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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Saturday, 28 March 2015

Going Home: The unspoken part of the 'Grown Up' Gap Year

In the General Assembly hall at the UN.  SO. EXCITING.
Despite the fact that it's snowing AGAIN today, nothing will destroy my ongoing joy and excitement about visiting the United Nations recently.  One of THE best things my performing-arts-focused high school did was to get a bunch of us to participate in the UK version of the Model United Nations, and I credit those experiences entirely with any confidence I have in public speaking and my belief that knowledge is power (as opposed to shouting the loudest!).  So going to the real thing was extremely exciting.  Didn't quite get to meet Ban Ki-moon, but hey, that's for next time!
A Nancy Reagan gift at the UN

It also gave me the opportunity to catch up with some lovely Fulbrighty types too.  The end of our American adventures is rapidly approaching, and apart from causing us all to get incredibly stressed about work, trying to get everything done before we leave, it has also prompted us all to ponder 'going home' and what this even means.  Safe to say we're already plotting an 'American Re-migrants Support Group'; because I find myself incredibly sad that my time abroad is coming to a rapid end.

I thought this year would cure me once and for all of my enthusiasm for the almost annual moving around that has come to characterise my 20s; one final fling of my rucksack around the world and then I'd be content to settle myself a little in one place.  In reality, and to my surprise, it has had quite the opposite effect.  Discussing this with other friends who have temporarily emigrated, we all have this strange sinking feeling of 'safety' with returning home, almost like we're not totally sure where we belong anymore.  I know I am incredibly lucky to be returning to a country where I can continue to work in my fields of interest, a luxury not bestowed upon all of my immigrant buddies.  Not just that - I have an amazing job to go home to!  Much as I enjoy research, I have come to really, really miss being a clinical doctor and I am really looking forward to combining research with medical practice again.  Research on its own, whilst awesome (when it works), is only half of my professional soul, and I miss the other half!
Finally submitting DNA for deep seq!
The first thing to go right for a while.
We were excited.  

And yet - I really enjoy living overseas, and in the advent of Skype and FaceTime, missing home really doesn't bother me as much as I thought it might.  Of course I am missing all kinds of stuff - my sister's 30th birthday, my niece's first steps, the occasional wedding, a hug from Mother P.  But as my bestie from med school reassured me - when it comes to close friends and family, they will always be there, regardless of where I am.  I realise talking to a face on a screen isn't the same, but I feel like I am almost more in touch with key people - I just make more effort. At the same time, I love the mentality that has been integrated in my brain as an immigrant - an even greater enthusiasm for exploring this damn beautiful world, a greater degree of self reliance (and resilience), talking to strangers and making friends.  In the latter, I have been more than richly rewarded in the great people I am lucky to call friends on this side of the pond: friends who have helped me through all of life's ups and downs, and even more wonderfully, are willing to rely on me as a friend in return.  Living abroad has raised more questions about life than any of my immigrant chums and I ever expected - all of which I'm still processing and digesting.  But it feels very healthy to allow all this thinking to happen.
A chunk of the most quoted text in the world
I remember my family commenting to me a few years ago that they had long feared I might settle abroad when I 'grew up', and I had scorned this at the time.  Now, I'm not so sure... However, I will say this: if I emigrate again for however long, I'm going somewhere warmer - this winter is just never-ending.

Homemade mango pickle
nom nom nom...
But I'm not yet a grown up - that's a few years away.  In the mean time, I'm excited for the job I'm going home to, the research I am still doing here and my currently rather insane work:life balance (read: doing both at 100%) - although I am getting way better at enforcing occasional hermit-ness.  I've had some truly wonderful friend-merge dinners recently (I LOVE friend merges) - possibly a favourite was Keralan curry night, complete with mango pickle (see right!) and my #1 wine from my Californian trip which I managed to find in a CT wine shop (no arsenic in sight...).
I just wish someone had told me that remigrating home is looking likely to be way harder than leaving it in the first place.  Yes, I know.  #firstworldproblems.  Don't worry, I do count my blessings every day. 

Wednesday, 18 March 2015

The Middle Ring - how to avoid Vanishing Neighbours

Spring in Rhode Island
I have it on good authority that the cherry blossom in the UK is in full bloom - we have a way to go here in Connecticut, but Spring is definitely in the air, finally.  The walk to work feels fresh rather than freezing - hurray! - and means people are a bit more willing to offer a 'hi there' and 'hello'.

Middle Ring embracing at Brown.
I recently went to a talk by an American scholar, Marc Dunkelman.  I'm still working my way through his book, 'The Vanishing Neighbo(u)r', where he talks about how the traditional relationships that make up (American) society have evolved and the consequences of this evolution.  He describes how we, as individuals, are like planets with rings of people around us.  We nurture the rings close to us (our closest friends, family etc), and those far away (aspirational ones - things we are aiming for or want, from people we likely don't know); but these are at the expense of the middle ring - people we know in the 'ish' sense - people we work with, the people who live in the same building, the guy who owns the coffee shop, the postman etc.  So for example, I came home on Sunday evening and quickly Skyped my mum (Mother's Day!) - but pre-Skype I couldn't have done this and instead might have said hello to my neighbour.

'Spring' in windswept NYC
Does this resonate with you?  I have certainly pondered it. I have come to think I have two levels of middle ring - the people who are in my immediate vicinity such as neighbours, the shopkeeper etc; and the second level of middle ring - people who could easily be inner ring were it not for timing, geography and hours in the day, such as the new friends I made at a Fulbrighty seminar I went to last weekend with 130-or-so new friends, or indeed travel friends from the past.  I feel pretty content with the Middle Rings - I appreciate and nurture them as much as I possibly can, the latter often with the help of social media and an open-minded attitude to friendship.  An inevitable consequence of my globe hopping?  I suspect so.  But I don't believe it's a bad thing.  It just makes the world a much smaller place.
As evidence of its magical power, here, in no particular order, are a few recent musings from both Middle Rings in my world.

- Coffee.  I came back from Cali and it's all I crave.  Best parts of this are fun encounters at my new favourite coffee shop (which has a tree inside!) and the lovely couple who own it (MIDDLE RING ALERT).  For me, the UK's #1 tea fan, this is RADICAL.

@AS220 print shop
- People love a British accent.  No.  People love MY British accent.  Given that in the UK, my weird stunted Scottish twang is often confused for Irish/Canadian/American/Swedish, this is quite an adjustment to be told by the Middle Rings that I sound 'incredibly British' which in turn is 'so cute and wonderful'.  As anyone who knows me and my feelings about compliments, this is... challenging and hilarious.  I don't think I've ever been called cute in my life (apart from in reference to my sneezes) and I didn't think the British accent was held in particularly high regard - apparently I was wrong!

- Brits everywhere - we really do apologise too much.  A new Argentinian friend told me that every time I want to say 'I'm sorry' I must instead say 'I'm happy'.  I thought that was pretty neat.  Sometimes the Middle Ring just tells it like it is.

- Being a Fulbrighter is like giving the Middle Ring a perma-hug - but what does being a Fulbrighter mean to me?  I'd say many things, but will boil it down to two taken from that recent seminar - it means having only a two hour break during a full day and night of activities, but still finding a bunch of people who want to use that time to go running with you, and discovering that even if the club you end up at is fantastically awful, you will still have everyone embracing it 100% with not a hint of snobbery.  Probably with some traditional dancing going on, even though what's playing is some dance music disaster.  And obviously, assumed friendship.

- The world is full of incredibly kind people who shift inevitably between Inner and Middle Ring, and I'm just kind of mega blown away by that.  I will never change being open to people and sharing worlds whenever I can, and hope I will continue to channel that in both my personal and professional lives, because the inner/middle continuum is a great one.

- I was nowhere near as embarrassed as I should have been when singing away to the radio at the top of my lungs whilst in the tissue culture room, thinking the lab was empty, when my boss peered round the door to say he's 'enjoying' my musical contribution.  Not even a blush when the repair man came in as I bopped away to Gershwin.  Perhaps lack of concern at Middle Ring embarrassment is a sign of comfort in life (as one should never feel embarrassed around the inner ring, and you shouldn't care what relative strangers in the outer ring think anyway!).

- I have instigated a new activity every time someone has a science success - it's called 'Learn a Ceilidh Dance'.  With much arm twisting, I got two of my lab people to learn the Gay Gordons to celebrate a much-wished-for successful Western Blot, and have the promise of a dance with my current lab collaborator should our experiment work next week.  Perhaps the Middle Ring lends itself particularly well to Cultural Exchange?

@AS220 Youth piece
As an emigre, I guess I must accept that to an extent, I neglect the first level of the Middle Ring because I sometimes prioritise the inner ring with the help of Skype and so on.  But equally, it is phenomenal how happy and glow-y I am when I have that chat with the coffee shop couple, or the lady at the post office, or play squash with a lab friend, or whatever.  Regarding the second Middle Ring, well I think it's pretty telling that I have just made my first social activity plans for my return to the UK with the friends I made a decade ago in Ghana for our 'ten year anniversary'.  So Middle Ring does not mean neglect if you don't want it to.
Pawtucket Cotton Mill

So I guess the Middle Ring is one I embrace as much as I can given the international spread of my friends and family, and it's been pretty damn good to me.  Maybe the Middle Ring is more about just making an effort, being more ready to say hello, and keeping the door permanently open?

Thursday, 12 March 2015

A Man's a Man For A' That?

The first lines of Rabbie Burns' poem will be well known to anyone who grew up in Scotland.

Is there for honest Poverty
That hings his head, an' a' that;
The coward slave - we pass him by,
We dare be poor for a' that!

I recently read the memoir of a woman who had been exiled to Siberia from Poland during the Second World War.  Near the end, she talks about how hunger, a theme that is interwoven at every stage of her tale, is the worst form of torture.  She describes how hunger eats away at your soul, takes your energy and removes your hope.  When I was a 22-year-old living in London, I lived on £1 a day for a week to increase my understanding of the impact of hunger.  One week of carbs and not much else allowed me to empathise with hunger and poverty in a way I could scarcely have anticipated beforehand.  After just one week I felt tired, fed up, focus-less, disinterested and out of steam. I couldn't believe the all-encompassing impact hunger would have on my ability to do even the most basic tasks, let alone study or work.  And I only had to do that for one week - I am clearly not suggesting I can relate to the long-term suffering experienced by the woman I was reading about in the book, or the many millions of people in the world who are hungry everyday.  Hunger is torture.

Every day I walk to work through the centre of my Connecticut town.  Usually it's a quiet walk; a few others head to the medical laboratories on foot.  But as I cross the two main roads near the hospital, I usually encounter a few of the city's homeless community.  The hospital resides in one of the more troubled areas of town, and we are advised not to venture beyond the other side of the hospital for our own safety.  When I finish late in the lab, I get the university shuttle bus to my door because it is apparently too dangerous to walk home alone.

Despite my travels and clinical experience in a few developing countries, poverty in the USA exists in a way I have never seen before.  This is not just the lot of my city of residence - I don't think I've taken a single ride on the subway in New York without being accosted by someone begging with a speech in the tube carriage.  Homeless people live on many a San Francisco street corner.  Many have mental health issues - which is worth noting given the recent shooting of a man in Los Angeles who was homeless following treatment for mental illness.  The chasm between rich and poor feels enormous, and intensely along racial lines. Is it like this back in the UK and I just haven't noticed?  Having trained to be a doctor in one of the most deprived parts of the UK, perhaps, but nowhere near to the same extremes.  In my as-yet brief medical career in the UK, I have seen many sides of society through my patients, and feel we can relate to each other in some way, regardless of wealth, poverty or anything else.  Here it feels like the divide is astronomically bigger.  Add gun control (or lack thereof) to the equation and it's a toxic mix that feels very much like 'us' versus 'them'.  When you have nothing, I guess what is there to lose?

The political divide here reflects the manner in which people do, or don't, want to deal with this.  I guess it's basically socialism versus conservatism - is the state responsible for supporting everyone to give them a fair shot, or is it up to the individual?  Personally, I find it very hard to stomach the latter argument; when the abandonment from society is so complete with regards to housing, education and healthcare, where is the individual supposed to start when they can neither shave nor wash, buy new shoes never mind a suit, or be adequately nourished to the point where one can think straight?  If this was a country struggling to make ends meet I would understand - but this is the wealthiest country in the world, no?

We are made to feel like we don't matter as individuals all the time - either by people who we know (argh!), or by the bigger institutions that rule the world (double argh!).  I hate it when people make me feel like I don't matter - not because I think I'm the most important person in the world, but because I'm a person with feelings, ideas and thoughts, and in my old age have learnt my worth in the world.  I struggle to know how to deal with living in an environment where so many people must feel like no-one cares, and to know what I can personally do about it.

As Spring seems to finally be arriving in Connecticut, and the piles of snow beside the road finally have a chance to melt, I am relieved also for those who call the frozen pavements 'home' for the night that warmer times are coming.  Certainly more so than in the UK, I give up my spare dollars when I have them, accepting this is a short fix, and that the reasons for this divide are far more complex than this blog has space for.  I can't change an entire social set up on my own, as a foreigner, in nine months - but feel utterly dissatisfied with the apparently rhetorical question of 'well what can I do?'.  I'm running a half marathon next month in NYC.  I'm not doing a formal fundraising thing, but if you are so inclined, I would much appreciate your throwing a few pennies/cents to Columbus House which is based near where I live.

On the wall by my mother's desk at home is pinned a prayer that has always resonated with me, increasingly so as I get older (written by Reinhold Niebuhr, American theologian who, as it turns out, studied at Yale Divinity School.)

'God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
enjoying one moment at a time;
accepting hardships as the pathway to peace...'

I hear what he's saying. But when it comes to poverty, it's overall rather depressing to think that we haven't progressed much from Robert Burns' sentiments, despite the fact they were written over 200 years ago. And when it comes to the USA, it is this powerlessness to help one's fellow man that is probably the number one thing that stops most Brits I have met from contemplating a long term emigration to this side of the Atlantic.

 America, land of the free. Well, if you can afford it.  

Tuesday, 3 March 2015

Then Came The Morning (Said the Scientist)

A New Hampshire morning...
... celebrated with snow angels - surprisingly tricky in deep snow
I have always been a morning person.  I am one of those weirdos who basically never sets an alarm because, barring disasters, I will always wake up early.  Perhaps it's my body giving me a metaphor for life; that every day is new and something to look forward to, or that days should be enjoyed in their entirety.  (If only it were a metaphor for me being early, or at least on time.  Neither of which are my strong points).  Maybe that's why some of my favourite songs are about mornings - Early in the Morning (James Vincent McMorrow), Saturday Morning (The Eels), Dawn (from P+P - Jean-Yves Thibaudet) and of course, if you're ready with a bit of air guitar, Beautiful Day (U2).  Friends from teenage times will remember that throughout the Maroon 5 music phase that swept our high school years, Sunday Morning was my favourite song - OH I've just put it on; SO WONDERFUL!  I've started listening to an awesome Brooklyn-based country band called The Lone Bellow, from whose album I've borrowed the title of this blog post (which in fairness could be interpreted as sad - but somehow manages to be uplifting!).  Even my favourite composer, Max Bruch, has some wonderful Morgenlieder which soothe and uplift the heart.

Food of kings - simple, but effective.
I am trying to translate this approach to mornings to the laboratory - I started writing this blog post when some of my 'science' started going right, but then stopped because I didn't want to jinx it.  Much like using the 'q' word in hospital ('quiet'), saying 'lab stuff is working' is a sure-fire way to ensure the good times come to a swift end.  I was getting incredibly frustrated a few weeks ago, and frankly disheartened, by the fact that nothing was working.  This is the lot of the scientist, and you're probably bored, dear blog reader, of hearing me whine about it.  But Science is not so much a Science as an Art, and therefore the more you get stuck in, the more variables and variants there are, and the more creative you can be with it.  Perhaps that's why so many scientists are keen on art and music - we're really creative types, just with pipettes rather than paintbrushes.  I miss my paintbrushes though - they didn't make the temporary emigration cut :(!  Fortunately I have my violin here - but then I don't know what I'd do without her.

My research project here is to do with brain tumours - gliomas.  A hugely under researched area in comparison to cancers of the lung, breast and colon to name but a few, it attracts a disproportionately small amount of funding relative to the number of people who develop brain tumours.  I have cared for a number of patients with brain tumours - a horrible disease with limited and frankly vintage treatment options.  I am trying to develop a new brain tumour cell line by incorporating a well-known but poorly understood genetic mutation into brain cells.  The aim is to better understand the impact of the mutation, with the long term aim of developing new therapeutics.  Easy!

The biggest challenge with gene-based research like this is that we know so much and yet so little.  The human genome project was published in 2001, but we still don't really know what to do with this wealth of knowledge.  I'm currently trying to take advantage of DNA's natural ability to fix itself and the impact this has on the strength of the bonds between the two strands of DNA in this area to work out which of my cells has been clever enough to take up my mutation.  But this technology is extremely new - even the ability to sequence DNA in affordable fashion is pretty radical.

...and the flip side... but a justified statement.
Life is far too short to hold grudges, so as with most things, I am quick to forgive science its transgressions when it doesn't play the game - just an extra challenge to work around.  And it's fun working out why not when it's not.  And certainly makes traipsing to work in anything up to -18C with light, glittery snow falling even though it's March entirely worthwhile.  I attach some photos from a wee trip we made this weekend up to New Hampshire - good food, good friends, good hiking, good for the soul.  An excellent way to soothe any science or life stressors - which I still think I have been remarkably lucky with. Case in point: I discovered yesterday I will be homeless here in a couple of months - a problem that was solved within 12 hours thanks to generous offers of spare rooms.  See?  This is why overall I refuse to see people as anything other than wonderful and good.  

When I think back, many of my happiest and most significant memories are mornings.  Surely that's the true definition of a morning person?  But now I must insist.  Pick any of the above, crank it up to full volume, and if you're not either soothed or dancing around your room like an idiot you're doing it wrong.  Because no morning songs are ever sad, and I'm rooting for joy all round right now!

(And please could y'all not have any more major car crashes in my absence. Or minor ones for that matter.  Practically gave me a heart attack, and I'm not licensed to do anything about that over here).