Soup kitchen

Hi,


This week was my final week on this psychiatry rotation, and looking at it in the 'bigger picture', perhaps my last ever psych rotation. This goes for all of the specialities I have done this year, as unless I choose to take a rotation in one of these specialities when I am a junior doctor (fingers crossed) or choose to specialise in that speciality, I will not do that speciality ever again! This is an extra-big deal for specialities like obstetrics, and psych, where most of the 'acute' conditions are dealt with by specialists. Not such a shame for obstetrics (I have seen things...), but I have really enjoyed psychiatry, and while I don't think its the speciality for me, its a shame to say goodbye.

This week, the main parts were spending a session in a soup kitchen (but not that one) for homeless people, and another 'simulator session' with a robotic mannequin. The 'simulator session' was a repeat of one which I had earlier this year, where a mechanical patient had a disease and you had to try and manage it appropriately  The patient was programmed to respond appropriately to certain interventions, meaning this is a good way for us to practice treating someone without risking killing the poor patient. Last time, we almost did this, by forgetting about an allergy to penicillin. This time, I like to think I have learnt a little, as this didn't happen. It is still a very exciting simulation, as you get caught up in the experience, giving orders to your other fellow 'doctor' and the nurse who is there to help you look after the patient. We had problems such as lots of blood coming out of the rectum, perforated bowels, asthma attacks and so on. Very exciting!

However, I am meant to be on a psych placement. Sometimes it doesn't really feel like that, as there is so much else planned into the weeks I end up everywhere. Even the psychiatric placements are not always very psychiatric, as you may be able to see from some of my previous weeks. This week, the best placement was at a soup kitchen. It was run by a charity (a church) for anyone, and gave out free breakfasts and lunches. It seemed that this service was heavily used by homeless people, but if I had known about this a few years ago, I could have got some good meals when my budget became a problem! About 50 people were fed breakfast, and then hung around 'til lunch, and I am told that this is a quiet day! There is clearly a great demand for this service, and between breakfast and lunch there was a jumble sale of warm clothing for the homeless people. Not everyone there was homeless, some people had houses sorted out, or hostels, but were still without money for food. There was no need for the people using the service to pay, but many contributed a small amount (50p or so) just to try and help out. I was there to help serve out the food and generally much in with the volunteers who ran the place, and they were all a lot of fun! The person who cooked all the meals was a chef who worked the evening/night shift at one of the restaurants, but came here each morning to cook lunch from food scavenged from supermarkets at its sell by date. He explained that the evening job was for his rent and food, whereas this morning volunteering was for 'him', and let him feel he was doing something useful. These sort of unsung heroes lurk everywhere!

I am not too sure why I was placed here as part of my medical rotation, as it certainly didn't have much medical stuff in it, but it was very interesting talking to the people turning up. If I had more time, I would like to volunteer somewhere like that, but I just don't have time to spare at the moment... Many of the people didn't really want to talk to me about their own social situation, but were happy to engage in a chat about other things such as the economy, or literature. Many of them were surprisingly well read! One of the people there had studied history with Gordon Brown at university, and created a reading list for me, which he wrote on an A4 sheet of paper. Sadly I lost this cycling home afterwards! Another person was talking to me about the opposite of fragile. I would have said that this was robust, but was quickly told that I was wrong. Fragile things break easily, robust things just last longer before breaking, so this is not the opposite. This man claimed that there was no real word for this, but the best explanation would be 'antifragile', meaning something that becomes stronger when stressed, rather than weaker and breaking. He had a number of good examples of this, but the one that best stuck in my mind was (of course) to do with medicine and science. 
A hypothesis is a fragile thing, and can easily be disproven. A more robust thing would be phenomenology, being the study of phenomenon. Much harder to prove something is wrong, unless you are measuring it correctly, but still not the opposite of fragile. Here, he claimed the opposite was evidence based medicine (something close to my heart). In EBM, the more you stress your hypothesis (lets say that defibrillation can restart the heart, and save a life), the stronger it gets, as it gains more evidence. Antifragile! (This Antifragile  book may have been on my 'reading list' - I am so sad I lost that!)