How's The Internship Going?

This question is the most obvious and the most commonly asked of me wherever I go. Today, I have the time to ponder on the perfect answer to it.
Hmm...so, how is this internship going? One thing is for sure: I'm enjoying this phase only because I have my friends with me (and by friends I mean, people I like, call friends and who also work as much as I do). Working in a hospital can be a lonely feeling....you are working with and under residents, who you can have no choice of. Right now, thanks to the delay in the Entrance examination results, we are short of Junior Residents. That means that our Senior Residents are quite frustrated with the amount of work left for them to do and, in turn, we, the Interns suffer, because we need to work more than usual and also do all the petty jobs there are. In such a scenario, if you don't have decent people to work with you, pour out your innermost emotions to, have a laugh with and remind each other of your plight, life sucks.  That's where, I have been lucky enough.
Of course, there are people called 'cutters' in our batch too. The word is used to describe an intern who wriggles out of the work assigned, usually to study. Such a person is usually more thick-skinned than the rest of us (as interns, you have to be thick-skinned to survive the mental ordeal in SGH), has absolutely no conscience to provide a haven for guilt and loads the rest of us with extra work. In my batch, we have about 3 such people. We've been able to distance ourselves from them, but time and again, fate just plays into their hands instead of ours. Currently, there are 4 of us, who've sort of decided to stick together, because we work well together. 3 of us were together in the Orthopaedics posting and we had a blast. The fourth girl joined us during our ENT Rotation and we managed very well. We decided to do day duty during our Csualty &Trauma rotation. We've left that place with the Chief Medical Officer saying that our team of four was one of the most sincere and hardworking lot he's seen in a few years. Such a nice compliment to hear!
So, going back to the question: I shall be biased now because of the Casualty rotation. Upto the start of Casualty, internship was fine. Paediatrics was over and done with (that itself is such a liberating feeling. I realise it now when I go to the building and there is no reason why I should need to enter it), Orthopaedics was fun and signed off, Otolarhingology (ENT) created a few issues regarding the Interns' rotation but we scraped through and Ophthalmology just proved to be my favourite yet again. So far, so good. Apart from the ENT completion signatures, I had all the others and things were good. I particularly enjoyed Ophthalmology. All that I ever did was measure the vision of patients and take labs, but I'm so completely in love with the subject, I enjoyed that bit too :-)
My hate for Casualty began during Orthopaedics. On our Emergency days, the intern had to sit in the Casualty and do the preliminary of the Ortho patients. Obviously, that was NOT my favourite job. The Casualty Interns posted at that time weren't more than acquaintances of mine. Seeing them run around here and there like freaking doctors, added to my negativity about the Casualty. I used to get this helplessness sort of a thing watching them. I used every opportunity to run away to the ward. There was lab work, blood issue calls, the HIV-HbsAg testing and trips to the OT to help out the residents a little. I did not sit at all, but I got that helpless feeling out. I felt better about myself. It worked for me.
This attitude carried into the start of my Casualty posting. On day one, I did not want to start the posting at all. I wanted to run away from the place and hide myself in some tiny little corner of the world where nobody would find me. But, by the end of the day, that thought itself was hiding in some deep dark corner of the world.
Looking back, this has been my best posting till date. A 12-hour day duty, managing more than 80 patients per day (all sorts - malingerers to psychotics, chest pain+breathlessness to assualt, alcoholics to RTAs, dog bites, cat bites, pig bites, monkey bites....everything) is not a joke. We did not get time to sit. My whole diet was ruined because my ages-old routine of 4 meals a day at fixed intervals was kicked out. There was a point when I almost collapsed there due to exhaustion. But, amidst all this, I loved every moment of this duty. My fear of putting an  intravenous catheter, a Ryle's Tube, a Foley's....everything was dealt with. I'm more confident of myself now...I managed to put my CPR skills to good use (finally, the BLS, ACLS workshop can be properly thanked :-) ). But, if there is one thing I enjoyed more than anything else in the world, it was the Minor OT. We dealt with all kind of wounds....my mattress and simple suturing has flourished during these 15 days. I love doing it all. Such a constructive way of getting rid of all the frustration and anger that boils inside you when you have to listen to 10 relatives per patient asking you 10 different questions. I had realised long back that I love surgical work. In these 15 days, I have also realised that when a patient comes with complaints of chest pain+breathlessness+hypertension, I lose interest. Its so obvious that Cardiaology is so not my thing. The area of the CMO dedicated to Surgery and Orthopaedics was my home, my go-to place when things got out of hand. I could calm myself down, doing the preliminaries of those patients, setting their wounds right, giving them hope that things would become better.
We had all sorts of patients - suicidal attempts (I and a friend sutured a wound in 3 layers - the only one in these 15 days :-) ), cases of castration, hit-&-run cases, accidental machinery injuries, self-poisoning for all sorts of reasons....I got a look into the kind of life people are forced to lead. That was disheartening because, when you have all the luxury in the world, some people don't even have 10 bucks to make a case paper. Old men with BPH complaints came from afar and refused to go back, because they had no fare. Aged women travelled for 2 days to come here and be told that they should have come 2 days before or after....that part of a direct view of reality made me depressed. I will do something for such patients in the future, because, they deserve every bit of it.
The casualty is an excellent place to learn. Medicine, Surgery and Orthopaedics residents are always there and they always managed to teach us a little something. Yes, this 15-day posting was wonderful. So much so that now it is over and I have this vacant feeling. My elective posting is Dermatology and it's back to being an intern doing all the menial jobs. I'm still in that mode of activity and multi-tasking. It is going to take a long time to get back to my usual job. Ha ha ha. Check this out. On day one, I had already hated every minute of that Casualty. Now I actually miss it. He he!!
So, how's the Internship going? It's going well. I'm enjoying it and I've learned quite a bit :-)

BLS and ACLS

I thought of writing about the two most important things for me right now, together, but then it didn't really make sense. Let's have two different posts then.
I managed to complete the Basic Life Support and Advanced Cardiac Life Support Courses. I am now a certified provider of both, and man, am I so confident and happy about the two!!
Day one was really good. One of my chief problems has been talking to people. Somehow, the two years higher secondary school and the four years of college taught me everything except communication. I haven't been the kind of a person who makes friends everywhere she goes, and these experiences just added to that trait more than ever. I haven't been doing a lot of out-of-college stuff, so the chance of trying to get out of this trait never came. I was worried about the experience of doing this alone. But, you know what, I'm not that bad after all. I did meet new people and definitely made a new friend :-)
Going back to the actual course- BLS was fantastic. Initially, the task of doing 5 cycles of 30 chest compressions with an interruption of <10secs :-="" :-p="" a="" after="" aha.="" aha="" an="" and="" anything="" arm="" as="" association="" at="" been="" between="" beyond="" bls="" but="" by="" can="" cardiopulmonary="" certified="" course="" day.="" designed="" do="" end="" examination="" got="" had="" has="" heart="" helps.="" hurt="" i="" if="" in="" into="" involves="" is="" it="" learning="" man="" merican="" method="" mode.="" more="" my="" nbsp="" now="" of="" on="" over="" p="" perceived="" period="" plus="" practical="" protocol="" providers="" really="" resuscitation="" s="" see-and-learn="" session="" step-by-step="" stupid="" superb.="" teaching="" technique="" than="" the="" there="" things="" this="" time="" to="" tough.="" under="" was="" we="" well="" were="" which="" wrist="" written="">

ACLS was more taxing. The whole process was beautifully organised. We were shown videos of teams managing cases...step-by-step videos....followed by putting-it-all-together videos, so the idea of an ACLS team was put through to us via visuals than mere didactic sessions. Those videos were a class apart. I have always admired the importance of protocols and organisation given in the Healthcare system in the US. This course provided perfect evidence to my previous heard-from-others respect.

From my point of view, the ACLS was more demanding. I haven't worked in a hospital before, haven't been a part of a team that needs to save a dying patient, haven't ever needed to think fast, act fast, be on my toes all the time, manage a whole team, think of what everyone is doing and ensuring that it done well. That is exactly what this course was about. I was the youngest person there, having just completed my final year of undergrad (and not even a doctor on the first day, our results were declared that evening). I was quite taken aback, when they said that we were going to be tested on our ability to be team leaders and guide a team to perform an ACLS service. Yeah, here I was, fresh out of medical school from India (where they don't teach you anything not-theoretical)....having my own doubts about calling myself a doctor and now, I was supposed to consider myself the most experienced out of the whole team and order them around as if I knew what it was exactly I have to do. I've always had my doubts about my own capabilities, but the second day of our course, those doubts stood out like tall pillars hiding me from what I knew was to be done. The instructors kept saying that when you know the algorithms by heart, there isn't much difference between a doctor and a non-medical person. All you have to do is follow the protocol and the algorithm.
Then came the task of identifying cardiac rhythms. Have I ever mentioned how stupid I am, when it comes to cardiac rhythms? Those ECGs were never taught to our batch (our bad, and only our bad. All my friends in other batches came to final year knowing how to read ECGs). They gave me nightmares during exams (and my final university examination, luck stood by me. I got an Inferior Wall MI to identify, the only rhythm I could identify). So, when they said you have to analyse rhythmns, yes, I threw up inside of me. I'd rather do something else. What added to my stress further was that everyone else already knew the rhythms (thanks to being doctors working for years, or doctors who'd completed their internship.). I was terrified. Let alone having ever seen a defibrillator or a TCP device before, I couldn't even identify rhythms. How was I to know whether to shock the patient or not?
Day two left me a little bruised inside. I was wondering how I'd fare in the examination the next day. I was wondering whether it had been a good decision to do this course now, at the start of my internship. A lot of questions swum around in my head, as I mugged up all those algorithms and tried out all sorts of permutations and combinations of them, thinking of patients weaving out of one rhythm and going into another.
I don't know whether it was the feel of a new day or just the fact that I'd studied hard enough to finally get hold of the idea, but next day (i.e. yesterday) when we practised again, I was understanding things, thinking for myself, looking at myself as a team leader, and gaining confidence as I did it all. It helped that our instructor was very pleasant and very nice about all the doubts I had, explaining every little thing to me. So as luck would have it, my practical went really well. So well that the examiner asked me where I worked :-p Lol!! When I told him that I was yet to start with internship, he gave me this surprised+satisfied look and said, "Very Good then. I thought you were working in some institution." Such a boost. The theory was a little tough, but I managed to get the required percentage. Yay!!

So now I am a certified BLS and ACLS Provider for two years....I have the confidence to know and do exactly what I need to save a dying patient in the casualty....and yes, I feel more like a doctor now than I felt immediately after our results were declared (when I officially became one :-p) 

The Day Before

I can't believe I'm being like this. Although, I actually believe it. yes, that blasted day is just round the corner and all I can think of and wish for is Jan 12th to return back.....ahhh...those wonderful first few days after exams got over....so relaxed, so carefree, so alive and so real....I can't bring them back, but I keep wishing for it.

I have no expectations this year, that I have to stay true to. The Rank 2 from last year managed to get that demon off my chest. Of course, I won't be terrified the moment I know the result is out (like last year. I freaked myself out. I swear I have a dual personality disorder. One is as cool as a cucumber, the other as Type A a personality as can be.). I know I probably did all I could for those exams. I was just glad to see them through and know, just know that I had managed to do enough to see the back of them. It isn't the same as last year. It is different. Yet, the fear of the result does not go away. Thanks to my awesome 2nd year result, I now have expectations that are so sky high, I simply know I haven't done that much hard work to do justice to them. I want to do so well. I want that No. 1 and that hurts.....it is no use asking for that No. 1 when you haven't put in the same amount of effort. When I haven't done enough, why should I want it? 

That is the question that plants the fear of tomorrow in my head. The passionate desire and the practical common sense clash, and that irrational desire always gets the upper hand. Whoever said that practicality is always victorious. I know exactly how I'll be feeling minutes before I open that page:

"Please please please God, let me pass (with really awesome marks, I'm not going to lie to you).

No God, just let me pass, I don't care about those 'awesome' marks (but I do!!).

NO God, let me pass....and let me get what I truly deserve (maybe a teeny weeny bit more?)

NO ABSOLUTELY NOT. I know there are many others who have done much more than me, so you know, just give me what I deserve and get it over with. Nobody is going to ask me about this 10 years down the line (oh but they will, because more marks, stronger CV, better chances. Logic, girl.)

Damn your 'logic'. You know better than myself what I've managed to do and not do. I know you'll be just, because you have many people to care about, and frankly, all of them are asking you for the same thing as I am. So, thank you for some wonderful results in the past 2 years. Hope it is the same this year, at least enough for this year."

Yes, that will be the conversation in my head....between that Desire and that Practicality. Ultimately, the Practicality will get strong enough to drown that Desire's voice, but my Desire isn't one to back down so easy....it'll continue screaming...at a really low volume yes, but it shall continue. I hate myself for being like this (for being human actually....who doesn't aspire things out of their reach, eh?)...I'm not one of those self-centred people who think they are so important for the world to survive, so I do feel wrong when I pray the way my Desire just prayed. But, it is a trait I haven't been able to get rid of. All thanks to identifying my true potential after the disasterous first year. This does not just include the exam performance. It includes all those small post-end examinations that managed to make me believe I was good at Medicine.

Any way, I've enrolled for a Basic Life Support and Advanced Cardiovascular Life Support (BLS & ACLS), conducted under the aegis of Symbiosis Institute of Health Sciences in association with the American Heart Association. It starts tomorrow. I shall try and concentrate on the course and not answer any calls/messages or communication of any kind that says, "Results are out." Lets hope this has the same effect as taking a journey to a destination unknown.....to try calm my nerves down a little. I do have a strange feeling that that isn't going to happen....and that this course is not going to be as great as I'd initially thought it was going to be. I'm not much of a hands-on person...and that is exactly what this course requires. But, it is essential in my endeavour to be eligible for Universities abroad, so need to do it. Sigh.

Help me, Dear God....calm me down, let tomorrow be a happy day, and let this year come to a decent end :-)