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.