Units and each Unit takes turns to allot and take class for us.
This drags on-heart lesions, lots of TB and pleural effusions, ascites and fluid thrills, pulsating abdominal masses, enlarged livers and spleens, strokes and facial palsies. It's a very long list and we are told that really, there is no defined case list at all. Anything can come, it's just vital to examine systematically and arrive at a working diagnosis. As long as that can be justified based on history and findings (which must be accurate of course), the odds of passing improve dramatically.
This sounds simple in concept but there are many, many roadblocks. I hear of a someone, a topper, who found a lymph node and made a diagnosis that could have only been made with prior knowledge of the case. His history and examination were top notch, but he failed. My hearing has become selective. Instead of hearing success stories, all I can think about is who failed in previous exams, why they failed, how they got unlucky, which examiners were "lousy" (or "bastards"), how tough the exam is and how exotic some of the questions can be.
Pondicherry is an alcohol haven and once, while driving to the bus stand at 7AM to book tickets, I saw an open booze shop and a lone cyclist, probably a worker in one of the many factories, cycle along to the shop, order a peg, gulp it down and speed off, all while still on the bike. It is no surprise, therefore to find so many cases of cirrhotic livers and distended abdomens, enlarged livers and bleeding varices.
I have thought about my own liver occassionally but the standing joke is that one must get the liver enzymes to work regularly by imbibing enough lest they fall into disuse atrophy. And I have kept them busy.
It's an uneventful posting. Nothing has changed from the last time. Dr RP with his "Diagnosis Doctor!!", preceded by a long diatribe in incomprehensible Tamil, his shotgun approach to Medicine, Dr KRS with his stern, professorial looks and fantastic diagnostic acumen, Dr TKD with his reputation of being fair and impartial in exams and Dr AA with her silent, uncomfortable pauses between questions. Classmates reading fervently, me looking a little lost, patients being examined multiple times and probably suffering in silence, the usual feeling of doom and gloom and the odd panic attack.
The subject is so vast that I really don't know where to start. Some have called Medicine "Intellectual Masturbation" but I don't feel particularly intellectual right now. Reading has to be done however, so I read Davidson, mug up the thousands of signs and symptoms in PJ Mehta, read all the notes I can and listen to all the classes in earnest. These are the last few classes of my MBBS days and each one can make a difference.
The days pass by. Interclass and Spandan whizz past. I hardly see anything and in the few events that I do manage to see, I feel guilty after half an hour and go back to read. Spandan will be back next year, when I will hopefully be an Intern and I can devote all my attention to it then.
For now it will have to wait.
October 1997
It's all come down to this. My last 4 weeks as a Medical student. Surgery is my last posting and will finish 2 days before my Send-Ups, the full scale dress rehearsal Exam before the Univs. By this time, all I am doing is reading. The reading, of course, is punctuated by lunch, dinner, classes and the odd Snappy excursion but it's all about reading now. I feel comfortable with OG and most of Surgery but Medicine and Paeds remains a problem,especially the theory simply because of the size of the subject. I have to focus now on Surgery however, in these last 4 weeks of my student life.
Surgery has logic. There are visible things to examine-ulcers, swellings, breast and thyroid lumps, abdominal masses, varicose veins, hernias and hydroceles. There are well defined points in the examination of each of these and at the Undergraduate level, fairly structured treatment plans and options that we need to know. I like Surgery even though the smell of infected ulcers and cancers of the penis can drive one straight to the loo. Surgery, however, does not like me. About a week into our posting, some of us are called into Prof AK's Office. There are about 6 of us and we are called in separately. When the first guy goes in and comes out with a worried look, some rapid, urgent questioning reveals the problem. It's attendance.
Sigh.
I'll never come to terms with attendance. The college requires 75% and this can be condoned to 65% with a fine. Except for Pharmacology where I landed up with 64.6% and therefore 1 class short, getting stopped from writing the exam in the process, I have managed to make it through each attendance related potential disaster. I have even done well in exams so far aggregating about 69% in the Univs. I hate attendance as a criteria for writing an exam but rules are rules and I am probably short again in Surgery.
I walk in. It's a fairly bland office with the usual cupboard of books and journals, some furniture, a tubelight and an examination bed and green screen.
Prof AK, with his ultra-dignified looks and horn rimmed glasses perched on the bridge of his nose, peers down at me, standing nervously 6 feet away.
I have imagined this scenario happening to me. In previous years, it has happened to a few of my seniors and they gave me this wonderful piece of advice:
If told that you are short of attendance, tell Prof AK that you will make it up by attending Casualty posting during your study break.
This worked for them and they were allowed to write the exams.
Prof AK is serious. He has a paper open in front of him and quotes exact figures of my theory and Clinics attendances over the past 3 years. They are not flattering but not that bad either. I am both a bit amazed that I attended so much and a bit upset at myself for not attending enough.
So I quote Shom's gospel.
"Sir, I am truly sorry but I promise to make it up by attending Casualty posting in my study leave. I 'll go every day for however long you want me to go"
Prof AK gives me long look, no smile and in a firm, even, almost fatherly tone, says
"Look man. If you attend classes in the 14 days of study leave you have, both your numerator and denominator will increase. Your attendance percentage will hardly increase. So there's no point doing that. I can't allow you to write the exam".
I come out. I've given up now. I don't care about the exam itself. What I'm worried about is how I'll convey this news to my parents. They took it well the last time and I wiped that memory off with my best performance in the subsequent 5 paper exam. That was then and I am now in the same situation. It's frustrating and depressing. Of course, I have only myself to blame.
5 months earlier, a notice had been put up stating that all of us needed to pay the 400 Rs or so of tuition fees for the year by a certain date. I read it, saw that the date was a month or two away and forgot about it. The deadline passed, another reminder, complete with warnings about "Name removal from the Register" came and went and my fees remained unpaid because I forgot to tell my parents.
In class a few days after the second deadline, my name is not called in Attendance. Thinking this has to be an oversight, I walk up and find that my name has been witheld owing to unpaid fees. To make matters worse, the College has sent a letter stating exactly this to my parents who, I imagine, would have been less than amused to read about their son, in a far away land, not paying the token fees simply because he forgot and has got his name removed from the Register.
The matter is remedied quickly after an awkward phone call home. Now another much more awkward call may be required.
There is still hope. Historically, no one has been stopped from exams in Surgery because of attendance. The fall-out of my one-on-one meeting with Prof AK is that he now knows me quite well and is well aware that I have attendance issues. This has put extra pressure on me to do well in the upcoming Send-Ups and I HAVE to pass this. I get the feeling that if I fail, I won't be writing the exams.
The posting drags on. I haven't yet seen a Varicose veins case and I'm worried. Varicose Veins involves tying tourniquets at defined points on the leg to see which veins fill and which don't. The idea is to locate the perforators and see which are patent. It sounds simple enough but I know that unless I see it, or better still, actually do it myself, it will be very difficult to suddenly do an accurate examination in the pressure cooker atmosphere of the exam.
There is a Cancer of the male breast somewhere in the Wards and we make a beeline to see it since it is rare and so will definitely be kept in the exams. The problem with Breast Cancer is that the treatment for each stage is unclear. We have been told many different things for each stage and it's very confusing. We approach Prof AK for a class, having been told that he often takes lecture classes right at the end to clear up really tricky issues.
The class is wonderful. Breast Cancer has never been clearer. He even explains Estrogen Receptor measurements (in fmoles/L), takes time to answer all our questions and just demystifies it completely.
Then, this happens...
Normally after a class, the teacher calls out attendance by name which is entered into the register as either an "A" or a "P". Some of them choose to pass this register around and we mark ourselves. This is rare however.
Prof AK passes the register. This has happened with senior batches and Prof has a reason. The register starts from the bottom row where the front benchers sit. The register has the entire attendance from the start of 1st Clinics. In theory, all the "A's can be overwritten to "P" and for the first two rows, the register passes quickly, first because Prof AK is 2 feet away and second, because this group of people probably do not have attendance issues anyway.
The drama starts after that. The register is passed very slowly, each guy taking time to overwrite as much as possible while desperately trying to hide this from Prof, standing and waiting for the return of the register. There is much tension because we know that at any time he can call for the register and some of us might get left behind. The register is almost snatched from one another and by the time it reaches me, I barely have time to overwrite as much as I can, and to anyone it will be quite obvious what has happened. After a while, bored of waiting Prof AK calls for the register and walks off.
There is an audible sigh of relief.
We later learn that he does this for every batch for whom he takes a last effort class. We had been warned
"Bugger, he will circulate the register. Make sure you get your hands on it"
A few days later, with the posting nearly over, the Dept posts the Attendance list. I am at 82%. I know that not of all this increase is because of me and the register.
He didn't have to do this, but he did, knowing that exams are round the corner and that's the best place to expose knowledge lacunae.
Send-Ups:
2 days. 2 days in which to revise nearly the whole of the last 4 years. There will be a theory paper in Medicine, Surgery and OG. This will be followed by Clinics in those subjects with a short case in Paeds and Ortho as part of the Medicine and Surgery exams respectively.
The structure is thus:
Medicine:
1 Long case-45 minutes to examine and write a case sheet
1 Short Case-15 minutes for examination
1 Paeds case-20 minutes for examination
A bedside viva in each
This is followed by 2 spotter diagnosis and viva on them, a viva on microscope slides, instruments and ECG and a drug viva.
Surgery:
1 Long Case-again 45 minutes
2 Short Cases-20 minutes total
1 Ortho case-20 minutes
A bedside viva in each
This is followed by vivas on Operative surgery, surgical specimens, instruments and X-Rays and general theory viva.
OG:
1 Obs Case-30 minutes
1 Gyn Case-30 minutes
A viva for each case.
This is followed by vivas on Insruments, X-Rays and a Normal Delivery demonstration with a dummy baby and pelvis.
The real killer is the Long Case. It carries 75 marks out of 150 and in 45 minutes, we have to take a detailed history, examine completely, get a diagnosis and then write all of it down. In the case presentation, whatever we say is matched with whatever is written. If something is not written, it is assumed it has not been done. It's vital to write a good case sheet.
The short cases do not need a case sheet. But that makes it trickier because one must then present logically from memory. Examination findings are key here.
In general, if one does well in the cases, the later vivas do not really decide the Pass/Fail result. However, one has to pass separately in Theory and Clinics to pass overall.
My Send-Ups do not start well. The Medicine paper, as expected is not good. The rest I manage well. I am particularly nervous about Surgery Clinics. I need to pass this because even after all the attendance register shenanigans, I'm not sure I'm out of the woods yet. The Long Case has a hard mass in the umbilical area and I don't know what it is. Dr Benjy, my examiner kind of half nods, half shakes when I venture "Ca Stomach" and I walk out not knowing what just happened.
Prof A, the head of OG comes for my OG Viva. This can be make or break time especially if she decides to come for our University exams as well. She is sweet, the vivas are great and I walk out feeling much better about life.
The results are announced. I fail Medicine. I get 75/150 in Surgery. I pass!
OG is a breeze.
Surgery puts up the final atendance list on the notice board. I am at 82%. No one in the class is short.
I'm nearly there. My study leave starts now. Univs are in 12 days.
whew!!!
ReplyDeleteWhat a hoot, dude. From less than 65% to 82% in 2 weeks - and you think Prof. AK did not notice? Likely, true to form, he cast a benign eye upon the attendance register, smiled to himself, and decided to accept the numbers presented to him at face value.
ReplyDeleteAnd no running to Casualty in the evenings during study break to get a tolerant SR to sign attendance sheets! Lucky dog!!
I had edited that part but have since redone it. It's now more accurate. Pretty much like "anonymous" above.
ReplyDelete