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This January my nan was cross with us for not properly celebrating her 100th birthday, despite the fact that that a) she hated celebrating anything and b) she’d just turned 90. If this makes it sound like she was losing the plot, I’ve done her a disservice. Mental acuity was not the problem, but she never gave up an opportunity to get angry about something. She was angry her entire life. 

Born in Germany in 1927 (making her fucking NINETY), things were fine until her mother sacked off her kind, quiet railway engineer husband for a syphilitic kitchen salesman whose claims to fame included conning everyone in sight out of their savings, and getting a full house in his own game of STD bingo. When he finally died, his funeral on a hot summer’s day was enlivened by his rotting corpse exploding and seeping through his (stolen) coffin. Well played, my great-grandmother. What a catch. He had disliked children but had enjoyed hurting them, so she had shipped hers off to other relatives, which is how my nan came to live on a farm in what was then Prussia, with her grandparents, who she’d never met. Tales of her childhood there sound very very cold, and very very poor (“We all gave each other a carrot for Christmas”), and her main nutrition at this time seems to have come from eating whole raw onions and drinking pigs blood soup, to which she attributes the fact that her brown hair never went fully grey. I’ve never been able to bring myself to follow this advice, and am cheerfully cultivating a white streak. 

By the sounds of it, things carried on being bleak and cold but broadly uneventful until the Nazis moved into town. Hitler (“he wasn’t a nice man, I didn’t like him”) had a bunker nearby, and all the kids would be ordered out into the street to wave as he passed, my nan and other brown-haired children being ordered to stand hidden behind the more on-brand blondes. My nan’s grandparents hid some local Jews in their cellar, and upon being found out, narrowly avoided being shot themselves by producing my great-great-grandmother’s Mutterkreuz, a special medal she’d been given after losing all of her five sons in the First World War. Typing that sentence has made me feel extremely ‘Christ, I don’t know I’m born.’

Later, the Russians marched on their village and my nan was taken away to a prison camp. She didn’t go into lots of detail about what happened there, but when I mentioned that I was thinking of visiting Russia some years ago, her response of “My god don’t go there, they will beat you and feed you bone gruel” reinforces my opinion that her experience was Extremely Not Good. By the time the camp was liberated by the Red Cross in 1945, she was malnourished and very unwell and was immediately taken away to a hospital in the Harz Mountains, where she remained for four years. FOUR YEARS. During this time she had raging TB, had her entire left lung removed and received not one visitor. Interestingly, she describes this as the happiest time of her life; I think perhaps she was just glad to be warm, and fed, and looked after. 

Upon leaving hospital she somehow reunited with her real father, got into West Germany, and gave birth to my mum. No further details were forthcoming on this period, and perhaps I’ll always have a lingering sense of regret that I didn’t push harder for answers. When my mum was around 3, my nan met an English mechanic working in Hannover, whose romantic ambition was clearly to meet a traumatised, asthmatic German girl with a dark past and a small child and live happily ever after. Which they sort of did. 

Sort of. I’ve struggled to decide over the years whether my nan had an undiagnosed personality disorder (possible) or just had so much anger festering away inside of her (probable), or a bit of both; but she was very hard to live with. My mum and her (step)dad became everything to each other as they expertly manoeuvred around her moods and abuse. I was blissfully unaware of this until my late teens, at which point I became old enough to cop for this too. It’s difficult, because while she was clearly an awful mother, she was a wonderful grandparent, and some of my very best childhood memories are of days spent with her. When she was in a good mood, she fizzed with charm and made you laugh until you couldn’t catch your breath; when she was in a bad mood I wanted to throttle her. Endlessly captivating to small children and all animals, she could mimic anyone or anything and frequently made me cry laughing with the merciless accuracy of her impressions. Despite these and many other charms she pushed people away her entire life, cutting out her family back in Germany (she may have had good reason for this), managing to alienate friends, neighbours and – periodically – us. But we take Duty very seriously in our family, so she has been well taken care of even when it hasn’t been rewarding to do so; has had her shopping done even when she’s been so angry she’s left it in the hall to rot while she sat out a self-imposed hunger strike in her bedroom; and been forgiven after saying truly unforgivable things, because that’s just what you do, isn’t it. For what it’s worth, I don’t think she could help it. 

So there won’t be a funeral, because only we would go anyway and we would hate it, but I wanted some people to hear about her and her life, because she really was remarkably strong. I wish her life had been easier, I wish she’d been better looked after and I wish she’d known how to be kinder to herself and everyone around her. I didn’t always like her but I loved her, the complicated little cow xxx

Day 1. While I mull over how I might have put on half a stone and ricked my back, someone attempts to extract my wisdom teeth using a vaginal approach but no anaesthetic. I worry I’m dying but it turns out I’ve just got my period. I hate everybody.

Day 2-5. I smell like an abattoir. Not just any abattoir but a really bad one that would probably fail an Environmental Health check. To try and distract myself from all the pants-related pain I sweat more, cry more, eat more and get hairier. Now is the perfect time to have lots of sexy feelings but unfortunately I am repellant to all humans. I hate everybody.

Day 5-13. Recovery. I begin to trust, love and live again. Reluctantly at first, I re-engage with society, beauty products and fitness facilities. It’s a slow process but I start to believe that not everybody in the world is a complete twat. I am cautiously optimistic about the future.

Day 14. Hi everyone! You won’t believe this but today I am BEAUTIFUL. Maybe even too beautiful, should one person have this many blessings? I’ve finally grown into my looks, and this is it guys, my thirties are going to be MY decade! All my clothes look amazing, I keep stumbling into perfectly-lit rooms and everyone fancies me. This is the best my hair has ever looked. I can’t wait to get on with the rest of my beautiful, amazing life!

Day 15. Inexplicably, I wake up looking like Ludo from Labyrinth. I hate everybody.

Day 16. Eating.

Day 17. Crying.

Day 18. Shouting.

Day 19. Fighting.

Day 20-28. It’s time for a serious assessment of many things. I don’t like to overreact but my otherwise happy marriage is on the rocks due to some wet towels on the bed and we need to have A Proper Discussion About Our Future. My husband mildly mentions that it is almost exactly a month since our last Proper Discussion. Trying to respond rationally, I pack a bag for the airport because everyone in my life is better off without me. The half stone I’ve lost over the past few weeks has crept back on and my hair looks dreadful. I am terribly hungry and I want to sleep with everybody, not in a good way but until they are dead. I absolutely cannot fathom why I feel like this. I hate everybody.

All through pregnancy I was pretty bloody nonchalant about the birth bit. Months of lying awake at night all hot and bothered had got me really fed up, I was sick of hefting my stomach around and people in the street looking at me as if I constituted some sort of medical emergency. The endless vomiting, the carpal tunnel syndrome, the relentless torpidity of my bowels all seemed much more tiring than the idea of ‘doing a birth’. ‘I’m more of a sprinter than a distance runner anyway!’, I thought cheerfully. My game face was very much on.

Then, as my due date approached and then passed, a nagging doubt took hold of me and started festering inside, growing bigger and bigger each day until I was carrying a baby, a placenta and a big old lump of scares. I didn’t talk about it, because I was trying to pretend it didn’t exist, but then it just came tumbling out and I spent a few hours in tears, legs crossed, thinking fervent anti-labour thoughts and researching ‘ways to keep babies inside’.

So I developed this phobia of the whole thing, and then even more stupidly, a fear of the fear itself. Settled nicely in among all my other insecurities is one about being strong, being brave. Feeling or appearing weak terrifies me just as much as do snakes, drowning or falling down stairs in ill-fitting slippers to only be found, knickerless and without makeup three weeks later by a postman with a pet tarantula. Ugh. It took me a lot to confess this fear, and having geared myself up to make this startling revelation to family and friends, I felt they weren’t being completely sensitive when they delivered their robust responses, mostly along the lines of “Dude, OF COURSE you are.”

So there you go. Everyone is scared, and it’s a very reasonable fear. Reasonable not because the birth bit is so terrible, but because the anticipation is much, much worse. You’ve got horror stories from unhelpful people, your own imagination running wild and you’ve been gearing up for one moment for an unreasonably long time. This is why waiting to go in for an interview is much worse than the interview itself (usually, unless I dunno, you soiled yourself while trying to explain where you see yourself in five years time). Pregnancy is one of the most protracted countdowns in existence, and what with hormones and very normal fears and hopes, it’s not surprising everyone choosing to do it goes a bit loopy at the end. It’s fine to be scared, but from the other side the only useful thing I can say is the terror comes only from the unknown. Once it all kicks off, whether naturally or in my case, sixteen days late with huge amounts of chemical coaxing, you will be so busy DOING that there won’t be any time for THINKING, and in my experience, this way round is much, much better. Until then, you’re stuck in the crazy little waiting room in your mind. I can’t tell you how to get out of there, but I can say, like most waiting room experiences, it is improved by friends, books, telly, strolling around, dozing occasionally and eating plenty of crisps.

Love and luck to those who are waiting xxx

 

 

What were you doing in April? Well I was having a birthday, holding out to complete six months of breastfeeding in order to receive a certificate (never got this – still pretty miffed, fyi) and trying to do some more of this medical blogging business that seemed like such a good idea one night when I’d had a few beers and sang John Grant’s ‘GMF’ thirteen times in a row.

In that last blog, I wrote down this piece of information: ‘80% of diagnoses are made from the history alone’. Remember that? It’s okay, me neither really, but let’s pretend we do in order to carry on unabated with the next enthralling chapter of this series. Given, then, that most of our information about a patient comes from merely having a good old chinwag, how else can your medical professionals track down clues to diagnose you? I will, at some stage – Christmas 2017, I imagine – discuss investigations that are done, because they are a vital component of diagnosis and monitoring, but before I get there let’s chat about EXAMINATIONS.

Chances are you might not have undergone many of these. When you visit your GP, perhaps they’ve taken your blood pressure, or listened to your chest if you’ve gone in with an infection. Most women will have had smear tests done, the results of which get sent off for INVESTIGATION (golly, this is all tying together beautifully), but we don’t often get a full work-up. It tends to happen more in hospitals, where problems may be more acute and generally follows the point where a person is admitted and has had their history taken. The point of examination is to look for signs, a person can tell you their history, but their body will demonstrate these physical clues that are manifestations of the activity inside our bodies. Clever eh?

Examination follows a nice little order. Medicine loves routine, and following the same one in the same situation is also a very handy way of making sure bits don’t get left out. So, when doctors examine someone we Inspect (have a good nose), Palpate (have a feel of things), Percuss (tap things to see how they sound) and Auscultate (have a listen with our prized stethoscopes). My stethoscope is orange and you can have that personal fact for nothing because, my friends, sharing is caring and I’m a very caring person.

If you went into hospital with dizziness and head pain, you would undergo a very different examination to the one you’d be given if you were, say, throwing up blood, so for the purposes of this post, let’s pretend you’re going in with acute stomach pains. Whoever was seeing you would want to perform a full gastrointestinal exam, so I’ll talk about that here, with digressions if I think it’s interesting. We’ll get along better if you take the word ‘interesting’ in it’s very loosest interpretation here.

SO, after the initial hand-washing, introductions, explanation of procedure and gaining informed consent (i.e. you know exactly what will be happening to you and you agree to it), the doctor will start having a good old nose at you, not even close up. They might have been doing this from the moment you walked / were carried in / they came to your bed, because there’s a lot of information that can be collected by simply being observant. You can usually tell if someone is in pain, if their breathing is normal, if they have any medical appliances by the bed such as walking aids or oxygen, or maybe some of their medications are on the side. 

First port of call for a very detailed inspection though is the hands. Although they probably seem fairly irrelevant when you’re clutching at your belly in agony, our hands show a lot of signs relevant not only to our gastrointestinal system, but our heart and lungs as well. Impressive eh? Glad I’ve got your attention actually, because I might be about to list some things and lists are always hard-going. Just getting Miss Marple-ish about the fingernails alone can reveal the following signs:

  • Koilonychia (where your nails become more concave and spoon-shaped), which may point to iron-deficiency anaemia
  • Leukonychia (whitening of the nails) which may be due to injury (those small white dots you get from time to time) or a sign of low albumin levels or liver problems
  • Nail clubbing (take the same finger on both hands, place nail against each other, normally there is a little diamond-shaped space at the nail bed between the two – in clubbing, this is absent). Nail clubbing is most commonly an indicator for heart and lung conditions, but can also occur in gastro stuff like Crohn’s or cirrhosis
  • Tobacco staining – if someone says they’ve never smoked but their two ‘smoking fingers’ are stained, this is important information
  • Palmar erythema  (reddening of the palms around the thumb area) which can be an indicator of many conditions such as liver disease, although it often occurs in pregnancy or may be part of a skin condition like eczema.
  • Dupuytren’s contracture (where the fingers, particularly small and ring finger, curl in towards the palm, affecting function) which may ‘just happen’ but may be an indicator of liver cirrhosis. It also tends to affect men over forty with Viking ancestry. Little free fact for you there.

After this the patient is asked to hold out their hands straight in front of them, this checks for tremor, and then to extend the wrists so the fingers point towards the ceiling, which may reveal asterixis, also known as a liver flap, where the hands jerk in this position and which may be an indicator of liver problems or even carbon dioxide toxicity. At this point it’s good to take the pulse at the wrist (your radial pulse) as that’s always good information to have. 

So there we go. That’s part one of how to do a gastrointestinal exam, and I haven’t got beyond the arm yet but my baby is waking up from her nap, the cats are fighting in the chimney and my personal hygiene requires some rather thorough and urgent attention. You’ve either switched off or are furiously checking your hands for signs that you about to shuffle off this mortal coil in an imminent fashion (spoiler: you are probably not). I hope you found this vaguely interesting but in the highly unlikely event that you did not, may I warn you that there will only be more of these to come and refer you instead to Google Images and the keywords ‘cats in bikinis’. You’re welcome. 

When did it become okay to take photos and videos of strangers and put them online? Not just in a ‘Fifty Most Hideous Family Portraits’ way, but as an everyday comment on your surroundings? Why is ‘internet shaming’ an acceptable thing for us to be doing to each other? Now maybe I’m just a paranoid old fanackypants with disappointingly thin hair, fluctuating self-confidence and a questionable taste in clothes, but I think I resent this trend not only because I’m scared someone will do it to me, but because I think it’s – to be a bit old-fashioned about it – hugely ill-mannered.

My Twitter feed is full of it – particularly in this heat, where people (sensibly) wear fewer clothes. So someone you deem as unattractive got their body out a bit, feel free to judge them if you like (silently, in your head), but don’t go and bloody DOCUMENT their failings as you see them. We talk a lot on there about how shamefully the media treats women celebrities, but it’s just as grotty when any of us post photos of other ordinary people for the crimes of dressing worse/having a higher body fat percentage than us. I don’t really feel like sharing a photograph going, “Ugh, look at her shit shoes” is furthering any particular cause I want to be part of.

Do we judge people on their appearances? Yep, all the time. I probably do it to every single person I see and sometimes (because I’m not always a nice person) I think some pretty horrible things. In order to maintain the fiction that I’m not an utter cunt, though, I find that my snidey commentary is better left unexpressed. Even if a person is dressed like a uberwang deluxe, it’s not that big a crime really is it, compared to, ooh I dunno, secretly taking their photo and splashing it all over the internet for lots of people to laugh at. Can you image how gut-wrenchingly horrible it would feel if you suspected someone across from you on a train was photographing/recording you because they’d decided you were somehow less well dressed than they are? What would you even do? If you challenged them, I imagine they’d deny it, and it’s not like you’re going to demand to look on their phone, is it? You’d end up feeling like an utter worm.

That whole scenario feels pretty ‘Mean Girls’ to me, and I don’t really want any part of it. I was bullied once for the way I looked, and I’m not that keen about doing it to anyone else. So what, you are better-looking/better dressed than that person you’re sneakily spying on? WELL DONE, YOU. You must be a better person with better morals and stuff, surely. Finally – if you aren’t sure whether or not it’s a bit of a cunt’s trick to do this, try asking your parents/grandparents/any old people you find knocking around. Pretty sure they’ll cuff you round the back of the neck.

What do you mean, you can’t believe I’ve got more to say on this subject? Well, I have. I will not  be silenced, my voice must be heard, I refuse to be interrup…. (sorry, just broke off for half an hour there to run around with a teddy bear on my head, shouting “Whoosh! Weeeee! Oooooh! Splodge!” – fairly rewarding if you have the right audience, but choosing your demographic is key).

I have a seemingly niche view on this baby business, and it’s one I’d like to share (gingerly, quietly, never leaving my back exposed) with people who may do this themselves one day. My earth-shattering revelation is tantamount to this = in the main (special circumstances notwithstanding, please contact my legal team etc etc), it’s ALL FINE. It’s all fine, you will be fine, you won’t make a complete hash of it and it’s not dead complicated. My secret suspicion is that lots of the advice, webpages, forums and woeblogs out there exist solely to make women feel miserable. They help perpetuate the myth that once you’ve pushed a lovely little alien out through your vagina you will be forced to carve out an entirely new identity out for yourself, possibly involving changing the username on all social media accounts to ‘mummy’ something and suddenly and inexplicably using acronyms to refer to your family. You might think, reading some stuff out there, that you’ll no longer be able to chat to your mates who don’t want / can’t have / haven’t got kids and that NO-ONE WILL UNDERSTAND YOU COZ OMIGOD IT’S ALL SOOOOO DIFFICULT.

I’m not saying it’s not hard, like, (it can all get a bit despo when you’re cry-feeding into a box of Maltesers at three in the morning, watching a particularly disturbing episode of Criminal Minds – creating a Nurturing Environment is Soooo Important) but there are cubic hectares of the internet devoted to blogs which describe in painful, waiting-to-die level detail just exactly how much solid stool little Mungo has generated this week. It is hard, but if you’re lucky enough to be a healthy person with a healthy baby, it is also FINE. The hard bits are harder than you think, the great bits are greater than you think. That’s it really, it’s all just fine.

My advice would be (and I’ve thought about this because I wanted to come up with something really pithy and erudite) that nearly all advice can just shit off. If you are a reasonably nice person then I’m sure you’ll do a bang-up job, because most reasonably nice people will try quite hard to look after the human being they brought into existence, like people have been doing for, oooh zillions of years (must check the statistics on that, but ‘a zillion’ sounds sort of right). Whilst the internet has given us many wonderful things – cat pictures, beard tumblrs, Acorn Antiques on youtube – it has provided a previously unprobed level of complexity to some fairly commonly-occuring human activity. Thus when you’re all stressed out and all this stuff is new and a bit of a shock and your baby isn’t sleeping very well and you’re desperate, a few little keystrokes will find you in the midst of hundreds of people in the same position (that position is frequently squatting a corner, wearing a nightshirt that has, frankly, seen better days but for now is held together with blood, toast crumbs and an inordinate amount of your own stinky dairy supply).

Here’s the suckerpunch though – you’ll join this forum, maybe post something, read what others have got to say and YOU WON’T FEEL ANY BETTER. Once you’ve been advised to try co-sleeping, to avoid co-sleeping in case you roll on your baby and suffocate them, to let them cry it out, to never leave them to cry it out, to keep them in your room/put them in another room/hold them/don’t touch them by people who have established themselves as an authority on the matter, you’ll probably find yourself wondering if your bath is deep enough to pull a Virginia Woolf and just leave the whole sorry mess behind. I’ve picked sleeping, in this instance, but you’ll find this state of affairs also applies to feeding, crying, teething, weaning, pooing, smiling and existing. It can be dictatorial, applies a load of unnecessary jargon to some fairly normal stuff, excludes non-kids folk, judges you swiftly and without mercy and is frequently just incredibly, utterly dull.

What people almost certainly won’t say are these things: The first few weeks are a bit shit and it’ll almost certainly get better soon, you just need to hang in there. If someone removed me from the greatest hotel in the world and unceremoniously forced me out through an inadequately-sized catflap, I’d be pretty pissed off too. In there the stream of food was constant and one reclined in an almost permanent state of blissful slumber. Take those things away, and going forty-five minutes without some grub is really going to grate. Add to that your world is now colder, louder and full of enormous shouting monsters who have had the temerity to constrain your beautiful fat nakedness in clothes and STUPID FUCKING HATS, ugh, and it makes sense that it will take a while to settle in. After that point, they might sleep or they might not, and that is just the way it goes, my friends. Shocking, innit, but they’re all different. It’s almost like they’re HUMAN or something.

So my prescription is this is, broadly speaking, ignore all the advice (apart from mine because it’s really, really great) and just get on with it, remembering these maxims. Never, ever settle down to feed your baby without at least three drinks lined up in front of you. Avoid ‘mini-adult’ clothes, waistbands and socks, you’ll all be happier. Up to a certain point, sleep IS replaceable with crisps and Dime bars. To Charly and Clairy, I wish you all the best, you’ll be ace at this because you are wonderful people. Nothing complicated about that xxx

 

 

People always ask me what kind of doctor I want to be, and although I’ve got a couple of ideas (a kick-ass glamorous one who studiously avoids contact with phlegm obvs), I’m still quite open to the idea of what I might end up specialising in. I’ve got to try it all out first because some things sound amazing – “I SAVE BABIES! I RUN AROUND WITH A DEFIBRILLATOR! I PUT MY HANDS INSIDE BRAINS!” – but who knows, maybe the prospect of an in-depth association with rare skin diseases may eventually prove unavoidably alluring. One thing I probably won’t end up in though is any kind of research, because I’d rather be talking to someone than reading academic papers, and because I come out with ‘facts’ like this on a regular basis:

‘80% of medical diagnoses are made from the patient history alone’.

There you go. That’s an interesting idea isn’t it? If I was more academic and better at writing papers I’d find the source of that information and tell you if it was true or not. Alas, I’m not, so all I can say is “My teacher, Mrs G, told me it and I believe her because she has that sort of face”.

A patient history is that seemingly endless list of questions your doctor asks you in the hope of getting to the root of your problem. It starts off very broad and gets more specific, and although sometimes it can seem irrelevant (“Do you have any parrots at home?”), there is, amazingly, a master plan at work. Although medicine does involve lots of bone parts and myriad invisible and theoretical gates and loops and processes, what underpins it – to my mind at least – is a series of patterns, which is to say that if you have, say, an ulcer, you will often (although inconveniently not always) present to your doctor with a similar history and experience as another person who has also had an ulcer. The purpose of a history is to look for these clues and patterns, and hopefully point towards some possible theories which you may or may not confirm with tests and investigations, depending on whether or not you think it is warranted.

So then, for the purpose of this post, let’s talk about stomach ache (SHUT UP, THIS IS FUN, OKAY?).   If you tell Twitter, you’ve got a stomach pain and are being sick, what responses do you get? As previously stated, I’ve done absolutely no research on this so I’m going to go with my Scientific Gut Feeling and hazard a guess that people will say the following things:

1. Awww, babes xxx (because Twitter is essentially a lovely kind place unless, y’know, anything’s happened in the news)

2. We’ve all had that here mate, there’s a bug doing the rounds xxx

3. I always get that, drink some camomile tea pet xxx

For the sake of clarity, I want to say at this point that there’s absolutely nothing wrong with any of that, we all do it, I do it all the time. After all, you go to online people mostly for sympathy and reassurance rather than medical opinion, which they would be irresponsible and wrong to give. If you want to find out what a doctor thinks, you need to go and see one. I’m saying it merely to make a comparison – when we consider it a ‘lay’ matter, we’re all quick to diagnose not just each other but ourselves, and remedy things accordingly. We base that diagnosis on our own experience, or things we’ve heard about, but what we very rarely do is delve any deeper into the matter.

If you were concerned enough to get a bit more medical and take your stomach pains to the doctor, they might approach it rather differently. There’s a fairly set pattern to taking a complete history (which isn’t always necessary), but I think I’ll wang on about that on a different occasion and just talk today about PAIN. Doctors love talking about pain, and like to get really into the nitty-gritty of exactly where, what and how you feel it. Not because they get any kind of pleasure out of this, or because they’re really nosy (although, disclaimer: I AM REALLY NOSY), but because finding out the small details will quite often reveal a pattern which can hopefully be recognised, confirmed and treated.

So, this stomach ache we’ve got, yeah (Are you still with me? Stay with me), let’s talk about that. There are lots of snazzy little frameworks about to help medical folk remember to ask all the right questions, but my personal favourite is SOCRATES. Thusly:

Site – Where is this pain exactly? Splitting the abdomen up (not literally, like, but IN YOUR MIND), into a noughts and crosses grid gives you nine areas, and pain in different ones of these points to different sources for the pain.

Onset – How long have you had it, and how quickly did it start? Again, different illnesses/diseases have different patterns of onset.

Character – What sort of pain is it? Interestingly enough (in a geeky about linguistics type way), people often use the same words – a dull ache, a sharp stabbing pain – to describe pains when they have the same underlying conditions.

Radiation – Does the pain move? For example, in a very classic textbook presentation of appendicitis, most of us know that you feel the pain in your lower right belly. BUT DID YOU KNOW, in that same classic presentation, the pain starts off in the central abdomen before radiating down? See, aren’t you glad you stuck around for this?

Associations – Does anything else happen when you experience this pain?

The others are Time course, Exacerbating/Relieving Factors (stuff what makes it worse/better) and Severity, but frankly, I’m a little bored of this list and I imagine you are too. Suffice to say, this list of questions is what takes you from ‘girl with stomach pain’ to (please use your best ER voice for this), ’35 year old woman presenting with severe right-sided stabbing abdominal pain of sudden onset, four-hour duration associated with nausea and vomiting and relieved by lying down and abstaining from food’. Sounds totes profesh, dunnit?

Of course, not everyone handily presents with a pain, but if they do and the medical staff treating them ask these types of questions then they’ve got a good starting point to maybe make some guesses as to what’s going on and start sorting the person out. Isn’t that amazing? Making a diagnosis just by ‘having a conversation’? After all, according to Mrs G, 80% of diagnoses are made just by CHATTING to people and asking the right questions (this satisfies so many of my thwarted amateur-detective ambitions).  So there you go, there’s a start to explaining some of the stuff we learn at medical school and why sometimes your doctor asks you a bazillion questions and doesn’t necessarily do any tests. You may care, you may not, but well done if you got this far, you deserve a lollipop. Do any doctors still do that? THEY SHOULD.