“Lights. Camera. Action.” (…and then back to work)

Ok, so I know that I only wrote a blog a few days ago but today was such a pivotal day that it would be a failure upon my promise to share my adventure through medicine with you if I didnt. Before you wonder, no, I havent finally got a girlfriend, and no I havent (yet) seen the light and quit my job.

Instead today, I did my first ever filming shoot for a television programme in which I talk about some of the science behind the human body. Now I am sure you may be thinking, “hang on, where the hell did that come from?!”…so let me explain.

I love my job as a doctor. I think that we are by far and away the most interesting, dynamic, and ever-evolving natural machines on the planet. And every day I get to see that in action at work under the strains of illness, trauma and chronic disease – learning every day as I do so. Before I became a doctor I did other bits and bobs related to the human body too – a PhD (randomly, funded by the US Army) in Performance Human Physiology and Nutrition, and a degree in Sports and Exercise Science. What I guess I am trying to say is that I have continuously looked for a way to satiate my interest for the human body. That’s afterall part of the reason I write this blog – to share some of the fascinations that occur within us.

And SO we come full circle to the reason why! – About a year ago I realised that I wanted to share my love of science, health and medicine with others. Trying to teach my nana about the ‘stress response’ was just no longer doing it for me! And so I set about trying to find someone who would help me get into media as a scientist and doctor – for TV, radio, print and online – I mean why not? I am luckly, afterall, that I have a family who have always told me to dream big (and I do – EVERY day!). So, I managed to do that and now work with an amazing team from a very successful management company. It was this team that got me the first job in media – the one that I have elatedly completed today!

Now I’m not going to go into the details of the programme as that will all be revealed in the next month and I will come back to you all and tak about it. That said, let me tell you a few things about it:

(1) I was bloody nervous and definitely could have done with a strong whisky!

(2) I actually had someone bring me a towel to mop my brow (as apparently I was ‘glistening’) – note I did NOT request this!

(3) They do actually say “that’s a wrap” at the end which was of huge pleasure to me as a nobby novice..

(4) It turns out that those big lights they use with the cameras are REALLY bright – I am now nursing a headache 5 hours later…

It was such a fantastic buzz, I really cannot tell you, and what’s more is that I got to spend 3 hours talking about topics I love. It was the kind of day that I should really call work – but it just wasnt – it was shear bloody pleasure and joy. I am riding high. What’s more exciting is – I have another job like this lined up in 3 weeks time for a different project talking about another aspect of health. I can’t wait. You know, I meant to take a photograph of the set up but in the haze of enjoyment completely forget. Sorry!

At the same time though I am very guarded about all this. I am grounded, sensible and grateful for my role as a doctor and the responsibility that comes with it, as well as what society expects of me. I am aware that, sadly, the medical profession is not one that likes or encourages this sort of lateral deviation from traditional medicine. I am taking a risk. I hope that a pursuit of passion does not damage my career. Then again, in the pursuit of passion, risk is worth taking.

I imagine the response, once the programme is aired and I (hopefully!) do more work, will be a mix of negativity, deprication and mickey-taking. I am also well aware that this is just part of what I signed up for when I decided to start doing this sort of work. That said, I would hope for all the negativity there will also be a wave of positivity and support for what I am trying to do – forge a different sort of work stream, engage people with this amazingly cool topics, chase MY dream, and at the same time have a blast.

Who knows where it will take me, but if you are reading this right now – you are at the start of the journey with me, so thank you for reading and sharing in this with me.

Right, I must crack on, I have a case report of primary lung adenocarcinoma to write…and it’s not going to do itself. You won’t hear from me for 2 weeks now as I am on-call this Friday, Saturday and Sunday so will be working straight for the next 11 days.

No rest for the wicked 😉

Have a great week,

Dr Nick

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Modern Man and the Ebbing Drive to Survive

The human body is truly impressive. When you think about it, for a complex organism that attributes over half of its body weight to water, it does a remarkable job at keeping us alive. It achieves this thanks to the complex, interacting and interconnected biological systems that comprise it. In working in such dynamic second by second synergy, body and mind, battle forces both intrinsic and extrinsic to them, in remarkable and enduring fashion. It does so hiding in plain sight of our daily life.

 

The words ‘enduring fashion’ are chosen carefully – for we really have evolved to survive as a human race. We have truly endured. After all we were not always sat in our heated homes, well-fed and guarded from disease by modern medicine. Indeed, through the ages the body and mind have had to work as one to overcome unparalleled hardships that environment, animal and man have yielded.

 

In this regard, modern life in 2014 is very different to the centuries past…

 

Obesity, excessive sedentary lifestyles and hedonistic living now threaten us. As a result we have forgotten what a wonderful evolutionary gift we are. We are no longer the men and women who can confidently say that we are built to last. Instead we battle our 21st Century enemies – an expanding waistline, sedentary desk job, and the television remote. Even communication has become as sedentary as our past times with the advent of the Smart Phone and online social networks. Disease is no longer infection and trauma for we have developed technology to overcome those. Instead disease is a social vector for sedentary lives, poor diets and excess of drinking. These have given birth to chronic diseases like type II diabetes, ischaemic heart disease and arthritis. All insidious and hiding in plain sight of our everyday lives for us to look at- but never really see.

 

Yet medicine advances, life expectancy lengthens, all despite these challenges to years of adaptation.

 

As testament to our ebbing innate evolutionary desire to survive, the global institution, the World Health Organisation (WHO) have had to take up the mantel to help support and guide the basic needs of survival – exercise, food, shelter. Guidance, we might add, that for our ancestors in the centuries past did not require to help guide them. It was already inherent – their survivor instinct was active – not dormant like today.

 

The need to survive in modern day is no longer a demand of the physical. It is after all not a requirement; Food is already caught, shelter already built and warmth already generated. It is an altogether different kind of survival. It is a survival of the mind to cope with the social and economic demands and pressures to conform. This does not require the survivorship that evolution nurtured.

 

So this begs the question – is modern man still equipped to survive like evolution intended? Can the body and mind of the modern man still cope and survive when stripped bare of the essentials of life that are currently served to them on a golden 21st century platter?

 

Or perhaps, deep within us still, is that hidden survivor instinct and ability just waiting to be awoken…

 

Just a thought as I had my morning coffee..

 

Dr Nick

When Three Hearts Stop

Last Friday morning I woke up at 5.30am wishing that I could be transported off to another life – one where the alarm didnt ring off at such an unsociable hour and one in which I didnt have to stretch my already worn out brain for another 12 hour shift. I had after-all just completed my first week of medical on-call shifts. This meant that as well as working on the stroke ward from 7.30am until 6.30pm I had to then continue on until 10pm running around the hospital dealing from everything from a drug chart needing to be re-written, to a patient who had become haemodynamically unstable i.e. they were about to become another mortality statistic for the hospital. I was flat out knacked that Friday morning as a result, and all I wished for was a quiet simple, no frills day – with maybe some free chocolates from a patient’s family for being such a lovely doctor. Well, we can live in hope.

How very unprepared I was for the Friday that lay ahead.

It started off fine – I dragged myself onto the early morning train, avoided eye-contact with the new crazy guy that now seems to frequent my carriage daily, dressed in a black string vest and wearing what can only be described as a face that says “I want to kill”. I got into work, grabbed a coffee, and printed out some blood request forms in the doctors mess (the common room), before wandering down to the stroke ward.

That, ladies and gentlemen, was the beginning of the end of my quiet Friday life that I had politely requested.

All hell broke loose.

My cheeks had barely compressed into the seat at the ward desk, as I was reading through a new patient’s notes, before a nurse sprinted out of the bay opposite me – “she’s not breathing!!”. The mind works in funny ways – as I felt myself saying rather sarcastically “ok – Well, let’s press the cardiac arrest bell, shall we?!”. Suddently everything was in motion – my junior doctor colleague also on the ward obligingly jumped on the patient’s chest and began chest compressions, I ran to get the crash trolley – wheeling it down the ward, driving it like I stole it, before slapping on the shock pads onto the patient’s chest around the ongoing chest compressions, and nurses expertly set about getting oxygen mask, intravenous access and bloods on the patient. Suddenly the 5 of us there became 10 as the on-call medical team turned up to expertly help lead the arrest. This, all before 8am. Everyone was caught off guard but we had managed to get to work incredibly quickly – for which I was immensely proud. We worked on this lady for 45 minutes but sadly owing to her long list of health problems the prognosis was always going to be poor and she did indeed die.abg

[An example of an arterial blood gas (ABG) result we use to assess a patient’s metabolic status e.g. in a cardiac arrest – note though this ABG result is not from a patient who went into cardiac arrest]

Now the day was really out of sorts as I had to talk to a very clearly upset family and manage the next steps in their late mothers care (I say ‘care’ as I believe we have a responsibility still after death to be respectful, transfer the body, and help make what is an unimaginable pain – at least a smooth process).

“Nick – I think you need to see this patient”…a nurse politely says to me in an effort to soften the blow of handing me another patient about to die. You cannot be serious – I thought to myself in true John McenRoe style. Indeed, a second patient, within an hour of the first dying was about to die. This time though, the story is written a little differently for this is a lady who was for supportive care only. What does that mean? Well, quite simply it means that we do not actively treat an illness for we as medical professionals along with their family, have decided that it is in her best interests to just support her symptoms and that cure is futile and would only prolong pain, suffering and distress. Nobody wants those. I went to see her and for the second time in less than an hour and a half, had to certify a death.

Sod the coffee, I need a whiskey now.

But, life is not going to allow me thoughts of a whisky just yet, for I have an entire ward round of patients to see (admittedly two less than before) and I am already hours behind time. Getting home for 6pm is looking like that hopeful lottery win. Optomistic at best.

So the day continues, all without a single break, as each patient perfectly throws up problem after problem, and my brain, body and spirit slowly becomes crushed that little bit more as the afternoon ticks by. As I come to the last patient on the ward round around 5pm I do what my old intensive care consultant calls the “end of the bed-o-gram” and I look at this patient. I look at her for a good 30 seconds, remembering how she looked yesterday.

This lady, who is not for resuscitation (just like the previous lady and for similar reasons), is clearly dying right now. And within 10 minutes she was dead. Very peaceful, pain free, comfortable, and not alone. I completed my third death certificate of the day. I was in disbelief – this has never happened to me before – draining didnt even begin to describe it. I had to look over my shoulder to check that Death himself wasnt following me! I checked a mirror – at least I had a reflection – I was still alive.

So the clock ticks round to 6.15pm. The ward round is done, nobody else has died, and my senior house officer is back and helping me tidy up lose ends. But the day wasn’t quite ready to release me yet. For simultaneously TWO brand spanking new patients are wheeled in by the London Ambulance Service Team onto my ward…

“You got two repatriations from Charing Cross Hospital, boss. Where do you want them?”

I wanted to say anywhere but THIS ward, but of course I just smiled, crying inside that sort of deep sobbing cry that only babies do, and directed them to their beds. Now if you are wondering what the big deal is – having two brand new patients that is – let me explain: Each new patient requires the following:

1. A full clinical history taken

2. A full head to two examination of every single system – cardiovascular, respiratory, musculoskeletal, genito-urinary, gastro-intestinal and neurological – the latter of which takes over 30 minutes alone!

3. A cannula inserted and a full set of bloods taken

4. A chest e-xay

5. An ECG

6. A full clerking proforma completed

7. Telephone handover to the night team

And I had two to do, on a Friday night, after a week of hell, when all I wanted to do was a) have my lunch (now a  very warm chicken wrap) and b) go home. I sobbed internally once more.

…..8.45pm.

That is when I finally left – a full 3 hours and 45 minutes after my working day, according to the wonderfully effective ([cough]) European Working Time Directive told me I should have gone home, I left work…and had my lunch. I had nothing left to give.

…Now I am of course writing this on a Sunday evening having spent a wonderul weekend back home with my mum and dad, seeing my unofficial godchildren and my best friend. I stilll feel tired from last week but I am mentally refreshed and a little more reflective than I may have been on Friday night – mainly because I can actually think now. My week, and particularly my Friday all sounded rather dramatic, tiring, and challenging – and to a degree yes they were. But as I sit here, with the news on in the backrground hearing stories of soliders being blown up in combat, civilians fleeing oppression, families loosing their children to dog attacks, I feel very very grounded again. And thankful.

My day was hard, yes, but people experience days, weeks and years that are infinantly harder and painful.

It was just a day after-all.

On that note, find something to be thankful for and enjoy every single day.

See you next week,

Dr Nick

“The Greatest Threat to Human Health of the 21st Century”

That, ladies and gentlemen, is quite the statement, isnt it?

“The Greatest Threat to Human Health of the 21st Century”

But what is this threat you might wonder? I imagine some of you may think it war, natural reasources drying up, mass migration, or massive rise in diseases that we can no longer treat. In a way, you are all right. Quite simply the global climate changes that we are seeing have the real and credible potential to trigger all of those issues we dread – and more in fact.

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Now, if like me, you may read profound statemennts like this all the time in the news paper headlines, and after a second or two of “oh that sounds bad” thoughts running through your mind, you crack on with your day don’t you? I know I do. For the threat isnt imminent is it? The biblical floods arent suddenly going to appear with, well, with Russell Crowe, beckoning your pet budgerigar onto his wooden ship that he built with Emma Watson, nor are you going to find a large chunk of arctic ice disrupting your school run as you drop off the kids. But this is the problem isnt it – a bit like the obesity pandemic that is engulfing us – we think climate change is a problem for the future.

It seems this problem is fast catching up with us.

According to the Intergovernmental Panel on Climate Change (IPCC) – the very smart people who are trying to save us from ourselves – this is a world-wide “threat to human survival, health and well-being”. I don’t know about you (and yes, I agree, it does sound a little like a line from Will Smith’s blockbuster, Independance Day), but that is a little terrifying. Suddenly, with statements like that, I start listening. What makes matters worse is that apparently 50% of this issue of climate change is down to what we as humans have done – it’s “anthropogenic” – i.e. we made it happen.

So what is the fall out from this? Well, according to the IPCC there are six major issues:

1. Increased scarecity of food and water

2. Extreme weather events

3. Rise in sea levels

4. Areas becoming uninhabitable

5. Mass human migration

6. Conflict and violence

I don’t know about you but none of that sounds particularly attractive a proposition. What I find alarming is that we are already hearing so much about the changes that are happening around the world – ice-caps melting, temperatures changing by what we perceive to be insignificant margins (but which infact destabilise the very eco-system we exist within), and freak weather – the latter of which we, right here in the UK, have born witness to over the past couple of years.

It appears, ladies and gentlemen, that we are at a tipping point. One that the IPCC states could lead to “a catastrophic collapse of interlinked human and natural systems”. This is not a problem for the future – this is a problem for right now. And THAT IS the problem isnt it – because we are all fighting something that is effectively blind, untangible and so insidiously slow growing that we lack the patience and resolve to wage war against it. That is not our fault, I would argue, as it is inherently in human nature. However, it appears that now we have to assume responsiblity for the invisible beast that we, to all intense and purpose, have created by our very own modern day, demanding, carbon-fuelled existence.

So, what can we do? I say WE in terms of the human race. I know, I know a very grand statement from a lowly junior doctor sitting with a cup of tea and a slice of key-lime pie (I made it last night – it was my best yet!) but still! Well, for one there needs to be immediate action as this is now, according to the IPCC “an emergency” and we need action at all levels: individual, family, society, political, and financial. We need to act as one global community not a group of disconnected, disagreeing, disruptive States. Maybe we should get Bono involved and get a concert going…Why set all these differences aside? Well, bottom line, as far as I can see it – if there is no earth to inhabit, these inter-State problems are irrelevant! There simply wont be any States.

Interestingly not only would changing the way we live help stave off climate change’s march to our removal as guests from this planet but, it may also make us a little healthier! Ok, putting on my doctor hat – here is the score: if we create and promote more active forms of transport, like cycling or electrive cars, we reduce the risk of cardiovascular disease, obesity, diabetes and cancer. The same goes for cutting down on red meat (and hence helping reduce demand on supply when climate change is making that demand harder to supply anyway). Furthermore if we were to use less fossil fuels, reduce carbon emmissions and so on, air pollution will go down – THAT means less respiratory diseases like asthma and chronic obstructuve pulmonary disease.

I know you will all read this and say yes, yes we know all this. This is where I bring out my favourite of the big guns – the “Knowing-Doing Gap” – We are know climate change is happening and it has devastating effects but still we don’t do anything or at the very best a sub-therapeutic amount to ot cause effective change. There quite simplu is a GAP! So, perhaps you make the tiniest of changes tomorrow. So what you may think. Well, imagine if a million people made the tiniest of changes together. That starts to add up does it not.

Let me help you. In return you help me. Then we can help others and others in return help us. We can all change. We need to change before climate change starts to know even louder on our shores. This isnt the rest of the world’s problem now – it is ours as well.

Now, with that in mind, I doning my rain-coat and going to find Russel Crowe to hitch a lift in the Ark….

Dr Nick

“No not Dr Mick…DR NICK…NO Betty!…I said DR NICK!”

Evening all,

Well talk about a change of pace!

This week I bid farewell to my job in intensive care medicine and said hello to my new job on the care of the elderly ward…average age 93 years…with a list of medical problems equally as long.

Now if intensive care was the Ferrari of medicine – exciting, sexy, shiney….Care of the elderly is a bit like that really comfy arm-chair you have – enjoyable, bit of an funny smell, pleasing for a while but you worry you might become part of it.

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It was, I must say a shock and I have a feeling that this may take a while to get used to. However, I have to say that after only three days on the care of the elderly ward, where I have the pleasure (and I do really mean that!) of looking after 17 lovely old ladies who have suffered a stroke…or two…well in one case…7 (She IS a fighter!)!

So as I sit back with a whisky (no, I have not suddenly metamorphasised into a 80 year old man…I am a genuine lover of the drink, as my regular readership of 3 – my mum included, will testify) and think about this week’s ‘changing of the guard’ if you like, I have come to see some very clear differences, that may in some cases, take a while to get accustomed to:

1. I have to shout a lot louder at my patients…or, at times, just put in their hearing aids
2. I have to talk about Frank Sinatra if I want to win their trust (I even let out a verse of ‘My Way’ today..)
3. Sleep is a patient’s favourite hobby.
4. Eating is their second favourite hobby
5. A clinical assessment requires deviations into stories about the war (which are fascinating, and humbling all at once)
6. A hot topic seems to be if I a) have a girlfriend b) am married and in one rather odd scenario c) “am one of those new age boys that likes other boys”…I clarified I was not the latter and that I was indeed unattached because, of course, I was “dedicated to looking after my patients” [reality: can’t seem to trap the right girl!].
7. The number of medical problems has jumped from 1 on ITU i.e. massive heart attack or over-dose, to 20 on care of the elderly i.e. ischaemic heart disease, hyptension, previous cancer, arthritis, depression and pulmonary fibrosis…on top of the stroke.
8. You have to repeat yourself A LOT…

Now in case you are reading this and thinking what a disrespectful young man! etc etc…let me re-assure you that this is all said tongue in cheek as I infact am absolutely have a ball with these old girls! They are such fun and so unbelievably sweet in the face of such challenges. Afterall what lays ahead for them and their families are the realities of getting to grips with the irreversible changes that the stroke has brought to their lives so suddenly – in a literal blink of an eye. It is a pleasure to be looking after and helping them.

Look at me, going all soft.

Ok, so we should probably digress to a little bit of science and medicine ever so quickly and talk about what a stroke actually is. A stroke in laymans terms (I by the way, operate in laymans terms) is the equivalent of a heart attack in the brain – ‘brain attack’ if you like. Its medical definition is an irreversible deficit in central nervous system brain function beyond 24 hours as a result of a vascular event. This vascular event may be in the form of a blockage of a brain blood vessel i.e. a thrombus (from a ruptured cholesterol plaque in a brain blood vessel for example) or a embolus (a blood clot from another source such as the heart in patients with atrial fibrillation which encourages blood clots to form, and which is ‘thrown off’ circulating around the body to end up blocking an brain blood vessel). A vascular event may also be, in 10-15% of cases, the cause – this is in the form of a brain bleed (a ‘haemorrhage’) such as in trauma or a aneurysm. Whether it is a thrombo-embolic event or a haemorrhagic event both lead to a lack of blood flow to parts of the brain causing a paucity of oxygen (i.e. ischaemia) as the brain is starved of oxygen and eventually causing an infarction – brain tissue death.

Where this happens in the brain will dictate what functional deficit will occur for my 17 lovely ladies. If the stroke for example happens in the LEFT side of the brain’s blood supply then the ability to move the RIGHT side of the body may be affected – and visa versa. This is because the brain controls the opposite side of the body that it is on. Weird set up I agree.

Stroke is a huge subject and I would like to come back to tell you more about it over the next few months – I am sure I will. For now, let’s not worry too much about the details and focus on what a fun few months I have ahead.

Right, it’s friday night…maybe I’ll put on some Frank Sinatra as I sit here drinking my whisky over the London skyline.

Have a great weekend.

Dr Nick