I am no magician, and neither are any in the fraternity, yet many a man expects from us the same alacrity. At the sight of a white coated, stern, mollified or flat faced being, the common man feels naked as pertaining to his ills, and oft wonders why a simple narration of his complaint doesn't set in motion a epiphany. One that should be a natural elucidater as to both malady and curative. Further questions often are seen as an I'll fated escarpade, a waste of time, a little toying perhaps.
Like a gixel puzzle, most, if not all, the pieces of a story are needed to come up with a diagnosis of disease or possibly a mere lack of it, or hypochondriasis (a medical condition in which physical symptoms are manifest, with no notable disease process, that stems from one's belief of possessing ill health). I must add, nontheless, that even with all the pieces readily available, it is far from child's play working one's way to get to the bottom of the case, and paint the perfect or near perfect montage of the condition. Sometimes, the task is aided by a mere stroke of luck, yet many a time, brain matter, and time has to be expended to come up with a succinct construct. At saundry times, a simple glance does it all, at others, a concord of speech and touch and other machinations necessary have to be employed. Then there are times when nature seems to conspire against all that is called scientific erudition- a case of idiopathy-
In medical practice, dexterity of both mind and hand are a requisite. For what the mind can not appreciate, comprehend or fanthom, the hand by touch must elucidate. Perhaps it's a compliment to the thinking process, and acts to show care and concern.
Seven years. Not eight, not five or six, simply seven. This is the time course for medical rite of passage. It's not cast in stone or written in the skies, but in my part of the world, it bears sway. The first four (premed) prepare one for the clinical years. Books are read religiously, terms and conditions are put to memory at all cost, even with the use of mnemonics,which often have to be remmebered at great pains too. Perhaps it's an inculcation of the idealogy that error may be fatal in medical practice. Though this be true, yet I believe that fear of failure decapitates any sprout of creativity . It assails the zeal to try. One is left with no option but to live by the book in the strictest sense possible. Any deviation is apostasy . For some, this worked to instill a fear of the trade, and so they opted out of the ship or stayed aboard for time already lost.
like a turn of new season, winter to spring or summer to autumn . First the bud, the flower, the fruit (if any) then the fall of the leaves ,and the cycle restarts. Time too was takin an ever winding turn. Relentless in its course. Peers that opted for slightly shorter courses like four and five years soon left the stage. Soon they took on a more mature form, as they walked a new lane as lawyers, merchant men, bankers and the like. One in my course would wonder weather the length of time we had to run was really worth it. We felt, perhaps, like babes that could not be weaned off from a mother's milk. But we walked it with patience nontheless. It was our lot.
I do not consider my self or any in the profession as standing in the gap of death and life, but if by any chance we do stand anywhere near it, it is only to observe and lend a hand to nature to take its course. Nature breads life, and allows it to ebb away into utter silence. It puts up a fight to sustain life, and gives up only when beyond its capabilities, perhaps our work is partly to prevent it from waning too quickly. Sometimes physiology goes heywire and has to be rewired.
The hardest thing I have come to learn in my apprenticeship is to be able to accept my gaps of knowledge,wether evident or not. I would rather conjecture a story, evading reality, perhaps explaining away things that seem off kilter, out my my grasp. 'A doctor not knowing? That's absurd! Or so I thought. But the sooner one realized his/her limitations, the better at practice and patient care one would become, as it would necessitate consultation. Of course knowing nothing or too little, like a clean slate, sterile brain , adatic, or hypodatic as was wittingly refered to, was unacceptable. So like any good student I had to have a balance between the 'know it all' and 'no data' . The former, unlike the later was obviously the easier option.
In seventh year atlast. The happy estaste. Nothing much changes however. It seems all still too abstract. Much like a surfer who finally gets to surf the highest wave, a surfers dream, yet at the end still thirst for something more. One wonders at what point 'they' really get to feel all-ready for the task. At what point does one feel ,'I can do this' and really 'do this'? At what point does one get to have pretty much all the common diagnoses, drugs and respective doses ,with their indications and contraindications at the finger tips? Does it all creep in as a stealthy slithered creature unawares ? At one moment, one begins to wonder Wether all classes were attended. But courage is gathered by precedence. "We are not at all the first, and neither are we the last." Seventh year is like a tip of a crescendo or the highest note in an appergio. One is placed in a unit comprising of a small number of fellow seventh year and fifth year clincal students, stands as the last line of defense in a 'wiring session' (a term loosly used to mean a question and answer session which may occur anywhere within the confines of the hospital). A case or a row of cases would be presented at the bedside or any place of convenience. Senior doctors, as per custom, would tease out information from the presentation and throw a barrage of questions like a bombshell , a times, to test the comprehension of the case by the students. These session wavered between a warm friendly milieue to a 'hot sit' kind of experience. Sometimes it was fun and laughter, but more often, it felt like a an eternity of stress on the student.
By the time one makes a touch down at the foothills of the seventh plot, much of the zest is gone, years of a rigorous rut have sapped out the strength from within. The only incentive to moving on is the fact that it's the last leg of the race, a fore tell of the end. The end of the race or game as it were. A new dawn is brought to view. One may look back at moments of failure , disappointment and all the possible embarrassing moments faced in clinical practice and count every bit as worth more than a dime. Of course not up for a relieve.
