The 5 and half years

In the beginning

It was 1978, November. Medical college that should have started by June started only in November. There were cases in the university against the admission that continued for about 5 months. Finally, after this long wait, we were Medical students! In those days there were only 2 professions that was considered worth joining - Medicine and Engineering. And between the two Medicine was the elite one! (That is what we thought). So, it is with great anticipation and joy that we joined toe college. Of course, there was the fear of the ragging. But much to our relief there was a court order that our batch should not be subjected to any ragging and should be protected by police! This was because the previous year, a physical assault during ragging had ended in loss of life of a student and mental breakdown of another!

But as we entered the college and the Anatomy dissection halls, and classrooms, we were faced with not too encouraging professors.  Or we felt as if they were not too encouraging. It looked as if they were there to make sure that the lack of ragging should in no way affect us in being “broken in”.

For men shoes will be looked at carefully, if not polished well, we would be sent out of the class. Shoes were mandatory, there were no sneakers those days and any other footwear was nonacceptable. Unshaved faces were a taboo. This continued in to the next five years. I remember, a professor who would start the day, in the ward in third year, running his hand over our faces. This included senior lecturers down to third years, and if anyone had a stubble, Rs 1/- would be collected as a fine. (End of the posting he threw a party with the money he collected!). For women, the dress code was also clear – Sarees and hair put up.

Dissection tables and Laboratory were others place where it was made sure that our dress codes and the way we behaved aligned with what the professors expected. If not, in various ways, it was made sure that we align! Of course, there was the constant communication that you are coming into a profession that is different, that a decorum in dress, manners and behaviours was expected. The professor’s role was to see to it that this was communicated clearly in addition to the knowledge and skills that were being given to us. There was no compromise allowed in these early years in knowledge and skills – I will share this more in another blog.

As we went through this “breaking in”, it did not make much sense then. Some took it with fear, some took is seriously, some took it very light. These emotions were evident for the professors to observe. So much so that we were 4 Mathews and each of us was given a nick name by one of professors. Serious Mathew, Shivering Mathew, Silent mathew and Smiling Mathew! (you can decide which one was me). We suffered, tolerated, smiled it through over the next few years and we became doctors though these experiences did not make sense then!

But today, looking back today it makes sense! They were not telling us that you are the elite and cream of the society (that is what we thought!). They were telling us, it is a privilege given to you, recognize the same and align your life to what is expected from a person who has been given such a privilege! The identity of being a doctor was not a “earned one alone” but one that is “bestowed up on you”! And live in gratitude to this fact!

They were telling us - earn the right to be respected as you interact with people, by your dress, your decorum, your behaviour and your overall appearance itself! We were expecting others to respect us with our white overalls and stethoscope around our neck! We were being told, respect is to be earned by your behavior and not expected to be bestowed on you!

We were being reminded - you cannot be a doctor by knowledge and skills alone, (though you cannot compromise these) but who you are is equally important! What we want to become was upmost in our minds mostly – I wanted to be the best surgeon in the town! But the importance of who are and should be, was being instilled through these “breaking in”!

These were not only taught but role modeled by many of these teachers – lives that influenced the young minds that observed these people.

Something that I need to be reminded each day. It is a privilege to be part of this profession! I need earn the respect by living a life that role models gratitude. Who I am is more important than what I have become!

Following the beginning

The breaking period was over, and most of us managed to come through the 1^st MBBS – the Anatomy, Physiology and Biochemistry saga, though some friends had to wait a few more months! This was in no way the assessment of who broke in or not, but part of life, some go fast some go a bit slower, but at the end of the day, all journey together!

But for me the next year was more challenging than the previous year. The year of Pharmacology, Pathology and Microbiology! In one sense the beginning of the 2 water shed years, when life is taken a bit more relaxed. (We had a 4 and half year course with 1 years each of 2^nd and 3^rd MBBS, and 1 ½ years of 1^st MBBS.) I had done reasonably ok in the 1^st lap of the 4 and half year journey, but the second lap I struggled, mostly in one subject – Pharmacology. I did manage to finish the year without major challenges but did not enjoy the same nor did get many marks! And this was observed by the 2 lady professors we had.

I remember both calling me to their room, opening my answer paper and showing where I have made mistakes. I saw marks like 1/8, 1/16 etc.! They had a marking system by which if there were eight points they expected in an answer and only one is right, they will give you 1/8 marks! But after showing me the mistakes I had made, they started enquiring. Are you on drugs, do you have a “girlfriend” and or “love issue”! They had considered that I was not doing well because, I have lost focus by either getting into drugs or falling in love! It took some time to convince both that I had neither of these issues, but I just could not remember pharmacology.

I was left with this deep impression of the combination of “strictness and compassion”, “expected standards and caring heart” something that I have tried to hold on to but not been able to role model that well like them!

On the other hand, the lady professor in Pathology, had another great ability! Seeing me doing reasonably well in Pathology, she called me and asked me to consider Pathology as a career option. I enjoyed Pathology, but I never considered this as a career direction. But she was keen to encourage me into the same.

I had similar experiences later in life too. Working in neurosurgery as part of neurology posting before getting into Internal Medicine, the professor of Neurosurgery calling me to his office and trying to encourage me to take up neurosurgery, and few other professors like that in Nephrology and Neurology. The ability to see the potential in another person and encourage and motivate that person to move ahead in life in an area which he or she thinks they might do well!

The ability to see patterns, and correlate the same, than byhearting information (Path vs Pharm) was a sign of my learning style, which probably was the reason I moved into Internal Medicine. More about that later, but if I had recognized that then, I would not have taken the de routes I tired!

Reflecting later in life, I realized – teaching is about role modeling character. Learning is about inculcating these in the learner’s life! Leadership is about expecting a set of standards from your followers but being caring and compassionate. Leadership is about seeing the potential in persons life and supporting him or her to follow that path.

I hope in my life journey I have followed my teacher’s examples!

The watershed year

I do not have much lasting impressions from this year, since in Medicine this is the watershed year. The 4^th year, with Social and Preventive Medicine, which was generally seen as a necessary evil (which I regrated in latter years) Forensic Medicine, and couple of other departments, was seen as a season to get through to enter in to the final year! Of course, the campus election politics was a good distraction too.

A few events stand out in memory. One was the SPM tour and some of the learnings in that trip. The highlight was the one visit to a rural hospital at Ambilikai, Oddanchathram and the stories I heard form Dr Cherian, the founder. Walking into theatre where he was doing a major abdominal surgery under open Ether, and then hearing stories of how he had operated on some challenging patients under open ether. An Esophageal resection and a Stomach pull through for a Carcinoma Esophagus, A vascular surgery for a Axillary artery AV fistula with one hand gigantism, and a few other stories, from a Khadi mundu wearing internationally trained surgeon, left me dreaming that, this is the direction that I might follow! (It did not happen, and more about this later). Then in the nearby CF hospital, a double FRCS (Opthal and ENT) cycling and coming to hospital again in a Khadi mundu challenged my paradigms of thinking!

I was observing that there was another way of practicing medicine! One can be an internally trained good surgeon but have a lifestyle which is different from what I had seen in my limited exposure of my Medical college!

Of course I cannot forget, how we missed one of our class mates during the stay at Ambilikai, all of us going in search of the person, and finding him happily sitting and sleeping in the toilet after a full stomach and spirit!

The other memory was staying in a small PHC for a month and visiting the homes and the PHC Outpatient department, generally seen as a relaxed time away, to make most of it, but something which opened my eyes to understanding health from a slightly different way. Something which I did not cultivate much in those years, much to my regret in later years!

These experiences would go a long way later in life, in my choices of life directions. Though I would give up surgery intentionally, these life experiences would challenge my context and way of engagement.

There were many other life role models in the medical college, that challenged my thinking, some that were disturbing, some that were motivating and some others that were worth emulating. These left a lasting impression, that my life is being watched, and what is seen by others could either confuse or motivate someone else! We learn by observing life!

The finishing year and race

The last year, was one which started and ended with a bang! The time flew fast. But was in one sense the culmination of all what had gone before. The three core specialties where we spent most of our time, was challenging, confusing, invigorating and but a great learning experience. What remains in my mind is the diverse ways of being taught and learning.

In Obstetrics, we were privileged to have some of the best of professors, but we learnt (At least I) with fear and trembling. No nonsense teachers, who would expect standards that seemed unattainable! I remember, being asked by post graduate students to keep watch from the window of the third-floor labor room to look out for the professor’s car coming around the corner. So that we can be ready for “face presentation”. I did learn much, more out of fear than enjoying OG, but how I later regretted, when faced with various complications of labor, how I should have tried to learn more and enjoy what I learn too!

Medicine, we had a professor in our unit posting, who had left his “specialty” on leave to make money and returned to teaching after a few years of break! We were disappointed for not having had the opportunity to be under some of the so-called stalwarts! But we had a teacher, who was open and vulnerable, but was helping us to learn together by interaction and discussion than an unapproachable teacher! May be this some rubbed off on me, my learning styles have been one of learning from each other. But I did not end really want to pursue this field at that point of time. Because I was over-awed by another specialty!

Surgery was the one which overawed me. The Director of surgery with his 6 foot frame, the pancreatico-lithotomies he would do, the multiple short cases he would make us examine, the special attention  I thought had, and the long rounds train – 20 plus people following him on rounds, was glamorous and inspiring. Similarly, there were others in his team and other teams who were equally good in their work and very open to teach! And this left a deep desire to follow this path, till I was exposed to something equally (or more glamorous) later in life!

But each of these experiences left some lasting marks on my life. The competency and standards of behavior expected from a doctor, whatever specialty one might be in, the lifelong learning that is required for a doctor and of course how young minds can be inflenced by role modeling from life, and the glamour, which in itself is not bad!