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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.

Sunday, 21 June 2015

Justified - the Case for the Doctoring Gap Year

Clinton, CT.
Well blimey, here we are. My last week in the lab! Time to pack up my pipettes and hand them on to someone else, and leave Gary in the hands of my successor to find out all of his secrets. In many ways it has felt like all of the pain of starting a PhD without actually having done one - but perhaps a good omen for if/when the time comes that I've still come out smiling! But finally it is starting to feel like it's time to return to the green pastures of England, and back to my beloved stethoscope. Saying goodbye over and over again is exhausting, as is squeezing every last second with final defining moments rather than planning new ones - which most recently include sun basking in Boston's beautiful public gardens, dabbling my toes in the sea off the Connecticut coast and finally trying my first lobster roll. I am assured this is a feeling common to all temporary emigres - but that doesn't mean I won't be PHENOMENALLY sad to leave.

Boston Public Gardens, MA.
I guess it should be the time to become profound, but to be honest, it's been such an overwhelming couple of weeks, on top of, well, a VERY overwhelming year, and I think it will take me many months on my return to even begin to process it all.  So I won't try here and now!

I know that sounds overdramatic, but what the hell - I left my job, my friends, my family, and potentially my career, with many, many months of uncertainty and put all my eggs in the American basket on my own.  But hey, I did it - and it's been a blast.  I left my little island in exchange for this massive one, and created a life from scratch whilst learning to do a new job.  It was most certainly not always easy - perhaps the easiest way to describe it is that despite leaving home nearly a decade ago, having embraced backpacking at every turn and working as a doctor for two years, this is the first time I feel anything vaguely resembling An Adult (emphasis on the 'vaguely').  Living abroad means having no back-up plan when it turns out you're going to be homeless, when your bank card gets defrauded and you suddenly have no money because everything has been blocked, and dealing with every single personal and professional disaster on your own.  I have FAR from done it all correctly and perfectly but in many ways I feel ruined for life, because I think unless you've lived abroad, it's a complex bunch of emotions that are hard to explain (and I worry that makes me sound a bit of a travel snob).  Why should a junior doctor take a gap year, especially one that doesn't involve doing any clinical work?  Living abroad makes you resourceful and self sufficient, because you have to be, and extremely humble to your own fallibility.  And I made Gary, and who knows, maybe one day I'll prescribe a drug that Gary helped to identify! I think those are enough good reasons to do it (re. fallibility as per the famous report) although there are many more yet to reach the 'conscious' layers of my brain!  Of course I was never really 'alone' - I am ever grateful to some key people who have been Extremely Important along the way.
Solitude - the lot of the emigre!

Three cubed on the
High Line, NYC
Jeremy Hunt probably SHOULD be alarmed, because all the baby docs such as myself that have taken time out have certainly come to appreciate that life as a junior doctor does not have to be the exhausting treadmill we thought it might be, and that a bit of pick'n'mix career-wise makes us better, saner doctors.  Amongst my friends alone, we have covered every continent (except from Antarctica) during our medical gap years - from relatively well trodden routes to Australia and New Zealand, to being an Ebola doctor in Sierra Leone, a paediatric PhD student in India or an expedition medic in Mexico.  It has been my very great privilege to share multi-time-zone Skype chats with friends I have known nearly a decade now from medical school who have taken their stethoscopes and explored the world.  Of course, I am equally chuffed for friends who have taken the alternative adventure route of setting down roots and starting families, one of whom I will be lucky to be going to a music festival with (27 weeks pregnant!) in a few weeks' time.  Adventures come in many forms, as my jewellery collection reminds me every day, but I know I have been incredibly lucky for this to have been mine.

From Toon to Tamil Nadu and now to NYC!
Dr P and Dr P. 
Amidst all of that, this ancient creature turned three cubed with some truly excellent and special people from all parts of her British and American life - feel a bit gushingly lucky. I'm not really one for material presents, but was lucky to be gifted some lovely scribbles in notes/cards, a mountain of books and a pair of awesome-ly crazy trousers. And if that sums me up in a nutshell, I'll take that.

And with that, I'm off to spend my final days with my best guy, Gary the Clone, whilst continuing the stream of goodbyes and pack my bags for my final American adventures, this time on my own.  Normally the most sociable bee you can imagine, I actually can't wait for some quality time on my tod.  Mountain of books - check.  Paints (<100ml for the flights!) - check. Journal - check.  Crazy trousers - check. Blog pals, I'll be back: “The adventures first, explanations take such a dreadful time.”  Dreadful?  Not dreadful.  But they do take time!  

Saturday, 13 June 2015

What being a doctor teaches you about life

Happy weekend, chaps and chapesses from one EXHAUSTED lady.  This week the humidity and heat went from zero to 100 in one fell swoop, and no amount of fans and AC have made sleep a whole lot easier.  I'm hoping that seeing as I've survived Indian/Malaysian/West African levels of humidity that I'll get used to it.
More lovely sunsets courtesy of East Rock.
In my exhausted state, I have therefore had a lot of time (lying perfectly still in hopes of catching a light breeze...) to exercise my brain instead and do the sort of 'life pondering' I enjoy, strong amongst which is the fact that soon I will be returning to my other job as a doctor.  Now that I have a rota and even a list of names of those I'll be working with (one of whom is a great friend of mine - win!), it's starting to seem a little more real.  But a year away from night shifts and 12-day work marathons (which is what I'll start on - whoop!) and ward rounds etc has given me some valuable time to consider what being a doctor has taught me about myself and life. So here it is - life as seen from the hospital applied to the real world:

- Man is not meant to be alone - all junior doctors will have at least one story (usually zillions) of the confused older man or lady admitted because they are 'off legs'.  Acute delirium means they have no idea who they are, who you are, where they are, why they are there and what the hell is going on.  When these patients are alone, it is as if they are lost to us completely, no longer people but instead bodies with organs and problems.  When they have loved ones, family or friends, there, it is as if a key unlocks something familiar and they become something of themselves again.  To me, every time, it is like magic.  So yes, man is not meant to be alone.

- Laughter is Very Important medicine - I feel I don't really need to say much more about this one other than to add that laughing my head off has got me through some of the most miserable days, and that some of my oldest, fittest patients were the ones who lived with joy and a giggle rather than misery and a scowl.

- Sometimes you have to say things you don't want to say, and people have to hear things they don't want to hear.  I mean, this is totally the pits.  I remember the first bit of truly terrible news I had to deliver - a patient who had somehow got the impression their cancer was 'cured' (it was a kind of cancer that can't be cured), and I had to tell them and their extended family late one evening that it had not only returned but spread widely.  They teach you at medical school about delivering bad news, with 'warning shots' and all the rest of it - but telling people things when every part of your gut and heart is screaming 'NOOOO!' is something I find incredibly hard.  Sometimes to care is to say the things no-one wants to hear (including yourself), and being ok with being a little bit hated for it (including by yourself).

To address any under-eating: Totally not my usual 
food vibe, but a cook-out triumph nonetheless!
- Looking after yourself is extremely important.  I set this in the context of a recent heated debate shared with a group of American friends where we were discussing weight and under-eating at times of stress.  I learned during my emaciated London days that when I'm stressed, my body goes into some kind of weird shut-down mode and rejects any kind of food - thus eating (or not eating) is something I take pretty seriously, particularly because, being a thin bean, I haven't got much to spare! When stressed on a night shift or whatever, it is easy to put yourself second to your patients all the time - and every time I feel guilty for saying 'No' (cardiac arrests etc excepting, obviously...) to have just ten minutes to eat some food and drink some tea.  But you can't look after other people unless you spend just a smidgeon of time looking after yourself.

- When you are at your lowest and most miserable is usually when something amazing is going to happen - WHY?!  I don't know (genuinely!)!!  I have come to value the times when I have felt SUPER low - both clinically and in the lab - when I felt totally swamped during my most traumatic on-call night shift, my audit was sapping all of my time with no discernible progress, or I had to throw SO MANY experiments away and hope that Experiment 3000 (that's how many single cells clones I screened) would work.  But then one patient said thank you, the audit ended up winning a prize, and of course I found Gary the Clone!  Which is why I never, EVER give up hope in things or people, especially when I'm feeling low - because only when you stick at something at its most desperate do you give it a chance to convert into something awesome.  Perhaps being at the lowest, worst point is what is needed for the very same things to have a chance of reaching their full potential?
Lake ZOAR! Love that it sounds like something from
Star Wars...
- Never lose faith in people - it takes a lot, and I mean a LOT, for me to dislike someone, including colleagues.  We've all had colleagues we don't get on so well with.  One of my most controversial colleagues did, however, spot, diagnose and manage a patient who rapidly became unwell at a point when our senior colleagues weren't entirely sure what was going on.  She can also be credited with a lot of what I am doing professionally now.
For what it's worth, I don't think there is anyone I actually dislike, apart from the obvious ones (Hitler, Stalin etc), but I think they are somewhat beyond redemption.

- It is far, far better to live driven by love than hate - life experiences as well as my job leave me in perpetual awareness of how short life is.  And my patients never told me about the things they hated - they would tell me about the stuff they loved and the things they missed.  The circumstances that led some patients to be in the Intensive Care Unit I used to work in were often so cruel and so random that it was hard to not question the fairness of life itself.  I've said before that my quick-to-forgive nature is often interpreted as my being a pushover, and how I see it as quite the opposite - and also living in hate makes me mega sad, and I don't like to be sad (who does?!).  And so, even when I say hateful things, it is only ever driven out of love, because I have seen how quickly life, or even just our minds, can be snatched away.

- Everyone makes mistakes.  It's how you forgive yourself, respond to and move forward from mistakes that's important.  And anyone who criticises you for getting stuff wrong is just hiding the stuff they're embarrassed to have messed up (or clearly has no insight into the mistakes they've made, which is infinitely more worrying...).  This is the best Ted Talk I've ever watched - and helps me to forgive myself a little when I think on the mistakes I've made.

- And finally - don't be afraid to give a little of yourself. I was recently reading about the remarkable Paediatrician and Aid Worker, Dr Annie Sparrow, who said 'The more loss you go through, the more you can share with other people'. Or as John Keats would say: 'it seems to me that we should rather be the flower than the Bee - for it is a false notion that more is gained by receiving than giving - no, the receiver and the giver are equal in their benefits'. The only way to survive, I'd suggest, when you live professionally with loss, but also when living with loss, whatever your definition of this is, in life.
In sitting here writing this, moving only to tap on the keyboard, the breeze has totally done its job!  It's almost like the weather knew I was in need of salvation or something - something I am more than happy to send on to others I know who need it right now.  I get overwhelmed sometimes when I think about how much I still have to learn about the world - but feel very lucky that through my job I am given a glimpse into so many aspects of human life and nature.  What else can I do but to try and learn from it?

Thursday, 11 June 2015

The Trouble with Girls?

Burlington, VT - although I liked 
seeing the real thing in Machias, NY!
The one point on which I have failed spectacularly to leave my homeland behind is radio - sorry, NPR, I just can't seem to tear myself away from the BBC and particularly its podcasts.  They have been my constant companion through long lab days, making me laugh embarrassingly loudly at its Friday Night comedy shows (which obviously no-one here finds funny, with the subtleties of British life and humour not relevant to the USA at all - but I can highly recommend!) or short novels which run the perfect length of a protein assay.  

There may not be obvious connections with the things I am about to discuss - but bear with me!  Because I'm somehow going to try and connect Sir Tim Hunt's comments on 'the trouble with girls' in laboratories, the United Nations, a BBC World Service book club podcast about a book on Afghanistan under the Taliban and Emma Watson of Harry Potter fame - and why men and women should both be championing equality for their own benefit.  

How could I NOT write a blog post about the absolutely hilarious story that hit the news - ladies of science, tie up your luscious locks, cover up your bikinis and put some long, sensible trousers on, because apparently we are a BIG DISTRACTION in the lab (and don't get all weepy about it in the process).  

Places to be young and grow old :)
Hilarious, but perhaps a serious point to be made.  Lordy knows there aren't enough glass ceilings without eminent scientists such as a Nobel Laureates stating that the problem with women in the lab is that everyone falls in love with each other whilst the women go about crying all the time.  Workplace romances are obviously, clearly, not the select store of laboratories, and hey, I have not cried once about work this year - not a claim that can be made of my job in healthcare!  But anyway - I'm (hopefully?!) stating obvious points here - people fall in love in all kinds of workplaces, and women are not cry babies, thank you very much.  Why do the women have to leave?!

Brewery Tour 2015 - possibly #1 so far...? Switchback, VT.
Obviously his comments were based on women in labs, a world where there is generally (or from what I have experienced) equality.  But his comments are rooted in perceiving the weakness and fragility of women.  Despite this, around the world, women are much persecuted because of societal or religious notions of what they are supposed to be doing - and staying mighty strong in the process.  It rather puts any whining I've done about being a female doctor or whatever into perspective, knowing and simultaneously resenting that I feel 'lucky' to have grown up in a society that broadly respects women as equals.  Although people can express gender equality as an aspiration on morality grounds, when I went to the United Nations those many weeks ago, we were lucky to listen to an amazing talk by a representative from the (deep breath in) Office of the Special Representative of the Secretary-General for Sexual Violence in Conflict.  It was really quite amazing the evidence she presented, economically, for gender equality and the role of women in society; I mean, obviously sad that some people need this kind of persuasion, but the depth and strength of the arguments were ones even I, as a woman, had not considered.   Yasmina Khadra's discussion of his latest book, The Swallows of Khabul, in one of my favourite book club podcasts to date had me compelled throughout - a book which has some centre on the experience of women under the Taliban, but is very much explored through the perspective of the society, and men, that exist around it.  But - I found particularly moving the author's description of his personal response to the part of the book he found most difficult to write about. 

I would like to live here, please. Littleton, MA.
This reaction towards this, and his general mega-respect for women expressed throughout the podcast, made me think on Emma Watson's talk on gender equality, which I realise has its critics, but I happen to be a big fan of - mainly her section on gender equality being an issue for men as well as women.  A great little excerpt:

'Both men and women should feel free to be sensitive. Both men and women should feel free to be strong… It is time that we all perceive gender on a spectrum not as two opposing sets of ideals.'

I have written/spoken previously of my experiences as a female doctor or 'leader' (sorry that just sounds so cheesy...) - but even as I wrote those things it felt almost fraudulent to talk just about my experience of these things As A Girl, as if I was missing something.  As 'Hermione Granger' (currently my hair icon...) points out, exemplified by perhaps both Sir Tim Hunt (even if he didn't intend to do so!) and Yasmina Khadra - why must we focus on female habits to be weak and meek, while men are strong, thereby allowing neither to be the other?  In my role as a doctor, and generally in life, I think it is important I am allowed to be both, and my male counterparts to be the same.  Increasingly I realise when I was writing about being a female doctor, perhaps I should have been thinking more about gender equality for both sexes.

Reading back this blogpost, I am led to feel it's rather a swirl of thoughts rather than successful crafting of specific ideas and conclusions.  Another thing to add to the seemingly endless list of things to process from all I have explored during my time in the USA!

In other news, this weak, fragile (!) woman wishes she could chop herself into a few pieces and distribute them in several corners of the world right now - India, Oxford, Wiltshire, Newcastle, and wrap a few hugs around some key people that she is missing a very great deal (despite any game face to suggest otherwise).  But until then, back to the lab - there is nothing #distractinglysexy about lab work - perhaps something to consider for those who read Sir Tim Hunt's comments and were considering a career switch to get in on the action...

*puts her sexy wide-rimmed spectacles back on*

Addendum (21st June 2015) - Given the media storm that has followed the comments made by Sir Tim Hunt, I just wanted to add my personal view given the events that have followed, light hearted as this post was intended to be at the time of writing.  It is my personal feeling that his comments were not made in the serious belief of the inferiority or weakness of female scientists, having since read more details about the whole situation, although undoubtedly his comments were ill-advised (as he has acknowledged).  This blog is not written by an angry feminist (more a positive one!), and I somewhat disagree with the heavy handed-ness Sir Hunt's comments provoked as I feel it rather closes the door for discussion around the genuine challenges facing scientists or doctors where gender or indeed any discriminator are concerned.  That was the spirit in which the above post was written.  

Friday, 5 June 2015

Sweater Weather

New roomie, and key MSc assistant.
This has been a very exciting few days (although summer disappeared this week - I write this wearing a JUMPER (sorry, Americans - a SWEATER!)!  I hope the warmth is being enjoyed somewhere else instead):

- I have a home
- I submitted my MSc dissertation 
- I (think I) have Made Cancer (pending repeats, further validation....etc)
- I have applied to my very first non-clinical conference with an abstract as a first author (obviously no idea if it'll be accepted, but still, a milestone of sorts)
- As well as the other obvious things to be thankful for - friends, family, food in my belly etc.

And genuinely (and those who know me back in the UK will think I'm lying but I PROMISE this is true) - it was all very enjoyable - nay, chilled! Maybe I'm destined for a career in science after all... or maybe living in a perpetual state of craziness has just become far too normal for me.

A visiting friend (who by chance works in cancer-themed healthcare herself) quite rightly asked me - 'so why does this matter to me and the kids I look after?'

Gary and the most American thing we could
find to celebrate!
This question had me hopping with excitement, as has this whole week.  It was basically the accumulation of my entire year's work in the USA, and science, as you've probably gathered, is a tricky little bugger.  I've had entire weeks go by where literally NOTHING has worked.  And the odds of Making Cancer were heavily stacked against me, as it turns out messing around with DNA is pretty tricky.  My sanity with clone screening has definitely been challenged! But a combination of blind optimism and early acceptance of possible failure (which I will not call pessimism, merely realism) have served me well, although of course it is easy to forgive and forget when the good times return.  Hopefully, assuming repeat experiments go ok, I have Made Cancer - aka Gary (it got too confusing to call him 'Plate A1, Well G5 etc etc'.)  Gary the clone has survived from one cell up, which in itself is pretty amazing.

So to go back to the whole Who Cares question?  Well, this is basically what Translational Science is all about.  We have Made Cancer with genetic characteristics that are currently poorly understood.  Gary will help us learn more about the impact of these genetic changes.  And we can also do some pretty nifty drug screening stuff to find new drugs from which patients will benefit.  Great work from a single cell called Gary.

Y-town doing its whole 'beautiful sunsets' thing
This matters because I have looked after patients with this sort of cancer and it sucks.

Hence - Translational Science can convert laboratory discoveries into something from which patients might benefit.

And I think that's pretty cool.

By Dr K R Purshouse MBBS (Hons), BSc (Hons) aged 26 and 23/24ths.

Now, I am off to do some more exploring in between finishing my Science.  Lake leaping and beer tasting, anyone?