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Jan van Gijn
LIFELINE Jan van Gijn Jan van Gijn is chairman of the department of neurology at Utrecht University (since 1983), and editor of the Dutch Journal of Medicine (since 1996).He ignored the calling of classical languages to study medicine in Leiden.He trained as a neurologist in Rotterdam and London, and became a late and ardent convert to evidence-based medicine. He directs a research programme in stroke (including subarachnoid haemorrhage). Who was your most influential teacher? A shared tribute to Hans van Crevel (clinical research) and Arthur Staal (bedside manners). Which event has had most effect on your work? Reading Henrik Wulff ’s book Rational Diagnosis and Treatment. I can still picture the lounge in the North Sea resort where I savoured it, in the early 1970s. What would be your advice to newly qualified doctor? Do not economise on the history, and find delight in avoiding investigations that clear your waiting room but not your conscience. How do you relax? At a tranquil meal, exchanging the day’s events with my wife (a GP), a glass of Cape wine at my elbow, and a neurotic Siamese purring on my lap. What is your favourite book? I resisted an affectation with Icelandic poetry. My true favourite is an outright classic: Thomas Mann’s The Magic Mountain has everything, from pangs of love induced by slamming a dining room door to the mystique of early radiology. What is your greatest Mobile telephones.
fear?
What is your worst habit? Rewriting other people’s sentences —not even Anglophones are spared. What is the greatest love of your iife? My new bicycle (after appropriate mourning for its vanished predecessor). How would you like to die? At a few months’ notice.
172
Would you care for some ice, Sir? anada is a large country. It used to be second to the USSR in size. But since the latter’s demise, what now? Much of the Canadian population hugs the border with the USA, and cynics say that they do this to get better reception from US television stations. There are ten provinces in Canada, equivalent to states in the USA, and also two territories. The latter, in effect, make up a great deal of the land mass in Canada between the 49th parallel, largely the US/Canadian border, and the North Pole. So, most Canadians crowd around the megalopoli of Toronto, Montreal, and Vancouver. Territories in the circumpolar area are essentially something only to be enjoyed on the Discovery channel on TV. At one time it was thought that the N o rt h e rn passage in Canada was the way to the Orient. Many gallant sailors wasted themselves and their crews attempting to find the passage. Given that it was a lost cause, Canadians have become ambivalent towards the frozen wastelands far to the north. So who visits this part of the world? In any number it is mainly immigrants. For reasons better known to themselves, immigrant health-care professionals coming to Canada,by and large,have a romantic view of the great frozen waste. Can you imagine an Indian lady doctor in a sari getting exuberant about her practice there? Well she does, and so do many of her kind.It is a kind of counter colonialism of a remarkable and wonderful kind. What happens when you are there? Here lies the rub. Universities in the south of Canada maintain their moral conscience by being generous with services to these remote and underserved places in the north. This means that doctors from universities in the south fly to the villages inhabited by American Indian or
C
Inuit people and act as visiting specialists. This is all well and good but has to take into account that the patients are culturally different and may speak poor English. Thus, you might have to deal with a young man who does not actually speak but takes off his woolly hat to show signs of trichotillomania; or the young woman who starts to have epilepsy, probably hysterical in origin, but for which a trip to the medical centre 300 miles away is thought warranted. Usually such a patient has a normal electroencephalogram. Given that diagnostic standards are somewhat limited, what of the travel? Flying in the north is done by bush pilots —excellent human beings but full of idiosyncracies. What do you make of a pilot who likes to check out a herd of caribou by diving down on them and who likes to drop into a settlement for a bottle of Crackling Duck (not quite vintage wine)? To add excitement to the trip, the pilot takes off from a frozen lake and aims at the church spire just for the hell of it before pulling back the joystick. Finally, he likes to keep the door of the aircraft closed with a pair of pliers. The denouement for me was travelling with an ENT colleague. H e insisted on sitting next to the pilot, and since he was a big rugby player it was no contest. I had to sit in the back. His patients, also in the back, were young kids going to the medical centre for removal of tonsils and adenoids. All was well until the pilot spied a herd of caribou. He immediately descended and did a few wiggles of his aircraft. His inexperienced young passengers promptly vomited all over me and the fascination of the frozen medical frontier promptly disappeared. Per ardua ad astra, but no ice please.
Robin Eastwood
THE LANCET • Vol 354 • July 10, 1999
fear?
What is your worst habit? Rewriting other people’s sentences —not even Anglophones are spared. What is the greatest love of your iife? My new bicycle (after appropriate mourning for its vanished predecessor). How would you like to die? At a few months’ notice.
172
Would you care for some ice, Sir? anada is a large country. It used to be second to the USSR in size. But since the latter’s demise, what now? Much of the Canadian population hugs the border with the USA, and cynics say that they do this to get better reception from US television stations. There are ten provinces in Canada, equivalent to states in the USA, and also two territories. The latter, in effect, make up a great deal of the land mass in Canada between the 49th parallel, largely the US/Canadian border, and the North Pole. So, most Canadians crowd around the megalopoli of Toronto, Montreal, and Vancouver. Territories in the circumpolar area are essentially something only to be enjoyed on the Discovery channel on TV. At one time it was thought that the N o rt h e rn passage in Canada was the way to the Orient. Many gallant sailors wasted themselves and their crews attempting to find the passage. Given that it was a lost cause, Canadians have become ambivalent towards the frozen wastelands far to the north. So who visits this part of the world? In any number it is mainly immigrants. For reasons better known to themselves, immigrant health-care professionals coming to Canada,by and large,have a romantic view of the great frozen waste. Can you imagine an Indian lady doctor in a sari getting exuberant about her practice there? Well she does, and so do many of her kind.It is a kind of counter colonialism of a remarkable and wonderful kind. What happens when you are there? Here lies the rub. Universities in the south of Canada maintain their moral conscience by being generous with services to these remote and underserved places in the north. This means that doctors from universities in the south fly to the villages inhabited by American Indian or
C
Inuit people and act as visiting specialists. This is all well and good but has to take into account that the patients are culturally different and may speak poor English. Thus, you might have to deal with a young man who does not actually speak but takes off his woolly hat to show signs of trichotillomania; or the young woman who starts to have epilepsy, probably hysterical in origin, but for which a trip to the medical centre 300 miles away is thought warranted. Usually such a patient has a normal electroencephalogram. Given that diagnostic standards are somewhat limited, what of the travel? Flying in the north is done by bush pilots —excellent human beings but full of idiosyncracies. What do you make of a pilot who likes to check out a herd of caribou by diving down on them and who likes to drop into a settlement for a bottle of Crackling Duck (not quite vintage wine)? To add excitement to the trip, the pilot takes off from a frozen lake and aims at the church spire just for the hell of it before pulling back the joystick. Finally, he likes to keep the door of the aircraft closed with a pair of pliers. The denouement for me was travelling with an ENT colleague. H e insisted on sitting next to the pilot, and since he was a big rugby player it was no contest. I had to sit in the back. His patients, also in the back, were young kids going to the medical centre for removal of tonsils and adenoids. All was well until the pilot spied a herd of caribou. He immediately descended and did a few wiggles of his aircraft. His inexperienced young passengers promptly vomited all over me and the fascination of the frozen medical frontier promptly disappeared. Per ardua ad astra, but no ice please.
Robin Eastwood
THE LANCET • Vol 354 • July 10, 1999