On the timeline on this site’s About page, my pre-medical years take up one line: 1994–1996, pre-medical sciences, Khalsa College, Amritsar. The MBBS that follows takes one line as well, and so does each stage after it. A timeline is an honest form within its limits. It records arrivals. It has almost no way to record preparation, which is where most of the hours went.
Early in A Portrait of the Artist as a Young Man, the small Stephen Dedalus opens his geography book, finds that he cannot learn the names of places in America, and turns instead to the flyleaf, where he has written down himself and where he is:
Stephen Dedalus Class of Elements Clongowes Wood College Sallins County Kildare Ireland Europe The World The Universe
He reads it downward, and then, Joyce tells us, “from the bottom to the top till he came to his own name.” It is one of the great addresses in fiction, a child’s attempt to locate himself in everything there is. What catches me now is the second line. Class of Elements is the name of the class he belongs to, and the name is a promise. These are the elements; the compounds come later. Before he is placed in a college, a county or a country, the boy is placed in a stage, and the stage’s name already implies everything it is meant to be the beginning of.
Pre-medical works the same way, and once you look at the word it becomes odd. It names a stretch of a life after something that had not yet happened. Few of us would like our present year described like that. A man of forty-five is rarely introduced as pre-retirement, though the description would be accurate enough, and it would tell you nothing whatever about what he did on Tuesday.
What a Row Can Hold #
A row on a timeline can establish three things: that a period existed, where it was spent, and what followed it. Those are not small things. The row for 1994 to 1996 is true, and it can be checked, and it places the years correctly between school and medical college. What a row cannot establish is what the period contained: the subjects that were hard and the ones that were easy, the methods that worked and the ones that did not, the weeks of progress and the weeks of none, the mood of an ordinary afternoon.
For my own two years I will add very little to the row. I will not reconstruct marks, examinations, the process by which one stage led to the next, or any scene from a classroom or a laboratory, because I would be inventing them, and an essay on the value of a forgotten year would be a poor place to manufacture memories of it. What I can do is ask what kind of thing such a year is, why it is so easily forgotten, and whether it has a value that does not depend on what came after it.
The forgetting has a mechanism, and it is not carelessness. Once an outcome exists, the period before it survives mainly as its cause. The admission, the degree and the title are the facts that get repeated, in applications, introductions, biographies and obituaries, and each repetition compresses the years behind them a little further, until they are a single line or a subordinate clause: after pre-medical studies at Khalsa College, he entered medical school. The year is not so much forgotten as digested. Its substance has been taken up into what followed, and what remains visible is the residue, a date range and the name of an institution.
That is efficient, and for most purposes it is fine. But it settles, without ever asking, a question that seems to me worth asking: whether the year was worth anything in itself, or only as a means. The answer a timeline implies is the second one. I want to argue for a more complicated answer, and to argue for it without the sentimental conclusion that every preparatory hour is secretly precious.
A Future Lent in Advance #
The prefix does real work, and not all of it is bad. It orients. A student who knows his subjects are pre-medical knows which of them will matter later, and has a reason to endure the dull chapters. It gives effort a direction and a horizon, and it gives the year a name that other people understand. Medicine itself is full of the prefix, and uses it well. The preclinical subjects, anatomy, physiology and biochemistry, are experienced by many students as an anteroom to the wards, and turn out on the wards to be the language in which nearly everything is explained. A student who skimped on them does not discover the cost until years later, at a bedside, when an explanation he ought to be able to follow simply does not land.
But the prefix also borrows. It lends the year a future in advance, and it charges interest. Everything the year contains is now measured by whether it serves the destination. Subjects that do not lead there become detours. Interests that wander from the path become distractions. And the worth of the whole period is staked on an event outside the student’s control, an examination result or the number of seats available, so that if the event does not come, the prefix turns retroactively into a description of something that did not happen. For a student who goes on to other work, pre-medical becomes the name of a door that stayed shut.
The European novel of formation began with exactly this problem, and solved it more generously than a timeline does. Goethe’s Wilhelm Meister’s Apprenticeship, published in 1795 and 1796, is the book on which so many later novels of formation were patterned that it is treated as the model of the type, the Bildungsroman. Its hero’s apprenticeship is aimed at the theatre. He wants to escape what he sees as the empty life of a merchant’s son, and his obsession with the stage drives most of the book. By the end he has renounced his theatrical ambitions. The years of apprenticeship, the Lehrjahre, literally the years of learning, led somewhere other than where they were aimed. In the sequel, Wilhelm Meister’s Journeyman Years, published in 1821 and in a revised form in 1829, Wilhelm studies anatomy and comes to a medical calling, and near the close he pulls a young rider from a river and saves him by opening one of his veins. The rider is his son Felix.
The moment at which the apprenticeship ends is one of the strangest scenes in the novel, and one of the most useful. Near the close of the seventh book, Wilhelm is brought into a hall that was once a chapel, where shelves meant for books hold rolls of paper instead, and the members of a society that has, he discovers, been watching over him for years appear to him one by one from behind a curtain. One of them tells him that it is not the instructor’s duty to guard the pupil from error, but to let him drink his error to the dregs, so that he finds it out. Then a figure in armour, dressed as the ghost of the old king of Denmark from the Hamlet Wilhelm once staged, speaks in what he takes for his father’s voice, assures him that he will repent none of his follies, and offers a sentence that any honest account of a preparatory period could take as its motto: “Steep regions cannot be surmounted save by winding paths: on the plain, straight roads conduct from place to place.”
On a table lies a small roll, which an abbé hands to him as his indenture, the certificate that his apprenticeship is over. In Thomas Carlyle’s translation it begins, “Art is long, life short, judgment difficult, opportunity transient,” which is the first of the Hippocratic aphorisms rearranged, one of the oldest sentences in medicine turned into a certificate of apprenticeship. A little further down it says, “The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain.” And it distinguishes two kinds of teaching. One is “like baked bread, savory and satisfying for a single day; but flour cannot be sown, and seed-corn ought not to be ground.”
Then Wilhelm looks more closely at the rolls on the shelves and finds that each is labelled with someone’s apprenticeship, and that one of them is his own. The years he thought he had spent foolishly on the stage had been recorded all along, by people who regarded them as the substance of his formation rather than a detour from it.
What I admire in Goethe’s arrangement is that the theatre years are not treated as waste. They are the apprenticeship. The German title names the time, not the trade: these were his years of learning, whatever they were learning toward, and the novel’s interest is in what they made of him rather than in the career they were meant to produce. The genre that grew out of the book has usually kept faith with that. Joyce’s Portrait ends on the threshold, with Stephen setting off “to forge in the smithy of my soul the uncreated conscience of my race,” and we never see what he forges. A novel of formation stops at the door because its subject is the formation.
Tiārī #
The Punjabi word for preparation is ਤਿਆਰੀ, tiārī. It is the word for what a student does before examinations, and for what a household does before a wedding or a long departure. Its range is wider than the English. A dictionary will give, alongside preparation, completion, physical fitness and willingness. The word holds readiness of body and of will alongside the readiness of knowledge, and it assumes that a person can be prepared or unprepared in all three at once.
Bhai Vir Singh, the Amritsar poet who was among the central writers of the Singh Sabha generation, has a short poem whose title is the plural of that word, ਤਿਆਰੀਆਂ, tiārīāṅ, Preparations. It belongs to his collection Trel Tupke, Dewdrops, of 1921, and it is very short. In my paraphrase: Ranjha is still in his village of Takht Hazara, playing among his brothers’ wives. The potter is still at work, the vessel still raised in his hand, shaping a slender Heer with her head bowed, standing at the bend of the river. The mighty Chenab moves on, and each small drop stands still.
To feel its force you have to know the story it declines to tell. In Waris Shah’s Heer, written in 1766, Ranjha is the youngest of the brothers of Takht Hazara, a village on the Chenab. After his father’s death he quarrels with his brothers over land, and in Waris Shah’s telling he leaves home when his brothers’ wives refuse to serve him food. He finds his way to Heer’s village, takes work herding her father’s cattle, and the qissa that has been sung and retold in Punjab for more than two centuries begins. Bhai Vir Singh’s poem stops before any of it. Ranjha has not left. Heer is not yet finished. The river that will carry the whole story is moving, but its drops are still.
As I read it, and it is my reading rather than a gloss the poem insists on, this is a poem about the time before a story counts. It is the part of the story that the famous scenes overshadow, because the famous part has not started, and the poet has given it a title and a poem of its own. That is a quiet judgment in itself: that the preparation is worth looking at for what it is. The last image carries the paradox of every preparatory year. Seen at the scale of the drop, nothing moves. Seen at the scale of the river, everything does, and the river is made of nothing but the drops.
The potter in that poem brings another Chenab story to mind, and it is the one I think of most when I think about preparation. In the qissa of Sohni and Mahiwal, as it is commonly told, Sohni is a potter’s daughter who crosses the river at night to meet her lover, keeping herself afloat on an earthen pot. One night the pot that has been fired in the kiln is replaced with one that has not. It looks the same. In the water it softens and gives way, and the river takes her.
Punjabi has exact words for the difference. ਕੱਚਾ, kaccā, is raw, unripe, unready, unbaked; ਪੱਕਾ, pakkā, is baked, ripe, hard and firm, and by extension genuine. A ਕੱਚਾ ਘੜਾ, kaccā ghaṛā, an unbaked pot, is the image of something that has the shape of readiness without its substance. What makes the image so exact for a preparatory year is that the difference between the two pots is invisible until the river tests it. Both are the same clay, thrown on the same wheel, with the same curve to the shoulder. One has spent its time in the fire and one has not, and nothing on the surface tells you which is which.
That is, I think, a truer picture of preparation than the familiar one of steps on a staircase, because it puts the value where it belongs. The worth of firing is not in the look of the pot, and not in any single moment of the firing. It is in a change of state that only the water reveals. A student who has been changed by a pre-medical course and a student who has merely sat through one may look alike on a timeline and on a mark sheet. The difference shows later, at a bedside, where an explanation lands or does not.
The image has limits, and they matter as much as its truth. A fired pot can still crack. A well-prepared swimmer can still meet a flood, and the qissa itself is a story in which the crossing fails for reasons that have nothing to do with the swimmer’s readiness. Preparation changes the odds of a crossing; it does not guarantee one. Nor is the firing done by the pot. Kilns, fuel and time are supplied by someone, and in the case of students they are supplied very unequally.
What the Work Was #
Without pretending to remember my own hours, I can describe what a pre-medical course of that kind asked. Its subjects were physics, chemistry and biology. Its materials were dense textbooks, problems to be worked through, diagrams to be drawn and labelled, practical work at a bench, and examinations sat without notes. Its demands were less glamorous than any later stage of medicine and in some ways more basic: to read a difficult page more than once without resentment, to tolerate being bad at something for weeks before being adequate at it, to keep a large body of material in order when no one is checking each day whether you have.
The most consequential change such a year can make is also the least visible, and it concerns language. Take a single word, osmosis. At first it is a definition: the movement of water across a membrane that lets water through but holds back what is dissolved in it, from the weaker solution toward the stronger. It can be recited, and examined, as a definition. At some point, for most students who stay with the subject, the word changes its nature and becomes a tool. Put a red blood cell in pure water, and the definition predicts that water will move in and the cell will swell, perhaps until it bursts. Put it in strong salt solution, and water leaves, and the cell shrinks and puckers. Nobody needs to memorise those two outcomes separately. They follow from the word once the word has become usable, and years later the same word is still working, at bedsides and over the bags of fluid that hang beside them, explaining why the strength of a solution is never a matter of indifference.
That change, from a word you can define to a word you can reason with, does not happen on a date. It appears on no mark sheet; an examination that asks for the definition cannot see it. Multiply it by several hundred words across three sciences and you have a fair description of what a preparatory period can build: a scientific language that has moved, unevenly and unrecorded, from the page into use. Everything later in a medical education is explained in that language. The student who has it does not notice it, which is exactly why the period that built it is so easily forgotten.
I should be careful not to load the year with more than it can bear. Accounts of preparation have a way of assigning every adult virtue to the period in question: discipline, resilience, curiosity, the capacity for hard work. Some of those, in any particular life, were formed earlier; some later; some never quite. I cannot reconstruct, with any reliability, which changes happened to me during those two years and in what order, and I am wary of an account that would give each one a convenient date. What I can say is that the habits I lean on most as a physician are of this unphotographed kind, and that they had to be laid down somewhere, by someone, before they were needed.
The Flat Part of the Curve #
In 1897 two American psychologists, William Lowe Bryan and Noble Harter, published a study of telegraph operators learning to receive Morse code. When they plotted the operators’ speed against weeks of practice, the curves did not rise smoothly. They climbed, ran flat for long stretches, and then climbed again. Bryan and Harter called the flat stretches plateaus, and in a sequel of 1899, subtitled “the acquisition of a hierarchy of habits,” they offered an explanation that has had a long afterlife. During a plateau, they suggested, the lower-level habits of the skill, first letters and then whole words, were becoming automatic, and only when that had happened could the learner’s attention move up to larger units and the visible curve begin to rise again. Their summary was one of the better sentences in the history of psychology: “Automatism is not genius, but it is the hands and feet of genius.”
It is a consoling picture, and its consolation is the reason to examine it. Later researchers were less sure that plateaus are as common, or as meaningful, as the telegraphers made them look. In 1958 the psychologist Fred S. Keller published a paper with the pointed title “The Phantom Plateau,” and the argument over how general the phenomenon is has never quite closed. I do not need it to close. The image has survived because so many learners recognise it: a stretch of honest effort in which nothing measurable improves, while something underneath may be being rebuilt.
The word may is doing a great deal of work there, and the honest version of the plateau argument has to admit it. A flat line on a learning curve is not evidence of hidden progress. It is a fact that has several possible explanations. The learner may be consolidating, as Bryan and Harter proposed. Or the method may have stopped working, and further effort with it will produce further flatness. The measure may be blind to the change that is happening, as a timed test of reception speed is blind to an operator’s growing accuracy. The learner may be tired, or ill, or distracted by something the curve knows nothing about. Or the learner may simply be stuck. The line looks the same in every case.
So it’s only a plateau, keep going is comforting advice and sometimes wrong advice. Persistence with an ineffective method is not hidden progress; it is persistence. The better attitude toward a plateau is diagnostic rather than devotional. Treat the flatness as a hypothesis, change one thing, and watch whether the curve responds. A physician will recognise the stance, because it is how a stalled treatment is handled: neither abandoned at the first flat week nor continued forever on faith, but examined, adjusted, and judged by what happens next.
A preparatory period looks, from outside, like one long plateau, and that is part of why it is forgotten. Its changes are real but they do not show, and some of the weeks that felt like consolidation were, no doubt, simply weeks. A fair account allows both.
Scaffolding #
There is a stronger objection to the whole argument, and it comes from inside the experience of anyone who has prepared for a selective examination. Much of what such preparation builds is not formation at all. It is scaffolding. It consists of knowledge tuned to the examination rather than to the subject: the formats of questions, the topics that recur, the ways of eliminating a wrong option, the mnemonics that hold a sequence just long enough to be written down. Some of it is forgotten within weeks of the examination, and it was meant to be. To praise the whole of a preparatory year as formative is to pretend that the scaffolding was part of the building.
The objection is right, and I would rather absorb it than argue it away. A fair account of preparation has to separate what became structure from what was only ever scaffolding. The structure is the part that keeps working after the examination: the usable language, the habits of reading and reasoning, the ability to learn the next hard thing. The scaffolding is the part that served the test and then came down. Both had their uses, and the scaffolding is nothing to be ashamed of; buildings are not put up without it. Goethe’s indenture had the distinction already: some instruction is baked bread, good for a day, and some is seed-corn, which should not be ground. But only the structure supports the claim that the year had a value of its own. The scaffolding’s value was entirely instrumental, and it lapsed with the instrument.
The difficulty is that the two are hard to tell apart while they are being built, and from inside they feel the same. An hour spent learning the pattern of past questions and an hour spent finally understanding why a reaction goes the way it does are both, at the time, preparation. Only later does one turn out to have dissolved and the other to have held, like the two pots in the river. That is one more reason to be modest about what any particular preparatory year produced. It is also a practical point for anyone in the middle of such a year. The scaffolding is necessary, but it helps to notice, now and then, which hours are going into which.
Keats at Guy’s #
Before he was known as a poet, John Keats was a medical student. In October 1815, after a five-year apprenticeship, he registered at Guy’s Hospital in London and lodged with other medical students at 28 St Thomas’s Street. In July 1816, at twenty, he passed the examination at Apothecaries’ Hall that qualified him to practise as an apothecary. He chose poetry instead.
A record of that medical year survives, and it is a better witness to it than any later account. Keats’s notebook from the winter of 1815–16 holds the notes he took as a pupil at Guy’s from the lectures of Sir Astley Cooper: anatomy, on the bones and ligaments, and physiology, in twelve lectures on the blood and blood vessels, the nervous system, the muscles and absorption, with the ninth lecture missing. The original was bequeathed to Hampstead’s public library by Sir Charles Wentworth Dilke, and a photocopy made in 1923 is held in Philadelphia. It is what a preparatory year mostly looks like from inside: a young man writing down, lecture after lecture, what an older man said about the body, with one gap where a lecture went unrecorded.
A biography arranged by outcome would treat Guy’s as a detour, a preparation for a door Keats declined to open. Keats did not think about formation that way, and the clearest statement of how he did think about it comes from a letter. In April 1819, in a long journal-letter to his brother George and George’s wife Georgiana in America, he rejected the common name for the world, “a vale of tears,” and proposed another: “Call the world if you please ‘The vale of Soul-making.’” He explained himself with an image from the schoolroom. “I will call the world a School instituted for the purpose of teaching little children to read—I will call the human heart the horn Book used in that School—and I will call the Child able to read, the Soul made from that School and its horn book.” A hornbook was a child’s first primer, a sheet bearing the alphabet, protected by a thin layer of horn. The soul, he wrote, is made by “three grand materials acting the one upon the other for a series of years”: the intelligence, the heart, and the world.
What I take from the letter is its measure of value. The product of a schooling, in Keats’s scheme, is a person able to read, not a certificate of having attended. A schooling is judged by what it makes of the one schooled, not by which door it opens afterward. By that measure his year at Guy’s needs no later career to justify it, and neither does any other period of learning that ends somewhere unexpected.
I would not import the whole letter into an account of a pre-medical year. Keats was writing theology, not pedagogy, and he insisted that “a World of Pains and troubles” is necessary “to school an Intelligence and make it a soul.” That may be true of souls. It is not a good principle for designing a course of study, and it has an unattractive afterlife in the romance of the ordeal, the belief that a hard preparation is valuable because it is hard. A difficult year is not made worthwhile by its difficulty. When preparation hurt, the pain was usually a cost, not the lesson, and it is fairer to the many students for whom it was simply a cost to say so.
If the Door Had Not Opened #
Preparation is easiest to praise after success. At that point every hour can be given a place in the explanation: this exercise built discipline, that difficulty produced resilience, the delay made the later achievement possible. The account is satisfying partly because the outcome supplies its evidence in advance.
A harder test is to ask what would remain true if the next admission had not arrived. The chemistry would still have been studied. Some explanations would still have become clear. A student might still have learned how to compare answers, recover from a poor examination, or recognise when a method was not working. These possibilities need confirming in any individual life, but they do not depend logically on a medical degree appearing afterward.
Every year a great many students across India complete their pre-medical sciences and go on to other work: research, teaching, pharmacy, engineering, business, the land. If their preparation was worth something only as a step toward medicine, then for all of them it was worth nothing, and that is plainly untrue. They carried away the same chemistry and biology, the same practice at sitting with a hard page, the same capacity to learn the next difficult thing. Some of them did not want the door; some wanted it and were not let through. The second group matters to the argument, because the door is not opened by preparation alone. Seats are few. Money, distance, the quality of the teaching available, the timing of an examination and the state of a family’s health all bear on who enters, and a story in which persistence always pays is an insult to the many people for whom it did not.
The test also guards against the opposite mistake. Time spent preparing is not automatically time well spent. An ineffective study method can remain ineffective despite effort. A demanding path can become less appropriate as a person learns more about it, and leaving it is not proof that the preceding years were wasted. Wilhelm Meister’s theatre years were not wasted because he left the theatre. Respecting preparation includes permitting a change of direction.
A fair account therefore asks two questions separately. What did this period produce? And what happened next? The answers may be closely related without being the same. A timeline needs only the second question. An essay has room for the first.
What Comes Before the Result #
Medicine has its own version of this argument, in one of the first genuinely useful ideas a clinician learns. A test result does not mean the same thing in everyone. What it means depends heavily on how likely the condition was before the test was done, the pre-test probability, which in turn depends on the slow and unglamorous work of asking, examining and thinking.
A worked example makes the point better than a principle. Imagine a test that correctly identifies 90 per cent of people who have a condition and correctly clears 90 per cent of people who do not. Give it to a thousand people for whom the condition was, beforehand, as likely as not. Of the five hundred who have it, 450 test positive; of the five hundred who do not, 50 test positive falsely. A positive result is right 450 times out of 500, or 90 per cent of the time. Now give the same test to a thousand people for whom the condition was improbable, say two in a hundred. Of the twenty who have it, 18 test positive; of the 980 who do not, 98 test positive falsely. A positive result is now right 18 times out of 116, about 15 per cent of the time. The test did not change. The printed result, in bold and perhaps flagged in red, looks identical in both groups. What it means was largely settled before the sample was taken.
The analogy needs its limits stated. Pre-test probability does not settle a test’s meaning by itself; the test’s own accuracy matters too, and a more specific test would change these numbers considerably. And a life is not a test result. A degree is not a positive finding, and a preparatory year is not a probability. What the comparison does show is something about attention. In both cases the dramatic moment, the result or the admission, gets the bold type, and in both cases much of its meaning was decided earlier, in a period that receives almost no notice once the moment has come.
The Year on Its Own Account #
The fairest account of a preparatory year, I have come to think, is one that would still be true if the next door had not opened. By that standard the year has to be described in its own terms. It asked for attention, time and repetition, and for a willingness to be bad at something before being good at it. It could build, in the right circumstances and without anyone recording the date, a working scientific language and some habits of work, though which habits, and how firmly, are questions for an individual life rather than a general essay. It cost what any such period costs: hours, and the other things those hours might have held. Whatever came afterward can then be added as a consequence, which is what it was, without being allowed to serve as the year’s only justification.
Stephen Dedalus read his flyleaf twice, once outward from his name to the universe and once inward from the universe to his name. A timeline can only be read outward, from the row to what followed. The row for 1994 to 1996 will stay as it is, one line among five, and it should; a timeline has its own job to do. But the line stands for a stretch in which, seen at the scale of the drop, nothing much seemed to move. It was the time in the kiln, when the clay that already had its shape was becoming, or failing to become, something that would hold in water. Most of what came afterward was carried across on whatever that time had made.
Evidence and Editorial Note #
Documented findings. The essay relies on the author’s public biography: pre-medical studies at Khalsa College, Amritsar, 1994–1996, and the MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002, as listed on the site’s About page. The flyleaf passage, Stephen reading it “from the bottom to the top,” and the closing line on the “smithy of my soul”: James Joyce, A Portrait of the Artist as a Young Man (1916; Project Gutenberg). Wilhelm Meister’s Apprenticeship (1795–96), its role as the pattern for the Bildungsroman, Wilhelm’s theatrical obsession and its renunciation: Wikipedia, “Wilhelm Meister’s Apprenticeship”; the Journeyman Years (1821; revised 1829), Wilhelm’s study of anatomy and medical calling, and the rescue of Felix by opening a vein: Wikipedia, “Wilhelm Meister’s Journeyman Years”. The scene of the indenture in Book VII, chapter IX, the remarks on letting the pupil drink his error, the ghost of the king of Denmark, “Steep regions…”, the indenture’s opening, “The height charms us…” and the baked bread and seed-corn: Goethe, Wilhelm Meister’s Apprenticeship and Travels, trans. Thomas Carlyle (Project Gutenberg); its echo of the first Hippocratic aphorism is standard knowledge. The Punjabi ਤਿਆਰੀ (tiārī) and its senses of preparation, completion, physical fitness and willingness: Wiktionary. Bhai Vir Singh’s poem “Tyarian” (Preparations) in Trel Tupke (1921), paraphrased here from the English translation in Cosmic Symphony: The Early and Later Poems of Bhai Vir Singh (Internet Archive); the collection’s date: The Sikh Encyclopedia; his Amritsar birth and death and Singh Sabha involvement: SikhiWiki. The qissa of Sohni and Mahiwal (the potter’s daughter, the crossing of the Chenab on an earthen pot, the substitution of an unbaked pot) is described as commonly told; versions differ in detail and the outline is stated from general knowledge. The Punjabi ਕੱਚਾ (kaccā: raw, unripe, unready, uncooked) and ਪੱਕਾ (pakkā: hard, firm, ripe, baked; figuratively genuine): Wiktionary; ਕੱਚਾ ਘੜਾ as general usage. Waris Shah’s Heer (1766) and Ranjha’s background at Takht Hazara on the Chenab, the quarrel over land, the brothers’ wives’ refusal of food in Waris Shah’s version, and his herding of Heer’s father’s cattle: Wikipedia, “Heer Ranjha”. The definition of osmosis and the behaviour of red cells in hypotonic and hypertonic solutions: standard biology. William Lowe Bryan and Noble Harter’s studies of telegraphers (Psychological Review, 1897 and 1899) and their account of plateaus and a hierarchy of habits: standard histories of the psychology of learning; the sentence “Automatism is not genius, but it is the hands and feet of genius,” as printed in Popular Science Monthly, vol. 55 (1899), via Wikisource. Fred S. Keller, “The Phantom Plateau,” Journal of the Experimental Analysis of Behavior 1(1), 1958, 1–13: bibliographic details confirmed via Scilit; its questioning of the plateau’s generality is stated in general terms. Keats’s notebook of notes from Sir Astley Cooper’s lectures at Guy’s (winter 1815–16), its contents, the missing ninth lecture, its bequest to the Hampstead Central Library by Sir Charles Wentworth Dilke and the 1923 photocopy: archival description, Historical Medical Library of The College of Physicians of Philadelphia (MSS 2/211). Keats’s registration at Guy’s Hospital by 1 October 1815 after a five-year apprenticeship, his lodging at 28 St Thomas’s Street, and his passing the examination at Apothecaries’ Hall on 25 July 1816: the University of Victoria’s critical chronology Mapping Keats’s Progress. The “vale of Soul-making” passage, the school and hornbook image, the “three grand materials” and the “World of Pains and troubles,” from the journal-letter to George and Georgiana Keats of spring 1819: Letters of John Keats to His Family and Friends, ed. Sidney Colvin (Project Gutenberg), where the passage falls in the April 1819 portion. The dependence of positive predictive value on prevalence or pre-test probability: FPnotebook, “Positive Predictive Value”; the numerical example is the author’s own arithmetic on hypothetical figures. That many students who complete pre-medical sciences in India go on to careers outside medicine is stated as a general observation, without figures. Vendor representations. None.
Recollection and tradition. That the author completed pre-medical studies at Khalsa College in 1994–1996 is part of his published biography. No mark, examination, admission process, gap, disappointment, teacher, classmate or study scene is described or implied. The demands of a pre-medical course are described in general terms, and the essay states explicitly that the author does not reconstruct the order or timing of changes in his own case. The reading of Bhai Vir Singh’s poem is offered as the author’s interpretation of a translation; the Gurmukhi original is not quoted.
Analysis and forecast. The readings of Joyce, Goethe, Keats, Bhai Vir Singh and Waris Shah, the account of the prefix, the treatment of plateaus as hypotheses, the comparison with pre-test probability and its limits, and the argument that preparation deserves to be valued independently of its outcome are the author’s personal interpretation and ethical preference as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.