Hermit Mode: On

After settling in at my friends Richard’s and Henry’s place by claiming a corner on the floor of their living room, my mind turns to next Wednesday’s exam, which has been like an angry cloud hanging over my head threatening to strike for the last three days. I have exactly one week to gather all the knowledge that has been leaking out of my brain over the last six weeks and try to somehow shove it back in there in a somewhat organized fashion. With a subject as broad as internal medicine, it’s like trying to review the last three years in one week. Sounds a lot like Mission Impossible to me at the moment, but I have no other choice. So for the next week, my habitat will consist of the library, hospital wards, and my corner of the living room floor.

Signing off – ‘til next Wednesday.

Whoa, We’re Halfway There!

Woohoo! Exams are over, and I am a free man for the next two months. How I need the break, especially after such brutal exams yesterday.

The exams were in Bundaberg, a little over an hour away from Hervey Bay. They were horrible. I must have looked terrified while I was sitting in the lobby of the hospital waiting to get called in. Nurses, wardies, and everyone else who walked past me stopped to tell me, “It’s not that bad.” After an excruciatingly long wait, I was finally given my patient. Then the rest happened so fast, I hardly noticed that time just flew by. At the end, the examiner said cryptically, “I’m not allowed to give you feedback at this point. But enjoy your break and I’ll see you next year.” Yeah, hopefully not in the same scenario.

I spent the rest of the day stewing over little details that went wrong in the exams and every answer that I got wrong or needed prompting for and the awkward silences when I didn’t know what to say, until the evening when I got together with a few of the doctors from the medical team and had mulled wine. Ah, alcohol, I am so glad we are friends again.

Today’s plan: pack up everything I own into my car.

Tomorrow: drive to Brisbane.

Sunday: fly out to California.

Next Wednesday: off to Washington, DC.

And that’s just the plans for the next seven days.

It’ll be a good summer break.

Waiting for the Execution

Tomorrow I will be taking the exams for medicine rotation, and I am feeling restless, unable to concentrate, and in complete sympathetic overdrive. Studying? So over it. I have been staring at the pages of my books and nothing seemed to have gotten through. This afternoon, feeling like I was getting nowhere with studying, I went to the pool for a swim. After jumping into the pool, I felt like my arms were made of putty and just wouldn’t cooperate to allow me a good swim. After splashing around in the lane for a half hour, moving like I’d just learned to swim, I gave up and walked back home.

I don’t know why I am feeling so nervous. You’d think after having taken so many exams in my life, it wouldn’t be a big deal anymore. Maybe it’s because the whole exam is live, as opposed to written like almost all of the other exams I’d taken before. Maybe it’s because my grade for the whole rotation will be from the exam tomorrow. Or maybe it’s actually excitement from knowing that I am one day away from a two-month holiday.

I take my pulse. Forty-eight per minute – pretty normal for me. Maybe I am not that nervous after all. But my palms are sweaty and have been for the last three days. I feel like I am waiting for my execution tomorrow, watching the clock tick away, dreading the inevitability of it but, at the same time, looking forward to when it’s over.

All right, no more studying. I am going to watch some video clips on Youtube and hopefully I will get tired at some point.

Not the Sharpest Knife

With two weeks of the rotation over, I am finding myself getting less stressed out by not being able to answer the impromptu quizzes thrown my way on a daily basis. I must be getting used to it. On a good day, I may be able to answer half the questions. Sometimes when my rotation partner and I get grilled together, it really takes the pressure off, even if the other person is just standing there for moral support. Other times, I am give a reprieve and get sent to do some practical things like putting in cannulas in patients’ arms and taking bloods. My fine motor skills are leaps and bounds better than my ability for memory recall. Find a vein in a frail and dehydrated old lady with paper-thin skin big enough for a medium gauge cannula? No problem, I’ll give it a go. List the causes of pleural effusion? Out of the dozens of causes, I’m stuck after listing four. If the career of a physician is predicated on the ability of memorizing long lists, I may have better luck at surgery where manual dexterity counts for something.

Post Mortem

Eight o’clock, my rotation partner and I walk through the green doors. In front of us, the body of an old man is perched on top of a stainless steel cart. Next to the cart is a sink with a spray hose and a stainless steel bench with a cutting board. To the right is a bench with various sharp tools designed to cut through any organic material. The man on the cart died suddenly last week at home. Today the pathologist is going to perform a autopsy and try to find out the cause of death. In Queensland, all autopsies have to be witnessed by the police, so two police officers are also present.

In walks the pathologist. We exchange greetings and he starts working. Wielding a scalpel, he expertly makes an incision from the man’s jawline, down his neck, through the middle of his chest and abdomen, all the way through to the pubis. As he peels back the chest tissues and abdominal wall, the room is immediately permeated with the smell of three days of decomposition, despite the refrigeration. I look around: the smell does not even register with the pathologist, my rotation partner and the police officers start breathing through their mouths. Luckily for me, I am not bothered by the smell. Having peeled back the man’s chest, the pathologist takes a bolt cutter and snaps the ribs one by one until he can lift up the whole front rib cage off the chest like popping the top off a tin can. Next, he frees all the internal organs from the chest and abdominal cavities, slices the tongue from the mouth through the chin, and in one fell swoop, picks up the whole collection of internal organs from tongue to anus and everything in between and lays it down on the bench. The pathologist’s assistant picks up the oscillating saw and goes to town on the skull. In no time, the brain, covered in its fine web of arteries, is presented to the pathologist.

Each organ is weighed, catalogued, sliced, and examined for abnormalities. In the mean time, the pathologist’s assistant sews up the body, leaving a small opening in the abdomen into which he puts a plastic bag. All the chopped up organs are returned to the body into the bag, like so much table scrap being swept down the garbage disposal. The whole procedure is cold and clinical, without any emotional attachment. The person on the table was someone’s father, someone’s husband, someone’s grandfather; but in here, he is just a body whose cause of death the pathologist is trying to determine.

Toward the end of the autopsy, the door to the room swings open. Another body is brought in on a steel cart. “Suicide by hanging,” announces one of the wardies, pointing to the noose still around his neck. The pathologist’s assistant takes the spray hose and cleans off the ants still crawling on the body, then pushes him into the morgue. “We’ll do a post mortem on him later to make sure it was a suicide and not a homicide,” says the pathologist.

With that, the autopsy comes to an end. We thank the pathologist and head to the ward.

Back to the Grind

I am scared.

Today was the first day of the last, and the toughest, rotation this year: internal medicine. Ward round started in the intensive care unit, where I met the consultant I would be attached to for the next four weeks. Immediately, I found myself struggling to answer the questions he threw at me as we saw each patient: chest x-ray interpretation, causes, investigations, and treatments for secondary hypertension, community-acquired pneumonia, and heart failure. Standing in front of the consultant to my left, a senior medical officer (SMO) and a principal house officer (PHO) to my right, I tried to wrestle my brain back from the beaches of Fraser Island as steam started to build up under my collar. It was like playing dodge ball while being chained to a fence post. Two hours later and satisfied that I got a taste of what was to come in the next eight weeks, the consultant left; my battered body sat in a heap on the floor. I picked myself up and finished ward round with the SMO and the PHO.

I finished the day with a long list of things to look up: too much information to learn, too little space in brain.