Apnoea positive

It’s 9.30 pm. The admissions to the emergency room continue to pour in – the beds have been exhausted, but the floor still has a few square feet of room. The interns and residents rush to complete their unfinished tasks, constrained by the limits of a 24-hour day. Away from this hustle and bustle, patients in the wards prepare for bed. The ward workers roll out their mats, hoping it will be an uneventful night. It rarely is.

In the meanwhile, far from sight, four of the hospital’s senior consultants gather in a small unassuming room on the sixth floor that holds a single patient.

“9.41 pm, ventilator disconnected”, calls out the nurse, as all eyes glance at the rhythm on the ECG monitor and the saturation on the pulse oximeter. The 26-year old boy on the bed lies motionless, without breathing. The trained eyes of the people in the room are nonetheless able to see the chest pulsate with every impulse of the heart – a heart that continues to beat in a body that has become incapable of living. The silence is punctuated only by the alarms from the disconnected ventilator and the scratch of the Anaesthesiologist’s pen as he meticulously records the patient’s vitals every few seconds.

The minutes roll by until the nurse calls out the time again – 9.49 pm. The Anaesthesiologist draws a blood sample and reconnects the ventilator. The Internist reads out the blood gas analysis, and records his findings in the case sheet: “Second apnoea test positive”. The patient is now essentially a living cadaver.

Brain-death occupies that very precipice between life and death, when the brain, the seat of consciousness, has completely and irrevocably ceased function, yet the patient continues to have an intact circulation; a beating heart. Oblivious to its predicament, the intrinsic automaticity of the heart ensures that, when supported with artificial ventilation, it continues to pump blood, even if it is to a dead brain.

Yet from this grimmest of circumstances, this particular patient’s final act is one of noble sacrifice. A few hours from now, in the dead of the night, three or even four individuals will be rushed into operating rooms across the city to prep for surgery – a surgery to replace a failed liver, a failed kidney, even a failed heart – an organ obtained from the still body of a young boy on the sixth floor.

“So long as men can breathe, or eyes can see,

So long lives this, and this gives life to thee”

- Sonnet 18

"Know Your Status"

For the past couple of months I have begun to start showing the classical signs of long-term unemployment, reflected by a sleep cycle that swings from anywhere between 5 am and 5 pm (sometimes extending a complete 12 hours) and over-grown unkempt hair that a crow could easily mistake for a nest.

Given that I now have an infinite amount of time to ponder about the mysteries of life, the universe and everything, I decided to get myself an HIV test. Before your imaginations run wild, let me clarify that I've worked with a lot of blood during internship, and sometimes been less careful than I should have been.

This would probably be a good time to describe myself. I am thin. Very thin. Some call it malnourished, emaciated and anorexic, but these are just jealous fat people. Incidentally, weight loss of more than 10% qualifies as Stage 3 HIV, as per the World Health Organisation. Added to this, my erratic sleep cycle means I'm quite sleep-deprived if I have to venture into the outside world during the day. In short, if you ever meet me, I look like the textbook description of an HIV-positive cocaine-smoking drug addict.

(I'm sure that paragraph made some of the ladies swoon)

I walked into the lab, and, being sufficiently vague since there were people around me, told the lady at the counter that I'd like to take a blood test. I don't fault her for asking "Which one?". I said the word "HIV" loud enough for the guy standing next to me to hear. Despite his shock at just being told that the tests in his prescription would cost him 3.5K, he looked even more shocked at what I had just said. I proceeded to say that I was a 23-year old, without a prescription, presenting for testing voluntarily and without a referral.

I probably looked quite suspicious at this point because the nurse who drew the blood was totally cold shouldering me. None of the usual "So what did you have for lunch?" or "Don't worry this won't hurt" lines. The only thing she actually said to me was "You can go". Hand gestures sufficed for everything else. 

Obviously I could've just said upfront that I was a doctor, and probably even gotten myself a discount, but hey, where's the fun in that right? It's not everyday that you have the pleasure of switching roles with a drug dealer.

Anyway, that was two days ago. Today I get to resume pondering about the mysteries of life, the universe and everything.

PS. I like the way they say "Please" at the end

Oh, To Be In England

Two months of studying for the Indian post-grad medical entrance exam makes you feel like you've aged a few decades. Mercifully, a little holiday in the UK seems to have done me some good (though the hair loss seems to be permanent).

I realised that cows have a very good life in the UK. They're fat, well fed, lazy, have amazing weather and do nothing all day but eat. They even have actual bridges across the highway that were built especially for them to cross (If I was any good at blogging I would probably insert a "Why did the cow cross the road?" joke here, but I dont know any). Cows in India are much like the house surgeons - emaciated and overworked. But then I suppose English cows do tend to get eaten a lot, so I'd still say that's India - 1, England - 0.

Another thing weird about the UK is the birds. Apparently, people arent just nice to each other, they're nice to wildlife as well. This has led birds to view the human species as walking food-dispensers, and nothing more. Now they act almost as if we're in a real-life Rise of the Planet of the Birds. They all ganged up on us when we went to the Lake District, thinking we had food for them. Like we were going to spend a whole one pound on bird food! I just wish I had some chicken nuggets to chew on though. Just to show them who's still at the top of the food chain.

But besides the birds and animals, a certain group of people enjoy a particularly privileged life in Britain - cyclists. Now I'm no stranger to cycling. Every working day of my third and fourth years at Chengalpet Medical College I huffed and puffed and rode my 10-year old bike through 40 degree temperatures, through the great Cyclone Nilam of 2012, through flat tyres and malfunctioning brakes, through roads that cavemen could build better, through buses and bikes, through autos and cars - all to have it stolen while I was terrorizing children during my Paediatrics internship. 

But in the UK, cyclists are treated like kings. You don't get honked off the road like you would in India; no, in the UK you quite literally race the guy who had the gall to try and overtake you. No more "I'll just go off the road for a bit so you can pass me". Here you use an entire lane and ride your bicycle bang in the middle of it. I once saw a cyclist single-handedly create a mini-traffic jam just by cycling down a one-lane bridge. And by cycling, I dont mean actually pedalling. No, she was just letting the wind and gravity do the work, blissfully unaware of the 10-car pile-up behind her. Try doing this in India and not only would the deafening noise of car horns quickly make you aware of your situation, but those same cars would probably run you over, just for good measure.

Now I'm back in India, though, and was welcomed back to class with an extremely fascinating 10-hour lecture on biochemistry. More hair loss to come, I suspect.

Flogging a dead horse

The day you finish your year-long work-like-a-slave internship, you find yourself slightly delirious and roaming the streets at two in the morning, singing about happy days being here again. I was under the impression that this would be followed up by an entire year of just letting loose and chillin'.

I, of course, was wrong.

Being unemployed isn't all its cracked up to be. Especially if the said unemployment is justified by your intention to focus all of your energy on sincere and determined study to pass an examination in 6 months.

Not sufficient that the exam in question decides the specialty you're stuck with for the remainder of your sane lifespan, it's syllabus includes everything that you've "learnt" over the last five and a half years. And more.

To aid you in your impossible quest, you enroll yourself into an "Institute" that deals with this kind of thing. It's mildly disheartening that the price of this enrollment is approximately half of all the of money you made during the entirety of your 1-year internship.

You then find out that much like a meal at a restaurant, you're given a menu card of the different courses available. Calling myself an average student would be over-stating my abilities, so I skipped right past the "Achiever's batch" and the "Deligents batch" and went straight for the "Beginners batch" package. Unfortunately, and I say this with a touch of pride, I was over-qualified for this, having finished both my 3rd and 4th years of under-grad. I therefore settled for just plain old "Regular" (Yes that's what it's called, I kid you not)

"Regular" classes are a behemoth 11, or sometimes 12-hour session (with a 30-minute lunch break of course). I generally tend to start seeing stars somewhere about half an hour into the lecture, as evidenced by the sudden epileptiform discharges recorded in my class notes. I find that a lot of people in this class are surprisingly resistant to these hypnotic effects that I experience on a daily basis. I suppose they've either been rendered catatonic by their stint as interns or they were blessed at birth with all the emotion of a pot noodle.

While I was sitting there in Psychiatry class today, being told of the important differences between illusions and delusions and psychoses and neuroses, I was left thinking "We are all just prisoners here; Of our own device"

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.

The "Pump Handle" Test

Study vacations are here again, and at around 3 am this morning, the already minuscule "common sense" area in my brain decided to call it a day. As I sat there reading Orthopaedics, I decided suddenly, after 21 years, to try out that whole 'learning-by-doing' thing.

I therefore stretched out on the floor, and attempted to bring my right knee to my left shoulder. A rational person of course would tell you immediately that this was not possible. But these are study vacations. I havent been rational in a while now.

This test is apparently positive in a person with ankylosing spondylitis, where it causes pain. What kind of sadistic psychopath comes up with tests like these anyway? The only way this wouldnt hurt someone was if they were comatose. 

I, unfortunately, was not. So as I lay there writhing in pain, I decided that I either have ankylosing spondylitis or I fractured a bone or two while attempting to check.

Either way. I'm going to go find myself an Analgin now.

Poda Podi: "It’s cool man, it’s cool"

A brief synopsis for anyone who missed this gem of a movie.

It begins with the hero (I will henceforth call him Mr. Hero for the sake of simplicity) mis-quoting Hamlet, saying “To love or not to love: that is the question” while violently moving his body to what appears to be music.

Mr. Hero then goes to a bar, meets some girl who dances with him simply because he’s filthy rich, and then instantly becomes his girlfriend. After a few jokes involving lodges in Mahabalipuram, she becomes Mrs. Hero.

Unfortunately for Mr. Hero, his wife likes to dance salsa, which he finds terribly offensive. So he decides that the only solution is for his wife to get pregnant. Mr. and Mrs. Hero then have a baby (doll).

Thanks to some brilliant script-writing, we now enter the intermission while faced with this massive ground-breaking twist in the storyline.

In Part-2, Mr. Hero decides to go bash up his wife’s dance partner, and his wife repays him by *accidentally* killing their baby. She then gets angry with Mr. Hero for several months because it's all his fault. Mr. Hero then tries to re-kindle his lost love by declaring to his wife's dance instructor “I want to have 10 more babies and I cant do it by myself”. This seems to be a satisfactory apology, so Mrs. Hero moves back in with him.

But their marital problems continue; not because of the dead baby, but because of the salsa dancing, which of course is way more important. After much visual and auditory trauma to my senses, they both finally decide that the only way to win the dance competition would be to dance together. Unfortunately he’s useless at this, so the judges all go “You’re terrible. But we’re still putting you through to round 2”

Mr. Hero then decides that he is a “kuthu dancer” and so Mr. and Mrs. Hero both simultaneously have a 3-minute long generalised tonic-clonic seizure on stage, and in response the judges jump up and start dancing. This of course means that they win round 2.

They then have baby #2 and we are informed that there are 14 more rounds to go. Thankfully, this is where the movie ends with a “To be continued” notice as the credits start to roll.

Poda Podi is quite a movie. This is 1 hour and 58 minutes of acting, which takes place despite several drawbacks:

1) It has a total cast of 4 characters (Mr. and Mrs. Hero plus a completely mad chitappa with an even madder wife)

2) There is no real story-line

3) It takes place entirely in London and Disneyland, where people seem to neither know english nor tamil properly

Despite all of this, it still relentlessly plods on for almost two hours, and for that it must be applauded.

(PS. It's still better than "Enthiran")

How to fix a road. Chengalpet style.

Step 1: Find a small tiny road which is simultaneously used by lorries, trucks, cars, share autos, bikes, stray dogs, grazing cows, a couple of pigs and my cycle. This road must be too small to permit two-way traffic, and so who has to go off-road depends on a clear hierarchy based on size (though pedestrians still rank higher than my cycle)

Step 2: Dig up the entire side of the road making it tinier by half, because it wasnt a big enough challenge already to look death in the face every time you pass someone

Step 3: Wait for the rains to convert your open grave on the side of the road into a swimming pool

Step 4: Add a bunch of stones to spill all over the road. Because punctured tyres are fun.

Step 4: Watch as this small tiny road continues to simultaneously be used by lorries, trucks, cars, share autos, bikes, stray dogs, grazing cows, a couple of pigs and my cycle, effectively disproving Pauli's exclusion principle.

Of course there is always the alternative route. In this particular case, it looks like this:

As the saying goes, "Two roads diverged in a yellow wood, And they were both equally bad"

But then I complain too much. I'm sure the road will be fixed one day, and the two opposing lanes of traffic will live in harmony once more. 

And when that day comes, I'm sure my grandkids will be around to enjoy it.

"GBM"

Nomenclature is a funny thing. Words often come to be used in contexts that are diametrically opposite to their actual meaning.

Take, for example, the word referring to 'professional guidance of the individual'. Counselling. Ask any twelfth standard kid waiting to be sentenced counselled to a college. Before going in he will understandably be close to a nervous breakdown. After coming out he will require another form of counselling. Grief counselling.

Another interesting phrase is the "General Body Meeting", or what college students affectionately call a GBM. Every now and then, there arises an issue that requires the full participation of the entire student fraternity to help resolve. This of course is through free and open exchange of ideas in a public forum.

At least, thats what I used to think.

The next time I'm heading to a GBM, I'm bringing popcorn.

New-born babies are ugly. There, I said it.

My classmates of course screamed bloody murder when I made my little observation, but that does not make it any less true. Babies become cute only about ten minutes after they're born, until which time they compete with earthworms and slugs in terms of cuteness.

After an entire week of night internship in the labour ward, I find the place about as appealing as a concentration camp. It's perpetually filled with screaming women, all flailing about on four-foot high metal beds (and occasionally falling off, IV line and all) with the entire room smelling of an aroma that comes from a cocktail of shed placenta, faeces, blood, and sometimes vomit (some textbooks call it "vomitus" with the clearly mistaken belief that that makes it somewhat less revolting)

But then all of this is normal. Abnormal happens every now and then too, like the one woman who got up to go to the bathroom and ended up coming out with a baby in her hands. I try not to think about what might have happened in there.

To put up with all of this on a daily basis, the people who work in the labour ward obviously have to make some modifications to their thinking processes. This acclimatisation involves disconnecting the part of the brain which deals with empathy and upping the sarcasm tenfold, resulting in responses like "Oh, you want a caesarean? The doctor's at the tea shop, let me just go get her"!

In the midst of all this chaos and screaming, out comes a baby, bathed in blood and choking for air.

Forgive me, but "cute" isnt what comes to mind.

The internet is like a drug

You keep telling yourself that it isnt. But it is. I realised this today, after two days and 14 hours of no internet, and two days and 14 hours of aimlessly wandering the house (the two are of course not related in any way)

There are three stages of addiction apparently.

Stage 1: Preoccupation/Anticipation:

"Constant cravings for a drug are the very first sign that addiction is taking hold."

We're all in this stage, lets be honest. But when you unplug and re-plug all the telephones in the house and move them around and change the wires and repeat that a couple of times in a pathetic attempt to bring the internet back, that's a pretty clear sign.

Stage 2: Binge/Intoxication:

"As the drug is introduced into the body more frequently, larger amounts are necessary to continue experiencing the same high."

With the intention of engaging the mathematically inclined readers of this blog, I am going to draw a graph, because maths people usually like that (Physics people like graphs too, but they're usually just boring horizontal and diagonal lines. Maths people came up with the Batman equation)

Res ipsa loquitur.

Stage 3: Withdrawal:

"The withdrawal symptoms experienced anytime the drug is not present cause tremendous suffering"

"Tremendous suffering" is putting it mildly. Over the past two and a half days, I have played around fifty games of solitaire and hearts (each), picked up the telephone once every 10 minutes to check if it was working, went to some fancy doctors meeting out of sheer boredom (the use of words less than five syllables long was strictly prohibited), and even contemplated going back to Chengalpet to use the internet there.

So obviously I have a problem. But then so do lots of people. They just dont know it yet. And its a very simple test to know if you're one of them. Throw your modem off the second floor (or just the computer table will usually suffice) and see what happens to you.

So I'm a final year now. Apparently.

It is now three and a half years since I joined college. That's 43 months. Or 1315 days. Considering the fact that I am supposed to be "working" as an intern in another year, I somehow thought I would feel a little less dumb by now. I dont know what gave me such a ridiculous idea.

The last few days involved a bunch of random people whom we've never met before, asking us things that they knew we didnt know, while being visibly entertained in the process. These people are what we call external examiners. They are a kind of sub-species of the human race who delight in the sorrow and misery of others. Much like demontors, but in real life.

One of them kept mumbling something that I presume was English, but I cant say for sure. The only clear thing I heard him say to me was "You can go". Another one kept setting us random tasks, one of which was a make-shift ex-tempo acting assessment, in tamil. While I think my excellent command over the language held up quite well initially, it may have started to crumble when I told my fictional patient (translating literally) "your cochlea broke". And by the time I had got to explaining what lip-reading was, the smile on the examiner's face was so wide, I decided it was time to wind up.

And as if the externals werent bad enough, the patients that I was allotted had equally strange personalities. One mentioned quite casually that she was electrocuted 6 months ago, but she was too busy hoarding biscuits to answer any of my other questions properly. One thought I was a proper doctor and started telling me all of his life's problems. In the interest of transparency I told him that I was a third year having a final exam. He became surprisingly quiet after that. I wonder why. I proceeded to write down a previously memorised diet for him, while his son watched me fill up my paper. He apparently works at Kalaignar TV, so it is possible that I might be in the news some time.

Either way, I am finally a final year. Or third year part 2, if we're going to get technical. After a year that included "field visits" (which meant knocking on people's houses at 2.00 in the afternoon to measure the sizes of their rooms and to look inside their bathrooms), and had enough drama to take a new TV serial through at least two seasons, final year cant possibly be that bad.

I hope.

Park's Textbook Of Preventive And Social Medicine: 21st Edition

The general consensus is that this textbook is the best there is for third years.

We'll just see about that, shall we? The following are direct quotes from the book.

General dumbness/randomness/failed punch lines:

• Insects, rodents, animals and plants are constantly working for their survival^(p.35)
• Accidents are no longer considered accidental^(p.374)
• "Use of stolen vehicles" is one of the precipitating factors for accidents^(p.378)
• Damage from accidents may be minimised by "wearing leather clothes and boots"^(p.378)
• Years wrinkle the skin, but worry, doubt, fear, anxiety and self-distrust wrinkle the soul^(p.547)
• "Times of India" listed as one of the references^(p.560)
• In Kwashiorkar, oedema is present in the lower legs and lower arms^(p.591)
• It is possible to classify individuals with reference to two poles: children with insufficient but proportioned growth and those with normal height, but who are wasted^(p.591)
• Nations and civilisations are linked together not only by ideas but also by bread^(p.602)
• Anger can cause a person to be rude and sarcastic^(p.625)
• The traditional barber is called a nai^(p.636)
• The arithmetic mean may look ridiculous^(p.786)
• "Noise, invisibility, congestion" are barriers to communication^(p.795)
• Newspaper readers are often seeking newspapers^(p.805)

Technical errors:

• Guinea worm disease is a public health problem in India^(p.722)
• Toxoplasmosis is classified as a virus ^(p.262)
• Earliest sensation affected in leprosy is light touch^(p.288)
• Psoriasis is a hospital-acquired infection^(p.333)

There are too many typos to list, but the book did end up calling affluent societies "effluent societies"

But then lets forget all of these minor infractions for a minute, for to err is human after all (though to err this much for 21 editions is indicative of either extreme ineptitude or an underlying organic brain lesion). 

There are bound to be several excellent uses for this book, though only a few come to mind:

• It can be used to line the bird cage and collect droppings
• You can point and laugh at any poor soul who's stuck reading it
• It is sturdy enough to be used as a murder weapon

Final exams: Because sleeping is for the weak

This picture's been passed around a lot on facebook. But from what I saw over the last week, I've realised that this is a gross misconception. The actual last five minutes (more like the last 30 minutes in my case) were spent thusly:

I even tried asking one of the invigilators what was causing my fellow classmates to make such obvious physical effort in filling out the answers while I was counting the number of fans on the ceiling. Perhaps there was some kind of secret puzzle that had to be cracked in order to reveal another essay or something. On the first day I even tried putting all the first letters of each line together, and ended up getting "Edtda Wddaldcvpcg Svatanmaitiwtttb". How intriguing. It actually didnt sound too different from some of the actual questions they had asked, like "What is GOBIFFF?"

I finally decided that the most effective way to spend all my free time would be to take a quick nap. You would understand my astonishment then, when everyone came out of the exam hall and told me that there was no time to finish writing everything that they wanted to.

The way I see it, there are two possible explanations. Either I am selectively blind to some kind of invisible ink that they used to print the back of the question paper, or I'm just plain dumb. And I have dont think they used any invisible ink.

Either way, it was all over yesterday, and then we went to watch some random movie called Marina. After a week of not sleeping, you dont usually care much for such things as quality when you select a movie. But unfortunately, this particular movie also had some strong advice for the audience, delivered in typical tamil-movie style - very indiscreetly; advice that no fresh-out-of-the-exam-hall college student wants to hear. Advice on the importance of education and studying hard.

Oh the irony.

My exams are a few days away

And with that in mind, I have decided that it is time to make a few amends.

It may have appeared from previous posts that I did not particularly like my SPM textbook. This could not be further from the truth. It is such an amazing book that mere words cannot describe it's brilliance, and students like me are privileged to have such a masterfully written text as study material.

Dear SPM book, this song is for you.

"What? You've never seen a hypocrite before?" - Leonard Hofstadter