CHAPTER VII ‘THIRD YEAR SYNDROME’

CHAPTER VII

‘Third Year Syndrome’

    ‘Renal glycosuria’ is reported in examinees, which I prefer to call ‘examination glycosuria’. I read about this for the first time in Thorpe’s Textbook of Biochemistry.

    But when I entered the third year class, I found medicos had developed several symptoms, one such illusionary I have already described in the previous chapter. Many friends of mine had costly, beautiful and fanciful stethoscopes and they had an illusion that Littmann’s could turn them into great cardiologists. It was much later, I read, ‘Cardiologists are great liars who can discern the cardiac events, even in the minute protodiastolic phase of the cardiac cycle.’

    A senior student was reported to be wandering on the long platform of Samastipur wearing a stethoscope, after he joined third year class. My brother had purchased for me a cheap stethoscope for Rs. 28 and when I faced a case of ASD in the third year, it was difficult for me to accept Prof. Mohan Mishra’s finding that there was not only a split, it was also wide and fixed. Now, the days are gone that such seniors taught third year students and even if it be so, could bear, not less than 5-6 times, “Sir, I cannot appreciate the split or murmur.”

    Here, I am going to describe the syndrome, which every neo-stethoed medico experiences in some ways. The medical textbooks also mention it but I have only christened it as third year syndrome.

    As the students read the description of any disease, they try to search out its signs and symptoms in their own bodies. It is not unnatural from the phenomenological approach of the psychiatrists who believe that the patient’s symptoms and life events should be compared to that of their own. Here, in this syndrome, described by me, a medico matches his/her symptoms with the books or lectures.

    I was a good student of Physiology and I do not remember when I counted my pulse for the first time, may be in some phase of emotions as sparingly described earlier. I found it to be fast. My tutor would have taught me the causes of tachycardia and I related it to my thyroid. I was also lean and thin, and, every symptom of thyrotoxicosis was in me.

    Not less than six  MRCPs counted my pulse and more or less it was fixed at 120. Dr. A. P. Singh ascribed it to some cardiac origin. Dr. N. P. Mishra after elaborate testing, including the tedious BMR on Benedict-Roth’s classical apparatus ruled out hyperthyroid. But I had no faith in the conclusion and I consulted Prof. Mohan Mishra who asked me to have sleeping pulse rate counted by my roommates. It was normal but for the final check, he asked to get PBI done. I went to Patna for it where one of my known doctors took me to consult Dr. S. N. Arya who was much impressed by Prof. Mohan Mishra and he further advised me to get circulating T3 and T4 done, as those tests had just become available at Patna. I went to the Sen Laboratory and deposited part of the required fee and gave my blood. My accompanying doctor said, “There is a well-known name of Dr. C. P. Thakur, consult him also.” 

    Dr. Thakur could find soft systolic murmur grade II and prescribed Inderal and asked me to come after some tests such as ECG, etc. I told him that I wished to go to my home for Chhath Puja (actually, I had no money left with me). He said, “O. K.” In those days, the Ganga had to be crossed by steamer and all the way I was thinking about the murmur detected by the doctor.

    I returned to Darbhanga and saw Dr. B. N. Mishra sitting in the lawns of his quarters. I met him and told him my problems. He questioned my going to Patna and asked me to take several drugs including phenobarbitone. I got those drugs and took a table of phenobarbitone and then I went to see the evening offerings in the Chhath Puja. I became drowsy and was forced to sleep in a nearby house of a doctor.

    Next day, I returned to the hostel and asked a junior friend to return the medicines and bring Horlicks in lieu of them, which he did. After three weeks, I went to Dr. Mishra again and said that I was O. K. He advised me, to repeat the same drugs for three weeks more in order to break the vicious cycle. I did not take the drugs. After three weeks, I again went to him and told him that I was O. K. He was pleased.

    My roommate had Physiology papers after some days and a question on thyroid function test was asked. He said that he could answer only on the basis of our discussions and I also feel that   I could designate this syndrome.

    Alas, none of the top physicians felt my grip whether I was warm? None of them noticed my other complaint of anaesthesia around the knee, which I will describe later. The syndrome itself had caused functional murmur, by God’s grace; it could not be ’machinery’ by new techniques of medicine. Thanks, I did not have motor neuron disease (as CNS is taught in final year) and could have only ‘thyrotoxicophobia’.

Maharshi Charak Shapath

                Maharshi  Charak

    (Approx. 600-500 B.C.)