The University of Bristol

Medical Students‘ Magazine

Black Bag the

1

The University of Bristol Medical Students‘ Magazine

VOL. II NO. 1 WINTER TERM, 2010

EDITORS: D. R. A. Cox & R. A. F. Pellatt

SUB EDITORS: P. K. Barnes & F. K. McCurdie

CONTRIBUTORS: Eoin Dinneen, Freddie Herbert,

Aisling Longworth, Carlson Oma,

Piers Osbourne, Annie Pellatt

‗Never trust a doctor whose office plants have died.‘

Erma Bombeck

Black Bag Winter 2010

the

Contents Page

Editorial . . . . . . . . . . 4

A Word from the Sub Editors . . . . . . 5

A Study of First Year . . . . . . . . 6

The X—Factor . . . . . . . . . 12

Face Cancer . . . . . . . . . 16

Going Home . . . . . . . . . 20

Freshers‘ Bar Crawl 2010 . . . . . . . 23

Life as an Ophthalmology F1 . . . . . . 25

Body Pump . . . . . . . . . 29

Personal Statement . . . . . . . . 35

Educational Crypticities . . . . . . . 38

Robot Wars in New York . . . . . . . 39

Coffee Break . . . . . . . . . 43

Reviews . . . . . . . . . . 45

Editorial

T ick follows tock follows tick follows tock… Our days

are numbered; our time‘s almost up. And we‘re not

just talking about the final exams less than a week away

(which we should really be studying for, rather than writing

this at 1.47am). With six raucous years of university under

our belts, it is not without a wince of panic that we find

ourselves on the brink of docterdom and old age.

It‘s been a ball. From that first slippery pull in Wedgies

to the last Jäger-Grenade on this year‘s pub crawl (featured

centrefold), we‘ve loved every minute. If this is your first

year at Bristol we‘d advise Camel Lights, unprotected sex

and Blast Billiards (Gold). Steer clear of Lizard Lounge.

For our final edition, we present advice on how to

make your way from Bristol to London, one man‘s dream

of appearing on The X-Factor, a particularly disturbing

medical drinking game and a junior doctor‘s view on his

ophthalmology rotation.

We will be leaving you in the capable hands of our sub-

editors, who will be steering The Black Bag‘s helm over

the coming year and have a word or two to say overleaf.

Eskimo tradition held that once a person reached a

great age, and was no longer useful, they would walk out

into the frozen desert, never to return. So we too must

close Microsoft Publisher, stop typing, and never grace

these pages again. Thanks for reading.

R. A. F. Pellatt & D. R. A. Cox

A Word from the Sub Editors

A s two pairs of eyes sparkled over whiskey on crushed

ice, the welcome was warm. Those faces that had

haunted fresher dreams since the spoof lecture had some-

what softened. Fears of an initiation involving a sacrificial

offering, a blood binding oath or at least a branding iron

began to subside as the pile of beer bottles grew higher.

We were being received into the Black Bag contingent,

a daunting charge that came with a 111 year legacy. Jack

Daniels, eased with brown sugar and lime, along with The

Strokes, accompanied us as we spiralled into a blurry

conversation of editing, scandal and gynaecology.

Several hours later and armed with cans of warm

cider, we journeyed into a realm rather unfamiliar to us; a

realm where legends are born. It was fitting that our

baptism into the medical school magazine should involve

the unceremonious bursting of our Lizard Lounge cherry.

Upon waking, with any feeling of dignity expelled (along

with whatever Mr Donervan had sold us) and still with

valuables in pocket (always a bonus), we knew it had been

a success. We knew we were ready: perhaps not functional,

not wearing trousers, and expected at anatomy dissections

in five minutes – but we were ready.

And so with this, knowing little about journalism and

even less about medicine, we begin our journey as editors

of the Black Bag. May God/Hippocrates have mercy on

our souls and youth have mercy on our livers.

P. K. Barnes & F. K. McCurdie

6

F ollowing the recent GMC inspection of Bristol

Medical School, a number of curriculum changes

have been enforced. As the medical school works hard to

try and ‗review, streamline and update the entire

curriculum‘ we at the Black Bag have felt it necessary to

run an inspection of our own.

We have sought to better understand the attitude,

behaviour and outlook of those arriving at Bristol Medical

School this term. We distributed feedback forms through-

out first year lectures and asked the baby-faced freshers‘

opinions on our fine institution...

A Study of First Year

7

F ollowing a recent GMC inspection of Bristol

Medical School, a number of curriculum

changes have been enforced. As the medical school

works hard to try and ‗review, streamline and update

the entire curriculum‘ we at the Black Bag have felt

it necessary to run an inspection of our own.

We have sought to better understand the attitude,

behaviour and outlook of those arriving at Bristol

Medical School. The first years…

8

9

10

Madame President instigates a

‗zero-tolerance‘ policy with the new

Galenicals Committee

F. K. McCurdie

12

The X – Factor

L et me tell you a story. A

story of childhood ambi-

tion, vivacious talent, invented

memories and shattered

dreams. It begins early one

sunny morning in Cardiff, the

largest city in the county of

Wales (N.B. that was not a

spelling mistake). I‘m stood

next to Dermot O‘Leary – his

pheromones fill the air. An

elderly man in the queue in

front of me turns, nodding at

O‘Leary, and remarks,

―He could shag all day if he

wanted, couldn‘t ‘e?‖

I nod.

I‘m not sure what exactly

prompted me to audition for

Britain‘s greatest singing con-

test, The X-factor. The prom-

ise of fame? An entertaining

mid-week jaunt? A foray into

investigative journalism?

Probably a mixture of the

above, but, having now stood

in the queue for an hour, the

latter seemed to describe my

situation most accurately. I felt

like Louis Theroux on acid.

Looking around, I soon

realised that I was encom-

passed by a menagerie of the

mentally ill and the tone deaf,

and yes, I was one of them.

After around two hours of

an exhausting swearing compe-

tition against a man with

Tourette‘s Syndrome in the

queue behind me, Dermot slid

in, like a 21st century version of

The Fonz, and shhhed the

crowd – silence fell immedi-

ately. I couldn‘t help but stand

in awe of this man, a modern

day Elvis whose charming

‗chap next door‘ demeanor

commanded the people as he

repeatedly mistook, misread

and mispronounced his ten

syllable lines from the auto-

cue. He was the ringmaster in

the centre of the freak circus.

Each time he tried to read a

link from the screen the crowd

would be forced to ‗silently

cheer‘ (the sounds of cheering

were to be added in the edit,

presumably from a crowd

whose cheering possessed

more of that je ne sais quoi…

more X-factor). We stood

13

there in the stiflingly early

morning air of that Cardiff car

park watching Dermot, with a

furrowed dyslexic brow,

squinting at the lines scrolling

past on the screen.

I was beginning to get

bored when a man standing

next to me turned and, grin-

ning manically, inquired… ‗So,

you like Doctor Who?‘ If I

learnt nothing from my nine

week psychiatry placement

(which I probably didn‘t) it‘s

that vulnerable adults such as

this gentleman should have

their anonymity persevered

when written about in a case

report such as this, so for the

purposes of this article I shall

refer to him as Mr. X.

Mr. X, as I previously

mentioned, had the grin of a

maniac the likes of which I

have never seen (on anyone

other than Nina Beck).

However, his smile, smeared

across a dysmorphic face, was

instantly likeable. ‗Here‘s a

man who likes life‘, I thought

to myself. Moments later my

preconceptions were validated

as I watched him smiling to the

point of exploding whilst he

recited the lines from a Doctor

Who episode from memory.

Mr. X was a happy man and

would become a… well yes I

suppose I should say it, a

friend for the remainder of the

day.

It was as a result of this

friendship that a new sense of

melancholy swam over me as

we entered our third hour in

the queue. For I knew what

fate had in store for Mr. X.

He, unlike others in his

situation before him (see S.

Boyle 2009), was not blessed

in the musical sense. This left

me with a bitter taste in my

mouth: Mr. X‘s destiny was to

be exploited by Cowell and

Co. for the amusement of the

general populous (much as I

am doing here) only to be

screwed up and thrown away

like yesterday‘s copy of The Black Bag. However, this cloud of

empathy was soon to dissipate

from my mind: I callously cal-

culated that I best stay with

Mr. X as he was sure to get

onto the television and proba-

bly provided my best chance

of becoming famous by proxy.

It was with a sense of over-

whelming relief therefore that

I saw Mr. X the next day in the

car park with a hundred other

hopeful idiots as he, like me,

had won a golden ticket into

the second round. By this

point, however, I thought it

best to break off my friendship

with Mr. X (he was becoming

a bit over friendly) and

decided to just ‗concentrate on

the music‘.

Sitting in the waiting room

(the one they always show you

in the early stages) with the rest

of the circus was a bizarre

experience for two reasons.

For one, the ratio of crazies to

normals had increased expo-

nentially, the producers having

hand-picked the most de-

ranged of applicants from the

previous day. Two: I was hung

-over, feeling fairly sick and

wearing yesterday‘s odourous

clothes (a clever ploy by the

producers to make the whole

thing seem like it happens on

one day). Like Dumbo watch-

ing the pink elephants dancing

in front of me, I was scared

but nonetheless enchanted.

The wait in this area was

but a moment compared to

that of the previous day.

Before I knew it, I had been

called to a small room where I

14

‗I‘ve only ever wanted two things in life: to

sing and to help myself and so many more,

just by… singing‘

stood in front of two executive

producers with a video cam-

era. I knew the routine: I

would employ yesterday‘s

fabricated story, stare straight

down the camera and lie.

Maybe even try and squeeze

out a tear. In the full knowl-

edge that this could be my

final showdown, I took a deep

breath and began the elaborate

sob story that I had invented

on the way to Cardiff the

previous day.

I regaled the producers

with the tale of a young boy

from a small (unspecified)

village who did fairly well at

the local school and was thrust

into the academic life, the one

true hope of a village where no

one before had even been to

sixth form, yet alone univer-

sity. I dropped my head to the

floor and elaborated on the

pressure I felt from home, my

dislike of the medical life and

my childhood dreams:

‗I‘ve only ever wanted two things in life: to sing and to help myself and so many more

just by… singing.‘ The producers both

smiled. Yes! I‘m in. All that

was left to do now was sing.

I have never seen a smile

drop from a person‘s face

quite so quickly. I can‘t imag-

ine the faces I pulled as I

heard less than a Leona Lewis

performance emanate from

my vocal chords. There was a

brief silence. The producers

had become altogether more

business like and stark. One of

them, looking through the

papers they had on me

glanced up and said,

‗It says here you‘re only a

year away from being a doctor,

is that true?‘

‗Erm…yes it is.‘

‗Well you‘re clearly not

going to quit to go to boot-

camp to have a 1 in 20 chance

of being famous, are you?

What do you want to do?‘

‗I want to be a surgeon.‘

‗Thank you for your time

Daniel, have a nice day.‘

The dream was over. As I

left I heard that Mr. X had got

through, I hope to see him on

television soon.

I didn‘t even get to see

Cheryl.

D. R. A. Cox

15

H ave you ever played

Face Cancer? If you are

a medical student at Bristol

University, the answer is

almost possibly yes.

Confused? I‘ll explain.

My housemate and co-

editor claims to have invented

Face Cancer with his thespian

friend some five years ago, as a

young first year student at

Bristol University. Such a

claim from said housemate

and co-editor I would nor-

mally approach with caution,

given other outlandish aspects

of his personal history, such

as:

My family are gypsies and my grandfather was left on the

doorstep of a bakery

I can run 400 metres faster than anyone else (including

Usain Bolt)

I‘m probably the cleverest person I know

On this occasion, however,

I think we can give him the

benefit of the doubt.

The story goes that these

dramatists were looking for a

way to practise keeping a

straight face while delivering

sobering and heartfelt lines on

stage. We‘ve all been there:

something is supposed to be a

moving, tear-inducing solilo-

quy, but one just can‘t help but

breakdown laughing as the

suspension of disbelief is, well,

suspended.

So they came up with Face

Cancer. One person plays the

part of the doctor. The other

is the patient. The patient has

the hideous imaginary disease

Face Cancer. The doctor has

to deliver the bad news:

‗I‘m sorry to say Sir/

Madam, but you‘ve been diag-

nosed with Face Cancer.

We‘ve run all the tests, and

there is nothing more we can

do for you.‘

As the diagnosis is made,

the person playing the part of

the patient must mould his/her

face into the most grotesque,

Face Cancer

16

17

ugly, distorted image that their

muscles of mastication will

allow. The doctor has to

deliver his lines looking the

patient straight in the eye, with-

out laughing or hesitating and

with the utmost sincerity. If he

succeeds, he is the victor. If

he laughs, he loses.

‗Horrible!‘ many of you will

say. ‗What awful mockery!‘

And indeed, this would at first

glance appear to be the case.

A non-medical person might

quiver that future doctors

could be so callous, so uncar-

ing, could distort suffering into

entertainment.

Superficially, this is true.

And Face Cancer has become

something of a staple among

those medical students

inclined to indulge in the odd

drink; the more rambunctious

players have even been known

to include ‗sound effects‘ and

‗props‘.

The truth is more subtle.

While outwardly appalling,

Face Cancer is actually close to

the reality of doctoring life.

You‘ve all attended the ridicu-

lous communication skills

sessions, where one must enter

18

into the realm of theatre and

make-believe and tell an

‗actor‘ (in the loosest sense of

the word) that they have diabe-

tes, or need to come back for a

chest x-ray because of some-

thing sinister. You all know

who I mean by ‗Big Boots

Lady‘. These deplorably false

scenarios are a subconscious

training for the days when we

really will have to tell people

that they‘re overweight, unwell,

or even dying. A friend, now

an F1, says that he finds most

of his time is spent delivering

bad news, talking to relatives

and counselling distressed

patients.

Face Cancer is really the

ultimate refinement of these

communication skills. I would

venture that it has made me

more adept at sincerity than

any half-hearted effort of the

medical school. So many of

our exams are about acting;

about putting on a show. If

you can turn up for the OSCE

with a smile on your face,

while inside cacking your

pants, the pass is already

yours.

Tired, bleary, flu-ridden

with sagging bags under the

eyes after a winter weekend on

call; at the end of the shift,

desperate for a bubble bath,

what will I do when Mrs C‘s

daughter asks me to sit with

her and discuss her mother‘s

condition? Because our inter-

actions can‘t all be real, no

matter how highly we aspire.

It is here, when all I want is

hot chocolate and X-Factor,

that I will turn, and put on my

mask, and forget about going

home and sit with Mrs C‘s

daughter and explain that her

mother is not at all well. It has

nothing to do with being a nice

person, or being a big bag of

cuddles and kisses; it is about

professionalism, about your

duty as a physician.

As future junior doctors,

our young lives will often

encounter death and unhappi-

ness, undoubtedly more so

than university companions

studying law, or engineering,

or history of art. One could

go mad, seeing so much suffer-

ing. Humour is one way of

dealing with this. The morbid

becomes the mockery; the fear

becomes the frivolity.

But the last laugh is inevita-

bly on us; for all our making-

light of clinical life, we are the

ones who must go to sleep at

night. And here the dreadful

and the depressing are ampli-

fied all the more so. A joke

shared with friends over tea

does nothing to ease the mind

in the small hours of the

morning‘s darkness, when all

one has is one‘s thoughts.

All rather sobering, really.

R. A. F. Pellatt

19

Oliver ‗Boo‘ Mclaren

20

Going Home

If I ever need to return home, there

are three options available to me...

1. The Humble Automobile

The first and cheapest option is my housemate and his car. He

lives close enough to have at least one mutual friend from home

on Facebook (although ‗friend‘ is a strong word, considering that

neither of us have spoken to that person for several years) When

coupled with amusing conversation and the ever potential trip to

the services for a Burger King (and a quick round of Time Crisis

2) it is generally the most pleasant way to travel.

However, it is inevitably ruined by the M4- which other than

the Bath-Bristol cycle path appears to be the only road route out

of this fine town. On a good day one can expect to spend three

hours in traffic desperately trying not to make eye contact with

that guy in the Porsche who you cut up for fun at Junction 19,

and on a bad day you just have to hope the car is stocked up with

enough water and Wine Gums to last the week.

If somehow, you make it unscathed, it is only to be met by

the joys of a fifty zone littered with orange cones in no particular

order, road work signs with no particular road workers and an

average speed check with no particular camera to slow down for.

21

2. The Humble Locomotive

My second option is the train. The train has the potential to be

very fast: there is no traffic on the railway and therefore nothing

(one would imagine) to stop the vehicle from moving as fast as

a...steaming freight train.

One would also postulate that given the online seat reserva-

tion service provided, there would be a nicely upholstered space

on which to comfortably park one‘s rear end. And given the

price of the tickets (unless you book seven months in advance

and bank with Natwest) one might even go as far as to expect a

clean, spacious ride full of upstanding members of society, and

even someone playing a grand piano in the corner.

Instead, I find myself sitting on my suitcase sandwiched

between the lavatory and the exit-door with somebody‘s

fold-down bicycle resting painfully on my shins. The reason for

my predicament: the gentleman in 17D quietly told me to ‗piss

off‘ when I suggested that he might be sitting in the seat I clearly

remember reserving.

To my immediate right, a fat adolescent shell-suited female

shares Alexandra Burke with the train through the tinny speaker

of her mobile phone. To my left, a male youth emerges from

the W.C. with the word ‗fuck‘ humorously rearranged in large

letters across the front of his t-shirt, accompanied by a smell

somewhere between a rotting corpse and a pilonidal sinus.

Far from rocketing along, we are at a standstill, probably just

outside Didcot Parkway (a station that I am sure only exists

because somebody high up in National Rail lives there). Failing

that, we are near Reading, a town that I would not want to visit

even if they annually hosted some kind of indie music shagfest

there. The reason we are trapped is, of course: ‗Leaves on the

track‘.

I supposed it could have been worse… and then it actually

was when the buffet car steward proudly confirmed that my

sandwich and coke did indeed cost £7.50.

3. The Humble Motor Coach

And so I am left with the coach. A late booking had made the

fares similar for both leading companies; National Express won,

having marginally more leg room. An astoundingly empty bus

meant that I did not have to sit next to somebody with dengue

fever or an annoying penchant for eating ‗cheese and onion‘

crisps loudly. Thankfully there was nobody behind me who liked

saying ‗literally‘ loudly and repeatedly. In fact, everything was

going handsomely until I saw this sign:

ATTENTION! All Drivers:

Before you reverse from the bay:

Close the vehicle doors and ensure all passengers are secure.

Depress foot brake and engage reverse gear.

Check mirrors and around the area before moving off slowly.

Keep a sharp lookout for moving vehicles. Seriously? The door was closed but I was not secure. Surely

before being allowed to talk into that cool handheld micro-

phone, a coach driver must be deemed competent enough to

notice if the goddamned door was flailing in the wind.

The door was not my only concern: ‗engage reverse gear‘?

Oh, because normally I just slam it into first and (if I remember

to release the brake which you also kindly pointed out I should

do) plough the coach initially into your incredibly helpful sign

and then into the waiting area, maiming or killing a few potential

passengers. I said a silent prayer. The reminder to ‗check the

mirrors‘ almost made me wish the driver didn‘t know how to

reverse - at least he would be looking in right direction.

I can only hope that this sign is some kind of red tape used to

cover the company‘s back - a tool created entirely for the phrase

‗I told you so‘. Because if National Express drivers have a

tendency to wildly ignore moving vehicles unless reminded to,

then screw the extra inch of leg room, I‘ll take one ticket for the

Megabus. Thanks.

P. K. Barnes

22

FRESHERS’ BAR CRAWL ‘10

FRESHERS’ BAR CRAWL ‘10

25

Life as an Ophthalmology F1

P eople feel a multitude of

emotions on their gradua-

tion day from medical school.

Pride, relief, excitement — to

name but a few.

I, however, felt only two.

Amazement and fear. Amaze-

ment that I had come to the

end of my student days with-

out having to repeat a year.

Fear because I knew the days

of playing Call of Duty 6 on a

casual Tuesday morning were

over and that I would now be

required to work for a living.

Yet for all this complaining,

I am one of the lucky ones. I

didn‘t head off to start on

MAU, care of the elderly or

colorectal surgery. No, I was

to start my medical career

working in ophthalmology.

The first order of the day is

to arrive at work on time. My

start time is 9am, so living a

ten-minute walk away from the

hospital means that you can

roll out of bed around 8.15 (or

8 if you‘re one of the few who

enjoys watching Chiles and

Bleakley‘s cheeky flirting on

Daybreak).

Arriving at 9, I immediately

show my face and see if there‘s

anything that needs doing

urgently. There never is. I

then dump my bag and settle

in to my first cup of tea.

Next I proceed to pre-op

assessment: an elderly Chinese

lady for surgery who speaks no

English. It brightens my day to

think the COMP 2 organisers

are patting themselves on the

back for having prepared us

Bristol grads for this kind of

event. That done, I have a

purposeful mosey up to the

ward to see if we have any

inpatients. Today (as usual)

there are none, so I sneak off

to the mess to hide and check

out holidays on the internet.

By now it‘s just about

approaching lunchtime. Be-

fore I head off for my statutory

one-hour, I go down to the

outpatients to check everything

is ok. I bump into the medical

photographer who asks if I

fancy doing a fluorescein

angiogram on a PP (secret

NHS lingo for ‗Private

Patient‘). Despite having very

borderline cannulation skills

(getting below 50% success on

Lovell‘s card in ACS), I agree.

The fluorescein angiogram,

in a nutshell, involves me

taking a four-minute medical

history, inserting a blue

cannula (in first time today),

injecting the fluorescein and

praying they don‘t have an

anaphylactic reaction.

If the patient did start feel-

ing unwell or became short of

breath, it‘s probably the time

where I‘d curse myself for only

remembering the infamous

prawn cracker joke from Dr A

Tim Lovell‘s STAN teaching

session. (Although I‘d take that

joke, and the others regarding

mobile phones and location of

vending machines, over the

dose, route and drugs used in

anaphylaxis anytime.) Never-

theless, the patient is fine, and

I get a £25 cheque in the post

for my ten minutes of

fumbling around.

Back to the doctor‘s mess,

now a second home. With

TV, newspapers and unlimited

tea, toast and cereal, it is a

perfect oasis away from real

medicine. Occasionally, there

is some banter going around

the mess, usually involving the

most recent F1 mistake, or

who did what at the last payday

party. We also have the

privilege of the mess balcony,

though I haven‘t worked up

the courage for a crafty

cigarette out there yet; perhaps

in F2.

This turns out to be a bad

lunch, as while being subjected

to the usual banter at my

expense about having a ridicu-

lously easy job, I‘m then given

two white card referrals by

other doctors who seem to

take the delight in shifting

work onto me.

At around 2.30pm, I stroll

back down to the ward to see

what‘s going on. Very unusu-

26

The first rule of ophthalmology is: ‗If in doubt, ship ‗em out.‘

ally, I encounter a nurse asking

what she should do about a

lady complaining of chest pain.

‗She‘s probably just whinging

and has indigestion‘. Even so,

I take a quick history. Her

words of heaviness, shortness

of breath, nausea and previous

operations mean that I‘m

lightening fast at fobbing her

off to A and E for another

Bristol grad to deal with. The

first rule of ophthalmology is:

‗If in doubt, ship ‗em out.‘

I go to see the referrals.

This is where the ophthal-

mologist‘s very own lightsaber,

the ophthalmoscope, comes

into play. You simply march

onto a ward, shine it around a

bit and pronounce that the

patient should be booked in as

an outpatient. Job done.

It‘s now 4, and my thoughts

are of going home, but there is

still plenty of time to flirt with

any medical students/nurses.

Never underestimate the

power of scrubs and a stetho-

scope. Frankly they can be em-

barrassingly successful at luring

women in (not that I‘d know,

it‘s just what I hear).

At 4.45, I pack up my

belongings, and start the short

walk home, safe in the knowl-

edge that, after tax, I‘ve

probably earned 50 quid.

*****

I n summary, it‘s easy to see

the attraction of ophthal-

mology. Few on-calls, few

emergencies and a long lunch.

The downsides are that

ophthalmologists seem to

forget all the medicine they

knew very quickly and every-

one seems to think you are a

complete joke. Also, the pay

on an unbanded job is such

that a McDonald‘s cashier with

two stars on their badge would

laugh if they saw your pay-

cheque.

At the end of the day

though, my colleagues will be

there till 7.30, about to finish

their fifth PR or tenth TTO.

I‘ll be the one cracking into his

first beer watching The

Inbetweeners on channel 4

OD. Oh, and I‘ve got to

cannulate two more private

patients next week… enough

cash for a good lap dance.

Lad.

Dr P. Osbourne

27

L ast night, friends con-

vinced me to go to one of

the ‗Body Pump‘ sessions held

at a Gloucester gym. There, I

was told, I would have a ‗really

good time‘. I would ‗feel

great‘ afterwards.

‗You‘ll probably want to go

every week!‘ said beaming

faces. Sophie, a Body Pump

veteran, literally wet herself at

the thought of it: ‗Oh! I just

can‘t wait! I‘m so excited! It‘s

so much fun! You really must

come!‘

I will offer the reader some

information to set this tale in

context. Never in my 23 years

of life have I entered a gym.

Quite frankly, I would rather

spend the evenings picking

fluff out of that curious place

at the top of my bum crack

than galumphing away on

some treadmill and inducing

early osteoarthritis by repeat-

edly lifting metal lumps

(reference pending).

Anyway, partly out of bore-

dom, partly from the lack of a

six-pack and partly out of

intrigue I went along that

evening, timidly trailing

Sophie, too afraid to venture

forth into the gym complex

alone. I was momentarily (and

regrettably) abandoned while

she attended to the female

changing room. We then en-

tered the large hall where the

‗main event‘ was to take place.

The clientele are not quite

as I expected: yes, a fair spat-

tering of lycra, head bands and

neon leggings; but also many

who don‘t fit the stereotype.

Several girls appear to have

had one too many a Dairy-Lea

Dunker, with pink podgy faces

and those irritating follicular

red spots on their upper arms.

A slim elderly woman waits

Body Pump

29

with hands on hips like an

expectant regular. Our eyes

meet for a second and I get the

distinct impression that she

wants to kung-fu-kick me in

the ghoolies. At the front, a

tall chap with a substantial beer

-belly is wearing a black

Slipknot T-shirt. Greasy neck-

length hair adheres to his pale,

blotchy face. He is already

sweating.

We take our places facing a

wall of mirrors, allowing me to

fully appreciate my physical

inferiority. Accusatory spot-

lights beam from above; at the

front large speakers from the

sound system.

From a side door our

instructor jogs up to the front,

informing us through his

microphone-headpiece that he

is ‗Graham‘, and ‗are we ready

to pump it up?‘ Graham is

wearing a tank-top and features

a tribal tattoo on his right arm.

His hair is a spiky gelled mess.

He winks after every sentence.

There is some banter

between Graham and the regu-

lars: the old girl who looked at

me menacingly gets a shout

out: ‗Good to see you‘re still

going, Denise!‘ She doesn‘t

smile, and Graham sheepishly

realises he‘s overstepped the

mark and concentrates on

someone else, the greasy Slip-

knot fan, named Karl, at the

front. Karl, we hear, has come

to Body Pump with a ‗raging

cold‘ that will no doubt ‗infect

everyone‘ through the air

conditioning unit. He turns

his sickly face to the rest of us

apologetically; we give him a

shared glare in return.

Graham pipes up: ‗Are you

ready to feel the heat?‘ The

first track kicks off, a dance

remix of Summer of ‗69 and

suddenly everyone is following

Graham as he lifts his weights

into a variety of poses. ‗One!

Two! Three! Four!‘ I clasp my

bar and mimic his actions:

‗Work those triceps! Down

slow for one…. two… three…

and four… and up fast!‘

Now I f ind myself

30

31

straddling the step-up box, the

bar of weights bearing down

like some beast from above. I

flex my arms up and away

from my chest to Graham‘s

camp calls, and the sweat trick-

les from my face, legs, back…

well, from everywhere. But I

begin to think that maybe, just

maybe, I‘m actually a pretty

butch bloke after all, and

maybe all this weight lifting

malarkey is a nonsense, as I

expected. I suppose you

could say I began to feel rather

good about myself. I even

stole a look at myself in the

floor-length mirrors and swore

I could see a bicep.

Then I look left and

Sophie, in real life a short

ginger girl, is lifting three times

the weight on my bar. She is

not sweating a drop. In com-

parison, my bar is like a stick

insect. The bicep in the

mirror disappears. Then a

sudden ‗clink‘ in my back and

a simultaneous acute pain; the

next few pumps are agonising.

My arms quiver with the

shudder that exercise beyond

one‘s limits induces.

As the (worryingly good)

dance remix of Summer of ‘69 comes to an end, I see Sophie

is smiling and chatting to a

muscular bloke about what a

good pump she‘s just had, ‗It‘s

just a shame the weights were

so small!‘

‗So that‘s the end, right?‘ I

say, between gasped breaths,

trying not to appear too eager

for the agony to conclude. I

try to put my hands on my

hips and thrust my chest

forwards like the rest of the

group, but this makes my back

hurt more so I end up looking

like a flamingo with a broken

leg. Denise, the old girl, is

looking at me and smiling for

the first time. I begin to

wonder if the country would

be a better place with euthana-

sia legalised.

‗No Pellatt, don‘t be stupid!

We‘re here for another hour!

Are you okay?‘

I‘m obviously not. I‘m a

human arrhythmia with life-

threatening asthma. I want

nothing more than to go home

and sit in front of a screen

shooting things on the PS3.

But God forbid appearing like

a pansy in front of a girl…

28

‗I‘m fine, it‘s just it was

going so fast and I was worried

it was already over! I‘m having

such a good time, you were

right about this! It‘s rather

easy really.‘ I manage to

squeeze a smile but inside I‘m

racked with palpitations. I‘m

already in pain. There may be

permanent damage.

‗Oh,‘ says Sophie, ‗well if

you‘re finding it easy then put

some of my weights on your

bar. I don‘t think you‘ve got

enough.‘ I try to hide the

look of horror on my face.

‗Yes, you‘re right,‘ I say,

and before I can make up

some excuse about a congeni-

tal back problem she‘s already

put the extra weights on.

Graham is at the front

again, skipping like some

nymph on crack. And as the

bass starts up through the

speakers:

‗You! That‘s right, the

lanky girl at the back! Bar up!

Let‘s go! This one‘s a dub-

step change-up of Paradise City. One! Two! Three! Go!‘

He‘s talking to me.

R. A. F. Pellatt

‗Postnatal Depression‘ by A. Longworth

visit outofourheads.net for a showcase of creative work by Bristol Medical students

My desire to become a doctor was sparked early on

by my fascination with the biological sciences. I

indulged my interest in anatomy and physiology by

several opportunistic learning routes. For example,

I made sure I tuned into every episode of House and

ER. Not only did I find the clinical and scientific

accuracy fascinating, but I wanted to become part of

a profession where everyone is clever, rich and

glamorous. The final realisation that medicine was

the vocation I was born to pursue came with my

completion of Theme Hospital: a complex task that

required initiative, instinct and a profound

understanding of the day to day running of Health

Services.

In order to consolidate my belief that I should

become a physician, I spent a month at the local GP

practice, where I grew to appreciate the multiple

roles interacting together to provide the best

patient care. I learnt the importance of spending

entire afternoons stapling together prescriptions

and came to understand the challenges of appearing

to be interested by receptionists answering phones,

drinking coffee, and attempting to find something

‘fun’ for the work experience student to do. The

most rewarding aspect of this particular placement

was discovering that it is possible to fall asleep

with both your eyes open, and standing up.

As a doctor, I would be keen to pursue academic

research avenues to enhance my clinical career.

From my background in science, I appreciate that

evidence based medicine and clinical research are

vital to inform and enhance modern medicine. I

suffer quite severely from post alcohol exposure,

and through much trial and experimentation, have

concluded that alka seltzer is in fact the best

hangover cure.

I am incredibly sociable and have fantastic inter-

personal skills, being able to talk to people of any

walk of life. I enhanced this particular quality dur-

ing my time at senior school. I managed to survive

my experience at this below par comprehensive with

no more then a bit of spit in my hair, and the corner

burnt off my English work book. Only someone pos-

sessing incredible powers of reasoning, empathy and

wit can manage to survive such a place unscathed.

As I was filtered through the social sieve of

University, I found myself at York. Here, I enhanced

my interpersonal skills further. In particular, I

learnt how to understand those severely intoxicated

and in turn, how to make myself understood when

severely intoxicated. Having a busy social life has

made me learn effective time management: I have

often had to attend more than two parties in one

evening.

Once more, I was passed through the university

filter, this time to the level of post-graduate

study. When I arrived at Bristol University, I was

shocked to discover the social de-evolution that

the majority of postgraduates undergo. This was the

most recent, and most challenging, test of my

interpersonal skills, from which I learnt a very

important lesson: there are some people you just do

not talk to.

I am a keen pianist, which is an essential skill of any

doctor. In addition, I am an accomplished sports-

man. I played hockey when I was eleven years old,

had a brief stint as a lacrosse player during GCSEs

and was forced to do cross country during PE

lessons. I watch Wimbledon every year and am

pretty sure I could win. Furthermore, I went on all

of the Duke of Edinburgh expeditions.

A career as a doctor can be extremely stressful and

challenging. I employ several effective methods of

dealing with stress, which include smoking, having a

cheeky pint and watching Americas Next Top Model.

Candidate 6079 Anon.

(drei

Educational_Crypticities_ Each set of pictures amounts to a medical

condition. Answers in Coffee Break.

example hash + emo + toes

= Hashimoto’s

ein

zwei

(

- )

- )

M edical journalism is a

dog eat dog world.

Smut, decay, destitution, poor

poetry and unforgivably large

P-values abound.

One of the few constants in

this dark, tumultuous sea of

literary backstabbing is that the

editors are invariably pricks,

but that they are also always

right. In light of this advice it

seems I would do well to listen

carefully to the instructions I

got from my honorable

colleagues on the editorial

board of The Black Bag.

They commissioned a

‗stylistically editorial, technol-

ogy-orientated piece on travel.‘

I decided on a brief descrip-

tion of my time spent on

attachment with the Robotic

Surgery Team at the New

York Presbyterian Hospital‘s

Department of Urology. In an

attempt to placate my demand-

ing editors and in the knowl-

edge that, at the time of asking,

this article was to form the

sum total of the Black Bag‘s

‗Travel Supplement‘ as well as

all of the journal‘s new

‗Innovation & Technology‘

section, I have decided to

divide the article into the

following helpful sub-headings.

Travel: New York

Despite its fame, Manhattan is,

in fact, a surprisingly small

place, a little smaller than the

fifth smallest country in the

world, San Marino. Whereas

little San Marino boasts a

population of 29,000 resi-

dents, ‗littler‘ Manhattan is

home to some 1.6 million

New Yorkers and receives an-

other 46 million visitors a year.

Amongst which there

happens to be enough space

for a staggering number of hos-

pitals. Uptown to downtown

and everywhere in between,

hospitals of all shapes and

sizes can be found in Manhat-

tan. Some that cover whole

blocks, others that occupy but

a single floor in an office.

Some that serve the uninsured,

huddled masses; others that

only look after the richest

patients on the planet.

Extremes are abound in

39

Robot Wars in

New York City

Barack Obama tries his hand on the da Vinci surgical system

New York. Homeless people

settle down for the night out-

side the guarded foyers of

multi-million dollar apart-

ments whilst obese smelly

women shuffle onto the metro

and stand next to worryingly

skinny, effeminate young men.

Such extremes exist in the

hospitals as well. Some are

colossal empires with recep-

tion areas which feel decid-

edly more like four star hotels.

Conversely, although I never

visited one of Manhattan‘s

public hospitals (tourists are

recommended not to) their

leaky, rain stained facades

afford a glimpse into the other

extreme of healthcare.

Robots: Expensive Toys for

Surgical Boys

For those of a science-fiction

incline, you will be gladdened

to hear that the development

of surgical robots was initially

the result of work carried out

by NASA scientists working on

Virtual Reality technologies for

unmanned planetary explora-

tion missions. By wearing a

pair of remote control gloves,

the viewer could direct the

camera and thus survey the

aliens on Mars, for instance.

Things progressed from

here via the American

Military, who fancied it as an

option for remote control

surgery on the battlefield, to

find its niche in laparoscopic

surgery. There has been some

resistance.

Commentators have felt

that such emphasis on all this

high-spec equipment will her-

ald a dangerous departure

from long-standing good surgi-

cal practices. Some of these

anxieties are not entirely with-

out foundation. One morning

during the attachment, quite

unexpectedly and unexplaina-

bly, the multi-million dollar

robot simply did not turn on.

Mercifully, no one had yet

gone under the robot. The

sole inconvenience was that

the patient had his operation

rescheduled (in impressively

American style, for the very

next day), but it does not take

a surgical maestro to realize

that the consequences would

be a trifle more serious if any

such technical mishap hap-

pened at a different time.

Initially thought to be

groundbreaking in delicate

cardiology operations such as

mitral valve replacements, the

robots aimed for the heart but

hit the prostate.

Instead, fame was found in

urology. About 95% of all

prostatectomies done in the

US are now done robotically

and the robots are becoming

increasingly popular in obs &

gynae procedures as well as

ENT surgery.

Back on this side of the

pond, when Southmead Hos-

pital got its robot four months

ago it was only the seventh in

the UK – a statistic made all

the more remarkable by the

fact that the newest robot – the

da Vinci SiR costs in the

region of £2 million with addi-

tional maintenance costs of

about £100,000 annually.

Healthcare is a different

beast in the US. The medical

staff work eye-wateringly hard.

There was a rule I was in-

formed of on my first day but

which I was never in any real

danger of violating, ‗Medical

students are not allowed to

come in to hospital before

4:15. Other than that, com-

pulsory academic meetings

begin at 5:30 or 6 o‘clock

every morning of the week ex-

cept Friday.‘

Despite this, for a long time

health has not been a right in

America, it is a product. Like

the TV or the fridge; you get

only what you pay for. This

means that the hospital phi-

losophy is not one of public

service but instead of business.

The New York Presbyterian

Hospital proudly boasts a

gross receipt for the fiscal year

2007 as $2.8billion. That‘s

greater than the GDP of some

lesser sized commonwealth

countries. When I asked an

attending ‗What are your

criteria for recommending this

procedure to your patients?‘

he replied, ‗Do they have a

prostate? And do they have a

cheque book?‘

Bloody Americans.

E. Dinneen

41

‗Much like the exam results,

Kat Whelton is unavailable

until next Tuesday‘

F. K. McCurdie

‗There is no curing a sick man who

believes himself to be in health. ‘

Henri Amiel

‗It is a good thing for a physician to

have prematurely grey hair and itching

piles. The first makes him appear to

know more than he does, and the

second gives him an expression of

concern which the patient interprets as

being on his behalf.‘

A. Benson Cannon

‗In the nineteenth century men lost

their fear of God and acquired a fear of

microbes. ‘

Anon

‗A smart mother often makes a better

diagnosis than a poor doctor.‘

August Bier

‗Treat the patient, not the X-Ray.‘

James M. Hunter

Bedside Banter

‗Patients usually feel better after

receiving hand transplants.‘

*****

‗Paediatricians are just doctors with

little patients‘

*****

‗They tried to save him with an

I.V. but it was all in vein.‘

*****

‗After a few days in hospital, I took

a turn for the nurse.‘

*****

Educational Crypticities answers: 1)Cholera: COLLAR + RAH

2) Asthma: ASS + (MARMITE - MITE) 3) Halitosis: HALLE + TOES +(KISS — K )

Website Review onexamination.com

I f you enjoy reading ‗Giblet‘ but aren‘t sure if you can afford to

subscribe to Nature, or if you are beginning to find the New

Scientist a little simplistic and too full of articles on the Large

Hadron Collider, this could be the site for you.

It offers a wide range of different, up to date articles on the

medical world as well as giving you the chance to upload any

articles you have found which you think may be of interest. It also

allows you to leave a comment about any articles you have read, as

well as pretend to have an educated opinion on a current event

based on snippets of other users‘ more sensible comments.

onexamination.com/fresher contains an online self-assessment

tool from the same site, offering a range of questions aimed at

medical student freshers, covering biochemistry to system-based

physiology. The site will track your scores and allow you to sit the

questions at your own pace, or under examination timings. Once

answered, each question is expanded and analysed, generating an

average score for the user. Best of all: it‘s free.

P. K. Barnes

We welcome comments on any of the articles published

(excluding complaints). Please address correspondence,

including submissions, to The Editors at:

blackbag2009@googlemail.com

free to those

who can afford it.