GKT Gazette - Autumn 2013 by GKT Gazette

AUTUMN 2013

Volume 127, Est. 1872

Guy’s, King’s College and St Thomas’ Hospitals FREE on Campus gktgazette.org.uk

Inside:

Professor Ellis

Exclusive interview with the Gazette

What Are They Smoking? A critique of current drug policy

Measles, Mumps & Rubella Vaccine

The case for mandatory childhood vaccination

and much more

Established 1872 Vol. 127, Issue 1. Number 2580. ISSN: 0017-5870 Website: www.gktgazette.org.uk Email: editor@gktgazette.org.uk

The Lecture Notes series The Lecture Notes series provides concise, yet thorough, introductions to core areas of the undergraduate curriculum, covering both the basic science and the clinical approaches that all medical students and junior doctors need to know.

GKT Gazette, Room 3.7, Henriette Raphael House, Guyâ&#x20AC;&#x2122;s Hospital, London, SE1 1UL The opinions expressed are those of the authors and do not neccessarily represent the views of the Hospitals, the University, or the Gazette. All rights reserved. Cover photo courtesy of Charlie Ding

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GAZETTE

Contents 6 7 9

Editorial

A handover editorial

Letters

Anonymous view on RSH app fiasco

News

Unveiling of Wittgenstein plaque, Saturated Fats: Ceasefire?

Features

Arts & Culture

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Interview with Professor Ellis, What Are They Smoking?

The Light Show, Schwitters and many more

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History

Research

Dental

Nursing & Midwifery

Dame Cicely Sauders, Guy’s At War

The Joy of Soy

King’s vs. Barts: The Drink-off, Oral and Maxillofacial Surgery

A Room with a View

Book Reviews

Careers

Obituary

66 70

Overcoming Postnatal Depression reviewed

Interviews with the FY1 doctors Dominic Beer

Sport

Women’s Waterpolo, Rugby 1s, and more

EDITORIAL

LETTERS

Phoenix Noun 1. a unique mythical creature that, after being destroyed, rises from the ashes with renewed youth to live through another cycle. The phoenix is eternal.

few months ago, the offices of the GKT Gazette were broken into and robbed by an unknown perpetrator. They

would like to begin by thanking Gareth for giving me the opportunity to take over the role of editor, and congratulating him on his success in both ensuring that the Gazette improved issue by issue, and in widening participation to include students across the many subjects taught at Guy’s, King’s College and St Thomas’ Hospital campuses. In my time as editor, I want to continue Gareth’s legacy of inclusivity, carry on his success in getting excellent content and persist in our

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stole our main computer, which had all our past issues, records, documents, and the only version of the latest issue of the Gazette. To say that the loss of the computer crippled us would be an understatement, and is the reason for the drop in our usual high output, for which I apologise.

fully do the role of editor justice anymore, and so with a great deal of sadness and a small amount of relief, I’m handing over the reins to the new editor, Simon Cleary. He was the former layout editor, and has been one of the main driving forces behind the Gazette’s success. I feel confident that I have left the Gazette in safe hands, and he will lead it from strength to strength.

However, we have now recovered, and like the phoenix, are as strong as before, ready for the next cycle. If you’ll permit me to drag out this metaphor just a little further, I’d like to announce a new editor to lead the Gazette for this new cycle of life.

I’d like to say thanks to everyone I’ve worked with, and thanks to the readership for your input and support. It was a pleasure.

I have too many commitments to be able to joint desire to grow the role of the Gazette as a forum for discussion between students and staff of all of the Schools that teach at the hospital campuses and our highly supportive alumni community. Further to the above, the Gazette team are currently working on updating our shop, the sole outlet for hospital memorabilia, as well as the open access publication of 140 years of GKT and Guy’s Hospital Gazettes. Keep an eye out for these resources, as well as exclusive online content, on

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Gareth Wilson (Outgoing Editor)

our new website at www.gktgazette.org.uk. I hope that you enjoy this issue!

Simon Cleary (New Editor)

Letters to the Gazette The Gazette always invites its readership to interact with our writers. See an article you like? Want to disagree vehemently with the opinions of one of our contributors or writers? Please let us know! Send all correspondance to editor@gktgazette.org.uk, and you will see it in the next issue of the Gazette!

Dear Editor, *Cracks knuckles*

egarding the Reproductive and Sexual Health (RSH) app fiasco, the Medical School has come down on the individual who supplied the questions from the app, but there seems to have been no admission of responsibility or explanation for why the examiners allowed a single person to supply half of the questions for the whole exam paper in the first place. The whole situation was compounded by the fact that all the assessments for the year had been scheduled for a ridiculously short time frame straight after the final rota

tion, with some people having to do the part A OSCE just two days after their written exams. The addition of a forced RSH exam resit in the middle of all this chaos left many people completely exhausted by the time they had to sit their part B OSCEs. Fortunately the Medical School have addressed the issue for this year by... using exactly the same exam schedule as last year. Sincerely, Stressed from Southwark

- ERRATUM The Winter 2012 edition contained the caption ‘Dr Stuart Paterson, pharmacology lecturer and party animal’. We would like to extend our apologies. The caption should have read ‘Dr Stewart Paterson, pharmacology lecturer and party animal.’ - MISSING One all-in-one computer. Last seen in 2nd floor Doyle’s House, GKT Gazette office. Reward for information leading to safe return: one genuine Guy’s Hospital mousemat.

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NEWS

Plaque Commemorates Guy’s Hospital’s Undercover Philosopher Lewis Moore MBBS4

New Textbooks from Wiley-Blackwell

Wittgenstein was described by Bertrand Russell, his philosopher colleague at Cambridge, as, “the most perfect example I have ever known of genius as

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All written by renowned names in their fields, they feature fully updated and new artwork, MCQs and answers for self-assessment, and an enhanced Wiley Desktop Edition in the price of the book. This provides an interactive digital version of the book featuring downloadable text and images, highlighting and note taking facilities, book-marking, cross-referencing, in-text searching, and linking to references and glossary terms.

Photo courtesy of Charlie Ding

n October 9th, a blue plaque was unveiled in the Guy’s Campus colonnade to commemorate the life of Ludwig Wittgenstein and the time that he spent at Guy’s during the Second World War. Wittgenstein is widely regarded as one of the finest philosophers of our age, his posthumously published, ‘Philosophical Investigations’ was rated the most important work of 20th century philosophy. His work explored many fields including logic and the philosophy of language, mind and mathematics.

traditionally conceived; passionate, profound, intense, and dominating”. True to the genius stereotype Wittgenstein became bored easily, despising the sluggish pace of academic life in Cambridge. Along with this he felt it inappropriate to teach philosophy while the country was at war and sought a more hands-on contribution to the war effort, volunteering in the pharmacy at Guy’s Hospital.

He famously told patients not to take their medication (perhaps after seeing the ‘number needed to treat’ analyses) and despite his efforts, failed to keep his true identity hidden from his colleagues. He once jested that there might be a huge statue of stone erected for him in front of Nuffield House, but concluded that “no monument of stone could

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NEWS

really show what a wonderful person I am.” Perhaps this is why a blue plaque was chosen instead by the John Fry group, the group of Guy’s Hospital alumni who made

this memorial happen. If you are interested in learning more about Ludwig Wittgenstein, there was a 1993 film made about his life,

or if you’re feeling immensely intellectual then why not crack into ‘Philosophical Investigations’, available in the Maughan Library, or online via library services.

GPs to offer Skype-style Video Consultations Katie Allan MBBS4

atients may soon be able to arrange remote ‘virtual’ consultations with their GP, through a Skype-style video link. Plans to change the way doctors use technology, with the aim of increasing access to GP services and reducing the burden on over-stretched A&E departments, also include using text messages to give patients their test results, and supplying community nurses with iPads.

Photo courtesy of Charlie Ding

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The plans to pilot such a scheme were announced by David Cameron at the Conservative Party Conference in Manchester

this October. The introduction of video consultations is part of a wider series of changes to the structure of GP services, including the controversial plan for surgeries to open 7 days a week. The government will spend £50 million on a pilot scheme to trial the new measures, and GP surgeries across the country will be able to bid for funds to upgrade their technology and increase staffing. Some GP surgeries have already started using video links in their everyday practice. According to Dr Sirfraz Hussain, a GP at the

Moss Side Family Medical Practice in Manchester, the video consultations have been popular with patients, and more useful than telephone consultations. ‘Communication is mainly non-verbal. You miss out on that on the phone. Skype means you no longer have to miss out on the non-verbal cues.’ Dr Hussain feels that the service could be particularly useful in situations where patients are reluctant to leave their homes, such as when there is heavy snowfall, or outbreaks of infectious diseases. However, there are concerns that reliance on the internet and text messaging

may exclude older people who may not have access to such technology. A further issue is that video consultations do not allow for physical examination, potentially resulting in the doctor missing important findings. Dr Hussain agrees that the technology has its limitations, but remains positive: ‘It will never replace the core of general practice sometimes you have to put a hand on their tummy or be able to feel the patient. But it is a great tool that can add something and has lots of applications. We are quite excited.’

Saturated Fats: A Ceasefire? Lucy Webb Intercalated BSc

or the past 40 years, saturated fats have been relentlessly demonised by the medical profession, and government guidelines have dictated

that the amount consumed should be decreased due to their alleged role in the causation of obesity and cardiovascular disease (CVD). Dr

Aseem

Malhotra,

interventional cardiologist at Croydon University Hospital does not agree with the conventional wisdom. In the British Medical Journal this October, he published an opinion piece, exploring his belief that carbohydrate

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NEWS

fuelling the obesity pandemic? Perhaps not. The national food survey has demonstrated the effectiveness of government initiatives to reduce saturated fat, falling from 56.7 g/day in 1969 to 29.2 g/

Photo courtesy of Charlie Ding

intake is a much stronger contributing factor to CVD. While saturated fat intake correlates with levels of large, buoyant low density lioprotein (LDL) particles, small, dense LDLs, those implicated in cardiovascular disease (CVD), have been shown to be linked to dietary carbohydrate intake. 12

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Further to this, some recent studies have found saturated fat to be cardioprotective, although this result may be confounded by the abundance of A and D vitamins in the dairy foodstuffs consumed. CVD risk aside, surely calorie-dense fats are

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day in 2000. Unfortunately this has had the opposite effect on the national BMI, which has taken a sharp upstoke over the same period. This effect may be due to the replacement of dietary fat with sugars and other carbohydrates. We all know the physiology; carbohydrate induces insulin production which stimulates adipose tissue to store energy. We have all felt the overwhelming and pathological hunger of a sugar crash. Perhaps not all calories are born equal. The British Heart Foundation maintains that there is conflicting evidence, and a reduction in saturated fats, and therefore cholesterol does indeed lower cardiovascular risk. What was not discussed in Dr Malhotra’s article is the major role of oxidised

LDL in the early stages of coronary artery plaque formation and the protective role of antioxidants in the diet, primarily from fruit and vegetables. Perhaps he was attempting to make this point when he advocates a ‘Mediterranean’ diet; however, without explicitly addressing this point, the article appears incomplete. Although some of what Dr Malhotra says is indeed valid, the health conditions associated with a highcarbohydrate and highsugar diet being at times more worrisome than those

associated with a high-fat diet, a lot of what he said can be easily misconstrued by an already confused and largely scientifically illiterate public and should therefore worry health professionals. Inevitably the UK press aided the public in their misinformation with the Daily Express running the headline: “Eating Fat is Good For You”, prolonging the ever-popular excuse for poor nutrition. The true message of the article, that a diet with a higher proportion of saturated fats and a lower

proportion of carbohydrates can be better for you than vice versa, remains controversial within the medical community. Dr Malhotra has been criticised as irresponsible for airing these views, but with the disjointed and inconclusive state of the evidence regarding diet and health outcomes, perhaps it is the medical establishment which has been irresponsible in prescribing dietary advice based on evidence which may not stand up to scientific scrutiny.

Registered charity no. 803716/SC038827

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NEWSTURE

NEWS

‘What Doctors Don’t Tell You’: The alternative health magazine that campaigners want off supermarket shelves. Katie Allan MBBS4

these serious conditions in favour of ineffective or dangerous alternatives.

Top doctors and scientists have criticised What Doctors Don’t Tell You since its launch last year, and are now targeting major retailers including Tesco, Sainsbury’s and WH Smith, asking them to stop stocking the publication.

Dr Margaret McCartney, a Glasgow GP, spoke out against the magazine on Radio 4’s Inside Health programme, claiming it was ‘a publication full of rubbish’ and that its articles were ‘ridiculously alarmist’. Other high profile campaigners include the science author Simon Singh, who was last year threatened with legal action by the magazine’s distributor, Comag. Singh has said: ‘to be fair, the magazine does contain lots of examples of advice that doctors won’t tell you, but unfortunately this is simply because the advice is often sensationalist and pseudoscientific’.

controversial alternative health magazine has become the target of a campaign to remove the publication from supermarket shelves, over concerns that it may be giving readers dangerous advice.

In recent editions, the magazine has featured headlines such as ‘Sunbathe your diabetes away’ and ‘Vitamin C fights it all: from AIDs to measles’. Campaigners have raised concerns that these claims have no scientific evidence to support them, and could cause readers to reject conventional therapies for

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Campaigners more recently turned their attention to the national retailers stocking the magazine. Initial complaints were unsuccessful;

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Tesco, for instance, responded that ‘we are in the position of offering our customers choice rather than appointing ourselves as censors or moral guardians’. However a growing response from both social and mainstream media has resulted in both Waitrose and Sainsbury’s announcing that they will cease to stock the publication. The magazine’s editor, Linda McTaggart, has hit back at her critics, claiming that the intention of What Doctors Don’t Tell You is to fight the ‘conspiracy of silence’ within conventional medicine. ‘We are going to continue to over-burden the NHS with a lot of treatments that are less than good unless we open this debate...we need conventional medicine to open its mind to other potential treatments’. Photo courtesy of Charlie Ding

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FEATURES

HISTORY

Ellis Onwordi

MMR

The Case for Mandatory

he citizen’s right to freely access healthcare has been enshrined into British society since the establishment of the NHS in 1948. Accessing healthcare when it is required is, of course,

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not mandatory: the state imposes no penalties for failing to get appropriate treatment. This is, however, of limited relevance in the case of children, whose lives depend on the actions of their seniors. No child is expected

Prev. page: South Wales measles outbreak in Summer 2013, Above: Andrew Wakefield with anti-MMR protestors

Childhood Vaccination

to make sensible decisions concerning their early vaccinations. Thus the responsibility for a child’s vaccinations lies elsewhere. In this country, we have deemed that such responsibility resides ultimately with the parent and with the parent alone. Is this misguided? Does the state not also bear considerable responsibility for the wellbeing of the child? Traditionalists would likely resist such notions as government overreach. It must remain the parent’s prerogative to ultimately take life decisions on behalf of any child below an age at which it is deemed capable of rationally making its own decisions. The parent is most heavily invested in wellbeing of child, and state intervention diminishes the parent’s ability to rear the child in the manner he or she deems appropriate. These claims would likely underpin their argument. However, we must be alert to conflict of rights such an assertion entails. In defending the parent’s right to believe what he or she

wants to believe about vaccination, and to rear the child according to those beliefs, are we not also denying the child’s right to goodquality healthcare regardless of the beliefs (accurate or otherwise) of his or her parents? As the child can only utilise his or her right to healthcare by proxy, the state must surely take a keen interest in the beliefs and motives of the representative. It would certainly be unfair to suggest that the state takes no interest: in the midst of the latest measles outbreak in Swansea, the government has pursued flexible initiatives to maximise the uptake of the MMR jab, and thereby to reduce disease and prevent outbreaks. In addition to establishing special weekend vaccination clinics, the government has sought to allay the fear of parents by debunking the discredited Andrew Wakefield’s myths about the MMR jab with the evidence, and by elaborating on the very real dangers that may result from a failure to vaccinate.

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In essence, the state relies on an enlightened populace in its bid to drive disease down – on its ability to explain rather than coerce. But, as admirably liberal as this approach is, does it suffer from being hopelessly naïve, blind to the hard realities of rising levels of some infectious diseases in our society? In the United States, vaccinations have been made mandatory to prevent the spread of disease, such that a child without the necessary vaccinations will not be allowed to use the public (state) school system. This is not simply a case of cruel, collective punishment wherein the child suffers the consequences of the parent’s oversight. The problem is less that the parents’ choices put their own children at risk and more that, because of the nature of communicable disease, it puts society at large at risk. The decision of the state to make vaccination mandatory is intended to keep those unvaccinated children, who have a greater likelihood of catching and spreading communicable diseases, away from other children to whom they may pose a threat. Those defending the parents’ liberty to reject vaccination for their children must concede that they are also necessarily defending their right to, through negligence, allow their children to catch and spread disease. Presumably this was not the intention of their defence though it is the result nonetheless. Schools containing

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hundreds of young children provide excellent breeding ground for diseases such as measles. It is surely unreasonable for parents, who have ignored the state’s provisions, and the overwhelming scientific evidence, to expect their children to be granted the same right to attend state schools when they harbour the ability to catch and spread such diseases to staff and to their fellow pupils with much greater likelihood than those children whose parents heeded the warnings. Is this hypocritically illiberal from the selfprofessed “land of the free”? I think not. Children whose parents have deeply held philosophical or religious objections to vaccination are exempt from this mandate. In addition, the mandate does not apply in private, church and home schooling – these options remain open to parents who would rather that their children did not receive vaccinations. Crucially, it must be noted that this is not compulsory vaccination, in which the parents would be obliged under law to vaccinate their children, and not to do so would be illegal, resulting in consequences such as fines and imprisonment. Under mandatory vaccination, parents retain their right under law to reject vaccination – they must simply seek out other means of educating their children. Such aggressive state intervention explains, at least in part, why US vaccination rates sit typically between 92% and 98%; compare this with an uptake rate of just 78% in England and Wales. According to the WHO figures,

the incidence of measles per 100,000 sits at 0.05 in the US; it is now at 0.80 in the UK. MMR uptake rates have been rising once again in the aftermath of the Wakefield debacle, reflecting the triumph of science over speculation. The argument has been won. And yet, we are still failing to reach the 95% immunisation rate required to achieve herd immunity. The rate of those receiving their first jab before the age of two has risen to 91.2%, from under 80% in 2005. However, there are significant regional disparities: in London, the MMR uptake rate is just 86%.

If we want to be sure of achieving herd immunity, mandatory vaccination could have a role to play in the UK. The US is doing a much better job of achieving high levels of immunisation, and we could benefit from their approach. I am wary, however, of the dangers of provoking resistance by making vaccination mandatory. There is a risk that, by attempting to harness the machinery of the state to coerce parents into accepting the reasoning of frequently aloof scientists, we could, by antagonising those already on the fence, see a rise in mistrust of clinicians and

of government, and, perhaps in the short term, a wobble in the progress already made in the uptake of jabs. The state has taken more coercive measure in the past: so low was the uptake of smallpox vaccinations in Victorian Britain that compulsory vaccination was introduced. Fines, imprisonment, and the seizure of assets were repeated until the parent complied with the demands. This, perhaps unsurprisingly, provoked riots on the streets of North Yorkshire. It is, however, also credited with a sharp decline in the rates of smallpox. A YouGov poll in April shows that in the UK a majority (55%) now support compulsory vaccination, with 28% opposing. This

FEATURES

should not provide cause for us to start braying for the criminalisation of thousands of parents with mostly noble intentions: we should not abide a perverse tyranny of the majority, under which actions according to different beliefs are suppressed under law. It does, however, show the direction of travel of opinions on public health issues, away from the live-and-let-live attitude of the past towards one more attune to the grave social consequences that accompany the state’s light-touch approach when the health and lives of many – typically the young and the infirm – are put at stake. If we are to regard the state as being responsible for the universal provision of healthcare to children, then perhaps we must also accept that it has some rights to intervene directly to ensure that children are receiving it. We may, in time, view mandatory vaccination, that keeps hazardous, unvaccinated children out of the state’s own schools, and thereby out of close contact with other children, as a necessary component of the state’s public health armoury. Though it may in the short term hinder the progress that winning the argument has made, it may in the long term provide the UK a victory over measles and other communicable diseases resembling that achieved in the US.

55%

Below: Results from a poll of 1765 adults in Great Britain who were asked: “Would you support or oppose making it legally compulsory for parents to have their children vaccinated with the MMR injection (a combined vaccination against Measles, Mumps and Rubella)?” Source: YouGov poll, April 2013

28%

The GKT Gazette 17%

For more information, contact advertising@gktgazette.org.uk Support Oppose Don’t Know

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Invites Companies to Use Our

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Since the writing of this article, a High Court ruling ordered the mother of two girls aged 11 and 15 to have her children given the MMR vaccine against all of their wishes.

Anthony Nolan is a pioneering charity that saves the lives of people with blood cancer who need a blood stem cell, or bone marrow transplant. Now, every day, we help two people in need of a lifesaving transplant by using our register to find remarkable donors who have matching stem cells, or bone marrow. www.anthonynolan.org

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Photo courtesy of Charlie Ding

What Are They Smoking? Lewis Moore

MBBS4

hree stories have come to my attention this week that have made me feel that we are approach ing the dawn of a new era of drug policy, or at least we should be.

harms, not ignore it altogether for the sake of votes. For more from Professor Nutt watch his astounding 2012 lecture to the London School of Economics at: bit.ly/1c2qkxr.

Kofi Annan, former Secretary General of the United Nations (UN) has issued a statement, highlighting the many failings of current policy and calling on governments worldwide to ‘break this century-long taboo’ and ‘adopt more humane and effective ways of controlling and regulating drugs’. He makes no explicit recommendations, wisely noting that this incredibly complex issue has no one single answer, but the message is clear: drug policy should prioritise the health and safety of the people, and should cease to waste money on antiquated and ineffective policies. There is a special session of the UN General Assembly to discuss the future of drug policy in 2016. Aside from making some fantastic points, Annan’s commentary adds legitimacy to this crucial debate and further dispels the notion that only the far left and drug users themselves wish to see a less punitive and more reparative approach to drug problems worldwide.

A shocking press release earlier in October this year, by the Drug Policy Alliance in the United States reported the case of an autistic Californian schoolboy who was falsely befriended and then coerced into procuring drugs for an undercover police officer. He was later arrested in front of his classmates in part of a wider sting which saw the arrest of 22 students, many of whom had special educational needs. The child in question has been ‘scarred’ by the abuse and ‘hounding’ that he suffered at the hands of the Los Angeles Police Department (LAPD) and his parents are now taking legal action against the school officials who thought this was a good idea. This incredibly misguided policy to ensnare and damage the lives of the children it claims to protect, exhibits the kind of moral recklessness that people will only seek to justify in the context of a ‘war’. The LAPD ceased its undercover sting campaign in schools in 2005, but this technique highlights the damage done by the War on Drugs, not only by standing in the way of progressive change but by actively persecuting otherwise normal members of society, the vulnerability that was exploited in this particular case makes it all the more lamentable.

On November 5th, Professor David Nutt was awarded the ‘2013 John Maddox Prize for Standing up for Science’, by a joint panel consisting of The Kohn Foundation, the ‘Sense about Science’ charity and the scientific journal, Nature. For the uninitiated, Professor Nutt was made chairman of the UK Government’s Advisory Council on the Misuse of Drugs in 2008, but was given a somewhat dishonourable discharge in 2009 for suggesting that UK drug policy is at odds with the current scientific evidence (affectionately known as the Nutt-sack scandal). This award speaks for the passion that the scientific community has for this issue; Drug policy should closely follow drug research in the pursuit of minimising individual and societal

These stories and many more highlight a growing feeling in the UK and across the world that drug policy is neither aligned with the available evidence or the best interest of the people. Whether it will change more along the lines of the medical marijuana movement in the USA or complete decriminalisation as implemented in Portugal remains to be seen, but one thing is for sure, the status quo is not working.

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Background Practical Anatomy teaching in the first two years of medicine at Kings’, consists of dissecting under the supervision of anatomy demonstrators. During my sessions, Professor Ellis could be found hovering, with a scalpel, ready to give tips and impromptu lessons on how best to dissect. If you attended these sessions you often found yourself in awe of his skill , knowledge and captivating stories. I could go into an in depth history of Professor Ellis’ illustrious career but you might be more interested in his interview instead…..

Interview with Professor Ellis Matilda Esan MBBS 4 Pre-interview adventure… hen the opportunity to interview Professor Ellis arose. I jumped at it without a second thought; contented that all I needed to do was keep my nerves under control and turn up to the interview. I was a little unaware of the pre-interview adventure to follow, which involved writing a letter to Professor Ellis… by hand! Having posted the carefully

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written and manually spell-checked letter , I found myself anxiously watching the post like a diligent child waiting for a Christmas package. Hoping almost desperately for a positive reply . You might imagine my excitement and trepidation as I opened my handwritten reply from Professor Ellis, which stated that I could indeed interview him on behalf of the GKT Gazette.

What inspired you to go into Surgery? In regards to becoming a surgeon, for some time I thought I would have to become a physician and rely on identifying disease through my stethoscope. This is because at school my carpentry skills were poor and I was of the understanding that somehow surgery and carpentry were correlated. However some years later , during an introductory auscultation course at medical school . I discovered I could not hear anything through my stethoscope. I was very disheartened and went to see the surgical tutor. Two main things came out of my conversation with him: he removed the chewing gum a colleague had stuck inside my stethoscope, he also highlighted with an example that surgery and carpentry were

not correlated .So I could indeed become a surgeon if I really wished to. I understand that you graduated in the same year as when the NHS began. What did you think of it then and what do you think of it now? We were not too bothered initially as it did not alter the way we did our jobs. The pay however did increase from fifty pounds a year to one hundred pounds. Back then we literally lived in the hospital with everything from our meals to laundry being done there. I retired in 1989 so it has been some time since I worked within the NHS. However, I can say that back then the hospital itself was your life, it was more than just a job and we thoroughly enjoyed ourselves. There was a deep sense of responsibility to your patients and at times other parts of your life got neglected. Essentially there was no finishing time. On reflection, I do think that the NHS is a wonderful concept, even though it is going through a difficult phase now. To be honest what I think of it now could form a lecture discussion lasting at least one hour. Finally, I will add that there is no going back to the way things used to be. What is your advice for aspiring Surgeons? The interesting thing is that in my experience surgeons choose themselves. I have never

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Photographs courtesy of Charlie Ding

said to any student or doctor that I want you to be a Surgeon. Thus, far, I am yet to come across a surgical trainee that I have had to take in the office and say “Look you are not going to make a good surgeon because you are clumsy and you can’t tie a wreath knot.” What is your advice for aspiring teachers and lecturers? You can improve on your teaching skills, however I feel it is something that is inbuilt - you are either good at it or not. I know I am a good teacher because people tell me I am. Something to

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remember is that there is no correlation between a brilliant scientist and a brilliant lecturer.

emotions to cloud your judgement during an operation. That is why you should never operate on someone you know.

Can you tell me of an interesting case you came across during your career? There were many throughout my career. A memorable one includes operating on Princess Anne’s bodyguard who was shot three times whilst protecting her. One thing to note about being a good surgeon in cases like this, is that to some extent you have to forget who the person on the table might be related to. There is no room for allowing

What was your Inspiration for Clinical Anatomy? A bright anatomist, who was a lecturer in Anatomy came to see me and emphasised that it was rather unfortunate that clinical students were forgetting their anatomy. He suggested a possible solution might be writing a nice little book which linked clinical medicine with anatomy. I agreed and we approached a publisher who was happy

with the concept. However soon after this, the anatomist’s professor vetoed against his involvement with the book. Therefore the initial versions of Clinical Anatomy went from possibly being by two authors, down to the one.

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Kurt Schwitters:

Merz, Merde and the Art of Collage Sabina Checketts MBBS 5

id you ever make a collage during your school art lessons? You probably have Kurt Schwitters to thank for this. A German artist pioneering the ideas of Dadaism, (a group of artists reacting to the horrors of the First World War, who described themselves as a “non-movement, who were not artists and whose art was not art,”) and a member of the avant-garde (those who pushed the boundaries of the status quo), he fled from the Nazis who considered his art to be “degenerate”. Initially Schwitters escaped to Norway but after the Nazis invaded in June 1940, he ended up in Leith, Scotland. Labelled an

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official “enemy alien”, he was interned in various camps throughout Britain, finishing up with 16 months in the “artist’s camp” on the Isle of Man accompanied by his son, Ernst. This camp got its name due to the high proportion of artists, writers, professors and other intellectuals present amongst the 1,205 internees. A shortage of art supplies meant the internees had to be extremely inventive when creating their art; Schwitters even made sculptures from porridge. Schwitters and other Dadaists believed that art could be made from anything. Schwitters coined the nonsense term “merz” as while making a collage he divided up the name

Prev. page: Adolf Hitler in front of Schwitters’ work during the Degenerate Art Show, 1937. Photographer anonymous., Right: Portraits of Kurt Schwitters in 1944

“commerzbank” cut from a newspaper and was amused by its similarity to the French slang word ‘merde’, meaning rubbish or sh*t. Whilst in the camp, his childhood epilepsy returned and he was well known for some rather unusual habits such as sleeping under his bed and barking like a dog- perhaps influenced by the anarchism and nihilism of Dadaism. His son attributed the return of his epilepsy to Schwitters’ depression at being interned with no confirmed date of release. Once released, he lived in poverty in London and painted conventional landscapes and portraits to attempt to make a living from his art. He continued to exhibit and network with the international Dada movement and the art world as a whole. When the war ended in May 1945, he moved to Ambleside in the Lake District with his companion, Edith Thomas, who he nicknamed Wantee after her habit of inquiring if he would like a cuppa. In January 1948 Schwitters died, having suffered, over two and a half years, with asthma, strokes, a broken femur, haemorrhage, pulmonary oedema and a heart attack that finally killed him. He had received a letter offering him British citizenship the day before he died. This is the Tate’s second major Schwitters’ show. The first started badly after the catalogue had to be withdrawn and reprinted when Schwitters’ son, Ernst, declared the cover image, Blauer Vogel (Blue Bird) to be a fake despite it being declared his “greatest” work by John Elderfield, the world authority on Schwitters. Convincing Schwitters fake collages are still often seen for sale on eBay raising issues about the ease of creating collages and merz art. This second show displays his collages and sculptures alongside wistful portraits created in the internment camps. The exhibition contains a great deal of his early work created between 1919 and 1939. The show makes much of Schwitters’ late work done in London influencing Pop artists such as Richard Hamilton and Peter Blake but in the catalogue it is suggested his very late work diminished in quality. It is suggested that perhaps this was due to his failing health although another kinder idea is that he reassessed his vision for his work towards the end of his life. The reduction in quality is not clear whilst looking at the show although in later life Schwitters must have worked with poorer quality materials due to wartime restrictions on availability. This was a regrettably repetitive show of an artist who had an adventurous and inspirational journey through life.

ARTS & CULTURE

‘Light Show’ at the Hayward Gallery

You and I, Horizontal, Anthony McCall

Sabeen Chaudhry

fter having received rave reviews and exceptional hype, Light Show at the Hayward Gallery has been fully booked every day since its opening, (I can vouch for this since I work there,) but it seems to be having a predominantly polarising effect on the gallery-goer. In short, and to use the familiar term; apparently you either love it or you hate it. However, my visit resulted in my remaining uncomfortably seated on a spiky fence (though perhaps facing in a positive direction). In any case, it seems an appropriate time for an exhibition to focus specifically on light. The relevance of light with regards to art might seem fairly obvious. Curators agonise over how an artwork should be lit, whether it should be hung next to the window or in a shady corner, and light can even have a lasting impact on the artwork itself with paintings being bleached or degraded. Throughout history, light has played an important, often metaphorical or suggestive role within artwork, from Bernini’s sculpture of St Te-

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resa, illuminated by golden rays of light, to Kandinsky’s abstract representations of the experience of light. But, perhaps most obviously, we require light to perceive visual art, and due to our dependency on it, it also has the power to influence the way in which we perceive an artwork. Light influences and initiates modes of perception, and this is very much the flavour of Light Show.

denoting the government censor’s erasures. Although “explicit” as the artist intended, thematically it is perhaps treading an already well-trodden cliché into the ground. Many of the works also use light to create physicality, using “artificial light to conjure a sense of sculptural space that directly calls into play our individual perceptual responses.” Such is the case with Brigitte Kowanz’s Light Steps, floating fluorescent light-stairs that lead up to nowhere, and Nancy Holt’s Holes of Light. The latter work which is essentially holes in a large central wall through which light is shone from alternating sides, casting circular shadows on the walls on either side, skilfully creates an impressionistic light-architecture that shifts with the changing light. Though, the most successful work in this respect is by far Anthony McCall’s You and I, Horizontal which makes use of a projector, haze machine and computer scripting to create a seemingly sold light-sculpture. This consists of light beams and tunnels that can bisect one’s body as they are walked through, throwing the shadow onto a wall such that participation in the artwork extends to incorporation into it. Upon entering the smoke-solid tunnel of light inside the room, one is compelled to suspend all disbelief; it feels like another dimension where

It is only a relatively recent development that an artwork can be the source of light itself; that artists can use light as a medium, and this contemporary ‘light-art’ is the focus of the exhibition which includes works from the sixties to the present day. These include cascading waterfalls of light, columns of light conceived via séance, water droplets flashing in strobe-time, and a room where one seems to undergo Violet Beauregard-esque colour changes. The works range from the more philosophical to the political, with Jenny Holzer’s Monument, flashing text from ‘war on terror’ themed declassified US government documents, partly obscured by marks

Light Steps, Brigi

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objects are cast in two-tone: shadow or bright light. In the booklet that accompanies the exhibition, it is stated that “some [of the works] require our patience and attentiveness before they fully reveal themselves,” and a brief chat with a visiting Kiera Knightley (when handing over her coat at the cloakroom) revealed that she’d enjoyed “the one with the strobe lights,” but ultimately she felt that you have to be “in a certain mood to really get it”. Therein lies a popular assumption about this brand of art; that the artist’s intention, the concepts they have carefully imbued the piece with, will reveal themselves if we see the works in the right way, with the right frame of mind, if we’re in the right mood. Furthermore, it is often assumed that this is an important concern for the average viewer (or at least that it should be). However, one could argue that it is a viewer’s own subjective experience and interpretation of the piece that is tantamount. 32

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Indeed, children seem to enjoy the exhibition most freely, simply experiencing without the arduous task of trying to decipher the art-speak of the text accompanying the artwork to elucidate an artist’s intentions. Though I’m not advocating an exclusively experiential approach to a contextual one, I would recommend context-less immersion in the work first, then reading the blurb and experiencing it again. Indeed, one of the most interesting things about the exhibition was the visible and audible audience response to the artwork, and the imaginative subjectivities arising from people’s experiences of something that we know so well subverted, manipulated, and removed from its usual context. One viewer, upon leaving Doug Wheeler’s Untitled, (a room lit with a doughywhite light that eliminates shadows,) remarked that it “feels like being in a sack of flour”. ‘Light Show’ at the Hayward Gallery has now closed. Chromosaturation, Carlos Cruz-Diez

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ARTS & CULTURE

Thrillseekers John Hardie MBBS4

pushed him too far leading to his unfortunate demise, but for most of us it needs a little stoking after too much time in London hospitals.

edical Students crave challenge and adventure. The interview process ensures that every one of the bright-eyed individuals sitting in the Greenwood lecture theatre is ready to be taken out of their comfort zone, be pushed further than ever before, and learn as much about themselves as they do their patients. Sadly, the monotony of learning yet another lecture about biochemical pathways, or the futile quest for logbook signatures has the ability to quench that initial thirst for development and new experiences. This is why actually going out and seeking adventure whilst at medical school is so important. ‘Chrisopher McCandless, portrayed in the 2007 film ‘Into the Wild’, said that the very basic core of a man’s living spirit is his passion for adventure. Perhaps his spirit

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Once again, medical students from are beginning the organisational frenzy of elective plans, medical school ski trips and summer expeditions. There are plenty of ways to combine these exploits with medicine, as some of the excellent guest speakers at the King’s Wilderness Medicine society, and as part of the Wilderness Medicine SSC have recently demonstrated. In the mean time, whilst the tedium of planning continues, the London film scene has much to offer in the way of spirit-stoking encouragement.

‘So many people spend their entire lives asleep while only a select few know what it is like to be truly awake’ - Jack Cravatt, Stealth

2013 being the 60th year since the first confirmed ascent of Everest, the British Film Institute on the Southbank are running the ‘Extreme Summits’ film festival until the end of November. The series of films explore the triumphs and tragedies of some of the most ambitious mountaineering ever attempted. Most notable are screenings of a recently restored version of Captain John Noel’s 1924 film ‘The Epic of Everest’. The film captures the last known movements of Mallory and Irvine as they make their final attempt on Mount Everest. The two climbers never returned - the mystery of whether they were in fact the first to the summit remains. The silver-nitrate film has been expertly restored, and few would dispute the historical significance of the footage. However, the 90-minute film does at times become an exercise of endurance itself, as many of the grand static scenic shots that might have appealed to an audience in 1924 appear somewhat less dynamic to the 21st-century viewer. That said, the scale and pioneering nature of these early expeditions is well illustrated, particularly the pictures of a contingent of 200 llamas for transport, and a bewildered colonial-era commentary on the Tibetan people.

‘Thrillseekers’ Adventure Film Festival (‘Adventurefest’) offers a slightly less cerebral analysis of the process of expeditions, instead presenting visceral footage of human endeavour. The film-festival runs annually in October and November, with London screenings in cinemas in Brixton and at the Imperial College Cinema. This year, the short films feature some astonishing camerawork, portraying kayaking, mountaineering, BASE jumping, mountain biking and skiing, to name but a few disciplines. Closer to home is Hayley Easton Street’s film ‘Stealth’ following a young man’s successes in breaking into some of London’s most prominent landmarks, and filming some incredible parkour (‘free running’) stunts. In addition to the visual treat, the films are truly inspirational, showing the dedication of each individual and how they enrich the lives of those around them through their passion for life. Even if you don’t have ambitions yourself to climb K2, study tropical medicine in South America, or trek through the Amazon, the pioneers portrayed in the films offer some inspiration through their determination to squeeze as much out of life as they possibly can. As Jack Cravatt from ‘Stealth’ quietly asserts – ‘So many people spend their entire lives asleep while only a select few know what it is like to be truly awake’. For more information on the film festival visit: ‘www.adventurefest.co.uk’. Autumn 2013

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HISTORY

later, he left Saunders five hundred pounds with the request to become “a window in your home”. This window in his memory is still present in the hallway of St Christopher’s Hospice, a single sheet of plane glass.

Dame Cicely Saunders Fi Kirkham MBBS2

KT Medical School is privileged to count some of the heroes of medicine amongst its previous students and staff. To study at GKT is to walk in the footsteps of greatness and so it is hard to remember the more human side of some of our forebears. Never was this truer than of Dame Cicely Saunders (1918-2005) who trained not once, but twice, at GKT. Having always wanted to be a nurse, her parents felt that this was not a profession suitable for someone of her social background, and so she enrolled at St Anne’s College, Oxford to study Politics, Philosophy and Economics. At the outbreak of World War Two Cicely Saunders saw her chance to defy her parents and escape to her chosen profession and so began studying at the Nightingale Training School, now a part of KCL, as a student nurse. After just four years Saunders’ childhood back problem returned, putting an end to her dream, and saw her return Oxford. This must have been immensely dif-

ficult for someone who had struggled with shyness and had always felt “an outsider”. With nursing impossible due to the physical demands, Cicely Saunders returned to the medical profession as a social worker and lady Almoner of St Thomas’ Hospital after discovering Christianity while holidaying with friends. It was during this time she first witnessed the plight of terminally ill patients, who would often be informed there was no more to be done. This fatalistic attitude was one Saunders would fight against for the rest of her life with the deeply held belief that “there is so much more to be done”. This sense can only have been heightened by her falling in love with David Tasma, a Polish Jew who escaped the Warsaw ghetto and was dying of cancer. Although not bound by the same laws as other medical professionals their feelings for each other cannot be deemed ethical. The relationship is often described as a spiritual love affair or even friendship for fear of controversy. When Tasma died a short time

The pain and suffering Cicely Saunders saw on a daily basis led her to return to training at GKT, this time to qualify as a doctor. With these qualifications she began work at St Joseph’s Home for the Dying, researching pain control, particularly the use of morphine, in end of life care. While there, she not only conducted pioneering research into how to balance the symptoms of terminal illness while still leaving the patient well enough to experience a good quality of life, but she also fell in love, again with a patient. Whether this relationship was ever more than a meeting of minds remains a subject of debate, but Antoni Michniewicz was a central figure in Saunders’ decision to found the hospice movement. His death coincided with that of her father and another close friend, leading her to a state of ‘pathological grieving’. These tragedies prompted Cicely Saunders to approach Albertine Winner, the then head of the Department of Health, for support to open a place specifically where the dying could live. Seven years after the death of

Michniewicz, St Christopher’s welcomed its first patient. The aim was clear: to meet the physical, social and psychological needs of patients, as well as their family and friends, through expert pain relief and holistic care. Among the first staff of the hospice was Florence Wald, the former Dean of the School of Nursing at Yale University. Wald attended a lecture given by Saunders; afterwards she noted, “until then I had thought nurses were the only people troubled by how a terminal illness was treated”. In response to the lecture Wald left Yale and came to Britain to learn how the hospice movement was changing the lives of the terminally ill and, when she returned home, she took these lessons with her. Forming the American Hospice Foundation, Wald credited her actions to Saunders giving her international recognition. In 1980, Saunders married Mariar Bohusz-Szyszko, a Polish painter, eighteen years her senior. Fifteen years later he died at St Christopher’s hospice. During the rest of her lifetime, Saunders achieved twenty-five honorary degrees from all across the world, as well as awards including Order of Merit. She became Dame Commander of the British Empire in 1979 and in 1989 was awarded the Conrad N Hilton Humanitarian Prize on behalf of the movement she had started. Cicely Saunders died in 2005 in the hospice that she had dedicated her life to. Her attitude to the treatment and support of the terminally ill drove her to redefine palliative care in this country and across the world. As she said: “You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully but also to live until you die”.

Dame Cicely Saunders, DBE, OM 36

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in all London hospitals is to be cut. Thus Guy’s will not contain more than 200 inpatients. This is especially welcome at Guy’s, since Guy’s House – the Surgical Block – is built upon insecure foundations, and expert opinion has been given that it is too dangerous in war conditions to be habitable. Since, almost without exception, the operating theatres of every hospital in London have glass roofs and usually are at the top of the building, and so are of no value in time of war, theatres have had to be built in basements. At Guy’s, the basement of the Out-Patient Building is being fitted out as emergency operating theatres. As the number of in-patients in the Hospital is to be diminished, so is the number of the medical staff. The services of every qualified man, nurse and clinical student are, however, required for work within the sector. The majority will be posted at the base hospitals, but will serve their turn on the skeleton staff which is running Guy’s itself.

Guy’s At War Compiled by Joshua Getty MBBS4 To many who have hurried through the quad, lounged in the park and dedicated hours to the theatres of Guy’s Hospital, it is inconceivable that this great medical school could be no more. Yet in the dark days of 1939, with Europe on the brink of total war, staff and students alike were faced with the realistic annihilation of both our home and our very way of life. Through the eyes of our forefathers at the Gazette, we are privileged to share the stories of their bravery, camaraderie and sacrifice in a time of shadows and fire that we can scarce imagine. 8th April 1939

he preparation of medical services for what is still euphemistically called a National Emergency has been developed steadily since the crisis last September. The scheme, whereby London is divided into sectors, each centred on one

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of the great teaching hospitals, and feeding a series of base hospitals in the contiguous countryside, is well known to most medical men. The teaching hospital is to be a casualty clearing station, where cases are classified according to their injuries and emergency treatment only is instituted, before their transport to the base. The number of beds

At the outbreak of war, all teaching will cease. Thus the normal occupation of all students will for the time being come to an end. It is likely that all the pre-clinical students will be required to serve their country in non-medical capacities, but it is hoped that all students in the clinical period will remain attached to the Hospital until teaching is resumed. It is clear that they will have clinical experience of the utmost value, and in the stress of emergencies will have opportunities of using initiative and bearing responsibilities such as cannot occur in normal conditions. Guy’s, then, if war occurs, will be an organised first-aid station where the treatment will be mostly that of shock, haemorrhage and trauma. For the first, warmth, fluids and

morphia will be required; for the second a well-organised blood transfusion service, based on the use of pooled blood of Group IV donors to be stored and administered by methods for which the medical service of Barcelona has been largely responsible. Physical trauma will be treated according to the ordinary rules of emergency surgery, into which the treatment of shock and haemorrhage of course merge. Lastly, mental trauma, the frequency of which is not to be under-estimated, will need to be vigorously and immediately dealt with. Let no one suppose that to be in a state of readiness for war implies a conviction of its inevitability. A state of mind of surly resignation in the community is the surest way to bring it about. We foresee it as a possibility and face it with a sense of reality. We are ready to extract from it what we can of humour; but our professional education, no less in its ethical than its scientific training, enables us to see more clearly than most people the inherent evil and uselessness of war. Arguable though it is, we must put faith in the old principle of which so many examples may be quoted for or against: Si pacem vis, pare bellum. 12th August 1939 On August 8th, the Hospital staged a rehearsal of the general black-out. House-officers did their night rounds in wards of which the single table light was heavily draped in black crêpe, while the drone of an occasional aeroplane overhead reminded them that their bruised shins and eyes strained from writing reports in twilight were suffered in an honourable cause. Suddenly a resounding crash was heard, and inquisitive people, running out, found blocks of masonry lying in the roadway near the entrance to the Medical

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HISTORY

Block. Looking up, one could see that a cornice and a good part of the overhanging stone that decorates the upper part of the doorway into the Medical Block had become detached. Had the reverberations of the bombers overhead dislodged the stone by a sort of sympathetic rhythm similar to that whereby marching soldiers can destroy a bridge? Or was the Medical Block trying to express its readiness to be bombed along with the more venerable but perhaps no more decrepit Surgical Block? Buildings are easily credited with personalities of their own, and it is pleasant to think of Hunt’s House, whose personality is more readily appreciated than analysed, displaying a petulance at the care and interest recently applied to the Surgical Block. 9th September 1939 We are at war, and under that prime necessity Guy’s has accommodated itself quicker and more easily than could have been thought possible. At the time of writing, no Air Raids have occurred, but two false alarms (one at 2.30 a.m.) have given everyone an opportunity of learning some of their new duties. Guy’s is now a casualty clearing station of about 250 beds, whose function it is to feed the base hospitals of the South-Eastern Sector of London. The Surgical Block is closed, all in-patients are to be in the lower wards of the Medical Block, and the OutPatients’ Hall is cleared of its benches and reconstituted as a reception room for the sorting out and first treatment of casualties. The first sign of abnormality in the Hospital appeared on August 26th, when

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students were invited to dig trenches in the Park. These were in the form of a W, with entrances at the Medical School, Medical Block and Nurses’ Home. The work was admirably done, with such keenness that the free beer supplied by the Acting Superintendent lasted longer than had been budgeted for. The patients were evacuated on September 1st. By the evening there were only 27 cases left in the Hospital. The hospital staff has dispersed to the six main hospitals of the Sector – Guy’s, Farnborough, Orpington, Pembury, Dartford and Grove Park. At Guy’s, there are left some thirty qualified men, under the command of Mr. Cook, with Dr. Bishop as Deputy Superintendent, about 120 students, 130 nurses and 100 of the Administrative Staff. The doctors luxuriate in the marble halls of Nuffield House; the students are at the moment in the College or sleeping in the surgical wards – they are to take up permanent residence in the Nurses’ Home. Meanwhile Surgery continues as usual, and Medical and Surgical Out-Patients are seen daily at 10 o’clock. Lectures have been organised, for the qualifying examinations are to be held as usual. It is our earnest hope to be able to continue publishing the Gazette, whatever may happen. For this we need the co-operation of our readers. By the next issue we hope to be able to report news from the other hospitals “down the line,” but, in addition to this, contributions will be needed. The next few months are likely to provide experiences that will be worth recording.

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16th December 1939 The Emergency Medical Service was first organised mainly to deal with air-raid casualties. As yet we are still ignorant of what will be required of the E.M.S. should bombing attacks on towns be made. We can only rely on guesswork and the experiences of others and shape our organisation from both of those. Recently Dr. Trueta, who was chief of the Surgical Clinic in the Hospital General de Catalunya in Barcelona during the Spanish Civil War, and who had experience of over 340 air-raids, has spoken and written of the injuries inflicted by bombs and the organisation necessary to deal with those injuries. His experiences and views deserve close study. Unfortunately for us, he had no experience of gas bombs, gas spraying or incendiary bombs, all of which may fall to our lot. His description of bombing attacks on Barcelona are instructive. To destroy buildings and fortified places heavy bombs were used. Because of their weight only a few of these bombs can be carried by an aeroplane, and they bury themselves deeply in the ground. Thus on exploding their fragments and explosive blast are directed upwards rather than laterally. They possess great destructive power and injure in two ways. The flying fragments wound, often mortally, civilians in the head, chest and upper abdomen, and when not mortal such wounds are very severe and accompanied by much shock. The explosive blast of the bomb causes the collapse of buildings and crush injuries to the occupants. Such crush injuries usually result in much damage and shock, made worse by the delay required for extricating the injured from fallen masonry.

Treatment is very urgent and mortality high for both types of wound caused by heavy bombs. To injure and terrorise civilians light bombs were used. A single aeroplane can carry many of these and, as they are light, they scarcely bury themselves. Thus the direction of their propelled fragments is lateral. These fragments are small, splinter-like, and travel at great velocity. They cause multiple wounds, more often in the legs and abdomen than elsewhere. Externally these wounds may appear small and not severe, but the small bomb splinters do much internal damage and may start considerable haemorrhage. Shock is common. Treatment is again urgent. Dr. Trueta insists that because of the urgency of surgical treatment for wounds caused by both types of bomb, the injured must be taken immediately to a hospital, not delayed by being sorted at a first-aid post. An air-raid or series of air-raids that were successful would result in the production of a great number of casualties requiring very urgent treatment. Air-raids (unless continuous) provide essentially short bursts of very high-pressure activity. It is interesting that in Barcelona during such bursts of highpressure work medical practitioners were pressed into hospital service. The question we must ask ourselves is: How many of our hospitals in areas likely to be raided are sufficiently replete with receiving room and surgical staff to be able to treat the inevitable scores, perhaps hundreds, of wounded without serious delay? We wonder.

Next issue: The Home Front, 1940-1941.

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RESEARCH

The Joy of Soy: Spicing Up Menopause

Jingda Liao MBBS3

eeling saucy? When Chinese New Year takes place many of us indulge in Chinese food to celebrate the arrival the New Year. Chinese takeaways often get bad press for being unhealthy. However, this could soon change as new research points to the health benefits of soy, an ingredient that has featured in Chinese cuisine for over a millennium. There is a lower incidence of breast cancer and osteoporotic fractures in Asian women compared to western women, which has

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been linked to the consumption of soy for at least 20 years. In the West, most people are familiar with soy sauce, tofu and soya milk. A splash of soy sauce on your chicken chow mein or stir-fry not only enhances flavour but studies have shown that soy-based diets may alleviate menopausal symptoms, as well as offer protection against heart disease, cancer and diabetes. About 70% of women will experience hot flushes, night sweats and loss of sex drive during menopause as a result of oestrogen deficiency. In addition to these undesirable effects,

long term oestrogen deficiency results in bone loss. The conventional treatment for these symptoms is hormone replacement therapy (HRT). However, amidst concerns that HRT increases the risk of breast, ovarian and endometrial

cancers as well as stroke, many are turning to soy as a natural alternative. Most soy products are a rich source of non-steroidal phytoestrogens called isoflavones which may help to relieve symptoms of menopause. Time to bring out the soy sauce? Letâ&#x20AC;&#x2122;s take a look at the science behind soy and see if it really can spice up the menopause. Soy isoflavones - the HRT alternative? Isoflavones are bioactive plant hormones that share structural and functional similarities with the bodyâ&#x20AC;&#x2122;s own sex hormone, 17Î˛-oestradiol. Isoflavones bind to oestrogen receptors (ER) effectively mimicking oestradiol to activate gene transcription. Genistein and daidzein are the most

abundant isoflavone metabolites produced by intestinal microflora. They have agonist/ antagonist activities depending on the target tissue and endogenous oestradiol levels. In vitro studies showed that isoflavones had antiestrogenic effects in high oestrogen environments but oestrogenic effects in low oestrogen environments. This suggests that in postmenopausal women who have low circulating levels of oestradiol, isoflavones would promote oestrogenic effects; ideal for those searching for a natural alternative to HRT. Clinical trials - the reality It is plausible that isoflavones can improve menopausal symptoms. However there is no current consensus due to the heterogeneity of trials. Insufficient treatment durations and failure to account for ethnic differences have contributed to the controversy. Variable isoflavone content in different soy foods and inter-individual differences in bioavailability are also confounding factors. A Cochrane review of 25 randomised trials in 2004 concluded that isoflavones in soy products did not alleviate menopausal symptoms. However, another review of 14 recent trials found that soy isoflavones did reduce hot flushes in menopausal women who took at least 50mg isoflavone supplements per day. This highlights the importance of achieving a sufficient plasma concentration of isoflavones to produce an improvement in climacteric symptoms. This is especially significant given that the mean consumption of isoflavones in

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RESEARCH Below: Genistein molecule, a phytoestrogen, belongs to the category of isoflavones. Source: Wikipedia

Western countries is 1-2mg per day. The question is whether you can get enough isoflavones from dietary sources alone or whether supplements are required. More standardised studies with better experimental designs are needed in order to evaluate the putative benefits derived from soy consumption. Whilst recommendations cannot be made for soy isoflavones as a therapy for vasomotor symptoms experienced during menopause, research has shown that it can be potentially therapeutic in other ways.

poly-unsaturated fats possess antioxidant properties as well as the ability to lower blood cholesterol. Countless epidemiological studies support the beneficial role of soy in clinical conditions such as diabetes, cancers, and cardiovascular diseases.

Beneficial effects Soy foods can form a part of a healthy balanced diet and are alternatives to meat and dairy for many vegetarians and vegans. In 2002, the health claim consuming ‘25g of soy protein every day as a part of a low fat diet could help to lower cholesterol’ was approved in the UK. A growing body of evidence suggests that other soy components such as proteins, polysaccharides and

Breast cancer - what’s the risk? Paradoxically, the risk of breast cancer increases with age in post-menopausal women even though their oestrogen levels are lower. This is because mammary tissues convert circulating steroid precursors into oestradiol. The hormone dependence of the majority of breast cancers raised fears that exogenous phytoestrogens might promote breast cancer. A greater risk of breast cancer

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Autumn 2013

was not evident in a randomised control trial which enrolled healthy menopausal women who took 80-120mg soy isoflavone supplements over 2 years. Little evidence exists which suggests that dietary exposure to isoflavones increases the risk of breast cancer in women who are healthy; furthermore, it does not worsen the prognosis of patients with breast cancer. Unlike HRT, soy does not seem to increase the risk of breast cancer. Not only that, but it may also increase survival rates in women diagnosed with breast cancer. There was a lower risk of recurrence of breast cancer in postmenopausal patients who had a high dietary soy isoflavone intake. In another trial, soy isoflavone intake was associated with a lower risk of death and recurrence among 5042 breast cancer patients. This inverse association was statistically significant in women who had ER-positive or ER-negative breast cancers as well as tamoxifen users and non-users. Mechanisms of action How might isoflavones improve breast cancer survival? In normal physiology, endogenous oestrogens promote breast cell proliferation in preparation for milk production. This very property also drives the growth of oestrogendependent breast cancers. All this happens when oestrogens bind to oestrogen receptors expressed in breast tissue. Then the hormonereceptor complex translocates to the nucleus where it binds to DNA to control gene

expression. But competition with isoflavone molecules reduces the amount of oestradiol binding to oestrogen receptors. Instead, isoflavones stimulate the production of sexhormone binding globulins which reduces the concentration of free active oestrogens. Isoflavones also inhibit 17β-hydroxysteroid dehydrogenases which synthesize oestradiol from relatively inactive oestrones. Both molecular alterations ultimately decrease oestrogen levels in the circulation. Hope not hype The cornucopia of health benefits derived from soy consumption may not be a myth; soy seems to be beneficial in conditions such as diabetes, cancers and cardiovascular diseases. Experimental and epidemiological data have shown that isoflavones can improve human health. Soy’s role in spicing up the menopause by alleviating symptoms is, as yet, unproven. However it seems probable that soy could help to improve menopausal symptoms in the same ways as HRT, without the associated risks. No adverse effects associated with soy isoflavone intake have been reported in humans. Whilst the menopause can be a tough time for women, including soy in your diet whether you’re male or female could reap many potential benefits.

Autumn 2013

GKT Gazette

Antibiocalypse? Is bacteriophage therapy a new weapon in the fight against resistant bacteria?

Lewis Moore MBBS4

n optimistic, yet fiercely scientific article published in the Daily Mail last December pondered: “Are giant pandas the latest weapon against superbugs?” . This gave me some hope that we are not, in fact, headed towards the end of modern medicine. Imagine my disappointment in January when the same illustrious publication warned “Antibiotic resistance is now as serious a threat as terrorism and could trigger an apocalyptic scenario”. Perhaps they’re missing the point slightly, but the fact remains that drug resistant bacteria cause over 150,000 deaths worldwide and despite our best efforts in curtailing GP prescribing, the inevitable march of resistance is rendering our entire repertoire of antibiotic agents gradually impotent. We should sort it out then, but how? Professor Otto Cars of Sweden’s University of Upsalla suggested to the British

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Autumn 2013

Medical Journal that we may need to incentivise pharmaceutical companies to research these otherwise less-than-profitable avenues. He also raised the possibility of United Nations involvement in this global threat, in the same manner as we have seen with action on climate change. I present to you here a new plan of attack: we swallow the spider to catch the fly. Phage therapy is an elegant idea dating back as far as the early 1920s. Bacteriophages, viruses which selectively attack bacteria, are administered to the patient. They attack and lyse (cut open) the bacteria, replicating themselves in the process, and may even evolve to stay a step ahead of the development of bacterial resistance. If only it were that simple, we’d have killed the pathogens already and be back from the lab

RESEARCH

in time for tea and medals. In reality phage therapy faces a great number of challenges in the form of investment, regulation and patent laws as well as pharmacokinetics, pharmacodynamics, and the immunogenic consequences of the mass lysis of bacterial cells.

ate phage could rescue mice with near-fatal vancomycin resistant enterococci sepsis. This achieved 100% efficacy, however, delivery was by intraperitoneal injection, a technique not known for its popularity with patients or peritoneal organs.

The natural reaction of Joe Public, and indeed the regulatory authorities appears to be one of fear. Nobody likes viruses, or wants to eat viruses in case they get infected. The reality couldn’t be further from the truth; phages are incredibly specific for their targets organism and will infect only a handful of strains of one species of bacteria. This makes them incredibly safe, but also challenging to deliver effectively. Cocktails of around 20 phages are required to achieve the breadth of even a narrow spectrum chemical antibiotic agent, a practice that sits very uneasily with the regulators.

Randomised controlled trials of phage therapy have been conducted on both sides of the Atlantic, with approval from the FDA and MHRA, respectively. Phase 1 and 2 clinical trials have shown extremely positive results in the treatment of wound and ear infections with excellent clinical outcomes and no significant negative effects. Topical applications such as these mitigate the risk of systemic side effects and bypass the challenge of delivering phages to the appropriate tissue via the circulation.

One of the major problems of delivering effective phage therapy is the immunogenic response that bacterial lysis causes in the body. Normally bacteria are safely contained within a white cell before they are eviscerated by oxidative and enzymatic forces. Without containment, cell wall components and bacterial peptides are left to roam free. The effects could be very messy indeed, as these components are the main reasons for pathogens actually making us ill. This challenge has been met with a great deal of ingenuity, with several non-lytic approaches being explored: by exploiting the second viral life cycle, the lysogenic cycle, viral DNA can be spliced into that of its bacterial host. This effectively allows us to reprogram the bacteria to do whatever we want: to die for instance, to express antigens that would attract an immune response, to secrete antibacterial peptides,or to regain sensitivity to traditional or outdated antibiotics. Trials in mice found than an appropri-

Other potential applications of phage technology have included specific, cheap and fast tests for identifying bacteria, killing bacteria in an agricultural or food preparation environment as well as the countless possibilities that spring from any advance in exerting genetic control over an organism. Bacteriophage therapy and technology is an exciting area of research with worldwide interest, fledgling success in the trials and a potential to pick up the slack in the bacterial arms race. The technical and political challenges are great, but the need for new therapies appears to be greater.

Autumn 2013

GKT Gazette

RESEARCH

How Close Are We To Eradicating HIV? The Case of the Missisipi Baby Zoya Arain MBBS4

he case of the Mississippi baby cured of HIV quickly became world news. The discovery evoked similar excitement to some of the previous milestones that have characterised the fight against HIV and AIDs. Significant developments such as the discovery of HIV resistant African sex workers and the recognition that suppression of HIV levels in the blood with antiretroviral drugs could dramatically reduce the likelihood of transmission have revolutionised the field. Is the Mississippi baby case the big breakthrough long awaited by the 30 million people infected with HIV worldwide? Is AIDs yesterday’s epidemic? The case presented at the annual HIV conference in Atlanta on 4th March 2013 by Dr Deborah Persuad and colleagues described a baby girl born to a mother with HIV in Mississippi. The mother, unaware of her infection status had not taken antiretroviral drugs during her pregnancy, which are thought to minimise the probability of maternal HIV transmission to the foetus to around 1%. Upon transfer to the Mississippi Medical Centre, 30hrs after birth, her physician Dr Hannah Gay administered 3 antiretroviral medications rather than the conventional 1-2 before confirming the child’s infection status as, given the circumstances, she was deemed to be at high risk of infection. The medication was continued for 18 months after which time the mother and baby stopped attending

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Autumn 2013

the medical centre. When the pair eventually reappeared it emerged that the child had not taken medication for 5 months. Dr Gay retested the viral load, expecting that the virus would have rebounded, but instead to her great surprise no evidence of infection was found. Although scientists later discovered small traces of viral genetic material in the blood, it appeared that the child was no longer in need of HIV treatment and therefore ‘functionally cured’. The case has raised many questions. The term ‘cure’ has a significant meaning for the millions infected with HIV worldwide, healthcare providers and researchers. In order to evaluate the extent to which this case illustrates the ‘cure’ for HIV patients, it is imperative to define the criteria for a cure in the context of the infection. Exposure to HIV can occur due to contact with infectious bodily fluids, for instance during sexual intercourse, or in the case of a neonate, in utero, during birth and breast feeding. However, exposure itself does not necessarily result in infection, and antiretroviral drugs administered within days of exposure can prevent the infection from taking hold. Infection only occurs when the virus invades immune cells and becomes incorporated into cellular DNA where it can lie dormant for years.

Although antiretroviral drugs have dramatically improved the life expectancy of millions diagnosed with HIV by effectively suppressing the replication of HIV, they are unable to eradicate dormant inactive copies of the virus. It is therefore necessary for patients to continuously take medication in order to prevent resurgence of the infection. The question is therefore, whether the Mississippi baby was infected with HIV and then cured? Dr. Mark Siedner argues that this is unlikely: “We know that she was exposed to HIV, some cells in her blood were found to contain sleeping virus but we don’t know if these cells were from the child or maternal cells transmitted through pregnancy or birth”. He suggests that it is more likely that treatment after exposure to HIV prevented infection. However, if this is the case of a patient infected with HIV being ‘functionally cured’, it is not the only one. It has been suggested that similar treatment could be effective in adults, although early diagnosis is crucial. Asier Sáéz-Cirion from the Pasteur institute for the regulation of retroviral infection in Paris, assessed the outcome of 70 patients with HIV who had been treated with antiretroviral drugs soon after diagnosis; between 35 days and 10 weeks post infection. In all of these cases, drug regimens had been interrupted for various reasons eg. personal choice, or to enable participation in a drug trial using a different protocol. Although the majority of these patients quickly relapsed after their drug regime was interrupted, 14 did not, and have been able to stay off antiretroviral drugs for 7 years on average. “It is not an eradication, but clearly they can live without pills for a very long period of time,” according to Sáéz-Cirion. He further suggests that early treatment is helpful because, “it limits the reservoir of HIV that can persist, limits the diversity of the virus and preserves the immune response to the virus that keeps it in check.”

However the mechanism enabling the remission of HIV in a few patients after early treatment remains a mystery. The famous case of HIV being cured in a patient with leukaemia after receiving a bone marrow transplant from a HIV resistant donor in 2008 does not seem to offer an explanation. None of the 14 patients in the French study, or the Mississippi baby were found to carry protective HIV resistance genes.

HIV virus showing skewed (laevo) symmetry Source: Russell Kightley Media

For the estimated 30 million individuals with HIV worldwide, the aforementioned studies do not offer a cure for HIV nor do they make a case for the cessation of antiretroviral drugs. They do however; suggest the benefits of early diagnosis and treatment. According to Andrew Ball senior adviser on HIV/ AIDS strategy at the WHO in Geneva: “The big challenge is identifying people very early in their infection; many people resist testing because of the stigma and potential discrimination. There’s a good rationale for being tested early, and the latest results may give some encouragement to do that.”

Autumn 2013

GKT Gazette

DENTAL

the face for aesthetic or cosmetic purposes is also undertaken by Oral and Maxillofacial Surgeons. Dento-alveolar surgery is the most publicly known branch of OMFS dealing with extraction of impacted or difficult teeth and surgery for the placement of implants or prostheses.

Changing Our Faces: An Introduction to Oral and Maxillofacial Surgery Sarah Siddiqui BDS4

Maxillofacial surgeons are now involved in surgery of the head and neck ranging from third molar extractions all the way to facial transplant surgery.

It is a relatively new surgical specialty when considering surgery in general. It first came into light when general surgeons in the latter half of the nineteenth century developed an interest in oral and facial surgery in the USA and German speaking countries in Europe. Over the course of time it has developed into a truly fascinating specialty with a wide scope of surgical opportunities. Oral and

OMFS offers a range of different subspecialties. Cranio-facial trauma provides a large cohort of the OMFS patient load. It involves immediate management to long term surgical rehabilitation of patients who have suffered the effects of gunshot wounds, machinery injuries, road traffic accidents or a heavy night out! Oncology in OMFS can involve small local flaps for skin cancer to all day complex surgical reconstruction using micro-vascular surgery for extensive squamous cell carcinomas. Craniofacial OMFS is dedicated to treating development anomalies leading to conditions such as early fusion of the cranial sutures and cleft lip and palate. Orthognathics deals with advancement of various bones of the face such as the maxilla or mandible. Surgery of

famous philosopher Marcus Cicero (106 - 43BC) once stated that “the face is the picture of the mind”. Our faces provide us with our sense of identity and a means of expression. It is the first thing people notice about us and its disfigurement can lower our confidence and self esteem. The progression of science and surgery has given us the ability to change our faces to remove pathology, restore function and improve form. Oral and Maxillofacial Surgery is a branch of surgery which deals with surgery of the face, mouth and jaws.

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Autumn 2013

Scientific research plays an important role in pushing the scope of OMFS. It has led to the advent and evolution of various prostheses, imaging modalities and even the use of tissue-engineered products and cells to help develop new bone! In the UK, dual qualification in both medicine and dentistry is required for OMFS training. The conventional route was for dental graduates to then attend medical school before commencing specialty training. This is no longer the case and many medical graduates with an interest in surgery of the head and neck region are opting to return to dental school on graduate entry programmes. In fact our very own college provides the only shortened 3 year dental course specifically designed for medical graduates. Following dual qualification, trainees must complete their foundation and core surgical

training, before undertaking five years of specialty training as a registrar. Although the training pathway may seem longer due to the need for dual qualification, the average time to attain a consultant post is similar to other competitive surgical specialties. So don’t let the seemingly lengthier training pathway deter you from pursuing a career in OMFS as it is a very rewarding career option and you get to enjoy the perks of student life twice! You might be left wondering how can you get involved and find out more about Oral and Maxillofacial Surgery and whether it is the career for you? GKT has its very own society dedicated to this cause! KOMSOC is a society set up by undergraduates and second degree students wishing to pursue a career in OMFS. We provide lectures introducing OMFS and relevant head and neck anatomy. We have also helped facilitate observer placements in clinics and theatres and projects in OMFS for our members to help them gain more experience. KOMSOC will be holding various fund raising events throughout the year to raise money and awareness for various charities involved with facial disfigurement. So come and get involved with KOMSOC and we can introduce you to the exciting field of Oral and Maxillofacial Surgery! Photo courtesy of Charlie Ding

DENTAL

solution could possibly be found and how this monumental decision would change the course of history, but I implore you to remain calm and hold on tight to the seat of your pants, for a solution was found. One as elegant as a NiTi endodontic file and as simple as the design of a DG16 probe. King’s students would dress in costumes beginning with the letter ‘K’ and Barts students would dress using the letter ‘B’. Brilliant!

King’s vs. Barts: The Drink-Off

Not all however were content, there was uproar amongst those who wished to utilise the letter ‘G’ for GKT, but our heroic pastpresident Charles William Pidgeon stepped into the abyss and calmed the beasts baying for blood, reminding them that we are working together toward a brighter future, one where only Kings shall walk the land!

And so it was, costumes ready, drinks poised, disco music on pause, and within the blink of an eye the fabled evening was upon us. With the committees of the two dental schools dressed in army uniforms to ensure peace was maintained, the merry frolicking went on deep into the night. To say it was a success would be akin to calling the works of Michelangelo mere doodles. Students intermingled, varieties of geometric shapes were displayed upon the dance floor and the mythical evening was already taking on the form of a miracle in common dental lore. And the future? For infinity is our limit, the possibilities are unimaginable and the students of King’s and Barts will forever be united as one, for we are the chosen people, the enlightened dentists of tomorrow, right?

Photographs courtesy of Charlie Ding

Charlie Ding BDS4

n human history, rivalries are nothing new; they shape us, sculpt our societies and even push our species to evolve, should you believe in such things. There is one rivalry however which is largely hidden, unseen, one which is larger than Gravity versus Flight, more dramatic than Sherlock versus Moriarty, and more vindictive than Liverpool versus Everton. This is a story of epic proportions which traces the social union of two London based dental schools, a marriage in a night club that many said could not be done, but happen it did and forever it shall be remembered as one of the many wonders in the history of KCL Dental Society. King’s and Barts have always been like oil and water – one being extra virgin olive oil and the other being dirty dish water – for which is which the reader has to decide. There were a few however that believe the two can mix 58

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Autumn 2013

and eventually grow to be something much more than the two dental schools could ever achieve on their own – the brave men and women aptly named the Events Officers. The idea was raised at a Dental Society meeting, and it was dismissed for being a pipe dream, “IMPOSSIBLE” barked the unbelievers, “INSANE” screamed the fanatics... The Events Officers themselves however never gave up, never did they relent, and looking windward they embarked on the journey that would lead them to the Promised Land... A club called Amber next to Moorgate. The events officers from Barts were contacted and plans drawn up to incorporate both dental schools, but this was not a road without bumps, the chief amongst which was what theme the evening would be. At this point the reader is probably dizzy with anxious excitement to find out what Autumn 2013

GKT Gazette

NURSING & MIDWIFERY

A Room With a View

doses of painkillers if they had a natural scene (containing trees) outside their window than if they had no view (a brick wall) outside their window. This research suggests that pleasant views can have a positive impact on patient recovery, but what does it mean for our inner city hospitals where a nature filled scene may not be possible? Can a view that is arguably equally stunning, yet contrastingly urbanised have a similar effect on recovery? St Thomas’s hospital is situated on the Thames river bank directly opposite the Houses of Parliament. Three-bedroom flats in a similar location cost as much as £5million. Guy’s hospital, with its 30 floor Tower Wing has views spanning right across

London, across the road tourists are charged £24.95 for The View From the Shard. Thanks to the NHS our patients get premium views free of charge. I think that a room with a view, whether urban or rural, can have a positive effect on patient recovery – especially if it is perceived as attractive by the patient. Although there is little scientific evidence for the impact of urban views on patient recovery, those at St Thomas’ undoubtedly improved my overall experience and brightened my day – and I believe that vistas like these do the same for many patients. After all, wouldn’t this view brighten yours?

Sarah Cleary Adult Nursing 2nd Year

hen I moved to London in September I was impressed by how beautiful the city is, with its astonishingly tall buildings and sparkling night lights. London has an average of 27 million overnight visitors alone every year, many of whom admire the vast array of landmarks such as the Houses of Parliament, the London Eye and the new tallest building in Western Europe, the Shard. I was delighted to discover that patients in London’s most central hospitals are not exempt from enjoying the beautiful views.

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Autumn 2013

When on an evening medicine round in Guy’s Hospital, a staff nurse, patient, relative and I were all able to glance out of the window to admire the London Eye, lit up and changing colour. For a few moments the circumstances that brought us together went out of the window, a much needed and enjoyable escape especially for the patient. This got me thinking about the potential benefits to patients of having a room with a view. A study by Roger Ulrich, published in a 1984 edition of the journal Science showed that patients recovered quicker and needed fewer

Autumn 2013

GKT Gazette

BOOK REVIEWS

Overcoming Postnatal Depression

Lalesia Ngoke MBBS4

his is a workbook designed to help women suffering postnatal depression to overcome it, in an honest and open fashion. It uses a ‘fiveareas’ approach in this regard; life situations, people and events, altered thinking, altered feelings, altered behaviour and altered physical symptoms. It is made clear from the introduction that use of the book and whether the user wishes to begin their journey is completely their personal choice; this helps to emphasise, that the reader is in control. The content outlines two preliminary workbooks to help the reader navigate the book, after which are the workbooks under the five areas. The authors take care to signpost in the first few pages of the book, informing the reader of the purpose of

GKT Gazette

Autumn 2013

BOOK REVIEWS

At the beginning of each workbook the author has placed quotes in speech bubbles that may correlate with the user’s thoughts, e.g. “my baby means nothing to me”, helping the reader to identify their thoughts without feeling judged and to decide if they need to use that particular workbook. This is an important and non-confrontational method of engaging with the reader and assisting them in choosing the correct workbooks. The layout and font used make the text easy to read; open spaces are easy on the eye and are an indirect way to subconsciously make the reader feel at ease, whereas if the pages were text-laden, the reader could easily feel pressured and less likely to use the

workbook. Any jargon is used it is explained. Importantly, the text reads as if the author is present in the room, conversing with the reader, making this book an excellent tool for its target audience. Cartoon illustrations are used, at the start of every workbook, to illustrate the topic covered by the workbook; this provides an alternate way for the reader to engage with the content. Some readers may find the tone too simplistic considering its adult audience, however it is clear the authors have tried to find a balance between being clear and firm and avoiding the clichéd over-friendly fluffy approach, an attempt to engage a larger proportion of the target audience.

the workbook, and encouraging them to continue reading despite the likely difficultly of doing so. It is important that the authors relate to the reader, as this will increase the probability of the book achieving what it was created to do. The ‘workbook ‘ format comprises situational examples which the reader can relate to with a range of open and closed questions styles commonly used in clinical practice to facilitate effective practitioner-patient communication. There is ample space to write answers, checklists are available to actively monitor progress/achievements and practical steps to help the reader fit the workbooks into their lifestyle - these features make this book very user-friendly.

Title: Overcoming Postnatal Depression Authors: Chris Williams, Roch Cantwell and Karen Robertson Price: £21.99 ISBN: 978-0340972342

Autumn 2013

GKT Gazette

CAREERS

•

FY1 doctors: The Transitions

• •

Matilda Esan MBBS4

ach year of medical school welcomes with it a fresh-faced batch of first years, and bids farewell to the final year students who find themselves abruptly released from the sphere of student life. Often when questioning a final year about whether they are excited about qualification, they stare at you from sleep deprived eyes and manage to muster a yes. However, the stifled excitement always seems tainted with fear. For the purpose of this article, I decided to find out from the horse’s mouth just how it feels making the transition from a final year medical student to FY1 doctor status. As a fifth year medical student, what were your expectations of life as an F1? • A busy lifestyle, however I was pleased that I would be able to put all the theory I had learnt over the years into practice. I was truthfully excited.

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Autumn 2013

•

I was terrified of the responsibility. I didn’t want to talk to the F1’s as many of them appeared disillusioned and disheartened. As a final year student I remember taking an X-ray down to another ward and meeting an F1 on the way who turned to me and said “Six years of studying and I am a glorified secretary”. I thought it would be quite tough at first , as there would be a lot of things to get used to. However I was hopeful that if I was placed in a teaching hospital, I would be well supported. I also felt like I was ready to be a doctor, having spent such a long period of time in medical school.

when I am on call. Some people like the idea of always having to turn to a senior and I can see why I need to check the decisions I make with someone else. However it can feel a little restricting at times. On the upside being an F1 is not as bad as I expected. You still manage to get a really good social life and network of friends with great common ground. Working at the weekends is rubbish but you have to start somewhere. You leave medical school kind of feeling on top .Now you have to go back to the bottom. You realise that you will need to work your way up to the top again and you just get on with it. Though I was scared of the responsibility it was not actually that bad on starting It’s all about organisation and about prioritising. You need to be fast and efficient with doing jobs. The job was similar to my expectations. I enjoy it especially Fridays because it’s the weekend. However in all seriousness I enjoy my job and could not do anything else.

•

A CT2 doctor within earshot couldn’t help but add - “ I really enjoyed life as an F1, I had a great social life and it’s the best stage of being a doctor”.

Do you have any advice for final years on their way to qualification: • Take the opportunity to help the house officer on the ward as a final year. In final year, I was under a consultant who expected me to be on the ward rounds and present the cases of all the patients we had seen back to him. I also got to learn the practical side of things, such as doing jobs. This definitely helped me and was a valuable experience as I felt a sense of responsibility and part of the team. Work hard and become experienced with taking blood and putting in cannulas. Thank you to all the FY1 doctors, who contributed their views to this article. I guess a final word which seems obvious, but is relevant is don’t be afraid to ask for help!

What does it feel like now that you have been an F1 for 6 months? • I am a little bit disappointed. This is because being on a surgical team involves a lot of admin work, more than you thought. In addition to this I can make very few decisions independently, except 2013 Graduation photos, Charlie Ding Autumn 2013courtesy GKT of Gazette

OBITUAR Y

OBITUARY

career path lay in Medicine. It was at Oxford that Dominic became a Christian and from then on his faith played a pivotal role in his life. He was consistent in living out its highest principles with integrity and humility.

1956 - 2013

Michael Dominic Beer Michael Dominic Beer, Senior Lecturer Guy’s, King’s and St. Thomas’/Institute of Psychiatry (GKT/IOP) and Honorary Consultant Psychiatrist (Challenging Behaviour and Intensive Care) Bracton Centre, Oxleas NHS Trust, Head of Section History of Psychiatry (GKT/IOP), was born in Reading, Berkshire on November 4th 1956.

ominic went to Leighton Park school, Reading as a Day Boarder in 1965. Here he excelled both academically and as a sportsman captaining hockey, football and 1st XI cricket. His interest

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Autumn 2013

in cricket was lifelong, as an MCC member and an active player in the Old Leightonians CC until recent ill health precluded this. Dominic was appointed Head of Grove House, Head of School and later became a School Governor. In 1975 he gained a place at Wadham College, Oxford to read Modern History and Modern Languages (German). His German language informed his interest in the History of Psychiatry which developed later. During his second year, Dominic decided his future

Dominic entered Guy’s Medical School 1st M.B. course along with a number of other Oxbridge humanities post-graduates. He found the course particularly challenging as he always admitted to lacking some visualspatial skills so anatomy had to be learned by rote! It is perhaps not surprising that he chose a career pathway that involved more intellectual challenges as well as drawing on his compassionate and servant-hearted qualities. He was very much involved in Guy’s student life as a regular football player down at H.O.P and as President of the Christian Union through which he met fellow Guy’s student, Naomi Salter, who became his wife in 1985. While completing his Psychiatric rotation at Guy’s, having trained under such illustrious personalities as Professor Jim Watson and Dr Maurice Lipsedge, Dominic spent a year at the Wellcome Foundation, where he achieved his MD in the History of Psychiatry. He became a member of the Royal College of Psychiatry in 1989 and a Fellow in 2004. In July 1994, Dominic became Consultant Psychiatrist for the 15 bedded low secure Challenging Behaviour unit at Bexley

Hospital, part of Oxleas NHS Trust, which served various London boroughs. He developed expertise in Intensive Care and Low-secure Challenging Behaviour Psychiatry during this time. The clinic, known as the Heath Clinic, was part of the Bracton Centre for Forensic Services. As well as an active role on the MSc programme at GKT , especially on the anthropology, history and humanities modules, Dominic had teaching responsibilities for the MRCPsych and MBBS course at GKT. He was head of Research and Development for Oxleas, as well as Head of Clinical Audit. He was active in research with over 70 publications in the area of Psychiatric Intensive care, Low-secure Care and historical aspects of Psychiatry. He was assistant editor of the History of Psychiatry, on the editorial board of the Journal of Psychiatric Intensive Care and referee for various other scientific journals, as well as a regular speaker on the national circuit in his field of expertise. He was co-editor of the only worldwide textbook on Psychiatric Intensive Care, published in 2000 and 2008, by Cambridge University Press. Dominic was one of the key founding members of the National Association of Psychiatric Intensive Care Units (NAPICU) in 1995, together with Carol Paton and Stephen Pereira. Concerns over the poor care

Autumn 2013

GKT Gazette

OBITUARY

and treatment of patients in locked wards prompted the development of the first UK survey for Psychiatric Intensive Care, and the subsequent development of the first national multidisciplinary conference on Intensive Care Psychiatry, supported by Oxleas NHS Trust. This formulated the building blocks for NAPICU, with Dominic as Chairman (1997-2001). It was his gentle, sensitive, reflective and quiet manner, as well as persuasive qualities that resulted in the rudiments of NAPICU, especially in procedures and operations, which ultimately led to its successful establishment today. Many on the NAPICU Executive Committee have benefited from Dominicâ&#x20AC;&#x2122;s counsel and wisdom and many of those patients in Intensive Care and Low-secure Care are indebted to Dominic for the considerable difference NAPICU has made to the lives of those with severe and enduring mental illness over the past 17 years. NAPICU has been responsible for formulating National Minimum Standards in Intensive Care Psychiatry and Lowsecure Care, as well as establishing various multidisciplinary educational courses.

Dominic bore the long-standing illness from which he died, with characteristic calm, dignity and patience. He was granted the honour and respect of colleagues at the Celebration held on the occasion of his enforced early retirement in 2011, when many tributes spoke of his outstanding contribution to the field of Mental Health, his scholarship, managerial skills and above all the kindness, courtesy and unfailing good humour he showed to those with whom he came in contact. He made the most of the time left to him, enjoying to the full the benefits of the London cultural scene, with frequent visits to the theatre and art galleries. Dominic was able to fulfill a long held desire to discover himself in paint, producing a veritable effusion of vibrant oil paintings, which received much acclaim. Dominic died on April 19th 2013 aged 56. He leaves his wife, Naomi, a GP in London and 4 children.

Following his chairmanship, he remained on the NAPICU Executive Committee from 2001 to 2005 as Treasurer. He was also an active member of the Christian Medical Fellowship as well has his local Community Church.

GKT Gazette

Autumn 2013

GKT Gazette

SPORTS

to some brilliantly constructed goals by Freeman, Turpin and Summers. The train journey into northern Surrey (they really do use the term ‘University of London’ loosely) had mostly been spent feeling smug about the travel reimbursement from KCLSU (Egham being located approximately 200m outside the M25 cut-off), and making sure we knew each other’s names – the squad of 16 featured nine players making their KCL debuts. It must have been time well spent, as communication on the pitch was remarkably efficient, and the game flowed beautifully through midfield with some great transition play by Hedges, Lewis and Boyce, and a particularly smooth fall-to-the-knees-andcatch-the-ball-there-anyway by TJ.

Lacrosse: KCL Ladies vs. Royal Holloway Luisa Ramirez Intercalated BSc (Management)

ollowing a short hike around Royal Holloway campus in search of their new pitch (eventually located through a small forest, behind a halls of residence), a declaration that “warm-ups are overrated anyway”, and the discovery that we’d brought

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two right-handed goalie gloves, it’s not hugely surprising that we conceded an early goal in this, our first match of the season. Happily, it was just the kick up the backside that we needed to get stuck right in and by the end of the first quarter we had a juicy lead, thanks

Considering the referee’s laid-back attitude to calling, well, anything at all, injuries were thin on the ground. Karma came back, however, to smash Freeman in the forehead not long after she spent 2 minutes on the sideline for taking the skin off one of the opposition girls’ noses. Quite literally. At the opposite end of the (mercifully small, fitness levels considered) pitch, Boylan did a

cracking job in goal, supported by Routledge, Ridgley and Ramirez (it’s something about the letter ‘R’) in defence. Though RoHo snuck a few goals past us, their key players were marked out of the game in the final quarter by some top-notch double team action from Towning and Turpin. Just when you thought a cheeky RoHo-er had slipped through the defensive net, Henshaw was somehow there every time, and we thus maintained our lead, finishing up with a 14-8 win. This week’s man of the match was Carolyn Freeman, but really the performance of the whole squad as a unit should be emphasised on this occasion, particularly as it was our first time playing together! UCL next week… bring it on.

Team: Lizzie Boyce, Ellie Boylan (GK), Carolyn Freeman, Emily Hedges, Jess Hargreaves, Sarah Henshaw, Sophie Lee, Fabia Lewis, Meghan Pexton, Luisa Ramirez, Joanne Ridgley, Amelia Rosenberg, Emma Routledge, Charlotte Summers, Rebecca Towning, Emma Trevor-Jones (C), Laura Turpin.

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GKTWFC: 2012/2013 Season at a Glance Dundee University Students' Association

2s, 6-0, following their embarrassing twitter banter. In another memorable match, they endured a dislocated jaw, a dislocated shoulder, and several muscle strains in order to draw with Royal Holloway 2s, 3-3, and of course, all invalids making it to post match Guy’s Bar! The 2s also fielded a team at NAMS Newcastle and put up a fantastic fight in an incredibly difficult group. The crowning glory of the their season would be clinching the title of ULU Cup Champions!

FC boys for the first time in years. At AGM we said goodbye to a whopping 14 leavers, and elected a promising new committee, not without some impressive candidacy speeches involving guitar performances.

Off the pitch: Of course the only thing better than being on the pitch with us is being off the pitch with us. We have many fond memories (or lack thereof) of Guy’s Bar, “ball-planking” around the city, team dinners, Fresher’s Tour to Birmingham in all of our Disney themed glory, and going to NAMS Newcastle with the GKT

And on that incredibly cheesy note, if you would like to join our family this year, whether you plan on contributing to chasing cups and medals, or you’d just like to partake in some fancy dress shenanigans, please feel free to drop us an email at kclmswfc@gmail. com, and we will welcome you with juniper juice and open arms!

A recurring theme at AGM was one that has really resonated with us this season and seasons past: GKTWFC is more than a club or a couple of teams; we are a family.

Juli McCulloch Intercalated BSc (Sport and Exercise Medicine)

ast season has been an action packed season for GKTWFC. We started off the year with the most impressive numbers of freshers in years. The majority managed to survive fresher trials, and thankfully continued to come back for more (gin). The 1s: Despite losing just one league match all season, due to unfortunate league technicalities, the 1s narrowly missed out on a BUCS league promotion. In terms of cups, they were LUSL Cup semi finalists, defeated in the first game they lost the whole season... in March. The road to the BUCS cup was an emotional and physical battle. They will always remember the quarter final match against brutal Westminster University, in which they suffered a dislocated patella (casually popped back in and returned to 72

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play), a goalie with injured ribs, and a sprained ankle in the center midfield. The 1s fought valiantly in the BUCS Cup final, finishing with a 2-1 loss to UCL in a spectacular match. At NAMS in Newcastle, the 1s progressed through three rounds of penalties after the group stages to become silver medalists. To top off an amazing season, the 1s also continued their undefeated streak over KCLWFC, and contributed to GKT bringing home the Macadam Cup. The 2s: The 2nd team significantly improved this year, proving time and time again their incredible resilience, even in the face of teams who seem to enjoy stealing shoes. They consistently fielded teams that held their own against many other 1st teams in their LUSL league, and there were several notable matches in their season. The 2s “smashed” the RUMS Autumn 2013

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one, two, three defenders and calmly slotted the ball into the net. A glorious goal. Ladies for miles around squealed with delight, and chants of ‘Long live the fro!’ echoed around HOP. Posh Tom (Tom Chandler) made some penetrating runs through the midfield in search of the D. His eyes lit up as a golden opportunity presented itself, with a ball pulled back sweetly, as if on a golfer’s tee. He took out his driver, took a large backswing and thrust his little arms with all his might, but unfortunately connected with nothing but air. Later on, however, Tom did make amends by fluffing a reverse stick shot that somehow squeezed its way between the goalie’s legs. We had the lead.

back and drew level. This is where our preseason fitness came in handy. The pressure was piled on for the last 10 minutes, but alas, we couldn’t find the backboard. Despite maintaining the majority of possession, the score remained a disappointing 2-2 draw. Noteworthy performances came from Geoff Lawrence who filled in at centre back due to Khush Shah sustaining a nasty ankle injury. Geoff also had an unbelievable performance later on at Guy’s bar. Sachin Sharma also had a lively game and posed a serious threat down the right on the counter. Despite suffering an ankle injury late in the game, he battled through due to a lack of substitutes.

Unfortunately, this wasn’t to last long, as Imperial pounced on a bit of poor work at the

1’s Held to Draw by Imperial Medics Anthony Dalrymple MBBS1 9th October 2013

n a chilly Wednesday afternoon, two titans of the medics’ hockey world met on the field at Honor Oak Park for an epic match. GKT were looking to make amends and get back to goal scoring form after a narrow defeat at the hands of RUMs.

Muth suggested was in the top 5 best looking medic hockey players in all of London), walked through the centre of the pitch into the D and neatly slotted a reverse stick shot past Dan Curley. Not the start we were looking for.

The game started in sluggish fashion. A few of the GKT side were feeling the burn after Sachin Sharma’s early season fitness drive. The opposition took full advantage of our slow start and their number 9 (whom Theo

After some inspirational words from captain Sachin, we picked ourselves up and looked to strike back immediately. The equaliser came from a bit of magic from Calum Craig. Drawing power from his perfect perm, he beat

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Guy’s 1’s vs.

beautiful attacking move. Interplay between Koh, Kailey and Ovenden sent the latter through for a second unconverted try. The joy was short lived, as a spell of laziness from Guy’s allowed the QM 10 through for an unconverted try of their own, leaving the score at 13-8.

QMUL 2’s

The lads responded well, remaining in the QM 22 for an extended period. The referee, famed for his love of overtime, deemed there had been a Guy’s infringement and the pressure was released. The game then turned scrappy as fatigue took hold. A second Ralston penalty took the score to 16-8 and, despite some late pressure, Guy’s held out for the victory.

Will Denehan MBBS4 14th October 2013

ine South London weather greeted Guy’s 1st XV after a dull journey to Chislehurst, the home of Queen Mary University of London 2’s. Excellent work from the forwards early in the first half was followed by an attempted decapitation of Luke McNickle, leading to a penalty, which was beautifully converted by James Ralston. Some good phase play soon gave number 9, Don Koh, the chance to make a sneaky break down the blindside, and sent Charlie Ovenden over for an easy try. A missed conversion meant Guy’s had an 8-0 lead. QM’s decision to play a hooker at centre certainly wasn’t paying dividends. Straight from the restart, after a diving catch from Jack Lily D’Cruz, the QM prop decided to have a snooze on the wrong side of the ruck. So blatant was the infringement, that 76

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For his line out stealing, two outrageously sweet takes from restarts and all round prowess, Jack Lily D’Cruz was awarded the traditional prize for his man of the match performance.

Team: 1 Isaac Parker 2 Zack Taylor 3 Dan Caplin 4 Arjun Desai 5 Jack Lily D’Cruz 6 Jonny Turpie 7 Phil Beak (c) 8 Tommy Knight 9 Don Koh 10 James Ralston 11 Charles Ovenden 12 Tom Crisp 13 Luke McNickle 14 Balrik Kailey 15 George Eynon-Lewis 16 Iain McGregor 17 Kaz Arabi 18 James Bramley 19 Lolu Oluwole-Ojo

even the most uninformed onlooker could have predicted what came next. The man was sent to the sin bin for 10, with a feigned look of confusion, and abundant banter from the Guy’s bench. With no front row replacement for their binned prop, QM requested uncontested scrums. Despite the opposition contravening BUCS and IRB rules by not having a front row replacement, the game was allowed to continue. A lapse in concentration from the boys in blue and gold allowed QM a penalty, which was duly converted to leave the score at 8-3. The half finished on a relative high, with Guy’s camped firmly in the opposition 22. A cheeky chip from Balrik Kailey almost put Ovenden in for his second try, but the bounce eluded him and the first half was over. At the start of the second half, Tommy Knight’s extensive hand cream regime came to fruition, as hands as soft as silk triggered a Autumn 2013

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Guy’s Hospital II

Vs. Shooter’s Hill II Tom Fenner MBBS3

Tries: Ovenden, Kosasih, Ralston Conversions: Ralston (2) Team: 1. Isaac Parker 2. Will Denehan 3. Dan Caplin 4. Tom Fenner 5. Samir Zaman 6. Matt Hemmings 7. Stuart James (c) 8. Bernard Harrington-Vogt 9. Rory Heath

10. James Ralston 11. Israel Sotonwa 12. Luke McNickle 13. Charles Ovenden 14. Bryan Herry 15. Ryan Koay 16. Hayden Baer 17. Seb Kosasih

28th September 2013

uy’s 2nd XV travelled to Kidbrooke to face Shooter’s Hill for another classic Bishops Finger League clash. The opposition, clad in brand new easy-tear shirts were clearly out for an abrasive game, setting the tone with some big hits, and aggressive work at the breakdown. The spirited young men of the hospital team refused to let this get them down, however, and managed to play some rugby, albeit rather unattractive and sloppy for the majority of the first half. A solid defence was breached once after Shoots made good use of a rolling maul, and forward picks. Half-time score: 5-0 to Shooter’s Hill. Guy’s started the second half brightly, with a slick backs move resulting in a try for Charlie Ovenden. A few minutes later the forwards crashed the ball back up towards the opposition’s line with some strong, direct running from Bernard Harrington-Vogt and Will Denehan. The backs capitalised on

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the territorial advantage with a try touched down in the corner by substitute winger Seb Kosasih. The majority of the second half then continued in the same vain as the first, with slow, forwards rugby largely dictated by the sturdier Shooter’s Hill side. Luck was with the opposition, as a rather kind referee did not reach into his pocket despite a laundry list of blatant infringements. Frustrations kicked in, as Guy’s were forced to defend for extended periods, and gained little possession of the ball. Despite their apparent hold on the game, Shooter’s Hill failed to put any more points on the board. An exhaustingly sluggish, and error-filled game was somewhat salvaged at the death with a sweet 40m dash to the line from James Ralston to leave the final score at 19-5 to the gold and blue. It wasn’t pretty, but we’ll take it. Man of the match went to Will Denehan for his superb running with ball in hand.

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FEATURES

Penelope B Hewitt

Guy’s Hospital and The Addington Golf Club

y 15th birthday present from my parents was membership of Banstead Downs Golf Club. I wasn’t really interested in golf at the time but it was obvious that it was a present that I couldn’t send back and get something else instead so I had to make the most of it. I went to the weekly coaching sessions with the ‘pro’ in the school holidays, played in junior and ‘adult and junior’ competitions, went to the ‘Surrey Girls’ coaching sessions with Bill Cox at Fulwell (‘ease and grace, ease and grace, hit it, girl, hit it!’), played in their matches and the South-Eastern Juniors events and, eventually, the ‘Kayser Bondor Ladies’ Open’ at Moor Park. My parents weren’t fantastically keen golfers. They had only taken up golf because they had bought a house opposite Banstead Downs Golf Club, in 1935. During World War II they decided that golf made a good escape from a stressful life and they were able to play there together at a time when going away on holiday was difficult. They hadn’t even bothered to get handicaps until I wanted to enter the fathers and daughters competition. I still wonder whether they wanted me to play golf because they were fed

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up with me ‘botanising’ (finding interesting wild flowers on the chalk downs when I walked round with them) rather than finding their balls for them? Or was it because they had become convinced that I really was going to pass my four science ‘A’ levels and go on to medical school? I had heard my father say that all the medical people he knew either seemed to play golf or go sailing and he reckoned that playing golf was more compatible with academic success: he was Director of the Medical Research Council Institute at Carshalton but had got there via first class honours in chemistry with physics rather than a medical qualification. In October 1956 with exemption from the 1st MB year, having obtained the required A levels, I arrived at Guy’s Hospital Medical School in a year with about 20 female students out of a total entry of about 100, previous years normally only having about 3 – 5 women students. During the first week there was a ‘Freshers’ Evening’ at which all the Medical Student Societies set up stalls where their representatives recruited new members. I duly went up to introduce myself to the Captain of Golf (I think he had a 4 handicap, a London University ‘purple’

and had played in the English Amateur Championship) only to be told that their society was ‘men only’. It was the only society I was interested in joining so I went home very disappointed ‑ they had allowed my elder brother to play even though his interest in golf was far less than mine. However, it turned out that this was probably the best thing that could have happened!

I found two other girls who played and had handicaps and three others keen to learn, one of whom had a car so was vital for transporting us, so we formed the Guy’s Hospital Medical School Ladies’ Golfing Society. The next priority was to find ourselves a home course. The male students at that time were based at Shirley Park and had previously belonged to some other local

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courses which had asked them to move on after excessive revelries. I therefore wrote to four other courses where I would like to play and were within a reasonable distance: Addington, Royal Wimbledon, Walton Heath and Sundridge Park: two courses at one club could mean more space available, I thought. To my delight I had a letter back from Addington (a course I knew only by repute – I had never even been there) saying ‘do have the courtesy of the course while we consider your application’. My father drove me there and ‘caddied’ for me. I got as far as the 9th fairway but then I didn’t know where to go. I was quite pleased with myself having successfully driven across a rather scary chasm but couldn’t work out where to go next. There were four men playing up what I now know is the 10th fairway so I asked them where the ninth green was. When they pointed across an even bigger chasm, which at that time had a large pine tree growing in it near the wooden bridge, I think my jaw must have visibly dropped. Anyway I eventually got all the way round and ‘lived to tell the tale’. Not long afterwards, to my great delight, I received a letter to say we were welcome to join for two guineas per annum provided that Mr Nils Eckhoff, Consultant Surgeon to Guy’s Hospital, signed our application forms. He was a lovely gentle giant of a man, a South African born ex-Rugby player who, despite taking size 8 1/2 gloves, did the most elegant plastic surgery. He was always a great supporter of the medical students and willingly signed our applications. A little while later he interrogated me in detail after one of his ward rounds to ascertain such important details as whether I was able to carry the rough when driving on the fourth hole, and continued to take a friendly interest in our activities.

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Encouraged by our initial achievements we contacted the Golf Foundation to enlist its support. It agreed to fund coaching sessions for us with Robin Robson on Wednesday afternoons. The Guy’s Hospital Clubs’ Union agreed to fund our subscriptions on the basis that they were not providing us the facilities for golf whereas other sports, such as rugby and cricket, had provision at their Honor Oak Park grounds, while swimming, tennis and squash were catered for on the Guy’s site. We therefore got our golf for nothing – we just had a ‘whip round’ for a Christmas present for Robin Robson each year. We truly were very fortunate. Meanwhile we discovered that there were a number of other ‘Guy’s men’ who were members as well as Nils Eckhoff. ‘Jock’ Houston (Physician) who became Dean of the Medical School, John Dow (consultant Radiologist and his wife Catherine, and at a later date John Maynard (Consultant Surgeon) and Geoff Koffman (Transplant Surgeon). Also, Ian Kelsey Fry was there – he was a Guy’sgraduate who went on to work at St Bartholomew’s as Consultant Radiologist and Dean of the Medical School. By the time I qualified (1961) I had become so attached to Addington that I kept on my membership throughout my post-graduate training years, despite having little time to play, and was still a member when I joined the Consultant Staff of Guy’s Hospital (as the first female to become a full consultant there) in 1973 and was able to play in the consultant staff knock out. This really made me realise the great advantage of being a Lady Member at Addington compared with other golf clubs around London. I was able to play with a guest at weekends with equal standing with the male members. One Sunday I was playing a match at Addington against our Professor of Chemical Pathology (a member of Wentworth) and we were waved through a men’s four-ball on the 16th hole. I did feel

some pressure to show that I was a respectable golfer to justify this so concentrated really hard and produced a decent stroke. A voice I recognised said ‘good shot’ and I realised it was Ewan Campbell (who had succeeded Robin Robson as the club professional) and we had just been waved through by the ‘Captain and Pro’ playing their Sunday morning challenge. An annual staff versus students match that used to take place at Huntercombe on Henley Regatta day was subsequently transferred to Addington and more recently John Maynard started the Borough Golfing Society which had a mix of Guy’s Staff and non-medical people who worked in the London Borough of Southwark. In 1993 they decided that they would invite the one female member of the Consultant Staff that they knew played golf (PBH) to join the Society. The first meeting I played in was at Rochester and Cobham Golf Club where I had never played before. By some fluke I won the day with 42 Stableford points (playing off my 15 handicap). They were so impressed that they gave me not

only the prize for the day but also the prize from the previous (Christmas) meeting that had been abandoned due to snow. After a convivial lunch one of the Society members said to me: ‘you just wait for the next meeting, you won’t stand a chance on that course’. I enquired where that was and the answer was Addington. They were a bit worried when I told them that was my home course.

Guy’s Hospital is now part of an NHS Trust with St Thomas’ which brings with it opportunities to play at West Hill and Rye but, unfortunately, less involvement with The Addington. The Medical School is linked with King’s College which doesn’t seem to be particularly interested in golf so I wonder whether future members of the medical profession in South-East London will be as well represented at Addington as in the past? Anyway they have now, for the third time, made me Lady Captain in 2013 which is The Addington Golf Club’s Centenary Year.

The GKT Gazette Invites Companies to Use Our

Advertising Space For more information, contact advertising@gktgazette.org.uk Autumn 2013

GKT Gazette

King’s Women’s Water Polo

2012-13 A Brief Summary

CREDITS

The Gazette Team

Joshua Getty Deputy Editor History Editor

Katie Allan News Editor

Lewis Moore Deputy Editor News Editor

Kate Anstee Deputy Editor Treasurer

Zoya Arain Features Editor

John Hardie Ajay Shah Arts & Culture Editor Research Editor

Megan Clark Dental Editor

Georgie Day Nursing Editor

Sam Evbuomwan Matilda Esan Book Reviews Editor Careers Editor

Tom Fenner Sports Editor

Anya Suppermpool Layout Editor

Hannah Asante Advertising Officer

Harriet Churchill Nutrition and Dietetics BSc 3rd Year

s the season draws to a close, the King’s women’s water polo team can only be astounded with their success this year. For the first time in club history, the team played in the BUCS National Trophy Finals on Monday 29th April 2013 in Loughborough, with previous years being unable to make it past the qualifying rounds. Following nine undefeated qualifying matches, King’s represented the best southern university team. The finals were against Loughborough University, who in front of their large home crowd, unfortunately performed better on the day. However, this meant that King’s took home silver medals for the BUCS Trophy league, along with a promotion to Division 1 next year. Furthermore, in the UPolo league the girls also had a great year finishing 3rd overall, with the mixed team coming in 2nd in LUSL water polo league. 84

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The dedication and commitment to training and matches all year has obviously paid off and throughout the season we have seen some spectacular play, aggression, goals scored and of course some phenomenal saves from Rees-Jones, with plenty of drinking and terrible moves along the way! A special mention goes to Peter Vella for coaching us this season and putting up with all the girls! Congratulations to all the 2012/13 squad for this season: Alice Hully, Alison Hopper, Emma Christie, Gemma Morris, Harriet Churchill (Captain), Karina Sharma, Lucy Cheetham, Lucy Granat, Megan Clark, Meriki Hill, Natasha Venchard, Philippa Harrison, Portia Rees-Jones, Priya Rogers, Rita Pencz, Rose Evans, Emma Stenson and Sarah Dyson.

Nayaab Abdul Kader Charlie Ding Merchandise Officer Photography

With Special Thanks To: Lucy Webb - News Writer Ellis Onwordi - Features Writer Sabeen Chaudhry - Arts & Culture Writer Sabina Checketts - Arts & Culture Writer Fi Kirkham - History Writer Jingda Liao - Research Writer Sarah Siddiqui - Dental Writer Sarah Cleary - Nursing Writer Lalesia Ngoke - Book Reviews Deputy Editor Will Denehan - Sports Writer

Anthony Dalrymple - Sports Writer Juli McCulloch - Sports Writer Luisa Ramirez - Sports Writer Harriet Churchill - Sports Writer Professor Stephen Challacombe - Trustee Margaret Whatley - Administrative Support William Edwards - For Assistance and Guidance King’s College London & our other donors for generous financial support Autumn 2013

GKT Gazette

The Guy’s, King’s College & St Thomas’ Hospitals Gazette

Volume: 127 Issue: 1 Number: 2580 ISSN 0017-5870