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

Goodbye and Good Riddance, Dry January

If, like a sizeable proportion of the UK population, you signed up for a ‘Dry January’, you’re probably just about to grab the barman’s attention and celebrate the end of a month of abstinence.

red wineI won’t miss this January one little bit. But it’s not giving up booze that made it hard.  The bits of Dry January I can’t handle are:

1 People imagining that one month off the sauce will magically cancel out 11 months of serious abuse. The prevailing belief is that it doesn’t matter what you do to your liver before or after January. Anything goes because it gets annulled like a Catholic marriage. Yes, all you folks that didn’t have a sober half hour in the whole of December – I’m talking about you. And no, it wasn’t really that smart to finish off every single bottle in the house before New Year’s Day, just to avoid temptation.

white-wine crop

2 People seeking sponsorship for their abstinence. It’s only one month! It’s barely long enough for your liver enzymes to return to normal (if they’re seriously raised, you should be looking at 6-8 weeks or longer, like life).  Is there no such thing as self-control unless you can get some dosh out of it?  No? OK, so the next time I give up chocolate for three years, I’ll make a Just Giving page and ask everyone I know for serious money.

3 Pious facial expressions when ordering ‘just an elderflower’. Because, obviously, giving up the hard stuff for a small fraction of the year, while remaining self-indulgent on every other front, really turns someone into a saint.

IMG_2985

4 Ever-longer lists of ‘mocktails’, almost as expensive in restaurants as the alcoholic versions. Along with a hefty helping of calories, some also come with twee names like ‘Nojito’ and ‘Abstinence on the Beach’.

5 Hilarious signs about Dry January. You know the kind of thing, often found outside pubs or on Facebook. pub sign dry January

6 Intense conversations about alcohol, mostly around its history or cultural aspects, and not all of it correct:

“In the middle ages, ale was safer to drink than water.”

“Even children drank beer and it was much stronger than it is today.”

“Arabs don’t even have a word for booze.”*

So long, Dry January. Welcome, Dry February.

ooOoo

*Oh yes, they do. There are even words for wine and beer. In fact ‘alcohol’ comes from the Arabic.

More on fatty liver disease and liver enzymes: When and how to evaluate mildly elevated liver enzymes in apparently healthy patients.

 

Five tips for Freshers’ Week

escolaresAny minute now, university towns will be invaded by young people, many of them away from home for the first time.  By definition, freshmen will be desperate to cram in as much as possible into just a few days.  Freshers’ Week can be a full 7 days, a mere 5 at some unis, or stretched out to what’s billed as ‘the best two weeks of your life’.  If you survive.

US-style hazing* isn’t part of the freshman experience in the UK, and may be illegal anyway.  But giving ridiculously cheap alcohol to 18-year olds and seeing what happens?  That’s a totally acceptable, even obligatory, part of the initiation that is Freshers’ Week.

It usually begins with an event called the Mingle and can end up anywhere.  Alone the way, the student body gets into heaps of trouble: sex, accidents, drugs, debt, stress, freshers’ flu, gastric complaints, hypothermia, blackouts, lost underwear, chlamydia and the full shag (syphilis, herpes, ano-genital warts and gonorrhoea).

instant idiot 1There’s no shortage of sensible advice around, but few students heed it. Here, passed on by an infinitely wise third year, are 5 tips for making the most of Freshers’ Week.

1 Smile at everyone.  You never know who will be your best friend.  Even better, snog everyone.  Make sure you post the evidence on Facebook.  You want people to think you’re friendly, don’t you?

2 Save time by multitasking.  It’s possible to drink beer while doing almost any other activity eg crossing the street, wrestling on the rooftop.  You can also make new friends in the queue at the sexual health clinic (see tip 1).

3 Be ambitious.  The Freshers’ Fair is an intoxicating event meant to convince newbies that anything’s possible, even if, for some very good reason, they’ve never tried it before. You’re tone deaf?  A choir beckons.  You’ve inherited Auntie Pat’s tremor?  Then the rifle club is for you.  Just sign up and pay up.

4 Send automated messages back home.  Whether text or email, these should be regular and reassuring.  Sample messages to start you off:

Hey Mum.  The library is fab!  I plan to spend a lot of time there.

Hi Dad.  I’ve joined the Chess Society and the gym.

This will ease the way when you run out of money sometime during week two.

5 Do the Circle Line pub crawl. Legendary and utterly London, this is where a second year, usually from some society or club, takes unsuspecting freshers to down a pint at each one of the 27 stops on the Circle line.  It’ll make a massive dent in your wallet and your liver, but at least the next day you’ll be too wasted to get into any more trouble.

*For more on hazing, see http://www.stophazing.org/