The clinical assessment, essentially a practical
examination, was the critical part of the final examination which would decide
whether I was fit to put the letters MB ChB after my name and commence my life
as a doctor. It began with a requirement
to analyse a specimen of urine. With
three other equally apprehensive candidates, I was shown into a small side room
off the main hall.
On a long wooden laboratory
bench there were four glass phials each holding about 50 mls of fluid. Alongside
was a Bunsen burner, already alight, and a variety of chemical reagents in thick
brown bottles identified by their labels, such as Fehlings A and Fehlings B.
“Each of these bottles contains a sample of urine,” the
adjudicator said. “One sample contains
sugar from a diabetic patient, one contains protein, one has blood in it and
the final sample is normal. You will each
be given one of these urines and you will have twenty minutes in which to analyse
it using the reagents provided.”
It seemed odd that in a so called modern teaching hospital
we were expected to analyse the samples using methods from the Victorian era. The nurses on the ward could test urine for all three abnormalities in 30 seconds flat using commercially available paper strips.
Did they still treat syphilis by rubbing mercury into the
skin of sufferers I wondered? I suppose we had to be grateful that they
hadn’t turned the clock back to the days when the test for sugar was to put a
finger in the urine and taste it for sweetness!
I looked at the four samples. One was red, the other three were straw
coloured. Clearly the red one was the sample that contained blood and my silent
prayers were answered when I was indeed handed the red urine to test. Within five minutes I'd run the test and
confirmed the presence of blood. I then waited to be called into the main
examination hall to face my examiner.
I was nervous,
incredibly nervous, and felt an urgent need to use the loo. Anyone who suggests
that there is no connection between
anxiety and physical symptoms, particularly
gastrointestinal symptoms, must have led a very sheltered and stress free life!
Certainly
they cannot have experienced the pressure felt by medical students as they
approach the final examination of the medical course.
Pass and you become a doctor.
Fail and you spend the next 6 months swotting
and praying that you will be luckier next time.
As I waited to be grilled by the examiners, it seemed inevitably that
having found blood in the sample of urine that I’d analysed, the initial
questions would revolve around the causes of blood in the urine and the
treatment of these conditions. I therefore began to formulate in my head a list
of all the possible sites in the urinary tract from which bleeding might occur.
I started at the kidney where urine is
formed and considered each part of the system down to the tip of the penis from
which urine is voided – at least it is in men! (I mention this to prove that I am indeed a bona fide doctor and have a
working knowledge of anatomy.) I also
prepared a list of the various diseases that might be responsible for blood loss
from each of these possible sites. Having done so, I felt reasonably happy. I was as ready as I was ever likely to be to face
my inquisitors.
I would however have had much less confidence had I known
what dastardly trick the examiner was about to play on me!
Paul’s encounter with his
examiner will be subject of a future Blog
He had ambitions to become a sex maniac but he
failed his practical. Les Dawson
1934-1993
Comment In years gone by when urine had to be
tasted to detect the presence of sugar, a trick was practised by senior medics.
They dipped their middle finger into the urine but then surreptitiously inserted
their index finger into their mouths before passing the urine sample to one of their juniors with a frown and saying. “I’m not sure about this. Tell me what you
think.”
Mentioning syphilis brought to mind Voltaire’s account of
King Charles VIII (of France) military invasion of Northern Italy in 1495. “On
their flippant way through Italy, the French casually picked up Genoa, Naples
and syphilis. They were thrown out of Naples and Genoa but they did not lose
everything; syphilis went with them”.
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