But, this time it looks like they might be right. For the non-medicos, and non-clinical medicos, and those blessed ones doing ENT, Dermat or Ophthalmology, housemanship is that phase in a doctor's life where God makes you pay in advance for all your expectations from life. It is that one year that, decades later, gets talked about during alumni meets, like survivors reminiscing war stories. The year that supposedly roughens you and toughens you up, and in short, leaves you with one foot in the psychiatry ward. And when that year stretches for another 3 whole months.. sometimes it gets hard to tell doctor from patient.
15 months!
That I've been expected to work 24x7 (And anyone who thinks that was an exaggeration can shove it).
Been asked to be at 50 bedsides across 3 wards at once.
Since I've last looked at a patient as a person, instead of a list of investigations to be sent.
Since I last slept with my phone switched off.
Since I went anywhere out of campus without worrying about being called back.
Since I last walked through campus without checking if I'm being followed by some patient's relative.
Since I last had an uninterrupted conversation, or a meal, or a movie, or anything.
Deep breath. There. That's officially the last time I crib about it.
Make no mistake, I do realize how lucky I am. As a friend very pointedly pointed out, there're a lot of people out there who'd kill to be doing MD Medicine from KEM. (My response that that's what they'd be doing even after they join the course, didn't amuse her. Maybe she'll get the joke after she gets a seat.) And now that I'm done with it, I've already started thinking of it all with a hint of fondness (the horror!) So this blog post is in part, an attempt to forever capture the pain.
It is also, in part, an attempt to warn off other innocent children, from being mistakenly lured into this murk; and if that doesn't work, atleast to try and lend some help in making it through.
So these are the things I'd want to say to myself, if I were joining as a fresher in this wonderful institution and field.
1. DON'T PANIC. Far better people than you have crashed and burned. It's no big deal if, sorry, when you make an ass of yourself.
2. The world is smaller than you think. A lot smaller. Infact, your world is exactly one room big, and its called the ward. It's not comfortable, even though it has a hundred beds in it. It's not clean, even though there are hand sanitizers and surgical spirit bottles everywhere. It's not safe, despite all the sharp instruments at your disposal, and the sleepy security lady. And you never have enough time, even though everybody is patient.
3. People die, deal with it. No seriously, that's your job. Do something.
4. Then again, people do die. They die in front of you before you've seen them. They die before the ECG report comes, or before that syringe gets loaded, or the defibrillator turns green. They die despite you doing everything you could. And sometimes, they die because of you, something you missed, or overlooked, or ignored, or overdid. Deal with it, and act faster the next time.
5. Einstein was right, it's all about the relatives. Patients have surprisingly very little to say, which leaves all the interactions in the hands of their dear ones. And oh dear! How they can annoy you. A co-operative relative is worth his weight in gold, and a silent one might even see his patient successfully treated. The irritating ones invariably 'learn a lesson', Dr.Karma sees to that.
6. 'It's all political. Where you're posted, how your seniors interact with you, the punishments you get for the crimes you get caught, it's all part of a higher power struggle between the dean, the heads of the departments and your PG guide.' Keep telling yourself this, it helps not to take things personally.
7. Medicine is all about logic. So pretend to be logical, it'll confuse all the other pretenders.
8. The Emergency Medical Service section is the pride of the institution. What other department can boast of an inflow of around 40 patients per minute? Throughout the day and night? All handled by 4 doctors huddled behind one table, battling to keep the onslaught at bay? Add a bunker and grenade smoke, and you have the medical remake of Behind Enemy I.V-Lines.
9. Explaining poor prognosis is an art, and a vital one. Some are born with the gift, and every patient in their ward can be found sitting peacefully with their relative , waiting for the supposed inevitable. And when they learn that their common cold is infact curable, to behold their joy is a gift in itself.
10. DAMA. Denial, Anger, Melancholy, Acceptance, These are the stages a patient or relative goes through while realizing that clearly, this hospital is not the best for this patient's survival. And they ask for 'discharge against medical advice'. It is important to note that no self-respecting physician in a government hospital, however over-worked and frustrated, can ever actually advice someone to take a patient elsewhere. That is a decision those people must reach themselves.
11. From time to time, you will be called upon to resuscitate a patient, which would be getting whatever part of him that has stopped working to restart. A lot of gadgets are available for this kind of thing; when in doubt, use all. Chances are that one of them might work; also, it creates a favorable impression of the 'doctor trying to save life', which looks a lot better than the 'confused doc puzzles over gasping patient'. It is customary for a screen to be put around such a patient during these procedures, but it is also customary for a dozen relatives to be craning their necks above, below and though it to catch all the action. Active resuscitation can save more than one life.
12. Sometimes despite all your huffing and puffing, the patient, doesn't. Then you are asked to declare the death to the relatives, with tact and understanding. It helps if you know their native language, but what helps more is if you and they have a common language at all. Else, face the situation where, after you've spent 15 minutes declaring a patient, the relatives ask you if he's going to be ok. True story.
13. Safety first. There are more dangers lurking in a hospital than the hardest level of minesweeper. Wear gloves, masks, condoms, space suits, whatever it takes to avoid multi-drug resistant tuberculosis, HIV, malaria, syphilis.. U get the drift. And soon, you'll be instinctively dodging cough droplets like Neo dodging bullets. And you'll be more paranoid of pricks than a heterophobic lesbian.
14. Sleep. Everywhere and every chance you get, for who knows when you'll next have the opportunity. Sleep in the sideroom, the ICU couch or the last row of the seminar hall during presentations. Remember, an apparently sleep-deprived houseman looks like an apparently hard-working one. Score.
15. Keep your friends close and your interns closer. Every week of your year is determined by the kind of intern posted under you and invariably, by the end of the season, you'll have seen all the possible episodes. The bold and the beautiful, the young and the restless, the gossip girls, the pretty little liars, the f.r.i.e.n.d.s, the mental(ist)s, the heroes, the mad men and the walking dead. As long as they draw true blood, send the Big C(ollections) on time, it's Justified. But by chance should one turn up who's completely lost, or has arrested development, just shoot me!
16. Study, if and when you feel like it. Housemanship is more about survival than scholarships, nobody expects you to know much, and the fact that you may be brilliant is very neatly hidden by the fact that you haven't slept or had a bath in 3 days and you look like shit. So relax, and read for no other purpose other than your own curiosity.
17. Lastly, no matter what, keep some distance between you and the chaos. Remember, the year is transient and so are the people in it. Besides, whatever you do, it is going to end at some point; you may as well give it a good shot. And who knows, Dr.Karma might see to it that you get as good a houseman as you when you turn registrar. So heads up.
Well, I think that wraps it up. All the best, kid. I'll see you on the other side. I'm off to see a movie. If you need anything, leave a message; my phone will probably be switched off.
3 comments:
Class act dude! :-)
memories ... memories ... memories ....when refreshed they are akin to a deja-vu phenomenon ...much obliged for this glimpse into the past....
Too Good!!
But this is all needed to make us better doc and person too.
Keep it up.
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