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“To cure sometimes, to relieve often, to comfort always”
Medical exams come in two types. The first type, which involves over two hundred people exhibiting tachycardia (increased heart rate), shortness of breath, cold clammy hands, shivering, and signs of rabies (impending doom) – all clearly systemic, alarming symptoms, is not particularly comforting nor curative. The only thing they manage to cure would be delusions of grandeur.
The second class would be the physical examination. This usually involves a set sequence of things to observe, starting from the hands, then the face, neck, and then the abdomen/ chest, depending on the system examined. The actual order of things is not too complicated, but having to perform it on a stranger (or an actual human being, really), in front of an eagle-eyed audience, really sets on an attack of the nerves.
The neurological examination is rather endearing. It involves raising your eyebrows, puffing out your cheeks, and showing your teeth. If you can do that, you must be neurologically intact!
A friend was excited about the per rectal training today. “The breast exam is on Friday!” I told him. “Nah, too clinical” Was his response. And truly, we need to be professional about these things. No-one wants to imagine a bunch of giggling university students, as they sit, shivering on the doctor’s couch. My first experience with the breast examination was something I will never forget. After being drilled not to say “I want to feel your breasts”, I duly went into the cubicle, introduced myself, and said “I want to do an examination of your breasts”. The elderly lady regarded me dubiously, demanding “And what will you do to them?” “Errr… I will…. Feel them…”. After the ensuing shouting, the tutor actually ran after me to check that I was not traumatised for life.
I have heard interesting tales from seniors. One actually fell asleep in the middle of taking a patient’s history (of narcolepsy, perhaps?). Another, after expertly reassuring the mock patient that his chest pain was perfectly normal, thinking it was a communication skills station, realised to his horror after the bell had rung that he was supposed to have had diagnosed peritonitis – quite a serious condition.
Nervousness aside, it isn’t all fun and games. A classmate, being the sixth person to examine the simulated patient, asked to skip the vocal resonance part of the respiratory exam to save time. The tutor replied “that may save you time now, but if you miss a sign, the patient will waste lots of time later”. In that moment, I realised that our bumbling through this learning process now has some Greater Meaning, somewhere else. The disjunct of watching myself and my classmates, who usually spend our days like slugs sleeping in the lecture theatres, or parasitizing off the wise words of professors, dressed up like mini-doctors, voices trembling mildly as we ask patients for their kind co-operation, is far from comforting. But in a way, everyone has to grow up. We can’t be Peter Pan forever.
People often ask: what is the meaning of life? I don’t know, but the meaning of that day was that we all remembered to not miss that step in the exam. In the exam itself, and in the future, where the test is someone’s life hanging in the balance, and not just that of depressed medical students. The thought that the trade-off of my momentary pain will potentially be able to allieviate someone else’s in the future makes me, at least, feel relieved.