Midnight Musings : A Journey Through FCA and Life

An article by Dr Vinesh Sookur 🥰

As an anaesthesia registrar entering the final year of training, the world can feel like a blurry, caffeinated dream—one that gets blurrier each time you must wake up at midnight for yet another reading and study session.

For me, four years in a Registrar post has been a great experience (Ah don’t feel ‘that’ much sad for me dear friends, I knew the rules when I engaged myself, so whining about it would be definitely hypocritical! And well, we are here to be ‘hippocritical’ – pun intended to the guy that decided the Hippocrates oath should be our motto). Tiring, interesting, nerve wrecking on some days but well, South Africa is the place you want to be if you want to grow exponentially.

In all fairness, the proverb ‘What does not kill you makes you stronger’ applies here- You will be out of here, good enough to manage most scenarios and the cherry on the cake- you will have one white bead follicle for every day that almost went wrong. Hopefully, the massive weight ‘upgrade’ from a full-time gym goer to a panda bear mode will not be riddled with the likes of Diabetes, hypertension, lipids clogging your arteries, or well, depression. Well, I have been spared till now, thanks to my lovely life partner- my pillar, my support system and well, some days I feel, The Dr Jekyll that brings back my Mr Hyde back to nirvana mode.

And now, the only door left unopened is the OSCE/ Viva for a full certification. It might sound like a form of cruel joke, but it’s all part of the ride. What do I prefer- theory or osce? Well, theory, simply because I am like an ADHD kid when I answer OSCEs. I feel like there is a massive lack of communication between my Broca’s and Wernicke’s area just at that point in time. Theory papers? Well, I have time to give myself some real peeps talk and motivation even when I see a question about split billing in my paper.

Let’s get back on the train: Here’s the thing—when you’ve spent almost four years learning how to manage the intricate dance of sedation, gassing down, pain relief, and a bit of patient soul-searching (if you ask the patient, of course), it doesn’t hurt to lean on your favourite quotes from movies and TV shows to keep you going. The truth is, there are moments of sheer brilliance followed by moments where you wonder if you’ll ever get the back on properly. And then there’s everything else. Like the looming terror of the OSCE, where the examiner appears on your screen like the lion in the bush and well…. You are the little gazelle… Run little gazelle… run… Or be Kraven the hunter- the choice is yours.

On the Final OSCE VIVA:

You’re going to make it through the OSCE viva. It's just like a jump in the Matrix. Except the code is medical and the consequences are real.”

Adapted from The Matrix - everything you’ve been taught about medicine feels like one giant code. One misstep, one wrong choice, and things could go sideways. You feel like Neo, jumping from one dilemma to another, trying to catch that last anaesthesia machine setting just before the patient wakes up.

Harry Potter knows how that feels too:

"I’m not worried, I’m just exhausted. But I’ll deal with it like a hero does—by pretending I’m not a complete mess."

It’s basically the anaesthetist’s motto. You’re running on fumes, but your patients have no idea. Your “hero” moment? Keeping them alive while juggling multiple drugs for them and coffee for you and hoping you don’t accidentally mix up your dosages. The last simple enough case of the night at 4am- where you pull up the soft jacket on your head, set the alarm limits on your ventilator and monitors, slump down in that plastic chair next to the ventilator and tell the intern- Chomie, this case is yours to grow up. Hibernation mode for you and sometimes ‘butt clenching’ mode for the intern.

On Being a Supernumerary Trainee:

"It’s not a perfect world, but it’s a good world, and that’s enough." — One Tree Hill

When you’re an unpaid supernumerary trainee, you're learning the ropes while wondering if you’ll ever see a paycheck or even a reasonable night’s sleep. You get it. You signed up for it as an adult. So people, stop whining. You’re not getting paid. At the end of the day, you do your job, you care for your patients, and you go on. This hits home because you know the world of anaesthetics isn’t perfect. It’s a place of constant noise, buzzing machines, and being asked if you’ve checked the dosage, yet here you are, giving it everything you’ve got. That’s enough.

The thing that will occasionally tickle your mind- People trying to compare their own situation to others (or you). First thing- why would you even compare yourself to others- That is the utmost level of stupidity I have ever seen. Isn’t it better to just track your own progress or life? Well, my mentor said- Common sense is not so common and I say- The world is full of educated illiterate beings. So, rambling aside, the internal conversation in my mind at that time à You don’t reply to a donkey braying at you, that will bite you in the ass. Yet sometimes I lose the battle with a huge smirk on my face and I have never regretted it- probably since most of my comments are hidden sarcasm that would need quite some level of intellectual reasoning to comprehend.  Though one of my bosses told me- Your eyes convey a lot even if your mouth stays shut! Well, so much for me trying to be nice and cordial! ROFL.

On Being an Only Child Caring for Your Mum:

"If you don’t try, you’ll never know." — The Big Bang Theory

You don’t get to opt-out of life, and when you’re an only child shouldering the responsibility of caring for an aging parent, there’s no manual for it. Anaesthesia’s challenges have prepared you for dealing with high-stress situations but being the one who must make sure mum’s alright when you are miles away from home – that is something else entirely. Sheldon Cooper may not be the expert on emotional labour, but he’s got a point here—if you don’t try, you’ll never know. Sometimes the best you can do is just show up, even if it feels like you’re holding it all together with just caffeine and sheer determination. For that- I must say- my adopted parents- Sneha’s parents, are gems. I couldn’t have managed it all without them. Not to forget my cousins who troubleshoot till I rush back whenever there are issues. And well, credit to my wife for finetuning all of it!

On Life as an Anaesthetist:

"Why so serious?" — The Dark Knight Trilogy

You often deal with people in their most vulnerable moments. Their fate is in your hands—literally. Yet, sometimes you can’t help but find the absurdity of it all. You prepare, you worry, and you relax, but in the end, you know it’s all just a game of chance, much like the Joker’s chaos. But you must hold it together. Because as Batman would say, "People need hope."

And in your world, hope comes in the form of a safe anesthetic for your patient, a well-timed gentle airway management, and the knowledge that—if you can survive all of this—you might just make it through to the other side, stronger, wiser, and possibly with more caffeine stains on your scrubs than ever before (sometimes be prepared for that innocuous brown or red stain not being coffee!)

On Friends, and the Ultimate Realization:

"How you doin’?" — Friends

And then there’s Friends. Joey Tribbiani, with his eternal charm and questionable life choices, might not be the role model for an anesthetist, but his one-liner is spot on. When you find yourself at the end of a long shift, every decision made, every gas switch confirmed, and the monitor finally quiet after a tense few minutes, you might as well channel Joey. You’ve made it. You survived the chaos. And now, you can finally ask yourself the age-old question: How are you doing?

As you walk into that final viva, ‘unready’ to face the questions that might make your brain short-circuit for a moment, remember this: "The more you know, the more you need to structure your answers in that 10 minutes." A little advice from The Dark Knight goes a long way in anesthesia. Keep calm. Answer what you know. And for the love of God, don’t panic. It’s just another day of keeping the world from getting too dark—one patient at a time. You kept patients bleeding to death on that operating table alive, isn’t it? So do this one for yourself- Keep your heart beating, let the catecholamine surge maintain enough cardiac output and cerebral perfusion and besides the occasional tremor setting in, dance through those questions!

So, what’s the takeaway here? There’s humour in the darkest moments of life.

There will be times when you’ll feel exhausted, burned out, and wondering if you’ll ever catch a break. But remember: You’re not alone. Even Batman, Sheldon, and Joey Tribbiani had their moments. If they can survive Gotham, the Big Bang, or a failed pick-up line, surely you can survive that last exam. Just remember to breathe, laugh at the absurdity of it all, and—if in doubt—quote a little Friends. After all, it’s better than wondering if you just gave the patient too much gas.

To all exam takers - You will survive this. Just trust yourself. And well, if you don’t, trust God.