The ‘Learning Curve’ and the ‘Gut Feeling’

I just completed my postgraduate exam in surgery. Thank God, I passed and I am happy that I could perform well in the exam. But the exhaustive preparation that has been going on for the last two months revealed me some realities of academic life.

 I have been in the field of medicine for last ten years. For a surgery exam, one has to be well versed with all the related topics starting from anatomy. Anatomy was my favorite subject during the first year of medicine and I had learned in pretty well. I used to look up the etymologies and tried to learn a little more elaborately than just mugging up. After five years, I had to revise anatomy in detail for my pre postgraduate entrance examination. Now again, I had to do a detailed revision before exam. But the thing I realized was that, even after repeated revisions, when I tried to recollect, it was difficult. It was not that, I don’t remember things; rather things were getting messed up in the head. There was an explosion of several things or feeling of mining out something from depth.

Second thing, there was no more surprise questions. During the undergraduate time, it was common to see new terms or diseases, in the exam question paper, that haven’t heard off. Later we had to search through the textbooks to find them. But now, it is rare to come across a new term. But this does not mean that I know what that term means. I know I have read about it, but I find it difficult to recollect about it.

While reading a book, I have started to appreciate things that are mentioned in subtle way, but have a greater meaning. For example, while describing a surgery, the author may have mentioned things like where to cut, what direction to cut, where to hold etc., which did not make much of sense in early years of medicine learning. More depth of knowledge is felt while reading the same lines that I read some years ago.

I wonder, what was the purpose of all those hard-core physics and higher mathematics, which I learned in the pre medicine classes. I was fond of solving those problems and used to feel authoritative on those things at that time. During that time, I thought I would never forget those theorems and formulas, because those were so thorough and I could do calculations at flick of my thumb. But now, I even find it difficult to calculate BMI, without a calculator.

My aim is not to point the inadequacies of the education system, but to look, deep to my own brain activities. Has it reached its memory limit? Why cannot I recollect things, when I need, at least those which I spend time to memorize? I had a feeling some years earlier that everybody had the same capacity to memorize and learn. But now I recognize, everybody have different capabilities, the reason why some find it difficult to learn things the traditional way. I can say this, because working in a premier institute of the nation has given me the opportunity to meet people, some of whom are extraordinarily brilliant. I have considered myself an average intelligent person and I know, when I work for a thing and when I don’t work for a thing. I have seen how these people simply drift through situations, which I have to struggle to.

I am not at the brim of a nervous break down or anything of that sort, but definitely now I can imagine how things can go wrong if someone tries too hard on themselves. Said this, taking an exam is about strategy and one don’t have to be a super computer to pass any normal competitive exam. The basic thing for good exam preparation is to know one’s own limitations and plan accordingly. Also brilliancy and intelligence are not above compassion and common sense, qualities that are really required for a successful happy life.

It is true that one have to read multiple massive books on their way to become a specialist or super specialist in medicine. But it is not necessary to remember all that stuff all the time. It is not humanly possible. During the early periods of practice, it will take a little time to recollect the important things that has to be taken care off, while treating a patient. As time passes by, all those steps come as a reflux, rather than reasoning out the logic behind it, and the time required to attain that capability is called the ‘learning curve’. This is the reason why the ‘gut feeling’ of the professor is always better.

The wonder drugs

          Recently there was a flood in my country and lot of related things were flooding the social media. One thing I noticed was the list of essential medicines. Three of my favourite medicines were in the top of the list. There are lots of things that need appreciation in the field of pharmacology. But I love these three drugs because of the magic they do. I am sure everyone reading this will have used these medicines more than once.

Acetaminophen (Paracetamol)

This is number one drug. Can you believe this drug has been discovered a century ago? However it required repeated testing and clarifications regarding toxicity before it became available for public use in the second half of last century. Fever, body ache, malaise, head ache, you name it, it is the first thing to be swallowed. I hated the bitter taste when I was a kid.

Till recently I believed that animals could take all the drugs, which are safe for humans. But it is not so. Each animal different metabolism and drugs can turn out to be toxic to them. Paracetamol is toxic to cats and they are used as toxin for snake control program in Guam!

ORS (Oral Rehydration Solution)

The concept of ORS therapy has been developed within the last 40 years. It is a simple solution for a dreaded problem. An attack of diarrhea can make one all empty. ORS really helps to fill up the missing volume and make feel better. It is from my and my patients experience that, it is definitely one of the best solutions.

Nasal Decongestant spray/drops (Oxymetazoline, Xylometazoline)

This is a day saving drug. All of us know how tiring it is to work with a stuffed nose. This is the magic drug, which clears the nose within seconds. I have been a fan of this drug. This medicine has saved my day, more importantly my sleep, than any other one.

Given that, there is no wonder why these medicines top the list of essential medicines. All of them are over the counter medicines and I think every one should have it in their home, unless they haven’t got it already.

I respect those wizards who make these magic potions. Medical science would not have done much to alleviate the sufferings of human being with out the contribution of chemists and pharmacists who dedicate themselves for the development of new medicines.

The Inherited sins

       Do you believe the sons and daughters will have to bear the weight of their fathers’ sins like they inherit their fortune? Well, I don’t have any definite answer. I have been taught to keep away the fortune, which has blood on it, not literally blood, but the money, which is not earned in a right way. Yeah, that is a thing, which we can try to do. But what about knowledge, that has been obtained distilling sufferings and pains of innocent human beings? As a man of modern medicine, who believes and practices the ways of science that has been evolved as a result of hard work of numerous famous and infamous people belonging to several generations, I think I am obliged to carry a part of their sins too.

             The first and primary principle of modern medicine is ‘do no harm’. It makes sense and it is easy to practice in a usual clinical case, given the comfort of advanced pharmacological and anesthetic facilities available now a days. There was a time when pain was inevitable part of medical treatment. Thanks to our forefathers who had spent their lives developing and researching, providing todays comfort. As we go through the history books, we come across many of them. A great majority of these physicians are not mentioned anywhere, but still it is imaginable how these people contributed.

              Same time, when we go back to history of medicine, we come across notorious doctors who operated on normal people for no reason, patients with no reason and painful procedures, which were used to make a normal person insane. The time, when women were subjected to cruel surgeries without their consent, the outlaws and slaves were treated as guinea pigs, the holocaust victims upon whom grave experiments were done is not so far. There is no end to the list of declassified project reports, which include injecting harmful substances to normal people and withholding standard available treatments to patients without their consent for the purpose of research. It is understandable that we do not print those names in history books as glorious chapters, but sure we do make use of knowledge attained through such inhuman experiments.

             So, having evil past will make us evil? I don’t know. But if there is something as inherited sins, then I think it is not going to be contained with the man of medicine, I am sure, the patients or people who are benefited from the use of those knowledge are also going to share those sins. Sure, there has to be a heart of hardened feelings to be a true man of medicine. We practice our knowledge upon the patients in good faith.

Cacography; The art of beautiful handwriting

       The doctors are notorious for their handwriting. Well, everyone in this profession knows it is a bitter reality. Most of the medical students will find it difficult to decipher their senior’s case sheets. But as the medical life progresses, we get used to it. We learn to decipher things. The writing becomes just a matter of giving the brain a cue to guess what is meant. Most of the time we manage. But there are some very difficult cases that can really tear your head apart. I am lucky to have some people with such blessing with me.

           I have wondered why it happens. Most of the medical students are of high intellectual grade, the reason why they got it into this profession. One factor may the shear volume of things of repetitive nature we have to not down daily. I have handwriting, which is good if I write slowly, but as it get busy it gradually deteriorates. Sometime I deliberately write in a shabby manner because I am bored writing the same thing many times. Rarely I do that to prevent other people from reading.

I have also seen, some doctors who actually take sincere effort to keep all their writing neat and clear. They need appreciation. There are some other people whom I hate so much. They write in such a way that, if you look from a distance it is all uniform even calligraphy. But if you try to read what they have written, you will be in soup. There will be so many incomplete words and meaningless strokes. One of my friend underlines wherever he finds comfortable. Those lines do not mean anything.

patient position

          When you are a surgeon, then you will also have ample opportunity to express your artistic skill. Here is my colleague’s impression of patient position for donor nephrectomy. Look at that expression. So deep and thoughtful.

Some non-vegetarian thoughts

    Yesterday we had a luncheon at our Department chief’s home. On the way back, some one asked me how was the party? I replied “It was very nice, although the food was veg”. Yeah, exactly that is my point. I take a mixed diet (that’s how we say. We are not non-vegetarians because we also eat vegetarian food. Lol). If some one asks me what are my feelings towards vegetarians, “I don’t have anything against them and I am perfectly ok living with them although I feel pity for them in my mind.” 

        Recently one of my teachers, who is a vegetarian by choice, was persuading his son over phone “son, please eat something at noon, when I come in the evening, I will take you out and we will have a nice dinner”. This really ignited my thoughts. My mom had to persuade me endless time to have food, especially school tiffin, lunch etc. But all that time it was vegetarian food. Positively, I cannot recollect even a single time when she had to persuade me to take a chicken or meat dish. I am talking about me. I have little cousin sisters who are like, all allergic to food, no matter what it is.

       I have a close college friend. Chicken biriyani is like an antidepressant for her. After a harsh day in college or hard day at hospital, it was beautiful to see her face glowing with happiness after a nice meal. Now, this is a common phenomenon seen in Delhi. So many vegetarians live here. I had a roommate, a typical Delhite. I can remember how desperate she was when she had to stop eating non-veg food, because her boyfriend did not like it. The funny thing, she was happy to have non-veg whenever she was fighting with him. That relationship is still going on with periods of intermittent war and peace.

    

     I had another batch-mate, a vegetarian. She was totally allergic to eggs. Even a smell of egg, or faint trace of egg, she will swell up and have rashes. Poor girl! I have never met a vegetarian, who does not drink milk. As of me, I have never ever eaten a vegetarian dish that I would prefer than a non-vegetarian dish.

     To have a friend who enjoys eating and drinking the same things as you do is the best friend you can have.