Exhibit A

Blessed are the Cheesemakers

A well known local cheesemaker walks into the clinic, a quick examination of her notes reveals her cholesterol is sky high, but she denies eating fattening things. A silent stalemate fills the place as the elephant in the room shifts about uneasily. The doctor decides to go for it.

“Well that certainly is a puzzle Mrs. Dempsey…. how about dairy products?”

“Let me think, dairy you say? Humpf…”

She then begins in the slow deliberate tones of someone who’s first language is Irish,

“Of cream, I would take not a bit.

Of milk, I would have a drop in my tea.

Cheese. Cheese I would have. With one grape or maybe two.”

Baby medicine (medicine for babies, not carried out by babies)

Nine months of planning and hoping and dreaming, maybe longer, maybe even years of it. Babies are the embodiment of pure potential; each one a blank little person with endless possibilities. Hospitals and parents go to extraordinary lengths to ensure that this potential is preserved. These ideal human beings receive ideal forms of medicine.

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The habitat of the neonatologist struggles to strike a balance between science and humanism.

Babies in boxes. Small babies. Thin babies usually. Wires everywhere, bleeping noises and tubes. And unfortunately they all look the same. It’s a cliché to say that all babies look the same but babies in boxes really do look the same. It’s subjectively and physically hard to see past the perspex and the woolly hat and the NG tube. They all obscure the features that might make the baby look like a unique individual. But in neonatology looking like everyone else isn’t a bad thing. When your baby doesn’t look like the others you start worrying.

So how do the neonatologists do it? Hang on to the humane when presented with the bionic?

When approaching a baby in a box the first rule is to state the obvious and emphasise that a child is the subject of your examination; not the paraphernalia attached, hanging out of or surrounding it: “This is a baby boy in an incubator.”

Once humanity is established the science can be addressed as secondary and supportive to the initial premise.

In their ethos, neonatologists are uncompromising in their humanism. However science has to be harnessed to achieve the best results for their patients. This seems to be a guilty pleasure for the neonatologist. If you ask one what initially attracted them to the specialty many will answer that they liked intensive medicine. This translates into a statement about enjoying real time physiology and pharmacology. The NICU is essentially a living lab.

To soften the science for parents and the babies the walls are painted in pleasant colours with the letters of the alphabet, conjuring images of a nursery. The lighting is dim and voices speak in hushed tones. This is part of the science too: calm environment leads to calm babies and calm babies can put more energy into growth.

Like the physical environment and the science of the neonatal unit, a lot of thought has been put into the spirit and work ethic there. Attention to detail is important, it is not necessary to look at the example of Belfast to realise the vulnerability of the lives in the boxes. General hospital infrastructure has a lot to learn from the environment and methods of  Cork’s neonatology centre. Everyone who works in the unit is a colleague, hierarchy exists but it does not intimidate socially, professionally or personally. All input is valued. The care is holistic and takes responsibility for wellbeing  of patients in its broadest sense. This is a specialty that makes time to illicit feelings from families and staff. It is recognised by the consultants that their concerns may not be the same as those of the parent and unless both sets are addressed any meeting will be less than satisfactory. Ideal medicine for the idea of humanity.

The room is colourful. Everyone is in their socks on a play mat, looking at the four year old.

“I think we’re done with our assessment for now, the physio and Speech and Language therapist will be in to chat with Jamie in just a moment.”

—-awkward mental search for small talk——-

“So Jamie… did Santa visit?”

Jamie shakes his head, and hides his face in mothers coat. We all look at mum.

“No Santa didn’t come, we forgot to open the door to the chimney.”

Everyone in the room is shocked. More shocked than if she had just struck the child in front of us.

Epiphany

In some parts of Ireland the 6th of January is known as Little Christmas, or Women’s Christmas or Women’s Little Christmas. I haven’t really seen anything done about it before but it must be a big deal here. Last night Cork was filled with women. Every corner had a crowd of them and every restaurant was packed with them. Pudgy hands diving for more prawn crackers. A sea of fur coats.

A world without men. It was an eerie and noisy place.

“Show me URL and I’ll show you mine”

Naturally I panicked. That’s the last time I go to a blogging convention.

ER

Before the ambulance crew arrives, everyone knows the outcome. Pulseless rhythm for more than 20 mins is not a good sign, the patient is rushed into the resus room. The arrest team go through the drill. When they are sure nothing can be done, students and anyone else who feels like it, are encouraged to give chest compressions a go, it’s a great training opportunity. Resuscitation! A slightly more advanced form of Operation! - that game you played as a kid. A nurse pushes open the door,

The family have arrived. [She gives a meaningful glance]

Everyone sobers up and remembers what has actually just happened. This exciting training morning is about to be the worse morning of these people’s lives.

Things are tidied up, syringes put away, a blanket is placed over the private parts of the individual in question, the students are told to get off the body and someone professional-looking (not the cleaning lady) takes over the CPR. Chairs are arranged around the trolley. An air of calm fills the room as the family are ushered in, they begin wailing, sobbing at the sight of the blue lips and multiple drips.

Please wake up son.

The head nurse presses them into the chairs by the shoulders, she whispers that it has been over 40 mins and soon the life support techniques will have to stop. They nod. The consultant doctor clears his throat to draw attention to his existence.

One more set of compressions, and if there is no pulse we will have to stop. 1, 2, 3…

(in this time powerful prayers for miracles are being muttered)

…28, 29, 30. Check the pulse!

No pulse.

[pause] A small child, grabs at the consultant’s trouser leg; eyes like saucers.

Ok, one more set …and then that really is it.

Again it begins- the count to thirty. No pulse.

[the young wife looks up, pleading.]

…This is going to be the last one. The last one everybody! LAST ONE!

The professional-looking person preforming the chest compressions curses silently under their breath, it’s tough work.

This time it really is the last one. The pupils are checked. They are fixed and dilated. (The family don’t know that it is impossible to assign meaning to this. The drugs that have been administered produce much the same effect as death.) But it’s procedure.

The wail goes up again. Suffocating sobs. This is the recommended practice now, bringing the family in before the death is declared.

If pre drinking is being called “pr-inking” should this pre waking be called “Pr-aking”?

Samuel in the Sauna

Dad has been going to the pool in recent months to try improve circulation to a bad leg. But in the last week something odd has been happening.

- Well one day I didn’t feel like swimming so I went to the steam room. I couldn’t see a thing in there, but I sat down. I was startled when this voice came up from a big puff of steam. The voice says he’s Latvian and engages me in profound philosophical discussion, we discuss the nature of being, the afterlife and briefly talk about bikinis. Then the voice excuses himself and the conversation ends.

I went back the next day and the same thing happens: a discombobulated voice with a foreign accent. This time he asks me about the direction of my life and am I happy with it, he says he is a baker but knows a lot about art. We cover the Russian modernists.

I’ve gone back every day this week to speak to the voice in the steam and I can’t be sure about the body anymore.

Face to the pubes

Face to the pubes is a legitimate expression in the world of birthing, it indicates that the baby is in a less than optimal position when crowning. Ideally the face should be to the ground when entering the world. Babies aspiring to a view of the stars are termed “Face to the Pubes”.

Personal grooming “down there” has always been a source of great confusion to me… no direct guidelines, no common wisdom. While an older girl offered to pluck my eyebrows in school, no such offer was ever made with regard to “down there”. Upon asking guys what other girls they had slept with did “down there” I received shrugs, nothing could be directly said and the styles in porn seemed unrealistic for daily up keep.

And then I met Helene. Although this was admittedly helpful, I always felt doubtful that she was representative of common practice.

So I’ve been conducting an informal observational survey during my Obs and Gynae rotation. And it seems that no one knows what they’re doing “down there”. Lots of variety… perhaps this the last frontier of individual expression in female aesthetics?

There was a trend in ladies in labour to go for a “short back and sides” look. Maybe they were aware of the approaching moment of prolonged exposure under multiple gazes and felt obliged to be radical about the whole issue, or maybe they wanted their baby to have the best view possible.

Creation

In the amazing world of artificial insemination (AI or IVF or call it what you will) large amounts of a particular hormone is needed. This hormone is FSH. Oddly enough it is a hormone which appears at high levels in the urine of post menopausal women.

When IVF first started out they used to send milk lorries (US translation: trucks) to collect urine from Italian convents (a wonderful source of old lady pee, free from the STDs that are so frequently a feature of nursing homes these days).

Is this another Da Vinci code-esque conspiracy: Has the Roman Catholic church found a new means of going forth and multiplying? Did the Italian nuns know this was where their urine was going? Is this an infringement of their chastity? Does it amount to participating in an immaculate conception?

If you were to give it a brand name, would you call it “pURINE?”

These musings are irrelevant. The industry has changed: they outsource to South America now.