How to become a Doctor...or atleast pass medical college exams..

Disclaimer: This is a very personal view on things I have learned over the years. There is no intention to hurt anyone or any belief, custom, usage, practice or institution. Life is too short to waste time in criticizing others. No one has a monopoly on truth and the correct way. It is just one person's views on things at a particular time. I have learned .........(please read the full disclaimer at the first blog.. the same still applies)

Well, I was going to speak about the Government today, but my oldest friends wanted to know how to become good doctors (they've been trying for the past 10 years) and so I thought, I may digress a bit and remember the great times I had in the Medical College - doing everything except studying medicine.

The first one and a half years i.e. the First Professional was really fun. First time out of home - in a hostel - was such fun. You could stay out as much as possible. Have the worst food on earth possible - in Zakaria market, have absolutely sinful Qorma, overflowing with oil accompanied by fresh dunlops (thick tandoori rotis - the kind they can only make in Aligarh). Till date I never enjoyed anything more than the absolutely greasy kaleji, nahari and bheja of Dodhpur dhabas. Last year, I was invited by the AMU Study Circle & the VC to speak to younger generations about how to get into the Civil Services ( after my truthful speech about what I did while at the University, the Vice Chancellor had the most painfully contrived smile, I have ever seen, while handing over the customary momento to me - Institutions never like too much of truth, I guess); I skipped the VC's hosted Lunch to eat at Khaala ka Dhaaba - I wasn't much missed though, at the Lunch.

The halcyon days of your youth are not to be killed by attending lectures on Gluconeogenesis at 8 AM in the morning. Our hostel - Hadi Hasan Hall, was next to the college and one could reach the Lecture Theatre in about 6 minute from one's room. I could not manage to reach the college before 9:30 and then too - the canteen only. I once got a standing ovation for attending the morning lecture but it was actually a mistake - I had forgotten to sleep and thought that it was still yesterday. My attendance was chronically short. 10% was allowed with a Medical Certificate which all good doctors, especially the BUMS ones at Dodhpur readily supplied for 10 Rs. I remember, Mohd Arif Siddiqui, the Dean was fed up with MBBS students apparently being treated by BUMS doctors regularly and he disallowed any MC except from a "proper doctor". Quite illegal step, I think. I missed the chance to start an agitation on this. Dear BUMS / BAMS friends vote for me!
The rest of my attendance came from generous proxies by friends until I became a professional agitator and teachers started recognizing me.

Needless to say, I wasn't fulfilling all my parents wishes. Back home, they were proudly telling everyone " our elder one is an engineer and the younger one, a doctor". I always passed with good enough marks, though. Last three days before professional exams are generally good enough to mug up the Table of Contents in each book... the rest of the story you can make up. Especially if your handwriting is bad enough, you can just write some relevant terms in BOLD and underline them. Color pens are very good for passing exams. Rest of the drivel should be so illegible that a teacher - tired from checking numerous copies - should just glance at the sheets and scrawl middling marks. The only true art is in knowing relevant headings and a few diagrams. The headings come from a detailed study of TOC. And, diagrams, well... the secret is to learn mindlessly a few diagrams and fit them somehow in all initial questions. For example, if the question is Describe, the nerve supply, blood supply, origin, insertion and actions of Gracilis. - and you know only the diagram of the femur bone, one can write- 'Gracilis is the muscle of the inner thigh, a.k.a. the rape muscle' (these interesting titbits are the only things that medicos know). Underline Gracilis, write it beautifully in colored pen, then underline the whole statement and repeat it in different forms in the story that follows. Give the headings of Blood Supply, Nerve Supply.... and underline them in colored pen.. you can write any illegible thing below the heading. Then describe the femur bone because it is somewhere near gracilis, and then make a diagram of the bone that you know. You could give the skull diagram also by talking about the differences between gracilis muscle and the skull; like one is a bone, the other is not. One lies at the superior most part of the body and the other lies infero-medially. Geeta kahti kuch karm karo, mat chinta phal ki kiya karo; man me aaye jo baat, parche par likh diya karo.Chances are that the instructor will give you marks enough to pass - he in any case would have forgotten the question in the first case if your story telling art is good enough ( it is also sometimes surmised that he is himself a bit hazy about the muscle). Keep repeating in between, the only fact that you are sure of - gracilis is in inner thigh somewhere. Please don't use the word somewhere. Being evasive is ok, being impudent is not. Being polite gets you anywhere. If you are docile enough, our educational institutions will never fail you. But please don't be oversmart.

I remember my vivas as if they were yesterday. Before Professionals began, demos (demonstrators) revise the subject matter for the benefit of those who missed some lectures. I missed those too, so when I was sitting in the Dissection Hall waiting for my turn at the table, I had not seen a single specimen and the mind was very hazy from the last minute page turning. I studied a lot of (and the only) anatomy in the last few hours. Prof. Mehdi Hasan - the greatest teacher I have ever seen, (truly) - was taking the viva, and I whispered to another monkey in lab coat, sitting next to me -
" what is this that MH is holding in his forceps?"
" What, u've never seen a trachea?"
" Uhh, OK! I couldn't recognize it from the distance" - (though the tracheae can never resemble anything else - I learnt later when I saw it from close - the first time in my life - at the exam).
As it turned out, I got the tracheae to speak about.
" Yes, tell me, what is this?"
" Sir, It is a trachea" I said proudly - the only specimen I recognized - God is Great.
"Good, Good" MH was a great guy in encouraging students.
" So tell me, if there is an abscess in the lung, which lobe is most likely to be affected?"
I knew one more fact, the right bronchus is wider and straighter, so any foreign body is most likely to enter the right lung somewhere. So I repeated the only fact I knew as many times I could.
"Sir, the right bronchus is wider. As the commonest cause of an abscess in the lung is a foreign body, whichever lobe it develops in, is more likely to be in the right lung, as the right lung.. is connected to the oropharynx by the the right bronchus which is one of the two bronchii attached to the trachea. As it is not only wider but also more aligned with the bronchus, I believe, the chances of a foreign body falling in the right lung are significantly greater than in the left lung, as I said the left lung is connected by the left bronchus, which is one of the two divisions of the trachea, that connects the mouth through the oropharynx with the lungs. So,it can be surmized that statistically, more abscesses will form in the right lung than in the left."
Remember, getting the beginning right, is very important. It sets the tone of the viva correct. As they say, well begun is half done. And MH - who was a member of the 'Nomina Anatomica' and whose references were in Grey's Anatomy, has better priorities in life than to take pleasure in failing students.
"Very Good... so what lobe is it formed in, in the right lung?"
I thought about this, how to answer a specific one. Then inspiration struck me. I vaguely remembered, that there are some lobes called basal lobes, so a body falling down should go to the lowest ones.
"Sir, in a basal lobe of the right lung"
" Excellent, Excellent, ... which basal lobe would that be..?"
He looked at me expectantly from above his small reading glasses perched above his roman nose. MH was a very kind hearted 'institution' with a huge bald pate where a few wisps of long hair were left to themselves. He was truly one of the greatest people I have known and one of those whom I unfortunately, failed to learn much more from. Now, he was infront of me and wanted me to go further, when evasion is the last refuge of every lazy monkey. I thought hard. Suddenly, I remembered a diagram from a class Xth book. In profile, a human body's lungs appeared to me to go lower near the back.
" Sir, posterior basal lobe" I hazarded.
MH got up and his stentorian voice (like Prof Challenger's in - Journey to the Center of the Earth) boomed across the DH. He called all the teachers around. He could. He was the Head of the Department and also the Dean.
"This boy did not know the answer but he thought about it and he gave the correct answer by thinking about it. This is how, you all must study Anatomy. You must think Anatomy, You must Dream Anatomy, You must sleep Anatomy......"
My viva was over.

I can never forget him. He used to make everyone feel good - not the other faculty though! I owe not just my passing Anatomy but what I learn't from the incident. He made you feel so good despite the inability to answer a simple question in the first go, that all my life since then, I have always tried to encourage and motivate people rather than castigate them. He helped me be a better person by his kindness. He was no fool. He knew more Anatomy than any one else in the world but he was kind to young students. He knew that I knew little but he was searching for something to make me pass. The most important thing that a Doctor needs to learn is kindness - not cleverness. I don't know if I will ever be able to be like him in whatever I do with my life but I think I do try to be kind as (and if) I grow up.

The next viva was Physiology and my turn was at Prof (Mrs.) Shrivastava's who always taught the Central Nervous System. Unfortunately, for last minute students like me, CNS comes at the near end of Guyton's Textbook of Physiology and I had never reached those chapters. Classes - those few that I had attended- were spent more fruitfully sketching cartoons or reading a novel. So when I stood outside her chamber, I was like the great seers. 'Know Thyself and know thy ignorance'. In this I was one with the great sages. I knew that I knew not. That is the first step to greatness.
I entered, and Madam asked me:
"What is the process of converting short term memory into a long term memory?"
This was an absolutely new one to me. I hadn't known that we have different memories. I began to think of a good story to get around this tough one. There didn't seem to be a way to evade this one. You can't tell a story against a straight one at the wickets. You bat or you are clean bowled.
But hope is eternal. Never give up without trying, is a lesson well learn't. So I began.
" Ma'am, Short term Memory consolidates into the Long Term Memory...."
" Very Good.. Excellent. I have been asking many students this same question but your friends do not know the basic terminology also... what can I ask them... Good.. you can go."
I thought she was crazy. I never gave an answer. I came out and took out my Guyton. You will not believe, that the process of conversion of STM into LTM is called CONSOLIDATION. I am not fibbing but this was my Physio viva. It was as if fates were conspiring to push me to the next year. The more I found medicine tedious, the more fates wanted me to study further. I guess, I must do something for Healthcare. This cannot be but destiny:-) Lesson for students : Learn to speak well and ignorance is bliss. If you shoot sufficient arrows in the dark, one will hit the target - if there is one.

The last viva was Biochem, which was a subject to which I took as a duck takes to fire. I knew zilch, zero, cipher, shunya. I had got down to my friends' copied notes only the evening before the written exam; and no man however intelligent, can do whole Biochem or a significant bit in one night. I was ofcourse later destined to do Post Graduate work in both Anatomy & Biochem as if powers that be (the tough ones above earth) had decided that the two subjects I least liked (apart from Pharmacology - another deadbeat subject), I should further (not) study. My viva this time was with the external examiner from AIIMS - a guy with a french cut beard and a superior manner. When I entered, he was sitting with Prof Qasim. He threw a full toss at me.
"Please tell me about Anti Freeze Proteins" This was outside the syllabus. But Lehninger, the textbook of biochemistry that most of us used, had small boxes in some pages where irrelevant but interesting things were talked about. Anti Freeze Proteins was one such box. Sabahat Azim, being a young free monkey had read such boxes only. The info in them was completely irrelevant but mightily interesting. Imagine, instead of mugging up large cycles and equations, who would not want to know why fish in sub-zero temperatures don't freeze? This examiner must have become tired of asking all the usual questions. And thus started a great Arthashastra. He would ask questions and I would answer them. He would ask more and I would answer more. I could see the perplexity and pride on our internal examiner, Prof Qasim's face. He must have been wondering " who is this brilliant student, that I didn't notice all year round?" I was only noticeable in his lectures by my absence. He didn't even know my name.
Then I don't know why, but Prof Qasim started asking me basic questions. I did not know Gluconeogenesis, Glycolysis, SGPT, SGOT etc. They must have been quite confused and would have concluded that this is a very studious but not very bright student who has mixed up all the basics but still remembers very tough things. If you wear spectacles and look serious and if your examiner does not know you actually, you can get away with murder. Only look a bit frightened. It helps the ego of the examiner to see the fright in a student. My great innings at fielding irrelevant questions still helped me clear the exam. Lesson for internal examiners: Please leave the well alone; if the external examiner is impressed with your student, please do not try to over impress him with how excellent are your students. Moral Lesson for all: the most apparently irrelevant things in life may be the most important things.
I cannot but moralize here a bit. Please do not be serious. Life will not throw text books at you - so loosen up a bit. One can get through life (or medical exams) with fun or self inflicted torture. Pick one. Fun is really better, I can tell you.
I have given you wisdom on how to become a doctor ... not a good doctor. That lesson comes a bit later............. Do not be afraid... I am a self proclaimed teacher about every thing under the sun. So I will keep inflicting pain as long as you keep reading. There is much more to medical education than all this...


(There are only two followers of my blog currently. One of them is my wife. Who says no husband is a hero to his wife? The few who are reading this, please follow my blogs otherwise, from the next time onwards, all anecdotes will be with names of real people. The only insurance is enrolling as a follower. As they say
"Know thy enemy")