Wednesday, December 31, 2014

The Hunger Games

This article first appeared in the July 2014 issue of the RACGP Publication Good Practice. It was written for a GP audience, who I hope would have fond memories of all the food terminology. Perhaps it was just me. The published version was edited slightly, but this is the original.

Being a doctor makes me hungry. Surely, many of us spend a morning clinic thinking about lunch, and an afternoon clinic wondering about dinner. I’m pretty sure it has been the same throughout history. I imagine Hippocrates eating herring, Galen tucking into grapes and Vesalius enjoying veal. However, I think they had stronger stomachs than me. I trained at one of those traditional medical schools that did dissection, and the combination smell of meat and formalin meant I was never hungry. 

This didn’t seem to be true for previous generations of pathologists, though. All those historical types were clearly distracted by their stomachs, as any quick leaf through a medical textbook will tell you. I imagine that as their assiduous students examined yet more examples of pathological body fluids, they’d ask their teachers for adequate descriptions.
“What does this stool look like?”

“Redcurrant jelly.”

“And this one?”

“Rice water. Better wash your hands. It’s supper time.”

There would be no fluid too disgusting to describe in tasty terms, every internal organ was ripe for culinary description.

“Your next patient looks a little unwell. Yeuch, he’s just vomited in the waiting room.”

“So he has. And, my goodness, it looks like coffee grounds. Remarkable.”

“Oh. I thought it looked like soil.”

“Watch and learn, dear pupil.”

The analogies continued. As they probed deeper, medicine became like a banquet. The main course was cauliflower ear, with subtle flavouring found in livers that looked like nutmeg. The cheese course was supplied by chest granulomas described as caseating. No-one could resist the chocolate cysts on the ovaries. After the food had settled, the skin was eagerly examined for port wine stains and café-au-lait spots.
It appears we might now be running out of foods to use. Arguments break out, amid confusing errors as to precisely which diseased organ looks like a strawberry. 

“Wasn’t it that strawberry naevus?”

“No, I thought it was a strawberry cervix.”

“Actually, I was talking about the strawberry tongue. I’m not sure how you missed it!”

I’m not sure I believe they really could see these things. Perhaps all they were cooking were the books.

And back to reality. If the thought of all that pathology puts me off my next meal, this is reinforced by my next patients who bring with them the strangest of menus. The first person tells me he has a frog in his throat. The next person has butterflies in her stomach. She’s worried, she tells me. Something is eating away at her. Up next is someone who knows something is wrong from her gut instinct. It’s quite a relief to find my next patient is so hungry she could eat a horse, but she is pleased as the treatment seems to be bearing fruit. My final patient has a few lumps in various places, which I carefully examine and document their sizes – a grain of rice, a pea, and, most surprisingly, a grapefruit. 

I reach the end of my surgery, running particularly late. After this procession of unpalatable symptoms, all I have the appetite for now is my apple, which is successful at keeping the doctor away from his lunch.

As my afternoon patients start arriving and peeling off their coats in the waiting room, I anticipate the feast to come. I reassure myself that, running late, slow food is healthier for all of us. Feeling better, my appetite for the work is not diminished. I look forward to the afternoon with relish.