80th Anniversary Edition by Galenicals

Editors-in-Chief: V. K. MANDAGERE & M. Y. QUINN Cartoonist: M. ACHANTA Sponsorship Director: P. MODI Crossword Designer: A. CLARKE Contributions: L. ALIM, J. McALINDEN, C. STRATFORD, M. WALKER, O. COLLERTON, A.T. CYNIC, Dr. T. THOMPSON, J. KONDRATOWITCZ, C. HARMER, Dr. R. A. F. PELLATT, T. GREENSLADE. @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. 2

THE BLACK BAG Dedication To Ottie Uden Editorial Letters to the Editors Galenicals Sports

4-5 7-8 9-11 14-16

Satire: News In Review Memeology: memes in medical education Medic Tribes: the orthoLAD

17-19 20 22-23

Special Feature: Editors Through The Ages

24-37

Commentary & Politics: The Way of Mortification The Junior Doctor: what’s in a name? Discrimination: a plea The True Meaning of Life

39-41 43-44 45-46 47-48

Stories:  A Night Out

49-50

Crossword Editors’ Afterword Crossword Solution Runner Up Front Cover

51 52 53 54

DEDICATION TO OTTIE UDEN

“It is diﬃcult to put Ottie into words, when she was so very special. She lived her life so vivaciously, threw herself into everything and brought such happiness to all those around her. We are all still struggling to come to terms with her death and life will never be the same without our beautiful Otts. She was happiest when surrounded by her friends and could not have been more excited about becoming a doctor. Here are some photos of her having a brilliant time and how we want her to be remembered. She will be always be in our hearts and forever part of our futures.” 5

EDITORIAL Reflections

from

the

Editors

80 years. It seems extraordinary that The Black Bag could survive this long. The magazine (formerly journal) has gone through several phases: from scholarly musings by esteemed Professors, to brash clinico-phallic humour. In eighty years, we’ve been stripped of advertising, dissociated from the medical faculty and, at one point, almost sued. But we live on. Hidden in the depths of E29, a frantic whispering can be heard. “How could he!” …“He’s crazy, I tell you, crazy!”. To the bewilderment of his friends, Collerton skipped his “Microbiology of the GI tract” lecture and decided to report some behind-the-scenes action back to The Black Bag. He knew about the seedy underbelly of the staff room in the Biomedical Sciences Building, his friends, oblivious. With a journalistic integrity worthy of a UMeP reflection, Collerton brings us the scoop on the underground news from Autumn Term: complete with Aztec rituals, rural murders, and celestial glycolysis. But this year’s hard-hitting journalism doesn’t solely affect the insular bubble of the pre-clinical medic. This term’s special edition of The Black Bag showcases the great writing repertoire of Bristol Medical School. Students, staff and alumni— all have contributed. Taking up a large chunk is our special feature “Editors Through The Ages”, where we have interviewed ex-editors of the fabled mag, right back up to the 1950s. It’s strange to think that the job of an editor hasn’t changed that much in sixty years. We’re still bugging people to write for us, we’re still constantly promoting the magazine (though perhaps now

on different platforms) and we’re still struggling fill up forty or so pages just in time for the end of term. Jumping outside the confines of undergraduate medicine, Joanna Kondratowicz provides her ever-insightful commentary on the wider world of medicine and politics. Questioning the term “Junior Doctor” itself, Kondratowicz reports on the dangers of overlooking the larger issues and tackles an often underappreciated aspect of working in the NHS . Following on from this critical issue within the British healthcare system, Chris Harmer makes his début in The Black Bag, with a polemic argument regarding discrimination in the workplace. Closing off this term’s edition is a story by the first generation of MB21-ers and our first year rep, Thomas Greenslade. Biting, acerbic prose and fast-paced dialogue — Greenslade’s (semi?) fictitious tale takes us through his own perceptions of the standard night out of a medical student. Before we close off this Editorial, it would be egregious not to mention the remarkable front cover of this very special edition. Winner of our competition co-hosted with the Arts In Medicine society, Camilla Siig of first year does us the great honour of crafting her extraordinary artwork. Competition to win was fierce, but in runner up place is India Vecqueray of second year, whose drawing you can view on the final page. On top of her art is a quotation from the honorary editor of the very first edition of The Black Bag in 1937. “I hope that The Black Bag will have a long and vigorous life and that it will travel wherever old Bristol students are to be found. Our aim is for it to be a link between all students, present and past, wherever they may be… If it attains this objective, its success is assured.” — Norman Burgess, Hon. Editor, The Black Bag, Nov. 1937

Yours, The Editors

LETTERS TO THE EDITORS If you want to respond to any of our articles, or even write just a short piece, e-mail us at blackbag@galenicals.org.uk and we’ll publish it as a Letter.

Dear Eds., I am writing to introduce readers of The Black Bag to GALENICALS - the Medical Society - which has represented students for over 150 years. We have numerous targets set for this year, and I wanted to highlight some of our most important. Welfare has always been a priority for both staff and students, so this year we are going to introduce welfare representatives for each year group. We will be working with the faculty as well as the dentists and veterinary students to train peer welfare staff who will help to provide an extra layer of pastoral support. The welfare representatives will help solve minor problems and direct students to available services and resources. Drop in sessions have been a great way for students from all year groups to come and talk to the Galenicals committee, raise issues and get advice. We will be supplementing this with ‘tea time talks’ and welfare cafes during exam periods. We will continue magnifying students’ voices and ensuring their opinions, ideas, concerns and expectations are heard by the faculty, the university, and on a national level. We will be working with the faculty and use student feedback to make appropriate changes as well as introduce feed-forward mechanisms; allowing good ideas and practices to be shared and implemented throughout. This is particularly important when considering teaching across academies. Widening participation is an issue we are passionate about. However, we want to ensure that not only are we helping students get into medical school, but we are supporting them throughout their journey here at Bristol by increasing accessibility to resources. With over 60 sub-societies affiliated with Galenicals, and new ones forming every year, being part of a sub-society is an important aspect of the medical school experience. Building on

the community and leadership they provide, we are launching the first subsocieties conference. This aims at creating a platform where students can share ideas and experiences as well as gaining valuable communication and leadership skills; setting forth strategies that could be implemented by future committees. Creating an alumni network for Bristolâ&#x20AC;&#x2122;s medical graduates is a key point for Galenicals this year. Whether it is career advice, revision help, or mentoring opportunities, our graduates have a wealth of knowledge to share, and so it is important we ensure they are still engaged after graduation. Finally, one of the biggest issues we want to tackle this year is the issue of expenses and hidden costs. Medical students have longer academic years as well as more travel requirements. However, a lot of these occult expenses are not accounted for, and we want to create surveys to gather detailed information about these costs. We will also be working nationally with medical societies across the country aiming to change policies about funding, loans, grants and bursaries for medical students. With our targets set in place we have a lot of work ahead of us, but we look forward to achieving these goals and continually improving the student experience. L. ALIM & Galenicals Committee 4th Year MB ChB President of Galenicals

(Editorsâ&#x20AC;&#x2122; Response: Despite Linaâ&#x20AC;&#x2122;s excellent work improving welfare and widening participation, we must warn readers that the opinions expressed in this Letter are purely those of the Galenicals and not of The Black Bag. The Black Bag cannot and will not condone communication with veterinary and dental students of any kind.)

Dear Eds., It is with great excitement that I anticipate the publication of this, the 80th Anniversary edition of The Black Bag. For those of you that are (so far) unaware of me and have escaped any shameless self-promo at election time, it could be said that I am indeed a certified keeno. Holding this title with pride, you can imagine the excitement on my face and butterflies in my belly at the prospect of writing for such an illustrious publication. As any good keeno would do, I took myself through the archives for inspiration (the library hold some beautifully bound issues, or it’s all online for those of you into the whole modernisation thing). After many hours of chuckling quietly to myself, I have concluded that medical students as far back as 80 years ago were really not all that diﬀerent to ourselves, and I would certainly welcome the return of mock trials (some of us most certainly need to be tried for negligence), 25p film nights and of course 2005’s fittest medic announcement. But enough of all that. As some form of Faculty representative - allegedly democratically chosen - I am taking this opportunity to congratulate The Black Bag on reaching such a momentous age. The Black Bag has been an ever-fixed mark through Bristol students’ medical education, providing light relief in the testing times such as World War or the introduction of MB21. It has consistently had a committed editorial team, evoking responses of “what?” and “can they really say that?” For this I would like to thank each and every one of those teams. I look forward to seeing the upcoming edition, the winning front cover, and adding it to my personal collection could I be a true keeno without one? Here’s to 80 years more of showing just what medical students can oﬀer the world: drinking, “another clerking?” and The Black Bag. J. McALINDEN Keeno/Faculty Rep 2nd year MB ChB

Dear Eds., I would like to call attention and praise the new “college” system within Bristol Medical School. Mummy and Daddy were ever so upset when I didn’t follow the family tradition of Harrow then Oxford, but now Bristol is collegiate, I can relax in the comforting knowledge that I am at an equally rigorous university. Anon

GALENICALS SPORTS UBHRFC 2017. A new season. A new coaching team. A new league. A new training ground. A new start. The club this season has been going through a rejuvenation, bringing with it completely new challenges. After the disappointment of last season getting knocked out of the NAMS plate to Liverpool and losing to Nantes, a radical change was needed. Bringing in a whole new coaching staﬀ certainly has its challenges but the club itself hasn’t looked this strong in years. Freshers Fair was, by some estimates, quite successful. 28 new players entered the club this year, allowing for us to expand to two regular teams for the first time in many, many years. The strength in depth now however, goes to rival even the best UBH teams of the past. Entering Gloucester 3 has been interesting, but it has been good to become even more involved in local club rugby. Whilst our goal is Gloucester 1 or Gloucester Premier league and the teams in Gloucester 3 are maybe not brilliant, the regular rugby has allowed the club to really bond and become a brotherhood. NAMS this year didn’t start brilliantly, losing 25-22 to a strong Peninsula side. Yet this hasn’t disheartened us, completing a double win over Birmingham Medics 57-17 in the 2s and 25-8 in the 1s in a friendly. We also showed them that we are much more fun at social, which probably gave them a rather sad bus back. Next up is Swansea and our chance to make up for the earlier NAMS loss and to implement those structures that we are so close to perfecting. Varsity looms ahead of us, with beating Cardiﬀ for the first time in 4 years our goal. Combine with this the rest of NAMS, Old Boys, winning Gloucester 3 and reclaiming Nantes and this could be one of the most memorable UBH seasons in history! C. STRATFORD, UBHRFC Captain 4th Year MB ChB

GALENICALS

RFC

Last season was particularly eventful for GFC, with the boys engaging in a closely fought home varsity vs Cardiff as well as what would prove to be a very messy sports exchange in Nantes against the French. The Gs also snapped up the opportunity to host NAMS in our beloved Bristol in what was probably the highlight in a very successful year for the club. Because of the strong intake of freshers and very good retention over the past few years, at the turn of the season the club decided to expand to play in a Sunday League, alongside the traditional intramural matches on Wednesdays. We also introduced Monday night football at Clifton College to increase the amount of football available to club members and to help improve Ciaran Barlow’s horrendous touch. Following on from a triumphant (yet responsibly run) welcome drinks that greeted the freshers, GFC welcomed Cardiff for varsity on the luscious greens of Coombe Dingle in early December. With the Gs missing a few key players, it was always going to be a tough contest against the traditionally better Cardiff side. Despite battling hard, the boys came away from the match narrowly losing 1-0. However, being the inherent winners we are, you can ask Cardiff who won the social afterwards. With the emergence of

arguably the best squad GFC have put together in recent years, we will be looking to get one over against our friends across the River Severn when we clash on the 9th December later this year. March meant that a shed load of footballing members, armed with a bottle of port, were destined to descend on to a coach dressed in ponchos, sombreros and glued on moustaches – those that could grow the real thing were shaved appropriately. The ferry across provided a welcomed break to get away from the confines of the coach. In order to stretch our legs, we wandered the ferry aimlessly, entertaining ourselves outside on deck with our Mexican themed songs and other social related activities. The following day the Frenchies showed us their true sportsmanship by leading us to a gravel pitch (yes gravel) on which we would play our match. Wearing football boots on this pitch was unsurprisingly dangerous with many of the boys taking several tumbles during the game, despite this, the match was played in good spirit and everyone enjoyed themselves. Later that evening we were lead to the building where we would eat the traditional French cuisine of Domino’s – the same place morphed into a rather cool club in which we socialised in until the coach picked us up to take us home in the early hours of the morning. Early April saw us host NAMS – the biggest footballing event on any self-respecting medical school’s calendar. The committee had worked hard on this for months beforehand and to have the whole day and night run smoothly with over 1000 people attending was very rewarding for the guys that helped organise such an occasion. The second team lost dramatically in a 10-9 penalty shootout and the first team performed very well and managed to reach the quarter finals – this means that we will be taking two teams up to Manchester (the eventual winners of the competition) this year as opposed to the one team that we usually take. This year has also seen a slight reformatting of NAMS. The big knock-out competition on one day still exists but there is also a second tournament sorted by regional groups. Those that top the groups play the group winners of other regions in knockout phases before the winner is decided in the final. We have started the group strongly with a good win over Swansea and we are looking to take our momentum forward in to Saturday’s match against Exeter. The club is looking up after another good intake of freshers. Despite our questionable footballing ability at times, there are many positives to take forward into the following seasons. The club is growing well and we will continue to enjoy our socials and look to challenge for titles in the coming years. M. WALKER, Galenicals FC Captain 3rd Year MB ChB

NEWS IN REVIEW First term UNIVERSITY LIFE— Dr. David Morgan considers ritual sacrifice to appear more approachable The pre-clinical coordinator seeks to present a warmer and more welcoming front to the returning students to the MB ChB programme. Dr. Morgan has turned to the Aztecs for inspiration, presumably for their legendary friendly receptions, along with the surprising permanency of their traditions. On an unrelated note, he has recently also watched the movie “Apocalypto”.

Mohit Achanta

This news comes after feedback from his previous welcome speeches, which were compared to “a bad mescaline trip” and “the sort of thing you heard at the Somme before the whistles blew” by members of the student body who would wisely wish to remain nameless.

The advantages for Dr. D. J. Morgan are as numerous as they are terrifying. He not only has the strength of twenty men and “the destructive power of a T cell” (his words) but also the ability to rip out the heart of any student, both literally and figuratively. He states that “the crippling fear of failure and daily crises I see in our medical

students are just not enough”. When asked if this practice would continue in lectures for MB21 students, he simply said; “Lectures? No, this year we’re focusing on soul crushing in a purely clinical environment.”

THE WORLD OF MEDICINE— Rural murder rates drop sharply as aspiring orthopaedic surgeons return to medical school Figures from the September have shown a drop-oﬀ in rural murder rates. Local authorities have attributed this to the return of would-be orthopaedic surgeons to med school after a fruitful summer of part-time abattoir work. Concordantly, the consumption of real ales and rates of unsuccessful night club propositions have also fallen in an annual pattern dating as far back as 1833. Historically, these yearly fluctuations have been accompanied by “murder microfluctuations” on a day to day basis, thought to be largely due to the appropriateness of the weather for rugby. When approached for comment, orthopaedic surgeon Mr Don Rockles seemed unsurprised; “Well you know how it is, you just lose it and suddenly, your neighbour’s ribcage is sitting on the mantelpiece.” He continued, “You develop some coping mechanisms as you get older, but I know I still feel antsy going to bed, wake up in the morning to find the budgie pinned to the wall with anatomy pins. Probably to do with testosterone.” When asked whether he thought this was also the case for those aspiring female orthopaedic surgeons, Mr Rockles said “I’m sorry, I don’t think I understand the question.” This is observed regularly for a great many disciplines. The simultaneous return of future paediatricians and neurologists is responsible for an observable fall in “people just really needing a hug” and a noticeable uptick in mean personal hygiene respectively.

ENTERTAINMENT— Star Wars: The Last Jedi hailed as ‘the most educational yet’ due to hour-long Eleanor Griffiths cameo Review screenings of the latest installation of the monolithic space-opera series have landed. Critics are divided, apart from on one issue… While risky, the decision to allow Dr. Griffiths’ cameo to extend to an hour long talk on the similarities between Midichlorians and real life mitochondria has paid off in spectacular fashion. While the occasional, awkward pause for slide changes were noted, long-time fans of Star Wars will know that stilted delivery is really part of the authentic experience and a full-on lecture is only really an extension of George Lucas’ vision for the prequel trilogy.

Likewise newcomers will no doubt find the refresher useful; mainly as a guide to the hard science that the movies adhere to. More importantly perhaps, Dr. Griﬃths’ discussion of the one-time downward slide of the Star Wars that the Midichlorians symbolised is really a cautionary tale of caring too much for anything, as it will only ever let you down. As Yoda himself said, “Do, or actually do not. You know what don’t even try.”

Inspired by Dr Griffiths, the BRI’s Clinical Teaching Fellows are premiering SCAR WARDS next term

O. COLLERTON 2nd year MB ChB

MEMEOLOGY Memes in

medical

education

History has presented us with several revolutions in medicine. The 19th century left us with germ theory. The rise of antisepsis occurred at the turn of the 20th century. The invention of complex imaging techniques we ascribe to the recent past. But the true defining feature of our generation is the explosion in medical memes. “Dopamemes for Reward-Seeking Teens” “Haemolytic Memes for Anaemic Teens” “Poorly Opposed Memes for Surgically-Inclined Teens”

Haemolytic Memes for Anaemic Teens

These are just few of the big names that have enriched medical education in the last year or so. A group in Newcastle conducted the world’s first Randomised Control Trial to investigate the impact of memes on student performance. The results were staggering. 1) When exposed to 10 hours of medical memes after ward rounds, students on average performed 24% better in OSCEs. 2) When “meme breaks” were implemented in Anatomy classes, the average mark on students’ Turning-Point quizzes increased from 5.2/10 to 9.8/10. 3) An experimental cohort had lectures and clinics completely replaced with memes. This cohort of proved to be 85% better in examinations compared to the average student, and 63% better than a random group of qualified doctors. Dr D. Ankness of Newcastle University, who led the study, told us that the students who were most exposed to medical memes were able to out-doctor their Consultants. One student was even able to cure a disease which had not yet been discovered. Professor U. Gott Beend of Oxford University and the Association for Medical Education said that “universities and hospitals simply don’t know how to train up the best doctors. Lectures are out of fashion; nobody cares about PBL anymore. Memes categorically demonstrate a more eﬃcient way of teaching medicine. My message to medical school deans is this: Improvise. Adapt. Overcome.” V. K. MANDAGERE, Editor-in-Chief Intercalated BA Medical Humanities

Graduating from Bristol Medical School this year? Perhaps you are already scurrying along the wards as a junior doctor? Or are you a consultant preparing your next lecture on Why Medical Students Aren’t As Diligent Nowadays? For any of the above scenarios, you’d want to keep in touch with your favourite magazine, THE BLACK BAG!

This year, we’ve teamed up with the Galenicals Alumni. Graduates of Bristol Medical School can now subscribe and have the journal sent directly to their doorstep. Simply go to https://goo.gl/forms/r08kXTZrLbg7RQvZ2 and for an annual fee of £18, you can read about the whimsical world of your medical alma mater.

MEDIC TRIBES T h e o r t h o LAD He swaggers in on the first day of University into his new room at Hiatt Baker Hall, donning flat-front pressed trousers and a button-down light blue shirt. Settled on his mantelpiece lie his collection of knives, three empty beer bottles and a copy of Gray’s Anatomy, with specks of animal blood dotted about the front cover. He marches out of his room and peers around the corner to see another fresher moving in. “Mr. Don Merkel, how do you do?” he introduces himself before his neighbour asks. While he speaks, he swings his NHS lanyard to his side, like a lasso. “Oh hey, what do you study?” “Oh me? Just messing about for five years before I set up my orthopaedic private practice with my brother.” —— The first lecture in LT 1.4, everyone settles in for SHM. As the other first years introduce themselves, Don keeps to himself. Behind him he could hear the voice of several students saying that they chose medicine to ‘help people’. Vomiting in his mouth, he writes their names in a little black book marked ‘ future victims’. His thought was cut oﬀ by a shrill voice— “Society, Health and Medicine seems really interesting!” says his neighbour, eating his raisins pensively. Mr. Merkel spits out his protein shake in disgust. “WHAT?! I thought SHM stood for Sawing and Hacking Metatarsals!” Trevor Thompson introduces: “The role of resilience and self-love in healing”, with the first slide on Maslow’s hierarchy of needs. A rage builds inside Mr Don Merkel. Who was this hippy? Don is training to be the world’s best orthopaedic surgeon: he didn’t care about “patient wellbeing”. He angrily stomps towards the front of the lecture theatre, punching several girls on the way. “Rubbish! My brother says only hierarchy you need is the three Bs: BEERS, BITCHES AND BONES.” ——

A year had passed and Don grew weary of the medicine course. His attempts to muscle himself into the operating theatre were to no avail; he simply could not comprehend as to why he got kicked out of the BRI. Placing his home-made scalpels back in his bag, he strides up St. Michael’s Hill and sees a reminder on his phone about a Consultation Skills class. “Jah, Jah, das is gut — Oh hallo der, you must be Don. Please sit, you can be our first volunteer for Consultation skills.” Don sits in the chair in front of the class, smirking. This was his moment, he could show off to his peers his extraordinary knowledge of medicine he had learnt off his brother. The actor enters, he arranges his hair and places his stethoscope around his neck. It was the classic case of the antibiotics-fearing mother. Don begins. “Listen here lady, I’m the doctor. Your child HAS to take antibiotics, or else she’ll die. Do you want that?… No, no, that’s all pseudoscience, it’s really rather stupid of you to believe that. If she get’s worse, surgery’s the obvious answer. I can operate, my brother trained me on our pet dog, Humerus.” A deafening silence. The tutor wants a word with Don, alone. “Mega, she’ll probably just graduate me on the spot” thinks Don. “Don…what you did just there…I didn’t feel as though you really empathised with her problem.” Don, not quite understanding what she meant, explodes with fury. Leaving the room in a fit of ortho-rage. as well as receiving the news that he’d been rejected from the Dissection SSC (“I can’t believe Sarah Allsop thinks she knows more about anatomy than me!”), Merkel seeks the solace of his only remaining friend, Julia. Sitting in the Hiatt Baker library, the pair quickly advance from studying Gray’s Anatomy to studying each others’. Later, after ensuring that the whole of Stoke Bishop was traumatised by their clinical love-making, Don tentatively takes Julia's hand, and stares deep into her eyes. “Julia, my tasty little tibia, there’s something I need to tell you that I’ve never shared with anyone before…” He takes a deep breath and steadies himself. “I got ‘Mr. Don Merkel’ etched onto my stethoscope the day I got my offer…I wanted people to mistake me for a Consultant.” “Oh Don,” Julia whispers, as her eyes fill with tears, “That’s the most beautiful thing I’ve ever heard.” A TRUE CYNIC

EDITORS THROUGH THE AGES Interviews

with

ex-editors

For eighty years, Editors of The Black Bag have meddled their way into the lives of Bristol Medical School. Poking, prodding, bugging every soul that breathes in the institution with that irksome question “would you like to write for The Black Bag?” But now, the editors of the past have all grown up, cast the shackles of their former journal, and developed into fully fledged doctors. In this article, we have traced back former editors of The Black Bag right back until the 1950s to reflect on their Editorship and training at Bristol Medical School.

1 9 5 0 s

Dr. Martin Knapp MB ChB (Hons.) MD (Bris.) FRCP FRACP Nephrology Graduated 1959, Editorship 1956-68 What was your most memorable moment at Bristol Medical School?

“Back in 1956, we shared Physiology lectures with other faculties. A friend once returned from Christmas to Burwalls (a former Halls of Residence). He demonstrated his new electric shaver to us: a novelty at the time. My roommate expressed some interest and saw it as a method to avoid barber charges! We offered him a trim, but from nape to occiput, his hair was a “cricket pitch”, shaved to the bone but not visible by him even in the mirror. He arrived at the Physiology lecture the next day just on time to avoid “lock-out”. He turned to sign the register, where 100+ students collapsed in mirth. His only solution was an all-over No. 1 crew cut!”

Tell us about your editorship “In 1960, we suspected that the teaching staff did other than teaching. I commissioned articles from Professors to explain what research they did. Our Prof. of Anatomy investigated the lymphocyte, a topic which then only took up a paragraph in student textbooks! His department had a state-of-the-art electron microscope and they studied the cell at great magnification. We had no idea we were being taught by a world leader! That time was the birth of the specialty of Immunology, and we were completely unaware…” Tell us about your career “I have had a long and varied career in academic nephrology in the UK, USA, Australia, Iraq and Saudi Arabia. My favourite appointment was in Nottingham contributing to starting up the new medical school and starting up renal services. I also enjoyed 20 years as regional physician in Australia before I retired at 80. I continue to promote information technology and chronobiology in medicine , having set up an R&D unit for medical IT and chronobiology in Nottingham in the mid-80s. My advice to you is:

Set your goals and stick to them. If you get knocked back, find support from your peers and get comment from those more senior who you respect. Get up and keep on going”

1 9 6 0 s

Prof. Brian Gennery MBE MB ChB FRCP FFPM Pharmaceutical Medicine Graduated 1964, Editorship 1962-3

What was your most memorable moment at Bristol Medical School? “The funniest moment was whilst we were doing our obstetric residence when evenings could be quite boring. We would often play poker and one of my friends bet his whole terms money on one card and lost. We all fell about laughing, but no one called in the bet.”

Tell us about your editorship “I do not remember any outstanding articles, just the problem of filling an issue. I am sure getting contributors is still an editor’s nightmare. This was good training as I am now an Executive Editor of the British Journal of Clinical Pharmacology and my biggest problem is getting referees,”

Tell us about your career “I had an amazing and varied career. I spent five years in the army followed by nearly four in general practice. I then moved into pharmaceutical research and development, working for large international companies and small biotechnology start-ups. I had the opportunity to work with a large number of leading experts in many fields of medicine and science, literally across the globe. I also chaired a committee at the MHRA for six years and have spent the last decade in academia, first at the University of Surrey and now at King’s College London 26

where I run MSc programmes in Clinical Pharmacology and Drug Development Sciences. My advice: be bold and take opportunities that come your way, they may never come again.”

1 9 7 0 s Mr Samer Nashef MB ChB FRCS PhD Cardiac Surgery Graduated 1980, Editorship 1976-9

What was your most memorable moment at Bristol Medical School? “I was on call at the weekend Mr Nashef was in a medical covering many BRI wards when I was school rock band called paged to see a man on the geriatric “TRAUMA” ward. The nurse explained that he had died quietly, that he had been expected to die soon anyway and that the medical team looking after him had no plans for any dramatic resuscitation should it happen. The only reason she called was that he had to be certified dead by a doctor before contacting the mortuary. I ambled at a leisurely pace towards the ward and walked straight to the one bed with curtains drawn around it. He was clearly an old man well into his eighties and was sitting motionless in a standard NHS armchair by the side of his bed. I felt for the pulse in his neck and thought that I could detect something weak and thready there, and then I noticed that despite this he was not breathing. I moved his jaw forward to open up his airway and he instantly took a deep breath and opened his eyes. He most certainly was not dead yet. I helped him back into his bed, drew open the curtain and went to tell the nurse the good news. She was walking out of the office saying "thanks for that, I've already told the family. They took it well - they were expecting it". Whoops.

We had to do something. After a quick panic, we phoned the family back, lied through our teeth, put on a frantic theatre act and pretended that he was being resuscitated, and that we'll call again with the outcome. A few minutes later we called them again to report the successful outcome of the non-existent 'resuscitation'. Whether the family were relieved or upset to hear the news, I was never quite sure. Nowadays, 'do not resuscitate' orders must be discussed with the patient and family before being instituted, we all follow a duty of candour of being totally honest with our patients, even if the truth hurts, and we would have never got away with what the nurse and I did so many years ago.”

Tell us about your editorship “My proudest achievement was to bring the then defunct journal back to life. I was also pleased with our journal covers, which consisted of tasteless spoofs of film posters that were box office hits at the time: a one-legged John Travolta in Saturday Night Fever, Scar Wards in the style of Star Wars and so forth. I had to make up the letters to the editor at the beginning, and that provided a fantastic opportunity to poke fun at fellow students and members of the establishment. We had a fantastic medical student artist in residence, Andy Winterbotham, who drew cartoons scattered throughout the magazine and also compiled an irreverent cryptic crossword for every issue. I still remember his first clue: Bruce’s genetic theory of diarrhoea? (4,2,3)”

Tell us about your career “I became a heart surgeon at Papworth Hospital, created EuroSCORE for assessing the risk of heart surgery, wrote the Naked Surgeon and became a Guardian and Financial Times crossword compiler, thanks to Andy introducing me to the delights of cryptic crosswords through The Black Bag.”

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Dr Tim Reilly MA MB ChB MD FRCP Gastroenterology Graduated 1987, Editorship 1985-6

What was your most memorable moment at Bristol Medical School? “I can’t really pin down one moment from Bristol Medical School. Bristol was a great place to study and live, and things were quite different back then. One remembers people and places.

There was Prof Speller, a microbiologist who lived in hope of having a new bacterium named after him, so he could call it Spellerella. There was Spiny Norman: the biochemistry lecturer who could explain DNA without notes in precise fluent uninterrupted sentences with no hesitation repetition or deviation, just perfect measured cadences lasting an entire lecture. There was the surgeon out at Southmead who would wait until the first year student nurses being shown round on day 1 were peering in at the window of theatre before starting to throw bloodied swabs over his shoulder as he bent over the wound. There was the pub just up the hill from the BRI which had a phone line from Casualty (as we called A&E back then) so the junior doctors could take calls over their pint. There was the long run from Casualty down the corridor of Phase 2, under the road through the underpass, and up 4 flights to the medical wards in the old building (have they knocked it down yet?), every time the crash bleep went off, which was often as DNARs were pretty unheard of in those days. Kept you fit but disappointed, as the outcomes were never good.”

Tell us about your editorship “I was a ‘mature student’, a description which is at least 50% accurate. My previous degree was in English, which is why I suppose I got fingered as a good choice to edit The Black Bag. I could spell pretty well. Good networking skills, keeping up to date with the zeitgeist, ability to lead and inspire a team....not so much.

But, we did produce a couple of issues, and they weren’t too bad as I recall. We reported this new disease that was ravaging the gay community in San Francisco caused by a virus then called HTLV3 which selectively attacked the immune system. And we managed to annoy a Professor of Obstetrics by poking fun at academic medics, so that was a score. I remember late nights as the deadline approached sitting up writing all the book reviews and drawing the cartoons myself. I no longer have the copies I produced so I can’t embarrass myself by re-reading my efforts.” Tell us about your career “I did my middle grade jobs in the Midlands (Derby, Birmingham). Not being a scientist, but needing to do a MD to get a Senior Registrar job, I struggled with my research years. This is one scourge you don’t need to contend with these days. Moving to Scotland was a good thing and I’ve had a great 20 odd years as a consultant gastroenterologist, when I finally made the grade, doing the stuff I enjoy. I’m still peering up bile ducts after retirement, a service I set up 17 years ago in my hospital. As a former educational supervisor I would say to anyone struggling with their undergraduate career, (why am I doing this, do I really want to be a doctor?), consult widely, consult early. I have seen several young doctors who were going through medical school because their school or family pushed them to opt for Medicine but whose heart wasn’t in it, and who blow up when they hit the FY1 year, and it’s such a waste. Better to get over the embarrassment and get it sorted out before it becomes a problem. But I think pastoral care may be better now than it was in my day. “

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Dr Ramzi Khamis MB ChB PhD MRCP FESC Interventional Cardiology Graduated 2000, Editorship 1996-7

What was your most memorable moment at Bristol Medical School? “I cannot really remember much.. It’s all a bit of a haze! I do know however know that my very best friends are still those from Bristol University and I still do not remember much every time we meet! In the photo from left to right (after me) is Michael Whitehouse (Orthopaedic Consultant), Daniel Marsh (Plastic Surgeon in London, and also in the photo below), Chris Powell (also Plastic Surgeon).”

Tell us about your editorship “I had a great time turning The Black Bag into a tabloid! We (perhaps infamously) were the ones who ended up getting the magazine banned for publishing nude and very rude photos. We got into a lot of trouble with the Dean! Thankfully, this was quickly reversed and the journal regained reputation with a new editorial team focusing on quality rather than circulation volume.”

Tell us about your career “Little did I know when I edited Black Bag in my second year that I will end up being the Translational Research Editor of EuroIntervention- a serious cardiology journal! In fact, I had no idea that I would end up as a consultant interventional cardiologist and an academic, with a BHF Fellowship at Imperial College London! Really at the time, I was very much 32

hoping to be a scuba diving doctor on a Red Sea resort, teaching tourists how not to get decompression sickness… I kind of still hope to do that one day! What happened I hear you ask…? Well, on reflection, I do think Bristol Medical School prepares you to do anything you in life: editing Black Bag was only the start!”

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Dr Richard De Butts MRCP MB DTMH Acute Medicine Maj Julian Lentaigne MB ChB Military Medicine Graduated 2005, Co-editorship 2003-4

What was your most memorable moment at Bristol Medical School? Richard: “Probably the spoof lecture for freshers which we organised. My favourite bit was when a friend came in dressed in tails to announce a meeting of the ‘Bristol Old Etonian and Harrovian Medical Society’. As he read out the list of the societies perks including 1st choice on medical attachments, dinners with viva panel members and senior consultant input in your job applications, the anger and horror in the room was almost palpable.” Julian: “My funniest moment was getting mugged right next to the BRI, off St Michael’s Hill. I was coming home at three am or thereabouts, from a night out. Taking a shortcut behind the old church, I was stopped by a wouldbe mugger. After a bit of a tussle, in which I threw my kebab at him, he took my wallet. Some Good Samaritan students who were passing had phoned the police, who arrived very soon and we set off in hot pursuit with blue lights and sirens. This was very exciting, but ultimately futile. As we were doing a

second pass of Park Row, with hopes of catching the thief fading, the car in front veered to the left seemingly to avoid the police. It continued driving into the ESSO garage, and straight into a petrol pump. A lady fell out the driver’s seat, clearly worse for wear. The policemen explained that the search for the thief would have to be called off as they promptly breathalysed and cuffed the lady. Once she was bundled into the boot, we all set off back to the central police station for me to fill out a statement, and for her to spend some time in the cells. The journey down to the station and the language I learned that night was one of the more colourful episodes at medical school.”

Tell us about your editorship Richard: "The article which I particularly enjoyed writing was a look through the history of The Black Bag. Although it started in 1937, its predecessor was called 'The Stethoscope' and was first published by medical students in 1898. There were some amazing articles in there including one by the first ever female medical student at Bristol which was an amazing read. They are stored in the medical school library and worth a look. My other favourite article was the 'seven deadly tins' where we hosted an extra strong lager tasting session at our student house in Highbury Villas. Amazingly people did actually taste 7 different brands of extra strong lager and rate them although after this it quickly descended into drunken chaos.”

Julian: “My recollection of editorship was that it was incredibly difficult! Getting just two editions out a year was hard work. People never seemed to deliver on articles or photographs, and filling 26 pages with humour was a real challenge. Though I loved the seven deadly tins, and a completed false guide to Bristol for freshers, I was most proud of our two centrefold board games. They were based around well know board games, and we actually played a few rounds ourselves. Some of the ‘community chest’ cards were great fun to write. I’m not sure whether the fact that we never had a lawsuit from Hasbro ™ says more about the small readership of the magazine or how little the games resembled their originals.”

Tell us about your career Richard: “After graduating I worked for a year in Torquay. There was a hospital play written by the FY1s, consultant versus juniors football and regular free waterskiing put on by the doctors mess. I then headed off to London for the rest of my training, including treating athletes during the 2012 Olympics. My career highlight was taking 18 months out of training working for Medicin Sans Frontieres in South Sudan and Sierra Leone. A great chance to use the skills I had built up for a really positive end and also an amazing experience. Although this sort of thing isn't for everyone, if you are interested, do follow it up. Bizarrely, I remember people telling me that taking time out would make getting a specialist training number more difficult, but I have found that having done this it has helped my career hugely through the experience itself as well as providing endless interesting interview answers to dull questions.”

Julian: “My career highlights have been many, and for me, the variety of my medical experience has been more important than any one goal. I signed up with the Army shortly after getting into medical school, and I’ve practiced medicine in some fairly interesting parts of the world – Kenya, Kuwait, Afghanistan and South Sudan and some fairly interesting situations. I’m now well on the way to getting a CCT in Respiratory, Intensive Care and General Medicine - one of the last triple accredited doctors in the country I believe. This has given me an insight into working in most parts of the hospital, which I think will be a real asset as a new consultant. Doing a year’s ‘Darzi Fellowship’ in London was a great insight into the mysteries of how the NHS works, and gave me some time away from the coalface to develop my own personal leadership style, and have a go at developing patient centred care and services at a fantastic institution – The Brompton Hospital. My advice to current medical students is that there is no great rush. I’m nearly forty now, and still not a consultant! My variety of experience and taking time away from a traditional career path has at times been frustrating, but overall, has made me, I think, a more rounded clinician. When I started out at Med School, ten years seemed a long way away, but it seems to be no time at all looking back. Enjoying the journey is as important as getting to the end goal.”

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“Dr” Peter Barnes BSc MB ChB Graduated 2015, Editorship 2010-3

What was your most memorable moment at Bristol Medical School? “You know what they say about Bristol

Medical School – if you can remember it, you weren’t there. Or was that the 60s… I still tell people about the time I stayed behind in the library at Wotton Lawn (Gloucester’s Mental Health Hospital) to complete my psychiatry presentation. When I left, it turned out my card had timed out after 6pm – trapping me inside. I then spent a while convincing one of the nurses that I wasn’t a patient and that I had capacity to go back home to Discovery House…”

Tell us about your editorship “In the early days I never knew where the money came from to print the magazine. I used to tell people it was adverts but I had no idea. One of the Treasurers started asking questions but he got distracted by the 4th year exams and then replaced by a new guy in September who actually offered to fund the printing via Galenicals. Other than that I just used to spend my time walking around the Freshers’ Bar Crawl and trying to take pictures of people making out or throwing up to print in the centrefold of the Freshers’ edition. That was the only reason I went to the bar crawl – I had much less fun the year after I hung up my camera.”

Tell us about your career “Every zero day is a highlight of my career. My advice for current medical students would be this – I wish I appreciated how hard it was to drop out of med school when I was a student. Sure you can fail the odd exam, maybe even resit a year. But by the time you get about three years in – you are just too expensive to kick out. Oh…and always make time for lunch. Everything is exponentially harder when you are hungry.” V. K. MANDAGERE, Editor-in-Chief Intercalated BA Medical Humanities

THE WAY OF MORTIFICATION Mortification: great embarrassment and shame. "they mistook my mortification for an admission of guilt" synonyms: embarrassment, humiliation, chagrin, discomfiture, discomposure, awkwardness shame, loss of face [Oxford English Dictionary] I know you students look up to us Faculty members, revere us a role models and exemplars, as doctors who have gone the extra mile on the long road to medical excellence. But the cold truth is that we are idiots, just like you. Sooner or later anyone who entertains a high opinion of themselves has to face the harsh reality that, despite their eﬀorts, chagrin and humiliation is forever lurking in the wings. Most mature people carry with them a small collection of memories that, however well suppressed, return to haunt their dreams and dent their delusions of superiority. Mortification! What a wonderful word, signalling the death of pride and the slaughter of misplaced self-esteem. Let me illustrate from my own wretched experience. Take for instance my first term as a Lecturer back in 2001. The then Professor of Ethics and Law in Medicine was the venerable Alastair Campbell. This bearded wee Scot was an ethical force in his own right. A member of the Iona community, his beady eyes and sharp wit were not something you were overly keen to get on the wrong side of. So, there we all were, pencils sharpened, ready to hear the good Professor toss the first caber of the Year One MB ChB lecture course, a course in which I was to tutor a small group of budding Aristotles. Campbell had wisely counselled everyone to make sure mobile phones were oﬀ, but about five minutes into the lecture, one chirps into sonorous life. We all looked around ready to assault the culprit with the evil eye, as they scrambled to silence a noxious Nokia. But no 39

unfortunate was identified, and the phone rang on of for another minute before the miffed professor could restore order and continue. Five minutes later the phone burst into life again. This time a more concerted search was instituted as the lecture descended into complete chaos. Mortification! The phone in question was in fact my own. I had dropped my bag with the phone in it to talk to a colleague, and then moved to my final seated position about three rows and 10 seats away to the left. My bad luck was revealed to the entire assembly and I dearly wished for a large hole to appear, into which I could safely disappear, perhaps for ever. Although bound by his beliefs to forgive me for my idiocy, he did at least allow himself to comment that he hadn’t expected his lecture to be sabotaged one of his staff. My career is an idiot actually began long before I even qualified in medicine. I remember doing a ward round in Saint Mary’s Hospital in London. In those days London teaching hospitals still had huge “Nightingale” wards complete with majestic nurses in starched uniforms and white headdresses. The ward round was being conducted by a sexagenarian general physician – of the decidedly old school. As the round wore on, my attention wore off, possibly in the direction of one of the aforementioned nurses. I was awakened from my reveries by a question from the Consultant along the lines of “Tell me, Thompson, what isthe leading cause of acute shortage of breath in a 50-year-old man?” (in those days it was still common to be addressed by one’s surname).

Mohit Achanta 40

I had been attending long enough to know that we were parked by the bed of nicotinic taxi-driver, wearing an oxygen mask and struggling to breath. Caught oﬀ guard all I could think to say was “ascent to high altitude, Sir?”, an answer which drew sniggers from my contemporaries and a withering, nay despairing, look from the doctor, who memorably quipped, “what are you thinking, Thompson, Harrow-on-the-Hill?”. I’m starting to see a theme here, sensory inattention, in situations where much attention is called for. I spent six months working in the A&E department of St James’s Hospital in Leeds. This is one of these spectacularly busy inner-city hospitals with A&E divided into “majors” and “minors”. I remember pulling back the screen of one of the minors cubicles and seeing a woman sitting on the examination couch with a small sword sticking out of her head. Though relatively new in the job, I knew instinctively that this was not a minor presentation and called to one of the senior nurses for help in shifting the patient to somewhere more suited to neurosurgical assessment. However it was soon pointed out to me that this was the ceremonial headdress of a woman in traditional African clothing – attending with her son who had an unpleasant cough. The department dined out on this story for many a week. This reminds me of another mortifying diagnostic error which I have been too ashamed to share before now. I walked into another cubicle at Jimmy’s, with my head buried in the patient’s notes where I read “incident in mattress factory”. Without properly looking up, I asked my patient what his problem was. He didn’t actually answer me but rather lifted his hand, from which action the diagnosis was (mortifyingly) evident. He had a large metal spring going in one side and out the other of his left index finger. Sometimes mortification is retrospective. I remember being collared by my Surgical Reg who claimed to have laughed himself to sleep over the Social History in my clerking of a 54 year old man admitted with bowel obstruction. It read simply “very nice wife”. The same Reg expressed utter disbelief that I had pocketed £20 given to me by a grateful patient. The poor man had been in agony with urinary retention… Over the years I have been mortified more than once by my students. I remember sauntering down Whiteladies Road, feeling especially good about myself for some reason, and being approached by two charming female medical students. “Dr Thompson…”, they began… I was expecting some request for SSC supervision or a compliment on my latest lecture… “we weren’t sure if we should tell you” they quavered, “but your jumper’s on inside out”. OK, a public service of sorts, but still humiliating. It reminds me of the most wonderful, and I believe honestly delivered, bit of feedback I ever received on one of my early psychoneuroimmunology lectures - “Dr Thompson’s lecture was like A-level psychology, but without the content”. Bravely said laddie. I am actually proud to be an idiot. Life is better if you can embrace your inner idiot, get rid of the idea that you are in any way especially wonderful at being a doctor, student, lover, pastry chef. You don’t even have to interject with the caveat that everyone else is an idiot too. Welcome mortification in your life – it is a useful reminder of what you truly are. DR. T. THOMPSON Head of Teaching for Primary Care

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4902: 04/17

THE JUNIOR DOCTOR W h a t ’s i n a n a m e? The Front Page of The Times recently ran the story about the UK Chief Medical Officer’s backing for the abolition of the job title “Junior Doctor”. This came after Oxford University academics had branded the term (which encompasses all doctors in training before becoming a consultant) “unjust, progressively inaccurate, detrimental to self-esteem, and widely misunderstood by the general public.” Since then, doctors around the country have weighed in on whether or not the term is useful, useless or worse: an underhand attempt to distract from the NHS’s numerous struggles (the announcement was made the same day as a report by the CQC warning that NHS safety could be deteriorating). To give some historical context, the term junior doctor previously encompassed the roles of ‘pre-registration House Officer’, ‘Senior House Officer’ and ‘Specialist Registrar’, but after ‘Modernising Medical careers’ changes came in, in 2005, these terms were scrapped and replaced by ‘Foundations year doctors/ FY’s’ and ‘specialist registrars/ST’s’. Since then there has been a lack of coherence in use of the terms, with many clinicians and patients still using the ‘old’ names. The 2016 Junior doctors dispute made it particularly obvious that there was confusion over who came under this label of ‘junior’.

Reasons given for abolishing the title ‘junior doctor’ centre on the word ‘junior’ itself being ‘belittling’. According to Oxford Academics, it is detrimental to self-esteem and morale especially for those who have been working for as many as 15 years as doctors. However, if they were called something else, this problem would probably still remain, because it seems unnecessary to have an umbrella term for doctors at different training stages who have little in common other than not being consultants. Another complaint is that it is out of line with other hospital professions, none of which use the term ‘junior’. Though of course, there is no reason why doctors must conform to this norm and it must also be noted that “juniors” exist in other respected professions such as the law e.g. junior barristers. Other arguments are that the term is confusing both for patients and other medical workers. Current nomenclature is vague and widely misunderstood even by hospital staff (I have encountered nurses who don’t understand what I mean when I ask if they’ve seen the “FY1 on call”). The old system worked well and much of public understands better who an ‘SHO’ is, for example, members of the public/patients often think ‘junior doctors’ are medical students. However, this issue seems to stem not from a problem with the term ‘junior’, which is a non-jargon, familiar term, but rather from the fact that there are too many terms to describe the same grade as well as inconsistencies in the way they are used. For example, the term ‘junior’ has become widely synonymous with 1st and 2nd year clinicians. Introducing another term in place of ‘junior’ would just create more confusion and would bring with it other problems and bring with it new connotations. A survey of 400 junior doctors, 50% thought the term “bad for morale” but some, like Dr Rachel Clarke, have branded the issue a “distraction of a manufactured debate about job titles” that “serves a convenient purpose to have junior doctors bickering among themselves about what they would like to be known as.” This may be true but it’s not a good argument against making a change per se. Even if it is a comparatively small issue, anything to boost morale, especially if cost neutral, is surely a good thing as long as it does not prevent further improvements. However, it is true that there runs a deep dissatisfaction amongst those at the start of their medical careers, which is unlikely to be healed by a simple name change. Principally, if junior doctors were more respected the word ‘junior’ wouldn’t be seen by some as a degrading term. Most of the articles written about the issue have pitched the debate as one over whether or not the word ‘junior’ is a dirty one, but it seems that many of the arguments for and against really aren’t about the word at all. Really, the issue seems to be that people are being called junior for far too long. There are further issues about whether the labels given to different training grades are confusing matters further and may be better replaced by old terms of usage or more familiar words unlike ‘FY’ and ‘ST’. The point is that doctors and particularly ‘junior doctors’ feel undervalued, and petty issues like this will continue to be contested until they feel they are being listened to on the big issues. J. KONDRATOWICZ Political Columnist 3rd Year MB ChB

DISCRIMINATION A plea

Leaving medical school is going to be diﬃcult. Although many years away, I cannot fathom trading in my lizard lounge loyalty card and the two societies I am currently active in for a pat on the back and a cold clinical ward full of sick patients, all of whom need my help.This day may not seem as a traumatic experience for those of you in clinical years as it does to me however, my fears are not without merit and I am sure many of you reading now will be able to relate.

“I would like to see a white doctor.” Away from the liberal bubble of Bristol in the bright lights of Mississauga, Ontario, a video was captured of a patient demanding to see a “white doctor” as her son was experiencing chest pains. It is quickly evident that the original healthcare professional who tended to her son did not fit this patients’ demands and was clearly an unacceptable choice to treat her son. This four-minute video truly shines a light on fears many medical students will face in the future: Discrimination. I am not afraid to be a minority in medical school. I am the openly gay son of a generation of immigrants who came to this country to seek a better future and educate themselves further. In medical school, I have faced little discrimination, but once I swap my red “medical student” lanyard for a plain, cold, corporate blue “NHS” lanyard, why should this stop? Theoretically, the NHS is on my side with the Equality Act of 2010 aimed at quashing any troubles I may come across in the future, but why have 1 in 10 NHS employees surveyed feel they were discriminated against? The unfortunate truth that clouds my bright, gleaming future of curing and aiding patients is the the reality that I am likely to face discrimination in the future. I may be discriminated against because of the colour of my skin. Alternatively, I may be discriminated against because of my sexual orientation. But the saddest part of this experience maybe the fact I could be discriminated by my fellow colleagues. The same colleagues with whom I trained. You see, throughout medical school, we meet so many different people with backgrounds opposite to our own. We are taught about discrimination, diversity and disability, and yet discrimination between doctors in the work place is still prevalent. You don’t need me to tell you that diversity amongst the workforce is important. A diverse workforce can tackle the complex issues a diverse population of patients brings. A diverse workforce grows faster and more efficiently as a multitude of backgrounds and cultures comes together to reach a collective goal. Most importantly, a diverse workforce encourages a sense of affinity to the population it treats. The NHS even takes actions to 45

promote diversity where minorities are being under-represented. This could involve promoting a member of staﬀ due to their sexual orientation in a situation between two equally qualified candidates with the aim to reduce underrepresentation. And so, this is my plea. A plea from a second year medical student who is uncertain about the future that lies ahead. A plea for all those who too are uncertain about what becoming a doctor will mean for them. Becoming a doctor means many things, you have the honour of helping your patients, but that should not come at the cost of losing your respect for your fellow colleagues. No doctor should have to live in an NHS flourishing with discrimination and no medical student should have to fear what lies ahead. Let’s work together to make a stronger, more diverse NHS in which both patients and practitioners benefit. C. HARMER nd 2 Year MB ChB President of Galenicals LGBT+

Mohit Achanta

Inspired by the wit and lyricism of Bristol Medical School’s literati? Or are you gushing with fury and vitriol at the mere sight of our humble chronicle? Well…Why not write for us? Any contributions welcome. Just email blackbag@galenicals.org.uk and pitch your idea for an article!

THE SECRET MEANING OF LIFE Wisdom from an alumnus (Disclaimer: when The Black Bag initially requested an article from the illustrious Dr R. A. F. Pellatt, a former editor, we expected a whimsical and gorgeously satirical piece. However, he has recently fallen in love, and is far less cynical and certainly less satirical than he was “back in the day”.)

The lady in bed fourteen has had a subarachnoid haemorrhage. She is 34, has never smoked, takes no regular medications and lives as healthy a life as one could hope to live. This morning, she woke up with a severe headache and vomiting. Her CT scan showed little leaks of blood oozing into her subarachnoid spaces, compressing the soft lobes of her brain within the confines of its cranial coffin, leading the crushing pain she now feels. She is lucky, overlooking the fact an artery has burst in her brain; but lucky in that she will undergo a relatively simple endovascular intervention, and walk out of the hospital with her mind and body intact. The man next to her was less lucky; the large clot that lodged in his vertebrobasilar artery has effectively destroyed his brainstem, and he will die in the next few days. I sit here, in the intensive care unit of the Gold Coast University Hospital, Queensland, Australia, surrounded by tragedy, death and misfortune. Nowhere in the hospital is the fragility of life more present, more compounded and more visible. Here, the very worst things that can happen have happened. Children have been hit by cars. Young men dropped dead from sudden unexplained cardiac arrhythmias, electrocuted just in time to restart their hearts, but too long to reverse the death of their brain. Fathers have collapsed from previously unknown blood clots silently conglomerating in their lungs; mothers have bled to pale, pulseless forms in unexpectedly complicated childbirths. The reality of any medical career is a discomforting familiarity with death. As we advance through our profession, each of us will confront at different times a sense of pointlessness, of disillusionment, at the worthlessness of living. That is not to say that we as doctors are particularly unique in this fact; anyone can chew on ideas of existence, from the porter to the philosopher, from the mechanic to the mathematician. But certainly, being in the medical profession renders one closer to life and death that in other walks, and perhaps one is more prone to pondering, more acutely aware of what can go wrong, and when. In intensive care, every patient is sick. I mean sick in the way that doctors say ‘sick’, not cough-and-cold sick, but about-to-die sick. They are also generally young, and generally unfortunate. Working in this department and in these 47

surroundings for a period of time inevitably skews one’s outlook. For although these thirty or so beds represent only a fraction of the hospital’s capacity, and really only a pin-head of the local population at large (who are generally going about their days with coffees and lunches and remembering to close the gate and did I turn off the air conditioning and did you hear about Mary’s husband and how expensive have avocados become and spare change and washing and a leaky roof), to us they become normality. And that becomes a weight, because we become used to suffering. Life becomes pointless. Everyone is dying. Our world is the very sick, the very unlikeliness of their happy recovery, the absolute certainty of the deterioration and death of us all. Doctoring can be like this anywhere, but nowhere more so than here, in intensive care. We become cynical, cold creatures, callous, dark jokes and pessimistic irony a protective cloak. Death surrounds us. Morbidity warps our brains, and we lose sense of the usual grief process, the usual familiar mechanisms and reactions to unhappiness and loss. And at worst, the black cloud will settle; the thick duvet of smothering depression as we wander limply, dulled, disillusioned, damp. But one can react in another way. One can look out at the world, and embrace that which is good, is wonderful, is beautiful. One can take pleasure in small interactions, in the touch of another human being, in caring. One must, to paraphrase the old cliché, see medicine not as a science, but as an art. In the end, our science will always be defeated. Our greatest advances will always succumb. Our drugs and defibrillators and scalpels and surgeries will inevitably fail. Our patients – and of course, ourselves – will always die. It is in only in our art that we as doctors can affect real difference. For art is infinite; art is a connection between man and man; a vitality, an expression. The most important facet of medicine is not in curing, but in caring. We forget this, of course. But it serves to remind ourselves every now and again that humanity is not built on bleakness, but on relationships. Our connections are important, and we must, even in the dark corridors, where pale, shaking things quiver in dimly lit rooms, where infusions and machines and pumps and blood and sputum and urine and chest drains and faecal management systems and arterial lines and sternotomies and horrors so awful they might be considered medieval tortures; in all this we must see beauty. For beauty is the secret meaning of all life. Dr. R . A. F. PELLATT Ex-Editor 2009-11 PYG6 Emergency Trainee Gold Coast University Hospital, Australia

STORIES A night

out

“Alright mate? Pack of ten, err twenty, Marlboro lights. Bottle of Stella and a bag of Monster Munch. Yeah, pickled onion.” “Peer reviewed studies have shown that calling cigarettes ‘light’ is misleading.” “You what?” “Smokers don’t benefit from lower nicotine and tar levels – they burn through the whole cigarette.” “It’s 2am and I could not give a flying…” “They promote the illusion of safe smoking.” “I can see them behind you. They’re literally next to your hand.” “Sir, I cannot sell you this product in good conscience. To paraphrase Britney, it’s toxic and you’re slippin’ under. “Sweet Jesus. Give us the Monster Munch then.” “Big or small?” “Excuse me?” “They do mini Monster Munch now.” “Oh right, I’ll try them.” Snow has stopped falling through the harsh lights of the petrol station. It has only been a dusting. Mush blends with spilt diesel to form a black stain on the student’s trainers. The cashier pulls all the items together without shifting his feet. A quick twist of the torso and he can reach everything a drunk needs on a Saturday night. Hairy-backed hands toss everything into the payment hatch. Sprinkling a handful of change on top, he settles back on his perch and turns Netflix up. There are 3 seasons left and the night isn’t getting any longer. “These don’t look any diﬀerent.” The kid squints into the packet. “Give us a look.” The cashier flicks the hatch open. He crushes a fist into the packet, sending crumbs and tangy fumes flying around the booth. “Like I said, mini edition.” “Screw you dude.”

The student’s mate had forecast a hell of a night. And our hero is keen. He wants to start clocking up the kind of tales everyone else tells at pre-drinks. Some kiddy had climbed Thekla’s greying mast. Swinging like a scrawny epiglottis from the hyoid bone, he’d told the whooping crowd that he was bigger than Kanye, before landing a twenty foot jump onto the dockside. Tonight is the night. Our student is dribbling with excitement. Sauntering out of the garage he tucks the cigs into his front pocket, wedging the too big beer bottle into the back of his jeans. They’re dangerously tight, but they look good with a fitted white shirt. The grip of the cold sucks the puff out of his chest. He’s pushing against the tide, other boozed up groups surging towards the city centre. Not for him. Everyone’s meeting up in Lounge. “Mediterranean diet my friend. Lamb Doner? No artificial trans fats.” “I’m really full actually.” “Come on mate, just a nibble.” “Thanks but you’re alright.” £2 lunch meal deals have given way to mixed meat grills at twice the price. Lebanese rhythms mix with the sweet scent of roasting meat. Inside, the servers are sweating beads onto white kitchen tiles. Standing in the doorway is taking the sting out of our student’s numb hands. The student is wrecked. Some part of his brain carries on narrating events, offering opinions. Even if his body ignores them. Lagging behind reality, he thinks that reaching for his beer will leave it smashed and wet on the floor. To his surprise, it’s now in his hand. Shit. No lighter, can’t cop the pap off. Pop the caff off … open it. “Give it here kiddo. Stop messing around.” The stranger is talking a bit too loudly. It’s just her way. Bomber jacket and ripped neon stockings, one green, the other pink. She’d once thought that colour-coding with 35 different shades of highlighter would help her pass anatomy. The student gives a slow blink, and opens his eyes to find that he’s now drinking the amber liquid. “Nice one.” “Impaired coordination. Patchy memory. Slurred speech. All symptoms of…” “Stroke?” “Alcohol intoxication.” His eyelids collapse again and he’s inside the club. The beat just dropped and the room got sexy. Time to make bad life choices. As White et al. (2002) found, students who blacked out were statistically more likely to think that stealing a traffic cone was funny, have unprotected sex with their flat mate’s visiting sibling and write this article for The Black Bag. T. GREENSLADE 1st Year MB ChB 50

31/10/2017

Crossword Puzzle

Across

Down

2 4 5 6

Inventor of the stethoscope (7) Osteoarthritic node of the hand (9) The first Doctor Who (7,8) Bruising over mastoid process (7,4) 8 Author of ‘Complications’ and ‘Better’ (4,7) 10 22q11 deletion (8,8) 13 Embryonic structure aiding descent of testes (12) 16 Film of 1990 and 2017 about unwise medical students (10)

1 3 6 7 9 11 12 14 15

C22H28N2O – opioid analgesic (8) Festively named form of haemophilia (9,7) The hapless laboratory assistant of Dr Bunsen Honeydew (6) Fuchsiabranded college (9) 16 cell embryo (6) Bone named for watercraft (9) FOOSH fracture (6) 19th century physician, noted for work on infectious disease (a plaque to him can be found at the top of Park Street) (7,4) Sildenafil (branded) (6)

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 us- students, staff and alumni! All ideas are welcome. Email us at blackbag@galenicals.org.uk

— YEAR REPS: Year 1: T. GREENSLADE Year 2: N. REES Year 3: J. HUTCHINGS Year 4: C. ALBRINES PROOFREADER: M. E. C. McGLADDERY

31/10/2017

Crossword Puzzle Answers

Across

Down

Inventor of the stethoscope (7)

C22H28N2O – opioid analgesic (8)

4 5

Osteoarthritic node of the hand (9) The first Doctor Who (7,8)

3 6

Festively named form of haemophilia (9,7) The hapless laboratory assistant of Dr Bunsen Honeydew (6)

Bruising over mastoid process (7,4) Author of ‘Complications’ and ‘Better’ (4,7)

7 9

Fuchsiabranded college (9) 16 cell embryo (6)

11 12 14

Bone named for watercraft (9) FOOSH fracture (6) 19th century physician, noted for work on infectious disease (a plaque to him can be found at the top of Park Street) (7,4) Sildenafil (branded) (6)

10 22q11 deletion (8,8) 13 Embryonic structure aiding descent of testes (12)

16 Film of 1990 and 2017 about unwise medical students (10)

http://www.whenwecrosswords.com/crossword/_/522593/crossword_answer.jsp

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“I hope that The Black Bag will have a long and vigorous life and that it will travel wherever old Bristol students are to be found. Our aim is for it to be a link between all students, present and past, wherever they may be… If it attains this objective, its success is assured.” — Norman Burgess, Hon. Editor, The Black Bag, Nov. 1937

THE BLACK BAG Galenicals Publication Bristol Medical School 56