NLDS 2021: REFLECTIONS

The 2021 AMSA National Leadership Development Seminar, though held online, greatly influenced and presented essential personal and professional skills for medical students. Here are the reflections of three Monash students, sharing their experiences of the event and tips they received from the speakers they heard.

Sue Liu – “advocacy is not about being the loudest in the room”

In an era of Zoom fatigue, NLDS was the one webinar that had me actively engaged and sitting on the edge of my seat. And that’s saying a lot, when I struggle with any class longer than one hour! 

It is such a privilege to have had the opportunity to listen to the unique experiences of the speakers and learnt some key lessons to bring into my personal and professional life. As a quieter individual, I have struggled with the conventional idea of advocacy requiring the  loudest person in the room. Instead, advocacy is about exploring who needs to listen and how to shape your thoughts in a way that directly impacts them.

The project, despite being optional, is something I would thoroughly encourage any future delegates to take up. It was truly one of the wildest 48 hours I have ever experienced, and certainly not devoid of the panic and cramming of university group assignments. However, the opportunity to work with such passionate individuals who were determined to make a tangible project with such potential and have it evaluated for implementation by prestigious AMSA figures was an opportunity like no other. Big shoutout to Nebula and Jas ❤ 


Britney Pham – “we need to learn to follow the advice that we give to others”

If there’s one take-away from any leadership seminar, it is usually to fall down seven times and stand up eight. NLDS 2021 certainly demonstrated this in its inaugural online format, which made for a flexible and engaging event with a variety of high-profile guest speakers despite lockdown. So what exactly can a first year medical student (with an abominable wifi connection) take away from a virtual NLDS? Here are the 3 tips I picked up… and the personal interpretations that I’m taking with me.

Tip #1: Be open to new opportunities

Translation: The ‘doctor’ is a fluid character and every student that enters the med school conveyor belt leaves with unique experiences. Our workload might feel overwhelming and it can be difficult when we are sizing ourselves up against practitioners who have national certifications in their co-curriculars, have published more journals than there are bones in the foot, or successfully balance fully fledged families with their irregular ED calls. However, we all have 24 hours in a day, and apart from the time consumed by our uni timetable, we have liberty over what is scheduled in between. Pick up a new project – it can be unrelated to Med! Read a different genre. Listen to a rising artist. These are the small opportunities that might just help us find the niches that we end up pursuing beyond the ‘hobby’ status.

Tip #2: Operate with restraint

Translation: Establish your principles and limits. What is it that we value most and why are we studying medicine? Every student, like every doctor, must find the courage to say what they agree and disagree with doing. One day, we could be the case studies in an ethical dilemma, and it will boil down to our personal values and reasons for working in the field, in the first place. We can begin by signposting in our own lives, leaving ourselves hints for future reference, for when the current time becomes the past memories and experiences that we look back upon. Ultimately, we need to learn to follow the advice that we give to others.

Tip #3: Lead for the 80%

Translation: The percentage sign might immediately draw our minds to assessment tasks and exams, but this 80% is actually in relation to the people around us. Despite our best efforts and intentions, medicine does not lend itself kindly to unorthodox ideas, and as future doctors, we have to keep in mind that reshaping the healthcare bubble is more work than an individual can achieve on their own. While this possibly means that we will not be able to do enough for 10% of the population in our own time, and another 10% of patients will believe that we are intervening beyond necessity, there remains an 80% whom we will lead, and that our medical advice will have a visible impact on. There is no need to wait for someone to create change, when we are the ‘somebodies’ who can do so of our own accord, from day one.

Now, if there’s one take-away from any first year medical student’s writing piece, it is usually that Zoom is not the ideal place to begin the pre-clinical journey, let alone attend the NLDS. Despite this, I am confident in saying that the artistic licence that results directly from a combination of poor bandwidth, choppy shared screens and buffering audio, leaves me with the above (hopefully creative) translations, from what otherwise would probably have been three very profound and professional tips.

In all seriousness, let’s find ways to incorporate new opportunities into our lives, remembering to operate with restraint and lead for the 80% (at least). NLDS 2021 was a pleasure to attend, and is certainly an event I would encourage students to keep an eye out for in coming years.


Clara Charbine – “we have to meet others where they are at”

As Jane Austen writes in “Persuasion”, “we each begin with a little bias and upon that bias build every circumstance in favour it”. Each one of us navigates the world differently, picking up a multitude of experiences which shape our values and views of what surrounds us. ‘Crossing the aisle’ is an understanding that, inherently, we see things differently. It’s about meeting others where they are at. Paying attention to what their values and views are and using this to build common ground and a shared vision that is in everyone’s best interests. Rather than claiming your view as ‘the truth’, taking time to understand opposing views and facilitating two-way discussion without judgement or confrontation. 

NLDS taught me the art of advocacy and the importance of not simply raising awareness of an issue that exists, but more importantly coming equipped with solutions that can be explored. It taught me that there are many more stakeholders within an issue than we think and to carefully consider the impact of changes on all stakeholders involved. Taking the time to learn more about what is valued by other stakeholders and having a strong foundation of your own core values is a fundamental skill in crossing the aisle in leadership and is one that I hope to encompass as a future doctor. 


This pieces was submitted as a part of the Visual Art category of The Auricle’s 2021 Writing and Visual Art Competition

Legend for you

Blue dots signify innocent lives

Red mostly for trauma and blood shed

Yellow for the opportunities and resources we have

Green for glimpses of hope and growth

And the rest is up to you

It’s not hard to understand

It’s easy to stay oblivious, look away

It’s difficult though

For me

And for the rest of us

Who have had to live the experience

Who have had to do nothing but just watch

And quite frankly

Times I have had to look away

To preserve what I have left

When there is so much to see

I’m aware some of us have lost our sights

Either against our will or through our actions

But I promise you I still see things

And that I will make sure I do

And that the rest of the lenses do

We will see this through 

Yet for now, choose your battles

We want progress

We rest.


For more information on Myanmar and how you can provide support, please visit the following links.

Mental Health Support Services

  • Emergency Contacts / Suicide Helplines Lifeline: 13 11 14 Suicide line: 1300 651 251 Suicide Call Back Service: 1300 659 467
  • Monash Counselling Services Monash Counselling Monash counsellors are currently offering telehealth (video or phone) consultations. If you’re a Monash student, your appointment will be free. Emergency and After-Hours Mental Health Monash offers free and confidential 24/7 phone counselling for Monash students and staff: In Australia Students: 1300 STUDENT (1300 788 336) Staff: 1300 360 364 Outside Australia From Malaysia: 1800 818 356 (toll free) From Italy: 800 791 847 (toll free) From elsewhere: Students +61 2 8295 2917 Staff +61 2 8295 2292
  • Faculty Contacts The following people are happy to be contacted: Dr Philippa Corby: Part of the Wellness Academic Group philippa.corby@monash.edu Dr Matthew Thong: Registered Psychologist // Director of International Student Welfare matthew.thong@monash.edu
  • Independent Contacts DRS4DRS An independent, confidential service for medical students and doctors. They are well-versed in dealing with the issues that face people in the medical field.
  • Difficult Circumstances Jodie Vickers jodie.vickers@monash.edu If you feel that your circumstances are negatively affecting your studies, please send Jodie Vickers an email. She will do her utmost to provide as much university support as possible.
  • MUMUS Reps – Can contact your relevant academic and social representatives.

A Poem.

BY MELANIE POWER

The following piece was a part of the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “Where the art of medicine is loved, there is also a love of humanity.” Uttered by Hippocrates millennia ago, has this adage stood the test of time?“

the boy
cannot explain
his swelling anxiety


the need he has
to be in that room
holding her
a minute ago
a day ago
years ago
to make up for lost time


his need builds
with every step
towards her
why has it taken him so long?
to hold her
to breathe her in
to look into her blue eyes


the doctor
cannot hide
his welling tears


the grief he has
to see his patient
of unfaltering strength
now cachectic
of unwavering selflessness
now taking greedy breaths
into sunken cheeks

yet the beauty of it all
makes his heart ache
the record playing
the flower in her hair
her hand resting
on the head bowed
at her bedside

how he wants
to kneel there too
to clasp her hand and explain
the privilege it has been
to observe her
navigate toward death
with such grace

but it’s not about him
it’s about the boy
who stays at her bedside
day and night
watching with anxious eyes
the person he knows
is fleeting


an eternity passes
and the boy arrives
bursting inside he finally sees
her sitting in her chair
by the record player
as she always did
when she was well


wordlessly she opens her arms
and the boy rushes toward them
wrapping himself in them
fleetingly
achingly
breathing her in
finding home in her blue eyes


but then
his own eyes open
and the boy cannot explain
the tears that fall


Know Right

BY MICHELLE XIN

The following piece was part of the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “The pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously“.

We do not know what we do not know.

Does this unsettle you?

To chase the tails of knowledge, relentlessly.

To walk the roads of answers, endlessly.

To mine the gems of truth, tirelessly.

What do we know when we know?

When we know, a door is closed.

“Unfortunately, the tests did not show what we were hoping for.”

When we know, another door is opened.

“Doctor, how long do I have left?”

We do not know.

Our work is scaffolded by ladders and stairwells – up, up and up. We work to learn more, feel more, understand more, give more. To know more; this forms the foundations of our abilities. Each step is cushioned by knowing, trying to know, or at the very least, the illusion of knowing. We are reassured by answers, by the concrete of our schemas, our evidence-based guidelines, our research. We want to know because it makes sense to know.

We know that once we know, we can synthesise and process and generate. Differentials, management plans, approaches, teaching points. We know this is important. We know that the answers to the questions we pose help us and help them. We know it is harder for us and them when they are unable to answer our questions.

For how important knowing is to us and our profession, it is incredible how fickle it all is. How fallible we are when it comes to knowing. We need to know right. We need to know well. We need to know, without being told what or how to know. We need to know, even when no one does.

Chasing knowledge can be a place of comfort, but only when we want to know, and we are willing to face the consequences that come from doing so. When our landings are blanketed by foresight and the privilege of being the one asking the questions, knowing does not seem so difficult, or surprising, or shocking.

For those at the receiving end of our interrogations, our prods, our palpations, our auscultations – they undergo these without knowing, with compliance, with blind trust. Often without knowing the outcome, emerging uncertain and waiting. They trust us to know, and to know what is best for them.

Sometimes, knowing changes everything. We know what to do. They know what to expect. They know what to do. This pushes us to ask, to seek, to test, to scan, to biopsy, to re-scan, to re-test, to find the answers, without end.

The universe knows better than to give mortals this book of answers; and yet we are tantalised by the possibility of omniscience; by the power that comes with knowing. It is bold of us to assume we know, and that we know best.

Because we do not know what is best. Let alone know what is.

We are grounded by dissonance between the biochemical results and the presentations, the holes in research and the management plans being drafted. We are bound by the preconceived, traditional notions of how things should be, and thinking we know because our predecessors seemed to know, and that is enough, right?

When you next chase the tails of knowledge, have a look at the creature whose tails you are chasing. What would you like to know? Its tails? Or itself? Or the reason for your chase?

When you next walk the roads of answers, ponder where the paths lead, and who forged these beaten tracks before yourself? Where are you headed? Why are you walking? Or running? Or running away?

When you next mine the gems of truth, consider the weight of the tools in your hands, the darkness that surrounds you, and the bright shimmers beneath. What are you looking for? What will these gems become when they are unearthed?

Find comfort in not only knowing, but also the process of doing so, and in understanding how we come to know that we want to know. 

And find solace in not knowing, for we are beautifully human when we have the courage to continue, to strive, to believe, despite not knowing.

“I don’t know.”

“That’s okay. Thank you for your honesty. I can’t expect you to know everything – you’re only human after all!”

See Wisely to Treat Entirely

BY MATTHEW LIM

The following piece received an honourable mention the Visual Art section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “ ‘The value of experience is not in seeing much, but in seeing wisely.‘ William Osler

My visual piece has been influenced by the dehumanisation of patients in medicine. William Osler has also said: “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” My visual portrays the value of experience as the ability to take a holistic approach to medicine and personalise medical treatment by placing more emphasis upon patients’ own personal desires when deciding treatment options. This message is displayed through the depiction of faint
silhouettes of people visible within the words on the computer screen – in order to see these silhouettes, you need to “[see] wisely” rather than “[see] much” (if you zoom in close enough to read the words, you will not be able to see the silhouettes). The words on the screen relate to ‘the medical interview’, and choosing to see patients solely as this set of information (rather than as people) will result in dehumanisation. The large stack of books is reflective of the ease at which medical students can sometimes reduce a patient into a set of symptoms to be diagnosed, especially when studying the signs
and symptoms for a variety of medical conditions.

How Much Do You Want To Know?

BY LAURA TAN

The following piece received an honourable mention in the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “The pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously.

Tell me more from less; that’s the key
But first give me the numbers to their identity
What is a good referral, but that which is
short, sweet,
and doesn’t put the ear on the other end to sleep


With eyes never wide enough to absorb the whirl of a hospital,
wee students internally chant, ‘drink, drink from the fire hydrant’
only, this inherited mantra has lost the part
that mentioned we could use a cup
Who knew that quenching our thirst for knowledge
simply boiled down to distilling details


One way or another, we each develop our own filter
Ever since our first mischievous fictitious fabrication we’ve been
well acquainted with omissions
Gradually we learn that patient details are redacted
because trust is a veil under which vulnerabilities are kept secret
Confidentiality is the key that allows us to do our jobs while discreetly
carving out a distinct part of our lives from those we share it with
Some stories just can’t be told without context;
context that’s often either too medical or too personal. So
we compartmentalise, we internalise


We immerse ourselves in the stories of others:
bookmarking their medical progress, shaping their future
Hopefully, one man’s misfortune and discomfort,
through respectful inquiry, can be averted
in another


In the spirit of full disclosure, we are not entirely transparent either:
from his unavailing “almost got it, sir”
to her ‘I’m sorry we stuffed up’ underlying “…circumstances, unforeseen”
we work amidst the blaring coloured codes attempting to paint over our attempts
to plug the leak on a barely buoyant ship


Someone may have once said
understanding is knowing what to do with knowledge,
wisdom is knowing when to use it
Likewise these white lies may have their place
when intended for another’s benefit.
White lies we don’t condone, often compromise someone else’s wellbeing
Those that we do, stem from good will so
by all means, lie.
But never for yourself,
or worse still,
to yourself
Say what you see, kindly

“I’m not a procrastinator. I’m just extremely productive at unimportant things”.

BY NATASHA RASARATNAM

There is nothing more satisfying than binging a TV show with a deadline looming. It’s funny how in the face of exams or an assignment due date, everything, and anything but the task at hand becomes a thousand times more appealing. After all, “I’m not a procrastinator. I’m just extremely productive at unimportant things”. It’s within a generic line straight from Pinterest, that I find comfort towards my procrastinating tendencies.

It’s a process many of us are familiar with; procrastinating an assessment by pretending it doesn’t exist until we realise it’s too late and pull an all-nighter to make the deadline. We regret and vow to never do this again only for the cycle to repeat. We all know that procrastination is the bane of every student’s existence, so why is it so appealing despite the onset of stress that it inevitably brings on?

A common misconception surrounding procrastination is that it’s driven by laziness and poor time management. In fact, procrastination is the manifestation of a complex psychological process that has been unravelled and examined within a whole body of research. The key to procrastination is that we are aware of the consequences that come from delaying the task at hand. So, if we know it’s bad, why do we still procrastinate?

Procrastination is driven by negative emotions of anxiety, frustration, or self-doubt about the task at hand. These emotions have been exacerbated during the pandemic where loss of routine and our usual coping mechanisms has sent procrastination to an all new high. Driven by an instinct akin to “flight or fight”, we seek to combat the negative emotions associated with the task rather than the task itself. These feelings of anxiety and frustration cloud our judgement and leave us more vulnerable to impulsive commands.  The result is mindless scrolling through Facebook or binging a TV show to secure short-term happiness, and offset the discomfort associated with the assignment. This moment of relief is perceived as a reward for procrastinating and is one of the reasons why it’s so hard to break the cycle.

Eventually, when the deadline is looming, we return to the task at hand. Except our initial anxiety and stress is even greater than before due to the time lost whilst procrastinating. These feelings are often accompanied by self-blame and regret which further exacerbate the initial distress we were trying to avoid in the first place. Over time as this cycle continues to repeat, it not only affects overall productivity but has a damaging impact on mental and physical health.

So how do we break the cycle of procrastination? There are many self-help books that talk about starting tasks early, setting goals, and removing distractions. Solutions I’m sure we have all heard of before. The one solution that I was surprised to read about was the importance of self-forgiveness and self-compassion. Much of the stress that results from procrastination is the guilt and shame of having wasted time, for not starting earlier, for sabotaging yourself. This negativity we direct toward ourselves is the most harmful.

A study following over 100 first year University students found that students who were able to forgive themselves for procrastinating on the first exam, were less likely to engage in procrastination on subsequent exams during the assessment period. The researchers postulated self-forgiveness increased student motivation due to a drive for self-improvement, in turn increasing productivity.

The benefits of self-forgiveness and self-compassion extend beyond procrastination and have been associated with lower levels of depression and anxiety. Of course, these two concepts are easier said than done. It can be easier to forgive others than to forgive ourselves, after all we are often our harshest critics. At the end of the day, it’s important to recognise that there are many people who procrastinate (I say this as a self-confessed master of procrastination) and it’s not something to bash oneself about. I’m sure you wouldn’t be so hard on a friend who procrastinates as you are on yourself. So as the dreaded end of year exam season approaches, please remember to be kind to yourself.

Helpful links:

Self-forgiveness and self-compassion: https://melbournecentreforwomensmentalhealth.com.au/articles/179

General tips to prevent procrastination: https://time.com/5322514/stop-procrastinating-tips/

References:

Sirois, Fuschia, Kitner, Ryan, Hirsch, Jameson. Self-Compassion, Affect, and Health-Promoting Behaviors. Health Psychol. 2015;34(6):661-669. doi:10.1037/hea0000158.

Wohl MJA, Pychyl TA, Bennett SH. I forgive myself, now I can study: How self-forgiveness for procrastinating can reduce future procrastination. Personality and Individual Differences. 2010;48(7):803-8.

Haupt A. Why do we procrastinate, and how can we stop? Experts have answers. [Internet]. The Washington Post; 2021 Jul 09 [cited 2021 Sep 17]. Available from: https://www.washingtonpost.com/lifestyle/wellness/procrastinate-why-stop-advice/2021/07/09/13b7dc2c-e00e-11eb-9f54-7eee10b5fcd2_story.html

ACCEPTANCE

BY Jessica Hinh

The following piece received 3rd place in the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “Australia has one of the best health systems in the world but it is far from perfect. What would a perfect health system look like?

The next patient was due in five minutes. With the gentle, languid air of someone who’d perfected a routine many times, the doctor scrolled through the calendar and clicked on the patient profile, ready to skim through the history.

Blankness occupied each of the profile boxes. A new patient. The doctor flipped open to a fresh page in his leather-bound notebook, feeling the cool, heavy metal of the fountainpen sink into his palm as he etched ‘New patient – age 24’ at the top. He knew that the younger doctors at the general practice clinic found it strange that he still took histories with pen and paper, but there was something inconceivably romantic about the lost art of writing and penmanship.

There was a knock on the door, and a young man entered the room with a countenance so spiritless that it gripped the seasoned doctor’s heart. Ill-fitting, worn-out clothes draped off him, starkly contrasting the pristine navy wool that was perfectly tailored to the doctor’s body.

‘He doesn’t speak much English,’ chimed the receptionist who had accompanied him to the door. ‘He’s a refugee – just came to Australia a few months ago’.

‘Thanks, Fiona. Come in, son.’

The young man took a seat in front of the rich, mahogany desk. The doctor observed quietly as the young man’s eyes darted around the room, his gaze momentarily pausing at each personal element adorning the office – a photo of the doctor and his wife surrounded by their three children, all smiling in unadulterated mirth, a university diploma for graduation of medical school in 2021 encased in a chestnut frame, and a small flag draped over the bookshelf emblazoned with a white star in front of bright stripes of yellow, green and red.

The doctor inspected the patient’s face. It was impressionable and naïve, yet weathered and cautious. He knew this disposition well. It ensconced a soul, hardened by trauma, loss, and heartache, yet brimming with unbridled potential.

That had been his own spirit decades ago.

The doctor had fled the advancing flames of persecution with his family back when his country was embroiled in devastating violence and hatred; when some of humanity’s ugliest crimes were inflicted upon innocent people whose background and culture mirrored his own. He’d wept in frustration and rage at the failure of the governing body to protect his people; at the way people of his ethnicity were deprived of basic humanity and were instead, mercilessly subjected to genocide.

The doctor hadn’t been a doctor back then. He’d traversed the oceans with his family as a seeker of asylum. He’d spent many days and nights at the mercy of the earth’s relentless, mercurial forces. He’d endured experiences so harrowing that it physically and mentally broke him. He had sought refuge in the squalor of camps, surrounded by many who harboured the same hopeless destitute that he had unwittingly internalised.

And it was all in the hope of seeking sanctity in the new country. Australia was a country that promised to fill all the emptiness that trauma had so cruelly left. He believed it to be the place where could find acceptance, rebuild his broken soul, and carve out a future where success wasn’t a concept so distant that he would never allow himself to even think about it.

‘Australia’s one of the best countries in the world!’, he would routinely hear, so much so that the phrase dwindled into meaningless sentiment.

And yet, it wasn’t.

On the surface, Australia seemed perfect. It had buildings bathed in cement and glass grandeur and infrastructure of gleaming precision. The country boasted cleanliness and wealth that he would still marvel to this very day.

Yet, for months and years after arriving in Australia, the doctor had never been plagued by such a paradoxical, perplexing feeling of safety yet instability. Though surrounded by people who preached acceptance, how was it possible to feel belonging when most of the people you encountered knew nothing about your culture, your language, or your history? How could you feel safe when you didn’t understand your new society? How could you feel settled when you didn’t even understand how your new society worked; when the concepts of education, law and health were as foreign as the people that brought them to life?

As the doctor stared into the eyes of the young man sitting in front of him, he saw the uncertainty and fear which he himself had projected when sitting in front of a doctor for the first time in Australia. The unsettled feeling internally gnawing at him had been compounded when the doctor started the consult in a manner that made it obvious that he just didn’t understand him.

After all, a healthcare system will never be perfect unless it’s perfect for everyone within it

But things were different now. He had become a doctor to make sure of it.

He valorised the role of healthcare, the one constituent of society that deeply needed cultural safety and acceptance. Fuelled by the desire to weed out barriers which prevented people like him from receiving quality healthcare, he spent his professional career seeding roots for a better system; one that promoted inclusivity as much as it lauded innovation and research. During this time, he continued to educate himself and others of the rich tapestry of cultural nuance, and the importance of ascribing acceptance to people who came from a different background to you.

After all, a healthcare system will never be perfect unless it’s perfect for everyone within it.

Things were different now.

He regarded the young man with poignance and kindness.

“We’ll look after you, son. Let’s call for a translator.”

White Chocolate

BY ROBIN CHEAH

The following piece received 3rd place in the Writing (Preclinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “the pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously

When I was a child I visited my great aunt in Singapore – my Yi Poh – and it was an occasion that I’ve always remembered. Despite being in her 90s, my great aunt was as lively as any other friend I would see at the playground. She had made the long trek by foot south from Guangzhou to Malaysia to eke out a better life, living through years of poverty. Yet, when I met her, she was vibrant and cheerful. She seemed unfettered by everything, so much more carefree than my relatives who seemed restrained by family or politics or careers or business. Although the language she spoke with my mother flew over my head, her kindness transcended the language barrier. Her smiling, calm face, the energy with which she spoke to me stood out to me.

When we were leaving her small condominium, she stopped me as we left. She had a gift: a bar of Whitaker’s white chocolate. She put it in my hands and waved bye-bye with a genuine smile — for the first and last time — whilst my mum told her off in rapid-fire Cantonese for spoiling me.   

That bar of white chocolate was destined to sit in the pantry when we arrived home in Australia, a fate best explained by my mum’s hard stance on sugary chocolate. I would occasionally look at it but would never eat it. And so, as it sat on the shelf over time the bar of Whitaker’s white chocolate morphed into a memoir of how kind my Yi Poh across the sea was, even as she faded into a name occasionally brought up over the dinner table.

Years after that visit to Singapore I had somehow found my way into medical school and, anxious about being left behind, soon got caught up in the same academic scramble as my peers. It occurred to me mid-way through first year, though, that what was most important was to make good on a burning desire: the yearning for more knowledge. 

Some pieces of knowledge, though, seemed more important to me than others. Who needed to know the ten steps of glycolysis anyway? Spurred by remarks from older relatives in medicine and clinical-year students, I tried to spend some time interpreting vitals and other test results in preparation for the inevitable clinical years. For a while, it turned out well – I felt more confident, comfortable and knowledgeable whenever relevant scenarios would crop up in tutorials or past exams – and amid medical school’s uncertainty I settled into a state of relief over having studied the “right” things.

This attempt to get ahead of the curve culminated, so coincidentally, in a conversation immediately after I had finished my final written exam last semester. I breathed a sigh of relief, gently closed my laptop and walked victoriously into the living room where I found my mum deeply engrossed in her phone. She was hunched over, staring intently at whatever was on the screen.  

She called me over to her desk and she asked me curiously and quietly: “What do these numbers mean?”

“What do you mean?”

“Here,” she said, as she pulled up a photograph from her family’s Whatsapp group. “What do these numbers mean?”

A very slight, though unignorable uneasiness crept up in me. These were Yi Poh’s vitals, light green numbers juxtaposed on a black screen – her blood pressure was low, maybe even very low, her O2 saturation was below 95%, temperature 37-point-something, heart-rate around 110.  

The kind Yi Poh I had always remembered faded away: my academic instincts kicked in and I was seeing numbers. It felt like an exercise no different from a Friday ICL tutorial. What was the lower limit for normal blood pressure again? In the moment, it occurred to me that maybe I was not as good as interpreting vitals as I thought I was.

I told my mum that Yi Poh’s blood pressure and O2 levels were low, which only opened the gates for a flurry of questions from my concerned parent: “What’s sepsis? Apparently they say she has pneumonia. How did she get it? She also has chole-something, can you read this out to me? Is she going to die?” 

I felt overwhelmed, partly because I couldn’t possibly explain to her what was going on with Yi Poh’s myriad of diagnoses, from her septic shock to hospital-acquired-pneumonia. How could I have forgotten the different gallbladder diseases just a day after the very paper examining them? What seemed like a reasonable amount of knowledge to get me through my exams was barely enough to explain to my mum what Yi Poh was going through. The pursuit of learning had left me with more confidence than the knowledge I thought I wanted and needed. 

“The pursuit of learning had left me with more confidence than the knowledge I thought I wanted and needed”

More importantly though, something felt wrong about how clinical it all seemed to me.

Later that day I came to a realisation: I had spent the entire conversation neglecting the single fact that Yi Poh was simply dying, vitals or diseases be damned. 

Since that afternoon I’ve found it impossible to remember Yi Poh without also recalling that conversation. Perhaps her memory would have found a more peaceful closure in my mind had she simply passed away with my mother telling me in tears, “Yi Poh has passed on”. Maybe it was my oblivious obsession with what was ‘clinically relevant’ and to be so sure of my understanding that quietly relieved her of any humanity in my head. Why didn’t I just let go of my arrogance?

As I write and reflect now, part of me even feels psychopathic for disregarding the fact she was dying in favour of interpreting her vitals like a fictional patient’s. 

Another part of me, living in the present, tells me to move on: there’s no point ruminating on a single afternoon

And another part of me, looking pessimistically towards the future, asks me: will this be the way I see future patients? Are they all going to dissolve into a formless series of vitals and test results and differential diagnoses before me?

Medicine, at least its biomedical, academic aspect, is fuelled by the pursuit of knowledge: the acquisition of a neverending repertoire of examinations, histories, differential diagnoses, statistics and parameters. Yet, as important as these are to remember, there’s also another type of knowledge I realise I need sorely. It’s the ability to juggle the interpersonal with the scientific, to recognise that there’s a human being with loved ones and a whole life behind the panel of vitals needing to be interpreted. It’s the ability to just step back and realise that maybe, just maybe, your individual desire for knowledge isn’t always the right one. 

How proud I was; how naïve I am. 

Sometime during the recent July lockdown, my mum threw out the bar of white chocolate as we were cleaning the pantry. It was hiding behind a half-full bag of chips, obscured by to neglected curry packets. As I was making tea for us, she casually remarked: 

“This chocolate’s old. Yi Poh gave it to you, didn’t she?” 

STRAIN

BY JESSICA XUE

The following piece received 2nd place in the Visual Arts section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “Emerging from the ashes…

“Shattering patriarchal and machismo culture, she stands fatigued but determined. Her left hand supports her back, which aches under societal pressures so haphazardly piled onto her. She is burdened. Tired, she tries to stand strong for her unborn daughter, filled with excitement over the purity of her innocence yet equally fearing the bullets that try to pierce her potential. Despite efforts to break her, she is confident in the solidity of her own ability. Of their beings. She emerges from the ashes unrelentingly, for she is valid, independent and capable.”

Materials: Pencil, Charcoal, Watercolour Paint

Dimensions: 100cm x 70cm

Emulation of Sylvie Guillot

I HUMAN

BY BILL WANG

The following piece received 2nd place in the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “the pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously


Congratulations Citizen 2077, you have been chosen to take part in the latest ground-breaking trial of the century. The sacrifice you make to science today will elevate us all into the future. Now for the next name in the draw…


The newscaster warbled on, its words fading into the background of Citizen 2077’s mind as the world seemingly unfolded around him. He grabbed the countertop to steady himself, the room spinning around him as his vision seemed to narrow to pinpoints, casting the rest of the room into darkness. He forced himself to look back at the screen as the newscaster began finishing up the morning reports.


As usual, all selected citizens will be contacted at 10am by the Bureau of Health Advancement. Once again, we thank you all for your service. In other news, security forces have retaken sectors 7 and 9; we will provide further updates during our noon bulletin.


So he was doomed. Slowly he sank to his knees, staring down at the tiled floor, its mosaic pattern suddenly looking like the hieroglyphs found in a crypt.


The consulting office in the Bureau of Health Advancement was unsettlingly clean, the artificial white and rounded edges almost nauseating to look at. The consultant had been exceedingly patient, explaining in great detail the upcoming procedure and the expected outcomes; however, he still didn’t understand one thing.


‘Why must I lose my arm?’ Citizen 2077 asked.


The consultant sighed, waving an arm lazily behind him. One of the walls of the room began to fade away, unveiling the neon city below. ‘What do you see?’


Citizen 2077 looked. It was a familiar sight, but today – with the prospect of losing his arm – he let his gaze take everything in. The swirling tumultuous purple clouds that seemed to never fade from the sky, the dank mix of ozone and smog that hugged the buildings of the city, the even fainter neon lights that shone through the tunnels criss-crossing the city streets.


‘Our world is dying,’ the consultant continued flatly, ‘ever since the rebels shattered the sky we have been slowly withering, deprived of the light we need to survive.’


Citizen 2077 thought back to the educational material he had been inoculated with about old Earth. A time when sunlight could reach the surface and the atmosphere was non-corrosive. Like all the others in this new society, he had been taught to yearn for that old world but to never forget the struggles of today took precedent over any foolish dream of the past.


As if sensing his continued uncertainty, the consultant stood up. ‘Come, let me show you something.’
They walked for a while through the shifting maze that was the Bureau, the cold white illumination removing any sense of depth – as if they were simply walking on the spot. Eventually the consultant stopped outside a door, yet like all the other doors it was unmarked and unremarkable, letting the biometric detectors verify his identity before stepping in.


A stasis chamber sat in the middle of the room, tubes running nutrient solution and drainage piping connected haphazardly across its top and bottom. A panel on the front pulsed a pale green, a gentle cascade of numbers flowing across its screen as it monitored the contents within.


A rebel.


Citizen 2077 stared up through the plexiglass into the shadowed face. The rebel, like the ones shown on the newscaster, was dressed in a black trench-coat – eyes obscured by sunglasses. Up close it didn’t look so remarkable – nothing close to the hulking monstrosities he had imagined they would look like.


‘And yet they can survive in this ruined world,’ the consultant said.


Had he read his mind? The thought unsettled Citizen 2077, his train of thought crashing to a halt. ‘So you are going to replace my arm with that thing?’ he gestured vaguely towards the rebel in the tank.


‘Yes. The ultimate goal being of course to create a perfect body that can survive in this new world. Now I think you are well aware of the consequences of refusing a request from the bureau, so when you are ready to have your operation step through that door.’ At the consultant’s words a door, previously hidden in the shadowy corners of the room lit up.

The consultant gave Citizen 2077 a perfunctory bow and then left the room.


The beeping of surgical monitors awoke Citizen 2077, the operation was done. He immediately ran a diagnostic scan of his body, focusing intently on his right arm. Nothing.


In the place of once rich telemetry that would report electrical charge, hydraulic pressure and sensation, there was just a yawning void of emptiness. The only new thing he could detect was a fluid pump embedded in his chest, forcing a mixture of iron and oxygen into his new arm, and pulling out carbon dioxide from the other end.
In one fell swoop he pulled off the blanket, staring down at the pink warm flesh.

Dissolving Boundaries

BY AAHANA DUDANI

The following piece received 2nd place in the Writing (Preclinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “Where the art of medicine is loved, there is a love of humanity.” Uttered by Hippocrates millenia ago, has this adage stood the test of time?  

Dear Dr Kakoti,

You mightn’t remember me, but my mother was a patient of yours a few months ago. She’s ill at ease with doctors, so I usually accompany her, but this time I noted the immediate relief on her face when she saw your brown skin, just like ours. I want to thank you for the kindness you showed her that day. Even though you didn’t speak much Hindi, and she only spoke broken English, you didn’t rush her or make her feel like a burden, you empowered her by explaining things with diagrams, slowing down and having me fill in and translate wherever needed. I can’t tell you how much of a difference it made to her.

In the past, she’s staunchly defended her independence; she’s the kind of mum who still at the age of 84 cooks up big feasts for each of our birthdays (and there are five of us kids!), helps out weekly at the local temple and takes her grandchildren on shopping trips. But she’s had some tough experiences with doctors in the past. After the last appointment she attended alone, I heard her crying in bed, and she finally admitted that the doctor’s impatience –  and later outburst of anger –  at her slow English had caused her immense embarrassment. 

After the harrowing breast cancer diagnosis, you really were a beacon of light for us, and although we were referred on to a specialist, your compassion didn’t go unnoticed.

Tara Bajaj – Kalpana’s daughter

Dear Tara,

I’ve never received such a letter before – thank you for such a kind and uplifting message. Oh – and please call me Aanya. 

I have a lot of patients, but there are always individuals who stand out; your mother was one such character. I remember her greeting me warmly, as she walked into the room with a nervous smile. To tell you the truth, I was nervous too– although I’ve been an oncologist for years, breaking bad news to patients doesn’t get any easier. She was a real trooper through it all. 

It’s always a pleasure to serve the Indian diaspora, and I’m glad your mother was at ease with me. It wasn’t hard at all to connect with her – she struck me as such a kind soul. In medical practice, and also growing up, I often felt that showing emotion made me weak, but I’ve since learnt that I couldn’t be farther from the truth. Allowing myself to empathise deeply with your mother formed the basis of a strong bond – one that could transcend any language or cultural barrier. It was such a human moment, and I’m grateful that she felt heard and supported.

As for speaking Hindi – I wish I knew more than the few words I do! My mum moved here with me when I was quite young, and unfortunately, I lost all my fluency bit by bit. I’m trying to refamiliarise myself with the sounds of the language again – mainly by listening to songs and watching movies – but it’s definitely a challenge!

Thanks again for writing, it was lovely to hear from you.

Aanya Kakoti 

Dear Aanya, 

Although we don’t see you often now, mum loves it when I translate your letters for her. This relationship is so special to her – and to me too, of course. Thanks for keeping in touch all these years. 

Indeed, telling our friends and family was tough. We took your advice and told my brothers all together, and her close friends one-by-one. Cancer is all a bit hush-hush in our community, as I’m sure you know. Some of mum’s friends were certain she got sick because she had done bad deeds or because she used to eat meat; that karma was catching up to her. It took me a while to convince her that that was not the case – and your reassurance really helped. Either way though, it can only have been confronting to hear something so accusatory from our friends.

As you know, mum has been undergoing chemo for several months now. At first, she was able to keep up most of her daily activities, but lately she has become weaker and more fatigued. She’s started losing hair too, and though she’s stoically making peace with the fact, I can tell it impacts how she feels about herself. 

Something that brought her a lot of joy, though, was making this mithai for you to wish you happy Diwali. Hope the New Year brings you and your family much happiness and good fortune! 

Tara 

Dear Tara,

What gorgeous mithai! I’m really touched. Eating Indian sweets really makes me long for home, and reminds me so much of my own mother. In fact – the close relationship you have with your mum  –  I hope she’s doing better now – inspired me to properly reconnect with mine. 

I didn’t cook with my mum the way you did growing up – we weren’t altogether close. For a single mother to raise a child in a new country was a feat in itself, but she worked multiple jobs to be able to provide for me the best she could. Between my being glued to my desk in high school and university, and her having to work odd hours, we didn’t spend so much quality time together. But in this profession, I’m reminded daily how important it is to seize every moment with those you love – and I’ve been trying to do that more and more with my mum lately. 

Given your talk about cooking, I asked mum to teach me to cook a traditional family curry recipe that I loved as a child. There’s something so utterly human about cooking a simple meal with another person and enjoying it together – it was lovely. It’s true that we learn as much from our patients as they do from us – you and your mum are a testament to that.

Best always,

Aanya Kakoti

Aanya – 

It is with a heavy heart that I write to tell you that mum passed away last week. The chemo worked well and she was cancer free for years, but it recurred, metastasising in her lungs some twelve years later. I know you and I haven’t written in a while, but I thought it only right to tell you just how much your presence has meant to mum over the years. That you truly got to know her, her values and wishes, and got to know us – her family – too, made a world of difference.

I’ll leave you with something mum said, a few days before her passing. I know you’re learning Hindi – I think you’ll appreciate it. 

Jab do log ek doosare ko samajhte hain, ek akshar bhi bolna nahi par ta hai; bas, unke aankhein dekhane se pata lagta hai ki hum ek hee thaan se kate hain

When two people truly understand each other, not a word needs to be said; just a glance at their eyes and you know you’re both cut from the same cloth.

Take care, Doctor. I can’t thank you enough for all the warmth and compassion you’ve shown our family. It has truly changed our lives. 

With every good wish,

Tara Bajaj

Preservation

BY NATALIE EVANS

The following piece received 1st place in the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “Where the art of medicine is loved, there is also a love of humanity.” Uttered by Hippocrates millennia ago, has this adage stood the test of time?:”

Like Plath said –

about the woman in the ambulance,

our red hearts are meant to bloom through our clothes,

meant to bleed with the blood of lives lived, lives trying to live, lives failing,

picked for our hearts that bleed when patients bleed.

She talks of Poppies in October –

we pick poppies all year,

pick them on a sunny day and preserve them,

press them into notebooks and assignments,

almanacs of patient species.

Eyes cloudy with the frost of age,

skin so papery you can see blue rivulets,

that collapse in fright –

they’ve done this before.

He has had enough,

with each little stab he says so,

poppies are no ordinary bloom you see,

for you can fall asleep in poppy fields.

Students talk with one another,

human amphorae with facts to pour like wine,

spilling over the floor,

and we slip and tumble in it all.

History to the Anaesthetist and body to the Surgeon,

life sliced like an apple,

into neat little pieces of yes and no,

of midnight fevers and asthmatic wheezes.

How did we get here?

A timer ticks down and a bell rings,

what I want to know is, is there blood in the cough?

And why do I care? Now I remember.

You can suffocate on air,

when tar gluts your passages,

and you rip off the oxygen mask.

Yesterday I saw his wife.

We pick poppies all year,

pick them on a sunny day and preserve them,

press them into notebooks and assignments,

almanacs of patient species.

I don’t want to die – no gas cries the boy,

when you go to sleep it’s like you are dead,

I promise I’ll stay still – promise.

Needle pricks flesh and not even a flinch.

Wisdom comes from those,

who’ve travelled the same path before,

but found new ones as they walked,

in forests of past obscurity.

When knowledge comes,

and stays,

settling down in tired heads,

then the real work begins.

We pick poppies all year,

pick them on a sunny day and preserve them,

press them into notebooks and assignments,

almanacs of patient species.

You know it’ll fry my brain,

those electrode things and the seizures,

God wouldn’t like it.

We tell him God has no choice.

I’m eighteen and I want to help people.

Don’t say that,

everyone says that,

tell me, can you prove it?

Birth, life, death,

and then birth again,

humanity prevails in shrieks and wails,

and the brag of the heart I am I am S1 S2.

You cannot help without heart,

for the automaton sits in the corner,

it can tilt its head and extend its hand,

but it is cold to touch.

When did you start using?

Oh maybe twelve or thirteen,

for when people hit you,

you look for other kinds of hits.

On the street,

a woman begs for money,

it is for medication,

yes but what kind and I know and she knows and she goes.

Starry-eyed flirt when you start,

years pass,

as you fall in and out of love,

you think this romance might last.

Jigsaw people,

wheeled along antiseptic floors,

the pieces of the human puzzle,

all scrambled in our hive minds.

Missing pieces,

lurk within body and soul,

sometimes found,

mostly lost. 

Flicking through crumpled pages,

notes from the wards,

endless quotations,

wondering what did they mean?

We pick poppies all year,

pick them on a sunny day and preserve them,

press them into notebooks and assignments,

almanacs of patient species.

Will I get better?

Where do we go –

            in the end?
                        Who will we be -
             before then,
                         lost in a sea
                                    of maybe, 
                                                             of we’ll see.

Author’s Note: 

“Plath” refers to poet Sylvia Plath, and fragments from her poetry, ‘’Poppies in October’’ and, ‘’Tulips’’, as well as her novel, ‘’The Bell Jar’’, are referenced throughout the poem.

Choice

BY JAMES GUNASEGARAM

The following piece received 1st place in the Writing (Preclinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “the pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously

I haven’t been in a clinic waiting room for years, and the longer I sit in this one the less I miss the experience. The walls are painted a shade of beige that reminds me of cardboard, this plastic chair feels like it might give out at any moment, and they told me to show up ten minutes in advance but they’re already fifteen late.

A mother and her son sit across from me, her flicking through a magazine from the small mountain on the coffee table between us and him engrossed in a novel. I squint at the cover, hoping it’s not too obvious as I try to discern the title. H…A….R…Harry Potter. I blink a little in surprise. He can’t be more than six or seven. Was I reading at all at that age, much less chapter books? I guess they teach it better these days.

The receptionist calls my name and my attention snaps back to my appointment. I gather my things, flash a polite smile at the others that both are too captivated to receive, and get up. A disembodied hand waves to me from the doorway of one of the consultation rooms. I follow it in, almost bumping into the short woman on its other end. She gives me a broad smile.

“Good morning – sorry about the wait. I’m Dr. Truong. Have a seat and we’ll get right to it.” She gestures to a chair in front of her desk and I lower myself into it, memories of school resurfacing at the constant little directions. She sits on the other side and shuffles a stack of papers as she begins to speak.

“Today we’re just going to go through some of the options you have from here. You can relay all this to your partner at home, and Greenfield IVF lets you make the choices right on their website. It’s all very stress-free.”

She glances up at me and waits for my small nod before continuing.

“Greenfield says they’ve had a successful fertilisation, so you have a viable embryo ready to go – a girl, if you’re interested. Before they let her progress further – how much do you know about gene editing?”

I rack my brain, sifting through hazy memories of high school biology. “…I remember enough. I’m not too fussed about the details.”

She nods, seeming a little unconvinced but either too polite or too indifferent to press it. 

“Right. Well, the important thing is that it’s easiest to make any changes at this stage, before the embryo has started dividing. So now’s where you’ll have to decide what you want them to do.”

Dr. Truong slides one of the sheets across the desk, a series of black-and-white lines highlighted here and there in angry red.

“You and your partner are both carriers for Cystic Fibrosis, and as it stands your child will inherit the disease. Greenfield offers single-gene disease protection as standard, so they’ll fix that up for you free of charge. There’s a few other nasty things they’ve spotted,” she reaches over and gestures to some of the other red highlights, each with a small disease name printed next to it, “which they’ll take out as well.” She leans back and smiles.

“Pretty cool, isn’t it? A couple decades ago we wouldn’t even have known until much later.”

“Yeah.” I smile back. My uncle had bad CF – I remember going to visit him in the hospital after he had a lung transplant when I was just a kid. I look over the sheet again and notice the title: “Section A – Genetic Diseases”. 

“Are there more sections?”

She withdraws another page from her pile, spinning it around on the tabletop as she slides it over to me. This one is much more lively, with large images covering the page and the title proudly sitting at the top left: “Section B – Enhancements.”

“This is some of the newer stuff. Tweaks to height, hand-eye coordination, IQ-“

Did I hear that right? I shake my head and frown slightly. “I’m sorry, what?”

“Oh, it’s not perfect. These are pretty complicated traits, so…”

She keeps talking, but I’m no longer listening. My eyes slide down the page, over neatly curated options to make your child perfectly smart, capable, talented. Everything you could ever want.

This feels… wrong. My gut tells me that humans aren’t meant to be perfect. We’re meant to be a little messy and rough and broken. Isn’t that what makes us human?

But the more I think about it, the more doubt creeps in. Maybe it’s so easy to cling to our imperfections as proof of our humanity because we’re messy and rough and broken, and we like to think we’re human. Not only human, but the best we can be. Maybe I don’t want to acknowledge that there might be better humans because it makes my own struggles seem pointless instead of heroic.

If I refuse the changes, will I be giving her the gift of humanity? Will she see it that way? Will she appreciate her imperfections when she needs braces? Will she feel more human for struggling through her times tables while her classmates are mastering violin? Or will she feel robbed of a better future because of my choice?

Dr. Truong finally seems to notice that she’s not getting through and stops. Her face contorts for a moment and she hesitates before speaking again.

“I mean, you could always go unmodified.”  

Unmodified. That word feels so insidious, transforming being… normal into a deficiency. Will her classmates feel the same way, raised with the knowledge that they’re better? Will they mock her as “unmodified”, with the casual venom children so easily employ?

Maybe normality is a burden in this new world. Isn’t my role as a parent to give her the best chance possible? Why shouldn’t this be part of it? I didn’t blink at curing a normal disease. Would she grow up feeling like her sluggish thoughts and little flaws were their own ailment?

Am I giving her a normal childhood, or holding her back from a better one?

“I… I’ll have to think about it.” 

I raise my gaze off the sheet and look back at Dr. Truong. She gives me a smile that doesn’t quite reach her eyes. I can see her flick her wrist as she reaches for her desk drawer, surreptitiously checking the time. There are more people to see, people who won’t be as stubbornly hesitant as me.

She pulls out a glossy pamphlet and slides it over. The picture on the front is a mother and her child. Perfect teeth. Perfect eyes. Perfect everything.

“This’ll explain a little more,” she says with the same customer-service smile. As if the problem was that I understood too little.

“Either way, your partner isn’t here today and we don’t recommend you make the choice alone. You don’t have to decide now. But you will have to decide.”

I offer her a hollow thanks, gathering the sheets as I stand. I have this wonderful, terrible power in my hands, and no idea how to use it.

Maybe it would’ve been better not to know.

Book Review: A Country Doctor’s Notebook

BY ISAAC TANG

During the mid-year break, I came across a book in my sister’s collection that was small and slim (always a good sign!) with a rather benign, if not dull, title: A Country Doctor’s Notebook. I immediately assumed that it was yet another text about the joys and challenges of rural medicine to persuade more people to join its overburdened workforce. However, the blurb surprised me with some unexpected titbits of the book’s exotic setting and thrilling historical account – “twenty-five year old”, “lone doctor”, “depths of rural Russia”, “1916-17”, “eve of Revolution”. Moreover, this “lone doctor” is based off the first-hand experiences of the author himself, Mikhail Bulgakov (1891-1940).

With a large dose of dark humour and raw honesty, Bulgakov plunges into his collection of short but gripping tales. He uses many terms that are familiar to us as medical students but it is the stark differences in time, culture and medical knowledge that set these terms in shocking contexts, making the reading experience a surreal one at times. For example, we all know what an amputation is. But now imagine you are an intern on your first day as the only doctor in wintry, rural Russia without electricity and modern utensils and you have to amputate a girl’s leg. Plus, you have only watched an amputation… once. Some of us who have completed our women’s health rotation will know what a “transverse foetal lie” is and may have hazy recollections of a procedure called “internal podalic version” to help deliver this abnormally positioned baby. Again, imagine you are the same hapless doctor forced to do this for the first time in the middle of the night on an extremely distressed woman with only an obstetrics textbook to guide you.

For me, the anxiety is definitely palpable because I know for sure I would have collapsed under the same circumstances. Indeed, this poor doctor only has 2 midwives and a feldsher for assistance, with the footnotes graciously explaining that a feldsher is “a partly-qualified medical assistant” (emphasis mine). Despite his catastrophising thought processes and persistent self-doubt, the doctor, to my surprise and sometimes disbelief, carries out various surgeries and procedures successfully from pure determination and fortune. But Bulgakov also records some disastrous failures, including an unsuccessful internal podalic version which causes a baby to be delivered with a broken arm – and stillborn. In another instance, he accidentally pulls out a man’s tooth socket when he only meant to extract the tooth. In fact, when he sees the “enormous, jagged piece of gleaming white bone”, he almost “burst[s] into tears”. The doctor, that is. The patient has no idea what just happened as he is not told; he is only instructed to “rinse”.

This gives an appalling assessment of the culture of medicine back then – the paternalism and the lack of transparency. Bulgakov never records disclosing to his patients the fact that he has just graduated from medical school and has never done the procedures that he intends to perform e.g. tracheotomy, hernia repair. He does not even dare to inform his midwives or feldsher about that. Displaying a sense of arrogance and superiority also appears to be an expected part of early 20th century medicine, especially towards the illiterate, impoverished and superstitious peasants Bulgakov encounters. There is no hesitation in directly denigrating a patient and their relations. A patient’s emotionally distraught grandmother is called “stupid” and promptly “pushed out of the room”. The doctor scolds and berates patients who do not accept his advice and he laments patients who present late in severe stages of disease. Understanding social determinants of health was clearly not core learning then, for he fails to appreciate the long distances his patients need to travel and the poverty and strenuous farming that characterise their difficult lives.

However, he does recognise that there are systemic problems that must be solved. Most of his stories are set at night, symbolising the overwhelming darkness of ignorance that he has to fight. He realises that health literacy and education are needed for a population to remain healthy. When he discovers an increasing number of syphilis cases in his catchment area, he begins to record his findings and reflect on how he can better convey the seriousness of the illness to his patients. Written before the discovery of penicillin, the proposed treatment of syphilis consisted of inconvenient, regular application of mercury cream on the skin that the patients had to adhere closely to. He also knows that he must have more doctors working with him to adequately meet his patients’ needs – a request to his employers that goes frustratingly unfulfilled.

His stressful working conditions are shown to have a great impact on his mental health. He never fails to remind us that he passed medical school “with distinction”. Yet he suffers from imposter syndrome, harbouring numerous fears that, out of shame, he feels compelled to hide behind a veneer of confidence and self-sufficiency. Before he runs off to peek at his textbook again, he tells his midwives he is merely gone to get cigarettes. Seeing approximately 100 outpatients a day and caring for 40 inpatients, he feels that he is gradually losing his personality. His irritable outbursts towards non-compliant patients likely signify his burnout. Thus, news of a violent blizzard is received “joyfully” as patients are prevented from reaching the clinic, allowing the doctor and his assistants a short-lived reprieve. In a tragic turn of events, he later receives news of a doctor acquaintance who loses his life after years of battling morphine addiction in secret. What makes things sadder is that Bulgakov does not reveal in this book that he himself had become addicted to morphine. Despite continuing to specialise in venereology, he eventually quitted medical practice to become a full-time writer.

In many ways, A Country Doctor’s Notebook shows us how far medicine has progressed and really instils in me a sense of gratitude for the improved conditions that we work in. But some issues touched on in the book still haunt us today in some way – poor health literacy, underserviced rural populations, the difference between medical school learning and actual practice, doctors’ mental health. Placed in an unfamiliar setting, this short book bursting with thought-provoking tales ultimately gifts us with a unique yet relatable perspective on what it means and what it takes to be a good doctor.

Being lost in (pre-clinical) medicine.

BY ROBIN CHEAH

I’m one-and-a-half years into medical school and I can already say I’ve been lost multiple times.

‘Lost’ is, admittedly, a broad word. It’s a word with a myriad of possible meanings: emotionally, socially, physically, academically, acutely, constantly. But that’s what makes it so powerful. From making a wrong turn and ending up at anatomy 15 minutes late, to feeling utterly overwhelmed by content, to reflecting on what my goals even are – no word has encapsulated medical school quite as well as ‘lost’.

It’s easy to feel lost in the academic rat-race; barrages of content, an increasingly vast repertoire of examinations and symptoms and special tests and eponymously-named signs to not just remember but also understand. One moment, it seems achievable – “I think I remember all of this systems review” – and another moment a revision lecture or practice exam topples all of that down. It’s an erratic tide that rides highs and trembles at terrible lows – the short-term panic attack in a tute where you know utterly nothing –  with no ultimate direction. Sometimes the wave does vaguely point somewhere – “I need to know more about this” – and those moments of curiosity are refreshing when they arise.

From making a wrong turn and ending up at anatomy 15 minutes late, to feeling utterly overwhelmed by content, to reflecting on what my goals even are – no word has encapsulated medical school quite as well as ‘lost’

Adding to the confusion, there are those quasi-clichés such as “preclin doesn’t matter” or “It’s not on the exam” creeping into every second conversation. It instills a constant uncertainty: what truly matters and what doesn’t? Am I wasting my time on things that don’t matter? Am I just wasting my time studying if I’ll learn everything on the wards? Everything academic becomes ambiguous; every assignment is distilled into a weighing scale of effort with outcome. An essay might be pass-fail, but it’s also an opportunity to learn something important – but there are also exams nearing, that group assignment, the new thyroid examination to revise. Is all this theoretical content even important? Doing well on exams doesn’t really matter, right? The questions sometimes pile up into an incomprehensible heap regardless of where you think you are.

But being lost extends to more than just study – life is more than that. Acronyms for interest groups can fly over one’s head, leaving only the question of specialties (harkening back to the “What do you want to study in uni?” of VCE days). Even if there is no expectation to choose or commit or even consider, its ubiquity as a conversation topic makes it seem like there is sometimes. It can feel like a constant reminder that you don’t have goals, that you’re indecisive and God forbid, can coalesce into self-judgement.

It’s easy to judge yourself for being lost, for all its meanings. Being lost academically means you’re not smart enough or hard-working, or that you’re trying too hard or wasting effort. Being lost socially means you’re not good or nice enough to be liked. Even not having concrete goals feels like you’re indecisive. This is perhaps the point where that wave of ambiguity swells into a tsunami that drowns you in doubt. It is truly dangerous, especially when there’s that constant calling to keep revising, keep studying, keep up with the new content and lectures and go to class. It can be hard to stand firmly when you’re drowning like that.

In a way, the idea of feeling lost and unsure grows sobering; it’s somehow paradoxically reassuring to know that it’s the norm

In a way, the idea of feeling lost and unsure grows sobering; it’s somehow paradoxically reassuring to know that it’s the norm. Maybe what one needs is just to put their head down and do what they’re doing, but with conviction and confidence. Perhaps what we all need is to forgo the “It’s up to you” and make a decision ourselves as to where to go and what to do; resultantly, we’ll reap the rewards and pay the prices. Alternatively, you get acquainted with being lost, accept it and understand it’ll be there forever and as a result become numbed to the uneasiness it brings. But those are just two possibilities; the outcomes are infinitesimal, rightfully so for a term that has so many meanings.

Will that seemingly-omnipresent uncertainty ever fade away? Being lost in a hospital definitely sounds like it could happen. Being lost in the content of clinical years sounds more like an inevitability than anything. And it’s not even a medicine-specific struggle, either — there’s uncertainty in university life regardless of course.

Maybe being lost and uncertain isn’t an enemy but rather a friend we’ll get used to.

Worry

BY Nicholas Wilkes

Have you ever found yourself worrying about one specific thing, which somehow leads to numerous other relevant or/and irrelevant worries that you just end up spending hours being anxious and worried? Have your worries ever interfered with your focus on studying and working, which eventually made you even more worried as the deadlines are coming closer but you have even less time left? Have those worries ever followed you till you go to bed, when you feel tired and sleepy, but somehow those worries during the day just cannot leave your mind, and the next thing you know it is almost the time you need to wake up and now you are still awake and left with more sleepiness and worries?  

All of the above situations may sound quite familiar to some of us, and a lot of people may have experienced that vicious cycle of worrying at some point in their life. In fact, worry in and of itself is not as bad a thing as we may tend to think it is, a healthy amount of worries can actually serve to help to motivate us to take action to stop those uncomfortable feelings and thoughts. However, worries can also easily become a cycle of self-perpetuating negative thoughts that are uncontrollable and detrimental to not only your productivity but also your happiness in the long term.

“However, worries can also easily become a cycle of self-perpetuating negative thoughts that are uncontrollable and detrimental to not only your productivity but also your happiness in the long term”

There’s a saying by Corrie ten Boom which I find more and more accurate the more I think about it –  “Worry does not empty tomorrow of its sorrow. It empties today of its strength”. Excessive worries indeed can adversely affect our study and work and put a strain on both our mental and physical health as many studies have shown. So, now we know that it’s bad but how to stop it?

The very first step of tackling worries is to realize and accept that you are excessively worried and you need to do something about it.

The very first step of tackling worries is to realize and accept that you are excessively worried and you need to do something about it. It can be hard to totally eliminate worries especially if your problems can’t be fixed right away, but you can always set aside a designated time for worrying. Instead of staying worried for all day and everyday, set a fixed period of time like 30 minutes a day when you can think about your problems. During this time, identify what is worrying you and try to list out different options of how you may deal with this problem. When you can come up with a plan of what to do, you can then take small steps toward the goal, which would be way more productive than just being chronically worried without a specific solution. This special “worry time” should be far away from your bed time so not to compromise with your sleep, and whenever you catch yourself worrying not during this set time, make sure you try to think of something else or do something to distract yourself. Of course, things are easier said than done, but do not forget to give yourself time to control the worries, share your issues with your loved ones and be patient and understanding to yourself while you are dealing with all the stress and worries. I hope that that reading this may somehow help you to briefly forget about your current worries, and will motivate you to set your own worry time soon when I strongly believe you can also find a way to overcome your problems.

#ChooseToChallenge: Why gender equity is a medical issue

By Sophie Skuza and Dana Boden (MUMUS Gender Equity Committee)

Trigger warning: sexual harassment and sexual assault

The voices of women have dominated the Australian media landscape over the last two months. To recap, we’ve had 4 allegations of rape against one man in our Federal Parliament, a historical rape allegation brought to light against one of the most high profile people in Federal Cabinet, and a petition started by Chanel Contos to teach comprehensive sex education in schools at an earlier age. 

These events, along with International Women’s Day on March 8th, have contributed to the recent widespread outrage felt by many individuals across the country, and resulted in the nation-wide Women’s March 4 Justice held on March 15th.

While, at first glance, these issues – namely gender-based discrimination and the sexual assault of women – might not be strongly connected to the medical profession, the reality is that these issues are still commonplace. Within hospitals and other healthcare settings, to this day, there exists the rampant mistreatment of women, both as patients and as colleagues. Women and people of diverse genders still face challenges every day, which is why the battle for gender equality is so important.

Dr Caroline Tan Source: http://drcarolinetan.com

Take the case of Dr Caroline Tan, a neurosurgeon whose career was derailed after she spoke out against the sexual assault she experienced from a senior colleague in 2005. Despite winning the case against her senior colleague in 2008, Dr Tan believes that her decision to take action against the sexual assault she experienced contributed to her being shunned by other surgeons and repeatedly overlooked for positions within both public and private hospitals. During her VCAT hearing, Dr Tan was accused of fabricating her sexual assault experience as an ‘excuse’ for her poor work performance. She was forced to relive her assault in vivid detail, while her authenticity was criticised when she couldn’t recall exact details about the “colour, size, or shape” of her abuser’s penis. It was also revealed that the individual she initially reported the assault to, the head of her department, responded to the tune of, “What do you expect when you dress the way you do?” after she disclosed the details of her assault to him. Dr Tan’s abuser did not face any disciplinary action, and he continues to work with the same employer (at Monash Health).

Dr Tan’s case was referenced by Dr Gabrielle McMullin, a Sydney vascular surgeon, at a function in 2015. Dr McMullin, who, rather than praising Dr Tan’s strength in reporting her assault, made the shocking and heartless suggestion that surgical trainees should stay silent and complicit if they have been sexually assaulted by a colleague, as speaking up about their abuse could have consequences for their careers. She went on to say; “What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to comply with the request. The worst thing you could possibly do is to complain to the supervising body, because … you can be sure that you will never be appointed to a major public hospital”.

Possibly the most horrifying part of Dr McMullin’s speech was when she said Dr Tan probably would have been “much better [off] to have given [her abuser] a blow job on that night”.

“This unacceptable abuse of power is unfortunately far too common within the medical profession, especially due to the strength of hierarchical structures existing within hospitals”

This unacceptable abuse of power is unfortunately far too common within the medical profession, especially due to the strength of hierarchical structures existing within hospitals. The entrenched belief that women should simply accept and comply with unwanted advances to further their careers serves only to subjugate women while encouraging further violent and illegal behaviour from men. It also contributes to the attitudes surrounding misogynistic statements such as, ‘she slept her way to the top’, rather than revealing the reality of this statement: ‘she was taken advantage of by men who use their positions of power to dominate women’’. Furthermore, Dr McMullin’s comments disempower women from seeking counsel after they have experienced sexual harassment or assault, causing profound feelings of shame, hopelessness, and trauma.

The case of Dr Caroline Tan is disturbing, tragic and outrageous. Her story is hard to hear, and it is a stain on the medical profession that we should all be ashamed of. But rather than just accepting her story, we have to change the narrative. We must ensure there are no more individuals treated as Dr Tan was, and rather than victim blaming and coercing women into silence, we must encourage them to speak up, and support them whilst doing so. We cannot continue to live in a world where the choice exists between a woman’s career and her safety.

The theme for this year’s International Women’s Day is “Choose To Challenge”: why not challenge yourself to be a stronger ally for women and other people of diverse genders, or challenge others to change their behaviour towards women?

It begs the question: what can I do to help?

The theme for this year’s International Women’s Day is “choose to challenge”: why not challenge yourself to be a stronger ally for women and other people of diverse genders, or challenge others to change their behaviour towards women?

  • Call out misogyny and other gender-based discrimination/prejudice.
    • If you hear others, including your friends and family, speaking about women in a derogatory way, stand up for women and tell those individuals that the way they are speaking is not ok.
    • If you see a woman being bothered or harassed, walk over and support her.
  • If someone opens up to you about sexual harassment or assault, do not victim blame them. Listen, hear, and encourage her to report. Do not get defensive or pass it off as unimportant/insignificant.
  • Advocate for women’s issues and other gender-diverse issues – sign petitions, attend protests, spread information!

————————————————————————————————————————————————

The MUMUS Gender Equity role was founded in 2018, and since then the Gender Equity team has worked hard to bring representation and inclusivity to Monash Medicine through four key areas: curriculum, social media, community building and advocacy.

In the past few years, great things have been accomplished, including:

  • Making the anatomy curriculum more trans inclusive by changing male/female to assigned male/female at birth
  • Introducing asking sexuality into the reproductive history, to avoid assumptions of straightness
  • Introducing pronoun stickers to clinical student name badges
  • Data collection to ensure MUMUS is accurately representing the medical student body
  • Upskilling events with panels of incredible female-identifying medical professionals

In 2021, we hope to bring even more inclusivity to the curriculum, as well as running incredible events, building community through our Facebook group SafeSpace, and spotlighting incredible health professionals on our socials!

Tips for Wellbeing: Global Pandemic Edition

By Molly Maxwell

When I entered Year A, I knew that the hardest challenges I would face would be those that I had not considered. A global pandemic was definitely not something I had prepared for. As today is my first day of online schooling, I feel there is no better time to share some ways we can adapt to our new version of normal and get out the other side to help all of the medical staff who are fighting for us today.

 How to: Pandemic University

  1. Most important (for all aspects of life) is routine. Establishing a routine of “normal” study hours is essential to allow us to maintain our sanity whilst in isolation. This includes actually getting out of bed and getting dressed which can be challenging when you don’t have to.
  2. Make an online study group. Thanks to the wonders of the internet, this is not so hard for us through Zoom, Facetime, or the Forest app. It’s a great way to keep yourself accountable and maintain some socialisation.
  3. Be adaptable. Online learning is not the greatest way for us to learn to be doctors but that doesn’t mean that it can’t be a good way. Accept our new challenges for what they are and use this time to build resilience and adaptability which is essential for our future.

How to: Outbreak Wellbeing

  1. Remember to exercise. With gyms closing around the country, it’s important to still maintain an exercise regime at home. A plethora of online at home workouts exist for free on the internet so you can look after your body whilst in isolation.
  2. Go outside. With social distancing and isolation our reality, remember to still go outside. If you’re lucky enough to have a backyard or balcony, use it. A bit of vitamin D and fresh air can do wonders for our wellbeing in trying times.
  3. Social distancing doesn’t mean distancing socially. Whilst we can’t go and hang out at the pub or with all our friends for the time being it is important that you still make an effort to communicate. This golden age of technology means that remote communication is as easy as ever so find new ways to hang out whether it be a niche PowerPoint night broadcast over zoom or daily phone calls with people you love.

How to: Nurture your mental health

  1. Acknowledge your feelings. This is a scary time for everyone. It is okay to feel frightened or stressed or defeated, but you are not alone. Let yourself be not okay. Remember that this is a temporary situation and that you will not have to feel this way forever.
  2. Reach out. If you are struggling to manage your mental health during this crisis, seek help. If you are already seeing a mental health practitioner, many offer telehealth to attend your appointments from home. There are also many online resources from Beyond Blue and Lifeline that can give you handy tips including this forum to speak with people who are in the same boat as you.
  3. Self- care. Now is a perfect time to incorporate self-care into your daily routine and make looking after yourself a priority. This can be anything from taking a relaxing bath to getting ready for the day. Make sure to prioritise making yourself feel good (easier said than done). We all deserve to go a bit easier on ourselves right now.

Hopefully some of this was helpful to you. If all else fails, download Tik Tok and go on a deep dive. This whole pandemic thing should be over by the time you get out. Wash your hands and be kind to people!

Musings of a Worn-Out Med Student

By Rav Sellahewa 

You’re too harsh on yourself. You have always been your sharpest

critic. You have a strong and over-powering superego, a voice in the

back of your head- that tells you off. You hear it whenever you don’t

study, whenever you don’t gym. It tells you off when you want to

relax. It represents an idealized self-image of yourself. An image

that you no longer have the tenacity to maintain. You have spent too

many years of your life trying to appease it. Too many years fighting

off the urge to laze around and watch Netflix. You’ve finished 4 years

of medical school, a BMedSc(hons), and are nearly done with your first

5th year rotation and you are tired. You’ve earnt a break. You need a

break. Tell your super-ego to go get f****d. It’s time to give in to

your impulses and desires- and let your Id shine. It’s time to watch

that god-awful reality dating show on Netflix and enjoy it, because

you deserve it.”

 

Fifty-Four Years Ago

By: Bowen Xia 

For: The Auricle Writing Competition 2018

Prompt: ‘What is a piece of advice you wish you hadn’t taken and why?’

In a small house, a year 6 student sits in a dimly lit room studying hard all day to prepare in the hopes of entering a prestigious selective school. Surrounding him are boxes of certificates, medals and trophies of various competitions and outside that, on a patchwork couch, his parents and siblings huddle together watching the latest episode of the ‘Simpsons’ on an old box TV. They ask him to join but he has more important things to do. Ha! His family’s periodic bursts of laughter mix over the TV static and he blocks his ears. One day my hard work will pay off and then I’ll be truly happy.

6 years later…

In a prestigious high school, a year 12 student sits in an empty classroom studying hard all day, to prepare for his VCE exams, in the hopes of studying medicine at a prestigious university. His blazer is adorned with numerous academic and leadership badges and his brow is furrowed and beaded with sweat whilst gazing at the citric acid cycle. Bam! A ball hits the window and shouts of his friends playing outside fill the room he shuts the window and closes the blind. One day my hard work will pay off and then I’ll be truly happy.

4 years later…

In a prestigious university, a fourth-year medical student sits in the medicine building foyer silently studying hard all day, to prepare for his end of year exams, in the hopes of gaining an internship at a prestigious hospital. In his bag sits his Netter’s flashcards, four medicine textbooks and his trusty Classic III stethoscope. Slam! The silence is broken as his peers leave the building for their weekly pilgrimage to the ‘Nott’. He stares back at his Anki cards. One day my hard work will pay off and then I’ll be truly happy.

3 years later…

In a prestigious hospital, an RMO sits in the staff breakroom revising hard all day, when he is not on shift, to prepare for his eventual registrar exams in the hopes of joining a prestigious speciality. On the table sits his fourth cup of coffee, a Cardiology III stethoscope, two patient files and a model of the brain. Creak…! Some colleagues leave the room and head off to Zoukis for a well-deserved break, but he resolutely refocuses on his studying. One day my hard work will pay off and then I’ll be truly happy.

9 years later…

At a recently founded clinic, a neurosurgeon sits in a consulting room working hard at night. It has been a long day chock full of patients and paperwork but hopefully, he will be finished soon. On his desk sits a framed picture of his family, a pile of bills, a neatly drafted cover letter and a brochure titled ‘AMA Nominations Opening Now!’. Click…! He opens the main door to his house. All the lights are turned off except a small night light in the lounge room where it shines dimly on the couch and two small sleeping figures are illuminated. He picks up a piece of paper lying next to them and inspects it. A squiggly drawing of his family is on it and underneath is scrawled ‘please come home soon Dad!’. A tear rolls down his eye. One day my hard work will pay off and then my family will be truly happy.

12 years later…

In the nation’s capital, a high-ranking member of the AMA studies some documents in his empty boardroom. When he is not attending meetings all day, he prepares his family’s finances. In his wallet sits a real-estate business card, a prescription for Xanax and a well-worn photo of his children. Ding! A message appears on screen ‘where are you dad? I can’t see you in the audience from the graduation balcony’. As the Prime Minister and his panoply of staff enter the room, the text message is dismissed with a sigh. One day my hard work will pay off and then my family will be truly happy.

20 years later…

In an inviting, large, well-kept house no one enters except for the occasional cleaning staff. On the balcony, a recent retiree idles all day on a sunchair waiting for the clock to strike 5:30 pm. In a bin next to him sit two empty pill boxes, one bisphosphonates and the other NSAIDs, and a torn brochure titled ‘Europe travel guide’. Beep… beep… beep! He unsteadily gets out of the chair and shambles towards his phone. Every movement seems to be painful but made with determination as he stops the alarm. His daily ritual has begun as he calls the two people that matter the most to him. Both go to voicemail but not without him sending two text messages that are left on seen. As the sun begins to set and the darkness approaches, he begins writing a letter.

My dearest angels,

I am truly sorry that I could not make you happy, but I hope this letter can. Fifty-four years ago, I a young, eager boy promised myself that I would not stop pushing forward into the world until the right moment to enjoy life to its fullest arose.  Alas, that day arose too late and I an elderly frail man will bountiful time and material can make neither you nor me happy.

 I blame this on ill-disciplined motivation and determination and insufficient time. If only, my promise was made when I was younger, and I tried working harder, today’s grief would be avoided. Our past conflicts were due to our different outlook on life but as your father, I cannot let you continue making the same mistakes as me. I implore that you resist being complacent and discontinue your premature enjoyment of life. If you do not stop working hard for the future, you may be happy in the end.

 

With Love,

A Sorry Old Man

The Adventures of Pen

By Rav Gaddam

There are many things that bind the medical student community together; our love of stealing food, the ability to still be bamboozled by an ECG, and of course, our innate skill to lose pens at a rate that Ebola has got nothing on.

But have you ever truly wondered what happens to a pen? Where does it go? What adventures does it have? Ever wonder about the people and things it sees?

Well, if you’re reading this article, you can guess that I have.

My pen’s journey began last year, when I lent it to my consultant who snapped their fingers at me and gestured to my pen as they were on the phone. “Do you also have some paper?” I was also asked, while begrudgingly handing over my favourite black pen.

I was unfortunately called away by a registrar, lured away with the promise of being able to cannulate the next patient. As you can expect, I never did get that pen back, and I assumed it had been lost in the depths of the pen blackhole that is a hospital.

At the same time though, I also imagined that my pen saw many exciting things in its life. It would likely have been used to draw up a drug chart to save a patient from a DVT, or sign path forms for a renal patient on dialysis. It could have been used to write down obs on a glove in ED, or provided comfort to that paeds patient who had left their mark on the hospital (likely on the walls, possibly on the bed covers). It could have also vacationed in world of hospital administration, and heard all the juicy gossip about the number of beds that were not available that week. Who knows what the pen could have done; the possibilities are endless!

Well, in some exciting, awe-striking news, I found the pen.

Nearly a year later, as I rocked up to the first day of my new rotation, I found “pen”, as I affectionately now call it, sitting innocuously in a surgical theatre. “It couldn’t be,” I thought to myself. “After all this time?”

Now, I can imagine some of you scoffing at this story, and some perhaps even accusing me of stealing a pen that perhaps did not even belong to me anymore, for it now belonged to the hospital. Pish-posh, I say. This event was a reunion that would have put The Notebook to shame, and made you weep like the time Mufasa died (it’s been 24 years, and I still cry. Every. Single. Time.)

It would have been a reunion story for the ages, a tale so splendid that David Attenborough would have wanted to make a documentary about it.

That is until the consultant snapped their fingers, and off my pen went on an adventure again.


Featured image from user FP Network on The Fountain Pen Network

Dating Medicine

By Ning Yih Kam

My relationship with Medicine has been a tumultuous one. It is very much like I’m dating medicine…

My love for Medicine started with an infatuation – a crush, as some might say. I was attracted to the prospects Medicine offered me. ‘He’ appeared reliable, strong, caring and sometimes even mesmerising. But that is all I know about Medicine. I was attracted to the security he provided me with, the respect everyone seemed to have for him, and his seemingly endless intellect. But that’s not why Medicine was attracted to me. He seemed to respect my diligence, my willingness to make sacrifices for the things I wanted. He appreciated the fact that I could hold my own against him.

Then Medicine asked me out. I vividly remember the day he did so – it was nearly 3 years ago now. Even the fact that he bothered to ask me out seemed like such an honour – people were practically throwing themselves at him – and here I was, a plain Jane, that Medicine asked out. I was elated to say the least. On our first date, he woke me up at 8am in the morning, with a call – telling me not to worry, the first few months of a relationship he said, were always the best – the Honeymoon period, or so he called it. And he was right, Medicine for those months, never ceased to be charming, provocative and ultimately seductive. He could’ve seduced those who were at first, totally uninterested in him, and put off by his demanding attitude. I did not just want to be with him, I wanted to be him.

And then we celebrated our first anniversary. The first of many, I would’ve hoped. He gave me a utilitarian, digital watch and says, ‘I don’t want you to miss any of our appointments – they’re all important’. I was so pleased at the gift – I hadn’t expected any, but at the same time, I was profoundly confused – surely, we will have some time outside of each other?

It was by third year that the cracks in our relationship started to appear. At first, the thought of spending all my time with him had made me so happy, but all of a sudden, as I watched my friends enjoy their social lives, I realised how restrictive our relationship had become. And that wasn’t all. There were stories. People who had dated him before told me to beware of the initial allure, of his initial charms. ‘He doesn’t work out for everyone, you know’, said a friend.

Third year, the relationship had become a chore. He wanted more and more. He was insatiable. My time, my intellect, my life: everything was not enough for him. Nothing was ever enough. Maybe our shabby foundation had started to rattle us. We decided, or rather, I decided, that I needed time away from him – time to do what I loved to do, without him intruding. I just didn’t feel like me anymore – I felt like my life was overrun with assignments, OSCEs, hospital placements and more.

During our time away from each other, I realised how shallow my reasons were for dating Medicine. What had attracted me to Medicine? Was it the unattainability? Was it the glamour? Was it the constant challenge? Was it the allure of making a difference? Perhaps it had been the strange amalgamation of all of the above.

As I contemplated my return to Medicine, I knew I would have to confront all I had learnt in the past 3 years. The reasons that had drawn me to Medicine initially, now appeared feeble – or even slightly repulsive. A return to Medicine would require stronger foundations. I needed to be able to justify the long hours, the years of less than desirable working conditions, the intellectual rigour and the physical exhaustion.

At the end of my deliberation, I decided to return to Medicine. In my cynical moments, I thought I was returning to him because I had nowhere to go. In my moments of positivity, I felt I was returning because of a faith that things would work out between us. But ultimately, the appeal of either of these extremes never lasted. I didn’t want to return to Medicine cynical or hopeful. What I did want to do however, was to return to Medicine not in a way that consumed me; but in a way that allowed me to retain who I was.

This is why we couldn’t date anymore. I look at Medicine now, as an equal. I’m not exhilarated by his presence, and I am no longer ignorant to his flaws. I want Medicine to be part of my life, not my whole life.


Featured image from Four Seasons Hotels and Resorts