Walk into the ball to the overwhelming smell of bacon. My feet follow the scent automagically until I find a brightly lit marquee, a beacon of meaty goodness in the darkness. I approach the minimal queue, and four young blonde ladies reach out towards me, each offering a sandwich with more bacon stuffed in it than the next. Four curvaceous, short skirted beauties behind a mound of fried meat, literally forcing more upon me every time I finished a roll.
I guess this is what religious folks mean by heaven.
*****
On the other side of the ball there is a stall giving out coffee. Sure, it’s instant, but it’s swish Whittards instant, in a range of flavours and served by equally gorgeous, though less bacony, ladies. Coffee in hand, I walk outside to find an inflatable Gladiators-esque attraction, where young women sit atop a horizontal pole and hit each other with a blow-up giant ear picker until one falls off. If only there was jelly involved, I hear you thinking.
But then that guy turns up. You know the one. At every event there is a guy in a kilt, who isn’t even Scottish, who turns up, gets lairy and ruins it for everyone. Pushing his way through the crowd, he invites his friend up to the contraption, shoes the delectable ladies using it away, and jumps up to the pole. I couldn’t turn away fast enough. Turns out he was being properly Scottish with regards to his underwear.
So the other day I picked up my freebie degree. It allows me to do certain traditional things, most notably get free dinner every so often at my old college and drink coffee in quite an old room. But one of the most exciting is vote for the new Chancellor of the university, now Philip is standing down.
BRIAN BLESSED – NOMINATION FOR CHANCELLOR OF CAMBRIDGE UNIVERSITY.
Thank you for your letter of the 31st May 2011, I must admit that I am absolutely staggered by the content.
I understand that more than fifty members of the Cambridge University Senate, holding Cambridge MA’s, have nominated me for the post of Chancellor of Cambridge University, and of course, I am delighted to accept that nomination.
For me, Cambridge has always been the centre of the earth, there is brightness and light there that rivals that on Mount Everest. The University buildings are architecturally beautiful, the whole setting is wonderful and enchants the soul.
I am thrilled to be asked, and wish you every success with the campaign.
Yours sincerely
BRIAN BLESSED
See this group for more information, and thispresscoverage for why we’re doing this. I handed in my signed nomination this morning…
This is a curious clip, and appears to have been produced by someone, maybe a behavioural neurologist, or neuropsychologist with considerable insight into NEAD and particularly patients views on their disorder. There is the bit towards the end with the head injury, and “crying wolf”, and then the recurrent leitmotif of the little dog (?wolf, ?seizure alert dog); before finally the theme switches to welfare benefits, and then she is then apparently cured by a new boyfriend. This was, I suspect, produced by a clinician with an interest in functional disorders, or possibly by a patient who had recovered from NEAD (Doctors.net.uk)
Worth a giggle. But it does raise a more serious point about the way we handle, and are taught to handle, psychogenic and psychiatric disorders.
We learn as students about the management of mental health conditions, the psychopathology behind why the patient feels and responds that way, and to look at the illness in a holistic, patient centered way. We consider the advantages and disadvantages of ‘labeling’ such patients, the social aspects of the etiology of their health condition and their care, and ways of reintegrating patients with severe psychiatric disorders into their community and employment. It’s all very nice, working for the patients, taking what they say seriously and applying clinical skills to make things better for them.
Then we get exposed to the patients by clinicians. We’re on post-take ward round with the consultant who brushes off the apparently fitting patient as, “just another one of her pseudo-seizures, leave her alone for half an hour then we’ll send her home”. We’re in A&E with the registrar who asks with a resigned sigh if you would “go find out what she’s taken this time” and pointed in the direction of the patient with borderline personality disorder who’s attended for the third time this month. It’s hard not to become convinced by the cynical approach of the experienced clinicians that they’re the ones who are right. The lectures are divorced from reality; On the front line, these people are untreatable, repeat offenders who waste our time, and as the healthcare assistant muttered as she walked past an apparently ‘cry for help’ suicide attempt, “you just can’t cure ‘em”.
It’s sad, in a way. I like to think of myself as having at least a little bit of desire to care for people, hence getting into this whole medicine jazz. And I have good friends, both in person but also online, who have these apparently ‘untreatable’ diagnoses applied to them. The majority do try and help themselves, working with the psychiatric teams, trying desperately to become ‘normal’. Jobs, friends, education – they manage, despite the obstacles that having this label throws in front of them. Sure, there’s the occasional relapse, but on the whole they are putting in a lot of the leg-work themselves, with support from the medical profession.
So why can’t I treat the person in the A&E bed the same, trying to give them the same support, rather than just counting down the minutes until their paracetamol levels come back safe and we can boot them out to clear up a trolley? Is it depersonalization, protecting myself from the draining effects that caring for someone in that condition can have? I treat my friends differently from my patients, and I think that’s only correct, but do we go too far the other way? Or am I learning to treat patients that way vicariously, following the examples of the doctors around us?
Perhaps it’s like all the jokes within hospital and the ambulance service about GPs. The reason primary care gets such a bad rep is that you only see and remember the bad ones. This blog is full of stories from when I was working in Yorkshire of grossly inappropriate jobs given out by GPs, but a disproportionate number were given out by the same few doctors. The majority of general practitioners do a good job, caring for their patients themselves, and only referring to the A&E pathway when absolutely necessary, and often with very clever and subtle catches. But you barely remember them: All that sticks in your head is the waste of time jobs, and those where the patient is on the verge of dying because that catch was never made.
Chronic mental health may be like that. The majority of people we see are the same patients over and over again. Perhaps they are the ones who don’t want to help themselves, the minority. There can’t be just one borderline patient, one NEAD in the city, but they’re the ones we see over and over again. One could argue that the issue isn’t their mental disorder, but something more fundamental about their personality. We shouldn’t apply who they are and the way they behave to everyone with that same label, the vast majority of whom are working hard to cope in the same way someone with a chronic physical illness like asthma or diabetes does.
But unlike the bad GPs, is it right that we write them off as uncurable? Or should we be applying the same, arguably unattainable, model of the perfect clinician doing everything for their patient, and still try to give them all the help we would someone actively trying to get better? Or is it a lost cause, the issue lying with them as a person, rather than their illness? Would our time be better served treating as mental health practitioners those who want to be treated, as emergency clinicians those people who’s illnesses or injuries are life threatening?
And more fundamentally, is the personality/illness distinction really our call to make?
Gaze steadily at the white + sign in the middle of this blue square, close up for about 20 seconds or until you start to see ghosting around the edges. Then transfer your gaze to the + sign in the pale blue square. You see a white after-image where your ability to perceive blue was fatigued. The fatigue gradually wears off.
There’s nothing chimeric about white, but when you do the same with this pair the red fatigue you create makes you see a blue-green after-image on the black background. In the real world black cannot have a hue. There is almost no blue or green light reaching your eyes from the black area. So this blue-green yet black colour is chimeric — impossible in nature but visible to humans.
Good fun (for limited values of fun). But there’s also a serious, sciency, almost-relevant-to-NHB-exams side. Check out the original paper here to semi-revise colour-encoding ganglion cells and their links to V1…
I’ve always been a concepts guy. I like to understand, to think things through. And I’m reasonably good at it. That’s why I think I did pretty well at geology, why I’m told I’m a half-decent clinician, and why I find supervisions so interesting. It’s also why, aged 16, I decided not to do medicine. Because my major (academic) weakness is an inability to rote learn facts, and that’s all it seemed to be.
I just can’t do it. I dig on the theory and concepts behind why things work the way they do. I love the mental process of problem solving, and especially the application of this to the human body. I worked out over time that a lot of actual medicine is that, figuring out what’s going wrong and what you can fix. This (amongst other things) prompted me to reconsider the career. But for some reason, obscure and obtuse facts still don’t stick in my brain. And right now, that’s all we’re being asked to do: Learn lots and lots of facts and regurgitate them on to a multiple-choice answer sheet. Education by bulimia.
The issue with a lot of it, I guess, is that I don’t see the relevance to what we’re being asked to remember. Clinically, that’s what specialties are for. I’ll never as a house officer be asked to look at a photograph of some bacteria and identify them. No, I’ll take cultures and send them to the pathology lab. Similarly with cancers, I’d never have to think about exactly which gene went wrong first in the development of someone’s adenocarcinoma. By the time that’s important to me, if I were to become an oncologist, the management (and likely theory behind the development) will have changed anyway.
And regardless, if I was asked to do any of this, I’d look it up in a book or on the internet. That’s why the books exist. What’s the point in memorizing everything when there’s always more that needs remembering? Surely they should be teaching us, examining us in the critical thinking and problem solving skills that we need? These skills can complemented by a textbook, but not the other way around.
Cathartic but futile moaning is all this is. Perhaps I should stop complaining, and just get on with trying to ram facts about different cancers and bacteria into my head, alongside a list of drugs that are no longer in use. I’ve only got myself to blame for applying here after all…
Turns out an Irish paper, The Sunday Business Post, are looking for a new copy editor after they let this gem hit the front page:
The headline was rapidly corrected to “Bishops agree new rules on sex abuse“, a more appropriate tag-line to a rather positive move by the church. Unfortunately, the correction never made it as far as stopping the press:
I used to find all my friends getting married and having kids slightly unnerving, even upsetting. I still like to see myself as a young teenager, back in college or first year, with none of this “adult life” shit to worry about.
However, I’m starting to come to terms with it: Friends with kids are excellent (you can have fun playing, then hand the thing back when it begins to smell) and given I now have a impending marriage I probably shouldn’t complain about that one too much. But now my friends are starting to do even more horrific things. They’re starting to die.
I found out today that a guy I lived with as an undergraduate was found dead the other week. Little is known about what happened, so I definitely won’t speculate here. Regardless, I miss the guy; I was really looking forward to catching up with him at our upcoming MA ceremony. It’s upsetting that someone I’ll never again be able to talk to someone I was once so close to, but who drifted inevitably away when we all graduated and set off into the Real World.
So here’s to a man who I shared countless drunken kebabs with, pulled out of the sludge after a failed King’s Swing, and who taught me more than I ever, ever wanted to know about masturbation techniques. The man who was always there for his friends (except while “busy” showing himself some love), who intervened in my one and only “fight”, and who was surprisingly bad at Unreal Tournament for a compsci. The man who helped me cheat my way through first year computer science, who earned me a ten pound firebox voucher by being shot with a compressed air rocket launcher, and attempted to bugger me (more than once) with a traffic cone.
Months ago, I made a drunken bet as we escalated our way through the realms of EXTREME emergency medicine that it would be possible to intubate using just a spoon, a torch, and a length of rubber hose. Looks like I’m not the only one who thinks it possible – from Primary Anaesthesia in 1986:
If the light on the laryngoscope fails, clean the contact between the blade and the handle, and check that the bulb is screwed in place securely. If this fails, use your spare laryngoscope, which you should have instantly available. Or, transilluminate his pharynx by shining an electric light through his neck as in Fig 13-12. If you don’t have a laryngoscope you can use a bent spoon.
