Emergency Medicine

Emergency medicine feels the pressure of time; patients are waiting for you, targets need to be met, and life-saving decisions need to be made. Salvador Dali’s melting clocks, however, remind us that time is neither relative nor fixed; attempting to forcibly manipulate time beyond your abilities can disrupt the natural progression. The department will always seem chaotic. Take the time you need to ensure that neither you nor the patient spirals out of control.

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Gillian Turner

Gynaecology

The spiral is a pagan fertility symbol. In gynaecology, the major milestones are marked by the beginning (menarche) and end (menopause) of a woman’s fertile period. Treatment is balanced between improving symptoms and fertility wishes.

“It is more important to know what sort of patient has the disease than what kind of disease the patient has.” -Caleb Parry (1755-1822)

Parry was fascinated between the connection between events in his patients’ lives and their diseases. His aphorism is particularly relevant to gynaecology because many of the diseases are chronic, and the choices of treatment are many. Take endometriosis for example – what is the right treatment? Well, this depends on who has got it – where they are in their lives, how much the pain matters, what the plans are for future pregnancies etc.

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Charlotte Goumalatsou

Paediatrics

Helter skelters should be fun – as should our childhood. Pushing off at the top requires bravery and boldness, and so do many new adventures and experiences in childhood. These years are about finding our way in life. In order to do this we need the boundaries, love, and protection that allow us to flourish in a positive and safe way (helter skelters would not be fun without the protective side wall). Good health allows us to grow and develop, yet there should be access to healthcare and treatment when required. Not all children have good health, access to healthcare, or a safe and loving home. It is our job to try and ensure we identify those in need and put in place what is needed to help them climb back up to the top of the slide and continue on their journey.

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Carolyn Pavey

Orthopaedics

“To thrive in life you need three bones; a wish bone, a back bone, and a funny bone.” -Reba Mcentire.

It is easy to look at a single joint in isolation, yet the masters of this specialty are able to take a step back and optimize the entire body structure. Orthopaedic surgery embraces the entire patient journey from diagnostic assessment, operative interventions, and rehabilitation. Knowledge of anatomy is therefore key; you won’t be able to identify the abnormal if you don’t know what normal is!

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Gillian Turner

Psychiatry

If you stare at the image, you will start to see the spiral spin. Your brain is tricking you into believing that this two-dimensional image has genuine depth and movement. This optical illusion causes your brain to confuse the subjective experience with an objective reality and this is happening because your brain is working as it should.

But what happens if odd experiences like this start to intrude on your life? When living with a mental illness, it isn’t so easy to filter things and find the objective. And mental illness can define who you are in a way that physical illness do not.

In psychiatry you will develop the ability to understand, recognize, and treat people who are having experiences which are stopping them living their lives the way they would like.

To be a good psychiatrist (or doctor, friend, or human) you need to listen to the person telling you about their experience. So listen… if you listen, you may be able to help.

Image from the Oxford Handbook of Clinical Specialties. © Baldwin, Hjelde, Goumalatsou, and Myers. Used with permission.

Obstetrics

The uterine spiral arteries sustain life in utero, bathing the placenta with nutrients which twist and wind their way down the umbilical vein to the baby, to be returned to the placenta by coiling umbilical arteries.

Pregnancy is a risky affair for babies and mothers. There are many direct causes of maternal mortality in the United Kingdom, but if an obstetrician could be granted one wish, it would not be to abolish these; rather, it would be to make every pregnancy planned and desired by the mother. Worldwide, a woman dies every minute from the effects of pregnancy, and most of these women never wanted to be pregnant – but either had no means of contraception or were raped. So the real killers are poverty, ignorance, and non-consensual sex, and the real solutions entail education, economic growth, and an equality of dialogue between the sexes.

Image from the Oxford Handbook of Clinical Specialties. © Baldwin, Hjelde, Goumalatsou, and Myers. Used with permission.

Primary Care

GPs may feel the weight of the universe as they navigate the seemingly infinite workload and resist collapsing into a black hole. However, the spiral shape of our own galaxy, the Milky Way, is a reminder to think about the opportunities for holistic and integrative care on an individual level; to pick up cues as to what is really important to our patients, and to make a real difference to their well-being, mental health, and social functioning.

Image from the Oxford Handbook of Clinical Specialties. © Baldwin, Hjelde, Goumalatsou, and Myers. Used with permission.

Trauma

The Koru is frequently used in Maori art as a symbol of perpetual movement and creation. It is based on the unfurling fern frond which eventually points inward to indicate an eventual return to the beginning. As the fern unfurls, the people of New Zealand view the Koru as a new beginning. Each of your patients is a new opportunity to do your best. Don’t let the tough shifts pull you down, instead touch them into your Koru so that your return to equilibrium is hastened. Those experiences will stay with you but it’s your choice how you let them affect your next patient. Victims of trauma, no matter how trivial, have suddenly been ripped out of their comfort zone. It’s our job to guide their Koru back to harmony and facilitate their new beginning.

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Gillian Turner

Ophthalmology

Doctors assume that our eyes are passive organs whose sole job is receiving and organizing photons. Philosophers and physiologists are less sure. Ludwig Wittgenstein once said:

“When you see the eye, you see something going out from it. You see the look in the eye. If you only shake free from your physiological prejudices, you will find nothing queer about the fact that the glance of the eye can be seen too. For I also say that I can see the look you cast at someone”

If you were Wittgenstein’s pupil and he cast you one of his notorious glances in a tutorial, would you meet his gaze? Choosing where to look can be perplexing. You might toy with the idea of looking in the eye, but then back off. MRI shows different parts of the medial frontal cortex are active when we choose to make eye movements of our own free will, compared to when we face duress and conflicting choices.

So studying eye movements teaches us about the seat of the soul, if we accept that appreciating and resolving ambiguities is the essence of consciousness.

Image from the Oxford Handbook of Clinical Specialties. Used with permission © Ken Banks

Anaesthesia

Staring at the centre of this spiral for long enough might just trick your mind into a hypnotic stupor, yet we suspect you would snap back to reality should a needle venture your way.

The full triad of muscle relaxation, hypnosis, and analgesia is required for effective anaesthesia to take place. Should one component be misplaced, situations such as awareness, agitation, and pain arise. Anaesthetists are masters at balancing and manipulating this triad to ensure the necessary surgical procedure can take place. The role of the anaesthetist has expanded to encompass not only the provision of ideal operating conditions for surgery, but also intensive care, resuscitation, alleviation of acute and chronic pain, obstetric anaesthesia and anaesthesia for diagnostic procedures. A detailed knowledge of general medicine, physiology, pharmacology, the physical properties of gases, and the working of the vast array of anaesthetic equipment are essential in order to practise well.

Image from the Oxford Handbook of Clinical Specialties. © Baldwin, Hjelde, Goumalatsou, and Myers. Used with permission.