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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.

Wednesday, 18 February 2015

Identity Crisis, doctor style

My sister and I often reflect on how strange it is that activities we were forced to participate in as children, such as weekend walks in the countryside, are now activities that we proactively seek out with fervour and enthusiasm.  It is true that as an adult, I definitely find both energy and solace in mountains and by the sea.  As such, I left a few pieces of myself in the Sierra Nevada, and in the Pacific Ocean on the Californian coast for safe keeping before heading back to the frozen East Coast.  


Ocean Beach, SF
Because did you know that emigrating causes one to have something of an identity crisis?  

Since I was 14 years old, all I wanted to do was become a doctor.  And then I became a doctor, and loved it, and didn't mind the long hours, being scared witless, the crying-in-broom-cupboard moments and my frustrations when my knowledge hit a wall.  I count myself incredibly lucky to never have regretted my choice of career, with the occasional traumatic on-call exception.  
Not the worst sight to wake up to...
Camp stove dinner triumph
But moving to America has been a bit like being on life heroin - you suddenly think about what life is really about, and what the possibilities are.  Of course I still want to be a doctor, and a scientist.  But it has been the first opportunity I've had to reflect on the various little side projects I've done along the way - this blog for one thing, but also other writing projects for other blogs and journals, medical politics work with the BMA, integrating global health aspects into both clinical and research work, teaching anyone from primary school tots and teenagers to medical students and other junior doctors, travelling with my trusty (and now verging on falling apart) rucksack... I mean, cool, but it kind of makes my head hurt just thinking about how I squeezed it all in.  And now that, lucky bum that I am, I have got my dream job back in Oxford (plus/minus international research element) for a few years, I feel compelled to take the chance to chill the hell out and give life a little time to happen with some of the aforementioned projects and just in general.  The question is - what does that even mean?

A few thousand feet up and 12 miles later
The lovely fellow Fulbrighter with whom I hiked and camped around Yosemite National Park recently and I were discussing this balance of knowing what you CAN do with what you WANT to or SHOULD do.  Mainly because we're conscious that, as Fulbrighters, we're seen as these super career-hungry go-getters with endless focus and drive.  Well, true that I don't like to be bored (or boring), but speaking for the two of us, we're just massive nerds who love what we do.  Go-getting, me?!  That just sounds hilarious.  I've come to realise that I'm getting to a stage in my as-yet fledgeling career where I'm going to have to start making decisions about what I want the rest of my life to look like and what activities will be involved.  This is borne out of loving clinical medicine and *all-the-other-stuff-I-listed-above*, but that there are only so many hours in the day.  Plus it's just awesome to give life itself a chance to happen in all its randomness and unexpectedness.  I believe doing a job like clinical medicine also lends itself well to a bit of mix and matching if you want it to be.  For example, I did a trial run of doing a proper bit of writing while I was in California (those train rides are long...) and it was wonderful (experientially, that is. The quality of the content... tbc...).  

Managed to turn my back on that view long enough to smile at a camera...
Don't get me wrong, these are very first world problems.  I am lucky to do a job I could do anywhere and prefer to embrace the uncertainties ahead. But I also know all too well that life is short and beautiful, as my time in Cali reminded me.  In the interim, I also wish I could be gifted my appetite and the ability to sleep back, which, despite the glorious physical exhaustion of the last few days seem to have both temporarily left me.  A bit of solid reflection on the kindness shown to me by new and old friends in Cali, the East Coast and UK (even if not all are UK based at the moment) already helps.  I was thinking as I headed back to Connecticut from California how crazy it is that I came here just five short months ago, not really knowing a soul, and how lucky I am for the multi-national friends I have made, in addition to the wonderful old friends from various life adventures who continue to add sparkle to my life.  People are so GOOD!  The next four months will whizz by.  For some reason, that reminds me of a passage I read during the summer which gives me a big smile whenever I think of it.
'And now these three remain: faith, hope and love. But the greatest of these is love.' (1 Cor 13.13)
After all, an identity crisis is not so bad as long as you have some lovely folks by your side.

Tuesday, 10 February 2015

What they don't tell you about science (and medicine)

When I turned five, my birthday present was my first bike.  It was pale forget-me-not blue, and I was so excited to ride it on the thin concrete patio that linked the house to our back garden.  Living in the West of Scotland, despite having a birthday in June, it was still fortunate to have nice enough weather to do a trial run on the day itself.  That was a great bike.
I want to ride my bicycle...
So it was rather a treat to get to ride an almost identical bike several thousand miles away, 21-and-a-half years on.  Riding through Sacramento's sunny streets on a 'winter' (read: 18 degrees celsius) afternoon is just one of the many heartwarming, life-loving moments of recent days after an incredibly stressful couple of weeks (/months!).  

Napa Valley
I've listed this posting as 'What they don't tell you about science (and medicine)' - but perhaps I should call it 'How to pick a job which is nothing like what people think it is'.  People often say to me 'what a solid career choice you've made' or 'it's a job for life' - and about my time in the US as a researcher at Yale as 'you're sorted' and ''you'll always get a job in science'.  I've never believed any of these, but these last couple of months prove, rightly, that nothing is certain.  I applied for a job to return to almost as soon as I arrived in the USA, along with thousands of junior doctors across the UK.  I was lucky enough to get consecutive job interviews, first in December and again in January; but that involved two trips back to the UK.  There's nothing like the cost of a plane ticket to put on the pressure. And justifying your salt as a doctor is stressful both in the context of having done it for the last 2 years, and in my case taking some time out to do research - you feel that you have a lot to justify.  By no means is it seen as a positive thing by all people that I've taken myself off Stateside for the year.

Macarons! Yum yum yum.
The route to becoming a total wine snob...
What's joyous is that I get to do this all over again in 2-3 years' time.  And then another few years after that.  And that's just the clinical bit, where at least there are usually jobs around.  Depending on how much I wish to make science an integral part of my career, I'll be joining the 'publish or perish' world which brings a whole other dimension of uncertainty.  Scientists are revered as being brainiacs trying to save the world - but they are poorly remunerated with very little job security for the privilege.  So before you think that the road is lined with gold for doctors and scientists alike - the exact opposite is true, particularly for the latter.  

Alongside all of that, obviously the job you are doing at the time must also continue, and science does not always play the game.  My 'science' has been working ... variably.  It is somewhat disheartening when an experiment you have been working on for six weeks appears to not be working.  The number of failed experiments that go into one scientific paper - I think it's probably a 1 in 10 ratio of success to failure.  But when those successes come - oh boy!  So exciting!

State Capitol of California
So having traversed all of that, I am now falling in love with life and the world again having taken myself off to California to continue my 'cultural exchange' and give my little brain a rest.  And boy, the love is flowing; the kindness shown to me by a series of relative strangers is blowing my mind.  My senses are kind of overwhelmed with all the sights, smells and tastes that California is offering me - having meandered through the beautiful Napa Valley, exploring the historic corners of Sacramento and creeping through Big Trees (aka Giant Sequoias) Park, I'm probably going to have go on some sort of diet after sampling buttery Chardonnays and fruity Pinot Noirs, sticky Macarons (the salted caramel - WOW), full-flavoured cheeses, delicious lamb dishes, and even a genuinely good portion of fish and chips... and all under the guidance of incredibly kind new friends.  All good stuff for the soul, and good for reminding you about all the things that are great in the world.  After all, a job is necessary but it is just a job.  The kindness of people is of far greater value and one that I am feeling the full force of at the moment.  
I'll leave you with this: we had a chinese lunch yesterday and this was the contents of my fortune cookie.  I'm not sure I have enough of worth to write a whole book yet - but I am not at all short on ideas!

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...