Tuesday, September 28, 2010

"He that saves one life, saves mankind entire."

So, finally my prelim examinations end on a happy note, considering that I have successfully and with a rather substantial margin, passed all my practical examinations and also hopefully, my theoretical examinations as well. This exam has taken a lot out of me, I havent slept more than three hours a day for the last, well, two weeks. And I have realised that sleep-deprivation only initially clouds your mind, but brings a strange serenity afterwards. I felt that pretty much every day these last six days but well, not constantly. My mind seems to return to its natural state of turmoil as soon as it is free from the stress of relentless reading.

So while my tired eyes are screaming for me to shut them, I must empty my mind again of thoughts and since this blog has served that purpose well in the past, I can trust that it shall do so again.

Now, that I am a mere two months away from my final MBBS qualifying examination, I feel as always the deep disquiet that accompanies the insecurity I occasionally feel about the matter of actually being able to treat real patients. I have determined that around three times out of ten I am able to reach a satisfactory diagnosis by a process of thinking that will obviously require great refinement that I hope maturity and experience will supply. I have also studied somewhat sufficiently and trust in myself to be able to devise some kind of method of management most of the time, except in emergency situations where I have found I dont possess enuff calmness to proceed without anxiety.

Today, my professor told me that he thought I was a good student and then he asked me how much I have been scoring these past few years. I told him I had scored 75% exactly in my first year, nearly 73% in my second year and a little more than 71% in third year. He smiled and said, "How much do you expect to score this year?" I replied that I just hoped to pass, which is true. He said something that I'll remember forever, I think. He said something like "Madam, if you score 75%, there is still a deficit of 25% when you're dealing with human life. Isn't that rather a lot?"

I had not thought of this. I replied that there is a certain reasonable expectation of knowledge and skill from a good doctor and I hope to reach that expectation and that is all. He said he agreed that doctors aren't superhuman computers and are bound to make mistakes, but the cost of every mistake is disproportionately high.

He wished me luck for my final examination and I walked out, quite paradoxically anxious, instead of being flooded with end-of-exam relief as I had hoped I wud be.

This was not the only incident that affected me these last several days. On the day of my surgery exam, a lady with a grossly enlarged nodular thyroid, put her warm hand on my arm when I sat down beside her to write her case down. She asked me if she was doing the right thing having the operation done becoz her family discouraged her and this scared her. I assured her that she was, and that the surgery wud help her. I sensed acutely the fear she felt when she pressed her fingers harder into my arm. I held onto her hand while I proceeded to write her case, I only left her side when the resident in charge of the exam told me the time allotted to me was up. I said to myself, I had reassured her effectively but I cannot be certain.

The second time something deeply affecting happened was in the paediatrics examination yesterday morning. Paediatrics is always hard, I find it painful to watch children suffer. It just seems so unfair. This 11 year old girl with a previous history of TB lymphadenitis had developed sudden-onset hemiplegia and motor aphasia. While I questioned her mother about how it started, the mother grew increasingly agitated as she described her ordeal in trying to get her child admitted to the hospital and how it took eleven hours for the process to be completed.

Then as I asked her about the child's development, she told me how her daughter was the most intelligent of her five children. She teared up and told me, "Meri beti kitni achchi hai. Usko aisa kyun hua? Woh abhi baat bhi nahi karti hai. Doctorsaab, woh theek ho jaayegi na?"

This really tore at my heart. I told her to be strong and that the doctors here wud do everything they cud to help her child.

I watched my batchmate who was allotted the same case, interrupt the mother repeatedly to write the history down in a hurry and I realised how easy it is to become so utterly desensitized towards another human being's agony. And how it is also easy to forget that they are human beings at all.

I have tried, all these years, to be as considerate and as kind as I possibly cud. I have watched my father and my own paediatrician interacting with their patients and I hope ardently to be as good as them some day.

I know that my conscience shall hold me forever answerable and responsible if ever I go wrong with anything. And knowing this scares me.

But I am thrilled to think that I shall help to relieve suffering, if only fractionally. I am convinced that I shall always try.

I dont know if these qualities will make me a good physician some day, but the answer is in the attempt.

When I told my best friend about these patients today, she smiled and told me, "You know why they talk with you. Becoz they can sense that you really care."

She is right. I do care. I pray I dont turn jaded or casually cruel or even rude like the few people I have seen who are that way.

At the same time, I cannot give myself over to studies entirely. I must pursue all that I love or I shall become a mean, incomplete person. I can also never ignore the deeper calling that asks me to examine philosophically the matter of suffering and death. I cannot stop myself thinking about it. I hope that I can be rational and useful inspite of it.

Please, please, the powers-that-be, please let me be successful in this much.

I really admired that Talmudic saying that is the title of this post. It was inscribed on the ring that the Jews that Schindler saved, gave to Schindler at the end of the war. I really want to believe in it.

P.S. I just read this back to myself and I think the tone is a little detached. I wonder why that is, becoz I have only sometimes experienced such turbulent emotions before. Perhaps now I shall be able to sleep.


T. said...

My dear girl you do have a deeper calling and because of that Im certain that you'll be a fantastic physician, inshallah. this also means you will give your friends free treatment. *nudge wink nudge*

and you don't sound detached you sound like u're trying to distance urself from something that troubles u. that is all. :-)

and since your exams are now done can we finally go out to town? :-D

S. Susan Deborah said...

I read this a soon it was posted but the comment was skewed. now I'm back to record my thoughts here. I loved this honest meandering of your thoughts and believe me, not once did I feel you were detached. If one is detached, is such passionate rendering possible.

I am glad for the thoughts you have about your studies and the deeper calling. Your patients are indeed blessed and fortunate to be treated by you. I wish you the best in your exams and life.

Joy always,

Tangled up in blue... said...

T. :) *hugs* That is the nicest thing you've ever said about me, you know that? :) :) :) And sweetheart, I hope you never ever need my treatment or anyone else's for that matter..

and yes! Lets go on Saturday na! First, to Strand, then Bombay Store, then Sterling to catch either Khichdi or Anjaana Anjaani..you pick! :) And check your mail! And reply, quick quick!

Tangled up in blue... said...

Susan, thank you. I feel much bolstered by the thought that people have so much faith in me. :) And I think the way I write has really changed so much that I can barely recognise it as my own any more. Thats why whenever I read my own posts, I can never replicate what I felt when I first wrote them..

And yeah, I'll need all the luck I can get to pass those last exams. so many thanks! :)

Soin said...

i wanted to be a doctor for long. my cousin who lives with me is a gyno. so i visited here once in hospital during my tenth holidays. after that i decided not to become one. what you have keyed down is what runs in my mind as i in my first month of job. so yeah it usually sorts it self these things. or they sort you.free

Tangled up in blue... said...

Haha..watching gynaecologists at work is a sureshot way of discouraging anyone from taking up this line of work :D Yes, hopefully things will eventually sort themselves out..like they pretty much always do..

R said...

Can't predict the future, but you're right, things will sort themselves out as they Always do. Very inadequate word, but Chill. =) Destress. I'm biochem tentatively premed so I know the mind-numbing effort even the preliminary stages take.
One thing I can say for sure though- sincerity is definitely not something you lack. :)

JD said...

Most of the time, I do not envy students of medicine.
The time post reading this was not one of those times.

You've achieved the kind of philosophical catharsis very few do. Sleep deprivation clears up a lot of things, you're right.

Oh, and inform your near ones that at times in the future, get you to read this post. It's going to be important that you do, someday.

Most importantly, thanks for this. A lot. :)

Nitisha said...

TUIB, that was such a warm honest post! All i feel like doing is giving you a hug and i dont even know you! :-) No, it wasnt detached, it was just so insightful and great.
Your exams end, mine are around the corner. Life. :-P

Tangled up in blue... said...

Riddhi, thank you! :) *hugs* Thank you for that! And you're pre-med, wow! Good luck! :)

Nitisha, Thank you! And if you need further proof to convince you abt how maddening life can be at times, think of how my final university exams will start around the time your exams will end..:D See, how it always comes a full circle?

Tangled up in blue... said...

JD, man, where have you been? I know why you say that, and I'll make sure that I get around to reading this a lot and maybe, subconsciously that is why I wrote it. It'll be like a mission statement of sorts! :D And you know what, we envy engineering students a great deal actually! ;)

Nitisha said...

Karma is a bitch, Karishma. It really is. :D

But but, I love this post so much that if I ever really meet you, I shall treat you to vada-pav in true Mumbai style. :)

Tangled up in blue... said...

And so it is! But you what, I am not as partial to vada-pavs as I am to pani-puris..which reminds me, I havent eaten any in ages, which calls for going off to khau galli right away! :D see you later!

Tangled up in blue... said...

*you know what

JD said...

We lead this symbiotic life of sorts, medicine and engineering. Hmmm, maybe I'll write about that someday :)

Srishti said...

TUIB, this is one of the best posts I have ever read and thus I will refrain from using a super-excited tone and will try to maintain a peaceful demeanor.
The very fact that you care so much about those patients speaks volumes and automatically tells us that you definitely WILL try your best, no matter what. In an episode of Bones, when the people are examining bones, Angela says, " Do you think that we sometimes forget that these Bones are actually people, who were alive like us once?". I guess thats the process of desensitizing. I really don't know whether one is supposed to care so much or not, But I know that if I were to be treated by someone, I would want them to care, regardless of the 'hand-shaking' theory of Boman Irani from Munna Bhai. Because don't you think that if someone cares, you have a lot more faith in them and that in turn would make the doctor try their best?

Anyway, this was a wonderful post and I wish all the very best in your future endeavors!

Okay, and, YOU ROCK! :)

Tangled up in blue... said...

Srishti, thanks for that comment! :) yeah, I have often wondered about that myself..perhaps a dispassionate doctor is a more logical one..like Brennan wonders if people and emotions are interfering with the brilliance of her logical mind. But from what I have seen, in a profession where one has to deal with people constantly, you cannot become a soulless automaton. You have to be able to retain that humanity becoz its not just about the right diagnosis or clinical reasoning. There's also a large amount of reassurance that helps a patient. It is a human being after all. So, maybe the trick is to care, but not allow yourself to become anxious or panicky, to keep your cool and on occasion, to give free rein to your intuition. The best doctors I've seen often have great intuition or "gut feeling" as they call it.

Tangled up in blue... said...

*It is a human being after all that one is dealing with.

Deeksha said...

This reminds of my med post during internship....

I began with a routine catheterization and I am sure you'll get to it soon when it goes 'plop' in your hand and you know you have burst the urethra inside. I tried again and it happened this time but I took a look at the urine bag and it was filling up with blood along with urine. To say I was mortified is an understatement.

He was an elderly, terminal male patient with plenty of relatives each of whom had questions of me and and I could not answer 'This is one of those 3% times that this happens' or whatever.

All I know is that he was the centre of my world for the next four days as I checked up on him personally first thing in the morning and did everything for him personally. I talked to my house(wo)man about it who seemed cautious but vague about it. I went through the endless trips to the blood bank to make up for the loss, if nothing could be done of the eventual stricture. It was a nightmare. What made it worse was that it was not just that for him and his family.

On the fifth day, he passed away.

My HM convinced me it was not me. That he was terminal from the beginning and there was not much hope. That he died of other causes. But to even get around the fact that I could have contributed in any way to this was so difficult for me that I chose not to deal with it at all.

I would have made a terrible doctor.

Tangled up in blue... said...

Dee, thank you for telling me this. Nothing I can say will help you look at this in a better light so I won't try. But I understand from this that it is of most importance to firstly, like Hippocrates said, one must do no harm. And, you know, sometimes I wonder if it is even possible to be a truly good human being and a truly great doctor simultaneously.