DOCTORS MAKE DRAMA

Working surgeons and clinical researchers under Sir Ara Darzi have been working with a theatre company to create a unique three-week event in London Bridge comprising new plays and debates for Spring 2007. Prof. Nadey Hakim, transplant surgeon extraordinaire, is also involved. More news to follow once details are confirmed ...

Nick Silver Can't Sleep

Although not without interest, I found this Radio 3 play on insomnia oddly soporific! Janice Kerbel's Nick Silver Can't Sleep is part of Artangel's Nights of London series of artist-led projects exploring the city with people who wake, work or watch over it. Kerbel developed her project in conversation with insomniacs, sleep scientists and botanists. Listen again here after 4th November.

Metamorphosis

Franz Kafka's modern classic Metamorphosis is showing at the Lyric theatre in Hammersmith until Sat 28th October.

The bizarre tale of a man who wakes up to find himself turned into a giant spider and his family's response to this comes alive beautifully on stage. Set to an original, haunting soundtrack, the 2 storey stage allows the audience to simultaneously experience the changing reactions of the family from fear and disbelief to transient kindness followed by negligence and downright ruthlessness , alongside the increasing isolation and suffering of the transformed man.

I was struck by the parallel situation of various people with chronic diseases such as cancers but also mental illness, which is heavily stigmatised because it is so poorly understood from both the clinical and public perspectives. I found the sense of betrayal by the sister was particularly poignant, in contrast to the denial and indifference exhibited by his parents.

With the exception of a few humourous interludes (I think designed to take the edge off the raw emotions felt by the audience), the play stays faithful to the story. Incredibly powerful - well worth seeing.

Review: 'The Blackwater Lightship' by Colm Toibin

It’s the early 1990s in Ireland and a young man, Declan, is in the final stages of AIDS. He has hidden his homosexuality and his illness from his family until now. His sister Helen, through whose eyes the story is told, his hard-bitten mother and his proud and obstinate grandmother will all react in different ways. Helen has never forgiven her mother for her utterly inept handling of their father’s death from cancer twenty years before, which left her feeling unloved and emotionally isolated. Now Declan wants to spend a few days in his grandmother’s house on a crumbling cliff in Cush and the family is reluctantly forced together to support him. His friends Paul and Larry are mercifully competent at dealing with the physical exigencies of illness and prepared to put up with the family’s hostility.

Colm Toibin’s writing style is deft and engaging. One cannot help but hear the Irish accent in his dialogue. ‘Oh look who it is now, look at her, look at her hair!’ shouts Granny at a panelist on the The Late Late Show. There are plenty of humorous interludes to lighten what would otherwise be a rather solemn narrative.

The decommissioned Blackwater Lightship of the title is a metaphor for the unfathomable loss of something expected to be consistently dependable – like the love of a mother or daughter.

The doctor, although she doesn't feature prominently in the story, comes off refreshingly well in this account. She is a consultant known to her patients as ‘Louise’. She’s given out her home number and is caring, worried and engaged in spite of the inevitability of Declan’s condition. Declan's friend Paul was medically literate in a way that seemed a credible and respectful reflection of the knowledge carers acquire through proximity and experience with chronic illness.

I didn’t know that this novel included an illness narrative when I plucked it off the shelf. I can recommend it as a lyrical account of family relationships in times of crisis.

'A Pervert's Guide to Cinema'

Behind the rather ambiguous title, A Pervert's Guide to Cinema is a brilliant documentary film about cinema and the psyche. The endearing and engaging Slavoj Zizek, Slovenian psychoanalyst and philosopher, takes us on a magical demystifying tour of how films play on notions of fantasy and reality. Zizek uses psychoanalytic concepts, but explains so clearly with apt clips from a range of films, that no one should be deterred by the theory.

The film, which I should warn you is long, is divided into three parts. Part 1 deals with the workings of the unconscious in movies. It maps the way film uses Freudian concepts to confront anxiety, and of this Hitchcock is exemplary. Part 2 looks at desire: this part is particularly persuasive about how fantasy is used to escape reality but when fantasies become real they are even more nightmarish than reality. He draws on Solaris, The Piano Teacher and David Lynch's movies to demonstrate. Part 3 is about illusion. We know film is an illusion but why do we still find it so convincing? Zizek shows how even when we know what will happen, we still are drawn in by the subjective experience of spectatorship.

What makes this film so much more than a lecture, is that Zizek travels to locations and interperlates himself into the sets of the movies he discusses. Zizek's style is witty and frank, and his emotional intesity on screen makes him as good a performer as any RADA-schooled actor. Probably predictably, he draws mainly from the horror genre which lend themselves most readily to Freudian/Lacanian concepts of subjecthood, but the array of films referred to is wide: The Matrix, Eyes Wide Shut, Blue Velvet, The Tramp, to name but a few

Fascinating, enlightening and enjoyable -- everyone interested in film and representation should see this movie. I recommend seeing it in the cinema as the clips have much more presence than on TV. But if you can't make it to the ICA before 2 November and you're interested in the ideas, an edited transcription is here.

StudentBMJ is well worth a look

Regular contributors AJ and Taz have an article called 'The Detox Diaries' in this month's StudentBMJ. It's about their experiences of trying a detox diet, and is informative and funny. AJ and Taz are both away on placement at the moment, but have promised to blog their experiences when they are back in Blogger contact.

In the same issue is an article by James Thomas from Leeds on the value of creative writing and poetry to medical education. Hear, hear!

Test Site 2006

Not so much a coathanger round an old sock as a rat down a drainpipe! Sorry, I know it's not exactly relevant to medical humanities but Tz's last post and The Guardian's piece on this new work in the Tate Modern's Turbine Hall just seemed to coincide - serendipity or what? It's Test Site, Carsten Holler's latest at Tate Modern. Apparently you reach speeds of 30mph as you descend. God only knows what that does to you. I feel a PCC outing coming on!

A coat-hanger round an old sock

It occurs to me that I haven’t blogged much on the actual subject of colonoscopy – it is my sole paid occupation of the moment. It is probably, to most people, a distasteful subject. Those who have some inkling of what it consists of usually assume a gas mask would be necessary, along with some borderline crazed personality fixated on faeces. A faecophile-dominated profession. In fact the bowel is pink and clean if you have a patient who can read the information leaflet (despite the multi-ethnic population of our city, our hospital sends them out only in English, on the understanding that “there’s usually someone who can translate in the family”), and has not been forced to take the bowel preparation as an inpatient where they forget to give it you, then feed twice the dose to you four hours before, having not allowed you to drink or eat for 12 hours. Of course this inhumane experience for the patient is also a disaster from our end: a dehydrated patient with a poo-filled gut leads to some very exasperated operators of the flexible friend, and doesn’t often get us any further with a diagnosis. The main point of it all, after all.

I am inspired to write because for the last two hours in between breastfeeding my teething baby back to sleep, I’ve been filling in the details of my colonoscopies of the last few months on an Excel spreadsheet. Mind-numbing, hence the break. However, it has set me thinking. I had a break from even this for a year to have my baby. At present I am entering the data from before I left to have her. My success rate is quantifiable - and I have just, after 3 months, made it back to pre-baby levels.
The colon is a long loopy thing. Passing this bendy tube round it is just difficult enough to be a challenge (luckily for the patient, or not, depending on your view). It is akin to trying to pass a coat hanger through a very long sock with your eyes shut. And, like surgery, you don’t mind doing the same thing again and again if it is complex enough, as there is a satisfaction to doing this well, and a motivation to keep improving and making it more efficient, or more elegant. I remember timing my appendectomies until I had done one in 25 minutes from first incision to finishing sewing up. After that, I felt cutting the time down further would be a triumph of bravado over safety so I stopped timing. The next challenge came with perfecting the size of the incision, and then with training others. I have spoken to some old greybeards who say that it all palls in the end. And all you are left with is the money. But that would be cynical.

The process of learning is predictable. There are known, anatomical bends in this thing and they are like markers of your learning curve. First, get out of the rectum my dear. This is particularly hard in women who’ve had a hysterectomy (so they say... this may just be the kind of surgical folklore which is brought in to buttress up one’s ego after failing at something). Indeed, one of my first bosses used to give me 3 minutes (the time he could, bravado all the way, make it all the way round in) at the beginning of each colon. I spent 3 months up the recta of half the population of that small seaside town before I ever made it out of a rectum... And so it goes on. Splenic flexure, hepatic, and that final hurdle, the ileocaecal valve. Despite being at separate ends of the scope, with very different opinions as to whether it should be advancing or withdrawing, you and the patient jointly cheer when it gets to the end – the delightful sight of the only recognizable bit of bowel drawing into view like a long-awaited harbour: the caecum. I even don’t mind a bit of the brown stuff here (very un poo-like and liquid. The scope ensures there is very little smell, and when you turn the hepatic corner into the last lap, often with difficulty and a sense of triumph, the poo has also, you note, been struggling to make it round the corner. Its lakes are a welcome sight of homecoming.)

Perhaps I haven’t mentioned colonoscopy because its outer reaches (inner reaches) are not for the faint-hearted. Indeed, they might make you think I was weird.. Well, I am glad to say that for once I was joined the whole trip round by a patient who was just as weird the other day. He’d had some of the usual jollop which I often suspect is over-dosed in order to render the patient a proper, asleep well-behaved patient who doesn't interrupt. Only, occasionally it has the paradoxical effect of inducing intense garrulousness. One of the recognised jobs of the endoscopy nurse is to take over talking to the talkative patient so that you can get on with the test. Serious. This patient, however was different. He was interesting. At least, many may be interesting only one doesn’t have time for small talk when one is wrestling with the splenic flexure. But he was interested in what he was seeing. So are many patients of the well-informed, not hung-up variety. But this bloke was just free-forming. Never has the inner landscape been so variously described and discussed. It was an alien territory. It was – as I explained, commonly referred to by us as looking like a Toblerone – the transverse colon. He was ecstatic over that idea and all forms of chocolate were dredged up and became parts of the colon: the Roses green triangle, Curly-Wurly, the inside of an easter egg... We passed the liver - give us a wave! And detected all his recent abuses of that organ. We were underwater, pot-holing, finding caves over little pink crests of bowel. Like the inside of an accordian. We were – somewhat like the part of the Tracey Emin film “Top Spot” where a girl is lost in endless tunnels with a carnivorous predator spotted padding forward – we were in tunnels. Trains, buses (the bendy buses of course). He wanted to know what everything was, every little ridge and vessel and streak of tomato. I’d found a fellow enthusiast. We could have been a team. Only his colonoscopy – thankfully one twinge only at the splenic – was normal. He had no indication for one again in the forseeable future. Sigh. A perfect partnership briefly twinkled, and was gone.

Inside Mental Health

This week sees an Inside Out London special to commemorate Mental Health Week. It promises to explore the lives of the mentally ill and investigate cutbacks in the mental health system. Sarah Tonin (pictured above), is just one of the cases examined. Sarah courageously admits that "the world has always been a scary place". She has been battling with mental illness for 38 years experiencing a range of different psychosis from agoraphobia to hallucinations. You can read more about Sarah and others here. The half-hour program will screened on BBC1 this evening at 7:30pm.

Tracey Emin subjected to our gaze

Last night the Medical Humanities Society/Purple Coat Club took a look at the work of Tracey Emin. Beth, who is interested in art and psychoanalysis, gave us an introduction to Emin by way of Jacques Lacan's concept of 'the gaze'. Beth showed us how Emin's work positions the viewer, particularly in the work 'The Last Thing I Said to You Was Don't Leave Me Here', where the gaze is returned, not only visually, but also by invoking other senses such as smell, taste and touch. The picture can be viewed in a double frame of reference, as a vulnerable girl who has been the victim of abuse, but also with the connotations of Tracey Emin, the provocative artist, whose work seems somehow 'stuck' in her adolescent experiences. Using very traditional iconography in a self-reflexive fashion, Emin denies any voyeuristic look by invoking the other senses. The vulnerable child, for example, returns the smell of fear, and denies any caress however tender. The articulate artist, however, screams out loud and the sweet smell of freedom to voice her position fills the air.

We watched Emin's film, 'Top Spot'. It is an intriguing work which combines a variety of representational approaches. It features a group schoolgirls, first shown being interrogated (by Emin, off-camera) about sexual experiences. Although the girls look 'innocent', many have traumatic or shocking stories to tell. There are no male characters -- these are alluded to rather than realised -- although phallic symbolism abounds. Bleak scenes of the Margate beachfront are interpolated with scenes of Egypt where one of the girls apparently goes to try and track down her lover (although it is never clear whether this is a fantasy or not). The film has an unsettling climax which, like some of the preceding scenes, is shrouded in ambiguity.

The discussion after the film involved a lively discussion on role of autobiography in art, and what came across as convincing or contrived in the narrative. The sexualisation of the girls, portrayed as normative, was perhaps the most striking theme. Although the film was undoubtedly shocking, there was a sense of detachment because the viewer is never really drawn in sufficiently to identify with any of the characters. The camera technique never adopts any of the girls' point of view so the viewer is permanently in the uncomfortable role of voyeur.

Views on Emin's work in general were divided: some expressed grudging admiration for her ability to be so successful in spite of what might be perceived as a dearth of conventional artistic talent, others were infuriated by her inability to 'move on' from evoking her teenage experiences in her art. Is she brave to expose her life to public gaze -- the details of which many people find distasteful?

Emin's work does offer an insight into a particular slice of British life that is depressingly accepting of exploitation as unexceptional. The medical system doesn't even begin to engage with teenagers who seem to consider it unthinkable to submit to any kind of supervision. As Anna pointed out, the film and the issues it raises could help doctors not be complacent about the backgrounds of some adolescents. Ellen highlighted the awkward position of the teenager in the medical system: suitable neither for the adult ward nor the paediatric setting.

Thanks very much to Beth for giving us a theoretical framework with which to think about the positioning of the gaze in art in general and Emin's work in particular.

Manic Depression

As someone with a close relative who suffers from the condition, I was interested to hear Radio 4's Case Notes present a program on manic depression recently. The program gave some insight into treatment regimes, lifestyles and therapies which might help in managing the highs and the lows. I began to appreciate how the cocktail of mood-stabilizers, anti-depressants, sleeping tablets and anti-psychotics might help, if the sufferer remembers, or chooses, to take them as prescribed. Sufferers shared their experiences and talked candidly of what the episodes of mania and depression felt like for them. Mood stabilizers do what they say, that is smooth out the highs and lows. A sufferer I know personally told me once that the medication just makes her more acceptable to society at large. It numbs her and life is difficult - she misses the manic episodes when she felt on top of the world. You can listen to the Radio 4 take on things again here.

Exciting new blog on the scene

Daniel Goldberg from the University of Texas has started a new Stateside Medical Humanities blog. It's impressively scholarly with a range of useful resources in the sidebar. Take a look and be awed. It will include abstracts from the important medical humanities journals and has links to medical humanities programs at various academic institutions. Goldberg is also developing a lexicon which will be a useful touchstone for terminology. The blog is an important contribution to raising the profile of the discipline and deserves our support and participation.

Top Spot

At the next meeting of the Purple Coat Club I will have the pleasure of introducing the work of Tracey Emin. Emin isn't part of my research but just one of those artists whose work never fails to engage my interest. Emin came up recently on this blog in a discussion around abortion. It struck me then that while her work does not portray medicine as such, it certainly engages with some themes and issues of interest. Abortion, rape, abuse, to name but an unpleasant few. Many have accused Emin of a kind of narcissistic self-interest in her work which goes no further than that. I've never taken that view myself for I believe she has much more to say. Anyway, on Thursday 5th October I will briefly introduce her work then show her film Top Spot which recently came out on DVD. Love her or hate her, everyone has a view on Emin, so I am looking forward to a live discussion after the viewing. See you there.