Things not to do in a viva

One of the rumoured-malignant professors we have in Internal Medicine is Dr. Aysha Badawi. Despite the rumours, I like her. She gave us lectures in Cardiology and Rheumatology. Her lectures are usually very long, 2 hours minimum-

She started her Rheumatology lecture with "ihna 3andina a very long lecture" haha that got me chuckled defeatedly

-and she likes to ask and when answered correctly will give you a "right you are" or a glare if you answered like one of the lay men.

And yes, she is strict and kind of scary like the rumours say, but I like her. Because I learn.

I was examined by her during my Internal Medicine end round exam. I was ushered in by the resident and the station I got was Cardiology. Just me, the patient and time. I don't like Cardiology, mind you. Never easy on me. But I was to examine the patient within the minutes allocated, so it was relatively easy and my patient was a kind old chap so it was enjoyable.

No idea who was going to examine me, so I did the full examination and rehearsed my history. More than ten minutes had passed. I even had time to borrow a friend's sphygmo to check the patient's BP (I never bring one to an exam, too bulky to carry around. So I like to go without it and just tell my examiner "I didn't check his BP because I don't have a sphygmo" but maybe I have to change for the final exam).

And then Dr. Aysha came in. I foresaw being butchered.

She went ahead and examined the patient before turning to me asking me to take his pulse. I did and commented it fully.

"..equal volume-"

"What are the causes of unequal volume?" She interrupted me.

"Coarctation of aorta, pancoast tumor, and the rest I forgot. Sorry." I grinned.

Okay maybe I shouldn't have said that.

She wasn't amused. Dr. Aysha gave me the deadliest death glare I had ever seen.

Scratch that, I really shouldn't have said that. Haru was screaming in my head "Why did you have to be stupid do you want us to fail???" and that froze me up from otherwise blurting out "Justjokingpleasedon'tfailme."

It was plain wrong for me to enumerate only two and said "and the rest I forgot" because I was clearly showing no effort. That question can be answered logically by simply analysing what would obstruct or compress just one side of the upper limb. I was lazy and it showed. It served me right to be death-glared, I wouldn't even be surprised if Dr. Aysha sent me away at that point.

But she didn't. Instead she went on and asked me other things and made me do the full cardiac examination in front of her and had me explain the basis of each one of them.

That moment I thought how very forgiving of her to overlook my lapse of judgement. I was sheepish for the reminder of the exam, being humbled by her. She was tough but her questions were clear and didn't deviate from what we studied in the curriculum. She really is a good professor. I learned what professionalism means.

We discussed the management in brief and then I got to "patient will be on life-long anticoagulant."

The atmosphere then was of finality, that I had just answered my last question and would be dismissed uneventfully. But she kept firing.

"What is the dose for the anticoagulant?"

Inside my head, Haru went "Oh shit."

Don't take a leaf out of my book kids, but I don't like numbers so I didn't study the dose before the exam. The patient told me he took 5mg of Warfarin when I clerked his history earlier, but there is the risk of the patient being mistaken. I was tempted to answer 5mg, but I can't risk that.

When you don't know, offer another related answer. So I did this trick I last used in my Ophthalmology final viva when the prof asked me the name of the condition but I forgot and gave him the pathogenesis of that condition instead. Basically I answered a 2-word answer with a 2-sentence.

I smiled confidently and answered Dr. Aysha. "I don't know the dose but I know his INR should be kept 2-3."

She nodded. "Very good. You may go."

"Thank you doctor. Have a good day."

I skipped on my way out. Safe with a "very good" from Dr. Aysha! Alhamdulillah.

P/s: The dose for oral Warfarin is what keeps his INR 2-3, usually around 5-15mg daily.

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Goofing around is fun but not exactly respectful. Here's another tips for you guys:

1- avoid using Egyptian ammi with your professors especially "eeh" or "aiwah". Use the standard Arabic "na3am".

2- address them respectfully as "sir" or "doctor".

3- be thankful and wish them good day.

4- SMILEEEE. A butchered smiling face is always better. Makes outsiders think you die as a hero.