When you cut the antibiotics in half,
Don’t forget to blunt the ends before swallowing.
Wow, I apologise for the unexplained hiatus I took. 2 months! This post is going to be an unofficial breakdown on the summer exams here in Bristol med school and how I found them (they’re finally over for me, now let’s hope I’ve passed </3).
Structure: 60 MCQ questions (40 anatomy + 20 histology); 45 seconds per station (hence 45 mins long). The anatomy questions are 50:50 between pathology and identifying structures.
What: In Term 2, we began the Systems unit – for first year, we learn about the cardiovascular system and the musculoskeletal system. Each system integrates both the anatomy DR sessions, histology practicals, and the of course, the abundant lectures. Students tend to prefer Systems over MCBoM, because this is actual information we may need to retain as doctors in the future since it’s much more focused on pathology and we begin distinguishing the normal from abnormal. And for this same reason is why students buckle down and revise that little bit more than the January exams, because it’s the real deal.
Final remarks: Dare I say, the most fun exam, since approximately 60 of us are crammed into the DR, madly stressing under the same sky of glaring white lights that illuminate the bags under our eyes. It’s kind of teamwork in the most independent way. I remember seeing some questions that no way came up in the red booklet, like “What does the umbilical cord contain” and then permutations of 1 artery 2 veins/2 arteries 1 vein etc. – don’t freak out about it. Chances are, if you’ve done your revision and this has not come up in the statements, your course mates will feeling equally baffled. And, there will definitely be specimens you’ve never seen before, like how I saw a hand with Dupuytren’s contracture; not a difficult question, but very interesting to see.
Structure: 120 best of five questions (mind you, different from MCQs – all could be correct but one answer better than the other); 3 hours.
What: Basically, anything could come up based on all the hundreds of lectures you had since the beginning of Term 2. Also, some random questions pertaining to the various practicals, eBiolabs and STAN sessions could come up.
Final remarks: Back in high school I was one of those annoying kids who learned everything on the syllabus and beyond. In med school, that ain’t gonna happen. We’ve all gone from “I’m going to get top in my class!” to “I pray I get 50%”, because if you’re attempting to learn ALL the lectures from Element 5-9, you’re crazy. And no, not crazy in the smart way. Be efficient with your time – 12 hours revision per day will do more harm than good. All I can say for this exam is, just do it + repetition.
Structure: 60 best of five questions; 1.5 hours.
What: Basically all the theory you learned in Systems that isn’t anatomy or histology.
Final remarks: I did a lot of idiotic things. For example, on the exam, they wrote “osteoprotegerin” and my mind threw a tantrum because for goodness sake I swear I have never seen that in my life why would the examiners do th- oh. OH. It’s…the same thing…as OPG… Also, there was quite a bit on skin and joint infection stuff which I completely neglected (when in doubt, choose S. aureus). And I spent crazy long revising what cytokines and pro-inflammatory mediators were seen in rheumatoid arthritis and osteoarthritis, but none of that came up.
Take all of this with a pinch of salt (because we are the last year in the MB16 program of Bristol; starting next year is the fabulous new MB21). Everybody is vastly different in their revision style and approach to learning, so let me just say: I’m not smart. Honestly. I rely a lot on being hardworking. If you’re one of those who naturally assimilate information from just listening to the lecture once through and have the ability to formulate an intellectual question to ask afterwards as well as retain it in a few weeks, amazing! You are awesome. But I’m definitely not one of those people. So, that’s the direction & perspective I took on these exams; it’s just a little something to be aware of.
On Wednesday, 22nd of March, marked a monumental day. And with most monumental events in Bristol, it took place in the Great Hall of the Will’s Memorial Building. So, after a failed session of attempting to write up notes on heart arrhythmias, I skedaddled down to the post office room, because I forgot my admission ticket was mailed to us personally, and rushed out at approximately 6:35pm.
I walk into the foyer, and enter the Great Hall with uttermost shock – there, right in the centre above the audience, hangs a 1:500,000 scale reproduction of the moon’s surface. It’s part the Museum of the Moon exhibit, conceived & created by Bristol-based artist Luke Jerram, happening on the weekend. I mean, outer space. That is my absolute dream, my version of a fairy-tale without the fancy bits of characterisation, the embodiment of every single star-gazing app on my iPhone. Since the event was in honour of Sir Paul Nurse whose work was on fission yeast that eventually led him to win the Nobel Prize of Physiology or Medicine in 2001 (in conjunction with Tim Hunt), there were projected electron microscopic images of Schizosaccharomyces pombe on the walls. Being in that place, surrounded by just raw science rooted in curiosity from the incredibly detailed craters on the moon (I saw Newton’s crater) to the rod-shaped cells swirling around, I might have almost teared up. Almost.
I won’t dwell too much on the actual programme details – it was a beautiful ceremony, with great background music by the prestigious Bristol Hornstars (fantastic jazz band that I was so confident about joining back last summer but too intimidated when I heard them play), and the opening ceremony. Let me just say, in the latter, there was a performance by the poetry & creative writing society of Bristol’s SU, and it was this grand poem of the journey and advancements in science. I mean, yes, it was very delightful, but…“like how the microorganisms festered in the library textbooks” and “oh, like yeast, *looks up to a higher power* let my mind grooow…”? I appreciated the science metaphors but it was a tad difficult to take seriously. Hey, wasn’t just me – the professors around me were a choir of collected muffling of laughter.
Moving on swiftly…the installation itself. Watching the robing of Sir Paul Nurse and presentation of the ceremonial items felt all very royal – one of the items included the key used by King George V to open the Wills Memorial Building in 1925, and the new chancellor made sure the audience could catch a glimpse of it. And then his address. Wow, I’ll just say, I was blown away by the end of it. I’ll admit, initially I found myself zoning out occasionally as he went on about the merits of education and university, but it’s hard to get bored by him, because he is a fantastic speaker. He talked about 9-year-old him in his pyjamas on his front porch watching Sputnik-2 being launched, and the long & lonely walks back from school that allowed him to observe spiderwebs and growth of nature which fuelled his curiosity of science. And to think, just over a year ago, I had been reading about his discovery in the IB Higher Biology textbook in the Nature of Science box, thinking, “Man, just imagine…” With a very subtle lisp and a razor-sharp enunciation of his words, there was only one word I could describe his entire presence: historical.
I don’t know. Maybe it was the moon. Maybe it was the Great Hall’s beautiful architecture that dates way back. Maybe it was the spirit of the predecessors, including Winston Churchill, that I felt throughout the ceremony. But to me, it was all history. Sir Paul Nurse’s history of his childhood, the Great Hall’s history, the ceremonial item’s history, science’s history…and suddenly, I had this sudden urge even greater than before, to be part of that. To be part of history. I want to do something great and meaningful. I can only do so much but I’ll try my best as I’ve always done.
I was in a bit of a daze afterwards – from the Elderflower Champagne at the drink’s reception, meeting my lecturers (pharmacology gang), racing up the stairs with a friend to gaze at the moon again, trespassing up into the high levels via steep winding stairs for better views, silhouette photos against the moon backdrop, sprinting back home at 8:48pm realising I’ve got a pre-practical quiz that I have to do before 9:00pm, getting 100% on said quiz (took literally 4 minutes), and eating a forgotten dinner. It was such a fantastic event, and I am grateful I had the opportunity to go (respond to your emails fast!). Really, I could say more about how inspiring the entire event was and how excited it makes me to know Paul Nurse is Bristol’s new chancellor, but it wouldn’t end if I began. So, here’s to an incredible future of science that I dream to be a part of.
*Warning: this post contains explicit details about cadavers.
Last Thursday, I attended Bristol’s annual Anatomy Thanksgiving Event in the Great Hall of the Wills Memorial Building. It was a beautiful service, giving the opportunity for students and staff to express their appreciation and thanks to the families of those who donated their bodies to the Centre of Anatomy.
I did not know what to expect, debating what colours were appropriate to wear – it was not exactly a grieving event, as this was explicitly made clear during the opening remarks, and definitely not a full-blown celebration of education in anatomy. Confusing, really.
I go for middle-ground attire (nothing too flashy, nothing too dismal), and upon entering the Great Hall, we were each given beautiful stemmed white peony flowers. And then the service commenced with an opening speech from the head of the centre for applied anatomy, followed by a free church chaplain. There were poems recited, and melancholy music, one filled with lingering chords and a simplicity that was so stunning yet simultaneously emotionally overwhelming at the same time. Members of the centre for applied anatomy went up to give their thanks, each with their own scripts – how difficult it must be, I thought, to write such a speech. There’s only so much you could say, a limited scope of vocabulary appropriate to stay clear of offence and any triggers.
I had been rather solemn and contemplative at this point, more out of appreciation and common courtesy for the opportunity I had to learn from cadavers, but it did not really hit me until we were invited to put the flowers of thanksgiving in one of the five differently shaped glass vases at the front. We formed two lanes: those putting flowers in the vase and those who had finished, and I was trailing back to my seat once I was done, humming quietly to the song the choir was singing. A lady who was walking back had eyes brimming with tears, and in the other lane was I presume her friend, because they held each other’s hands. And suddenly, they embraced – the lady cried, and I could see her fingers clutching her handkerchief trembling. They stayed like this for a while, even as the line halted just for them. It was a standstill moment, where receiver and the giver finally aligned, and nobody would dare break the fragility of it. I was stunned.
Retrospectively, maybe the cadavers in our anatomy sessions were not treated with the uttermost respect perhaps required – we’d stick our fingers in their mouths out of curiosity, interlaced our fingers with the cadaver hands in intimate pretence, tugged on the tendons to make individual fingers move to scare our friends, playfully hit each other with a femur, stroke the calves (gastrocnemius) saying “#GOALS”, open up the transversely-cut penis aggressively in front of the guys as a joke, and so on. I’m guilty of having done all the above. The demonstrators, being experts in their field, were also very accustomed to the cadavers and sometimes did not use gloves before sticking their hands in the abdominal cavity of a cadaver, or would just lightly scold us for inappropriately playing around with the limbs. And I know this can be seen kind of terribly, that we’re supposed to be treating them with more respect – after all, these cadavers were once walking, had families, and had a life. The families I had met at the event, remember their loved ones as breathing, whilst we saw them dripping into collection tins under the metal tables. But I guess this was our coping mechanism: a glazed superficial persona we switch to once we wake up and smell the formaldehyde; the clumsy tightrope walk of first year medical students wondering where along the scale of total emotional isolation and hearts-on-our-sleeves we should be. I know if I think too much about this cadaver as a person, somebody who once harboured memories I’ll never know of, the face may terrify me more than I think it will. I know it’s kind of sick, almost sadistic, that we think this way. But we’re just humans trying to cope.
Once the ceremony was over, we all went into a backroom with sandwiches, tea, coffee, and other wonderful tidbits were served. This was the time where we had the opportunity to talk to the families and thank them – this, by far, had to be the most difficult situation to initiate a conversation in. I drew so many blanks as to how I should begin: thanks for donating the body of your loved one? Thanks for helping us learn better because anatomy is the most exciting part of the week? Thanks for letting us benefit from the bodies? None of the phrases sounded right in my head – either too blunt, too crude, too insensitive. I ended up saying something along the lines of, “Thank you for coming today, giving us an opportunity to express our gratitude for donating the body of your loved one – anatomy really enriches and benefits our practical learning, and I hope I can give back just as you have given to us.” The responses from the families were thankfully not raging anger against me (I was fully expecting this to happen at some point, because I 100% thought I would get my words wrong). Instead, some would immediately ask, “Do you get spooked seeing the faces?”, some would thank us graciously, some would jump into the story of how their loved one died – however, every single family I talked to always were surprised to hear that anatomy was our favourite subject of the week, which I was, in return, surprised by. Because it was the honest truth: anatomy is so vastly different from any high school subject, and it is a true privilege to see textbook prose come to life (ironically). Everything I said was genuine. I was happy to have told the families this, because it really did make them smile when I told them how much it benefited and enriched the program to have real cadavers to study from. One lady even said, “Well then, maybe I shall donate my body, too!” One family said they did not even know their loved one had already signed papers to donate their body to the university and did so without discussion, and it understandably took them a while to get over that fact, but were more than happy to hear us, the students, were learning from the cadavers.
The service was unlike any other, unique in its intent and beautiful in its approach. I RSVPed the event, entering with a “Oh dear, what am I doing, I’ve seen your loved one sprawled on a table with weird smells” mindset, but I walked away from Will’s Memorial enriched with a feeling of peace and even more respect. Maybe medical, dentistry and vet students won’t completely stop picking the noses of the cadavers or giggling when studying the urogenital & anogenital region, but I whole-heartedly assure you, we truly appreciate the opportunities we get in the dissection room that help us gain knowledge. We’re still learning how to deal with cadavers, as well as figuring out what mentality we should embody. But there is definitely nothing more we want to do than try our best to be good future doctors.
So, as part of the curriculum coursework, one of our assignments was to do a creative piece – it could be a poem, an imaginative fictional story, a musical composition, or even an interpretive dance. For those who feel strangers to their right hemisphere of the brain, a long essay is another option (but bumps up the minimum word count requirement). This element, and this particular assignment, was genuinely one of the reasons I chose to study here in the University of Bristol. Honestly, the amount of emphasis put on the human basis of healthcare is incredible – we’re even going to have a 30 minute session next week to do mindfulness meditation (all educational!). So, without going into details, I present my original piano composition, “It’s Worth It”, penned about a courageous patient I met on home visit. It would not be a lie to say I wrote this in three days, but I would be lying if I said I hadn’t been tinkling around with motifs for a couple of months.
On Day 1, I fooled around for 2 hours on a piano with a missing G key and both pedals broken off so I had to jam the tip of my shoe into the hole to sustain, and came up with a loose framework for my composition.
On Day 2, I was back in the alternative music room, with an upright acoustic piano that reverberates too loudly and has a pedal that is squeaky like no other. Really. It was bad. And there was an uprising rock band next door (walls are not soundproof) who were shredding their souls out. But I figured out more embellishments and got more comfortable with what vision I had in mind. The pressure of having to upload the assignment in a few days made metaphorical beads of sweat trickle down my temples.
Finally, on Day 3, I was talking to a friend who lived in CHH (where I had moved out from), and asked randomly about the baby grand piano tucked away in there. “Come during dinner-time, so no one will be there,” she said. I had booked the piano room in the Bristol SU for the following night, but thought, hey, why would I miss out on an opportunity to play a beautiful piano? It was a devastatingly windy night, and I charged through, face numb and leaning so far forward I would have fallen if the wind had not been that strong. Honestly. My contact lenses were so dry I swear they were clinging onto my cornea for dear life. I reach CHH, and go in the piano room – I didn’t think I would record, but I ended up doing so. Because, I realized, the longer I think about it, the further away I am from the initial emotions I felt about this wonderful patient I was inspired by. So, with mistakes and lack of any technique from my classically-trained years, I produced the recording you hear below. Some of it is improv, and I probably won’t ever play it like that again. Raw and real.
Here is a quote from the patient that beautifully sums up the meaning of the song: “Because I’ve enjoyed living life so much already, I want to continue. I quite like life. Of course, you don’t want to get old, and there are some things in life you won’t like. You got no choice in these things. But it’s worth it, don’t you think?”
And I couldn’t agree more.
EDIT: So, my GP nominated me for the Year 1 GP Placement Prize for this reflective piece and another essay I did on a rape consultation. That in itself was something I personally was incredibly shocked by and celebrated with chocolates, but I recently received an email saying 19 people were nominated, 10 people were shortlisted and they had selected the top 3…and I received first prize! I’m just so very happy the message of courage the patient gave to me came across in my work. Gah.
*The patient has given permission for use of his words.
Despite having examined juvenile skulls frequently in the past anatomy sessions, I am still always in awe at how breathtakingly light and fragile they are. And as I trace my fingers over the fontanelles in amazement, I’m constantly thinking to myself,
“This will never get old.”
I’ve noticed quite a few ways freshers (including myself) communicate with their friends and family via social media, so here is an unstructured framework of that. Maybe a tad more geared towards international students. Specifically Asians. Maybe not.
Ignoring Skype in this list because that is a given, and is usually a secondary communicative device anyways since you organize the call via the methods listed above. Oh, and I don’t have Snapchat.
It is the end of Week 10 at medical school, and the perfect way to celebrate is a little compilation of common phrases I hear from my fellow colleagues (much love). By no means a complete list…