Trigger warning – frank discussions of healthcare some may find upsetting.

‘D’you mind if I grab a blood sample from you?’

‘Ooooh do you have to?’

‘Ideally, yes… you know how it is.’

Like so many other long-term patients, this lady was a bit moody. Living a life that’s completely entangled with and inseparable from the hospital had taken its toll. But whilst I was taking this lady’s blood, she lightened up. I’m not sure if the same thing happens to my male colleagues, but like so many other patients, she started asking me about my life, was I married? Did I have children? Did I live nearby?

‘Not any children, but I’ve got one growing inside me’, I said, gesturing to my abdomen.

Her face broke into a wide smile, ‘That’s made my day that has!’

And with that, we were chatting away – pets and babies galore for about half an hour.

It’s difficult trying to share stories of hospital life, patients and health. I want to stay true to the experience. It’s so important that we share – sometimes I feel like everything that goes on inside the hospital is so separated from normal life. It’s like somebody’s taken an axe down the middle of ‘normal life’ and ‘hospital’. And yet, so many of us will spend our formative experiences in hospitals. Through storytelling and science communication I’d like to be able to open up this terrifying divide, and make hospitals and health seem that little bit less scary.

But the thing is, ultimately so many of the experiences we have are Not Normal, at least this is what a psychologist recently told us in our doctors teaching session. It’s hard to get the balance right, to share without oversharing, to let people know that yes it is difficult and it is sad, without scare-mongering. And for me, some of the saddest and most difficult parts of what happens in hospitals, such as going to ITU, the realities of CPR or what happens when somebody dies – these things should be spoken about and discussed more openly. I hope it would set us all free that bit more of our fear of hospitals and death.

My difficulty is, how do I share stories whilst staying true to the patients? Some of the experiences we share with patients are so difficult, that I feel those moments should stay only ever between the people who experienced them in that room. And even when I change almost all the details of a story so that patient anonymity is completely protected, I’m still sharing something that’s based on somebody’s own intimate and potentially terrible story.

As I navigate through the world of being a scientist, science communicator and doctor, it’s a line that I tread so incredibly carefully, and will continue to do so. I hope to get it right, to share without over-sharing, to explore some of the terrible things that happen in hospitals, but in their context of being a part of life and something we can all hopefully come to embrace with less fear.

Going back to my slightly grumpy lady, I’m sad to say that 24 hours later I would be bent over, plunging the palms of my hands into her ribs. CPR isn’t at all like it is in the movies. I would feel her ribs break under the weight of my compressions. So many people don’t realise this is a normal part of CPR, a terrible injury that we inflict in order to try and save a life. I would see her face turn pale, feel her pulse flutter and finally I would sit with her, hold her hand and let her go peacefully.

The pain of losing her was immense. The pain of having to give her CPR, such a brutal form of medicine, will stay with me forever. I wanted to share this story, not to scare people, not to be sensationalist, but to just open the door slightly into our world. Yes it can be scary, yes it can be raw, but there’s so many human stories, so many kind people and personalities hidden under there if we just open our eyes and let it in.

Because this lady was occasionally grumpy, but lovely, kind, empathetic and very much alive. I just happened to meet her and care for her at the end of her life. Amongst all of the Not Normal, there’s also a hell of a lot of Normal stuff too. I feel honoured both to have shared a happy Normal conversation with this lady, to smiled and laughed with her, and I also feel honoured to have cared for her in her final moments.

*This is a representative story, all details have been changed to maintain patient confidentiality.

I was exhausted. My feet ached as I wildly paced up and down the hospital corridor looking for a free computer to work on. Nope, all busy. Fine, I thought. I’ll do the blood test I need to do. I started riffling through the drawers, looking for needles and vacutainers to take blood. None. Fine, I thought. I’ll search the ward next door.

Several hours later I had worked my way through my list of jobs and has one thing left to do. My shift had ended 30 minutes ago, and yet, I thought, perhaps this was the most important job of all. The funny thing was, this job didn’t require a doctor or a nurse, just a human.

The job concerned a long-term patient, let’s call him Liam. Liam had been in hospital before I’d arrived, and so I’d known him for many weeks. Every day I’d approach his bed with my heart sinking. An NG tube dangling from his nose, his dark brown eyes were fixed on the wall in front of him. His hands were stiffly on the arm of his characterless hospital chair. The four walls around him were his chamber and had been ever since he’d suffered the stroke that brought him to hospital. He didn’t have to tell me just how down he was. It was written all over him.

Strokes are funny things; they can take so much from a person beyond just their ability to move. Already frail before his stroke, Liam was now plunged into a world I couldn’t understand. I had seen him with a speech and language therapist, let’s call her Jane, who was brilliant. Jane explained to me how Liam no longer understood visual stimuli. He could look at a pen and knew to write with it but didn’t know what it was called. Though he could write, he couldn’t read or even recognise his own writing. On top of this, his ability to complete tasks with multiple steps had evaporated. Ever British, one of the hospital tests for this is to make a cup of tea. Although physically able to, Liam couldn’t get through it.

One day, I walked in and Liam looked a little brighter. His NG tube was finally gone and he looked a bit different. As I talked through his progress with him, he fell suddenly silent.

‘I… I should like to see my wife again. Before we both go.’

And with that, my job was to find Liam’s wife – another inpatient – , to track her down, and to take him to her. I found her a 20 minute walk away through the hospital on another ward, hooked up to a drip. She has her own medical demons to fight and didn’t have much longer to live. Neither had seen each other for weeks.

Organising the meet-up was a right faff. Porters, ward-clerks and nurses on both the wards needed to be consulted with. I needed to make sure Liam would be safe all the way to his wife’s ward, whilst there and back. I needed to make sure he didn’t just get stranded in the hospital somewhere. I needed to make sure she actually wanted to see him too. I needed to make sure Liam was safe to sit, that he’d been to the toilet, that he wouldn’t miss his medications or a meal.

It was now an hour and a half past my shift ending, and my partner questioned my motives. ‘This is very valiant of you Charlotte, but there’s a limit. Surely somebody else can do this’ he messaged. But, if not me – then who? Could I stand to go home when this man might never see his wife again? Especially when she was literally in the same building. What if this was their only chance to see each other again? I briefly thought of what I would give to see those who I’ve lost again, even for 5 minutes, just one conversation – what would I give?

With the help of our ward-clerk and a healthcare assistant, we assisted Liam into a wheelchair. We swung out of his, bay, through the manic beeping chaos of the ward, and out onto the cool, quiet stairwell. Into the lift.

I saw Liam gaze at himself in the mirror. I will never forget that gaze – I can’t explain it. A mixture of recognition and hope, but also as though he was perceiving something totally alien. He reached up to his hair and nervously patted it, slightly neater. Rearranged his dressing gown. Straightened his hospital pjamers.

The hospital atrium was large and quiet. Almost like a cathedral at night. I pushed Liam along its length in silence, the wheelchair rattling slightly over the flagstone floor. Up into another lift, and another short walk, and we were there. I spotted Liam’s wife, her eyes shone. She leant forward across her bed to Liam and reached forwards. I wedged Liam’s wheelchair right next to her bed facing her.

And with that, I left. I spoke the nurses, ensured that Liam would be safe on this ward, and that a plan was in place for his care and for his return to the stroke ward.

Such a simple thing to do, such a small task. The truth is everyone in the NHS is desperate to do things like take Liam to his wife. But with so few staff, with so few services, it’s becoming impossible to even take patients to their scans, to take patients to the toilet, to provide basic care needs. The one thing we set out to do – provide care and humanity – is slipping away from us.

Names, places and details were changed to keep anonymity

You might have seen Justin Bieber’s face in the news recently. His little boyish face right there, giant on my TV in a lovely super-up-close shot showing that he had facial paralysis on one side. Ramsay-Hunt Syndrome, they said. Ah yeess. I thought. The classic. Ramsay-Hunt syndrome is one of those things medical school exams love. If Bieber had been in one of our hospitals whilst I was on ENT (ear, nose and throat) then the consultants would’ve for sure sent us his way to get a full history and examine him.

Ramsay-Hunt syndrome happens when your Varicella Zoster virus, the chickenpox virus, reactivates and gives you shingles. Usually shingles aren’t that much of a big deal, apart from being horrifically painful. But when shingles happens in your ear, nasty things happen. The nerve that supplies the ability to move your face runs via the ear. And when this nerve gets inflamed or infected, it can stop working. Hence you stop being able to move your face.

The thing the news consistently failed to mention, is that this is a Herpes virus. Bieber had ear herpes. And this whole thing reminded me of my simmering desire to right a blog about the fact that WE’VE ALL GOT HERPES.

It severely pisses me off when people act all YUCK I DON’T HAVE HERPES, when I’m sorry but you almost certainly have herpes.

It takes me back to my early uni days, where after having a bit of soreness in the vulva I’d gone on an internet searching spree about herpes. I scrubbed up my knowledge, and ever since then I’ve loved learning about herpes viruses. They’re just fascinating, and we’ve all got them.

Anyway, I was trying to explain the fact that we’ve all got herpes to this incredibly posh woman who was in my house. She was more keen on explaining to me in an incredibly patronising way that straightening my hair is ‘bad for it’. Mate, I don’t give a shit, it’s keratin.

She just wouldn’t believe it. She couldn’t. ‘I DON’T THEY’VE TESTED ME FOR EVERYTHING THERE’S NO WAY LITERALLY NO WAY I COULD HAVE IT,’ she bleated. It may have had something to do with the fact I was having this conversation with her in front of somebody I suspect she wanted to mate with. They don’t routinely test for herpes, I said. Unless you’ve got symptoms. Because what’s the point of knowing when everyone has it? If you’ve got sores, they’ll usually give them a swab to see what’s there (via PCR). But the blood test isn’t that useful and doesn’t tell you that the sore you might have is even related to herpes, since you’re so likely to have herpes antibodies in your blood anyway.

The fact is, 90%* of us carry the herpes simplex virus (HSV). This is the virus that causes cold sores and genital herpes. There’re two different types, HSV type 1 is more associated with cold sores, and HSV type 2 is more associated with genital ulcers, but there’s considerable overlap. You can get either virus at either end of your bod. A lot of us would’ve caught HSV type 1 very early on in life, from being kissed by your mum, for example. Others will have been exposed to it during their first sexual experience. It just depends.

In the vast majority, the virus doesn’t do much as all. It simply infected your cells, goes along your nerves, sets up camp there. And silently, it sheds viruses very slowly in a way that spreads the virus.

Some of us are super unlucky, and the virus has an absolute relentless rave/ party and leads to ulceration. Sometimes severe. For these people, the amount of viral shedding, and therefore likelihood of spreading the disease is higher.

But I want to be totally brazened and direct about one thing. There is nothing dirty about this. There is no yuck. There should be only sympathy for people who suffer from cold sores and genital herpes. Because WE’VE ALL GOT HERPES, and they just had the terrible misfortune to get symptoms. Remember, if you’ve ever judged somebody for having herpes, that you also almost definitely have herpes too.

Bieber’s varicella virus is another type of herpes virus. As is the Epstein-Barr virus, which causes glandular fever. I’ve had an Epstein-Barr virus in a spate of fairly minging glandular fever, so I’ve definitely got herpes.

I feel like we should all be more open about the fact we’re riddled with viruses. In fact, when you look at our genome, it’s littered with the fossils of hundreds of thousands of viruses. And of course we’re also caked in bacteria. I feel like we need to embrace the fact we exist within a microbial world. And let’s not judge people for what viruses that have in their ears, face or front bottoms. It’s natural and we’ve all got it. Let’s talk about it more, get help when we need to, and of course, get that all-important smear test**.

Everyone, sing it with me. WE’VE ALL GOT HERPES.

*ref: https://pubmed.ncbi.nlm.nih.gov/11930310/ estimates vary

**The human papilloma test that the smear test looks for isn’t a herpes virus, but I just wanted to drop in a reminder to us to get our smear tests 😊

‘PLAY IT AGAIN’ I demanded from Leo. Always happy to listen to his own work, he set up the speaker and played his musical creation. I sat back in my creaky wooden chair and looked out across the palm trees as I let the sound wash over me. In the sky I could see eagles circling overhead. A strange sight I’d now got used to in Kerala – where instead of sea gulls, their beaches have eagles. The sky was faint blue turning to orange as the sun set. As I listened to Leo’s piece, I was stuck by a strange mixture of emotions. Nostalgia, sadness, pain, excitement. It’s incredible what the piece has come to mean for me.

We were set an incredibly boring piece of homework by the university, called a ‘DPP’. I diligently completed my coursework in the most boring way possible. Over the past 4 years of training within the NHS, I’ve become accustomed to jumping through the necessary hoops. Sometimes passion and flair just hold you back, and you need to just get the job done and save yourself the aggravation of getting emotionally invested in your work. Leo actually read my project and found it even more painfully boring to read that it was for me to write it.

But for his ‘DPP’, Leo managed to push forwards and create a work filled with passion and emotion. I think we’re all a bit flabbergasted by what he managed to make. A piece of music that captures what it’s like to be in A&E, as a healthcare practitioner, patient, family member. Anyone really.

In the words of the Emergency Department consultant Dr Sue West-Jones – who we’ve all come to look up to as a kind of Goddess- in a message to Leo:

‘It conveys the intensity of the noise of the department yet turns the noise into the sounds of life, sounds that save lives and sounds that sometimes describe the ebb of life.

These are sounds which have filled my life as an ED clinician – very powerful sounds that can easily add to the stress of my role, but you have given them beauty and clarity.’

Leo started off just making the piece for a bit of fun, but it’s evolved into so much more. He managed to get access to A&E with a sound recorder – I think it was a proper one, I imagine it being big and fluffy. After having the necessary clearances, he recorded sounds from all the machines and the general non-stop screech that A&E emits. He recorded a drip machine, blood gas analyser, doctor phones, alarms and more. He was in smart work clothes whilst taking these recordings rather than scrubs – not wanting patients to think he was in his role as a healthcare practitioner. As a result a few of our colleagues became mildly alarmed by his appearance, briefly believing him to be part of some sort of inspection process (‘ARE YOU FROM INFECTION CONTROL!?’).

With the sounds in hand he set about creating. The process started in our mouldy house in Swansea at our electric piano, but would take Leo all over Wales as he visited different hospitals. The cello part was recorded in our little house overlooking the bay on Ynys Môn, an island in North Wales where we worked with GPs. Cramped in the little loft overlooking the sea, he toiled away playing the same bits of cello over and over again. It’s something I really admire in musicians, and something I’ll never understand as an inpatient and fairly intolerant person.

Our friends visited us on Ynys Môn and listened to the piece. I loved seeing the mixture of emotion on their faces as they listened to it. The music speaks to something deep inside you, something that you can’t articulate with words.

And now here we were in India, approaching the end of our journey as medical students. Coming to somewhere so far away, I wondered how our medical cultures would be different. And sure enough, lots of things are different. Snake bites, for example. And submersion injuries. And lots of late presentations that sadly ended in the need for a transplant. But what struck me and Leo the most were the similarities. The deep well of emotion that Leo’s music explores unites us all, especially post-pandemic where worldwide we’ve experienced a similar shitstorm.

So sat in India I breathed in the sweet, hot air, and – in the line NHS practice – reflected on the years I’ve just had. It’s hard to put it into words. But I think Leo’s piece describes it perfectly.

You can listen to it here:

https://soundcloud.com/leo-polchar/accident-emergency?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing

I was knackered. In front of me was a row of model vaginas, and next to them a row of speculums. Each speculum was a different length, from a about 20 cm down to about 10. Our job today was to get ourselves fully and competently trained in for what a lot of people is a terrifying, invasive, and painful ordeal: cervical examinations.

‘And this is the medium long, for ladies who have given birth…’ the teacher went on, talking us through the slightly tedious but very important choice of speculum size for cervical examinations.

‘…and there are no nerve endings in the cervix, so this bit shouldn’t be painful.’

I internally snorted and raised my hand to let the teacher know that it was so painful for me that I cried and fainted. She was delighted by this sort of interaction. The discussion was lively, with all of us owners of cervices, and all of us desperate to do our best for patients.

The teacher went on ‘… and this one here is a virgin speculum…’

I felt my insides freeze, as I raised my hand again to ask what reason we could possibly have for calling this a ‘virgin’ speculum.

Because I absolutely hate it. The word ‘virgin’ needs to disappear from our language with immediate effect. Used only for olive oils and for strange greedy companies, and that’s it.

Why do we need to label people who haven’t had sex with this revolting term? Why – just because you haven’t sexual experience – do you need to have this potentially humiliating, nonsensical, vomit-inducing term attached to you?

It’s vile on so many levels. This idea that if you haven’t had sex you’re some sort of desirable ripe fruit ready for the picking. An idea sewn by creepy men from the past. A patriarchal heap of bullshit. An idea rooted in religious tripe. Don’t get me wrong, I like some aspects of religion, but this sickening frilly little lace crown given to young women who haven’t had sex isn’t one of them. Why is it such a big deal that Mary was a virgin anyway? Why do we call her ‘the Virgin Mary’? Since when do we refer to people by their sexual experience? Okay sure, from now on you can call me ‘They Who Have Not Had Sex For Four Days Due To Vaginal Thrush Charlotte.’

And on top of that, let’s face it, you can be extremely evil and snakey without ever having sex. And you can be wonderful and sweet whilst having lots of sex. The term ‘virgin’ means nothing.

Why do we need to burden young people with this label? Teens have this identity attached to them which is embarrassing and creepy, that they then feel they have to shed. THEY DON’T NEED TO SHED ANYTHING, BECAUSE BEING A ‘VIRGIN’ ISN’T A THING. When you have sex you gain an experience, hopefully a positive one, you don’t lose anything. You don’t shed any frilly little lace crown. The lace crown was never there. And that’s without even mentioning how soul-destroying this term must be for victims of sexual abuse.

I can’t get my head around it. ‘Virgin’ used in the context of sexual experience needs to end. What does it even mean? It seems to be wrapped around the idea of a penis going inside a vagina as some sort of holy miracle. It’s deeply heteronormative; completely ignoring gay sex or sex that doesn’t involve vagina-around-penis action. What is sex between humans anyway? In my books, it’s consensually allowing yourself to be sexual with somebody else. End of. No need to imagine what that means for different humans, no need to hype it up or attach it to notions of ‘purity’ or ‘innocence’. And let’s be clear, if sex isn’t consensual, it isn’t sex. It’s assault.

Language is important, it changes the way we feel and therefore the way we act. Please join me in boycotting this term. Politely ask people not to use it when you hear it. Let’s stop heteronormalising language around sex.  Let’s stop making people feel like shit either because they haven’t had sex or had a terrible first sexual experience. Let’s stamp out the creepy patriarchal haze that the word ‘virgin’ creates. Let’s stop referring to humans or speculums for that matter as ‘virgin.’

I turn around, smile and wave to the next patient. He has an open and kind face, with big brown friendly eyes.

‘I can’t see you!’ he shouts.

Ah yes, this patient is blind. ‘Okay sir!’ I yell back. ‘Be with you in just a minute – we’re having a look at your notes.’

He’s a smart man in his 50s, with a lovely attitude and big smile. His large head supports a ginormous pair of glasses, which confuses me. Do people usually wear glasses when they can’t see? Maybe he’s got partial vision.

His neck isn’t very visible, with large folds of fat storage falling down to his chest. His abdomen is quite simply huge – a massive pushed out beach ball with his breasts tipping over the sides at the top. His legs by comparison, are thin and spindly; sporting a pair of compression stockings that I’d been told in my teaching the previous day absolutely don’t work.

His blindness is the result of type 2 diabetes, an illness that plagues everything he does. Type 2 diabetes is a nasty one. I get the feeling sometimes that people think you can just take a pill for it and it’ll go away, but it’s rarely that simple. Type 2 diabetes gets your networks of small blood vessels into trouble. Like the ones at the backs of your eyes, and the blood vessels in your kidneys. It also results in your feet going numb, causing giant ulcers to develop. Sometimes people need a toe, a foot or half a leg removed because of it simply dying away.

As we chat more to this lovely man, we learn that he’s hoping to walk more. Maybe switch to a zimmer frame for stability, hopefully working up to a few steps to he can get around the house. Continue to care for and feed himself.

I look down at his urine pooling in a little bag at his ankle. It’s quite red. Looking in his notes, I see this man has chronic kidney disease. And heart failure. It must be hard work for his heart, pushing blood to all that extra adipose tissue. Gosh. He’s on a lot of medication.

As he chats away to us, he mentions his diarrhoea. It’s normal for him, he says, after he had his gastric bypass. He’s got only a short gut now – one that doesn’t absorb as many of the nutrients, which instead find themselves going straight into his poo.

What’s this man’s outlook? Will he be walking in a year? How long will his heart hold out? His kidneys?

He’s an interesting guy, full of stories and smiles. He deserves everything. He deserves life.

So why is he like this? My heart breaks for him. Despite everything the NHS has done to help him, he appears to be slowly being killed by a Western diet.

After only a short time in medicine, I’m already crushed by how many of these patients we’re letting down. Sometimes you see them on the Friday, and they’re not there by Monday morning. The fat on their chest weighs heavy, sometimes too heavy for them to expand their chest and breathe against. The fat in their cells causes the genome to switch into an inflammatory mode – making cancers and infections more likely.

I feel so lost with how I can help. All I know is I have to do something. People seem unaware of what obesity might do to them one day. I was, until I saw inside hospitals. Most of us seem preoccupied with how fat makes them look, rather than what it’s doing on the inside. I just want to be clear at this point, that every single human is 10/10 for attractiveness. We’re all sexy. We don’t need to worry about that shit.

What we can do is eat plants, eat plants to live. If it’s not a plant or a fugus, if it’s not obviously something edible, we shouldn’t bother buying it. I mean honestly, what the fuck is a kit-kat? Or milky way? Or a microwave meal? What sort of wacky corporate bullshit has convinced us to open a plastic packet and eat the congealed factory-produced contents within?

I don’t have the answers. But I’m ready to listen. If you struggle with weight, I want to hear your story.

There’s a lot of talk in the press at the moment about ‘medicalising obesity’. Talking about it as a medical condition, one that we prescribe for and follow as a GP. Part of me is tempted to think this could help. I don’t know what people who struggle with weight gain might think about this, though. I’m worried that it’s not that simple. Food is so intertwined into our culture and social expectations. And then there’s the immense cloud of mental health issues that drive us all to have unhealthy relationships with food, and then there’s poverty and the addictive nature of certain foods. We need robust ways of helping people. I’m sure people do not choose to become obese, but they can choose to eat obesogenic foods. Are these the same thing?

I’m not sure. But over the next decades of my life I want to help people like this gorgeous patient with the big friendly brown eyes I met in hospital. Nobody should have to live with the awful health affects of obesity. Nobody should die of obesity.

The patient I’ve spoken about here is fictional, based on the many patients I have met so far in hospital.

My eyes snap open. Some negligible but sinister noise must have stirred my subconscious. I try to rationalise the noise. The radiator clicking? Or perhaps a scurrying tarantula? Or maybe an evil wraith standing by my window, tap tapping on the glass to wake me up and steal my soul. Looking wildly around my room, I try to remind my brain that it’s a ridiculous bastard and needs to pipe down.

I’m 30 years old and I still regularly wake up in the middle of the night, too terrified to bear being in the dark anymore.

Like for so many other people, being locked inside alone for 2 weeks with possible covid-19 has prompted strange things from my brain. I think my brain is only kept sane by the presence of other human brains. And as much as I appreciate my new roommate, Phillip, he’s not that sociable. I first met him when he crawled under my window. There’s a significant gap between my window and the wall, leaving a nice space for new friends to crawl into my room. Phillip strolled into my life a few days into my isolation, and scouted out a shell that my boyfriend gave me. He has since moved into the shell and made it his permanent residence.

As somebody with a mild phobia of spiders, his arachnid heritage does bother me somewhat. However, I feel we have an agreement. He stays to his shell, and I stay away from the windowsill.

When I was young, I’d always fall asleep with the hall light on, bathing my room in a soft orange glow. If my mum or dad tried to switch it off, I’d immediately wake up and yell at them to turn it back on. It’s strange as an adult how nostalgic I feel towards that hall light, how safe it made me feel, and how much I yearn for it now as an adult.

So many of my silly phobias – I know they are not rational. It’s strange how they dominate so much of my behaviour, especially now it’s spider season and I’m often sleeping on my own in a big house. For all the logic that humans reckon they have, so many of us are incapacitated by our irrational fears.

Does it make any sense to view humans as logical? For the most part, we simply aren’t. Emotions seems to speak louder than sense to a lot of us, and I’m by no means excluding myself from this. But do we make sure we rationalise when we really need to? How many of us think about the injustice behind the decisions we make? How many of us put our biases and prejudices aside when we interact with another human, or for example, vote for the Tories?

The thing is, and I’m not making excuses for people here, but how many people are actually thinking for themselves, and how many are simply reacting to the information that has been bottle-fed to them by society? Sometimes I feel like there’s not much difference between my instinctive terror in the night and some of the life-altering decisions people make every day. If we’re just reacting, how can we ever progress?

And here we get to what’s really wound me up, and what so often occupies my thought. I always wondered what would make people change. Is it finding out the truth? Is empathy? Is it environmental damage? Is it justice? Food safety? I thought to myself, after all the horrific zoonotic diseases we’ve suffered as a species, perhaps a really horrific pandemic would finally make people change.

Battery farming is one of the world’s purest forms of evil. It pushes living beings to the brink. It squeezes out the possibility for any small-scale local farming to be successful, pushing desperate people into keeping and slaughtering wild animals. Creating breeding grounds for demented viral illnesses. The meat industry caused this pandemic. It caused a PANDEMIC, and yet people are STILL FARMING FOR MEAT. It’s also caused loads of other pandemics we’ve had too. And antibiotic resistance. And obesity, cancers. Food inequality. Was it really worth it all for the bacon?

Such huge human loss. And as we’ve just heard, 17 million mink are now to be slaughtered due to the gene for the covid-19 spike protein mutating within their tiny frail little bodies as they live out their lives in cages, farmed for their fur. Shall we just carry on doing this? See how many more viruses we can culture in these festering conditions?

How many more people will have to die before we realise what we’re doing to ourselves with our diets? We’re strangling the planet. Since I come from a position of privilege, a strange place where I can buy any slaughtered animal I want at the click of a mouse, I know it’s my duty to try and feel the violence and the injustice in the small decisions I make. I’m not perfect, but I’m trying.

I used to gently suggest to people that plant-based was the way forward, for so many reasons. But now I feel different. I feel a sickness rising in my body, tears coming to my eyes. I want to throw myself to the ground, scream, beg you, plead with you. Please, stop this.

Honestly, I’ve researched and thought about this a lot. I’ve been thinking about this since I was 6 years old and I first asked what sausage roles were made out of. I’m afraid of the dark. I think it’s because it takes away your evidence for the existence of anything, it leaves you blind, you can invent any old shite when the light’s off.

This isn’t me reacting. It’s the deepest, most logical, most rational belief that I’ve ever had. Life is worth more than greed.

‘Okay, nobody feel under any pressure to say anything interesting’ I said as I glanced nervously sideways to my two friends. We were at my Swansea garden bench with kitchen table sat haphazardly next to it on the bumpy grass. Two of my outgoing, energetic friends sat to the side of me in silence, each with a pint glass of wine in front of them.

Nobody had seen each other for months. ‘So, anything interesting happening in your life?’ I would be asked. ‘No, nothing. Literally nothing. I was thinking about hand-washing this really annoying hand-wash only dress yesterday, but then it didn’t happen.’ Thankfully, most of our stories were boring ones. Lockdown has meant something different for everyone, and for me it’s left me understanding that I am in fact quite lazy, I enjoy taking my time to do things and we can rush to do boring things when we’re dead.

But I did also have my own unique experience this weekend, which I’ll share with you now partly because it’s medically interesting, and partly because it scared the absolute shite out of me.

I was sat having a tasty breakfast of yoghurt, granola, banana and nuts in the Dorset sunshine, chatting away to my boyfriend and his mum. Trying to defend my somewhat snobby notion that it’s ‘easy to get into Cambridge’, which I should never say in front of anyone, which makes everyone instantly hate me and I’m not sure why I’m writing it here. I felt myself become dopey. I couldn’t think straight. Maybe my dopiness was why I even mentioned this totally offensive ‘opinion’ of mine.

I felt a familiar sensation, overwhelming heat, darkness swirling in from the sides of my vision. ‘I’m going to pass out’ I suddenly announced, and half-stacked, half-fell as I flung myself desperately onto the rug in the back room. Pain started to build in my abdomen unlike anything I’d ever felt before, agonising twisting and tugging. And this is coming from coeliac with IBS whose spleen has exploded in the past.

Fuck, I thought. I’m going to shit myself. I’m going to pass out, and then shit myself whilst passed out, in front of my boyfriend and his parents. So for the second time in my life, I experienced the process of desperately trying to drag myself to a toilet, and expel a turd before losing consciousness and sliding back onto the floor. I did manage to wipe, I did not manage to flush.

When I came round, my boyfriend was with me. The pain was building. I couldn’t bear it. I started to wildly wonder what on earth was happening to me. Sweat ran down my body as I shook with agony and the stabbing and twisting in my guts intensified. As numbness started to spread up my hands and feet, they turned white and my nails turned purple. My boyfriend pressed down on my nail and released it, a crude measure of blood supply to the peripheries. ‘Is it less than 2 seconds’? I squeaked, remembering my medical textbook definition of a normal capillary refill time. He only looked at me sadly. ‘What’s happening to me?’

I knew I was going into shock.

My brain searched through the options. Burst stomach ulcer? I did have gastritis and had been overeating somewhat lately… ‘Rona? Holy mother of shite, did I have ‘rona? ….  Or could this be allergic?

I couldn’t really sit up without passing out again. But I did for enough time for my boyfriend to pass me an antihistamine, on the off-chance this was some extremely strange allergic reaction. Incredibly, within minutes, my abdo pain eased. It still hurt, but it wasn’t dominating my every fibre of my existence anymore. I felt I could sit up, and as a result was transferred from the bathroom floor to the sofa. I weakly leaned back and tried to process what had just happened as the pain eased.

At the same time, I noticed loads of really annoying rock-hard crap stuck at the back of my throat, and wildly started trying to pick it out, occasionally retching revoltingly. My ear canals became insanely unbearably itchy. And then all of me was itchy. As I leaned forward, my boyfriend saw huge welts had appeared on my back. And then on my stomach. And then around my lips and up my arms. The boy rang 111, then looked back at me. ‘No’, he said. ‘This is ridiculous. We’re going to A&E.’

The breathlessness had returned, my throat was tightening, the rash was spreading. My boyfriend sat next to me in the car, as a veteran of anaphylaxis, he had two epi-pens ready to fire. They didn’t mess around in A&E, sending me straight to majors.

Of course, as soon as I got there I decided I was fine. Bored, I wanted to leave. Was the rash really that bad? I mean, the worst of it had been the painful collapse and the abdo pain. Yes I suppose, I thought to myself, the throat constricting was probably concerning. My lovely friend who works in the department visited me with some words of comfort. Of course, no visitors allowed. She nudged three starburst towards me which I devoured with delight.

A&E were incredibly efficient. My nurse was fantastic. After being given the all clear to go home, she noticed that I couldn’t sit or stand without passing out, something the doctor had failed to notice. So the cannula went back in, and I watched impatiently as hydrocortisone was squirted into me and saline drip drip dripped into my veins.

I was sent home with a goody bag of prednisolone. I felt completely wiped.

I feel strange after this experience. It happened so fast. It was fucking weird. It was scary. And now I’m scared of food. Not enough to stop me eating, but enough to make me think. Things can change so quickly.

Going back to my garden party in Swansea, we of course all had a wonderful time, danced on tables, yelled profanities at each other, and a small amount of wine-induced vomiting took place. I’m so grateful for what I have, and I’m so sorry for those who have lost so much over these past few months. I’m taking the positives forward from my atypical anaphylaxis. I’ve learned just how much an allergic reaction can cause your blood pressure to plummet leading to collapse, and also that anaphylaxis can cause a rise in neutrophil count (who knew, right!?). The abdominal pain remains a mystery.

Anyway, if you’ve got this far in my rant, I hope you’re happy and healthy and enjoying the company of those around you. And if they randomly collapse, consider anaphylaxis.

 

 

 

**** There are lots of stories of the different ways anaphylaxis can present online. Mostly posted by parents about their children, and many of which describe how odd the symptoms can be. I recommend a read of them. An example is here:

https://www.facebook.com/jberghaus/posts/10217085205236409

It was 2012, and I was in a bed at Kingston Hospital. I felt like every single cell in my body was violently throwing up, and that I was lying in a lake of that boiling, stinging cell-vomit. My mouth was drier than the Atacama desert (the driest place on Earth, according to Wikipedia). I was completely consumed by nausea and wasn’t aware of my collapsing lungs and my body’s struggle to get oxygen into my circulation.

I must have been quite poorly, because when my sister arrived, she saw my oxygen sats were 75. Too low to keep me going for long. She slammed the emergency button and started manically fiddling with the medical equipment (I have no idea to this day what they were giving me). As medical staff rushed round me, the only voice I remember hearing was my Dad’s, cracking with emotion, saying ‘I thought somebody was going to let me speak to a doctor.’

I shouldn’t have been on a general ward, but there wasn’t any space for me on a high dependency unit. I felt like I’d fallen through the cracks in their care. Whenever I have a fever, I become deeply confused and have almost no insight. I wasn’t aware I was acutely ill and couldn’t tell the doctors. Partly because I was mostly unconscious. But also the confusion.

I remember, despite my obvious illness, my complete inability to communicate to the doctors that I couldn’t breathe through my nose. It was simply too full of snot. Yet they kept putting me on the blasted nasal cannula oxygen. Eventually my sister firmly yelled ‘SHE CAN’T BREATHE THROUGH HER NOSE’ spurring them to finally put me onto an oxygen face mask.

My collapsed lungs were disgustingly sticky, every time I took a deep breath, I could feel them peeling themselves open like two sides of an overly warm egg mayonnaise sandwich. It was my job over the coming days too cough up all the skank puss/ dead white cells/ mucus that had accumulated in my lung bases. It was agony, every cough felt like my stitches would burst open, causing my liver, pancreas, kidneys and intestines to fly across the room at force.

I recovered quickly once given oxygen and the antibiotics had worked their magic. Within 5 days or so, I was sitting up, happily bolting down food and then vomiting it back up minutes later. My appetite has always been strong, even after open surgery on my abdomen.

And so it was, the Epstein Barr virus settled down for the long haul in my glands, I recovered from the glandular fever and started to comprehend the fact that my spleen had just exploded.* The surgeons insisted to me that it would have no effect on my life; that I could live a totally normal life.

That lie still greatly pisses me off. I don’t care if I was ill, I deserved to know the truth. Because being immunocompromised with regard to specific bacteria is deeply irritating, especially when you have a love of camping, the rain forest and animals. All the things I love that unfortunately carry bacteria which could now be lethal to me.

And here we are in this strange medical crisis! Like so many others, I sit here in my house for months on end. I was one of the lucky bastards who received ‘the letter’ from the GP. Advising me not to leave the house for 12 weeks for any reason, and giving me cheery advice such as ‘sit somewhere where you can see out a window’. And the fact that it’s stopping me from getting on the wards and helping out hurts so much. After all this training, my life has been halted by silly glandular fever I caught 7 years ago by sharing some cutlery with a promiscuous housemate.

My future in medical school is now uncertain. I don’t actually know *how bad* it would be if I caught COVID-19, I can’t find any data on the ability of spleenless humans to cope with viral infections. I have to entertain the idea that it might be *bad*. But if there’s no vaccine, how can I return to the wards? Should I risk it for a chocolate biscuit and just go back anyway? Or be sensible and put my health first?

I’m also fully aware that I’m being a self-centred moany little child. COVID-19 is tearing people’s lives apart one pneumocyte as a time, and I’m beyond blessed to be able to live by the beach in Swansea with my lovely housemates. I’m just struggling to pull together the threads of my uncertain future.

On the other hand, if my spleen had never exploded, I might never have turned towards a medical path. I’ve got to make sure I never lose sight of that fact that being really ill is properly shit, and I should avoid that if possible.

In March, I found a baby apple tree growing out of a rotting apple. I’ve potted it now, and I’m hoping it’ll grow up to be a big, strong Chelsea-supporter (this is something my Dad would always say – you’ve got to eat that so that you grow up to be a big, strong Chelsea-supporter! Despite only pretending to support Chelsea to look cool in front of his kids).

Beautiful lovely things can come out of shitty situations, and like my little apple tree I’ve got to turn my face to the sun and be hopeful.

 

*My spleen spontaneously ruptured as a result of the Epstein Barr virus (which had caused glandular fever), causing me to internally bleed into my abdomen until I passed out and was taken to hospital. They diagnosed grade 4 splenic rupture and removed my spleen. Apparently, people with coeliac disease have goofy spleens anyway, and for anyone with glandular fever there’s a chance their spleen might rupture.

A few years ago I was in Bangkok and it was pissing it down with rain. I was taking shelter under the corrugated metal roof of a bar. I had a flight the next morning at 6am.

‘If it carries on like this, I’m going to have to get a glass of wine.’ I mumbled to myself.

 As the rain thundered on the road became a river (complete with people passing on boats) and the cockroaches started to jump into my sandals for shelter. I heard a light Irish voice from the table next to me say,

‘I think you’re going to have to get that glass of wine..’

Whilst the cats and dogs fell from the heavens, this young woman and I chatted on through the evening and into the night, discussing everything from the darkest moments of our lives to our twisted dreams for the future and how and when we most recently shat ourselves.

In that moment, we were best friends.

One evening of friendship with a human I would most likely never see again, neither of us had anything to gain from talking to each other.

I realise now how rare it is for an adult to suddenly make a friend for no reason. Remember, when you were a kid, you’d randomly make best friends with another kid in Tesco or wherever, only to never even know their name? Where has all the spontaneous, joyous, easy friendship gone?

Is adult communication becoming a bit sad? Do we live in a world where we have to know somebody forever, add them on Facebook and keep monthly correspondence in order for our relationships to be of worth?

Communication in all its glory and awkwardness is a constant source of both joy and exhaustion in medicine, but before I started my studying I confess I wasn’t interested in one-on-one interactions. Where’s the grandeur in politely explaining to somebody why their diabetes has returned, why they’ve got spotty elbows or why you’ve unfortunately got to insert a finger up their bottom?

Before coming here I dreamed of being a scientist alongside being a science communicator; I loved standing on stage and making people laugh, or seeing a room of eyes light up when you told them a fun fact. Carrying the energy of the room made me tingle with excitement. But in medicine there’s none of that, your communication with people is in quiet privacy (supposedly), and you are the means of delivering understanding. It’s not about me, it’s about them. I am just the messenger.

My sister is a neonatal nurse. Some of the moments she shares with the smallest, youngest most vulnerable little lives as they pass on will only ever exist in her memory now. She is the only living witness to their last moments. Does this make her interaction with them any less worthy?

I’ve come to realise now just how precious small moments are with people, including both those you love dearly and those you might only know for a few moments.

All the small moments we’ve had with people, they still exist forever in time. If you could build a time machine and go back to them, they’d still be there. It comforts me know that the people I’ve lost or people I know I’ll never see again are still chatting away to me back in 1997. And these fleeting interactions aren’t trivial, they stay with you for a long time, perhaps for the rest of your life, and can fundamentally change not only your path but who you are as a person.

I’m inspired by how much humans can gain from one another even in a short space of time in small ways, and it’s glorious being able to see this in medicine*. As I move forward, I’m trying to shed my coat of ignorance, arrogance and narcissism, and focus on the person in front of me with an open mind.

 

*you can also really fuck things up in medicine by communicating badly, which unfortunately I’ve also seen quite a bit of. I’ll try not to do that.