Roma, Italia

Last week I had the incredible opportunity to participate in a medical ethics conference hosted by University of Notre Dame Center for Ethics and Culture at their Rome campus. As you may recall, this is the second year that I have been able to attend this medical ethics conference.  I had a bit of deja vu returning to the conference that helped fuel my desire to study bioethics, and more broadly, healthcare from the perspective of the humanities. To be fair though, this had a much different feel since we were just a block away from the Colosseum. 😉

I was impressed with how far I have progressed in my understanding of medical ethics in a year’s time.  Don’t misunderstand this as me thinking I’ve got it all figured out. Far from it! But I much better understood the language of this field and have become a bit more comfortable making bioethical arguments.  I guess my studying is paying off. 😉

I could write a book about what I have taken away from the conference discussions and then fill a few other volumes about tasting delicious Italian food… (click for enlargements + captions)

 

 

…strolling through beautiful museums, piazzas, and villas…

 

…standing in awe as a pilgrim in Rome (and Vatican City)…

 

…but I might have to drop out of my master’s program in order to make time for that. Instead, I present to you a snapshot at the intersection: is spirituality relevant to healthcare, medicine, and the understanding of bioethics?

This sends me back a few weeks ago when I was invited to speak to KCL’s Life Society about palliative care. From their website:

“We exist because universities are important spaces for the exploration of ideas and opinions, and it is important that the Pro-Life voice is heard on campus. Our message is a positive one, it is not about shaming or blaming, it is about discovering the beauty of human life, and protecting it.”

To be honest with you, I was pretty freaked out: why are you asking me?  How am I qualified to speak? To which the student in Life Society replied rather straightfowardly: You study bioethics right?  And you’re going into medicine? Seems like you would have a better idea about the topic than any of us!

It is amazing how much you can learn when you have to ‘teach’. I didn’t just want to speak on my own authority since, despite her encouragement, I honestly didn’t think I had much authority at all. In search of good reference material, I consulted a voice for whom I have profound respect, Ed Pellegrino, whose name I was introduced to little better than a year ago and whose literature continues to be a source of guidance in my study of bioethics.

Though I wouldn’t do justice to ‘summing up’ Pellegrino’s philosophy in a blog post, a central aspect is that:

Cure may be futile, but care is never futile.

The optimal end of healing is the good of the whole person– physical, emotional, and spiritual. The physician, manifestly, is no expert in every dimension. He or she, however, should be alert to the patient’s needs in each sphere, do what is within his or her capabilities and work with others in the health care team to come as close as clinical reality permits to meeting the several levels contained in the idea of the good of the patient. [1]

Considering the fact that a patient’s physical condition often provides the trigger to visit a doctor, it follows naturally that doctors have a reputation of focusing on the physical aspects health. Sometimes they are so focused though, that the patients’ emotional and spiritual needs are forsaken.  Although this applies to all aspects of medicine, I think it is particularly relevant to healthcare at the end-of-life which provided a good framework for my talk with the Life Society. It was also helpful for the conference last week where the keynote lecture was about international perspectives on the euthanasia debate… AND this week’s topic in my Case Studies module: “Ethics at the end of life– the biopolitics of dying.”

This post would get out of control if I tried to summarize all of the points relevant to this topic, so instead I’ll leave you with some important questions that I’ve been mulling over:

  • Does care change when cure is futile? Should it change? How so?
  • Aquinas’ Doctrine of Double Effect is often cited as a reason to prohibit euthanasia. Is there really a difference between [a] giving medication to a person that is intended to give them comfort but has a foreseeable outcome of shortening his life and [b] giving medication that has the intended effect of shortening his life? If there is a difference, how should this inform our ethics and legality of end of life care?
  • Conversations about emotional components of health (and even more frequently, spiritual components of health) are often omitted from clinical encounters. How does this effect patients’ care?  Should physicians be responsible for providing this care? If yes, in what capacity? If no, who (which member of the health care team) would better be able to provide this care?

Until next time,

A

[1] If you have access to a university library or other collection of journal articles, I highly recommend reading this full article! –> Pellegrino, E. (2001). The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions. The Journal of Medicine and Philosophy, 26(6), pp.559-579.

Featured image: St Peter’s by night

Pre-Vote News: “Mitochondrial Donation: Is it safe? Is it ethical?”

Last night I had the amazing privilege to attend a debate in the Houses of Parliament regarding today’s vote about whether or not to amend their 2008 Human Fertilisation and Embryology Act (HFEA). The debate was hosted by the Progress Educational Trust (PET), an independent organization that “urge(s) you to vote in favour of the Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015.”

I’m rushing this post to press, so please forgive the lack-luster writing quality– I thought you might enjoy an update while the news is fresh. My understanding of biology is helpful, but please understand that I am no expert on this.  All information provided is correct to the best of my knowledge– but if you see some errors, please let me know!

What is mitochondrial disease?

Most info in this section can be double checked on Wikipedia.

  • A set of diseases caused by faulty mitochondria, the “powerhouse” organelle in the body responsible cellular metabolism– converting the food we eat into energy that is usable by our body (ATP — adenosine triphosphate)
  • Symptoms: mostly effects organs that need a lot of energy such as brain (seizures, demintia); heart (cardiomyopathy “heart muscle disease”); muscles (weakness, cramping); ears / eyes / nerves (deafness, blindness, neuropathic pain)
  • Although in 5th grade we learned that all our DNA is stored in chromosomes in the nucleus of our cells that we received from our parents — half from Mom (egg), half from Dad (sperm)– this is only mostly true. It’s more like 49% from Dad (stored in the sperm’s chromosomes) and 51% from Mom (49% stored in the egg’s chromosomes, 2% stored in the egg’s mitochondria). This 2% is exclusively passed through the maternal line. (eg: George’s mitochondrial DNA came from his mom, which came from her mom, which came from her mom… George’s wife will pass on mitochondrial DNA to their children.)
  • While 85% of these mitochondrial diseases are caused by genetic mutations in chromosomal DNA, ~15% of mitochondrial diseases are caused by mutations in the mitochondrial DNA. This subset of mitochondrial diseases is where we focus our attention.

What is mitochondrial donation?

“A type of in vitro fertilization (IVF) that involves conceiving a child using biological material from three people — the child’s parents, plus a mitochondrial donor” (PET briefing).

You may have heard about this in the media as a “3 parent” embryo.  a somewhat misleading description since parents are not just defined by genetic relations. (Think about parents of adopted children.)  Even if emphasize the importance of genetic lineage, the embryo would only receive ~2% of its DNA from the “3rd parent” (the woman who donates mitochondrial DNA). Remember: 98% of the DNA is from the chromosomes of the egg & sperm.

The HFEA is proposing two specific techniques:

1. maternal spindle transfer (MST)

Mitochondria from a donor egg is transferred to the Mom’s egg. The Mom’s egg (now containing healthy mitochondrial DNA from the donor) is then fertilized with Dad’s sperm using IVF techniques.

2. pronuclear transfer (PNT)

Mom’s egg is fertilized with Dad’s sperm using IVF. A donor embryo is formed using donor egg and potentially (though not necessarily) donor sperm. The healthy mitochondrial DNA from the donor embryo is transferred to the embryo formed from the Mom’s egg and the Dad’s sperm. This technique results in the death of the donor embryo, the ethics of which are briefly outlined below.

See the HFEA’s website for more info on these two techniques.

What are the main ethical considerations?

Lots of things to consider! But for time sake (I have to run to class!) I’ll talk about two:

1. Is mitochondrial transfer safe?

Again, this is contested. Based on the debate yesterday, my understanding is that these techniques have been researched for 30+ years. The majority of this time has been spent with animal research, but the last 5 years have used human embryos. The results are promising, but we wouldn’t understand the effects until it is tested in humans.

This technique is unique in the fact that it changes the germ line. It is very difficult to predict the social and biological harms / benefits of this type of alteration. There have been a few experiments in humans that use similar techniques, (US — late 1990s, China — 2003) but the results have either been unsuccessful or indeterminate.

Note: In the US, the FDA has NOT yet approved mitochondrial donation for clinical trials. This takes for-eh-ver, so even if / when this advances to the stage of clinical trials, it will be a long time before it is available to the general public.

2. What is the moral status of an embryo?

A highly contested question. According to UK parliament (2002) the embryo has some non-negligible moral value that is less than the moral value of person after birth. This matches their policy that permits the use of IVF to select against severe genetic disease and states that embryos may be used for research purposes only when they are ≤ 14 days (“early embryos”).

One of the strongest voices on the other side of the fence is the Catholic Church, which states that “human life must be respected and protected absolutely from the moment of conception” (2270). Contrary to popular belief, the Catholic Church does encourage “research aimed at reducing human sterility” (2375). However, it opposes “techniques involving only the married couple… that dissociate the sexual act from the procreative act” (2377 — eg: artificial insemination / fertilization) and strongly opposes “techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple” (2376).  This understanding matches the Catholic teaching that sympathizes with infertile couples but maintains that a child is gift– there is no “right to a child” (2379).  As such, the Catholic Church does not support the proposed changes– especially PNT which creates and destroys the donor embryo, a means to the end of creating a healthy embryo.

The vote will take place this afternoon (London time) so stay tuned to the news!  Based on the views exchanged at the debate yesterday and the fact that IVF is permitted in the UK with costs covered under the National Health Service, I’m betting that this proposal will pass at least in part– definitely for MST, but perhaps not for PNT because of the ethical reasons explained above.

And if you made it through that whole post, here are some photos for your enjoyment.

Sounds of Silence

I’m happy to report that this week was filled with interesting lectures* and other events…. and an extra few hours on the dance floor. 🙂 Though my skills don’t come close to those of the dance.addict@mail.com (no joke) who signed in before me, I am quite enjoying the (non-competitive) classes with the KCL Dance Society.  My hamstrings can attest to the fact that I haven’t done so many kicks since I was a majorette (twirled baton in marching band) in high school.

Dancing, running, or even just walking around town– it is rather simple to take the ability to participate in such activities for granted. I know I’ve mentioned this before with respect to navigating numerous flights of stairs at tube stations without lifts or escalators, but I think it is worth revisiting. This week’s reminder came to me on Guy’s Campus, the science / medical campus.   Since I don’t have classes on Guy’s Campus, I don’t frequent it as much, and thus my decision to find a bathroom quickly became an adventure in the basement of the Hodgkin Building: a maze of sloped corridors presumably designed to accommodate gurneys.  Despite KCL’s good intention of hanging signs (TOILETS —> ) I still couldn’t manage to find the regular facilities.  Having spotted a empty handicapped-accessible room with 1 toilet, I decided I didn’t need to pick a fight about about the poor signage (which didn’t actually direct people to this singular toilet).

Now, I’m sure most of you have entered a handicapped-accessible stall someplace: it’s most notable feature is its large size that can accommodate a wheelchair or other similar medical device.  Hospital bathrooms usually add in a few bars that the patient and / or medical assistant can use for support. This bathroom not only had those features, but also (most memorable for someone who is 5’10”) had the sink and hand dryer at levels that would be easily usable by someone who is sitting.  The engineer in me was taking stock of these details: “Nice! Someone was really thinking when they designed this!” But I couldn’t help but think of the countless other public bathrooms that I had visited where the design seemed to forget that people who are confined to wheelchairs probably have the same desire to wash and dry their hands as people that are able to stand.  I’ve never had to navigate a public restroom whilst in a wheelchair, though I think that if I ever had to design one, that is definitely a test I would want to apply.

In Engineering design courses, we are constantly reminded to envision our product from the user’s lens. For example, my senior design team was tasked with building a hearing screening device for newborns in South Africa. Our motivation was rooted in the understanding that most cases of hearing loss could be ‘corrected’ if deaf children who were diagnosed and given treatment (eg: hearing aids, extra language development instruction, etc) before critical language development years; children who were diagnosed after this period of critical language development (typically identified by unresponsiveness to loud noises or delayed ability to speak) would never attain the speaking proficiency of their normal-hearing peers.   Though I dare say my team did a pretty good job of accounting for many of these nuanced factors that can make or break the successful implementation of a medical device into a community, I don’t think we ever considered whether the parents would actually prefer to have a deaf child.

I mentioned this topic in a post at the beginning of last term, and after months of sitting with this idea, it still doesn’t sit well with me.  But a marked sign of development is the fact that I better understanding the arguments surrounding the case and can articulate some of my own perspectives that amount to more than ‘an odd feeling’.

Another marked sign of progress is my improved reading speed.**  In between my assigned readings for my classes, I’ve managed to read some more about this case of choosing deafness in the book that our program director (Dr Silvia Camporesi) recently published–  From Bench to Bedside, to Track & Field: The Context of Enhancement and its Ethical Relevance.  Despite the fact that my teammates and I didn’t consider the possibility that some people would prefer to have a deaf child, Silvia notes that:

“Empirical research suggests that deaf people often have a degree of preference for a deaf child, and a rather smaller number would consider acting on their preference with the use of selective techniques. [***See references below.] It turns out that such parents do not view certain genetic conditions as diabilities but as a passport to enter into a rich, shared culture” (p 54).

THAT is certainly some food for thought for engineers trying to implement hearing screening devices.

Last week we were invited to attend Silvia’s book launch. This was pretty exciting since the last book release that I can remember attending was for Harry Potter 7, and no, J K Rowling did not make a guest appearance at Meijer. This intimate event was shared with a good showing from our Social Science, Health, and Medicine department as well as Silvia’s husband & parents who made the trip in from Italy!

At the book launch with some of my classmates. Photo courtesy of Silvias mom. :)
At the book launch with some of my classmates. Photo courtesy of Silvia’s mom. 🙂

Considering the theme of my musings, I was excited to learn about and attend a Deaf Arts Festival hosted in London this past weekend. (Photos courtesy of Silvia.)

I managed to catch the last part of the student theatre production. Although they provided some super-titles on the background screen, the main method of communication was British Sign Language and a bit of loud, low frequency sounds that you could feel.  Perhaps my favorite part was the silent round of applause at the end of the show– something that looks quite similar to jazz hands or spirit fingers at a basketball game.  I can’t say I understood everything (I think they were performing a modern interpretation of Hamlet?) but it certainly provided some good think time.

And now I’ll leave you here to give you some think-time of your own.

Cheers,

Andrea

*I’ve saved my notes from one of my favorite lectures this week which gave a philosophical response to “What does it mean to love a person?”  If I can time this well, I might be able to release this mid-February… 😉  Stay tuned!

**I suppose that comes with practice, and goodness knows that those skills had become quite rusty during my years at UM.  Reading a biotransport textbook (30% text, 70% equations) is vastly different than reading a paper about withholding blood transfusions from Jehovah’s Wittness children.

*** References:

Middleton, A, J Hewison, and R F Mueller. 1998.  “Attitudes of Deaf Adults Toward Genetic Testing for Hereditary Deafness.” American Journal of Human Genetics 63 (4): 1175-1180. doi:10.1086/302060

Stern, S J, KS Arnos, L Murrelle, K Oelrich Welch, W E Nance, and A Pandya. 2002.  “Attitudes of Deaf and Hard of Hearing Subjects Towards Genetic Testing and Prenatal Diagnosis of Hearing Loss.” Journal of Medical Genetics 39 (6) (June): 449-453.

Featured image: also from the Deaf Arts Festival. Photo courtesy of Silvia.

It’s beginning to look a lot like Christmas…

Hello from Michigan!  Classes are finished for the 1st term, and I am fortunate enough to spend the next few weeks with family and friends in the Midwest.  As you may have noticed with the post dates, I’m a bit behind on writing… Alas, there are only 24 hours in a day, but as I have been often reminded: write now, cherish the gift of memories forever.

Since we are less than 1 week away from Christmas (!) I’ve bumped this post a bit higher on my priority list. Over the last few weeks (or really months, since Londoners don’t have Thanksgiving to delay the anticipation for Christmas) I’ve been soaking up the spirit that warms a cold chapel during a candlelit Advent caroling service… that shimmers in lights adorning Christmas trees in city squares… that radiates from a mug of mulled wine or tin of minced pie.

Advent Scenes
(10:30) Covent Garden, (12:00) Banner advertising candelit advent carol service at Guy’s Campus with mince pies afterward!, (1:30) Admiring the ceiling of Westminster Abbey before the carol service began. This is the one photo I managed to snap before my neighbor was chastised for doing the very same thing. Oops. :/ (3:00) Outdoor 30′ tree in Covent Garden, (4:30) Near Hyde Park, (7:30) Proper Coffee! Served at the Winter Wonderland in Hyde Park, (9:00) ~30′ paper Christmas tree near the Southbank Center, (Center) Nativity at KCL Guy’s Chapel

 

 

It is truly something to behold, and while I think I’ve done a good job of participating in and appreciating the Wonder, I guess it blends into the scenery after a while?  Driving away from O’Hare with “Season Greetings” written in lights on the Blue Line train traveling next to us, traveling into a (comparatively) unlit city center was a bit… odd.

I’m not saying London is some holy land– it works the commercial end of the holiday season just as much, if not more than the average American city– but this Advent season makes it quite clear that the UK countries are officially Christian (England = Anglican) while the US does not have a state religion.  Interested in whether or not this was representative of the citizens in those countries, I did a quick census consult. Fun fact:  59% of UK citizens and 76% of Americans self-identify with a Christian religion.  Hmm.

Oxford Street Christmas Retail

 

Monty the Penguin

This incongruity doesn’t just have an effect on December festivities, though. It also shows up in the bioethics classroom.  Take for instance organ donation, a topic I considered for one of my papers this month.  Views on organ donation vary quite a bit between different religious (or ethnic) groups ranging from a “commanded obligation” to donate to (essentially) an obligation not to donate. (See UNOS Theological Perspectives for more info.)  Should these religious views be taken into consideration in determining bioethical practices?  This is up for hot debate among bioethicists and my interest in the intersection of philosophy, theology, and healthcare has placed me smack in the middle of this debate.  Though I think I’ve derailed the post enough, this topic will certainly be returning in future months. 🙂

Until then, Merry Christmas & to be continued…

(Featured Image: One of many Christmas trees & ice skating rinks in London– this one happens to be right next to my KCL Strand campus!)

Bristol: England’s Ann Arbor

Quick snapshots from Bristol! This trip was planned as a detour en route to my Host visit in Cornwall, so it was only 6 hours long.

Some brief observations:

On three separate occasions people came up to offer help.  I’d like to think I don’t look that helpless, but I suppose looking at bus routes or consulting a map in a small-ish city is a good indicator.  Not only did these people stop to ask if I needed help, they even offered to go out of their way to walk to a key intersection or otherwise point me in the right direction.   I’ve made a habit of being rather self reliant in London.  Even if I did ask for directions, there is a pretty good chance that the person may not know where Such-n-Such place is because (a) London is so vast and (b) there are so many “transients” (people like me that have just moved here, tourists, etc) that you may end up asking someone who is more lost than you are.  Beyond that though, the pace of life in London is faster.  If someone is power-walking in a tailored suit and heels, she is probably not going to want to break stride to see if you need help.  No time for that.

I also might point out that I wouldn’t necessarily describe this helpfulness as friendliness.  (That’s not a word I would use to describe an initial encounter with many Brits.)  They weren’t interested in starting a chat about my American accent, why I in Bristol, or other questions you may get in a small town.  Rather, they saw a need, fulfilled it quite cordially, and went along their merry way. Combine that with an abundance of street art, the type of people that like street art, delicious food, the University, students… and, well, it was almost like being in Ann Arbor for the afternoon. 🙂

 

Around Bristol Collage
Strolling the city. Clockwise from top left: 1 The bankside; 2 St Nicholas Market; 3 A pub that would have fared well in A2; 4 Clifton suspension bridge– celebrating 150 years!
Banksy etc collage
The left panel features 2 pieces by Banksy— Mild Mild West & Golden Earring.
Love and Light Collage
Stained glass window is from Sts Peter & Paul Cathedral.
MShed collage
Snapshots from the MShed. Top center is represents the annual hot air balloon festival that Bristol hosts.
Street Art collage 1
Easel: dumpsters, apartments, convenient stores…
Street Art collage 2
A final sampling of my favorite street art.

 

The Doctor Is In

Most people don’t get excited to take a visit to the doctor’s office.  I, however, considered it quite the opportunity.  Since I am a full time student in the UK, I am “entitled to National Health Service treatment” and was curious to see how treatment would vary from what I had previously received back home in the States.  This is by no means an official comparison of the systems, but I thought it would be interesting to share my first impressions.

To register, I took a 10 minute walk to my “local surgery” (the neighborhood clinic) and filled out  10-15 minutes worth of paperwork: name, address, have I previously registered with the NHS, have I received treatment in other countries, etc.   I turned it in and was told that it would take 24 hours for the paperwork to be processed, a requirement for making an appointment.

I phoned ~25 hours after submitting my paperwork and was delighted to hear that I was in their system AND that I could have an appointment the following afternoon.

Receptionist: We have 14:10, 15:40, or 15:50 available.

Me: 15:40, please, that fits in perfectly after class.

Receptionist: Ok, you’re all set.

Me: Oh… ok. Thanks… Um, did you need my chief complaint?

Receptionist: No, you’re all set.

I arrived for my appointment ~15 minutes early and took a seat in the waiting room.  This feels like home. 🙂 Someone from the surgery would open the door to the visiting rooms every 5-7 minutes and call a patient back. Almost exactly at 15:40, a young man (couldn’t have been more than 3-4 years old than me) in a button down shirt, dress trousers, and of course London approved supah-nice dress shoes opened the door and called my name.  Hyperaware of my polka dot wellies, I picked up my purse, walked over to him, and was directed toward the first room on the right.

Let’s pause for a second– a pretty good reenactment of my mild deer in headlights response.  This room to which I was being ushered appeared to be an office: large L-shaped desk with a supah-fancy office chair on the far side of the desk and a no-frills standard chair closer to us.  “Hello I’m Dr X,” he said as he pulled out the standard chair, offering me a seat.  I obliged. He walked around the desk, took a seat in the supah-fancy chair, and asked with a warm smile:

“How can I help you?”

Umm. This felt like an odd encounter with the Customer Service department. When I successfully pushed those associations out of my mind, flashbacks of uncomfortable interviews rushed in:  So, tell us about yourself, Andrea. What do you know already?  Do you want to know where I’m from?  About my family and childhood? The things that shaped me into who I am today?  My hobbies and interests?  My experience that may be beneficial for this position?  The reason I chose to apply?…

As a new patient, I was anticipating that there would be a medical history or basic physical exam incorporated into the visit, but perhaps he had read through my registration paperwork?? Dubious.  A significant portion of that registration medical history focused on which, if any, family members had been diagnosed and treated for high blood pressure, diabetes, or other high profile illnesses.

Umm.

I’m not sure what I had expected to happen in those few seconds of mind-overdrive, but when I finished my internal commentary, I was still uncertain how to answer the question. And he was still looking at me with a smile awaiting my answer.

“My lower back…” I offered cautiously, making sure I had started along the correct route before it was too late to turn back.  He nodded reassuringly, so I continued. After 3 minutes, I was given reassurance that I was taking care of myself in a reasonable manner.  He also provided me with a paper that had pictures of people demonstrating different back exercises (most of which I had already been doing) and gave me an opportunity to request a prescription.

me: For which medication?

GP: A pain medication.

me: Right. Which medication?

GP: A non-steroidal anti-inflammatory prescription drug.

me: I see…  (Unsure if he had intended for his answer to sound condescending, I opted out of describing ibuprofen as a non-steroidal anti-inflammatory over the counter drug.) And do you think I will respond any differently to it than I have been responding to ibuprofen?

GP: No, you’ll probably respond in the same way. You’ll just be able to purchase more than 32 X 200mg pills at a time.*, **

me: Ahh. I see. Well, then no thank you. I think I’ll stick with ibuprofen.

 

6 minutes after I entered the room, he bid me adieu.  Rx: continue self care, but complain more loudly to the facilities management about a better mattress (Student accommodations can be a bit dodgy sometimes.)

 

me: Oh, do I need to check out with reception?

GP: No, no. You’re all set.

me: Ok, well… (I guess that makes sense if there isn’t a chart or copay!) Thank you.

GP: You’re welcome.

 

*This was in reference to an exchange we had shared a minute earlier. Fun fact: in the UK, the max recommended daily dosage for ibuprofen is 1200mg as opposed to 2400mg in the US. You are also limited to buying 2 blister packs (where each pill is stored in it’s own individual foil compartment) with 16 pills X 200mg.  I’m no ibuprofen addict, but I wanted to buy a pack to keep in my purse, backpack, and desk… and was turned down.
**Although a prescription may have been more convenient, it certainly would have been more expensive.  Under the NHS, the flat rate would have been £8 compared with £0.32 per 16-pill OTC blister pack.

***

 Before any fights breakout, let me remind you that this is 1 anecdote.  Two points are required to make a line, and hundreds if not thousands of points are required to draw conclusions.

Rather than attempting to compare US vs UK health systems with very little data, I spent most of my reflection time this week thinking about the way this experience fits into what we have been discussing in my Foundations of Social Science, Health, and Medicine (FSSHM) class.

What is the significance of a the doctor-patient relationship? How is this relationship impacted by the length of the appointment? Or the arrangement of the clinical room? Or by (lack of) physical contact?  How is efficiency defined in medicine? By the number of people seen? Or the number people who receive care? How is care defined?…

I’m planning on shaping some of these questions into my FSSHM essay, so you will be hearing about this again.  In the mean time, I have two videos to recommend:

 

1. Wit

“A renowned professor is forced to reassess her life when she is diagnosed with terminal ovarian cancer” (IMDb).

My thoughts: A very moving story. Some aspects border on becoming a caricature, but as with any caricatures there is as aspect of truth to be seen.   I have experienced this type of “treatment” and I’m sure a number of you have as well.  It pains me to know that situations like this exist, but I find encouragement by interacting with physicians that actively fight this frightening stereotype.

Unique qualities: script features a lot of John Donne, 4th wall is broken (protagonist speaks directly to the viewer)

 

2. A Doctor’s Touch

“Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam” (TED).

My thoughts: An important video for any health care provider or patient.  Yes, that’s you.  If you’re short on time and have to choose one video, watch this (even at 1.5 speed if you have to!)

Many thanks to Dr Behrouzan (one of my FSSHM lecturers) and Zoe Walters (amazing friend and current pharmacy student) for recommending these to me!

Let there be light!

This week’s M&M (Mass & a Museum) Sunday routine was spent in Kensington at the Science Museum and Our Lady of Mount Caramel.  I say routine, but life in London is always full of surprises.  On this particular morning, my walk to the tube station crossed paths with a herd of half-marathon runners.

 

Other than the Natural History Museum, the Science Museum was the only thing on the “Exceptional” / “Worth a Journey” list on my trusty street map that I hadn’t yet visited.  There were enough bio-exhibits to keep me satiated, but in general this wasn’t one of my favorite museums.  (Perhaps my expectations were too high? Or perhaps, with such gems as the Imperial War Museum or the British Museum, my standards have shifted to be quite high?)

 

The one objective bonus of this visit was the other museum-goers: apparently Sunday morning is the prime time for parents with children 4 years old and younger to venture out.  Many a buggy (stroller) to be found.  Though I’ve grown rather accustomed to the British accent, there is something absolutely adorable about it’s utterance in a child’s voice. To get the full effect, you must put on your best English accent whilst reenacting this scene:

 

Boy 1: Mummy! (tugs at the neckline of a darling little sweater) I’m warm, Mummy!

(Mom proceeds to help Boy 1 take off his sweater, take off his shirt, remove his teeny-tiny undershirt, and get dressed again.)

Mom: John (presumably the father) can you check with Henry? He also might be a bit warm.

(Henry, the younger brother who couldn’t have been more than 3 years old, trots around the nearby exhibits.  He darts behind a tower of old VWs and, out of direct eye sight from either parent, attempts to get into the passenger’s door of the lowest one. Meanwhile, John lengthen his stride to catch up to the swift toddler, soon discovering Henry’s situation.)

Dad: Henry!  Come out from there! (The space between the Tower of Cars and the wall surely would not have fit a full sized person. John’s voice becomes a bit more stern.) Henry. Come out. Now. No, do not touch the car.  Henry! No, you cannot get in the car… (John continues to rationalize with Henry until the boy surfaces again to the open air…)

 

Perhaps this doesn’t appear to be so humorous to the general populous, but for me, it brought back a flood of memories of growing up with my younger brother, Henry.  At 6’5″, he is now considerably taller than the British Henry that I had the pleasure of encountering this week, but he (17 years old) and my lil sister Geraldine (15 years old) bring just as many smiles to my face.  Special shout out to H & G, who will be heading to the State Championship matches this week for high school Varsity Tennis and Golf, respectively.  I’ll be cheering you on from London!

Just before I headed to Our Lady of Mount Caramel, I received a message from my friend, AB: “They’re celebrating Diwali in Trafalgar Square today!” Goodness, and just when you think you’ve made it through the “Exceptional” / “Worth a Journey” list!… 😉

I made it to Trafalgar Square around 2pm, just in time for the public dance performances. Nothing like a good bit of Indian dance music (including Bollywood favorites like “Jai Ho!”) to put a little swivvle in your hips.  Since the music and dancing could be heard from all parts of the Square, I was able to check out the side booths, quickly joining the queue for a free sari.  That’s right folks: they had piles of folded saris (~6 meters of beautiful cloth– it’s all in the way it it tied on you) that they were dressing people in FOR FREE.  The queue looked rather short, but since it takes a non-negligible amount of time to tie a sari, this translated into ~40 minutes.  I passed the time by reading one of the few physical (not digital) books for class.  This one was about Cosmopolitanism, which (as Wikipedia succinctly defines) is a philosophy “that all human ethnic groups belong to a single community”.

 

Considering the circumstances, I couldn’t have chosen a better reading topic.  Here were a few of my main observations.  (Before I get myself into stereotyping situations, I’ll preface this by saying that my understanding of Indian culture is mostly shaped by my travels there in 2013 with the University of Michigan Society of Women Engineers.)

  • Diwali is the Hindu festival of light  that celebrates the triumph of good over evil. Like other religious feasts such as Passover (Judaism), Easter (Christianity), and Ramadaan (Islam) the specific date depends on various lunar calendars instead of our traditional 12 month Gregorian calendar.  This year, Diwali falls on October 23, but London got a jump start with their October 12 festival.  (I liken this to having a Christmas parade in early December.)  When I glanced at the announcements from Our Lady of Mount Caramel, I was admittedly a bit amazed when I saw the main article was about celebrating light.  Upon further reading, I realized that they weren’t actually advertising the celebration on Trafalgar Square– rather, remembering the other-worldly solar activity (now referred to in Catholic tradition as the Miracle of the Sun & apparition of Our Lady ) at Fatima in Portugal October 13, 1917.  Though the overlap of events probably wasn’t intentionally constructed interfaith dialogue, it provided an excellent bridge for understanding.
  • India is a fascinatingly diverse country with a cultural color palette that is very different from what I’ve grown accustomed to in the US.  My interest in Indian culture began when my older sister Gretchen spent a 11 weeks working as an engineering intern in Chenai, and incidentally, wore a sari every day.  When she returned home, we attempted to resurrect our childhood days of playing dress up, but despite Gretchen’s best efforts I never managed to successfully make the sari look presentable.  Even when I traveled to India with SWE, the pants, long top, scarf combo of the salva kameez was all that I could handle. Since this (London) was my first experience getting fully draped in a sari, it seemed only fitting that my “blouse” was my Keep Calm and SWE On cranberry V-neck.
  • If the Brits love of queuing is on one extreme, the almost non-existent queuing strategy in Indian culture is on the other extreme.  I particularly remember a situation when I was trying to order food in the domestic airport terminal in Delhi.  Though American’s don’t queue with the same amount of fervor as Brits, I still relied on my American mindset as I approached the display case… which turned out to be rather ineffective: I stood while a steady flow of business men (from my perspective) “cut in front of me”, ordered their meal, paid for their meal, and began eating.  I’m not trying to make a case for either system, just trying to contrast the two.  While proper use of elbows and hand waving are key components of communication in India, I’m pretty sure that would earn you a stern British glare in London.  Such a juxtaposition: forming a queue while women tied saris and men politely guarded the entrances from passersby that tried jumping the queue. (Madam, madam!  The queue is this way!)

 

(Click on photo for expanded view + full caption.) 

The day was made complete by a delicious lunch of chole (spicy chick peas). Though it may not measure up to the dishes that I enjoyed wilst in India, it was indeed tasty.  My task now is to find the restaurants that have made London legendary for having the best Indian food outside of India.

Featured Image: sunrise from my apartment window