Wednesday, October 24, 2007

Sword Swallower

I tend to be suspicious of hype. I was totally prepared to be unimpressed. But I didn't expect it to cater to my kitschy tastes. And the result? I fell in love. There you have it. Straight from the horse's mouth, although I am not a horse, and will kick anyone who calls me a mare. I'm talking about Om Shanti Om. It's very unlike me to like a song because I enjoyed the video, but KK's voice has a peculiar way of frying my brain. And, like I said, I'm drawn towards kitsch. I can offer no other explanation. Go watch it.

I'm trying to delay the inevitable, but I can't think of anything else right now. Oh wait, there's this. Very impressive.

By the way, I passed the ENT end posting. I wasn't expecting to.

Do you still want to read about my boring life? Come on, there are millions of better things to do. Like picking your nose. Um, you still want to know about me? Although it beats me how anyone could be interested in the dreary event that is my existence. OK, here goes. *gulp* I have a confession to make- I love Orthopaedics. Who would have expected it to be so fascinating? Mind-blowing, utterly bewitching, yada yada yada. No, this sudden change of heart has nothing to do with the cute PG student in my unit.

First day. We entered the ward, and scanned it for the presence of white-coated figures. There was one. Bandaging somebody's leg. The figure straightened, and we went up and introduced ourselves as the new batch of students posted in Ortho. He said he was a PG student, and told us to go meet the unit chief. Suddenly, a child with CTEV handed him a toy, and he turned and smiled at her. I immediately went into ventricular fibrillation. Oh. My. God. That kind of smile should be made illegal. No wonder the sex ratio in the state is plummeting.

I was so disoriented that I agreed to present the case. That too on the first day, when no one knows what to do. Needless to say, it turned out to be a joke.

A little boy brought with a painful, swollen knee. I had to bribe him with chocolates before he allowed me to examine him. That brought back horrible memories of a child with Tetralogy of Fallot in Paediatrics. The case sheet (which we aren't supposed to refer, so we never fail to do that) said he had septic arthritis, and I was in no state to disagree. As luck would have it, the child turned out to have pyogenic osteomyelitis. Fortunately I'd mentioned it as a differential diagnosis. Seems it's really hard to distinguish between the two clinically, unless you do some special scans. That was forgiven. The rest was not. The skin overlying the swelling was not red, as I had stated (gundadi, roughly translated as bluffing, is my birthright), in order to give added weight to the diagnosis of an inflammatory condition. I'd forgotten that the kid was coloured like coal. I also managed to knock over the X ray lobby, after which I got so flustered I held the X ray upside down. I don't know how to read an X ray, stop asking me to do that. Anything other than a chest X ray, that is.

The next day, a PG, who had been present during my joke presentation, took a class on fracture neck of femur. Dammit, he didn't have to tease me about the red skin. Like we needed a reason to laugh. My unit mates are notorious for giggling at inappropriate moments.

Our teachers are having a lot of trouble digesting the fact that we had a month's posting last semester. They also cannot believe that we have, in fact, passed our Anatomy exams. I was forcibly reminded of the existence of structures like the rotator cuff and bicipital aponeurosis. If teachers ask unnecessary questions, they should be prepared for our answers. We also teach them new things, like, the nerve supply of the supraspinatus muscle is the axillary nerve.

I'm rambling, am I not? Blame the PG for scrambling my brain. I'm not the only one, by the way. Skoda had diligently read up fracture neck of femur when she came the next day. I can tell you everything about the Gustilo and Anderson classification of open fractures in my sleep. Arch is an expert on the different types of sequestra. I would have topped every single exam if all the departments could boast of at least one specimen of such magnificence.

Dear lord, how time flies. I have to go read chondrosarcoma now. The PG said he'll ask us questions tomorrow. Skoda and Arch stand no chance against me. Hah!

Friday, October 19, 2007

The ENTing

I'm done with ENT. Yay!

The end posting exam was an unpleasant experience I would definitely not care to repeat. The highest point of the exercise was when the examiner gave me a clue to the answer (pilot) and asked me to name the person who flies in the sky. Unfortunately, I grew up on a diet of comic books, and still need a fix every time I feel down. Nothing like people wearing underwear over their clothes to cheer you up. Things went downhill from there. Technically, I did give a correct answer, but the examiner misconstrued my enthusiasm for the man of steel as impudence, and soon, I found myself being bodily ejected from the room. I hope she gave me a pass mark for correctly identifying the radiograph as an X ray of the chest, with a neck attached to its upper end.

The ENT department would have been a nonentity without that St Clair Thomson guy, which, if you ask me, is a very silly name for a man. Every other instrument seems to be named after him. It could be 2 people, St Clair and Thomson, the bestest of friends since Thomson and Thompson. But I still maintain that a man named St Clair would have been regarded with contempt by his peers, but not Thomson, who would have had forceps stuck up various orifices had he expressed his disdain. So we have St Clair Thomson quinsy draining forceps, St Clair Thomson adenoid curette, St Clair Thomson long blade nasal speculum, St Clair Thomson post nasal mirror, etc. By the time the surgeon finishes asking for a St Clair Thomson adenoid curette without guard of a different size, the patient would have half bled to death. But wait a minute an hour. Here comes Mollison's blunt tonsillar dissector and anterior pillar retractor to assess the damage. Hold that bleeding point with the Waugh's long dissecting forceps with tooth, while I get some gauze to stuff up the area using my hands. ENT is a weird subject.

I'm afraid all this rejoicing is useless, since I have Orthopaedics next. As if I haven't had enough of nailing and hammering with all the work being done at my neighbour's place. If any male wants to make a sexist remark like 'Orthopaedics is a man's work, you had better stick to Ob-G', please give yourself a castration. No, you won't need any surgical skill or anaesthetic. I promise you, it will be painless. I do not want to look back when I'm 70, and think, I think I spent a total of 3 years probing somebody's vagina.

I wish we could have all those kutti/chhottu/tiny 2 week postings again. Except for the Family Planning one, naturally. I do not want to watch an abortion being performed again. The sight of those tiny feet lying in the dustbin were more than what I could handle. There are genuine cases, when the pregnancy has to be terminated, but most of the women attending the FP OPD wanted to get rid of an unwanted baby. Why the **** don't they use contraceptives if they don't want more kids? I don't blame the FP guys for forcing contraceptives on those murderers. Doctors aren't hired killers.

Dental posting was fun. Every single day was spent at home. I think it was my favourite posting ever. I enjoyed Psychiatry until they took us to the Mental Hospital, where the incurably ill patients were. I still have nightmares about that place. Don't get me wrong, the patients aren't mistreated there. I only discovered that insanity is no laughing matter.

I loved my 2 weeks in Radiotherapy. Not out of any particular interest in the subject, but none of us girls missed a single class. *sigh*

Oh, and how can I forget Respiratory Medicine? It was like going on a picnic everyday. The Resp department is on the top of a hill, about 15 minutes from the college, and the view was awesome. We once bunked class to climb up the terrace, from where we could see for miles. It was Omigosh's class, so we weren't missing out on anything, unless you count our first hand knowledge of the deplorable state of medical education in the state as being insufficient. We know we're a bunch of incompetent idiots, thank you.

The kutti postings were also a a great excuse to catch up on gossip. I think it was during our ROME (Re-Oreintation of Medical Education, or the posting to which all the corridors lead) posting that we took turns measuring each others' shoulder breadth, height, and um, certain circumferences. Mid-arm, O corrupt souls.

I loved chairing the verandah committees, heading the restaurant inspections, organising the pilgrimages to the beach, being initiated as shopping Guru's disciple... Kutti postings. Those were the days...

Wait a minute. I believe this post had something to do with my delight at the conclusion of my month long ENT posting. I knew I was in deep trouble earwax the day I heard a professor say, 'Wax removal is an art.'

Wishing you all a Happy Vijaya Dashami. It's not a very happy occasion for me, in spite of having gotten rid of my textbooks for a while. I don't like the herbivore that has taken over my body.

Sunday, October 14, 2007

Medicine 101

It has come to my knowledge that people have strange ideas about the medical profession, and in particular, about medical students. Like, we are always found buried under piles of textbooks. I have been authorised to abort these misconceptions. By whom, you might ask. Authoriser, authorisee, author, all me. We do not believe in outsourcing.

1. All medical students (and doctors) are brilliant.

That one's true. Except for that hag in Physiology who flunked me in first year. And that snot-nosed guy who keeps sending me love poems. See for yourself.
Patient presenting with head injury after falling from a tree. Medico takes the history.
Medico: How did this happen?
Patient: I fell from a coconut tree.
Medico: Do you have a family history of any relatives falling from coconut trees?

2. Medical students spend all their free time studying.

Of course not. We engage in a number of activities that do not involve books. Like examining each others' tympanic membranes, scouring the wards for patients with heart murmurs, listening to professors bragging talking about their surgical skills, helping our dearest professors de-stress by having them shout at around us, honing our assmosis skills, etc. After these extra curricular activities, we unwind at the on-campus, free, air-conditioned dormitory known as the Library. A few of the pillows we used last year are are shown on the left.

3. Medical students are arrogant jerks.

I was very shocked to hear this one. We are not arrogant. Filthy Muggles! How dare you speak of us that way? *points knee hammer* "Avada kedavra!"

4. Medical students do not have a sense of humour.

First of all, I doubt that sentence is grammatically correct. Shouldn't it be senses of humour? And it is absolutely untrue. It may be a warped sense of humour, but it exists.
Me: What does a patient with diplopia say when he sees a bee?
R: Two bee or not two bee?
Me: Yeah, muscae volitantes (a condition that is also known as 'swarm of bees').
Both: Hahahahahaha!

5. Medical students (and doctors) do not fall ill. Ever.

Yeah, we gave up our humanity when we chose this profession. And the initiation ceremony involves a bone marrow transplant from Wolverine.
I think there was one person in my class who did not get measles during the outbreak last year. Me. Because I was at home recovering from chicken pox.

6. Medical students start minting money as soon as they graduate.

This one doesn't even merit an answer.

7. Medical students are the ones performing surgical procedures in the medical colleges.

I have done 4 thyroidectomies, 3 laparotomies, 6 hysterectomies, 2 hernioplasties, 8 tonsillectomies, 5 CABGs, 2 hip replacements, 4 face reconstructions, and 7 appedicectomies. Jeez! I haven't even seen a CABG. I have given a blood transfusion once. Meaning I hung the bag of blood on the stand. I can draw blood from veins, but so can a lab technician, and they do it better.

8. Medical students are interested only in Medicine.

I have no idea how this one started. Is it because we are called medical students? This bears no semblance to the truth. We are also interested in Surgery, Obstetrics & Gynaecology, Paediatrics, Orthopaedics, Anaesthesia, Ophthalmology, ENT, and in sub-specialities of the above, although individual preferences will vary.

9. Doctors make easy money for a simple job.

36 hour shifts are all in a day-and-a-half's work to a doctor. Occasionally getting beaten up by drunk patients is part of the fun. Physical exertion is definitely not a problem, especially to those who perform an average of 4-6 CPRs a day. Not if you're built like a pre-bite Peter Parker. Oh, and a starting salary of 4 figures unquestionably falls into the 'easy money' category.

10. Medical students are hard-working.

There are some of us ruining our reputations this way, but most of us would be insulted if we were called hard working. Our brilliance lets us make do with all-nighters before the exam. Oh, and most times, it doesn't feel like work. :)

That should do away with a lot of myths. OT tomorrow. I have an adenoidectomy to perform. Good night.

Tuesday, October 9, 2007


What happens when a hypochondriac starts learning Medicine?

My mom is convinced that I am one. (I'm not.) She reminds me of the time I 'pretended' to have appendicitis to get out of school. She says I got the idea from Roald Dahl. I had fever, I vomited, and the paediatrician hurt me when he palpated my abdomen, so I winced. He told me it was appendicitis. Reading 'Boy' the week before had nothing to do with it. Come on, how could an eleven-year-old know where the McBurney's point is? But my mom insists that my getting well in a week, without surgery, had something to do with me faking illness. *indignant*

I'm not a hypochondriac, but I do tend to think "Hey! That's my symptom." when I read my books. Who hasn't felt that way? But that doesn't make me a you-know-what.

We were told to auscultate our own hearts as homework, during our Medicine posting, to know what a normal heart sounds like. I swear I wouldn't have done that unless they'd told us to. The time when I got my new stethoscope doesn't count. I had even auscultated my cat. So, the homework. I looked at my Littmann. Littmann stared back at me. I gently put the ear piece in my ears (duh!), and lightly tap the diaphragm. Whoa! That was loud. I place it on my mitral area. Lub-dub. Lub-dub. Lub-click-dub. Lub-dub. Lub-dub. Wait a second. Was that a mid-systolic click? Lub-click-dub. Lub-click-dub. Yes. It is. *thunder and lightning* (for effect)

Mitral Valve Prolapse. It's not as scary as the name. It is usually asymptomatic, non-progressive, and benign. The only disability is that patients can't travel to the Moon. Or got to outer space. Some of my cousins have MVP, and so does my brother. That's a positive family history. Marfanoid features is another indicator. Um, yeah, that too. Some.

I looked up MVP on the net. I was all "Oh boy! Oh boy!" while reading it. To quote, "The typical profile is a slender (yeah, baby!) young (yeah, baby!) female (yeah, baby!) with long, tapering fingers (yeah, baby!) and a model’s figure (Oh, boy! Oh, Boy!)." Can you blame me for thinking have MVP? Also, people with MVP are high strung, prone to anxiety attacks, and have a hypersensitive startle reflex. All me. It doesn't require any treatment, so I haven't gotten it confirmed. I'm sticking to the 3rd rock.

That doesn't make me a hypochondriac. Meet a true hypochondriac (I checked, it doesn't have any synonyms.), my friend Fat (name chosen for obvious reasons). It was summer, and she wasn't drinking as much water as she should have been (given the state of the toilets in the common room). Her pituitary compensated by increasing its ADH production.
Fat (after a trip to the toilet): Nothing.
Me: Oh.
Fat: Could it be renal failure? Like that patient we saw today?
Me (checks pulse): Looks normal. No oedema. Um, doesn't look like renal failure.
Fat: But there's definite oliguria. In fact, I might even say anuria.
Me: Anything else?
Fat: Very irregular. Only once or twice a day. It's dark.
Me: And you think it's renal failure? Seriously?
Fat: It isn't?
Me: If you'd use that brain of yours, assuming you have one, you'd know.
Fat: Oh, yeah. Man, can't believe I missed it. Enlarged prostate!
Me: (I didn't say anything, but you can imagine the expression on my face.)
Fat: Oh. You were saying?
Me: Drink more water.

My brother told me about the 3rd year syndrome, a condition that affects medical students who have started their clinical postings. He looked forward to my claiming that I had hydrocoele*, because he considers me a You-Know-What. Fat's enlarged prostate certainly gives her Voldemort status.

To use a dreadfully clichéd expression, on the other side of the coin, there are many genuinely ill people who pretend they are perfectly well. One of the guys in my class (let's call him Leg) came to the Orthopaedics OPD, with muscle weakness. He'd been shifting rooms, and Sir laughed and said it was due to the strain, and prescribed a pain killer. But something in his gait warned Sir, and he called Leg back. He asked him to squat on the ground, and get up without using his arms for support. He couldn't. Proximal muscle weakness. Leg insisted he was fine, but he was forcibly referred to Neurology, where he was diagnosed with Guillain-Barré syndrome and was hospitalised. (He recovered completely, in case you were wondering.)

One of the things I do have is migraine. I've had it since I was 8, with all the classical symptoms. It doesn't come on very often, once in a few years or so, but when it does, it's hell. I need a dark, soundproofed room to rest in until the attack passes, with a toilet close by so I can go puke my guts out every 2 hours, and loads of painkillers that don't do any good. Since it's the classical type, I can prevent an attack as soon as I start seeing shimmery lights. The last episode was 4 years ago, and I can't tell you how happy I am about it.

Ordinary headache is one of my pet miseries, there's never a time when I don't have even a twinge. Sometimes, it gets really bad, with severe pain in my eye, like a red hot poker inside my skull is trying to gouge my eye out. I've consulted plenty of doctors, they would give me Paracetamol, and that was it. But it never did much good.

Imagine my horror when I heard one of my teachers saying 'severe pain in the eye, usually unilateral, throbbing in character, is typical of migraine. If not preceded by any aura, it's common migraine.' I have both kinds of migraine? Oh. My. God.

I had an atypical migraine headache yesterday. I'm supposed to start long term drug therapy if I get another one soon. I'm hopelessly forgetful when it comes to taking any sort of medicines on a regular basis, but something tells me I won't forget it this time.

*Seemed like a good opportunity to reminisce about a hydrocoele surgery I saw. It was a huge one, and it splashed all over my mask when they were cutting it open. Ewwww! moment.

Saturday, October 6, 2007

Not Again

I got this SMS yesterday.
"The SPM exam to be held on 11th has been preponed* to the 9th."
That's when I knew an exam had been scheduled for the 11th.

SPM stands for Sleep Producing Medicine, known in some places as PSM, Pain of Studying Medicine. Because of these flattering expansions, the Social and Preventive Medicine people have changed their name to Department of Community Medicine. We, the tortured, continue to call it SPM, of course.

The ENT people are away at some conference, and there are no classes for a couple of days. I have plenty of time to drown in the Park (that's our SPM textbook), but somehow, I can't do it. Exemplifies my innate laziness perfectly.

This SMS did the rounds a few months back.
Life of an MBBS student:
Kapde hai, Pressed nahi
Wallet hai, Paise nahi
Lecture hai, Attendance nahi
Mobile hai, balance nahi
Friends hai, Girlfriend nahi
Exam hai, Tension nahi
Padhna hai, Mood nahi.
For the Hindi challenged, the rough translation looks something like this:
We’ve got plenty of clothes, but they aren’t ironed
We have wallets, but they have no money in them
We have lectures, but not enough attendance
We have mobile phones, but there’s no balance
We have friends, but no girlfriend
We have exams, but we aren’t tensed
We have lots to study, but we aren’t in the mood to.
This also illustrates the simplicity of Hindi, but that's beside the point.

I have to go study mug up the subject (understanding it is beyond my capabilities) now. I hope all the dust on the book won't make me snore.

*I know there is no such word, but hey, this is India. We speak our own brand of English.