Year 2 Bristol Med School | Summer Exams

It has only been a few days since completing the final summer exams, and you bet your sweet bippy I’m still experiencing severe withdrawal symptoms. These episodes are of an unfortunate recurrence after every exam season, and leave me chaotically conflicted. I’m gonna call it…post-exam subjection trauma (PEST). You know what I mean; how every little ordinary detail in daily life triggers this automatic all-out regurgitation of lecture knowledge where you completely blackout, before snapping back into reality dry-heaving “May 16th please be kind to me”.

*sees a mother breastfeeding her baby in public*

Okay oestrogen = ductal system, progesterone = secretory system? Ooooo but don’t be fooled since progesterone & oestrogen actually inhibit lactation. Nice one. And then, what was it? Oh, dopamine inhibition due to suckling relieves restraint on PRH, prolactin release causes milk production, oxytocin causes that weird “milk ejection reflex”…that reminds me of the “viscous fingering” mechanism in the parietal cells of the stomach, omg that lecture was kinda weird, ha ha ha *still staring at the breastfeeding*

Sigh. This is what PEST does to you – you only see science, not people. 

Anyways, I did a similar review last year of the Year 1 summer exams. Thus, as a sucker for continuity, here’s another.

Systems of the Body 2: Paper 1 (April 23rd)

Structure: 70 best-of-five questions | 1 hour 45 mins

What: Gastrointestinal, respiratory, renal

Remarks: Because we had January mocks on Systems 2, this was just a smidge less terrifying than the others. I have to say, it was much more clinical than I prepared for, but I was definitely expecting it. There was one question where it said a man came in with fever, diarrhoea, etc. and we had to figure out which bacteria he is most likely to be infected with. At this point, it could be any of the options. But then, the vital bit of information is that upon history-taking, it is learned he works in a lab…with lizards.

…so, okay. I get medical school is all about lateral thinking, but the lizard thing was just a little bizarre. Can’t get over it. Lizards.

With drug names, I can safely say this on behalf on all of us: we don’t remember them entirely, and just commit the first syllable to memory. It’s best-of-five, after all. For example, one of the cysteine leukotriene antagonists for asthma is montelukast, but I just think its that Monte Carlo drug, or the synthetic analogue of PGE1 protecting the stomach mucosa for peptic ulcers is misoprostol but I remember miso soup. And then, we all have our idiotic tactics of remembering a list of drugs. Anti-emetics, for example: the 5-HT receptor antagonists. One of them is Nabilone, which sounds like Naboo, that planet in the Star Wars universe, so extraordinarily picturesque it’s almost euphoric (one of the side-effects of the drug). Or furosemide is a loop diuretic; I remember this by the thinking “fur” = dogs, one of my favourite dog breeds are shiba inus, and they have curly tails (“loop” diuretics)…

A lot of the tactics used are incredibly crude, linking up selective information required for exam purposes only in a strange way. And then for others, you go over and over them again, until they just suddenly give way. Like, for me, I didn’t want to just accept the definitions of SaO2, CaO2 & PaO2 – we’re told it’s saturation, content and partial pressure, respectively. I never really properly understood this in relation to the equations given, but one day, it just randomly fell into place for me: SaO2 = the oxygen binding to Hb, PaO2 = the oxygen actually dissolved in plasma, and CaO2 = summation of SaO2 & PaO2. Highly likely I’m just really slow, but I never really got it until I kept staring at it.

Systems of the Body 2 & 3: Anatomy & Histology Spot Test (April 25th)

Structure: 80 MCQ questions | 45 seconds per station (1 hour exam) | Includes topographical anatomy, case scenarios, pathology cases, clinical examinations, radiology, and histology

What: Gastrointestinal, respiratory, renal (Systems 2); nervous system, endocrine & reproduction (Systems 3)

Remarks: Right, so this was the exam I was more disappointed at myself in compared to the others. Anatomy tends to be the slightly (better subject for me than the written papers (keyword: slightly), but I walked out feeling absolute dismay; it didn’t feel like the dozens of hours spent revising, especially on the topics you make an extra effort to understand, paid off. Things that we spent a lot of time in the DR learning (“You need to know this!”), like the various strictures of the oesophagus & its multi blood supply or the lumbosacral plexus roots, didn’t even come up. We had a whole practical dedicated to ears & eyes, and only 2 questions max came up in total for both. My friend said she only knew the answer to another question because she happened to overhear someone directly ask the demos; so unless prompted, there would be no explicit answer that wasn’t even in the booklet (but apparently on the exam).

The questions came at obscure angles, like the innervation of the ureter (only PSNS, only SNS, both PSNS & SNS, etc.) – not even joking when I say it’s this tiny, vague statement at the bottom of the renal booklet “Nerve supply via autonomic plexuses”. There was one station displaying a radiograph of the thorax, and the right lung clearly showed pleural effusion. The question was, “What is the pathology in the left lung?”, in which the correct answer was simply “Normal”, which I didn’t even realise was a trick question until somebody asked me after the exam, “Hey, that trick question though, right?!” I think what irks me is that the formative spot questions in the sessions give the wrong impression of the style of questions that actually came up. But then again, this was just my experience; a lot of people came out feeling pretty good, and that it went better than expected, so I could just be an unpopular opinion (story of my life).

Systems of the Body 3: Paper 2 (April 27th)

Structure: 70 best-of-five questions | 1 hour 45 mins

What: Nervous system, endocrine & reproduction

Remarks: Held in the grandiose Will’s Memorial Great Hall, it was a pretty adorable way to finish the gruelling pre-clinical years. Most of us were tremendously jittery beforehand, because of the fact we have handbooks the length of your average 3.5/5 Goodreads YA novel and tedious 9-5 lectures that happily shoved us off the cliff into anxiety. So, it was a shocker to say the paper went much better than anticipated for the majority of us. Once again, a rather clinical paper – there were quite a few questions on contraception applying theory to legitimate context useful in practice, which I appreciated (though mind-boggling at points). The first question threw everybody off – “How does alcohol cross the blood-brain barrier?” For some reason, I thought drawing the molecule for ethanol would help me decipher the answer (it didn’t). Ask us about the basal ganglia pathways in relation to Parkinson’s disease, and we’ll give you this immaculate answer all backed up with Vancouver referencing. But a stupidly easy question about alcohol’s solubility properties? Well-played, examiners, you’ve caught 228 med students off-guard. My favourite question asked how a patient with mania would present at the GP – one of the options had convoluted SAT words with way too many vowels, but the real star answer was “Staring at the wall and counting”. Not the right answer, but just…right.

There were other little bits I picked up on, like how there were equations the lecturers specifically said to commit to memory, like % ionised, that they just straight up gave in the paper anyway. Then various pathways, including the motor & sensory tracts, auditory & optic pathway, or the spermatogenesis & oogenesis processes, barely made appearances, if not at all. Embryology was absent. It was a little frustrating, because with those topics,  it actually took a substantial amount of time to methodically learn them step-by-step. Then there were those one-off questions, like what the uterus fundal height is by 20 weeks – it’s this tiny sub-bullet point on a slide amongst 37 others, let alone in a booklet of 225 pages. Or which condition can cause increased feet width; intuitively, most would choose acromegaly anyway, but this information was in a video the lecturer showed, not on the actual lecture slides given.

••••••••••

I know a lot of this was nit-picking and complaining about parts of the paper, but overall, I understand exams will always be like this. The really wishy-washy, extremely unpredictable questions that you’ll feel are unfair, but you gotta play the game whether you like it or not. What I’m basically saying is, no matter how much you revise, it’ll never be enough – the learning isn’t necessarily harder than IB or A-levels, but probably down to the sheer quantity and conceptualisation of certain ideas (e.g. the reticular formation or the basal ganglia). It’s learning how to cover everything effectively (but not beating yourself up if you don’t, either), preparing to accept there isn’t always a correct answer, but most importantly, being able to not always want to know why. I say this with a conviction suitable only in this context; this is a mindset that our high school curriculums set us up to think, that there is always some kind of explanation for every question-mark – it’s the whole “big fish small pond” syndrome shaking up the high-achieving kids who tumble down the pyramid. Falling isn’t the issue, but trying to climb to the top again purely out of familiarity, most definitely is. Whether you agree or disagree, hopefully it’s something to think about.

©TMK

Term 1 • Year 2 Bristol Med School | Reflection

 

So, I don’t do these much – a solid year has passed since the last one. Well, here I am, giving you my less-than-wise perspective on how I found the last few months. So, it’s rumoured Term 1 of Year 2 is objectively the most leisurely time of your entire medical school experience in Bristol, to which is a statement I do not object – but it’s not saying much compared to everything else.

Let’s skip over explaining all that standard lecture curriculum stuff you can read on the website; what’s differed from Year 1 is that after finishing a lecture-based teaching block studying a particular system in the body (i.e. respiratory, gastrointestinal, renal) lasting between two to three weeks, we all get placed into a hospital in or around Bristol. Our stethoscopes slung proudly around our necks (£90 worth of the hypocritical attitude “Just don’t ask us to properly use it”), it’s the ultimate committal point-of-no-return investment.

I’d really like to point out how it positively warms my heart to watch my medic colleagues take a history and do clinical examinations on actual patients – everybody slowly emerges with their little personality quirks. Like that intimidatingly buff dude who got in Clicendales last year who is actually adorably soft-spoken and displays great open body language. Or that girl always rocking denim overalls you’ve never really properly talked to who unconsciously leans very far forward, engaging far more with the patient. Or the legend card guy on nights out, who consistently makes sure to repeat back the information to put the patient at ease she/he is being actively understood. I’ll even say it’s humbling to being a part of the beginnings of my peers’ medical career – sappy? Yep.

Aside from that, you’d think medical students would find the clinical environment extremely exciting; and don’t get me wrong, we did desperately yearn for those hospital placements after living in E29 (groggily waiting as the clock ticks a few minutes after the scheduled hour before somebody shouts “LECTURE CANCELLED, CHECK YO EMAILS!” which unfortunately happened far too often). However, there was a surprising collective thought a few of my fellow colleagues had about the 3-day formalities:

“I’ve realised people are just…so tiring. Is that bad?”

We’re still figuring it out. Even myself, I found the weekend leading up to ICS Placement was a bit of a dreaded countdown – it’s the culmination of having not finished going through the Respiratory Element and then we’re expected to know Gastrointestinal pathologies for the following Monday; exhaustion from everything else in our lives not medically-related; fear of the much-too-real insight into the lives we will lead in the many years ahead…

I guess it’s some mild form of empathetic burnout – honestly, actually sitting down with patients is always incredibly humbling and we would never be insincere about it. And yet, at the end of the day, you flop onto your bed in bare-below-the-elbows attire with the lanyard uneven around your neck, utterly exhausted. And I swear, if I met somebody new during that period, I would’ve immediately blurted out the preprogrammed “Hi-my-name-is-Holly-I’m-a-second-year-medical-student-etc-etc-etc”

Anatomy was chill as always. Top tip: no matter how weird your question, ask. Really. As long as you use anatomical terms, you can practically ask anything whilst sounding vaguely intellectual – the demonstrators will possibly be the more openminded people you’ll meet, given the niche nature of their job. And even though your friends (you know who you are) are cackling at your sincere curiosity of the science behind certain, ahem, activities, you’ll certainly thank yourself for not needing to do an uncomfortable Google deep-dive without UV protection from the bare exposure to everything but the science.

And now, January exams have ended (before I hightailed into London – what is it with me escaping to that city after tests?) and Term 2 has begun with the highly anticipated neuro (negatively rumour-drenched from older years). A brief review of Week 1 so far? Let’s just say, I’m seriously enticed to do work rather than celebrate my birthday next week.

’til next time.

©TMK

Laughing Gas | Time Capsule Log 💊

I’ve never tried laughing gas. Just never felt the need to; I’ve seen some of my friends intoxicated with the substance, and that’s enough entertainment in itself. But, the history of this party drug is a pretty incredible one – you’ll realise a lot of great inventors are elite masters of self-experimentation (yeah, not me) and this guy is no exception. Let’s get to it.

It began in 1772, when Joseph Priestly first discovered nitrous oxide, and he successfully synthesised it in 1775. Then came along young English chemist and inventor (plus, future president of the Royal Society), Humphry Davy. In October 1798, he joined the Pneumatic Institution in Bristol as the laboratory operator, and for you Bristolians out there, you’ll be extremely proud to know it was there where Davy played around with stoichiometry and delivered the laughing gas of your parties today! Oh, and just for your interest, this organisation was formed to exploit usage of recently discovered respiratory gases for medical practice – thus, the date 1798 is a pretty vital marker for the rapid progress in the discovery of respiratory gas for times to come.

***A lot of the quotes and information below comes from Davy’s “Researches, chemical and philosophical chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration” (1800). 

Davy was dead keen on determining the effects of inhaling nitrous oxide (“…I resolved to breathe the gas for such a time and in such quantities, as to produce excitement equal in duration and superior in intensity to that occasioned by high intoxication from opium or alcohol.”) With the aid of his assistant, Dr Kinglake, during his first few experiments, he described “a slight degree of giddiness”, “pleasurable feelings” and “sublime emotions connected with highly vivid ideas”. So, Davy began increasing both the dosage and the frequency of the experiments over the next couple months, and he does allude to a potential medical use of nitrous oxide, “The power of the immediate operation of the gas in removing intense physical pain, I had a very good opportunity of ascertaining.” 

Ya boi began inhaling the gas in out-of-work hours by December, and “felt very great pleasure when breathing it alone, in darkness and silence, occupied only by ideal existence”, though remained incredibly diligent in logging his scientific entries. Ugh, nothing sounds more tempting than a long session of optimistic nihilism, ammirite?

Later, he constructed an “air-tight breathing box” where he would sit for hours and hours, inhaling way too much of that addicting gas, and nearly died on several occasions. He began allowing others to partake (what a selfless man) and I highly recommend you read all the entertaining experiences of his acquaintances, friends & family getting high on this hippy crack. All for science, of course. For example, you know talented poet Robert Southney? Dude who wrote “Goldilocks and the Three Bears”, and the epic 1796 poem “Joan of Arc”? Oh yes, he tried out this gas and stated it “excites all possible mental and muscular energy and induces almost a delirium of pleasurable sensations without any subsequent dejection”.  Ayyy, a delirium of pleasurable sensations leading to talking bears who eat porridge! (Jk I don’t want to assume anything, but who knows…)

17w0tj3hnu7qijpg.jpg
Pleasure was so cheap back then

I know I’m making it sound like Davy was a sneak who used the excuse of science as a coverup to enjoy the bouts of pleasure – but honestly, he really did bear medical intentions in mind and was an intelligent guy. Davy was close to recognizing that inhaled nitrous oxide could be valuable for anaesthesia; however, the usage of nitrous oxide at upper class parties and fairs only increased its reputation as a novelty and decreased its respectability as a medical tool. 

So lets just skip ahead and head across the pond to meet our next figure, Horace Wells, who saw the gas as a way of reliving the pain of dentistry in 1844. In fact, he had such great success he got a chance to perform it for a crowd at Harvard Medical School…and no, they weren’t a friendly bunch. Wells extracted the tooth of a complying patient, and there definitely was a lot less pain than usual, but the patient mentioned still feeling some pain – this was enough for the judgemental physicians to boo Wells off the stage, and Wells committed suicide a few years later. Wow, doctors, way to go – what’s the purpose of your occupation, again?

Two more decades until nitrous oxide was used again publicly. Two! Okay, we’re almost there. Well, its reintroduction around 1870 was somewhat permanent, and remained the golden dental anaesthesia until the 1960s. It kept its position in anaesthetics, though not at the forefront; although plenty of physicians use it in their practice to this day, it isn’t really something anyone would admit to because even medical grade nitrous oxide can leave people anaemic and are potentially lethal even in the right amounts. Eek.

Nitrous-Oxide-Chemical-Label-LB-1591-096
MySafetyLabels.com

Nitrous gas has its iffy reputation, but the fact euphoria is mentioned on labels today endures its original recreational usage from over 200 years ago. So, next time, when you’re buying a canister of this stuff at some awesome party, give thanks to your 20-year-old pal Davy doing exactly the same thing 219 years ago.

Sources:

https://eic.rsc.org/feature/nitrous-oxide-are-you-having-a-laugh/2020202.article

https://io9.gizmodo.com/5934877/the-strictly-non-medical-history-of-laughing-gas

https://en.wikipedia.org/wiki/Pneumatic_Institution

http://www.independent.co.uk/news/uk/home-news/how-dangerous-is-laughing-gas-legal-highs-hippy-crack-nitrous-oxide-safety-facts-explained-a7088226.html

http://justsayn2o.com/nitrous.history.html

http://publicdomainreview.org/collections/the-nitrous-oxide-experiments-of-humphry-davy/

http://www.smithsonianmag.com/smart-news/heres-what-it-was-discover-laughing-gas-180950289/

©TMK

Year 1 Bristol Med School | Summer Exams

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).

Systems of the Body #1: Anatomy & Histology Spot Test (May 30th)

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.

Top tips:

  1. DO NOT NEGLECT HISTOLOGY. In Term 1, students saw histology as a bit of a joke, thus neglecting it partially or completely, and got away with relying on knowledge retained from the histology lectures in LT 1.4 those few weeks ago. Sorry, but this ain’t gonna work for Systems! I highly recommend going over the virtual microscope slides (no need to remember the names of each slide – they label it in the exam), identifying what things are and functions of certain cells/structures. All you need to know is in the lecture and the VM, so don’t get all worked up with histology, but do not neglect it. People came out of these exams saying “The frikken histology stuff though, not even funny how much I guessed…”
  2. LOOK THROUGH THE RADIOGRAPHY SLIDES. Again, be efficient with your time and don’t dwell extensively on them, but they definitely come up – it’s the only kind of pathology you’re seeing in first year, so whatever slides they use to teach the clinical stuff, focus on those. They won’t give you a random tiny fracture in the 4th metacarpal bone to identify. Sometimes you’d like to rely on your anatomy knowledge of where things are, but there are just things the radiography slides have that can trip you up if you haven’t seen it before.
  3. KNOW OBVIOUS SIGNS OF CERTAIN PATHOLOGIES. Okay, really obvious. But, if the case scenario starts talking about a 63 year-old man complaining of pain radiating to his back, you can almost guarantee the answer will be coarctation of the aorta without having to read the rest of the scenario. Or if there’s an image of splinter haemorrhages or Osler nodes, it’s bacterial infective endocarditis. If you attempt to remember the hundreds of other causes of back pain or splinter haemorrhages, or research the extensive pathophysiology of pericarditis, it’s a waste of your time at this point – to pass the exam, just key points.
  4. NEVER LOOK BACK. It’s so easy to think back 7 stations to that question on the umbilical cord when you’re looking at the brachial plexus, and be tempted to change your answer. Stop! Don’t do that. I was a victim of that in the January exams. Completely derails your focus on what’s currently in front of you. Trust yourself, because knowledge is lingering in that brain of yours and don’t question your instinctive answers.

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.

MCBoM Element 5-9: Written Paper (May 31st) 

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.

Top tip:

  1. DO WEIGHTED REVISION. What does this mean? The number of questions per element depends entirely on how much content there was in that unit and how much lecture time was dedicated to it. So, I tended to focus a bit more on Element 8  (clearly not enough, judging by the amount of guesswork done on all the hospital acquired infection stuff…).
  2. START EARLY. Even before all the CVS & MS stuff. Just because the amount of content will make your head implode if you begin two weeks before the exam. Just take it slow and let everything pass your eyes at least once through.

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.

Systems of the Body #1: Written Paper (June 1st) 

Structure: 60 best of five questions; 1.5 hours.

What: Basically all the theory you learned in Systems that isn’t anatomy or histology.

Top tips:

  1. CUT THE WAFFLE. You know when you’re listening to Mediasite, and then the lecturer begins droning on about their current research project (ahem stem cells)? Yeah, don’t even bother understanding that stuff – no way they can test us on information they can’t even validate yet. Maybe during summer if you’re really keen on their expertise, but for exam purposes, skip that portion of the lecture.
  2. DRUGS DRUGS DRUGS. There are some lecturers who highlight exactly which ones to remember, and then there are ones who give a list longer than your arm. This is where you really have to listen to the lecturers – which one do they mention a lot? For example, the calcium channel blockers do end in -dipine (well, one subset of them), but the one selective for the heart is verapamil. As for learning side-effects, just know the more outstanding ones – like, one of our questions was “Which of the following drugs has a side-effect of rhabdomyolysis?” and a string of foreign words were listed, but the only drug ever mentioned to have that special adverse effect were the fibrates. Just little things like that.

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.

©TMK

Sir Paul Nurse: University of Bristol’s New Chancellor!

     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.

Screen Shot 2017-03-24 at 23.44.48.png

     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.

IMG_1757

     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.

IMG_1741.JPG

     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.

©TMK

Anatomy Thanksgiving Day: Meeting Families Who Donated Cadavers

*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.

©TMK

“It’s Worth It” (Original Piano Composition)

     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.

©TMK

 

Skull

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.”

©TMK

Term 1 • Year 1 Bristol Med School | Reflection

  • The mock anatomy spot test was better than expected, but that isn’t to say it was easy. Plus, I had fun. Too many flashbacks of the senior maths challenge when having to draw a straight line through the bracketed letters, and of those SAT summer classes I took centuries ago when I had no geographical preference about university (until I realized the US vs UK difference; now I’m in Bristol).
  • I can finally put an anatomical term to those creepy figurines with abnormal body part sizes seen in every science museum ever: homunculus. Phew. What a word. I definitely glossed over that word on placards.
Homunculus. Just if you needed a reference. Kinda regretting putting it on because I didn’t realise it would be so large… (Image courtesy: Front_of_Sensory_Homunculus.gif)
  • Also, when I look at people attempting duck-face for a selfie, all I can think is, “LOL nice work obicularis oris gr8 job”
  • Rocotillo’s milkshakes are incredibly divine (but frown upon student funds), and I hate how it is less than 250m away from me. So, so tasty. Mmmmmmm.
  • Will’s Memorial Library + “The Imitation Game” soundtrack by Alexandre Desplat + “The Theory of Everything” soundtrack by Jóhann Jóhannsson + late-night anatomy revision = a productivity arising from new-found motivation, because you realize there are bigger things in life you can accomplish by succeeding the upcoming obstacle.
  • It’s hard to find people to eat out with, because money will be a pertinent issue with students. But then again, I guess I can afford it because I’m a bit of a loner who spends money on food & experiences >>>>>>> alcohol & clubbing.
  • The Great British Bake-Off had some outrageous drama and apparently that’s major with all the British kids. And I’m still enthralled by X Factor because I’ve never kept up with any TV show in my life and this is all new to me, so it’s a guilty pleasure because I never grew up with Simon Cowell on TV.
  • Bristol is a very hipster town (apparently). I don’t really see it, or maybe because I feel Bristol is exactly as how I’d like it to be. “Raise the Bar” do fantastic slam poetry events, original Banksy artwork is all over town, I’ve seen enough shops that have plentiful vegan options, and the vinyl shops stock John William records including “Revenge of the Sith” which I was tempted to buy but realized I didn’t have a vinyl record player.
  • Speaking of “Revenge of the Sith”, I will definitely be making a post about “Rogue One”, because I don’t care about those people who passed out negative reviews due to lack of lightsaber battles to satisfy their sad little George Lucas inner 1970 child.
  • Dough balls from Pizza Express is…a thing. We don’t get those in Thailand. We get something similar, but everything is just so English here I cannot help but make a clear distinction of “Thailand VS England” when there really isn’t. I saw this Facebook event about free snowball dough balls day – what even!? It was quite exciting because I’ve never done anything that infringes upon my education – the shop opened at 11:30am, the biochemistry practical started at 11:30am, the chef comes out with an impending frown and says to come back at 12:00pm, so my friend and I Naruto-run to the Biomedical Sciences Laboratory Building up the hill just in time to put on a lab coat with the rest of the med crew but I am madly perspiring all over the equipment like a sinner in church.

IMG_9992

  • P.S. ^ The above is my version of going out to SWX on Friday night.

©TMK