Do you follow your GP on Twitter?

I did. For a day. I pretty quickly realised that I didn't want to know what he really thinks about his patients and his practice. Not that he named anyone, it was more an attitude I detected. I do know him well, so perhaps that was also a factor. His tweets made me feel uncomfortable.

Then, last week I 'twistened' in to the RCGP twitter feed from their panel discussion on GPs and their use of social media. Frankly, it made me feel ill. Some patients may be taken in by their GP's use of social media, but when the chips are down, what really counts is the face-to-face time with a caring medical professional.

I do follow other healthcare professionals on Twitter, in my capacity as social media networker for two small charities. One is a local cardiovascular support group, the other is a local older people's community centre. I follow the CCG, local GPs, specialists, hospitals, and associated support and community groups. The GPs will almost never interact, retweet or favourite, but they are always on hand to dispense politically correct health care messages.

I really do think that if GPs are on Twitter that it should be for the engaging and interacting, not for spouting those same old messages that the Government is paying for. It is boring. We know we must not smoke, drink or eat takeaways. We know we must eat five portions of fruit and veg a day, exercise regularly, check our breasts, have a smear test. 

What we want to know is that when we really need to see a doctor, the receptionist will be helpful and sympathetic, the waiting room will be clean and inviting, and the doctor will be available, and will see you on time.

Now, if you could tweet that, I'd be happy to follow you. Until then, I'll communicate at our next appointment, whenever that might be.

I'd love to know your thoughts. Do you follow your GP on Twitter? Does your GP follow you bacK?

Beware the medical receptionist

OK, maybe I'm a busy-body. But it really irks me that someone can sit behind a desk and fob me off with bull shit. Apologies for the language, but I am not in a lady-like mood.

The latest transgression comes from the receptionist at my GP surgery. After taking a week to track down a repeat prescription, I went armed with the request. The receptionist waved her hand dismissively, and said they never pay any attention to additional information on the request, such as to where the prescription should be delivered. I was somewhat taken aback by this. Why then, ask the question at all? Moving on, I asked if she would feed back my surprise to the practice manager. Her response? Oh no, the practice manager is far too busy to worry about problems with repeat prescriptions.

Well, we'll see about that. Being a practice manager myself, I know there would be a spot of bother if any of our patients' prescriptions went missing. Occasionally, Dr B does leave the prescription at the wrong hospital, but we always put it right, and most patients understand how this happens.

I completed the online feedback form and was pleased to receive a reply and apology. I'm sorry that I had to bother the practice manager at all. If the receptionist had done her job correctly, and if she had been trained to deal with customers, I mean patients, like me, all would have been resolved amicably on the day.

I'm sure she was the same person who told me to leave my name with her, and my data would be excluded from the recent government-NHS link-up on patient records. Not likely.

The moral of the story. Stand your ground. Make sure that things are put right. It's your right.

My #postacstory

Leaving research was a little bit like leaving South Africa. It was an ending without a  beginning, but still rather exciting. The fact that it wasn't entirely my decision did cause some anxiety, but this was outweighed by the knowledge that I had to be with my Mother during the last few weeks of her life.

Three years on, and I was recently asked to participate in a survey about what research staff do next. I surprised myself with the the answers I gave to the questions. Surprised because although I had been out of research and science, the skills I developed as an academic were still very much in use.

Scientific research is not just about pipettes, and buffers, extractions and electrophoresis, endless gels and PCRs, number crunching and statistics. Research is about teaching, communication, critical thinking, independent working, problem solving and time management. Scientists are project managers, networkers, innovators and leaders. And these are all valuable transferable skills.

So, far from feeling let down about not being in research, I felt uplifted after completing the survey. I had insight, and it has given me confidence that my role as practice manager is worthwhile, intellectual and most importantly, it has a future.

My academic story lasted 22 years. My post academic story is just 3 years old. Sometimes, it takes a prod of conscience to appreciate the gifts we have.

If you want to find out more, click here.

Heart health takes more than just a donation to the British Heart Foundation

I support the British Heart Foundation (BHF). They have funded research projects I have worked on, and, locally, they provide vital equipment in our local hospitals. Their organisational size and the research areas they fund mean that they are an extremely powerful charity, with a high public profile. Being involved in small, local charities I know how hard it is to engage with donors, to get people to part with their pounds for a charitable cause. So I'm not surprised by the increase in ever more 'in your face' fundraising. It just doesn't sit well with me.

And so it was, that when I watched the latest BHF appeal on inherited heart conditions on TV, I felt deeply disappointed. Not because their appeal isn't worthy. Of course it is. It is simply misleading, causes worry, and doesn't say how to get help if you are worried. It's all about getting the donation.

Your doctor will tell you that these heart conditions are complex. There are several causes, more than one gene, and certainly more than one inherited condition. I would urge you to visit the C-R-Y website for a simple outline of sudden cardiac death, one of the conditions specifically referred to in the BHF appeal. A simple ECG screening test can detect if there is a problem.

Yes, do donate to research. Yes, the BHF funds world-class research and researchers are breaking new ground all the time.

But please, also understand what you can do for yourself and your family NOW, TODAY. Be informed. Look after your heart.

The 'white coat effect'

More than 10 years ago, a student doctor in my GP surgery botched a simple blood pressure reading on me. He cranked the cuff up too high, which made me angry and hurt my arm. By the time he managed a reading, my BP was way up. So he called in the b*tch female GP I never go to. Unsympathetic, she sent me home, but not before decreeing that I should report for another BP measurement the following week. And so began 6 months of BP measurement hell, which ended with my husband, a cardiologist, phoning the senior GP to get a sense of perspective. 

I do not have high blood pressure. I never have. They labeled me with 'white coat effect'*. Rubbish. What I have is a built-in annoyance with idiocy. Particularly in GPs. It starts when I book an appointment. Thank goodness I can now book online and avoid the ferocious gatekeepers. I then check-in at the handy terminal (avoiding said miseries/nosey parkers) at the desk. I sit and wait and wait and wait (sometimes up to an hour). The waiting room is hot, uncomfortable, smells of the great unwashed, and is full of sick people. I try yoga breathing. I stretch. I take a walk. I browse the Cosmo. I feel my blood pressure rising, but I am not sick. I just need a prescription review. I wish I could run away. Unfortunately, I can't avoid the actual doctor. He does have his uses. 

Eventually, I am called. He repeats my contraception prescription annually, provided I can provide a BP reading. He accepted that Dr B was suitably qualified to monitor my blood pressure. I hope he never finds out that Dr B doesn't have time to take my home BP readings; I do it myself. I bought a BP monitor with the right sized cuff for my arm. I take the measurement on my left arm, about 1 week before I am due to see the doctor. Tickety-boo. All is well. Life goes on.

Does anyone else feel like this when they go to the doctor? 

*For more information about 'white coat effect' click here.

Care.data : I'm opting out

Updated. NHS England, having listened carefully to patients and doctors, have decided to go ahead with the plan to automatically upload your medical records to a central database. If you don't want this for your information, you need to opt-out. 

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Two weeks ago, an innocent looking leaflet dropped through the letterbox. A quick read of it, and I decided I needed to know more about the Health and Social Care Information Centre (HSCISC). OK, I've been to the website, consulted my GP practice, spoken to a few hospital doctors, and listened to the public debate. I'm definitely opting-out.

Why? 

Firstly, the data which your GP will give the HSCIC will not be as anonymised as the information leaflet would have you believe. Your date of birth, gender and NHS number will be linked with your medical data. So, if there were to be a hack attack, or  someone with malicious intent, all our personal information could be exposed.

Secondly, having worked as a researcher, I know that it is devilishly difficult to keep track of all the data and what it can be used for. In theory, specific permission has to be sought to carry out analysis of the data, but these applications are usually very broad-based, to enable researchers to carry out what we in science happily call 'fishing expeditions'. That is, we don't actually have a null hypothesis but we think we can make something from all the information. It is bad science but it pays the bills and almost everyone does it.

It's not right. 

I have previously said that I wouldn't give blood for experiments in the research lab. Cells and genetic material from these experiments can be stored for years without anyone accounting for it. Any number of researchers can have access to this material, and with very few questions asked. I declined then, and I'm declining now.

In principle, I'm not against the use of data, or for that matter, donated blood or tissue, but until there are better controls across all universities, I do not believe that is possible to know exactly how your data is stored and used. And don't think that your information will stay in the UK either. It is widespread practice to share research data across research communities, in Europe and further afield. These collaborations maximise the research dollar, but will expose the vulnerability in data protection.

If you are concerned, make sure you register your opt-out with your GP today.

Women in STEM careers

Written evidence submitted by Lesley Beeton PhD, in my personal capacity (August 2013).

Summary

• Science teaching for girls at school would benefit from ‘women scientists in the  classroom’
• Science degrees should not be seen as the second choice to Medicine or Veterinary science
• A foundation ‘term’ at university before embarking on BSc study would cement the science basics, increase confidence in the subject and produce stronger postgraduate candidates

1.    Introduction

I am a biologist. I was not encouraged to take chemistry and physics at school, but with school leaving distinctions in biology and maths, I was accepted for BSc study. I spent the summer at foundation school, catching up on chemistry and physics. These are skills which I have used ever since, in my medical science research career.

I have a PhD in the genetics of cardiovascular disease, but I followed a more traditional university career of BSc, Bsc Hons and MSc, before embarking on PhD study as a mature student. This path allowed me the hone my research skills, develop transferable skills and grow with confidence.

I supervised final year BSc student research projects at the University of Surrey from 2004 to 2011.

I am a science blogger, commentator on medical practice, advocate for dying matters, and practice manager for a specialist cardiology practice. I support Thandulwazi Maths and Science Foundation in Johannesburg, South Africa.

2.    Women scientists in the classroom

I was taught by the same very enthusiastic biology teacher for 5 years at high school, and I enjoyed it very much. There was no encouragement to study chemistry and physics, although I was very capable and did take maths. I understand that school education should be broad-based in subject matter, but giving girls the easy option of biology and a language or art, instead of physics and maths, is not good practice.

The successful women scientists I know all demonstrate an understanding of these basic science skills, crucial to calculations and experimental design in the laboratory.

A programme of getting women scientists into the classroom would help to overcome this reticence, build confidence and open new horizons for pupils and teachers.

I mentored a GCSE pupil for a short period in the laboratory. This student wanted to apply to veterinary school after A-levels. As competition for vet school places is fierce, pupils must demonstrate their passion for the subject. The pupil had no knowledge of the basics of cell biology, as there had not yet been any teaching on mitosis and meiosis. I found this staggering.

3.    Encourage Science degrees as first choice

Half of the undergraduate students I supervised had chosen BSc study as a second choice to Medicine or Veterinary Science. These were mostly women students, who were hoping to successfully re-apply after graduation. These capable students saw a career in science teaching, research or strategy as a significantly lower career choice.

Outside of the key centres of excellence in science, research funding is limited. Women scientists, like myself, wanting to work close to home or have flexibility around family life, have little choice. Move or commute, or don’t have a career in science. This is a great loss to science. More flexibility and improved career development funding would see more women staying in science, and showing their daughters that a career in science is worthwhile. What better example to set.

4.    A foundation ‘term’ for better scientists

Undergraduate final year science students could not perform basic calculations, such as ratio and proportion, molarity, molality, or titrate acids and bases. They were unable to prepare solutions for the laboratory, often misunderstanding simple instructions such as make up the volume using a volumetric flask.

Such was their lack of confidence that complex laboratory and experimental instructions had to be written down in detail, like a ‘recipe’ book. Final year students should be able to work independently, with supervision. These students graduate as BSc Hons but lack the necessary skills for postgraduate research or research careers. Many leave science altogether at this point.

Conclusion

Science careers begin at school. It cannot be left to universities to produce scientists. Girls must be shown the value of science careers, as they are many and varied, but all require a strong, confident knowledge of the principles which underpin our subject.

Read the Science and Technology Select Committee report published today.

*STEM Science Technology Engineering Maths

Could all the money in the world find a cure for cancer?

I honestly think the short answer to that is no, but I would love to be proved wrong. 

Funding shortfall

There are any number of high-profile cancer research campaigns, all begging and pleading for funding. The UK medical research funding bodies are really stretched at the moment. Their funding was cut in the first round of austerity measures back in 2009. At the time, research scientists were warned that as much as 20% would be cut from research budgets, and that the remaining funding would be more focussed on translational research, that is, research which would yield applications in medicine, technology, engineering, for example. This meant that much basic science research into novel therapies was cut short. The EU-funded project I worked on for 4 years, looking at a novel gene implicated in cardiovascular disease risk, was cut off from the next funding round. The shortfall in funding vital research will have to be made up from private funding, legacies and public awareness campaigns. So I am always interested and supportive when I hear about anyone embarking on this sort of fundraising for projects near to their hearts. Because behind every campaign is a passion, a love, a loss. 

New campaigns

Two new campaigns have Twittered into my timeline. Two new lines of research into novel therapies for cancer. One is a campaign for more funding for immunotherapy by Ruth Stavric, the other is iCancer, campaigning for more funding for a cancer-busting virus. I have not read the preliminary research on which either of these campaigns is based, so I would urge cancer patients and their families to approach with caution. And in the UK (to my knowledge), these therapies are not available, apart from a small number of pilot study immunotherapy clinical trials. 

Cost

Yes, cost is an issue. The stats for cancer care are astonishing, and an ageing population will present with more cancers. The health authorities are already facing increased detection rates of cancer in patients over 65 years, across all cancers. There is no doubt that a widespread roll-out of novel therapies across the NHS is never going to happen. Indeed, it is rare, even for cancer care of patients who can pay for it privately, to deviate from the standard treatment at the moment. Pharmaceutical trials do go ahead, but the clinical criteria for entering many of these trials limit the number of patients who can enter the trial. There is also a vast minefield of medical ethics to consider, on top of constant monitoring, blood tests, scans and the like. Which goes some way to explaining the lag behind research discoveries.

A bit about the science

The science behind cancer is very complex. On a molecular level the initiator of a rogue cancer cell can vary from a genetic mutation to a break in a chromosome, or a response to an environmental stimulus (like a cold, or a chemical toxin). That is why a 'one size fits all' approach to cancer treatment is unlikely to be found. Breakthroughs in cancer research in the 1990s discovered the bcr1 gene, tamoxifen responsive breast cancer, the bcr-abl cluster in leukaemia, and clinicians have been successfully using this knowledge for a number of years. So it's a long term project. And best results across all cancers will most likely come from a number of approaches, some tailored to individual genetic make-up, some tailored to the individual immuno-regulation response, some using tried and tested chemotherapeutic agents, and some based on faith and alternative therapies. Many cancer patients will benefit from a multi-approach. Many will not.

Living with Mom's cancer

My Mom died of cancer last year. She was only 66 years old. She had small cell lung cancer, a very aggressive form of cancer. Without first stage palliative chemotherapy, she would have been dead within 4 months of her diagnosis. As it was, chemotherapy gave her another 5 months with us. She opted to stop chemo after 4 months because it made her too ill to spend time with her friends, family and grandchildren. And she died a dignified, peaceful death at home. You can read about Mom's story and our positive approach to Mom's cancer. Mom's cancer was complex, made up of different cell types. These small cells spread throughout Mom's lungs and into her spine and other organs. Nothing could have stopped the relentless march of those cells.

And I'm reminded at this time, of two other inspirational women. Ellie died earlier this year, having followed every line of treatment she could, to fight her breast cancer. Kris started CoppaFeel! to promote awareness of breast cancer in young women and is in part behind the new campaign of breast awareness. 

Dying matters

Despite their best efforts, oncologists cannot save every cancer patient. Whilst I applaud all efforts at new discoveries, fundraising and the brave people who take part in clinical trials, people still die from cancer. I would like to see more funding for end-of-life care. More funding to train more people to talk about dying. Because when cancer has run its course, your loved one deserves the best. A peaceful, pain-free death. 

For more information and support to talk about dying, see Dying Matters. Living with Mom's cancer is a member of the Dying Matters community.

Dear Doctor

Thank you for taking the time to listen to my concerns. I feel that we have made great progress in working out how to help Dad. I know that you don't feel that the recent dementia campaign is widely beneficial, and I appreciate that you may be seeing more of the worried well as a consequence of the campaign. But for the families of people who may be affected by dementia, having a public campaign like this will make it easier for us to have the difficult conversation and to make plans for Dad's future care.

You see, Dear Doctor, at the end of our allotted time of 7 minutes, we will only have scratched the surface of a deeply complex condition, for which Dad will eventually need specialist care. 

And as most people who come to see you, Dear Doctor, actually have 4 or five things to discuss, it's hardly surprising that we have to return to see you time and time again, until we eventually give up and live with the pain, or we are referred to a Consultant.

And so, Dear Doctor, I was surprised to find that the Royal College of General Practitioners is running a consultation about the future of general practice and patient care in general practice. Surely, the future of this most vital service would be of wide interest in communities? The consultation is running until 8 October - I hope that many patients will take part.

And finally, Dear Doctor, I signed up for the Patient Participation Survey at the Surgery. I was asked today about what I consider to be the most important aspects of general practice care. These are my responses.

1. Length of appointment time with GP (appointments are very rushed especially for older patients with complex issues)

2. Better information about late running clinics (maybe a text message if the doctor is running more than 30 minutes late)

3. End of life care at home (better planning would help patients and families)

4. Out of hours care (ThamesDoc is a tedious process often of several phone calls followed by 'come to the walk-in centre')

I look forward to our next meeting, Dear Doctor. 

A comment on: Eat, fast, and live longer

A BBC Horizon programme presented by Michael Mosley. This programme explored the role of diet and nutrition in ageing.

At Cornell University researchers are studying a genetically modified mouse strain, which exhibits longevity (longer life) with a calorie restricting diet. This work has been extended to human study at Fontana Washington University. Here, they have set up a long-term study of dietary intervention. The principal investigator was quite confident that the people undertaking this approach are a new species. I doubt this very much. Participants are restricted to 1,900 calories a day, usually eaten at breakfast as a huge bowl of fruit. Time will tell if this approach does indeed lead to a longer life, but if positive results were needed, age-related tests were conducted. These included assessment of balance and reaction times, as well as blood tests for metabolic markers, and levels of body fat. Mr Mosley’s assessment was pronounced as ‘not good for his age’, but the balance and reaction time tests are both subjective and can be improved with practice. More alarming was the absolute declaration that following the calorie restriction programme for just one year will result in a reversal of disease progression. In fact, the researcher went on to say that after following the diet for 10 years, J (a volunteer) would never develop a stroke or heart attack.

The truth is that in order to fully assess the risk of death from cardiovascular disease or cancer, we would need to sequence every bit of DNA in every person in the world, follow those people from birth to death, and analyse their lifestyles for diet, exercise and environmental factors. Then, we might be able to say who will die from heart attack, or not. Some research, including my own, has identified important genes, which contribute to the risk. I have also found out that the normal variation of these genes, interacting with certain environmental factors, like stress, injury or infection, can affect the way the body responds. So, you see, it is a very complex picture, and not simply down to calorie restriction.

Professor Valter Longo, from the University of Southern California does add some science to the discussion. His research centres around an important metabolic protein, Insulin-like Growth Factor 1 (IGF1). Reduced levels of IGF1 in the blood have been associated with slowing cellular metabolism (the so called ‘go,go’ mode), increased repair of DNA damage and protection from age-related illness, in a genetically modified laboratory mouse strain.

Ex vivo research (that is, in cells taken from the animal’s body) have shown that cells in ‘go’ mode are more susceptible to cancer, as they do not show efficient cellular repair. Studies in humans have shown that calorie restriction together with a low protein diet leads to reduced circulating IGF1 levels in the blood. The mechanism of action for this is that as glucose (blood sugar) is depleted in the body, the body (in particular the large muscles) start burning fat for fuel. The liver stops or slows production of IGF1, pushing the cells into repair mode. This is not a happy state of affairs for the body of an active man or woman. Prolonged fasting can be dangerous and should only be done under medical guidance. Extreme metabolic changes can occur with short fasting protocols too. Proponents of the alternate day fast or the 5-2 fast regimes often report that they are unable to exercise on fast days due to dizziness and weakness.

The main tenet of the piece is portion control, which I endorse. It’s no secret that if you eat less and move more, your body will be stronger and healthier, provided of course that you maintain adequate nutrition. And the emergence of these fasting diets for sustained weight loss should be viewed with some skepticism.

There was no discussion about the role of our genetic make-up and ageing, or longevity. Yet, many of us will know people who live long and when asked the secret, simply say eat well, exercise a bit, and have fun.

PhD student hardship

It's a funny thing, PhD funding. It's nothing like the funding for undergraduate study. Sometimes the best candidates don't even get funding. And if you do secure three years of funding, the harsh reality is that it probably won't be enough to live on. Add to that the fact that many PhD research projects won't be completed on time, and there are many postgraduate students at British Universities in severe financial hardship.

Some supervisors are particularly cynical about student funding. Instead of working towards a 'get out' plan, students are deliberately held back, to complete research, analysis or manuscripts. A PhD project is not the student's life work. It is a stepping stone to their future. And that future cannot begin until the thesis is handed in and the viva voce exam completed. 

A peculiar trap is the 'continuing' status. No funding is available. Technically, lab work must have been completed. Students must be in the final stages of analysis and thesis preparation. The rules are stretched, however, to accommodate the never-ending search for the perfect result.

Scientists, the perfect result doesn't exist. If it did, we wouldn't need research. We could simply set the hypothesis and only do experiments to prove it is true. More important is the research which seeks to explain the imperfect. Sometimes, the answer is bigger than a PhD project, and students and supervisors would do well to remember this.

The PhD thesis should set the hypothesis and the means by which this hypothesis will be tested. Once those tests have been done, the hypothesis will have been proved or not. That is the thesis. A thorough examination of the literature will aid the student in the discussion of the thesis. A well written thesis, with sound arguments based on a solid understanding of the context of the work will secure the award of PhD.

It's not rocket science. Don't make it more complicated that it needs to be. And above all, the PhD student knows more about the minutia of their field than the supervisor. Be confident, and enjoy your PhD.

Gross Anatomy: the death of an inspiration

I was saddened to read of the death of Professor Phillip Valentine Tobias, one of the iconic South African academics of our time. He inspired me, and gave me a life-long love of science and the human body. How many young scientists can say that about their teachers today? 

RIP PVT.

This was first published on The Camel's Hump in April 2012, but it seems appropriate to reproduce it here as my tribute to Professor Tobias.

Follow @Shackleford_LB

Gross Anatomy

POSTED BY SHACKLEFORDLB ⋅ APRIL 18, 2012 ⋅ 6 COMMENTS

FILED UNDER  ANATOMY, DISSECTION, EDUCATION, MEDICINE, RESEARCH, SCIENCE

I went to Medical School in 1987. It was an incredible experience, crammed full of learning from inspirational Professors at the peak of their careers. My stand-out memory is the first day of Gross Anatomy. Faced with dozens of cadavers in shrouds, fresh-faced students in crisp, clean white coats, and that smell – I couldn’t wait to get started. Such a privilege.

Each precious body had been donated to medical research, to help train doctors, nurses and physiotherapists. We stood next to our allocated body, four students in a group, and recited a modified Hippocratic Oath. We were to dissect the body over the academic year, 565 hours of dissection, in detail, covering all organ systems, blood vessels, nerves and the brain. Our bible for the year was Man’s Anatomy by Tobias and Arnold, in three volumes. Professor Tobias and Professor Arnold were the big beasts of Anatomy. We were in awe of them. They were known affectionately as PVT and JCA (behind their backs of course)!

Getting started was a hand-trembling affair, guided by this illustration. Skin preserved in embalming fluid is very tough. But once you’re in, you’re in – and the delights of the human body were ours to explore. Over the weeks and months, we committed to memory all the arteries, veins, nerves and bones (oh, my poor parents had that box of bones in their living room); using mnemonics to remember the long lists. For example, Peter And Paul Masturbated So Much Their Balls Shrank refers to the branches of one of the thoracic arteries (I wish I could remember which one)! I can remember, though, that this one refers to the twelve cranial nerves: Oh Oh Oh To Touch And Feel A Girl’s Vagina Very Happily (or something very like it). The point is, we were drunk on anatomy for that year. We were walking encyclopaedia of lists of body parts, our text books were marked in wax pencil (I still have one I used in 1987), and nobody would share the lift with us because the smell permeated our clothes and hair. We knew it and we didn’t care. We were doing something that not many people ever get to do. It would shape our lives in the future. Some would go on to be world class surgeons, some physicians, sports scientists, pharmacists. I decided on a career in research.

Who knows how a career will turn out. I didn’t even do Science at school. I was expected to study Languages at University. I’m grateful to a Biology teacher for showing me something different, and changing my life. She asked me to help her clear out the cupboard in the lab. What we didn’t find in there. And lurking at the back, in a dark jar, was the most gorgeous pig foetus. We changed the preserving fluid, to reveal the tiny, perfect animal; when was he put in there, kept for me to find? I was hooked.

And so, standing in the dissection hall, several years later, in the basement at Medical School, I knew I was in the right place. I grasped the scalpel with both hands and made the first cut. Nine months later, the Technician was standing over the cadaver we had been working on. It approaching the final Lesson – the brain. He used a tiny, whirring saw to remove the cranium. He revealed a clean, shiny brain in situ. In order to complete the study, we had to remove the brain, with all the cranial nerves in tact. I had the smallest hands and I put them on either side of the brain, inside the skull. I tugged gently and felt around the base of the brain, to free the nerves from their restraints. A little more tugging, and I had the brain in my hands. We prepared the dissection and made 1cm slices through the brain, sectioning it in cross-section. I have never forgotten that moment. And neither will countless other medical students. That brain, sectioned, preserved and displayed can still be seen in the Anatomy Museum at Wits Medical School.

Gross anatomy? I don’t think so. Stunning, wondrous anatomy, is more like it.