Tired, dark, sunken eyes stared back at me as I looked into the mirror. No matter how hard I tried to hide it, the toll of my insomnia became more evident with each passing day. As I tied my long, wavy hair up into a pony, I practised wearing my favourite disguise. A warm smile which reached my eyes coupled with a voice that exuded just enough confidence that would gain anyone’s trust. I glanced at my reflection to make sure I looked presentable before donning on the brightly coloured mask that fit snuggly over my nose and mouth. My eyes roamed around the room to make sure I hadn’t forgotten anything as I walked out and locked the door behind me. 

With the sun’s morning rays beating down on my back, my legs trudged towards the Surgery department while my mind flipped through the diary in my head that contained all the information I had absorbed, hoping that it was sufficient enough to get me the marks that I required. As I neared the towering structure that had the name of the department written in bold on a bright red signboard, I counted every breath I took to bring my frantically beating heart down to its normal rhythm. I strode into the department through the double doors seemingly calm and collected.

As the minute hand of the wall clock passed eight, more students with exhausted looking faces walked into the classroom. By eight-fifteen, the room was occupied by the fifty-two students who were to give their final professional practical examination for the day. My fingers drummed on top of my hand-written notes and my leg shook while the two mugs of caffeine I had consumed for breakfast coursed their way into my system. When the clock struck thirty minutes past eight, the postgraduates walked in with an air of authority signalling the start of an intense day of scrutiny.

I packed up my things into my bag except for the five essential items that I stuffed into the pockets of my white apron; a stethoscope, a tuning fork, an inch tape, a torch and a hammer. Along with the five essentials, my pockets also contained pens, pencils, a hand sanitiser and most important of all, my admit card. I stood up from my seat, straightened out the creases on my apron and followed the instructions given out to us. 

As one of the first ten students, I was sent to one of the professor’s chambers where our vivas would be based on the pictures shown to us. My heart beat steadily in my chest while I shifted the weight of my body from one foot to the other all the while running through the images in my head that I had memorised. I counted my breaths, told myself a thousand times to keep calm until my turn came up and I was ushered in.

The hairs on my arms stood erect as my eyes fell on the tall, dark man seated behind the wooden desk. Out of all the professors, I got the one who was notorious for bringing down students just for the sake of it. Luck was clearly not on my side. I could hear the blood rush in my ear as I slowly neared the empty stool that stood in front of him. Even though half his face was hidden behind the grey coloured mask, I could sense an amusing smile spread across his face. I tried my best to maintain the disguise I wore but felt it falter when he leaned on his desk and his eyes met mine. 

I gulped as he turned his laptop towards me with an image of an incisional hernia. To prevent my hands from shaking, I interlaced my fingers and countered as many questions as I could that came my way. I was somewhat elated to know that I had answered most of his questions correctly even though his compliments felt more like a taunt. I was almost going to breathe out a sigh of relief when he asked me a question that took me by surprise. 

“Can you tell me the pneumonic that I gave in my class for hernias?” He asked, waving his pencil in the air. 

My mind immediately raced through every single pneumonic that I had come across but to no avail could I specifically recall what he wanted to hear. I shook my head in silence and mumbled the words we were taught to say whenever we didn’t know an answer, “Sorry sir, I don’t remember.”

“Have you ever attended my classes before?” He asked while rocking sideways on his swivel chair with one leg crossed over the other. 

“Yes sir,” I replied feeling the façade I had built up crumble. I could sense a sardonic smile behind the mask and immediately braced myself for whatever insult coming my way.

“Guess you attend my classes with your eyes wide open but your brain shut.” He let out a laugh as he flipped through the images on the screen and finally halted on an image of an oral lesion. “Can you tell me the differentials for this lesion?”

I rattled off the various names that popped up inside my head until I could no longer. Silence ensued between the two of us while he stared at me.

“Did you say Erythroplakia?” He asked, scratching his grey head with the end of the pencil.

“Yes… sir,” I stuttered, feeling a sense of dread wash over me. I knew I shouldn’t have said it. But saying something remotely correct seemed better than saying nothing at all. 

“Does it look patchy to you? Do you even know what it is?”

“Sir, it’s a premalignant condition,” I answered, my eyes darting towards the image of the oral cavity with a large breach in its epithelium coupled with erythematous spots.

“Does it look like a premalignant condition to you because to me it doesn’t?” I could feel the weight of his gaze on me as I scrutinised the picture one last time. I wanted to answer that one couldn’t really say if an oral lesion was pre-malignant based on a picture. But decided against it when my brain recalled one of the fundamental rules of medical school. Regardless of what the situation is, the teacher is always right. Unable to find the right words, I remained silent.

“So tell me who is right?” He asked, the tip of his pencil hovering above the file that contained the names of the various students. 

“You are sir,” I mumbled. 

“Say it loudly.”

“You are right sir,” I repeated myself loud enough for him to hear me. 

He nodded his head once, glanced at my roll number pinned to the lapel of my apron and scribbled a number next to my name. “You can leave.” He added waving his hand like I was a mere nuisance. I gulped down hard, thanked him as I got to my feet and walked out into the bustling corridor. 

I told myself it wasn’t that bad even though my hands were shaking. I walked to a secluded area, took in a few breaths, gave myself a short pep talk, donned the mask and moved on to the next viva I had to give, pushing all thoughts of the first one to the back of my head. I went through the other four vivas without any hindrance. It was not until I was allotted my long case did my jitters return.

As I stood next to the patient’s bedside, my mind began to replay the incident that had occurred the previous day. I never knew that a mere stranger who I’d meet for just ten minutes would make me question my self-worth by the end of the day. I remembered the rudeness of his tone, my inability to keep calm and my brain blanking out. But what left the biggest imprint on me was the look of pure disgust and rage on the external’s face. 

I shook myself out of my thoughts and continued with my history and examination all the while donning the façade that was prone to crumble once it was prodded. I spoke respectfully to the patient, examined the lump on his right upper abdomen and once I was done, I thanked him for his cooperation. As I sat down to complete my written work, the scene from the previous day and this morning replayed itself in my head. My legs began to shake and so did my hands. Even though I kept telling myself to remain calm, the other half of me screamed at me for botching things up. 

 It was past four in the evening, my head hurt and my stomach grumbled. Other than the two mugs of coffee and the half-eaten sandwich I had for breakfast, I had nothing else to eat. Even though we got a thirty-minute break to refresh ourselves, the mere thought of food made me nauseous. As I stood in line and waited for my turn patiently, the sense of dread returned. But before I could talk myself down, I was ushered in. 

When I saw the professor who was seated behind the wooden desk, I froze. He was one of the many professors that I kept high up on a pedestal. Immediately, I told myself that botching this viva up was out of the question. If I did, I would never forgive myself. This time, I would leave the room feeling content. But the reminder of the previous day’s event coupled with this morning’s catastrophe made my determination to perform well falter.

I steadied myself as I took a seat before him and waited for him to say something. His gentle eyes met mine and gave me the signal to proceed. I gripped on to the sheet of paper as I narrated my history and examination findings. He nodded his head while listening intently only interrupting when he needed to ask me a question. When I completed my narration I looked at the tall, fair man who wore a mask over his face and a turban on his head for any further questions. Everything was going according to plan. But just when I thought I was going to leave the room with a big smile on my face, a snag came up.

“Can you tell me the procedure we use when a large stone is present in the common bile duct?” He asked in his calming voice. 

My heart dropped. The answer was at the tip of my tongue but my brain blanked out and it refused to give me the answer that I required. I screamed at myself internally. It was an answer I knew but I just could not recall. After struggling for a few seconds to conjure up the information that I needed, I gave up. With a bowed head I repeated the words that I didn’t want to utter, “Sorry sir, I don’t remember.”

“It’s Choledochotomy,” he replied in the same calming voice. All I could do was nod my head feeling very displeased with myself. “You presented your case well.” He added which brought a faint smile to my lips. He gave me the signal that I could leave and I immediately stood up, thanked him and walked out of his chamber. I finally let out a sigh of relief before packing up my things and heading back to the tiny room I called home. 

As I took a shower, I revelled in the fact that my long case had gone well. But just as soon as the euphoria came, it dissipated. My thoughts wandered back to the moments that left me feeling miserable. Tears trickled down my cheeks while the shower sprayed water over my head. I dried myself, ate some food, drank another mug of instant coffee and opened up another book to prepare for the next examination.

*

Illustration by Mimi N.