SYNAPSE ISSUE 2
FROM THE PRESIDENT Welcome to our second edition of Synapse! We have plenty to tell you about since we brought you our first issue. First and foremost I would like to extend a big welcome to our new cohort of 2013! We are delighted to have you join us here at Bond and look forward to the next few years we will spend with each other. We all came to meet many of the first years during our Initiation Day, which we have more on later in this issue. What was initially a wet and gloomy day became exciting and jam-packed with plenty of interesting activities including an obstacle course, gladiator ring and mechanical surfboard! We definitely did not let the weather get us down as we enjoyed the afternoon and were treated to a wonderful dinner to cap off the night. Soon after the rest of the years welcomed the first years at MSSBU’s traditional MedEagle night at Hotel CBD. We had well over 150 medical students who came down to bust a move, possibly make a little love but mainly just to mingle and get acquainted with the rest of the medical students at Bond. Most recently, your MSSBU played host to the inaugural All Abilities Olympics, which welcomed young adults with disabilities from the local Gold Coast Community. It was a beautiful day outside on the new Bond Oval, which allowed us to serve up some food, fun-filled activities and smiles all around. All in all, the AMSA dream team of Andrew Robinson and Tabrez Sheriff did an absolutely amazing job in putting it all together and starting what was the first of hopefully many more All Abilities Olympics to come! I am also proud to announce a new collaboration with the HMSA, the very first Med and Health Week! This week promises to be filled with good times for the entire HSM faculty including a BBQ brunch, our traditional Med vs Health Touch Game, an inter-faculty Soccer Game and capped off with the HMSA’s award-winning Physical. Last, but certainly not least, we have the AMSA Convention coming to the Gold Coast this year!!! It is a week long convention filled with informative and exciting seminars and activities during the day, and night time events you definitely do not want to miss out on! One of these nights is the Kapow! Event on Friday, 12 July. Kapow! takes place at Movieworld and promises to be a night that you won’t forget. Tickets are selling out fast, so get onto your AMSA reps ASAP! That’s all for now, but keep your eyes peeled to our website (www.mssbu.org) and our Facebook page (www.facebook.com/TheMSSBU) for all the latest and greatest from your Medsoc!
Farhaan Patel President MSSBU
CONTENTS PRESIDENT’S WELCOME 1 Farhaan’s welcome message for our lastest issue of ‘Synapse’! ........................................ MEDSOC EVENTS 3 Take a look and see what your MedSoc has been up to lately. ........................................ ‘MY TEACHER’ 5 Yin Lin of third year submits her short story about dissection week, and it’s a sdfsdfsdf wonderful read! ........................................ GPSN REPORT 7 Our GPSN rep Joon Sung keeps us posted on what GPSN have been up to lately. ........................................ ALL ABILITIES OLYMPICS 9 Tabrez Sheriff takes us through one of the most exciting events all semester! ........................................ STUDENT PROFILE 11 We take a closer look at Hayleigh Chiang’s journey into medicine! ........................................ POST-GRAD TRIVIA NIGHT 12 Janice reports on the great night our postgrads shared together flexing their minds ........................................ ALLTRIALS CAMPAIGN 13 Jack O’Sullvian takes a closer look at how publication bias is truly skewing EBM, and what you can do to help. ........................................ ES MEYERS MEMORIAL LECTURE 15 ........................................ GRAND ROUNDS 16
Edited and designed by: Aninda Antar & Bianca Rajapakse
Today, I am going to open a corpse. I’m eighteen and in my first year of university. Apprehension jars my every movement as I approach the white sheet stretched tight over a humanoid form. I stare, try to imagine, try to prepare myself. But like a cold shower, no preparation is enough. This could be my grandfather, my grandmother, my uncle. An aunt. But it’s not. “Be respectful,” my lecturer raises his hands, palms upwards. A hybrid of an invitation and a call for peace. He smiles, “this person has lived, laughed, loved, and been loved in return. And died.” His last word is spoken almost with awe.
I glance up at the clock hanging on the white white wall: ten minutes past. After this, piano lessons. Piano lessons? My cheeks burn: focus! But my fingers dance a scale up my thighs. The clock stares me down, expressionless. Whenever you’re ready. As if you can ever be ready. Heart beating hard against ribs, I fold the white sheet firmly down. The sour smell of formalin springs up and fills my nostrils. My throat constricts, my lungs protest, but I make myself stare at him. He looks peaceful. There are wrinkles on his forehead, wisps of hair combed against his scalp. His nose is slightly flared, as if he’s going to breathe with me in the next rising of my chest. This isn’t my grandfather. But it is someone else’s. I have to force myself to breathe, and listen to time passing in clicks like a metronome. It’s funny though: only when death is so near that you become crazily aware of time leaking past you. With all the technology and medicine in this age and time, death is still something we can’t measure, explain or understand. Blood pulses through my veins, pumped from my heart. He has experienced this too. He has lived as well. As instructed, my colleague folds the sheet a little lower. My fingers tighten around the scalpel. Shining, cold, and sharp. But it is my colleague who makes the first incision. Dizziness takes me. I have to look away. The clock: it ticks, it tocks. Tick, tock. When I play the piano and sometimes it’s just wrong and I can’t get Mozart right: I’d just sit there, listening to the beat of a metronome. Tick. I wipe my sweaty palms against my trousers and my hands inch forwards, breath by shallow breath. I’m scared. But this man must have been scared too, when he made the choice to donate his body to the medical school. His family and friends would have been scared, too. Was his family happy that his wishes were respected? Or was there dispute around it, words bombing at one another, the family not ready to let him go. But we can’t harness the sun, and we can’t stop death. On the other side of the room, a group squeals, someone giggles. Our lecturer slides over, calm. “Cassie, where is your respect?”
T E A C H E R
T E A C H E R
The student is mortified, and I feel her angst. We want to learn, excel, memorise drugs and disease, symptoms and statistics. But to do the best we can is to remember that we treat people, not disease. To respect this body I need to think of him as a person. The evidence is all around us, if we focus beyond the peeling flap of skin. The stitches on m’ knee lil’ girl? I was showing off m’ motorbike with m’ mates and it got outta control. I stretch on my gloves. I’ll know this person’s most intimate secrets, know him inside out, know him better than his lover. Better than his doctor. That scar down m’ chin – ah, that’s when I was barely knee-high. Tried to finish a race first, tripped and landed wrongly. The burn marks on m’ wrist – that’s cooking for the first time to impress a lover! And you see m’ writer’s bump? There’s a law degree. But to know him as person, and then cut him. Such a condradiction of actions: to love, and to hurt. The more I know about him, the more I don’t dare touch him. But cut I must. Running a gloved finger over his skin, his scars, him… The simplicity of the clicks of the clock prompts me to relax, to think of that solely, and then, when my mind fills with the ticks and tocks, then, I try again. Hey, girl, learn from me. That’s what I’m here for. The clock salutes its agreement with a hand. Black hands against a white face. Nothing is so black and white in real life though. This is what it is to be a doctor. To hurt in full knowledge of the person you are hurting, to let that rip at your soul and not harden yourself to it. I wipe my sweaty palms against my plastic apron. Only to realise the sweat is harboured inside the plastic gloves. The clock ticks. Ticks again. My fingers close around the cold smooth handle of the scalpel; I feel its dead weight in my hand. I have felt the velvet of deer lungs before, and the bursting ripe tomato feel of a rabbit’s heart. In the weeks to come, I will slide a finger down a tibia, see how bones are glued by tendons and muscles. I will feel the weight of a human heart in my palms, know how the inner organs of man lock into one another in an intricate puzzle. We’ve leant off textbooks and digital images, but to actually touch something, someone real, is our first step out from the world of books. It is only when we see – and feel, and hear – what normal is in a body that we will understand what is going wrong in our patients. That is the gift of a body donor. One body donor will teach many dozens of doctors, dentists, physiotherapists. These dozens of people will go out and help hundreds. Not only their pain, but the pain of their family: their children, their mothers, their friends. Indirectly, one body donor has changed the lives of thousands. No matter the petty indiscretions in the course of their lives, the fights, the crimes, the betrayals, they’ve given their last gift to man kind. One can be selfless in their death. I glance at the clock again. Mozart will understand: the man before me will tell him Hey, your piano student, the one who’s learnt all your music and more – she’s my student, too. Piano can wait. My life can wait. And for now… I’m eighteen, and in my first year of university. Today, I am going to learn from my teacher.
GPSN Bond had a flying start to 2013 with the O week signups + Icebreaker sessions for our new first year medical students. It was great to see so many bright and enthusiastic faces as they embarked on their medical journeys, and a nostalgic feeling as I myself was there exactly one year ago soaking up my life as a medical student and the abundant array of freebies which lay before me. To recap some of GPSN Bond’s events and highlights of 2013 so far;
BNL 2013 conference- Parliament House, Canberra Back in March we were fortunate enough to represent our faculty in the GPSN/GPRA “Breathing new life (BNL) 2013” conference in Parliament House, Canberra. The 3 day conference which ran from the 18th-20th of March 2013 was truly an inspiring and unforgettable experience for myself and Clinton Colaco who was selected to accompany me to the conference. The theme of BNL 2013 was “GP workforce 2025”, the conference provided opportunities for medical students, current GP’s and politicians to voice their concerns/issues and find solutions and initiatives which will pave the way for the GP’s of the future to improve the quality of life for our communities. The conference was attended by the power house of General practice which included Professor John Murtagh, Professor Michael Kidd and keynote addresses by the Honorable Tanya Plibersek (Minister of Health) and Peter Dutton (Shadow Minister for Health and Ageing). We were also very privileged to watch Dr. Aleeta Fejo receive the inaugural Wakapi Anyiku Doctor Oomparani (Aboriginal Doctor for Everybody) Award in recognition of her passionate advocacy for Aboriginal health and her work in assisting Indigenous registrars.
BOND UNIVERSITY REPORT 7
Account from Clinton Colaco of BNL 2013 The GPSN conference itself was split across three days with the second day being a joint venture with GPRA entitled ‘Breathing New Life into General Practice’ that was held in The Great Hall of Parliament House. Executive members from each of the 21 GPSN clubs across Australia came together to discuss the functioning of their clubs, difficulties and successes, and ways of improving GPSN and the future of General Practice. We were given a unique opportunity to talk to GP registrars from across Australia and hear from them about their path. I was particularly fortunate to have met an old family friend of mine who originally finished her medical degree in NSW before moving to Victoria as part of her training. Who knew we would meet in Canberra! Come 6pm, the GPSN exec made sure we hit Canberra city on Tuesday to dine in style at one of the local popular establishments. On the Monday, we were fortunate enough to visit the Australian War Memorial and have our cocktail event there. Inaugural GPSN Bond Firstwave Scholarship information session 2013 The inaugural event was held on Tuesday the 4th of June, 2013 for first and second year medical students. The aim of the event was to create awareness of the successful GPSN Firstwave scholarship and provide additional information and past experiences from last year’s scholarship recipients. The information session was a huge success due to all the students who participated (even though some came just for the pizza :P). I would like to thank the last year’s scholarship holders; Frank Dorrian, Piyumi Balasooriya and Srisuvira Nathan for sharing their experiences with the students. And finally my team for their support in making the event happen; Peter Chan, Jaffar Hosain, Terence Sue, Terry Cheng, Kartik Vasan & Brian Ng. UPCOMING EVENTS
Inaugural GPSN + BUSHFIRE Clinical event 2013 feat. Professor John Murtagh I am pleased to announce our major GPSN Bond event in collaboration with BUSHFIRE (our rural health club), which will feature Professor John Murtagh on Saturday the 6th of July, 2013 at Bond University School of Medicine. This special event will also involve clinical sessions organized by BUSHFIRE and drawing of the long anticipated Xbox 360! So far it has been a very exciting year for GPSN Bond and a real privilege to serve as the GPSN Ambassador for Bond University. I would like to thank all the students for their interest and support and please do not hesitate to contact me for any GPSN related questions. Thank you Joon Sung GPSN Ambassador Bond University
BACHELOR OF SPEECH PATHOLOGY
What was your journey to medicine like? It was not until I had my first 6 week block placement for speech pathology at Logan Hospital that I realized I really wanted to learn more and study medicine. After I finished that placement I put my energies into studying for GAMSAT and trying to get into medicine. It took me a few years. I ended up working as a speechie at the Prince Charles Hospital in Brisbane for a year and a half and I had to complete a bridging Chemistry course to try for Bond. Finally Bond accepted me and I still can’t believe it! How do you balance studying with other commitments like working? I work casually as a speech pathologist. I basically work in nursing homes and see a few private patients who have suffered strokes. I am so lucky to have found a job that I can fit in around my timetable. My boss is very flexible and I can work as much or as little as I like. This allows me to put my studies first. Who inspires you? My father is a big inspiration for me. He started from very humble beginnings and he has worked so hard as a physiotherapist to get where he is today. He has taught me if you work hard are determined you will be successful and reach your goals. What did you want to be when you were little? I wanted to be a fashion designer. I can’t sew to save myself so I don’t think I will ever achieve that dream! What’s the most embarrassing album you’ve ever owned and do you still have it? I have a cassette tape of Britney Spears’ first album and it is currently in my old car. I still play it from time to time! Life motto? “The future belongs to those who believe in the beauty of their dreams” – Eleanor Roosevelt. This got me through all the knock backs when I was trying to get into med.
Annually, 55,000 Australians suffer heart attacks(1). Of these, only 10,000
will be fatal(1). Why do 45,000 Australians survive their heart attack annually? Why has the number of Australians dying from heart attacks every year decreased by 32% since 2000(1)? Rigorous and systematic appraisal of what works and what doesn’t. Evidence Based Medicine has allowed Australian Doctors to fine tune prevention and treatment techniques. Improved intervention has directly elongated the lives of mothers, sons, daughters and grandparents. Although the applied principle of Evidence Based Medicine has undoubtedly improved the quality of care across all fields of medicine, currently, its potential is sadly restricted. It is estimated that half of all clinical trials conducted have never been published(2). Without publication, the vital information attained in these trials is unknown, shielded from the eyes of doctors, governments and patients. As a direct consequence of this publication bias, lives have been unnecessarily lost. Lorcainide is an anti-arrhythmic drug that attempted to gain commercial approval for post-myocardial infarction (MI) arrhythmias in the 1980’s. During the early stages of the approval process, a trial was conducted to assess its effectiveness. This trial showed an increased risk of death associated with the use of Lorcainide and consequently, the drug was withdrawn appropriately(3). Although Lorcainide was correctly banned from use in post-MI arrhythmia prevention, the trial proving this, was never published. Over the following decade, many drugs gained commercial approval (for the same indication) with a similar chemical structure to Lorcainide. Some of these medications carried the same inflated risk of death and resulted in an estimated 100,000 premature deaths in America alone(4). As frightening as the above example is, numerous other cases of publication bias causing unnecessary death exist. Rofecoxib was approved in 1999 for the treatment of osteoarthritis, pain and dysmenorrhea. Tragically, over the following years, it became apparent that Rofecoxib increased patients’ risk of cardiovascular adverse events, specifically stroke and heart attack(5). The drug was eventually withdrawn in 2004 and after much scrutiny, Merck & Co. – the drug’s manufacturer, admitted to withholding evidence that Rofecoxib increased risk of cardiovascular complications. Merck &
Co. suppressed results of clinical trials that demonstrated the devastating side effects of Rofecoxib. Rofecoxib was removed from the market, but only after 80 million patients had taken the drug, Merck had pocketed $2.5 billion annually and tens, if not hundreds, of thousands of lives were unnecessarily lost(5). The AllTrials campaign is an online petition and initiative of the British Medical Journal, Sense About Science, James Lind initiative and the Centre for Evidence-based Medicine (University of Oxford) demanding that all clinical trials be published. With publication, information attained will be available to doctors, academics and governing bodies to make appropriate, evidence based decisions. Currently, the petition has more than 55,000 signatures and attracted public signature and endorsement from prominent health organisations around the world. As a future practitioner concerned about my future patients, I signed the petition. WWW.ALLTRIALS.NET
1. Australia NHFo. Heart Attack Facts: National Heart Foundation of Australia. Available from: http://www.heartattackfacts.org.au/heart-attack-facts/. 2. Song F, Parekh S, Hooper L, Loke YK, Ryder J, Sutton AJ, et al. Dissemination and publication of research findings: an updated review of related biases. Health technology assessment (Winchester, England). 2010 Feb;14(8):iii, ix-xi, 1-193. PubMed PMID: 20181324. Epub 2010/02/26. eng. 3. Cowley AJ, Skene A, Stainer K, Hampton JR. The effect of lorcainide on arrhythmias and survival in patients with acute myocardial infarction: an example of publication bias. International journal of cardiology. 1993 Jul 1;40(2):161-6. PubMed PMID: 8349379. Epub 1993/07/01. eng. 4. Goldacre B. What Doctors donâ€™t they prescribe. In: TedTalks, editor.
know about the TedMed: TedTalks;
5. Topol EJ. Failing the public health--rofecoxib, Merck, and the FDA. The New England journal of medicine. 2004 Oct 21;351(17):1707-9. PubMed PMID: 15470193. Epub 2004/10/08. eng.
Errol Solomon Meyers MEMORIAL LECTURE
The ES Meyers Memorial Lecture comprises a forum for a person of distinction to present a perspective of endeavour and achievement. The Lecture was begun in 1957 in honour of Professor Errol Solomon Meyers, one of the most significant founders of the Medical School in Queensland, and his contributions to medicine. We are delighted to announce that this year’s Lecture will be delivered by Dr Nicholas Coatsworth. Dr Coatsworth is a Past President and current Director of Médecins Sans Frontières Australia, and is the Deputy Director of Disaster Preparedness and Response at the National Critical Care and Trauma Response Centre in Darwin. We trust that you will join us on this occasion for an enlightening Lecture from a truly inspiring individual.
GRAND ROUNDS Number Two: High Grade
A 55 year old male presents with progressively worsening swelling of his left lower limb, which has been there for the past three days. He is running a high fever, and appears to be confused. A collateral history from the wife reveals a loss of appetite in the patients from onset of symptoms. “This is the fifth time this has happened in the last two years, but it’s never been this bad”, she mentions.
Left leg swollen, tender, and erythematous. L/S inguinal lymphadenopathy Lung fields clear Patient confused and febrile 120 bpm pulse 90/60 mmHg BP RR 22/min
Returns as 465 mg/dL (25.8 mmol/L)
WBC/DC: 25, 000 Neutrophils 95% Lymphocytes 4% Hb 14.1 g/dL PCV 43% Platelets 210, 000
............................................... RENAL FUNCTION ABG Blood urea 59 mg/dL (high) Serum creatinine: 154 mmol/L (high)
pO2: 95 mmHg pCO2: 35 mmHg saO2: 97% pH: 7.35 HCO3: 35 mmol/L
From the options below, select what your ideal course of management would be, providing reasons: - Antibiotics - Insulin - DVT prophylaxis - IV fluids
Discussion of answer to be published next issue.
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