The Auricle 2022 Edition 2

THE AURICLE

Volume 5 Edition 2

March-April 2022

IN THIS EDITION...

Editors' Letter ............................................................................................................ 1 Humans of Medicine: Ishka de Silva ....................................................................... 2 Black Crow: a short story .......................................................................................... 4 The doctor I will become .......................................................................................... 6 Spotlight: Ending Period Poverty ............................................................................ 8 The Glasshouse .........................................................................................................11 Research Corner: Long Covid ................................................................................ 14 Poem: Overcommitted ............................................................................................ 17 TV Review: This Is Going to Hurt .......................................................................... 18

EDITORS' LETTER Dear readers, Welcome to Edition 2 of The Auricle!

It seems that time has flown by since we released our first Edition for 2022. Thank you for all of the kind support and feedback we received from the January-February Edition. We were really proud of the writing, photographs, and artwork from our contributors and it was an honour to share it with this audience.

Edition 2 brings together more fantastic work from Monash medical students. In these pages you will find creative writing, poetry, informative pieces, and a TV review!

Lachlan Coman is currently completing a Master of Public Health.

We implore you to please share The Auricle with your friends and family - this is a student-created magazine and we would love to be able to showcase this work for as wide an audience as possible. There's something in here for everyone.

And if you've ever thought of putting pen to paper and letting your creative side flourish, The Auricle might just be the place for you. As Editors, we love nothing more than receiving an email from a student who has taken the brave step of submitting their work for publication.

If you'd like to get involved, please get in touch! Our email address is publications@mumus.org.

Jordi Shahab is undertaking a BMedSc (Hons) year.

As always, happy reading!

Lachlan Coman and Jordi Shahab

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HUMANS OF MEDICINE: Ishka de Silva

In this next instalment of Humans of Medicine, where we sit down with impressive Monash med students, we profile Ishka de Silva - the 2022 MSA President.

Can you tell us about yourself and your journey through medicine so far?

For sure, I completed fourth year last year in Gippsland and am on an intermission from medicine this year as I was elected President of Monash Student Association (MSA) for 2022.

I’ve always enjoyed getting involved at Uni, I have been the treasurer of Team Med, had roles at AMSA Global Health, and been a volunteer with Possible Dreams International. I made fantastic friends in my preclinical years and have loved watching us all move through the degree and go down different paths.

I'm sure many people are aware that you are the current MSA President.

How did you get to this role? What's driven your ambition for this?

I found out about MSA in 2020 and was struck by what the organisation does. I became particularly passionate about their student advocacy and the work the women’s department does.

I was elected as a general representative on the Monash Student Council (the board of directors of MSA) last year and became more involved in the women’s and education departments. This role also showed me how important MSA is; it is the representative body for all 47,000 students that are enrolled at Monash and plays a massive role in standing up for students and creating the student experience.

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I had crazy big imposter syndrome when I first told my team I was interested in running for President, and never thought I would be successful. But, I had seen the student experience take massive hits during the pandemic and wanted to lead a team to support our peers and bring back the student experience.

What are your goals in the role for 2022? What does the role entail?

As President, I act as the Managing Director of MSA, which operates as a $6 million not-for-profit organisation. I’m responsible for negotiating with the University, namely the Vice Chancellor, Deputy Vice Chancellor (Education), Faculty Deans and other senior staff members. I’m the official spokesperson for MSA and so speak to external

stakeholders such as the media and government. I’m also the director of day-to-day management, provide directions for long-term strategic planning, and lead a team of 150 student representatives and 40 staff members.

The role provides so many different opportunities, our main goals are to revive campus life and all of the social and co-curricular experiences that students deserve at University, make education and assessment policy more fair, compassionate, and accessible, and increase support services for student’s mental health and overall wellbeing.

What are your plans from 2022 onwards?

Ah! I am not very sure. I will return to med school next year and will most likely complete a bmedsci.

I’m not super sure what happens after that, but I do have interests in aged care, palliative medicine and public health.

If you could offer some key advice to our junior medical students, what would it be?

Don’t feel like you have to do what the people around you are doing! I felt a lot of pressure to do things like research and medical related cocurriculars, these are very valuable opportunities, but there is also a whole world outside of medicine that can benefit from your contribution and provide you with unique skills and experiences.

How else do you spend your time?

Anything else to add?

I love having a boogie with friends and doing body pump classes at Monash Sport.

Please feel free to add me on social media or get in touch! msa-president@monash.edu

Ishka de Silva is a medical student and currently the President of the Monash Student Association.

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Black Crow

Words by Devangna Tangri

My name is Crow, Black Crow. I’m a crow, and my parents knew it. That’s why they named me Black Crow.

I woke up today and had a party with my friends. Billy from the big oak tree down the road even came down, and he never comes. Alicia from the house 2 streets away was always happy to party, so I knew she would be there. We all got together and loudly cawked at each other for hours, annoying all the humans who were trying to sleep. It was only 7am in the morning, but if you ask me, that’s the best time to party.

No humans to disturb us with their amazingly loud cars and trucks, no kids running at us and yelling, ‘Shoo! Shoo!’ What did we ever do to them anyway?

After cawking at each other until it was about 9am, we went our separate ways, searching for food. I hopped over the fence right under the ginormous tree where I had constructed my nest, because there were always delicious worms in the garden next door. They had a beautiful vegetable garden which I loved to tuck into as well. Those humans were really nice to me. Every day they left out a bit of fruit, some rice, and some grains for me to chew on. As I happily crunched and munched, I sat peacefully and stared around me.

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The world was so beautiful. The grass under my feet was so soft. The expansive, vibrant sky, with all the colours anyone knows, lay above my head like a blanket. The magical Earth with everything I could ever need, was my home. I felt so lucky. Through the window, I saw the humans who had been so nice to me since I could remember. There were two women. They had a small puppy running around the house all the time, and even the puppy was nice to me. I played with him regularly. I felt the wind softly touch my feathers and the warmth of the sun radiate through me, giving me a very particular cozy fuzzy feeling. However, it wasn’t long until I got really really hot. It was suddenly the afternoon, when the sun is the strongest, and I hadn’t realised. I would normally go and put my hat and sunscreen on.

I started to sweat, and pant, and felt really faint. It was the middle of summer, and boy was I boiling. I didn’t even have the energy to find some shelter to hide from that hot midday heat. I felt my feet slipping, my eyes closing, everything started to go black....

I woke up, confused for a minute. Why was I wet? As I got up, I saw two giant faces in front of me, staring at me with wide worried eyes. I was petrified, and shot away in the blink of an eye to my nest in my tree. ‘Are you okay, Black Crow?’ enquired one of them, staring up at me. She had black hair and eyebrows, and deep brown eyes. At first, I was hesitant. Then, it dawned on me that they had probably scooped me up and arranged a bath for me, saving my life! It was a lovely fountain in their backyard with a dish perked on the top, full of water for me to have a splash in. How had I not seen that before?

It was perfect, and so kind. And they knew my name.

I flew back and jumped into the cool, calm water and immediately felt like someone had restored my life force. I felt refreshed and alive again. I watched as their expressions turned from gloom to glee, wide smiles spreading across their faces.

They yelled ‘Wooo!’ hugged and kissed each other, and stared back at me for a while. Then they went back into the house, holding hands. They were the nicest people I had ever met.

Devanga Tangri is a Year 3B medical student.

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The doctor I will become Words by Samantha Yee, Year 1 Piece submitted for the Year 1 HKS Essay Prize.

The doctor I want to be will be like a cell; Perhaps she will be a skin cell, Working interconnectedly with others to surround her human’s body. She will be her human’s first contact with the outside world, protecting and supporting them.

Though she may face the stressors of the world, she will endure, heal and grow with the knowledge that she is not alone in her pursuit to do the best by her human.

Or perhaps she will work more internally; Perhaps she will be a red blood cell, Traversing the complex planes of her human’s circulatory system to communicate with other diverse systems.

The doctor I want to be recognises she is small like a grain of sand in the beach that is the health system she works in. She may question at times her ability to effect the change she wants to see, becoming disillusioned by the myriad of political, socioeconomic, historical factors that remain stubbornly entrenched in Medicine.

But no matter the cell she chooses to become, she will never forget: her importance.

That in moments of joy, solemnity or grief, she will be with her patients every step of the way.

The doctor I want to be will be like an organ; Perhaps she will be the brain, Remembering the privilege that comes with the power of her medical knowledge and training. That especially in a time of a pandemic has highlighted how inaccessible this knowledge continues to be for some. She will never forget how fortunate she is to have this privilege to translate medical theory to lifesaving action; to be an unwavering pillar of support for those who need her.

Or perhaps she will be the heart, Recognising that beyond transporting lifeblood, she is also the epicentre of emotion. That despite her daily proximity to the precipice between life and death, she will not allow herself to succumb to apathy but instead, with every ounce of her strength, extend her empathy, compassion and sincerity to all her patients and their families. She may cry, laugh or get angry, but it is the very presence of these emotions that define her as the doctor she chooses to be – a human first and foremost.

Starting my medical journey in the midst of a pandemic could not affirm with more certainty why I have chosen to embark on the lifelong journey of becoming a doctor. COVID-19 has exposed the deep inequities that are rife in the healthcare system and beyond. From one’s socioeconomic status to the country that they live in, these factors can dictate whether health is a basic human right or a commodity for a privileged few. Yet, despite these systemic barriers, I have no doubt that my passion for and drive to harness the power of Medicine will lend me the strength to be an advocate for the voiceless but, most importantly, to be the human that my patients need.

SPOTLIGHT: Shedding Period Poverty and Bleeding Freely Written by Palak Gupta, Emily Whalen, Surabhi Shashishekara, and Meghna Prasannan from the Women’s Health Interest Society of Monash (WHISM)

There’s no doubt about it - the female reproductive system is capable of amazing things. For those with uteruses, this pear-shaped organ has the ability to nourish and support a foetus through pregnancy. In the meantime, however, the monthly cycle has significant consequences for people who menstruate. For ∼3-7 days per month, individuals experience discomfort, bloating, mood changes and fatigue, and also suffer the hefty financial burden of purchasing disposable period products.

the reduction of period poverty through annual charities. One such charity is ‘Share the Dignity’ which has provided over 3 million sanitary products to support menstruating individuals in need, through a yearly callout for period product donations. These efforts have helped to ease the difficult choice between period items and basic necessities that many are forced to make.

Let’s face it - periods are pricey. In fact, individuals will spend almost AUD$10,000 on pads, tampons and other sanitary products during their menstruating years. Surveys have shown that more than 60% of Australians have had to scrupulously budget each month for period items, whilst 79% have actively forgone such products in the past. For many, each monthly cycle calls for innovative ways to craft, substitute, or re-use items in order to make ends meet.

Scotland Laws End the Financial Bleed

This problem isn’t a contemporary one. Like many ‘sensitive’ topics, the issue of period poverty has only really been brought to light in recent years thanks to the overwhelming push to ‘de-taboo’ the conversation around menstruation. As such, organisations like the Australian Women’s Health centre, Jean Hailes, have opened the door towards

Efforts to battle period poverty have been made in Scotland over the years. Such strides ultimately led to the national provision of free period products for those who need it being enshrined in law in January 2021. So how did our friends across the pond get to this world-first?

SCOTLAND’S TIMELINE TO ENDING PERIOD POVERTY 2017

2018

2019

2020

2021

1.

In September 2017, a 6-month pilot scheme was run by a local social enterprise, Community Food Initiatives North East, in Aberdeen where they trialled models of distribution (e.g. cash, pre-paid card, ordering online, etc) of free period products in educational institutions and community settings. The scheme eventually received financial backing of £500,000 from the Scottish Government. The emerging findings from this pilot highlighted the need for a distribution model that limited barriers to access, and one that was discreet, so people were not being identified as needing “help”.

Considering this, what better way was there than to make period products free for all?

2.

Guided by the trial, Scotland became the first country to make pads, tampons and other period products free to students of schools and universities in 2018. Other countries in the region have also attempted to follow suit with England and Wales, in 2019, pledging to distribute free sanitary products to all state-funded schools and tertiary institutions.

3.

Scotland proceeded to extend the provision of free period products by unanimously passing ‘The Period Products (Free Provision) (Scotland) Bill’ which legally requires local authorities to make products like pads and tampons free and easily accessible within public settings. Whilst the widespread social impact of this move may take time to come to fruition, leaps were made during the parliamentary discussions around the bill, with stigmatised topics like endometriosis and heavy bleeding, being highlighted and openly addressed by politicians.

or other unsanitary materials to substitute for period products. These unhygienic practices not only increase the risk of infections, but also mental burden. The uncertainty of not knowing where the next ‘pad substitute’ will come from has debilitating effects.

In the last few years, the Australian government has allocated significant funding towards the provision of free sanitary items in government schools. In particular, Victoria has become the first state or territory in the country to ensure period products can be readily and freely accessed by adolescents in state schools. The allocation of AUD $20.7 million seeks to provide these locations with pad and tampon dispensing machines. The overarching goal is to reduce anxiety around periods for adolescents, support the cost of living for families and importantly, ensure that the natural process of monthly menses does not interfere with a child’s educational experience.

That said, the case of Scotland is proof-of-concept that a legislative approach to overcoming period poverty is feasible and sustainable. It is only a matter of time before similar laws ripple across the globe.

The Australian Impact The proposition of free sanitary items inevitably benefits those living beneath the poverty line, in unstable housing conditions or precarious financial situations. Studies have sadly shown that more than 1 in 5 Australians currently use toilet paper, socks REFERENCES: 1.

Coggan M. Big ‘bloody’ survey reveals extent of period poverty in Australia [internet].

Melbourne, AUS: Pro Bono Australia. 2021 Aug 4. Available from: https://probonoaustralia.com.au/news/2021/08/big-bloody-survey-reveals-extent-of-periodpoverty-in-australia/ 2.

Duffy S, O’Shea M, van Esch P. Imagine having your period and no money for pads or tampons. Would you still go to school? [internet] Melbourne, AUS: The Conversation. 2021 Mar 8. Available from: https://theconversation.com/imagine-having-your-period-and-nomoney-for-pads-or-tampons-would-you-still-go-to-school-156570 3.

Women’s Health. Women On Average Spend $9379 On Their Period Throughout Their Lifetime [internet]. Crows Nest, NSW: Women’s Health. Available from: https://www.womenshealth.com.au/average-cost-of-period/ 4.

APS Group Scotland. Access to Sanitary Products Aberdeen Pilot: Evaluation Report.

Edinburgh, UK: The Scottish Government, 2018.

5.

The Scottish Parliament. Period Products (Free Provision) (Scotland) Bill https://parliament.scot/bills-and-laws/bills/period-products-free-provision-scotland-bill

Further, the benefit of free period products extends beyond the economic relief to freedom of activity.

In Australia, many young teenagers are missing numerous days of school due to ‘period embarrassment’, a lack of available products and most commonly, the simple yet harrowing shame of beginning a heavy period at school with no access to sanitary products. Understandably, these cyclic absences snowball into missed education and a lack of opportunity to fully participate within school life.

The biggest argument against the distribution of free period products often comes down to the expected environmental burden. In a climate where plastic and non-biodegradable materials threaten the future of our ecosystems, many valid concerns are raised regarding the risk of increased wastage if sanitary products were to be made readily available. To tackle this issue, increased government funding may be required to allow the distribution of more environmentally friendly products such as menstrual cups or biodegradable pads and tampons.

Ultimately, the question at hand comes back to the necessity of these products and their impact on the lives of those without access to them. The Australian Government needs to enact tangible changes to enable all people who menstruate the opportunity to bleed freely.

Period.

Palak Gupta, Emily Whalen, Surabhi Shashishekara, and Meghna Prasannan are all committee members for the Women’s Health Interest Society of Monash (WHISM).

THE GLASSHOUSE Writing by Kylie Choong

This is very real. The story is entirely made up – written within 10 minutes – but I have seen this feeling in many people around me, and this feeling also resonates with myself at times. This is a story about feeling depressed, but not feeling like your feelings are worth discussing or even be anything worse than the ordinary human experience. It’s the uncertain feeling about whether your problem is big enough for you to have the audacity to burden someone else about it, and this feeling is a universal experience in this pandemic. The ending of this story, although cheesy, is how I wish the narrative could end, but is certainly not the case sometimes.

Content warning: This story may contain potentially distressing themes.

The tiny drops of condensation trickle down my bedroom window. I stare intently at the slow race, each drop running their own pace until one of them joins the other and they join forces and reach the end of the race at double the speed.

It is the middle of Winter in Australia, and the first sunny day since a slew of dreary, endless rainy ones. But it makes little difference to me. Makes little difference to anybody. The dewy grass outside would be covered in tiny droplets of rain, each filled with a whole world of microorganisms – each a symbol of the life that it would support – but I wouldn’t be there to smell it and may never will. Inside, on the other side of the fogged-up glass, the heater in my poorly ventilated room is cranked up high, the smells in my room stewing away as it lingers in the air. My room smells the same as it had all month now­– like the dinner I had last night, and the many meals I had before that.

My nurse comes in again. She’s got that smile plastered on her face behind the thick hospitalgrade mask that covers up most of it. Those deep wrinkles beside her eyes are filled with a profound sympathy, a pity, for me. Yet, her lifeless eyes, no matter how hard they tried to sparkle, are filled with her own exhaustion, sadness, and pain. The same words fall out of her mouth.

“Are you doing alright?”

And an automated response falls out of mine, “Yeah, I’m alright.”

But I’m not. If this is “alright”, I’d hate to know what “not alright” would feel.

I am burdened. I am burdened by my own guilt for feeling sad. Because I shouldn’t be. I’m here, alive. People care for me in this institution I call home.

I’m one of the lucky ones. I’m not special.

Everyone is going through the same thing in this awful pandemic.

But I stare into her eyes anyway, searching for any sign that she may have the room for me to share my burden. And she made room.

And that’s when all the pain came pouring out. The pent-up anxiety and sadness rushed out in a cathartic wave. I tell her about how I felt horrible for feeling this way, that I know we are being kept inside for our own safety, for our own survival. But in this glasshouse that I call home, the heat only felt suffocating, and stunting. Every day, I am afraid that life will never be the same again, that my friends and family I have not seen for years will never return, that I should be doing something useful with all this time on my hands, rather than feeling pitiful

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for myself. I feel horrible for unloading on her, and for feeling like my problems were any worse than hers. But I have aged; life has taken away my youth, my mobility, my loved ones, and now it feels like any last freedom I have is being taken away too. I want to leave. I want to feel better.

With every sentence I say, a choking sob escapes my body. I feel myself uncontrollably sobbing, each sob making me feel more distant to her than before. But my nurse breaks protocol, and every COVID-19 quarantine and distancing rule, and pulls me towards her, pulling me into a warm embrace. I feel myself being pulled out from the deep dark hole I was spiralling down into and I feel the soothing warmth of the room for the first time. I hold onto her, vulnerable and shaking. As we sat there, two strangers holding each other close, the raw human emotional connection breaks through all barriers and PPE, and another two drops of condensation join to finish the race down the windowpane together.

Kylie Choong is the Committee Events Officer for MUMUS Community and Wellbeing.

If you are feeling troubled or are worried about a friend, please do not hesitant to get in contact with: A trusted support person MUMUS team members – Calvin Lu (cluu0003@student.monash.edu), Shreya Mago (smag0009@student.monash.edu) University support [available to metropolitan, rural, & international students] – philippa.corby@monash.edu, jodie.vickers@monash.edu, or call ‘1300 STUDENT’ (1300 788 336) Lifeline call or chat – 13 11 14 or https://www.lifeline.org.au

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Introduction & key definitions: As the COVID-19 pandemic continued into late 2020 and 2021, patients and clinicians increasingly began to recognise a post-acute COVID-19 syndrome, that is now commonly referred to as ‘Long COVID’. Respiratory (e.g. dyspnoea, chest pain) and neuropsychiatric (e.g. fatigue, sleep disturbances, myalgia) symptoms have been frequently reported by affected individuals, and researchers quickly noted the similarities between the post-acute COVID-19 syndrome and postacute viral syndromes seen following infection by other Coronaviruses1.

Medical understanding of post-acute COVID has advanced with such speed that the WHO was able to recently publish a case definition for Post-acute COVID-192.

This defines Post-COVID-19 Condition as occurring in ‘individuals with a history of…SARS-CoV-2 infection, usually 3 months from the onset, marked by symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis’. The definition also states that symptoms may be either ‘new onset’ or ‘persistent’ following acute COVID infection, generally having ‘an impact on everyday functioning’2.

Many researchers have also identified a ‘subacute COVID-19’ syndrome that encompasses symptoms lasting from 4 weeks to 3 months1.

This review will encapsulate the latest research into post-acute COVID, highlighting general principles and practice points that are important for soon-tobe junior doctors.

Epidemiology & Risk Factors: Estimates of the frequency of post-acute COVID19 syndrome vary depending on the population studied, ranging from an 11% rate of residual fatigue in a study of Italian children3, to a 76% rate of any symptom in a study of discharged COVID inpatients in Wuhan, China4. In general, rates of post-acute COVID are reported to be around 3065% for hospitalised COVID patients and 20-40%

for non-hospitalised individuals, though few studies have yet used the new WHO case definition1, 5.

Identified risk factors for post-acute COVID are increasing acute illness severity, increasing age, female gender1 and, to some extent, pre-existing respiratory disease5.

Clinical Features: The clinical manifestations of post-acute COVID19 have been well-documented and are summarised in Table 1. The most common symptoms are highlighted in bold; the overwhelming majority of patients with ‘long COVID’ will have at least one of these1, 2, 5.

Pathogenesis: Post-acute COVID-19 syndrome is recognised as a multi-system condition, with the potential to involve the respiratory, cardiovascular, haematological, neurological, and renal systems. A seminal review published in Nature Medicine identified the predominant pathological processes of post-acute COVID as chronic inflammation, direct viral damage, and post-acute sequelae of severe illness (‘post-intensive care syndrome’)1.

Chronic inflammation appears to be the most important of these, causing pulmonary fibrosis (responsible for respiratory symptoms), endothelial dysfunction and coagulopathy (cardiovascular, respiratory, and haematological), chronic neuroinflammation (neurological) and focal glomerulosclerosis (renal)1. Respiratory symptoms (e.g. dyspnoea) are thought to be caused by both pulmonary fibrosis and microvascular thrombosis6.

Downregulation of the ACE2 receptor (which is bound by SARS-COV-2 surface proteins) is thought to also cause cardiac and vascular remodelling7.

Table 1. Clinical manifestations of post-acute COVID-19 condition.

System Respiratory

Clinical manifestation

Dyspnoea (especially exertional) Cough (common in discharged inpatients) Hypoxaemia & need for longterm O2 supplementation Neuropsychiatric Fatigue Cognitive dysfunction / ‘brain fog’ Sleep disturbance Mood disturbances Headache (typically tension-type) Arthralgia / myalgia Cardiac Chest Pain Palpitations Dyspnoea Haematological Thromboembolic events Renal Reduced eGFR Other Hair loss Multisystem Inflammatory Syndrome in Children (MIS-C)

Management: There is limited evidence regarding specific measures to treat the long-term sequelae of COVID-19 infection8; in any case, a general understanding of referral pathways and medical management principles is more useful at a student level than an in-depth understanding of the specialist management of post-COVID sequelae.

A guideline published by the British Thoracic Society recommends a clinical assessment for respiratory, neuropsychiatric and cardiac sequelae for all hospitalised patients 4-6 weeks following discharge from hospital, as well as a Chest X Ray9.

Functional investigations (e.g. PFTs, 6-minute walk tests) and imaging (Chest CT), D-Dimer screening and cardiac investigations (ECG, echocardiogram) can then be considered based on history and examination findings, and the patient’s risk level for the condition/s being assessed for by each test9.

The management of post-COVID-19 condition, and its societal impacts10, is likely to be the focus of future research into the condition. Those of us who choose to specialise in fields such as respiratory medicine, neurology, cardiothoracic surgery, public health and general practice will likely be involved in the management of post-COVID sequelae in the years to come. Indeed, COVID-19 and its medical and social impacts, it seems, will be here to stay for patients and clinicians alike.

Andrew Duan is a Year 4C medical student with interests in neurology, internal medicine and clinical research. He is one of the Education Officers for the Medical Research Students' Society.

Implications for clinical practice & COVID research: As soon-to-be junior doctors, we should consider ‘long COVID’ as a possible differential for a patient presenting with a symptom of post-acute COVID, such as dyspnoea or fatigue8. However, a thorough clinical assessment must always be performed to rule out red flag symptoms (e.g. worsening or sudden onset dyspnoea, chest pain, new-onset delirium or focal neurology) and exclude serious and common diagnoses that may be the cause of the presenting symptom/s8. Indeed, Post-COVID condition should be treated almost as a ‘diagnosis of exclusion’. It is the author’s experience that patients recovering from COVID-19 tend to overattribute their symptoms to ‘long COVID’.

Key features of the presenting complaint, such as the time course relative to the patient’s episode of acute COVID-19 infection and the severity of the symptoms, may help to delineate post-COVID condition from other diagnoses. Multiple causes for a presenting complaint (e.g. dyspnoea caused by COPD exacerbated by recent COVID-19 infection) should also be considered.

REFERENCES 1. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-15.

2. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV, Condition WHOCCDWGoP-C-. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22(4):e102-e7.

3. Buonsenso D, Munblit D, De Rose C, Sinatti D, Ricchiuto A, Carfi A, et al. Preliminary evidence on long COVID in children. Acta Paediatr.

2021;110(7):2208-11.

4. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-32.

5. Nguyen NN, Hoang VT, Dao TL, Dudouet P, Eldin C, Gautret P. Clinical patterns of somatic symptoms in patients suffering from post-acute long COVID: a systematic review. Eur J Clin Microbiol Infect Dis. 2022;41(4):515-45.

6. Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020;142(2):184-6.

7. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017-32.

8. National COVID-19 Evidence Taskforce. FLOWCHART: CARE OF PEOPLE WITH POST-COVID-19. 2022. In: COVID-19 Living Guidelines [Internet]. Available from: https://covid19evidence.net.au/.

9. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax.

2020;75(11):1009-16.

10. de Leeuw E, Yashadhana A, Hitch D. Long COVID: sustained and multiplied disadvantage. Med J Aust. 2022;216(5):222-4.

OVERCOMMITTED Overcommitted.

After a week of going out every day and night I slammed my head onto my pillow as tears fell out of my eyes.

I just want time, me time!

A night in, a day to relax.

Time spent away from people, without guilt.

Moving to a different country, you want to explore everything.

After years of online learning robbing away the so-called ‘best years of your life’ you just want to put yourself out there.

But we all have a limit.

I realise today that I can’t keep going on like this. But how do I find the balance? What is okay and what is too much?

Why am I meant to figure everything out myself? Wasn’t I just a kid a few months ago.

Aadhya Vyas is a second year medical student.

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Television Review: This Is Going to Hurt

By Jordi Shahab

If you've found yourself on Binge in recent months, it's possible you may have stumbled across the new series 'This Is Going to Hurt'. Or perhaps you are familiar with the book, authored by doctor-turned-comedian, Adam Kay. I found myself watching the series over two days, isolating unbearably with Covid in Horsham (would not recommend).

The series follows Dr Adam Kay, a talented but imperfect registrar with a dry, sarcastic sense of humour, through his time on the obstetrics and gynaecology ward at a major NHS hospital in the UK. 'This Is Going to Hurt' presents differently from previous medical dramas. The series maintains comedy and entertainment whilst authentically capturing the tremendous burden placed on doctors working within an overburdened medical system with minimal structures for support.

But what I also liked was that the series explores the effect that medicine can have on personal life and relationships; how ordeals within the hospital don't disappear once you walk out that door. It reminded me of the first time I had a patient cry in front of me following her terminal diagnosis. There's no teaching on how to leave your problems at the hospital.

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This is a series unlike no other, and cannot be grouped in with existing perceptions of medical TV shows that glamorise medicine. We're used to doctors being portrayed as superheros, working long hours but reaping the rewards for their efforts. But what happens when this isn't the case? How about when we're belittled by a consultant or waiting 4 hours for a doctor to arrive, only to be informed they're not coming in? THIS SHOW was the first to give me this.

Further, we see interesting commentary on the health system. A criticism on the private health system when a woman suffers from a major post-partum haemorrhage and requires emergency transport to a public hospital. Money, it seems, cannot buy health. We see the terrifying ease at which mistakes in clinical practice can lead to a potential career-ending lawsuit. The patients that are rushed in and out daily, with little opportunity to provide complex and personalised care to patients.

The audience are privy to one of the lead characters, Shruti, and her exceptional character development throughout the series, portrayed by Ambika Mod. As medical students, we are faced with the realisation that our current passion for medicine may not sustain itself. We witness Shruti's ecstasy after performing her first delivery, to the eventual monotony she perceives to be her job. In one scene, she is seen nonchalantly informing a family that their fetus is non-viable.

This Is Going to Hurt is not always easy watching, but has moments of humour and humanity that shine through.

Jordi Shahab is the Co-Editor of The Auricle.

The Auricle March-April 2022

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