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 :-)

Musings of an Insecure Mind (innate + internship-effect)

It has been almost two months since I last wrote. Internship SUCKS. And as days go by, the feeling of getting used to the whole routine doesn’t make this thought any more palatable. When I was in final year, all I wanted was to get out of it and redeem myself with that one month break between results and the end of exams. During that one month, each day, I went a step closer to the beginning of this internship. Damn, I hated that.

We’ve had Paediatrics and are currently posted in Orthopaedics. Let’s begin with Paediatrics-

If there is ever a place that can frustrate you no end, upset you to interfering with your sleep, anger you to the extent of wanting to burn the place down, exhaust you to such a degree that the mere thought of burning the place down makes you anxious about the extra work you have to do….it is Paediatrics. I did not see my home clearly. I used to leave early in the morning and come back late night only to go to sleep and start with the same routine all over again. We did not get any holidays (No Government Holidays and no Sunday Holidays either). I was pitted against the most annoying girl on earth (no, probably universe)….not just annoying, manipulative, irritating, fussy, un-accomodating and a COMPLETE BITCH, if there ever was one. Out of the four weeks that I was posted in Paediatrics she was with me in three. It started with small fights, and by the end of the month, there was a war. One more day and I swear I’d have slapped her in front of the entire ward. That would have been exhilarating. I don’t mind working long hours and learning something. We did not even do anything amazing. In the ICUs all we ever did was monitoring, until I got myself the job of taking skin and rectal swabs for new patients and making the Bubble C-Pap for the Respiratory patients. I did learn Tracheal suction. I think that was a major landmark, because after we interns started doing it, all patients on the ventilator walked out healthy. Since there was no Junior Resident posted with us, and the Senior Residents thought it below their dignity to do something like a tracheal suction, we lost a few patients to ETT blockage. That thought hurt, you know. It was our fault, after all. So, the next a patient was put on the ventilator, we all took the responsibility of ensuring that a block wasn’t the cause of death. The pride I felt when I saw that girl walk home (breathing on her own) was the highest feeling I got in that one month.

We did not do lab, all we did was, take it from the residents and send it to the concerned laboratory. That was a bad feeling. I mean, you are interns. Lab collection is what you DO. In Paediatrics, they stripped us off the one job that we usually do with a little pride. Add to all this, the stress of the Project, Poster and 25 MCQs that we have to make during that one month. I was intent on making a paper out of my project, so I had to do it properly. I don’t know how I managed it all. I haven’t been so lost to the world and its happenings as I was during that one month.

Orthopaediacs, in comparison, is a fairytale. They have allowed us rotations so ultimately, each of us needs to go and work only twice a week. Emergency days are terrifying. It is heavy and there is no question of eating or even sitting down on that day. I finished my second ED yesterday and I was dead. Completely dead. But, I get time at home….time to make my research papers, time to send them to journals, time to do all the other work I have pending (like writing this blog J ) and time to just sit and still tell myself, you shall have time to study later on.

All is currently good. But, of course, I can’t wait to finish Orthopaedics. I like studying it, but I don’t like being a part of the team. I don’t particularly enjoy the whole scene, never have.

What I really want to write about today, is something that I heard yesterday. So friend of mine messaged me yesterday saying that he may be the topper in Paediatrics in our college. The list may be out this week (or there may be a function this week) and since he isn’t here, I may have to go and check. Have I mentioned before that my Paediatrics marks hurt? I missed out on distinction by one mark (and that left me with no distinctions this year, which hurt in places that I knew it would hurt). Wost part is, I know exactly where I lost that one mark that could have given me something close to pride about my performance this year. Yesterday, he told me that he may be the topper and also that he had crossed that distinction mark (75%). I had been cherishing this tiny hope that I may be the topper of Paediatrics (because the people above my rank have all scored less than me). I was hoping that I may get at least one prize this year (since all the others are totally out of my reach). But, that doesn’t seem to be so now. This friend of mine has scored way lesser than I have. It never crossed my mind that he could get more marks than me in any subject. When I read his message yesterday, I had half a mind to not reply and half a mind to send a really rude message. Ultimately, I gave myself some time to cool down and sent a congratulatory message. Which has left me pondering over my morals-

I always give importance to the marks scored. I want those awards, all that adulation, not because it swells my pride up to the point of bursting, but because it makes me think a little better about my own capability. In the long run, nobody will give as much importance to number of distinctions I got in so many number of subjects, or the list of prizes I won for my academic excellence in college (not even at the University level), or that fact that I stood 1^st/2^nd/4^th in class. What will be more important is the research I’ve done, the papers I’ve published, the places I’ve been to, the skill I have, the knowledge I manage to use practically (all that an examination doesn’t test at all!). And yet, I go hankering after all these marks, all the ranks, all the awards I don’t get….I, even if it is for a moment, spoil all the positive relations I have with people I call ‘friends’ and wish they go rot in hell. I hate being like this. This is insecurity. Insecurity that shouldn’t even be present because time and again, I’m facing examples of people who haven’t had the kind of academic achievements I’ve been lucky to get, but are doing amazing things, getting awesome placements in the best Universities in the world.

I wish I could change myself, I really wish I could. It is a good thing to desire to achieve the best there can be. But, it comes with this sort of a mentality as an auxillary, then it isn’t worth thinking of reaching that place.

Yes, its all out now…feeling better J I have a two day off now. I hope I study J

A Medicine Disaster Story

Me - At the BEGINNING of the Medicine  Posting

Me - MID-WAY through the Posting

Me - 2-3 days BEFORE the Term End  Examination

I write today, having emerged from a vicious battle; a battle that left me feeling thwarted and scarred; a battle which made me question the very reason I was put in there; a battle which gave me sniff of victory early on, only to take it far far away at the end.

Good evening, dear Readers, welcome to the post-term end report of the Medicine Term-end.

The past week has put forth shocks at the speed of, well, not light...at the speed of sound. It all started on Monday. I decided to go for the OPD after 2 whole weeks of staying out of it. I am a pretty sincere student, so I was feeling really guilty for not having attended it, in the previous two weeks. I reached the OPD and there came 

Shock No. 1 :Our not-so-down-to-earth Chief Resident had LOST HIS VOICE!! Ok, so a few words about this guy. He loves to talk. In fact, there isn't a second when he won't talk. He is a mountain of knowledge, but doesn't    complement that with much humility. He teaches really well, too, but wastes time in between. And - what irritates me most- he loves to be on great terms with the teachers, usually at the students' expense. I simply hate it when these residents make it their job to trash students. We're supposed to be little children. Treat us with care and love, will you!

So, this guy had lost his voice. It didn't stop him talking, but yeah, the load had reduced. It was funny and sad. Funny, because his voice was really gone, and it was nice to see him helpless for once :-p Sad, because, he wouldn't really be able to teach, and because, I pity every single person who gets a sore throat.

Shock No. 2 : He knew my NAME and RANK STATUS in my class!! I know I've done well in the past, but that simply doesn't put me on the map, right? Here I was, standing in the OPD, regretting every single moment for coming, and enjoying every single moment for hearing that funny voice. Out of nowhere, when I answer wrong, he says. " Why are you answering like that? Aren't you the topper??" Wow. The guy gets his information and how! I was pleased, yes ( I agree I don't have a lot of humility inside of me), but I was flabbergasted at the same time. How in the world did that happen?? And on top of that, he took my NAME.  Oh my God! Now he knew me. Any chance of being unnoticed went out of that OPD door.

Shock No. 3 : I know no ECGs. ECGs have evoked that Phobia system in my brain. Due to the miraculously perfect functioning of this system, I get Phobias of things very very easily. Stuff like the darkness (unless I can see the dark sky studded with its diamond stars), lizards, heights, certain chapters in Maths, Physics, FMT, Biostats and the newest addition - ECGs, freaks me out immensely. The fact that nobody really taught us ECG properly put together with another fact that almost everyone in class and in my batch could read ECGs pretty well, just multiplied that problem. Our tutor did teach us ECGs, but fact is that the patterns shown in books are never really seen in practice thanks to the machine-related errors. ECG- reading also requires practice, which I do not do, because I am so phobic about the whole thing. As the week went by, I started having panic attacks. I did not have the time to read the book and practice reading 100 ECGs and the ECG was worth 5 whole marks. Knowing me, you know how particular I am about each and every mark.

Shock No. 4 : I develop a sore throat and severe Sinusitis with GI symptoms too...Swine Flu?? This was the biggest scare of them all. The lingering thought in my mind that any day, I could end up in the hospital, ate up a lot of the tension related to my term-end, but brought on newer and bigger problems. I had taken the vaccine, you know. I have also gotten sick a lot of time since then. However, this time, the clinical features of Swine Flu have changed and it is now associated with GI symptoms. Also, I have spent a lot of time in SGH, with no mask and the place has loads of suspects. So I couldn't think of anything else. It turned out to be baseless and stupid any way. The GI symptoms went off in a day. I am healthy as a pony (I won't say horse, because I am on the thinner and smaller side) right now. Scary, though.

Shock No. 5 : We find our new CR ( not the one from Shock No. 1) taking our term end instead of Kadam Sir. WTH!!
The tradition is that if Dr. Kadam is present, he takes the Vivas of the first and the last groups. We were the first. It was known and expected by all that we would have to face him. In fact, the three of us were waiting for that moment. We have had the experience of his Viva last year. To say it in one word - SATISFACTION. Agreed, he asks his own set of questions. They make you think, and they follow a logical pattern. More importantly, he leads you on. There aren't hints as such, but he puts you on the right track. You learn too. Ultimately, even if you haven't been able to rattle off all that you know, you are satisfied because you have managed to wriggle yourself out of his Viva in a good way. That feeling can only be felt. No words will describe that feeling.
Having been there once, we knew we were in a good, if not, better position to face him. Disappointment showed on all our faces when that CR walked up to us. If he had been nice, it may not have mattered. What can you do, when every answer of yours is shot down with a big "NO", before you even complete it? And who can calm you down when you say something you know is correct and the reaction is , "Are you writing a new chapter of CNS?! Hahahahaha!!! You know nothing!" This misnomer of a Viva continued for half an hour. It ended with all of three of us telling him we did not like Medicine and we were NOT interested in doing it. The look on his face was worth it. We had taken such a wonderful case and he ruined our moment of pride. There is no way I am even going to look at him again, let alone, talk to him. The end result was that, we didn't really warm up for the Univ exams, we didn't get to know questions that we may face later on, we did not learn anything new, our old knowledge was laughed upon and our morale related to CNS and Medicine wasn't just broken; it was ground into microscopic little pieces that we can't even put together. Oh, and yes, it made me decide I shall not take up Medicine. I would take it up if my life depended on it, but then I know I am strong enough not to be faced with such a choice.

Me - AFTER the Term-End examination
"I will not rest until I have had my stomach's fill."

This disaster wasn't foreseen, especially after a nice table Viva in which I could identify and read the ECG and the X-Rays and even talk about the instruments and drugs. I hope I don't face such an episode any time in the future. I am not made of wood, and a repeat of that term-end will not leave me stronger than before. It will just add to the misery.

Over the weekend, I have healed my wounds. I start afresh today. We have Orthopaedics Posting now and I aim to finish reading the book once at least. I completed two chapters today so I know I am going to manage this.