COVID nutters

 The reality of the pandemic is clearly hard for some to accept.  It was always one of those existential fears that I had, having read lots of science fiction and studied biology and then medicine at university.  I'd read a lot about pandemics in the past.  I knew they were bad and that we were due one.  I knew it would probably happen.  It's just a bit of a shitter that it actually happened.

COVID has happened.  It's almost everywhere and it kills tons of people.  Accept it and deal with it.

Some people can't or won't accept it.  Some reach for a comfortable conspiracy theory to protect them from the brutal truth that humanity is sometimes insignificant in the face of nature and a wee virus could wipe us all out.  COVID-19 isn't going to eliminate the human race but it's still nasty.  We need to do what we can to reduce and avoid infections.  Vaccines, washing our hands, social distancing, wearing masks - all small personal sacrifices to reduce infection rates and reduce deaths.  Some people can't so this.  Idiots like Ian Brown of the Stone Roses and various quack doctors post mad shit on the internet and people believe them and that has consequences.

The UK government haven't helped.  Initial standard Eton arrogance quickly followed by bewildered blind  panic bolstered by exceptionalism from Dominic Cummings and standard avarice has muddied the water creating a fertile breeding ground for the conspiracy theory nutters.  We need a government of adults and the UK does not have this.  

We will be living with COVID forever.  We will probably need yearly COVID vaccines for some time and normality will take some time to return.

The big lesson is don't eat random wild animals.

Dystopian reality

 Over the years I've read a lot of dystopian science fiction, I've watched the movies and I've read the comics.  I never dreamt that I would be living the reality in 2021.  This morning I was out in the freezing cold queuing to get my first shot of the COVID vaccine, wearing a face mask.  I got on buses that were near empty and saw crazy people hanging around central station.

It's fucked.  On top of this, Donald fucking Trump continues to be the president of the united states of america, at least for the next couple of weeks and he basically incited an attempted coup that involved the storming of the capitol building in Washington D.C. by a bunch of freaks including fucking Ariel Pink.  In the UK we have an evil Tory government with Boris Johnston as out prime minister and cunts like Jacob Rees Mogg causing as much badshit as they can.

10,000 people in the UK have died with COVID-19 since Christmas leading to a grand total of 80,000 deaths related to a new disease in under a year.  Shit is majorly fucked up.

I miss my dad and some of my friends who are dead but in a way I'm glad they don't have to live through this shit.  I'm ok, I have a comfortable middle class existence but Scotland right now is fifty shades of bleak thanks to idiots voting for things like Brexit and the Tory party.

I hope the vaccine works at least a bit.  Not sure if anything will fix the damage to the UK after Brexit and COVID.  Hoping for Scottish independence but suspect that is unlikely.

Diagnosis - TV series

Diagnosis is a Netflix TV series based on the New York Times 'Diagnosis' column written by Dr Lisa Sanders.  Lisa Sanders is an attending physician (a consultant in the UK) who previously contributed to House MD as a medical advisor.  House MD is one of my favourite medical TV shows.

In Diagnosis she looks at 8 diagnostic challenges.  The majority of these cases are neurological in origin.  To reach diagnosis in these cases she published a column online and invited people from around the world to make suggestions.  In several cases a diagnosis is reached.

This is almost an exercise in folk medicine, with random strangers making diagnostic suggestions.  Unsurprisingly Lyme disease is mentioned a lot and unsurprisingly positive Lyme tests suddenly appear.  In some cases I was not satisfied with the ultimate diagnosis and in at least one case I think the patient was unsatisfied.  A lot of mistrust of doctors is vocalised which is common.  Some doctors are good and some doctors are bad.  All doctors make mistakes and all doctors get things wrong.  Some diagnoses are hard to understand and will be refused by the person with the symptoms.

As a medical TV show, I enjoyed this, partly because it was mainly neurological problems and partly because it is what I see in clinic on a regular basis.

Worth watching.

When things are good

Sometimes things are good in life.  It's probably just for a while but sometimes, for a bit, the road gets easier.  It's important to realise that you are in a good time because if you don't you only realise when it's gone.

I'm in a good bit now.  I'm doing a new job that feels worthwhile.  I'm in a good relationship.  I have money in my pocket.  I am fortunate.

At this point I look around me.  I'm doing well but that's not true for everyone.  One of my school friends is very sick at the moment.  He's a young man with a young family who's normally healthy and he has been critically ill in a hospital ITU for over a week.  The doctors are doing their best and he is almost stable,  In that situation, almost stable is a victory.  Bad things can happen with no warning so when things are good, enjoy them.

More generally, our current government are doing their best to fuck the country up.  I will never understand the Tory 'rich obnoxious idiot' mindset.  I will never understand why they have contempt for people less well off than themselves.  I guess humanity is a variable thing.

Anyway, right now, life is internally and locally good for me so I'm going to enjoy it

Is medicine in the UK fucked?

Why would a smart school kid want to be a doctor?

I didn't work hard at school.  I wasn't interested.  I was more interested in music and comic books and having fun.  Eventually I grew up, decided I wanted to do something worthwhile for society and my community and decided I wanted to be a doctor.  I wanted to help people.  So, at the age of 23, more than 15 years ago, I went to medical school.

Unfortunately I never had rich parents.  Both my parents had jobs.  Jobs working for the state where they worked hard but they were never paid very much.  Now I probably earn more than my parents did when their salaries were combined.  However at medical school I had no money.  My parents didn't have much spare to give me although they gave me what they could.  I got bank loans, overdrafts, hardship loans and hardship fund awards.  I managed to pay my rent and eat and get through medical school and become a doctor.  When I graduated at the age of 26 I was about £40,000 in debt.  It took me seven years to pay that back.

Being a doctor isn't cheap.  You give the GMC money, you give the BMA money (if you want), you pay to sit expensive exams (sometimes more than £1000), you pay your Royal College money (to train and to be a member), you pay your medical insurance and finally you pay a big chunk of money to be on the GP register or the consultant register.  Also, you get a small study leave budget so you pay a fuck load of cash to attend course, buy textbooks, buy equipment and make yourself good enough to do the job.

Also, you damage your personal life.  You travel about.  I've lived and worked in lots of cities and towns.  I've spent 3 and a half years as a doctor mainly living in hospital rooms.  I've slept on the floor at work when I'm meant to be oncall for emergency work (from home) but I don't have a car and I don't trust a taxi to get me into hospital quickly enough for a patient who needs me.  You miss time with family and friends.  You don't spend enough time on relationships.  You blink and you're nearly fucking 40.

So why do you do it?  You do it to help someone.  You might stop them dying.  You might get them out of ITU.  You might stop them becoming disabled.  You might help control their pain or their inconvenient chronic disease.  You might help.  Because you want to help people.  Because you are a doctor.

You are a doctor 24 hours a day, 7 days a week, 365 days a year for the rest of your fucking life until you get to stop being a doctor.  You realise that life is precious and wafer thin.  You know that sometimes you can help and sometimes you can't.  You always hope that you won't be the only doctor on a plane (and that the other doctor is an anaesthetist and not a public health consultant).

So being a doctor is tough but you do it because it's a part of you.  The NHS is a useless monolith sometimes but it helps everyone without asking questions.  It is a privilege to be able to treat every patient without worrying about costs so I guess the monolith is worthwhile.

All this is fine and good but it's becoming more and more unpleasant being a doctor in the UK.  The current rich kid clown show of neoliberal Tory twats that is molesting this country has decided to fuck with the medical profession.  They have picked notorious fud-nugget Jeremy Hunt as their frontman for this project and he is trolling the doctors in England in a massive way.  He is aiming at a reduction in take home, spendable pay for junior doctors of approximately a third.  He is claiming that this is a pay rise and that doctors need to work seven days a week.  He's like a Bizzaro version of a health secretary from a Superman comic. Backwards and fucked up.

Nowadays medical students often have debts of about £70,000 when they graduate.  If they get paid less they won't break even till they are in their 40s.  Hard work and no money makes you miserable.  Why would a smart school kid want to be a doctor in the UK?

We won't have the best and the brightest as doctors if there is no obvious reward.  The job is horrible. It will only be worse if you don't get a comfortable wage.  Smart kids will do something easier that pays more.  They'll work in finance.  Talent will be lost.

Medicine in the UK is probably fucked.  The NHS will probably be dragged down with the medical profession.  Jeremy Hunt will laugh all the way to the bank.

Happy happy, joy joy.

Teaching

I regularly reflect on what a lucky bastard I am.  I spent the last week teaching a full year group of medical students about my speciality interest.  I had a great time.  Teaching is one of the most enjoyable parts of being a doctor.

Part of what you want to do is stop the students falling asleep.  A lot of medicine is boring.  It's difficult to just absorb a stream of facts.  It's also difficult to filter the massive amount of information that we deal with.  Hundreds of pages of medical data are published every day and the vast majority of it is bullshit.  You want the students to walk away with knowledge of the important stuff that will save a life and help patients get better.  You want the important stuff to stick.

By teaching, you learn.  I've learned some neuroanatomy myself this week and I've come to realise that my understanding of at least one condition was wrong.  I don't know if this is because I was taught badly myself 16 or 17 years ago or if I just misunderstood a concept.  The important thing is that I have corrected my knowledge now.

We were trying to make things fun for the students so we set up a text number on a mobile phone to let them ask us questions as well as a twitter account.  We got a lot of useful texts as well as a few abusive ones.  I used the twitter account to promote YouTube videos of examination skills, patient experiences and other useful websites.  If the students are interested they will check it out.

I'm a bit of an extrovert so I enjoy public speaking.  My problem is, that as a Glasweigan, I tend to swear or say inappropriate things.  The students did seem to like this.  I didn't say anything that was too out of order, especially when I compare myself to a surgical colleague who started to talk about shagging goats.

We got some decent feedback and hopefully it was a success.  With luck the students will pass their exams and some of them may even develop a greater interest in neurology as time goes on.  I have to get back to regular doctoring this week but I'm already looking forward to my next bit of teaching.

Achievements

So it has been a big week for me in a way.  I had the viva for my MD thesis on Monday crowning nearly five years of research work.  My examiners liked my thesis (much to my surprise) and it will be accepted by the University.  An achievement.

Does that make me an academic? I have 3 degrees in science, medicine and research.  I do clinical work and I have clinical qualifications.  I work hard and I am probably a bit addicted to it.  Work is almost an end in itself.  Money is a happy side effect.  I have published a few useful scientific papers.  I hope they are useful as other authors have cited them but it is difficult to be sure.  I have made tentative moves to do more academic work.

How do you know when you have achieved enough? When can you sit back and relax? What drives you on?  Sometimes I feel like I have blinked and 15 years have vanished.  At times my life has been a whirlwind.

I like helping people when I can and I like to have an interesting life.  I get bored easily and I like a bit of variety in my life.  Research and teaching give me a bit of variety.  Clinical work is enjoyable too but burnout is always possible and important to avoid.  

I honestly don't know why I work so hard.  I do it because it's easy and it gives me something to do.  Work means that I don't need to think too much about anything else and I can feel like I am doing something worthwhile.  I guess I'm lucky to have a job that lets me do that.  I have a job that sometimes lets me feel like I'm achieving something.

Thesis submitted

So, after 4 years and 7 months I've finally submitted my MD thesis.  It was a massive amout of work but I've finished it.  The feeling of relief associated with this is immense.  I now have my evenings and weekends back and I no longer have a constant feeling of guilt.  It's not totally over because I still have a viva examination but this will take a few months to organise.

So,  I'm free.

For a bit.  Since August I've spent an average of 8 hours working on this thing.  Eight hours of solid unpaid work every weekend.  A big chunk of my life.  At times I wasn't sure that I  would get there but I did.  It cost about £180 to get 4 copies of the 300 page document printed.  They weighed a tonne.  But it was a good weight.

That's enough egotism for tonight.

Grant Hart - live at Mono, Glasgow

I went to see Grant Hart at Mono last night.  I've been listening to Husker Du since I was about 12 and 'never talking to you again' is one of my favourite songs ever.  I loved seeing him play but it was heartbreaking to watch.  He does not look very well.

I'm not sure who the support act was.  He sounded like a one-man-band playing the Ramones.  It was OK but I don't think I'd rush to hear him again.

Grant came on and he looked terrible.  Even from 20 metres away I could see that he is jaundiced.  He looked worse later on when I bought a single from him after the show.  His teeth are a mess.  As a doctor this was sad to see.  I've worked in a few Glasgow hospitals and I've seen a lot of people in liver failure and you don't want to see a musical hero like this.  I don't know if it's viral hepatitis from when he was injecting drugs or if it's booze or if it's cancer but Grant Hart looks like a very sick man.  As a musician in America I don't think he has a health care plan and I strongly suspect he isn't getting much in the way of Husker Du royalties.  Poor bloke.

The sound in Mono was not great but Hart shone despite the sonic problems.  His voice continues to be great and he ran through his back catalogue playing requests as people shouted them out.  He played his songs from Husker Du including She floated away, Books about UFOs, Pink Turns to Blue and Sorry somehow.  He played my personal favourite never talking to you again as well as stand-out solo tracks like 2541 and Admiral of the sea  by Nova Mob.  He kept going for nearly 2 hours.  It was great to see.

I am worried about him.  He looks very sick and I hope he is getting decent medical attention.  I hope his health improves and he keeps going. 

Sometimes there are good things about being a doctor.

Every so often you do manage to do something worthwhile as a doctor.  Today we managed to get a young woman home after more than 80 days on the ward.  The woman had an unusual diagnosis  (anti-NMDA receptor encephalitis) and I managed to guess what was going on.  I did the right test quickly and we confirmed the diagnosis early.  We managed to deal with all the problems that can occur in this condition and we managed to deliver the correct treatments (or at least what are hopefully the correct treatments).

I cannot say that we got everything right all the time but we did our best and the patient seems to be better.  Her partner and her family were very happy.  I got a bit embarrassed and slightly teary when they were saying goodbye.  As a doctor you don't really expect people to thank you.  I'm just there to do a job to the best of my ability and I get paid well for it.  People are often unhappy with their doctors and I'm always a bit surprised when they are nice to us.

So, despite being run off my feet and working like a blue-arsed fly it was a good day.  We got a good result.  We don't always get them.

Kobe Steak - Is it worth it?

I've been a doctor for nearly 7 years and for most of that time I've not had much money. I finished medical school with £40,000 of debts that I am still paying off. To compound my financial woes I spent 2 and a half years doing clinical research on a basic wage while paying a very expensive mortgage. I was living on about £200 a month for a long time.


I started a new job in February and I now earn a lot more money. I've bought some new clothes and I have been treating myself to lots of other stuff. I like meat and I wanted to try a Kobe steak.


The Kobe steak that I went for is not a real Kobe steak. It is Wagyū beef which is essentially the same thing but doesn't need to be reared in Japan. The animals that this meat comes from are allegedly massaged and fed beer. So the steak I had (at the Grill on the Corner in Glasgow) was very nice. It had a melt in the mouth quality and it was a good size. It was well cooked although I wasn't too inspired by the chips that came with it. I feel that I got my £55 worth but I am sure that I had equally nice bit of meat in the past.


A good experience but probably not one I will repeat regularly.

Shitty things about being a doctor

So after working in clinical research for a couple of years I'm back as a full time clinical doctor. I love my job and I love my speciality but there are bad bits in this job. This week I have told one man that he is going to die soon and I have been present as another man was told that he was dying. Both of them were nice blokes. Sadly, another one of our patients died of an aggressive illness that we were unable to control.

But that's my job and I have to be there for my patients. I have to give them bad news in a clear and understandable manner and I have to give them whatever information they need. It's important not to be openly upset when you give bad news to someone because you don't want the patient to feel sorry for you. You are there to help the patient and that's it.

Doctors are human and this stuff can get to you. There are a lot of good aspects of the job that balance this out but it still sometimes hits me like a kick in the nuts.

Living in cupboards - medical training.

So I've been a doctor for nearly 7 years and I'm now back to living in a crappy room in a hospital miles away from home. So far I have spent two of the last seven years living in cheap, shitty rooms in hospitals in the arse end of nowhere and tonight i might be starting another two year sentence.

This is an essential element of medical training. To get a broad spectrum of experience you need to work in several units. Unfortunately the subspeciality I work in has training at national levels so if you rotate between units you will probably end up being at least 60 miles from home. I am now working on the other side of the country.

This is good in a way because I am exposed to a wide range of clinical units and I see lots of different types of clinical practice. It's bad because I can't sleep in my own bed and I'm a long way away from my family. Training as a doctor can really fuck up your life.

So I'm sitting here in a room that is probably about the same size as a prison cell. It's not warm but I'm surviving so far. I've not seen any insects yet but I am sure that they will come. The walls are tissue paper thin and I can hear every fart next door. That's life I guess.

Hopefully I'll get a decent pay check at the end of the month and that might make things a bit better.

Maybe.

British doctor killed in Afghanistan

Sad news over the past few days. A young British doctor was killed while doing humanitarian medical work in Afghanistan along with several other doctors of various nationalities. The doctor involved, Dr Karen Woo, used to write a blog. It's fairly well written.

http://explorerkitteninafghanistan.blogspot.com/

RIP

James Le Fanu - how the mighty have fallen

So, after being disappointed by 'why us?', a book that I took to be essentially hocus-pocus I learn that James Le Fanu has been supporting homeopathy.

http://blogs.telegraph.co.uk/culture/tomchivers/100044706/a-response-to-dr-james-le-fanu-on-homeopathy/

I really loved 'the rise and fall of modern medicine' but I guess I just have to accept that he got lucky and generally he's a bit 'mystical'.

Bummer

The little stranger by sarah waters

I picked up this book in Fopp at the weekend for £2. I didn't know much about the book although several things about it appealed to me. The story is about a doctor in the Leamington Spa area after world war 2. I actually spent 5 years at medical school/working as a first year doctor in Warwickshire so the setting was familiar to me.

The book is also a bit of a gothic/psychological horror story. The protagonist is Dr Faraday, a man from a poor family who has done well in life. Faraday narrates the book, describing the misfortunes of the Ayres family in their decaying family seat, Hundreds Hall. Strange things happen in the house suggesting that it is haunted.

I really enjoyed the story and there are a few interesting things that happen. I have talked about some of these things below. To avoid SPOILERS I have used a different coloured text.

To READ SPOILERS select the area below.

Faraday appears to be an unreliable narrator in the style of James Hogg's 'The private memoirs and confessions of a justified sinner'. Faraday appears to be a catalyst for the decline of the house, initially damaging it as a 10 year old child.

Initially Faraday appears to be trying to help the family although with time many of his actions appear to be more selfishly motivated. While the narative supplied by Faraday appears to be neutral he may well be denying many of the unpleasant things that he does to the Ayres family. Towards the end of the book his selfish actions appear more obvious (for example he himself carries out the post-mortem on his prospective mother-in-law, an activity which is surely against medical athics. He also seems to emotionally manipulate Caroline Ayres into becoming engaged to him and at one point he may even attempt to rape har).

In the latrer segments of the book Faraday is more visibly unhinged, even in his own narrative. It is certainly possible to interpret the death of Caroline Ayres as murder. There is also a telling section in the epilogue where he returns to the house, thinking he may be able to see the ghost before realising that all he can see is his own reflection.

A good book. Worth a read. Please leave a comment if you have any other thoughts on events in the book.

philosophy of science

I'm a medical doctor. I have a science degree, a medical degree and a post-graduate medical diploma. I'm currently working on a research degree (MD). I like science. I like learning stuff. I like to know how things work.

So why is science good? Why is science valid? Why is aspirin better than a homeopathic medication if you have a heart attack? Why do type 1 diabetics prefer insulin to acupuncture? Why is the theory of evolution more credible than creationism?

I've always been interested in these questions and when I was at medical school I did a special study module entitled 'introduction to the philosophy of science'. (in medical school you normally get to do a couple of 'special study modules' to broaden your horizons and help you appreciate life outside medicine). I took this module with 2 of the more intellectually adventurous guys in my medical school. It basically involved us sitting around and having a nice chat with a professional philosopher at Warwick University for 3 hours every week. I loved it.

We were able to convince the philosopher to assess us with an evening 'poster presentation' with cheese and beer. It was great.

One of the big problems with clinical medicine is that you don't get to think much. You solve clinical problems quickly. You sort people out, patching them up and 'fixing' them efficiently so that you can tend to as many patients as possible. You graduate from medical school and all of a sudden it's 6 years later. You're 30 years old and you've barely drawn breath.

I wanted to do clinical research for many reasons. I always wanted to be a scientist and discover stuff. Obviously I realise that the concept of actually 'discovering' something in medicine is a load of bollocks but as a child it really appealed to me. I also wanted to pause for breath and check my pulse after several years of clinical medicine. It's nice to be your own taskmaster for a while and to be able to escape the Stalinist thrust of the NHS. I love the NHS but it wears you down. I wanted to keep the option of a future career in academic medicine open and I wanted some time to teach medical students and learn a bit more about my own medical subspeciality. I feel that I am achieving most of these goals.

I better return to the point of this post. As part of my research degree I recently took a further course on the philosophy of science. The course was good and rejuvenated my interest in the subject.

The course tackled several interesting subjects. The main difference between science and pseudoscience seems to rest in properties of scientific theories. If a theory is scientific it can be tested experimentally and potentially proven wrong. Pseudoscience is often untestable. Many scientific theories are backed by expermental data. Pseudosciences are often slow to produce objective evidence.

The course also tackled the relationship between science and religion. Science and religion are very different things and they probably should be kept as far apart as possible. Religion only devalues itself by trying to interfere with science and scientific attempts to disprove religion are probably futile and seem to be as meanspirited as kicking the crutches away from a man with one leg. Science and religion are non-overlapping majesteria and should probably be kept apart.

As a side issue I would say that clinical medicine is probably more of an art than a science. Patients are not experiments and we should remember that.

The course also looked at the evolution vs. creation science debate. Basically creationists are idiots who do not understand evolutionary theory or its implications. Creationists expose themselves to ridicule and their religion is damaged by attempts to describe fossils as 'a test'. Even in Darwins lifetime evolution was described as 'religions friend disguised as a foe'. The person who made this statement was observing that the process of evolution could be seen as a mechanism of intelligent design that could have been used by some interventionalist creator God. If I was a religious nutter I would be promoting evolution as evidence of devine fingerprints. Creationists are a bit too stupid to pick up on this. I'm happy to settle for Pascal's wager myself.

So, to summarise this rambling post, the philosophy of science is an attempt to explain why science is important and why it can be trusted and why it is more useful that reading a horoscope.

If you want to read a bit more on the topic try
What is this thing called science by A.F.Chalmers
Philosophy of science - a very short introduction by Samir Okasha

Parkinson's disease - patients perspective film

Here's a clip from a film about Parkinson's disease made by a girl I knew when I was younger.

Parkinson's disease is a common neurological illness that we need to learn more about. The treatments currently available for this condition are not perfect and more research is needed.

Simon Singh wins libel case

'I'm gonna sue you! I'll sue you in England!' - 'Tom Cruise' in South Park - The closet episode

British libel laws are draconian. British people don't really have freedom of speech or a free press. If you want to say something that a rich person disagrees with (even if it's just daft stuff about famous people) it is very easy for them to bankrupt you in an English court.

Laughing at famous people is one thing but these libel laws become very problematic when they are used to suppress scientific discourse. Simon Singh, a respected popular science writer, wrote about several non-evidence-based claims that some chiropractors had made. The British Chiropractic Association then sued him for libel. They could have bankrupted them.

Thankfully the nefarious ploy of the BCA backfired. Anti-libel campaigners systematically reported British chiropractors to advertising watchdogs resulting in numerous fines for BCA members (who became slightly dischuffed with the BCA). On the 1st of April a sensible judge kicked the BCA libel case out of court and Singh walked free. A victory for common sense, science and freedom of speech.

I was fairly happy.


http://news.bbc.co.uk/1/hi/uk/8598472.stm

Sir James Black - Cool dead guy

On the 22nd of March Sir James Black, the Scottish medical scientist died at the age of 86. He won the Nobel prize for medicine in 1988. He helped develop both beta-blockers and ranitidine. As I doctor I have prescribed beta-blockers on several thousand occasions helping patients with heart problems. As an individual I take ranitidine whenever I have acid reflux. Black also has a building named after him at Glasgow University. I spent a long time in that building as a science undergraduate.

Black has left an indelible mark on medicine.

RIP

http://www.telegraph.co.uk/news/obituaries/medicine-obituaries/7507080/Sir-James-Black-OM.html
http://www.timesonline.co.uk/tol/comment/obituaries/article7072983.ece
http://www.heraldscotland.com/comment/obituaries/sir-james-black-1.1015395
http://thescotsman.scotsman.com/obituaries/Obituary-Sir-James-Black.6174782.jp