This is who you're reading about

My photo
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.

Wednesday, 29 April 2015

#IAmAScientistBecause... or: A Junior Doctor's Perspective of Lab Research

Philly cherry blossom - ka-ching!
The #IAmAScientistBecause hashtag is featuring increasingly on my Twitter feed - it has even reached the giddy heights of a Nature editorial.  As a junior doctor masquerading as a scientist, I'm not sure I'm totally qualified to give much of a view on either doctor-ing or science-ing; but perhaps you're a medical student or junior doctor wondering if lab research is for you?  Here are some of my reflections of the ups and downs of trying to be competent at two fields that seem closely related whilst in practice being completely different:

- If you do ANY kind of lab-based research, no amount of lab coat wearing will stop you ruining half your clothes with bleach.
- Book the thumb physio, because pipetting has given me worse RSI than any amount of drug chart rewriting.
- You will feel stupid compared to your full-time science student colleagues most of the time.
- It would be great if you could clamp your hand over the perpetrator's mouth when you are introduced as 'Dr BlahBlahBlah' to his or her colleagues, because it gives a misleadingly optimistic representation of your abilities.  Because you're 'not that sort of doctor' in a lab.
- Somehow the ability to do even basic maths seems to go completely out of the window, which does not aid the feelings of stupidity.
- It prolongs your training by, well, flippin ages.  One of my great friends from med school will be a qualified GP in a year, whereas I won't even be a registrar (/resident) by then. Accept, and move on.
- Scientists will hate you a little for the fact you managed to get both medical and science degrees in 6 years, and you know as well as they do that doing a science degree in a year obviously does not equate knowledge-wise to a full science degree.
Food Tour '14-'15 contd. Probably
the best food I've eaten Stateside - grateful to
my former Philly local friend who took us
to the yummiest eateries.
- It is sadly neither feasible nor sensible to wear a sign saying 'I do know how to do my other job, I promise' when you make yet another mistake in the lab or take a whole day just to get the basics of an experiment down.
- Going to work in jeans rocks.
- It is very weird to go a whole day when the only thing you have achieved is a lot of reading or maybe changing the media on some cells and call that day a success.
- Nothing works.  Ok, perhaps things work 5% of the time.  In my lab, we call that the '7am on a Saturday morning' moment - the reason why we keep coming back for more. That moment is just priceless.
- Suddenly, stats become fun - Prism is AWESOME. Never have graphs and p-values been so exciting.
- It's pretty rocking to be able to just go for a coffee when it's all going horribly wrong and regroup.  If only we could do that during horribly stressful nights on call?  If only we had Bernard's Watch!
- If you have a fun lab (comme moi) it can almost seem wrong that you get to work with such a bunch of intelligent nutters and call it 'work'.
- Experiments become a bunch more exciting when you give them cool names.  We ran this awesome deep sequencing experiment which we lovingly called Crazy 8 (rather than 'that-experiment-where-we-have-eight-samples-and-we-don't-know-which-one-is-best').  And you know?  It was the wildest (to quote an American) experiment and it worked!
- When you're having one of those days when you don't want to talk to anyone, cells are OK with silence.
- Lab life facilitates musical growth for you and your lab buddies alike.
- You work to get the work done rather than to hours set by someone else.  Yeah, so that means sometimes working late or at weekends, but it also means you can have regular hobbies, take a weekend trip, or post your mum's birthday present, as long as you get your work done.  It's a bit like being treated like a grown up!
Tourists! Philly - home to (I think, as I realise
this is a big statement) my new favourite
art gallery.
- It's great to have complete ownership over your work - well, it sucks when it's going badly, but rules when things come together.
- You will feel a jammy bugger for the relative job security being a doctor provides - ultimately, if that publication doesn't pan out, or your research funding runs out, someone will always want to employ a doctor, somewhere.  Our full-time science colleagues do not enjoy such luxuries.
- And hence, have new respect for pure scientists once you get to see close up how tough it is as a career despite being populated by the smartest, most qualified people you will ever meet.  I mean, they don't dish out PhDs like sweeties.

But basically, if it's for you, you will think how much it rocks that on the one hand you get to work with people in a hospital with all the complexities of patient care (ohhh how I miss it), and on the other exercise a totally different part of your brain transferring all of that to lab research.  What's amazing is that that's a 'Thing'!  It's a job that actually exists!  Someone wants to employ me to be with patients AND do research!  And in my current case, it's a Thing that allows me to live abroad for a year and get paid to do so. Ridiculously lucky.
Colourful DC! And source of the most
incredible seafood market accidentally
discovered in a dodgy part of town ever.
And museums. Oh just great, basically. 

I have been busy-ing my face off in the lab and in life, as many a single cell clone needs to be screened and close friends start adventuring to pastures new.  Generally with the Spring nearly over (feels like it's only just begun!) I'm hoping some of the aches and pains hanging over from Winter start to ease.  If my science could follow suit, that'd be sweet!

#IAmAScientistBecause... well, who wants a quiet life anyway?

(Hence a few recent travel snaps. Shame I couldn't take my newly acquired paints!  Best present ever.  Thank you thank you thank you.)

Tuesday, 21 April 2015

Proud to put the 'I' in Immigrant

Like the lifting of some kind of dark mist, the optimism and fresh joy that has come with the arrival of Spring is almost tangible.  The buds on the trees are swollen to bursting, and there is a certain positive energy in the air - it is time for a fresh start.
And that's how you do Spring.  

Clearly the political calendar agrees, and I have been observing with interest the debates and discussions happening in the UK as the general election approaches.  It seems likely that any fresh starts are going to be a bit of a mish-mash of different parties rather than an outright winner.  But to me one of the stand-out issues is that 'I' word - Immigration.

Food exploration - post-half
marathon.  Surely food = one
of the best parts of migration.
Thanks also to these brunch
guys for the copious ice packs
for my knee!  
I am SO fed up of hearing the political rhetoric around 'these bloody immigrants' and 'what it means to be British'.  Ok, so what does it mean to be British?  Sitting around drinking cups of tea?  Whinging about the weather?  Being white? Never wanting to leave our little island because nowhere else could possibly be better?

As an immigrant myself at the moment, the product of a Euro/UK union, and as a doctor and scientist(-in-training), I find the obsession with immigration frankly embarrassing.  At the same time that everyone is complaining about immigrants stealing 'our' jobs, hundreds of migrants are dying in the Mediterranean fleeing from conflicts we have decided are not our business.   The NHS would fall apart without doctors and nurses migrating into the UK.  Science is full of people willing to move across oceans to spend a few years working abroad - every lab I have ever worked in has been populated mostly by immigrants, contributing to science in a way that will ultimately benefit the UK population.  

These immigrant knees are
good enough for her. 
Of course, I've heard the argument that these are the migrants we want or need, but this suggests that immigrants are like computers without lives and families, dreams and aspirations.  How arrogant of us to want to 'import' what we need for as long as we need it, only to be ready to discard them the second their purpose has been served, despite allowing them to create an entire life and career in our country.  As Frankie Boyle (not someone I admittedly always agree with) puts it in this article, we have no right at all to be so snobby about the rest of the world given our own role in its history.  

You know what?  We could emigrate too!  Perhaps we can apologise for the fact treating Brits in Europe costs 5x more than treating European tourists in the UK in the process.  Most Europeans I've met over here, or indeed when I was in the UK, spend their 20s comfortably and enthusiastically moving all over Europe studying and working.  And if learning another language is really so awful (I realise I'm massively biased, but really, it's not), there are other places in the world worth exploring.  With a significantly better climate.  

As an immigrant myself at the moment, I find myself increasingly embarrassed of my British passport, and the sighs of envy that sometimes come from other immigrants when they hear my British accent.  I've heard stories of Eastern European researchers leaving the UK because they got so tired of being looked down upon because of their nationality.  What a loss not only to that research field, but also our conscience as a country.  

Manhattan as seen from Queens.
Last weekend I was sat gazing over the New York skyline with three other immigrant chums ahead of my half marathon, musing about, despite any personal and professional traumas, how ridiculously sweet our lives were at that exact moment and feeling that we had no right at all to complain or worry about anything.  I had no control over where I was born, and so far, I suspect largely thanks to my passport, have had little restriction on where I go in the world by virtue of said passport.  How can we judge others in such snobbish fashion for wanting the same opportunity to build a life and career abroad, and why on earth are we so reluctant to do so?  As this African proverb tells us:
If you want to go fast, go alone.
If you want to go far, go together.
 - And I'm all about the team game.  

I've just booked my flight back to the UK, and I only hope that my fellow voters will vote with sense rather than misplaced emotions in the interim so that I still like the country I'm going back to.  Immigrants of Britain, I am with you.  

Thursday, 16 April 2015

Permanently the doctor on call (apparently!)

Thesis writing while waiting
for my clones to grow... and
not a stethoscope in sight...
Right, that's it.  I am outing Big Sister P.  No amount of ocean has been able to disrupt this one fact: I am her on-call paediatrician.  In fact I'm not always sure she wants to chat and catch up, or just borrow my medical brain in relation to my baby niece... With the assistance of WhatsApp and FaceTime, I have given advice on everything from rashes and medication queries to coughs and vomiting issues.  Folks, I decided long ago that paediatrics was not for me, but it turns out that picking your specialty professionally does not mean everyone else stops treating you like a GP.

... while (dinner) partying Spring
style; dragon fruit and time to put 
another shrimp on the barbie...

I wrote a while ago about the time I was called upon to be all doctor-y on the London Tube last summer, and almost all of my medical friends have some story to share about 'this one time' when they were out running, or on a plane, and someone needed 'A Doctor'.  That's fine.  I think I'm fairly comfortable with the divide of 'this is life threatening' and 'this is probably not' for most clinical specialties. 

But really, where can I draw the line?!  The last time I did paediatrics, obstetrics, ophthalmology or ENT was when I was at medical school.  So I did the on call shifts, helped to deliver a few babies, assisted in a couple of cataract operations and contributed to relieving a few people of their tonsils; I am not an expert.  And yet regularly people ask me 'I know it's not your field, but can I just tell you about this rash...'  In the USA, I am usually saved by the fact that, aged 26, most Americans assume I'm still a medical student, and I'm not going to be that moron that introduces themselves to everyone as 'Dr Purshouse'.  The major exception to accepting my role as a doctor over here is in relation to my fellow foreigners with terrible health insurance.  A friend of mine gave up trying to get a GP to see him after he slipped on the ice and thought he'd fractured a rib; no-one would see him with his insurance, so he ended up asking me.

The shorts are back ON! Hello long lunches
on the grass in the sunshine :)
In Big Sister P's defence, she describes me as The Barometer - i.e. how much should she panic.  Fair enough.  I don't have children and I found it pretty terrifying having sole responsibility over my niece in NYC for one afternoon and evening (new respect for solo parents - the subway plus buggy on your own presents a neat little challenge).  But what if I give the wrong advice?  What if I don't see that rash properly, or do some calculations wrong?  Especially having been out of the clinical game for 7 months now (7 months in the USA! It is just zooooooming by), I am scared enough about going back to clinical work in some competent fashion three months from now without being quizzed about unfamiliar specialties in-between.  Often I feel I'm just stating common sense advice, and almost invariably feel like someone who has had children (like, oh, I don't know, my own mother..!) might be a better bet.  But of course I'll do it, within my own comfort limits - perhaps my niece represents just one person that won't turn up unnecessarily at a GP surgery or A+E, and if we all think about it like that, we might just start addressing the attendance crisis facing these frontline health services.

My weapon of choice
The first opera I ever watched was 'Die Zauberfloete' - 'The Magic Flute'. I guess I was 9 or 10, and my parents will tell you that I thought I'd find it really boring, even bringing a stash of books with me to read (What a brat, eh?!). However, I was completely engrossed and loved it from start to finish. For years to come, whenever a room was redecorated in our house, and it became all lovely and echoey in the absence of carpets or furniture, my mum, sister and I would take it in turns to recreate the Queen of the Night Aria (or more accurately - 'Der Hölle Rache kocht in meinem Herzen' - hell's wrath boils in my heart - yikes!) - which features one of the highest notes in the soprano vocal range, and therefore we were really little more than squeaking.  My violin duetting partner and I recently laughed til it hurt recreating this in string form.

Moral of the story?  I love singing, and I love singing all kinds of stuff.  But that does not make me an opera singer.  Much like being a doctor does not make me a paediatrician, an obstetrician or an orthopaedic surgeon. So ask away if you must - but please take all advice with a piece of salt.

Perhaps I should start charging a small fee - a friend suggested I should charge by the hour plus the time difference... genius.  Start forming an orderly queue, please.  

Monday, 13 April 2015

The Opposite of Curiosity

Curiosity is both my greatest friend and biggest enemy.  My curiosity has in recent weeks been well and truly on a leash - but in 'restraining' it, or rather, allowing curiosity to find me, I feel I've been able to appreciate what's going on around me with fresh eyes.

This has been vastly facilitated in part by having various visitors which has therefore required me to SIT STILL and NOT MOVE (well...perhaps it's more accurate to say that I have stayed in the tri-state area and moved a lot within that... the Spring countryside is just irresistible!).  Visitors and American friends alike have taken my enthusiasm for world-merging with great spirit, and hopefully enjoyed sharing a world for a while. But - I shall take my own advice, pipe down and say little more about it other than provide a few snapshots of recent joys, which I hope will speak for themselves.

Probably the one part of a New York brunch I could leave,
but at least I'll try anything once.  Plus, nothing
can taint my love of Brunch.

Pecan pastries.  If I weren't doing so much running/squash/you-name-it atm, I would be getting very, very fat.  I can safely say Easter was a feast in every meaning of the word: thanks Team America.

This was randomly stuck on the window of a shop that is being renovated near my flat, and just tickled me. True, as exemplified by this previous post! But also, said post is a reminder that there can always be more great bike rides :) 
Transatlantic Easter-ing.

Surely the best $8 I have spent in recent times.
Beyond therapeutic to do a quick sketch when
a spare five minutes presents itself.
Spring is fighting through! Perfect for my morning runs
although my right knee currently does not agree.
Ageing sucks.

These are just a few little things.  I played my last concert here recently; the beginning of 'lasts' but we're not thinking about that just now!  Letting life happen to me rather than making it happen myself is not something I am historically very good at, but perhaps I should try harder to let it be so.  It's pretty lovely.  (Although spoiler alert - such notions will be fairly imminently paused - despite having a thesis to write and brain cancer to cure, I have a country to explore here, after all.  But you know.  After that.)

Thursday, 2 April 2015

Failure is Always a Good Way to Learn

Music seems to be a heavy theme of recent blogs.  Isn't it amazing how music can influence and reflect your mood?  I have been blasting everything from Einaudi, Brahms and Arvo Part to Phoenix, Bloc Party and Arcade Fire on the lab speakers of late.  Recent concert highlight (hard to pick just one...) - Liszt's Piano Sonata in B Minor - what a journey!

As I've just jumped the 'unlucky' 13 (000! Thanks, lovely readers, whoever you are!) mark on this blog, I thought I'd tackle all-things unlucky and find a positive spin.  The title of this blog post comes from one of my favourite bands when I was a teenager - and now - Kings of Convenience. The lyrics pretty much define why the outdoors are such an important place for me; a place where there is no blame or retribution or, well, failure.  Here are some of the highlights:

I wish I could travel overground
To where all you hear is water sounds,
What do you think of our high-quality arts and crafts?
See, scientists can be creative...
Lush as the wind upon a tree.
I wish I could travel overground
To where all you hear is water sounds,
To capture and keep inside of me.
Failure is always the best way to learn,
Retracing your steps until you know,
Have no fear your wounds will heal.

I have just had to throw three months worth of lab work in the bin, literally (slightly anxiety-inducing given that I have a thesis due in two months), and hands down the worst thing about living overseas is feeling like a friend failure for those back home.  The risk of failure is everywhere, from big things like jobs and relationships, to little ones like missing a phone call or forgetting to send a birthday card.  Big fat failure lies at every turn.

My research in beer form.  What a find from the boss...
I maintain that a bit of failure is good and healthy, and it is constant.  I fail at stuff all the time; just thinking about my funding for coming to the USA, I applied for a whole bunch of grants and scholarships, and got precisely none of them apart from the Fulbright. Well, of course I am grateful and glad for the one I DID get; but there is nothing more soul destroying than weeks of preparing an application, only to be told in three lines that you, yes YOU, weren't good enough.  When I applied for my first job after medical school, I got rejected without interview at most places I applied.  Lab work is utterly soul destroying when it isn't working, again because it feels like a very personal, individual failure - I feel like the world's suckiest scientist at the moment.  More generally, I cringe all the time remembering things I have said (or not said); surely speaking before thinking is one of my biggest faults.  Don't even get me started on my failures where my friends, family and the rest are concerned (but you'll forgive me if I keep them to myself!).  People often assume that stuff just 'works' - I'll concede that overall I've been very, very lucky thus far, but really - if only.  It's just easier to avoid talking about the failures, and as a result they remain unseen.  Damn that game face.

Clinically, I harbour my own guilt of bad decisions made and failures that I have come to accept and live with.  That once meant telling a patient I had made a prescribing mistake that fortunately didn't affect their care, but could easily have done.  On another occasion it meant telling a relative that their husband had died after they suddenly had a heart attack which we couldn't save them from despite 45 minutes of CPR - so no active failure, but it certainly feels like it when you've been crying about it in the patient's toilet for fifteen minutes and then have to get your face and professionalism together to talk to their family.  There's been a photo doing the rounds of a doctor after he lost a patient - I have certainly pulled that pose more than once.

A bit of the Bindra lab!
But in time I have come to realise that failure is really how one chooses to see it.  Without wishing to get too profound, perhaps we allow what society dictates as success and failure to cloud our judgement.  As a girl with a career (shocking!), there are many views I encounter about my work/life balance and society's expectation that my ovaries dictate my every move.  Clinically and particularly scientifically, I must accept that sometimes I will fail, in someone else's eyes even if not in my own (although one of my other major faults is usually seeing it the other way round).  Failure is a part of life, and I have learned in time to try and forgive myself and others - like an alcoholic, I guess acceptance is the first step to recovery.  And maybe that makes me seem like a pushover - well, whatever.  I feel quite the opposite about it.  Of course, all easier said than done.

I only have to cast a glance at any newspaper to know my failures are of absolutely no import.  So I'll take comfort from the successes, however small, and focus on them instead, all the while trying to live and learn, and maintaining some bigger world perspective.  Case in point - realising the happiness of taking my stresses out on the pages of a journal or in the park when I'm out running - and the peace of keeping them there (as opposed to letting them come out of my mouth!).  The overworrying - well; that's a work in progress...

NB: The photos are from a bit of recent lab-success celebrating - good to stay positive even if my lab stuff isn't working at the moment :)
N 'in più' B: Just to round off the music theme - I've been reading a Gershwin bio recently to accompany listening my way through his back catalogue - turns out there's a rather large coincidence between Mr Gershwin and my field of science research...