Midsummer's Night Scream

You're unlikely to see a more curious juxtaposition of stilettoes, graffitied rubbish bags and stupendous paper modelling than those currently featuring in the ICSM Drama Society's production of 'My Parents the Eco-Warriors'. The play, by Martin Bailey and Richard Moss, is a loose yet recognisable rewrite of 'Midsummer's Night Dream'. What happens when a pharmaceutical developer turns bad? Why, unregulated clinical trials of love drugs of course! The resulting sexual shenanigans in the forest come as no surprise. Less predictable is the set-piece at the end of the show involving a full-on parody of 'Top Gun'.

The props, many of which were handcrafted, were impressive, if somewhat unevenly distributed amongst the cast. There was a mind-bogglingly well-fitted tool kit for anyone wanting to do a bit of DIY, but poor old Pooja had to mime cleaning the floor!

Delivered by a well-rehearsed and sizeable cast, there were plenty of laughs, particularly for the gender-bending fairies (played by -- I hope I've got this right -- Jamie Willson, Hisham Harb, James Corbert and Naren Govinderajah). Dominic Teichman playing Bottom had a big part (no pun intended!) and was either word perfect or a very good improviser. Ania Barling and Ciara Abbot's 'chavs' were scarily convincing. Ricky Stanton as Swampy was hilarious with his Russell Brand accent and delivery. Taz Rashid as the Bollywood-wannabe Pooja showed real star quality -- watch out Meera Syal. It was obvious that the cast was having a complete blast and the enthusiasm was infectious.

The show runs until Friday 2 March, performances start at 7.30 pm in the Union, Beit Quad, South Kensington campus, Imperial College London. It costs £4 for Imperial students and £6 for other species.

Medical mavericks

A four-part series on BBC4, Medical Mavericks: The History of Self Experimentation, fronted by journalist and former medic Michael Mosley, has been presenting the ‘curious, gruesome and sometimes fatal ways in which scientists have transformed medical knowledge by using themselves as guinea pigs’.

In the best tradition of BBC documentaries, these programmes combine a heady mixture of biography, scientific explanation, medical demonstration, archive footage, location filming, dramatic reconstruction, expert comment, and, of course, self-experimentation.

In the opening programme, which dealt with the discovery of anaesthetics and their introduction into medical practice, Mosley was dosed up with nitrous oxide under medical supervision. He happily administered repeated electrical shocks to his arm while he giggled like a child. No wonder that laughing gas is addictive.

The second episode looked at the development of vaccines and the scientists who literally took their own medicine. Programme three, just broadcast, explored the links between food and health and described the extreme lengths to which pioneers in the field were prepared to go to prove their hypotheses about the role of diet in health and disease.

The series is both interesting and entertaining but suffers from its unhealthy focus on the stories of mavericks who tend to be exotic figures on the edge between madness and genius. The public will not be surprised that medics may be driven to the point of life-threatening arrogance but there are less extraordinary ways of doing good medicine.

The final instalment will cover the intrepid scientific explorers who injected themselves with rather nasty infectious organisms. It will feature Barry Marshall, the Nobel prizewinner who swallowed H. pylori to demonstrate Koch’s postulates in the only way possible without an animal model. I am not so sure that he would like to be in the company of some of the mavericks featured in the series.

An American dentist, Horace Wells, demonstrated the benefit of nitrous oxide by having a tooth removed while under the influence. This historical reference lets me finish with a joke that will prove much more painful. Did you hear about the yogi who had his wisdom teeth extracted without anaesthetic? He wanted to transcend dental medication. Ouch!

Crap on the telly

The New Year’s TV schedules are typically obsessed with obesity and health.

Channel 4’s contribution was a new series of You Are What You Eat, featuring the infamous Gillian McKeith and ominously subtitled Gillian Moves In. The format involved the self-styled holistic nutritionist scouring ‘the fat of the land’ to identify ‘supersize slobs’ with ‘thick hides’ and diets like ‘porky pigs’. She aimed to trap two unwary subjects in her TV home and then subject them to a draconian diet and exercise regime.

In the first programme, Ian and Sharon were confronted with a food-laden table showing the full horror of their weekly intake of salt, saturated fat, and monosodium glutamate. This gave McKeith the opportunity to swipe the stodge petulantly onto the floor and stamp all over it. Following further humiliations, the pair was sent home with ‘recipes, rules and reassurance,’ only to be visited again so that the ‘evil diet witch’ could trash the kids’ crisps as well.

McKeith has been the target of heavy criticism for advocating diets that have little scientific support, but there were only fleeting signs of such barminess here. On the contrary, the little information and advice she offered seemed modest in its claims. And after eight weeks, both inmates had lost two stones in weight. Ian could now play football with his son for more than a minute and Sharon was out shopping for sexy lingerie again.

McKeith is also well known for her obsession with crap. Her goal is the perfect poo: smooth, soft and easy to pass. For aficionados, that’s a type 4 stool – like a sausage or snake – according to the official Bristol Stool Form Chart. True to form, McKeith did not disappoint her fans as she duly inspected the captives’ disappointing and disgusting turds.

Shit was also firmly on the menu in the first of a new series, The Truth about Food, going out on BBC2. The series aimed to reveal the science behind the food we eat and what food does to our bodies. As the first of several well-known personalities slated to present the show, newsreader Fiona Bruce enthusiastically examined different aspects of food with the help of ‘top scientists’ and 'guinea pigs' plucked from a willing public.

Amiable truckers Don and Wolfgang demonstrated the importance of dietary fibre as they drove across Europe. High fibre replaced their conventional fare of greasy-spoon fry-ups and tinned food straight out of the can. The new diet helped the truckers get their transit time – the time food takes to traverse the tunnel between mouth and anus – from one to two days down to about 12 hours, helping to clear potentially cancer-causing toxins from the bowels.

The workings of the gut were further illustrated with the help of the ‘pill cam’, a neat piece of technology in the form of a large pill kitted out with its own lights, camera and video link. Swallow the pill and it goes with the flow, filming the sights on the way and showing us the delights within. There were also some helpful graphics to show the pill passing through the system. It was good science but as Don put it: “I can’t stop the truck every two hours to take a shit.”

The young ranchers working in Colorado, on the other hand, were more than happy to contribute their droppings as often as needed. One group dined on vegetables containing high levels of ‘prebiotic’ nutrients known to stimulate the proliferation of beneficial organisms in the gut. A second group ate ‘probiotic’ yoghurt containing live healthy bugs. Faecal analysis showed that the vegetables were better at increasing the good bacteria over the bad ones. The side effect of eating artichokes, leeks and onions was predictable.

Much farting and latrine humour was also evident among volunteers living in a compound at Paignton Zoo and surviving on 5 kg of raw fruit and vegetables daily, a diet similar to that enjoyed by apes in the wild and by our ancestors millions of years ago. Just 12 days of this unusual torture succeeded in reducing the participants’ cholesterol levels by more than 20%, a good thing given the role of cholesterol in heart disease, and it also reduced weight and blood pressure.

So, at the start of 2007, the couch potato had plenty of opportunity to cosy up in front of the telly - home-delivery pizza, bottle of fizzy rot, and remote control to hand - to ponder our pre-occupation with bodily functions and to imagine how good it would be to escape our modern, unhealthy way of living.

Pilot plays

Yesterday afternoon saw a pilot read-through of two plays: 'The Body Snatcher' adapted from a story by Robert Louis Stevenson, and 'The Gift', a brand new offering from writers Hughes & Toosey who form part of the Metal & Bone theatre company. The venue was highly suitable: the quaint and intimate old operating theatre near Guy's Hospital. The cast is made up of professional actors who gave very strong readings. The plays were followed by a short discussion in which the company rather bravely encouraged suggestions for how to develop the script before the plays are performed in April.

The two pieces worked well as a double-bill. In Stevenson's eerie story, Fettes, a medical student, becomes embroiled in body-snatching for medical research. Things go wrong when his superior involves him to cover up a crime. 'The Gift' highlights the benefits of medical research by focusing on organ donation. A dysfunctional family is reunited under tragic circumstances. Communication is a major theme here, not just between a mother and her son, but also between a medical student and a consultant haunted by a medical accident. The uses of dead bodies and ghosts feature in both plays.

The problem with inviting audience suggestions is that consensus is impossible and predictably the audience disagreed about the merits of the plays. There was a lot of discussion about how male-dominated they were in spite of two very strong female actors in the company. Personally I felt that if the consultant in The Gift was a woman, it would be all too easy to stereotype her as 'flakey' because of upset over an accidental death on the operating table. There was also discussion of whether 'The Gift' was an appropriate title: did it overdo the 'message' aspect of the play? Does it give too much away? However, the quibbles were rather minor and I reckon the plays are headed for success. The whole project looks very promising and I look forward to seeing the finished product. Good luck and well done to Soma and her team at Metal & Bone!

MTAS

I suppose I should write something about the whole MTAS issue, with yours truly shortly about to descend through its birth canal to A Job. But I just don't know what to say. I'm so bored of the moaning and whining about a system that despite being riddled with flaws, is still one we all have to endure.

[For those not in the know, this is the system used to allocate medical school graduates to their first jobs, now known as the Foundation Programme. The system it replaced essentially involved sending a CV, whereas the newer system is a nationwide scheme bringing the UK into line with the European Working Time Directive, which caps the number of hours a junior can work per week. Many trusts have realised that they can save money by having more experienced doctors on call alone, rather than supervising the less experienced House Officers, which neatly cuts down their working hours too. Another major point of the new scheme is that first year doctors can gain all their competencies in one year, rather than two.
The new system is a two stage application process, the first part allocating an applicant to a geographical area, the second to a post within that area.]

I found myself in the 93% of final year medical students who got their first choice - in my case the competitive North West Thames Deanery. Despite having a respectable academic score, my response to the 'interview on paper' questions appeared to let me down - I scored little over half marks in this section, which seems to bear little correlation to the amount of preparation that went into it.

This has ultimately left me in the position of being at least 225th in the queue for jobs, out of a possible 295 jobs available in my deanery (the UK has been carved up into different territories, each with specific trusts and their jobs). Essentially this means I'm unlikely to get one of the coveted 'London' posts (anything within the M25). Fortunately, I'm happy to work elsewhere, and in my view the jobs are all the same anyway (broadly, four months Medicine, four months Surgery, and four months of a Specialty).

Naturally pay, hours and location varies, along with the standard of the Doctor's Mess, as well as hospital accommodation. However, one of the more concerning flaws in this system is the fact that applicants have no idea of who they will work for, what banding their job will be (that is, how much their pay is), nor what hours they will be required to work. Is this not an infringement of basic human rights - the right to freedom of information, especially that pertinent to the daily dealings of one's life?

Considering public misconception of junior doctor's salaries, and the fact that Phlebotomists and check-out girls in Tesco earn more per hour than junior doctors (no joke), I find it perturbing. This country must learn that unless it treats its young medical staff appropriately, the shortfall of Consultants further down the line will be catastrophic. Sure, salaries are cosy enough for GPs, the workhorses of the NHS, but there must be an incentive to train, and the potential to earn more, not less, than the amount of debt medical students graduate with (in my case, currently in excess of twenty thousand pounds).

I don't really know what else to say. Of course I hope to get a post of my choosing, with a decent salary and not to be too badly overworked, but who knows? It's a lottery, and thus one must resign oneself to chance. I'd like to hear lay views on the prospects for medical school graduates - after all, it's our hands you'll be in.

sisterhood of motherhood

The keys are sticky with my daughter’s new-found ability to scale any item of furniture, including the bookcase. Wearing times, punctuated by long lines of meaningless letters kkkkkkkkkkklllllllll. Yet this third and last time round the transition from babyhood to childhood is just as fascinating, and because more familiar, I am observing it more dispassionately.

So, torn about my upcoming return to work. That will be no surprise to anyone with kids who works. I’m only impressed to find that I have subtly let the memory slip in these last few years. I thought at the time that I’d never forget the double-edged guilt of part-time work. And if it was part-time work, what is the rest of it? People would very nicely say, “enjoy your day off” as you finished at the hospital and I’d object to the gap between the concept of a day off the phrase implied, lying towel-headed at some spa sipping a freshly made smoothie, and the reality – battling a clingy baby and a stroppy toddler into a pushchair that falls over backwards when they struggle out it is so piled with shopping and bystanders are just standing at the bus stop pretending not to look. You flush with anger at being so thoroughly the public spectacle of despised over-wrought mother with toddler that allows everyone to comment, yet seemingly removes the ability to help. Not allowed onto buses, tutted at, not allowed into cafes. No pressure group for us – no time. We are all just waiting the day they grow up enough and you can chuck out the pushchair in triumph; or crowding together in poorly-maintained huts to avoid the scathing eye of the public, and chief among them, you, you young perfectly manicured no-kids-yet woman..

“What did you do before... [kids – this word often replaced by an ironic laugh]?” The question happens surprisingly late in an acquaintance between mothers, struck up over chippedmug tea in a council hut as the kids cover the walls and your legs in paint. I have known someone for 6 months before they admit to having been a doctor in the past. When we had an identity of our own, apart from “Josh’s mum”. I of course immediately admitted being a doctor too. Indeed for years I’ve lied. I’d pretend to be a writer or talk vaguely about “work”. The only other times I’ve pretended not to be a doctor are way back, on club dancefloors in the middle of the night when it was less a lie, more not wanting to remember. We keep it under wraps. I do not yet know why. Can it be a sense of having fallen from great heights – such dizzy-sounding pinnacles of success as surgeon, buyer for Harrods, head of an international charity – to the low-status yet commonbonding position of mother? We are all as one, united by toddler tantrums and food objections. There is something in that. I think also that there is a pleasantly social normality to these conversations – akin to dog owners talking on the heath while their dogs bound around their legs. Admitting to having been a doctor – marked as such forever – changes this interaction permanently. It changes differently with different people. Some, you see, immediately compute how useful you might be – for on-the-spot diagnoses, for stories: my friend is a doctor and she says.... For some, it puts you in a social category that especially for some mothers and I’m one, is not obvious from your attire. In fact for everyone, it nails you to a certain position in society, and a type. You are one of the white-coated gang - less heroic more distrusted and surely rich? No longer can be self-determined but in a pre-packaged slot.

Oh well, fewer of these encounters await. I am leaving the sisterhood of motherhood to cross back to that different beast, the Working Mum. I must return to a proper job, not just my lovely (days off) of colonoscopy but the full hurly-burly of patient care. Dread – there may be. I hope not – it is the death-knell of a job. When the dread of Monday creeps so far into your weekend that it infects Saturday morning, that is the time to consider your position. No, on the contrary I am quite excited to be going back. Privileged to be allowed back in and very aware of a responsibility to make it work this time. Hopeful and positive. Hmm. Watch this space.

MMC Allergic Reaction

My Medical Career (MMC)

"Staff," send for a doctor; This patient's ill.
She's 34, 5 days post op and on the pill."
Shrill, indignant, loud the staff nurse spake,
"What's this got to do with me? I'm on break."

"But she's not well," the student nurse insisted,
And with awkward questions ceaselessly persisted.
"She's got a slight temp, and a painful leg,
She's breathing fast, don't make me beg?"

"Where's the F1?" howled nurse frustrated
"He got fed up and emigrated,"
"The F2 is on their way…?"
"No she has three interviews today…"

Then into the fracas the gallant NP weighed;
Overweight and overpaid.
Blonde hair scraped back and face with makeup pallid,
No history needed, an exam not valid.

Legs apart there stood the bimbo,
A troubled frown and arms akimbo.
She took a breath and from her lips did peal
The 64,000 dollar (a year) question – "How does that make you feel?"

The student nurse was now quite worried
And to the desk and phone she hurried
The number dialled a poor choice.
Three rings and then a voice;

"Hello?"

"I think she's shocked," piped our hero.
BP is low and "sats" read zero.
It was the hospital manager who calmly stated –
"It's OK, the machines were never calibrated."

Redialling now in frenzied panic,
Jaw set, expression manic.
Calling on the betrayed, the damned, the low:
She grimly bleeps an SHO.

One she's told has been found hanged:-
The phone in its receiver clanged.
A second joined the milit'ry,
And livid stalks the JDC.

She rings an FTSTA
No hope, no job, no respect, no pay.
"I'd really love to come and meet her,
But I've got this sodding R*TA."

Down the list her finger scans,
And quickly formulates some plans:
"The STs," she beams and quickly dials
And prays that this will end her trials.

'Alas' - through gritted teeth the doctor grated, -
Though advertised the post was not created.
"I swear to all of you this day,
One day I'll get the BMA"

She rings the sub-consultant post,
And in drifts this consultant's ghost.
A swollen calf he quickly spies,
"Sorry I only do the thighs."

He looks into each dismayed eye
The patient gives a strangled cry
This half-wit, half-doc blithely sighed,
"Yes I am that specialised."

"I got this job through filling forms,
I know nought of metabolic norms.
Good in teams, the patient central,
It's not my fault MTAS is mental."

A crazy, desperate, last resort,
She can taste the RCN report,
Half-mad, half-baked, hell-bent;
She rings the 5th year med-student.

Again this poor waif is out of luck,
This med-students a total schmuck.
He has left to perform an ECD,
An Emergency Conversion to Dentistry.

Jon Barlow

Air time

For those of you wondering why the TV listings have disappeared from the sidebar of the blog, I find I just couldn't keep up! It would have been quicker to list programmes that don't have medical content. With the media's ongoing obsession with weight, it was possible last week to channel-hop between a documentary about a treatment centre for anorexic children, obese Brits trying to survive on unappetising bush food in the Kalahari, and the tacky glamour-fest that is 'America's Next Top Model' where most of the girls looked like they ought to be in that anorexia treatment centre. Mesmerising as this all is, I have had to resolve to give up TV or face shelling out exorbitant student fees again next year because I won't have finished my MA.

Some programmes feel just too relevant to miss though, at at least one can type up bibliographies while listening to the radio. There is a wonderful series on the history of modern medicine on Radio 4 at 3.45 pm on Monday afternoons. When it started with a poem on the joys of bloodletting, I knew I was going to like its slant.

I notice a new medical sitcom started on Channel 5 tonight at 6.30. Called 'Out of Practice', it's about a family of doctors. It's on every weekday. Having children to feed precludes watching TV at that hour so I wouldn't be tempted even if I didn't have a dissertation to write, but please do post a review if you do catch the show. Similarly, if anyone has half an hour to spend a week, sifting out the medical shows from the TV schedules, the job of updating the sidebar is up for grabs!

Rankin's Eyescapes

The eye and the iris are the subject of this exhibition at The Gallery, 125 Charing Cross Road, London. "The eye is the first thing that I look at," says Rankin. "I ask subjects to communicate with the camera through their eyes." The project includes extreme close-ups of eyes belonging to the photographer's family, friends and collegues. You can check out Rankin's website and other projects here.

The show runs from 8th February until 3rd March.

Free tickets to readings of plays created with doctors

MAKE HISTORIC DRAMA IN THE THRILLING ATMOSPHERE OF BRITAIN'S OLDEST OPERATING THEATRE!

PILOT READ-THROUGH OF ROBERT LOUIS STEVENSON'S 'THE BODY SNATCHER' AND NEW PLAY 'THE GIFT'.
SUNDAY 18TH FEB AT 4.30PM
THE OLD OPERATING THEATRE (BRITAIN'S OLDEST OPERATING THEATRE)
ST. THOMAS' ST SE1
TRAIN/TUBE: LONDON BRIDGE

FOR FREE TICKETS:
email metalandbone@googlemail.com, marking the subject 'PILOT TICKETS'. State how many sit-down seats you need. This is a preserved 1820s theatre for viewing operations. Some seats are standing/restricted sit-down views. Access is by a steep spiral stair only.

Metal and Bone theatre company have been collaborating with doctors. Come and hear the work-in-progress and give your critique, joining theatre writers, artists, surgeons, and social commentators. Your critique will help the final drafting of the plays for a three-week run in April.

'The Body Snatcher' is an adaptation of Robert Louis Stevenson's story written during Victorian fears about the black market trade in corpses. An ambitious medical student, Fettes, finds his conscience compromised when his anatomy class needs more bodies. 'The Gift' is by new writers Hughes & Toosey. It's 2007. No-one in the hospital wants to face death. An ambitious junior doctor, Krishnan, tries to impress his famous surgeon, about to perform a transplant. Something happens to make the surgeon suddenly feel vulnerable. Can he recover his confidence, and perform the life-saving operation in time?

This will be an exciting event bringing the medical sciences and humanties together in the very spot (almost) where Keats, then training to be a surgeon, was inspired to write two sonnets.