STOP SAYING ‘VIRGIN’

Comfispec Disposable Vaginal Speculum - Medium Long (Pack of 25) - HCE  Healthcare Equipment

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 women 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, all of us women, 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.’

Eat Plants to Live

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.

I am afraid of the dark

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.

Phillip – my new roommate

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.

Atypical Anaphylaxis

Miep sunflower

Miep enjoying lockdown life. Sunflower seeds are amongst the suspects for this incident.

‘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

Sticky lungs

apple trees 2It 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.

apple trees

Meeting in Bangkok

golden mountain, bangkok

Wat Saket, Bangkok

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.

Underneath their clothes

Seeing another human naked and vulnerable is usually something you do when you’re about to get personal and intimate with them. Perhaps at a beach, or if you’re feeling wild enough on holiday to fling your clothes aside and streak across a field of sheep, getting sheep poo stuck firmly between your toes as you go. But otherwise, no, nobody sees each other naked.

CT_Brain_MCA_Infarct

CT brain scan with right sided MCA infarct

Or so I thought. This week I have completed Nursing Week, and I’ve been thrown into personally caring for some incredibly vulnerable patients. And for me, one of the most startling experiences was becoming well acquainted with the fragility and vulnerability of the human body.

Us medical students wear scrubs, so we look like any of the other nurses or healthcare assistants. Almost as soon as I was on the ward, I found myself helping an elderly gentleman limp his way to the bathroom. His skin was hot and sweaty, his brow was furrowed with concentration from the effort of walking. He was clearly in pain. After an agonisingly slow journey to the toilet, he finally made it. Having made it this far, he then explained to me that he needed a cardboard tube to wee in. Confused, I held one of the cardboard tubes over his penis which he proceeded to wee into. He then slowly lowered himself backwards into the toilet, apologising profusely, began to have a poo.

This was the first time in my life physically helping somebody to the toilet. Honestly the only thing I felt whilst helping this gentleman was empathy and compassion, mostly for the fact he felt so guilty for taking my time so that he could do a poo. One of the most basic physiological requirements and somehow this poor gentleman had been made to feel as though he didn’t deserve it.

There is so much to do on the ward. The nurses and healthcare assistants and constantly being pushed to breaking point. It’s a physical job, and I get stuck in. By the end of the second day I find I’m completely used to the smells and the sights, they fall so far to the side of the main aim; to make the patient comfortable.

One of the hardest parts of the job I find is failing to communicate with patients. When your patient is clearly terrified and in pain, but also paralysed and unable to speak, how can I decipher their needs? I arrange the tiny, bony limbs of one patient as best I can into a comfortable position, open the blinds and arrange her so that she can see out to sea. But does she want to see the sea? What if she’s exhausted and wants nothing more than soft darkness so that she can sleep?

One patient in particular I find I click with. She’s brash, upfront, even aggressive. She’s hilarious. I take delight in helping her wash, she barks orders at me and then apologises and giggles. With the energy of someone so much younger and healthier than herself, I feel sure she’ll recover and return to her nursing home within the next week.

When I return to the ward on Monday I find that the energetic woman I made friends with has died suddenly over the weekend.

I knew that life-changing events and death occur in hospitals of course, but somehow I also didn’t fully comprehend it.

The next week, I change over from working with the nurses to working with the doctors. Part of me finds this immensely satisfying. Finally I can understand why the patient’s left arms is paralysed, why the patient can speak but not form words, or why the patient doesn’t comprehend where they are. Managing the patients from the doctor’s end involves a lot more thinking and looking at scans, but also a lot less time physically caring for the patient. After spending a week taking care of the patients personally, the most I might do for them now is hold a cup of water for them. I stand next to the doctors in my smart clothes (not scrubs anymore, now that I’m with the doctors) as they take notes, and see the nurses and healthcare assistants rushing by.

Nursing week was such an eye-opener for me. Swansea is the only Medical School that does it, yet I can’t help but feel that if every doctor knew more intimately the life of a nurse and of their own patient’s personal care, they would be much better doctors.

One thing I think we all secretly (or openly) know is that some doctors are arseholes. Pretty much every human has at least one story – when they visited the doctor extremely anxious with worrying symptoms only to have their symptoms dismissed and to be sent away feeling ignored. I feel at the very least a patient deserves to be listened to, be respected and to have their symptoms acknowledged.

I’ve had two emergency surgeries in my life, both from conditions that should have been picked up the first time I presented them to a doctor. I can’t help but feel that the fact I was a young woman complaining of abdominal pain might have something to do with it (are you pregnant? It’s probably your period pains.)

I am hopeful that the arsehole-doctor conundrum is being addressed. I feel that graduate entry medical schools are a good start, where the medical students have led a previous life to medicine and have perhaps been humbled a bit by living a bit longer. I’m not sure that going straight into medicine at 18 after A-levels is a good idea. One thing I’m sure of is that if doctors and nurses understood each other a bit better, we might have a much happier NHS.

And coming back to the original theme of this post (nudity) – as for dealing with my own naked body, after seeing so many humans battling every day to be able to move a limb, hold a pencil or swallow their food, I’m grateful every day for my own fairly functional fertile female ape of a vessel.

I don’t like crickets, I love them.

cricketI recently went to a ‘Women in Surgery’ event, where a lot of chat regarding ‘Role Models’ was flung about. A couple of people seemed to be fairly invested in the idea that they needed a fellow human surgeon to whom they could relate and aspire to be. Now, I’d already miss-behaved at the event by attempting to stuff an apple core down my friend’s top during the Role-Model-Discussion saga (what absolute banter I am), so I didn’t add my own inspiration story.

It was in fact a cricket that inspired me to want to become a surgeon.

Not a cricket bat, a genuine little insect that looks like a grass-hopper but is in fact a cricket. Actually, come to think of it, it might have been a locust (note to self: google locust/ grass-hopper/ cricket phylogeny and morphology).

During my biology degree, one of my praticals involved sellotaping down the wings of the (query) cricket, then jamming the poor thing at the end of a ruler and poking it and seeing how far it could jump. We then did some sort of maths and worked out that the back legs of the cricket were in fact a Big Deal. It didn’t occur to me then that the whole thing was a hilarious waste of time, it seemed obviously an important learning opportunity. I dunno, maybe it was useful in some way. Then as much as insect physiology is fascinating, it does amuse me that the Cambridge professors chose that particular practical, which involved a bunch of 18 year olds wildly chasing vast numbers of crickets around a lab whilst shrieking with delight.

Towards the end of a practical, I found myself sitting in a quiet corner gently removing the sellotape from the wings of my cricket. It required absolute concentration. I cannot even begin to describe my devastation had I accidentally torn the wing of the cricket and left her injured. Before I knew it, the rest of the class was queueing up to have their crickets de-sellotaped by me too.

It was then that I realised that I was alright at manipulating small things with my hands, zooming into something with my mind and absolutely concentrating as though my life depended on it. I could be a surgeon, I thought.

I wouldn’t revisit that thought for about 8 years, but the cricket planted the seed.

One of the things I struggled to understand was that not everyone loved the crickets quite as much as I did. As a vegan and animal-lover, I expected to find huge quantities of like-minded humans within the confines of my biology degree at Cambridge. I was confused and a bit dismayed to find myself the only vegetarian on the course. How could you be so passionate about understanding animals and still be naive enough to eat them?

There’s really no argument for it anymore, the animal-flesh and animal-secretions industry in the UK and beyond is absolutely rife with the suffering of animals. And people are blind to it. You, sitting there, reading this, are probably currently forming your own counter argument as to why you totally definitely should eat meat. You’re in denial. And now also probably annoyed at me for moaning, but hey ho I’ve got to try.

Coming into medicine I was even more surprised. When it comes to empathy, where should we draw the line? With humans? With humans who live near us? With humans who have the same values as us? It very quickly becomes a dark argument. I’m clear with myself that every patient I ever see I must absolutely feel empathy for and engage with, but sometimes I find it difficult given the choices they make. And this isn’t just the patients that decide to eat animals, smoke, drink, or shout incredibly loudly for no reason, it’s those with the terrifying moral compass that seems to have been skewed by a life of difficulty. To stare into the face of a patient who beats their partner, abuses their child and spouts racist or sexist language and still feel true empathy; that I find hard.

Sometimes I wonder if it’s better for me to think of humans like I think of other mammals – mammals that mean no harm, that are ultimately good, but through no fault of their own may have become a danger to others. Then I can feel empathy. But then, I also completely dehumanise humans with this approach. It removes respect for their autonomy to make an informed decision and give consent. I also find this approach, seeing patients as somehow ‘other’, deeply patronising on their behalf. But is it also a tool that allows one to be a better doctor? I’m not sure.

I’m currently at Bristol Parkway on my way home from giving a talk to 18 year olds about to start their degrees. I gave them a whistle-stop tour of antibiotic resistance, a problem which amongst many, many other problems in our society, stands silently on the shoulders of poor animal farming practices and slaughter. I hope they listened.

Why I hate Alexander Fleming

fungus

A fungus I myself accidentally cultured whilst doing my PhD. It may have had incredible properties, we’ll never know. It has since been incinerated.

I can’t remember how we got onto the conversation. I was sitting in a pub in Brighton with my old Cambridge friends playing Scrabble and drinking Diet Coke because I was hungover AF. I was also moody because I had an extremely itchy butt – you know that weird insane itchy butt thing you get after you’ve been in the sea and sat on a hard chair? Drives me bananas. Anyway, Alexander Fleming came up in conversation, and I absolutely flew off the handle. My friends suggest I write a blog about it to get all this rage off my chest, so here it is.

Alexander Fleming. Alexander. Fleming. Heard of him? Heard of him yeh? WE’VE ALL HEARD OF HIM. I’m so sick of hearing the story of the discovery of penicillin, or the invention of pencillin as some so aptly like to put it. Of course, it was not invented, it evolved via natural selection in the fungus penicillium – cheers little fungus! We should really thank fungi more in life, and thank Fleming less. If I hear the story of how this human accidentally left his plates whilst he went on holiday and came back and OH LOOK penicillium had killed off some bacteria (I hate myself for telling it now) I’m actually going to projectile vomit into my own handbag.

Learned it at school, learned it at college, learned it at every single event ever, hear it on the radio, learnt it at uni, now even at medical school Alexander Fleming and his dastardly discovery haunts me in every corner. Can everyone just please stop talking about it?

Okay so that’s item 1 of my hatred out of the way (stop talking about it), now on to item 2: glorifying people (usually men) unnecessarily when no praise is due.  All Fleming did was go on holiday. Did he culture the fungi so we could extract the antibiotic? No. Did he engineer its mass production to save lives? No. Is he really annoying? Yes. It was Florey and Chain, the champions of mass producing this fantastic antibiotic who we should really be thanking*. And also the hundreds of test subjects, many of whom had to drink their own wee to re-extract the precious penicillin, since it is excreted mainly unchanged in urine.

*If you’d like to learn more about Fleming’s undue credit, I’d like to direct you to The Rise and Fall of Modern Medicine by James Le Fanu.

More generally, I’m so sick of everything in biology being smothered in male praise. Smothered in Nobel prizes for these unbelievably advantaged humans, humans who without the money being thrown at them, without the systematic privilege they were granted, would never have achieved in such revolting abundance. It makes me desperately sad to think of all the nameless faceless people who will never be spared a thought for their role in the story of scientific discovery, just people they weren’t a big fat shiny rich bearded white man.

I’m exhausted from everything in biology being named after men. The pouch of ‘Douglas’, a sack in between the guts and the uteruses of most women, named after DOUGLAS. Oh, by the way, he’s a man. Cooper’s ligaments, the things that hold up my tits, named after COOPER. Bartholin’s glands, these are glands either side of your vagina that frequently become inflamed (of which one of mine currently is). MAN. TOO MANY MAN.* Every single little festering part of my female anatomy seems to have had a man’s name firmly adhered to it. I just want to wield an umbrella and swat away all these unwelcome names from my innards.

*Sorry men, most of you are great

Clitoris_inner_anatomyAnd just to add insult to injury, did you know that the clitoris, in all its glory, was not discovered until 2005? In our anatomy class, whilst we have lovely detailed model penis’s from 20 years ago to learn from, we had to use an improvised plasticine model made by our lecturer for the clit. In reality, our clitorises are kind of like a giant four-pronged claw.

Okay so item 2 done, one more item of hatred left. Item 3. I used to be scientist, I spent nearly 5 years in the lab slogging away for a PhD in genetics. And I am so sick with rage about these ‘accidental discovery’ stories. Oooo isn’t science a happy accident! NO IT’S NOT. It’s carefully planned and plotted, meticulously followed through and painstakingly recorded. These accidents are far too celebrated. We should, I believe, direct our rage at them instead. Even if these happy little accidents of discovery do happen, they shouldn’t, because it annoys people. Like me.

So I hope I’ve convinced you to also hate Fleming. Penicillin is quite good though, I suppose.

I’m back to medical school this January, and instead of learning about pregnancy and childbirth I wrote this highly questionable blog post. Please do feel free to challenge my ideas.

Also a note – instead of moaning about men, we should move forwards in society by sharing both the success stories and oppression stories of all humans. I’m a bad example and I’m sorry. More morally palatable posts will follow.

Happy New Year!

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.