'Health of the Nation'

Magnum Photos, the renowned photo agency, is collecting photos showing the changes in UK Healthcare in the last 60 years.

Currently in the archive are photos such as one showing blood samples being sent by carrier pigeon, but the aim is to contain photos of the current NHS too, especially to demonstrate a healthy nation (as a result of sixty years of free healthcare).

Magnum photos would like input from NHS staff regarding subject matter for their project. Send suggestions to betha@magnumphotos.co.uk. An exhibition is planned for 2008.

BMA Photography Competition Winners

Readers may remember this previous post advertising the BMA/STA Annual Medical Student Photography Competition.

This year's winners have been announced, the overall winner was Neil Gupta, a fifth year student at Imperial College, London.

The theme was 'Medical Student Life, at Work, at Play'. The winner received a return flight to anywhere in the world.

The winner and runners up:

Mindshock: Transplanting memories?

I wonder if anyone saw this programme on Channel 4 last night. It reported a controversial theory that the heart may play a role in forming emotions, personalities and memories, based on the experiences of some heart transplant patients. This radical possibility clearly challenges the conventional textbook account of the heart as just a pump, and embraces the metaphorical vision of the heart which has featured in literature and the arts for centuries. The first person to report this was a heart transplant recipient in Boston twenty years ago who reported a sudden penchant for beer, green peppers and KFC nuggets, later found to be firm favourites of her young male donor. Strict confidentiality regulations meant that she could not have had access to this information, nor the name of her donor which she correctly gleaned from a dream.

However I wasn’t entirely convinced by some of the cases. One transplant patient who developed a love of classical music was found to have received a heart from an American violin-playing teenager. I couldn’t help feeling that if the recipient had developed an interest in hip hop or rock, this too could have resonated with the donor’s musical interests. Another placid woman received the heart of a boxer, and subsequently reported violent tendencies. Again, it seems far too convenient to attribute this simply to the stereotype of a violent boxer. A particularly fanciful example was a man who became a prolific writer of poetry, only to receive a letter from his donor’s family containing lines of verse.

One thing seems apparent; the quagmire of confounding factors. Clearly a major medical procedure such as a heart transplant is likely to induce a degree of introspection and promote some lifestyle changes. Perhaps just the notion itself of having a heart transplant is sufficient to drive changes in personality, just as surviving a car crash may be life affirming for some, or traumatic for others. The effects of immunosuppressive medication in altering moods have also been implicated. However, this may not explain all of the reports, nor the finding that in a blinded study of 70 transplant patients that felt a change in personality, 10 matched their donors’ closely. The discovery of neuronal populations in the heart has also led to talk of a ‘little brain’ and ‘heart intelligence’, and the possibility that some memories may be stored in the heart. The last word finally went to a Prof Paul Pearsall, one of the strongest proponents of a sentient heart. Seemingly bursting from the pressure of keeping a lid on the puns for the last hour or so, he finally succumbs: ‘We better wake up and have a heart’.

Purple Coat Club news

We were originally going to discuss Ian McEwan's novel "Saturday" on 6 July, which features a neurosurgeon as the main character. However, many people who'd expressed interest are away next month, so this will now take place on 10 August. Instead, we'll be watching the 1931 film 'Arrowsmith' on the 6th (next Thursday). Apologies to this year's medical humanities students who have probably seen this. The film is based on a book by Nobel-prizewinning author Sinclair Lewis. The story covers the medical career of Martin Arrowsmith, a flawed but well-intentioned protagonist who experiences medicine in many of its guises: as a research scientist, a pathologist, a public health official, an epidemiologist and a small-town GP. The novel is prescribed reading on many American medical humanities courses (but don't let that put you off!). You can read more about the film here.

We will be meeting in Rm 311, Mechanical Engineering Building, South Kensington campus, Imperial College London (no. 29 on this overly-complicated map). Everyone is welcome. We start at 19.30. Please e-mail me if you would like to come and are not a student or member of staff at Imperial so that I can arrange access to the building. Popcorn and wine will be on offer!

Art and Abortion

I have read AJ and Richard's post below with great interest. Inevitably, I turn to art to make sense of life. Tracey Emin famously appeared very drunk on TV and swore a lot before crying out 'I want my Mum', or words to that effect. Her work My Bed, strewn with used condoms and other debris, was berated by the popular press when it first appeared in the gallery. Emin continues to make controversial work, although she is now pretty mainstream with her own gallery in Tate Britain. Okay, I love Emin's work, so what's my point? My point is that all her work displays an amazing degree of fragility. This particular work, Tiny Emin, is no exception. It recalls the children she has aborted. In the context of the debate (below) on abortion the image says it all. Yes, the law has to protect the unborn child - and I believe it does that sufficiently well as it is. But it also has to protect the woman. Perhaps, as Richard suggests, there are some women who get rid of pregnancies without giving it a second thought. For the majority, however, I believe it is a decision they have to live with every day. Emin certainly does, as this work bears testimony. Emin exposes her self in her work so that the seemingly brash, narcissistic artist turns out to be nothing of the kind.

Abortion Debate

I've just been angered by watching the BBC News at Ten, and seeing the report on the abortion debate. The head of the Catholic Church in the UK has called for a decrease in the limit at which an abortion can be performed (currently 24 weeks). I find it frustrating that someone in such a position of responsibility can speak out so recklessly about such an inflammatory issue.

The Abortion Law in the UK has been established since 1967, and there is no real reason to bring the limit forward - i.e. no new evidence about foetal development or similar. There are currently no plans to change the Abortion Law, but it must be pointed out that most women who have abortions do so before 12-13 weeks, and only a small proportion go beyond 20 weeks. Although more foetuses now survive at 24 weeks, there is an association with long term problems - it's not all plain sailing.

Being a Pro-Choicer, I feel that the Cardinal concerned is ignoring the newer holistic approach to healthcare - that is, the biological, psychosocial and social factors that blend to create a healthy individual.

World Cup Injuries

Watching the England match as part of the World Cup last night, I watched with concern as Michael Owen injured his knee in the first few minutes of the game. The pain and shock was clearly evident on his face during the many replays.

It turns out that he has ruptured his anterior cruciate ligament, which connects the front part of the upper tibia to the back part of the bottom of the femur.

His teammate Wayne Rooney recently fractured his right fourth metatarsal in the run up to the competition. Read an excellent Medical Student Newspaper article about it.

ICSMart Exhibition

ICSMart Summer Exhibition

An exhibition of artwork by medical students at Imperial College, London.

"Flair, creativity, inspiration and interpretation...
These are words commonly used to describe both art and science. Herein lies the aim of ICSMART - to bring the two worlds of art and science together."

21st & 22nd June 2006, 8am-8pm
Charing Cross Hospital, Reynolds Building, rooms R2 and R3 (first floor).
Admission free!

The Life of the Corpse

AJ's post below ,and his mention of autopsy and identity, prompted thoughts of what happens to our bodies after we die. Artist Teresa Margolles deals with just such issues in her work in and around the morgues of Mexico City. As the title suggests, Lavado del cuerpo (above) shows a cadavre on a slab being washed. Margolles trained and worked as a forensic technician in a Mexico City morgue before becoming an artists concerned with the "life of the corpse". The poverty and deprivation of life in the City are reflected in the corpses which turn up in the morgue. The victims of volence, drug abuse and the many anonymous dead arrive daily. Margolles' work forcibly removes the distance we would normally place between ourselves and the dead. By eliding life and death, by placing us in the presence of death, she gives new identity to these people. The anonymous cadavre on the slab becomes the subject of her art and we are forced to conside the person beneath the skin. One particularly transgressive example of this in Margolles' work is found in Entierro. The minimal aesthetic of the concrete block in the gallery belies what it contains. What it contains, in fact, is the miscarried foetus of a woman who could not afford to have the child buried. Margolles, it might be said, immortalised the child, placing it at the centre of this work and the centre of our consciousness. Margolles describes her work: "Since the start of my career early in the 90s, I have been working on an aesthetic approach less about death than about corpses in their various phases and their socio-cultural implications. I work on lifeless bodies, with what is decaying, and always start with the question: "How much does a corpse experience?""Her vapourization perfomances (using water which has been used to wash corpses) are particularly chilling. You can read about them here.

Stethoscope

I was browsing the net and came across this rather nice picture of a stethoscope. I like the way it appears to be disintegrating, yet is laid upon a stainless steel slab, almost like part of an autopsy or crime scene.

For me it represents the death of a doctor, with a loss of identity, as well as symbolising the shortcomings of clinical judgement, in cases of misdiagnosis.

Donating for Davis; Korn frontman does ITP awareness

June is never a good month for me. Every announcement of exam timetabling has me wanting to kick the UMO after yet another clash with the Download Festival!

Whilst this year's Download was no less spectacular than that of previous years; (Alice In Chains provided an exceptional set) it wasn't quite the same for Bakersfield's finest. The mighty Korn found themselves performing with a series of equally-competent stand-in vocalists due to Jonathan Davis' exhaustion; reason unknown.

In a non-stereotypical turn of events, the reason for his absence turned out to be 'Immune Thrombocytopenic Purpura', an ailment Davis has endeavoured to explain to followers on the band's official website.

Here's to hoping that the awareness Davis brings will translate into an increase in platelet donations; the National Blood Service has reported an annual 17% shrinkage in UK whole blood and component donations over the years. With demand quickly outstripping supply, there's no time like the present to get that all-important annual act of altruism in. Don't just stand there. Donate to be different.

Art Asthma?

Talk about avoidance strategies. I should be finishing my chapter and here I am blogging. This review of Sharon Ellis' exhibition in LA describes her work as 'art asthma'. The remark, of course, is not to be taken literally. Yet, as a non-medic, even I can see similarities between the whispy, breathless shapes in the image above and an image of the airways of the human lungs. Art asthma, maybe, but a breath of fresh air to the imagination.

In the House of My Father

This is Donald Rodney's piece of 1996-7 called In the House of My Father (left). The small sculpture he holds in his hand is made from sections of his own skin which were removed when he was having treatment for sickle cell anemia. Dealing with issues of identity, family and home, Rodney used the small house to symbolize fragility and futility. He died in 1998. You can read more about him and his work here.

Mom's Cancer by Brian Fies

A new book took up residence in my medical humanities personal minilibrary this week: Mom’s Cancer by Brian Fies. This is no ordinary pathography. It is a series of beautifully drawn, witty and poignant cartoons that tell the story, not only of Fies’s mom’s cancer, but also the effects that her illness has on him and his sisters. Mom’s Cancer started as a web comic in 2004 and it quickly garnered plaudits, winning the Eisner Award for Best Digital Comic in July 2005. Mom's Cancer navigated its way through in-boxes and weblinks, not unlike an immortal cell line circulates around research laboratories. The intention in publishing it now as a book, according to the editor Charles Kochman, is to guarantee it a permanence that it might otherwise not had had if it remained solely in cyberspace. It’s well worth it. The volume is exquisitely produced with a cloth binding, tactile cover, and colour printing throughout on high-grade paper, in spite of most of the graphics being grayscale. In a nice touch, flashbacks are in sepia and there are the occasional forays into full colour. The production does justice to the quality of the content.

Fies is an outstanding artist and writer, but what makes the narrative so effective is Fies’s ability to conceptualise aspects of his topic in thought-provoking, allegorical visual vignettes. For example, Mom’s symptoms are shown in a visual parody of the game ‘Operation'. In Fies’s version it is called ‘Inoperable’. A particularly telling series of images show how people get ‘superpowers’ when they face an emergency: they become more of what they already are, with extra abilities to wound family members all trying to act in Mom’s best interests.

The book’s ‘emblem’ that patterns its endcovers is a chess pawn and a die. What could be more appropriate for a disease in which both strategy and chance play such important roles in the success or failure of treatment? The pawn is particularly apt, given the bewildering array of decisions, counter-decisions, advice and commands through which Mom’s family must try to guide her.

Mom’s Cancer is an inspirational work of great love and care. In spite of its serious subject matter, this is not a pathos-saturated book. Fies’s ability to universalise his particular and personal situation affords an authentic, original insight into the realities of coping with serious illness. You can read more about the book here, Brian Fies's blog is here, and Kid Sis's blog is here.

Tax the Fat

Last week saw the broadcasting of a controversial documentary "Tax the Fat" by Giles Coren. Giles went on a quest to seek opinions on whether fat people should be taxed in order to save the NHS £1 billion; money which is spent on obesity-related diseases every year. Two out of three adults in the UK are overweight or obese at the moment. Considering predictions of an exponential increase in average weight, he proposes that people with a Body Mass Index above 30 should be forced to pay higher taxes, thus shifting the burden away from those living a healthier lifestyle.

While the documentary was certainly thought-provoking and generated some good arguments (should overweight air commuters pay "excess baggage" fines?), I found the style of the commentary to be somewhat prejudiced and unnecessarily harsh at times.

Interestingly, Giles is a food critic and columnist for The Times and GQ magazine.

Below is a snippet from the documentary.



Did anyone else watch this documentary? What are your views?

Ward Round

They lurch by,
Sulking faces peering in;
Threats uttered
Circumstantial, meandering the corridor.

He trudges in,
Dirty feet scuffing the linoleum
With filthy clothes
He faces us, staring: a king amongst mortals -
A crown of matted locks.

He speaks, of
Rights, wrongs
Ranting, raging
Raised voices

Silence

Explanations, medications
Benefits, side effects
Injection, Section
‘See you next week’.

Endless T.V.
Bouncing ping-pong balls
Cigarettes
Art therapy

Alex J Hamilton

Anatomy Acts Exhibition

Currently showing in Edinburgh is a collection of Scottish anatomy models, collected from medical schools and museums.

View the programme here.

13th May - 9th July 2006
Edinburgh City Art Centre, admission free

GP's Surgeries: A 5-Star Service?

This BBC News article from yesterday reports a new scheme to grade GP surgeries, via assessment from doctors, nurses and patients, according to criteria such as opening times and provision of additional services. The Royal College of General Practioners feel this system will improve patient reassurance in the healthcare they are receiving.

It is based on a pre-existing scheme, which would bring General Practice more into line with hospital grading. It would be a similar 1-3 star scheme, assessed every three years, and voluntary. The scheme may come into effect next April.

With recent press regarding pay rises for GPs, some feel this kind of regulation justifies the salary increments. Personally, I feel that as a society, we often forget how lucky we are to be able to turn up ill, and to be able to receive free, outstanding quality treatment. I'm all for greater patient involvement and better regulation of services (after all, its people's lives we are dealing with), but there comes a point where we become too consumer-orientated. This is all very well in an american-style system of private healthcare, but under the NHS patients perhaps ought to make some allowances for the drawbacks of such a system.

What do others think? Would the GP grading system tempt you to think about changing doctors? Is three years too long for GPs who get 'blacklisted' to be re-evaluated?

Sing for Joy Benefit

My aunt sings in a community choir for people with Parkinson's disease (as well as other conditions) and their carers, called 'Sing for Joy'. They have a benefit to raise money to keep themselves going for another year:

Saturday 8 July, 7.30pm to 11.30pm
at the TUC’s Congress Centre, Great Russell Street, London WC1

Nearest tube: Tottenham Court Road (Northern and Central lines)
Tickets: £15 or £8 concessions (NUS and claimants)

Meze food included, pay bar and raffle – full disabled access.
(There is also a screen in a side room showing the relevent World Cup match!)

Self Medication

Nice little piece over at pickledpolitics regarding the new trend of self medication, (promoting better patient choice?) especially with regards to Ritalin, the trade name for methylphenidate, used to control children with the behavioural problem Attention Deficit Hyperactivity Disorder. Ritalin is similar to amphetamines and thus has been abused by adults to enhance their productivity, especially among students.

More to follow on this when I remember a word I am looking for. This is what revision does to your brain...

*** Update *** 12 June 2006, 21:05pm

I finally found the word. Brought up by a colleague when discussing Paediatrics, she referred to Epicureanism, the philosophical practice: (from Wikipedia)

"Epicurus believed that the greatest good was to seek modest pleasures in order to attain a state of tranquility and freedom from fear (ataraxia) as well as absence of bodily pain (aponia) through knowledge of the workings of the world and the limits of our desires."

This is a concept commonly seen in Psychiatry, where Schizophrenic patients may turn to drink or drugs to escape the strange sensations they encounter. We originally discussed it in reference to adolescents with Cystic Fibrosis becoming non-compliant with their medications, exploring alternatives.

Morale Misery

A friend currently undertaking Medical Finals has just received a letter informing her that her bankrupt NHS Trust can only afford to pay her Band 1a for her Foundation 1 post, beginning in August.

Band 1a is to the tune of £21,000. This is roughly equivalent to the amount of debt a typical medical student might accumulate during their training. With the implementation of tuition fees, the abolition of grants, fewer jobs for junior doctors, a new and flawed application scheme and six years of training, its a small wonder that anybody applies to medical school at all.

On the other hand, this Times Money article features a friend - in a similar F1 post - whose NHS Trust can afford to pay her £29,000; eight thousand pounds more. [The Trust is on the outskirts of London - and thus less desireable to some].

The inequality amongst house jobs is quite staggering, and with the new Multi-Deanery Application Process proving a lottery for jobs, morale is low amongst students.

This is hardly the type of letter I'd want to receive during the biggest exams of any medical student's life. The Government need to think strongly about how their decisions are affecting our lives, or we might see some worrying trends in the future.

Kiss Kiss

Last night the Purple Coat Club discussed 'Kiss Kiss' by Roald Dahl. This is a delightful book of short stories, each with a delicious twist. Those familiar with Dahl's children's stories will recognise the dark humour which is characteristic of his writing, plenty of which is in evidence in 'Kiss Kiss'. Our favourites turned out, probably unsurprisingly, to be the ones with medical overtones: 'William and Mary' in which the brain and an eye of the controlling William are preserved after his death. His wife exacts sweet revenge by taking up all the habits he forbade while alive, flaunting her smoking while Williams seethes passively, the pupil of his eye contracting into a 'minute black pinpoint of absolute fury'. Another favourite was 'Royal Jelly' where a bee expert feeds his baby daughter royal jelly with dramatic results.

We were impressed with the level of research that had gone into making the stories accurate: 'William and Mary' demonstrated a knowledge of anatomy, 'Parson's Pleasure' of antiques, and 'Royal Jelly' of apiculture. Many of the stories satarise marriage. Dahl's life involved no small measure of medical tragedy. One of his daughters died of encephalitis aged 7 and his son suffered from hydrocephaly. His wife, actress Patricia Neal, had a series of strokes while pregnant through which Dahl nursed her, only for the marriage to crumble when she discovered he was having an affair with her best friend. More information on Dahl's life here.

A museum devoted to Roald Dahl opened last year in village of Great Missenden in Buckinghamshire. It is packed with interactives, and the 'story centre' will fire imaginations of everyone interested in reading and writing. My favourite exhibit was a crocodile posing as a bench (ala 'The Enormous Crocodile'). Dahl was also an accomplished photographer. Some of his photos from his time in the RAF are also on display. If you're a fan, you might want to visit the Roald Dahl official website which is rather innovative.

Blogging and Coma Mix-up

This terribly sad BBC news report documents how a family cared for their car-crash victim daughter for weeks, only to realise her identity had been mistaken as she emerged from her coma.

The casualty was in fact the daughter's college friend, meaning the daughter had in fact died in the crash and been buried by the other girl's family. The two girls look remarkably similar (see pictures on the original story link) and the coma victim was reported to have facial lacerations as well as wearing a neck-brace.

The family documented their experiences by web-log which can be found here. There is no explanation provided by the hospital other than the victim being wrongly identified.

[Thanks to Farrah for the links.]

MurderBall - Review

Murderball is a docu-film, charting the rise and rise of Wheelchair Rugby, a Paralympic sport. The documentary follows the US and Canadian teams in their fierce fight for the coveted gold medal at the 2004 Games in Athens.

Several dominant personalities carry the film through: Joe Soares is a former US team superstar and present Canadian team coach; his passion for the game is almost overwhelming. The film explores a little of the relationship with his son, (who is portrayed as a bespectacled overweight drip) and his emotional coldness towards his own flesh and blood that he cannot seem to relate to.

Mark Zupan is the young face of the team, promoting Wheelchair Rugby both to newly-injured young men and at press conferences alike. His charisma noticeably affects those around him, especially one young man in particular, who injured his back in a motorcycle accident - we can see the boyish delight in his eyes as Zupan permits him to have a test-drive of his customised titanium wheelchair.

The film examines the player's approach to their injury, and the opinions held between those who were abruptly injured in the course of their everyday lives, and those who were born with quadriplegia. It also examines blame and responsibility, talking to the driver in an accident that paralysed another of the players.

In short, we learn that these men are no different to any other; they have the same desires and needs, which in many cases are fulfilled in their entirety by the sport. It provides a macho, masculine persona. It is a form of exercise, that especially strengthens the upper body. It allows for a 'boy-racer' mentality with the customisation of wheelchairs. It also provides female interest - those featured in the film seem fascinated by the players - yet also an intrinsic support network for individuals in similar situations.

This film deals with highly charged emotion, both a sense of loss and despair, as well as passion, commitment and unity. It changed my preconceptions about spinal injuries, and gave me insight into networks available for people with life-changing injury or illness. Thoroughly recommended.