Tuesday, November 13, 2012

The Chronic Case of DOCTORitis

An 18 year old male patient by name Mr. CET STUDENT, presented to LTMGH with chief complaints of an ambition to become a doctor since childhood. He was apparently asymptomatic before the thought, and the presenting complaint was sudden in onset, gradual in progression, with an ever increasing severity since the past 2 years and was stimulating in character, aggravated by seeing  successful doctors, and relieved after chilling out with the non medico friends.

Past History - No similar complaints in the past. He is not a known ratta master and slogger. Ranker since school. However, didn't find medicine equally easy. On general examination, he was conscious, coherent, co operative, well oriented to time, space and person, but is little disturbed.

Personal History - Single (even after several repeated attempts otherwise)

Family History - No reported case of doctoritis present in family.

Higher functions - Normal.
Attitude - Ambitious.
No abnormality was detected on clinical examination. He was admitted, for observation to relieve his complaint, and was subjected to a battery of investigations spanning over a 5 and a half years, involving all the senior members of the college.

At first he was reluctant to get 'treated' (ragging), but gradually was cooperative. He was put under tremendous pressure in the latter part of the first year. Complained of palpitations and nausea the day before the exam. Was not prescribed anything. He ultimately cleared the first year exam. This phenomenon continued till the third year, and a good response was noted as his chief complaint started to show some sort of improvement. All of his engineering friends were well settled. He was aging. He was feeling insecure.

Observation - Somehow, by god's grace, he was able to clear the final MBBS exam.
But, the journey was filled with a tremendous amount of pressure, tension, insecurity. He was tired of the investigations and even questioned himself during the announcement of results. He did not have any previous experience of doing this.

Today he is an intern and is preparing for PG Entrance.
Super added syllabus induced insomnia has recently developed. It was initially mild, but gradually increased to present state.

Today he doubts... He doubts his intellectual capability, his intrinsic curiosity and wonders whether he really needed this. He is even more confused than ever, about his ambition. He wants to achieve and prove it to everybody that he is somebody precious in this world. He wants to exemplify his existence. He realizes that the journey which he faced is just a preview of what lies in the Pandora's Box for his entire life. Digging through mountains of difficulties, he found himself stranded in the land of nowhere. So many roads to choose from, but each more confusing than the other. And now he wants to go back! To that very time when he chose this and change everything, but then is again confused as to what must be changed. The treatment and investigations the college gave were too much for him. Was it worth? Is it worth?

And suddenly he realized one thing... It is this journey which makes you unique. It is this very journey that carves a doctor out of you, that gives you all the stress and mental training required to be licensed to deal with lives. On top of all, it gives you the individuality which is also a by-product of this arduous journey.

He pondered over his condition and realized that this is the way, life here is and hence his complaint grew in terms of severity. He realized that every person who joins medicine and is ambitious to reach the finishing line is a successful person. He realized, there is no UNsuccessful practitioner.  Every doctor represents a success story.
This chap now realized that he was ground mentally and physically. And finally became a doctor, without even realizing.

Conclusion - MBBS teaches you a lot of things. Some very pleasant and some not really. Forget the stress and enjoy the road. The result will be an unforgettable journey...

Monday, November 5, 2012

He Just Laid There...


He just laid there. Waiting to die. A tiny beam of light entered the room, piercing the curtains. It landed on his face. He didn't shun away. It made him warm. Maybe the only warmth in the freezing cold. He thought, a cup of chai with some chapatis would be so great. But it didn't matter much now. It won't matter much any further. This shall pass. SOON...

He heard the cuckoo cooing. Or at least he thought he did. He didn't know what time it was or what day it was. But he chose to believe that it was a pleasant spring morning. And he SMILED!

Smiled?! How can one just smile in the face of death? Was he content? What had he accomplished in his lifetime to be at peace? Was he remembering his fond memories? Was he seeing the faces of his beloved ones? Where were they anyway? He just laid there, on his deathbed. But none of his family ever came to see him. Did he even have any?
He wasn't very rich. At least his clothes and belongings said so. They were in fact, practically non existent. He wore the same shirt everyday. Wet, it smelt bad. Vomit, fungus, blood. He just laid there, waiting to die. 
Cancer, had caught him really badly in its grip. But he wouldn't cave in so easily. He was too stubborn. He had decided to not to surrender to it, or at least the hospital staff.
 They tried to convince him to change into the hospital clothes. He didn't budge. They also promised to get him a shirt just like his. A dark pink one. "Which man wears PINK shirt these days?", he remembers that nurse whispering. But he still won't agree. All the biological additions to the shirt had given it red, green and yellow tinges. Maybe, that shirt was something special to him. And maybe, he wanted to breathe his last while still in it. He just laid there, smiling. Waiting to die. He didn't ask for a heater. Happy with closed curtains, he didn't let them switch on the lights. What would he do with all that light? Just stare into empty nothingness? Realize his own loneliness? Still in his late forties. And it was his birthday today! He wondered how the tune for the 'Happy Birthday' song went. He hummed a few notes but soon his cough put an end to all the excitement. Coughing, gasping for air, he still smiled. How childish of him to try and sing to himself.
It was silent. What broke it intermittently was just the beeps of a machine that told the doctors that it wasn't yet the time to sign that death certificate. They kept it ready anyway. Cruel? What could they otherwise do? This homeless could never pay the bills of the hospital.
He thought he should sell his ring and thank them with all that he could. Trying hard to lift his hand up, he felt he was trying to move boulders. He heard the bones chuckle at his efforts, he let a sigh out. Bringing the ring finger close to his eyes, he opened them. In that tiny beam of light he couldn't see much clearly with his moist hazy eyes.
And he was shocked! The tiny beeps in the room now crooned faster. He opened his eyes wide open to find his ring finger empty. Then, he realized something and the beeps mellowed down. He let his hand fall by the side again and heaved a sigh. He remembered; it was stolen many days ago. Not that it mattered much. It was a stolen one anyway. He felt sorry now, for having taken away something from someone that would've meant the world to them. He imagined, having to part with that shirt of his. The thought itself was so painful. He regretted all his wrong doings now. Living off the streets, he never thought about the tomorrow. Friends? You don't really have them when you just share footpaths. Acquaintances, yes. But with all that he has done or rather not done for anybody, will anybody remember him at all? Maybe he won't be punished in hell for his sins. Maybe he won't be damned. And maybe there will be some place for him in the heavens. He just laid there... Waiting to meet his lord.
 He was once a free bird. Living carelessly. Celebrating life, even when he didn't have a great one. Does one really need money to be happy? Luxury, to live like a king? He welcomed morning suns on his face and bid good nights as he stared at stars in heavens. He drank till he fell down and got up to drink again. Death? He never thought about it. Never. And now, he just laid there... Reminiscing.

 His room was in one corner of the hospital. He could hear innocent laughter of a small girl who had come to meet her dad in the room just across the wall.
He could feel the grief and sorrow of an elderly woman crying for the loss of her husband. He envied him. He envied them both. For they had love. For they had somebody who cared. Somebody who grieved. Somebody who prayed. Somebody who would miss them when they were gone. And he asked for nothing more than that. Nobody out there in that huge world would care or even know about some sick, ill, lonely, diseased. He didn't want to die like that. With nobody knowing that he existed. That he ever lived. He just laid there... Hoping somebody would know.
He wasn't disturbed much even by the hospital personnel. His existence remained now merely as a bed occupant. Often an intern would come and note his vitals. Measure his pulse. Simply the human touch would add a few more breaths to his last remaining few. He had otherwise refused any medications. With no therapeutic hopes left, the only pills they could give him were to reduce his pain. To let him go quietly. To make his end softer. Had that happened he would be practically gone long before he really did. He wanted to feel every moment of existence. He wanted to feel the pain, it reminded him that he was still alive. He wanted to live every moment while he was 'alive', as much as he could. He just laid there... Waiting for death to lay his icy cold hands on him.

The door opened. The lights came to life. In came a maid, with a broom in her hand. She smiled at him, inquired about his well being. Asked him if he had breakfast that morning. Sweeping as she spoke, she asked him his name. "Naam kya hai aapka, chacha? Diwali aa rahi hai, aapke gharwaale kahan hain?" She finished her job and came up to the bed. She smiled at him and noded. She said, "Daro mat chacha, sab theek ho jayega" and she left.

Everything will be alright. Everything will be fine.

He smiled. He couldn't speak, but he felt really nice. He could hear the beeps slowing down. Tired, as they were, they told him that it was time. His breaths became slower. He closed his eyes and smiled. A tear drop escaped the corner of his eye and trickled down along his cheek. The drop disappeared on touching the sheets and he knew it was time for him to go too. At least somebody now knew that he existed. That he lived. That he died. Now, he just laid there...
 ... At peace.

Sunday, June 17, 2012

A Guide To 1st Year MBBS - The DOs and the DON'Ts


(NOTE: Some pictures are not visible due to certain reasons. Will try to update soon)
 
I remember the day I knew I was getting admission into a medical college. I was overjoyed and overwhelmed. Couldn't wait for the professional course to start and finally wear that apron. My dream since I had first thought of being a doctor.
Well, you are here reading this. You might just be the ME one year ago. Over-enthusiastically Googling for study tips, book lists, memory write ups or just stalking your seniors in 1st year M.B.,B.S.

Kudos then! I'm sure you must've rocked your CET, come out bang with a huge score and an amazing rank! Admission process will be done and you'll soon know which medical college is going to carve out an amazing doctor out of this little genius.

I decided to hence in short write how your 1st year M.B.,B.S. will be, how you will have to study and which books you can use.

You'll have the Dean's (headmaster of college) address. Your professors and seniors will welcome you to the institution. And the lectures will begin. Our seniors gave us the tour of the college and a map of it. But if not, be sure to explore the campus.

Mainly in a medical college, newbies are afraid of being ragged. But don't worry, most colleges have really strong anti-ragging committees and you have good protection against any bad behavior. You won't be ragged! At least physically. But if your seniors try to talk to you, ask your name, CET rank or hometown, don't be shy and run away. To get people talking most seniors try to devise funny games and weird tasks. Be a sport and play along. These moments will strengthen your bond with them and believe me, you are going to require their help A LOT! They can advise you on which books to use, which lectures to attend and even what clothes to wear on the day of vivas! Being a chicken will only keep you from these words of the gurus! You might be made to complete some journals or bring cigarettes from the naka, but its a part of it.

(note, hereon the post will be more specific to medical colleges of Mahrashtra. Other state colleges may or may not have the similar pattern.)

(This is a huge and a very long post. I have tried to nearly cover all the aspects. If you cannot finish in one reading, make sure you bookmark the page and finish it later.)

Coming to the academic affairs. You won't deal with any patients this year. Apart from those asking you for directions or some  room no 312.
You will have 3 non-clinical subjects for your 1st year.

1) Anatomy
2) Physiology
3) Biochemistry

Anatomy is basically the study of the master piece. The intricate structure of human body.
Physiology will tell you how this creation works fascinating wonders. The body processes.
While Biochemistry will tell you how the tiny non-living magician molecules interact with each other to sustain this miracle of life. (you know the Glycolysis pathway and Krebs' cycle, right?)
You must have done the basics in your 12th, but now these will be much detailed.

Each subject is taught by a department.
Each department has
1) Head of Dept (HOD)
2) Professors
3) Associate Professors
4) Assistant Professors / Lecturers
5) Residents (The PG students of that subject)
6) Non-teaching staff like Peons, Clerks etc.

Each dept will have separate classrooms, lecture theaters, labs.
Of the 6 working days you'll have
3 days Anatomy
3 days Physiology + Biochemistry.

Morning lectures will be followed by an afternoon break and practicals later.
75% attendance for lectures and 
80% attendance for practicals
is compulsory according to the MUHS (Maharashtra University of Health Sciences, Nashik) rules. Try to complete it. You don't want the hassles at the time of form filling for the finals.

You'll have 2 main exams, whose marks will be considered as internal assessment marks, which will contribute to your final score.
1) Terminal exam - based on portion covered till then.
2) Preliminary exam - entire syllabus.
(Papers set by the college itself)

Minimum of 50% score is required separately in theory and practical exams to pass.
And believe me, its not a cake walk.
35% minimum in internals is required to be eligible to appear for final exam.
 You have theory as well as practical exams. The practicals include the Practical experiments you perform (in Physiology and Biochemistry) and Vivas on the topics. Vivas are basically like the oral exams we've had in schools. Practs are very scoring and boost up your percentages, but also the ones where you will be really tested and can't fake knowledge.

Final Exam-
1) 2 papers of each subject with 50 marks each
2) Practical Exam for 60 marks
3) 40 marks internal assessment (20 each for theory and practicals)
Total of 200 marks for each subject.

You may have small part completion tests arranged by some departments throughout the year, but their marks won't be included for internal assessment. (however don't let this be a reason for you to take them casually. Studying for these exams helps a lot to reduce work load for finals.)
You'll have journals for each subject. Make it a point to complete them on time and get signed. Otherwise finally when you need time to study for prelims, you waste time drawing shabby diagrams and writing shit! Avoid making mistakes/shabbiness while completion if you don't want redraws.
The finals are in May-June. These are conducted by the University. Common papers to all medical colleges of Maharashtra. You get a month long preparatory leave after prelims and before finals to study for them.
M.B.,B.S. is in fact a course of 4.5 + 1 (compulsory internship) years.
1st year - is of practically only 8 - 9 months
2nd year - is of 1.5 years
3rd year - is of 2 years

(Don't ask me why they call it an year then)
As the portion is huge and time left after admission process is small, 1st year is in fact comparatively more difficult than 2nd year.


Bhalani's are the one stop shop for anything and everything related to medical education. You'll find one Bhalani's shop near every medical college. From all the books, to dissection tools, to aprons. Everything you'll get here. The KEM wala Bhalani is the largest though I guess with lots of options for books. The Bhalani's publish another book, which is the manual for 1st year. All the details of exams and college process will be available in it. But most importantly, it has the IMP (important) questions and question papers of previous years, which are very necessary in studying for your exams.
I suggest make medium sized 100 pages innumerable notebooks for every chapter being taught in the lectures instead of a large one for each subject. This will prevent the hassles of having to find a particular chapter finally when you need to read. Jot down as many points as possible.

-Firstly because it helps in memory reinforcements and you start learning from the lecture itself.
-Secondly, the points explained by the professors are from books that you’ll never even hear of. And these help a lot during exam preparation.

(For LTMMC students, write each and every word spoken by Dr. Mahendrekar, Dr. Jaya in Anatomy,
Dr. Iyer, Dr. Pawar, Dr. Mishra in Physiology and
Dr. Dipnaik, Dr. Mane, Dr. Dias in Biochemistry)
A doctor once told me, nearly 50% of the medicine that you practice in your career will be learnt in 1st year.
Let me now tell you about each subject. And books to be used.

1) ANATOMY

This is the largest and most extensive of the three, requiring intense hard work and sincere efforts. The first fear that every medical student faces, is the fear of long words - HIPPOPOTOMONSTROSESQUIPPEDALIOPHOBIA.
How to remember the anatomical terms? Forget the remembering part, even pronouncing them sometimes reminds you of 'She sells sea shells...' tongue twisters. This can be easily tackled with a smart idea from day 1.
Most of the medical words have Latin/Greek origin. Studying the etymology, that is, how the word has been derived will help you a lot in remembering the words, as you'll know the meaning of the word. It's fun too.
Common Carotid artery - karos means deep sleep. As this artery is main supply to head and the brain, any hindrance can cause coma.


You'll need a medical dictionary. Dorland is best but I would suggest Taber's as it has clinical teachings too.
Taber's 20th edition is Single Volume and Dr. Natrajan's book
To study etymology, I made a small diary. Where I would write down  the Latin/Greek roots of words and their meanings. Search any damn word in Taber's, check the origin. Such study will let you understand even new words you come across for the first time also, as the roots are same. A medical dictionary app on your Android can come handy.
My Diary
Also there's a book called Understanding Anatomical Terms by Dr. Natrajan of GSMC. I found it very useful and interesting.

Now there are again different subjects in Anatomy itself. That's what makes it larger.

General Anatomy
This is basically introduction to basic concepts of Anatomy. The first few lectures will be conducted on this. General Anatomy by B. D. Chaurasia is a very small book that can be used for it. If you are interested you can read it even before the college starts. Make sure you finish reading it completely, once before the terminals at least. Otherwise from exam point of  view only 2/3 chapters are asked as questions.

Gross Anatomy
This is the anatomy which you can Grossly see. That is without any microscope or special techniques. Here you will learn by dissections of cadavers (preserved dead bodies with embalming). Now I know there are many notions about this, but no, it is not frightening. And you get used to the smell and fumes of formalin in 2 days. Some people do faint or feel giddy on first day. But this doesn't mean they are weak or anything. Just try to avoid standing near edges to prevent getting hurt in case you are feeling giddy and might fall. 2 weeks later you'll get so used to dead bodies that you'll play with the dissected adipose tissue! However learn to respect the cadavers. These were thoughtful people who donated their bodies so that doctors of tomorrow could learn. Don't feel ashamed to do anything. You might have to dissect rectum and remove stools manually if they're inside.
Giving up all the shame and inhibitions is what you'll anyway learn in a medical college.
You'll be divided in batches and share dissection tables. Take turns dissecting. The portion is divided in 5 parts called Regions
1) Upper limb
2) Lower limb
3) Head, Face and Neck
4) Thorax
5) Abdomen

You will have different batch teachers for every region who will guide you in dissections and take Lecture-cum-demostrations (LCDs) for specifically your batch. They will also take the osteology that is study of bones for you. You require a bone set (unilateral/bilateral) which you can buy from your seniors. Don't buy the Plaster of Paris ones, you need originals.
Mr. Sakhalkar from Sangli can also provide you with bones if they are available - 09923269674
Gross anatomy forms the largest chunk of marks in Anatomy and will be most useful further in your career.

Books-
1) Cunningham's Manual of Practical Anatomy
This is a superb book and guide for dissection, but is mostly ignored by students because of its complicated language. Every college makes it compulsory to carry this book to dissection hall. The step wise dissection and description helps a lot. Correlate the dissection in situ with the beautiful diagrams. Usually when 4 people are dissecting, others must read Cunningham and direct them. This happens smoothly during the first few months when you are excited. However slowly people find playing Angry Birds more interesting. But don't ever get away from dissection table even for a minute. Keep looking and dissecting whenever possible. I used to fight every time for dissecting and as later other people got bored, I practically dissected everyday. This will help more than reading theory even 5 times as you'll understand relations and form pictographic memory. Especially important if you dream of becoming a surgeon tomorrow. Initially it will be difficult to understand Cunningham, but as you get hang of the anatomical language you'll bless me for stressing so much on this book. Remember, nearly 60% of gross anat you will learn in college. So pay attention to every detail in LCD, however sleepy you might feel after the lunch. Feel free to go and see bodies assigned to other batches too. Helps to learn variations. Don't be worried about damaging any anatomical structure. People usually stop dissecting by the fear that they might cut some nerve. But better do it now on cadaver rather than doing it on a patient in surgery later. Similarly don't shout on your friends who damage anything.
2) Human Anatomy by B. D. Chaurasia - 3 Volumes
This is the bible for theoretical gross anatomy. It has amazing line diagrams which can be easily reproduced in exams, but are shitty and boring for understanding. Mostly people substitute Cunningham with B. D. Chaurasia (BDC we call it) but it is necessary to have both. The descriptions are very good in form of notes which if you write in exams will fetch you perfect scores. But don't just mug the answers. Try to understand every concept, otherwise the mugged memory is there to stay only for few weeks. Reading BDC after Cunningham and dissection is the ideal way. Read a particular chapter from BDC the very same evening it is completed in LCD that day. Because you won't understand much of the next LCD unless you do so. Most colleges also display their program for the next day. So if you know what will be taught next time, try to glance through the chapter at least, so that you aren't completely blank before the LCD. This will certainly help in topics which are very huge and covered in a jiffy by the teachers running on tight schedules. As you come across new word, remember to find its roots in Taber's and note in your diary. Also read the Clinical Cases of that topic from BDC given at the end of chapter.

1st year subjects are non-clinical, that is, you learn the fundamental sciences. But the patient tomorrow will present  (come) in your CLINIC with some complaints, symptoms when something goes wrong. Clinical correlations, either in Anatomy, Physiology and Biochemistry are these usual complaints and disorders. These are very interesting and exciting. Diagnosing (finding out whats wrong) is the most fun! But don't get carried away much by it. Its what you are anyway going to learn next 4.5 years, so concentrate more on basics.

Writing clinical points at the end of answers earns you brownie marks, but not if you've not written the basic anatomy of it.

3) Human Anatomy by Vishram Singh
This is a newer substitute for BDC, which has more clinical correlations. I've personally never used it, but they say its good. May help you in scoring as your points would stand out of the usual BDC written papers. Whether to buy Vishram Singh or BDC, your choice.

4) Clinical Anatomy by Richard Snells
Best book for clinical anatomy, but less of anatomical details. Helps best after you've read BDC. Most used by post graduate (PG) aspirants. Subscribe from library rather than buying.

5) Anatomical Basis of Clinical Practice by Henry Gray
This is the BIBLE of anatomy. If you manage to read this, you'll be a GOD of Anatomy. But not recommended. Firstly because its huge and has complicated language. Reading a page takes 1 hour. Secondly, you aren't expected to know such details at under graduate (UG) level. Anyway BDC is a word to word, point wise copy of Gray's. So you don't miss the important details. Use library versions to read certain topics like Perineum from it which aren't given nicely in BDC or to solve your doubts.

6) Students Version of Human Anatomy by Henry Gray
This is a hand book bible, condensed edition of original. May substitute BDC as it has better diagrams (paintings) for understanding. But disadvantages are, does not have point wise description and simple line diagrams needed for exams.

7) Atlases
These are collection of pictures of anatomical structures along different planes and views. These are a MUST to understand and learn Anatomy. Ideal way of studying Anatomy on the evening of LCD would be with a mug full of steaming coffee, BDC on your lap and different Atlases spread on table. Whenever BDC describes something, try to look for it in the pictures. TRY TO FIND EVERY FRIGGIN' DETAIL of that structure even if it means aching backs with hours of page turning. This investment of time is worth as there is reinforcement of pictographic memory of dissection. Also as our dissections aren't perfect, you can see all that you might have damaged in dissection. Options available are -
- Atlas of Human Anatomy by Frank Netter
All time favourite. Best for understanding relations, courses and finest details. I couldn't find even a single mistake inspite of trying to, desperately! Best according to me. BDC + NETTER  + CUNNINGHAM + DISSECTION = ASSURED DISTINCTION

- Atlas of Anatomy published by Thiemes
My favourite, because of amazing clinical and physiological correlations. Also better for osteology, joints and muscle attachments than Netter. However isn't as flawless as Netter's.

- Colour Atlas of Human Anatomy by McMinn
Best for those final touches to concepts and practical exam study as it has real time pictures of dissected bodies rather than paintings. Let's you understand textures and real looks of anatomy.

- Grant's Atlas of Human Anatomy
I sincerely have not much used this, hence can't comment. However it is the most used by my seniors and clinicians for its accuracy. They sometimes prefer it over Netter's.

Having 1 Atlas at least is a must. Rather USING it is a must! I have seen people reading BDC without using any Atlas! Its like wearing a Tuxedo without wearing a trouser or even any underwear! Superficially you think you're looking smart and handsome. But down there (conceptually) you are a total NANGU (naked).
I myself have the top THREE Atlases. And I made it a point to check the structure being described in BDC from all possible views and all possible atlases. Takes a hell lot of time on those LCD evenings, but once done, you can then read BDC alone. Also you score SEXY HUGE in practicals! Also, if your college provides you with a journal for Gross Anatomy, make sure you complete it that day and get it signed from your batch teacher before he leaves for another batch when the next region starts.

Histology
Histos is tissue while logia is a study. Here you basically study different tissues under microscope. Good understanding of histology will help you better understand the physiology of the tissue.
Lectures on different topics are conducted during morning sessions while you have practicals in the Histology lab the very same day, where your batch teachers explain the structures again.

Books-
1) Human Histology by Inderbir Singh
A very good book covering all details from Gray's. Very detailed explanations and functional aspects.

2) diFiore's Atlas of Human Histology
Must carry it during histology practicals and read carefully as you stare at the slide under microscope, side by side.
Don't waste your time during histo practs. People generally take a look at the slide and then while away checking out the gals and guys of the batch. When all the 56 exam slides come together, it becomes difficult to distinguish epithelia from connective tissue. So make it a point to remember the specific features of the slide. Complete the journal that very week and read about the slide from journal too. You can use only eosiniphil and hematoxylin pencils for diagrams. These are very frustrating as they break easily. `Buy pencils of a company called Staedtler, darker and stronger (these aren't available everywhere, so tell your Malad/Chembur friends to bring them for you. they are costly, so sort out the money matters then and there.) Draw diagrams from diFiore's only. And perfectly. Otherwise you might get redraws. You won't be allowed to attend the next histology practical unless you submit the completed journal of previous practical. After finishing the diagrams, read the theory about the slide from Inderbir Singh. Your next histology practical will be a week later. So doing 1 diagram every day will reduce the work load and give you efficiency at the slides you study.
You have to do this besides reading the Gross anatomy that has be taught in the LCD taken that day.

Embryology
This is the study of the developing human, in the womb of the mother. You must have done the basics of it in 12th, now you will learn the process. Good understanding of embryology helps a lot in understanding the WHYs of gross anatomy.
You will have lectures similar to Histology but no practicals as such. Some day, you will showed different models (plastic statues) of embryology by your teacher and these models will be kept in finals for viva.

Books-
1) Human Embryology by Inderbir Singh
Basically the BDC for embryology. Beautiful line diagrams, simple language. Enough for those who just want to pass in it. Must use for exams.

2) Langman's Medical Embryology
Detailed and beautiful description. Real photographs and amazing concept teaching with clinical developmental anomalies. Used by most teachers. Combined with Inderbir Singh for exams is the winning combination.

3) The Developing Human by Moore and Persaud
Basically the Gray's of embryology. Excessively detailed, breath taking photographs, huge no. of clinical cases. Recommended for specific topics like Pharyngeal arches, Cardiovascular, Urogenital system development. Use library versions.

4) B. D. Chaurasia's dream - Human Embryology
New in market. Not much used. Basically a competition to Inderbir Singh.

Neuroanatomy
Study of the Nervous system. You will have lectures on it. As you finish Head, Face and Neck (HFN) region, you'll be shown different parts and cut section specimens of brain in the dissection hall. These will be kept in practicals and there will be a viva. Read the same evening of the lecture and revise BEFORE sections are shown. Reading the Central Nervous System physiology which forms a huge chunk of marks in Physio, will help you better understand the Neuroanatomy. Read corresponding chapters from Physiology even if they are not taught along with anatomy as the function will help you understand structure. And vice versa.

Books-
1) Textbook on Clinical Neuroanatomy by Vishram Singh
All time favourite. Most preferred and helps a lot even in Physiolgy. Very good clinical cases.

2) Human Anatomy by B. D. Chaurasia - volume no. 3 
After the HFN descriptions, Chaurasia has included a section for Neuroanatomy. Very good for cranial nerves study. But I prefer Vishram Singh.

3) Clinical Neuroanatomy by Richard Snells
Haven't personally used it, but applauded hugely by all my friends who did. Amazing clinical cases.

Study Neuroanatomy just like Gross Anatomy, with Atlases.

Human Genetics
Study of genetic heredity and clinical basis of congenital diseases. Lectures are conducted throughout the year. Not asked in practicals only in theory. Smallest book and smallest syllabus. Hence ignored completely by most students (including me). But a guaranteed question asked in finals, predictable questions and cake walk for 4 marks. Especially in our finals, no question was specifically asked on General Anatomy or Embryology but it was asked on Genetics. Human Genetics by Dr. Gangane is the most used book. Even in that we have only selected chapters, not the entire book.

Radiology and Living Anatomy
Radiology is study of anatomy using advanced imaging techniques for diagnostic purposes. Like X-Rays, MRI, CT scans, Arteriograms, Bronchograms and Ultrasonography. These are appropriately taught in the LCDs of specific regions and a 5 marks viva is conducted. B. D. Chaurasia gives a basic informative chapter on Radiology at the end of a region. Snells gives amazing clinical correlations. For people more interested in it, there's a book by Halim Das.
Living Anatomy mainly includes testing a live subject. In the practicals, a peon is made to sit and you are supposed to check different actions of muscles, palpate (check by touching) arteries, etc. Even this is covered extensively in BDC and mostly ignored by students.

Complete the specific sections of the Gross Anatomy journal which are reserved for these other subjects too.

This is all about Anatomy. As you see, Anatomy itself is so huge and takes up so much time during the entire year, that at a point you wonder if you have applied for a Post Graduation course in Anatomy. But if done systematically, Anatomy is very rewarding and raises your percentage very much. Also it forms the foundation for Surgical branches and  hence must be perfected right now.
The Anatomy department of LTMMC conducts a 100 (theory + practs) marks part test after completion of every region, which includes all the portion taught in Gross, Histo, Embryo, Neuro General anatomy and Genetics from the previous exam day to the next exam day. Study for them as your burden will be reduced for prelims and finals and also you'll get enough practice of answering in vivas. However they aren't considered for internal assessment.

2) Physiology

Physiology, according to me, is the most interesting subject of all three. Function determines the Structure. Every anatomical structure has developed for its specific function. And hence understanding Physiology will help you understand Anatomy better. The opposite is also true.
Physiology requires patience, creative imagination, curiosity - the thirst to know the HOWs and WHYs and logical, deeply conceptual study. But once you understand it, there's no forgetting. This demands extra attention in lectures and lots of doubt-asking to the professors.
It is mostly ignored by many because of its simplicity and easy understanding but it becomes difficult to finally finish it for prelims and finals especially if you have bunked or not paid attention in lectures.
Understanding the basics of physiology is very much required as it will form the basis of Pathology and Medicine in subsequent years.
Do not bunk lectures of any subject, especially not of physiology. The direction of thought, the clinical manifestation and general ‘FEEL’ of the topic, you’ll only get from the professor’s teaching. (VIP for LTMMC students, where we have amazing professors like Dr. Iyer, Dr. Deshpande, Dr. Mishra).
Passing in Physiology is fairly simple if you have a logical thought process and attentive mind in class, but scoring a distinction requires near perfect answers, which needs hours of slumbering at concepts and ideas you won't find in the usual study material!

You will have Physiology lectures in the morning with 1 or 2 Biochemistry lectures interspersed. And 2 out of 3 days you will have physiology practicals with 1 out of 3 being Biochemistry practicals in the afternoon. Physiology practicals can be of –
1)  Hematology – small experiments where you have to use your own blood, with small finger pricks. (eg. Hb by Sahli’s hemometer.) It doesn’t pain much and slowly you get used to pricking yourself. If sight of blood freaks you out and if you feel giddy, stand away from table edges. You can also ask any peon to give you pricks. Because most of the times, out of fear our pricks aren’t deep enough to give enough blood for the experiment. Hematology procedures are mostly taught by residents (PG students of Physiology.) The teaching part of it, thus can be boring. Hence fight the urge to sleep. Also, feel free to ask any doubts to senior professors after practicals.
2)  Clinical Physiology – A boy from the batch volunteers as a subject (otherwise the teacher selects at random). On the subject you will be taught physical clinical examination (those things a doctor usually does when you go to him with stomach ache or cold complaints). Write down the extra points told by residents (saves time of reading Hutchinson). Do not feel shy in either volunteering or examining the subject. As I said, in medicine, give up all the shame and inhibitions.
    The clinical abnormalities (which you obviously don't see in your friend) are taught (ineffectively) by the residents. Most of the times, you don't understand much in spite of concentrating. Hence learn to be curious and find out, what would change a normal physiological state and cause the abnormality. You have internet on your phones and seniors along the corridors. Learn to be parasitic and nibble away at their heads, keep asking questions. The more you learn clinically oriented, the lesser do you tend to forget.
3)  Charts/Graphs/LCDs – Here you will be explained different charts or graphs (eg. Understanding ECG.) But these topics are mostly even covered by senior professors in their lectures. Hence paying attention in lectures will help you here.

Books- (contact Mr. Advait Sonar, LTMMC for details on this section)
1)  Medical Physiology by Guyton and Hall
This is the bible of Physiology for UG students. Unlike Gray’s of Anatomy, this book is very lucid, understandable, Amazingly Interesting and the best book to easily build your concepts. Reading Guyton is like reading story books. There is a fluency in the description, hence the thought processes become clearer. You just can’t afford not reading this book. In fact, I have advised many juniors to start reading it as soon as possible, even before the college starts. (downloadable .pdf versions are available on net). Finishing 5 chapters of physiology before the commencement of teaching helped me a lot in reducing work load when anatomy pounced on with all those words.
The drawbacks are –
i)  Redundancy – The same concept is re-explained throughout the book wherever required, thus increasing the thickness. However this in fact helps in concept strengthening.
ii)  Descriptive – The chapters aren’t point wise. Hence writing perfect answers for marks scoring becomes difficult.
iii)  Lacks certain details – When the professors teach during the lectures, they include many different points from various books, which aren’t explained in Guyton but are expected to be written in exams. Here, notes of teachers can help. (other option is reading reference books)
iv)  The hematology and immunology section dealt in college in excessively detailed and clinically oriented which is not sufficiently dealt with by Guyton. However reading them once from Guyton will form the basic concepts needed for understanding other books. Khorana is the most preferred book (never used by me)
MUST HAVE GUYTON!. If you think of buying other book, I would advise downloading the online version and printing the chapters that you would want to read. Hence you need not carry a huge book, also giving you the liberty to attach those pages to your class notes.

2)  Ganong’s Review of Medical Physiology
Professors’ favourite. Almost 90% of the lectures will be based on this. Thinner as compared to Guyton, but note that it is a REVIEW. Hence, not much descriptive. Used by PG aspirants for CET preparation. However certain points from this books are expected to be known at UG level which will be explained in lectures and must be noted down. Reading this book after Guyton will give you extra edge in exams. Not advised because of complicated language.

3)  Textbook of Medical Physiology by A. K. Jain – Volumes 1 and 2
Most of the students substitute Guyton with this book. It is a complete book with word to word simplified copy from Ganong, hence preventing the notes writing. Also very systematic, point wise and thus huge bonus for marks scoring. Has innumerable line diagrams, tables and flow charts which when included in papers are examiner pleasers! Amazing However not as lucid and descriptive as Guyton and tends to become very factual and hence sometimes frustrating. Not many mistakes. My personal favourite.

4)  Physiology Prep Manual for Under Graduates by V. D. Joshi
The beloved darling of under graduates. For its Question-Answer format teaching. A copy of Guyton without the unnecessary redundancy and perfect point wise description. Also covers the hematology section very well.
Students who usually ignore Physiology either for enjoying their first year, or simply because of anatomy work load, usually resort finally to this book for exam preparations, as it makes completing one reading, possible in those desperate times. However this book will not help a one bit in developing basic concepts and will only confuse more, than help without prior reading of Guyton and lectures. My advice would be to use this book for exam preparations only after reading the concerned chapters from Guyton.

5)  B. J. Notes
My B. J. Notes
I don’t know whether this can be included in the list for books. These are nothing but printed notes from the professors of BJMC, Pune which are extensively circulated throughout the medical colleges of Maharashtra. Highly systematic, point wise, concise, including only the questions asked in the exams. No diagrams, typewriter script and dull pages with infinite markings make it very boring and tiresome to read. But a winner during exam preparation, as it covers all the points. WILL NOT AT ALL HELP DEVELOP ANY CONCEPT. My advice would be to use this after reading Guyton, only during the exam preparations. Also must refer to A. K. Jain (AKJ) for the necessary line diagrams.
If possible, procure these at the commencement of the year. (You will easily get them from your seniors, which will have their markings and ever those of THEIR seniors. Or you could buy it from a stationary shop besides the BJMC Pune.) As you read Guyton throughout the year, I would suggest you see the types of questions being asked in BJ Notes and try to frame your answers from Guyton.
If you dream of distinction in Physiology, making your own perfect answers would help a lot. For that-
i) Check the questions of BJ Notes
ii) Read corresponding sections from Guyton and AKJ
iii) Add points from Guyton and flow charts and line diagrams from AKJ to the systematic points of BJ Notes.
iv) Make your own notes and answers for questions.

6)  Medical Physiology by Sembulingam
It is point wise, very systematic and ample of flow charts. It has beautifully explained hematology. However, many mistakes and controversies. Not recommended by professors. (Some LTMMC professors hate it)

7)  Practical Physiology by V. D. Joshi
A MUST HAVE for practical examination preparation. The journal prescribed by MUHS usually has less details. This book makes up for it and includes many important viva questions. Hutchinson’s Clinical Methods (use the library version) is a book for Medicine, which explains Clinical Examination beautifully with lots of pictures and solves many doubts which the Residents teaching these topics can’t.
My advice – buy 1+3+5+7
Your logic and understanding will make it fairly easy to pass Physiology exams, but scoring huge here is a Herculean task and requires tremendous efforts.
One thing for sure, Physiology is a subject to be loved and romanced & <3 :)
This will form the largest basis of your concepts for successful medical practise, so be sure to perfect it.

3) Biochemistry
Biochemistry is the subject that deals with mainly the chemical reactions taking place in the biological world, in this context, the human body. It mainly has Chemistry of these different compounds (Carbohydrates, Proteins, Lipids, etc. just the way we had in 12th, but in much more details) and their metabolic reactions and pathways taking place in tissue metabolism. It will also deal with molecular biology that is DNA and RNA (the stuff we did in the chapter Biotechnology).
Basically, Biochemistry is the language of Biology, the study of which is essential to understand basic functions and working of cells at molecular level. The details of these, will later be of your great importance in you field of Medicine. (Medical field has two approaches of therapeutic treatment - Surgery (by cutting into the skin) and Medicine (by just sending in battalions of molecular soldiers) )

Most people (including me) fail to grasp the beauty of this subject in the initial few months, never seeing it beyond the "senseless" metabolic reactions and "mugging".
Biochemistry is much more than these, IF TAKEN SERIOUSLY. Which rarely happens, as this is the easiest of all subjects! It is a darling of last minute readers as Biochemistry being the smallest and the simplest can be easily covered. And it shoots up your percentage like anything. With li'l bit of extra hours of reading and few more mugs of dark coffee on the night prior to the exam, you can easily score a distinction in this. YES, it is easy.

Now my views on this subject are a wee bit controversial, and it depends on you if you decide to follow them. (frankly speaking I myself have never studied this much. Not even 1/4th of the Physio that I've done. Hence, Shivani Chopra will be the best person to seek advice in this subject)

The chemistry part of Biomolecules is mainly dealt in 12th. So initially it will be kind of revision with added details. According to the MUHS rules, it isn't compulsory to remember the structural formulae of the molecules, but I stress on doing so, as the structures help a lot in understanding many reactions. Feel free to continue using your basic concepts of chemistry from 12th, here.
The metabolic reactions and pathways form the largest chunk of marks and hence are obviously studied by everyone. Now here, in medicine you won't be showed structures of every intermediate or even taught anything about the reaction. You'll just have to mug the names of chemicals in order, with the necessary enzymes and biocatalysts/conditions. This tends to become boring and difficult, and hence I suggest the method of writing down pathways. After you finish reading once, go on filling notebooks while you try to remember what you just read, which will tell you where you are getting stuck. Reread and rewrite. Make charts of these and put up on the walls, study table and behind the toilet door (esp the difficult ones. Sitting on the toilet the alpha wave activity of brain increases, making it easier to concentrate. Ever wondered how all your awesome ideas you've got while emptying your rectum?)

Biochemical details will tomorrow help you clinically in diagnostics. But with so much of Anatomy and Physiology load, Biochemistry obviously doesn't get much time.

Now I'll be very practical and sensible while saying this. Don't break your head much after Biochemistry on the lecture days! Yes. Firstly, it is easy and hence can be easily covered later. Secondly, most of the part being memorizing, you anyway have to reread everything before the exam (Unlike Physio. One time investment, life time returns <3). Thirdly, if you try to do all three simultaneously there's a huge chance that you might just not give the necessary attention to either Anatomy or Physiology which are much much much more important clinically. (I hope none of my prof.s reads this) And the necessary concept clearing part can be easily done in the lectures (esp LTMMC, 'coz we have the best Biochem dept. of all the colleges). So pay attention.


Biochemistry practicals are very very simple, its like the usual chemistry practicals we do, by mixing all those reactants. Not much to say here, just don't bunk.
Note that however, the clinical applications taught in the demonstrations will be very useful later.

Books-
1) Biochemistry by U. Satyanarayana
This is the most preferred textbook. Very precise, short, concise. Includes separate box for clinical texts. Very beautiful and EXAM NECESSARY flow charts and cycles. Perfect for answer writing. (some professors will freak you out by telling how incomplete and wrong it is, but don't bother much. I really don't think you must spend your energy reading extra reference books here.) However, personally I find it monotonous and boring.

2) Textbook of Biochemistry for Medical Students by Vasudevan
My favourite. Very conceptual and student friendly. Loads of pictures and glossy pages (yay). I call it the Guyton of Biochemistry.
Not much exam friendly though, as the description isn't objective. But preferred by many professors over Satyanarayana. (Ingale sir's (Biochem HOD LTMMC) favourite. State references from this and be sure to get butt loads of marks in viva)
You also get a small handbook free along with it, which helps in last minute revision for vivas.

I would say, own both of them. Concentrate more on Vasudevan.

If you have followed everything perfectly for Anat and Physio you will get enough time for Biochem just before the exams and it will be lot easier if you've paid attention in lectures.

Preparing for exams
Remember preparing for your 10th std. exam? (esp if you are from SSC.) All the question papers were predictable and clearing them was just a piece of cake. Well, 1st year exams will most probably be the same with the only exception that the syllabus is "Oh-My-Holy-God" HUGGGGGGEEEEEE and time very less.

If you followed the above advice year along and studied from day one,  relax! You'll surely pass. You can start getting worried about your distinctions.
You can surely trust my methods. They helped me score the highest in the terms, prelims and 3 out of 5 part tests.

The Bhalani's book I mentioned initially will help a lot. Don't keep studying the questions given in the chapter wise list. The 1st year M.B.,B.S. syllabus and exam pattern changed few years ago and everything became simpler. Thank God! If we anymore had the '85 papers, we'd surely be repeating the course thrice! THAT TOUGH the questions were. So, to study the questions, go to the end of the book where you will find question papers of all the years. Study the questions asked in last 7-8 years, perfectly as these are asked very frequently. By the end of the year you will be able to predict entire question paper. But this is only to be done for prelims and finals. Doing so initially will only ruin your conceptual study. In prelims, most medical colleges ask the questions asked for finals in the finals of previous years.

20 MCQs of 0.5 mark each are also asked per paper. You cannot prepare much separately for these. MCQ books are available but won't help you much as you won't find time from theory. Rather reading theory carefully and lecture notes will help you crack them.

Importance of Lectures
I agree, not all your professors will be great. But whatever it is, unless you feel nauseated by the lecturer (believe me that can happen) don't bunk the lectures, however sleepy you might feel. Writing down notes helps fighting sleep.
Sometime you might feel that rather than attending boring lectures why not bunk and read in library, but believe me this never happens. You'll go outside, and soon feel like roaming around the college. You'll meet your  seniors and keep talking to them. And even if you read in library, the amount you read will not be even half  of what has been taught in class.
Plus, attending lectures gives you a logical line of thought. Remember that these professors have infinite times studied a single chapter from various books and hence whatever they tell you will easily drill into your skulls. This is especially true for physiology. And yes maybe completing that level of Angry Birds or breaking your friend's record in NinJump and Lane Splitter can wait.

Chilling out - The Medicine for Medicos

Relax! All these academic guidelines must have got you hyperventilating and you must be freaking out!
No, medicine isn't Hades' den where sinners are tortured with boiling oil poured into the ears! Medicine is rather Aphrodite's temple. You have to worship her, and that itself is satisfying! (Aphrodite's worshipers prayed by having sex with her priestesses!)
All work and no play, totally makes you completely gay!

Yes, we're Nerds. But rather cool ones! SEXY and we know it!
You'll never know how the year went by. (esp the Sionites ;) .) From the first week itself of being a Medico, you'll have a totally chilled out time with "Spice" and "Slice". Our cultural and sport events. Participate in them, get to know your seniors. Play along if someone's pulling your leg.

Roam around. Check out all the awesome places in the neighborhood. Every place has a specialty. That chatpati Pani Puri or that orgasmic Gelato. King's circle is a heaven for the foodies. Guys into gaming action, start working on the Counter Strike team and get ready for the fests in January. Go to other colleges and kick their asses! Be friendly with all your batchmates. Explore everybody's talents. Singing, mimicry, playing an instrument, football, cricket, badminton, debates, acting... Name it and you'll have a chance to show it off! Make your batch proud. Be good to all professors and earn the 'pichle saal se achhi hai ye batch' tag from all the HODS (we have done it this year peoples!! B] )
Be good to everybody. Especially the hostelites. Make them comfortable. Don't let them feel left out. Don't make fun or be judgmental. Not everybody went to convent. NOT STUDYING IS NOT COOL IN MEDICINE! DON'T GO AROUND CALLING PEOPLE NERDS! If you don't start becoming one too, you'll soon be scurrying to clear the year.
Arrange for a trip somewhere nearby. Elect a CR (class representative)! Celebrate him. He's/she's gonna take care of all you guys. From attendance gochis to getting notes from professors.
Help your seniors if they ask you to. During Trinity (conference of medical students) and Ashwamedh (the most fantabulous college festival) times, help with simple chores of invitations and running around with trays of coffees.

Pirate Day! Aye Aye Captain! Arrrr
Arrange for a choreographer and give in your name for a batch dance compeition. Participate in Avirbhav, marathi drama. Let your seniors know about your skills, you might be called on for something. Attend all the days and nights during Ashwamedh. Don't worry much about the prelims which will be held soon after it. If you miss Ashwamedh, you'll keep cursing yourself throughout the year! Don't miss the JAM (just a minute). Watch the Doctors' Debate and see how the Pros sort it out.

Participate in that treasure hunt. Roam around looking for clues and get bonus for your embarrassing pictures and videos. (Pole dance at a bus stop)
Amey Date Live

Avirbhav
Wanted to learn some new dance form? Attend the Dance Workshop. Follow different themes and dress funky on the Costumes day.




If you are HAWT, hop on, onto the Fashion Show team. If you've got the MOVES, STEP UP onto the College Dance team. Watch the celebrities perform live on stage and HEAD-BANG your head to concussions! Feel the roar of hundred dhols and dance with goosebumps. Participate in the sports events.

Represent the college and make us proud. Be on the Quiz teams. Show 'em all, how Sionites excel at everything.



DJ Sanghvi Fashion Show Team
And you thought Medical School meant NO FUN, eh?

Enjoy the canteen. Hate the food, yet order it everyday. Enjoy the Hot Chocolate from chhota canteen. Enjoy the AC in the library. Have peaceful sleeps with your head on BDC.

Line Maaro! Fall in love or at least infatuations! Oggle at your seniors (main achha laga toh direct bol do!) and curse how your batch has nobody interesting. Make mistakes, learn from them. Get your hearts broken (infarct??) and let your friends mend it with Fevicol! Get Whatsapp and get chatty! I can personally take your classes at flirting.

Meet me if you are a Sionite. I'd love to be bugged by you.
If you are a girl and want to thank me, text me :P
If you are a guy, help me complete my journals next year! :D
And if you're neither... Well, just chuck it. XP
No, I don't expect the 3 idiots ka 'janab taufa kubul karo' but a 'Hi' here and a 'Hey' there would be great!
Listen to our college song. Enjoy it, sing it. Love the campus, connect to it. Be proud of your institution.

Be good to patients, be helpful. Respect the value of human life. You're gonna be a doc! And no matter what Amir Khan says, people will still continue to believe that there's a God in you.


You don't just enter Medicine. You begin a new life. My best wishes to your journey...


Credits to Mrunal Awalekar, Kasturi Sakhardande, Varun Wani, Vivek Patil and Sourabh Ghewade for suggesting additions.

Call/Text/E-mail me for any further questions. Happy to Help ^_^


--- the Eternal.Denied.Monk