ACCEPTANCE

BY Jessica Hinh

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

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

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

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

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

‘Thanks, Fiona. Come in, son.’

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

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

That had been his own spirit decades ago.

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

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

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

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

And yet, it wasn’t.

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

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

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

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

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

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

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

Things were different now.

He regarded the young man with poignance and kindness.

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

Are you OK?

BY TRACY NGUYEN

Are you OK?

Extensive research has shown the amazing impact of communication and its positive impacts on people’s mental state. Being genuinely listened to may be all one needs in his/her darkest day, and conversations can really save lives. This year national R U OK Day was on Thursday the 9th of September. I am sure we have all heard of, if not been very familiar with, this day every year, which is dedicated to be a reminder for all of us to have a conversation with someone we are worried about and offer support to people who are struggling with their life’s challenges.

However, to be able to look out for other people, it is very important to make sure that you are OK first. Before asking anyone that question, give a moment every day to check in with yourself:

  • Be an understanding, patient and kind listener to your own body and mind as how you would be to someone you care about who is going through hard times
  • Give yourself complements for keeping up until now through the tough days; tell yourself that it is fine to be unproductive, upset, frustrated and imperfect today.
  • Remember your presence alone is a blessing, and as long as you are still breathing, there will always be hope at the end of the tunnel, and tomorrow will definitely be a better day awaiting ahead.

In this pandemic with all the uncertainties and challenges, especially during multiple periods of lockdown when you may be physically separated from your loved ones or your normal sources of comfort, it is normal to feel lonely, as if there is only you left struggling all by yourselves in this world. But remember that you are not alone.

If no one has asked you R U OK today, let me be the one who asks. “R U OK? What’s been happening?”. Let me remind you that there’s always someone out there who have been thinking about you and want to hear your stories and know how they can help. Let me remind you that sometimes there are conversations that may be too hard for you to share with family and friends, and if you ever feel concerned about your own safety or the safety of other, please contact a professional as soon as you can. And let me remind all of you who are reading this, no matter how tough things may seem now, that I am confident that you WILL BE OK. Take care!

White Chocolate

BY ROBIN CHEAH

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

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

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

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

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

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

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

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

“What do you mean?”

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

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

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

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

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

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

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

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

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

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

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

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

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

How proud I was; how naïve I am. 

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

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