Sunday, December 31, 2006

'Trading Places' and 'Yes, I'm Asian'

Congratulations to Sonia Wolf and Robin Som for their articles in this month's studentBMJ.

Sonia's piece concerns her transition from medical student to patient and back again when she discovered a malignant melanoma.

Robin's piece examines Asian parental attitudes towards their children's career choice, and the impact on the way those children are later perceived.

Both make for interesting reading and have already received responses through the website's online comment system. Well done!

Thursday, December 28, 2006

A Million Little Pieces - Review

This dark and honest account of a young man’s attempt to escape the clutches of drug and alcohol addiction is an unforgettable book.
James Frey is twenty-three, and has been addicted to most substances since the age of eight, with barely a few days of sobriety in fifteen years. Coming-to on a plane with no front teeth, a hole in his cheek and a staggering hangover, James’ long suffering parents check him into a famous rehabilitation centre for what is, to all intents and purposes, his last chance.
The breathless style conveys the sheer mind-boggling emergence through detoxification, with the dream-like hallucinating and internal subconscious priorities manifested. The lack of punctuation, far from making the prose a difficult read, actually gives the idea of a flurry of ideas, the repetitive, consistent desires.
‘A Million Little Pieces’ is no sob story. Frey’s genuine beliefs and initial lack of remorse keep the reader open-minded, and so the pages turn, James becomes an intriguing character that we find ourselves hoping will succeed. His rehabilitation is a rocky road, and the hierarchy within his unit is somewhat similar to a prison.
But James is an unconventional character who maintains his own beliefs, rejecting the conventional Alcoholics Anonymous and the Twelve Steps. Despite the pessimism of the staff, James’ own way ultimately proves the right path for him – his philosophy is simply to decide to stop, not replace one addiction with another (meaning religion) – which brings up an interesting theological debate as well as a discussion on the notion of addiction as a disease.
This book examines interesting issues surrounding drug and alcohol addiction, including psychiatric aspects and multi-factorial risk factors for potential addiction.
This is one of the most powerful and compelling books I’ve ever read; the very fact it is a memoir makes it unbelievably astonishing.

Bodies - Review

Bodies is a visceral, gripping book. It is written in a vein similar to Bedside Stories, but without the humour and return to reality between each instalment – we chart the journey of a Houseman from his first day on the ward, and through his junior years.
Ultimately, this book is the tale of the dark side of doctoring: the cock-ups, covers ups, guilt and strain. It is virtually an anonymous account – we never learn the central character’s name, and mostly the other doctors are anonymised; patients are nicknamed. This does give a disturbing edge of reality – how much of it is, or was, real?
Bodies deals with conscience, the hidden curriculum and red tape, and the insider concept of whistle-blowing – exposing another as negligent, and exposing yourself in so doing.
Mercurio writes extremely well – the book is compelling – and despite its gritty negativity, the tangible sensations described mean this book stands alone from its TV serialisation counterpart.
One wonders, having read the book, about Mercurio’s audience – my medical background meant I didn’t have such a need the glossary (that I discovered upon turning the last page), but even this doesn’t fill the void. I came away from Bodies feeling strongly that Mercurio has a message, a clear and pointed message, targeted at those to whom he can make a difference.
‘Bodies’ refers not only to corpses and death, but also human bodies, alive, anatomical beings. It is almost as if one makes the transition from human body to corpse if one were a Houseman in the book – and the the bodily fluids, secretions and disturbances are encountered along the way.
The catalogue of errors that make up the book serve as a warning and a red flag to future medics; they also go some way to provide an explanation to why things do go wrong, and what results if these errors go unheeded.
We achieve resolution in the book, but not necessarily in the way anticipated or desired. Flashes of humanity come and go in the characters, but as readers we maintain our own throughout.

The Time Traveler's Wife - Review

Audrey Niffenegger's book is a tale spanning a few decades, ultimately concerning the love between Henry and Clare, but also examining Henry’s ability to leave one time in his life and appear in another.
Despite lacking plausibility, and owing some plot aspects to convenience, this makes for a good book. The author uses the sense of impending doom or imminent danger to create tension and to keep one turning pages.
The style is detailed, with at times over thorough portrayals of methodology in art for example, which clashes with the sketchy medical explanation for Henry’s ability to time-travel. It is written from the point of view of both Henry and Clare which serves to give balance, as the character of Clare is somewhat pure compared to Henry’s darker features.
As well as having a medical slant, the book also has political sympathies, bringing in themes of family, music, art and research, which may seem ambitious but give a rich sense and blend.
Henry has been able to time-travel since a young age, usually unexpectedly and associated with unpleasant effects such as nausea and vomiting. He first meets future wife Clare when she is a small girl and he is middle aged, but in reality they are much closer in age. They form a strong bond and we learn not only what it is like to time-travel (with its related inconveniences) but also what it is like to live with, love and deal with a partner who vanishes without warning, for an unknown amount of time, who may be in danger.
The book reached an interesting peak for me when Henry and Clare try to have a child. The author has explored potential health consequences of such an affliction – Clare suffers multiple miscarriages as her foetuses time travel outside her womb and are immunologically rejected as they re-enter.
‘The Time Traveller’s Wife’ has a broad appeal and is written in a neutral manner, making it accessible to readers from all backgrounds. One always has the feeling of what is about to happen but nevertheless one continues to read, seemingly making the conclusion all the more satisfying.

The Kite Runner - Review

Khaled Hosseini's 'The Kite Runner' is a beautiful yet tragic account, which brings together themes of kinship, culture, loss and redemption. Set in Kabul, the latterly in Peshwar and America, this is not a medical book, but the subtle references to medical school and the diligently detailed passages set in hospitals or referring to medical conditions make me unsurprised that this book was written by a doctor.
This book chronicles a society in a way crucial to its memory, and its customs, history and characters, and then destructs it through the course of it’s civil war and internal struggles. This has the effect of making those fragments all the more precious, seeing the whole has gone.
'The Kite Runner' is not a happy book, and at times when one feels all is well, heartache is lurking around the corner. Themes of nobility and honour permeate the text giving the book an unpretentious grandness. In a similar vein to the Bookseller of Kabul, the author presents a slice of life in Afghanistan to the western eye; we find familiarity in class divide, religion, war and family. Clearly, we compare these themes to our own experience, which highlights the difference.
We follow Amir, the central character, and his relationship with his father, their servants Ali and Hassan, and his father’s friend Rahim Khan throughout his life, and the secret bond that ties them all together.
‘The Kite Runner’ refers to the Afghani tradition of kite fighting and chasing the fallen kites. This serves as a metaphor: running away, coming back victorious; falls from grace; conflict, struggle, glory, but most of all, the play of children, the wounds of glass, the teamwork required.
This is a deeply moving tale, a sad story, but wonderfully written and told.

The Machinist - Review

This dark film sees Christian Bale in the lead role, playing machine operator Trevor Reznik in an industrial plant.
The opening scene sees Reznik disposing of a corpse and being illuminated in the beam of a flashlight. This sets the scene for Reznik’s odd behaviour during the film and lets us know as the audience that Reznik has or will commit a crime at some stage.

Reznik is thoroughly underweight and his appearance will draw gasps of shock from viewers. He seems to be obsessive – monitoring his falling weight, always going to the airport cafĂ© late at night, and avoiding sleep.

Essentially he has a psychiatric condition somewhere between paranoid schizophrenia, obsessive compulsive disorder, post traumatic stress disorder and reactive depression, and his journey in discovering for himself what is going on, and the tricks his mind plays on him makes both compelling and fascinating viewing.

Suppressed memories contribute pieces towards scenes played in Reznik’s mind which he experiences as reality, the resulting confusion adding layers and tension to the final ‘reveal’.

The film is an interesting example of the ‘split-personality’ of schizophrenia so beloved by modern film-makers. Despite this being an inaccurate interpretation of the condition, it makes for marvellous screenplay.

The dark and foreboding atmosphere and the paranoid edge are useful to consider the feelings of someone suffering from a psychosis and to provide an explanation for some of their actions and behaviour, although it doesn’t do much for the image of mental health.
Bale is brilliant as the tormented Reznik and his devotion to the role is evident.

Tuesday, December 26, 2006

Seasons Greetings!

I'm sure you'd be pleased to know it's not all humdrum in journal-land. The BMJ's Christmas Special has brought up a number of well-worn chestnuts in a timely & humourous fashion.

Who'd have thought Clooney et al would be involved in a serious study, pitting the attractiveness of surgeons versus their physician counterparts? Read the conclusions of the Barcelona-based study group here.

Ditto the oft-trivialised experiences of doctors as patients. A marriage between medics is one phenomenon seen sporadically at the shrink's, but what about the real psychology doctors experienced when letting someone else take control? The responses to 'Doctors as Patients' are certainly interesting to behold & indeed empathise with, in addition to the thoughts of our Kiwi counterparts on how they think their doctors should dress. There's certainly some food for thought, given the ongoing review in proximal climes.

A Merry Xmas and a Happy New Year to you all - let's take a special minute to raise our glasses in thanks to Giskin for yet another successful year!

Keep Blogging!

Thursday, December 14, 2006

Recollections of child birth


The click of the PCA is comforting in itself,
although my head is thick with morphine and
everything is heavy and confused.
They say I should go and see her
and I suppose I should
but ... I am disconnected.
I drag my body from the bed.
The tubes and wires and monitors come too
and they wheel me down to meet her.

He has to tell me which child is ours -
I don’t know her because I wasn’t there.
She is naked and red, her skin transparent,
covered in down and I still feel disconnected.
She is a stranger and I don’t want to hold her,
but I know it’s expected, so I should.
They hand her to me with her wires and her tubes,
lying in a garish WI crochet shawl,

Someone takes a photo and I try to smile.
Everything feels so far away and I am lost.
This is not how it was in the brochure,
no NG tubes and mainlines there.
My head is spinning and I am screaming inside.
They tell me how well we are both doing.
Can’t they see I am dying inside?
It wasn’t meant to be like this at all.

They put her back in the incubator and
I am wheeled back to the quiet terror of ITU.
I can’t see or hear with any clarity.
The lights are low and soft, perhaps to hide the pain.
Although I repeatedly click the PCA
I am still screaming inside, I wasn’t there,
I wasn’t there and I can’t remember her name.
The whole sordid nightmare loops around and plays again

Tuesday, December 05, 2006

addressing the work, life, bedroom imbalance

From writing weekly contributions I have been reduced to monthly and then to bi-monthly blogs and this is only having three kids and working one day a week. This is the nature of the extra work of another child: not quite the total life-changing event that one child was. And yet with one child, and two parents, one of you can have time off; both of you can remain in vague contact with the person they once were, and the persons that person knew. With two children you seem to enter the proper family zone. Like my attempts to give up smoking during which (I had plenty occasions out of the 18 campaigns it took) I noticed the warped pleasure it gave smokers to re-convert an ex-smoker. “Come, die with me...” they seemed to be saying. And, at 3am in an endless night in casualty with an operating list stretching forward all morning ahead to the blinkered afternoon in clinic where you foresaw yourself stumbling over words and staying late to dictate the letters slower and slower like your Duracell batteries finally running down: ‘Come on, come out for a fag’. You grab your moment. Inhale a bit of non-work outside, just out of earshot of the sea, and round the corner from the stars.
Yeah, just like that. Those whose lives are already sold out to children beckon you to join the fold: well, are you going to go on and have another? Are you trying? It never ceases to amaze me how close people can get to asking you about how much sex you are having and thinking about the details of it when they hardly know your name. Something about kids allows an incursion into what was your private life – from the hand on your bump of a stranger on the tube (I’ve had to restrain myself from thumping a few. Restrain, as it wouldn’t look right, from a heavily pregnant woman. Thumping because your instincts are to thwack anyone who so blatantly invades your personal space and is over, say 5 years old) to the sweet ladies in the street who stop you on the pretext of cooing over your baby in order to lecture you on what you should be feeding them and what to dress them in. It is the men who suffer the worst from this. A friend in Boston was accosted by a lady who stopped her car in a blizzard to shout at him for having his baby out (warmly strapped to his front and under his coat) in this weather. Note, she didn’t offer him a lift...

I’m not sure I can blame society and other parents for having three kids in a two bed flat. However problematic this may be, I am seriously starting to worry about going back to working three days a week. It still sounds pretty part time, but there is a huge difference between a sessional job with no responsibility beyond, and being a surgical registrar with responsibility for the firm: on-call patients, the post-op patients, the list, the important ones from clinic, learning and teaching. I know myself now, and I do not have a part-time mentality. Ironic that, when so many full-timers do. I find it impossible to clock off, in fact some of the satisfaction of the job is going home knowing everyone is sorted. And there is the concern about having not operated for what will be three years. The surgical profession rarely has someone back from a maternity leave that has gone on so long, unlike GP or other specialties with women predominating who are having to accomodate real flexible working; however, people do often take out three years to do a PhD/MD (this will soon cease so we are led to believe). Although it is not essential and not monitored, it is assumed that most trainees will have kept their hand in by doing locums during these three years. And then they re-start in the job bang and the system has to cope. My late boss, who’d had some maternity leave herself used to say that the operating comes back easily, like riding a bike. She warned me that it was the judgement that fell behind. At least doing a PhD, you’d come back an expert in a small section of some esoteric bit of molecular stuff that you’d have been to a few conferences to talk about. Your confidence would be high at least on an aspect of the academic side. All I’ll be qualified to talk about is multi-tasking the toddling baby, the new schoolboy’s homework and the older schoolboys nightmares.
At least it is yet a long way off.
I’ll keep the blog posted as the big days near – though even less frequently on the current showing. It’s my last chance to complete my training. I just wonder if I want it any more...