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

A Parent Worries Forever

Seen that touching Lloyds Bank photo where the mother is hugging her ‘baby’ before he nonchalantly sets off for university? I can’t reproduce the image here, but you can check it out by clicking on Lloyds Bank.  I showed it to some of my friends, who variously remarked on the mother’s height relative to her son, the blissful smile on her face, and the flimsiness of rucksack on the son’s back. 

Those with children noticed none of these things. Their reaction was just terror.

When expecting your first child, there’s usually a golden moment during which you’re thrilled at the prospect of having a baby but haven’t yet realised you’re heading for a lifetime of worry. Well, savour it while you can.

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My twin boys arrived when I had one son already. In a flash, my anxiety levels trebled. The children seemed intent on working their way through the alphabet, with accidents, asthma, appendicitis, and (scariest of all) anaphylactic shock.

Some letters stand out more than others. D was for Duplo, a normally safe toy, except when you stumble face first into it. G was for golf club, as when eldest son was smacked in the face by a 5 iron at the school fete, necessitating yet another tip to A&E.

FreeImages.com/Aron Kremer

Occasional false alarms brought light relief. At eighteen months, one son was on the bus, sitting forward in his eagerness to miss nothing. When the driver braked suddenly, my son’s face collided with a metal handrail. He screamed, and bright red stuff poured copiously from his mouth. I laughed hysterically when I found he’d only been chewing on a red crayon.

FreeImages.com/Trisha Shears

In my novel Hampstead Fever, I couldn’t resist including a super-anxious new mum. It’s not just the prospect of mishaps that cranks up her worry levels. She has studied the parenting books, so she’s aware of potentially lethal conditions like sepsis, where symptoms can be minimal in the early stages yet take a child to death’s door within hours. Like many parents, Laure suspects it’s dangerous to let her guard down, because that’s when things are most likely to go wrong.

Worry can drive mums (and dads) to become over-protective, turning into helicopter parents and doing for their children things that they should be learning to do for themselves.

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For some parents, anxiety becomes hard-wired. I’ve seen them make idiots of themselves as they continue to stalk their kids on social media throughout their teens and even twenties, panicking if they haven’t posted anything in the last few hours.  

Not me, of course. I’ve finally learned to ditch unnecessary anxiety about my offspring. I’ll tell you how I did this. Not this minute, though, because first I need to text my sons to see how they’re doing without me.

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Rebel with a Cause

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.

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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.

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How to Write a Book Review

For starters, what tempts people to review books at all? If it’s for a prestigious magazine or newspaper, it could be money, though rookie reviewers are often happy to review in return for a free book and a chance to raise their profile.

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It can also be a chance to preen, to get in as many bon mots as possible, and to dazzle readers with a vertiginous vocabulary. If there’s room to slip in a lethal knife wound as well, so much the better. Will Self’s review of Julie Burchill’s Unchosen is often quoted as the epitome of this type of review:

“I can’t really dignify her latest offering with the ascription ‘book’, nor the contents therein as ‘writing’ – rather they are sophomoric, hammy effusions, wrongheaded, rancorous and pathetically self-aggrandising.”

He goes on to cite “Burchill’s repugnant gallimaufry of insults and half-baked nonsense.”

One snag is that it wasn’t a review as such. Still, it’s pugnacious stuff, and entertaining to read. Unless, perhaps, you are Julie Burchill.

Accusations are the stock-in-trade of many reviewers. In The Scotsman, Allan Massie says of Craig Raine’s oeuvre The Divine Comedy: 

“It isn’t a novel, no matter what author and publisher choose to call it. There is no real narrative interest and the characters are no more than names.” 

He goes on to give evidence for his view, leaving the public in little doubt that Allan Massie is a more riveting read than the book being dissected.

FreeImages.com/Davide Farabegoli

For a short while there was even the Hatchet Job of the Year Award. But several things have happened since then. Firstly, jokes about hatchets are a bit tasteless in a troubled world. Secondly, there are now more reviews on blogs and book review sites, far more than you’ll find in mainstream publications.

Online reviews like these are more workaday, and may serve their purpose better than the virtuoso variety. old-books1

Reviews just have two main tasks: guiding potential readers to their next book, and helping authors write what readers love most.

More readers could leave reviews, but I know that many feel inhibited from doing so. Yet the rules, such as they are, are pretty simple.

1 Short is OK, though preferably not as short as the one-word review “Book”.

2 Never include spoilers.

3 You don’t have to be a smarty-pants. In fact, it probably detracts from the value of your feedback. Just concentrate on what might help readers like yourself. 

4 Did you like the book? If so, say you did. You could also describe briefly what kind of book it is. “It’s a fantasy story about a girl who finds herself in an alternative reality which contains talking animals, strange new rules, and a lot of fun, some of it clever.” That’s not the most erudite description of Alice’s Adventures in Wonderland, but it’s enough to guide people, and it doesn’t give away the plot.

5 If you didn’t like it, don’t be rude. 

6 By all means add whether, in your opinion, the story is fast-paced, has lots of characters, is full of suspense, contains wonderful dialogue, and so on. It is your opinion, not the opinion of an English Lit professor, but it should be founded on evidence.

Your evidence should come from the contents of the book, and not depend on whether you liked the shoes on the cover, or whether Amazon delivered it to the wrong address. Here’s what one recipient wrote of a second-hand book:

“The book was in much worse condition stated, it would have been nice to have been warned about the blood stain that ran through several pages. Not happy at all as had to buy a second copy.”

7 If you feel like it, you could say which characters you liked in the book. Were they well drawn? Did their dialogue ring true? And so on.

8 Try to mention who might be the ideal reader. “Fans of cosy mysteries may enjoy this book.” It doesn’t hurt to mention other authors of books along the same lines, if any come to mind. But there’s no need to wrack your brains.

There’s a lot of really helpful advice on this blog post by top 1000 Amazon reviewer (and author) Debbie Young. If you’ve never written a review before, just come on in. The water’s lovely.

***

I still have a soft spot for this spoof review of Orwell’s 1984, by a reader called So-Crates. As feedback it’s not that useful, and you need to know something about 1984 to appreciate it, but it does show that jokes don’t have to have a butt.

“Do not buy this book if you’re expecting to find out anything at all about 1984, as this writer seems to have been living on a different planet. I was trying to do a bit of research into the influence of New Wave on cross-over dance music in the Mid-Eighties, but I found “1984” a complete waste of time… Jackson’s “Thriller”? (the soundtrack of the summer, and the biggest selling album of all-time) – not mentioned; Frankie Goes To Hollywood (their breakthrough year leading to world pop domination) – not a whisper.”  

You can probably guess what he says of The Road to Wigan Pier.

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How to Launch a Book

Launching a ship requires a goodly crowd and a large bottle of champagne. Exactly the same principles apply to book launches, though without all the sea-water.  

Daunt Books, Hampstead Heath

I’ll skip the question of whether you “need” a physical launch. I didn’t have a launch for any of my non-fiction books, unless you count one publisher’s lavish effort with a bowl of peanuts and about three people.  

Here’s what I learned from the launch of my novel Hampstead Fever earlier this week.

1 My best tip: share the launch with another author. But no sailing under flags of convenience.  You must like the other author and their book.

I shared Wednesday evening at Daunt Books, Hampstead Heath, with my fellow author Christine Webber. It was her second novel and my second novel, and we’d both had around 12 non-fiction books published already. While Who’d Have Thought It? isn’t much like Hampstead Fever, it’s in the same genre and both make good summer reads.  

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2 Invite people because you like them, not just because they’re “useful”. The second type has a disconcerting habit of finding something more interesting to do on the night. Besides, you’re celebrating your achievements, so you should enjoy the proceedings.

3 Don’t be ill.  I got this terribly wrong last week. On the plus side, some people thought it was a clever marketing ploy.  “So,” said one waggish author friend. “I suppose you’ve got Hampstead Fever?”

4 Have plenty of food and drink. Especially drink.  If you can, have someone to serve people wearing white gloves. Class.

Fron L to R: me, Orna Roass, Jane Davis

From left to right: me, Orna Ross and Jane Davis

5 Take a pen. Of course you’ve already practised your authorial signature and worked out what to write by way of dedications, but something to write with does come in useful.

6 Get someone to take photos. Even better, ask several people, just in case. Make sure they capture the really important shots, eg with your family.

Christine with some friends

Christine Webber with some of her friends

7 Say a few words about yourself and your book.  You might mention the drawers full of unpublished masterpieces, or explain why you write instead of doing something easier, like transplant surgery. Thank key people, but remember it’s not an Oscar acceptance speech. Five to seven minutes will do, especially if more than one person speaks. Christine and I didn’t do readings, but many authors do. At a recent multiple launch, authors from the Triskele collective had others read excerpts aloud, to great effect.

7 Consider getting someone to introduce you and/or field questions from the audience. Someone might want to know how you write (“Is it true that you do your best writing in a rainy orchard with nothing on?”) or whether that scene is based on real life. On second thoughts, skip the questions.

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8 Consider merchandise (bookmarks, pencils and other trifles) or a draw for a book-related prize.  You could also have a slide-show or a book trailer running. The sky’s the limit, really, but it can become tacky, look desperate, or interfere with sheer enjoyment of the event.  

Concentrate on essentials like chilled fizz and plenty of copies of your book, and you’ll have a great send-off for your new title.

Pippa and Bethany of Daunt Books

Pippa and Bethany of Daunt Books

What Not to Say to an Author

It’s wonderful being an author. While there’s rarely much money in it, you get to do what you love. It’s probably the most fun you can have with your clothes on.

There’s also the sheer joy of opening a box full of copies of your shiny brand-new book. That, as novelist Helena Halme points out, never gets any less exciting.

Helena Halme's latest book

And it’s a thrill meeting readers and getting feedback, especially when you find out your words have made a real difference.

But there are people who say the most inane things to authors. So, with the help of one or two fellow writers, I’ve compiled a roundup of things that really grate:

1 “Are you published?  Will I have heard of you?”

Well, yes, the author generally is published. Otherwise they’d probably not call themselves an author. As for hearing of that person, it depends. I know several people who never heard of Kahlil Gibran, yet his book The Prophet sold tens of millions of copies.

FreeImages.com/Mana Media

2 “Why don’t you get your book made into a film?”

If it were that easy, I think we’d all be knocking on Hollywood’s door. It’s not, which is why, until we get the call, we’re selling our books at around £7.99 a pop (or less; usually much less for the ebook). Not quite a direct route to the Walk of Fame.

3 “I do a bit of writing myself.”

I mustn’t scoff, because occasionally someone like David Lodge says this. More often, though, the follow-up is “I wrote a letter to my local paper once” or “I’ve written a 100,000 word novel from the point of view of a slug. Could you read it for me and help me get it published?”

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4 “I’d write a book too if I had the time.”

The implication is that their life is far busier than the author’s, and that no talent is required.

5 “When I retire, I’m going to write a novel.”

Usually uttered by someone who’s never even written a shopping list. See 4.

6 “As you’re at home all day, could you just babysit/pick up a parcel for me/come out shopping with me?”

Because writing books is some romantic thing that just happens when you click your heels and make a wish. It’s not like it’s a proper job, right?

FreeImages.com/Kia Abell

7 “Where’s my free signed copy?”

Because, obviously, authors are happy to work for free.

Many thanks to my fellow writers, especially Vivien Hampshire and Georgina Penney, both from the Romantic Novelists’ Association.  If you ever meet one of us, you know what not to say.

‘Who’d Have Thought It?’

My posts normally have less ambiguous titles, but today’s contribution is from my fellow author and journalist Christine Webber whose forthcoming novel is called exactly that, and, as you’ll see, the name is just right. Over to Christine.

After 30 years of being conventionally published, Who’d Have Thought It? is my first independent venture. The novel sees my return to fiction after 29 years (doesn’t time fly!) of penning self-help books.
A lot of the knowledge I’ve acquired as a health writer, and as a psychotherapist, has crept into these pages. I’ve had tremendous fun fictionalising situations that I see all around me.
But my main reason for writing this book is that I find mid-life much busier and more unsettled than I had anticipated. Most people I speak to – who are also of ‘a certain age’ – say the same thing.  That sentiment underpins the story of Who’d Have Thought It?  
Here’s a brief extract from a chapter well into the novel, when my main character, Annie, has been persuaded by her best friend Janey to try internet dating.

FreeImages.com/Doru Lupeanu

She pushed open the door of the all-day bar and saw him immediately. As he had promised, he was sitting near the mock fire in the middle of the room. He had highly-polished shoes, a blazer and a cravat. A cravat! Dear God, she thought, I didn’t know you could still buy those.  

His eyes lit up when he saw her. He jumped up and lurched forwards, apparently eager to plant a kiss on her cheek. Quickly, she held out a hand to be shaken.

‘I think,’ he said. ‘Not that I’m used to this kind thing, but the form is that, on a first meeting, each participant gets his or her own refreshment.’

‘Fine by me,’ she smiled.

As she waited for the noisy coffee machine to steam her milk to a high enough temperature, Annie was able to view Roger in a mirror above the bar. He was about sixty. Dapper. A little tubby. Not overly tall. Perfectly respectable-looking – but her heart was not in this outing, and she wondered how soon she might decently leave without seeming rude.

‘Ah, not a drinker, then,’ he said with evident disappointment as she returned, carrying her cappuccino.

‘Bit early for me,’ she murmured. 

FreeImages.com/Carien van Hest

He raised his eyebrows. ‘Ah well, once you retire, there seems no reason not to drink whenever you want to. And the excellent thing here is that mid-afternoon, you get a deal – steak and kidney pie and a pint. Had my grub earlier. Very fine!’

She stirred her coffee, stifling an urge to giggle.

‘And they do two-for-one meals on Monday, which is really top value. You couldn’t get a better meal anywhere. And, if I say so myself, I do travel a lot, so I know what I’m talking about.’ He paused to take a deep gulp of his ale.

‘Last month, for example, I accompanied a young lady to the continent for a long weekend. Very luckily, I got a cut-price deal on the overnight ferry crossing. And if you make sure you’re one of the first on board, you can get good reclining seats so you don’t need a cabin. Of course, with the ferries taking care of two nights, you only need to shell out for one night in a hotel. And I found a pretty decent B and B …’

‘And are you still seeing that “young lady”?’ Annie asked innocently.

He took a swig of beer. ‘No! She rang me after we returned to say she’d gone back to her husband. I was bloody annoyed because I had rather pushed the boat out on her account.’

‘That would be the ferry boat, would it?’ Annie murmured, gazing at her rapidly disappearing coffee. ‘Yes, I suppose some women can be awfully ungrateful.’

‘You can say that again,’ he remarked before he launched into a story about another young lady who had let him down.

Surreptitiously, she glanced at her watch. Janey had said she might ring to see if she was coping. 

Fortunately, a couple of minutes later, her friend obliged.

 ‘So sorry,’ she explained to Roger, ‘I have to get this…’ Then ignoring Janey’s whispered question about how things were going, she spoke loudly into the phone: ‘Darling … Oh no! No, of course. I’ll come right away…’

‘Trouble?’ Roger’s brown eyes – which had, up until now, twinkled with a benign expression – gazed somewhat angrily at her.

‘I’m afraid so. My daughter’s having a crisis at the moment. And I have to go. That’s what mums are for.’ She stood up. ‘I would thank you for the coffee, but since I bought my own I won’t bother. Good bye.’

He harrumphed: ‘Well, I must say … Still, maybe another time.’

She was halfway to the door. ‘Probably not,’ she said over her shoulder.

Who'd Have Thought It?

Who’d Have Thought It? is out on June 10 in paperback and as an ebook.