Autumn 2020

THE BLACK BAG

BRISTOL MEDICAL SCHOOL Autumn term Ed., 2020 1

The University of Bristol Medical Students’ Magazine Est. 1937 Editor-in-Chief: Molly Van der Heiden Vice Editor: Emma Harvey Illustrator: Barbara Piecha Social Media Representatives: Cecilia Gran & Chloe Wong Contributors: Adewale Kukoyi, Anna Cairns. Dolores FawcettHill, Eve Miller, Guy Wilmott, Isabel Cara, Jack McAlinden, Katherine Grigg, Kathryn Orr, Matthew Summers and Niamh Roberts

2

The Black Bag Autumn 2020 (Pandemic issue) Editorial ………………………………………………………………………..4 Galenicals’ President’s Speech……………………………………………….5 Tribute to Matthew Ward…………………………………………………….7 Interview with 21km over 21 weekends…………………………………….8 Thrown in at the Deep End: A Conversation with the Class of COVID…9 NHS Staff Parking……………………………………………………………11 Arguing with Anti-Vaxxers: Tales from the Coalface……………………11 An Honest Reflection of TB1 in Year 2…………………………………….13 Dear NHS Poem……………………………………………………………..14 Interview with Matt Hancock………………………………………………15 Guide to Gloucester Academy……………………………………………...20 MSF Interview…………………………………………………………..……21 Working during a pandemic……………………………………………..…23 Satirical MCQs…………………………………………………………..……25 12 Weeks of Medic Christmas………………………………………………26 Ye Olde Black Bag……………………………………………………………28 3

EDITORIAL Welcome dear readers to the Autumn term issue of The Black Bag. In particular, a warm welcome to all of the new freshers. I am sure you are settling in well and keeping Medadmin-1 occupied with a stream of banality. By now you will have discovered the thrilling news that those most active on the pre-uni group chat are in your CBL group for the rest of your life.

The absurdity of this term is difficult to put into words. It has definitely been the most challenging term of my medical school career so far. Upon taking the position of editor for 2020/2021, I considered how I would make my contributions to The Black Bag memorable.

Hoping that by creating a website and launching on social media that would be enough!

However, I need not have fretted because 2020 is the year we will all long to forget. Imagine describing the dystopian world, in which we currently roam, to your year ago self – utter madness. Of course, there have been some highs – no university or exams from March last year or knowing that a vaguely loud few coughs ensure at least a few days off.

However, it has also been astoundingly tough. I hesitated to mention this in my editorial, reading predecessors’ they are all terribly amusing and light-hearted. However, it would be incredibly naïve to think that we remain unchanged by this experience. By training during a pandemic, we will have a very different experience and outlook compared to those who came before us. We live in an increasingly complicated world and the impact of COVID-19 on our generation’s mental health is so devastating that I simply cannot brush over it and ignore it.

This issue is a dedicated pandemic issue. In the Galenicals president’s address, Jack mentions the 1945 Black Bag issue which is the first to be produced in Peace time. I have included some excerpts at the end of this issue in the hope that it will provide some comfort; we will see the end of this awful disease. I have also included for the same issue, a rather amusing story about a W.C. I hope that in my editorship, we get to produce the first post-pandemic issue.

I also want to take this time to remind you to submit any material to The Black Bag. This magazine has been made by the students at Bristol Medical School since 1937 and now more than ever, its impertinent to have an outlet from medicine. In addition, our writers and content creators’ meetings are every Monday at 6, do pop in if you ever need a rant, a chat or a giggle!

M. van der Heiden Editor in Chief

4

PRESIDENT’S ADDRESS Dear Readers, It is a great honour to pen an address to you in this, the most joyous of mediums, publication in the Black Bag! In a year where you’ve had plenty of emails, messages and video briefings about the ‘unprecedented times,’ I’m glad to be part of the light-hearted fun of the Black Bag. It is itself an example of precedented times; long-standing Bristol Medical School humour that won’t be interrupted by the pandemic and will continue to provide hard-worked medical students a break between clerkings, LT1.4 lectures or nights in Lounge (even if it those breaks now exist between accuRx consultations, blackboard collaborate lectures and Zoom quizzes – remember drinking on Zoom doesn’t count as drinking alone). I can only hope that this presidential address will be significantly more enjoyable for you than hearing a dishevelled Boris Johnson announce yet another lockdown.

In some ways it is a slightly unusual time for this – we are now in the twilight stage of our term as a committee, a term that’s delivered mixed emotions. We’ve had a great deal of responsibility for ours and the Medical School’s COVID response but have all been tinged with sadness seeing ambitious plans going unrealised as a result of the pandemic. However, I have this year been inspired by many previous presidential addresses in the Black Bag and have used them to understand the history of Galenicals and the committees that have led it in the past. Therefore, I use this address to celebrate the seventeen excellent individuals I have had the pleasure of working with on committee this year. Each of you, through your commitment and hard work, in spite of many disappointments, has ensured that our society truly weathered the pandemic storm. Should this address ever fall upon the eyes of future committees (I surely can’t be the only one who gets lost in a rabbit hole of Black Bag reading...) then I urge you to remember your predecessors and those who have gone before in Galenicals. Past committees will be here to support and advise you – heed Eleanor Roosevelt’s advice – “learn from the mistakes of others, you can’t live long enough to make them all yourself.”

Perhaps my longing for this committee to be a part of the history of Galenicals is because this year marked the 85th anniversary of the founding of Galenicals. It’s quite remarkable to think of the many world events and the changes that have happened during the existence of our society. In 1935, when Galenicals was formed, penicillin was recently discovered and those who were in our shoes back then wouldn’t have been able to prescribe it. Our celebrations of this anniversary were subdued with another national lockdown, and plans of cake in the Academies and a formal dinner had to go – yet more to celebrate when we finally can after the end of the pandemic.

When starting our term, the committee agreed on seven priorities: improving the profile of Galenicals; delivering exciting, diverse events and campaigns; improving the transparency of our student voice work and representation; strengthening relations with both Bristol Medical School and Bristol SU; continuing our commitment to welfare and equality, diversity and inclusivity; and ensuring we are sustainable. I believe that as we approach the end, we’re in a good place to deliver these priorities by handover. We have made Galenicals more visible and useful to the members, are in a very healthy financial position and are more transparent with minutes and the Constitution online. We’ve worked well with the Medical School and SU this year and are currently analysing data for our EDI Analysis, working to become more

5

inclusive than ever before. Events and campaigns obviously suffered this year, and sustainability will continue to be a priority going forward, but we’ve done some work behind the scenes to engrain it in all that we do. It has definitely been and continues to be a busy year for Galenicals!

Should you be in need of a lockdown activity, I’d thoroughly recommend reading some of the old Black Bag editions. There is a collection kept online at issuu.com/galenicals and the Medical Library holds further editions. For a particularly interesting parallel between our current lives and the lives of past students, I’d recommend the 1945 peacetime edition – an insight into the thoughts of students following the only comparable challenge facing society in the lifetime of the Black Bag and Galenicals. Reassuringly, medical students will always be medical students and the stereotypes will always apply.

Finally, I would like to dedicate this address to Matt Ward, one of our own, who we sadly lost this year. May he rest in peace.

J. McAlinden Galenicals President 2020-21 – GALENICALS COMMITTEE 2020-21 – Jack McAlinden – President Catrin Masson – Foundation Vice President Narendra Mampitiya – Senior Vice President Lucy Willis – Secretary Callum Craig – Treasurer Kieran Howarth – Alumni Director Bash Hamza – Colleges Director Emma Bache – Community Outreach Director Shay Wahid – Events Director Sheena Parmar – Events Director Brianna Robinson – International Director Amber Knapp-Wilson – Mature Students Director Alice Watts – Performing Arts Director Shalaka Dixit – Sponsorship Director Francesca Blest – Sports Director George Hurst – Sports Director Kimran Birring – Webmaster Natasha McGowan – Welfare & Equalities Director –

6

Tribute to Matt Ward On the 17th of October, Matthew Ward, a year 3 medical student passed away whilst on placement.

Many of us are still reeling from this loss. In November I read some poems on Instagram that touched on the subject of grief. We included one of them here to remind you to take time for yourself and check in with those around you. Read the poem aloud to yourself and listen to the gentle rhymical timbre of the words.

Allow these words to create a stillness in this hectic world and provide a comfort.

This issue is dedicated to Matthew ward. We will never forget him, and I hope one day that I am even half the doctor that he would have become.

M. van der Heiden

The Noble Nature Ben Jonson It is not growing like a tree In bulk, doth make man better be; Or standing long an oak, three hundred year, To fall a log at last, dry, bald, and sere: A lily of a day Is fairer far in May, Although it fall and die that night— It was the plant and flower of Light.

In small proportions we just beauties see; And in short measures life may perfect be.

This poem comments on how life is important even when its cut short

7

Interview: 21 half marathons over 21 weekends On the 28th of Novemeber, Matthew Summers and Guy Wilmott decided to embark on a massive challenge; to run 21 half marathons over 21 weekends in memory of their close friend Matt Ward. They will finish in late April.

Why did you choose to complete this challenge?

MS: On the 17th October 2020 our lives changed forever as we lost Matthew to depression. There are no words to express how heartbroken we are. It may be a surprise to many, that Matt had been suffering with depression for a number of years. His pain and anguish became too much, and he decided to take his own life. We know this is not the answer.

GW: Just before he died, Matt had celebrated his 21st birthday. Hence why we chose to run 21 km over 21 weekends. We are asking that people make a donation into the Samaritan’s in Matt’s name. Samaritans are a fantastic charity that not only provide 24/7 help at the point of crisis, but also take action to prevent the crisis.

What has been the hardest weekend so far?

MS: If you had asked me this question after the first half marathon, I’d have been sure that it would get easier from there and I’d never be as sore as I felt in the car on the journey back from Bath. In true 2020 style, however, I have had to isolate on the last day of term and stay in Bristol for an extra week or so. This left me with the one and only option of running the half in my small garden here in Bristol! I could run for about 5 seconds before I have to turn and run back to the other end. With the help of my house (and sometimes the neighbours) keeping me company along the way I thankfully completed it in less than 3 hours. I’m sure that will go down as the hardest mentally at least!

GW: We have had so much support and it makes a huge difference! Having people running and cycling alongside has really kept us going. Right now, I think we’re both feeling pretty good, I reckon the next few weeks might be the hardest, my legs definitely aren’t used to running this much!

Do you think there is enough teaching on mental health within medical school?

GW: This is a great question, I guess the short and easy answer is no. It can sort of be answered in two ways in that as far as being a Doctor is concerned, we do get taught a lot on specific psych placements. I’m not here to blame the medical school and I know Matt spoke very well of the support he was getting from them. I do hope though that in running this we open up more conversations between the university and students about how we can move forward and encourage people to access this support.

8

What are you most looking forward to doing once you have completed the challenge?

MS: Seeing the final tally! It’s been such a crazy time watching the Just Giving page pass all our wildest expectations. It really has made it so easy to motivate ourselves on the weekends and keep going. I am dreaming of the day we can both have a lie in on a Saturday, though!

How bad are your blisters at the moment?

MS: For now, I’m blister free… I am slightly worried that my running shoes are on their last legs and are going to fail me soon. So, bring on the blisters when I’m wearing the new ones in! We got very carried away with the first half and didn’t pace ourselves in the slightest so hopefully with our new tactic of ‘slow and steady’ I’ll keep any serious niggles away.

GW: My feet are actually holding up quite well, it’s the joints that are the worst!

How can people donate to the challenge?

MS; The Just Giving page! Any donation, large or small, is a huge help! Samaritans are such a fantastic charity, and it would mean the world to bring something positive out of such an awful and tragic situation.

Interviewed by M. van der Heiden

YE OLDE BLACK BAG: WE MAY NOT HAVE BEEN ABLE TO ATTEND THE FRESHERS BAR CRAWL IN FULL SWING BUT LOOKING BACK AT 2010 THIS MAY HAVE BEEN A BLESSING….

9

Thrown in at the deep end: A conversation with the class of COVID

“We were soldiers being sent over the trenches into the firing line” On the 23rd March 2020, PM Boris Johnson announced a nationwide lockdown in response to the Covid-19 crisis. Less than 2 weeks later, on the 3rd April 200 final year Bristol medical students graduated early to work in the UK’s hospitals. “We were soldiers being sent over the trenches into the firing line”, one told me, fresh from 3 months of work as an interim foundation doctor. Bristol was one of the first medical schools in the country to fast-track the qualification of its ready-made and raring-to-go final year students, who signed up in great numbers. Interim foundation doctors could choose to work in their university town, home town or the trust they’d be joining as junior doctors, and one told me it was heartening that so many Bristol graduates chose to stay in the South West area and work with their medical school mates.

As final year students returned to their last placements in Bristol in January 2020, having sat their finals the previous November, the emergence of CoVid-19 in China was nothing more than a distant news story; at best, an interesting point of research, at worst, the butt of a joke.

Over the next few months, the wave that crested in Wuhan would rush towards the shores of Europe and break catastrophically across the world. For these early graduators, it was when certain students were recommended to change elective plans that the severity of the virus hit home. At first it was “some of the far-off places… Philippines, China [but] over the week, more countries [were] added to the list of where the uni [was] banning us from going”. Longawaited and anticipated elective plans were “dropping like flies”. Finally, on the 5th March an email was sent out: all electives were cancelled. “Pretty soon after that…[there were] rumours of us graduating early”.

The last two weeks of placement were cancelled, and final year medical students, along with most of the student body, found themselves back in their family homes. The overwhelming feeling, I was told, was a keenness to get out and help. “It felt…pointless just sitting at home doing nothing when we could start work as an interim foundation doctor”. But it took some time to get to that stage – portfolios needed to be completed and pulled together, exam passes checked, support forms filled out for health and wellbeing. The ex-students I spoke to praised the tireless work of Andrew Blythe, head of year, who “carried all of us… got us all “doctorready””. “You didn’t really know what the timescale was going to be…[you were] always waiting for that email: you have to be back now, you’re starting working”. Almost a month later, provisional GMC registration received and Zoom graduation ceremony completed, they were ready to go.

Leo, one foundation doctor I spoke to, although excited to start working, admitted to the apprehension associated with entering the medical profession during a pandemic. He described “an overwhelming sense of danger: we didn’t know how dangerous COVID was or wasn’t going to be, we didn’t know how bad things were going to get, we didn’t know what the PPE situation was”.

10

Phoebe found herself placed on a 30 bed COVID ward in Gloucester, which was to become the peak of the South West. The consultants on the ward were originally geriatricians, but soon many other specialities were redeployed to help. Orthopaedic surgeons, rheumatologists, ophthalmologists and dermatologists all spent time on the ward - “everyone was just trying to work it out”. It was a unique experience seeing doctors with diverse medical backgrounds working together and bringing whatever knowledge they could to fight the virus, which Phoebe described as “amazing for both patient care and teaching purposes”.

This included a refreshing of traditional hospital hierarchy, with certain seniors accepting that medical juniors of other specialities were best placed in general medical knowledge to lead a ward round. The consultants on the ward rotated every 3 days, whereas the interim F1s were there Monday to Friday, providing continuity. The turnover of staff from different specialities was fascinating and meant that Phoebe got “random bits of teaching”, but it also meant that the new consultants wouldn’t always know that she was the interim, so “they just assumed I was fully functioning”. Did she feel out of her depth? “I was overwhelmed…Most of the time, I was the only F1”, but everyone on the ward was supportive, “checked in a lot” and became, cheesy as it sounds, “a really big family”. Importantly, because the situation was new to everyone, it was OK not to know everything. Or anything, even. “There were geriatric consultants looking after 35-year-olds. Because everyone didn’t know, it didn’t matter if sometimes I didn’t know either. Everyone helped each other out”.

Harry worked at Southmead where staffing and levels of support were comparatively higher.

He described watching substantial technological advancements take hold within the space of a few weeks – new apps being developed (“Facebook for hospital patient flow”) and a “Registrar on-call” system where the registrars shielding at home could give advice down the phone or chase blood results. “[It was] a really interesting time – because of the need, they needed to work out better ways of doing everything. The staff had to be very adaptable”.

Over their three months as interim F1s, they learnt more about hospital life than any hours of medical school placement could give them. Things like knowing the names of the nurses on the ward, discharging patients and planning social care, everything in fact that happens after 5pm on a weekday. And on a serious note, they came face to face with a virus unlike any found in Kumar & Clark’s Clinical Medicine, a disease that struck unexpectedly and uncontrollably and has changed the face of medicine forever.

The interim jobs finished in July, and on the 5th August, the new doctors started their F1 rotations. Having worked during the greatest medical crisis in a generation, the F1s I spoke to felt that, unsurprisingly, settling into their new jobs was a walk in the park. “I was totally relaxed”, said one. Overall, it was a steep learning curve, but one that these graduates are proud to have scaled. Inevitably, they will be forever defined as The COVID Cohort, bringing experiences with them into their new careers that no graduates before them could ever have imagined. As Phoebe put it, “We’ll always be that generation that pulled their socks up and had to help”.

Written by Eve Miller

11

NHS workers rewarded with pricey parking permits Written during Lockdown, Kathryn Orr reflected on the shocking news that NHS staff had to be paid for parking. Of course, this abysmal policy was soon overturned.

It’s finally time to celebrate returning to ‘normal’ life and you will be glad to hear that includes paying to actually go to work – hoorah!

Free parking is a national outrage anyway. Who in their right mind would allow staff to get away with such theft? I mean, surely our frontline workers don’t mind contributing a little for the privilege of long hours, humongous work-loads and the holy-grail of career aims – burnout! Paying for this utter privilege? Yes please!

Upon hearing of a potential return to hefty permits and fines, NHS worker Ms. Fi Waiver exclaimed with utter relief, ‘thank goodness, back to a simpler pre-COVID time! I was beginning to feel rather over-appreciated.’

The thrill of watching your hard-earned salary dwindle each month truly is a rite of passage for all NHS staff. How else are we meant to feel connected in a socially-distanced world?

You may be surprised to hear that this is not a new issue; strikes for free parking have raged on for centuries. Legend has it that Richard III was an avid supporter of the cause and look how that turned out? Just like him, we may end up stuck in a car park forever. After all, we have paid enough rent to live in one.

Maybe we should take a leaf out of our neighbours’ book? Wales has the right idea with free parking for NHS staff; so why can’t we follow suit? A petition to move our great city across the border may indeed prove more fruitful.

The previous permit expired on the 31st August 2020. So, keep your eyes peeled and hey, let’s look on the bright side for once…what a great incentive to walk to work. It should only take a few extra hours!

Written by Kathryn Orr

Arguing with anti-vaxxers: tales from the coalface by Dolores Fawcett-Hill In the dark depths of Lockdown 2.0, there was only one place I could find solace, support, and amusement during those long nights: my village noticeboard on Facebook.

As someone born after 2000, I browse Facebook with the same smirk of anticipation on my face as one might have when watching two people start a fight in a club, or when your pet is about to do something stupid - just waiting for that perfect moment, when all hell breaks loose in the comments section of a post.

Like a gift from God, I stumbled across such a moment on my village noticeboard, in the form of a post which was gaining a lot of traction. Simply put, it read: ‘Go on then. Covid vaccine, yes or no. Please don’t slag each other off.’

12

With nearly 700 comments from a village of just a few thousand, this post had caused a spark which lit up debates between neighbours, and inflamed the opinionated. Everyone was eager to have their say, providing a fantastic insight into the minds of the vaccinesceptics.

One of the most contentious comments argued that ‘the vaccine is all a way of getting everyone’s DNA on a database’, sharing concerns of how the government would use this information to control everyone’s lives. What the government would do with the control of an army of pensioners is, of course, a question that ruins the fun of that debate, but if the fantastic Margaret Keenan is ever spotted popping into the Kremlin on her way to M&S, we will know where to point the finger.

A concern was raised that ‘they reckon this virus isn’t man made, but if that’s the case, they’d never have a vaccine already’, and I can follow that logic. It’s classic political sleight of hand: Make a virus, cure the virus, rule Britannia et cetera., with only the minor intermediary steps of mass unemployment, a crippling recession, and tens of thousands of needless deaths. I’m amazed it doesn’t happen more often.

One of my favourite arguments in favour of the vaccine was ‘I’ve done lots of things that are bad for me, so I may as well do something that’s good for me’. I agree, and it should be widely proclaimed that if you’ve ever drunk a Jager-bomb, you really don’t need to worry about what’s in the vaccine.

In a riveting turn of events a few hours after the original post, the owner of the local Chinese takeaway chimed in with his opinions, to which someone swiftly replied ‘shut up and answer the phone’, just months after we were clapping on our doorsteps for such vital key workers.

A common thread amongst the hard-wearing anti-vaxxers, is that they are predominantly 30-something men who have had to turn to Facebook to spout their conspiracy theories, after one too many sympathetic nods from their spouses. There is a strong sense of individualistic obstinacy amongst this population that I can almost respect - hid behind ‘don’t tread on me’ Facebook banners, with a portfolio of shunned Doctors’ hot takes to cite as evidence, these people are so convinced that they’re right that it's jarring to my personal sense of intellectual entitlement. As someone succinctly put it: ‘Nope. Had that sh*t back last December. Survived’, and the almost unfortunate thing, is that they’ll keep on surviving, vaccine or not, as members of one of the least affected age groups, leaving the most vulnerable members of society to bear the brunt of their intransigence.

After the initial excitement, the Facebook page has returned back to regular programming lost cats, noise complaints, and the occasional moan about littering in the park - but I make sure to stay vigilant. You never know when you might have to weigh in on a debate with some almost violent sarcasm, doing your bit as a medical student in the wider community.

Written by Dolores Fawcett-Hill

13

An Honest Reflection of TB1 in Year 2 If I were, to sum up, the first term of my second-year experience in one word, it would be “satisfactory”. And that’s not to undermine the hard work that went into delivering a “blended” learning experience; it’s merely a judgement of what has been a challenging first term. There is no doubt that the situation we all find ourselves in is unique. Not only are we training in the middle of a global pandemic, where things are uncertain (to say the least), but we also need to remain mentally resilient to keep afloat. I have often found myself chronically bored with looking at the same screen and after prolonged use, irritable at the sight of Zoom or Microsoft Teams.

However, I would not say it has been all “doom and gloom.” I have been able to engage with content on a much deeper level, balance Medical school with other university roles and also learn more about myself (deep, I know).

The blended experience also offered the chance to teach aspects of Medicine creatively. A moment that stands out would have to be our “Lifestyle Conversations” lecture with Professor Trevor Thompson - where best-selling author and nutrition expert, Dr Rupy Aujla, joined us from his kitchen!

The less glamourous aspects of online learning - remote tutorials and lectures, have been a breath of fresh air in comparison to first year. The clinical focus has put things into perspective and serves as a foundation for the later stages of medical school. Learning to escape the online environment with fresh air has been my saving grace, and with the introduction of E-Scooters in Bristol, I have been chasing the adrenaline rush from a quick ride!

Under the current circumstances, the start to second year has been okay. It is encouraging to see the potential for some face to face teaching in TB2, and with the new vaccine being rolled out, it could spell the end of Zoom and Microsoft Teams (I joke!)

Written by Adewale Kukoyi

14

Dear NHS Poem: “Being in Bed 10” Buzz buzz Footsteps Buzz buzz The alarm bells go off Trapped in a bed, damn that chest tube hurts Confused…. What’s happening to me today?

Surgery? Discharge? Someone please tell me that I’m fine Footsteps Nice nurses, distant doctors – kind to me, very kind to me Don’t replace the visitors that COVID are keeping away Buzz buzz I’m used to being in the know, a student, here to learn Now I’m a patient, Confused, and jealous of anyone who knows anything Footsteps I’m alone, I feel awful, being told I’m here to heal The midnight footsteps are stopping my sleep, And I feel twice as bad as before.

It’s a horrible place recover Because of the buzz buzz And the footsteps Written by Niamh Roberts

15

Interview with Matt Hancock by Katherine Grigg

Sunday 15th November, 7.30pm.

I’m a third year medical student at Bristol University and I write for The Black Bag. We invited the Health Secretary, Matt Hancock to be interviewed which he kindly agreed to. The Health Secretary spoke to me from his office at home over Zoom. He managed to give me 20 minutes of his time in between finishing his red box and putting his children to bed.

KG: Several wards at Southmead Hospital in Bristol where I’m on placement as a medical student have been converted into COVID wards. What health consequences do you think will come from the prioritisation of treating COVID versus other illnesses?

MH: Well, I think it's a central and incredibly important question for the NHS. We know in the first peak when we didn't know as much about the disease, that there was a huge backlog of untreated patients. We are having to work our way through those.

I just hope that second time round, we have much better knowledge of how to keep the NHS going for all the other patients who rely on it, whilst also obviously tackling the challenges that COVID directly throws up.

I'm really proud of the fact that the NHS has kept, for instance, reducing the cancer backlog even during this second peak and protected cancer services. In fact in September - I was looking at the national figures last week - nationally the amount of cancer diagnostics was slightly higher than September the previous year - that's because of the catch-up and we've got to keep those services running.

Now there's two ways to do that. One is to reduce the amount of COVID in the wider population, hence the national lockdown. The second is just for us to really think hard and creatively about how we make sure that we can get services to people who need them.

I think the public understands it better the second time round as well (I don't mean to blame the public - far from it) but we've been able to successfully get out the message that the NHS is there for you, so we haven't seen the fall off in the number of people coming forward.

I was worried about two consequences – firstly people who did come forward or were on a waiting list but couldn't get treated because treatments were cancelled. But then there's also the people who didn't come forward but have got health problems.

This will lead to a greater burden in the future, sometimes with much worse disease - such as with late presentation of cancer or mental illness. With mental ill health we've seen some people coming forward who didn't come forward during the first peak who end up with a much more serious illness as a result.

16

KG: I've definitely seen some of those patients - late presentations due to the first lockdown.

What difficult decisions have you had to make in the past nine months?

MH: Many of the decisions have been choosing between unpalatable options. There are very significant consequences of the decisions for people.

There’s all the decisions which might not have been on the national front pages but are really heart rendering. For example, the decision on how to support grieving families who want to see their loved ones and want to go to the funeral when they might themselves be COVID positive. That is really upsetting.

It's a bit like the live question at the moment of care home visiting. Care home visiting is really difficult because you don't want to put the people living in care homes at risk but at the same time you know that the visiting is a lifeline for them.

KG: Indeed - I've been shocked myself about the lack of visitors in lockdown. Before lockdown visitors would really make a patient’s day.

MH: Yeah, it can. Then we had the problem in maternity, where partners were not allowed to go to a birth. That is a really big thing to miss. Thankfully I hope that now with widespread availability of testing we can ease some of these terrible trade offs.

So where it's a straight trade-off between, for instance, the risk of visitors versus the need for people to see others and their loved ones, the best thing to do is to reject the trade off and try to find a way through. In this case the wider availability of testing will hopefully mean we have a far better regime.

KG: What do you think about the exodus of junior doctors that have gone to work abroad in countries such as New Zealand or Australia? Do you think we need to tempt them back?

MH: Yes! I definitely want to tempt anyone back who goes abroad. I understand why you might as a junior doctor, having just qualified 6 hard years, be tempted to go to Australia for a couple of years.

I looked into it pre pandemic – of course it is much more difficult to make that sort of switch now for the time being. It turns out that there's almost the same number of people coming the other way.

Lots of student doctors and junior doctors asked me about it and we find that it’s par. My Australian opposite number says he gets asked exactly the same question ‘Why are there so many people who want to disappear from Australia and go to Britain’ (It’s definitely not the weather).

Of course I’m in favour of making sure that working in the NHS is as attractive as it possibly can be.

I’m also up for making it as easy as possible for people, if they want to experience working in Australia for a bit, to be able to.

I’d also like it to be easier for people who trained in other similar jurisdictions like Australia or New Zealand - where essentially the training is very high quality as well - to be able to come to us. I think that sort of exchange benefits everybody.

You have to make sure the minimum standards are there in terms of qualification and what people are learning. Overall, I'm quite open minded and I think it's quite a good thing.

KG: What do you think should be done to incentivise more British students to become medical students?

17

HM: A great question. We have seen the numbers applying going up and this year we have a record new batch not least thanks to the algorithm issue with A levels over the summer.

I want to hear what you think we should be doing.

It’s not just about making studying medicine even more attractive, what I want to do is make working in the NHS hugely attractive.

It's a brilliant mission driven job medicine - it's all about helping other people and can be hugely rewarding. I'm sure that's what drives most people to go through the very hard and arduous process of applying and studying.

Sometimes working in the NHS is less than the sum of its parts and it doesn't as an organisation make it as easy as it could do and as enjoyable as it could be. Some of these things are simple things like rest-break areas and people showing appreciation.

I was actually reading Adam Kay's book ‘This is Going to Hurt’ when I was given the job as Health Secretary and it made a real impact on me. I hope that we can improve the NHS as a place to work in.

But what would you do to attract more people into medicine?

KG: I think it is a big question. I think there are lots of incredibly talented medically minded people that opt to not do medicine, when they would be really suited to it. I would be pro encouraging more people to apply for medicine.

(KG: Because of the time constraints I didn’t elaborate on my thoughts on the question. I would make the NHS a more attractive place to work by improving pay, improving mental health services for healthcare professionals, improving work life balance, decreasing the incidences of burn out, increase the ease of flexibility between the specialities with career changes, and I think there should be easier access into practising medicine regardless of age.)

Do you think that the Health Secretary should be a doctor?

MH: I think that would be fine, but I don't think it's necessary because it's not my job. It's Chris Whitty's job to be a doctor and give me clinical advice. It's my job to be the representative of the people. There would be no downside to the Health Secretary being a doctor.

As Health Secretary I want to make the system run as well as possible, but I don't think being a doctor is necessary to do the job. It’s an important decision in terms of what we do. Getting clinical advice is important but also representing patients is important.

The NHS consumes £145 billion worth of taxpayers money (it's actually more than that this year because of the pandemic) and so I think that it is the democratic legitimacy that is most important.

I know that that's not a view universally shared amongst doctors. You could also ask the question ‘shouldn't the Health Secretary be a nurse’ because the biggest number of employees within The Health Service are nurses not doctors.

I think listening to doctors yes, being a doctor - not necessarily. But I would say that wouldn't I! KG: What do you think the mental health impact will be from making students isolate in halls of residence?

MH: I know, it's terrible. This is another example a bit like visiting in care homes that I really worry about.

18

I talked quite a lot to the Royal College of Psychiatrists before the 2nd lockdown about about the mental health consequences of lockdown. Their view was that there are both mental health consequences of lockdown and COVID getting out of control.

Long COVID is a serious condition and it has mental health consequences for some. If you don't lockdown then you can end up having worse lockdowns later. It is something I worry about.

I'm really keen to ensure that people get the support that they need whether that's through peers or services on the ground, or through IAPT or other digital services widely available for anxiety and depression.

I'm also really worried about the late presentation of very serious mental ill health which leads to more serious presentations.

I'm sure late and more severe presentation is a consequence of people not being able to get the support they need especially during the first lockdown. It’s another reason to be cautious about going into lockdown.

KG: Do you think that medical students and nursing students alike should have to pay for their degree?

MH: I think that it's fair to ask people to contribute. With nursing and with medicine it's a shared responsibility. The NHS and government fund part of medical and nursing degrees. Taxpayers ultimately pay for a significant portion it, but so do students. I think that's reasonable.

Medicine is well paid career and because almost everybody can get a job afterwards you have got a high degree of confidence that you’ll be able to pay it back.

Jobs in medicine are significantly better paid than the average pay in the country, where the taxes come from. I think this is a fair debate, but I do think it's reasonable that that there's a shared responsibility.

KG: How are you feeling about this second lockdown?

MH: Well I wish it hadn't had to happen. I think everybody feels that. It is too early to see how effective it is being yet, but I'm pretty hopeful that it'll get things under control. I really hope we can get out at the start of December.

The combination of mass testing and the vaccine looking like it might be on the horizon makes me hopeful. I think everybody needed that good news about the vaccine when it came through last week.

KG: At Southmead hospital where I am on placement, people were definitely pleased to hear about it. How do you envision Christmas this year - will families be able to be together?

MH: I hope so. I can't say exactly how we're going to do it because we're trying to get an agreed approach across England, Scotland, Wales and Northern Ireland. Those discussions are still going on.

I don't want to prejudge them because one of the features of the pandemic has been things being done differently across the four nations.

Lots of people travel across the UK at Christmas and have family in different parts of the UK, so we're trying to come to an agreed approach across all four nations.

19

I think that would be really good if we can pull it off and I really hope we can then have Christmas as normal as possible. I don’t know if it’ll be fully normal, but I think everybody would really like to see that.

KG: Thank you for your time Secretary of State. I don't know if there's anything else you'd like to add for the magazine?

MH: There is one thing I would like to say if I may – I’d like to say thank you. Both to you for having me on, but also to all of the student doctors and junior doctors in and around Bristol. For the commitment you are showing in the work that you're doing.

It is not an easy time to be a student doctor in the middle of this pandemic. I hope it's a really interesting time but it's not an easy time and I appreciate it, and the public really appreciates it and it's hugely valued.

Your work is particularly poignant for me because I know Southmead Hospital well. My sister was treated there when she had a very serious head injury and almost died and they saved her life. Your work matters to me, so thank you.

Written by Katherine Grigg

20

Guide to Gloucester Academy Out placement can be a daunting prospect, so knowing a little bit about the academy you are headed to is always helpful. Here are some key instructions for making the most of the Gloucester experience.

First, work out how you are going to get to Gloucester. Pick a friend with a car - preferably with a questionable MOT - and switch on the iPhone sat nav. When you get to Gloucester, you will locate the random side street where the Whitfield House accommodation is situated, and subsequently fight with the 10 other cars of students for a space. Be prepared to listen to a vital 5-minute lecture from the academy staff on how to use a key - essential learning in your early 20s. Those lockdown home workouts will now come in handy as you lug your suitcases up two flights of stairs (apparently the lift is a risk for COVID transmission, but the narrow flight of stairs is not).

Whilst we are discussing luggage, you must remember to bring all the essentials. These include your newly purchased placement clothes – which you won’t actually need because Gloucester is making all students wear scrubs but failed to tell you – uncomfortable smart shoes, stethoscope, textbooks, flares to remind you of Bristol. Do be sure to refer to the useful email about kitchen equipment which clearly states “there may be some pots and pans”, allowing you to buy a whole new kitchen set to make sure you are covered!

The flats and rooms are lovely. Spacious, modern, warm, with strong Premier Inn vibes, it is a place you will be very comfortable for the next four months. Recycling bins are not available, so the Bristol climate-conscious vegan mindset should be forgotten about for the duration of your stay. Whitfield House is situated in a colourful part of Gloucester and you will be regularly woken by fighting in the middle of the night, along with the occasional police car.

Make sure you know your way to the Redwood Education Centre. It is only a 10-minute walk from the accommodation, but this does not consider the fact that the Gloucester Royal Hospital site is a maze. The walk is a lovely way to start the day, taking you through a tunnel under the train station, although you must learn to master the skill of avoiding the faeces on the ground - good practice for hospital! Once you have found Redwood, you will be greeted by some truly lovely clinical fellows and the very kind lady from the café who gives out free coffee. However, do be aware that you may actually end up based in Cheltenham Hospital, which allows you to enjoy a 50-minute bus ride in peak rush hour traffic.

Within a 5-minute walking distance of the accommodation, there is a Tesco Express, Wilko, and a Kaspa’s Desert Parlour for when you want to channel your inner 13-year-old girl. Gloucester nightlife consists of drinking in the streets or attending a few dodgy bars, so you are very much spoilt for choice. You will be required to follow the trend and purchase a membership at the popular ‘The Gym’ chain. Each evening, you can join all the classic Bristol medics rugby lads there and worry you are being followed on the way back home.

Overall, Gloucester is a great academy to be in and living in such a weird town is an experience you will never forget.

Written by Niamh Roberts

21

Interview with MSF Written by Anna Cairns Since her first MSF mission in 1998, Mary Houldsworth, who goes by the name of Flowa, has worked as a Nurse/Midwife and Health Promoter in many of the world’s conflict zones and crisis areas.

From treating displaced peoples during the famine in Ethiopia, to being on the frontline of the Ebola virus pandemic in Liberia, she has experienced the many complexities of delivering healthcare to those caught in the crossfire of conflict or in the epicentre of humanitarian catastrophe.

I spoke to Flowa about her experiences working for MSF and the lessons that can be learnt from the Ebola outbreak in light of the current Coronavirus pandemic.

AC: What were your initial motivations for working for MSF? MF: When my two sons were teenagers, I really wanted them to have gap years, but they refused, so I had one instead! I travelled to Calcutta, in India, where I discovered that an English doctor, Jack Preger, ran a street clinic. He had six hundred patients a day. We set up a mother-and-child unit and, and treated patients living in the slums. Our clinic was the only place that offered free treatment to the extremely poor. I saw, first-hand, the difference that accurate diagnosis, medication, and prescribing made to people’s lives, which eventually led me to MSF. AC: Do you have any stories which you feel encapsulates your experiences working for MSF? F: During my last mission in Ethiopia, we were deployed to care for five thousand internally displaced persons (IDPs). Houses had been torched and plantations taken over. Families were forced to grab their children and flee at short notice. They were housed in five, large concrete coffee warehouses, where the babies were delivered on the concrete floor. As well as antenatal care, I taught infectious disease recognition to a respected woman in each warehouse. Patients suffering from TB and tropical disease were referred to the local hospital. As you can imagine, the tension in the camp led to outbreaks of violence. The mental health team treated women, set up a football team for the men, and set up play sessions for the children. We set up a vaccination programme in the local clinic and organised contraception - which was in high demand. All this was achieved in the context of a difficult political situation, and all within two months.

AC: Did you notice that there were different challenges from mission to mission or did you notice a common theme throughout?

F: Security is always one of our main concerns. In South Sudan, on Christmas Eve, there was firing over the compound and we slept fully clothed with our emergency bags packed, ready to run. I always want to know about the political situation and I always ask about the weather. In South Sudan, I was living in a tent in 44 degrees and the clinic was under a tree. Whereas in Afghanistan, it was -20 degrees at night, so I went to bed with more clothes on than when I went to work. I also found that local hospital treatments could be a challenge. We often solved these issues by sharing our knowledge and our skills.

AC: How do you deal with the psychological aspects of Aid work?

F: The psychological effects of Ebola affected the whole team when I was in Liberia at the height of the outbreak. It was the first time that Ebola had reached a city and it was the largest team that MSF had ever had on a project. I kept saying to my staff, “Come on team, we’re making history”. They ended up winning the TIME magazine’s award for workers of the year. We had 110 deaths a day and you have to suppress that grief, which is horrendous. We needed to build trust with the community, who had difficulty accepting that their intricate burial rites spread the disease rapidly amongst the family members. We were working very long days and I had three days off in five weeks. It was

22

demanding and, of course, it all erupts when you get home. We have a debriefing session in the country and a volunteer coordinator rings you within 24 hours of getting back to see how you’re getting on and offers psychological support.

AC: After a mission like that, how do you adjust to life back in the UK? F: When I came back from Liberia, I had to self-isolate for three weeks. While I was in Liberia, I had sent a photo of myself in full PPE to a friend who forwarded it to the local paper. People were scared about Ebola so when I came back people were absolutely petrified, and I’m still not allowed back to my local choir.

When I’m in a refugee camp anywhere in the world, it takes me five minutes to work out an outline of things that need to be addressed. It takes me five months to readjust to England. You’re bursting with everything you’ve experienced but people don’t want to know.

AC: What drives you to keep going back?

F: When I hear about conflict on the news, I always think, “Will I get a phone call?”. I like to be challenged. There’s also the curiosity - I wonder about the main concerns. For example, in Goma, in the Democratic Republic of Congo, we were expecting people to be worried about Ebola, but their main concern was the infected water supply. We brought in water and sanitation engineers to address the issue, as it was their priority. You always feel very apprehensive about going, no matter how experienced you are, because you know that you’re going to meet new challenges.

AC: How do you balance working for MSF, working in the NHS and your personal life at home? Have you had to make sacrifices in any of those areas?

F: I’ve never felt as though I was making sacrifices to work for MSF. My children had left home and there were no family ties. I consider working for MSF as a privilege because I’ve travelled to remote corners of the world. The people I’ve looked after have given me far more than I’ve given them.

AC: You have talked about being on the ‘frontline’ dealing with the Ebola pandemic in 2014, do you think there are any lessons that we can learn from that outbreak, in the context of the current COVID-19 pandemic?

F: Ebola was named as a virus of fear and ignorance and I see that played out in the COVID pandemic. Some people won’t go out and they run the risk of mental health problems. My friend’s daughter is part of a group who don’t believe that COVID exists. It reminded me of my time in Liberia as a health promoter. I used to speak to the local hygienists, and they worked out that roughly 10% of the local community didn’t believe that the virus existed. We invited local midwives, religious leaders and traditional healers to discuss the realities of Ebola and relay accurate information to the community. I think that it requires specialists to debunk the myths about Coronavirus and deliver the truth to people who don’t understand the purpose of the guidelines and regulations.

AC: Do you have any advice that you’d give to anyone dealing with the COVID-19 pandemic first-hand in hospitals at the moment?

F: I do. MSF has been established for almost fifty years and has dealt with many disease outbreaks.

We recognise that it is emotionally, physically and mentally demanding. I think that the NHS probably needs to implement a way of monitoring staff well-being and standards in regard to the Coronavirus pandemic. There needs to be someone who listens and gives staff psychological support.

Ebola was a new situation even for MSF. Every day we had several staff meetings where we had to come up with solutions to problems that we had never had to deal with before. It was a huge learning curve and I think, in the context of a pandemic, constant communication is very important.

AC: What attributes do you think that you need to be part of an MSF team?

F: You need to be flexible and adaptable and able to work in a team. You need to be prepared to encounter traditions that you have not seen or experienced before. For example, in Ethiopia, during the daily coffee ceremony, mothers were giving young babies the strongest coffee I’d ever tasted.

Another example was in Afghanistan, where I noticed that babies weren’t being breastfed for the first

23

four days because the locals believed that the milk was sour. There will be times when you need to decide which issues are life threatening, and which are long-standing cultural traditions. I decided the Ethiopian mothers had drunk strong coffee daily throughout their pregnancies, so chose not to address the issue. However, in Afghanistan, where maternal death rates were high, we conducted a workshop on the safe benefits of ‘breastfeeding immediately after delivery’ for the mother’s safety as well as the babies. This new information brought about a change in behavioural practices.

AC: What advice would you give to healthcare students who are considering joining MSF or other similar aid agencies in the future?

F: Go camping and have a weekend without hot food, WI-FI or electricity. Learn French or Arabic and get some overseas experience. There’s a very good organisation called ‘Care4Calais’, who provide support to the refugees in Calais. Undertaking a tropical medicine course is also essential and there are courses available in Liverpool and at the London School of Tropical Medicine.

AC: Do you have any plans to work for MSF in the future?

F: I’d love to! I’ve had my bag packed for a year! If nothing comes up, I’m thinking of going to work in the Moria Camp in Lesvos with a smaller charity.

For more information on MSF, including how they set up a COVID hospital for homeless people - a project that has now finished - check out the link below. http://msf.org.uk/

WORKING DURING THE PANDEMIC: INTERVIEW WITH IZZY CARA Isabel Cara is a year 3 medic who after University closed in March 2020 spent the majority of her lockdown working for the NHS. We caught up with her to discuss working during a pandemic and how coronavirus has impacted her medical school experience.

How did you spend your pandemic?

During the pandemic, I was fortunate that my local DGH, Northampton General Hospital (NGH), was able to offer a scheme for returning medical students. The program involved us working as ‘clinical assistants’, a novel role that incorporated many of the skills that we had already learned (or were learning) as medical students. These included practical skills; and jobs such as preparing notes for the ward round, ordering scans, venepuncture, cannulas etc.

Having worked at NGH as a phlebotomist during my previous two summers, I had developed a good relationship with my manager there. She e-mailed me outlining the emerging clinical assistant role that was being planned, and that’s how I got the job!

How did you manage to study simultaneously whilst working?

The clinical assistant scheme was created as a bank role in order that medical students would be able to fit their studies around the job. I was therefore able to book my shifts to avoid my online lectures. In this way I felt that I was able to continue my theory learning as well as gaining valuable clinical experience.

It was also nice to get a bit of normality from working in the hospital. Obviously, hospitals had to carry on as best they could during the first wave of the pandemic, so it was really refreshing to be able get out of the house and talk to people who weren’t in my ‘bubble’.

Did you ever get coronavirus?

Yes, within the first week of lockdown, my parents and I managed to catch coronavirus. My brother (also a medical student!) returned a week after me and managed to pick it up too. Fortunately, all of

24

us had very mild experiences with COVID and the only troubling symptom was my parents and I losing our senses of smell for a few months.

In retrospect, I think we were very lucky to catch coronavirus when we did. As my dad is on immunosuppressants it was reassuring to know that he was unlikely to be at further risk and to an extent this helped to offset the stress of lockdown. Despite my relatively positive experience of lockdown, I can really appreciate how difficult it would be for some people. I know that many of my friends really struggled with their mental health during this period, especially those who had to isolate on their own.

Did you witness the NHS struggling to cope or do you think it managed all the time?

Coronavirus has definitely had a very conflicting impact on the NHS. While during the initial few months the pressure on beds at Northampton (and elsewhere) was significantly reduced and A&E attendances dramatically declined, I can appreciate how this has only added to waiting lists and long-term stresses on the healthcare system. On a national level, it does appear that COVID has showcased some fantastic elements of the NHS: multiculturalism, team-working, equity and an absolute commitment to its patients. However, it has also highlighted limits to the resources that are available.

In my experience, I didn’t see wards being overrun, or oxygen supplies running out. Nevertheless, my parents are both doctors at NGH and in recent months I have heard from them how their departments have struggled to keep services going during this time.

How has coronavirus impacted your studies?

Despite COVID, I have really enjoyed my first term of clinical placement. There has been a reduced amount of face-to-face care and teaching but I appreciate the lengths to which our supervisors and CTFs have gone to replace that with online teaching. At the BRI a number of wards have closed, and it has sometimes been challenging to get enough clinical exposure through ward rounds and clinics.

This meant that I missed out on opportunities presenting patients and developing clinical skills on the wards.

Based on your experience, what impacts have you seen that COVID has had on patients and staff in the NHS? While working, the biggest impact I saw on the patients was isolation in the hospital: being unable to have visitors and see their family. One of the wards I spent time on was the stroke ward, home to many elderly patients often for several weeks. It was saddening that they were unable to see their loved ones, especially during a time when they were most vulnerable. However, the staff went to extraordinary lengths to ease their feelings of loneliness, organizing facetime calls and bringing patients to the window to see family who were outside. They worked around the clock to not only ensure the safety of their patients during such an unsettling time, but to bring a little normality too.

I would definitely recommend working in any aspect of the NHS to a medical student before graduating! It’s great way to improve your bedside manner, develop important clinical skills and also get used to working in a team in a clinical environment. I found working as a phlebotomist and as a CA an invaluable experience that I really enjoyed!

25

The Black Bag’s MCQ Exam

1. Jonny is a 3rd year medical student at the pub. He is asked to use the NHS app to give his details for track and trace. He unfortunately never downloaded the app despite supposedly being a representative for it. He gives his details despite thinking this might mess up his plans to have a dinner party secretly with some other medics later in the week. They were in his bubble anyway right? What should Jonny do after being reminded to get the NHS app on the next weekly bulletin?

A. B. C. D. E.

Download the NHS app Talk to the beautiful CTFs about it Keep talking about COVID 19 as if he knows everything, because he is a medic Debate the topic in the common room of the Bath academy Do not download the app, as this could mean he has to isolate and then not be able to see his mates

Answer: C He should keep talking about COVID 19 as if he knows everything as this maintains the public’s faith in the health service.

2. Tallulah is a second year medic and is at home now for the Christmas holidays. She is asked by her family all about medical matters, including the pathophysiology of hay fever, how does paracetamol work, and what is the difference between vaccination and inoculation. How should Tallulah go about answering the questions?

A. Answer that she’s not sure B. Always answer with ‘that is an interesting question, but we haven’t been taught about it yet.’

C. Answer to the best of her ability, admit she might need to look something up D. Answer with what she reckons is the most likely answer, dropping in some fancy terms to prove she is highly knowledgeable E. Answer that it is beyond a lay person’s understanding so she cannot explain it to her family. Only medics would understand.

Answer: D Dropping in fancy terms is a highly advisable way to convince the lay person that you know what you are talking about.

3. Dorothea is aware that CLICENDALES might not be able to happen this year. She so loved being in it in her second year and told everyone she knew about it. How should she go about coping with the fact that gathering an audience of 2000 might not be advised in 2021?

4.

A. She should relive CLIC from the last year through posting another Instagram about how special an experience it was B. She should just wait until 2022 because she still has 3 more years of medicine C. She should decide to run a marathon as she must always be doing charitable things as a medic D. She should take up stripping for her flat mates so that she is ready for auditions next year E. She should use ‘was in a strip show’ on her Hinge so that she can keep talking about CLIC to people who haven’t yet heard about it Answer: C This is the best way for her to use her energy as she loves achieving, but also looking charitable. Virtue signalling is always a good use of a medics’ time as they are especially good at it.

Written by Katherine Grigg

26

On the first day of Christmas, my true love gave to me A revision list for the OSCE. On the second day of Christmas, my true love gave to me Two replay lectures, And a revision list for the OSCE. On the third day of Christmas, my true love gave to me Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the fourth day of Christmas, my true love gave to me Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the fifth day of Christmas, my true love gave to me Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the sixth day of Christmas, my true love gave to me Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the seventh day of Christmas, my true love gave to me Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the eighth day of Christmas, my true love gave to me Eight friends a-baking, Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the ninth day of Christmas, my true love gave to me

27

Nine face masks itching, Eight friends a-baking, Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the tenth day of Christmas, my true love gave to me Ten Blackboards crashing, Nine face masks itching, Eight friends a-baking, Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the eleventh day of Christmas, my true love gave to me Eleven flu jabs jabbing, Ten Blackboards crashing, Nine face masks itching, Eight friends a-baking, Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. On the twelfth day of Christmas, my true love gave to me Twelve doctors dancing, Eleven flu jabs jabbing, Ten Blackboards crashing, Nine face masks itching, Eight friends a-baking, Seven TABs a-doing, Six CTFs crying, Five eBiolabs, Four long case clerkings, Three stolen scrubs, Two replay lectures, And a revision list for the OSCE. Written by Emma Harvey

28

YE OLDE BLACK BAG AUTUMN 1945 “THIS IS THE FIRST UTILITY EDITION OF THE BLACK BAG TO BE PRODUCED IN PEACETIME. WITH THE POSSIBILITY OF THE EASING OF THE PAPERSHORTAGE IT SHOULD BE POSSIBLE BEFORE LONG FOR THE BLACK BAG TO QUIT BATTLEDRESS AND APPEAR ONCE MORE IN CIVVIES. “

29