Some postings you’re really in the thick of it, and in some you are nothing more than an inconsequential spectator. Internship shows you both the extremes.
While internship as a whole is often generalised as one entire year of demanding and arduous work, this could not be further from reality. Every department has its own personality, accordingly the work required from interns also varies. On one hand there’s surgery and the like, where interns have considerable responsibility and are an indispensable part in functioning of the system, and on the other hand there are the more laid back postings like Psychiatry and Anaesthesia where interns come more out of protocol than necessity. What really is serendipitous is having heavy and lighter postings alternatively. So after fifteen busy days of casualty, it was a relief indeed to have Anaesthesia posting following it.
Anaesthesia is really like the obscure character in a story who keeps your curiosity afloat but never stays long enough for you to delve deeper into his story. Till final year we know of anaesthesia as the sorcery of making a person nearly give up all autonomy over his own body while the surgeon is free to poke and cut, as the patient enjoys a peaceful slumber. Final year introduces us to the subject of anaesthesia, but being constantly under the shadow of mammoth surgery, it nearly always gets overlooked. Then comes internship when we actually come face to face with it, and understand that anaesthesia isn’t limited only to sedating patients on OT table, but the reach of this branch actually goes far and wide. Pain management, ICU, resuscitation, critical care medicine, emergency medicine – all are very much domains for anaesthetists. And a department operating under so many banners undoubtedly meant that we interns would be divided between them, and it will not necessarily be a uniform distribution. And that’s exactly how it was.
I got allotted one OT for a week and Pain Clinic for another, both of which were easier of the lot. My friends who got posted in Trauma ICU and Trauma OT really had their work cut out for them, and while my timing rarely went over four hours, they were never let off before six hours. Few others were placed in Surgery ICU which was in neither extremes work wise. ICUs really were the places where you got some valuable experiences though, like learning intubation and ABG sampling. I’ll have to wait till upcoming postings to try my hand at these it seems.
Anyway, my OT was the one for paediatric and psychiatric cases. My primary, and perhaps the only job in the OT was to stand in a corner and observe, perhaps do one odd task here and there. Anaesthetists in the OT are more than capable of handling everything on their own, and no one would miss the intern if they don’t even show up. It was in a way, very liberating as I could stand and observe whichever case I wanted to, and however long I wanted to, and could just be a fly on the wall. And also leave early every once in a while.
Every alternate day was E.C.T (Electroconvulsive Therapy) day and contrary to our imagination, it is actually a very brisk and smooth procedure, hardly exceeding 2 minutes, with not more than half an hour spent by the patient in the OT, including all the accompanying anaesthesia. It was a nice coincidence that almost a week later, I would again return to the same OT, bringing patients for ECT, this time as a Psychiatry intern.
Psychiatry was quite rigid with respect to time table and schedules, although the work itself was never tiring. The OPD was a busy one, with many patients coming with complaints exactly as they are described in a textbook. We were sometimes asked to take history of some patient and present it, this was the first time since final year that we were asked to do something so academic. Needless to say we would fumble a lot initially but got a hold of it towards the end. Hyperactive children, adults with depressive symptoms, gender dysphoria, hallucinations were some of the cases I saw.
Psychiatry ward is a place constantly trying to contradict everything in itself in order to maintain a certain equilibrium. The ward is locked from outside at all times but the patients are encouraged to walk around inside ever so often. The ward Nurses make every effort to try and dissipate the sombreness of the ward by holding a morning prayer and motivation session for all the patients together. There is a terrace with a beautiful view right adjoining the ward, but the entrance is kept padlocked lest a patient should take unwanted advantage of the elevation. An Interns work in the ward is fairly limited to the occasional sampling, paperwork, vitals monitoring and taking calls to other departments, meaning that there is plenty of free time to while away. Try as I might I couldn’t study for all of the free time, so I would hang around on the terrace, or chat away with my cointern. Duty never extended more than six hours.
This month of internship was thus a mellow one where we could kick back and relax a little. There was more than enough time to study, which now that I come to think of it, I should’ve utilised better considering that my next assignment is going to be in Orthopaedics, which is notorious for being a rigorous one.