Silver Linings

By Anonymous

Sometimes (more like all the time), I wonder whether I’m going to be a good doctor. I’m sure everyone in medical school has thought about this at some point. There’s the constant worry over whether you’re doing the right thing: do I know enough anatomy about the lower limb? How many procedures do I have to do to be excellent? Why isn’t my mindful eating of this chocolate bar working?!?!  But sometimes that question can be a bit blunt and you find yourself asking ‘What if I’m not enough?’.

In a spiralling whirlwind of self-doubt, I often find myself thinking of all the reasons I wouldn’t make a good doctor. Sure, these begin with things like ‘I’ve forgotten the entire brachial plexus’ or ‘shoot, I should probably have most of my logbook signed off by this time of year’; but at the end of the day, it always comes back to one thought. How can I be a good doctor when I’m also a patient?

I’ve struggled with mental health issues for the past 7 years, and the stress of medicine most definitely does not help. I’ve seen counsellors and therapists and psychiatrists, tried medications, tried meditation and a heap of other things. After all that though, I’m still here. As a patient. It’s almost laughable how often I feel unqualified as a medical student – how am I supposed to look after other people when I can’t even look after myself? I’m meant to be learning how to help save lives, not contemplating whether my own is even worth living. Everyone expects me to arrive to hospital smiling and ready to engage myself in a wonderful learning opportunity yet some days, I can’t even get out of bed. Some days, I can’t bring myself to shower or eat. Other days, I make it to class but have panic attacks outside where nobody can see me. How can I be a good doctor, when I myself am plagued with a myriad of problems?

Trying to be a doctor, whilst struggling as a patient, is infuriating and heartbreaking and can make you want to give up altogether. But sometimes, there are moments where I am grateful for what I’ve been through. When you come across somebody with your condition, your understanding as a doctor becomes so much more credible. Not only do you understand the medical side of things, you understand what the patient is going through. Your sympathy becomes empathy. In some way, you feel more comfortable because you can relate to them. I remember first learning about mental health in preclinical years, and a simulated patient came in with ‘depression’. I could see the whole class looking at him with sad eyes, feeling sorry for him as he explained how he no longer enjoyed his hobbies and how everything took effort and seemed like a chore. As he continued to act, I wanted to nod along and say ‘I get it! I really do!’. I wanted to repeat the phrase ‘I understand things have been difficult for you’, but actually mean it this time because I did. I did understand! I was finally able to find an upside to my depression, and it was actually going to help me become a better doctor.

Being a patient and having a life-altering condition can seem like the most annoying and inconvenient thing at times. I wouldn’t wish ill health on anyone, but I guess once you’ve got it, flaunt it. Sometimes, it’s not such a terrible thing after all.

 


If you or someone you know, be it a friend or a colleague, have had a difficult time and wish to seek further help or assistance, you can call LifeLine Australia on 13 11 14, Suicide Callback Service on 1300 659 457, Victorian Doctor’s Health Program on 9495 6011 or visit beyondblue here and headspace here.

A conversion from Convirgin to Conveteran at Convention

By Bowen Xia

Perth Convention and Exhibition Centre. 7 July, 1:35 pm

Hundreds of ‘tired and emotional’ medical students from the nine states and territories murmur in the crowd. In the middle of the stage sits the AMA WA President, AMSA President and other VIPs who could end your medical career with a single email. On the right-hand side sits the acclaimed UWA team whose university has blitzed the Emergency Medical Challenge, Sports Day and Brawniest Medical Student Challenge.  On the left, the battered and beleaguered away team from Monash, whose university has won a grand total of zero competitions (except the most emergencies triggered). All eyes are on what their first speaker has to say. ‘Ladies and gentlemen, there must be mandatory reporting of mental health issues in doctors.’

*Record scratch*

*Freeze frame*

Yup, that’s me. You’re probably wondering how I ended up in this situation and how I have a GCS of above 3 at Convention. But to understand how we got from ‘attending convention’ to convincing important doctors and our future colleagues that we are legally obliged to report them to APHRA at the mention of ‘burnout’, we will have to start at the beginning. And no, I did not pass out from a previous night and then wake up on stage conscripted to the Monash Debating Team.

Before I attended AMSA Convention, it seemed like an exotic event where medical students attended not only to create once in a lifetime memories and friendships but to lose them at the same time, the only remnant being a one-week memory gap and 20 unexplained Ubereats orders. I decided to attend, however, after some convincing from friends and a first-ever excuse for visiting Perth. Thus, I joined the enigmatic MUKEG and decided to place my name down for Convention Debating as a joke. I had debated before, but nothing could have prepared me for Convention Debating, where the aim is not only to destroy your opponent’s arguments but to also inflict third-degree burns on your opponent and their university. Personal attacks, once a reason for disqualification, were now necessary and sufficient for success.

At Perth, I was greeted by a lovely Melbourne weather experience consisting of a heavy downpour mixed in with regrets of not bringing an umbrella. On my arrival at the Convention Centre we were all outfitted in our battle gear for this week, the universally acclaimed Monash Camo, with Monash veterans of many conventions decked with more badges than a North Korean General. The camaraderie was palpable in the air, and I soon learnt the traditions of my Convention forebearers and the ceremonies of my elders, such as the boisterous singing of Monash-themed songs and the sport of ‘rowing’.

One of the amazing therapeutic benefits of Convention was the ability to wake up every day at 7 am – a momentous feat considering my immaculate record of absenteeism at 8 am lectures. All this to prepare for the first debate against Adelaide. The Monash Debating teams of previous years were not well acquainted with success after usually being knocked out in the first round. However, we were miraculously successful. We also witnessed the neurotoxic effects of Adelaide’s water as logic and reason were unheard concepts to them. Yet what they lacked in logic they made up for in their roasting, with one of our speakers repeatedly accused of ‘dressing like a sexual offender’. However, there is no trauma a good social night cannot cure. Each social night was a fascinating concoction of music, flashing lights and dancing. Convention socials allowed me to befriend the same person three times. First cordially before social, second during and third the next day asking if we have met before. I have to admit that I was a heavy drinker during Convention – a heavy drinker of water that is, due to one specific sport, ‘Remier League. If you ever spot a group of your friends slapping their arms and faces and making strange sounds, it’s not a satanic ritual, rather an opportunity to experience a decade-long tradition.

The other reason to wake up at 7 am is to register for the awesome academic workshops. I got to experience being a forensic pathologist, orthopod and a plastic surgeon all without placing any patients at harm. The speakers for the plenaries each day were extraordinary, from gold medallists to comedians, it truly was a Convention of brilliant minds and people.

Through a whirlwind of social nights, academic days, sporting events and unprecedented debating victories, the inevitable day of the finals drew closer. As a result of my contribution to debating I was awarded with the prestigious role of ‘Victoria Guard’. I was in charge of defending her honour and dignity but ultimately, she was harmed. My fall from grace, trial and punishment could warrant a new article but let’s return to the scene.

*Unfreeze frame*

My voice falters for a second. Riverside Theatre is silent. I think I have Broca’s Aphasia. I try to continue. Yet what if I embarrass myself? In front of my future colleagues and senior doctors? Then I remember why we were here and how tirelessly we worked to be on stage. I decide if I embarrass myself it will be because I went ‘all in’, not because I ‘folded’.

A tsunami of words runs through my mouth as I run through our model, arguments and a couple of mild bants against the opposition team. There is a bit of scattered laughter throughout the audience, but I do witness a mild smile from one of the VIPs. I end my speech and the debate continues. Both sides are neck and neck in terms of speakers and soon the adjudicators go to decide. They come out.

‘The winner of today’s debate is Monash’. After a second of making sure it’s not a ‘La La Land moment’ our team goes ecstatic. Proud Monash songs fill the room and I think I see Sir John Monash himself smiling in the audience. But all good things come to an end and convention was no exception. I left Perth with my bag a medal heavier, my heart heavy due to the end of Convention and my brain enlightened with lifelong knowledge, experience and memories.


Featured image from AMSA (Australian Medical Students Association): https://www.amsa.org.au/blog/perth-convention-2018-management-team-applications 

Don’t forget to feel

By Anonymous

Content warning: Sexual assault. Some readers may find aspects of this article distressing.

This first-year feels like the “looks can be deceiving” and the “don’t judge a book by its cover” adages have been used extensively in recent times. Probably because they are accurate and important for exposing individuals to the truth. On the outside, to their friends, this first-year seems bubbly, sarcastic, and always up for a joke. They’re on top of their university work, holding down a part-time job and maintaining a social life. What could be the problem? Everything seems to be falling right into place!

Behind closed doors, however, this same first-year is struggling. A lot. Not because of the stresses of med school. Not because of the crippling anxiety from society telling us we must “fit in”. Not even because of their financial difficulties at home. This first-year is struggling with Post-Traumatic Stress Disorder after being sexually assaulted last year.

It happens to so many people; but it shouldn’t.

This first-year experiences flashbacks of that fateful night last year and cries. They cry and cry and cry until there are literally no tears left. They know it isn’t their fault. They know there isn’t much else they could have done to stop it. They know they have an incredible support network that is truly there for them, no matter what. But it doesn’t always help.

Living with such a debilitating condition is tough. There is such stigma surrounding mental health and too often we, as future medical practitioners, strip the condition back, leaving the individual raw, naked and vulnerable. This first-year recalls an ICL/PBL tutor explaining PTSD as “having bad memories”. Not only did this infuriate this first-year, as the tutor had reduced such a complex combination of thoughts and feelings to merely “bad memories”, but it made this first-year feel invalidated; like their experiences could be stripped down to mere words on a page that miraculously manifest themselves in the anatomy, physiology and pathology of a living, breathing, human. This first-year was just another number next to the name of a condition.

We have become so desensitised to the humanity of medicine. So often this first-year hears “give it time and you won’t be so detached” or “in a couple years you’ll be able to make more rational decisions” or, and this is the worst, “don’t be so emotional”.

This first-year is fed up with being told how to feel. Feeling is natural. It is such an ingrained part of the human psyche that to live without feeling is, in this first-year’s opinion, not living at all. Yes, we are influenced by the clean, crisp whites that surround us in hospital wards. Yes, we are warned of becoming too attached to patients and their lives. But it is reaching the point where we, ourselves, are becoming that sterile, clinical whiteness that surrounds us.

Enough is enough.

This first-year is not trying to tell anyone that the way they cope, process, or understand anything is either right or wrong. Not at all! This first-year is trying to open up a dialogue. A dialogue that attempts to break down taboo points of conversation. A dialogue that aims to strive towards equality and awareness in our community. A dialogue that brings these issues to the surface so we can be cognisant of the fact that these feelings are felt by members of this community and so we can ultimately make a goddamn change!

This first-year will probably cry tonight. They will probably cry and cry and cry until there are no tears left. This first-year’s life will not miraculously improve after letting these feelings out onto this page. But, this first-year’s life will not miraculously end now either. This first-year has a long road ahead and is writing this to begin paving a road that will lead to a more positive future. One with independent thought. One with acceptance and tolerance.

One with feeling.


If this piece has brought up any issues that may be affecting you, you can contact Lifeline on 13 11 14, the South Eastern Centre Against Sexual Assault (SECASA) on 9594 2289 or the Sexual Assault Crisis Line (SACL) on 1800 806 292. 

Oh, they’ll be back in 20

By Zakary Doherty

Who am I?

I am the most sacred event in the hospital.

I will occur regardless of the situation.

The patient is about to arrest?

The floor is understaffed?

I will go on.

You want to find a staff member when I am occurring.

But you can’t.

Family want to ask a question.

Bad luck.

You’ll be walking down the hallway as you hear the laughs.

You’ll be approaching the door as you hear the jokes.

You’ll sit down as you hear the gossip.

What am I?

I’m the nursing tea-break.

How it is to be labelled crazy

By Anonymous

We have all met Borderline patients on the ward. We are told they are manipulative; “Don’t trust them,” we’re told.  I nod along, agreeing with the words my superiors say. However, I do wonder how they would respond if I turned to them and said “ I have Borderline”. I imagine the responses would be varied; some may laugh me off, thinking I am telling a funny joke. Maybe others would get defensive, tell me that my psychiatrist got it wrong. They struggle to understand how the medical student in front of them, the one that has been keenly asking questions, can be the same as the “crazies” they see. Finally, some may respond by shutting down the conversation and avoiding eye gaze. To them I will be the odd story that they tell their partners when they go home. However, I don’t plan on telling those above me about my diagnosis; instead, I will continue to nod with each word they say.

I feel that many of you are questioning the truth of this article. How could one of the “crazies” infiltrate our ranks? How could we not know this person? Who knows; maybe some of you are looking around at your colleagues trying to see if a neon sign appears above my head? But here I am, sitting in your tutorials and laughing at your jokes. This is not supposed to make you distrust those around you or make you fight your superiors when you hear them make a derogatory comment. Instead, it is to make you realise that we are people too.

Sometimes I wonder if I should have become an actor. To those around me I am full of life and happy. I am confident and appear to have my life in order. However this is not the true me. Instead, I am flat. I feel nothing. My emotions are so supressed that even I struggle to identify as to when I am deteriorating until it’s too late. I used to be labelled as volatile and unpredictable. Now I have become so good at suppressing my feelings that even I don’t feel them. Anxiety takes over my dreams and I have nightmares about everyday situations. However, I have been told so often not to be anxious that I now dismiss my nerves as an over-reaction. Relationships are hard. The last thing I want to do is burden others with my issues. Instead, I isolate myself and hide myself from the world.

My diagnosis is only made worse by that fact that my treating team has told me not to share my diagnosis with others. What job prospects would I have if the wider community knew about my condition? I would be ridiculed and judged from afar by those who don’t know me. Very few individuals know that I was hospitalised over the semester break. Suffering from a major depressive episode, I was hospitalised for four weeks. Walking around the private psychiatric hospital I experienced life on the other side. The stares when I would leave the clinic with my wristband on, the looks of disbelief when I finally let the nurses into my dark mind. Even now whilst the rest of my cohort is studying hard for our final exams, I am in hospital. Getting my treatment early in the morning so I can run to placement. I can’t fail this year because of attendance. However, on Monday when my peers ask me what I did over my weekend, I will respond with a smile on my face and say that I just studied.

This piece isn’t supposed to change the minds of my peers. Instead it is to give me a place to say to those that are struggling with a diagnosis that you are not alone. There are others in this world that are not a “stereotype” and are trying their best just to get through. However there are some battles we cannot win. Do not be ashamed to just nod your head when your superiors judge a person based on their illness. We cannot all be advocates (high five to those who are); it’s okay to just focus on your own survival. 

Indicators of a successful clinical year

By Tiffany Tie

In medical school, we are constantly assessed through various modalities including assignments, examinations, OSCEs and MCRs.  However, there is a growing body of research which suggests that certain experiences on the ward are highly predictive of students developing strong clinical acumen. This list can be used to formatively self-assess your progress throughout the course.   

1. Unwittingly following your registrar to the bathroom

You trail after your registrar like a lost puppy, from ward to ward, clinic to clinic.  You follow them down the corridor that doesn’t seem to lead anywhere… and then they enter the bathroom.  A good registrar is someone who signposts when they are going to the toilet.

2. Fainting in hospital

This can happen on the wards, in theatre or in clinic.  It is not a sign of weakness; rather, it is a true sign of commitment to medicine.  Just remember to faint away from the patient, especially if you are scrubbed.

3. Deciphering a drug chart

The scribbles on drug charts resemble the trail of a spider that tap-danced across the page.  Deciphering this brings into play the pattern-recognition skills from section 3 of the UMAT. Hospitals that use electronic prescribing systems fail to provide this exceptional educational opportunity.     

4. Meeting the MET call criteria for low urine output

A wise registrar once told me that the hospital systems just would not function if not for the hidden workforce of unpaid medical students.  As a consequence, you build stamina to go through days with early starts, no food, no water, no opportunity to void and mild AKI

5. Anxiously awaiting or sending a fax

Healthcare in Australia is amazing in its ability to provide universal care and to single-handedly support both the historic pager and fax industries.  A device on which you can receive but not send messages is essential for maximising efficiency.

6. Substituting meals with coffee

An average small flat white with regular milk contains all three macros: 7 g fat, 8.8 g carbohydrates and 6.2 g protein.  If you have a nice intern, registrar or consultant, then who says there is no such thing as a free lunch? Or maybe that was payment for the 10 discharge summaries you did yesterday afternoon.  Wait, coffee doesn’t count as lunch…. Or does it?

7. Getting conned into a research project

When a seemingly innocent clinician pitches their idea to you, beware of phrases such as “it’ll look good on your CV” and “it won’t take much time.”  Trawling through medical records to extract data for “only a few patients” is a similar experience to repeatedly banging your head against a brick wall.

8. Obstructing the hallway

Physicians think, surgeons cut, medical students obstruct.  

Lessons on Leadership: NLDS 2018

By Rose Liu

Earlier this semester alongside 9 other Monash Medical Students, I had the wonderful opportunity of attending the AMSA National Leadership Development Seminar (NLDS). I’m writing this piece to share the thought provoking and inspiring lessons shared by the presenters: including what it means to be a good leader, how to be politically engaged and mental health in medicine. Thank you to the NLDS team for their hard work putting together this wonderful event, and to MUMUS and the Monash Medicine Faculty for their generous financial support.

The NLDS brought together a variety of speakers with diverse backgrounds to share their opinion on what makes a good leader. A universal theme carried across all the presentations was the importance of character – namely having integrity, being kind and being humble. Other traits which came up again and again included the ability to build a team and empower team members, being persistent and resilient, creating a safe culture of trust, and being approachable. It was particularly interesting to note how many of the skills required as a leader differed according to context. For example, many of the political leaders emphasised the importance of not blindly accepting the status quo and being able to motivate team members, as the process of advocating for and passing a policy can be very arduous and faced with many roadblocks. Contrastingly, leaders with a more entrepreneurial background emphasised the importance of resourceful problem solving, identifying how problems are formed from first principles, and knowing which problems are viable to solve. It seems like the technical skills required for leadership differ depending on the context, but the foundation of leadership lies in one’s character and ability to work well with others.

The major theme of the conference was political engagement. I’ve always been intimidated by the prospect of being politically engaged after watching Question Time on national television (and much more intimidated after watching Question Time in person). The conference brought in influential political leaders and policy makers whose talks elucidated an empowering message that we as medical students are not just idle observers of policy changes. Rather, medical students can influence policy change through political engagement, such as being involved in advocacy groups, writing to your MP and organising a meeting with your MP. Our efforts can influence issues as diverse as abortion laws, asylum seeker rights and medical workforce policy. It was interesting to hear multiple presenters talk about the unique role of doctors as one of the most trusted community members whose opinions have great influence: one speaker commented that her most successful advocacy campaigns have been when medical students and doctors have been involved, and likewise a former politician explained how politicians love to work with doctors and often try to recruit them. With the immense trust society places in the medical profession, we are in a unique position to influence policy in the best interest of our patients both as doctors and as medical students. 

A confronting topic which recurred throughout the conference was mental health in medicine. The Beyond Blue National Mental Health Survey of Doctors and Medical Students found that 1 in 5 medical students had suicidal thoughts in the past year, and more than 4 in 10 medical students were highly likely to have a minor psychiatric disorder. Several speakers emphasised the importance of being honest, not just about our strengths but also our vulnerabilities. Too often in medicine, because of both the culture and the type of personality that medical schools inadvertently select for within candidates, medical students and doctors hesitate to reach out for help. To create widespread improvements in the mental health status of medical students, a systemic culture change needs to be implemented: by making it easier to report bullying and harassment, enforcing safe working hours for doctors, and creating avenues of seeking help. A message that really stuck with me is that ‘the behaviour you walk past is the behaviour you accept’: a leader leads by example, and that means confronting and calling out unacceptable behaviour when it occurs and not being a passive bystander. When we progress into senior leadership roles in hospitals it is our responsibility to ensure that we enforce a safe culture for junior doctors and medical students to feel comfortable asking for help and reporting distressing behaviour.

The most exciting take home message from this conference was the idea that as medical students, we do have the ability to have a positive impact in our communities and we are not just passive bystanders to the status quo. This can be through many mediums like political advocacy and entrepreneurship. In my opinion the simplest and most important way we can all be leaders in our everyday lives is through having the character of a leader: one of integrity, kindness and humility.

A Day in the Life of a BMedSc Student

By Steph Davies

Sometimes I feel like I’ve fallen off the face of the earth. Not quite a med student, not quite an honours student. I don’t quite fit into any category, which I have learnt makes it very easy to be forgotten. What’s more is that nobody understands what on earth we spend an entire year doing. Not only is our year very different from medicine and other courses, no two BMedSc students do the same thing. It can be very hard for someone on the outside to understand what a BMedSc is like. Research projects are notorious for things going wrong. Unlike in a medical degree where if you follow all the directions everything will probably be fine, research projects almost always have a part that doesn’t turn out as planned. And like I have learnt all too well, mistakes happen. In a way, this year has been more challenging than any other year in medicine.

So here’s a sneak peek into one of my days, in the hopes that us BMedSc students will be a little better understood and a little less forgotten.

7am: Today is the big day, I’ve spent two weeks culturing patient samples to generate an immune response. For some context, my project is on adverse drug reactions to anti-epileptics and characterising the patient’s reaction at a cellular level. This is the part where I get to see the results of two weeks of work. I would be more excited but I am still practically fast asleep. I’ve done this a number of times so I work with my supervisor like clockwork, each taking different jobs. I’m finally at a stage where I am trusted to do most of this by myself without my supervisor watching my every move. The first step is to count the cells I prepared a day earlier. 1, 2, 3, 4, is that a cell? Looks like it might be dead. I’ll count it anyway, I could use the extra numbers. 5, 6, 7. You get the picture. Alright, onto the next step. Count some cells. What’s after that? Count some more cells. Over and over again until I am really, really sick of counting cells.

10am: Three hours later and the experiment is finally set up. Now I’ve got two hours to kill until I have to do anything else. Time for that magical time of day. Coffee. Then, back to the office for some ‘light’ reading for my literature review. By light reading I mean that I’ve read over 100 papers in two months; although by the end of the two months, reading tends to constitute a quick ‘control + F’ to find whatever it is I’m really looking for. Despite being tedious, this process has helped me to develop a specialised knowledge in immunology, specifically in relation to the interaction between T cell receptors and human leukocyte antigen molecules. A BMedSc provides a unique opportunity to learn in depth about a niche area of medicine. Something we don’t normally get the opportunity to do in medicine.

I am lucky to be in a lab where there are seven other research students in my office, each working on a slightly different project. Whenever I have a question (which is often) there is always someone around to help out. This can involve anything from locating papers on the structure of T cell receptors to letting me use their free printing.

12pm: Five hours since I started and it’s finally time for step two. I calculate how much of the reagent I need and add it to every single well of the four plates. Then back into the incubator it goes for another four hours. This project involves a lot more killing time than I expected. Luckily, it also involves a lot of multitasking. At this stage of the year I can be juggling 6 different patient samples at various stages. I spend this break learning how to perform PCRs (polymerase chain reactions) with my supervisor. I have been really lucky to learn a variety of skills during this year. Ranging from cell culture to flow cytometry and analysis of T cell receptor sequencing (this is still very much a work in progress). I have been quick to learn that lab work requires fine hand eye coordination as well as the ability to work quickly and accurately. With more and more practice my fine motor skills have picked up although my gross motor skills have unfortunately not improved. Luckily, my supervisor has been there to catch anything I happen to knock over, like a full measuring cylinder, before disaster ensues.

4pm: Another four hours and it’s time for step three. I promise, despite the long hours lab work is actually fun. This time I make up a stain consisting of antibodies bound to fluorochromes so that I can identify what sort of T cells are causing the reaction (and whether they’re still alive). This is the part of the day when I know I’ve nearly made it because after this there are only two steps left. At this time of day there are usually quite a few people still left in the lab so there’s always someone to hang out with during the incubation periods. Usually they are also avoiding doing any work. Soon enough though I’m back in the lab for the next step. This is probably the only time when I cut my breaks short because the later I run, the later I get to leave.

6pm: Fast forward to the last step which involves washing off the previous addition and spinning the plates in the centrifuge. It’s also at this stage that I forget to turn on the centrifuge and come back to find it hasn’t even started. Provided that everything goes to plan and I don’t perform the last two steps in the wrong order (this has happened, killing all my cells and rendering the day’s work useless) I usually finish by 6pm. I’ll have to wait until tomorrow to find out if the experiment has actually worked.

An open letter to Greg Hunt MP; Tobacco Tax is a smoking gun

By Grace Scolyer

Dear Greg Hunt MP,

Stop taking money from my cousin.

When I think of the people who should be paying the most tax proportional to their income, I think of the big earners, with their multiple properties and multiple cars, their children in private schools, whose assistants make reservations at fancy restaurants for them. But I’m not writing to you about tax cuts for large and small businesses and the adjustments made to tax brackets. I’m writing to you about my cousin.

My cousin Anthony is a gorgeous thirty-three-year-old man who loves the NBA, magic cards, playing guitar, and painting. In high school he was social, popular, loved acting and playing sports, and was a prefect. Since the age of eighteen though, he has been battling severe schizophrenia.

Anthony is unable to support himself financially. He has struggled to keep a job. He struggles to make his government income last the fortnight. It is through the support of his family that he is able to survive, and often, survive is all he can do.

Survive, that is, and smoke.

Anthony smokes a pack a day, and has done for many years. When he smokes, he is focused, mindful, yet between puffs, he is lost in his internal whirlwind of chaotic thoughts and voices. He takes another puff; he is back, and the cycle continues. It calms him; he remembers to breathe.

My family often refer to smoking as a part of his treatment. As a medical student myself, who is fully aware of the risks associated with smoking, it seems almost paradoxical to call it therapeutic, but it is hard to deny. His medication changes, as do his moods, as do the volume and rhythm of the voices that control him. But this never changes: he will always find himself on his balcony holding a cigarette to his lips.

He has tried to stop countless times, because he cannot afford a pack a day. He spends half his pension on tobacco. But there is no hope in him stopping, not in the foreseeable future. It is undeniable though that the biggest impact smoking has on his life, aside from the positives, is financial.

Mr Hunt, this is not a health promotion issue. I care about rates of lung, throat, mouth and bladder cancers. I care about COPD and asthma and heart disease. But I also don’t think this tactic is working. If it were, with the taxation of cigarettes rising 12.5% every year, we would not be seeing the first increase in tobacco use in decades. If this were an effective health promotion measure, Australia would not have the smoking rates it does. If this were an effective health promotion approach, those facing financial hardship would have significantly lower rates of smoking than the rest of the population.

This is a financial issue. My question is how the government can justify benefiting from the most vulnerable members of our society. Because that is who is impacted by tobacco tax, and it benefits no one – except you. With tobacco tax rising at the rate it is, the financially disadvantaged are taxed more heavily, proportional to their income, than the richest people in the country. And that might sit alright with you, Mr Hunt, but I can see the impact it is having on people, and it is not alright with me.

I would like my cousin to stop smoking Mr Hunt. I would like us to find a way to make that happen together. In the meantime, I would like his life to be just a little bit easier. And I can think of one easy way to make that happen.

Kind regards,

Grace Scolyer