Phase I - Nonsense

This post is dedicated to R, for the shoulder to cry on , for the times she kicked me when I needed it, for being there for me, always.
You're the best, hon.

Statutory warning: Smoking is injurious to health.
Also, this is a very long post.

The Onam holidays are on now, and I have nothing to do but sit at home and study. Study, yeah, right. So I thought I’d do a series on medical education. Readers (R, that’s you. You know no one else reads my blog. You’ll get that biryani tomorrow.) expecting Albert Schweitzer’s experiences in medical school are requested leave before they are disappointed.

Our syllabus is divided into 3 phases. Phase I consists of non-clinical subjects, phase II of paraclinical subjects, and phase III of clinical subjects, taking 9 semesters, in the ratio 2:3:4. Then there is the rotating internship for a year, after which we graduate as full-fledged doctors with a licence to heal. That was cornier than a cornfield, but I couldn’t think of a better word. Alternatives are welcome. (R, that means you should leave a comment. You’ll get an ice cream after the biryani for that).

Those who fail to pass phases I and/or III will lose 6 months, and will become what is called an ‘additional’ batch. They will be 6 months behind the ones who passed, and 6 months a head of the junior batch.

Phase I, the first 2 semesters, is called (surprise!) first year. Phase II, that is semesters 3, 4 and 5, is called (surprise! No, really.) third year (see?). No one knows why. Medicos just do not have a second year. Legend has it that when Adam sent Cain and Abel to medical college, Cain failed his first year exam, and went into the additional batch. Since there were only 2 students in the college at the time, Cain was alone in his batch. The authorities felt sorry for Cain, because he cried, and said that first year will be made a year-and-a-half long, so that Abel would still be still be in first year. Abel did not like this very much, and insisted that he was a second year student, since a year was over. Abel promptly decided he too was a second year. Abel , who did not like this at all, gnashed his teeth and muttered under his breath. After all, Cain was his brother, and his only classmate. At the end of 6 months, they took the exam again, but Cain failed, again. Abel had passed, and he began to refer to himself as a third year student, since Cain was still in his second year. Cain, who did not like this at all, got very angry and killed Abel. The authorities saw that the whole problem was caused because Cain was still in the second year, and said, “Let there be no more second year for medicos. Amen.”

Phase III has 2 parts- part 1 (semesters 6 and 7) is called fourth year, and the final 2 semesters make up the final year.

I walked into class on my first day, and saw that I had 200 classmates. Yes, 200. No, actually, it’s 199, not counting me. Wait a minute. There were 199 students in total. But if you count the teacher, there are 200 people in a class. Oh, but attendance has never been higher than 90%, so… Aaahh!!! *tears out hair in frustration* There are 199 names in the register. *whew*

I knew about 4 or 5 people previously, the rest were all strangers. People from different places, different settings, different outlooks, with one very important thing in common- all of us had new white coats. Haha, I was kidding. Some used their old lab coats from school.

First year consists of 2 semesters, with 3 subjects- Anatomy, Physiology, and Biochemistry. Anatomy is one of the easiest subjects in the curriculum, and quite easy to pass. We just needed to memorise the names of all the structures in our body, their relative positions, their embryological origin, their blood supply, nerve supply and lymphatic drainage, and their histology. Oh, and osteology too. Like I said, ridiculously simple. It also helped that the teachers are saints. They never yell at us, they are all very even tempered, they never throw our books out the window, and liberally give us marks on our written tests. I believe (please prepare yourself for a nasty shock, R, even if you know what’s coming) 20 (don’t say I’m exaggerating, R. This is my blog.) people passed the first exam. About 50 passed the second one. Quite a few passed the final exam. Even I passed the final internal exam, that’s saying something. I managed to get a first class on the University (that’s 65% and above)!!! I was so shocked my tooth fell out. The dentist had pulled it out earlier that day, but who can say? I lost a tooth the same day my results came out, and it might be cause and effect, for all I know.

The first time I flunked an exam, I cried the whole night. Cut me some slack, people, (am I carrying the joke too far, R? Hey, that rhymed.) that was the first time ever. I got enough chances to get used to it, and eventually it got so bad that they would declare a holiday every time I passed, so I could throw a party. I laugh hysterically when people ask me if I get good marks at college.

Dissection sessions began on the first day itself. The first thing that hit me was the smell of formalin, which is used to preserve the bodies. No, the first thing that hit me was the door, which did not like being pushed open, and smacked into my nose. The second thing that hit me was the smell. My breakfast threatened to leave my system as fast as it could, but I managed to convince it that suicide is not the answer. I got used to it in a few days, but never learnt to perceive it as anything less than unpleasant. To me, it always seemed like spoilt curd, and put me off curd for a week. The next thing I saw was that all the cadavers were naked. There were 10 in all, and 20 students would be at the same table and share a body (R, please smile here).

I found out which table I was assigned to, got a stool, put it down next to the head, and sat down next to a hyperactive female who told everyone within hearing range (about a kilometre) to run for cover if she threw up. The cadaver was of a dead male, with a shrivelled up body. The skin all wrinkled and dark, no hair, peeling nails, a horrified “I-can’t-believe-I’m-dead-and-medicos-are-going-to-cut-me-up-what-did-I-do-to-deserve-this” expression on his face, mouth open, teeth rotten, no eyeballs, a tag on his toe identifying him as number 9. A couple of days later, we christened him Freddy, after the cadaver my friend’s dad dissected back when he was a first year. Many people name their cadavers; I think there was one called Urumees, from some movie where this guy keeps on saying “Athaanurumees.”

Our dissection manual is called Cunningham, and this is the only text allowed to enter the dissection hall. All textbooks not following this dictum will be sent outside the class through the window, so they stopped coming in. The Cunningham uses extremely simple descriptions, like, “the artery is found medial to the lateral border of the superior part of the humerus, posterior to the supraspinatus muscle, anterior to the inferior part of the pectoralis major.”

I remember my first day. All 20 of us were sitting at our table, in our brand new white coats, staring at Freddy (who didn’t have a name then), and they started the roll call. It seemed to go on forever. Finally, after about a century or so, it ended, and we were told to read the first 25 pages of our Cunninghams. That was when we discovered that the Cunningham had been written in Chinese, so we decided to check if any of our tablemates was from China, or spoke Chinese. We were all bonding and stuff, all senti about “Oh, we’ll be spending the next 5 years together, thank God you’re so nice and friendly, I’ll never forget you as long as you live. What was your name again?’ when the lecturer assigned to our table came up to us and said, “Read the Cunningham? You can start doing it now,” and left. Yes, people, she left.

She didn’t wait to see 20 horrified faces staring at her and went back to the staff table to discuss the latest gossip. Someone (no prizes for guessing who) went and opened the dissection set (a box full of gleaming metal instruments, and an old-fashioned shaving razor for GOK what), asked her, “Ma’am, what do we cut it with?” She laughed and came back, and showed us how to make incisions and reflect structures as flaps and other things. For the record, I did not faint. Off the record, I blacked out the second day, but that was because all the people crowding around Freddy to look at his brachial plexus interrupted my oxygen supply. Anyone who says otherwise will be beheaded.

Physiology was an interesting subject. The Physio lab was where we unleashed the sadomasochists in us. Take a sterile lancet, sterilise the fingertip, prick the finger, get a drop of blood, place it on a... Whoa! Prick the finger? Blood? Stop screaming. (R, I didn’t mean you. It was a joke. You know no one else reads this). Well, yeah, we use our own blood for most of the experiments. Those of us queasy about pricking their own fingers would get their neighbours to do it for them, who would readily comply. Some, like me, got their neighbours to donate some blood. We also did experiments on frogs, getting our white coats covered in soot in the process.

What do I say about Biochemistry? They were the guys who introduced us to urinanalysis. Don’t freak out, (again not aimed at you, R) it was not real urine. The subject was easy, and supposedly easy to pass, but I’ve never passed a Biochem internal exam in my entire life. The University was a breeze, and that’s all that counts, so no big deal.

Soon, everything fell into routine. Lecture classes from 8 to 10, then practicals for 2 hours, lunch break for an hour, and then 3 hours in the dissection hall, the routine occasionally interrupted by exams, fests, exams, batch tours, and exams. Oh, did I mention that we have exams? Because we do, you know. I may have forgotten to mention that earlier, so please note the point, we have exams.

We need to pass all the 3 subjects in both the theory and the practical exams for the University exams to be able to enter the next year. Otherwise we fall into the additional batch. No one wants to be an ‘addi’, so we are under a lot of pressure (the inside of a steam engine pales in comparison) to perform well.

I hated first year. The pressure, the backstabbing, the insane workload, generally a “what the hell am I doing here?” feeling, but I do have a lot of fun memories. Failing to recognise a gluteus maximus muscle pinned for the first spotting exam and writing pectoralis major, completing the records in theory classes, presenting “extra hepatic biliary system” before a baffled batch at breakneck speed, attending a Chinese, I mean cardiology CME because they needed people to fill the auditorium (but we never got any food), staging a dharna at the Principal’s office for some reason (again to give the illusion of number), chaya and vada at the canteen after class…

Explanation of some of the terms:

Backstabbing: I figured I’d get it out of my system, and tell people why I really hated first year. It took me a while to fall into the rhythm of learning stuff so that I'd retain at least 10% of what I'd studied, so I found the first exams really tough. Everyone assured me they had found it really tough too, that they would definitely flunk, flunking was no big deal, blah blah blah. Long story short, every one of my ‘friends’ passed with excellent marks, and they promptly cast me out of the group because I was the only one who hadn’t. The hypocrites. I was miserable for a good portion of my first year. It wasn't until the final sessionals that I fell into track. I had only V (does not understand what ‘read my blog or I’ll kill you’ means), but I saw her only in class; she being a hosteller and me a day scholar, our paths didn’t cross much, and neither of us had a cellphone back then. I still hate the day scholar common room. R (I love you for reading this), A (does not know what a blog is), Twin (will not accept bribes), Small (does not have a net connection) and the others became my friends only after first year. Horrendously lonely doesn’t begin to cover how I felt in first year. Learning things by heart was never my forte (refer my class 10 mark list for the social studies marks), and it's what first year is all about. So many names to memorise. God, how I hate Anatomy.

Spotting exams: These are a part of our practical exams, when a specimen is kept, and a structure is pinned. We have to identify the structure, and answer the questions kept on a piece of paper. There will be at least 10 such specimens, and we have about 2 minutes to answer each one, at the end of which a bell is rung, and we move to the next specimen. We have spotting exams in all the subjects, until final year. Instruments, case descriptions, drugs, gross (gross as in macroscopic, not as in ‘ewww gross’, even though some of them are) specimens, and histological specimens are the ones commonly kept.

CME: Stands for Continuing Medical Education. Seminar conducted for a group of specialists, sponsored by drug companies, where they meet up, eat a lot of good food, and fall asleep while someone drones on about the latest trends in the subject. They would often get the first years to fill up the auditorium, to fool the speaker into thinking he was addressing a large crowd. First years are the only ones to be found together at the same time, all the other batches have clinical postings in different parts of the hospital.

Presentation: This is the bane of my existence. It often involves charts and/or overhead projectors, and rarely, Powerpoint. The victim has to teach a topic to a group of batch mates, and 1 or 2 teachers who will grade the unlucky one. I started enjoying giving presentations only last year, with a Pharmacology one. Took me a while to get rid of stage fright. We have individual case presentations in the clinics, which are less taxing, probably because I love doing it.

Gluteus maximus is the largest muscle in the pelvic girdle, and the pectoralis major is the largest one in the pectoral girdle. Oh, who am I kidding? I mixed up the shoulder with the butt. I have “Number 1 Chump” written on my forehead.

Coming soon, Phase II - The Honeymoon. If and when I write it.

While the Light Lasts

We have been at the RIO for 2 weeks. Things are a little easier, now that we're familiar with the terms, and actually know what some of them mean. I can confidently nod my head when someone talks about PCIOL, and tell others about the ACIOL I once saw, and I can then let my imagination take over, in the spirit of fishermen, and convince them that the patient also had iridodonesis and bullous keratopathy, and was on the brink of death, it was only my timely intervention and presence of mind that saved him. Absolute bull, but only people who know a little ophthal would know that.

The objective of studying medicine seems to be to learn as many cool sounding terms as you can, say, fibroplastic parietal endocarditis with peripheral blood eosinophilia, or progressive multifocal leukoencephalopathy. I don't know what these are, but I sure know the names. Any time I need to sound important, I just talk (in a loud voice) about the case of Creutzfeld-Jakob disease case I saw that morning. Which is again a lot of crap, because CJD is seen only in cannibals. No, wait, that was Kuru. Or was it Gerstmann-Sträussler-Scheinker syndrome? See what I mean?

One of my many qualities, apart from my humility and modesty, is that I will answer any question put to me, regardless of whether I know the answer or not. Let me illustrate, with a scene from my Radiotherapy posting. It was after this class that I became a die-hard fan of the Sir, and he is one of my role models.
Sir: Which thyroid cancer has the maximum propensity to metastasise? Follicular, medullary, anaplastic, or papillary?
Me: Medullary?
Sir: No, try again.
Me: Follicular.
Sir: Come on, you know the answer.
Me: Right. Definitely papillary.
Sir: There's just one more left.
Me: Anaplastic.
Sir: Very good!
Sir smiles. Kya smile hai!
Sir: You're never gonna forget this, are you?
Me: No, sir.
Sir: This is how you learn, from your mistakes.
What a guy! Anyone else would have bawled me out.

But there are times when all the fun and games are forgotten, and we become acutely aware of how much responsibility being a physician carries. When we see a young woman hit by a train whose left leg was brought separately, a dying old man forcing a smile and telling us to be sure and find out what his disease is when we become doctors, a little girl who stops crying when we reassure her it isn't going to hurt and we'll hold her hand if she's scared... And then we stop goofing around, start studying in earnest, resolve to become better students so that we can become good doctors, start taking our studies more seriously, make it our first priority. Unfortunately, this phase never lasts long, at least for me, but while it does, I have this uncontrollable urge to study hard and actually be someone worthwhile.

There was a little girl at the OPD today. She was 6 years old, and her uncle brought her in because she had an intermittent squint. She smiled shyly all the time while she was being examined, and peeped through her fingers. We smiled at her, as we do with all children. Madam enquired why her mother didn't bring her in. Her uncle replied that she'd died when the child was 43 days old, while her father was fighting in the Kargil war, as there had been no news of him for a while. They found out later that her dad was OK. He is still in the Army.

We don't know whether her dad loves her, gives her all the love and care she deserves, when he comes home on leave, if he does come to her. We don't know whether the uncle she's living with takes good care of her. We don't know how her mother died; did she commit suicide? Could she have, with a 43-days-old daughter who needed her? We don't know if she's happy, for all her little smiles. We don't even know what's wrong with her. But that we can find out. It's the only thing we can do for her. We can do the best we can to put her right.

I don't know enough to treat a patient with a common cold. It doesn't require treatment, but that's beside the point. The point is that I'll be a doctor in 2 years, whether I do or not. It may not matter now, but it will, then. If to no one else, at least to me. Because I'll want to do more for that little girl than smile at her.

I think it's time I finally hit the books, with all the seriousness it requires. This one's for you, little girl.

Ulcerated corn-ya

Funny how a lot of terms in Ophthalmology seem to end in ya. Pseudo-fake-ya (that's redundant, but I did not coin the term), a-fake-ya, corn-ya, you've-ya... OK, I'm overdoing it. But I hardly ever do anything, so I tend overdo it when I do. (Bad sentence. Go stand in the corner.)

What I wanted to say was, I took a case! After giving attendance at the canteen, Skoda was distressed to hear that I hadn't seen a case yet, since I didn't know where the wards were. She decided to rectify this horrible situation, and took me to the ward, which was posing as a construction area in an attempt to keep me out, complete with loud noises designed to render a stethoscope non-functional. Errr... Not the stethoscope. No one auscultates eyeballs, so my Littmann is gathering dust at home. *sob*

The first sight that greets me in the wards is an old man being assaulted by a gang of hoodlums. Closer examination revealed the goons to be none other than Tall, Short and Bachhu. On seeing me, they immediately lost interest in the old man and transfered their attention to me.

Bachhu: AP has come to take the case, guys.
Me: But-
Tall: AP will present the case today.
Me: But-
Skoda: I love her presentations.
Me: But-
Short: Cute nurse.
Me: But-
Tall: I haven't heard her present a case yet.
Me: But-
Bachhu: We'll help you.
Me: But-
Skoda: Oh, thanks Bachhu.
Me: But-
Short: Cute nurse.
Me: But-
Tall: Ammava, enthu pattiyitha? [What happened to you?]
Me: But-
Patient: Ente ponnu mone, oru pani vannappo thudangi enikku kannu kanan vayya. [My beloved son, I can't see after a bout of fever.]
Me: But-
Skoda: Sure it isn't another hooch tragedy?
Me: But-
Short: Cute nurse.
Me: But-
Tall: Yeah.
Me: But-
Bachhu: Relax, AP. This will be a breeze.
Me: But-
Skoda: Don't worry.
Me: But-

Everyone ignores me and Tall proceeds to take the old man's history. His left eye (not Tall's, the patient's) was swollen shut, and Short gets the patient to prise it open so we can examine it.

Everyone: Gaaah! What's that????
Patient: A corneal ulcer of bacterial aetiology, secondarily infected with some fungal pathogen.

OK, the patient didn't say that, but it would have been cool if he did. Anyway, the poor guy had a huge ulcer on his cornea, a yellowish opaque area, right on top of the pupil. The conjunctiva was inflamed, red, swollen and fleshy, and looked like something out of a horror movie. It looked worse than the eye in the picture, and that cornea isn't ulcerated. Believe me, this is mild compared to the poor guy's eye. The corneal ulcer paled in comparison, but the two together made for a gruesome combination. I believe conjunctival involvement to this degree is less common.

After completing the case taking, I was led back to the lecture hall. Madam came and asked, "Who is presenting the case today?" Skoda lifted my hand into the air. Tall, Short and Bachhu merely grinned. They'd done it before.

I was made to stand in front of the whole class (29 suddenly unfamiliar friendly faces) and read out the case. I'm trying to forget the major chori [very loosely translated as scratch] I suffered at the hands of that chori Madam. She made me read out each line twice, and by the time I reached the end, I was a nervous wreck.

Madam(after I've read out the history and examination twice): So, what is your diagnosis?
Me(nervously): Corneal ulcer-
Madam: Which eye???
Me: And immature cataract. Oh. *pause* Left eye.
Madam: If you couldn't see the pupil, how do you know he has cataract?
Me: Oh. *pause* Mild immature cataract, right eye.
Madam: Class, is there anything such as mild immature cataract?
Class: No, Ma'am.
Madam (to me): You are such a moron.
Me: Yes, Ma'am.
Madam: So, tell me the diagnosis once again.
Me (sweating profusely): C-c-c-corneal u-u-ulcer, l-l-left eye a-a-and m-m-I mean, i-i-immature c-cataract, r-r-r-right eye.

She didn't let me return to my seat, and I had to stand there while she started speaking to me in Chinese.
Madam: How will you clinically diagnose the aetiology of a corneal ulcer without resorting to laboratory tests? In case you cannot make a clinical diagnosis, what are the lab investigations you will do? Will you do a corneal scraping or a direct illumination fundoscopy?
Me: Huh?

All right, that question is bull, but she did go on and on about aetiological clinical diagnosis and predisposing factors and GOK what else while I stood and sweated. She stopped the class after a collective groan when our watches showed 12.15 and she was still bulldozing along about stages of cataract. Greatly moved by the experience, Short and Bachhu carried me to the bus on a stretcher.

Anyway, I made Tall buy me a Jumbo Chicken Sandwich after we reached the college (the Ophthalmology department is not situated in the Medical College campus). Short and Bachhu couldn't be found.

The ENT people had scheduled a torture session after lunch, but it was cancelled, and we all went home. I spent the rest of the day alternating between the toilet and the bed. I think there was something in my sandwich that had no business being there.

Out, Patient!

I used to love OPD postings, but this is overdoing it. I mean, OP every single day? It's getting monotonous. The main problem is, I think, that we haven’t been divided into units. We don’t know any of the teachers that well, we don’t get to know the patients, we don’t see any procedures being done, and, most of all, we don’t get that feeling of belonging somewhere. It’s 4^th sem paediatrics all over again. That was one of the horriblest postings ever, with the possible exception of Ob-G. In paeds, the problem was similar, we weren’t divided into units, but there it meant we’d never set foot in the OP’s. Ward 4/5, day in and day out, screaming children, hostile mothers. And no ward classes on most days because the teacher was busy. I attribute my dislike of paeds to that dratted system.

I still enjoy the OP, the different variety of cases we see in a single day is amazing. It’s just that I’d like to rest my feet once in a while. I can just about feel the valves of my veins slowly losing the war against gravity.

The ophthal OP is kinda easy. As my cousin, an ophthalmologist, said, in ophthalmology, what you see is what you get. Hordeolum, conjunctivitis, cataract, pterygium, corneal ulcer, and a lot of other conditions are obvious on torchlight examination. I’m becoming something of an expert at distinguishing pseudophakia from aphakia. Oh, who am I kidding? A monkey with a torch can do that. I'm such a fake, ya.

I haven’t presented a case yet. Will do soon. I like taking cases, and I don’t mind presenting them, because I know I’m not that bad at it. I’m not great, but hey, that’s what I’ll be doing for a good part of my life in the future, and I might as well learn to do it right, if not well.

On the subject of case taking, just how do they manage to reach a diagnosis so quickly in an OPD? It’s just not ophthal, it's the same in medicine or surgery or paediatrics, or even one of my least favourite clinical subjects, orthopaedics. How they discard the irrelevant information, how they know exactly which leading questions to ask, and voila! We have the diagnosis. This rarely fails to amaze me. Someday, I’m going to do this, become a great clinician. Even if I have to open my textbook and actually read.

My First Ophthal OP

Dad fell ill, and I had to cut 3 days of posting. Bunking isn't a hardship, even though I like the subject. The only subject I hate bunking is Medicine. Ah, there's nothing like Medicine. The air conditioned lecture hall, bed allotment, our veranda committee, sneaking off to the canteen, meeting the entire unit there, from chief to the house surgeons, taking cases, showing off the stethoscopes, case presentations... God, I enjoyed myself so much. It isn't gonna be the same in final year. You know, I strongly suspect I was rambling.

Wake up at 7-30, ablutions, dressing, posting breakfast, and yada yada yada later, I'm in the Ophthal lecture hall, which, by the way, looks like a schoolroom, complete with charts on the wall (Anatomy of the Eyeball). I was kinda nervous, since I hadn't seen a single patient (10 seconds staring at Bitot's spots on the first day does not count).

Anyway, the PG student who took the class (Anatomy and Diseases of the Pupil) had the same name as me! She was stunningly beautiful too! ;) Must be the name.

I decided to pay attention, and got slightly lost. 3 days of absence does matter. Physiology was never my strong point, but it was better than my knowledge of Anatomy. I still maintain I passed the bloody subject due to Moore (he certainly gets my vote for entrance to heaven, if they take votes for that). Anyway, the class wasn't too tough to follow. Light reflex, near reflex, pathways, abnormalities in pupillary shape, size, number. Yeah, number. I was quite surprised to hear that one eye can have more than 1 pupil. That's abnormal, of course, and fortunately, quite rare.

Skoda, Arch, Lotus (Lotus is a guy, for those of you who aren't batch mates) and I went into some specialty clinic only to get chased out because still-wet-behind-ears on their 1st Ophthal posting students don't know enough basics to understand the specialty, and were advised to move to the OP, where they were all apparently awaited us with eagerness. Yeah, right!

At the OP, we were ignored by everyone. Really busy place, with a lot of doctors sitting behind a small table, about a couple of feet apart from each other, and a large crowd of patients. Most of the doctors were surrounded by our batch mates, the half that has posting in the OP today.One sir, a madam and the unit chief were the only ones who were free. The unit chief was out of the question, we were too scared. We hesitated between the sir and the madam, and finally moved to the sir, who I thought I'd once consulted for my headache. Turns out I was right, but thankfully, he didn't remember me. The four of us stood behind him, and standard medico OP procedure (bending over, straining to catch what the prof is saying, craning our necks to get a look at the patient and the lesion) followed. Most of the patients had hardly sat on the chair and described their illness when Sir made a quick diagnosis and sent them off. The guy's a genius!

Our moment arrived when a patient came with pterygium. Seeing our blank faces, he made Arch get her text and read out the bit about pterygium. I finally know what it is. And that's not all, I know the causes, the clinical features, the pathology, and the treatment. Yay for me!

We saw lots of conditions today, apart from pterygium, but didn't go into as much detail as pterygium. Chalazion, pterygium, cataract, hordeolum, mucus fishing syndrome, and GOK what else.

At 11, we said we had class and went off to the lecture hall. A presented the case, iridocyclitis. We And then we heard there was to be no theory class in the afternoon, so we all went home. Ans so ends the tale of my first day in the Ophthal OPD.

Eye Am Loving It

I started my 4th year postings today. I'll be in the Regional Institute of Ophthalmology for a month, unless the 3rd year practical exams intervene. I know it's too soon to say this, but I love ophthalmology.

The day started off OK. Made my mom find and iron a clean white coat. The coat and steth had been in hibernation for the past couple of months. Had my usual 'posting breakfast' (a glass of milk with some Horlicks or something thrown in for that 'extra energy') and rushed to college in an auto, listening to the driver ranting about the death of his friend's dad today morning!. The ride ended soon enough, thank God.

The college bus took us to the RIO, and had to put up with the usual teasing, "Sit here, AP, with him. Come on, don't be shy.", inside the bus. I'm gonna kill that K and his friends. I hardly ever speak to the guy in question.

It felt like school reopening day, with the rain and all. We were told we'd have a morning lecture, then be split into groups for posting in different places (OP, wards, clinics) for an hour, and a class again after that. I didn't know much about ophthal, in spite of having a zillion relatives who are ophthalmologists, and was surprised to hear of specialty clinics like 'Cornea Clinic" and "Squint Clinic".

The class a whirlwind through the history and examination in Ophthalmology. I caught a couple of new terms here and there - ectropion, metamorphopsia, pterygium... I found the class interesting, unlike most of my friends.

To cut a long story short, Skoda and I found ourselves in the cornea clinics, losing Arch and Hope on the way, after visiting a couple of other clinics. I loved it! The madam there wasn't the yelling kind, and told us to bring torches the next time, or get kicked out, quite civilly. Neither of us realised that was a tongue lashing until we thought about it. Nice change from the "Get out of my OP, you useless bit of excrement who can't carry even a torch! Don't ever show your worthless face in here again. " bit we've been hearing since the clinical postings started. Frankly, it's insulting to hear that in front of the patients who don't respect you anyway since they always recognise students by the slightly apolegetic air we assume when talking to the patients.

Since it was our first day, and our knowledge of the subject was next to non-existent, we were told to look around at the instruments and charts. Thanks to my chronic headache, I'd been tested for visual problems and knew what some of the instruments were for. The thingy for checking the IOT is placed on the eye, and it looks a little like the compass from geometry class. Scary! But the cornea is anaesthetised, so it won't hurt. Trust me on this, I've had it done.

I was really surprised to see the by-standers (hate that word, personally, I prefer the term relatives) being treated just as nicely as the patients, being told to sit down and all. There was a really funny incident when Madam was telling us that the patient had a little tension after checking the IOT, and the patient's daughter affirming, "Yes, she's a little tensed, Ma'am."

I saw my first case of Down syndrome that's been pointed out to me as a Down. Pretty sad. The kid was really kinda smart, and I couldn't help being sorry for him, standing there with his little hands in his pockets, doing everything he was asked to with alacrity, totally unaware of the significance of the whole thing. I also saw my first Bitot's spots, and described it correctly. Proud moment! Of course, any idiot could do that, but me idiot did it first. :)

We didn't have any class after the clinics ended, and went home (no afternoon lecture today) by ordinary bus after we learned that the college bus wouldn't be coming.