Those enchanted four and half years

Chapter 15

The lectures, as usual, became as boring as they could get. Half of the lectures we would sleep, half of them we would pass paper chits. However, the most exciting part of our routine undoubtedly was clinical postings.

Clinical postings were a form of practical which we had to attend throughout MBBS, starting from the second year. We were posted in various clinical specialties like Surgery, Medicine, Orthopedics and Obstetrics by rotation. In these postings we were taught how to elicit proper history from the patient pertaining to the disease and how to examine various systems of the body, how to arrive at a clinical diagnosis, what investigations are done to arrive at a final diagnosis, and finally the treatment of the disease.

On the first day of our Medicine clinic, Tanay, Sufee's latest crush, taught us the basics of history taking. "A proper history is the clue to the diagnosis. Today many advanced techniques are available for diagnosis. However, unless you have good clinical skills, you can never make a good physician. The 'old' methods of clinical examination are 'golden'." He told us. He further taught us to elicit history of patients, in various diseases. "Now we will go to the wards. Divide yourselves into groups of 2 to 3 and take a proper history of patients here. Tomorrow one of you will present the history, and then we will move on to general examination."

There were two wards, one male and one female. We entered the male ward. I and Arun approached the first patient. He was an elderly man, maybe in his late fifties. He was reclining on his bed and had been listening to Tanay. He did not make any effort to sit up as we approached him. As we stood next to him and took out our note-books and pens, he kept looking straight ahead without acknowledging our presence.

"What is your name?" Arun asked. All histories began with bio-data of the patient. He did not respond. "Uncle what is your name?" Arun tried again. But still uncle did not respond. I and Arun looked at each other. Arun shrugged. I looked around to see everyone busily and successfully jotting down history of their respective patients.

"Uncle please tell us your name." I tried. "It's in the file." Uncle finally responded in a very harsh tone. "We'll jot down the biodata from his file later." I whispered to Arun, "We should start with his HOPI (History Of Present Illness)." Arun nodded and asked, "Why have you come here?" Uncle had once again become unresponsive. "What are your complaints?" I tried to reframe the question. "It's in the file," he repeated in the same tone. Now we were really irritated and exasperated. "We know everything is in the file, but we want this information from you," Arun said, still trying to keep his voice calm. "Why should I give you this information?" Uncle unexpectedly sat up. "Who are you? Some useless student who's trying to learn from my 'case'? Why should I waste my time on you? Or on any government student? What has government done for me? I am suffering from chronic hypertension, thanks to our government! I always remained underpaid in the government job. I never got salary on time, my extra work was never appreciated, my due increments were never given, and when it was time for my promotion, they sacked me over a petty issue, just so that they could give my place to a minister's brother-in-law! I don't have money, my only asset was honesty, and this is what I get in return! And you people, who think life is only fun, come here on bikes and cars, and ask us our complaints? Are you really bothered about what my complaints are?"