The Difficult Part- Beginning the Medical Wards.

I DIDN’T like them much at all. The wards, I mean.

I had liked school. I was in a government run one in Thrissur. Rows and rows of tightly packed wooden benches, were packed like match boxes.

Each was taut with a row of sweaty grimy boys jostling with one another for writing space. Classes – and crass humour from the back benches. The intervals punctuated with boisterous play, juvenile ego clashes and gang wars.

I had loved it. The only bad thing about them was that there were no girls. Classes eleven and twelve in junior college were no different.

I had thought that Medical School would be vastly different. But till now, it had been pleasant enough. It was tough, but I had survived. I had passed the pre-clinicals. Now it was time for the clinics.

The white coats were the same for most people, though I had a new one stitched for the occasion. The stethoscope was, of course, new, though I did not know what to do with it.

After the pre-clinicals, this was my first day at the wards. Delicious anticipation and incipient dread battled in my mind. We were a batch of twenty posted in general medicine.

I had never ventured into the main hospital, though it was only half a kilometre from the lecture halls and labs. The college building was silent, ordered and smelt of chaste science.

The hospital was crowded and reeked of sweat and suffering. The people in the OPD looked at us curiously. There were men and women, some young and some bent over with age.

Occasionally, children ran around among the forest of bare legs and folded dhotis. We ambled along the corridor milling with patients, and reached ward number M1. Five of us were posted in the first unit.

Sivasankaran was there. My best friend Gopal, of course. Then there was Sheeba. I tried not to think about her. Distractions are bad, when you begin.

I badly wanted to start. This was what it was all about. I was eager and studious.

The rows of beds housed sick human beings. Gaunt faces radiated despair. Some eyes glinted with grim resolve, while others were permanently pooled with tears that stung in your eye when you looked at them.

Some patients lay on the floor. Husbands, wives, mothers, fathers, sons and daughters of those in the beds milled about, and a constant chatter of unease hovered in the air, like smog over Kochi in the mornings.

Laughter was rare, but there. You had some power to bring it on, I learned later.

I was an introverted kid. I was totally at home in any academic setting. The classes were elementary.

The Biochemistry lab was exciting. But a room full of people with problems churned my insides with dread.

You had to walk in everyday at eight, clad in a white coat and meticulously polished shoes.

In our pockets were the stethoscope, tendon hammer and other accessories, and in our chest was the thud, thud of pretending to be something that we were not. We were as far from being a doctor as a drab caterpillar was from a butterfly.

Our job was to examine as many patients as we could, for practice. Then one of us had to present a patient as a ‘case’ to the professor. History, physical findings and provisional diagnosis. That was the drill.

The place seemed stuffy to me. The General Medicine wards were the cleanest in the entire hospital. But I had a feeling of breathing in stale air. Could one hold the breath for hours till the morning sessions were over?

After the lunch break, I could go back to the clean and scientific comfort of the pathology or microbiology lab. When my friends took the history from the patient, the words flew by my distracted mind, like bats flying past the window.

They had no hope of roosting in my brain.

I learned that if you were really not interested, there was a crowd of distractions and indifferent students for company.

I could stare at Sheeba. Surreptitiously of course. Her small frame bent over a patient was a study in abstract beauty. The not-so-abstract parts of her anatomy did not escape my attention.

One had to be careful. Girls were uncannily good at catching you staring at them. She would suddenly look up from her stethoscope placed on a patient’s chest and direct her piercing black eyes at me.

I would hastily remove my eyes that were drifting down her neckline through the half opened white apron. I was good at changing my expression from greedy eagerness to sweet and smiling in the fraction of a millisecond.

Her shy smile assured me that I had succeeded, though my subsequent experiences with the fairer sex taught me what a fool I really was. Then there were young nurses to ogle at.

When my fellow students were furiously discussing the various alternate diagnoses that were possible, I eyed the corridor with a wild surmise. I had found that you could get to it in four rapid and confident strides that were a prelude to a lazy stroll to the canteen.

The canteen was a wild and wonderful place. The student’s section bulged with like-minded white coated loafers. Dirty male jokes and ego-jostling ruled the arena.

A few of the unruly girls pranced about, like performers in a circus. The bonda with the consistency of a cricket ball and the scalding tea made time flow steadily till I could see Dr. Baburaj walking back to the wards with his interns and residents through the window.

He was going back to the main ward from the annexe ward after completing the rounds. He was going to take the clinical class of which I was a part. That was my cue to run back.

When the person who was to present the case started with: ‘Good morning sir, this elderly gentleman presented with complaints of pain abdomen and occasional vomiting for the past two months’, I would be among the audience staring with a studious intensity at Professor Baburaj, attention dripping from my face.

We were taking turns to present cases. The medical students, as a lot, were so eager that if one was reluctant enough, it was easy to avoid your turn.

‘What are you playing at? Don’t you want to learn?’ Sheeba would ask me, in our pre-lunch canteen sessions, which had become regular now. I would squirm and change the topic.

One morning as I was pottering about in the ward, Dr. Baburaj came abruptly in. My insides did a double summersault as he beckoned me with a finger. I went to him. He looked at me and asked:

‘When was the last time that you presented a case?’

I pretended to think. My eyes eyed the ceiling fan while my heart leaped as if to jump and touch it. I scratched my head and stammered incomprehensibly.

‘What was that? I didn’t get you. In fact I don’t think you have ever done it.’

I didn’t contest this claim. I was no lion-hearted criminal. I knew when I was beat. I hung my head with the appropriate amount of remorse. That is often the best way.

‘Examine that gentleman in the corner. Him. Mr. Selvakumar.’ He pointed. Then he left.

I looked and saw a gruff old gentleman lying in a corner bed. I walked over to him and asked his name. He answered reluctantly. He gave me a cold look and then averted his gaze. Undaunted, I proceeded.

‘I am going to ask you about your illness. Then I want to examine you,’ I told him, in an official tone. Wasn’t that how these things were done?

‘You are not doing anything. Leave me,’ he replied bluntly. I was taken aback.

Most of the patients in the government medical colleges were resigned to students prodding at them. I had taken him for granted. This was unexpected. Moreover, I was a social retard when it came to strangers. I fled.

‘He is not letting me look at him. Er…uncooperative patient,’ I told Professor Baburaj later.

He looked at me with faint amusement.

‘Excuses, when used in Medicine, had better be good. This is not good enough. If you don’t present him within two days, I am going to be extremely uncooperative,’ he said drily.

My reticence vanished. I hung around the ward the entire afternoon, trying to strike a conversation with my patient every now and then.

‘Why are you haunting me like a spectre?’ he asked me.

‘Why are you so irritable, er, Uncle?’ I asked.

‘I want some tea. There is nobody with me,’ he replied.

‘Give me the flask, Uncle,’ I said. I ran with it to the canteen. I felt awkward doing it. Who is it for? A patient. Ha! I imagined these exchanges in my mind.

He sipped at the tea in satisfaction. I learned that he has a son who did not talk to him anymore. I got the number from him and called from a pay-phone booth down below.

‘I am a doctor from the hospital. Don’t you want to see your father who is ill? He loves you and said that he is very sorry if he has offended you,’ I said through gritted teeth.

Saying sorry never came to me easily. Here I was shamelessly doing it for someone else.

Next day I examined a beaming Selvakumar with his son by his side. The presentation did not go that well, but I got the hang of it.

It took some more time for Dr. Baburaj to thaw. But after a month I became very good.  I survived the third year, and by the time I reached final year, the pendulum had swung to the other side.

I was overconfident. I had mastered clinical skills. What more was needed to become a doctor? It seemed fairly easy. What was all the fuss about, I wondered.

After I passed, my internship was in the same unit. We practically lived in the wards. That was how I became friends with Sunil, a patient admitted to the ward.

We were the same age.

‘You were in Model Boy’s? But I also passed tenth in ’88,’ I exclaimed. It turned out that we were in different divisions.

As a former school mate, I became a sort of personal physician. The mother brought me rose apples from her garden. Sunil had unexplained anaemia.

I sent for a peripheral smear, a microscopic study of his blood, the result of which was rather suspicious.

‘Did you examine him well?’ the professor asked me.

‘Yes, sir, there is a group of lymph nodes in the right groin that is enlarged.’

‘You know what to do,’ he said.

I called up the surgeon and arranged a consultation. He had to have a lymph node biopsy. A flame of dread germinated in my mind.

‘It is not something serious. Is it, son?’ the mother asked me. He had no father. ‘He is the only one I have,’ she continued, betraying anxiety.

‘Don’t be dramatic, mum,’ Sunil chided her.

The biopsy came as lymphoma. It was a dangerous cancer. I had to break the news to them. His mother cried for one hour. Sunil sat petrified.

I mouthed meaningless platitudes while my eyes brimmed over with tears. I had a peculiar feeling that I was somewhere I was not meant to be.

Sunil was referred to regional cancer centre. They kept calling me. Seeking reassurance.

I called him, once or twice – not more than that, I told myself. You can grieve with a patient. But one can’t be too involved. I was afraid to.

But they were looking for guidance. For being someone I was woefully inadequate to live up to. I suddenly realised that the job was rather difficult.

A week later, his uncle called me. Sunil had died. A sudden reaction to chemotherapy, he said. He thanked me for all I had done.

I had done nothing. I couldn’t do anything.

I couldn’t cry. I wouldn’t.

But by the end of my three month posting as an Intern in Medicine, I had stopped feeling other people’s pain.

I had to master professional empathy. Otherwise what lay in the future was nervous breakdown. I became good at it. I became relaxed. It was not so difficult, I told myself.

We slept in fits and starts, in between calls from the ward. One night I had to go down to the ward from the interns’ quarters at the top of the building at two in the morning.

The patient had breathlessness. He had some cardiac illness. I only knew this much as he was admitted that day. I examined him and it looked to me like cardiac failure.

Ordering an injection of Frusimide, I went back to sleep.

By morning, the patient worsened and had to be moved to the ICU. I could not make out what was happening.

Dr. Baburaj came in the morning and examined him.

‘Did you give Frusimide?’


‘This patient has constrictive pericarditis. It is not cardiac failure. Frusimide worsens the disease.’

Cold snow rained down on my insides.

‘But the physical findings are identical. How was I to know?’ I became automatically defensive.

He leafed through the case sheet and showed me the OPD chit. In a small corner it was written in a miniscule hand: ‘Constrictive pericarditis.’

I stood and stared, incapable of speech. I didn’t see. I didn’t look. It was written so small.

It had been two a.m. I hadn’t slept in three days. I hadn’t had my breakfast. So many thoughts tumbled about in my mind, like clothes in a washing machine. But not a peep came out of my mouth.

Excuses are so difficult to utter in medicine. And also pointless. I stewed in my juices till the patient became better by afternoon.

By now the professor had become effusive. I relaxed. The patient was back in the ward.

‘You know, Jimmy, you had better go and explain what happened to the patient,’ Dr. Baburaj said casually. I froze.

‘Explain the illness to him. Discuss the problems. If you want to be honest, you can tell him about the Frusimide. But you should do it in such a way that it should not become an issue. It is your choice.’

I sweated afresh into my already soaked shirt. I could choose, isn’t it? Whether to be honest or a deceitful coward?

But should be tactful enough and not rock the bloody hallowed boat. And save my own and others’ skin in the process. Very easy indeed. Who was I? David Copperfield?

I slowly walked towards the patient’s bed. I hadn’t had lunch also. My belly protested with an outpouring of acid.

‘Careful. Some of the relatives are already mumbling something about a wrong injection being given,’ one of the nurses whispered to me on the way.

Suddenly I realised that the five years of study was really easy. The difficult part was just beginning. (Jimmy Mathew)

Dr Jimmy

I am a Doctor, Writer and Science Communicator. I am a member of Info- Clinic, and have written a few books. This site features my blog posts and stories. Thank you for visiting. ഞാൻ എഴുതാൻ ഇഷ്ടമുള്ള ഉള്ള ഒരു ഡോക്ടർ ആണ് . നിങ്ങളുടെ താത്പര്യത്തിന് നന്ദി .