24 hours

Disclaimer: Everything written below is for a hearty laugh. Characters are simply inspired from the dazed, confused, overworked yet happy lot of interns from the 2012 MBBS batch of AIIMS Bhubaneswar. I miss you guys!
7:00 am, Hostel

Cuckaroo-coo! My neighbour’s phone screeched ruthlessly, jolting awake an entire wing of somnolent interns. Six months of internship had made us respond to the ring of a phone with instant palpitations and an impending sense of doom – I tell you, Pavlov’s dog was luckier. The owner of the wretched contraption was Intern Pemphigus foolacious, the Dermatology intern. Though it was a fact universally acknowledged that Dermatology interns had to be inside the hospital whenever sunlight was falling on planet earth, this foolish braveheart continued sleeping blissfully. How I envied his nonchalance!
I was awake and had an hour to do something worthwhile. Should I go for a jog? But then a minimum of four miles would be covered anyway while getting reports from Radiology and Biochemistry. Crossed out. Should I read about Wegner’s? There was a patient who was provisionally diagnosed with it and I had vowed with the usual post MICU (Medical ICU) rounds, hypoglycaemic fervour to read up on it. Through the morning sunshine I could see that my Harrison lay beneath quite a pile of thousand page comrades and my single volume Robbins pathology on top was the cherry on the cake. Heavy weightlifting – too daunting a prospect in the morning. There was this nursing student, Sister Pretty, who had helped me with the lumbar puncture the other day. What about a hot bath, a clean shave and finally ironing my sickly, not at all white coat? But then I was going to the MICU, the brewery of resistant bacteria and fungi. I say, two baths in a single day is unquestionably a waste of national resources.

Thinking of the MICU, made me involuntarily think of the sister in charge, Sister Grouchy and shrivel up. Sister Grouchy’s scowl of disapproval whenever a buffoonish intern approached her was legendary. Man, I must make this lady smile at me once before I finish, I decided with resolve.

8:00 am, still in bed
Only when Sister Pretty’s face had started merging into Sister Grouchy’s did I realise that I had drifted off into slumber. In a record 15 minutes, all pumped up with deodorant, I was swallowing away the sort of breakfast I would advise against professionally – greasy, devoid of fresh produce and sprinkled with the sweat of our hardy cooks. The devil phone rang again and the perennially disheveled O & G intern, Intern Nanny hurried off popping a boiled egg into her mouth. Apparently after babysitting a remarkably vocal primi in labour for the entire night, the lovely lady had started crowning the moment she had come to eat. Such providence I tell you!
Intern Haribhakt Yojana, the Community medicine intern sat languidly sipping a cup of coffee. Some interns mirrored their departments successfully and this fellow looked like he had life figured out. He looked like a real doctor, the kind you see in those ambiguous TV ads, complete with his shiny stethoscope. The attire was necessary to be taken seriously because he would be the doctor in the Primary Health Centre. I on the other hand had paired my shabby white coat with my old Reebok running shoes. Stamina to last the day was far more important than impressing Sister Pretty for the time being.

9:45 am, MICU, morning rounds
Lady Grouchy gruffly informed that the professor had arrived for rounds as I gave her my best smile. I hadn’t completed my notes but thankfully it was Professor Greymatter with the Senior Resident, Dr. Swag in tow. Interns liked Greymatter. He acknowledged our existence and made sure we learned something. He probably wasn’t as ancient as he looked and behaved. But then I have this theory that medicine people age prematurely with the opposite being true for surgical branches. Maybe it had to do with exercise – medicine people seemed too philosophical to work out but that’s not evidence based of course.
Medicine rounds had changed from the Osler service of yore. A seamless flow of GCS, TLC, bilirubin and creatinine values took precedence over palpation and percussion. I might not be an athlete or a guitar player or the guy who scores with girls but spurting out numbers and facts was my forte, courtesy, years of memorizing chromosome numbers and IPCs. This process continued interspersed with us, the great healers, hitting a few unwitting patients with a knee hammer, scratching their grimy soles with our keys or flashing bright light into their confused eyes.

1:00 pm, Casualty
There are some departments that make you feel at home. For me it was the Casualty – the blood and gore, the chaos, the speed made me feel alive. Real work was always aplenty.
​“No RTAs yet,” said Brother Action grinning as he passed me, always on the go. He used to my partner in crime during my casualty rotation, sewing and fixing fractures.
I had come to pick up my best friend Intern Ryly for lunch. She was busy inserting a nasogastric tube into a cranky old man. As I watched her sternly ordering the old man to swallow, I remembered the shy girl from MBBS. Oh how she had always mumbled, fumbled and stumbled during her vivas. I couldn’t help but marvel at how this long journey had changed us all forever.

1:30 pm, Mess (either way a mess)
I made it a point to have a slow lunch, come what may. The Pediatrics and Surgery interns, Intern Frustoo and Intern Cut-it-off sat beside us. Intern Cut-it-off was bragging with glee about the sebaceous cyst he had just excised.
“Didn’t rupture the cyst wall at all,” said Intern Cut-it-off, adding proudly “See, see, I took photos too. What a beauty! Sir reckons he will give me a hydrocele next.”
“I climbed up and down three times to give samples and get reports for a lumbar puncture I did not even do,” interjected Intern Frustoo glumly, in his usual depressed tone.
“Come on now, you made such a big difference in that kid’s life,” said Intern Patience, the Psychiatry intern kindly, trying to calm Frustoo down, “You have to use mature defence mechanisms to deal with these challenges . Voluntary suppression, dear or why not use humour?”
Intern Baba, the Anesthesia Intern, suddenly spoke up from a corner. Baba was seldom seen but rumours have it that his special hideout was in fact the library, a place rarely frequented by other interns.
“Forget all that. Listen now Frustoo and listen carefully. The advice I am giving has had a hundred per cent success rate in all departments,” said Intern Baba, the all knowing, “First – tunnel vision. The minimum eye contact you make with residents, the less work you get. Second, be as slow as humanly possible. You and only you can dictate the pace at which you collect a report or fill up a form. You must make them realise that you are incompetent to be trusted with important work. Lastly, dazzle them with a smile whenever you are given fresh work. It screws with their mind, makes them feel guilty.”
With that Baba disappeared, undoubtedly to the library again. Frustoo wasn’t much convinced with the pearls of wisdom and began moaning again. Sensing more tragedy was to follow, I made a hasty departure.

3:00 pm, MICU, evening rounds
Armed with two files in one hand and two MRI films in another, no doubt looking like a pompous fool as Sister Pretty sat watching, I had returned from the Radiodiagnosis department. I looked at the crumpled up list of To-Dos that the Senior resident had entrusted me with – 50% done, not too bad. There was a time when I would have honourably tried to do it all. But no more. The radiologists were usually the cool lot, nerds staring at the black and white, oblivious to the sputum, pee and cries. We interns, specially the likes of Intern Frustoo who visited the department at least half a dozen times to discuss some child’s wrist or brain scan had frustrated them enough. They shooed us away these days.
Not that it bothered us anymore. Being at the bottom of the screaming chain, every intern’s self esteem hits a nadir midway through his internship but afterwards it takes a turn for the better. The scrappy intern starts adding drugs and doses to his/her repertoire – Rabeprazole, Omeprazole, Pantoprazole – we mug it all. For blood, ascitic, pleural or lumbar fluid we poke and poke and succeed in draining the poor patient eventually. With punctures and per vaginal and per rectal exams on a daily basis, the previously feeble ego rises resolutely. We know something after all. With the dawning of this epiphany the humble intern stops caring when being told off. S/he now realises the one true goal: arm yourself with knowledge for the future.
I quietly told my senior that his personal presence was necessary for the rest of the work and joined the evening round. Hakuna matata.

1:30 am, MICU
BRCA1 gene is on chromosome 17. I was rereading the same sentence in a loop. My job was to monitor an old man, GCS 3, hooked on norepinephrine, dopamine and whatnot. Though my knowledge regarding ECG changes, ventilator settings and emergency drug dosages was fuzzy to say the least, I knew enough by now that he might crash the moment I go to nap.
“Hey,” said Intern Frustoo, “What are you reading there? Might I join?”
Frustoo apparently had been sent down to the adjacent PICU (Paediatric ICU) to monitor a sick child. Most likely his reward for following Intern Baba’s formulae for success. He held a sheet of paper with columns drawn for all the vitals to be recorded every 15 minutes – I thanked God that my time there was done.
“Surgery MCQs,” I replied grimly, “Last ditch effort to fire up the dead grey cells and do a miracle.”
PG entrance exams was our Betaal that clung on to us. We had to carry the ghost everywhere but like King Vikram we did learn something because of it. So we sat, two reasonably good looking, arguably smart young chaps as my dad puts it, mulling over breast and thyroid carcinomas amidst the beeps of the monitors and the farts and midnight wails of the ICU patients.

8:00 am, Hostel
The best feeling was walking back to the hostel knowing that you owned the next 24 hours of your life. Thankfully, the old man had lived through the night and I had been saved from doing all the paperwork. For all those judging me, I tell you, it is quite a challenge to the muddled, sleep deprived brain to get the carbon papers oriented correctly to make three copies of three different forms.
Inspite of being a Sunday, ironically Kumbhakaran had arisen early and I met him in the corridor. Pemphigus foolacious took one strong look at me and ordered, “Eat. Bath. Get ready in an hour. 10 o’ clock show at Keshari.”
I grinned as I entered my room, all sleep vanishing. With friends such as this, internship had sure become a ride to remember.
​​

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To The Girl In Her Mid-20’s

Loud Thoughts Voiced Out

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You’ve spent so many years looking forward to this phase of your life. And it always looked so cool. So glamorous. So filled with love and laughter.

Yet here you are. With knowledge that it’s anything but.

It’s messy buns and messier lives. It’s baggy shirts and overflowing laundry bags. It’s a lot of work and never enough money. It’s freedom with responsibilities. And life is no longer what it seemed.

Different people are doing different things.

Your best friend’s getting married. Your old classmate is killing it with success. Your ex is happy in love. Your old mate is drowning in drugs. Different people are doing different things. But not you. You’re just existing. You’re getting through everyday a little better than the last. But then you have days where you can’t get up at all.

You spend your Friday evenings holed up in a corner because you’re too responsible to drink…

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One’s voice is one’s prerogative but to what end?

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Two front page headlines appear on today’s newspaper (TOI): 1. German prof rejects Indian student for ‘rape problem’ 2. US University fraternity closed over racist video.

Rape, racism, gender equality, feminism, freedom in all forms seem to dominate the papers and the Indian psyche these days. What I cannot digest is the strong opinions which people often seem to express particularly by means of social media. There is too much of randomness, too much of uncertainty, too much of selfishness to make statements with such assurance. To what end? I ask myself. Through yesterday’s newspaper headlines and conversations with a couple of friends, I want to share just this:

I shall start by sharing tit bits of two conversations that I had with my friends yesterday:

1.  “Dekhli?! (saw?!)…that’s how educated Europeans thinks abt indians… hands-on experience in Germany” – Whatsapp message by a friend studying in IISc Bangalore. He had spent last summer as a DAAD WISE fellow working in a German University. Jist: * While working there, he had felt that he was being silently discriminated, something which I have heard from numerous other people. * He now believes that Germans will use this as a reason to refuse internships to Indians. Going by social media and my friend circle who have applied for PhD and Masters courses abroad, this has sparked unrest.

BBC made the documentary India’s daughter (Nirbhaya incident) which according to some will make people outside the country view India’s sons with suspicious eyes. Whether the video was made for sensationalism or altruism, I don’t see how that can be the issue. The second article mentions about a racist video containing slurs against African American people by the sigma alpha epsilon fraternity of the University of Oklahoma. The same set of problems exist everywhere. They just take different forms. Bottomline: it BBC’s prerogative to make a video and they did. If educated individuals are worrying about the impact that this video will have on their future, the government’s troubles of reversing such an image will certainly be exponentially more. The government’s decision to ban it similarly was its prerogative. Foreign universities might be reserved while taking in Indian students. But these universities can do as they choose; it’s their prerogative after all.

  1. I mentioned the first article regarding the German rejection to a friend of mine, a fellow medical student of AIIMS Bhubaneswar. She replies instantaneously that it is uneducated men who commit atrocities like rape and lamented that educated Indian males will be suffering because of it. I pointed out the adjacent article where an Indian Law Professor (aged 53 years) has allegedly attempted to rape his PhD student. Both were front page news.

The way I see it, both the rapist and the victim have one thing in common- there is no bias in distribution in either category. Teenage school girls being impregnated in government hostels, old women being raped and murdered, western or Indian attire really makes no difference. Same goes for the rapist, from the young undergrad who rapes his girlfriend to your beloved uncle, a bus conductor to the director of a central government institute – there is no respite.

I sit back and think about the varying opinions, about the right and wrong of things. Taking sides, I conclude is possible. The only thing that everybody (as per my humbled opinion) can be in unison about is the fact that both rape and racism (when proven) are bona fide offences punishable by law. As citizens of our country we should try to make a change, no doubt. We see and feel what best suits us. We can philosophize and talk and post and share by taking sides and forcing (online abusing has become all too rampant) others to see likewise: what’s the point? Mob lynching an alleged rapist like the incident in Dimapur? Substituting one crime for another?

It all comes down to doing and not discussing and bashing one another. How? In our own capacities, of course. In India, theory always triumphs over practicality (something which I am planning to write in my subsequent posts).

As a medical student I need to understand the psyche of a victim, the medico legal procedure and management in all its dimensions. As a citizen, I need to dissipate myths and encourage equality and tolerance amongst all sections (in India, we all know that divisions occur in all forms – class, money, gender, caste). We all can talk and talk and talk and nothing can come out of it till we start doing something about it.

My favourite love story

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My favourite love story

My parents are the best people that I know of in this whole wide world. Don’t get me wrong, I am not blind to their flaws. Their awesomeness, however, remains forever undeniable.

Since I have sworn to finish off all the Ophthalmology MCQs of the last five years, let me take this long cherished digression and reminisce about the two people whom I love more than anything.

It was the 1980s. They met while doing their Chemistry Masters. Typical, I suppose for love to brew in the Chemistry lab. My dad (the way I picture him) was this genius brought up in a village amidst nature and books. He finished his entire education from school to PhD to Post Doc on scholarships, a principle that he indefatigably tries to instil in us. He was in the top 10 of the state during his 12th standard (this still is somewhat of a big deal in my state). Medicine, engineering – anything was his picking. A quiet, self assured man, extremely loyal friend and a student with an unreasonable desire for perfection (he used to make me rewrite my English answers thrice!), my dad decided to study engineering. He attended a month’s worth of classes in the best college of my place and then left abruptly after getting into an unpalatable conflict of opinion with one of his professors.

He always had strong opinions something which has undoubtedly rubbed off on me. Once his mind was made on a matter based on sound logic, rarely anyone could change it (mother being the occasional exception). He used to tell me how he used to listen to foreign radio channels at night and devour any magazine or book that he used to come across at that point of his life. He then chose to study basic science – Chemistry, for that matter, something which even today by many people is seen as the last resort of those who can’t make it in medicine or engineering. This moronic line of thinking is thankfully changing with time. History has it that my grandfather (who was the Vice Principal of a school) too had been selected for medical school but the letter had arrived late. I must confess that this history of two generations of my family (plus the doe eyed looks of my grandmother) had been one of the triggers behind the switch (reverse of my father) from IISc (Indian Institute of Science) to AIIMS (All India Institute of Medical Sciences).

My mother on the other hand, I find, had a more remarkable story. She is the most fiercely independent yet accommodating person that I know of. Brought up in a town, she has never lived in home after her 10th standard. When in home, my mother biggest joy was to go for a ride with my grandpa in their jeep. After completing her education living in hostels, she started living in the big city, all alone working as a lecturer of Chemistry and looking after her baby brother. Such heart, such independence, such character in those times! Cooking, knitting (all of my sweaters are the products of her ingenuityJ), investing in weird business ideas (that’s a whole different hilarious chapter) to name a few, my mum always has her plates full.

My mother was really pretty and smart. Dad, well, did look dashing in those old photos of him in bell bottom pants wearing dark glasses (what’s with men and sun glasses?!). Being brought up in a village, climbing trees, fishing (he often tells us this story of how he caught a huge tortoise once with glee) and what not, my dad used to be sceptical of the rich city students who appeared to have more of flash and less of substance. In all fairness, both of his daughters would fall in the latter category now ;). If you can’t cut a coconut with ease, you have a problem mister!

In spite of my dad’s prejudice and different family upbringings, it was fortunate that my parents managed to find each other. I chanced upon a couple of my dad’s diaries (I sincerely hope he never reads this post!). Written in his elegant handwriting, I saw how deeply he cared for her and how he had wondered whether she felt the same while he sat across her in a train during a class picnic. The language, the expression!  That’s the same person who excuses himself while watching a romantic movie (the only movie he lasted through with me was Blood Diamond :D).

After his masters, my dad went to the Indian Institute of Science, Bangalore, arguably the best in the country, for doing his PhD while my mum started working as a lecturer back in Guwahati. They maintained a long distance relationship and decided to marry only after dad submitted his thesis. My dad has always described the five years that he spent working there as the most energetic and inspiring time of his life (my one year as a BS student in IISc was no less inspiring; that place has magic!). In contrary to the popular notion of working late at night, dad used to get up early in the morning and do his experiments in peace.

Such endeavour earned dad the J C Bose gold medal for the best thesis of the year and he at once got a job in Gauhati University back in Guwahati. Then of course, in 90’ my parents finally married (trumpets!). Both of their families were very different. My mum was a Brahmin whereas my dad belonged to a Hindu sect who were the disciples of Srimanta Sankerdeva and technically didn’t do idol worshipping but rather naam kirtan.

You might be expecting a lot of drama and opposition from either family. This is the part which I like best. There simply wasn’t any. Actually, if you meet my parents you will realize that nobody could have dared to. Secondly, I must mention how grateful I am to belong to the North Eastern part of the country where people are inordinately rich in their thinking. Here people are allowed to marry for love and girls are cherished and expected to excel as much as guys. What is the point of have giving kilograms of gold as dowry when you aren’t rich enough to give your daughter her own life’s freedom?

These were two self built, fiercely independent people who had the highest of academic qualifications and stood on their own feet. While my dad takes away the thunder in terms of academic achievements, it was always my mother who used to guide me though my science in school with precision. My mum in course of time finished her PhD and even did her Post Doc in 2011 in Georgia Institute of Technology! She told me once that apart from a few family heirlooms, my grandparents didn’t spend a penny for their wedding. My father’s side didn’t dare to visibly complain. Of course there were obstacles. My father’s mother herself was a strong minded woman. She for years refused to eat food made my mother but now I see how completely my mother has won her over.

They married quietly in a temple, accompanied by friends and family. As a child I used to bug them, asking them for details of their marriage, regarding the clothes she wore. My mother told me that they never had any fancy big reception. Both families individually gave a treat to the locals.

They bought everything for their first home together. That original furniture had accompanied us for quite some as children. I now see why my mother was so sentimental regarding that ugly, enormous white showcase and the oversized Philips TV J .

It may not be Romeo and Juliet but to me a Brahmin girl marrying a general guy, attaining excellence in their careers in their own terms, setting up a new life with their own hard earned money with no mention of dowry or a gaudy wedding remains forever the most inspirational love story. Something we, me and my sister often tell ourselves, can’t possible live up to.

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A Sincere Day

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23rd February:

Today has been one of those rare, productive days when you are filled with energy and purpose! You know when everything looks bright and shiny and you just feel like working and learning 😀 . For three hours, me and my friend New Fight Seth (I am not joking, this is his name 😉 ) kept on observing and asking and learning in the Surgery Department today. Starting from common cases like lipoma, sebaceous cyst, haemorrhoids, ANDI (Aberrations in Normal Development and Involution), fistula in ano to serious ones like a painful pyocele, advanced breast cancer, massive ovarian cyst and a particularly gruesome case of leprosy, what a complete experience I have had in my Surgery posting today!

Both of us also got to see an endoscopy done and did a DRE (Digital Rectal Exam). It was my third DRE and well, I blame my small fingers for getting not results 😦 . My hopeless dainty fingers are hopeless during percussing the abdomen too!

As I write this, I am going through some of the questions that popped into my mind today. I am noting down some which I found rather remarkable:

  • First of all: breast cancer staging is a tricky business. History of the patient I saw today and you will understand: 34 year old lady had a lump in her areolar region with dimensions of around 6 cm, slight puckering of the nipple, multiple central axillary nodes and no fixity to the chest wall. On palpation, my professor noted ipsilateral swollen supraclavicular lymph nodes and then everything changed. The stage of her cancer at once became ominous (Stage III at least if I am not mistaken). It had been her first visit to the doctor. Strange isn’t it? A woman comes with no complaints at all apart from a slight lump and her life changes. Another keeps on complaining about cyclical mastalgia (breast pain coinciding with the menstrual cycle) and all that is requiring is counselling and evening primrose oil (after exclusion of any serious pathology of course). For me, this staging business is very confusing. Bailey and Love’s Short Practice of Surgery has an overly simplified (their so called pragmatic) classification of breast cancer whereas Sabiston has a scary, complicated TNM classification table. Got to clear up the mess!
  • The particularly gruesome foot of a patient who had had leprosy since many years left me quite shocked:
Huge abscess in the foot of a leprosy patient

Huge abscess in the foot of a leprosy patient

Scary isn’t it? Yet, the patient doesn’t feel any pain. This loss of nerve function is the culprit which has mad the foot sustain multiple injuries and deform in this serious fashion.

In India, leprosy is officially eliminated which is misleading in itself because by elimination, government statisticians mean that the overall incidence is less than 1 in 10,000. Considering our population, you can manage the disease burden. With the advent of multi drug therapy effective treatment is possible. Like my Dermatology Sir rightly said in his stimulating class, it’s of utmost importance to know the clinical features and remove the myths and social stigma around it.

On this note, I end. I shall be grateful for feedback and discussions regarding topics related to medicine, science etc. So many questions, so many things to know!

The importance of knowing the science and never judging

Med Student’s Valentine’s Day

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February 14th: V DAY

Rose petal in candlelight

Rose petal in candlelight

MORNING

That day of the year again. No time to sign internally as I have to rush to my Obstetrics theory class at 8 am. For an hour, I listen to the different causes of antepartum hemorrhage and am utterly convinced that OBS is rightly a very bloody business. I wrap my mind around the differences between abruptio placentae and placenta previa and chant ‘sudden onset, painless, causeless, recurrent bleeding’ for the latter in my mind. Yea, that’s why med students think about most of the time. Phoosh, I reach Surgery for my clinics and we examine a 24 year lady with an enormous cystic swelling in her abdomen. It apparently has been increasing since birth and we ask her surprised why she never consulted a doctor before. She tells us that she has never had any problem because of it and even today, she had come only because of her relatives. Happens doesn’t it? Initially, we all notice the glitches in things but then we stop noticing it and it just starts getting bigger and bigger! Oh D/D: mesenteric or omental cyst? That’s discussed under the Medicine tab which is in my home page.

 AFTERNOON

Processed with VSCOcam with g3 preset Me and my friend Saswati go shopping to pick out the perfect gift for her guy. We debate animatedly about choosing the multitude of Marvel superheroes or plain old Batman for a T. After that we drop by the book fair where I pick up a book by Swami Vivekananda. All my life I have been hearing about his infallible and incorruptible character. One must know for oneself. All ready to be swayed by the magic of his words. We rounded up our outing by buying the cheapest possible roses for our blind dates (coming to that later) and had an awesome time sharing a pizza! Pineapples on a pizza work for me!

EVENING

Never say no to ridiculous ways to have a laugh!

Ready for my blind date with a first year junior 😛
Never say no to ridiculous ways to have a laugh!

So I and Saswati (whose guy is out of town but who is in on the joke of course) had given our names in a lucky draw to be set up on blind dates for fun. As it turns out, two poor first year guys got stuck with us (or we with them). Unfortunate fellows, couldn’t flirt, were really awkward initially and the overall experience was umm…let’s me say no more. Overall, me and Sasu had great fun dressing up and grilling those poor fellas. You can have fun with guys in different ways in Valentine’s! 😛 This blind date has enlightened me about the perils of being set up. No regrets though, it’s not every day that you can go out a first year junior and have a laugh! 😀 😀