Spring 2017

THE BLACK BAG

BRISTOL MEDICAL SCHOOL Spring Term Ed., 2017

Editors-in-Chief: V. K. MANDAGERE & M. Y. QUINN Illustrator: S. BURGE Sponsorship Director: P. MODI Crossword designer: A. CLARKE Proofreader: M. E. C. McGLADDERY Contributions: C. J. PRATT, B. GOMPELS, Dr. B. HOLE @BlackBagBristol The Black Bag theblack_bag The Black Bag has been the medical school magazine since 1937. Published thrice every year, we are the voice of both students and alumni.

Initially designed by the Faculty of Medicine as a scholastic publication, the Black Bag was taken over by students in the 1970s and replaced with a slightly less-polished perspective on the raucous life of medical students.

Today, our articles range from the informative to the satirical, providing a platform for both thought-provoking discussion and comical musings. We look to reflect on the wide variety of Galenicals sub-societies (sports, music, drama) as well as to evaluate (and lampoon) the current state of the Bristol Medical School and the world of medicine.

The Black Bag are always looking for contributors. If you are interested in writing for us, please email: blackbag@galenicals.org.uk

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THE BLACK BAG

EDITORIAL SNAPMEDIC DISSECTING THE DEMOS CARTOON ODE TO ST. MICHAEL’S HILL MEDIC TRIBES: THE KEEN MEDIC THE LIFE OF A RENAL REGISTRAR SURGICAL ASPECTS OF THE CRUCIFIXION CROSSWORD BOOK REVIEW EDITORS’ AFTERWORD CROSSWORD SOLUTION

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5-6 8 9-15 16 17 18 19-25 27-29 30-31 32 33 34

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EDITORIAL Spring Term has hit us, hard. The dizzying heights of respiratory and renal have faded away and the hell that is neuro, endo & repro haunt us daily. It’s 2am, a bottle of gin down, Mediasite is still reverberating in our ossicles, but THE BLACK BAG still lives on.

The most exciting competition of the century is back. Far better than the Commonwealth, the Olympics Games and the Great Pottery Throw-down put together, SNAPMEDIC returns! Send us your funniest snapchats at theblack_bag and win some serious dough (see page 8).

Winners will be released in the Summer Term edition.

This term has been packed full of events. Clic was a resounding success, as always, with a certain member of the editorial team enjoying far too much gin beforehand. Hyper-excitable at 7pm, she had to be cautioned by the bouncer for being too loud. She also got shouted at by the photographer for throwing a thorn’d rose at the bare-footed dancers. What a pillock. Some bodies were so incredible that they were immortalised in .gif form. Raising buttloads of money (get it?) for charity, and hauling in thousands of Facebook likes, Clic truly was a highlight of everyone's year.

As our pre-clinical career comes to a close, we have many teachers to thank.

But perhaps those with whom we interact the most are the Anatomy demos.

Page 9 shows our interview with the demos, as we pry into their deepest, darkest secrets. Well no, not really. We’re quite tame. Either way, enjoy reading.

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Following his first MEDIC TRIBES article in the Autumn Term edition, A True Cynic (a nom de plume, would you believe) writes an observational case study of The Keen Medic on page 18. His acerbic wit and charming prose will take your breath away.

Many of you clinical students will be looking towards the future as to what your career will entail. In order to help you make that decision, we have included an article by Dr. Barny Hole, a renal registrar at Southmead Hospital. Journalling three typical days, Dr Hole takes us through the daily procedures and types of patient one would see as a Nephrologist. We hope this article will give you an in-depth insight and inspire you to consider a career in Renal Medicine.

This term we received an interesting email from a gentleman called Mr Ian Leslie, an Emeritus Consultant Surgeon at the BRI. Reminiscing about his days at Bristol Medical School and fond memories of THE BLACK BAG, he has sent us the Spring 1959 edition which was not in our online archives. It is remarkable that he has kept the issue all this time. To thank him, we have included a particularly interesting article from that edition called Surgical Aspects of The Crucifixion. This thought-provoking piece outlines the pathophysiological changes that could have occurred at the death of Jesus Christ.

A final note to you all. We implore you all to send your ideas for articles, stories or poems to The Black Bag. Only through your help can we excel. So grab a pen, and get cracking.

Yours, The Editors.

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The Elizabeth Blackwell Institute for Health Research, known also as the EBI (it just sounds better than ‘EBIHR’, plus it means ‘prawn’ in Japanese - who knew?!) supports students and graduates interested in health research.

Are you an undergraduate? Then get a taste of research through various avenues via the INSPIRE scheme.

INSPIRE is a UK-wide initiative designed to engage medical, dental and veterinary undergraduates with research.

INSPIRE offers a broad range of activities, opportunities and incentives for Bristol students to engage with medical research teams. These opportunities have been developed by the INSPIRE committee (led by Liz Coulthard and Tony Pickering) through consultation with current students and with matched funding from the Faculty of Health Sciences and the Elizabeth Blackwell Institute.

@INSPIREUoB • Vacation studentships • Research Elective Bursaries • Conference funding

• Intercalation Research Consolidation Bursaries • Intercalation prizes Students from the Medical, Dental and Veterinary schools of Bristol, Cardiff, Exeter and Plymouth have joined forces to launch a Journal that showcases original research undertaken in world-class laboratories and clinics by fellow students.

The Journal is produced by a team of student editors from the four universities. It is a key part of a collaborative project under the national INSPIRE scheme funded by the Wellcome Trust and administered by the Academy of Medical Sciences.

The first edition of the journal was published Autumn 2016, and is now available in pdf form at www.bris.ac.uk/medical-school/staffstudents/student/inspire/ejournal. The second edition is planned for October this year.

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SNAPMEDIC theblack_bag

Send us your funniest medic snaps and earn major £££!

Previous winners include…

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DISSECTING THE DEMOS What lies beneath the blue coat?

The anatomy demonstrators are an enigmatic bunch. We all know them, we love to love them. Everyone has their favourite. But what really lies beneath the blue coat? Here at The Black Bag, we get an exclusive look into the inner workings of our mysterious demos.

Firstly, which medical schools did you all go to?

Mike: I graduated from Cardiff Stuart: Glasgow.

Dan: Warwick. I did undergraduate Neuroscience at Bristol first.

Matt: Also Warwick. And I also did Neuroscience at Birmingham.

Lucy: Bristol.

Why did you apply to work at Bristol?

Dan: I’m Bristol born and bred, all my family live here.

Stuart: The weather.

Mike: It’s very close to home for me, I’m from South Wales.

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How Welsh are you?

Mike: I’d have to deduct a few points because I don’t speak Welsh, but I’m from The Valleys so I’d give myself a solid 8 out of 10.

Stuart: I would give myself 8 out of 10 for Scottishness too. Down here everyone thinks I’m really Scottish but at home I’m considered quite posh.

What are your future aspirations after you’ve finished teaching?

Lucy: Obs and gynae, but I definitely want a year of fun first. I want to go travelling and find myself, turn into a hippy.

Dan: Well I’m a GP by trade so I’m already done. This was my ‘gap-yahhhh’, my goose is officially cooked. I’ve loved this year so much, it’s great to get the teaching experience.

Matt: Neurosurgery is the plan. Ideally I’d like to stay in the southwest.

Mike: I’ve applied for ophthalmology this year. I’d like to go down the surgical route, hopefully staying in Bristol.

Stuart: Exactly the same as Mike, we’re both scrambling for the same jobs at the moment!

Did you fail any exams at medical school?

Matt, Mike & Dan: No! Stuart: I very nearly failed an SSC, it wasn’t really made clear how important it was. I had to kiss a lot of arse shall we say.

Lucy: I failed my epidemiology exam in first year. I got 49% and it absolutely killed me.

What’s been the most embarrassing moment of your career so far?

Dan: I was showing a group of students how to cannulate a patient. I succeeded in my cannulation, stepped back impressively, and ended up falling over the patient’s footstool. I went completely arse over tit and landed on the floor in front of everyone.

Stuart: My first on-call at the BRI. I was really nervous and thought I would go to the toilet before I got an emergency bleep. I went to the bathroom, undid my belt, and my bleep fell right into the bog. Thankfully I hadn’t yet pissed into the toilet. I had to run to the technicians office and told them I had accidentally dropped it into a cup of tea.

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Lucy: I once did a speculum on a female patient. When I looked inside, I completely freaked out when I saw loads of blood. I ran out of the room to find a consultant and cried ‘she’s haemorrhaging, I don’t know what to do!’.

The consultant turned and whispered to me ‘she’s on her period…’.

What would you do differently if you went back in time to re-do medical school?

Matt: For me, not getting caught up in the idea of one specialty too early. I pigeon holed myself quite early which I don’t think is a good thing.

Stuart: I think it was hard to adjust to doing really well at school and then coming to university where everyone was the best and so you feel like you’re working really but only doing average.

University is such a good part of your life and I wish I had been less ground-down and enjoyed the lack of responsibilities.

Lucy: I kind of wish I had enjoyed it less! I sustained rather a lot of alcohol related injuries at university and I don’t really appreciate the big scar I have on my forearm

What did you do?

Lucy: I fell over at clic! Mbargos is my favourite club though, I flippin loved mbargos.

Stuart: I once fell out of a tree while drunk and dislocated my shoulder.

Dan: I wish I had travelled more. I think I discovered travelling too late on, both in medical school and life, I wish I had started when I was an undergrad. If you get a chance to go on any mini-electives take it, if you get any offers to go on conferences abroad take it.

If you were an organ of the body, which one would you be and why?

Stuart: Obviously I would be the humerus, because I’m such a funny guy… Sorry, it had to be done.

Dan: I’m going to go with the floccular node of the cerebellum because I’m the oldest of the group.

Lucy: I’m the prostate. I irritate all the boys. Hypertrophy? Get it?

What do you like to do to relax after a hard day of demoing?

Matt: Punk IPA is particularly tasty.

Lucy: Sauvignon Blanc from new Zealand

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Mike: Hendricks gin.

Urm… we were asking you about hobbies, but it seems all yours include drinking. *All laughs.* Stuart: I like a nice cycle or a good run.

Lucy: I have recently started yoga and painting!

Matt: I kite-buggy on the downs, it’s really fun.

You’re not really supposed to do it on the downs but I can sometimes sneak it.

Dan: What do I like doing? Horse-riding maybe. I used to ride my friends horse but it’s recently been sold so I don’t have that anymore ☹ I enjoy shopping at Fortnum and Mason and visiting Clifton Lido.

Dan, your tastes are far too expensive for our demographic.

Stuart: As a group we love going out to the vets barn. Baby guinea pigs.

Dan: In the last trimester of the guinea pigs pregnancy you’re not allowed to disturb them. We know a lot about guinea pigs now!

Stuart: Mike likes dungeons and dragons.

Mike: I’ve been press-ganged into this by a friend of ours. Actually, dance is what I do mainly, mostly salsa these days. I started when I was about 7.

So you teach 1st and 2nd year medics and dentists, have you noticed any big differences between the medics and dentists, and who do you prefer teaching?

Lucy: I love teaching the first year medics. It’s all so new and exciting for them.

Dan: I like the medics most, mainly because that’s what we do and where we can make the most difference.

Stuart: You’re all very well behaved. Good boys and girls (very thick Scottish).

Lucy: Medics are a lot more extroverted than dentists, they all seem to have more character.

Stuart: I don’t think they’re that different really, apart from maybe the dentists are more studious and focussed. Each group from the years are so different though.

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Why did you want to be a doctor when you first applied?

Matt: To be honest I’m not sure anymore! The things I enjoy now are definitely not what I thought I would. I like being busy and getting things done. I love all the tech involved too. I have never once thought ‘ah I can’t wait to get home and leave work’, I’ve never thought that it was so boring that I was desperate to leave.

There’s never any clock-watching.

Mike: I have quite a short attention span. I thought there would be enough going on that it would hold my attention and keep me interested.

Stuart: I can’t imagine having a boring job sat at a desk all day. I love being up on my feet and solving problems.

You are really busy but you’re never going to be bored sat on your arse.

Dan: It’s so long ago now because I’m so old! The reasons definitely change over time.

Lucy: Because I got the grades, I like people and my family really wanted me to do it!

They chose well for me though, I love it.

Explain another demo in one sentence.

Stuart: Lucy is smiley, a mother hen, emotional and sporty.

Lucy: Stuart is funny, a good leader, light hearted and surprisingly good when you need a good chat. Emotionally intelligent!

Dan: Mike is organised, very intelligent, immaculate always, focussed and unflappable.

Lucy: Mike is smelly!

Mike: Oi! She’s been trying to pin this on me for months. There was once a terrible smell in the DR which she’s been trying to blame on me.

Stuart: When I fart in the DR I make sure I always move around straight after. You made the mistake of staying in the same place.

Mike: Dan is hilarious and jolly, eccentric, eloquent, highly refined, very reliable, he always knows everyone’s names, very level headed.

Lucy: Matt is a genius, always very serene and collected when teaching, very empathic and gentlemanly, very courtly.

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We have two questions submitted from people in the year. The first is for Lucy: What makes your skin glow so much?

Stuart: Happiness? Joy? Matt: Sweat?

Lucy: *Laughs* I use good moisturisers by Clinique, the gel one and the night one. Recently I’ve started using a korres facial wash. Thanks for the compliment!

And for Dan: How do you maintain your fringe?

Dan: *Laughs* I don’t put anything in it actually!

My dad and granddad were bald as coots when they were my age, so I think I’m growing it out because I’m scared of that!

Matt: Are you sure it’s not a ‘something about Mary’ moment?

Dan: *Laughs* I wouldn’t go that far for good hair!

If you could design an ideal partner for yourself, would you want them to be a medic or a non-medic?

Dan: I think it’s got to be non-medical for me, my wife is a primary school teacher.

Mike: I would go for medical actually. If I came home after a really bad day I think it would want someone who could properly understand what I was going through.

Stuart: I think the main thing is whether or not you like the person! To me the job isn’t really important at all, though I think conversation around the dinner table would be more interesting if they did something different.

Matt: Hm I think my ideal partner would be a barrister. Generally medics are quite weird people.

Lucy: I think job is really important. It’s funny because when you first start university you think ‘ooh doctors are so fit’, and then you become one of them and think ‘oh that hasn’t happened to me yet!’

Stuart: Speaking of relationships, I noticed recently that there was a strange outbreak of marks on all the necks of the first years. *Laughs* There must be some rash going around. It was always the really quiet ones too. Every week, lovebites everywhere!

If you were on death row, what would you want your last meal to be?

Lucy: Chicken and mushroom and leek pie. I just really like it.

Matt: …. That’s shit.

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Dan: A fray bentos pie. Is that it?

Stuart: A munchie box. A Glaswegian specialty. A pizza box full of chips and doner meat, naan bread and 4 or 5 different types of pakora. It comes with a bag of salad but you just bin that on the way home.

Dan: I would want mine to be a steak with béarnaise sauce.

Matt: You bastard, I was going to say steak and chips! I wouldn’t have sauce, I’d want the pure steak flavour.

Mike: Very specifically, I had a Malaysian housemate that made the most amazing Beef Rendang. That would have to be my last meal. Sadly he’s now moved back there and I can’t have it anymore.

Thank you very much demos for a fantastic interview. The article will be out soon.

Dan: It’ll be interesting to see what you really think of us!

The Editors.

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An Ode to St Michael’s Hill Lecture theatre 1.4 Oh, how I miss you More and more Sure, the lectures by Jan Frayne On biochemistry Drove me insane But it’s hard to fail Isn’t it?

With good old Mo Sohail And sure it was A lot of nine to fives But I really do miss When we had lives It was easy to go out A fair amount Yelling the trusty phrase “First year doesn’t count!”

They say the grass is greener On the other side But I can’t help but think They might have lied Just know that now For old St Michael’s Forever I will be Your disciple.

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nd

C. J. PRATT year M. B., Ch. B.

MEDIC TRIBES: The Keen One "Medicine is a vocation, not a vacation" they inform their Arts flatmates as they pootle off to bed at 9:30 the previous evening. After a quick mindfulness reflection and a kiss on their bedside picture of Trevor Thompson, they drift into a deep ten hour slumber.

Strolling in 20 minutes ahead of schedule, the cool, calm, collected and keen Medic slides into L.T. 1.4 and takes their usual place at the front right. Here, they are directly under the air conditioning and exactly 45° to the lecturer: providing optimum viewing capacity. They are in medic heaven. They didn't come here to mess about.

Slowly the lecture theatre begins to fill around them- the sounds of other humans communicating are an unfamiliar noise when accustomed to the silence of the Medical library and Herman the Janitor’s dulcet, Caribbean tones.

50 shades of highlighters are spread out on the table in front of them: fail to prepare then prepare to fail as they always say. Simultaneously glaring at anyone making more than 5 decibels of noise, they begin noting down every single word the lecturer utters. Out of the corner of their eye they spot the First Year Shmedic- slithering in the back of the lecture theatre approximately 2 minutes and 7 seconds late. "How can they live with themselves?" they mutter under their breath.

But do not be deceived by the straight-laced attitude and NHS lanyard from the 1.5 days they spent on ICS last term. Their cool, calm persona is yet to be corrupted by medic wine tasting. Catch them on the following Saturday and it will be difficult to recognise the shadow of a man. With teeth stained by France's finest Merlot, they can barely even stand, let alone tell you the main cause of painless jaundice.

On top of putting aside an hour a day to polish their stethoscope, publish for the BMJ and of course, maintain their perfect work/life balance, they have also managed to help cure nine diseases in sub-Saharan Africa every summer for the last five years. But what is most infuriating of all of this (despite some debate as to whether they are actually human) is that they're all just really nice people.

A TRUE CYNIC

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THE LIFE OF A RENAL REGISTRAR Do you wear glasses? Are you better at chess than contact sports? Were you bullied at school? Maybe you should consider Nephrology as a career…

Nephrology (Renal Medicine) involves care for patients with acute kidney injury, chronic kidney disease and end stage renal failure. If this doesn’t mean anything to you yet, just you wait for the 2nd year. Blended with general medicine, transplant surgery and the just plain weird, nephrology tends to attract the kind of nerds who made your exam grades look pitiful.

Academic ST6 Dr. Barny Hole, an alumnus and lecturer at Bristol Medical School, takes us through a few days in the life of a renal registrar.

Day One Morning – Minor Operations Nephrology is pleasingly varied. One particularly satisfying boon is that one can stick needles in people. Two main procedures are daily events for Nephrologists: central line insertion and kidney biopsy. This morning, I have both.

About one in three patients who develop kidney failure does so without preparation for dialysis. This reflects poorly on the specialty and represents, at least in part, a systematic failure to help people prepare for their futures. These people need a central line for access to their

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blood so that they can be plumbed into a dialysis machine. Using ultrasound, I identify the internal jugular vein and puncture it with a needle. I place a long soft-ended wire into the vein through the needle, then take the needle out, leaving the wire in place.

Next, in a manoeuvre last seen in Saw-7, I make a subcutaneous tract starting above the nipple and exiting at the root of the neck by forcing a bent knitting needle under the skin. Lidnocaine is amazing stuff. Finally, in a Paul Daniels moment (may he Rest In Peace), the tract and wire are used to guide a drinkingstraw-thick silicone catheter into the superior vena cava and all the holes are sewn up. I am yet to kill anyone whilst performing this act.

Kidney biopsy is equally brutal, but done through a much smaller hole.

When we cannot figure out what is wrong with someone’s kidneys, we take a bit the size of a grain of rice out and find someone even geekier to look at it under the microscope. Getting it out involves firing a spring-loaded biopsy gun into one of the most vascular organs of the body. After nearly five years of doing this, my heart still races before pressing the button. I haven’t killed anyone by doing a biopsy yet either, but I cannot recommend one.

Amazingly all four patients thank me for my mutilation.

Afternoon - General Nephrology Clinic Clinic is meant to start at 13.30pm, but the morning clinic overruns to 14.00. By the time the first patients have made it through the gauntlet of being registered, weighed and having their urine dipsticked the clinic is already running fifty minutes late. Seventeen to be seen – thirteen minutes per patient. Most will be known to the department and the

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majority will have chronic kidney disease – usually with progressive decline in kidney function. Up first is a 79 year old retired butcher (immediately apparent from his missing thumb). He comes with his wife - both are overweight and infirm. He has an extensive list of comorbidities. It takes a precious four minutes to usher them the fifteen meters from the waiting area to the room (nine minutes remaining).

His kidney function (eGFR) is seventeen. His chart shows unwavering decline in kidney function. His current rate of decline will see him reach an eGFR of eight (the average score of patients starting dialysis) by late 2018.

“What have the doctors talked to you about in clinic?

They said my kidneys aren’t what they used to be and fiddle with my pills…

Has anyone ever talked to you about what the future has in store?

What do you mean?

Has anyone talked about what you would want to do if your kidneys pack in?

I don’t want that to happen…

Sure. Neither do we. But have we talked about it?

Not really. I certainly don’t fancy that dialysis thing…”

Six minutes remaining. Six minutes to discuss kidney failure. Six minutes to discuss uncertainty. Six minutes to discuss decisions: dialysis or conservative care? Choose now or wing it for a bit? If 21

dialysis, what flavour (haemodialysis or peritoneal)? It takes sixteen minutes and still feels perfunctory, incomplete and unsatisfactory. The clinic is now running almost an hour late. Sixteen patients to go. Most are in their seventies or eighties. Most will die without developing kidney failure. Some will though and we know that they will fare much better if they have had an opportunity to make a plan about what they will do if this happens. The clinic will go on until 18.30, by which time my blood pressure will be higher than anyone’s I have seen today.

Before going home, I nervously pop into the ward to make sure the four patients I maimed in the morning are still alive.

Day Two Renal registrar on call There are several problems. Firstly, nearly everyone has kidneys. Even those who don’t are my problem anyway. Secondly, kidneys are weedy.

If you get pneumonia, gastroenteritis or have surgery, your kidneys throw a wobbly. There is usually nothing wrong with the kidneys, per se, it’s just that when people are ill their kidney function drops: acute kidney injury. However, about one in fifty people with acute kidney injury have some horrible pathology, meaning their kidneys will be destroyed if we do not intervene immediately. It is the renal registrar on call who is expected to spot these people. Our hospital is the regional renal centre meaning that I provide input for patients with kidney problems across six counties.

The on-call phone will ring fifty times today. I speak with GPs, hospital doctors and specialist nurses. I provide advice to surgeons, anaesthetists and dialysis units. I am asked to recommend management for patients I will never meet. Often my advice is ignored. Frequently I get the

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impression that I am only being called so “discussed with renal” can be written in the notes, passing the buck onto me.

The day is busy, exhausting and demanding. There are tough bits: I lose my patience doing battle with the bed managers as I attempt to admit patients to a hospital that is fit to burst. However, there are rewarding moments: I bring someone back from the brink with a dialysis machine.

This is generally regarded as the Nephrologist’s special power. I help a couple of patients avoid dialysis through careful fluid prescription and pharmacology. I take great pleasure from discovering the cause of patient’s hyponatraemia and winning the bet for the amount of urine in a patient’s bladder (2143mls). I hand over to my colleague at 18.30 and finish off the remaining paperwork before cycling home at 19.30.

Thankfully, I did not spot any patients with “injury have some horrible pathology, meaning their kidneys will be destroyed if we do not intervene immediately”. I hope I didn’t miss one.

Day Three I start my block on the ward today. For the next month, I will arrive on the ward at 8.30am each day and stay for eleven hours. Nephrology registrars tend to be more present on the ward that those of other specialties. This ‘senior-led’ approach It is probably the result of a specialty that attracts the particularly anal. Essentially, everyone works at one level down: the consultant is a Senior Registrar of Old – wardrounding three times a week, seeing all the new admissions, taking calls about sick patients by day and night. The ST grades work like junior registrars/experienced SHOs – basing themselves around the ward, knowing the patients, their creatinines, what day they dialyse, the names of their relatives. The core, GP and year two foundation trainees work like house officers: managing bloods, forms, admin and jobs. The

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F1s are plankton. The consequence is an oasis of medicine practiced as it should be – patients on our ward get high quality care.

I enjoy the ward block. I will see many patients whom I have known for years I will see some of them receive a kidney transplant, which will be life-changing for them. They will stop dialysis and return to something very close to normal life. I met a patient recently whose transplant kidney was a year older than me. I tend to see more patients at the ends of their lives. Managed well, this can be highly satisfying too.

Mostly, I will provide general medical care for patients who fall under our care only because they have renal problems in their background – usually on dialysis or post-transplant. Such patients often get called ‘renal patients’. There is no such thing as a ‘renal patient’. These are all people who have had the ill-fated experience of developing kidney failure. They can get the unfair reputation of being demanding and difficult to look after. In reality, what they tend to do is expose the inadequacies and insecurities of those looking after them. Many will have had kidney disease for longer than you have been on the planet. To survive kidney failure, you have to know it – and there is a lot to know.

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To keep your transplant, you have to be fastidious, a perfectionist, even anal… perhaps becoming a little like those who have helped you along the way.

Nephrology is my specialty of choice due to the sum of its parts. It has ITU: with the critically unwell, post-operative transplant recipients and bleeding biopsy sites. It has General Practice, managing cardiovascular risk factors for people who wouldn’t know there was anything wrong unless they had a blood test. It has elements of biochemistry, care of the elderly, palliative care and immunology. Together, these parts sum to the perfect specialty for the über-nerd. Shapeshifting between intensivist, GP and everything between, I feel stretched and activated each day at work. Renal medicine provides the stimulation needed to deal with the frustrations of working in an NHS that is under extreme pressure and I am excited about spending the rest of my career as a consultant nephrologist.

Dr B. HOLE ST6 ACADEMIC REGISTRAR, RENAL MEDICINE SOUTHMEAD HOSPITAL & UNIVERSITY OF BRISTOL @BarnyHole

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CROSSWORD

Across 1.USS Enterprise medic, originally played by DeForest Kelley. (2,5) 3.The three islands of the Bristol channel. (5) 5.The three islands of the Bristol channel, ____ Holm. (4) 6.Trip hop pioneers, named for Somerset coastal town. (10) 8.Where you might find Roth’s spots. (6) 9.Matt Groening’s jovial family physician. (2,7) 12.“No idiot pub crawls” establishment. (3,1,5) 16.Pop duo from Bath, who told us that “Everybody Wants to Rule the World”, _____ for Fears. (5) 17.Generic name for Eliquis. (8) 18.Medical pioneer, whose most famous innovation required Sarah Nelmes, James Phipps and Blossom. (6) 19.The three islands of the Bristol channel, _____ Holm. (5) Down 2.P. falciparum, P. ovale, or P. vivax infection, for example. (7) 4.Now a year old, Afia the gorilla was delivered by caesarian by this Prof.

(5,6) 7.Local doctor and legendary cricketer, born 1848. (1,1,5) 10.Facial sign of hypocalcaemia (eponymous). (9) 11.Doogie Howser M.D. actor – Neil Patrick _____. (6) 13.Sounds of _________, heard on auscultation for blood pressure. (9) 14.Ca10(PO4)6(OH)2, or hydroxy_______. (7) 15.Nickname of Bristol City FC. (6)

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BOOK REVIEW The Chemistry of Human Nature - Tom Husband There are few books out there which so clearly outline the biochemistry of the human body for the average reader. As the First Year will probably agree, Biochemistry is an extremely complex topic and takes up the majority of their studies. Tom Husband’s The Chemistry of Human Nature outlines the molecular basis of space travel, taste, pleasure, lust, violence and so much more. His look into what makes up human experience provides much thoughtprovoking discussion, integrating other disciplines such as Philosophy and Psychology.

A particularly interesting section was the The Chemistry of Violence, which delves into the genetics behind it all: is there a candidate gene for violence? Is there an evolutionary advantage to violent behaviour? The chapter examines the role of the MAO gene in the violent phenotype, simultaneously explaining some key biological processes such as transcription and translation. Furthermore, Husband explores various studies to illustrate the epigenetic factors at play.

The Chemistry of Human Nature is an in-depth and wide-ranging exploration into essence of mankind’s qualities, strengths and weaknesses. A challenging, but exciting book for any medical student.

V. K. MANDAGERE 2nd year M. B., Ch. B. Editor-in-Chief of THE BLACK BAG

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EDITORS’ AFTERWORD Thank you for reading THE BLACK BAG. It took us blood, sweat and tears, so even if you didn’t enjoy it, keep it to yourself.

Medical Students were once described by Charles Dickens as “a parcel of lazy, idle fellars, that are always smoking and drinking and lounging…”.

We hope this issue has you fully convinced that he was right.

If we haven’t just put you off, why not send us an article? We want the whole of the Bristol Medical School community writing for usstudents, staff and alumni! All ideas are welcome.

Email us at blackbag@galenicals.org.uk This will be the final edition of THE BLACK BAG this academic year which will be printed and hand-delivered to you; whether you are sitting in the fiery depths of L.T. 1.4, the cool breeze of E29, or your academy common room. Our Summer Term edition will be online only. Keep a look-out on our Facebook page!

The Autumn Term Edition of the next academic year is a particularly special one for THE BLACK BAG: the 80th Anniversary.

We are teaming up with the Arts In Medicine Society to hold a competition to see Who can best design the 80th

Anniversary front cover? Keep up to date with both Facebook and Twitter pages for more details!

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CROSSWORD SOLUTION

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THE BLACK BAG Galenicals publication Medical School, Faculty of Health Sciences University of Bristol 36