A study in inter-faculty relations

By Natalie E Evans 

It was upon a midnight clear when the three discovered each other. Awakened from their slumber by the whispers of wind which breathed their way through the fronds of palm trees. The one with the stethoscope round her neck awoke first – or so she thought.

Her last memory had been of playing hangman in Active Learning – but suddenly she had sand beneath her feet and night’s cool embrace upon her skin. In front of her lay another – an individual whose face was hidden from view by the cloak of night. She tentatively took a step closer when she felt someone push from behind. Suddenly her face was in the sand and a foot was planted firmly on her back.

A voice came out of the dark.

‘State your name – whoever you are.’

The one with the stethoscope wriggled out from the foot, heaved herself up and said with a salute,

‘My name is Laura Jacobs and I’m a first year medical student at Monash University. I don’t know why I’m here but I was probably asked by a GP to take your medical history or perform an examination or jab you with a needle. Don’t worry though, everything we discuss will be between yourself and myself and your doctor –’

‘Spare me the spiel.’ said the disembodied voice. ‘I thought you might have been the one who dumped me here but obviously we’re in the same boat.’

‘And who are you?’ said Laura.

The other stepped into the light.

‘I’m a law student.’ Silence, then –

‘Need I say more.’

Laura let him have his moment of significance and then interrupted it with an obsequious flourish of her hand,

‘Perhaps your name my lord?’

‘Paul.’

Laura noticed the Paul wore something strange.

‘What’s that?

‘Oh – this?’ Paul touched his head, ‘It’s a wig. I sometimes wear it when I’m at home studying to make me feel more motivated.’

The two students fell into stilted silence as they surveyed what was visible of their landscape in the darkness.

‘What do we do about –it?’ said the Paul eventually.

‘The one still asleep?’ said Laura, turning around.

‘Well was,’

The third one had disappeared.

‘Where did they go?’ said Laura

‘Well I don’t think it’s in our jurisdiction now to do anything about it.’ said Paul,  ‘The – individual – has moved off to where it’s someone else’s problem.’

‘Like whose?’ asked Laura.

Before the two could begin an argument ripe with the fruit of bitter conflict they heard a shout and then a thump.

‘Quick, we’d better help.’ said Laura.

‘No – not our problem any more, remember?’ replied Paul.

‘It’s not in my code of ethics to leave someone to die,’ Laura continued, ‘Beneficence, justice, non-maleficence, those are my divinities.’

Laura tore through the undergrowth, stumbling over ferny tendrils and occasionally splashing through black pools of water. Paul reluctantly followed, slapping at any stray vines that attempted to mess with his wig. In a small clearing lay the third – the moon illuminating her curled up silhouette.

Laura stopped about a metre away – Paul nearly crashing into her.

‘Well? Aren’t you going to fix her? What’s the diagnosis?’

Laura’s fists unconsciously curled up.

‘You think I can treat her? I don’t know anything about anything!’

‘But you do med,’ Paul snapped back, ‘therefore you’re basically already a doctor.’

‘I can recite the contents of the femoral triangle and the popliteal fossa but that’s not going to help us here!’

‘But you have a stethoscope around your neck.’ pointed out Paul.

‘I only used it once in a vital signs assessment but the assessor was so busy trying to get the Wi-Fi to work she didn’t even see I was doing it right!’

‘Help!’ said the one sprawled on the sand.

‘What brought you in to see the G- I mean, what happened?’ said Laura.

‘Well, I was fake sleeping before, and heard you two plotting against me so I ran off. Then I ran into this palm tree here because I couldn’t see.’

‘So you didn’t dump us here either.’ said Paul, stroking his chin in contemplation, ‘How curious. I wonder who did.’

‘Can’t you just help me?’ said the one on the ground.

‘Of course.’ said Laura, bending down. The other slowly sat up, and rested against the offending trunk of the palm tree.

‘I do arts. What about you two?’

‘Law,’ said Paul, ‘she does med, hence the stethoscope.’

Laura started palpating a few anatomical landmarks.

‘I don’t suppose anyone knows how we got here?’ said the arts student.

‘Nope.’

‘Well then – I might just head to the beach and write a distress message in the sand. I’ll do it in the phonetic alphabet too – put that linguistics to good use.’

‘What’s your name?’ cried Laura, hurrying after the arts student.

‘Name’s are of trifle importance at a time like this,’ called back the arts student. A wind rippled through the trees, ‘what matters are our values, our talents – our creative enterprise which shall save us from this dystopian land.’

‘Have it your way then,’ mumbled Paul as he struggled to keep up.

‘But,’ continued the arts student, her words tossed about in the air as if they were ships upon an ocean, ‘if you wish to refer to me by name, Theodora de la Roule is the one to use.’

Once Laura and Paul caught up with Theodora she had already scrawled a number of messages in the sand. Her handwriting was curiously elegant and loopy.

‘Are you sure any would-be rescuers would be able to read that?’ said Laura, peering at the cursive script.

‘I don’t know, but I love it. I squish all my university commitments into two days so I do lots of random stuff the other five days of the week. Calligraphy is one of my hobbies.’

‘Hobby. Maybe I should get one of those.’ said Laura.

But her thoughts were cruelly tossed aside as a horde of helicopters descended overhead and landed on the churned up sand. Bright yellow lights winked and sparkled as three individuals came striding towards the sorry party of students.

They were the three heads of faculty – each wore a steely glare.

‘You have failed us.’ boomed the first.

‘I am especially disappointed in you,’ the medicine faculty head (that would be me) exclaimed to Laura, ‘I assumed a medical student would be able to foster good interfaculty relations. But no – you stand back and critique handwriting!’

Laura hung her head in shame.

‘And you forgot to palpate the tibial tuberosity!’

‘Hey, wait a second,’ said Paul, pointing to the cowering arts student, ‘I think you are to blame for this after all! You’ve been acting strangely this whole time! I bet your name isn’t even Theodora de la Roule!’

The arts student broke down.

‘They told me I had to participate, and feign ignorance! They threatened to cut arts funding again!’

“This Monash University experiment is deemed a failure.” said the law faculty head.

‘And you’re right about the name,’ said the arts student between sobs, ‘I’m really Jessica Smith.’

 

 

 

 

 

 

Are surgery and Social Media Compatible?

BY NEBULA CHOWDHURY

Initially, one may think that the only links between ‘surgery’ and ‘social media’ is that they both start with the letter ‘S’ and that they are two things that an average middle-aged person may not completely understand. However, upon deeper reflection, one would realise that we have been using social media to benefit the surgical world in many ways.

 

Social media is increasingly playing a role in surgical education. Relying on books and lecturers alone is an obsolete concept as students are perpetually utilizing the Internet to complement their studies. In her editorial, “Using social media effectively in surgical practice”, Texas cardiac surgeon Dr Mara Antonoff writes her experience of supervising an intern who was placing a central line for the first time. She recalls watching in awe as the intern did the process flawlessly. When Dr Antonoff asked the intern who had taught her, she clarified that she learnt it through ‘Youtube’ and had only physically gone to one simulation class. This highlights the changing nature of the way education is being delivered to the next generation of surgeons. Various social media sites contain vast amounts of credible content. On ‘Youtube’ alone, there exist numerous medical education channels such as John Gilmore M.D, Dr. Najeeb Lectures and many more. Education through social media is not limited to medical professionals – certain content is created for the prospective patient. A leading Sydney Plastic Surgeon, Dr Eddy Dona, live-streams entire uncensored cosmetic procedures on his Snapchat channel. Though controversial, Dr Dona believes that this strategy successfully provides people with complete medical details so that they can look past the ‘glitz and glamour’ of plastic surgery in order to make a holistic decision on whether to undertake a cosmetic procedure.

 

Social media is also a prodigious platform for information sharing and discussion. This is due to its ability to bring large numbers of like-minded people together. For example, The Royal Australasian College of Surgeons regularly updates their Facebook page to keep surgeons and medical students updated on the happenings of the surgical world. Social events, important journal articles and many other relevant information are all conveniently curated in one place, providing a highly accessible medium for health professionals to keep up with the important knowledge. Additionally, the fact that social media allows for the easy gathering of people from all over the world enables health professionals to engage in scholarly discussions with colleagues that they might not have been able to reach otherwise. For example, there exists an “International General Surgery” journal club on Twitter, which goes by the name of “Int Gen Surg J Club”. This club connects thousands of medical professionals who meet online monthly to discuss new articles related to general surgery. The many contributions of people from 69 nations allow for a more sophisticated discussion- and it would have been impossible to maintain such monthly meetings if they were to do them in person.

 

The fact that social media enables widespread reach also renders it an attractive realm for advertisement and publicity. Both surgeons and hospitals use their social media pages to share success stories and promote their practice. Dr Simon Ourian, the Kardashians’ plastic surgeon, has posted hundreds of pictures on his Instagram account ‘simonourianmd1’ showcasing the various dermatological cosmetic procedures that he has done. Recently, on their Facebook page, the Royal Children’s Hospital also posted a video of a young girl going through her cancer treatment. 5-year-old Christy was diagnosed with aggressive neuroblastoma and the video shows the cycles of radiation therapy, chemotherapy, stem cell transplant and other procedures that the little girl went through until she was finally in remission. The posting of success stories and procedures confers credibility and experience onto the business, incentivizing prospective patients to choose them over other services.

 

There are also patient-specific services empowered by social media – such as financial services and support services. It goes against the fundamental nature of surgery to cost patients an arm and a leg but that happens to be the case for many procedures. For patients in need of financial aid, there are many crowdfunding websites around the world which allow them to raise the money required. A prominent local example is mycause.com.auwhere surgical patients or their families can start an online campaign by posting the amount that they need to raise, accompanied by pictures and a brief medical story. Patients would then continuously update their treatment progress and donors would comment the amount that they gift along with a message for the patient. These sites are accessible worldwide, connecting patients with almost anyone around the world. This makes it more likely that the patient would encounter someone that would sympathize with them, increasing their chances of receiving a donation. In terms of support services, there exist many online support groups for patients that have undergone various procedures or are experiencing a certain condition. The global website inspire.comcontains hundreds of these in one place. Patients can join an online community and talk to other members, benefiting from the company of people that can empathize with them.

 

However, there are certain disadvantages to having social media linked to the surgical world. The notorious doctor-rating websites such as RateMDsand Vitalsare a good example. The fact that many patients ‘google’ their surgeon places too heavy an emphasis on such platforms and their ratings which have a possibility of being misleading. These sites allow for anonymous reviews and have features where doctors can pay to have reviews hidden or have banner advertisements on the pages of other non-paying doctors. These ‘tactics’ reduce the integrity of these websites, not making them an honest provider of surgeon information, instead fostering a toxic sense of competition.

 

So, are surgery and social media incompatible? Not at all. Amongst its many other uses, it is already being employed in the educational, informational, promotional, financial and supportive aspects of surgery. Despite the problems, there is a net benefit in employing social media in surgery. It is already enriching our present surgical world and there is no doubt that if managed correctly it will continue to do so in the future.

Straight

By Jun Kim

2018 Auricle Writing Competition: Highly Commended

“Mr Hodge-Johns?”

There’s always one. The whole school calls me Hodgey and yet there’s always that one kid every year who takes the extra second to say my tongue-twisting institutionalised name.

Back in 2022, my automatic response to being called Mr Hodge-Johns would have been to exclaim that I wasn’t a surgeon. But none of the kids got it, and it cut me more deeply than I’d bargained for, so I dropped that line into the “never again” basket. It has stayed there for forty years, and it wasn’t about to come out today.

“Mr Hodge-Johns? Can I ask you a question?”

I could sense the irritation in stressed Year 12 girl’s voice. I smile slowly without sound as I swivel around in my wheelie-chair, which groans softly in disapproval of my summer diet of ice-cream and beers. Within seconds, I’m wading my way through another rendition of “you’ll learn it next year if you do maths at uni”. There was once a time when I used to teach beyond the study design, but tenure has capped my efforts at the bare minimum. Is loss of motivation a symptom of burnout? I know burnout is a symptom of burnout, I learnt that much from the mindfulness bloke. Maybe I would have learnt more if I went to lectures.

Am I bitter? I can’t say I haven’t lived a fantastic life; one full of meaningful relationships and enjoyable moments, along with the opportunity to shape young minds. For over forty years, I have been able to consistently generate laughter and confidence and educational satisfaction within my students, whilst also maintaining a good work-life balance and having time for leisure activities.

And yet, despite all that fulfilment and achievement, I can’t help but wonder about the journey I might have had if I’d kept going straight. Back at the start of 2016, it was like I was in a manual car, driving towards my ideal future of being a doctor. I headed off without any help from Google Maps, because the road was long and bumpy but straight – med school, intern, resident, registrar, consultant. But as I continued, I realised that the drive was harder than I thought. Med School Road had far more hills and traffic lights than I’d bargained for, and after passing through primary and secondary school without a hitch, it felt like I’d forgotten how to stop and start the car. Jarring gear changes and unfortunate stalls at intersections made me doubt whether I was on the right path, eventually compelling me to enlist the help of satellite navigation as I barely made it through Third Year OSCEs.

You know when you’re fairly confident about the route you’re meant to take but you turn the navigation on just to be sure? It was like that for me when I said, “Ok, Google”, and asked to be taken to my future. I was in the left lane expecting to stay straight towards 4C, when Ms Google said, “In 200 metres, make a U-turn”. A questionable pair of lane changes and a vicious U-turn later, I settled into a new route which led me through the Education part of the Clayton campus and eventually back to high school, where I hopped out of my car and have remained ever since.

Did Google Maps make a mistake? Or at least, did my Google Maps make a mistake? Quite possibly, because my Ms Google back then was Blake, a Year 12 student whom I was privately tutoring. He was a high-achieving student and he wanted to get into Medicine at Monash, so I often talked about my experiences of medical school, perhaps with more honesty than I should have. He was more of a listening type with a fairly shy nature, which meant that his words were infrequent unless I prompted him. But after a lesson which combined clear explanations of hypothesis testing with accounts of how difficult I was finding the Gen Med ward rounds, he did have this to say:

“You should just become a maths teacher, Tim.”

I do sometimes wish that my pursuit of secondary teaching was a whimsical daydream formed by an apathetic third-year student who’d had enough of feeling like he knew nothing in medicine. I do sometimes believe that the steps of my working life should have been plotted along corridors of wards and labs, not classrooms and lockers. I do sometimes dream about what I could have done if I’d kept going straight.

An Issue that should be addressed

By Anna Bayfield 

Hello, my name is Anna, and I have an addiction to Australian politics – “the ScoMo express”, “shoegate”, “it’s okay to be white” – I cannot get enough. Through the year I get my fix from the weekly Australian political analysis podcast by ABC Radio National  “The Party Room.” Patricia Karvelas is an ABC political journalist who co-hosts the podcast, and as a fan I quickly became aware of an unfolding media scandal she has been embroiled in late 2018. Ms. Karvelas was instructed to leave Question Time due to “showing too much shoulder”  – the offending piece being a white blouse with capped sleeves deemed “sleeveless”.

This story stuck with me as it occurred just weeks after I had a similar experience on my psychiatry placement as a fourth-year medical student. I was taken aside by a female colleague of the male doctor whom I had been shadowing for the morning, who told me, in a very apologetic way, that her colleague believed the way I was dressed was inappropriate. She tried to throw me a bone to soften the blow – she shrugged her shoulders and gave a sympathetic laugh; she joked that it was “silly” because every other day she would “come into work dressed like a hoe” but that her colleague was “old school” and had felt the need to tell me.

It is interesting, a small repudiation by someone in the workplace on your clothes – it should not be a big deal. If it is simply a matter of professionalism, like washing your hands thoroughly, or examining a patient in an appropriate way, it should sting a little bit as any criticism does to perfectionistic personalities, but ultimately it should not seem personal, or evoke any deep-seated emotion.

Why then, did I spend weeks cringing over this comment? Why did I go through a Kubler-Ross-reminiscent evolution of my attitudes towards it? I began with dismissal; I rolled the comment off my shoulders with an effortless shrug. Fair enough, I thought, I should have known better. Did I think I was dressing inappropriately when I chose my clothes that morning? Of course not, but I guess I was wrong. I would learn from this mistake. Within the minutes it took to walk from the hospital entrance to the car, I shifted to doubt. Was what I was wearing really that inappropriate? I had seen other doctors wearing stilettos before – surely that was more inappropriate if only from a practical perspective? My doubt turned to anger, then to bargaining. Maybe I would not be so annoyed about this if the male doctor in question had just spoken to me himself, instead of asking his female colleague to speak to me. I mean it did not have to be a gendered issue, but he had made it one! And then this female doctor – did she agree with her colleague? If she did, why had she apologised on his behalf? And if she did not, why did she not tell her colleague so and refuse to pass along criticism she did not agree with?

I spoke to a number of friends about my thoughts, but could not quite articulate myself the way I wanted, nor could I quite evoke a response that satisfied me. I did not want sympathy, I wanted validation; affirmation that I was objectively in the clear and had committed no wrongdoing.

After about a week of this I managed to burrow to the roots of my discomfort, and it came down to two essential points unique to the issue of what is deemed “appropriate” workwear for women. Firstly, I was embarrassed because I feared I had made a mistake. I could not find the objective validation I sought, I could not simply look up the correct answer; this was a grey-zone marked by opinion and personal values. My second source of grief was the criticism itself – I had essentially been told I had dressed too provocatively for work and it hurt. It did not sting like any other criticism, it was strangely degrading and humiliating. How could I not know how to put clothes in a respectable way on my own body? How could I fail at this blindingly simple task that nobody else seemed to have a problem with?

At this point many of you may be rolling your eyes and thinking I am over-analysing, and maybe I am. However, that does not change the crux of the problem in this scenario, and that crux is this: fearing you have dressed provocatively for work, and being punished for it, is a uniquely female problem. The fact of the matter is – I cannot think of a male colleague in my life who has ever looked in the mirror before heading off for work, or placement, and thought to himself – “am I dressed provocatively?” Perhaps; “am I dressed inappropriately?” or “am I dressed too casually?”, but never a question of whether his clothes convey an unwanted sexual message.

It is important to note here that I am not saying that this is the male gender’s fault. We are operating in a world of shifting sands. The bedrock values that inform our everyday decisions are evolving rapidly, often without even our noticing. There was a time where it was consistent with our values that women should dress more conservatively. That is certainly still true in some cultures that exist within multicultural Australia, but in many other cultures that value has changed. Women’s bodies are no longer seen as hyper-sexualised objects in need of protection from the world at large. The problem is that, although overtly our values have changed, subvertly – as reflected through the policy that a woman’s shoulders are not permitted in Question Time – the remnants of this anachronistic belief system still persist without our knowing. That is why I have written this article. That is why I think this is an important topic of conversation. That is why we need more women like Patricia Karvelas. We cannot change the things we do not name. Like a slender thread of mercury winding its way down a riverbed from an occult  source upstream, we cannot recognise the significance, and danger of seemingly innocuous comments on dress code policy unless we go looking beneath the surface.

I considered for a long time posting a photo of what I was wearing that day, but decided against it. Posting a photo would only serve to validate my own feelings if you agreed with me. The point, in my view, is not whether or not what I wore was appropriate, but rather, the bigger conservation. Why do we consider some things appropriate, and other things not? Is our rationale behind this distinction fair? If it is fair, is it there a way we can better frame it so as to not humiliate women when criticising them? I do not know the answers to these questions – they exist in the grey zones, shifting sands and murky riverbeds. I hope through writing this, through others reading it, and through leaders in the community openly talking about it, that we can find these answers, so that women such as myself do not have to feel alone or ashamed for the deceptively simple task of choosing a shirt to wear to work.

 

Living by default

By Sarah Jaboury

‘I refuse to bend.’

Not sure if you’ve heard that phrase before, but I certainly have; and although a little pretentious, I feel that it’s nevertheless a good way to describe the quality of resilience. In a profession like ours, resilience is not just important, it is ever so necessary to our survival.

Being a medical student was never the main stressor or source of pain in my life; I’m a bit atypical in that I have always used it almost like a coping strategy, to feel control amidst overwhelming loss. To clutch at a sense of drive and purpose when, to be raw, I used to and occasionally still feel that outside of medicine, I was empty. But I’m waking up now; I’m realising that I can’t rely on that alone as a crutch forever. It’s not good enough. It’ll never be good enough, and I’ll never be satisfied just on that.

I think that’s part of the reason so many people around me, the people of our time, are so fucked up. We’ll never – we can’t be satisfied. The typical type A medical student personality is just an overt phenotype of how lost our generation is. Be more, do more, so you can be better, and have a better life – this is the message constantly shoved down our throats, not just by the media, but by every single person around us, including the endlessness of our own thoughts.

It’s a classic case of the chicken and the egg – is it that being pushed to continuously improve our lives creates the sense of not being or having ‘enough’, or is it that our feelings of deep dissatisfaction with our lives are what drives us to constantly, desperately search for ways to ‘fix’ them? Or is it that we lack resilience? Where does resilience come from?

The answer is the only thing I know and feel with certainty, and that is that it is a choice.

You choose what you can survive. You choose what you can come back from. It might be an easy choice or a hard one, depending on what challenges or losses you experience, and the time you have to adapt, but at the end of the day it is entirely, and wholeheartedly, a choice.

I want to take this second to make clear that this does not mean that if someone has given up, then they are weak, or selfish, or lack mental strength. Essentially, what I’m proposing is a hack – a ‘cheat’.

There is no such thing as ‘strength’ – there is, however, a will to fight for your life. Almost like stubbornness – a refusal to bend, and a decision made based on that to continue, unconditionally. Something that I’ve trained to be a reflex— living by default.

And I’ve not just been living, but highly performing. It’s so much easier to do when there’s no fear of failure, but instead the knowledge that no matter what happens to me, so long as I still have the air in my lungs and the blood in my heart, I can choose to, and therefore I can, survive. It may sound like a miserable, zombie-like existence, but I’ve found that when I abandon searching for meaning, I am the most likely to find it in the most unexpected of places. And at the end of the day, I’ve survived. It’s a win.

Living by default means that even when you’re lost and confused, when everything is up in the air and you are at your God’s end for why you are even doing this anymore, and why are you trying, and what is the point of all your effort and all your suffering and the sleepless nights and it’s not even good enough, it’ll never be enough you’re not HAPPY it’s not working—

STOP. Stop thinking.

Just continue.

Just keep breathing. Keep doing. Go to sleep and wake up and keep going.

Fight for the sake of fighting. If you can simply continue, it’s a win. No matter what happens, the earth will keep spinning, the planets turning, and humanity will always have something inherently beautiful and worthwhile in it, for as long as we survive. It’s in there, it’s just a puzzle, and it’s subtle, and despite what you’ve been told there’s no sure-fire way to find it and hold it down.

Don’t listen to what anyone else tells you to do. Your only job is to survive. Do what you need to, be kind to yourself, and know that you’re doing all you can, and that’s enough.

And if you ever feel lost, just breathe, sleep and repeat – and you’ll be okay.

A Deserted Island

By Cecilia Xu

Auricle Writing Competition 2018: Clinical Runner-Up

It is a scathingly hot February morning, and three separate O-Week cruises have capsized in the Pacific Ocean. The sole survivors of each ship – a law student, an arts student and a medical student – find themselves marooned on a desert island with no hope of rescue. As three profoundly different beings, will they be able to overcome their instinctive discordance and find a way to escape? Or will they succumb to the elements?

Our first subject is bespectacled, serious and thoroughly unamused by the circumstances. The sea spray and open sky are a stark change from the law student’s usual habitat, which is typically abundant with books and devoid of all sunlight. In an attempt to recreate its natural surroundings, the law student has stacked twenty extremely boring textbooks (which it had been inexplicably carrying on a recreational cruise) to form a wall. Atop this wall, it has placed what appears to be an undergraduate commerce degree to form a protective roof. It has taken note of its two companions, one sitting serenely on the beach and one lying face down on the sand. It wonders vaguely if it can use its powers of persuasion to convince them to eat each other.

On a sandy dune nearby, a figure is seen staring contemplatively out to sea. It does not appear perturbed by the dire situation. As a matter of fact, it appears to be rather enjoying the ocean breeze through its unnaturally blue hair (dyeing of the plumage is common amongst students of the arts as a strategy for identifying each other and attracting mates). It does not seem aware that it is not alone on the island, nor does it seem to care if it is alone or not. It just is.

The final specimen is lying face down in the sand, hopelessly inebriated from their seventeenth apple cider on the now shipwrecked cruise. Upon waking, they blink perplexedly for a moment before registering their surroundings and immediately launching into a fully fledged panic attack (years of basing their worth on academic results have resulted in extreme emotional lability and a fragile self-esteem). Approximately twenty-six minutes later, the medical student slowly rises to a sitting position and looks around – a general inspection, if you will. It identifies two lesions, one blue and benign looking and one possibly malignant but well circumscribed by what appears to be several obscenely thick textbooks.

Time passes. The law student schemes, the arts student dreams, the medical student internally screams. Just as there seems to be no hope that there would be any interfaculty interaction, the arts student stands up from the dune and waves, first at the law student, then the medical student, as if seeing them for the first time. “Hey!” it shouts. “Did you guys get stranded here too?”

At long last, the three parties make their way to the centre point between them and meet. They exchange names and the last memories they had before their boats sank and they washed up on these unforgiving shores. They express their feelings about being stranded and argue about what should happen next.

“We should sue the university for negligence!” the law student proposes.

“Negligence is but a social construct,” says the arts student.

“The mitochondria is the powerhouse of the cell!” the medical student blurts out, trying to be useful. Alas, it is of almost no use, as the medical student has not yet undergone metamorphosis into the clinical stage of its life cycle.

They converse for several hours before hunger becomes the predominant emotion, and they decide to split up in search of food. The medical student manages to catch a fish using a suturing needle and thread that it found in its pocket. The law student starts a fire using its spectacles and one of the more boring law textbooks (to clarify: the textbook is of a flammable use as opposed to an instructional one). The arts student is usually herbivorous, but makes an exception due to being stranded on a desert island (a scenario it has frequently been asked about before) and cooks the fish for the group to share. They sit down to their first meal as castaways, and by the time they finish, the sky has begun to grow dark.

“We need to build a shelter to defend ourselves from the elements,” the law student states sensibly.

“You keep the fire burning for the rescuers, and I’ll weave a tent out of flax,” says the arts student.

The medical student begins to recite the steps of the Krebs cycle but soon realises that the others have already walked away and begun their practical tasks. The medical student instead amuses itself by subtly inspecting a mole on the law student’s chin to determine whether or not it could be cancerous.

By nightfall, the three youths are sitting in unprecedentedly close proximity under a cube-shaped flax tent (it’s rustic-avant-garde, the arts student had said). More importantly, they seem to be defying the laws of nature by talking about things they have in common.

“We hate Turnitin,” the law student says.

“We love coffee,” the arts student adds.

“We all have bones,” the medical student offers. The other two nod sympathetically.

They lie in silence as the world around them grows darker and more uncertain. They know not whether they will survive the night but they do know one thing: they are not alone.

***

Professor Mitchell leans back in her chair and clasps her hands across her lap. It has been another long day for the Dean of the Medical Faculty. Blue light flickers across her face, reflections of the hundreds of video screens displayed before her. Each screen reveals a fresh scene of carnage: law students smothering arts students with white powdered wigs; medical students trying to perform chest compressions on themselves.  

But there, in the bottom left-hand corner, marked Simulation 59314, is the breakthrough that has eluded the faculty for decades. A bespectacled law student, a blue-haired arts student and an emotionally vulnerable medical student are sleeping peacefully, side by side on a desert island. Professor Mitchell picks up her cellphone and excitedly hits speed dial.

“Michelle,” she says, “I’ve got an idea for improving interfaculty relations.”

A Good Resus

By Jason Ha

2018 Auricle Writing Competition: Clinical Winner

The Emergency Department had had a quiet Friday evening, and as usual, no-one
dared to actually utter the ‘Q’ word unless they were ready to face the wrath of some
veteran Emergency staff. Just a few broken bones, a few cases of pneumonia, and
the typical bread and butter glorified GP cases – just the usual.

It was a quarter past eleven, and I had just finished documenting the details of my
previous patient, when the ANUM appeared at the door of the hub, straddled the
door frame and announced, “10 minutes before our urosepsis gets here. Get
everything ready.”

I had always wanted to see a resus in action, to feel the adrenaline coursing through
my veins – it had only been a few weeks earlier that I had taken part in a simulation
session. There were certainly recounts about how an effective resuscitation would
ensue: clearly defined roles, a steady stream of communication, a strong leading
clinician who were the eyes and ears of a smooth seamless operation. Patient
saved. Simulation session successful.

I’d been strongly encouraged to take part in a real resuscitation, to put what I’d
gained into practice, to refine those skills and to see the ED clinicians in their
element, so when I was asked if I wanted to be involved, I seized the opportunity.
By the time I’d gathered my belongings and opened the curtains, I was greeted by a
flurry of activity: putting on gloves, drawing up medications, powering up the
defibrillator and monitoring system, checking the oxygen, readying the resus
paperwork.

“Ready? Ever done CPR before?”

“A few times. But never on a real person before.”

“Well, now’s your chance.”

It was all I needed to understand the gravity of the situation: this was a grandmother
who only just half an hour ago had been at home, laughing at a TV show with her
husband, on the phone with her two children, or Facetiming with relatives from her
native home country.

And as she was wheeled in by paramedics, I could see her laying on a stretcher limp
and spread-eagled, devoid of the pink flush of life, with each passing second
punctuated with the pneumatic hiss of an automatic chest compression system.
Even among the clamour of the beeping monitors, the clatter of medication vials, and
the cacophony of voices, I could just pick out a few snatches of the conversation.
“82 year ol—yes, from home with her husb—”

“—ext dose of adrenaline ready!”

“—vious history of a UTI, felt unwell after dinn—before she collaps—”

But it seemed that this was no easy resus.

As I alternated in and out of hovering out of the way and performing a cycle of
compressions, I was aware of the hiss of oxygen as two airway doctors managed her
airway at the head of the bed. I could vaguely hear the drill of an intraosseous port
being inserted into the head of her tibia by a nurse, who had only shown me the
technique earlier that morning. I glanced over and saw that the senior registrar, who
had only earlier that week single-handedly managed cases of ruptured ectopic
pregnancies and trauma, had beads of sweat collecting on her forehead, as she
positioned herself to place an IV line amidst the jostling of the arm, dangling
precariously off the side of the bed.

I hadn’t noticed that an hour had passed, nor the fact that my stethoscope had fallen
off my neck during CPR and lay forlornly on the resus bay floor. It hadn’t occurred to
me that I was drenched with sweat, or the fact that it was now a Saturday. And as I
returned to my umpteenth cycle of compressions, I felt a hand on my shoulder.
It was over.

It didn’t matter now that the paramedics had arrived at hospital within just 20 minutes
of her collapsing at home. It didn’t matter that we were a well-oiled team, rehearsed
to the very last detail. In fact, it didn’t matter that we’d done everything we could,
given her all the right medications (even gone for an intraosseous line!) and placed
lines, ports, and leads in nearly every part of her body in our unsuccessful attempt to
revive her.

I gathered my belongings and was ushered out of the cubicle by a nurse. As I turned
back to look, I could see her husband cradling and sobbing into her left hand, and I
realised that—despite all my training, the numerous tutorials, simulations and
drills—nothing had prepared me for this.

My medical training could train me to mechanically recite the DRSABCD algorithm,
and practise advanced life support until it was imprinted in my memory. I could tell
you the number of times that I’d practised and even taught the correct technique for
compressions, even list out every single MET call situation when I had been a
bystander.

Yet this was controlled chaos – the only way to describe the choreographed and
calculated way each clinician moved through the resuscitation bay, directed by a
consultant standing at the foot of the bed, with hands in his pockets. Everything was
orchestrated, thought-out, planned – no miscalculations or missteps, a symphony
without a baton, a performance without cues.

Ultimately I wished I hadn’t been so naïve and that I could have prepared myself
better. But there was no way I could have. The gruelling nature of the operation, the
futility of the whole exercise, the difficult decisions to cease resuscitation, the ephemeral nature of human life, and the emotional aftermath: these were all things
that I could have only learnt by being present. These were lessons learnt the hard
way.

But despite it, there was nothing I could have done anything differently, and perhaps
in some ways, it is a rite of passage for many of us in medicine – an emotional
catharsis of sorts.

As I left the ED, I bumped into the ANUM at the exit, who gave me a weak
exhausted smile.

“Now what you saw back there—that was a good resus.”

The Balloon

By Jasmine Elliott

Auricle Annual Writing Competition 2018: Pre-clinical Runner-up

‘Toughen up,’ ordered the grade 6 teacher at the student upset with their C in a history assignment they had spent hours on.

‘Just let it go, who cares?’ laughed a friend when the year 9 student came to them, frustrated with the bullying that permeated their friendship group.

‘You’ll never be a good doctor if you care so much about everything,’ shared the doctor who had spent the prior twenty minutes lecturing the year 12 student about how they didn’t suit the medical profession.  

‘The people who don’t care as much always do better,’ reflected a friend after the year 12 student told them about yet another application that fell through.

‘Maybe you should take a leaf from their books.’

And so I did. I took their leaves and transplanted them into my metaphorical tree. I began to shift my perspective; from valuing the act of caring, to seeing sensitivity as a flaw, something that had and would continue to hold me back. I would still care… a little. I would distance myself; close enough that I would do well, but detached enough that when things inevitably fell apart, I could immediately bounce back and keep looking forward. I would no longer be seen as weak and malleable, but strong and steady.

Sweaty palms and shaky knees transformed from fear to fuel. A composed face and rehearsed smile would surpass any expression of weakness. Tears were a waste of hydration and hope always meant there was further to fall. Rejection would no longer shatter me into a million pieces, but barely leave a mark.

All of this fell into place for a perfect millisecond. I was stoic, composed and immoveable.

But I was denying myself.

Is this what success looked like? A chain of hidden vulnerability. A pursuit of insensitivity. A journey to diminished feeling. An escape of emotional investment.

As Hannah Gadsby reflects in Nanette, ‘Why is insensitivity to strive for? Why is sensitivity a particularly bad thing?’  Yes, big dreams and self-investment may have made me more prone to falling, but also had the potential to build me up. Yes, helping others sometimes meant I didn’t help myself, but in another sense helping others does help me. It’s a source of growth, of personal fulfilment and an integral part of my identity.

My caring too much had proven to be a problem, but not caring couldn’t be the solution; it’s not a choice, but something I had to compromise with. Doing well could no longer be analogous with my supply of oxygen, but I still needed to inhale hope and exhale hard work to survive.

My caring too much, my sensitivity, are part of who I am. My ambition may fling me into the depths of failure, but it’s also my propellant into the heights of fulfilment. As soon as I tried to skirt around the feelings of loss, disappointment and sadness, the other end of the spectrum became fractured.  

My caring too much, my vulnerability, makes me human, and this humanity isn’t a weakness but an asset. It’s the seed from which passion and dedication grows. It’s what makes both failure and success real. It drives me to do what I do, to study medicine and work to create change – we just have to make sure our hands are firmly gripping the steering wheel.

Everyone made the act of caring so binary; you care, or you don’t. I thought that sensitivity was either intrinsically good, or intrinsically bad.

This is the advice I received.

It’s become so clear that caring is not an on/off switch, but a dial in our machinery, one that we learn to control with time. An inflated balloon may burst at the touch of a needle, but without air it will never rise.

This is the advice I wish I had taken.

A Rainbow In The Shadows

By Brendan Stevenson

Auricle Annual Writing Competition 2018: Pre-clinical Winner

The closet is a strange land of diverse ideologies, trending political beliefs and outdated social norms. It’s a cluttered space to hide our skeletons and to store our gifts. It can be impossible to remember why you came here and, for some of us, impossible to figure out how to leave. That all changed for me the day an eclipsing slice of light peered from beneath the door, illuminating my surrounds. That rectangle of light became a shoreline and the world beyond it an ocean: An enigma whose waves tugged at my feet but whose depths I would seemingly never experience. My fingertips creeped beneath the door as I grasped for answers and probed the perimeters of the unknown, but it wasn’t enough. I mustered all my courage, placed my quaking hand on the door handle and stepped into the light. I interlaced my hands and placed my thumb and index finger above my head, exalting this illusory weapon of strength towards my higher self as I dived into the openness. After blasting through the surface, I was suspended in the murky waters of self-doubt and words left unspoken. I waited for a response, hanging suspended by the makeshift rope of strength I had constructed.

Shortly after, the silence was filled with the echoing words “It’s just a phase”. This was the blade that cut my rope and sent my head spinning. My fragile beliefs were shattered into indistinguishable fractals, scattered into the wind above me as I swam back to the shoreline. For many years I cast stones of fantasies into the future, longing to put the pieces back together, watching as missed opportunities rippled into the horizon. For me, this is what it felt like to come out of the closet. Those words are etched into the pages of my narrative like a watermark, the story never to be read the same again. I regret taking these words as a gospel and rejecting my identity as this cultivated a willingness to be shaped by the razor-sharp edges of rigid ideologies. This became a habit of commodifying my soul for social currency. The curation of an idealistic self to meet the expectations of others is act of daily mask wearing, constant tongue biting and facial flushing. It is building a life upon the emotional rubble of denial which widens the gaping abyss between truth and lies.

It can be impossible to live stranded on an island or locked in the dark. Yet our society raises the tides and bolt down doors with ideas of normalcy and a fear of the unknown. These closets are not unique to sexuality and gender, but apply to race, religion and any individualistic trait of self-identification. The danger of self-denial is not merely the truth that keeps us trapped, but instead the wider cognitive framework that it encompasses. It has taken many years to reject those words and to comprehend that even our idols may not understand us, and that we may not understand ourselves, and that’s ok. There is often a moment in our lives when we realise that these walls that entomb us are mere lines in the sand. In my case it was realising that I was shackled by comfortability, wrapped tightly by fear of exposure and controversy. Today this is no longer the case. Instead I wield the flame of individuality and set alight to the pages of my history in an effort to incinerate the parasitic dogmas which plague our societal narrative. This revolution begins with a spark, a toe in the ocean or a hand on a doorknob, and ends in a roaring fire. It is the melting away of masks like candle wax, returning their malleable like clay for us to shape into our own works of art.

I am not suggesting that piercing the veil of cognitive biases and unbolting doors is an easy process. Yet once the flames settle a phoenix will rise from the ashes, a symbol of freedom and liberation that will take our society to great heights. To a land where doors no longer exist and oceans can be traversed. As medical professionals, friends and parents we are in the position to float a raft to anyone who may be drowning or stranded. I urge you to consider the oceans, the shorelines and the flames that reside behind closed doors, and to nourish the strength it takes to leap into the unknown. By alchemising our biases into a precious stone like state we can harness the kaleidoscopically vibrant light of individualism, because in the dark a rainbow goes unseen, even if it is just a transient “phasic” beauty.