Fables from (the other) America –II

1.. Need live study partner, LA, ASAP!!!

The title of this chapter was my post on an online forum, about a week before my clinical skills test.

The same evening I got the phone call.

‘Can start practice tomorrow ?’ those were his first words. They were in an extremely accented & broken English.

I was caught unaware.

 I wanted to say .. hey mister? Hold your horses there ...I don’t even know your name yet ... 

But instead i said, very slowly, clearly and as politely as i could, trying to use those Interpersonal skills that i was trying to practice for my Clinical Skills Test..

‘ I am sorry ‘ ,pause 2 seconds, ’ but ‘ pause 2 seconds, again, ‘what was your name again ? ’

‘It is aa-lllaa-xxx..’ he said stressing on each syllable.

Our conversation lasted barely two minutes.  He suggested that since I had not much time left before my test, he would be willing to drive 40 minutes against the morning traffic, to come to my place, to practice cases starting the next day, at 9 am. 

I said yes, out of necessity.

It was exactly 8 days before my test, and I desperately needed a study partner to practice. I had been doing the online practice for a week now and I was not sure that it was helping me a whole lot.

But, I was apprehensive about this whole thing with Alex.

For one, I did not know him.

I  did not even  know which country he was from? (He never gave me a chance to ask that over the phone, he was so fast!)

Or  how old he was? I could not make out from his voice.

Was he still a student or a MD already?

Would he be able to help me at all?

Would I be comfortable practicing cases with him? I did not have many days left. And his overt enthusiasm to start practicing the very next day even though his test was 2 weeks after mine, raised my suspicions.

 But, I decided to take the chance.

 2. The gynecologist from Peru

It was a bright day. The sun was out, and I sat on the steps outside the apartment, with my laptop,  waiting for what I thought would be a  lanky, awkward looking foreigner in his twenties.

A few minutes later, Alex Fernando Ramos Antonio walked up the stairs.

 He was in navy blue scrubs, had flung his coat on one of his arms, as he used the other hand to grab on to the reeling of the stairs to climb up with some difficulty.

He had an average height, some what coarse facial features and his hair were salt and pepper, though still more of the pepper.

He smiled to me, genuinely,  and held out his hand , ‘ Alex ‘ , he said with his accent.

I smiled back, shook his hand, and invited him inside. I poured lemonade in two glasses and offered him one of them.

 He took a sip, and simply said ‘ Can practice now?’ , and so we began.

We would practice cases, trying to simulate the test setting as much as possible, timing them and following them with simulating note writing also.

We would do 5 cases starting 9 am. Take a lunch break for an hour at 1 pm , and then do 3-4 more cases till 4 pm when Alex would leave for work.

The live practice was helpful for my preparation, but, the lunch breaks were more interesting.

Alex finally told me that he was from Peru. He landed in the United States four years back when he won a VISA lottery in his country.

He use to apply for the same lottery every year just for fun. But when 4 years back, his name was announced on the list of a handful of people who had been offered a chance of permanent residency in the Unites States, his wife and he did not know what to do.

Alex was a full fledged gynecologist, in the capital city of Lima. He had done his medical school and residency at the government college and hospital at Lima.  He had studied everything in Spanish.

Though there were no gynecology fellowships in Peru, he had worked in a cancer centre for a few years after residency, and therefore was well versed with therapeutics including the surgeries of all gynecological cancers. He had chosen to specialize in cervical cancer as it was the most prevalent of the women’s cancers in his country.

Interestingly, he quit his job at the cancer center a few years after training.  Then, he and his wife, who was a nurse, together with a few volunteers hired a few ambulances. They would drive outside the capital city to the small towns and villages in the interiors of the country with the purpose of providing medical care to women who in his words ‘no see any doctor ever before.’ They conducted camps for screening  pap smears and colposcopys.

Usually, Alex, would be the only MD, on the entire team, that also performed numerous surgeries on women who were found to require them for various gynaecological problems including malignancies. Though he didnot make a killing like his fellow oncologists, at the cancer center, he thoroughly enjoyed his work.

But, winning this lottery changed everything. Their three boys desperately wanted to move up north. Their youngest son, who was eight, wanted to visit the Disney land. Their twelve year old boy, wanted to study at the ‘white boys school’. And their eldest,16 then, had already set his eyes on a film and mass media course at a college in Boston.

 So like all loving parents they decided to transform their lives for the better future of their children.

3.  Lessons over  lunch !

I was impressed.

Though we continued to practice cases, it seemed so futile at times. This whole deal of clinical skills testing which mostly involved being pleasant and polite to an actor pretending to be a patient. ...

 I might need it, but Alex surely did not!

He told me, he had been taking English classes, separately. But, what if he was not fluent in the English language, he was proficient in performing a radical hysterectomy, and even more, he was willing to do it for free.

On our first practice day, when he finished telling me about his body of work, I asked him, ‘Alex, Is it possible for us exchange places, I want to be a surgeon and you can have my English skills.’

He smiled, and wrinkles ran all over his rugged face. His eyes twinkled. The man was satisfied. 

He spoke simply, sometimes messing up the grammar, on occasions using the wrong tense. But if you listened carefully, it all made a whole lot of sense.

During my rotations and my preparation for CS, I would always be nervous about my accent and ‘english proficiency’ as they like to call it.

 Alex made me realise, how over rated the language really is.

During the lunch breaks I would heat up the few basic Indian dishes that I could manage to cook the previous night. He would usually grab a sandwich on the way, but always request for some of the home cooked food, ‘ gimme jus like you  have it.. I want taste’

We would talk on all kinds of subjects. He would ask me things about the Indian culture, family system, independence, politics. He would quote Gandhi on a few occasions.

He would tell stories of his childhood and of his youth. Though, I called him by his first name, and he was about the same age as my dad, he reminded me the most of my nanu (grandfather) with his slow paced speech and his way of narrating anecdotes.

 He even taught me a few interesting facts on the politics and economics of countries of the South American Continent.

When i told him, that I had, till date been oblivious of these very basic facts, he chuckled and remarked, 

‘ya! True, people often forget that there is another America in this world....’

4. Doctors from the ‘other’ America.

Of all his stories, I was most impressed by the one about a young doctor from Argentina.

I would like to share it with you guys.

On the last day of our practice, during the lunch break, Alex was going through maria(the girl who gave me the sublet)’s canvases that were lying at the back of the room. He pulled out a magnificent charcoal portrait of a young man, and showed it to me.

‘Do you know him?’ he asked. I simply shrugged my shoulders.

Ernesto "Ché" Guevara, he told me, was born to a rich Argentinean family in the early 20^th century. He was a smart kid, and went on to study medicine at the government medical school at Buenos Aries. After completing school, he, like any other young lad of his age, decided to a buy a motorbike and travel all over South America.

He rode to many latin American countries which at that time were ruled by oppressive monarchs. Being a medical doctor he would provide basic health care to the people where ever he stopped. But he soon realised that the only way to end the suffering of the impoverished masses was to over throw their anarchic rulers. His first experience with armed revolution or guerrilla warfare as it is called, was in Cuba, with Fidel Castro, when they defeated the US backed dictator Fulgencio Batista. He went on to become a minister to Castro’s government in Cuba, though he continued to lead movements for the liberation of many other South American as well as African nations.

Finally, he was executed, on being caught fighting a guerrilla war against the anarchic government of Bolivia, an year before he would turn forty.

Alex told me, that Che’(meaning dear), like he is lovingly referred to, continues to be revered as a revolutionary hero of the poor by many a communist leaders, even today.

Then he asked me , ‘ your parents are doctors, right ? Do they ever think of politics’

‘If they have time they try to cast their votes, but that’s about it...’ , I said...

He went on to tell me how many successful doctors in his country would go into politics as they felt they wanted to do more, for the greater good of the common people.

‘You should think about it, too ... ‘ he added.

  

5.  who is up for it ?

Though my dear CS study partner was an idealist, he did remind me of some very basic facts.

 We guys in India, enter medical school at the tender age of 17 or even younger. The entire stress is on trying to sieve out what the system considers the smartest kids, and place them into medical school. It is believed by all that they would make the finest doctors.

Students have their own reasons to take up medicine or a particular speciality. It could be because a) their parents want them too, b) there are big bucks involved, c) people will respect me, consider them a stud !

Someone want to specialise in internal medicine because diagnosing is fun, surgery because it is about art and finesse, radiology because it is chill or dermatology because no one dies, really.

Perfectly valid reasons in themselves!

But have you recently heard a fatcha/fatchi/batchmate/senior tell you that they wanted to be a doctor or go into a particular branch  to be able to help the target population , make a difference in their lives, or simply give them some hope or at-least a little reassurance.

Everything said and done, the fact remains, that (excuse me for the cliche’ but its true) medicine is a noble profession and qualities of a doctor do include compassion.

Sadly, these qualities are neither sought after by our medical education system and rarely if ever are found in our doctors and students.

I am not trying to give you a moral science lesson here (though I sound like it, very much). What I want to say is, if someone is not capable of empathizing, he/she should realise it. There is nothing wrong with it, really. Rather, the sooner it dawns on you the better, so that you can find other things you are good at.

Now, before you close this file and send me an email about how I am surely losing my mind, I would like to end by to requesting all my dear friends to find for themselves the right calling... be it medicine, a particular speciality, or something else.

Because 30 years from now, I want us all to be smiling with satisfaction, and not reeling with depression/anxiety/anger management issues/ accusations of harassing subordinates or anything else worse .  ;-)

Meanwhile, I have an open offer to take a week’s holiday to Peru, and do some charity Ob-Gynae work while I am there. Alex promised to host me and any friends I would bring from India. So who is up for it ?!