Oxford, Medicine, Coffee

Air pollution in Sri Lanka - a rant

2011-05-29T12:42:00.000+01:00

Something burning, 24 hours a day.

I need to get something off my chest. Haha. We all do, even if we don't know it yet.

It's hard to know where to start - there are so many things wrong in this picture. But let's start with those chimneys.

Sri Lanka has a few things to sort out, and the air people breathe in Colombo is a good place to start.

Did you know this country has emissions rules? And vehicles get emissions-tested? Hard to believe, when you see the exhaust from the average minivan. I've heard that vehicles sold here constitute "Japan's dumping ground".

This country needs nuclear power. The whole world does. We have to stop burning diesel and all other sorts of lazy polluting fuels, not just for the biosphere but - being purely self interested - for us, for people.

I say nuclear because i think it's the feasible option. Renewables could do the job too if we can get enough of them. Whatever, we need electricity to replace petrol, diesel etc, and we have to get it without burning hydrocarbons. No-one wants to be energy-poor again (people haven't listened to Illich). Fossil fuels have been fantastically cheap, easy energy - just try to cycle at 20mph, then do the same in a car or on a motorbike - and we need to make sure electricity is there to take their place).

I cycled home from Colombo tonight, and my snot is blackened by all the god-knows-what in the air. (I'm almost the fastest thing on the main road, because the traffic is so bad, at standstill mostly, but confident motorbikes - and me - can go up the inside, where the tarmac stops. Dirt surface, no pavements, somehow they can afford 4 or 6 lane highways, but no pavements, it's appalling. Yay for suspension though).

Why do we put up with this? The black stuff in one's snot at the end of the day, i mean. We wouldn't put up with someone pissing all over us, and that might be healthier. Or do rich people who matter just hang out only where the air is clear?

They have some Thorium here, but not the skill or commitment to use it yet. I saw a newspaper headline (one of the english ones) that was effectively "Government rethinking nuclear due to OH NOES NUCLEAR GONE WRONG IN JAPAN". Not v encouraging.

On that subject - the way I see Japan is:

OK, bit silly putting a power plant in earthquake area, and right on the coast. But all of japan fits that description (or is mountains) so they had little choice.

And then, what happened is actually a great ad for how safe nuclear is. Plant runs merrily for decades, then is hit by a R9 earthquake and tsunami, and just about melts. There's time to get out. Some deaths, workers at the plant, which is thankfully mostly automated.

Take any other power plant, most of all coal, and you'd have more deaths over those decades (from massive piles of coal falling on people etc), then more deaths on the day in March. Plus deaths at the coal mine. (I know uranium mines aren't safe either, but they're smaller).

So why the resistance? is it the cognitive bias, to avoid the possibility of "dread" events - rare terrible catastrophes - even if it means being subject to more everyday harms that far outweigh the dread possibility?

Yes, nuclear can be a catastrophe if it goes wrong. But burning fossil fuels is a catastrophe even when it goes right - it's just a fundamental component of doing it. When we grow up, we have to get past our irrational fears - of the dark, of spiders - and it's time we do the same about nuclear.

Cargo bikes, trikes... Why not a trailer?

2011-05-10T09:11:00.000+01:00

I’m a medical student, about to be a doctor. I move house annually, I don't have a spare £1000 and have no garage – so a dedicated cargo bike or trike is out of the question.

Last summer, I remember being asked, by a local cyclist of a certain age, “what’s a student doing with a bike trailer”?

However, a simple trailer (one of those £80 “avenir mule” jobs) works fantastically for me. At the risk of sounding clichéd, it just fits into my lifestyle.

It cost the same as filling a 4×4’s tank, but it’s lasted me 3 years now, and still going strong.

I do the weekly shop with it. I’ve moved furniture (a butcher’s block) with it. I’ve transported nearly 40kg of commercial espresso machine and grinder with it. I’ve shifted gym weights with it. When my partner arranged a medical student event in Oxford and needed to transport refreshments (crisps, snacks, fruit, and at least 20l of drinks), she took the trailer.

When it’s not being used, it folds up and lives on top of the big freezer in our utility room.

I find it’s quite welcome on the roads – maybe Oxford’s drivers are used to this sort of thing, or maybe the yellow tarp over the top is a help. People tend to give me plenty of room! There’s the odd cycle path that clearly hasn’t thought about people with more than two wheels, but you can manage.

My point is – doing this is entirely normal, not extraordinary. I don’t have room for a car, nor do I feel like spending thousands of pounds, just to move me and my stuff around.

For exactly those same reasons – space, and a lack of a few thousand quid or so – I don’t have a cargo bike (or trike). It’s just not practical.

But a trailer – now that just does the job, and tidies away when it’s not needed. So, why wouldn’t I have one?

Vehicular Cycling, the Right to Ride: who is the CTC for?

2011-05-04T09:32:00.000+01:00

I've just read Freewheeler's post, "Lorries killing cyclists: what is to be done?"

This is a great summary of the situation - there's a real sense of energy, and understandable frustration, from his writing, and it really pins down the issues.

I wish I was in the UK at the moment, to help with the good work of the Cycling Embassy. As it is, I'm out of the UK until June - I hope to get involved once I'm back.

I say this as someone who rides a bike, who loves to ride, who feels like the world is a better place when people can get from A to B by bike. That it should be one of the most obvious choices in the world. And that the bicycle, although not the whole solution, is a necessary element in any better world.

I'm also a card-carrying CTC member. To ride a bike in the UK, I've become a "cyclist".

After 6 years of riding the bike, I'm now a fully-fledged vehicular cyclist - out of necessity rather than by choice. With my helmet and my Saturn yellow coat, I can get out there and "share the road", even when other road users aren't too keen to share it with me. My lifestyle has adapted to include VC.

I've had my near misses. One collision, where I was rear-ended by a motorist on a country road. So far, nothing serious, nothing to stop me cycling, or worse.

But VC is a choice, however forced, that I am able to make. Most others, not so young or fit or brave (or foolhardy), can't begin to choose this way of life. And why should they have to? I wouldn't wish VC on my worst enemy, let alone family or friends.

When both my partner and my parents started cycling to work, I felt an immense sense of happiness, joy, even pride. Actions speak louder than words, I thought. I'd set a good example. It wasn't cheery comments, along the lines of "you'd have to cycle for 3000 years, on average, before you'd be hit by a car!" that had made the difference. Instead, all they'd needed was to see that it was possible, and they made the "right" choice for themselves.

Once your loved ones take up cycling, a funny thing happens. They're exposed to the world of crap, the indifference, the utter criminal negligence on the roads that you've been weathering for years. They can drive, they know the rules of the road, yet they're shaken by their experience. They come home and tell you about it.

Suddenly, VC doesn't seem as much of a solution as it did before, when it was only your life on the line. Another day, and another cyclist - someone's sister, or son, or father - is killed while riding their bike. And the world goes on.

I like to think I've done my family a good deed, helping them get on their bikes. The cheery statistics do tell me it's a net benefit to their health. But the thought that they could be next, that VC is putting them at risk every time they're out on their bike, makes me more than a little uneasy.

So, what is the CTC for? Is it for radical change, for everyday cycling, for everyone, and for the conditions to make that happen? If so - why so little mention of The Netherlands, Denmark and the rest? Except to suggest that we can't ever have what they have, and that it'd be wrong even to start, even to try.

The denialism, the head-in-the-sand to what is happening in the UK, is breathtaking. Statistics manipulated, presented in relative terms to inflate the numbers. "50% more cyclists in London", for example. Gaudy saturn yellow press releases on cycle training, lorry driver "awareness", the endless helmet issue etc. And meanwhile, cycling in the UK flatlines.

CTC, LCC, Sustrans - all have collaborated in preserving the status quo.

CTC and LCC - One road for all, shared - but not equally of course. Understandably - it's hard to share with vehicles several orders of magnitude larger or smaller than yours.

Sustrans, of course, has taken a slightly different approach, at best seeking out excellent off-road routes. At worst, they have conspired to tidy cyclists out of sight, out of mind, dumping them onto inadequate towpaths or old railways. These may not be direct, but at least they're scenic.

In the 1950's, the British Medical Association was strongly opposed to the creation of the NHS. Doctors felt the status quo served their interests quite nicely. But the change was not intended to benefit them - it was for everyone else in British society. In time, the BMA realized that medicine was bigger than their members' interests.

The CTC has been protecting its members' interests since its inception. It bitterly opposed the introduction of segregated cycling facilities almost 100 years ago, suggesting that cyclists might lose the "right to ride" on the road.

Over the following century, it backed itself into a corner, still defending that same right. Except that fewer and fewer people want to ride on those roads, such as they are. What works for me, and other cyclists, on a fast Sunday ride or Tuesday evening training session, does not work for the vast majority of the population. "Cyclists" are now a much derided, pitied, ridiculed minority, and most adults never ride a bike.

Does the CTC wish to see this change?

Or will it watch, as its members add Hi-viz to their wardrobes, lights to their helmets, air horns to their bikes, cameras to their handlebars, and decide that it knows which products to review for this year's Xmas Cycle magazine?

Mmm, Infrastructure...

2011-03-18T09:42:00.004Z

Cycling in Oxford occurs despite, not thanks to, the council. We're a small, 2-University city, so lots of people want to do it, but how do they help?

With infrastructure like this. An undulating lumpy strip of road, sandwiched between a bus lane and people parking up on the pavement. (Oh, and if you have a tricycle - or a pushchair, or a trailer, or a wheelchair, don't bother. You're not welcome here). Given the quality of the surface, it isn't wide enough for one bicycle, never mind passing.

Of course, in this photo I am "going the wrong way" - but I promise you, the other side of the road is worse. No bike lane, no bus lane, just a potholed gutter.

As a "vehicular cyclist", of course, none of this is a problem. I can just "take the lane", "adopt primary position", and all the other survival strategies I use on a daily basis, just to survive cycling in this mess. And this is exactly what I do. (I even have a rather fetching Saturn Yellow jacket to wear on these occasions).

But there's no way I can suggest cycling to friends and family, given these conditions. "It's fun, and fast, and easy" just doesn't ring true when people come up against this. Something which should be relaxing becomes terrifying at times, even to experienced cyclists like me - how on earth can people new to cycling take it?

Fuels prices would need to be a whole lot higher, to get people cycling on paths like this.

Cycle parking solutions - Horwood Close

2011-01-30T12:08:00.001Z

Space for 6 bikes; more if necessary!

As detailed before, our cul-de-sac has totally inadequate parking for bicycles (ie almost none).

In the interim, I have built a parking station on our driveway. It has room for 6 bikes comfortably, and more can pile on if needed. We have been using it constantly for a year now, with no problems. 3 wooden pallets, a claw hammer, a saw and some nails is all that's required.

At first, local drivers didn't know what to make of it - people had grown quite used to parking on our driveway. They would attempt to park as close as possible, making it impossible to get bikes in and out.

Gradually it has been accepted as a fixture. My partner suggested painting it brightly, turning it from a heap of wooden pallets into something in its own right.

Recently I came across the RoadWitch project, and realized this is probably similar to what we have done - reclaiming space from the car. On a smaller scale, of course - and only to turn a single parking space over to multiple bikes.

Perhaps free residential parking spaces elsewhere could be turned over to bike parking like this? Ideally our councils would be the ones to do this, and would identify locations where it's needed most. Sheffield stands would also be a better choice than wooden pallets.

Oxford is fairly fortunate to have good bike parking in the shopping and university parts of town. But residential streets have been neglected so far - on-street parking should accommodate bikes as well as cars.

Car-sick Oxford cul de sac

2011-01-30T11:37:00.004Z

The view from my window

This is a fairly typical image in Oxford. An ordinary cul de sac in Headington (Horwood Close, OX3 7RF, if you're interested).

Oxford is a 2-university city. With this comes students - lots of students. In turn, buy-to-let landlords and letting agents move in, either out of financial self interest, or a strong sense of social responsibility. Or maybe an element of both.

To accommodate the student population, and to extract the most rent from their investments, it's common for these to "renovate" properties to house more people than originally intended.

This is visible in the photo above. See the house in the background, with the white garage door? Every house in the close started off like that. One by one, the garage doors have been bricked up, adding a bedroom and making these 5 or even 6 bedroom properties.

That's what the building site in the photo is about - renovating another student house.

With no garage and 5 or 6 students per house, you'd expect a few parking problems - and you'd be right. I'd estimate there's 2 cars per household - the photo doesn't show the scale of the problem, as it's a Sunday morning and some of the cars are off running errands etc.

Oxford Brookes' campus is 1km away. The older Oxford colleges - 2km. Perfect for cycling.

Yet this cul de sac has a major car problem, and no cycle parking. (There are a couple of Sheffield stands up at the far end of the cul de sac, but nothing at this end).

What is needed is parking for maybe 30 bikes. This could replace 3 parking spaces. Nothing fancy, just Sheffield stands, perhaps with a bus-shelter style roof over the top. (I can dream).

Pehaps when local councils approve building alterations, as they have done in this close over the last 10 years or so, they should require that the property developers also put in the necessary infrastructure to suit the changing use of the housing?

So, when family homes for 4 people, with garages, become student households of 5 or 6, the developers should pay for on-street bike parking. Like how big housing developers may be required to build a school when they want to build 500 homes, but on a smaller scale.

Next post - my stop-gap interim solution.

Stop the child murder - UK edition

2011-01-29T13:32:00.012Z

Parents in the UK, and the rest of us, have a terrible choice to make. I hope it is not an understatement to say this - and that the title is appropriate.

The choice is this:

- On the one hand, letting your child out to play, or to ride a bike to school, seems like madness given the state of the roads (and the steady stream of news peddling fear). So most parents keep their kids in, and drive them to school. If i had young kids, there's no way I'd let them cycle on the very roads I ride every day.

- On the other, keeping our kids inactive is storing up an epidemic of health problems for the future. Obesity, diabetes, depression - it's here already, and it's going to get worse.

We need to let our kids get out, be active, and cycle to school. For that, we need to make a major change to our environment.

This has happened before.

In the Netherlands in the 1970s, a few people recognized that car usage was on the way up. Also, the number of people killed or seriously injured (KSI) on the roads was also on the increase.

"Stop de Kindermoord" ("Stop the Child Murder") was the response.

David Hembrow has already detailed this (at http://hembrow.blogspot.com/2011/01/stop-child-murder.html ).

It was abhorrent and unacceptable that child deaths would be the cost of driving - their government responded to this, and gave the necessary attention and money to developing safe, effective cycle routes. (Ones you would actually want to use, not the paint-on-pavements "safe-routes-to-school" the UK has opted for). Cycling increased, and deaths on the roads fell in the same period.

So, if the UK is to have its much-mentioned "cycling revolution", perhaps we need to make this less about cyclists, and more about children?

The nutjobs can rant and rave about how cyclists "ride on the pavement and run red lights and don't have lights and don't even pay 'road tax' and murder policemen and...", because they don't cycle and they don't know anyone who does.

But everyone knows children, or can sympathize, and would wish them well. And best of all, they're on our side! They overwhelmingly want to get out more, and to cycle.

We are in a very different position to the Dutch in the 1970s. We have engineered cycling completely out of the equation, off our streets and out of our collective consciousness. The scale of this erasure is so complete that it would be hard, now, to make the case that children are dying on our roads. The problem is so bad, that parents have chosen to protect their kids by keeping them off the streets. We're still killing them, but softly - depriving them of activity and fresh air now, and setting them up for major health issues later.

We can offer helmets, and cycle training, and say we're promoting cycling, but as long as we fail to address what keeps cycling at pitiful levels in the UK (2% of journeys; 68% of adults never cycle), all that training just helps people ride around Centre Parcs - they won't do it out in the world.

This is why i despair of the mainstream cycling lobby in the UK - the CTC, and Sustrans, who seem to have colluded with TfL and the DfT to maintain "vehicular cycling" as the only option. It's certainly the only way i feel safe to cycle in the UK, but it's a last-resort survival tactic i wouldn't wish on my loved ones, or anyone else.

(Vehicular cyclng - Copenhagenize has a tongue-in-cheek discussion at http://www.copenhagenize.com/2010/07/vehicular-cyclists-secret-sect.html )

Their "hierarchy of provision", with dedicated cycling facilities at the bottom, is no doubt meant with good intentions. We would all prefer calm, safe roads (designed with cycling in mind) to the pisspoor pavement bike lane / shared-use paths that serve no-one and put pedestrians and cyclists at risk. To be honest, this is broadly what they call for.

The outcome, however, seems to be that the middle option, "reallocation of carriageway space" (aka gutter cycle lanes), has been overwhelmingly popular with planners. It costs peanuts, and doesn't interfere with the road layout (since dashed-line "advisory" cycle lanes, the commonest type, allow any vehicle to drive in them). The better options - actually improving the road network for cycling - are just seen as too hard.

The CTC tells us that they "believe that pavements should be safe for pedestrians, and that the carriageway should be made safe for cycling". Neither has happened. Cycling (and walking) are flatlining in this country. Unless we rethink radically, and change our priorities, it's only going to get worse.

Interesting article on student protests

2010-12-10T16:51:00.002Z

Don't know if you follow her already (I subscribe to her rss) but Laurie Penny's most recent bit in the New Statesman is very interesting:

http://www.newstatesman.com/blogs/laurie-penny/2010/12/young-protesters-police

I don't agree with the protesters about tuition fees. I think they're sadly necessary, mainly as a legal mechanism to insist that EU students pay for their degrees - something a "graduate tax" could not achieve. And that the effects can be mitigated with a matched student loan. So that people like my parents, but in the next generation, can get to university.

But I totally agree with the protesters about what (I think) these protests are becoming about. Not student fees, but the government's turning-their-backs on young people and democracy, in favour of oligarchy, corruption and riot police. Their unwillingness to engage with the public. That's something I can imagine marching about.

Grrrr. Also, today's Daily Mail homepage is highly recommended. I don't usually go there, but it's important to see how they portray this stuff.

Mushrooms - Grifola frondosa

2010-10-30T23:46:00.005+01:00

AKA Maitake, or "hen of the woods".

This mushroom is delicious, and difficult to mistake for anything else. It's also likely to be as big as your head. One bracket is the size of an ordinary mushroom - and the clump might weigh over a kilogram.

Close up of underside (fingers for scale).

Luckily, there are no poisonous bracket fungi! So, if you can just be sure that it is a bracket (not hard), then you are safe. Of course, most are inedible just because they're too chewy / taste rubbish, but if you're desperate, at least you won't die.

The most edible bits are closest to the edges of each bracket. The middle is very fibrous. I found this one in September, by which time it's already quite tough.

It makes excellent mushroom stock, though! Chopped up, stored in freezer bags (in the freezer) - then when you feel like it, you can put together a potato and leek soup with a mushroom stock base. Mmmmmm.

On another note - I have very tolerant housemates! They put up with me walking through the door with this thing. (2 of them, in fact).

Mushrooms - Agaricus xanthoderma

2010-10-25T14:35:00.008+01:00

Tasty tasty mushrooms?

They look delicious, don't they? They're not...

These fine looking mushrooms were growing in undergrowth just on the edge of the hospital grounds.

(I'm Mr Blurrycam today, and for that I apologize).

(I took the first photo a while ago, on a sunnier day, in a different hospital).

So, the Agaricus genus contains many of the edible mushrooms we all know - including Agaricus bisporus, the cultivated shop mushroom. It also includes A. campestris and A. arvensis, the Field Mushroom and Horse Mushroom. Mmmmmm!

Sadly, it also includes this false friend - Agaricus xanthoderma, the Yellow-staining Mushroom. Ugh. Rather than smelling nice, or mildly of aniseed like the others i mentioned, this one smells... weird. Like phenol.

It also highlights why it's important to be thorough in your identification. Apart from the smell, this one looks very similar to the tasty agarics. The trick is to look for the yellow stains at the base of the stem -

- which is why, when picking agarics, you need to scoop out the whole stem from the ground! DON'T break it or cut it off!

With this mushroom, if you crush or bruise the base of the stem, it turns strongly yellow. And then you throw it away. Otherwise you get to be very sick, if you eat it. (And as always, wash your hands). Sorry I didn't get a photo of the yellow - Google it if you're interested.

If you're not sure, DON'T eat it. Check with an experienced mushroom hunter, or a good book, or both. I'm using Antonio Carluccio's "The Quiet Hunt", and loving it!

More on mushrooms as I find them...

Prioritizing, or the importance of really important stuff

2010-10-12T22:39:00.005+01:00

It can be difficult to juggle, to prioritize, or sometimes to see the woods for the trees. This is not going to go away any time soon (and, incidentally, is the subject of a whitespace question we're tending to at the moment). But it can be enjoyable.

Making a list helps, obviously. But that's a pretty poor response to life's problems - what, list it all, then rank them? It can be a pretty helpful response, as long as you leave out the more nebulous issues. (Angst over existential things can always wait).

How to identify the important stuff? Really, only major situations with serious consequences, that are remediable, count for anything much. Irremediable ones get triaged "blue", and you move on.

Currently this means juggling 3 issues:

Finals (distant, but v v important)
Job application (up close and personal, also very important, a bit nebulous)
Mood (ongoing, needs close supervision, easily dealt with through sleep hygiene and exercise - usually a bike ride).

Good thing is, these are greatly dissimilar. which means one can chip way at them all, if not simultaneously then ~concurrently. (Does that make linguistic sense? Don't think so.)

All need attention for roundedness. Learn medicine, get a job, and adjust to clipless pedals. I'm getting there!

There's a 50% chance I'll take citalopram, for research purposes, in around a week's time. Here's hoping that doesn't knock any of this out of balance.

UPDATE - now taking the citaloplacebo, and submitted the job application last night. Prioritizing's going OK!

Action Arrows 100 - charity bike ride

2010-09-20T12:11:00.008+01:00

So I did this thing yesterday - 100 miles, on a bike, for Action Medical Research.

(Sponsor me! It's not too late! Go to http://www.action.org.uk/sponsor/pjmcnally for more details).

This was great fun, and hard work - it's a long slog to the finish. Plus i wanted to do it faster than I did Oxford to Cambridge, which was only 82 miles. (Though i was alone then, on a heavy town bike, with luggage).

In the end i managed 6 hours 37 minutes riding time, 7 hours 18 minutes total. Which I'm pleased with! Many roadies, on £1000 plus bikes, did the same or slower. Plus i had a crash, which didn't help. (But didn't lose too much time - bike unscathed because it landed on me, and me just covered in road rash in places).

Things i learnt:

You really go a lot faster in a bunch. Like 4kph faster, for the same effort. Unless you're on the front. It must be partly psycholoigical , too. Don't get dropped! Really fun, holding on to the pack.

In the last 30km, if you think you can manage only 22kph by yourself, stick with a bunch doing 28-30kph! The effort will be comparable to pushing 26kph, and you'll get home sooner - maybe less strenuous overall, too. Plus you cross the line together :)

Crashes don't hurt at the time. You don't notice where you're bleeding til someone mentions it.

When you go down, you have enough time to think, "the bike is coming next" before it does.

You need to hope the guy behind is alert and clear enough to not go over you (i was very lucky).

Motorola phones are built like tanks. That's 2 crashes this one's survived.

Clipless pedals. Everyone is using them. In fact, one of the best compliments the roadies gave me, when we finished together, was "well done, you did well keeping up with us on that bike - i mean, not a light bike, no bike shoes, pedals with clips+straps - you did very well. Showed us up"). So - might have to go clipless sometime soon.

Etc etc. Bikes are great! But i knew that anyway.

Cycling/Medicine...Yes, that's a slash...

2009-07-26T22:48:00.004+01:00

..."Is there a doctor in the building?"...

So...

I worked the Cyclox stall at the ACCAN(1) event this Saturday, up in Blackbird Leys. Banging the drum for cycling. Oxford's not the perfect city for cycling - nowhere is - but it's pretty close. There's no better way to get around...

Stop, before I go too far. Let's just take it for read that: 1) I think bikes are great, and 2) I spent my Saturday happily informing all comers, young and old, of this.

In fact, most of my Saturday was about bikes. But a small portion of it was medicine, unexpectedly, out of the blue. I didn't go looking for it - but sometimes, these things come to you.

Lunchtime, at the Leisure Centre where ACCAN was meeting. I'd spent the morning talking bikes, cycling, transport, to anyone who came near our stall or looked interested. It was just before 13.00, and I'd collected my lunch (from the food stall - v v popular), then returned to stand beside our stall, poking my rice with a plastic fork.

A woman was coming my way, slowly. When she reached me, she grasped my arm - rather more assertively than I would have expected from her small size and weak/gentle appearance - and said; (I'll paraphrase);

"Can you get me a seat? I don't feel well. Get me a seat, please".

I sat her down at our stall. I asked her name, age, (mid 60's) and what was the matter - i also told her i was a med student.

"I have some pain, just here [points to sternum, with all five fingers squeezed together, forming a diamond shape], and i don't feel well at all".

- oh no, that gesture - it's suspiciously like one of the three that people make to describe an Acute coronary syndrome -

"Ok - just relax - is your pain just there, or anywhere else as well? And is there anything else?"

"No, it's just here [lays right hand flat across chest, again at the sternum, perhaps slightly to the left]. I just feel so weak, and a bit sweaty".

- two of three -

"Has anything like this ever happened before? Is this pain familiar at all?"

"I had something similar after breakfast this morning, but I sat down and it went away. Not as bad as this. I've never had anything like this before".

"Ok. Are you with anyone here today? Or is there anyone at home with you, or children nearby?"

"No, I came here on the bus this morning by myself. And I live by myself - and I don't have any children. This isn't serious, is it? I've just booked my holidays, I'm going away tomorrow"...

- At this point I felt her pulse. 60, regular. What?! Mine was probably higher than that. Maybe she's rate / rhythm controlled? -

"Well - it may be nothing, but it's best to be sure. Are you on any medication for your heart / have you ever had a heart attack, or angina?"

"No, nothing like that at all. I have inhalers for my asthma, and thy... [thyroxine] for my underactive thyroid, but nothing else".

"Right. Well, I'd just like you to sit here, and I will go to the Red Cross stall and ask for assistance".

- The first person I meet on that stall is wearing a Red Cross uniform, but he's painting a woman's nails. I ask him if he's medically trained; "Ah, no, you want [name], he's over there somewhere". Right, thanks.

I discuss my findings with the first aider; it's my lucky day. He's a trained community first responder, and has oxygen and a defibrillator in a bag under their stall, just in case. We agree that he'll stay with the patient, and I'll make a phone call for an ambulance. He's immediately calming the patient down, slipping a sats probe onto her finger (98%, 58bpm), and I see that she's in good hands -

999 - "Emergency services; which service do you require?" "Ambulance, please".

- After this, everything happens quickly. I give the details of the patient ("Yes, she's awake, she's not in any pain now, she's not blue"...), tell the reception where to send the paramedics, and get back to the patient. The fast responder arrives, then the paramedics. They take the woman to the back of the ambulance, do a quick ECG, and decide to take her to hospital; I feel relieved, somehow - my call was needed after all -

Strangest this is, I remember the first responder asking, once I'd ~presented the patient and suggested a cardiac cause; "Right - and what other emergencies could present like this?"

"With this pain? Oesophageal rupture, aortic dissection, or just maybe a PE?"

- for a moment, it was just like an evening in MAU. A familiar experience - in an unfamiliar setting. There was even the enigmatic "Hmmm.", of the questioner's faint surprise at the answer to his question (that it was answered ~correctly? that the answer was bizarre and wrong? You never can tell) -

And then, back to promoting cycling, and life goes on.

1. African Caribbean Community Action Network. (They were promoting healthy living behaviours, including exercise. In Oxford, that ought to include cycling).

Briefly, almost a year

2009-06-26T23:14:00.005+01:00

Nearly a year, and what has changed?

Well, quite a lot. Since August 2008, the following:

Not living alone*
4th year Medicine - all of it*
Travel - Hong Kong, Ireland*
Autumn, Winter, Spring, Summer...*
Coffee - my appreciation*
Coffee II - meeting the people*
5th year Medicine - starting in July*

(Below, extra details for the obsessive / me) -

Maria and I have co-habited for >11 months now. And this is a good thing.
This means a Laboratory (academic) course, then a little general practice, followed by true clinical rotations. In my case - DGH, SSM, Surgery, then Medicine. And finished with an OSCE.quite a lot to keep track of, and too much to think about now. Hopefully, the SSM will result in a poster presentation this September.
Christmas in Hong Kong - quite different to how they do things in the UK. And then a quick summer cycling holiday, in Ireland's northwest.
Of course. This made for an exciting 4th-year. Being snowed into your DGH accommodation, able to reach the hospital but not return to Oxford (we biked to the attachment, the day before the snows came), makes for good medicine.
Over the year, I've progressed from fluffy-clouds cappuccino to some of HasBean's finest, and also my own over-roasted (home, pan-roast) espresso. From there, I've moved on to oven roasts, and replaced the little Gaggia Carezza with a 2nd-hand commercial 1-group Bezzera, net weight 27kg. (The water in its boiler maybe weighs more than the Carezza). Its restoration - my Spring DIY project. Meanwhile, I take an AeroPress to work more days than not. This July, I've taken delivery of a Behmor home-roaster - will let you know how that gets on.
At first online, discovering an community of knowledgeable people, and then this June meeting many of them during one underslept, overworked (and overcaffeinated) week in London. (a global health course by day, and coffee most evenings). Remarkable, how hardworking and welcoming a community these people have made.
Neurology at the moment; most of all, it's strange to be in Oxford, in the hospital, over the summer. July means summer heat and convectional rainfall - time to be outside - but the hospital carries on as usual...

Paid to lie on your back... ATLS

2008-08-15T15:08:00.005+01:00

I'm mostly away from internet at the moment, but while in college I'll mention this -

There are a wide range of ways you can sell your body, or use thereof, or of parts thereof. One of the great things about being a medical student is, the full range of these is made much more available to you than to most people. (Except perhaps the oldest profession). Today, I tried out a new one.

The ATLS, advanced trauma life support course, is a surgical equivalent of ALS, and is examined from time to time in Oxford. They need bodies. Live, complicit ones, with a sprinkling of medical knowledge, to simulate various scenaria. Today, they were testing registrars on their trauma skills, and i went along.

Arrived at 07.30, after a (really excellent) cappuccino, homemade to wake me up (and for the love of the thing). I was assigned a car-crash scenario, wherein I would have driven into a utility pole and been thrown from the vehicle, through the windscreen. This needed serious makeup; moulage. They built up material on my face (brow ridge, nose, and filtrum) - which they then cut deeply into, adding fake blood, and gave me bilateral jaw bruising consistent with a fracture. Also, some left-sided chest bruising, over my ribs and diaphragm, suggested hemothorax or a perforated diaphragm (when accompanied by my appropriate acting). I had to fake a dislocated left hip, too.

Next, I was laid on a wheeled bed, and my left leg had a makeshift splint attached. A collar and blocks braced my neck for c-spine injuries, and a Guedel (endotracheal) tube (with the tube cut very short, to avoid choking me) was put in my mouth. Loose clothes and a blanket covered my fake injuries; the candidates would have to find them. I faked stridor, with plenty of gurgling and a fast, shallow respiratory rate. This was the state a doctor would receive such a patient in, from an ambulance, so this was the state each candidate was to find me in!

I was to fake this airway trouble, and consequent breathing trouble, for a while, then slow it down and go quiet, as if not getting air in or out. Faking a GCS of 3-4 throughout. The candidates would try to avoid it, then go for the major step of intubating me when i became worse, then examine and manage the rest, with all the kit etc. This was very interesting.

They were mostly encouraging. One or two oddities - like, if you've intubated an almost unconscious person, so they won't be able to groan, you should still give them lidocaine before sticking the knife in for a chest drain!

And another thing - the Churchill is an old hospital, single-glazed in many non-patient areas, so the rooms we used are fairly cold. Fine when lying down under a blanket, but as the exam goes on, the candidate pulls that off and opens your shirt (to examine chest etc). Fair enough, totally necessary, go right ahead (I don't say this - i'm faking GCS 3-4); but - when your x-rays come back and you go to examine them, cover your patient! They will get cold! They're hypovolemic and tachycardic! They will die!

Seems minor, in a make-believe exam, but they go through the practicalities of intubation, cannulation, chest draining - why not aim for best-blanketing-practice, too?

(To be fair, one of the 8 candidates did cover me. On another, unrelated note, 7 of the 8 were men).

(She was very good).

Estage agents, and into a flat...

2008-08-13T12:48:00.003+01:00

So, my tenancy has begun - I have moved into a flat, for a year at least.

Or, more specifically, I have moved all my things into a new flat. I came home for one more night, to return the car i had borrowed for the move. Today I must cycle in with the final trailer-load of stuff. (two parts practical to one part fun; like a very wet martini).

Our estate-agents, who have responsibility for the flat (as it's a managed property), confirmed my thinking on the estate agent business model yesterday. That is, to turn a profit, an estate agent should do as little as possible while collecting in money. IE, they should use as few staff as possible to run as many properties as possible. This seems to be true.

I'd phoned ahead, asking about my keys, and was told to turn up any time after 12 noon. I left it until 16.00 - and they still were not ready. I think my arrival was what prompted them to get keys organized for me - because i was told that someone had gone, at that moment, to have a set cut. I was to meet said person outside the flat - which I did, after another wait. Perhaps they didn't realize key-cutting is a non-instant process.

That said, the flat itself is excellent. Quirky, with small stairs between the split-level floors. It's laid out not quite all on one level, but with insufficient stairs to call the different bits different floors. Confusing, yes - I have no idea what you'd call such an arrangement, but i like it!

Now, to the bike-and-trailer.

Flat, good coffee, world gone mad, and telecoms...

2008-08-10T02:38:00.003+01:00

Hmm... aha! The state of the UK telecommunications industry! Its mindnumbingly stupid admin structure! Its inability to get even the simplest things done! My valiant fight with BT and Tiscali!...

...is all something no-one needs to suffer through. </rant>. Otherwise, a new place to live is only a couple of days away; this can only be good news. I can't be the only person who takes great pleasure in arriving in a new place, learning how it works, seeing how it can work, improving and tweaking it... Well, this is the nature of the geek.

It is the Olympics, and that can mean only one thing - time for a war. Sort of. I'm enjoying playing BBC, Times, Guardian and C4 coverage of the South Ossetia issue off against eachother, in my head, with a little sense/pragmatism thrown in. Try it, it's fun!

And on that note - if anyone is in London, South Bank, any time soon, and would like to try a good coffee (really, a good coffee), you'd be on the right track by heading for the Concrete cafebar, at the Hayward Gallery. The few extra steps are worth it, and it's an unbusy place in the day. Perhaps the crowds are waylaid by the bigger, flashier places near the London Eye.

For your extra steps, you receive an attractive place (utilitarian, cool), and fresh-ground Union Hand-Roasted (ie: London-produced) beans used to make your cup. Without any rush! Honestly, I don't remember seeing a barista take so long over two cups before - but confidently, not hesitating. The result was a night-and-day difference to the highstreet *$, Costa or Caffe Nero ~equivalents. (In this case, tilde likely means ersatz). With exciting rosetta latte art, suggesting the staff really know their coffee. Way more than I!

Perhaps this can be a level to aspire to, in the Sleeper Service. Or, I could just go out for coffee more. Either sounds good, really.

One week pre- new flat...

2008-08-06T20:39:00.001+01:00

Hmm, yes - about to start a 12month living in Headington, beginning next week - mildly excited.

I think i might even be ready for it in time, more or less. Am not ready now, of course; that would be premature. But by Tuesday? I should be.

Trying to plan ahead, today, it struck me that the telecoms companies are really poorly geared for what must be a relatively common event. That is, new people moving into a flat, within a larger building, and attempting to set up the phone line, line rental, broadband package etc ahead of time. This is made very difficult. In fact, BT were unable to tell me that the phone line already installed was one of theirs; i deduced this from the non-availability of their competitor, Virgin Media, in the OX3 area.

Or, are my expectations somewhat unusual?

When i arrive in a new house, i'd expect:

- Electricity
- Water
- Heating

all to work from the moment i arrive. I'd expect most people would, too. But to that list, I would add:

- Phone line / Broadband

as a utility, more or less. Yes, I'd expect to need to tinker a little with hardware and settings to get a wireless network up, but in my mind i should have this finished in the first day.

Is this too much to ask? One pointer would be this; when the Education (i think) minister promised a few years back that highspeed internet would become ubiquitous, commonplace, a necessity of 21st century life etc (I'm paraphrasing), going so far as to suggest that government should ensure its provision in every home, the subsequent backpedalling, the U-turn, was an impressive sight.

The sentiment was dialled back. They didn't mean it. That bit about it helping UK industry, about it increasing our competitiveness on the world stage? (paraphrasing again) Oh, that means it can pay for itself. Us? Pay? No...

Ultimately, reliable internet access in the home was classed as a luxury (on the dichotomous necessity/luxury continuum, then being used to assess which items are required to participate in modern society). Except for those families with secondary-school age children, of course; they need it to do their homework. (No, I'm not making this up). The rest of us can go to our local library (9-5, Mon-Sat) and get it for free (really, I'm not).

This might have had some merit, had they not put a TV, and accompanying license therefore (color), firmly in the 'necessity' category. TV would provide an inexpensive source of information on a wide range of things, allowing the citizen to participate in 21st century UK, so the argument went.

So, to be a good citizen, I should have TV but not necessarily internet? I should consume information as it's fed to me, but not seek it out?

Oh dear, my third decade, and I'm still not with the program.

Ah, rain!

2008-08-01T00:11:00.001+01:00

Finally, the weather breaks. Heat and humidity give way to proper rain. Fantastic.

I'm right up under the roof, my desk up against a wall which follows its slope. So when rain comes, I get the best of it, and the full sound hammers through the slates.

I have vacuumed what feels like a whole worldful of surfaces today, interspersed with logistic driving-my-family-around. The reward is that I can now sit back, all civilized-like, and read or type under the slate roof. A luxuriant way to end the day.

Recipe - modified Ramadan food

2008-07-31T22:35:00.001+01:00

This tasty thing came about from:

- my possessing a bag of glutinous black rice, and almost no knowledge regarding its use

- a google search for "glutinous black rice"

- and the subsequent retuning of a Ramadan breakfast recipe I found.

Ingredients:

150g glutinous black rice
200ml water
200ml whole milk
1 cardamon, ground
1/2 tub chopped mixed peel
~50g sugar (brown/white to taste)
salt to taste

Soak and rinse rice. Put in pan with water and milk. Bring to boil. Add sugar. Simmer, covered, as gently as possible, for >30mins, stirring occasionally. When thickened, add mixed peel and ground cardamon. Salt to taste. Thicken further until desired consistency is achieved.

This is a long way from the Ramadan recipe (which, among other things, called for a 1:1 relationship of rice to sugar), but it makes a delicious rice pudding with more fibre than most. And, it's purple! (This looks especially cute next to a good coffee).

Grasshopper on a cactus

2008-07-28T01:30:00.001+01:00

This evening, a rattling sound came from my windowsill. On the 3rd floor.

Somehow, there was a grasshopper stepping carefully over a cactus. What a masochist!

A rich full day -

2008-07-22T00:34:00.001+01:00

This week...

I shall mostly be doing jury duty. But, I can't talk about that. So, instead, I'll confine this to PM ideas.

MD is in Iceland, probably attempting to verify sightings of "stripy cows" she made there, long ago. Good luck to her. We have a house to move into, from the 12th of August. It's cosy, but grand; convenient, but secluded... oh, I can't explain. Except that to go from living at home, with regular 9 week sojourns in college accomodation, to living in one's own (rented) place, with a 12 month contract, renewable, no need to move out every 2 months, etc etc - this is very exciting. (I want to decide on furniture, and furnishings; for once this is a place I can mould to suit how i wish to live (cf student accomodation, to which one must mould oneself)).

With a little bit of space, I'm thinking, we could have good coffee in the Sleeper Service. I could get back into the swing of it. With a bit of research.

(Aside - I worked in my college bar, a lot, in my 2nd year, including the day shift. Well, I had no exams in 3rd term. They have a 2-group automatic, plumbed-in machine, which made great espresso - probably because the boss knew how to clean it properly. I was pretty spoiled, actually - apart from a flimsy aluminium toy-espresso machine, this monster gave me my first experience pulling shots, and after not very long i could produce the odd tasty one. I read the manual, but was hardly trained, more of a button-pusher than anything else).

Now, MD's house has a Gaggia Coffee - and this is fun, too. So many variables! All I can say so far is, I can make a strong coffee. No other adjectives, yet.

So - for the Sleeper Service - a small machine, a good grinder, and some fresh beans. Serious stuff. Perhaps I should cover some more down-to-earth bases than really-good-coffee, first of all - but this is more fun.

Norwich to Oxford! Camping!

2008-07-21T00:56:00.002+01:00

This was fun. A 165 mile trip, spread over 3 days. By bike!

To Norwich, by train, on 13/07/2008. This is an experience in itself; taking a bike on a train is still not an entirely ordinary thing to do, in the UK. Yes, the train companies promise it's fully acceptable, on paper, and to the government ("look, we are green, honest"), but when it comes to actually allowing it... they do, just. But they don't make it easy. One needs to be fairly pushy, and pretty strong.

But, one gets to Norwich, anyway. And there, people live on boats! With campfires, and space for tents - and a relaxed way of life. Perhaps information-poor (no internet), but idyllic, otherwise.

Then, back to Oxford. Norfolk, Suffolk, Cambridgeshire, Bedfordshire, Buckinghamshire, Oxfordshire. Six counties! England changes, when you travel this far. (Fields of spinach become fields of wheat). And, put a ruler on a map, Norwich to Oxford, and you hit Cambridge halfway - so that's what we did. Half a day to get to Mildenhall, camping under a flightpath, another day to Ridgemont (and amazing lunch in Cambridge), then the rest of the way, to MD's home, on Wednesday.

Afterward, we recovered more easily than the bikes did. (Mine had a repair on the Thursday). And with no ill-will towards them!

Idyllic existence is nice, sometimes.

An incident, spun thus...

2008-07-08T01:39:00.010+01:00

----------------
When the headline begins "Death Crash Cyclist", the details are usually all too familiar.

A cyclist and another road user meet. Physically. This does not go well for the cyclist. Cue, in approximate temporal order:

lurid imagery
apportioning of blame,
rationalization of the causes,
and a promise that lessons will be learned. Often in the form of an undertaking to redesign the road, the junction, or the cycle facility; rarely in the form of a promise to change future behaviour, from all interested parties.

And so we proceed, much as before.

Today, however, the Metro headline was more sour than sanguine. In full:

Death crash cyclist 'mowed down teen'

What does one say to that? A seemingly complex case, reduced to 'Cyclist did bad thing STOP cyclist inhuman, cyclist bad STOP', perhaps with an undertone of 'cycling bad STOP' thrown in too.

From the few facts in the piece, it would seem that both cyclist and teenagers were acting as humans do. Imperfectly. This death seems a terrible mistake - that the cyclist was on the pavement near these people (why?), that he perhaps could not tell they had been drinking, that one of them would step out at the last minute, unaware of the potential danger, and that he could not avoid the collision once that had happened.

But to equate that to 'mowing down' the bystander, to suggest he meant to cause this injury, this harm, this loss, is monstrous. And unbelievable. Ask any long-standing cyclist; when someone steps out in your path and you collide, it hurts. For both of you.

I've done this, colliding with a pedestrian who stepped into the road without looking. We both had only minor injuries - but i wouldn't choose to repeat the experience. No sensible person would; if this cyclist was insensible enough to, he'd be in need of psychological help, not a sentence.

More facts over at the Daily Mail's article, 'Cyclist killed teenage girl on pavement 'after refusing to swerve to avoid her ''. For example, that the cyclist was doing 17 - 23mph. And that the teenager had drunk 2 cans of Stella (5.2% ABV).

And a helpful reminder, from the Daily Mail: "It is illegal to cycle on the pavement". These, the last words of an article which makes it clear, witnesses cannot agree where the cyclist was, road or pavement, when the collision occurred.

But no matter, 'Bad cyclist did bad thing STOP' still sells papers. Who reads this, and feels better for having done so?

(Those links, if reading without html -
http://www.metro.co.uk/news/article.html?in_article_id=208306&in_page_id=34
http://www.dailymail.co.uk/textbased/news/article-1032894/Cyclist-killed-teenage-girl-pavement-refusing-swerve-avoid-her.html
).

Sandal-wearing, Guardian reading, leftist liberals...

2008-06-30T00:16:00.003+01:00

Where is this idea from? That the left are invariably vegetarian, sandal-wearing, and vegetarian-sandal-wearing? And why does it persist?

But this week, i'm almost there. I'm a Guardian reader - almost - i read it where it's free, in college. I'm sandal-wearing - almost - flipflops seem most practical in a house where there is a dog. Vegetarian? Um, pass on that one (although the best argument, the one that's pushed me closest to it, is the 'world resource consumption / efficiency' idea). Perhaps this counts as 'leaning', ideology wise.

So this week, i've seen the usefulness of a car; moving out of college would have been 10 times harder without one. Not impossible, i hope, because inventiveness comes out of necessity, but much harder. On some occasions, they're the best option - and to vilify the things is simplistic. (And often, when we do, we forget we rely on those owning them, to continue doing so, to our benefit).

To minimize that dependence, this week i learned to tow a trailer. By bike. And this is quite fun! It let me offload a load of stuff to a charity shop, 6 miles away, in a couple of hours. A car-boot full, in fact. And did me / my legs some good, too. Hopefully, once i'm a busy clinical student, i'll keep this up whenever a car-boot seems the easiest option - weekly shopping, moving junk... And when a motor vehicle really is the only option? There's always renting...