The Auricle 2023 - Edition 3

THE AURICLE Volume 6 Edition 3

September - October 2023

THE

CON

TENT EDITOR'S LETTER ............................................ 1 HUMANS OF MEDICINE: DR.MAITHRI ................. 2 INTRODUCING THE OSSICLE ............................. 5 C&W - A DYING EMBER .................................... 6 C&W - KAVINDEE MANNAPPERUMA ................... 8 VISUAL ART WINNERS ................................ 11-12 CREATIVE WRITING WINNERS ..................... 13-24 FINISHING MEDICAL SCHOOL: NOW WHAT? ...25-29

EDITOR'S LETTER Dear valued readers,

Welcome to The Auricle’s September-October Edition, our third (and final!) instalment for 2023. We are absolutely delighted to share this publication with you and the creativity of the contributors featured in these pages. As mentioned previously, the MUMUS Publications team is publishing regularly, so if you've missed our previous publications please do check them out!

Wow! We’ve already arrived at our final instalment, what a year this has Yash Patwardhan is currently a 4C Student completing his been for the MUMUS Publications Team. To begin with, it would be Children’s Health rotation. wrong of me to not ackowledge the work of Eric Wang & Angelica Haskins who behind the scenes have been the driving-force behind the ‘Human’s of Medicine’ Podcast initiative this year, and more recently our Auricle Editions, as well as the successful running of our Creative Writing and Visual Art Competition.

This instalment of The Auricle is always quite special, it’s because we have the absolute honour and privelege to showcase some of the brilliant submissions that we received for our annual Creative Writing and Visual Art Competition. Pairing these delightful pieces and visuals from our talented student-body are also self-care pieces from our Community & Wellbeing arm, and of course a written excerpt of our interview with the ever-inspiring Dr. Maithri Goonetilleke (you can listen to this on Spotify too!)

Finally, I just want to ackowledge just how much of a joy it has been bringing our first season of MUMUS' Humans of Medicine podcast and these Auricle editions to you all - truly a highlight for all involved.

Again, to you our audience, have a wonderful holiday period and a restful break, I’m sure we'll catch each-other sometime soon Signing off one last time, Yash Patwardhan, MUMUS Publications

Eric & Yash speaking with Dr. Maithri for Episode 4 of ‘The Ossicle’, MUMUS’ very own podcast!

The Auricle September-October 2023

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HUMANS OF MEDICINE

In each edition of The Auricle, we interview a member of the Monash medicine community. We hope to provide you all a glimpse into the lives of the clinicians and medical students around us, and hopefully remind you all, that ultimately, we are nothing more but human. If you think you or someone you know would have an interesting story to share, please contact us!

Name: Dr Maithri Goonetilleke MAITHRI, CAN YOU TELL US ABOUT HOW YOU ENDED UP IN MEDICINE? Great question. So I, like many students, had that amorphous sense that I wanted to help people as a young person. I knew that there were issues in the world I wanted to address. I often thought I wanted to be a lawyer but oddly enough, every time I did a vocational/career questionnaire, the answer of the medical practitioner kept coming up. So I guess I have those questionnaires to blame for what's happened since.

WHAT WERE THOSE ISSUES IN THE WORLD THAT YOU SAW THAT YOU HAD WANTED TO ADDRESS? Yeah, so my background is Sri Lankan, and I came to Australia during the Civil War when I was young. I didn't come from a privileged background and was constantly aware that I was leaving a space where many people were suffering through war, illness, poverty, and death. I had a dad, and I still have a dad who has worked for many many years in the context of marginalised people. So he is a minister in the Uniting Church, and he set up and ran this place called the House of the Gentle Bunyip which was a shelter for people with schizophrenia who were often homeless.

And it was just an accommodation, a place where people with schizophrenia, often very significant levels of schizophrenia, who would

become homeless, could come in and stay.

And he was essentially their friend. He didn’t have any agenda, would just show his compassion. So I watched him do that for 12 years - he would get calls at 1 or 2 in the morning, from someone that was standing on the roof of a building all ready to jump, and asking him “Hey, I need you to be here.” And he would just say “I’ll be there”. That was his mantra “I’ll be there.” And so his example was really powerful for me, because he was never evangelising or trying to get anyone to believe anything - it was just about being compassionate and being present. And so I saw that and I thought, well that’s something I’d like to do in a secular way. And that’s how I ended up in medicine.

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COULD YOU TELL US MORE ABOUT THE WORK WITH POSSIBLE DREAMS INTERNATIONAL? AND WHAT YOU DID TO ADDRESS THE STRUCTURAL FORCES AT PLAY? It was life-changing. It truly changed the entire lens in which I saw the world. I left medicine with the same linear understanding of health that most medical students have. I.e. When someone has a medical condition, we treat them with some prescriptive measures, and then non-pharmacological and finally pharmacologically.

Afterwards, the patient will follow our advice, take the medications and everything will be great.

But in these places that are fraught with structural violence, which mind you, are also present even here within a 30 minute drive in Melbourne, people’s agencies to make changes in their lives to effect that changes that you have prescribed them are limited by the structures which are around them. So structural forces such as legal and governmental issues, geopolitical craziness, climate change and structural racism all coalesce to create this impenetrable barrier for people.

So one of the things I focused on whilst in Swaziland was focusing on the power of cultural autonomy. And having local people in the centre of the story compared to the wellmeaning foreigner. I truly think the heart of global health is dethroning ourselves from this global health story, and putting the local person back in the centre of the story.

And then number 2, is recognising the structural forces that are at play. Whilst I was in Sub-Saharan Africa, they truly had this holistic way of doing things. They haven’t been indoctrinated into a system of education where you have this linear way of looking at the world.

MOVING AWAY FROM YOUR WORK WITH POSSIBLE DREAMS INTERNATIONAL, CAN YOU TELL US ABOUT YOUR DAY-TO-DAY LIFE NOW? Yea, so my partner and I recently moved to the Mornington Peninsula, which we’ve been really enjoying, I’ve been spending lots of time taking beach walks with our dog. She’s a Golden Retriever x Samoyed cross, and just a fluffy golden ball of love.

Before we made this move, I was working 3 jobs. 2 of which were clinical jobs in rural Gippsland, where I was just driving 3 hours in the morning to work, and then 3 hours back. I wanted to continue working in those spaces, but I also recognise that balance is important, and so I’ve brought back a lot of my hours at Monash instead, so that I can also do some fiction writing.

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I find that especially with medical journals and public health, there’s a particular language that we use which is a bit restricting. So I really want to expand beyond that.

Outside of medicine, I’ve also got my own hobbies. I also go to the gym. I do that for my old skinny thirteen year old me to remind him that anything’s possible, and really, to defy my own sense of who I am. It also helps to balance all the cerebral stuff that we do.

Singing has always also been a passion of mine, and I've even considered a career in singing. I remember going on Australian Idol back in the day. I was still studying at that point, and I went to Sydney, and I had to make this very dramatic decision at the time. “Will he come back and sit his exams or will he go on and sing”. So I’m glad I chose what I did as music has accompanied me my whole life.

When I was working in Africa, I was actually involved in bringing a choir of young Swazi people to both Australia and then the Uk, and they toured both countries and told their own stories about living in rural communities in Swatini. I think that was really powerful.

The Ossicle Episode 4 - Keen to hear the whole interview in Maithri Goonetilleke full? The full interview is available on

WHAT ADVICE WOULD YOU GIVE TO YOUR YOUNGER SELF AND TO OUR MEDICAL STUDENTS? Yeah, it's a very provocative question and you know I think this, I mean there's lots of advice I give and if, but one of the things I would probably say is two things.

First, follow your bliss. Know what ignites you and what brings you to life. Think about that and find a way to turn that into a career.

Medicine can truly be so corrosive to the human spirit if you allow it to be, if you allow yourself to be stuck in roles you don’t want to be in, or if you are being bullied, or instrumentalist as part of a machine. Allow yourself to live out the fullness of humanity by finding out what you are truly passionate about.

The second thing I would say is that at some point, you will need to make a decision about whether you want to be ethical or whether you want to be popular. What I mean is many of us care about justice, care about addressing health inequities. However, what you’ll find within the medical institutions is that if you do care about those things, then you won’t always be in the majority. In fact, there’ll be times in your career, where you will be in the minority, and where you will need to state your case. You might be the only voice for humanity, for justice, or for equity in the room saying that, but you will need to make your peace. Do I want to be ethical? Or do I want to be popular?

“YOU WILL NEED TO MAKE A DECISION ABOUT WHETHER YOU WANT TO BE ETHICAL OR WHETHER YOU WANT TO BE POPULAR”

our Spotify 'The Ossicle' podcast.

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Introducing...

The Ossicle

By now, you might have ~heard of ‘The Ossicle,’ MUMUS’ very own Spotify podcast ! If not, don’t worry. Here’s a breakdown of what you’re missing out on and why you should be listening !

What is ‘The Ossicle?’

ANATOMY RECAP You might know of the ossicle as the smallest bones of the body. Found in the ear, the ossicle is made up of three bones: the malleus, incus and stapes, and have an important role in transmitting soundwaves to the inner ear, allowing us to hear.

Fig. 1. The Anatomical Ossicle

What you might not know, however, is that MUMUS have their very own Ossicle, a Spotify podcast series, adjoint to the Auricle, where we publish recordings of our ‘Humans of Medicine’ interviews.

For each episode, we interview a remarkable individual involved in the biomedical sphere who is doing remarkable or unconventional things with their degree.

Each interview is neatly packaged in a bite-seized podcast episode readily available on Spotify--perfect for those long commutes to and from placement.

Fig. 2. The MUMUS Ossicle For our most recent interview, we met with Dr Maithri Goonetilleke, a senior lecturer in Global Public Health at the Department of Epidemiology and Preventive Medicine, here at Monash, a former TEDx speaker, and founder of NGO ‘Possible Dreams International.’

Check out our podcast to learn more about his remarkable story and career as clinician and public health worker.

The Ossicle Episode 4 Maithri Goonetilleke

The Auricle September-October 2023

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A Dying Ember: Losing Passion For Medicine.

Written by members of the C&W team

… and just like that I was already in Year 2 of Med School! I was used to the endless stream of anatomy. I thought I had got the hang of it by now, but the endless downfall of lectures, ethics tutorials and #embryologymatters was finally bringing me to my breaking point. Everywhere I looked, all I saw were shining medical students, complete with 10,000 card Anki decks and perfect palpation technique.

Am I really cut out for this?

In 6 months, I am going to be in hospitals, involved with “real patients” doing “real medicine”. The mere idea makes my stomach churn. I don’t want to leave what I know, the comfortable uni life of Friday ICL’s and C&C workshops with Rich and Barb.

Yet, the fear of fucking up a cannula next year is nothing compared to the gnawing feeling inside of me, a void I don’t want to can’t confront: Maybe medicine just isn’t for me?

Maybe all my stress, anxiety, and countless hours staring at PSP slides is not because Med is hard, or I am just going through a rough patch, maybe it’s because I’m not cut out for this.

I’m not as smart as the rest of them, not as hardworking, not as diligent, not as curious…

And maybe I’ll never be…

I could feel my heart pounding as I first stepped into the hospital as a new 3B student - the rush of excitement intertwined with a tinge of nervousness coursed through me as I took a history from a vascular surgery patient, listened to a heart murmur for the first time and scrubbed in for an endovascular AAA repair, all on the same day.

I love this, I thought, I could do this everyday for the rest of my life! How privileged am I to be part of a team whose role is to help and support people through their pain and suffering, and bring them back to health? You can tell where this is going.

Weeks passed by and getting up super early became harder and harder each day, and I could feel the passion and enthusiasm diminishing after each ward round, drop by drop, until it wasn’t enough to keep my eyelids open during Wednesday lectures and my corporeal form at the hospital some afternoons. I felt drained, all my energy sucked out like an empty ampule. I was flat. I was frustrated. I was unhappy. I was overwhelmed by the seemingly endless tasks in the logbook. I was ashamed when I couldn't remember the nerve roots contributing to the ilioinguinal nerve. I felt invisible at the back of the team in ward rounds, some sort of deadweight which always somehow got in everybody’s way. What has happened to me?

If this sound at all familiar, then have no fear, for you are not at all alone! Whether you are in your pre-clinical or clinical years, losing motivation and/or passion for medicine is a common challenge that many medical students face at some point in their careers. If you are in this situation, you can try to focus on the positive impact you can make on patients' lives no matter how trivial they seem (as a clinical student) - even if you are only chatting with them and taking a quick history.

Going through a period of demotivation and burnout may mean a need to take a break. Sometimes, a break from routine can help you recharge and regain perspective. Reach out to a trusted mentor, professor, or senior colleague in the medical field. They can provide guidance and perspective, as they may have experienced similar feelings during their careers. And as always, the C&W team is here to support you along the way, and don’t hesitate to reach out to us even if you just need a chat!

The Pink Elephant in My Passenger Seat KAVINDEE MANNAPPERUMA

There is something I find slightly scary about sitting alone with my thoughts in a confined space. I do this sometimes when I am driving by myself. I don’t turn on the radio. I don’t put on my Spotify driving playlist. I choose to sit in silence, but there is often something inexplicably unsettling about it.

I usually do this when I have a lot on my mind, when I feel like I need a moment of peace to hear myself amidst the rush of my thoughts. I often find, however, that whenever I try to clear my head this way, those thoughts become even louder.

Turning it all off does not seem to help.

The void fills so quickly, like it is insatiable. I am taking inventory of all of the outstanding tasks I have to complete, running through mental lists and writing new ones. An oddly specific food craving emerges. A clever comeback materialises too late. I somehow end up humming a song that I haven’t heard or even thought about in at least ten years.

Then suddenly, my brain presses play on a little montage of all of the embarrassing moments in my life, and I am thinking about random mistakes I once made or things in the past that I kind of regret.

If you have a tendency to overthink, silence can really lend itself to spiralling. I think that might be what people mean when they say that it is deafening.

There is no talking but so many things are being said, all at once and over the top of each other in your head. It becomes even more resounding, the more you try to quiet it.

I recently learned that this is a psychological phenomenon called the “pink elephant paradox”, which illustrates how the more you try to actively suppress thoughts, the more difficult they become to avoid. In spite of the irony, it weirdly made so much sense.

Pushing thoughts away does not seem to make them easier to ignore.

This knowledge of the universality of this experience was comforting to me; that this is something that all humans struggle with.

I still drive in silence sometimes, except now whenever I do this, I try to take it as an opportunity to tune in to how I am feeling. What am I looking forward to?

What am I worried about? Instead of fighting off any inner musings I find unpleasant, I try to just be aware. The technique is to be an observer – watch your thoughts, acknowledge them as they arise and then allow yourself to move on when you are ready.

In this way, the silence becomes reflective and can provide a surprising amount of clarity.

There is an inner conversation that we are all constantly having with ourselves for our entire lives. I have found that when I am a good listener, it helps me to be a better friend to myself. In turn, I think that helps me to be a better and happier version of myself.

THE AURICLE

Prompts for 2023: Creative Writing: In the 21st century, what does it mean to be successful?

“To cure sometimes, to relieve often, to comfort always.”

With the growing popularity of technologies such as artificial intelligence, what does the art of medicine now mean to you?

Should we give what we can? Discuss.

Visual Art: The essence of humanity Mother Nature

2023

VISUAL ART

1st place Rayyan Baig Title: “I See Your Future” The story of this piece is related to the prompt: The Essence Of Humanity, and what drives each one of us to do the things we do. As an optimistic medical student, what drives me is what I imagine myself to be in the future: as a surgeon! I’ve read about all the negatives and hard work that will go into getting there, but this painting is snapshot of what I dream to be, knowing in the end it is worth it. In the artwork the focus is on him: the actual surgery and background don’t matter. What matters is the almost angelic light descending on him; as you take in this piece I hope you feel the amount of heart and emotion I feel too!

2rd place Wai Chung Tse: ‘On the edge ’

3rd place Wai Chung Tse: ‘On the sea ’

CREATIVE WRITING FIRST PLACE WINNER

JAMES MORE GUNASEGARAM There’s a spirit that lives in your psyche, burrowed deep inside it like a parasite. You may not know its presence, or you may feel it so acutely and so strongly that it makes you ache. It has no name. But you’ve probably heard its call: “More.”

Most of us meet it on the road into medicine. It offers a simple promise, at first. You are anxious and unsure, daunted by the enormity of the task before you. It calls out to you, and it tells you that More is the answer. Your parents, your teachers, those who’ve walked the path before, all tell you the same thing – that More is the only path to where you want to go. So you listen and you follow its instructions.

You study More and learn More, so you can score More than those around you. You practice again and again to convince your interviewer that you are More kind and More clever than the others, so they will let you through to the career you want so badly.

For a while, things are good.

Better than good. You do what the spirit tells you and you get into medical school.

Your friends and your family are proud of you, and in your mind the spirit whispers that by doing More and achieving More you are worth More. It promises that if you just do More your dreams will come true, and the certainty of its promise is like a warm blanket.

You could stop there, if you wanted. Some do. But most do not. After all, you’ve worked so well together so far. The spirit is a trusted companion in your head, and it tells you that there is still so much More to be had. And you like the feeling of having More, the praise and the prestige and the approval.

What’s the harm?

So you keep listening, and it shows you. It teaches you that you must study More and score More and know More. You must answer correctly More and stay late More and be More liked by

MORE JAMES GUNASEGARAM CONTINUED

your team. You must be on More committees and find More mentors and network More. You must do More research and go to More conferences.

There will always be More to do, to fit in, to struggle through.

And if you ever waver, ever begin to doubt that More is the answer, there are so many voices that join the spirit’s call.

The colleges that guard the gates to your future tell you that you will need More on your CV and More references and More experience if you want the future you were promised. Some of them tell you they have no choice, that this is the only way to decide, and the trueness of that statement does not make their cry for More sound any different to the rest. And the people that make it past the gatekeepers and into their futures seem to be so much More than you could ever hope to be yourself.

So you remember the promise the spirit made you before, that if you do More you will achieve your dream, and you dedicate yourself to More anew. More is a lighthouse on the coast, guiding you across a treacherous sea, and if you can just keep its light in view you will make it to the other side.

But the spirit is greedy. It does not confine itself to your work and quiet down when you leave hospital and set aside the books. It follows you to the

the things you enjoy and heckles you from the sidelines with its cries for More.

You should be ashamed for doing these things when you could be striving for More, it says. Or if it tolerates them, it does so to pressure you to do More in them too. What is the point of sport or music or charity, it demands, unless you can prove you have done More of them than anyone else?

In fact, the spirit spends much of its time concerned with other people. More must always be relative to someone else, and that makes them competition. It doesn’t praise or flatter your friends’ achievements like it does yours. When they do More, it berates you for falling behind and hisses angrily in your ear that they are making your More worth Less.

And that is a grave insult indeed, because the spirit teaches you to fear Less with a passion and recoil from it in disgust. More is what brought you here.

Less is failure. Less is letting down all the people that sacrificed to bring you this far, who did so much More than you have done so far. The spirit inflicts fear and anxiety on you whenever you stray from More, and now its promise becomes a threat. You will do More or your dreams will slip from your grasp and shatter. The blanket of certainty clings to you, suffocating you, and now

MORE

CONTINUED

you know without a doubt that you have to do More or you will fail and it will be your own fault.

You can keep chasing More forever, if you want. Some do. And it is not easy to let go of More after being pressured into it so hard for so long. But it no longer has anything to offer you, and maybe it never truly did.

The spirit will not leave you when you graduate. It has buried itself far too deep to ever be fully removed. And it thrives in medicine, because here too there will always be More. More weekends and More night shifts and More unpaid overtime. More jobs to chase and More patients to see and More ways to prove yourself to your seniors. More tolerance of bullying and belittling and More bosses to woo into references and More research and More degrees to stay ahead of your peers. And whenever you falter the spirit shrieks that you are doing Less and becoming Less. As you draw close to your guiding light it starts to burn, and you’re no longer sure why you’re doing More but you have to do More because you have no other measure of success anymore. If you cannot do More you are nothing and nothing will become of you.

One day you will finish your training, and you may think that surely this is the end and there can be no More. But the spirit will only grow louder, for now there is no goal to guide you and More stretches out in infinite directions.

No matter how far you climb, no matter what you achieve, there will be More to do.

Someone will have More. They make More money and they command More prestige and they seem More happy and they get More referrals and they have More children and they get More research grants and their car costs More and they have More titles and they give More money to charity and their patients are More satisfied and they travel More and they save More lives and they have More impact on the world and they get More time off and what the spirit will never tell you is that there will always, always be More.

The spirit will never fall silent. It will always hound you, roaring and cursing and begging for More. You have to choose to stop listening, and that might be painful and stressful and slow. But once you leave it behind, you can do something you never got to do with More – you can choose your own Enough, wherever you want it. And you don’t have to wait until you’re a consultant to feel like you’re Enough.

You can stop listening any time you want.

CREATIVE WRITING 2ND PLACE WINNER

AN

UNEXPECTED FRIEND Written by Tuyen Pham

I was at it again; the eternal hunt for patients with 'good signs'. I wandered through the maze of wards like a rudderless boat, each nurse station an island in a sea of floating, faceless patients.

They proved as elusive as ever, but as a freshfaced third-year medical student my search was fuelled by coffee, naivete and an impressive zest for the concrete jungle of hospital life.

Predictably, however, desperation soon began to erode at my enthusiasm. Potential patients turned down my requests for histories one after the other, with many shooting me blank stares or telling me outright that they were sick of students.

In a last-ditch effort I decided to finally brave the dementia ward, a floor of the hospital that I'd left undiscovered until now. The first nurse I asked pointed out a cardiac patient nearby with a clear murmur. Jackpot. I set off to find them with a bounce in my step, already reaching for the stethoscope curled around my neck.

At this point you're likely expecting that I waltzed into this patient's room and planted my stethoscope on their chest like a flag, vibrating with joy as I heard the first audible murmur of my career. Revived, I'd strike up a conversation with the patient only to find out that they were being transitioned into end-of-life care. Perhaps I would contemplate the nature of palliation and come to a pithy conclusion about the meaning of life.

That's the way these stories usually go.

But in this one, I never made it.

AN

UNEXPECTED FRIEND

Five doors away from their room a horrifying, blood-curdling scream stopped me in my tracks. I almost tripped over the carpet in shock. The patient in the room I was passing had her hand outstretched, blue eyes looking straight at me as she cried out for help. I quickly overcame the paralysis of my fear and scrambled through the door towards her. My heart pounded so hard it felt like it would ricochet out of my chest. I was only three weeks into my first ever clinical placement. Was this an emergency?

Were there any nurses around? Where was that button?

It didn't take long to realise, however, that there was no crisis. As I knelt down next to the makeshift bed on the floor and exchanged my first words with the frail woman before me, it became clear that she was only distraught by the staff's deliberate ignorance to her cries. She simply wanted someone to acknowledge her for who she was; long-suffering geriatric.

Classic dementia case. Dressmaker from Athens.

Human crushed alive by the weight of one hundred years. Woman by the name of Helen.

Then the pendulum would swing and she would once again lapse into confusion. I must have introduced myself a dozen times in that hour.

As I learned how to reassure Helen I also learned her uncanny quirks, like the way she hated compliments about how well she looked for her age, and her talent for being able to name the fabrics my clothes were spun from better than I could.

"Is this silk?" Helen asked one time. I shrugged. "You're the dressmaker. You tell me!"

She rubbed my sleeve between her fingers and wrinkled up her nose, almost in disdain at the telltale texture of polyester. "It's a blend."

For one hour I sat by her side, holding her veined hands as she oscillated between states of delirium and lucidity. In one breath she would scream out for her daughter; in the next she would cry with gratitude purely because I had taken the time to speak to her.

Suddenly Helen lurched upwards with a surprising burst of strength and clasped my hands. "Be careful of the bad people out there," she told me fiercely. Only when I nodded did she settle back into her pillows, satisfied.

Whenever she slid into that brief penumbra that her condition would occasionally allow her she would turn to me and ask for my name. I would give it.

I wondered if she meant to speak of people in general, or if she was referring to those outside her room. From her perspective they were the enemy, people who refused to look her way or even acknowledge her existence.

AN

UNEXPECTED FRIEND

But as healthcare workers on the other side of the curtain, we know that there's a different story at play. In a dementia ward overflowing with geriatrics, the clamour of screaming patients was the established hospital soundtrack. The staff were run into the ground, burnt out, stressed and overworked. Every other patient was making unreasonable demands, abusing staff or screaming for attention, and at the end of the day it's simply inconvenient to care.

Compassion was a finite resource exhausted eons ago, a fossil fuel deemed unsustainable to keep reaching for.

Afterwards I was told not to enter the room when patients acted like that; there was nothing that I could do for them. But had I not experienced the exact opposite?

But as I watched nurses shake their heads and roll their eyes to Helen's face, as they stood outside for twenty minutes with their back to her while she pleaded for them to turn around, it occurred to me how scared these dementia patients must feel. Many like Helen only wanted their existence to be acknowledged. Instead they were met with retreating backs and shakes of the head.

Helen told me that I was the only person who had responded to her in days. No wonder she'd taken to screaming. I was overcome by sadness not only for the patients, but for these people who had been so worked to the bone that they struggled to acknowledge another person in need.

But perhaps that's just another spoonful of sugar to help the medicine go down. Don't we see enough of that already? You talk to peers about how you feel and they throw thought-ending cliches at you like it's a defensive play. 'It is how it is'. 'That's just the job, isn't it?'. This is the way things roll around here. Studies have shown this and studies have shown that. But have studies shown the smile of a 100-year-old woman as she offers you the flowers in her room? Have studies shown the look on her face when you tell her you'll visit again, even though nobody else will?

To this day I wonder if I was making a rookie mistake. These patients were unlikely to survive or even remember me. Was I setting myself up to be hurt? Perhaps sensitivity was a skin that I would shed as I underwent my metamorphosis into a doctor.

Perhaps in years I would look back and smile ruefully at my innocence, glad that I aged out of the blissful ignorance of youth.

What studies have in fact shown is that the more we see, the more our empathy reduces.

Maybe once you've exited the revolving hospital doors enough times part of your soul gets snagged on the way out. You grow resistant to it the further into the waters you wade. Pulsus paradoxus, not only in the flesh but in the mind.

AN

UNEXPECTED FRIEND

Around me it was already happening. I could sense the detachment on the lined faces of the other doctors, the way they walked around looking like a beaten edge.

But as a medical student I still inhabited that interstitial space before true responsibility set in, where I could spend hours with patients and bask in my own warmbloodedness. I was determined to remain there for as long as I could. And so each afternoon I mounted the stairwell to the dementia ward in my best outfit, emotionally bracing for Helen to have forgotten me. To my surprise, although she continued to ask my name, her face would reliably light up in recognition each time I rounded the corner. I would sit cross-legged by her bed as she shared stories, commented on the colour of my skirt and cried for her dead husband. Often times we sat in pure silence. In the relentless din of the hospital, we had found a brief window of peace.

Through this I am reminded of the archaic practice of bloodletting; withdrawing blood from our veins in manageable doses for therapeutic benefit. In school we're encouraged to break in our organs. Let them feel something.

Haemorrhage those emotions. But medicine dictates that there is a point where the proof of concept intersects with the economics of real life. You see your first few deaths, get a taste of the job and now it's time for the heart to shut up shop.

Anything more and it's just an impracticality, an obstacle to vault over by yourself in the shadows of bathroom cubicles and hospital carparks. I'm told it becomes a practised motion after a while.

All this to say, do we really feel as much as we think we do? I watch how humans pass by each other, each of us encased in our own mutinous bag of flesh. So many numbed to the senses, afraid to expose ourselves to the cold bite of life. Conservative management, all the way through. But I scored just past the middle of the bell curve and ended up here by a centenarian's bedside, listening to disjointed tales of Athens and hushing her cries. I'm no medic, but what I know is that people die. They die of disease, of heartache, of pure dumb luck, but also of time. I wonder how long you can lay there on the floor, crying out for the people in front of you to look your way, before you start to look away too.

I remember when Helen asked me to meet her daughter, the one child she had not outlived. The next afternoon I slipped away from my ward round early and climbed the stairs to her room, hoping that I'd finally catch her family during visiting hours.

Instead of her familiar smile, I was greeted by someone soaping down the blow-up mattress on the floor. The flowers that Helen had offered me were gone from the corner of the room. There was not a trace of her left.

A panicked interrogation of a nearby nurse revealed that she hadn't died, but had actually been discharged. Although I was grateful for Helen's health, I still felt a melancholy pang at having never said goodbye. If she died, would I even know?

AN

UNEXPECTED FRIEND

I decided then that my barometer of success as a doctor would not only be a patient's physical outcome, but also how I made them feel. Now I'm no medic, yet. But what I've learned is that love for people is the vital artery that links us, the connective tissue that binds us together at the marrow. And when the chemicals corrode us, when our bodies give way to the elements and the eternal march of time, perhaps we'll realise how hollow our hearts really are, and how the blood pushing through them, that proof of life, is only a composite of every interaction we've shared with another person. After all, we have each other's air in our lungs. All we can do is give mouth-tomouth and exchange those precious words of comfort and reassurance. Ask another what their name is and what they need. Have them ask my name too.

I don't know if these words will still be true to me in years to come. Perhaps desensitisation is unavoidable, a dead end that every path in the maze leads to. But I truly believe that all I’ve got to give in life is my own time and understanding. That's the real finite resource. And when my stores are depleted down the line, when I'm scraping at the bottom of the barrel for any dregs that I have left, I hope I'll search within myself for the pockets of compassion that I've kept hidden away for a rainy day. I pray I'll remember to keep mining for it.

CREATIVE WRITING 3RD PLACE WINNER

picking up the pieces.

“How much did you know about your father?” she asked.

The knot in my stomach tightened. “He wasn’t around much when we were kids.

He’d come back from the war maybe once a month, but then we’d see him less and less. Sometimes we’d just get a letter home, and other times nothing, no way to know whether he was dead or alive. Maa held down the fort while he was gone, even when Jacob – my youngest – caught the polio. She was a strong woman, but we could all see that it was slowly eating away at her.”

“I’m sorry to hear that. Can I ask what he was like... your father, I mean?”

J A I N A M S H A H I scavenged my mind for memories that I knew didn’t exist. “I couldn’t tell you. I tried a few times to remember what he looked like, but I only remember his uniform. I’d never seen him without it. I try to latch on to details – if he had a gruff or a soft voice, whether his eyes were blue or brown – but all my recollections are vague, hollowed-out. Whatever kind of man he was like before, when he came back from the war for good, he was unrecognisable. Maa couldn’t take it, and he moved out soon after. Not a word since... well, except for today.”

“I wish we had been meeting under better circumstances.” A pause, punctuated by the ticking of a clock.

“I’d imagine the word of his passing would have come as a shock to you then?” I tried to think of the most sanitary response. I knew what grief was supposed to feel like – it took me the better part of winter to get over Maa’s death. This didn’t feel like grief. When I got the call from the funeral home to come and collect his belongings, I’m not sure if it registered that a piece of my life had been lost forever. It was eerie, sitting with news that ordinarily should have broken my spirit, feeling nothing but indifference and wondering whether it was even right for me to go.

“Is everything alright sir?”

I snapped back to reality, realising that my hesitation had already spoken volumes. “Yes... yes, I suppose it was quite unexpected,” I blurted out, unconvincingly. The responses, which had until now been calm and clinical, strained under the heaviness of repressed emotions that blanketed the room.

I“I understand things have been... complicated between you and your late father. The reason that we are reaching out to you is because, one month before his passing, your father volunteered his body for organ removal and donation should he die.”

I felt each syllable reverberate in my mind as I struggled to decipher what to do with this news. I’d learnt very little about my father in the time since his disappearance from our lives, but to imagine him as charitable went against every memory of abandonment I had grown up with.

“Did... did you need my signature, or something?”

“No, that won’t be necessary, given you’ve been estranged for so long. Your father, however, did make a special request. We usually don’t do this, but he was quite persistent that he wanted you to have something – a way, he said, for him to make up for the many memories he didn’t have a chance to make with you.” Before I could have a moment to react, she reached into her briefcase and slid a small, unassuming leather journal across the table towards me. I didn’t notice it at first, but I could feel my eyes glaze with a thin film of tears.

“Take as much time as you need.”

Like a hopeful child receiving a gift-wrapped present for his first Christmas, I hesitantly opened the notebook to the first page, my heart heavy with anticipation. In carefully inked words, it read:

To my dearest son, Elijah. I know I haven’t been the father that I wanted you to have. I wasn’t there to teach you how to tie your shoelaces, or to give you your first pair of baseball gloves. You, your Maa, Mary and your two little cherubs, Jacob and Peter, deserved better. I wish I had spent more time with you, but I knew you’d be safer without me. I’ve made the decision to donate my organs to give others a second chance to have a good life, to live with their family – a chance that I wish I had had.

I’ve asked the good folks at the funeral service to paste the pictures of the recipients of my organs in the pages of this book

– hopefully, through the lives of these wonderful people, you might get a glimpse of the kind of person that I aspired to be... for you.

My eyes welled and I felt a lump form in the back of my throat. I tried to hide my tears from her, and more so from myself, because it frightened me to be feeling this way, but there was no use. I flipped the pages, skimming through dozens of pictures of men, women and children whose lives had been changed, each with a handwritten caption from my father. These are my eyes... A fourteen-year-old boy partway through kicking a soccer ball through the goals. He had been blind since birth because of a rare tumour that meant both of his eyes had to be removed, but you wouldn’t have been able to tell from the picture, the way his sparkling green eyes lit up in the sun as he was about to make the game-winning point.

These are my lungs... A slim-looking gentleman sat under a spotlight on stage, his arms splayed out as if hugging the sky, facing a crowd of retirees, all with their mouths open.

He’d been living with a genetic condition that clogged his airways up with mucus, yet now his voice filled so many others with hope and gave them a new lease on a healthy, happy life.

This is my liver... A grey-haired woman with a stethoscope around her neck stood in a brightly lit hospital room, arms crossed but with a big smile across her face. She had accidentally suffered a needlestick injury after a 48-hour shift caring for thousands of sick patients, and descending into unremitting liver failure. She still works at the same hospital, to this day.

This is my heart... A young college student stood in front of her class in a black gown, shaking hands with the dean as she accepted her certificate for having graduated magna cum laude out of her cohort of nine hundred peers. She was born with a rare, congenital defect in her heart that her doctors said would cause her heart to fail before she could celebrate her seventh birthday.

And this... this is me... An elderly pensioner with softly defined facial features stood at the foot of his bed with a cane supporting him. He was a retired firefighter who had saved countless trapped

individuals from fiery wrecks, but in one unfortunate incident, suffered severe, irreparable burns to his face. With the gift of a new identity, he could continue to walk alongside the community that he had served for all of his life.

I closed the book before I could read any more and said my thanks, grabbing a few tissues from the counter before I made my exit. As I made my way towards the car park, I felt the tension in my shoulders dissipate and a newfound sense of tranquillity bathed my mind. I had never had the chance to get to know my father while he was alive, but I felt strangely connected to him in a way that I’d never thought would be possible. I’d only seen glimpses of him as a child, like a shadow, but now I feel like I knew him for who he truly was... an honest man with a kind soul, the sort of man my Maa wanted me to become.

Opening the door to my car, I heard something fall to the ground behind me. A pamphlet lay on the concrete, fallen from the back of the notebook I had been gripping tightly this whole time. On it, in big, bolded letters, read, ‘Make the choice, pledge to donate your organs today!’ I picked it up with a smile across my face, locked the car behind me, and, with a spring in my step, walked back towards the room I’d only moments ago left behind.

ANITA DATE

F I N I S H I N G M E D I C A L S C H O O L : N O W W H A T ?

THERE IS ONLY ONE WAY TO LEARN. IT'S THROUGH ACTION. EVERYTHING YOU NEED TO KNOW YOU HAVE LEARNED THROUGH YOUR JOURNEY. PAULO COELHO, THE ALCHEMIST

Ask any final year medical student how they’re feeling about our upcoming year of junior doctorhood, and you’ll be met with a variety of responses. Some are thrilled to be equipped with a stethoscope and the shiny new title of “doctor”, keen to hit the wards to put their knowledge into action. Some are apprehensive, daunted by the thought of being responsible for real, living (well, hopefully!) patients. And some, with two months of time off uni to fill, have put internship out of their minds, using this time to travel the globe, recharge and explore before an upcoming rollercoaster of a year.

There is no right or wrong way to approach internship. Having spent 3 years rotating through various medical departments, passed 5 years of exams, interacted with hundreds of patients and repeated literally tens of thousands of anki cards, our cohort is well and truly ready for the next big step: figuring out how to actually be a doctor.

No amount of shadowing as a student will prepare you for the first time a pager is thrust into your hands, or the worried faces of staff turning to you, the doctor, to make a decision; what mix of drugs is going to make its way into the living person before you; to bring a heart rate up, a temperature down, to restore a conscious state?

No longer are we able to say, sorry, I’m just the medical student, and look nervously around the room until the “real doctor” arrives. For many years, we’ve been protected behind our medical student title, unable to cross the invisible border that delineates student from clinician. But having passed our final assessments, accepted a job offer and with a provisional AHPRA registration on its way, I’m now picturing us in these scenarios. I realise now that the only real barrier was time. We're all on the precipice of crossing that line, tasked with utilising still-developing clinical skills to make choices when the medical students ask the ”real doctor” what to do.

An intern’s role is largely to be the medical secretary of the team, which is usually comprised of: a senior consultant (although they’ve finished full training, they’re only present half the time), registrars (who ooze the most up-to-date treatment knowledge in line with the exams they’re studying for), residents (whilst still only a few years out of medical school, always seem unfazed by the intricacies of being a real doctor), and then of course, the interns: recent graduates who, until recently, were medical students with no real responsibility other than making sure coffees were delivered on time to the weekly radiology meetings. Us medical students filter in and out of rotations, taking one of two approaches: 1. scribbling down every new word and sign you hear or 2. just trying to stay awake until the end of a ward round. Nearing the end of medical school, option 3. enters: you now know enough medicine to try to figure out what the interns are doing: Soon you’ll be one of them. Yet with no formal intern training other than observation, attempting to learn “how to doctor” via this approach seems a bit like having to construct a house of cards whilst falling out of an aeroplane. And you’re not sure if your parachute works yet. Starting work as a junior doctor seems quite literally a trial by fire. So it’s a good thing most interns commence their first weeks as a part of a well-supported team.

Luckily, we have a few good years beforehand to figure out how to do all the other aspects of life.

Whether it is spending time exercising, spending time with friends, or spending all your centrelink payments, medical school is a perfect time to learn where your other hobbies and interests lie. Medical school has a somewhat rigid and fixed progression: memorising specific guidelines, protocols and parameters. Of course, these parameters are followed for good reason. Numbers can tell us when to worry and when to reassure. But sometimes, this extreme focus on perfection can be debilitating. As a person who has never entirely fit the mould, writing has been my main creative outlet to process the ups and downs I’ve had along the way.

In my first year, my writing documented the imposter syndrome of suddenly being surrounded by the nation’s brightest minds, inundated daily with new content, struggling to stay afloat in a sea of people who always just seemed to know how to swim. When I moved 7 hours away from home to start my first clinical year, I brought my writing habit along with me, and documented with excitement the long list of firsts: first day on the wards, first successful cannula, first time scrubbing into a real life surgery! (Is this what being on Scrubs feels like?) As the sole 4th year student parallel consulting in a rural town, living hours away from anybody I knew, writing helped me to validate my experiences and to feel supported. Writing also got me through the sadder moments: unsuccessful code blue resuscitations, the suffering of angry and hurting patients, family violence situations.

While the medical student sparkle of new experiences did eventually wear off, I know that writing will always be a healthy outlet for the difficulties of the job that lies ahead. While I might not know exactly what that looks like as an intern, I know that our obstacles can shape and improve us – and what better medium for this important selfreflection than through writing?

As I head towards internship, I’m still not quite sure what to expect.

Will it be a year of frantically charting orders, cross-checking every medication and chart to make sure each dose is correct? Of chasing the team down identical corridor after corridor while erratically typing notes and pushing the COW? (the Computer On Wheels, although I’ve completed enough rural placement to be unfazed if an actual cow appeared on the wards!) Will it be a year of belittlement?

Of apologies, our vocabularies cluttered up with “I’m sorry, I don’t know yet, let me ask my registrar?” Of fumbled encounters with family members, words never doing justice to their loss?

Maybe I'm catastrophizing... Maybe us soon-to-be interns will remain safely protected from "real medicine" for another year.

Despite heading off into the unknown, I am excited and humbled to be graduating into a profession like medicine. That’s the funny thing about the passage of time; looking back, we know how we got to where we are. Yet looking ahead is like trying to see through a thick fog: we can guess, maybe using a gloved hand or a pen torch to examine what we’re faced with, documenting our findings along the way. But we’ll only really know what happens when we’re in the thick of it. So as to what new challenges internship will bring forth? Only time will tell. Time, and of course, plenty of writing!

-----------Anita will be completing her internship at Bendigo Health in 2024.

Between seeing patients and attempting jobs, she can often be found scribbling drawings and ideas all over her ward round notes.

Stay tuned for her follow-up piece in one year's time: Finishing Internship: Now What?