The pleasure of autonomy and humour

I spent all of Wednesday working on my research project proposal. My research is going to be about the impact of visual impairment on food choices, and neatly combines my previous life with my current one. The actual research will take place next semester, starting in September, but I have to scope it out and get all the details sorted and submit applications for ethical approval and Criminal Records checking and everything else done this term.

It has reminded me of times gone by, not just in the subject matter, but in the focus I can bring to something that interests me and is left to me to manage in my own way. I hadn't realised how the rigidity of university study had contributed to the stress that I feel. Quite a lot of the art of coursework is working out what exactly is wanted, decoding the instructions, knowing who will be marking it and what they are like, trying to conform to the restrictions imposed so as to get a good mark.

Whereas, this research is being pretty much left up to me. My supervisor is happy to meet, and I am keen to get her advice on how to put the thing together, but the ideas are mine and the way I am going about it reminds me of how I used to work, back when I had a proper job. I have been enjoying the practical details, working out exactly how I will recruit volunteers, where the interviews might take place, how they will give informed consent. It feels good to have been responsible for my own destiny for a day.

Another thing I realise I have missed is the social side of work. At university I spend most of my class time with the same group of 30 students. I don't have much in common with any of them, there are a few that I actively avoid, most are fine. But in the past, in the various workplaces I've slaved in, there's usually some sort of light relief during the day, some social interaction or jolly story that someone can tell. Spending hour after hour sitting listening to a lecturer and watching a Powerpoint presentation is not interactive, even if they do occasionally make us work in pairs or groups - it's always work. There are few laughs.

I suppose I am to blame too. I don't watch the things everybody else watches on TV, I have no idea who the hot celebrities are or what music or bands are popular. I'm not interested in clothes or fashion, hairstyles, jewellery or shoes. I hate the negative gossip and criticism about the course, lecturers, tutors and other students. If I'm working, I don't want to be distracted by small talk or interrupted with questions, I want to get the job done and go home. It's tough to make conversation, but perhaps I should try harder. I don't make friends easily.

I was reminded of the real world of work and the need for a laugh by our lecture on Monday about renal disease, delivered by a practising dietitian from Sheffield. She was personable, informal, knowledgeable, enthusiastic and funny. She mistimed the lecture horribly so the first half of the notes took most of the time and the rest had to be squeezed into the remaining little bit, but never mind that. She conveyed such enthusiasm for the wonders of the kidney that it has almost overtaken diabetes as my possible future specialist area (but there's still plenty of time for that to change).

The main facts that have remained with me since the lecture are as follows:

1. You only need one kidney, as long as it works. They are that good.

2. Dialysis has transformed the care of kidney disease, effectively converting a fatal disease to a chronic condition, albeit at a reduced quality of life than with healthy kidneys.

3. As well as ridding the blood of waste products (e.g. urea), the other significant functions of the kidney are to secrete erythropoeitin (vital to the synthesis of red blood cells), make vitamin D, and control blood pressure through the renin-angiotensin system.

4. A kidney 'transplant' is not really a transplant, because the old kidney stays where it is, and a new one is plumbed in between the old one and the bladder. It's really a kidney implant. So someone who has had six kidney 'transplants' will have six kidneys, only one of which will be working.

5. Dietary therapy for later stages of kidney disease consists of keeping sodium, potassium and phosphate intake low while trying to maintain the intake of protein and energy. This is pretty difficult, because protein is associated with phosphate in food, and nearly everything contains sodium and potassium.

At one point during the lecture, the lecturer mentioned some teaching that she had done with medical students. She had been talking about the difficulties of using BMI as a measure of obesity with kidney patients (who often have a good deal of water retention), and particularly with amputees.

Of course you will know that BMI is calculated by dividing a person's weight in kg by the square of their height in metres, and there are ways to correct for various issues such as water retention and amputation. She asked the students how their BMI calculation might be affected by amputation.

One of the students said, "After one amputation, BMI would go down, but then it would rise again with a second amputation."

She was puzzled by this answer, and asked him to explain.

"Well, after the first amputation the patient's weight would decrease, but after the second they'd be a whole lot shorter", he answered confidently.

I guffawed. I don't think anyone else laughed at all, or if they did, it was a quiet snicker. Just me, then.