Why working with doctors can induce hypertension.

Whenever my Manager at work asks me to go to the ward to set up a patient with overnight ventilation treatment, I internally groan. This reluctance is the direct result of a combination of three things:

1. The patient is too ill to comprehend, hear or understand what I'm saying. In a role where communication is key, having difficulty channelling information seriously sets me back, normally on time (and sometimes on patience). I don't have anything against ill patients, most of them are lovely people, but when you've already been rushing around all morning and stressed all afternoon; facing challenging patients is the last thing you want.
2. The doctor is annoying. This has been the case usually. I have worked with only a small range of doctors, but in each one I found something to get annoyed at. If it wasn't egotism, or mismanagement, or even ignorance, then it was definitely the doctor's negligence towards the patient's mere presence, if not mine. I remember one actually talked about how I was going to do my job without even introducing me to the patient or the patient's translator. Actually there was one that I found tolerable, and that was because he didn't say much but actually asked questions as opposed to acting like he knew it all. 
3. The patient has run away smoking and no one in the entire hospital can track him down, even after several hours of absence. 

My ward work this week had to spread over 3 days. The first day I was told by my Manager that a patient at a different hospital needed an emergency sleep study done. Normally we don't do such things as the studys need to be booked in advance as the sleep centre only have a limited number of ambulatory recording devices used to study the patient while asleep. However the patient was moved to our hospital and I was sent to wire him up. A consultant had demanded it be done, so it was done, and done it was. So I went, and did it, but I felt sorry for the patient because he had to be wired up 6 hours before he actually went to sleep. The patient, thankfully, did not complain.

The next morning I removed the wires and immediately analysed the data. What I saw was one of the most severest forms of obstrucive sleep apnoea I had ever found, it was right up there in the top 3 most severe OSA cases I had ever analysed (Oxygen saturation level would drop into the 50% range occasionally). Poor man, I couldn't even imagine how he lived! I talked it over with the consultant a few hours later during which he spoke to the registrar on the ward, five minutes later a request form was placed into my hands to set the patient up on treatment. I told the doctor in the same instant that I would be at the ward before four pm. This was at 14.30.

I get to the ward in a rush because I had so little time and so much to do, but I reached the ward at 3.35. I went to the patient' bed to find... a bed. No patient either ontop, beside or under it. I searched the room thoroughly.

I ask the doctor 'Where is the patient?'
She replies, very nonchalantly 'Oh he's at the eye clinic' and proceeds to call the eye clinic immediately. 'How long can you stay?'
'5 minutes.' I say, not being annoyed yet as I'm thinking of getting home in time for my driving lesson (which got cancelled due to drained petrol stations).
'The patient's on his way up.' said the doctor when she finished talking to whoever was on the line.

So I wait for the patient, 5 minutes later and I remember that I told the very same doctor that I would be down before four... so why did she send him away???? 10 minutes into the waiting game and I tell another doctor (the registrar) that I am  leaving and that I had warned the doctor previously of when I would be arriving. I don't normally like the registrar (he explained a patient was dying to me right in hearing range of the same patient) but he was sympathetic and asked if there was anything he could do.. maybe he could set up the patient on a ward CPAP? I declined politely as I honestly did appreciate his sentiment; saying the patient wasn't going to die without one night of treatment.

Guess what the registrar did?

The next day I called the ward in the morning, saying to God knows whoever I was talking to, that I wouldn't be able to come in the morning as I working two people's shifts (understaffed should sooo be the NHS middle name), I would be there in the afternoon.

I manage to get there in the afternoon. I knock on the patient's room door, to get no reply, I knock a little louder calling out a subtle 'Hello?'. Getting nothing, I walk in warily to find the patient snoring, fast asleep; a clear sign of symptomatic OSA. When I woke him up, the first this I hear is a complaint about the ward CPAP, how it was uncomfortable and how it was at such a high pressure he felt like he was choking. I restrain myself from shaking my head. There is no point saying 'No' to a doctor.

I set the patient up on long term CPAP and I quickly understand the patient has not been given any details about his sleep study results. So I give him a brief overview; warning him that he might not want to hear the figures. But bless, he was as excited as a golden retriever and even fetched a pen and paper; enabling him to write down what I said. I spent nearly an hour with him, he told me of what appeared to be the doctors emotionally blackmailing him into using CPAP and about how he was at risk of stroke... bla bla bla.

You must understand that the main complaint of this patient was severe headaches... Considering that a sign of OSA is headaches, even when the O2 saturation level only drops by 7%, that a pretty bad headache might appear when the sats drop by 20% for most of the night and 40% for the rest. But no, further investigations were carried out during the course of the day and the patient had to have three (possibly unneccessary) lumbar punctures to analyse CSF. Oh how I felt for this poor man.

He was to be moved back to the former hospital by the neurologist's command for extra tests. Maybe I'm being too blase, maybe this man has an intracranial tumour, I don't know and neither do the doctors. But shouldn't a painless investigation be considered and done before more invasive ones like lumbar punctures If the evidence suggest so? I don't mean to sound arrogant, but I'm pretty certain his severe OSA is what is causing his headaches, so shouldn't the patient be left to try out the treatment in peace????

Arrrgh... the pain... the wasted money... the politics of it all. So silly.

The Woman in Black

On sunday I watched the Woman in Black with a friend when we had arrived too late at the cinema to watch The Artist.
'You do know it's a Horror' warned my friend.
'Bah, It's Daniel Radcliff, I'll laugh throughout it' said I, waving her off while paying for the tickets.

I did not laugh, nor did I scream, I just simultaneously gasped and stopped breathing. That was when I was actually watching, which was 70% of the time, the remainder of which I sat as far down in my seat clutching my friend's hand and cover my eyes with the other. She wasn't much help when I would ask what was happenning as she was covering her eyes too. 20 minutes into the film, I was dying for it to finish, literally dying, if my tachycardia and stalled breathing had anything to do with it. I tried to calm myself by thinking of Radcliffs wooden laughable acting in the first Harry Potter film, I guess he can actually act now.

Hence, I cannot say I enjoyed the film, or the notion of a Horror movie. Why any sane person would voluntarily pay hard earned (or government protracted) money to be scared so far out of their seats that their heart stops, is beyond me. I theorise it is why we enjoy Rollercoasters and being chased by raging bulls: the need for adrenaline. The need for it to interrupt our normal boring modern lives. Is has once been said that due to adrenaline playing such a deep role during the time of hunter gathering, being pumped with adrenaline is a requirement linked to our evolutionary ways. I personally can do quite well without horror films, rollercoasters, or bulls. So I stubbornly hold the opinion that the world is actually upside down because there is still a market for horror films.

Perhaps I am not being fair to the film... No I am not. I thought it would be a beneficial experience despite the horror as it was based on a famous novel and set in the turn of the century. The film was based on the typical horror plot: psychotic woman wanting revenge for her dead son, bla bla bla. I honestly think society needs to rethink its stigmitism with 'The Mad Woman' I mean.. there's never a 'Mad man' its usually a 'Drunk Man' but lately there have been more 'Drunk Women' too.

Lets consider the literature that deals with mad women: The Street Car Named Desire, Jane Eyre, The Woman in White and Madam Bovary.

It's safe to say that it's usually woman that get mad in literaure, and perhaps their use by horror films is a tad insulting to mad woman, they are poeple, perhaps not with sound judgmental capabilities, but still with the capacity to feel offended. Madness comes in many shapes and sizes, it is very rare that a mentally unsound person is barking raving lunatic that thinks of she jumps high enough she will reach the moon. Mad people can be quiet, and they are usually the ones you should keep your eye on.

So, The Woman in Black's Mad woman is not your usual mad woman, she screams constantly, and it can get annoying after a while. People in unrest don't scream like they're being electricuted, they shift their eyes and breath heavily. Urgh.. I'm ranting.

At the end of the day, I did not gain or learn anything from watching The Woman in Black except that the Victorian notion of a Mad Woman still maintains its strong grip in our social psyche today.  Good points are that it was well directed a it did propell my heart into my throat. So as a horror film it did what it had to do and did it well. I just think that it was all pointless and belittling to those with mental illness. And come to think of it, it's an insult to mothers! Mothers who have felt what no parent should; of having to bury their own child would never wish the same pain on other parents! Let alone making other children kill themselves! Gah! The whole thing is messed up!The Woman in Black is a film that screams to me that modern society have an undeniably incorrect idea of what mental illness is.

Driving Lesson 5

I can stop the CAR!!!! Isn't that wonderful! But I apparently accumulate more problems than what I solve. This involved 'shaving' the parked cars, a translation to the term 'shaving' is getting so close to the car you could hit their side mirrors if they were open. Which I very nearly did do. I also nearly hit/killed three teenage boys as they came out from school... that was because I had been driving too fast while steering left.

But I can stop the car! Of course it took me a while to do so without panicking. I only drive onto the curb and stalled once! Improvement eh? But I can stop the car!!! I hope by next lesson to get it all today togther. It seems that my brain, ability to co-ordinate and multi-tasking levels are what are stopping me from getting promoted onto the main roads and third gear. The idea of doing 70 miles an hour on the motor way seems such a far off dream... or nightmare, but I hope to get there sooner than later.

TEDxImperialCollege

As a fan of TED talks you can imagine my face of excitement when I heard an independent TED talk was organised at my former University for the 24th of March 2012. You can also imagine how I felt when I realised I was too late to register for it. But thanks to God and a truly amazing person I managed to buy his ticket off of him when he said he wouldn't be able to make it. So I was back to being euphoric.

The only down side was that I had to wear a different name tag, a boy's name tag too, but thankfully he has a unisex name so I managed to pull off the identity fraud. I jest. I did tell the registry station the truth, 'legit' is my middle name after all.

It was a truly wonderful day with a fine tuned mixutre of former TED talk videos and actual live TED talks, there was also a performance of 150 year old sounds; played from magnificent genuine Gramaphones that didn't make much sense in the beginning but then you could finally make out the sounds of a steam engine. Unfortunately once the realisation was made the novelty died off and I think the audience (myself included unfortunately) were not able of appreciating the effort to play the sounds or the value of their preciousness due to a dividing phenomenon called MP3.

All the talks were interesting, some were relevent and some were truely inspiring. The first talk by Manel Tores was about Spray on Fabric that I heard of in the news a few years ago, yes it was interesting, but I felt Dr Tores' passion for the new fabric's capacity in the fashion world overtook the perhaps more sort of 'sensible' capacities in healthcare etc. I felt that the audience didn't share his passion for skin tight spray on fabric either. Perhaps the audience didn't share his enthusiasm because most of them were men, I know it's sexist to say that men are not interested in fashion, but most of the audience were imperial guys, and from my 4 years experience in Imperial, I haven't met one that was interested in catwalks.

The second talk by the ever inspiring Nick Sireau spoke of a rare disease that affects his two sons and how he and his companions strove to bring to light the diease's very existence and the importance in funding research into it. He named his talk 'Fundamental Diseases'  as it was found that research in to rare diseases (which don't get much publicity, funding or notice) aids in discovering how more common diseases work, such as osteoarthritis. His story, starting from the birth of his son and ending in the national recognition of the disease, was truly inspiring. It made me realise that parental love is not simply a tear jerky moment in some sad film where a father carries his dying daughter in his arms (Anyone watch The Woman in Black?), it is a drive to protect one's child against all odds of success, and it can work if you are proactive about it.

The third talk was about music and the genome by a polymath, stand up comedian and anaethetist called Andrew Morley. Honestly, I really didn't understand it, I got the genetic side, just not the musical and I think that's due to my own severly limited musicality. Somewhere there was supposed to be a point that was meant to reach me, which didn't. However, I think it was that different topics and different subjects of study can overlap and collaborate. But I'm not sure if that was it.

We had a break (muffins and fruit) then back to the Great Hall (my last visit of this place was for the enviable task of performing an exam).

Fourth talk of the day was by an enthusiastic gentleman called Michael Korn who spoke of his pull out screen or wall divider. A product that originated as an undergraduate project and developed into a reality. His talk was mainly aimed at designers and engineers, which I am neither (I am an artist and scientist). I felt Korn's talk was vital, because at imperial the main career direction you get is to sell your soul to the Financial industry and work forever in the city's investment banks. The essence of Korn's talk was not about his pull out divider, but that there is actually another way to career development for Imperial Graduates other than The Banks. Imperial say their Careers Advice office is one of the best, but when I was an undergraduate I just remember being lost.

Fifth talk was by Alexander Schey who described his team's success in driving an electric racing car through both of the Americas. I knew of this from television when the treck was being televised. It was inspiring, but forgot to mention that electric cars are truly and undoubtedly expensive which is why they still haven't become the nation's favourite type of car despite many attempts to convert the people.

Sixth talk was by a truly wonderful woman called Sofie Scott, and coincidentally the only female talker of the day. Before I veer off into a feminist rant I'll explain what Professor Scott described in her talk. It was mainly about her work in laughter and how it is a globally recognised tool of communication despite language barriers. The talk was an opportunity to learn why we have laughter and how important it is. I'm not sure if it has a medical significance but I'd definitly like to learn more.

Before the break (a.k.a FOOD!) John Graham-Cumming gave the seventh talk, a highly enlightening mini lecture on the history of computing, or more specifically the work of Charles Babbage; a semi mad man who had a passion for numbers and half finshed projects. He designed the world's first computer or 'Analystical Machine' or simply, a calculator. It naturally never got built because the man's mind was too busy creating more ideas, but the London Science Museum (my second favourite place in the world) later created it in order to demonstrate Babbage's work (I keep thinking of cabbages everytime I type his name down), the Science museum must have liked him because they also hold possesion of his brain. Graham-Cumming also described the alliance of Babbage's ideas with Ada Lovelace, Lord Byron's daughter (the only legitimate one), who could be considered the world's first computer programmer (my feminist level soared with pride at this moment) because despite having Byron genes, she had a numerate brain and wrote a book on Babbage's work.

The food came and went.

The 8th talk for the day was by an undeniably inspiring man calle THE Professor of Public art, the number of men of his species needs to increase in order for competition to drive them and formulate even more great works of public art as his talk inspired. From the title I had not expected much, but I did not know what to expect at all. What was described was a wonderful world never previously thought of before; simply works of art held in public; which are mostly statues with complex latin inscriptions. What Prof Shoben described was that it didn't have to be complex and historical but simple and straight to the point, inciting feelings like happiness warmth and splendour in the viewer. I honestly enjoyed it, I think his talk and field (though very different from my own background) has the ability to change the most difficult thing: human thinking.

The penultimate talk was by a young undergraduate student called Joanis Holzigel, who spoke of how he and his team managed to install an electrilisation promgramme (not sure about spelling) in a town in Rawanda. The talk may not have been as... interactive as the others but it still highlighted the remarkable achievments of Imperial undergraduate students. Pat on the back to them!!

The final and perhaps most stunningly shocking talk of the day was by an ex offender and former prison inmate, probably the first one to step into Imperial's Great Hall. Mr Junior Smart is now a founder of the St. Giles Trust's Southwark Offenders Support Program. He pointed out the limitations of the British disciplinary systems and how there is a shockingly high percentage of re-offenders. He spotted out the flaws in the system, what it costs the government (three times my annual salary per inmate per year) and how to help resolve it. I thought it was a rightfully powerful talk to end the day and hope there are many more sucess stories like his to happen.

The talks closed and then I left with Miss. Short-Fuse into Queensway and ate more food before going home rather late.

Driving Lesson 4

So I had my fourth driving lesson today, it was by far more mad than the others. I first started with just learning how to steer, which was basically turning left endlessly and never getting it right. Eventually my steering was good enough to start learing gears, this is where the real frsutration started. On my first lesson with gears I could lift my foot off of the clutch fine and no engine on earth could have stalled. But then on my next lesson everything went pear shaped and I must have stalled 4 times in a row in front of the give way line before the raod. If I had the strength to bash up a car I would have done it.

At the start of my lesson today I was getting much better with the clutch because I had developed a unique foot tchnique that will only work with my tiny feet. The rule is to keep your heel on the floor, I can't do that, I simply don't have enough foot to do it. So I lift my foot off as much as possible and lift my leg the rest of the way. My left leg is now very tired.

My seething cumulative impatience with the repetition of the roads was palpable, so Ron (my absolutely great instructor) took me onto a main road (you know, with other cars, street lights and all that jazz) to show me why we needed to stay on the smaller quieter roads with the annoying infinite humps. I was SO excited! I even moved onto third gear! My heart was racing the whole time, but I truly enjoyed it and can't wait till I'm good enough to do it again. The lesson was learned, even though I managed fine with Ron on the main road, I wasn't ready to do it without his instructions so more practice was required.

My main driving problems are remembering to steer while changing gears and stopping before the give way line. God help me I just can't do it. I have no idea when or how to push down on the brakes and I still panic everytime there is a car behind me.

God willing, I hope I learn it in the end!

Wild Swans, By Jung Chang

Part of my new and spontaneous interest in Chinese history was reading Wild Swans by Jung Chang. I guess I'm kind of late reviewing this considering it was originally buplished in 1992, but it was such a lip biting, zone out for 7 hours, earth shattering piece of biographical history... that I couldn't pass up a chance to write about what I thought of it.

The Book encospasses a historical account of the political and social climate of China from the early 1900s to the late 1970s all through the eyes of three woman; the author's grandmother who was made a concubine to a Warlord General, the author's mother who was a member of the newly formed Communist Party and the author herself and how she was swept into the brainwashing effects of Chairman Mao and his government.

The book hence went through the varying lives of three different generations that was tumbled, twisted and turned within a matter of 20 years between them. From the Famine of the Great Leap Forward to the atrocities of the Cultural Revolution. What I found most shocking was how Chang's grandmother had bound feet, a painful experience of breaking the toes of a young girl's foot to bend over the sole of her foot, a process that had to be repeated during the course of development to prevent them from healing. All because the sight of a hobbling woman had an erotic effect on men; supposedly inticing a protective instinct in them. A woman without bound feet was doomed to a life of spinsterhood and blamed her mother for not binding her feet when young.

I could go on an on about this wonderfully researched and compelling book that you can honestly trust coming from the prespective of a woman who had been in thick of the Moa mania of 1960s China. What I simply couldn't understand was how a nation could get swept away into treating Mao as a Deity, some revered sacred man who's word was gospel. Coming from an Islamic background myself, I was taught not to even bow my head to another being other than the One God. So how an entire nation with it's many millions of millions of people could be so tightly held in Mao's grip is very difficult for me to comprehend; I belive it was the reason for the misfortunes of the Cultural Revolution, with their book burning, teacher disrespecting and knowledge truncating beliefs. It was backward, an awaful time, at time which the Chinese still today accept was a horrible murdering cruel dark era of their history, but the same people still hold Mao in high esteem even though it was crystal clear that he only wanted to acquire personal power, that power like most powers corrupted him, and corrupted him absolutely.

Still, I think I have to grudgingly accept that Mao did raise China out of the Kuomintang's corrupt ways and help to get rid of Japan's infiltration. And perhaps his tight grip of the nation's politics allowed China to progress to what it is today; the world's second largest economy. But like all powerful leaders, I believe the power he held turned him a little crazy, just like Muammar Ghaddafi, Assad and Bush. I think Mubarek was a little more saner than the rest of them, but definitly as power hungry. I theorise that this type of madness could be called 'Presidential Power Syndrome', a state of mind that rejects logic in order to find foundations for one's own decisions, and rejects basic humane qualities like reason, emapthy and guilt. Thankfully I think the British political leaders are a bit distant from attaining this syndrome, but they may be just a little silly in their own way, which is probably, simply, an unavoidable a feature of British politics.

Lesson for the day: don't think you're God.