FRCS: The Internship Edition

 

Every doctor has to be a beginner before becoming an expert.

    I passed MBBS and went for internship to Delhi. Base Hospital was a hell-hole back in those days. If you even walk the roads, they said, you will learn medicine. My first rotation: surgery. During my first week in surgery, I had acquired exactly three skills: Holding a retractor. Looking concerned. And nodding whenever anyone mentioned anatomy. The third one was my most developed skill. I had perfected the expression of a man who understood everything while, internally, I was still trying to remember which side of the patient the liver lived on. And if life wasn’t as easy, the unit chief was a tyrant.

    Not the ordinary, garden-variety tyrant who occasionally raised his voice and made resident shudder. He belonged to the old school of surgical dictators who believed that fear was an essential component of postgraduate education and that an intern’s self-esteem was a clinical condition best ignored. His footsteps in the corridor could straighten a slouch, silence a conversation, and make a fully qualified doctor suddenly remember an urgent appointment in another building….., in another city…..

    Then, one morning, while we were trying to look useful in the OT, he came to where we interns were. How many of you have assisted me? Most had. I hadn’t. He asked looking at me. “What about you?” He had already decided I had been sufficiently useless till now. I thought while looking at him. He looked at me with a patience of a ticking bomb. And just when he was about to explode, I replied. "Never!" He looked like a disappointed bomb which has been defused in the last second. And with deathly calm gaze, he said the worst four words that I heard that day. “You’ll assist me today.” The 'me' was the problem.

    My breathing left the building, just like Elvis. But….. I nodded gravely. It was an impressive KILROY nod. It conveyed confidence, commitment, and absolutely no understanding of what was about to happen.

    The case was an open cholecystectomy. My assignment was simple. Hold the retractor. That was it. No suturing. No cutting. No decision-making. Just stand there and hold a piece of metal. I remember clearly the thought that crossed my head, 'What  is the worst that could happen!' Talk of optimism.

    “Scrub up!” said the senior resident. I washed up. And got to the gloves. You know whats funny about surgical gloves. The may have five slots for five fingers but three fingers usually go in one slot and the rest of the slots hang aimlessly like an interns. The chief rolled up his eyes so much that I thought they would go all around and come up from below. “Try again” someone suggested. I did and managed to put all fingers in the correct slot this time. 

    The surgery started. The first five minutes no retraction was required. The next ten minutes, I was excellent. The retractor was exactly where it was supposed to be. I was standing perfectly still. The chief seemed satisfied. He even gave me a wink! I began to believe I had found my calling.

    Then…., my arm started hurting. Not ordinary hurting. Just the kind of pain that makes you reconsider your entire career while maintaining the facial expression of someone who is thoroughly enjoying the privilege of being there. At fifteen minutes, my shoulder was negotiating with my brain. At twenty, my forearm had ceased to be part of my body and had become an independent protest movement. At twenty-five, I was no longer holding the retractor. I was clinging to it for survival. And then, I shifted my grip by approximately two millimetres. 

    The chief looked up. “Why is the liver moving?”

    There are questions in medicine that have perfectly reasonable answers.

    This was not one of them.

    “Because the patient is breathing?”, I asked. Thought a small AFMC humor would do well. It didn’t. He stared at me like a Doberman, who has just seen a small puppy eat from his dish. "Is he not supposed to" asked he, icily. I froze. Retractor slipped. And the liver moved again. To a third person, it looked like a challenge.

    By now, the retractor was trembling in my hands like a tray full of glassware during an earthquake. 

    “Steady!” he barked.

    I tried. 

    "Steady!" He repeated much colder now and looking at me directly

    I tried again. But the more I tried, the more my grip loosened. Like sands on a beach. The tighter you grip, the faster they slip.

    “Look at me!” said the chief. Everyone looked up. I was already looking at him and told him so meekly. I thought telling the truth would be the right thing. 

    My brain was motivated to follow the chief’s order. My arm had other plans. The next few seconds remain available in my memory in slow motion. My fingers weakened. The retractor slipped. For the first time that morning, it demonstrated considerably more initiative than I had. The OT matron caught it before it could hit the assistant or I would have been charged with assault.

    Silence descended upon the theatre. Not ordinary silence. Imagine the silence before the commanding officers gives the order to the firing squad to fire. Everyone was looking at me. Strangely, even I remember looking at myself. Probably my spirit thought it's better to have an out of body experience.

    The chief glared at me. I looked at him. Then I looked at the retractor in the matron’s hand. The retractor, quite unfairly, looked innocent. I, with beads of sweat under my OT cap, indicated to the Matron to give it back. She refused (thankfully)!

    Then I heard a strange voice. The chief hissed. “Can you please leave?” he said. I wanted to say ‘yes’ this but something inside my brain told me not to. And I left much to my relief and also of the rest of the OT. Strangely, I felt a small surge of pride. I had stood beside a surgical tyrant and lived to tell the tale. 

    They say internship prepares you for FRCS—Forceps, Retraction and Cutting Sutures. I eventually became quite good at cutting sutures. As for forceps and retraction, I preferred to leave those to people who still had careers to lose….

Looking competent and being competent are two very different things. 

Internship is where you discover the difference

and, occasionally, discover it in front of your unit chief.

    Like I said, every doctor has to be a beginner before becoming an expert. 

    The problem is that medicine (and life) rarely gives you the privacy to be a beginner. You learn in public, make mistakes in public, get corrected in public, and sometimes get thoroughly humiliated in public. But perhaps that is also how medicine (and life) shapes you. You slowly learn to ask, to observe, to try again and, most importantly, to laugh at the person you (or your teachers) once were. Because somewhere between the trembling retractor (or your job), the angry chief (or your boss), and the sutures (or problems) you cut, you realise that being a doctor was never about knowing everything. It was about being willing to keep learning. The same goes for being alive.....