I would like to tell you an anecdote about my final surgical oral exam. I had a unique patient. While he was cooperative, there was a moment when I nearly had a heart attack!
The patient, oh I do remember him well, how could I forget him? He was a young man with Buerger’s Disease which is a rare disease of the arteries and veins in the arms and legs. It is also called thromboangiitis obliterans — the blood vessels become inflamed, swollen, and can become blocked with blood clots (thrombi). This eventually damages or destroys skin and the surrounding tissues leading to infection and gangrene. It initially manifests in the hands and feet, but it is possible that it could eventually affect larger areas of the arms and legs.
The significant point to note is that everyone ever diagnosed with Buerger’s Disease smoked or had smoked cigarettes or used other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop the progression of Buerger’s Disease. For those who don’t quit the disease progresses to cause gangrene, and sometimes amputation of all or part of a limb becomes necessary.
In my exam case, my patient’s nemesis was chewing tobacco. He had started using it since he was 10 years old when his much older cousin introduced it to him, and he had subsequently become addicted. But as he unfortunately now got to know, the consequences were ultimately grim for him.
Iqbal was a friendly, cooperative man who had already gone through the examination process the day before with another group if exam hopefuls, and still wasn’t (yet) too irritated. I was therefore able to complete his history and detailed examination quite quickly, since the case, despite the misgivings of others, was actually quite straight forward. Thereafter, I just had to wait till the professor’s examination team came to my patient’s bedside to cross examine me about the case.
While I waited for the examiners, I chatted with the patient. He told me stories about his family, how he met his fiancé, and the business he was hoping to start after he was discharged from the hospital. He added that I was the first student that knew what I was doing (with reference to his case). I was relaxed and not at all appalled by his illness. While I had the time, I tried to persuade him to stop chewing tobacco, because that was one of the reasons that he had this disease, inasmuch he should take care of himself because a young man needs his limbs desperately… Of course, he does. Amputation should never be an option if it could be prevented.
Finally, I saw that the professors had entered the far end of the ward and were two beds away, starting the viva voce of one of my friends. But my day wasn’t destined to be smooth, was it? Where was the drama? The fun? What is a perfect day without a routine dose of adrenaline? Well, just as I turned my back to check my notes, I heard a rustling sound and footsteps walking away. I swung around to see that my patient had disappeared!!! Now I was on the verge of a panic attack! I nearly fainted with the effort to slow down my breathing and my racing heart.
Surely, I’ll fail my surgery exam if my patient wasn’t there! Oh God! I’ll be good! Please make my patient come back! I don’t want my professional degree to be delayed because of a minor glitch! These words were just whizzing through my mind, making me even more anxious instead of calming me down.
I tried looking for my patient as discretely as possible, asking the passing nurses and the ward orderlies whether they had seen him. They just shrugged and continued with their jobs. Just when I was nearly at the end of my tether, lo and behold! In the last moment, I saw Iqbal hurrying towards me, weaving in and out in the aisles of the ward, trying not to bump into anyone. In one of his hands, he carried a bowl of ripe, washed grapes and in the other, a bottle of cold water. He succinctly handed them to me saying “You have been on your feet the whole day, and I didn’t see you eat or drink anything! Something suddenly compelled me to get you some food and water before your exam. I do want you to do well as you were talking so kindly to me. I thought that this would help you bring your energy levels up and concentrate on your exams”.
That was enough to render me was speechless for a moment, and of course I was touched! It was also so unprecedented! Actually, to be honest, at the time I was feeling the effects of low blood sugar since I hadn’t had any breakfast that morning, and the fruit did perk me up. Therefore, when it was my turn to be examined by the invigilators, trust me, I was alert, focused and didn’t have my usual exam anxiety. It goes without saying that I happily passed my surgery viva voce with flying colors.