Advice from one very tired person to another

By Nicola

Oh, sleep… that really great thing we all wish we got more of! This week’s topic is all about sleep, it’s function, and some tips to help get more of it. We’re going to get educational here, so buckle in for some good ol’ VIA revision that will hopefully convince you to stop studying/watching Netflix/playing LoL and get some shut eye.

Sleep has three main important functions. One, NREM (non-REM) sleep is for restoration and repair, it allows for tissue repair and energy recovery. Two, REM sleep has a big role in memory consolidation* (*pro-tip: study something really important just before bed!). Three, sleep overall is a method to conserve energy and hence is a protective mechanism, something we can observe in hibernating animals.

When we don’t get enough sleep (which, mind you, is so often with all of us…), there are a plethora of consequences that accumulate. We have the real obvious one – we don’t perform as well the next day, yawning through a 8-10 hour day of placement and lectures, and making more errors in seemingly easy tasks. There is an increase in our sympathetic nervous system drive, which over time predisposes us to hypertension. A change in dietary and hunger hormones causes a higher appetite and probable weight gain. Lastly there is higher levels of nocturnal cortisol secretion which can lead to insulin resistance.

Have I convinced you to go to sleep yet?

The balance between our sleep drive and our wake drive (i.e. the Circadian rhythm), plus the role of melatonin, promote sleepiness when we need sleep and will wake us up when we need to get up. Things like, having varying sleeping and waking times make it difficult for this homeostatic mechanism to work effectively, explaining partially why sometimes we wake up feeling absolutely awful (some of it might also be because it’s 5:30am and we need to be on ward rounds by 7am). This kind of imbalance is seen with shift workers or in jet lag, and have been demonstrated in a multitude of studies to be associated with impaired attention, poor decision making, mood alterations, and even higher incidences of cancer long-term.

How about now? Are you feeling sleepy?

One of the biggest contributor to our poor sleep patterns, other than staying up to all hours studying, is being on our screens too late. The effect of blue light on our Circadian rhythm and melatonin secretion has been researched by Harvard University, and even dim light can mess it up. Blue light isn’t all bad though, during the day it’s awesome – boosting attention, improving reaction times, and mood. With blue light in our faces all night, our poor brain thinks it’s still daytime.

But just filtering out our blue light emitting screens isn’t going to solve all of our sleep issues, it helps a lot though. The best thing to do is have great sleep hygiene. This is defined as “recommended behavioural and environmental practice that is intended to promote better quality sleep”.

Here’s a (not exhaustive) list of things which are associated with a better night’s sleep:

  • Sleep scheduling, this is having a set time to fall asleep and wake up every day. This is difficult with the changing schedule of clinical placements and classes, but I found that at least trying to get to sleep at the same time every night helps!
  • Aim for that 20-30 minutes of exercise every day, but no later than a few hours before bed. You get all the fun, no-metabolic-syndrome-benefits of exercise but it’ll also tire you out enough to sleep.
  • Meditate! (I am so so so sorry that pre-clin ruined it for you, I promise it’s good). Apps like “Calm” or “Headspace” have specific guided sleep meditations.
  • Read a book before bed (and I mean a paper back one, e-books have no place here).
  • Avoid caffeine later in the day. Say… no later than 3pm… I know, shocking right, but that stuff hangs around in your system for ages! That includes caffeinated teas too! It’s suggested to not have any caffeination 6 to 8 hours before bed.
  • Try and have your bedroom for sleepy times and sexy times only, no study times. Again this is super difficult if you’re in student accommodation (read: a shoebox), but maybe try studying at the library or in the lounge room.
  • Don’t lie in bed awake, get up and do something else and come back to bed once you’re tired.
  • Listen to a sleep podcast, this is a really good one – Sleep Restore.

Good things come to those who wait – change isn’t going to happen overnight. Sleep hygiene and consequently improved sleep is a habit you need to work on. Did you know it takes approx. 4-6 weeks for form a habit? Good luck, and enjoy your new-found good nights of sleep 💤

 

P.S. in all seriousness, if you’re having trouble with getting to sleep, staying asleep, or having daytime sleepiness, especially after trying the above tips, please see your doctor 🙂

An Uncomfortable Truth

By Natasha Rasaratnam 

I was lucky. I was lucky that my grandparents left Sri Lanka to seek a better, more hopeful future for their children. I was lucky that I did not have to grow up in a war-torn country whose scars are only beginning to heal. Yet for those who lived through the 25-year civil war, the trauma is everlasting, hiding under the facade of a country that wants to forget the legacy of its conflicts. It is no surprise that after these decades of violence, mental health issues have risen dramatically in Sri Lanka. Yet this spike has not been adequately met with appropriate treatment and education. At its core, this crisis is underpinned by an entrenched cultural stigma towards mental health conditions.

Stigma is when there is a negative perception of someone based soley on them experiencing a mental health issue. More often than not, stigmas aren’t born from malicious intent rather due to a lack of understanding yet nonetheless they create a barrier for people to seek help. In Sri Lanka, it can sometimes be thought that having a mental illness or being associated with someone who does, negatively affects your employment and marital opportunities. This is exacerbated by a lack of mental health workers and information that is not readily available to the public. As a result, particularly in rural areas, it is more common to take people to faith healers or temples rather than seeking professional help. There are also cultural associations that link these illnesses with the notion of ‘karma’ and resulting in them being considered as fate with blame being laid on the person themselves. There are also some views that mental illness simply doesn’t exist and people “just need to get on with it”. This dismissive perception associated with mental illness is deep-rooted and spreads beyond South Asia to immigrant communities worldwide.

Closer to home, despite all the ‘R U OK days’ and mental health awareness events, there are still communities in Australia in which mental health is a stigma. Although we’ve made vast improvement to tackling the stigma surrounding mental health conditions, we must not be complacent in thinking we have completely solved the problem.

Growing up in a migrant community has its ups and downs. Everyone is friendly and wants to know about you… maybe too much at times. Coming from a Sri Lankan background, it is not unusual to hear older members of the community dismiss depression as a weakness of character and not a valid health condition. Similarly, suicide is often mentioned in hushed tones, more a source of shame rather than the tragedy it is. Of course, these attitudes cannot be generalised to all members of the community and I am lucky to be surrounded by a family that understands and values the importance of mental wellbeing.

Yet the consequence of this underlying stigma can have devastating effects on those already isolated due to their mental health. A friend was told to “just pray it away” by family members as a cure for her severe depression. Although faith can be a healing force, the dismissiveness of these comments resulted in a toxic environment at home of further isolation and distrust. Mental health stigmas not only stop people from speaking out about their health but can also worsen the situation perpetuating a vicious cycle.

These perceptions are so ingrained in the older generations of migrant communities it’s difficult to weed them out. Unlike Sri Lanka, Australia has the resources and educational tools to reform and erode taboos such as these. However, despite their admirable aims events run by organisations such as Beyond Blue and Headspace can have little reach to address older members of the community.

To an extent this is also a generational problem rather than a cultural one. Hence, it falls upon us as the next generation to strive to engage in a conversation with our parents, grandparents, aunts and uncles about mental health.  For all their flaws, migrant communities are tight knit, and it is this support which can be utilised to help those struggling the most rather than demonising them. Cultural leaders have the power to make change and it is only through our conversations with them that we can start to see this stigma being overcome. We’re the lucky ones – we have resources and information at our fingertips. Our communities’ ignorance can no longer be an excuse.

 

Kicking Goals for Mental Health

By Kit Ming Foo

March: the time of year when footy fans around Australia rejoice after 6 months in the wilderness finding creative ways to spend their weekend. However, when the first bounce occurs, all eyes are on the players. Every little thing that they do is examined under a microscope. Every goal is celebrated but also every dropped mark or skewed kick is met with sighs of disgust and for some, even boos. Such is the life of an AFL player, where everything they do is in the spotlight, good or bad. Everything gets scrutinised and what the fans and media fail to realise is that at the end of the day, there is still a human being behind these athletes, someone who has put in so much to end up where they are now.

 

On the 17thof December 2018, news broke that one of North Melbourne’s players Majak Daw, had an incident on the Bolte bridge where he fell and sustained serious injuries. Suddenly there was an immense focus on not only Majak’s well-being but also that of the wider AFL population. In the months leading up to this incident, many other players such as Richmond superstar Dustin Martin discussed their battles with mental health, yet many felt that not enough was being done by the central administrative body to look after the wellbeing of the players. This all changed in the aftermath of Majak’s bridge fall as the CEO Gillion McLachlan introduced a mental health manager for the league and highlighted that mental health was the “No 1 issue for the playing groups”.  Whilst the AFL has taken some encouraging steps in addressing this issue, it is unfortunate that the catalyst for change from the status quo was such a devastating event.

 

Now some of you may be thinking, this is the Auricle, a medical student journal so why is AFL being mentioned? Taking a closer look, you can draw many similarities between being a player in the AFL and a member of the medical profession. Many of the things that were mentioned above apply to medicine too. Both professions require high levels of dedication to be successful. Both come under heavy scrutiny when things go wrong. Both have the capacity to place massive amounts of pressure on players and practitioners alike. Finally, both have started the long journey to make mental health a priority.

 

In recent years, prominent doctors have started social movements such as Crazy Socks for Docs. With this, medical student mental wellbeing has also been brought into the spotlight and this is something that needs to be taken seriously. For many of us, this is a topic that we have all heard about but until we personally have to confront it, either through our own                    experiences or a friend’s, it is in a way something that is hard to relate to. Problems with mental health are actually more common than we think. A study published by BeyondBlue in 2013 involved the responses of 1,811 medical students and revealed that around 10% had very high levels of psychological distress. This is three times as much as the general population, so why do we not hear more people in the medical profession talking about their struggles with mental health?

 

Much like AFL players, few medical students ever share their stories publicly, meaning that countless more go through these battles in secret. Admitting to one’s own mental health struggles to the world is not easy, let alone telling the people closest to you. As a result, like many footy players, medical students try to hold it together whilst they are in the eye of the public, whether it is on the hospital wards or in tutorials. Because of this, a facade is put up, tricking everyone into thinking that everything is fine, when in reality the opposite is true. If a star player like Dustin Martin can do it, so can many medical students.

 

The aim of piece is not to say everyone should have the courage to tell the world everything, but rather to try and make having a conversation with trusted friends easier. We as a profession need to improve the way that we all think about mental health. We need to accept that it is a problem that all of us have a responsibility to deal with. Breaking down the barriers to seeking help is one way to start and to do so we need to remove the stigma that many of us associate with doctors asking for help. Our profession is built on being empathetic towards our patients but why are we not the same towards our colleagues when they are in times of need? If we do not change our response to this, the topic of talking about mental health will never be made easier. People will continue to avoid seeking help and this problem will continue to grow. Such changes in mentality obviously take time to transpire and it is unrealistic to expect a change overnight amongst the medical profession. However, much like how we have begun to see shifts against bullying in the workplace and safer working conditions, everything needs to start somewhere and we all can have a role in championing a change to make talking about mental health easier.

 

Medicine is a team game and much like being on the footy field, we need to look out for our mates. Battling issues with mental health can make a person feel isolated and often the onus is on them to make the first move and talk to someone about it. At the end of the day there is truth to this as it really is up to the individual and whether they want to share their experiences. Sometimes though, people are just waiting for an opportunity to open up. Simple questions such as “are you alright” or “is there something that you want to talk about” may be all they need. Let’s all make sure that we look after our friends and get through this season together.

 

The Cannula Volume One

Editor: Idew Wokefield

BMedSci Insight

New research by medical students determined the optimal free food to faculty disciplinary meeting ratio. The non-blinded non-randomised ‘randomised control trial’ was held over 8 weeks and involved a cohort of 100 third year medical student participants at [De-identified] Hospital. Participants were given the choice to grab a slice of pizza, fruit or ‘whatever they could get their hands on’ from a ward meeting or conference. In total the experimental group had participants ranging from obtaining 1 slice of pizza a week to 2 whole pizzas, 3 sandwiches and a slice of garlic bread. Side effects experienced by the experimental group included 5 participants forced into a research paper seminar, 6 roasted by consultants and 12 experiencing faculty disciplinary meetings. Side effects experienced by the control group included 20 experiencing FOMO for missing free food and 1 unfortunate participant that was roasted by an intern for standing within 1 metre of a tray of chicken nuggies. The results show that there is an exponential relationship between ‘amount of food obtained’ and ‘number of faculty disciplinary meetings’ but there were a few outliers from the experimental group that had escaped the notice of faculty. Comparing ‘number of faculty disciplinary meetings’ against ‘general wellbeing/ number of nights drunk, there was no correlation. Therefore, the results of the experiment can be summed up by the words of one participant, ‘Faculty disciplinary meetings are a small price to pay when you get provided three meals a day at the hospital’. Shortly after the statement, he was expelled from the hospital after ‘accidentally’ eating the Clinical School Dean’s lunch.

[De-identified] Hospital In-focus

A new report has found [De-identified] Hospital productivity has decreased by 50% after the introduction of PebblePad. We have an exclusive breakdown of the situation from one doctor that did not want to be named, ‘It was 12pm and I had just finished up the ward round when I was accosted by a gang of medical students after a cannula. After multiple successful attempts of acupuncture and one successful cannula, I was getting ready to head off to lunch when they pulled out their phones on me. I waited through my lunch break, my unit meeting and a MET call for the students to get PebblePad ready and in my haste, I accidently closed the browser. I left the hospital in the dark that day’. An emergency hospital executive meeting was called to discuss how to deal with the threat of increasing use of Pebblepad by medical students. The most popular agreed option was the ‘pretend they don’t exist’ solution which is practised by 20% of doctors and 80% of neurosurgeons. This option is also known as the ‘neurosurgery triad’ where medical students are never spoken to, looked at or acknowledged to exist. Other solutions discussed included the expulsion of all medical students including students that have never used Pebblepad and the introduction of ‘Safe Pebblepad Use Rooms’ where Pebblepad use by medical students is supervised.

If you are a writer, fan, hater or corporate lawyer for [De-identified] Hospital, please send your ideas, money, hate mail or cease and desist letter to xxx1.spam.1xxx@gmail.com!

 

“So tell us, why do you want to become a doctor?”

In the months of my final year of school, the question of ‘Why’, of ‘Why medicine’ occupied my mind with an almost irritating intensity. I was in two minds regarding this question, seeing it as both deeply important and as yet another obstacle during that frenetic period, something for which an appropriately polished response had to be crafted. From the paranoid searching on annoyingly cheery sites with titles such as ‘What med schools love to see in applicants?’ to a final medentry ‘workshop’ before the impending interview, I’d formed a rigid notion of what the ideal reasons ought to be. Perhaps mistakenly, although I would say not uniquely, medicine seemed akin to a fortress of sorts, to which admission was reserved for the near saintly, those of faultless moral character, to those fuelled by purely unselfish motives, in short to those among us for whom this was a vocation, an intense, abiding calling.

 

In the face of these rarefied ideals, I felt the sharp sting of unworthiness, the feeling that I was an alloy of jostling motivations that couldn’t possibly be allowed entry. As I look back now, I think that arriving at the decision to really pursue medicine was, at least in the beginning more of a process of subtraction and elimination rather than one arising out of a deep-seated conviction. I knew what subjects I enjoyed and tended to do well in, and those, to put it charitably, in which my aptitude left a little to be desired. Considering this, I knew I had little interest in pursuing a math heavy field such as engineering or something similar. My passions and perhaps just as importantly, my strengths (I hope your eyes haven’t just glazed over) resided in the bio-chemical domain, in that ‘soft machine’ of the human body. It was this fascination, part scientific and part motivated by a certain paranoia about the inevitable propensity of cogs within this machine to malfunction that impelled me, to commit to the path of medicine. However, this interest was the original impetus, by choosing medicine, I wanted this nascent passion to intersect with humanity. To use the little knowledge I had or perhaps I should say still have, and build upon it, in hopes that ultimately it may be of some use to someone, that it may ease their suffering or sickness, in hopes that perhaps it may make – and I use this well-worn phrase unashamedly- a difference.

 

However, this doesn’t represent my motivations in their entirety, it would be wrong of me to cut out the less lofty reasons for my decision; in this case let us not separate the wheat from the chaff. To admit that one might in some small part be driven by the likelihood of a monetarily rewarding profession (eventually) or by the prospect of healthy career options, although after an ominous lecture concerning the internship crisis I am not so sure, was close to profane. Yet I recognise motivations such as these along with a subtle familial encouragement did play a role, a junior one but a role nonetheless and I would venture to say that these more material considerations may have in part influenced others too, at least judging by the number of biomedical memes we make. However, I don’t mean this as criticism, we as medical students or as prospective medical students do not live in a vacuum. Instead we’re shaped by the environment around us, by familial expectations: hopes that their children might enter a few select professions are so common in certain families, perhaps in some of those from a migrant background that they border on sociological phenomenon, by professional aspirations, by financial prospects, these can all seep into us via a sort of osmosis as we decide what it is we want to do with our lives.

 

Yes, it’s true that being solely or largely motivated by more worldly reasons, those of security or prosperity would be unwise in the long term as the path to and of medicine is lengthy one. A path of training followed by more training, of assessments succeeded by more assessments, in short, one of ultimate deferred gratification and if someone doesn’t feel a degree of passion for the material and its application in aiding others in their time of need then they’re at risk of deep dissatisfaction. A worrying prospect for both the individual and especially their patients.  However, I maintain to ask that we completely void ourselves of those prior concerns is requiring, in my opinion, the impossible. It is asking us to be a little more than human.

 

On a final note, I would add that although I still hold the core of those same motivations, I did prior to beginning medicine, in the months since then, something else has been added into that original foundation. Through seeing and interacting with patients if only in a rather limited capacity, I am at times filled with a terrible, and I don’t mean that in the pejorative, sense of responsibility at what will be expected of me in the future. That I will be privy to individuals at their most vulnerable, through sickness and malady and that they will place a dizzying amount of trust in my and the profession’s ability to steer them through their illness. It is the knowledge that at this moment there are people, some well and some ill, some young and some old and some who are as yet unborn, none of whom are known to me but whose paths may one day cross with mine that impels me to continue. It may be a brief encounter or a more prolonged liaison, however in that time I will have to honour and live up to the trust that has been placed upon me.