Monday, February 28, 2005

Million-dollar debate

There's a very interesting discussion going on over at Bioethics Discussion Blog on the ethics of the ending of the Oscar-winning movie Million Dollar Baby. It also raises the question to what extent a work of fiction is 'entitled' to take liberties with the legalities of ethical issues in a field like medicine. Is it irresponsible to portray emotive end-of-life scenarios in a way which is not congruent with reality? Or do we overestimate the extent to which moviegoers extrapolate cinematic portrayal to real life?

The movie has also been criticised for its portrayal of disability: check out this article in the Chicago Tribune by Lennard Davis which includes salient thoughts on portrayal of disability in cinema in general. Davis says:
'So-called normal people are fascinated and haunted by the person with a disability, probably because, unlike any other identity, one can go from being a normal to a quadriplegic in a matter of seconds. Most white people aren't going to become black in their lifetimes, and most men (with a few exceptions) aren't going to become women in the near future -- but the shaky and uncertain position of being normal can easily convert by a simple medical report into a state of being disabled overnight. That's why most film viewers are so quick to either idolize or pity the disabled person (almost always played by a normal actor), and are so quick to acknowledge
euthanasia as a quick fix to the as-yet unfixable condition of quadriplegia.'

Friday, February 25, 2005

See the Sea Inside

Thank you to Sarah Evans for submitting this film review:

Ramon Sampedro lives in a farmhouse in rural Spain, surrounded by beautiful countryside, with his father, brother, sister-in-law and nephew. Now in his 50s, he is a quadriplegic of more than twenty years. Diving into the sea, he hit his head and broke his neck. This scene is shown a few times in the film, each time chilling to watch, and evocative. The story follows Ramon's 'journey' as he tries to persuade those that love him and the high court that he should be allowed the right to die.

The plot develops as two women enter Ramon's life to help him. The lawyer, Julia, is has a terminal degenerative disease, and Rosa (a local Spanish girl with two children) who having seen his plea on the news, befriends him with the intention of giving him a will to live.

This poignant topic is explored with maturity and balance by the director (Alejandro Amenabar), and deals with the religious, familial and social implications with a delicacy of untangling single hairs.

A further highlight is the setting. Moving music contrasts with landscapes and beaches that calm the emotion -- portrayed most often when Ramon takes flight in his dreams, liberated from his bedbound waking state. These evocative scenes frame this watercolour perfectly, which is all the more vibrant for being spoken in Spanish.

Rarely am I moved by films, but the Director surrounds Ramon with different characters all of whom portray their varying feelings towards his wishes. There is someone for everyone. It is gratifying to have alternative opinions explored and leaves the viewer feeling even more involved.

This is an excellent film both provocative and moving, and one I would strongly recommend especially if you're in the mood for an experience. 5/5!

Sunday, February 20, 2005

Medicine-related events coming up

There seems to be a plethora of health/medicine-related events on in London over the next few weeks. Here is a list of the ones I've noticed:

The Dana Centre is hosting the following debates or talks:

These are free but must be pre-booked on 020 79424040 or e-mail

On Thursday, 24 February, 19.30, the Royal Institution is hosting a lecture called 'It's epidemic'. On 3 March at 19.00 there is a talk called Adapt or Die? on the physiology of exercise.

The Royal Society also has a number of interesting events which are free and no pre-booking required:

We'd be happy to host blog posts on any of these events if you do go along and feel moved to write a summary or review.

Monday, February 14, 2005

Making the Rounds

Tamzin's medi-relli blog gets a mention on this week's Grand Rounds -- an inspired idea by Nicholas Genes at Blogborygmi. In Grand Rounds different medical blogs take turns to round up the best of the week's medical blogging activity. Click here for the archives. Medlogs is also a good site to bookmark for a regularly updated aggregration of medicine-related blogs.

Sunday, February 13, 2005

'Saturday' reviewed

Originally uploaded by Giskin.
Reading a book by an author as well-known as McEwan is like watching a movie with a famous star: you experience it in a double frame of reference. The awareness of the celebrity superimposes itself on the character. It's difficult not to see the protagonist HenryPerowne as an alter-ego of McEwan himself, especially as there are many autobiographical strands running through the novel. Therein perhaps lies a clue to the success of the novel: the imaginative themes (most notably neurosurgery) are masterfully enacted, and those clearly based on McEwan's own experience (his mother's decline into dementia, for example) are authentic and sensitive without resorting to melodrama.

Some reviewers have characterised the tension in the plot between a scientific world-view (characterised by Perowne) and a literary one (carried mainly by his poet daughter) as a sort of 'rivalry' in which literature wins out. Literature does indeed triumph in the plot (I won't give it away), but there is a far more subtle undercurrent here. The very way in which McEwan writes about brain surgery - the medical equivalent of rocket science - shows that writing about anatomy, neurology, surgery doesn't have to be an exercise in demystification. There is nothing didactic or condescending about the way in which McEwan wields the surgical terminology, it is unforced and lyrical. It has to be said that TV shows like ER in which an unstinting barrage of medical terminology is no bar to communicating meaning have illustrated that the forms of words are capable of shaping sense in the absence of denotative meaning. I don't know what a pilocytic astrocytoma is, but I'm grateful to McEwan for realising that he does't have to explain: it doesn't matter to my understanding of the story. The temptation to educate is one, I suspect, few trained neurosurgeon writers would be able to pass up. The ability of a literary writer to inhabit so effectively the persona of a neurosurgeon without unweaving the rainbow (to coin a phrase) shows a reconciliation between literature and science, I would argue, rather than the former necessarily trumping the latter.

This is not a book with intricate and complex subplots and sweeping psychosocial narratives. In spite of, or perhaps because of, this, it is the epitome of the novel as a genre. It has a strong narrative thread, several clearly identifiable metaphorical themes, a well-built sense of place (London is beautifully evoked), a climax and a denouement. The political dimension on the war with Iraq is perfectly tuned to articulate the ambiguity felt by so many of us on this issue. Only one aspect rang false for me. It was a passage about the futility of the punctiliousness of a streetsweeper when behind him, 'cartons and paper cups are spreading thickly under the feet of demonstrators gathered outside McDonald's on the corner'. I can testify to the fact that no self-respecting marcher would have been seen dead in McDonald's that day. McDonald's might have had two million people pass their doorway in the icy cold, but I suspect there was precious little by way of trade.

Henry Perowne is a likeable hero. It is refreshing to have external events drive a character's internal reflections when so many plots are built around the material consequences of the internal crises of characters. I enjoyed reading Saturday and not only for the content. The book is beautifully typeset on nice quality paper. All in all, a thoroughly good read.

Wednesday, February 09, 2005

Regular colonist: relative medical

If you are or have ever been a medic, you will at some point become that most feared and disliked item, a medical relative. A medi-relly. Of course, the right of patients to request to see their own notes now has led to an inability to write: nice lady, annoying daughter. That was the role I played this time. Was quite nervous, stressed about it. You are in the bind of caring deeply that your mother gets decent treatment, and aware that you can use your inside knowledge to get a better-than-average deal, but also hesitant to invoke this preference, as is the doctor treating your relly. It even causes delay – due to the assumption that you will be over-reacting to her symptoms. Diagnosing a herd of zebras hearing hoofbeats out your window. (More likely to be mounted police sorting out football trouble where I live). Finally you tire of no action, that NHS lowest common denominator, and, ignoring your scruples, get your relly over-investigated and iatrogenically injured. There is no easy way to play this balance: talking over your unmedical relative, thus interrupting their doctor–patient relationship; yet unable to remain silent while they skip over symptoms that seem to clarify everything.

Mother and I have got it down to a tee though; we were like Morecombe and Wise – me the straight one. The poor doctor did his best to look welcoming – below consultant status, a registrar I think, a lot more bullyable than his boss anyway (the very same who cost me my sleep the last few nights). He kept appealing in his polite Spanish way to mother for some support – a neat reversal of the usual role. She in turn was most well-behaved: she charmed him; and talked nonsense. (After, before the door shuts behind us, Mother hisses: Hey! Not bad looking, or what?) She circumvented every attempt to wheedle a real symptom from her, or evince any evidence of concern about her respiratory status. I have invoked the spectre of my siblings. “I speak for them: we are worried” I declare, feeling the weighty responsibility of the spokesperson role – me, the doctor of the family. (No point declaring it’s not my area, I know nothing of asbestos/rashes/moles: they never believe you). The doctor with a hint of desperation appeals to mother: family pressure! he declares. He tries to turn it back on her: How do YOU feel? She laughs, coquettish, and says, oh, don’t ask me about it. I have no idea! He wants to know, is she worried, worried she will die?

I want to tell him that this cheery joking persona is a front: she has, with a great to-do, written her will most solemnly; is talking of stickering items in the house for after she dies; has become stuck on her own symptoms, inability to walk like she could, breathe, rush. It is dominating her life, I want to say. I am hesitant to interrupt again. “You seem to do a lot” he says to her. He doesn’t believe me. Trying pointedly not to look at me aware I have something to say. Knowing it is weak, I can’t resist piping up here anyway. I merely assert, “she does a lot less than she used to”.

Grimly, I imagine being on his side of the table. What a hopeless patient: and that daughter never shuts up when will they go? I hear the daughter come up with, “she feels faint sometimes” but gets shouted down by her mother: “no no, not FAINT.., STRANGE. I feel strange sometimes, and have to sit down before something happens.” Does this declaration help? I imagine him trying to write a referral form for the test I want her to have – some further investigation without going so far as an angiogram with its attendant risks. “Episodes of strangeness”. It won’t wash. She, meanwhile is bumbling on about her Spanish neighbour – it is merely coincidence as it is news to her after that the doctor was also Spanish – “she understands all English. Even IRONY” she tells the man whose English is so perfect she hasn’t noticed he isn’t English. He is keen to avoid another conversation with me, so ticks away our time by chatting about her neighbour. I don’t let him off the hook so easily. Naturally, as he is talking to us both, he engages my eye contact after a while. He is a nice bloke, fundamentally, and isn’t going to cut me, but also is a little afraid to take me on. I wait for eye contact and then butt in with a roll-call of her risk factors. I reel off family history, recent history and symptoms; I itemise the case for the investigation as if trying to pass Finals with Honours. Meanwhile she interjects with a minute-long diversion on the context of her first collapse, the park, what the weather was doing that day... I jag her knee with mine under the table and she mutes. I feel like a prosecution lawyer summing up my case and the key witness has said quite enough.

For relief, I allow him to set mother off again on some amusing digression, and when he next can get a word in, he outlines the further options, with the “do nothing” one at the end. I don’t allow him to finish. I am leaning forward, about to interrupt as he starts to itemise his list of possible tests when mother, her acting never far from the surface, interjects with perfect timing, “yes, I’ll have that one, thank you”. This rather floors him. It floors me. What a double act we have become. It is like I feed her the lead and she slams in the punchline. She waits for no further explanation, but, having been what seemed to be the ignored one in the power struggle of the medics, trumps us with her ultimate card: that of actually being the patient. I’ll have that scan, thank you. I was mistaken. She was not a witness, she was obviously judge and jury.

I see him write out a list of her risk factors and symptoms in the cramped space on the form and try to read upside down. Is it my summing up, verbatim? It amuses me to think so. He is halfway through, and thinks perhaps he will ask the boss – but here his niceness comes through. He looks at me straight and says, in a way that an English doctor, too afraid of his own status would have found difficult: the boss didn’t want to do more investigations, did he? I knew this full-well, hence our delighted seige of his good self. He is half standing, as if to go through and ask. I imagine the result: the boss will have none of our arguments especially second-hand. He will remain implacably true to his previous opinion that no more should be done. The registrar will have to deal with us after passing on this verdict. He is weighing it up. Whether it is niceness or a fear of taking us on, thwarted, that triumphs in the end, he sits down again. Gracious in victory, I offer him this: if the scan is negative, there is nothing more to do, is there? He reads this as the offer it is: do the test and we’ll shut up. For his own sake – I can well see the boss reading the notes next time, a little annoyed that his junior has reversed his decision, especially if the result is his predicted negative, and seeing through the slightly exaggerated letter the defensive junior will write to cover his tracks: I didn’t give in to pressure, her symptoms truly had deteriorated... He will hand notes over to said junior with glint in his eye: your private patient, I believe, Jeeves. Burdened, junior trogs off for his due punishment for over-using his admittedly slight powers of autonomous action.

We are, however, triumphant. For the moment, it is all that matters. We will deal with disgruntled boss and Jeeves when the scan is negative. If positive, I shall merely feel relieved to have found it before she drops dead having her feet done. It occurs to me that the request might bounce if they are very stringent: and it will bounce to the boss possibly who will throw it out, but these concerns are in the future. We celebrate our success in the dismal concrete hospital car park over a thermos of soup and hunks of salami before I waft back up to London, exhausted with the day’s work.

Tuesday, February 08, 2005

Blogging is therapeutic

Interesting article in today's Guardian about the proliferation of blogs written by those suffering from serious illness. These somewhat ironically named 'health' weblogs provide support and information for fellow sufferers but are also cathartic for the writers and provide a strong sense of identity and perspective.

These pathographies can be seen as following a trend set by journalists John Diamond, Ruth Picardie and Ivan Noble who died last week. Clive Seale, in his fascinating book Media & Health, explores how 'heroic narratives of the self', such as those penned by journalists Diamond and Picardie, undermine Susan Sontag's claim that cancer has is not subject to the same romantic idealisations as tuberculosis. He contrasts the ability of columnists to defiantly 'speak out about their individuality' with the way in which 'ordinary heroes' are constructed by the media (inspirational stories charting exceptional emotional transformation by women and underlying personal strengths in men).

Now that blogware has enabled 'ordinary heroes' to speak out and circumvent stereotypical media constructions of illness, will there be material consequences as a result of this power shift? Seale suggests that the media has at times valorised complementary medicine 'that assist in the task of breaking up the authority of orthodox medical expertise' -- a trend bucked by Diamond's advocacy of orthodox medicine. He also suggests that commercial interests are starting to target consumers directly through advertising with consequences for the way health care is structured. Will this encourage active management of illness by patients or will it be exploitative? This is starting to look like a lecture handout, so I'll stop at that.

Monday, February 07, 2005

Lemon Princess

Just to prove that we're not totally Londoncentric, here's notice of a new play at the Courtyard Theatre, West Yorkshire Playhouse in Leeds. The Lemon Princess is billed as an account of 'a fictional vCJD sufferer and her experiences with the American doctors who thought they had discovered a wonder drug, the journalists who thought they had the scoop of the century and a government who didn't want to know'. Sounds ambitious and intriguing. It runs till 5 March.

Sunday, February 06, 2005

Complimentary on complementary

Delighted to see a good review of Toby Murcott's book The Whole Story in yesterday's Guardian. The book looks at research on complemetary therapies against a background of the rise of evidence-based medicine. The conclusions support one of the justifications for medical humanities as a discipline: there is a great deal more to healing than science and technology, and the relationship between pratitioner and patient can make a material difference to the outcome.

Toby is a friend and sometime guest lecturer on my science communication course at Imperial. The students are always intruiged by the story of Toby's cat who was gravely ill but made a seemingly miraculous recovery after homeopathic treatment. I wonder if psychoneuroimmunology (the effects of the mind on the body's physiology and vice versa) extends to animals?

Tuesday, February 01, 2005

Conference announcement

The third annual conference of the Association for Medical Humanities is being held at the Knowledge Spa, Truro, Cornwall, 10 to 12 July 2005. The title is 'Metaphors for Practice: the Art of Healthcare' and the themes are :

  • Narrative interpretations of practice, particularly narratives of music, film, and visual art
  • Medical humanities and the education of healthcare practitioners
  • Medical ethics
  • The medical humanities and changes in clinical practice.
It looks like a wonderful programme. One of the speakers will be Abraham Verghese -- an inspiring and insightful writer in the field of medical narrative.

Click here for details on submitting papers.

Important information about the next King's Dialogue

Because of overwhelming demand to hear author and neurologist Oliver Sacks, the venue has been changed to accommodate a bigger audience. It will take place on 3 March at 6.30 pm (not 6 pm) in the Lecture Theatre of the Franklin Wilkins Building, Waterloo Campus, King's College, London (very close to Waterloo station). Tickets are freely available to anyone but should be booked in advance on 020 78482929. His theme will be 'Narative and medicine: the importance of the case'.

George Rousseau's talk on Literature and Medicine

Thanks to Neil Vickers from Kings College for help with this synopsis.

The King’s Dialogues kicked off on Thursday 27 Jan with a very interesting talk by George Rousseau on ‘Literature and Medicine - the state of the field’. Professor Rousseau gave an account of the development of L&M as an academic discipline and how, during the 1970s and 80s it struggled to find a niche in the shadow of Literature & Science (L&S) which emerged as the dominant field. L&M never tried to develop according to its own lights. People who were interested in it tried to build it up by 1) establishing that a sufficiently wide and deep body of texts existed that would justify L&M's existence as an academic subspecialty and 2) by trying to help others interested in L&M to get tenure in humanities departments. It was hard work: there was no Athens, no BIDS, no bibliographic software to speak of. And the professional struggles were filled with the usual venality. Most importantly of all, L&M scholars never tried to get near the experience of illness.

Like many humanities scholars, L&M specialists were aware of Foucault from the 60s on and found his work fascinating. But they did not appreciate why it was destined to become so important. Prof. Rousseau said that with hindsight that importance was clear: Foucault grasped earlier than any other thinker of his generation the primacy of the body for virtually branch of progressive humanities scholarship that was then seeking to anchor itself in university curricula (feminism, history of oppressed groups, early queer theory, etc.).

Rousseau passed the lion's share of his professional life (1966-94) as Clark Professor of English at UCLA. He described how he witnessed the impact that the AIDS epidemic had on literary theorists. L&M specialists were slow to understand its relevance for their own discipline. They understood its relevance for themselves personally (Foucault's death from AIDS added poignancy to this recognition) but the response was ultimately inadequate, he said, in spite of Sontag’s inspiring work.

A major theme of the talk was how emergency medicine and the technological response have become paramount in medicine, whereas the doctor-patient relationship, especially trust, has been neglected. L&M, he argued, is healthier outside academia, witnessed by the abundance of patient and doctor narratives. Literature has much to contribute to medicine – ‘we are the stories we tell’ – but medicine also has much to teach literature. Anti-science prejudice in the humanities still needs to be challenged. In spite of attempts to come up with a grand theory of L&M, none has emerged. Professor Rousseau advocated a new field, ‘compassion studies’ that would focus on histories of trust, compassion and tolerance – elements he argued are especially lacking in American society, and are particularly poignant on Holocaust Memorial Day.

Professor Rousseau has recently published a collection of essays, Nervous Acts: Essays on Literature, Culture and Sensibility.