Lone Traveler

 

When one steps into med school in first year, it feels like being in a forest of unknown faces. While some people are lucky enough to find some of their known faces in this crowd, not all have such luck. Slowly introduction begins, followed by exchange of phone numbers. Before we know it we are divided into a couple of huge groups. Study groups form, as in first year everyone is motivated and reading all the standard textbooks seems like a status symbol.

However, the funniest part about these groups is that, seldom do they remain intact. As the so called “friends” show their true faces, hearts are broken, trust is shattered and phone numbers are blocked or archived. The study groups then fall at the bottom of your contact list waiting to create a surge of nostalgia before being permanently deleted. Sometimes it is about two friends liking the same person, at other times it is about inferiority or superiority complex based on the all-important, “Mb results.” After all, not many people have the openness to accept that the friend you used to teach and help before exams ended up scoring more than you.

But humans are social beings after all, and hence they form new groups again, smaller ones this time. These new friends initially seem so much better than the seemingly toxic groups you left behind. The initial few days are spent in discussing the ‘red flags’ of the people you left behind, or who decided to leave you behind. But soon, even the new group seems only slightly different from the old one as new ‘red flags’ are discovered. Actually, knowing a person is like viewing a slide under a microscope, the closer and more magnified view you get, the more pathologies you are likely to find. Finally, when they decide to enter ‘khep groups’ in final year without telling others the decision to label them as selfish, self-centered ‘batchmates’ seems only too easy.

At the end it is only you and your closest friend(s) who decide to stay, and accept your ‘red flags’ as they are. The others reduce to people you say “Hello” to in corridors or who ask for pdfs before Final MB. Though we have many friends to start with, by the end of Final year, we are essentially solo travelers, left with colleagues or batchmates, not friends. Some people become so much like strangers that one is even scared to ask, “Hey we were best buddies once. Remember?” A small voice inside us says, “Leave it. They probably do not remember.”

This is probably what makes final MB tougher, as one cannot turn to others for support, everyone has to fight their own battles. Does this mean that people stop helping each other? Definitely not. They still provide crash courses to each other outside exam halls, ask doubts, roast that one examiner who kept asking questions like “What do you think was the relation between Bailey and Love?” But that’s all. Thus, when at night you are alone in your study room at home, or your hostel room and the syllabus seem too tough, too big and the exam too near, you tend to call up your mother only to hear that small, “Everything will be fine tomorrow, sleep now.”

Photo courtesy- Shuvojyoti Rakshit

Someone once rightly commented, “If after MBBS you end up being in touch with even six of your college friends, it is great.” Movies like “Chhichhore” or “3 idiots” give us utopian ideas about college friendships but no one prepares us for the harsh reality. So, when reality strikes the heart protests a little, “This was not how it was supposed to be. Where did I go wrong?” The answer to this question is nowhere to be found. Maybe it is a part of adulting to be able to suck it up and move on after someone leaves. But is it the right thing to be expected from a person- to leave or to be happily left? How can we trust anyone then? God knows.

 

 

The perks of being a first bencher

 

On the first day of school, sometimes even on the first day of college, our parents teach us about the perks of being a first bencher. They tell us that first bencher is the first step towards becoming a topper. In college however, the attitude changes and the middle and last benches tend to fill up faster than the front benches which mostly remain empty. This trend continues till third year. In final however the picture changes entirely. One finds a long line of students standing outside the doors of seminar rooms waiting to run to the coveted front row as soon as the door opens. Sitting in the class feels like a musical chair contest, where chairs are literally snatched away even before one can blink.

This scenario continues in most classes throughout the year until exam comes up. Then one finds most of the confident first benchers rushing back to occupy the back benches because, the saying goes: “Desperate times call for desperate measures.” If you are late to the exam hall or attract too much attention to yourself, the invigilator might invite you to occupy the ceremonious “First bench”. While most examiners prefer to bring the back benchers to the front bench, there are certain masked men who prefer to bring the already doomed first bencher further forward, that is, when two front rows are empty, they call the poor third benchers (technically first benchers) to fill the front row. If you had this sort of an experience during semesters and thought that it could not get any worse, well this author then has to tell you that it can.

Photo courtesy: Dibya Adhikari

Sitting on the front bench during final MB right in front of the CCTV and the observer’s desk is a different game altogether. The Dean of Student Affairs asks the poor first bencher everyday, “How’s the paper?” Probably she expects an answer different from, “Its terrible.” But one doesn’t always get what they expect in life. One doesn’t get to turn, has to talk in sign language if at all. At any point of time, one finds at least one among the many invigilators staring her down. As the observers munch on tasty patties, the poor first benchers are distracted by the smell, and find their stomachs groaning as exam time breakfast tends to be light for most people. The torture doesn’t end there. One gets to be within earshot to hear departmental gossip, family issues of the invigilators and how they believe that this generation is doomed.

While some invigilators are kind enough to provide some MCQ answers even without asking, most others are not so. Some of them make up ridiculous rules like: “No extra sheet can be given in the last 30 minutes.” Some others like to take away students’ answer sheets in the middle of exams and another third group, shout so much and so suddenly that students tend to drop their pens as a startle response or forget answers they were about to write. As someone once said, these strange people, as soon as they catch someone cheating, react in such a way as if they have caught an entire gang of drug dealers.

To add to the students’ woes come a bunch of perverted bouncers who take the opportunity of frisking to touch the poor students in inappropriate ways. One wants to scream, “Why are they getting money for doing this, while I have to toil through this month-long torture just for a meagre internship salary?”

But dear reader, if at any point of time in the exam hall, you feel helpless, do remember to look at your first bencher friend who sits infront of a bunch of observers, and try to imagine yourself in their place, you will probably end up feeling better. Do not tell yourself that the person is writing so much, and probably does not need help, because you never know exactly what a person is writing, and how much related it is to the question asked. So, take a chill pill and thank your lucky stars that you are not having to listen to the chatter of your irritating invigilators.

Photo courtesy: Unknown

 

 

" What is your case?"

 

The answer to the question in the title is something we all know: “I am a case of hyper-syllabus hypo-preparation syndrome, Sir.” Sadly enough, this answer doesn’t fetch any marks. Final MB is probably the last hundred meters of the marathon race of MBBS and it is not for the weak-hearted. This becomes clearer as one stands with a smile in front of a sadistic Professor with a Golden Littman proudly hung around his neck, constantly reminding oneself, “DO NOT CRY HERE!”

The centre of attention for students in Final MB practical exams is the revered and feared demon called “Long case.” This is essentially a patient, whose entire history the student has to collect painstakingly and come to a diagnosis about his condition. This is more easily said than done. Some tired and irritated patients give you the wrong history, changing it entirely in front of the teacher, while some kid keeps howling at the top of his voice no matter how many chocolates you give him or how much you sing for him. Some students are unlucky enough to land up with patients who have so many diseases and complications that they are no less than a textbook themselves. The question one faces in the exam hall is, how much to write? If one writes complicated symptoms, it invites unwanted questions, and on the other hand if one misses points in the history, one earns praises like, “You can’t even write a history properly? You are definitely not eligible to pass.”

Photo courtesy: Ritadeepa Jana

Someone once rightly commented, “It is easier to become a long case than to prepare for one.” This author feels that an important part of preparation for any viva, be it long case, short case or tables, should be to practice lip reading, so that if a kind PGT tries to prompt an answer you are not stupid enough to miss it. While some professors come only to traumatize students there are some others, who do not really consider the exam to be an exam. To them, it is just another class in the ward during which they kindly teach students operative procedures like “Evisceration of sac.” When this category of professors asks at the end of the viva: “How do you think your viva went?” one finds herself at a loss to answer. The mind wonders, “Did I even answer any question? Wasn’t it mostly him teaching me?”

If the patient is a baby, there are other issues like, the patient might decide to poop during examination, or both mother and child might decide to follow the Gandhian philosophy of Non-cooperation movement or the child might decide to cry in front of the examiner. As a professor of Pediatrics once rightly commented, “If the child cries during examination, you have to cry too.” But what does one do if the child doesn’t stop crying inspite of the student’s best efforts? Well, the answer to this question is: PRAY.

There is yet another entity called as a short case in Final MB practical. The term “short” case is a misnomer. This is essentially the same as long case minus the writing part. The duration of the viva depends on the nature of the examiner and the performance of the student. Often this is such a case which one NEVER saw throughout the entire duration of final year. Cases like Tetralogy of fallot, hypospadias, papilloma and osteoarthritis make appearances in this so called “short case”. In most cases the only way to prepare for such cases is through hall collection, during which one goes on asking anyone and everyone, “Hey tell me something you know about this topic. Anything will do.”

Photo courtesy: Shuvojyoti Rakshit

The answer to the question in the title can be very tough as, the answer you say may not fall into the examiner’s idea of correct answer. Not many examiners are kind enough to understand the condition of students, so the viva tends to be grueling, physically and emotionally. One way forward is to accept the situation with a smile and wait for that one easy question the examiner decides to ask, answering which can be the game changer. But mostly, one is so drained by the end that even easy answers evade us. This is why during such situations, we must constantly remind ourselves: “It is not over until it is.”

Concentration Camps

 

It is often said that government hospitals do not offer much space to their patients who often have to spend days lying in dirty trolleys in the corridors and cannot be provided with beds. But people seldom speak of the plight of medical students who do not have proper classrooms to learn in. One can argue that wards are the best places to learn directly from patients. True that. But they probably forget or have never faced the plight of being one of the 40 students barely breathing inside a room meant for 6 people at max on a hot summer day trying their level best to concentrate on a chest Xray showing “Egg on string” appearance. The mind at that point becomes a perfectly reflective surface through which no studies seep in and the only thought one has is to jump out of the window.

The same can be said for ward classes during which hapless students standing at the back barely get to peep in and observe clinical examinations. Students often have to hear, “Why don’t you attend classes?” But why would they if class means standing in the ward for 2 to 3 hours being able to see nothing. While NMC recommends small group learning, the reality couldn’t be further from that. Whether one gets to learn in “small” groups depends entirely on the “Unit division”. Some people are unfortunate enough to be posted in units where the teacher asks them to get lost on the very first day refusing to teach or the teacher himself/herself remains lost only to show up on the last week of posting and grumble “Where were you people all these days?” Then again, in the exam these lost teachers are the ones who say, “I have never ever seen you in the ward. No wonder you know nothing.” These unfortunate ones have to loiter from one unit to another often at the mercy of their batchmates who sometimes shun them unkindly for increasing the crowd in their assigned “Small groups”.

Are the people who send their friends away from their own assigned units toxic? Probably not. They do so because of the increasing crowd which makes learning difficult as well as because of some of the over-enthusiastic students who always want to be in front during every class and do not want to make a single compromise, thus forbidding the people at the back to see. One at times wonders why they do it. Well, the answer probably is the fact that by the end of third year most wise people realize that MBBS is essentially a cut-throat race and it is easier to treat it as such instead of falling into stupid emotional traps like friendships or wanting to grow together. In this game of “survival of the fittest”, there is no room for letting others grow. Also, is there a guarantee that tomorrow in a similar situation the other person will step aside for you? Thus, a vicious cycle begins.

In a desperate attempt to learn, one takes the help of unstable chairs, stools or even patient beds to stand up and have a bird’s eye view of whatever is being taught. Unfortunately or fortunately, till date no student has fallen to have a fracture and make the authorities realize the sorry state of UG med students. Will an accident be enough to open their eyes anyhow? That is indeed doubtful.

Does this problem only affect the students? No. It affects the patient who is sick and yet has to put up with 20 students staring down at his groin and then practicing hernia examination on him one by one. It also affects the teacher who has to teach without kicking the hapless female student who sits at his feet during class, that too in kho-kho position, to take up minimum possible space.

Is the situation entirely as dreadful? Probably not. Some departments do offer air-conditioned seminar room where the old HOD Sir still teaches the students the art of clinical examination. Some other departments offer spine-chilling large seminar rooms where less than 10 students have to appear for a quiz under the scary supervision of their masked professor. As they say, silver linings! But that doesn’t lessen the problem itself. Will a time ever come when MBBS students can have classes like normal humans? As far as the current situation indicates, not anytime soon.

 

 

THE "CORRECT" METHOD

 

From one’s childhood one is taught the correct method for a number of activities like the correct method to brush, to tie shoelaces or to fold clothes neatly. We absorb these methods by seeing our family, teachers and friends and being able to do such day-to-day activities properly and independently improves us and makes life easier. MBBS is no different in this regard. A medico is supposed to learn the correct method of patient examination by carefully examining their professors and Post Graduate Trainees (PGTs) so that day-to-day patient care gets easier and more effective.

One learns the correct method to palpate a patient’s organs or the best way to elicit reflex responses from a patient. One also learns the best method to coax a crying child to measure his head circumference (Pro tip: Singing about "Washing Powder Nirma" might help sometimes.) or the correct method to wash one's hands in six not-so-quick and not-so-easy steps.

While one spends a lot of time and energy trying to acquire these skills in the ward convincing unwilling patients to cooperate with the learning process, or reads standard textbooks to know the universally accepted methods of clinical examination, in the end the only realization that hits hard during Final examinations is that there is no such thing as “correct method” or “accepted method”.

One can learn or practice a particular method but will it be accepted as “the correct method”? Well, that depends on sheer luck. If “your method” is the same as “examiner’s method” then probably yes, but if the two turn out to be even a tiny bit different then “you are not fit to pass”. No matter what you have done throughout the year, only luck can decide whether you will hear praises or go home in tears.

Speaking of “correct method” one wonders “Does the correct method of conducting an examination consist of telling a student that you are unfit to pass right at the beginning of an exam? Why is the exam divided into so many parts if only one viva can decide everything about one’s abilities?” One also wonders why all standard textbooks mention atleast 3-4 methods of palpating organs if there is just one correct method. Ultimately the difference between the “textbook method” and “examiner’s method” or “student’s method” is much like the difference between a language and its various dialects. While language consists of what you say, the dialect mainly refers to the way you pronounce it along with some fine tuning of the words. If one speaks a certain dialect it does not give him or her the right to insult another one. But alas! Life is seldom fair.

How can this problem be solved then? One way can be to bring out SOPs (Standard Operating Procedures) of all the different clinical examination methods alongwith videos which the students can follow and the examiners, under no circumstances, can deny. However, this is a huge task and as the saying goes, “Who will bell the cat?” So, students can only continue to suffer while clinicians continue to devise their very own, personalized, “correct methods”.

 

 

Khepology

 One of the things final year of med school brings into one's life, besides anxiety attacks, dark circles and constant fear of failure, is the ordeal of "Khep classes". This weird term refers to a set of extra ward classes which final year students take under the guidance of Post Graduate Trainees (PGTs) in order to gain clinical exposure and learn the art of patient examination. 

At the very beginning of the year starts the crazy race of getting into "Khep" groups under various PGTs. Some outstanding students join multiple groups for the same subject to earn themselves the golden title of "Khepologists". While the morning ward classes go predominantly unattended, many students leave themselves entirely to the mercy of these all-important "Khep" classes. Such is the craze about these classes that one sees friendships breaking over one question: "Why didn't you add me to this particular khep group?" The answer to : "Which Khep group did you join?" is guarded as a national secret worth dying for by most students who would rather answer questions about their private fantasies than about khep.

Each of these "Khep" groups has an organizer- in some lucky groups it is the PGT himself/herself while in other groups the responsibility of organizing classes, convincing Mr. Busy PGT, finding patients and informing others falls on a poor, hapless student. Thus, a tough life begins for the poor organizer who always has to answer questions like, "When is the next class?", "Why don't you go and convince Mr/Ms PGT?" . After countless phone calls, unanswered text messages and unfulfilled promises when a class is arranged after all, one feels as if one has already won a gold medal for being "Khep organizer of the year". But at the end of 2hrs of standing in the stuffy ward, one's fellow khep mates comment, "This class was a bit theory based. Why don't you tell him to make the class more clinical examination oriented next time?" This leaves the poor organizer to wonder, is all this worth the effort?

By the end of the year one realizes that maybe all the khep organizing was not worth the effort so one shifts to practicing on friends in hostel. These group study sessions, jokingly called as "Hostel Khep", yield much more in terms of learning the clinical methods and getting them right. As a bunch of people get together to share their cumulative knowledge gathered from books, ward and khep, one also finds probable questions, and answers to one's doubts. But theses classes also come with two major follies: 1) You cannot be sure that the method you agreed upon is indeed correct. 2) None of the findings are generally present (unless your hostel buddy is secretly harboring some disease).

But as it is said, everything has its pros and cons. While the effectivity of the khep classes depends on the enthusiasm of both the students and the teacher, and the effectivity of group study depends on the knowledge of the group members, but at the end of the year anyone who wants to learn truly will get the basics somehow or the other. 

Lastly, if khepology is an art, it has certain formidable, talented artists who attend two khep classes for the same topic of the same subject under two different people within the same evening. Kudos to these rare talents because of whom the art of "Khepology" is achieving new heights every day.

Photo courtesy: Shriya Mukherjee

Beginning of the end

 February- the month of realizations, is finally here. In this month some people realize their love for the next door neighbor girl when they get dolled up in sarees for Vasant Panchami, while some less fortunate people, like the medicos, are faced with the realization that more than half of the exam syllabus is left to be covered with less than 30 days to go. As the shortest month of the year brings bittersweet pangs of love for some people and all-bitter palpitations for upcoming exams for others it stands apart from the other months as the torchbearer of change. This change takes place in our routines, our mindsets as exam tension exhausts most of our thinking capacities, in the weather around us as winter takes a bow for the time being and in the number of cups of our beloved chaye we consume per day.

Sometimes exam season makes one weirdly productive- some people find time for exercising (something that is easily forgotten on normal days), some lazy bloggers dust the cobwebs off their creative writing skills and get back to work, while some voracious readers complete entire novels on a single day just to experience the thrill of reading forbidden books during the exam season.

While at other times the mounting pressure proves so great, combined with the sleep-inducing weather that even a cup of coffee becomes a z drug which easily lulls one into a comfortable sleep, followed by a surge of tremendous regret after waking up, scrolling through some shorts to clear the mind of guilt, and falling back to sleep with a 'clear mind' after an hour of idle scrolling.

Routines prove useless, all plans fail, study group doubts send chills down one's spine as one realizes that they are from unseen and unheard-of topics, and mostly friends keep piling up their depression on one another so that the net depression level of the group never steps down from the constant high value. 

With so much on one's plate even the Valentines week just round the corner seems bleak for the hapless medicos. While February brings in so much trauma it is also the month we cling to for dear life. We fervently wish the fragile February a long long life just to prevent March from marching in with the heavy load of the formidable, preposterous "MB", whose full form evades us even as we appear for it one last time.

So let some good memories and sarcastic observations bring light into this February. Get ready for a series of trips down the memory lane in this series of entries, so that we can all hold on to our leftover sanity as we prepare for the least awaited arrival of our "Most Beloved"(MB).