By Anonymous

Within your placement, ask a consultant about a clinical protocol he/she had to follow in the last week. Was there any aspect of the protocol he/she disagreed with? How did the clinician deal with this?

“Tell me about the demons, Gerald.”

A smile spread over the patient’s face at the psychiatrist’s question. The smile was genuine and innocent, and perfectly suited his chubby, childlike face. “Well they’re always around me. They keep me company. Look, there’s some right now,” he said, pointing at the ceiling above the psychiatrist’s head. I fought the urge to look where he was pointing for a moment, but then it overwhelmed me, and I looked up, to see a disappointingly demon free ceiling.

The psychiatrist seemed less interested in entertaining this fantasy and kept his attention squarely on his writing pad. Every now and then the scratching noise his fountain pen made against the paper was overpowered by a screech from the ward. The patient seemed transfixed with how the gleaming nib danced under the down lighting of the interview room.

“Have you told your family about the demons?” questioned the clinician.

“The demons are my family.” The psychiatrist looked up from his writing pad, a disconcerted expression permeating his usually infallible poker face. He hadn’t heard that one before.

“These demons, do they speak to you?” he quizzed. Gerald nodded a content, energetic nod. “Do they ever ask you to hurt yourself?”

“No, Doctor, never.” The psychiatrist went quiet for a moment, tapping the back of his fountain pen against his chin.

“What about other people, do they demons ever ask you to hurt other people?” the psychiatrist changed tact. Gerald nodded a more vigorous, almost violent nod, the smile on his face expanding to the point I was afraid he might swallow his own head.

The psychiatrist’s eyes narrowed. “Gerald, the demons aren’t telling you to hurt me, are they?” Gerald let out an involuntary giggle. The psychiatrist’s gaze flickered towards the door to his right for a brief moment, then returned to Gerald. “What are they telling you to do right now Gerald?”

Between bouts of giggling Gerald stuttered out an answer; “They’re saying to take that silly pen of yours,” his response was punctuated by more erratic laughter, “and stick it in your eye.” As Gerald continued to cackle away the psychiatrist purposefully capped the fountain pen and tucked it securely away inside his suit jacket.

“I think we’ve got everything we need Gerald, thank you for your… candidness,” the psychiatrist drew the interview to a close, and turned to me as Gerald skipped out of the interview room. “Thoughts?”

I hesitated for a moment before offering an uncertain answer, “He’s not reacting to the Clozapine the way we had hoped.”

“So, what do you recommend?” he pushed.

“Maybe we try something else.”

“We have tried almost everything else. Clozapine is the end of the line, it’s for treatment resistant schizophrenia. It’s what we use when nothing else works. We’re kind of stuck now.”

“We could up the dose-”

“And risk agranulocytosis,” my shoulders slumped as I attempted to shrink away into my chair. “It could put an end to the psychosis though,” he offered, and I beamed at my first correct answer all day, “by killing him.”

“Oh,” I sighed.

“We stand behind the TTO,” he said standing up, “There’s not much else we can do at this point.”

“Um, this may sound like a stupid question-”

“There are no stupid questions,” he interjected, “only stupid people.”

“Right.” This was reaching record levels of discomfort. “What exactly is a TTO?”

“A Temporary Treatment Order. Its kind of a measure we use for acutely ill patients, that is patients who are at risk of harming themselves or others if untreated,” he explained, “We can install one provided it is the least restrictive means to ensure safety, and it allows us 28 days in an inpatient facility to form some sort of immediate action plan. For Gerald, I just want more time to see if the Clozapine will take effect, as we are very much in the transition phase between antipsychotics.”

“Uh huh,” I nodded.

“It’s never ideal, but its sometimes necessary. Some patients really deride it, but Gerald’s a relatively agreeable fellow. Violent fantasizations aside, of course,” he clarified as he turned to leave the room and return to the psychiatric ward. After a brief hesitation I followed.

 

By Emily Robertson 

COVID-19 isolation got you bored at home? Exhausted your list of to-do things around the house? Need a break from study? If you haven’t yet jumped onto the podcast bandwagon, now is a perfect time. With more down time during this weird situation we find ourselves in, listening to podcasts can be a great distraction from the constant COVID-19 updates. Here are some of my podcast recommendations:

Medical

Med Conversations – This is an Australian podcast by doctors working in Melbourne. There are many very useful episodes particularly for 3^rd and 5^th year students about important conditions – a good way to study without requiring much effort.

Humerus Hacks – Another Australian podcast by two Melbourne based doctors, they provide helpful mnemonics and humerus ways to remember important facts about conditions, you will be sure to have a good laugh.

Junior Docs – An Australian podcast by two junior doctors about the transition from medical student to doctor, aimed at assisting this transition with episode focuses such as avoiding burnout and choosing a specialty.

Conversations in Obstetrics and Gynaecology – An Australian podcast with a number of episodes relevant to 4^th year women’s health content.

Health/Lifestyle

The Food Medic – By British doctor Hazel Wallace. She interviews leading experts in their field to provide evidence-based advice on how we can live healthier lives. I also recommend following Hazel on Instagram and checking out her website for lots of delicious and healthy recipes.

The Doctors Kitchen – A podcast by British GP Rupy Aujla covering a range of topics from healthy eating to how to prevent and treat illness. He interviews experts in their field of health and medicine.

In Good Health – A relatively new Australian podcast by Dr Sandro Demaio exploring the science and research behind how to eat better to improve mental, physical and social health.

Health Report – An ABC podcast aimed at all Australians to bring clarity to the health and medical issues from social, scientific and political points of view.

News

The Squiz – This daily podcast provides a quick 10-minute snapshot of the major news headlines in Australia and around the world.

True Crime

Chasing Cosby – A moving podcast by Nicki Weisensee Egan about the rise and fall of American comedian Bill Cosby. Each episode delves into the sexual abuse allegations made against Bill Cosby by numerous women.

The Lighthouse – A podcast by the Australian detailing the strange disappearance of 18-year-old Theo Hayez in Bryon Bay, a young backpacker from Brussels.

True Crime conversations – A podcast by Mamamia that explores some of the world’s most notorious crimes, each episode details a different crime by talking to those who know the most about them.

Caliphate – An award-winning podcast by Rukmini Callimachi from the New York Times and her quest to understand ISIS, she speaks to former members of the jihadi to get an insider view of the world of ISIS.

Other

Shameless – A pop-culture podcast by Zara McDonald and Michelle Andrews with episodes released twice a week, Mondays are a wrap of the top pop-culture and celebrity news and Thursdays are an interview with an influential person.

Love Etc. – A podcast by Bumble delving deep into all things love, including dating with an STI, cheating and emotional abuse.

Gertie’s Law – This podcast by the Supreme Court of Victoria is a must listen for anyone who feels they need to scratch up on their knowledge of the legal system. It takes listeners inside Victoria’s Supreme Court and explains the daily workings of the court and we hear from judges about why they make the decisions they do. Episodes cover many topics from sentencing, mental health, juries and the criminal trial process.

The Joe Rogan Experience – A podcast by comedian Joe Rogan where he interviews a wide range of guests. A must listen is episode 1109 with Matthew Walker, The Science of Sleep.

 

By Anna Shalit 

It’s getting close to midnight, and you’ve spun deep down the rabbit hole of conspiracy theory videos on YouTube. Eyelids heavy, a yawn escapes, and with it the panic sets in – you’ve done none of the seven hours of cardiology revision you promised yourself you would do tonight, and you didn’t see your friends either because you told them you needed to study. The tight grip of anxiety wraps around your gut and the pressure starts to build from within. You take deep breaths and think back to the advice from that self-help podcast you were obsessed with in first year – don’t stress. The answer is simple. Inhale. Exhale. Practice self-care.

If we look anywhere in the media, self-care appears simple. It’s a bar of chocolate and a bubble bath. A new outfit or a pair of shoes. A “thing” which simply by its possession will ease our anxieties and lull us into a state of manageable calm… Or maybe it’s yoga? I saw that fitness model eating an acai bowl on Instagram and she said she just thinks calm thoughts and all her problems go away…

Particularly as medical students, we feel the weight of high expectations and many of us struggle with perfectionism. Our type A personalities allow us to believe that we are not only capable of doing everything and doing it perfectly, but that we have a responsibility and an obligation to. Motivated by guilt and fear of failure, our superhero complexes are weaponised against us when we inevitably burn out, becoming another form of self-flagellation.

On one hand, we are told that no one is to blame for mental health issues and for burnout – that we shouldn’t feel guilty about anxiety. And yet we are also told that the answer to our issues is self-care, and that our problems can usually be fixed by our own means with the right mindset. So how can the responsibility be ours without the blame? When self-care is not enough, if we can’t do it on our own, how will we not just feel that we’ve failed again?

If anxiety manifests itself as a form of pathological self-obsession, then will introspection really fix the root cause of the issue?

Self-care becomes another box for our list-minded brains to check off from our daily tasks. Instead of easing our perfectionism, we aim to perfect self-care itself. Except that the thin young white heterosexual female poster child of wellness is not exactly an attainable image for most of us and so we fail once again.

Who really benefits from this vision of self-care that we are being sold? Is it us, who carry the burden of our personal issues as well as the responsibility to fix them? Or is it the people who can sell us the answer – the people who benefit from our compliance to systems which exploit us? By asking us to focus in on ourselves, neoliberalism has successfully stifled any resistance against the systemic issues that are making us anxious in the first place. The expectations that are perpetuated by a society obsessed with self-image and perfection, a labour of gender, race and wealth.

Why do we need self-care in the first place? Because we are flawed humans and not supernatural beings. Because expectations are high, and our hopes are even higher. Because we are left on our own, pitted against each other in our hyper-individualised society, having lost the collective mindset that our grandparents believed might change the world.

There is an uncomfortable truth we must face – that if self-care aims to fix all our problems, then it is destined to fail. Losing the superhero complex is about more than accepting imperfection. It’s about letting go of the self-improvement obsession completely and replacing it with community building, support and engagement. Finding balance in our lives has to be about more than suffering through hours of study to be rewarded with ice-cream. It has to be about remembering why we do the things we do and caring for ourselves and each other all the time, not just resorting to consumption in times of panic.

Professional help, or even support from friends and family, is treated as secondary to fixing all our problems ourselves with mindfulness and self-love. We risk making people think that they are not struggling enough to justify reaching out, that services are only there for crises, that friends only need to be called in the middle of the night. But we should be encouraging people to seek help far before they reach that level of need.

What if we followed our own medical advice, and looked to the source of the problem, an upstream approach? Helping each other as opposed to trying to fix ourselves both teaches us that we are not alone, and that by putting our care out into the community, we will get it back. If our self-care is turning outwards we might end up not needing self-care at all. Not only because of the collective support, but because we can change the societal norms and pressures which cause so many of our anxieties in the first place

Self-care is important, don’t get me wrong. But it has to be redefined in a way which rejects this hyper-individualised approach. What if instead of individual self-care, we practised caring for ourselves as a collective?