GKT Gazette - Mar-Apr 2014 by GKT Gazette

MAR - APR 2014

Volume 128, Est. 1872 FREE at King’s College London Campuses at

Guy’s, King’s College and St Thomas’ Hospitals Inside:

Fair Pay for all KCL Employees College caves in to London Living Wage campaign

A Date with the Dean

an exclusive interview with Prof Carney

Exam Stress How to stay sane

and much more

GKT

football teams

Win the

matches that they played at the

Macadam Cup but the Cup is lost to KCL 6-9 over all events

Anaesthesia

at a Glance Julian Stone William Fawcett

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MCQs a n ine

Obstetrics and Gynecology

at a Glance Fourth Edition Errol Norwitz John Schorge

Haematology

at a Glance Fourth Edition

at a Glance Third Edition Dorian J. Pritchard Bruce R. Korf

Ophthalmology

The Foundation Programme

at a Glance Second Edition

at a Glance

at a Glance PRACTICE WORKBOOK

Jane Olver Laura Crawley Gurjeet Jutley Lorraine Cassidy

Edited by Stuart Carney Derek Gallen

Medical Sciences Jakub Scaber Faisal Rahman Peter Abrahams

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Established as the Guy’s Hospital Gazette in 1872

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Oncology

Physiology

Graham G. Dark

Third Edition

at a Glance

at a Glance Jeremy P. T. Ward

Medical Sciences

at a Glance

Website: www.gktgazette.org.uk Email: editor@gktgazette.org.uk

Front cover photo courtesy of Charlie Ding Back cover photo courtesy of Anya Suppermpool

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Edited by Michael Randall

GKT Gazette, Room 3.7, Henriette Raphael House, Guy’s Campus, King’s College London, SE1 1UL

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Vol. 128, Issue 2. Number 2582. ISSN: 0017-5870

MCQs

Roger W. A. Linden

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GKT

GAZETTE

Atul B. Mehta A. Victor Hoffbrand

Medical Genetics

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The at a Glance series The market-leading at a Glance series is used world-wide by medical students, residents, junior doctors and health professionals for its concise and clear approach and superb illustrations. Each topic is presented in a double-page spread with clear, easy-to-follow diagrams, supported by succinct explanatory text. Covering the whole medical curriculum, these introductory texts are ideal for teaching, learning and exam preparation, and are useful throughout medical school and beyond.

www.ataglanceseries.com

Mar - Apr 2014

GKT Gazette

EDITORIAL

Contents 5 6

Editorial

Victories and defeats

News & Views

Dental

Nursing & Midwifery

Book Reviews

42 51

London Living Wage, Hospital Closure Clause, and the Health and Social Care Act

Applying to Dentistry as a graduate and the Amchi Project

Anabolic steroids and stafﬁng levels

The Cambridge Illustrated History of Surgery and a new book reviews in brief section

History

The end of WWII and the lady with the lamp

Research

PERK inhibitors, Wellcome Image Awards, and the science of free will

Careers

Letters

Features

Obituaries

Arts & Culture

Sport

A rebuttal to “Why medics are the worst people in uni” and a critique of male attitudes towards Ostetrics and Gynaecology

A date with the dean and a call for information on “perpetual medical students”

Bridging the art-science divide, Keats’ Corner and a playlist for Spring and Summer

You win some, you lose some

Coping with exams and planning your perfect medical career

Appreciations of Dr John EK Moore and Dr Alan W Hind

The Macadam cup and more...

Simon Cleary Editor

espite the misleading headline, I’m sorry to report that for the second time in its 11-year history, the Macadam Cup has been lost to the teams representing the rest of King’s College London. Congratulations to all who took part, and see the Sports section for a summary. In better news, the College has given in to pressure, much of which was from students, to ensure that all employees are paid the London living wage. Whoever said you can’t change anything in student politics? Meanwhile, an eerie silence has fallen over campus as revision season has begun. Students - don’t let the long nights in the library get you down and check out graduate Sally Kamaledeen’s guide to exam preparation in the Careers section. A massive thank you to the students, graduates, staﬀ and patient who made this issue possible. If you would like to get involved in the Gazette in any way, please do not hesitate to contact me by emailing editor@gktgazette. org.uk. Enjoy!

NEWS & VIEWS

London Living Wage Finally Secured for all KCL Employees

was a key issue promoted by the KCLSU president, Sebastiaan Debrouwere, who is currently pushing for rapid renegotiation of contracts to ensure staﬀ receive adequate wages as soon as possible.

Teona Seraﬁmova MBBS2

The London Living Wage comes to £8.80 an hour, and is considered the minimum that individuals should earn, according to the cost of living in the capital. Although this had been promised to all staff in 2010, outsourcing of cleaning staff meant that some individuals were only paid £6.31 per hour, the current national minimum wage. Further, this wage had increased below the level of inflation. Evidence followed that many staff members were struggling to look after their families and pay travel 6

GKT Gazette

expenses, leading to a huge outcry from students and staff alike. Student activism and increased awareness regarding the issue led to the Principal, Rick Trainor, finally ensuring that the London Living Wage was provided to all King’s College London staff. Although the promise had been made in 2010, the outsourcing of

Mar - Feb 2014

cleaning services meant that a significant proportion of staff on our campuses failed to receive adequate wages. Indeed, if we consider that KCL pays some of our staff members up to £200 an hour, a fair wage has been long overdue.

In a statement, Rick Trainor stated that “The College has now considered all the legal and ﬁnancial issues

this new higher wage would be provided to all staﬀ, including students working for the College, in August 2014. As well as demonstrating the power of student activism, this is a crucial step to ensuring equality across our campuses, and a victory for KCL workers.

BMA Renews Call To Repeal 2012 Health and Social Care Act

Although staﬀ contracts are yet to be altered, there is pressure to complete this quickly. Indeed, this

Lewis Moore MBBS4

Photo Courtesy of Charlie Ding

ast month saw a crucial breakthrough for the staff and, indeed, students at King’s College London (KCL). Following a huge crosscampus campaign, led by workers and students alike, the London Living Wage was finally promised to all staff at KCL.

relating to the payment of the London Living Wage to contract staﬀ. We recognise the strength of feeling within the College community on this subject and have reached the conclusion that this is the right thing to do. We intend to move forward as rapidly as possible.”After mounting pressure, it was recently announced that

he introduction in April 2013 of the Health and Social Care Act 2012 was the largest restructuring of the NHS since its inception in 1948. There was signiﬁcant opposition to the bill at the time from organisations such as the British Medical Association (BMA), and the Royal Colleges of General Practitioners and Nursing. The BMA have renewed their

call to repeal the act for the following reasons: • Competitive tendering, introduced to improve eﬃciency has caused the fragmentation of services, which need to be united to provide continuity of care and a holistic approach to patients, especially important as the aging population increases the proportion of patients with multiple chronic conditions.

• Public health services have been disrupted, with a loss of 5000 staﬀ nationwide. Of 590 public health staﬀ surveyed by the BMA, 71% had noticed an increase in bureaucracy since the act passed. • General Practitioners (GPs) report an increase in their already stretched workload. Of GPs surveyed, 50% had not engaged with the changes

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NEWS & VIEWS

in the act, a crucial problem as GPs are to take on some of the commissioning responsibilities of the dissolved Primary Care Trusts. • Appointment of the Oﬃce of Fair trading to regulate commissioning decisions is seen as wholly inappropriate, as this body was set up to regulate private markets, not make decisions about the provision of clinical care. BMA chairman Mark Porter said, “The damage done to the NHS has been profound and intense… what we need now is an honest and frank discussion about how we

NEWS & VIEWS

can put right what has gone wrong without more topdown reorganisation”.

National Institute of Health and Clinical Excellence spending policy.

“The damage done to the NHS has been profound and intense.”

While the act is unlikely to be repealed, the BMA call reminds doctors that good patient care should remain the objective despite the “political football” that is being played with the NHS. Patients require an integrated service, and while communication between NHS organisations should be encouraged, it has in fact been stiﬂed by the act whilst carving up the NHS and ‘competitively tendering’ its services to the lowest bidder.

Mark Porter, BMA Chairman

The act has thus far cost the NHS in excess of £1.5bn and is widely thought to have failed to deliver improvements to patient care. To put it in context, this money could have been spent on treatment to achieve 75,000 Quality Adjusted Life Years according to current

power when trying to close maternity and emergency care units at Lewisham hospital. The new powers allow the closure of hospitals and units which are performing well, and the Lewisham closure would have been legal if these laws were in place last year. Labour shadow health secretary Andy Burnham said of the clause: “It subverts the

established process in the NHS which requires that any changes to hospitals should first and foremost be about saving lives, rather than saving money, and it puts management consultants, not medical consultants or GPs, in the driving seat.” Public outcry followed, with many voicing feelings that the NHS is suffering for its use political football field,

‘Hospital Closure Clause’ Passes Through House of Lords days, close or downgrade a hospital if a neighbouring trust is in ﬁnancial diﬃculty.

Rebecca Trenear MBBS4

n the 11th of March, 2014, Parliament passed into law a clause allowing the Health Secretary to, within 40

GKT Gazette

Despite widespread criticism, clause 119 of the Care bill was passed to ‘ensure patient safety when

Mar - Feb 2014

trusts are found to be failing’. It is impossible to view this act outside of the context of the High Court ruling in October, which deemed that the Health Secretary had acted outside of his

Unsatisﬁed with bringing down the axe on the NHS, the coalition government have decided to bring down the hammer.

from a government whose election manifesto promised “No more top-down organisations of the NHS”. The new law has caused concern those working in Lewisham and beyond, if the closure does indeed go forward the patient demand will be displaced to neighbouring hospitals, including the nearlybankrupt Queen Elizabeth Hospital, Woolwich, and to King’s College Hospital, whose maternity and emergency services are already approaching breaking point. While the democratically elected members of parliament have our delegated authority to make decisions regarding public spending on health, the current framework appears to have put too much power in their hands, not giving enough power to members of the profession, research teams and members of the public.

Illustration by Kate Anstee

Mar - Apr 2014

GKT Gazette

LETTERS

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 correspondence to editor@gktgazette.org.uk, and you will see it in the next issue of the Gazette!

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

ear Editor, I remember dreading my Cardiology rotation as I had thoroughly disliked the preclinical teaching on the subject, and was worried about being able to detect cardiac murmurs. Of course everyone has a rotation they’re looking forward to the least, and being worried about starting a rotation after having previously struggled with the preclinical concepts is understandable, but it is less acceptable to have preconceived ideas that you will not enjoy the rotation due to the gender of the patients or doctors. Sadly I’ve noticed an immature attitude from some of my male colleagues towards the Reproductive and Sexual Health (RSH) rotation

where Obstetrics and Gynaecology (O&G) is the main specialty covered.. During the years preceding fourth year I heard comments such as “O&G? That’s for batty boys” and “O&G? It’s for pussies”. When I intercalated in Women’s Health, there were twenty-five of us on the BSc course, and just two of these were men. During my tenure as President of O&G Society, the attendance of male students at our events was woefully low. They even avoided our stall at Fresher’s Fair like the plague; the odd straggler wandered up without realising which stall they were headed for, panicked once they got to our table and eventually shuffled off awkwardly to another stall mumbling

excuses about how they hadn’t done the rotation or it didn’t interest them. One of my male friends who has wanted to do O&G for some time, related the comments he received from his colleagues when he voiced this to them such as; “It will destroy your sex life” and “Why would you want to spend the rest of your life working with hormonal and volatile women - and that’s just your colleagues!”. He was called a pervert several times, which in particular really irked me; I wonder if students wanting to do Gastroenterology are labelled a “pervert” for wanting to specialise in a ﬁeld where you have to routinely perform rectal examinations. Is

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GKT Gazette

LETTERS

this really diﬀerent from having to perform vaginal examinations? It might be surprising to some, the high proportion of female trainees in O&G is relatively recent development and in 2011 it was recorded that still over half the consultants within the specialty are still male (53.4%). So the real question is, despite their seemingly negative preconceptions about the rotation, do male medical students enjoy O&G? It seems a few do, often exclaimed with such a tone of surprise as if shocked to ﬁnd their Y chromosome still intact. The same male medical student

mentioned earlier also said that once his colleagues had completed the placement their attitudes were markedly less negative. It’s hard not to make judgments in life, and it’s not a crime to go into a rotation with preconceived ideas of whether or not you will enjoy it. The real issue arises when people cannot overcome these preconceptions and open their minds to the possibility of engaging with something they had not thought it possible to enjoy. Fear of a rotation that you can hopefully ultimately enjoy and learn a lot from, simply because of your gender is something I hope

we can strive to change in the future. Best Wishes, Rahee Mapara MBBS4

Strand student discovers one simple trick to write highly viewed articles. Medics hate her! The Tab, once just a Cambridge student tabloid but now a limited company that oﬀers students nation-wide a platform to develop important listicle-writing skills, published a piece on GKT team chants on its King’s page in the run up to the 2014 Macadam Cup. The article, which began “Why medics are the worst people at uni... Medic students at King’s are dicks. Here’s why [sic]” and went on to challenge GKT chants in a format familiar to those acquainted with BuzzFeed, succeeded in mildly annoying some at the hospital campuses (and in generating those all-important pageviews). Alice Hully thinks that the article should have been thought through a little more.

ear Editor, Firstly, in the interest of journalistic integrity (perhaps a novel concept to some), I should point out that I have an ulterior motive in writing this article. As both a proud 12

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GKT medic and captain of the ladies waterpolo team, Turnerʼs piece managed to doubly oﬀend me. Not only did she suggest that all GKT medics are arrogant elitists, but that only Hockey and Rugby should be considered

Mar - Feb 2014

ʻproperʼ sports. This is perhaps an ironic twist as it highlights her own elitist tendencies as a hockey player: perhaps the pot should check the colour of the kettle before trashing it in a sensationalist gossip

rag. Lauren has so far declined my generous oﬀer to join the waterpolo team in a training session, in order to assess how ʻproperʼ it is for herself. What also interests me are the two assumptions that the article makes. Firstly, that only medical students go to GKT: there are a very large number of physios, biomeds, dieticians, nurses and dentists who also make up the student body, but who somehow always seem to be overlooked by those who make sweeping statements about GKT. Secondly, the assumption that GKT and ‘Strandies’ cannot or should not be friends: I have a number of very good friends who happen to study at the Strand and all of whom found the Tab article ridiculous. I am sure that the article was designed to be controversial and to raise stakes before upcoming Macadam Wednesday, it may also be true that Ms Turner meant it as a joke. However, this does not change the fact that it insultingly stereotypes a large portion of the student body. If the internal competition between GKT and KCL is indeed so ridiculous, then why encourage it by making GKT medics feel as if they are under attack? As one commenter pointed out

beneath the article, was it not the same Lauren Turner who had recently praised the union of KCL and GKT against UCL for this year’s varsity series in a similar article? Perhaps the worst thing about the article is its rampant hypocrisy. Not only in terms of the elitist sports comments, but also because the article gives the impression that Lauren is the very thing she is supposedly denouncing the medical students for being. Her comments suggest that she dislikes the KCL GKT rivalry, and yet by writing the article she is fanning the ﬂames of mistrust and dislike. She attacks medical students for allegedly claiming that they will make more money than Strand students and then goes on to suggest that many Strand students will work in the ﬁnance sector. GKT is accused of being un-sporting in their victory, and yet Turner is more than happy to crow about her own victories with KCL hockey (the vast majority of whom I know to be intelligent and reasonable people, just like the majority of Strand students incidentally). As a parting comment, I would also like to suggest that King’s Tab has more than just a small role to play in this debacle, by

encouraging sensationalist opinion pieces, designed to insult and polarise its readers. It is a shame that a hub of supposed international, academic excellence supports such (and I use the term loosely) ʻjournalisticʼ endeavors. I genuinely wish Ms Turner all the best for her future. But then again, maybe I donʼt because I am an elitist, gloating dick with a superiority complex and average intelligence, who will likely get a job upon graduating. Long live GKT! Regards, Alice Hully MBBS2

A KCL fan (left) and “former GKT patient” (right). Photo via the King’s Tab

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FEATURES

A Date with the Dean

to develop something new. We are also about to make a number of new appointments. Over the coming months I’ll be able to talk in more detail about this.

Interview by Lewis Moore MBBS4

3. Engagement. We need to increase the number of Faculty engaged in education and raise the proﬁle of medical education in King’s College London and our partner trusts.

hile his speeches are as powerful as his demeanour (and his ability to throw a wine reception), there remains some confusion as to what the new Dean of Medical Education is here for, and what he does. Our bearded, renegade reporter, Lewis Moore met him one wet Monday afternoon to discuss cheese, Exeter and a few points about the provision of medical education to GKT’s ﬁnest.

Lewis Moore: You are now ﬁve Months in as Dean of Medical Education. How are you ﬁnding it? Stuart Carney: The one word that sums it up is busy! I have been trying to forge relationships with 19 partner trusts, 300 general practices, the Deanery and colleagues across the university. This has been alongside the personal challenges of moving to London from the south west of England. LM: What is a Dean? What does the job entail? SC: The Dean of Medical Education is in charge of the medical degree programme, which includes everything from admissions to teaching, assessment and pastoral support. LM: You were appointed here with a view to championing ‘innovation and research excellence’, what is your plan for MBBS at King’s? SC: We cannot escape from the fact that the student experience in the School of Medicine has not been as good as we all want it to be. We are working hard to address these issues. But to put this into a broader context I would like to highlight two reports which I have co-authored: The ‘Shape of Training’ report

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(General Medical Council, Oct 2013) and ‘Broadening the Foundation Programme’ (Health Education England, February 2014). These reports recognise that we all need to refocus our attention on ensuring that doctors are better equipped to care for people living with multiple long-term medical conditions. 23% of our population live with two or more long-term conditions. All medical schools in the UK need to ‘up their game’ in this area. That being said, there are 4 things that we need to look at, here at King’s: 1. Culture. The student should be ‘king’; we need to move to a more student-centred model. Our excellence in research may have partly been at the expense of the MBBS student experience. The ﬁrst stage of improving the culture is to listen and respond to what the students want and need.

4. Curriculum rewrite. This will be progressively rolled out from 2015, it will begin to address the issues of preparing our graduates for practice and ensure that our graduates can also care for those presenting with chronic conditions, a diﬀerent proﬁle of illness than we have previously prepared for. LM: You opposed the old system whereby career advancement was based on rugby contacts instead of merit. Do you see a way where we can move past that and perhaps become a bit more modern? Or is that just a pet hate?

SC: I think the issue here is and has to be, about appointing people on merit and not as a consequence of patronage. The bottom line here is the world has moved on and medicine similarly has to move on. And it may be that if you play rugby, you’re particularly good at some aspects of teamwork and therefore the two aspects work together. But it shouldn’t be that just because you play rugby that determines your career trajectory. LM: I feel that the logbook system is demotivating to students who feel that once they’ve got a particular skill signed oﬀ, that’s them done for the term and that they need not practice that again until OSCEs. Do you think logbooks are something that will continue to be part of the curriculum in the future? SC: While we do need to provide evidence that individuals can perform particular skills we also need to move beyond a tick box exercise. I think the pendulum has swung too far in favour of sign oﬀs as opposed to global clinical judgement. Firm heads and those

Prof Carney (second from left) sipping on gin and... gin at the 2014 Hockey AGM Photograph courtesy of Charlie Ding

2. Reorganisation. We are about to reorganise the Division of Medical Education as we create a School of Medical Education, which all students will be part of. There are currently around 160 people who are, on paper, directly line-managed by me. There is no way in the world that I can manage this many people. A well-deﬁned structure will ensure that students and staﬀ will know who to go to if they have a problem or if they want

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FEATURES

supervising have already begun to see a shift in the post-graduate arena, and similarly we need to see that shift in the undergraduate arena.

environment where students feel that their teachers and supervisors are taking an interest in them. We need to foster a stronger sense of belonging.

One of the other issues we want to look at is whether ﬁnals should be brought forward, allowing students to focus on the transition to be a safe doctor during the ﬁnal months or year of medical school.

LM: A recent controversy that made the headlines was the scrapping of third year resits; those plans have been suspended for the current academic year. Are there still feelings that this should happen in the future and that students shouldn’t be able to sit those exams?

LM: Is moving the exams forward to Jan or October something we might see in the next few years at King’s? SC: This is on the table as part of the curriculum rewrite and we will be reviewing the evidence. The Shape of Training Report recommends that full registration is awarded at the end of medical school. LM: Moving on to King’s, slated for teaching and feedback in all recorded statistics, you’ve touched on this earlier but why do we lag behind UCL and Imperial College, why are we ranked 13th best in the world but 29/30th in the UK? SC: I don’t think it’s just a function of size but that does play into it, I think that other medical schools of a similar size have been able to create an

SC: I think the principle here is that we must ensure that students are safe to progress to the next stage. This is not just about passing an exam but is about ensuring that students have sufficient time to develop the required skills they need to progress. We are focussing on strengthening the formative written exam and do plan to remove the exemption examination in phase 3. LM: Students and clinical staff have identified problems with hot OSCE feedback, and students might be told on the piece of papers given back to them by the examiner that they were competent, yet when the numerical results came back a student was told they’d failed the same station for which they’d received glowing praise. And in some cases the other way around, has this system been revised, are there plans to revise it? SC: I am concerned by the reports that there is sometimes a significant mismatch between the hot feedback and the final results. We are working to address this. LM: Can you reassure us that this is being investigated fully? SC: Yes, it is being investigated fully. I can’t say that it’s never going to happen again, but we do need to reduce the risk of this.

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LM: There is seemingly unanimous agreement by fourth and fifth year students that there is overcrowding of clinical placements with an adverse impact on quality teaching and clinical experience, are any measures being taken to account for that? SC: Overall the number of medical students has been reduced in England by 2%, King’s figures have been capped at 403. The Cambridge transfer system will cease as of 2017. This will enable us to reduce the number of students in our firms. There are a lot of rich training environments in our hospitals which we are not using. We will be looking to make better use of this at this as part of the curriculum rewrite and reduce the size of placements. LM: There are a lot of rumours floating around that we are merging with St. George’s can you comment on this? SC: I think that this highly unlikely. That would create a vast medical school which I don’t think is in anybody’s interest. LM: Alice Nutbourne, a 5th year medical student would like to know what your favourite cheese is? SC: Good question. I have three favourites at the moment: Morbier, Manchego (Particularly the Tesco’s and Waitrose finest Manchego) and Brie.

‘Ratalie Rung’ has asked if you’re married? SC: I am not LM: Any plans? SC: Hahahahahahahahahahahahahahah… LM: Any imminent plans? SC: …hahaha I have no imminent plans to get married. LM: Since the days of Ancient Greece medical students and free wine have been known as a lethal combination. In the context of the amount of wine consumed did you witness any behaviour which you’d like to comment on or bring to the attention of the Gazette readers? SC: Maybe as a consequence of the alcohol a number of students were very frank about their experiences. I didn’t witness anything beyond that. However The KCLSU and MSA campaign for Dry January should make us all stop and think about our alcohol intake. Abridged for print edition. For the whole interview, please see www.gktgazette. org.uk

LM: Classic. A twitter user known as @ portypie has asked if you watch Scrubs and if so what’s your favourite character? SC: I don’t watch Scrubs, is it still going? My favourite show at that time was the West Wing. LM: A fourth year medical student who, to protect her anonymity shall be referred to as Mar - Apr 2014 GKT Gazette 17 Photograph courtesy of Zoya Arain

FEATURES

Perpetual Medical Students David KC Cooper University of Pittsburgh When I read the article that is reprinted below (with the permission of its American author, Dr S. Robert Lathan, and the editor of the Baylor University Medical Center Proceedings, Dr William Roberts), I immediately felt it would be of interest to many students and alumni/ae of GKT or, indeed, of KCL. Dr. Lathan reminisces on a 10-week elective spent at Guy’s, which was not unusual for American medical students in that era. His article relates speciﬁcally to a species of medical student that no longer exists, yet I understand was not that uncommon before and immediately after the Second World War (WWII). Today’s reader may be amazed that such students ever existed, but they did. When I was a medical student at Guy’s (at the exact time of Dr Lathan’s summer sojourn at Guy’s in 1961), I well remember the professor of surgery, Hedley Atkins (later to become the president of the Royal College of Surgeon and knighted by the Queen) relating stories of such students to us. In the early post-WWII years, there 18

GKT Gazette

were evidently a handful of such perennial students whose medical studies took second place to their sporting or social interests, thus delaying their medical qualiﬁcation. Several were outstanding sportsmen, particularly rugby players, but others were more social people, like John OrmsbyGore, who is proﬁled in the accompanying article. Some of these perennial students determined that their best means of qualifying was to take the ‘Apothecaries’ examination (LMSSA). This examination consisted of four parts – medicine, surgery, obstetrics and gynaecology, and pathology – and each part could be taken separately on a monthly basis until passed. Atkins was an examiner, and he, with his co-examiner, would examine the students each month in the form of a viva on the fundamentals of clinical surgery. One particular student– unforgettable to Atkins – was from a very wealthy family and, always immaculately dressed, would arrive at the examination hall in a

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chauffeur-driven RollsRoyce. Such was the grandeur of his entry into the room that Atkins and his colleague, their tongues very much in their cheeks, would stand as a sign of respect as he entered, eliciting his good-natured protestations, begging them to be seated. The student would sit elegantly in front of the examiners’ table, cross his legs, and look at them expectantly with a confident and good-humoured expression on his face. After some initial social niceties, the examiners would proceed to question him and, whether he knew the correct answer or not, he would never be lost for words. Examples that Atkins gave us remain vividly in my memory today. For example, in response to a question on how he would treat a dislocated shoulder joint, the student replied, ”I’m so pleased you have asked me that question because only last Saturday I was playing polo with Prince Felix of Bavaria when he had the misfortune to fall from his pony, and clearly dislocate his shoulder. I hopped off my pony, manipulated the joint – without anaesthetic, of course – and I’m pleased to say he was able to get back up and score three goals in the final chukka.” The two

examiners invariably found his response entertaining, if lacking in the surgical details they required. When once asked to describe the symptoms and signs of a vesicovaginal fistula, he replied, “Forgive me, gentlemen, but the complications of vesico-vaginal fistula are so horrendous and disturbing to me that I am afraid I simply cannot bring myself to discuss them.” Knowing that Professor Atkins had served in WWII as a relatively junior officer, the student would frequently attempt to curry favour with his interrogator by flattering him throughout the course of the examination. “As Major Atkins well knows from his wartime experience, that condition is very difficult to treat,” he would say. “However, as I am sure Colonel Atkins would agree…” and so it would go on… “As Brigadier Atkins has previously mentioned…” By the end of the viva, Atkins would often end up at least as a General. I am not sure whether the Apothecaries examinations are still offered to today’s medical students, and would be interested to know. By the 1960s, however,

the number of these “unforgettable” students was rapidly dwindling, and St. Thomas’s, with its rather liberal selection criteria at the time (based to some extent on one’s school and sporting prowess), may have been the last bastion of them at the London medical schools. During my own time at Guy’s (1957-63), we had a handful who took their medical studies rather casually, but did not quite approach the status of the perennial student. One 1st MB colleague would disappear for days at a time buying, and then proﬁtably selling, surplus Army equipment, such as tents and jeeps. At the end of the academic year, he predictably failed the examination and, as a result, was called up into the Army

(as conscription was still in existence, though in its last throes). He later reported to us that, in view of his experience, he had been put in charge of an Army store. This seemed to me to be an excellent example of putting a fox among the chickens. Although I never heard of him subsequently, I have no doubt he ended as a multimillionaire. Other contemporaries who remain in my memory include one who was a gifted concert violinist – a member of a well-known quartet - who chose to study medicine through a growing interest in music therapy for psychiatric patients. Sadly, the demands of his diminished, but continuing, musical career distracted him from his medical studies suﬃciently to

Dropping oﬀ the modern-day perpetual student at their 11th exam re-sit Illustration: Kate Anstee Mar - Apr 2014

GKT Gazette

FEATURES

prevent his success at 2nd MB, and he returned to music full-time. Another memorable colleague was a 1st MB student who had taken up a place at Guy’s after turning down a place to read history at Oxford. Just before the end-of-academic year examinations, I asked whether, if he failed, he would return to repeat the course (which was possible at the time). His remarkable response was, “Yes, I think I will. I mean the food here is pretty good.” I presumed

he referred to the food in the Spit, with which opinion some would have disagreed. In the event, he did fail, but did not return to repeat the course. I presumed he had decided that discretion was the better part of valour, and had taken up his place at Oxford. Perhaps the food was even better there. The occasional former perennial student was still in evidence, one of whom was reminiscent of John Ormsby-Gore proﬁled by Dr. Lathan. He was a general practitioner in

William Babington, still cramming away...

Photo Courtesy of Charlie Ding 20

GKT Gazette

Mar - Feb 2014

south London who seemed to divide most of his time between coaching the Guy’s Hospital Boat Club 1st VIII and acting as the doctor to the Oxford University Boat Race crew. He was from a wealthy family (in the retail business) and so how much actual medicine he practiced was uncertain. He was a great character, and his stories of his medical student days were always highly entertaining. He had ‘studied’ at Guy’s for no fewer than 12 years (including one where he transferred to Bart’s for a year) before he qualified. As WWII interrupted his ‘studies’, he patriotically commendably volunteered for the Army and was put in charge of an antiaircraft gun in a London suburban park. He was given strict instructions not to fire the gun if the enemy aircraft were below a certain altitude. One night, however, the enticement proved too strong. He simply could not resist firing at a particularly low-flying bomber, as a result of which he blew up a local school. He was ignominiously sent back to Guy’s to complete his ‘studies’, which he eventually did. These were obviously students of a different breed and from a different era; all were colourful characters who added to the

quality of life of those who mixed with them but who, though perhaps having a more serious approach to medicine, assuredly had a more mundane and duller approach to life. I recommend to you the reminiscences of Dr. Lathan’s stay in London in 1961 as a visiting American medical student (Baylor University Medical Center Proceedings 2013;26:4256). (I have taken the liberty of making some very minor modiﬁcations and abbreviations to his original article.) An unforgettable, perpetual medical student, 1961 by S. Robert Lathan In the spring of 1961, during my sophomore year of medical school at Johns Hopkins, I had an elective quarter at Guy’s Hospital in London along with my roommate, Larry Kirkland. Shortly before that, I had encountered an old friend of mine at Davidson College, Don Stewart (now a neurosurgeon), who explained that he had spent a wonderful year at London at St. Thomas’s Hospital. Don suggested that in London I should immediately contact John Ormsby-Gore at the “St. Thomas’s Club.” I found that the St. Thomas’s Club

was a club for medical students that had a bar and was across from the hospital. After a few weeks in London, I decided to call John; it was fairly late, around 9:30 p.m. He talked to me shortly on the phone, asked about my location, and immediately said, “I will send a taxi to you soon.” About 30 minutes later, I found John at the St. Thomas’s Club enthralling several medical students with continual stories. John was also a medical student, but seemed somewhat older, in his mid30s. He was an excellent host, oﬀering several beers (English “pints of bitter”). The time of midnight came shortly, and I was invited to go to an Indian restaurant with the group. They explained their custom: “We English never have dinner before midnight.” I discovered that John Ormsby-Gore had been a medical student at St. Thomas’s for a long time— perhaps as long as 15 years—after serving in World War II as a military oﬃcer. John’s father was a “lord,” a former member of Parliament, and an authority on archeology. John’s brother was the ambassador to the United States and a close friend of President John F. Kennedy.

John had also met “JFK”, but was not really in the “same circle” and called himself the black sheep of his family. When I asked John about his medical school activities, he talked about spending almost every night at the St. Thomas’s Club and serving as manager of the St. Thomas’s rugby and cricket squads. He did not talk much about his experiences in his medical school courses and clinical work. When I asked about his plans for finishing medical school and the required “qualification tests,” he said: “Oh, I’ve considered the qualifications, but it’s very tough and takes about 6 months’ work before the test, and every time I seem to think about the test, it’s at the same time as Royal Ascot, to which I always go.” John Ormsby-Gore was always hospitable to me during my several weeks in London. He was an encyclopedia of all the important events in London and also suggested the best travel places in England, Scotland, and Wales. I recalled a special Saturday in mid-June with John showing me and Larry the “Trooping the Colours” annual parade in which the Queen’s personal troops honor her official birthday.

Mar - Apr 2014

GKT Gazette

FEATURES

GKT Gazette

My roommate, Dr. Larry Kirkland, and I still remember our kind,

Mar - Feb 2014

Perhaps some of the readers of the GKT Gazette can throw light on the subsequent career – medical or otherwise – of John Ormsby-Gore, or perhaps Dr. Squires or one of his contemporaries can provide reminiscences of that era at St. Thomas’s. Address for correspondence: David K.C. Cooper Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Starzl Biomedical Science Tower, W1543 200 Lothrop Street, Pittsburgh, PA 15261, USA Tel: 412-383-6961 Fax: 412-624-1172 cooperdk@upmc.edu

CLINICAL ANAESTHESIA

CLINICAL BIOCHEMISTRY

ELDERLY CARE MEDICINE

EMERGENCY MEDICINE

Lecture Notes

Carl Gwinnutt Matthew Gwinnutt 4th Edition

Simon Walker Geoffrey Beckett Peter Rae Peter Ashby 9th Edition

Claire G. Nicholl K. Jane Wilson 8th Edition

Chris Moulton David Yates 4th Edition

with extended material online'

EPIDEMIOLOGY, EVIDENCE-BASED MEDICINE AND PUBLIC HEALTH

HAEMATOLOGY

MEDICAL MICROBIOLOGY AND INFECTION

OPHTHALMOLOGY

Lecture Notes

Yoav Ben-Shlomo Sara T. Brookes Matthew Hickman 6th Edition

Chris S. R. Hatton Nevin C. Hughes-Jones Deborah Hay David Keeling 9th Edition

Tom Elliott Anna Casey Peter Lambert Jonathan Sandoe 5th Edition

Bruce James Anthony Bron 11th Edition

CLINICAL BIOCHEMISTRY

TROPICAL MEDICINE

PSYCHIATRY

Lecture Notes

11th Edition

Simon Walker Geoffrey Beckett Peter Rae Peter Ashby 9th Edition

Nick Beeching Geoff Gill 7th Edition

Gautam Gulati Mary-Ellen Lynall Kate Saunders 11th Edition

Lecture Notes

DISEASES OF THE EAR, NOSE AND THROAT

Ray Clarke

CLINICAL PHARMACOLOGY AND THERAPEUTICS

Gerard A. McKay Matthew R. Walters 9th Edition

PAEDIATRICS Lecture Notes

Simon J. Newell Jonathan C. Darling 9th Edition

with extended material online'

and i st

with extended material online'

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.

www.lecturenoteseries.com

Mar - Apr 2014

GKT Gazette

14 - 6 2 4 3 3

In the past few years, I have read of several OrmsbyGore family celebrities and also tragedies and accidents. Of David’s five children, one son died of gunshot wounds, an apparent suicide, and one daughter died of a heroin overdose. Lady Harlech died in a car accident in 1967, and Lord Harlech died in a car crash near his home in 1985. However, I have been able to find very little about my good friend John Ormsby-Gore. Internet sources provided only four lines about him recently: “Capt. The Hon. John Julian Stafford Ormsby-Gore, late of the Coldstream Guards, and educated from Eton College and Oxford University, who died on 18 April, 2008, after a short illness, age 83, a son of the 4th Baron Harlech.” Unfortunately, there was no information concerning his medical experience at St. Thomas’s Hospital Medical School.

hospitable English medical friends. We especially remember Dr. Dick Squires, who was also in medical school at St. Thomas’s and invited us to spend a weekend with him in his home in Wantage, Oxfordshire, only a few feet away from the statue of King Alfred the Great (871-899). I have had the fortune of visiting Dr. Dick Squires two other times and most recently saw his restored Lains Barn dating in part from 1750, which is now used for community and educational functions. Dick is now a member of the Order of the British Empire

ge ma s

John Ormsby-Gore (18161876) was the ﬁrst Baron Harlech and was a British Conservative member of Parliament. He was elected to the House of Commons for Caernarvonshire in 1837. William OrmsbyGore (1885-1964), the fourth Baron Harlech, was the father of our friend, John Ormsby-Gore. He was also a Conservative member of Parliament. David Ormsby-Gore (19181985) was the ﬁfth Baron Harlech and a British diplomat and Conservative member of Parliament from Oswestry in Shropshire. He was John’s older brother and had been educated at Eton College and Oxford University. David knew John F. Kennedy well from Kennedy’s time in London while his father, Joseph P. Kennedy, had served as the American ambassador. After Kennedy’s election as president, David

was appointed British ambassador to the United States from 1961 to 1965. In 1965 he took his seat in the House of Lords as Lord Harlech. He also had a successful career as a television executive.

self-te

Not many tourists could find this unique event. More than 40 years after my wonderful 10-week stay in London, I continued to try to find what had happened to John Ormsby-Gore. I contacted St. Thomas’s to find his address, without success. Finally, I decided to use the internet and found very unusual facts about the Ormsby-Gore family.

FEATURES

training. Thanks from the House Committee must go to Steph Hollis-Smith who managed to put her Christmas Show training to good use and coordinate things so eﬀectively. All talent shows require an Andrew LloydWebber hit (here we had Wishing You Were Here from Phantom of the Opera) and a garage band with an excessive number of amps but they don’t all get a fully grown man singing in a Gollum voice- their loss. Without doubt the strangest performance was given by Lister House’s Hamilton Morrin. He sung his own version of ‘Wrecking Ball’ with a few lyric alterations- “I came in like a mountain troll” being a particular favourite, and all in the voice of Gollum.

GKT’s Got Talent Photographs courtesy of Charlie Ding

The illusions from Mohamad Zeina of Lister House left the audience speechless. His tricks required perfect timing and even had the added danger of audience participation. Despite this Mo pulled oﬀ a won-

derful performance of incredible complexity and deservedly took 2nd place. With so many singers and guitar players it was no surprise the winners were of this ilk but they were the stand out group. Anna Kessler, Sherry Walker and Vignesh Dhileepan also known as TARP, from Saunders House, sung a ‘Stand by Me’ medley, no small task with one member of the group suﬀering from laryngitis. Overall GKT’s Got Talent was a huge success and thoroughly enjoyed by all who attended and the House team should be congratulated for such a smoothly run show. We may have started the evening with the question: has GKT got talent?- by the end of the evening we were left in no doubt. Dubious at points and outright bizarre in places but GKT most deﬁnitely has talent.

Fi Kirkham MBBS2

he lights go down (only 45 minutes late) and the audience hurry to take their seats. Greenwood Theatre is hushed with the anticipation of a night of peculiar ‘talents’ and hugely comic mishaps- this can only be GKT’s Got Talent. With their usual comic genius, Alex Warren and Sujan Sivabramaniyam opened the show with the question: has GKT got talent? Over the next two hours we would be subjected to an onslaught of guitar playing singers and bizarre party pieces that may or may not have deserved a more public appearance. Inevitably the stars of the show were the judges: Despo Papachristodoulou, Jeremy Ward,

GKT Gazette

Mar - Feb 2014

Stuart Knight and John Philpott-Howard. Their witty asides and backhanded compliments would put Simon Cowell to shame. As always there were some standout performances and in the case of this show, it would be the backstage crew who spent more combined time on the stage than any single act. Chair moving and microphone rearranging was performed with such dedication it drew cheers from the audience long before the interval. Despite the regularity of their appearances they ran the show to perfection; no act was left without a microphone and with minimal fuss the complexities of a full performance were managed with almost no

Mar - Apr 2014

GKT Gazette

New Music

Spring-Summer Soundtrack Rolake Segun-Ojo MBBS4

With the novelty of 2014 quickly fading, there’s all the more reason to soundtrack your life with new and exciting music. The quick ﬁx for monotony: fresh tunes. Broods

Moko

As far as family ties go in the music business, Caleb and Georgia Nott’s are career deﬁning. The name Broods touches on both their brother and sister relationship and their often forlorn lyricism which speak of personal experience. Despite their sombre inspirations, the New Zealander duo combine disarmingly clear vocals with immersive synth to make for a surprisingly heady experience of heartbreak. Broods have already made a big impression with their single “Bridges”, listen to this track and more on their self titled EP out now.

With her powerful gospel-inspired vocals and 90’s house sensibilities have earning her comparisons to Massive attack and Portishead, it’s no wonder that Chase and Status were keen to have the New Cross singer feature on their high charting single, “Count on Me”. Although Moko’s unique name and style adds to the growing intrigue surrounding her, her single “Freeze” shows her greatest appeal is in her striking vocal talent. There’s more on the horizon for Moko, but ﬁrst check out her EP Black.

GKT Gazette

Mar - Feb 2014

Alva Leigh

Elle King

Hailing from Nashville, you might expect to hear the well-worn back story of a singersongwriter waitressing to make ends meet until a break came along. Ironically, Leigh only chose to take up a full time music career after she left Music City for London Town. Describing herself as a cross between Regina Spektor and Rilo Kiley, she’s clear on her musical identity and preferences; ‘a big strong vocal, a pretty melody, a pulsing rhythm and introspective lyrics’ are all evident in her new release ‘Modern Love Song’. Recently featuring on Grey’s Anatomy with ‘Calling Me’, Leigh’s melancholic folk pop is making transatlantic waves. Look out for release of her new album later this year.

A show business pedigree can often eclipse a chance in the limelight, but Elle King is stepping out of the shadow of her actorcomedian father, Rob Schneider, and heading in an altogether different direction. That’s not to say she’s without a sense of humour; whilst her raspy vocals may be best suited to soulful blues, her ironic tendencies allow her to do an unexpected cover of Khia’s “My Neck, My Back”. With a wide range of influences from Etta James to AC/ DC, she has found friends in Grammy Award winners and fellow music enthusiasts Mark Ronson and Jeff Bhasker. Her regularly tweeted updates on their progress in the studio foretell of good things to come. In the meantime, listen to already released tracks “Good To Be A Man,” and “Playing for Keeps”

Mar - Apr 2014

GKT Gazette

ARTS & CULTURE

Bridging the Gap Between Science and the Public

Christina Georgallou BSc Physiology 2013

any health issues facing society here and around the globe, demand considerable public investment to reverse. With any issue however, wide-ranging understanding, interest, and approval, are fundamental in determining community support. That being said, reports collating research into science communication activities and public attitudes toward science, have indicated a startlingly high percentage of the population who demonstrate a concern about what might go on ‘behind closed doors’ in research institutions. This is further compounded by miscommunications between science and its coverage in the media. It is therefore clear that with the demand for funding in all areas of health research ever growing, the need for

better public understanding through more accessible mediums of communication are indispensable. Scientists have long struggled to communicate their research to the general public, often ﬁnding that their academic arenas of professional practice do not encourage direct public engagement. ‘Public understanding of science’ in the UK has existed since the mid-1980s, following a report published by the Royal Society which problematised the public’s knowledge of science. This gave rise to a variety of science communication activities aimed at improving people’s science literacy. Following the politically damaging bovine spongiform encephalopathy (BSE)

crisis, another important report was published. This report by the House of Lords Select Committee on Science and Technology suggested that science needed to establish a new relationship with society. In the past decade ‘public engagement with science’ has emerged as a field in its own right. It describes the myriad of ways in which the activity and benefits of higher education and research can be shared with the public. Central to the concept of public engagement is the notion of open dialogue and multi-directional interactions between research scientist, policymakers and the broader public. The role of the visual and performing arts is often overlooked in this regard, yet the arts have long communicated issues, influenced and educated people, and challenged dominant paradigms. Throughout history artists have produced artworks that have attempted to jolt their Left: detail from Kafukufuku Woman by Elson Kambalu, photo: Wellcome Collection Opposite: detail from Fossil Necklace by Katie Paterson, photo: MJC, courtesy of artist

GKT Gazette

Mar - Feb 2014

communities out of complacency, articulate concerns about social justice, deﬁne and summarise debate, and provide enduring images that continue to inspire people down through the ages. Despite acknowledging the potential of the arts in communicating science, few scientists have merged science with the arts. There is, therefore, considerable scope to grow this area of endeavor and, potentially, have a huge impact on public attitudes. Notable strides toward this greater understanding have been demonstrated by the Wellcome Trust, most recently ‘Foreign Bodies, Common Ground’, an exhibition at the Wellcome Collection. This made public the work of six artists during their residencies in six Wellcome Trust-funded research centres around the world. Artists spent at least 6 months exploring the activity of researchers based in Kenya, Malaysia, South Africa, Vietnam and the United Kingdom and produced new work

in response to their experiences. During their encounters in the realms of medical science, the artists were outsiders or foreigners bringing a diﬀerent set of aims or objectives to those of the researchers they met. This is comparable to the majority of medical researchers, who are often foreigners in relation to the communities they work with. Alongside the aim of teasing out some of the more personal, philosophical, cultural and political dimensions of health research these artistic investigations highlighted the complexities of cross-cultural exchange, while also reminding us of our common ground and humanity. Elson Kambalu, an artist based in Lilongwe, the capital of Malawi demonstrated his fascination in the cultural complexities between research teams and the communities they serve. He invited a broad spectrum of people from both urban and

rural backgrounds to create work inspired by their understandings and experiences of health studies. These projects allowed participants to express and discuss their views regarding research using the traditional technique of earth painting. In this way participatory work focused on listening and sharing can potentially assist with the delineation of science research amongst the communities that encircle it. Science is progressing at an outstanding rate. The rate-limiting factor here however, is the dubious support from the majority isolated by the baffling world of science research. The use of the arts to convey complex scientific information, promote new ways of looking at issues, connect with people emotionally and create a celebratory atmosphere may indeed be an effective way to win the support of the lay audience worldwide in the pursuit to reverse global health issues.

On a related note, in 2016 Science Gallery London will open in the building on St Thomas’ Street currently used by Macdonald’s as part of an initiative using art to attempt to engage the public with research at Guy’s Campus. Watch this space! Mar - Apr 2014

GKT Gazette

ARTS & CULTURE

Keats’ Corner Our featured poet this issue is Ian Allan. Ian fell ill with Guillain-Barre Syndrome ﬁve years ago and was a patient at both King’s College and St Thomas’ Hospitals during the acute stages of his illness. He spent exactly one year in hospital, since which he has relied on a wheelchair for mobility. After becoming aware of Ian’s poetic talents, we were happy to publish his work and oﬀer him a platform to vent his frustration at the government’s recent handling of welfare payments to disabled people. If you would like your work to feature in Keats’ corner, please email it to editor@gktgazette.org.uk, or use our website’s submission form which allows anonymity or the use of a pseudonym if preferred.

The Iain Duncan Smith Lament

The Amchi Project 2013

Ian M Allan Dear British Government You’re really having a laugh Reducing all me benefits By nearly half. You clobbered me for bedroom tax You’ve taken away my pride I cannot afford to go outdoors So now I stay inside. I’m not a benefit cheat or a scrounger It really makes me balk To be so persecuted Just because I cannot walk. You allow multi-national companies To evade paying their fair share of tax You may not wish to hear it But these are the simple facts. The rich are getting richer The Government is unforgiving The disabled are really struggling With the cost of living. Blatant tax evasion by Starbucks By Google and Amazon It’s not surprising that the disabled Are feeling that they are being shat upon. 30

GKT Gazette

Mar - Feb 2014

Photograph courtesy of Olivia Johnson King

It is no exaggeration To say that the whole situation is a mess With a display of such incompetence Perpetrated by IDS Millions of pounds they’ve wasted Gross ineptitude they’ve shown Now targeting the weakest in society No wonder people moan I never thought a British Government Would ever stoop this low Causing despair and suicide And rejoicing with each blow Disability Discrimination, it certainly is But some are too blind to see They’ve even been backed in a Court of Law So much for the British Judiciary. One day we’ll have a foreign invasion On a scale that knows no bounds With their armies rescuing the disabled On humanitarian grounds. One day this will be in history books So future generations can see The most shameful treatment of the disabled In British History. © Ian M Allen 2014

Olivia Johnson King Intercalated BSc (Regenerative Medicine & Innovation Technology)

n 31st July 2013 I eagerly left the UK to spend three weeks on a dental outreach project in Ladakh, India. Ladakh is one of the most sparsely populated regions of India with just four qualiﬁed dentists to treat 180,000 inhabitants. The Amchi (Buddhist nuns) are relied upon heavily to provide healthcare to the communities. This project started in 2012 in collaboration with the European Dental Students’ Association (EDSA), Wisdomtooth and Manipal University. The aim was to teach the Amchi about oral healthcare and train them as local medical care providers so they could in turn educate the community about their dental hygiene. This summer the project brought together a multinational team of doctors, dentists, dental students from Europe and interns from Manipal University in India. During the vis-

it, our team travelled to some of the remotest areas in the Himalayas and set up dental camps in schools and hospitals where people of all ages were taught about oral health care. At times, the sheer altitude of the region (5000m) and challenging terrain made it diﬃcult for the team and the residents trying to reach the hospitals for treatment. Despite these diﬃculties, over 1500 people were screened for medical and dental problems and received care from the team. Thanks to the project’s sponsors all these people were provided with the medication they needed and a supply of toothbrushes and toothpaste. The residents were very appreciative of the work we did and we hope to return in 2014 to continue this worthwhile cause.

Mar - Apr 2014

GKT Gazette

DENTAL

Photograph courtesy of Charlie Ding

Life as a Graduate Entry Dentistry Applicant

Vignesh Mohan

or all the hundreds of excited undergraduates starting their ﬁve year BDS course every year, there are always those unfortunate A-level students who were unable to gain a place at dental school. For the latter set of students who remain keen on pursuing dentistry, they are left with two options: either resit your A-levels and reapply to study dentistry the following year, or pick a Biomedical-related degree and apply for graduate entry dentistry three or four years down the line. Due to the reluctance of dental schools to accept resit candidates, most of the unsuccessful applicants who still plan on pursuing dentistry choose the option of studying a Bio32

GKT Gazette

Mar - Feb 2014

medical-related degree. One problem I faced was that due to my single minded determination to study dentistry, I somewhat naively didn’t have a backup career prospect in mind and simply chose to study three science subjects for my A-levels, somewhat limiting which degrees I could study at university. So I ventured down the historically well-trodden path of studying Biomedical Sciences, with the hope of getting into graduate entry dentistry upon the completion of my degree. Everyone has diﬀerent experiences on their time as a graduate entry dentistry applicant. For me, it was not an experience I enjoyed. You’ve spent your teenage years dreaming about going to university to study dentist-

ry and about life as a dentist. You visualised how much you would enjoy university, looking forward to attending lectures and the patient contact. The thought of spending the next ﬁve years of your life with students who all share your passion for dentistry excites you. However, in my endless teenage daydreams about my future, I never accounted for the fact that I wouldn’t get the grades for dentistry and would instead study Biomedical Sciences for three years.

tude Test. Along with previous qualiﬁcations and exam results, some UK dental schools use your UKCAT score to decide whether you make the grade for the interview - talk about pressure for one exam! You are torn whether it’s worth going to UKCAT courses and how early you should start studying for it. You then have to work on your personal statement, trying to squeeze every bit of your application and work experience into the annoyingly restrictive word count!

Don’t get me wrong - Biomedical Sciences is perfectly good degree. However, it wasn’t nearly as stimulating to me as I would have liked. There was just a single module related to human anatomy for the entire duration of my degree. Instead, I became trapped in a seemingly endless cycle of gene therapy and Western Blot analysis. Meanwhile, my school friends were living my dream of being a dental student. But I realised that in life you get what you deserve - I would need to work as hard as I could over the next three years, trying to gain a 1st class degree prediction whilst obtaining as much dental work experience as I could. Fast forward two years and so far so good. In my ﬁnal year of my degree, I have been predicted a 1st class classiﬁcation. Next comes the UKCAT, the UK Clinical Apti-

Choosing which dental school to apply for is much more straightforward than the application itself, as only a handful of universities in the UK offer graduate entry dentistry. King’s is the standout option and you hope and pray that they accept you. Once you send off your application, you become accustomed to checking the UCAS (Universities and Colleges Admission Service) website and your email every day, getting a mini-heart attack every time you receive an email from UCAS, only to find out that it’s a monthly newsletter. The wait is endless and you spend so much time thinking about your application that one begins to daydream about life as a dental student again…

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NURSING & MIDWIFERY

Benching the Myths About Steroid Use Em Johnson PGDip Nursing 1st Year

The use of steroids within professional sports is banned but within recreational body building their use has become prolific. The 90’s penchant for skinny boys has been muscled away by the desire for a bulked up form and we are asking ‘Do you even lift, bro?” and the answer is probably “Yes”. However, weight training alone does not achieve the body desired and those wishing to attain a dedicated body with a part-time approach have found steroids very easy to access. Health professionals are now seeing a rise in health problems which can be directly linked to steroid use with relatively few aware of how to effectively treat steroid abuse and dependency. Steroids naturally occur within the human body, the steroids being abused are synthetic versions of the naturally-occurring male sex hormone testosterone. Testosterone has both an anabolic and androgenic effect on the body; meaning it both encourages muscle building and works to enhance typical masculine features. 34

GKT Gazette

Mar - Feb 2014

Illustration by Sharmin Malekout

s the world says farewell to Sochi and the Winter Olympics and looks forward to Rio 2016; we are reminded of the sheer magniﬁcence of the human body. The physical feats achieved by those at the top of their game have motivated many to take up sport to improve their own ﬁtness. However, for some, the pursuit of physical improvement can become a deadly one.

Unlike other abused substances, those using anabolic steroids tend to be very knowledgeable in their use. In addition steroid users are mainly employed persons in well paid jobs who are concerned about their physical appearance. Their anabolic steroid use supports a conventional fitness regime. This combination of education, economy and a fear of legal repercussions mean that those using steroids will not access treatment for harm relating to steroid use until they become very unwell. Legally steroid use is banned and classified under the Misuse of Drugs Act as a Class C drug, placing it in the same class as ketamine and illicit valium. The penalties for possession are up to two years in prison with an unlimited fine and, although prosecutions of this severity are rare, the threat of a criminal record can be a real barrier to accessing support.

Those abusing steroids may present with sexual dysfunction, acne, thrombosis, high cholesterol, injuries sustained through poor injecting practice and, in some cases, experience of mental illness including psychotic episode. Typically injection technique will be learnt from other users or via internet tutorials. Without specialist training users risk injecting at the wrong depth, hitting nerves and causing painful abscesses. The use of steroids has been linked to serious heart disease, caused by the secondary action of the steroid hormone on lipids within the body. This may lead to high cholesterol and liver damage including non-alcoholic fatty liver disease. Although users look at the peak of physical fitness they may actually be laying the foundations for diseases and damage normally associated with a sedentary and gluttonous life style. I was fortunate to spend some time with Smart Muscle, a specialist treatment service for those using steroids. The clinic is staffed by experienced drug workers who have knowledge of steroids and are able to make appropriate referrals. Smart Muscle is a unique service based in Soho’s Chinatown and serves any steroid user who walks through their door. The aim of the centre is to provide those using steroids (or just considering to start using) up to date information on how to use safety, diet advice, exercise programmes, safer-injecting technique, clean needles and counselling. The focus is not necessarily on dissuading users from taking steroids as often they have already made up their minds, but to ensure safe and effective use. Steroid use comes with its own lexicon and with a very informed service user group, for generic substance misuse professionals this may seem an intimidating client group. Smart Muscle also works with other healthcare professionals to share their knowledge and experience, enabling the early recogni-

tion of signs of steroid abuse and those who may be at risk. “Many of the guys who find us think they know a lot but, sometimes after a counselling session they realise they can get the results they want without steroids and that the risk of harm isn’t worth it. Other people just come for clean needles” – Smart Muscle Worker Typically a cyclical regime known as stacking is adopted. Greater gains are the aim of the simultaneous use of different steroids along with a drug-free period. However, there is no evidence behind this practice and the reality of not making the desired gain leads people to simply use more steroids a second time. Smart Muscle educate users on how to get the most of a cycle so they reduce the number of cycles a person may use which decreases the overall risk of harm. Steroid users I spoke to identified changes in their testicles and the uncontrollable aggression coined as ‘roid rage’ as their concerns. Many users had not considered the longer-term health implications or how steroids worked within their bodies. The Smart Muscle Service is unique. I would recommend any professional concerned about steroid misuse to contact them for more information. A health professional meeting a visibly fit person with a high cholesterol level, severe acne, and recurrent infections may wish to consider steroid abuse as a factor. The service is free and confidential and for anyone using or thinking of using anabolic androgenic steroids and other bodybuilding drugs. They offer a free needle exchange service and advice on safer injecting as well as advice on training, diet, healthy lifestyle and supplements.

Mar - Apr 2014

GKT Gazette

NURSING & MIDWIFERY

life on the coalface have historically been unwittingly responsible for nurse recruitment; they must be held culpable for unsafe levels of staﬃng and the impact this has on patient outcomes. Paradoxically, when the standard of care falls below the exemplary it mostly is, the nursing profession bears the brunt of criticism.

Georgina Day Adult Nursing 3rd Year

n stark contrast to the axing and downgrading of thousands of nursing posts, many trusts in central London are actively recruiting nurses from overseas to protect patients from the harm caused by poor staffing levels. In a market as predictable as ill-health and the perennial need for trained nurses, it is indefensible for this habit of ‘boom and bust’ workforce planning to endure. The adverse impact of poor staffing on patients is plain to see – both anecdotally and from the many reports on poor nursing care arising in the aftermath of the Francis inquiry. Despite long-standing recognition of the importance of safe staffing levels, there is an inadequate supply of nurses. This is a worsening problem; with the national move to a degree-only programme able to offer fewer training posts coupled with high levels of natural attrition, resulting in a net reduction

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in the nursing workforce. Yet, with an ageing hospital population of increasingly unwell patients, the demand for nurses has never been greater. Jane Ball, Deputy Director of the National Nursing Research Unit based at King’s, reported that 87% of nurses are regularly forced to leave essential care tasks undone because of a lack of time. One might expect this to become more apparent with the emergence of new and increasingly intensive medical technologies demanding a capable and adequate nursing workforce. With greater expectations on nurses to fulﬁl an extended medical role one can only anticipate criticism to grow. In recent years there has been little incentive for hospital management to increase nursing posts, as they struggle to meet targets under the severe ﬁnancial restraints of the day. Managers with little understanding of

Photograph courtesy of Charlie Ding

Stand Up and Be Counted

A study contributed to by nursing researchers at King’s, provides evidence that patient care is compromised when nurses care for more than eight patients per shift; with increased mortality rates arising from neglected care tasks, failure to rescue patients from adverse events, medication errors and cross infection. Even at a ratio of 1:8 many studies have observed practice to be unsafe and so this is recommended as an absolute limit to guide service delivery, but one would argue that this is still unacceptable if nurses are to deliver safe, dignified and compassionate care. To any student starting out in practice, one is struck by the need for nurses to routinely work overtime and through their lunch breaks in an effort to meet the needs of their patients. Despite this, nurses feel they are unable to consistently deliver the level of care they would like for patients. This constant feeling of ‘not doing enough’ is psychologically destructive, with the nursing workforce experiencing unprecedented levels of stress-related absence and burn-out. This serves to perpetuate a ‘vicious circle’ where the best people either do not enter the profession, or leave it prematurely. Building on the success of campaigns in Australia and California, the Safe Staffing Alliance and its tagline of ‘never more than eight’ (patients to one registered nurse) is gaining increased support. They call for ward managers, answerable to the Trust Board, to be empowered to make decisions on staffing and resource levels dependent on individual levels of patient acuity and dependency. In

the UK, 43% of shifts exhibit poor staffing levels both in terms of the number and skill level of the nurses on duty. Under these circumstances care and safety are compromised and patients are put at risk; this must be escalated so that calls for change may be heard. More radical still is the 4:1 campaign, which was established in 2013 by a group of nurses and has already rallied the support of 21,000 people signing an online petition. The aim of 4:1 is to galvanise NHS staff and the general public through social media campaigning to put pressure on the Government to implement mandatory minimum staffing levels. Their recommendations have been endorsed by nursing union strategy reports post-Francis. Despite overseas evidence that establishing a legal duty for safe nurse staffing improves patient outcomes, Jeremy Hunt, Secretary of State for Health, remains reluctant to apply this to the UK. Current Government policy is to leave decisions on staffing to the individual trusts whilst monitoring them via monthly published reports on staffing. From August 2014, NICE will publish department-specific guidelines. However, there are concerns that the proposed guidance lacks the clout to trigger change and that the issue requires further consideration by the Department of Health. The indefatigable nurse Jenny Lee’s rousing statement of ‘I need to care, I can’t ration it or turn it into an efficiency, that will never be my way’ stirred something in all of who tune in to Call the Midwife. Despite considering myself a caring student nurse, I cannot help but fear that I’m already letting Jenny down. Our modern day training tells us of the pressures of acute hospital care and we are continually assessed in terms of efficient delivery. Whether ‘care’ or ‘efficiency’ proves to be the watchword when we are faced with our first shifts as registered nurses – and responsible for eight acutely unwell patients - is yet to be seen. Mar - Apr 2014

GKT Gazette

BOOK REVIEWS

Book Reviews If you would like to write a review, please contact editor@gktgazette.org.uk and we will order in a review copy for you. Reviewers this issue: Lewis Moore, Zahra Jaffry, Anya Suppermpool, Simon Cleary, Samuel Evbuomwan, Hew Torrance, and Rebecca Trenear. Oxford Assess and Progress: Clinical Specialties This pocket-sized text is a self-assessment tool to accompany the Oxford Handbook of Clinical Specialties (OHCS); it provides a range of questions across the clinical specialties encountered at medical school and beyond. The book contains hundreds of Single Best Answers and 50 Extended Matching Questions on the different topics covered in OHCS. The content of this text overlaps mostly with the fourth year curriculum, but also covers psychiatry and ophthalmology from third year and general practice from year five I found this book to be a useful revision aid for those rotations which I had already completed, highlighting areas which I know well and others that require room for improvement. The chapters have sufficient explanation to support the choice of answer, with signposting for the reader to seek a deeper understanding if they see fit. This is a useful and enjoyable text, small enough to carry in a back pocket. I will be using it enthusiastically when exams inevitably creep up on me this year. LM Operative Orthopaedics: The Stanmore Guide This is the first edition of a book that largely serves as a revision tool for trainees about to sit the FRCS (Tr & Orth) but may also be used by anyone requiring an overview of common elective orthopaedic procedures. Each chapter is written by a consultant and a trainee, a combination that unites the knowledge and experience of a teacher with the needs of the student, this expands its appeal to a wider audience. The line drawings and outlines of structures at risk, for instance, are brilliant for conceptualisation and understanding but the reader is limited in applying it to patients due to very few photographs and x-rays. The worth of this text lies in giving a comprehensive overview before observing or performing a surgery or going into an exam. The viva questions at the end of each chapter are especially useful in this respect, providing a realistic test of facts acquired from the text, specifically designed for anyone preparing for surgical exams. ZJ

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Mar - Feb 2014

Me, Myself, and Why Who am I? Am I the printout of my whole genomic sequence? Am I where I fall in the Myers-Briggs Type Indicator assessment? Or rather my brain scan? Jennifer Ouellete, an orphan, sets out an unconventional journey to find her true ‘self’ through genetics, neuroscience, psychology, and philosophy. Ouellete, like Mary Roach, lays down scientific constructs in a witty and humorous yet straightforward and friendly approach. Within each topic Ouellete tackles, she doesn’t explore it to its full potential. Moreover, the whole book oddly fails to develop an overall argument and lacks a strong conclusion. Nonetheless, Ouellette admirably and piquantly captures the self in various perspectives. Recommended for anyone who wants an introduction to “the science of self” and to be entertained as well! AS Biology Under the Influence In 31 essays, Lewontin and Levins critique prevailing attitudes in the biological sciences from a radical leftist standpoint. Highlights include The Dream of the Human Genome, an outcry against the fetishisation of genes written as excitement around the Human Genome Project was reaching fever pitch, and Genes, Environment, and Organisms, in which Lewontin soothes biologists suffering from Physics Envy by explaining why their science is more than Chemistry and Physics applied to life. For those with an interest in public health that are prepared to ‘take the red pill’, The Return of Old Diseases and the Appearance of New Ones, Is Capitalism a Disease?: The Crisis in US Public Health and How Cuba Is Going Ecological are also insightful, although some may find the ideology and academic style of writing off-putting. SC Crash course in general medicine For many years the Crash course series has provided concise and easily digestible textbooks for students. In its fourth edition, the crash course in general medicine continues to follow this ethos. To its benefit this book presents up-to-date clinical knowledge in a clear and simple format, this is useful for gaining a good understanding of the basic concepts and allows essential time saving during revision. The initial chapters focus on the structure and importance of taking a comprehensive medical history and key signs to elicit on medical examination. The highlight of this text is the many practice exam questions based on the different topics. Set in the familiar Single best and Extended matching format. Even though the crash guide for general medicine is designed for summarising key knowledge and quick absorption, it works just as well as a blueprint to build you clinical learning on. SE Mar - Apr 2014

GKT Gazette

BOOK REVIEWS

The Cambridge Illustrated History of Surgery Author: Prof Harold Ellis CBE, FRCS RRP: £45 ISBN: 0521720338 This book, now in its second edition, aims to deliver a single volume introduction to surgical history, intended not only for the medically trained but also the interested lay individual. Written with Professor Ellis’ usual engaging style and wit, this charts in detail the evolution of surgery from its primitive beginning, through Ancient Greece and Rome, the Renaissance, taking in the birth of anatomy and the discovery of anaesthesia and antisepsis, which then signified the advent of modern surgery. Each chapter is richly illustrated with images of the principle surgeons, well-researched anatomical drawings and specimens. Within each chapter there are short excerpts from the diaries of main protagonists, the most compelling being Astley Cooper’s description of the management of an iliac aneurysm of a former Guy’s Hospital porter. Pertinently, the book then dedicates a chapter on the impact that war has had on surgery, citing that ‘the only thing to benefit from war is surgery’. This is backed up with extraordinary examples of innovation and bravery displayed in both the first and second world wars, not only by the doctors, but also by the patients. With this topic in mind parallels can already be drawn with advancements in our trauma care and limb prosthesis from the recent middle-eastern conflicts. 40

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The book then goes on to focus on relevant sub-specialities. As a retired general surgeon Ellis has clearly focused on topics with which he is most familiar; there is however a separate chapter on orthopaedics. In these sub-specialist sections he often describes his surgical heroes, a great number of whom are illustrious alumni from Guy’s and St Thomas’. This unashamed author bias is part of the charm and his passion for justifying their place in history is one of the reasons this book is so readable. After reading this book, it is remarkable to reflect that Professor Ellis has trained, practised and taught during one of the most prolific periods of medical and surgical invention and advancement. This makes one wonder what practices, routinely carried out today, we will look back upon with disdain at the end of our careers. I whole-heartedly recommend this book to health professionals of all stages, particularly those interested in exploring the rich heritage of the three hospitals at which they train or work. This book should be the first port of call for those students wishing to know who Hunter, Kocher, McBurney, Paget and Scarpa and other luminaries of anatomy and surgery really were. Reviewer: Hew Torrance, Royal College of Surgeons (England) Research Fellow

Oxford Handbook of Clinical Medicine, 9th Edition Authors: Murray Longmore, Ian Wilkinson, Andrew Baldwin, Elizabeth Wallin RRP: £30 ISBN: 0199609624 I have a confession, dear reader. I have never read the Oxford Handbook of Clinical Medicine (OHCM). Of course I have trawled it looking for answers to my consultants’ ever ominous questions, attempted to memorise the pages on ECGs and blood test interpretation and laughed at the page on taking exotic infectious disease histories; we all fondly recall asking each other, “Do you sometimes wonder if your goat miscarried last year?” or, “Did you have a stray pig living under your house when the monsoon started?”. However I had never actually opened the book at the ﬁrst page and read for the sake of learning the art of medicine. This was most likely a grave mistake because the ﬁrst chapter of the ninth edition is an 18 page essay on what medicine actually means, and how doctors can and should practice it. For those of you who are way ahead of me on your textbook reading, this edition has more than doubled its initial thoughts on the holistic side of medicine, and this is a theme which runs through the entire book.

Of course there are the expected updates on pharmaco-management in all specialities, surgical techniques which might be offered to patients, and relevant research; it is still a fantastic quick reference guide to common medicine. However, there has been a “slow down” symbol introduced, to encourage the user to “pick up cues about what is really important”. A similar symbol has been adopted for drug treatments where the side effects may outweigh the benefits of doing nothing, such as prescribing penicillin for an untested sore throat, where a honey-lemon tea may be equally effective. It’s great to see the OHCM embracing such an openly patient-centred approach which encourages looking at the patient as a whole, rather than as a “fracture” or “heart attack”. I would highly recommend this book for all junior medics, both students and professionals, not only for the hilarious history taking suggestions. Reviewer: Rebecca Trenear, MBBS4 Mar - Apr 2014

GKT Gazette

HISTORY

Florence Nightingale was born in 1820 to an upper class English family; she was an unlikely nurse. In a time when hospitals were regarded as dens of iniquity and medical professionals were drunk on duty, nursing oﬀered a lifestyle far from her parents’ dreams of a good marriage. They introduced her to countless members of the English peerage in the hope she would make a good match yet she remained resolutely single. Nightingale’s father spoilt her and allowed her every whim; in particular he fostered a love of statistics and languages far beyond the range of most other girls’ education. Despite this devoted attention Nightingale suﬀered long periods of depression throughout her adolescence resulting in a feeling of worthlessness and confusion over the purpose of her life.

Florence Nightingale

Deeply unhappy, the seventeen year old Florence Nightingale had the ﬁrst of several episodes where she sensed God calling her

to do his work. At the time she was unsure what this work would be, but gradually she realised her purpose was nursing. Despite this new-found vocation, her desire to please her family meant she stayed silent for some years during which she developed a complex, imaginary world. She drifted in and out of reality, losing hours at a time to daydreams in which she would perform the heroic acts she felt were her destiny. Eventually, at the age of twenty ﬁve, Nightingale expressed her desire to become a nurse to her parents and sister. The responses ranged from hysteria in the case of her sister to total refusal from her father. Her childhood of always getting exactly what she asked for allowed her to remain resolute and six years later she began her training with the agreement of her family – on the understanding it remained a secret.

What lurks in the shadows cast by the lamp? Fi Kirkham MBBS2

erhaps the most famous British nurse, Florence Nightingale has become more legend than mere historical ﬁgure. Commonly known as the Lady of the Lamp, her story is one of great heroism where the actions of Nightingale and her nurses saved countless lives and resulted in reforms long overdue to decrease death rates from poor conditions.

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Mar - Apr 2014

Her practices became the basis for modern nursing techniques and she founded the world’s ﬁrst secular nursing school at St Thomas’ Hospital. Regarded as a ‘ministering angel’ by soldiers treated by her during the Crimean War, Nightingale was the sweetheart of the British press. Whilst she is rightly remembered for her great deeds, is there more to her story?

Mar - Apr 2014

GKT Gazette

HISTORY

In later years she refused to support the campaign for women to be allowed to pursue a career in medicine despite pleas from Elizabeth Blackwell, the first female to qualify as a doctor in the United States, who had initially encouraged a conflicted Nightingale to follow her dream of nursing. When they first met, Blackwell was already qualified having been desperate to escape the confines of life as a woman in British society. She helped Nightingale turn her dreams into a reality and Blackwell presumed that, eight years later, the favour would be returned. Blackwell had hoped to use Nightingale’s newly found celebrity status as the Lady of the Lamp to help inspire other women to fight for their place in the medical profession but Nightingale worked against the movement. Whilst she supported female nurses, she felt that doctors should remain male because the two jobs required very different traits stereotyped to each sex. Her stubbornness devastated Blackwell who had counted on her old friend’s support and in this way one of Nightingale’s only true friendships was irrevocably damaged. Florence Nightingale’s time in the Crimea showed her ability to organise almost to the extent of compulsion and the data she collected formed the basis of her reform suggestions, which revolutionised nursing. What is less well known is that she regularly alienated herself from the nurses she worked alongside, who found her cold and unsociable. This side of her personality could be seen in her youth where suitors would 44

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Mar - Apr 2014

remark on the radiance of her smile but upon conversation she could be distant and disinterested. Her relentless commitment to improve conditions could make her very unforgiving of others and complaints were made against her behaviour by her staﬀ, which Nightingale would claim were a result of jealousy. The money collected by the Nightingale fund in response to her work in the war would be used to establish the nursing school but by the time of its opening she had shunned society and conducted her various campaigns from the conﬁnes of her bedroom. While much of modern nursing owes its foundations to the tireless work of Florence Nightingale it should not be forgotten that she was very much human and not just the heroine of modern myth. The sense of never having achieved enough would remain with her until her death in 1910.

Guy’s At War: The Latter Days Compiled by Hannah Cliffe MBBS4 After the havoc visited upon Guy’s during the Blitz of 1941, the later years of WW2 were comparatively calm. The following Gazette excerpts showcase some of the practicalities of being a student at Guy’s during those years; from celebrating Christmas on the children’s ward to guarding key London sites against invasion; from growing vegetables in the Quad, to providing life-saving aid to survivors of Belsen Concentration Camp.

6th Februrary 1943 he evacuation of the wards was accomplished smoothly and, although it took longer than ideal, was a very credible performance by those on duty that night. The time was lengthened by the fact that the students were just starting a new appointment. The evacuation of the upper ﬂoors of Hunt’s House to the basements of the rest of the Hospital buildings does not, of course, make the patients any safer from

high explosive, but does enormously facilitate their protection in case of ﬁre. There are numerous ﬁre-escapes in the Hospital, and they were in use in 1940 – but the portage of patients down those escapes, especially under “blitz” conditions, is no easy task; even now our imagination reeled when we heard of a patient manhandled down those escapes, a patient weighing sixteen stones and incontinent of both faeces and urine.

Mar - Apr 2014

GKT Gazette

HISTORY

29th May 1943 The sight of students sunning themselves in the Quad, comatose on the grass, is due to the finish of the M.B. exams. A much less pleasant feature of the past week has been the continued, if unsuccessful return of enemy aircraft to our skies, with the resulting disturbed nights and spurting of ack-ack fire at intervals, but so far, no casualties. Many people have commented on the invasions of the Hospital by American officers during the last two weeks. At Guy’s, an attempt is made to show them the working of the Hospital, the historic side of the place and the “sights of London”; visits are paid to Thomas Guy’s tomb, to the Museum and Library, and from historical motives, of course, to “The George”.

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24th July 1943 Perhaps one of the oddest features of wartime Guy’s is the varied horticultural eﬀorts apparent in the Quad and Hospital. An interesting sideline here is the pharmaceutical department’s eﬀorts at growing belladonna and hyocyamus. It is this spirit and tradition of Guy’s which must be carried on to the post-war Guy’s, in whatever form or shape the Hospital may be rebuilt, for it is this spirit which forms such an important feature of one’s training.

27th November 1943 Time has sped at an unprecedented pace since the first shock of the German offensive against Holland, Belgium and France. The local Defence Volunteers formed at the time have evolved from the rather pathetic though gallant body to the capable and efficient Home Guard of to-day. Guy’s students were organised into what we hope, rather dubiously, would have been a body effective against invasion. Until this time there had been no military training at the Hospital since the outbreak of war, when the London University Service Training Corps had to be disbanded. The spirit of the hour imbued members of the unit with intense enthusiasm; they – we – were almost too glad to spend the nights “guarding” key points armed with a small-bore rifle and six bullets amongst three men. Standing outside in the early morning, the guns rumbling fitfully in the distance, a single thought occupied the stillness: “Are they louder, nearer than before?” Surely a situation calculated to thrill even the most plethoric! The following summer, under the National Service Acts, all students were obliged to join some Civil Defence unit, exemption only granted on recommendation from the Medical School. It is a happy English instinct that to be ordered to do anything unusual immediately invokes some resentment – “happy”

Based on a true patient case, Lewis Moore MBBS4 George, a 57 year old engineer comes to the surgical admissions unit complaining of a rapid onset of severe pain in the right upper quadrant (RUQ) of his abdomen. What does your diﬀerential diagnosis include? How would you proceed?

GKT Gazette

Mar - Feb 2014

in that it provides an additional reason why would-be Fuhrers meet with short shrift in this country. But the resentment was soon overcome with sane thinking and a Guy’s unit came to stay.

clinical period. However, it is to be hoped that students will not claim exemption unless they personally are convinced that their professional studies will suﬀer. It is a matter of individual conscience.

At present the School authorities are willing to recommend a student for exemption from the Civil Defence duties after a year of the

8th January 1944 Four years of war do not seem to have dimmed the magic of Christmas. A tour of the Hospi-

Abdominal pain always has a long diﬀerential, but the RUQ focus points towards local structures such as the liver and gallbladder, the hepatic ﬂexure of the bowel, the heart, kidney or the lungs and pleura. A large proportion of RUQ presentations turn out to be biliary colic, but we must rule out more serious pathology before assuming this to be the case. A full history and examination will provide the basis of our assessment and management of this case. An ECG should be performed to look for ischaemic changes.

Mar - Apr 2014

GKT Gazette

HISTORY

tal revealed every ward and department had again turned to and produced every possible variety of decoration, ranging from the purely artistic to the purely ingenious. The following letter comes from Dr John Kilby, a Guy’s graduate, written upon his return from harrowing work with the Medical Student Relief Unit at Belsen Concentration Camp, shortly after its liberation. Dear Sir, We arrived at Belsen after the British had been in occupation for eighteen days, and so did not get an idea of the place as first found. The 10,000 corpses had already been removed by the SS guards under British persuasion – they worked a twelve hour day with no respite. The camp was composed of two separate compounds for men and women, each with five or six huts. The huts were designed to hold thirty people originally, but we found that they had held anything from two hundred to five hundred.

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Our job was to keep the internees alive in the huts until hospital accommodation could be made in the SS Barracks and Panzer Training School adjoining the camp. The ﬁlth of the huts was indescribable, for in the fortnight preceding the liberation, the SS, in an eﬀort to control the typhus epidemic, had forbidden everybody to leave the huts, although every inmate had diarrhoea and most vomited

all food. The newly dead in the huts were not all cleared away, and we found the bodies being used as pillows, tables and coverings by their living comrades. The death rate when we started was about five hundred daily, but fell to fifty after a week. Feeding was the next problem, as when people have been starved for a long period their digestive systems change making it impossible for them to take normal food. As there has only been one comparable famine observed, in Burma recently, little was known about the best form of food to use en masse. After trial and error it was found that the food most could retain was the gruel used in the Bengal famine. This, together with stews, was used until, on hospitalisation; adequate protein therapy could be carried out. The two outstanding diseases were typhus and tuberculosis. The former took a terrible toll before it was brought under control by effective anti-louse treatment. Even if people recovered from the disease, the complications, together with their general weakness, often proved fatal. Tuberculosis was clinically obvious in about 30% of the sick, while there must have been an overall rate of 50-60% in the whole population. There were many surgical conditions, abscesses and gangrenous bed sores which had often eaten through to the bone. The apathy of the people was appalling, the sick not caring whether they lived or died,

On general inspection you notice that George has had his left leg amputated, and the remaining leg is dressed for ulcers on the medial side. The patient keeps the leg raised as this reduces the pain in the ulcers. He appears a little red in the face. ECG, cardiovascular and respiratory examinations were all normal. On examination of the abdomen the liver is found to be enlarged and the peritoneum contains free ﬂuid. What does your diﬀerential contain now?

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Mar - Feb 2014

Photographs courtesy of Imperial War Museums

and the ﬁt – those who could walk and collect their own food – just sitting about, not bothering to help themselves or anybody else. One woman whom I was trying to persuade to drink the foul tasting casein hydrolysate by telling her that it was the only means of keeping her alive, said “What reason do I have to live? My family are all dead, my home is no more, and I shall never be strong. I may as well die.” This was the attitude of many.

We saw few results of the tortures inflicted by the SS and their Medical Officers, as they mostly proved fatal; but I heard of intravenous benzene injections – said to be experiments concerning arteriosclerosis – and of subcutaneous injections of boiling candle wax. Teeth with gold fillings were wrenched out without anaesthesia, and floggings were daily occurrences. Despite all this, I think the greatest torture of all was the gross privation

Cirrhosis of the liver is the most common cause of ascites, but would usually present with a shrunken liver. Malignancy of the gastrointestinal tract is another important cause, but would usually be a more insidious onset. Budd-Chiari syndrome is an occlusion of the hepatic veins, often caused by an embolic event but also can be due to local pressure ie. from a tumour. It classically causes the triad of ascites, helatomegaly and RUQ pain.

Mar - Apr 2014

GKT Gazette

HISTORY

RESEARCH

and neglect suffered by all indiscriminately. Gradually the camp was evacuated, and the inmates taken to hospitals in the SS area via the human laundry. This was a large panzer stable with about fifty tables on which people were scrubbed by German nurses and covered in louse powder. About 800 were dealt with per day, regardless of their condition. We then treated them in the hospitals giving casein hydrolysate where necessary, and to the rest proper medical and surgical attention under RAMC supervision. On May 21st the last hut was ceremoniously burned, together with a picture of Hitler and a Nazi flag, and now there stand at the main gate two big painted signboards saying, in English and German: “This is the site of the Infamous Belsen Concentration Camp, liberated by the British on 15th April, 1945. 10,000 unburied dead were found here, and another 13,000 have since died, all of them victims of the German New Order in Europe, and an example of Nazi Kultur.” Yours faithfully, John V Kilby

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16th September 1945 Early in the year 1721 is to be found the ﬁrst mention of Thomas Guy’s new hospital, the site being leased for 1,000 years at £30 per annum.

A lease for a thousand years! What impudence! But scarce a quarter of that time has run and part of the land which once so prudently bought lies waste, the buildings on it razed to the ground, hollow mockeries of his humanity and foresight. Perhaps more cruelly tragic is the scorched rubble whereon stood part of the old St Thomas’ and the broken walls of the present day hospital by the river at Westminster. Truly, poor old Guy’s interests have taken some hard knocks. But the temples of healing can never be utterly destroyed by the onslaughts of the barbarians. We are being trained here at Guy’s in the arts of healing the sick both in body and mind, but are we training ourselves in the arts of citizenship and democratic responsibility? It lies wholly within our power to do so. Guy was nothing but an optimist when he looked ahead for a thousand years, and we who seek to build afresh the broken remnants of his idea must catch something of the spirit of his sublime optimism and faith in the generations to follow after. “In war: resolution. In defeat: deﬁance. In victory: magnanimity. In peace: goodwill” Winston Churchill, 1948

George has never drank alcohol and has recently had a hepatitis screen by occupational health at his work. This was clear. Other than his leg ulcers, George reports having a blood problem whose long latin name he does not remember, he has no other medical history or family history. He regularly takes warfarin. When his bloods come back, aside from his deranged liver enzymes, you notice that his haematocrit is 0.75 (Normal range 0.4 – 0.5 for a male). What is going on?

GKT Gazette

Mar - Feb 2014

The perks and pitfalls of PERK inhibition

Ajay Shah BSc Pharmacology, Extra Mural Year A paradoxical idea There is no doubt that age-related neurodegeneration poses a great challenge for the world’s health and social care providers. The pursuit in unlocking the brain’s secrets is arduous, challenging and impractical. Despite this, scientists have elucidated many former unknowns. We know that in a plethora of neurodegenerative diseases (e.g. Alzheimer’s and Parkinson’s disease) misfolded proteins accumulate in cells, inducing a regulatory stress response that hampers the production of proteins1. Paradoxically, the body’s natural attempt at curbing potential damage may compromise brain function1. It has been shown that dysregulation of protein production could play a crucial role in neurodegenerative diseases, occurring through the manufacturing of proteins which are essential for normal brain functioning1.

A growing body of evidence suggests that stifling this stress response or unfolded protein response (UPR) might protect against neurodegeneration in diseases such as Alzheimer’s. In October of last year, an article in Science Translational Medicine reported protection of the brain in a mouse model of prion disease (evidence in prion-diseased mice can translate into other neurodegenerative disorders such as Alzheimer’s)2. Researchers led by Prof Giovanna Mallucci at the MRC Toxicology Unit in Leicester fed prion-infected mice an inhibitor of the enzyme PERK, an important performer in this stress response2. At the stage when untreated mice became terminally ill, the treated mice showed only mild signs of disease, retaining most of their brain cells and performing as well as normal mice in cognitive tasks2. This remarkable pre-clinical discovery has captivated the field; the findings have the potential to transform our understanding of

This patient’s ‘blood condition’ is Polycythaemia Rubra Vera, as evidenced by the enormous quantity of red cells in his circulation. This increases the tendency to clot, so he takes warfarin to prevent this from becoming a problem. The amputation and the ulcers on his legs are a product of deep vein thrombosis (DVT). Does this information provide any clues to the problem with his liver?

Mar - Apr 2014

GKT Gazette

RESEARCH

neurodegenerative diseases to ultimately save lives. Promising animal evidence The Leicester researchers tested an oral PERK inhibitor, GSK2606414. Mice were

fed GSK2606414 at around the time when the brain begins to fail. Twelve weeks after infection with the toxic prion protein, the untreated mice developed extensive brain breakdown and began having characteristic behavioural problems. Astoundingly, the animals treated with the PERK inhibitor maintained the normal numbers of brain cells and had little degeneration. They also preserved important proteins, distinguished new objects from familiar ones just as well as the mice without disease. A portion of the GSK2606414-treated mice showed some signs of early prion disease, but none showed classical diagnostic features.

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The researchers then pondered the effect of treatment in mice that were already surrendering to prion disease. They fed the molecule to another group of mice when neurodegeneration and memory problems became obvious. Incredibly, the animals treated with GSK2606414 had normal brain cell counts and only minimal neurodegeneration, contrasting with the severe loss in untreated mice. The beneficial effects were seen present even though the treatment did nothing to reduce the accumulation of misfolded prion protein. This is supportive of previous research, which has suggested that a high level of misfolded protein is not always related to the clinical state2.

Yes, while we generally worry about DVT throwing oﬀ clots to the lung, the liver is also susceptible to this, Budd Chiari syndrome occurs when a clot occludes the hepatic veins. The liver will swell signiﬁcantly, stretching the liver capsule and causing pain.

Dark side of the drug Unfortunately this particular molecule had alarming systemic side effects. All mice given the inhibitor developed mild diabetes and lost around twenty percent of their body weight. This dramatic weight loss led the researchers to cease experiments to adhere with regulations governing UK animal research. Regrettably, this meant the scientists were unable to evaluate survival rates from the prion assault. However, the research is momentous in providing proof-of-principle that restoring the production of proteins can prevent neurodegeneration in prion-diseased mice. Controversy Scientists have pointed out that it is difficult to compare the data from this study with other novel prion drugs, because other studies report outcomes in terms of survival time1. Other molecules that hinder the accumulation of misfolded prion protein in mice have been shown to delay disease onset by up to two months1. It has been suggested that GSK2606414 could be administered directly into the brain to evade body-wide effects so survival data could be acquired1. Nonetheless, critics have warned that chronically quashing the UPR maybe unsafe because PERK mediates an important adaptive response to stress throughout the body1. UPR induces autophagy, a process by which cells rid themselves of superfluous protein and so suppressing autopha-

gy could actually increase toxic protein levels. Indeed, regulating the regulator always seems to be contentious. The future Although more studies are needed to elucidate survival eﬀects, the work has shown that the UPR pathway represents an encouraging target for drug discovery. The group at Leicester plans to test the PERK inhibitor in other models of neurodegenerative diseases, a fundamental next step in this area of research. Potential treatments would presumably have to a balance between enhancing protein production and sustaining autophagy. The results are encouraging; and although not imminent, the potential to change lives is within reach. References: 1. PERKing Up Protein Synthesis May Prevent Neurodegeneration | ALZFORUM. (n.d.). Retrieved February 12, 2014, from http://www. alzforum.org/news/research-news/perking-protein-synthesis-may-prevent-neurodegeneration 2. Moreno, J. A., Halliday, M., Molloy, C., Radford, H., Verity, N., Axten, J. M., … Mallucci, G. R. (2013). Oral treatment targeting the unfolded protein response prevents neurodegeneration and clinical disease in prion-infected mice. Science Translational Medicine, 5(206)

He will be treated with thrombolysis, but failing this a stent can be placed surgically to restore patency to the occluded vessel. His current dose of warfarin was apparently insuﬃcient to prevent these events so his target INR will be increased and the dose adjusted accordingly.

George was given an abdominal ultrasound, which located the blockage in his hepatic veins.

GKT Gazette

Mar - Feb 2014

Mar - Apr 2014

GKT Gazette

Mar - Feb 2014

Wellcome Image Award for Researchers at King’s

Institute of Pharmaceutical Science researchers Izzat Suﬃan and Khuloud T Al-Jamal have had some of their work, the above scanning electron micrograph, featured in the 2014 Wellcome Image Awards. The image shows a group of breast cancer cells (blue) that have been treated with nanocarriers containing the drug doxorubicin, which is causing the programmed death of some of the cells in the cluster (purple). The scientists are working to develop nanocarriers that can selectively deliver drugs to Mar - Apr of 2014 GKTan, Gazette 55 kill cancerous cells whilst sparing healthy tissue. Image courtesy Izzat Suﬃ PhD Student,.

RESEARCH

Neuroscience and the Death of Free Will Anya Suppermpool Neuroscience BSc 2nd Year

uppose you are standing in a cafeteria line choosing your dessert. You don’t know whether to pick the apple or chocolate cake. You know the apple is the healthier choice and the cake is fattening, but the latter is far too tantalising. The next morning, you weigh yourself, and think, ‘If only I had chosen the apple instead!’ You should have. You could have. Or could you? Choices and decisions are fundamental to human existence. We navigate through our lives with the belief that we have free will, of which mental states initiate neural events in the motor areas of our brain to drive actions and produce our intended change in the world. However, recent cognitive neuroscience studies challenge the century-old question of free will, suggesting that free will is just an illusion.

In the 1980s, Benjamin Libet and colleagues discovered that our brain makes choices before we are conscious of them1. In the experiment, they asked subjects to look at a small clock, choose a random moment to press a button, and then had them indicate where the hand had been on the clock when they had the urge to press. During the whole set up, Libet measured the subjects’ readiness potential (RP) - a build-up of electrical signal in the supplementary motor area (SMA) involved in the planning of intended movement. Although it is well known that the RP preceded the physical action, Libet investigated the relationship between the potential and the felt intention. Their data showed the RP began around 500 – 1000 ms before the time reported of felt intention. This supports the idea that neurons in your brain know you are about to choose the cake half a second 56

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before you know so yourself. We simply become conscious of the ‘decision’ and believe that we are in the process of making it. Recent studies took it a step further. Soon and colleagues found that the outcome of a decision can be encoded up to 10 seconds before it enters awareness by analysing the activity of the brain via functional magnetic resonance imaging. They asked subjects to press a button with either their left or right hand and reported when the urge to press it2. Interestingly, Fried et al. found that by stimulating the SMA and pre-SMA with implanted electrodes in conscious epileptic patients, the patients reported the ‘urge’ to move a certain part of their body3. The critical point is that their limbs are not moving – the current merely generates the ‘will’ to move. Furthermore, upon increasing the electrode currents, the said limbs physically move involuntarily4. These ﬁndings not only support the fact that brain activity precedes the conscious volition but also points out that free will is capable of being hijacked.

Photograph courtesy of Charlie Ding

atoms, work in the same way within the brain as out in the physical world. The mind is the brain thus the law of nature governs all mental states. Hence ﬁndings have rejected the concept of dualistic free will and go conjointly with determinism.

If voluntary actions are not due to conscious volitions, how can we regard ourselves as acting freely? Thoughts simply arise in the brain, what else could they do? The truth about us is strange, ‘the illusion of free will is itself an illusion5’, says Sam Harris, a neuroscientist and author.

Despite his ﬁndings, Libet does not interpret his data as evidence against free will. He believes that free will works by vetoing - the conscious retains a right to veto any action in the last moment. But where would such veto command come from, if not the same route as its original action command? The decision to modify or veto an action is also preceded by deterministically generated unconscious processes – creating a never-ending loop of unconsciousness to consciousness. Libet’s attempt to save free will is not entirely nonsensical. This issue is so much more alarming than choosing what to eat for desert.

An important concept is that mental states are simply biological mechanisms. We live in a universe where everything is determined by the laws of nature: atoms and particles behave in probabilistic ways. Mental states have neural properties. The laws of nature, such as those that dictate the movement of

These scientiﬁc ﬁndings carry implications for moral responsibility and sense of agency. If free will is dead, then moral and legal responsibility may be close behind. If we don’t know where our thoughts and decisions arise and all our actions are deterministically generated, how can we be responsible for our ac-

tions? Does it make sense to praise, blame or even punish someone for an action when it is not free? Before reaching any conclusion, it is important to consider these studies looked at rudimentary kind of actions. The decision of when and which ﬁnger to ﬂex is hardly analogous to the decisions we exercise when making moral or life choices. Nonetheless, we have to keep an open mind and brace ourselves for the havoc on our sense of moral responsibility when we work out how and why we choose the chocolate cake instead of the apple. References:

1. Libet, B., Gleason, C., Wright, E., & Pearl, D. (1983). Time of Conscious Intention To Act In Relation To Onset of Cerebral Activity. Brain , 623-642. 2. Soon, C., Brass, M., Heinze, H.-J., & Haynes, J.-D. (2008). Unconscious determinants of free decisions in the human brain. Nature Neuroscience , 543-545. 3.Fried, I., Katz, A., Mccarthy, G., Sass, K. J., Williamson, P., Spencer, S. S., et al. (1991). Functional-organization of human supplementary motor cortex studied by electrical-stimulation. Journal of Neuroscience , 11, 3656–66. 4. Haggard, P., & Libet, B. (2011). Conscious Intention and Brain Activity. Journal of Consciousness Studies , 47–63. 5. Harris, S. (2012). Free Will. New York: Free Press.

Mar - Apr 2014

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SHOP

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Here is a selection of our Guy’s, King’s College & St Thomas’ Hospitals memorabilia 13

1 2

Key (images not to scale): 3

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1 2 3 4 5 6 7 8 9 10 11 12 13 14

Photographs courtesy of Charlie Ding

Large Hip Flask Tie - GKT Shields Tie - GKT Stripes & Shields Tie - Guy’s Stripes Tie - STH Narrow Stripes Tie - STH Wide Stripes Silver Plated Guy’s Tie Slide Gold Plated KCH Cuﬄinks Silver Plated Guy’s Cuﬄinks Hand Painted Shield STH Dark Wood Guy’s Lapel Badge (front and rear) Guy’s Bookmark Guy’s Mousemat Guy’s Leather Key Fob

Memorabilia are now available for purchase and collection from the Gordon Museum reception. See overleaf for price list and mail order form.

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GKT Gazette

CAREERS

Career Pathways after Medical School Matilda Esan MBBS4

t some point during the last two years of medical school, I came to the decision that I no longer wanted to select Special Study Components (SSCs) which were library based and involved slaving away over essays without any human interaction. However, this decision meant that I would need to turn to a taught SSC if I was looking for a bit of the human touch. Having decided that I did not want anything heavily science based I decided to branch out and select a topic which was not going to be soul-destroying.

as noting down current ideas we had about our future speciality.

Cue the drum roll please, as I announce that my selected SSC was… ‘Creating your Winning Medical Career”.

The second session involved becoming familiar with the UK training pathway and recent changes it has undergone. Meanwhile, the exploring careers session was especially useful for gaining a realistic view of our own personal life and career values and how the two relate.

With regards to my initial expectation, the truth is that I was just hoping I would gain more direction as to where I wanted to end up post-medical school. On reflection now, it was a big ask for a 12 week programme. Surprisingly enough my perspective and outlook on life post-graduation changed greatly. The Structure of the SSC On a weekly basis we met up with a variety of doctors from different walks of life, as well as the careers advisor. The first session involved outlining our expectations as well

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Highlights of the SSC The next session involved going to the London Deanery careers conference which was unknown to me until the SSC - it is completely free and aimed at medical students and junior doctors. The day itself was exceptionally well organised and useful aspects included the career stands, with an array of specialities placed all in one room and 10 minute interviews with a careers advisor.

the Haematologist allayed my fears about not being able to cope with laboratory work by explaining that throughout the training programme I would receive constant training for laboratory work. On the other hand the emergency medicine consultant helped me to bust some of the common myths regarding his speciality. Other useful sessions involved • Myers-Briggs type indicator session • Professional portfolio and CV building • Reflecting on the SSC Should you pick this SSC? If you are coming to the end of your medical degree and find yourself becoming very anxious about your lack of awareness and preparation for life after medical school then this is definitely for you. Even if you

don’t decide to pick this SSC here are a few helpful hints: • King’s has excellent career services located at the Strand, Guy’s and the Waterloo Campuses. For further information visit the King’s College London webpage, log into your student account and click the King’s Careers and Employability tab. • Don’t rely completely on second-hand information of juniors or fellow medical students. Speak directly to the consultants who have come out on the other side. • Know what your career and life values are and be realistic.

Then came the taster days which involved interviewing a specialist consultant of our choice (speciﬁcally a consultant as this is the climax of a speciality and it was deemed important to know how people feel at the end of formal speciality training. I arranged my taster days with an emergency medicine consultant and with a haematologist. Both interviews were really insightful, as

Mar - Apr 2014

GKT Gazette

CAREERS

How to stay sane during the revision and exam period Sally Kamaledeen FY1 Doctor

t is that time of year again. The seasons are changing, the days are becoming longer and that inexplicable feeling of impending doom and dread is slowly creeping over you. Yes – it is revision season again, and as you slowly emerge from your winter hibernation and wake up to the seemingly insurmountable pile of notes, lectures and books in front of you, you need to adopt eﬀective and realistic strategies in order to make the best use of the time you have left. Here are a few tips to help you get organised, knuckle down and start swotting:

1) Make a syllabus: The first step is to define what you need to know and familiarise yourself with the topics that may come up in your exam. For medical students, the School of Medicine Core Curriculum on the Virtual Campus http:// virtualcampus.kcl.ac.uk/vc/medicine/core/ default.aspx is a good start and a PDF version has recently been uploaded to facilitate printing. Alternatively, you can identify the most important topics by briefly leafing through a general medical textbook and writing out a list of the common conditions, especially ones frequently encountered on the wards. Making a list of the lectures that were given during the year is also helpful, as not only will you be able to tick them off once studied, but this will also give you an idea of the topics that you are expected to read around and be familiar with. 2) Collect past question papers: Questions have the great tendency of repeating themselves in exams, especially if they pertain to common things. Make sure to browse around and ask your peers in the years above to pass on any past papers they have acquired, some are actually available on 64

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the Virtual Campus. Also, while money can often be scarce as a student, it is worthwhile investing a little and signing up to a question bank like OneExamination (www.onexamination.com) or Pastest (www.pastest.co.uk). You will be actively thinking and activating your memory while doing the questions, and the answers usually come with well-written, thorough explanations, allowing you to not only assess your progress but also to acquire knowledge as you go along. 3) Make a study plan: Once you have done the above, making a study plan will help you outline the time you have remaining and use it eﬀectively. Split up your topics and lectures over the number of weeks, allowing more time for diﬃcult topics and be aware of days on which you have other commitments, such as lectures or attending at your placement. It is always wise in your revision timetable to allow a couple of empty weeks pre-exams in case of any emergencies such as illness, any outstanding topics that remain to be revised, and to give yourself a chance to practice more past papers and questions. On a daily basis, aim to revise for at least three hours, working

in 50 minute chunks followed by 10 minute breaks. Trying to work continuously without any breaks will only make you feel saturated, tired and de-motivated. Your brain activity is at its peak after a quick, refreshing break, and you will come back to your notes and books eager to pick up where you left off. 4) Revise actively: During revision, make use of your learning style. If you are a visual learner, try drawing out your notes into colourful mindmaps and flow charts, illustrating them with helpful doodles and diagrams to help you memorise the information. Visual learners also work best by writing out thoughts and facts and tend to have photographic memories, often recalling during exams the way the pages of their notes and books looked like. If you are an auditory learner, try vocalising your notes, or explaining topics to one of your friends. Auditory learners also benefit most from discussing topics with others and are usually the sort of students that find recording lectures helpful. If you are a tactile learner, meaning that you learn by having an active, hands-on approach, your might find posting notes around your room or house then revisiting each one in a certain order or revising during physical activity helps your learning. Also, employing props or materials during your revision process, for example drawing out dermatomes on a plastic doll, or making a small paper box and labelling it with the parts of the heart or the contents of the ear canal would be helpful revision aids if you are this type of learner. 5) Stay human: The revision and exams period can really take its toll on even the calmest and most collected of students. Although a small amount of stress is needed to keep you focused and motivated to succeed, it is often too easy to slip into unhealthy, damaging habits when our anxiety escalates. Try to look after both your

physical and mental health in the coming few months, by going to the gym in your breaks or taking long walks to de-stress, eating well and staying close to your family and friends and looking to them for support. Recognise when you have done a good amount of work and reward yourself with a well-deserved break, and keep in mind that reward when you are revising in order to always have something to look forward to when you meet one of your revision goals. Remember, you are not alone, keep in touch with your peers and do not isolate yourself from others as often just voicing your concerns and worries to a good friend and seeking their support and advice can be enough to get a surge of motivation and hope and help you feel more positive about your exams. There is light at the end of the note-scattered, folder-ﬁlled dark revision tunnel. Before you know it, you will be out of that exam room in an exhilarating sense of relief and ready to enjoy your summer. Good luck!

GKT Gazette

OBITUARIES

Dr Alan Wheelton Hind 1918-2013

An appreciation by John Hellewell and Ross Watkin

r Alan Hind, the last of the Guy’s anaesthetists on the Staﬀ at the inception of the Health Service in 1948, died recently aged 95. Alan came from a family with long connections with Guy’s going back to the 1870s; his grandfather, great-uncle and uncle all being Guy’s men. He came to Guy’s in 1937 and qualiﬁed in 1941. In the Spring of that year he had a lucky escape when a German bomb came through the roof of Hunt’s House and exploded in the stairwell where he was working at a desk: he was blown into one of the wards, fortunately with no serious injury. He joined the Royal Army Medical Corps in 1942 and served in India, Malaya and Burma, returning to Guy’s in 1947 having married a Guy’s nurse, Margaret Fearnehough, in St. Paul’s Cathedral, Calcutta in 1945: she was then in the Queen Alexandra Imperial Military Nursing Service. It was during his years in the Far East that he developed his interest and skills

GKT Gazette

in anaesthetics and he was appointed anaesthetic registrar in1947 and consultant in 1949. At that time ‘Anaesthetics’ was recognised as a specialty in its own right and was beginning to make significant advances which enabled progress to be made in many branches of Surgery, particularly in cardiac and neurosurgery. Alan played a prominent role in the development of anaesthesia for the latter at the Guy’s/Maudsley Neurosurgery unit in Denmark Hill, then under the direction of the eminent neurosurgeon, Murray Falconer, who had been appointed in 1949. They worked closely for many years during which they developed a treatment for temporal lobe epilepsy. Alan devised an anaesthetic technique using incremental doses of sodium thiopentone that enabled the abnormal focus to be localised and subsequently removed. In many ways this was the forerunner of modern techniques made possible by the refinement in drug effects.

Mar - Feb 2014

Alan was also an accomplished mechanic who persuaded the planners of the need for an engineering workshop in the Anaesthetic Department in New Guy’s House in the early 60’s. This proved very useful in the early days of Intensive Care when Alan modiﬁed a Starling pump for use as an infant ventilator that became invaluable in the postoperative care of small infants. Alan was a superb teacher emphasising the importance of constant observation and attention to detail at all times. With no monitoring equipment, apart from the sphygmomanometer, this was crucial to the safe outcome of an operation. One small, but useful example of his teaching was in the detection of central cyanosis: in the presence of peripheral vasoconstriction, patients would often appear cyanosed. However a quick massage of the ear lobe would cause instant vasodilatation that would quickly reveal the true situation. Above all he was a kind man to whom one could turn at any time for advice or support, which to a junior anaesthetist, often under stress, was immensely reassuring: he will be remembered by many anaesthetists with gratitude.

Dr John Edmund Keir Moore 1926-2014

ohn Moore died peacefully at home in Pangbourne, Berkshire, on 21st January 2014 at the age of 87. The funeral took place at the church of St James the Less, also in Pangbourne, on 3rd February. John was born in Malta on 26th October 1926. His father was a Medical Officer in the Royal Navy, serving at the Royal Naval Hospital there. With the exception of a short time in Ireland, John spent most of the first seven years of his life in Malta. The family returned to live in England in 1934, initially in Plymouth and then Gosport as his father’s naval appointments changed. In 1939, John’s father was appointed to HMS Maine in Alexandria; John and his brother, Richard, did not see him again for three years. Richard has described John as his “informant, guide and leader” during those times. In 1940, John became a boarder at Bradfield College

cantly senior to him, was later to become his wife.

Obituary courtesy of Maurice Moore in Berkshire and started to get to know the county that would become his home for the majority of his life. As this was wartime, he joined the Home Guard whilst at school. Sometimes this involved being on the look-out for German paratroopers whilst armed with a pitchfork! In 1944, John left Bradfield to go to Magdalen College Oxford to read medicine and follow the profession of six generations of his family before him. His grandfather, Sir John William Moore, had been a leading fever specialist at the Meath in Dublin in the late nineteenth and early twentieth centuries. After Magdalen, John moved on to Guy’s Hospital in London, where he completed his clinical training and qualified. In 1951, he secured a position as a houseman at Paddington General Hospital and it was there that he met Rosa Piggot, a fellow doctor – who, though at the time signifi-

In 1952, John joined the Royal Navy to do his National Service and was appointed to be Medical Oﬃcer on HMS Sparrow. He was sent to Korea where he saw active service during the war there, surviving some hair-raising experiences. After the armistice, the remainder of his service was spent in Simonstown, South Africa. In 1954, John returned to England. He and Rosa had corresponded throughout his time at sea and within six weeks of his return, they were married. Rosa was at the time working in Reading and in 1955, John secured a position in Reading too, working as a family doctor - becoming a partner the following year. A son was born in 1955 and a daughter followed three years later – both born at Guy’s Hospital. John also worked as a GP in the Oxford Road Practice in Reading and, in the years before he retired, as a doctor at RAF Benson, and for the DHSS, including visits to Broadmoor. John was dedicated to his job and over the years many patients have talked of his kindness and willingness to take time with everyone. In retirement, John and

Mar - Apr 2014

GKT Gazette

OBITUARIES

Rosa moved to Pangbourne where he continued his life of service to others – not only had he been a doctor, but a scout leader and member of his local churches, too. Now he took on the role of a volunteer driver, and a coffee maker at a mother and toddler club – something that he and Rosa enjoyed very much. They celebrated 50 years of marriage with friends, family and a trip on the Orient Express in 2004. The latter years of John’s life

were tinged with sadness. The loss of his grandson, Nicholas, to a car accident touched him deeply, as did the deaths of so many friends and former colleagues. His devoted love and care for Rosa as she became increasingly incapacitated, before her death in 2012, could not have been greater – he had endless patience, even when things were not easy. He was, though, delighted to be able to spend a little time with his two great-grandchildren.

Macadam Cup

John leaves a son, Maurice, daughter, Barbara, daughter-in-law, Annie, granddaughter, Amélie and great-grandchildren, Daniel and Emma. John was a strong supporter of the work of the Royal National Lifeboat Institution throughout his life. Donations in his memory can be made direct to Royal National Lifeboat Institution.

Just Out of Reach for GKT Teams Anya Suppermpool Neuroscience BSc 2nd Year Simon Cleary Editor

atches of heavy rain didn’t stop play at the 2014 Macadam Cup, the annual contest between King’s College London (KCL) teams and their hospital campus-based rivals, the GKT squads. From earlier victories in waterpolo and squash - and a loss in swimming - KCL were leading 2-1 before the main day. Tensions were high and the pressure

GKT Gazette

Mar - Feb 2014

Photo: Guy’s colonnade Courtesy of King’s College London

was on at the new Honor Oak Park ground for what an anti-GKT article in The King’s Tab had referred to as ‘proper’ sports teams. The atmosphere was tense as clouds hovered over the men’s rugby pitch. GKT took the ﬁrst points of the match with a superb penalty. KCL stood strong and drive lineout, ending

Mar - Apr 2014

GKT Gazette

SPORTS

with a touched down in the corner. In second half, the wind was not on GKT’s side. KCL kicked deep into our half and score, securing their victory. Nonetheless, GKT fought back as hard as they could and scored a try late in the match, ending with the score of 10-12.

In truth, KCL showed great spirit and ability and they deserved to carry the Cup back to the Strand.

GKT women’s rugby fared much worse. With their disappointing result from Varsity the week before, KCL women were determined to prove themselves. Their defence was solid and their plays were good. Our medics fought their best through the muddy pitch, but failed to prevent a 0-52 thrashing.

In the meantime, other thrashings were being dealt out to KCL football teams by both the GKT men’s and women’s squads. The men’s team produced a fantastic performance leading 3-0 by the end of ﬁrst half. They ended the game with 4-1 scored by Daniel Plaxton, Fred Thoman (GKT Men’s Player of the Day), Justin Grandison and Ryan Elliot.

On the women’s football side, KCL scored the ﬁrst goal against GKT’s stand-in goalie. With a winning streak to maintain, GKT girls fought back hard for a 4-1 win. The game was brutal with 3 GKT and 2 KCL injuries, including one collision of heads and two players having to be carried oﬀ the pitch to an ambulance.

Right: KCL player holding dearly onto a GKT player in Men’s Football

Despite the cold and wet weather, GKT netball girls made fantastic play. The entire team truly had their game faces on and played great netball leading 28-0 in the ﬁrst quarter. Although KCL did make it on to the scoresheet to bring the score to 43-3 by halftime, the GKT defence were untroubled, and even the quickest Strandie found it hard to get through. GKT continuously turned the game around to their advantage with great communication and tactics (especially by Alice Ewer, GKT Women’s Player of the Day) resulting in nearly doubling their score to GKT 82-11 KCL by the end of the match.

Photographs courtesy of Anya Suppermpool

GKT women’s hockey gave their best attempt but luck was not on their side. The KCL women dominated the game winning 0-4.

Left: Stressed faces of GKT supporters along the sideline as the day procedes

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Mar - Feb 2014

Men’s hockey was the last game of the Cup, so with the knowledge that KCL were in the lead by an unbeatable 8-6, the GKT hockey team played their best but lost 1-2 to KCL. As the day was coming to an end, KCLSU VP for Student Activities and Facilities Liam Jackson read out the results from each fixture and it came as no surprise that KCL had won their second Macadam Cup with an overall score of KCL 9-6 GKT. In truth, KCL showed great spirit and ability and they deserved to carry what used to be the St Thomas’s Rowing Club champagne bowl back to the Strand. The 2014 Macadam Cup was a great effort from both KCL and GKT – not to mention the enthusiastic supporters on the sidelines. GKT, still the victors of 9 out of 11 Macadam Cup, remained in good spirits, singing as they headed off for Guy’s Bar for further spirits.

Mar - Apr 2014

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SPORTS

GKT D, which was brilliantly saved by a diving stick. The game then opened up in midfield with some mesmerising end to end play. RUMS managed to nick a goal just before half time after some swift attacks down the flanks -not an ideal end to the half, and RUMS now had their tails up. The second half started at a lighting pace. The teams traded blows at either end but neither was able to break through. Unfortunately the fitness of the RUMS team really began to show, with GKT legs visibly beginning to tire. The opposition applied sustained pressure for a lot of the second half and the breakthrough finally came for them at a short corner. A flick smartly saved by Dan Curley fell loose in the D and was quickly put away by a RUMS stick. Poised at 2-2 with ten minutes to go, RUMS had all the confidence, and GKT heads were down after allowing a 2-goal lead to slip. Both sides had chances in the nail-biting

closing minutes, but neither could convert. After 70 minutes there was nothing to separate the two sides, leaving the result to be decided, cruelly, by penalty flicks. Step up Alec Dawson. Bang. Top left. Goal. Dan Curley steps forward, his intimidating stature eclipsing the goal. Saved. GKT and RUMS both slotted flick after flick, and a few nervous moments came courtesy of Tom Chandler due to a poor effort that thankfully crept in. It all came down to Theo Muth to seal the deal. He coolly and powerfully drilled the flick hard, right into the back of the net, right into the history books. Victory for GKT. Goals - Theo Muth, Alex Wells Flicks Scored - Alec Dawson, Tom Chandler, Khush Shah, Calum Craig, Theo Muth Assists: Tom Chandler, Fergus Catmur Man of the Match: Dan Curley

Varsity Glory for GKT fter weeks of anticipation Varsity had finally arrived. As the first Varsity competition ever played between GKT and RUMS hockey, it was the team’s chance to claim their spot in GKT folklore with the first victory. It was a bitterly cold Monday night at HOP, and the stands were packed with an eager crowd. Captain Sachin rallied the troops with a spurring locker room speech and they were ready to be unleashed. GKT started well and controlled the game

GKT Gazette

Mar - Feb 2014

for the first twenty minutes. Theo Muth quickly put GKT 1 nil up when he reacted first to a saved shot and smartly slotted the ball in. After a sustained period of pressure the lead doubled. Alex Wells took a brilliant reverse stick shot first time, which kissed the post on its way in. GKT were well and truly on top and the game was theirs to lose. RUMS, however, were not going to give up that easily and came back fighting. The opposition were awarded a penalty flick following some scrappy play in the

Mar - Apr 2014

GKT Gazette

Photographs courtesy of Sachin Sharma and Andrew Baigey

Anthony Dalrymple MBBS1

SPORTS

Guy’s Hospital 1 XV vs Cambridge University (LX Club) st

Stephen Challacombe Martin Rushton Professor of Oral Medicine, King’s College London October 20th 2013 Grand-opening of the new Clubhouse at Honor Oak Park

eventy-seven years ago, Guys Hospital RFC played Cambridge University to celebrate the opening of the new stand and extension of the ground at HOP. The match was won by Cambridge (11-3) and was featured on Pathe news. A report is available from the Guy’s Gazette from January 1936 (GUY’S HOSPITAL GAZETTE 75 1936). Both Pathe news and the report feature Frank Cocks, father in law of Professor Challacombe, who went on to become Bishop of Shrewsbury and Chaplain in Chief to the RAF and played in the back row for Cambridge.

GKT Gazette

Mar - Feb 2014

To celebrate the opening of the new clubhouse, Cambridge were again invited to be the opposition and sent down a strong side of mainly the 60 club and some ﬁrst XV players. A report of the earlier match had been sent to their coach, Ian Minto and so CURFC were aware of the history of HOP and the match was well supported and watched by various ‘blues’ as well as the home crowd. In spite of the most appalling weather and a strong wind blowing the rain down the pitch, both sides played enterprising rugby that warmed the hearts if not the bodies of the crowd. Playing with the wind, Guys found themselves a score behind after some ominously fast movement from

Cambridge. To the delight of the crowd, Guy’s then hit back with two tries to take the lead, and a further try before half time. A lead of 20-7 did not look enough, especially as the heavens had opened and the wind strengthened to gale force. However, Guy’s tacking around the fringes was committed and very eﬀective. In spite of two Cambridge scores, the team began to get on top with some classy moves and passing allied to some vigorous tackling, inducing mistakes from Cambridge. A robust rolling maul was the catalyst for the next score and a wonderful short pass from the Guy’s standoﬀ put the replacement Arjun Desai through for the try. Guy’s ran out winners by 32 points to 20. In the new Clubhouse speeches were given by the Cambridge Coach and past presidents of Guy’s, with shields exchanged. The man of the match selected by the Cambridge coach was Duncan Steele. CURFC indicated that they would very much like to forge stronger links with GHRFC in spite of the result! All things considered, it was a very suitable and memorable event to mark the occasion. 77 years on and Guy’s Hospital RFC’s prestigious history as the oldest rugby club in the world is set to continue as the club begins a new era with their second brand new clubhouse.

Teams : Guy’s: 1 Johnny Elias, 2 Rauri Hadlington, 3 Dan Caplin, 4 Rob Hone, 5 Rhys Davies, 6 Charlie West, 7 Zack Tarrant Taylor, 8 Jack Lilly D’Cruz, 9 James Hatﬁeld, 10 James Cuthbertson, 11 George Eynon-Lewis, 12 Alex Witek, 13 Rhys Harris, 14 Luke Mcnickle, 15 Joe Wilkinson. Replacements: 16 Tim Davis, 17 Ed Sheppard, 18 George Child, 19 Phil Elliot, 20 Arjun Desai, 21Tom Pacy, 22 Peter Gretton, 23 Mike Forsythe,24 Duncan Steele. Coach: Richard Aitken Cambridge: 1 Toby Haseler, 2 Pat Calvert 3 Ollie Exton 4 Leo Buizza 5 Nic Viljoen 6 Harry Williams 7 Nick Roope (Capt) 8 Oli Webster 9 Alﬁe Lloyd 10 Richard Cha 11 James Moore 12 Steven Clarke 13 Yemi OgunYemi 14 Tom Hudson 15 George Smith Replacements: Tom Jellicoe, Alex Goring, Francois Okoroafor, Callum Benson-Maxwell Coach/Manager: Ian Minto

Photographs courtesy of Katie Davis

SPORTS

kept up that family feeling that makes our team so special and, looking onto facing 3 long months without each other, it’s safe to say we can’t wait for the next season to start. Kati Lestak Intercalated BSc (Global Health)

GKT Gazette

Mar - Feb 2014

it’s been a tough year, we came together to form a team that each of us is proud to be part of. With the end of the season, it is also time to say goodbye to our leavers. The seven of you (heroes) have made a lasting impact on this team and club, and you will be dearly missed both on and oﬀ the pitch.

Aisling McGeough MBBS2

Juli McCulloch Intercalated BSc (Sport and Exercise Medicine)

Cara Hanley MBBS3 Lucy Anandappa BSc Human Sciences 3rd Year

The 2s: GKT 2’s have also had a cracking season, continuing on from an absolutely smashing one last year. With plenty of new blood, the team has gone from strength to strength in their play, maintaining a mid-table position for much of the season and their best NAMS result to date. Highlights have included our screaming win against RUMS 2s, playing in the sun at Regents Park against SOAS and our almighty cup battle against UCL 2s on our astro. But it hasn’t been all work and no play. Most importantly, however, we’ve

Photograph courtesy of NAMS 2014

The 1s: The 1st team this year was composed of a mix of GKT freshers and experienced players, many in their last year, and we were determined to make a lasting impression in every match. We kicked off the season with a last minute win against KCL. Despite the challenges posed by the rains and resulting floods, we ploughed through two leagues, picking up key results along the way. We took it to the wire but secured a BUCspromotion in our last league game with a 3-0 win against the University of Kent. We turned up to NAMs tired, hungover, and with broken bones in some cases, but we rallied through seven back-to-back matches and made it through two intense penalty shoot-outs to reach the final. Unfortunately we met a rampant Nottingham side and couldn’t quite bring the title home (next year!). We finished the season on a high with a continuation of our winning streak over KCLWFC with a 4-1 domination at Macadam Cup. Even though

Photograph courtesy of Anya Suppermpool

GKT Women’s Football: A year at a glance

The socials: In terms of our social calendar, this year has been nothing short of amazing off the pitch as well as on it. This began with an epic freshers’ trial early in September, where we initiated our wonderful freshers and welcomed them into the loving family that is GKTWFC. We have maintained our tradition of gin and snakebite- fuelled shenanigans at Guy’s Campus’ finest establishment: Guy’s Bar; spread our GKT love (and simultaneously created some havoc) nationwide by taking trips to Liverpool and Sheffield and strengthened our links within the GKT sports community through supporting at events such as Varsity and Macadam. Friendships have formed, experiences shared, and a family has grown. GKT ‘til we die!

Words from the President: On a more personal note, when I joined GKTWFC it was a little known, small club on its way up. People mixed us up with women’s rugby. We struggled to recruit numbers for fresher trials. We had little connection with our associated GKT FC boys and little communication with any other sports club. We didn’t have an email account, a twitter account, or a website. I am so proud of how much the club has grown and developed over the last few years, but at the end of the day the ethos and spirit of the club hasn’t changed at all. The oﬃcial deﬁnition of a club is “an association dedicated to a particular interest or activity”. We are so much more than a few teams of people that like to play football and go to Guy’s Bar (although both still come pretty high up on the list). I’m sure that everyone in the club would agree that we are a family and a support network. Everyone is welcome, everyone is on the same level no matter how skilled or poor you are at football, and most of all everyone bleeds blue and gold. I can’t wait to see where we will be in another four short years.

Mar - Apr 2014

GKT Gazette

Team 1st team 1st team 1st team

2nd team 1st team 1st team

2nd team 3rd team

10 10 10 10 9 9 9 7

4th team

3rd team 1st team

2nd team 3rd team

10 10 10 10 5

1st team

2nd team

Played

1st team

2nd team

GKT Gazette

The Gazette Team

GKT TEAMS BUCS SCOREBOARD 2013/2014

Won

Drawn

Lost

MEN’S BADMINTON

4 of 6

WOMEN’S BADMINTON 3

MEN’S FOOTBALL

3 3

WOMEN’S FOOTBALL

MEN’S HOCKEY

7 2 1 4 3

1 1 1

WOMEN’S HOCKEY

0 0

0 0 1 0

0 1 6 5 6 7 9 7

WOMEN’S NETBALL

7 4 2 6 6 2

Mar - Feb 2014

0 1 0

MEN’S RUGBY 0 1

WOMEN’S RUGBY 0

League Position

3 5 3 8 7 8

Lewis Moore Deputy Editor News Editor

Kate Anstee Deputy Editor Treasurer

Joshua Getty Deputy Editor History Editor

Anya Suppermpool Layout Editor

Katie Allan News Editor

Zoya Arain Features Editor

Sabina Checketts Arts & Culture Editor

Ajay Shah Research Editor

Megan Clark Dental Editor

Matilda Esan Careers Editor

Sam Evbuomwan Book Reviews Editor

Georgie Day

Tom Fenner Sports Editor

Hannah Asante Advertising Oﬃcer

Nayaab Abdul Kader Merchandise Oﬃcer

Charlie Ding Photography

Rebecca Trenear Staﬀ Writer

Zahra Jaﬀry Staﬀ Writer

Fi Kirkham Staﬀ Writer

Rolake Segun-Ojo Staﬀ Writer

4 of 6 2 of 6 1 of 6 1 of 6 4 of 6

Nursing & Midwifery Editor

5 of 5 4 of 6 4 of 6 5 of 6 5 of 5 2 of 6 3 of 6 5 of 5 4 of 8 5 of 8 6 of 6

With Special Thanks To Rahee Mapara - Contributing Writer Teona Serafimova - Contributing Writer Alice Hully - Contributing Writer Em Johnson - Contributing Writer Hew Torrance - Contributing Writer David KC Cooper - Contributing Writer Anthony Dalrymple - Contributing Writer Iam M Allan - Poet Olivia Johnson King - Contributing Writer Christina Georgallou - Contributing Writer Sally Kamaledeen - Contributing Writer Hannah Cliﬀe - Contributing Writer John Haslewell - Contributing Writer

Ross Watkin - Contributing Writer Maurice Moore - Contributing Writer Lucy Anandappa - Contributing Writer Kati Le Stak - Contributing Writer Aisling McGeough - Contributing Writer Juli McCollogh - Contributing Writer Cara Hanley - Contributing Writer Sharmin Malekout - Cartoonist Professor Stephen Challacombe - Trustee Margaret Whatley - Administrative Support William Edwards - For Assistance and Guidance Many thanks also to King’s College London and our other donors for their generous support

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

Volume: 128 Issue: 2 Number: 2582 ISSN 0017-5870