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On the brain, emergency surgery and intubation

On the brain, emergency surgery and intubation

Photographer:Fotograaf: Loraine Bodewes

Professor Therese van Amelsvoort shares a meal with independent medical fraternity e Causa Ignota

They don’t have obnoxious traditions, they’re not braggarts and, with the exception of a stray biomedical scientist, they all study medicine. Hence the fraternity name e Causa Ignota, which means ‘of unknown origin’. Or in other words: “You’re sick and we have absolutely no idea why.” Take a deep breath, because things are about to get graphic.

Nothing in the tidy flat in Scharn would give away that this is a student house. Shortly after six pm the doorbell rings and Professor Therese van Amelsvoort sweeps in like a whirlwind. As a physician slash psychiatrist, she instantly captures the attention of the room. After her studies in Rotterdam she went looking for adventure, she says, and ended up spending one year in Luxembourg, two years in Switzerland and eight years in London.

“The work in England was intense, dangerous even. I first worked with children from disadvantaged areas and then in the emergency room, with all the aggression that entails. Once a patient came in pointing a gun at the receptionist and then shot himself through the head.”
What brought her back to the Netherlands? “I was abroad for eleven years, hadn’t voted for three and didn’t even know what a ‘purple’ cabinet was. I realised, if I don’t go back now, I’ll lose my homeland. It would have been better for my career to stay in London, but the quality of life was lower than in the Netherlands.”
How so? asks Tiemen van Oorschot. “It was all about work and the pace of life in London is hectic. Everything takes time, especially travelling. Back in Amsterdam I found myself walking fast all the time. I always had bags of time left over.”

“May I invite you to the dinner table?” Chris Kivit asks, in his best butler’s voice. He shares the flat with a fellow student (who is nowhere to be seen). “We’re eating pasta romana with mushroom sauce, an old family recipe.” As his fellow students burst out laughing, Kivit maintains that his grandfather’s grandfather hailed from Italy.
Van Amelsvoort tucks in with relish.
“You can really taste the Italian carrots”, quips Stijn Daalderop. Meanwhile, the strains of jazz music – Dixieland – can be heard in the background.

Van Amelsvoort turns to Tanguy Dewaele. Does he already know what branch of medicine he wants to specialise in? The Belgian student, who speaks faster than an auctioneer, has no idea; he suffers from the affliction of enjoying too many things. He is, in any event, keen to escape the Netherlands and Belgium. Van Amelsvoort can recommend it, naturally. She has even spent time in Iceland and Yugoslavia; the latter during the war, and she concedes that her family back home was worried.
Not only in war zones but in the Netherlands, too, doctors need to be able to absorb some blows. Dewaele was once in the emergency room when someone was brought in missing his nose, with smoke coming out of his mouth.
“You get used to it”, Van Oorschot says. “Actually you become completely numb. I’m just back from India where I interned in a paediatric ward. One moment you’re helping to reanimate a baby and the next thing you know it’s dead. And then the attendant asks me to intubate the child, for practice; to insert a tube into the trachea to clear the airway. I hadn’t had much experience doing that, so it was actually useful. But in the Netherlands it’s considered a bit off, ethically speaking, whereas in India it just happens. You do learn from it.”
In Europe as well, Van Amelsvoort says, treatments vary from country to country. “The earliest antipsychotic is still commonly prescribed in England, but not in the Netherlands. We use Semap, which you don’t see anywhere else in Europe.”

Why did she become a psychiatrist? Dewaele asks. She is a doer, she replies. “And as so often, a good medical internship determines which specialism you choose. I found the brain and the nervous system the most fascinating and elusive. Every patient is a challenge, whereas by the tenth appendix it’s not all that exciting anymore.”
What’s more, as a psychiatrist you can live a fairly normal life. “As a woman in surgery, you had to sign a contract saying you wouldn’t get pregnant during the training programme. But as a psychiatrist you’re not going to get called out of bed for an emergency operation. And surgery can be physically demanding; some operations take ten hours.”
Psychiatry is the broadest specialism. “There are 3,600 psychiatrists in the Netherlands, and even that’s far too few. Psychiatry has by far the most vacancies.” Next week psychiatrists from all over the country will descend on the MECC for the annual spring conference, with many dozens of symposiums, lectures and workshops. Van Amelsvoort is scheduled to deliver a plenary lecture. “I speak regularly for large audiences, but this doesn’t happen all that often.”
She turns the focus back on the students: what kind of association are they? “We’re the fraternity eCI or e Causa Ignota”, Daalderop says. “Too bad the book club’s called that too.”

The students eat together once a week, and everyone takes turns cooking, Van Oorschot explains. “There’s always beer and something with a substantial number of calories.”
“Usually hamburgers”, Kivit says.
“We have one unwritten rule”, Dewaele adds. “It has to involve meat. Vegetarian is a no go. And fish is too expensive.”
Maastricht also has a medicine sorority, MDD Floreciente, with whom the founders of eCI once had a close relationship. But that’s ancient history, the students say. “We never see them out on the town. They don’t go to the pub on Wednesdays like other student associations.”

Stijn Daalderop * 24 * medicine * member of Causa Ignota

Chris Kivit * 21 * medicine * treasurer

Tanguy Dewaele * 20 * medicine * secretary

Tiemen van Oorschot * 21 * medicine * member

Therese van Amelsvoort * 1966 * professor of psychiatry * married, one son * lives in Maastricht

Scores by prof. Van Amelsvoort (5 max.):

Food: 5 (“I’m keen for the pasta romana recipe”)

Hospitality: 5 (“I’d recommend a meal with eCI to every professor”)

Cleanliness: 5 (“It’s cleaner than my place; my husband thinks I still live like a student”)

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