Hunting for Clinical Examination

So, over the past few weeks I've been hunting for videos of Clinical Examination of various systems and joints and all, to help me gain some confidence with my own skills. Found a great blog called http://imedrxtv.blogspot.in...it has the MacCleod's Examination videos and also the Dr. Ghanshyam Vaidya clinics. Any one who needs either of them, can definitely have a look.
Today, I watch a youtube video of the Knee Examination. Thought I'd put it in here. its a big help to all those people like who have had to manage Ortho all by themselves, and need some help with the practical part.

From the Heart

There are a few singers who manage to touch your soul with their voices. Here's to you Adele, for touching my soul too....

My most favourite Adele song yet: Rolling in the Deep

Death

Its 3 am in the morning and I can’t sleep. I’ve gotten up to news that always shakes my soul, no matter who is concerned. It’s a death, and one of a close relative. Did I see him in the past 10 years? No. Do I remember his face? No. But my grandmom told me a snippet of how cute a thing I was way back when I was 4 years old. And that snippet is enough to pull me into this mindset…a place where I can’t decide, again, how to deal with the trauma inflicted upon us mortals by something called Death.

I don’t know what everyone is going through. There isn’t much crying, but there is a hush. A hush that is heavy with all the regrets about things that could’ve been done, should’ve been done, that may have been done and better sense prevailed. There is a hush that usually surrounds such news …it wants to say a lot of things, but somewhere between the brain and tongue, it stops…as if not wanting to come out, lest it unleash a cloud of emotions we can’t deal with.

He was beyond 80 years old…he was ill…there was a huge chance this was going to happen…but, when it does, this thought doesn’t make it any easier. The only consoling thought could be that he was restless…he didn’t like being the way he was…he was getting angry about his situation…this was the only way out…but, it doesn’t make it any easier when you ask yourself, “Was it?” It wasn’t the doctors’ decision to make it happen, it was made by Someone Somewhere….Someone who thought it was time to go.

Such thinking doesn’t make it easier either. Who would wish things turned out this way? Who would want to feel all the rush of emotions at this moment? When you begin to realize that you will NEVER see that person again, it hurts….in that pit of your stomach that isn’t even a part of any happy feelings that could make it easier. It hurts, because along with that knowledge, comes a load of memories…when he first held you…saw you walk for the first time…watched you get your first award…saw you in your darkest hour to give you strength that only a parent could give…all the fights, all the good times… and then, that so-called consoling thought doesn’t seem so consoling any more…

In death, every hate that you’d ever felt towards that person seems to evaporate (unless it was a murderer or something…in that case, things would be different maybe)…you end up saying to yourself, yes, it was stupid…maybe I shouldn’t have gone so far. But, it hurt that time, and maybe for years after that…and so you never really ended up taking about it. Now that is what you regret. A lot.

Death is the rule of Nature. Is it just us Humans who end up feeling this way? This barrage of emotions that erupt with such news…a turmoil that we can’t deal with? And, why does everyone say time heals everything? It might suppress the memories, it might bring new ideas, new avenues…somewhere deep down, the old ones still remain…and this transition. This transition from right now to then, isn’t that a painful process? How should you deal with the idea that somebody has gone to a place where he can’t be reached, can’t be seen, can’t be felt. A place, we say, exists, but don’t know much about…does it really? Or is it just the end. An abrupt end to a mortal life that had to end from the very time it began.

These questions come up every time. Is there any answer to them? Life goes on, as it should. But, there has to be a moment when these ideas get overwhelmingly too much. What does a person do? How do you deal with Death. How do you manage to let go of all those regrets, all those happy memories that hurt so much? Most importantly, how do you run away from your own mind that refuses to want to deal with it all and move on. This moving on process, reducing a person’s being to a mere memory….is that fair to him? He lived a life….a life that was pieced together by his own work and those around him. He lived A LIFE. Is it fair to reduce that life to a memory that threatens to disappear when it gets too distant? Would you want to remain just a memory? In that case, this means we’re selfish enough to wish the people close to us shouldn’t move on at all. Yet, that is not how life is supposed to work.

Maybe some day, I’ll find answers to all these conflicting thoughts that eat me through and through. However, if there’s something I learn from this, it’s that, you have to say everything you want to, to every person in your life. Tell them you love them forever, whatever may happen in the future. You shouldn’t want to say it when its too late.

May his soul rest in peace. 

Theory Examination Over

Over the past 2 weeks, I’ve realized the following:

1.       I hate exams. I thought I lived for them, but I don’t.

2.       If Final year is supposed to be hard, it doesn’t even compare to the stress you go through during the exam. Looking back, I don’t know how I made it through in one piece.

3.       Papers always turn out differently this year. They are all expected questions, yes, but you don’t feel like you’ve written expected answers (or this might just be me talking).

4.       The age old superstition : the lesser you’ve done something, higher the chance of it actually ending up in the paper. It sucks through your brain. Oh, it SO does! And probably, that’s why you end up staying awake the whole night.

5.       Everybody but you, seems to be less concerned about the examination. It’s almost as if, you’re in one boat and everybody else in the other. It actually isn’t like that, but that’s how the world looks to you.

6.       The MUHS does NOT care about us students. They prepare papers full of spelling mistakes, repeat short notes in the same question (which is: Answer any three out of five. So that effectively reduces us to answering 3 out of 4. Or taking that bold step of writing the same answer twice hoping you’ll get 3 marks two times over.

7.       Surgery still freaks me out. I did it almost twice. Almost, because, there were a few chapters I did not do twice. Yet the day before both my papers, I was freaking out. And I was almost wishing I hadn’t taken up this course of Medicine.

8.       I always fall sick before my exams. Thing is, the week before my immune system decides to take a holiday, and I suffer. Surprisingly, this time, I got better like 2 days before the exam began, to reach my designated centre and end up with the flu AGAIN. Seriously, there was a time during the paper I had to allot to clearing my blocked sinuses!!

9.       I am exhausted. I don’t want any more testing, I don’t want any more theory answers to be written. I’m so tired of taking all this stress, it’s reduced my weight to more than is normal during a preparation leave.

10.   And, did I mention, I’m still hating Final year? Oh yeah, I’m still hating it, and I simply can’t wait enough for 13 Jan to come.

So how were these exams? The same exams I was so worried about, the exams on which nothing depended, my parents had absolutely no expectations from, I had no expectations from, the exams for which I literally turned the entire household’s lives upside down….yeah they were ok….all of my papers were more or less the same…I didn’t find any paper extremely easy, but no paper was pathetic either….I liked my Obstetrics paper best, because I drew a lot of diagrams, and they didn’t ask the questions I’d dreaded. I think I like my Paediatrics paper least, but that’s just because I couldn’t give the finishing touches I’m so used to giving all my papers. And it sucks to end your undergraduate examination on that note.

It’s what I’ve been through in these past 2 weeks, that’s so important. I suck at managing stress. Oh man, I really suck. My mind plays all sorts of games with me, and it’s so freaky. My usual method of calming myself down went to the dogs this year. When I told myself, “Shut up, stupid little girl, you’ve prepared well!!”, another louder voice used to come up behind me slowly and say, “Oh yes, little girl, you’ve prepared well. Tell me, do you know that you can’t remember the treatment charts? Or diagrams? Oh and by the way, you’ve not even touched contraception yet….and what about Skin….and you have even done your usual dose of MCQs this year.” It’s so hard to get rid of that voice once it starts.

This past month has been dreadful. I don’t think I’ve ever suffered so much in any preparation leave. It has been a combination of low confidence, sucky memory and a vast portion that refuses to even come close to the finishing line. The result : a complete wreck of a person, worried parents, indecision about the future and an ardent desire to just let go. They say Medicine is tough, so this is just the beginning. I’m really worried about my brain and its tolerance capacity. So, yes, there are some tough decisions to make in the coming month- regarding my future, what I want to do, how I want to do it, and the best way to keep my brain stable. I almost resorted to some anti-depressants and I don’t want to go down that road ever again. That’s why this decision will be so important to me.

Right now, I’m already worried sick about my practicals. The worry doesn’t make it any easier to start studying again, but it does affect the general day. I wish I had some confidence in myself. I really do. I hate this low self-esteem I have about my case-taking and practical skills. Of course, I have good enough reasons to feel this way, but I also have good reasons NOT to feel this way. Our timetable isn’t out yet. All we know is that, practicals in our college will be held from 1^st to 12^th of Jan, 2013. Nothing more. I want to know the exact details as fast as possible…that way, once I have a deadline to get to, it’ll make it easier to manage my study timetable.

God bless me and my case-taking skills. One ordeal over, another to start very soon. Oh I hate Final Year!  

HAPPY DIWALI!!!

Good Result :-)

Congrats President Obama for a new term in office :-) Cheers to the guy who's made me believe that Politics does have some genuine people !!

The Effects of an Illness

Ok, so as a part of growing up, you have to deal with illnesses. Some are small, the flu kind...they make you lie in bed for a few days, give you a headache, a sore throat, fever...u take analgesics, anti-pyretics, anti-histaminics and within a week, you get back to work. Then there are some other illnesses that lurk around inside your body for years before you come to know they existed. There are a few others that tend to show themselves now and then. We just fail to identify the symptoms.
I seem to have the third category. In past few months, there has been a lot of buzz about Vitamin B12 deficiency in my family. My very first patient correctly diagnosed was my mom. She had complains of burning patches over her toes. They used to just come and go. I asked her to get her B12 profile done and it did turn out to be B12 deficiency. A few injections down the line, she said she had never felt better! Her Physician pointed out a lot of other signs of B12 deficiency that she had. So, it had been around for quite some time. My grandmom has had problems with haemorrhagic patches over her skin. A little trauma and the next thing you know, there is a sizeable reddish purple patch over her arm. When my mom told her to get her profile done, she was diagnosed with B12 deficiency too. She can't tolerate the injections, but she takes them once a month to just feel better.
I did not think I was going to end up with it too. But, over the past year, I've been feeling that I'm having memory issues. I don't remember my friends' birthdays, can't remember people favourite foods, toys, cars, etc...and most bugging, can't remember things I've read like hours before. I could feel the contrast between Me of 2nd year and Me of third year. We got my profile done, and it was really really really low. I had a 137 where the normal lower limit is 211. I was put on injections immediately. The funny little patient I am, I can't tolerate pain much. I had some fainting episodes after the third and fourth injections. My parents decided no more injections for me. I was to stay of medication only.
Funny thing about oral medication is, you never know how much is exactly going into your body. So I even started with all the milk eggs and stuff. I couldn't feel much of difference really. I still had episodes of tingling and still felt my memory wasn't back to normal. But, yes, it did improve a bit.
It was only in this last week in my PL, that I have really started to think I might have gotten back to my really low levels of B12. B 12 deficiency is characterised by a lot of things. Among them, there is a point about mood swings. I don't have mood swings, but over the past week, I had started getting worried about my exams, worried about finishing my portion, missing my friends like crazy (to the extent that I messaged sentimentally to a few), missing my family when they'd go out for work. I kept thinking about the future and how it was all going to wrong for me. And these episodes would just turn up spontaneously. Next thing I knew, I'd have tears in my eyes and I'd be crying like there wasn't an end. It freaked me out. Because, I am not like this. I don't think about results and study. I just study. I don't think about the future. I live in the present. And, yes, I do miss my childhood like crazy and get sentimental, but I do NOT cry in this manner.
When I broke down in front of my parents, it was the last straw. Because I didn't even know what I was crying about. I was nervous and tense. About everything. Anything specific? I had no answer to that. We all knew I was ruining everything- my health, my mental capacity, and my chances of seeing these exams through. It was very frightening. Was this year so bad, that I'd turned into a mass of nervous wreck?
When I calmed down a little, I thought back to the time this had first happened (before my Surgery Paper during the prelims). I'd broken down at that time without any warning too. Then when I had my B12 tablet, I'd felt a little better, more in control of my emotions and senses. Then I thought about all the mornings nowadays, when I take that tablet. I'm not very tense at that time. The time I freak out is 5 am in the morning when I get up because of that fear. And, in the evenings. The period around 9 am -12 noon is a calm serene one. That got me thinking that I should start with the injections. Maybe not every day, but at least once a week. I am not the kind of a person thwarted by exams. I kinda live for them. SO there had to be another reason for my erratic behaviour.
And you know what, it has actually helped! I took an injection on Monday, and since then, I haven't felt any of that fear of destruction and that insane need to cry. I'm still a little concerned about staying alone at home, in case I go back my last-week self, but I managed to stay alone at home today afternoon and I'm just fine. So, yes, it has been my B12 acting up again. I'm actually a little shocked, because I sudden;y feel like a patient. A patient who was totally utterly lost and defeated and now, one shot of the medication has given him a new life. I think I'm going to take the injection monthly for the rest of my life. If I could get so tense about a stupid exam that I just need to pass, imagine what sort of hell I shall put myself through later on, when there are bigger and scarier things to deal with (patients' lives, for example).
Mom says I shouldn't take weekly injections right now. But, I so don't want all this to repeat again in my PL, I'll try convincing her to give me one more a week before my exams or something. Till then, its oral medication and being my normal self.
Phew!! Scary, freaky experience. For a moment I thought I'd have to go get myself a psychiatrist's consultation with a few prescribed medications. Let's hope it doesn't get down to that.         

SNAKE!!!

That slithering reptile and I have a wonderful history. We meet regularly. Unexpectedly. And I lose a few years of life, thanks to the sudden rush of adrenaline all through my blood vessels and the spontaneous overworking of my heart.
Ever since we moved into our new house (not so new now) 3 years back, we'd heard stories about how people here found snakes in their homes...some found them in their bathrooms, others in their gardens, some 'lucky' ones found them on their beds, occupying it as if the bed were the snake's rightful place, not that poor human being's. There was this one day, when we were still in the process of doing the interior, that mom came home with photos of a snake caught at the home of our to-be neighbours. We were excited. Previously, my only tryst with a snake had been watching one cross the road as I cycled...that too from a distance. When we moved into this current home, we were told it was only a matter of time before we became members of the sacred group "Snakes In Our Home". It took a year, but we did get there.
I don't remember if I'd written about the snake visit last year. It was a day before Diwali. I opened my bathroom door to find something on the wash basin. Something that did not look like an earthworm. Something that was definitely a snake. We called the concerned people and after an hour of intense searching, they found it hidden under the lining of the wash basin. That was tiny. Although initially scared, I managed to gather my wits together in time, and enjoyed watching the whole process.
My second time was the scary one. If I die at 65 years of age, I shall always say in Heaven that I was supposed to die at 70 years, but that fateful day changed that equation forever. It was evening. I was watching TV. For some unknown reason, I decided to watch till 6:30 pm instead of 6:00 pm. I heard some bottles fall. Since they are kept near the window, it's usually due to the wind. So, I looked up expecting to see an empty window. Instead, I saw a thick black rope hung in a U-shape around it. It was moving. Told myself I was imagining things. How could a rope move?? And even if it was, it would be outside the window. Because, all the doors were closed and all our windows have the mosquito screens placed. I couldn't see properly because the kitchen lights were switched off. That sort of made it worse.
Then, without any warning, that rope moved faster and twirled around the sink taps!! Crap. It was a snake. INSIDE MY HOUSE. AND THERE WAS NOTHING BUT EMPTY FLOOR BETWEEN IT AND ME. That was the moment I realised what petrified with fear is like. I couldn't move. I couldn't remember where I'd kept my cell phone. When I tried the landline, I couldn't remember my parents' cell phone numbers. When I got my phone out of my room, I couldn't operate it properly. When I finally got through to my mom, even her assistant realised there was something majorly wrong, my voice was so shaky. Yes, that day, I understood fear. And in the process of understanding fear and trying to save myself, I chucked what I should've done i.e., sit quietly and keep an eye on that snake. It was huge. It extended from the top corner of the window down to the tap where it had managed to twirl around a few times. That and the fact that I couldn't see properly (add on, being alone in the house) pushed me out of the house without any further thoughts. It was an hour before those people came and they searched the entire area, but couldn't find it. I slept in fear for the next couple of nights. And I can never look at that sink in the same way again.
The third time was less scary, because this time, the snake was hanging down from our backyard roof and I was sitting safely in my room that looks into the backyard. There was a screen, broad daylight and a confused snake still deciding whether to enter our backyard or move into our neighbour's. Previous experience told me to keep a watch on the snake and I made sure I saw it go. This time, I was alone but, braver. When it isn't inside your house, my nerves don't crash down.
Today was sighting number 4. Again, I was alone, in my room, not thinking about a snake at all. Heard the movement of a mug and buckets. Told myself, it is that cat. Obviously, can't be a snake. Look down form my window and bingo! SNAKE. Long long long...could only see the body and tail, no head. Yes, I was freaked out. My mom says she thought so too when she talked to me. Couldn't get through to the usual guy, he gave me another guy's number. While doing all this calling, that stupid snake, after having searched the whole area around our wash place, decided to go down the drain. When I told this to the snake guy, he told me to throw some water with phenol down the drain. I told him I wasn't going to do it. Keeping an eye on the snake is fine. Going right to where it is and trying to irritate it, is NOT. He came and did that. He said that since these snakes can't stand the smell of phenol, it would come out in an hour or so, if it were still in the drain. It did. And he caught it. I'm putting up the videos here. It was huge. Like 6 feet long. It was the same one I saw last time. Mom thinks it is also the one I saw that dreaded second time. Maybe. Because that snake was definitely long. Thank God, this snake was caught. My home was slowly turning into this cluster out-of-bounds areas. I'd have probably just been left with my bed as my safe place. And now Dad has to believe me. He thought I'd mistaken ropes or other things for snakes last two times. Mom was totally freaked out too. I was at least quiet with my emotions. She was literally dancing in her place.

Please dear slithering reptiles. I admit it. I'm shit scared of you guys. I do not like to even see you guys. Please spare my life and stop coming into my field of vision. 4 times. 4 times we've had snakes in our house. All 4 times, I've spotted them. Please no more. Please.        

The Break

Did I take a break? Not really. So, after the exams, I had to complete and send my research project to the ICMR, clean up my room, clean up  the house, get some decent sleep, just get away from studying for a few days. Unfortunately, that did not exactly happen. I couldn't do everything and when time came to get away to Mahabaleshwar for the weekend, I had spent an entire night trying to get my project done and was carrying all my work with me.
It is such a pain the ass to do something like that. I haven't been to Mahabaleshwar in a decade. I was really excited about roaming around there. Having the incomplete project hovering about in my thoughts did help much. Mahabaleshwar was wonderful....cool, windy and very friendly. On Saturday, we enjoyed our hotel completely. We were staying at Evershine Keys. Nice hotel :-) lovely food :-) Yesterday, we visited all the "Points" in Mahabaleshwar. My favourite had to be Kate's Point. It overlooked a river...the water was crystal blue, and it reminded of the Pacific Ocean for some reason. The scenery all over Mahabaleshwar is so pretty!! I simply love to places like that, so I've been one happy person over the weekend. Knowing that I have to start studying from today males me cringe, especially after reliving all those wonderful memories of the weekend.
The market in Mahabaleshwar was so inviting!! There were shops after shops of footwear of all kinds, purses, handbags, hats, artificial jewellery and the pride of Mahabaleshwar - Strawberry with Cream :-)) Mom and I went crazy with all that footwear...we bought so many!! Over all, I had a wonderful time.
What makes me relaxed even more today, is that I managed to finish writing my report yesterday night and sent to the ICMR. I was worried that there may be a lotof load on the site (after all, today is the last day of submission). But, sending a report at 2 am in the morning always eases the load a little :-p
My experince with this project has been enriching. It wasn't enjoyable. I remember that initial period. It was all new, the hunting for patients, talking to them, convincing them to take the required tests, interactions with the lab personnel, getting the statistics done, getting my ethics certificate...and the most difficult of the lot, trying to get my Guide to talk to me for a few minutes. Getting into the groove and setting a time table that I could follow was a task. Juggling my studies, exams with the time that went into this was an even bigger ask. I've already given up hope that I'll match my own standards of the last two years. I just want to do well enough to be proud of myself and this year...
Lets see how everything pans out. I hope they accept my report. The four months have been tough and I don't want any more trouble related to this project. Best of luck to me for the next one month :-)

The Prelims Over :-)

Looking at the few results that have come out, its not been the happiest of times, but its not like I expected to rock my exams.

These 3 weeks have been nerve-wracking. First, it was back to back papers. That pretty much left you with no time to really brood over the previous paper or the next one. My acid-test was the Surgery paper. My relationship with Surgery hasn’t been smooth. I like the subject. I love it. Its amazing how that is possible. Surgery is Anatomy clinicalised, if there is such a word. I used to HATE Anatomy. I couldn’t visualize anything in there. But, here I am, 3 years down the line, liking the subject that is the advanced course of the subject I hated.

Any way, so as much as I love the subject, I’m not very confident about it. So, when it comes to an exam or a practical I get so paranoid. The day before my Surgery paper, I was at my wits’ end. It is all thanks to my dad who somehow got me through that paper, with all his discussions the day before. Before my Surgery 2 paper, we did the same, but it wasn’t as successful. My paper wasn’t the dream that I wished I’d had. It was a cross-over between a normal dream and reality.

The rest of the subjects have been ok. I know my Obstetrics paper wasn’t as great as my Gynaec paper and the difference in the marks showed it. I know that my Med 1 paper was 100 times better than my Med 2 paper. Yes, those marks showed that too. My practicals were pretty fine. The Gynae pracs were especially better than expected. I got decent marks too. My internal assessment marks for my pracs are more than those for theory, so that does say something. The med practical was supposed to  be fine, but my marks didn’t show it. I was pretty disappointed with that.

At the start of this prelim exam, I just prayed that I get through it somehow, any how. I did. THAT is an achievement. For a month back, I was totally unprepared. Totally, completely, fully. I didn’t know how things were going to fall in place. They did. Not perfectly, but they did. To me, that is all that matters. A friend of mine says I’m overly competitive. I don’t believe that is true. I know the kind of answers I write or give in Vivas. After having taken exams for the past 20 years, I can say I’m an expert at it. There was a time when my papers were held up in front of the class to demonstrate how a paper should be written. Even now, in medicine, there is always something that I like to incorporate in my answers to make them better than the person before me. After all, the checking of papers is relative, isn’t it? All students study the same amount. All students write the same amount. They write the same things too (biology of the body won’t change with each paper, will it?). The difference between a 67/80 and a 40/80 is the method of presentation. It is your answer that shows your ability to succeed. And, I know I have to keep doing that to score more.

Do these scores matter anywhere? Not really. But, they do stand to give me a shot of confidence. So, I know that next time I write a Gynaecology paper, I shall be sure of myself when I’m writing it. The Obstetrics paper, on the other hand, will require some more effort on my part. When I know that I’m managed to score among the top brass of my batch, I know that I’m up there knowledge-wise.

These upcoming preparation leave days are going to make all the difference. I know that. It is going to be one tough month of studying. But, having gone through my prelims, I know I need to work extra-hard to stop myself from losing it before or during the paper. Our practical dates have also been declared and they are a month away from the theory exams. So, the upcoming 3 months are going to be the make or break of my Medicine journey. In this last leg, I can’t give up or be loose. I’m going to make each and every day, each and every second count.