Throughout medical school, I often wondered when I would cross the threshold of responsibility in the profession. When would I finally feel capable of managing a patient entirely on my own? 

This led me to ask: what does it truly mean to be responsible? 

When I first started college, even something as simple as paying my bills felt like a significant responsibility. But five years later, that task has become so routine that it barely registers as such. It seems that once I grow accustomed to an activity I once considered challenging, it no longer feels like a responsibility.

I now entertain the idea that responsibility is not a fixed destination but rather an evolving process that shifts with our perception and familiarity.

The threshold of responsibility as an Indian doctor 

During my clinical postings in the second and third years of medical school, a senior was always there to correct my mistakes. Whether I took an incomplete history, misdiagnosed a condition, messed up the insertion of a venous cannula or struggled with a nasogastric tube, someone more experienced ultimately bore the responsibility. Professors reassured us that, as the junior-most medical personnel in the hospital, we shouldn’t be afraid to make mistakes. While this system was comforting, it did little to bolster my confidence in my own knowledge and skills.

India’s overpopulation offered a solution to my low self-confidence. When the patients vastly outnumber the doctors, each medical professional becomes an invaluable resource for the community.

For a long time, I didn’t grasp that responsibility isn’t something Indian medical students have to actively seek; it’s imposed on us before we’ve had a chance to contemplate our competence. I began to understand this when the community medicine and family medicine resident doctors packed a group of 25 students, including me, onto a bus for school health checkups. I quickly forgot about my craving for responsibility faster than my friends’ birthdays. My new thought was: Shouldn’t we be trained for this?

As we headed to the school, I hoped for a briefing from the residents, but none came. Upon entering the building, we set up our tables and equipment and waited for the students to arrive. I continued to anticipate some last-minute guidance or instruction, but when the students emerged, I realized I would need to rely on my raw clinical judgment for the day. These children’s lives and wellbeing were in my hands, and despite my persistent self-doubt, I resolved to rise to the challenge with everything I had.

Ignorant children

My first station for the day was the anthropometry table. Instead of making challenging diagnoses, my tasks were simple. I read the weighing scale and told the kids to stand up straight with their heels and heads against the stadiometer to measure their height. I imagined the worst-case scenario: mistakenly adding a few kilograms to a child, labeling them as obese and crushing their hopes of being the popular kid in their social circle. 

I sought to experience the burden of responsibility, but all I could think about was that three years of medical school had led me to read numbers from various devices. Even my friends at the ear, nose and throat (ENT) station, who struggled to hide their disgust at the sight of hoards of earwax, seemed to be having more fun.

When my group found a student with a high BMI, we advised them to cut back on junk food, eat more fruits, go outside and exercise, blabbering generic recommendations that seemed unlikely to make a difference. We were providing lifestyle advice to children with helicopter parents, ignoring the fact that these kids had as much control over their existence as a boat in a storm. We should have educated the parents instead. They were the ones allowing their children to consume junk food, discouraging outdoor play and possibly even forcing them to attend tuition classes instead of playing with friends. Moreover, if these parenting methods were reflections of societal expectations of how children should be raised, the scale of the problem was far beyond the scope of 25 immature medical students. I couldn’t help but question whether our advice to the children was ultimately futile.

Thankfully, our stations changed soon after. I left behind the stadiometers and moved to the ENT station. 

My first patient sat before me. I asked his name, which I promptly forgot two seconds later, and chalked up his age as “young and insignificant.” I picked up a tuning fork from the table beside me, and he began to whimper. I patiently observed his reaction, trying to understand what might be causing him to behave so strangely. His eyes seemed to be trying to wish the tuning fork away. I reassured him that I wasn’t planning on shoving it inside his ear, and he quickly calmed down.

I explained the procedures for the Rinne and Weber hearing tests, telling him I would place the tuning fork at various points on his head and he’d need to let me know when he stopped hearing the vibrations. These tests would help me determine if he had a hearing problem, which ear was affected, and whether it was due to an ear canal obstruction (conductive hearing loss) or a nerve injury (sensorineural hearing loss). He nodded five times during my explanation, leading me to believe, beyond a doubt, that he was either a genius or a con artist. I realized I would spend the time trying to determine which one he was, rather than assessing his conductive and sensorineural hearing. 

To perform the Rinne test, I struck the tuning fork and placed it on the mastoid bone behind his right ear. I instructed him to raise his hand when he could no longer hear the sound. After a few seconds, as the vibrations of the tuning fork gradually diminished, he raised his hand. I then moved the tuning fork’s prongs close to his ear and asked if he could still hear it. He listened intently for a few seconds — during which I stopped feeling the fork’s vibrations entirely — before shaking his head. I almost felt like telling the kid that I had just diagnosed him with hopelessness. After all, it was my job and moral duty to counsel him about his condition. 

However, before jumping to conclusions, I decided to confirm my diagnosis with the Weber test. I struck the tuning fork again and placed it at the top of his forehead. When I asked if he could hear the sound, his eyes converged on my hand with a curious expression, as if trying to see the vibrations. He replied that he wasn’t sure. I didn’t bother asking the real question — which ear was the sound louder in. Clearly, he hadn’t understood how the tests were supposed to work.

I set aside the tuning fork, feigned seriousness, and slowly explained the tests’ procedures again. The kid nodded just once this time, but that didn’t reassure me. While it could mean he understood better, it could also mean he understood even less.

After repeating the tests I obtained theoretically sound responses. The Rinne test was negative in his right ear and the Weber test was localized to his right ear, indicating right-sided conductive hearing loss. Such findings typically suggest an obstruction in the ear canal — most likely earwax.

I picked up an otoscope, and the student’s eyes instantly widened with a mix of trepidation and reverence. He clung to my promise not to insert anything into his ear, but I was about to break our pact. I reassured him that I would just take a peek and that it wouldn’t hurt. Before he could respond, I swiftly positioned the otoscope at his ear. He squirmed, as children often do out of habit when facing medical procedures, regardless of their invasiveness. However, he quickly settled once he realized it wasn’t painful. Meanwhile, my own stomach began to churn. 

A few months earlier, I had been studying late into the night in my room. I could tell by the way my friend strolled in and collapsed onto my bed, his semi-solid form molding to its shape, he had grown weary of his exam preparation. Seeing that I would no longer make any more progress memorizing the TNM staging of cervical cancer, I closed my book and asked him what was new.

He told me to choose any object in my room. Surprised by his randomness, I rolled my eyes, which landed on my favorite dusty fluorescent jacket hanging on the door. He then asked if I could guess what it would taste like. I narrowed my eyes, and a rough, dust-filled taste burst into my mind. Turning back to my friend, I was quite impressed by how he was unapologetically steering us towards failing our exams. He explained that he had read somewhere that we could imagine the taste of anything we saw, even if we hadn’t tasted it in real life.

Back in the present, as I stared down the magnified view of a large glob of earwax in the student’s ear, I could confirm my friend’s theory was accurate. The taste, indeed, seemed greasy, a bit sticky and salty. Suppressing my gag reflex and projecting some annoyance at the student, I advised him to visit a doctor to restore his ability to listen in class. 

Small conversations

After spending considerable time acknowledging the ear wax-producing ceruminous glands, I moved on to the psychiatry station. This was the station I was most excited about. I enjoyed talking to small children; they wore their hearts on their sleeves, said amusing things and kept me entertained. Our task at this station involved asking specific leading questions to assess common issues such as ADHD, learning disorders and signs of depression. Additionally, we were to counsel girls on menstruation.

A scrawny, freckled boy sat before me, looking nervous. I asked how he was doing. “Good,” he replied. I inquired about school, asking if everything was okay. “Yes,” he said. Are there any issues in class? Are your grades good? “Yes.” Do you have friends? “Yes.” Is everything all right between you and your friends? “Yes.” At any point in time, has anyone told you that your behavior isn’t appropriate? “No.” Is there anything you’d like to discuss? We can talk about anything that you want. “No.”

I stared at him blankly, and he stared back. Concluding that he had long outgrown the need for my advice, I sent him off. Another girl took his place, and the exchange played out similarly. Perhaps I was too intimidating? I didn’t think I was. I spoke directly in everyday situations, but I used an overly sing-song voice with patients and kids to soften my demeanor.

This wasn’t going well. I wasn’t entertained, nor was I confronted with any high-stakes, life-or-death scenarios. Sure, I had always desired a peaceful life, but I hadn’t realized that peace would inevitably come with boredom.

The little girl with too many “best friends”

A tiny girl approached the chair next, making a small leap to climb into it. She settled with her back hunched and her legs dangling, giving me a scatterbrained expression. I asked her name and a few basic questions, which she answered with little enthusiasm. “Do you have friends?” I inquired as politely as possible — any softer and I would have been singing. She said she had a best friend. I nodded encouragingly. “Can you tell me more about her?”

“Yes, she’s my best friend. We eat together, play together and have lots of fun. But sometimes, she doesn’t talk to me.” 

“Why do you think that is?” 

“I don’t know,” she said dejectedly. “When she does that, I stop talking to her too. But then, after a few days, everything returns to how it was.”

Now this was more engaging. At least she was responding to my questions. Perhaps I could now move on to the actual problems I was supposed to evaluate.

“Okay.” I paused. “How are your studies—”

“I have another best friend,” she interrupted, looking directly at me. “And sometimes, both of them start talking to each other and ignore me. Then I feel sad.”

“Why do you think they do that?”

“I don’t know.”

I “hmmed” and asked slowly, “Do you think you might have done something to upset them?”

She looked up with a concentrated expression. “One time, she asked me for water, but I didn’t give it to her because everyone drinks my water, eats my food and finishes all of it.”

“That’s not very nice of them,” I agreed, remembering all the times my own friends’ parasitism peaked. 

“And one time she didn’t do her homework, so I told the teacher and the teacher scolded her,” she added, looking at me.

I tried to detect a hint of humor, but she seemed genuinely confused. Maybe she had some form of intellectual disability, I considered, staring at her, nonplussed. “Do you think what you did may have annoyed her?”

“Yes. But I said sorry afterward, and then we became friends again.”

I had forgotten how dynamic and random childhood friendships were. “Well, that’s good. Now, do you get good grades in…” Even as I asked the question, I felt like a hypocrite. The girl was in fourth grade, and I was quantifying her intellectual capabilities based on test results. 

In contrast, I had never taken a test until my 10th-grade board exams. I had no right to judge her, considering my history. I didn’t want to propagate the notion that failing to obtain good grades indicated a mental condition. 

Luckily, the girl interrupted my question. “I have another best friend,” she said with the same blank look, but her voice was enthusiastic now. “His name is Virat Kohli.”

As in the Virat Kohli, the world-famous cricketer? 

In my first year of medical school, I learned about the urethra and its two muscles that prevent urine leakage from the bladder. One, the internal urethral sphincter, opens involuntarily when the bladder fills with urine. The other, the external urethral sphincter, is under voluntary control — or so it was said to be. 

What the little girl said almost made me forget normal physiology — I very nearly wet myself. 

I felt as if the world had faded away. What remained was me, the girl, and — according to her — a 30-something-year-old cricketer attending fourth grade in a small school in Jodhpur, India.

I composed myself. “Do… umm — is Virat Kohli here right now?”

The girl nodded, and I suddenly understood why people found movies like Annabelle scary. “He’s right there,” she said, turning around and pointing toward a mass of students at the anthropometric station.

I couldn’t see anyone in particular. But then again, I doubted the girl was pointing to someone specific. Perhaps he wasn’t even tangible. The crushing weight of responsibility suddenly hit me like a train. Was this girl having hallucinations? What if I missed diagnosing her, her condition worsened, and she became a mortal danger to others? How many lives were at stake, hinging on my juvenile clinical judgment? The predicament was bigger than I had imagined. I wanted to be responsible for patients, but was I capable enough? How many budding serial killers would I need to miss before I gained the experience to detect them accurately and confidently?

As I tried to get a read on the girl, she met my gaze with the same emotionless expression. Yes, she fit the pre-serial killer profile perfectly. Her cute demeanor was most certainly part of the act.

I tried to recall the signs of hallucinations and how to rule them out. “Does Virat Kohli talk and interact with you?”

“Yes. Virat is his actual name, but we call him Viraht Kohli.”

I hadn’t asked for the information, but my body responded. I could once again hear the clamor of the students and the residents scolding my batchmates. The blurred world came back into focus, and suddenly, the girl seemed like an average child. I felt a wave of annoyance wash over me. A slight miscommunication between us had almost led to me wetting my pants.

“Is there anything else you’d like to talk to me about?” I tried to mask my irritation.

“Yes.”

“What?”

“I don’t know.”

I observed her, unsure of what to say. I saw an expectation in her eyes.

“Do you want to tell me more about your friends?” I asked tentatively.

She nodded eagerly and continued telling me about her other best friends. It turned out that even the children who pulled her hair were her best friends. I was beginning to consider diagnosing her with Dependent Personality Disorder.

But I was no longer annoyed. I now felt as if I could empathize with this little girl. She was enjoying the chance to share her life’s problems. 

Someone to listen

I recalled that when I was ten, my biggest concerns revolved around friends: Who was mean to me, who I wanted to be friends with but wasn’t cool enough for, who I had a crush on and so on. I wanted to tell someone my age at the time, but no one listened attentively. After all, if a child can voluntarily sit still and pay attention for a long time, there’s a high chance that something is wrong with their upbringing. That’s why I realized I needed someone older and more mature to listen to my “serious” problems.

I had been excited to talk to the children today, but I didn’t expect their problems to be genuine. I approached the interactions like an ignorant adult, thinking their concerns were tiny and insignificant. I felt guilty. So for the next 15 minutes, I paid close attention to every bit of nonsense that exited the girl’s mouth. 

She told me about her best friend who stole her homework, pushed her and ate her lunch. She had another best friend who told lies to others about how mean she was. Someone else kept stealing her bottles and pens. There was a teacher who scolded her for no reason, though sometimes it was because she didn’t complete her homework. At home, her older brother annoyed her.

I “hmmed” and “aahed,” acknowledged her stories, asked leading questions based on what she told me, until finally, she stopped talking.

There was a peaceful silence between us. “Is there anything else you want to talk about?”

“No,” she said, but didn’t leave.

I waited thirty seconds, but she continued to watch me.

“Okay, you should go to the next station now. They will check to ensure there’s nothing wrong with your eyes,” I said. “I enjoyed talking to you.”

“I liked it too,” she replied in a sing-song voice before climbing out of her chair. 

As she tottered away, I considered my role in our interaction. I had wanted to make her feel understood, give her a space to share and provide relief. However, I hadn’t given her any advice or suggestions about her problems that would help in the long run.

In my experience, when people thrust their advice at me it makes me hesitant to share my emotions. The girl’s talkative nature might have mitigated that discomfort, but I didn’t want to take the same risk with her. As a result, I changed nothing in her life. I simply listened to her, hopefully made her feel accepted in the process, but I made no lasting impact.

Perhaps my duty was to explain what she should do, hammer it into her head, and push for change. While that approach might have left her feeling misunderstood, maybe it would have been more beneficial for her in the long run.

Or maybe there was some middle ground. The possible ways I could have handled the situation were endless. I couldn’t decide which one would have been the right decision, the responsible thing to do.

But what if responsibility doesn’t necessarily mean always doing the right thing? Of course, I would strive to take the correct course of action. But perhaps it’s not so straightforward — distinguishing what is correct and what isn’t. Maybe responsibility isn’t about always doing what is right, but rather about making a conscious effort to do the right thing.

[Ting Cui edited this piece.]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.