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.
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.
Entertaining as always... Was good.reading...
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