SURGICAL TRAINEES: HAVING A WINE

Ed Fitzgerald Whilst many readers will be used to trainees having a whine, I would wager far fewer will be used to trainees having a good wine. Having read Professor Aldersons excellent recent article on his Secret Life [1], I felt the need (after a glass of wine) to add a few further comments.

Journal of the Association of Surgeons of Great Britain and Ireland. Number 36, March 2012

need a good coach to guide you. Finding a good wine merchant, or knowledgeable friend, is every bit as important in life as having a good GP (probably more so in fact, and certainly better for your health). But to really understand a wine you have to go and visit where it comes from no hardship, given that these happen to be some of the most beautiful corners of the world. Explore the land, meet the makers, and eat the regions cuisine. Only then, can you really get under the (grape) skin of what makes a great wine. This is as much about people, history and culture as it is about ripeness, tannins and vine canopy management.

There is certainly a lot of pretentious tosh spoken about wine, and a straight-talking Geordie approach is as good a way as any of cutting through that! However, wine is very subjective, and the need for wine talk to describe it is important. There are as many different opinions on a bottle of wine as there are people drinking it, a situation not a million miles away from some clinical encounters I have experienced. The mumbo-jumbo of wine tasting talk (think Jilly Gooldens infamous sweaty saddles comments) is not always helpful. Nonetheless, I would argue that wine tasting has evolved its own technical language through the need to give physical descriptions to subjective sensations or appearances, in the same way that our own medical language originally evolved for similar purposes [2]. These days, we take for granted the whimsical Greek tradition of likening anatomical structures to musical instruments, plants and animals - perhaps Jilly Gooldens elaborate wine tasting descriptors may have fared better in an earlier era? Wine tasting itself isnt a magic art, although it sometimes appears so. Its as much about experience as confidence; experience in having tasted enough wines to make judgements, and confidence to accept and interpret what your senses are telling you. Translating a physical sensation like smell or taste into words is difficult, but it does get easier with practice. Tasting is completely subjective. We each inhabit a unique sensory universe, formed by memories and experiences. There are no rules, just opinions. However, some are more informed than others. Tim Atkin, wine writer Wine tasting is a contact sport, and the more you make that contact the sharper you are and the more knowledgeable you become. Reading books can only get you so far. Like having a good mentor in surgical training, to really explore wine you

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I am pleased to have sipped some of the outstanding wines recommended in Professor Aldersons article, including Moss Wood, Grant Burge, and Vasse Felixs finest but only when the boss is paying (hence rarely!) A great deal of my personal pleasure over the years has come from exploring far-flung or unfashionable wine regions in order to find the undiscovered, great value heroes of the wine world. This has only been partly successful, in that some of the wines I fell in love with 10 years ago have now been discovered and I can no longer afford to purchase them! But, for fellow junior doctors on our meagre salary, it is worth spending a little time digging around off-the-beaten track: Compromises are for relationships, not wine. Sir Robert Scott Caywood Getting good value from wine is not just about looking for under-valued wine regions or grapes. Currency fluctuation plays a part, with South Africa and South America currently offering better value than Australia and North America. Also important are the actual cash-values of what youre prepared to pay. Cheap wine is a false economy, yet in the UK the average price point for a bottle of wine is only 4.85. Duty and VAT already account for half of this, and when the retailer, shipper and fixed-costs (bottle, label, cork, etc) are taken into account, very little is left

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over the wine itself. The following figures are a little out of date now (VAT is 20%, duty now 1.81/bottle, and youd be lucky to find any bottle worth drinking at 3.99), but they do show how spending a little extra on a bottle gives a return on the wine inside out-of-proportion to your extra spend [3]:

Wine is a food, a medicine and a poison - its just a question of dose. Paracelus, 16th century Swiss physician Wine and the medical profession make good bedfellows for several reasons. Undoubtedly, there are some historical medicinal links, now being evidence-based by current research into the anti-oxidant Resveratrol (3, 4, 5trihydroxystilbene) [4] and other polyphenols found in grape juice and grape skins. This alone cant explain the fascination and passion that many doctors hold for wine. Personally, I enjoy reflecting on a number of similarities between the art and science of wine and medicine. Both topics involve an element of uncertainty. Some consumers will be uncomfortable and even baffled by the many variations in wine: what it will taste like, how it will develop with time, how it accompanies food, and whether two bottles of the same wine will even taste and age in the same way. Despite many years of playing this game, I still find myself scratching my head sometimes as to how the same wine can taste so different seemingly just because its not a sunny day outside!

I was convinced forty years ago - and the conviction remains to this day - that in wine tasting and wine-talk there is an enormous amount of humbug Thomas George Shaw It strikes me there is scope for more winerelated articles in the JASGBI. The Surgeons News magazine from the RCSEd runs a regular column [5], and I hope the JASGBI will consider introducing something similar. Perhaps even a wine tasting at the ASGBI Congress? As a shared interest, there can be few other non-clinical topics that bring so many colleagues together for such a sociable activity. As one of the founding principles of ASGBI was the promotion of friendship amongst surgeons what better lubricant to facilitate this that than a good glass of wine? References
[1] Alderson D The Secret Life of On the subject of wine JASGBI 2011 35:24-25. [2] Wulff H R The language of medicine J R Soc Med. 2004 April; 97(4): 187188. [3] Robinson J Why cheap wine is a false economy in the UK, and the US http://www.jancisrobinson.com/articles/inside051113.html [4] Smoliga J M, Baur J A and Hausenblas H A Resveratrol and health A comprehensive review of human clinical trials Mol. Nutr. Food Res 2011, 55:11291141. doi:10.1002/mnfr.201100143 [5] Surgeons News http://www.surgeonsnews.com/spectrum/wine

Journal of the Association of Surgeons of Great Britain and Ireland. Number 36, March 2012

wealth of wines, wine makers and wine regions waiting to be discovered. The medical nerd is well catered for in the wine-world, with pointscores to memorise and vintage charts to recite. Similarly, those of a more romantic or philosophical disposition can wonder at how the science of terroir - the geology, geography and climate of a vineyard - translate into the art of making and enjoying a wine every bit as individual as its unique vineyard site. Good wines - and not the industrial scale, chemistry set wines too often seen these days - are much more than a liquid commodity. Every one of these has a story to tell, but many branded wines have now lost contact with the place that the grapes were grown and the people that made them.

For doctors, who spend a career trying to rationalise uncertainties, these unpredictable facets are perhaps less troubling and, indeed, add to the fascination. Without doubt, there is also an endless academic pleasure in learning about wine too, and like constantly progressing medical knowledge, every new vintage will add to the

Editors Note Ed Fitzgerald had the hepatocyte-challenging role of President of his University Wine Society, and is a previous winner of the Australian Wine Bureaus University Wine Challenge blind tasting competition. He still embarrasses himself by maintaining a small wine blog of tasting notes and musings. edwardfitzgerald@doctors.org.uk Further contributions on the subject of wine (or other areas of interest to Fellows) would be gratefully received.

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