The Journey through NEET PG 2020

This post is solely for those who are targeting the upcoming PG Entrance exams and this is only about my experience so far. Many others might have used better methods to crack the exam and get ranks in the top 100 or top 1000 but I hope this will help someone starting out to reach their goal.

Background: I did my MBBS in a private college via a General Merit Seat. Academics were given importance and we did participate in quizzes at intra-college and inter-college level. The patient load was just adequate and much lesser than your average medical college. For my internship, I worked at Hassan District Hospital for 10 months under all the departments (minus the stipend though) where there was significant workload and opportunity to do procedures, assist in surgeries and conduct deliveries (due to the absence of PGs in most branches).

After this, I joined DBMCI, Bangalore for the regular classes on weekends. I was also a Plan C User of Marrow. The classes were well organized with the best faculties conducting the classes from 8 to 8 or likewise. Each subject class was followed by a few days gap and a test on the same subject in the next week after which we began the next subject. I attended VIBE and found it to be extremely useful for an Image Based revision.

After the classes got over around September, I began my revision as per a timetable and tried to complete 3 revisions. I attended the Central Institute exams as well and tried to improve after exam. I got 192 in NIMHANS, 2338 in AIIMS, 935 in JIPMER and 2093 in NEET PG.

So, here’s the deal:

I’m pretty much an average student and I think my memory fails me more often than I like to admit. But that meant I had to figure out ways to overcome this.

My father and I sat down and worked out the ranks required for the branches I’m interested in and the marks that correspond to it. I had a target to score above 800 in order to make it under 2000.

1.       Do your research.

Please sit down and look at the cut-offs for the colleges your branch of interest based on the last two years. Now look at the marks scored for these ranks. Essentially 800+ is needed for something in 2000 and under. If you are looking at Radio/ Dermat at a top college, you might have to push it a notch higher.

2.       Follow a Time table.

Be it DBMCI/ DAMS or Marrow, follow the test schedule religiously. Plan to finish that subject in the time period given and also revise it once on the last day. Take your tests seriously.

3.       Notes are important.

I cannot emphasize the important of good notes. You will thank yourself for writing things neatly, legibly and in a way that you can understand even 6-8 months later. If you missed something/ fail to understand something, make sure to clarify it in the same session or during the break. If you are one who remembers by examples and similes used by the teacher, don’t hesitate to write those down in your notes. It always made things simpler for me when I was reading the subject after a long gap.

4.       Go back and read. The same day.

This is probably the single most important suggestion given to me by a senior. I found this very hard but I tried to follow it. No matter what time your class gets over or begins, it’s important to go back and read the day’s topics and even solve MCQs on it, if possible. During the gap, read slowly and try to make sure the idea is clear in your head. If needed, refer a different source for an explanation. If there are some IMPORTANT topics left out (which are usually very few to none), add it to your notes in a few words. I solved MCQs from a few Subject books and also from Marrow QBank.

5.       Take GTs.

Now this may seem like a controversial point but I think it would be an early exposure to the length and pattern. I began taking GTs for AIIMs in April and the NEET Pattern from May using both Bhatia and Marrow as my sources. My initial scores were very low but I plotted a graph that showed my growth over the months. This graph can be a boon or bane. I Initially saw good progress but after August, the growth rate was much slower (I was stuck at getting 180-190 qs right) and also fluctuated often. Nevertheless, use it as a reminder to show yourself that you’ve come this far and to motivate yourself to go further.

6.       Read well, revise more.

Again, you might wonder why do people stress this point so much, because it’s 100000% true! It’s easy to read something once but when asked to recall it when asked in a twisted manner 6 months later, you realize what they mean. Focus on revising in between your subjects, taking GTs as a way of testing yourself. Revision should not be a passive process: It would be more effective when it is retrieval of already encoded information rather than creating a new memory of the same. 

What does that mean? 

Say you read Amino Acid Metabolism in April. One way to revise it in June would be to sit and recall whatever you can from One carbon Metabolism to Phenylketonuria to the polarity of the amino acids. When you actually sit and recall, you find gaps in your memory and then you fill it up by revising the entire chapter but at a slightly faster speed.

Personally, I found this very, very hard. I found it more convenient to just read the whole thing again but it was only few months later that I realized how important this was and began to do this, even if it meant more time. I used a white board where I started recalling everything I knew on that subject. Initially, this really affected my confidence but I realized it was the only way I would test myself before the exam.

7.       Sources are plenty, trust your own.

The truth is, there are plenty of sources for the same content. Stick to what you have and go by it. Don’t dwell on controversies. I chose Bhatia Faculty and many of the teachers overlapped with the Marrow teachers. I personally found them to be relevant, concept oriented and very helpful. I think other institutes are also equally good at what they do so just believe in what you’ve joined. I referred the Marrow videos when I had doubts in my notes in a few areas. Of course, there are going to be new points in every source you read, but you’ll have to draw a line somewhere and decide how much of it can you actually remember at the end of the year.

8.       Schedule

For the average student, a good plan is essential to get through the maze of preparation. Target the AIIMS exam. Believe me, it isn’t as hard as you think it to be. You can target your revision such that you have given a good first revision by AIIMS. Practical knowledge and common sense are two things you should remember to carry with you on the day of the exam! Plan every single day before hand, plan for the upcoming exam such that you have a few days leeway to revise high yielding points in the last 3-4 days. Make sure you’ve gone through the previous year papers well because the central institutes always have a few repeats or similar questions which you wouldn’t want to miss.

9.       Traps.

Stay on your own path, don’t dwell on comparisons with your friends or random Telegram groups. Don’t get discouraged by plateauing scores; identify where and why you are going wrong. I categorized my mistakes into 3:

·         New topic,

·         Known topic but did not read properly (reduce these by clearing the concept such that any way it is asked, you don’t fumble)

·         Known topic and silly mistake (work on eliminating these)

Don’t go chasing different sources. Keep to yourself and keep the morale high. Rejuvenate yourself with good music. A regular 15-minute walk can get you some fresh air and a change from being indoors all day. Track the number of hours, if it helps. Some days are good, some are not so good. Don’t dwell and hate yourself for the bad days but try to make the next day a better one. It's equally important to have a good support system. I'm grateful my parents stood by me through the year and for the friends who helped in making it seem less daunting. I often felt we were all in this boat together, going through the rough seas.

10.   Belief.

At the end of the day, it’s a long and tough journey. You’re running a marathon and you will need refreshments along the way to stay hydrated. You can’t afford to burn out towards the end, in fact, you need to have the ‘josh’ to push yourself even more towards the end. You need to remind yourself EVERY SINGLE DAY that you want this, and work on making the most of THAT DAY. An important line by a topper that remained with me is that if you want to score a century, you don’t think about that all the time, instead, you focus on each ball that is being bowled at you. Likewise, get down from the lofty dreams and focus on making the most of EACH DAY. At the end of the day, when you go to bed, you need to try to have the satisfaction that you made the most of that day and tried to use it as effectively as possible. Don’t look at the gap year as a struggle, but as a chance to a create a better life for yourself and your family. I am forever indebted to Dr. Thameem Sir and Dr. Apurv Mehra for their motivation and never-give up attitude.

At the end of the day, give it your best. If you can afford to prepare full time for PG, please do so. Give it everything in you. Whatever be the result, prepare such that you had no regrets or ‘what if I had read a bit more’.

Best wishes to everyone beginning this journey.

Quarter of a Century.

Uncertainties and doubts loom large

But it was time for the annual recharge.

They say nature has the power to heal

With renewed vigour and zeal,

I set off towards yet another climb,

Except this was one was past bedtime!

Through the city we trudged for an hour or so,

And then we began our trek underneath the starry glow.

Puffing and panting, I was breathless in minutes,

Looking down, I could see the lights of the nearby rustic huts.

Why go through this, I asked my sedentary self plenty

But perhaps this is Nature's cashless fee.

As the cold winds taunted us towards the edge,

I knew this was a test I could not sledge.

Settling down into a sleeping bag on the hilltop

I realized there are so many things in Life I cannot stop

But the beauty of the nightsky was mine to cherish

The whizzing shooting stars were mine to wish.

Waking up to an ethereal streak of colour

That slowly grew into shades of pink and amber,

A peacock screamed lustily in the distance,

And Nature thus showcased her brilliance.

In the midst of the uncertainty that lies ahead

Not knowing the upcoming paths I shall tread,

This moment would be mine for eternity

Nature demands, but also unconditionally provides.

A New Decade.

10. Makhna - Drive 

9. Naznina

8. Manzar Hai Ye Naya - Uri

7. Believer

6. Fight Song

5. Hall of Fame

4. A Million Dreams

3. The Fighter

2. Challa - Uri

1. And recently - Malang Malang

And some more songs that gave me a lot of peace. It's almost like a routine to begin the day with some of the invigorating hymns of Shiva/ Hanuman/Durga.

There's a lot uncertainty about the road ahead and it's hard to deal with this cloud hovering above but we can only hope that there's going to be sunshine soon. If not, try to create my own happiness and take what life has to offer with gratitude.

The 2019 was a year that was a challenging transition; from the routine of hostel life to adapting to one at home. It's been a bittersweet experience but one that is perhaps necessary to progress to the next phase of life.

Here's summing up the journey through the subjects that I love and the ones that I have grown to love.

Biochemistry's cycles and pathways have a similar destiny,
Molecules interact within our body with the sole aim of energy.
The hand and foot are an Anatomist's prized tricks,
Leaving us baffled with overlapping muscles and intricate vessels.

Physiology attempts to simplify the complexities of our body,
With flowcharts, formulae and graphs.
While Psychiatry divides the maladies of the mind,
Based on myriad symptoms and specific durations.

Worms and their larva, but some with their operculated egg,
Don't even get me started on identifying mites and ticks by their leg!
Viruses with their myriad shapes and sizes arrive,
Only to be silenced by vaccines; killed and alive.

Through mosquito stats and sanitation facts we sojourn,
While nutrition facts and occupational hazards cause some heart burn.
Through charts and graphs we hope for some reprieve,
But the normal distribution curve has several tricks up its sleeve!

The pathways of disease were dealt in Pathology,
Mechanisms inside the microscopic cell lead to macroscopic changes!
With its artistic histopath slides in 50 shades of Purple and Pink,
Every tissue marker seemed to have a link!

Transporting us to the Labor Room,
OBG thrived on giving us scenarios in the womb.
From interpreting the partograms of obstructed labor,
To staging ovarian and endometrial carcinomas,
This subject surely couldn't be ignored!

What begins with audiograms and tympanograms,
Escalates into a variety of -plasties in tiny orifices.
ENT has its tuning fork tests and hearing devices,
Even as we fumble with the inner ear diagrams.

Cunningly similar, yet subtle differences emerge,
Fundoscopies of the eye have seen a recent surge.
Ophthalm explores beyond the mundane cataracts and conjunctivitis
Into the realm of corneal ulcers, dystrophies and uveitis.

Be it the tall and tented T Waves of Potassium excess,
Or the giant a waves of tricuspid stenosis,
The ST elevations of an MI to its exact artery involved,
Waves of all kinds are always favoured.

If splints and tractions of Ortho fill you to the brim,
Wait for the named fractures of every limb,
In Dermat, you navigate through the many layers of your skin,
Fungal infections and STDs are its kith and kin!

Milestones from a neonate to an unsteady toddler,
Abundant Syndromes like Turner, Edward and Potter.
Facts and figures, scores and cancer stages,
IPCs and CrPCs fill our pages,
A race against time, a chance, perhaps of a lifetime!

.

The last of the trees of my neighborhood.

The last tree in my street was axed today,
In a matter of minutes, she was brought to the ground.
By an electric saw that ripped across her broad trunk,
The tree that saw me through my childhood breathed it's last.

The tree that welcomed me 16 years ago into this quaint neighborhood,
Was a royal Gulmohar that bloomed every season.
A carpet of red draped the roads,
Even as families of birds perched above.
The morning melody of their chirps
Will only be a thing of the forgotten past.

She lived older than I will ever live,
And humbly gave herself as a home
To myriad creatures aplenty
But she also gave shelter to a little girl's dream,
Even as I sat underneath her broad trunk with a million thoughts agleam.


In fond memory of the Gulmohar trees that were successively put down over the years.

Limitless Love .

Wrinkled with the fine lines of their ripe age,
Peppered with the ills that poverty bring,
Bereft of the love and care of their offspring,
They arrived with savings of their meagre wage.

Immobilized by disease, she lay bedridden
Yet beneath the pain, a coy smile was hidden,
Aged yet agile, he rallied around for her care,
Her infected foot, he vowed to repair.

He pleaded and prodded all day long,
Until even the hardest heart melted at his adoration,
His relentless efforts would make her strong,
She regained her colour with his dedication.

A love so pure they shared,
That crossed boundaries of age and ill health,
Others often watched and admired
That their attachment was their one true wealth.

An ode to Mrs. S and her husband whom I had the opportunity to meet during my surgery postings at Hassan.

Skills with the Scalpel and Beyond.

January began with the excitement of nearing the end of our internship. After the debacle that was the NEET PG exam, I began with my stint in the Department of Anaesthesiology.

While most of the time, I was involved in having a look at the Pre Anaesthetic Evaluation of the patient, shifting the patient to the OT and monitoring the vitals, there was also the opportunity to intubate the patients either in the OT or in the ICU and also in giving spinal block to patients being posted for LSCS. Less often, there were also epidural anaesthesias given and Central Lines inserted. The 15 days in the Department involved elective OT, Emergency OT (which was followed by a day off) and ICU duty.

Another thing about the Anaesthesiologists in the Department was how they were always so full of questions! I particularly had an interesting time discussing with Dr C as well as Dr H who were open to all kind of answers and also provided interesting points to ponder upon.


Following this stint in Anaesthesia, it was time to get my hands dirty in surgery! And literally so; With diabetic foot debridements aplenty and the casualty bustling with head injuries, there was never a dull moment in this Department.

Although I was initially very apprehensive about my non existent surgical skills, I was extremely fortunate to be in what I would consider the best unit in surgery. Headed by Dr K who had a huge patient pull (never a day passed without patients turning up saying they were related to him and thus demanded VIP care) and with Dr N and Dr V  who were good spirited and encouraging to the interns, it made for a moderately busy unit with good surgical exposure for an intern. Particular credit must be given to Dr V who almost ALWAYS made it a point to involve the interns in any decision making and gave ample opportunity to do the procedure (skin to skin). At a time when our incisions are still unsteady and prone to fishmouthing, Sir had the confidence to give us a chance to learn. We initially had Dr K as our JR who was well informed and guided us in the casualty for critical cases and later we had Dr P who was also a friendly guide in the wards and the casualty.

As a surgeon, While Hernioplasty, Lap. Cholecystectomy, mastectomy, BK/AK amputation, Trendelenburg Procedure (for patients with Varicose Veins) and cyst excisions remain the elective bread and butter, the emergencies like acute appendicitis/rupture, hollow viscus perforations are the emergency cases which would require early preparation of the patient and an operation at the earliest. Of course, there are a host of local procedures which also come under the jurisdiction of surgeons such as local cyst excisions, incision and drainage of abscesses, suprapubic catheterization, foreign body removals, excision of ingrown toe nails and many many more! Basically a general surgeon has a lot on his plate!

One of the important things I learnt in surgery is that the operation per se is only one part of the treatment provided by the surgeon. The pre operative care as well as post operative care are as important as the procedure itself and goes a long way in deciding the prognosis of the patient.

There were patients who had fairly uneventful surgeries but developed complications post operatively owing to their preoperative comorbidities such as COPD or uncontrolled Diabetes.

A particular patient I will remember is the HBsAg positive Mr. GN who came to the casualty with pain abdomen at night. When his USG happened only the next day afternoon, it revealed a case of intussusception which was operated upon the following day after ensuring he had received some nebulisation in view of his chronic smoking history. While the patient recovered quickly post operatively, he returned soon enough with abdominal wound dehiscence and swab cultures showed sensitivity only to colistin.

Mrs. S was another long term occupant in the Female S/D ward who only had her old and wrinkled husband caring for her relentlessly. Day in and day out he followed us until we made arrangements for free blood transfusion for her, until we had posted her for a below knee amputation that eventually gave her some relief.

Being a part of her OT was another memorable experience altogether with the Gigli saw!

There were a few interesting cases such as a pancreatic cancer in advanced stages. She presented with obstructive jaundice so a Triple Bypass surgery was done with a palliative perspective. There was the patient with open skull fracture who came to our casualty one evening. The contents of the cranium were clearly visible and were palpable. The patient was surprisingly stable so a quick wash and some stay sutures later, we had him rushed to NIMHANS but I had my doubts on his prognosis. Imagine my happiness when I returned after a few days leave and saw the same patient referred back from NIMHANS after an anterior cranial fossa repair and moving around normally!

Thus, after 2months of learning in the Department of Surgery, after even giving a seminar on post operative management of a surgical patient, with some wonderful memories with my co intern Sanjana, with the new junior interns, it was time to bid adieu to the last leg of my internship at Sri Chamarajendra Hospital, Hassan.

Summer Child..

The mere memory of you in me
Once had words flowing in a fervent breeze
You remain etched within my soul
Irreplaceably firm from the roots.

I often wondered what had I lost
That words failed me when I needed them most.
Empty and hollow were the echoes of my musings,
Quietly I sheltered myself from my own bruises.

Like the sea that goes back to the sands in vain,
I burn bright in this self inflicted pain,
I smile at the cost of my sanity
And for the fleeting moments of unreality.

Observations in OBG: The joy of bringing babies to life!

As always, with a hint of excitement and ladles of nervousness, we reported to the Department of Obstetrics and Gynaecology just about two months ago. As we were shuffled into the 3 units A, B and C (each withits own unique reputation), Labour room and Casualty, some had Lady Luck on their side while some others knew they had a few more hurdles to cross than the rest.

The Department is one of the busiest at HIMS, notorious for its hectic schedule which reflected upon the interns and staff alike. I was posted in B Unit which initially had the all-male staff of Dr. Rajashekhar Sir (Unit Chief), Dr. Shridhar Sir and Dr. Raghupathi Sir. Later Dr. Nishitha ma'am joined the Unit. On my first OPD day, I learnt the main steps of taking and ANC case including the examination. Now these were things that I could learn well only with time so initially it would take me some time to localize the Fetal Heart Sound (FHS) but slowly, over the weeks, my ears began to get trained to recognize the familiar rhythmic beating, to make an estimate of the gestational age by the abdominal examination and also to assess about the progression of labour based on the PV examination.

A typical duty day involved a quick prerounds of the Post Natal Wards, Immediate and Late Post Operative Wards, Special Ward, ICU and Gynaec Wards after which we had the ANC rounds with the staff and the rounds and follow up of all of the wards as advised by the professors during their rounds. After this we hurried to the ANC OPD to clear the cases and give admission to those in labour. Any emergency case would be taken up for LSCS once all the investigations were in place. By 4PM, there would be rounds by the duty doctor of all the ANC cases admitted during which he/she would decide the course of action: Watch for Progress/ Shift to Labor Room/ Prepare for LSCS or maybe even discharge in case they were not in active labor.

Following this was the tedious process of writing the case sheet (which was later marginally simplified by a book which we had to fill up) looking at any loopholes, any deranged laboratory values or medical / surgical comorbidities. Usually there would be few cases taken up for Emergency LSCS where we were required to assist and close up. The common indications were Meconium Stained Liqour with Foetal Distress, Cephalopelvic Disproportion, Previous LSCS, AntePartum haemorrhage, Pregnancy Induced Hypertension(PIH), Abnormal Lie/Presentation among others. Along with the usual ANC cases, there were several cases of spontaneous/ threatened/ missed abortion or cases who came for MTP or HIV/HbsAg positive which were dealt with in the Septic Labor Room. Cases required strict monitoring of vitals were shifted to the High Dependency Unit (HDU) where PIH, Ecclampsia, Pre eclampsia and GDM cases were monitored by the labor room interns and staff.

One notable incident that occurred when on duty was the case of the 'Tubectomy Meningitis' as I'd like to call it. Two patients who had been operated earlier in the morning, developed restlessness and became disoriented later in the evening even as their vitals remained normal and their laboratory investigations revealed no obvious imbalance. While we monitored the patients all night long in the ICU, the patient attenders were increasingly impatient and we even had to deal with the mob and media attention. They were referred to NIMHANS the following morning where they were said to have 'Bupivacaine Induced Aseptic Meningitis'. Now the patients made a complete recovery but it brought about a lot of changes in the OT and the Post Operative Care of the patient to prevent such instances.

What began with hesitation and reluctance towards this subject gradually changed into respect for this demanding yet equally fulfilling career choice. From the first LSCS assisted to the first baby delivered via normal vaginal delivery, there was a definite surge in my interest and respect towards this department. From bullying irresponsible and intoxicated patient attenders to arrange for blood for their anaemic patient in labour to holding the hand of the sobbing woman who had just had an IUD (intrauterine death) in her first pregnancy, there was something to learn in everyday of OBG.

The Gynaec Ward had its own set of patients who needed to be operated upon for commonly a Fibroid Uterus or  a Uterovaginal Prolapse but I also got to see a gigantic mucinous cystadenoma of Ovary in an otherwise frail woman of 70years operated upon successfully. There were plenty of ruptured ectopic that came our way, especially on the C unit duty days but as Dr. R said it, a "quick in, quick out" approach works best to handle these cases. Be it with the interaction with patients or their attenders or sometimes with the professors, nursing staff and even our colleagues, there has been some real high voltage drama we've witnessed/been a part of.

Towards the end of two months, I did feel relieved that it had passed with no major mishap but more importantly, I also felt like I was actually doing something. Perhaps the posting where I definitely had *some* relevance to the Department even though we were mostly treated otherwise. :')

Labour Room with the Roomie!

Of course, the completion did not pan out as expected and it definitely was a disappointment but nevertheless, irrespective of the outcome of my derailed completion/erroneous extension I will be thankful for everything I have learnt from the professors and nursing staff during my 2 month stint in the Department of Obstetrics and Gynaecology at SCH, Hassan.

Unfulfilled Dreams.

Little ones who did not see the light of the day,
From tiny undefined forms in gray,
To well formed twins in full bloom,
Sat snugly encased in their mother's womb.

For nine long months, she waited with bated breath,
As weeks turned into months, the belly swelled
In hopes of pink and blue, the young mother dwelled,
Alas, she only saw them after their death.

Young and naive, she felt their plea for help,
Day after day, she heard their beating hearts aloud,
She pleaded in vain for them to emerge from her womb,
But alas, she would only see them entwined at their tomb.

In the memory of the unborn twins of S, who could have lived.

The Lessons and Learning in Medicine (2)

As the days wore on, we had an established pattern among ourselves to divide the duties. Of course, there were differences of opinion but somehow we managed to work it out in the better interest of the patients. There was no time to hold on to any disappointments because on duty day, you are always on your toes! A particularly fond memory I will hold is of finishing the rounds and catching up with Sanjana C, my co intern over the cases and how their treatment was progressing.

Rounds with each professor was a different experience. While some looked at the investigations to have a clear-cut evidence to their probable diagnosis, others relied on clinical features to base their treatment. While some discussed rare or important diagnostic features and 'never to miss features', others preferred to leave it open ended with questions to ponder over and get back rather than supply the answers themselves. On the whole, rounds was when we had an idea how each consultant would approach the same case and thus develop our own blueprint.

Thank you Sir :)

There was Sahana, the 19 year old who has been a puzzle I couldn't figure out. She came with icterus, h/o fever and passing high coloured urine and bilateral pedal edema and her Liver Function Test was completely deranged. She tested negative for Hepatitis B and Hepatitis C and her USG abdomen showed mild ascites and pleural effusion and her CT scan correlated with this. While her pedal edema decreased during the course of her stay in the hospital, her LFT did not show any improvement and hence her icterus remained.

Being a government set up and the festive season, the test reports for Leptospirosis and Hepatitis A were postponed and we had to discharge the patient and review with the reports. I did not have much hope of seeing her again but imagine my surprise and relief when I received a call (I still have no idea how her mother caught hold of my number) from her regarding her reports nearly a week after her discharge. We finally had a diagnosis! What I had suggested to the professor (after seeing in the Micro Lab that they carried out these investigations) actually turned out to be a valid diagnosis. She finally had a diagnosis! Hepatitis A it is and she was asked to review on a monthly basis with LFTs.

There was the patient with massive pleural effusion and my co intern and I did a pleural tap which yielded a straw coloured pleural fluid which on analysis had high levels of ADA (Adenosine DeAminase) which is an enzyme elevated in Tuberculosis.

Then there were the suspected cases of H1N1 which required early detection and intervention to prevent fatality. There had been a few suspected cases which went undetected and they had succumbed to secondary bacterial infection which ultimately led to respiratory failure. The protocol involves isolation of the patient in a separate ward, taking a throat swab and sending it in the VIM container to the DHO office who would then courier it to the Viral Research Centre of KMC, Manipal. The patient is usually started on 2nd line (failing which, 3rd line) antibiotics along with the antiviral Tamiflu  (Oseltamivir 75mg) and continuous nebulization and O2 inhalation. There have also been a few cases which were recognized early and treated accordingly even without the throat swab reports since that had been getting delayed.

Just when I had begun to regret how I had not performed an ascitic tap in the course of my medicine posting came a case on our Pre Duty day of Cirrhosis with gross ascites. As is the procedure we start the patient on appropriate medication to increase the fluid loss and also perform 'paracentesis' to drain the excess fluid from the abdomen which may be from 1-2L at a time. Unfortunately, the primary diagnosis of Myxoedema Coma couldn't be treated in time and she did not make it.

There are some moments when you know that under different circumstances, your patient would have survived; be it the young man with a haemorrhagic stroke who was referred back from NIMHANS who developed further complications and had massive internal bleeding and succumbed to it or the other young patient, again referred from NIMHANS for myoradiculoneuropathy and dysautonomia who was on ventilator support after he was here and had renal failure in a matter of time and he had a cardiac arrest soon after. There are several limitations in the set up so you know you are bound by those restrictions but it is the ones who can make it with the existing facilities who must not be missed!

Towards the end of my posting, I also had an experience of 'Protocol Duty' which is basically a duty doctor being available at all times to any
Politically Important Person (PIP) like the CM or the Ex PM or a certain MLA who were on a visit to the district. While it was mostly uneventful and spent in the sweltering heat of the ambulance understanding how bureaucracy works, it also gave an opportunity to visit the Hassanamba Temple which thronged by visitors when it is opened for a few days in the year.

But it was the last day which truly lived up to the intensity of Medicine duty with several MIs, CKDs and poisoning cases, several cases collapsed and some were resuscitated against odds. It was a truly memorable duty and at one point it was a matter of shunting from the ICU to the ICCU as there were alternate calls from either places.

Medicine had its highs and lows with moments of elation at a diagnosis made at the right time or a procedure that went well or a patient recovering well or even an attender recognizing your small contribution in the recovery of the patient. There were moments when you were frustrated by the delays in the system, the unavailability of even the simplest of medicines by government supply, the brash behavior of the patient attenders and sometimes their complete ignorance and lack of interest in the patient despite their deteriorating health. And then there were better moments when you see your patient successfully weaned out of the ventilator and wave you a goodbye after a prolonged stay. There are patients attenders who are thankful for the visible change in their patient or atleast for the efforts made towards their recovery. There were those who gave in every bit of their time and effort to see their patient turn over a new leaf and it was always a pleasure to interact with such folks.

All in all, Medicine was exciting and terrifying despite the patient load. It might have been physically and emotionally draining (when you realize you have been declaring deaths on such a regular basis, a sudden wave of emotion hits you over the fact that he/she is more than just their vital stats which is all you know about them.) But it offered a wonderful learning experience from the management of common cases to performing the basic procedures in the casualty, wards and ICU. From having the fear of facing the patient for not knowing what to do to approaching the patient to assess the vitals, starting the immediate treatment with a possible diagnosis in mind to explaining the prognosis of the patient to their attenders, it has been quite an eventful journey with some of the best cointerns and professors I could ask for.

With trepidation and excitement, I set foot into OBG, my home for the next two months. Here's hoping for new adventures :)