My Worries: Obesity, Breasts and Budgets

I can feel the way I think changing. Whilst watching The Fellowship with my housemates last night, we had a fairly lengthy interlude during Weathertop to discuss exactly where Frodo was stabbed, which vessels had been missed and how lucky he was. Also, why didn’t the Witch King Angmar have better stabbing aim!? Or during my recent sci-fi indulgences, I’m not thinking ‘wow, that’s a lot of blood coming out of that person’s mouth’ but ‘hmm is that blood from the stomach or from the lungs or both? How would I work that out and treat it quickly in an emergency setting?’

My Stethoscope

My first stethoscope

As well as spending enormous amounts of time watching shit (or excellent) TV with my housemates, I’ve got to know them very well in ways most people don’t usually know their friends. For example, Leo has a slow, steady and easily palpable (feel-able) pulse. Maisy’s pulse is somewhat erratic and difficult to find, the vessels in her arms are difficult to access. Lewis and Leo have both had the pleasure of finding my apex heartbeat, which for a woman involves having fingers sunk into the bottom, left part of the boob.

As well as feeling the way I think change, in the last month I’ve had many more opportunities to interact with patients. And to be honest, the biggest difference between practicing a cardiac clinical exam on my friends versus doing it on patients is that the patients are often fat. I didn’t really realise just how much you need a patient to extend their neck to find a carotid pulse when they are severely obese, or just how difficult it can be to orientate yourself with regard to their organs.

Obesity is a truly devastating problem, especially here in Wales. It breaks my heart (metaphorically)  – and eventually breaks theirs (literally) – to see patients struggling so much to maintain a healthy weight. 10% of the NHS budget is spent on type 2 diabetes; a disorder that correlates highly with obesity. And these patients are often coming in with multiple other things wrong with them, either all caused or complicated by their obesity. It is such a great shame, and to be honest I have no idea how it can be solved. Surely there must be a better way to help these patients.

I think most of us, smoking, drinking, eating what we fancy, don’t know it will affect us 40 or 50 years from now. If a patient could see their future after smoking 20 fags a day for 15 years, where they’re incapable of walking 50 metres in one go, would they stop?

So much of our healthcare demands these days fit into one of two categories:

FUCK, DO I HAVE CANCER?

and,

please give me antibiotics

Some could argue that our preoccupation with cancer is a good thing, knowledge of our own physiology can surely only help us identify things early. But it worries me how much anxiety this is causing patients without having a real impact on altering behaviour. I know from my own experience that I am terrified of getting cancer, and yet I almost never examine my own breasts because I find it too frightening. My boobs are so lumpy anyway, how could I possibly notice something? And yet I also know logically that a simple self-examination once a month in a stress-free manner might be achievable. I guess I’ll work towards it.

The antibiotics thing is a whole other rant, for another day. But I’ll just quickly note that a 2015 survey by WHO found that 76% of people think that antibiotic resistance is when your body becomes resistant to antibiotics. This is not what antibiotic resistance is. This is terrifying.

Another change this month is my tolerance for phenomena that some may find revolting is rapidly increasing. Bit off poo flung towards you? That’s fine. A child’s snot on your leg? Just brush it off. An atrophied (dead) leg passed along to you? Examine it carefully and learn what you can.

There’s beauty and a huge amount of diagnostic value in this stuff.

I hope that as I move through my medical career I can help find better ways to communicate to people how they can best manage their healthcare. I find that humans are intrinsically interested in the way their own bodies work, and are delighted to learn more especially if you can link it to evolutionary and embryological science. I hope that over the next few years, more people turn around and examine their shit before they flush it, feel their breasts or testicles, over-think injuries in films and re-examine their own lifestyle choices. Practice with your friends and lovers if that helps.

And if anyone has any idea how I can help affect this change, I’m all ears.

Diarrhoea, Wheeze and Swollen Finger

Diarrhoea, Wheeze and Swollen Finger. Those are the titles of my first three academic weeks at Medical School, and as you might imagine I’ve spent a hell of a lot of time thinking about poo and pus. I feel as though I’ve been lurched out of reality and stuffed full-thrust up a human’s arse, where I am beginning to re-adjust and observe my surroundings.

And it is fascinating.

humans are doughnut-shaped 3

Humans are doughnut-shaped

I’ve always loved the gut, and those who know me know I take true delight in accurately describing each turd that I lay to friends, family and colleagues. Recently I gave a talk to thirty young parents and their infants at an event called ‘Babble Talks’, where I excitedly described how humans are in fact doughnut-shaped, with a hole running through the middle, and that that hole is our gut. Their blank faces suggested that this concept is perhaps not as fabulous to others as I find it. To me, it is an epic evolutionary marvel that humans (and others) have managed to create a warm squashy environment within themselves where bacteria live and food can be mashed, from which our cells can pick and chose molecules that we then assimilate into our own tissues. And of course, the rest is sent to the rectum.

humans are doughnut-shaped 2

Alongside my delight at studying the physiology, anatomy and pathology surrounding humans comes the slightly painful amount that we need to know. It’s been only three weeks and already my brain is smarting from just how many types of cell, cytokine, bone and bacteria there are.

Of course at the forefront of all of this is how it is going to help the patient, which is something I am adjusting to. As somebody who likes to gobble up knowledge I need to trim myself back so that I can aim to be a good practicing doctor and not a walking medical encyclopaedia. Do I need to know the exact structural pathway of folate synthesis in bacteria to be a good doctor? Maybe not. Do I need to know exactly where the liver is? Potentially.

Knowing something like ‘exactly where the liver is’, by the way, turns out to be a little harder than I expected (I am still yet to find my housemate’s liver, and concede that she may not have one, or it has moved).

Occasionally I catch myself, and I feel morbid and heartless for finding such delight in our biology. Last week I stood inspecting a lung in one hand and a heart in the other whilst beside our cadaver. I screwed up my face with confusion as a I delicately replaced the organs back into the human’s open chest, trying to match up the blood vessels and eventually becoming frustrated with how 3D humans are. Just too many vessels.

But then I glanced sideways down at the hand of the cadaver, and like a swift punch in the stomach I remembered that this person has lived, laughed and eventually lost.

Last Friday night myself and my five first year medic housemates sat around our very studenty kitchen table with a bottle of wine and discussed how we feel about death. Death has already touched us all in different ways, and it’s something that we’re going to become familiar over the course of our careers. I hope that I am strong enough in the future to pick up the grief that I witness and experience and carry it with me.

I have been thinking a lot about my Dad since coming to Swansea, and have found fresh waves of grief washing over me. After three weeks at Swansea, I feel like I’ve been there for years. I sigh with relief when I visit my childhood home in London for the weekend; I run into my room and stuff my face into the pillow of my bed. I feel homesick.

I’m not sure why I feel like this. I’ve been away from home before for much longer and much further afield. Perhaps it’s because I’ve moved onto something new, something that my Dad will never know about. I feel as though I’ve moved physically further from him by coming to Swansea, and further still in time by stepping onto the next stage of my career. Part of me wants to freeze time so that it stands still forever, so that I can never move further away from him. What will I feel like in 5, 10 or 20 years? It terrifies me that one day I could’ve lived more years without my Dad in my life than with him.

For the second time this week, I find myself tearing up on the train thinking about all of this. When I think about death it sometimes feels overwhelming. The grief I know so many people feel as a result of injury and illness coupled with my interest in medicine leave me balanced on a knife edge; with the glory of living biology on one side and the tragedy of loss on the other.

I text my family about the last time I went to B&Q with my Dad, he pushed my sister and I on a trolley and we laughed as we picked from the various ‘shades of white’ a colour for our living room. Then I put down my phone, open ‘An Introduction to Pathology’ and start reading.

Un-becoming a Scientist

My sister and I at BSUH Special Care Baby Unit

For lots of my friends and family, it’s a bit of a shock when I tell them I’ve decided to quit science and start a medical career. I spent most of my life wanting to become a scientist, I’ve spent six years specialising in genetics, and now I decide to rip up my plans, get another revolting student loan and start from scratch!? Am I mad?

I guess there’s two reasons for this change, firstly I want to be a doctor, and secondly science turned out to be not for me.

During my time as a PhD student I felt the foundations of who I am shift considerably. On my first day as a PhD student, my face was shining with excitement, I was ready to put in the hard work, to contribute towards the mountain of knowledge that underpins our understanding of the universe. I was expecting to be welcomed into the scientific community, to collaborate, share ideas, design experiments and ultimately to discover stuff. But I was also moderately realistic, knowing that research is a fickle creature and often your hypothesis turns out to be complete bird terd.

On top of that, I was very focussed on my own successes. I didn’t have a lot of care for the dilly-dallying of humans, with their ridiculously flawed political systems, corruption and currency. I didn’t even really feel I was human, I was a Scientist.

And oh my, how much that all changed in the last 4 and a half years of my PhD. The biggest change for me was losing my Dad. I was in my little student house at Cambridge when I got the call from my Mum saying it was advanced stage 4 colorectal cancer. I felt confused, sick. Anyone reading this who has experienced the terrors of cancer knows that disarming, disorientating feeling. But I remained fully in denial. My whole life, if I had wanted something, really, really wanted it, I had always got it. I would argue, study, fight, raise funds, whatever it took. I really wanted my Dad to be okay, so he must be, right?

After many walks in Kew gardens with my family and many confused evenings in the lab frowning at the mechanisms that might be those malfunctioning in my Dad’s cancer cells, I finally found myself in Kingston hospital facing the worst. And as it was, we got in the car home that night with only four family members instead of five. It tore us apart.

That was the summer of 2014. The shock from losing my Dad would stay with me for two years, but in the immediate aftermath I simply I stared down our little garden in Southwest London for a month. And then returned to the lab.

The lab. A place of where 95% of your experiments fail, where you barely speak to anyone all day and where you are persistently ignored, where you must miraculously be successful using every ounce of your energy or die trying. Least to say, I was not impressed by the paper-chasing, profit-driven, egotistical behaviour I saw.

At a friend’s viva party, I recommended him to take some time off after him finally finishing his PhD that day. He was in lab every day including weekends, he looked ill. He needed rest. He glanced nervously sideways at his boss, and said

‘er no, no champagne for me, I’ve got to be in early tomorrow. For the paper.’

I registered my dismay. His health and happiness were worth more than a paper! And in response, his boss leaned over and glaringly said to me,

‘See. That’s a real scientist.’

Fuck this, I thought.

All this time during my PhD, who had I really helped? What was I really working for?

In stark contrast, my sister, an intensive care neonatal nurse, was working hard every week to save the most vulnerable lives. I had to see what her work was like, and so one winter I found myself in Brighton and Sussex University Hospital (BSUH) special care baby unit. The little hearts beating in the tiny little persons, within their plastic incubators broke my heart but I found a deep respect for the nurses and doctors caring for them, and a raw fascination for the process of their diagnosis and treatment.

By this point, I was a different person. I had faith in my physical capabilities in terms of accuracy and dexterity, I knew I could stomach the vast amount you need to know to be a doctor, and I was ready to face the agonising emotional strain of working in healthcare. It had taken being treated like an idiot for four years of my PhD for me to finally realise that I was clever. I had also had a window into the NHS, and into suffering. I knew I could be a good doctor.

I’m so delighted to be starting medicine, and particularly delighted to have been accepted to study at Swansea. I’m so excited to learn everything I can about the human body. And I’m happy to be going into medicine as a graduate student, with the insight and understanding I’ve gained during my years studying for a PhD.

So it turns out unbecoming a scientist for me meant I found what I really want to do, it was medicine. I feel like taking off my Scientist hat has enabled to me to put on my Human hat, and I can’t wait to get started.