The Glorious Things Interns Do

1. Clean cupboards.
2. Bring tea, coffee, food for the senior docs.
3. Take senior doctors' family members to the dentist.
4. Basically, make senior doctors' family members feel important, show them around, do their work for them, so that your senior looks good.
5. Go to the bank and finish your seniors' work for them.
6. Fill forms. Tons and tons. Since seniors are too high and mighty to fill theirs themselves.
7. Accompany patients everywhere. Since they will otherwise get lost and some time will be wasted. An intern's time on the other hand is obviously worthless.
8. Beg all the time. For X-rays to be done, USGs to be done, investigations to be done, reports to be given, appointments to be given. Beg for syringes, needles, bulbs, gloves. Beg, haggle, fight, steal, scream, weep. Whatever it takes to get the job done quickly. (Though of course, all this should actually be getting done all by itself, as a basic requirement for any hospital to function).
9. Suck up to everyone, from the mama to the sweeper to the nurse to the resident doctors to the HOUs to the Dean.
10. Put up with flirting and ogling housies (exclusive to female interns).
11. Arrange for alcohol etc. for your residents (exclusive to male interns).
12. Trace reports. Although they should never require tracing in a fully functional hospital. 
13. Make phone calls from your cellphone for your seniors' work.
14. Scan books and textbooks for your seniors.
15. Check and tally the department's accounts for your seniors.
16. Find the X-rays or files or reports your seniors lost. 
17. Never learn a thing.
18. Never treat a patient.
19. Never question your seniors.
20. Put up with the sisters being mean to you all the time (I confess there have been occasions when they've left me close to tears with their unnecessary and uncalled for meanness).

From mkk:
21. Shoot and develop X-rays.
22. Forge prescriptions under some other Dept HOD's name.
23. Find pillow for the lecturer to rest on.
24. Help the medical instruments supplier extract money from BMC so that they get few thousand rupees of commission.
25. Take night ward rounds and write CM notes as the housemen are too busy (read lazy) to take themselves.
26. Get the tube lights fixed!
27. Renewal of medical registration.

From Tangled up...:
28. Pick up the housie's laundry and deposit it in her room.
29. Count the number of functioning and non-functioning ventilators in the ICU and write down the names of the companies as well as who donated the money needed to buy them.
30. Go to the new hospital building from the old to call the registrar because the intercom wasn't working (God forbid, they actually have to use their mobile phones!)
31. Count the number of tables and chairs in three wards.
32. Pick up lunch order from a restaurant because the restaurant had no one to deliver it.
33. Spread a bed sheet on the bed in the doctor's room in the Emergency so the lecturer can sleep on it.

All this donkey work we do isn't going to help us in any way as a doctor, or as an individual. Our seniors aren't even going to thank us for it, or acknowledge our existence once we've finished doing their work. It's just going to be time we wasted in our life. Zero benefit. The only way it helps is that they HAVE to give us the sign on the log book at the end of your posting. Since we did all their donkey work. Interns just want the sign, seniors just want their work done. So no one complains.

Some people seem to think that the PG doctors are so overworked, it's no crime if they shed some of their workload onto the interns. But I beg to differ. As PG students, they worked hard, got admission into college, and are now going to spend the next three years becoming doctors. This is a part of their deal. They're getting paid for this. It's part of their job profiles, and it will help their patients. (Yes, the very ones they actually get to treat). Their seniors will teach them, and help them in their careers, if they do their jobs well. And they better do it well! But is it really a part of an intern's job profile to do their seniors' donkey work?

As medical interns in a government hospital, we're supposed to get a hands-on experience in treating patients, and improving our medical knowledge, we're supposed to be developing skills, not doing our seniors' work for them so that their lives are easier (while they never give a thought to our lives).

Frankly, dear seniors, we don't even mind doing your donkey work, since we are the junior most in the hierarchy, but at least we should be taught something once in a while. Don't look at us like hungry leeches, with the only thought in your head when you see an intern being how to extract the most from them and get the highest amount of dumb work done from them. We've finished medical school, the least you can do is treat us with some respect. Like, maybe remember we are now your colleagues? Ever heard of the words 'please', and 'thank you'? If you're asking us to do your personal work, at least ask politely! Ever thought that you should maybe do your job once in a while which includes teaching us something? Rather than just thinking hard and inventing work for the intern every time you see one sitting ideal? Hope you get the message someday. Till then I'll just go back to living the frustrating life of an intern.

P.S. My ongoing orthopedics rotation is turning out to be a nightmare. Though this post may seem a bit extreme to some, I swear all of it is true, especially as far as this one rotation is concerned.

P.P.S. Feel free to add to my list of 'The Glorious Things Interns Do'. I will be updating the list as your comments come in.

"Always use your own clinical judgement..."

Here's a story of how I learnt a good lesson in the practice of medicine recently.

There was this patient who'd been coming to my hospital's Casualty OPD since the day I joined. He'd turn up every couple of days, at different times of the day, complaining of pain in his right knee joint.

He would walk in with this bandage tied around his knee and complain of unbearable pain. And then ask for painkillers. My senior told me he's been coming like this for quite some time, has been evaluated by many Doctors, who all say there's nothing wrong with his knee. He'd probably gotten addicted to the pain killers, or that's what everyone thought was the case. He would never go to the regular morning OPD, he just came to the Casualty OPD everyday.

So over the next month, I watched him come in multiple times. Sometimes we just gave him the drugs, sometimes we told him there's nothing wrong with him and shooed him off, sometimes we gave him placebos. But always, he would be back for more pills.

Of course, there's no such protocol followed like counseling such a patient or giving him a psychiatry reference. No one thinks it is necessary or advisable to do such things. Hell, no one even gets such ideas.

Pretty soon all the interns, all the Doctors, and all the staff started recognizing him well. Most refused to give him any treatment whenever he turned up.

One time I saw a Doctor tell him that he should wait outside quietly, come in only when he saw that particular Doctor (himself) over there, only during his shift, and then he would get the pills he needed. The Doctor then proceeded to prescribe Diazepam to him. Was that some kind of weaning tactic? I don't know. I didn't ask. We don't generally question our supervisors about their prescriptions, or about anything for that matter.

Then, after a month or so of this, he now came in during one of my night shifts and started complaining of pain in his left knee joint. Of course no one batted an eyelid or probably even noticed the difference. He came in  with three people carrying him, complaining of severe pain.

I told the on-call Medical Officer that he's been coming with similar histories all month long, since he (the MO) didn't seem to recognize him. Even the nurse recognized him, and the tons of prescriptions he had with him showed the same thing. The MO still listened to him, elicited his history. The patient mentioned that he had had a fall 4 days back, and since then developed severe pain in his left knee. This ticked something off in my mind since I clearly remembered him with a bandage over his right knee in the past.

The MO then examined him, and noticed there was a slight swelling over the knee joint. That, combined with the history, was enough to convince him. He sent him for an X-ray, and called the orthopaedician on-call to have a look. It was 12.30 am at that time.

The Orthopaedician on-call came in, took one look at the patient, got livid and started shouting at him. The patient it seems, had been coming in two-three times per day, everyday, for the last three days, complaining of pain in his left knee. But every one knew that he was a so-called addict so they just ignored him, or just gave him pain-killers and sent him off. The orthopaedician was furious that he had been called at midnight once again for that patient.

In the meanwhile, his X-Ray came. It showed a fracture lower end femur, with increased joint space, probably due to ligament tears. This man had been walking around with a fracture for four days now and no one had thought about evaluating him. In his defense, the Orthopaedician said that the patient had not given any history of trauma or fall before that particular day, so he had not thought about getting an X-ray.

Even after his diagnosis, the patient didn't want to get treated as he didn't have any money. He kept asking for some pills so it would be alright. When we asked him about addictions while taking his history, he confessed that his only 'addiction' was that he needed to take pills at night to sleep.

Finally, the patient was advised to temporarily get a cast, and arrange for more money for further surgical management, or go to a bigger hospital where a Trust Fund could be used to pay for his treatment. After he left, the MO on-call told me: "You see now what a good thing it was that I sent for that patient's X-ray? You should always use your own clinical judgement rather than listen to what others tell you. That's called practising good medicine. I saw that he had a swelling over his knee, so I sent him for an X-ray."

And that was one of the best lessons I have learnt in a long, long time.

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.