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. 

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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.