IN MY DEFENCE

Last week, I wrote about the hardships faced by medical students. Bouquets it garnered aplenty; the brickbats inspired this post.

One discerning reader opined that I am a nasty fascist who is critical of patients for being sick *speechless*. Another observed that my head was stuck up my own arse *weak smile*. Two enterprising dissidents even composed a limerick and haiku in my (dis)honour *chuckles*!

Others concluded that I am arrogant, conceited, self-absorbed, self-congratulatory, pretentious, ignorant, ridiculous and wallowing in self-pity. In return, I offer some personal experience and perspective.

Budding doctors have fun too! We participate in college fests and House marathons. We inflate condoms, entangle nasogastric tubes, administer subcutaneous injections to jacketed books and compose outrageously inventive answers in our exams. We also spend some time doing absolutely nothing.

It’s never enough. Youthful impulses can be satisfied; Youth cannot.

Medical school is a dysfunctional social experiment in which personal boundaries are eliminated. We have stripped, palpated, percussed and auscultated each other. Everyone knows everything about everyone else. I was waylaid in the loo and relieved of a urine sample that was analysed by a third of my batch in a biochemistry practical.

That we emerge (mostly) sane is a minor miracle.

We learn by doing. And making mistakes. Multiple skin punctures for intravenous access. Catheterising the wrong orifice. Sounding a tender spot. It’s tough on patients, but it’s tough on us too.

A test of memory admits us to the course; the course itself is a test of character. Is it okay to pull the chubby cheeks of a nephrotic child? Giggle when an over-atropinised patient challenges you to a duel? Double up with laughter when a woman in labour, fully dilated, stands up and declares she’s going home?

It isn’t what we deal with that makes us awesome. It’s how we deal with it that does.

Because we man (and woman) up. Turn over a new tree. I yam what I yam and it’s not all that I was.

There is nothing theoretical about our occupational exposure to disease. A patient with multi-drug resistant tuberculosis once coughed straight into my face. I’ve been drenched by the amniotic fluid of a dead born baby. Four of my intern seniors are on prophylactic Anti-Retroviral Therapy because they were accidentally pricked by HIV-infected needles.

Despite this, none of us has, or is going to, quit. It is nothing short of heroic, and I refuse to be humble about it.

I will graduate this year. A fresh Chartered Accountant will not be asked to audit a Fortune 500 company. A recent engineer will not be required to protect his country from cyber terrorism. But as a medical intern next year, I may just be called upon to singlehandedly resuscitate a breathless/pulseless patient.

In a world that still values human life above all else, there’s more than just a little pressure to learn how to save one.

‘And yet’, as a reader put it, ‘I would like to live this life’.

Cheers!

* * *

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52 thoughts on “IN MY DEFENCE

  1. Do not bother about people who don’t understand what it takes to be where we are…you are doing great !
    Cheers to you ! Mrigank !

  2. Mrigank,u have voiced what others take for granted. All of us should acknowledge the sacrifice we make and the hardship,both mental and physical we endure. But the other side of the coin is the job tion

  3. My batch mate contracted tb spine within a month of starting general medicine while another contracted tb and became a mere shadow of his former self. Another ties crepe bandages on his swollen feet because he has been on his feet for straight 36 hours. These aren’t just horror stories we make up in our heads for self pity. They are real. At least in the Indian context. I agree that you did not have to defend yourself. We know our stories and we will willingly go through it again. And no, it is not a job that we just ‘have to do.’ Kudos on yet another nicely put post. Good luck for the criticism. Hate is better than indifference. 😉

    • I agree with what my fellow docs are saying here. Living inside a hospital for literally a decade surrounded by people with just diseases is something these guys will never get a grip of. To them, doctor means ‘SELFLESS’ : they don’t consider to what extent selflessness goes.
      Medicineandbeyond, I contracted TB sacroilitis and could not move for 2 months. I could not sleep at all because if i did, my leg would move and the sacral nerve would get stimulated causing excruciating pain. I got swine flu 3 weeks before my pg university exam. I know exactly how harrowing these experiences were in my life.

      I realise your need to justify and I appreciate the effort you took with this post. I just want you to please not take what others say to your heart. These are guys who come crying for a papercut and sniffles. They grimace and wince when they see a person cough near them. They will never understand how tough the course is and how many teams we have to watch people die in our arms over and over again. They will stick to three words they know to justify their insults – ‘Hippocrates Oath’ and ‘Selfless’.

      Above all else, be strong mentally. There is so much more in life we will face with our patients and caring for them in their moment of distress. These comments by unknown faces who stand to judge without being able to do half the work you do doesnt matter.

      http://www.theappletini.com/2013/06/godyears-on-being-doctor-in-india.html

  4. Few professions offer such immense job satisfaction. So we take the crap with a smile and for granted.

  5. 🙂 I know nothing about medicine. But I salute you for going through it all with a smile. It is true. So true. Although, from a patient’s perspective, doctors are my least favourite people. You are awesome. Let not anyone tell you otherwise.

  6. I’m not a doctor to be, but I am friends with too many since I am a nurse. To everyone else, it’s all real. There are no flowers in this story, I’ve seen and lived with this life-saving lifestyle where we loose ours.

  7. Loved this post, as i did the previous one too.,,, as bout the hate mails, don’t even bother… I mean seriously, how many of them would know the feeling of holding a fully grown macerated stillborn? It’s traumatic,n things like that somewhere seem to leave a mark day will never really fade…. So at 22, when my friends in other professions can choose to b perfumed n go ‘eeeeks’ over a blob of mucus somewhere, in other words, be ladylike,pardon me if at d end of a day of being slathered in grime n blood n amniotic fluid , i don’t really care…. None of this can be taught, is wat many ppl on d other side of d fence don’t realise. U know, d ” so wat, u hv been trained for it, so deal with it” kinda concept….

  8. Very true, its not everyone’s cup of tea to become doctors, having a sister studying medicine i can realise the patience and hardwork which is required…..this is a profession where u cant leave ur job half done for tomorrow as the office hrs are over …… dear u have no reason to defend urself, u all are great.:)

  9. like someone commented in your last post..if someone didn’t like your previous post, they can go and vent it out on their own blog 🙂
    all doctors working in india and anyone who’s known a doc personally will agree with you and empathize.. for the rest no point even getting bothered about what they say.. because some people dont want to understand, they just want to argue 🙂
    and believe me you will be called upon to resuscitate a breathless patient next year.. I have.. and you will do it instinctively, and at that moment..you will forget everything else about the patient, his name,religion,gender,age,profession,race,community everything..something that no one in any other profession will.. and that’s what makes you and all of us heroes. Period.

  10. many thanks to those who infuriated u in the previous post-in return ur followers(me included) got another teriffic post..rock on Mrigank:-)

  11. Hey hey!

    Stumbled upon your blog today through Facebook, and couldn’t stop reading! I am already a fan of your writing style and your style of narration 🙂 Brilliant work. Looking for more amazing posts!

    Best,
    Suezelle

  12. I actually loved your post from the other day about doctors. And its funny how this applies to you no matter where you become a doctor. I don’t like to show off about it because people get annoyed and thing that being a doctor has made me self conceited but I think that the rite of passage that we go through from being med students to clinical students to interns and residents..It literally alters your personality. You become less judgemental (i hope so), you accept things and try to fix them and now dwell over the unfairness of it. You become detectives, you become counselors, you become lawyers for your patients and you become a savior..All because of this one profession. In fact, you become so intricately involved with your patient and their life that at times, you don’t even know what the barrier is.
    And that is the reason we go through this hell/heaven conundrum. And its worth it..Because we can look in the mirror one day at the end of our lives and realize that we have literally made a difference in thousands of lives. Our presence mattered..

  13. I am not good at statements in English, but i read both the post they are terrific and true, i can only say you are one of the chosen one by Almighty to be able to practice the only profession which rates you next to him. Keep up the good work we trust you

  14. You write very well, Mrigank! I do not know you; I started reading your blog because a friend posted your piece on “South Indians” on facebook and I was pleasantly surprised to learn that you’re a doctor too! Do make time to write and to follow your hobbies no matter how busy your profession keeps you. Cheers!

  15. Mrigank.
    kudos 4 bravely voicin it out… four years ago, as an intern , v rushed outside our og casualty to attend to a refered case of swine flu.. a lady , in her seventh month o gestation… the patient, we were informed by the accompanyin intern, was spirallin down. We had asked for a kit.. when it seemed like decades n no kit was brought, v decided to go in with jus masks… alas. a tertiary care hospital , n we were denied even the simple masks while on duty… after the patient was intubated n settled in the MICU, I took the liberty to check the nurse’s drawers. stacks of gloves n masks! “for an emergency”
    . My co resident has been vaccinated for everythin from Tetanus, to Rabies, n is ON PEP. Inspite of repeated questionin, many parents deny HIV positive status(. N many staff nurses , single gloves, let alone a kit.) Situations r horrid in some tertiary care setups. harrowin , even… n when all this is reported to our higher authorities, (director, prof) we are branded incompetent. in many colleges that ive worked at,”universal ” precautions are denied to trainee doctors…

    God save us.

  16. As a medical student, I have been equally difficult and sometimes upsetting experiences- I DO understand, and I STILL take issue with what you’re saying. I refuse to pat myself of the back for having been offered the opportunity of a lifetime. There is nothing heroic about becoming a physician and practicing medicine- it needs to be done, and it is a huge honor to do it. Yes, there are lots of strange and unique situations that medical students go though, but none of these experiences makes us worthy of the self-congratulatory nonsense that I see all over the place in this profession. Medical school is hilarious, weird, and fun. Obviously it’s hard work, but that doesn’t make it heroic. That just makes it a job- an awesome, challenging, fascinating and worthwhile one at that. Did you take any time off between college and medical school? There’s a big world out there- a little perspective might do you some good. Your experience in med school is important and worthy of your own reflections, but it is not even close to universal. I kindly ask you not to represent it as such.

    • Yeah, there’s nothing heroic in choosing a profession in which one saves lives on a daily basis. Not at all. /sarcasm

      Come on, now. This is not a zero-sum game. Medicine can be both an honor and a trial, both a job and a heroic calling. What is with this urge to put down physicians? I have no problem with saying that nurses are heroic, that first-responders are heroic, that police officers are heroic, that firefighters are heroic, even when they are “just” people doing their jobs. All of these people are heroic due to the nature of their work–and by the same token, doctors are heroic, too.

  17. Well i did not read your earlier post, But id comment just on the basis of this one. firstly, yes, im your new follower, in love with the way you write. Personally, im super scared of Hospitals, and had nightmares while doing my internship. So i honestly appreciate each and every Individual from the Doctors to the watchmen in the Hospital. Totally agree with you on the post, and waiting to read more of your entries 🙂

  18. I am an engineer and my older sister a doctor. And we both are from one of the ‘top’ colleges. I have seen her go through med school. I was ashamed at the amount of effort I put in to earn my ‘professional’ degree compared to her. And right after we both graduated the difference in our salaries was even more shameful (although the situation now is different 😛 ). I agree med students dont just learn medicine, its totally transformative. I chose to do engineering cause I knew I couldnt do what she was doing. On hindsight I regret it a little even though I love what I am doing right now. One incident I remember – I was picking her up from emergency room duty and happened to see her training an intern for a lumbar puncture (you insert a needle into a patients spine to get some fluid). It is supposed to hurt real bad. The intern made a couple of bad attempts and then got it right. With the patient screaming his lungs out, the medical team was rejoicing and shouting ‘treat time’. I was shocked and had a fight with my sister later. She said – do you think its easy for us to inflict pain on someone? And after 36 hours of being in the emergency, the thought of a lunch out (treat) with friends is the only thing that keeps us sane”. She has seen baby girls being dumped in trash cans, she has seen her patients die but still during her PhD research when her sheep died she cried, she has had to go through some fancy TB treatment herself… oh I can go on with my stories and I am sure my sister has many more. I dont know what else to say here !

  19. Nice write up!
    Medicine has always intrigued me, but I chose Engineering over Medicine during my college days.
    Both my Mom and Dad are doctors and I clearly know what you are talking about! I have seen the amount of respect they command(Note: Not demand!!!) from their patients/friends/famlilies.
    One word to all the *good* doctors/interns/students out there – *Respect*

  20. I thought both pieces were well written. It had a lot that rang very true and a few bits mildly exaggerated. But so what ? There is something called artistic license. It is ironic though – The ones who thought your article was a bit much – went on to add that you have your head up your arse/that you were a fascist and what not!! Hilarious! Abuse based on a good piece of prose ??? ( irrespective of whether you agree with it or not) NOW THAT is a bit much I should think 🙂

  21. Simple question to all the haters out there…If someone paid you around 24000 rupees a month to be at direct risk of contracting diseases like Tuberculosis, HIV and Hepatits (all of which are life threatening and debilitating) on a daily basis and i literally mean on a DAILY BASIS..would you take the job? No? Didnt think you would.

  22. Well, its not as if someone forced you to be a Doctor, fact is most of you are doing it to make a lot of money, so lets not kid anyone here and wallow in some fake sacrificial self pity. I do know that being a Doctor is the most noble profession that you can ever be in, as it involves saving lives. But the fact of the matter is the tone of the post was clearly, “we are gods gift to the world” and thats what got some criticism. While no one expects to get free medical advice, everyone hates mercenaries who walk around like they are Gods gift to the world.

  23. Hubris will get you nowhere good. Doctors who envision themselves as heroes often envision themselves as God… that you refuse to be humbled will be your downfall.

  24. Senior medical student here. First off, you write wonderfully. Also, I don’t think there has been a doctor-in-creation that has not had every thought distilled onto this nor the previous post. However, I, like all my classmates were absolutely aware of what we were getting into. Choices in life are just like medications – risks and benefits. And clearly the benefits of doctordom AT LEAST outweigh the risks. This past year saw about 10 qualified applicants for every 1st year medical student position at my medical school. Say what you want about youth and other opportunity costs, for the rest of your life you will be smothered in prestige as seen in many of the commenters on these posts, not to mention an income which, in the US at least, is significantly (p<0.000000001 🙂 ) higher than the national median.

    Make no mistake: our job is challenging and, by a severe minority denigrated, but we are privileged – a status to be humble about; come hell, high water, or bodily excretions.

  25. Wow, you are an incredible writer! I am a US Physician from Texas A&M College of Medicine and a product of Scott & White Hospital Family Medicine Residency. I have been “officially” practicing now for 4 years out of residency. You couldn’t have worded my feelings and emotions more eloquently. Others who think you are writing with need for “respect” are completely wrong. Hold your head high and continue to write what you do. I personally feel that I could care less about “respect,” I just wish patients had a tad more “patience” with us medical professionals. While there ARE some docs out there that are money grubbing, worthless, incompetent, emotionless pricks; most of us absolutely LOVE our profession and would do ANYTHING for a patient in need. There is nothing better than SERVING others! Write on, my friend.

  26. Every field and profession has “dishonest and unpleasant selfish people” as does medicine. But that doesn’t mean that every doctor should be taken for granted or insulted or called greedy. We make sacrifices to be physicians that no other field demands. We have less time to spend with our kids, our families, our spouses. We remain sleep deprived, can’t eat dinner in a restaurant without a call from a patient who didn’t think twice to call and tell you about a knee pain that’s been an issue for months but that you needed to address after hours. We are glared at with disapproving stares if we choose to have time for ourselves or take a vacation. Don’t remember being told if I am a doctor it included sacrificing any form of a normal personal life. Today after 12 years of taking care of HIV patients and saving lives, I sit alone, with no real personal life, my only friends being colleagues. its a lonely life. I have no regret being a physician but I regret being forced into forgetting about me. As I only have one chance and one lifetime too. It’s not my job to sacrifice my own well being and life and dreams because I chose to be a physician.

  27. Man, I am a doctor, practising for the last 8 years. You have a deeply weird and disturbing attitude to your patients and your studies. *I’ve been drenched by the amniotic fluid of a dead born baby” really???? how did that happen? I think you might have been standing in the wrong place fella…. If you consider yourself a hero or ‘sacrificing’ yourself to medicine you are in the wrong profession. Maybe with time and experience you will see that being a doctor and serving patients is a PRIVILEGE not a sacrifice….if you want to be a martyr religion is a much safer bet then medicine. This smacks of a typical medical student attitude of ‘oh. look at me, amn’t I wonderful..I’m going to be this hero doctor…’ If that is your real opinion, stop studying medicine and do something else because your implicit attitude to your future patients is going to make you a very bad doctor.

  28. Nice Read however, the use of the F… word could have been avoided. About your opinion and the array of comments received. Time and again, just like Mr. Kamal Hassan was snubbed by a group of illiterate Muslims (i am a Muslim from Kerala), I sadly see a bunch of us here taking Mr. SRK to the cleaners for the depiction of South Indians the way he did. In my honest opinion (not demeaning anyone), the intelligent viewer should refrain from thinking about a movie beyond anything but 2 to 3 hrs of time pass. There is a cliche(sad but true) associated with portraying South Indians from the times Indian movies started, where a formula is stuck in the head and has worked with the masses. One SRK cannot turn it around in a movie. The best things are better left unsaid and we should be proud of people who truly define what we have achieved and nobody can take it away from us(South indians). In my opinion, we do not have to ask for anything more

    In no particular order

    Presidents of the Country – 8 times out of 13 Presidents (So Called South Indians)
    Scientist – C V Raman (Nobel Peace Prize Laureate First Asian and first non-White to receive any Nobel Prize in the sciences)
    Nuclear Research – Abdul Kalam (President)
    Directors – Mani Ratnam, Manoj Night Shyamalan, Mira Nair
    Actors – Highest Paid Actor in India – Rajnikant, Kamal Hassan, Mammootty, Mohanlal (Maximum National Awards) VijayanthiMala, Sridevi, Rekha Hema Malini (Top Actresses of their era)
    Cinematography – Santosh Shivan Ravi K Chandran
    Art Direction – Sabu Cyril
    Music – Ilaiyaraja (Maestro) A R Rahman (Double Oscar Grammy) (Kolaveri Di – Global Sensation if anybody liked it or not) SPB Yesudas (Record Holder for maximum songs in maximum languages)
    Cricket – Kris Srikanth G Vishwanath V Prasad Srinath Kumble (10 wickets) and many more
    Tennis – Vijay Amritraj Ashok Amritraj (One of the first Indian Hollywood Producers Hyde Park), Sania Mirza (First Indian Women Grand Slam Winner), Mahesh Bhupathi
    Athletics – P T Usha
    Hockey – Dhanraj Pillai
    Football – I M Vijayan
    Chess – Grandmaster Vishwanath Anand
    International TV Host – Padma Lakshmi
    Technology – Wipro Infosys HCL (To name a few)
    First Mosque In India (whether it is relevant or not) – Calicut or Kozhikode
    Largest Luxury Car Factories – Chennai

    Love it or Hate it – Best IPL Team – Chennai Super Kings
    Love it or Hate It – Indian Defense Minister A K Anthony
    Love it or Hate It – Indian National Congress has formed a government (Largely due to DMK Support)
    Love it or Hate It – BCCI President (Srinivas – even though he is not good)
    Love it or Hate it – India

    Strange but True – CEO of SRK’s Companies – Venky Mysore

    Love us or Hate us, you just cannot ignore us – We being intelligent should take it in the right spirit that we are always important else, why would they make a movie totally dedicated to us(if they portray it right or wrong).

    Any reaction will portray us in bad light and create more hatred.

    Request all viewers and listeners to take it in the stride and hold our heads high and not bother about what they say, coz We know we are better any time hands down!

    Cheers to our South Indian Pride and please feel free to add details if I have left out any!

  29. Dude!
    Simply loved both the blogs. Like n number of docs who have said it already, these all were exactly my thoughts all throughout my internship. (That’s all i have worked in a hospital :-P)
    I think your “stool, slime and psoriasis” comment was misunderstood by some of the readers. (Though Personally i feel you could have avoided putting psoriasis and stools in the same bracket). I totally understand what you want to convey there.
    I remember an incident from my Surgery postings. I was trying to put a Ryles tube in a patient when he puked all over the floor including my feet :-S. I was obviously grossed out and was clearly agitated for quite some time. After some time the surgery resident comes to me. Puts an arm around my shoulder and tells me, “i dont want to give you all big “sacrifice” talks but just think that you have got this small opportunity to give it back to the society. Not everyone gets it. Use it wisely”. I guess that pretty much sums up everything nicely.
    In these 4-5 months that i have been sitting at home and preparing for the PG, there was not a single day when i did not miss Sion, both the college and the hospital. I cant wait more to work again with the “stools, slime and psoriasis” again and that too, willingly! 🙂

  30. Lol I know so many medical students who write crap like this. News flash, medical school is so hard for most of you-because you never had to work before in your life. As a former UG who worked full time, and did research, volunteered, etc, etc. I have never felt I have had more time-and I am a third year. Med school is only hard because the majority of those who attend it never had a real freaking job or did anything outside of be a neurotic pre med and high school student. Rich people (or future rich people in this case) love to think they worked harder…

    • Newsflash .. not all medical students are rich.
      Some medical students have actually done some “real freaking job” prior to med school
      Many even have done stuff that are “outside of … a neurotic pre med and high school student.”
      Really!
      Lastly … “Rich people (or future rich people in this case) love to think they worked harder…”
      I can only say: ha ha ha … I wish!

  31. Better than the first piece! Many thanks to the detractors who spurred you on to pen this; they still won’t get it, you know — but you can’t please everyone. You remind me of an eloquent colleague of mine whose writing used to give us something to smile about as well as ponder on in medical school. To a lesser or greater extent, doctors face these situations in all countries — Nigeria where I trained and where I have worked for nearly 10 yrs is no different. Mrigank, Keep writing — it’s an amazing outlet to ensure you retain your sanity and other parts of your being which can so easily become lost in translation. Wishing you all the best!

  32. We, who smile when asked what we do because we know the answer will raise your brow;

    We, who wallow in the pride of our status and position, because although we may not always make as much as you do, we will never be corporate zombies;

    We, who bask in our erudition, for each moment spent in the dark cellar lined with medical texts elevates us to the next level of knowledge that you may only be in awe of;

    We, who enter any conversation with a sense of confidence that no matter what you deny us, you cannot hold back that gentle yet telling head-nod that you deem a necessary, if even grudging, acknowledgement of our presence;

    We, who bear a gravitas that is instantly attractive in a largely frivolous world;

    We, who bring a deep sense of purpose to our daily work, because if we don’t, people may die;

    We, who must remind ourselves every single day that while what we do may seem mundane and perilously resemble drudgery, it impacts lives in a way that nobody else can;

    We, who earn the skills of engaging the entire panoply of the human form, assigning ourselves a breadth of expertise that is inconceivable to most others;

    We, who have first-row seats to the human condition, from the moment of conception, to birth, to growth, to aging, to death, all the while maintaining an equanimity that a philosopher would aspire to;

    We, who are friends, philosophers and guides to the people we meet;

    We, who are sought after at dinner parties, family occasions, religious ceremonies, the neighbor kid’s birthday, because merely by association with us, people see their social value appreciate;

    We, who get away with more than our share of run-ins with the law, solely because we append a convenient prefix to our names;

    We, who will never have to concern ourselves with the source of our next paycheck;

    We, who benefit from the luxury of using nothing but our educational credentials as a passport to international adventures, simply because we’re fortunate enough to be trained in engaging a primal need of human beings everywhere;

    We, who enjoy the bliss of being able to surround ourselves with intellectuals;

    We, who find professional role models in the most stellar men to have ever walked the earth;
    We, for whom being an excellent human being is always a choice;

    We should realize that the price we pay is enviously little.

    • Clap, clap, clap. Agree, except for this which I cannot understand: “We should realize that the price we pay is enviously little.” The price doctors pay to become doctors is enviously little?

  33. I have been following your blog for quiet sometime now. I wanted to ask you a direct question sincea long time. I have not been to a doctor since 8-10 years. I have a policy that I will visit a doctor only when I have an accident. Not on account of illness. I am a very different person (everyone says this. right?) What do you have to say regarding this? I dont trust doctors. I dont trust anyone’s judgement of mine whatsoever. I need to be shown the x-ray, I need to hear my lungs in a stethescope. The doctor needs to present his observations and convince me. Its my body, and what he may percieve is not my concern. We both have to agree on the treatment and then proceed. I know no doctor will agree. So I just dont go to doctors. 10 years, going stubborn (Not Strong).

    • To each his/her own. You don’t trust doctors so you don’t go to them. We are free citizens here (unless we live in North Korea … ha ha ha) and free to live (and die) in a manner that we want. 🙂

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