Final exams: Out on a limb

As 40 years of medical records  are carted away, a retired physician remembers some beginnings.

Its engine roaring, the huge truck lumbered away down the lane. Now being digested in its vast belly weae the shreds of hundreds of files; the records of patients, procedures, successes, and a few failures. Gone forever in 13 minutes.

The man allowed himself a wry smile and turned back to enter the basement door. As he did so, he glanced at the set of diplomas and certificates leaning against the wall. Reaching down, he abstracted two large framed samples and, returning to his chair, sat down and examined them.

The young student tapped lightly on the door before going in to see the patient who was waiting for him. She was sitting up in bed, a magazine prop­ped against her enormous abdomen. 

“Hello, I’ve come to take your history and examine you.”

“Yes, I know.”

“Oh, ah, er, good. Now why are you in the hospital? I mean, what all led up to you being here?”

The young woman blushed slightly and looked about almost furtively to left and right, as if seeking to es­cape. Then she faced him with a grin.

“It’s twins,” she blurted.

“Oh, I see. Oh good. Well, thank you.”

Great! He had the answer already. Got it in one, as they say.

Now, like a prosecutor all ready with a verdict, he had to build a case to substantiate and support it.

Easy! Yes, she certainly was “big for dates” and she had gained an ab­normal amount of weight. All the symptoms of pregnancy were very ac­centuated in her case. Best of all, there were twins in her mother’s family.

Sir Malcolm entered the room. Tall, craggy, thick gray hair somewhat tousled, he was an imposing figure. So he should be. The world-renowned obstetrician’s presence was almost palpable.

“Weel, what hae ye go then, laddie?” he asked in his broad Scots burr. 

The student carefully related the story he had obtained as well as his findings.

The great man listened and then, looking over his spectacles, he said, “So ye think it’s twans, dae ye?”

“Yes, sir!”

Rising from his chair, Sir Malcolm allowed a slight smile to crease his face.

“Aye, so dae I,” he said, making for the door. He opened it, and looking back at the by now inanely grinning student, he added, “Guid lad.”

The student and the young lady laughed like the co-conspirators that they indeed were. The student grasped her hand and pumped it wildly. 

“Thank you! Thank you! You were great!” he exulted.

She smiled delightedly and he almost wanted to embrace her, but it was, of course, manifestly obvious that someone else had done that almost exactly 9 months previously.

Emerging from the building into the cold wind of a Scottish summer, he looked back at the granite walls behind which he had spent his student days.

Only now he was a doctor.

The man smiled and turned to the second imposing framed document. And the smile became a grin.

The vast examination hall resembled a railway station with people scattered about, some in groups and others in twos and threes. 

The candidate finished examining the young man’s knee. No doubt about it… “IDK.” Internal derangement of the knee. One of those long, catch-all terms which medical men employ to cover every eventuality… and themselves.

In this case it meant serious ligament damage, probably from injury. 

“Thank you very much, sir.”  Failure to extend this courtesy meant failure.

“Ow, tink nuthin of it, mate,” said the Cockney roofer.

“Well, what have we here?” a booming voice echoed in the cubicle. 

Turning, the candidate found Sir Reginald Windsor looming over him. A large man of ample girth, sporting a black jacket and striped trousers, a heavy watch chain and gold half-moon spectacles, he was the epitome of the Harley Street consultant surgeon.

The nervous candidate described his findings and pronounced his confident diagnosis.

“WHAT?” bellowed Sir Reginald. The candidate was transfixed with terror. 

“Young man, I’ll have you know that this chap has been sent up from Greenwich by a duly qualified Fellow of the Royal College with the diagnosis of possible tuberculous arthritis. Are you going to stand there and dare to say that you actually disagree with that opinion?”

Out on a limb. Perhaps literally.

Dry mouth. Hard swallow.

“Yes, sir.”

“SO DO I!” thundered the examiner with a huge impish grin spreading over his florid features. “Well done, young man. Good luck to you!”

Whew! Oh my God. Holy cow, never again.

The rest of the exam was a blur; then suddenly, it was all over. 

The candidate tottered down the steps into the gloomy London November afternoon.

Utterly drained, exhausted, totally spent; eviscerated, even, he felt; and may have looked like a worn out, wrung out, discarded dish cloth.

But he wasn’t. He was a surgeon.

The man carefully replaced the two framed diplomas. Forty years.

Then he climbed the stairs to the kitchen, put out the light, and gently shut the door.

You know, I really should hang them up again somewhere.



Dr Fraser is retired from pediatric general surgery at BC Children’s Hospital, where he was head of surgery. He enjoys reading, writing, and erratic golf.

Graham C. Fraser, FRCS, FACS. Final exams: Out on a limb. BCMJ, Vol. 50, No. 6, July, August, 2008, Page(s) 346 - Back Page.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply