By Sarah Jaboury

‘I refuse to bend.’

Not sure if you’ve heard that phrase before, but I certainly have; and although a little pretentious, I feel that it’s nevertheless a good way to describe the quality of resilience. In a profession like ours, resilience is not just important, it is ever so necessary to our survival.

Being a medical student was never the main stressor or source of pain in my life; I’m a bit atypical in that I have always used it almost like a coping strategy, to feel control amidst overwhelming loss. To clutch at a sense of drive and purpose when, to be raw, I used to and occasionally still feel that outside of medicine, I was empty. But I’m waking up now; I’m realising that I can’t rely on that alone as a crutch forever. It’s not good enough. It’ll never be good enough, and I’ll never be satisfied just on that.

I think that’s part of the reason so many people around me, the people of our time, are so fucked up. We’ll never – we can’t be satisfied. The typical type A medical student personality is just an overt phenotype of how lost our generation is. Be more, do more, so you can be better, and have a better life – this is the message constantly shoved down our throats, not just by the media, but by every single person around us, including the endlessness of our own thoughts.

It’s a classic case of the chicken and the egg – is it that being pushed to continuously improve our lives creates the sense of not being or having ‘enough’, or is it that our feelings of deep dissatisfaction with our lives are what drives us to constantly, desperately search for ways to ‘fix’ them? Or is it that we lack resilience? Where does resilience come from?

The answer is the only thing I know and feel with certainty, and that is that it is a choice.

You choose what you can survive. You choose what you can come back from. It might be an easy choice or a hard one, depending on what challenges or losses you experience, and the time you have to adapt, but at the end of the day it is entirely, and wholeheartedly, a choice.

I want to take this second to make clear that this does not mean that if someone has given up, then they are weak, or selfish, or lack mental strength. Essentially, what I’m proposing is a hack – a ‘cheat’.

There is no such thing as ‘strength’ – there is, however, a will to fight for your life. Almost like stubbornness – a refusal to bend, and a decision made based on that to continue, unconditionally. Something that I’ve trained to be a reflex— living by default.

And I’ve not just been living, but highly performing. It’s so much easier to do when there’s no fear of failure, but instead the knowledge that no matter what happens to me, so long as I still have the air in my lungs and the blood in my heart, I can choose to, and therefore I can, survive. It may sound like a miserable, zombie-like existence, but I’ve found that when I abandon searching for meaning, I am the most likely to find it in the most unexpected of places. And at the end of the day, I’ve survived. It’s a win.

Living by default means that even when you’re lost and confused, when everything is up in the air and you are at your God’s end for why you are even doing this anymore, and why are you trying, and what is the point of all your effort and all your suffering and the sleepless nights and it’s not even good enough, it’ll never be enough you’re not HAPPY it’s not working—

STOP. Stop thinking.

Just continue.

Just keep breathing. Keep doing. Go to sleep and wake up and keep going.

Fight for the sake of fighting. If you can simply continue, it’s a win. No matter what happens, the earth will keep spinning, the planets turning, and humanity will always have something inherently beautiful and worthwhile in it, for as long as we survive. It’s in there, it’s just a puzzle, and it’s subtle, and despite what you’ve been told there’s no sure-fire way to find it and hold it down.

Don’t listen to what anyone else tells you to do. Your only job is to survive. Do what you need to, be kind to yourself, and know that you’re doing all you can, and that’s enough.

And if you ever feel lost, just breathe, sleep and repeat – and you’ll be okay.

By Cecilia Xu

Auricle Writing Competition 2018: Clinical Runner-Up

It is a scathingly hot February morning, and three separate O-Week cruises have capsized in the Pacific Ocean. The sole survivors of each ship – a law student, an arts student and a medical student – find themselves marooned on a desert island with no hope of rescue. As three profoundly different beings, will they be able to overcome their instinctive discordance and find a way to escape? Or will they succumb to the elements?

Our first subject is bespectacled, serious and thoroughly unamused by the circumstances. The sea spray and open sky are a stark change from the law student’s usual habitat, which is typically abundant with books and devoid of all sunlight. In an attempt to recreate its natural surroundings, the law student has stacked twenty extremely boring textbooks (which it had been inexplicably carrying on a recreational cruise) to form a wall. Atop this wall, it has placed what appears to be an undergraduate commerce degree to form a protective roof. It has taken note of its two companions, one sitting serenely on the beach and one lying face down on the sand. It wonders vaguely if it can use its powers of persuasion to convince them to eat each other.

On a sandy dune nearby, a figure is seen staring contemplatively out to sea. It does not appear perturbed by the dire situation. As a matter of fact, it appears to be rather enjoying the ocean breeze through its unnaturally blue hair (dyeing of the plumage is common amongst students of the arts as a strategy for identifying each other and attracting mates). It does not seem aware that it is not alone on the island, nor does it seem to care if it is alone or not. It just is.

The final specimen is lying face down in the sand, hopelessly inebriated from their seventeenth apple cider on the now shipwrecked cruise. Upon waking, they blink perplexedly for a moment before registering their surroundings and immediately launching into a fully fledged panic attack (years of basing their worth on academic results have resulted in extreme emotional lability and a fragile self-esteem). Approximately twenty-six minutes later, the medical student slowly rises to a sitting position and looks around – a general inspection, if you will. It identifies two lesions, one blue and benign looking and one possibly malignant but well circumscribed by what appears to be several obscenely thick textbooks.

Time passes. The law student schemes, the arts student dreams, the medical student internally screams. Just as there seems to be no hope that there would be any interfaculty interaction, the arts student stands up from the dune and waves, first at the law student, then the medical student, as if seeing them for the first time. “Hey!” it shouts. “Did you guys get stranded here too?”

At long last, the three parties make their way to the centre point between them and meet. They exchange names and the last memories they had before their boats sank and they washed up on these unforgiving shores. They express their feelings about being stranded and argue about what should happen next.

“We should sue the university for negligence!” the law student proposes.

“Negligence is but a social construct,” says the arts student.

“The mitochondria is the powerhouse of the cell!” the medical student blurts out, trying to be useful. Alas, it is of almost no use, as the medical student has not yet undergone metamorphosis into the clinical stage of its life cycle.

They converse for several hours before hunger becomes the predominant emotion, and they decide to split up in search of food. The medical student manages to catch a fish using a suturing needle and thread that it found in its pocket. The law student starts a fire using its spectacles and one of the more boring law textbooks (to clarify: the textbook is of a flammable use as opposed to an instructional one). The arts student is usually herbivorous, but makes an exception due to being stranded on a desert island (a scenario it has frequently been asked about before) and cooks the fish for the group to share. They sit down to their first meal as castaways, and by the time they finish, the sky has begun to grow dark.

“We need to build a shelter to defend ourselves from the elements,” the law student states sensibly.

“You keep the fire burning for the rescuers, and I’ll weave a tent out of flax,” says the arts student.

The medical student begins to recite the steps of the Krebs cycle but soon realises that the others have already walked away and begun their practical tasks. The medical student instead amuses itself by subtly inspecting a mole on the law student’s chin to determine whether or not it could be cancerous.

By nightfall, the three youths are sitting in unprecedentedly close proximity under a cube-shaped flax tent (it’s rustic-avant-garde, the arts student had said). More importantly, they seem to be defying the laws of nature by talking about things they have in common.

“We hate Turnitin,” the law student says.

“We love coffee,” the arts student adds.

“We all have bones,” the medical student offers. The other two nod sympathetically.

They lie in silence as the world around them grows darker and more uncertain. They know not whether they will survive the night but they do know one thing: they are not alone.

***

Professor Mitchell leans back in her chair and clasps her hands across her lap. It has been another long day for the Dean of the Medical Faculty. Blue light flickers across her face, reflections of the hundreds of video screens displayed before her. Each screen reveals a fresh scene of carnage: law students smothering arts students with white powdered wigs; medical students trying to perform chest compressions on themselves.  

But there, in the bottom left-hand corner, marked Simulation 59314, is the breakthrough that has eluded the faculty for decades. A bespectacled law student, a blue-haired arts student and an emotionally vulnerable medical student are sleeping peacefully, side by side on a desert island. Professor Mitchell picks up her cellphone and excitedly hits speed dial.

“Michelle,” she says, “I’ve got an idea for improving interfaculty relations.”

By Jason Ha

2018 Auricle Writing Competition: Clinical Winner

The Emergency Department had had a quiet Friday evening, and as usual, no-one
dared to actually utter the ‘Q’ word unless they were ready to face the wrath of some
veteran Emergency staff. Just a few broken bones, a few cases of pneumonia, and
the typical bread and butter glorified GP cases – just the usual.

It was a quarter past eleven, and I had just finished documenting the details of my
previous patient, when the ANUM appeared at the door of the hub, straddled the
door frame and announced, “10 minutes before our urosepsis gets here. Get
everything ready.”

I had always wanted to see a resus in action, to feel the adrenaline coursing through
my veins – it had only been a few weeks earlier that I had taken part in a simulation
session. There were certainly recounts about how an effective resuscitation would
ensue: clearly defined roles, a steady stream of communication, a strong leading
clinician who were the eyes and ears of a smooth seamless operation. Patient
saved. Simulation session successful.

I’d been strongly encouraged to take part in a real resuscitation, to put what I’d
gained into practice, to refine those skills and to see the ED clinicians in their
element, so when I was asked if I wanted to be involved, I seized the opportunity.
By the time I’d gathered my belongings and opened the curtains, I was greeted by a
flurry of activity: putting on gloves, drawing up medications, powering up the
defibrillator and monitoring system, checking the oxygen, readying the resus
paperwork.

“Ready? Ever done CPR before?”

“A few times. But never on a real person before.”

“Well, now’s your chance.”

It was all I needed to understand the gravity of the situation: this was a grandmother
who only just half an hour ago had been at home, laughing at a TV show with her
husband, on the phone with her two children, or Facetiming with relatives from her
native home country.

And as she was wheeled in by paramedics, I could see her laying on a stretcher limp
and spread-eagled, devoid of the pink flush of life, with each passing second
punctuated with the pneumatic hiss of an automatic chest compression system.
Even among the clamour of the beeping monitors, the clatter of medication vials, and
the cacophony of voices, I could just pick out a few snatches of the conversation.
“82 year ol—yes, from home with her husb—”

“—ext dose of adrenaline ready!”

“—vious history of a UTI, felt unwell after dinn—before she collaps—”

But it seemed that this was no easy resus.

As I alternated in and out of hovering out of the way and performing a cycle of
compressions, I was aware of the hiss of oxygen as two airway doctors managed her
airway at the head of the bed. I could vaguely hear the drill of an intraosseous port
being inserted into the head of her tibia by a nurse, who had only shown me the
technique earlier that morning. I glanced over and saw that the senior registrar, who
had only earlier that week single-handedly managed cases of ruptured ectopic
pregnancies and trauma, had beads of sweat collecting on her forehead, as she
positioned herself to place an IV line amidst the jostling of the arm, dangling
precariously off the side of the bed.

I hadn’t noticed that an hour had passed, nor the fact that my stethoscope had fallen
off my neck during CPR and lay forlornly on the resus bay floor. It hadn’t occurred to
me that I was drenched with sweat, or the fact that it was now a Saturday. And as I
returned to my umpteenth cycle of compressions, I felt a hand on my shoulder.
It was over.

It didn’t matter now that the paramedics had arrived at hospital within just 20 minutes
of her collapsing at home. It didn’t matter that we were a well-oiled team, rehearsed
to the very last detail. In fact, it didn’t matter that we’d done everything we could,
given her all the right medications (even gone for an intraosseous line!) and placed
lines, ports, and leads in nearly every part of her body in our unsuccessful attempt to
revive her.

I gathered my belongings and was ushered out of the cubicle by a nurse. As I turned
back to look, I could see her husband cradling and sobbing into her left hand, and I
realised that—despite all my training, the numerous tutorials, simulations and
drills—nothing had prepared me for this.

My medical training could train me to mechanically recite the DRSABCD algorithm,
and practise advanced life support until it was imprinted in my memory. I could tell
you the number of times that I’d practised and even taught the correct technique for
compressions, even list out every single MET call situation when I had been a
bystander.

Yet this was controlled chaos – the only way to describe the choreographed and
calculated way each clinician moved through the resuscitation bay, directed by a
consultant standing at the foot of the bed, with hands in his pockets. Everything was
orchestrated, thought-out, planned – no miscalculations or missteps, a symphony
without a baton, a performance without cues.

Ultimately I wished I hadn’t been so naïve and that I could have prepared myself
better. But there was no way I could have. The gruelling nature of the operation, the
futility of the whole exercise, the difficult decisions to cease resuscitation, the ephemeral nature of human life, and the emotional aftermath: these were all things
that I could have only learnt by being present. These were lessons learnt the hard
way.

But despite it, there was nothing I could have done anything differently, and perhaps
in some ways, it is a rite of passage for many of us in medicine – an emotional
catharsis of sorts.

As I left the ED, I bumped into the ANUM at the exit, who gave me a weak
exhausted smile.

“Now what you saw back there—that was a good resus.”