December 12th

These blog posts are thinning out to say the least, partly because I'm busy, and partly because I've already said a lot of things I wanted to. Which is better, repeating yourself endlessly, or staying silent once you've said your piece?

Quote of the Week

  • "This house has been far out at sea all night, |The woods crashing through darkness, the booming hills, |Winds stampeding the fields under the window |Floundering black astride and blinding wet |Till day rose; then under an orange sky |The hills had new places, and wind wielded |Blade-light, luminous black and emerald, |Flexing like the lens of a mad eye." - Ted Hughes, Wind

Monday, 12 December 2011

Beautiful voices.

Wow. Six months since my last post.

I thought I'd do something a little different here, since university and jobs and social things are getting quite droll now, and I really do want to not have to think of important things all the time. Instead, I'd like to pay tribute to some of the best vocalists I've heard, mostly inthe 21st century. Enjoy.

The vocalist here is Soundmouse, and I love this because of the way she harmonises - there are vocalists who are good at singing over a song, till the instrumentals disappear, but sometimes what you need is a more subtle approach.

Cee Lo Green has some considerable talents. Combined with Danger Mouse's composition, he rocks the microphone like a reborn Marvin Gaye.

Some of you might remember this song in the movie "V For Vendetta". Cat Power has that ageless voice that captures the imagination.

Skye Edwards, front vocalist for Morcheeba and labelled the 'voice of soul'.

Beth Gibbons, in a slow-burning song that builds into a sonic soundscape. Instrumentals from Rustin Man.

Florence Welch's voice needs no description. Bizarre, gothic lyrics somehow fit perfectly with her upbeat voice.

*Good music needs a good sundsystem to give it justice.

Wednesday, 15 June 2011


Three weeks ago, I took my resits for 4th year. The results would tell me whether I'd get to carry on the degree, or have to repeat a year, or God forbid, change my profession to "social commentator and general dogsbody" (last week, I got news that I'd passed, but six others didn't).

There's something terrible about having to resit an exam, especially one which you spent a year preparing for. The stakes are higher, the potential impact of your actions or inaction more clear. And there's the doubt as you measure yourself against yourself, and the jealousy as you measure yourself against others. And of course, the uncertainty, as you scramble to find out what went wrong, and what to do, all in a limited space of time.

Suddenly, I'd turned back into the little kid who was crying at not getting a math question right. My memory is fuzzy, but I remember sitting at a little blue plastic table that my parents had gotten just for me, and Dad was looking over my shoulder. I had learned about carrying units at school, and I'd been hammering at my workbook for a million years (time passes differently when you're a kid). I was on one of the last questions, the ones that would tell me If I'd gotten the idea of the lesson that day: 11+9=?

I thought to myself: "I know this, I can carry that number forward", and carried forward a little too much, and got 110 instead of 20.

Dad said, "not quite" (or something similar), quite calmly, and I stared at the question again.

When I saw what I'd done, tears started flowing down my cheeks. Dad must've thought he'd pushed me a little too hard, because he went quiet for a while.

But I wasn't crying because I'd been pushed too hard, and it wasn't anything that Dad had done: I was angry at me, because I KNEW the answer - I'd gotten the idea of units, I'd gotten the idea of carrying forward. And I KNEW I could add - but I'd overestimated myself, and didn't think of making that little check of where to put that carried unit. Dad wasn't pushing me too hard: I was the one who was pushing myself, and I wasn't happy because I'd failed to live up to my own expectations, because I assumed I was ok, rather than checking my working.

Fast forward to the present day: I'm not doing basic math anymore, in fact I'm very rarely doing math at all. This is a whole different game, a game played by grown-ups, where the rewards are getting your sick man to tomorrow, and failure is simply not an option: we don't make mistakes, because the consequences are visited on people who put their trust in us. In that sense, I guess I'm still that little kid I was: there's no such thing as getting 9 out of 10 in an exam: it's got to be perfect.

Of course that's not the reality: doctors make mistakes all the time, and med students even more so, but we don't aim for that. No doctor worth their salt will ever stop and say "that's good enough". Our all-or-nothing mentality is probably what really separates us from most other professions. It's what makes doctors workaholics and bad parents, alcoholics and smokers, nitpickers and critics of other peoples' work. It's what makes us more likely to keel over from heart attacks and jump off bridges.

And that's the way it's going to be, for a long time to come.

Thursday, 2 June 2011

It was over, the trepidation and the fear and hesitancy had all built up and been washed away by the exam - and now I walked across a field on the way home, away from the hospital and its examiners and simulated patients, away from the ECGs and plain film radiographs and blood test results that showed heart failure with Kerley B lines and primary hypothyroidism with macrocytic anaemia. I knew I was going back to Northampton tonight, to be ready to watch major thyroid cancer surgery and complete the tasks left in the workbook. But now, right here and now, with the sun in my face and the grass below my formal shoes, I was giddy as a child, I wanted to dance, I wanted to sing, I wanted to scream and shout for all the free time I had between now and when the bus came for me, to take me back to the world of operations and chemotherapy and ward rounds, of workbooks and signatures and reflective essays, of resits and exam results and degrees.

That evening in the field, I didn't do the things I wanted to. But I was glad, estatically and madly glad, which I hadn't been for a long, long time.

Friday, 31 December 2010

Random Discoveries

I love the internet for its inherent power to access information, particularly new information that delights the senses and feeds the mind.

Number One: Poto and Cabengo

This really strange video is of Poto and Cabengo (Grace and Virginia Kennedy), a pair of twins who spoke their own unique language for the first 8 years of their lives. This is called idioglossia, and in this case is unique because of the duration which the children spoke it.

Number Two: Marcus Aurelius, Meditations

Marcus Aurelius was an ordinary bloke who ruled the Roman empire for 19 years, and was considered the last of the five "Good Emperors". He wrote down his thoughts, or Meditations, as they are now known, in his spare time, and though he never intended for anyone else to read them, his Meditations are considered one of the most important Stoic documents of all time. You can find copies strewn liberally across the internet, and I encourage you to look through them when you can - although it would be good to get one that has been translated into fairly modern English. Interestingly, there is a strong parallel between the tenets of Stoicism and those of Christianity.

Number Three: Mahalia Jackson

I stumbled on Mahalia via a friend who sent me a Duke Ellington song, and when I heard her voice my hairs stood on end. Nothing I write here will do justice to the sheer power of her voice, so I won't try. Instead, sit back, shut your eyes, and listen.

Number Four: Hardwired Happiness

Again, I'll let the main man do the talking. There's a massive truth in this that just isn't realised often enough, and whether you buy into it or not, take a while to reflect on how relevant your goals and ambitions are.

I hope that this New Year is an enlightening one.

Monday, 27 December 2010

Millenium I

There's just something about really good books that makes you want to share them with everyone else - this is definitely one of the best I've read all year, and this year I read Joseph Conrad, Bram Stoker and WIlliam Golding. Dragon Tattoo was the one that I absolutely couldn't put down.

For those of you who don't know, Stieg Larsson's The Girl With the Dragon Tattoo (the first in the Millenium trilogy) begins with a semi-failed financial journalist being placed in an Agatha Christie-styled mystery. From the one-sentence summary, the book could devolve into just another factory-made novel, but doesn't because Larsson throws so many other things into the mix that we sometimes forget that the book is about a missing girl.

Making the main character (Mikael Blomvkist) a financial journalist was Larsson's first major deviation from the formula, and allows him to ground his character in a very different reality from that of the common thriller - we've heard enough about the detectives who always seem to have the same modus operandi, and we've become bored by the everymen who stumble on improbable government conspiracies in every other thriller.

Not every thriller has to be about an amnesiac assassin, and not everything is the fault of powerful people in American or Russian governments. Blomvkist, being the only main character in a thriller who has other things to worry about besides the main plot, doesn't even believe that there is a murder for a while. Instead, he desperately wants a crack at one of Sweden's stockbrokers, a wholly different beast, more elusive and much harder to kill. No matter what the reader thinks of the topic, we feel Larsson's clear disgust at an economy where bankers can lose millions to currency speculation and get away with it.

Henrik Vanger drags Blomvkist into the situation by hiring him to solve the decades-old mystery. Vanger is the former owner of the Vanger corporation, a company that actually produces goods rather than trading stocks. He is a man of industry, represents Sweden's declining manufacturing power, old but still wielding considerable financial and political clout. Through him, Larsson reminds us that there is a distinction between the share market and a true economy based on production.

But Blomvkist and Vanger both take a backseat to Lisbeth Salander, for whom the book is named. She dresses like a punk, acts like she is socially unaware and has no friends, but is capable of digging up the deepest, darkest secrets of anyone with a social security number. She is initially hired to do a background check on Blomvkist, and gets more involved in the mystery for her own reasons. Salander is an enigma, including, we suspect, to Larsson when he first began writing. We understand that something terrible has happened to her, but don't know exactly what (until the next book); we know that she operates on her own set of principles, but can't be sure what drives her to create them in the first place. And because she is such a unique person, we find ourselves waiting to see how she behaves, just so that we can divine more about her mind.

The book has so many extras that it almost defies the Law of Necessary Characters. Notables include Erika Berger, Blomvkist's lover and partner; Nils Bjurman, Salander's guardian; Harriet Vanger, the girl whos dissappearance still influences Henrik Vanger; her brother Martin who has grown to take over the Vanger corporation, and Dragan Armansky, Salander's boss. All of them add their own colour to the picture, and serve to make the book so much more than just another thriller.

Larsson writes so that the plot becomes a tool to allow for character development, which is so far another unique aspect of the book. Part of the way in, I found myself thinking more about why the characters behaved the way they did, than about how they solve the mystery. A clue comes in the book's original Swedish name - Män som hatar kvinnor. Its English translation is Men Who Hate Women.

Thursday, 23 December 2010

Nov 4th - Dec 22nd

In my earliest incarnation of this blog, I declared loudly that I wouldn't make it about what I did last Thursday, or who I had coffee with. This post is diary-esque, but I don't think of it as breaking the rules, but maybe bending them a little - after all, I've not truly blogged in a long time, and I want to put down some of my experiences in words before they slip out of memory. Maintaining policy, I've tried to make this more about the ideas that spawned from events, rather than the events themselves - and therefore have cut out a few events about which my ideas are still developing.

When I got back from Malaysia on the 9th, I went straight back to work - the Mental Health block was in full swing, and I buried myself in it as much as I could, to stay occupied. Come to think of it, I really did enjoy the block, even though it was rather bad timing, and involved a lot of travelling between three hospitals - the Leicester General, the Glenfield General and another one in (of all places!) Coalville.

Granddad died on Wednesday November 24th, 2010. He passed away without suffering, and left behind a wife, four children, four grandchildren, and two great-grandchildren. I don't think I will fully comprehend how much he did for the country, nor am I sure that I want to. All I know is that he was my granddad, and I will remember him as such.

I flew back for the funeral the next evening (Thursday), arriving in the wee hours of Saturday morning. It was my third flight in four weeks, and I felt it - but what I felt was nothing compared to what grandma and the rest of the family are feeling, and I shan't make a mountain out of it - I managed to make it back for the funeral, and for that I am grateful.

The funeral itself was an outpouring of grief, for us, and for people who'd never met him but were profoundly affected by his governance. But as ever, the politicians and reporters were there, hoping to prey on his reputation. I refuse to let their presence spoil the memory of that event - it was dignified, and it was cathartic. For us, and for the hundreds of people who gave up their time to say their prayers or help in some other way, it was to mourn his passing, and remember his life.

The silver lining was meeting up with family, especially those whom I hadn't met in years, or in some cases, whom I had never met before. But there was little time to get to know them. I spent less than 2 days on the ground before flying back to Leicester and jumping straight back into the block, which was now in full swing.

The weekend after the flight, I went to London for a WHO simulation, and argued my heart out with fellow 'delegates'. I learned a few things about Malaysia - we're apparently the world's 19th largest trading nation (or 21st, depending on the sources you use), and we have our own pharmaceutical industry - most of our companies produce generic drugs, but we do have a few patents, including a 3-in-1 antiretroviral that allows users to take a single pill a day, rather than having to remember them all. The WHO sim was true to life in that we didn't manage to pass any of the major resolutions about drug patents - at one point we were quite literally arguing over a comma, and I felt myself die just a little bit.

On the social side of the WHO sim, we saw the Ameteur Transplants, a comedy duo who were both practicing GPs. They were excellent in every way, although there are some sketches that I simply can't repeat. I met some new and old friends as well, whom I hope to meet again sometime in the future.

Back in Leicester, I was thrown immediately into two subsections of the block - learning disabilities, and elderly week. LD, as it's called, is a junction between neurology and psychiatry, because the brains of LD patients have experienced some kind of insult in birth or early childhood, and comprises a spectrum of disease ranging from Down's syndrome to Autism. The consultant I was attached to was appropriately trained in neurology and psychiatry. LD was incredibly interesting, and looks to be a challenging field - when patients don't communicate the same way that you do, it becomes a Sherlock Holmes-styled detective game to find out what's wrong.

Elderly week was...bad. I could tell the moment the smell of old people wafted towards me on the ward. My suspicions were confirmed by the fact there was a lump of poo and a pool of urine towards one corner of the corridor, and a voice in the distance saying "please God, I can't take it anymore," over and over again.

I met a few lovely ladies, along with the psychiatric baggage they brought with them. Susan (name changed) had frontal lobe dementia, which meant that her mood and personality had been forever altered because the part of her brain controlling it was degenerating. She spent her time shouting at everyone as loudly as she could. Janet, whom I later discovered was the source of both the body waste and the incessant talk of not taking anymore, had full-blown Alzheimer's. Annie, on the other hand, seemed completely sensible except that she insisted to be sent home, and would burst into tears every time I said I couldn't do that because I was a medical student. After about 30 minutes of trying to take a history from a lady who would only talk about going home or cry about the same, I took the opportunity to disappear while she was distracted.

Of course, the unspoken question in geriatrics is, what happens to you when you grow old -mentally, and physically? I suppose I'd have to get used to depending on people, but the idea that my mind is going to slowly decline into nothingness - that doesn't bear thinking about. I value my mind above so many other things: cogito ergo sum, what are we without our minds?

A final week in General Adult just confirmed how fascinating psychiatry is. Schizophrenia in particular is just...incredible, simply because of the things that people see and hear. One thing also quite interesting is the "delusional system", a system of false beliefs that people build for themselves based on something that they see or hear (whether it's a hallucination or a real perception). For example, someone may hallucinate of a little green man which then disappears, but then build a belief that the Martians are sending recon teams to scout the planet before they invade us en masse, and nobody can see them because they disappear when people do.

Depression on the other hand is a completely different kettle of fish. Being severely depressed is like having your deepest darkest fears come true, and then accepting them because you think you're worthless. And then there's depression with psychosis, when people hear voices telling them that they're worthless, and other nice things like they'd be better off dead, and that they aught to commit suicide. Nasty stuff.

The exam, for such an interesting topic, was actually kind of disappointing. There was no mention of eating disorder (up to 10% mortality rate), substance abuse (worth US$40 billion a year for the cartels in Mexico), and just a smidgeon of personality disorder (psychopathy, which is best described in Hannibal Lecter, wasn't covered at all!). We had a few videos and some questions about them - oddly enough, the sad person was depressed, the one who thought God had a personal message for him was schizophrenic (irony?), and the one who was worried in crowds had social anxiety disorder. In all fairness, psychiatry is a massive field, and a single exam probably wouldn't be enough to cover all of it. But at least try, dammit!

Following the short and fortunately sweet exam is the Christmas holiday, and for once it's an honest chance to take a quick breather, and reflect on what's happened in the past few weeks. It's also an opportunity to meet up with friends before the long march to IPE, which brings me to the present moment - sipping at leftover Bak Kut Teh from last night's dinner and listening to Max Richter. I'm going to keep myself busy this holiday, because I have so much to do, and for once I actually want to do it.

Thursday, 4 November 2010

Ineffectual Gesture

My granddad had a stroke last Tuesday and is now in a coma. He may never wake up.

The media descended on the ITU almost immediately, followed soon after by the politicians. I arrived, tired and disorientated, direct from England, only after the press had been picking at the news for days.

I know it's bad because almost the whole family has gathered, even the cousin I haven't seen in four years because he moved to America.

We visit twice a day, even after midnight. My aunt, the more spiritual among us, reads prayers in English and Tibetan. She brings monks to chant some more, at least every second day. I've given up trying to understand the spiritual world, but the Tibetan prayers somehow calm the nerves, taking the edge off.

The rest of us whisper into his ear and hold his hand, and on good days we get a few twitches in his fingers, one every few minutes, and we talk more about everything, anything, because we hope he can hear us, and because silence would be an admission of defeat.

On other days, when there's been no response, we sit and stare, trying to divine his fate from the lines running across the screen. So what if his blood pressure has gone up by 12/8? What difference is it that he has a ventricular ectopic after every 8 heartbeats instead of after 9? It's a pointless, futile endeavour - Mum and Dad know it, I know it, the cousins and aunts know it, the doctors know it - but we all do it anyway, because on bad days, the monitor and the chart are the only link we have to him.

Questions are asked - Should we resuscitate if he has a cardiac failure? How long do we want to wait for him to wake up? Four years of training seem useless as I try to help come up with answers.I explain how resuscitation can leave people with broken ribs and punctured lungs, and how it may be better to not resuscitate. As the words leave my mouth, I feel like I've betrayed him.

We visit again, arriving in ITU after midnight and staying for hours, watching the lines move slowly across the screen as the machine pumps air into and our of his lungs. It's an ineffectual gesture, accomplishing nothing. But it's all we can do to show we care, and by God or Buddha or the powers that be, we will do it for as long as we can.