The office

Came in to work to find this in the morning.

Time for renovations.

A story of separation

A husband decides to leave his wife. He’s often complained loudly that theirs was never a good relationship anyway.

‘I pay in way too much into our joint bank account,’ he shouts, ‘and she’s so controlling! Telling me what I can and can’t do with my life’.

‘Like what?’, a friend asks.

‘She says I need to view her friends as equals and we should share our talents and ideas so we can be healthier and aspire to be the best we can be. Can you believe it? Sure I’ve learnt more about how the world works and discovered lot of new ways of thinking about science and nature, art and culture (and I’ve even made good money over the last 40 years!) but I’ve changed beyond recognition. I mean just look at all these new spots on my face! And when I lost my factory job soon after we got married and the bosses told me they couldn’t and wouldn’t find me new work she didn’t even retrain me!’ She just said ‘Well then, we need to find something else productive to do’.'

‘But if it was important to you why didn’t you do more about it?’

‘It didn’t matter so much once I started our business and that started going well. But a big part of me feels a bit left behind and neglected. She should have done something about that. She had the chance. I’ve paid in lots of money into our joint bank account remember?’

‘Didn’t you buy a house together with that money?’

‘Yes, but I paid for the furniture all by myself. And just look at all these spots on my face! I miss my youth, when I used to live like a bachelor and could visit girls from all over the world. I want to take back control of my life. I want to stop having to listen to my wife’s Kraftwerk albums every Sunday!’

‘So what happens now?’

‘I don’t know. To be honest, I haven’t really thought much about that. The most important thing is to have made the decision. She says it’s sad but if that’s the way I feel then we should finalise the divorce as soon as practical so we can both move on and just be good neighbours. But get this, my lawyer says that it doesn’t have to be this way for me. He says that I can stop paying but still visit her whenever I like and even go to the cinema and have meals (at her place) when I want to. I’ve said some pretty hurtful and untrue things in the course of all this (she did too!) and I do regret a few of them but I know she doesn’t really mean what she says about the terms of the separation – she still needs me!’

‘So you’ll work something out?’

‘If she agrees with me then sure. In the meantime, I’m off to check out my old flames. I know they’ll be overjoyed to see me again - I've neglected them long enough!‘

‘And the grandchildren?’

‘They need to stop crying. It will really be ok in the end. Trust me.’

Schadenfreude

Listening to a Something Understood episode on Schadenfreude, I was struck by this quote in Hobbes' Leviathan. He argues that those with the least self-confidence are most likely to laugh at the defects of others. I think I have been guilty of this flaw, and it's been especially revealing since I suffered a bit of a setback at work.

Sudden glory is the passion which maketh those grimaces called laughter; and is caused either by some sudden act of their own, that pleaseth them; or by the apprehension of some deformed thing in another, by comparison whereof they suddenly applaud themselves. And it is incident most to them, that are conscious of the fewest abilities in themselves; who are forced to keep themselves in their own favour, by observing the imperfections of other men. And therefore much laughter at the defects of others is a sign of pusillanimity. For of great minds, one of the proper works is, to help and free others from scorn; and compare themselves only with the most able.

Happy International Day of Radiology

Happy International Day of Radiology!

It's a day to celebrate the value of radiology in the detection, diagnosis and management of diseases. This year's focus is on brain imaging and all the progress we have made over the last 40 years.

I'm really enjoying my new specialty and it's nice to see it promoted.

Celebrate well!
Moc

Autumn Cleaning

Six years of medical school notes. Time to recycle

Mid-year resolution

Whilst in Edmonton, I flicked through the University of Alberta Faculty of Extension Fall 2011 Programme. It has inspired me to dig out those old Gujarati, French and Portuguese books and finally master the languages…

"Learning a language is more than making unusual sounds and learning a new alphabet. It's about communicating and understanding. It is a cultural experience. As you develop your vocabulary and perfect your pronunciation of a new language, you will find delight in the cadence, idioms and forms of expression. And through words and sentences that you will learn, you will gain insight into how others around the globe view their world…"

Bloody anecdote

After a long struggle against the incredible veinless man, I managed to get enough blood for all many tests we wanted to do. Just as I was withdrawing the needle, though, the plunger of the syringe popped out and flew across the room. Blood splattered all over me, the patient, the bed, walls and floor. Nurse walked in just then, surveyed the scene and concluded that I must have just killed the patient.

Colleagues

Titilayo, Princess, Gugu, Shiny, Girlie, Bongie...

Nurses have the best names EVER!

Moya Moya

When you're asked to review a journal paper containing medicalese that you've never even heard of ("bilateral encephaloduroarteriosynangiosis augmented by bifrontal encephalogaleo-/periosteal synangiosis", anyone?), you know its going to be an interesting week.

Cooking

Since the mouse debacle, my host family have taken to cooking lunch (in addition to dinner) for me. Today I decided to replay the favour and prepare dinner for them. Then I discovered that they don't have a microwave... So now I won't be preparing dinner for them.

Moral: I need to learn to cook!

Breakfast in bed

 “Breakfast in bed!” I thought this morning as I heard a sound at the door this morning. My host family here in the West Country, where I’m doing my general practice rotation, joked that they would give me everything I needed during my three weeks here, but I certainly wasn’t expecting to be served in bed. Unfortunately duties had been delegated to Angus, one of the family cats, and small dead mouse has never really tickled my tastebuds…

 

From Funny Cats Pictures

Breast eyes

Being a medical student can offer a glimpse into the lives of other people that few professions provide. Patients have revealed things to me that they haven't disclosed to their doctors, friends or loved ones, including some stories I'd rather not have been privy too. Sometimes that intimacy, be it emotional or physical, can overwhelm.

This week in theatre, I witnessed a number of breast operations, including mastectomies, lobectomies, cyst removals and enhancement surgery. For the final operation yesterday, however, I got more involved.

A lady had visited her GP regarding a growing lump she had noticed on her right breast. Unfortunately it turned out to be an invasive ductal carcinoma, and further investigation revealed a tumour in her left breast as well. To survive, she would need both her breasts surgically removed: a bilateral mastectomy. This would require more assistance than the previous ops, and it was decided that the registrar and house officer would operate on her left breast, whilst I scrubbed in and assisted the consultant to resect the right.

It wasn’t a particularly technically demanding case, and within forty-five minutes or so we were getting ready to send the resected tissue to the pathology lab. That’s not to say, however, that it wasn’t bloody (and, given that we used diathermy, that the smell of burning flash wasn’t in the air). Breasts are very vascular, and there were many spurting vessels as we made the initial incisions. When we had finished removing and before the surgeons had begun making the flaps and reconstructing the site, there were two big, crimson, almond shaped holes on either side of the chest. It was like staring down at two huge eyes where the breasts should be.

Breast eyes. From Bra Art. Not a particularly appropriate picture, but there aren’t many when you do an online image search for ‘breast eyes’.

Having breast surgery must be pretty traumatic for any woman (and the 300 or so men in the UK each year) diagnosed with breast cancer. From the psychological perspective (the fear of death or major morbidity, body image issues, effects on family and friends, sexual intimacy concerns, etc) as well the physical. And having surgery will almost certainly not be the only reason for visiting the hospital for investigation or treatment: lymph node biopsies, radiotherapy, chemotherapy and hormone therapy may all also be on the horizon. And like most cancers, it's a long term-diagnosis, even if we do all succeed and the patient achieves remission.

Gladly, the results of all this treatment is improving patient care. Since the Breast Cancer Screening Programme was introduced in England in 1988, there have been an increasing number of women diagnosed with the disease, but a steady drop in women dying as a result.

Source: http://www.statistics.gov.uk/cci/nugget.asp?id=575 

And like many common diagnoses, the good news is that future patients are likely to do even better and benefit from even more advances in surgical, medical, pharmacogical and psychological care.

Happy new year...let's go exploring!

Award of the Year?

In 1999, the Old Paddington Cemetery in Kiburn had the honour of being awarded the title of the UK's 'Cemetery of the Year'. On the way to Dublin today, I sat an even more unusual award. The certificate below was proudly displayed just above the 'facilities'...

Snow

It's snowing again in London, which means...

One of 884 million

We have been without running water at home for the past week.

Last month, our builders connected our plumbing to the water supply. Unbeknownst to them or us, this needed to be performed (and not just inspected by) the water supplier. Due to the risk of contamination, our supply was therefore cut off until the (newly installed) pipes are replaced, inspected and reconnected, something that won’t be completed until tomorrow. We have (temporarily) joined the 884 million people worldwide without access to an improved water source worldwide.

Of course, this isn’t strictly true. Our neighbours have been extremely generous with their taps, and we’re certainly not going to amongst the 1.8 million people dying of waterborne diseases each year. Nonetheless, we have had to cut down on our usage dramatically, and are much more aware of potential wastage.

Despite the fact that we are all a bit aromatic, there have been other benefits too. We have reconnected with the folks next door and my biceps have become much more developed.

(No) Hopenhagen?

From the USA Today. Wishful thinking?

Cycling heroes

The summer soundtrack to my childhood was the Channel 4 theme tune to their Tour de France programme. Whatever I was doing during the day (usually looking after my sister), I would get back in time to watch the highlights of epic three-week, three-thousand kilometre plus cycling race. The colour, the language, the countryside, the record-breaking crowds, all of it was new to me, but the biggest impression was undoubtedly left by the riders themselves.

From the hurtling, headlong roller coaster thrill ride of the sprints, to the lung-busting, leg-breaking slogs up the mountain, I had never seen such mental and physical exertion. You could see the pain and the internal battle the riders were experiencing as the climbers struggled to keep up with the sprinters on the flats, and vice versa as the big men were being blown away by the mountain goats as the race hit the Alps and the Pyrenees. It made me want to be a cyclist, to push my body and my mind to its limits.

Few people who have watched though, can forget the accidents. Pile ups caused by a rider cornering too fast, enthusiastic spectators getting too close to the action, punctures, wet weather, animals, wrong turns, all of those could change the complexion of the race and a riders dreams of glory in a moment. One such moment befell my former favourite rider, the kamikaze Uzbek Djamolidine Abdoujaparov with a spectacular nickname: The Tashkent Terror. Three-time winner of the Green (points) Jersey for the most consistent sprinter, he had a unique (and actually rather dangerous) riding style and would stop at little to win. On the final stage of the 1991 race, as the peleton approached the Champs Elysee in Paris and the finish line, Abdoujaparov got too close to the barriers and crashed. Very badly. With speeds approaching 70 km/hour, other riders sustained injuries as he and his bike somersaulted into them, but Abdou undoubtedly came off worst: extensive facial injuries and at the very least a fractured clavicle. A reminder of how dangerous professional cycling can be.

The crash and his will to return to Le Tour (and indeed win the final stage in Paris) in 1993 served to increase my admiration for the Uzbek. However all this changed as I learnt that even heroes had their (major) flaws. Abdoujaparov had been doping to enhance his performance and was kicked out of Le Tour in 1997, subsequently choosing to retire. He was not the only one, however. Indeed, the past couple of decades have been a bad time for cheating in cycling, with other favourites of mine, including Il Pirata Marco Pantani, the best climber I have ever seen, Bjarne Riis, Erik Zabel and Alex Zulle all being banned.

I still follow the Grand Tours of cycling (The Tours of France, Italy and Spain), but no longer hold the riders in the same esteem. There is always the suspicion that these outstanding feats of human achievement may be tainted by illegal and often dangerous performance enhancement. That’s not to say there’s still much to admire. All of the peleton must have made enormous sacrifices and undertaken thousands and thousands of hours of training to reach where they are. Hopefully they’ll have dodged injury and illness and be at peak fitness by the start. Now they just have to ride the three-thousand or so kilometres as fast as possible. Any rider with serious intentions on the race must also be able to work well as part of a team, but also have the courage to grit their teeth and bear the pain when trying to ride away from their rivals or match their attacks when their mind and body is telling them to stop. For the lesser lights of the team, riding back down a mountain to help a stronger member that’s fallen into difficulty or to collect drinks for the others is often required. Collapsing in a heap and/or fainting must be left for after the race, but with the knowledge that the cycling must begin again the follow day as the race to Paris continues.

I have other heroes now but Abdoujaparov, Pantani and co inspired me to take up cycling and have left a very strong impression.

Cardiology emergency - no students allowed!

Spent in the echocardiology lab. The teaching was good and we were learning quite a lot. Midway through examining a patient, however, the doctor was called urgently to the next room. A lady had become unresponsive following surgery to replace one of the valves in her heart, and it was looking likely that she may need be to resuscitated. "Run, please doctor!" the panicked secretary whispered after summoning him. My fellow med student and I followed in the hope that we could learn first-hand how such an emergency is managed by the healthcare team. Unfortunately, when we arrived the curtain surrounding the bed was shut it our faces. "We must respect the patient's dignity", one of the staff said.

I accept that she wanted to call the most experienced healthcare staff and that if we were inside we may have been getting in the way, but we are senior enough now to recognize this, which is why we wanted to observe from a distance. Besides, we also may have been able to predict and fetch any equipment that may be needed during treatment. Respecting the patient's privacy and dignity is of course essential, but I don't see how us watching would have been compromised this, or indeed the care delivered to them. And in my six years at medical school, aside from the more sensitive topic area of gynaecology, out of hundreds of patients I can count on one hand the number of patients that have refused my presence in the consultation or examination room.

In the hyper-aware state an emergency renders you, it would have been a tremendous learning opportunity for a situation we are bound to experience as junior doctors next year. What a pity we weren't allowed to be a small part of it this time around.

Week's achievements

Another set of random things I've done this week, in no particular order:

1. Got my hair cut by an Afghan pop star, Sattar Sahill (check him out on YouTube, he’s got hundreds of hits!).
2. Saw some cataract operations. Microsurgery is very, very impressive.
3. Attended my university’s Freshers’ Fayre.
4. Flossed.
5. Reconnected with my (parents’) African roots by attending the Zanzibar Social Club’s annual gathering. Way cool, despite the fact that the average age of the partygoers was about 65.
6. Celebrated my birthday with lots of carrot cake.
7. Started reading ‘Anna Karenina’.
8. Moved into to temporary accommodation, sharing a room with my sister for the first time in fifteen years.
9. Began applying for a very exciting summer job in Japan next year.
10. Was given a smartphone!