My Surgery Internship.

One of the most memorable moments in my life will always be the surgery internship I did during the last phase of my graduation at Mysore medical college, Mysore. Also probably that was the time when my surgical dreams took shape. Internship is the time when medical students are exposed to new things both happy and sorrow moments, it’s the time when common things are seen in a different way or rather it could be said that common things ‘appear’ in a different way, and its the time when the routine takes a spin. It becomes common to take a stroll and have tea at 3am in the chilly rainy weather, and not very surprisingly you will be the one who will be asked to deliver the bad news to the relatives of the deceased.

(Compulsory Rotatory Internship is a 12 months programme where MBBS students are posted fulltime into different branches of medicine to gain firsthand knowledge of the functioning of the speciality. There are no exams during this period and they will be called ‘Doctors’ henceforth. It is compulsory for all medical students to undergo the training immediately after their final exams to formally complete the degree, and it is also their first time when they earn for their work. It is also believed that it is the time when young doctors payback something to the society for what they have learnt from the patients.)

Surgical rotation was no different for me for it had all the masala similar to a bollywood movie. It had fun, thrill, sorrow, surprises and a take home message too. (Sorry, the last one is obviously not related to a bollywood movie!).

The first day I went to the postings I first reported to the junior PG, a wiry, tall, balding guy looking as if he had had something to eat three days ago, who seemed oblivious to his surroundings for the patients around him were all talking loudly but he never seemed to care and was busy with his bundle of case papers in front of him. I made my best efforts and was successful in waking him from his preoccupation. He looked at my thin frame and smiled and said ‘So you are the Bakra’(All my batch mates had bribed the peon at the office to get themselves posted to ‘easy units’ which had less work for the interns. I was the bakra as I didn’t want to bribe nor did I find surgical work uninteresting). I smiled back. ‘How much do you weigh?’ ‘Sir?’ I re-questioned him, being a bit surprised by the unrelated question. He glanced at me vaguely showing no signs of answering my doubt. ‘Fifty six, Sir’ I said following him to a patient’s bed. He found time to examine me again from head to toe and declared ‘You will lose two Kgs before the next postings’! He moved to the next bed as I stood there and wondered what the guy was talking about.

In a couple of days I found out that this was a cool unit, contrary to my batch mates’ beliefs. The unit chief, staff and the PG’s never cared if I came or not as I was the only Intern in the unit. (Other units had 2 interns; some units even had 3 interns, though the workload in those units was less than my unit. The interns were legally supposed to be posted equally to all units depending on the work load of the units. My unit having the heaviest load had just me, courtesy the peon at the office!). On another day I overslept and reached the wards late, but everybody behaved as if I was there all the time. Sometimes when I was late, and if somebody asked me why I was late, I simply told them that I was in the other ward and they kept quiet. This was supposedly the dream unit for an intern as you could come and go as you wished and still you got the attendance, freedom and stipend too!. I was thrilled as if I had hit the jackpot.

Though I had heard of the enormity of the crowd that would be gathered at the Out Patient Department (OPD), it took me some time to see and grasp the events that were unfolding in front of my eyes. A huge crowd had gathered in front of our OPD which was surprisingly calm, each awaiting their turn to be examined by our unit chief. The crowd consisted mostly of poor farm labourers who could not afford to pay the minimum bribe other surgeons from different units demanded of them. Our unit chief was the only unit chief (out of six units) who wouldn’t accept bribe to perform surgeries. Rows of patients sat in front of a lone table and three chairs (one each for the unit chief, patient and a senior postgraduate) in our unit chiefs chamber which also had two examining tables at one corner. The senior PG was there to help the unit chief to conduct physical examinations quickly and bring in new patients to the exam tables as soon as the unit chief finished examining the first two. It was real hectic as the OPD would continue from morning 8.30 to evening 6, with a gap of 30 mins for lunch. (The official OPD timings was from 9am to 4pm, with a one hour gap for lunch). Our unit chief would be very calm all throughout till the end of the day.

But the day would not end there for the PG’s, they had to take care of the emergency surgeries all throughout the night and had to work till the next evening. (More than 30hrs of continuous work at the hospital!).They took turns to go have food during this time.

If I had thought that the post-OPD day would be less laborious I was wrong. It seemed as if the OPD had shifted to our wards! Our male ward which had about 24 beds almost had 60 patients now!We had to search below the beds not to miss the patients during our morning rounds. A list of patients who were admitted for surgery would be made and preference given to patients who were waiting for longer periods, and as usual, when the list became too much some patients would be permitted to go home and come on the next weekly post-OPD day, that was how the wards were full though the admissions were comparatively less.

Everything seemed filled to the brim with patients.... the outpatient unit chief chamber, the wards, the beds, operation theatre list and the brains of the PG's!

The operation theatre ran till 4pm (on our specified day of the week) though the official timings was till 1pm (courtesy sympathetic Anaesthetic and Nursing staff who permitted surgeries to be performed till late hours).Due to the heavy workload the PG’S struggled to complete the case sheets just before the patient would be taken for surgery (which was supposed to be completed at the time of patients admission four days ago!).

Within a week of joining the unit I came to know why the staff and the PG’s never cared for what I was doing, of weather I would do some work or not.... that was simply because they had no time to think of things other than their patients! If I didn’t do some work they would do it themselves instead of asking me again to do it and then wasting some more time to recheck if I had done it properly or not. It was a dire necessity to believe in themselves and never mind what the other person was doing. Their behaviour was more because of a sort of compulsion and a reality to understand their situation they were in, than anything else.

I was enlightened! I began to take interest in things from then on and tried to make the work of the PG’s easy. I had come to the unit to learn surgery but now I was learning more about life than just surgery.

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Six weeks later and a week before my completion of Surgery postings when I was dressing the wound of an amputee on our post-OPD day the patient asked me if I was feeling OK. I shifted my gaze from his pus filled wound to his pale face and said I was fine, was there a problem. He bent his head a bit and avoided my eyes but with a thin smile on his face he told me that my mouth smelled bad and I looked as if I had not eaten for days. I didn’t know what to do... I was embarrassed to the core as I remembered that I had forgotten to brush my teeth that morning. Also, I had not shaven since a week and was in the same shirt in which I had done my night duty. I recovered in time and finished the dressing and left the room with a smile!

I also weighed myself on the last day of my Surgery postings and surprise... I had lost two Kgs!