Grand Rounds

Volume 2, Number 44: The Garden

Welcome to our garden. We’ve gathered together a multicoloured collection of species from all over the world. We’re interested here at Medical Humanities in artistic and literary metaphor which is why we’ve chosen gardening as our theme this week. So often matters medical are portrayed in the language of war: the fight against disease, the battle against cancer. These are the metaphors that have dominated medical discourse in the mainstream media. Yet, the military metaphor is not inevitable. Health-care professions tend their patients with the devotion and attention that gardeners lavish on their plants, hoping to keep them healthy. Medical Anthropologist Cecil Helman demonstrates in this narrative, ‘Possession’, the parallels between illness and a breakdown of order, as if in a garden overgrown with weeds. Our blogs, of course, are also little patches of territory, requiring cultivation and maintenance, and facilitating cross-fertilisation of ideas. We hope you enjoy a virtual tour through our 'Grand Grounds'.

The Knot Garden

Whether in Medieval, Renaissance or Contemporary times, the Knot Garden has always been characterised by intricate design detail. Like well-designed horticultral reports, the compartments of these gardens told their own stories through plant and pattern.

• Over at Breath Spa For Kids Shinga reports in song on the effects of pollution on children's lungs. A Buteyko Breathing practitioner and CapnoTrainer (biofeedback) trainer, Shinga raises awareness of the effects of pollution on our children. The statistics are frightening.
  
• The impact of the environment upon our health is taken indoors in Andrew Barna's report at Hospital Impact. Barna's survey of the 2006 Industrial Design Excellence Awards, gives particular mention to the Medical and Scientific Products category. The Insulet Omnipod Personal Diabetes Management System strikes me as a cross between a mobile phone and an IPOD. Products like these look familiar. Perhaps that sense of familiarity makes them easier to use.
  
• The precision of the Knot Garden must require a manual, or perhaps a good gardening program, to guide the gardener through the maze of planting, pruning and weeding. In a similar way, Grey's Anatomy (starring Ellen Pompeo and Sandra Oh) guides the medical student. Or does it? At My Life, My Pace, we get a student's take on 'school, lab and life' and find out house Grey's Anatomy misguides students about the training and lifestyles of surgeons.
  
• Sitting in a quiet corner of the Knot Garden we have time and space to contemplate and wonder. Rica Lode's poem at Genetics and Health concerns her frustration in trying to find pre-implantation diagnosis for neurofibromatosis 1 (NF1), from which her husband suffers.
  
• Talking RN presents us with some poignant thoughts on invasive brain fungal infection. They "sang ... in five-part harmony then they prayed". This is surely Talking RN's reflective side.

[Picture courtesy of http://www.bannut.co.uk/images/knot1.jpg]

The Flower Garden

The Flower Garden always puts on a good show! Yet, who knows what lurks beneath the borders and bushes, what disease might spread unbounded?

• Ideas for Women considers the therapeutic value of art in coping with breast cancer. Blogger Trisha explores the idea that expressing emotion through visual art and music brings healing.
  
• At Unbounded Medicine Dr Jon Mikel Inarritu presents us with biomedical images. Looking at an image of human colon cancer cells, he remarkes, is beautiful and bad at one and the same time.
  
• The wonderful image of a rollercoaster, 'delivered' to us at Navelgazing Midwife, doesn't exactly hide something bad behind the beautiful. Rather, what we have is a strangely apt analogy for birth and parenthood in a photograph of a fun fare ride. How come? Well, sometimes you laugh, sometimes you cry and you have little choice but to go with the flow and enjoy the ride!
  

The Gazebo

This is the place to relax and chat about interesting cases. We've assembled a group of bloggers here who, sundowners in hand, all have stories to tell about incidents this week that have meant something to them.

• Sometimes illness presents treasured opportunities, as Diabetes Mine found out when prompted by a question from her nine-year-old.
  
• Six Until Me relates an encounter with a diabetic child at a health fair which made a strong impression.
  
• When children turn into adolescents, doctors often find themselves having 'That Talk': the one about sex, drugs and alcohol. One such talk took place in The Examining Room of Dr. Charles, during which Dr Charles almost divulged a recipe for the greatest Sangria in the world, and his commentors seemed to get sidetracked into other prickly subjects!
  
• ChronicBabe has a round-up of tips from her readers on how to handle those irritating people that don't appreciate what living with a chronic condition is like.
  
• My Humble Opinion tells the story of a survivor of abuse illustrating how important an understanding of body language and non-verbal cues is to effective intervention.
  
• Dr Jest is off on holiday, but before he goes, he reflects on the difficulties of a holidaying doctor and asks for advice on appropriate behaviour when carrying out a breast examination in Dr Jest's Caseblog.
  
• Doctor Anonymous no doubt would also appreciate a holiday. He poses some tough questions after a long night of being on call. He also gets some answers to the question, 'Why?', from his readers.

[Picture courtesy of http://lilithlotr.ejwsites.net/2003calendar/hobbits-rivendell.jpg]

The Physic Garden

Created in the pursuit of research of the properties, conservation and origins of plants, and to train apprentices in plant identification, the Physic Garden represents the technical side of our submissions.

• Cancer Commentary advises on earlier detection of lung cancer via a novel blood test.
  
• Role reversal in acute appendicitis: rather than look at the classic signs and symptoms, RDoctor Medical Portal gives us the patient experience.
  
• Read a personal account of 7 ways Yoga has helped the writer at RadicalHop.com.
  
• Medical judgement is a difficult call. Experience breeds authority, as demonstrated in this difficult case of possible ectopic pregnancy over at Storkdoc.

[Picture courtesy of http://mindthegap.se/chelsea%20physic%20garden.JPG]

The Kitchen Garden

Growing your own fruit and veg can be both nutritious and fulfilling – here we take a look at the role of nutrition and medicine.

• Coffee is nectar to the hospital hive. Thankfully it's memory enhancing too, says straightfromthedoc.
  
• Sceptical of natural remedies? So is Hot Cup of Joe in this review of Kevin Trudeau’s ‘Natural Cures’.
  
• Obesity is bigger than ever. Is this thanks to the American diet?, asks diseaseproof.com.
• Unconventional approaches to treatment are all very well, but what about in the case of a child? Respectful Insolence fills us in. [Part 1] [Part 2]

[Picture courtesy of http://www.nyccompost.org/illustrations/tomato.gif]

The Potting Shed

The potting shed is the space where growth is acknowledged. Medical knowledge is accumulative, and often this involves adapting our ideas to accommodate new developments. It is like selecting an appropriate new pot for a growing seedling.

Tara Smith at Aetiology tells of new research into biofilms that helps explain why antibiotic treatment is so often unsuccessful in ear infections.

Garden insects can be helpful or harmful: a similar ambiguity is highlighted by Corpus Callosum who looks at whether genetically modified mosquitoes could be key to controlling disease.

Few of us may have heard of COPD but Shinga over at Breath Coach says that this pulmonary disease is on the increase and deserves more attention.

[Picture courtesy of http://news.bbc.co.uk/olmedia/1020000/images/_1023527_bill150.jpg]

The Herbaceous Border

Hospitals and gardens have something major in common: beds.

• Emergiblog, blogging from her local Starbucks, explains why immediate bedding is a bad idea, whether one has the collywobbles or not.
• Being on the other side of the consultation has lead GruntDoc to evaluate his own bedside manner.
  
• While we're admiring the flowers here, it seems apt to mention Allergizer's link to information on the collection of vespids for their venom to be used in life-saving vaccines.

[Picture courtesy of http://www.st-andrews.ac.uk/~gdk/stabotanic/jpegs/herbbord4.jpg]

The Greenhouse

In the Greenhouse you can grow specimens in specialised conditions. The blogs in this section are revealing of cultural differences and show the value of different perspectives.

• Tundra Medicine Dreams provides an illuminating insight into the role of breastfeeding in Yupik Eskimo culture in Alaska.
  
• An evocative, illustrated travelogue from Borneo Breezes takes us to an innovative community training programme for medics in Malaysia.
  
• Warrior Mom travels to Paris every fortnight (okay, Paris, Texas), but it seems like another world when it comes to gynaecological healthcare for deprived communities.

[Picture courtesy of http://www.thefineartcompany.co.uk/photos/kew-gardens-prints.jpg]

The Walled Garden

There are many taboos in medicine akin to walled areas to which access is restricted. One of the consequences of the rise of blogging is that previously unspoken of areas have been opened up to debate. Bloggers break down walls and provide alternative voices to those in the mainstream media.

• A major issue this week has been the arrest of health professionals for alleged euthanasia in the wake of Hurricane Katrina. Kevin, M.D. is providing rolling coverage of reactions to the arrests.
  
• Nurse Dan explains why he finds aspects of the story so disturbing.
  
• Euthanasia raises issues about what constitutes 'do no harm'. So does the involvement of health professionals in capital punishment. Should they assist in executions? Digital Doorway has strong views on the matter in this thought-provoking discussion.
  
• Ruminating Dude comes to the conclusion that it has been a bad week for the medical profession. Medication errors, conflicts of interest, and off-label prescribing have led him to conclude: 'Some doctors think they're just plain special.'
  
• Speaking of prescribing, InsureBlog has serious qualms about drug advertisements aimed at patients.
  
• Hospital Impact is dubious about the growth of retail clinics. There's a lively debate going on about their merits and drawbacks.

[Picture courtesy of http://www.bbc.co.uk/scotland/whereilive/coast/images/
southwestandayrshire/walled_garden.jpg]

The Tool Shed

Tinkering in the tool shed is a pastime for some, but when does tinkering become meddling?

• Fixin’ Healthcare suggests a less technical approach to medicine.
  
• Depending on technology makes Nurse Dan uneasy…

The Arboretum

Depression and anxiety can feel like one is lost in a forest of conflicting moods and emotions.

• In her new blog Alone, 18-year-old Jessica describes how she hopes blogging will help her cope with her depression.

• Happystance presents a thoughtful discussion on what constitutes unhappiness vs depression, and how governments can intervene to facilitate happiness and resilience.
• Anxiety, Addiction and Depression Treatments highlights a study that shows how sad-mood stimuli can trigger relapse in depression.

[Picture courtesy of http://www.terradaily.com/images/tree-rings-bg.jpg]

The Garden Path

The garden should be a safe place, but sometimes dangers lurk...

• Dr Deborah Serani gives advice on what to do if you are the victim of a stalker.
  

• Should you be unlucky enough to be in a collision with a moose, Inside Surgery has some tips on how to survive.









• If you happen to be cycling along the garden path, Flea will want to be assured that you have no previous injuries. He thinks Floyd Landis, winner of the Tour de France and soon to be receipient of a prosthetic hip, is setting a bad example to sports-mad kids and their parents.
  
• Do you feel you're being led up the garden path by well-intentioned but anxiety-inducing gatekeepers? Rita at MSSP Nexus Blog has a public service announcement on being persistent when scheduling an appointment.
  

[Picture courtesy of http://www.andreyyanev.com/Oil%20on%20canvas/A%20path-50x40.jpg]

This blogging bouquet was brought to you by cross-continental collaboration between Giskin, AJ and Beth. Thank you to all the contributors and to Nick who makes the Grand Rounds grand. Next week's Rounds will be hosted by Inside Surgery.

[All unreferenced pictures are from AJ's own garden.]