Success and peace

I made it. I have passed my exams. I am now a doctor. A real doctor. The kind who would deliver a baby on a plane. Dr hunny aura and Dr little laura and Dr lowra and Dr beegee.

I am very happy and relieved. There are prettier ways of writing that, more ebullient ways of writing that, but at the heart of it, that is how i feel. I have wanted this for a very long time, i have been working towards it for a very long time, and i have endured for a very long to get it.

And now it is here, so now i can rest.

Allow me to tell you about the clinical part of the exam. This is more for me to read over when i am old and can’t remember than for others to read, so it may not be of interest, unless of course you find these things interesting.

There were ‘data stations taken on computer on a separate day looking at X-rays, blood test results, which antibiotics to give for which infections, that sort of thing. I was convinced i had failed those.

Then there were 7 ‘stations’ on a separate day. These were in the hospital outpatient department, each lasting 7.5 mins, expect for the history station which was 15 mins. They were each examined by a pair of examiners, one a medic, one a surgeon, and each pair of examiners assessed 2 of the stations before starting with a new pair. The mark for each station was out of 4. 4 is high pass, 3 clear pass, 2 borderline fail, 1 clear fail.

So i assembled at the given place in my special required outfit and white coat, and was given a handful of paper for the examiners to write the marks on. I was led down to outpatients, where a ‘helper’ met me, took my papers and led me to my first station. I began.

First, cardiovascular. A lady lying on the coach with no top on. My hands, icy cold and shaking. The pulse neither slow rising, irregular nor difficult to find. No clues there. The blood pressure – not allowed to be known. Listen, i can actually hear the murmur for once! Time it carefully. Not clear when it comes. Time to present. I decide the diagnosis based solely on the fact i could hear the murmur clearly suggesting it is loud and harsh, which is most likely to be aortic stenosis.

The examiner gives nothing away but asks a few questions about aortic stenosis. The bell goes and the 2 examiners plus me move on to the next station. I still do not know if i was right about the murmur or not.

Second, vascular. A man, legs exposed, large, obvious ulcer. Examine, drop stethoscope on floor (second examiner picks it up for me, answer questions. Lots of confusion over whether venous or arterial. I argue the case for both, believe it is both at different points, but answer the questions about both correctly. Still not clear what type of ulcer it was. Examiners looked slightly bemused.

Third, respiratory. new examiners. Scary examiners. 2 male examiners. A man, obviously out of breath, not looking particularly well. I drop my stethoscope on him while examining his hands. Nervous giggle, stony faces from the examiners. Massive scar across back and chest. Mild wheeze throughout, questionable dullness on the left base. Time to report findings. Not really certain of what i have found, but say it anyway. Examiner looks unimpressed. Asks what the scar is. Complete blank on name. He asks what it is used for. Complete blank – suggest heart or lung. He asks if it goes into the chest or abdomen (it is roughly over the level of the shoulder blades). I say chest. Such a basic question, he is considering failing me. The bell goes.

Fourth – abdomen. Man with walking stick, mental retardation. Start to examine hands, examiner tells me there is nothing to find in the hands. I continue to the face. Examine abdomen. Scar, but nothing to feel. Panicing. Present findings and admit that except scar i found nothing. Examiner looks disapproving and points to fistula on the man’s wrist. But he’d told me there was nothing to find in the hands! Yes, but not the wrists laura. I then told him about the fistula. Decided it was old and no longer used, must have had kidney transplant (therefore, should have felt the kidney). Examiner told me he used to be an insulin dependant diabetic but no longer needed insulin. Why could that be? Silence. Feel myself going red. Admit i dont know as the bell rings.

Fifth – neuro and eyes. (most dreaded). New examiners. 2 men. Considering just giving in and running out crying. Pull myself together and decide that i’ve already failed so i’ll just go in and be bold. Lady sitting in darkened room. Worst fears realised – it’s going to be ophthalmoscopy. Told to examine eyes. Sit in chair – chair to high, put on my little girl lost act to the examiners and get them to help me lower the chair. Examine visual fields – succeed in finding obvious defect! Examine pupils – succees in finding defect! Pick up ophthalmoscope, look for red reflex – hear examiner say "very good". Look in first eye. Cant see anything. Pupil very constricted. They told us in an exam the pupils would be dilated to make it easier. They lied. Still, look in second eye which has dilated pupil due to the defect. Actually manage to see disc! Looks pale. Right answer! Discuss causes. Examiner seems impressed. Bell rings.

Sixth – man on bed, trousers pulled down, genitals on display. Examine groin. Never done it before in reality. Do the routine. Examiner seems impressed. I tell him everything i know about hernias – how to tell which type, treatment, complications of treatment, risk factors. He never asks me a single question, i just tell him without being asked. He looks a bit stumped when i stop talking. Points to scar on patient’s hip, asks what it might be from. I say "knee replacement". The idiocity!! Both examiners burst out laughing, and cede that the patient does indeed have a knee replacement and i must be psychic (the knees were covered). We all have a good laugh, and they let me go before the time is even finished for that station.

Seventh – history taking. Young woman tells me she has chest pain on walking, and has been unable to sleep at night due to feeling hot. I immediately assume she is depressed and this is a social consultation. Eventually twig that she has pneumonia caused by legionaires disease from having just come back from a holiday in spain! Slightly different to my first thoughts! Examiners seem very impressed that i discovered that though (on talking to other people, it seems they got pneumonia, but not the cause).

Bell rings. Done. Walk out. Walk blindly past the other candidates who are all chatting away excitedly about how it went. Keep walking head down. Will not cry. Must not cry. Get out of the hospital, onto bike. Not really looking where i’m going, almost run over several times.

Convince myself i have failed. Very bad times.

Get results.

I have passed. I am a doctor. I am capable of doing something good. I am worth something.

Tell friends and family. Everyone SO happy, proud of me, giving me attention for doing something right and good. Parents over the moon. Friends wanting to talk to me. Maybe they do all love me. Maybe i am worth something to them.

Maybe i’m just going to be a damn fine doctor, and maybe i might just make a difference to some peoples’ lives.