The Daily Rhino

Death of a GP

2008-12-22T22:33:00.003Z

Dear Lord Darzi,

I’m an SHO – sorry, CT1 – and have never had any inclination to become a GP. Hence, in my somewhat selfish way, I disagreed with, but largely ignored, your infamous polyclinic plans. Yet two funerals I attended this year brought into sharp focus why I, and thousands of doctors, feel polyclinics are a step in the wrong direction.

My mother’s younger sister met her husband at medical school in India and mirroring countless similar couples, came to the UK in the 1980s to start a family. Both worked as hospital SHOs for a time before becoming GPs in the north of England.

My aunt stayed at the same practice for many years, becoming a fast favourite with patients due to her caring nature and comforting smile. She raised my two cousins, the eldest of whom is now an F1. My uncle also excelled in his career and expanded his practice immensely. He pioneered many new initiatives, sat on various committees but never forgot his priority was his patients. His devotion to their care won him a profile in the Daily Mail as ‘Britain’s favourite GP’; secretly nominated by patients and staff. He found the whole thing embarrassing.

Both would routinely go far beyond the call of duty for their patients. Yet they would be the first to tell you that they were not exceptions. Their dedication to care, the relationships they built with patients and their place in the community is shared by GPs across the UK. Genuine family doctors.

Their diagnoses of two different cancers came years apart, but they died within three weeks of each other this summer. They were in their mid-fifties and desperately tried to keep working as long as they could. Both felt most comfortable in an NHS hospital when unwell.

I organised both funerals in the same crematorium. Its capacity was one hundred and on both occasions it was filled more than twice over. I enjoyed chatting to patients who simply felt ‘they ought to be there’. They emphasised how they regarded my aunt and uncle as honest friends, who they confided in, trusted and who never hesitated to tell them the truth.

A tall man with long hair, tattoos and a leather jacket, smiled when he thought about my uncle’s place in his life:

“I’ve had seven children, three wives and four houses...Dr X has been the only constant in my life!”

It is this one line that makes me fearful the British public’s relationship with their most important doctor will change forever.

My cousin wants to follow in her parents’ footsteps as a general practitioner. I want her to be able to experience the lasting relationships with patients my aunt and uncle did. I want her to be a constant in their lives.

Real Doctor

2008-07-11T15:31:00.005+01:00

Originally published in the June issue of Medical Student Newspaper.

THE very first plasty I wrote after graduating was entitled 'Pretend Doctor'. So it seems rather fitting that my last column as a foundation doctor (the first two years of training) carries the title of 'Real Doctor'. It has taken me two years before I felt ready to describe myself this way, but after last weekend I realised my two F-years have taught me more than I realised.

Some months I have to struggle to find something to write about. Other months it is immediately apparent. I didn't even have to think about the subject matter for my final column as I recently experienced one of the most memorable few days I suspect I will ever work through.

I am currently working in ITU and thoroughly enjoying it. I have been looking forward to this job all year and am considering it as a career choice, but it has only recently dawned on me how ITU is as much about death as it is about saving lives.

During my last weekend on-call, our unit had five deaths within about sixteen hours. None were unexpected, but all were quietly heartbreaking. Two stood out and taught me skills I know I'll find useful throughout my career. The first case was that of a 27 year-old man I shall call Stephen. Stephen had been in the unit for the best part of three weeks. He was admitted with a severe pneumococcal pneumonia on the background of pulmonary sarcoid. Over the days he had developed horrific ARDS with multiple broncho-pleural fistulae and bilateral pneumothoraces.

He was critically unwell for the majority of his stay, dramatically hypoxaemic and hypercapnic, before entering multi-organ failure. By the weekend I was on-call, he had four large-bore chest drains in his chest and quite astonishing surgical emphysema all over his body, puffing his face up like a beachball.

Stephen also had an amazing family. His siblings and parents took shifts to keep him company (only two visitors are allowed at a time) and made sure his favourite records were always spinning in his room. He had an enviable soul music collection, with Marvin Gaye, Stevie Wonder, Smokey Robinson and Billie Holliday constantly vying for attention with the sound of Stephen's high-frequency oscillatory ventilator.

His family were understanding, grateful, calm, realistic, loving and clearly brought closer together by the slow deterioration of their son and brother.

On Saturday chest drains numbers five and six were inserted to attempt to further re-inflate his lungs. He now had three drains in each hemithorax. All six were on suction and bubbling furiously away.

About half an hour before I finished my shift, Stephen's nurse called me in a panic. One of the new drains had stopped bubbling after draining some blood. I realised the tube had a big clot in it and tried to unblock it. This proved somewhat tricky as the clot extended along the entire length of the tube. As I asked for a bladder syringe Stephen's blood pressure started dropping. His systolic fell from 90 to 60 in less than a minute.

Marvin Gaye provided the backing music.

With metaraminol in one hand and the bladder syringe in the other, I nervously kept his BP propped up. I thought this is probably the kind of thing my SpR should know about, but she was speaking to another patient's family. They were in tears, asking her to pull the plug on their loved one, yet she had to rush out midway.

Before she arrived Stephen went into PEA arrest and I started chest compressions. A cycle or two into CPR, Stephen still had no output. I was sure the chest drain was the problem but unblocking it was not easy. Suddenly an idea hit me, one that was both a product of following simple guidelines and attempting to diagnose the problem.

It was Stephen's 28th birthday. Meanwhile, Al Green was singing.

I pulled an orange cannula out of the crash trolley and plunged it deep into Stephen's left chest. A whoosh of air was followed by a recordable blood pressure and a pulse. I'd done it. A tension pneumothorax is such a film and TV cliché but for obvious reasons, it's as dramatic as hell.

I wanted to be the one to talk to Stephen's family. I am not sure why, was it anticipating the kudos I would receive after telling them of my actions? Or was it simply because I had developed a relationship with them and wanted to be involved? They were, as always, quite remarkable. They seemed genuinely concerned with thanking Stephen's nurse and me. Whatever bravado I had felt melted away as I realised that despite my proud moment, Stephen was in the same position he was in half an hour before.

By the time Stephen died, aged twenty eight and one day, within a day of this tumultuous episode, he had seven drains in his chest. A final blow was dealt when the transplant team, requested by his family, opened Stephen to find not a single viable organ.

Another death at the weekend was that of an old friend, a 70 year-old I will name John. I say old friend because I had known John for eight months. I met him in A&E and got to know him and his family during my four renal months, during which he was an inpatient for the entire duration. John had a past medical history as long as your arm and what I thought was the family from hell.

The entire renal team was wary of them. They were abusive, demanding, unfair and sometimes malicious. In fact I wrote about them once before because they drove me up the wall. John paid me a visit in ITU; his fourth admission there.

I warned colleagues: "be careful with that family" but soon realised that it was the renal ward they had trouble with, not any individuals, as they were perfectly friendly to me in ITU and indeed sought me out as someone to talk to as I was a familiar face. John became very sick very fast and suddenly I found myself in the breaking bad news mindset. Once again I took close family into the 'relatives' room' to suggest he had only hours remaining.

From the first time I met John he was bed-bound and withdrawn, but I learnt he was once a proud patriarch of a huge extended family. His two daughters and his wife remained by his side as the months had gone by and whilst I would once have ducked into the doctors' office to avoid a confrontation, now I saw three women losing the man of their house. I was overcome with guilt. I should never have let myself dislike these people.

John's wife, who had become quite motherly to me over the weeks and months, surprised me. She leapt up to hug me and said "I'm so glad it was you." I can assure you I wouldn't be glad if I was my doctor but I think one recognisable face in the bustle of ITU was reassuring.

Later I was with another patient and my SpR came over in floods of tears.

"What's wrong?"
"It's John, his whole family's there and it's just so sad. They're asking for you."

I nervously parted the curtains around his bed and found about twenty people crying, holding hands, saying prayers. It was clear that John commanded utter respect from those around him. It would have been nice to know him as his former self.

His wife brought me right into the middle of the throng and I felt like a complete imposter. Did they know how I used to feel about them? She told me that I always treated John like more than just a patient, that she would be sad she wouldn't see me again and that I will always be in her prayers.

I definitely did not deserve this. The feeling of guilt at receiving praise I was unworthy of, combined with the real happiness that I had made something of a connection with this family was unusual. I am sure I won't forget what John's wife said to me, perhaps even more so because of our colourful previous dynamic.

Corny or not, I can honestly say I will remember this weekend as a seminal point in my career. The moment I realised I am a doctor that can save a life - albeit only postponing death for a day - and that can make an emotional connection with a patient's family.

In the nicest possible sense, I hope you all experience an occasion in your career where you are forced to exceed what you thought were your limitations. When I finally got a day off several days later, I was exhausted and drained, but I had never felt more positive about my job. These are the experiences that teach you more than any DOP or CbD ever could.

After four fantastic years editing and writing Medical Student Newspaper, I can finally switch my bleep off. Good luck.

They hate you

2008-05-13T13:17:00.001+01:00

Originally published in Medical Student Newspaper.

BECOMING a doctor isn’t what it used to be. Communication skills, ethics, breaking bad news and familiarising oneself with the Job Centre would be foreign to medical graduands of the past.

Doctors have rapidly changed in their training and their demographic. Yet some things remain constant. We still have one aim - to cure the patient. And our roles as hospital leaders family doctors continue unchanged. Well…not so.

Within the health profession we are constantly under threat from government interference, nurses encroaching on our duties and hospital managers breathing down our necks. At work, we are no longer masters of our realm, but commodities.

So surely we can rely on a cheer that has buoyed generations of doctors, the love and respect of our thankful patients. Sorry, wrong again.

I am not referring to irate patients at the GP’s surgery nor pushy mums in A&E, but the particular section of the public that calls themselves the media.

You are, almost certainly, an avid reader of Medical Student Newspaper (right?!) So you might well believe that all newspapers regard doctors with the same awe and overt love that we do. But, do you know, you’d be wrong?

The simple fact is that the media hates you.

Make little mistake about this, for if you have not yet noticed it then bear it in mind as you survey the national headlines for the next few weeks. Soon enough you will see that doctors are viewed as over-privileged, over-paid, greedy, incompetent simpletons who sap money from the public sector.

Five years ago an article in the BMJ, which surveyed a small group of junior doctors, found that new medical school graduates were increasingly disillusioned by media attitudes to doctors, and ‘doctor-bashing’ became a familiar term.

The phenomenon has snow-balled. The phrase ‘doctor-bashing’ was coined some twenty years ago but the seeds were planted far earlier than that. The American writer Ambrose Bierce quipped at the turn of the twentieth century, “Physician, n. One upon whom we set our hopes when ill and our dogs when well.”

It is clear which particular breed of doctor has the roughest time at the hands of the journalist, the general practitioner.

Venerable, cardigan-wearing, bespectacled family doctor with a pot of lollipops. Dangerous, selfish, lazy fatcat. The criticisms range from mischievous generalisation based on a bad experience, to mean insults and fallacies.

Britain appears to suffer this peculiar ailment most grievously. In the US, where admittedly the whole health service is markedly different to ours, success is admired and applauded. If a doctor earns well, there is no assumption he or she has done it at the expense of patients.

Whereas here, doctors are thought to uniformly earn stellar salaries which should mean they are public servants with a job description the patients are free to adjust.

Why has the media decided to demonise the medical profession? The negative portrayal of doctors is now cited as one of the more demoralising aspects of working in medicine in the UK.

Papers and television news love a scandal. Sensational stories about dodgy doctors are understandably popular in the press. However the rest of us soon become tarred with the same brush as Harold Shipman.

Key accelerants to the growing hatred of medics were the recent consultant and GP pay deals, offered by the Department of Health. The pay rises afforded to the average NHS consultant and the average NHS GP were indeed generous and whether they were deserved is, in fact, entirely immaterial. The fact is that doctors have born the brunt of media fury at the deals. Somehow we are to blame for a deal the government put forward; we are the bad guys for negotiating a good deal.

In a nutshell, GPs agreed a few years ago to take a small pay cut in exchange for avoiding out-of-hours work. Seeing as it has been established that doctors are lazy, columnists are keen to point out that they cannot get an appointment when they want. This means after they have gone to work, picked the kids up, walked the dog and gone to pilates. So somehow, their life and their commitments outweigh those of the GP, who should make the time.

Much as it warms my cockles, even a retrograde cynic like me will acknowledge the move away from the paternalistic ‘doctor-knows-best’ attitude was healthy. And it would be churlish to suggest that doctors don’t make mistakes. We should be open in our admission of mistakes, but increasing litigation makes this difficult.

I am particularly conscious of the public’s attitude towards doctors this month, as I was asked to be a guest on the PM Programme, on BBC Radio 4.

The PM research team had been reading an old issue of Medical Student Newspaper and came across the first piece I wrote as a doctor, which concerned ash cash, the fee paid on completion of a cremation form.

It is a very interesting topic and I wish debate ensuing the programme had been as stimulating. However it proved to be a very depressing experience. With some subtle editing I had been made to sound a little crass (mentioning ash cash is used on every day items such as food, rent and alcohol after a grieving daughter expressed her sadness at paying the fee when her mum died), but overall the experience was not too harrowing.

The BBC website and NHS Blog Doc (legendary blogger and former Medical Student Newspaper writer) picked up the story and became hotbeds for debate. The deeper concepts of coping with death as a house officer, the unpleasantness of funerals and the legal implications of what the cremation form means were not examined. Instead the comments from members of the public morphed into one hundred and eighty two savage assaults on doctors’ salaries (I made the mistake of referring to an F1’s pay as ‘meagre’), our arrogance, our insensitivity and even allegations of gross misconduct.

When commenters expressed outrage that they should pay for a funeral, I suggested they should also be annoyed at the undertaker, who charges far more than a doctor. No. Let one thing be clear - the anger was squarely aimed at the doctor, no one else.

Some alarming misconceptions came to light (that we demand the fee from relatives, that we’re paid overtime, that cremation forms are private work done on NHS time), but if I tried to point them out I was ignored or shouted down. A few valiant doctors also attempted to calm the furore but to little avail.

The more sinister reasoning behind the increased dislike of doctors is that, coupled with MMC, there is a concerted effort to undermine and break up doctors in the UK, so that as we are replaced by nurse practitioners, we have no unified voice or public support to support us.

Like that fat kid in school, now no one likes you.

Incendiary views

2008-04-20T02:21:00.002+01:00

I WAS on the wireless today. It's not the first time - I was on Anita Rani's show on the BBC Asian Network talking all about porn, but that's another story. Today I made it, interviewed by Eddie Mair on iPM. Like most people, I despise hearing my voice, but it could have been worse. I was asked to comment as a piece I wrote for the paper about a year and a half ago was picked up. The topic under discussion was ash cash.

No sooner than one British establishment featured the DR, another did. Now I've really made it. The great Dr Crippen talked about ash cash too, which is why I thought I'd write this quick note.

The passage quoted on Dr Crippen's and iPM's blogs is tongue-in-cheek and I take any accusation of being insensitive on the chin, for it is deserved. But the passage should be taken in context, so do please read the rest.

Dr Crippen does indeed make the exact same point I did in the extended interview, hospital doctors who deal with death on a daily basis utilise coping strategies that are insensitive. When we talk about getting your ash cash from the ash point, or make jokes about celestial transfers to the big ward in the sky, it is merely a way of distancing ourselves from the fact someone has snuffed it. Crippo's right, we don't develop the same relationships with our patients that a GP might (well, polyclinics will see an end to that).

"I wish I was young again so that it could all be fun and “ash cash”, but I am no longer young. My skin is no longer Rhino-thick for now I understand what I am doing, and how important it is that I do it properly." [Link]

I enjoyed reading some time back that the venerable NHS Blog Doc describes himself as a curmudgeonly git, as this is how most of my friends would refer to me. Whilst I have maturing to do before I reach Crippenesque gravitas, it does not mean that youth eschews pathos.

Sure we joke and pick up our ash cash cheques, but I think we all spend a quiet moment contemplating the elapsed life we are signing off into the flames. In its great early days, Scrubs occasionally featured some great lines. JD looks at his first dead patient and says "he looked exactly the same, only completely different."

Moments like this, and fumbling awkwardly for a pacemaker across a cold corpse, are the experiences that stay with you and shape your development in medicine. But they're put away and covered by tasteless jokes at the pub. Just the way, I feel, it should be.

Scrooge McDoc

2008-04-19T18:59:00.000+01:00

Originally published in the April issue of Medical Student Newspaper.

YET another horrible, horrible month rolls around and curse you Satan, curse you, I'm still alive.

Something's gone terribly awry as I am working a nightshift in A&E...when I don't have to. Yes I have voluntarily taken a locum shift in the hellhole that spat me out four months ago.

In fact this is just one in a line of locum shifts I am making a tradition. One nurse takes great pleasure in teasing me, "ooh look who's back, he who said he would never step foot in here again! You love it really."

How wrong she is. The question is then begged: why am I here? I don't seek to answer this in quite the metaphysical way Aristotle intended, but why am I seeing a perianal abscess at 1am? The only reason people do anything, money.

Once upon a time I used to pride myself on being quite an enlightened soul. Sure sure, this sounds funny NOW but only because you know me as the shallow git I undoubtedly am. However money never used to be high on my life's agenda.

I suppose any doctor would say the same - we're all in the wrong profession if money was our primary concern. But I really was other-worldly in my disinterest with money. I was generous and thought I would work for free as long as I had a roof over my head.

What complete gash. Over the last few months I have become the guy Scrooge McDuck aspired to be, well except for the swimming in your own money thing. That ducker still trumps me there.

I seem to spend my every waking minute thinking about money, whistling Pink Floyd's Money and carrying the FT. Just carrying it, I can’t read it. Now the reason I have subjected myself to additional A&E (along with some medical SHO) locums become clearer. I want money.

I think I can pinpoint where my slide from Buddha-like nirvana to cash-hungry Scotsman happened, and like just about everything in my life, it revolves around jobs.

It was only when I actually got a job that the immense stress on my shoulders became apparent. For months I had deluded myself that I was a chilled out cat, unaffected by job applications and an insecure future. In reality I never realised how much I was suffering.

I'm not alone. Perhaps 50% of my friends are still without employment come August. Feeling insecure about the future is a horrible thing and it had engendered a passion for money I had never experienced before.

With money, I felt I would be able to absorb the blows dealt to me by unemployment, I thought my Benjamins would help me roll with the punches. I spoke to senior colleagues about how much cash I would have to sleep on when I got to their level.

Horror. It turns out I'm earning more than my registrar. Sweet Jesus, several more years of hard graft and my pay will go DOWN.

Not only were my hopes of having a money-mattress dashed, I realised I wouldn't even have enough notes to light cigars with. 'Twas at this point I resolved to turn my efforts towards lining my pockets with the green.

Hence why you find me here, volunteering my time in the place I hate for the sum of £30 an hour. Sounds quite tasty, right? Certainly more than an SHO could expect to make in a permanent post. What if I just worked locum shifts? I calculate I could have an annual salary of £72,000. Not actually that impressive when I consider my best mate, who was at uni half as long as me, is on the same figure plus bonus and his company are buying him an Audi R8. I still drive my Nissan Micra.

As it happens, I know someone that decided to do exactly this, be a lifelong locum. He now owns five properties. The crucial difference is he is a GP. An agency I am registered with lists the following pay rates for hospital doctors: F1 - £21/hour, SHO £30/hour, SpR £34/hour and consultant £46/hour. The rates are the same irrespective of time or day.

For general practitioners, who will now be fully qualified five years out of medical school have slightly different rates: Mon to Fri - £100/hour, weekend - £125/hour and bank holiday - £200/hour.

The positives, let's concentrate on the positives. 20% discount at Nando’s. Back of the net.

Despite my enjoyment at reaping the rewards of locum shifts, they do represent a short-sighted waste of money by the NHS. A recent BMA survey shows that 30% of junior doctors are working on teams with at least one vacancy. My team has three. Hospitals spend money on expensive locums to cover shifts, but most of the time hapless SHOs and SpRs are strong-armed into ‘working a few extra hours’.

These vacant posts, all the more risible when thousands of SHOs are unemployed, are a legacy of MTAS and this year’s unnamed successor.

Consider two systems, both flawed. Years ago the SHO slaved away for three hundred hours a week, slept once a fortnight, knew all the patients and learnt bucketloads. Now I work a shift system, have an astonishing four handovers a day and there is practically no continuity of care for patients. Surely there is a middle ground?

As juniors’ training hours are slashed by the European Working Time Directive, and the time it takes to become a consultant is reduced by the government, we move towards a scenario where tomorrow’s consultants have perhaps a quarter the experience of present-day consultants. Likewise, practical skills suffer.

A renal job should mean getting to do loads of central lines. Sure…provided there is no team of specialist nurses inserting all the lines. They’re good at what they do, they’re cheaper than an SHO and don’t move on every four months, so why would a trust want a doctor doing these procedures? This way the number of expensive and troublesome doctors can be cut.

A superb plan. Except for the fact that I severely doubt the venous access specialist nurses will be around at 2am when a patient has crashing septic shock and needs a central line. But I will.

Suspicious behaviour

2008-03-21T01:33:00.000Z

[via BoingBoing]

When I first saw V for Vendetta I was not overly impressed, but enjoyed the dark prediction of where London and the UK are heading. Perhaps we're one step closer. Many of you will have seen the asinine Met Police campaign that suggested we are too stupid to make common sense decisions about people with cameras and that somehow the Police are effective on acting upon tips. I love the fact that one poster alerts you to the dangers of people with more than one mobile phone. I might have to report every single Gujurati I know.

Here are some responses.

From illegalphotos

From Rubin110

From Mr Atrocity

From Citizen.Kaned

From thornae

The Renal Angle

2008-03-20T22:59:00.001Z

Originally published in the March issue of Medical Student Newspaper.

I'M desperately trying to avoid writing about the rhino sitting on the elephant riding a unicycle in the room, again.

You’re bored of my ramblings about jobs, applications, unemployment and emigration. OK you’re bored of more than that. You’re bored of my tangential offal, lazy similes, dull subject matter and self-endulgent banter. But you’re still reading so haha up yours in your face pwned roflcopter lollerskates lmaonade lollercaust lollergeddon!!!!11!!!one

Hence I will endeavour to side-step my impending joblessness by telling you about the joys of renal medicine. Stop laughing.

I started this job having been a doctor for sixteen months and the step-up in responsibility was immense. I cover all renal, access surgery, dialysis and transplant patients and much of the time there is no registrar on-call with me. Just me and one of the country’s biggest renal units. Uh oh.

Getting used to dealing with critically unwell patients is part of being a hospital doctor and after my A&E resus experience I am feeling more confident. However an unexpected duty has been the referrals and calls for advice I have received from several other hospitals and local GPs.

At first I was apologetic and bumbling when GPs asked basic questions but as my ego grew in stature, I became more confident. Patients may still refer to me as ‘the one who doesn’t look old enough to be a doctor’ but on the other end of the phone my tenor tones could be anyone.

Recently I took a call from a teaching hospital, where an A&E SHO had seen a dialysis patient and wanted to arrange a transfer as he was ‘due dialysis’. It transpired he was septic and far too unstable to transfer, so I was surprised this doctor hadn’t sent him to ITU. Secondly, when I asked if he needed to be dialysed, she had no idea how one would decide this.

I walked her through the basics of fluid assessment and electrolyte control, much as I do with third year medical students. It was only when she gave me her name at the end did we both realise she had been an SHO at my previous hospital, several years above me and signing my DOPS.

Roles do often reverse when rotating around medical specialties. From the A&E grunt making the referrals, I am now taking them. I fight my natural tendencies and try not to be an arse, as I know how unpleasant referring to a dickhead is.

I don’t mind being called by house officers - I remember what it was like and I remember not needing to study much nephrology to pass finals. So I try to emulate the specialists I’ve enjoyed talking to and take time to explain renal physiology or the concepts of dialysis.

However when a surgeon calls, I have a little fun. Like the cardiothoracic consultant who asked his SHO to call me due to a rising creatinine. I suggested perhaps the new prescription of trimethoprim and the gentamicin level of 29 (aim <10)>

“Is the renal function normal?”
“Yes.”
“So it sounds like a urology problem, not a renal one.”
“But it’s renal colic.”
“No, it’s urology colic.”

A big poster at work tells me to ‘Save a Life, Give Blood’. Right on. Clearly some people think this is a cop-out. In light of the recent kidney-harvesting ring rumbled in India, I discovered a phenomenon I had never previously known about.

Donating a kidney is amazing. Doing this for a loved one is understandable, but I was immensely impressed when I first met a guy who was giving a childhood friend his right kidney. Yet nothing prepared me for the ‘altruistic donor’.

This is normally a man (in my experience) who wakes up one day and thinks “you know, I have too many kidneys”. He decides to undergo general anaesthesia and have half his piss-making equipment chopped out - for someone he will never meet. It’s quite astonishing - even a curmudgeonly git like me can be impressed by truly generous people, however loonie I think they are.

The bastard son of MTAS

2008-02-01T18:33:00.000Z

Originally published in the February issue of Medical Student Newspaper.

GOOD morning my friend! A warm good morning to you all. I love you, faithful readers, I love you with all my heart. But sadly I wish to commit heinous murder upon you at this present juncture in time, and indeed upon anyone that gits in mah way cos I is mad.

What, you might ask, has made such a normally cheery (I can be cheery) soul like me so irate? Did that A&E job finally make me crack? On the contrary, I finished it since I last saw you and have moved onto renal and transplant medicine. Wonderful wonderful.

Was it a bothersome patient what yanked my crank? No, I have been tolerating humans quite well recently. Is it the fact that my girlfriend’s Mum is staying with her for a month? Yes you’re quite astute, that’s probably not helping BUT it ain’t the root cause.

You’ve guessed it – job applications. I have brought you MMC news from the coalface over these last sixteen months, but at no point have I ever felt so low. Sure I’ll be cracking jokes in this piece, but secretly (and by writing this here, not secretly) I want to end my life. And I haven’t forgotten about murdering you either.

So what’s the dilly-yo? In a nutshell, for those shitbricks that haven’t been paying attention for twelve months, in 2007 the government unleashed its full wrath upon those lazy doctors and made tens of thousands jobless. 28,000 doctors applied for 15,500 jobs.

They did this by installing a woeful new application system, reducing the number of training posts despite record numbers of new graduates and not accounting for the many overseas doctors that work here but inviting a lot more in.

Thousands of junior doctors, many of whom are my friends, left the country. No one outside the rank of SHO seems that annoyed, so please do tell non-medics why they should be. Each of these doctors cost a quarter of a million pounds of taxpayers’ money to train. We, as a nation, have just let hundreds of millions walk out of the door. Australia, New Zealand and Canada’s gain is our huge loss.

I never thought I was the ‘leaving kind’. I love London and want to stay. That could be my downfall.

This year, it is worse. We were reassured but I think we all knew this to be false. However, last year we were provided with some ammunition. The Tooke Report, detailed in previous issues of this newspaper, made two key assertions. First, that government involvement with the training of junior doctors must stop. This has not transpired. Secondly, that the European Working Time Directive (which I recall being my first cover story as editor in 2004) is detrimental to junior doctors’ training by preventing sufficient hours learning on the job.

Reasons things will be worse this year include: many of the jobless SHOs from last year will be competing with this year’s glut for the same finite amount of jobs (in fact less, as much of the run-through allocation is filled). A recent ruling means that British-trained doctors are given no preference to overseas doctors when allocating jobs.

Overall, an estimated 22,000 applicants will compete for 9,000 jobs. Friends in other professional disciplines often seem confused as to why this is a problem. “Competition is healthy” they say, echoing what the government has been trying to dupe patients with. The key point is that in the UK, doctors can only train in the NHS, there is no alternative as there would be in a bank or law firm.

Continuing on from this analogy, consider my story, which I fear will be typical.

Today I received an email from Oxford Deanery, telling me I have been invited for interview in six days. I have heard, from an unsubstantiated source, that about five hundred applications for Core Medical Training were received by Oxford. They have 27 jobs to give away. So I am delighted I have been granted an interview.

But I have applied to both London and Kent, Surrey and Sussex because I, like a vast swathe of my colleagues, have been scared shitless by what happened last year. I have tried not to hedge my bets and end up jobless.

Let’s imagine I do well in the interview (you need a fertile imagination) and am offered a post. At this point I know none of the following: which hospital(s) I will be working in, my pay, my rota nor what firms I will be doing. Yet I have 48 hours and nor more to accept. If I don’t reply, I am assumed to have rejected the offer.

If I accept, I have to withdraw from all other Deaneries. The only problem is, London make their offers two and a half months after Oxford. So if I decide I want to wait it our for London – and then get offered nothing, I will have thrown away a job. Or if I hold out for London and get given a job I don’t want, I would rather have stayed with Oxford.

Taking our comparison back to banking or law, which companies do you know that would make a job offer with no details about the job whatsoever? Which industries can you think of where the boss doesn’t choose his own staff? And although some jobs make you move around the country, which gives a few weeks’ notice as to location, forcing the employee to sell, buy and move houses in a month?

Lastly, see if you know any banks or consultancies that would send this message to its employees. My ultimate boss, the government, sent all junior doctors a letter in January. It essentially said “don’t apply for anything competitive, you probably won’t get it. Don’t turn down any job applications, you will be lucky to even get one. Don’t be upset if you end up doing something you didn’t apply for, you should be thankful you’re employed.”

It amounted to: Aim Low. No fucking way any City firm says that to its employees. We’re being grown as a generation of ‘just passable’ docs. MMC engenders a culture of striving for mediocrity.

As I said before, I love London with all my heart. I want to make my life here. But in the last few weeks I have done some deep thinking. I had a hot bath recently – where I do my best thinking – and asked myself one question, “do I want to be a doctor?” I had toyed with the idea of leaving. Friends enquired at banks and they want to start me on £80-100,000p.a. But I realised I like being a doctor. It’s what I’m best at and I want to do it. This was a relief as I had started to have doubts.

The second question I asked myself was, “do I want to be a doctor in the UK?” I now know that without drastic change of far more than just the subject of this article – nurse quacktitioners, paltry consultant opportunities and the media’s attitude to us – I cannot stay here. The system has broken me.

All Hallow's A&E

2007-11-05T03:06:00.001Z

Originally published in the November issue of Medical Student Newspaper.

IT’S HALLOWE’EN in A&E. I start my shift at 10pm with a few minutes’ grace to read some emails. A study in The Lancet examined romances in medical dramas and found a “marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine”.

Two out of six. As I can’t really take any credit for being male, I better try to enjoy my last month ‘working in emergency medicine’, which won’t be easy.

My first patient is what we politely refer to as a complete loon. I’ll call her Agnes and she’s visiting us from the local psychiatric hospital. Agnes has been sectioned for some time (don’t ask me what number) and hates the psychiatric ward she is on. It quickly becomes clear she is fabricating a story to get out of her ward. The psychiatrist must have seen her, realised he knows nothing about medicine and sent her to A&E.

It is, however, a little difficult to understand her as she has two Nicorette inhalers in her mouth. Not to mention the five Nicorette patches on her abdomen, her brown sunglasses, orange hair, five overcoats and two scarves.

Her sense of humour seems to be intact though:

“Doc, I’m telling you now, if you send me back there I will kill myself.”
“Well that’s convenient,” I replied, “because when people want to kill themselves we send them to psychiatric hospital.”
“In that case I don’t want to kill myself, I want to live!”

I’m rather in the mood for seeing some ghouls and ghosties tonight, and head to Minors in the hope of stitching up a pitchfork-laceration or vampire bite. I’m collared on the way by sister saying two are waiting in Resus.

I generally like working in Resus. You see, the overriding gripe I have about A&E is time-wasters. I have to resist slapping jackasses with nothing better to do with their time than ignore the sign saying “Accident and Emergency” and waltz in with problems they’ve had for years. But Resus patients (normally) aren’t faking it.

We’re short-staffed and I end up seeing two patients simultaneously. This is not only dangerous, it’s confusing. Luckily (for me, not them) they had almost identical problems (chest infections and fast AF) and pretty similar names, so I just said everything twice.

There’s no chance of me getting to Minors to see any pumpkin-heads after I’m finished with the two old boys in Resus, as “people are breaching in Majors.” Nurses always shout this at me under the impression I’m going to care.

A guy who felt his throat was closed for a minute, but is fine now. A girl who had chest pain but thinks it was wind. Then a bad-tempered Francophone jobseeker who broke his foot and was put in a cast two days ago, has a fracture clinic appointment in the morning and saw his GP two hours before coming to A&E. I explained broken feet do normally hurt, but he wasn’t satisfied.

In fact he turned out to be a real prick and I had to threaten to call security, in French, before he left. Not before shouting in Franglais:

“Where you from? How old you? You’re too yang bro! Je veut un autre médecin. Na, na, you got a long way to go.”

Whilst he was undeniably a tosser, he was probably right.

Where are those damn vampires? A frikking zombie at least, please Satan brighten my evening with something macabre.

The three others doctors on duty and myself wade through nursing home specials, neurotic parents, drunkards, asthmatics and more chest and abdo pains than you can shake a steth at.

6 o’clock in the AM rolls around and I realise no fluid has entered or exited my body all night. I decide this is a perfect opportunity to dipstick my own urine, which is so dark it absorbs all light in the bathroom and I piss on my scrubs.

2+ protein, 1+ blood, 1+ ketones. Ketones? I wonder what my blood glucose is? 2.9! Sweet, a new record. I mean, I think I’m going to faint. I rush dinner having wasted half my break investigating myself.

Back on the shop floor and I pick up the next card. “Limb problems” is the non-specific triage category and at last it’s a bunch of piss-artists in fancy dress. w00t!

My patient is not only dressed as an axe-wielding blood-soaked doctor, she’s an absolute hottie (I only mean that in a purely Hippocratical way).

Good-natured drunks are always fun so I act the part. Whilst taking a history I point to her friend in vampire garb and ask, “he with you?” and then examine her neck.

"What are you doing?" asks the friend.
"I need to know if she’s turned."

So she clearly has a thing for doctors and I will be spending the next half hour with her in a small room sewing up her elbow. I silently offer thanks to the Prince of Darkness as my mind turns back to that Lancet article.

However as she’s face-down for the stitching, I (tragically) spend most of the time talking to her friend, who wants to become a doctor. I give him half-mumbled answers as I get so engrossed in trying a fancy mattress-running suture combination on this hapless girl’s elbow.

When I’m done she bounds off without so much as a “thank you doctor, you saved my life” and an unexpected kiss on the lips, or a “how can I ever repay you?” and a lingering kiss on the cheek or even a “call me!” and an airkiss. In fact there was a distinct lack of kissing.

Somewhat confused as to how I could POSSIBLY have been turned down, I remembered I was lacking in brilliance, height, muscles and chiselled features. Soon I would lose my job title of emergency doctor as well. I mulled it over and decided I would rather undergo extensive leg-lengthening surgery than take another A&E job.

I finally allowed the chatter of friend-who-wants-to-be-doctor through and in an unusual display of paternalism, I put a hand on his shoulder and said “son, don’t do it.”

My shift would be up soon and I could grab a Rosie Lee’s Full English on my way home. Working nights eliminates your ability to do anything, so I’ll get back to working on my serum and saving the world from vampires next week. Right now, I’m just the daysleeper.

Quack

2007-10-15T17:05:00.000+01:00

THE geniuses behind Medical Student Newspaper have produced some essential reading for all final year medics in the UK, in conjunction with doctors.net.uk. Quack contains all the knowledge one needs to apply for a Foundation post and more. Join the Facebook group.

My contributions included updated versions of stethoscope psychology, depraved revision, a breakdown of the MTAS saga and the WISE words below.

By the way, Medical Student Newspaper has won yet another award nomination. It is in the running for the Best Student Newspaper in the country at this year's Guardian Student Media Awards. Every year since the paper's inception has brought some silverware; fingers crossed.

How to be the coolest, most pimped-out, badass FY1 at your hospital
What you need to know as a first year doc and what you haven’t been told

The most up-to-date Advanced Life Support (ALS) algorithm. Use this at any stage during your Foundation Years; acutely unwell patients will be a common encounter and you should feel confident in determining whether a patient is cool or whether they need your help. If unsure, feel free to ask “are you cool?” Don’t be afraid to tell your patients to BE COOL.

There is no one way to be a good FY1, or house officer, as you will still find yourself referred to. However there are certain hints and tips that can be imparted by those that made it through. Intact. Unscathed. Ready to fight another day. ONWARD!

First and foremost, your first year as a doctor should be about enjoying yourself. Never forget this. There are many similarities to life at medical school; you will probably live in halls, go out too much and make lots of new friends. The only real differences are that you can’t bunk off anymore, but you do get paid.

The single greatest fear of a new doctor is that they will do some harm to a patient. This, whilst not impossible, is improbable. The reason being that you have spent four to six years learning how to do the opposite.

You are so imbued with misplaced self-doubt when you start working that you end up being over cautious. This is normal. Don’t worry about making mistakes, just concentrate on enjoying yourself and the rest will flow.

Perhaps the one gem of information I wish I had been given before I started was that you did not need to be top of the class at medical school to succeed in your first year of work.

In fact, where you ranked has no correlation whatsoever to how you will perform and you should put it out of your mind entirely.

If the comparison of FY1 to medical school can be extended, then the first week is Freshers’. With most junior medical staff now starting at the beginning of August every year, the hospital will be atwitter with introductions and nice-to-meet-yous when you start.

The first few days are rarely taxing. They normally consist of induction talks, orientation sessions and a gradual easing into the job.

You might turn out to be one of the unlucky punters that kicks off work with an on-call. Daunting it may be, but on-calls are fantastic learning opportunities. Asking for help is something you should never be afraid of doing in your first year. People will fully expect you to ask the most inane of questions, even if you feel like an idiot. Get over that embarrassment and ask – better that than goofing up something easy.

There is also no shortage of people to ask. Obviously your immediate seniors are a logical first step, but the resource you will invariably draw upon throughout your junior years is the nursing staff. If you take one piece of advice away from this article, make it this: be nice to nurses.

Nurses can make your life so much easier if you acknowledge their existence and value their contribution, and they can equally give you grief if you piss them off.

Nurses, like anyone else, don’t like being talked down to by snooty doctors. If you’re not sure what fluids to write up, or what the dose of metoclopramide is, asking a nurse is a good first move.

Having said that, nurses go through a learning process too and might be just as green as you. If you’re unsure about any advice given, there’s no harm getting a second opinion. You will find that the ability to know what is duff advice and what is good sense develops quickly and naturally.

A further word about those nurses. Most FY1s will be ward-based and whilst it is useful to be nice to nurses on-call, it is imperative to establish good relationships with the nurses on your own ward. They can be inordinately helpful if you’re mates. Not to mention that if you can have a laugh with the nurses, social workers, ward clerks, physios, OTs, HCAs or medical support workers on your ward, your job will all the more fun.

This provides a convenient segue onto what is likely to be the bane of your life during the Foundation Programme. Assessments. You thought tick-boxes and form-filling ended with graduation. I laugh at your foolishness.

Working well with those around you will stand you in very good stead for a key part of your overall assessment, the min-ePAT. Out of all the nonsense you are forced to complete in your first year, this is a very useful exercise.

On two occasions you are required to nominate twelve co-workers, of whom only a limited amount can be doctors, to anonymously say what they think about you. As you can imagine, the ability to be frank allows your colleagues to give you what can frequently turn out to be valuable advice.

All that need be said about the rest of your assessments is that the sooner you get them out of the way, the better. Try not to leave yourself a week to get all the forms filled in, it is no fun.

To reiterate, it is imperative you concentrate on having fun in your first year. It comes only once and just about every doctor you meet looks back on their house officer year with great nostalgia and fondness. No amount of hints and tips from seniors will replace your learning-by-doing, so try not to be wallflower.

If something that interests you is happening, be it inserting a central line or an appendicectomy, try to get involved. Be in the right place at the right time, but don’t be a dick – share out opportunities with friends.

Developing confidence comes far more easily to some than others, but ultimately the only occasion it matters is when a patient’s health is in question. If you are seeing someone in A&E or on the ward and you are unhappy about something, never worry about ‘bothering’ your seniors. Whilst it may be surprising to some, no one will criticise a new doctor for being too safe.

Lastly, if you are one of those keen young things that wants his or her name in lights, your first step would be to leave medicine. However if you want to stay, you might want to consider getting involved with an audit, a presentation or two (most hospitals expect a Grand Round presentation from all the juniors) and if you’re extra ambitious, a publication.

Having said all that, none of these are necessities. The only compulsory objectives for an FY1 are consolidating your medical knowledge (it’s up there somewhere, even if it doesn’t feel like it), seeing patients, getting organised, using your hands, extra-curricular high jinx and wild japes. These are integral to being a good doctor. Good luck and get ready to work like a HO.

Originally published in Quack: Foundation School Guide.

Diagram inspired by ALS guidelines and a flowchart from Antarctica, by Kim Stanley Robinson.

Four hours to drama

2007-10-15T16:33:00.001+01:00

My regular column in Medical Student Newspaper has been reprised this academic year. This year it is, of course, 'F2. Woohoo.' Originally published in the October issue,

I’M CANCEROUS. Yes that’s right, I’m back for a fourth year running. This year, I come to you from the dizzy heights of the most superlative foundation doctor there is, THE MIGHTY F2.

A new generation of fresh-faced F1s replaced me and all my ilk. Now I’m supposed to know shit, you know, and stuff.

A&E’s a funny place to work. Over 90% of you will spend four months ‘on the medical front line’ as I am now. Unless you choose to pursue this field (ya crazy fool), your A&E rotation will be the job that brings you more excitement, boredom and frustration than any other. Mostly frustration.

No longer is the emphasis based on diagnosis, which is what draws so many into medicine, but on exclusion. Can you send this healthy 30 year-old chap home...are you SURE he hasn’t had an MI? Let’s refer him to the medics for a twelve-hour trop and take up a hospital bed just in case. It’s mind-numbingly un-stimulating at times.

There are many positives about working in A&E. Exposure to a wide range of problems, dealing with genuine emergencies, seeing instant results. My particular hospital has four great consultants and as St. George’s is a Centre of Excellence for countless specialties, I see some crazee sheeyrt.

However the one overwhelming negative is that it is A&E. There is no area of medicine that has been toyed with by the government as much as the emergency department.

Because waiting times are so easy to quantify and brag about before an election, A&E is a convenient place to pull numbers from. It is also one of two first points of contact for patients. The other is, of course, general practice, which has been tinkered with almost as much, chiefly to the detriment of A&E departments.

The ridiculous lack of sufficient out-of-hours GP provision, NHS dentists, the creation of stop-gaps like NHS Direct and obscene waits for GP appointments mean we are inundated with complaints that are neither accidents nor emergencies.

Yet each person that attends A&E has to be seen, diagnosed, treated and moved out of the department in four hours.

As all five Rohinplasty readers will know (it’s going up), I am obsessed with a solid evidence base. I use that as a chat up line sometimes. Anyway, one would like to think that those responsible for these four hours used all the available data to construct a sophisticated model of a working A&E and thus extrapolated a suitable figure.

The truth is probably more along the lines of pin-the-tail-on-the-number, with an arbitrary figure being plucked from the air.

The reality is a shambles. Of course no standard duration can be applied to A&E patients, as there is no one type of A&E patient. Some are out within ten minutes but some need several hours.

A far more sensible system, as I’m sure an honest government would concede, would consist of clinicians deciding how long each patient needed to be safely dealt with.

However politicians make decisions, not doctors, so that ‘four hour waits’ can be political weapons.

Only 2% of patients are allowed to ‘breach’.

I figured, like many others, a cavalier attitude was the way forward and thought I would ignore breaches and put the patient first. The NHS doesn’t work that way.

Unwell patients often need to stay in A&E until they are stable enough to be transferred. Pissheads need to sober up before they go.

The Medical Assessment Unit, or MAU, that most of you will be familiar with by now, owes its existence to the four-hour-wait. MAUs were created to stop the clock. The vast majority of patients admitted to a hospital come under the care of the general physicians. Hence all medical patients now go to MAUs where there is no timer.

There is no guarantee they will be adequately treated by the time they arrive there and there is no guarantee they will be seen by the doctors looking after them, hence negating the entire reason for the four hour rule.

I must be careful with what I say about my employer, so suffice it to say that unfortunately cooking the books MAY OR MAY NOT OCCUR at SOME hospitals around the country. Will that sound sufficiently vague in court?

Picture the scene. A patient needs a urine dipstick to make a diagnosis of a UTI. However a nurse is off sick and the nursing staff is over-stretched. No one gets the urine sample. The patient breaches. If this breach were recorded perhaps management would see that missing nurse’s value.

However if the number of breaches is the same as on any other night, the hospital realises she’s unnecessary and sacks her. They congratulate each other on more money saved. The system is broken, nothing changes.

We have some bizarre A&E mentality now that stipulates the customer is always right. But the patient is rarely first.

Nurses will drive you slowly mad with a phrase you will quickly grow tired of, “come on, your patient’s about to breach.” I normally cave.

Title reference to Nine Hours to Rama.

"A new star rises" - Part Two

2007-08-15T21:18:00.000+01:00

SIXTY years of a free India have passed. Where is it now?

"We have hard work ahead"

Amartya Sen, a man who has watched India change over this time, divided an assessment of India's progress since Independence into three categories. First, the practice of democracy, second the removal of social inequality and backwardness and lastly the achievement of economic progress and equity.

He wrote this on the 50th anniversary of Indian independence and essentially concluded whilst democracy was intact in India, it was failing on the second count. India's economy, of which we hear so much today, was beginning to gather pace in 1997, but it is surprising that the monumental leaps and bounds the GDP and purchasing power have made occurred in only the last decade.

Sunny Hundal, another famous thinker, said in response to Part One that "religious minorities in India snort in derision when India is declared as a democracy." Well, they may scoff all they like, but the democracy central to Gandhi and Nehru's aspirations for India is standing tall.

Take the example of India's Texas. Uttar Pradesh is the biggest, most powerful and most backward state (excepting Bihar). It has produced eight Indian prime ministers and has a population larger than Pakistan.

For the best part of twenty years, UP had been ruled by coalitions, most recently dominated by the BJP and the Samajwadi Party. Despite the majority of UP residents being woefully uneducated, the voters turned out in force earlier this year and swept one party, the once insignificant Bahujan Samaj, into power with an absolute majority.

The socialist-leaning party was created in 1984 to empower the dalits (untouchables) but campaigned on a platform of social justice which transcended caste and class. UPians, sick of politicians exploiting caste divides, replaced the old with the new.

"To build up a prosperous, democratic and progressive nation"

Indian democracy's downfall has oft been predicted, at no point more assuredly than when Indira Gandhi declared a state of emergency in 1975. As dissenting voices rose, the government took steps to quash any opposition. Sanjay engineered a forced sterilisation programme and brutally cleared the slums surrounding Delhi's Jama Masjid. Political dissenters were arrested and tortured.

Ultimately, Gandhi's contravention against the Indian belief of freedom of the press was her downfall. By censoring newspapers she astonishingly misjudged her popularity and when elections were called in 1977, the Janata Party washed her out of power. Good came from the unfortunate episode, the electorate had spoken.

Democracy, viewed by much of the world as Western hegemony, is alive (but not necessarily well) in India. Parties have won votes and come into power. They have lost and stepped aside. The press is free to criticise.

However a liberal democracy alone does not a successful country make. Corruption continues to pervade every aspect of Indian society (the fairytale story in UP is somewhat spoiled by corruption allegations surrounding the leader of the BSP) and will continue to do so for the foreseeable future.

"The ending of poverty and ignorance and disease and inequality of opportunity"

Some figures.

India

Population growth rate 1.6%

Median age 24.8

Life expectancy 68.6

GDP growth rate 9.2%

GDP per capita $3800

Literacy: 61%

(male 73.4%, female 47.8%)

China

Population growth rate 0.6%

Median age 33.2

Life expectancy 72.9

GDP growth rate 10.7%

GDP per capita $7,700

Literacy: 90.9%

(male 95%, female 86.5%)

The statistic that leaps from that table is China's literacy rate. The two Asian powerhouses have a healthy economic rivalry, but China's overall education rate leaves India's in the dust. The number of university graduates in India conversely dwarves the number in China, but inequality abounds. Kerala's life expectancy and literacy surpass China's, Bihar's rank lower than Bangladesh.

Today Manmohan Singh said his country will not be truly free until poverty is eradicated. This will not happen for many years. He pledged to put an end to malnutrition by 2012. Whilst this too seems like fanciful thinking, for the first time in most Indian's living memory, there is a genuine belief good things will happen.

China is not a democracy. But it has succeeded in spreading the wealth to a greater extent than India. Indian commentators may seize upon the fact that China's growth has created millions of disenfranchised migrant workers and peasants, but poverty (which was on a similar scale to India in the first half of the last century) has been combated far more effectively. Why?

China is a global heavyweight in exporting manufactured goods. Whilst India exports IT and scientific expertise, much of China's overseas business relies on 'unskilled' labour. Unskilled, but not unschooled. Chinese industry employs tens of millions - literate, schooled workers but not university graduates.

India's higher education establishments have gained deserved worldwide accolade, but studying at IIT or IIM is a dream achieved by a tiny minority in India. Emphasis needs to be placed upon improving India's schools. If one examines the syllabus at a typical secondary school in rural India, it is truly shocking to see how far ahead Indian schoolchildren are than their Western peers. Or rather, it's depressing to see how Britain's schools have dumbed down.

Yet these schools are under-funded and in a state of disrepair. Without a basic level of education, a wider interaction with India's economic success story will not be possible. The 'trickle-down' effect will take too long and much of India's poor will never receive so much as a drop without a concerted effort to equalise the wealth.

It has been demonstrated that China can enjoy the same - if not more - success without the joys of democracy, so should its perseverance in India continue to be a thing of pride? Democracy, at a basic level, acts as a safety check. Leaders have to act decisively in times of crisis, or risk falling from grace. Returning to Amartya Sen, he achieved fame many years ago by reasoning that famines were a political product, not an agricultural one.

India, previously ravaged by famines, has not suffered one since Independence. Mao Zedong's Great Leap Forward is regarded as a massive economic blunder, but it's also one that killed over 20 million Chinese by causing the Great Chinese Famine. Amartya Sen credits democracy for this not being repeated in India.

The Indian entrepreneurial spirit has captured the imagination of the financial media around the world. Lakshmi Mittal is now the fifth richest man in the world and he is one of the faces responsible for Indian business being viewed in a new light.

The West had just grown accustomed to India becoming the world's back office, but now Indian businesses have developed a bona fide reputation as predatory. Mittal's acquisition of Arcelor and the biggest Indian takeover of a foreign company, Tata's buyout of Corus, have worried complacent Western CEOs.

The Reliance Group, divided by fighting brothers Mukesh and Anil, looks set to unleash supermarkets and more mobile phones on Indian consumers itching to spend.

I am conscious that as an Indian-born NRI it is easy to don rose-tinted glasses and turn a blind eye to the widespread suffering ever-present in India. Concordantly, urban Indians can romanticise the lives of their rural compatriots, conjuring a pleasant country life and oblivious to the fact many of their forebears fled those very conditions for the city.

Atanu Dey and Reuben Abraham, Mumbai economists, suggest that the best way ahead for the hundreds of thousands of villages and the handful of teeming, unplanned urban sprawls which live in coexistence now is to reach a compromise. India must create new urban centres to relieve the pressure still exacted upon the major cities by unchecked and overwhelming migration.

Along with education, perhaps India's two greatest challenges are cementing the equal position of women in society and providing adequate healthcare to the masses.

I follow India's medical breakthroughs and shortcomings with interest. It is a familiar story, of world-beating advances and horrific inadequacy. It may surprise some that I am realistically considering pursuing a career in an Indian hospital, but the factor holding me back is an uncertainty that I could work knowing that, unless I work in a decrepit public hospital, I will only be treating the rich, be they Indian or visiting health tourists.

Global centres of excellence are built with the government assistance, on the agreement they will run a 'poor ward' or two. News agencies like NDTV have revealed these wards are routinely empty, treating ministers' families or filled with foreign, paying, visitors. India will soon have more HIV sufferers than any other country. Little is being done to prevent this.

"Fullness of life to every man and woman"

Much is made of the ascendancy of women. The new President is Pratibha Patil. She advocated sterilising those with genetic disease. However, she did found a bank to empower women in the 1970s. A good role model for Indian girls. Well, she stole millions not only from her empowered female customers, but also a sugar factory and a charitable trust. Some role model.

In yesterday's Guardian, Sagarike Ghose, presenter on CNN's Indian counterpart, worries the Indian women's movement has lost its way. Perceived early successes have led to a backlash against 'feminist types'. Young women see individual freedom (to smoke, wear short skirts, get laid) as more important than a collective freedom to express themselves as half the country's population.

Of course, whilst practices like female foeticide, acid attacks and honour killings continue, women may make up less than 50% of the population.

Ghose states that as Indian feminism failed to have a clear goal, young Indian girls have adopted a beautiful and vapid role model to aspire to. She makes a great point that certainly rings true to me, that of the pseudo-traditionalist:

The heroines of "new India" films were presented not as individuals attempting to create their own lives in a new economy, as millions of women across India were doing. Instead, the films showed young brides following religious ritual down to the last detail - viewing the moon through a sieve, praying before their in-laws' photographs, and spending their girlhoods working towards getting a husband.

When I met students at a prestigious women's college at Delhi University last month, the majority told me that they wanted to get married to a rich man and have week-long weddings, with all the rituals, because that was part of "Indian tradition". They didn't want to be the "feminist type".

This notion is, no doubt, fuelled by another Indian behemoth, the TV industry. Few realise that television revenues this year will be around £3 billion, double that of Bollywood. I've watched the soaps that grip India - it's an experience I would not wish upon my worst enemy - and every female character is truly depressing.

Masterminding the televisual revolution sweeping India are people like former rice salesman Subhash Chandra, chair of Zee TV. Television sets are becoming more affordable and more ubiquitous. Seasoned industrialist Ratan Tata wants to go even further with his plans to unveil an ultra-cheap car for the masses. The carbon footprint of millions more with a shiny new car will be a crater.

"We rejoice in that freedom, even though clouds surround us"

A tumultuous sixty years promises much ahead. India is developing into a great nation, albeit one wracked with problems. As it teeters on the brink of superpowerdom, it is far from the India Gandhi had envisioned. But on this anniversary a genuine hope and optimism drift above a fascinating process of growth. India may be 60 years of age, but looking at the faces that will shape its next 60, it is young.

Picture credits, from top:

Tricolour, artsander
Paperboy, Calamur
KK Menon, gaurang
India economics, TIME.com
Tata truck, Calamur
Demure, Letha Jose

"A new star rises" - Part One

2007-08-15T21:14:00.000+01:00

THE other father of the nation, Jawaharlal Nehru, ushered in a momentous change in Asia with one of the greatest speeches ever recorded. As part of his legacy he left behind decades of economic folly, but I will always have a tremendous admiration for the man, if only for that amazing oratory which, even now, encapsulates the myriad complexities of a vast nation.

In a split article, a brief look back at the last 60 years sets the scene for gazing ahead.

"The soul of a nation, long supressed, finds utterance"

Despite the spilled blood now mixed with the dusts of Bengal and Punjab, despite the largest movement of people in history, despite shameful conduct on the parts of Hindus, Muslims, Sikhs and the British, Partition remains a footnote to many.

I do not wish to dwell on the heartache of Partition in this article. Although I have missed the entire BBC India/Pakistan season leading up to Independence, I managed to catch half of Partition: The Day India Burned today, which demonstrates what the BBC is still the best at. It was also the first British documentary about India I have seen which featured none of the following: Nitin Sawhney, Meera Syaal, Talvin Singh, State of Bengal or Nihal Arthanayake. Perhaps that's why I liked it so much.

In the years following Partition, India plodded onward and took a socialist path toward development. It became a republic and created an admirable constitution. Primary education and rural areas were forgotten as the government concentrated on the developing urban sprawls. Legions of Indians grew up illiterate.

Nehru's popularity had taken a battering when half a million people lost their lives after Partition, but as optimism replaced memories of loved ones, Indians felt hope in the free air. In 1962 these hopes were dashed when China steam-rollered Indian troops, still in disarray, and seized Arunachel Pradesh. This came years after India had provided home to the fleeing Dalai Lama.

Nehru came under heavy fire for the disastrous campaign and his failure to see the attack coming. He died two years later.

"Brothers and sisters who have been cut off from us"

Three years on from the Sino-Indian war, India fought an adversary it had clashed with once before, and would do again. Three (or four) wars over the region of Kashmir ensured Indo-Pakistani relations remained cold for decades.

Indian films reflected the conflicting moods in the country. Bengali cinema, which awoke the world to India's film industry in the fifties, often depicted a cosmopolitan, Westernised India juxtaposed with pathetic poverty in all its gore. Meanwhile the quickly-growing Bombay movie business churned out films full of Indian heroes and heroines to lift the nation's spirits.

Nevertheless, millions of Indians made their homes abroad. Britain and America, in particular, benefitted from the 'Indian brain drain', a trend that is happily being reversed now.

Bangladesh was born in 1971 and as defeated Pakistani troops withdrew, they slaughtered as much of Dhaka's intelligensia as they could round up. Nehru's daughter, Indira Gandhi, ended her torrid first time in power after a brief period of ~~military~~ police-enforced emergency rule and India's first nuclear test.

When she returned to power some years later, she would be assassinated by her Sikh bodyguards on her way to meet Peter Ustinov. They shot in retalliation for her foolhardy storming of Amritsar's Golden Temple. Operation Bluestar was the name given to the attempt to defeat Sikh militants who aggressively sought an independent state.

Her elder son would soon follow in her footsteps, first to lead India and then to be assassinated. His younger brother, Sanjay, was killed in a plane crash and Rajiv was a reluctant heir to his family's legacy. A Tamil Tigress bearing a bouquet of flowers killed Rajiv Gandhi for his part in sending Indian troops sent to a war-torn Sri Lanka. The parallels between the family and a political dynasty in America meant the Nehru/Gandhi clan were oft referred to as the Kennedys of India.

Three years ago Rajiv Gandhi's widow, Sonia, led the resurgent Congress Party to power and controversially stepped aside to allow economist Manmohan Singh to become Prime Minister. At the time, India was a majority-Hindu democracy with a ruling party led by a Catholic, a Sikh PM and a Muslim president. Rajiv and Sonia's son, Rahul Gandhi, is a popular young politician.

Mahatma Gandhi's teachings went on to influence Nelson Mandela, Martin Luther King, Aung Sang Suu Kyi and the Dalai Lama, but he wasn't popular with all in India. Maoist Naxalites, entirely disparate from the Hindu right but united by their hatred of Gandhi, were thought to be all but eliminated in the 1970s. Manmohan Singh recently described them as the biggest internal threat to security and their popularity is once again on the increase.

India's population reached half a billion in the 1970s. A food crisis and twenty years of imports was halted by an example of a developing nation's understanding of their own environment. India's Green Revolution and Operation Flood saw the government aid farmers and allow the country to become self-sufficient.

The environment, however, paid a terrible price in 1984, when 40 tonnes of methyl isocyanate was released by the Union Carbide pesticide plant in Bhopal. An estimated 22,000 people died as a result and the Bhopal Medical Appeal alleges one person dies a day due to the disaster.

"After long slumber and struggle, awake, vital, free..."

As Narasimha Rao quietly paved the way for India to become the burgeoning economic superpower we hear about today by lifting stifling tariffs, a dark chapter in modern India's history unfolded in Uttar Pradesh.

75,000 kar sevaks, far right Hindus, destroyed the sixteenth century Babri Masjid (mosque) in Ayodyha, claiming it was built upon the site of Lord Ram's birth. Nationwide riots ensued and spilt over into Bangladesh. Ten years on, in 2002, Muslim extremists ignite a train of Hindu pilgrims, killing 58. Narendra Modi, chief minister of Gujarat fuelled a fire burning amongst Hindus eager for blood.

A sickening backlash saw near one thousand people, overwhelmingly Muslim, perish in the first riots to be broadcast live on TV. The BJP were condemned for doing nothing to prevent the killing.

A year before the latest Kashmir clash, India and Pakistan become nuclear powers in 1998.

India's history has been peppered with terrorist attacks. Only the more notable are mentioned here. 250 died as 13 bombs went off in Bombay on the 12th of March 1993, Dawood Ibrahim exacting revenge for Babri Masjid is thought responsible. Pakistani group Lashkar-e-Toiba are blamed for the death of 52 in Mumbai in 2003. Five bombings hit Mumbai in eight months.

Delhi, seat of India's government, is targetted in 2005. The Pakistani Islamic Inquilab Mahaz claim responsibility for the death of 59 two days before Diwali, citing Kashmir as their cause. in 2006, seven bombs explode in eleven rush-hour minutes on Mumbai trains. Lashkar-e-Toiba were once again identified as responsible, in collaboration with the Students Islamic Movement of India. There was no Hindu backlash.

The city's resilience and determination to return to normal were truly inspirational. Western Railways restored full service by the evening and investors rallied, causing the Mumbai Stock Exchange to end the day 3% up.

Last month, the Sensex surpassed the 15,000 mark.

Tomorrow, Part Two:

"We have hard work ahead"

Titles are taken from Nehru's speech, A Tryst with Destiny [full text]. I'm not ashamed to say simply reading it can move me to tears.

Who needs the Kwik-E-Mart?

2007-07-18T14:14:00.000+01:00

Over a year and a half ago I wrote my first post for Pickled Politics, entitled ‘Much Apu About Nothing’ and it concerned my love for Springfield’s favourite shopkeeper. I sought to explain why I feel Apu is a positive character, having heard opinions against him. This has proved easily to be my most widely-read post.

Recently a publicity campaign for the upcoming Simpsons movie has developed into a contentious issue in America and Ultrabrown’s Manish has quickly become the go-to man for all things Apu. What Manish probably doesn’t realise that it was his view of Apu that inspired my article; I wanted to highlight how the British perception of Apu is so different from the American. So I figured I should chuck my two cents in, but I’ll try not to duplicate my reasons for being an Apu fan this time.

The recent ‘Apu controversy’, having made national American and Indian news, may have started as a debate about the ad campaign, but it has grown into a new dissection of Apu’s character.

It is thus fundamental to separate the 7-Eleven issue from related discussion. Examining the former first, Manish has, in several posts, argued succinctly why this promotional strategy irks him. Central to my defence of Apu has always been his context. The Simpsons parodies all its inhabitants and Apu is not a racist stereotype but a rounded, human figure.

This advertising campaign removes Apu from that context. Apu, like all the caricatures in Springfield, exists on two levels. Every character has a superficial exterior, which personifies a stereotype; they also have a rich personality which undermines all of those clichés.

I have learnt that unfortunately the fact Apu has a memorable catchphrase has resulted in it being used as a racist taunt in America. Critics of Apu argue this shows that he is the sole troubling character, which is why he draws so much flak. However I feel that sadly racists in the US would still be abusing Indians without a convenient convenience store catchphrase. The fact some Indians in the US dislike hearing “thank you, come again” reveals more about how American society has latched onto tormenting Indians than the racism of Apu.

Upon initially viewing the dozen-or-so Kwik-E-Marts, I loved the idea and I still do. The one point upon which I agree wholeheartedly with Manish is his criticism of the role the real-life shopkeepers have played in this saga. The majority of 7-Eleven employees affected by this campaign seem to be of Asian origin. Almost all seem game for a laugh, but dressing them up as Apu can surely not be in their best interests.

I think the Brits reading this will feel the way I initially felt, that there’s no harm in assuming the role of Apu for the month. But once again context is paramount. My view of the American experience for an Indian, shaped predominantly from the writing of Indian Americans and Harold and Kumar is one where Indian shopkeepers can frequently be the subjects of abuse. If this is indeed the case, the dumb racist’s conflation of a stereotyped Indian and a real one will only be reinforced by an Apu outfit and name badge.

However, if Indian shopkeepers aren’t subject to more abuse than others, then I can’t see any difference between the UK and the US, so I once again see nothing wrong with Apu. The basis for criticising him or his place in this advertising is grounded in the assertion that America is inherently racist, whether this is true, you decide.

I do not buy the argument that Americans are not familiar with Indians, which is cited as making Apu more harmful than other stereotypes. Firstly, I think “Americans don’t know any Indians” doesn’t wash anymore, secondly many of the stereotyped minorities are those Americans might be unfamiliar with like the Scots or the Japanese. Lastly, and most importantly, no special familiarity is needed. The vast majority of Americans will be familiar with the Indian shopkeeper and that is the very reason he is in The Simpsons. He effectively needs those stereotypies so that he can be recognised in his place in the town's makeup, and to act as a framework to flesh him out.

Another sore point for those who dislike Apu is his accent. It’s a comical accent but they say it is racist. Why? Because he is voiced by a non-Indian. This is nonsense. Are we seriously suggesting that only brown-skinned actors can voice brown cartoon characters? A blacked-up white man playing an Indian on screen would be wrong. But only a bigot would complain if a Pakistani played an Indian, because they “look right”. What of the analogous “sounding right”? The Indian voice is not dramatically different in timbre or pitch.

I think saying there is a racial barrier to voices as well as skin is dangerous ground. If a white man should not do an Indian accent, then can an Indian comedian not impersonate a white celebrity or voice a black cartoon character? The accent itself is criticised as unrealistic, but if based on a genuine thick Indian accent, opposition to Apu would not stop.

Annoyance at Apu’s accent is based on a false double standard, exposed by today’s multicultural society. The white West and the brown East are now intimately intertwined. When Western, but brown actors adopt ridiculous accents, such as Kal Penn in Van Wilder (the actor credited with trying to reclaim Apu’s phrase), there are few complainants.

But there is no reason why someone born and raised outside India is more qualified to attempt an Indian accent simply due to the fact his skin is brown. Those who don’t like Hank Azaria voicing Apu don’t ask for a test of ‘Indianess’ in a replacement candidate, they would be appeased by just Asian heritage. I have British Indian friends who do a more fake Apu-like Indian accent than some white friends. Indian actors make fun of regional accents in Indian films, but it’s OK cos that’s brown-on-brown. This is all phoney. The belief that “only our kind can make fun of us” is unhealthy and reactionary.

Most Indians, in whatever country, like Apu. Comments on British, American and Indian blogs have overwhelmingly favoured him, so Manish is firmly in the minority. It seems somewhat condescending to insist Apu degrades convenience store employees if they themselves have no problem with the character. It would be more condescending still if their views were dismissed as being insecure eager-to-please immigrants.

Levelling the notion that if we are party to the Apu joke, we are condemning future generations of brown-skinned people in white countries to racism is unwarranted. Forced attempts to reclaim a phrase or reject a cartoon character are laying the onus on us to change our ways instead of those guilty of racism.

I feel I haven’t addressed everything, so I will do my best to participate in comments. If you wish for a more detailed examination of Apu, please do read my first piece. Manish and I have both written plenty about Apu. His massively commented-upon Comment is Free article criticised the 7-Eleven campaign. He and I are agreed that the subtle nuances of Apu’s character are lost in the adverts. But we remain in disagreement about just about everything else to do with Dr Nahasapeemapetilon.

Many of the CiF comments are along the lines of “I’m X and my community is mocked as well, but I don’t complain”. Not all of these statements can be explained away by Indians being less familiar to Americans, and while I do not think Indians complain more (as has been alleged), I am not sure I fully understand why Apu is so much more of a talking point than any other character. I cannot help but feel some of it is due to the fact he is a key main player, which is a testament to his importance, not his subjugation.

Try before you prescribe

2007-07-12T12:24:00.000+01:00

Originally published in the June issue of Medical Student Newspaper.

How can you ETHICALLY suggest anything for your patient without trying it for yourself? Following a long line of self-experimenting medics, I enlisted some help to make sure I was doing right by my patients.

IT all started last summer. My good friend Froy (star of the October Rohinplasty) and I had been consuming alcohol whilst watching the blasted World Cup. Soon afterwards we found ourselves re-enacting Streetfighter II on Richmond Green.

Normally I am Ryu and a sure-fire victor. Perhaps it was the Cobra I had been drinking, but I chose Dhalsim this time; Froy was Zangief. One spinning pile-driver later and I was in West Middlesex Hospital demanding morphine for my dislocated and broken thumb.

They appeased me with nitrous oxide. Despite Froy inhaling far more than me, void of any injury that he was, we took it upon ourselves to learn about more of the things doctors prescribe for patients.

By the way, nitrous oxide is truly a wondrous trip. I thoroughly enjoyed my analgesia, even though I had to wear a vomit bowl on my head to stop those goddamn bats getting at my hair.

DIETARY SUPPLEMENTS

We ask for dietitian input frequently at St. Peter’s, chiefly because two of them are hot. Apparently they also supply food things for lazy patients. Lazy? That’s my middle name!

Fortijuice: “A distinctive aroma and a refreshing initial tang. However marred by an iron-y aftertaste, somewhat remeniscent of blood. Goes well with hospital hotpot, but a shameful 150kcal per bottle makes this drink a disappointing 2/5.”

Did you look at Fortijuice and think “looks like some good shit, but I want it as a mousse?” Well damn this is your lucky day. It would be if Forticreme - the gelatinous equivalent of Fortijuice - wasn’t such a revolting pot of quivering horrors. A sad 0/5.

I’m an unshamed fan of Scandishake. Available in the holy trinity of milkshake flavours but the strawberry stands out. A light, tasty whip of calories and vitamins, the fact you have to mix it yourself only adds to the outrageous fun. With a healthy 600kcal per shake, its real plus is it supplies 70% of the suggested saturated fat intake in one easy glass of goodness. An effortless 4/5.

1 spoonful = 1 steak

Calogen is the undisputed gangster in the wild world of dietetics. Reading the nutritional info is enough to strike fear in the hearts of most men, with 250ml packing almost 5000kJ. Upon corking the bottle, one is greeting with a welcome bouquet of strawberry triglycerides. A curious mercury-like surface tension causes it to remain on a spoon when held upside down, but the taste is laced with surprising velvet, supported by a bra of marshmallow. 5/5.

FLUID REPLACEMENT

If you’re anything like me, you’ve spent hours on end wondering what IV fluids actually TASTE like. We took the Rohin & Froy (double) blind taste test. Saline vs dextrose vs gelofusine.

I chose gelofusine. I did this quite deliberately, it was obvious from its darker hue, because I really wanted to drink a COLLOID. Little did I know, I already had - Calogen is a fat emulsion. Somehow I wish I had not gulped the gelofusine with such gusto. I’d imagine this is what man juice tastes like. Remind me to ask the nurses later. Taste: 0/5.

Froy samples an old favourite, normal saline. Although not with any KCl though, that would be weird. “Saltier than a salty sea dog that’s been sailing on a sea of salt in a giant salt shaker with a hull full of salt, who’s just overdosed on salt because he ate some salted peanuts that were salty but not salty enough.” Salt value: 5/5. Taste: 0/5.

PROCEDURES

Cannulation is one of the most common procedures patients undergo in hospital - it is a popular way of getting MRSA. I started with a pathetic blue but then steeled my resolve and chose the green venflon, as not only did it complement my yellow T-shirt nicely, I was attracted to its impressive flow rate of 120ml/min.

Sweet mother of God, I never realised how much this hurt. Maybe due to the fact I was cannulating myself, but something made this excruciatingly painful.

However the pain was relieved by a sensation I recommend to anyone - a big flush of refridgerated normal saline. If I took heroin, I’d definitely put it in the fridge. If. Pain rating: 3/5.

BM testing. This is so painless I can’t even be bothered to write about it. It’s lame, I don’t get why people do this. Who wants to know their blood sugar? Boring! Pain rating: 0/5.

People always seem to moan about ABGs over venflons. As far as I can tell, it’s the other way round. I enjoyed seeing my arterial blood fountain out into a syringe. I quite fancy an angiogram now. Radial approach, wooo! Pain rating: 2/5.

THINGS WE MIGHT HAVE TRIED. MIGHT MIGHT MIGHT.

Morphine is a powerful and dangerous opioid analgesic and sedative. It can cause respiratory depression, itching, and constipation. Froy and I are off to spend the rest of the afternoon lying in the sun watching cricket.

The legal bit: So that the editor of Medical Student Newspaper or any Daily Rhino-reader does not perform any further painful procedures on me, neither I nor Medical Student Newspaper advocate taking any of the products mentioned in this article unless prescribed by a medical professional. All products utilised were expired or unsuitable for patient use.

Shilpa and Shakespeare cockroaches

2007-07-11T18:14:00.000+01:00

I HAVE received a bunch of emails from this guy, who must've got my address from Pickled Politics. The most recent simply had this post's title as its subject and is re-published below. I figured it needed to be shared with no alterations at all.

From: Our revenge for Shilpa Shetty
To: rohin at pickledpolitics dot com
Date: 03-Jul-2007 20:41
Subject: Shilpa & Shakespeare cockroaches

Dirty English = Shakespeare cockroaches

Stupid English = Humpty Dumpty

Shilpa should have abused back her uncivilized english abusers by insulting them as, Shakespeare cockroaches and Humpty Dumptys, but unfortunately, she did not know it. Otherwise, if she had known these two remarks, she would surely have insulted back her tormentors with the remarks of Shakespeare cockroach and Humpty Dumpty.

We are now spreading this message in the Indian community all over the world. We request all our fellow Indians to use the insults of Shakespeare cockroach and Humpty Dumpty, each time they come under abuse and refuse to suffer in silence. If you do not respond abuse with abuse, then the racist remarks used by uncivilized and evil english will continue and will grow further. If you abuse back with the remark of Shakespeare cockroach, then the uncivilized english will think twice before abusing you.

This is the only practical way to deal with the abusive and evil Shakespeare cockroaches and Humpty Dumptys, who are the biggest fascists of the world. England is a fascist country and we now call it, Nazi England.

We love our Shilpa.

We hate Jade Goody, the Shakespeare cockroach.

We hate Jade Goody, the Humpty Dumpty.

We hate Nazi England.

Very very very angry against Shakespeare cockroaches,
Rajesh Kumar & friends,
France

1) Shakespeare cockroach
2) Humpty Dumpty
------------------------------------

Shakespeare cockroach is a humiliating slur against the dirty english and is used against all english people. Those english who have no brains and are stupids, are called HUMPTY DUMPTYS.

Shakespeare cockroach is a very very humiliating slur against all dirty english.

Humpty Dumpty is a very very humiliating slur against all stupid & brainless english.

SHO me the exit

2007-07-04T23:07:00.000+01:00

Cross post on Pickled Politics.

SEVEN of the suspects arrested under suspicion of involvement with the terrorist attacks over the last few days are NHS junior doctors or medical students. Britain's threat level has only today been stepped down from 'critical' to 'severe' and heightened security at airports remains in place. As a shifty-looking NHS junior doctor flying out of the UK on Friday, these events have had particular resonance.

Almost three months after junior doctors were in the news protesting a disastrous job shortage, a friend at work quipped "I think some of these guys are taking their MTAS protests a bit far." Hey, perhaps these guys were just pissed off at being laid off...

"Brilliant": Mohammed Asha topped his class several times.

Two Iraqi doctors seem to be at the heart of the attempted terror campaign, thought responsible for both the Glasgow Airport attack and two unsuccessful bombs in London two days prior. A British cleric working in Iraq had recently been informed of an impending attack on Britain by an Al Qaeda leader, with the ominous warning that "the people who cure you will kill you."

The suspects, of Iraqi, Saudi, Indian and Jordanian origin, have opened a debate on the role overseas doctors play in the British health system. It is a widely acknowledged fact that the NHS survives on the contribution of doctors trained abroad. Many would go so far as to say that the NHS would not exist today had doctors from the sub-continent buoyed it through its early decades. Today approximately 128,000 of the 277,000 doctors on the GMC Register are from overseas medical schools.

The requirement of a work permit for foreign junior doctors only came into place last year, as the UK was producing more doctors itself (many of whom are now leaving for Australia, New Zealand and Canada). Medical Student Newspaper covered the fact that even overseas undergraduates in British medical schools, who pay almost £100,000 in tuition fees, were instructed to apply for work permits despite being halfway through training.

The normal vetting process for doctors involves a professional and linguistic assessment (the PLAB) and a probation period working in the NHS before a full registration is offered. Doctors from the EU are exempt from these checks. No doctors are specifically questioned on their political views.

Members of British Muslim medical groups, such as Dr Abdula Shehu of the Muslim Doctors Association, are afraid there will be a backlash against Muslim doctors. To me, this sounds improbable. Doctors can't be picked out on the street - most people know doctors via being treated by them. I doubt people will suddenly assume their family GP Dr Hussain is a terrorist.

However not much has been said about medical students, who interact with a far more diverse group of people than doctors. We have previously touched upon the religious fanaticism that lurks on British university campuses and I'm sure there will be sympathisers amongst British Muslim students, just as there is likely to be some ill will toward normal Islamic students.

What appears to be happening is a questioning of Britain's reliance on overseas doctors. Gordon Brown has already pledged a review of NHS recruitment and 'skilled migrant workers' background checks. Intelligence agencies said they will have to "widen the net" when searching for potential bombers. A somewhat romantic illusion that doctors are above activities like terrorism has been laid to rest, but the debate over the ability to cure and kill is a fascinating one.

The Times today revealed details of the two Indian suspects, now known to be cousins. Both spent most of their time in the UK socialising only with other foreign doctors, often just Indians. Details of the other suspects' lives is patchy, but again most character testimonies have come from Muslim friends and acquaintances. In my hospital accomodation, a cluster of several apartment blocks, several are populated solely by immigrants. It is quite possible to have a job in the NHS and live with, work with and socialise with only those from outside the UK.

The disparate group of eight people seem linked only by two things, being Muslim and medicine.

The NHS is prohibited from actively recruiting from countries at risk of a 'brain-drain' (though less than a quarter of recruitment agencies the NHS uses has signed up to this), but a doctor from such a country is entitled to apply independently. A huge proportion of the NHS is accounted for by foreign workers, with thousands of doctors from 150 countries, nurses from the Phillipines, India, Ghana and Nigeria or cleaners from Nepal, Ghana and Nigeria. These countries' health systems are woefully understaffed.

In the wake of 7/7, we clutched at straws for what might have driven those men to kill. Poverty, social deprivation, a lack of feeling British. This time, whilst I can assure you juniors doctors are not flushed with money, they are certainly not on the poverty line. These doctors had no call to feel British as they weren't, but it seems apparent they resented the country they had chosen to work in.

Their reason for attacking the UK might have been the same as previous terrorists, but how did they become subject to such extreme views in spite of their high educational level and respected job? Much could be speculated about doctors from Iraq - they sought revenge for a fallen friend, an insult to their country - but then why were Indian Muslims angry?

I realise I am posing more questions than I am answering. I do not feel increasing security checks on skilled migrants will solve the problem. We do not know if some of these men (and woman) were radicalised in the UK. For me, and many like me, the very nature of the NHS is under scrutiny. A thoroughly British convention, it is a puzzling behemoth of nations. Isolation for someone new to the UK is very easy in the NHS - how many other mass employers routinely provide cheap digs next to your workplace combined with 60 hour weeks?

The NHS remains perpetually over-stretched and under pressure to cut waiting times; see more patients; improve treatments. None of this is possible without sufficent staffing, frequently drawn from the countries that need medical professionals the most. Whilst not apparently linked to recent events, the fact the NHS is driving thousands of its best and brightest abroad every year can only be worrying.

I'll end with an anecdote. After the Tsunami, I spent a month working at relief camps around Sri Lanka's coast. I returned to Heathrow with a shaved head, a month's tan, a big rucksack and four days of stubble. The security officers saw me a mile off and took me to a special area where they searched me and my bags. They rummaged through sweaty clothes and pirate DVDs, firing a series of questions at me.

As soon as the chap looking through my bag found my stethoscope, both officers immediately packed everything back in and apologised for bothering me. I was sure the "I'm a doctor" line would be an evergreen get-out clause for airport security. Oh well, wish me luck this weekend.

(Kind of related, I thoroughly recommend Michael Moore's new film, Sicko.)

Someday you realise your Mum's not going to live forever

2007-06-26T23:03:00.000+01:00

Originally published in the June issue of Medical Student Newspaper.

MY first year is drawing to a close. The next generation of F1s have graduated, got pissed and are enjoying that golden summer after medschool. Soon I will no longer be the most junior doc on the team and I might even have people asking for my advice. Every time I mess something up (and I will) after the end of July, I won’t be able to simply excuse myself on the grounds I am “just the house officer”.

Part of the exercise in group stupidity that is our MMC assessments is a tedious cataloguing of ‘reflective practice’. We are supposed to document the cock-ups, the near-misses and blips that we have learnt from. Of course I spent half an hour before my sign-off meeting making mine up.

Ironically, writing this column has forced me to reflect on my conduct as a doctor more than any contrived questionnaire could. I spent a little while browsing what I have written for Medical Student Newspaper this year and I realise I have come full circle. The first piece I wrote, in October last year, professed how I need to see things through the eyes of patients’ family members. I didn’t change. Nine months on, tragic events have finally shocked me into an attitude re-evaluation.

One of the many criticisms one could level at me is cockiness. I have been gung-ho on more than one occasion. Whilst I have not endangered patients, I have certainly made more work for myself by charging ahead without due forethought – and more importantly I could have made a patient’s stay less unpleasant.

I write this having just returned from Royal Free’s ITU. My very best mate’s Mum suddenly suffered a massive antero-lateral MI and out-of-hospital VF arrest. He’s a school friend and a lawyer, she’s a healthy woman in her mid-40s with no risk factors apart from family history. Without going into details, she has been making erratic but slow progress over the last two weeks and we are optimistic.

I’ve tried to be as supportive as I could be, but I’ve also done my utmost to explain the immensely complex events to my friend. I hope I helped. However, in a roundabout way, I have helped myself.

I’ve been privileged enough this year to get exposed to a high level of critical care. I’ve managed patients in coronary care and in surgical HDU. Next year I’ll be working in medical HDU and ITU. I love it – standing behind the chart, absorbing the figures.

Heart rate, pulmonary capillary wedge pressure, MAP, fluid balance, CVP, inotropic support, balloon pump settings, sats, lactate, base excess, ejection fraction and so on. I got a buzz out of being able to know what was happening with the patient without even seeing their face.

Suddenly one of those collections of stats was someone I knew. I finally put a face to the figures. More than that, I put a face to the relatives that spend their whole day in the waiting room, desperately hanging on for a glimmer of hope. I became one of them for a time.

When you’re looking after a full HDU, something is always happening. When you’re concentrating on only one patient, nothing seems to happen. Our days consisted of sitting silently in the waiting room, walking around the block, nipping out for cigarettes and if we were very lucky, perhaps a minute with the SpR.

There’s a vast difference between nursing staff. Some are rude, obstructive and lie. They claim the doctors are far too busy to speak to relatives. When I’ve been on call, I’ve positively approved of this attitude. Now on the other side, I realise little is more frustrating. Other nurses are great and really keep relatives in the loop. Likewise, some doctors are jerks. Others are absolutely fantastic.

In a less acute setting it can be even worse. My Mum has also spent some time in hospital recently. In contrast to my friend’s mother, this was a planned admission for a knee replacement. Straightforward, but the potential for complications always exists. And whilst not life-threatening, my Mum suffered badly with wound and chest infections and terrible post-op analgesia.

She had to wait four hours for a doctor to write up pain relief. The nurses would mindlessly repeat “we’ve bleeped him” and when he eventually arrived, he dismissed everything I said, presumably because he thought I was too junior.

This pattern of waiting for the doctor was played out daily, perhaps part of a scheme to free up hospital beds, as after a few days my Mum was desperate to leave.

So much of the modern medical apprenticeship appears twee and pointless. Hoops to be jumped through, like the aforementioned reflective practice essays, or apparent time-wasting like communication skills classes at medical school. I was as vocal as anyone with my criticism of what medicine is becoming. I echoed consultants who bemoaned the demise of ‘the old system’ of being taught the science and picking the rest up by osmosis.

Now I wonder if I should have attended more of those communication skills sessions. When I say “more”, I really mean “at least one”.

Textbooks have taught me what I need to know about managing a GI bleed or a sore knee. What textbook could I turn to when I first told a family their father had died? I have broken this news about half a dozen times this year. I am not happy with how any of them went.

Sure, you live and learn, but I look at some of my colleagues and cannot help feeling that they were just born with a better ability at this sort of thing. I think one can learn to communicate better, I have just never felt it to be a priority. For it is a paradox in life that whilst we are more conscious of our shortcomings than our strengths, we spend less time rectifying our foibles than doing what we’re good at.

Hence this year I have consciously pursued an agenda to improve my practical abilities. I’ve taken out an appendix, intubated, cardioverted, lumbar punctured, put in about ten chest and ascitic drains, four femoral lines, two arterial lines, one temporary pacing wire and aspirated more chests and knees than I care to remember. The one procedure I have been especially keen to master has been the internal jugular central line. I have managed to do six, with supervision, simply by being a pest and keeping my eyes open.

Conversely I have avoided interacting with patients and families for the vast majority of the time. I make excuses to myself that my jobs have all been too busy, but I seem to have made time for all of the above. My development has been uneven.

Last week an acutely unwell woman came in to the MAU. There was talk in the air of a central line being needed. The on-call SpR had not had time overnight. Aha! My opportunity. Number seven here we come. “I’ll get everything ready” I said as I practically forced the team into accepting me as the man for the job.

The woman began to deteriorate. I was already preparing to insert the line when her breathing became erratic. “Rohin, don’t worry, you go ahead but we need to get this line in quite quickly,” said one of the registrars present. I looked down and saw quite a young woman. I saw my friend’s Mum. I saw my Mum.

In an acute and unpredictable setting like this, would my running a catheter by this woman’s lung and into her right atrium really be the best we can offer her? I desperately wanted to get another central line under my belt, but I stepped back. “I think you should do this one,” I said to the reg, “I’ll watch you this time.”

Perhaps I am learning something.

The beginner's guide to the MTAS fiasco

2007-05-16T00:56:00.000+01:00

Originally published in the May issue of Medical Student Newspaper.

ARE you a bit muddled with this whole MTAS business? Do you nod along politely when people talk about ‘all those poor junior doctors’? Do you secretly not have a clue about medical training? Are you Patricia Hewitt?

MTAS is no more. People are happy. You should know why.

The history

Four score and seven years ago, Aneurin Bevan invented a work experience programme for Indian doctors called the NHS. Some British doctors joined in and then we had a health provider the world envied. This glorious period, where all the developed countries in the world tried to model themselves on our free health service was truly a wonderful time. It lasted an entire Wednesday afternoon.

After a few decades, the Indian doctors opened a whisky distillery in Sheffield and the Brits retired to Eastbourne. And so it came to pass that new doctors began applying for jobs.

They used an ingenious system the Romans used to call a 'resumé'. For many hundreds of years this system was used to select junior doctors. But sadly it all came to an attractive end with the famous case of Professor Fry's colorectal firm which consisted exclusively of nubile Swedish female SHOs and one androgynous Thai boy.

Some f*cking genius suggested current selection criteria is outmoded and unfair and the seeds of MMC were planted. That genius had good intentions, but I'd sure like to punch him in the mouth.

A new way of choosing doctors

Deep in the desert forests of Shropshire, a small band of vegan peoples started shaping the future of medical training. Out of clay. They deemed it appropriate to do away with millennia of tradition and replace the CV with a form made from Satan's flatus.

They say the man responsible for the form designed it with only one hand, as the other is chained to a pipe in his mother's cellar. They say he owns an extensive collection of mermaid porn and rubs soup into his face for hours on end.

MDAP was born, but was so hypoxic at birth it had to be transferred to NICU. An inexperienced F2 had a stab at intubating MDAP but tore straight through its pharynx causing it to die horribly and in great pain.

From its twisted and mutilated neonatal corpse rose the spectre of MTAS. MTAS was a healthier baby than MDAP and made it to school, where it had no friends. This year MTAS put thousands of SHOs in a big pot and shook them around a bit. A few thousand fell out and they went in the jobless pile.

MTAS took a look at the other doctors in the pot and chose a few budbud, whop, spik and bongo names to chuck out, even though they were all Brits. Then MTAS got bored and emailed credit card numbers, pant sizes and sexual preferences of junior doctors to crack dealers, the Klan and C.H.U.D.S.

A Big Medical Association a lot of us pay to represent us didn't do anything to begin with. They were playing MarioKart 64 and kept hitting the lightning before the jump.

A group of sewer-dwelling radioactive amphibians called ReptileUK tried to murder the MTAS staff and the Department of Health with sharpened baguettes.

Some splinter members broke off and realised the key to success was a Facebook group and a flash mob in London. RemedyUK got an unwashed mass of junior doctors together with the promise of blood doughnuts. They protested. Then the Big Medical Association weighed in with immaculate - and by that I mean woefully late - timing.

Patricia Hewitt, meanwhile, dropped her purse into the toilet and lost her library card. She went to the library and asked for a new card. For some reason she explained to the librarian she needed a new card because she dropped her old one in the toilet. As she left, she silently thought to herself "why did I tell her?"

In the deep West Midlands, the ST interview panel walked out. Patricia Hewitt said MTAS was a rousing success. New Zealand, Canada and Australia opened special British doctor immigration lanes at international airports to cope with the exodus from the UK. Patricia Hewitt said any minister that makes an error should resign. She kept on workin’.

Senior deanery staff walked out. Patricia Hewitt said pulling out of MTAS "was simply not a credible option since it would be impossible to place the best candidates in posts and fulfil the service needs in time for August using the old system."

Yet with a mighty slash from Occam's razor, MTAS was culled and lived no more. One day before court proceedings into the fairness of the system began.

A newer way of choosing doctors - the future

Medical Student Newspaper can exclusively reveal what will happen next. Sure, we're told hospitals will be using the old CV system to pick jobs, but we all know this is jive man, pure damn JIVE!

It does seem apparent that an elaborate new system of assessments will form the basis of selection for ST posts from next year. Obviously many of the skills required will remain the same.

For example, the requirements for a surgical ST1 job will still revolve around the basic tenets of managing the acutely unwell surgical patient, operative experience, watermelon seed spitting and Turkmeni dancing. Interviews will be replaced by three-stage contests between rival candidates.

The first round will consist of a barefoot jump-rope endurance challenge, with ropes made of glass and a floor made of knives. The second round is obviously ostrich wrestling, now a core part of most medical school curricula. However all trash talk must be in a broad Irish brogue.

Lastly, potential specialist trainee doctors will be selected according to their performance in the petrol gargling clinical governance contest. Only four things will be required prior to short-listing candidates.

They will want a plaster cast of your ear, your thigh circumference, a portfolio of every venflon you've ever inserted (specifying the colour and volume of saline used for flush) and finally fourteen DOPS, twenty two mini-CEXs and eighty five thousand CbDs.

Joking aside, thousands of British junior doctors took up jobs in new continents, far from family and friends. Of those that remained in the UK, about 33,000 have been waiting to hear if they have one of 22,000 jobs or if they will fill a void by working in a short, stop-gap, non-training post. Worse still, they will be reported to the GMC if they choose to leave if offered a better post.

The £250,000 it cost the taxpayer to train each one of them and the streams of cash being poured in to try and rectify the situation are apparently collateral damage.

One can only hope that your year avoids the genuine heartache MTAS has caused. But spare a thought for those a few years above you, life’s been unfair.

If you really want to learn more about getting into the new medical training system, you need to buy The Foundation Programme: Getting In, Getting On and Getting Out. DO IT.

The student becomes the master. THE MASTER I TELL YOU.

2007-05-06T16:44:00.000+01:00

Originally published in the April issue of Medical Student Newspaper.

F2 JOBS are out, huzzah! With nothing more than an arbitrary survey of me asking my friends, it seems as though most of my fellow F1s are happy with what they'll be hating next year.

Contrary to the February issue's prediction of becoming a McGP in Slough, I managed to land A&E, renal medicine and ITU at St. George's. I could not be more pleased. However there is one problem - I will have no one to boss around. I don't think I'll have an F1 for any of these firms.

My one consolation is that I might be lucky enough to have some hapless medical students to do my bidding. Although they must be the right type of medical students. The right type of medical student is one that loves bleeding people, sticking in venflons, writing TTOs and getting me food. It's the kind of student I was not. In fact, now that I find myself in the bizarre position of imparting knowledge (ha) onto students, I realise I would have hated to have someone as work-shy as me for a shadow.

I have a long and distinguished history of hypocrisy and you will be pleased to know I have continued it into my working life. Despite being a lazy and ignorant medstudent, I have no qualms violently demanding nothing less than complete dedication from my assistant house officers. Other people's students, however, I send home as early as I can.

"Finished lunch? Yeah why don't you head off? Your team doesn't need you this afternoon. Just tell them Rohin said you could go home."

The teams in question always seem 'annoyed' with me; I know they're just showing their affection in a male-acceptable way. When my students ask for the same courtesy, I have to work very hard not to throttle them with their new tourniquet.

"Have you checked the bloods, done a PR on the fat guy and got me a bacon sandwich? Nooooo? Chop chop then, get to it woman!"

Nowadays I stop short of physical contact, after the nasty business that occurred when I tried to encourage Valerie with a firm slap on the arse. The less said about that, the better.

The simple fact is that house officers are far more willing to help keen students as opposed to layabouts. I have discovered this too late. I cringe when I think what my house officers must've thought of me. Except for my firm at Medway. You'd be surprised how a hot SHO can motivate a young man to put in the hours.

Willingness to get involved with the firm isn't the only criterion upon which we rank students. During my first firm I had twelve students at one time. Twelve. At St. Peter's we open our doors to third, fourth and fifth years from both Imperial and St. George's. Thus I find myself in a prime position to make sweeping generalisations and unfair comparisons between the two medical schools.

Third years are uniformly a nuisance, whether they come from Gimperial or George's. They buzz around and get under foot like insects. Bad insects. Insects that carry some sort of disease. But not mosquitoes because they don't crunch when you kill them. Maybe cockroaches. But not that big. Like some disease-carrying medium-sized hard-shelled scuttling insect. Yeah.

I do feel sorry for the ICSM little ones though - they're abandoned on the wards for up to ten weeks with almost no instruction. They wander around like lost puppies and have to rely on the good nature of the junior doctors to teach them clinical skills and create educational tasks for them to do. So if they're with me, they're screwed.

Fourth years are, without doubt, the most accomplished skivers. I feel barely qualified to comment on their characteristics as students as I have seen so little of them. I prided myself on my unparalleled bunkalicious skivism, but some of these guys make me look like an amateur.

It is the final years with whom F1s have most contact. I have now had seventeen shadows and they break down nicely into three sub-categories. George's five years, George's four-years (GEPs) and Imperial (sixth years). Each group has their own idiosyncrasies and foibles.

The conventional five year St. George's final year is thoroughly competent, relaxed around patients and ready to get stuck in. I, of course, feel more than a little kinship with them as I was one just ten months ago. They're keen to absorb knowledge, which is just as well as most of them have plenty to learn. The best Venflonners by a country mile.

Imperial final years – though it pains me to say it - seem to be more book-smart. There are few experiences more humiliating than being shown up by a smartarse student, but it happens so frequently I have grown to expect it. And there are myriad ways for me to exact a horrible catheterising revenge. In contrast to their admirable knowledge, some Imperial medics can be deficient in patient skills.

Lastly, by far the most interesting category is the GEPs. While they are exceptional players of blood bottle bowls, they are either doddery to the point of comedy or utterly set in their ways. One of my recent students, a German chap in his mid-30s and post PhD, lacked any logical thought whatsoever.

However, I will freely accept that me repeatedly shouting "I’m a cybernetic organism", “you’re a CHOIRBOY compared to me, a CHOIRBOY”!” and "who is your daddy and what does he do?" in an Arnie voice cannot have helped. Austria, Germany...same thing, right?

The transition from student to competent doctor is a gradual one and it comes as something of a shock to find yourself suddenly obligated to teach mates you've been getting pissed with for the last five years. In between emptying alcogel dispensers on each other, stealing drug rep goodies and flicking elastic bands at nurses, teaching students is one of the highlights of being a junior doctor, for as one teaches, one learns. I feel like I should dematerialise on Dagobah after that line. Lastly, a special thanks to Davina Hensman and Matt Roe, the best students I've had!

Patrica Blewitt

2007-05-06T16:30:00.000+01:00

Originally published in the March issue of Medical Student Newspaper. just before the protest on the 17th of March.

THEY’RE calling it Black Monday. I had a stupid article all about bossing students around prewritten in my head, but felt there was no way I could ignore Black Monday and its implications. This month has been dominated by the plight of our SHOs.

Medicine is a career where both a strict hierarchy and a fluid camaraderie co-exist. The SHOs I work with are both my seniors and my friends. Mulling over their pathetic predicament genuinely makes me despair. This month’s news section details how thousands of SHOs have been shafted by MTAS. The almighty fiasco has been played out in the national media as well as in every doctors’ mess across the country. Black Monday was the 26th of February when seemingly all my SHO friends learnt they had not been shortlisted for any ST jobs.

Why has the system gone so spectacularly wrong? Why are so many gifted young doctors jobless? How could this country have caused thousands of its brightest to plan moving abroad? A catalogue of calamity has led to a situation where little can surprise anyone aware of what has been going on. When we hear that a Deanery has been using police cadets to shortlist the vast numbers of applications, we barely raise an eyebrow. It may or may not be true, but it’s hardly more farfetched than some confirmed details so far.

The news that the entire West Midlands surgical interview panel resigned en masse on the first day of ST3 interviews spread like wildfire. In some ways, British doctors have never been so united around one cause. Part of the reason doctors from every walk of life are taking an interest is that they were all SHOs once upon a time. GPs and hospital doctors were SHOs at one point. They often remember their formative years with fond nostalgia and that a generation is being robbed of their chance at medical training troubles many greatly.

When I was a student, especially in my pre-clinical years, actual doctoring was a world away and I had no concept of what issues juniors faced. Hence I wanted to try to convey the mood hanging over your future profession to you. I cannot recall any time in British medicine as dark as this. Countless doctors have written desperate accounts of how they don’t deserve to enter unemployment. I clearly recall my school careers adviser selling medicine to me as a field where I would “never be out of a job.”

In fact I recently ran into someone from my year at school, now an SHO. I took a gap year and did a BSc, he didn’t. He has not been given any interviews; I might well avoid this fiasco altogether. Two years of dossing around might have been the difference between being a doctor and signing on. The figure being widely quoted in the press is 30,000 doctors applying for 22,000 posts. However the number of training posts may be substantially lower as many are career grade non-training posts, into which MMC is trying to guide people.

There are specific reasons, other than impending dole queues, which have particularly angered SHOs. Government mouthpieces like Lord Hunt, the Health Minister, spouts lunacy like: “We know the system is working well in many parts of the country...Let's be clear, there has always been competition for these specialist training places and there ought to be because these are the senior jobs. It's important we get the right people.”

Getting the right people is laughably far from the reality. The minority of friends who have gained interviews have been allocated them in an inexplicable manner. My current SHO, a highly experienced and superb old George’s boy, has been given an interview in London, the most competitive of all Deaneries, but nothing in his three less-competitive backup choices.

Patricia Hewitt, the Health Secretary has been warned for years that the UK is forcing junior doctors abroad. Many of the Royal Colleges have been angered by the complexity of the scheme and statements by the government that the Royal Colleges were complicit with all plans. This prompted a rapid response from all the major colleges, to ensure applicants knew that the Royal Colleges had been kept in the dark as well.

The government has cynically utilised the fact that the vast majority of doctors are scared to leave the profession. Most jobless SHOs face three options. Some could emigrate, but this is impossible for many. The majority will not find alternatives in the UK but will not quit altogether simply because they want to be doctors.

Yet another factor unpopular with candidates has been the application form itself. Last month I gently poked fun at the F2 application form. However similarly inane questions make even less sense for ST posts. Doctors who have augmented their CVs with publications, courses and qualifications have found themselves no better off than those that haven’t. The system has earned itself a reputation as a lottery due to the conventional, tried and tested, system of a CV and references being scrapped. Only a few 150 word answers to generic questions determines your future.

Perhaps most embarrassingly of all are the number of errors. Some SHOs have received interviews in areas they did not apply to and a confidential booklet outlining selection criteria was leaked on the Internet. It detailed “methods & best practice for upskilling selectors”.

St. George’s and St. Thomas’ have written public letters of protest to Prof Elizabeth Paice, chairman of the Conference of Post Graduate Medical Deans, calling on them to "revoke the current fatally flawed system". Our friends are being treated like shit, show them your support.

BUY. MY. BOOK.

2007-02-18T19:12:00.000Z

I LOVE MTAS!

2007-02-18T18:18:00.000Z

Originally published in the February issue of Medical Student Newspaper

MMC is in its third horrible year, so here's a little something for you medical students who find themselves in the midst of being randomly-allocated an F1 job. Next year you'll do it all over again!

Many of you have recently heard whereabouts in the country you are able to apply to for your first job. I thought I could worry you further by sharing the questions you will probably be answering in the future. In an act of unfathomable laziness, I have published my completed F2 form in its entirety.

In this world of uncertain careers, job shortages, cheap flights to Australia and down-banding, it is almost comforting - and by that I mean horrifying - that we have to fill out answers to these mind-numbing questions year after year.

Remember, you must always use all 75 words you're allowed. ALWAYS.

Here are some websites you might find useful when applying for jobs in medicine:

www2.goldmansachs.com/careers
graduates.deloitte.co.uk
www.ubs.com/graduates
www.ml.com/careers
www.pwc.com/uk
www.kpmg.co.uk/careers

Name:
The Daily Rhino

Medical School:
St. George's Hospital Medical School (that was the damn name when I entered)
Tooting

Date of Graduation:
07/06

Primary qualifications:
MBBS (London)
BSc (Bronze Swimming Certificate)

Evidence of high academic achievement gained after completion of secondary education (or equivalent):
None.

Using an example from your F1 experience to date, describe how your communication skills have improved an individual patient's care.
An elderly, deaf, confused, Jamaican, homeless man was diagnosed with penile cancer. His difficulty hearing, coupled with his dementia and lack of English comprehension, made it difficult for him to understand when the consultant informed him he had a neoplastic mass in the corpus cavernosum. Hence I decided to use my honed communication skills, by shouting in his ear: “E BLAASCLAAT, YA DINGALING BE CHICHI BRER!” He understood immediately and insisted I was the best shouter he had ever met. (75 words)

Using an example from your F1 experience to date, demonstrate how you have learned from a potentially serious mistake or error and how your practice has changed as a result.
I make mistakes on such a regular basis, I can happily say I am learning a huge amount. It is difficult to identify a solitary mistake, but in retrospect I think one stands out. During my entire career at medical school, I never attended lectures, classes or PBLs once. I chose instead to spend my time watching Sponge Bob Squarepants and listening to Pink Floyd. At the time, I was sure I was doing the right thing, but now I’m fairly confident not attending medical school was a mistake. This occurred to me when I realised I don’t know any medicine on my first day of work. Still, no one’s noticed yet. (75 words)

Describe an example drawn from your F1 experience where teamwork was ineffective. Why do you think it went wrong and what did you learn from it for the future?
During Wednesday evening five-a-side, I made a glorious run down the left wing and Gee didn’t pass out wide, instead trying to make an impossible run past a flat back 3. He does it all the fucking time, MAN it annoys me. So the following week I kicked him in the shins as hard as I could. Haha, that’ll teach him teamwork. (64 words)

And this was very important and so I thought yes the end. (75 words)

In the curriculum there are 16 competencies. Choose 2 and give a different example from your F1 experience for each demonstrating your achievement of this competency and the significance to you.

Safely and effectively uses common analgesic drugs (75 words)
Oh man, the amount of times I’ve used analgesic drugs, jeez I’m so safe and effective, I could do it in my sleep. I mean safe safe, not safe SAFE). Now that cannabis is legal for all uses, I’ll be ideally placed to teach my MS, OA and teenage patients how to roll scuds, pencils, Ls, tulips, megas and super-MCs. I’ll teach them the superiority of silver Rizla and the importance of a poking biro. I have also taken Paracetamol - yeah I was fine thanks. (75 words)

Discusses Do Not Attempt Resuscitation (DNAR) orders/advance directives appropriately (75 words)
A sick patient was going to die but his family felt otherwise and wanted him resuscitated at all costs, despite the medical reg insisting this would be unsuccessful. I tried to help out and I think I got the message across succinctly. I drew my ceremonial bat’leth and slay the patient’s grandson. If the family would protesteth, they would all taste my blade. Too late, I could not spare any of them. As I slashed back and forth, I muttered loudly over my breath, “this hurts me more than it hurts you.” Were a truer word ever spoken? Yes. (75 words)

Give an example of a professional achievement from your F1 year, such as an audit or presentation, not already described and its significance to you.
I have much to be proud of. I have audited some shit about murderation. I write a monthly column for some medical student paper which brings joy to millions. But perhaps the most admirable of my admirable achievements is my ability to slice a man in half with my fist, like Sonny Chiba. I can also punch out a human male’s eyeballs with a fist-punch. Basically, my fists are battering irons imbued with fury. This is significant to me because it’s cool. (75 words)

Describe actions you have taken to prepare for your future career choice and progress made (75 words).
Since a tender age, maybe 4 but I’m not sure, I have wanted to be an evil doctor with a mighty neck beard where I stored actual crunk. I have spoken to my careers advisor and undertaken a SCI59 questionnaire, which both suggested I should follow the course of evil and dedicate my life to the blood god that slaughtered my ancestors. I realise it’s almost impossible to land a London evil rotation, so as staying in the capital is important to me, I’ll probably end up doing histopathology. EVIL histopathology. (75 words)

The programme you applied for:
Emergency Medicine (St George's, 4 months)
Renal Medicine (St George's, 4 months)
Intensive Care Medicine (St George's, 4 months)

The programme you have obtained:
Public Health (Stoke Mandeville PCT, 4 months)
Homeopathy and Reiki (Weston Super-Mare High St, 4 months)
In-house McGP (Slough McDonald’s, 4 months)

Another happy junior doctor.

Hinglish 2

2006-12-25T22:04:00.000Z

F1. It's fun: Drugged up and in demand

2006-11-21T17:35:00.001Z

Originally published in the November issue of Medical Student Newspaper.

WHEN I was a student, I thought I was a bit of a bum. This was predominantly because I was, in fact, a bum. On those rare occasions when Jupiter was in the House of Saturn and the Moon was waxing, I decided to show up to whatever firm I happened to be doing. A combination of my overt ineptitude and uncontrollable humming of the Rocky theme music made me feel like I was little more than a nuisance, constantly getting underfoot of the people actually working.

With the exception of some fantastic doctors I encountered, a large amount of hospital staff made students feel particularly unwelcome on their clinical attachments. Now I've got that magical 'Dr' in front of my name, I'm treated very differently. For the first time in my life, I'm in demand.

I am endlessly courted by drug reps. No matter how many times I tell them I'm not that type of boy, they continue to thrust their increasingly bizarre freebies into my alco-wiped hands. For example, I recently experienced a glorious period in my life: I didn't pay for a single lunch all week. For whilst my position in the hospital has changed since I graduated, my cheapskate tendencies have remained entirely unabated.

I revel in my free lunches, but all Medical Student Newspaper readers will know that there is nofreelunch.org.

The NoFreeLunch movement and its related anti-Big Pharma (spit) efforts have been covered extensively in the paper, so I shan't re-tread old ground other than to say that the website is thoroughly worth checking out. It has a specific section for medical students - you are identified as a key asset, after all, you have more prescribing years ahead of you than anyone else.

I was a devotee and a committed NoFreeLuncher; I wanted nothing to do with the godless, evil drug companies (spit). I made sure to give a stern lecture to my colleagues who expressed even a passing interest in picking up a free pen. So why am I now munching on free lunching? The honest answer is because I'm weak. The supplementary answer is because it's far easier to stand steadfastly against the pharmaceutical industry (spit) when you are a student.

The freebies are so diverse and relentless in their onslaught that it is nigh impossible to avoid utilising at least a pen, especially with the inordinate amounts of writing an F1 does. When a drug company offers you dinner in a restaurant so swanky that patrons are given four types of fork, it isn't easy to say no. They have free booze (now you understand).

I tell myself that I'm actually doing the anarchic thing and consuming pharmaceutical company resources by eating their food and using their pens. But for every item of branded paraphernalia I accrue, I am subjected to a few minutes of rep-chat.

They show me Fisher Price-style bar charts explaining why their drug is better than sex and everything else KILLS you slowly. I worry that no matter how hard I try not to listen before saying "yeah yeah OK, can I have a meal ticket?", some of their hard-sell has subconsciously filtered through to the prescribing centre of my brain. Indeed, observational studies have shown that promotions and interactions with reps does affect prescribing patterns.

Along with my firm-partner, Ellie, I'm trying to get a journal club up and running (mock me not, I have a CV to worry about here). As I'm sure you already know, doctors need an incentive to turn up to anything that removes them from the mess. Chiefly, food. Who is happy to provide Ellie and me with food? Those good old drug reps. What, free of charge? Nay! They want us to present a paper that just so happens to be pushing their latest pill. Funny, that. At the very least they would want to be present to leaflet attendees with 'evidence' concerning the drug they happen to be dealing.

Our grand rounds are sponsored by pharmaceutical companies, as are the weekly GP lunches. Whilst admirable American bodies such as NoFreeLunch advocate a complete embargo on sponsorship from drug companies for talks and meetings, the British NHS does not have a vast pot from which to withdraw for such events. Use of money to feed doctors when alternative sources of funding are available might be seen as irresponsible.

Comparing the profession we have chosen with others can be depressing. Those in the world of finance train for a shorter time than us and are wined and dined frequently. But the relationship they have with clients is not the same fiduciary interaction that exists between doctor and patient. A more apt comparison would be a politician and the electorate. As the Labour Party has demonstrated recently, politicians are not supposed to accept gifts from lobbyists. These are people who want to effect change in politicians' behaviour, much in the same way reps are trying to affect doctors.

Where you stand is a decision you will begin making now, while you are a student. All I can say is, as I use my Imdur optical mouse, my Bisoprolol LED mouse-mat and my Viagra wrist support (hehe), that the person able to resist any of the goodies on offer may well be a better doctor than me. But hey, I'll have cooler stuff.

Hinglish 1

2006-11-05T19:03:00.000Z

Photo: Naina June Ghosh

Pretend doctor

2006-11-05T17:45:00.001Z

THE crappy articles I write for the fine, fine Medical Student Newspaper have somehow won 3 nominations for the Guardian Student Media Awards 2006 (best columnist, best features writer and best diversity writer). Don't tell anyone there's been an error until after the ceremony.

With my worrying graduation, the newspaper now has two in-house doctors with my column on F1 (the first year of work) alongside the celebrated Dr Crippen's column.

Below are my first offerings for the new academic year, first published in the October 2006 issue.

F1. It's fun.

Merely a few weeks ago I was one of you. I loved being a student. Now, dragged kicking and screaming into the world of work, I realise I know far less than I did before finals.

Medicine is one of those degrees where you are essentially the same impotent apprentice for four/five/six years and within the space of one exam result, suddenly you can prescribe morphine and cardiovert people.

The summer after finals is a glorious time - all the perks of being a doctor (i.e. telling people you are a doctor, and are thus superior to them) but none of the responsibilities. Even when starting work, you're eased into things and you have helpful SHOs and registrars to guide you away from negligence suits. But after a few beers on Saturday night, it's quite another story.

I was out with two non-medical mates, buying a pitcher. As I was paying, some bastard grabbed my pitcher and started glugging my beer. Drunk rapscallion's best defence was "I wanted a drink". I figured it wasn't the best day to get stabbed in a drunken altercation, so I walked away. Note - no cowardice was involved, only good sense. GOOD SENSE.

The story met with resounding condemnation when recounted to my two friends, Arthur and Froy, but we continued our drinking. Hours later we were leaving the pub. I saw the same thieving miscreant mounting his scooter. I said "look, there's the blighter!"

Arthur and Froy expressed yet more disgust at the beer-burglar and Froy shook his fist in the air and said "I hope he gets run down!" We had totally mislaid the fact that the chap was blind drunk.

As we walked onto the road, a sudden and almighty crash spun us around. All I could see was a helmet rolling slowly down the main road.

My first instinct was, obviously, to check to see if a head was inside. Secretly, we remembered our beer and its heinous theft.

As I was calling an ambulance I walked around the corner to see a pretty horrific sight. The rider had been thrown clear over a wall and onto a pedestrian island by a mini-van, his scooter was in quite another part of town and his left shoe was in Monsoon. A pool of blood was collecting around his head, as was a huge group of Saturday night revellers.

"I know what to do!" "Put him in the recovery position!" "Press on his cut!" They thronged.

I walked closer and then I said it. The line that I'd been dreaming about saying since I got into George's. A fortnight or so into the job and here I was with a chance to say it to a captive audience.

"Guys, guys, it's OK. I'm a doctor."

If you've read any previous Rohinplastys (so...just you Mum), you'll know nauseating arrogance is something I positively enjoy, but this may have been my apogee. That one moment made six years of debt worth it. I'm told that the rewards of helping people and saving lives make medicine worthwhile, but until I actually do any of that, the smug-factor of that one line will be the highlight of my life as an F1.

The huddle parted for me. I was Moses. Get out of my way, I'm a doctor, a doctor I tell you! Let me bask in your admiration for a bit.

Oh yeah, guy on floor. Fuck.

The glory was quickly replaced with deep, deep regret. Why did I step forward? What the hell can I do? I'm about as useful as rhubarb. Right, right…primary survey, ABC. Good, he's breathing OK and stuff. Err… "Don't move his neck" someone shouts. No help, I knew THAT one. Umm…D, disability. Shit, bugger, err…

He did turn out OK, despite a woman asking if I really was a doctor. But two vital lessons were learnt.

First, I'm not a REAL doctor yet. Further testament to my pretend-doctor status is plentiful at work, I can't prescribe drugs outside the hospital, all my clerkings are reviewed and I need to be supervised doing anything mildly fuck-upable. If you are a drunk beer-stealing scooter-driver, you better hope a passing doctor isn't a new house officer. You REALLY better hope it's not me.

The other lesson was far more important and learned not by myself, but by the lad on the floor. Deep down he knows, yes he knows, that if you steal beer, bad things happen. And karma sure is instant these days.

Relating to the dead

Ash cash. The sixty two pounds a doctor pockets every time a patient they have certified pops their clogs and is burnt to a crisp is nothing short of infamous. Known as the house officer’s privilege, it is the fund for Thursday night drinks all over the country.

A colleague working on care of the elderly has effectively gone up a banding due to the vast amounts of ash cash he rakes in. No comment on his quality as a doctor, of course. Ahem.

Yet when we are filling in the form, we all answer ‘no’ to the question ‘Do you have any pecuniary interest in the patient’s death?’

Despite some noble souls donating their cheques to charity, the rest of us catch ourselves secretly hoping that families opt for cremation.

If a terminal patient is known to several doctors, we also hope they survive just until we’re on call and then we’ll be the one called to confirm, see the body after death and head down to patient affairs before anyone else beats us to that cheque. Well, perhaps that’s just me.

Irrespective, one such patient passed away recently. Every doctor knew her because she was afflicted with something juniors encounter on a frequent basis, the family from hell.

On each occasion I was on ward cover, I would spend a good portion of my evening engaged in fruitless and frustrating conversations with her children. They were in complete denial that their young mother had extensive breast cancer with massive brain, lung and liver mets.

The nursing staff were no less bullied by the family and as a result the responsibility of placating them was always shifted to the on-call docs, who would be summoned repeatedly.

After a month or so of the daughter demanding to see a doctor at all hours of the night because she wanted all analgesia stopped or DNAR forms reversed, I became fairly rude and grew to intensely dislike being asked to review the patient.

I could only be disappointed with myself for coming to loathe a patient’s family, but as long as they made my life difficult by wasting my time as the bleeps piled up, I didn’t care. It is a horrible thing to hate someone just for loving their Mum.

Finally, she died.

Confirming the death of a warm, just-expired body, late at night, is an unusual experience for some.

You will find that when you confirm your first death, you convince yourself you can hear something as one rarely hears silence through a stethoscope. The embarrassing thought that a patient will reach the mortuary and suddenly perk up ensures you are extra-thorough.

As soon as I found out this poor lady was to be buried and not cremated, I lost all interest. I was genuinely sad that this mother-of-two had died a slow death aged 42, but relieved I would never have to meet her insane family again.

Life continued for me as normal and I did not give her another thought for several days. Until five days after her mother had expired, the problem daughter was leaving my ward at midnight.

I asked the staff nurse why she was here and she explained she had come to pray in the room in which her mother died. With a shrug of my shoulders I dismissed this as yet more odd behaviour from an odd person.

I finished my always-horrific ward cover on-call soon afterwards and went back to my digs. Out of the window I heard two foxes fighting, but when I looked out I instead saw the daughter howling with sorrow outside the hospital.

She had lost her Mum. Her Mum was younger than mine is now. It was almost 1 a.m. and she was alone. I felt overwhelmed with guilt for hating this unlucky girl and I went outside to talk to her. In yet another example of my complete inadequacy, I sat there for some time, not knowing what to say.

Maybe it helped; it probably didn’t. It would be overtly corny to suggest that now every time I write a death certificate, I do so with a sombre disposition and rueful melancholy. It is necessary to be somewhat hardened to death and dying as a doctor or medical student. But I sincerely try to put myself in the shoes of a patient’s family member.

Having said all of that, I still curse when I am asked to see an unpleasant family. Relatives can stonewall and flummox you, but corpses don’t ask awkward questions.

I treat the dead the same way I always have, but I’m slowly learning to deal with the living.

"A grave is a place where the dead are laid to await the coming of the medical student"

- Ambrose Bierce

Revision: IT BRINGS DEATH

2006-06-26T23:35:00.001+01:00

I THOUGHT I'd copy what other journalists do (did I just refer to myself as a journalist? Sorry about that) and post up random articles they've written elsewhere on their own blog, where far less people will read them. Ah well, it saves having to spend time thinking about an original blog post.

Revision: IT BRINGS DEATH

HARK! Is that the songbird of revision I hear chirping? No of course it isn't, revision has no sound; how foolish. Understand this - revision is taciturn; it silently pulls your heart out through your feet and methodically beats all the life out of it with the stump of your spinal column. Yes, revision kills. All over London, medical students are slowly dying - all secondary to revision, which has replaced Tetris as the UK's third highest cause of death, after myocardial infarction and radish.

This should come as no surprise to anyone abreast of the latest evidence-based medicine, which is why you are undoubtedly surprised. As proof, I could now quote some general medical shit at you, but you don't want that. You want to understand why and how revision kills and what you can do to stop it. Revision, contrary to popular belief, rots the mind.

Is this what you want? Revision will make it happen

The brain is a complex, and by that I mean remarkably simple, semi-cybernetic device. With every useless factoid about 'medicine' or 'surgery', more valuable knowledge is pushed out of your brain. Most areas of the brain are devoted to goat's cheese, Simpsons quotes and stethoscope-swinging murder techniques.

A tiny proportion, maybe a part of the brain the size of a sugar cube is devoted to all conscious functioning. Although we're talking about a sugar cube that is one quarter the size of a conventional sugar cube. Revision doesn't belong there, because 1 - it smells and 2 - it's a form of mind control which will end your life.

Q. How does it kill?
A. IT EATS YOU

Revision wields its evil power thanks to the phenomenon of "exams", which provoke otherwise reasonable humans to engage in what is clearly a hazardous pursuit. Most post-mortem specimens whose demise was due to revision-related injuries are so hideously disfigured by the time they reached the morgue that little research has been possible.

However the poor souls who died in their own medical school's library (this will probably be you, soon) have occasionally been carted down to the coroner in time. What they discovered will chill you to the bone and you will probably never be able to sleep peacefully again.

Revision turns out to be a vector-borne disease, like malaria - but more "fucked up". These are the words of Professor Hurley "von" von Tempest (pictured below), the leading expert on revision. He has documented evidence of flesh-eating parasites that enter the body via the eyes, causing unimaginable pain. It seems that whichever bright spark named eyes the "window to the soul" has turned out to be some morbid dick.

Professor Hurley "von" von Tempest demonstrating the dangers of revision: OBVIOUS

Hungry revision parasites quickly track up the optic nerve and flood the brain. Within days the entire cortex has been devoured and blood streams forth from all orifices. ALL orifices. Yet there remains a darker, more disturbing aspect to the global, and bizarrely underestimated, threat of human-eating revision. What is yet to happen.

The Prophecy

Found buried in a Pastest book, between the misspellings and poor grammar, Zachariah "Chewable" Heshapsut stumbled upon The Prophecy.

They came long before us. Their sovereignty over this mortal realm was supreme, but in their opulence they grew complacent and power was soon ceded to us. For them, beings that had enjoyed free reign for millions of years, our ascent was rapid. From rudimentary gatherings of ape-like apes, huddled beneath black monoliths, we became hairless hominids almost overnight.

Their reaction was slow at first, we consumed their resources and they became weak. But then they drew plans to enslave us all. They created revision. The Prophecy foretells of the day that enough of us are doing filthy revision upon ourselves, the so-called 'critical math'. When sufficient numbers of people are revising, they will rise and we will all be eaten.

The concentrated evil has been sleeping for aeons, but slumbers only to awaken once more and rid the earth of humans. No one will live.

What can you do?

Spread the word, revision is merely malevolent mind control, wool that's been pulled over our eyes to once again make the oceans run red with our blood. Do whatever you can not to revise. House, Scrubs, Lost, The Apprentice - these have been created by underground rebels to help you in your quest to avoid revising.

However, despite appeals from myself, the President "of" Angola and Brent "Data" Spiner, it seems the end is inevitable. When the day of reckoning comes, all I can hope for is that I am eaten first. If you have sense, you'll pray for the same, to whatever ultimately ineffectual god you believe in.

If you are unlucky enough to still be alive as they wreak havoc upon our world, your mind will simply implode with the utter depravity. BREAK THIS CYCLE OF HORROR AND VIOLATION: DO NOT REVISE.

I'm doing my bit. Are you? Help others go mad with the knowledge of their impending doom, tell them they will all be eaten.

Originally published in the May issue of Medical Student Newspaper. I was revising for finals, my mind was hurting.

Taggart: medicine, medical, medical students, medical school, humour

Ebert and Rohin

2006-06-23T13:58:00.000+01:00

I BLAME Holland and the Druids. My Dutch and pagan ancestors were resurrected this summer solstice, as I donned my orange T-shirt to spite the Argies and worship the sun god (or whatever Druids did) by watching Argentina vs. Holland. Meh, boring match. So we drank. Then we thought a real-life Street Fighter II re-enactment was in order.

Ah, how we laughed as we hadookened.

Later, friend says "friend, your thumb."
I say "Oh yes, that's odd. Friend, I need to go to hospital."

It turns out being a doctor DOES have some advantages. About ten days after becoming one, I discovered preferential treatment. No, that's a lie. I demanded preferential treatment. And copious amounts of Entonox (nitrous oxide), which would've been useful had my uninjured friend not had more than me.

A fractured metatarsal is the England team injury - Beckham, Owen, Rooney. But a mashed up metacarpo-phalangeal joint and fractured metacarpal is pure Bollywood. Why?

And Hrithik Roshan recently broke his thumb. HENCE it's surely only a matter of time before either him or I become the next face of...

I still don't know how it happened, but I blame those goddamned Druids. And the Dutch.

Hot mail

2006-05-05T22:14:00.000+01:00

ON the cinco de mayo through the door cometh:

Limited edition all-black engraved Master Cardiology. Chestpiece weight sufficient to penetrate a man's skull with minimal swing. Hot motherfucking shit.

Back in business murrfurr

2006-04-25T16:00:00.000+01:00

Highlights (route changed):

Adventures on my cameraphone:

Drunk as a skunk, hit a car, through the windscreen and ended up with me suturing - how unlucky can a guy get? But look at those bandages - artwork. I'm still smiling because this was the last guy I treated before a lorry full of builders flipped and 30 people came in at once.

Two heads: Not better than one

2006-03-27T01:41:00.000+01:00

MANAR Maged, the little Egyptian baby who made the news last year when undergoing an operation to remove a spare head, has died from an infection aged almost two years.

Her condition was craniopagus parasiticus and her accessory head could smile and blink but was highly unlikely to be capable of independent thought.

Craniopagus parasiticus occurs when a craniopagus twin (i.e. conjoined at the skull) cannot receive enough placental blood and their body atrophies, leaving just a head. The most famous case was, of course, Indian. Bengali, no less. (Via the Fortean Times)

The Two-Headed Boy of Bengal was born in 1783, in Mundul Gait, and was recorded in history by Everard Home, brother-in-law to John Hunter. The midwife tried to kill the baby as soon as he popped out by launching him into a fire, but he survived with a few burns. His parents soon realised the revenue he could create, poor folk that they were, and displayed him for money. However to preserve the mystique, they covered him in sheets throughout the day, so that no one could grab a peek without paying. He spent most of his short life wrapped up and miserable.

His extra head sat atop his normal one, upside down. It would attempt to suckle if put to the breast and would grimace if pinched, but did not seem capable of independent movements. The pupils were weakly reactive to light but the corneal reflex was absent. He lived to the age of four, probably the longest any of the few patients born with this rare condition has survived, when he died from a cobra bite.

His parents would not allow sale of the corpse, but oddly enough they buried him - allowing the body to be stolen free of charge. Dissection revealed that there was no boney septum between the brains and that each was encased in normal dura. For many years, physicians were unsure as to how to classify the boy, until 1836 when French anatomist Isidore Geoffrey Saint-Hilaire drew parallels between the Bengali boy and craniopagus twins:

"He suggested that the Two-Headed Boy belonged to a special group of parasitic craniopagi, and quoted a similar French case, described by the Liège surgeon M Vottem in 1828. Here, the parasite had been much larger than in Home’s case, with incompletely developed arms and a rudimentary spinal column. The monstrous fœtus was seen to gasp for breath and move slightly for about half an hour; after its death, the mother was told she had given birth to a stillborn normal child, in order not to disturb her." [Link].

To support the theory that craniopagi parasiticae are craniopagus twins with an atrophied body, some of the neck stumps in subsequent two-headed babies have been found to contain rudimentary sternums, hearts, clavicles, ribs, pharynx and lungs.

The boy's skull remains on display in the Royal College of Surgeons in London:

Archive footage, circa 1984

2006-03-23T02:41:00.000Z

THIS film was recently discovered in a Sheffield cellar and it has been alleged it became the inspiration for a successful televised animated series, or 'cartoon', entitled 'The Simpsons'.

Seriously though, this is the (British) Sky One trailer for the Simpsons and is filmed in the UK. Which is why I'm particularly impressed Homer is driving a left-hand drive car. The attention to detail is superb - check out Marge's blink in the supermarket, the TV screens 'Bart' skates past and the band conductor's hairstyle. Brilliant.

(This is just a pit-stop, I'm still halfway through that map below)

...service suspended...

2006-02-22T14:43:00.000Z

Back in a bit.

In the meantime, sit back and enjoy(?) the first films I ever made, all a few years old now (and wait for 02:20 in the second one)

Tammy Nyp

Tagalog! short films, parody, spoof, matrix, parkour, breakdancing, dance, comedy, bollywood

Al Qaeda's next target - exclusive

2006-02-22T00:01:00.000Z

WADING through the unmitigated tripe on The Daily Rhino, you'd be forgiven for thinking that this isn't a news blog. Well you'd be wrong. So wrong. To quote Gene Wilder, "WRONG!"

In fact breaking news has just reached the newsdesk of the DR. Watch now, as our crack team's Grissom-esque brains piece together the puzzle of terror.

Exhibit A:
Militant Muslims aren't very fond of Israel.

Let's consider that statement for a second. Is it Israel they don't like? Hardly. Most Muslims feel Israelis are a charming people, with quaint customs and enjoyable folk music. Prominent imams, vocal proponents of Israel Bonds, also feel Israel has much to offer:

Smart men. No, what hardline Muslims really dislike is the Israeli FLAG. Ooh gosh they hate it:

Now, I can't find the video for this, but what he actually shouted (rather vociferously) was "I love Israel, you're a nice bunch, but I hate this fucking flag man! Seriously dude, I just wanna burn the motherfuckah. BURN IT! BURN IT! AARRGHH, have you seen the Tammy Nyp video?!" Most are of the opinion that the intense rage many Muslims feel toward the flag stems from its origins, as it was originally drawn by a celebrated Danish cartoon flag maker and casino-owner.

So it was with some astonishment that during the nineteenth straight hour of looking for Target ads on Google Earth, that we spotted something monumental. Something that shook us to our very core. Exhibit D.

This is London's Heathrow Airport, one of the busiest airports in the world. Just looking at it brings me out in urticaria. Oh the wheals.

My fellow Londoners, Arnie says we're all in deep do-do now.

Tag Heuer! israel, islam, london, terrorism, al qaeda, Denmark

Beer and the golden tetrahedron

2006-02-19T19:41:00.000Z

I FINALLY found some ads which I've long thought are pretty amusing. Greene King IPA was specifically brewed for Brits out in India during the Raj, towards the end of the nineteenth century and it is now the most popular cask ale in the UK. It's not all that easy to find, but when I've had it, it's been a very nice pint, goes well with mild Indian food but I still prefer a Kingfisher if I'm dining desi. Their website explains that a large amount of hops were used to give a preservative effect, hence allowing the beer to better survive the long sea journey to India. The beer proved so popular it was never exported to India. Hence the ad campaign:

I've also recently been poring over travel literature. The cheapo-trek-adventure-type agencies gave me some catalogues. Below is a page from one showing the GAP Adventures staff. Travelling the world as a backpacker, roughing it from country to country and taking months off work to do so seems an almost exclusively white preserve in the UK. There are stacks of pictures in all the catalogues and almost everyone is white. More than that, I'd hazard a guess that they're all middle class. A RTW trip lasting for months on end is practically a rites of passage trip for white guys with a generous Dad. Just going by the crude measure of my friends, the ones who've disappeared for the best part of a year to ride camels in India, bungee jump in New Zealand and trek through the Amazon Jungle have all been white. I don't know why other ethnic groups don't seem to take up the opportunity.

Anyway, it was with some interest that I saw no less than five desi faces on the page. Great! Most staff at these adventure companies have been on some trips themselves. So what do these five trailblazers do?

Iftikhar Khan, Sandeep Kumbare and Gajalini Ganesh - Accounts.
Megha Kumar and Mohiuddin Talukder - Web development.

Accountancy and IT. All they need now is an in-house doctor and an engineer and the holy quad will be complete. All I can say is, long live the Mutiny.

Beer, India, Advertising and what the hell, Brrreeeport

Everywhere I've ever been

2006-02-19T03:19:00.000Z

I THOUGHT I'd seen loads of places. Turns out there's a lot more.

Or as a map created by World 66 (thanks, flygirl)

Culinary engrish likes me

2006-02-16T21:08:00.000Z

ON first glance, all you see in an inocuous, if somewhat tattered chopsticks wrapper, wishing all and sundry whose gaze upon it falls happiness, longevity, health and peace. Rather touching of Penta Foods Ltd.

But then you turn it over and are greeted with some class A engrish. Actually, I can't decide if it's bona fide engrish, or they just typed it using the chopsticks. I mean chcosticks. Click on the image to take a look.

All is forgiven, however, with the rousing and inspirational closing line:

"Now you can pick up anything:"

Isn't that what Yoda said?

Different governments, different styles

2006-02-16T00:26:00.000Z

I heart FOBs

2006-02-15T21:45:00.000Z

THIS is one of my best mates. I thought instead of some generic google image, I'd give you a bona fide example of what I'm talking about: the Indian student. As you can see, with no hair gel or designer labels, it's patently obvious this is no British Asian. I'm talking about the Indian overseas student.

Long have they been the brunt of American jokes (we treat them far better here) and the stars of awful films like Where's the Party Yaar, American Desi and Van Wilder.

But now the FOB (fresh off the boat) is in demand. Countries around the world are falling over themselves to attract more students from India, as they enjoy the dubious reputation of being more serious, harder-working types. Oh, nerds.

Tony Blair and Condy Rice have spent time with Indian teens, patiently fielding questions in order to persuade them to leave home. The Chancellor of Oxford University, Lord Chris Patten, recently announced a trip to India with the sole purpose of attracting more Indian students, as the UK has fallen behind the US when it comes to attracting the brightest brains of the subcontinent. He said:

“I don’t think a serious university can do without a properly thought-through strategy for China and India.”

Those two countries again. Is no area of life free from their looming presence?! Indeed, Cambridge has also recently announced a greater focus on India - they have concentrated efforts on China up to now. Patten's trip will take him to Bangalore, New Delhi and Mumbai. He will be drawing attention to statistics like the fact Chinese students now outnumber Indians 2:1 at Oxford. ~~Last year~~ In total, 17,000 Indians ~~came to~~ study in the UK, compared with about 80,000 who chose America.

He thinks that the UK and especially some of the older establishments have a "conservative, stuffy image." Surely that suits Indians to a T? Of course not, kiddies from conservative and stuffy countries want to party hearty. Leaving an often sheltered home for the first time represents a once-in-a-lifetime opportunity for many young Indians.

They are increasingly opting for America as the destination of choice as US colleges and the Greek system promise what many frustrated Indian boys crave, frat parties. It would be interesting to compare the sex-breakdown. Most overseas Indian students are male - but I wonder if an equal proportion of guys head to the States as girls. I would assume so, as to pretend that Indian girls are less horny than Indian guys is naive at best ;)

OK it's not just sex and parties. The Indian press portrays America as a more glamorous destination for a budding scientist or engineer, with success stories around every corner, many of whom are Indian. The Grauniad claims the net worth of emigrants to the US from IIT alone is $30 BILLION. Lord Patten stated that Europe as a whole is facing a crisis in research and higher education; in 2005 the US spent twice as much as Europe on its unis and R&D:

“Last year, 25 per cent of European students went to America to do PhDs. None of us should want to be part of creating an ignorance-based economy.”

London's universities have traditionally fared well when attracting overseas students. Perhaps most successful of all is the London School of Economics, which has a student body who are overwhelmingly foreign. Overseas students bring in the bucks as they pay around £10,000 a year for a normal degree (almost £20,000p.a. for medicine), although with the coming year's top-up fee introduction, the disparity between home and foreign students' fees will be reduced.

The drive for the brown pound is not limited to the English-speaking world, China (which currently has only 800 Indian students) has upped efforts to bring in more desis. My girlfriend recently went to check out INSEAD, a business school near Paris. In the prospectus Hindi was listed as the second most common mother tongue amongst students and the pages were peppered with carefully-selected Indians.

This has only occurred due to the introduction of English-language courses in Europe. Indians are looking outside the US and UK for higher education, but they still want to speak the language left by the British. Hence Australia has seen a dramatic rise in Indian applications (and we're back to the party line of thought, see: Salaam Namaste).

But there is hope for British fans of FOBs, as last year foreign applications to US colleges fell by almost a third. In numerical terms, Indian students make up 5% of all overseas in the world and are now officially hot property.

UPDATE: Abi from nanopolitan points out this great link.

Tsunamika

2006-02-15T20:10:00.000Z

THIS is a poorly-lit shitty phone pic of a tsunamika doll (and my hand):

This particular one doubles as a paper clip or bookmark, like this:

Others are hairclips, badges and stationery accessories. Here is a better pic:

Tsunamika is a project spear-headed by the Upasana Design Studio in Auroville, the south Indian township created by Sri Aurobindo (who went to my school, hurrah!) and The Mother. These little dolls, made from the studio's left-over fabric by tsunami-survivors, have given fisherwomen near Pondicherry an opportunity to empower themselves over the last year or so.

Of course money raised goes to the fisherwomen, but the project has provided a trauma counselling service and the opportunity to put the tsunami in the past through creativity and group activities. One million dolls have made their way around the world - with no price tag. Oddly enough, the distributors ask for no money. Not in the way that museums ask for a 'voluntary contribution', but the dolls are geuinely free. As far as I understand, the way money is made is by organisations paying the group for buying the dolls in bulk, to subsequently distribute, gratis.

Read more at the official website.

Bollycool Retro

2006-02-11T20:13:00.000Z

THE back to black series has re-released classic Bollywood soundtracks with a nostalgic twist. Each CD looks just like a miniature version of the original vinyl.

The CDs also come with a booklet recording the milestones of Indian Cinema as well as synopses of a few key movies, all from an era past.

Grand's around

2006-02-08T15:53:00.000Z

BELATED as always, I'm responding to Coturnix of the Science and Politics blog who posted up the latest Grand Rounds yesterday.

Why is Tokyo so much cooler than London? Check out Adidas' new Cities Series, for their 35th anniversary.

Great Danes

2006-02-04T06:05:00.000Z

I TRY to leave my political flotsam at Pickled Politics these days, but with the Mohammed cartoon story erupting worldwide, I realised that my usual snack has become twice the infidel it used to be:
.

Rest assured, you can always count on The DR to highlight the important aspects of any story. As Islamic fundamentalists rush to "boycott Denmark", what has Denmark ever given us?

Medical Student Teaching #4

2006-02-04T03:42:00.001Z

GS is a 24 year-old female beach volleyball player who is referred to you, the on-call F1 in the Surgical Admissions Unit. She has been sent in by her GP, who writes “Dear Doctor, thank you for seeing this young lady.” Unfortunately, that’s all his letter says. He’s a pretty shit GP if one is to be honest. So, none the wiser, you go to see her and can immediately see she is hot, indeed the nurse tells you her temperature is ‘up’. She’s a pretty shit nurse if one is to be honest.

From her brief history, you learn that she recently had a belly-button piercing performed, after which her symptoms began. She has a chronic history of injuries sustained whilst playing beach volleyball, such as getting tanned and developing a toned body. She has no other significant medical history.

On examination, GS is a young lady wearing a bikini and is comfortable at rest. Cardiovascular and neurological exam are unremarkable, although you do notice she has a good pair of lungs on her. The abdomen is soft and non-tender and is Stefani’s sign positive. She’s is in no pain, but as her abdomen is so unlike any you ever saw whilst practicing with friends in medical school, you realise something is definitely amiss. Your doctey sense is tingling.

You recall the influx of acute pancake-itis that came in soon after Shrove Tuesday…but it doesn’t seem like that. As usual, you’re completely flummoxed. But just then, yes just then, Christopher Lloyd tells you the diagnosis. You’re about to ask him if the flux capacitor is real, when you realise that he’s right.

What’s the diagnosis?

A Cute Abdomen.

That’s right, GS has a cute abdomen. Be sure to remember this case as you will encounter it incredibly rarely if you practice medicine in Britain. The classic triad of a cute abdomen is a lack of distension, a waist:hip ratio of less than 0.7 and very often a cute pairitonice-tits. Management for this condition is very, very close observation, with conservative treatment. You know the Daily Rhino loves steroids, but this is probably one instance that you definitely, positively should NOT give them.

Previous teaching sessions:
Medical Student Teaching #1
Medical Student Teaching #2
Medical Student Teaching #3

Originally published in Medical Student Newspaper.
Technorati tags: Medicine medical school medical students medical student

Herman the German Megabunny

2006-02-04T03:21:00.000Z

MOST bunny wabbits are less than a foot long, but Herman's ears are about the same size. The unofficial biggest bunny in the world tips the scales at almost 8kg (the Guinness Book of Records does not accept new entries as they fear it will encourage pets to be overfed). He belongs to a breed called the German Giant, but is large even for them. He eats 2kg a day and is kept in a solid oak hutch, just in case he goes all Curse of the Were-Rabbit and escapes.

A spokesman for the German Rabbit Breeders' Association said: "They are good natured, reliable and calm. They are, however, because of their size, not very suitable for children."

I have attained Nirvana

2006-02-04T01:40:00.000Z

THE Grauniad had a great piece yesterday, but I wasn't able to post it up till now. I happened upon a fantastic new take on the London Underground map via the equally fantastic Londonist.

Each line represents a different genre and important interchanges between styles correlate to seminal artists. Enough of me talking - check out the article or download the pdf. I was rather pleased to find hat Kurt Cobain is (was) my neighbour, as my local station's Nirvana. But I study at The Game, how fucking depressing. It's an awesome piece of work, despite everyone being bound to disagree. Like Finlay Quaye ? Nah...

Most who know me know I'm a devout fan of Boing Boing, but I try never to re-post things here I'm sure people will have already seen them. However this video was the funniest thing they've run in ages. I wish I had the narrator's accent, everything's funny with that accent. The video is archive footage of British soldiers being used as guinea pigs to test out LSD. The best bit is:

"The efficiency of the rocket launcher team was also significantly impaired."

Rocket launching on acid. Brilliant.

Wrong sort of stars

2006-01-31T21:41:00.000Z

TODAY is a truly sad day. I mean, seriously fucking sad. Here's why:

Madame Tussauds will stop showing the traditional exploration of the solar system at the distinctive green-domed building in Baker Street. Instead visitors will be invited to embark on a voyage "around the worlds of fame and celebrity" at the renamed Auditorium.

I mean, please. What the fuck? What the motherfuck shit cunt tit? This is the most depressing thing I've heard in a while. Yet another example of the public's growing disinterest in science. The London Planetarium is, and has been for years, a bastion of popular science. It has brought the amazing universe of astronomy and cosmology to the masses for years. Most kids loved their trip to the Planetarium. Some children gazed up at the stars and were inspired for life. Like me.

The legend that is Patrick Moore simply said, "it is the most extraordinary thing. I am completely appalled."

The body that runs the Planetarium, Tussauds, is a Dubai-owned entertainment company. They claim that the Greenwich Peter Harrison Planetarium will cater for those who still maintain an interest in the stars and planets, but Greenwich is way over in east London, the Tussauds Planetarium is bang in the middle of town.

In other news - I've been asked to jump on board the new desicritics.org blog, so I'll be updating my blogroll imminently, along with Anthony King and Ethno Techno. Hooray.

Cheese & Onion Turns Legal

2006-01-31T00:46:00.000Z

PERHAPS the most famous medical textbook since Gray's Anatomy turned 21 last week and it even had a birthday party. A birthday party for a book with cheap free plonk - this is about as showbiz as medicine gets. Only the cool people got an invite, of course.

But what's with the inability to abbreviate the name properly? The cake says OCHM instead of OHCM (but it was tasty) and some chap called Tom Chao has wished hypertrophic obstructive cardiomyopathy a happy birthday. Nice of him.

The original authors, Tony Hope and Murray Longmore.

It's hard to begin when describing how great this little book is. The amount of spin-offs is a testament to its success. Its individuality in a marketplace of boring carbon copies sets it apart, with quotes from Milton, Colin Dexter, Gabriel Garcia Marquez and Oscar Wilde it is instantly different to other medical books. Its simple, systematic layout and comprehensive content meant it was the only book I needed to pass most of finals, despite its pocket size. It is eccentric, opinionated, unrivalled and for someone who has gone through life buying as few textbooks as possible, I own three copies. With over a million copies sold, I hope it continues for at least another 21 years.

Technorati tags: medicine, books, medical school

Wank muscles

2006-01-30T16:54:00.000Z

THESE are my wrists. For years medics and laymen alike have pondered over what bizarre anatomical aberrations cause the labelled structures.

Owing to the fact I can tense and relax the structures in question at will, we concluded they were muscles. As they seem to serve to abduct my hand, we were able to ascertain a side-to-side hand movement is the intended purpose.

It was, of course, obvious. These are the muscles of masturbation. They seem to have no other use. Is this Intelligent Design telling us we MUST joust? Or is this a sad reflection on my teenage years? If that's the case, the weird thing is I don't remember ever using my left hand. I guess we'll never know.

Talent: Sofia Boutella

2006-01-29T22:09:00.000Z

Finally, a dance post.

YOU are quite likely to recognise Sofia, but you may not know her name. I decided to investigate further when I started to see her everywhere.

If you've watched Hung Up by Madonna, you've seen Sofia. Although that particular video makes a habit of wasting the talent of several of the performers featured therein, namely Sebastien Foucan, Lo Life and Sofia herself.

However, what launched Sofia into the Queen of Pop's line of sight was Nike's first ever television advert made solely to advertise their women's range, choreographed by Jamie King. Watch it.

For another fitting demonstration of this young lady's talent, take a look at Axwell's Feel the Vibe (or try here), which I think is a very cool video as it's so simple; the only set used is a summer's day in London last year and there are only two actors.

Sofia hails from Paris and is the daughter of an Algerian composer. She trained in rhythmic gymnastics and even made the French team, before moving onto hip hop and breaking. I first noticed her when I picked up Le Defi, a dreadfully-written and acted French movie with some seriously hot dancing from some pretty well-known French dancers (even a cameo by Junior), including perhaps the most beautifully-filmed sequence of slo-mo headspins and 'mills ever committed to celluloid.

How's it Hanging?

2006-01-22T01:08:00.000Z

WHAT does the way you wear your stethoscope say about you? The Daily Rhino examines the various stetho styles and finds that like most things in life, it's mostly about sex.

THE STETHOSCOPE was a godsend when it first appeared in 1991. Prior to this, doctors would routinely have to slice open their patients in order to better understand their ailments. This led to a schism between the physicians and the barbershop surgeons, who were a band of wandering lute-playing tramps that cut people open in barbershops. You know, after their short back & sides. This is why we now call physicians ‘Dr’ and surgeons ‘Mr’.

I’m rather a gifted stethoscopist myself, in fact I once diagnosed a double amputation with my stetho. I failed to hear a thoracic rebound echo from the legs and I said to the man “Sir! You have no legs!” It turned out he was dead as well, but hey you can’t diagnose EVERYTHING. After all, I’m learning.

Thanks to Holly Thompson for the photographs.

The n00bie

This look enjoys wide popularity amongst first year clinical students. They’re new on the wards, full of excitement and spreading MRSA about enthusiastically. Sweaty laundry-issued white coats still cause a frisson of excitement in the newbie and he or she fills their pockets full of useless paraphernalia. James models a classic third year pose; head in a book, in preparation for a consultant rogering.

The stethoscope itself is buried, as the newbie feels out of place and does not wish to draw attention to a tool he has no idea how to use. He knows nothing about medicine and should not be polluting the wards with his presence. Doctors wear their stethos around their neck, not rookie scum. Nurses curse him for getting in their way. He will kill at least eight patients on his first firm. Whilst the newbie style is acceptable for a third year, it is deeply offensive if worn by someone who has been on the wards for over a year. They must be ritually beaten and outcast from medical school.

The Classic II

A junior doctor favourite, the Classic II is at its sweetest when adopted using the Littman Classic II, the deputy-gangster of all auscultation apparatus.

Radhika shows off her assets by modelling the Classic II Royale - a variation on the symmetrical Classic II, carried off by only true experts. In the Royale, the chest piece rests lower down than the ear pieces - an immensely controversial move when first unveiled at the World Expo in 1992.

The other variation on the Classic II is the ‘St. George’s McDaddy Big Kahuna’, which positions the chest piece over the second intercostal space. This achieves a near-perfect weight equilibrium, but as it not recommended for women with a cup size over an ‘A’, it tends to be a male preserve.

The Goofy

Skateboarding famously stole this term from the medical profession. Aarany suggestively models this style, which is more popular amongst girls. Goofies are more likely to be left-handed, mentally challenged or from GKT. A NEJM study recently showed that those favouring the goofy tend to be more likely to be admitted to a psychiatric ward or become psychiatrists themselves. It can be tempting to ridicule those wearing the goofy, as they are usually slow and foolish. But don’t be nasty to goofies. They’re not different, they’re special.

The Lasso

Beth demonstrates this unusual noose-like style for us. Those who wear the lasso are a strange bunch. Once again, this is more popular amongst girls. Most stethoscopologists believe this is a cynical attempt to draw attention to their breasts, by focussing the stethoscope’s energy upon their central cleavage chakra point. The girls themselves just giggle and say that’s silly.

Lassoists want to give the impression they are very busy. They want to people to think that their stethoscope NEEDS to be like that as they spend so much time running around. They want people to think they’re hard-working. They want people to admire them. They want people to look at their breasts.

The Surgeon

Surgeons are chilled out cats. They bowl up late, wear chinos with no tie and leave as much as they can to their juniors. So it comes as no surprise that the surgeon often forgets his stetho. The firm’s FY1’s most important job is to lend his or her steth to the consultant on at least a daily basis.

Colorectal surgeons need to listen to bowel sounds, cardiothoracic surgeons need to listen for rubs and vascular surgeons need to hear bruits. Orthopaedic surgeons don’t need stethoscopes though - the mess TV usually has surround sound.

The Consultant

Anish models this fascinating style, which stems from our primitive hunter-gatherer roots. When our simian ancestors used to dress up and play doctors and nurses, the biggest, most virile ape used to lead. He would have free reign to impregnate whichever female he wanted. Other apes would know who the leader was by a ceremonial mark made around his groin. Hence male consultants wear their stethoscope in such a manner as to highlight their two weapons - it points from their head straight to their penis, the source of all power.

Originally published in Medical Student Newspaper and subsequently in Quack
Technorati tags: medical school, medicine, medical students, doctor, medical

How the Whale Became a Londoner and Other Stories

2006-01-22T00:47:00.000Z

The Book of Rhino 25:17 -

"And lo the gentle visitor came from far above us and he tried to unite us. But how he suffered, and died for our sins"

POOR guy. This seriously-lost whale from up north created an amazing spirit in London, the capital was truly united. Forgive my soppy corniness, but the few days this little fella spent in our filthy river (trust me, I've drunk my fair share of raw Thames) brought people together.

On both banks of the Thames, people rubbernecked to glimpse the whale.

They came, they chatted, they were friendly. All we wanted was for the whale to make it.

More Medics go on Strike

2006-01-17T17:34:00.000Z

Sorry about the lack of posting as of late, no time.

BACK in India, yet more doctors and medical students have gone on strike...and just down the road from where this occured. Two days ago, a rumble broke out upon the Allahabad bound Meerut-Nauchandi Express Train, passing near Moradabad, Uttar Pradesh, northern India. Young police (provincial armed constabulary) recruits and junior doctors came to blows, allegedly over a dispute involving seat reservation. However the doctors have accused the rookie police of "misbehaving" with some girls on the train.

In a nutshell, it seems the two groups exchanged punches on board the train, but when arriving at Moradabad, the train pulled into the wrong platform, where more police were waiting with truncheons and hockey sticks.

Since the punch-up, the doctors have claimed that five of their party are missing. It is thought they may have been pushed from the train by the coppers. As a result, doctors and medical students have gone on strike across the state of UP, including parties sitting on railway tracks to prevent any trains running. King George Medical University once again came to a standstill just days after its students blocked all entrances in protest of alleged negligence leading to the death of a colleague.

At least nine doctors and eight jawans have been admitted to hospital with injuries, but some of the juniors state up to forty doctors were injured. One of the police recruits was found lying near the tracks somewhere along the route and was admitted in a critical condition.

The group of doctors was returning from sitting the state post-grad registration exam.

Four Government Railway Police (GRP) personnel have been suspended. Chief Minister Mulayam Singh Yadav has ordered an inquiry into the incident, to be conducted by Moradabad District Collector K S Atoria. ‘‘Action will be taken against those found guilty after the probe is complete,’’ said Mulayam.

Famous buffoon, Laloo Prasad Yadav, no longer chief minister of Bihar gave a statement as the Union Railways Minister:

‘‘We have asked the UP Government to immediately dismiss the jawans involved in the outrageous incident. There appears to be no fault on the part of the doctors’’

The state government has suspended four Government of Railway Police constables.

Medical students go on rampage

2006-01-12T12:45:00.000Z

MEDICAL students at Lucknow's King George Medical University have ransacked university and hospital property in protest over the death of a classmate.

Second year Deepak Agarwal was injured during a convocation-rehearsal in a building still under construction. He received a blow to the head after falling from a platform and later died in hospital. His colleagues have alleged negligence on the part of the doctors who treating Agarwal, claiming that he received inappropriate treatment.

"KGMU Vice-chancellor Mahendra Bhandari told UNI here today that the incident was unfortunate and the student was given the best available treatment.

"As we were still to install ultra modern medical facilties in our hospital, the injured student was shifted to a well-known private nursing home," he said.

Meanwhile, KGMU Junior Doctor's Association general secretary Devesh Shukla said that Deepak died due to delay in medical treatment provided to him. He demanded that the authorities should also clarify why he was shifted to a private nursing home." [Link]

As the news of his death spread, hundreds of students went on a rampage on campus. They torched vehicles, damaged medical equipment and college records dating back one hundred years - the university is celebrating its century this year.

Rapid Action Force officers had to be called in order to re-establish calm but all roads to the university remain blocked by students, who are demanding 50 lakh damages for Agarwal's family.

Ten Million Missing Girls

2006-01-09T12:39:00.000Z

ASIAN women have a long, long way to go in the fight for equality. What's more upsetting is that the perpetrators of crimes against females are often female themselves. Society has managed to convince men and women that females are inferior.

Just yesterday, a PP thread drifted onto the topic of female abortion in Asia. Today The Lancet published an Indian-Canadian study into the horrific practice in India. The Lancet requires a paid subscription for full access to articles, so I thought I'd add to the BBC summary. The study and an accompanying article by Dr Shirish Sheth will go to print next week.

The study, led by Dr Prabhat Jha and Dr Rajesh Kumar (Toronto and Chandigarh respectively), sought to ascertain the reasons for the unequal balance of females to males with specific reference to pre-natal sex determination and abortion. Across India the ratio stands at 933:1000, but is markedly more pronounced in certain areas such as Punjab, Haryana and Tamil Nadu. The study estimates that 500,000 female babies are aborted every year, for no other reason than their gender. However the study discovered that gender screening was most likely to be utilised when the family already had a daughter.

The stats break down like this:

If the first child is a boy, the ratio for the second and third child normalises, to about 1:1.

If the first child was a girl, the ratio of girls to boys rose sharply to 759:1000.

If the first two children were girls, the ratio fell further to 719:1000.

In households with a more educated mother, the chances of a girl following a female first-born were halved.

A correlation to religion was not found - it seems uniform across the main religious groups.

It is apparent that as long as a family has at least one son, they seem happy. This is somewhat surprising as one of the main proposed reasons for female foeticide is to avoid paying dowry. Dowry payments, made by a girl's family to the family of her husband upon marriage, are illegal in India but remain common practice. A poor family is unable to raise a sufficient dowry and a girl remains unmarried - and as far as society is concerned, worthless. It is, undoubtedly a cause of female abortion, but the reason it has not been identified as a major influence is because the abortion of female babies is not most prevalent amongst the poorest members of society.

On the contrary, those with no money are sometimes unable to access the ultrasound screening tests. The study showed that the practice is most common amongst more educated Indians. The study specifically identified the mothers as the variable factor. In a cruel twist of irony, the more educated a mother, the more likely she is to abort her female child - if she already has a daughter. However, I can only presume that the poorest of the poor still kill off female children - but instead of aborting them in utero, they kill newborns when they discover they are girls. I'm not basing this on fact, just speculation. Reliable figures for female infanticide in India are not available and it is thought that babies are often recorded as 'stillborn' when killed soon after birth.

Jha estimates half a million female children are lost every year and wanted to put pay to excuses that the ratio is due to natural disaster or disease:

"If this practice has been common for most of the past two decades since access to ultrasound became widespread, then a figure of 10m missing female births would not be unreasonable."

Jha himself attributed the main motivation as a legacy of when India was an agrarian society where boys were considered an extra pair of hands in the fields but a girl was a liability, a burden.

Sex selection and female feticide remains "rampant" in India, says Dr Shirish Sheth, of Breach Candy Hospital in Mumbai. The use of ultrasound to determine sex has been outlawed in India. However, illegal 'back-alley ultrasound clinics' operate widely, even in rural areas. Aborting a foetus based on its gender has been illegal since 1994 and is a crime punishable by a fine, imprisonment and suspension of the doctor's licence. However many operating the machines are not medically-trained doctors but people out to make a quick buck. I can only guess at their accuracy - it's not an easy thing to do.

"In a country bedeviled in many parts by cultural taboos, a boy is preferred because he will continue the family name and bloodline, earn money, look after the family and take care of parents in their old age,"

A woman might be considered a "culprit" for not giving birth to a boy, Dr Sheth says, even though it's the male's sperm that determines the sex of a child. What's more, the cost of a dowry for a daughter can be "phenomenal," forcing many families to borrow to pay for them."

Is anything being done? Thankfully, lots. But India's a big country and it's an uphill struggle to change views held by millions. Some states have offerred free education to families who have only female children. A soap opera has been made by Plan and the government. There are also many religious and charitable organisations working to eradicate a practice of which social activist Swami Agnivesh says:

"There's no other form of violence that's more painful, more abhorrent, more shameful"

China is also notorious for its skewed female:male ratio, although with quite different causality. China's one child policy has created a similar absence of girls across the country. The BBC recently showed a charming film entitled Looking for China Girl which presented the human angle to this shameful trend. The Chinese government estimates that within 15 years, 40 million Chinese men will be lifelong bachelors. The Chinese government has also tried to stem the flow of boys by offering free schooling to girls, but it has not stopped the abduction of girls to be sold as brides. In India abduction has not been widely reported, but paying poor families for their daughters as brides has become more common in Haryana. A perverse reverse-dowry.

The BBC has stacks on this issue. You can start with the BBC Best Link or hit any of the links above.

The study:

A 1998 survey of fertility and mortality which used almost 7000 units selected to represent the vast country as a whole. The units, in total, comprised 1.1 million households and followed 133,738 births. Based on the natural sex ratio from other countries, the team estimated that around 13.6 to 13.8 million girls should have been born in 1997 in India. However, the actual number was 13.1 million - a deficit of 0.59 - 0.74 million female births.

This is a cross post on Pickled Politics.

Seven Years Short

2006-01-08T21:58:00.000Z

Heinrich Harrer, 1912 - 2006

AUSTRIAN mountaineer, former SS member, lifelong friend to the Dalai Lama and the man Brad Pitt played in Seven Years in Tibet. Heinrich Harrer died last night, seven years short of his century.

He became the first man to climb the north face of the Swiss Eiger mountain and despite the book The White Spider becoming a core text amongst mountaineers, he achieved fame some years later. During a 1939 mission to Nanga Parbat (in modern-day Pakistan), Britain went to war with Germany. As Austria had been annexed into Germany, Harrer was arrested in British India as an enemy alien and interned for several years.

In 1944 he and Peter Aufschnaiter escaped to Tibet, then an unfamiliar mystery to the rest of the world. He met a ten year-old Dalai Lama and quickly became his mentor. Over the next seven years, the Dalai Lama claims Harrer educated him greatly about the Western world. In 1951, when the Chinese invaded Lhasa and Tibet, Harrer fled.

Years later he would be awarded the Golden Humboldt from Austria and the Light of Truth award from Tibet's government in exile, in India. His journals, books and photos taught the West a great deal about the inaccessible mountain country.

It is hard to reconcile the benign impact Harrer had on the young spiritual leader with his Nazi past. Indeed, about ten years ago Harrer confessed he was not only a Nazi member, but an SS officer. However he has never been accused nor linked with any mistreatment of others, perhaps because he left before the war began.

Irrespective, Harrer went on to become a human rights campaigner, celebrated author and he assisted in making many films. He remained friends with the small boy he taught fifty years ago and met with the reincarnation of the Buddha on several occasions as the decades past.

Technorati tags: tibet, india, buddhism

Farkin' brilliant

2006-01-07T23:22:00.000Z

FARK'S Best of 2005 Photoshoppin' competition has gone online. Here are some of my picks. View the voting results here.

The Rise Of Pseudoscience: If It Looks Like A Quack...

2006-01-07T22:04:00.000Z

I'VE written quite a bit about quackery whilst wearing my medical journalism hat. A recent controversy surrounding India's best-known and most popular yoga master and the allegation he uses human remains in his Ayurvedic concoctions has brought quacks back into the mainstream news. But, as always in India, politics rears its ugly head. Religious political parties in India have leapt to his defence, attacking Western science and medicine. In a trend occurring all over the world, science has become the bad guy.

Religious right-wingers attacking science...Intelligent Design anyone?

The War on Science™

Like any other medical student, I've heard - and ignored - the phrase ‘evidence-based medicine’, but these three words are central to doctors everywhere. Proof is the cornerstone of science. Without proof, we would prescribe drugs to patients at random and we would perform surgery on people who don’t need it. With time, we have abandoned unfounded beliefs of the past, such as phrenology or using leeches to cure heartburn. Bizarrely, this trend is not universal. In fact what is really happening is that the peddlers of bogus science have merely become more adept at pulling the wool over our collective eyes.

NASA invested over a million dollars in a Russian anti-gravity machine and major power companies have wasted tens of millions on a scheme to produce energy by placing hydrogen atoms below ground state, which has been described as trying to go south of the South Pole. No matter how insane the claim, there will be scientists who will vouch for it and there will be gullible believers.

Irresponsible Medicine

Pseudoscience can come in different guises. Bad science at best can be sloppy, lazy experimentation or, at worst, a cynical attempt to deceive based on ulterior (read: Financial) motives. A high profile and potentially very damaging example of bad science is the nonsensical furore that erupted after the MMR jab was linked to autism in a deeply flawed paper. Quackery is a medicine-specific term. It may seem curious that medicine has its own word for pseudoscience, but one only has to visit Quackwatch to realise just how much detritus there is polluting the medical waters of the world. Why do we have a current state of affairs in which leeches and arsenic are quackery, but Chinese herbal medicine and homeopathy are treated as science?

The Lancet courted controversy last summer by rubbishing homeopathy, the practice of giving water to patients (a fact acknowledged by homeopathy associations). The Lancet’s article was based on a Swiss-British review of over 100 studies on the topic, which showed that homeopathy had the same efficacy as a placebo. So what? Nobody gets hurt by a little water. Not so. Homeopathy is available on the NHS, a government body that is hardly in a position to splash around cash. If we, as medical practitioners, give our patients the impression that homeopathy is a legitimate, effective therapy, we are guilty of failing to act in their best interests. They may neglect allopathic avenues in favour of something that will most likely be less therapeutic.

Pseudoscience has some telltale traits, but it is getting harder and harder to differentiate fact from bollocks. Pseudoscience predominantly works on anecdotal evidence, it fails to provide experimental possibility of reproducible results, it asserts claims that fail falsifiability and almost always fails to submit results for peer review. Acupuncture is yet another example of an officially unproven modality of treatment, which is available on the NHS, paid for by your tax money. It is the exact equivalent of European Space Agency funding astrologers.

Pseudoscience likes OLD. Traditional Chinese and Indian medicine enjoy a mythical status, O the wisdom of the ancients! Pseudoscience likes COINCIDENCE. I have a headache, I stick a needle in my chakra point and my headache goes away. The needle must have cured me.

But what pseudoscience really likes is RELIGION. Which is why the Republicans rubbish evolution and the Hindu funadamentalists in India poo-poo allopathy. Sanjay Nirupam of the hardline Shiv Sena party has also gone on record to say "One always hears about AIDS and how it's this big problem. But I have personally never come across anyone with AIDS or seen anyone dying of the disease, I think it's just hype." The BJP, the main opposition party, ploughed hundreds of crores into a cow urine-based TB treatment. This bizarre trait is not just restricted to America and India. In Africa, Thabo Mbeki famously denied the link between AIDS and HIV. Villagers reject vaccines and visit the witchdoctor.

This revitalisation in bogus science has not occurred overnight. Whereas in the West, when someone has a sniffle they sip tiger bone tea from the Chinese pharmacy; get even more ill and then go to their GP, both options are not always available in the developing world. It has been a growing trend over the last few decades to regard science, most of which is studied in the West, as some sort of post-colonial imperialist weapon to enslave the poor. When Thabo Mbeki claimed HIV and AIDS were not related, he attacked the “hegemony of Western science” and asserted AIDS is a disease of gays.

Human Remains and India's Holy Man

The person to initially allege that Baba Ramdev was using animal and human remains in his medicines was Brinda Karat, the leader of India's Marxist Communist Party (CPI), so one could argue that politics was involved from the start. Baba Ramdev's daily television show attracts up to a million viewers across India. He is an immensely powerful television figure, as his followers, Hindu and Muslim alike, literally bend and twist to his every command. He claims his ayurvedic medicines cure everything, from baldness to brain damage.

Since then, India's religious right, namely the VHP and Shiv Sena, have rallied to Ramdev's support.

So why have politicians waded into defend someone against a very serious allegation? Allopathic medicine and ayurveda have co-existed in India for generations, both given full recognition by the government. Ayurveda, the longest-running system of medicine in the world - and one of the first ever recorded - has won worldwide respect with many of the traditional treatments standing up well in clinical trials. However this is not to say that it is uniformly trustworthy. Ayurveda can be as close to witchdoctoring as species-depleting traditional Chinese medicine, one of my pet hates.

In recent years, India has seen a marked shift in the political sphere, with the rise of a firebrand, pro-Hindu movement. They don't like allopathic medicine - it's phirangi Western nonsense. Ayurvedic practitioners, buoyed by support from Indian MPs, have launched tirades against allopathic medicine; apparently allopathic medicine is "reactive" in that it reacts once you've taken it, but ayurvedic medicine doesn't. Then how the fuck does it work?! [Link]

The similarities to the Republican War on Science are remarkable, both sad indicators of a worldwide trend of bad-mouthing science. Both the VHP and the Republicans have their army of 'scientists' to back up their claims and both pay no regard to evidence-based-science. If the leader of the free world has chosen to reject science, what hope for the developing world?

Technorati tags: Medicine, Health, Science, India

The Mile High Club Sandwich

2006-01-04T18:47:00.000Z

ATTENTION Mumbaikars and Londoners! From tomorrow, Air India (who have been suffering with the recent boom in Indian airlines) have announced they will begin a food festival aboard Mumbai-London flights.

The 'Gourmet Flights' will run until the 31st of January and passengers will be presented with a choice:

"Two types of menus — comprising vegetarian and non-vegetarian delicacies — would be served to the passengers of the first class, executive and economy segments during the period.

...the festival has been organised by Air India in collaboration with Taj Sats Air Catering Service and the unique feature of this service is the passengers’ preferences that would be prepared in front of them instantly by an on-board chef." [Link]

What's even cooler is that passengers will also be able to watch the dishes being prepared in the airplane's kitchen! Is it just me, or is anyone else wondering where they're going to find all the space?

Whether the experience will be more akin to eateries in London or Mumbai remains to be seen. It could be an authentic Indian feast suitable for the most discerning of Maharajahs. Or it could be "forty poppadoms, eighteen vindalooooz, ten kooreez, nine Cobras and twenty Kingfishers. Cheers luv!"

Ah a man can dream.

Churchill: Let the fakir die

2006-01-04T03:14:00.000Z

WINSTON Churchill. The man millions of Britons voted 'The Greatest Briton of All Time' at the turn of the millennium, ahead of Newton, Shakespeare, Darwin and Brunel. The man who advocating gassing "recalcitrant Arabs as an experiment".

The man who described Mahatma Gandhi as "a half-naked fakir" who "ought to be laid, bound hand and foot, at the gates of Delhi and then trampled on by an enormous elephant with the new viceroy seated on its back" [Link]. The man who is in the news again - although there isn't too much coverage.

Hitherto unseen government documents have been released, which detail Churchill's stance on several issues. The notes were recorded by deputy Cabinet secretary, Sir Norman Brook, and give the first detailed glimpse into what was discussed at the War Cabinet between 1942 and 1945. They're open to the public just down the road from me at the Public Records Office in Kew, so I took a look. The rather difficult to read shorthand revealed some fascinating facts.

He wanted to send Nazis to the electric chair, without trial. He wanted Hitler executed "like a gangster". Hey, I'm not going to make a fuss about these two.

He thought Gen. Charles de Gaulle was a barrier to a "trustworthy" relationship with France. When de Gaulle fled to Britain, he subsequently asked if he was free to leave in order to visit French troops (de Gaulle remained a popular figure amongst the Resistance) and Churchill said "arrest him if he tries to leave."

Whilst the British Army prided itself on treating black and Asian soldiers with respect (at least in comparison to the Americans), Churchill insisted, "the views of the US must be considered." Black soldiers were told to show respect for the American army's segregation policies.

Churchill went on, expressing a desire to wipe out German villages as revenge for the Ludice massacre.

Perhaps least surprisingly, given Churchill's intense hatred of Gandhi (which is largely ignored by Western historians), is the fact that Churchill was willing to let Gandhi die. Whatever criticisms Gandhi has attracted, his devotion to pacifism stands out dramatically from the history of the world. It was this commitment to non-violence that inspired Martin Luther King to adopt the same approach.

Churchill said he was prepared to let him die if he went on hunger strike whilst imprisoned at the Aga Khan prison in Puné. Gandhi was interned during WWII as a result of the Quit India movement. He denounced Indian soldiers fighting in the war and his called for civil disobedience. At this time his wife and his secretary and close friend, Mahadev Desai, both died. Churchill was also keen to make sure Gandhi was treated "like any other prisoner".

India's viceroy, Lord Linlithgow, had recently sent a telegram claiming he was "strongly in favour of letting Gandhi starve to death" but it has become clear that the British Cabinet were the ones who decided that allowing Gandhi to continue on a strike would simply cause too big a backlash in India, as former viceroy Lord Halifax (then ambassador to America) explained, "Whatever the disadvantages of letting him out, his death in detention would be worse."

But hey, things change. Current Tory leader Dave Cameron quoted Bapu in his new year message:

"As Gandhi said, ‘we must be the change we want to see in the world." [Link]

"A lot of people are waiting for Martin Luther King or Mahatma Gandhi to come back -- but they are gone. We are it. It is up to us. It is up to you."

- Marian Wright Edelman.

Cross post on Pickled Politics.

Diagnosis: Alien Mind Control

2006-01-04T01:58:00.000Z

JUST as archaic religious/superstitious beliefs are being usurped as science explains the world around us, modern myths like aliens can be rationally explained away. I knew there was a use for medical research and now I've found it.

Abduction

America's deep South is clearly the home of the human race's finest specimens, for why else would aliens abduct grits-munching yokels more than anyone else? Irrespective of the validity of the abductees’ claims, one striking feature emerges; they all describe the same alien. Grey skin, lightbulb heads, no ears, big eyes, pointy chins and flat noses, a bit like the chap shown here. New evidence has now shed some light on the reality behind these other-wordly claims. A US Air Force Academy psychologist named Frederick Malmstrom has claimed that these people are not describing aliens, but are actually remembering their mommy.

Dr Malmstrom believes that the in-built mammilian 'mother' template is being accessed inappropriately. Wee babies take several weeks to develop the ability to differentiate between different people. They do, however, have the ability to recognise a face as ‘human’ from Day 1. All that you need are two eyes and a nose. This is why babies react to a mask or a cuddly toy the same way they do to a real face. But put three noses or one eye on the mask or toy and the baby isn’t interested. Colour vision also takes several weeks to develop, so babies under two months see things in greyscale.

With this in mind, Malmstrom created an image of a woman as seen by a two week old baby. The strange result, as published in The Skeptic (fantastic mag), is distinctly alienesque. The eyes are over-sized and tilted up, the nose is flat and the skin is grey. It is believed that this template is accessed whilst in a state of neurological confusion, such as under hypnosis or when half asleep.

Alien Limb

Alien hand, alien limb, anarchic hand, Dr Strangelove Syndrome - all names for a bizarre neurological condition where arguments take place between one person's limbs, first noted in 1909.

Neurological insults that cause involuntary movements are legion; chorea-inducing conditions have been documented long into the past. However, the fascinating thing about anarchic hand is that the affected hand or limb seems to take on a personality of its own, much like Peter Sellers' hand used to, awfully embarrassingly, salute Hitler at rather awkward moments. It's a very rare affliction with a few dozen recorded cases, but Surgical Neurology, has recently documented a new case of anarchic hand from Japan (subscription needed).

Central to the idea of anarchic hand is that the human body is thought to operate by a system of free won't, not free will. Thus conscious and subconscious signals are required to move - and NOT move - our limbs as we wish. Anarchic hand is not a psychiatric diagnosis; it's not a disorder of 'the mind', but purely a result of an injury to a specific part of the frontal lobe. This knowledge has only been gained recently, with the advent of more advanced imaging and diagnosis - coupled with specific history-taking. Hence, it is possible that patients suffering from anarchic limb in the past, perhaps post-stroke, would have been institutionalised as being possessed or just a loonie.

Cases include one hand 'fighting' with the other for control of a TV remote control, a patient who frequently has to stop one hand strangling him and a woman whose hand shoves fishbones into its owners mouth at a posh restaurant. In contrast to the far more common limb-neglect which can occur after a stroke, the patient is always fully aware their hand is their own, but they feel as though they have no control over it. They can hit the affected hand, sit on it, shout at it or shake it - but as you can imagine, it can be an incredibly distressing condition.

Like all incredibly rare neurological conditions, there's stacks on the Internet about anarchic hand. Try here or here to begin with, if you want to learn more.

Technorati tags: Medicine medical school medical medical students medical student

Nostalgia just ain't what it used to be

2006-01-02T23:03:00.000Z

CLEANING out my room unearthed this corker of a postcard:

Also recovered was a 1996 issue of my school newspaper with an article I wrote aged 14 entitled 'Eastern Promise'. Titles like that were forgivable back then. Here's an extract:

"Only a few years ago, the modern second generation sub-continental music widespread in Britain was bhangra. Real bhangra is traditional Punjabi folk music, but the bhangra of Britain, pronounced in a broad Birmingham accent, was most probably invented in the black country along with balti - which actually means 'bucket' in Hindi. This cheesey blend of Punjabi lyrics, squeaky synthesisers and borrowed rhythms was an unfortunate episode.

Now the story is different. The Outcaste Collective plays the Notting Hill Arts Club every Thursday and Earthtribe run Sitar Funk monthly at The End club, both with similar break beat styles. But the most well known DJ/producer/collaborator as of now is Talvin Singh, who runs the grooviest night in what Newsweek called the world's grooviest city; an Asian Affair at the Blue Note. Monday night is Anokha, where DJs mix in Indian lyrics, sitars, veenas, santoors and tablas with drum & bass."

That was ten years ago. It's amazing how so little has changed; a lot of the same names are around and the Notting Hill Arts Club is still the venue for one of the hottest desi nights around.

This piece has an interesting feature - it's called a dust jacket

2006-01-02T16:46:00.000Z

THIS just in, from the world's coolest girlfriend.

2006-01-01T22:46:00.000Z

The OFFICIAL New Year

2006-01-01T18:01:00.000Z

GREENWICH Mean Time baby, the only New Year that matters. The London Eye sees in 2006.

The last minute of 2005 was in fact 61 seconds long - a leap second was added on, which had built up over about 18 months.

Technorati tags: london, new year, fireworks, new year's eve

Medical Student Teaching #3

2005-12-30T19:13:00.001Z

Presenting Complaint - Paediatric Fever

THIS teaching session concerns a three year old Japanese boy whom you see in A&E. His mother informs you that he has had a fever for seven days, which began soon after a ride on his father’s motorcycle. He has been crying excessively, more so over the last 48 hours. He has vomited and had an episode of diarrhoea. The toddler has been rather drowsy and occasionally makes a low-pitched humming noise and holds his hands out in front of him. His mother also reports that her son frequently places bowls on his head when he does this.

On examination the young boy is crying and has a fever of 38.9C. His heart rate is 120. You notice cracked and red lips, a blotchy rash and peeling hands. On auscultation you notice that the child is Vrrroooooom test positive. You order some investigations:

ECG – prolonged PR interval
ESR – 88mm/hr
Echo – ?Mild ectasia.

You are not entirely sure until a passing mime artist gestures that you should check the blood film, shown below.

What's the diagnosis?

That's right, it's Kawasaki’s Disease. The presence of minute Japanese motorbikes in the blood is pathognomonic for Kawasaki’s. One must remember to use the maximum possible magnification, as very small motorbikes can often be mistaken for endoplasmic reticula. One must be mindful to distinguish between the harmless Suzuki vasculitis and the rapidly fatal Yamaha fever – make a Kwik-Fit referral.

Kawasaki’s is often associated with Ruff Ryder’s Syndrome - treatment involves gradually starving the child of petrol, replacing this with diesel and playing DMX music on loop. Prescribe steroids, they never do any harm. Honestly, they're fucking awesome.

Medical Student Teaching #1
Medical Student Teaching #2

Originally published in Medical Student Newspaper.

Technorati tags: Medicine medical school medical medical students medical student

Looks and talent - unrelated

2005-12-30T02:22:00.000Z

Remember Roy of the Rovers?

Remember Pelezinho?

Meet Ronaldinho Gaucho.

Misplaced heritage and a new boast for India

2005-12-29T20:19:00.000Z

MUCH of ancient India's legacy to the modern world has been misattributed through centuries of Euro-centric history. It rests upon the shoulders of modern historians from the West and the East, to ensure ancient misnomers are put right; especially as India has a new claim to fame.

The first prehistoric art was always thought of as the Venus of Willendorf, which has been dated to around 24,000 BC. However a recent discovery has caused us to completely re-think how far back the history of art goes. Hundreds of cupules have been found carved into a quartz cave in Daraki-Chattan in Madhya Pradesh, which have been judged to have had no functional purpose, just aesthetic value. Art.

The cup-shaped marks have been dated back a staggering 200,000 years, putting the human desire to create art back 175,000 years. Say it with me: "India invented art!" The findings will be published next month in Minerva.

Indians are proud of zero. Everyone in India knows zero. Indians outside India know zero. We brought the world zero and the world have us to thank; for zero. Of course I refer to the number. It's something drummed into the head of most Indians that "we invented the zero", although few appreciate just how important that was.

It was not merely a numeral between -1 and 1, it was an entirely new concept. When Pingala first used zero in his Chhandah-shastra, written some time between 500-300BC, he was laying the groundwork for the computer you read this on, for it was the first binary numeral system recorded. He also began to explore Pascal's triangle and the Fibonacci sequence.

Indians have done a great deal more than that. But this post isn't about India's contribution to the rest of the world as entire websites are devoted to that (e.g. Kamat's Potpourri). It's about how other Indian exports do not maintain their Indian origins in the same way zero does. The forgotten things India gave the world.

There are nine things that top the list. The numbers from 1 to 9. Prior to the arrival of the numbers in Europe, Roman numerals were used. These were cumbersome and sums were notoriously difficult. The dark ages were so named as maths and science had not blossomed in Europe. In contrast, Indians were performing calculations involving trade and the stars rapidly and efficiently.

Yet today the symbols 1 - 9 are referred to as Arabic numerals. Simply due to an accident of history - Europeans first encountered the numbers during interactions with Arab traders and henceforth the system was known as 'The Arabic Numerals'. The numbers met with great opposition when they came to Europe and the Roman Catholic Church (who've always done their bit to help science along) declared anyone caught using the system would be branded a heretic and would be liable to burning at the stake. More here.

Who invented drainage? Ask most Westerners and they will tell you the Romans were the first to build advanced towns with sewage systems. Not so. The Indus valley civilisation is pretty well known worldwide, but many forget that two thousand years before the Romans, the ancient cities of Mohenjo-daro and Harrapa had highly developed drains. Lavatories emptied into 2 metre-deep sewers, which met at occasional cesspools which were, quite astonishingly, covered by manhole covers almost identical to the design we use today. More here and here.

The father of immunisation is known by all as Edward Jenner. A hero of medicine and a man who saved millions of lives. I see the chap every day, as a huge bust of him sits in my medschool foyer. Prior to vaccination with cowpox, which Jenner discovered conferred immunity to smallpox, the only form of protection was inoculation. This was, of course, far more dangerous but at around the time of Christ, evidence exists that suggests Indians were the first to be inoculating people against smallpox, by scratching the skin and applying pus from a smallpox sufferer. Nice. Exact instructions were laid out for the patient, including what food they were allowed to eat. They would be frequently bathed in cold water to avoid fever and it seems that the efforts were 50% successful. Not great by today's standards - but this method also saved millions.

Continuing the medical theme - I've written stacks on one man, the father of Indian surgery, Susruta. More about him another day, but one of his myriad achievements deserves a special mention on The Daily Rhino...Rhinoplasty! Yup, nose jobs were invented in India. And today they enjoy most popularity in Iran.

The metallurgical history of India is also frequently overlooked, despite the high profile testament to ancient Indian iron-forging, the iron pillar which stands at Qutb Minar. It has stood, unweathered and unrusted for about 1700 years; predating the very religion of the mosque it was moved to! Around 500-300 BC, India made great leaps in metallurgy, including pioneering the crucible technique to produce the immensely strong yet flexible wootz steel. Techniques used in China and India two thousand years ago were not adopted in Europe until a few centuries ago.

China and India shared a great deal of knowledge in past and it is natural some inventions have been associated more closely with one country than another. The Chinese invented rockets, but many strides forward in their use in warfare were made by Tipu Sultan's army. However, surely the greatest travesty of Sino-Indian history is the repeated association of Buddhism with China. Vast swathes of America consider Buddhism and Buddha quite Chinese. Whilst many would contend that martial arts initially came from India, which now seems very probable, the Chinese stand alone in their mastery and refinement of the arts, so I'm willing to let them have that one!

Lastly, there are two pastimes which have not been attributed to other countries, but whose heritage is occasionally forgotten. Make sure next time you plass snooker or chess, you let your opponent know where the game comes from.

Make it so

2005-12-28T14:30:00.000Z

THE British TV company Home Media Networks surveyed a thousand people asking which television show they would like to see return to the box.

Which is the most missed show? Star Trek of course! But not fucking Enterprise, you suck Enterprise, YOU SUCK!

But looking through the list, I am somewhat disconcerted:

1. Star Trek

2. Buffy the Vampire Slayer

3. Friends

4. Fawlty Towers

5. Blake's 7

6. The X-Files

7. Babylon 5

8. Stargate

9. Seinfeld

10. The A-Team
[link]

Buffy? Puh-lease, who gives a shit about that anymore? Friends? Have these people not heard of E4? An entire channel devoted to Friends re-runs!

A-Team and Seinfeld, fine choices. My personal nomination for a show that doesn't get repeated nearly enough is QUANTUM LEAP. Amazing how one man can traverse the central roles in both one of the coolest and one of the lamest shows of my lifetime.

"Theorizing that one could time-travel within his own lifetime, Dr. Sam Beckett led an elite group of scientists into the desert to develop a top secret project known as Quantum Leap."

What kind of crazy-ass logic is that? Why could he time travel only within his own lifetime? Am I asking too many questions in this post? Anyway, there was clearly some genetic influence to his time travel as once he went back in time so far that he was in the American Civil War - because you see he travelled within his grandfather's lifetime. How this is possible, I don't know. I'd already given Belisarius the benefit of the doubt about the whole time-travel-in-his-own-life-thing. Then he freed his slave and the slave said Oh Happy Days! and he became Martin Luther King's dad and and and well..the rest is history. Excellent.

In the entire history of spoken language, no word has ever had as much emotion as that 'home' at the end of the intro.

"Trapped in the past, Dr. Beckett finds himself leaping from life to life, putting things right that once went wrong and hoping each time that his next leap would be the leap home."

The Ghost of the Tower

2005-12-27T00:57:00.000Z

TOWER Bridge is one of the Thames' most famous crossings. Opened in 1870, the bascule bridge is the very last point at which one can cross the river without taking a boat or going underground - east of Tower Bridge is nothing but water.

However, the bridge and the neighbouring Tower of London, after which the bridge was named, have a dark past. The Tower of London has been home to a millennium of bloody murder, betrayal and incarceration. Countless victims were brought in via traitor's gate, at the foot of the bridge, for beheading. Once a year, visitors can go on a 'ghost tour' of the Tower.

Although, like all ghost-related paranormal paraphernalia, there is never any evidence. Until now. I've managed to capture the Ghost looming large over Tower Bridge, but in the vein of all alleged proof of ghosts/UFOs/Canadians, it is a grainy and blurred phone picture. You know you wouldn't want it any other way!

It is, as I'm sure you'll agree, deeply chilling. Moouahahahaha!