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.

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.