WHAT DOES THE DOCTOR THINK THIS MONTH?

August 2012

Now, this is quite a complicated article, where the first few paragraphs set the scene for the main theme; it is really important that you concentrate, as the first part is quite complicated and I shall be asking questions later. When I started as a medical student at The London Hospital 50 years ago, we were not allowed near a patient for the first 2 years. Our time was spent learning Anatomy, Histology and Physiology. I dissected six corpses (kind people who had donated their remains for medical research or tramps who were not quite sure what had happened) and spent many, many hours buried deep in Gray's Anatomy. We had a weekly “viva voce”, an oral examination, a terrifying experience where we had to state clearly the anatomical facts we had learned. We had to describe the medial, lateral, superior and inferior “relations” of all the structures about which we had learned. Medial is nearer to the central vertical line through the body and lateral is farther away. For example, your eyes are medial to your ears and your mouth is inferior to your nose. We were assisted in this by a great many anatomy mnemonics, every first letter of which described an anatomical structure. They were quire colourful – Structures passing through the superior orbital fissure (a crack in the skull above the eye) were remembered as Luscious french tarts sit naked in anticipation – Lachrymal nerve, Frontal nerve, Trochlear, Superior division of Oculomotor, Nasociliary from the Ophthalmic nerve, Inferior division of Oculomotor, Abducens nerve. My favourite was used for the course of the Lingual nerve, which supplies the tongue, The Lingual Nerve describes a curve around the Hyoglossus. Well, I'll be f*c*ed, said Wharton's duct – the b*st*rd's double crossed us!

The serious study to learn all the Anatomy was carried out in complete silence and I soon developed the ability to shut out the outside world when studying_._ Such was the need for precision in the vivas that we all rapidly developed the ability to think clearly before speaking and to enunciate very clearly. Before going to university, I spent my summer holidays working in my father's Liverpool warehouse under the care of “Our 'Arry”, the manager. During my first (and only) Summer holiday from University, I went back to work and “our 'Arry” soon exclaimed “R. A.  Ee, Yer don't 'arf talk posh now” (Note – my parents had a phobia about names being shortened so they called me Ian. I spent my entire school life being called Ee)(Further note: R. A. is theLiverpool equivalent of theNorfolk “or right, are yer?”

Later in my training, we developed the skill of taking a history from the patient, examining them, planning treatment and carrying it out. We were then taught to reflect upon what we had done and work out ways it might have been done better. All through my life, I have been oblivious of the surrounding world while studying or reading and I have spent a lot of time in reflection and planning the future. Management calls this daydreaming and not paying attention and I suppose it must look like that. Anyhow, one morning, I was reflecting and planning when I heard “Is this an old dress?”. Head Office had walked in. Now, being a bloke, this question set off alarm bells, flashing lights and so forth in my head. There are certain scenarios where a man can rarely win – Compliment her on her new dress and she will tell you she's had it for months and name half a dozen places she wore it. Not noticing she has a new dress is equally bad. Telling her that an outfit looks slimming can be dangerous. “Does my bum look big in this?”  Equally dangerous. (Reminds me of the lady in the burkha asking “Does my bomb look big in this?”)

Back to the question “Is this an old dress?” Pause for thought – never speak without thinking. Take a chance on “Well, it looks quite new, (gulp) Have you had it long?”. Stand back. I was quite relieved by the reply “No, I have only just bought it and I asked you whether it made me look old. The failing hearing had done it again – I had only registered part of the question. That reminds me of my favourite joke about the three people out for the afternoon:

It's windy today, isn't it?    Nah, it's Thursday.   So'm I – Let's have a cup of tea!

I was sent a cartoon the other day. It shows an early caveman dragging his wife around by the hair. He meets another caveman and, while chatting, announces “I have decided to teach her to talk – what harm can it do?”

EUROPEAN HEALTH INSURANCE CARD – HAS YOURS EXPIRED?: This card replaced the E111 several years ago. If you carry it when abroad in Europe, it gives you entitlements roughly equivalent to the NHS. Years ago, we all changed from the E111 and have since carried the new cards. Until I read an article yesterday, I had not realised that these cards carried an expiry date. Sure enough, Deannie and I have been carrying cards which expired 2 years ago! They are very easy to renew online and you may wish to check the expiry date on yours before you set off across the Channel.

Best wishes to you all                                                                                Ian Nisbet