Friday, December 23, 2005

Suburban Shaman at the British Museum

Cecil Helman, award-winning medical anthropologist, will be giving a talk on narratives in medicine, and reading from his book Suburban Shaman: Tales from Medicine's Frontline at the British Museum (Moser Room) on Thursday 19th January 2006 from 4.30 - 6pm. The talk is part of the UCL/British Museum lecture series on 'Making Things Better'. Admission is free. His book was published in South Africa a while ago (it comes out in Britain next month), and I can wholeheartedly recommend it. It is a sort of gentler version of Kaplan's The Dressing Station. The book is beautifully written and parts of it stay with you long after you've finished it.

Next Purple Coat Club meeting

Our next get-together is on Thursday 5 January in room 311, Mech. Eng. at Imperial College (South Kensington campus), starting 7.30 pm. We'll be watching and discussing 'One Flew Over the Cuckoo's Nest'. Please e-mail me if you don't have swipe-card access to the building, so that I can give you my mobile phone number so that you don't get stranded outside in the cold! As usual, everyone is welcome!

The body revisited at the ICA

During January, the Institute for Contemporary Art is hosting a series of talks called 'The Body Diminished'. It explores ideas about 'body politics'. Talks take place at the ICA, which is on the Mall in London (combine it with a walk in the beautiful St James's Park), on 11, 16 and 17 January. More information here.

Wednesday, December 21, 2005

No moans about the Hypochondriac

On Monday night I went to see The Hypochondriac, a farce written by Moliere written in the 17th century. It was excellent. Farce can be a bit dodgy, but I reckon they got it just right. There is plenty of potty humour but fine performances and a degree of restraint in the interpretation meant that it never degenerated into slapstick. The play pokes fun at the medical profession. Argan (the hypochondriac) is desperate for his daughter Angelique to marry a doctor so that he can receive free treatment. She has fallen in love with someone else. Throw into the mix a scheming servant, a slightly psychotic medical student, a wife on the make, and a troupe of dancing doctors, and you have all the ingredients for a very entertaining evening.

Henry Goodman as the lead is wonderful. Kris Marshall (the son, Nick, from the TV series My Family) plays the romantic suitor of Angelique (Carey Mulligan fresh from her performance as Ada Clare in Bleak House). The Almeida in Islngton is a gorgeous theatre. Students can get £10 seats, and you'll be at no visual disadvantage owing to the intimacy of the theatre. It's on until 17 January. Not to be missed.

Sunday, December 18, 2005

Should surgery be seen to be done?

Oh my goodness. Check out this initiative to screen webcasts of surgery in a bid to attract patients. It's the 'live' bit that makes me feel queasy. If it were a straightforward advertisement it would be slightly less objectionable, but by making it 'live' it plays on the edginess of the potential for procedures to go wrong. The pressure of having to 'perform' on the part of the surgeons might compromise patient care if there are unexpected complications. The theatre (more aptly named than ever) will sport advertising logos. Conflict of interest anyone?

Tuesday, December 06, 2005


The 'Journal of Humane Medicine and Medical Humanities', Cell2Soul, has just released its winter issue. It's open access. The quality is decidedly mixed in my opinion, but worth taking a look at, particularly a report on 'biliotherapy': prescribing books instead of pills. Also in this issue, some of the 'personal canons' (lists of 10 books that someone has found 'resonating') are quite revealing. And there is a selection of poetry. I liked this one.

Sunday, December 04, 2005

The Constant Gardener

I saw this incredible film last Sunday, based on the novel by John Le Carre, directed by Fernando Meirelles (director of City of God), screenplay by Jeffrey Caine and starring Ralph Fiennes and Rachel Weiss.

The broader theme of the film tackles the corruption surrounding drug company research, and more specifically the advantage-taking regarding health issues in Africa, especially concerning AIDS and TB.

Weiss plays the wife of a British diplomat who discovers some alarming evidence surrounding drug trials in Kenya. Her activism results in her brutal killing and her findings begin to unravel when her husband, played by Fiennes, investigates following her death.

This is a deeply sad film that encapsulates an extremely worrying issue. The acting is superb, with the two main characters bringing to life a beautiful relationship in truly convincing and natural way.

The film is thrilling and intense, but I am reluctant to give too much away in terms of the plot. Do go and see it on the big screen; the images of the south of Sudan and Kenya are breathtaking. An important film.

ONE life

Dont miss BBC1's ONE life this Tuesday at 10:35pm. It features a doctor with Kallman's Syndrome (Neurones that carry GnRH in the brain fail to develop, so the pituitary gland is not stimulated to produce LH and FSH. These normally stimulate the gonads to produce sex hormones, meaning that sufferers are permantently pre-pubertal. They also have no sense of smell.) and his subsequent treatment, which results in him going through puberty in six months - at the age of 33! Review to follow.

Wednesday, November 30, 2005


ICSM Light Opera Society are proud to present this year's production of Oklahoma! There is a phenomenal amount of talent from the medical school in this musical featuring the directorial guidance of David Bonsall and Natasha Clunies-ross and the rest of the crew. The performances are from Monday 5th to Friday 9th December from 7pm at Wilson House, Paddington. Tickets are on sale now; there is a dedicated team on campus or email for reservations.

If anything, come and see me play a dodgy Persian peddler (I almost don't have to act!) and you can point and laugh. Plus you can join the cast afterwards for (a few) drinks in one of London's drinking establishments! What more could you want?

Tuesday, November 29, 2005

Review: 'When You Cure Me'

Last week a group of us went to see 'When You Cure Me' at the Bush Theatre in west London. It was the premier of the play, written by Jack Thorne. The action takes place in the teenage bedroom of Rachel (played by Morven Christie) who finds herself partially paralysed after a traumatic event. I don't want to give too much away here as the premise of the play sounds very off-putting, but it is definitely worth seeing for anyone interested in patient perspectives of trauma and the burden it places on friends and families. Rachel's boyfriend, Peter, desperately wants to help, but to what extent must he bend to Rachel's vacillating and contradictory whims?

The intimacy of the Bush Theatre and the realism of the production (be warned: involving bodily functions), combined with emotional intensity, makes the role of Rachel a tall order. Christie delivers on this very convincingly. The teenage angst of Peter is well portrayed by Samuel Barnett. Gwynth Strong (Cassandra of 'Fools and Horses' fame) plays Rachel's well-meaning mother (although one kept expecting her to come out with 'Oh, Rodneigh!').

The action forces the audience to move between various points of view. Although Rachel's situation demands sympathy, her exasperating behaviour shows that there are limits to what victims (of crime or illness) can reasonably expect of those around them. According to this interview in Time Out, the play was informed by the writer's experience of being bed-ridden with the dermatological disease cholinergic urticaria. It runs until 17 December. More details here.

Postively Red Debate TODAY

'This house believes the promotion of abstinence is themost effective way to curb the global AIDS pandemic'

Debate with:
Dr Roger Ingham (University of Southhampton)
William Meara (US Embassy)

6.30pm, Mech Eng Room 342, Imperial College, SW7 2AZ FREE

'Meet the Robinsons'

Tomight is the first night of 'Meet the Robertsons' -- a series of improvised dramas exploring personal conflicts and beliefs about health and illness within three generations of one family of Caribbean heritage. Each drama will be followed by an audience discussion. To reserve a FREE place email or call 0207848 8418. Bookings must be reserved in advance andplaces are limited. Click here for more information on these dramas and the issues they are tackling.

First night: 'Michael and Lyndon': A drama exploring living donor organ donation
29 November 2005, 17:30: Robens Suite, 29th Floor Guy's Tower, Guy's Hospital.

Friday, November 25, 2005

Thoroughly Modern Medics

I caught the tail end of this TV programme on BBC 2 this afternoon. It follows a group of third year medical students for a week in a 1950's style hospital, having to learn to practice medicine the traditional way. Unfortunately I believe it was the last in the series. Did anyone else see it?

I'm suprised the students (more info here - they were from King's) subjected themselves to public humiliation. I'm even more surprised that patients did though...

World AIDS Week 26th November - 2nd December

World AIDS Week - Positively Red@ Imperial
Medsin-Imperial are running a week of events to raise awareness about HIV/AIDS :

Sat 26/11 'People, Possibilities, Promises'
Conference chaired by Prof Gazzard, Chairman of the British HIV Association,
Conference covers 'Society and Culture', 'Treatment Access' and 'Projects in the Developing World'
9am-4pm, Drewe Lecture Theatre, Charing Cross Hospital, W6 8RF , £3 students, £5 staff

Mon 28/11, 'Satan and Simon DeSoto'
Tues 29/11
Play by Ted Sod, Produced by IC DramSoc
7pm, Reynolds Bar, Charing Cross Hospital , £4

Tues 29/11 'This house believes the promotion of abstinence is the
most effective way to curb the global AIDS pandemic'
Debate with Dr Roger Ingham (University of Southhampton), and William Meara (US Embassy)
6.30pm, Mech Eng Room 342, Imperial College, FREE

Thurs 1/12 'Reflections'
Vigil with music and song
7pm, Queens Lawn, Imperial College, FREE

Fri 2/12 'Paint the Reynolds Red'
Fundraising Party with Cyan Jazz Band and Funkology Break Dancers
8pm, Reynolds Bar, Charing Cross Hospital, £3 in advance, £4 on the door Oly: 07709566752

Thursday, November 24, 2005

Maternataxi Poem

There is an interesting article on 'Maternataxis' and a mildly irreverent but nonetheless amusing poem written by two ambulance crewmen on the subject over at Nee-Naw. Original website 'Through The Eyes of an EMT' is here.

An Inspector Calls

ICSM Drama Society are putting on what has been called a "fantastic" adaptation of J. B. Priestley's critically acclaimed play, "An Inspector Calls". Directed by Mona Salih-Abdulrahman, and featuring talent from across the medical school, this is definitely one not to be missed.

The play is on from Wednesday 23rd - Friday 25th November at The Union Concert Hall, Beit Quad, South Kensington from 7:30pm.

Check out the trailer here!

Saturday, November 19, 2005

World AIDS Conference - 26th Nov

People, Possibilities and Promises

Conference of Imperial College AIDS awareness week

Saturday 26th November: 9am - 4pm
Drewe Lecture Theatre, Reynolds Building, Charing Cross Hospital, London W6 8RF

Chaired by Prof. BRIAN GAZZARD
Consultant Physician & Research Director of HIV/GUM, Chelsea & Westminster Hospital; Current Chairman of the British HIV Association

Society and Culture
Russia and Injecting Drug use: The social and political context of an HIV epidemic and its prevention
Dr. NICK THEOBALD: Stigma and Association with Taboo
Ms. AMANDA ELY (HIV-Social Work): Stigma and Challenges Faced by HIV + Children and Young People

Treatment Access
Ms. ROWAN HARVEY (Terrence Higgens):
Living with HIV in the UK today
Dr. MUN-YEE TUNG: Current Treatment Options
Dr. RICHARD ASHCROFT: Ethics of Treatment Access

The Challenge of Treatment Provision in South Africa
Dr. GARETH TUDOR WILLIAMS: Rolling out antiretrovirals for children - facts meet fiction
Dr. HERMIONE LYALL: The Challenge of Treatment of HIV+ children
Dr. SAM ALLEN: Treatment Access Programme in Botswana

Projects in the Developing World
NIKI LEE (Zisize)
Charity establishment in South Africa
Dr. RHONA MACDONALD (MSF):Overseas Development Clinician Experiences of Projects combating HIV-AIDS
Ms. FLICK THORLEY (Nursing)/ Dr. CHLOE ORKIN Establishing Project in Botswana

Projects with student involvement [Medical Students, Engineers Without Borders]

Tickets: £5 waged £3 unwaged with free buffet lunch
All profits go to Kenyan Community Education Charity: ICODEI (details on website)
Seats limited, to book your place email
Any further queries contact Oly: 07709566752.

Tuesday, November 15, 2005

Chart success for hospice project

One of the most successful enterprises in Medical Humanities has been the Rosetta Life project, which works with hospice patients to produce art of all kinds. The Rosetta Requiem focuses on music. Here is a press release on one of the songs. Go here now to download the song and support this very worthwhile project.

We Laughed at number 15 in the UK pop charts

'We Laughed' entered the UK pop singles chart at number 11 last week and is still holding its place in the charts in its second week - number15. The song had its first airing on Jeremy Vine's BBC Radio 2 programme on 20 September, prompting an immediate response from listeners wanting to know how to get hold of a copy of the song. It is written by Billy Bragg and Maxine Edgington, a hospice user from Trimar Hospice, Weymouth and was produced as part of the Rosetta Life song cycle, Rosetta Requiem, funded by Culture Online. It celebrates the love between Maxine and her teenage daughter, Jess, and isinspirational as a legacy from a mother for her daughter.

We have no commercial backing for the song and rely on word of mouth tokeep the single in the charts. We need to sell another 1000 cds tomake the top ten. If you have not yet bought a copy of the cd, pleasedo so now so we can keep Maxine's song in the charts and Trimar Hospicein the news! We Laughed is also available as a download from iTunes and other music download stores. See our Home page,, for links to CD and download online stores.

Billy Bragg described how the songs came about: "The three songs on this CD are the product of a series of song-writing workshops that I conducted at the Trimar Hospice in Weymouth during February 2005. I was invited to take part in theproject by Rosetta Life, a charity dedicated to helping those facingterminal illness to share their experiences through the medium of art, poetry, film or song. "Every Friday morning for six weeks, I worked with half a dozen women who came to the hospice for palliative care as they fought against theeffects of breast cancer. After a couple of weeks of talking about the process of song-writingand a few singalongs, the ‘Friday Girls’ began opening up to the ideaof writing a song. Maxine Edgington had the clearest idea of what shewanted to do. In our first one-on-one session, she pulled a framed picture out of her bag andsaid ‘Look, I’ve been given six months to live. I don’t want to mess about. I want to write the song of this picture’.

"When her condition was diagnosed in November 2004, Maxine’s thoughts turned immediately to how she would be remembered, particularly by her fifteen year old daughter, Jessica. "Determined that Jess should have positive memories of her after the grieving was over, Maxine commissioned a professional photo shoot which produced beautiful images of mother and daughter smiling together, looking as if they had not a care in the world. This was how she wanted to be remembered. As Maxine says ‘Cancer is terrible, but at least it gives you the chanceto put things right with those you love’.

"One of these photos, which can be seen on the cover of this CD, was to be the inspiration for Maxine’s song. Over the following weeks, she wrote reams of words, pouring her feelings out onto the page. My job was to take the words that best expressed the sentiments in thephotograph and shape them into a song. I provided the melody, but thewords are Maxine’s alone. She called the song ‘We Laughed’. In June, I got together with some local musicians and we recordedthis CD. The additional tracks feature lyrics written by two of the ‘Friday Girls’, Lisa Payne and Veronica Barfoot. That there is not ashred of self-pity or morbidity in any of these songs is a testament tothe spirit of these three women. I found the experience of collaborating with them to be inspirational.

You can find out more about how Maxine and Billy wrote the song, including short film clips of them talking about the process. Rosetta Life, the Trimar Hospice, and the women will benefit from the sales of this CD.

Monday, November 14, 2005

Euthanasia Debate

Euthanasia Debate
Wednesday 16th November 6:15pm
Lecture Theatre 1, SAF Building, Imperial College London

Chair: Professor John Laycock

For: Dr Margaret Branthwaite (Barrister and former consultant physician and anaesthetist at the Royal Brompton, representing the Voluntary Euthanasia Society)
Against: Professor John Wyatt (Professor of Neonatal Paediatrics at UCL and expert in Christian medical ethics)

This event is run by the Christian Medical Fellowship at Imperial College.
Light refreshments will be available.

Contact for further details.

Saturday, November 05, 2005

Medicine on stage and screen

I was excited to see that the Almeida in London is staging Moliére's classic farce 'The Hypochondriac'. We have just been studying Moliére's doctor plays in the Literature and Medicine MA at King's, on which I am a student. Doctors are relentlessly pilloried in Moliére as being ineffectual and money-grabbing. Our tutor, Neil Vickers, has it that it is a thesis for the Renaissance theme of the triumph of the grandeur of nature over learning (epitomised by medicine). The London production runs from 17 November to 7 January: more information here. Coincidentally, the Belgrade theatre in Coventary is also showing a new version of the play, running from 7 to 19 November. Their website has a 'hypochondriac game' which seems to involve 'shooting' as many patients as possible. Hmm...

Also attracting attention is the documentary film 'Murderball' about wheelchair rugby. The film has been acclaimed for its unpatronising attitude to disability. Reviews here, here and where to see it in London, here.

TV influences medicine

Widely reported in today's press is the story that a new category of health professional is set to be introduced: Medical Care Practitioners. These will be (mainly science) graduates, fast-tracked through two-year training programme and will serve as assistants to doctors at a level between doctor and nurse. The proposals for the new scheme are under consultation. The Guardian reports a Department of Health official saying that it 'brings roles from the television drama ER to the heart of the NHS'. I blogged here an example of an episode of ER influencing the introduction of new medical techniques.

'House of God'

We discussed 'House of God' by Samuel Shem at 'Purple Coat Club' on Tuesday evening. I think it is safe to say that all of those present found it a pretty ghastly read. The book is a 'docbuster' widely read by medical students. It is famous for having introduced terms like 'gomer' ('Get Out of My Emergency Room') for geriatric patients, 'buffing' (making a chart look good regardless of the patient's treatment or condition) and 'turfing' (the process of moving patients between departments so that they are no longer your problem). So far, so bad, but the text is saturated with laviscious sex, drugs and suicide. None of the characters is particularly likeable (perhaps bar Berry). The staccato style of writing made it difficult to keep track of the somewhat insubstantial plot. In spite of it being awful, the book did make a good topic for discussion, with a lively debate on characterisation -- all the medics seemed to recognise people similar to those 'parodied' in the text -- and malpractice. Some of the themes have undoubtedly informed TV series such as 'Bodies' and 'Grey's Anatomy'. I think that the book is worth knowing about, if only as a cautionary tale to what medicine looks like when stripped of its humanity: it's diabolical, for patients as well as practioners. Other opinions?

Thursday, November 03, 2005

ONE life on BBC 1

On Monday evening I caught a documentary on BBC1 about IVF following infertility, and the story of one particular family who worked together to produce a baby.

Alex was 28 when her smear test showed a tumour on her cervix. Although she survived the cancer, the radiotherapy treatment left her infertile.

Determined to still have a child, Alex came up with a plan: she asked her twin sister Charlotte to provide her with an egg, and her older sister Helen to carry the pregnancy. This would mean the child would be the closest genetic match possible, and Charlotte wouldn't have to go through the whole procedure alone - something she wasn't keen on doing given she had not particularly enjoyed her previous pregnancies.

The long and short of it is that Helen gave birth to a baby boy, Charlie (apparently no reference to sister Charlotte), and Alex undertook the appropriate legal proceedings in order to adopt the child from her.

There was a definite air of wistful sadness on Helen's part when the child was taken directly to Alex upon birth, and when Charlie returns to London with Alex. However, the ability of two sisters to provide the ultimate gift for their sibling was so touching and kind, and made for good documentary material.

Monday, October 31, 2005

Venue change for Purple Coat Club

The PCC meeting tomorrow night will now take place in R1 on the Imperial College Charing Cross campus, at 7.30.

Sunday, October 30, 2005

Interested in Surgery?

There is a Minimally Invasive Surgery Evening on Thursday 3rd November in the Reynolds (Drewe Lecture Theatre).
Barry Paraskeva and Raj Agarwal will be there from Prof Darzi's team at Mary's as well as Alun Davies (Surgeon at CX) and Prof Bailey (President of the Association of Laparoscopic Surgeons) all talking about the future of minimally invasive surgery and what kind of things we can already do.
Should be an interesting evening.
Starts at 6pm and free drinks and nibbles will be provided after the meeting courtesy of the MPS

For more info contact

The Old Hippocratic Oath - 425 BC

This is from Oxford Handbook of Clinical Medicine:

I swear by Apollo the physician, and Aesculapius and Health and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and stipulation - to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation, and that by percept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by stipulation and oath according to the law of medicine, but to none other.

I will follow that system of regimen, which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and holiness I will pass my life and practice my Art.

I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of the work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every act of mischief and corruption; and, further, from the seduction of females, or males, of freeman or slaves.

Whatever, in connection with my professional practice, not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such shall be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

Thursday, October 27, 2005

Declaration of a Doctor

Read by all new doctors at the graduation yesterday:

Now, as a new doctor, I solemnly promise that I will to the best of my ability serve humanity; caring for the sick, preventing disease, promoting good health, and alleviating pain and suffering.

I recognise that the practice of medicine is a privelege with which comes considerable responsibility and I will not abuse my position.

I will practice medicine with integrity, humanity, honesty and compassion; working with my fellow doctors and other colleagues to meet the needs of my patients.

I shall never intentionally do or administer anything to the overall harm of my patients.

I will not permit considerations of gender, race, religion, politial affiliation, sexual orientation, nationality, or social standing to influence my duty of care.

I will oppose policies in breach of human rights and will not participate in them. I will strive to change laws that are contrary to my profession's ethics and will work towards a fairer distribution of health resources.

I will assist my patients to make informed decisions that coincide with their own values and beliefs and will uphold patient confidentiality.

I will recognise the limits of my knowledge and seek to maintain and increase my understanding and skills throughout my professional life. I will acknowledge and try to remedy my own mistakes and honestly assess and respond to those of others.

I will seek to promote the advancement of medical knowledge through teaching and research.

I make this declaration solemnly, freely and upon my honour.

Wednesday, October 26, 2005

Diane Arbus: Revelations

Recommended by the lovely Ann-Marie:

Running from 13th October 2005 - 15th January 2006 at the V&A is a retrospective exhibition of '50s photographer Diane Arbus' most important work. Her work has been described as 'contemporary anthropology' and juxtaposes stereotypes in New York in the 19-50s and -60s. A fascinating freakshow?

Thursday, October 20, 2005

Clegg Scholarship

The Clegg Scholarship is a paid 8 week experience in Medical Journalism at the BMJ offices in Tavistock Sq, WC1. It can be done as part of an elective and you have the opportunity to earn £1200, a great help toward student debt!

Students ought to have previous writing experience but can apply at any stage of their medical career...

Wednesday, October 19, 2005

It's good to chat

Further support for the 'interactive' model of communication in medicine reported on the BBC website today: a study has shown that patients benefited in a variety of ways from using websites that provide peer support in the form of chat rooms or discussion boards. Those that aim to be purely informative were less helpful.

Tuesday, October 18, 2005

Purple Coat Club news

The Purple Coat Club meeting this month has been put back to Tuesday, 1 November, which means you have time still to read the book under discussion: 'The House of God' by Samuel Shem. It's the sort of book which will either delight or horrify you, and there is bound to be lively debate about the way in which it depicts the medical profession. So that's Tuesday, 1 November, 7.30 pm, in the Sir Alex Fleming building, Imperial College, the room ajoining MDL1. We'll combine it with a 'show and tell'. I intend to bring along a hysterical bedside routine from TV series, 'The Singing Detective'.

Then, AJ is organising a trip to see 'When You Cure Me' at the Bush Theatre in Shepherd's Bush on 22 November. Tickets are just £6 for students. A pre-theatre dinner is in the offing as well. E-mail AJ directly to put your name down.

We've realised that it is going to be a lot easier for students to come to the PCC if we have it at the beginning of the month rather than at the end when rotations are usually wrapping up and there are exams and such. So from next year, we'll be meeting on the first Thursday of every month rather than the last Tuesday. Please check the sidebar for dates and events.

Tuesday, October 11, 2005

The Boy Whose Skin Fell Off

On Sunday night I was watching Channel 4's '50 Greatest Documentaries' (fascinating - number one was 49up which I blogged a week or two ago) and whilst it stirred up interest in a number of films, it showed one in particular directly after the programme, called 'The Boy Whose Skin Fell Off'.

It tells the story of Jonny Kennedy, a 36 year old man trapped in the body of a boy whose skin detaches from his body with slight trauma, the increased skin turnover eventually giving rise to cancerous change. This condition is known as 'Dystrophic Epidermolysis Bullosa (EB)', and the film charts Jonny's last four months leading up to the send-off he is planning for himself. In the time remaining to him, Jonny promotes his charity Debra and we learn a little of what life is like for a sufferer of this condition.

The documentary is very saddening and raw at times, leading one to question how detached a documentary film-maker ought to be in such a scenario. What makes such a depressing topic so watchable is Jonny's cheeky sense of humour, and his nonchalant attitude towards death. But the film achieves its main aim of raising awareness of the condition, with over half a million pounds worth of donations having been received since the film was first aired in March 2004.


A post on behalf on Anjali:

Crusaid’s fourth art exhibition, ARTAID 05, is to take place at the Royal College of Art on Thursday 13th October.

ARTAID 05 is a collection of personal statements on the global HIV and AIDS crisis which seeks to unravel the stigma and discrimination surrounding the virus and plays a critical part in raising awareness of HIV and AIDS.

New artists contributing include Michelle Prazak, Thierry Bal, Anne Urquhart and Richard Cuerden, who will appear alongside established artists such as Tracey Emin.

For more details and to reserve your place, call the events team on 020 7539 3896 during office hours or email

Friday, October 07, 2005

Surgical drawing

Don't miss the start of a major new arts series, Secret of Drawing, on BBC2 on Saturday, 20.10 to 21.10. The first episode includes a discussion with surgeon Frances Wells as he explores the link between drawing and surgery. Frances not only draws his own operations but is also an expert on Leonardo da Vinci’s anatomical drawings. Indeed, he has even used da Vinci’s drawing of the heart as the basis of a pioneering new form of surgery.

Battle lines are drawn

The Institute of Ideas, which likes to rattle cages, is hosting an event called 'The Battle of Ideas'. It takes place at the Royal College of Art, Kensington Gore, London, SW7 on 29 - 30 October 2005.

There are six themes (Books, Community, Culture, Education, Health, International Relations), but the Battle for Health takes place on Sunday. One of the speakers in the debate on 'Ethics on Trial' includes our own Richard Ashcroft, Professor of Medical Ethics at Imperial. Other speakers include Ray Tallis, Professor of Geriatric Medicine at the University of Manchester, and Simon Crompton and Jane Clarke both of The Times.

Institute of Ideas' events are always a bit like R4's 'Start the Week' with bells and whistles. Well worth getting fired up about.

Wednesday, October 05, 2005

Bedside Stories - Review

What was obviously an addictive and amusing column makes an uneasy transition to paperback here in Michael Foxton's novel, a compilation of his writings during his two-year stint at the Guardian.

Foxton (a nom-de-plume) tells - with gory detail and sensational revelation - of the highs and lows of his life as a Junior Doctor, and his passage from first day as a PRHO, through his rotations (including A+E), culminating with his SHO post in Psychiatry.

Sceptics might claim Foxton tends towards the negative, but having set the standard it is usually difficult, especially in the media, for a leopard to change its spots. The negative side is always going to be the more interesting, the more passionate, and the easier to divulge.

Foxton is amusing, irreverent, pessimistic, bleak, yet insightful. He is unashamed to admit mistakes, which as a reader I found compelling. He is unafraid to lift the mystery surrounding the profession and yet still seems to retain a sense of right and wrong. As a medical student, I found myself relieved that others sometimes feel as bewildered and unconfident as I do - but also that eventually these disappear with experience and age.

Foxton will not appeal to all due to his opinionated nature, and some may feel the book is more of a rant than a story. Indeed 'Bedside Stories' seems an odd choice for a collection of columns that lack cohesion. Links become repetitive and similar points are expressed that make for awkward continuity between passages. At the end of the book, Foxton explains why he stops writing, but then we are presented with an extra column about Gunther Von Hagen's live dissection on TV which provides a clumsy conclusion to the book, which I felt shouldn't have been included, not being in keeping with the other segments.

Overall I enjoyed this book for its dark humour and for the cynical approach to the trade I am to join. I feel any doctor would likely enjoy the book for its 'we've all been there before' mentality, but nurses, social workers and other healthcare professionals may feel Foxton arrogant and difficult to digest. I hope my career is not quite as exhausting and persecuting as his!

Saturday, October 01, 2005

Humour Prescription

A man was hit by a sofa, a pillow and a cushion.

A hospital spokesman described his condition as "comfortable".

(courtesy of popbitch)

Wednesday, September 28, 2005

'Now, Voyager'

A thoroughly good time was had at the Purple Coat meeting last night, lubricated by a generous donation of wine. 'Now, Voyager' was both touching and hilarious -- and afforded a real insight into the 1940s and what passed as female empowerment. The story draws on a rich tradition of 'transformation': in this case, neurotic 'ugly duckling', Charlotte, is sent on a cruise by her psychiatrist in an effort to overcome the negative influence of a domineering mother. There she meets and falls in love with a married man. Naturally, things must remain chaste so ritualistic cigarette smoking acts as a substitute for sex ('The film must have been sponsored by Marlborough', said AJ). The plot is satisfyingly twisty and wonderfully melodramatic. We all agreed the acting was splendid, especially Bette Davis as Charlotte and Gladys Cooper as the matriarch. One can see why this film is such a treat for film theorists. Although all the female characters are strong and powerful, the measures of success are still deeply paternalistic: beauty, wealth, social accomplishment and the love of a man. These are my views, informed by the lively post-film discussion. Please do chip in with more commentary...

Tuesday, September 27, 2005

Death of a Salesman

On the weekend I watched Death of a Salesman, which came heavily recommended by a close friend. Starring Dustin Hoffman and John Malkovich, this Arthur Miller play was brought to celluloid in 1985.

Dustin Hoffman plays Willy Loman, and won a Golden Globe for best actor in this performance. Willy is a man on the brink of a breakdown cum late-life-crisis, as his once promising career as a salesman has dwindled to nothing, his sons have amounted to nothing and he experiences increasingly severe manic-depressive episodes.

The film retains the feeling of a play, with simple sets and minimal sophistication, being mostly filmed as mid-shots, with little zooming or long shots. Towards the climax of the film we see more close-ups, which is surprising considering the intensity of the film. I was blown away by the acting in the film as so often in the cinema, you are brought into the world of the film; yet this was the first time whilst watching a film that I felt like I was actually at the theatre. The performances are powerful and empassioned, the cast is small and scenery bare (set mostly in the Loman house, and disorientatingly occasionally in other locations), which all contribute to a raw sense of emotion throughout the film.

I was quite exhausted by the end, although the film was quite an experience. It is not the sort of film that one might watch idly, it requires concentration and thought - plus time (it is 133 minutes long).

Anyone interested in mental health will like the film for its handling of nervous breakdowns, mania, depression and kleptomania. Others will relate to the family dynamics and reflection within the film.

Monday, September 26, 2005

The Motorcycle Diaries

Last week I managed to watch The Motorcycle Diaries, directed by Walter Salles. Based on the journals of Alberto Granado and Ernesto Guevara (a.k.a "Che" Guevara), the film charts the companion's journey from Buenos Aires around South America on a battered 1939 Norton 500 motorcycle.

Alberto is a biochemist and Ernesto a medical student only one semester away from qualifying. Ernesto has various opportunity to practice his skills on their journey, not least when they arrive at a leper colony in the Peruvian Amazon. We see the beginnings of Ernesto's later political inclination when he becomes bothered by the segregation in the leper colony, and refuses to wear gloves to treat the patients, irritating the nuns who run the colony. One night during his birthday celebrations, Ernesto swims across to the leper colony from the 'safe' side of the river where the uninfected live. This symbolic moment encapsulates Ernesto's 'crossing over to the other side' both politically and medically; his approach to patients is both unconventional and passionate.

Having travelled in Peru last year I had wanted to see this film for its footage of Machu Picchu and the Amazon, and was pleasantly surprised to discover Che Guevara was a trained doctor. Although he finished his training, he never completed an internship, and as we all know went onto pursue a political career before being assassinated in 1967. His companion Alberto is still alive today, living in Cuba, having co-founded the Faculty of Medicine at the University of Santiago.

There is a Guardian Interview and info about the film available too. Overall a good film whether you are medically or politically minded or interested in foreign culture.

Sunday, September 25, 2005

Generation Gap

Her house smells comfortingly of shortbread and tea and young cat,
Stories spill flitting between all nine of her decades.

I stare at her head pondering on neurons,
The odd intensity of her delivery,
On and on, fast she talks, exhausting,
And only the inhaler interrupts.

In the digression I visualize her mind map;
Overlapping, intertwining and cloudy blots.
Expelling itself before the time takes over,
A lengthy legacy to be left.

Friday, September 23, 2005


A writhing snake
Bucks and quivers,
Thrilling bliss.

Red splashes
And orange streaks
Are its markings
As it slithers into the incision
Stealthily, a clear, hungry belly.

Fluid slurped turbulently
Gushes through its coils
A hard greedy mouth
Becomes blocked by debris
Choking the hiss.

‘Suction please.’

Alex J Hamilton

Thursday, September 22, 2005

Next Purple Coat Club meeting

There will be a screening of 'Now, Voyager' at 7.30 pm. Please note the change of venue: we'll be meeting in the MDL overflow room, level 1, Sir Alexander Fleming Building on the South Kensington Campus at Imperial College London. E-mail me if you need further directions.

Everyone is welcome -- there is no 'membership' as such. I received a very nice letter from Danny Abse giving me permission to reproduce on the blog the poem from which the Purple Coat Club takes its name:

Pythagoras’s song

by Dannie Abse

White coat and purple coat
a sleeve from both he sews.
That white is always stained with blood
that purple by the rose.

And phantom rose and blood most real
compose a hybrid style;
white coat and purple coat
few men can reconcile.

White coat and purple coat
can each be worn in turn
but in the white a man will freeze
and in the purple burn.

Hunterian Museum, London

I enjoyed a long overdue visit to the Hunterian Museum yesterday. It occupies floor space in the Royal College of Surgery, near Lincoln's Inn Fields in London. The museum was refurbished about a year ago and the results are very aesthetically pleasing. The museum is a showcase for the collections of John Hunter, younger brother of the more-famous William after whom the Hunterian Museum in Glasgow is somewhat confusingly named. John was originally apprenticed to his older brother before becoming an anatomist, a collector, and a surgeon in his own right. His collections, beautifully displayed in spot-lit glass cases, include a huge range of anatomical and pathological preservations as well as natural history specimens from all over the world. Particularly impressive is the skeleton of the 'Irish Giant', Charles Byrne. There is an art exhibition on at the moment showing the work of the Medical Artists Association.

There are free, half-hour tours of the Museum at 1 pm on Wednesdays where you can learn more about John Hunter -- it's a fascinating story.

Wednesday, September 21, 2005

Psychiatry on page and screen

It's a bumper month for those interested in the representation of mental health (or mental illness). First, Sebastian Faulk's new book, Human Traces, deals in depth with psychoanalysis. Some commentators say too much depth, but that's unlikely to bother those of us who are interested in the literary inscription of all things medical.

Then there's the adaptation for cinema of Patrick McGrath's novel, Asylum. The book was highly acclaimed, but the film has received mixed reviews. For anyone interested in the book, there is a rather nice set of discussion questions on it here.

Thursday, September 15, 2005

49 Up

Don't miss '49up' tonight at 9pm on ITV1. We watched some of it as part of our sociology course in the first year, and it is quite fascinating.

Michael Apted has followed several children every seven years throughout their lives. Ostensibly about class divide, the programme has inevitably evolved into a soap-opera cum reality-tv cum documentary. The children now have families of their own and this installment chronicles them at age 49.

7up, as it began, looked at various children representing the differing social classes in Britain in 1956. It compared their education, living conditions and aspirations. From the common thug to the snooty brat, seeing their change and development makes gripping television. Some children have turned out almost exactly as predicted; others have made surprising choices, some have opted to leave the programme.

The class system of the past is still present today, albeit greatly altered and less prominent - although a popular media issue when public school university applicants are selected against, for example. However we shall see whether the products of it still fit the same niches as before, and furthermore how it affects their own children.

Wednesday, September 14, 2005

HIV Article

The Guardian had a very interesting article in the Weekend supplement on Saturday about HIV perceptions and the (flawed) subsequent government investment in HIV Awareness. Worth a read.

The celebrity campaign mentioned can be found here.

Tuesday, September 13, 2005

It's a girl!

For those of you wondering about the silence from our irregular colonist, Tamzin, I am delighted to be able to tell you that she gave birth to a beautiful baby girl, Kezia, a fortnight ago. It was a tough pregnancy and we wish Tamzin and her family (she already has two sons) all the best.

Monday, September 12, 2005

Laughter is the Best Medicine

A panel of Doctors was asked to vote on adding a new wing to their hospital...

The Allergists voted to scratch it and the Dermatologists advised no rash moves.
The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated that they were all labouring under a misconception.
The Ophthalmologists considered the idea short-sighted; the Pathologists yelled, "Over my dead body!", while the Paediatricians said, "Grow up!"
The Psychiatrists thought the whole idea was madness; the Surgeons decided to wash their hands of the whole thing, and the Radiologists could see right through it.
Internists thought it was a bitter pill to swallow; Plastic Surgeons said, "This puts a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water.
The Anaesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.
And in the end, the Proctologists left the decision up to some arsehole.

'Finding your funny bone' has more information on the importance of humour in medical practice, as does this BBC article.

Saturday, September 10, 2005

I've seen that face somewhere before...

Opened the 'Rise' section of the 'Guardian today' and saw a mugshot of our own aj! I hope they paid an appearance fee.

Thursday, September 08, 2005

Forthcoming events: September rounds

After a rather quiet August in London when all the activity seems to head north of Hadrian's Wall, London is buzzing with events again.

The Dana Centre (behind the Science Museum) is hosting a mini series of events on pregnancy and childbirth. It kicks off on 13 September at 19.00 with 'Unwanted Pregnancies: the evolution of abortion'. On 14 September, 18.30, there is an opportunity to play the much-hyped Democs card game. The game aims to stimulate debate on controversial science-based issues, in this case stem-cell research: more details here. There is a discussion on mental health on 15 September, entitled 'Is it You or I Who Should Be in the Asylum?' (there is something decidedly iffy about the grammar in that title). This event will be webcast here. Things are bound to get heated on 21 September when the topic for discussion will be 'Too posh to push?' on the role of elective caeareans in childbirth. If it all sounds a bit heavy, some light relief is scheduled on 28 September, 19.00, when Y Touring Theatre presents a play about memory called 'Mind the Gap'. On 29 September, 18.30, Full Beam Visual Theatre are putting on 'The Man Who Discovered That Women Lay Eggs' billed as the 'epic and comic story of how man finally unravelled the truth about his own origins in 1827'.

Over at the Royal Institution, in the hallowed Faraday lecture theatre, there are also a number of events that look interesting. On 27 September, 19.00, there is a lecture rather unimaginatively entitled, 'Processing of visual information' by Michael Brady and VS Ramachandran. There is a talk on 'Perspectives on our ageing world' on 29 September at 19.00. Worth booking tickets for in advance, I suspect, is 'Anatomy for the terrified!!!' by Susie Whiten on 11 October at 19.00. An 'evening of wonder' is promised. Can it live up to all those exclamation marks without being puerile or patronising? Tickets for all RI events cost £8 (concessions £5).

The Hunterian Museum, London, is running an autumn lecture series called 'Surgeons at War: Trafalgar to Tikrit'. It includes talks on medicine and surgery in the Crimea, plastic surgery after the WWII, and life in a field hospital. On 28 September, 18.30, there is a free talk by Fiona MacNeill, 'Breasts Laid Bare', 'iconography and history of breasts and the treatment of breast cancer through the ages'.

On in Edinburgh at the Scottish National Portrait Gallery until 27 November, is an exhibition 'The Healing Touch' which examines the role of Scottish men and women in medicine. It coincides with the quincentenary of the Royal College of Surgeons of Edinburgh. Shown here is Johann Zoffany's painting, 'William Hunter lecturing at the Royal Academy'.

As usual, if anyone makes it to one of these events, we'd love to hear about it.

When You Cure Me

The Bush Theatre is running a 'Tainted Love' season this autumn and one of the featured plays is called 'When You Cure Me' by Jack Thorne, directed by Mike Bradwell. It runs from the 16th November - 17 December 2005, tickets are £14 (£9.50 for students).

The blurb says: "Rachel and Peter have been going out for 6 months. Then Rachel gets ill. She doesn't want her mum to fuss, she doesn't want Alice to be her new best friend, and she certainly doesn't want James to tell bad jokes. The only person she wants is Peter. Peter doesn't know what he wants, but he thinks he can make her better again. When You Cure Me is a bittersweet tale of love and misunderstanding, and discovering that what we say and do can be different from what we think and feel."

A possibility for our arts-based outing for the Purple Coat Club?

Monday, September 05, 2005

Heart-felt dance

'Amu' is a dance work devoted to the heart. Created by Random Dance, it's premiering at Sadler's Wells. It was created in collaboration with heart-imaging specialists. Performances take place at 7.30 pm, from 15 to 17 September. Click here for more information. I am tempted to go, if only to see if it lives up to the promise, made in the billing, of 'questioning both the physical functions and symbolic resonances of the human heart'. As far as I know the physical function of the heart has beyond question for a considerable time, but I'm always happy to be proved wrong!

Sunday, September 04, 2005

Before I Say Goodbye - Review

I did well to save my first tear until page 82 of this short (116 page) book. A beautiful yet terrible précis of the last few months of journalist Ruth Picardie's life, her strong sense of bravado and utter acceptance of her death mark it a unique read; moving, funny, awfully sad.

The book starts out as a collection of Ruth's e-mails to friends, and their responses. Gradually these become interspersed with Ruth's column in the 'Life' supplement of The Observer, which chronicles her cancer experiences in a brief, punchy style. With a surprising audacity she tackles issues of enormous emotional importance, capturing the whirlwind nature of her illness; discovery, chaotic spread, failure of both conventional and unconventional treatments, complications, the idea of her own death.

Abruptly, her column becomes a shadow of the strong, forthright memoir we are accustomed to: we learn that Ruth has in fact been admitted to a hospice. All the while we have been thriving from the strength of her column - the seeming invincibility means that we never really believed it was so bad. But it was. Then the shock hits - she is intractably ill and the column is no more. Indeed, her sister Justine closes the column in the final entry, explaining the turn of events.

After the first column, various letters from Ruth's readers are included in the book. In general, most write to share their own experience of cancer and to impart some morsel of advice or simply to lend their support. They focus on Ruth's dilemma of leaving her twin toddlers - how to create a lasting memory of their mother, who had been ill with cancer for half of their lives. The letters are immensely moving and poignant; most of those that pen them seem afraid that Ruth might find them too mushy, but as readers we are quite sure she valued and embraced every one.

Justine writes the final 'Before I Say Goodbye' column. Ruth has died, earlier than expected. But her last few emails were not the brazen, self-deprecant humour of the past; instead brief poorly punctuated messages - the decline is clear.

The book ends with a chapter by Matt Seaton, Ruth's partner and 'coparent'. He frankly discusses the unfortunate complications Ruth suffered before her death - her brain metastases involved her frontal lobe, meaning she experienced confusion, aggression, a lack of inhibition, and became stuck in repetitive thought cycles. We realise how attached we have become to Ruth, simply from reading her emails, as we witness her spiralling descent towards the inevitable end.

The book closes on Matt's handling of the end. He acts in a way some might perceive to be a little coarse - deciding not to be present at the moment of Ruth's death, and to take the twins to the hospice to see their mother's body - but I certainly sympathised with his logic. He believed the twins would not have a definitive idea that their mother was dead without the tangible concept of death via a corpse. A little raw perhaps, but conceivably important for Ruth to live on in her children's young minds.

The letters Ruth writes to her children are included in the book, as scanned copies. This is very powerful - the handwriting is so much more personal than the book's e-mail typeface, and her crossings-out and insertions are unedited. The letters are dear and bittersweet, and although there are hints of Ruth's mental involvement, they are example of pure maternal devotion and love.

I heartily recommend this book for its wonderful insight into a tragic world. It is a brief read that is more inspirational than depressing and makes one consider death in a different light. 10 pence from every copy goes to The Lavender Trust, a charity set up by Ruth Picardie and Beth Wagstaff to provide better support for breast cancer sufferers, something that Ruth felt lacking in her experiences. An important book.

Saturday, September 03, 2005

Foetus Snatcher

Channel 4 is currently running a 'Psycho' season and on Tuesday 6th September will be broadcasting 'The Foetus Snatcher' at 10pm, a documentary about the phenomenon of women who steal unborn children from their mothers.

The write-up in The Telegraph's Televison and Radio supplement tells of a near-term mother who was strangled with her foetal heart monitor cord, subjected to a crude caesarean - her attacker using car keys and biting through the umbilical cord - and left dead, with her living baby taken. There have since been several similar instances in the States.

It will be interesting to see how such a topic is handled by Channel 4, who have produced some high quality health-related documentaries recently. Review to follow.

Although I didn't manage to catch it, also in the series was The Sperminator on Tuesday 30th August, also at 10pm. This documentary dealt with a cowboy fertility doctor who provided his own semen samples to his unwitting patients and is believed to have fathered 75 children in this way. Unbelievably, he is also apparently the doctor to have pioneered amniocentesis, a procedure where amniotic fluid is sample as a diagnostic procedure during pregnancy.

All in all 'The Psycho' season seems worth watching, if you can abide the grisly nature of the topics handled. Did anyone else catch any others in the series?

The Curious Incident of the Alternative Review

I found this review of 'The Curious Incident of the Dog in the Night-Time' by Mark Haddon today in the student BMJ, written by an Imperial Medic colleague named David Ellis back in February 2004.

It relates to my original post in June about C4's 'Make Me Normal' programme in their 'Only Human' season, about a school for autistic children.

Saturday, August 27, 2005

Grey's Anatomy

LivingTV is launching yet another doctordrama on Monday night at 10 pm. If the amount spent on advertising it is anything to go by, it might be worth watching. Grey's Anatomy follows the lives of five surgical interns in their first year of being 'proper doctors'. So far, so predictable. The synoposis reads a bit like a tame version of House of God, which is November's Purple Coat Club book to read, by the way.

I can't resist a plug here for Amazon's new DVD rental by post service. For a mere £7.99 a month you can rent 4 DVDs (alternative plans are available for 3 or 6 DVDs a month). More details here. I have really enjoyed watching Dennis Potter's TV 'movie' The Singing Detective this month. If you're interested in dermatology or psychiatry, I particularly recommend it. The three-disc set comes with a director's commentary which is very revealing about the way it was made.

Purple Coat Club meeting: Tuesday 30 August

On Tuesday evening, we will be watching the acclaimed film 'Now, Voyager', starring Bette Davis, which affords an insight into psychiatry in the middle of the previous century. We start at 7.30 pm in Rm 311, Mech Eng, at Imperial College London. Everyone is welcome but if you don't have access to the building, you need to contact me to make arrangements to be let in. Dr Siv Jansson will be our guest.

UPDATE: Change of plan... Neither Yael nor Siv can make it, so we will be watching 'Brittania Hospital' instead, and 'Now, Voyager' next month. Apologies for last-minute changes.

Wednesday, August 24, 2005

Oxford Handbook of Clinical Specialties

An essential item for any medical student and an integral part of the white coat, the Oxford Handbook of Clinical Specialties, a.k.a the 'Salt and Vinegar' (it has a blue cover, as opposed to the 'Cheese and Onion' - green and yellow) is indispensable in the fifth year of medical school.

Having embarked on this penultimate year of medical school myself, and vainly trying to cut the mustard as a discerning medic, I ordered this book.

Factual and to the point, it provides an at-a-glance summary for the features and management of medical conditions, plus it fits in your pocket.

However, what I like most about this book are the humanities-inspired passages that intersperse the chapters. They remind us all what we are doing and why, without losing sight of the patient before us: that the collection of systems we are interested in makes up a person.

I haven't yet discovered all the passages and intend not to: finding them by chance is a more surprising and satisfying endeavour. My favourite so far prefaces the orthopaedic chapter and tells of the surgeon who labels his patients 'hags', and sets off irately down the ward, abandoning his humanity with every step, his fury arising from his realisation that he is letting his humanity go. The author of the chapter comes to their own realisation when exhaustedly collapsing onto a patient's bed: when the patient moves over to make room, they grasp the notion that the hags must make room for the doctor, and vice versa - 'they are all in the same bed'.

What a pleasure to know such an influential book contains a quick reference guide to humanity as well as medicine. It prides itself on multidisciplinary learning, which it achieves to a high degree.

The Gout Gremlin

Unfortunately my current rotation (musculoskeletal - a.k.a rheumatology, dermatology and orthopaedics) doesn't allow me much time to watch the news and keep abreast of bloggable items, but this morsel in today's lecture interested me.

This depiction of gout, a disease in which high levels of uric acid are deposited into joints, is an historic perception of illness. Uric acid is very insoluble and so rapidly crystallises in the synovium. It most commonly affects the big toe and ankle, and presents acutely with a hot, swollen and tender joint.

This idea of a malicious, malevolent creature feasting parasitically from the body is a common take on ill health and a convenient metaphor, especially when disease is poorly understood. In this case, germs are not involved, but it's easier to blame a mischevious creature for the problem rather than your alcohol intake...!

Saturday, August 13, 2005

House calls

Jenny Rattray at the UMO recommended House, currently showing on Channel 5 at 22.00 on Thursdays, and I finally got round to watching a couple of episodes. It completely bucks the trend of most modern hospital dramas towards realism and goes for idealism instead. The show's main draw is 'Dr House', played intriguingly against type by Hugh Laurie, with a gravelly American accent, a permanent 6 o'clock shadow, a limp and an attitude problem. House has no regard for ethics or hospital procedures and he frequently places his patients' lives at risk, but he always works out the correct diagnosis in the end. This (at least in the two most recent episodes) was down to Sherlock Holme's type deductional reasoning based on bad reactions to experimental medications and taking a chance on the less obvious diagnosis. House has three sidekicks. Curiously, none of them seems to have a caseload of more than the single patient featured in each episode. It's supposed to be set in a teaching hospital, yet the environment looks more like a law firm that's been featured in an episode of 'House Doctor' (sorreee!) and the patients seem all to have private rooms. There isn't a ward (or a nurse for that matter) in sight. House has a spacious office that looks like a board room. Are you sure this isn't science fiction?

Okay, so reality doesn't intrude on the plot circumstances, but what really interests me is why the show remains so watchable when the vast majority of viewers (with no medical education, myself included) have no conceivable chance of 'solving the mystery' ahead of House. The fun of reading an Agatha Christie novel or others in the detective genre (of which House is a medical visual example) is that you get to have a shot at working out whodunnit. With House you have no chance of second guessing the obscure diagnosis. Dr House is blatantly far more interested in the diagnostic puzzle than in the patient, and is thus the antithesis of your caring, communicating doctor. Yet, someone that determined to provide a definitive answer to a complicated set of symptoms and circumstances is hugely compelling as a doctor. Uncertaintly is a deep-seated cause of anxiety and I think the satisfactory resolution aspect is what contributes, I think, to making House compelling viewing. It would be interesting to hear comments on the show from a medical point of view.

As a quick aside, starting tonight on BBC2 at 19.35 (repeated on BBC4 at midnight on Monday) is The Guinea Pig Club, a drinking club for disfigured WW2 pilots. It's based on a book, The Reconstructions of Warriors, by Imperial College's Humanities Research Fellow, Emily Mayhew, who has a special interest in the history of plastic surgery. She won an award for her work on the series.

Monday, August 08, 2005

Portobello Film Festival

If, like me, you wish you could be in Edinburgh, there is some cultural compensation in the form of the Portobello Film Festival, kindly brought to my attention by Will Melia. It's conveniently situated for Imperial medical students and it's free.

Suzy Wilson, who runs our movement workshop on the Imperial medical humanities course, is artistic director of an innovative theatre company, Clod Ensemble. They are off to Edinburgh soon but there is a 'preview' in Shoreditch on Thursday 18 August. Performances at 7 pm and 9 pm at St John's Church, Pitfield St, N1, and tickets cost only £2.50. E-mail Roxie at the Shoreditch Trust to book.

Assessing risk

Interesting story on the BBC website today on how we can better judge risk. The 'social amplification of risk' (those factors which are difficult to quantify but have a significant impact on how we perceive risk) has been neglected in research -- it's good to see these matters being taken seriously.

Saturday, July 30, 2005

What makes a good patient?

When asked this during our humanities course, I replied 'co-operative'. You can imagine my delight when I discovered Stan, the model patient.

The programmable dummy is a learning tool for students, and can take on various clinical personas. Students can examine him, take his pulse and even administer drugs.

It is a technological step that is perhaps the consequence of the age old debate surrounding our profession and the way it educates - the fact that we as medical students practice on people. This is explored in depth in Atul Gawande's 'Complications'.

It also harkens to the established medical profession view of patients as objects rather than people - the dummy cannot give any verbal information (and who said 90% of the diagnosis was in the patient history?).

Obviously a great teaching aid, I hope Stan does not stand in for real people for medical students. Without a patient narrative, we lose our ability to empathise and also the individual mental portfolio of those patients we have met over the years, who stood out because of their unique particular stories.

When students practice on one another, they realise what it is to be scrutinised, which teaches consideration and respect. It also teaches sympathy to an extent, I know what is like to be cannulated badly - perhaps why I am loathe to do it to a patient.

Stan's full name is Stan D Ardman, aka Standard Man. Lest we forget, he ought to come with a reminder: standard people aren't mute!

Thursday, July 28, 2005

Attack of the metaphors

The military metaphor has for years been integral to the way we talk about modern medicine, but it seems the kind of language used is already becoming more specific in the wake of terrorist attacks. Take this opening paragraph from an article on today's BBC website: 'A nanocell that can burrow into a tumour, cut off its blood supply and detonate a lethal dose of anti-cancer toxins has been developed.' The article goes on, 'The researchers loaded the outer membrane of the nanocell with an anti-angiogenic drug and the inner balloon with chemotherapy agents. They also created a surface chemistry which allowed the nanocell to evade detection by the immune system.' Even the article's title, 'Nanoparticles double hit on cancer' seems to allude to recent events. It quotes Henry Scowcroft of Cancer Research UK as referring to nanoparticles as a sort of therapeutic 'Trojan horse', attacking the cancer cell by stealth from within.

This is eerily similar to the kinds of language being used in the press to describe the London bombers: 'terror cells' that have evaded detection by appearing 'normal' on the 'surface' before detonating lethal bombs. Of course the difference being that the nanocells are supposed to be the heroes in the scenario rather than the terrorists...

Wednesday, July 27, 2005

Random Acts on campus

Thank you to everyone who came along to the Purple Coat Club discussion of the book 'Safelight' by Shannon Burke last night. Our guest was Tom Reynolds of Random Acts of Reality, and he is every bit as nice in person as he is on his blog. Opinion was divided on the merits of the book. Tom reassured us that the level of corruption in the emergency services described in the novel (set in Harlem in the 90s) could never occur here. The protagonist in the novel, Frank, takes -- and sometimes sells -- photographs of injured, dying and dead people he is called out to attend. We had a lively discussion on the ethics of the use of photography. Tom pointed out that paramedics would get the sack very quickly if they took photos of 'the scene', yet he can't stop passers-by from taking photos. And, as we've tragically witnessed over the past few weeks, mobile phone images can suddenly go from being voyeuristic opportunism to being useful evidence. We're very grateful to Tom, who can rightfully claim cult status after this profile on the BBC website, for coming along.

The Purple Coat Club (so named after a poem by physician writer Danny Abse: copyright precludes my including it here but if you e-mail me I will explain) is open to anyone interested in books and film with a medical bent. We meet at Imperial College London on the last Tuesday of every month at 7.30. Please get in touch for details of venue if you would like to come along.

Tuesday, August 30: Watching the film 'Now, Voyager'. Siv Janssen, who lectures in literature and modern drama, will be our guest.

Tuesday, September 27: We're watching the cult film 'Britannia Hospital'.

In October we are having an art-related outing, watch this space for details.

On 29 November we're discussing Samuel Shem's book 'The House of God'.

Monday, July 25, 2005

Designer Hearing Aids

It was a welcome break from my ironing pile and the overly addictive reports on the bombings on BBC News 24 to come across the feature on designer hearing aids.

Almost certainly the idea of a hearing aid conjures up to most an outdated chunk of formica displayed over the chest or cumbersomely behind the ear.

It will come as a refreshing surprise to many then to see the Hearwear exhibition at the V&A this week. There are a range of stylish designs, from the glasses that have a small protuberance on the arm to act as the hearing aid, to the noise-reducing-headphone style aid that mimic the latest fashion accessories to the iPod craze. Some of the designs can be seen here.

This is certainly an exciting development for the deaf, perhaps long overdue. I don't see the designer colostomy bag around the corner though...

Sunday, July 24, 2005

'Casualty City' unleashed

Medical student Ellen Dean has created a fabulous comic, 'Casualty City'. Check it out here.

'Ether Frolics' -- a mental stroll in the dark

'Ether Frolics' is a very effective form of immersion theatre. The audience participation is not overt: no one is cringe-inducingly pulled up on stage. But the production gives you a feeling of being outside yourself looking in. This evokes the experience of anaesthesia when one is precariously poised between physical numbness and neurological sensation. The staging takes place in the dank, intimate space in the vaults under London Bridge Station. When the lights are off, the blackness is absolute and tangible.

The action is preceded by a well-crafted monologue from real-life anaethetist David Rosenberg -- one of the three performers. What follows is a series of surreal tableaux, part staged, part cinematic, part audio, and part designed to give your own imagination free range. For me (having only once had to have 'a general') it was an interesting exploration of the simultaneous freedom anaesthesia provides from control over your subconscious and the dread of not being able to communicate or direct your thoughts coherently. The surround soundscape and slick staging (how do they manage complicated scenery changes so quickly in absolute silence in the pitch black?) made for a memorably unsettling experience.

Talking to my friend GP Patricia Law afterwards, we were impressed by the way the production 'made space' for our own imaginations. The production cleverly captured the universal aspects of drug-induced sleep: echoes of infantalistic dependence, Alice-in-Wonderland type fantasy, horror of medical blunders, muffled overheard conversations... I loved it!

'Ether Frolics' is on till 30 July at the Shunt Vaults, and then at the Edinburgh Festival, 21 to 28 August 2005.

Friday, July 22, 2005

Cracking conference

The Medical Humanities Association conference took place in Truro in Cornwall this year, at the Knowledge Spa -- a fancy new facility attached to the Peninsula Medical School. The 'Spa' bit turned out to purely metaphorical, but it is such a lovely part of the world that it was a suitably invigorating environment for a conference in the absence of a jacuzzi for delegates (although some of us had a paddle in the sea at the opening-evening event at St Ives!).

I won't blog every session I attended, but the plenary speakers' sessions are certainly worth a mention.


I'll start with Abraham Veghese's talk. My expectations were high after we discussed his book, The Tennis Partner, at the Purple Coat Club last month. He did not disappoint. His talk was carefully crafted and full of interesting anecdotes. He began by saying that it sometimes takes years of practice for doctors to realise that are part of 'story' and often become spokespeople for disease. Clearly doctoring is useful for writing, but is writing useful for doctoring? His answer was an unequivocal 'yes'. He went on to analyse the value for doctors of story, character and metaphor.

On story, he said that conflict is a key ingredient. Story has to have conflict, crisis and resolution. Patients' everyday lives are not story, but when a patient walks into a doctors' surgery there is story (the potential for bad news lurks). Patients' stories are important to them. They wait for an epiphany. Verghese said that the real challenge was when there is no resolution -- no cure to offer. Referring to his work with AIDS patients, he said that he had come to the realisation that 'in not having anything to offer, you have everything to offer'. He used a wonderfully apt analogy for the illness experience: imagine you are robbed of everything that is dear to you. If the police come knocking at your door the next day and say, 'we caught the robber, here's all your stuff back,' you will be cured but you will not be healed.

On character, Verghese said that doctors use lots of traits to decide about character, but most telling is the patient's story. We teach medical students to translate these stories into medical narratives for diagnosis. In so doing, he said, we lost the patient's story: the language of science doesn't keep the voice of the patient alive -- an important element of the story is lost.

On metaphor, he pointed out the richness of metaphor in medicine and called for new metaphors for our age. He argued that the metaphors currently used in medicine do not reflect the patient's experience and that we should be actively engaging our imaginations more often to come up with new metaphors.

His talk was based on his paper in the Annals of Internal Medicine which I recommend to anyone interested in medicine, creativity and narrative.


Another of the plenary speakers was Lorelei Lingard of the University of Toronto. Called 'A Rhetorician in the Operating Room', her talk gave a fascinating insight into the practical uses of discourse analysis. She took as her starting point the notion that language performs social actions (allows identification with groups and professions). She analyses talk patterns and tensions in the operating theatre to identify major catalysts of tension. She focused in her talk on notions of professional roles. She used examples to show how people constructed the roles of others in the operating theatre totally differently (and generally more negatively) to the way they constructed themselves (e.g. surgeons' perceptions of nurses andexaggerated), and this was exagerrated in trainees. Interestingly, everyone saw themselves as the patient's advocate.

Usually, rhetoric is used purely descriptively in discourse analysis, but what I liked particularly about Lingard's work is that she (and her team) designed an intervention. The used written scenarios and video dramatisation of tense incidents to examine the assumptions of motivations behind what people say. They were able to come up with a team checklist designed to target communication failures. Initial results show that incidents of tension in the operating theatre were reduced by half. She ended off her excellent talk by reflecting on the role of the 'outlander' (someone who becomes a member of the team without engaging in the studied activities), and how difficult it is to remain objective.

Her research is published in Medical Education (abstract available but full text requires subscription).


Paul Robertson's talk 'Music and the Brain' was a real treat. We entered the lecture theatre to the harmonious strains of his violin. His talk was an exhilarating trip through his various collaborative projects which blend science and sensation including Songtrees and Swansong.


Yes, the talks were very inspiring and I enjoyed all the sessions I attended. (I also gave a paper on using poetry and art in medical humanities education which was fun to do). However, the real value was meeting and talking to such a diverse range of people. Medical Humanities is a fantastic umbrella for bringing together and valuing expertise from across the lines along which education is usually so divided. Where else would you find artists and anaesthetists, poets and paediatricians, sculptors and surgeons, PGs and GPs?

Next year's conference is being held at the Southern Cross University, New South Wales, 27 to 30 July 2006. It's called 'Taking Heart' and precedes the Byron Bay Writers Festival.

Thursday, July 14, 2005

Arts Festival

Anjali writes:

While perusing the latest edition of "Big Issue" I came across an article about a Festival for the homeless the "Ten Feet Away Festival":

It is a festival of a wide variety of events featuring many means of creative expression by homeless people such as workshops in music, opera and theatre. There will be paintings and poetry, etc. The reason I was particularly interested is because Cardboard Ctizens Theatre Company will be performing "King" - a novel about a community of homeless people in France by John Berger. I thoroughly enjoyed his book "A Fortunate Man" so i thought this might be of interest.

They'll also be screening "The Man Without A Past" by the Finnish director Aki Kaurismaki and an evening of opera and caberet from Street Wise Opera and the People Show All Stars.

The festival is on until 31 July.