The Black Bag Summer 2022

THE BLACK BAG

BRISTOL MEDICAL SCHOOL Summer term Ed., 2022 1

The University of Bristol Medical Students’ Magazine Est. 1937 Editor-in-Chief: Molly Van der Heiden Illustrator: Ruby O’Mara Contributors: Adewale Kukoyi, Alice Watts, Akshata Valsanger, Finn Graham, Louis Davenport, Manisha Premlal Max Gerard, Molly van der Heiden, Katherine Grigg, Tiga Hombrey, Veronica Girgis

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The Black Bag Spring 2020 ………………………………………………………………………………………….. ………………………………………………………………………………………….. …………….Editorial…….…………………………………...……………………....4 ………………………………………………………………………………………….. ……………….…Poem: Half Price Lateral Flows..……………………………...5 ………………………………………………………………………………………….. …..President’s Address...……………………………………..………….………..6 ………………………………………………………………………………………….. …………...Our new presidents…………… …………………...………….……..8 ………………………………………………………………………………………….. …………...Galenical’s Committee 2022/23…………………...………….……..9 ………………………………………………………………………………………….. ……………………….…..WHERE THE HELL is Bristol Medical School?.....10 …………………………………………………………………………………………..

Interview with Sarah: Sun, Sea and Serious Business….….………..…...….12 ………………………………………………………………………………………….. ………….Ketamine –A Peeping Tom at the Keyhole to Eternity…….….…15 ………………………………………………………………………………………….. ……………………How to be a LGBTQ+ ally………………………..………....17 ………………………………………………………………………………………….. ………….This is Going to Hurt Review……………………………………...….19 ………………………………………………………………………………………….. ……………………..….Divorce’s Grey Area….....………………………………21 …………………………………………………………………………………………..

The Magic of Mushrooms…………………………………………………………..23 ………………………………………………………………………………………….. ……………………So do you like medical history in your curriculum ….....26 ………………………………………………………………………………………….. …………………………Why would you go to medical school to put someone to sleep? A reflective account………………………………………………………...27 ………………………………………………………………………………………….. …………………………………………Run, Fresher, Run………………………..28 …………………………………………………………………………………………..

Ye Olde Black Bag……………………………...…………..…………...………….39 …………………………………………………………………………………………………..

………………………………………………………………………………………….. ………………………………………………………………………………………….

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EDITORIAL Welcome dear readers to the Spring term issue. In last year’s Spring Editorial, I described how excited I had been to declare that issue the first post-pandemic Black Bag issue. As I am currently writing this, all isolations, lockdowns and coronavirus caution has been finally removed and it almost appears that everything is back to normal. However, it would be naïve to believe in this new set of rules entirely and I know many healthcare professionals currently working on the front line have little confidence that it is the right decision. So perhaps tentatively, I will quietly think of this edition as the first post pandemic issue. However, it does not come without the acknowledge of the hardship and unsettlement that the last two years have brought and a sense of uncertainty as to whether this really is all over. I have written a poem below which I hope summarises, with some hilarity, the strangeness we all are feeling in this shift from pandemic state to normal. When digging through The Black Bag archives I found their first post-war issue and extract referring to the first peace time issue. I wonder if our feelings mimic in some small way, the sense of uncertain freedom that those students faced as they returned to medical school, albeit after significant more disruption, and perhaps we can learn from their strength and resilience in attempting to piece back normality.

Of course, we are not in a peacetime. Almost overnight, as all coronavirus news disappeared, our headlines flooded with news from Ukraine. In addition, there are conflicts occurring elsewhere in the world including Yemen, Palestine, Ethiopia and many more countries and communities, all of which deserve our aid and support. To be a doctor in a community is largely a role that is greatly respected; when we graduate there is not an open job market and theoretically, we could work anywhere in the world.

According to the World Health Organisation, in 2020 there were 82.4 million people worldwide who were forcibly displaced. Thus, I urge every single one of us to read the news, stay informed of the tragedies occurring around the world and consider the impacts this has on our colleagues, support networks and patients.

Finally, I know that Alice Watts, the Galenicals president, has focused a lot of mental health this year. Alice and I both knew Matthew Ward well as we were on placement with him when he sadly died last year. As we as a medical school move on from this, I feel it’s important we keep Matt in our thoughts and remember his journey. To be kind to one another despite our own internal struggles is what will make us the best doctors we can be; and this is a quality that Matt embodied throughout his life.

M. Van der Heiden Editor-in-Chief

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Half Price Lateral Flows “Lateral flows, lateral flows, Made by the man himself, BOJO Half price, great condition” The market staller shouts and blows Around him, people shake hands with inhibition.

“What about you miss, those bags under your beautiful eyes, Maybe coronavirus has caught you by surprise?”

“And you kind sir, surely you know that the food from Mabel’s Is always past it sell by date labels

You can’t taste it Not at all?

2/3 off thirds of tests at my stall” “Come on ladies Have-a-look 2 for 1 Protect that beautiful grandson” “Excuse me will you take 50p?”

Yes of course, says the market staller wearily

“MADAM PLS STEP AWAY IF YOU NEED A PCR” “Christ let’s just leave, grab the LFTs and the car”

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PRESIDENT’S ADDRESS

Alice Watts Galenicals President 2021-22 Hello all. Thank you for taking the time to read my address. After 13 months in the role of Galenicals President, I can’t quite believe that I won’t be sending any more briefing emails, chairing any more SSLCs or working on the door of Lizard Lounge at Galenicals socials!

I’m immensely proud of what my committee has achieved this year.

They’ve done some amazing work including the expansion of the welfare network to the academies and optimising equality and diversity by working more closely with the faculty and running campaigns for notions that we are passionate about.

I thought I’d use this opportunity to highlight some of the things we are most proud of this year but, most importantly, thank you all for your efforts in making Medical School life better for everyone.

Back in October 2020, the Medical School lost Matt Ward to Mental Health. I had the pleasure of living with Matt during my 3rd year and I don’t think my life will be the same without him. He taught me many life lessons and inspired me to run for this role. Many of the things that I did this year, I did for him, in the hope that we can better support Medical Students battling with Mental Health.

I read a staggering statistic earlier this year which read ‘two thirds of Medical Students in England have experienced mental health pressure during their medical degree’. It goes without saying that Medicine is an extremely challenging degree and future career. We wanted to see how much we could do to optimize mental wellbeing in our medical school.

We recognised that students’ mental health really suffered when they were away from their support networks in Bristol, so we wanted to grow the communities of students in out-placement academies. We did so by training welfare reps in Mental Health First Aid and attached these representatives to academies. These reps ran events in each of the academies and were easily contactable and visible through our poster campaign.

Back in May 2021, myself, Sabrina (equalities director) and Mary (international director) wrote up a report on racism in the Medical School, particularly the outplacement academies. Following on from this report, there are now ‘speak up 6

guardians’ present in every academy who you can reach out to for support and assistance in raising concerns regarding racism and other forms of discrimination.

We could not have done any of this without or noble Welfare Director, Ffion, who partnered with Bristol-based charity Project:Talk for a number of events including ‘life on the wards’ and ‘coping away from home’.

It has been a pleasure to work with Galenicals’ sub-societies and experience all of the things that they have done independently. I must mention the efforts of LGBTQ+ Health who ran a campaign lobbying the University to allow Bristol Medical School to sign GLADD’s charter against ‘so-called LGBTQ+ conversion therapy’ with Galenicals. We were successful in campaigning and Bristol Medical School were given permission to sign the charter.

Being Galenicals President has been a fantastic learning experience and I am thankful for the skills I’ve acquired and the people that I have met. It has been really tough at times, but I think I will genuinely miss it.

I have now handed over to two incredible women; Manisha Premlal and Veronica Girgis, who will be leading Galenicals for the next year. They ran in competitive elections and bring exciting manifestos. I am looking forward to seeing the future of Galenicals.

Very best wishes, Alice Watts Former Galenicals President (2021-22)

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Our new presidents: MANISH PREMLAL

Hey, I’m Manisha and I’m a third year Medical student and will be one of your co-presidents for the next year. I was thinking about my last few years at Bristol and decided to apply for the post last minute. My time at Bristol so far has been really great, despite the pandemic and things not going as expected, I’ve managed to meet some wonderful people and enjoy my time here. Going forward, I really want that to be the case for everyone. University can be a rocky time for some, the course can be stressful, life can get a little complicated and sometimes we just need a friendly face to talk to. I want it to feel like a safe, happy space for everyone where you’re genuinely enjoying yourself and feeling like you’re thriving.

Keeping students connected with societies and socials and feeling like they’re part of something and not just a number is really important to me.

Hopefully with our brilliant committee this year we can aim to do that this year.

VERONICA GIRGIS

Hi everyone, my name is Veronica, and I will be working alongside Manisha as your co-president of Galenicals this year. I am currently intercalating at the University of Manchester and I think my time away from Medicine has given me motivation to make my last 2 years at Bristol count even more!

My experience in the first 3 years had its ups and downs, I’ve made lifelong friends and enjoyed how medicine has pushed my learning to new levels but at the same time there were periods where I felt very isolated. I think it took me some time, before I realised that uni isn’t all about Medicine, and there’s so much more we can get out of our time. In addition to this, I was also inspired by people around me shaping students’ experience! Medicine connects us all and there are so many ways we can support each other and help each other grow. I think this role is going to teach me so much, I’m excited for the experience it will give me and I hope I can do it justice for all of you. Please don’t hesitate to contact any of us anytime and good luck to everyone with their exams! :)

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GALENICALS COMMITTEE 2022-2023

CO-PRESIDENTS: MANISH PREMLAL VERONICA GIRGIS VICE PRESIDENT: ELIZA BURGESS

SECRETARY: LIZ BAYRAMOVA TREASURER: MADOC MILLER WEDMASTER MAKS TABOR SPONSERSHIP DIRECTOR VERITY WAY EQUALITIES DIRECTOR SALMA HASHIM EVENTS DIRECTOR EMILY SIMPSON AND MILLIE KNIGHT SPORTS DIRECTOR IZZY ELKINGTON SOCIAL MEDIA DIRECTOR BETH MCDOWELL WELFARE DIRECTOR MADELINE GOODFELLOW SUBSOCIETIES DIRECTOR AMY FOWLER

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Where the hell is Bristol Medical School?

The internet isn't sure - it gives a list of places with 'Bristol Medical School' in the name, but these are just buildings some people from the faculty use from time to time. Someone's office, an admin room, a filing cabinet, but not the medical school.

Look at images of Cardiff, UCL, Barts; they all have buildings, new and old, but definitely medical schools. They're large, imposing structures which project a confident, professional image of medical education.

Ours is a fairly unique situation to be in. We have an unusual course which takes us not just all over Bristol but all over the South West. In a single day you might spend a morning in a GP in Gloucester, followed by an afternoon tutorial on St Michael's Hill looking out over Bristol, then to a random sub-society at a far-away leisure centre or pub.

Different furniture, different buildings, different cities.

If you're familiar with the history of the medical school, you'll know it's a surprisingly interesting, rich and nuanced story. It goes some way to explain the situation we all find ourselves in today.

Our story started in 1737, and it wasn't until 1892 that an actual Medical School was built - in those 155 interim years, there was a sporadic mixture of teaching: lectures given in people's houses, an anatomy lab built where the College Green Cathedral pulpit now stands.

Random internships were offered in the various hospitals, infirmaries and psychiatric hospitals in and around Bristol, and due to the lack of Royal College exams for many years (and the unofficial nature of a medical education in past centuries), it just went on in this patch-work fashion for decades and decades.

That 1892 building is now the Department of Geography; you can see the motto of the RCP above the entrance, translated by Chaucer as 'The life so short, the craft so long to learn'. The medical library was forced to move in 1911 because the University wanted to use it as a Council Chamber and Senate Room, and as years went by, more and more of the building was used by other parts of the University, and the Medical School was gradually pushed out. The medical library went to the basement of the 'Bristol Royal School and Workshops for the Blind' for four years – this was an institution which taught blind people skills they could use for paid work.

The library then was moved to the racquet court of the Drill Hall until 1925, and then went underneath the main library in Wills, and finally ended up where it is now.

What a mess.

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In 1919 the Board of Education sent a man called Sir George Newman, (the Medical Secretary) to check Bristol out. In a meeting, he said Bristol might have a medical school which "was great in tradition and in the length of its history, but it was not great in all respects... it was" he said "all at sixes and sevens". The man had a point - take our placements; until 1922 if you wanted to do this clinical work as a medical student you paid the hospital, not the university, with money split between the hospital staff. Predictably, this created competition between different hospitals to attract medical students.

Eventually it was decided that students should pay tuition to the university, and staff could take on part-time temporary teaching roles at the university, which is essentially how it's done today.

There were attempts made at collating the many parts of the medical school into one big university hospital, but this never happened despite funding being made available by Henry Wills.

Hospital politics got in the way, and nothing much has changed. There are multiple University Hospitals, and we now take part in placements across the Southwest. There is no set building, no set list of staff, no set placements. We will end up being taught practically anywhere, by anyone, at any time over the course of 5 years, but somehow, we all come out the other end as competent Doctors. That's pretty cool if you ask me.

Ours is a medical school that works via Outlook, blackboard collaborate, and MyBristol. Tutors come from a range of departments and careers; everyone does something else - teaching medical school is a side-hustle. They give up their time, and we see them regularly for a few weeks, months, or years, and then we vanish from each other's timetables. Ships passing in the night, tourists in each other's lives.

Nothing may seem particularly permanent at Bristol Medical School, but that which is permanent cannot be seen. It's the precious knowledge we attain, the relationships we build, and the experiences we gain that will last lifetimes, not bricks and mortar. And we wouldn't have it any other way.

Written by Max Gerard.

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Sun, Sea and Serious Business Have you ever wished you lived on a tropical island like the Maldives? Perhaps even thought about what working there would be like? We all know a little bit about what working in healthcare in the UK is like, but don’t often know much about it outside the UK. Sarah, who is currently studying her masters in Epidemiology at Bristol had a fascinating role before commencing her studies with us. She first studied a bachelor’s in health rehabilitation in Australia, before joining the public health sector of Maldives under the WHO. She was kind enough to share with us a little about her life in Maldives and what working in such an influential role in public health was like.

I understand you are studying a master’s in Epidemiology at Bristol, what made you want to join Bristol Medical School?

One of the main reasons I applied was because Bristol was part of the Chevening scholarship scheme, which allows international students to study in the UK. I wanted to study epidemiology for a while because of my job. We are a very small country and when it come to higher education, especially health related, we have very few opportunities. You either have nursing or public health, whereas I was hoping to study a more specific course like Epidemiology.

Chevening was how I could get there. Obviously, Bristol has a great reputation, especially when it comes to health research. A bonus was that Bristol itself is a beautiful city.

What was your role in the ministry of health?

I manage the national emergency and health preparedness program, and I have been doing this since 2017. It is a very rewarding job, but it is a very busy job as well, you had to be on call 24/7. Even when emergencies that weren’t directly health related like fires or flooding occurred you had to be prepared to coordinate the health sector. When the Maldives emergency operation system was established in February 2020, I was a leader in the contact tracing team. I used to supervise all the contact tracing teams under the guidance of health prediction agency. I worked in contact tracing till September 2020, and then this year I started working with the vaccination campaign. Getting all the data from the island was a part of my role, it was very different from other parts of the world because we are all islands. Then, I transitioned back to contact tracing in the smaller islands. At a point we were getting about 2000 cases daily within a population of 400,000. We had to separate our contract tracing, so we had to separate sections between smaller islands and Male, I worked with establishing a system for atolls (the smaller islands in the Maldives) as our old system got so overwhelmed (we actually had to revert to google sheets at one point – we ended up setting up a google sheets for each island). I’ve worked in different areas of the response so far it was an interesting experience – I don’t think it’s one that anyone else could’ve gotten.

Prior to your role at the Ministry of Health in the Maldives, what roles did you work in?

I finished my bachelor’s in health and rehabilitation science in Australia. My degree was focused more on allied health, but we had one module around health promotion and public health in our last year. When I went back home there was no scope for allied health as we

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don’t really have that there. I was unemployed for 6 months, since I had that one module of public health the minute a position came, I took it.

My first position was at the society for health education at the Maldives. There I was a programmes officer and responsible for communication and resource utilisation. We ran workshops to provide education for sexual and reproductive health, mental health and similar things. We would travel to different islands and have workshops for parents and teachers, for different sub populations. I loved travelling within the Maldives, and I naturally gravitate towards jobs I can travel more. I worked there specifically to support the elimination of measles in Maldives, we carried out a nationwide MMR vaccine campaign to create the herd immunity that was required. We were able to get certification for elimination of measles from the WHO in 2017. Maldives is one of the few countries in our region which reached that goal, because we have good vaccination rates and we worked to maintain that. Because I got to know the work and the people there, I got really interested in it.

How did you find the role/what pushed you to take it?

At my previous position, I felt like I wasn’t fulfilling my potential. I was doing stuff that was more administrative. It happened by chance, an acquaintance mentioned WHO were looking to hire a consultant for the measles campaign. I had an interview, and they were happy with my experience, and from there I transitioned to my current role.

How did you find working there? What did you like about it/what challenges did you face?

It’s combination of good and bad. It’s a very small country, we are severely understaffed. Over here, there is probably a large department whereas back home our entire national surveillance department was run by 3 people. With the emergency preparedness and response program, I am the only permanent staff. You get the freedom to do what you want, you can say “this is what needs to be done this year”. The bad thing is that you get severely overworked, because you are doing the work of 3 or 4 people by yourself. A lot of people working in the ministry, we are crazy about our job. We prioritise it over ourselves. It can be a bad as sometimes you tend to put your personal life to the side.

How did the pandemic affect your life there?

I think it was different for me as I was personally involved. None of the staying home applied to me. We started our prep work in middle of January. As emergency program manager, I had to be a part of everything. Since January I have been working since coming here. We prepped very early on, and we were praised by WHO. Basically, it was all day and all night, I only went home to sleep. Only social life was within work, so I got to know my colleagues on a more personal basis. It became like a family at work for me.

The Maldives has a very lovely reputation as a holiday destination, but what was living there like?

In my country, I live in a place called Male. It is capital city of Maldives and it’s the most crowded city in the world. It has a 5 km radius so you could walk through the whole city, with 250000 people living in the small space. The way the Maldives is arranged is in chains of islands. There are capital islands with the centre hospitals. The smaller islands only have one doctor and a couple of nurses. The island life is peaceful, compared to the city of Male which is quite congested. There are a lot of people, lot of noise. I always have the luxury that I can get on a boat and get to a beach in 5 – 10 minutes, I feel very lucky because of that. People here have their own idea of tourism; they think it’s simply private resorts which our usually owned by foreigners. We have local bed and breakfasts and guesthouses on local islands now, where

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the profit goes to the communities. They give you a better chance to experience the community rather than a 5-star hotel.

Was it difficult transitioning from working life to being a student?

It’s not that difficult, it just took some time to get used to things. My job was very full on, so sometimes now I feel like my mind is more relaxed whereas before I felt like I was on-call 24/7.

Now I just focus on my studies. I was grateful that my work gave me unpaid leave, so my job is waiting for me when I go back. They have given me the space to study, they haven’t bothered me other than figuring out where the files are.

Do you have any plans for after you finish your course?

I am hoping to get a job in the epidemiology section – right now I work in the health emergency and preparedness section. Even though the titles are different, because we are a small country you end up doing a little bit of everything. I am looking forward to going back and am hoping to improve the epidemiology system. Right now, we are very understaffed so I feel like can go back and improve some of the surveillance systems, so we are better able to predict increases in cases.

What would you say to people who are perhaps interested in migrating to the Maldives and finding similar roles?

With Maldives, we have a lot of foreign doctors and nurses. In our country, we don’t have many health resources so there is a lot of demand. You get to work in very different situations, for example like a small island community. We have had medical students come and intern previously when they have requested. We didn’t have a medical school until very recently (23 years). There’s always a high demand for people from other countries back home. When you come from another setting, you bring a different perspective with you which we value.

Written by Akshata Valsanger

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Ketamine – A Peeping Tom at the Keyhole to Eternity…

Written by Max Gerard A new wave of ketamine hype has swept the western world, catalyzed by the pandemic, to the point where in the autumn of 2020 some twitter users announced that the influx of ketamine jokes was considered cringe.

Ketamine From club drug to dissociative therapy agent, ketamine’s future is now looking bright.

The gradual de-stigmatization of the once scary ‘horse tranquilizer’ is leading to a new frontier of clinical research into the drug.

An awareness of ketamine’s medicinal effects is hardly news. In 1985 the World Health Organization designated K an ‘essential medicine’ due to its anesthetic and painkiller properties. The drug was widely used in the Vietnam war by the U.S. Army under the name ‘Ketalar’, and to this day it’s still used as an anesthetic in Emergency Rooms around the world. This is also where it got the reputation as a horse tranquilizer, as vets also use it as an anesthetic.

At high doses, Ketamine knocks people out. This was discovered by a man called Edward Domino, who conducted the first human trials for the drug. He conducted his experiment on prisoners back in the 1960s; I’m sure the ethics committees of today would have something to say about his choice of subjects. More importantly however, Domino also discovered that at lower doses, there were some intriguing psychoactive effects in his subjects, despite them remaining lucid.

Usage What does Ketamine feel like?

In the late 1970s, a prominent doctor, researcher and (most interestingly) mystic John C. Lilly MD self-administered in order to achieve an altered state of consciousness. His description is stunning - he describes his varied experiences as “a peeping Tom at the keyhole of eternity.” - Reflect on that one for a second.

In a Vice article published towards the end of 2020 titled ‘People Are Using Ketamine at Home to Escape Their Pandemic Reality’, it quotes a woman who started using Ketamine as a way of coping with the mental burden of the pandemic. She’s quoted as saying; “Some people get into witchcraft. Some bake bread. I’m doing ketamine,".

Unsurprisingly there’s little data collected about how many people are starting to dabble in drugs like this, but the Vice article shares some anectodical evidence from suppliers which suggests an uptick in use during the pandemic. One reason for this might be the effects that this substance has on the mind, whereby users remain lucid

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but still dissociate from their body. Ketamine is a dissociative anesthetic, and this potential widening of the gap between their perception and reality was welcome for many during lockdown, a time of heightened feelings of uncertainty, stress and loneliness. Use of ketamine has been compared to drinking a glass of wine at the end of the day –it allows people to unwind, to get away from the stressful noise of daily life in their head. It's also been used as a club drug, particularly infamously in Bristol, for the same reasons; people can remain lucid and aware of their surroundings but still dissociate their mind from their body. It’s been described as similar to weed edibles, but the come-up is slower, and with more intense effects.

Dangers Those who use Ketamine can become dependent, and it’s easy to; people have described it as a ‘low investment’ drug. Not only is it relatively cheap, but its effects are not so long-lasting that you can’t take it in the morning and plan something in the afternoon –its effects only last around an hour.

Naturally there are dangers to Ketamine; most importantly there’s a risk of overdosing, but prolonged exposure can also have detrimental effects on several systems.

Dependents of Ketamine often have serious bladder issues sometimes leading to the bladder being removed, along with immune system problems and a plethora of other negative effects. Such stories of people’s bodies being trashed by Ketamine can be found online, such as the death Nancy Lee from Brighton who over 7 years slowly destroyed her body though Ketamine use, but she never exercised, didn’t eat well – she didn’t look after herself; perhaps a symptom of the lack of adequate drug education in schools.

Research The anti-depressive effects of Ketamine are well-researched, but what’s interesting researchers now is the best way of administering the drug, as well as the best way to make use of its effects. The combination of Ketamine as a dissociative substance, which lasts for about an hour, alleviates anxiety and depression and allows subjects to remain lucid, makes it a good candidate for being used alongside psychotherapy. This is being trialed in Bristol, where the UK’s first Ketamine-Assisted Psychotherapy Clinic was launched last year. It costs £6000 and has been deemed costly by some, and perhaps lacking evidence for being used in this way. The goal for this therapy seems to be to combat treatment-resistant addiction, depression and anxiety by medicating subjects with Ketamine, which assists them in opening their mind to allow more productive psychotherapy sessions.

The Future Ketamine has a promising clinical future. Through open-mindedness and destigmatization, we can help more patients than ever before in the world of Psychiatry, but we need to work safely, and in the most effective way possible to maximize the benefits this drug can bring.

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How to be an LGBTQ+ Ally

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I asked some of my fellow queer medical friends what makes a difference to them. These points might encourage you to reflect on your own behaviour and biases but remember everyone is unique and these people do not speak for the whole of the community………………………………….…………………………………………... ……..

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STUDENT VOICES

He/Him For me, being a good ally is simply about being aware of the LGBT+ community and about making sure that those little, small things that make people feel more accepted/included become part of a normal routine. For example, asking ‘are you seeing anyone/are you dating anyone?’ rather than saying ‘have you got a girlfriend- making no assumptions. Being aware of pronouns etc.”

She/Her “Something I appreciate is not assuming the pronouns of a partner. When people ask, “have you got a boyfriend?” it’s awkward to explain no, and it sets a very heteronormative way forward that makes me feel defensive from the start. Despite knowing they are probably very accepting, a part of me worries from that point forward about coming out to someone who may not be inclusive.

Medical professionals have assumed the same and it’s difficult to feel comfortable to speak openly, especially when having conversations about sexual health.”

He/HimAn“Ially don’t non-queer people realise to think the LGBTQ+ community is a how powerful their opinion can be a room.

If I heterosexual and cisgenderinperson that raise actively a pointsupports about the LGBT+ inclusion or community and the wellbeing, I often get the impression movement towards equality. people may think it is me just shoehorning my identity into the situation. When someone who isn’t personally affected by that issue in their day to day lives speaks up on it or backs you up when you speak up on it, the others in the room definitely take more notice. I often voice something in a medical setting because I feel an LGBT+ perspective hasn’t even been considered in that situation, only for that to be met with silence or just awkward looks around you. This can be so crushing; that silence often masks shame and an unspoken disapproval for your identity. Privilege is powerful and the opinion of non-lgbt+ people is often still far more resonant and audible above our own. Yes, that needs to change in due course, but until then, back us up!”

An ally should both amplify the voices of individuals within the group and An ally to the LGBTQ+ community is a heterosexual and cisgender person that actively supports the community and the movement towards equality.

An ally should both amplify the voices of individuals within the group and individually challenge the behaviour and ideas that continue to oppress and damage the LGBTQ+ community If you want equality, you are already an ally but to be an active ally there is more work to be done Here’s how you can get started: 1. Check your privilege and learn about the history, oppression and challenges of the LGBTQ+ community 2. Be open minded when listening to others 3. Reflect on our own unconscious biases and prejudices 4. Don’t assume people are straight and cisgender, start to think outside the heteronormative world we live in 5. Language matters – get confident with the right language when talking with LGBTQ+ people 6. Call out the problematic behaviour and language when it is used and educate others on why it isn’t acceptable 7. Know that you will sometimes make mistakes and take responsibility when you do 8. Turn your allyship into an action rather than a label by doing the work

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Review: This Is Going to Hurt The most common question medical students have been asked ever since Adam Kaye’s best-selling non-fiction medical memoir was published back in 2017. What a treat to find out a screen adaptation of the book had been released as a seven-part comedy-drama on BBC1. The excitement to start it was overwhelming; a book that spurred on (or perhaps deterred?) a generation of unknowing teens to embark on a medical career, naturally I curled up on the sofa ready to watch the entire series in a day or two.

Before I divulge any tantalising spoilers, binge watch it yourself or open the book to find out for yourself just how brilliant his story is. But for those still unaware and lacking the time to watch it themselves let me explain, the series charts the turbulent life of acting registrar Adam Kay in his job in Obstetrics and Gynaecology at an NHS hospital in London in 2006. During the series Adam is faced with innumerable challenges trying to juggle his personal and professional life in a chaotic system that is the current NHS. From broken computers and faulty emergency alarms to Adam struggling to get a psych review of a vulnerable 19-year-old patient who attempted to perform cosmetic surgery on her vulva, the series provides a startlingly accurate representation of the realities of life on an NHS labour ward. The direct juxtaposition between Shruti, one of Adam’s more junior colleagues, on her NHS shift, and Adam’s shift in private care where the staff get room service, an abundance of clean scrubs and each nurse only has one patient to care for further emphasises the underfunding of the NHS. The shock on the faces of my non-medic housemates, asking “is this really what it’s like?” or “surely this is just the stuff of fiction?” demonstrates just how desperately we need change.

What was most impressive about This Is Going to Hurt is how it explores the struggles doctors face daily in such an honest, accessible way. For example, a central plot within the series follows the ramifications of Adam’s his first big mistake. In the first episode, he discharges a patient named Erika because he believes she is faking her symptoms.

We later learn that Erika is displaying early-warning signs of pre-eclampsia, and Adam is forced to perform an emergency Caesarean to deliver her 25-week-old baby. As a junior doctor, Adam is ill-equipped to perform this surgery and consequently, Erika loses a lot of blood and Mr Lockhart, the consultant, is called in to take over. Adam is tormented by his mistake; throughout the series he sees flashbacks of the incident and eventually Erika lodges a complaint against him.

However, in watching all that precedes Adam’s decision to discharge her, you naturally sympathise with him: the day Adam consults Erika, he wakes up in his car just before his shift, parked in the hospital, having fallen asleep from exhaustion the day before.

The hospital is overrun with patients and Adam is the most senior doctor present. He is called back in for an extra shift that night, missing his best friend’s stag do. You 19

realise that these working conditions would force even the most experienced doctors to make mistakes. The public expects doctors to be more than human - not just NHS heroes, but superheroes. But mistakes will always be made when working in a fragile, unsupported organisation.

This is most poignantly emphasised by Adam in the series’ final episode. In the previous episode, we learn that Shruti has taken her own life. At his tribunal, Adam honours Shruti’s life and draws upon the overwhelming stress she, himself and other healthcare professionals experience when forced to work in a broken system. He even points out that one medical professional, like Shruti, takes their own life every three weeks. The irony is that Shruti made very few mistakes in her job: she successfully assists delivering triplets; catches a ruptured ectopic pregnancy early; deals with Adam’s haemorrhaging patient swiftly; passes her incredibly difficult specialty exams first time; and deals with a domestic abuse case with unceasing compassion for her patient, even when she herself gets abused by her patient’s husband. It was this compassion that reduced me to tears; it showed the public just how much of the job goes further than medicine. I was upset, confused, and angry when she took her own life. The gradual deterioration in her mental health that was so tangible on screen felt unbelievably unfair. It was such a powerful, heart-rending demonstration of the ridiculously harsh realities NHS workers face daily.

On a more positive note: the humour. Kay’s script for the series is just as laugh-outloud funny as his books. You laugh, mostly when you feel you weren’t meant to, and especially when Ben Wishaw breaks the fourth wall in a such a brilliantly comical, almost appalling way. The dark humour is a perfect means of introducing difficult issues in an entertaining, approachable manner. It is perhaps also what some doctors use to smile in the face of adversity. As Steven Fry said, ‘it is painfully funny, the pain and the funniness somehow add up to something entirely good, entirely noble and entirely loveable.’

This Is Going to Hurt really did hurt but was even more worth the watch because of it.

One thing’s for sure, I won’t be going into Obs and Gynae.

Written by Tiga Hombrey

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Divorce’s Grey Area

Once a week, I look after an elderly lady, Pat, whilst her husband goes to the local bridge club. Pat has Parkinson’s and whilst she remains mentally agile, her body is beginning to let her down, to her increasing frustration. For a while, I worried she was depressed and so I was pleased to hear her friend Sue was coming to stay indefinitely. When I first met Sue, Pat’s grandchildren remarked loudly with the kind of unawareness that only children can get away with, that Sue “was homeless so she had to stay with Granny”. Upon my admonishing, Sue replied that she had left her husband of 50 years last month and so in fact the children were correct; “at the age of 68, I am homeless”. She later recounts to me that she met her husband aged 20, he was 35, and his controlling behaviour had weighed her down for years. During the first coronavirus lockdown she was hospitalized for an extensive period due to endocarditis, during which she was, to her surprise, the happiest she had been in decades. It took her just over a year after that realisation to leave her husband. She attributes part of her courage to divorce him to her GP, who when Sue confided to her that she felt too old to leave her husband, simply replied that plenty of people do at her age.

In our society we romanticize the last few years of marriage, in fact “growing old together’ is one of the most frequent phrases in wedding vows, and nearly always the ending of any romantic film or book. The idea of ending a relationship that late in life is at odds with the genial picture of a grey-haired couple gardening together and dying a few days apart as they simply cannot live without each other. Although this is a beautiful picture, it is unrealistic and increasingly outdated. In fact, Sue is not alone in her decision to walk away from nearly 50 years of marriage. In England and Wales, despite that fact that divorce across all ages is on the decline, the divorce rates for opposite sex couples aged 65 and over have gone up by 46% between 2004 and 2014. This dramatic change in the living arrangements and daily lives of a large number of over 65s has vast health consequences and it is impertinent that we aim to explore and understand this phenomenon. What is causing this increase and how does this impact the health and social networks of older age divorcees?

Why is Divorce in the Elderly on the Rise?

There are several factors cited as being responsible for this increase in divorce amongst older adults. One common theory is that due to the inherent gendered nature of heterosexual marriage, women having to take their husbands’ name etc, that as women have become more financially independent and socially liberated, they have begun to challenge the constraints of sometimes, decade long marriages, and this leads to eventual breakdown of the marriage. A study by Hochschild and Machung (1989) found that even couples which felt they had a gender equal marriage, still displayed traditional disparities between childcare and housework. In older marriages, children may have now left the home and the wife may feel she no longer is motivated to do the housework in order to appease her husband; a functional human being perfectly qualified at doing the work himself. Older women are more likely to be educated than previous generations and as such may have more financial autonomy and be less trapped in unhappy marriages. This theory is supported by research which shows that women are often the catalyst figure in the breakdown of heterosexual marriages. One study found that women in the US were responsible for 69% of marital ending.

Another theory is the idea that women are more in romantic demand when they are younger and therefore older men are more likely to divorce their long-term wife in order to seek out a younger woman. However, this theory is unsupported and is at odds with the evidence above that women are often the ones asking for a divorce.

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A much better theory is the idea of increased longevity. “Life expectancy has increased in the UK over the last 40 years” and therefore we have a much greater population of over 65s. The impact of such an increased life span on divorce was explored by a 1998 study which suggested that “increased longevity and health extending into later life may increase the availability of and responsiveness to spousal alternatives when childrearing nears the end in a marriage.”. The doubling of the rate of divorce among middle aged and older adults between 1990 and 2010 translates into a substantial increase in the number of people aged 50 and older who experience divorce.

What does this mean for the health of our elderly patients?

When couples divorce later in life; there can be vast consequences. The mental health impacts of divorce are extensive, and the loss of a long-term partner can be akin to grief in its ferocity.

In addition, there may loss of a carer and individuals may have to rapidly learn new skills that they have had a partner completing for years’ such as cooking. As we begin to respect and view social medicine and anthropology with an increased interest amongst medical research, we must acknowledge this shift in lifestyle and living arrangements of a large proportion of our elderly. As doctors, we must respectfully refrain from stereotyping and allow older people to explore new relationships and take risks in leaving old ones.

As for Sue, she is so extraordinarily happy it is hard to describe, she has bought a campervan and converted it to fit her needs. She stays with Pat and her daughter during the week, and then at the weekend she heads off around the country to explore. Of course, there will come a point where this is not physically possible; an 80-year-old living in a campervan is probably a living arrangement that many of us would judge and pity. However, the freedom she feels is similar to that of a teenager leaving home for the first time. She is discovering herself again and that is worth far more than the sanctity of a house with heating and a partner to die with.

As out whole society is living longer, with more social and sexual freedom, we must try to encourage older individuals to make good choices that allow them to live out their life in a positive way and not shame them into unhealthy environments just because we fear dying alone.

Written by Molly van der Heiden

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The magic of mushrooms – an interview with Barney Neal I had the pleasure of speaking to Barney Neal, the chief communication officer at Albert Labs, a company working to quickly get psylocibin licensed to treat mental health conditions. We spoke about psychedelics and how they might be a treatment one day on the NHS.

What are you working on at the moment?

I have several roles. My first is working at Albert Labs, a biopharmaceutical company that conducts clinical research on psylocibin. We are looking to support cancer patients with their mental distress. I’m also the cofounder of the Psychedelic Medicine Association. This is a platform that aims to educate the front line of the health service on psychedelics. I used to work in venture capital, and I am an engineer by trade.

Why is your company called Albert Labs?

It’s named after the notable swiss chemist Albert Hoffman. He first synthesised psilocybin from mushrooms. After he synthesised psylocibin, he ingested it. He then saw potential for the use of it in psychiatric disorders.

When was psylocibin first synthesised?

1952. We’ve had 70 years of knowing about these drugs but given the stigma and politics around them we are only just getting to legalising them now.

How does the treatment work?

There are 3 stages. Pre-therapy, where you prepare the patients for what a psychedelic experience might be like, and the overwhelming feelings that come with the treatment.

Then there is a single dosing day. The patient will be treated in a very cosy setting with nice lighting, music and soft furnishings. They will be dosed with 25mg of psylocibin. 30-40 minutes later they will be in a full-blown psychedelic experience. During this time, they will be accompanied by a psychotherapist. They will monitor the patients, making sure they are comfortable. They will ‘hold the space’ to allow the patients to heal themselves.

Third, there is post integration, where patients are helped to integrate new ways of thinking back into their lives.

Why is Albert Labs running trials on cancer patients?

Cancer patients can be those who struggle the most in society. It’s impossible to imagine the anxiety and mental distress that someone facing cancer endures. We want to help them with their unmet needs.n the UK alone there's about 1.2 million cancer patients who have severe

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distress. That is the number of patients we wish to treat. These patients have anxiety, depression, or existential crisis.

What is existential crisis?

This is the fear of dying. It needs to be discussed much more. Psychedelics could be hugely helpful for this.

Do we know how psylocibin actually works?

I’ll explain as best I can. The person who I always take inspiration from is Dr Robin CarhartHarris. He’s the head of the centre of psychedelic research at Imperial College London.

Following admission of psychedelics, fMRI scans show that the brain enters a state of hyperconnectivity. In this state, areas of the brain that don’t normally talk to each other, or connect, appear to connect.

An area of the brain, called the default mode network, is also deregulated when taking psychedelics. This area is responsible for one’s ego, or sense of self. Deregulation of this area leads to a change in the way one thinks. This is very powerful. People also feel like they are having an out of body experience, where they are looking down on themselves.

One analogy that I like uses the image of a skier. An ill person’s brain connections are like that of a ski run where all the pathways have repeatedly been carved out. It is hard to not go down the path that has already been carved. But with a fresh layer of snow, or psychedelics, it allows you to carve out your own path. This is similar to how neurons work, new neural pathways are opened up after taking psychedelics. The way we think changes after psychedelics. New thought patterns develop. These changes happen after just a single dose.

What if you took psychedelics without the pre- and post-integration?

This won’t cure your mental ill health. You need the pre- and post-therapy paired with the psychedelic to help ill mental health. Recreational psychedelic use, say at a music festival, is for pleasure, but isn’t helpful to your well-being in the same way. In a controlled treatment setting there are factors like comfort, and safety that help the psychedelics improve mental health. Your mindset is really important to control so that you have a good or healing trip. The outcomes are so much better in the clinical setting. And the risks are far worse recreationally.

Are there any good documentaries on psychedelics?

Yes. ‘Magic Medicine’ is great. I like how they describe psychedelics as like having the best therapy in a single capsule, but the therapy is yourself.

Does stigma still delay psychedelic research?

Absolutely. And stigma limits funding. We need to improve attitudes to psychedelics still.

Nixon’s war on drugs suppressed society and was all about controlling people. The US government spread misinformation on psychedelics to accelerate the prohibition of these substances.

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Do you have any book recommendations on this topic?

‘Sedated: How Modern Capitalism Created Our Mental Health Crisis’ is fantastic. It looks into how we treat mental health. Lots of people are given SSRIs that don’t work on them long term.

SSRIs are better as a short-term solution, for example for people with suicidal ideation.

Psychedelic assisted psychotherapy could cure someone’s mental health indefinitely.

Are psychedelics clinically available anywhere at the moment?

Oregon state in the USA is in the process of legalising certain psychedelics. Canada has a very liberal relationship with drug policy. There’s an interesting charity out there called Therapsil. Therapsil treats cancer patients with psychedelic therapy. 500 therapists went through their own psychedelic experience to help better how they treat patients with psychedelics. Truffles, a psylocibin is legal in Amsterdam. This is just a loophole because they are essentially magic mushrooms but are truffles, so they grow underground. In Jamaica, or some south American countries there are legalised uses. Importantly, nowhere has legalised psychedelics for medicinal use.

What research approaches are Albert Labs using?

We use a real-world evidence approach. This is a subtype of clinical trials that looks at a broader data collection with a focus to what happens in the real world. It is a much faster method to get drugs licensed than randomised controlled trials. It is the method by which COVID vaccines were developed.

How long do you think it will be until psylocibin is available on the NHS? Another company, COMPASS pathways, estimates that psylocibin will be available on the NHS for treatment resistant depression in 2025.

Our company, Albert Labs, hopes to get psylocibin assisted psychotherapy licensed by 2023.

Have you used psylocibin yourself recreationally?

I have. I’ve tried psylocibin, LSD, and MDMA. The whole class of psychedelics are completely misunderstood. Luckily, I have never suffered from depression. But when I experienced these substances, I just knew that they could better someone’s mental health. Most people are unaware that psychedelics aren’t crazy and have huge potential.

Written by Katherine Grigg

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So do you like medical history in your curriculum?

I’m not talking about taking a history - that’s something we all have to come to terms with learning. No, I am interested to see what people think about learning about the history of medicine. Galen, Avicenna, Lister and the like.

Why should you be interested in cramming more into the already pretty packed 4-6 years we “enjoy”? Well, simply, it will have two benefits that I guarantee you’ll be interested in.The first is that, quite frankly, if we learn our history, we’re less likely to repeat the tremendous messes that our ancestors have found themselves in. In truth, as a profession we have already made a considerable number of catastrophic errors that even a fresher on Tuesday morning with a brass pig stamp on their hand could begin to question. Of course there are those who more complex errors. To look back over our history, allows us to find those mistakes and not do what they did. That’s putting it simply (and facetiously) but I do believe there is an awful lot to learn from these blunders.

For example, and I hate to bring it up, if we consider the pandemic. Through studying, and being familiar with, the conditions that stopped (or proliferated) the coronavirus pandemic, we can far better equip ourselves to tackle the next pandemic that will hit us.

Secondly, and perhaps more immediately useful, is the fact that historical anecdotes help facts “stick” in your head. Many of our lecturers employ this technique and often use tales of discovery and strange experiments to preface a key point. Whether intentional or not, that story can provide a neat little story to help you remember what the important detail of that topic was.

You’re definitely going to be more likely to remember the importance of electricity in the human body after learning that Luigi Galvanni liked making severed frog legs dance by sticking electrodes on them (look it up).

This can be scaled up to remembering larger subjects. It can be helpful to look at the entire topic in the context of it’s discovery and development.

I invite anyone who doubts otherwise to listen to Bedside Rounds. I owe my understanding of sensitivity vs specificity pretty much entirely to his episode on the history of diagnostic testing, where he discusses how those concepts formed in the minds of medical researchers during the early 20th century. There are some under fully human (so also very strange) stories out there in medical history.

Yes, you can probably tell that I very much enjoy learning about history after reading all this.

And while, yes, this may just be me wanting to indulge in my interests as part of my course, I believe a dash of a history into our learning could make things more interesting and more memorable.

Written by Louis Davenport

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“WhY WouLd YoU go To MeDicaL ScHool to PuT PeopLe tO sLeEp?” A reflective time that comes to mind would be on my anaesthetic rotation. I shadowed a speciality registrar (ST5) in anaesthetics and an ACCS trainee, and the day started off well. I got involved in a range of cases, learning about specific anaesthesia, various conditions, and their management. I felt part of a team.We went into the last case of the day, where there was a specific note to 'have a consultant anaesthetist present' from the very beginning. The consultant anaesthetist for the day was very busy with other procedures and supervising other theatres but quickly judged that the ST5 was competent enough to carry out the procedure.

This was then communicated with the consultant ENT surgeon, and everything seemed to go smoothly.

The main reason a consultant anaesthetist was required for this procedure was that the patient had Turner's syndrome. Turner's syndrome is a genetic condition that presents with various manifestations. The first noticeable one was that the patient was challenging to intubate due to her internal anatomy; she had multiple comorbidities, making it tricky to cannulate her. In fact, I tried and failed to cannulate the patient, with the ST5 having to quickly take over. They also had to put an arterial line in the patient. This created what others would call a 'delay' but what anaesthetists would call 'adequate safety time'.

Ultimately, the patient was anaesthetised safely. It was only until bringing the patient into the theatre that there seemed to be a problem. The consultant ENT surgeon loudly proclaimed that he wanted a "f***ing reason why this took so long". The registrar initially laughed - thinking this was a joke. Still, the surgeon carried on with his outburst of expletives, stating that we've "wasted his time" and he needed to attend a "parent's evening". The room began to descend into chaos. The registrar clapped back, stating that this was a difficult patient to anaesthetise.

Again, the surgeon rebutted and said, "well, the consultant should have done it". Then, like clockwork, the anaesthetist walked in, coming to the defence of the registrar and taking control of the situation with her professional manner. I stood in the corner and watched this whole ordeal, shocked and unsure of what to do or how to even help. Did I contribute to this delay?

Instead, the assisting surgeon, an ENT registrar, used this as an opportunity to teach me some basic ear anatomy. I was almost dismissed from the anaesthetic team as they seemed so focused on getting through the procedure. The ENT registrar called me over to look at the procedure the consultant was performing. It felt like he wanted to appease the situation.

However, he did make a sly pass at anaesthetists, saying that "why would you go to medical school to put people to sleep?" The same could be said for his own infatuation with ears.

Nevertheless, I still managed to stay focused and listen attentively to his teaching.

I didn't end up staying for the whole thing. The room started to get packed with more budding ENT surgeons - as this was, I heard a "fascinating procedure", but with the last event still fresh in my mind and the clock hitting 4:30 pm, I decided to call it a day. I thanked the team and quickly asked the ST5 to sign my logbook, which he happily did. I left and felt an element of shock with what I witnessed. I have never seen a doctor act so unprofessional toward his colleagues. That poor communication ruined the environment, making it toxic and silent. I vowed from that day to always try to keep my emotions in check when speaking to colleagues.

It's something I do anyway, but understandably, when it comes to being a Dr, I sense I'll have many things thrown at me that could dampen my spirit. But in this instance, I thought: Would my outburst make things go quicker?

Written by Adewale Kukoyi

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RUN FRESHER RUN Since Lockdown 1, everyone and their dog has seemingly taken up running. Strava downloads were on the rise, Asics trainers began flying off the shelves and the world record 5k incredibly had 5 whole minutes taken off it by Rachel, 15. That’s why we decided to reignite an old flame and create yet ANOTHER medic subsociety, BUMS (Bristol Uni Medical Society) on the Run. Dead in the water for a few years, we aimed to get people back out again on a Thursday evening to get a bit of a sweat on amongst an obnoxiously large group of runners. Our inaugural run was in early October, attracting medics far and wide (plus the odd mathsy imposter) for a jog around the Downs. We’ve managed to keep up around 30-35 runners each week since, even through the depths of winter where the commitment has been second to none (from both the cold and the runners). The group has been highly varied - with a strong base of original BUMS coming every week as well as new faces appearing on the regular. We are really appreciating it not being pitch black at 4pm every week now, and hope to start getting some sunset runs around the Downs and Ashton court going again soon! After the weekly run, we like to finish at a different pub each week for a cheeky pint/lime + soda and a bit of chit chat. So if you ever notice a bunch of sweaty individuals wearing inappropriate pub gear on a Thursday evening, that’ll most likely be us! We love new faces and really encourage anyone to come along, we are as slow as the slowest person and focus more on socialising rather than stamina! It’s a brilliant way to get out the house and feel accomplished - what else is there to do on a Thursday at 6?

Insta- @bumsontherun_ Facebook- Bums on the Run

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YE OLDE BLACK BAG 2013

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Thanks for reading J Lots of love, The Black Bag Team 30