The Long Case

“Why are you not getting any coffee for yourself?” Prof Kichu Nair, my tutorial teacher, asked me, looking quite confused. He looked at Julia, Allison and Angela as each of them got their own drinks and I didn’t.

Even he knows that no medical students would willingly refuse free coffee from his treat.

So I whispered to him discreetly. “I am fasting today.”

“Oh, is it Ramadhan already?”

Hmm…I was torn inside. Nak cakap ke tak nak?

I cleared my throat. “Well, Ramadhan is next week. Actually I fast as a way to say thanks to God that I passed my long case at first attempt. We call this nazar.”

Prof Kichu Nair smiled. “Oh, that is sooo good of you.”

I am relieved.

Some people are not very understanding of our practice. The Western people especially would be confused as to why we should offer anything to God as a way of saying thanks. They just don’t understand.

But I know as an Indian, this professor would totally get it, without me having to explain further.

****

Sometimes, simply fasting for having been granted from Allah what I wish with all my heart, just does not seem enough. I have been so blessed and I am very conscious of the fact that there are times when I am not thankful enough.

I am a whiner. That’s my coping mechanism. Whining makes me feel better. I don’t always seriously mean whatever it is I whine about (like, I do exaggerate a little, lol) but it just makes me feel better to be able to talk it all out.

My mom gets headache every time it’s nearing my exam. So, I told her, “Mak tak payah risau. Angah bukannya tension pun tapi Angah nak habaq ja.” Heh!

And this time I told her, “Mak, ni kali terakhir mak dengaq angah kompelin. Lepas ni dah tak dak exam. Lepas ni mak dengaq angah cakap yang best-best ja. Tapi kalau angah pass la. So mak kena laaa doa kat kak ngah.”

I am fully aware that my success in the long case has nothing to do with me. It’s been destined. We put in our effort in trying to achieve anything in life solely because it’s what God has commanded us to do; not because we believe that our success totally depends on our effort.

As a Muslim, it is simply unthinkable to believe that we succeed at our own effort. There are so many other things and factors outside our control that could cause our downfall:

1)What kind of case we got.

2)How nice the examiners are

3)Are there any interruptions during the interview (like lost medication chart/the patient has just received a bleak diagnosis an hour ago and therefore was not in a helpful mood/ the patient’s doctor was doing a ward round at that time and therefore interrupting your interview)

4)Simple natural circumstances (like panic attack, overslept, trapped in a traffic jam and arrive late etc etc)

My case was quite simple: a 69 year old gentleman who presented to the Mater Hospital with right calf pain and dyspnoea at rest, on the background of recently diagnosed heart failure, haemochomatosis, and 5 years history of atrial fibrillation and hypertension.

I mean heart failure is simple. Atrial fibrillation and hypertension are like everyday cases. It’s only haemochromatosis that I had not quite covered properly because it was not very common. In fact, it was actually the first time I came across a patient with haemochromatosis.

My examiners are Prof Hensley and Dr Nimmi Atharuliya…they are nice too (but they did fail one of the students in my group; so they are nice with conditions attached).

And I could make the most of the one hour time I got with the patient because the interruption was minimal.

In all accounts, Allah has helped me to pass.

It’s never just my effort. I put in effort simply for my own psychological satisfaction and to make myself feel better. I put in effort simply to comply with the sunnahtullah that we should work hard for an outcome. But the end result is in the hands of Allah alone and I claim no part in it.

For those who are still in doubt that any outcome is independent of your own effort, let me make known to you some events that had happened on the exam day:

Case 1:

One of the most brilliant medical student in our batch failed her long case. Even the tutor was surprised that she failed because she is knowledgeable, confident and knows everything. She works hard for the long case. If I don’t know something, I would definitely feel comfortable simply listening to her answers.

So, why did she fail?

-She got a patient with endocarditis on the background of systemic lupus erythematosus (SLE). Tough case!

-While she was doing the interview, the patient’s doctor was doing a ward round and broke the news of a diagnosis of bowel cancer to the patient. So afterward, the patient was crying and in distraught and the medical student simply could not take a good history from the patient.

-While doing the viva, the brilliant medical student accidentally said ‘pericarditis’ instead of ‘endocarditis’. She KNEW it was endocarditis, but through a slip of the tongue, she had answered ‘pericarditis’ instead. She did correct herself later, but the examiners thought she had done so on promptings rather than because she truly knew the fact.

One of the students had seen her came out of the examination room, crying.

It’s just heartbreaking because everybody knows that she is a very brilliant, a very passionate medical student who would have passed soooo easily if she got my case, instead. If anyone could pass with the case that she got, it would have been her.

The case was just too complicated and the circumstances did not help matters very much.

Case 2:

Another Australian student failed because she forgot to say ‘aspirin’ as one of the key treatment for myocardial infarction (heart attack). Just because of ‘aspirin’, she failed. You know, sometimes you think you already know all there is to know about heart attack, but you could still fail just because of one simple thing.

Case 3:

Another Australian student failed because he got mental blank during the viva. Furthermore, while he was doing the interview, the patient was also having lunch and she ate so very slowly; these things affect the maximum time you would get with your patient. In the long case, your patient and her medication chart are the only source of information that you would get and you should use all the interrogation skills that you have accumulated throughout the years to get him/her to answer your questions properly. If you get a helpful patient who has great insight of his/her condition and is on top of everything that has happened to him/her in the hospital, then you’ll be fine.

But not everyone was as lucky as I am.

I walked out of the viva room, feeling relieved. Thanks to the patient, my history was complete and they had nothing much to ask for further clarification. So we went straight to question-and-answer session. I could answer most of them but I got stuck at Haemochromatosis. Prof Hensley said that Haemochomatosis is rare, so he just said that I could do my 48 hour task assignment on it.

Because the patient was knowledgeable about his condition, I was able to get a complete history and they have nothing much to ask. So I finished the viva10 minutes early than I should have. So, while waiting outside the room for the result, I kind of know that I was going to pass simply because they let me out of the room early.

When they invited me back into the room for a feedback session, I was already cool and calm.

The examiners said, “we think you did quite well.”

And in my heart I praised God non-stop. Everything went so ideally for me on that day because Allah had made it easy for me.

I have always had easy cases, helpful patients and nice examiners on alll my long cases. I am so thankful that I have made it this far. Apart from a psychiatry OSCE, there will be no more exams for the rest of the final year. How cool is that!

I am now 3/4  of a doctor.

And as far as I know, all Malaysians in my batch have passed their long cases at first attempt; Suhaila finished first, and on the second day both Balqis and I finished our exams. Wani did her exam at Gosford and she passed as well.

Since I have passed the biggest hurdle in Medicine, and all that is left now are just filling up my logbook and completing my attendance, it’s gonna be a longgggg holiday until I actually start working.

I can now celebrate my Ramadhan with calm ease and tranquil contentment.

Alhamdulillah.

2 thoughts on “The Long Case

  1. “I am a whiner. That’s my coping mechanism. Whining makes me feel better. I don’t always seriously mean whatever it is I whine about (like, I do exaggerate a little, lol) but it just makes me feel better to be able to talk it all out.”

    im a swearer, if the term exists.

    Like

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