The Auricle 2022 - Edition 5

THE AURICLE Volume 5 Edition 5

October - December 2022

IN THIS EDITION...

Editors' Letter ............................................................................................................ 1 RESULTS: The Auricle x MIPS Creative Writing and Visual Art Competition ..... 2 Creative Writing Honourble Mentions: "The Caretaker" by William Upjohn ................................................................... 3 "Quieter Now" by Zoe Weimar ............................................................................ 8 "Expiration Date" by Laura Smith ....................................................................... 9 MED PALS: A Comic Series ..................................................................................... 12 Visual Art Honourable Mentions: "Metamorphosis: a neurological perspective" by Fathima Ijaza Irzan .............. 14 "Tides of Change" by Christopher Photopoulos ............................................... 16 Community & Wellbeing: To New Beginnings by Laura Gilbertson .................... 18 Community & Wellbeing: Good Enough by Charlie Ho ....................................... 19 The Doctor I Aspire To Be by Jarrett Lee ............................................................... 21 Spotlight: High Altitude Medicine by Lachlan Coman ......................................... 22

EDITORS' LETTER Dear readers, 2022 has come to an end! As this edition is published in the last days of December, we want to extend a huge thank-you to you for your continued support of The Auricle.

This is our fifth and final edition of 2022. During our time as Publications Officers, it has been our aim to edit, produce, and share with the Monash medicine community a magazine of the highest quality. We approached this task with high expectations - chiefly that we would be able to showcase the largest range of creativity from our peers in this magazine's history. Hopefully we have met that expectation.

Lachlan Coman is currently completing a Master of Public Health.

Throughout 2022, the support from our readers has been phenomenal. It has been wonderful to be able to see how many people have engaged with this publication. So, thank-you for sticking with us through five editions. We sincerely hope you have enjoyed reading.

Our final edition features the Honourable Mentions from our Creative Writing and Visual Art Competition. It was an impossible task judging this competition, and the work featured here is truly phenomenal.

We're sure you'll agree. We also present an impressively entertaining series of medical comics. There's also a new Spotlight piece on high altitude medicine. Finally, you'll be able to see the final instalments from our friends at Community and Wellbeing, who have shared with us some moving, powerful, and humorous pieces throughout the year.

Jordi Shahab is undertaking a BMedSc(Hons) year.

Thank-you once again for reading. Enjoy!

Lachlan Coman and Jordi Shahab

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The Auricle x MIPS Creative Writing & Visual Art Competition 2022

RESULTS CREATIVE WRITING 1st Place: Natalie Evans, "Stardust" 2nd Place: Khue Le, "I am Everyone" 3rd Place: Tessa Quinlan, "Never Let Them Fall" Honourable Mentions: William Upjohn, "The Caretaker" Zoe Weimar, "Quieter Now" Laura Smith, "Expiration Date"

VISUAL ART 1st Place: Anna Noe, "Reflection" 2nd Place: Charlotte Raberger, "Retro Funk" 3rd Place: Lois Segun-Beloved, "Empty Celebration" Honourable Mentions: Fathima Ijaza Irzan, "Metamorphosis: a neurological perspective" Christopher Photopoulos, "Tides of Change"

HONOURABLE MENTION, Creative Writing "The Caretaker" by William Upjohn Caretaker's Log: 02/08/54,675 C.E (Estimated Earth Date)

This is likely to be my final statement. I have not made many other entries to this log, a decision that I now regret. I am not sure who, if anyone, will read this. I seek only to explain what happened on my satellite, and to enlighten those who would otherwise not understand what lead me to undertake what I did. I do not seek forgiveness, because I know I have not done anything wrong. This is not a confession.

I am not sure how long until my satellite will be found, or by whom. In case this part of our history is forgotten by those who discover it, I shall provide a brief amount of context. In the year 54,345 C.E, our sun began expanding at a rate far, far greater rate than our scientists had anticipated. This gave us around 50 years to escape our planet and retreat to a safer distance, before life on earth became unviable. The decision was made to place as much of the population as possible into a hibernation-like stasis or “cryo-sleep”, and put them safely on millions of satellites in orbit, far away from the now malignant sun. Most, including mine, were placed in orbit at a distance similar to that of the former planet Pluto. The plan was for other, exploratory spacecraft to search deep space for a new planet with conditions favourable for colonisation. Once this new planet was found, the cryo-sleep satellites would be brought over and reawakened.

Using almost light-speed travel, the estimated time for this mission was between 60 and 80 Earth years. This timeframe has come and went, without transmission or signal from any of the thousands of exploratory craft. It seems overwhelmingly likely that all missions have ended in failure.

My satellite is one of the smaller models placed into orbit. It initially housed 100 individuals in cryo-sleep. It is almost entirely run algorithmically by AI; however, the decision was made to include a single human overseer to ensure the smooth running of all the ship’s functions. This overseer, or “caretaker” as we came to be colloquially known before launch,

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could override any direction from the ship’s AI, to prevent computer glitches or malfunctions from jeopardising the survival of the satellites’ occupants.

Being a healthy young male with a favourable genetic profile, I was chosen to be the caretaker of my vessel, a position I was honoured to accept. While the position was demanding, and the prospect of decades of isolation not very attractive, I was assured that personalised neurotropic medications would be administered to ensure my mental wellness was preserved. The fact that I was unlikely to secure a position on a satellite otherwise, and be left on the soon-to-be uninhabitable Earth also contributed greatly to my decision to accept.

The first few decades of orbit were largely unremarkable. I developed a routine of monitoring the sleeping passengers and certifying all vitals were in the desired range soon after waking. I then spent my time confirming our orbital path was optimal, supervising any maintenance activities, and generally ensuring that the satellites processes ran smoothly. In order to preserve power, communication with other satellites was completely ceased after the first year. As a result, I had no contact with other humans, only being able to communicate with the satellites’ AI. While this might have been emotionally detrimental to a normal person, the medications I took daily ensured that my mental state remained favourable.

Though the 24 hour cycle of days was now arbitrary, I kept to a pattern of 8 hours sleep followed by 16 hours of waking, trying to avoid the cognitive disturbances found in disrupting the normal circadian rhythm. I ate three times per day, and bathed regularly. The temperature of the satellite’s internal spaces, where I lived and worked day-to-day, was kept to around 14 degrees Celsius. This low temperature was maintained in order to slow metabolic activity and decrease the rate of aging. This meant I was permanently slightly cold – though this is a small price to pay for the supposed increase in longevity.

It wasn’t until my 35th year in orbit that the first complication occurred. During my annual health scan by the satellite’s medical AI, a sizeable adenocarcinoma was found in the hilum of my right lung. This most likely due to exposure to radon, an inert gas that can leak from small nuclear reactors such as the one powering my satellite. While I was not yet experiencing symptoms, it was still a threat to my wellbeing, and I elected to have it surgically removed. The satellite had multiple automated surgical robots, capable of 4 The Auricle October-December 2022

performing almost any surgical procedure at a standard far exceeding human surgeons.

Multiple passengers in cryo-sleep had already had procedures performed on them by the machines. They were not even awakened from their stasis – part of the contract for being placed into cryo-sleep involved consent to any procedure the ship’s medical AI deemed necessary.

The operation was a success, at least initially. The tumour was resected completely – however, 4 years later, I developed more tumours, this time spread throughout both lungs.

Breathing was becoming increasingly difficult, and I experienced haemoptysis on a daily basis. This presented a clear and present threat to my life, and subsequently to the functioning of my satellite, and to the lives of all those under my care. The only possible treatment was a lung transplant.

While my subsequent actions may appear unethical, it must be kept in mind that my death would certainly jeopardise the lives of all those on my satellite. I could not allow this to happen. It was a difficult decision to make, but ultimately, it is a decision that I stand behind.

I took no pleasure in making this choice, and to this day I find the whole process distasteful.

I detail my decision here not out of pride, but simply to allow future readers to understand what happened.

I elected to take the lungs of one of the passengers. It was a very grim choice to make, but I eventually settled on those of a 55-year-old man, whose name I will not mention out of respect for the dead. He was a healthy adult male who didn’t smoke, and the medical AI suggested that his organs made the most favourable match. This wasn’t truly necessary – the immunosuppressive medications I would take made virtually any donation viable, although matching did reduce the risk of complications. I cannot detail all the factors that went into my decision, but after 2 weeks of deliberation, accompanied by increasingly severe symptoms, I finally made the decision to go ahead with the procedure. I had to manually override the medical AI, but the surgery went off without issue. The donor was not brought out of cryostasis during the procedure. He did not suffer.

The new lungs were completely successful, and it was almost a full decade before I needed another organ donation. Perhaps due to my constant use of neurotrophic medications, my renal function had deteriorated to a dangerously low level. I required a transplant. Selecting

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a donor was far less ethically difficult this time, as transplanting a kidney would not result in the donor’s death. For the sake of brevity, I will not give the details of this donation, nor for any of the subsequent ones. Again the procedure went by without issue. The donor was in cryo-sleep for the entire surgery, and was successfully returned to her cryo-pod afterwards, without ever knowing such a procedure took place.

I will not give unnecessary detail about all the subsequent transplants. Initially, at least, I held out as long as possible without using any more organs. However, as the length of my mission extended longer and longer past the expected end point, the aging process resulted in the inevitable deterioration of my body. The successful running of the ship was paramount, and this success was dependent on my input. As such, any and all actions I undertook were necessary, and in my opinion ethically sound. While it appears increasingly likely that I will not have to explain my actions to any individual in my lifetime, I would like to emphasize that I stand by the decisions I made.

Over the almost 280 years that I have now been caretaker of this ship, I have had to extend my lifespan much, much further than would be natural. I have considered bringing a passenger out of cryo-sleep and training them to be a new caretaker, allowing me to finally give up my position, but this is not a viable alternative for many reasons. The most important one, in my opinion, is that the neurotropic medications, which allow me to function under enormous psychological strain, are personalised to my neurological profile. They would not be effective in any other individual. It seems overwhelmingly likely that another person in my situation, faced with the cold, claustrophobic, completely isolated conditions that I live in, would be made insane. I think of myself as something like a deep sea fish, one that inhabits unimaginable pressures without issue. Any normal organism, however, would be crushed.

In order to prolong my life, I have received new transplants of almost every viable organ in my body, as well as various tissues and vessels. I have been through 48 sets of lungs, 40 hearts, and 44 pancreases, as well as countless skin, marrow and vessel grafts, just to name a few. I am not wasteful – I do my best to maximise the number of organs I can use from every donor, and try my best to prolong the use of every organ that I receive. It is difficult, however; as my age increases, the amount of use I get from each transplant lessens. While my first new heart lasted me over 30 years, currently, a new heart will only last me four.

This has meant that I am requiring new donations more and more frequently, a situation that 6 The Auricle October-December 2022

is as regrettable as it is inevitable. It brings me great emotional pain to accept organs from those I am supposed to take care of, and were it not for my medications I likely would not be able to cope. These actions must be undertaken to fulfil my duty as caretaker.

I have all but given up hope of rescue – I have not received any transmission, from another satellite or any other craft, since the silence descended all those years ago. I have considered the possibility that my equipment is faulty, and all the other ships have been rescued while I remain here alone, unable to receive the signal. These idle speculations serve no purpose but to heighten my distress, so I avoid them as much as I can.

I imagine that my story is not unique, and that every other living caretaker has had to make the difficult decision that I have. My supplies are dwindling: I have only 20 more untouched donors to use, and my needs are increasing with every year. I do not know what I will do when I have run out, when my satellite has no more passengers and I am left truly alone, orbiting a dying star. According to my ship’s navigational system, we have almost finished our first complete orbit around the sun. I only wish my satellite had windows, that would let me look outside and see the stars. It has been far, far too long.

That concludes all that I wish to say. This is not a confession. <end of transcript>

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HONOURABLE MENTION, Creative Writing "Quieter Now" by Zoe Weimar It is much quieter now than before The room had filled, filled, filled And then drained. Closer night draws.

Though rustling blankets murmur amongst themselves, the air is still Swaddled warm and wearing a striped hat Something tiny and new sleeps In her arms, as we marvel at His newness, her strength. The teabag steeps Of course, there’s beauty in first breath, first touch Yet those less-remembered moments in-between; with kind words said And hands held tight and laughter shared, hold such Intangible softness. She shifts further up in bed The sound of my steps punctuates the room’s quiet, as I bring her the hot mug of tea To brew it is my privilege, however small or unskilled an act it might be

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HONOURABLE MENTION, Creative Writing "Expiration Date" by Laura Smith “Presented with bilateral pulmonary embolisms. CT scans came in this morning and showed stage 4 lung cancer. She’s probably got about 6 months to live. If she’s lucky.”

“A walking ad for Quitline.” Laughter from the team of respiratory clinicians.

“They should take her picture for the back of the box while she’s still alive.”

Medical students shadowed the doctors, lingering behind and doing their best not to get in the way. Struggling to find the situation humorous but not wanting to be impolite, Eloise halfheartedly attempted a smile.

Two years of textbooks and artificial clinical scenarios with paid actors hadn’t prepared them at all. Eloise thought of anatomy lessons, of the hours spent dissecting pungent corpses and appraising ‘specimens’- human body parts chopped up and laid out on tables. Confronting was barely the right word to use after everything they’d seen in their first week in the hospital.

When the ward rounds were over, one of the younger doctors approached the students and suggested they visit the patient in bed 32. “Take a medical history. Just ask her why she’s in here and make sure to have a listen to her lungs. Let me know what you find.”

Pacing the hallway just outside bed 32, Eloise wondered whether it was facetious to pry, poke and prod at a woman who had limited time left on earth and was faced with the task of accepting her own mortality. Her ward buddy grew anxious with her, twisting his stethoscope and inspecting it closely, as if to find moral guidance within its diaphragm.

“Can I help either of you?” Brash and unforgiving, the ward nurse peered down upon the two 3rd-year medical students, her overbearing presence immediately quashing their ethical doubts.

“We’ve been sent by the Resp team to have a chat with Mrs Greenwood, are we alright to head in?”

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Clearly unimpressed by their hesitance, the nurse let out an exasperated noise and nodded her head in the direction of bed 32.

Flowers drooped in the corner of the room, their presence gaudy and somehow melancholic against the harsh white hospital walls. A tiny television screen hanging from the roof was tuned into a reality show that Eloise’s mother would have described as ‘American trash’.

Mrs Greenwood’s attention barely shifted from the show as the students introduced themselves and obtained her consent for a medical interview and examination.

Her bedside table was littered with empty food containers and medications, and a pile of books and magazines. Eloise’s attention was drawn to one particular title- ‘Turning a new leaf; how to embrace a healthy lifestyle!’.

“If you don’t mind Mrs Greenwood, could we turn off your TV for a moment to ask you some questions?”

“It’s June, dear.” The patient gave Eloise a warm smile as she switched off the screen and indicated for the students to continue in their history taking.

“First of all, could you tell us why you’re in hospital at the moment?”

“Well I’m still asking myself that. I was fit as a fiddle a week ago when I started noticing a sharp pain in my chest.”

“And your husband called an ambulance, is that right?”

“Yes, my Dad died of a heart attack, so of course that was the first thing I thought of. Lucky it wasn’t that! I had a couple of scans and apparently I’ve got clots in both my lungs.”

“And did they notice anything else on the scans?”

June didn’t notice the tremble in Eloise’s voice and the way her eyebrows rose and furrowed in strained sympathy.

“Nope. I’m all good. I’m on tablets to thin out my blood and I’ll be back home tomorrow.

My husband’s coming in later today and we’re having a meeting with the doctors to plan my discharge.”

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Eloise’s teeth clamped down on her tongue, a metallic taste filling her mouth and drowning the tears she felt rising in the back of her throat. Her fate would be revealed later today, in what hospital staff referred to as a family meeting. Mr Greenwood would have already received a ‘warning shot’; a purposefully ominous phone call instructing him to come in to the hospital immediately to discuss his wife’s health. Maybe there’d be others too; siblings, children, even grandchildren. They would all suspect something was wrong. But June still had no idea.

June said the whole experience in hospital had caused her to have a ‘health enlightenment’.

Though distressed initially, she had managed to conjure optimism by committing to lifestyle changes she thought were probably long overdue.

“I’ll be quitting smoking, obviously. Don’t want anything else nasty turning up in my lungs.

But I’m also taking the opportunity to start exercising more and eat lots of fruit and veggies.”

Blurry photographs crudely cut out and blue-tacked to the wall were almost unbearable to look at when Eloise entered the room, but now she refused to avert her gaze. Anything to drown out the fleeting hope of a woman on her deathbed. She wasn’t here to read the chapters of a book she already knew the ending to.

In medical school, they’d been warned against medical paternalism; doctors being accused of playing God, of defying patient wishes, of intervening in the natural course of life. Right now, Eloise felt close to divine power as she forced back the words that would bring an end to June’s world. Neither of the students could bring themselves to touch her so they thanked her and took off without listening to her lungs.

An elderly man, perhaps in his late 60s, wandered down the corridor with a bunch of mismatched flowers, roots still attached from where they were yanked out of the garden.

Eloise thought she saw a glimmer at the base of his eyes as he turned and entered the room they’d just left.

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MED PALS A genius comic series brought to you by anonymous creator, Regina Phalange

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THE END

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HONOURABLE MENTION, Visual Art Fathima Ijaza Irzan, "Metamorphosis: a neurological perspective"

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HONOURABLE MENTION, Visual Art Christopher Photopoulos, "Tides of Change" Tides of Change [Aerial drone footage. VIC, Australia. 22.06.22] When we seemingly drown in our everyday life as we navigate this ocean of possibilities, sometimes all it takes is a walk on the beach to come up for air -- to breathe is to reflect, to stay grounded, to change.

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To New Beginnings

Writing by Laura Gilbertson, from Community and Wellbeing With the end of medical school fast approaching (for some of us at least), I thought I’d check in with some of the things I’m feeling as this phase of life comes to a close.

Change is incredibly scary. It’s certainly not easy saying goodbye. Goodbye to friends, to places, to teachers, to memories. Goodbye to being a student, the world of no responsibility and of clocking off at lunch time.

And yet at the same time there is the excitement of something fresh. The world of work. The possibility of new friends and new memories. That feeling you get when you hold the pager or make a referral (and only get yelled at a couple of times) – like, hey, maybe I can do this? In many ways I’m excited to no longer be a student, to finally feel like I have a place, and like I’m no longer a fly on the wall.

When I think back to the first day of medical school, I’m not entirely sure how we got here; how and when everything changed and came together. I think we all battle with imposter syndrome to some degree, especially in the early years. After feeling out of place for so long, it’s heartwarming to reflect on how much I’ve grown and how much I’ve learnt. I did make the right decision all those years ago.

I also appreciate that medicine is not everything. Finding happiness and meaning outside of work is important, especially as we approach a busy and emotionally demanding internship year. Take time to check-in with yourself and prioritise self-care; watch that movie, go to that restaurant, take up that new hobby.

Most of all, I hope you’ve learnt that you’re worth it, that you belong. You will make an incredible doctor. As long as you show up, try your best, and show genuine care for the people around you, the world truly awaits.

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Good Enough

Writing by Charlie Ho, from Community and Wellbeing Mediocrity, such a word reminded me of a bland taste, a lukewarm sensation, an apathetic aloofness. It had evoked in me dissatisfaction, disappointment, even disdain. After all, mediocrity must have resulted from a callousness, an insincerity, negligence of duty. Mediocrity means that I hadn't worked hard enough or done my best; it was glaring evidence of my mistakes, yet another blemish painted on the proof of what a failure I was. I sighed, then scoffed at myself thinking about the things I could have done differently, a wave of “what-if”s flooding my head. After all, a mediocre result isn't exactly going to get me anywhere. After all, my best was never good enough.

Who cares about my efforts when outcomes are all that matters? I released my breath I had been unconsciously holding. I took a final glance at the report in my hands and tucked it away into the depths of my bag, as it by removing from sight the document would lessen the pang of guilt I felt being branded as mediocre.

That pretty much sums up what used to be my train of thought every time I checked my score and feedback for any assessment.

I’m sure it is not an unfamiliar experience among us medical students, given the tendency of doctors being perfectionists. Yet, over time, I have come to peace with mediocrity and learnt to embrace and appreciate the feeling.

Born into the cut-throat culture of Hong Kong, I had been conditioned into viewing life as a race. The real pressure of getting a head start early on in the race was plain as day — parents filling up their children’s timetables with endless classes, extra curricular activities and competitions from the moment they speak their first word, devising a strategy for getting into a “Band 1” secondary school, camping overnight just to be first in queue for a chance of their kid getting in a prestigious kindergarten. Instilled in me was the doctrine that being mediocre was to be left behind, a loser deserving of none other but the worst. Mediocrity was simply not an option, god forbid even mention burning out — if I couldn’t handle a little stress, I must be weak-willed and unworthy of anything.

Of course, that sort of mentality only proved to be detrimental to be mental wellbeing and soon, other areas of my life started to be affected as well — my hobbies, sleep, physical health, relationships — it seemed as if my life had become undone by my own hands, the roots of despair digging deeper and deeper down my mind. All the self loathing begot worse performance which continued the vicious cycle and before long, I hit rock bottom.

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Fortunately, you being able to read this piece means that I have gotten better and here is something I wish I could have told myself about mediocrity earlier on.

First is arguably the hardest step. Accept mediocrity and the discomfort that comes with it. Be compassionate to yourself when you don’t meet your own standards. Getting muddled in your head about how terrible it is that you have done a mediocre job is going to be harmful at best and will definitely not help in any way whatsoever. Know that recognising the mediocrity is proof that you care about what you do and is the first step towards improving your craft. It is in fact possible to be your own critic while being kind to yourself.

Next is something easier said than done. Enjoy the process leading up to the end result. If what matters are only results, your motivations may not be the most sustainable and you might consider rethinking your reasons for doing that something, perhaps even consider taking a break and coming back to see if that something is what you truly want to do. Once you start enjoying the process, the end result typically tends to turn out better, while a mediocre result ends up not having that much of an impact on your overall wellbeing, overall increasing your capability in producing a better result.

Last but not least may be the cheesiest advice I’d give myself: even if you never end up with something that exceeds mediocrity, you are and will always be good enough.

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The doctor I aspire to be

By Jarrett Lee, Year 2 Medicine Student

Human beings are fragile. We cut ourselves while preparing dinner, fracture our limbs playing a game of footy, and damage our organs with a tad too many beers. Medicine, however, never fails to offer a way out on every occasion. We have our wounds stitched. Our bones fixed. Our livers changed. But when confined within the parameters of what medicine is capable of, and confronted with the realities of decline and mortality, we as fragile creatures are often left unready and unprepared. It is often acknowledged that the duty of a physician, in its empirical form, is to fix. We pride ourselves on our ability to repair, to mend and to recover what is broken. But when we encounter a disease that cannot be treated, or a wound that is unable to close, when we as physicians are challenged with a problem that is no longer fixable, herein lies the moral conundrum. Do we forge ahead, knowing that medicine can possibly do more harm than good? Or can we muster up the courage to recognize the finitude of our lives, and accept the painful truth that we are in fact – dying?

As I foray through my last semester of pre clinicals, I grapple with this dissonance – the jarring disconnect between the principles of what medicine can accomplish, and its otherwise obvious reality. And strangely enough, the struggle to understand the inevitability of death and dying, albeit a grim one, has framed carefully my beliefs on what medicine truly sets out to do, and forged, in the crucible of mortality, the cornerstone upon which my beliefs as a doctor-to-be, have been built. Yet above everything, there remains the question,heavy but eloquent, one written so beautifully by Paul Kalanithi in his novel ‘When Breath becomes Air’. A question that seems to shoulder the weight of mortality, yet beautifully encapsulates the soft fragility of human life. And so, I ask – ‘what makes life meaningful enough to go on living?’

In the years to come, I hope to become a doctor, one who can answer this question with much confidence. A doctor brave enough to understand when to recognize defeat, and when to keep on fighting. One who isn’t afraid of telling a young mother that the cancer has spread to her liver, her brain, her lungs and her bones; and that she is almost certainly going to die. A doctor willing to lay down hard truths; that it might betime for her to halt the drugs and the surgery, and instead consider what might truly be important – spending time with her family.

In the years to come, I hope to become a doctor, not one who understands death, but one who understands what comes directly before. A doctor who understands that human beings do not fear dying itself, but the process of dying, the process of losing the very qualities that make us Human. And when that defining moment begins to bare its fangs, I can only hope to be the doctor who dulls the teeth of mortality, so death becomes just a little less – harrowing.

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SPOTLIGHT: High altitude medicine Written by Lachlan Coman

The clouds above part. Behind the white mass of condensation, the dominating peak of Everest is unveiled. A ridgeline emerges. The jagged rocky ridge, thrust into the air by tectonic forces eight thousand metres below, is covered in the ice and snow which on fine days streams like smoke from the top of the mountain. Beneath a prominent step is a tiny black dot. Another dot inches slowly upwards and meets the first, before the clouds close over and the mysterious scene is hidden from view. *** The two dots were George Mallory and Andrew Irvine, spotted for the final time by Noel Odell on the 8th of June 1924. This famous last sighting took place during their ill-fated attempt to become the first people to summit Mount Everest. The two were never seen again.

Today, more than 300 people have died on the slopes of Everest. Many thousands more have perished attempting extraordinary feats amongst the mountains of the world. High altitude is dangerous. Yet the risks to human health do not deter a small number of radical people who push themselves and their bodies to their limits in the pursuit of a feeling most of us cannot understand.

Patients suffering the effects of high altitude don’t often present to hospitals in Australia, a country whose highest point stands at just 2,228 metres. But the field of High-Altitude Medicine is niche and fascinating, often attracting a special breed of mountaineer-doctors.

Last known photograph of George Mallory and Andrew Irvine

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The famous hanging glacier and peak of Ama Dablam (6812 metres)

Why do so many people perish on the mountains?

Well, there are some obvious explanations. Some are unavoidable risks – avalanche, rock falls, storms, and gear failures. Alpine biomes are freezing, sub-zero environments which can cause frostbite and hypothermia. The effects of fatigue, dehydration, hunger, and confusion result in mountaineers making potentially fatal mistakes.

Altitude itself, however, poses a unique challenge to humans whose elevation exceeds 3500 metres. Barometric pressure decreases at higher altitudes, causing a near-linear drop in the partial pressure of atmospheric oxygen. At the summit of Mt Everest, the amount of oxygen available to alveoli for respiration is just one third of the amount available at sea level. The result is a sharp drop in arterial oxygen saturation that occurs in people ascending higher than 3500 metres.

The most common complaint among mountain climbers or trekkers is Acute Mountain Sickness. This is a syndrome characterised by malaise, nausea, headache, and lassitude, and occurs in most people approximately 6-26 hours after ascent. While uncomfortable, AMS can be treated by simple analgesia and commonly resolves spontaneously. A serious effect of AMS is the impaired decision-making capacity of unwell people who can place themselves in danger.

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Two extremely uncommon but life-threatening sequelae of Acute Mountains Sickness are high-altitude pulmonary oedema (HAPE) and high-altitude cerebral oedema (HACE).

These occur in 2% and 1% of climbers respectively.

HAPE, the symptoms of which include breathlessness and frothy or bloody sputum, can rapidly lead to cardiorespiratory failure and death if left untreated. It is caused by a breakdown in the blood-gas barrier of the alveoli, resulting in the accumulation of extravascular fluid and restricting gas exchange.

The symptoms of HACE include drowsiness, headache, ataxia, papilledema, coma, and death. A swelling of the brain is caused by a sudden increase in cerebral blood flow at high altitude. Both HACE and HAPE can occur without warning and present acutely.

The treatment for all forms of AMS is straightforward: bring the patient down in altitude and provide oxygen therapy via a mask if available. If possible, the patient should be evacuated to medical facilities via helicopter. Nifedipine is used for HAPE, and dexamethasone can reduce the symptoms of HACE. However, prevention is crucial, so ensuring climbers are acclimatised by ascending slowly is the single best method of preventing Acute Mountain Sickness. Acetazolamide is a useful medication that can help reduce the symptoms of AMS. Climbing at high altitude is risky. It is not just the inherent hazards of the terrain, but the great physiological stress of altitude can have devastating effects on the human body. ***

Helicopters are often used for rescue in Nepal. Photo: Getty Images

Conrad Anker scours the north face of Everest with a keen eye. He is a tall, thin man with an angular face – a famous American mountaineer and rock climber who is well respected in mountaineering circles.

The Auricle October-December 2022

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On the 1st of May 1999, Anker is searching for something – a clue to the past that has eluded others for more than 75 years. He is looking for the bodies of Mallory and Irvine, whose disappearance has left an unanswerable question behind: were they the first to summit Everest?

On the slope below, Anker spies an unusual object. It has the appearance of a rock – flat and white. But as he approaches closer, a grim sight appears. Exposed in the scree on the north face of Everest is the corpse of George Mallory, whose pale white back has been exposed to the elements by rotting clothes and has drawn the attention of the search party. With evidence of rope marks, a fractured right leg, and a massive wound on his forehead, it appears that Mallory fell to his death on that fateful day in 1924. The body of Andrew Irvine has never been found.

We may never know why Mallory and Irvine fell to their deaths on Mount Everest. But the dangers of high-altitude climbing are real and present. It claims the lives of dozens every year. But just as the danger remains eternal, so does the inexplicable desire among many unique humans who set off into the mountains in search of adventure.

Conrad Anker and the corpse of George Mallory. Photo by Jake Norton/MountainWorld Photography

20 The Auricle October-December 2022