How To Nap like a Pro

The Nap

Life in the Mediterranean has got a pretty good track record when it comes to health. There’s the celebrated Mediterranean diet (which I definitely battle to achieve), active lifestyles, plenty of red wine – and the siesta. Now the siesta has been around for a while, with its origins dating back to when Latin was not just a GCSE subject. The Spanish translation literally means ‘nap’. Built into a way of life, the siesta is designed to battle the combined heat of the Mediterranean climate and the omnipotent post-lunch energy dip that inflicts the many.


Do they know something we don’t know?

You see, if we put a microscope over our non-Mediterranean lifestyles it will show a very different health landscape – high fat and sugar diets, economically-forced sedentary work-focused lifestyles, about two bottles of red wine too many each week, and definitely not enough sleep. To unpick all of this may see us here a while (and I have some redecorating that needs doing) and so what I’d like to do is chat about the nap and ask the question: is there science in the siesta?

Now it would probably seem a little remiss of me to talk about the nap without talking very briefly about its big brother – sleep. Time for a quick thirty second recap: Sleep is broken into a series of ninety-minute sleep cycles. Each cycle sends you from light non-REM sleep into deeper REM sleep before starting the cycle again. You may therefore have about 4 to 6 cycles each night. Of course, for you and I, these sleep cycles are often seamlessly continuous and form our traditional night of sleep. The reality is that many of us don’t get enough sleep and we’ll go into this more another day. For now, let’s look at how we can repackage that need for sleep – in a nap.

Now, being a doctor, I need to make things very simple because otherwise I will invariably struggle, I assure you. As such, for my benefit – and I hope yours, let’s first establish by what we mean by a nap, by properly defining it. A nap is a short period of sleep that affords you that transient detachment from your conscious mind and body. Like most factors that affect our physical and mental function, the nap has been pretty extensively researched. The research has concluded some key functions of the nap for you:

  1. To enhance your ability to process information and consolidate learning
  2. To reverse a state of information overload that you may be experiencing
  3. To reduce your risk of cardiovascular disease (don’t ask me how – likely multiple factors at play here)
  4. To increase your levels of alertness and your motor (i.e. muscle) skills
  5. To avoid experiencing a ‘burnout’ which presents as frustration, irritation and reduced physical and mental performance

Before we dive into the two different types of naps I am going to drizzle just a little bit more science over our Mediterranean nap plans. You see, during a day your brain constantly absorbs and processes information. That will of course vary depending if you are, for example, in a mentally complex and demanding work state – or sat on the sofa, in your pyjamas at three in the afternoon with a re-heated pizza slice (it’s your workout ‘rest’ day, I know) watching Bargain Hunt. Anyway, we digress – back to the science. Now, a part of your brain called the visual cortex will in turn slowly become saturated with information from your day as it is continuously tested and engaged mentally. Similar to a muscle in your body, it reaches a threshold where it no longer can function effectively. This is your big knocker banging on the burnout door. This burnout threshold however is not all bad, particularly if you can recognise it in time. Just think about that point as the safety mechanism, a way of your body saying “whoa, buddy just take your foot of the peddle for a minute”. In doing so, you’ll allow your brain to process and preserve the information already there and not waste new incoming information that has nowhere to go and cannot be consolidated. That is where sleep, and as a short-term solution, naps come in as a means to cement that final stage of learning and processing.

So how do we get a that necessary mental ‘chill pill’?

The first type of nap is your classic power nap. The power nap is a twenty-minute short sharp nap that is long enough to take you into the early shallower stages of your sleep but not into deep (REM) sleep. It’ll afford you brief physical respite and allow that mental pressure value to be released in order to let off some steam. This way you can wake from a power nap feeling physically and mentally refreshed and ready to tackle the ongoing challenge. Remember though, it won’t be long enough to cement and consolidate any learning – you need deep REM sleep for that – and that’s where your second type of nap comes in.

The second nap is called the consolidation nap. The consolidation nap is a longer nap of around ninety-minutes that potentially takes you through a full sleep cycle via deep REM sleep. The beauty of this longer nap for you is that it allows for your brain to undergo what they call cortical plasticity. This, in a nut shell, means memory and learning is cemented on your brain. Of course, beyond this, the other mental benefit is that while asleep your subconscious continues to process your problems in the absence of all that conscious background noise that fills your life. That’s why you sometimes have those Eureka! moments after a nap. I am of course, still waiting for mine.


The bubble had to burst some time. Writing this I know for all of us, the above is all well and good – in theory. In the real world, we all often have busy hectic, insatiable lives that don’t afford time for twenty-minute (let alone ninety-minute) naps. We also don’t have a Government (unless you are reading this in the Mediterranean somewhere, in which case you have probably just woken up from a wonderful enforced nap) that endorses the siesta. I for one cannot imagine my medical practice suddenly demanding I nap each day – despite teasing me day in and day out with a patient examination couch that could definitely double as a nap worthy bed. We have 24 hours in our day and still that is not enough time for us to do all what we want to do.

There’s the rub however. We need to be malleable, adaptive and smart in finding ways to go about our days so that we can implement physical and mental performance enhancing measures, like the nap. After-all in the long run it is better for your performance and your health. It is also in theory, more efficient. And anyway, who doesn’t love a nap. So, consider ways in which you can incorporate a nap into your life. Perhaps it will be task and time specific, for example when revising for exams or doing a weekend of interview or meeting preparation. Or if you have the time, add in one long nap a week, perhaps after work mid-week to just re-charge.

The magic bullet? Well, if all that fails, good luck and move to Spain.

See you next week.


@DrNickKnight (Twitter)


Your Life Lesson from a 6 Week Old Baby

Well here we are. Forty-eight hours into being a GP registrar and I still have a licence to practice. TICK. All my patients are still alive. TICK. My colleagues still like me (I think).  TICK. I’m still rolling with the Lycra. TICK. Time to make hay while the sun shines.

Of course you and I know this will only last a certain while. After all, life – real life not Hollywood life – is also about the curve ball, the surprise, the unannounced.

And with that in mind, let me tell you about my youngest patient of the day –  a little man just six weeks old. I mean, Love Island was on for longer than he has been alive. He came with that fresh book smell we all love, and naturally had attached to him a two attentive first-time parents who had bought enough from MotherCare to prop up any ailing economy.

My task of this 15 minute appointment – the six week baby check. It’s a head to toe job where I basically make sure this little man has been put together properly. Thankfully I have done this before; Not quite an ‘old hand’ but not quite a ‘popping to the loo to Google “how to check a baby”‘ situation  (there was a time, yes).

To the tune of my lazily scraping chair (my legs are feeling the cycle ride today), I get up and grandly announce for them to strip their baby down and put him on the examination couch. They get to it like a pair of eager army recruits, peppered only with the under the breath exchanges of short, terse words as dad struggles to negotiate the Panda themed baby grow – fully aware that my judgement of their parenting hangs on the very task. I tap some notes on the computer while quietly enjoying the mini-domestic unfolding. Two minutes later, the little man is prepared and I step up to the mark. Game time.

As I stare down upon him sprawled on the examination couch, all pink, chubby and squirming, I can’t help but think how happy he looks. Not a care in the world.large

How your luck can change, little man.

Like a burst water main his own ‘little man’ suddenly kicks into action and he starts to pee. I have never seen something so remarkable. He has managed to pee in the perfect arc – enough to rival one of Mother Natures rainbows –  launching it over his body and straight onto his face. Instagram would have loved this.

The expression he gave was golden. If I could paraphrase on his behalf, it would have been “W.T.F”. If you don’t know what that means – good on you – that’s clean living.

And so in that moment it reminded me of a valuable life lesson. Sometimes shit just happens. I mean this little man didn’t expect at that moment in time to get a face full of urine – especially his own. But he did. Likewise we don’t expect to fall ill, get dumped, not have the level of fitness we did 10 years ago, or realise one day that we don’t fit into our jeans anymore. But we do.

It is however, what happens next that counts.

Do you stand up, dust yourself off, learn from it and move forward? Or do you bathe and wallow in the fact that something bad happened and fail to even try to move past it? My humble advice – think like my little man in clinic – he took it in the chin (literally), had a bit of a cry,  some milk and then had a nap. By the time he has woken up, he’s shaken off the experience and is onto the next adventure.

Maybe we should all take a leaf out of his book when life urinates on us.

See you next week.


Twitter: @DrNickKnight

First Impressions are Difficult in Lycra

So this is it. Twelve months time and I will be, barring an catastrophic cock-ups on my behalf, a fully qualified GP.  My wife is thrilled – it means we may be able to finally upgrade from the Citroen C2 – which while a spritely 1.1L car – does feel a little bit like forgetting your P.E. kit and having to borrow the cast-offs from the lost property box. Sorry, Citroen.

On the plus side, my final twelve months are in GP surgery within cycling distance. Sorry Citroen – you’re dumped. On the morning of my first ride to work, inspirational thoughts of Sir Chris Hoy, leapt into my mind. He really rocked the lycra. After then staring at the exceptionally pathetic state of my cycling lycra collection, those same thoughts leap out my mind. Replaced was a steely determination that swept over me (last experienced when tacking that stuck ring pessary in clinic), and after a few sharp inspired breathes, conjuring of warm thoughts (for the sake of my own dignity), I wrestled into my lycra.

Thirteen miles later (it’s actually only 11 miles away from home but I got lost – twice), I arrived at my new GP surgery. Home for the next twelve months. I’m excited. The bike locked outside, I took a moment to whisper some inspiration words to myself – “don’t kill anyone on your first day” (extremely difficult given that I just observing this week) – and stepped into the surgery.

Now they say first impressions count.

I really hadn’t thought this through.

A first impression that says professional, diligent, and presentable – are a real stretch when you are standing in front of your new boss, two receptionists and the surgery clinical manager dressed in what can only be described as a gimp suit for wayward cyclists. A fatally placed water splash mark from my (cold) water bottle over the groin is the sucker punch.

Like anyone caught compromised, I realised, on the balance of things, that I had two options; Apologise profusely, trying to explain the series of unfortunate life (and faulty water bottle) choices that led to these lycra choices and regain some impressional ground back – or, pretend like there was absolutely nothing wrong and, that this is just the way I roll.

I, ladies and gentlemen, chose to roll.

Next week I begin to see you – the patients. I cannot wait. Let’s enjoy the next twelve month adventure together, shall we?


@DrNickKnight (Twitter)


THE HEALTH CONVERSATION: Prologue and how to use my book

The Health Conversation: My online book for everyone

By Dr Nick Knight



This is a book for everyone.

I have written it with a mere personal hope to remind, refresh and recharge the actions that we may take in life and which influence our health.

Be rest assured that closing your eyes and listening to whale music does not feature.


About the Author

Nick is a 34 year old doctor training to become a General Practitioner with a special interest in fitness, exercise and lifestyle health. He currently lives in London with his new wife, Jess. They both dream of escaping to the countryside one day and getting a dog called whisky. Nick, incidentally, also likes whisky.



Please consult your General Practitioner before enacting upon any of the advice or descriptions in The Health Conversation. This book is written for everyone but health prescription needs to happen on an individual basis.




Prologue: My Passion

How to Use This Book

Modern Living

What is Health?

Key Tools

Twenty One Conversations for Twenty First Century Health:

Conversation 1:                Age as a Barrier

Conversation 2:                Alcohol

Conversation 3:                Bodyweight

Conversation 4:               Celebrity

Conversation 5:                Death as Part of Life

Conversation 6:                Diet

Conversation 7:                Exercise

Conversation 8:                Existing Health Conditions

Conversation 9:                Family Empowerment

Conversation 10:              Internet

Conversation 11:               Mental stimulation

Conversation 12:              Mood

Conversation 13:              Sedentariness

Conversation 14:              Sexual Relationships

Conversation 15:              Sleep

Conversation 16:              Smoking

Conversation 17:              Social Respect

Conversation 18:              Stimulant Drinks

Conversation 19:              Stress

Conversation 20:              Teamwork

Conversation 21:             Technology Drain

A Quick Reality check

What to Do Now?

Summary of The Health Conversation

Appendix 1:                       How Doctors Diagnose

Appendix 2:                       Snapshot Health Card


Prologue: My Passion

I often wondered what a prologue was. Yes, I am most certainly not going to pretend to be clever enough to know already. Thanks to the Internet (which we will discuss in all its shades of grey later), I now know it to be an act or event that leads to another. Here is my prologue – from garden hole to GP trainee.


It all began when I was a kid. To me, playing was largely defined as throwing my battle-scarred action-figures on their latest mission into some cavernous muddy hole (that I had joyfully torn out of the wonderfully manicured garden-bed that my parents had slaved over), and then dunking them in some ice-cubed filled water pit. Little did I realise that this was the start of my fascination with the human body. You see, deep down, apart from the subliminal messages I was sending my parents (clearly I wanted a pond) I was asking my action figures to ‘survive’ in extreme and challenging environments. I was asking them to push their, albeit plastic, physical abilities and mental strengths to their very limits. I was, I guess, concomitantly testing 1990s Chinese manufacturing durability.


Now that passion, to explore the human body and mind, it seems has never left me. In fact, 25 years on, that child’s play which saw me constantly muddy and sacrificing toys to huge garden holes, has grown into my career. And I bloody love it. You see after three long degrees including a degree in Sports and Exercise Science, a PhD in Performance Human Physiology and finally a degree in Medicine, I now work as a doctor in specialty training to become a GP by 2018. I should add that this was never the plan. I chased a girl to Oxford to do my PhD (she then dumped me a month into being there). I then only went into medicine initially after a stint in the City, where I fast realised I a little too rough around the edges to cut it or enjoy it. I wanted to roll my sleeves up and have an adventure.


Ok, so it is true that all my patients might not have just escaped from some muddy garden hole (though I’m sure it happened in a movie once) or bucket of ice-water but what’s happening to them is not a million miles away – their bodies are being stressed, attacked and challenged – this time however by disease, illness, trauma and the degenerating chronicity of their health. And you know what, this isn’t anything that new; Thousands of years ago Neanderthals had similar problems, and then some, in the form of hunting huge carnivorous animals with a bit of sharpened wood. No thanks.


Nowadays and exponentially more so since the supercharged and flamboyant arrival of the 21st Century, a new problem is thrown up: choice. Choices are all around us. It is these choices that are leading many of us blindly and unwittingly into health troubles. We have our modern day health enemies, hidden as wolves in sheep’s clothing, like as our dear and old loyal friend the television remote, fast-food on every paved street, and a pathogenic and inherited fear to break a sweat with some exercise. Trust me when I say that if our bodies had a voice these would not be the choices they would make. That is the thing though isn’t it. They, our bodies, do have a voice. They are making their statement of intent and distain at what we are doing to ourselves very well known: heart attacks, type two diabetes mellitus, obesity, depression (yes, depression) and chronic lung disease.


Of course luckily for us we also live in an era that celebrates unbelievable advances in scientific research that filters from the laboratory into our everyday lives, and developments in medicine that allow us to identify, treat and prevent disease better and earlier than ever before. And you know what, for me, it’s that fine balance, that personal artistic interpretation between the wise, the not so wise, and the dam-right stupid choices we make in life, combined with our pre-determined genetics and those life events that just happen, that make you and I just so fascinating to explore.


I feel incredibly fortunate to be a doctor. We have a privilege to go beyond the looking glass and step into and affect (hopefully for the better) our patients’ and their families’ lives. With that comes a responsibility, one which I take very seriously. This book, I hope will reflect that, and too reflect my passion for health. It is just one way in which I wanted to share what I have had the privilege to learn, see and experience as a doctor in his early years.


Right, so serious paragraph aside, how do I want to wrap up my first ever prologue? Whether it’s the science behind our health, or how medicine helps us battle and beat disease and disability, I admire the human body. It transports us into a hidden world full of life, death, adventure and struggle that rivals any Hollywood Blockbuster.


And for me, it all began with one plastic toy and a garden hole….



How to Use This Book


“Whether you think you can, or you think you can’t – you are right” [Henry Ford]


This is a book talking to you about every day issues which influence your health. It’s a mix of my opinion, observation, rant and information. That’s it really. There is I promise, no hidden agenda, no magical secrets revealed to lead you to everlasting good health and no hidden message. It is not a Sudoku puzzle of health but should instead be Ronseal™ for health i.e. it does what it says on the tin.


As such I have written The Health Conversation without any long scientific, medical or encyclopaedic rambles. It is instead written largely from my memory (which is not great, I must confess) using the last 15 years of experience I’ve been fortunate to have across science, health and medicine. This calls upon what I have learned in academia, anecdotally experienced myself, seen in society, and learned inside the NHS.


There is too very good reason I have chosen to write it this way. And no it is not because I couldn’t be bothered to drudge up the umpteen oversized (and overpriced) medical and scientific textbooks that now live in my basement cohabiting in unison with the mould that is slowly over taking it but it was rather a genuine conscious choice to leave them there. You see by doing this, the detail and depth of information I hope to provide will stay true to my goal of delivering digestible, simple conversations about health and the issues surrounding them that we all need to be aware of. In keeping with this same theme, I have deliberately renamed the chapters as conversations and kept them short and snappy at to three pages or less. Let’s be honest, if I can’t summarise in three pages what you really need to know about one of these topics I’m not doing my job of delivering digestible information! Besides, who really wants to read a 4th, 5th or even 6th page about smoking or exercise?! I know I bloody-well wouldn’t. If I wanted that, I’d go back to medical school again. At the end of each conversation I’ve included 5 key takeaway points.


So that’s my part of the deal. What do I ask from you in return? Well, first of all I want you to treat this book like that friend who’s not quite on your Christmas card list but you see them occasionally for coffee (when it’s convenient to you and you’re at a loose end). By that, I mean pick this book up, put it down, dip in, and dip out. I want you to enjoy it when you read it but not be burdened by it. Of course, it may also be that not all of the health conversations are relevant for you – in which case, please don’t read them and do something more fun instead. Perhaps on the other hand, it may be that a particular health conversation is relevant to a family member or a friend. If this is the case, pass them the book with the chapter ear-marked for them.


Now I only have two requests to seal this completely unofficial and in no way legally-binding partnership between you and me. The first is that you must have hope. Jokes aside, we all possess the ability to fine-tune our health. Just consider that quotation by Henry Ford at the top of this chapter for moment; it’s about self-belief isn’t it? That is the reason why it’s my favourite quote. For self-belief is fantastically potent and contagious and has the ability to transform our lives and those around us. Whatever your goal, perhaps triggered by your doctor’s orders, your parents’ comments or just something you see in the mirror that you are not happy with, you can achieve it. Don’t listen to any silly bugger who says otherwise. So please, that is my first request, that you have hope. It costs nothing. The second and final request is please be patient. Things do not happen overnight. If you can overcome this, the greatest adversary to any goal known to human-kind, you will in time, achieve your goal.


So that’s it. If you can have hope and be patient then this book may help provide insight, direction, and support to you as you go about achieving those health goals that you yourself decide to set.


Before we launch into the twenty-one conversations that form the body of The Health Conversation, I want to talk to you about a three matters. The first matter to discuss is the many challenges that modern living has unceremoniously thrown in our face (while supposedly enriching our lives) and how these have affected our overall health. The second matter involves asking you to consider what health actually means. Yes in the first instance this is a seemingly simple question but actually I think it’s more complex than we may first think. Finally I hope to provide you with three principles (the knowing-doing gap, self-motivational interviewing, and the contemplation cycle) that I’d like you to have in the back of your mind as you thumb through the various health conversations.


Remember – don’t think too hard as you read this book. It’s designed to inspire not give a headache.




Have a great week, all and please come and say hi on twitter and share this blog.



Familiarity: The Double Edged Sword to Our Growth

Familiarity is quite simply knowledge of something. That can of course be for better or for worse. I mean, I am familiar with how I feel with my 6am alarm but that doesn’t mean I like it. On the other hand, I am familiar with that wonderful feeling that I have when I take my first sip of morning tea to start the day. The thing is, in order to be familiar with something, you have to experience it repeatedly. What I want to talk about is that sensation of unfamiliarity and how we need to stick with it so that it does become familiar.

Now being a doctor definitely has its downsides. One of those big downsides for me is unfamiliarity. I, along with all the other doctors that go through their medical school placements and then their speciality training rotations will encounter this. For me, it is made all the worse because I am always, unequivocally lacking in my confidence as I start a new training post. So there I am, every 4 months – starting a new unfamiliar training post with no confidence. It is such a pain in the arse and very much a ground hog day experience until I fully quality as a general practitioner – and then, onto Sports and Exercise Medicine!

So let me give you an example; at the end of July, I would walk onto the gastroenterology every ward – a familiar ward, my medical stomping ground, knowing ever little corner of it, the staff, where I can hide my coffee without my being told off my the ward sister (aka the boss). I was comfortable. I was confident and that translated into how I felt about the medicine I practiced. Fast forward into August and I can’t even find my way to the paediatric ward. I don’t know the staff. I don’t know the expectations of me in paediatrics. In fact, I can’t remember the last time I spoke to a child. I don’t even try and hide my coffee because I’ve spilt half of it down my trousers. So, when I do finally arrive for my first day I am not only late but appear to be incontinent. In short, I was in unfamiliar territory.

As type this I have just finished a week working my 9th week in paediatrics. I can now navigate a babygrow effortlessly having conquered this, the rubix cube of the garment world, I have resuscitated babies and I have dealt with unwell children as part of the paediatric team. I no long wear my coffee on my trousers but in a mug – with its own hiding space. In essence, I am now familiar – and happier for it.

So why am I am talking about familiarity? Well, it’s something that affects us all. It’s also something that grows and evolves with time – and as it does, so often does our confidence, knowledge and application. And that is why we need it! We need unfamiliarity to stretch and unceremoniously push us out of our comfort zone. That, afterall is where we grow. Stay in familiar territory for too long and we stagnate. Nobody wants to stagnate!

My worry however is the period before we feel this confidence and the risk that many of us let our heads drop, let our motivation wain and we quit. I have definitely been there with my career in medicine – constantly taken out of my comfort zone, constantly questioning my ability, and constantly considering leaving medicine. But you know what, every time, and I mean EVERY time, I get through that period of unfamiliarity – and in its wake is familiarity, more confidence and more application. Now of course, yes, like I said in the beginning, it’s not always ‘nice’ familiarity. But you know what, even then I learn how to deal with it – and soon It is no longer a surprise and is an opportunity to adapt and evolve. Afterall if you cant change the situation, change the way you well about it.

I hope that if you are reading this, you to decide to stick with it, to get past that period of unfamiliarity and know that you will get into that familiar zone with progression, knoweldge and application at your fingertips.

And don’t forget – after a while, dip your toe into more unfamiliarity. It’s how we all grow….


The Mystery of the Hole in My Lung: The Doctor Becomes the Patient!

It was precisely 20 days ago that I was at work. It was a Monday morning and I had just finished a busy weekend admitting medical patients from A&E. The Sunday was slightly trickier than usual – I felt like I’d slept in a funny position and my right ribs ached. Still, nothing like a steady stream of patients to focus the mind, and so on I cracked for the 12 hour shift. That night when I got home, however I could hardly breathe. Bent over double on the bed, panting like an expectant mother, I looked to my girlfriend with a glance that said “What the hell is all this about!” I am after all a fit, young(-ish) 32 year old with no medical issues. After failing to convince me to go back to A&E at 1am that morning – my argument being that I’d just spent 12 hours there and I am under no circumstances going back tonight – some knock-me out painkillers, shot of whisky and the classic of all medical inventions – the hot-water bottle (thanks, Mum), I fell asleep….albeit with a breathing rate of 30 per minute.

The next morning things were no better. Being the stubborn mule I am, I still refused to go to A&E – after-all we were short of team-members on the ward. Sadly however, once my registrar saw me hunched over like Golem from Lord of the Rings, puffing away at 30 breaths a minute, I was sent packing down to A&E. I had failed.

Now there are not many perks to being a doctor. With that said, that Monday three weeks ago, I was exposed to one of the greatest cornerstones of the NHS – comradery. You see as soon as I wondered down into A&E, had a quick word with the A&E registrar on the shop-floor saying that I needed an X-Ray to exclude a collapsed lung (that, since I am tall and skinny – well I prefer athletic! – a spontaneous pneumothorax was the most likely cause of my breathlessness), I was whisked into an A&E cubicle. Over the next few hours I had seen 2 A&E consultants, 2 A&E registrars, had a chest X-ray and CT scan, been squeezed into a respiratory clinic that afternoon to be seen by a Respiratory Consultant, and had the on-call medical team drop in to see if there was anything they could do. I was utterly humbled by the togetherness and sense that within the NHS, we look after each other. Now I say all the above not to anger people – and I appreciate some may dislike the fact that I had what is, yes, preferential treatment – but these people whom saw and treated me where my colleagues (for I had spent 4 months working in A&E) and my friends. Throughout the entire process, I spent my time wondering how I could repay them, to show my gratitude for their timeliness in treatment and kindness.

Now not one to be a debby-downer on the situation, let me tell you my two highlights of that day spent in A&E, CT scans and outpatient clinics. The first was the utterly bemused look on one patients face who saw me donned with a cannula in my arm, hospital gown on, being wheeled down the corridor – for I had been the doctor who had treated him only the night before! The second musing was the locum puzzled nurse (who didn’t know I was a doctor) who came in to see me in the A&E cubicle to insert a cannula, only to find me with my own stethoscope listening to my own chest, before defiantly stating that I will insert my own cannula thanks – though as it turns out that isn’t so easy, so I had him do it in the end. Being a patient was a huge eye-opener – you are devoid of control – something that as a doctor, I have a lot of. It brought a definite new respect for what it is like to be a patient. Plus, cannulas bloody hurt!

Anyway, we digress. It turned out that I didn’t have a collapsed lung. In fact it turned out that I had a 2.7cm hole in my right lung – described as a cavitating lesion. Now it is fair to say that this came as a surprise to the A&E team – and to me. What can cause a cavitating lesion like this?  Well, many things including infections like tuberculosis or a fungus. And yes, cancer can as well. This latter diagnosis kept me up for a few hours on that first night I got home befor, at around 4am, I decided that I should stop being an idiot – a 32 year old man who has never smoked, has no risk factors and no other symptoms of malignancy – does not have cancer. And so I put it from my mind from then on.


[CT Scan]

The initial X-Ray

[Initial Chest X-Ray which we expected to show a collapsed lung)

Of course we still didn’t know what it was. The reward for not knowing was an investigation called a bronchoscopy. This is a way to look into the lung and take some tissue to look under a microscope. Now the best way to describe it is this: picture sitting upright in a chair, a little drunk, and then having someone funnelling a slowly leaking hose-pipe down your windpipe and your lungs….all while telling you to “just relax and breathe” in a tone that would be a hit in any yoga retreat. Let me tell you, it is NOT possible to relax…and as for the breathing…well, you feel as though you are drowning. Thank God for midazolam. It was fair to say this sedating drug did its job – I didn’t even recall the first conversation with the respiratory consultant after the procedure.

Post bronch

[Post bronchoscopy – Oh course, I have no recollection of this picture. Bad hair day..!]

Of course from that day that I went down to A&E to get that ‘quick’ x-ray, I have not been back at work. Why? Well, if I did have tuberculosis, I would be a huge infection risk – particularly as I am now moving into paediatrics – and those little people have far weaker immune systems than you or I. As such, while the hospital doctors that are treating me wait to see what bugs grow in the Petri-dish to see if it is tuberculosis or something else, I have to be at home.

Three weeks at home may sound like a luxury. It was hell. I felt a fraud, lacking in purpose, lost even. You see I felt well in myself after a week of antibiotics and guilty that I wasn’t at work. It made me realise how much I value my job as a doctor, how it is part of my identity and that I love that. I am after all, proud of being a doctor and working with such brilliant healthcare teams. Although, it is true that I became a very good house-husband over that time, the itch to return to work never left me. And finally after three weeks of waiting and waiting, I have finally been given the all clear to return.

After all that has happened, two questions do still remain: what IS that hole in my lung? And how can I possibly thank all the people that cared so much for me while I was converted from the doctor to the patient.

Only time will tell…


The Greener Grass? Life in Primary Care Medicine

As I type this I can only describe a ‘buzz’  about me; physically and mentally I feel pretty good right now. I don’t mean to sound smug when I say that but rather just that I feel I have been on quite a tortuous journey with medicine and how it aligns with my way of life and desires for the future. I am more relaxed, happier, driven and my old self again – after probably 3 or 4 months of losing those aspects a little. Even my family tell me this – and as we are all aware, probably the majority of families know their children best.

So what’s changed?

The short answer is that I have moved out of secondary care medicine (that’s hospital medicine) for 4 months and am now working in primary care (that’s general practice). Life is very different for a doctor in primary care. Now although I am still very wet behind the ears in general practice, being stumped by how to treat Mrs Smith’s achy joints, or little Jimmy’s sore red toe after his swimming lesson – for I am used to patients with severe sepsis, widespread infections, acute heart failure, and massive strokes – I never had to worry too much about the less acute side of medicine.

General practice doctors are true generalists – and I envy their knowledge. It is so broad, so encompassing, that they have to know a little about everything – both the chronic conditions, such as Dementias, Parkinson’s Disease, Chronic Heart Failure, Diabetes, and the acute conditions such as recognising meningitis in a sick child. To make this all more challenging – they typically have about 10 minutes per consultation to take the history, examine, diagnose, and make a plan – whether that be for further investigations or management. And they do it all without the support of investigations on their doorstep – you can’t get a ‘quick X-ray’ or ‘blood test’ or’ MRI scan’ to see if they do have a disc prolapse. You have to use your intuition and experience.

This week, as it is still part of my ‘introduction’ phase of my rotation as an FY2 to general practice, I am doing joint sessions with a GP before getting my own patient list next week. This means that we are both in the consultation room, and take it in turns to sit in the ‘hot seat’ and lead the patient consultation with the other watching in the corner. This is great fun! However, what is beginning to wear a little thin is, during the times when it is my turn to sit in the corner and observe, the patient walks in and says “oh, you’ve got a medical student with you”.


I have to just smile, and usually say nothing and bite my lip. My poor lip – it has taken quite the beating this week.

I really enjoy the set up of general practice too – you get a nice big office which, as Louis from X-Factor would say “you can make your own!” and super-comfy chairs. And SO much tea.The training scheme too is more condensed that hospital medicine (though I do appreciate for the ‘patient’ that this may be a less than favourable situation) and so you are qualified much sooner – with a lot more flexibility.

Now I have spent a lot of time reflecting this week about that word – flexibility. I know that I my ambitions are slightly skewed compared with many junior doctors for I not only want to be a good, safe doctor first, but I want to write about health, do some sports and exercise medicine, get more into media work (for the love of talking about it not the public eye status, I should add), and also some expedition medicine. This globally is within the context of having a family – most importantly for which, I have time for. General Practice is the ONLY career path (beyond leaving medicine altogether) that would allow me to do this. I will stand to be corrected on that…

That is food for thought and something that I need to mull over in the lead up to choosing my career route. The deadline for that decision, out of interest, is this November – so not long to go. I feel I know what is the most natural decision to make but I will talk it over with my family first – they are often my voice of reason!

This week I also got a better understanding of what a GPSI is. Now, pronounced “GYPSY” , I never really quite got why all these GPs had such a strong affiliation with the Gypsy community…and then I discovered that is stood for GP with Special Interest. Oh. As my mum would always (and still does in fact) – for someone seemingly smart, I can be very stupid. I cannot disagree. In the practice that I am at currently, we have GPs with special interests in maternity, diabetes, genito-urinary, musculoskeletal, and dermatology. I could be a GP with a special interest in Sports and Exercise Medicine.

I like the sound of that.


Needless to say after a relaxing weekend seeing friends, going to the cinema (Expendables III, oh dear), and some reflective walks through Battersea Park, I feel very good about things. I am looking forward to hitting the GP practice tomorrow for another good week. It’s a busy week too – I have to finish another article for the Independent, and I am doing my final filming session for the Discovery TV show called “What Have I Got” – more on that perhaps another time. All in all, life is good.

Have a great weekend everyone,

Dr Nick