There is a song by the Amateur Transplants called ‘Finals Fantasy’ which describes in humorous detail how stressful clinical exams can be. Having not done any viva or objectively structured clinical examination (OSCE) style exams for many years indeed I had long forgotten those fateful lyrics but they were brought back to the forefront of my mind as I sat waiting in a coffee room at the Royal Victoria Infirmary in Newcastle for the viva section of the part 2 FRCOphth exam to begin.
Clutching a sweat soaked letter from the college in my clammy right hand I looked again at the timing for the viva; 12:45pm it said. The OSCE itself was still two days away but at the rate time was moving at it might as well have been next year. I had arrived in that fearful coffee room at noon precisely, in order not to be late, and even though I had sat there for what seemed like nine days the time on the wall clock was still only 12:20. Around me on three sides were nervous ophthalmologists staring into space, some of them clutching equally sweaty bits of paper.
I suddenly realised I was the only man in a sleeveless shirt. The stress of this discovery manifested itself as some form of acid reflux and as I swallowed hard I caught the eyes of the candidate sitting opposite me. He was sweating profusely with sweat running in two independent rivulets down his face and he looked at me briefly with a frightened look, before looking away. Frightened look. Kocher’s sign. At least according to Kanski. “Hang on,” my inner voice said. “What is the eponymous name for lid lag then?”
Fear, and gastric pain, gripped me for a second as I pushed all thoughts of organising the signs of thyroid eye disease away from the immediate moment. I had been attempting to push so much clinical knowledge into my brain over the preceding few months that it was threatening to become disorganised and I was fearful it would somehow all get instantly deleted if I tried to touch it at this delicate time.
Just then somebody’s book fell to the floor with a slap against the linoleum. Although this was not a loud sound, the entire room jumped and although, again, nobody spoke, some form of group appreciation of how nervous everybody was sunk in. “Hyperacusis,” my mind said again, uninvited. “A sign of stress. The stapedius is supplied by the facial nerve. Upper and lower facial nerve palsies; how do you clinically tell the difference?” I willed myself to stop autoquestion mode and this was only done by looking at the clock. 12:20. No change. I looked at the book that had fallen. It was the Oxford Handbook by Denniston and Murray, although it seemed this version was much better preserved than mine and had lots of post-it notes sticking out from every page. The owner of the book sighed and lifted it from the floor before opening it and reading from a seemingly random page.
Just then a new candidate entered the room. She looked around nervously, not making any eye contact with anyone, and sat down on the squeaky black chair next to the door. I guessed she was perturbed at the squeak as she rifled around getting a huge file out of a plastic bag to start reading, but possibly thought that the social stigma attached to swapping chairs in this stressful environment was not worth the mental effort. I wondered how anybody could even think of studying at this juncture.
I got out my own Oxford Handbook and randomly opened it to page 592. Optic atrophy. I read pointlessly for about ten minutes then put the book back, having realised I might as well have been reading The Rise and Fall of the Roman Empire judging by how much was going in. At least it passed some time. I looked at the clock: 12:20.
“Time seems to be on standby in this room,” I said to the candidate at my side, suddenly and surprisingly draining the tense quiet that everybody was steeping in until then. My fellow candidate jumped and looked me briefly in the eyes before turning away, confused, to tidy up her hijab. I cursed myself for speaking. Speaking, caused by the recurrent laryngeal nerve, offshoot of the vagus nerve. Dear Lord! How do I do the cranial nerve test for it?! And what is Parkinson’s sign! What is the regulator for NHS trusts in case of complaint and what is the Welsh equivalent? I looked panic stricken around the room and picked up my Oxford Handbook again.
Page 920, Index. I looked at it blankly for a while before noticing another candidate’s quizzical expression; no doubt wondering why I was reading the index. I smiled at them and closed the book. Nothing I ever read an hour before an exam never came up anyway, I mused. Looking around again I noticed nobody else was wearing a poppy, this being the 11th November. An acidic fairy danced in my oesophagus as I removed my poppy and placed it in my shirt pocket. “Shouldn’t stand out,” my brain said, mischievously, to itself. I replaced the poppy on my shirt immediately afterwards, remembering my grandfather, before removing it again.
Page 59, in vivo confocal microscopy. I noticed my left palm was getting even slippier with sweat and rubbed it on my trousers.
Suddenly there was movement by the door. An official looking lady came in, counted us all, looked confused and left again. Everybody stared at the open door. What could it all mean? Who was she? Who am I? Where am I? When am I? I looked at the clock. It was 12:20.
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