4 years in : What changed? (Part 2)

A little detail about me before I begin this post : I am going to be the first doctor in the whole of my family, immediate and extended family, near and far relatives, paternal and maternal side, everything included. Literally, the first.

So obviously what little knowledge I had about this field, during my pre med school years came from watching the doctors I’d been to in the past. I knew when I was 6 that I wanted to become one too.

So during each visit to the doctor’s clinic I’d watch them with awe at the way they’d put the bell of their stethoscope on my chest asking me to inhale deeply. Or the gentleness with which they palpated my abdomen when I complained of a tummy ache. The precision with which they looked at my posture and made a diagnosis of chondromalacia patellae (it’s a knee condition that I have, as a consequence of my flat feet).

How many kinds of doctors do you think I would have gone to in the 17 years of my life? I can count them on my fingers. A paediatrician, a general physician and an orthopaedic surgeon. Add a general surgeon and an obstetrician to that list to for good measure.

And so for the longest time I thought when you say “doctor” it’s either one of those things. Anything else, was beneath this degree. Oh what a naive kid I was.

Came med school and slapped me a paradigm shift. I realized how things in this field work. It’s not each doctor by himself cocooned in his own department. We are all a team working together for the betterment of our patient. A surgeon cannot confirm his suspicion of a tumour without a diagnosis by the pathologist.

A surgeon cannot do anything if the anaesthesiologist decides to not turn up to the OT that day. What good are drugs that a physician prescribes if the microbiologist doesn’t tell him if the bacteria are sensitive to them or not? Every orthopaedic surgeon needs a physiotherapist to help him rehabilitate his patients after long periods of immobilization.

And what can I say about a radiologist that the long line of patients outside the waiting room can’t? Every day they get patients referred from all the other departments to give them a glimpse of what is happening on the inside of a patient’s body. And yet, sometimes in spite of extensive imaging we can’t find the cause for the patient’s distress. Enter: Department of psychiatry, because a disease with no symptoms, is a disease in itself.

A trauma specialist and a forensic expert ; one to immediately manage an emergency and prevent death, the other to look into the cause of death and let the others know so we don’t make the same mistakes again. History repeats itself, but that’s not a liberty we are granted.

Wait, I jumped the gun, didn’t I? To become these big shot doctors all of us have to get through first year of med school don’t we? What would we have done if not for our professors of Anatomy, Physiology and Biochemistry? Hell, even those formalin clad cadavers have played their part well.

Nobody is above or below anyone else. Not one branch is boring or less important. We are a well oiled machine working day in and day out. Every form that’s filled, every signature made, every diagnosis confirmed is teamwork deciding another human being’s life. Or death, for that matter. We are all in this together, all equally responsible, all equally important.

Med school has taught me a lot of life lessons. But this is probably one of the greatest.

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4 years in: What changed?

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You know how when you’re in school, nearing high school and people start to ask you what you want to be when you grow up, three options pop in your head (Only applicable if you’re of Indian descent) Teacher ,doctor or engineer.Yeah well it was only two for me. Teacher?No way! Why would I want to be the brunt of innumerable jokes, called nasty names or try to tame an unruly bunch of ungrateful kids.

You see, I was one of those kids, sat in the back seat because I was tall but ended up acquiring all the traits of a back bencher.You know what I mean..snacking, doodling, hangman…we weren’t big on phones back then.I wasn’t unruly or unkind to my teachers(I might have thrown a paper ball on a teachers back once…or twice) and I was liked by all of them.But I had no exceptional admiration for them, because really, how challenging is teaching anyway right?

My mother was a teacher too and a great one as I have heard from numerous students of hers.She spoke about the constant stress and low pay high workload.But above all she loved being a teacher and always expressed how rewarding a job it was and how nice it was when students acknowledge and greet you outside of school.

Come med school. Year 1 comes and goes, Year two come and goes.Year three.Now it wasn’t a single incident that caused me to transform my views on the whole subject but rather I didn’t even know when I started to feel this way.In year 3 and 4, we interact more with practicing doctors and the focus is more on clinical skills and about integrating the knowledge acquired over the past years to identify medical ailments in patients we see.And this is a skill we cannot acquire though anywhere but another person, a professor.

Enter amazing doctor, who actually notices insignificant little humans in white coats.This is Step one: of my transformation,”OMG he’s so busy, but he still notices us”

Step two:”OMG, he has sick patients and he wants to know our names.”

Step three:”He actually remembers our names!”

Step four: “He’s teaching us.”

Step five:”He’s teaching us so well, we’re enlightened now.”

Step six:”I can’t wait to be as cool and busy as him and still enlighten young minds.”

This is the abridged version of how my outlook towards professors have changed in the past three years.

The thing is a doctor is unlikely to be appointed to a job or even achieve a promotion solely on the basis of their teaching skills because of which they don’t even have to put in the effort to teach well.This is why i appreciate it more when a doctor takes time and energy to not just teach but teach well, because more times than less the knowledge we get from them isn’t in any textbook.

The older ones, come with years of experience, every word that they speak is of value, other are young and fresh, we can relate to them more.And then there are some, who are just bigger than life. A particular professor comes to mind, he kinda knew everything about everything related to his field and had just this limitless knowledge. And not only did he have this knowledge but he would teach you—however much time he had, he would teach. He was great at the bedside, loved being a doctor and loved being a teacher. It just came through in everything he did.

These days ,it makes me pretty excited to think about the day I get to teach a group of young budding doctors because boy do I know what a difference it makes to be taught well.Clinical teachers are a valuable resource and I feel like the value of a good teacher can never be lost.Like we study in med school, its like a vicious cycle except not vicious,A good teacher inspires students and an inspired student becomes an inspirational teacher.

To all my teachers: Where I am and what I do is the result of all the hard work and belief you put into me, for this –Thank you.

Words and Deeds

It’s Friday evening. I step into the dimly lit lobby and I am wafted by the smell of shampoo, conditioner and other hair care products. Three pairs of eyes look at me. “Yes?” asks the seemingly senior looking lady among the three. “I need to wax my legs”, I answer meekly. Wait, before you decide that this is some frustrated post on feminism or the impossible beauty standards set for women by the patriarchal society, let me clarify, it’s not. I’ll save that for another day.

Anyway, she leads me to the room where strips of paper will soon pull out my body hair. There is already a lady waiting there for me with no expressions on her face. “Waxing no? Change”, she orders and hands me a very flimsy gown. I stare at her for a few seconds and as I realize she isn’t leaving the room, I’m yet again taken by surprise by how foreign a concept privacy is to Indians.

Resigning to my fate, I turn around and change into this not so modest gown barely covering my assets. She asks me to lie down on the bed in front of me face down. And she begins the ordeal of putting hot wax, sticking the strip and pulling out the hair from the roots. I have blissfully zoned out to my happy place. Doing this at least once every month kind of makes you immune to it. I know, being a girl is hard.

As she progresses northwards, I get shy. I pull on my gown meagrely to cover my modesty. The woman is into her apply-stick-pull mode now and pays no heed to me. Besides I don’t think she even cares. Nevertheless, I am shy. Just then another lady walks in, because what even is privacy? They have a brief conversation in a language I do not understand so I pick only scraps of what they’re saying.

Lady number 2 asks lady number 1 if she wants help. Lady 1 denies and tells her she’s almost done. That was it. But on her way out, lady number two bumped into something or someone, I do not know but something happened and lady 1 giggled. And I was instantly embarrassed. I am lying there almost butt naked and they are giggling. WHAT?

“Did they make a joke about me? Was it my legs?” I instinctively think. And that’s when it hit like a bolt from the blue; this must be exactly how our patients feel when we huddle around them taking history. Mind you, I do not have body image issues nor was this my first time. Yet I was embarrassed.

The patients that get admitted to our general ward are sick and in a lot of pain, physically and emotionally. They have serious medical conditions warranting them to be admitted in a hospital. Most of them are daily wage labourers and missing even a day of work is taxing to them. And we very-enthusiastic-eager-to-learn medical students hover around their beds, prodding their chests with our stethoscopes tossing out words like “ejection systolic murmur” “Velcro crepitations” “bilateral basal crackles” hardly hiding the amazement from our faces.

We go in groups of 10, sometimes more. While two of us actually talk to the patient and build a sort of rapport with him, eight others stand behind with our faces buried inside our textbooks reading about which disease the finding points to. Nobody is denying the fact that finding textbook features on a real patient is astounding. But there definitely has to be a code of conduct.

We probably don’t realize how our behaviour is coming off. Or maybe we know all these theoretically but fail to practise it. We grumble and whine when the senior doctors tell us how important empathy and ethics rather than medicine itself. We get reprimanded countless times for the same.

But what I know now is, they’re right you know? These doctors; they’re right in doing so. We’re going to be doctors, dealing with humans. Not just humans, sick humans and their very worried families. Our patients are human beings with real feelings and real disorders. So while learning to diagnose them is important, empathy and compassion are a big part of this job.

Back to the grind

I can finally breathe.Two months of living on a strict timetable, studying all day, counting my 5 hours of sleep by the minute.All motivated by one goal, you would think it is to top the exam or something but really… it’s just to pass. There is no winning in med school is there?

Well that was three weeks ago and now here we are final year med students.Not to mention, we’re back in Medicine rotation, one of our favorites, not just because challenging and all of that but it gives us the best stories to tell.

Not much has changed since the last time we were in Medicine except( hopefully) the extent of our knowledge in the subject.

The other day a passing incident we had with a patient, or rather our reaction to a situation made me realize that we might have changed a little. We have a selected bunch of cases we will be tested on for our final exam, so we hunt for patients with particular diseases so we can practice eliciting a case history. Because of this a number of med students flock to the same patient at different times to take a particular patients history. Crick and I approached a middle aged man and began asking him questions for our case sheet and he answered but never made eye contact and muttered all answers under his breath. When it came to us asking him to take off his shirt to examine him, he looked at us disgustedly and said that it wasn’t just 5 or 6 students who’d come to him but around 20!

Second year med student me, on hearing this would’ve felt guilty for subjecting a patient to even the slightest discomfort and would’ve walked away only to approach another patient who’ll eventually shoo us away . But to my surprise we both stood there adamant to finish the complete case history whatsoever, and we did, for our own good and maybe for the good of our future patients.

I must say,this whole incident left me quite confused but in about a year we’re going to be doctors.It doesn’t seem real and scares me more than my final year exams.Because honestly it’s terrifying to think that I am going to be let loose around patients to diagnose them.Though in reality I won’t be diagnosing them alone, it would still be real nice to give justice to the title in front of my name and not merely be a shadow in a white coat following the senior staff.

So even though my target for the year is to do well in my finals, one of my goals is to improve my clinical skills.

A little late but nevertheless, Have a good year everyone and stay focused!

More to it than it seems

Before I begin this post I must tell you this, (not really) Watson and I are suckers for Random Acts of Kindness. We adore stories of people who do good deeds without expecting anything in return and are the reason for someone’s smile.  So even though today’s post has fresh content, it still revolves around the same central theme. Guilty (Not).

December is exam season in med school. If you take a walk through our campus, you will see people huddled in groups in random spots over an open textbook trying to cram as much information as possible. The library needless to say, is packed with different cadres of students.

The first years holding bones in their hands, trying to figure which part of the body it belongs to, the second years carrying books heavier than them, the third years like us, the final years who have only to put up a placard saying “don’t you dare come talk to me, I have no time”, those preparing for their post graduate entrance exams and the post graduates themselves all with the common aim to just get through these exams.

As twilight approaches each day, the sky outside gets beautiful and cool breeze starts to blow. People like us; we step out with our books for a breath of fresh air and a change of scenario. (Read: the library smells of sweat) We sit under the trees or on the grass and study.  Trust me, it feels as refreshing as it sounds.

However, there is a hitch. Apparently we have to head back inside the library as soon as the clock strikes 9. You’d think it’s because the authorities want to keep their students safe from malaria. Yeah that isn’t true. It’s just a bizarre rule. Every night then, the security guard who I’ve recently known is a boy of 20, comes to each one of us and “requests” us to go back in.

And we as convincingly tell him we’re on our way. Satisfied with our answer, he moves on to tell the next group of students the same thing. After he has finished telling everyone and seeing how not one person has budged, resigned to his fate he goes back and sits in his chair. (In our defense, the library is really HOT.) But, this is routine. And by now we are all immune to it.

It so happened that on this particular day, the head of security came on rounds at about 21:30 hours and seeing all of us still studying outside, he went cuckoo in the head. He yelled at our very-innocent-not-his-fault- security guard and threatened to have him fired. Filled with guilt, all of us slowly trickled back in.

On my way in, I heard him talk to an insignificant guy who had also been out there studying, “He yelled at me in front of all of y’all. Its okay what can be done?” and smiled and walked off. That night as I lay in bed, the guard’s smiling face consumed me with guilt. I went to sleep with thoughts of “Damn, I feel so bad for him.” Come next morning and all was forgotten.

The following night, as we sat outside on the grass, we were on the lookout for the head of security guy. But we sat outside to study after 21.00 hours nonetheless. Twenty minutes later, this seemingly insignificant guy comes back from dinner holding with him a parcel of what could only be food.  He says something to the guard, hands him the parcel and gives him a small pat on back. Then he picks up his book and continues studying.

I wasn’t the only one watching this. As I absorbed what had just happened, I looked around to see my expression of wonder and awe being reflected off of others’ faces too. Oblivious to him, a collective murmur of “Did he just get him food?” “Oh my god that’s so sweet of him” “Damn dude” went through the group of onlookers.

While I just felt bad for the guard, this guy actually went ahead and did something about it. I saw the smile on the guard’s face when he took the parcel from him. One insignificant man’s one random act of kindness inspired one trivial girl to write about him and probably restored some of the onlookers’ faith in humanity. The insignificant man did his very significant part. It’s time for us to do some.

Who knows what a little kindness can do? You could set off a chain reaction. They say, no kind action ever stops with itself. So in the spirit of Christmas, let us all go out and spread some love today. God knows we could all use some of it. No act of kindness, however small is ever wasted.

P.s. For those of you who are from our college and reading this; The guard is a 20 year old boy from Assam. He finished tenth grade last year. He works as a guard to save money to finish studying 11th and 12th grade.  If nothing else, smile at him whenever you see him.  Apparently we intimidate him.

And if he can work as a guard to make money to finish his education, we can get through this month of exams too. All we have to do is park our asses in a spot and study all day 🙂

Also, 18 days until Christmas, yayy!

The enemy within

On account of studying in a different state than my parents I have come to travel alone a lot. Which is great for me because travel stories make for good content (if you’ve read our posts you’ll know). By virtue of this, I’ve had the fortune only few have, of meeting new people and listening to some of their stories without having to put in effort to stay in touch later. (don’t judge me, I’m only human).

Each time the ice breaker seems to be “Oh you’re doing medicine? Third year? Oh okay. You know funny story actually a relative of mine…”And they proceed to tell me some medical problem their friend or relative has had in the past.

In this instance I speak about, the same sequence of events unfolded. However this time I had a problem which was twofold. 1) This lady by my side didn’t stop with narrating an incident. She went on to ask my opinion about it. Now I am but a third year med student, how can I be the second opinion to a cardiologist? So as she looked expectantly at me I struggled to put the scraps of my pharmac, path and medicine knowledge together and give her a satisfactory answer.

And 2) I was really sleepy. Anyway somewhere through the next hour she gave me a story that I am now writing about so I am not complaining.

Apparently, the lady in question, had a neighbour who recently passed. Her family is suspecting it to be a case of suicide because they now think she was under depression. I was sincerely nodding my head and sympathizing with her when she asked me “But dear tell me, do you think it could have been depression? I mean she seemed so normal.”

Yes aunty, she could have been depressed. Here is why.

Depression isn’t a disease where you can list out its signs and symptoms. It doesn’t have a face. It doesn’t come knocking on your door in the quiet of the night, it comes like the drop of a pin on a sunny beach morning. It doesn’t do shit to you in terms of altering your cholesterol levels or urine sugar levels. What it does instead is make you FEEL like shit. I have never been depressed medically. But I’ve been sad at some point or the other. Haven’t we all?

Now imagine having that feeling intensified plus your brain convincing you that you deserve the worthlessness you are feeling. Imagine there is no light at the end of the tunnel. You don’t know how long this tunnel is going to be or if the light will ever shine through. Imagine feeling you have no purpose here. That is what depression does to you.

The worst thing about depression though? Left untreated it can actually kill, if not your body, then your mind and soul. It is like a faceless dementor sucking the soul out of a living person who is still expected to live, smile and act normal only because people don’t believe or understand what is going on with them.

But how can we understand? It’s like explaining colour to a blind person.

To those of you who are reading this from a third person’s point of view, remember : Be kind. If a friend comes and tells you that they are feeling purposeless or sad, take them seriously. Talk to them. Be patient. Tell them how important they are to you. Lead them to the end of that tunnel. Your actions today can have an effect on somebody’s tomorrow.

To those of you who are reading this and relating to it, remember : Talk. Talk to a friend or family. Get help. Therapy isn’t taboo. It is brave. If you don’t think you can confide into someone, come talk to us. Don’t be so hard on yourself. Give yourself time to heal even though it may seem hard at present. Be patient and kind with yourself when you are healing, just like you would with anyone else. You are loved. You are wanted. You have a purpose here. You are braver than you believe, stronger than you seem and smarter than you think.

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The beautiful picture above was captured by our dear friend Burj-Al-Arun. He captioned it “32 medical students, one journey” and aptly so. But when we saw this picture (Forgive us, we’re two old souls sometimes) we saw something more than just the colorful umbrellas. Each umbrella has a story to tell. Each one of us carries a burden, some of our’s larger than the rest and others’ so large that it’s almost debilitating.

And yet we wouldn’t know a thing because that’s the nature of this disease.

So be observant. Ask how someone’s doing if they seem down. Hell ask how someone is doing even if they seem fine, smile at everyone and be kind. It could make all the difference in the world.

It’s the outside that matters

A long time ago or to be precise 5 years ago, back when I was in the 12th grade, my English professor asked my class if we would take a pledge with her.It was just another casual day and I don’t know what prompted her to do this, nevertheless curious as we were about what it was, the 32 of us said we would. She told us to raise our right hands and recite after her.”From this day forward I will never judge another person, solely based on how he/she appears.”

I kept my promise, I really did…for a WEEK.What?Its pretty hard and to this day every once in a while I remember my promise and try to renew my pledge.The thing is, in my opinion, its in our nature to judge someone based on how they look.I mean think about it, we dress up well because we want to make a good impression.People get tattoos, piercings, dye their hair so that other people notice right? Would we still do it if no-one else could see it ?Now I’m not generalising, there may be some of you saints out there who genuinely do not make snap judgments about people, but I’m speaking for the rest of us, mere mortals.

I think the first impression of an individual can be likened to a synopsis of a book.It gives you an insight, it might pique your interest or it might not impress you at all.However this assumption of yours can be changed after you read the book.This is why appearance matters, it is what you want others to see, it is that version of yourself that you want to project to the world.

Patients come to the hospital stressed and with potentially dangerous medical conditions, they obviously do not want to be burdened with dealing with a doctor who appears,well..queer. Not to mention that they could be two or three generations older than you.To put it plain and simply, a doctor will not be taken seriously if his attire his off, no matter the skill he possesses.Like the saying goes-Dress to attract not to distract.

Finally, as much a this hurts for me to admit, I think its justified for medical schools to frown upon students dyeing their hair in bright colours or getting large visible tattoos and piercings. Because although it doesn’t seem like it matters, it helps to ingrain the idea that a professional attire makes a patient feel respected and safe.I read a study on patients’ preferences for doctors appearance and apart from the usual, what I took away from the article was that if there is anything that a doctor should want to wear to impress a patient, it should be a smile.