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

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.