So I think I've found a new webcomic

Consistent, funny and smart. You should go check it out.

sci-ence.org - a skeptical comic and blog

Why I may never eat crab

My wife is from Maryland and loves eating crabs. She promises me an almost transcendental experience next time we go back to visit her parents - we'll eat crabs fresh from the Chesapeake Bay, sprinkled liberally with Old Bay. I've never eaten crab before and thought it sounded wonderful. Notice the past tense there.

I was down with that until this week's NEJM showed me how eating crab can go wrong. The kind of wrong that comes with haemoptysis.

Paragonimiasis

So this is the New Year

Aside from losing what little hair I have left over a project which developed a life of its own, broke out of the laboratory and terrified the local villagers, I've been listening to The Making of Modern Medicine, which was originally a series on BBC Radio 4 which follows the evolution of medicine from the time of Galen and the humours through to the mid-to-late twentieth century and high science.

Andrew Cunningham speaks eloquently and with good humour on a topic which I think too few medics have any notion about. In much the same way it behooves us to know how our own countries were born and a how they impacted the world, I think medics should know a bit about where medicine (as an art, as well as a science) comes from. The story has a very engaging narrative and includes, where appropriate, actual documents and notes made by doctors from the ages. Obviously it cannot cover absolutely everything, given that it covers several thousand years, but I think the editorial decisions made about which topics to focus on are well chosen.

For me, the biggest take home points for me were how we as modern medical students owe almost everything about the current teaching style to post-revolutionary France. "Little reading, much seeing and much doing" was the message from the teaching hospitals of Paris of the early 1800's - institutions which did not previously exist at a time when medicine was more about lectures and watching someone else dissect or perform examinations, rather than the student getting stuck in. The other resonant message was how medicine has moved from the times of Galen and Hippocrates when the patient would tell the doctor that they were unwell to the more modern, scientific world in which the doctor tells the patient when they are unwell - Indeed you cannot be unwell until a doctor says that you are unwell. I don't want to come off as reductionist about that point I can't help but feel that something has been lost there (as regards communication and relating to patients), something subtle but important.

Anyway, it's a great listen and very good value for money (6+ hours) - excellent gym fodder, when you want to take a break from the books and want something medical but light-hearted and engaging. And maybe someone else to read for you!

Amazon (UK) link: The Making of Modern Medicine
iTunes (UK) link: The Making of Modern Medicine

Clubbed to death

Causes of Clubbing

A friend of mine wrote this rather neat guide to the causes of clubbing, for those times when you want to wipe that supercilious smirk of the Reg's face following the question "Well, what does clubbing mean?".

Add him on your RSS reader of choice and follow him on Twitter - he does this kind of thing more often than is entirely healthy for a med student!

A liver is not just for Christmas

A story on the BBC health website (generally a handy resource, I find) on how "detoxing" by staying off the booze for a month is pretty pointless:

"Detoxing in January is futile, says liver charity"

I'm not overly surprised at the stance, but it's nice that there is a statement from the British Liver Trust on the issue. Certainly, if people can be convinced that moderation rather than abstinence is a safer, healthier and perhaps more importantly, more achievable goal we would all be for the better - patient and doctor alike.

Seems a fitting start to the new year.

Christmas: The other silly season

I hope you've all had a lovely Christmas/ Holiday period and I'd just thought I'd share a couple of corking papers in this month's British Journal of Medicine. Traditionally, the BMJ treats Christmas as a bit of a silly season when it comes to content and publishes papers which might be considered a bit frivolous at other times of the year. Anyway, these are my favourites from this year:

"Relevance of the expression “obs stable” in nursing observations: retrospective study"

"Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study"

Both papers are freely available as PDFs for your consideration.

See you all in the new year!

Long weekends and tiny epiphanies

I think I know how the panda feels sometimes

The last three weeks I've been running a project looking at communication between doctors and patients.

The last weekend I lost my brand new (less than 24 hours old) iPhone 4S.

These seem like relatively unconnected events, other than that they both happened to me. One, however is a causative agent. One is a symptom.

I know it is the most over-used cliched post for a blogger to talk about their experiences of depression. We get it, you feel blue sometimes, get over it etc. etc. But this past three weeks have had me becoming re-acquainted with something I thought I was entirely over. In what I now view as a former life, I was lab monkey who worked by themselves for 8 hours a day in a lab where I was the only person there, for months at a time. During that job, something broke inside me. I tasted despair and such crippling psychic pain that I had days of missed work where I would pad around my crummy flat and wonder what would happen if I just stepped out in front of the bus that went to my job, rather than getting on it.

It was, to say the least, not a time I remember fondly. The more I've learned about clinical depression, the more I am sure I was suffering from it. Not that I ever sought medical advice at the time or subsequently. I probably should have, with hindsight. But whatever. I think the loneliness of working a job that was going anywhere, by myself damaged me in a profound way.

I've written about this before in a brief post when it seemed like a more distant time.

Things changed when I moved to London, started nursing and making a positive difference in the world. Everyone I helped, healed me a little bit. I worked as part of a team who spent a lot of time together, worked hard, partied hard. I got married and learned to trust and share my space with someone. Learned that maybe I didn't have to bear the occasional weight of existential dread by myself.

But running this project for the past few weeks has involved me living as an observer, watching, not interacting or involving myself in some of the sadder aspects of human existence. 8 hours a day, by myself, in a crowd of people.

I think you can see where this is going.

I didn't pick up on it at first. Then slowly things happened. I passed up on going to the gym. On going to my Krav Maga classes.

Then I went drinking on the Saturday night. I was back with old nursing friends and we tied one on. We painted a small patch of Soho red. It was an explosive release of... Something for me. And I got drunk. blind drunk. In the process lost my 'phone and didn't care, because I was too busy drinking and trying to savour being a part of a group again.

Monday I was still a bit hungover. But, I pulled myself together enough to get stuff done and in recounting the weekend to med school friends, suddenly realised what was going on in my mind. This realisation has made all the difference. I'm now spending my spare time on the ward revising and learning and talking to the medics. Engaging with the world.

I guess my point in all of this is sometimes you're not as healed as you think and maybe it's a reminder to be on your guard against demons you thought you'd vanquished.

(Oh, and the sad panda shirt is from the A Softer World line at Topatoco)