AMSA Panacea: Volume 51 Issue 2

PANACEA OFFICIAL MAGAZINE OF THE AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

Find Your Fire VOLUME 51 ISSUE 2 NOVEMBER 2017

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Editor’s Foreword

What drives you?

Regardless of your dreams, goals, or aspirations, we all need that flame within us to keep us going.

Sometimes, this flame flickers.

Sometimes, it burns out - that’s your time to refuel.

This “Find Your Fire” edition of Panacea is a collection of works from medical students (and a doctor) from all over Australia. These works all represent the author or artist’s own individual flames.

In the process of choosing a theme, I wanted to create a magazine that could resonate with each and every reader, and I would like to thank the creative contributors of Panacea Volume 51 Issue 2 for making this small dream come true.

I truly hope that you enjoy these works, and that they add a sparkle of fuel in your journey to find your fire.

Warmest regards, Michelle Kim AMSA Publication and Designs Officer

PANACEA Magazine

Volume 51 Issue 2

CONTENTS 6 8 10 11 12 16 20 22 24 26

A Letter To My (Maybe) Consultant Self Maddi Taylor Fracture At Five Thousand Tarren Zimsen For Life, Liberty And The Pursuit Of Hoppy-ness Helena Franco Finding Your Fire Kai Yuan Tey Almost Anatomical Lauren Squires Letters From The 2017 AMSA Event Convenors National Convention: Scott Ashby Global Health Conference: Holly Richter National Leadership Development Seminar: Honor Magon + Ming Yong Rural Health Summit: Nilasi Senevirane + Ryan Horn Saying No Erika Strazdins Two Difficult Patients Andrew Wang Heart In Hand Thomas O’Donnell Find The Fire That Burns Twice Carrie Lee

27 30 31 32 34 36 38 40 42 43 44 45

Vector Feature Article: Turning Up The Heat Tara Kannan The Eternal Flame In Medicine Jessica Win See Wong Frontiers Feature Article: Rural General Practice Dr Aneesa Iqbal Fire In the Shower Giselle Bravo It’s Not Enough Rachel Wong Women in Mentorship Program Rhea Navani Fire Comes From The Heart Niranike Jeyarajah Developing Leadership Jeffery Wang Find Your Fire Sarah Tan Letter To Myself Bernard Koh Re-igniting The Flame Gretel Whiteman Through Enlightenment Or Conditioning Linda Alexander

a letter to my (maybe) consultant self,

By Maddi Taylor (Griffith University, IV) Maddi Taylor is Vice President Internal of the Australian Medical Students’ Association. She has just completed her final year at Griffith University and will be working in Townsville next year.

Maddi, It’s been a long time since finishing medical school. I wonder which specialty you ended up choosing; OBGYN, neurology or something I haven’t even considered yet?

I wanted to write a letter after finishing those final exams and the two years of placement to remind you of how it felt to be a student. Remember the first day of every new rotation? I had no idea where anything was and trying to find the right registrar or the right ward was always difficult.

There were so many times on rotations where you were questioning why this was the course of management chosen for the patient, how they ruled out the alternative differentials or whether anyone had considered another medication. But the opportunity to ask questions was few and far between and bedside teaching happened so infrequently that you didn’t know how to prepare for it. You always looked at the consultant, the one making all these complex decisions, wondering of their thought process while wishing they would share it with you.

Do you remember how you felt like a valued member of the team on ED? Where you were given your own patients to work up, take extensive histories from and report back with your assessment? That opportunity to hone your clinical reasoning was probably the best part of your clinical placement and taught you the most about being a doctor. Those experiences with patients every shift where they were ‘your’ patients really made you remember why you started this degree to begin with.

Do you remember how humiliating it was in orthopaedics on your first day and you were expected to know who the consultant was, where the patient list was and to have reviewed their full case and relevant anatomy before hand? That was a tough day; but you got through it. Or the renal ward round where you were brutally quizzed about electrolyte imbalances in CKD patients and scoffed at for not knowing the answers? Teaching by humiliation certainly made you study more but it was one of the lowest points of medical school. Don’t forget that, and make sure you call it out in others whenever you see it taking place. And that goes for not only medical students but interns and registrars as well. Lead by example in the way you want others to treat their students.

Do you remember how special you felt when your consultant took a special interest in teaching you when it was an area you were interested in? Being able to spend entire days with the OBGYN consultants opened your eyes to what a career in that field was like and made you love the speciality even more. It was so special

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to have the consultant mentor you and provide advice about getting onto the program. You worked so much harder to impress them because of how much you respected them. Make sure you be that mentor for as many as you can, everyone needs guidance and advice at the very beginning.

Most importantly, stay passionate about education. The Hippocratic Oath states: “…to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures and every other mode of instruction, I will impart a knowledge of the art…to students bound by this contract and having sworn this Oath to the law of medicine.”

Clearly training new mdical students was an integral part of being a physician over 2000 years ago. It is astounding how many doctors still fail to realise the importance of passing on their knowledge, expertise and wisdom. Clinical acumen is something that takes decades to accrue, make sure you impart just some of your knowledge onto your students for what little time you have with them.

I hope you are doing well and enjoying wherever we ended up!

From, Your medical student self

P.S.: Oh and don’t forget to buy your students coffee.

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Fracture at Five Thousand

By Tarren Zimsen (James Cook University, VI) Tarren Zimsen is Treasurer and Executive Director of the Australian Medical Students’ Association, he is also a final year medical student at James Cook University. The inspiration for this article occurred whilst travelling after a 6-week elective in South Africa.

57 days living in Africa would have to be the highlight of my medical degree. The clinical training in the trauma unit of the Tygerberg hospital in Cape Town was a perfect base to explore the marvels of the rainbow nation. On completion of my rotation I took the opportunity to head over to Tanzania and do some hiking. At 5000m above sea level we pulled into camp and I got a tap on the shoulder. I had thought my clinical medicine component of my trip was well and truly over, but little did I know work needed to be done.

Headache, vomiting, insomnia, and dizziness are all part and parcel of acute mountain sickness. I had hiked to these altitudes before, but this time I was really coping a beating. For an individual that never takes a paracetamol, I was burning through my painkillers, on max doses of Diamox, and struggling to eat anything or get any quality sleep.

On Day 5 of the hike we left the Myra Hut (altitude 4100m) bound for Arrow Glacier (altitude 4970m). This was a reasonably non-technical section but the accumulative fatigue and altitude was taking its toll. Finally, we pull into camp. It’s about zero degrees, I am exhausted, I have a headache and I just want to lie down in my tent. I drop my bag and I am about to open the zipper when Thomas, my porter, taps me on the shoulder.

“Doctor, doctor, one of the porters is injured. Can you have a look?”

“Sorry, Thomas,” I explain. “I am only a medical student, I haven’t finished training yet. There is nothing I can do.”

“He fell over. His wrist is really painful.”

“Okay,” I state, “I’ll have a look.”

I walk over to the porter’s tent and “Gaps” is sitting in the corner holding his right wrist. It is swollen and tender on the radial side. No snuff box tenderness, normal examination of the hand, elbow and shoulder.

No other injuries noted and I breathe a small sign of relief as everything neurovascular is intact. I suspect a possible distal radius fracture. I need X-Rays and a cast. Crap - I’m on a mountain and not a single other person to give me any help.

I’ve got a fracture to set at 5000 metres.

By this time, I have 22 porters around me. Some are taking photos on their phones, a lot of them yelling at the patient, some of them trying to give me advice in a half-Swahili, half-English language that a lot of them spoke. The director of the company was looking at me for advice. Sometimes you are not the right person for the job, but you are the best available. This was the situation I found myself in. By running away from this problem, I force someone with less experience and less skills than myself to make this decision.

I grab some fire wood from around the campsite, an old crepe bandage that someone handed to me, and I

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splint the arm. We grab a sheet, cut it into a triangle and put him in a sling. There is one slip of paracetamol in the very underdone first aid kit and so we give Gaps a couple of those. Then I look at the director and say, “He can’t work anymore, I think it is broken. Let’s walk him down and get some X-rays.” The following day the entire expedition made it to the peak of the mountain and in 36 hours I was back at the hotel with zero symptoms of my mountain sickness so I went to visit Gaps. Colles fracture of the distal radius, he was to stay in a cast for 6 weeks and everything was back to normal.

On reflection from this incident I could draw so many parallels to my medical future as well as my day to day life.

The first thing that I realised that in medicine, student leadership or in life: “Failure to make a decision, is making a decision.” When the chips are down and people are looking for a call, you must make a call.

Over the next 36 hours following the incident, I became more and more comfortable with the decision. Not because I knew I was correct, but because I knew that it was the best that I could do with the facts that were presented. Although I did get this call correct, it could have just as easily have been a sprained wrist.

I would have evacuated two porters two days early and forced the remainder of the workforce to carry extra weight for no reason. Hindsight is 20-20 and over-analysing the mistakes that one makes, although is critical for personal learning should be undertaken very carefully. At the end of the day everything we do has a risk, but the better and the quicker we become at assessing and accepting those risks, the more comfortable we will be with making decisions whether they be big or small.

The second lesson learnt was that as a future medical practitioner you must always be hyper-aware of your environment because there is a fair chance someone else is having a worse day than you. Whilst it might be tough to be a caffeine-deprived medical student with a long case to prepare for, you are surrounded by members of society that are the sickest they have probably EVER been. Being polite and caring when you go to take bloods, put in a cannula or taking five extra minutes to explain the surgery can really go a long way for the patient and have very minor impact to yourself. The stresses of medical school and being a junior doctor are real. By no means am I trivialising the constant absorbing of pressure that we have all become so used to dealing with. What I personally want to draw attention to is the power that one has in these positions. For patients sitting in ward beds for days, sometimes weeks, on end, a 10-minute conversation can and does go a long way.

As my medical school days come to an end, what I am slowly coming to realise is that the career we have chosen will be greater than ‘simply a job’. People will look for guidance and advice in all corners of the globe. Being able to clear your mind and make a decision that is in the best interest of the patient is a challenge that we will constantly have to deal with. Most of these decisions we will get right, but sometimes we won’t. Ensuring that we have the appropriate cognitive frameworks in place to appropriately deal with the inevitable, is essential for all.

Four weeks later, Gaps found Tarren on Facebook and sent him a message - everything is healing well, and he should be back to work shortly.

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For Life, Liberty and the Pursuit of Hoppy-ness

By Helena Franco (Bond University, V) I recently completed my elective at Yale University, as a visiting international student with the Ear, Nose and Throat and Head and Neck surgery service. It was a fantastic opportunity, the best surgical education I’ve received during med school, and an experience I’d highly recommend to any interested students!

It was a quick and initially uncomfortable adjustment to the American way, with post-Conventionexhaustion and a jetlagged Monday morning 10-hour mandibulectomy and fibula free flap reconstruction.

However, once I worked out the correct timezone, it was the best learning experience, and certainly the best surgical teaching I’ve had, being encouraged to scrub in and assist in every surgery.

The opportunities I received at Yale were unparalleled. In just one rotation, my general surgical skills, surgical anatomy and clinical reasoning all improved so much. However, I was still writing “oedema” in notes, referring to operating rooms as “theatres” and using the wrong vowel to spell “GORD”. From the operating room, to clinics and journal club, I’m so grateful for the warm welcome I received from Chief Yarbrough and his wonderful ENT, Head and Neck team at Yale.

During our limited spare time, a second year medical student took our group up the Harkness Tower for the famous playing of the bells, I went to watch a Good Charlotte concert on campus, experienced a Yale University White Coat Ceremony, and used a map to find the cardio room in the 14-storey PayneWhitney Yale Gym, just casually built in a gothic castle.

Despite being mistaken as British almost every day, and failing to find Dr Grey or Dr Karev roaming the surgical ward, it was an experience I’d highly recommend to keen students. I applied through Yale Medical School, and the application process is very clearly detailed on their website. If you are successful in securing an elective there, please get in contact so I can give you the address of the best pizza and beer bar in America, so conveniently located a few minutes away from the University!

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Finding Your Fire

By Kai Yuan Tey (University of Tasmania, II) In an interview with the New York Times in 2013, Dr. Khaled Hosseini (a physician and novelist in the United States of America) has described that Medicine as a profession is one that requires patience, perseverance and discipline.

Many bright individuals have decided to read Medicine and settle on it as a career for altruistic purposes, however it is not hard to realise that many would find their passion burnt out by the end of medical school. For instance, in the book - When Breath Becomes Air, Dr. Paul Kalanithi has mentioned that despite medical students often entering medical schools with aspirations to become surgeons or entering specialities that people would often described as fulfilling yet comes with poor work-life balance, towards the end, many have instead opted for a specialty with a better work-life balance. In my humble opinion, this is largely due to the intrinsic nature of medical profession which easily leads to both physical and mental exhaustion. The journey to the end of medical school is gruelling and what it requires of us after that is the willingness to embark on a life-long process of learning, keeping current with the latest knowledge and technologies, as well as the ability to constantly be empathetic – putting ourselves in our patients’ shoes. Furthermore, by the end of medical school, many of these people would be at the age of starting a family, leading to a shift in priorities in life. Personally, I do feel burnt out at times as well from the constant grinding to keep up to mark in medical school, however I also do believe that it is important for one to continue to constantly find their fire and refuel it as it is only then that it will be fair to those who entrusted their lives into our hands.

I believe that as part of self-care, it is important for us to take a break once in a while regardless how busy our schedules are. Taking a break allows us to recharge and recover from our mental and physical exhaustion. It prevents burnout and allows us to reflect on our actions and practises so far and therefore enabling us to act on them and hence benefit our future patients further. Also, by a having a break, it also allows us to strike a balance between work and family, strengthening our relationships and building up social supports, which would be beneficial to both our families and ourselves in the long run.

Similarly, it is also important for us to keep a life outside of medical school. We should continue to pursue our passions, be it sports, music, painting et cetera, as this would benefit our mental health and takes off the stress. We should catch up with our high school friends, who are not in medicine, occasionally as well.

It is only when you can take care of yourself and prevent burnt out, that you can better take care of others. It is important to bear in mind that medicine as a profession is a life-long journey, it doesn’t end after medical school or anytime sooner. It is tiring and gruelling and the journey may put off the fire in you at times, but that is exactly what makes it fruitful and fulfilling. Hence, I urge everyone that when you feel like giving up or feel that you are really burnt out, just take a break, and recall the very reason why you started out this journey.

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ART// Lauren Squires

(University of Queensland)

Lauren’s complete collection can be found on her Facebook page, “Almost Anatomical”.

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From your

convention convenor 2017 scott ashby With no exaggeration, I can say that attending my first Convention fundamentally changed my life.

I couldn’t believe what a group of students had achieved in creating this experience. It inspired me, and reminded me what our cohort is capable of. It changed my perception about Medicine, I felt re-energised for a degree that had become exhausting and confronting in so many ways. I met incredible friends who challenge me, support me, and who I am in awe of. My future career pathways broadened throughout the week as I realised all the potential directions my life could take. I for the first time felt comfortable to explore being gay because not only are all kinds of diversity common at Convention, but they are also celebrated. I got on the plane home a different person, incredibly glad that it had happened (and very sad it was over).

Really the only experience that has topped my first Convention in terms of life-changing experiences, was convening Convention three years later in Sydney.

Two years in the making, but what a ride it was. I had the great pleasure to work with a team of incredible leaders and all-round stellar humans, who I can’t thank enough for what they taught me and for making the experience the adventure that it was. I wouldn’t have had it any other way.

To all of you that attended Sydney Convention this year, I hope your lives were also a bit changed by it.

To all of you that didn’t, no hard feelings, but do what I did and listen to your friends when they say, “you need to go once”.

Perth and Hobart, over to you. Get excited, I know I am.

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From your

ghc convenor 2017 holly richter Dear AMSA member and fellow med student who should be studying but has better things to do, Allow me to take you back to 2014. I remember my first AMSA Global Health Conference so clearly. We arrived in sunny Sydney, dropped our bags, and walked into the weird and wonderful Masonic Centre; I was a first year and had literally no idea what to expect. What happened next was epic and truly a once in a lifetime opportunity. Over the next four days I heard speeches from interesting and exciting people who'd come from literally all over the world to cover topics that I had always been passionate about, but until now had never actually done anything about because, frankly, I didn't know how to. At the morning tea breaks, and at night during social, I made friends with other excited and passionate young students and I soon realised the power of GHC to not only inspire us, but teach us what to do with that inspiration.

When I was told my team and I were going to host GHC2017 in Adelaide I felt so overjoyed at the idea of being able to pass on this legacy to our delegates. At the heart of everything we did for GHC2017 was our vision: Inspiring, Empowering, Creating Change. It's not enough to feel emotional after seeing an amazing speaker, or to have a d&m at social about political injustices and our public health sector; you have to be given the tools to take that passion home and turn it into action. This is what my team and I wanted to do for GHC2017, and I'm so thankful to all our legendary delegates for coming with us on that journey. Over four days and five nights we showcased the best of Adelaide; the politics, social issues, and future of global health; the multitude of ways in which you can get involved and, most importantly, stories from around the world about real people, real systems and real solutions to complex problems.

GHC2017 was an inclusive, sustainable and life changing conference that AMSA is extremely proud of.

My med school journey is ending now, and soon I'll be an intern. I look back on the last four years with fondness and incredulity, and AMSA has played a huge part in not only shaping my experience, but changing it for the better. I encourage you to make your time in medical school something you're proud of, something you love, and something you'll always cherish as uniquely yours and entirely rewarding. I also encourage you to be a leader. The standard you walk past is the standard you accept. Never stop fighting for what you believe in, never give up and never forget that you are one of the most fortunate people in the world and this is not only an absolute privilege, but a great responsibility. We are so lucky, living here in Australia and attending some of the best medical schools in the world. We are surrounded by wonderful friends and teammates and an endless supply of resources waiting to be tapped into. Make something of your excitement, your passion and your dedication and leave the world a slightly better place then when you entered it.

With so much respect and a healthy dose of global health love, Holly

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From your

NLDS Co-Convenors 2017 honor magon + ming yong Connect, Inform, Represent. This is, as we all know, the central vision of AMSA. In a speech addressing AMSA 3rd Council, Rob Thomas, AMSA’s incoming president, commented, “[…] we often talk about the represent part of AMSA but we don’t talk about the connect and inform, which is just as, if not more, important for the people in this room.

Why do we keep coming back to AMSA? It is because of the connections we form and the information we gain […]”

We are examples of AMSA’s first vision “Connect,” somehow always returning to the organisation within arms-length of each other. We both met at Third Council 2014 in Hobart, Ming as part of James Lawler’s NSW Executive Bid Team, and Honor, the Deputy Convenor of the Brisbane 2016 Convention Bid Team. In 2016, we encountered each other again, having walked substantially different paths than originally imagined, but both holding the same roles for two of AMSA’s biggest events – Ming, the Publication, Promotions and IT Officer for the 2016 Newcastle GHC, whilst Honor, the Promotions Officer of the 2016 Townsville Convention. However, this would not have occurred had Ming not reached out to Honor in 2015, urging her to still remain involved in the opportunities that AMSA provides.

Our story is one of many within the organisation that demonstrates the influence AMSA has at connecting medical students across the country. Both of us recognised this, and this, the power AMSA has at connecting medical students, was the basis of our passion toward co-convening NLDS2017. In 2017, we dreamt of an NLDS where delegates attended the conference ambitious and passionate, but leave upskilled, with the tools and inspiration to see their passion to the next level. Most importantly, we wanted delegates to leave NLDS2017 more connected to AMSA than ever, and above all, to leave with the power of being connected to each other. We want to see these connections shape the future of AMSA, to see these connections take flight in future AMSA Executives, committees, and event teams.

After NLDS, we saw the roots of wonder and passion slowly establishing throughout AMSA, eager to grow when their time was right.

We have had the privilege and honour of seeing so many of our delegates again since NLDS, and each time, they come to us with a story of a new endeavor they’ve embarked upon. From NLDS, we have produced advocates, we have produced organisers, we have produced team players and we have produced creatives, that will go on to serve AMSA and the greater medical profession for years to come.

To Jess, Andrew, Ynez, Brett, Han, Lindsay, Cathryn and Vru – thank you for sharing in this journey with us, and thank you for choosing to continue your leadership journeys. We look forward to our reunion in 2018 where we can play Space Team again. Through the diligence and hard work of our team, we have seen our dreams realized. For that, we are truly grateful.

If you see yourself as an aspiring leader in medicine, or perhaps are curious about what opportunities there are outside of medical school, we urge that you apply in this coming year.

It is a game changing experience. We look forward to calling you our colleagues very soon, and are excited to see others flourish in the near future.

Yours in orange, Honor and Ming

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From your

RHS Co-Convenors 2017 nilasi seneviratne + ryan horn You know that feeling when you’re on a rollercoaster and you feel that thrill of hurtling down a semi-unstable metal track: wind blasting your cheeks, tears from screaming/laughing too hard tracking into your hair, and the familiar anxious twist in your stomach. That pretty much sums up what we, as Convenors, felt organizing RHS. Would we do it again? A thousand times yes.

If you haven’t heard of RHS17, don’t worry – we’ll give you a proper education that’ll give Armando Hasudungan a run for his money. What is RHS? The AMSA Rural Health Summit, otherwise known as RHS, is like the baby sister of the AMSA Events family. It’s a national conference that brings together medical students across Australia who all share a passion for rural health. The event was initiated in 2016 and being only our second year running, RHS17 ended up being exactly what we envisioned and more.

In 2017, RHS was held in the beautiful City of Wollongong, NSW over a sunny spring weekend, and brought together just over 100 medical students across Australia. We had legendary keynote speakers such as Dr Gerry Considine, amazing rural-health focused workshops covering Indigenous Health to rural mental health, and plenty of interactive breakout sessions.

The rural weekend was capped off by an insanely wicked night boogying at our Cocktail Gala. The entire event went off without a hitch all thanks to the wonderful RHS subcommittee and the energy brought by the wonderful RHS delegates.

As Convenors, we jumped into this project passionate to make our mark in the long future RHS will have. We doubled the number of rego spots, moved the conference to a regional town, and flew in some truly phenomenal rural health leaders – all while keeping rego at sixty-five dolleroos. That’s right - $65. An absolute bargain.

The moment we kind of realized how amazing RHS was going to be was when registration sold out in under 1.5 hrs. That was a truly special moment for us and showed us that there are a huge number of medical students passionate about rural health.

After months and months of slaving away to organize RHS, it went by as fast as it came.

Before we knew it, we were tearfully saying our goodbyes to a team that had become family and wishing we could rewind back time so we could relive the excitement that was RHS. We’re a little biased, but RHS was one of the top highlights of 2017, second only to Steve Harrington in Season 2 of Stranger Things. It was incredible to see so many enthusiastic students under one roof who were filled with so much passion and drive to instigate change in rural health. As Convenors, it was humbling to know that we were standing amongst a building full of future rural health leaders and medical professionals committed to improving the lives of rural communities. If you want to be part of the fun, make sure you keep an eye out for RHS18 because I promise you, it’ll be a hoot and a half.

From, Nilasi and Ryan

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•

Saying No

By Erika Strazdins (University of New South Wales, VI) That Fear of Missing Out Tutoring, several exciting research projects, conference presentations, publications, medical society positions, mentoring, volunteering, committee positions, work opportunities — there is a limited supply of these and often intense competition amongst medical students for them. Preparing for the competitive medical workforce makes you realise that you need these experiences and connections, and want to take every opportunity that comes your way. That FOMO makes it hard to say no.

I’ve experienced it personally, and I’ve also seen it in peers — we bite off much more than we can chew and “balance” essential tasks (lectures, tutorials, clinical placements, assignments, and the study set by our supervisors) with these other, extra-curricular opportunities. Then adding in more mundane things like work to pay the bills and domestic duties, we are lucky if we can squeeze in the building blocks for wellbeing — relationships, exercise, sleep, and hobbies. Achieving “balance" in these aspects of a medical students’ life is only ever transient — as each is its own dynamic system. This balance needs some extra give, and so that is why understanding how much you can do well, and when and how to say no is an important skill for self-care now and your future career as a medical professional.

How to Decide When presented with an exciting opportunity take a moment to think: • How exactly will this help with my future goals?

• Will this improve an area I need to develop?

• Is this in my best interests, or the person who is asking?

• Is this something I would enjoy?

Be honest with yourself about what you want, and this will help you to prioritise and know when to say no.

How to Respond “No” • Be tactful “Thank you for thinking of me, but I am afraid that I won’t be…”

• Be honest and succinct in your reasons Too busy — “I’ve got a lot on at the moment and don’t think I would be able to give this the time and energy it deserves. If something similar comes up later in future, I would love to be part of it.”

Not in line with your goals — “It sounds really worthwhile, but at the moment I am a bit more interested in [XYZ]” • Be ready to repeat no “Thank you again for asking me, but I won’t be able to commit to this right now."

• Recommend someone else — give them an opportunity “I know of someone who is really passionate in this area and extremely capable. Could I introduce you?”

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“Maybe” • Give a time frame for an answer “I would love to get involved, but I have a few things on at the moment that I need to check first. Would you mind if I got back to you after the weekend?”

• Seek more information to inform your answer Especially if you are unsure about how much work this new endeavour will take (ask someone on the team or who was there before you or in a similar position) or if you are unsure how it will contribute to your goals (ask a senior or mentor in the area of interest).

“This sounds interesting, but to I am not familiar with it. Could you give me some more information about what this involves so I can think it over?”

“This is all very new to me, and I want to be sure I am suitable. I might just ask a couple of people and get back to you.”

“I Still Really Want to Do It” • If after some thought you feel that this opportunity will be best for you, then say yes. However, it might necessitate saying no to something you are already doing. It can provide a wonderfu

chance to re-evaluate your other pursuits, especially as your goals may be changing or some

existing commitments may not have turned out how you thought they would.

• Saying no to something you are already involved in Honestly and tactfully communicate with all those involved — it often helps to consider the wording beforehand and run it past a friend.

Agree with the team on what needs to be done before you finish.

Arrange a clear handover.

Make an offer to be available after if they run into any problems.

Saying No By saying no, you are showing maturity: both in honouring your exisiting commitments, showing the person that you are giving this new opportunity the respect it deserves, and also showing insight into your own capacity and goals.

This article is dedicated to Professor Graham Jones, an outstanding doctor, insightful educator, and inspiring mentor — who helped me learn how to say no.

References 1. Bresnahan M, Cai DA, Rivers A. Saying no in Chinese and English: Cultural similarities and differences in strategies of refusal. Asian Journal of Communication. 1994 Jan 1;4(1):52-76.

Stewart DE, Ahmad F, Cheung AM, Bergman B, Dell DL. Women physicians and stress. Journal of women's health & gender-based medicine. 2000 Mar 1;9(2):185-90.

2. Carter LA, Barnett JE. Self-care for Clinicians in Training: A Guide to Psychological Wellness for Graduate Students in Psychology. Oxford University Press, USA; 2014.

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Two difficult patients

By Andrew Wang (Monash, V) Outside the nurses’ station, there sits an elderly lady who is on hunger strike. She has been there for the last few hours, her fierce, beady eyes staring down anyone that happens to catch her gaze.

Her hair is grey and her wrinkles line a dignified face that had once held stern authority. A professor of mathematics in a past life, in a world far removed from the slow-moving chaos of the geriatric rehabilitation ward. Most of the time, she is silent because speaks Mandarin Chinese. But now and again, she screeches one of the few English phrases she knows.

“Warffin, NO!” She may have been a professor in a past life, but here, we call her the warfarin lady. Over the last two weeks, her complaints had become increasingly filled with false and intractably fixed beliefs. She doesn’t speak English so the job of translating would fall to me during morning ward rounds. In these mornings, she would plead her case with the desperation of the unjustly convicted, clasping my hands in that bony grip of hers, eyes steely with resolution. She would, invariably, request that her warfarin dose be ceased. She would say the medication makes her joints ache and her eyes red and dry. That it gave her renal failure and dirtied her blood. No amount of our gentle convincing or our stern words would convince her otherwise.

She seemed to be a completely different person to the old lady I’d helped to admit. That old lady had croaked at me in bare phrases, barely mustering the strength to sit out of her bed. We learnt from her family that her desire to cease warfarin was not newfound. Rather, the days spent in the ward had given her strength to allow her to return to her old ways of thinking - the same beliefs that had caused the very stroke which had precipitated a lengthy and immensely complicated ICU admission. As the weeks passed, it became increasingly difficult for me to translate on ward rounds. Seeing her made me feel worn out, guilty and frustrated. She didn’t understand. She was off her food again. For the last time, madam, starting the warfarin didn’t cause your stroke. She still wasn’t improving. Was it because of me? The team told me not to become attached, but I did. She reminded me of another patient, the prednisolone lady. For years, prednisolone lady had been plagued by pain and swelling in her joints.

The inflammation persisted despite a cocktail of steroids and anti-rheumatics and anti-inflammatories that only ever seemed to increase in dosage.

Prednisolone lady had been admitted to a different ward in that same hospital. There, she had been crowned in a plastic wreath of tubes and lines as the arthritis reared its ugly head, courted by a procession of the medical students, nurses, then interns as they struggled to insert a line. And she had sat there, regally accepting their apologies with a masterful command of broken English and a growing collection of puncture wounds. Years down the track, prednisolone lady stopped her medications cold turkey. The disease wasn’t getting better. The steroids were causing weight-gain and the non-steroidals were causing stomach pain. To the exasperation of her long-time GP, she turned to alternative and unconventional medicine - cupping and scraping and even bee stings until her skin had welled up with bruises.

My mother was the prednisolone lady. In her, I saw a reflection of the professor on the ward. And it made it hard to stop caring about her as she requested that her warfarin be ceased.

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Both ladies had frustrated their treating teams. They were obstinate and obstructive and distrustful of Western medicine. There is a common term in general practice to describe these patients, patients who for somehow ‘exasperate, defeat and overwhelm their doctors by their behaviour’. They’re called the ‘heartsink’ patients1. And such ‘heartsink’ patients abound. A survey of doctors in 1996 found more than 15% of more than 600 patients presenting to a primary care setting were deemed difficult2. These ‘heartsink’ patients are a heterogeneous group. Different patient characteristics manage to frustrate, concern and intimidate different doctors. But the blame doesn’t always lie with the patient. Physician factors such as burnout, poor communication skills and insecurity may make a doctor more likely to perceive their patients as difficult3.

For myself at least, it was (and still is) too easy to attribute my feelings and frustrations to patient factors. It is easier for me to call patients warfarin-lady or prednisolone-lady than to delve deeper.

All the anger tantrums and the stubborn refusals of warfarin and the bee-sting therapies functioned as evidence for a patient’s lunacy and ample justification for my feelings. I realized that the 15-minute window that a consultation allows us to peer into our patients’ lives is all too inadequate. It is hardly enough time to see them, in the darkness of early morning, ritualistically tipping anti-inflammatories into their left hand until it is filled with tablets. Nor is it enough time to see them on their off days, when their children would come home from school to find them in a dark room with blinds drawn shut and sheets pulled tight.

It’d be too easy for me to moralise here, to say that all doctors should understand their difficult patients.

But sometimes it is either not possible or not easy to empathise. Whilst this may terrify us students born into a world of empathy filled medicine, some doctors aren’t superhuman and are instead time poor, caffeine addled individuals bound again by paperwork and bureaucracy.Our medical training often teaches us an approach that portrays ill patients as walking and talking problems of the biomedical nature. And these patients can be solved. We can inhibit the cellular processes that cause them disease, fire radiation into their bodies to eradicate erratically growing cells, pull clots out of their blood vessels.

But this approach to medicine may also be the reason we have ‘heart-sink’ patients. Their problems aren’t biomedical. They can’t be solved. Rather, as Butler and Evans propose, their problems instead arise from ‘psychological, social and spiritual’ sources, sources that are difficult to decipher4. Faced with a wound that is social or psychological instead of biomedical, a physician may feel that their role as a healer is compromised. Hence, the feelings of frustration and the heart-sink that follow3.

As I sail into the sunset of my time in medical school, bedraggled but not defeated, I regret that more time had not been spent with the difficult and different. Difficult patients are not high-yield. You certainly won’t get them in your MCQs or your OSCEs. But you will get them on the wards, in your clinics, amongst your friends and, like myself, in your family. No future fifth-generation tyrosine kinase inhibitor will solve the problems of these patients. And that is why they’re important. Because ultimately, they teach us a very important lesson. They show us the importance of shifting our goalposts, the importance of understanding our frustrations and the extent of our limitations.

References 1. O’Dowd TC. Five years of heartsink patients in general practice. BMJ. 1988 Aug 20;297(6647):528-30.

2. Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JB, Linzer M, Verloin deGruy F. The difficult patient. Journal of general internal medicine. 1996 Jan 1;11(1):1-8.

3. Lorenzetti RC, Jacques CM, Donovan C, Cottrell S, Buck J. Managing difficult encounters: understanding physician, patient, and situational factors. American family physician. 2013 Mar 15;87(6).

4. Butler CC, Evans M. The ‘heartsink’ patient revisited. The Welsh Philosophy And General Practice discussion Group. Br J Gen Pract. 1999 Mar 1;49(440):230-3.

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ART// Thomas O’Donnell

(University of Notre Dame Sydney, II)

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Find The Fire That Burns Twice

By Carrie Lee (University of New South Wales, IV) Carrie Lee is the Editor of AMSA Global Health’s journal, Vector.

Every year there is a niche subset of people who voluntarily subject themselves to excruciating pain for the chance of reaching glory – chilli eating competitions.

Headaches, central cramping abdominal pain, cardiac arrhythmias, vomiting. This is just a taste of the symptoms described by feisty competitors at a recent chilli-eating competition in Canberra this year, which left one enthusiast in hospital. It’s a merciless game of plant versus human. In one corner of ring is the fearsome Carolina Reaper, the hottest chilli in the world according to the Guinness World Records, clocking in at 2.5 million Scoville heat units (SHU). Thought your snapchat was on fire? It’s a mere matchstick compared to this beast of a chilli pepper.

A few years ago, two fellow med students took a fundraising chilli eating challenge to the extreme.

The challenge was pretty simple – post a cringe-worthy video of yourself chomping on a garden variety chilli for 10 seconds, tag your friends to condemn them to the same fate, and donate to the nominated charity. But for these mavericks, regular chilli wasn’t enough – they got in contact with a chilli farmer who generously gave them the world’s two hottest chillis – the Trinidad Scorpion Butch T (1.5 million SHU) and the Carolina Reaper. The video was lit, but they spent the next day putting out the fires burning through their GI tract faster than you can say Red Hot Chilli Peppers. Apart from the quality entertainment (that sounds horrible but they lived to tell the tale), the benefits were reaped in the awareness and donations to the worthwhile charity cause.

But on closer examination of this curious case study, there are similarities that resonate between chilli eating and studying medicine. To an extent, by lighting the candle for our future careers in medicine, we too are pushing our minds and bodies to the limit, partly because we find it interesting, and partly because we think it’s a worthwhile cause. Both medical school and chilli eating competitions surely attract to a certain kind of eccentric person. The kind of people who value working towards goals, even if those goals are extreme and the path to accomplish them is peppered with challenges.

Meanwhile, as for a mere mortal such as myself, even an undercover chilli hiding in a salad results in dramatically flailing for tissues, with tears streaming like a Coldplay song. I think I’ll stick to my wimpy mild to medium sauce and save my stomach the trouble.

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Feature Article From Vector: Turning Up the Heat

By Tara Kannan (University of Newcastle, I) American environmentalist and journalist, Bill McKibben, offers a simple yet revolutionary proposition in the climate debate: “leave oil in the soil, coal in the hole and gas under the grass”.

The Birth of an Idea Divestment is a very simple idea. You just remove your money from companies that are involved in extracting fossil fuels. It’s a novel movement in the climate debate that is different from your traditional change-yourlightbulb kind of ideas. Its underlying basis is that to avoid catastrophic global warming, we will need to reduce our carbon dioxide emissions. There are three key numbers that explain this. First, remember 2˚C – that is the maximum warming aspired to in the Paris Agreement1. Secondly, we have a ‘carbon budget’ of 565 gigatons which is essentially the amount of carbon dioxide that can safely be released into the atmosphere while still complying to our 2˚C rule1. Most importantly, the third number to know is 2795 gigatons1. This is the amount of carbon dioxide that will be released if all of the documented fossil fuel reserves were burned. Addressing a sixfold rise in energy demand in the last 50 years, fossil fuels provide 90% of the energy we need through coal, gas and oil2. Yet, the US$1 trillion industry releases greenhouse gases into the atmosphere and thickens Earth’s blanket of air pollution, leading to seven million deaths per year due to pneumonia, asthma, heart disease, stroke and cancer3,4. Needless to say, carbon dioxide is a tiny molecule with a big bite. So, while we could encourage people to change their lightbulbs and switch to public transport, if companies continue to dig up and burn their reserves, then these rather feeble measures will prove useless. This is where divestment comes in - a movement about shifting your money away from the problem and towards the solution.

Turning Back Time In history, divestment has been shown to be a powerful political tool in several major movements. Exactly a generation ago, a time when South Africa’s Apartheid was our world’s largest moral issue, two prominent figures created massive change. Nelson Mandela and Desmond Tutu suggested a revolutionary tactic, imploring Western institutions to cut their economic ties with companies backing the Apartheid regime.

Experts often deem this as the model of symbolic pressure as it raised awareness and embarrassed many American businesses5. Then, through the 90s, a movement against the tobacco industry took place to shun the industry’s negative impacts on health. Along with regulation and taxation, tobacco divestment had a sizeable impact on society, shrinking the industry and smoking rates5. Most recently, divestment from companies with ties to the Sudanese government has been a major campaign which aimed to denounce the Sundanese genocide. Some Western institutions including Brown University divested; however, other investors interested in the Sudanese’s valuable resources simply filled their place. Drawing from this rather unsuccessful campaign, fossil fuel divestment activists are encouraged to weigh the impact of divesting from a company relative to giving up their voice as a shareholder.

Fuelling a Movement Nevertheless, the balance scales show that divestment is well worth the bet. Major goals of the fossil fuel divestment campaign can be captured in the following5: a) leverage the power of investors and institutions to make strong political statements and influence policy change b) raise awareness of the impact of the fossil fuel industry in our society c) lead the market to consider the effects of climate change when evaluating any investments

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d) drive capital investment into clean energy and other climate mitigation strategies Above all else, divestment stigmatises the fossil fuel industry, eroding its social license to operate and posing the largest threat to companies where any alternative measures pale in comparison. And, if you have not figured it out yet, the fossil fuel divestment campaign is not a normal movement. There are no great leaders. There is no Gandhi or Doctor King of the climate movement. But, it relies on something even more exciting: social change.

Blossoming Ideas Since its initial conception in 2010, the idea of fossil fuel divestment has been spreading like wildfire. The campaign celebrated its first major victory in mid-2014 when Stanford University committed to divesting its US$18.7 billion endowment from the industry6. Later that year, the campaign inspired the People's Climate March where a 400,000-strong crowd flooded Manhattan’s streets, demanding U.N. action on global warming5. By 2015, around 2500 investors representing US$2.6 trillion in assets had divested, including major organisations such as the Rockefeller Brothers Fund and the Canadian Medical Association7. Back home, Australian universities are making bold statements. La Trobe University, Swinburne University and the Queensland University of Technology pledged to divest their A$40 million, A$150 million and A$300 million portfolios from fossil fuels respectively8. Recently, both Monash University and the Australian National University have partially divested8. But sadly, Westpac, ANZ, NAB and the Commonwealth Bank – which make up the ‘big four’ banks of Australia — have failed to divest, instead funding the industry to the tune of A$5.5 billion in 20158.

Pop Goes the Bubble From the economic point of view, fossil fuel divestment is falsely thought to come with financial uncertainty and major repercussions. Addressing this, a key argument in the fossil fuel divestment campaign is that returns will, in fact, improve once investors have divested – an argument based on a concept called the ‘carbon bubble’. Much like the ‘housing bubble’ of 2009, the ‘carbon bubble’ has its underlying roots in the fact that our financial markets maintain an extraordinary overvaluation of fossil fuel reserves that is likely to burst5. The problem here is that, to comply with the ‘carbon budget’, all reserves simply cannot be burned, or else, there’s no doubt that we will find ourselves amidst catastrophic climate change.

More importantly, with increasing pressure from pollution regulations, competition from renewables and one of history’s fastest growing stigmatisation campaigns, the value of fossil fuels is already diminishing5,9.

Last year, energy use emissions grew less than 1% for the third consecutive year10. Oxford university researchers and commercial analysts are predicting that fossil fuels are likely to become ‘stranded assets’ which cannot be used, rendering them worthless to investors9,10. It follows that investors should prepare for such a scenario by selling their assets now rather than after the ‘carbon bubble’ bursts when investors are likely to lose money. Preparing accordingly, investors in Wall Street banks, such as HSBC and Chase, have demanded that fossil fuel companies discuss the risks of the bubble; while, oil companies, including Shell, are now committed to disclosing their asset portfolios and discussing the bubble5. Similarly, with major financial news venues such as Bloomberg and the Financial Times now backing the movement, we are beginning to achieve one of our primary aims: influencing the economy’s thinking on climate change5.

In fact, as of September 2017, US$5.53 trillion has been divested by 749 institutions8.

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Renewable Energy: A Brave New World of Investment So, you move your money away from the fossil fuel industry and then what? Many experts have shown that investing in ethical funds such as the renewable energy industry will have financial returns similar to, if not better than, the fossil fuel industry11. Renewable energy has made ambitious headlines around the world.

For instance, China recently became home to the world's largest solar farm at 27-square-kilometres which can produce 850 mega-watts of power - enough to supply around 200,000 households12. However, even though renewable technology needs to be used by all, it's only accessible to those who can afford it. Addressing this gap, many grassroots movements are committed to providing renewable energy to developing nations. For instance, one such foundation, Liter of Light, teaches communities to recycle plastic bottles and use locally sourced materials with the aim of illuminating their homes – a strategy which has received much recognition and is often adopted for use in UNHCR camps13.

The Power of Smaller Players Speaking of smaller players making big waves, medical societies and faculties, are major targets of the fossil fuel divestment campaign. As highly regarded entities within universities, they are large enough to matter but small enough to have an influence on. Most recently, the University of Newcastle’s global health group, Wake Up!, switched from the Commonwealth Bank to Newcastle Permanent – a major win in the medical scene. Although divestment will not cripple the fossil fuel industry overnight, this strategy can still operate effectively, conveying a loud and clear message of disapproval – an objective we are closer to achieving thanks to societies like Wake Up! One of divestment’s main jobs is to draw attention and challenge the status quo – a powerful opportunity to be noticed, and be remembered, in times of tragedy and turbulence. It’s a movement that inspires students, banks and universities alike to make ethical commitments and invest in a sustainable future. With global warming looming large, now is the time to blaze trails and boldly transform the climate debate.

References 1. 350.org. Do the Math [Internet]. Math.350.org. 2017 [cited 15 September 2017]. Available from: http://math.350.org/ 2. Elliott L. Can the world economy survive without fossil fuels? [Internet]. The Guardian. 2017 [cited 15 September 2017]. Available from: https://www.theguardian.com/ news/2015/apr/08/can-world-economy-survive-without-fossil-fuels 3. Macguire E. Tightening the tap on ‘$1 trillion’ a year fossil fuel subsidies [Internet]. CNN. 2017 [cited 15 September 2017]. Available from: http://edition.cnn.com/2012/07/18/ business/fossil-fuel-subsidies/index.html 4. WHO. 7 million premature deaths annually linked to air pollution [Internet]. Who.int. 2017 [cited 15 September 2017]. Available from: http://www.who.int/mediacentre/ news/releases/2014/air-pollution/en/ 5. Apfel DC. Exploring Divestment as a Strategy for Change: An Evaluation of the History, Success, and Challenges of Fossil Fuel Divestment. New School for Social Research.

2015; 82:913-37.

6. Carroll R. Major University Divests $18 Billion Endowment From Coal Companies [Internet]. HuffPost. 2017 [cited 15 September 2017]. Available from: http://www. huffingtonpost.com/2014/05/07/stanford-university-divesting_n_5276899.html 7. Rowe JK, Dempsey J, Gibbs P. The Power of Fossil Fuel Divestment (And its Secret). The University of California eScholarship. 2016.

8. Go Fossil Free. Divestment Commitment [Internet]. Go Fossil Free. 2017 [cited 15 September 2017]. Available from: http://gofossilfree.org/commitments 9. Ansar A, Caldecott B, Tilbury J. Stranded assets and the fossil fuel divestment campaign: what does divestment mean for the valuation of fossil fuel assets?. Smith School of Enterprise and the Environment. 2013.

10. Brahic C. Living with climate change: Have we reached peak emissions? New Scientist. 2017; 234: 32-4.

11. Collett J. Ethical funds outperform [Internet]. The Sydney Morning Herald. 2017 [cited 15 September 2017]. Available from: http://www.smh.com.au/money/ethical-fundsoutperform-20130712-2ptyd.html 12. Phillips T. China builds world’s biggest solar farm in journey to become green superpower #GlobalWarning [Internet]. The Guardian. 2017 [cited 15 September 2017].

Available from: https://www.theguardian.com/environment/2017/jan/19/china-builds-worlds-biggest-solar-farm-in-journey-to-become-green-superpower 13. Liter of Light. Liter of Light - About Us [Internet]. Liter of Light. 2017 [cited 15 September 2017]. Available from: http://literoflight.org/about-us/ 14. International Energy Agency. Global Carbon Dioxide Emissions, 1980-2016 [Image on internet]. 2017 March [cited 2017 September 15. Available from: https://www.iea.org/ newsroom/news/2017/march/iea-finds-co2-emissions-flat-for-third-straight-year-even-as-global-economy-grew.html

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The Eternal Flame in Medicine

By Jessica Win See Wong (University of Melbourne, III) Jessica Wong is the Editor of AMSA Rural Health’s magazine, Frontiers.

When I think of fire, it reminds me of the candle-light ceremony I participated during my AMSA exchange in Armenia. It was an Armenian tradition that at Christmas Eve, you light candles at the Mother Cathedral and take the church candle home. The candle light is a symbol of hope and blessings for the new year. I also remember the time I visited the Armenian Genocide Museum, where there was the eternal flame at the centre of the Genocide Monument. The flame is a symbol of eternal life, and one which symbolises a nation’s gratitude towards, and remembrance of, the victims of the Genocide. How does this relate to medicine? Well, I thought of the eternal flame as a symbol of passion and motivation for studying medicine.

Within my three years of studies, I have witnessed students who are passive in their learning, often finding ward rounds and clinics not worth their time and that their time is better spent on textbooks instead. I have witnessed the competition and the stress associated with striving to become a perfectionist in medical school. I have seen students questioning their choice in medicine, putting in bare minimum effort in and also getting the minimum learning out. I was there when my friends struggled and suffered from depression and anxiety. I saw my friends who lost one of their family members during their studies. I have exchanged words with a patient in one of his last days at the hospital, and vividly remembering the empty bed the next day. And sometimes, I too feel my flame for medicine is flickering and about to go out at any moment. However, I have also witnessed many patients’ health improving over time.

With appropriate support and encouragement, I have friends who initially battled with depression and slowly improved over time. The moment I witnessed the birth of a baby in the delivery suite, the times I saw a smile on a peer’s face, the moment when a patient expresses gratitude to you, it seemed like all the hard work for medicine was worth it afterall.

The motivation for studying medicine is like an eternal flame and the candle itself represents our physical and emotional health. Learning medicine should be fun. As we are all learning and striving to become good doctors, we should also enjoy our learning process. Nevertheless, many students are occupied on the idea of becoming the largest and best flame possible and before they know it, their flame has gone out. If we cannot enjoy what we are learning, how can we even enjoy doing medicine as a career? The medical journey is a tough and a long-winded one, full of obstacles and unexpected detours that may frustrate many students no matter how well they have planned themselves ahead of time. So how can we prevent the flame from extinguishing? How can we keep our passion and motivation for medicine without damaging ourselves in the face of obstacles?

First, we must choose how we want to see things in life. I myself choose to view the world through rose-coloured glasses. I believe how we choose to view and react to obstacles is the key to thriving in life. By looking at the positive side of things, we are able to turn an obstacle into an opportunity for growth. Yes, in many occasions, putting in a lot of effort may not always result in a better performance, but it is the mere action of trying hard that deserves a pat on the back. When face with unexpected detours in life, we should not avoid but welcome and embrace them in order to enjoy our medical journey to the fullest.

More often than not, it is during the times we spend on the detours that we find the things that are more important than what we wanted.

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Feature Article From Frontiers: Rural General Practice

By Dr Aneesa Iqbal (Neal Street Medical Clinic, GP) Early 2002: ‘Come on Aneesa, let’s do some visits’.

It was early 2007. My trainer, Jo, was showing me how a day in general practice usually was, the first week of my registrar year in semi-rural North Wales, UK. We made a nursing home visit to an elderly patient who was suffering from Parkinson’s disease and dementia. My trainer later told me he was an accomplished pianist and had presented initially as he was unable to play certain notes. Jo mentioned it made him sad to see this change, but also happy that he has continued to care for him. It was at that moment, that I realised that being a GP meant more than medical care. It was a journey that meant standing alongside patients through highs and lows, health and illness, births and deaths. I finished my training and moved to a larger city and then to Australia.

It was 2015 when I again saw a job advertised in Gisborne. I visited the area, a little village, quaint and beautiful, the countryside quite breathtaking. It reminded me of my very first general practice experience.

I have been working here for nearly 9 months now. The challenges of a rural general practice become easier as each day goes by. The awareness of knowing the distance patients travel to access care, the knowledge that a scan cannot be arranged the same day. The fear of trying to juggle care of the frail and elderly, not wanting to be in hospital and at the same time not compromising their safety, or care.

The biggest challenge I see is the problem of retaining a rural workforce. This is impacted by factors including young doctors with families, a lack of social interaction and distances to access further education.

Furthermore, the sense of Isolation and long hours of work deter many from rural workplaces. However, with the advancement of technology, some of these issues have been made easier, with the capacity to have video/teleconferences meaning that sending and receiving images and investigations for further advice and specialist opinion is much easier.

Looking at such perceived difficulties from a distance can seem very daunting, but if it is part of training, then it would be more acceptable. The quality of practices providing training in rural areas, the support network and mentoring would all improve student experiences. The general conception and association that somehow training and working in rural areas is less prestigious needs to be addressed at a student level. There are many advantages, such as being in a small team, the feeling of belonging and recognition, sense of community, as well as the hands on experiences that are certainly not possible in urban practices.

These benefits really need to be addressed and highlighted at a student level.

Again, going back to my training, I remember going to a local pharmacy to collect a script for myself. The pharmacist looked at my name and said, ‘So you’re the new GP with the handwriting we can read – nice to meet you!’

The future of rural health lies in the way we educate our younger generation, not just doctors – but for everyone. This can be done by portraying the benefits and removing the stigma associated with a village or rural career as well as incorporating rural placements as a regular part of the training program. Ensuring that student feedback along with supervisor experiences are relayed and shared amongst peers and juniors will encourage students to challenge themselves in a rural context. Last but not least, adequate financial remuneration is important – for after all, a holiday would not go amiss!

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Fire In The Shower How a Shower Changed My Life

By Giselle Bravo (Deakin University, III) It’s 7:30 at night, raining, windy and 5 degrees outside, there’s even an unmistakable odor of urine in the air. Why on earth am I standing under a bridge, in the dead of winter, in the middle of Melbourne’s CBD? Then I hear a gentle song being sung in the background, it gets louder, yet the running water muffles the beautiful lyrics. Then the song stops, a few minutes go past and the van door swings open. The hot steam from the shower brushes against my cold face, and the person inside emerges with a grin from ear to ear and says “that was fantastic, I haven’t had a shower in weeks!” This amazing stranger just warmed my heart. That is exactly why I’m here on this dreadful night. I am here to provide homeless Melbournians with the opportunity to have a free hot shower.

A team of dedicated volunteers takes the Shower Van and it’s sister, the Laundry Van to various locations throughout Melbourne almost every single night. They work tirelessly to assist those in need of these services. To think that two brilliant young guns from Brisbane came up with the idea to fit a van with two washing machines and two dryers to provide services to those needing it most.

Then a few years later they decided to take the next step of fitting a bigger van with two showers.

Genius.

Almost 10 months ago I attended one of the very first Shower Van shifts in Melbourne, little did I know that on my very first shift I would become a Team Leader, let alone 4 months later be taking on the role of Melbourne Showers Service Manager. But from that first shift I was hooked, this was something I had to be a part of; it was truly love at first sight.

I am a third year graduate medical student, and I spend the better part of my day in class studying, thinking about studying, trying to understand what I’m studying, and feeling guilty for not studying.

So I desperately needed a break. I wanted to give back to the community, but in a way that I could feel actually useful. Orange Sky is my break, it’s not a job, it’s not hard, and in fact it’s the one time of the week were I am completely relaxed and medicine is tucked away deep in the back of my mind. I tell people that Orange Sky is my passion, a love that gives so much but never asks for anything in return. Yet some people don’t understand how anyone could do this. “Isn’t that dangerous?”, “What about all the drug addicts?”, “Can’t someone else do that?”. Firstly, I feel safest when I’m with my team and our regular Friends. They are all familiar faces and we know each other’s stories, but most importantly they know we are there for them and everyone appreciates that. Secondly, being in the hospital 5 days a week (sometimes 6 if I have assessments to finish), I am around a lot more drug addicted people then I have ever encountered on the streets of Melbourne CBD. Someone has threatened me in a guarded hospital ward before, but never on a Shower shift. Thirdly, well I am someone else, so looks like I’m perfect for the job.

Did you notice how I said regular Friends? One of my favourite aspects of Orange Sky is that from your very first training session they change your way of thinking by using one word. Friend. We only ever refer to any person using the vans or simply coming over for a chat, as our Friend. It is

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a beautiful way to verbally show everyone that we are a family. We are a big Melbourne family and we need to stick together. Our Friends come from near and far, sometimes they make the trip just to sit down for 2 hours and have a conversation. One night I had a Friend who thanked me for keeping him company for a few hours on shift, he broke my heart when he said he hadn’t spoken to anyone all week, not one word. He didn’t use the showers that night, or the laundry, or the near by food truck, he just wanted some genuine company. Sometimes that’s all a Friend wants, and as volunteers we are here to offer that.

I never expected to become so passionate about something outside of medicine, but I have. Every time that I tell someone new about Orange Sky and the countless wonderful moments that I have had with our Melbourne Friends, I just feel such a fire inside of me. I want to tell the world and tell everyone that just one shift can change your life, let alone the lives of our Friends. Medicine was a difficult choice, it takes a lot out of a person, of course there are a multitude of rewarding experiences, but there are many more sleepless nights in between. I made my career choices but those dreams are still a few years away. With Orange Sky I’ve found my passion, and it’s right here, right now.

You might catch me at the hospital during the day, but at night I’ll most likely be hanging out under a bridge somewhere on the streets of Melbourne, by an Orange van, chilling with Friends.

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It’s Not Enough

By Rachel Wong (University of New South Wales, II) The times are changing. There are more women in medicine than there has been ever before. Medical education, universities, and workplaces are changing to reflect a more diverse and accepting culture.

Even in my current second-year cohort, females make up 51.7% of the 3739 medical students across Australia1.

The times have changed. But even then, it’s not enough. This year, I attended a Q&A panel at UNSW about gender equity in the medical workplace which addressed the seemingly harmless banter dealt with in the hospital. To be assumed as nurses by patients instead of doctors, to be referred to as ‘girls’ instead of ‘women’ and to be excluded from men’s ‘locker-room talk’, especially in male-dominated medical specialities, were all common experiences encountered by every single one of the female speakers. It was especially heartbreaking to hear females being downplayed but even more so, when they began to downplay themselves, internalising that idea that being a doctor belonged to a man.

As an aspiring dermatologist, I was shocked by the statistics when researching this article. It was confronting to read and hear about the gender biased culture in medicine from colleagues, patients, and friends. It is frustrating to know that although over half of my peers are female, we are less likely to attain the title of professor than males. It is frustrating to know that even though 60% of trainees in dermatology are women, these numbers fall drastically when they reach advanced training2. This is supported by the ABS stating that out of the 2,758 medical practitioners in training, where 46.2 % are female, the proportion of females drop dramatically across all specialty occupations except pathology3. Medical universities and workforces need to change, and they need to change now. So what can we do about it? There are likely many contributions to this disparity in gender representation in the medical profession, and one of these is gender bias. This is something that we, as medical students and doctors, need to not only be aware of, but also actively address. It is often unconscious and pervasive, which means we need to tackle it from multiple levels.

1. Changing the Medical Curriculum Gender bias training is critical in forming the attitudes and behaviours of medical students, which will have far reaching impacts in our profession. Therefore, it needs to start with changing what we learn at our universities. We need to address the lack of discussion about gender differences in medical school and address the ignorance and unawareness within the medical community of students and teachers4. While implicit measures involve having a proportionate number of female surgeons, doctors, and allied health workers, explicit measures could involve tutorials and lectures on recognising discrimination and graded assertiveness training as part of a more comprehensive clinical education. Radboud University from the Netherlands is one such example where the change to encompass gender bias training within the medical curriculum was strongly supported by the teaching hospital itself and all the training coordinators involved, which allowed it to be highly successful in implementing gender perspective within clinical and teaching environments5, 6.

2. To Our Teachers While we can change the medical curriculum, it can only work when it is enforced by our educators.

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However, in a study regarding Swedish medical university educators, there was a significant difference in male and female perspectives on the importance of gender6. In order for gender bias training to be enforced in a teaching environment, it is essential that both male and female teachers can work together to implement this in our education. Thankfully, there are many examples of medical schools that recognise and act to tackle gender inequality. By personally recognising the need to tackle gender inequality, it provides the opportunity to firmly integrate gender bias training into our environment. The John Hopkins Department of Internal Medicine has implemented a female mentoring program since 1990, educated faculty members on tackling gender discrimination and promoting gender equity and is highly supported by high-level university officials and department heads, leading to its success7.

3. To Our Leaders Dr Atul Grover, the chief public policy officer of the Association of American Medical Colleges states that “increasing the number of women in faculty and leadership positions at medical schools will be critical to providing role models for junior faculty and a diverse, well-balanced leadership team”2. To ensure that this work can continue, we need leaders who are capable of recognising and addressing gender bias. We need women who can mentor females and assist in including women in projects and committees. We need women who can enhance the professional growth of female faculty in medicine7. Although women have increased in number within the medical workforce, the lack of female leaders and role models is clear. By enforcing a system where females are encouraged to partake in leadership, and where a good balance does not mean an exclusive choice between careers and families, only then can we be represented fairly in leadership8.

4. To Our Students We have the opportunity to shape our profession in future. But we have to start now -- recognise it, increase awareness in our medical faculties, and develop skills to tackle it. When we decide to identify and address gender bias, we aren’t just changing the attitudes of students but also future doctors, so that the sexual harassment, intimidation, and discrimination within universities and the medical field that occurs now will be eliminated.

Often, it is hard for students to challenge gender attitudes within university. But with teachers and leaders who can pave a path to awareness about gender bias, discrimination, sexism, and reflection on our current stances, it gives us the opportunities to relate to each other, share our own experiences, and demand the need to change because it’s not enough9.

References 1. Medical Deans. 2017 Medical Student Statistics [Internet]. Sydney NSW: Medical Deans; 2017 [Cited 2017 Oct 21]; [1 table]. Available from: http://www.medicaldeans. org.au/wp-content/uploads/Table-2.pdf 2. Grover A. The Good and Bad Statistics of Women in Medicine [Internet]. The Wall Street Journal; 2015 [Updated 2015 Oct 29, Cited 2017 Oct 21]. Available from: https://blogs.wsj.com/experts/2015/10/29/the-good-and-bad-statistics-on-women-in-medicine/ 3. 4102.0 - Australian Social Trends, 2003 [Internet]. Abs.gov.au. 2017 [cited 21 October 2017]. Available from: http://www.abs.gov.au/AUSSTATS/abs@. nsf/7d12b0f6763c78caca257061001cc588/2a7c6e498f342fb2ca2570eb008398cb!OpenDocumentAuthor AA, Author BB. Title of report.

4. Van Leerdam L, Rietveld L, Teunissen D, Lagro-Janssen A. Gender-based education during clerkships: a focus group study. Advances in Medical Education and Practice.

2014;5:53-60. doi:10.2147/AMEP.S56765.

5. Verdonk P, Mans LJL, Lagro-Janssen ALM.Integrating gender into a basic medical curriculum. Medical Education, 2005;39;1118–1125. doi:10.1111/j.1365-2929.2005.02318.x 6. Risberg G, Johansson EE, Westman G, Hamberg K. Gender in medicine – an issue for women only? A survey of physician teachers’ gender attitudes. International Journal for Equity in Health. 2003;2:10. doi:10.1186/1475-9276-2-10.

7. Ward L. Female faculty in male-dominated fields: Law, medicine, and engineering. New Directions for Higher Education. 2008;2008(143):63-72. doi: 10.1002/he.314 8. Leopold TA, Ratcheva V, Zahidi S. The Global Gender Gap Report 2016 [Internet]. Geneva Switzerland; World Economic Forum; 2016 [Updated 2016; Cited 2017 Oct 21]. Available from: http://reports.weforum.org/global-gender-gap-report-2016/economies/#economy=AUS 9. Kristoffersson E, Andersson J, Bengs C, Hamberg K. Experiences of the gender climate in clinical training – a focus group study among Swedish medical students. BMC Medical Education. 2016;16:283. doi:10.1186/s12909-016-0803-1.

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AMSA Gender Equity: Women In Mentorship Program

By Rhea Navani (Monash University, III) Rhea is the 2017 AMSA Gender Equity Coordinator,

The need for gender equity has been a hot topic. Ever since the scourge of bullying, sexual harassment and discrimination in Medicine was catapulted to the headlines in early 2015, Medicine has been forced to investigate the cultures that they create. Much have been written on the relentless bullying that is experienced by junior doctors, often felt more keenly by female-identifying or non-binary trainees.

Accordingly, many complementary words have been written about the desperate need to crackdown on inappropriate behaviour, implement anonymous reporting structures, to correct the pay gap and allow for greater flexibility in training pathways and in essence, to radically change the culture we have created and tolerated.

It is a sad reality that whilst female medical students represent just over half of medical graduates each year, these same women disappear with time. There is a systematic lack of women across Medical Deans, AMA and Medical Training College Boards as just three examples. In AMSA, just four of the past nineteen Presidents have been female, with 0 Treasurers in the past seven years being female. Indeed, even at student conferences that we attend, we tend to be listening to male speakers. For example, retrospective analysis of plenary speakers at National Convention from 2011 to 2017 (attended by over 1000 students each year) found that six of the past seven years had significantly more male speakers than females, with the average proportion across the past seven years being 37% females. Clearly, female voices are being lost in the crowd. In turn, this means that younger women lack easily identifiable role models to draw inspiration and guidance from.

And so I created the Women in Mentorship (WIM) Program. Launched in June, the program aimed to empower women by inviting them to identify and develop their leadership aspirations. Mentees were asked to describe their passions as well as areas of leadership they wanted to develop and were then matched up to appropriate mentors.

Over three weeks, I read 89 applications from junior medical students. Most were in their first few years of medical school. Many described their fascination with Medicine broadly, but were unsure of a direct pathway to take. Passions ranging from refugee advocacy, climate change, blindness, and research were identified. The 70 mentors were similar; though, a larger proportion had identified a more specific area of Medicine they wished to pursue, they too were driven by interests in equally diverse range of interests and spoke of their determination to leave a mark on this world.

However, perhaps the most striking motif across the mentees application was the lack of self-confidence.

Almost all of the mentees talked about baulking at public speaking and translating internal passions into external advocacy. I’m passionate about the rights of the marginalised but I’m constantly nervous at the podium. Others described a paralysing self-doubt, which had them failing to apply to positions that they were interested in or delegating their roles to other people. I want a mentor who can teach me to use my voice, many of the mentees asked, not knowing that this desire was shared by every other application sitting in the software.

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The self-confidence gap between women and men is well-documented in research. At the same time as institutional barriers that prevent women from succeeding (from the assumption that childcare is solely a woman’s responsibility to stereotypes about our leadership styles) are beginning to be torn down, we are crippled by a lack of self-confidence. We collect degrees, experiences, and are highly competent – and can still wake up feeling like a fraud, attributing our successes to luck rather than skill. Unfortunately, progression in the marketplace is not solely dependent on objective measures of competence, and requires a healthy dose of confidence. This “confidence gap” as it has been dubbed, has real consequences – a famous internal review of Hewlett-Packard’s personnel records found that men applied for promotions when they met 60 percent of the requirements whereas women only applied for promotions when they felt they fit 100 percent of the requirements . That is, women miss out on future opportunities when they fail to recognise the value of their qualities.

The mentorship program was created to create a space for women to support and connect with each other. There exists a cultural myth that women are each other’s worst enemies – as if the barriers holding us back are not societal barriers, but rather exist within our relationships with each other. We’re bitchy, toxic and will burn each other. The program kicks that myth in the face by recognising the empowerment that female friendship can bring.

Being female, it is likely that we have all experienced some degree of discrimination. Whether that be the annoying common assumption that we are all nurses, or that desires for intense careers need to be weighed against the assumed weight of childcare responsibilities, or experiences even more serious - the program allows women to connect to someone who just gets it. That’s not to say that men aren’t able to understand and sympathise with this issue or that men don’t experience some degree of gender-based stereotyping.

Rather it is an acknowledgment of the status quo – that women are disproportionately represented in leadership – and that the bulk of gender-based harm hurts women. Validating these experience is powerful.

Women are able to discuss these issues and work together to share advice on confronting them. You can work through the self-doubt that likely affects both women in the relationship, to ensure you don’t fail to grasp the opportunities that present to you. Beyond that, mentees receive a role model; someone who they can turn to for advice, inspiration and guidance. By passing on advice to their junior counterparts, mentors are validated in their leadership experience.

It is important for all medical students to seek out mentors of varying ages, genders and aspirations. We hope that WIM can continue to empower women, and sustain the huge interest it gained in its first year, to inspire, guide and challenge women in years to come.

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ART// Niranjike Jeyarajah

(Griffith University, II)

“Fire comes from the heart”

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Developing Leadership

Reflecting on Six Years at the Australian Medical Students’ Association

By Jeffery Wang (Monash University, V) Jeffery is the National Executive IT Officer and Chair of AMSA Medical Education. He was elected a life member of AMSA at Council 3 2017 and has written about his time at the company.

I still remember the first time I heard about AMSA. It was O-Week 2012 at Monash University, and my first week ever of medical school. Our MedSoc president Ash Witt and AMSA Rep Rob Evans were holding an afternoon “What is AMSA” information session in one of the Menzies lecture theatres, and I, the very keen first year, had showed up first – fifteen minutes early. It was from the front row of this lecture theatre that I witnessed Rob throw on his orange AMSA shirt, browse the AMSA website on the projector and chat to Ash about the talk that he had planned.

It’s no great secret that eighteen-year-olds are easy to impress, and I was certainly no exception. There I was, in the same room as two titans of my medsoc – final year medical students, leaders, real adults! – witnessing something real: a quiet moment between mates. I took verbatim notes as Rob spoke of all the initiatives AMSA ran, and all the ways AMSA advocated for every single medical student. My eyes were glued to the screen as he played the Perth Convention 2012 promotional video, and I browsed the AMSA website diligently while others asked questions. I didn’t know at the time the impact that AMSA would have on my medical school experience. All I knew for sure were two relatively minor things: 1. Ash and Rob were mature, composed and eloquent – the kind of people I wanted to be like when I “grew up” 2. AMSA was a slick, mature, professional organisation. The consistent branding across the website and Rob’s orange volunteer shirt was revolutionary to me My second experience with AMSA was later that week, at MUMUS’ first Thinktank meeting of the year.

A grand total of six people were in attendance that evening, including our AMSA Rep. Elections were held with all positions uncontested, and I landed my first (and last) medsoc position as MUMUS’ Policy Officer. While both my position and the committee that I was part of were small, this first foray into student leadership set the tone for the six years to come.

It was in my first few months of medical school that I had my first taste of being an AMSA Volunteer. With the help of my AMSA Rep and a few others, I wrote the AMSA Organ and Tissue Donation Policy, which was passed at First Council, 2012. Under Rob’s leadership we also started the MUMUS AMSA e-ThinkTank Facebook group, which allowed us to greatly improve our engagement of clinical students off-campus.

This group, which has grown from just the five of us in 2012 to over 700 in 2017 was our committee’s legacy.

In 2015, after a couple of years away from AMSA, I put my hand up to lead one policy team, and then a second, and then a third. Experience tends to compound, and roles within AMSA are no exception. I’m very grateful to Matt Lennon, then-Policy Officer, for continuing to encourage me to volunteer for things and continuing to give me these opportunities. 2015 was also the first year that I attended Council. I still remember being nervous to present my policy to Council in person for the first time; getting up in front of a hundred and fifty people, each with their own highly impressive titles and positions. Luckily it didn’t take long for me to realise that even MedSoc presidents and the AMSA Exec are just people, and I still keep in touch with many of the friends I made at my first Council to this day.

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2016 saw the election of a second consecutive NSW executive. The board had directed that AMSA diversify our activities as an organisation, and Matt Lennon, as the new Vice-President (External), selected me to be the founding Chair of AMSA Medical Education. Along with Matt and my fantastic team I’ve spent the past two years in this role developing a sustainable medical education resource database, facilitating discussions between MedSocs, and engaging in research into how medical education is delivered across Australia. AMSA Med Ed is truly something that all medical students can benefit from, and key in guaranteeing AMSA’s relevance in the student community even as our student demographics change to a more mature cohort. I’m truly grateful to both the 2016 executive and my own 2017 executive family for giving me the chance to see the early years of this committee through.

Towards the end of 2016, Rob Thomas asked me to join his Queensland-based bid for the 2017 AMSA Executive. Having worked with him previously on the Classification of Medical Programs Policy and AMSA Medical Education, I was confident in Rob’s passion for advocacy and excited to join the team as IT Officer.

Being on the executive this year has allowed me to achieve so much more than I had originally anticipated.

Apart from the strictly-IT side of things, my role on the executive has allowed me the opportunity to be involved in decision-making across all parts of AMSA, attend Convention and GHC for the first time, develop my public speaking skills, and most importantly engage our members. Despite all this, the parts of this year I will hold onto dearest will be all the moments shared with our executive team – from that first retreat when we had just been elected, through all the frantic days and nights at Convention, GHC and Councils, to all our meetings, spontaneous retreats and anaphylactic reactions. The bonds you form with your exec are what make the job so worthwhile.

AMSA is as much about the people we work with as it is about the work that we do. The opportunities available to you within the company snowball not just because of your experience and skills, but also the people you’ve met along the way. It’s important to not just put your name in for committee positions but to actually put effort into your roles and do well in them. Becoming friends with your managers and team members and making them want to work with you again is critical to opening doors and progressing through AMSA, and indeed any real-world career.

I joined AMSA as a first-year partly because I was impressed by the organisation, and partly because I was impressed by the people who represented it. I did not in my wildest dreams expect that I would end up where I am today – an executive of the company, a founding committee chair, elected by Council as an AMSA Life Member. By now I’ve got my own orange shirt. I’ve represented AMSA’s interests externally with MDANZ, AHPRA, MBA and the AMC. I’ve completely redeveloped the same website and internal branding guidelines that were so magical to me in first year. I’ve given so many speeches on behalf of AMSA and reports in front of Council that I don’t even get palpitations at the thought of public speaking any more. I even gave my own “What is AMSA” talk to a Menzies lecture theatre filled with Monash preclinical students earlier this year. I’ve done all this, but I still don’t feel anything like Ash or Rob. But I guess I am.

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Find Your Fire

By Sarah Tan (University of Tasmania, II) This letter is addressed to my 19-year old self when I first entered the MBBS programme.

Dear Sarah, You’re finally here. Walking through the sliding glass doors of your medical school on your first day will feel invigorating – and it should. You cried your eyes out when you received your IB results, knowing full well that you had just fallen short of the rumoured cut-off to read Medicine in Singapore and you weren’t quite sure if your parents would agree to the hefty sum involved in an overseas education. You eventually applied to numerous medical schools overseas and you’ve waited an entire year for an offer and now that you’ve finally got it, receive it with open arms and make the best out of it. Amidst all the excitement, you will still feel that slight tug of disappointment in the pit of your stomach at the “if-onlys” but you will soon learn to appreciate that things are probably better the way they are now rather than what you’d hoped it to be.

Despite people telling you how first year is a breeze, you will struggle. You won’t be able to wrap your head around neoplasias, you will feel overwhelmed by the Musculoskeletal System and worst of all – the gap year will take its toll on you and you will find yourself struggling to remember what study technique works for you. You will find yourself fumbling around in the first year, not quite sure what to do with the information thrown at you and you will lock yourself in your room days on end trying your best to cope.

You will watch as your fellow batchmates go for endless parties and road trips whilst still maintain their distinctions and you will silently berate yourself for not doing any pre-readings during your gap year or that perhaps you were not quite cut out for this profession as you originally thought you were. Your social life will be no better, from failed relationships to people gossiping behind your back but you will stay grounded in your decisions and channel your energy to your work, knowing the price at stake and the passions that fuel you.

Although not very far off from where you first started, I would like to remind you of two things. First, Medicine is an arduous journey and everyone has their fair share of frustrations. Being a perfectionist, you will still compare yourself to others but perhaps go easy on yourself this time knowing that being in Medical school, in itself, is already a privilege to be cherished. You may not be the most intelligent nor the most talented but focus on what your strengths are and you won’t go wrong with that. Second, don’t let Medicine wear you down. Days will be long and lecture notes even longer but don’t let your physical and mental exhaustion rip you of your passion for helping people. You chose Medicine with the heart to serve the sick and needy and nothing should strip you of this. Keep your faith, fuel your fire and you will find joy in Medicine, I promise.

Love, Sarah

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Letter to Myself

(and for anyone out there struggling)

By Bernard Koh (University of New South Wales, II) Dear Bernard, Med school was all you ever wanted. You devoted everything you had in secondary school and JC to get into medical school. When you failed, disappointment became your best friend. But you did not give up. No, you strove to improve yourself, to understand more about what medicine entailed, so that you could say to yourself and anyone who doubted you, I know why I want to do this.

You will eventually make it into medical school (all glory to God for this). However, it would be an overseas one. Initially, you will not feel proud of it, but eventually you will grow to accept and embrace it. Importantly, this is the chapter which life will hit you hardest.

Leading up to exams, you will drop any other commitments you consider unimportant. You do this because all you ever want to do is to prove to yourself that you can do this; that you are cut out for this journey you so determinedly tried to achieve before. However, life will not pan out this way. You will study till you are so tired that you just feel like crashing but can’t because you know if you do, you will fail. In class, you will look around to see classmates scoring 80s and 90s, and you will ask yourself, with your 60s and 70s, ‘am I cut out for this?’. But you will have enough to make it through. You will have friends who look out for you, despite their own busy schedules (treasure them). You will be determined to do your best, in spite of your results, because you remember the sacrifices your loved ones have made for you to be here. You will fail, and you will fail again despite trying harder the second, third, forth time rounds. In these moments, everything you had hoped to achieve will be met with regrets and disappointments. But hang in there. You may not have a perfect WAM, but you will learn that God is good, and life is more than just grades or success.

Feeling all alone will happen to you more often than you would like. You will have less friends than most. You will to go sessions and in a sea of people, you will feel as if you were the only person there willing to be your friend. But look past that when you feel all alone. It is alright to be a loner. You will have true friends who will go through life together with you. They will do the sweetest things e.g. buying you your first-ever study bible you will grow to love, messaging you the day before your exams that they are praying for you even though they themselves have more exams/assignments. Be grateful for them. Surprise them back.

Appreciate that you have each other to go through this tough obstacle called ‘life’ together.

In the end, you will be reminded time and time again that you are never quite enough for life. But take heart because God is in control of your life. He is doing a new thing in your life, and this new thing simply has more ‘downs’ than ‘ups’. But everything works for His glory. Learn to live with the downs, just as you treasure the ups. Embrace the truth that your life is for God and God is doing something beautiful in you. “Remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the wilderness and rivers in the desert” (Isaiah 43:18–19).

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Re-igniting The Flame

By Gretel Whiteman (Griffith University, III) My time on the psychiatry ward has raised as many questions as it has answered about the mind. This complex organ of ours that sets us apart from other animals and makes us human can arguably be one of our biggest downfalls. The human frontal cortex is an incredible gift that enables us to be problemsolvers; capable of complex reasoning and remarkable discoveries, and to feel emotions at levels that no other animals can. However, a human brain taken over by illness is devastating – there’s no pain like emotional pain.

When a person allows their mind to be creative, think deeply, or make discoveries, they let subconscious thoughts spark off each other – creeping into consciousness until the sparks fly, and thoughts or feelings blaze into wonderful ideas or complicated thought processes, and experiencing the heights of human emotion. It makes us who we are as humans and as individuals. Our brains ignite the most allencompassing love, far beyond the instinctive love of species with less developed brains. We feel pride at accomplishments, and we can empathise with our peers; it is beautiful to think of how brightly our thoughts illuminate and warm us as a person and as a species.

Yet sometimes the mind can be too complex. Sometimes there is a darkness in the back of the mind, a parasite that grows from an imbalance in our own brains, and sometimes it swamps the beauty of everything else. It dampens the sparks of healthy thought and smothers the struggling embers. It haunts different people in different ways. It might paralyse its host with fear; it might suck out and feed off all of their emotions. It can grow and subside in waves. When it grows it can become a monster that casts a dark veil over its host’s eyes, separating them from the rest of the world, and the world’s brightness and colour fade beyond it.

According to the Australian Bureau of Statistics, depression is the leading cause of disability in our country and suicide is the leading cause of death between the ages of 15 and 44. The will to live is an innate part of being alive, so you have to ask yourself how much agony a person is in to look to the physical pain of self-harm, or the nothingness of death, as a respite from their emotional pain. How relentlessly awful was their day-to-day life for those options to be a relief? It’s incredible how much stigma there is around something so common; a chemical imbalance in the brain is treated with absurd caution by so many. If a person has diabetes they get help for their blood sugar; if a person has hypertension and risks a heart attack they seek treatment. If a person has a serotonin or dopamine imbalance and risks suicide it should be the same, and yet often it is considered too embarrassing to make public. How did mental health attract this attitude when other illnesses escaped?

My time in psychiatry has been eye-opening and intensely interesting, but very sad. It’s obviously extremely difficult to watch people struggle with a variety of illnesses that are invading their head space and working their way into personal thoughts, desires, and personality. It is awful to watch an individual’s sparks and flame of healthy thought and personality dampened against their wish. A fortunate patient on the psych ward will be lucky enough to find that fire that makes them who they are again. Like any other specialty, the role of the health staff is to attempt to rid the body of illness as best as they can; in psychiatry, it is to help re-ignite a person’s flame.

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Through Enlightenment or Conditioning

By Linda Alexander (University of Notre Dame, II) At 6:45am – I arrived to what appeared to be a ghost town – there was no one in sight and it was pitch black.

I stood at the empty reception for a few minutes, after all my nursing home placement was scheduled for 7am, until I saw a light emanating from the end of the hallway and I heard an uproarious laughter. I made my way towards the room and was rushed in by the nurse who asked “are you the student doctor?”. Before I could introduce myself properly a meeting had started and the practice manager was going through a handover of every patient. I sat in silence, zoning in an out of the myriad problems that needed attending to – one resident ended up with another’s dentures, someone was on a hunger strike and a lady probably would not make it past lunch – the last comment had me baffled. The practice manager had mentioned it in a monotonous tone, almost in passing that it confused me even more. Who would not make it past lunch? Make what past lunch? Did he mean they would die today? Why? How did he know? None of these questions were answered and he had moved on to the last few residents as I was mulling over the realities of an aged care facility.

The morning started off pleasantly, I visited the dementia ward and conversed with the patients. Their stories – both true and fabricated – were fascinating. One resident, an 89-year-old Scottish lady, tried to convince me that she worked at the aged care facility and helped feed the residents. She also told me that her sister worked down the road and that on weekends they would ‘travel to Australia together.’ There were other ladies who held dolls in their arms, convinced that they were their children. There was also a 50-year-old gentleman who aggressively demanded I fetch his shoes; they were on his feet. The ward was unlike anything I had experienced before but it did not prepare me for what I saw next. The nurse told me that it was time to leave and that she wanted to check on a lady who was palliated. I followed, and we walked into a brightly lit room. Laying there was a lady who looked unwell. The nurse and I both hesitated for a moment before another nurse and medical student rushed into the room and said “yes she’s dead, we need to pronounce her”. The medical student and I stood in the corner before the second nurse said “put some gloves on if you want to touch her”. I hurried over to the box and offered them around. I then felt for her radial pulse, which was absent. Her skin was leathery. I felt for her carotid pulse and must have pressed a little firmer because I felt the pulsations of my own fingertips. While I was checking the pulses, the nurses had listened to her chest, reporting nil heart or lung sounds. I asked if we should try a sternal rub. One of the nurses rubbed her chest with some force and the patient suddenly made a loud “ARRRGHHH” sound.

We all jumped back in incredulity and for the first time that day, my heart was pounding. The other medical student who was still standing in the corner said “I think that was air coming out when you compressed the lungs”. The nurse rubbed her sternum twice over and she remained silent. She was in fact dead and at 9:56am, it was pronounced. The other medical student now came over and tried to straighten her leg, “rigor mortis” we both muttered in awe. We all stood there for a moments silence. The nurse then opened the window and explained that she wanted the lady’s soul to have a path of exit. She then draped the blankets over her lifeless body and placed a rose on her chest.

It was a sad and beautiful moment. I knew then that being in medicine meant that I would see many dead bodies and I was thankful that my first experience was one where the life was truly respected and that there was no pandemonium like there would be in a hospital setting. After her death, I looked at the many pictures hanging on the wall, of her youth and her family. I learned that she was 98 years old and that her husband lived close and visited her daily. I learned that her son would visit her every morning but he hadn’t that morning because he was in hospital for knee surgery. I hoped that her son would not think his absence caused her death. The experience inspired me to better understand myself and my own views of death. I do think this is necessary, especially in medicine, to know – or at least to be content not knowing. Medical training will allow each of us to process the death and dying of our patients – either through enlightenment or conditioning. The 98-year-old woman made me realise that I am here because I want to prolong life, just in case there is nothing else.

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