HEART BEAT Maurice NeliganAccording to Sashruta (5th Century BC), a pupil who is pure, obedient to his preceptor, applies himself steadily to his work, and abandons laziness and excessive sleep, will arrive at the end of the science he has been studying.
At the time of my final medical year I had never heard of Sashruta, and I am sure that the majority of my class would have subscribed more to the St. Augustine viewpoint on purity. But the rest of Sashruta's advice seemed the way to go. Thus the pilgrims set out on the last student journey with varying degrees of willingness.
I suppose many people have educational experiences that return to haunt them in their dreams. Personally, final year and the final exam, before being let loose on an unsuspecting public, recurs vividly in my dreams. I still awake occasionally, disturbed by lack of knowledge about some abstruse condition that has somehow appeared on a visionary exam paper.
In the half-world of awakening, relief comes slowly with the realisation that it is all in the past. Nonetheless the experience can be vivid and unsettling. Leonardo da Vinci enquired: "Why does the eye see a thing more clearly in dreams than in the imagination when awake?" I do not know the answer but I do know the intensity of that time lives with me still.
It was no longer a time when lectures and clinics were a matter of choice or inclination and could be skipped at will. The realisation that the sand in the hourglass was running, and that at the terminus was our final exam, was indeed sobering. We were to face examinations in Medicine, Surgery and Obstetrics and Gynaecology over a three-week period in June.
We would have written exams in all subjects. We would also have clinical exams, in which we would be allocated patients in order to take a detailed medical history and conduct a thorough physical examination. There would also be a collection of "minors", lumps, bumps, x-rays, pathological specimens, etc., which we might be invited to discuss at the whim of the examiner.
The loci of these examinations would be scattered around the city and not necessarily in the teaching hospitals of your own university. It was also a principle that your clinical exam was never to be held in your own hospital. First came the written papers, then a brief pause, then the major and minor clinics in whatever hospital in the morning, and then reversion to the university in the afternoon, for the oral examinations.
Those were the mechanics of the system. The problems arose in acquiring the facility to deal with the component parts. We were well used to exam papers and oral examinations, and anticipated just the usual problems here, albeit tempered by the magnitude of the occasion, but the clinical exams were another matter. Facing two examiners gazing bleakly at your physical examination of some unfortunate patient and coming up with a credible, real working diagnosis; that was the problem. This was compounded by our belief that to fail in this moiety of the exam, was to fail overall.
Sir William Osler, great physician and teacher, said: "In what may be called the natural method of teaching, the student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, means to an end." Right on, Sir William! Nothing has changed.
Mornings had clinics and tutorials, afternoons had lectures, in the evenings, books. It was relentless study and time spent socialising or playing games was almost resented. The key word here is 'almost'. Such times however were regretted and resolutions of even harder work were entertained. Even the weekends were not exempt. Every Saturday afternoon car loads of students left for Drogheda, where another greedy consultant, Vincent Sheehan, gave up his free time, for nothing to teach the final students. These were intense sessions concentrating on things you were likely to meet in the exam. God rest you, Sir, you represented the ideals of the great medical teachers.
Back in Dublin we intently studied our own lot of professors. A change of expression, a nod, a wink assumed significance. Were any subjects in particular, being stressed? Who were the external examiners to be and what were their specialities? Rumours, no matter how ridiculous, took wings and were avidly believed. It was hard to set an anchor in such a swirling sea, but unless you were to be swept to ruin, it had to be done.
Studying, until two or three in the morning, all day Sunday, with the feeling that God had not sent enough hours. The days passed like lightning, but the volume of reading never seemed to diminish. Panic was never an option, but at times it was close. Self centred, irritable, annoying our parents and non medical friends, we were a collective Royal Pain in the Ass. We had only one goal, get the exam and rejoin the world. I am still in final med and the hour of truth is almost upon me. I hope I sleep tonight.
mneligan@irish-times.ie
Dr Maurice Neligan is a cardiac surgeon