Internal (Eternal) Medicine: Part 4 of 4
November 7, 1998
Saturday
Finally, the last two weeks of Internal Medicine! The last two weeks in which I am supposed to study for the oral exams (you open your mouth and doctors look in for cavities ;-D)
The “orals” are held on the 3rd to the last day of the 10-week Internal Med rotation. It’s supposed to integrate all that you have learned for the past 10 weeks, but of course I don’t think it’s humanly possible to retain and recall all of this in 15 minutes. Anyway, the last two weeks were spent in the medical ICU (MICU), where interns are co-decked with clerks for patients (meaning each patient has 2 students in charge of him, an intern and a clerk; a clerk is a 4th-year medical student, i.e., next year’s intern). Clerks do all the paperwork and scutwork, and the intern’s job is to help the clerk with the theoreticals of the case (which does help the intern review for the orals). So the intern is basically an “S.O.L.”, or space-occupying lesion (in neurology-speak, a brain tumor occupying precious space in the skull which may have been better allotted to healthy, working brain tissue; S.O.L.’s sometimes just don’t occupy space but even compress healthy brain tissue so that they don’t work optimally, if at all). Being an S.O.L. has its advantages (more time to cram) and disadvantages (takes up MICU callroom space – the small MICU callroom is occupied by 7 clerks, 6 interns and 3 residents, hopefully not at all any one time).
Studying for the orals was tedious, because the topics were so extensive and SOOOO LOOOONNNGG, I had to go into seclusion for 2 weeks (no movies, dinners, gimmicks*, etc.). I think the objective was to spend most (if not all) of my waking hours studying. Of course, knowing me, waking hours tend to be short ;-P…. I think this is what studying for the medical boards would be like (Oh no, not another round of extensive studying and cramming).
The orals: my block drew lots to determine who would go first. I drew the second spot (thank God, not the first!). This would determine the patient case given to you. At the orals, you’re given a piece of paper with a patient’s history and physical exam. Based on this, you’re supposed to diagnose the disease(s) of the patient within 15 minutes. Then you enter the exam room and the consultant (professor) and residents ask you about your diagnosis, what laboratory exams to order, how you interpret your labs, your treatment and advice to the patient before he is sent home. I didn’t get the diagnosis outright – I entered the exam room sure that my diagnosis was wrong (I knew there had to be a unifying disease for all those unrelated symptoms) and yes, it turned out to be the wrong one. Anyway, eventually I got the correct one, although my treatment plan was incomplete. I left the room sure that I had failed, and would have to take the orals a second time (if one fails the orals a second time, he has to take 2 extra weeks in the wards – yuck, mega-yuck!). Of course, the diagnosis isn’t the be-all and end-all of the orals. It’s a thinking process – what labs to order, how to interpret them, how you arrive at the diagnosis and what are your bases for ruling out other disease entities as cause for the patient’s symptoms (ruling out differential diagnoses).
At 2 PM, word came that only 2 people in my block of 9 passed – this was the lowest passing rate ever! I wasn’t one of those 2 people. It was so depressing. Two of my blockmates and I decided to watch a movie (The Truman Show – pretty good). During the movie, I got a page from my blockmate Solomon: “I have good news for you. you passed the exam. Please tell Van [my blockmate right beside me] that she also passed. I talked to Dr. Salazar and she said the 2 who passed earlier were from the other batch only.” It turns out we examinees were divided into 2 groups of 4 and 5 under 2 different sets of consultants and residents, and in that other group only 2 out of 4 passed. In our group, 4 out 5 passed. Hooray! We decided to celebrate by eating out [actually we decided to have a good dinner regardless of exam results… this message made the food seem doubly good].
I know it wasn’t pure luck that got me an eventually-diagnosable case, a good panel of consultant and residents who helped me with the orals, and gave me a passing grade despite not getting the diagnosis at the outset. At least I wasn’t in the dark while I was in the exam room (no mental blackouts, thank you). And I know that the Holy Spirit guided me through the orals too, helping me remember at least some of the stuff I read. To all those who prayed for me and with me, thank you! Thank God!!!
We knew Eternal Med was finally Internal Med when in our last two days the medical books we had read were replaced with new reading materials: Cosmopolitan, Glamour, the daily newspapers…. The best time I had in Internal Med was at 5 pm, Oct. 29, Thursday – I was finally DONE!
Notes:
Parts 2, 3 and 4 of Internal (Eternal) Medicine were all written on the same day, likely because I was catching up on writing about experiences and couldn’t do them in real time. Internal Medicine was just very, very busy plus I didn’t have access to my email for most of the weeks on this rotation.
* Gimmick – Filipino English for “leisure activity” or “fun stuff”; during internship this generally meant going out to eat or going to the movies.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
