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EXPOUNDING THE REAZLES FOR SNEEZLES AND WHEEZLES
Wednesday, 18 October 2006
IATROGENIC PANCREATITIS

I admitted a lady this afternoon with a third episode of pancreatitis within the last twelve months.  She neither drinks, nor has any gallstones apparent on abdominal ultrasound (which together account for 90% of cases of acute pancreatitis in the UK).  She also lacks the remaining rare but recognized risk factors for pancreatitis: trauma, Cocksackie/Mumps infection, scorpion bites, steroids, hypercalcaemia, etc.

The patient has a twenty pack-year history of smoking, and a background of Ischaemic Heart Disease, Hypertension, and Type 2 Diabetes Mellitus.  Her list of regular medications includes Simvastatin, Bendroflumethiazide, and Enalapril. Tucked away in the fine print of side effects associated with all three of these drugs, is pancreatitis.

So the suspected culprits have been stopped and will shortly be reviewed.  Interestingly, while writing her drug chart from the list of her regular medications on EMIS, I noted she was not currently on either Aspirin or Clopidogrel - rather odd for a person boasting every risk factor under the sun for atherosclerotic disease.  A search of the patient's notes revealed a previous gastritis in association with Aspirin.  And Clopidogrel?

Causes pancreatitis.


Posted by tinqerbelle at 11:40 PM BST
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IN AWE

The King Edward VII Memorial Hospital is a 28-bed hospital in Port Stanley, Falkland Islands.  It caters to the 2000 civillian and 2000 military residents of the Falklands, and the fishermen of the surrounding isles.  All routine and emergency medical services are run from the hospital, and include a helicopter Search & Rescue Service, daily general practice clinics, flying doctor service for rural settlements, an A&E, ITU, and elective as well as emergency surgery.

The doctors that are central to the healthcare system are the kind I can only dream of being, thanks to the Modernising Medical Careers crap which is responsible for the mass confusion surrounding junior medical jobs in the UK.  Here, the four GPs, one surgeon, and anaesthetist are together nothing short of a super-hero team.  They see, treat, admit, and manage patients with the skill and ability of an entire hospital kitted out with superspecialists of every variety.

I'm particularly awestruck by the surgeon.  One man - Pakistani too :-) - and he performs any surgical procedure required - orthopaedic surgery, caesarean sections, reconstruction of a hand following trauma, herniae, appendices, whatever.  The limiting factor is not his skill, but the aftercare which is possible in such a setting, and the technology available.  And as it's just the one surgeon, I'm the lucky duck that gets to assist on all the procedures.  Not that it's brain surgery we're performing, but even an inguinal hernia is more exciting than an organ transplant when you're the one closing rather than the one watching on a remote screen.


Posted by tinqerbelle at 12:01 AM BST
Updated: Wednesday, 18 October 2006 12:11 AM BST
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Friday, 6 October 2006
PRISON BREAK
Mood:  chatty

Stanley has a prison - a room at the top and a few in the basement of the local police station.   Today we went to perform a health check on a man who had done some not very nice things and had accordingly been sentenced to 28 days.  Had he been sentenced to 31, he would've been home in 24, with a week off for good behaviour.  It was quite a contrast to the UK, where prisons are overflowing.

We left casualty and drove in the government jeep used by the doc on call to turn the corner, blink, and arrive at the station.  Chatted with the officers, tried on some hats, looked in two ears, listened to a heart beat, checked the lung bases, squished a belly, chatted with the officers, got into the jeep, blinked, turned the corner, and were back to work in the ER.

Little cottages, multicoloured rooftops, and my Chief Medical Officer waving to everyone as we drive past.  I felt a little like postman pat's cat. 


Posted by tinqerbelle at 10:12 PM BST
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Thursday, 5 October 2006
MED STUDENT - DOES THE JOBS YOU HATE
Mood:  don't ask

The trouble about being in a community as tiny as this is you can't talk about things "in general".  The General tends to get offended as in a 28-bed largely empty hospital, there are only specifics.

So I can't tell you the details of the first autopsy I witnessed, how the person died, or about any critical incidents that may or may not have surrounded the event.  I might just get away with saying that the closet-sized mortuary is next door to the chapel, and while cleaning up the overspill ran under the door and destroyed the chapel carpet.  At midnight, I was sneaking mops from the ward, and jumping up and down on incontinence pads on the chapel floor, trying to soak it up.

Despite its size, the King Edward VII Memorial Hospital does have a range of pathology to boast.  On my first day I came across Ramsay Hunt Syndrome, recurrent pericarditis, life-threatening hypercalcaemia, and talcum-power inhalation resulting in ten respiratory arrests overnight.  Only one day in theatre so far, but I feel as though I'm going to learn a lot.


Posted by tinqerbelle at 4:43 PM BST
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Friday, 29 September 2006
SANTIAGO
Mood:  a-ok

Wow. 

Fourteen (incredibly long) hours over the Atlantic and I arrived in Santiago just after seven am local time this morning.  The people are so friendly (or perhaps I´m just out of London?)  The keyboards are, however, annoying me; all the punctuation is in the wrong place, and although I can see it, I can't get to the 'at' key.

I had lunch at a lovely sea-food restaurant near my hotel in the district of Vitacura about five miles east of the city centre.  Then headed to Parque Metropolitano (apparently the largest city park in the Americas).  The map I'm using doesn't really differentiate between motorways and roads that pedestrians can actually walk along, but I survived and eventually got to the centre.

Santiago is snuggled between the Andes and the Coastal mountains, and as you can imagine the views are spectacular.  I have two more days here in seven weeks time on my way back from the Falklands, and now have a pretty good idea of what I want to see.  Meanwhile, bedtime, as it's a four am start, for a six am flight.  More from the Islas Malvinas!


Posted by tinqerbelle at 11:42 PM BST
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Thursday, 28 September 2006
OLA!
Mood:  hungry

Yesterday while shopping for Wellington boots on High Street Kensington, I asked the salesperson whether they would be suitable for walking over uneven terrain.  He inquired where I was headed.

"The Falklands," I replied.  His eyes widened.  Holy crap, I thought.  I´m actually heading for the Falklands.  Months of planning and preparation, but it only really hit me yesterday!

So I´m now in Madrid, having flown from Manchester airport earlier today, waiting for my flight to Santiago, Chile, where I´ll be spending the whole of tomorrow, and then flying to Port Stanley, East Island, The Falklands on Saturday for seven weeks.  I´m so excited!  This is my first trip to South America, and indeed the southern hemisphere.  I´m itching to get out of the airport though; there´s a whole city outside I´ve never met.  The airport itself is pretty but so quiet.  It looks a little like an expensive shopping mall just before opening hours. 

I´ve booked my luggage through to Santiago but realised as soon as I landed in Madrid that I wasn´t given a luggage tag at Manchester.  Let´s hope there´s still a big black suitcase waiting for me in South America! 

Only eight minutes until my Internet time expires, so more from across the pond.  Of course, those of you who know me know that the actual going across the pond bit represents a slight challenge (flying over water scares me - this has more to do with the sharks in the water than crashing in shark-free water) but I´m armed with the necessary chemicals needed to reduce the chances of my arresting as a consequence of SVT.  Sixteen hours to Santiago.  Speak to you then.

Mahim x


Posted by tinqerbelle at 9:45 PM BST
Updated: Thursday, 28 September 2006 9:47 PM BST
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Tuesday, 26 September 2006
SPLASH
Mood:  accident prone

It started as any other 24hr shift in Labour Ward- as usual the babies had been born just before I got there.  The day dwindled, the thermostat in my hypothalamus tangled up around itself in the confusion between icy theatres and tropical baby units.  Another c-section, another assist, another procedure I'd logged too many of.  Another I didn't get to close.

They walked in almost together.   Three colours, three faiths.  With only pain, a bump, and their medical student in common, the widowed refugee, the prostitute, and the married student each took to their own room and through the course of the night etched themselves deep into framework of my most vivid memories. 

The primip refugee barely made a noise.  My broken Arabic would have been an insufficient offering in return for the history I traced through her medical and psychiatric notes.  And then I missed the baby; she fell asleep with an epidural at barely four centimetres and I went to assist on a laparoscopic ectopic pregnancy.  An hour later I returned to meet her newborn.  I asked if she'd named the baby, she shook her head and after a moment's pause asked me mine.  "Mahim," I replied, with an Arabic accent that doesn't quite belong in a Persian name.  She pondered, dismissed, and smiled.  So did I.

Next door the prostitute was wailing for methadone.  She was high, drunk, studded with track marks, and accompanied by all the aromas of street life with the attitude of a dissocial rottweiler.  She was also in active labour for the fifth time, though she had no idea of the whereabouts of the fruits of the previous four.  But she wanted this one, and the combination of heroin, drug-fuelled and logical paranoia, laced with the probability that someone was going to take her baby, was too powerful for any drug or team of medical professionals to overcome.

At 6cm she needed the bathroom.  The midwife tried to get her to stay put for just half a minute while she examined her, to make sure it wasn't the baby coming.  But there was no way to stop her.  The woman made it back into the room as one person, climbed onto the bed on all fours, screamed.  And then the baby fell out of her.  Stunned, gasping, flaring, drenched in meconium.  The placenta followed like a bullet.  The cord was cut, the baby wrapped within 30 seconds of her having walked back in through the door.  I don't think she knew what had happened.  I ran to call paeds.

An attempt to inject the woman with Syntocin resulted in the needle and syringe being hurled at the midwife.  Police, security, social services, paediatrics, obstetrics, the senior sister, the medical student watched as the baby was taken away, watched as the mother tried to struggle against "the greater good", watched the most painful sight I've ever had to endure, watched.

And then move on.   One room further down and pretend the world is a wonderful place for a young married woman and her husband about to hold their first child while my mind hovered in the space I had walked out from.  Eighth procedure of the night.  Twenty-three hours into my shift.  I  knew she carried a blood-borne virus.  I know what universal precautions are.  But as I delivered the baby's head the world was bathed in red and I tasted blood.  My heart stopped.  I didn't.  I completed the delivery, cut the cord, took the cord bloods, and delivered the placenta.  Then I excused myself.

I had been splashed in the mouth and eyes with blood I knew to be H - positive.  With trembling fingers I dialled the number for Occupational Health.  I stepped out, shocked to find it was daylight.  I waited for my eyes to adjust, be a little less blinded.  And then I was the patient.  Forms, questions, needles, blood, vaccines.  Fear.  It's easy to forget the latter when you're the (student) doc.

For me it ended well.  Follow up was clear at six and twelve weeks.  But being told how slim the chances were of my having contracted a disease by this mode was a pitiful means of reassurement; mostly it pissed me off.  In my mind, the unlikelihood did little to quell the possibility.  Perhaps I'll try and incorporate that into my patient manner.

I left London to go back to my family home after that shift and the Occ Health work up.  I was met at the station by the Haematologist Daddy who only waited as long as it took my seatbelt to be fastened to ask whether I cared for the taste of meconium.

There's always room for humour.


Posted by tinqerbelle at 4:26 PM BST
Updated: Tuesday, 26 September 2006 4:45 PM BST
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TO DONE:
Mood:  rushed

2003 - 2006: 

  • Teach the UK's five best Latin & Ballroom teams exactly how to cha
  • Medical Elective: Emergency Department, Services Hospital, Lahore
  • Win the 2004 OU Pool League as Captain of the Pembroke College Pool Team - (step aside, UN)
  • Dissertation: Shots in the Dark: The Management of Gulf War Illnesses
  • BA (Hons) Oxon, Physiological Sciences
  • Pembroke College Oxford
  • Move to Imperial College London
  • Riding in CABs
  • The first clinical year
  • Try to bleed a patient watching Thursday night Channel 5, erm, programmes
  • The Tsunami
  • Find lost security blanket
  • Put it away safely
  • Reside in a red light area
  • Reside in a Dorset Mansion
  • Fall in love with London
  • See school-friend after eight years
  • Miss Ro's wedding
  • The realisation that I have the best friends in the world
  • Needing them
  • Prague & Vienna
  • Being reminded that everything happens for a reason
  • Even though I may not find it
  • The earthquake in Pakistan
  • Paediatrics
  • Psychiatry
  • Obstetrics & Gynaecology
  • Pathology (exam; not the lectures)
  • Crying
  • The second clinical year
  • Mind the Kap at Earl's Court Station
  • Perform first solo surgical procedure
  • Reside in a red light area; again

Posted by tinqerbelle at 4:33 AM BST
Updated: Tuesday, 26 September 2006 2:05 PM BST
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Sunday, 12 June 2005
HOME AGAIN
Mood:  lucky

It is hard. Stumbling towards a shore I'll never see again, searching lost footprints to find where you left off, knowing I mustn't venture too far - this is where I once drowned.

I remember the scent of oranges, and the fear of urchins. The prayer call that let us know we'd been up all night, your counting in your sleep during the day that confirmed it. I know the winding road too, where the jeep sank and children laughed. I just wasn't looking ahead, I had no need.

I was looking up, at the diamonds that stunned serenity, in a forsaken land I called home. You were never far away.

Now when it rains I smile and think that this was once sacred. We grew up where blue skies took us for granted, and then we each walked out on them. Shit happens. Cut, heal, wither, break. But like the Boomerang you bounce back, and I can see the crags, not so far, and a soft place to perch. I've found the footprints, one big one small. Damn the urchins.

I'm the second to say I don't know where this is going. I'm just glad you're there.


Posted by tinqerbelle at 12:38 AM BST
Updated: Sunday, 12 June 2005 12:41 AM BST
Thursday, 9 June 2005
THE BEACH

December 22nd, 1998

I sift the wind for the answers to questions I'm too afraid to ask, as the solutions I yearn for are muffled by the clamour of your pride - a fragment of masochism which pretends to shelter you.

The authenticity of your deceit never ceases to astound, as does my gospel of lies. There isn't anything or anyone we haven't been. In my blindness I perceived your every glance, for in my vanity you are my priority, my self obsession. I am illiterate; I have read every account of your life and though I am fatigued there is no shade of your soul where I haven't rested. I radiated warmth through numbness and responded to every whispered heartbeat. Yeah I'm incoherent, but I've pondered every reflection of your mind. Those simple deliberations and chaotic perplexities. At least their confusion and obscurity make sense.

Searching for you is like seeking corners in bubbles. Their spherical perfection bursts with the tiniest caress. Spectra of illusions are apparent, delusions easy to choose, but their existence is superficial.

I beg you to tell me what I am, as I remain ignorant - a chalcedonic non-chalance clinging to a whim.

The knowledge of experience is a stranger to my heart. Yesterday's ashes from the cremation of dreams born in my own historical fiction are re-ignited by the touch of our gazes. Yet no fire is hot enough not to burn, once more each dormant desire is flamed. This hurt peals with an intense vociference that is silence. Can you hear me?


December 28th, 1998

A perfume of radiance veils my stench of misery to create an aura of adequacy. I try and fill aching voids with memories of passion, but they evolve into reminders of regret. Once more I've dropped the catch, lost the championship of togetherness, but I always make the final.

At dawn I found the corners in the bubbles and bathed in their foam. At noon, the tide threw me against crags whose danger signs I'd ignored. I tried to swim against the current of fate. I drowned. Now the sun has set, and the grains of love are too fine to catch, but my heart still foolishly sifts the wind.


Posted by tinqerbelle at 12:01 AM BST
Updated: Friday, 10 June 2005 11:00 PM BST
Wednesday, 29 October 2003
...AND DELIVER US FROM EVIL...

THIS HAS BEEN MY MOST DIFFICULT WRITTEN TASK TO DATE. I IMPLORE YOU TO READ IT. COMMENTS MAY BE FOUND BY CLICKING ON THE LINK BELOW THE ENTRY, AND THEN SCROLLING DOWN TO THE END OF THE POST.

I visited Blackfive's blog some days ago from a medical blog I really enjoy. The latter had strongly recommended an 'excellent' post by Blackfive, the content and consequences of which have cost me my sleep.

The entry was an account of a conversation Matt of Blackfive had with an educated but bitter and disillusioned Pakistani by the name of Masood. Masood was under the impression that the attacks of 9/11 were a Jewish conspiracy, and that the Muslim world was a puppet in the hands of the Semitic faith that controlled all.

The post inspired 65 comments, over 60 of which were hell-bent on Paki-bashing, deriding the Islamic faith, or displaying profound depth to their ignorance. Excerpts from the post and comments are shown below. My thoughts follow each box, and my comprehensive reply is displayed in red on the right. It also appears in Degrees of Divinity, Animated Stardust, and Intellectual Properties, among others.

The comments shown below by no means represent the 'worst' which were on display. I urge you to read the original article and the comments that followed.

AARON:

"It is a perfect display of how the Muslims are really a bunch of anti-semitic bastards who are in denial that they were the ones killed thousands of innocents on 9/11. Shouldn't they all just go to hell and die?"

I will not dignify the above comment with a response.

BLACKFIVE:

"How the hell can a guy be so well-educated and smart and successful in America and be so close-minded at the same time?"

I often wonder.

BLACKFIVE:

"How the hell can we ever convince people like Masood that "the Jews" aren't the problem - that his blindness is the problem? And if we can't convince the likes of him, how can we reach countless millions that don't have Masood's liberal education, facility with English, or access to our mediums?"

How the hell can we ever convince people like Masood Blackfive that "the Jews" "Islam" is not the problem - that his blindness is the problem? And if we can't convince the likes of him, how can we reach countless millions that don't have Masood's Blackfive's liberal education, facility with English, or access to our mediums?

BLACKFIVE:

"Simple answer: I don't think we can penetrate that kind of cultural and religious brainwashing."

I know how you feel. I'm banging my head against a brick wall right now.

BLACKFIVE:

"It really is us against them. Us and the Israelis and a few others against 1.6 billion zealots."

Masood seems to think so too. Yet that bothers you.

ROSS:

"...the Muslim culture hasn't contributed very much art, culture, or science in a few hundred years."

Barring cuisine, music, literature, architecture, and the odd Nobel Prize. Geez, what a moron.

PATRIOT:

"Islam is a virus, a virulent and incurable disease that causes planet-wide failure among its victims."

What does such a comment accomplish other than to encourage a homicidal maniac?

11AS:

(Referring to Moslems) "I don't feel hate toward people like this. I do fear that we can never integrate them into a civil society. They will never be citizens. It's like having a coyote on your property. You can ignore it for a long time, but if it starts gnawing on the pets or livestock, you have to take action."

Where would I begin to convince Masood that the world is not against him? That the international plundering code-named the "War on Terror" is not a War Against Islam?

JOSHUA:

"Let me just boil it down to this for you: Just because the Moslems are paranoid doesn't mean nobody's out to get them."

Yes, Joshua, I'm beginning to see.

RON:

Have a friend from palistine that lost her family home to the jews when she went on vacation. Upon her return she was changed to a homeless person.
Yep she does not like jews.


ANGUA:

Dear ron,
Have a friend who was raped by a man once. Yup, she hates all men. Including YOU, ron. You sure deserve all that hatred, ron. Even though you were likely not even on the planet when it happened. Certainly if she chooses to kill you, ron, it will be perfectly understandable, since the rape was your fault, ron.
In other words, can you really not see that it may be wrong to lump all people of a certain ethnic group together to get blamed for something one of them did?

So, Angua, will you wage war on her too. She does dislike you, after all.

JOSHUA:

Yeah Ron. Don't lump all people of a certain ethnic group together to get blamed for something a few of them did. Unless they're, like, Arabs. In which case lump away.

The torrent of abuse that Joshua withstood for daring to defend a faith was incredible.

DOC RUSSIA:

"If Islam is immune to pressure to moderate, than it must be destroyed..."

i.e. Be reasonable. Do it my way. Or die.

ME:

It's hard to know where to begin. But after reading the post and the comments above, I have to say that hatred is not unknown to those lamenting the views of some Moslems.

I am a proud Moslem of Pakistani, Arab, and British heritage. I have lived in Britain, Saudi Arabia, and Pakistan, and am presently a medical student at Oxford University. Much of my extended family is American, and I have had the pleasure of visiting them in the U.S. on many occasions. You have a beautiful country - it has much to be proud of.

Following the shameful calamity that was 9/11, the hatred my (very American) cousins have had to withstand is abominable, and I have to say, I am stunned and saddened by the views of Moslems, Christians, and Jews alike the world over. My notions are far from idealistic, but I don't believe in Bush's terroristic strategy of going to war against anyone who doesn't like him. I don't think many do.

My closest life-long friends are of all colours and religions: Hindu, Jewish, Muslim, Christian, Sikh, (Welsh ;)). Sometimes we don't agree on everything, but that doesn't prevent us from having an open discussion. And it certainly doesn't fill us with the need to go to war against each other. But there are a few concepts which shouldn't be difficult to understand in an educated mind:

  • about seven Palestinians die a violent death as a result of one Israeli death
  • or, one Israeli dies as a result of seven Palestinian deaths
  • this is unacceptable
  • there were no weapons of mass destruction
  • no Iraqi has ever been implicated in an international act of terrorism
  • there will always be differences of opinion; it is up to those with the power to reach out to the masses (like bloggers) to encourage peaceful dialogue and reduce the spread of false terror.

The ignorance of many in developing countries is at times shocking, but I am more concerned about the ignorance amongst those in the 'first world'. I'm not going to preach religion here, I doubt it would penetrate the minds of many, but I will state the four sources of Islamic law as a guide:

  1. The Quran
  2. The doings and sayings of the Prophet (pbuh)
  3. The consensus of opinion
  4. A person's own conscience.

Notice the absence of 'ignorant so-called Imam'.

I am a Moslem because I understand Islam. There are many Moslems that understand only the view of the only person in the village who can read the Quran, and he uses his literacy as a political tool. But they are starving, unsheltered, oppressed, illiterate, and very angry. And somewhere in an ever shrinking world there is a huge country with beautiful tall buildings and people with plenty to eat, all of whom can read and write, who look nice and have good clothes to wear. And, many of them hate you.

I take offence at the descriptions I read of Pakistani culture. Military dictatorship is not an ideal, but in a land riddled with corruption, for now it is the only way forward. Over 55% of Pakistan's short 56-year life has been dominated by military rule. Alas, it is only under military rule that we have ever seen economic progress.

My great-grandfather (an Indian) attended the University of Glasgow. My grandmother was Pakistan's first female lawyer. My grandfather topped the University of Sheffield. My mother is a doctor, my aunts are highly educated professionals who have travelled the world. They are what I am reminded of when I hear the word Pakistan.

Many immediate family members are Generals in Pakistan's well trained army. Some have spent time as Prisoner's of War in the horrendous conditions prevailing in Indian jails, following the succession of Bangladesh. They know what war and cruelty is.

Alcohol is available in Pakistan to any non-Muslim (the availability of alcohol always seems to be a sore point among those discussing the freedom within a land), tourists resorts are stunningly aesthetic, people are overwhelmingly friendly and hospitable. A tiny country, but Pakistan is home to almost all landforms - beautiful forests, mountains, deserts, and plains. If you haven't been there, you really can't comment.

My parents worked as British doctors (haematologist and general practitioner) for the Ministry of Defence in Saudi Arabia on a large military cantonment during both Gulf Wars. All parts of the world that I am from seem to be in constant unrest. America tasted war for a day and is still in shock. People hate the offenders, and they know they have a right to. Then why do you blame Iraqis for hating the power behind the sanctions that have crippled their children?

Is the CIA not intelligent enough to remove Saddam without waging bloody war?

I have an immense respect for the military profession. The only reason I will not be joining military service myself is that I do not believe in British (=American) foreign policy. It makes me sick.

May your family live a long, prosperous, and peaceful life. No true Moslem would wish peace-loving people anything but. I am sorry to hear that you are against me. I hope you have the wisdom to overcome this hatred.

God bless you, and yes, Allah be praised!
Happy Ramadan, Mahim

In reply:

BLACKFIVE:

Hi Mahim. Thanks for visiting.
No matter how bad someone has is it in another part of the world, it doesn't give them the right to fly an airplane into a building and kill thousands of people. Those that celebrate it, well, let's just say I won't ever forget the celebrations in certain places.
I have been to Peshawahr and Islamabad. About 20 years ago. It has nothing to do with my story. You are obviously well educated. Do you blame the Jews for everything? Well, do you?
Do you believe that the Mossad was behind 9/11? Well, do you?
I wasn't going to post this story about Masood until the Malaysian Prime Minister spoke his idiotic words. I think it's time that people understood that the hatred for Christians and Jews is very, very deep and is not penetrable in a lot of cases.
And using foreign policy as an excuse to not serve in the military doesn't really make me very sympathetic to you. Obviously, you don't feel like you are British, do you?
Why don't you move to France? They sound like they might be more your style.


Just because the hatred you feel is your own, it isn't more justified than anyone else's.

"There is no compulsion in religion, for the right way is clearly distinct from the wrong way. Whoever therefore rejects the forces of evil and believes in God, he has taken hold of a support most unfailing, which shall never give way, for God is All Hearing and Knowing."

-Quran 2:256

Through the din of angry voices, only one conclusion is audible: there is little to separate us. We each take a stance, attach it to a different cause, and then believe it presents us with the right to destroy one another. But donning a military jacket does not give us a moralistic license to kill; rather it binds us with a duty to protect. Loving our home does not mean defacing our neighbour's - it's like placing a beautiful photograph in an ugly frame. Raising our children is not contingent upon destroying someone else's future. Believing in the tennets of your religion does not belittle the faith of another. Moreover, not having a religion does not make it a non-sequator.

"Children of Israel, remember the favors which I have bestowed upon you. Remember that I have exalted you above all nations. Be on your guard against the day when every soul will stand alone. At that time no one will be able to intercede for the individual soul; no compensation will be accepted for past sins. Every soul will face me without help."

-Qur'an, Al-Baqara, Surah 2:47-48

There is no difference between the Suicide Bomber, the Israeli tank, and the American political agenda. They are all puppets of Western media, selfish political motives, and frustrated goons that understand nothing about true Islam.

BLACKFIVE:

"No matter how bad someone has is it in another part of the world, it doesn't give them the right to fly an airplane into a building and kill thousands of people."

You're absolutely right, Matt. But no matter how bad America had it for a morning, it doesn't give them the right to fly an airplane into a foreign land and kill tens of thousands of people.

BLACKFIVE:

"Those that celebrate it, well, let's just say I won't ever forget the celebrations in certain places."

They too will taste death one day, and be held accountable for their crimes. But can we, being more advantageous and, I hope, less ignorant, stop to examine why they celebrate? Can we leave room for the possibility that the only logical conclusion is not that they are all sick bastards, rather they are incredibly pissed off? Do you think the foreign policy of the world's only superpower has done them justice?

BLACKFIVE:

"Do you blame the Jews for everything? Well, do you?

No. But I do feel that the Israelis extending the boundaries of disputed land and ousting Palestinians from their homes are committing crimes against humanity.

We believe in Allah, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) prophets from their Lord: We make no difference between one and another of them...

-Quran 2:136


BLACKFIVE:

"Do you believe that the Mossad was behind 9/11? Well, do you?"

No.

BLACKFIVE:

"I think it's time that people understood that the hatred for Christians and Jews is very, very deep and is not penetrable in a lot of cases."

I think it's time that people understood that the hatred for Moslems is very, very deep and is not penetrable in a lot of cases. Again, that same brick wall.

BLACKFIVE:

"Obviously, you don't feel like you are British, do you?"

I'm damn proud of my marroon passport. I also cherish the green ones.

So. What would I do. I think I'm clever, right?

This is where I get radical:

  1. The freedom of religion is a salient feature in Islam. There are also laws of warfare, which strenuously forbid the harming of women, children, and the elderly. Murder is a form of Shirk, the greatest sin in Islam for which there is no redemption. Suicide bombing is WRONG. Terrorism is WRONG. Oppression is WRONG. So,
    • beat them at their own game
    • declare radicals to be non-Moslems
    • and give all the reasons why they truly are NON-MOSLEMS
    What we are fighting is not 'Islamic fanaticism', irrespective of what the terrorists call themselves. If I were chewing on a rare steak, and looked you in the eye and swore I was a vegan, would you believe me? You belittle anything and everything a fanatic does, except his declaration of Islam. Why?

    "O People of the Book! Commit no excesses in your religion: Nor say of Allah aught but the truth."

    -Quran 4:171

  2. Jews have a right to their own homeland. Moslems have to get used to the idea, just as the Moslems of the sub-continent needed Pakistan. It is only right that Jewish people have control over their Holy Sites in Jerusalem, just as Moslems and Christians should remain in charge of their respective areas. Moslems, start warming up to the idea. You will have to co-exist if you are to survive.
  3. Palestinians must be recognised as citizens of their own state. Only when the nation of Palestine resides in the country of Palestine will they be able to defend themselves with means other than acts of terrorism. Israeli settlers need to re-settle themselves behind the 1967 boundaries.
  4. The 'I was here first' argument is wearing thin. The conflict between Jews and Arabs has existed long before the revelations of Islam. It is a land war, not a religious war, and battles have occured since the second family moved in.
  5. Integrate the schools. I'm not stupid, I know the dangers. Make it compulsary for a Jewish child to sit next to a Muslim child in every school in the region. A suicide bomber will think twice before boarding a bus half filled with Palestinian children. It worked wonders in the States for targetting animosity between black and white children. It will help in Tel Aviv too.
  6. Lose the trigger in Trigger Happy. You'll be left with the equivalent of joy.

DOC RUSSIA:

This leads me to the conclusion that the "extremists" are not the extreme, but the norm, and that the "moderates" are just extremists tempering their overt attitude in order to mask the true face of Islam.

In conclusion, I appeal to the moderate muslims to get off the damned bench, and take back your religion! Your hour for action is passing, and if you fail, then the only outcome is a worldwide conflict where resolution will only be attained through the destruction of Islam forever, or a new, dark age.

I'm right here Doc. Right here. You say the most attrocious things about my Faith, yet I'm still smiling at you. I don't know how to be any more moderate.

Mahim


"So tear down the mosques, destroy the temples, demolish anything destructable. But don't ever break anyone's heart, for the heart is where the Lord resides."

- Punjabi folk song

(Another non-contribution to culture).



Posted by tinqerbelle at 4:11 PM GMT
Updated: Thursday, 5 October 2006 4:55 PM BST
Saturday, 25 October 2003
WHAT PREGNANCY AND MALIGNANCY HAVE IN COMMON

While cancer is one of the biggest Western killers, when considered on a "per cell" basis, it remains rare. One of the biggest complications resulting from cancer, other than the disease itself, is its ability to spread, or metastasise. Again, this spread is far from unheard of, but in actual fact, metastasis is inefficient.

The anatomical viewpoint suggests that the spread of cancer follows the routes available for the passage and growth of cells:

  • through blood vessels/lympathic ducts (=permeation)
  • along fascial (connective tissue) planes
  • immediate intercellular invasion (=infiltration)
  • through ducts of sweat glands or hollow body organs (viscera)
  • direct seeding in body cavities (e.g. an 'ascites' tumour grows suspended within a cavity)

If the anatomical viewpoint alone were responsible for the pattern of metastasis, then organ involvement would reflect the proportion of cardiac output (the volume of blood pumped by the heart per minute) it received. In light of this argument, the anatomical viewpoint is not a sufficient explanation for the spread of cancerous cells.

The seed and soil view also takes into consideration the production of growth factors by target tissues and resultant specific interactions between cancer cells and body tissues. This seems a sensible explanation for the preference of various types of cancer cells for specific tissues.

If labelled malignant tumour cells are injected into an experimental animal, the initial sites they lodge at are quite distinct from the sites of development of secondary tumours.

Cancer cells must:

  1. overcome adhesion at initial site
  2. travel to the site of invasion along routes mentioned above, and survive and remain tumorogenic during transit
  3. adhere to new sites, with the help of adhesion molecules (e.g. ICAMs)

    The disruption of this adhesion is of clinical interest, and has recently made the news. However, limiting adhesion also reduces the recruitment of immunological cells. Susceptibility to infection is increased in cancer; limiting leucocyte recruitment may have hazardous consequences. Furthermore, reducing adhesion may increase the likelihood of the occurence of metastasis.

  4. multiply at the site, supported by the production of growth factors by the target tissue
  5. escape demise at the hands of the immune system.

This final point is common to cancer and pregnancy. The foetus is a chimera, expressing both maternal genes and paternal genes which should be recognised as foreign by the mother's immune system. They're not.

Why? Possibly due to the expression of a molecule named 5T4, found on embryonic stems cells (ESCs), particularly the cells of the trophoblast - a placental layer. The 5T4 molecule is responsible for imparting motility to stem cells, allowing them to relocate (metastasise) to a new site. In adult cancerous cells, 5T4 is overexpressed. In normal cells, it is expressed at very low levels.

A new approach to cancer therapy is the administration of a vaccine which causes the body to launch an immune response to 5T4. Human clinical trials have proved succesful. A new "magic bullet" therapy is also under development, which involves a dose of antibodies to latch on to, and render ineffective 5T4.

It is unlikely the trials involved pregnant women, and even more unlikely (rightly so) that an ethical committee would allow such a trial. But what about subsequent pregnancies? Although IgG is the only antibody capable of crossing the placenta and entering foetal blood, any such antibodies against 5T4 could have catastrophic effects on a developing foetus. Consequences on foetal health seem to have escaped mention, but there is nothing to say the effects on pregnancy have been evaluated. If indeed no such investigation has taken place, the hype over the new found treatment may itself be premature.



Posted by tinqerbelle at 1:19 AM BST
Updated: Saturday, 25 October 2003 4:19 PM BST
Monday, 20 October 2003
DESIRES, DECISIONS, & DISSERTATIONS

I was ten years old when I categorically informed my parents while on the Oxford Open Tour Bus that I would study medicine here one day. My mother the General Practitioner shook her head and wondered if I would then settle down with a Pakistani; Daddy the Haematologist simply asked who was gonna pay for it. (Pass; why, you, Father!).

I've aimed for little else. I didn't plan on winning the National Debates; I had entered merely to gain experience. The National Poetry Competition was an even bigger fluke, having written a crap piece purposely to avoid selection (I was on commitment overload due to debating). The black belt fell into my lap after years of attendance and instructing, and I was Head of Student Council only because Rani voted for me rather than herself (there was a difference of one vote between us).

The future is fast approaching the present. Yesterday's Tomorrow is here today, Yesterday's Today just fades away, Still Today's Tomorrow is yet to come... There is a plan. Unfortunately, those things require implementation in an unpredictable, sometimes hostile environment. I'm daunted by my To Do list:

  • Complete dissertation on Gulf War Syndrome
  • Finish Degree in Physiological Sciences this year
  • Graduate from Oxford
  • Attend Clinical School
  • Become fluent in Arabic/French
  • Work for Red Cross where there's a conflict
  • Specialise in Trauma
  • Teach at a Medical School
  • Write lots of relevant, interesting articles

Hypothetically, it makes sense. My dissertation fits, I scored a high mark in my recent Systems Physiology paper, a hundred and fifty others are also graduating with a degree in Physiological Sciences from Oxford this year, loads of people speak French and/or Arabic, "War is Peace", and thus the need for Trauma Specialists, tutors do exist, and I'm literate.

But so much can go so badly wrong. Am I justified in being cautiously pessimistic, or is this an extended case of Med Student Syndrome?

Though not one to confuse pop lyrics for profound thought, I feel like Annie Lennox:

This is the fear, This is the dread, These are the contents of my head.

I've landed an incredible opportunity to work in an A&E in Lahore over Christmas break. I'm toying with the possibility of focusing my dissertation on a comparison between the prevailance of Gulf War Syndrome in Pakistani and British soldiers serving in the Middle East in the early Nineties; this requires cutting through some seriously sticky red tape.

And where's my motivation? Hovering around the vending machine. Need chocolate.



Posted by tinqerbelle at 2:24 AM BST
Updated: Monday, 20 October 2003 2:25 AM BST
Saturday, 18 October 2003
OH, THE DESPERATION

What is it about weddings that makes people so vehemently eager to make an impression, be it financial, status-related, or sexual? Is it the acknowledgement that the day belongs to someone else and blowing one's own (non-existent) trumpet seems the only way to steal the limelight? Or is it utter dim-wittedness compounded by stupidity and ego which forbids certain guests to realise that on the given occasion, the Bride and Groom are slightly more important than they are?

The absence of The One in the "Mahim plus One" invitation went down very well with some in attendance, and didn't help the air of desperation. Take for example, Sleezebag and Scumball (names have been changed but identities may still be apparent). After the reception dinner, those who could rushed up to the bridal suite to check on the England v. Turkey score. While being escorted back downstairs in the luxurious five star Pennyhill Park Hotel, Scumball (who I hasten to say was not the Best Man) informed me that my job as bridesmaid was to "appease" the Best Man.

Scumball: I thought it was the bridesmaid's duty to sleep with the Best Man?
Me: I don't think the Best Man's girlfriend would approve.
Scumball: For the purpose of this conversation I am the Best Man.
Me: In that case, for the purpose of this conversation, I'm the one getting married.

Sleezebag the Non-Subtle took it upon himself to embarrass me any way he possibly could, until the gracious groom swept in, dumped his new wife and my best friend on his ex best friend (Sleezebag) and spent the rest of the track dancing with me. And for that, Rob, I am eternally grateful. (Though Rani possibly isn't).

Drunken testosterone aside, the wedding was beautiful, even though I was required to say a few words - which is what I stood up and did, as I had left my speech in my bedside drawer in Oxford. Armed only with what I wasn't allowed to say (under order of Rani and in the presence of "adults"), I did the best I knew how. Apparently I made people cry. Boredom? Emotion? Desperation? We'll never know.

But here, by popular demand, is a copy of what was said. It pales in comparison to Dave the Best Man's speech, wherein he referred to the Groom as the Exorcist:

"He Robs us of our Spirits."
Very clever.



THE BRIDESMAID'S SPEECH


Seeing as Rob has been so kind to me in his speech, mine will have to undergo some sudden last minute changes.

I'm Rani's best friend. We met at boarding school, and it was immediately apparent to me and others around us that she really was one to work like she didn't need the money, love like she'd never been hurt, sing like no one was listening, dance like no one was watching.... Well, almost no one was watching...

[I don't think Carol the cleaner has quite recovered from walking in to Rani's room with the vacuum cleaner at 10:00am to see Rani standing on her desk chair, hairbrush in hand, best outfit on together with full make-up, grooving to "Do You Love Me?"]

We had secured full tuition scholarships together; we enjoyed the two highest positions on the student council; we were both prize-winners; and topped the A Level results jointly. When we would go out to eat on the weekends, we would be given four sets of knives and forks by the waiters - such was the quantity of food we could consume between us (though I can see Rani's in-laws are having a difficult time believing me looking at our respective frames). So imagine my shock, when Rani - my established life partner - called me up almost three years ago to the day to inform me:

"I'm going out with this guy called Rob."

It was true. Little had met Large, and I sulked for a little while at the thought of losing my best friend. Little did I know I was actually gaining another.

That's the wonderful person that Rob is, and it's been a pleasure and a privilege getting to know your family over the last couple of weeks. Special thanks to John and Angela for their generosity and hospitality, Rani's parents, Laif and Magyan, and Albin and Rajni, whose acquaintance I have made through photographs over the last few years.

Of course, with Rob in the picture, the eating competitions took on a whole new dimension, limited only by restaurant opening hours and expense. He still thinks he can out-eat me, he's sadly mistaken.

But the one thing we do agree on, is the beauty, talent, intelligence, and grace of his bride. Rani you have been an exceptional friend, a caring sister, and a loving daughter. You both deserve nothing but the best, which is why I'm so glad you have each other.

And so can we all raise our glasses... if I can find my glass [*search desperately for glass which has been stolen by Sleezebag*], and hope that -

May the road rise up to meet you
May the wind always be at your back
May the sun shine warm upon you face
The rain fall soft upon your fields
And more importantly, until we eat again,
May we have shed all the weight we gained in our last encounter ;)

To Rob and Rani!




Posted by tinqerbelle at 5:09 PM BST
Updated: Saturday, 24 July 2004 8:39 PM BST
WHAT SEX IS YOUR LIVER?

The sexual dimorphism of the liver has been recognised for decades, but it is only recently that the genes responsible have come under scrutiny. Different patterns of genes are expressed in male and female livers. This has consequences on the metabolism of various drugs and hormones, and impacts certain functions such as reproduction.

A news release from the Cold Springs Harbor Laboratory reports on the discovery of two genes that repress male-specific genes in female livers. Named Rsl1 and Rsl2, loss of function mutations result in the expression of male specific genes in a female liver.

In mice, anyway.



Posted by tinqerbelle at 1:44 PM BST
Updated: Saturday, 18 October 2003 1:45 PM BST

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