Thursday, March 17, 2011

I've got many doctors, I need a teacher.

So, it's been about 10 days since I started with internship.

I've been posted at a peripheral hospital in Mumbai for 2 months. From what I hear, this is probably the only place we get to actually do some medical work during our internship. The rest of the time, we interns just do mama-work (a peon's work).
(For any non-Hindi knowing readers, Mama is what we call the male helpers employed in the hospital to do all the non--medical work such as transferring patients, managing crowded OPDs, helping the doctors, etc. More often than not, they are the wisest and most experienced people in the institution. Mama is not slang, it's just referring to someone as 'my mother's brother'. It is a way to respectfully address a stranger who is elder to you.)

So far, it's been a good learning experience. Except, of course, no-one really teaches you anything. It's all self- taught. Trial and error. But then, nowhere in the Indian Medical Education System have I ever come across anyone who feels the need to teach us anything. That's totally unheard of. So how absurd of me to expect someone to do something like teaching, right?

So I have looked up youtube videos of all kinds of procedures: how to give I.M./I.V. injections/how to collect blood/how to give salbutamol nebulizations, etc. Sounds crazy, right? Well I did that because I'm just too scared thinking about what procedure I may have to do in the Casualty tommorow, and how bad it would be if I didn't know how to do it.

The nurses taught me how to collect blood, and give I.M. injections, how to start I.V. lines. Some were sweet and patient about it. Others just treated me like shit. But I just hovered over them till I learned.

There are still many more things I got to learn.

Today, for example, I was sent to do blood collections for the very first time. I knew it theoretically, had seen the youtube videos showing it, had observed someone do it long back in college, but had never practically done it.

The end result: A totally freaked out me, alternating between forcing myself to give it one more try on the poor patient and giving up and begging the pissed-off nurse to do it for me.

By the end of it, we had a wardful of patients with multiple pricks on their arms, and, thankfully, with the sisters' and the mama's help, all the blood ready to be sent for the tests.

Only one time did I manage to collect a patient's blood perfectly, at one shot, and I almost let out a huge cry of victory, in a wardful of sleeping and/or being tortured patients at 6A.M.

I'm sure this kind of scenario can work only in India. An intern who doesn't know how to collect blood is sent off to do it for an entire ward, and is expected to know how to do it, of course, miraculously, and no-one, absolutely no-one, even thinks about the patients for one moment. Thankfully, the patients also don't protest. They definitely didn't when I was pricking away multiple times at their ante-cubital veins (or what I thought looked like their ante-cubital veins).

I don't think they have such an option anyways. I mean they do have the option, but it's not really there, you know? Mostly, patients in Indian Government hospitals are treated like shit. There are exceptions of course, but in general, this is the impression I've got after all these years. Patients in these hospitals are treated like shit, just because they come from a not-so-privileged and not-so-educated background. I'll be writing more on this later.

For now, let's focus on the teaching part, or the lack of it.

I learnt how to give my first stitches from the mama, on an 8 year old with a CLW (Contused Lacerated Wound) on her scalp. It was, of course, a very messy job. But no-one cared. The mama tried his best to teach me well.

The actual medical officer who should have taught me, sat outside and read the newspaper.

That's the way things work. Everyone learns to deal with the system. And everyone gets moulded by the system, to become a part of it in the future. No-one tries to change it much.

The Professors berate us for not being hardworking and sincere, for not wanting to learn. But I beg to differ. I know there are quite a few professors who want to teach, and even try to. Very often, they don't know how to. But mostly, it's the PG students who teach the UGs, and that too because it gives them practice and helps them with their studies. And maybe because they know what it's like for the UGs. They've been there, done that.

The senior and highly qualified doctors, the ones who get paid to teach us, they hardly ever teach. It's a shame, because all their years of experience just goes to waste.

I'd like to add over here that, in these 4 and half years, I have also come across some fabulous teachers, who love their profession and who love teaching, who have scaled impressive heights in their fields and who still don't look down upon students. They've taught me, and they've taught me well. They have been great inspirations, and I hope to be like them someday.

So, here's my promise. If ever I'm in a position which requires me to teach, during my medical career, I solemnly vow to actually teach, to the best of my abilities.

For now, I just wish someone would teach me how to collect blood, insert scalp veins, take sutures, drain abscesses, write correct prescriptions, resuscitate dying patients etc. Because without that, I'm just scared all the time.

And I don't see how that can make me a good doctor.

P.S: Also, I still haven't heard the Eminem song from which my title for this post was inspired. I hope it's a good song.


  1. looks such a hard work... i hope you get used to it soon. everything seems difficult when you´re starting it, but then it just becomes part of the routine.

    hope your week is going well, dearest


  2. What 'medical work' in periphery? I am doing all the paperwork that can possibly be. Infact they had kept all the delivery notes for the past 3 months anticipating the intern to finish those off.

  3. Well Aayushi..a hard hitting piece this..I am sure someone is listening.. but keep your fingers crossed.. as they say..when student is ready teacher appears..

  4. Good Lord have Mercy! This is horrifying not only for you but for the patients! Goodness gracious, is it too late to get another internship somewhere else?

  5. Keep at it :) After all, in the end, you will be dealing with patients like me, who appreciate your humanity and compassion and humility more than anything else ....

  6. "The system moulds you". How true! When i started off my posts, i always greeted each patient with a smile. Now, the patient load is so high, i barely have the time or even want to make the effort to look up at the patient. The malingering, lack of drugs, lack of patient effort to get investigations done, empirical treatment are all piling on.
    But, i do swear that whenever a junior colleague ever approaches me, i won't act like its a crime to ask a question. I won't ever make someone feel inferior because people dont pass out of MBBS as world class cardiac surgeons for god's sake. Every stage in our education has a level of knowledge & i won't ever gloat that i have surpassed that just on account of my age or designation

  7. It's same everywhere in every field in India. Teacher's hardly teach nowadays and students are left on the mercy of internet or self study.

    A request... Don't forget what happened with you when you were a junior once you become a senior. And, help your juniors with every possible way.

    Also, don't stick to the normal norms of calling a poor uneducated patient a shit. Rather, stand against all odds in helping them because in India still doctors are considered second to God.

  8. a really good piece..really reflects your phase of internship well..

  9. @Stella: Thank you, you're awesome.

    @mkk: That sounds horrid. But nothing new, right?

    @rameshji: How I hope a teacher appears:)

    @Rhapsody: I don't get to choose where I am posted for my internship. The college where I study just allots it to us. And this is the situation in all Indian medical colleges.

    @Shaista: Thank you:)

    @Eham: I agree.

    @Rachit: I promise to treat my patients and my juniors with respect.

  10. Whoa girl! That sounds really bad! I had to visit a government hospital only once and the experience was shattering to say the least.. left me numb for days afterwards. Hopefully you will become thick skinned time progresses and you adjust to the system.. It's the suckiest thing to say but in India either you leave the system or you accept it..

  11. Aayushi didi (I feel like the more I talk to you, the more I feel I can't address you by name! Although 'akka' comes more naturally to me, and alliterates quite nicely with your name..), dunno how I missed on commenting on this post, as I have read it before and it has stuck with me!

    This is a really interesting post from my perspective to read, in particular because there is a fair bit of emphasis on teaching over here in the UK. However, having said that, I have also heard other people say how consultants and senior docs are usually too busy to pay attention to medical students (not junior docs like yourself mind you, so maybe it is a different ball game I am comparing) and do not properly teach the students, and how we have to do everything ourselves so hmm...

    Also, just out of curiosity - since you have heard of the OSCEs, what skills do they test you on in the OSCEs over there? I am asking because we are taught to write prescriptions, take blood, give IM/IV injections, etc. and we need to pass those stations usually in the OSCEs before we can progress through the years?

    (and wow, I am beginning to APPRECIATE why our med school has been drilling into us like mad about accurate and careful prescribing, we all found it such a bore but I can see how lost a doctor would be without having been taught it!)

    And I am very, very much a junior in the medical world myself (...!), but I completely get what you mean about vowing to help your juniors, I am the same. I remember going through hell and back with my yearly exams and I always used to think, if I can get through these now, I will help those in the years below as well as I can because I know what it's like to have no sense of direction!

    May I pass my medical degree (a rare achievement it will be in itself...) and may the sentiment of helping our juniors continue... :)

  12. i had almost given up on my blog but this post of yours kind of made me re-think and gave me something to write about, apart from the usual stuff of course. thanks. :D
    and an amazing post btw. same happened with me, escape that i learnt how to take samples in the Emergency Room :o