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.