HEART BEATI have almost finished the journey of my medical student years, albeit a much shortened version, writes Maurice Neligan
Having written final papers, we now presented ourselves for clinical and oral exams. Scrubbed and shining and in every way unrecognisable, resplendent in our new suits, we arrived at the relevant hospitals for the final chapter. In theory, this was not supposed to be your training hospital, but in practice this sometimes happened and was felt to be a good omen. Through the student underground, we also had a fair idea of the kind of clinical conditions we might encounter.
Thus it was for me that I found myself in the Coombe Hospital for my clinic in obstetrics. A brisk, efficient invigilator allocated me a patient in a numbered cubicle curtained off from the ward. My patient had a breech presentation of her baby, and was also diabetic, requiring insulin. This was a lot to be going on with, but thankfully that was all. She was also able to tell me that her baby hadn't turned around during the night. This provided a certain comfort for the physical examination.
In no time at all, the curtains parted and two examiners commenced to ask me all about the patient. The good lady herself gave me a wink and a broad smile as I went to work. In the afternoon, for the oral exam I drew the external examiner and a local professor. Two more courteous and pleasant men one could not hope to meet, and it was with disbelief afterwards that I realised that I had been with them for over an hour. I had no bad feelings after the day and, if not exactly confident, now faced medicine and surgery with less anxiety.
Medicine, in the now St James's Hospital, provided me with a patient with heart failure caused by a leaking heart valve (shades of the future!). Two brisk no nonsense examiners with straightforward questions required straight answers. The afternoon again provided me with the external examiner and a much-feared local physician. It was a very wide-ranging exam and I recall at one stage it touched on malaria. At the end of the day, I was relieved and felt that I was still upright.
Only surgery to go, and this time I had a problem. I drew the patient from hell. She was a seriously obese and taciturn woman, whose diagnosis of chronic gall-bladder disease had to be extracted slowly and painfully. To compound the problem for me was that she had almost no physical signs. I had two understanding examiners, who realised my difficulties. They pointed out to me that patients like this would be part of my working life. In the afternoon, I completed a full house of external examiners, in a searching and lengthy exam. Then "Thank you very much, Mr Neligan, I think that is all."
That's all, that's it? The exam is over and seven years of my life as a medical student were hopefully behind me.
The results were due the following day. They would initially be read out in the main hall in Earlsfort Terrace, and then posted on the examination boards. Nothing to do now but wait. We began to share our experiences. One unfortunatewas asked by the examiner to demonstrate the knee jerk on his patient. His trembling hand succeeded in landing the hammer on the patient's shin, whereupon the patient and examiner winced. A second attempt landed on the patient's groin.
There was a feeling of anticlimax, and of being somehow lost. We wanted to celebrate, but we dared not antagonise the gods. A relatively quiet night and we slept the sleep of the exhausted. Into town in the late morning to meet classmates, a few quiet pints, and a long walk. Then it was time and our silent little group walked the few yards from Hartigans to the Terrace. On time, the dean of the faculty appeared and read out the results. I was a doctor.
The working telephones in the vicinity were besieged. We returned to Hartigans with alacrity, and let our hair down unreservedly. A late migration to Alfredo's in St Mary's Abbey. Remember that any body Bed I presume at some stage. I awoke in the morning regretting the grain and the grape, but facing with excitement and anticipation my changed world.
mneligan@irish-times.ie
Dr Maurice Neligan is a cardiac surgeon.