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Sunday, October 4, 2015

Making of a Child Psychiatrist (25): Med School (3)

Back to reality, we began a detailed examination of the leg in the dissection room. There were intense discussions within our group as to what muscle was what. The demonstrator would expect us to have a grasp of the function of various muscles. In sessions we had to demonstrate our knowledge (or lack of knowledge to the mirth of the others). There were from time to time ribald jokes to release tension and make the process easier. Some would call this disrespectful of the dead, but within our group we needed something like that to help us come to terms with what we were doing. At times there would be practical jokes. A student would come in having travelled on the underground with the hand of his skeleton in his jacket top pocket. Someone came across a set of false teeth in one of the cadavers, and they became part of a rather odd conversation with the deceased. Demonstrators had a fund of old jokes to release tension if necessary.
Elsewhere we kept on with our physiology experiments. On the 1st March I recorded a meticulous experiment on “Isometric Contraction of Frog Muscle”. “The gastrocnemius muscle/ sciatic nerve preparation was used. The knee joint was clipped in the clamp and the tendon attached to the lever with thread. The sciatic nerve was laid across the stimulating electrodes…” There followed a detailed description of repeated experiments with graphs and tables showing the results, and then a conclusion: “From the graphs, it is shown that the optimum resting length for this frog muscle is about 2.67 cms. This gives both the best total and the best active responses”. And then a concluding comment: “It has been shown that muscles in the body are usually stretched to their optimum resting length”. You see, you all needed to know that, didn’t you?
I have said that my meticulous work must have been because I was finally doing something I wanted very much to do and do well, but it was also in part related to the fact we were doing something practical, visually satisfying, and part of a productive team process.
King’s is known for its religious underpinnings. There is a strong Department of Divinity, and many of my colleagues took the opportunity to do religious studies towards becoming an Associate of King’s College, with the right to put the letters AKC after their name. As the King’s online site tells us: “The Associateship of King’s College (AKC) is the original award of the College, dating back to its foundation in 1829 and reflecting the College’s motto: ‘sancte et sapienter’ (with holiness and wisdom). The 1829 Royal Charter states that the purposes of King’s College are to maintain the connection between ‘sound religion and useful learning’ and to teach the ‘doctrines and duties of Christianity’.” I chose not to do this, despite my years of church choir activity, and my one time leaning toward a career in the church. I would guess that derived from my experience of the year before with the local Vicar and his wife. I am fully aware of the holiness of the human body, and the wisdom needed to manage a career in medicine. But I have come to believe that it is important to be authentic in all things. The vicar and his wife had shown me their lack of authenticity in the contrast between what they preached and how they lived and treated not just me, but also their own family. So, I never did take up the option of the AKC.
Perhaps more surprising, I played with the idea of joining the King’s drama group, but just never seemed to have the time to join, and was fairly certain I would not have the time to rehearse. Similarly, I played with the idea of joining the choir, but made a distinct decision not to on the basis of the joyful immersion in what I was doing.
So my extracurricula activities were focused on getting to see Jan as frequently as possible, and taking a full part in the activities of Halliday Hall.
We played bridge in one of the larger rooms, at least once a week. There were probably enough card playing medical students for two tables (ie four people each), but often someone would be away, so actually getting to play was special. It took some weeks to find my way into a four after I had been asked the question. But I did appear to be able to hold my end up, and contribute to a partnership, so as time went on I became a regular. We played sometimes incautiously well into the night, and slept on the underground, arriving for lectures somewhat worse for wear. But there were some events that could intrude. One of these was the boxing match between Cassius Clay and Archie Moore (Thursday November 15th 1962). We dutifully interrupted our game, and trooped off to the room of a fellow med student who had his own black and white television. Luckily the fight only lasted four rounds, and we rushed back to the real meaning of life. Towards the end of our first year, there was an even more important fight for we Englishmen. Cassius Clay versus ‘Our Enery’ Henry Cooper (Tuesday 18th June 1963). No bridge that night, even though this fight only lasted four rounds as well and, despite Clay being knocked down at one point, was stopped when Cooper got a severely cut eyelid (unbelievably a TKO to Clay).
The Hall had its own rhythm with a burst of communal activity around dinnertime and after in the bar. At weekends there was less activities with many people finding exciting things to do, or going home to family. A feature of both the years I was a resident was ‘That Was The Week That Was’ (or TW3) headed up by David Frost. The show took aim at politics and mistakes or infamy of those in the public eye. It aired on a Saturday, which meant I sometimes missed episodes sadly. But on the days I was there, it was hard to find viewing space amongst a crowd of slightly drunk engineering, divinity and medical students laughing raucously.
One sad event that interrupted one of the shows, was the assassination of President Kennedy (November 22nd, 1963). The atmosphere changed in seconds from raucous to being able to her a pin drop, as we listened to what detail was available, and repeatedly watched the video coverage. This was one of those historic days in your life when you lose something – perhaps innocence, perhaps a piece of your faith in humanity, or perhaps a piece of your own humanity. It was outrageous that an essentially good politician and international leader, who had done such good in changing the atmosphere of the world, could be cut down in his prime. There were some lessons there that we all learned that day: Life can be short, and death can come unwanted out of the blue. We are not immortal. It does not matter how good a person we strive to be, and how much good we try to do in the world, death comes to all of us. Get on with life; it may be cut short. Make the most of what you have; it may be all you have time to get. Be kind to others, and try to be authentic; your legacy and peccadillos can all be made public after your death.

More later…

Haiku on Carry/ Black/ Right/ Critic


Carry my loved one
Safely back into my arms
Away from evil

A haiku a day
Will keep the doctor away
Carry on writing

Dot one carry one
Multiplication is fun
The old fashioned way

Dim politicians
Carry to the election
Then we switch them off


On the darkest days
My black thoughts and furrowed brow
Dispersed by your smile

A small black spider
Quietly building a nest
Panic amongst girls

Black words on paper
Create small golden visions
In another's mind


Mirror shows my face
Meditation reveals soul
Reflecting right back

Come right ear she said
Would you like the rest of me?
You're such a smart ass

Right light might help sight
But you have to be looking
To see others plight


Critique my haiku
Criticism can be good
Do critics know that?

Don't disturb critic
He will reach across the miles
Tear your work to shreds

Critic sat alone
Nobody thought to say hi
To be criticised

Saturday, October 3, 2015

Haiku on Mark/ Critical/ Blaze/ Word


Low tide flotsam mark
Red white and blue soldier crabs
Gather to parade

A quiet intrusive curse
Deep lines marked his face

With a deep dark sigh
He placed his leather book mark
Real life was calling


It is critical
With small children in the house
Not to be too clean

Observe the surface
Inspect it critically
Clean as a whistle

That's a filthy look
You're always so critical
Please clean up your mind


A blaze of glory
Tonight surviving nightmares
You are the hero

Tonight on the News
A blaze in a factory
Guard dog a hero

Mars the God of war
Hero annealed in the fire
Earth ablaze tonight


Always did love words
Playing with the sound of them
In any language

And the word was word
Like onomatopoeia
A meaningful sound

And the word was law
But then the law is an ass
On which no man hath sat

Friday, October 2, 2015

Haiku on Doubt/ Read/ Victor/ News


May be right or wrong
Make best decisions you can
Clear doubt from your mind

There can be no doubt
Stayed with me for fifty years
It must have been love

Try reading a book
Alone in peace and quiet
Knowledge removes doubt


Deep and meaningful
Words unspoken from your heart
Transmitted to mine

Deep down in her womb
She felt the smallest flutter
The future of life

With deep sympathy
I honour those who have lost
That is all of us


To victor the game
Now you can reset the board
Next time I will win

Whisper 'Execute'
Deprive the world of Victors
Reset us for Peace

In the game of moans
A whisper more powerful
Than the Victor's sword


An infant is born
Ready to be loved, adored
Won't make nightly news

Watching the bad news
Litany of mindlessness
The dark side of man

One good news story
A politician spoke sense
For the greater good

Sunday, September 27, 2015

Making of a Child Psychiatrist(24): Med School (2)

The next few days were full of expeditions to get to know the immediate vicinity to King’s, built between The Strand and the Thames Embankment (just a short walk down Surrey Street). Just across the road was India House, and there was public access to the basement restaurant and some of the hottest and cheapest curries I had eaten. Of course my mother had produced a great, if somewhat stylised, curry for numerous parties and occasions but somehow the ‘real thing’ came as a burning surprise immediately and two days later. Further to the west was Leicester Square, to the north of that Covent Garden, and in between all the London theatres that somehow we did not consider (and perhaps could not have afforded) in those early years. Walking east towards Fleet Street took me past Australia House and I have always wondered whether the repeated image of sun and surf and the promise of a £10 emigration somehow took up space in my mind. You either had to go round India House or Australia House to get to Aldwych to find Kingsway where, in Sardinian Arcade, there was a musty cramped little shop selling University memorabilia. Of course I needed a royal blue and red diagonally striped tie (which I still have) and, of course, a long cloth scarf in the same colours lengthwise (sadly long gone). They were worn with considerable pride. It was important to belong, to tell the world where I belonged. The shop also showed off an array of wooden plaques in the shape of a shield with the college insignia. I wanted one. I coveted one, but could not afford one at the time, and had to wait many years before getting one sent by post. It somehow remains a way of showing my heritage, and has sat on the wall in most of the offices in which I have sat. I have an identity: I was, and am still, a King’s man.
We had a list of prescribed textbooks for the main subjects (Anatomy, Physiology, Biochemistry, Pharmacology), and this necessitated repeated lengthy and fascinating visits to Foyle’s multistorey bookshop in Charing Cross Road. Having been a librarian at school, I was fascinated by the rows and rows of books from all round the world. Others were fascinated by the coffee shop; I never needed that. I was just happy with books, and happy to stay for hours, even though there was always an underlying purpose to each visit. There were other bookshops close by, and some of them antiquarian, but somehow they never had the fascination of Foyle’s. Perhaps not surprisingly (given my first day’s experience), I went a bit overboard in buying anatomy textbooks. I bought a copy of ‘Gray's Anatomy: descriptive and applied’, and a recommended guide for anatomical dissection – a brilliantly simple set of flip charts. Sadly I cannot remember the author’s name but, being a very visual person, I am eternally grateful for the ring back guides that were light enough to carry into the dissection room to assist. Somewhere along the line, I also acquired, and have retained, a copy of the very detailed and beautiful ‘CIBA Collection of Medical Illustrations’ by Frank Netter. These days, of course, it is easy to go onto the Internet, and find diagrams, photographs and MRI sequential scans of the whole body. But nothing compares with poring over a book, and turning time and again to a particular page until the whole thing is embedded in memory. Of course, exquisitely detailed anatomical drawings go back to the days of Leonardo da Vinci, and I am not sure anatomy has changed that much over the years. The new generation prefer the Internet; I prefer to hold a book, without the interruptions of email and other pop-ups.
We needed instruments, and almost furtively entered the recommended shop, whose name I now sadly do not recall. I do, however, have a visual memory of climbing some stairs in an elderly and slightly musty building. They were professional, never asking if any of us was a descendant of Burke or Hare, and responded quickly to our list of forceps, scalpels with spare blades, a probe, tweezers and surgical scissors, and a small boringly khaki canvas roll in which to carry them.
Dissection began on about Day 3, and we had directions as to how to proceed as well as an ever-present demonstrator to guide our thinking and hands. We began with the forearm of the upper limb, and no-one seemed awfully keen to make the first incision. I can still remember the discomfort of that first time; but then if you could not manage such an act on a long dead person, however could you manage on a live one when it might be a matter of life or death. So over the weeks we took turns uncovering the layers of skin, tracing muscles and the arteries and veins that had provided the blood flow to them, and eventually being able to lay out (and describe) the anatomy to please the demonstrator. This was real; it was important, and it left us all with a sense of wonder for the human body. I am sure that smell of formalin permeated not only my lungs, but also my clothes and perhaps my soul. If people moved away from you on the underground, there was always a thought that, perhaps, they knew what I had been up to.
Other topics had exercises in the lab, building from the very simple to the complex, but all providing a sense of how the body works. To this day I have my first Physiology exercise book, with its still schoolboy writing and the date of the first experiment (12th October 1962. Experiment 1 – Blood A: ‘Erythrocyte Count in Blood’). The reporting detail is like nothing I ever did at school; it was careful, precise and thorough. I wanted to do this; it was my future craft, and I was taking it seriously.
We built on examination of the various types of cell, quite literally counting them in squares under a microscope, to measuring heamoglobin levels. By the 27th October we were using an electric stimulator to get frog muscle to contract, and then practicing on each other’s palms. This was to become a way of life; practice on a partner and then they practice on you. On that day, I was working with ‘C. Lines Esq.’, my old friend Chris. Week by week we moved on, examining respiration and lung volumes and then the composition of exhaled air. We learned to use equipment like pipettes, microscopes and oscilloscopes. The experiments were always demonstrated first (see one), and then each of us would take a turn on our own specimens or on ourselves (do one). It was meaningful, grounding, and I gradually gained a sense of the pathway at the end of which I would be a doctor.
By February of 1963 we were doing group experiments which were randomized and controlled. For instance determining the effects of exercise, nicotine or pituitrin on renal output after taking on board a uniform water load. This was a feature providing a reality; we had to take small experimental amounts of all sorts of drugs through that first year to measure changes. When you have such an experience, you have a respect for medications that you cannot gain by reading a formulary and prescribing for some unsuspecting third party.
A weird thing happened one morning on my way to the refectory. I was passing a notice board close to the main entrance, and the word ‘Australia’ sprang out to hold my attention. I stopped, and looked closely. The ‘Inter-University Australia Committee’ (based at Oxford) was requesting applications from students interested in spending a summer holiday in Australia. A requirement was that the student had to have employment for three months, and had to arrange their own accommodation. But flights and transfers would be totally free - no obligation. After my initial disbelief, I read the notice again and again, checking details and dates and timing of applications. Then I wrote it all down. My parents and my sister had been in Adelaide, Australia, since March of 1962, and would be there for the full three-year posting. This might be a way of getting to see them. It might also be a way of getting Jan to myself for three months.

That night I rang Jan excitedly and discussed the possibilities. Then separately and later together, we discussed the ups and downs. She would be missing a whole summer season of contributing to her parents’ hotel. I would miss three months of working to supplement my grant. We discussed the whole thing with Reg and Bobbie, Jan’s parents, and I wrote an air-letter to Australia seeking a response as soon as possible. With agreement we put in our applications, not really believing our good luck, and with that faint sense of wondering about ‘the catch’.