Friday, 27 June 2014

On Becoming a Doctor–Internship


image1967 Saskatoon, Saskatchewan. 

We packed up our Volkswagen Beetle and, with some trepidation, headed off to beautiful Saskatoon, “the city of bridges” to begin a new adventure, my medical internship.


In order to be unleashed on the public, every doctor had to endure at least one year of what was called a Rotating Internship.  That means, you become part of the house staff of the teaching hospital, usually a facility of your choice, where you become more or less a slave, performing duties at the pleasure or whim of more senior house staff, attending physicians or obstreperous head nurses.  You must remain on call night and day for weeks or months on end and attend to the most menial or important task asked of you regardless of how you are feeling or your level of fatigue.  You may find yourself in the operating room, delivery room or the wards to which you are assigned any time of day or night, often without the opportunity to rest or eat and often sick as your immune system has worn out.  On one occasion, I worked for 52 hours straight without a rest!  We received the grand sum of $400 per month which worked out to a pittance of much less than a dollar an hour.

While “doing hard time” as an intern you have to be willing to bear the scorn of more senior staff responding to them with a friendly smile and a sincere “Yes Sir!!”  On the rare occasion that you have a bit of time on your hands you are expected to review patient files or study your books and medical journals.  Someone once told me before I began my studies that “you will be going through seven years of hell.”  It wasn’t quite that bad but there were times when I thought that person was close to hitting the nail on the head and I did endure the odd glimpse of hell!

clip_image001Arriving at the University of Saskatchewan Hospital, we brand new, wet behind the ears, interns, brimming with our new found but not yet practical knowledge, were issued our whites (so we could easily be identified as a potential slave, I guess). Then we were bombarded with orientation instructions regarding the policies, rules and regulations of the hospital, layout of the facilities and introductions to the staff.  We were also conducted to the windowless intern’s and resident’s quarters where we would spend many, many long nights trying to grab bits of shut-eye.  We were then assigned our initial rotations and off to work.

My first rotation was in psychiatry, which was OK as there were not as many emergencies requiring us to get up in the middle of the night to administer to patients who were mostly sedated anyway.  We might get the odd call regarding something mundane such as “Mrs. So and So needs a laxative,” but it was otherwise relatively peaceful.  However we were invited to register for shifts in the emergency department (ER) and they would pay us an extra $35 per shift which seemed to be a lot of money at the time.

clip_image002The U of A psychiatry department where I was initially exposed to this important branch of medicine was more of a Neo-Freudian psychoanalysis style of service compared to the U of S department, headed by Dr. McKerracher, a former wartime military psychiatrist, which leaned toward the more practical psychotherapy model.  I found myself performing Pentothal interviews, administering shock treatments and trying to help patients find ways of coping with their problems.  Most of the folks admitted to the ward were psychotic, as less serious patients were treated as out patients, so this was a good introduction to dealing with psychoses.  One of the more memorable admissions was the young man responsible for the “Shell Lake massacre” in which he had murdered his complete family with a .22.  There were also other violent criminals who were kept in a lock-up section with police guards. I was glad that the police were there as some of the inmates were unpredictable and could become very aggressive and violent.

I also spent quite a few shifts manning the ER and Poison Control Centre and preferred the late shifts as they were not overly busy except on weekend nights.  ER work was interesting and exciting – you never knew what the next case would be.   In addition to the usual heart attacks and other medical emergencies, there would be at least one gunshot wound per week, the odd stabbing and auto accidents and burn injuries.  We would stabilize the victims and then send them off to the appropriate ward for longer term care, which was fine with me.

  This was also a time when open chest cardiac massage was falling out of favour and closed chest resuscitation (CPR)  was now becoming the normal method.  I did perform many of these and most of the candidates survived despite the occasional rib fracture – mind you, fractures are easier to heal than death!  One of the most noteworthy events related to this was a man in cardiac arrest who was brought to the ER by ambulance.  The Code 9 team worked on the patient for over an hour but there was no sign of life, so they gave up.  Some student nurses who were observing this drama asked permission to try CPR just for the practice and feel of working on an actual human.  Well, that man walked out of the hospital three weeks later!!

The next rotation was on Paediatrics.  I enjoyed working with the kids but the cancer victims broke my heart as they usually died.  One of the many kids that I cared for had a brain tumour and would just lie in bed moaning all day unless his parents were there for their weekly visit from a military base where the father was stationed.  I used to read to the unfortunate lad every night when I had the time and he would quiet down and fall asleep, but I also had to drain cerebrospinal fluid from his head every day and that didn’t please him.  God, I hated that!  One of the little boys dying from cancer, an only child, was visited every day by his parents who were now past having any more children.  One day, they brought a stuffed toy called “Buzzy Bee” and it stayed with him in his crib.  Every time I see one of these or a similar stuffed toy, I think of that poor child and the terrible sight of the heartbroken parents as they cried over his little body.  There are so very many memories that are impossible to erase.

The Internal Medicine assignment was also interesting, especially from a diagnostic perspective as this was, after all, a university hospital and the cases were obviously more exotic than in most facilities.

OROne of my favourite rotations was on the surgical wards, though the workload was extremely high as they were short of interns and I was responsible for three wards rather than the usual single ward. I had to “live” in my little room (or cell) for sometimes a month at a stretch though most of the time I was dragging myself around the wards.  There were various surgical specialties in the hospital, being one of the largest in Saskatchewan.  So, I was exposed to cardiovascular, thoracic, neurosurgery, general surgery (my least favourite though not as tedious as neurosurgery) and traumatic and plastic surgery, my favourites.  You never knew what you were going to see or do in the next few minutes or hours.  I also enjoyed plastic reconstructive surgery though working on the burn unit was disheartening.

I’ll never forget Mr. P., a welder.  He was brought in from a high steel construction site with over 80% third degree burns.  One of his co-workers thought he would play a joke on him and, while he was welding a joint, threw a bucket of what he thought was water on him.  It turned out that it was paint thinner, not water, in the bucket and turned poor Mr. P. into a human torch.  He suffered through weeks of almost daily surgery but finally succumbed to a bacterium (Pseudomonas aeruginosa). 

Another fire victim was a chap who worked for my father and I had known him for many years.  When I was a little boy, he used to let me ride around with him in the heavy road construction equipment.  On the night of the accident, he was lighting flare pots when one of them exploded and set him on fire.  I visited him often and, to help him with his pain, prescribed cases of beer which we were allowed to do.  Alas, he too died from infection.

Gunshot wounds were interesting because bullets would ricochet around the body damaging various structures, so one minute you were repairing an intestine and the next an organ, vascular system, thoracic or nerves.  Hippocrates apparently once said “If you want to learn surgery, follow an army” and I thought this would be appropriate training for a military doctor.

Sometimes you couldn’t do anything to save a trauma victim and the kidney transplant team would be standing by.  U of S was one of the pioneers in kidney transplants but there was not the technology at that time to preserve organs, so the recipient had to be opened up on the operating table ready to receive the kidney.  On occasion, the trauma victim survived despite the poor prognosis so we would have to stitch the recipient back up and send him or her back to the ward to await another potential donor.  It is wonderful to see how transplant science has progressed so far from those primitive times.

Between operations, the surgeons would usually sit in the doctor’s room in their greens, drinking coffee and discussing politics, the economy and sometimes, even surgery.  One of the surgeons was quite racist and, on more than one occasion, asked me to show the more senior, but foreign house staff how to perform various operations, so I would end up as the surgeon and the resident would be first scrub!  I learned a lot about surgery from that and, more importantly, the patients survived.

Our brother, Graham, who was living with us at the time, had a Siamese cat named Foo Ling.  Poor Foo was born with an umbilical hernia and a twisted tail (and I think he was not at the pinnacle of the cat intellectual totem pole).  Fortunately, one of the med students was a veterinarian and agreed to help me fix the hernia and neuter Foo and our other cat for the price of a few beers.  However, the vet had never done an umbilical hernia, so I scrubbed in on the procedure one day in the OR and was able to perform the operation on poor old Foo who was anesthetised and strapped to Pat’s ironing board.  All of the cat operations that Saturday afternoon were successful and we all (except for the cats) anaesthetized ourselves with the beer while Pat was tasked with monitoring the two creatures’ temperatures with a rectal thermometer.  Oh joy!!

Being the sole intern on the three surgical wards had its drawbacks, however.  I was often up all night admitting patients and ordering appropriate tests and medications or assisting in the OR.  The Chief of Surgery was kind of a miserable New Zealander who took great joy in belittling and cajoling the house staff.  One night I was in the OR for an entire night assisting one of the cardiovascular surgeons with a bleeding abdominal aortic aneurism, finishing the procedure at 0735.  The Kiwi chief surgeon berated me for being 5 minutes late and then, as we stopped at each bedside, would ask me to list off the morning’s lab results, which of course I had not been able to see.  At every bedside, he chided me for not knowing the results and I decided on the spot that, perhaps surgery was not for me if I had to endure that sort of humiliation for another four to six years.

Obstetrics was another matter.  Delivering babies was a very happy event most of the time, though it usually involved being up all night.  95% of the time things went smoothly, even though these were often high risk deliveries such as breech births, forceps deliveries or Caesarean Sections.  However, when things went wrong, for example a haemorrhage, they usually went wrong extremely quickly and there was very little time to react and you had to do exactly the right thing to save the lives of the mother and child.

One horrible night I was alone on the ward as usual, delivering several infants, when Pat called and told me that she was in labour.  Upon her admission, I called the attending physician who quickly arrived along with the senior resident.  After an uneventful delivery of our healthy daughter, Kirsten Jean, Pat was taken to the recovery room and I had a couple of more deliveries.  One of the nurses frantically called to tell me that my wife was haemorrhaging severely.  Indeed, it was the worst post partum haemorrhage that I ever saw in my entire career.  Her attending obstetrician told me, when I called him, to relax, that I was just a “nervous papa” and to try to get some rest.  Even the nurses couldn’t convince him that something was seriously wrong and I was left responsible for her care. Over the ensuing hours I ended up setting up an IV, starting a Syntocinon drip, cross matching her for blood and giving her five units before the specialist finally arrived.  It had been like one of those terrible nightmares where you are trying to run away from something and your legs are like lead pipes and you can hardly move.  I went home at the suggestion of the Obstetrician.

A couple of hours later, the hospital called and informed me that they had just operated on Pat and that I could see her in the recovery room.  When I reached her bedside, she looked very pale and I couldn’t detect respiration or a pulse whereupon I shouted for the nurse who tried to take her blood pressure and then called a Code 9.  Pat was taken once more to the OR as I waited, pacing nervously back and forth in the doctor’s lounge.  Finally, I was informed that I could see her in the ICU (Intensive Care Unit) so I walked in and saw that she was breathing, had a detectable pulse and her colour was returning. Once again I went home, this time having stopped and picked up a bottle of rum – man, was I angry!  They say that alcohol doesn’t help situations like this, but, I swear that this rum helped more than milk or water would have!  I don’t know who the heck “they” are, anyway.

Wouldn’t you know it, Pat developed puerperal fever (a post partum infection) and her stay in the hospital was prolonged.  It seems that doctor’s wives are more likely to have more problems than other new mothers (I have no statistics to prove that – it just seems that way)!

I happened to be in the ER one night when the chief of a local band was brought into the hospital.  It seems that a couple of the residents of the reserve got into the booze and attacked the poor old chief with hatchets, fracturing numerous bones and causing deep lacerations.  He also had been scalped, but the scalp was still attached by a narrow strap of skin and could be stitched back on.  He spent hours in the OR while the numerous wounds were closed and bones reset and pinned.  Some weeks later he developed what is called  a Curling’s Ulcer, a gastric ulcer that may occur after severe trauma and it was haemorrhaging.  We took him to the OR and opened him up.  He had also been a bronco buster and there were many, many adhesions in his abdomen, making the procedure very long and complicated.  However, we were able to stop the bleeding and, by some miracle, he survived, walking out of the hospital over a month later.

One of the strangest cases was that of a little girl who was tobogganing on the bank of the South Saskatchewan River next to a wooden ski jump one Sunday.  Apparently, she lost control of the toboggan (as if there were actually any control) and ran into the structure.  Her abdomen was pierced by a 2 by 4 that went in from the front and out her back, by the grace of God, pushing aside and not damaging vital organs.  So she was brought into the ER and rushed to the OR for emergency surgery.  It was the practice of the hospital to call the patient’s family doctor as a courtesy.  Her GP had the reputation of being a rather obstreperous old coot who was prone to interfering, so the resident told him that his patient had a “splinter” whereupon the doctor instructed the resident to “remove the darn thing.”  This was done.

I could go on and on, writing about the many interesting, dramatic, sad and strange cases that I encountered as I spent the years of medical training up to that time.  Now it was time to leave the hospital and really learn about medicine.

imageIt was a tough, but exciting and rewarding year.  How did I cope with the really hard and disturbing parts and carry on though many times I felt like giving up?  First of all there was my family, Pat, Laura and then, Kirsten, my two beautiful daughters, plus my brother, Graham.  They gave me a strong sense of responsibility and motivation to complete that which I had started.  I also had other interests, like constructing radio controlled model aircraft along with my fellow aviation enthusiast, Graham.  I also took up photography and used the bathroom in our rented duplex as a dark room as I recorded the people and events in the life of an intern and the sights of beautiful Saskatoon.  When I was in my deepest and darkest period, I ordered a red 1968 Camaro Super Sport, the dreaming about it distracting me from some of the terrible things that I saw and experienced.  I used to keep the brochure on the table beside the cot in my Spartan intern’s room (or cell?) and when needed, I would pick it up and dream of the freedom of the open road.

But I made it!

Anaesthetists know nothing and do nothing,

Internists know everything and do nothing,

Surgeons know nothing and do everything,

Pathologists know everything and do everything,

But it’s too late!

As told to me by Dr. Neville Crowson, my mentor and friend and a great pathologist

Wednesday, 25 June 2014

On Becoming a Doctor–The Beginning


Medial SymbolUnlike many medical professionals, becoming a physician was not something of which I had dreamed from the time I was a child.  In fact, being a doctor seemed to be so totally outside of the realm of possibility that I hadn’t even given it a thought. Doctors, were after all, thought to be among the highly respected pillars of the community and must have come from families that had a much higher status than ours. Even the prospect of earning a university degree appeared to unobtainable.

It’s not that there weren’t doctors or other university educated professionals in the family, but they were mostly on my mother’s side.  In fact my great-great grandfather, John Harkness, was one of the first physicians in the part of Upper Canada which would later become Eastern Ontario, having settled near Iroquois along the St. Lawrence River. So there must have been medical genes floating around in my blood somewhere.  Many of his sons and grand sons became MD’s or PhD’s and my grandmother Ada Murphy (nee Harkness) was a teacher.  But most of these relatives lived far away from the Alberta prairies and were primarily figments of my grandmother’s conversations about the family she had left in the east.  She had been a teacher in Ontario but then, seeking adventure, headed out West where she met my grandfather, Alphonsus Wilmot Murphy and they eventually settled in Medicine Hat. My mother’s sister, Jean Murphy also taught school for a time in Buffalo Alberta which is led to my mother meeting my father.

It seemed to be infrequent that students from the ‘Hat attended university, but there were the usual crops of university graduates, mostly teachers and nurses.

Since the age of four, I hadn’t thought much about any career other than being a pilot (or a musician) – I had constructed numerous model airplanes and read extensively about aviation and aviators and you would find me in an airplane any time there was a chance to get off the ground.  I couldn’t afford flying lessons, so was determined to join the RCAF and become a pilot.  However, when I graduated from Medicine Hat High School I tried to join the air force and was informed that a university degree, particularly in engineering, was a requirement.

Unable to find a job, I accepted a position as an apprentice in a medical laboratory.  It is amazing how life takes its twists and turns and sometimes leads you into something totally unexpected - this temporary difficulty in finding employment turned my life into something totally different from that for which I had planned or expected to do.  Apparently, I did a pretty good job in the clinic because the staff offered me a scholarship to the University of Alberta where I would earn a Bachelor of Science in Medical Laboratory Technology, something that I felt was not otherwise affordable even though I had saved money from summer jobs, playing dances, militia and teaching music.

I was very honoured and excited about the prospect of going to varsity and went to see one of the science teachers at MHHS who was a fellow musician and friend.  Bob Ayling advised me that, since I had the potential, I should shoot for the top and go after an MD.

So, not knowing whether or not the future would consist of smooth or stormy seas, I set sail for U of A, UofCWelcomeCalgary, to commence studies toward a basic science degree, majoring in physics.  Understanding that I had only sufficient funds for one year, there was great uncertainty about my choice.

Realizing that I had only one chance to catch the brass ring, I worked day and night on my studies – to the point that I was failing miserably.  Seeking the advice of the varsity counsellor, I was told that I wasn’t applying myself sufficiently.  When I told her about my study habits, she then allowed that I was studying too much and recommended a book, “How to Study” which I diligently studied.

Heeding the advice in the book, my marks soared from failure to honours and I was on my way!  I did discover that I was more interested in biological sciences than physics and therefore changed my major to biology and chemistry.  I had always been keen on palaeontology and developed an interest in herpetology, the study of reptiles, as I harboured an interest in the study of rattlesnakes.  My professor, who was a herpetologist himself, advised me that I should find a more lucrative career and pursue my interest in medicine.  He sealed the deal by telling me that it would be advantageous to learn as much as possible about one animal (humans) and that knowledge would help if a career or hobby in either palaeontology or herpetology still caught my fancy later on.

One of the things that helped me with my studies was that Pat and I were married, a situation that motivated me to succeed and alleviated the distraction of loneliness, whereupon I was able to concentrate on my studies and maintain good marks.  I therefore became eligible to apply for entrance to the U of A Medical School in Edmonton, Alberta.

One of the hurdles was that I had to be interviewed by the Dean of Medicine, Dr. Walter McKenzie an event that worried me considerably. Dr. McKenzie was a pioneer of surgery in Alberta and I was trembling in my boots as I entered the interview room.  It turned out that he was a jazz drummer and we discussed big band music at great length  , especially when he found out that I was the founder and leader of the U of A big band.  When he asked why I wanted to become a doctor, I informed him that it was because I was deeply interested in medicine.  Having been a lab technician sealed the deal.

During the summer, a letter  from the University arrived and, after staring at it for a while, I gathered enough courage to open the envelope.  You can’t imagine the excitement and relief, tempered with trepidation, of reading “you have been accepted into the University of Alberta, Edmonton, Medical Program.”

So now it was time to pack our old car with whatever belongings we had and, with Pat and little Laura, head to Edmonton where we would be residing in a low rental development while commencing medical training.

Med School ClassThe first day of med school soon approached and I sat down in an auditorium with about 100 other hopefuls where we received an indoctrination lecture.  The professor told us to look to our left and informed us that that person beside us would not make it and then look to the right and that person would also not make it.  Well, that was a shock as I realized that I was on the left of the person to the right and on the right of the person to the left – that was sort of a double whammy!

We were then herded to the cadaver lab where we were presented with our boxes of bones, including a skull, and were assigned to our cadavers, which we would be dissecting for the entire year.  Several of the potential medical doctors quit on the spot!  The attendant for the cadavers was a short, rather stout Polish man with sparse reddish hair and one wandering eye (strabismus) who looked the part of a body snatcher (at least the movie versions).  This may have had some influence on those who decided that they didn’t have the stomach for the ensuing medical studies.

My three cadaver mates included Mark Rosenbloom, somewhat older than me, who possessed a Master’s Degree in Chemical Engineering from England.  Whoa!, I thought, what chance do I have against such exalted scholars, as there were also others who held more senior qualifications than me.  Mark and our families became lifelong friends until his death several years ago.

First year medicine consisted mostly of the basic sciences such as anatomy, histology, neuroanatomy, physiology, embryology, biochemistry, anthropology, genetics and other pertinent subjects.  Classes ran from 0730 to 1700 roughly and from 0730 to noon on Saturdays.  The workload was extremely heavy and most of us found that the pre-med Arts and Science did not fully prepare us for the intensity of work.  I set up a study corner in the basement – a wooden door formed the working surface of a desk ant a bookcase was constructed from bricks and boards, the ubiquitous style of the day.  I spent many long hours cramming information into my tired old noggin, stopping in the dreary hours after midnight having allowed  only a brief respite before supper and a short break during the evening.

In order to supplement our income, Pat would often babysit on the weekend evenings and I would join her with my microscope and a box of slides.  She would hand me a slide and I would be required to identify the type of tissue and whatever pathology might be evident – this is why I earned honours in Pathology, I suppose.

Many years later I rode my Harley-Davidson out to a motorcycle rally in Kananaskis, Alberta.  A member of the press queried me regarding the motivation for being a “biker.”  I responded by stating that “it is to help make up for all the Saturday nights when most of my friends were out in their sports cars or partying.”  I think the reporter may have understood.

One of the key courses for any budding physician was anatomy.  There was always a lecture at 0730 followed by three hours of lab time, every day except Saturday, spent hovering over our cadavers, dissecting and trying to identify structures that were beautifully represented in the atlas of anatomy but were never so discernable in the formaldehyde soaked bodies.  Our cadaver was a rather large, formerly derelict man, who was missing most of his teeth.  We spent many months with our new friend dissecting various areas of the body, starting with the upper limb, lower limb, thorax, abdomen and perineum and, the most complex, the head and neck.  There would be weekly exams and practical tests and also surprise exams that could be sprung upon us at any time.  My secret was to always be up to date and ready for a test at any time.  That way, I didn’t have to pull all-nighters when it was time for the big exams and  at least I was better rested than some of my contemporaries.

Lo and behold, I placed sixth in the class of 96 at the end of first year.

Summer employment was an issue as the medical classes ended later and began earlier in the year than for other faculties and employers wanted students for longer periods.  I was fortunate enough to get a job in research for the summer and was a co-author of a journal article titled “Electronarcosis of the Dog.”

Financially, varsity was a bit of a struggle, but we had help from our parents and student loans until joining the RCAF after second year medicine.  Until then, I thought that money was made of copper!

Second year medical studies were slanted more towards the clinical sciences.  Courses included Pathology, Pharmacology, Bacteriology and Virology, Surgical Anatomy, Surgery, Obstetrics and Gynaecology and a myriad of other clinical subjects.  A significant number of hours was also spent studying Psychiatry.  We also received some of our basic medical instruments such as a stethoscope, ophthalmoscope and sphygmomanometer (blood pressure cuff).  One night, after several hours of study, I picked up my stethoscope and listened to my heart.  To my horror, I detected a rather obvious systolic ejection murmur and I was almost afraid to fall asleep lest I wouldn’t wake up.  The next morning, I approached my cardiology professor for advice. He asked me how many cups of coffee I consumed on a daily basis.  I informed him that it was only 10 to 15 cups.  He laughed and told me to cut back on the java, and guess what?  - the murmur disappeared!  A good lesson about excesses!

Another event of note was that, from the bacteriology lab, I contracted Shigella dysentery, a most dramatic condition, to say the least, that kept me away from classes for a few days although I learned a lot about diarrhea!  That wasn’t as serious an event as one of the students who developed tuberculosis and missed an entire year.

One of the roughest times in my life was the death of my mother just before exams.  I took a week off class and my classmates took notes for me to review later.  Needless to say, I was very down and distraught but had to pull myself together and face my studies with as much diligence as one could muster under the circumstances.  I passed, however, still near the top of my class.

After second year, at the suggestion of my uncle, Oliver Skjenna,  an officer in the air force reserve, I joined the RCAF.  We now felt rich as tuition and book costs were covered by the military and I received about $150 per month in wages.  It meant that those of us in the Undergraduate Medical Training Plan (UMSP) were required to attend weekly parades, but it also meant that we didn’t have to concern ourselves about summer employment and, to top it off, we would get a whole month of vacation in the summer!  The first summer was spent at boot camp in CFB Borden where we not only learned about military discipline and medicine, but how to live with very little sleep.  Later in the course, we were required to set up a field hospital in the bush.  As soon as it was complete, we had to tear it down and move to another location.  This was repeated day after day and night after night until we were like zombies, the kind of stamina building that would come in handy in the future.

Third year was more into clinical medicine and we spent many hours in various hospital wards as well as in classes.  By this time, my brother Graham came to live with us and we moved into officer’s housing in CFB Griesbach, an army base on the northern outskirts of Edmonton.

The following summer I was posted to CFB Cold Lake aka the “Cool Pool,” an RCAF training base for supersonic CF 104 Starfighters, capable of delivering a nuke.  That was very exciting and I actually got several hours in this high speed and high altitude jet as well as other aircraft.  I actually went up to Mach 1.8 in the Starfighter which was one of great thrills of my life.  Pat, Laura and Graham camped with me at a lake near the base and we had a great summer.

Fourth year medicine was primarily clinical and we all spent many, many hours in various clinics and days and nights in hospitals learning, hands on, the intricacies of our chosen profession.  The end of the year was very, very stressful because success or failure depended on a couple of weeks of written exams and around 25 oral and practical exams.  There was one classmate who, because of the alphabet, was in front of me for the orals.  He would enter the room and after a minute or so would rush out and vomit and then return to complete the testing.  Man, did that ever wreak havoc with my nerves!  However, I knew the material very well and confidence grew by the day. 

One horrific exam was the surgery oral as one of the examiners was an old surgeon from Magill University.  He asked me how to treat a bubonocele, and I had no idea what the heck that was.  He chided me relentlessly until my professor finally interjected and noted that bubonocele was an archaic term for a femoral hernia – and then I was able to then answer the question, albeit being somewhat unnerved!  That’s when I realized that many surgeons possess a natural method of birth control – their personalities!

One exam was quite memorable - the Urology oral, conducted by our Honorary Class President, Dr. Bill Lakey, one of our favourite professors, and another surgeon.  Minutes before the exam I had opened  my urology text and the chapter happened to be about prostatic cancer which I quickly reviewed.  Somehow, I managed to steer the questioning around to the subject of prostate cancer and I aced the exam!

Now, finally, after all those years, we were finished, and after receiving our results (I still stood in the top quarter) we went through various  formal ceremonies, dinners and ethanol laced parties and were, at long last, convocated with our MD’s.  What a glorious occasion that was as members of Pat’s and my families attended the formalities and I was now Doctor Skjenna, the first in our Skjenna family line.

From the beginning when I decided to pursue this dream, the end seemed to be far, far distant in the uncertain vapours of time, but the destination was worth the journey and I could now relax for a couple of weeks before I undertook the next step which was internship.  The future would hold new and often unforeseen hardships as well as many victories and great satisfaction.

You go on. You set one foot in front of the other, and if a thin voice cries out, somewhere behind you, you pretend not to hear, and keep going.

Geraldine Brooks