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.

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JADE GUITERA – “a picture is worth a thousand words!”

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KHY YIE CHOO – “widened my horizons to the vast possibilities of leadership within the field of medicine”

Despite being held online, NLDS 2021 was truly an eye-opening experience! It was an incredible privilege to hear from doctors and leaders involved in leading Australia’s response for COVID-19, all of whom are inspiring examples of great science communicators. From learning about the importance of creating a self-narrative, to hearing A/Prof Melissa Kang talk about her insights as a medical consultant behind the ‘Dolly Doctor’ column, and learning about the intersection between legislation and medicine, these insights have undoubtedly enriched my thinking. In addition, keynotes from experts allowed me to gain valuable insights about how they overcame challenges to achieve success in their extraordinary career trajectories. Furthermore, practical skills on how to approach a problem as a leader, how to write more compelling applications, ways to approach a mentorship opportunity, and how to prepare for an important meeting are also some of my key takeaways from NLDS 2021. All in all, my experience at NLDS has definitely widened my horizons to the vast possibilities of leadership within the field of medicine. NLDS not only showcased inspiring examples of advocacy by doctors, but also allowed me to reflect on my personal leadership goals and gain skills that would make me a better doctor in future!

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YAJAT DUA – “You don’t have to be the leader all the time and I love having arrived at that place where I can just pause and listen to others.”

Being at a conference about the role and importance of leadership in medicine, I must admit I was taken aback when Dr. Vijay Roach, president of the RANZCOG, said this in his talk. As he went on to unfold the importance of humility and the keys to effective communication, I realized that most talks that weekend had subverted my expectations in an exceptionally unique way – every distinct story the speakers told conveyed such meaningful and applicable lessons that made me reflect on my life thus far and prepare for the future ahead.

It was a privilege to hear from the current leaders of the medical field in Australia: people who’ve not only shifted paradigms but are also willing to set forth their failures, positions they’ve been rejected from, and how those key moments shaped their journey. From Professor Peter Doherty discussing the pandemic and its end to Dr. Jessica Dean talking about challenges in advocacy, to individualized project pitching masterclasses with Dr Renee Lim, each speaker highlighted the myriad of possibilities ahead.

I assumed shifting to a virtual conference would mean forgoing the social aspects of NLDS but once again, expectations subverted. All the delegates formed such an insightful and lively group of people who kept engagement at an all-time high – it was such a pleasure meeting everyone and forming lasting friendships.

The team at NLDS21 somehow managed to crack the code for subverting zoom fatigue in the day, and creatively crafting stellar social events in the night.

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 ❤ 

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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.

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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. 

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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

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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

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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

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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!”

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.

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

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.”

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?” 

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

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.

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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.

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

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.

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.

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 20^th 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.

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.

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.

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!

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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!

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