Medical Smiles :
The Bedside Murmurs
The medical college is a strange place. Anybody who’s not studying there would like to have studied there. But all those who are studying there wish they were not there . The first year student is faced with an avalanche of information in the form of Anatomy of the human body ,it’s metabolic functions in Physiology and its chemistry in Biochemistry. Anatomy is not half as interesting as made out by connoisseurs of six pack and size zero. It’s all dead and frozen with the soulful accompaniment of the powerful stench of formalin. Many a wannabe doctor would faint in the first day. Yours truly did not, because I never thought of it as human body. It was all leathery and dry. Physiology in our times used to be full of carbon coated drums and croaking poor frogs who were butchered for study. Maneka Gandhi put paid to that and all frogs can breath easy. But the pain of pricking oneself for umpteen blood studies is heart breaking. Not to speak of the feeling when your early college crushes prick themselves. Biochemistry is your only link to the lab as we know from school days . Although collecting and testing urine is not exactly what you thought the guys in white overalls do. Phew.....
Once you enter your third..now second year you’re led in a flock, to the Hospital. Lest you get any ideas ,the junior students are treated with just about the same respect as a doormat. They wander around the wards like headless chicken as one of our leaders once remarked. Once in a while a junior faculty takes pity on them and call them out. When we were third years ,we had a Profesor..let’s call him Zach...who was very sympathetic to us. In the sense he was very reluctant to take classes. But he would lead us suddenly to a patients bed side. The harassed patient would invariably be a cardiac patient . With an additional sound in their heart called a murmur. Zach was fond of these murmurs. So he would put his stethoscope chest piece to the patients chest and disengage the earpiece. He would then invite the students one by one to adorn them and listen to the heart sounds and murmur. He was so confident about our abilities that he never allowed us to place the steth ourselves.
If you ever thought that doctors would hear amazing stuff through their tubes ,you will be cured by third year of Medicine. That year you will actually that accept doctors are divine because all that you hear will be hush push and lub dub. Zach would be describing a “ pan systolic murmur with a diastolic flow murmur.” You’re even more shocked your classmates, especially the female ones hear them.Later only you realise that all that they were hearing was the cloth rubbing on the chest piece. A Physician..those guys with an MD in General Medicine who perpetually detest the Cardiologists ...once remarked. “ Cardiologists are Gods. Because they can hear things other people can’t hear.” I would second that. It is another matter that the Echo machine deflated many of their egos. I’ve a friend who disagreed with the examiner about a murmur in a PG exam. The examiner was livid and demanded an Echocardiogram on the spot. It was done and lo and behold ,my friend ,the candidate was right. Just as surely he failed that attempt. Such are stuff Gods are made of.
Coming back to bedside ,the only worthwhile stuff junior students do is to study history taking. This is a laborious process . In the first days it takes an hour. I’ve always wondered what’s the point, since what we get in an OPD is all but five minutes . But it’s the custom and we need to follow it. The patient is subjected to a volley of questions starting from his childhood . By the time he is finished he’ll be too tired to speak and the student would be breathless. But some people, especially older ones enjoy the interaction.
The examination part is hesitant and clumsy when it comes to junior years and the patient smiles through the process . There are experienced patients who tell students “my liver is enlarged 3 cm”. Especially in exams ,these kind of patients are a treasure. Some Examiners are smarter. They instruct the patients not to reveal a certain finding that’s not very obvious. Like a swelling in a private part . The fate of the student is sealed unless the patient takes pity on the junior doctor fumbling around the bedside.
Once the examination is done, in the training period ,one sacrificial goat should present the case to the teacher . This is your training for the exams too..which you realise quite late. Most of us used to avoid this ,pinning hopes on an over eager student . And hoping that your turn never comes . One of my classmates made his turn memorable by stating that the patient has a Past history of suicide. The word "attempt "was swallowed by him with more swiftness than the guy once did his poison. The teaching Professor gave a quiziccal look and then burst out laughing. The class followed as you’re expected to,in a medical school.
Then there was this guy who was quizzing a teenage girl for symptoms of thyroid disease. The guidebook said 'ask for intolerance to cold ',so he was keen.
“ Do you feel cold without it being cold?” Was the first question.
The girl said No.( obviously )
He tried again.
“ Do you feel abnormally cold ?”. The girl giggled but said no.
He wasn’t one to give up easily.
“ When it’s raining ...in the night..do you feel cold?”
The girl went red probably from the imagery of a rainy night coming from the mouth of the guy was a handsome hunk. And she giggled and said “ Yes’
He promptly wrote “intolerance to cold “ in the notes.
Yours truly has had his share of bloopers. One that I remember vividly is searching the Obstetric ward once for a patient named prominently in the front page of case sheet as Rajalakshmi. I reported back to the Staff Nurse that I couldn’t find the patient. She gently pointed out that Rajalakshmi was the name of the treating doctor and not the patient .
The cake goes to the hapless female student who was appearing for her Microbiology exam. She was a chronic additional in Medical college parlance ,meaning she was a repeater many times over. The internal examiner wanted her to pass . The external examiner..the dreaded species in any medical course exam who lands from another university...helpfully agreed to ask a simple question.
“ Can you name a single celled organism?”
The internal suddenly realised the candidate was confused and he stealthily gestured towards the wall where an enlarged picture of amoeba was hanging . As luck would have it another creature of a different species chose the exact time to cross the picture. So our candidate confidently answered.
“ Cockroach,Sir”
It is not known what happened to the examiners but such are the stuff legends are surely made of.
The Bedside Murmurs
The medical college is a strange place. Anybody who’s not studying there would like to have studied there. But all those who are studying there wish they were not there . The first year student is faced with an avalanche of information in the form of Anatomy of the human body ,it’s metabolic functions in Physiology and its chemistry in Biochemistry. Anatomy is not half as interesting as made out by connoisseurs of six pack and size zero. It’s all dead and frozen with the soulful accompaniment of the powerful stench of formalin. Many a wannabe doctor would faint in the first day. Yours truly did not, because I never thought of it as human body. It was all leathery and dry. Physiology in our times used to be full of carbon coated drums and croaking poor frogs who were butchered for study. Maneka Gandhi put paid to that and all frogs can breath easy. But the pain of pricking oneself for umpteen blood studies is heart breaking. Not to speak of the feeling when your early college crushes prick themselves. Biochemistry is your only link to the lab as we know from school days . Although collecting and testing urine is not exactly what you thought the guys in white overalls do. Phew.....
Once you enter your third..now second year you’re led in a flock, to the Hospital. Lest you get any ideas ,the junior students are treated with just about the same respect as a doormat. They wander around the wards like headless chicken as one of our leaders once remarked. Once in a while a junior faculty takes pity on them and call them out. When we were third years ,we had a Profesor..let’s call him Zach...who was very sympathetic to us. In the sense he was very reluctant to take classes. But he would lead us suddenly to a patients bed side. The harassed patient would invariably be a cardiac patient . With an additional sound in their heart called a murmur. Zach was fond of these murmurs. So he would put his stethoscope chest piece to the patients chest and disengage the earpiece. He would then invite the students one by one to adorn them and listen to the heart sounds and murmur. He was so confident about our abilities that he never allowed us to place the steth ourselves.
If you ever thought that doctors would hear amazing stuff through their tubes ,you will be cured by third year of Medicine. That year you will actually that accept doctors are divine because all that you hear will be hush push and lub dub. Zach would be describing a “ pan systolic murmur with a diastolic flow murmur.” You’re even more shocked your classmates, especially the female ones hear them.Later only you realise that all that they were hearing was the cloth rubbing on the chest piece. A Physician..those guys with an MD in General Medicine who perpetually detest the Cardiologists ...once remarked. “ Cardiologists are Gods. Because they can hear things other people can’t hear.” I would second that. It is another matter that the Echo machine deflated many of their egos. I’ve a friend who disagreed with the examiner about a murmur in a PG exam. The examiner was livid and demanded an Echocardiogram on the spot. It was done and lo and behold ,my friend ,the candidate was right. Just as surely he failed that attempt. Such are stuff Gods are made of.
Coming back to bedside ,the only worthwhile stuff junior students do is to study history taking. This is a laborious process . In the first days it takes an hour. I’ve always wondered what’s the point, since what we get in an OPD is all but five minutes . But it’s the custom and we need to follow it. The patient is subjected to a volley of questions starting from his childhood . By the time he is finished he’ll be too tired to speak and the student would be breathless. But some people, especially older ones enjoy the interaction.
The examination part is hesitant and clumsy when it comes to junior years and the patient smiles through the process . There are experienced patients who tell students “my liver is enlarged 3 cm”. Especially in exams ,these kind of patients are a treasure. Some Examiners are smarter. They instruct the patients not to reveal a certain finding that’s not very obvious. Like a swelling in a private part . The fate of the student is sealed unless the patient takes pity on the junior doctor fumbling around the bedside.
Once the examination is done, in the training period ,one sacrificial goat should present the case to the teacher . This is your training for the exams too..which you realise quite late. Most of us used to avoid this ,pinning hopes on an over eager student . And hoping that your turn never comes . One of my classmates made his turn memorable by stating that the patient has a Past history of suicide. The word "attempt "was swallowed by him with more swiftness than the guy once did his poison. The teaching Professor gave a quiziccal look and then burst out laughing. The class followed as you’re expected to,in a medical school.
Then there was this guy who was quizzing a teenage girl for symptoms of thyroid disease. The guidebook said 'ask for intolerance to cold ',so he was keen.
“ Do you feel cold without it being cold?” Was the first question.
The girl said No.( obviously )
He tried again.
“ Do you feel abnormally cold ?”. The girl giggled but said no.
He wasn’t one to give up easily.
“ When it’s raining ...in the night..do you feel cold?”
The girl went red probably from the imagery of a rainy night coming from the mouth of the guy was a handsome hunk. And she giggled and said “ Yes’
He promptly wrote “intolerance to cold “ in the notes.
Yours truly has had his share of bloopers. One that I remember vividly is searching the Obstetric ward once for a patient named prominently in the front page of case sheet as Rajalakshmi. I reported back to the Staff Nurse that I couldn’t find the patient. She gently pointed out that Rajalakshmi was the name of the treating doctor and not the patient .
The cake goes to the hapless female student who was appearing for her Microbiology exam. She was a chronic additional in Medical college parlance ,meaning she was a repeater many times over. The internal examiner wanted her to pass . The external examiner..the dreaded species in any medical course exam who lands from another university...helpfully agreed to ask a simple question.
“ Can you name a single celled organism?”
The internal suddenly realised the candidate was confused and he stealthily gestured towards the wall where an enlarged picture of amoeba was hanging . As luck would have it another creature of a different species chose the exact time to cross the picture. So our candidate confidently answered.
“ Cockroach,Sir”
It is not known what happened to the examiners but such are the stuff legends are surely made of.
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