When Beer is an Aid to Diagnosis

With the FA Cup semi-final, pubs attract their fair share of crowds. Today I spotted a Spurs supporter with deposits of cholesterol around his eyes, along with a physique one can only get from eating all the pies.

This spot diagnosis took me back decades to my days as a medical student at the Middlesex Hospital, when we’d try to convince ourselves that time spent in a local hostelry was equivalent to the same amount of time spent poring over textbooks.  

Three essential texts

I say ‘we’ but the pub pathology sessions were a guy thing. There were just four women in my year. Swots that we were, however, we often tagged along to make sure we didn’t miss out on anything educational.

We didn’t just think of the pub as a causal factor in disease, though it must have been in some cases. One of doctors would regularly claim that the King & Queen had given him spider naevi (small blood vessel swellings typical of liver disease).

In the interests of presenting both sides of the story, I’d like to add that Steve from my year was convinced that impurities in the beer were to blame for all the complications of excess alcohol.

“Pints of Beer” by Simon Cocks is licensed under CC BY 2.0

Anyway, someone would go, “That’s a basal cell cancer over there.”

“Where?”

“Guy at the bar. Left cheek. Don’t stare.”

“So it is.”

“Also known as rodent ulcer,” another student might offer.

“Doesn’t spread to distant organs,” said someone else at the table. “Not ever.”

“Unlike squamous cell carcinoma,” added a show-off.

“You’d never know I had PSORIASIS – SIROIL 1959” by Nesster is licensed under CC BY 2.0

A pint or two later, one of us claimed to have spotted psoriasis. All nodded sagely, even though at that stage we barely knew the difference between psoriasis, cirrhosis, and sclerosis.

It was like winning the jackpot when a man with a stomping gait entered the pub one winter evening. This type of gait occurs in late syphilis, when foot position sense is lost, so the person bangs the foot down hard at each step. Although it’s possible that the man was just been getting the snow off his boots.

I like to think that the fictional GP Geoff from my novels will have once given pub pathology a whirl. On the whole, however, education has moved on. Sitting in the pub is not a learning method I’d recommend to my current medical students. For one thing, misdiagnosis is common. For another, it’s rude to stare.

Though sometimes it’s impossible not to. In one saloon bar, there was a man with a massive swelling down there.  So ginormous did it grow that he needed a wheeled trolley to help him (and it) get around. He finally did seek expert advice, but, it was said, only when one of the wheels fell off the trolley and needed to be replaced.

One keen student was desperate for the chance to shout, “Let me through – I’m a medical student,” but we never witnessed a medical emergency. Lucky, really, as our life support skills at the time would have done nobody any favours.

We never saw anything as dramatic as the stripper and the snake, though we all heard about it, naturally. This particular lady had a snake as part of her act, until the night her sidekick decided to hug her neck a tad too tightly. She was rushed to A & E wearing little more than a sizeable reptile, where an anaesthetist injected the snake with muscle relaxant and saved her life.

Photo FreeImages.com/Marcel Herber

As I say, we all heard about it. But we missed it. We were in the pub instead.

***

GP Geoff and other characters can be found in my novel Hampstead Fever.

You may also enjoy these posts:

What They Don’t Teach at Medical School

What Happens When You Become a Doctor

Hampstead Fever

How to Tell if You’re Old

Every time I go away, it takes me longer to recover. If you too find that jet lag lasts longer than the holiday, or that hangovers are more vicious these days, there may be a simple explanation: no matter how young you look, you could be deep in the clutches of anno domini.

Here are six more signs of age.

1 You enjoy sex. But a cup of tea and a nice sit-down are far more appealing, especially with a slice of Battenberg cake.

Royal Doulton teacup

2 Your kitchen cupboards are full of empty jars, take-away containers, and margarine tubs. Then you graduate to saving bits of aluminium foil, smoothing the creases out carefully to make it easier to reuse.

storing empty jars

3 You have to sit down to put your socks on. And you can’t put underpants on without holding onto something for balance.

pair of men's socks

4 You understand the meaning of “How are you?”, and know perfectly well that people don’t want to hear all about your gall stones or your hip replacement. But you tell them anyway.

5 Your mobile phone is powered up only when you’re expecting a call. After which you may turn it off. Or else forget all about it, until it plays Sgt. Pepper in the middle of a funeral.

Nokia mobile phone

6 It’s a mystery why people offer you a seat on the bus. After all, you still feel as young as ever. You even look it, as your mirror will tell you.

That’ll be the cataracts, then.

Apologies for not posting last week. I had some jottings for this post, somewhere. Spent days looking for the piece of paper, only to discover it right where I had left it. It was so unfair that I then had the worst gall bladder attack ever. A shocker, it was, I don’t mind telling you.

Ooh, before it slips my mind, you can now get my novel Hampstead Fever in many WH Smith travel bookstores, where it’s on a buy-one, get-one-half-price offer. Which is handy if you’re heading for a dose of jet lag.

Hampstead Fever, as seen in WH Smith

No Mother is Perfect

This week, a friend of mine happened across a book while tidying her daughter’s bedroom.

“Did your mother write this, by any chance?” she asked me.

 

Now Le Crazy Cat Saloon, with a cast of cats and a sprinkling of French words, may be amusing, but it’s hardly literature.

Nor is it politically correct. For one thing, it features a cat who’s a stripper. As my sons pointed out, stories about strippers aren’t exactly suitable for readers of all ages, no matter what the cover blurb says.

All the same, whenever people talk about my mother’s many books, or her cat paintings, Le Crazy Cat Saloon always features in the conversation.

On Mother’s Day, I have a vested interest in thinking that mothers should be remembered in the best possible light.

If I were to choose one book to remember my mother, it would be Cocktails and Camels. Although she wrote it just after Suez, and her divorce, it’s upbeat and funny.  Here’s how it starts.

I used to live in Alexandria—Egypt, that is, and not, as some Americans think, the one in Virginia. I liked Alexandria. There was no place like it on Earth, I used to think, and now, on looking back, I am quite sure there wasn’t. It was a nice, friendly little town basking in the sunshine and cool Mediterranean breeze, and in summer its streets smelled of jasmine which little Arab boys sold threaded into necklaces. Alexandria had plenty of character—characters, rather—Italian, French, Maltese, Turkish, even White Russians, to say nothing of Copts, Pashas, Effendis, and bird-brained but devoted Sudanese servants. The grocers were Greek, the jewellers were Jews, the shoemakers were Armenians, and the Lebanese were everywhere. The British Army used to play polo and complain about the heat. How they came to be there at all when they had a most roomy Empire in which to exercise is a long, sad story. For the British, though they like to look like good-natured and paternal fools, are, as every Arab knows to his sorrow, very cunning indeed, especially when it comes to taking advantage of trusting Arabs.

Happy Mother’s Day.

Note: Mother’s Day may be on the second Sunday in May in most of the world, but in the UK ‘Mothering Sunday’ aka Mother’s Day is today.

***

You may also like to read an earlier post: Dating, 1940s Style.

My London Book Fair 2017 #LBF17

Three days of trudging around Olympia with an increasingly weighty bag of goodies is too long, according to my feet, even when they’re well prepared.

well-worn Converse trainers

But two days, as I found out this year, isn’t nearly enough. While the London Book Fair is industry orientated, there’s plenty for authors to do. Here are some of my highlights.

1 Catching up with friends and colleagues, many of them from ALLi, the Alliance of Independent Authors.

With fellow author Helena Halme

with fellow author Helena Halme

 

me with cover designer Jessica Bell

with ace cover designer Jessica Bell

Making new friends is part of the fun too. Book people come from far and wide for LBF, like Aussie writer Rebecca Lang from Sydney.

ALLi authors

from L to R: Jessica Bell, me, Rebecca Lang, Glynis Smy

2 Talks at Author HQ.

Author HQ at LBF

The varied fare is excellent, and this year the seats even had proper backs for weary spines. Too bad Author HQ is once again tucked away at the far end of the first floor. You may need GPS and Kendal Mint Cake for the trek.

3 Author of the Day sessions.

They’re at the PEN Literary Salon, which is where I met the inspiring Alaa al Aswany a few years ago. Sadly, this year Roddy Doyle had to cancel his appearance, so, instead of a capacity crowd, there were half-empty benches where people collapsed to eat their sandwiches. As ever, there’s a dire shortage of seating, which is why visitors have to perch on the displays.

following the Yellow Brick Road

4 Learning more about organisations like the Society of Authors, Gardners the wholesalers and distributors, or the Booksellers’ Association. There’s a whole world outside sitting at a desk writing.

the Grand Hall, Olympia

With a bit of planning, you can also arrange one-to-ones with agents or publishers. There are other ways of publishing too. I should have spent longer talking audiobooks.

5 Admiring awesome new books. There are 20 new books published every hour in the UK. Some of them might even be yours.

General Practice Cases at a Glance

at the Wiley stand

6 Haggling over a bagel.

The sticker said £2.75 but it was £4.60 on the price list. In the end, I got it for £2.60. Nothing is quite what you expect at LBF.

salmon bagel

7 The bottle of Veuve Cliquot I won. This was thanks to Byte the Book‘s legendary networking session on the Tuesday evening. I also collected a dozen useful email addresses and a temporary tattoo.

With many friends and colleagues, I only managed snatched conversations between one meeting and the next. Others, like writers from the Romantic Novelists’ Association, I hardly saw. Next year, I tell myself as I get on the train home, it’s back to a three-day marathon.

On the subject of travel, I can’t resist a digression to add that my novel Hampstead Fever will be on special offer in selected WH Smith travel shops throughout the UK from March 30. That’s buy one, get one half price.

Did you go to the London Book Fair? What did you think of it?

There’s Something about Cranes

I’ll admit that, when I first began watching construction work, it was just to accompany three little boys who had an insatiable curiosity about how roads were dug up and relaid, and how buildings were put together.

My sons have long since grown into men. I don’t even know if they bother watching diggers any more. But I’m busy gawping at cranes.

Construction has many downsides, one of them being that much-loved buildings may need to be demolished first.

Strachey building, Newnham College, Cambrirdge

When a crane installed itself outside my flat, I was a tad concerned, as was Mishmish.

Mishmish with crane

But then I had the chance to observe the beauty that is a tower crane at different times of day.

crane-triptych

While the crane operator got to know the colour of our pyjamas and what we liked for breakfast, we got to know the crane and the things it picked up.

crane-diptych

Eventually, it was time for the tower crane to be dismantled. The operators waved goodbye.

crane

Sad? Not really. There are other cranes. London is full of them, as are other booming cities. 

img_2376

Of course over-development is a worry. But now, when I see a crane on the horizon, I no longer think of it as just a blot on my photo.

img_2277

Eight Things that Newbie Fiction Writers Get Wrong

I’ve lost count of the number of the people who’ve told me they’re writing a novel. I’ve also met more than my share of successful novelists. Let’s just say that first group of people is a lot larger than the second.

While there are many ways in which a newbie can go wrong, it often boils down to one or more of these common mistakes. old-books1

1 Using stock characters

The tart with a heart of gold. The tall black dude who plays basketball. The gruff schoolmaster. The academic with thick glasses. While stereotypes can occasionally be useful as shorthand, they’re only two-dimensional characters, and that’s not enough to engage readers.

2 Writing real-life dialogue

Yes, you read that right. Realistic dialogue isn’t an echo of real conversation. In everyday life, people use a huge number of filler words and meaningless sounds. Like this.

“Oh, hi, Debbie. Lovely to see you. Yeah, come in, come in. Well, no, I wasn’t really doing anything. Just the ironing, again. It’s OK, no need to take your shoes off. I’m not fussed about the carpet, honest. Right. Now. Um, how about a cup of tea? Or, er, maybe coffee? No, I mean it. I’ve literally just put the kettle on.”

At this rate your reader will be in a coma long before Debbie gets to hear about Mary’s cross-dressing husband.

Realistic dialogue, on the other hand, is a pared-down version of a word-for-word conversation. So it’s more like this.

“Come in, Debbie. Kettle’s just boiled. Look, there’s something I want to talk to you about.”

FreeImages.com/Jay Neill

3 Scenes with overlong description

These usually creep in because the author thinks the writing is so brilliant that it can’t possibly be cut.  Sometimes it’s reams of beautiful description or essential back story. If so, find other ways to get the information across. It’s best to drip details elegantly into your story rather than dump them in bucket-loads onto the reader.

4 Stretching the reader’s credulity

Your college student heroine is a virgin, and has no laptop, or indeed any device connected to the internet? In present-day USA? You’d need your reader to be as gullible as your heroine. There are always exceptions, though, as you’ll know if you read Fifty Shades.

FreeImages.com/spydermurp

5 Using clichés

Maybe your principal character laughs like a drain at her friend’s jokes, goes green with envy at her sister’s new dress, or sweats like a pig at the gym. If so, get rid of hackneyed phrases. Clichés should be avoided like the, er, plague.

6 Ignoring rules of grammar, spelling, or punctuation

Because an editor will fix it all, right? Nope. Your magnum opus may just get binned. Please don’t insult your reader by mixing tenses of verbs, or mistaking it’s for its.

7 Telling instead of showing

His pulse pounded and the words he had rehearsed stuck in his dry mouth gives readers a better feel for your character’s predicament than ‘He was scared stiff about the interview.’

FreeImages.com/Jurga R

8 Shifting points of view

Some books are written from just one character’s perspective, whether it’s in the first person or the third. Others may have two or more. The convention, which I suggest you stick to because it helps the reader no end, is to have just one point of view per scene, or per chapter. Whatever you do, don’t switch a point of view during a scene.

But none of that is a reason to give up if you’ve got a story to tell. The most worthwhile things take effort. Ask a drummer if a drum roll is easy. It is, after the first ten years.

Here’s a selection of books I’ve found useful or inspiring.

Steven King: On WritingThere’s also a blog post from Jon Morrow about it here

Dorothea Brande: Becoming a Writer 

Jessica Bell’s Writing in a Nutshell books, including Writing Workshops to Improve Your CraftShow and Tell in a Nutshell, and Adverbs and Clichés in a Nutshell.

Roz Morris: Nail Your Novel: why writers abandon books and how you can draft, fix, and finish with confidence.

Good advice or not? Please let me know.

Daunt bookshop

How to Alienate Your Doctor in 10 Easy Steps

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

National Health Service logo

But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

kitchen-clock

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.