Tips for Wellbeing: Global Pandemic Edition

By Molly Maxwell

When I entered Year A, I knew that the hardest challenges I would face would be those that I had not considered. A global pandemic was definitely not something I had prepared for. As today is my first day of online schooling, I feel there is no better time to share some ways we can adapt to our new version of normal and get out the other side to help all of the medical staff who are fighting for us today.

 How to: Pandemic University

  1. Most important (for all aspects of life) is routine. Establishing a routine of “normal” study hours is essential to allow us to maintain our sanity whilst in isolation. This includes actually getting out of bed and getting dressed which can be challenging when you don’t have to.
  2. Make an online study group. Thanks to the wonders of the internet, this is not so hard for us through Zoom, Facetime, or the Forest app. It’s a great way to keep yourself accountable and maintain some socialisation.
  3. Be adaptable. Online learning is not the greatest way for us to learn to be doctors but that doesn’t mean that it can’t be a good way. Accept our new challenges for what they are and use this time to build resilience and adaptability which is essential for our future.

How to: Outbreak Wellbeing

  1. Remember to exercise. With gyms closing around the country, it’s important to still maintain an exercise regime at home. A plethora of online at home workouts exist for free on the internet so you can look after your body whilst in isolation.
  2. Go outside. With social distancing and isolation our reality, remember to still go outside. If you’re lucky enough to have a backyard or balcony, use it. A bit of vitamin D and fresh air can do wonders for our wellbeing in trying times.
  3. Social distancing doesn’t mean distancing socially. Whilst we can’t go and hang out at the pub or with all our friends for the time being it is important that you still make an effort to communicate. This golden age of technology means that remote communication is as easy as ever so find new ways to hang out whether it be a niche PowerPoint night broadcast over zoom or daily phone calls with people you love.

How to: Nurture your mental health

  1. Acknowledge your feelings. This is a scary time for everyone. It is okay to feel frightened or stressed or defeated, but you are not alone. Let yourself be not okay. Remember that this is a temporary situation and that you will not have to feel this way forever.
  2. Reach out. If you are struggling to manage your mental health during this crisis, seek help. If you are already seeing a mental health practitioner, many offer telehealth to attend your appointments from home. There are also many online resources from Beyond Blue and Lifeline that can give you handy tips including this forum to speak with people who are in the same boat as you.
  3. Self- care. Now is a perfect time to incorporate self-care into your daily routine and make looking after yourself a priority. This can be anything from taking a relaxing bath to getting ready for the day. Make sure to prioritise making yourself feel good (easier said than done). We all deserve to go a bit easier on ourselves right now.

Hopefully some of this was helpful to you. If all else fails, download Tik Tok and go on a deep dive. This whole pandemic thing should be over by the time you get out. Wash your hands and be kind to people!

Musings of a Worn-Out Med Student

By Rav Sellahewa 

You’re too harsh on yourself. You have always been your sharpest

critic. You have a strong and over-powering superego, a voice in the

back of your head- that tells you off. You hear it whenever you don’t

study, whenever you don’t gym. It tells you off when you want to

relax. It represents an idealized self-image of yourself. An image

that you no longer have the tenacity to maintain. You have spent too

many years of your life trying to appease it. Too many years fighting

off the urge to laze around and watch Netflix. You’ve finished 4 years

of medical school, a BMedSc(hons), and are nearly done with your first

5th year rotation and you are tired. You’ve earnt a break. You need a

break. Tell your super-ego to go get f****d. It’s time to give in to

your impulses and desires- and let your Id shine. It’s time to watch

that god-awful reality dating show on Netflix and enjoy it, because

you deserve it.”

 

Fifty-Four Years Ago

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

The Adventures of Pen

By Rav Gaddam

There are many things that bind the medical student community together; our love of stealing food, the ability to still be bamboozled by an ECG, and of course, our innate skill to lose pens at a rate that Ebola has got nothing on.

But have you ever truly wondered what happens to a pen? Where does it go? What adventures does it have? Ever wonder about the people and things it sees?

Well, if you’re reading this article, you can guess that I have.

My pen’s journey began last year, when I lent it to my consultant who snapped their fingers at me and gestured to my pen as they were on the phone. “Do you also have some paper?” I was also asked, while begrudgingly handing over my favourite black pen.

I was unfortunately called away by a registrar, lured away with the promise of being able to cannulate the next patient. As you can expect, I never did get that pen back, and I assumed it had been lost in the depths of the pen blackhole that is a hospital.

At the same time though, I also imagined that my pen saw many exciting things in its life. It would likely have been used to draw up a drug chart to save a patient from a DVT, or sign path forms for a renal patient on dialysis. It could have been used to write down obs on a glove in ED, or provided comfort to that paeds patient who had left their mark on the hospital (likely on the walls, possibly on the bed covers). It could have also vacationed in world of hospital administration, and heard all the juicy gossip about the number of beds that were not available that week. Who knows what the pen could have done; the possibilities are endless!

Well, in some exciting, awe-striking news, I found the pen.

Nearly a year later, as I rocked up to the first day of my new rotation, I found “pen”, as I affectionately now call it, sitting innocuously in a surgical theatre. “It couldn’t be,” I thought to myself. “After all this time?”

Now, I can imagine some of you scoffing at this story, and some perhaps even accusing me of stealing a pen that perhaps did not even belong to me anymore, for it now belonged to the hospital. Pish-posh, I say. This event was a reunion that would have put The Notebook to shame, and made you weep like the time Mufasa died (it’s been 24 years, and I still cry. Every. Single. Time.)

It would have been a reunion story for the ages, a tale so splendid that David Attenborough would have wanted to make a documentary about it.

That is until the consultant snapped their fingers, and off my pen went on an adventure again.


Featured image from user FP Network on The Fountain Pen Network

Dating Medicine

By Ning Yih Kam

My relationship with Medicine has been a tumultuous one. It is very much like I’m dating medicine…

My love for Medicine started with an infatuation – a crush, as some might say. I was attracted to the prospects Medicine offered me. ‘He’ appeared reliable, strong, caring and sometimes even mesmerising. But that is all I know about Medicine. I was attracted to the security he provided me with, the respect everyone seemed to have for him, and his seemingly endless intellect. But that’s not why Medicine was attracted to me. He seemed to respect my diligence, my willingness to make sacrifices for the things I wanted. He appreciated the fact that I could hold my own against him.

Then Medicine asked me out. I vividly remember the day he did so – it was nearly 3 years ago now. Even the fact that he bothered to ask me out seemed like such an honour – people were practically throwing themselves at him – and here I was, a plain Jane, that Medicine asked out. I was elated to say the least. On our first date, he woke me up at 8am in the morning, with a call – telling me not to worry, the first few months of a relationship he said, were always the best – the Honeymoon period, or so he called it. And he was right, Medicine for those months, never ceased to be charming, provocative and ultimately seductive. He could’ve seduced those who were at first, totally uninterested in him, and put off by his demanding attitude. I did not just want to be with him, I wanted to be him.

And then we celebrated our first anniversary. The first of many, I would’ve hoped. He gave me a utilitarian, digital watch and says, ‘I don’t want you to miss any of our appointments – they’re all important’. I was so pleased at the gift – I hadn’t expected any, but at the same time, I was profoundly confused – surely, we will have some time outside of each other?

It was by third year that the cracks in our relationship started to appear. At first, the thought of spending all my time with him had made me so happy, but all of a sudden, as I watched my friends enjoy their social lives, I realised how restrictive our relationship had become. And that wasn’t all. There were stories. People who had dated him before told me to beware of the initial allure, of his initial charms. ‘He doesn’t work out for everyone, you know’, said a friend.

Third year, the relationship had become a chore. He wanted more and more. He was insatiable. My time, my intellect, my life: everything was not enough for him. Nothing was ever enough. Maybe our shabby foundation had started to rattle us. We decided, or rather, I decided, that I needed time away from him – time to do what I loved to do, without him intruding. I just didn’t feel like me anymore – I felt like my life was overrun with assignments, OSCEs, hospital placements and more.

During our time away from each other, I realised how shallow my reasons were for dating Medicine. What had attracted me to Medicine? Was it the unattainability? Was it the glamour? Was it the constant challenge? Was it the allure of making a difference? Perhaps it had been the strange amalgamation of all of the above.

As I contemplated my return to Medicine, I knew I would have to confront all I had learnt in the past 3 years. The reasons that had drawn me to Medicine initially, now appeared feeble – or even slightly repulsive. A return to Medicine would require stronger foundations. I needed to be able to justify the long hours, the years of less than desirable working conditions, the intellectual rigour and the physical exhaustion.

At the end of my deliberation, I decided to return to Medicine. In my cynical moments, I thought I was returning to him because I had nowhere to go. In my moments of positivity, I felt I was returning because of a faith that things would work out between us. But ultimately, the appeal of either of these extremes never lasted. I didn’t want to return to Medicine cynical or hopeful. What I did want to do however, was to return to Medicine not in a way that consumed me; but in a way that allowed me to retain who I was.

This is why we couldn’t date anymore. I look at Medicine now, as an equal. I’m not exhilarated by his presence, and I am no longer ignorant to his flaws. I want Medicine to be part of my life, not my whole life.


Featured image from Four Seasons Hotels and Resorts

 

Nick’s Healthy Bolognese Sauce

By Nicholas Wilkes 

With many of us off placements or back home and learning from online lectures, now is a good time to try some new healthy recipes when you need a break from studying. This week, I’d recommend trying this healthy Bolognese sauce recipe that I shamelessly stole from my mom. It’s a great meal prep item as you can easily scale up the size of batch to match your needs, and as most of the ingredients are optional, can still be readily made with the limited supplies on the supermarket shelves!

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COVID-19: The Debate Going Viral

By Anna Shalit

It was three weeks ago, the first day of my week of clinics on my paediatric rotation and I was assigned to the rheumatology clinic. I’d spoken to my family over the weekend and decided that since my placement was still going ahead, I wouldn’t be seeing them for a while, as I did not want to risk making them sick. Most of the children in rheum clinic were immunosuppressed and I had spent the train ride to hospital pondering how I would feel if I inadvertently gave one of them coronavirus. When the consultant at the clinic politely asked us if we minded just going to the library instead, I was almost relieved. The fear had set in and I had stopped feeling like a medical student and started feeling like a vector. Two days later the hospital asked students to stop coming in. 

Most of us chose medicine because, in some way or another, we wanted to help people. So being stuck at home in a crisis, completely powerless and unable to help, is frustrating to say the least. On clinical placement we can feel useless at the best of times. We’re constantly asking for things from people, whether it be asking the nurse where to find the cannulas, asking the doctor why they’ve prescribed one drug over another or asking the patient for their time and consent, we rarely get to genuinely give back. And yet placement is the best way for us to be able to give back in the future. If we can’t go to placement, will it impact our ability to be good doctors? In the long term, of course not. But the idea of being an intern with almost one year of clinical experience missing? That’s something to keep me up at night. 

I’ve gone back and forth so many times about what our role as medical students should be during this coronavirus pandemic. I don’t want to back down from a challenge, and I recognise that in lots of ways, being on placement in a time like this could be invaluable in the future. I’m also not worried about becoming sick myself – I’m young and healthy and I’ve got a far better chance of recovery than many of the doctors on the front lines. Besides, most of our placements would allow for us to avoid having contact with any cases. This is the reality of medicine – how can we simply put this massive part of our lives on hold and wait for it to end? What about when we’re the doctors during the next pandemic?

However, we can’t deny that we pose a risk to the hospital population. Young people are likely to be silent carriers of COVID-19. We could be the fistula allowing the virus to leak from the supermarket shelves into the wards. The potential to bring harm is not only terrifying, but unfortunately, very real. And as selfless as we like to think we all are, it is important to consider that there may be a significant risk to us too. 10% of the people in Australia with coronavirus currently are healthcare workers. This isn’t a risk to be taken lightly. Not to mention, while I’m privileged to be physically healthy, not all medical students are, and it would be completely irresponsible to insist they continue their placements at a time like this. 

So placements have been put on hold for now, but what about the all mighty “surge workforce” that the media is in a frenzy about? Those of us who have the ability to help are more than happy to step up. Most senior medical students could genuinely be of service to doctors if they were called upon. Sure, we can’t exactly manage complex patients on our own, but we can type notes, call the path lab, and (with shaky hands) do cannulas. Be it taking temperatures in fever clinic or writing discharge summaries for a strung-out resident, we will step up if that’s what doctors want. 

The reality is, however, that they must want us there, or we will be helping no one at all. In the meantime we’re trying to help in any way we can, setting up volunteer organisations to call isolated people, offering to babysit for healthcare workers and most importantly, staying home.

 If (and when) medical students are asked to step up and help, we will be waiting, and we will be ready. We might even be prepared. But until then, for me at least, it feels like the best way to help is to do nothing at all. 

 

 

Finding Light in the Darkness

By Monique Conibear

On a camping trip a few months ago, we had to drive over a 4WD track in 2WD cars after dark to find another site after our original campsite fell through. We were all tired and stressed, driving over sharp rocks and getting scratches all over the sides of the car. At the time it was horrible, however afterwards, I realised that through experiencing something like that we were now better equipped to deal with challenges in the future.

I still find it crazy to think that this time two months ago we had no idea this was all going to happen. We were going ahead as normal, planning out our semester and looking forward to events with no idea what was ahead of us. As usual, I was setting goals for the semester; trying to predict what sort of schedule I would have so that I could organise going to the gym more, using social media less and minimizing screen time. Goals such as this have become impossible, but instead I am growing in ways I never would have imagined.

Already I have learned a lot about dealing with uncertainty. You are never going to know exactly what your future will look like and that is okay. I don’t know whether the state will be going into lockdown tomorrow, whether I will start to develop viral symptoms or if someone I know will get sick. Usually that would make me stressed and anxious, however through this experience I have really learnt how to give it to God. I’ve learnt to acknowledge that he is in control and that I do not have to worry about what is happening. This has really helped me to remain positive and hopeful so that whenever I receive bad news I am able to remain peaceful and confident that we will all get through.

I have also learnt a lot about leadership through this time. In all of my committees we have had to brainstorm new and innovative ways to reach out to people, such as through Zoom calls, self-care videos and posts (such as this one). We have become better at thinking outside of the box, so that when everything goes back to normal we will still be able to implement some of these strategies to reach the students.

Finally, this experience is an opportunity to build resilience. Later on during that same camping trip, a friend and I found ourselves stranded at a random campsite (that needed to be booked) at 11pm with no service and no other place to stay. While our other friends went to try and book online, we were stuck there wondering whether we would need to drive another hour before we could actually get some sleep. Personally, I found that hard to deal with and if I hadn’t experienced other challenges in the past, I may not have been able to handle the stress.

This isolation experience is very similar. During this time it feels horrible and stressful and lonely. When we look back in a year or two, however, we will be able to say that it prepared us for future challenges in a way we never expected.

The Ward Rounds Stitch-up

By Lorin McIntosh 

Still jet-lagged from my summer trip, I woke up at 7:30, instead of 6:30am. After a frantic morning routine, I make it to the hospital with ten minutes to spare. I have left my phone at home, had no breakfast or coffee, but I am determined to make it the best day.

 

As I walked through the white washed halls, a feeling of fear mixed with excitement sweeps through my veins. It is my first day of medical internship. I have been placed at Eastern Health, my top choice from my clinical years, and am beyond stoked to start my first day as a real doctor. After I arrive at my ward, I introduce myself to the team and begin to print off the lists. Just as I am finished stapling the lists (perfectly in the top left hand corner as my consultant has requested), another intern arrives. I do not remember seeing a fellow intern on the roster, but I am beyond excited when I realise that it is one of my medical school friends. We begin the ward round, just as the third-year medical students arrive.

 

Patient 1: Abdominal pain

As we begin to see the first patient, my consultant decides to ask me the anatomical landmark of the duodenojejunal junction. In a moment of fear and sheer panic, I do not remember my preclinical anatomical landmarks, and take a guess. The third year medical student then answers “the ligament of Treitz”. He then asks me to perform the DRE on the ward round, a sinister form of punishment for my incorrect answer.

 

Patient 2: Chest pain

As I am still trying to finish my note from the previous patient, we then see a patient presenting with central chest pain, radiating to the jaw and right shoulder, lasting for 20 minutes. The other intern orders troponins and I begin the process to take blood. As I am about to take the bloods, a clinical nurse educator walks into the doorway with a clipboard. I take the literal best bloods of my life and am beyond proud of my venepuncture win. The lady with the clipboard then announces that she is doing a hand wash audit for the hospital, and I have forgotten to wash my hands before putting on my blue nitrile gloves.

 

Patient 3: New onset neurological symptoms

My consultant is busy teaching the third year medical students about STEMIs versus NSTEMIs, and I decide to drag my computer to the next patient. As I am setting up outside the patient room. I notice that the patient looks a bit unwell. She has the classic facial droop and just appears a bit drowsy. I decide to go in and examine her, as my consultant is immersed in his tutorial. I note that she has a left sided facial droop, left sided arm weakness, and slurred speech. I run to my consultant and inform him that we need to call a “Code Stroke”. We call the code; the stroke team comes; there are literally like 20 people in this woman’s room. That is when the neurology registrar recognises the patient. I failed to check her medical history to see that she had suffered a stroke several weeks ago. Her current neurological issues reside around carpal tunnel syndrome in her right hand.

 

We see 12 more patients, and the rest goes fairly smoothly. In an attempt to redeem my atrocious ward round, I decide to attempt the Allied Health handover. My handover goes absolutely amazing, and I am beside myself. My consultant takes the team to coffee, and we celebrate our first day as a team.

 

After a glorious coffee, I spot one of my old registrars from when I was a fifth year medical student. We chat, and I tell him about all of the mistakes I made on the ward round. He laughs and we reminisce on his days as an intern, and he tells me that he knows an intern who had a worse day. He then tells me that his floor had an intern that did not even show up on her first day. I laugh and make a joke about how my floor had two interns. As he leaves, I internally panic and bee-line it back to the ward to check the roster. That is when I realise that I went to ward 7.2, not ward 7.1. It was me. I was the intern that did not show up on my first day.

 

Disclaimer: This is piece of creative writing and does not reflect the author’s beliefs about their own experience.  

The First Sip of Coffee

As I sit in this coffee shop beginning to write my article, the world continues to rush around me. Exhausted students with deep bags under their eyes thrust their keep cup over the counter as they order a triple shot. Businesspeople in elegant suits plaster a smile onto their faces as they sit down for their third meeting of the day. The waitress, who is already two hours into her shift, tries to ignore the pounding at her head as she glances back at the clock.

Week 9 has hit, and with it a tsunami of exhaustion.

In the past few weeks I have noticed that every time I ask someone how they are going I get roughly the same answers. Busy, tired and ready for a break. Everyone I talk to is grasping on by a thread for the break so that they can finally have a bit of rest. Maybe we will actually catch up on sleep. Maybe we will catch up with friends. Maybe, just maybe we will even catch up on the lectures. I don’t know about you, but I always feel like I am falling into the trap of looking forward. Dreaming so much of the mid sem break that I want week 9 to pass in the blink of an eye. Dreaming so much of the summer break that I want the rest of semester to just shoot past. And then, when it is over, I look back and wonder how it passed so quickly. Disappointed that my first year is over and I will never be able to get it back.

Why didn’t I appreciate it while it was there? When I hit the snooze button 3 times and crawled out of bed, did I appreciate that I woke up this morning? Did I appreciate that I was able to get out of bed on my own without the help of a nurse or walking frame? Did I appreciate that I had family or friends that I could contact at the click of a button? Probably not. I was likely so distracted by how tired I was that I forgot to acknowledge these things. Taking for granted what others would consider a luxury.

Is it the same for you? Do you ever find yourself wishing time away? Not really appreciating the days you have and the experiences that you are going through? I’m sure we all do it sometimes, especially as the semester comes to a close. So distracted by the hustle that we forget to just be present and enjoy it.

What can you do today that will help make you more present and appreciative of what is happening?

For me this can look like a few things:

  • Praying
  • Thinking about what I am grateful for
  • Turning my phone off
  • Keeping a journal
  • Making a cooked breakfast
  • Reading my bible
  • Going for a run or a walk without my phone
  • Mediation
  • Yoga
  • Study or read in a coffee shop
  • Taking the time to really appreciate my cup of coffee in silence

This list is definitely not extensive, but it is a start. A lot of the time they can even be paired. I have noticed that thinking about what I am grateful for can have the biggest impact and so while I have that cup of coffee, I thank God for specific things. How the lecture last week made more sense than usual. How my little sister calls me when she needs some advice. How my friend trusted me enough to confide in me.

Writing my journal is very similar, it just helps to get it on paper. To cement it a bit more, and to give me something to read back on when everything is falling apart. In fact, all of them are probably quite similar. They are just about stopping, being present, being grateful. It just takes 10 minutes but it makes a huge difference throughout the day.

The challenge I set myself is to make this a habit. To take 10 minutes every morning, every day to just enjoy that first sip of coffee.

Will you join me?

 

The Arena

By Michelle Xin 

Over 150,000 faces join me each day – yet another member of the infinite audience spectating the arena; my arena.

I watch and I wait, for I am always surprised by those who enter my realm, and I will never know who might be next.

There have been moments in time where I have speculated and predicted. Even moments where I have hedged my bets, because it was clear that this next individual inflicted with the plague will soon succumb, as did their predecessors. When they arrive here, they are lost and aghast. They fight and they rebel, for this was not the outcome that they deserved, nor the fate which their beliefs promised. They ask me for more years, for more cures to the maladies of their time, for another chance in another world. Their presence in the audience is begrudging and initially disruptive, but they take their seats eventually when time wears away at their mortal fire within.

However, in the recent years, I have hesitated to extend my foresight into the living as the care in which the mortals have now devised add sand to their depleting hourglasses. Their medicines and machines have stretched the boundaries of time and have challenged nature’s course and equilibrium. There have been many who I have expected sooner, and yet they continue to occupy their thrones of dialysis chairs with defiance and calm etched into their faces. There are endings which I have not yet witnessed because instead, I have witnessed the life jackets of tablets and transfusions and operations assisting individuals to remain afloat.

In centuries past, I longed for the stories of mortals; their earnest spontaneity inspired me, their unbridled suffering intrigued me, and each youthful emergence into my arena invigorated me – for their arrival in my arena allowed me to hear of their tales and their memories, both freshly made and freshly severed. When the floods of individuals crowded my realm during the eras of living brutality, I sought out the faces with age written on them and found too few. Their stories were bloodied, undeserved and chilling. I could not wish for those vivid recollections, despite how heartless the mortals may perceive me to be.

Even today, there are those with many projected years who have their hourglasses tragically and prematurely broken. Their faces should not be in the audience, although the mortal world is fickle and chaotic, and chaos brews unpredictability and sorrow in its darkest moments.

Now instead, I wish for time. For more sand to be poured into their hourglasses. For their living reality to last, because only time will prepare them for the finite.

There are fewer individuals who are lost and aghast when they arrive here. Instead, I am the one who is lost in the gratitude and peace I am confronted by. The mortals’ medicines and machines have taught them what I have seen but have yet to experience – that life is a fragile creature, but nonetheless worth nurturing and treasuring. That there is strength in belief, in humanity, in the comforting reassurance of words and arms. That encountering the end can be hopeful and uplifting, as all that has preceded it is a chance worth taking and living for.

The only request that I dare to issue is for these medicines and machines to persist and to evolve and to expand, in order to afford as many individuals with this chance to live before they discover my arena. Even though these medicines and machines are fighting me, I am sorry that I must win in the end. Know that the victories gained when the extra grains of sand find their way back into mortals’ hourglasses is worth the fight, the celebration and the memory, even if it fades into the mind’s recesses one day soon.

 

It is your victory to possess the treasured time of mortality. It is my loss that I, Death, must take that away.

 

 

Old organs

By Elizabeth Xu Yanning 

 

My first memory of a physician was that of my father, called in the middle of the day to certify a death. He operated a small general practice clinic at the bottom of an apartment block and I was working at his reception during my holidays. Although almost a decade ago by now, I clearly remember following his kyphotic back, confidently maneuvering through the labyrinth of housing developments with his battered black leather call bag.

 

We emerged from the clunky elevator to a sea of footwear surrounding the door of the apartment. A large party greeted us with warmth and snacks, almost like the Lunar New Year with a grim purpose. He lay waxen and emancipated, mouth agape in his bed, surrounded by three generations of offspring. I stood to the side dumbly, just outside the bubble of grief around the bed as my father did the necessary flicks, pulls and swings. Paperwork completed and family members briefed, we left.

 

Truth be told, this encounter only came to mind during my final year of medical school, in my Aged Care rotation in the sleepy foothills of the Melbourne suburbs. There I met 99-year-old Margaret*, resiliently drowning from the fluid in her lungs from her worn out heart. 86-year-old Jörg* who had had a fall, but grew a dangerous bacteria in his blood just before returning home. 75-year-old Lynn*, who was brought in vomiting faecal matter from a tumour mushrooming into her bowel lumen.

 

The solution to their problems could have been straightforward: diuretics, antibiotics, and naso-gastric tube or surgery respectively. However, none of these medical interventions were performed. Instead, in a direct violation to my medical schooled desire to treat, the team and their families opted for comfort care and let them slip slowly off into the night by death or to the Palliative Care unit.

 

There was no saving of lives, no normalization of vitals, no utilization of national standard management pathways. Was this still medicine as I’ve come to learn? The frantic MET call and tubing and masks and mess, often preserving life beyond the misfortune, yet equally often not.

 

At this point, I recalled my first encounter of patient care with my father. There was an absence of infusion lines and pills, but an abundance of counselling and comfort. This was the practice of medicine when medicine had failed.

 

All of us will encounter deaths of patients under our care and might wring our hands at our ineptitude. Before we lose hope, there exist three etymologies that offer insight to our profession.

 

Firstly, the Latin root word for doctor is “docere”, which means “to teach”. Long before the advent of miraculous anti-microbials, analgesia and anaesthetics, the physician’s primary role was to identify, understand and educate the patient on their malady. Their success as a doctor was not based on their ability to heal, but to communicate. Even as junior staff, we have basic medical knowledge that can make a tangible difference. We know the implications of treatment: its purpose, importance and pitfalls. Patients often don’t. Jörg’s bug turned out to be Staphylococcus Aureus, a nasty sticky thing that would have required 4-6 weeks of nauseating antibiotics through a long line in the arm. He refused treatment when we informed him of his options, with full capacity and family consent. For more collaborative and interpretive patient management, we require a shifting of perspective to understand what a patient does not see. It was and still is our core duty to provide good counsel, to aid patients in recognizing and accepting when they are dying. As the ancient Jewish text of Ecclesiastes says.

 

“There is a time for everything and a season for every activity under the heavens: a time to be born and a time to die.”

 

We might not have entered a medical career with this sole intention, but eventually all of us will have to guide a patient and their family in recognizing the approaching deadline.

 

Another derivative is for our patients, or “patiens”, which is Latin for “I am suffering”. Despite the age of remarkable scientific advancements that we live in, we need to recognise that there comes a point where fixing every problem in our patients becomes unfeasible and even inappropriate. Century-old Margaret in refractory pulmonary oedema had such a worn out heart that not even an artificial cardiac pump would have helped. Before her transfer out, the simple medicine she received included pain relief, dyspnea management and a steady supply of crosswords. Surely simple measures such as these are not any less important than cutting edge bioengineering, if the patient benefits. Medical science was made to help the patient, not for the patient to help medical science. The inability to heal is not our failure. This is echoed in Being Mortal, Dr Atul Gawande’s spectacular tribute to dying in the age of medical advancement.

 

“Medicine’s focus is narrow. Medical professionals concentrate on the repair of health, not sustenance of the soul. “

 

Palliative care changes this. It recognizes the value in treating the patient, not the disease.  The Latin root word “pallium” or “a cloak” reflects its nature, its practice a warm blanket to keep a patient comfortable, gently acknowledging their illness. This care is the responsibility of all doctors: to recognize the need for comfort early and to help patients die as well as possible. Lynn with a bowel obstruction passed on comfortably with the help of muscle relaxants and sedatives, bowels relaxed and quiescent, nausea abated.

 

However, medical science cannot provide all the information. To understand the price and the prize of medical treatment for the patient, we should understand the patient’s life; their values and their wishes. Medical treatments are only as valuable as how much they leave a patient able to have another precious moment to spend doing or being with what they love. Junior doctors often have the most time on the ward to explore this more deeply with patient and loved ones, passing onto the senior team members. We should never forget the simple power of simply knowing our patient.

 

As an intern, we will never make a palliative decision alone or purely on medical science. By understanding our patients’ pathology, pain and values, we may guide them to write their life’s epilogue. Let us not forget our own souls, for in our shared humanity, we provide genuinely compassionate care. As we grow in our humble role, we will mature into organizing Advanced Care Planning, leading family meetings and ultimately cessation of treatment. Like my simple old-schooled father liked to quote:

 

“Cure sometimes, treat often, comfort always.”

 

 

*Pseudonym to protect patient confidentiality

A ‘Band-aid’ Solution

As usual, it’s been a big day. As you’re sitting down to browse Netflix, a voice interrupts.

 

“Clean your room! Why haven’t you watched yesterday’s lectures yet? Check the mailbox”

“What’s the hurry?” you respond, “I’ll have the energy to do it later”

“Unpack your lunchbox!”

“But I could do it tomorrow morning as I get ready for class,” you counter.

“Have you put your clothes in the washing basket? The milk’s almost run out too.”

“Ssshhh – I’m trying to focus on Netflix! I don’t see any point doing my chores since they’ll all just pile up again anyway. Besides, I’m gonna die one day so why burden my years with mundane tasks – especially since the universe might be a simulation run by aliens and by the way what is the meaning of human existence?”

 

Okay. You’ve proven your point and convinced the opposing voice – your own better judgement – to let you leave your errands untended.

But somehow you don’t feel relaxed.

In fact, the room remains messy, the work not done, and you’ve been distracted by the dialogue in your mind. It becomes apparent you’re actually feeling uneasy not from your impending death and the world being a simulation but rather because of the strain of thinking about yet-to-be-done tasks – it’s as if you’re doing them, only you’re not; a band-aid approach.

 

The good news is, it doesn’t have to be this way. The solution: become a robot. A drone. A mechanised incognisant automaton. This way you can simply download software into your brain to get you to do your chores on autopilot – everything from making your bed in the morning to packing your bag for the next day or tidying your room.

 

If that’s too much for you, there’s always plan B – having a routine! This way you can still take the motivational mental debates out of the process in much the same (albeit a more human) way. By habitually ticking a few key things each day you can get a sense of achievement and clarity, and the tying-up of loose ends might help quell some of those late-night thoughts about all the things to do tomorrow. What’s more, moving through a routine can be fun (the only thing that tops singing in the shower is singing while washing dishes!) and an opportunity to practise mindfulness.

 

This isn’t to say be a perfectionist and follow a routine down to the word 365.25 days per year – a day off here and there can definitely be worthwhile in the long-run to help make it a smart goal. After all, generallybeing on top of a routine means that things are already in order and it’s okay to take a day off when needed.

 

The next day you’re arriving when home a familiar voice pops into your head:

“It might be a good day to go for a run,”

“Okay, let’s rip this off like a band-aid!”

 

15 minutes later you sit down, content with your efforts and fully relaxed.