First & foremost to say, it was such a thrill & privilege to be able to conduct – thanks to Siobhan in the department – our session in the beautiful atmosphere of the old Anatomy Building lecture theatre (as photographed so perfectly here by Fionn McCann). Everyone was most impressed … even a tad sorrowful!
Opened up with our group recitation of Yeats’ ‘Paudeen’. They’ll know it off by heart by the end of the module!
Then had quick recap from one of the group on last week’s proceedings.
Then I set the mood for this week by reading Tríona Ní Dhomhnaill’s ‘The Mermaid in the Hospital’ as translated by Paul Muldoon. (“It was the sister who gave her the wink / and let her know what was what.”)
Then, somewhat unusually, I gave a sort of lecture on anatomy as a human pursuit and its significance in medical training – based on an essay I wrote for the ‘Irish Medical Times’ years ago when the Anatomy department was moving from its charming, nineteenth century home to the shiny new Biosciences building >
The idea is that perhaps to ensure the students adopt the appropriate attitude towards the privilege that it is learning from cadaveric dissection, some civilising influence of the aesthetic on display in the old building (architecture, art, history) needs to be / is being replaced by comparable influences in the new facilities – the orientation programme, the relatives room.
Keeping it somewhat personal, I told them about an old friend, Max Aguilera-Hellweg, who sat in this very room as a first year MATURE medical student in 1998/99, but who transferred back to the USA for the rest of his degree because of a dispute with the School arising from conflicting views of his book ‘The Sacred Heart’, which he had just published the year before. I read and analysed extracts from Max’s book, highlighting how his interest in medicine arose (a photographic assignment that led to an obsession) and his resulting intense, artistic fascination with representing the most full-on images of the workings of the body as revealed by surgery.
… Far from getting sick, I felt what I can best describe as awe. Photographing my first surgery was so foreign to any of my previous experiences that I couldn’t place it. I couldn’t compare it to anything. It is one thing to know there is a spinal cord in the hollow of your back; to see one for real is altogether different…
The cardinal glow of oxygenated blood reminded me that there was a man in there. A thick, milky-white strand covering the nerve tissue that stretches from brain stem to tailbone, splitting off into minute and multitudinous nerves, producing the sensations of heat, cold, pleasure, pain; the dura of the spinal cord lay revealed. I saw the painting above my grandmother’s bed. The one I saw as a child waking up from my nap. The one of Jesus. His heart bleeding, wrapped in thorns, engulfed in flames.
I realised I was in the presence of the most intimate, most vulnerable, most inviolate thing I had ever seen. The spinal cord had never seen light, wasn’t meant to see light, and at this moment was bathed in light. My first impulse, I must confess was to spit. To defile it in some way. Bring it down to my level. I didn’t, of course, but I felt I was in the presence of something so precious, so amazing, so powerful, so pure, I couldn’t bear the intensity.
“What is that?” I asked. “What’s it made of?”
“It’s like a sausage,” the surgeon said, “with toothpaste inside.”
We discussed the heightened language and thinking here; the artistic impulse; the impact such descriptions have on a reader, particularly whether or not they can be said to have benefits for medical student readers; we debated why Max’s impulse was to spit (including wondering was it actual!); we discussed the surgeon’s disabusing and mundane reply, in terms of professional distance and general normalisation.
Where before [as photographer] I searched the eyes of a man [for his soul!], the wrinkles of his clothes, the wear and tear of his shoes, I look now in the recesses of his flesh, the colour and texture of his liver, the markings and capacity of his lungs.
We discussed our impressions of Max from the extracts we’d read and how suitable his motivations were for someone becoming a doctor. We got into a detailed discussion about empathy.
We discussed how the suddenness of the migration from the Kingdom of the Well to the Kingdom of the Sick is handled (“It happened quickly, an inverse magician’s trick: now you don’t see it, now you do. From basketball and sprinting to bone sore with a limp. Hospital stays became frequent, and I missed the first three months of school four years in a row.”); the unbelievable trauma to the body and soul some treatments involve; how quickly a patient, even a young patient, become conversant if not fluent in the language spoken in the Kingdom of the Sick.
We went into some detail on the particular impact of physical difference on young people (“I got used to the limp … but gained a new self-consciousness… What I felt more than anything was overwhelming embarrassment. Ashamed of my bones and my scars and the clunking way I walked.”) and how if it’s difficult for a doctor to properly empathise with an adult patient, it can be even more difficult when the patient is a young person or a child. (Though some of them have thicker skin than others, was a point that was made.)
We discussed the clinical aspects of acne and blushing.
There are a couple of particularly harsh doctors portrayed in Gleeson’s essay, and we discussed how prevalent their behaviour might be in healthcare settings these days and whether or not efforts were being made to reduce the instances of such ignorant behaviour:
I explain this to the orthopaedic doctor, this man I’ve never met, and he does that thing I’m used to male doctors doing: he tells me I’m overreacting. A rotating blade is slicing into my flesh, but I need to calm down. When my mother starts to cry, he demands that she leave the room. Fifteen minutes later, I plead with him to stop and he finally gives up, annoyed.
On an early visit to the surgeon, to check my spine for scoliosis, I was asked to wear a swimsuit. Mortified, I cried all through the exam, and the doctor, growing impatient, threw a towel over my lower body.
‘THERE, is that better?’
It wasn’t. I was a self-conscious girl being humiliated for her sense of shame.
Perhaps understandably considering her analysis and perspective, Gleeson summarises perfectly the lop-sidedness of the relationship, particularly as it was back in the 80s:
The Doctor patient relationship had its own imbalances. I have never forgotten the sense of powerlessness in instruction: lie down, bend forward, walk for me. I have felt it counting backwards from ten under the stark lights of an operating theatre. Or when skin is sliced cleanly through. You are in someone else’s hands. Steady, competent hands – hopefully – but the patient is never in charge. The kingdom of the sick is not a democracy. And every orthopaedic doctor who examined me during those years was male.
We discussed the difference between Gleeson’s language / perspective and Aguilera-Hellweg’s.
A variety of analyses were put forward on this idea: “Our bodies are sacred, certainly, but they are often not ours alone… we create our own matryoshka bodies, and try to keep at least one that is just for us. But which one do we keep – the smallest or biggest?”
We noted the empathy behind her observation of another person in Lourdes hoping for a miracle: “He twitches occasionally but is otherwise motionless. There is drool on his face, and I want to say something to him but can’t.”
Also the pathos in: “This is the breakdown of bones, the slowing of a heart, the confinement of our own bodies: a being that once sprung into the world, vibrant and viscous and pulsing with life.”
Finally, we read and discussed Doireann Ní Ghríofa’s poem ‘To the Stranger Who Will Dissect My Brain’ (unpublished) and the students who spoke were extremely moved and impressed with the final description of the “exchange” that happens at the end of the poem between the remains and the (say) anatomy student: “Your brain will blaze bright,// alive and wild, and I,/ I will be the light.” Not only capturing the awe felt by medical students (& some photographers) but also the enlightenment – the final gift of the person who has donated their remains to medical education.
One student spoke about how the poem captured in a way that she could never achieve herself (and that no other language register could, perhaps) that feeling of awe that some students experience when they begin their anatomy dissections.
And to top it all off, the students were able to look around the old Anatomy Museum and get a sense of the history – betimes quite freakish and grotesque – of their studies.
First-year medical student creative writing assignments on anatomy:
I assumed when undertaking the anatomy dissection course that the strangest part would not be the dissection but the fact that we would be working on actual human specimens. I thought there was a strange sense of morbidity attached to educating someone who’s job it would eventually be to enhance and often prolong human life with bodies medicine may have failed. However upon beginning the course I have realised that this is not the case. The most unusual aspect in my point of view is the casual manner with which we all approach Anatomy, the relaxed and easygoing conversion that flows through the dissection theatre is natural yet one would think it out of place.
The donor bodies are often referred to as our silent teachers however they are never greeted with silence, be it the hum of chatter or the clank of our metal tools noise swells the dissection theatre to fill what would only be an eerie silence making the overall experience for students comfortable and and a place where learning comes easier.
Flicking through netters, there are thousands of images but none stand out. The memory however of holding a human heart is hard to forget. Its size, bigger than a human fist, the rough lumpy fat globules that cover the outer layers which contrast with the smooth almost silky lining of the inner vessels, and the dull red colour of its vessels is something that will stick in a student’s mind forever. It is undoubtedly an invaluable experience which enhances our ability as students to fully understand what it is we are learning.
“In order to learn the most important lessons of life, one must each day surmount a fear.” Ralph Waldo Emerson.
Leonardo Da Vinci once said; “Our Life is made by the death of others”. In order for my life as a medical student to begin, someone on this earth had to die. I wondered, as I queued up behind another white coat, where my “person” was when I was born, when I made my First Communion, when I found out Santa wasn’t real? I pictured what their life was like as a mother, a father, a golf enthusiast who dreamed of attending the Ryder Cup someday. Flickers of an imagined life ran through my head as we filed into the dissection room. For some reason I wasn’t afraid or nervous. Seeing the white sheet only brought back memories. I had already been in this situation before. My uncle was under the same infamous white sheet when I had to identify him with my dad in the morgue after his car crash. Having experienced that, I was prepared for anything. Nothing phased me to be perfectly honest, the smell, the eerie silence, death. Certainly I wasn’t prepared for the dissecting itself, but the initial exposure was just a silent reminder of what I had witnessed before.
What affected me more than the dead body itself was the idea that this was someone’s wife or mother, best friend or neighbour. The thought of the family and the huge void left behind was something that struck a chord deep within me. I felt a sudden surge of emotion stir inside me – for I had been the one left behind before, and I could somehow empathise with this woman’s family, wherever they were.
We were immediately flung into the deep end and the only way we could tread water was by picking up the scalpel and cutting. At the start I felt protective of this woman, I was afraid for her but I didn’t know why. I knew it had to be done and that she wanted us to do it, but I still felt like I was intruding on something – on her life, her personality, who she was. However, as the weeks went on, she began to resemble less of a person and I suddenly began to understand what the American novelist Chuck Palahniuk meant when he said “We all die. The goal isn’t to live forever; the goal is to create something that will.” By donating her body and allowing us to dissect it and learn from it I believe my “person” has left something behind that will live on forever – it’ll live on through me and my medical career.
– Yeah, let me tell you about this place. It’s all white: the walls, the tables, the machines. Everything is white. And then there are these windows through which a genie-blue light emanates: no park or busy street down below to look at. It’s almost as though you were trapped underwater. No one knows why they’re like that – keep people in or keep others out? There are also a lot of books, strewn around, all yellow, grey and ripped. The ground is speckled blue and you know the only reason they chose it was because of how easy it would be to clean up if an accident ever occurred. And then, there are the ghosts.
– No, no. They’re not the ones who scare people. They’re the ones who are actually afraid.
– What? Why?
– Because their bodies are covered by stiff, wrinkled and crackly plastic sheets. The few moments when it does get lifted, they’re staring straight up at white, sterile monster-machines that look like Doc Ock, with prying arms bent at awkward angles around their core. Their only companions are smirking skeletons who have long since grown accustomed to the chilling air that wraps around their bones and the dull humming in the background. They know they shouldn’t be afraid, they know they’re here for a good reason, but when they turn their heads and see the grey veterinarian tables next to them, they can’t help but retreat as deeply as possible into their skin.
‘Life in the Dead’
Only now, during this still, somber quiet do I feel the eerie presence of ‘the 12’
Only now do I feel the hollow eyes of the spooky skeleton, glaring at me,
What was once a stimulating sculpture is now but a clumsy collection of shapes.
For only now does it all feel so crude
This room full of sarcophagi, their impersonal bumps and crevices,
The insensitive obituaries “Bill, 85, COPD”
The pristine machinery, barely used;
Or the scalpels, laying ominously beneath their test dummies.
“Who in their right mind would lay themselves to rest here?”
However, this feeling of omnipotent uneasiness is precisely what focuses my mind,
It is in this unusual graveyard that I learn the most,
It is here that I reap the benefits of these selfless sacrifices to knowledge,
Perhaps I have not yet tasted enough of the drink of life, to know that death is not so sour, that this discomfort is not justified.
For only now do I realise that all this gives life to ‘the 12’
Life that inspires curiosity
Life that elicits epiphany
Life that empowers others to feed the weary its fabulous essence
Even when it seems furthest away…
The Irony of George
George lies in the name of science
in a room with strangers
whom he never met or never will know
He feels neither pain nor pleasure, just very low
They come in the name of science
They see him and they nod
But every ticking second turns glitter from gloom And they forget George was his name.
Once, he gave trust in the name of science And in white coats they played God They assured and yet they failed Yet now George was at their aid
The place was brighter, cleaner than I initially expected it to be; a synergy of a morgue, surgical theatre, classroom and a cinema all rolled into one room. Sitting there staring, reflecting, the white sheet remains motionless, like fallen snow it weaves only the bear contours of what lies beneath and of what once stood of a beautiful landscape. In that time I wondered about my first anatomy experience and what it means to grow, learn, achieve, and finally become a cadaver. Having just come from an all night TV marathon of ‘The Walking Dead’, the first time I entered that room I was very anxious but acutely prepared to see a body devoid of its humanity and excited about the panorama of discovery that will be viewed in this room over the coming year. I wondered why he donated his body? What were his motives? Was the end painful for him?
As the sheet was removed, I stood transfixed; absorbing every detail -my first patient’s skin was white, smooth and very cold, a marvelous marble statue to a lost hero. He was thin with signs of bruising along his arm – the result of countless hospital injections. At that point I wondered what his life was like, did he marry, did he have children? Our first task was to dissect the muscles of his chest and shoulders. This was it, I still couldn’t believe we were going to cut open a human being. Who is this guy? What did he like to laugh about? What did he cry about? As the scalpel surgically makes a trailing pathway through the skin down his chest, I am careful not to cut too deep in fear of damaging the vista beneath. His skin is slowly peeled away and I look and see what it means to be a cadaver, a person that was once a man. Muscles, heart, lungs liver, kidneys, stomach – they were all present. Dreams, goals, hopes, aspirations, love – they had passed on. What lies here now are merely the tools used to sustain life’s elements, a parting gift sculpted by the chisels of time and donated to education.
Before the words lecture, tutorial or even welcome had been spoken, we were rushed to the anatomy lab. My first thoughts of the room were that it was too quiet, too impeccable, too new. It’s funny looking back, because at the time, I also thought that my new classmates, in the dissection room with me that day, were too quiet, too impeccable.
Apprehension was the primary feeling amongst us. We were all eager to make a good first impression in front of our new classmates, our future friends. Fear wasn’t allowed. We were in med school now- looking at these donor bodies was soon going to be an everyday occurrence. Everyone tried to look brave. Nobody wanted to be ‘that girl’ or ‘that guy’- the one who fainted when he or she entered the anatomy lab for the first time.
It was my first time seeing a dead body, except that of my grandmother’s. That was different though. She was dressed in her Sunday best, her hair done and her makeup on. She wasn’t frightening. In this vast, unfamiliar, and chemical smelling room lay 12 dead bodies, unclothed, with only their towels and plastic coverings protecting us from the fear of failure. What if I couldn’t handle seeing what lay underneath? What if I found doing the dissections too gruesome? What if I failed at the only thing I had ever wanted to do?
Only four months later and I look at the anatomy lab through new eyes. It is no longer daunting. It is where new friends were made. It is where we laugh and chat. It is where we study what we ached to learn, what we came here to learn. The 12 donor bodies are no longer just dead bodies. They have identities and they have meaning. They are men and women that gave their bodies, so that we could go on to become exceptional doctors. It is no longer too quiet, too impeccable or too new. To my distaste however, it’s still as bad smelling as ever.
The graveyard is like no other, neither gloomy nor spooky. The smell. The environment. The sight. Everything is different. The grave is bright. Everything is white. From the floor and the wall, to labcoats and gloves, even the cover sheets for the cadavers. Everything is white. Maybe, so the students could stay bright, but not to feel fright. It is a grave, where the medic students have to learn, from the outermost skin of the body to the innermost complex organs, from the largest femur to the tiny little sesamoid bone. It is a grave that the medic students should fall in love with. Even the grave is full with creepy skeletons staring at them but yet they still come often. Even the striking smell of formaldehyde destroys their nose but it will eventually become addictive instead. And the corpse, will always wait faithfully on their grave for the students to come, giving every bit that they could so the students could one day be a doctor. So yeah, this is the graveyard, totally like no other.
Cold spills out like an open hotel door
Every fake skeleton’s missing a limb
Near open boxes full of people’s bones
The closest to strangers they’ve ever been
Every skeleton is missing something
By crusty old copies of Netter’s map
This is the closest to strangers we’ll be
The dentist smell just seems inadequate
Thick yellowed books like unanswered letters
Spotlights on elbows that never inflame
The dentist smell with no sense of judgement
And no shade of white plastic is the same
Spotlights on hinge joints make do for the sky
By open boxes spilling people’s bones Where no shade of white plastic is the same And cold falls out of the old hotel door
The Dissection Room
The white walls, the bright lights, the stainless steel surfaces, one may confuse this room for a hospital ward; however no patient is going to be discharged from here. Then bang; it hits you, the poignant aroma of decaying flesh combined with a concoction of chemicals; stomach turning, nauseating, almost overpowering, however, to the experienced anatomist it is somewhat familiar.
In each bay, beneath the white plastic tarps, they lie, stiff, cold, lifeless, preserved in time, positioned as they lay during embalming. They lie as though asleep; however will never awaken; for they are now in an eternal slumber.
Accompanying each cadaver is a brief description outlining their name, their age, and their cause of death, but one can only wonder; how they might have lived?, where had they be from?, what had they been like?. However we choose to disregard such details, as thinking of them may make the task at hand somewhat more difficult.
Although we can try overlooking the facts, we cannot however ignore the valuable contribution that these individuals are making to our training, we should feel privileged that they have given us an opportunity to attain a greater insight into the inner workings of the human body, knowledge that will hopefully stay to us for our entirety of our medical careers. For it is said that “knowledge is power” and to truly be an expert in something; one must first fully understand it and how it works. Just like an experienced horologist needs to comprehend the inner workings of a clock, we need to fully understand of the inner workings of the human body and appreciate how it ticks.
However I can’t but wonder; if these individuals had been fully aware of the fate that lay in store for the bodies. Had they envisioned, that on a weekly basis, five to ten overly enthusiastic students using an array of weaponry to cut fascia, sever muscles and break bone. Like a bunch of excited children on Christmas morning, ripping through the wrapping on their presents to discover what wonders lay inside, all in the name of exploration, all in the name of medicine.
But one may ask “is this really medicine?”, “is the purpose of medicine not to treat, to heal, to help?” Is the practice of dissection not a bit abstract from the grand scheme of modern medicine?, was their sacrifice truly worth it? only time will tell.
Probably the greatest testament to their gift will be how we apply this knowledge to help others.
What’s disconcerting in a dissection theatre isn’t necessarily the jury of twelve cadavers or the startlingly clean smell and feel of the place. Rather, it’s a mishmash of the two.
The moment you enter, the smell of formaldehyde is almost overwhelming but it fades so quickly you almost forget you ever noticed it at all. Until, in a lonely of intense concentration, it comes rushing back on the tail of the new smell, of sweat and evaporating fat.
When working at a table, it’s so easy to see yourself as a butcher, fixated on and meticulously carving up the slab of flesh in front of you.
It’s so surreal, therefore, when it all comes crashing back to sentimentality.
“Did Pamela have any children?” I wondered of my last donor. “What kind of life did she have?” “What does death feel like?” The banal and the profound aspects of life mesh and grind with the visceral reality of what was once alive before you and the sense of shame for momentarily forgetting these questions takes over – for me, at least.
That’s not to imply I’m above all the laughter surrounding the table. The humour in the theatre is shockingly bleak: “Death hilarious”, to quote Cormac McCarthy. Apparently it’s a coping mechanism, for dealing with the arguably traumatic scenes we see but whatever it is, the strangled laughs at a poorly cracked pun about the donor giving us a leg up or such hint at an emotional charge to the proceedings that we, as somewhat arrogant youths would try to deny.
(Some thoughts on choosing medicine as a career by first-year medical students in a creative writing module, TCD 2014)
Heart diseases cause 22.18 % of death in Malaysia which is nearly 1 out of 4 deaths that you can encounter in a typical hospital in Malaysia. The age adjusted death rate is 138.75 out of 100,000 populations, which is 2.5 times higher than the death causes by all types of cancer combined making it the number 1 killer in Malaysia. This frightening statistic is one of the reasons why I want to become a doctor or more specifically, a cardiologist. With the increasing fatality rate due to this disease every single year, I would like to add up the workforce of fighting this disease in my own country and if possible, the world. Local statistics show that heart disease risk factors, such as obesity, hypertension, diabetes and high cholesterol levels are on the rise. This arising risk factors is closely related to our lifestyle. About 75% of Malaysians never exercise at all but consume more food than the daily energy expenditure. Most of it are unhealthy junk foods. This is the second reason why I chose medicine as my career path. A doctor should not only be a person who sits 9 hours on the chair in a typical week days diagnosing and prescribing medicine to the patient. A good doctor gives advice to the patients and tries as best as possible to lead them towards healthy lifestyle as I believe prevention is better than cure. These are some of the objectives of a doctor which I am clear of.
Pretty cliche and plastic right? If I was given this kind of text, I would honestly just go through it as fast as I can because I can guess where it was going from the first sentence. I’m sorry to make you read one of the paragraphs in my copy-pasted-facts filled personal statement. Even I myself don’t clearly know what does age adjusted death rate really means or….what am I really doing in medical school. The only thing I remember for sure is how everything started three years ago. After passing the high school examination with a pretty good result, my family talked me into doing medicine when I was about to send an application for a local aviation company scholarship. I had reasoned with them about my choice but my parents are quite conservative (I don’t know if this is the right word). All they see about the most promising life I can live is that when I can head into the career path of an unremarkably average successful people. That is what I can simplify about their thoughts. At that point, I started to realise all these years I go to school because I am supposed to, not because I want to learn something. I don’t know if I’m lucky or unlucky to end up in a medical school.
I can’t help but always imagine the frightening future of me sitting on a desk in an typical government hospital like a zombie, 40 hours a week for a few hours of productive work just to pay taxes, support a family and get the largest mortgage that I qualify for and spend 30 years paying for it, when I know that I was close to pursue my dream. Don’t get me wrong. I honestly respect the medical profession as an honourable career. It is just me who can’t really accept how static the life of a doctor, working in the hospital.
Looking at the bright side, medical school is not that bad after all except for the fact that I only have to continuously study hard and accept the ethical principles that I usually don’t see eye to eye with to pass the exam. The stupidest thing I’ve tried so far is styling my hair in a way that makes me think that I look intellectual and wearing spectacles to make me look like I study hard. Doctors are not doctor for their appearance, but because they have interest in it.
The only reason I know that led me into this career is my need of satisfying my parents. I guess I don’t need to find so many reasons to do something that I have thousands of reasons to dislike when a meaningful one is enough. But I always pray that along this path, I will eventually find something that makes ME love doing medicine. Or if not, you’ll probably see me at a flying school in the future, leaving my medical degree certificate hanging on the wall for my parents.
PS: This is not an essay to express how much I blame my parents for making me choosing this course but rather to show how much I love them. They are not what you’d probably think of right now. Conservative is the best euphemism that I could think of for ‘narrow mindedness’ which I save for myself in case if I am wrong about medical career which I hope that I really am.
A med student and a Jamaican toucan shared the same dorm room. As you can imagine they approached life rather differently.
The toucan would frolic about the room washing, cleaning, cooking obscene amounts of ‘bacon’ all the while the student would hunch over a pile of books in the dim-lit corner, delving deep into another hours worth of meaningless minutiae. His stoic profile was his simple broadcast to his roommate “DO NOT DISTURB”.
As the toucan slapped on another batch of bacon he leant back on his bean bag as he blurted,
“Ey mon, I’d be a far betta docta than you man. I could get to de ospitale ten time quicka den you. We’re racing to Tallaght Ospitale tomorra”
And so it was that they would race. The student never wasted time talking to people while he studied, only when it was absolutely necessary. The student’s lack of protest was essentially meant it was on. That’s why the bird always spoke in definite sentences.
It was just then that the student considered his worth. He knew the toucan didn’t know the first thing about the talocalcaneonavicular joint, but when it came down to emergency logistics, do or die, get from A to B to save another human being, Timmy the Toucan would probably win.
“What am I doing with my life?” he began to think…
Why medicine? All I do is sit in this corner, never help Tim around the room. In a lot of ways, I’m useless. “Street Smarts” are lost on me, I don’t know the first thing about cooking and I don’t have a job. Is it really worth leveraging 5 years of uselessness with what would be (hopefully) a future of usefulness?
All my friends slowly drifting away.. The suspicious looks as I tell them I’m in at 9 for the 99th time. My xbox skills are clearly fading. Amidst this odd cacophony of doubt and worry, the student conks out.
The race was scheduled for 8 AM, before lectures of course, from the door of the BMSI to the door of Tallaght Hospital.
The two roommates arrived to the start-line together. The toucan looking slick as ever, shades, flatpeak, toothpick, the works. Beneath all the style however, he was unsettled. The entire trip to Trinity the bird wondered why the med had such an air of nonchalance about him…
“3…2…1… GO!!” squawked the toucan out of nowhere. The student smirked at how frivolous the toucan’s trickery would be. For just then the lad strapped into his newly-made jetpack, as one does! His proficiency with machinery allowed him to fashion his new invention from cups of coffee, coke cans, bungee cord and old anatomy texts. He rocketed into the air with such power, such force. He zipped past the toucan. ‘I’m not useless…’
It was just then. Right as he scanned over Dublin city that his mind bundled back to his anatomy lecture. Right then that he raised his head up from his A4 pad with scribbled toucans and jetpacks. For it was right then that he realized that this ludicrous daydream was oddly symbolic of his reasoning behind choosing medicine.
As an avid lover of machinery it may make more sense for this student to study engineering or other. For what are we modern-day humans without our precious tools? We are a stubborn race, we always attempt to better our lives. Out of our own sense of self-worth (or hatred of toucans) we enhance our output as an individual with machinery. This student, however, is enamoured by the concept of enhancing human’s output by enhancing their body and mind directly. For one day he considered the workings of a pacemaker and how intrinsically brilliant it is, despite being simple in concept. He thought of how the practical use of a car pales in comparison to that of an artificial limb, he thought of how the human body is in and of itself the most ethereal and visceral machine ever known. To understand even a portion of it is almost mystical, especially that squishy stuff at the top. This is his slightly bizarre reasoning behind choosing medicine.
This is not to say the cloud of doubt does not cast its shadow on him from time to time. But every time, the same thought shines through. The thought that maybe, just maybe, he could give one, just one person their very own jetpack of the body or mind.
And so his attention set on Dr. Mahony’s lecture. For he must plant his feet back onto this arduous path toward a medical degree, peppered with bioengineering knowledge to try make that jetpack…
People continually ask me why I want to be a doctor? Why I chose a career path laden with long working hours, a poor work – life balance and one which often comes with little gratitude for the work you do. They ask me this question looking for one simple, straight forward answer.
The Truth is I don’t have one.
My earliest impression of the medical profession came when I was admitted to hospital suffering with acute appendicitis. Rushed to hospital in the middle of the night, writhing in pain and delirious with a fever I was terrified and wished with every fiber of my being to be anywhere but there, the support, care and attention I got at the time has remained with me and made the memory a little less alarming. I was mesmerised by what they knew about me simply by testing my blood or asking a few simple questions, the ability at which they eased suffering sparked an immediate and long lasting desire within me to be a physician.
I love working with people. They annoy me sometimes and let me down, but I truly believe that people are good. As a doctor you can walk into a room and within 5 minutes of meeting someone be intimately involved in the most personal and vulnerable parts of their life. That is amazing and a privilege that most people never experience.
Often people assume it’s for the money or the status or the ability to play god. however the real reason is I am in medicine because I love learning, I love problem solving and I love people. When you find something you truly love, then money becomes less of a concern. So why medicine? Because I would never be happy doing anything else.
My conviction to study medicine has gradually grown from a feeling, a thought as tiny as a seed, a seed that originally settled in my soul, having been blown there from the observations I made watching my dad. He is a GP.
At the age of 18, when filling out the inevitably CAO form I had experienced death in my life, too much death for someone my age. The most significant was the sudden loss of my uncle in a traffic accident in 2010. While this incident altered me in ways I can’t even begin to explain, it also fully opened my eyes to the importance of the medical profession. I believe medicine and doctoring are veritable mélanges of the different experiences and emotions of the human condition.
Looking back on that time in my life, it is clear to me that it watered and nurtured that tiny seedling and is now a constant reminder of the good I can do. I believe that seeing someone youl ove hurting and yet being strong enough to hold your nerve and show support truly shows inner strength and compassion towards those who are ill.
[A fragment of life] Picture the scene. Sixty very liberal, very intoxicated youths in a Spanish villa, by an Irish harbour.
Questionable dance-pop and the questionable sing-along pulsing through the walls.
A smell of sticky beer, vodka and vomit in the kitchen.
A taste of sticky beer, vodka and vomit in everybody’s throat.
Outside, a youth is sprawled across a deckchair on the verandah. He’s covered in Jägermeister, dried blood, more beer – and of course vomit – and this particular youth is unconscious.
His pockets are empty: his wallet forgotten in a random bedroom he had napped in earlier. His phone is in pieces in the next room, having been danced into dust by a casually curious girl, but that’s another story.
For now, what’s important is the youth himself. Young, relatively innocent in his alcoholic sleep with Spike Island and Haulbowline and Passage West in the distance and the scent of fresh seaweed in the air.
The boy was less interesting that the setting. He wasn’t particularly distinguishable in this raving mess at all, but the narrator must introduce themselves at some point, no?
The question ‘Why Medicine’ has always been a question that lingers around me. It is something that people ask me often and at times I end up asking myself.
I grew up seeing my grandfather suffer terribly with Parkinson’s Disease. As he grew older his condition worsened and eventually inspired me to become a doctor to try to help others that have his condition.
Well, to be completely honest, that was my stock answer to the question of ‘Why Medicine’. It came in very handy during interviews or when people asked. I would briefly tell them about my grandfather and that would be that.
As much as the story is true, though, and as it does explain to others why I chose medicine, when I put the question to myself in private, I just answer that I just always wanted to. True, it is a little vague, but it’s the truth. I never imagined myself doing anything else for a living besides being a physician. I have heard doctors personally lamenting their busy lives and crazy hours, but that has never deterred me. Right now, I know what I signed up for.
Even though it might not satisfy the interviewers, I am happy with the answer I give myself. Anyhow, soon people won’t ask me the question and it will only be myself I have to answer. I plan to have no regrets about it.
The sun hit the water and exploded into a million shades of blue. The ocean was flat so I felt safe to roll over flat on my back to avoid its dazzling reflection and just let the water rock the surfboard back and fourth while looking into the brightening sky of the morning. There are few certainties in life, sure death is always one and taxes another, unfortunately, but there are always things you never think about, day will always follow night and occasionally even the ocean will take a break and cease its endless assault against the defenseless coast. However, in an embarrassing twist of fate an old friend was just visiting me in San Diego for the first time in a few years. She always loved to surf but didn’t get to do much of it anymore, and in anticipation of her arrival I had been boosting about the fantastic rollers we had been having for the previous weeks running up to her arrival and now that she was actually here it was, naturally, dead calm. She paddled over alongside me with a smirk on her face that conveyed both the frustration of the situation mixed with the delight for rediscovering a long lost passion. We had not only been high school students together but also undergrad and later PhD students at UCSD, we both studied biochemistry and both ended up in the same research lab. In fact she was the first friend I made upon moving to San Diego when I was 14. She later dropped out of graduate school, transferred to Harvard law school and became a senior lawyer for a major environmental organization. At some point while scanning the horizon for the next potential stir of water the conversation turned to why she left graduate school. To my utter astonishment she said it was because it made her feel ‘stupid’. After a couple of years of feeling stupid everyday it was time to move on and do something else. I had always considered her one of the brightest people I knew and her subsequent career supported this view. At that point the gentle push and pull of the ocean seemed to give way and become more bumpy and disturbed, the sign of a renewed assault, and even though the sun disappeared behind the marine layer again I kept thinking about her comment all that day and for some time the next too.
Her comment disturbed me for many reasons that I had never connected on a single line of thought before. What bothered me most was difficult to explain, science had by then made me feel ‘stupid’ also but I had either gotten used to it or had become too comfortable in the routine and security of daily life to give much thought to it or my previous childhood dreams of becoming a doctor. Either way I had been intrinsically unhappy for some time with my own career and the lack of direction and interaction with people on a daily basis that it entailed. But the metaphor ‘stupid’ that she had used implied a whole lot more than just this. For most people who study science we do it because we are good at it. In high school and college science means taking courses and doing well in those courses means getting the right answers on tests. If you know those answers you do well and fell smart. However research was completely different in that you needed to frame the correct question that would lead to a significant discovery, design and interpret experiments so that the conclusions are absolutely convincing, foresee any difficulties or problems and either solve those issues or look for ways around them and finally you only realize that you asked the right question in the first place when you get the right answer. In this context the scope of things I didn’t know wasn’t just vast it was for all purposes infinite and at that point all the dots connected and I saw the full picture. This realization hit like a wave in that I didn’t want to live such an uncertain life with no eventual practicality, end goal or purpose to it, just wondering around in a scientific desert till I either found water or died.
So then why medicine, simple, I’m a geek who loves science and loves a challenge. I also enjoy working with and understanding people more than lab rats. Another certainty in life is disease and illness and I’ve always had a genuine interest in health and the causes of ill health. Medicine simply offers the opportunity of a life that integrates all these interests, not just some of them, into a more holistic career. I still feel stupid though – it’s just in a more literal context now.
I was 4 and I was living in Italy. My dad had gotten a job over there and so, my mum, my older sister and I moved over there with him. We lived in an apartment in a humble but impressive town in the north, just outside Turin. We have a blissful life over there. The weather was perfect- It actually snowed in the winter and was hot and sunny in the summer-something we were not used to in Ireland. My dad’s office was no more than two minutes away from the apartment, which itself was about 5 minutes from the town that had scenic parks, divine pizzerias and heavenly bakeries.
One day, I think it was in January, we were eating lunch as a family in our apartment, as we did most days. My sister and I were finished school for the day- school ended at lunch time for our classes because we were both so young. As happened every other day, my dad went back to work after we ate and the three of us stayed in the apartment and played games, or whatever it is a mother does with her 4 and 6 year old daughters, in a foreign country and being 7 months pregnant.
My dad had only been back at work for about an hour when he received an anxious call from my mum. She told him that we all felt nauseous, dizzy and had bad headaches. She mentioned how my sister and I had fallen asleep on the couch, and how she would probably do the same now. My dad had eaten with us and he felt perfectly normal ,so food poisoning was ruled out straight away. Immediately he sensed something was very wrong, and he was right.
Within a couple of minuted after my dad arriving home, the ambulance had arrived and we were being carted off to the local hospital. The paramedics told us that they thought we had carbon monoxide poisoning. Carbon. Monoxide. Poisoning. I was four, so I was completely oblivious to what that was, but the look on my dad’s face told me it was bad. Really bad. I had never seen anybody look like he did before then, nor have I seen that expression since. Now, almost 15 years later I know what that look was for- he was facing the real possibility of losing his whole family.
We reached the hospital and already I had started feeling much better. Just getting out of that apartment and being given oxygen had quickly alleviated some of the symptoms. Unfortunately, my sister and I were in a different ward to my mum, and my sister did not take that well at all. She was hysterical. Me, on the other had, I was intrigued. It was my first real experience of being in a hospital. Obviously the situation wasn’t ideal, but I found myself living it up. I just remember being fascinated by everything; all the equipment, the doctors, the nurses, the oxygen masks, the IVs and the injections. I was four. I should have been afraid, but i wasn’t. I think it was then that it happened. I didn’t realise it at the time but now I know, that was where my dream and desire to study medicine came from. Thankfully we all made a full recovery, my my younger sister was born perfectly healthy two months later. I’m sure that if that outcome had been different I would not be studying medicine today. The skilfulness, the expertise and the kindness of all the doctors and nurses was inspirational! How could I want to do anything other than medicine?
After trying to lift her car several times, to no avail, Sarah had become accustomed to the idea that in order to become a superhero, she would need to earn her superpowers, the way Luke Skywalker had, rather than be born with them, like Clark Kent. Nothing would prevent her from becoming the thing she had dreamed of since she was a little girl. She had convinced herself it was a question of will and concentration, and would sit in her room for hours with her eyes closed, mentally preparing herself to the idea of flying. She knew that when she was ready, wings would grow out from her back. It would be difficult to get used to their weight, and to the tugging below her shoulders every time she unfurled them, but she would manage. Until then, though, she would resign herself to her imagination. She drew out designs for her superhero costume, and dreamed of flying from New Delhi to Atlanta in 4 minutes flat. She could see herself saving lives, and flying away as quickly as she had swooped in.
One day, while visiting her aunt and new-born cousin in the hospital, she went to buy herself a pack of candy while the adults cooed over the baby. She was standing in the corner of the elevator, munching on her m&m’s (focusing on the initial crack of the colored layer, then the sweet, melting chocolate, until finally the crunch of the peanut) when a woman in blue scrubs and a white coat walked in. Sarah stared at the back of her poney tail and admired the way every strand of hair was neatly tucked away, the way the white coat fell stiffly down without a crinkle or a fold. When the elevator doors opened and the doctor walked out swiftly, she didn’t hesitate to follow her.
A few steps out and she already felt like Alice in Wonderland, looking for the white bunny that had lead her here and instead finding a whirlwind of characters she never knew existed. There was the rush and buzzing, people flying from one side of the hospital to the other in a cool, collected panic, their ebb and flow resembling the careful mechanics of a clock. The doctors swooped in and out of patients’ rooms, rescuing the ones they could. She could imagine the surgeon, in the midst of a complicated surgery, calmly turning his face to the right, eyes still riveted on the bloody gap his fingers were in, and the nurse wiping away the sweat that was slowly sliding down his forehead. No shaking hands or rapid breathing, nothing to accompany the difficult task he was performing. Everyone just seemed to know where they were going and what they were doing. “This is as close as it gets,” she thought.
The uncertainty, the trepidation, the apprehension, the feeling of sickness in the pit of your stomach, it’s the first day. People tell you “it will be grand”, “everything will be okay”,“going to college will be the best experience of your life”, “you’ll meet so many interesting people”, “you’ll make so many new friends” and “your mind will be opened up to so many new ideas”, but they fail to prepare you for the anxiety and dread of the first day. Age or past experiences do little to alleviate the feelings of uneasiness or uncertainty. You are overwhelmed by fear, your thoughts are plagued by questions like “will I make friends”, “who will I talk to”, “how difficult will the course be” or more importantly “will I be able for it”.
A famous poet once said that “no man is an island”; he obviously was not referring to the first day of college. For in first few hours, we are all islands, isolated by fear, surrounded by a sea of uncertainty and despair. We go through the motions, conversing for the sake of conversing, hesitant to show our true selves or true feelings, our vulnerabilities are exposed, while all the time, the haunting questions resonate in the back of our minds.
However, as the hours pass and the tides of uncertainty begins to recede, causeways based upon budding friendships begin to develop and the students are no longer islands, but they become continents, united by this shared experience. However, these events do not transpire without losses, there are inevitably causalities along the way, like islands eroded by the waves of anxiety and fear, lost to the sea of doubt forever. One wonders if preventive measures were implemented, could some of these losses have been avoided.
As the days and weeks elapse and calmness ensues, the friendships that were forged on the first day become stronger and new ones develop and the feelings of fear, uncertainty and insecurity experienced on the first days become an all too distant memory.
The world is like a new place to be.
He has gone so far, he can’t believe;
So far, he thought he would never be;
So far, his old self could never foresee,
To a place so far from misery:
The world, they call Medicine Overseas.
The first time he touched down in Dublin, he couldn’t believe his eyes, yet everything was too vivid to be a dream. He had never been to any other country in his life, so it made him feel like the world was new.
And, on top of this, to be studying medicine after 12 years of school! This also felt like a new world to him. Every morning he woke up and still couldn’t believe he was in this new world.
His dream to study medicine overseas was finally real.
But why? Why he would actually want to study medicine? What makes him willing to sacrifice his life for this stuff? For money? There are lots of other less complicated jobs that would offer tons more money than medicine. For pride? No. For publicity? Nope.
The only reason that feels true to him is just to be a champion like his father. Seeing his father being so helpful to his community while he was growing up, has left him wanting nothing more than to follow in his footsteps. Throughout his childhood, he witnessed many heroic moments at his father’s clinic: people always seeking him out for help, looking to him for advice, thanking him. His father was just too good not to be a role model. That’s why he doesn’t care if it takes so much sacrifice, his whole life even, and why he doesn’t care about the voices of criticism about his chosen path. As long as he can be a champion for the people, just like his father.
And now, here he is, in a new world of medicine and Dublin, taking his first step on that path. Realising he has only just started the journey, and there is more then a thousand steps ahead to take, he doesn’t care: the most important thing is knowing that he is on his way in this new world.
One of the more pessimistic medical blogs that I read while trying to decide whether or not to stay in medicine defined it well – this course is Nerd Everest. In my experience, the most rewarding things to study are usually the ones that seem to actively repel any attempts to understand them. For a long time I hated learning piano, until one day it mysteriously clicked. Studying physics for the Leaving Cert was the same – at some point the thing just stops kicking you in the brain, and decides that you’ve earned a shot at real comprehension. Both required discovering a new way of thinking about the material, and I don’t think medicine is going to be any different. Some day, what seems like a melisma of clumsily co-opted graeco-roman, just a whole shanty town of syllables, may turn into something intrinsically meaningful and intuitive (I hope).
I can’t say I’m not disappointed at the lack of anything to just sit around and ponder, because that’s how I imagined college to be since I was old enough to imagine it. A possible exception is ethics, though instead of meandering philosophical chats, it’s a case of playing at being lawyers for a few hours, since one traditionally prestigious career wasn’t enough.
Medicine gets stuck in my head to a much greater extent than any other subject I’ve ever studied, in a sometimes literally visceral way. When I was on my way home at the weekend the moon was shining over the Suir as brightly as I’ve ever seen, and the first thing I thought about was how the texture of the river’s surface looked remarkably similar to that of the mystery hernia discovered at my anatomy table earlier in the week.
This year I live in the city, at the back of an old Georgian house with a view of a community centre from my bedroom window. While I’m glad that I don’t get tormented by traffic noise, there are drawbacks. This past week there have been exams going on in the centre, which have been giving me the fantods. It’s an environment that’s getting more and familiar, comfortable even, and I’m not sure how I feel about that. So what if the only thing I’m good at anymore is taking exams (and even then, it’s hit and miss)?
Medicine is a demanding subject, requiring a lifelong commitment to learning and hard work. Its practice is a combination of science and art. Knowledge of science forms the foundation for understanding the cause of the illness. The art is combining this knowledge with clinical judgment to determine a diagnosis and management plan.
Studying in a competitive field such as medicine can be a daunting challenge. For individuals with a learning disability, such as dyslexia, the ability to cope with the transition to an independent learning style can carry additional difficulties. However, it is important to remember that dyslexia is not a barrier to becoming a doctor and these difficulties can be overcome with appropriate support.
These guidelines aim to answer questions, provide information and quash myths. They are relevant for students already at or applying to, UK medical schools; or for medical students who think that they may be dyslexic.
THE recent debate on the mechanisms of admission to medical schools in Ireland has included a number of inaccuracies. The change in the medical school entry process arose from the recommendation in the government-commissioned Fottrell Report on Medical Education in 2006.
On foot of this, an expert group on entry into medical education, established by the Education and Science Minister, recommended combining the results of the Leaving Certificate with a new admission test. The new test would examine domains of learning which were beyond the scope of the traditional Leaving Certificate examination.
The Department of Education and Science and the Higher Education Authority then specifically requested that the University Admissions Offices and the Medical Schools consider the introduction of an additional assessment system to complement the Leaving Cert.
Following an official tender process, an educational provider — the Australian Council for Education Research, which administers similar tests in Australia and Northern Ireland — was selected to provide the Health Professions Admission Test (HPAT).
It was intended that this test would complement the Leaving Cert by assessing skills such as mental ability, reasoning, interpersonal skills, and professional attributes which lie outside the domain of the Leaving Cert. There was no intention at any level that this test, introduced at the behest of the Department of Education and Science, would introduce any form of gender bias. Indeed, this was one of the exclusion criteria in the tender process.
The Council of Deans of Faculties with Medical Schools of Ireland (CDFMSI) is firmly committed to ongoing assessment and evaluation of the mechanisms for entry to medical education to determine whether such approaches are fair and equitable, and also to ensure that any new assessment system is contributing to the development of high quality medical graduates. A simple knee-jerk response on the basis of the first-year results of HPAT and the adjusted approach to Leaving Cert scores is unlikely to be helpful as there are a range of factors, including familiarity with the process which may have contributed to some of the outcomes recently.
A research group comprising representation from the CDFMSI, admission officers, the Central Applications Office, Irish medical education experts, and international advisers has been convened for the purpose of ongoing evaluation of the entry process. This group will examine the concurrent and predictive validity of the new entry mechanisms as well as the impact on the socio-demographic composition of successful medical school entrants.
It will be particularly important to ensure that the new assessment methods enhance social equity with regard to medical school entry. In addition, it is critical that we determine that the new assessment procedures do not have a negative impact on the attainment of educational outcomes by medical students and graduates.
The medical schools are fully committed to the principles of gender equality and are concerned by perceptions that this assessment protocol was designed in any way to discriminate against female entrants to medicine. We do not believe that such a process would be acceptable or desirable for the future development of Irish medicine.
Prof Dermot Kelleher is chairman of the CDFMSI and head of School of Medicine and Vice-Provost for Medical Affairs, Trinity College Dublin