Gratte-ciels, George Micheal, and GPdom...

To stop this getting too medic-y, I thought I might write about some nice things I did this weekend.



I went to the Italian supermarket in Little Italy and bought olives, fresh pasta, artichoke hearts (ridiculously cheap) and risotto rice. I even heard someone say "Wow, this is just like my Mom (note: not Moma!) used to make!"


I walked on Mont Royal (the park on the mountain) and watched the most amazing sunset overlooking the city. I saw the St Lawrence river in the background, and in the foreground, the gratte-ciels (skyscrapers) as the lights started to come on for early evening, and felt at peace with the world. Here is a photo I am rather pleased with:

I bought two T-shirts, one with a picture of Farine Five Roses on (famous old grain silo sign that still lights up even though the grain factory is long gone), the other days "Vive le bec libre" (Long live free Quebec). A bit politique, but soooo Quebec!

I went to a Halloween party and danced with sailors, cowboys, vampires and George Micheal (!). I saw a girl who came dressed as Eve, which basically meant a bikini with 'fig' leaves stuck on, get told to cover herself up with a coat as she was breaching public decency! I got told off for lacking imagination by wearing scrubs and a tourniquet on my arm (you'd be surprised how difficult that can make drinking!)....I know, I know, but it was short notice. If I go again on Wednesday (actual Halloween) I'll make more of an effort (which seems to equal 'wear less clothes' for girls here....!).

I drank coffee in a cafe with bare brick walls and a piano in a corner, and wrote my thoughts down in my notebook, on a cracked wooden table, while Latino jazz played in the background. It has been cold this weekend- so cold that when I stepped into the cafe I wondered why they had a smoke machine on (it was the heat misting up my glasses!). Winter is coming- fast. My time here is shortening, which makes me sad, but I'm trying to enjoy every minute of it.

What I haven't given too much thought to is my UK-PFO programme (this year's MTAS). I have drafted answers to the questions, but not much else. Today I looked at the programmes. The areas I was thinking of applying to don't have many programmes that include Psychiatry. I'm not definite if that's what I want to do- but I do like it a lot, and it would be good to have it if that's what I apply for my Specialist Training in. Should I apply somewhere I hadn't really considered? Or risk somewhere I know with only 3 jobs that include it? Does it even matter that much anyway, especially at F1 level?

Ideally I want a job where I can do Psychiatry, Obs and Gynae, and GUM. But suggest GP and I'll shoot you, or alternatively myself. Suicidal/homicidal ideation, as they say here. Oh dear. Somebody fetch the sedatives, and pack me off to suburbia....

Keeping Up Appearances

The Mental State Examination is an examination of the patient’s appearance, behaviour, mood, thoughts, cognition and insight. (God, this sounds like a textbook. Bear with me!) It is a way to describe what’s going on in the patient’s mind at that point, and how the patient is responding to that emotionally. The first part, appearance and behaviour, should be so clear that you could read it and immediately pick out the patient in the waiting room if you’d never even seen them before.

For example: Young Causasian (?) male, yellow skin, short yellow hair, orange T-shirt, blue shorts , poor self-care ( wearing same clothes for 10+ years), excessive psychomotor activity.

Might describe:



The other day I read one someone else had written. It said something like “30 year old female, short blonde hair, plastic glasses, unshaven legs.”

The woman in question had suffered a chronic mental illness for several years. The ‘unshaven legs’ was, apparently, a reference to her poor self-care, and, although the patient denied psychiatric symptoms, was perhaps a sign that all was not well.

We all judge on appearances all the time. It’s human nature. But it seems psychiatric patients are judged more harshly than others. If I had a friend with unshaven legs, I might think about it this way- it’s winter so she’s wearing trousers most of the time/she’s single so not bothered about anyone seeing them/she’s been busy and forgot/she thinks it conforms to a patriarchal view of what women should look like so doesn’t do it on principle/ all of the above, but uses the latter as her excuse.

But, said the writer in question, when I ask him about it later: it was written in the mental state examination, because it could be evidence of her mental state. She’s not shaving because she’s not taking her medications and is now becoming preoccupied by her hallucinations. She’s not shaving because she doesn’t want her body hair to fall into the hands of her persecutors (apparently this is quite a common reason for patients with schizophrenia not to shave). She’s not shaving because she’s suicidal and doesn’t see the point as she’s planning to kill herself next week.


At this point, I pull my skirt over my knees, so no-one can examine my own legs too closely.

Amusing Experience of the Day

Sitting in a room full of doctors, nurses and psychologists, discussing what exactly defined "an Emo" (sic).

I think our criteria should be ready in time for DSM-V (which, by the way, I bought a copy of (DSM-IV) in French today, which excited me far more than I should admit to)

A strange experience

Something rather strange happened to me today.

I had a few hours between things, and decided to go and pay my rent (it was overdue). Unfortunately I had to go across the other side of town to pay it, but fortunately I have a weekly travelcard, so thought I should go and get it out of the way

I was on my way when I had to change trains. When I reached the platform, it was packed with people. I thought this wasn't unusual- it was at the intersection of two lines (and this city only has four tube lines) and quite central. I walked down the platform.

As I stopped, I noticed some people in fluorescent jackets on the line. My first thought was they were doing engineering works. Then I noticed they were crowded around a man who lay across the tracks. Their jackets were that of police and ambulence men.

It's funny how the brain works- my first thought was maybe he had a heart attack and fell. But with slow horror I realised it wasn't possible from the way he was lying, perpendicular across the rails (and the way the metro here is laid out, it would be virtually impossible to fall onto the tracks. It would have to be a consious decision to jump.) He was unconsious. On the platforms, every person was transfixed, watching in silent horror as more policemen ran onto the scene.

The metro workers started to tell people to clear the platforms, and only reluctantly did we start to move, turning back every few seconds to confirm with dread what we thought we had seen. It was horrible. I thought I was going to cry. On leaving the station, I was in two states of mind: one verbal, logical, thinking "How will I get across town to pay my rent now?" (and I know how callous that sounds but it was really the only response I can explain), and the second I can't explain in words as it was purely emotional, but it was something like "ohmygodohmygodohmygod".

I walked to the bus stop. Everything felt like it wasn't quite there- as if I was walking on a projected image of the city. I paid my rent on autopilot and ate a hot dog. It was only when I returned to the hospital I ran into one of the doctors in the street. When I told him what happened, he was very understanding, and bought me a cake 'to raise my blood sugar'. He said something similar had happened to him and he'd felt similarly shaken afterwards. I continued my day, feeling better at least that I had talked to someone and they'd understood.

The thing is: I've talked to suicidal patients, who've told me their plans in great depth. I've talked to people who've attempted suicide and regretted surviving afterwards. I've talked to people who say that if they leave hospital, they'll do it again. It was hard but I can handle it. But seeing a body, seeing it so final (I don't know if he was hit by a train, but there are signs everywhere that the tracks are live so anyone touching the lines would probably be electrocuted....) really shook me. Why wasn't this man someone I'd see in the ER saying "I feel suicidal, please help"? Had he already been? What was his story? Why was he there? And why was I there?

And why could neither I nor anyone else turn out heads away? Is it more that just a car-crash reflex? Is it our collective guilt for witnessing someone else's tragedy too late? Is it our shocked realisation that people do this, in front of our eyes and we can't pretend it happens somewhere else far away from our comfortable lives? Is it fear that it could one day be us or someone we know? Watching this man, I felt he was someone I 'knew', in that he was as much flesh and blood as I am now, and I wanted to turn back the clock and stop it from happening.

And why can't I stop thinking about this?

L'avenir

I am in love with the country.

I love its open spaces. I love its friendliness, and the fact that people are genuinly interested in where you come from, and what you're doing here. I love its coffee. I love its awareness in the environment. I love its bilinguality and the fact that people say things like "Quebec is part of the national psyche". I love its pancakes.

I love this city because at 8pm on a Sunday night you can go into a second hand clothes shop and look at old navy uniforms and ballgowns. I love its old houses painted in bright colours. I love the fact that people greet you with "Salut, hello" to see which you respond to. I love that the streets are alive all night, and people are happy. I even love the ongoing roadworks that girls step through in their stillettos on St Laurent.

In short, I want to move here. But it's actually very difficult. To apply for a residency (the equivalent of Specialist training, but which is done striaght after med school), I need to take two exams, one of which has to be taken in Canada. I'd also need to get permanent residence in Quebec (but why would they offer me residence without a job?). And only then could I even apply.

It's a hell of a lot of paperwork, but I could do it if I really wanted to (this elective required a lot of paperwork, and I managed that). But it also costs £500 to enter the exam. So I'd have to be certain about it. That'd take two years, and who's to say I wouldn't have a partner by then, a house, commitments, etc? It'd be 4 years here, by which time I'd be a Canadian specialist so couldn't go back to the UK without reconverting back etc. So I'd kind of be signing up to emigrate.

But I know people at med school who are already taking USMLE (the American equivalent). What future does the NHS hold? Maybe there won't be enough training posts anyway for my year group in 2 years (scary thought that I'll be applying for ST in two years...) so it'd be worth having a back up.

I'd love to do it. I just don't know if I can. Everything is set up for me in the UK- I'm on the conveyer belt and will be packaged off into the plastic bag of one speciality or another. But to move- that'd be jumping off my conveyer belt, filling in a zillion forms and trying to hitchhike to a supermarket in a different town (imagine I'm a carton of milk) just to get on a different supermarket's conveyer belt.

Oh but I love this country. I want so much to come back, but why do they have to make it so damn hard?!

Maybe I should just marry a Canadian...

This post could seriously damage your health....

I went to see a French film today. Despite being in a French-speaking city, I have done very little of it- my collegues are Anglophone, so are my friends, so are half of the patients. So I thought I should give French a chance.

The film was a documentary called Quebec sur Ordonnance (Quebec on Prescription). I'd heard people talking about it, and thought it sounded interesting, so off I went, to try and get through a foreign film without subtitles (The woman at the box office looked utterly perplexed when I asked if it had subtitles “Non….It’s in French. Why would it have subtitles?”)

The basic premise of the film was this: Drugs are baaaaaaaaaaaad (but the pharmaceutical industry is badder).

The themes of the film: Children on (prescription) drugs- bad, Old people on drugs-bad. Drug companies give doctors freebies- bad. Anyone can get antidepressants if they tell the GP they’re depressed (I hate these ‘set-ups’ using actors, it always seems a bit unfair).

A doctor made a mistake with a drug dose and my baby nearly died. A nurse made a mistake with a bag of fluid and my father did die. Prescription drugs bought on the street or the internet are very dodgy and may contain arsenic (this I agree is a Bad Thing). Psychiatric drugs-especially bad (Cue patient saying they take such-and-such for their ‘anxiety’- screen then shows it’s a big bad nasty antipsychotic and lists about 25 side effects).

All drugs are placebo effect anyway (Shopping centre experiment where people are given a placebo pill ‘to make them feel good’ and after 10 minutes they all agree they were sceptical, but it really did work) .

And finally , as the pharmaceutical industry only creates 4-5 new drugs a year, to make a profit they have to find new markets and so creates new diseases where there was none before, purely for their own financial gain (Which isn’t entirely untrue but their use of high cholesterol as an example was a bit odd).

The only point at which they came out in favour of medication was with a man, let’s call him Michel. Michel was chopping vegetables fifteen years ago when he heard a voice telling him to kill his father, which he then did (cue scary silhouette in background of man being stabbed), and has been in a secure unit ever since. Michel then showed us the two pills he took, one for his ‘anxiety’, the other for his sleep.

“And what would happen if you stopped taking them?” said the commentator ominously.

“Oh, the doctors tell me I’d hear the same voices again,” Said Michel cheerfully.

The moral of this story: Most people don’t need to take psychiatric medication, except when it’s stopping them from killing people.


And people wonder why mental health has so much stigma surrounding it……

* * *

In lighter news, my new favourite food is this:

What it lacks in nutritional value, it makes up in ridicoulosly artificial colouring.

I wonder which big pharma will soon be coming up with a pill to stop me getting hooked on it….

Delusions of Grandeur

It's funny what happens to me inside a hospital.

I'll be walking along the street, earphones in ears, beanie on head, scruffy coat with a few buttons missing on, typical student, engrossed in my own thoughts and my own music. I could be any other student, on their way to lectures or (more likely) on their way to get a coffee, to see them through a boring day.

I walk into the hospital, down the corridor, and still I could be anyone, a patient, a family member, or a member of staff. I'm completely anonymous.


Then I step into the doctors office, take off my coat, take off my earphones and enter the real world, feeling completely different. Feeling like I have a job to do, like I know where I'm going with my life, and like I can do it.


Do you remember Stars in Their Eyes? You'd get some 40-something housewife, telling you she enjoyed walking her dogs and doing watercolours in her spare time, then: "Tonight, Matthew, I'm going to be Madonna," and she'd step into the smoke, and when she stepped out, all peroxide wig and plastic crucifixes and fingerless gloves, for a second, just a second, she really was.


That's how I feel.


I go in feeling like this :

And I come out feeling like this: (who one of the patients said I sounded like!)

And tonight, Matthew, I'm going to feel good about it :-)