murmur
AUGUST 2020
P aylist Editor's Note | 4 Yashaswini Makkoth
Futures Made of Virtual Insanity | 10 Varshini Chandrasekar
The Instrument | 5 Maheen Khan Shahid
Blowin' in the Wind | 12 Anonymous
Generation Z, BLM, and What it Means for Medicine | 6 Ashraf Docrat
I Don't Sleep | 14 Toby Redler
Maybe Just a Little Simple Melody Is All We Need to Keep Our Boomin' Hearts Beatin' True | 8 Irfanul Hoque
The GUMS Puzzler | 16 Yashaswini Makkoth and Vinuri Abeygunawardana
Editor's Note Yashaswini Makkoth I was just six years old when my grandmother taught me the basics of Carnatic music, a classical style of Indian vocal training. “Sa Pa Sa”, analogous to “Do So Do”, was the first thing she taught me. These three notes are often sung at the beginning of each lesson as a vocal warm-up. I loved learning Carnatic music and it became a key part of my childhood. Our house was always filled with music. My mum would play Hindi and Malayalam songs as she worked around the house. However, I never really listened to the lyrics even though I understood and spoke both languages. I was more entranced by the stunning melodies - that is the power of music, you don’t necessarily have to understand it to enjoy it. However, the true beauty of music lies in its ability to enrich an experience or emotion. Moreover, if you start to reflect on a song, it will likely conjure up a memory that is inherently linked to it. Perhaps it was your high school graduation song, or a song from your favourite movie. Every song reminds us of a memory, no matter how mundane and each new song we hear is added to the soundtrack of our lives. The soundtrack of medicine is likely not that different to the soundtrack of life. In fact, someone once told me that the hospital was a microcosm of the real world. It is where birth and death coexist, as well as the many moments spanning between the two. You can hear cries of joy and sighs of relief, mingled with the melancholy of disappointing news. It is a symphony of human emotions, set to the rhythmic beats of the ECG monitors and the footsteps of the healthcare workers. Similarly, as you can see on the next page, Maheen highlights the music of the human body and the key role that doctors play in listening for any disturbances. Music is everywhere, you just have to listen. In this issue of Murmur, Maheen and I have tried to unite the design and written components of the portfolio, and so, for the first time you will see each written piece followed by an artistic one. Each person has also chosen a lyric that reflects the spirit of their piece. You will read about various topics in this issue, from the Black Lives Matter movement and the future of artificial intelligence to the importance of sleep. The artistic pieces delve into the need for equality and the importance of music as a whole. We hope this issue inspires, informs and enlightens you. In the words of the great philosopher Plato, “Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything.”
The Instrument Maheen Khan Shahid
The human body truly is an instrument. If you listen closely, you can hear its melodies: the rhythmic beating of its heart, the wind-like hums of its breaths, the splashing of blood against its vessel walls - a concerto indicating its optimum functioning. Doctors, in a way, can be compared to musicians. When the sounds of this instrument are off and there is fine-tuning required, we hear this dysfunction in murmurs, crepitations and bruits. We use this sense of hearing to correct the minor off-tuning in this well-orchestrated musical piece played by the human body.
Generation Z, BLM, and what it means for medicine Ashraf Docrat
2020 has so far been an unprecedented year. Whether it was the US killing an Iranian military general almost sparking WWIII in January or COVID-19 exposing compromised healthcare systems, supply lines and social security we have all witnessed just how easily everything we take for granted can be changed. However, what was perhaps even more remarkable was the explosion of Black Lives Matter (BLM) protests all over the world which were unparalleled in their scale even before considering they were occurring in the context of a global pandemic. What stood out about BLM was, unlike COVID-19 or the US actions against Iran, these disruptions were not caused by a chance zoonosis or the decision of a few politicians and military generals but was led by an extraordinarily large number of young people. People like Nupol Kiazolu – only 19 years old – led protests near Times Square as President of BLM Greater New York (Ballan, 2020). Kiazolu belongs to Generation Z, generally consisting of people born after 1996 who now make up the younger portion of our medical student cohorts and the very youngest junior doctors. Full disclosure: I too am a member of Generation Z. Our childhood was spent in the post-9/11 internet age, we saw the impact of the global financial crisis on our parents got our first smartphones in high school.
Floppy discs, cassette players, and MS-DOS are as foreign to us as horse drawn carriages and gramophones. We are comfortable with coordinating our lives through Facebook, SnapChat and other social media apps and are aware of the algorithms and influences that underpin what we see. What was remarkable about the BLM protests was their urgency. A global pandemic limiting mass gatherings was not enough to deter young people from the call to action. Racism and its side effects like policy brutality are not new foes but despite being young, Generation Z has seen is how little progress we have made on racism. However, unlike many generations before us, Generation Z has the capacity to spread its message like never before. Within hours, most of the world could easily access information about the death of George Floyd in Minneapolis and within days protests had to spread to countries as far afield as Australia, Japan, the UK and Denmark. BLM represents how Generation Z will not only refuse to accept inaction in the face of injustice but will also use tools at their disposal to incite change in a way that the generations before did not or were not able to. One of the rallying cries of BLM was to ‘defund the police’ in order to fund social programs that address issues like mental health and homelessness. Now, less than 2 months later, numerous cities across the US have scrapped planned funding increases and even cut police budgets.
up your looks "They're gonna clean e books With all the lies in th t of you To make a citizen ou th a gun Because they sleep wi u, son And keep an eye on yo the things So they can watch all you do" ical Romance Teenagers - My Chem
Beyond protesting, Generation Z has leveraged social media to agitate those unwilling to change. This was exemplified by the sabotaging of Donald Trump’s rally in Tulsa, Oklahoma by K-pop fans and Tik Tok users. They ran a sophisticated campaign on Tik Tok and Twitter that cleverly worked the algorithms to publicly reach large audiences while simultaneously avoiding being found out by Trump’s campaign. Their message was simple: reserve free tickets to the Donald Trump rally and don’t attend. The campaign was expecting in excess of 1 million people to attend and only 6 000 attended, simultaneously destroying his credibility but also highlighting the power of Generation Z to use social media to surreptitiously subvert those in power (Sakzewski, 2020). The medical field is not likely to be exempt from these forces. The BLM movement is highlighting Aboriginal and Torres Strait Islander health inequalities and continued failures of government to ‘close the gap’ (Rix & Rotumah, 2020). Unconscious biases are rife in the medical professional, even in those whom we trust to teach us. These biases result in poorer pain treatment and overall health outcomes in BIPOC. Additionally, issues like bullying and harassment in hospitals overwhelmingly impact junior doctors causing untold impacts on the mental health
of the future leaders of the profession (Srivastava, 2018). Social media has created an environment where Generation Z are not only exposed to these issues but can actively incite change and monitor the progress of those in charge. The BLM protests have exemplified that Generation Z do not tolerate an unjust status quo and are willing to push for radical changes (like defunding the police) to do what it takes to address inequalities and poor treatment. Generation Z, despite coming of age during uncertain times, are rallying against injustices in ways that appear to be swifter and more effective than past movements. While living through a global pandemic undoubtedly presents new challenges to progress, it also amplifies and highlights inequalities and injustices. It is hard to predict what the impacts of Generation Z-led movements like BLM will have on history but it is clear that young people will not accept ‘all talk and no action’ from society’s leaders and institutions or having to wait until younger people are in positions of power. It is clear that young people want to see action in addressing the myriad of problems afflicting society and they will hold those in power accountable for it.
Refer ences Ba
llan, R . (2020 On An , June d Off 12). Ge Social n Z Le https:/ Media ads Th /www . Forb .f e Blac o r blackes. k Live lives-m bes.com/sit s Matt es/reb atter-m er Mo e c c ovem abella vemen ent-on Rix, L n/202 t, ., & R 0 and-o /06/12 otuma ff too. B / -socia gen-z h, D. ut con lleadsmedia (2 0 v in 2 th 0, Jun /#d7e https:/ cing to e7cf319 e 19). /theco morro a88 Black nversa w’s he convin Lives tion.co alth w cing-to M o a m tter in rkers /black morro is toug health -livesws-he h. The matte care alth-w Sakze Conve r-in-h orkers wski, e rsation a E -is-tou lth-ca . (202 behin . r gh-140 0, Jun e-tood the e p b 6 oor tu ut31 22). W https:/ rnout ere Tik /www a t Trum Tok u .abc.n really p's Tu et.au/ sers a -trollnews/ nd Klsa rall donald 2020pop fa y? -trum 0 ns rea 6 -22/did ABC News. p-tuls Srivas lly a-rally -tiktok tava, R /12378 -users . (2018 harme 7 -kpop 68 , Octo d. The fansber 30 Guard https:/ ). Whe ian. /www n docto .thegu are-bu r s a a r r d e llied-a ian.co bullie m/com d, all o ll-of-s ociety f socie menti -is-ha ty is sfree/ rmed 2018/o ct/30/ whendocto rs-
Maybe Just a Little Simple Melody Is All We Need to Keep Our Boomin' Hearts Beatin' True Irfanul Hoque
“Maybe just a little simple melody Is all we need to keep our boomin' hearts beatin' true” Music Is Healing – Florida Georgia Line I met quite the eccentric old man recently. Captain of the catamaran I was cruising on that day. Once he found out that I was a medical student he told me stories of his uncle, a surgeon. In awe, he would watch his uncle live at his study desk, pouring hours into his books. Similar to the rest of us, the stress of medical school was something that weighed on the man. We all have our outs from the challenges, and this uncle of his found refuge in the radio by the desk. Countless hours of music were played from the little contraption, but in the most curious manner. The captain would see his uncle place the diaphragm of his stethoscope on the speaker and through this odd medium he would enjoy his tunes. Such is the beauty of song. A crucial element of human nature and a form of art that we value ever so greatly, such that we will always find a way to immerse ourselves. Is it not rare to find an individual who has a distaste for music? No matter the mood, one can find solace in a lyric that resonates with them. Whether in times of joy or sorrow, a tune exists to submerge you in emotion. Every one of us feels something different when we hear song. We delve into our own little worlds; you could even call it an escape. This is why they say music is medicine for the soul.
By Varshini Chandrasekar
Futures Made of Virtual Insanity “Patient 298, please proceed to Room 2.” “Patient 298, please proceed to Room 2.”
As the intercom echoed across the room, Marty started up from his chair, relieved to escape the chilly discomfort of the waiting lounge. He shuffled down the long corridor, wincing as his swollen calves began to ache. The door to the consultation room stood agape. Harsh white light flooded a space that lay painfully bare. A drab blue bed was pushed to one corner and a few medical instruments rested on an otherwise empty desk. Most significantly, a young woman sat on an office chair, waiting for Marty. But it wasn’t really a young woman. It wasn’t really a person at all. “Please enter and be seated Mr Stevenson,” the Bot ordered, its eyes unblinking. Marty obliged, carefully perching on the edge of the bed. “What is your purpose for visiting today?” “Well uh…I’m here for my test results. Had my bloods taken last week. I meant to come in earlier but my ankles started acting up again. They’ve been quite swollen lately. I’ve also been getting these terrible headaches that always seem to come on at the worst of times. Especially when I’m feeling a bit miserable…which happens to be quite often nowadays.” The Bot stared. It sifted through Marty’s complaints, extracting the information it required. “Your primary purpose for seeking this consultation is to receive blood test results. Is that correct?” the Bot asked, tilting its head to one side ever so slightly. Marty felt a shiver run down his spine. He’d never be able to adjust to these small idiosyncrasies. The Bot had been programmed in a number of ways, to appear more human. Ironically, the subtle gesture reminded Marty that he was speaking to a machine, for its eyes remained wide open throughout. He wondered silently, why no one had programmed the Bot to blink. “Is that correct?” it repeated. “Uh, well yes, I suppose so.” “Please wait while I access your records.” The old man waited quietly, studying the machine that sat before him. The Bot stared off into the distance, its gears whirring as it processed Marty’s records.
Its pale porcelain face had been sculpted to resemble a young woman of about thirty years. Brown eyes, a petite nose and a thin mouth decorated unblemished skin moulded from metal and plastic. It was a stark contrast to Marty’s own weathered appearance. After a moment more, the Bot spoke. “Your blood test results have been received and analysed. Of interest were the abnormally elevated blood creatinine levels. In combination with the proteinuria found in the urine sample provided on the 19th of July 2096, your results are suggestive of kidney damage.” Marty’s mouth went dry. "Wh-what does this all mean? Is it dangerous? A-am I sick?” Marty stammered, his heart pounding in his chest. The Bot’s gaze narrowed, fixating on the old man’s face. It smiled. “Further examination is required before conclusive answers can be provided.” Suddenly, Marty’s eyes filled with tears. “I’m sorry,” he apologised reflexively, dabbing his eyes with an old handkerchief. “I don’t know why I’m getting so emotional. Things have just been so hard lately. Kira moved overseas and John barely calls. All I do is stay inside all day. Sometimes I don’t have a reason to even get out of bed in the morning. And now this? Another medical problem? I just…” he whispered in despair. The Bot stared. Fortunately, it had been programmed to handle such a situation. Slowly it edged forwards, towards the old man. Its hand reached out, snaking its way towards Marty’s bent back. “There, there, I know this must be very difficult for you,” it stated, skilfully patting the old man’s back in a predetermined rhythm. Marty’s hairs stood on edge. It was all he could do to stop himself from recoiling. The Bot’s bloodless hand lacked warmth – instead it felt as if someone had placed an ice-cold shard of steel against his skin. The Bot, however, didn’t appear to notice Marty’s revulsion. Its expression remained fixed in a pleasant smile, as it attempted to soothe the old man. But Marty felt far from soothed. This Bot didn’t understand him. It could never truly understand him and through no fault of its own. Suddenly, Marty missed Dr Baker. He missed the genuine kindness in Dr. Baker’s smile and how his forehead would wrinkle with concern as he listened. He missed the comforting smell of eucalyptus and tea tree that always dwelled in his office. Most of all, he missed knowing that someone truly cared. But that was all gone now. Dr Baker had been replaced. By a machine. Cheaper and more efficient they had called it. The old man’s heart grew heavier. He desperately wanted to see a familiar face. He desperately wanted someone to tell him that everything was going to be ok. But no familiar face came. He sat there in silence and let the Bot console him.
Blowin' in the Wind Anonymous
How many ears must one man have before he can hear people cry? How many deaths will it take til he knows that too many people have died? Blowin’ in the Wind - Bob Dylan There will come a day, I like to think, when collectively we can believe that we are all brothers and sisters are equally deserving of a good life. A day in which we can see through our racist and chauvinistic conditionings and embrace with open arms the importance of equality. But what is the path of most allowance that will lead to a true revolution? I like to think that the revolution lies within love.
I Don't Sleep Toby Redler Despite increasing global awareness, doctors continually avoid, or are required to sacrifice, sleep. The demanding lifestyle that encourages this pattern begins well before people enter the medical profession, before becoming habitual, expected, and consequently, utterly dangerous. This single practice has shown to cause detrimental effects, not only to the person, but to those around them, and those for whom they care. Although it is unlikely to change in the near future, the benefits of improving sleep must be recognised by the healthcare community and the wider population, as a step towards correcting the current culture. The physiology of sleep is becoming fairly well-understood. Without accounting for genetic variance, most adults require 8 hours of sleep per night (Howard, 2005). Due to the circadian rhythm, increases in fatigue occurs between 2-6am and 2-6pm, with the degree of fatiguability dependent on the quality and quantity of the previous nights’ sleep (Howard, 2005). Sleep loss has been shown to impact on a number of key performance indicators, including: cognitive speed; problem-solving ability; memory; and, motivation (Howard, 2005). An issue with listing outcomes such as these, is they are difficult to self-assess. Many medical students and practitioners may believe that their performance has not been altered, as their ability to detect any alteration is also blunted. So to put it in terms that most people can relate to: just 2 hours of lost sleep is equivalent to performing with a BAC of 0.045% and 4 hours; a BAC of 0.095% (Howard, 2005).
It is widely thought that this habit of neglecting sleep is developed throughout the medical career due to a prioritisation of work over the essential activity. However, it is most probably founded throughout undergraduate degrees and the medical degree itself. The pressure on aspiring medical students to achieve is so great that sleep becomes yet another barrier to their goals. An obstacle preventing the absorption and retention of knowledge. But considering the effect of sleep on key performance indicators, it is not an obstacle, but an essential tool. Howard (2005) suggests that medical practitioners believe they can alter their needs for sleep through the use of motivation. Whilst motivation assists in avoiding sleep, it does not change the underlying physiology. In fact, “brief moments of sleep may intrude into wakefulness,” such that physicians may inadvertently be sleeping “during patient care” (Howard, 2005). Considering close to 50% of doctors report inadequate sleep, this is an alarming number of physicians that may be experiencing micro-sleeps during practice (Howard, 2005). There are a number of reasons that medical students do not receive sufficient sleep. Time is a major contributor, with hefty study loads and lifestyle commitments (Azad et al., 2015). Furthermore, medical students’ knowledge of sleep physiology and sleep disorders is often lacking, leading to an ignorance of its importance (Azad et al., 2015).
However, there are some specific factors that suggest that sleep deprivation may not be deliberate. “Hyperarousal of the autonomic nervous system and hypothalamic-pituitary adrenal axis overactivation,” is a common factor that can result from stress relating to exams, assignments, or a myriad of other influences (Azad et al., 2015). Another related factor that warrants some thought is “presleep cognitions,” including study, planning, and over-analysing, which were found to positively correlate with insomnia (Azad et al., 2015). Perhaps most interesting, however, is the effect of “screen time”. Evening exposure to short-wavelength light (SWL) from computer screens reduces sleep quality by increasing time taken to fall asleep, reducing sleep time, and increasing nocturnal awakenings (Green et al., 2017). The compounding effects of these factors on medical students has profound effects on sleep duration.
Ok, so the fear of sub-optimal performance and memory might not be enough to convince you of the benefits of sleep. So how about some severe long-term consequences. Chronic conditions are more likely to develop, including IHD, hypertension, and diabetes (Azad et al., 2015). Essential hormones, such as testosterone are suppressed (Kilburn, 2017). And now, for those of you who have the Hippocratic Oath printed onto the roof of your bedroom, and would consider it criminal to put your own wellbeing above those of your patients’, I invite you to consider the following. Aforementioned was the equivalence of sleep deprivation and BAC. Considering the safe BAC for medical practitioners is zero, sleep appears quite essential to maintaining registration.
Especially when you consider that events such as Chernobyl were correlated to sleep deprivation among workers, it appears obvious that your best patient care will probably occur by putting the book down and getting some much-needed shut-eye (Sermo, 2017). Finally, the ill-effects of sleep deprivation can lead to self-medication. And yes, this does occur amongst good-willed doctors who should know better. Azad et al. (2015) describe this as the “stimulant-sedation loop”; a method of maintaining mental acuity during the day and sleeping at night. A recent and, frankly, terrifying example of this was the arrest of a Gold Coast consultant for possession of ice, cannabis, ecstasy and magic mushrooms (Emery, 2019). Although an apparently extreme example, how far away are more clinicians and medical students from being stuck in this “stimulant-sedation loop”. Actions such as this put the general public, our patients, fellow staff, and ourselves in extreme danger. Although many of you may not be avoiding sleep, and may not even realise that you are sleep-deprived, I invite you to review your sleep hygiene and consider the inadvertent impact it may be having. To recap, what is the result of sleep deprivation? Medical errors. Poor patient outcomes. Poor personal health. Poor mental wellbeing. Poor personal health outcomes. Poor memory. Poor performance. So, remind me, how is sacrificing sleep really for the “greater good”? References Azad, M., Fraser, K., Rumana, N., Abdullah, A., Shahana, N., Hanly, P., & Turin, T. (2015). Sleep disturbances among medical students: A global perspective. The Journal of Clinical Sleep Medicine, 11(1), 69-74. doi:10.5664/jcsm.4370 Emery, L. (2019, December). Obstetrician caught with ice to resume work. Chinchilla News. Retrieved from https://www.chinchillanews.com.au/news/obstetrician-caught-with-ice-to-resume-work/3896065/ Green, A., Cohen-Zion, M., Haim, A., & Dagan, Y. (2017). Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities. Chronobiology International, 34(7), 855-865. doi:10.1080/07420528.2017.1324878 Howard, S. (2005). Sleep deprivation and physician performance: Why should I care?. BUMC Proceedings, 18(2), 108-12. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16200156/ Kilburn, M. (2017). What does sleep deprivation do to your hormones?. Avogel. Retreived from https://www.avogel.co.uk/health/sleep/what-does-sleep-deprivation-do-to-your-hormones/ Sermo. (2017). Sleep vs. schedule: Doctors face challenges in getting enough sleep. Sermo. Retrieved from https://www.sermo.com/sleep-vs-schedule-doctors-face-challenges-getting-enoughsleep/#:~:text=45%20percent%20of%20doctors%2C%20however,than%20five%20hours%20per%20night.
THE GUMS PUZZLER 1 2
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DOWN: 1. Hormone responsible for milk production 3. _____ sickness is a type III hypersensitivity 4. Quinolones inhibit bacterial DNA synthesis by blocking _____________ IV and DNA gyrase 8. Damage to the long thoracic nerve can cause scapular _______ 10. Bacterial growth occurs via ______ fission 12. Varicoceles are more likely to occur on the ____ side
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ACROSS: 2. Band-like muscle running from the anterior superior iliac spine to the medial side of the proximal tibia 5. Title of Taylor Swift’s new album 6. A branch of the facial nerve (hint: it innervates frontalis, orbicularis oculi and corrugator supercilii) 7. Age-related hearing loss 9. Damage to the axillary nerve leads to anaesthesia over the lower part of skin overlying the _______ 11. Junction of the cornea and sclera 13. The _______ chart is used to measure visual acuity 14. TB often spreads to the _____ lobes since oxygenation is greatest there
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Send your answers to yashaswini.makkoth@griffithuni.edu.au and be in to win a 4-month Osmosis Prime Membership!
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CREATE AS MANY WORDS AS YOU CAN USING THE LETTERS IN THE WHEEL Each word must contain the centre letter and at least three others. Each letter can only be used once. You cannot use plurals, proper nouns or foreign words. One of the words is a famous song title (hint: think Kelly Clarkson). Complete the table below and submit your answers!
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CLINICAL QUESTIONS
Identify this rhythm (from ABG ninja) Rate: 60-150 Regularity: Usually regular P Waves: Sawtooth-shaped PRI: Multiple P waves before each QRS: 0.08-0.12 A) Sinus Bradycardia B) 2nd Degree AV Block C) Type I Atrial Flutter D) Normal
What is the most common type of thyroid carcinoma? (from Geeky Medics, Dale Jobson) A) Follicular carcinoma B) Papillary carcinoma C) Medullary carcinoma D) Anaplastic carcinoma
Analyse the following ABG (from ABG ninja) pH: 7.53 PaCO2: 30 mmHg [HCO3-]: 24 mEq/L A) Uncompensated respiratory alkalosis B) Partially compensated respiratory alkalosis C) Fully compensated respiratory alkalosis D) Partially compensated metabolic alkalosis What are the key lab features in osteomalacia (from Geeky Medics, Dr Petal Elder) A) Normal serum calcium, normal serum phosphate, normal PTH, normal alkaline phosphatase (ALP) B) Increased serum calcium, decreased serum phosphate, increased PTH, increased ALP C) Decreased serum calcium, decreased serum phosphate, increased PTH, increased ALP D) Decreased serum calcium, increased serum phosphate, increased PTH, increased ALP
Designed by Vinuri Abeygunawardana
GUMS Publications and Design Team Vinuri Abeygunawardana, Varshini Chandrasekar, Ashraf Docrat, Toby Redler Chief Editor: Yashaswini Makkoth Chief Designer: Maheen Khan Shahid
