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.
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.
O my god....I don't wanna go to final year !!
ReplyDeleteThose exams actually seem tougher than any other subsequent exam..and I feel the same way to this day!
ReplyDeleteo my god!!!why don't they provide some food?sadists.
ReplyDeletei remember when i was intern in surgery i went with a resident to get lunch for the examiners and PG examinees, and it was loads...wonder if UGs also got the same ;) but seriously our `boss` takes viva exactly the same way now also as he did in your case !
ReplyDeleteYou have gone great length's to get where you are today. Be proud. Thanks for sharing.
ReplyDeleteGOD ! I don't know how I did it then but I never wanna go back to those times ever again.
ReplyDeleteWell...it is thrilling to read now..but would never like to go back to such days..never again...
ReplyDeleteNishikant, you MUST publish this for all humanity to know what we have to undergo.
ReplyDeleteCan be great TV serial....
ReplyDeleteAah deja vu.although ours didn't take as long as yours..maybe they mellowed down over the years?;-)
ReplyDelete