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

 

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.

Galaxia Ward 1102

2019 Auricle Writing Competition Second Prize

By Bill Wang

Prompt: Imagine you are fresh out of med school and it’s your first day as an intern. What will be the scariest/ wholesome/ funniest situation you encounter?

The floors were scrubbed clean, or as clean as anything could be in the wake of an explosive end to a jelly-based alien, the dangers of space peri-peri chicken for organisms without proper gas venting mechanisms it seemed. 

A few janitors were still standing in the corridor, waving vacuums across the last of the goopy green jelly that still plastered much of the windows and ceiling with a vengeance.  

‘Watch yer step’ one of them called out in broken Galactic Basic as Consta walked past. 

Consta shuddered, it was only his first day since graduating medical school from the prestigious Monash Space University and the stress of the ward round was already getting to him. He had trained to deal with problems humans had! How could they expect him to suddenly treat an Ethereal with end stage hocus-pocus space disease? 

Even worse was the resident that he was on call with. The man? Jelly? Amorphous blob? Had not spoken a word of galactic basic and only method of communication seemed to be increasingly agitated vibrating whenever Consta was making a mistake. 

He shook himself from that moment of self-pity, aware that the janitors had stopped their vacuuming to watch him stare into the literal empty void of space beyond the window. He wondered if he should say something – anything to reassure them that the newest intern in Galaxia had not already fallen insane – an event that appeared to befall over 78% of all new interns at the hospital. 

BOOP

The bleep strapped to his waist suddenly burst to life. 

‘BOOP! CONSTA TO WARD 1102’ 

He thumbed down to silence it and continued his brisk pace down the corridor, stepping cautiously around the green slime puddles. 

Ward 1102 sounded familiar in his mind, ‘did someone mention it during orientation?’ he mused.

Whatever the case, he did find it slightly concerning when holographic signs along the path to Ward 1102 started popping out. 

‘DANGER’ screamed one, providing an additional picture of an exclamation mark. 

‘INSTANTENOUS AND SLOW DEATH AHEAD,’ announced another. 

‘IT WILL BE SUNNY WITH LIGHT METEOR SHOWERS IN SPACE CLAYTON TODAY,’ came the next. 

‘hmm,’ Consta muttered. Had he forgotten to take his washing in today? Getting meteor impacts out of fabric was quite costly this far from the tailor star systems. Regardless, he was on call for another 36 hours so that would have to wait. 

Finally, he found himself outside the heavy airlock that sealed the entrance to Ward 1102. A set of 3 massive hydraulically sealed doors manufactured from indestructible-ium he would have to cycle each door one by one before he could even enter Ward 1102. 

As he stepped to the first door a robotic voice gave a coolly called out, ‘Attention, you are about to enter Ward 1102, containment unit for indescribable patients. Incidental death or insanity is not the responsibility of Galaxia Hospital.’ 

With that the hiss of pneumatic pumps de-pressuring the airlocks filled the corridor and as Consta began to walk forward the doors slid open and closed behind him with resounding thunks. Then he stood in the darkness. 

‘Over here,’ came a whispered voice from the darkness, ‘be very still and calm, they can sense fear.’ 

A splodge of goop landed beside Consta’s foot – he realised it was his resident. 

‘You can speak Galactic Basic,’ Consta shouted in amazement. 

‘Shush!’ came the panicked voice back, ‘if they hear us it will be over.’ 

Consta snorted. ‘This is all some elaborate rookie hazing prank isn’t it, the over the top warning messages, all the dramatic build up? I’ve read my share of horror novels; you guys aren’t going to get me.’ 

His resident swore quietly under it’s breath, ‘We don’t have time for this, here take this and for the love of whatever you believe in take me seriously – if it does turn out to be a prank you can shoot me with it.’

Consta felt a tendril drop something heavy into his hand, faintly he made out the outline of a plasma pistol. Now that was something that definitely wasn’t allowed inside a hospital. ‘Fine I’ll play along, what do you want me to do?’ 

‘Look one of the indescribable patients has escaped from their containment room, the ward staff have cut the power and vented the entire wing with paralysis gas. We need to secure the subject and return it to containment before they can turn the lights back on.’ 

‘That doesn’t sound like a job for doctors,’ remarked Consta. 

‘It’s because we are expendable, the space uni’s churn out medical students by the dime a dozen – hospitals can’t afford risking perfectly capable security guards on these trivial matters. Anyway, enough talk, we need to sweep this wing.’ 

And so, Consta began searching, stepping cautiously through the darkened wing – the faint glow of his plasma pistol guiding his steps across the ward. He suddenly realised he didn’t even know what he was looking for – what even was an indescribable patient? 

The scream suddenly split the silence – short and panicked before cutting out again. Consta immediately spun around and started sprinting towards its direction, skidding to a halt outside a consult room he realised was faintly illuminated by an emergency beacon that was independent of the main power supply. 

Hefting the pistol he slammed through the door and pointed it into the room. 

He saw his resident pointing a disintegration beam at someone else in the room – what was it? As Consta slowly made sense of the situation he realised the other figure was an exact copy of his resident – staring back at the first copy with a terrified look. 

The copy with the disintegration beam called out to Consta first, ‘quick! I have it cornered! It seems like the indescribable patient was hiding in this room and the light has restored its functions! On my count we need to shoot it together to bring it down, my beam alone can only hold it off!’ 

Almost immediately the other copy cut in, ‘Don’t listen to it! The indescribable patient’s gain the ability to steal memories and take the forms of those around them as their disease progresses! You need to shoot it now with your pistol to stun it!’ 

Consta swung his pistol wildly between them, realising that during both their pleas they had both inched forward towards him. ‘Get back!’ he yelled, ‘I may have taken the WHO oath to consecrate my life in the service of humanity but you two are definitely not human, so I won’t hesitate to shoot!’ 

The copy of his resident holding the beam weapon started bubbling, growing taller and twisting and turning as its outer layer slid off like a snake shedding skin. From inside his sister stood up. ‘Oh Consta, you wouldn’t shoot me, now would you? Now be a dear and shoot that indescribable patient before anything else has to happen.’ 

Consta swung the gun towards the thing masquerading as his sister and fired, splashing it with a bolt of sizzling plasma. Before it could even finish the unearthly echoing scream, he turned the gun again and fired on his resident. As he watched their forms burn away to reveal the twisting shadowy masses within Consta finally let out the breath he didn’t realise he was holding – his knuckles bone white from his grip on the pistol. 

‘Scan him.’ 

Consta jumped when the gravelly voice came from behind him. He swung around just in time to see the black visors of the hospital security team as they pointed a scanning device of sorts at him. 

‘He is clear, get him out of here.’ 

Two of the guards stepped forward and grabbed Consta by the arms, dragging him towards the exit. The rest stepped into the room and began firing, the whomps of plasma impacts accentuated by the further screams of the indescribable patient. Outside in the corridor his resident ran up, vibrating in agitation. It produced a set of pen and paper and began writing in broken galactic basic. 

‘Sorry, shouldn’t have sent you in there alone. Didn’t know it was unsafe. Assumed it was a simple task to locate and return patient to bed. Go home and rest.’ 

Consta could only nod. 

‘Thankfully you realised I can’t actually speak,’ called out his resident as Consta walked out into the bustling world beyond the warded gates of Hospital Galaxia. 

 

 

 

 

____________________________________________

Photo Credits to Josef Barton

https://wallpapershome.com/best-photos/?author=1274

When the weather changes

2019 Auricle Writing Competition First Prize

By Gizem Hasimoglu

Prompt: “How have your ideas and notions about being a doctor changed since starting medical school or entering clinical years?” 

 

When the weather changes, so do you.

The shaking off of leaves and the layering of dew,

The scorch marks of past fires and the blossoms of something new,

Medicine is like the weather – when it changes, so do you.

 

***

 Spring

 

Wide eyed, well dressed

Nervous butterflies fill the room

It’s your first day, no need to be stressed

‘Student doctor’ is your costume

 

Years of study have bought you here

Yet suddenly they seem so far

You have no idea what is to fear

You think you’ve passed the bar

 

It’s a new page, a fresh start

You take a deep breath and open the door

Excitement fills your heart

Looking around, you can’t wait to explore

 

Flashing lights, buzzing sounds

All the doctors seem to be saving lives

Magical seem the hospital grounds

You can’t wait to help someone survive

 

Summer

 

Wide smile, stethoscope around your neck

It’s a few weeks in and you’ve got the flow

You think you’re ready for a pay cheque

Yet you still can’t write notes, you’re way too slow

 

You know all the doctors by name

Although they don’t know you

You tell yourself you’re on the path to fame

And occasionally you get a free coffee too

 

Ward rounds and logbooks are becoming too easy

Although consultant questions still stop your breathing

At least you now know what to do when someone is wheezy

Perhaps maybe you should do some teaching

 

Patients think you’re important and first years idolise you

You can now hear murmurs, as long as they’re grade six

This is what it’s all for, you might finally help a few

Just stay away from hospital politics

 

Autumn

 

Tired eyes, looking defeated

Reality is slowly catching up to you

You’re feeling as if you’ve been cheated

You just can’t figure out by who

 

You reflect back on the start

Reminiscing about books with all the answers

As you stand here in front of endless patient charts

None of which seem to have curable cancers

 

The many lessons told about patients slowly fade

As they are replaced with the lessons taught by patients

The amount you know becomes outweighed

As the amount you don’t, begins to cause hesitation

 

The idealistic view of medicine you held so strongly

Starts to fade away like falling leaves

Slow at first but stripping you surely

As you feel the cold breeze you begin to grieve

 

Winter

 

Head low, shoulders down

The weight of the stethoscope begins to feel heavy

Patients look vulnerable in the hospital gown

And you no longer feel comfortable being so dressy

 

Only months left for ‘the brain tumour’ the doctors found

While ‘the murmur’ is struggling to breathe

You wonder what it will be like when it is the ground

Rather than the hospital sheets that they are beneath

 

When their families plead with their hopeful eyes

You no longer wish it was you they put their trust in

And when each of your sighs only amplifies their cries

Even a moments rest feels like sin

 

But this isn’t a hypothetical exam question

You realise there isn’t room for the unknown

When faced with a real life or death situation

The now empty patient beds make you feel alone

 

***

 

But do not despair for eventually Spring will return to you,

Summer, Autumn, and Winter too,

Life isn’t all about the daises, it’s about using what happens to renew,

That’s why medicine is like the weather – when it changes, so do you.

 

In the mood to dance?

Emily Feng-gu 

With calendars brimming with study, work, extra-curriculars, and social events, fitting in time for exercise can fall off the radar. Getting enough exercise shouldn’t feel like another burden on your time and mental space. For those of you for whom more traditional exercise activities, such as jogging or cycling, just don’t seem appealing, you might want to consider dancing. Associated with a range of physical and mental health benefits, dancing is a fantastic exercise option. Moreover, if going to a regular dance class is primarily for personal enjoyment, then it’s more likely to be a sustainable fitness regime.

Physical benefits

Even when undertaken at an amateur level, dancing is an effective way of improving fitness levels. Benefits differ depending on style, duration, and frequency of dance. In general, however, studies have shown that regular participation in dance can reduce the risk of developing several chronic diseases, including cardiovascular disease, diabetes, osteoporosis, back pain, and even neurodegenerative conditions such as Alzheimer’s Disease.

Furthermore, dance has beneficial effects on balance, co-ordination, and flexibility. Unlike some more traditional exercises which involve repetitive movements of a select few muscle groups, dance requires active concentration in co-ordinating and balancing complex movements and engages the whole body.

Mental benefits

Medicine offers a rewarding and meaningful vocation, but the path can be long and sometimes testing. Developing healthy coping mechanisms early is invaluable for maintaining wellbeing, happiness, and the right mindset to thrive as doctors. Regular participation in dance has been shown to improve mood, decrease feelings of anxiety and stress, and improve self-esteem and overall quality of life across a broad range of age groups.

Dance is also an opportunity to take a mental break and reconnect with the body. It’s a chance to tune out the planning, the ‘what ifs’, and the other million little things fighting for your attention, and genuinely appreciate what it feels like to live in a body. When going about our daily routines, our body runs on autopilot while our mind is elsewhere. Dancing prompts new movements and unfamiliar forms and makes it a little trickier to translate mental instructions into actions. This compels us to reappreciate the interconnected relationship between mind and body.

Finally, dance pays tribute to the body’s functional beauty. So much of the focus in media and pop culture is on what our bodies look like and how they might look ‘better’, but that entirely misses the point. Bodies aren’t for looking at, they’re for doing things. Dance can be wonderfully expressive and cathartic, a reminder that bodies are not passive objects but active forces able to change the space and world around us.

 

 

My experience

I used to think you had to be a certain type of person to be involved with dance, and it simply was not a mould I felt I fit into. It was only after being roped into a class by a friend that I realised my mistake.

The group present at my first dance class could only be described as eclectic. It included an effortlessly classy older couple who had been married for 40 years and had danced for 30 of them, two children who were too short to comfortably dance with anyone except each other, and everyone in between. Irrespective of age, size, or experience level, every person left smiling. I am the first to admit I had my initial reservations, but the experience was overwhelmingly warm and positive. Ultimately, it sparked an interest in dance I never imagined I would have.

The upshot

For anyone who is curious about starting or re-starting dance but feels intimidated, please take it from me – anyone can get involved. Round up some friends and sign up for a class, whether it be Zumba, salsa, swing, hip hop, ballroom, or anything else that takes your fancy. Alternatively, if dancing without any eyes on you is a more comfortable proposition, No Lights No Lycra dance events are held in the dark and have a fundamentally non-judgemental ethos. It may just be the one fun night out, but perhaps you’ll pick up a new way of staying happy and healthy.

 

The reality of imposter syndrome

“I’ll never be good enough”

“What am I doing here?”

“I don’t deserve this”

If any of these phrases sound familiar to you, you may be suffering from imposter syndrome. Imposter syndrome is a psychological phenomenon where you feel like you don’t deserve you own success. It’s that gnawing voice of self-doubt that only criticises and focuses on your flaws, or that fear of being outed as incompetent. It’s feeling like a fake or as though you don’t deserve your success, putting it down to good luck and timing instead.

 

If you relate to this self-doubt and fear of being revealed as a fraud, you’re not alone. Imposter syndrome is highly prevalent, with up to 70% of people experiencing at least one episode in their lifetime. In fact, I have a sneaking suspicion that it may be even higher in the high-achieving cohort of medical students and healthcare professionals where you’re surrounded by people who excel and the stakes are high. I’ve seen it in my friends, my peers, and it’s something I’ve often seen in myself. After my very first exam in medical school, I remember the fear of not belonging at medical school, of being revealed as some dumb high-schooler who had conned the interviewer into admission, despite the HD I had just recieved. Now at the end of my medical degree with internship fast approaching, these doubts still haunt me – I fear that I will be an incompetent intern, a deadweight dragging down my team.

 

Looking back over my years at medical school, I’ve now realised that this has been a massive source of stress, anxiety and low self-confidence, and I know that this will only get worse once internship and “real” responsibility starts. In addition, while imposter syndrome isn’t a diagnosable mental health condition, it can be linked to depression and anxiety. As such, what can we do to combat imposter syndrome?

 

How to overcome it?

Unfortunately there is no quick fix for imposter syndrome, but it can be overcome with ongoing, conscious effort. Some strategies I personally believe would be useful include

  • Gathering hard, objective evidence about your successes: write down a list of your achievements and skills. This isn’t bragging or tooting your own horn, it’s acknowledging that you are capable and deserving of your own accomplishments.
  • Talk with your peers in a safe environment: it can be really helpful to voice your thoughts – often you’ll find they share the same concerns, which helps normalise your feelings and lets you know you’re not alone

 

At the end of the day, remember: you are better than you think you are. You know more than you give yourself credit for. You have value. You are worthy. You are enough.

 

Keep Smiling

The warmth of the quilt enveloped me, as a blaring cacophony erupted in the background. It was 5:45am and unlike the four days prior it took everything to leave  my sheltered cacoon and step out into the world. Practically inhaling breakfast, it was another day I left my watch behind as I raced to make the bus. It was running late. Predictable.

Now doe eyed and eager, I brushed past the worried faces at the hospital elevator, racing up four flights. Can’t be late. Empathising with our COPD patients, I puffed into the empty doctors’ office. Drat. Why didn’t we start at the same time every day?

‘So what did the physiotherapist say?’, the registrar asked. Illegible, more illegible writing. It was already 2:30pm and we’d barely seen half the patients. ‘It’s just one of those days’ I told myself. ‘Just keep smiling’.

3pm. ‘Isn’t that your patient in Bed 5?’, the nurse yelled, as we finally sat down to lunch. It wasn’t my first MET call. It wouldn’t be my last. Plastering myself to the wall I watched the herds flocking to the scene like sheep. ‘Can’t breathe, can’t breathe,’ the patient gasped.  Only yesterday she had been telling me how upset she was her son hadn’t visited her in hospital yet. A moment I had cherished, congratulating myself for finally finding the time to truly get to know a patient. She remained surrounded. Lines, masks, leads.

‘Increase the oxygen, why isn’t there an alcohol swab here.’ With doctors and nurses engrossed in their individual roles the patient’s eyes moved to me. It took everything to muster my courage and give her a smile. We both knew, but neither said a word. Silence. Flat lines on the ECG. A life lost. My eyes darted over to the corner as her young son and his wife ran into the ward. A single tear trickled down his face. A missed oppurtunity.

 

Within moments I was rushing to grab a progress note as we moved to the next patient, the only remnant of our previous encounter being my quivering hand as I began to write. It was funny how I forced a smile.

‘Hey, hey, what’s wrong?’ I heard. It had only been a few hours; couldn’t I have smiled a little longer? How did they know? I felt angry. Why was I staring into space whilst the rest of the team continued to deftly craft intricate management plans for our complex patients?

My colleague stood me outside the room, as the team proceeded to see the next patient. ‘You have to learn to forgive yourself’ I heard her say ‘We all knew you knew her better than any of us.’ ‘It’s ok, you are allowed to feel this way’.

Maybe I had needed to hear that a few hours ago.

Maybe the smile wouldn’t have been so forced.

My hand may not have quivered.

We always expect ourselves to work at our best, despite the circumstances. We compare our responses and reactions to others, often more experienced. We feel guilty about taking our own time to process our emotions. Why? Maybe it is our internal drive, maybe we learn it from our environment and peers. But can we really bring the best care to our patients unless we are functioning at our best?

So…

 

Forgive yourself.

Take your time.

Realise.

You don’t always have to keep smiling.

The Meander

In February 2014, I was on top of the world. I just received my offer to study medicine. My life’s hard work had finally paid off. The rest would be a breeze; studying medicine is easy, a bit of memorizing, that’s all, and everyone gets a job at the end. My life was sorted! I became the model student, everyone’s goal, everyone’s dream.

I went into medicine full of joy and excitement, absolutely confident that I had more than what it took to ace this course. I was ready to live the dream, ready to become an excellent doctor…

I am still unsure when the turning point happened, when the dark hour of self-doubt began to settle in. It might have been sometimes before my first end of year exams, when I realised that I could simply not study enough to cover the scope of what could be tested.  It might have been outside the door of many OSCE stations, where I was paralysed by topics that I was not prepared for.

Or it might simply have been the daunting realization that I was not as dedicated, gifted and hardworking as I had thought…As I sit in front of my laptop, too tired to concentrate on studying after a day at placement, I think of my many fellow medical students who achieve higher grades than me, and who through their dedication to juggling uni with extra-curricular and research activities, also enjoy the benefits of having glowing CVs. As I struggled to answer my consultants’ questions, I resigned to the fact that I simply did not have the knowledge to impress doctors and build the social connections that everyone seem to value so highly.

Now, edging towards the end of my time at medical school, I have more questions than ever. Would I be able to cope with the demands of internship next year? How do I determine which one of those multitude of medical specialties suits me the most? Would I ever be good enough to overcome those increasingly difficult challenges that stand between junior doctors and training programs?

 

Through all my doubts and uncertainties however, there is one thing that I am confident about: I have had struggles and self-doubts through medical school, yet I have overcome them. My lists of achievements through medical school may not be less glowing as it was back in high school, but through each and one of them I have learned to strive to be a better version of myself, and these moments of personal growth would allow me to overcome the bigger challenges to come.

My achievements in school have given me confidence and pride, but I was so sheltered that I believed I no longer needed improvement. Medical school has allowed me to know that there is always something to aspire to and strive for, and that is a great feeling.

The journey as a medical student and doctor is long and meandering. Self-doubt and uncertainty are often intertwined with this path. If you ever find yourself feeling doubtful about your abilities, please remember that you have all accomplished so much to get to where you are today, and there is no reason why you wouldn’t continue to do so. Additionally, the greatest achievement is a journey, not an endpoint and I wish you all the best on this amazing journey.

The Wave

It always starts small – like a ripple – before slowly welling up inside. You know what’s coming next, so you brace yourself.

 They’re all just temporary feelings that will pass right?

The tachypnoea, chest pain, palpitations, vision changes, paraesthesia, depersonalization, flight of ideas, and that sense of impending doom. No amount of knowledge can prepare yourself for the wave that comes. It surges through every fibre in your body, filling every nook and cranny, relentlessly striking at every insecurity with more precision than a stressed medical student trying to cannulate a delirious dehydrated patient while trying to decide whether to call a code grey amidst a cacophony of beeping alarms. Its icy grip tightens round your chest, clinging to every breath as you struggle to maintain focus. Through ragged breaths you use every rational thought you can muster to counter your worries and overvalued ideas. And just when it seems you’re not going to make it, you do. You remember to breathe. The waters finally recede as you shut your eyes, inhale deeply and shake it off before ‘resetting’ and picking up where you left off.

 

Five years have passed in a flash and with the end of medical school in sight comes a barrage of different emotions: Joy, relief, sadness, dread. I would be lying if I said it was easy. “Peaks and troughs”, they said. Yet that one line cannot surmise all the obstacles one faced: Mental health issues, challenging colleagues and supervisors, social isolation, insomnia, 4-hour sleeps at night to study for the VIA, the list goes on. One that I found particularly troubling and persistent was anxiety. Here are some tips I found helpful.

 

Seek Help When You Can– You are never alone. Sometimes mates are good and all, but there are times when things can get too overwhelming. There are always avenues for help like Headspace and getting a mental health care plan from your GP. The student services at our clinical sites are also very understanding and always have our best interests at heart. Knowing when we are in over our head and seeking help is a good step in a positive direction. No matter how big or small your problems are, there is nothing wrong with saying you need help.

 

Take Time For Yourself– Never underestimate the power of taking some time to focus on you. Take a break from the books, get out there and take some time to relax. Exercise, treat yourself to brunch (not UberEats), hang out with your friends, visit a familiar haunt (or somewhere new). Remember to pace yourself and not burn out. So… Treat yo’self! J

 

Surround Yourself With Friends and Family – It’s easy to get caught up with work and rotations and lose contact with friends and family. Try and make it a point to spend some time with them. Grab a coffee, have brunch together, share your troubles, or just kick back and binge on Netflix. If not, drop them a call. Sometimes all we need is just for someone to talk to or laugh alongside with.

 

Mindfulness Works– We have all spent time savouring that tiny piece of chocolate, trying to focus on every taste bud as it slowly melted in our mouths – I wouldn’t know, I practically inhaled mine. A chocolate fondue fountain with strawberries would’ve worked better, but I digress. If you ever feel tense and unable to relax, meditation has been a great go-to for me. Taking a couple of minutes to regulate your breathing and doing a ‘body scan’ is a good way to reset and start over. If you’re like me, lacking imagination and would rather not type ‘relaxing music for stressed out medical students preparing for final year exams’ in YouTube search bars, then I would recommend the Smiling Mind app which is completely free and has several pre-set programs to select from (no, I do not have shares in the Developers’ company).

 

I hope these tips are useful for those who need it. Good luck for the rest of the year everyone!