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.

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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.

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.