surgo, inside the mind. may 2014

8/12/2019 Surgo, Inside the mind. May 2014

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May 2014 86:4


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1 Editors note

2 Medical news

3 Interview: Sir Graham Teasdale

5

Psychiatric illness and prescription highs

7 Insanity: a rational adjustment to an insane world?

8 Mad, bad, sad or dangerous?

9 Change is changing: the penny drops

11

Word-search, horoscopes and Yules yarn

12 Remembering Manvir Singh

Contents

James Tajkarimi

Assistant Editor

Josh Neilsen

Production Editor

Tom Baddeley

Finance Editor

David Boyle

Arts Editor

Contents


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Editors note

1

Editors Note

Editors note

Welcome to this years final Surgo and my final issue as editor; I think youll agree that

over the past 3 editions weve tackled almost all of the big issues facing healthcare and

the NHS today. From what Iain Swan actually does (aside from scaring Ayr studentsaway from club de mar), right through to how best to dress like cancer , curing all

hangovers everywhere along the way. Its been a pretty great year and this is a pretty great

finale

As summer gets closer and our collective mental health hits an all-time low, we bring you

an aptly themed issue. One filled with all things mental, a welcome antidote to the SL-

induced social anxiety, OSCE OCD and chronic placement fatigue that youre all

undoubtedly experiencing. If youre not, youre coping far too well. A few of you may

have noticed our first ever hand-drawn front cover, courtesy of James Yule, art teacher

and brother of Lady Anna Yule of Glen Coe. Have a gander at School of Yule on

YouTube to see the cover being made (alongside many videos on everything art). We start

this issue as usual, with medical news, before moving swiftly on to assistant editor James

Tadjkarimis interview with Sir Graham Teasdale, co-founder of the Glasgow Coma

Scale. After that, in true Surgo fashion, we dabble with a few more recreational drugs to

see if they have any place in the treatment of psychiatric illness (Jamie Henderson, pg 5).

To continue the theme, Tom Baddeley gives us an insight into the life and times of R D

Laing, psychiatrist and avid user of LSD. Contributor Mike Pretswell follows this with a

look into the past at all the famous, but mildly insane, figures of yesteryear.

Once youve got through all that, it gets distinctly more trivial. From health, to wealth

David Boyles last hurrah as arts editor, before he leaves the Surgo editorial team in

favour of the dizzying heights of Med-chir publicity; Change is changing; the penny drops

(pg 9) looks at a myriad of coping strategies for when our beloved one pence piece isdiscontinued. If you make it through this, have a go at our wordsearch, read another of

Yules lengthy yarns and check out your

horoscope courtesy of our resident psychic, Jane

Hamilton. We unfortunately end this issue and

the year, on a very sad note with the death of

medical student Manvir Singh; his family and

friends say a few words on page 12.

And so, thats it. As a final few words, Id like to

say a massive thank you to this years editorial

team and army of contributors. All of whom have

devoted many hours to a few genuinely

interesting articles and much Surgo silliness. We

reached an all-time high this year, both in number

of reads online at Scribd (593 no less -if thats

not a measure of ubiquity, I dont know what is)

and in bank balance, thanks mostly to our

fantastic treasurer Tom Baddeley. After a land-

slide victory at the med-chir AGM, Tom will be

taking the reigns as our new editor in chief,

guiding light, champion piggy-backer and Surgo

BNOC for the next year so watch this space.

Enjoy this issue and have a fantastic summer!

Ella Bennett


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2

News

Deep brain stimulation causes

Johnny Cash obsession

A Dutch man who received deep brain stimulation to help

treat his OCD has become obsessed with the music of

Johnny Cash. Mr B had an electrode implanted into his

nucleus accumbens (the brains reward centre) in an effort

to treat crippling compulsions and anxiety. As an

unexpected side effect, Mr B has now become obsessed

with Johnny Cash listening to him near constantly and

purchasing his entire record collection (and all his DVDs).

When the electrode is turned off Mr B instantly reverts to

his previous musical taste, the Rolling Stones.

New study links cynicism to

dementia

A study from Finland has shown that those with the

highest levels of cynicism are three times more likely to

develop dementia than their more trusting peers. The study

graded levels of cynicism by asking subjects to agree or

disagree with statements such as "It is safer to trust

nobody" and "I think most people would lie to get ahead".

They then followed them up on a variety of health points

over the course of 8 years. The study also reinforced

previous findings that link cynicism to heart disease and

depression, but did not find an impact on overall life

expectancy. So the good news for the cynics amongst us,

not that Surgo would ever be cynical, is that you still have

plenty of time to grow old and miserable.

Iron-age false teeth unearthed in

France

Builders on a luxury housing development in Frances C

hampagne region have unearthed an iron age burial chamber

containing the remains of noble woman. What is more

incredible is that archaeologists have found an iron tooth

in what remains of her jaw. This object is thought to be theworlds oldest implant. Some of the team involved have even

suggested that poor sterile technique in this ancient surgery

may have been the cause of the womans death.

Medical News

Response to social drinking may

predict future alcoholism

Do you enjoy a pint down the pub with friends? Is your first

response after not being knocked back from Viper to dive

towards the bar for a double vodka coke? These are

undoubtedly characteristics of half of the med school, but

unfortunately, this may be bad new. A new study has found

that those who receive a buzz or high while drunk are more

likely to become dependent than people with a more sedative

effect. So if you tend to doze off in a corner youre fine but

if after a couple of drinks youre a legs out, lashes on, queen

of the dance floor kind of guy, you may want to cut back.

CIA told to stop using vaccination

programs for spying

The White House has agreed to ban the use of vaccination

programmes as cover for spy operations. This follows a

year long campaign by US medical schools and public

health experts. They feared that such activities led to

increased attacks on healthcare workers abroad and lent

credence to radical imams claiming that vaccination

programs are an American plot to sterilise children.

The issue came to light in 2012 when Dr Shakil Afridi was

convicted in Pakistan of using a fake vaccination program

to obtain DNA samples for the CIA. These samples when

then used to locate a concentration of Osama Bin Ladens

relatives in the town of Abbottabad, and led directly to the

2011 assassination of the al-Qaeda leader.

GMC claims entry test for foreign

doctors is too easy

At present 95,000 internationally trained doctors practice in

the UK, making up nearly 25% of the total NHS work force.

Research conducted by University College London however,

has criticised the current licensing exams claiming that they

make gaining a UK medical licence too easy. The grounds for

this claim surrounds statistics suggesting that of the 1300foreign graduates that pass the exam each year, up to half

encounter serious issues after starting work. In addition to

this, of the 669 doctors struck off by the GMC over the last 5

years, 420 were trained abroad. This dangerous statistic has

prompted the suggestion to raise the exam pass mark by 13 as

a quick fix but ultimately, the GMC are looking at moving to

a different exam entirely.

Your handy summary of all things new and exciting

(did we mention trivial?) in the world of healthcare

courtesy of contributing writer Mike Pretswell.


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Interview

When you ask a member of thepublic what they think of whenyou mention Glasgow, more often than

not theyll reply with buckfast, The Old

Firm, or deep fried anything. Ask a med-

ical

professional, and theyll almost certainly

say the Glasgow Coma Scale: the jewel

in our proverbial healthcare crown.

The Glasgow coma scale, or GCS, was

developed and conceived by two of our

best and brightest neurosurgeons; Mr.

Graham Teasdale and Prof. Bryan

Jennett, published the journal article

detailing the GSC -Assessment of Co-

ma and Impaired Consciousness: a Prac-

tical Scale -in The Lancet in 1974.

With a whopping 8500+ citations andalmost 40 years of clinical use, the scale

has revolutionised how we stratify

patients with neurological deficit.

Whats more, in all this time nobody has

come up with an assessment scale that

can do it better.

The GCS started life as an answer to the

inconsistency in monitoring of those with

head injuries that existed in the days of

yore. Various papers had been written on

grading coma, but these relied heavily onsubjective opinion that was often

difficult to document correctly. Another

problem was that many used obtuse,

largely incomprehensible words to

describe patients like stuporose

semistuporose and obtunded (defined

as: a disorder of alertness associated with

psychomotor retardationapparently.)

This meant that many of these scales

were as useful as a bag of cats and

altogether erratic.

Following the publication of the GCS,

Teasdale and Jennett were tasked with

selling it to the masses to secure its use

in clinical practice. They decided to use

Glasgow in the title rather than their

surnames as they felt it would be morewidely accepted, and were probably far

more humble than your average neuro-

surgeons. Teasdale jetsetted all over the

world to promote the scale and thanks

mainly to widespread nurse endorsement,

the GCS was soon being used globally.

(with the exception of Edinburgh, one of

the last places in the UK to adopt it. No

surprises there.)

The beauty of the GCS is that its easy to

use, and allows anyone to assess andcommunicate the severity of a head

injury in a practical, reproducible way.

Its basis is simple. When assessing a

patient with a neurological deficit,

responses are split into 3 sections: name-

ly best eye, verbal and motor

responses. The combination gives you an

overview of the degree of impairment

and aids monitoring, a key factor in

making crucial decisions about patient

management. It is also possible to put

numerical values on the scale to form a

total GCS score of between 3 -15. The

quick witted ones of you will have

noticed that 3 is the lowest score you can

be accredited with...

The scale isnt without its critics. Some

in A&E feel its too complex, others in

critical care think it oversimplifies neuro-

logical damage. Some also feel that it

shows too much variability, particularly

as, though it was only standardised foruse in head injuries, in practice it is used

for almost all acutely ill patients. Some

have called for the scale to be changed

and several newer systems have been

compared to the GCS in terms of

inter-rater reliability (i.e how many

different doctors will reach the same

score when testing the same patient.)

Newer tests have been shown to be

better, but not significantly so. None

have approached the popularity of theGCS which is used in over 80 countries

across the world and has been translated

into more than 60 languages -even

Gaelic!

Criticism aside, apart from being pretty

easy to use, communicable and a good

monitoring tool in neurological trauma, it

has over the years given us a good idea

of prognosis. As youd expect, those

with a lower GCS have been shown to

have higher all-cause mortality. But

thats why its useful; it allows you to

stratify patient care accordingly. Over

the years GCS has been tinkered with,

tested and tried in many different

situations, and although it may have

changed slightly over the years, its

essence remains the same, and it will

always be the research that put Glasgow

on the medical map.

We managed to scoop an interview with

Sir Graham Teasdale a few weeks ago;very abruptly mind you, but what follows

are some answers to the rubbish

questions we asked.

3

Sir Graham Teasdale: 40 years of the

Glasgow Coma ScaleAssistant editor, James Tadjkarimi, meets Graham Teasdale, one of two pioneering neurosurgeons that

brought us the world-renowned neurological classification tool that is the GCS.


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Interview

4

Surgo: What has been your biggest

inspiration throughout your career?

Graham Teasdale.InspirationI dont

know, theres probably a bit of hubris

about that. I think one of my biggest

influences was a doctor I worked for inNewcastle, a neurologist called Henry

Miller. He was a giant character with

mordant wit who loved to take the mick-

ey out of psychiatrists; he made academ-

ia and neurology exciting to me. And

then theres Brian Jennett (co-author of

the famed 1974 paper) who was the rea-

son I stayed here in Glasgow. Brian had

a very clear, logical mind and wasnt

afraid of tackling big issues. In the 80s

and 90s there were big controversiesabout brain death and organ transplanta-

tion. Brian took on validating the concept

of brain death. I guess the third influence

would be a girl with a head injury called

Connie.

S. A patient?

G. Yes. Patients are your biggest

stimulus. Connie had a head injury aged

11 and we had agreed to do a documen-

tary in the BBC Visit series with

Desmond Wilcox, husband of Esther

Rantzen. We followed Connie from day

1 through her recovery for 6 months and

then came back 10 years later. I got very

close to Connie and her family; seeing

the strengths of ordinary people and how

Connie progressed despite moderate dis-

ability, to become a happy, lovely person

was very inspirational. In a way patients

come and go, but her story made me

aware of how badly head injuries are

managed and it acted as a stimulus to dosomething about it.

S. And how about something you most

regretted? Either doing or not doing?

G. Difficult, I think of times when things

went wrong in operations, and you know,

they come back to keep you grounded.

That doesnt mean I regret doing the

operation, but its good to keep a sense

of reality. In professional terms, no Ive

no regrets, except doing more researchthan I ever had time to write up and

spending too much time working and not

enough with the family.

S. What would you say is the most

bizarre thing that ever happened to you?

G. Being on a KLM flight, a call came

out for a doctor which happened to be a

head injury back in the canteen,. I arrived

and discovered that the stewardess was aneurosurgical nurse from Rotterdam.

S. So how do you feel about Jeremy

Hunt as health Secretary?

G. One think I like about Jeremy hunt is

that he makes it very clear that issues

need to be sorted. Whether he manages

to sort them only time will tell, but I

think in a way, far more so than any oth-

er health secretary hes willing to admit

that this system is just about broke. Nowfixing it by central reorganisation is not

how to do it, but at least hes making that

very clear. Its interesting, the

evolution of it all. There was a time

when the health ministers of England and

Scotland were the head of the health

service and defended it. But now whats

happened is theyvebecome at arms

length its worst critic. Very subtle, clever

politics, you position yourself as the

patients advocate and criticise the health

service on their behalf rather than

defending what the health service is

doing for patients.

S. Lets say you were given the NHS

budget tomorrow, what would you do?

G. A radical reduction in the number of

buildings, radical restructuring to bring

together primary and secondary care. If

thats not addressed its going to fail.

There has to be more medical practice

outside of hospital buildings.

S. how do you feel about the upcoming

referendum, I m sure youre fed up of

being asked about it?

G. I think in our house all the votes will

cancel out. Ill say no more.

S. In terms of a yes vote, do you think it

change much? Will Scotland have the

sufficient funds to keep things like free

prescriptions for all?

G. I think theres a slight issue concern-

ing what Scotland can and cant afford

and a lot of things have been promised.

Some policies are popular, but not neces-

sarily sustainable. I think wed see some

changes that are not quite as popular but

necessary, though I dont see great

changes to the way healthcare is

organised. Compared with England its a

much more organised system. Its chaos

down there.

S. So apart from GCS, what do you think

the most important change or discovery

in neurology has been ?

G. Its not one single invention or thing.

Its the way a number of things came

together to make it more successful

CT scanning came along, understanding

of brain physiology and intensive care

came along and these improved our out-

comes in theatre. It was a golden period,

It just all came together.

S. what advice would you give medical

students that wanted to get into

Neurosurgery; that ill-fated career?

G. Go and have a pint and think again.

(laughs) Its very difficult now, but Id

take a balanced approach. Dont spend

all your time reading Grays Anatomy,

see enough of it to be reasonably aware

and get an intercalated degree on the way

through. Partly because of educational

benefit; learn to think and be rigorous.

Doing an intercalated degree in

neuroscience is the best thing you can do

as an undergraduate.


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5

Everyones heard of the benefits

that come with the variety of

substances on offer in Subclub on aSaturday night but not so manywould consider these a form of actual

medical treatment. In some sensestheyd be right; over the counter LSD

is undoubtedly a distant dream/nightmare . But, is the clinical

potential of these substances being

ignored due to fears of exploitationand damage to (the already fantastic)

NHS reputation?

MDMA (Ecstasy)

Developed by Merck in 1912, MDMA(ecstasy) was ignored as a compound fora long time as it was thought to beuseless. It remained this was the US

Army decided to test any compound theycould get their hands on, even using itthrough a mind control program. Thedetails from these studies were releasedin 1973, by which time many haddiscovered the fun one could have withthe addition of a little MDMA. Soonafter this, politicians realised how muchfun people could have and promptly

banned it.

Although lots of research was conductedbefore the ban, it has come back intopharmaceutical research fashion overrecent years. Clinical trials started in the

2000s looking into the benefits ofMDMA in sufferers of Post TraumaticStress Disorder (PTSD). This wasfollowed up by two further trials where it

was used as an adjunct to psychotherapysessions. Though both study sizes weresmall the use of ecstasy within

psychotherapy did appear to have abeneficial effect; predictable enough feltmore able to sharing their feelings.Basically if you suffer from PTSDattending a rave during the 90s mayhave helped your outcome and listeningto Moby in an abandoned warehousemay not have been the worst thing after

all.

Ketamine

Ketamine is arguably the most common-ly used recreational drug in medicine atthe moment, and is becoming more andmore prevalent with expanding research.Its status as an illegal drug beganreasonably late with it achieving class Cstatus in 2006 following a series of casesdetailing bladder problems withexcessive use. Fair enough really, as

personally, I d rather not have abladder that holds only 100ml.

Ketamine has been used as ananaesthetic for years; it is even carried onAir Ambulances as part of their standardkit. But recently and more excitingly, ithas been trialled for use in those withresistant depression. A group from theOxford Health NHS foundation trusthave just released data on a small study

of 28 resistant patients, of which 18proceeded into remission followingtreatment with ketamine.

Magic Mushrooms

Magic mushrooms are one of the most

natural and native of illegalsubstances; just go out exploring in theScottish countryside and youll easilyfind these hiding in the woods. Classifiedas a Class A drug in 2005, theyre not thegreatest thing to be caught with on thestreets of Glasgow. The activeingredient, psilocybin, although tightlycontrolled, has been used in manyclinical trials as a potential treatment fora range of conditions.Psilocybin was firstinvestigated during the hippy 60s bysome rebel researchers at Harvard.

Ultimately however, the project wasdoomed as some killjoys in thedepartment said it was not the best use oftheir time. This coincided with the

Psychiatric illnessContributing writer Jamie Henderson looks into the psychiatric benefits of recreational drugs
http://trashcomplex.files.wordpress.com/2012/03/post-house-03.jpeg


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Inside the mind

6

FDAs decision to ban the drugpreventing anyone pursuing researchinvolving it, even within a clinical

setting (way-to-go, politics!).

It wasnt until the noughties that furtherresearch into the clinical applications ofshrooms was conducted. One of the mostsuccessful of these studies investigatedthe use of psilocybin in the treatment ofobsessive compulsive disorder (OCD).Although, yet again a small study, it didreport a decrease in symptoms of 23-

100%. Whats more, these effects weremaintained for several hours

post-psychedelic episode.

It is well accepted that magicmushrooms can help you to relax; this

prompted a study investigating their usein the treatment of depression in patientswith terminal cancer. A recently

published study noted that doses ofpsilocybin significantly improved moodfor up to 6 months. In addition to these

benefits, it has been reported thatsufferers of cluster headaches alsoexperienced a reduction in symptomsfollowing magic mushroom use.

LSD

LSD was first made in 1938 and as perusual was banned in the 1960s when

people started having too much fun withit. Following its prohibition, LSD wasnot used in any research until 2008. Inthe 50s and 60s, LSD was a relatively

common addition to psychotherapy andmany doctors using it in the UK reportedclinical benefits in a wide range ofconditions. Despite relaxation of thelegislation surround LSD, studies intoits clinical use are rare; there is somedata suggesting benefit to clusterheadache sufferers though research isconfined to case reports at the momentso more work must be done to fully

investigate the perceived benefits.

The work into the uses of theserecreational drugs for medicinal purposesis mostly in its infancy, due mainly tostigma and legislation. Nonethelessresearchers are beginning to explorethese uses again and look to be gettingever closer to proving that thesesubstances are serious contenders in thetreatment of many psychological

conditions.

and prescription highs


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Inside the mind

7

Insanity: a rational adjustment to an

insane world?Finance editor, Tom Baddeley, looks into the life and works of Glasgow-trained psychiatrist, writer and

patient, Dr R D Laing.

Ronald David Laing was borninto a middle class family inGovanhill, Glasgow in 1927.

Despite being financially stable,

with Laing attending good local

schools, it was a bizarre

upbringing; Laings parents

forbade him from playing withother children, keeping him on a

leash when they left the house.

Laings father and grandfather

fought frequently and his mother

was said to burn the familys

rubbish inside their home to

conceal it from the neighbours.

Laing also describes being repeatedly

told he was evil whist his mother stuck

pins in an effigy of her son, with the

intention of giving him a heart attack(which coincidentally, he later dies of).

Though undiagnosed, Laings parents

undoubtedly struggled with mental health

issues, something that was also to effect

Laing throughout his life.

Laing experienced several schizophrenic

episodes during his lifetime as well as

struggling with depression and alcohol-

ism throughout his career. It is this first

hand experience of being a psychiatric

patient that gives his books and theories

such unique insight. Laing attended our

very own medical school and graduated

in 1951. Following this, he worked as a

psychiatrist for the Bristish army before

becoming the youngest consultant in the

country at Gartnavel Royal Hospital.

Here, Laing quickly developed his own

approach to psychiatry; he called this the

interpersonal approach, a philosophy

that gained him recognition as part of theanti-psychiatry movement, a description

that Laing himself rejected. His theories

surrounded the notion that the feelings

expressed by his patients, largely

schizophrenics, should be taken as valid

descriptions of life experiences as

opposed to symptoms of a separate,underlying disorder.

Laing devoted large amounts of time to

quietly sitting with people in their cells,

listening and talking to his patients. In

addition to this, he organised a so-called

Rumpus Room; a day room for

patients allowing them periods of social

interaction. Laing criticised the practice

of psychiatry for disregarding the social,

cultural and environmental aspects of

mental illness and even went so far as to

reject psychiatric diagnosis entirely.

Laing argued that a diagnosis could not

be made solely on behaviour if no

pathological basis could be found; he

believed many of his patients were

simply reacting sanely to and insane

situation; Laing believed that

schizophrenia is a way of escaping

family pressures, negative experiences

and other emotional miseries, and that by

falling ill, the patient has in fact taken the

first step towards self-recovery.

Laing put these notions into practice in

Kingsley Hall, London; here the

staff and schizophrenic patients

lived together, and the patients were

treated with kindness and respect

whilst being given space to explore

their internal chaos. Sean Connery

famously sought help from Laing

here as he was struggling to cometo terms with his new fame.

Controversially, several patients

and employees were given, then

legal, high grade LSD to release

their inner demons or buried

childhood trauma. Many patients

did indeed achieve full recovery but

Kingsley Hall was seen as dangerous by

the GMC and was closed down after 5

years of activity. Laing was later struck

off after admitting in a BBC radio

interview that he was clinically

depressed and suffered from alcoholism.

His distinctive ideas about mental illness

were undoubtedly influenced by his own

experiences and suffering as a patient.

Unfortunately, this affected Laings own

family gravely; his son described him as

gentle but wild, cruel when hed had a

drink. A tragic situation, where as his son

aptly put, dad solved other peoplesproblems but not his own.

Laing died in 1989 at the age of 61.

Perhaps unsurprisingly, the Laingian

treatment model has now been largely

abandoned. This is partly because it is

very expensive to run but also due to a

commitment to medicalising psychiatric

illness. Laings legacy remains in some

areas however, with a much wider

acceptance of the social and

environmental aspects of psychiatric

illness, and a much greater respect for

patient needs and autonomy.
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8

Mad, bad, sad or dangerous?Its said that madness and brilliance are two sides of the same coin. Contributor Mike Pretswell, delves

into the past looking at some of our most famous, and in hindsight, most unwell, historical figures.

Michelangelo

Diagnosis: Autism

The great painter and sculptor may have produced some of the most beautiful works

ever seen but his eye for aesthetics did not extend to his own body. Weve all

squeezed an extra day (or two) out of questionably clean placement clothes but

Michelangelo wore his for months at a time and even sleeping in them. This meant

that when he finally did remove them most of his skin came with. He also hated baths

and supposedly smelled so bad that it was a challenge to be in the same room as him

(even by 15 century standards).

Michelangelo also hated company and was known for walking away from

conversations mid-sentence. His contemporaries (including the pope) assumed he was simply a weird, unpleasant individual but

modern psychiatrists suspect that he suffered from a form of high functioning autism.

Nikola Tesla

Diagnosis: Obsessive compulsive disorder

Quite possibly the most prolific inventor of the 20th century Tesla working on

everything from the electric motor to x-rays. As an electrical engineer, Tesla is

responsible for hundreds of tiny components that youve never seen but will be

found in everything from your oven to your iPod. He had a fantastic obsession with

detail and exactnessboth undoubtedly key to his success but also caused him a

few practical problems; Tesla couldnt enter a building until hed walked round it

three times and would only stay on the 3rd floor of a hotel in a room number

divisible by 3. Even more challenging given his work as an engineer, was his

phobia of circles and all things circular.

In the final years of his life, Tesla transitioned into the archetypal mad scientist dedicating more than a decade to the invention

of a super weapon to end all wars , coining the term death ray to describe it.

Isaac Newton

Diagnosis: Attachment disorder and Mercury poisoning

One of Britain's greatest scientist Newton certainly did a few crazy things, notably sticking pins in his own

eyes to see if he could still see them, but well chalk that up to curiosity. He was also however , very poor in

social situations and extremely angry at all times. On two separate occasions he nearly beat men to death

after they commented on the size of his nose. Later in life Newton became extremely paranoid and began

hallucinating. Studies carried out on sections of his hair have suggested that this was likely to be caused by

mercury poisoning resulting from long years of experimentation.

Abraham Lincoln

Diagnosis: Depression

Its relatively well known that honest Abe probably had Marfans but he also suffered from terrible bouts

of melancholy. He was incredibly empathic and claimed to feel the suffering of every one of his fellow

citizens. During the American civil war he reportedly spent days alone in his tent weeping for the

suffering of others.

Prototype death ray


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9

As the nights drew in over winters, and

the embers were glowing in the dungeons

of Surgo HQ we realised that life is not

as static as Phil Hanlon would have us all

believe. The current environment within

which we prosper will change in

countless ways and there is very little we

can do about it. What is change? An act

or process through which something

becomes differentseems like a

reasonably legitimate definition to the

simple-minded amongst you. But stop.

Drop. And rollout your pockets to

unleash a savage barrage of coins upon

this beautiful earth. Trot about any

densely populated land mass and your

hear the symphony of change as we all

heard; countless almost-worthless pieces

of legal tender. 1ps are the bane of my

life and it appears that the Royal Mint

agrees with me; we may be about to

follow in the footsteps of other pioneer-

ing nations, like Canada & Brazil, and

strip the penny away from our paws.

Before we analyse the future, lets

address the past. First issued on the 15 th

of February 1971 Decimal Day to the

scholars within our 6-person strong

readership the 1p coin has been a main-

stay of British culture ever since. Many

pennies tried before but none have quite

done the job that the 1p coin has done.

Featuring Betty looking the wrong way

since day 1 has been some task.

Weighing a hefty 3.56g pennies have

been a burden on our wallets but a

blessing in our lives. The childhood

favourite Penny sweets have led to the

loss of at least 926 diabetic feet across

the land [1]. However nothing is exempt

to the harsh economic downturn that we

are experiencing; the inflation on these

sweets has reached 50% in some regions

of the UK leaving pennies utterly

redundant. Pennies have led to countless

sessions for punters on the puggies and

ultimately mass bankruptcy for genera-

tions. But, once again, inflation has led to

the decline of these machines with

extortionate 2p machines replacing them.

It is the perceived lack of function and

use in modern society that has led to the

question as to whether we really need

pennies in our society? Countries like

Brazil, Canada, Singapore and a host of

others have withdrawn the equivalent

penny from their circulation and

reaped the almost unrecognisable

rewards. However, as long as we

continue to use and abuse the penny it

will forever be part of our lives. It is

down to the people of the Union to

march to Downing Street and cast it back

into the fiery chasm from whence it

came. It is a simple case of supply and

demand. There is no doubt that

economies can cope without them and

will thrive without the burden of having

to produce them.

Currently there are 11.3 billion coins

causing mischief and struggling to fit in

across the British Isles. That is a

staggering 113million quelle surprise.

What could we do with that?!? Well very

little to be quite honest as 1ps are only

legal tender up to the value of 20p. So as

such ,we here at Surgo, decided that we

would take control and find 10 very

viable solutions. We asked part-time

contributor and full-time misogynist

Daniel Taylor-Sweet for 10 things he

would do with all 11.3 billion coins...

Change is Changing: The

Penny Drops

The artist formerly known as Druid Boyle undertakes an introspective analysis of the future of our young

money cash money.

Ten things you can do with change:

1. 37 one pence pieces could be melted down and formed into a single bullion. This, we would send to the formidable gulags of

North Korea, where they would be formed into a miniature epitaph of Kim Jong Un. The statue would then be presented to the

president of South Korea, thus solving the long conflict on the Korean peninsula.

2. If one wanted to feel the exact weight of president Bill Clinton then 27,012 pennies placed in 5 empty pillowcases would give

you a fairly good idea.

3. A single coin could be hammered repeatedly until only several molecules thick this sterling sheet of metal could then be

shaped into a 2-piece double-breasted suit, which could be worn for weddings and other formal occasions.

4. 8 Lockheed C-130 Hercules bombers could be filled with spare change, flown over Chernobyl and dropped into the open

reactor damping the radiation making Pripyat finally habitable after almost 30 years


13/16SURGO

Change, life and the mind

10

Do you have an interest in writing or medical journalism?

Do you like graphics, enjoy art or want to draw us a cartoon?

Do you have an opinion or perspective that you think should be heard?Or just want to CV-build like a boss...?

Join the writing team atSurgo!

Rancid (-Rebekah Patton), Visionary ( -Hamilton Orr)

The scalpel-sharp edge of modern medical journalism ( -Iain Swan)

If you want to get involved, find us on facebook or email us at [email protected]

At this point I should point out that if youve made it this far you have far less of a life than I could ever dream of having. Its

been tough but education, education, education has to be delivered. The chances are the penny will remain forever more but

should we ever take the plunge into the pool of uncertainty, youll know fine well that Surgo speculated first...

Science. Choice. Change. Life.

Until next time...keep it relish.

Disclaimer: Views of Daniel Taylor-Sweet are not representative of the Surgo Ideology as set out in our manifesto for choice

5. Fat Joe and Lil Wayne are planning a re-release of their 2009 hit Make it rain in which a 2000L vat of molten one pence

pieces will be sprayed over Huddersfield.

6. Coins could be glued end to end making long cylinders. These cylinders could then be attached together to form a raft which

Ben Fogle would row to Iceland in and deliver as a gift to the people of Iceland, stimulating their faltering economy

7. The copper which coats post September 1992 coins, can be extracted using calcium hydroxide. It can then be given topatients with Menkes disease, thus earning me a Nobel Prize and world-wide global fame.

8. 208 one pence pieces could placed on top of each other replicating the great length (but not so much, girth) of the mighty

Jonah Falcon.

9. One could, if desired, melt all the pennies in circulation down to form a battery that could be used to power the small town of

Grimsby for exactly 18 hours.

10. All of the coins ever produced, in the entire world could be shuttled into orbit by Soyuz shuttles and dispersed around the

outer atmosphere. This would provide a coin-based shield, giving earth vital protection against asteroids, Sandra Bullock and

solar storms.


14/16SURGO11

In Silloth in the 60s there lived a young GP called Bobby. Silloth often saw lots of ships coming to deliver grain to the local Carrs

water cracker factory(other crackers are available). On this particular day an African gentleman from the grain ship walked into

the surgery looking terrible. He was pale and emaciated and he said to Bobby, Doctor, Im dying. Bobby saw that he was only a

young man and asked him why he thought this. To his shock the man replied that a Witch Doctor had put a spell on him.

Though used to all sorts of stories from the local townsfolk of Cumbria, this was a new one for Bobby. So, he examined him

thoroughly, surely there was an obvious cause for this mans illnessBut alas, everything was normal.Puzzled, Bobby realised

that he would have to take a different approach. He reached for the mirror on his desk, held it up to the man and said, I am

putting this mirror between you and the Witch Doctor. It will reflect the evil spirits back to Africa and break the spell.

One year on and an African gentleman with a spring in his step, a picture of health, comes into the surgery. He says he is here to

thank Bobbybut Bobby does not recognise him.After recounting his story Bobby realised that this was the very same

gentleman who had come to him, dying, just 1 year ago. The man told him that not only had he recovered, but on returning to

Africa, the Witch Doctor was dead. The mans mind was healed...and the power of suggestion had won.

Inside the mind

BRAINWAVE

CHANGE

CRAZY

DRUGS

ILLUSION

MADNESS

KETAMINE

MANIA

MIND

PSYCHIATRY

RORSCHACH

DEPRESSION

GRAHAM-TEASDALE

SCHIZOPHRENIA

Word-searchLook for 17 mystery hidden messages and 14 words with a

psych theme . Well post the answers up on facebook. Try not

to get too paranoid now...

+ 17 hidden messages (were watching you)

Jane Hamilton explores the

future through alternative

means.

Capricorn: Be prepared

for you local apocalypse

and sign up for pet

apocalypse insurance. Only

$135 per pet, no returns.

Sagittarius: Time is

moving quickly and things

are changing. Viper is

open, you must make the

most of this opportunity.

Scorpio: you will find love

in a hopeless place. Just

keep looking over your

shoulder.

Libra: There is no need to

X-Ray those around you.

Virgo: you are a highly

sexual individual. Consider

a medic sport.

Leo: Having flatmate

issues? This month you are

the issue. Take the bins out

more often.

Cancer: A new Chinese

takeaway has opened on

Dumbarton road. Take a

risk. Order a chow mein.

Gemini: You may feel that

your creative talents are

wasted in medicine. Think

Surgo. There is always

room for you.

Taurus: the new moon on

June 10th will bring good

fortune to those sitting their

OSCEs. Unless you forget

your chaperone. Then

youre on your own.

Pisces: You yearn for

attention and recognition.

As Mercury moves in with

Mars next March your luck

will improve. Consider

performing in next years

Revue.

Aquarius: An exciting

opportunity will be

presented to you over sum-

mer. This is something you

should worry about.

Aries: Consider predicting

your own death at http://

www.death-clock.org

Horoscopes

Yules Yarns


15/16SURGO

12

Manvir Singh, known to those

close to him as Sonu, was such

a smart and multi-talented

individual. The 21 years he

spent in this world were far too

brief, but his achievements

excelled others his agewho

could only dream of doing what

he had done. He was the star of

Glasgow, there wasnt anyone

who didn't know his name, of

his kind heart, let alone his

infectious smile.

When he shall die, take him and cut him out in little stars,

and he will make the face of heaven so fine, that the world will

be in love with the night and pay no worship to the garish

sun.

Sonus sister, Honey, feels that he was and will always be the

best brother anyone could ask for. His whole family are very

thankful for having him in their lives and feels that the time

spent with him was a rollercoaster of happiness and enjoyment

that was cut too short. Sonu was a good-hearted individual

and he would always be the one that people went to for help.

He was the kind of person that helped others and didn't really

ask for any help himself. You would find Honey always with

him, from watching movies, to

baking, to driving trips. Honey was

one of, if not the closest person to

him. Honey said:

I would always hang out with him

in his room and talk to him about

the most random stuff. My mum

and I would sit waiting for him to

bring food from work, which

surprisingly he would openly share.

Most weekends mum, dad, Sonu

and I would all sit together

watching a film that he picked out.I love him more than words can

describe, he was definitely the most

entertaining and loving brother I

could ever ask for.

A well-mannered pupil who was adored by all. He was

extremely intelligent, curious and keen to learn new things.

He never really needed to study for long hours, everything was

last minute revision, yet he still managed to accomplish

straight As in all his subjects in school. His best friends atschool fondly remember him as a cheeky, easy-going and

mischievous boy. Sonus commendable achievements for

various subjects throughout his years at school were

recognised at his schools annual Awards Ceremony.

Sonus most significant time of his life was with the dance

team Punjabi No.1. He was one of the first and original

dancers, dancing since 1999 when the group was first

established. As the group became more successful, he toured

the whole world seeing new places, meeting new people and

showcasing his talent. They performed in some of the most

prestigious venues including the SECC, Clyde Auditorium,

London Hammersmith Apollo and Wembley Arena, for high

profile events such as BBC Children in Need, Brit Asia Music

Awards and the MOBO Awards to name a few. The group

grew close from the many adventures they had on stage,

backstage, on tours and outside of the dance group. They were

best of friends and Sonu will be cherished in their hearts

forever.

A son, brother, friend, he meant so much to everyone. Sonu

was undeniably one of a kind!

Death leaves a heartache that no one can heal, but love

leaves a memory no one can steal.

If you have been affected by this in any way and would like to speak

to someone please contact the Medical School welfare team

([email protected]).

In loving memory of

Manvir Singh

Words of remembrance from Manis family and friends.


16/16

surgo, inside the mind. may 2014

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