AIPGMEE 2013 – First day, Second show

There’s two sets of people who take PG entrance exams, and you can tell them apart just by looking at them. Many of them will have some sort of reading material with them, and generally appear quite serious as they complete their last-minute preparations. These are the ones who are there to actually try and get a post-graduate seat.

Then there’s people like me – interns. This group of people are in attendance merely because their parents had insisted on paying Rs. 3500 for an exam they couldn’t dream of passing, and more importantly, because this provides them with a fool proof excuse to take the day off.

They began the long complicated process of allowing us into the building about an hour before the exam was scheduled to begin. We all had to have our photo ID’s and other documents verified first before being let into the waiting room on the inside. A lot of people were sent away at this point because of some slight irregularity in their paperwork. Believe me, it’s harder for a candidate with all his papers to get into that waiting room than for a terrorist with a bomb to slip past airport security.

Once I got into the waiting room, I found everyone sitting in absolute silence, while one of the organisers informed us that we were under video and audio surveillance. He began to rapidly pace up and down the room, making us feel like we were suspects in a murder investigation. He would swoop down on anyone who dared turn his head more than 15 degrees to the right and left, and say “Can I help you?” in a tone that sounded more threatening than anything else, and with a facial expression that reminded me of my textbook descriptions of risus sardonicus.

This was followed by each of us being individually escorted to our seats, after intentionally being led past a row of computers with live video feeds of the room we were to take the exam in.

Before we began the actual exam, there was a tutorial that was meant to acquaint us with the user interface, and I found this to be extremely beneficial. I would have been completely lost without such vital information as this:

The test itself was three and a half hours long, but I was done with my three hundred questions in just over an hour. This left me with nothing to do (solitaire was out of the question, unfortunately), in a room that was completely quiet, but for the incessant clicking of a hundred computer mice (or mouses; whatever), occasionally punctuated by a yawn or two from my fellow exam-takers.

Once the three and a half hours of agony had passed, my computer informed me that I had "run out of time" and my test had therefore ended. What a pity.

Now that the exam's over, all that remains is to wait for the rank list to be published. But I don't think I'll bother to check. Because the only answer I know for sure that I got right was the sample question in the picture above.

"And I was like Baby, Baby, Baby Noooo"

Being posted in Paediatrics is like being posted in a zoo, with my role being that of a chief zookeeper.

In the first half they let you deal with slightly older kids (with "old" here defined as 60 days from birth). Every morning, afternoon and night I get to terrorise them with syringes and needles. As pleasurable as this sounds, it gets dull after the first few days. There's only so many times you can hear screams of terror before your eardrums start to crack. Which is why they shift you out to the "Newborn" intensive care unit after two weeks.

Here you're placed in a huge room with 60+ newborn babies, most of them with tubes in their mouths, tubes in their noses, tubes in their urethras and tubes in their veins, all looking pretty much like aliens incubating. And the worst thing is that despite all of this, they're not the most alien thing in the room. That honour goes to the Staff Nurses.

Your one responsibility in the newborn unit is to "receive" babies when they're born by Caesarean section. It all starts off with a scribbled note from the Department of Obstetrics informing you that a certain number of pregnant women are scheduled to have a few kilograms taken out of them. This note comes at least four times a day (and night), at the most inconvenient of times.

You then make your way to the Emergency Operation Theatre, and get ready to wipe down a tiny wriggling newborn human being that's sometimes bathed in it's own faeces and choking on it's own secretions. It becomes a problem if the thing doesn't cry though; you then do the most doctor-ish thing you can think of - run and call somebody else for help.

The most difficult thing in this whole episode is carrying the baby. Some people hold the baby with a single hand, by the neck, during transport. I guess that's one way to do it. But being an amateur at baby-carrying, I tend to use both my hands, albeit awkwardly, while trying very hard not to drop it. Mothers "carry" babies. I "hold" them.

One month of Paediatrics is now nearly over, and it's only confirmed the one thing that I've always known. Children and babies are annoying. Terribly annoying.

O true apothecary! Thy drugs aren't quick enough.

Every admission day, my ward usually gets an assortment of cases - chest pain, hand pain, leg pain, finger pain, head pain, back pain and even tooth pain. Generally they come in their hundreds as a barbarous mob of angry (and allegedly sick) men and women all vying for the attention of 3-4 doctors (plus me) in what we call our Out-Patient Department.

This is fine.

What is not fine is when a guy drinks the night away, and then wakes me up at 3.00 in the morning to say his stomach hurts.

But even this is still tolerable. I just give him an antacid, tell him to go to sleep in whichever part of the floor he feels is least dirty, inform him that I will physically hurt him with a needle if he wakes me up again, and I can "abscond" him first thing in the morning.

[To abscond someone is to tell them "You're fine! See how much better you are now! You can go home today. Here, have a B-complex tablet! Cheers!"

The patient will then thank you profusely, say an almost tearful goodbye, think he's been discharged, and then leave. This is when you write in his case-sheet "Patient absconded", fold it up, and send it to the Medical Records Department]

But the worst type of "patients" are the nitwits who decide (usually while drunk) that it would be a good idea to ingest something poisonous. There's always at least 4-5 such geniuses everyday. Their choice of poison is a testament to their intellect. Even drunk people should know that rat-killer poisoning isn't even potent enough to kill rats.

Generally there isn't too much to be done for poisoning cases. They're welcomed to the hospital in the Emergency Room by a bunch of sour-tempered paramedical workers who yell, scream and slap them till a tube inserted into one of their nostrils reaches their stomach. They then proceed to rinse their bowels like yesterday's dirty laundry, yell at them some more, and then send them to the ward, where they're made to languish for a full 24 hours with no food or water and with their nasogastric tube draining disgusting yellow secretions from their insides.

I don't mind most poisons. If you want to willfully try to hurt/kill yourself, then be my guest. Just have the decency to do it somewhere where it won't affect me.

This is why I hate people who come with organophosphorous poisoning. Other poisons don't affect me. Organophosphorous poisoning does. These idiots need to be given up to SEVENTY vials of medication plus fluids - immediately. And this medication then makes them go into a delirium which means they start pulling out IV lines and creating general havoc. All this, while simultaneously having violent diarrhoea in a ward that already smells like the inside of a large intestine.

Some of the patients are nice enough to die before they reach the ward. Others die as soon as they reach the ward. Some others die right after you've put in about fifty vials of medication.

I think this is what is wrong with the world today. We lack an ideal poison - one that's cheap and will kill you faster than an Avada Kedavra. That way everyone's happy. Whoever wants to die can just die. And I can sleep on admission days. I think someone needs to start researching this ASAP.

And once all this drama has settled, the alcoholic guy in the corner will decide to once again remind you that his stomach still hurts. A few intentionally failed attempts at inserting an IV line will usually shut him up.

Yes, please

It is easier to cure cancer than to transfer a patient from one department to another.

The procedure is misleadingly simple on paper - Department A, which is looking after the patient, says "Kindly transfer the patient to Department B", and Department B writes "Yes, please" on the case sheet.

But then, as with all procedures that are this complex, there are bound to be a few complications.

One particular patient, being treated by Department A, had the misfortune of having Department B request the transfer, which was a serious breach of protocol. This led to a heated half-hour debate within Department A about who gets to say "Yes please".

The doctor who was on duty that day felt that since the transfer was requested by the other department, we had to say "Yes please". But the Staff Nurse opined that we had to completely disregard their request, and write another request of our own, saying essentially the same thing, except that they get to say "Yes please" instead of us. The Head of the Department, who by then had to be involved in this logistical catastrophe, also agreed that it was definitely us, NOT them, that gets to say "Yes please".

After further deliberations, it was ultimately decided that the best thing to do would be to just discharge the patient and let him go to Department B later. If he wanted to. Of his own accord. But definitely not because they requested it.

This whole episode has taught me one thing. If somebody asks me to oversee a patient-transfer in the future, I'm going to say "No thank you".

Two weeks down, fifty to go

My first posting as an intern (aka. a "house surgeon") is in the Department of Community Medicine, and this is equivalent to being given a paid vacation. The only problem is we have classes once a week. I thought I was done with this particular annoyance after third year, but it turns out that Community Medicine is like Hepatitis C. It just doesn't go away.

I've been "working" in the hospital for two weeks now, and am just starting to understand the dysfunctional inner workings of this fine institution which happens to be a state-of-the-art tertiary health care centre (allegedly). This is what I've learnt so far:

1) The Staff Nurse will be in a permanent bad mood, which will only worsen at night. She will also frequently say things like "Doctor! You cant use a separate syringe for each patient!". Take that, WHO.

2) If by now you still haven't pricked yourself somewhere somehow, you're not working hard enough

3) The Department of Sexually Transmitted Diseases should be re-named the Department of Awkward Conversations. Not a day goes by without hearing something like "Demonstrate how to wear a condom" or "How much money did you give her?"

4) Forget the principle of Universal Precautions. The hospital works under the principle of Universal Politics. Take any two people from a department, and chances are, they've got some reason to hate each other.

5) If you have nothing to do, leave immediately without making eye-contact with anyone you meet along the way. There is always something to do.

How to keep a diary

I now understand that the only reason people keep diaries is because they're all raging narcissists. I had just joined medical college when I decided that I want to keep a diary (which in itself further proves my Narcissistic Theory of Diary Keeping), because of course my life would be so amazing that future generations would want to know every tiny detail.

It took me about two minutes to decide that I was much too lazy busy to actually write anything down. This is the 21st century after all. Why write when you can type? Those future generations are going to thank me for not wasting paper.

My first realisation was that I had no idea how to talk to a Word document. I couldn't bring myself to type "Dear Diary...", so I decided to do a cold open, with just "I am going to write here everyday". I followed this up by typing out what I had for breakfast and what I watched on TV after that.

I was very regular with writing when I first started. Then after a few weeks I realised that my life was so mind numbingly boring that even I didn't want to read about it. This led to a steadily decreasing number of entries, and I made a grand total of ONE entry for the entire year of 2012. And it was still about what I had for breakfast and what I watched on TV.

At some point I seem to have decided that I was much too awesome to be keeping a private diary that no one could read, which is why I started this blog. The plan seems to have backfired though, because Google has a page-view counter, and the only time that number increases is when I refresh the page.

So anyway, I think it's time to get to the point. Dear future generations, today I had a bread and butter sandwich for breakfast and watched White Collar on TV.

You're welcome.