Tag Archives: medicine

20TH CENTURY MEDICINE, EGYPTIAN STYLE

Posted in Pills, Places by

Covid-19 has already altered medical practice forever but, thinking back, there’ve been many changes in medicine over the years. Most have been more gradual than the ones made necessary by this pandemic, but no less dramatic. The NHS care that I practise, and receive, is far removed from the care I experienced as a child growing up in Egypt.

With my mother in the garden

Antibiotics were few back then, and usually given by injection with a freshly boiled syringe and a reusable needle. I can still feel the cold oily pain of penicillin as it inched its way from my bottom down my leg.

“I don’t want an injection!”

Penicillin was better absorbed in this way than by mouth. There was also a trend of sparing a patient’s delicate digestion, hence the usual recovery diet of rice with boiled chicken, as recommended by every doctor. If the patient ran a fever, suppositories were deemed preferable to a couple of Aspro.

The French occupation of Egypt may also explain how often the middle and upper classes suffered from liver complaints. “C’est de la bile, chérie.” At least bilious attacks can be genuine. A tired liver or le foie fatigué isn’t even a real diagnosis.

Injections of vitamin B12 were popular in the mid-20th century, and not just for cases of proven deficiency. The impressive bright red colour of B12 flowing into a vein could hardly fail to make the patient feel better, never mind what was actually wrong with her.

Photo by fabrizio turco from FreeImages

The divide between haves and have nots dominated every aspect of life in Egypt. With no national health provision, the poor died young, blindness from trachoma was common, and amputees were everywhere.

If you could afford one, your family doctor would visit whenever requested, often with a cigarette in hand as he puffed his way upstairs. Once he extinguished it, he would examine the patient. As he usually wheezed more than the patient, I’m not sure he heard much through his stethoscope.

Granny waiting for the doctor to arrive

What medicine lacked by way of treatments back then was made up for by personal attention, much as alternative medicine still functions today. A little baksheesh to the receptionist ensured that you got seen ahead of others in the waiting room. It seemed unfair to me then, as a young child, and it was even less fair that most of the grownups around me couldn’t see a problem.

Photo by Martyn E. Jones from FreeImages

It’s almost incomprehensible now, but polio was a scourge that went back thousands of years. With outbreaks of paralysis among young children every summer, no wonder we all feared it. Jonas Salk’s polio vaccine didn’t come into use in the Middle East until the late 1950s. For some reason, both doses were injected into the back (not the buttock or thigh). The prospect made me run off into the garden where I promptly fell on the gravel. The two skinned knees and two grazed elbows actually hurt for longer than the polio jab. I’m pleased to say that the Salk vaccine, followed by Sabin oral vaccine, began the long road towards conquering polio worldwide.

Photo by Martyn E. Jones from FreeImages

According to hieroglyphics and papyruses, bilharzia was known to the Ancient Egyptians. The flatworms that cause the disease are water-borne, with a complicated life cycle that involves freshwater snails as an intermediate host. Bilharzia causes a heavy burden of ill-health, especially for rural children who paddle (and piddle) in the Nile or in one of the many canals. And yet, despite the toll on the population, many people living a comfortable life in Alexandria or Cairo 50 years ago had barely heard of it. The best remedy is prevention with clean water and good hygiene, so the story continues.

***

Although my forthcoming novel The Girls from Alexandria isn’t a book about medicine, you’ll find many aspects of a cosmopolitan world that has long since ceased to exist.

The Most Disgusting Diseases in the World (and How to Catch Them) – part 2

Posted in Modern life, Pills by

Following on from part one, and in the same vein for which Punch magazine was known, I bring you four more of the most disgusting diseases in the world.

I had to include acromegaly as the insistence of my son whose interest in endocrinology began at the tender age of four when we were on holiday in Switzerland and happened on a particularly florid case of the condition. By then, the diagnosis could have been made from a cable car 50 metres away (which it was).

“Mummy, why are that man’s hands so big? And why has he got pillows instead of shoes?” He pointed, I told him not to, and so on, until I noticed the man in question who really was sporting pillows strapped to his feet.

I explained about the pituitary gland and growth hormone, and my youngster thereafter abandoned Postman Pat books in favour of the British Medical Journal.

However florid acromegaly may become, the onset is invariably subtle, with coarse skin, greasy hair, an increase in hat size, a little deepening of the yodel, and difficulty making watches or doing up lederhosen. To avoid resembling our Alpine acquaintance, it’s best to seek help while you can still fit into your ski boots.

Even pillows may not be roomy enough if you’re infected with wuchereria bancrofti. Everyone seems to have heard of elephantiasis but there are two important things to note: you don’t catch it from elephants, and it usually begins with just a few enlarged lymph glands on the groin. Walking is therefore still possible, for a while. Swelling sets in later, often only in one leg, and sometimes in the scrotum too, should you possess one.

Eventually the skin develops rough folds and warty outgrowths, and the scrotum, if affected, can hang down to the knees, which poses problems at the tailor’s, and elsewhere. Prevention is key. Use a mosquito net, and avoid falling into Burmese septic tanks if you want to wear both legs of your trousers at the same time.

If you dislike rodents, you’ll hate Lassa fever. Transmitted by rats, it was discovered in the Nigerian village of the same name, which you might like to make a note to avoid on your travels.

After it was first described in 1969, the department of health send circulars so that no GP would miss this diagnosis.  As the years passed, I never saw a case, but the bumph was useful for wobbly dining tables.

Lassa has an insidious onset with symptoms that resemble other conditions, like fever, malaise, a flushed face, red eyes, nausea, and vomiting. Later, the nose, gums, mouth, stomach, and lungs bleed spontaneously – a plague of blood, with a high mortality rate. As I recall, Lassa is similar to other haemorrhagic fevers such as Marburg-Ebola, Green Monkey Disease, and Crimean-haemorrhagic-Congo-Hazara fever, though I’d have to check under the dining table to be sure.

Anyone who’s unconscious when arriving by plane from West Africa runs the risk of his drunken state being mistaken for Lassa fever, with the result that masked attendants whisk him off to a plastic tent in the nearest isolation unit until the tests are back. I need hardly add that the outlook is far worse when Lassa fever is mistaken for excess alcohol.

Next up is typhus, not to be confused with typhoid. Typhus is caused by germs called rickettsiae which breed in the gut of the louse, and spread to humans via louse faeces. Louse bites are itchy, and scratching them rubs infected droppings into the skin.

Weakness is one of the early symptoms, and it all goes downhill from there, eventually, if untreated, leading to multiple organ failure.

As alarming as typhus is, Tsutsugamushi fever (aka scrub typhus) is much more popular with medical students, because it has so many syllables and because it forms a painless but picturesque ulcer covered with a crust. More importantly, unlike other forms of typhus, an attack of Tsutsugamushi gives no immunity against further infection. Medics can therefore imagine repeated episodes of scrub typhus at each outbreak of acne, and some of them have been known to scratch for years after exposure to a single lecture.

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them): head, shoulders, knees, and toes.

You may also like to catch up on The Most Disgusting Diseases part one.

The Most Disgusting Diseases in the World (and How to Catch Them) – part 1

Posted in Modern life, Pills by

Putting my decades of medical practice to use, I bring you the chance to brush up on all the gruesome diseases you don’t remember, especially if they’re ones you never knew about in the first place.

It’s tongue in cheek, but, if you’re squeamish or easily offended, you may prefer a blog about macramé instead.

Feeling out of sorts lately? If friends think you look tired, colleagues call you burnt out, and Great-Aunt Frieda reckons you need a tonic, better check out your appearance in the bathroom mirror. Are your fancy new glasses slipping down your nose? If so, either you’ve been too busy to pop into Specsavers to get them adjusted, or that jaunt to South America didn’t agree with you.

You may have got New World Leishmaniasis. Don’t let the name fool you. It’s as old as the hills, and it’s still a neglected disease. The parasite finds a sandfly to hang out in, until the sandfly finds you. Within 18 months or so, the bridge of the nose collapses. Leishmaniasis also destroys the mouth and tongue, so that bottle of Gevrey-Chambertin you’ve been saving tastes just like British sherry. Soon, however, you will no longer care.

The cause of all the trouble is the innocent-looking leishmania parasite with a cute little tail. Rather like a spermatozoon, actually. But, unlike pregnancy, leishmaniasis can be avoided by simple measures such as sleeping on the roof. Sandflies can’t fly much higher than three metres. 

What could be worse than leishmaniasis, apart from income tax, baldness, and wheel clamps? It’s the infection so dreadful that doctors often refer to it as Hansen’s disease to avoid inducing panic in the waiting room. The condition starts with a bit of catarrh then progresses to muscle pains, enlarged lymph nodes, and sometimes a patchy rash.  If you’re any kind of hypochondriac at all, you’ll suspect from the very first sneeze that this is leprosy.

Soon you lose a little pigmentation, then a few fingers because they’re numb and you chop them up with the celery. By the time leprosy bacilli gets into their stride, the face is covered in boils and bumps, and friends are apt to be too busy to see you. There may be other complications including inflamed testicles and a spleen the consistency of sago. But enough. More details might be in poor taste.

Leprosy is highly infectious. Or else it isn’t. The experts don’t all agree. If your doctor rushed out of the consulting room, you’ll know which school of thought she favours. One study showed that the only sure way of contracting leprosy is to share a bed for twelve years with a leprosy patient. So there’s really no need to avoid waiting rooms, though you might want to steer clear of lactating ladies with leprosy because they shed the bacilli like there’s no tomorrow.

Actually, there is a tomorrow because leprosy is curable. Too bad that treating an entire village for a month costs nearly as much as a good lunch for four, not including service. 

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them), I’ll be talking about conditions affecting hands, feet, and other members.

My earlier version of this series originally appeared in Punch, an iconic magazine that eventually succumbed to circulation problems.

A Family Doctor’s Casebook (part 1)

Posted in London, Pills by

General practice partnerships are like marriage without the sex, muses Geoff as he installs himself at his consulting room desk.  He knows that kind of marriage. Shoving aside the piles of letters that need answering, he begins tending to the sick of North London.

Geoff is a GP from my novels One Night at the Jacaranda and Hampstead Fever.  Despite his problems and hang-ups, he’s everyone’s favourite. Geoff is a firm believer in the NHS, but the changes he’s seen in the 15 years since he qualified frustrate him immensely.

1 The first patient is a three-month old baby with the Lexus of pushchairs and a Yummy Mummy who reminds Geoff of his ex-wife.  She begins by complaining about the 20-minute wait, and the perennial parking problems within a mile of the health centre. All this is extremely inconvenient as she’ll now be late for her Pilates.

Geoff asks what he can do for her.

“It’s Alistair’s head,” she throws down like a gauntlet.

She’s right in thinking her baby’s skull is a tad asymmetrical. Plagiocephaly is common now that babies all sleep on their backs.  Geoff reassures her that it’ll right itself in time, once Alistair lifts his head and becomes more mobile.

FreeImages.com/Johan Graterol POSED BY MODEL

Yummy Mummy is sceptical. “Doesn’t he need one of those special helmets?”

Geoff explains that there’s no evidence they help.

The mother seems unconvinced. She’ll probably go and splash out thousands of pounds on a contraption that will only cause discomfort and inconvenient. Still, she’s now ready to move on to the next symptom. The practice has a new policy of one symptom per consultation, which Geoff routinely ignores. It’s demeaning to patients and wastes everyone’s time in the end.

The rash on Alistair’s buttocks looks like a common yeast infection which should soon respond to the cream Geoff recommends. This pleases the mother, until Geoff asks her not to leave Alistair’s dirty nappy in his consulting room bin.

“I don’t want to stink out the car,” says Yummy Mummy.

Geoff eventually persuades her to take the offending object away, even though he thinks she’s likely to dump it in the waiting room on her way out.

2 Next it’s Mr Legg in his nineties, with an aching left knee. Sometimes it’s his right knee, and sometimes it’s both, which is no wonder since both legs are badly deformed by arthritis. He attends the health centre every couple of weeks, yet refuses hospital treatment. As he puts it, “I don’t want to be a bother. There’s plenty of younger folks who need it more.” Mr Legg adds that he doubts it’s arthritis anyway.  “It’s probably just down to the shrapnel what got me during the war.”

Geoff asks where the shrapnel got him.

“In a little village near Germany, Doctor.”

doctor's bag

3 It’s a relief to see that young Mohammed’s eczema is improving. For a long while, his mother believed that a mild steroid was totally unsuitable for a three-year old, but the cream, along with emollients, has made a huge difference. Mohammed sleeps well now that he doesn’t scratch himself to ribbons. All in all, he’s a happy chappy, apart from a streaming cold that’s not a problem until he flings himself at Geoff and plonks a kiss on his cheek.

Geoff usually washes his hands between consultations. Today he washes his face as well.

FreeImages.com/Toni Mihailov

 

4 Now a young man sits before him. Unemployed, with a squat nose and tats up one arm. “Pain in me bollocks,” he says.

Might be a torsion. Uncommon in adults, Geoff knows, but, unless treated promptly, it can lead to gangrene of the testicle.

“Right. I need to take a look,” Geoff says, pulling the paper curtains across.

As he waits for the fellow to undress, he wipes the photo on his desk with a tissue. It’s Davey, aged four, at the beach in Norfolk. Happy days before the divorce.

“Ready yet?” Geoff calls out, increasingly aware of how late his clinic is running.

“Yeah. Course.”

Turns out the man is sitting fully clothed the other side of the drapes.

Patiently, Geoff explains what he needs to examine. Another three minutes pass while the man undresses.

On examination there’s nothing abnormal about the patient’s tackle, apart from the stink. Geoff peels off his gloves and flings them in the bin. “Hmm. All’s well there. When did you first get the pain?”

The man shrugs. “Maybe a week ago. But I ain’t got it no more, like. Not since I pulled that bird the other day.”

“Fair enough,” says Geoff, even though there’s nothing fair about it. The ugly, unemployed fucker gets laid just like that, while he, Geoff, has been celibate for ten months and counting.

***

Coming up soon, Geoff deals with a very personal problem. Meanwhile you may enjoy one of these posts:

How to Alienate Your Doctor in Ten Easy Steps

What Your Doctor is Really Saying

or, on a more serious note, an overview of sepsis in The Disease Nobody Knows About Until It’s Too Late.

Rebel with a Cause

Posted in Pills, Places, Writing by

Poetry and medicine intersect in Jane Davis’s latest novel, My Counterfeit Self. I’m delighted to welcome Jane back to my blog on publication day.

JDV-MCS2016-Clays-02

The main protagonist is Lucy Forrester, a political poet and activist. Anti-establishment all her life, she’s now horrified to find herself on the New Year’s Honours list. Her inclination is to turn it down. But what if it’s an opportunity…

When researching a cause for her rebel, author Jane Davis followed a thread from the first CND march from Trafalgar Square to Aldermaston, to the plight of Britain’s forgotten Atomic Veterans. Here is what she discovered.

“It is 1958, six years after American scientists disbanded the Atomic Bomb Casualty Commission in Hiroshima, having completed their data-gathering on radiation sickness. It is a supposed time of peace. Imagine you are eighteen years old, shipped to Christmas Island on National Service. It is the furthest you have ever strayed from home.

Your job? To stand on an idyllic white sandy beach and observe as scientists detonate nuclear bombs in the Central Pacific. When the signal is given, you must turn away from the blast and cover your eyes with your hands. There is no protective clothing. As the flash goes off, you can see your veins, your skin tissue, your bones, and through it all, diamond white, a second sun. Searing heat builds inside, until you imagine that there is only one way it can end.

Around 22,000 servicemen were ordered to stand and observe. Some suffered radiation sickness immediately, and some died. For others, symptoms followed patterns seen in Hiroshima. They lost their appetites, ran high fevers, and their hair fell out in clumps. Some appeared well for decades before developing cancers and other rare diseases.

It was only over time, as dots were joined, that some veterans became convinced their illnesses and disabilities were caused by nuclear radiation. Their bid to be recognised by the European Court of Human Rights was denied in 1998, which said it had no jurisdiction in the case. Largely ignored, and dwindling in number, the veterans referred to themselves as ‘ghosts’.

Then, in 1999, researcher Sue Rabbitt Roff at the University of Dundee tracked down and surveyed 2,500 veterans and their children, reporting unusually high rates of infertility and birth defects. This was the trigger. The columnist Richard Stott (1943 – 2007) of the Sunday Mirror then launched his Justice for Nuke Vets campaign.

If I saw this reported in the news, I’m ashamed to say that I have no recollection of it. There were always more attention-grabbing headlines. But when researching my novel, it was obvious to me that this is a cause Lucy Forrester would have thrown herself behind.

The British government continued to insist on more proof. It wasn’t until 2007 that two scientific studies demonstrated clear links. They also estimated that genetic birth defects would last for 20 generations – in other words, 500 years.

As a result, 700 New Zealand and UK veterans launched a class action lawsuit against the British government claiming NZ $36 million in damages. But it had all happened 50 years ago. The Ministry of Defence countered with a statute of limitations defence.

Following a parliamentary inquiry in early 2008, the government agreed to fund new studies into veterans’ health, and to pay interim compensation of £4,000 each.

By the time I completed my research, the government had set aside £25million (£5million a year over five years) for an Aged Veterans’ Fund. But this wasn’t only for the surviving Atomic Veterans. Approximately two million veterans were qualified to apply. In addition to applications from individuals, the British Veterans’ Association (BNTVA), the premier charity representing those who have worked alongside radioactive material for the benefit of the nation, can apply for funding for projects such as respite care or counselling. Whilst any such services may benefit the families of the Atomic Veterans, once the remaining veterans die, all funding will cease. Without an admission of negligence from the MoD, there will be no help for the 20 generations.

Many Atomic Veterans are proud to have served their country. However, given that the risks of exposure to radiation were either known or reasonably foreseeable, they had every right to expect their government to take care of them if things went wrong. They couldn’t have imagined that the British government would introduce a higher burden of proof than other governments, so that their American counterparts received compensation while they did not. It should not be left to the Prime Minister of Fiji to step in and award each surviving veteran three thousand pounds, saying, ‘Fiji is not prepared to wait for Britain to do the right thing’.

With Trident firmly back in the headlines, I hope that it will rise to the surface once more.”

You can find out more about the Atomic Veterans or make a donation here. 

jane-facebook-profile

Jane Davis is the author of seven novels. Her debut, Half-truths and White Lies, won the Daily Mail First Novel Award, and The Bookseller featured her in their ‘One to Watch’ section. Six further novels have earned her a loyal fan base and wide-spread praise. Her 2016 novel, An Unknown Woman, won Writing Magazine’s Self-Published Book of the Year Award. Compulsion Reads describe her as ‘a phenomenal writer whose ability to create well-rounded characters that are easy to relate to feels effortless.’ Her favourite description of fiction is ‘made-up truth’.

When Jane is not writing, you may spot her disappearing up the side of a mountain with a camera in hand.

You can also find Jane Davis on Facebook, on Twitter, on Google Plus, on Pinterest, and on Goodreads, as well as on her Amazon author page. 

Anyone who signs up to Jane’s newsletter receives a free copy of her novel, I Stopped Time. Jane promises not to bombard subscribers with junk. She only issues a newsletter when she has something genuinely newsworthy to report.

My Counterfeit Self is published October 1, 2016, and available in paperback and ebook formats.

jd-red-tbw

 

 

What They Don’t Teach at Medical School

Posted in Family life, Pills by

Today GP Geoff gets a new group of medical students to teach. The names may change from week to week, but there’s always at least one swot from Germany or the Far East, a home-grown rugger bugger who is too big for his chair, a student in a hijab, a gay man, a babe who fiddles constantly with her iPhone, and an argumentative leftie.

HP Rapaport Sprague stethoscope, circa 1981

Geoff is a character from my novel One Night at the Jacaranda.  I made him up, but, if you know much about medicine, he seems real enough.

Education is not a vessel to be filled, Geoff muses, but a fire to be lit.  He has forgotten who said, it, but he’s pretty sure the fire should stay lit for the whole of their careers. So the students need a dose of reality.

fire in the political belly

Geoff reflects on his fifteen years of practice. The reality is that patients wangle sick notes because they don’t like their work. They get prescriptions for things they could have bought from the chemist. Well, par for the course.

They also suck you into their lives and dump their shit.  So you get involved when they tell you about their affairs that went wrong, the drugs they score on a Friday night, or how much they hate a sister or brother.

Or when they’re still driving even though they shouldn’t be.

FreeImages.com/Juan Miguel Rodriguez

Case in point: nice Mrs Thingy. Geoff is not too hot good on names, but he knows he advised her very clearly not to drive until her seizures were under control.

The snag is her three children. Geoff instantly forgets what she says her husband does, but he gets the gist. Mr Thingy has to get to Ealing Broadway station by 7am so he can’t do the school run.

“Can you walk them to school instead?” asks Geoff, ready to extol the benefits of blue skies, fresh air, exercise, autumn leaves, and the rest.

suburban street

“Doctor,” she says in a wheedling tone, “if I did that, it’d be a mile and half each way just for the boys. And Poppy is at a different school. There’s just no time. I’d run myself ragged, and that’s not good for my seizures.”

“Perhaps a neighbour can help?” suggests Geoff.

She gives a pitying look. “They’re all pensioners near us.”

“What about asking at the school? You may find a parent of a child in another class who lives near enough to you.”  Geoff is aware he’s running late now.

FreeImages.com/Vikki Hansen

“Well, I don’t know,” says Mrs Thingy.

“Why don’t you talk to the school secretary?” Geoff suggests. He may even need to involve Mr Thingy, find out if he can start work later during term-time. This is as far as one could possibly get from looking through the test results and reminding her about her smear. Geoff makes a mental note to do all this later.

Mrs T says nothing. She stares as if the GP is the baddie who makes up the laws.

Geoff continues, “If you have a seizure at the wheel… Well. It hardly bears thinking about.  Remember the Glasgow bin lorry crash last year? The driver blacked out at the wheel and killed six people.” 

“I know, I know.”  Her glance at the door shows she’d like to end the conversation as soon as possible.

Geoff leans back in the chair, which isn’t far as he has a cheaper model than his partners. “You realize, don’t you, that I’m obligated to contact the DVLA myself if you don’t.”  (For readers outside the UK, this is the Driver and Vehicle Licensing Agency.)

Her expression freezes.  “But I thought confidentiality…”

“Doesn’t extend to situations where the public is in danger.” He shakes his head slowly as he pulls a sympathetic face.

“Oh,” she says in a small voice. “Right.”

Geoff knows what he will discuss with his students today. Confidentiality.

And the knack patients have of sucking you into their lives.

***

Easy tweet: “What They Don’t Teach at Medical School http://wp.me/p3uiuG-14k via @DrCarolCooper” #medicine #students

What Happens When You Become a Doctor

Posted in Pills by

Any day now and it’ll be the Killing Season, so-called. August 1 is the date when a fresh crop of newbie doctors arrives on hospital wards, bursting with enthusiasm and theoretical knowledge but woefully lacking in experience.

Jeremy's scalpel

In fact August is no longer worthy of that macabre tag. The month now begins with a sensible induction process for newly qualified doctors, with proper training in the tasks and procedures they’ll need to do in the coming months. Gone are the days of ‘See one, do one, teach one.’ The Killing Season is well and truly dead. Induction is a recent trend. I will never forget the utter panic on my first day as a doctor as I crept around in squeaky new shoes trying not to look like the rawest recruit. It was a Sunday—was there ever a more stupid day to start work?—and a patient had the misfortune of dying within 45 minutes of my arrival at the hospital. Now don’t jump to conclusions. I hadn’t even seen her before she died.

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

Wet behind the ears, I had no idea of the procedure to follow. Even scarier was the realization that I had two whole wards full of people to keep alive as long as possible. I rushed round to say hello to them all and check they were still breathing. At the same time, I said goodbye to many things: sleep, leisurely weekends, sitting on the loo without being bleeped. In short, to normal life. iv nutrition

While a lot has changed since then, including working hours, some things haven’t, as I realized from a recent blog post by Salma Aslam (by which I mean Dr Salma Aslam) Transitional state: med student to doctor.  It all came back to me. When you graduate from medical school, you may get a number of different reactions. 1 “Well done, but don’t go round thinking you know it all.” Don’t worry, I didn’t. And still don’t. 2 “So what?” That’s what I got from a group of arts students sitting around in the bar. They acted like they couldn’t care less about my news, but they were probably envious. 3 “Can you have a look at my verruca?”

plantar warts

Count yourself lucky. It’s much worse to be subjected to the long saga, in multiple episodes, of their entire medical history. This is when you get envious of those jobless arts graduates. 4 “The only thing that works for my migraines/arthritis/autism is kinesiology/homeopathy/acupuncture.” The implication is that allopathic medicine does nothing. Well, I’ll keep an open mind about that, only not so open that my brain falls out.

tablets

5 “You should get a job as a medical adviser on Casualty or something.” Yeah, right. Like nobody else with more experience wants to do it. 6 Perhaps the weirdest reaction was from my mother, who insisted I should now call her Dr Cooper. Why? “Because my daughter is a doctor, it’s like I’m the doctor. You may congratulate me now.” Get used to all of it. It may be a while before you hear the most welcome response of all: “Thanks, doc. I feel a lot better.”

medical bag

Easy tweet: What happens when you become a #doctor? http://wp.me/p3uiuG-12N via @DrCarolCooper #medicine

Some of my Favourite People are Books (part two)

Posted in Writing by

It’s usual for a list of great novels to include

  • an inscrutable foreign masterpiece from the present-day
  • one Jane Austen title (choice depends on intellectual criteria, such as which film hero was most fanciable)
  • an angst novel (Philip Roth often fits the bill)
  • To Kill a Mockingbird
  • Catch-22
  • and *drum roll* Anna Karenina.

bookshelf

Maybe you’re waiting with bated breath for Rosamund Bartlett’s new translation? Her Anna Karenina, due to be published in August, is already ranked about two millionth on Amazon (how does that happen? Tolstoy pulling rank again?).

Sorry to disappoint, but my choice of Russian blockbuster is by Boris Pasternak. When I first read it, I was neither a medic nor a writer, whereas Yuri Zhivago was both.

It snowed and snowed, the whole world over,

Snow swept the world from end to end.

A candle burned on the table;

A candle burned.

I loved Doctor Zhivago for its action, its setting, its characters, its lyricism (and Omar Sharif). I even studied Russian and tried to write poetry. Then I figured out the real lesson: to avoid becoming as self-absorbed as Pasternak’s hero. Also, not to turn into a bloke, especially not one with a frosted tache and a balalaika.

Dr Zhivago

Catch-22 may not be on this list, but I treasure another novel that gave rise to a very current phrase. Yes, the past is a foreign country in L P Hartley’s The Go-Between. Twelve-year old Leo figures out the facts of life. He also figures he’s being used.

“Well,” he said, “let’s make a bargain. I’ll tell you all about spooning, but on one condition.”

I knew what he was going to say, but for form’s sake I asked: “What is it?”

“That you’ll go on being our postman.”

While the lad was naïve by today’s standards, the book is still fresh for 1953 and nicely captures Leo’s post-traumatic stress. By comparison The Shrimp and the Anemone is rather dull. Which is to say that I don’t recall any spooning.

My choice of modern foreign masterpiece is the perfectly scrutable The Yacoubian Building. If you haven’t read it, it’s a lively ensemble novel peopled by a doorman, his family, a gay newspaper editor, Islamists, and the other motley inhabitants of the building on Suleiman Basha Street. Here’s a passage about the womanizing aristo Zaki Bey.

From Lady Kamla (she of the inexorable appetite) he learned how to start and when to desist and how to ask for the most abandoned sexual positions in extremely refined French. Zaki Bey has also slept with women of all classes – oriental dancers, foreigners, society ladies and the wives of the eminent and distinguished, university and secondary school students, even fallen women, peasant women, and housemaids. Every one had her special flavor, and he would often laughingly compare the bedding of Lady Kamla with its rules of protocol and that of the beggar woman he picked up one night when drunk in his Buick and took back to his apartment in Baehler Passage, and who he discovered, when he went into the bathroom with her to wash her body himself, to be so poor that she made her underwear out of empty cement sacks. *

The story may seem a bit ‘told’ for some, but that’s probably the nature of Arabic literature. The book has special resonance for me as I’ve lived in Cairo, although Al-Aswany doesn’t describe anything as atmospheric as my first terrifying day at school when I screamed so much that I threw up onto the teacher’s shoes.

For a tale that moves at breakneck speed and grips like a novice on a rearing stallion, look no further than Dick Francis. Low-brow? Maybe. Formulaic? Sometimes. But brilliant all the same, right from the off. This is from For Kicks.

The Earl of October drove into my life in a pale blue Holden that had seen better days, and danger and death tagged along for the ride.

I’m not the only fan of his opening style. Here’s what writer and blogger Emma Darwin has to say in Straight proof: what any of us can learn from Dick Francis.

Dick Francis

After brooding Russians, a traumatized adolescence, Egyptian neighbours and skulduggery in the stables, what could I possibly have left out? Chick-lit, that’s what. If you’ve read Me Before You by JoJo Moyes, you’ll know that Will has a life-changing motorbike crash.

“So, Patrick,” Will said, perhaps sensing my discomfort. “Louisa tells me you’re a personal trainer. What does that involve?”

I so wished he hadn’t asked. Patrick launched into his sales spiel, all about personal motivation and how a fit body made for a healthy mind. Then he segued into his training schedule for the Xtreme Viking – the temperature of the North Sea, the body fat ratios needed for marathon running, the best times in each discipline. I normally tuned out at this point, but all I could think of now, with Will beside me, was how inappropriate it was.

 What have all these books got in common?

A cracking story. Lots of conflict. Great dialogue. Wit, of course. I’m pretty sure there’s something else too, but it’s hard to analyse when you’re in awe so I’m damned if I know. Ask me again when I’ve got more of my own books onto other people’s shelves of favourites.

 

 *I had to correct the grammar in the English translation by Humphrey Davies. Sloppy editing, HarperCollins.

 

 

 

 

LEARNING TO BE SICK IN WASHINGTON, DC

Posted in Family life, Pills by

When my mother went to live in Washington, DC, in the 1960s, she discovered that being ill there was not like being ill in her home town of Alexandria, Egypt, where everyone fussed over her and soon made her feel better.  Here’s one of her stories.

“When will Dr Smarts be able to come and see me?” I asked the receptionist who’d answered the phone.  His name had been given to me by a friend.

The receptionist laughed. “Come and see you?”

“I have a sore throat and a temperature, my nose is stuffed up, and I can’t taste food.”

“I have a cancellation for 3pm tomorrow. Take two aspirins, drink plenty of fluids, and we’ll see you then.”

“Doesn’t Dr Smarts make house calls?”

“Not unless you’re in your 80s.  Even then, he prefers to see patients in the hospital.”

Hospital? I shuddered.

I called the school where I taught to say I was ill and wouldn’t be in. The secretary was understanding.  “There’s a virus going round.  Drink plenty of fluids.”  What was a virus? No Alexandrian had ever mentioned the word ‘virus’.

It was a miserable day spent alone.  My friends were either at work or otherwise engaged.  The only visitor I had all day was the building engineer who came to check the air conditioning.

Polish TV

But there was American TV, to which I had quickly become addicted. Alas, the early afternoon movie was an old one, Suez, and it made me homesick for Egypt.  When I saw all that sand and all those familiar persistent flies, I burst into tears.

Where was Nagibeh, our old housekeeper, to sit in my room till I fell asleep, and my little sister’s nanny, the fat Dia with her rosary and fervent prayers? Where was my mother to read me stories? Where was the kind Greek doctor who puffed his way up the stairs and who made me feel better even as he blew smoke rings into my face?

The following morning my temperature was up.  Although it was a warm September day, I was shivery.  I wrapped up as for a polar expedition and walked the one block to Dr Smarts’ office.  How extraordinary that he did not make house calls, and me so nearby too.

Dr Smarts was unimpressed with my symptoms. So I coughed over him and exaggerated my aches and pains. I did such a good job that he decided to run some tests.  He also wanted to know the medical history of every member of my family.  He was beginning to get on my nerves.  All I probably had was a bad case of la grippe, which some nasty-tasting medicine would cure in no time.  And here he was asking me about my family.

Sick as I was, I gave him a colourful account of being ill in Egypt.  Egypt? He wasn’t quite sure where it was. I even told him about the time I was so sick with indigestion, Father called the doctor in the middle of the night. I’d eaten a whole kilo of sudanis, delicious peanuts bought off a street vendor, and had thrown up 10 times.  Nagibeh had cleaned the carpet with savon de Marseille.  Dr Smarts had never heard of savon de Marseille.  His general knowledge was pitiful.

“Couldn’t you have just put the carpet in the washing machine?”

To give him credit, Dr Smarts was a good listener and jotted down everything I said.  No doctor I knew ever wrote anything except prescriptions.

“What do you normally eat during the day?” he asked.

“I have an English breakfast: eggs, bacon, toast, coffee.”

“Lunch?”

“Well, first there’s elevenses.”

“What’s elevenses?”

Ignoramus, I thought.  “It’s a mid-morning snack” I explained patiently. “I have hot cocoa and biscuits.”

“How many biscuits?”

“In our culture it’s considered rude to count what one eats.  However, if they’re chocolate, most of the box.”

“Lunch?”

“Where I teach, lunch is usually cold cuts and salad.  I’m not fond of lettuce.  I’m not a rabbit. But at 3pm before I pick my daughter up from her school, I have a chili hot dog at People’s Drug Store.  My main meal is dinner: chicken or meat, potatoes, spinach, a banana. No dessert. But sometimes before bed I have a tuna sandwich with mayonnaise.”

The doctor put his pen down and looked at me. “It’s a wonder you’re not the size of a house.”

“I ate much more in Alexandria” I replied hotly.  “My father and grandmother ate like horses, and weren’t fat at all. My mother hardly ate a thing and was always ill.”  Dr Smarts looked shaken.

“You know, Dr Smarts, in Alexandria they say ‘Eat, eat, bil hana wal shifa.’  That means with pleasure and good health.  We also say ‘Bon appetit.’ And doctors all make house calls.”

“We used to make house calls too.” He sounded wistful.  “Anyway, you’ll be fine.”

“What about a prescription?”

“Just drink plenty of fluids and take aspirin.”

I bundled up again under the amused eye of the receptionist.

As I walked home, I thought of what I’d write for La Reforme Illustrée, our friendly Alexandria Sunday paper. No house calls, no prescription, counting biscuits! How uncivilised.

I resolved never to be sick in Washington, DC, and you know what?  I never was.

© Jacqueline Cooper

More Certain Than Taxes, and More Painful

Posted in Family life, Pills by

In a few days I’ll be at a Cambridge University event, speaking to students who look forward to careers in the media.  But today I’m looking back at a serious topic.  My piece last month in The Sun newspaper went a bit like this…

Life is complicated, but dying is even more so.

As a doctor I’ve seen many patients whose lives are utter misery.  They’ve reached a stage where nothing can relieve their suffering and make their days bearable.   Some of them beg for death.  But assisting a suicide is against the law in England and carries a sentence of up to 14 years.

If it were the beloved family pet, the answer would be clear and compassionate.

It’s heart-breaking to have a relative who longs to die, and I really feel for the families, especially as my own mother is now suffering horribly. 

My mum’s spine is deformed and broken from severe osteoporosis.  She howls in pain, and in anticipation of pain before even being touched.  She’s incapable of doing anything now.  Every single thing the devoted team of nurses do for her hurts acutely. 

Sometimes she lies in bed yelling that she’s in agony. Or else she shouts over and over “Please help me, please help me.” Mum and me crop

No longer the person she was, she weighs 35kg and stares with blank eyes.  Everything she has been through in the past two years, including a major op that she nearly didn’t survive, has left its mark.  The pain is literally causing her mind to go, but she is still aware of how bad things are.  I sit by her hospital bed and hold her hand, and she sometimes tells me she wants to die.

Increasing the painkillers makes her more confused.  Some of the drugs make her paranoid.  I’m still hoping there’s an answer because it’s so awful to watch her suffer.

Don’t get me wrong.  I was never immune to the suffering of patients in situations like this, but when it’s one of your own you can appreciate the back-story and see the whole perspective of their lives.

Medicine has a lot to answer for.  Many people wouldn’t be alive had it not been for doctors.  On the other hand, medicine isn’t a perfect science and never will be.   I’ve been a doctor long enough to know at first hand that medicine is good at prolonging life, but not so good at sustaining its quality.   

When quality of life is appalling, or treatment too awful to bear, then the balance of pros and cons may suggest that treatment doesn’t benefit the patient.  In making that decision to withhold treatment, the relatives and patient’s wishes are vital.  If the patient can’t take part in the discussion, his previously stated wishes are taken into account.

Withholding treatment is totally different from deliberately hastening death, whether or not it’s with the patient’s consent.    

But there is what’s called the doctrine of double effect.  This makes a distinction between acting with the intention to kill, and performing an act where death is an unintended effect.

For instance large doses of pain-killers can shorten life.  But doctors give them only with the intention of relieving pain. The doctrine of double effect says that’s morally right, even though the primary effect (pain relief) comes with the risk of a harmful side-effect.  Sometimes that harm can even be foreseen, but according to the doctrine it is still OK, as it achieves the main benefit, which is relieving pain.

However the double effect isn’t often the get-out clause it appears to be.  Nowadays there is a huge range of pain-relieving drugs, and dosage changes tend to be tiny, so they rarely shorten life.

Medicine has come so far now that we need an urgent way forward on that most basic event, death.  Not all doctors are agreed on the right course of action.  If assisted dying is introduced in any form, we’d need strict safeguards against abuse, greed, negligence, incompetence, and probably a few other things as well.

Some doctors are vehemently opposed.  Personally I fear that legalising assisted suicide could change the doctor-patient relationship forever.  On the other hand, there’s also the hope that it would help medics honour Hippocrates’ order: “To cure sometimes, to relieve often, to comfort always.”

Since then, my mother has died, ending our suffering, though it continues for other families.