Chapter 33-Goodbye Old Friend

April 24 1995-next few days

8 AM on that day is as vivid as ever.
I am woken up with persistent knocks. There is none of the typical shouting that usually accompanies this kind of apparent effort to get inside-just a gentle, persistent knock.

I open the door, dressed in a towel and a T-shirt. It's bright outside, a typical Pondicherry morning.
The news is broken gently and softly.
I remember not being in denial, the first emotion that usually accompanies such news. I do, however, recall being completely stunned. Even though it sounds like a cliche, it seems that inspite of a bright, sunny, clear morning, things are in sharp focus yet a blur. I shuffle to the loo in my towel, see Dr J, the Warden standing outside, see and walk through him and spend some time inside, washing my face many times. I'm afraid that when I come out, I'll find out I'm not in a nightmare. I want to just stay inside the loo.

Outside I meet Shom, Vikrant's classmate and best friend. He tells me that Vikrant's flight was a bit delayed and instead of taking a risk trying to get the last bus to Pondy, he managed to hitch a ride with a truck going to Pondy.
On that dark, unlit highway, his truck hit another stationary one parked on the side, no hazard lights on. It was head on. The news is that death was instant and the truck was crushed like a matchbox.The driver escaped.

I recall Rahul telling us that he heard a scream in his subconscious last evening when we were chatting and waiting for Vikrant. This he told us at the time, not now, and I don't know what to make of it. Not that it matters. Suddenly not much does. I am supposed to be in class right now, but nothing could be further from my mind.
I dress in slow motion, a few people milling about in the corridors. There is talk about informing Vikrant's parents in Chandigarh and I am asked to go across to the Director's office in the Admin building. The Director and a few others are sitting inside and I sit too, unsure of what they want from me. They know that I knew Vikrant and our families are acquaintances and this is what they asked of me:
"Can you ask your father to inform Vikrant's father"?

I stare at them for a few minutes, not sure I heard right. But I make the call and inform my father and from 2000 miles away, I can almost see what he must have felt at that exact moment. I convey the Director's message to him and of course, he cannot do it. It's the College's responsibility and I say as much to them.
I leave before that call is made to Vikrant's parents. I won't be able to take it.

There is no pandemonium outside. Everything seems as it always has been. People going to class, milling about near the water cooler next the Histology lab. The news has not made its way around yet. I wish to God that it was a normal day but things won't be normal ever now, not normal as yesterday anyway.
One person will be missing from his family, from the College, from his class and from our gang. And that person happened to be my guide, my mentor,  a senior and a friend.

Vikrant and I used to pass time listening to Neil Diamond and watching him strum his guitar late into the nights. Nights in Pondicherry were always cool and with the front and back doors of the rooms left open, a lovely breeze blew right through it. A glass of the finest and some munchies from Snappy or the shacks used to complete a perfect evening.
Many evenings were spent like this and often there would be periods where I had to put up with Vikrant telling me to attend more classes, read more and pay attention to clinics. In many ways, he felt responsible for me since our parents went back much further than we did (His father treated my father's father for cancer) and it was in part, because of him, that I was here in the first place. There were just the two of us from Chandigarh, a long 54 hour journey away.
Sometimes we talked about Vikrant's brothers, settled in Holland as chemical engineers. All of them and I were from the same school in Chandigarh with Vikrant being the middle son. He was the only doctor among them. He used to smoke occassionally, far less than most of us but this fact was hidden from his family, like all of us secret smokers. His elder brother had dropped in last year and Vikrant had spent a whole evening airing his room and clearing all the "evidence" of his smoking escapades. The one thing he forgot was an ashtray which his brother found sitting neatly in the middle of the room. While Vikrant tried to explain it away, his brother told him he wished he had known so he could have brought the 2 Duty Free Cartons allowed back from Holland.

Vikrant was a popular figure in his class and many of his classmates are gathered around the bike shed in Lister House, just below his room. No one really knows what to do and what to say. Some opine on how dangerous it can be to hitch rides on trucks, with well intentioned, patronizing  hindsight.

Finally, Shom, Chetan, Plaha and a few others open up Vikrant's room. It has to be done. I go inside too, with the room exactly as it was 10 normal days ago. The black book cupboard, the guitar, some shoes, the mat on the floor, his chair with a reading board resting on the arm rests, some clothes here and there, books. 225 Lister House, 4 rooms down from mine. And so is the ashtray, still sitting neatly on the reading board perched on the chair, Vikrant's Harrison's lying on the coir mat on the floor next to it.

I open the book.
"In God We Trust". Vikrant wrote that at the front of every book he had. I put the book down and go out.
There are no tears. I am in too much shock.

Chapter 32-When a Friend Died

April 1995

Our Summer vacations start in May and even though College life is better than ever, I need a dose of home to keep things in perspective.
My trip to Chandigarh is a long drawn out process. The first thing that happens is the ticket booking. So, one fine Sunday, Rahul and I hop on his bike and make our way to Pondicherry Railway Station, whose sole purpose of existence is to let us book tickets on a brand new computerized system. The line starts early and can be long so we get there early. At 9 AM, we are already 25th in line.  We use this time to fill up our forms, carefully checking train numbers on a board behind us, marking off the 2nd A/C box and counting the cash. As the line inches forward, we realize that the guy behind the counter has probably just learnt computing and so, it's all one finger typing for him. By the time we get there, it's almost 2 hours and I just want to get out of there. The reward though, a ticket on the Tamil Nadu express, is worth it.
The trip will involve a 3 hr bus ride to the station in Chennai, a 34 hour train ride to Delhi and a 5 hr car/train/bus ride to Chandigarh. I look forward to that.

Vikrant has left for Chandigarh in the 2nd week of April on a short break and I am spending my time partly in Shom's room and partly in Rahul's. They are still not on talking terms and this situation is getting increasingly awkward for me. Vinay, Bong, Mishra and Jain are the other usual suspects in our evening post-mortems of the day.
Jain has developed an Osho fixation and spends some time late night listening to Osho tapes while cooking Maggi noodles and trying to convince me to listen too. On the one occassion that I do, I'm a little high and Osho makes a lot of sense.

I have moved on to Surgery posting in Clinics. Ulcers, lumps, bumps, abdominal masses, thyroid swellings, hernias and smelly cancers on the unmentionables are the highlights of our morning. This is actually a fun subject and one I get comfortable with the fastest. It's a logical subject with none of the games that Medicine involves. At our level, things are cut and dried and I'm grateful for that.
Thats the easy part though. There are some super sarcastic consultants, some specialize in blowing your head off, some are style personified (particularly the Head) and some are outstanding teachers. Our classes are taken in the OPD where we present short cases, get duly screwed, make our way to the wards, take a long case and get duly screwed there too.
We read a book called "Das" which is a clinical "how-to" book and this is more than enough for us babes in the woods for the moment. I know that for the finals, we will be reading a book called Bailey, a brilliantly written monster of a book but that can wait.

23-24 April 1995

Vikrant is supposed to fly back tonight. His flight reaches Chennai around 8 or 9 and I suppose he will catch a bus back from Tambaram, a rail stop just outside the airport where a number of Pondicherry bound buses stop for passenger pick-ups.
We know that he will probbaly get something from home, perhaps some sweets, so Rahul, Vinay and I loiter around the bike area of Lister House waiting to hijack him before anyone else does. It's getting late though and past midnight, we assume the flight is probably delayed. We know that he is keen to come back that day and won't delay his arrival at all since he must join work the next day at 8 AM.

We separate around 1, each of us with classes to go to.

24 April 1995 8 AM

I'm still sleeping. A loud, persisitent knock on the door wakes me up and I stumble out.

I am informed that Vikrant died last night. At about 10 PM. Near Chenglepet, between Chennai and Pondicherry.

There is not much else to say.

Chapter 31-Kids, Men and Bugs

March -April 1995

Coming back from a holiday, however brief, is always slightly depressing.

Our Kodai trip, like class trips tend to be, was a make or break trip for some and I saw some "pairs" being firmed up during the bus ride to and fro, cemented by long periods of togetherness while there. Kodai itself was beautiful, but getting there was a 12 hour pain. There was plenty to do-rowing on the lake, walking around the quaint town, mustering courage to go down Guna Caves and soaking in the many waterfalls. Condom and Vinay managed to have a huge fight over breakfast when one of them threw a glass of water at the other over an occupied chair. There were emergency loo breaks in filthy loos, awesome guitar solos and not so awesome singing on the bus rides and breathtaking sights of the Nilgiris. The weather was cool, cold even, and the air was crisp enough to make me not want to smoke in it. And I did not-for the two days we were there.

But now we are back in Jipmer and are faced with upcoming realities of class tests, records, lectures to attend, clinics to troop into and attendance to make up.

My Paeds posting is over in a blur and I have a new found respect for the Pediatricians who manage to examine these sick, often understandably irritable kids with supreme patience. There is more than just that, however, as they need to know dosages of drugs that keep changing as their patient grows older, milestones in a child's development, vaccines...etc etc.
I am appalled at the numbers of kids we see with dehydration and diarrhea, with malnutrition and skin disease and am depressed at the sight of kids with heart defects and cerebral palsy. We need to learn how to diagnose all of this and if you thought hearing heart murmurs in an adult was tough, try a kid's chest.

In the meantime, the slog continues.

Microbiology has a unique system of Internal Assessment, one that I have not seen in my 1st year and, I am assured by seniors, I shall not see again after I pass Micro.
This system is called "Tutorials". Just as a recap, each subject holds class tests throughout the year (about 4-5) and just before the Univ Exam there is a full scale dress rehearsal called Send-Ups. Out of all these, the best 3 are counted towards Internal Assessment and the marks divided so that one gets a result out of 30.
In Micro, the tutorials are like a small group viva and they happen throughout the year too. So this year, we will have about 4-5 of these. The average of these will make up one test towards Internal Assessment. It stands to reason therefore, that one must attend all the tutorial sessions to make it count since an abscence is marked a zero.
It also stands to reason that if one misses a tutorial, it might make sense to just skip the remaining ones totally. So I think " Why bother? Why not just skip it entirely?"......And so, starting with the first, I make it a point to skip all the tutorials valiantly resisting all exhortations to "just go bugger, it's the going that counts".

Our Medicine posting is up next. Located on the top floor (3rd) of the hospital, it has 4 units, each manned by Heads with contrasting styles and personalities. The Head is a short guy, a Professor and always wears a tie which is reddish or marron more often than not. He has a reputation of being very fair in exams and is thus a popular man. He speaks fast, holds marathon ward rounds and I make it a point to wish him at every opportunity.
The 2nd Unit is manned by a serious looking Prof who wears thick glasses and is considered by many to be the best clinician in the Department. He is apparently very fair in exams also and if he thinks you should pass then you will. Also vice versa- a philosophy I would agree with unless I were the one being examined.  He's written a small yellow book on Ethics and Clinical Skills in Medicine and we duly troop over to the Co-operative Stores to pick it up.
Then there is Dr PR. A smooth talker, even if most of the talk is in Tamil. He thinks Medicine is Maths.
"So Doctor, this patient has a one leg and a big spleen. Diagnosis Doctor!!!!" He says this with a flourish. And according to him, there is only one answer. Which in this case turns out to be Polycythemia.
The posting is an Introduction to Medicine and it is here that our stethoscopes are actually put to good use. We are constantly told that the stethoscope is actually just the end point of a well taken history and a thoroughly performed examination, but who's listening when there are heart murmurs to be heard and stomach gurgles to be identified? I quickly learn that Medicine is a game, where each piece of information may or may not add up to something at the end. It's a tough game, made tougher by my incompetent Tamil.
There are subtle signs like pallor and even more subtle ones like clubbing. Needless to say, this is the point where we all turn into hypochondriacs to varying degrees.

The posting ends with me just marginally more aware of the subject than before. We are all expected to read the bible of medicine, a book called "Harrison's" and this is a more than a mountain for me. 2 volumes of double column small print with no photos and crammed with facts. It's a brilliant book I'm sure and one that Vikrant swears by, but even though we need to read the first few chapters, I give up after duly underlining a few pages. There is enough time for that in the next 2 years.

There are some rumours going around about Vikrant and someone he's met in Ramanathpuram. I don't ask however, and he doesn't volunteer so it remains a rumour. He will going back home in a few days and asks if he can get anything from home, but since I will be following him soon after for my Summer Vacations, there isn't really.
Shom and Rahul are still separated by silence and I am the mediator.

With Osho sessions and Maggi noodles, beer and Old Monk, clinics and class tests, falling attendance and Snappy meetings, the days tick by. Just a normal routine that was soon going to get a massive jolt.

Chapter 30-Of Ward Leavings and Melted Tape Decks

Jan-Mar 1995

..and so, after failed attempts at asking names in Tamil and getting used to stethoscopes hanging around necks, our 1st 4 week OG posting is drawing to a close. We are escorted to the Labour Room to get a close-up view of the nitty-griities of delivering babies and the like. There are 2 Labour Rooms, one called "Clean" (CLR) and the other Septic (SLR). At first glance, the SLR is FAR cleaner and quieter than the CLR, but the SLR is where potentially contaminated cases (mothers) are housed.

It's chaos. It's overwhelming. And it smells of amniotic fluid.
The CLR is opposite ward 12 and the corridor is lined with a few pregnant mothers awaiting their turn inside. A ward just outside has patients being treated for Eclampsia (Epilepsy in pregnancy). We enter a pair of swinging doors and are greeted by a freezer located next to the door.
We are made to take some guesses on what this freezer could possibly hold.

There are placentas. Lots of them. Frozen.

There are 4 rooms with delivery tables and a few doctors running around. I also see the Final Year guys I had seen in the Ward, looking even more haggard and stressed. It turns out that they do this posting for 14 straight days, sleeping for 3-4 hours in the hospital, going back to the rooms only to eat and bathe.
They are the backbone of the Labour Room and do deliveries, suture wounds, assist in surgeries and generally run around all the time. They are also exempt from all classes except OG. I guess that''s the only silver lining.
When not doing all this, they monitor patients and rumour has it that their records are seen by Madam A. Hence ,there is much tension in the air. Bad behaviour in the Labour Room can come back to haunt you in exams it seems.

Our Ward Leaving arrives. When I call home the day before, my mother imagines that this event consists of a party to celebrate the end of our posting.
Each of us is allotted a case and we need to take a history and present it to whoever is coming to listen. Marks will be allotted and will count towards Internal Assessment. The history, naturally, is to be taken in Tamil. No interpreters are allowed.
I have mugged up all the Tamil needed and ask away. As usual, figuring out the answers is a problem, but I'm catching on just a little,enough to fool my examiner into passing me.....
So much for a party. Till I graduate, there will be about 30 more such "parties", increasing in intensity and importance.

There is talk about organizing a Class Trip, now that University exams are a year away and there is some time. There is a toss-up between Kodaikanal and Ooty.

In the meantime, the usual happens. Classes go on, some without me, Snappy sessions are in full swing, almost never without me, and rooftop and hostel parties happen regularly, never without me.
Our whisky drinking is progressing. Starting off with a crude brand called "Bagpiper", which tastes like a mixture of alcohol and spirit, we've moved up to "Bagpiper Gold". This is just slightly better but indicates improving tastes and better appreciation for the finer things in life.
A Rum/Coke pre-mixed drink called "Cariba" has made it's appearance and it saves time and money since there is no Coke mixing involved with the Rum. It's just OK and is in our arsenal for a short time, till Old Monk makes a roaring come back.
So it is Old and Gold for a while. And the parties continue in the wing, once in my room.

My room is a favourite venue for some parties since I have a Music System, a Philips deck gifted by Dad. This has a double deck, a radio, but no CD. I'm in love with it and try to catch Sri Lankan Radio, succeeding only after numerous attempts have been made at pointing the antenna in different directions.
Now, this deck has a plastic casing and has sliding controls on top. When the slider is slid, there is thus a gap going deep into the bowels of the thing.
In one particularly rowdy party, late at night, Vinay decides that he must mix the drinks as a bartender does. Therefore, he takes a 7 Up bottle, opens it and shakes it vigorously, with his thumb partially blocking the opening, creating a fountain of 7 Up which is supposed to mix with the Vodka some guys are drinking.
That is the theory.A steady stream of 7 Up lands on my deck and makes it's way through the various openings in the various sliders.
That was the day the music died (for a while).
The music splutters and stops. I am really pissed (and drunk). Everyone is taking turns to screw Vinay but I'm more concerned that that my deck just died. Someone gets the bright idea that "After all, it's just liquid. So if we focus the table lamp on it, the heat will get the 7 Up out of there and the deck should work". This sounds plausible and so I focus my lamp with it's 60W bulb closer to the top of the deck.
The party over, the music stopped and our stomachs rumbling, we head off to the shacks for tea, egg parathas and other sundry stuff.
About an hour later, Rahul and I come back to my room.

The heat has melted the plastic on my deck partially. The sliders now are stuck halfway. But it plays!!! My deck stayed that way forever. Melted, partially burnt but working.

In another party happening on the roof of Osler House, Condom is seriously drunk. It's a full moon and he's going on and on about how he's in love with the moon. How the moon is so beautiful and how it's shining etc etc.  This goes on for a while and finally, some part of our cocktailed brains figures out that he might actually be in love with a person and not the moon. This is interesting and we spend the rest of the night pestering him about who this might be. He does not oblige.
In other news, Rajeetha and Phani are now officially a pair and very happy about it. They are often seen spotted in the library or here and there, but always together. So Phani bites the dust.

My First Ward Leaving Later...

...So that's the end of OG and the beginning of Pediatrics, about which my memory is extremely fuzzy.

Pediatrics is spent mostly in the Ward, looking at impossibly small and desperately sick children and babies. The Ward is on the 1st floor and just outside it is an examination table where I always see someone trying to somehow examine a crying, screaming child.
The Head, Prof S, is a stickler for breast feeding and we are reminded constantly about it's various advantages and how bottle feeding is the new "pure evil". There are posters here and there about this, along with a chart showing the symptoms of something called "Dengue Fever" and "Chicken Gun Ya fever" which of course, sounds funny at first.
The feel of the Ward is the same we encountered in OG one floor below. The number of people is twice as many, since babies are accompanied by mothers, some of whom look so worried and helpless that it's depressing when I can't answer any of their questions, mostly because I just don't have the answers.
I haven't mastered the art of "saying something but nothing" yet that doctors somehow learn. I keep quiet.

Pediatrics this posting involves more History taking and an introduction to examination. I see pallor, clubbing, malnutrition, heart disease, kidney failure, cancers.
It's just depressing to see all this in a kid. Yet, we have to, and will be examined on it.
One guy takes 6 attempts to start an Intravenous Line on a kid who is so sick he can hardly scream. Veins in kids are small and fragile, I learn quickly and this is a skill where Pediatricians are masters. This subject requires tremendous patience, not my forte.
I decide that I cannot do Pediatrics later in life.

Along with this, we plod along in Pharm, Path and Micro. Other lectures in Medicine, Surgery etc are taking shape. I always sat on the back benches in 1st year and that has not changed. It's fun to read the graffiti on the benches and then to contribute some of our own. One feature about lectures that has not changed still is that the girls and boys sit separately. There is no decree or rule about this but that's how it happens. Always. The boys occupy the Right and Middle Sections and the girls sit on the Left.
Some girls sit on the front bench and take copious notes, often pausing to highlight important points and using Sketch pens.....
It's remarkable how interest in a class declines from front to back.

Our 1st Pharm Test is announced. This will be a 3 week marathon. So I gear up and make a Time Table for it like a good student would.
And like 99.9 % of Time Tables, it's shot to hell and I am studying at the last minute.

The theory part is OK..At least this is an interesting subject and Katzung is a Godsend. The pracs are OK too. In the PharmDyn lab, we draw lots to see what experiment we get. Mine involves injecting an unknown drug into some tissue to see what happens and then identify it. Something on receptor actions on isolated heart muscles. There is a viva also, typically sarcastic which is the norm for Pharmacology.
We then switch to Pharmacy where I have to make some kind of a solution. The "recipe" I recall well, but the damn thing just won't dissolve. So that's that.

The main viva is terrifying. One on One with someone whose sole purpose of existence is to make you realize how little you know. And so, after a reasonable exam and like most of the class, I fail.

Back in the civilized world of the hostels, I see Shom and Vikrant on and off on their way to and from the Rural and Urban Health centres. Internship is kind to them for the moment and Vikrant is making plans to go home (Chandigarh, my hometown too) in April. They have a 4 week Elective posting after their Comm Med posting and Vikrant has chosen to do Cardiology.
The lazy bums have chosen such things as Forensic medicine, where all one does is see some autopsies and sleep all day.
Rahul has exams in 2 months time but this is not deterring him in any way from the usual hostel party scene. Bong has disappeared completely and is engrossed in Final Year.

One evening in Snappy, me, Vinay, Rahul and Shom are wasting time as usual. Someone says something and before we know it, Rahul and Shom are in a nasty verbal exchange. Really nasty.
Now, Rahul is much better built than Shom and so before it turns physical, Vikrant intervenes and the two push off. They don't speak to each other or even about each other. For many days.
This is particularly awkward for me since I know both of them so well, they were both (still are) good friends till a minute ago and they live practically next door. In parties, they don't talk. They don't drop into each other's rooms. Like they don't exist.

Our Class Trip has been finalized. We are headed to KodaiKanal  for 3 days. It will be cold and beautiful, the booze will keep us warm and it promises to be much fun.

Kodai here we come!!
A few days later, we come to know that we will going to Kodaikanal. Awesome. I've never been there and this promises to be fun.....

Chapter 29-The first few weeks in Clinics

Jan-Feb  1995

This year, I learn fast, is supposed to be an 'easy' year. At least, that's the impression I get from the lunch time conversation around me but I really should know better, since it's a given that when one passes a semester, that suddenly becomes the 'easy' one and your current semester is a 'tough one man'.
1st year was such trauma that anything will be easy compared to that.

Post lunch is practical time. Today, it's Pharmacology. Other days will be Pathology and Microbiology.
We've already had an introduction to the subject by Prof S, who is the Head. Apart from the usual lectures, there are now two different sets of practicals....Pharmacodynamics which involves a lot of animal experimentation and Pharmacy (which is exactly what it sounds like). So we will either be chasing animals around the lab or mixing up powders and liquids.

This first afternoon, we are split up into two. 30 of us enter the powder room and the rest go to the animal farm. I'm in the latter group. I meet Dr G, the better half of Prof B, who fortunately missed us in our Anatomy Univs. exams. She is in charge of this lab and tells us that an upcoming Sleep lab is a pet project of hers. I suppose now is not the time to tell her that most of us have done PhD's in Sleep already and so we just continue on a guided tour of the Pharm Dyn lab. She seems a bit sarcastic and we are warned about attendance, record keeping, discipline in the labs and such typical routine academia related threats. And we discover that, in trying to be unique, the Dept has also mandated that attendance (!) in Practicals in Pharmacology carries marks (!!). Talk about juvenile rules, but rules that I shall have to obey.
With worktables on the sides and 2 big tables in the middle, the Lab also has some frogs and rabbits and guinea pigs. These will be our unwilling victims through the year and we shall be ably assisted in all of this animal experimentation by the Lab Assistants (henceforth called Lab Asses).
Our first class ends soon enough, mostly a mix of orientation to the Lab and the odd sarcasm laden threat.   And as usual, we troop back to Snappy where we spend the rest of the evening planning where to go for dinner and liquid appetizers.

This year, time will not be planned according to months. So, rather than saying that such -and such will happen in April for example, we start saying that it will happen when we are in our Medicine Posting or Family Planning posting etc. Just saying stuff like this makes me feel like a doctor and far removed from the disaster that First Year almost was. This is also the year where some classes are being taken by doctors actually practising medicine. In the early days, I'm fascinated by the concept of real doctors taking class and I listen with rapt attention, which unfortunately dwindles exponentially as normality and routine takes over.

Our time is variously spent taking patient histories, feeling babies yet unborn, getting worked over by Consultants at our poor history taking skills and getting used to the smells in the hospitals.
Some of our time is spent in the Wards (No 12 for Obs and No 16 for Gynae) where I sometimes see a bunch of very haggered, unshaven seniors huddled in a class. Someone tells me they are in Labour Room posting. Sometimes, we go to the Operation Theatre where I witness my first Caesarian which I suppose must be a landmark in every student's life.
There are 4 Units in OG and a couple of weeks into the posting, we meet some of the other big bosses in the Department. Dr GR is sarcastically magnificent. I wish I had her command of English. Prof H is reputed to be tough but fair. Dr RR, a gentle looking lady brings up the rear and there are many others who either take class for us or give us the "cases" to clerk and present.

It's just a few days into this year and the effort of waking up at 7 AM to attend class is already taking it's toll. Ashley and I still use the back of our cupboard to mark attendance and stay one step ahead, but sometimes we are just plain lazy to do even that, and so I'm losing track of where my attendance is. Attendance in the Final Year subjects like Medicine, Surgery and Ob/Gyn is computed from this year till the end of Final Year and so there is huge scope there to make up for lost attendance. In practical terms, this means that I can hardly be bothered to attend those classes, especially when they start the day.

Our Clinics are now following a predictable routine. Get there by 10, make yourself seen by the highs and mighties, clerk a few cases, present them, hang around seeing expectant mothers and their problems and note down every uttered word diligently. I hear terms like "quickening", "abdominal grips", "Dutta is a great book", "Dutta is a screwed-up book", "P/V exam" and I'm quite enjoying it.
My Tamil continues to be woeful and I spend some time mugging up the Tamil version of the questions I'm supposed to be asking patients while the rest of the class actually does the asking. When I do manage to ask a question a patient actually understands, the answer is completely unintelligible to me. Still, I suppose it's a start.

Pharmacology has started with an introduction to what the subject is about and some terms we will hear throughout the year. This Department, I learn specializes in extended torture and conducts class tests spread over 3 weeks. Week 1 is a theory paper followed by a viva in week 2 and a practical exam in week 3. Our first test on the Autonomic nervous System is scheduled in a about a month.

Pathology this year consists of the 1st 9 or 10 chapters of Robbins and also Haematology for which we need to read another book called DeGruchy. I think this will definitely be my favourite subject, slides notwithstanding.
And there is a "museum". Entry is free. All kinds of human diseased specimens are kept in formalin jars for close up viewing. There are appendices, hearts, lungs, kidneys and everything you can imagine. At least it's a bit better than the foetuses in the Anatomy Museum.
 Pathology lectures start off in a flood of doom, gloom and boredom. The initial lectures are full of how wounds heal and what inflammation is and so on. It could have been fun stuff to listen to but a quick glance at the Robbins-the recommended book,  tells me that I will be much better off just reading it.

There are actually 3 versions of this book. One is the encyclopedic version, thick and hardbound and this is the version I possess and am reading. Inspite of it's size, it flows very well and is brilliantly written. 

There is also a slightly condensed version of this written by the same authors and a pocket edition, apparently designed for people who can't move without their constant Robbin fix. 

They are referred to as "Papa Robbins, Mama Robbins and Baby Robbins" respectively. 

Pathology also has practicals, which at first consist largely of staring down microscopes looking at slides which have blue and red splotches on them. They are supposed to be something, I know, like tissue cells and ulcers and kidneys and lungs, but I was hopeless in Normal tissue slides (Histology, part of Anatomy) and this is worse. We are supposed to identify the normal parent tissue and THEN say what is wrong and I can't get past the first bit.
And we have to draw this stuff in our records.
I'm beginning to understand why record drawing is dumped on a few juniors during ragging.

In the meantime, I bump into Mishra coming down the stairs from his abode on the top floor of Lister House. He warns me "Golu, attend classes man". . Maybe he's heard something. I'm not too bothered , though and with an arm around his shoulders, we head off to Snappy to spend the rest of the evening. Shomeshwar and Vikrant are in the Community Medicine posting and are having a ball before the real Internship kicks in. 

Bong is in Final Year and I hardly see him these days, even though there is a year to go. That year is just one hard struggle it seems. 

Vinay and I continue to haunt Urvasi, MASS, Rendezvous, Seagulls and a few other bars at regular intervals.

It's just that getting there in autos is a pain so we try our best to catch people with bikes to come with us. 

We are also introduced to Microbiology, the subject that deals with which bugs can bugger humans and how to diagnose them and generally everything about them. We start off with some general stuff on antigens and sterilization and autoclaves and bacterial cultures. There is a "Cooked Meat Medium" , a "Blood Agar", a "Chocolate Agar" and some other very weird stuff. I am told that the diarrhea in cholera is called "Rice Water stools". 

In Pathology, I learn that when amoebae get inside the liver, the pus they produce is called "Anchovy Sauce Pus". There is "Bread and Butter Pericarditis", "Nutmeg Liver"....The list is endless. 

Why did they have to target food? 

In Pharmacology, everyone reads a book called Tripathi, which is fondly referred to as KDT (for KD Tripathi). This is a highly condensed version of some foreign books and has very little by way of concepts but more than enough material to pass an exam. The American equivalent is a book called Katzung (or Goodman Gilman for the nerdy brigade) and I start my reading with this book. It's lucid and clear and no-nonsense as American books generally are. 

The Micro book is called AnanthNarayan and is a good, if very fact based reading. That's the subject's fault I guess. Of course, there are other books for Parasites also but we won't get to those till next year so that's not a worry for me yet....

But Our first Pharm test is looming. So is my Ward Leaving in OG.

And those are worries indeed.

In MBBS, the fun never stops. 

Chapter 28-First Morning in the OPD

Jan 1995

On entering the main entrance of Jipmer, one can either turn left and walk to the College with all the Lecture Theatres or go straight right into the crowded corridors of the Obs/Gyn Dept. This is the first day of our Clinical Postings-Obs/Gyn and sharp at 10, after our first 2 lectures, we head here to Madam A's office.

Madam A is a small, petite lady. She may be small in height perhaps but she is every bit the personality we have all heard about. She says something and giggles, and we all giggle, totally humorlessly and totally nervously. As with many people, her reputation precedes her and we have been told that first impressions go a long way. How those impressions are made is beyond me so I just stand at semi-attention, nod and smile aimlessly when she does and look very serious. I hope that counts.
She is also supposed to have a massively good memory hence the need for a good first impression. I try to sort of hide and blend in with the others.Our steths hang around our necks and our aprons are spotless. Our standard OG book, called "Dutta" is NOT by our side, since apparently this is a no-no with Madam A-another benefit of advance warning by seniors and apparently a way to make a good impression, or atleast not create a bad one.

We enter the OPD. This is my first experience of a Govt. Hospital OPD, and boy, is it crowded. And hot. And there is a smell whose origin appears uncertain. It is a slightly sweetish smell, not unpleasant, but not too pleasant either. After a while, like the smell of formalin, I don't even notice it.
The OPD has a couple of big rooms with scattered tables around which the real doctors sit. All manner of forms and papers are littered about. I make out one or two fresh Interns who are also nervy, not because of Madam A, but out of sheer cluelessness. Some Residents sit around looking massively competent and unnecessarily authoritative and the Consultants are in a chamber next door.
There is an examination room consiiting of cubicles separated by green hospital curtains and occupied by hassled doctors and more than hassled patients. All the patients seem to answer to "Amma".

Then there are us. 13 or 14 of us, trying to look confident but failing miserably in the process and looking more like the lost bunch we really are.We keep small note pads by our sides hoping to write whatever pearls of wisdom fall our way. These notebooks are worth more than gold since in the Final Exam, 3 years away, viva questions can be asked from what we hear now. Much of that is not in the books.
The first half hour or so is spent looking lost and trying not to feel overwhelmed. Classmates I've hardly spoke to in the past few months have become brothers in arms. I'm almost the only one with NO knowledge of Tamil so the "lost" feeling is more acute for me.

We are soon spotted by a Resident whose reluctant responsibility is to teach us in the middle of a massive OPD.  We are led to one of the examination rooms where someone with a seriously sexy smile/pout introduces us to the joys of a Per Vaginal examination. She seems to have a "Come Hither" look which totally distracts me from what she is saying. Then, it's time for a class on how to take an Obstetric History. The Gynae part of the subject is reserved for later it seems. For some time we will focus on pregnant women and all the problems they can have.
Pregnancy is divided into 3 trimesters and we need to ask some specific questions for each trimester. That's the easy part. The tough part is the asking, since I can't actually do that. So, I resort to nodding cluelessly when someone takes a case and starts our first history-taking class. It's very systematic and I dutifully note everything down.

We listen to a foetal heart sound and it's magical. I feel a foetal head and that's amazing too, especially when I move my hands and feel a kick. I learn that we will need to figure out in what position a foetus lies in the abdomen, what the expected dates of delivery are, what "booking" means with regards to vaccination, and the various idiosyncracies of various potential examiners.
For most, Dutta is a good book. For Madam A, it's not. The technique used to feel a foetus, called "grips" is apparently described in the wrong order in Dutta, among other things.  She should see us with Llewelyn Jones, a British book, well written, but quite useless for exams.
If we do not warm our hands and the steth before examining, we fail. (This part is just for show. There are no winters in Pondicherry).
 Ditto for not explaining what's going to be happening when we examine a patient and not covering the patient with a sheet or asking for a privacy screen.
It's possible to fail even before touching a patient.

The first clinical morning ends with attendance. It's a nice feeling to marked present.

My first morning as a "Real" Medical student is over but the adventure is just beginning.

Chapter 27 -The start of Clinical Years

Dec 1994
I am at home, not doing anything much. One morning, someone in College calls me and tells me that I have somehow passed. This is not entirely unexpected, but this kind of news is always welcome. With exams, one is never quite sure and so, after 18 months or so in Jipmer, I have managed to navigate the 1st MBBS, and by all accounts, should be entering easier territory. Or so it seems. I wasn't to know it of course, but this year was going to be affect my life very deeply.

Jan 1995
I feel like I've entered a new class in school. The subjects are different, the books seem bigger and stranger. The teachers are new. For the past 18 months, we've been taught in Lecture Theatres on the 1st 2 floors of the College (Hunter and Bernard Theatres), and now we will move up, quite literally to the 2nd and 3rd floors. Pasteur Theatre and Lister Theatre will be our new homes now. Just moving up a flight of stairs makes me feel senior already.
Classes have not started yet and I'm already excited. For the next 3 years, we will be going to clinics, OT etc-doing the "real" doctor stuff. I have bought a new stethoscope, a Littman, quite expensive and at present, quite useless.

Advice has been trickling in:
"Golu bugger, make sure you attend classes"
"Just attend clinics yaar, lectures are just fart"
"Everyone fails Pharmacology"
"Make the most of this year-drink every day"
.....
Not all of it is solicited. In turn , I make it a point to act all senior and dispense my own advice to my juniors (the only junior batch I have), temporarily forgetting what drama it took for me just to get through Anatomy.
There are failures of course. About 15 from my batch. They will form the Additional batch and will repeat the failed subjects in 6 months time, and will continue throughout the course 6 months behind the rest of us. It seems cruel but I'm quickly learning that this course is not always fair and a far cry from the hey days of school.

After the relative paucity of subjects in the past 18 months, I am hit with the full load of stuff that will continue throughout the next 3 years. This is the real deal. For starters, there is the trio of Pharmacology, Pathology and Microbiology. These are the subjects we will be examined on later in the year.
Then, there is Medicine, Surgery and Obs/Gyn. There will be clinical postings as well as lecture classes on these which will continue till the end of the course.
And then, there is Preventive and Social Medicine. Known usually by its acronym- PSM, this one is a bit of a mystery. It is neither core clinical medicine nor a basic science and a quick glance at the book, written by "Park" shows that it covers things like Health Programmes, Statistics and a chapter on various types of toilets. I am told by seniors that PSM organizes fun field trips but the reading is very drab. Our introductory Lecture is taken by Prof Dana, who is affectionately known as Danny Boy. Unfortunately, in the same class he also tells us he is retiring soon.
On the first day itself, the entire class has been divided into 4 batches in alphabetical order for the clinical postings. I am in Batch C, and there I shall stay for the next 36 months. There is no question change of batches or any such thing. If you don't get along, its your problem.
Batch C starts their clinical life with Obs/Gyn. I start my clinical life with a mega crash course in Tamil.
For someone from North India, this is about as alien a language as they come. The script means nothing to me, the words sound as unfamiliar as they can and the first hour of my posting is spent in abject despair. Apparently, we will not get interpreters in our exams if the patient can speak Tamil. My MBBS course just went up several notches in difficulty but I take heart from the fact that no one has had language issues by the time Final Year arrives. One just learns eventually and I know I'll have to as well.

Rahul has also scraped through and has entered the Golden Year of MBBS-his batch will organize Spandan and the rest and it is perhaps the most relaxed year of MBBS, although "relaxed" just means a little less tension, a little less stress and a little more extra-curricular fun.
Bong has arrived in Final Year and I can see a change in attitude already. Casual gossip sessions are minimized, reading has started in earnest and he seems to exude this air of seniority. Final Year batches are an exalted bunch, a batch that has "been there and done that" and now has to "go there and do that" (pass the bloody Finals). He's reading the same books that I have just bought, except that they are all marked with highlighters and accompanied by reams of notes and scribbles. I guess my lovely new books will meet that same fate also.
Shom, Vikrant, Plaha, Mishra and all have passed Final Year and are now Interns. Their MBBS ordeal is over and will be replaced by the tragi-comedy that Internship can be. From the seniormost Med School students they are now the Junior most Hospital staff. Still, they get paid and don't have to study.
Vikrant and Shom are in Batch D of their batch and have started their Internship life with the PSM posting, also known as the "honeymoon" period of Internship. This is spent in either the Rural Health Centre a few kms away in a village called Ramanathpuram or in the Urban Centre near the sea called Kurchikupam. The RHC posting promises to be fun, with a casual OPD, and many hours spent drinking toddy and playing cricket.

It's a new year, a new day and a new chapter in my nascent MBBS life has begun. In my dirtyish shirt, covered up with my new, clean, white coat and adorned with my useless, expensive steth over my neck, I join my other Batch C mates outside Prof A's room. Prof A-she of the scary Maruti car, a legend in College and Head of the Obs Dept.

My Clinical Years have started. A milestone has been crossed.