Breast Oncology

I'm nearing the end of a two week breast oncology attachment. Its been an interesting time. Primarily, I have experienced a complete desexualisation of the breast - in fact, for some women, their breasts come to represent a source of fear, uncertainty and loathing. It may well incur negative outcomes for patient's sex lives, especially coupled with alopecia and other side effects of chemotherapy.

I have attended Breast Clinics in the past, and experienced high levels of emotion and worry by patients presenting with a lump. This is a stark contrast to the hardened patients who come to the oncology clinic for treatment of recurrence, taking it all in their stride, almost emotionless and matter-of-fact about their disease.

Feeling a patient's lump, and realising what I was touching - and what it represented - made me consider a woman's relationship with her lump. Personally, I'd want rid of the mass as soon as possible (which explains why many patients go privately to have earlier surgery). But patients with a large tumour have neo-adjuvant chemotherapy to shrink their tumour down to an operable size, and thus live with the lump for some weeks before it is removed. This must give them some form of psychological acceptance of their cancer - possibly explaining later matter-of-fact attitudes.

However, given how disfiguring the results of lumpectomy, wide local excision or mastectomy can be, it is no wonder that these women adopt such a stoic attitude to their cancer. Thankfully there is an incredibly extensive support network for breast cancer - if anything, perhaps over-representing the disease somewhat in terms of mortality (although one in ten women will get breast cancer in their lifetime).

Jo Spence documented her breast cancer experience, and here is her picture of her undergoing mammography, and her feelings about it:



"Passing through the hands of the medical orthodoxy can be terrifying when you have breast cancer. I determined to document for myself what was happening to me. Not to be merely the object of their medical discourse but to be the active subject of my own invesitgation. Here whilst a mammogram is being done I have persuaded the radiographer to take a picture for me. She was rather unhappy about it, but felt it was preferable to my holding the camera out at arm's length and doing a self portrait."

Readers can see a review of 'Ruth Picardie's Before I Say Goodbye', which documents her diagnosis and eventual death from metastatic breast cancer from the medhum.blogspot.com archives.

Big Bother

In the queue in the supermarket today I saw this article in The Sun. It claims Big Brother 7 is under fire from mental health groups Sane and Rethink for 'putting unstable personalities' into the house. We know Pete has Tourette's, and supposedly Lea has Body Dysmorphia, Nikki has been sectioned for anorexia, Shahbaz threatened to kill himself live on TV and Sam, a pre-op transsexual, is vulnerable and paranoid.

With two other contestants having already left the house, it seems this year's menagerie is imploding. Could this be the end for reality TV? Unlikely - I'm sure ratings are higher than ever.

Grand Rounds

We are featured on this week's Grand Rounds. It is always interesting to see how different hosts arrange the deluge of material submitted. KidneyNotes, this week's host, even has an mp3 version.

University of Michigan gets students blogging?

The University of Michigan Medical School's website is hosting the blogs of 12 students. Called 'Dose of Reality', the site claims to give 'insights, ah-ha moments, frustrations and excitement' relating to studying medicine at UMHS. A couple of things make me suspicious of the exact dosage of reality being doled out here. The first is that a disclaimer on the bottom of the blogs warns 'This page is maintained by UMHS Public Relations & Marketing Communications ... The University of Michigan may monitor this blog about the information you’ll find or delete inappropriate content. Any information provided in this blog is offered “AS IS” with no warranties, and no rights are conferred to you. You assume all risk for your use.' (Hmmm... the risks of reading a student blog...)

Given that the entries are long and often illustrated with photos, I wondered whether said public relations outfit pays these students to blog and/or has given each one a digital camera. Or maybe it counts towards their assessment! I wanted to ask, but there are no comment facilities.

I suppose this is no more engineered than the selective quotation, or student profile, that Universities often do to promote their courses (I'm forever picking out the good bits of feedback to promote the Medical Humanities course at Imperial), but I think corporate moderation really against the whole autonomous nature of blogging.

The Tragic Art

Physically exhausting and mentally taxing; the life of a ballet dancer is of endless fascination to the spectactors and speculators upon us. Few other subjects draw such passionate praise and blame from fans and casual observers alike, with the small matters of aseticism and sacrifice dividing the groups.

Waldemar Januszczck's review of Sam Taylor-Wood's latest exhibition pays heed to the tragic nature of our most demanding art and the dedication devoted to defying gravity.

He postulates that gravity is a fact of life and ballet dancers fight hardest against it, with eating disorders and excessive exercise amongst an arsenal of carefully-honed weapons. His equation of weightlessness with innocence and divinity is unsettling when considering that 'death' is the only method certain to achieve this effect.

The martyr complex is definitely worth thinking about if we are to find the solution to the Anorexic Experience.

A time to mourn

Cast out by Michele Petrone

Last night I attended a wake. It was meant to be a party to celebrate 8 years of Medical Humanities at UCL but there was an inevitable air of sadness: UCL's pioneering Centre for Medical Humanities is no longer being funded and has been forced to close. It is understatement to say this is a great shame. The Centre has served as a crucible for the discipline in the UK. Hundreds of healthcare professionals and patients have benefited from the excellent short courses run by the Centre. Magnificent, inspiring and well-organised conferences have invigorated the field. The BSc students lucky enough to undertake the varied and structured programme were last night effusive in their thanks, particularly to Debbie Kirklin and Heather Mitchell who have invested so much in the Centre over the past decade.

Although Medical Humanities at UCL was better integrated into medical education than most units, which operate on the margins with 'smash-'n-grab' forays into the curriculum, it was a soft target for the cash-strapped UCL. Situated in 'Primary Care and Population Sciences', one can imagine that it was tolerated rather than celebrated as being integral to its host department. The official excuse for closing the Centre down is 'Not enough research'. While I fully appreciate that research is a necessary and important part of academic life, an insistence on the primacy of research means that teaching is hugely undervalued. Universities are places where students come to seek enlightenment and training. Universities should not be factories for churning out papers in order to justify their existence.

The Medical Humanities Centre has, in fact, been incredibly productive over the years. Perhaps because it has so successfully fostered interdisciplinary collaboration, the Centre has not always received the credit for the publications of those whose activities the programme has nurtured. It is a pity this is not recognised.

Personally, I have been greatly inspired by the activities of the Centre for Medical Humanities. The short course in St Albans two years ago was a most memorable weekend. The Healing Humanities conference gave me the opportunity to meet the likes of Arthur Kleinman, Rafael Campo and John Fox. Artist Michele Petrone has become a good friend and comes and gives his life-enhancing workshop for our own students at Imperial every year. I also met Tamzin Cuming and Patricia Law on the short course, both of whom have also become friends and also collaborate on the Imperial course. Debbie Kirklin has been our external examiner and has been a fantastic sounding-board and mentor for our fledgling course.The loss of the Centre is a real blow to all of us who care about the humanitarian side of medicine. The closure ought to go down in history as a shortsighted decision, based on skewed priorities.

Outing on Thursday 1 June

The Purple Coat Club outing to see the Bodies exhibition at Earls Court is on Thursday. We are meeting at the entrance to the exhibition at 2 pm. Afterwards, there is a picnic in Hyde Park (weather permitting) where we'll be discussing this month's book Kiss Kiss by Roald Dahl. If it's raining, the 'picnic' will be indoors at 6 pm, Rm 313C Mech Eng, Imperial College London. E-mail me for more details.

The Purple Coat Club is an informal gathering of people interested in film, art and books with a medical bent. It's open to everyone from anywhere.

Next month (6 July, 7.30 pm) the book for discussion is Ian McEwan's novel Saturday, based on a day in the life of a neurosurgeon.

Inside the Ethics Committee

Radio 4 has just launched a second series of 'Inside the Ethics Committee' which explores real medical cases with clinicians that sit on ethics committees. This week, they look at testing for the heriditary bowel cancer HPNCC. Testing for adult-onset diseases in fetuses is controversial, not least because the test poses a risk of miscarriage. Listeners can give their opinions on the issue on the website or by phoning in. The programme is on Wednesdays 24, 31 May & 7 June 2006 8.00-8.45pm and repeated Saturdays 27 May, 3 & 10 June 2006 10.15-11.00pm. Or you can listen again here.

A Surprise Journey to a New Life: India Knight's latest project

Last week's Sunday Times saw India Knight write about Nell, her two year-old daughter with Di George Syndrome.

The response was huge. Thousands of parents wrote in to empathise, curious to know exactly why they and their children continue to remain 'completely invisible' in the mainstream media.

The response inspired Knight to launch 'Something Special', a comprehensive resource to be allocated a spot on The Sunday Times’s website. She intends to have parents using it as a database when seeking practical/peer support on living with a special needs child.

The idea, which is 'elastic', to write to Knight at the e-mail address given below, 'sharing your experiences, voicing your anxieties, passing on your advice' and giving her pointers on what to write about.

The project is open to relatives and friends with considerable experience or understanding of having special needs in their circle.

More details of the project can be found here.

Email somethingspecial@sunday-times.co.uk if you'd like to get in touch.

Alongside Knight's frank depiction, Emily Perl Kingsley describes exactly what a parent goes through when they find out exactly like to have the child they weren't expecting.

Adam Elsheimer

I couldn't resist posting this lovely image of Saint Elizabeth feeding the sick in hospital by Adam Elsheimer (c.1598). It is part of an exhibition of Elsheimer's work currently at the Staedel Museum in Frankfurt. The exhibition is the first ever of Staedel's work and comes to the National Galleries of Scotland in June and to the Dulwich Picture Gallery in the autumn.

IC Medical Humanities hits MS

This month's Medical Student pays tribute to the fantastic effort that was.

Check out their review of 'Medicine Interrupted' here!

Big Brother

The show we all know and love/hate is back on our screens in its seventh reincarnation, with all the usual exhibitionist characters. However, this year one of the contestants, Pete, has Tourette's Syndrome. It is questionable whether this is a ratings tactic or a genuine attempt to educate the public about a probably much-misunderstood condition. Tourette's is characterised by tics and coprolalia (involunatary, often rude speech).

Read the Guardian Unlimited opinion on Pete here.

Read a BBC roundup of the housemates here.

Medical Student Newspaper Team

Medical Student Newspaper, home to our writer S and Ellen Dean's devilish Casualty City, are looking for fresh blood for the editorial team next year:

"Are you interested in a future media career? Do you want to be the doc who sits on the GMTV couch and talks about MRSA? Or is your CV looking a bit sparse with F1 application time looming? If any of these apply to you then why not get involved with the UK’s largest free medical publication?"

This is a great opportunity for London medics to get to grips with putting together a newspaper, gaining writing and editorial experience and backing one of the best entirely student-run free newspapers in the UK.

Movie Medicine

Interesting piece on the MSN homepage about the portrayal of medicine in film and on TV. The blurb says:

"In a study published last week, doctors complained that comas are not accurately portrayed in films, which can therefore lead to a skewing of public perceptions and affect real life decisions. But what about other illnesses and conditions? Are film and television shows committed to the facts when it comes to ailments and illness? Richard Moore examines why the truth is very rarely allowed to get in the way of a good medical drama."

Medical Humanities Conference -- call for papers

The Annual Meeting of the Association for Medical Humanities will be held this year at King’s College London on 4 to 5 September. The two-day conference brings together health-care professionals, artists, writers and scholars. Last year's conference in Cornwall was a great success. The focus of the this year's conference is representation of health and illness. Guest speakers will include John Wiltshire from Latrobe University, Australia, Faith McLellan, Senior Editor of The Lancet New York, Sander Gilman, Emory University, Atlanta, USA and Anne Marie Rafferty, Dean of the Florence Nightingale School of Nursing and Midwifery at King’s College London.

The conference fee for students is £100 for two days (£50 for one day). Booking form here. I would also urge students to submit abstracts for a presentation: there was much talk of the student experience last year but little first-hand evidence from students themselves.

Abstracts should be sent by 31/5/2006 to: Brian Hurwitz, Medicine and the Arts,Department of English, King’s College London, Strand, WC2 2LS. Email: amh@kcl.ac.uk.

Complications - Review

'An extremely important book'

Atul Gawande's observations on the world of the surgeon is an effortless, slickly written masterpiece. Reading it, I felt it was one of the most important books any medical student might encounter, leading me to consider its potential as being part of the medical school curriculum.

Gawande covers a range of topics, devoting a chapter to each and providing a wide range of anecdotes, examples of cases and scientific literature to lend weight to the discussion. This provides the book a diversity, with analogies to fields other than medicine, making this book equally accessible to laypeople.

The areas considered in the book include practising on patients, fallibility and making mistakes, technology versus surgery, drug companies, motivation, superstition, chronic pain, nausea, obesity, autopsy, cot death, consent and uncertainty. Each are comprehensive and approached objectively, with the author unafraid to admit the flaws in modern medicine.

Not only is the book an educational read, but it allows access into a secretive world. For patients, there is the idea of handing over control to another, as soon as the haze of anaesthesia begins. For them, this book reflects the thoughts and worries of those taking care of them, as well as their own feelings. For medical professionals, this allows us to question our motives and doubts about what Gawande describes as 'an imperfect science'.

A personal drawback was the 'americanism' of the book; Gawande could have aimed at a more worldwide audience (There are a few cultural and geographical references which went over my head). Another aspect I found to be slightly clumsy was the confidentiality; 'A patient with x, whom I'll call Mrs Y'. Gawande already states in the opening pages of his book that he has anonymised his accounts of patients, and it interrupted the flow of the text somewhat.

What did non-medics feel about the book?

Student art competition

Previous winner: Solitude by Thelma John and Esther L. Pachuau, students at Christian Medical College, Vellore, Tamil Nadu, India

WIN FREE STUDENT REGISTRATION FOR THE NETWORK: TUFH 2006 CONFERENCE IN BELGIUM

Global Health through Education, Training and Service (GHETS) is sponsoring a contest to design the front of our 2007 holiday greeting card. Any individual health professions student from any institution worldwide may submit either their own original artwork, or artwork created by children or youth from their communities. The individual student whose entry is selected by the judging panel will be awarded free student registration for The Network: TUFH conference in Belgium in September 2006. The winning design and information about the artist will appear on GHETS’ 2007 New Year’s greeting card, which will be sent to nearly 200 partners and donors worldwide. Packages of greeting cards will also be sold to raise money for GHETS and our international partners, so your artwork could be seen by hundreds of people!

All entries must be received by Friday June 16, 2006.

Drawings, paintings or other similar artwork in any medium (pen, pencil, paints, etc.) are acceptable. Entries should reflect general themes related to global community health, but should not include the name GHETS or holiday greetings (which will appear inside the card). The final size of the greeting card will be no larger than 13 cm x 20 cm, so your design should fit into this space, either horizontally or vertically. All entries should be original work, either of the student making the submission, or of another young person who has agreed to let you submit the artwork on his or her behalf. Students may submit more than one design, but all entries become the property of GHETS and will not be returned.

Please include the following information with each entry, on a separate sheet of paper:
Artist information: Full name, sex, age, and place of residence (city/town, country) Your information: Full name, name and location (city and country) of your school, email address, postal address and telephone number

Send your artwork via postal mail to:
GHETS 8 North Main Street, Suite 404 Attleboro MA 02703 USA

If you have questions, or if you would like information on how to submit your entry by email, please email info@ghets.org.

GHETS is a non-governmental organization based in the USA and a program development partner of The Network: TUFH. GHETS and The Network: TUFH have joined forces to promote strategies for change that address the health-related challenges of poor and underserved communities in developing countries.

X-Men 3: The Last Stand

Next Thursday sees the release of the much-anticipated third and final film of the Marvel Comic's X-Men Trilogy.

The comic's concept is to do with genetic mutation and the development of the 'X Gene', a rare mutation manifested during adolescence that gives the recipient unususal abilities. These 'mutants' are feared and shunned by society, who resent their powers and are apprehensive regarding their often bizarre appearance.

There is a schism in self-opinion by the mutants however; those led by Professor Charles Xavier (Patrick Stewart) - who runs a school for 'gifted' youngsters - believe mutants can live side-by-side with humans, whilst those led by Magneto (played by Ian McKellen) believe they will never be accepted, thus are 'at war' with humans.

The previous films have dealt largely with stigma and acceptance issues, and controlling mutation, but the plot of this third and final film involves the development of a 'cure' by a pharmaceutical company, and the chance for some mutants to finally have the opportunity for anonymity, at the expense of their super-power.

Admittedly this is a big-budget Hollywood blockbuster, with a greater emphasis on special effects than medical issues of disease and cure, but I think the ideas behind the story are fascinating. We can extrapolate the analogies of diseases providing some kind of ability down to examples such as sickle-cell trait giving protection from malaria, and the preceeding and subsequent Darwinist natural selection. The film focuses on good versus evil (the age old comic book theme), but these are represented by individual's own perceptions regarding their status, as well as the average human's opinion - are mutants freaks?

If anyone is interested in the movie or has seen the previous films (or watched the cartoon like I did in my youth), I'd be keen to hear what you think.

You can see a seven-minute trailer for the new film here, or check out the film's official website.

A Note of Madness

Intelligent, intense and refreshingly honest, Flynn Laukonen is the perfect protagonist for Tabitha Suzuma's beautifully-written debut novel.

Entitled 'A Note of Madness', the narrative is centred around a perfectionist pianist, burdened by the expectations experienced when studying in a 'place where everyone strides with purpose'.

Faced with the challenges of independent living and university life, Flynn experiences an awkwardness compounded by a range of emotions and actions which perplex both himself and those who care for him.

Set at South Kensington's other competitive college, the story offers refreshing insights into the poorly-described condition of bipolar affective disorder, taken from both the doctor and patient perspectives.

The transition between monologue and narrative is especially effective in portraying the difficulties, and indeed, the confusion felt by Flynn and those around him. The use of monologue enhances the immediacy, capturing the awkwardness that characterises Flynn's disposition. This immediacy, depicted in carefully-chosen jargon-free prose makes the experience of his 'madness' infinitely easier to understand.

Words cannot describe how lucid and readable this story is. Given that one in four people in the UK suffers from a mental health problem, millions of us are going to either live with depression or a depressive personality sooner or later. A little understanding, (given the difficulties faced in getting emotional disturbances explored in a sympathetic manner) will go a very long way.

Highly recommended.

Designed With Care

This week sees a week-long investigation by CABE into the relationships between health and the built environment. CABE is the Commission for Architecture and the Built Environment and is concerned with improving peoples quality of life through the built environment they live and work in. You can check out their blog here. One of CABE's concerns is to foreground the way in which good design can improve local healthcare facilities. Their belief is that "By going beyond simply providing a place for the delivery of nursing and medical care, these buildings create a human, inclusive and reassuring environment - just when people need it most." A series of day-long seminars will take place from next month with one at St Bartholemew's Breast Care Centre on 19th October.

Julie Spollen

I thought I'd look up the winning artists from the Body of Work art exhibition that Matt just blogged. Julie Spollen, who won third prize, is the only one of the three I have been able to find any images for. The mouth piece and nose piece shown here were exhibited at the Royal College of Art in 1997 as part of the graduate show that year. Julie had previously studied design in Dublin before training at the RCA. The pieces she entered in the Body of Work exhibition are entitled Exhaust, Urban Mouth Filters and Nose Filters, suggesting some sort of environmental association perhaps - something to protect us from pollution maybe. Yet, in this 1997 image there is nobody left to protect. There is only a whiff of death, an eerie, breathless silence.

Not that I'm procrastinating or anything...

Exam is in less than 24 hours. What a perfect time to make my first medical humanities blog then.

For anyone who happens to be going to Belfast before the beginning of June, may like to know about an exhibition taking place at Queen's University. The links between art and medicine are being explored in an exhibition of work inspired by health 'in the broadest sense'.

Pieces on display include 'lifelines' by Struan and Kyle Hamilton, and 'Restore' by Hazel Neill (pictured) who are amongst the finalists in the fifth annual art competition organised by the Naughton Gallery at QUB.

According to the curator, Shan McAnena, the exhibits are the latest in a long tradition of pieces linking art and medicine, from the anatomical drawings of Leonardo Da Vinci to the installations of Damien Hirst.

Obviously, nothing could rival 'Medicine, Interrupted'...

The exhibition runs till May 27th and more information can be found at www.naughtongallery.org

Now, back to revision...

The Balint

Today I attended my first Balint Group, a psychotherapeutic approach to mental health, aiming to review conditions from an alternative point of view, to provide insight into the roots of mental illness.

It was fascinating; though largely silent, the group relies on input from whoever attends. Despite fits of giggles occasionally permeating the social tension, we explored two patient scenarios in depth.

Given Freud's recent 150th birthday celebrations, it would have been poor form to omit him from our analyses, and my patient ended up neatly fitting into a theory regarding subconscious sexual repression, resulting in a social phobia, depression, alcoholism, gambling, hypochondriasis/somatoform disorder, topped off with a bizarre facial tic.

Thinking about his problem stemming from a particular incident in his childhood made me reassess his whole situation, which proved quite saddening, given its chronic course and its negative affect on his life. He now attends a social group but seems unable to break his lifetime habits and still finds it near impossible to approach others.

I have so far found Psychiatry to be embracing of alternative therapies, especially Art, Music, Movement and Cookery, which the patients regularly attend, whether hospitalised or at Day Centres in the community. Indeed, regular attendance at groups can be enough to merit leave for patients under section. On the other hand, given that patients have little to do whilst under section (other than play table tenning and watch TV), any kind of activity would be welcome.

There are regular Balint groups for doctors of every level, from Consultant to student doctor. Click here for a paper on the merits of a Balint Group.

Inner Words Outside

Inner Worlds Outside is at the Whitechapel Gallery until 25th June. Entry is £7.50 and £4.50 for concessions. It shows what is normally considered 'outsider' art alongside the work of 'inside' artists.

As the Whitechapel write-up tells us:

Outsider Artists have included psychiatric patients, criminal offenders, self-taught visionaries, mediums and other ‘eccentric’ individuals. Interest in Outsider Art has grown with the rise of psychiatry. Artists like Paul Klee, Pablo Picasso, the Expressionists and Surrealists explored the psyche in search of autonomous creativity or childlike innocence, and turned to ‘outsiders’ for inspiration. However the way Outsider Art has been defined by biographical and psychological factors is now outmoded.Inner Worlds Outside now explodes the myths surrounding Outsiders, showing the parallels between Insider and Outsider Art, and the impact of unknown Outsiders on some of the greatest artists of the 20th Century.

I haven't had a chance to see it yet but will report back when I have.

The people we think we are

The Daily Telegraph today featured Max Pemberton's Trust Me I'm A Junior Doctor, a regular column in the Health section of the paper. Pemberton writes in praise of the much maligned legacy of Sigmund Freud. Despite his critics from Klein in the 1920's and beyond, Freud remains, perhaps, the central character of psychoanalysis. "Without Freud", claims Pemberton, "we would not be the people we think are now." Now that's quite an achievement. You can read the complete article here.

Black Sun

‘So through the eyes love attains the heart, for the eyes are scouts of the heart and the eyes go reconnoitring for what it would please the heart to possess…’

Black sun is an incredible documentary recounting the life of the French artist Hugues de Montalembert, who was blinded by an attack by muggers at his home in New York in 1978. Despite his profound disability, a few months on he is travelling in Indonesia.

This film is a sensory meditation on his interpretation of the world with one less sense. Incredibly moving and philosophical it is truly an impressionistic depiction, accompanied by a stream of images, of cities and landscapes; locations visited by de Montalembert on his travels. Throughout the viewer is reminded of all that we take for granted in looking. De Montalembert even compares the loss to castration. The artist describes the reactions of others; the extraordinary compassion expressed and disinibition in confessing life's intimate details to a blind face.

While throughout his story there is the inevitable melancholia as De Montalembert mourns for his loss, he also describes his celebration in being alive. It makes uplifting and life changing viewing.

Black Sun is being shown at the ICA until the 25th of May.

Secret Window

Anyone interested in the portrayal of mental illness in film might enjoy the 2004 film 'Secret Window'. Starring Johnny Depp and John Turturro, it is about a successful writer who spends time in a log cabin to overcome writer's block. When a sinister figure appears one day accusing Mort, the writer, of plagiarising his book, a trail of violence and suspicion ensues [I won't elaborate to save spoiling the ending]. This film has had some terrible reviews so don't expect a masterpiece!

Wild Strawberries

The Purple Coat Club met last Thursday to watch Wild Strawberries, (or Smultronstället in its native Swedish). This was another one of our 'Golden Oldies', dating from 1957 and directed and written by Ingmar Bergman.

It follows a day in the life of Professor Isak Borg, who is heading to Lund to collect an award for his service to Medicine. The Professor decides to drive to Lund rather than fly, which involves some hours, providing the chance to reminisce - we see in flashback some of the defining moments of the Professor's life. In addition to these memories are the disturbing sequences of the Professor's uncomfortable dreams.

The main theme of the film concerns Isak's lack of compassion and empathy throughout his life, and the realisation that his award amounts to nothing, given he is seen as a bitter, cold old man. His emotionless character is reflected by his 'weak heart', and his disastrous marriage has given rise to a son with all the same problems.

An undertone to the film is the superiority of men and the role of the woman is clearly defined. This perhaps reflects the age of the film, but fits in with Isak's mentality. His relationship with his housekeeper is one that could progress to that of a loving old couple, but the pair are both as bad as one another, and refuse to drop any formalities.

The Professor's catharthis provides the climax and ending of the film; where he realises the mistakes he has made and how they have made him the man he is. He then sleeps, and the film ends, leaving the viewer suspended - will he wake up?

We enjoyed the style of the film and its quirky manner, and agreed that the dream sequences were its hallmark, making it a memorable piece.

Outing and picnic in the park

The next Purple Coat Club meeting (Thursday 1 June) will consist of an outing to see the 'Bodies' exhibition at Earl's Court in the afternoon (meeting at 2 pm at the entrance to the exhibition), followed by a discussion of our next book, Kiss Kiss by Roald Dahl. If the weather is nice, we are planning to have an evening picnic in Hyde Park at about 6 pm, otherwise we'll meet in Rm 311, Mech. Eng. Everyone is welcome. Please e-mail me if you are interested so that we know how many to expect.

The Subject of Examination

I don't know very much about the work of Japanese artist Chihau Shiota but what I have seen is both intriguing and disturbing in equal degrees. The work is by no means focused exclusively on medical themes but the two works shown here have obvious resonance. The performance piece During Sleep (2002) placed a number of hospital beds in a room and filled the space with wool, strung in the air across the space. Shiota and a number of others initially occupied the beds, silent and motionless. It has clear visual links with the environment constructed by Marcel Duchamp in the 1942 Surrealist show in New York.

The second piece here, Ein Ort (2001), reminds me of two things. Firstly, Cornelia Parker's Cold, Dark Matter: An Exploded View (1991) - an exploded shed also starkly lit. At the risk of becoming too confessional, the second connection I would like to make is much more personal and perhaps more pertinent in the context of this blog. The harsh, intrusive lighting and the hospital bed restore a difficult memory - my own experience of hospitalisation when my daughter was born. Pre-eclampsia and HELLP syndrome made for a difficult time for us both. As the subject of examination and observation I was helpless and totally dependent.

Nintendo's Trauma Centre

Thanks to Rachel Souhami who spotted this review by Nick Gillett in Saturday's Guardian and thought it might be of interest. Anyone tried it?

Trauma Centre: Under The Knife NINTENDO DS, £30

While the classic board game Operation had you performing surgery with tweezers on a plastic patient with distinctly suspect internal organs (wishbone, spare ribs and butterflies in the stomach are all perplexingly absent from Grey's Anatomy), Trauma Centre refuses to back away from any medical detail, no matter how slight. Make incisions and injections, disinfect wounds, drain fluids, excise tumours, suture and place your bloodied extractions neatly into a dish as you treat injuries and try curing diseases - it's all in a day's simulated doctoring.

Using the DS touch screen and wielding your stylus as scalpel, syringe and even instrument of open heart massage, Trauma Centre's offbeat humour and unflinching use of complex medical terminology make it a curiosity that pulls you past the reams of text and occasionally brutally lumpy learning curve.