friday's children

Today I say goodbye to my two third year medical students who have spent 2 weeks at our practice. They have proved to be bright, thoughtful girls who seem keen to learn under my quirky style of precepting: I concentrate on making them see patients as whole individuals who usually labour under a complex range of problems (as we all do) only the tip of the iceberg showing itself as the presenting problem of the day. I also try to interest them in the history of medicine, as I did this morning, when we saw a patient with polycythaemia rubra vera, a condition where the marrow is set on overdrive, making too many red blood cells, and which unchecked can lead to strokes and heart attacks. It is one of the very few conditions which, even today, is treated by blood letting, as opposed to the vast range of diseases which used to be treated in this way, often to the patient's great detriment.

Sometimes, as it were by fortuitous accident, they got it right and treated congestive cardiac failure in this way, often alleviating the condition considerably. Certainly an improvement on the treatment offered by royal physicians stuggling to treat the moribund wife of Charles II. Having tried everything else, they used their most powerful treatment: putting a number of live pigeons in her bed with her. She died the following day. I tell these stories to the girls, warning them that it will not necessarily help them to pass finals, but may perhaps put their own careers in some sort of context.