This is who you're reading about

My Photo
Wilkommen to my blog - if you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I normally live and work as a doctor in the UK, and I'm currently taking a year out to do research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Friday, 16 January 2015

On Science


My friend Una was an anthropologist as well as a doctor: maybe that's why she could describe why science is so awesome better than I ever could.  As I prepare to switch my clinical brain back on for a medical job interview, this quote is, in a nutshell, why I love that I get to work between the two wonderful worlds of medicine and science.  

Sunday, 4 January 2015

Cancer - just an accident?

Four years ago, when I was doing my science degree in London, I went to my local florist to buy a bouquet of peonies for a departing colleague.  As I was in my fifth year as a student by this point, independent floristry was usually beyond my budget, so I relished the pooled funds that facilitated this acquisition (flowers are probably the one and only luxury item that I get squeaky about - they add so much sparkle).  At the end, the florist insisted on giving me a discount - 'you're doing cancer research - it's so impressive that you're working towards a cure'.  

Even then, I was sceptical.  Now, I am possibly beyond hope of a 'cure', a magic bullet.  And this article hit the headlines recently, and I feel it explains the source of all of those concerns. 

The Beeb reported on a Science paper with the headline 'Most cancer types 'just bad luck''.  In essence, it's an article which showed that 2/3 of cancers are caused by chance mutations, with the remaining (and that's a significant) third being due to lifestyle factors.  I guess I was a little surprised to read this, but on deeper thought, it's actually amazing that the balance is not more in the direction of random bad luck.  When one considers all the cells in the body (thats a few trillion, btw), all replicating at varying rates, some dying and being replaced by new ones, enough to sustain us for a lifetime.  And every time a cell replicates, it's got to make an EXACT copy.  And just like all of us, sometimes there's a mistake.  Some mistakes are harmless.  Others, not so much.  Cells have got a whole bunch of ways to scan for mistakes and erase them.  Cancer is essentially what happens when the mistake IS harmful and something happens which means the corrective system has gone wrong.  

So, there are a whole bunch of 'mistakes' that can happen, and equally there are a lot of steps in the 'identify-to-remove' repair pathway that can go awry.  Kind of amazing, PHENOMENAL, that it doesn't go wrong more often.  Some people are unlucky and inherit a gene which speeds this bad luck up - such as people with a BRCA gene mutation (like Angelina Jolie) who have a greater risk of certain cancers because they have lost part of the safety net.  

But how on earth can you a) know ALL the possible pathways which led to the cancer, b) work out which parts of the pathway went wrong and c) find a way to fix it?  And that's assuming it's one single thing that's bad enough to make cancer happen - what about if it's a team event involving multiple genes, multiple pathways, multiple errors?  

Snow in Connecticut
Clearly I don't think it's all hopeless - otherwise I wouldn't be so passionate about the research I'm doing.  This is ultimately what targeted therapy is all about, but I hope I've painted a picture of why 'curing cancer' is such a big ask.  It's not so much finding a needle in a haystack as throwing a needle into one and hoping it'll find the one green straw you laid in there.  Maybe we just need to change the language we use - rather than wanting a cure, how about 'living with cancer' - so it's not a fatal death sentence?  I was recently asked at an interview what specific area of cancer I was interested in; and it's not by accident that I have sidestepped to brain tumours as a research interest.  Imagine if patients with brain tumours, or pancreatic cancer, or small cell lung cancer, could just live with their disease rather than die from it?  I carry the patients I have cared for with these diseases with me, as a reminder of what we are trying to achieve, and it makes the goal less scary.  

'Cure' just makes me think that everyone is waiting for the single answer to the Cancer Question.  But what the article described above serves us to remember how blimmin' amazing the body is that we survive at all, and therefore what a huge wall cancer has placed before us.  But walls are made of many bricks rather than just the one; so perhaps chipping away and redefining the goal is a more achievable aim?

Perhaps this seems like a heavy post to kick off 2015 with, but as I approach a time of year which will forever be difficult for me and reminds me why I am in America, it is more designed to reiterate how incredible life is at all.  So go do something awesome to launch your New Year.

I'm not sure I could love this more. My latest contribution to quotation tennis, RH!

Sunday, 21 December 2014

Twas five nights before Christmas...

The last time I had a really vicious bout of the sniffles was this summer.  It's funny how well I remember it.  I was doing locum night shifts and had been burning the candle majorly in the run up, and personally and professionally I really wished I didn't need a steady supply of tissues and paracetamol on hand.  Now I feel much the same, having just had the most jet-set week of my life so far.

SWIMS 2014
So, with my herbal tea in hand, it's time for the Christmas edition of my scribbles.  Bless my blog, it's had a good year.  As has become my blog tradition, with Christmas upon us it is time to look back at the general mayhem and madness that was 2014 and 'learn' something from it.

This year:
January - SWIMS (That's 'Sensible Women in Medicine and Medicopolitics Society') held its inaugural conference in the Peak District, celebrating being normal ladies, basically.  January was the Month Of The North, and it was jolly wonderful.

February - I was up to my eyeballs in pipettes and petri dishes, trying to Do Science - and then remembering that being rubbish at something for a while is pretty damn healthy.
Tignes looking all lovely and white in Spring

March - I spent a lot of March revising for my MRCP part two exam.  I love this funny job I have called 'Doctoring' but it isn't half exhausting doing a full time job and then cracking out a nine hour exam between night shifts.  Lesson learned - this too shall pass.

April - I left the lab and went head first into night shifts as the Medical SHO; but actually through some of my own health strife I realised what life was like on the other side of the patient/doctor divide.  Puts things into perspective, that.

May - By this point I was well and truly medicine-d.  Breaking bad news and other such difficult conversations made me see, though, that this is totally the job for me.

June - ... on a similar theme, discussing end of life decisions - another one of those 'wait just a second there, I'm only in my twenties, how can I be ok discussing this' type moments.  And then realising it doesn't matter, because you're actually ok having this sort of chat and really it's a privilege to be the one doing it.

Wedding goofing around with my other bestie Matty
July - Apparently I didn't post anything in July, but I'll tell you for free that I was saying goodbye to a lot of excellent friends from the last two years as we finished our first official posts as doctors.  I'd argue these have been amongst the biggest in terms of friends, family and self, so it was a pretty big thing to say goodbye to.  Also - weddings.  So many weddings.  Marvellous!

August - I became a part-timer!  Oh it was wonderful.  Being a self-confessed work-a-holic, I became a work-and-life-a-holic.  This is when I got my cold, by the way.  I don't think Black Wednesday really had anything to do with it...

September - What a month.  Tears a-plenty, and that's from me, the ice queen.  Although I'd say what I learned from September that going and exploring pastures new doesn't mean what it did when you were 18.  Life really will still be there when you get back; it's more like 'adieu' than 'goodbye'.  That doesn't mean I didn't bawl like a baby when I gave my final wave to my friends, of course.

Claire and kickball in Baltimore
October - I moved to America!  What DIDN'T I learn, is probably a better question.  I learned that emigrating is the only way to really check if you're ready to be a grown up.  I learned that I am a lot more accepting of who I am than I thought.  I learned that making friends is still one of life's great joys.  I learned that I love my jobs, both of them, and that I am learning more about them all the time.   And I learned that alas, for me, there is nothing to equal the British ability to make a truly excellent cup of tea.

November - OpenCon.  'nuff said.

Oh to wander the streets of Oxford in December...
December - I can't lie - December has been flipping' hard work. I submitted another job application, various lab things went all 'science' on me (read: not working), my best friend went to Sierra Leone like the hero she is and amidst all of that... I got a job interview in the UK.  So back I flew, landing back in the USA two days ago.  Which was a lot more emotionally draining than one might think.  What did I learn from this?  Stop thinking, focus, and just go with it.  (But look after yourself.  As I've said many times on this blog before, no man is an island...)



New Haven's Christmas tree.  Subtle, huh?
So I really have no clue what 2015 will bring, apart from hopefully a renewed closeness with my stethoscope.  2014 had more twists and turns than I could ever have predicted.  Which goes to show, you really do never know what is around the corner.  Although I've had moments of doubt and fear, if 2014 has taught me anything, it's that you should never stop adventuring, whatever your definition of that is.  And with that - Merry Christmas, dear blog reader!





Monday, 8 December 2014

When your best friend goes to be an Ebola doctor

Unless you've been living on Mars, you will be aware of the Ebola epidemic currently sweeping West Africa.  My best friend, Claire, is leaving for Sierra Leone this week to work as a doctor with the Kings Sierra Leone Partnership (KSLP) at the Ebola Isolation Unit in Freetown.  Claire and I have been friends since our first week of medical school - we have lived together, travelled together, solved woes over endless cups of tea together, and grown as students and now doctors together.

Along with the rest of the world, I have been closely following the devastating events in West Africa. Towards the end of my time in the UK, I had a patient who was a returning traveller from the region, and I must admit that at the time, when Ebola was just appearing on the horizon, Ebola was well down my list of differential diagnoses in comparison to malaria, typhoid, yellow fever etc etc... I suspect if the same patient had come into hospital in the UK now, they'd be straight into an isolation unit.  It does make you wonder though how many of these common tropical diseases are now being untreated.  Having had malaria myself many years ago, it remains deeply troubling to me that so many people die from a disease that cost me about £1 ($1.50) to be cured of.  But now that Ebola has taken such a hold, how do you battle a war with so many fronts?

I have been struck by several aspects of the Ebola crisis.  Although comparisons between the AIDs crisis in the early 90's and Ebola are in some ways unhelpful (in terms of transmission, pathogenesis and disease course, they are totally different), they do highlight the gross inequalities in health provision, and how often it requires people in the Western world to be affected before they take action - as discussed by Kofi Annan.  Another is the role of the media - funny how the second it was reported that Ebola was marginally in control, it's no longer in the headlines. And finally, the mass hysteria about returning healthcare workers, quarantining and transmission risks.  This is despite the fact that, when asymptomatic, you are not contagious even if you have Ebola.

I'll admit, I wasn't super keen when Claire first told me her intention to go to work as an Ebola doctor.  Perhaps it was selfish of me, but having gone through the loss of close friends once, I just feared the worst - and that neither I, nor my friends, could go through that again.

But having read more about Ebola, the desperate need for staff and the immense progress in controlling the virus that has been aided by groups like MSF and the KSLP, I started to realise how ignorant I had been.  Of course there are risks, but when you consider how many foreign health workers are currently working in Ebola hospitals, and how few have actually contracted the virus, one must give credit to the healthcare staff there having developed very effective protection techniques.

Of course I am worried and anxious, and I will miss her hugely (it's amazing how Skype makes you feel like someone is not really that far away despite the fact I've been away for over two months!).  But rather than just sob to Kodaline, I shall instead say I am immensely proud of what she is doing; someone who has absolutely no idea how brilliant and brainy she is and will bring her zany love of life to everyone she meets in Sierra Leone.  Check out her blog for her progress (www.claireferraro.blogspot.com).  As Christmas time approaches, I for one will be keeping Claire and all of her colleagues and, of course, patients in Sierra Leone firmly in my thoughts.
This beauty was taken on the roof on which we slept in northern Ghana (note our delightful sheen despite sleeping outside...) during our backpacking adventures around Ghana, Togo and Benin in 2008 having just finished our second year at medical school.  

Saturday, 29 November 2014

The First Thanksgiving

Thanksgiving baking...
I'll keep this short and sweet, but much like my Christmas lovin' last year, I like to take the opportunity of these significant holidays to say a little woop woop for all the good things going on in hopes that you will do the same.  Especially having just celebrated this, my first thanksgiving!  Of all the American things I have experienced so far, this may be my favourite.  I was welcomed first into the home of a friend in New Haven, and then later in the day New York to have Thanksgiving dinner with a lovely couple who had invited me along with a few other international students.  And today I put the world to rights with various Fulbright folks who continue to add shine and sparkle to my life with their refreshing and new outlook on things I normally only get to discuss with other medics and scientists.  I refer you to Hello Science, Meet Art to why that matters, to me at least.  Perhaps I will come out of this year the well-rounded young lady I claimed/hoped/strove to be when I started medical school?
Thanksgiving food...

Life mantra?
So I am thankful for the old friends I have, and their messages, Skype calls (often at hideous times [for them] of night with the time difference back in the UK), Whatsapps and emails.  I am equally thankful for all these new friends that have entered my world, both by welcoming me into their community or by letting me share this awesome emigration adventure with them.

They are also incredibly polite about the fact that I seem to be making it something of a ritual that I explain my research to each and every one of them on the back of a napkin.  Perhaps I should be testing at the end of the year...

Sunday, 16 November 2014

Concepts of Open-ness - OpenCon 2014

I left my scarf in the cafeteria at the US Senate on Capitol Hill.

Well, there’s a sentence I never thought I’d say. 

It was not the only surprising and overwhelming thing that happened at OpenCon2014, an open access conference for early career types like me. 

Appreciating that readers of my blog are a mixed audience (seriously, message me, because I would love to know who you are!), open access is all about making research openly available.  It is the strangest thing that research which is publicly funded is then submitted to a journal, whereupon it is peer reviewed for free by fellow scientists (for no reward, professional or otherwise), and somehow it gets spat out the other end with a price tag.  And a hefty one at that.  Of course there are some editing costs.  But when even Harvard University is struggling to pay for the rising cost of journal subscription, it’s a clue that something is wrong. You can read about Open Access on some of my other blog posts. 

Co-founder of PLoS, Patrick Brown
OpenCon2014 was an international meeting of 175 students and early career researchers from over 40 countries in Washington DC.  Over the weekend we heard some of the most compelling and diverse arguments in favour of Open Access, Open Data and Open Education from equally compelling and diverse speakers.  Highlights for me were Patrick Brown, Co-founder of PLoS (Public Library of Science, now probably the biggest completely open access journal) describing how he set up PLoS despite having no experience of publishing. Peter Murray-Rust described the potential of text and content-mining to actually maximize the potential of existing research.  And finally, one of the most affecting talks for me personally was by Erin McKiernan talking about what we can do as early career researchers (she is herself one).  We spent Monday on Capitol Hill meeting relevant political figures in the Senate. Wow. Directly lobbying HELP committee members. Awesome.  In the afternoon a group of us went to the National Institutes of Health (NIH – who fund most publicly-funded American research) to discuss ‘openness’.

I could go on about how amazing this weekend has been, how inspired I feel, how excited I am about the projects and plans we have for the coming year.



But I am also scared. For one thing, I realised the extent to which I know nothing about data management and access.  Yes, I am part of the ‘digital, internet generation’, and have no computer phobias.  But that does not mean I’m an expert.  My experience of software is pretty much limited to Word, Excel, Powerpoint and PDFs.  I have never worked on ‘code’.  Managing data is something I find incredibly challenging.  Organising my data so someone else can use it later on – well, where does one start?
In addition, I am not so much an early career researcher as an embryonic one.  I can still count the number of publications I have on my hands. And most of the time I am the middle-ish author.  How does one leverage preference over an open access journal when often these decisions are made when I’ve already moved on geographically, and when I’m authorship small-fry?  And when any publication at all is a requirement on a job application?
These are not meant to be excuses, and I have considered how I’m going to tackle all of these (a MOOC on data management, contacting my librarian at Yale and asking for help from OpenCon peeps re the former, and initiating early conversations and just being bold on the email front re the latter), but it just reflects some of the challenges facing baby researchers like me.  And if we’re the keen ones, for whom Open Access is a clear ‘Yes’, then I can understand how it seems too great a mountain to climb for less interested peers. 

The NIH
I guess the key is to keep the fear in check and just power on with the support of my fellow open accessers, and continue to spread the word.  I really believe that open access and open data is the only way forward, and not only that, it’s better than the current status quo.   I want my research to be useful to anyone who wants to read and use it, and not just those who can afford to do so. 

But despite any fa├žade or game face, I am somewhat daunted.  So if anyone wants to help me on the journey, I’d be glad for the company.


(Also if anyone finds my scarf, it’s actually the only one I brought to the USA from home and it was one of my favourites.  My neck is henceforth now very cold.  It is forest green with burnt orange flowers bought originally in Dublin.  If found, message me.  Kind regards, KRP.)

Thursday, 13 November 2014

Hello Science, meet Art.

There's a certain image that is conjured in one's mind when one thinks of a scientist, and perhaps a doctor.  When I was a child, if you'd told me I'd end up doing what I do now, I'd have laughed.  Psh. Sounds boring.

It's not, of course.  It completely rocks (except when your gel doesn't transfer to your membrane because you thought the bottle said 'methanol' when it actually said 'transfer buffer'.  Doh.).

However, I like to think of myself as a bit of a chameleon, not least because my own family is a bit of a pick-n-mix of skills and activities, and therefore the notion of just being interested in your own field is a little alien to me.  But how well do science and art really mix?  They are different worlds.  The first inhabited by bespectacled nerds, often in white coats with beige outfits underneath, hermitting away with a pencil tucked behind their ear, muttering mysteriously and scribbling away in what might as well be Klingon.  The second, perhaps also bespectacled but undoubtedly more trendy specimens, not an inch of beige in sight, pondering life and the meaning of it all.

(Those were stereotypes I just described there, by the way, in case you missed that.  I'm not trying to suggest these are accurate or fair.)

I'd like to think I inhabit the former whilst having all limbs healthily outstretched to the latter.  I went to the Museum of Modern Art in New York this weekend and embraced the opportunity to stretch my thoughts to, well, MY thoughts.  The feelings evoked by paintings I've only ever seen on my computer screen, as well as those I've never seen before.  I went to listen to the poet laureate, Charles Wright, who gave a reading at Yale.  Sadly I suspect copyright laws prevent reproductions here, but having reread some of his work at home I was struck for the second time (the first obviously being when I heard it in the flesh) how some of his words resonated with me.  And yesterday I went to hear a piano recital by Boris Berman, master of all things Prokofiev.

Even Rabbie Burns (Scottish poet) features in NYC!
Interestingly, I think the main value to me of keeping my head in the artistic world is that it keeps me human.  When I'm being a doctor, it gives me a way to explain or explore my feelings and emotions.  When I'm being a scientist, I think it reminds me that really science is art, shrouded in formulae, chemicals and protocols.  I don't think either of these should be underestimated.  As a doctor, I am so often required to have emotions and feelings on an 'as required' basis, as if feelings were controlled by a tap, and sometimes that's really hard.  There are patients whose final hours I remember so vividly that I still see them now; the look on a patient's face when they know their hour is here.  There's something reassuring about listening to a piece of music or seeing a painting that evokes those feelings again, but in a safer environment.  Perhaps the composer or artist had a similar experience?  It is almost a relief that someone has managed to convert that emotion into another art form, and you can find a way to deal with it.  Equally as a scientist, it is so easy to get bogged down in this, that or the other assay, and forget that it is flipping amazing what you are doing.  That sort of helps when your experiment doesn't work for the twentieth time.  Because when it works the twenty-first time, it's beautiful.

So I'm quite content to be a bunch of contradictions; I think without it, science or medicine would have no meaning or joy to me.  It does mean you'll have to tolerate my hippy music if you're working near me in the lab.  Soz.