Academic Year in Picture.

It’s been quiet around here. It will remain so for a while.

See you on the other side.

IUD

You’re in a hospital room, 26 weeks pregnant, having a scan. Your blood pressure is a little high, your baby is a little small, but you’ve felt the baby kick this morning and it’s sunny outside. You’re lying on the red-cushioned examination couch, the lighting is down, and in the dim glow you’re staring at that industrial square-tiled ceiling that has infiltrated hospitals and schools everywhere. The gel on your belly is cold, but the doctor’s hand guiding the probe is warm and the air conditioning unit on the wall behind you is blasting frigid air at the medical student sitting by your side, sparing you its icy attentions. At your right, a screen shows the constant monochrome metamorphosis of ultrasound, moving and shifting with the glide of the probe on your skin. A pager goes, and the smartly-dressed midwife sitting in the corner shoots you a smile as she walks out of the room to answer it. Fans on the ultrasound machine are whirring away and the doctor is taking measurements: the distance around your baby’s head, the length of it’s thigh bone. His suit jacket is over the back of his chair, sleeves rolled up, and his voice is gentle as he asks you when you last felt the baby move. It was a couple of hours ago, just after your partner left for work, and you tell him this. You look left at the medical student, who drops his eyes from the screen to dredge up a wan smile, awkward, sad, reflexive like he doesn’t know what expression to make. The probe on your belly is still, and you turn back to look at the doctor as he speaks again. The look in his eyes breaks your heart.

“I am so, so sorry.”

****

I wrote this reply to a comment below, but it got so long I figured I’d just put it into the post. Bear with me, this is long.

Basically the placenta, which is responsible for the supply of oxygen and nutrients to the baby, had failed to implant into the uterine wall deeply enough. As such, the blood flow to the baby was reduced, and although that was sufficient for the first 20-odd weeks of this lady’s pregnancy the demands of the baby kept growing beyond the capacity of the placenta. Mum’s high blood pressure was as a result of her body trying to improve placental blood flow by forcing more blood through the narrowed placental arteries, but unfortunately that was both insufficient and began to threaten Mum’s health.* It is also the reason her baby was small, as it didn’t have enough to continue to grow.

Sadly, what I didn’t mention above is that when we scanned the baby, the heart muscle was still trembling slightly. There was no question that the baby had died, but had we scanned her at the start of the list rather than at the end, the baby would likely still have been alive. Luckily, this didn’t happen – had the baby still been alive on scanning, it would have shown signs of difficulty and Mum would have had a crash C-section, with all the complications that carries, as well as delivering a foetus so tiny that it would fit in the palm of your hand. The chances of that baby surviving would be minute; the chances of it surviving without severe abnormality would have been nil. Likely, the baby would have been delivered and died within a fortnight, and Mum would be left with a classical C-section scar (which increases the risk of rupture of the uterus and placental problems in her next pregnancy, it’s not a cosmetic thing).

Mum had an induced labour the next day to deliver her baby. I didn’t go. She consented to have the baby and placenta examined to see whether there was some abnormality that would have been responsible for the death, and had a battery of tests herself to exclude a variety of things about which the obstetricians were concerned. Currently, the thinking is of an early presentation of pre-eclampsia, but without protein in the urine this is cast into doubt and there are any number of chromosomal abnormalities of the baby which would achieve the same result.

Problem with being an obstetrician is that you don’t get to see the healthy normal pregnancies. In the scan clinic I was in that morning, this was not the only tragedy. It was bruising, and once the clinic finished I promptly went home, wrote the above, and spent the rest of the day distracting myself.

*In the event that there is a threat to Mum’s wellbeing in any pregnancy, maternal life takes precedent over that of the baby. Obviously, it’s usually not such a black-and-white clinical picture – there is often suffering or difficulty on behalf of the mum that is managed as best as possible until delivery, which solves the problem – but there are instances where the only recommendation the doctors can make is that the baby is either delivered early (can be very early, more common) or aborted (rare) in order to save the mother’s life.

Primary Insomnia

Primary insomnia is defined as a difficulty in getting to sleep, and it’s a new feature of my life. It doesn’t matter how tired I am, what time it is, what I’ve done that day. It only matters that I’m trying to go to sleep, and thus far I’m not managing it. Night after night. Hour upon hour. Racing thoughts, a blazing carousel of cognition that doesn’t shut off, considering, evaluating, rehashing; remorselessly flaring in the dark and keeping oblivion at bay.

Dramatic prose aside, I’ve thought like that all my life. Doesn’t matter what I’m doing, from eating breakfast to having sex, there’s always a detached and logical monolouge muttering away in the background. Whilst thinking demanding tasks is distracting enough to not blot it out (such as playing intense sport, or learning interesting things), anything that doesn’t completely demand my full attention allows that background thread to the fore. Needless to say, lying in the dark with my head on a pillow does not exactly demand my full attention.

This is why I prefer action films to chick flicks. In an action film, you get what you see – shit! they’re falling from a building on to a huge piece of netting! Whoa! Now everything is exploding! Awesome! There is very rarely anything else to consider about these scenes – they are predictable and slightly mind-numbing and that’s rather nice, once in a while (read: often). You can focus completely on the outrageous intensity of the scene and life is good.* Chick flicks, on the other hand, are just as predictable but lack that obviousness that numbs the action films – you’re thinking about the characters and the next sentence and the anticipating the next semi-humourous line and blam! film finished and you never got that moments quiet. Worse still, you then analyze the damn thing afterwards and you’ve got double the trouble for your money. I digress.

I want to sleep when my head hits the pillow. I want to slow down, shut down, blank out, but I can’t.

Unfortunately, it’s only going to get worse for the next two months.

*Also, ever noticed that some of the best films are action films with a good plot? Inception, the Matrix, V for Vendetta, Fight Club, Lord of the Rings trilogy. Sure, there are plenty of awesome films from all walks of genre out there, but many of my favourites contain no small pieces of action (actually, there are so many good films from other genres out there this paragraph is basically invalid, but whatever).

**Do sloths yawn?

Minimum Pricing

I will readily admit that my knee-jerk reaction to a minimum alcohol pricing was a firm and semi-outraged NO. What right have the government to make my life more expensive when a pint down the pub is already close-on £3.50? 40p per unit of alcohol? I’m not a heavy drinker by any standards but a swift stamping-down was in order. Rally the troops!

Back to reality. 40p a unit is nothing – it’s not putting 40p on the price of every unit in a drink, just ensuring that there is 40p in the price per unit of alcohol. Once I thought about it I couldn’t see many drinks that the rule would actually affect: Sainsbury’s Basics vodka, perhaps, and Frosty Jack’s Fake Rancid Cider, definitely – neither of which I drink but that are a staple for binge drinking culture. In fact, I suspect that the cost-per-unit idea doesn’t go far enough;* it won’t make a difference to £1 doubles night, for example, and I can tell you first-hand that £1 doubles are a deadly thing indeed.

Something so deeply ingrained in the national habit as alcohol is never going to be the easiest thing to address, but I think a 40p-per-unit requirement is a decent first step that targets only those buying in units rather than drinks. I honestly cannot name anyone who enjoys the taste of Frosty Jacks or budget vodka, but I can name plenty of people who have drunk the stuff (myself included). If it were the same price as a better quality vodka/cider, then the choice would be obvious. The only risk I can see here is that the overall price of all supermarket alcohol will rise as the lowest denominator does – Smirnoff will raise prices to avoid association with Asda Smartprice – but that is something I reckon will only affect spirits. Supermarkets don’t tend to have own-brand wines and beers and so that negative image will not apply. Finally, the ‘percentage creep’ of wines and beers should reach a ceiling. The benefits are manifold. Make it law. Brilliant.

*Of course, it would never get passed if it went far enough to put an end to binge drinking, and probably with good reason for all the moderate drinkers out there.

Gay Marriage

I’m sure you are all aware of the current furore over the issue of gay marriage. For those of you who’ve just returned from your 2-month solo rowing trip across the Atlantic the basic premise is that the government is planning to legalise gay marriage by 2015 and the Roman Catholic church is leading the charge against that notion. Various religious organisations are coming down on both sides of the fence, and the most recent development is a letter signed by 2,500 churches and a couple of archbishops condemning the whole idea.

I think it is assumed that gay marriage is a great idea – lots of equality, legal recognition (already granted by civil unions, but still) and by passing it some upstanding politicians will get a warm fuzzy feeling from knowing that they have been extra-PC today. I’m sure you’re familiar with that most wonderful of feelings.

*****

An evening in Pizza Express; I am chatting to a group of friends, one of whom is gay and generally has her head screwed on. This topic came up and I was surprised when she came down firmly against the idea of gay marriage, making me realise that I’d simply presumed that gay marriage is the best plan and was fully prepared for that warm fuzziness when the law was passed. Now, having spoken to her about it, I am not so sure.

What she was saying boiled down to this: marriage is a religious tradition and whilst it has been written into law and knit into the fabric of everyday life, it ultimately remains religious in origin and should be governed as such – by religious institutions. She found the idea that gay campaigners were effectively forcing the church to subject one of their most celebrated ceremonies to a definition change on the pretext of equality abhorrent, and shameful. Yes, she conceded that many non-religious people got married and that this was indeed a partial blow to the ‘religious tradition’ argument, but equally that those people who were non-religious and got married still did so according to the basic religious definition of marriage: a joining between a man and a woman.

At this point, especially after a couple of glasses of wine, I was floundering. A civil union and a marriage in the UK are legally identical – rights and responsibilities, tax and property etc are all managed in the same way regardless of which umbrella you fit under. As such, the only difference between the two things is in the name, and the fact that only homosexual couples can engage in a civil union.

That is where the problem lies. Civil unions are in need of legislation broadening their accessibility by heterosexual couples, and I believe that out of respect to centuries of tradition and spiritual significance marriage should be left as it stands. The word marriage means a lot to the church and to its followers, and to impose laws forcing them to accept what they believe in heretical* into one of their sacred ceremonies is deeply disrespectful. Gay people, of course, believe that not being able to call it marriage is deeply disrespectful. It basically comes down to who deserves the respect more – something mired in a bias so thick that wading through it will never be possible.

My gay friend has convinced me that I do not believe in gay marriage. Instead, I support non-discriminatory civil unions. Give marriage back to the church, I say, and let it be once again a religious ceremony to be celebrated and administered by the beliefs from whence it came. For everyone else a civil union is legally viable and is no barrier to a big party, and is held back only by short-sighted legislation forbidding it to the majority of the British population (and by the lack of a smooth verb to describe it – unioned? Civilised? Someone needs to think hard about this). I am shocked by my support of the Roman Catholic church (don’t hold your breath for the next occasion) but I realised that I was supporting gay marriage only because I hadn’t really thought the matter through properly – alongside everyone else I just saw the word ‘equality’ and assumed it was a step in the right direction. Equality may be a worthy aim, but in this case it’s being gone about in the wrong way.

Discussion welcome.

*rant for another time.

Indeterminate Time in Pictures

Been a while since I’ve had time to put take some good photos and put them up. Here we are…

Proof that not everything in hospital is ugly or functional.

Went flying recently, textbooks and all. Won at life in the airport, and can die a happy man.

Saw this in London, thought it was pretty awesome.

Medical Imaging II

You know those moments when the world slows down, the clock in your head leaving an age between ticks?

The place: paediatric intensive care. It’s a large room, busy, 8 bays. In one, a 13 year-old girl lies unconscious as she has for the past 9 days, her mother by her bedside. In another, a sprightly 6 year old boy is waiting to go back to the ward. The room itself is a peculiar amalgam of childish colour and medical marvel, bright paintwork and impassive machinery. It is  an effect that doesn’t quite work; a jarring and false attempt to lighten what is at heart a place where the sickest of children come to live or die.

There is a small crowd assembling around one of the bays, at the centre of which lies a incubator cot. Behind its transparent walls is a tiny infant, no more than a few days old, with an alien piece of translucent material in the middle of his chest. It is stitched into place, a yellowy brown colour, almost scab-like, and there is a sense that something lies behind it just out of sight. It feels wrong.

The crowd has gathered; three consultants and a scrub nurse, the registrar, two other nurses and a medical student. The concentration of expertise at the top end of the cot is extreme. It gets quiet, even the shallow breaths of the 13-year old in the next bay are audible alongside the twice-a-second bleeps of the infants ECG. The tracing is etched in green above his head, regular, and it stays that way as the surgeon moves in with a scalpel blade to cut away that repulsive patch in the baby’s chest. The anaesthetist has done his job well, and the baby is completely still as the blade cuts through the black silk threads one by one, breaking the stitches apart, peeling the material away from the shadowed recess beyond.

There is not quite enough light in the room to see from the bottom of the bed. Here on the ward there are no operating lights, just the cheap fluorescent lighting tubes set into the ceiling. The surgeon shifts a moment and the removal of her shadow suddenly casts the cavity in the baby’s chest into visibility. There is no gasp from the assembled crowd. Time doesn’t slow down, and the clock in your head keeps ticking away. Nevertheless, easily seen within the chest of this tiny one week-old is his beating heart, each pulse shown on the screen above as the wave of the ECG trace. It is wondrous to witness.

There are a few seconds, gone too quickly, while the surgeon inspects her previous work. Satisfied, she turns to the scrub nurse and begins to close the chest.

The baby in question had been operated on previously for a congenital heart abnormality, I don’t recall which one. They leave the chest open to avoid having to re-open to sternum in case of bleeding etc from the surgery. To do that safely they have to cover the wound with a sterile piece of material to reduce the risk of infection, hence the patch.

It really was quite something.