As of November 1st 2018, doctors in the UK can legally prescribe cannabis in a medical setting. This inspired me to consider the possible benefits of the emerging drug in the medical world which we do not know a great deal about but also what possible consequences come with it. Many other countries across the world are legalising the use of cannabis for medical uses such as Canada, Israel and many European countries. Recently I watched a British documentary which asked and answered a lot of the questions I have been left wondering after the legalisation here in the UK.

In order to understand the benefits, it is important to consider why attitudes have been changed, and this is because of 7 year-old Alfie Digely. Alfie was born with life threatening epilepsy and after many failed attempts of varying treatment, his family discovered that the medicine which had the greatest effect on the control of his epilepsy was cannabis oil. As a result, him and his family moved to Holland where they could use the drug recreationally but as soon as they couldn’t afford to live in Holland anymore they had to move back to the UK and his mother started to campaign. In June of 2018, Alfie was given the first ever license of cannabis oil in the UK. It is still unclear how the active chemicals (THC and CBD), are having an effect on him, but as well as controlling his epilepsy, it has had positive social effects on Alfie’s life as he us now engages in more conversation and can maintain prolonged eye-contact.

It is thought that cannabis can help others like Alfie as well as many other illnesses such as pain relief, Alzheimer’s disease, nausea, cancer and much more. But there are great concerns associated, none of these claims are scientifically backed and adequate research has not been done in this field. It is thought that long term, regular cannabis use can cause mental health problems in later life, primarily Schizophrenia and Anxiety. Currently, trials haven’t been conducted so dosage and safety is unclear therefore despite doctors in the UK having the ability to prescribe the drug to patients, they have been advised to refrain from doing so unless there are no other alternative treatment options.

The two active chemicals within the drug, as previously mentioned, are CBD and THC. THC is the chemical responsible for the ‘high’ feeling people would associate with the drug, this alters signalling between nerves in the brain and cannabinoid receptors, this chemical is responsible for the mental health issues associated with long term drug use. CBD does not result in intoxication, this is the chemical responsible for the control of epileptic seizures, however, how it does this is not fully understood.

King’s College London has been studying cannabis on the black market and it’s effect on mental health. Cannabis on the black market is referred to as skunk and it is 5 times more responsible for causing psychosis than recreational cannabis. This is due to the difference in concentration of THC. Skunk has a much higher concentration of the intoxicating chemical and is over 90% of cannabis on the market at the moment. Trials have also been conducted in a hospital in London looking into the effects of this potentially detrimental chemical. Over the space of 4 weeks, a group of volunteers were observed after inhaling cannabis with the same concentration of THC but varying CBD. When smoking THC alone, the physicians overserved worrying paranoia from these volunteers, the dosage with the highest percentage if CBD resulted in no observations of paranoia. During some of the tests, recognition of facial expressions was worst with 100% THC and improved as more CBD was added. This study suggests that CBD can outweigh a lot of the negative effects of THC and that it is possible to make recreational cannabis safer.

With my AS results day just moments away and UCAT even closer, the latter half of my summer holidays have been engulfed with personal statement drafts and countless practise questions for the ever-anticipated UCAT exam. Through all of this I decided I needed a break to take my mind of all this work (but still healthcare related of course), therefore in the past three days I took it upon myself to read this brutally honest yet humorous book of experiences Max Pemberton faced during his first year working for the NHS as a Junior Doctor in 2007.

I must say, this book definitely wasn’t an easy read and I found myself in deep discussions with my mother on numerous occasions whether the job of a Junior Doctor is really as bad as he was making it out to be in many cases and constantly hoping I would get to the end for him to have a marvellous epiphany and say that it was all worth it. But in many ways I think this was a perfect book to read as an A Level student who thinks she wants to study medicine but realistically doesn’t actually know the ins and outs of what the job entails, this is wherein think this book has helped me realise certain aspects of this.

Pemberton does an excellent job of portraying the struggles he faced as a Junior Doctor, but more importantly how he overcame these and learned from them in the future. From inserting cannulas which was a dreaded task was described as something he could do in his sleep now, along with many other minor procedures, I think with most things in life and much like my preparation for UCAT in only 5 days is that they just come with practise and suddenly you’re left wondering why you found it so daunting in the first place. Pemberton was able to overcome his ‘Big Mistake’ which lead to a patient being sent to the ICU, which is very reassuring to see how he accepted responsibility for his mistake and didn’t run from defeat.

Pemberton routinely is very complimentary of the NHS and how much of a huge accomplishment it is of Britain’s, highlighted in a conversation between and Ethiopian cleaner in A&E and a US Junior Doctor who marvel at the equality seen in this country and that they only dream of this occurring in their countries. This is definitely something I plan on researching into in the future as ‘free healthcare ‘is obviously and very controversial topics and many people hold very different opinions surrounding the matter. But nonetheless, it definitely has it’s benefits which Pemberton often takes a step back and appreciates the system around him and how it has helped so many people.

As previously mentioned, this book was often very daunting to read as he did a good job of making it sound like the worst job in the world as he considered quiting and taking up consultant management. But I refused to believe that those few months as a Junior Doctor would be so unrewarding and so unable to cope with that the only option seemed to be to quit (I also had to keep in mind that this book was written over 10 years ago and a lot has changed since in regard to the treatment of Junior Doctors within the NHS). My doubts were confirmed at the end of the book when Pemberton reflected on his year as a whole working on the wards of a hospital, he states that despite the challenges ‘it’s been an amazing experience, made all the more amazing by the fact that I survived it in one piece’. This, I thought, was a humorous yet touching way to conclude his year of events which allowed him to interact with such a wide variety of people and develop incredible relationships with patients and colleagues alike. He states that he’s ‘had some of the happiest memories anyone could hope for from a job. The learning curve has been exponential’ which leaves me excited and inspired to carry on pursuing my aim of becoming a Doctor.

Recently I have completed reading Being Mortal by Atul Gawande, it is a truly eye-opening book as well as an amazing pastime during the 35 minute train journey to school twice a day (when I’m not falling asleep from revising the night before). In summary, Gawande thoroughly explores the worrisome yet inevitable truths we are all going to face as we approach the end of our lives and how his experiences as a surgeon has effected his outlook on death as a human experience.

Throughout human history a biological transformation has occurred due to incredible advances in the healthcare system and human life particularly in the first world. Gawande presented two graphs which I thought were extremely interesting to observe. The first graph shows human health before the last one hundred years, every day was a roll of the dice and most people lived a healthy life until illness suddenly struck and the decline is quick and sudden, it didn’t matter if you were 4 or 50. However the second graph represents a more modern image of human health, we get ill, we get treated, we never regain full health but we proceed and so the cycle continues. Life expectancy has increased hugely and people expect to live until around the age of 80 and this is due to medicine. I loved this representation of what Gawande was trying to convey especially as I am a very visual learner

Gawande presented the argument asking should we see old age as a medical issue? Ageing is an inescapable thing that can only be slowed down by medicine and it is important to remember and come the terms with that death is not a failure, its simply apart of life and if it is treated correctly with the patients best interests and heart then its an achievement.

Another aspect to this book that I enjoyed was the consistent case studies throughout, I found myself absorbed Alice’s struggle for independence, moved by the story of Felix doing everything within his power to ensure his wife died a comfortable death at home and hurt by the narrative of Sara Monopoli. Unlike Alice and Felix, Sara was a young woman with a husband and unborn child and had clearly incurable cancer and limited time. The dilemma that most doctors face is knowing when we should try to fix and when we should not. In situations like this, medicine can do more harm than good. Repetitive chemotherapy treatments, countless medication and many surgeries made Sara Monopoli’s experience and a patient extremely painful. But the modern tragedy is that there is no way of knowing when our time will run out and the fact is we may be shortening or worsening the time we have left by going ahead with distressing treatment. It’s important to know when to slow down and focus on the human within the patient and how they can adapt and live the comfortable life they want.

This book compliments the documentary I wrote about in my previous blog post as Gawande often discusses hospice care, assisted living, palliative care etc. particularly in the first half of the book. It is suggested that palliative care can often prolong as well as improve the quality of life for the patient with an illness, maybe Sara Monopoli could have benefitted from this sooner. A common theme running throughout this book is the longing for independence, as soon as we’ve lost the basic ability to eat, walk, speak etc then what do we do when it can no longer be sustained? In most cases, elderly people find themselves in a prison like care home, lonely and depressed of the life they have lost. Too many care homes are resembling an institution and not a ‘home’. At the top of the hierarchy of needs by Abraham Maslow explained in chapter 4, is self-actualisation, the need to independently achieve and serve a purpose in life. Gawande explored alternatives such as true assisted living and a crazy story of bringing life back into the care home by introducing 4 dogs, 4 cats, 100 birds, a nursery and more.

There are many things I can take away from reading this book. The realisation that it is just as important to not offer medical solutions to an unfixable problem as well as offering medical solutions to improve the life of people. The ultimate goal towards the end of life is comfort and flexibility to be able to adapt and accept new ways of living and knowing that it is okay to ask for support when needed. It has also inspired me to want to read more around the topic of aging and terminal illness as it’s a topic which I find highly interesting.

On January 23rd 2019, the BBC released a documentary from the Horizon series narrated by Dr Kevin Fong who spent a couple of months focussing on the final stages of peoples lives, how palliative care effects these people and how we can regain control of the life we chose to live during the final stages.

He offered some very interesting a thought provoking questions throughout the hour long documentary; when is the right time to stop intensive medicine? Does a better death mean a shorter life? Is medicine going to improve or hinder the quality of a patients life? and is there always a trade-off between living longer and living better?

All are very difficult questions to answer on the surface but Dr Kevin Fong was able to research and help promote the importance of decision making regarding the end of ones life and eliminating some doubts or stereotypes that may be evident on many peoples minds.

He individually spoke to many different types of people with different diseases in different stages of their life but were all ultimately faced with the reality that they were inevitably going to die, possibly sooner than what they would like. One man that I found interesting and very eye opening was a patient named john in a St Christopher’s Hospice, he claimed to be envious of people who were dying and previously was full of fear for several years and he was becoming increasingly more depressed. However, once he accepted his situation he was able to plan the end of his life much better with family surrounding him, he received medicines to help him sleep and became a much happier person as he can now die without fearing pain.

Another inspiring individual was a patient named Barbra who recently discovered her cancer was terminal. She was scared of entering the hospice and never leaving although surprisingly I discovered that most of the patients in a hospice are out patients who visit maybe weekly for the specialised care they require. Barbra had never gave death any thought until she found herself facing it and I can imagine that is a scary process for anyone as the daunting feeling is, is it too late? I personally do not think it’s ever too late for palliative care although there is newly emerging evidence to prove that the earlier the palliative care is received, the better quality and quantity of life that person will receive. Once people have engaged with it and understand what is happening, it’s an easier process.

One of the key discussions I picked up on during this short film was an interview with Dr Katherine Sleeman of King’s College London, this discussing related directly to me as an aspiring medical student. She explained that however mad it may seem, she wasn’t aware that looking after people who were dying would be part of her role as a doctor. As a junior doctor it’s very easy to be in the mindset of trying to heal every patients and even harder to realise that the death of a patient is not a failure as it’s the natural course of life. She explained that this was not discussed when she was studying in medical school, medical students were whisked past beds of dying people with ‘ordinary’ diseases to see once in a lifetime symptoms.

It was very fascinating to consider the economic impacts of palliative care. There are just over 200 hospices in the UK at the time of producuing this documentary and studies have shown that palliative care services are either cost effective or cost neutral on an economic standpoint and recent evidence is showing that the earlier the care, the increasingly cost effective it becomes therefore it may be a route that is better for the patients AND cost effective. This can be possibly explained by the fact that people receiving care at home are less likely to visit the hospital as frequently due to illnesses and as a result more likely to die at home therefore resulting in a better quality of life and death as the majority of the population would like to die at home.

Is palliative care giving up? for people with terminal illness or a bad quality of life due to intensive medical treatment, absolutely not. Palliative care knows more about the principles of living than the principles of dying.

Every second of our lives really does count therefore we must embrace every opportunity to have a better life/death. Accepting the inevitable fate we will all face and discussing out thought and opinions with close friends and family will allow us to regain control. There is no right or wrong, it’s about what matters most to you.

Thanks for joining me!

Hi, I’m Sophie. This blog is my personal collection of thoughts and opinions I have gathered through research on current affairs, wider reading on topics that interest me and much more. I’m also here to document my journey as a medical student. I’m more than happy to share them with you and I hope you enjoy your experience delving into gripping topics that I felt are worthy of discussion and even leave your own comments on certain issues:)

Me (second from left) and my Kenya team, July 2018:)

About Me

I am currently a first year medical student studying at the University of Nottingham. Along with loving my degree, in my free time I enjoy reading (mainly philosophy books), pole dance, badminton and running.