28 March 2012
The practice of medicine is an art. Someone told me that once. It takes a lot of studying to become proficient at it. The funny thing is that it's rare to see someone who was efficiently proficient in the discipline . One thing I've always understood is that doctors are not infallible. Shit happens. But to think of the amount of studying required to become imperfect, it always made me wonder about the cost-benefit ratio of attending such an establishment. Maybe I'm making a mistake equating proficiency with excellence. Either way, the gauntlet had various encumbrances to measure our progress at one day being imperfect. One such minor hindrance was the dreaded "internal exam". These little bastards were the equivalent of midterms. Passing a subject required the aptitude to score enough "marks" (fobspeak for points on an exam) on three different disciplines: theory (written) exams, practical exams, and internal assessment. Theory was worth 100 marks, practical was worth 40 marks, and internal assessment was worth 60 marks. In order to pass a subject, one needed to score at least 45 out of 100 on theory, 18 out of 40 on practicals, and whatever balance was required on internals to get 100 out of 200 total possible marks. This system presented a delicate conundrum. It was theoretically possible to score the requisite 100 out of 200 on the entire exam. But if you didn't get the minimum passing marks in EACH section, you would fail the ENTIRE EXAM and have to take it over 6 months later. On the other side of the coin was passing each individual section but coming up short in the total required to pass. Yeah they liked to fuck you in multiple ways. Internal assessment encompassed the evaluation of such trivial things as attendance, behavior, and your scores on various "internal exams", the most important of which were "model examinations" which I will get to later. The marks that were appraised for your (sarcastically making quotation marks with my hands) assessment were pretty subjective. If CDS didn't like you, you were pretty much fucked. There were other teachers/professors who could give you a poor mark too. In physiology, it was the Head of the Department, a man we dubbed "Aquaman" because he looked like he had gills on the side of his face. In biochemistry, it was the illustrious Kartha whose passion for idli (steamed indian bread made with rice flour) was surpassed only by his passion for the Hexose-Monophosphate Shunt. In India, he who had the gold made the rules. The key was to score higher in other portions to make up for their lack of vision. But first things first. Our very first internal exam in anatomy encompassed the upper and lower limbs. It was only a written exam which consisted of 2 essays, 8 short answer questions, and 30 multiple choice. Essays in anatomy included structures like the elbow joint, important nerves and vessels, intrinsic muscles of the hand, etc. Short answers included the flexor retinaculum, a muscle, or an insertion of a muscle etc. Multiple choice could be anything. Our first one was scheduled for sometime in November. People started studying pretty hard for them. I noticed one thing right off the bat. The studying methods were different over there. I'm the type of person who grasps concepts and applies the new information I have gathered to create a new cogent process. In India, a lot of students used a process called "mugging". No, they didn't beat their other classmates for information. They memorized. And memorized. And memorized some more. Then they took a tea break. And then they memorized some more. I found it fascinating because I could pick a local classmate out of a line-up, ask them what it said on page 159 of Chaurasia's Anatomy (text of choice in hell), and they could recite it word for word without looking it up. These people had freakish recall abilities. When I crammed, I could do that as well, but not to the extent the locals took it. To be honest, most of my time was not filled with studying. It was filled with reading novels, talking with my boys, playing basketball, and eating pakora when the opportunity arose. I was like Matthew Modine's character in the movie "Gross Anatomy". I studied when I needed to. And I soon needed to start studying for these first exams. Seeing as how I wasn't very interested in anatomy, I asked some NRI seniors for some suggestions on essay topics and short answer possibilities. Logic dictated that picking the brains of intelligent people would be the way to go. But since the Indian experience was proving to be maddeningly illogical, I figured I'd just ask everyone I could for predictions of what could come on the exam and then make a list of stuff to study. King Surej told me about the brachial plexus. Sounded legit. Sushil suggested the great saphenous vein, the longest and largest superficial vein of the body. Something told me it had a shot. Anil The Long-Limbed suggested the median nerve. I didn't ask the 93 batch NRI's what to study because well, I hated them. So, with a sprinkling of predictions at my disposal, I set about to prepare for the first test. It was hard going in the beginning. I had no idea what to write for essays or short answers. I mean, in English class if the teacher needed an essay on the significance and use of foreshadowing and dramatic irony in Daphne Du Maurier's Rebecca, I most certainly could oblige. But something gave me the sense that essay questions in medical school were a tad bit different. Since I had no idea what to prepare for, I decided to use the first internal exam as an impromptu litmus test so I would at least be better prepared for the first one. Since our marks were so subjective anyway, I just considered them practice for the big dance that was coming in April. Before you could say supercalifragilisticexpialidocious, the first set of exams were upon us. The penultimate night had arrived and Mike, Ajit, and Abi were shitting bricks. Apparently there were probably 10 or more essay topics to cover as well as dozens of short answer possibilities. I wasn't in the mood to pull an all nighter, so I just studied one thing: the median nerve.The other three guys had no idea what to study the night before the first test. Mike was studying the elbow joint. Abi was studying the breast (made total sense if you ask me). Ajit was studying the femoral vein. I walked into Mike's room at around midnight to assess the preparations of our party.
"Hey Mike, what did you study?" "Oh man, Bobby, I studied as much as I could. I finished about 5 of the essay topics and 10 of the short answers. What did you read?" "Eh, I read about the median nerve." "And what else?" "That's it." "That's it?" "Yeah." "So out of 10 to 15 possible essays you've read ONE." "Your estimate sounds correct."
Mike gave me an aporetic look that counted as a smirk in my book. He shook his head from side to side, rolled his eyes, and dropped his nose back on page 159 of Chaurasia. Ajit was having an even worse time of it studying for the exam. He read about half as many essays and short notes as Mike had. I wasn't particularly inclined to study all that stuff when we would be tested on it again anyway. I left my friends to their devices and went to sleep. I like to think that I had dreams of a better place. At 7 am, my wind-up alarm clock went off (concession to the frequent power outages in the area). As per my usual daily ritual, I turned it off, got out of bed, scratched my balls, applied toothpaste to my Oral-B, and corralled my red bathroom mug. The rim and upper portion of the mug had been baptized by a grimy rim of salts and deposits that were present in the bathing water. I strolled on down to the bathroom to go about my business. The best part about the bathroom I used in the morning (along with several other guys I might add) was that the toilet was top-notch, even though it was a commode in the ground. One's rectum could expel a turd the size of the Titanic and not worry about it getting clogged. I sometimes noticed, rather unfortunately I might add, that toilets got clogged. The surest sign of a clogged toilet was to assess the degree of closure of the bathroom door. If the door was fully closed, odds were that there was someone using it at the moment. Confirmation came by observing a lungi draped over the door frame. If the door was partly open, leaving a sinister gap in between, chances were that that toilet was now clogged. Of course, the only way to assess the degree of outlet obstruction was to open the door and check. More often than not, if I came across a partly open bathroom door, I expected the worst. The worst comprised of turds floating out of the toilet and onto the bathroom floor, with the water level rising each time one tried to flush it. But on this morning, there were no surprises of that variety. As I pulled down my boxers and assumed the position, I thought about any other important things I should know about the median nerve. I came up with mnemonics for the relations, the course, and the muscles supplied by said nerve. As I was pondering the multitude of ways to answer, I reached over to the tap to turn on the water for my filthy mug. Consternation took a hold of my muscles of facial expression. There was no Adam's ale being expressed from the faucet. I now had no real way to clean my ass. And the worst part about it was that I had diarrhea. This was not your garden variety intestinal infection. I was genuinely a bit nervous about my first exam and had a bowel movement that has since been dubbed by medical students in India as the so-called "nervous diarrhea". The stress and anxiety causes your shit to somehow liquefy and come out in a semi-powerful stream with one or two squirts thrown in for good measure. For a minute, I supposed that I could have just tried the next stall over. I half squatted and half scurried to the next available water source in the bathroom, clenching my cheeks to make sure no go
Crusty And The First Internal Inquisition • Opuss № I