I am posting this blog about passing the Oral Bored Exam in Anesthesiology. This was my personal crossing of the Rubicon, a cross that I bore or any of the infinite myriad of any tiresome metaphor of your choosing for subjecting oneself willingly to torture.
Oral exams have always been my bane. I hated them all through med school. Written exams were never a problem. When confronted by live examiners, I would black out, forget everything I ever knew, including my name. The residency, for those who don't know, lasts for several years during which time one must pass a written test (known here in Israel as "stage A"), and an oral test ("stage B").
This was not my first attempt. In the past I have become almost catatonic during the exam, making the impression on the examiner that I am a total idiot (in the best case) that should not be unleased upon an unsuspecting public. The worst case scenario, is the examiner who has an orgasm if he/she can show the examinee that he/she/it possesses the intellectual capacity of an underdevelped amoeba. These sadistic characters are of the most odious kind and provoked quite a few vivid fantasies of examiner-cide. More than once I entertained the thought of showing up for the exam armed to the teeth with high powered rifles, a main battle tank, a couple of ballistic missles, or, conversely, some particularly cruel instrument of torture. The fact that I am not now serving a life sentence for muder in the first degree is proof that none of these plans were carried to fruition (despite the fact that I might have become a folk-hero on the order of Robin Hood).
The frustrating aspect of this exam, is that I rarely get flustered in emergency situations (which more or less occur every day). I can give a lecture to a hundred professors, treat 4 trauma victims simultaneously (supervising junior residents of course) and prepare my reserve unit for war without batting an eyelash. Put me in front of an examiner and I instantly become invertebrate.
The explanation is, as should be expected, psychological. All the aforementioned situations are normal for me. I have been extensively trained for such scenarii. But the exam is different. I am out of my element like a fish out of water.
This time I treated the cause and not the symptoms. Since the problem was psychological, I approached the preparation for the exam from that angle. First of all, a friend in the department (to whom I am indebted) helped me prepare. Whether knowingly or not, he used a method which is accepted in the treatment of phobia called: desensitization. Briefly, the patient suffering from a phobia is gradually exposed to the offending stimulus until the phobia disappears. For example, a person who is afraid of flying will be shown photographs of airplanes at first. Then, perhaps a tape of airplane sounds will be played. Eventually, the person will board a plane that will not take off, and the final step will be to fly. There are even flights scheduled that don't go anywhere especially for the treatment of this phobia. The patients will just take off and land at the same airport ( I don't know if access to the duty free is included in the treatment).
So thus we simulated cases discussed in an exam format. At first, we would discuss the cases at length for 1-2 hours picking apart the most minute detail of HOW to answer questions. This would be done in a very friendly atmosphere. Eventually after several months, my friend would play the "mean" examiner and the time for discussion would be identical to the time allotted a case in the exam itself.
In addition, I went to a hypnotist who used hypnotic suggestion to convert the uncomfortable situation of the exam to one where I feel like a fish back in water, i.e. the general feeling would be as if I were at work and not in an exam. Since I took a course in medical hypnosis, I easily enter an auto-hypnotic state which made this process quite effective.
The exam itself was still somewhat stressful but nothing like what I went through in the past. And, in fact, I now realize that I know more than most of the examiners. When the exam ended, the examiners entered a room to discuss the performance of the examinees. This is done especially for those who were borderline. In other words, an examinee may have performed badly in one or two stations making a poor impression. But if the rest of the examiners were impressed with the cantidate, then a vote is taken whether or not to pass the examinee. At the end of this process, which lasts for about an hour, the director of the exam invites the examinees one by one to be given the results.
This process is nervewracking. The exam itself is 4 hours. Another hour waiting for the examiners to finish their deliberations. And then, we each enter the holy of holies. I can only compare the feeling to what I imagine a condemned man feels when being lead to the gallows. Of the 7 condemned, I was the last to go in. The first went in, and came out with a smile - pass! The second went in - fail. How I know that terrible feeling. The enormous effort to prepare, all for naught. Not only the examinee suffers, the entire family suffers as well. For months my children saw only my photograph taped to the refrigerator door. My wife was a "stage B widow". The third entered the shrine - fail. My heart races, beads of sweat form on my brow. The fourth enters - a smile - pass! The fifth enters - pass! The sixth enters - fail. My turn. Suddenly the world is transformed into a universe of quantum mechanics, as I travel close to the speed of light, the universe around me slows down (what the heck, I was never very good at physics). I tread the hallowed ground. The lord of the known universe begins to utter the following words: I have good news and I have bad news. I feel my head swim, my knees feel weak. "The good news is that you passed all 8 stations. The bad news is that you did not pass with honors."
I replied that I will live with the calumny juuuuuuuuuuust fine. His holiness smiles and shakes my hand. Time returns to it's normal speed. As I exit the room, I hold out my fist with the thumb extended as Caeser did when deciding the fate of a defeated gladiatior. Thumb down - death. Thumb up - life. Maintaining a poker face I see the anxiety on my friends' faces. Slowly, and simultaneously I point my thumb to the sky and smile. Even now, just recalling the moment, I am overwhelmed with emotion. And then, a shout of triumph mysteriously is emitted from my throat. It sounds like the jubilant war cry of a Mohican.
The first person I call is my wife. I hear my daughter in the backround screaming with joy. Finally we can go north for the vacation I denied the kids for so long. Then I call my parents. Mom says that it was easier giving birth to me than watch me go through this. The rest of that evening raced by like a tornado. Needless to say, I didn't sleep much from the exitement. The weight of the world has lifted from my shoulders. It's time to start living again.