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the

Black Bag

The University of Bristol Medical Students‘ Magazine


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The University of Bristol Medical Students‘ Magazine VOL. II

WINTER TERM, 2010

NO. 1

EDITORS: D. R. A. Cox & R. A. F. Pellatt SUB EDITORS: P. K. Barnes & F. K. McCurdie CONTRIBUTORS: Eoin Dinneen, Freddie Herbert, Aisling Longworth, Carlson Oma, Piers Osbourne, Annie Pellatt

‗Never trust a doctor whose office plants have died.‘ Erma Bombeck


Black Bag the

Winter 2010

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Editorial .

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A Word from the Sub Editors

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A Study of First Year .

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The X—Factor .

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Face Cancer

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Going Home

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Freshers‘ Bar Crawl 2010 .

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Life as an Ophthalmology F1

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Body Pump

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Robot Wars in New York .

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Coffee Break

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Reviews

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Personal Statement

Educational Crypticities

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Editorial

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ick follows tock follows tick follows tock… Our days are numbered; our time‘s almost up. And we‘re not just talking about the final exams less than a week away (which we should really be studying for, rather than writing this at 1.47am). With six raucous years of university under our belts, it is not without a wince of panic that we find ourselves on the brink of docterdom and old age. It‘s been a ball. From that first slippery pull in Wedgies to the last Jäger-Grenade on this year‘s pub crawl (featured centrefold), we‘ve loved every minute. If this is your first year at Bristol we‘d advise Camel Lights, unprotected sex and Blast Billiards (Gold). Steer clear of Lizard Lounge. For our final edition, we present advice on how to make your way from Bristol to London, one man‘s dream of appearing on The X-Factor, a particularly disturbing medical drinking game and a junior doctor‘s view on his ophthalmology rotation. We will be leaving you in the capable hands of our subeditors, who will be steering The Black Bag‘s helm over the coming year and have a word or two to say overleaf. Eskimo tradition held that once a person reached a great age, and was no longer useful, they would walk out into the frozen desert, never to return. So we too must close Microsoft Publisher, stop typing, and never grace these pages again. Thanks for reading.

R. A. F. Pellatt & D. R. A. Cox


A Word from the Sub Editors

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s two pairs of eyes sparkled over whiskey on crushed ice, the welcome was warm. Those faces that had haunted fresher dreams since the spoof lecture had somewhat softened. Fears of an initiation involving a sacrificial offering, a blood binding oath or at least a branding iron began to subside as the pile of beer bottles grew higher. We were being received into the Black Bag contingent, a daunting charge that came with a 111 year legacy. Jack Daniels, eased with brown sugar and lime, along with The Strokes, accompanied us as we spiralled into a blurry conversation of editing, scandal and gynaecology. Several hours later and armed with cans of warm cider, we journeyed into a realm rather unfamiliar to us; a realm where legends are born. It was fitting that our baptism into the medical school magazine should involve the unceremonious bursting of our Lizard Lounge cherry. Upon waking, with any feeling of dignity expelled (along with whatever Mr Donervan had sold us) and still with valuables in pocket (always a bonus), we knew it had been a success. We knew we were ready: perhaps not functional, not wearing trousers, and expected at anatomy dissections in five minutes – but we were ready. And so with this, knowing little about journalism and even less about medicine, we begin our journey as editors of the Black Bag. May God/Hippocrates have mercy on our souls and youth have mercy on our livers.

P. K. Barnes & F. K. McCurdie


A Study of First Year

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ollowing the recent GMC inspection of Bristol Medical School, a number of curriculum changes have been enforced. As the medical school works hard to try and ‗review, streamline and update the entire curriculum‘ we at the Black Bag have felt it necessary to run an inspection of our own. We have sought to better understand the attitude, behaviour and outlook of those arriving at Bristol Medical School this term. We distributed feedback forms throughout first year lectures and asked the baby-faced freshers‘ opinions on our fine institution...

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F

ollowing a recent GMC inspection of Bristol Medical School, a number of curriculum changes have been enforced. As the medical school works hard to try and ‗review, streamline and update the entire curriculum‘ we at the Black Bag have felt it necessary to run an inspection of our own. We have sought to better understand the attitude, behaviour and outlook of those arriving at Bristol Medical School. The first years…

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F. K. McCurdie

Madame President instigates a ‗zero-tolerance‘ policy with the new Galenicals Committee


The X – Factor

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et me tell you a story. A story of childhood ambition, vivacious talent, invented memories and shattered dreams. It begins early one sunny morning in Cardiff, the largest city in the county of Wales (N.B. that was not a spelling mistake). I‘m stood next to Dermot O‘Leary – his pheromones fill the air. An elderly man in the queue in front of me turns, nodding at O‘Leary, and remarks, ―He could shag all day if he wanted, couldn‘t ‘e?‖ I nod. I‘m not sure what exactly prompted me to audition for Britain‘s greatest singing contest, The X-factor. The promise of fame? An entertaining mid-week jaunt? A foray into investigative journalism? Probably a mixture of the above, but, having now stood in the queue for an hour, the latter seemed to describe my situation most accurately. I felt like Louis Theroux on acid. Looking around, I soon

realised that I was encompassed by a menagerie of the mentally ill and the tone deaf, and yes, I was one of them. After around two hours of an exhausting swearing competition against a man with Tourette‘s Syndrome in the queue behind me, Dermot slid in, like a 21st century version of The Fonz, and shhhed the crowd – silence fell immediately. I couldn‘t help but stand in awe of this man, a modern day Elvis whose charming ‗chap next door‘ demeanor commanded the people as he repeatedly mistook, misread and mispronounced his ten syllable lines from the autocue. He was the ringmaster in the centre of the freak circus. Each time he tried to read a link from the screen the crowd would be forced to ‗silently cheer‘ (the sounds of cheering were to be added in the edit, presumably from a crowd whose cheering possessed more of that je ne sais quoi… more X-factor). We stood

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there in the stiflingly early morning air of that Cardiff car park watching Dermot, with a furrowed dyslexic brow, squinting at the lines scrolling past on the screen. I was beginning to get bored when a man standing next to me turned and, grinning manically, inquired… ‗So, you like Doctor Who?‘ If I learnt nothing from my nine week psychiatry placement (which I probably didn‘t) it‘s that vulnerable adults such as this gentleman should have their anonymity persevered when written about in a case report such as this, so for the purposes of this article I shall refer to him as Mr. X. Mr. X, as I previously mentioned, had the grin of a maniac the likes of which I have never seen (on anyone other than Nina Beck). However, his smile, smeared across a dysmorphic face, was instantly likeable. ‗Here‘s a man who likes life‘, I thought to myself. Moments later my preconceptions were validated as I watched him smiling to the point of exploding whilst he

recited the lines from a Doctor Who episode from memory. Mr. X was a happy man and would become a… well yes I suppose I should say it, a friend for the remainder of the day. It was as a result of this friendship that a new sense of melancholy swam over me as we entered our third hour in the queue. For I knew what fate had in store for Mr. X. He, unlike others in his situation before him (see S. Boyle 2009), was not blessed in the musical sense. This left me with a bitter taste in my mouth: Mr. X‘s destiny was to be exploited by Cowell and Co. for the amusement of the general populous (much as I am doing here) only to be screwed up and thrown away like yesterday‘s copy of The

Black Bag. However, this cloud of empathy was soon to dissipate from my mind: I callously calculated that I best stay with Mr. X as he was sure to get onto the television and probably provided my best chance of becoming famous by proxy.

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‗I‘ve only ever wanted two things in life: to sing and to help myself and so many more, just by… singing‘

It was with a sense of overwhelming relief therefore that I saw Mr. X the next day in the car park with a hundred other hopeful idiots as he, like me, had won a golden ticket into the second round. By this point, however, I thought it best to break off my friendship with Mr. X (he was becoming a bit over friendly) and decided to just ‗concentrate on the music‘. Sitting in the waiting room (the one they always show you in the early stages) with the rest of the circus was a bizarre experience for two reasons. For one, the ratio of crazies to

normals had increased exponentially, the producers having hand-picked the most deranged of applicants from the previous day. Two: I was hung -over, feeling fairly sick and wearing yesterday‘s odourous clothes (a clever ploy by the producers to make the whole thing seem like it happens on one day). Like Dumbo watching the pink elephants dancing in front of me, I was scared but nonetheless enchanted. The wait in this area was but a moment compared to that of the previous day. Before I knew it, I had been called to a small room where I

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stood in front of two executive producers with a video camera. I knew the routine: I would employ yesterday‘s fabricated story, stare straight down the camera and lie. Maybe even try and squeeze out a tear. In the full knowledge that this could be my final showdown, I took a deep breath and began the elaborate sob story that I had invented on the way to Cardiff the previous day. I regaled the producers with the tale of a young boy from a small (unspecified) village who did fairly well at the local school and was thrust into the academic life, the one true hope of a village where no one before had even been to sixth form, yet alone university. I dropped my head to the floor and elaborated on the pressure I felt from home, my dislike of the medical life and my childhood dreams:

‗I‘ve only ever wanted two things in life: to sing and to help myself and so many more just by… singing.‘

was left to do now was sing. I have never seen a smile drop from a person‘s face quite so quickly. I can‘t imagine the faces I pulled as I heard less than a Leona Lewis performance emanate from my vocal chords. There was a brief silence. The producers had become altogether more business like and stark. One of them, looking through the papers they had on me glanced up and said, ‗It says here you‘re only a year away from being a doctor, is that true?‘ ‗Erm…yes it is.‘ ‗Well you‘re clearly not going to quit to go to bootcamp to have a 1 in 20 chance of being famous, are you? What do you want to do?‘ ‗I want to be a surgeon.‘ ‗Thank you for your time Daniel, have a nice day.‘ The dream was over. As I left I heard that Mr. X had got through, I hope to see him on television soon. I didn‘t even get to see Cheryl.

The producers both smiled. Yes! I‘m in. All that

D. R. A. Cox

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H

Face Cancer

ave you ever played Face Cancer? If you are a medical student at Bristol University, the answer is almost possibly yes. Confused? I‘ll explain. My housemate and coeditor claims to have invented Face Cancer with his thespian friend some five years ago, as a young first year student at Bristol University. Such a claim from said housemate and co-editor I would normally approach with caution, given other outlandish aspects of his personal history, such as:

My family are gypsies and my grandfather was left on the doorstep of a bakery I can run 400 metres faster than anyone else (including Usain Bolt) I‘m probably the cleverest person I know On this occasion, however,

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I think we can give him the benefit of the doubt. The story goes that these dramatists were looking for a way to practise keeping a straight face while delivering sobering and heartfelt lines on stage. We‘ve all been there: something is supposed to be a moving, tear-inducing soliloquy, but one just can‘t help but breakdown laughing as the suspension of disbelief is, well, suspended. So they came up with Face Cancer. One person plays the part of the doctor. The other is the patient. The patient has the hideous imaginary disease Face Cancer. The doctor has to deliver the bad news: ‗I‘m sorry to say Sir/ Madam, but you‘ve been diagnosed with Face Cancer. We‘ve run all the tests, and there is nothing more we can do for you.‘ As the diagnosis is made, the person playing the part of the patient must mould his/her face into the most grotesque,


ugly, distorted image that their muscles of mastication will allow. The doctor has to deliver his lines looking the patient straight in the eye, without laughing or hesitating and with the utmost sincerity. If he succeeds, he is the victor. If he laughs, he loses. ‗Horrible!‘ many of you will say. ‗What awful mockery!‘ And indeed, this would at first glance appear to be the case. A non-medical person might quiver that future doctors could be so callous, so uncaring, could distort suffering into entertainment. Superficially, this is true. And Face Cancer has become something of a staple among those medical students inclined to indulge in the odd drink; the more rambunctious players have even been known to include ‗sound effects‘ and ‗props‘. The truth is more subtle. While outwardly appalling, Face Cancer is actually close to the reality of doctoring life. You‘ve all attended the ridiculous communication skills sessions, where one must enter

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into the realm of theatre and make-believe and tell an ‗actor‘ (in the loosest sense of the word) that they have diabetes, or need to come back for a chest x-ray because of something sinister. You all know who I mean by ‗Big Boots Lady‘. These deplorably false scenarios are a subconscious training for the days when we really will have to tell people that they‘re overweight, unwell, or even dying. A friend, now an F1, says that he finds most of his time is spent delivering bad news, talking to relatives and counselling distressed patients. Face Cancer is really the ultimate refinement of these communication skills. I would venture that it has made me more adept at sincerity than any half-hearted effort of the medical school. So many of our exams are about acting; about putting on a show. If you can turn up for the OSCE with a smile on your face, while inside cacking your pants, the pass is already yours. Tired, bleary, flu-ridden

with sagging bags under the eyes after a winter weekend on call; at the end of the shift, desperate for a bubble bath, what will I do when Mrs C‘s daughter asks me to sit with her and discuss her mother‘s condition? Because our interactions can‘t all be real, no matter how highly we aspire. It is here, when all I want is hot chocolate and X-Factor, that I will turn, and put on my mask, and forget about going home and sit with Mrs C‘s daughter and explain that her mother is not at all well. It has nothing to do with being a nice person, or being a big bag of cuddles and kisses; it is about professionalism, about your duty as a physician. As future junior doctors, our young lives will often encounter death and unhappiness, undoubtedly more so than university companions studying law, or engineering, or history of art. One could go mad, seeing so much suffering. Humour is one way of dealing with this. The morbid becomes the mockery; the fear becomes the frivolity.

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But the last laugh is inevitably on us; for all our makinglight of clinical life, we are the ones who must go to sleep at night. And here the dreadful and the depressing are amplified all the more so. A joke shared with friends over tea

does nothing to ease the mind in the small hours of the morning‘s darkness, when all one has is one‘s thoughts. All rather sobering, really.

Oliver ‗Boo‘ Mclaren

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R. A. F. Pellatt


Going Home If I ever need to return home, there are three options available to me...

1. The Humble Automobile The first and cheapest option is my housemate and his car. He lives close enough to have at least one mutual friend from home on Facebook (although ‗friend‘ is a strong word, considering that neither of us have spoken to that person for several years) When coupled with amusing conversation and the ever potential trip to the services for a Burger King (and a quick round of Time Crisis 2) it is generally the most pleasant way to travel. However, it is inevitably ruined by the M4- which other than the Bath-Bristol cycle path appears to be the only road route out of this fine town. On a good day one can expect to spend three hours in traffic desperately trying not to make eye contact with that guy in the Porsche who you cut up for fun at Junction 19, and on a bad day you just have to hope the car is stocked up with enough water and Wine Gums to last the week. If somehow, you make it unscathed, it is only to be met by the joys of a fifty zone littered with orange cones in no particular order, road work signs with no particular road workers and an average speed check with no particular camera to slow down for.

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2. The Humble Locomotive My second option is the train. The train has the potential to be very fast: there is no traffic on the railway and therefore nothing (one would imagine) to stop the vehicle from moving as fast as a...steaming freight train. One would also postulate that given the online seat reservation service provided, there would be a nicely upholstered space on which to comfortably park one‘s rear end. And given the price of the tickets (unless you book seven months in advance and bank with Natwest) one might even go as far as to expect a clean, spacious ride full of upstanding members of society, and even someone playing a grand piano in the corner. Instead, I find myself sitting on my suitcase sandwiched between the lavatory and the exit-door with somebody‘s fold-down bicycle resting painfully on my shins. The reason for my predicament: the gentleman in 17D quietly told me to ‗piss off‘ when I suggested that he might be sitting in the seat I clearly remember reserving. To my immediate right, a fat adolescent shell-suited female shares Alexandra Burke with the train through the tinny speaker of her mobile phone. To my left, a male youth emerges from the W.C. with the word ‗fuck‘ humorously rearranged in large letters across the front of his t-shirt, accompanied by a smell somewhere between a rotting corpse and a pilonidal sinus. Far from rocketing along, we are at a standstill, probably just outside Didcot Parkway (a station that I am sure only exists because somebody high up in National Rail lives there). Failing that, we are near Reading, a town that I would not want to visit even if they annually hosted some kind of indie music shagfest there. The reason we are trapped is, of course: ‗Leaves on the track‘. I supposed it could have been worse… and then it actually was when the buffet car steward proudly confirmed that my sandwich and coke did indeed cost £7.50.

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3. The Humble Motor Coach And so I am left with the coach. A late booking had made the fares similar for both leading companies; National Express won, having marginally more leg room. An astoundingly empty bus meant that I did not have to sit next to somebody with dengue fever or an annoying penchant for eating ‗cheese and onion‘ crisps loudly. Thankfully there was nobody behind me who liked saying ‗literally‘ loudly and repeatedly. In fact, everything was going handsomely until I saw this sign: ATTENTION! All Drivers: Before you reverse from the bay: Close the vehicle doors and ensure all passengers are secure. Depress foot brake and engage reverse gear. Check mirrors and around the area before moving off slowly. Keep a sharp lookout for moving vehicles. Seriously? The door was closed but I was not secure. Surely before being allowed to talk into that cool handheld microphone, a coach driver must be deemed competent enough to notice if the goddamned door was flailing in the wind. The door was not my only concern: ‗engage reverse gear‘? Oh, because normally I just slam it into first and (if I remember to release the brake which you also kindly pointed out I should do) plough the coach initially into your incredibly helpful sign and then into the waiting area, maiming or killing a few potential passengers. I said a silent prayer. The reminder to ‗check the mirrors‘ almost made me wish the driver didn‘t know how to reverse - at least he would be looking in right direction. I can only hope that this sign is some kind of red tape used to cover the company‘s back - a tool created entirely for the phrase ‗I told you so‘. Because if National Express drivers have a tendency to wildly ignore moving vehicles unless reminded to, then screw the extra inch of leg room, I‘ll take one ticket for the Megabus. Thanks. P. K. Barnes

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FRESHERS’ BAR


CRAWL ‘10


Life as an Ophthalmology F1

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eople feel a multitude of emotions on their graduation day from medical school. Pride, relief, excitement — to name but a few. I, however, felt only two. Amazement and fear. Amazement that I had come to the end of my student days without having to repeat a year. Fear because I knew the days of playing Call of Duty 6 on a casual Tuesday morning were over and that I would now be required to work for a living. Yet for all this complaining, I am one of the lucky ones. I didn‘t head off to start on MAU, care of the elderly or colorectal surgery. No, I was to start my medical career working in ophthalmology. The first order of the day is to arrive at work on time. My start time is 9am, so living a ten-minute walk away from the hospital means that you can roll out of bed around 8.15 (or 8 if you‘re one of the few who enjoys watching Chiles and Bleakley‘s cheeky flirting on

Daybreak). Arriving at 9, I immediately show my face and see if there‘s anything that needs doing urgently. There never is. I then dump my bag and settle in to my first cup of tea. Next I proceed to pre-op assessment: an elderly Chinese lady for surgery who speaks no English. It brightens my day to think the COMP 2 organisers are patting themselves on the back for having prepared us Bristol grads for this kind of event. That done, I have a purposeful mosey up to the ward to see if we have any inpatients. Today (as usual) there are none, so I sneak off to the mess to hide and check out holidays on the internet. By now it‘s just about approaching lunchtime. Before I head off for my statutory one-hour, I go down to the outpatients to check everything is ok. I bump into the medical photographer who asks if I fancy doing a fluorescein angiogram on a PP (secret

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NHS lingo for ‗Private Patient‘). Despite having very borderline cannulation skills (getting below 50% success on Lovell‘s card in ACS), I agree. The fluorescein angiogram, in a nutshell, involves me taking a four-minute medical history, inserting a blue cannula (in first time today), injecting the fluorescein and praying they don‘t have an anaphylactic reaction. If the patient did start feeling unwell or became short of breath, it‘s probably the time where I‘d curse myself for only remembering the infamous prawn cracker joke from Dr A Tim Lovell‘s STAN teaching session. (Although I‘d take that joke, and the others regarding mobile phones and location of vending machines, over the dose, route and drugs used in anaphylaxis anytime.) Nevertheless, the patient is fine, and I get a £25 cheque in the post for my ten minutes of

fumbling around. Back to the doctor‘s mess, now a second home. With TV, newspapers and unlimited tea, toast and cereal, it is a perfect oasis away from real medicine. Occasionally, there is some banter going around the mess, usually involving the most recent F1 mistake, or who did what at the last payday party. We also have the privilege of the mess balcony, though I haven‘t worked up the courage for a crafty cigarette out there yet; perhaps in F2. This turns out to be a bad lunch, as while being subjected to the usual banter at my expense about having a ridiculously easy job, I‘m then given two white card referrals by other doctors who seem to take the delight in shifting work onto me. At around 2.30pm, I stroll back down to the ward to see what‘s going on. Very unusu-

The first rule of ophthalmology is: ‗If in doubt, ship ‗em out.‘ 26


ally, I encounter a nurse asking what she should do about a lady complaining of chest pain. ‗She‘s probably just whinging and has indigestion‘. Even so, I take a quick history. Her words of heaviness, shortness of breath, nausea and previous operations mean that I‘m lightening fast at fobbing her off to A and E for another Bristol grad to deal with. The first rule of ophthalmology is: ‗If in doubt, ship ‗em out.‘ I go to see the referrals. This is where the ophthalmologist‘s very own lightsaber, the ophthalmoscope, comes into play. You simply march onto a ward, shine it around a bit and pronounce that the patient should be booked in as an outpatient. Job done. It‘s now 4, and my thoughts are of going home, but there is still plenty of time to flirt with any medical students/nurses. Never underestimate the power of scrubs and a stethoscope. Frankly they can be embarrassingly successful at luring women in (not that I‘d know, it‘s just what I hear). At 4.45, I pack up my

belongings, and start the short walk home, safe in the knowledge that, after tax, I‘ve probably earned 50 quid.

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*****

n summary, it‘s easy to see the attraction of ophthalmology. Few on-calls, few emergencies and a long lunch. The downsides are that ophthalmologists seem to forget all the medicine they knew very quickly and everyone seems to think you are a complete joke. Also, the pay on an unbanded job is such that a McDonald‘s cashier with two stars on their badge would laugh if they saw your paycheque. At the end of the day though, my colleagues will be there till 7.30, about to finish their fifth PR or tenth TTO. I‘ll be the one cracking into his first beer watching The Inbetweeners on channel 4 OD. Oh, and I‘ve got to cannulate two more private patients next week… enough cash for a good lap dance. Lad. Dr P. Osbourne

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Body Pump

L

ast night, friends convinced me to go to one of the ‗Body Pump‘ sessions held at a Gloucester gym. There, I was told, I would have a ‗really good time‘. I would ‗feel great‘ afterwards. ‗You‘ll probably want to go every week!‘ said beaming faces. Sophie, a Body Pump veteran, literally wet herself at the thought of it: ‗Oh! I just can‘t wait! I‘m so excited! It‘s so much fun! You really must come!‘ I will offer the reader some information to set this tale in context. Never in my 23 years of life have I entered a gym. Quite frankly, I would rather spend the evenings picking fluff out of that curious place at the top of my bum crack than galumphing away on some treadmill and inducing early osteoarthritis by repeatedly lifting metal lumps (reference pending). Anyway, partly out of boredom, partly from the lack of a

six-pack and partly out of intrigue I went along that evening, timidly trailing Sophie, too afraid to venture forth into the gym complex alone. I was momentarily (and regrettably) abandoned while she attended to the female changing room. We then entered the large hall where the ‗main event‘ was to take place. The clientele are not quite as I expected: yes, a fair spattering of lycra, head bands and neon leggings; but also many who don‘t fit the stereotype. Several girls appear to have had one too many a Dairy-Lea Dunker, with pink podgy faces and those irritating follicular red spots on their upper arms. A slim elderly woman waits

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with hands on hips like an expectant regular. Our eyes meet for a second and I get the distinct impression that she wants to kung-fu-kick me in the ghoolies. At the front, a tall chap with a substantial beer -belly is wearing a black Slipknot T-shirt. Greasy necklength hair adheres to his pale, blotchy face. He is already sweating. We take our places facing a wall of mirrors, allowing me to fully appreciate my physical inferiority. Accusatory spotlights beam from above; at the front large speakers from the sound system. From a side door our instructor jogs up to the front, informing us through his microphone-headpiece that he is ‗Graham‘, and ‗are we ready to pump it up?‘ Graham is wearing a tank-top and features a tribal tattoo on his right arm.

His hair is a spiky gelled mess. He winks after every sentence. There is some banter between Graham and the regulars: the old girl who looked at me menacingly gets a shout out: ‗Good to see you‘re still going, Denise!‘ She doesn‘t smile, and Graham sheepishly realises he‘s overstepped the mark and concentrates on someone else, the greasy Slipknot fan, named Karl, at the front. Karl, we hear, has come to Body Pump with a ‗raging cold‘ that will no doubt ‗infect everyone‘ through the air conditioning unit. He turns his sickly face to the rest of us apologetically; we give him a shared glare in return. Graham pipes up: ‗Are you ready to feel the heat?‘ The first track kicks off, a dance remix of Summer of ‗69 and suddenly everyone is following Graham as he lifts his weights into a variety of poses. ‗One! Two! Three! Four!‘ I clasp my bar and mimic his actions: ‗Work those triceps! Down slow for one…. two… three… and four… and up fast!‘ Now I find m yself

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straddling the step-up box, the bar of weights bearing down like some beast from above. I flex my arms up and away from my chest to Graham‘s camp calls, and the sweat trickles from my face, legs, back… well, from everywhere. But I begin to think that maybe, just maybe, I‘m actually a pretty butch bloke after all, and maybe all this weight lifting malarkey is a nonsense, as I expected. I suppose you could say I began to feel rather good about myself. I even stole a look at myself in the floor-length mirrors and swore I could see a bicep. Then I look left and Sophie, in real life a short ginger girl, is lifting three times the weight on my bar. She is not sweating a drop. In comparison, my bar is like a stick insect. The bicep in the mirror disappears. Then a sudden ‗clink‘ in my back and a simultaneous acute pain; the next few pumps are agonising. My arms quiver with the shudder that exercise beyond one‘s limits induces. As the (worryingly good)

dance remix of Summer of ‘69 comes to an end, I see Sophie is smiling and chatting to a muscular bloke about what a good pump she‘s just had, ‗It‘s just a shame the weights were so small!‘ ‗So that‘s the end, right?‘ I say, between gasped breaths, trying not to appear too eager for the agony to conclude. I try to put my hands on my hips and thrust my chest forwards like the rest of the group, but this makes my back hurt more so I end up looking like a flamingo with a broken leg. Denise, the old girl, is looking at me and smiling for the first time. I begin to wonder if the country would be a better place with euthanasia legalised. ‗No Pellatt, don‘t be stupid! We‘re here for another hour! Are you okay?‘ I‘m obviously not. I‘m a human arrhythmia with lifethreatening asthma. I want nothing more than to go home and sit in front of a screen shooting things on the PS3. But God forbid appearing like a pansy in front of a girl…

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‗I‘m fine, it‘s just it was going so fast and I was worried it was already over! I‘m having such a good time, you were right about this! It‘s rather easy really.‘ I manage to squeeze a smile but inside I‘m racked with palpitations. I‘m already in pain. There may be permanent damage. ‗Oh,‘ says Sophie, ‗well if you‘re finding it easy then put some of my weights on your bar. I don‘t think you‘ve got enough.‘ I try to hide the look of horror on my face. ‗Yes, you‘re right,‘ I say, and before I can make up

some excuse about a congenital back problem she‘s already put the extra weights on. Graham is at the front again, skipping like some nymph on crack. And as the bass starts up through the speakers: ‗You! That‘s right, the lanky girl at the back! Bar up! Let‘s go! This one‘s a dubstep change-up of Paradise City. One! Two! Three! Go!‘ He‘s talking to me. R. A. F. Pellatt

28


‗Postnatal Depression‘ by A. Longworth visit outofourheads.net for a showcase of creative work by Bristol Medical students


My desire to become a doctor was sparked early on by my fascination with the biological sciences. I indulged my interest in anatomy and physiology by several opportunistic learning routes. For example, I made sure I tuned into every episode of House and ER. Not only did I find the clinical and scientific accuracy fascinating, but I wanted to become part of a profession where everyone is clever, rich and glamorous. The final realisation that medicine was the vocation I was born to pursue came with my completion of Theme Hospital: a complex task that required initiative, instinct and a profound understanding of the day to day running of Health Services. In order to consolidate my belief that I should become a physician, I spent a month at the local GP practice, where I grew to appreciate the multiple roles interacting together to provide the best patient care. I learnt the importance of spending entire afternoons stapling together prescriptions and came to understand the challenges of appearing to be interested by receptionists answering phones, drinking coffee, and attempting to find something


‘fun’ for the work experience student to do. The most rewarding aspect of this particular placement was discovering that it is possible to fall asleep with both your eyes open, and standing up. As a doctor, I would be keen to pursue academic research avenues to enhance my clinical career. From my background in science, I appreciate that evidence based medicine and clinical research are vital to inform and enhance modern medicine. I suffer quite severely from post alcohol exposure, and through much trial and experimentation, have concluded that alka seltzer is in fact the best hangover cure. I am incredibly sociable and have fantastic interpersonal skills, being able to talk to people of any walk of life. I enhanced this particular quality during my time at senior school. I managed to survive my experience at this below par comprehensive with no more then a bit of spit in my hair, and the corner burnt off my English work book. Only someone possessing incredible powers of reasoning, empathy and wit can manage to survive such a place unscathed.


As I was filtered through the social sieve of University, I found myself at York. Here, I enhanced my interpersonal skills further. In particular, I learnt how to understand those severely intoxicated and in turn, how to make myself understood when severely intoxicated. Having a busy social life has made me learn effective time management: I have often had to attend more than two parties in one evening. Once more, I was passed through the university filter, this time to the level of post-graduate study. When I arrived at Bristol University, I was shocked to discover the social de-evolution that the majority of postgraduates undergo. This was the most recent, and most challenging, test of my interpersonal skills, from which I learnt a very important lesson: there are some people you just do not talk to. I am a keen pianist, which is an essential skill of any doctor. In addition, I am an accomplished sportsman. I played hockey when I was eleven years old, had a brief stint as a lacrosse player during GCSEs and was forced to do cross country during PE lessons. I watch Wimbledon every year and am pretty sure I could win. Furthermore, I went on all of the Duke of Edinburgh expeditions. A career as a doctor can be extremely stressful and challenging. I employ several effective methods of dealing with stress, which include smoking, having a cheeky pint and watching Americas Next Top Model. Candidate 6079

Anon.


Educational_Crypticities_ Each set of pictures amounts to a medical condition. Answers in Coffee Break. hash + emo + toes = Hashimoto’s

example

ein

zwei

( -

)

drei

(

- )


Robot Wars in New York City

M

edical journalism is a dog eat dog world. Smut, decay, destitution, poor poetry and unforgivably large P-values abound. One of the few constants in this dark, tumultuous sea of literary backstabbing is that the editors are invariably pricks, but that they are also always right. In light of this advice it seems I would do well to listen carefully to the instructions I got from my honorable colleagues on the editorial board of The Black Bag. They commissioned a ‗stylistically editorial, technology-orientated piece on travel.‘ I decided on a brief description of my time spent on attachment with the Robotic Surgery Team at the New York Presbyterian Hospital‘s Department of Urology. In an attempt to placate my demanding editors and in the knowledge that, at the time of asking, this article was to form the sum total of the Black Bag‘s ‗Travel Supplement‘ as well as

all of the journal‘s new ‗Innovation & Technology‘ section, I have decided to divide the article into the following helpful sub-headings. Travel: New York Despite its fame, Manhattan is, in fact, a surprisingly small place, a little smaller than the fifth smallest country in the world, San Marino. Whereas little San Marino boasts a population of 29,000 residents, ‗littler‘ Manhattan is home to some 1.6 million New Yorkers and receives another 46 million visitors a year. Amongst which there happens to be enough space for a staggering number of hospitals. Uptown to downtown and everywhere in between, hospitals of all shapes and sizes can be found in Manhattan. Some that cover whole blocks, others that occupy but a single floor in an office. Some that serve the uninsured, huddled masses; others that only look after the richest patients on the planet. Extremes are abound in

39


New York. Homeless people settle down for the night outside the guarded foyers of multi-million dollar apartments whilst obese smelly women shuffle onto the metro and stand next to worryingly skinny, effeminate young men. Such extremes exist in the hospitals as well. Some are colossal empires with reception areas which feel decidedly more like four star hotels. Conversely, although I never visited one of Manhattan‘s public hospitals (tourists are recommended not to) their leaky, rain stained facades afford a glimpse into the other extreme of healthcare. Robots: Expensive Toys for Surgical Boys For those of a science-fiction incline, you will be gladdened to hear that the development of surgical robots was initially the result of work carried out by NASA scientists working on Virtual Reality technologies for unmanned planetary exploration missions. By wearing a pair of remote control gloves, the viewer could direct the

Barack Obama tries his hand on the da Vinci surgical system

camera and thus survey the aliens on Mars, for instance. Things progressed from here via the American Military, who fancied it as an option for remote control surgery on the battlefield, to find its niche in laparoscopic surgery. There has been some resistance. Commentators have felt that such emphasis on all this high-spec equipment will herald a dangerous departure from long-standing good surgical practices. Some of these anxieties are not entirely without foundation. One morning during the attachment, quite unexpectedly and unexplainably, the multi-million dollar robot simply did not turn on. Mercifully, no one had yet gone under the robot. The sole inconvenience was that the patient had his operation rescheduled (in impressively American style, for the very


next day), but it does not take a surgical maestro to realize that the consequences would be a trifle more serious if any such technical mishap happened at a different time. Initially thought to be groundbreaking in delicate cardiology operations such as mitral valve replacements, the robots aimed for the heart but hit the prostate. Instead, fame was found in urology. About 95% of all prostatectomies done in the US are now done robotically and the robots are becoming increasingly popular in obs & gynae procedures as well as ENT surgery. Back on this side of the pond, when Southmead Hospital got its robot four months ago it was only the seventh in the UK – a statistic made all the more remarkable by the fact that the newest robot – the da Vinci SiR costs in the region of £2 million with additional maintenance costs of about £100,000 annually. Healthcare is a different beast in the US. The medical staff work eye-wateringly hard.

41

There was a rule I was informed of on my first day but which I was never in any real danger of violating, ‗Medical students are not allowed to come in to hospital before 4:15. Other than that, compulsory academic meetings begin at 5:30 or 6 o‘clock every morning of the week except Friday.‘ Despite this, for a long time health has not been a right in America, it is a product. Like the TV or the fridge; you get only what you pay for. This means that the hospital philosophy is not one of public service but instead of business. The New York Presbyterian Hospital proudly boasts a gross receipt for the fiscal year 2007 as $2.8billion. That‘s greater than the GDP of some lesser sized commonwealth countries. When I asked an attending ‗What are your criteria for recommending this procedure to your patients?‘ he replied, ‗Do they have a prostate? And do they have a cheque book?‘ Bloody Americans. E. Dinneen


‗Much like the exam results, Kat Whelton is unavailable until next Tuesday‘ F. K. McCurdie


Bedside Banter

‗There is no curing a sick man who believes himself to be in health. ‘

Henri Amiel ‗Patients usually feel better after receiving hand transplants.‘

***** ‗Paediatricians are just doctors with little patients‘

***** ‗They tried to save him with an I.V. but it was all in vein.‘

***** ‗After a few days in hospital, I took a turn for the nurse.‘

*****

‗It is a good thing for a physician to have prematurely grey hair and itching piles. The first makes him appear to know more than he does, and the second gives him an expression of concern which the patient interprets as being on his behalf.‘

A. Benson Cannon ‗In the nineteenth century men lost their fear of God and acquired a fear of microbes. ‘

Anon ‗A smart mother often makes a better diagnosis than a poor doctor.‘

August Bier ‗Treat the patient, not the X-Ray.‘

James M. Hunter


Educational Crypticities answers: 1)Cholera: COLLAR + RAH 2) Asthma: ASS + (MARMITE

- MITE)

3) Halitosis: HALLE + TOES +(KISS — K )


Website Review onexamination.com

I

f you enjoy reading ‗Giblet‘ but aren‘t sure if you can afford to subscribe to Nature, or if you are beginning to find the New Scientist a little simplistic and too full of articles on the Large Hadron Collider, this could be the site for you. It offers a wide range of different, up to date articles on the medical world as well as giving you the chance to upload any articles you have found which you think may be of interest. It also allows you to leave a comment about any articles you have read, as well as pretend to have an educated opinion on a current event based on snippets of other users‘ more sensible comments. onexamination.com/fresher contains an online self-assessment tool from the same site, offering a range of questions aimed at medical student freshers, covering biochemistry to system-based physiology. The site will track your scores and allow you to sit the questions at your own pace, or under examination timings. Once answered, each question is expanded and analysed, generating an average score for the user. Best of all: it‘s free. P. K. Barnes

We welcome comments on any of the articles published (excluding complaints). Please address correspondence, including submissions, to The Editors at: blackbag2009@googlemail.com


free to those who can afford it.

Black Bag 2010 3  

Black Bag 2010

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