The History of a Med School Sophomore: The Three Messketeers

You know you're in charge of your mess, when:

- you find yourself often lost in thought, wondering what to serve for supper the next day.
- your day begins with the watchman screaming your room number, while the cooks ring you up at the crack of dawn.
- you'd rather hide in the kitchen cutting vegetables than face the seniors' wrath.

Last one, I swear:
- Nothing excites you more than the sight of a cooking gas cylinder, all filled up.

What was that all about? Allow me to drag you to the very beginning.

It was a dark and wintry night, a light breeze wafting through the hostel's quadrangle. Thirty of us were gathered there, waiting impatiently for our ex-Class Rep to come to the point of this unforeseen meeting.
"Being in second year, as you'd all know, we've to take charge of the mess, since we'd be the only batch not having exams in December; now, you can form groups of two or three and either volunteer to be the mess prefects for a certain month, or we'll draw chits to decide."
A unanimous murmur rang in favor of the latter - nobody wanted to be left with the months we'd have internal exams, or in my case, holidays.

Seeing how we'd be required to interact with the workers a lot, the Keralites all teamed up with Kannada speakers. I joined Hita and Charulata, informing them I was ready for any month but December, as my parents would be visiting then. Assuring me of her good fortune, Hita grabbed a random chit and opened it to see "December" scrawled in it. Awesome.

A mutual exchange with the February mess prefects had us being assigned the shortest month of the year (sadly, 2012's a leap year)
Come January 31st and we were all gearing up for a crazy 30 days, not sure what to expect, self-assured enough to believe we could pull it off as good as we want.
A cheesy heart-shaped card on the notice board declared our names and room numbers to everyone in a neat font, not very unlike a bull's eye to the archer.

The other two had gone to collect a check from our warden, while I rushed to the kitchen, ensuring they'd clean out the store room. With awkward pauses, I tried making small talk with the workers, introducing myself. Looked like a long and winding Feb this year.

Now you'd think getting two days less than the other prefects was a major bonus for us, but think again. We had exams stretching over the first two weeks.

The month began with a crisis - that of cooking gas shortage. Running on one cylinder per day, we needed them delivered every 5 or 10 days. The problem started when there was a strike among the truck drivers, with deliveries for the previous week stalled, the fate of our kitchens left in suspense. The gas agency rarely answered our persistent calls, and a visit to the warden to map out the chaos was met with indifference. We had to beg, borrow or steal from the men's hostel or simply declare the mess off.

All just about the normal load a mess prefect has to shoulder. But the proverbial straw was having to run all around the place on the eve of our exam, apologetically telling everyone dinner would be served late, all thoughts about our paper out the window, while our batchmates were sacrificing everything from sleep to showers for a third revision.

The three of us just as well gave up on our studies, more concerned about our role as 'Prefects'. While the title made us feel like V.I.P.s initially, we were never informed about the other duties we'd land ourselves in:
Nobody told us that one of the evening cooks let his emotions decide whether to come for work, often being absent with no notice (and by some miracle, still surviving without any sort of phone in this age, much to our ire) giving us the job of preparing tea and milk for 200 boarders. We had no idea we'd be cutting vegetables, rolling chapatis and puris, flitting to groceries every half hour, all in sync with the cooks' whims, ultimately to be reprimanded for 'spoiling the workers by doing their work for them'. Who'd have thought of all the mental strain in convincing these Masterchefs to cook what we want, instead of something normally fed to cattle? I've lost count of the number of days dinner would be over before a quarter of us even got to the table, while other days the cat would already be devouring our would-have-been meals. Not to mention the
'un-Messy' work of taking care of the building's plumbing, electricity and other requirements, which included tiling and painting the entire hostel. The petrol and telephone expenses burnt holes in our pockets. We only have to thank our stars there was no water shortage to add to our woes.

But what takes the cake are the 'feasts' - mini-feasts given every Sunday and a major 'Monthly feast' any weekday of our choice. Unlike the other days, when we'd have vegetables delivered daily after texting them our list, we'd to go out ourselves and fetch the items we had in mind, serve everyone a fixed amount of sweets, ice-cream, drinks etc. In fact, half the time we were roaming the city buying stuff - from eggs and bananas twice weekly, again to be personally delivered to each student to hunting for CFL bulbs for the study hall - despite having to pay a fortune for our daily rations to be brought to the hostel.
The big one had us all pushed to the edge, as this was our chance to redeem ourselves for a month of bad luck - to treat them within budget, on time, taking care not to let our dampened spirits show through. For we were the last of our batch to remain in the city after the exams, as the free 2nd year kids all returned home for a week-long break. Nonetheless, as we approached the last of the 29 days, we were like exhausted athletes simply looking to finish the race, rather than aiming for a win.
Having made quite a lavish combination of items for the monthly feast, surviving flying tempers, empty petrol tanks and a race against time, the ending fared far better than the ill-fated genesis, but we'd already stopped caring.

What started out as a chance to revolutionize the whole system ended up with us being tossed up and down - we were no better than what we started with. Hygiene was still non-existent, the mess fees sprang to far greater heights, the workers grew even more autonomous, and we still have no wi-fi, heck even a functional TV remote, both which our male counterparts can easily boast of.

Still, I admit, it was a learning experience, with lot to gain from. I witnessed the power of a soft-spoken word over a harsh tone, when dealing with the workers. It was nice getting to know them more, enquiring about their state of affairs, though the constant demand for their wages prematurely grew tiring. My language skills rocketed along with this gregariousness. And oddly enough, all that dirty work we had to do ended up being a gratifying narrative in retrospect.

But, no way am I gonna ask for a revision of that lesson.

The History of a Med School Sophomore: Vital Signs

Back in high school, when everyone was still debating career choices, I was not only solid on which direction to head, but what specifics to aim at – Medicine, Pediatrics, Psychiatry and beyond.

I believed I was too clumsy for Surgery, too coarse for Dentistry, too deaf for ENT;  the non-clinical ones never even figured in my scheme.

So, it was a pleasant surprise when I ended up loving Surgery, officially the first of my postings, so much that I wondered whether anything could top it off.Two months later, I was rather reluctant to move toward K.R. Hospital on the first day of my Medicine postings: Five days of rounds in the ward and one day in the out-Patient Department? Somebody take me back to the Operation theater.

But as it turned out, the 6 weeks' exposure had its own portion to teach. Every day was different, every case unique.

The initial days were spent getting familiar with the subject, particular to the Respiratory and Cardiovascular systems. The vault of information was pretty vast, and while I was mostly blank, once I swallowed my pride, getting to pick up something new about our body's workings and the different ways things could go wrong had a thrill of its own.

The lessons I learnt, however, came less from the mouths of our Professors and more from the patients, everyday observations and each others' mistakes:
Even if clinical findings are more loyal to their textbook descriptions and hence easier to elicit, mastering Medicine requires more than just books.

Lesson #1 - Formula for Failure: ignore the basics.
A more complex statement would be, it doesn't matter if you can blurt out the rare conditions where jaundice manifests, if you don't  know how to tie a BP cuff:  Once, all five unit-mates couldn't figure out why on wrapping the sphygmomanometer (used to measure blood pressure) around the arm led to the emerging tubes being oriented opposite to what was required. The final diagnosis? Trying what's meant for the right arm on the left side.
Stretch that example to glitches in measuring pulse, taking temperatures etc. and you'll know whether you've earned the patients' trust and credibility.


It was further surprising to see how as we ascend the ladder, we slowly discard the riches we'd acquired at the base - considering ourselves, the interns and even the PGs who all stuttered at the simplest questions posed by the Professors. Maybe it's a new perspective, maybe we never thought so deep, maybe with knowledge comes the wisdom that we really have no idea, but one thing's certain - we've got a long way to go, dotted with detours and potholes.



Lesson#2 - You're never too big to prevent mistakes.
Referring to a particular incident of an error in judgement that claimed an innocent life. The victim, a middle-aged lady, was facing complications of Rheumatic fever, which rendered her heart weak. So what was the problem?
Our Sir, a senior doctor, admitted the patient and started her on immediate treatment. She was showing no signs of rapid recovery nor deterioration and was subject to a close watch.
Not close enough, as it turned out, for within hours, she went into cardiac arrest and was too far gone for medical intervention. She passed away, at the tender age of 38.


Only later did one of our PGs remark, "She was too complex a case for the medical ward - should have admitted her to Jayadeva (Institute of Cardiology) immediately. Never admit such patients..." Too little, too late.


Guess we'll learn over time when to realize just maybe we've got too much on our plate. Because sometimes courage comes in admitting when things are too much to handle.



Lesson#3 - Never take your patient for granted
Tragedy struck again when another patient in the female ward succumbed to complications from her ailment. The young diabetic's glucose levels never approached normal, staying in the high range from the time of her admission. So, one day, when she went into a state of confusion, signalling emergency, our PGs rushed her to the ER, and seeing no time to test her, assumed it was another hyperglycemic attack and administered several units of insulin to bring down the estimated rise in blood sugar. Alas, not only had they estimated the polar opposite, they ended up infusing more of the 'poison' that led to the state in the first place.

Lack of time, lack of infrastructure, lack of insight? Irrespective of the cause, the overdose proved too fatal for the 30-year-old, pronounced dead a few hours past dawn. 


This might have been an avoidable disaster, but that needn't be the case always. Imagine a doctor's plight in a world where hypochondriacs exaggerate every menial complaint while perfectly 'healthy' people dropping dead without any forewarning isn't unheard of. Are we expected to follow a principle of 'sick unless proven healthy'? At the same time, is the gargantuan amount of discrepancies in disease ever an excuse for blatant negligence?



Lesson#4 - Life never seems fair.
But how often do we realize when it is unfair in our favor?

One careful look at the medical ward and you realize your life-shattering problems of not being the coolest, owning the best or getting the most out of life are subatomic in comparison to the conditions people survive from or surrender to.

There was the case of the lady with alcoholic liver cirrhosis, whose unconventional drinking problem led to her husband and children abandoning her, everyone blaming her in a society where the reverse situation is condoned without second thought.
The mentally subnormal teenager with severe Iron deficiency anemia and combined vitamin B12 and Folic acid deficiency, rendered too weak and dependent to sit up in bed.
The blind lady with renal failure, looked after by her preteen daughter, who was just as efficient and stoic as people 20 years her senior.
The 18-year-old suffering from Progeria, a rare genetic mutation that made her look 50 years older, while shortening her lifespan by decades.
The middle-aged woman with cerebellar lesion, that made it impossible for her to stay upright when her eyes closed, even momentarily, messing up with her balance, fine movements and co-ordination.
Old men afflicted with Parkinson's disease,  rigidity, tremors and postural instability, making them resemble living ghosts - no expression, little response, limited movement. 

*

The list is endless - be it regarding the kind of cases we get, or the amount of lessons we are invariably taught. At the risk of sounding too much like a Sunday sermon, they're best left for contemplation than preaching.

At the end of the month, I realized that the patients are our best teachers, who teach us not just through the numerous symptoms they present but also through humble examples of strength in spells of weakness, perseverance through bouts of pain and faith during times of adversity.

And doctors, more than anyone, need to instill these into their daily lives.
Amen.

The History of a Med School Sophomore: The Torn Identity

Take things into perspective and life can range from petrifying to side-splittingly hilarious.

Being a medical 'student', for instance.

Initially, I was eager to devote all five senses to caring for the sick.  A few cases done and the examination sequence became purely mechanical, partly thanks to it not paralleling typical TV medical dramas: No impulsive 'code blue!'s, no transformational plastic surgeries, not even mind-numbing love triangles.

The patients we got often placed us at the bottom rung, showing none of the reverence our Professors were offered. Soon as they realize we're only doctors-in-the-making, they refuse to speak at all, preventing us from examining them; in extreme cases, altering the entire history to send us off in some tangent. The staff held us in no stellar heights either – every question that came our way only yielded aphasia.

True, it did little to revive my dying self-esteem. Yet, to me it was a badge of freedom – from responsibility, from duty, from blame. A green light to the mistakes our superiors would have to answer to; all in the spirit of learning.

But what happens outside the hospital is a whole different story.

Voila Community Medicine: a branch that announced the return of the driest school subject crossbred with the Science of healing. Don't get me wrong - in the real world, Preventive and Social Medicine is what MBBS is all about - looking after the needs of the masses, administering basic healthcare, averting major and minor medical mishaps, extending from the humble village doctor all the way up to the World Health Organization. But within the confines of college life, its monotony is seldom debated.

 The first week of the month-long posting, we were instructed on what we'd be doing out in the real world. Field visits consisting of us mimicking door-to-door salesmen, conducting surveys from a ready scheme, analyzing the allotted community's situation – the only reason we looked forward to doing them was to escape the dreary classes explaining the entire thing.

Seven long days later, we assembled in the college's parking lot, to be dropped to a slum nearby. I boarded the bus pre-occupied with the thought of conversing with people. I am no smooth-talker, but with the additional burden of communicating in a language I couldn't speak well enough to save my neck, things seemed pretty bleak.

Once there, two friends and I approached the first house. A teenage girl shyly stood by the door to their modest abode, occasionally shouting for her mother to help her with some answers. While the questions were purely ordinary, the interaction proved more insightful than anticipated.

There was the old lady who was so offended that we didn't have time to survey her house while we finished her neighbor's, she made us promise we'd return the next day itself. Or the mechanic and his family, crammed into a single room - sans kitchen, sans bathroom but not sans contentment. Despite prodding him more than once, what changes he wanted around the place, he assured us beyond doubt, he was as satisfied as humanely possible.

Contrast that with the B.Com Freshman, who was dismayed by the general apathy of the slum's residents towards development and  the lack of concern shown by the authorities.

The attention we got was flattering - offered tea, invited in, in one house made to wait a half hour, while the mother ransacked her house to locate her kids' birth certificates, ensuring we had genuine information. That last incident had us missing our bus back to college, forcing us to heckle a Rickshaw driver to rush us in time for class at the lowest fare possible, all in vain.
Yet, the minute he saw us don our white coats as we entered campus, he wouldn't accept anything more than 20 bucks - Rs.5 less than what we'd bargained for.

Funny too, when we're showered more attention than we deserve. What about the Rickshaw driver who picked up a few of my friends and me from college? On our way, we witnessed a minor accident, with the victim being carried off to the sidewalk while we got down. Just as people were trying to figure out whom to blame, our hero of a driver stepped forward shouting, "Have no fear - they are all doctors here!"
While five language-impaired Malayalees shot one question after the other to the confounded lady, I kept bugging them to check her vital signs, oblivious to any legal consequences. Declaring her fit as a fiddle, we disappeared as soon as a three-wheeler would permit.

Where do we come in, then, between the extremes of an omniscient practitioner and clueless freshmen?

Every course is multi-faceted, and medicine universally so. High about knowing 'stuff', overwhelmed by the distance still to be covered, so often insecure about the here and now  - it's all different versions of the same story. Irrespective of our route of entry, every pupil is dragged through a thousand and one sleepless nights, triple that amount of medical tomes and the adrenaline-rush of facing examiners that hold our fates in their collective palm, before being churned out a ready-made doctor.
Yet, one wound healed, one soul repaired, one life saved is sufficient for all those hours of pain to make way for a large moment of hope, achievement and gratitude.

Come to think of it, it's a vital part of our polishing into doctors. What better way to conquer suffering and serve faith than to be put through shades of agony and bliss ourselves?

Atleast that's the way I take it now.

Philosophically yours,
Dr? Lamya