In mourning

The ones left behind. In my line of work and especially in the setting in which I work, I see alot of widows. There is still a very strong belief in the local community where I work that a widow should be completely dressed in black for at least 6 months and even for up to a year. I've already been told by my significant other that if he were to die, I have to wear black from head to toe for a year!

But seriously, I always feel a deep sense of loss when I see one of these women in the waiting room and especially when one of them consults me. In true doctor stereotype, I never really know what to say to them. I mean, what can you really say to someone who has lost their life partner? Yes, some people take it harder than others, but I just imagine how devastated I would be if it were to happen to me. I usually just give my condolences, which they acknowledge, and then feel very inadequate. I always send them for grief counselling - I have such respect for those counsellors for knowing what to say and do.

As doctors, I think we tend to try and stay clinical because the work we do and the things we see would destroy us in no time if we reacted to it as people normally do under normal circumstances. But we do not work under normal circumstances. The circumstances are extraordinary, unnatural. So we keep a certain distance. We get philosophical. We switch off when it gets too emotional or when we can feel it permeating too deeply. But neither can we allow ourselves not to be affected or we would be in danger of losing our humanity. So I feel their loss. Then I move on.

I think it is probably a sexist society that dictates that a widow must outwardly show her grief by wearing black whereas a widower is not under any obligation to show any outer sign of mourning, but then again, most cultural norms and beliefs are passed from generation to generation by the women of that culture. Still, I think it is a very beautiful thing for a woman to show that she is mourning her husband's loss. However, I don't think that she should be forced to do it. In any case, whenever I see one of these women in black, I find it very poignant.

Misinformation

I read this article in a parenting newsletter recently and was actually impressed with its useful advice. However, there were two things that bothered me about it: firstly it states that probiotics strengthen your immune system, which isn't actually true, although it does boost the immunity of your intestinal mucosa, so it is somewhat true. But then it also had a blatantly false statement saying that anti-oxidants scavenge viruses and bacteria.

I decided to write to the editor. I didn't mention the probiotics statement because I thought there was an element of truth in it, but I pointed out that the antioxidants statement was completely false and that although antioxidants do infact help your body fight viruses and bacteria by scavenging free radicals and thereby strengthening the immune system, they do not directy fight viruses and bacteria. I thought this was important because perhaps the next time Jane public's kid has a bacterial infection she might think it's ok to only give the kid some anti-oxidants. Which may not be the brightest thing to do, but it illustrates how misinformation can be dangerous, especially in today's media hungry, self diagnostic world.

The editor forwarded my letter to the dietician who sent me a direct response:

Thank you for your comments. Indeed, this is a good example of what can so easily happen and the dilemma with which we are often faced when having to try to translate complex and often detailed explanations into simple language whilst having a limited number of characters at our disposal. For example, consumer research has shown that even a concept such as 'FREE RADICAL ' is poorly understood - let alone oxidate damage, reactive oxygen species etc.

I am certainly very aware that anti-oxidants in fact are involved in the complex processes relating to free radical damage associated with oxidative processes, that some do not necessarily posess anti-oxidant status (e.g. zinc) but are important in inherent defence mechanisms and that the link is not necessarily directly between the anti-oxidant and the bacteria/virus. However, in the spirit of the article and trying to make the point that food remains vital to enhance health - rather than supplements, I have tried to simplify the complexities associated with anti-oxidant functioning, colds and flue and the potential and role nutrients have and play in preventing disease. In addition, our editorial team had to cut text again and in the process of this, another bit of vital info got lost.

You are therefore 100 % correct in your assessment that this statement is not 100 % correct - thank you for bringing this to our attention.

I feel she was trying to justify telling an untruth for the greater good - although in this case it was actually a lie - and I'm not sure if that is justifiable. I think that as medical professionals we are obligated to hold ourselves to higher standards.

Foot-in-mouth disease

I was assisting in threatre today and we were doing laparascopic work. We were using a new system from a guy whose equipment we've used before - and this guy is really panicky on a good day. So today he actually had to be somewhere else, so he had someone else come to theatre (I think she's his rep or something) to see that there weren't any glitches. So at a stage, the surgeon tells this rep to phone the guy and tell him the screen is not working, the surgeon is screaming and that all hell has broken loose, basically.

She says she's a bit nervous do that because she's still rather new. So the anesthetist (who is just as bad as the surgeon, if not worse) volunteers to do it. He dials and the surgeon says "tell me when you're speaking to him and I'll start shouting". He chuckles menacingly. The guy answers and he puts the call on speaker phone.

He tells him that nothing is working and that nobody knows how to fix it. The surgeon timeously shouts "I can't work under these conditions!". The anesthetist goes on to say that his rep has been reduced to tears.

"I knew I should have come myself" he says, "I knew she couldn't handle it!"

The theatre explodes with laughter and he realises he's been had. He says something about the surgeon always trying to unnerve him. We all laugh.

Everyone except his rep that is ;)

...pants on fire

I've often wondered why patients bother to lie to their doctors. We have seen just about everything in the book as well as most things not in the book.

There's not much that phases me anymore and when someone has done something really stupid or embarrassing, I tend not to judge them, but when they lie (and trust me, a doctor tends to know when a patient is blowing smoke) that just down right annoys me...

If you get shot or stabbed in the middle of the night and come into casualties in a drunken stupor, we are not going to buy your story that you were selling bibles door to door and some heathen attacked you unprovoked and unexpectedly because you have nothing but goodness in your heart.

If come in with a foreign body stuck in your rectum, we are not going to believe that you were naked because you were on your way to the shower and en route accidentally slipped and fell onto it!

If you have half a steak stuck in your oesophagus, we are not going to believe that you only took a small bite and that it must have somehow expanded because of all the water you drank to try and wash it down.

Medicine is evidence based, so if the evidence is there, we'll believe what the evidence shows us.

I had this patient who complained of severe earache. I had a look and saw mostly wax, but peaking out from behind the wax I saw something which didn't look entirely normal. I actually thought it kind of looked like the leg of on insect - those things can get anywhere. I told myself it may just be a hair coated in wax, but I was not convinced, so I had no choice but to syringe the ear. Now, I absolutely hate syringing ears. When I was a 4th year medical student, we went on an "ENT camp" which basically entailed us syringing the ears of underprivileged patients for three days straight. It was horrible. I saw (and smelt) things there that I never want to see (or smell) again. But obviously I had to do it.

So I syringe and a whole lot of wax comes out. Then I look in her ear again and see what looks like tissue paper or cotton wool. So I ask if she had put an ear bud or something into her ear and she says no, she didn't put anything in her ear. Yeah right, I think. I syringe again and more wax comes out. Then, I syringe and out comes a blob of cotton wool coated in wax. I pick it up and show it to her.

She says she doesn't know how that got in there.

Road works

My commute to and from work has been quite difficult lately: there are road works on the one and only road between the town where I live and the town where I work. It's quite annoying to have to sit in such slow moving traffic every morning and every afternoon considering we moved here to get away from the big city and its evils such as traffic.



I must say though that if the company doing the construction cannot even label its construction vehicles properly, I have very little faith in them building our roads and bridges!