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.