#what are you going to do with a degree in physical chemistry with a premedical focus

[navigatorwriting]

23

"They haven't... breathed in six hours," the lieutenant whispered earnestly.

The captain raised an eyebrow. "I don't think I follow."

"I'm serious," they hissed back. "They aren't breathing. It's freaking me out. Please talk to them about it?"

They stared at the lieutenant for a few more moments, mostly trying to understand the bizarre request. At last they agreed, and the lieutenant left their office looking slightly less perturbed than when they'd entered a few moments before. The door had barely swung shut when the alien breezed into the room, looking... oddly translucent.

The captain stifled a confused cough and sat up straight. "So," they began, shaking off the eerie feeling of the alien's eyes on him. They struggled with this species; something about the shallow placement of their eyes made for off-putting eye contact. "One of our crewmates has informed me that you have stopped breathing and they are concerned for you." When the alien made no attempt to reply, the captain reluctantly continued. "Would you care to tell me why that is?"

The alien blinked with an audible smack of their eyelids. "Why is neglecting to breathe a point of concern?"

The captain didn't see that one coming. "Uh, what?"

"Why does my crew want me to breathe?"

"Breathing is important," the captain responded, utterly perplexed by this situation. "We are concerned you are trying to harm yourself by not breathing. Already you look... thinner?"

"Hum. Does it hurt you if you don't breathe?" the alien asked. They seemed to be thinking.

"Yes, of course it does," the captain said. "Does it not hurt you?"

"Not at all. It is natural."

"It's natural not to breathe?"

"Yes."

The captain remembered the labored sounds the alien usually made while breathing. It had not been long since they'd joined their crew, but they always exhaled with a great sigh as if they were clearing their throat every second. "Then why do you breathe sometimes?"

Now the captain was even more confused. "What does that mean?"

"To stay solid."

"I wished to sublime. It will be easier to access the caverns when we arrive tomorrow. I will deposit again once we are inside."

"You... what?"

"We are on a reconnaissance mission, correct?"

"Well yes, but—"

"And the embassy requires we destroy as little of the natural landscape as possible?"

The captain was starting to understand, they thought. "Yes..."

"Then my gaseous state will prove most efficient in this situation. The caverns are mostly sealed, as you know. I will fit through smaller spaces than I could in my solid state."

"... I see..."

"Is there still a problem, sir?" the alien asked.

"I—" The captain paused, shook their head to think. "No, there's no problem. Just... nothing I've seen before."

"Hum."

"Do, uh, let me know the next time you decide to sublime, though. Many of your crewmembers have no experience with your species and did not understand why you stopped breathing."

"I see," the alien responded. "Perhaps I may assemble a presentation on biophysical sciences?"

"For... what?"

"My crewmembers, to understand sublimation and the biological process of expelling heat. I will organize it for our 1800 debrief."

"...Sure. That's fine." The captain waved a weary hand to dismiss the alien, who walked out the door with a faint cloud trailing behind them. They let out a sigh and turned back to their paperwork, certain their hair would be turning grey after that conversation.

#what are you going to do with a degree in physical chemistry with a premedical focus #uhhh write fiction?? duh? #writing #fiction #snippet #writeblr #alien #space fic #outer space #fantasy #sci fi #my writing

[princepspollicis]

Day Two: Why postgraduate medicine?

I have always sought a broad study of humanity. The marriage of the social and biological science is absolutely essential to try to fathom the concept of the human, understand the holistic elements of healthcare and deliver appropriate responses. Indeed we must be a sort of “physiological anthropologist” to deliver compassionate, sympathetic care. I studied Prospero and Churchill on their respective islands, the Easter Rising, soviet purges, worldwide Great Depression, assassinations, riots, agricultural practice, lamenting poems and cold war unease and world war horror.

However the homogeneity of the modern British medical student is frankly bizarre. They are usually a math, science straight-A student, from an upper middle class background entering F1 at 22-23 years old. They usually have no humanities education, doctoring is their first full-time job and F1 is the first real experience of a modern NHS - brief assistantships aside.

Not only is this a narrow pool, its an exclusive club favouring those from more affluent backgrounds, resulting in delivery of care to the many, by the few.

When do these students decide to be a doctor? The answer is GCSE results day at the latest (they must have achieved excellent GCSE results, usually triple science then begin chemistry A level). Some of them are mere weeks into their 16th year.

It is becoming increasingly popular for undergraduate medical students to “intercalate”, or take a year from medical studies and jump on a final year of a BSc. If they pass the year, they achieve an iBSc in said subject, and then undertake a final MBBS year to achieve their PMQ, thus graduating with 2 degrees - to the chagrin of the BSc students for whom many more credits (and tuition pennies) are required for that first degree.

The iBSc whispers the virtue of a prior, or additional degree - including lab/dissertation/advanced biological concepts - but the step of moving medicine to graduate-entry is too far.

To what extent can a 15-16 year old, with exceedingly poorly myelinated dorsolateral prefrontal cortices has the capacity, insight or experience to judge their interest, or resilience, for a 40 year career in medicine.

We actually accept this diminished level of insight in various threads of law. They can’t vote. Require a parental letter of consent to serve in Her Majesty’s armed forces. They aren’t allowed behind a wheel with a full driving licence. They are not allowed to buy cigarettes. Indeed these future doctors still require adult supervision to drink alcohol in a pub and cannot buy booze from a store. And yet they are expected to have not only decided upon their profession, but studied a bespoke path, begun work experience and be applying for A-levels that are mandated.

How many readers of this article knew from which career they would retire from their sixteenth birthday?

The mould of medical student, and thus British doctor, remains a disproportionately homogenous middle-class, white with strong career advisors at their school (disproportionately private) and parents with connections into the Old Boy’s Club of medicine.

In many countries abroad, one must have an undergraduate degree (usually of four years) in order to sit a medical aptitude entrance examination. You cannot start medical, dental or veterinary school without a prior bachelor of science etc.

Whilst you can study any first degree, there is a “premedical” pathway that one must undertake. This relies heavily on maths, biology, chemistry and physics relevant to medicine, but nothing above AS level for UK audiences, and equal weight is given to social, psychological science and critical thinking/reasoning skills.

Indeed many American/Canadian universities actively state in their entrance requirements that non-scientific interests are to be prized. Phenomenal.

It is in this light that the 4-year graduate-entry course at Warwick is structured. Any degree at 2:1 or above is accepted, with extra points for postgraduate qualifications. The aptitude tests of various skills (including, but only 25% of which is, mathematical ability) accounts for a more influential part of the entry requirements. Twice a week in the first phase of the course (Y1), students undertake case based learning groups, consolidating lecture content and applying the preclinical science to actual cases, whilst fostering critical reasoning skills.

Warwick actively seek a broad base of ages, degree backgrounds and experiential knowledge to make up these small groups. They want everyone to be useful differently, they want the value of the multidisciplinary team to shine, they want the students to realise the team’s sum outshines its parts.

To this extent, such variety and heterogenous experience is not possible in undergraduate medical curricula, principally as they are all of similar backgrounds, ages and academics.

Medicine, it is often said, is as much an art as a science. There was significant pushback on this in the 20th century, yet increasingly social sciences, communication skills, empathy training etc are taught in medical schools.

Doctors are challenged to critically reflect on their practice, and analyse how best to discuss issues with patients. They are taught how to “put themselves in the shoes of another” from widely different circles, and understand their suffering - as best one can. This affects outcomes and wellbeing for both physician and patient. Very similar skills to literary dissection.

In the study of the humanities, we see commonality of personality. We study the class hierarchy. We examine the expression of many individuals, to better understand our own thoughts, feelings and emotions. This enables a better level of compassionate sympathy.

I have questioned the possibility of true empathy, which remains a broadly encompassing term roughly of the hew of: a state in which one can use the frame of reference of another to actively feel the experience of another. Many people disagree with this statement, saying empathy is simply understanding what someone is going through and wanting to affect positive change for them.

I don’t think either is purely, totally possible. Our perception is flawed, a non-objective set of sensory modalities and always runs through the filter of our memory and experiences.

Thus heartbreak to one person is of the same genre as it is to another, but never the same. When we empathise with a heartbroken person, we draw on our historical precedent of heartbreak or similar pain, but cannot truly know what that person is feeling. It is why on person’s sorrow is another person’s shrug and all the intermediaries in between.

Their feelings are an amalgamation of a unique capacity to permit conscious feeling, their upbringing, their genetics and the level of their coping mechanisms. Furthermore, reflection on a past state of emotion is notoriously tricky. We often look back and catastrophise, or use rose-tinted spectacles.

The belief one can understand the totality of the journey of another is important to correct, for both people in that relationship, be it familial, fraternal or doctor-patient.

Two men, aged 50, who have had heart attacks lie side-by-side in a hospital ward. One is an incredibly wealthy London banker, another sweeps the streets outside his home.

The banker lost his wife to cancer last year, his father to a similar heart condition when he was studying Economics. His children are estranged, in various exotic countries and he doesn’t want to worry them with the news.

The street sweeper is surrounded by three generations of doting family who are supportive, loving and worried.

Perception of suffering, processing of disease and stoicism of adversity are empirically, dramatically altered by genes and environment, by upbringing and current societal connections, by socioeconomics and gender.

By a myriad of things, most of whom we are not even close to elucidating.

Their experiences are wildly different.

It is challenging enough for 23 year old F2 Suzanne Broadchurch on hour 62 of the week, just off nights that she’s due back on the following night, to comprehend the ramifications of a myocardial infarction to a middle-aged man, lets not delude ourselves she can purely empathise the frame of reference of both of these.

But the goal is noble, the compassion sourced from some appreciation of pain, fear and scary prognostics is something she can have a semblance of understanding in. Maybe it wouldn’t help too much, but there’s a lot of poems and historical precedent, that is worth reading to get a bit deeper into these cocktails of human emotion, familial strife and economic anxieties that aren’t in physics AS textbooks.

It seems anathema, something guttural, that we can perceive the reality of another. We want to believe we know what our partner is experiencing at any one time. But, honestly, we are at a loss most of the time to perceive the reality of ourselves. Mindfulness can help, as can writing, but mostly we do not know where the emotions we feel arise from.

Its simple really, we all have different preferences of taste. Some people see a Twix as delicious, others are nonplussed, some think it tastes vile and others correlate a Twix to the wrapper that was on the floor the night they were attacked by their father. We all perceive the same sensory inputs differently. We all emote from them differently. We are all on unique journeys.

That doesn’t mean the act of attempted empathy, through compassionate sympathy, isn’t valid and worthwhile pursuing.

Actively remind yourself I do not know exactly what this woman is going through, even if her situation mirrors your own, but I can attempt to reach out to her, let her see her emotional experience is a valid response to the trauma of disease/socioeconomics/abuse etc, and then use that prior thought to formulate treatments to ameliorate in a bespoke way. That has excellent outcomes.

And it is served far better by those who come at the world from as many angles as possible. Graduate entry medicine fosters this capacity, this challenge. It brings in incredibly diverse persons of many ages, from 21-45 in my cohort, to tackle the health problems of our population.

So yes, we need a diverse cohort throughout life. From boardrooms, Cabinet, Parliament, the NHS to educational establishments and academia. The more heterogeneous the voice, the wider the panorama of the human condition we can comprehend.