My Other Blogs ...

Readers of this blog may be interested to know that I have a couple of other blogs which I update from time to time.

1. The Mad Scientist Cooks
This is not the sort of food you would expect to find in a gourmet restaurant, but it is imaginative, wholesome and healthy and easy to prepare using everyday ingredients.
http://themadscientistcooks.blogspot.com/

2. Naked I Came ...

A Journey Through Life In Poetry ...

This is a long-term project to post copies of all the poems I have written since I started writing poetry as a teenager in the early 1970s.

Poems:

http://songsofloveandlonging.blogspot.com/

Introduction and list of poems:

http://songsofloveandlonging.blogspot.com.au/p/naked-i-came-part-1-in-beginning.html

Feel free to have a look!

Pre-Hospital Medicine Update July 2012

As a member of some Australian Ski Patrol and Search and Rescue Medical Advisory Committees I have been putting together and circulating a Pre-Hospital Medicine Update every few months, containing information on the latest Australian Resuscitation Council Guideline changes as well as quite a few other things. As the contents are quite broad, I thought that it may possibly be of interest to others.

The update itself can be downloaded through the following link:
https://dl.dropbox.com/u/30234302/Pre_Hospital_Med_Update_Jul12.pdf
and the numerous documents referred to in the update are available in a ZIP file that can be downloaded from:
https://dl.dropbox.com/u/30234302/Pre_Hosp_Update_Jul12.zip

Future updates will be posted on this blog from time to time.

Melbourne Symphony Orchestra 2012 Season - Music of Maurice Ravel

Melbourne Symphony Orchestra 2012 Season

Saturday 21 July 2012 at 8pm
Melbourne Town Hall
(Approximately 2 hours)

Tadaaki Otaka, conductor
Katarina Karneus, mezzo-soprano
Jean-Efflam Bavouzet, piano

Program of music by Maurice Ravel (1875-1937)
Daphnis and Chloe: Suite No.2
Ravel: Sheherazade
Interval
Piano Concerto in G
Bolero

This was a rare opportunity to hear four of Ravel's works on the same program, occasioned by the MSO's special offer (advertised in "The Age" newspaper) of "Three Concerts for A$99, an offer too good to pass up.

Our seats were in the second-back row of the balcony, which had a clear view of the stage. It appeared that the concert was all but sold-out, as there was only a handful of vacant seats. Free programs were once again available.

The first piece, Daphnis and Chloe: Suite No.2 had an unmistakeable French impressionist feel about it. Not having read the program at this point, the opening section reminded me a lot of gently lapping waves and Debussy's La Mer. It continued on in a similar vein for a while, at times sounding more pastoral or alternately very much like a broad sweeping film score in the Casablanca genre - you could almost see a touching scene between Humphrey Bogart and Ingrid Bergman! Towards the end of the piece the music became much more agitated, sounding like a storm that had blown in, and finished in this mode. Otaka is a very elegant conductor to watch, and he managed to bring out the best in terms of the well-crafted musicianship of the orchestra.

Swedish mezzo-soprano Katarina Karneus acquitted herself well with the three songs of Sheherazade. She was a resplendent figure in stage in a cardinal red gown, but perhaps the choice of a halter-neck and a clinched waist with jewelled buckle was not the most suitable for her body-type. For most of the performance the orchestra provided an appropriate level of accompaniment but at times she was a little "drowned out". This was a charming and pleasant piece which well showcases the skills of the soloist.

The highlight of the program was probably the Piano Concerto in G, with soloist Jean-Efflam Bavouzet, who played with extraordinary energy and panache. There are obvious jazz and blues elements included in the score, including the influence of Gershwin's Rhapsody in Blue. This is an exciting piece which was executed well by both orchestra and soloist, and was very enthusiastically applauded by the audience. As an interesting aside, Bavouzet also has a Scandinavian link - he is the Artistic Director of the Lofoten Piano Festival in Norway. This simply fabulous group of islands is well worth a visit!

During the break between the two final pieces I ran foul of an usher whilst attempting to take one final non-flash photograph for this blog posting. I was told that there was no photography allowed during the performance, and when I countered that I was not taking photos during the performance, I was told that the break was also part of the performance! There is no signage in the Town Hall pointing this out to patrons nor any mention of it in the program or on the web site. I was upset by this, as I only wanted the photo to help promote the orchestra, and there is no way that a non-flash photo in the second-back row of the auditorium respectfully taken during the break would have been capable of distracting anyone. So, I put my camera away 'sans photo' but to make matters worse the usher sat right behind me breathing down my neck for the Bolero to make sure that I did not transgress. As a result, I was the one who was distracted and was no longer "in the zone" and able to enjoy the music to the same extent. It is one of those curiously unsettling human 'sixth senses' when you know someone is staring at you from behind. As a result, I dared not move a muscle lest it was misconstrued as a movement towards my bag and the offending camera.

The audience loved the performance, and Robert Clarke on the snare drum, appropriately placed centre stage, capably and consistently provided the rhythmic drive for the piece. I don't think that I ever saw the movie "10" with Bo Derek that made the Bolero somewhat infamous, and it is probably a good thing that it is now so long ago that many people would not be aware of this association. It was good to see the piece played as it was intended by a high-calibre ensemble, and to to hear the way that the theme colourfully swirls around the orchestra, all the time grounded by the incessant beat of the drum. It is a very clever piece whilst being quite primal at the same time, and it is not hard to understand its popularity.

Oodles of Flavour - Noodle Hut, Fairfield

Noodle Hut

136 Station Street
Fairfield Vic 3078
Tel: (03) 9481 2443
Hours: M-Th, Sat 11.30-21.30
Fri 11.30-22.00
Sun 17.00-21.30
CASH ONLY

This is a local eatery right next door to the Great Bite Fish and Chips (previously reviewed favourably!). There are other outlets of the same franchise aeound Melbourne.

They have a reasonable variety of Wok Tossed Noodles, Soups. Rice Dishes and Side Dishes (incuding vegetarian) and offer a fast and efficient service.

Our group tried out three dishes on this occasion: 

* Noodle Hut "Inferno" - thin egg noodles cooked with a combination of chicken, beef, roast pork and vegetables in a special chilli sauce ($10.80);

* Singapore Fried Noodle - stir fried thin rice noodles with light curry, shrimp, roast pork, bean shoots, onion, capsicum, carrots, egg and shallots ($10.80); and

* Fried Kwai Teow - stir fried thick rice nnodles with roast pork, shrimp, bean shooots, onion, capsicum, carrots, egg and shallots in a dark soy and chilli sauce ($10.80).

These were all very nice, with clearly fresh ingredients, and moreish i.e. it was difficult to stop eating them! The flavourings were quite mild and nothing to be fearful of. There was a good balance of noodles, meat and veggies, but it was a bit disappointing that most of the sauce was concentrated down the bottom of the pack, so I would recommend perhaps transferring the noodles into a bowl and mixing through prior to service. I particularly liked the Kwai Teow - the noodles were "melt in your mouth".

If you are after reasonably price, quick and relatively healthy food it is difficult to go past food like this. It is unpretentious and you know what you are getting, but without the risks of street food. Recommended!

Polar Dreams – Antarctica and the Arctic

On 18th July I attended a World Expeditions Adventure Presentation on voyages to the Arctic and Antarctica presented by Greg Mortimer.

From their blurb:
“Greg Mortimer is a pioneer in Polar tourism. Antarctica and the high Arctic have dominated his life for the past three decades. Greg has worked as a geologist in Antarctica, was one of the first Australian’s to climb Minto, the continents highest peak, and has personally led over 80 voyages to the region since 1992. No other Australian has more passion, or knows more about the Polar Regions, than Greg.

Join Greg as he outlines the numerous opportunities available to you to experience the wild untamed magnificence of Antarctica and the high Arctic. Discover what you could be doing in some of the world’s most precious and extreme wilderness landscapes, from South Georgia to the South Shetland Islands, the Antarctic Peninsula to the remote Ross Sea and as far north to Spitsbergen, Greenland & Iceland.

Greg’s visual voyage will provide you with a deep insight into the wildlife, history, majestic icescapes and of course what it’s like on board our ships and what gear you’ll need to take.”

Greg is a very humble person despite his many and varied achievements and it was a very enjoyable evening as he shared his personal account of what it is like to visit the polar regions.

Having lived and travelled extensively in Norway, including an Expedition Medicine course near Alta in the Norwegian Arctic, and visited Iceland (promptly falling in love with the remarkable landscapes), visiting places like Greenland and Svalbard and seeing polar bears (my favourite animal) up close and personal (but not too close!) is on my “bucket list” and readers of this blog will know that I have long had a hankering to visit and/or work in Antarctica. For a couple of years I have been trying to ‘get a gig’ as a ship’s doctor with one tour company, but no luck so far (keenly competitive as you might imagine – no pay but you get the trip for free!).

Greg shared his stories, personal impressions and some stunning photographs of Svalbard and Spitzbergen, Iceland, Greenland and Franz Josef Land (not a place many of us had heard of before) and some close encounters with polar bears. He also talked about the amazing bird life.

Moving to the other end of the world, he talked about Ushuaia, the setting off point in Argentina, the voyage to the Antarctic Peninsula, South Georgia, the main Antarctic continent and Macquarie Island and the varied climates, terrains and animal life in these different areas. There was one fun photo of ‘camping out’ in Antarctica under the midnight sun!

Greg told us that he had been to Antarctica 100 times, and holds a wealth of knowledge about the polar regions and its history. He will be leading some of the trips during the 2012-13 season, including a new “Ross Sea Explorer” trip travelling from New Zealand to Antarctica.

Based on what I saw during the presentation, World Expeditions appears to be a reputable, professional and responsible company and would be well worth considering if you are thinking about a trip to the polar regions. As for me, I would still love to go so will have to continue working on trying to find that ‘lucky break’!

For further information see:
www.worldexpeditions.com
info@worldexpeditions.com.au

Movie Review - Prometheus

This is Ridley Scott's 'prequel' to the "Alien" series. The title of the film is in itself a clever literary allusion as the film is both about the creation of humankind, the quest for scientific knowledge and unintended consequences – “fools rush in where angels fear to tread”!

(From Wikipedia) “Prometheus is a Titan, culture hero, and trickster figure who in Greek mythology is credited with the creation of man from clay and the theft of fire for human use, an act that enabled progress and civilization. He is known for his intelligence, and as a champion of mankind. The punishment of Prometheus as a consequence of the theft is a major theme of his mythology. Zeus, king of the Olympian gods, sentenced the Titan to eternal torment for his transgression. The immortal Prometheus was bound to a rock, where each day an eagle, the emblem of Zeus, was sent to feed on his liver, only to have it grow back to be eaten again the next day. In the Western classical tradition, Prometheus became a figure who represented human striving, particularly the quest for scientific knowledge, and the risk of overreaching or unintended consequences.”

The opening cinematography is absolutely stunning and would be worthy of any quality nature documentary. I had a hunch that it was my beloved Iceland (and the closing credits proved me correct), and we were treated to a spectacular vista of glaciers, glacial rivers, craggy mountain peaks, valleys, lakes and waterfalls. Visiting Iceland was one of the highlights of my life and I would certainly recommend having it on your "bucket list"!

(Note: Wikipedia is acknowledged as the source of some of the plot description.)

The introductory sequence itself is rather puzzling. A solitary hooded and robed figure strides to the edge of a waterfall, and reveals himself to be a powerfully muscled albino. A spacecraft hovers overhead and he opens a small container which is filled with a seething dark liquid. He consumes it, starts to convulse, his appearance changes and he literally starts to fall apart and topples into the waterfall just as a hovering spacecraft leaves. In the water his body appears to dissolve and his DNA rearrange itself and spontaneously develop into a new life form, the cells of which divide and multiply.

In the next scene we are introduced to two of the main protagonists - Drs Elizabeth Shaw (played by the luminous Noomi Rapace of "The Girl with the Dragon Tattoo" fame) and Charlie Holloway (Logan Marshall-Green), who are on an archeological dig on the Isle of Skye in 2089. They discover a wall painting that features a particular constellation that has independently been found depicted in a number of other locations around the world. They conclude that it is a guide map left behind by travellers (“the Engineers”) who want humanity to find them, the creators.

A deep space mission by the scientific vessel Prometheus to the distant moon LV-223 is funded by the Weyland Corporation. The human crew travels in stasis whilst the ship’s caretaker is an android named David (Michael Fassbender), who rather fancies himself as ‘Lawrence of Arabia’, adopting Peter O’Toole’s hairstyle and accent. Since the nearest star, Proxima Centauri, is 4.22 light years away, it is not clear how the Prometheus manages to reach its mission objective in a mere four years. Upon arrival the motley crew (in common with all “Alien” movies some people are there “just for the money”) wakes up and the full details of the mission are revealed by a hologram of an ageing Peter Weyland. Mission director Meredith Vickers (Charlize Theron) tells the scientists that she is boss. Conveniently they find a series of built structures on the surface of the moon and land the ship and go to investigate.

Inside the first of the structures, they find numerous stone cylinders, a monolithic statue of a humanoid head, and the decapitated corpse of a large alien, thought to be an Engineer. They find other bodies and presume that “no-one is home” alive. At this point I became a little agitated, as their biohazard precautions were less than ideal and I would not want these people keeping me safe from alien contagion. David secretly takes a cylinder, while the remaining cylinders begin leaking dark liquid. This liquid looks and behaves in a similar way to the infamous black oil in the “X-Files”.

A rapidly approaching storm forces the crew’s hurried return to Prometheus with the decapitated head, leaving lost crew members Millburn (Rafe Spall) and Fifield (Sean Harris) stranded in the structure overnight at the same time there is a “bogey” detected moving around inside.

Back on board Prometheus, in a cunning piece of wizardry that contains a direct reference to the original ”Alien” movie, it turns out that the alien head is wearing a helmet, which when removed reveals a very life-like humanoid head almost identical to the alien in the opening segment. DNA is extracted and found to match that of humans, and when residual electrical activity is detected in the head it is “brought back to life” with interesting consequences. Meanwhile the malevolent David, who has clearly never heard of Asimov’s Laws of Robotics forbidding harm to humans (not to harm or by omission of action, allow to be harmed, a human being), investigates the cylinder and discovers a dark liquid. He then taints a drink with the substance and gives it to Holloway. Shortly after, Shaw and Holloway have sex. At this point, things are a bit confused. There is clearly a hidden agenda, but what is it and who are the bad guys? David is one of them, and he seems to be collaborating with Vickers and another unseen person.

Bad things happen to the two men trapped inside the structure. A snake-like creature kills Millburn, and sprays a corrosive fluid that melts Fifield's helmet, exposing him to the leaking dark liquid. In echoes of “Alien”, we once again see humans being unpleasantly intubated by alien life-forms, and have the sense that this is somehow linked to that storyline. The crew later returns to the structure and finds Millburn's corpse. David goes off on a frolic of his own, even severing the video transmission to Vickers, and separately discovers a control room containing a surviving Engineer in stasis, and a virtual star map highlighting Earth (the special effects are absolutely stunning in this segment, including a 3D hologram of the Earth which wistfully fades away when the projection abruptly shuts down). At this point we are really wondering about David’s hidden agenda and recalling the folly of corporation hacks who thought that they could subdue an Alien and bring it back to Earth.

Holloway's ingestion of the dark liquid leads to an infection that rapidly ravages his body. He is rushed back to Prometheus, but Vickers refuses to let him aboard, and at his urging, burns him to death with a flamethrower. Later, a medical scan reveals that Shaw, despite having earlier revealed that she is unable to have children, is pregnant with an alien offspring. Shaw manages to escape from David and the fellow crew members that want to put her back into stasis (to ensure that the alien embryo is transported back to Earth – echoes of the “Alien” franchise again) and is just desperate to rid herself of the creature. There is an automated surgery table on the ship and she optimistically asks for a caesarean but it replies that it is only programmed for male anatomy and cannot comply. Whoever heard of such craziness – sending a robotic surgeon into deep space just to operate on males – I don’t think so! Thinking laterally, she orders it to perform the removal of a foreign body from her abdomen and has to undertake some pretty gutsy self-anaesthesia. Conveniently the machine has what looks exactly like a pair of birthing forceps to extract and subdue the squid-like creature. Shaw escapes and stumbles around for much of the rest of the movie clutching her stapled abdomen and in great pain. I have seen some women happily walking around the day after a caesarean but Shaw is really forced to ‘push to the max’ physically in order to survive.

Weyland (Guy Pearce) is revealed to have been in stasis aboard Prometheus pulling the strings, and explains to Shaw he wants to ask the Engineers to prevent his death from old age. As Weyland prepares to leave for the structure, Vickers calls him "Father". Before the party can leave, a mutated Fifield attacks the hangar bay and kills several crew members before being killed himself.

The Prometheus's captain, Janek (Idris Elba), speculates that the structure was part of an Engineer military base that lost control of a virulent biological weapon, the dark liquid. Janek also determines that the underground structure is in fact a spacecraft. The shape of the spacecraft is eerily similar to the one seen crashed in the opening scenes of the “Alien” movie, so various strands of the backstory have been woven together by this point.

Weyland and a team return to the structure and are foolhardy enough to awaken the sleeping Engineer. David, who has been studying Earth’s ancient languages during the long trip, speaks to the Engineer, who responds by decapitating him and killing Weyland and his team. Shaw just escapes the spacecraft as the Engineer prepares to fly away. Shaw warns Janek that the Engineer is planning to release the liquid on Earth and convinces him to stop the spacecraft via a suicide mission. Vickers and her lifeboat are ejected before Janek bravely collides the Prometheus with the Engineer's spacecraft. The Engineer's disabled spacecraft crashes onto the planet and rolls across the landscape, killing Vickers and finally dispelling that nagging doubt that Vickers was also an android.

Shaw goes to the lifeboat and finds her alien offspring, which is still alive and has grown to gigantic size. David's still-active head warns Shaw via radio that the Engineer survived the crash and is coming after her. The Engineer forces open the lifeboat's airlock and attacks Shaw. She releases her alien offspring onto the Engineer; it thrusts a tentacle down the Engineer's throat, subduing him.

Shaw feels that she needs to know why the Engineers would want to destroy the human race, which they had created. As there are more buried alien spacecraft which David believes that he can fly, she enters into a pact with him and recovers his head and body. In the dying moments of the film they launch another Engineer spacecraft as Shaw intends to reach the Engineers' homeworld in an attempt to understand why they wanted to destroy humanity. In the lifeboat, a large alien creature bursts out of the Engineer's chest. Guess what? It’s the same lifeform as in “Alien” except with pink gums and a very human looking set of choppers (teeth) rather than the metallic variety that we became so used to.

It is a good ensemble cast, with stand-out performances from Rapace, Fassbender and Theron. At times it is difficult to work out whether Shaw has an English or a Continental accent, and she has a tendency to mumble, detracting from the import of what she is saying. Fassbender is absolutely chilling as the soul-less and mercenary David, and Theron again impressively reprises the role of an ice-queen.

Although the plot does contain several predictable elements from the “Alien” franchise, it hangs together reasonably well and continues to surprise. Like Ripley and her android Bishop, Shaw and David are the sole survivors, leaving scope for a sequel if they do in fact make it to the Engineers’ homeworld.

The aforementioned scenery is stunning, as are the special effects. However, the underlying premise of the plot, that the Engineers would want to destroy humanity (a relatively primitive race) after having gone to all the trouble of creating them, remains perplexing. A friend of mine has it all worked out. He thinks it is all to do with intergalactic trade and there is a missing link with the “Alien vs Predator” franchise, in which the Aliens were bred for the Predators to hunt. Imagine the profits if you infect a whole planet and create a bottomless supply of Aliens! The whole deal may well have been brokered by the Ferengi, who are not unfamiliar with the Rules of Acquisition!

While it is not viscerally challenging in the same way as the raw horror of the original “Alien” movie or the sequel “Aliens”, there is sufficient unpredictability and murkiness of purpose to keep you guessing and at times on the edge of your seat. There is certainly a sense of the ‘puniness’ of humans in the overall scheme of things and it is in many respects a cautionary tale not “to mess with things you do not understand”. Both the humans and the imperturbable David (even when decapitated) are ill-prepared for what they actually encounter, and make the fatal mistake of assuming beneficence on the part of the creator Engineers. We see the whole craziness of what makes up human nature – love, folly, bravery, risk-taking, the quest for exploration and finding answers, betrayal, sacrifice and the will to survive.

Is it groundbreaking in the same way as “Alien”? No. Is it clever, complex and interesting? Yes. Does it raise more questions than it answers? Yes. Did I enjoy it anyway? Yes.

Sometimes watching a movie like this with some fairly significant unexplained portions of the plot is a bit like being a scientist in real life – we want to know all the answers but sometimes we just have to admit that nobody knows at the moment! The difference with a movie I suppose is whether it is a convincing enough package to engender a “willing suspension of disbelief”. This is one where you will have to decide for yourself!

CPD for Doctors (and Medical Students) - A Never Ending Story!

The Royal Victorian Eye and Ear Hospital (in conjunction with General Practice Victoria) presents some excellent clinical update seminars primarily aimed at GPs several times each year: http://www.eyeandear.org.au/page/Health_Professionals/Referring_to_the_Eye_and_Ear/Education_and_training/

These are always of a high standard and presented by experts in the relevant areas.

There is also a series of Saturday morning lectures in Otolaryngology and Dermatology suitable for medical students in their clinical years:
http://www.eyeandear.org.au/page/Health_Professionals/Education_and_Training/
http://www.eyeandear.org.au/content/Document/Training%20and%20Education/Saturday%20morning%20lecture%20series.doc

Between June and September of each year a Short Course in Perioperative Medicine is conducted by Monash University in conjunction with the Alfred Hospital Department of Anaesthesia and Perioperative Medicine. See: http://www.periopmedicine.org.au

This is primarily an online course with reading materials and a video lecture for each of the twelve weeks of the course (with multiple choice questions to complete for each unit), and an intensive face-to-face weekend at the Alfred at the conclusion of the course. 

Many aspects of perioperative management are covered and some of the topics included in the twelve units of the course are:
* Coronary artery disease and hypertension
* The Cardiac patient for noncardiac surgery
* Perioperative cardiac risk assessment and testing
* Heart failure
* Arrhythmias, pacemakers and AICDs
* Anticoagulants, antiplatelets and thromboprophylaxis
* Blood Transfusion Medicine
* Airway management
* Sleep apnoea
* Pulmonary disease
* Endocrine disorders
* Obesity
* Allergies and anaphylaxis

It has been an enjoyable (and very comprehensive) course so far but requires a fair degree of commitment as to date it has taken around a day to complete the materials for each unit.

A Diploma and a Masters in Perioperative Medicine are also available.

The second Melbourne Medical School annual MD Student Conference was held at the Melbourne Cricket Ground from 2-5 July 2012. This is a compulsory course component for MD students (the new graduate MD program is now in its second year) and covered a variety of areas including Clinical Research and Indigenous Health, Medicine & the Law and Healthcare Systems, Dealing with Death and Adaptation to Change, Mental Health & Well-being for Medical Students and Social Determinants of Health and Career Development.

Victorian Remote Area Nurse Update Program 2012 and Alpine Medicine Presentations

In July last year I attended the 2011 Emergency Management Conference in Melbourne and struck up a conversation with the Ambulance Victoria representative who was responsible for educational updates for the Victorian Remote Area Nurses, a group of remarkable (mostly) women who work in small bush hospitals and remote towns and are the medical first responders for their community. It seemed that there were some commonalities between the work that RANs do and the work that ski patrollers do as first responders in remote locations, and I offered (by way of networking) to assist with the annual update program for the RANs.

This is run annually as a two day program in both May and June, and the RANs are given a number of update lectures as well as rotating their way through a series of practical competencies designed to refresh their skills and assess their competency to practise these skills in a diverse range of areas. RANs must successfully complete some workbook materials prior to attending the Update. The workstations are manned by a very dedicated, knowledgeable and experienced group of (mainly) rural ambulance officers and midwives, and all materials are based on an extensive Learning Support and Resource Material package and the splendidly comprehensive Remote Area Nurses Emergency Guidelines (available from http://www.ambulance.vic.gov.au/Media/docs/RAN%20Guidelines-81ae0568-940d-404d-acd9-aae84eeeea0c-2.PDF). These are a great resource, and I have used them myself for training purposes.

The workstations cover:
1. Obstetric Emergencies
2. Respiratory Emergencies and Airway Management (Adult)
3. Altered Conscious States and Medical Emergencies (Adult)
4. Trauma (Adult)
5. Cardiac Emergencies (Adult) including CPR and DCCS (AED)
6. Paediatric Emergencies (Trauma/Cardiac) including CPR and DCCS (AED)
7. Paediatric Medical Emergencies (including Respiratory)
8. Splinting and Environmental Emergencies.

I was honoured to be invited to give a lecture to the RANs at each of the updates and to attend one of workstation sessions as an observer.

After discussions with the coordinator, the lecture I gave at the first update program covered Ski Patrol First Aid training and medications, ski resort demographics and injury profile, polar medicine training in Norway, hypothermia and local cold injuries and altitude illness. This involved a large amount of preparation, but skimming through the first sections and concentrating on the cold injuries and altitude illness I was able to fit it into the 45 minute allocation.

Shortly before the second session I received the feedback that the RANs found the presentation interesting but would have liked more material on hypothermia. I had presented all the existing material on hypothermia and local cold injuries in full so the only way to achieve this was to add extra material at the cost of the other areas in the presentation. The revamped presentation dealt only with these issues, which was a pity from my perspective, as a lot of work went into the other material, but I guess there is always hope that one will be able to use it on another occasion.

I have made the three versions available from Dropbox as a resource (but if any of this material is used due acknowledgment should be given to the sources as I have done at the end of the presentation):

Version 1 (original version covering all topics [129 slides]):
https://dl.dropbox.com/u/30234302/RAN_Alpine_Med_RC_2012.pdf

Version 2: (expanded version covering all topics [174 slides])
https://dl.dropbox.com/u/30234302/RAN_Alpine_Med_RC_2012_v2.pdf

Version 3: (abridged version covering only hypothermia and local cold injuries [90 slides]): https://dl.dropbox.com/u/30234302/RAN_Cold_Injuries_RC_2012.pdf

Some like it hot - Curry Bowl, Melbourne CBD

Lovers of curry will be saddened to hear that the Curry Bowl diner on Elizabeth Street has closed today (Sunday 15 July 2012) after thirty years in the same spot (due to redevelopment of the building). Their home-made Sri Lankan curry came in two forms - individual servings of curry treats such as samosas and potato balls, and generous platings of curries with rice (Regular, Biryani or Vegetarian Combos in small and regular serves for under $10).

There was normally a choice between plain and Biryani rice (with cashews), several vegetarian curries (today lentils, eggplant and a mixed vegetable curry) and chicken, beef or lamb curries. With the larger serving you could get samples of two vegetarian and two meat curries together with the rice. By way of tasty accompaniments yoghurt, pickle and chillies were available, together with two small pappadams for each person.

The curries were all nicely seasoned, and although the chicken was on the bone it was tender and came away easily. The meat was cubed and neither too dry nor too tough, with tasty sauces. The small strips of fried and curried eggplant were outstanding. The lentils were a nice golden colour and mildly spiced. Even the smaller serve was generous, and it was a very enjoyable meal, which more than compensated for the 'no frills' surroundings. The staff were always very friendly and genuine, and came across as taking pride in their food and the enjoyment that people gained from it.

There is another Curry Bowl in the city near the corner of Lonsdale and Exhibition Streets. Apparently the ownership is different, but the menu is similar, so one can only hope that the tasty food and admirable ethos will live on in the surviving location.

Review - "Moonshadow" the Musical

Currently playing at the Princess Theatre, Melbourne
http://www.moonshadowthemusical.com.au/

When I was a teenager I enjoyed the music of Cat Stevens, and was somewhat dismayed when he became Yusuf Islam and left his musical career behind. In recent years he has become just "Yusuf" and resumed his life as a performer in various ways. I was somewhat sceptical when, together with his co-writers he developed the musical "Moonshadow" as a 'feel-good' story showcasing the music of Cat Stevens. I had originally decided not to attend, but was offered a ticket as a birthday present. In the end I felt badly disappointed and wished that I had not accepted this kind offer.

I must preface this review by stating 'up front' that I am not a big fan of musicals, so they have to be truly exceptional for me to enjoy them. As someone who is a choral performer, I generally get a lot more pleasure from performing than sitting still and listening.

"Moonshadow" is decribed as "a life-long dream of its producer, Cat Stevens" which weaves forty of his songs (old and new) in some way into the production. It is a "magical story with themes that are both powerful and universal. It is about hopes and dreams, greed and power, right and wrong, but most importantly Moonshadow is about finding happiness and love".

The young performers playing the key roles of Lisa, Stormy and Patrick did an excellent job. For me Patrick was the stand-out performer, with a great voice and charisma and stand-out moves. He doesn't get the girl in the end but I felt that he deserved to!

The parents of Lisa and Stormy were also sensitively portrayed by older performers and were quite believable.

The sets, costuming and stage management were well done. It is interesting with the costuming that there are women and men with both covered and uncovered heads, and I wonder if this was a cultural tribute. There was a live band in the orchestra pit, but I felt a lot of the time the bass aspect predominated. The whole show started with a very strange synthesiser introduction. One thing that really 'bugs me' is that so many Australian performers insist on singing with an American accent rather than a more neutral accent. It grates, like fingers on a blackboard (a concept which is perhaps unfamiliar to a whole generation!).

Off-stage at various times we see the black and white "good shadows" (one of whom has a long white beard, looking not unlike Yusuf himself), and Moonshadow is sent as their emissary to Stormy, 'the chosen one', to assist him on his journey to rid the world of darkness. Moonshadow was perhaps the greatest disappointment. In short, despite being on stilts and towering over everyone else, he was a 'wimp', with insufficient persuasive powers over Stormy, who for most of the production is a "boy behaving badly".

In terms of the synopsis, parts of which are surely an allegory for Yusuf's own journey through life, we are introduced to a world where darkness is the norm and daylight is just a memory (not unlike the Norse 'Age of Ragnarok' where the wolf has swallowed the sun). Lisa and Stormy (who bears an uncanny resemblance to Julian Assange with a shock of white hair) were childhood sweethearts, and Stormy has a dream of finding the light and bringing it back to the world. He gives a picture of a tree bathed in golden light to Lisa, and she gives him a pendant worn by her late mother. They both promise to stay true to the dream. While Stormy remains in town, Lisa is sent away by her father to live with her aunt. She only returns after her aunt's death, and Stormy is reminded of his feelings for her, but Lisa's father has plans for her to marry Patrick, the son of Mr Matthew ("Matthew and Son").

For some unknown reason, although they live across the street from each other, Lisa's father and Stormy's father have developed a dislike for each other (although the two mothers were secretly friends). Mr Matthew seems to be the only one in town with any money, and Stormy's father derives their living by selling coffee and coffee beans. This is one of the humourous aspects of the production.

After Moonshadow appears to Stormy and informs him of his destiny as 'the chosen one', Stormy decides that "I know I have to go" and sets off on a journey of redemption to try to find the light. We are given the impression that this is a quest with a higher purpose, not unlike the search for the Holy Grail. However, Stormy is no Frodo, and things go downhill from here. The production wanders aimlessly over the next few scenes. Stormy finds a market in the country, ends up playing the guitar to an enthusiastic audience but shortly after Moonshadow essentially says "quit while you are ahead", someone gets robbed, the crowd blames Stormy, he gets beaten up and gets taken to the "House of the Half-Dead". With Moonshadow's help (after a quick prayer, perhaps another personal inclusion for Yusuf) he escapes, and then wanders off into a forest, where he encounters the evil Princess Zeena, who promises him what he has always been dreaming of.

At this point he conveniently forgets about those he has left behind - his parents and the love of his life, Lisa. A troupe of hippies wander along, and they seem to be on a bit of a 'trip', another clever allusion to the "sex, drugs and rock'n'roll" lifestyle of the 1970s. Stormy gets a new cloak, a new electric guitar and a lot of attention from the girls. Princess Zeena takes him to her home in the clouds, laughing all the way (and it is pretty clear that she has some barely-disguised evil intent). Interval arrives, and I am bored. I cannot see the point of the drawn-out previous few scenes, and feel disappointed that Stormy has been so quick to forget his mission and those that he loves.

After interval, the story is wrapped up with breath-taking speed. Moonshadow 'breaks the rules' and touches a mirror to try to help Stormy to "see himself". As a result, he begins to be visible to people other than just Stormy, incuding Zena. Before long, we see Stormy trapped in a cage, Zeena managing a factory that looks a lot like what we would expect Hell to be, and Moonshadow about to be extinguished by Zeena, who laughs maniacally, looking forward to stealing the last bit of light from the world. Mr Matthew also seems to be a collaborator.

Suddenly Stormy is free, running along a bridge with flames on either side. It was pretty unclear how this has happened, along with Moonshadow's reappearance. Stormy sees a vision of his future son, and somehow his reaction to this leads to the light being restored to the world. Then Stormy as 'the prodigal son' rides back into town, just as Lisa is about to be married to Patrick. In Stormy's absence Lisa's father and his father have resolved their differences.

The second-half of the plot seemed quite unsatisfactory, and was concluded with indecent haste. In the all-singing and dancing conclusion, Lisa and Stormy are reunited, light is returned to the world, and it seems that there is hope for the future for everyone. Even the jilted Patrick does not seem too unhappy. There is a touching cameo by the young Lisa and Stormy, singing "Morning has broken".

This is a production that promises so much but delivers so little. Although the music is timeless, the treatment of it was often not ideal and detracted from the enjoyment of familiar tunes. However, the greatest barrier to enjoyment is the gaping holes in the plot and to my mind Stormy did not do enough to redeem himself and at no point asks for forgiveness from those he betrayed. Patrick had worked hard to win Lisa's love, and obviously genuinely cares about her, but is instantly cast aside when Stormy returns. I felt empty at the end. It would have been much more meaningful (and genuine) to see Yusuf himself in concert.

I can't recommend it, but perhaps it would appeal to less-discerning young audiences or family groups. The musical was given its world premiere in Melbourne, so it will be interesting to see where it goes next.

A variety of souvenirs are available and are reasonably priced.

Medical Book Reviews: Jayasinghe ECG Workbook and Robbins Basic Pathology 9th Edition

Elsevier Australia has kindly provided me with inspection copies of the following medical books.

1. ECG Workbook. (Professor) Rohan Jayasinghe.

Churchill Livingstone/Elsevier Australia, 2012. Paperback, 224 pages. RRP $59.95.

http://www.elsevierhealth.com.au/au/product.jsp?sid=&isbn=9780729541091&lid=EHS_ANZ_BS-DIS-1&iid=

(A sample chapter is available: http://www.elsevierhealth.com.au/media/anz/samplechapters/9780729541091/ECG_Workbook_9780729541091_Jayasinghe_SampleChapter.pdf)

For many people ECGs are a bit like "Who's afraid of the big bad wolf”? In reality this includes quite a few of us. In medical school there are people who "just seem to get it" while others continue to struggle, and still "have their L-Plates on" after many years of medical experience.

This refreshing book is aimed at the clinical interpretation of ECGs. It is worthwhile to quote from the Preface written by the author:

“ECG Workbook provides an easy but systematic algorithm to follow when attempting to read an ECG. The exercises are aimed at training the reader to practise this algorithm repeatedly with different ECGs. The real-life clinical synopsis essentially links the ECG findings to the patient’s clinical context. This information guides the reader to make a clinical diagnosis with the help of the ECG findings, and then to decide on the optimal treatment or management plan. … It is hoped that by completing this workbook the reader will gain the required mastery to use ECG as a clinical diagnostic tool effectively and to make suitable management decisions with confidence.”

It is divided into three sections: 1. Basics of the ECG; 2. ECG-based diagnosis: pathology by ECG; and 3. ECGs and pathologies. There is also an Appendix listing the NYHA functional classes, and a detailed Index.

Beginning with Section 1, the pages are cleanly set out, with ample use of coloured headings, colour-shaded boxes for important points and plentiful use of explanatory diagrams. This chapter of 19 pages does indeed cover the basics in a very understandable fashion. It includes the cardiac cycle, the cardiac conduction system, ECG rate, scale and calibration, leads and direction of current travel, determining the cardiac axis and the causes of axis deviation, placement of electrodes and the difference between electrodes and leads, correlation of the leads to the region of the heart, and finally, reading the ECG. This includes a system for doing this together with the parameters of the normal ECG. To compliment rather than insult the author, for those craving a "Dummies' guide to the ECG", this is exactly the sort of thing you are looking for. The chapter is pitched at a good level and easy to follow, and puts the reader in a good position to approach the chapters on pathology that follow.

Section 2 is a chapter of 27 pages. It is set out in the same clean and comprehensive fashion as Section 1. An introduction on reading rate and abnormalities on an ECG is followed by a discussion of various pathologies, starting with different types of tachycardia and their management. Also discussed are bradyarrhythmias and bradycardia, heart block, abnormalities of the cardiac rhythm, normal and abnormal segments of the ECG, ventricular hypertrophy, myocardial infarction and ischaemia, other pathologies with mixed ECG changes, and finally pacemakers. All the common pathologies are discussed as well as some more obscure ones. Section 2 sets up the background for Section 3, which contains the ECG worksheets. After a brief introduction, 45 case studies follow.

The case studies are beautifully set out in two sections each. The first section contains an ECG on the left-hand page and a template for systematic interpretation on the right-hand page, including the various aspects of the ECG, further investigations and management. Before you start to feel that familiar rising sense of panic regarding "but what is the answer?", relax! The second section of each case study includes all the answers, and helps to drill the reader in the recommended approach to systematic interpretation, and helps to build confidence, as your answers can be directly compared to the recommended ones.

Being a paperback of around 250 pages, this book is very portable, and as well as being a workbook is also a handy reference, both in terms of Sections 1 and 2, but also the wide variety of ECGs included in Section 3. It is well-written, accessible and user-friendly. I would certainly recommend it, especially for those who feel a need to improve their ECG skills in a systematic fashion.

2. Robbins Basic Pathology. 9th Edition. Editors: Kumar, Abbas and Aster.

Elsevier Saunders, 2012. Hardback, 928 pages. RRP $103.99

http://www.elsevierhealth.com.au/Medicine/specialty/book/9781437717815/Robbins-Basic-Pathology/

Owners of the book can register it at studentconsult.com, which provides the facility to access the full text online, download images, add notes and bookmarks and to search across all individually owned Student Consult resources online. The online version of the book contains a special additional feature, "Targeted Therapy" boxes (stemming from an understanding of the molecular basis of disease), intended to provide examples of "bench-to-bedside" medicine.

When I was a medical student, our pathology 'Bible' was Robbins Pathologic Basis of Disease by Cotran, Kumar and Collins. I am the proud owner of the sixth edition and its little pocket handbook. This new book is the latest in a trusted and proud lineage. Many of the earlier products are also available via the Elsevier website. Back in those days material available on CD-Rom was considered pretty special and computer-based learning was fairly rudimentary. Since then there has been an explosion of Internet-based resources, and the editors are to be congratulated for "keeping up with the times". In one of the medical student tutorials that I take, students must report back and share with the rest of the class on Fridays the information that they have gleaned concerning the 'learning issues' for the week. Some students will bring their laptops and tablets and read off the screen. Such is the power of learning resources such as the online version of this book - provided there is an internet connection, students and health professionals can access this material wherever they are and use it as a resource in their everyday work.

The book contains 23 chapters over 870 pages, plus a detailed Index at the back. It is visually attractive, with a coloured strip at the top of each page making the chapters easy to distinguish. There is liberal use of coloured headings, diagrams, photographs, tables, orange "Morphology" boxes and blue "Summary" boxes. Even though the text is dense (as is to be expected in any serious medical textbook) the judicious use of colour, illustrations, boxes and space between the various elements makes it appear welcoming and engaging, as opposed to the forbidding nature of many 'old-fashioned' black and white textbooks. Each chapter has a "Chapter Contents" box in its introductory header, listing the key sections and their page numbers. This is a very handy navigation aid. There is also a bibliography at the end of each chapter.

The authors have strived to organise the chapters in such a way that the various groupings of pathologies and organ systems are logical. Some chapters do not have a specific attribution of authorship, whilst many of the chapters are written by other specialist contributors. As we have come to expect, the standard of the content is universally high. Many of the images will be familiar from earlier editions, but there are also many new ones, often showcasing the latest research discoveries.

These are the chapter headings:

1. Cell Injury, Cell Death, and Adaptations

2. Inflammation and Repair

3. Hemodynamic Disorders, Thromboembolism, and Shock

4. Diseases of the Immune System

5. Neoplasia

6. Genetic and Pediatric Diseases

7. Environmental and Nutritional Diseases

8. General Pathology of Infectious Diseases

9. Blood Vessels

10. Heart

11. Hematopoietic and Lymphoid Systems

12. Lung

13. Kidney and Its Collecting System

14. Oral Cavity and Gastrointestinal Tract

15. Liver, Gallbladder, and Biliary Tract

16. Pancreas

17. Male Genital System and Lower Urinary Tract

18. Female Genital System and Breast

19. Endocrine System

20. Bones, Joints, and Soft Tissue Tumours

21. Peripheral Nerves and Muscles

22. Central Nervous System

23. Skin.

In the interests of time and space and maintaining the attention of you the reader, it is probably not wise to attempt to review every single chapter, so I have selected one chapter as an example to demonstrate the general approach to layout and contents and the topicality and prescience of the authors in "walking the talk" as stated in the Preface: "This is an exciting time for students of medicine because the fundamental mechanisms of disease are being unveiled at a breathtaking pace. Pathology is central to understanding the molecular basis of disease, and we have tried to capture the essence of this new knowledge in the ninth edition ... We firmly believe that pathology forms the scientific foundation of medicine, and advances in the basic sciences ultimately help us in understanding diseases in the individual patient."

“Chapter 7: Environmental and Nutritional Diseases” examines diseases which are caused or influenced by environmental factors, including both the external environment and things that humans do to themselves (e.g., diet, drugs and alcohol). After the Introduction, the authors bravely enter into a discussion about the Health Effects of Climate Change and provide scientific evidence for the existence of climate change and list some of the serious consequences which are already occurring. The next key section deals with the Toxicity of Chemical and Physical Agents. This is divided into sub-sections (each with Morphology and Summary boxes) dealing with Environment Pollution - Air, Environmental Pollution - Metals, Effects of Tobacco, Effects of Alcohol, Injury by Therapeutic Drugs and Drugs of Abuse (oestrogens/contraceptives, paracetamol and aspirin; cocaine, heroin, marijuana and a list of "other illicit drugs"), and Injury by Physical Agents (trauma, thermal injury, hyperthermia, hypothermia, electrical injury and ionising radiation). Although one might perhaps argue that more substances could have been included, and more detail included on some of the given topics, a text such as this "cannot be all things to all men" and there are many other excellent references which do provide further information in these areas. However, what is included does serve an important function in "whetting the appetite" and encouraging readers to think beyond the superficial in terms of environmental injuries. The second key section is devoted to Nutritional Diseases and follows the same general layout principles. This covers malnutrition, eating disorders, vitamin deficiencies, obesity (another very topical inclusion) and concludes with short sections on Diet and Systemic Diseases and Diet and Cancer.

One small frustration is that, being an American text, the units of measurement may be different to those used in the Australian context e.g., Fahrenheit for temperature as opposed to Celsius.

The more that I looked at this book, the more that it was like opening a beneficent "Pandora's Box". It draws you in and engages your attention, and like those enraptured of the 'siren song' of old, you don't want to put it down. An odd thing to say about a text book, I know, but much of what the authors present to us about the underlying science of medicine is utterly fascinating. For those who wish that they had paid more attention in medical school, this is your "get out of jail free card", and for those embarking on the journey of learning, it is a marvellous road map. Highly recommended!

Indoor Climbing - Up, up and away!

For a long time I had wanted to try indoor climbing, and I finally had the opportunity earlier this year when Spreets had a special offer for Cliffhanger Climbing Gym in Altona, Melbourne.

I had been a bit of a 'mountain goat' as a child, and have always enjoyed scrambling up the side of hills and mountains, but had only previously had the chance to try climbing twice - once abseiling down the side of a rather steep seaside cliff during an "Expedition Medicine - Mountain Rescue" course in Tasmania in late 2007 and once ice-climbing on Franz Josef Glacier on the South Island of New Zealand in early 2007. I enjoyed both outings. Fortunately I took to it "like a duck to water" and was really invigorated by the experience. As you are working with a 'buddy', with one of you climbing and the other belaying, it is perfectly safe, and as a result there is no need for fear. We started out on the smaller walls, but after doing some of the easier ones, I decided to attempt one of the higher walls, and to my great surprise got right to the top. Since that initial success I have now conquered two of the other walls that go right to the top of the gym, which has been very exciting.

The thing that I love about indoor climbing is that it is an "all absorbing" activity that is both physically and mentally challenging. You are pushing yourself physically, stretching your arms and legs to perform seemingly impossible feats, and all the time problem-solving to work out how you are going to get up the wall - what hand-hold to use, how to transfer your weight, can I reach up there?, etc.

The staff at Cliffhanger have been both helpful and friendly. It is the highest indoor climbing gym in the Southern Hemisphere (20 metres). Highly recommended!

Westgate Sports and Entertainment Complex,
Cnr Grieve Parade and Dohertys Road,
Altona North VIC 3025, Australia
Telephone: 03 9369 6400
For more information see their web site: http://www.cliffhanger.com.au/

Medicine and the Law

Today I attended the first day of the University of Melbourne MD Student Conference at the Melbourne Cricket Ground.

It was great to see quite of few of the students that I have taught last year and this year, and one of my students from last year mentioned that the inclusion of sessions on "Medicine and the Law" in the program this year for the first time had stemmed from our discussions last year and my concerns that not very much was said about medicine and the law in the medical curriculum. If time permits, I may write more about the conference later, but the sessions today reminded me that I was asked to present a paper some years back on my reflections on my career as a lawyer and then a doctor. This is reproduced below.

Talk for the Victorian Medical Women’s Society meeting Tuesday 5.9.2006
“Medicine and the Law: Women doctors and lawyers get together for a combined perspective on lives and careers”.

“A Combined Perspective”

A famous Chinese philosopher once said that “even the longest journey begins with the first step” and life itself is a journey, in which at any point we are the sum of all we have been and all the places we have been in that journey. It is the journey itself and not the destination which is important. My personal journey has been a complex one and is still evolving. 

As the oldest child in a high-achieving family, the idea of gender bias was a foreign concept and it came as rather a rude shock when the realities of life in the big bad world dawned on me in my mid-teens. I studied maths, science and English in my final years at high school, and, driven by the desire both to be independent and to help people, faced the difficult decision of law or medicine. However as I also enjoyed humanities and languages, law/arts eventually won out on the basis that surely law was logical like science and also a helping vocation. I enjoyed the arts part – Swedish, fine arts, music, but found law dry and boring. I saw the light and tried to change over to medicine, but was too far into my course. 

So, I persevered, finished my law degree, honours in Arts and also a Dip.Ed., so I would be qualified to teach others. I found commercial law reasonably interesting, strayed into corporate finance, mergers and acquisitions and completed an MBA shortly before becoming a founding partner of a small law firm. The years that followed were an unsatisfying Herculean struggle with adverse circumstances and my yearning for medicine resurfaced. 

When I saw an advertisement for the new graduate entry medical course at the University of Melbourne I knew I had to apply, and was incredibly excited to make it through the arduous selection process and get a rare second chance in life. As a medical student I continued to work in the law firm at every available opportunity to keep things afloat, but ultimately lost everything I had worked so hard for when my then-partner hijacked the firm whilst I undertook a life-changing final-year exchange semester in Oslo, Norway studying women and children’s health. Since then I have kept my legal practising certificate but feel that my true vocation is clinical medicine.

People often ask me if there is anything in common between law and medicine, and if you dip below the surface, yes, there is. Both are professions which in the past have been regarded as honourable vocations which serve society. In both we are often dealing with people’s most pressing problem in life and we need to be good listeners and communicators and to be able to provide appropriate assistance and support. We never know who is going to walk through the door next, and have to be adept in dealing with people across all ages from a wide range of social, language and cultural backgrounds and often their families as well. Frequently people come with high expectations that we will be able to solve all their problems and will voice frustration and annoyance if we can’t. Unlike getting in the plumber or electrician, people often expect everything for nothing and are resentful if they have to pay for medical or legal assistance. As a lawyer it was a continual headache trying to extract payment from clients.

They are also both professions in which high standards of professional ethics and demeanour are expected by society at large. This can bring with it scrutiny at both a personal and professional level and a perception that you are a free resource that is available to be tapped at any time by family, friends and acquaintances, which can raise its own ethical dilemmas. 

In both professions there are requirements for continuing professional education in order to keep up-to-date, which requires the application of time and effort in increasingly time-scarce lives. Especially in the early years when you are establishing your career and climbing the totem pole, long hours and dedication are required whether you are a hospital medical officer or a young lawyer trying to achieve the requisite billable hours, and as we are all aware, there is a price to be paid for this in terms of the freedom to follow your personal interests outside work and being able to dedicate quality time to family and relationships. With such stressful working environments, friendships and support within the workplace can become very important in simply retaining your sanity and the motivation to keep going.

From a gender perspective, there are certainly areas in both law and medicine which remain clearly male-dominated and this throws up real and difficult challenges to overcome. The prevailing cultural benchmarks often have nothing to do with professional skills or aptitude. For instance, as a commercial lawyer you might need to show your prowess at wining and dining clients and knowledgeably discussing the footy and cricket, or when assisting with orthopaedic surgery display your ability to discuss the relative merits of various fast cars and electronic gadgets. Some people choose to play the game; others don’t. As Shakespeare wrote in Hamlet, “This above all: to thine own self be true, and it must follow, as the night the day, thou canst not then be false to any man.” (or woman).

On a lighter note, it seems that both medical and legal television dramas often bear little resemblance to reality, but can be worth watching as a bit of entertaining escapism!

Early in my medical studies it became clear to me that in general those in the medical profession did not understand how the law worked, and as a result tended to be highly traumatized when involuntarily brought into contact with it in a professional capacity. Conversely, it was also clear that the average lawyer did not understand the complexities of medicine. So I lobbied, rather unsuccessfully, for cross-fertilisation between the two professions at the training stage to increase awareness and understanding. We all seem to have an innate understanding of the concept of “natural justice” but legal process itself and the laws of evidence are highly technical and as an experienced lawyer once commented, “the law has nothing to do with justice”. For someone unfamiliar with it, it is a complex, intimidating, somewhat archaic and rather costly system. Once you are in the legal spotlight, it is rather like having a serious illness in that there is a loss of control over what is happening to you and the outcome is determined by external forces.

If you have never studied biomedical science, you may not appreciate the extent to which the human body is a complex piece of machinery; with genetic variation everyone is slightly different and no health outcome can ever be guaranteed. Much of what we do in medicine is rightly evidence-based but there are also many situations where medicine is an art rather than a science. In general, doctors use their best endeavours to uphold the Hippocratic Oath to “do no harm” but the outcome of treatment or intervention cannot always be foreseen or predicted. In these circumstances, medicine cannot be reduced to a black and white contract and a different model of dispute resolution is required than for a commercial dispute for instance. However, that said, the power and importance of good communication and adequate and appropriate record-keeping cannot be under-estimated in working within the constraints of our legal system.

In my work in Emergency Medicine this year I have been reminded reasonably often that the world is far from the egalitarian place I imagined as a child where for women it was not a case of whether you could do something but rather of how you would go about achieving it. We are the fortunate few – we speak English fluently, have had a good education and the opportunity to enter an elite profession and can decide for ourselves whether we want a career or family or both. Many women are excluded by economic or cultural imperatives from having such choices and never have the opportunity to explore their full potential. It should not be so, but we hold a privileged position and as much as we can rightly grumble about the challenges we face, we are doing something special in the overall scheme of things and by our achievements and gains making it just a little bit easier for those who follow.

As an experienced professional person starting from the beginning in a new profession, I have been keenly aware of issues such as lack of respect, discrimination and bullying, and I am sad to say that another thing that law and medicine can have in common is a “dog eat dog” mentality. It can be a jungle out there where “survival of the fittest” and “sink or swim” are the rules of the game. I am also a volunteer ski patroller and cross-country ski racer and was recently taken aback at the extent of kindness shown to me by virtual strangers when I experienced serious equipment problems during a race. Reflecting on this later, I realized that over my professional career I was not used to people being kind to me or helping me, which is a rather sad cultural indictment. So in closing I would like to suggest that as we are all fellow travellers on a great journey that we should take the time to be kind to each other and to help and support each other. To paraphrase the poet John Donne, “no human being is an island entire to itself”.

Thank you.