Friday, 12 September 2014

Wedding Presence - Part 1

Field of cabbages in very flat landscape
South Lincolnshire, August 2014 (Photo credit: Mr M)
Two Lolas and a Mr M have each produced a contribution towards the record of the Wedding Presence Camping Event that took place a few weeks ago. The majority is my account (in black), Lola II (in red) has contributed mostly food-related items, and Mr M (in blue) has given me his insightful observations and learning points, and all the photos in this blog post.

Introduction (by Lola II)

I love camping. I asked Lola I why she loves camping and she says it's waking up in the morning and looking out of the tent at ground level, smelling the grass and the dew and the outdoors. I love all that and I also love cooking and eating outdoors. On this trip, I took it upon myself to be Head Chef. Rather than have a Sous Chef, I had Washeruper and RemindMeHowToUseTheGasStove glamorous assistants, both of whom did a very good job of eating everything I produced.

Mr M and I have been building up our camping equipment to the point where this was going to be our first opportunity to put it all into use. So we insisted that, apart from Lola's tent and bedding, we would bring everything with us. We were also trying out our NEW TENT, a wedding gift from a Seattle uncle and aunt. The advantages over our other ones are a) it's waterproof and our bedding doesn't touch the side and get wet, b) we have a vestibule that allows us to store all manner of things so we don’t have to get clothes out of the car in the morning and, c) our vestibule gives us comfortable shelter in times of rain when it's too early to go to bed, too late to go anywhere and too uncomfortable to sit in the car.

My, what a wonderful time we had. Mind you, I've never yet been disappointed on a trip with Lola I, so I had no fear that this would be anything but a four night trip of mucking about and excitement.

Observations and Learning Points from a weekend in Lincolnshire (with trips into Norfolk and Cambridgeshire) (by Mr M)

Firstly ... and this has to be said .. Lincolnshire is incredibly flat ... and by flat I mean so mind numbingly flat that you would be able to see the curvature of the earth if there was anywhere higher than a hedge to view it from.

Secondly, and sorry to repeat myself, but Norfolk and north Cambridgeshire are also spirit level and spirit crushingly flat.

Having said all that, I should now probably mention all the things we did to distract us from the lack of hills and vantage points. However, as this is an educational blog, I've decided to focus on things learnt from the weekend and one piece of commentary.

Introduction (Lola I)


I reached the campsite pretty early, because I finish work early on a Friday. It was among fields, in the pancake-flat landscape of south Lincolnshire where the fields stretch away to the horizon and it seems as though 90% of the world is sky. The site was surrounded on all sides by 50-foot Leylandii hedges, providing shelter from the strong winds that blew almost continuously. The hedges also provided housing for flocks of pigeons, whose cu-coo-cu calling seemed very loud, along with a lot of flapping. This aside, the only fault with the campsite was the lack of a pub within walking distance. The ground was flat and soft, the shower was hot, the owners friendly and helpful and there was a fridge/freezer. They even sell blackberry jam - I await Mr M's verdict.

Having erected my tent with its back to the hedge, I realised that it would make more sense if my tent and Lola II and Mr M's tent faced one another, side on to the hedge, so I took the tent down and put it up again. By this time there had been a squall of rain, and I was tired, so instead of foraging for supper I sat in the car reading. It was dark by the time Lola II and Mr M arrived with their brand new tent, and they coped pretty well putting it up for the first time, although it needed minor adjustments later.
Learning Point 1: Don't rely on satnav and mobile data or even phone service when visiting the Wash area as there are no hills to put antennas on.

Learning Point 2: it was probably naive to expect a tent called "2 second" to be put up in 2 seconds. Fortunately, the tent only took about 15 minutes albeit in the dark and for the first time.
Oh, and I mustn’t forget dinner on the night we arrived. Mr M and I got to the campsite quite late and so dinner was a pot noodle each and a couple of bags of crisps, purchased from the campsite shop. A real success, since two out of three were reduced to £1 because they were out of date.

Day 1


We started the day with eggs, mushrooms and tomatoes courtesy of Lola II, and then off to visit Boston, Lincs. We visited the tourist information office which was in the Guildhall and included a museum - I learned that Boston was the home of the religious dissidents who became the Pilgrim Fathers - but it was lunchtime, and Mr M wanted to sample typical Lincolnshire fare in the form of sausages and plum bread. We were welcomed at the restaurant although told very clearly what we were and weren't allowed to do in the way of ordering - no sharing, we had to have a meal each. That's just the way things are done in that establishment.
Learning Point 3: Lincolnshire plum bread and Lincolnshire sausages are excellent but you have to get your own sausages and can't try your wife's, as in Boston they "don't share dishes round here."
Inside Boston Minster, August 2014 (Photo credit: Mr M)
It is not a particularly affluent area of the country, and we found prices to be very reasonable, not just for food but also household items. We did a bit of standard tourism too, visiting the main church (known as The Stump) and Mr M even climbed the tower to see if he could see any hills - he was rather disturbed by the flat landscape throughout the holiday. There was a wedding about to get under way, and we also noted that the majority of the attending ladies had made pretty poor choices when it came to dressing up. Maybe this is not typical of the local ladies in general, but it was striking in that party. We finished our visit to Boston with a short walk along the river, where we were briefly accosted by a man asking us to attest to witnessing him being assaulted by some youths, despite the fact that we had witnessed nothing at all. It was a strange sort of a day.
Commentary: Boston is famous for two things; Several of the 'Founding Fathers' aboard the Mayflower were from Boston (hence it giving its name to the American city) and, more recently if you're a Daily Hate Mail reader, Boston has a Polish population of at least 99% (Daily Express figures). While we saw some gravestone like markers of emigrants to the new world, there wasn't much else marking their escape from religious freedom (and yes I mean 'from' as they were actually escaping a fairly liberal society religion wise, and wanted to set up a strict Puritan community with no freedoms).

On the immigrant front, there does appear to be a large Eastern European population by both Mr M measures - number of people you hear speaking Polish/Latvian and Lithuanian etc, and my probably more accurate measure, how many shops there are catering to Eastern European needs. Interestingly, the latter were concentrated in a different part of town from the local shops and seemed to indicate that what the community misses from home are grocery stores selling pickled herring etc and sunbed salons.
Learning Point 4: There are excellent views of fields and, well, more fields from "the Boston stump" aka the tower of Boston Minster. Despite the brilliant views of the area and confirmation that Lincolnshire is as flat as a can of lemonade which has been open a week, I felt a bit short changed as there we're only 198 steps whereas the warning at the foot of the stairs had claimed there were 'over 200 steps'.
Boston 'Stump', August 2014 (Photo credit: Mr M)
Even though the weekend was supposed to be my present to the happy couple, I had failed to bring enough cash to pay the campsite fees and even had to borrow tent pegs from Mr M and Lola II. I had brought minimal food and not enough teabags, and done no research into local activities beyond searching for sushi restaurants (there are none). However, Day 1 finished with a gala dinner catered by Lola II and the successful camping stove. She had brought all the ingredients for chicken stew (it's probably got a posher name) followed by spiced hot chocolate, and we dined in style. Not only this, but I was also presented with a birthday present of a flight in a glider on the following day, courtesy of a local flying club. I spent the rest of the evening and next morning humming "She flies like a bird in the sky-y-y..."
Even though this trip was our Presence from Lola I, I wanted to celebrate her birthday-with-an-0-on-the-end by producing a gourmet dinner. We had an aperitif of homemade blackberry gin a la Mr M. My two camping colleagues then had a little snooze whilst I cooked Moroccan lemon chicken with couscous. This was then followed by a luxurious hot chocolate dessert.

The good thing about camping is that bowls and plates tend to be smaller than everyday ones and so portion sizes aren't excessive. Cleverly, by having Mr M with us we were able to take advantage of the fact that he didn't want his full share of hot chocolate and so us two Lolas were forced to finish it off for him. I always knew he was a good find. Also it's good practice to minimise washing up.
To be continued...

Lola II cooking a la campsite
(Photo credit: Mr M)

Friday, 5 September 2014

Not at work

Side view of a peacock displaying its tail
Groombridge Place, June 2013

See what happens when I don't have to go to work and I'm not away from home? Blogs happen, that's what. And I am told that Lola II is working towards her contribution to the Wedding Presence camping trip blog post (I think Mr M has done his, although he hasn't sent it through yet). So we are backing up a little now to report news from a week ago...

At work, I agreed to cover the ante-natal clinic, which takes place in the other Trust hospital - we don't have any maternity services where I usually work. As regular readers may remember, I am not a fan of ante-natal clinics, and this was no exception. There are too many patients and not enough time, and I felt rather exploited although the consultant and the nurse took care to thank me very appreciatively. Next time I will be more 'assertive' about time-keeping.

Back at my usual hospital I observed a patient being started with an insulin pump, which took quite a long time but wasn't very complicated really. I think that the hard work starts afterwards, to try and fine tune the background delivery of insulin to match the patient's needs from hour to hour. Being away from work this week I'm missing that part of the job, but I'll try and catch up with a different patient some time, to see the follow up.

And then there were a few things not related to work. It was a red letter day on Thursday: the first time I managed to run 5 km in under 30 minutes (all on flat tarmac). My timed runs on Saturday mornings with Parkrun are getting faster too, but despite planning to go out this week, I haven't felt up to it yet, partly because of the trip at the weekend, to see Landrover Man (LRM) and Bee Lady (BL).

This was actually me gatecrashing one of Mr M and Lola II's wedding presence, and it was lovely as usual. BL provided an extensive food preference questionnaire which also included attitudinal questions to see if she should be sticking with conventional choices or going a bit experimental. After a tour of the LRM/BL mansion and grounds, then the enormous and delicious dinner followed by games on Saturday night, we were looking forward to the usual standard of walking on Sunday. We only got a bit lost once and had to do a bit of off-piste mountaineering (Lola II was very brave and I got stung by nettles) but it was excellent, if exhausting. I had to have a sleep on the motorway on the way home, and was very glad not to be going to work on Monday. I think I felt the effects of the indulgence followed by the exertion for a few more days, but it may be the unaccustomed freedom of not being at work.

[Bee Facts: there were many, mostly about how to manage your hives - BL doesn't like killing a perfectly good queen just in order to limit the number. So she has ended up with ten hives, which is A Lot. LRM was very patient and listened to many, many Bee Facts without much complaint. Unfortunately it isn't quite so interesting to hear about his energy management spreadsheets.]

So this week I have welcomed my tradesmen about whom I have already written, and the latest carpenter says the job isn't big enough and has suggested another carpenter. I have donated blood without incident, and even managed to visit the charity shops for long enough to acquire the clothes that I was after. Yesterday I made an enormous effort and cleared out about two thirds of the clutter that was getting in my way, and then it was time for badminton. Today I had lunch with an old friend, and I am looking forward to the weekend, which holds the annual Food & Drink Festival.

Tuesday, 2 September 2014

Progress at Lola Towers

View with garden chess set and urn
Groombridge Place, June 2013
At last, I have taken just a few small steps forward with the lifetime's work that is the making of Lola Towers into a habitable residence that does not cause me embarrassment with every visitor. There have only been a few very small steps, but it feels as though I have created just a little bit of momentum.

We have had two callers - Bill the electrician, and Mark, who deals with household electrical appliances. Mark's job was the easier one, diagnosing and replacing a burnt out element that was preventing the fan oven from heating up while allowing us to use the oven in conventional mode. It was not such a difficult task to complete, and I would certainly be able to do the whole job myself in future. And I now have a working fan oven, and we had a lovely chat about diabetes as Mark has been diagnosed with Type 2 for about 30 years, has recently seen a Dietitian (not in the hospital where I work) and made many positive changes as a result.

Bill the electrician had a more difficult job, but successfully reconnected the doorbell, rewired a couple of light switches, replaced a fuse plate and failed to repair the dimmer switch but diagnosed the problem. He also recoiled (figuratively) in horror at the sight of our ancient fuse box with its ancient fuses made of actual wire, asking if we ran a power shower and shuddering (figuratively again) when I said we did. It's a wonder we are still alive, really. As the replacement of the fuse box is something I wanted him to quote for, his interest in the job, and his opinion that we are not safe in our beds until it is done is half encouraging, half disturbing.

We then spent a happy half hour trying to discover the hidden secrets of this Victorian house. Is the water system earthed to the main fuse? What about the gas supply? If not, the situation must be remedied, but all evidence is buried in walls, trunking or behind kitchen cabinets. Bill and I climbed down into the cellar where there are cables and pipes a-plenty, but which is which? I'm not even convinced of where the mains water enters the property. I have a feeling that the resulting quotation may be fairly expensive, but the job will include another task that I wish to be carried out: a survey of the exterior lighting and wiring, which I have long suspected of being installed by very amateur hands.

There is a third job which I had hoped to address during my week off. The airing cupboard was extended and new doors constructed by the admirable Alf, who excels at building, roofing, plastering, constructing a sturdy garden gate and painting the exterior of the house. His attempt at the finer touches of this indoor job resulted in a robust door that would keep wildlife out of a shed, but does not have the refinement required in a piece of indoor furniture. My attempt to find a carpenter, joiner or cabinet maker willing to quote for the job has so far resulted in very little, despite three possible leads - although one has just come back to me this evening pleading illness as the reason for failing to respond to earlier messages.

I hesitate to list the further jobs that I hope to achieve this week, because I invariably fail to get half as much done as I would like. Let me choose one: I would very much like to visit the wonderful Leamington charity shops for some more work tops and trousers. Let's see how I get on.

Tuesday, 26 August 2014

Quick catch up

Eagle sunning itself with outstretched wings
Bateleur eagle, Cotswold Falconry Centre, July 2014
Wow. Nearly a month. Some of you must have been getting impatient...

Very little has changed in the landscape at Lola Towers, although I have started to make my move on the state of the house, creeping up on it and surprising it so it doesn't have a chance to skip out of the way. I have arranged for an electrician to attend to many of the small electrical frustrations, and maybe a carpenter is going to visit to view one of the scenes of devastation. I have more plans and a week off work, when I'm hoping to plot a route through the tunnel to the light at the end, and maybe take a few tentative steps towards it.

In terms of events to report, obviously I haven't been sitting around thinking about blogging, I've been up and out there. Here's a list:
  • Cambridge Folk Festival
  • Return to Bletchley Park
  • Trip to London for Sister D's birthday, lunch with old friends, proper London theatre with Lola II and Mr M
  • Evening with the friends with whom we went sailing
  • Lots of badminton as usual, and a bit of running
  • Lola II and Mr M's Wedding Presence: a four-day camping trip
  • Meanwhile, Mr A...
  • And a little bit about work.

Oysterband frontman
Cambridge Folk Festival

It was lovely. Mr A didn't go due to the pressure and deadlines of his first contract job, but I managed to sell his ticket and I knew four friends would be there so I wasn't going to feel too lonely. Highlights, just in case anyone wants to look them up: Oysterband (well-established UK band, I'm a big fan but not as crazy obsessive as the other fans I met in front of the stage), Pokey LaFarge (American swing/blues band), Habadekuk (fantastic Danish high octane folk), Hazmat Modine (New York band worth hearing for the a sousaphone alone), and Loudon Wainwright III (I had no idea he was so funny - he made us laugh at a song about the situations in Gaza, Syria, Ukraine etc). I'd go again, except the tickets are almost impossible to buy, and the site is too crowded now that everybody brings chairs.

Return to Bletchley Park

This time with mum, and although we again spent many hours there, I still haven't seen everything. Another visit will be needed! Maybe with dad next time.

Trip to London

This included the opportunity to take part in a meeting of Overeaters Anonymous, which was very interesting though I felt very tense. I have since recommended the organisation to one of my patients. Also, the theatre - I haven't been to a real on-stage live play for many years, and had become so used to the conventions of cinema and DVD movies that I was surprised for a second when the applause came at the end.

Underwater fish Sailing reunion

This was mostly an opportunity to share photographs, but it was actually very nice to meet up again.

Exercise

I am very thankful for my continued good state of health, and intend to do all I can to keep it this way! I have not only continued running, but my pace is increasing very gradually, and I even did a Parkrun in Cambridge while I was there. Here's a little clip of Eddie Izzard promoting Parkrun, which actually includes footage of the Leamington run (you'll have to take my word for it).

Lola and Mr M in front of octagonal brick building
Kings Lynn

Presence

When we were on the camping trip, we discussed each of us writing about the trip and combining these into an entertaining format for the blog. So I'm willing to postpone the report about camping for a few days in case something appears. It was a really good trip, though.

Mr A

Mr A continues to work on his OU course while looking for employment, and as I write he is engaged in open warfare with the meadow that is the 'garden'. He has been on a successful camping trip with The Boy who is temporarily back from his travels, and a less successful motorcycle trip where, true to form, his bike broke and he came back after just one day.

Work

After much protracted discussion about extending my hours, where I was somewhat sceptical about the likelihood of any change quicker than in geological time, the boss phoned on Thursday and said that I could move to full time working from September (i.e. next week) until March. I am booked onto a training course at the start of October which will allow me to facilitate structured education for people with Type 2 Diabetes, but as ever there are as many questions as answers. For example, I don't know where I will be based or how many courses there will be or what I will do in the time that is not occupied with these courses. I am also filling in for colleagues on holiday - unfortunately, one session is an ante-natal clinic, but the other is a community clinic, which may be very interesting. On the whole, I am very pleased with the main permanent job I have been doing - pleasant colleagues and a small team in a friendly location - and maybe I'll go back to the part time option after March.

Composite flower with pink and yellow florets and buds

Sunday, 24 August 2014

What I've been reading

Image of the book cover

The History of Mr Polly
by H. G. Wells

narrated by Paul Shelley
"Mr Polly is an ordinary middle-aged man who is tired of his wife's nagging and his dreary job as a gentleman's outfitter in a small town. Faced with the threat of bankruptcy, he concludes that the only way to escape his frustrating existence is by burning his shop to the ground and killing himself."
It took a while to get going - about half of the book, actually, but then things moved forward a bit quicker. Quite different from Wells' science fiction (e.g. The Time Machine, The Invisible Man and War of the Worlds), this is just a simple history of an ordinary chap living a dull life until he burns his house down. It doesn't get a whole lot more exciting after his act of arson, but it's a pleasant read nonetheless.


Image of the book cover

Mike and Psmith
by P. G. Wodehouse

narrated by Graham Seed
"Mike is a seriously good cricketer who forms an unlikely alliance with old Etonian Psmith after they both find themselves fish out of water at a new school, Sedleigh. They eventually overcome the hostility of others and their own prejudices to become stars."
Apparently this is one of Wodehouse's earlier works, and it shows. Not as refined, not as funny, not such whimsical use of language as the later books, and the greatest sin from my point of view is that a whole chunk of plot towards the end of the book is re-used in a later Blandings book that I've read quite recently. The reviews also point out that if you're not too familiar with the laws and rituals of cricket, then a lot of it won't make much sense.


Image of the book cover

Me Before You
by Jojo Moyes
"Will Traynor knows his motorcycle accident took away his desire to live. He knows everything feels very small and rather joyless now and he knows exactly how he's going to put a stop to that."
Although the author is pretty fair minded about setting out opposing arguments for the moral point (avoiding plot spoilers here but you can probably guess what it's about), I have pretty much made up my mind which side I'm on, so the alternative view seemed unconvincing. Quite a few people have recommended this book, and it was a good choice for audio because in print I would have skipped ahead just to find out what happens more quickly. I suppose that means it was a bit long-winded, but I didn't really mind, I was just a bit impatient to see if it ended satisfactorily.


Image of the book cover

Portuguese Irregular Verbs
by Alexander McCall Smith

narrated by Hugh Laurie
"In the unnaturally tall form of Professor Doctor Moritz-Maria von Igelfeld, we are invited to meet a memorable character whose sublime insouciance is a blend of the cultivated pomposity of Frasier Crane and of Inspecteur Clouseau's hapless gaucherie."
There was nothing wrong with this book at all, it was perfectly all right. But there was nothing outstanding about it either, and because of the Germanic background of the main characters, the narrator rightly used a German accent for their dialogue, which felt a bit like mockery. I'm not inclined to seek out the subsequent books in the series, but if you felt like reading this I wouldn't stop you.

Thursday, 31 July 2014

Half a century


Empty barrack with columns, beams, paned windows
Block C, Bletchley Park
I can't believe it's a week since I last wrote something. Maybe time is passing more quickly, or more likely, there's much less that I feel like sharing publicly.

I have reached my half century without serious setbacks, and I feel most thankful. I enjoy what I do most days, and have been taking a bit more care to pursue activities that are both mentally and physically satisfying. Watching films and reading books as well as working, learning, writing and listening to music fulfil the intellectual criteria, and I've continued to play badminton twice a week even through the recent heatwave, when drinking more than a litre of water over two hours is often not enough.

Then there's the running. I completed my challenge of learning to run, and wrote about doing two Parkruns, so I knew I could run for 5 km. Looking back, I wrote at the time that I wouldn't rule out doing more, and in the last couple of weeks I've been out running on my own and did another Parkrun, and faster than before. It's incomprehensible. I still don't really like running, but I'm still doing it, even when it means getting up early at the weekend. If you'd told me even six months ago that I'd be running for the joy of it, I would have laughed in your face. I'll let you know when I've worked out what's going on.

Just to add to all of this, I decided not to let a whole summer go by without skiing, so I took myself off to the Snowdome to have a bit of a practice, thinking that it would be pretty quiet on a midweek day in July. It wasn't that busy, but still a few groups learning to ski. I found I hadn't got as rusty as I expected, and that an hour on the slope was enough to get me back in the swing of things. Time to book the next holiday?

Mr A has got a contract job, which is very good news, but as with all things relating to Mr A, it is stressful. There is a major deadline imminent, and no doubt some other deadlines to follow, which always puts the pressure on. He has, however, been getting some very good results in his latest Open University module. No particular news to report from Lola II and Mr M, who continue to get up to mischief at every opportunity. No news from the pub next door, and our house is still shabby but functional. The garden is even more overgrown than before, which is to be expected since I haven't been out there except to pick some mint and unblock a drain after a thunderstorm.

Main entrance to Bletchley Park mansionWe still have no working doorbell, and our (landline) telephone system relies on four handsets with rechargeable batteries, of which three seem to have stopped recharging. The batteries seem to be custom models soldered into the handsets, making replacement complicated. Note to those who telephone the house - if you leave a message we can play it back on the base station and then hunt down a handset that works, or phone back using a mobile. There is very little chance of us actually finding a working handset in time to answer your call. Or if we do, the handset will probably fail within a minute, cutting you off. And our mobile phones will probably not be in the same room as us...

Other recent events: a trip oop north to a barbeque with H&B, which was lovely. The mid-season falconry centre barbeque, which was pretty good considering most people there communicate better with birds than with strangers (I don't necessarily exclude myself from that description). A trip back to Bletchley Park, which has developed enormously since my last visit back in 2008. Re-reading that post, I learned a lot more detail on that visit about the actual decryption methods, presumably because I was part of a small academic group. This time the information was much more general: how the place was run, who was there, how it felt to be one of the workers rather than the exceptional genius of Turing, Welchman and the rest. The entry fee allows repeat visits for a year, and although I was there for about five hours I didn't see all that I wanted, so I'm planning to go back next week before my holiday ends.

Woodworking in the woodland
Mr A and I have also visited our southern friends who have bought a nearby area of forest, and are working to restore it to its original state by gradually getting rid of the planted softwoods and allowing native woodland to regenerate. They are also having fun camping there, and have started to create a mountain bike track and an obstacle course as well as hosting the annual 'Run Forest Run' (which, for those who have not seen the Tom Hanks film, is a rather amusing reference to Forrest Gump).

That's it. I've got stuff to do, packing for my birthday treat: a weekend at the Cambridge Folk Festival, where I have previously spent my 30th and 40th birthdays (and possibly also my 20th, although it's too far back for me to have recorded that attendance). Here's to the next half century!

View of Bletchley Park mansion across the lake

Thursday, 24 July 2014

Outpatients and inpatients: clinics and wards

Honeysuckle
Groombridge Place, June 2013
The consultant-led clinics have been a bit like a roller coaster for a week or two. One of our regular consultants has been ill, and sometimes another doctor has provided cover, and sometimes the admin staff have had to try and contact everyone to cancel at short notice, and sometimes patients have turned up and been seen or not seen depending on who's available and what's needed.

For one particularly busy pump clinic (where patients with Type 1 Diabetes who are using insulin pumps usually spend much more time with the Diabetes Specialist Nurse than in most clinics), we only had one DSN, and the consultant delegated the clinic to two subordinates, neither of whom was familiar with how to manage a patient using a pump. This meant that the poor DSN had to support the doctors as well as trying to do her own job. The whole thing provided a pretty unsatisfactory experience for the patients - none of whom complained, despite having to wait ages.

The whole scenario was relayed back to the consultant, who overcompensated the following week by bringing three doctors with him. Unfortunately we don't have enough rooms in the building to house all these doctors as well as ourselves, and consequently neither the DSNs nor I were able to see patients and we had to squeeze into rooms occupied by researchers and secretaries. There were also far fewer patients booked into this clinic than the previous week, which meant all these doctors had long gaps between patients. At one point, a patient with a baby and a toddler was dealing with a nappy change in the room I was in, and the only place left for me to sit was in the waiting room.

This is unusual - most of the time the clinics run pretty efficiently and on time, and most times I get to see the people I think I should be seeing. I have taken to advertising the very low carbohydrate lifestyle with a few posters on the wall, and flyers given to the patients that I think might benefit. This has rustled up a few candidates, and I am starting to build towards a group that can meet regularly to share experiences and recipes and generally keep each other motivated. There are plenty of others who don't need or want to follow that diet, and I am still seeing new people all the time. It is always very interesting, even if I sometimes end a consultation thinking that I could have done better. There are plenty where I feel I did well.

And in between all this interesting and rewarding outpatient contact, for the last five weeks I have had to spend a day a week on the wards. I've disliked this type of dietetic work from the start, and now I've come to hate it. I would rather spend hours with a recalcitrant diabetic who has no intention of taking any advice from me or anyone else while ignoring spiralling blood glucose, than 15 minutes trying to get a confused malnourished inpatient to drink a sickly sweet milky supplement because that's all we have to offer. I would rather be resigned to the inevitability of diabetic-related complications than despair at the likelihood of hospital-acquired pneumonia.

I have enormous respect for the nurses and healthcare assistants on the wards, who are frequently doing three or four things at the same time, often unpleasant and involving bodily fluids or orifices or both, and who listen to me with patience and good humour even while I'm telling them what they already know. But despite my regard for ward staff and their dedication to doing the best they can, the institutional setting thwarts most of their best efforts. I heard today about a patient with Type 1 Diabetes - elderly, frail - who kept having hypos while in hospital, so the doctor stopped their insulin. Just stopped it. Two days later, the patient had to be transferred to the main hospital for life-saving treatment in intensive care.

Our health service is amazing - the care that is offered without additional payment in NHS establishments is incredible. But I would do almost anything to avoid having to spend even one night in a hospital ward.

Monday, 14 July 2014

Diabetes services

Sunset over harbour and hills
Greek sunset, June 2014
I've got a half-written blog post that I've been trying to finish, but it's taking ages because it needs a bit of thinking time and I'm just not getting round to it. So I'll do some writing off the top of my head, just to keep things ticking over.

I'm still working five days a week, being paid for about five hours on that fifth day doing general dietetics on the wards, which means mostly nutrition support. The hospital is a small one with only six wards, and holds patients who are not acutely ill and/or who live in the area. They are generally old and not actually needing further treatment but cannot go home until some sort of provision is arranged to make sure they can cope (a 'Package of Care'). Nearly all those who need dietetic input are not eating or drinking well, usually because they have dementia. I absolutely hate it. I have two weeks to go before the Dietitian who has been off sick is due to return, and I shall do everything in my power after that to be completely unavailable for this type of work in future, although there will be a lot of moral pressure to 'help out' if a similar situation happens again.

My real job is still very interesting. I have managed to start two people on the very low carb plan, but unfortunately one did not return for the follow up appointment and wasn't answering the phone when I rang. My first Structured Education course for people with Type 1 Diabetes finished this week. This is designed to give people a lot of information and practical experience of how to best manage their diabetes, and we run it one day a week for four weeks. We had eight attendees, and all of them seemed to get a lot out of it. I found it a little stressful to have so much responsibility for delivering material that is so critical to the course.

At least half of the course is about carbohydrate counting. This is a skill that is fundamental to good control of Type 1 Diabetes for those who want to have the flexibility of eating what they like when they want to. Teaching carb counting is a core skill for a Diabetes Specialist Dietitian, and I would say I have reached an intermediate skill level - not too bad, but I've only been doing it in earnest for a few years. Nearly all of the people on the course have had diabetes for much longer than that.

Despite my nervousness, it went quite well, although I think I can improve with practice. We cover all sorts of ways of estimating the carbohydrate content of food - using food labels, weighing food and using reference tables, using apps, websites and pictures, and plain and simple educated guesswork. The part that makes me a little bit uncomfortable is that while my estimates are based on my experience with a number of different people as a day job, I don't actually act on the data and inject insulin, so I don't get any personal feedback about the accuracy of my estimates. When I get it wrong, it's someone else that suffers. I take this responsibility very seriously, so I often lose sleep worrying about whether someone I've seen in the day is going to end up with very high or very low blood glucose as a result of something I've said.

As well as the course and the individual consultations, there has been some discussion in the Trust and the Clinical Commissioning Group about funding to expand the very low carb programme that we offer. This has caused some controversy, because we haven't any solid evidence for its value in our service. We have lots of anecdotal evidence of patients who have found it life-changing (in a positive way), and we have a spreadsheet with lots of data, but the data hasn't been analysed and there's been no data collection from those who haven't found it helpful, nor have we sought views from anyone who may have experienced negative effects.

There are a number of healthcare professionals in our Diabetes service who are positively messianic about the plan, and they are all in favour of the expansion in funding because they have seen so many people find it beneficial. Having joined the service so recently I am more sceptical, and feel that we must carry out some analysis of our data to provide evidence of benefit and investigate any negative aspects properly. Our Team Leader has very sensibly defused the situation with an eminently rational proposal, including the view that we should be offering people choices rather than putting all our energies into selling the low carb idea.

Whenever I have met up with other Diabetes Dietitians, I have asked them their views on very low carb diets. So far I haven't met any that are offering anything like our plan, but they have all been very interested in hearing about what we do. I would like our next stage to be a proper audit of what we have, if not a research project culminating in a peer-reviewed publication, but I'm not volunteering for the job.

Wednesday, 25 June 2014

Sailing

Fishing boat moored
Ionian sea, June 2014
We were on holiday and now we're back, have been back for a week or more, and where has all the blogging gone? It's gone to work, that's where, with five-day full-time working for three weeks and the realisation that I had taken my extra spare time for granted over the last five months. I'd got used to being able to play badminton on Monday and Tuesday and have a lie-in on Tuesday and Wednesday, thus allowing me to function when necessary at work for the remaining week.

Coming back from holiday on Sunday, then straight into full-time hours for a week has also reminded me how old I am. One of the very young badminton players (i.e. under 30!) was talking about where she would be going to party on her birthday after badminton finished on Tuesday at 9.30 p.m. It made me remember that I used to do that once. It was lovely being young, and the observation that youth is wasted on them is becoming a common refrain. And no young person has ever or will ever understand.

Saturday morning was the first opportunity for lie-in, and what time do you think I woke up? 6 a.m, that's what time. Birds singing, sun shining, bin lorries reversing, distant trains and nearby cars and even more nearby snoring. I finally gave in at 7 a.m.

Back to the holiday - it was in the Ionian sea off the coast of Greece, in a very large catamaran with four other friends, and we stopped off on the coast of Ithaca and Cephalonia and probably some other places. I wasn't paying attention, really - I wasn't in charge, and there was nothing much to see that was memorable or of historical note in any of the villages or towns we saw, except a couple of presentation boards in the town square of Stavros on the island of Ithaca, suggesting that Odysseus's palace had been found. We didn't go to the site, though. It wasn't that kind of holiday.

Golden sunset over the harbour

Instead we sailed, and while our friends Mr and Mrs Captain who have their sailing qualification did the driving, the rest of us sat in various shady (or sunny) corners of the boat and read books or surveyed the scenery. It was a great holiday for reading. I thought there would be more swimming, but the water was still fairly cold. I did swim twice, and was reminded how buoyant the sea is - I think the last time I swam in salt water would have been in the King Alfred baths in Brighton when I learned to swim as a child with Auntie Sylvia. You can just float if it all gets too tiring.

Mr A became a knot specialist. We were all expected to help with the mooring, which is the trickiest manoeuvre in a sailing holiday when you don't want your enormous catamaran to come into contact with any rocks, jetties or other boats. This is quite important, I came to understand, a bit like the importance on land of not coming into contact with railway bridges or other cars or, in the sky, with other aeroplanes. I'm quite confident with my half hitches and clove hitches, and I could do a bowline at a push, but by the end of the week Mr A could do a bowline upside down while suspended from the dinghy. He actually practised tying knots with his eyes closed.

Mr Captain did most of the steering and played with the sails when there was wind, Mrs Captain was in charge of the anchor, and my special skill turned out to be driving the dinghy, which is needed if you have to moor at a short distance from the shore because the mooring is too shallow for your enormous boat. I only had a couple of goes at it, but they went quite well. Our other two friends on board were in charge of swimming and smoking roll-ups if these were needed, which they mostly weren't. In fact, Mr and Mrs Captain did 90 percent of what needed to be done, Mr A did 5 percent (mostly knots) and the remaining three of us did virtually nothing. I did cook lunch twice, so that was a small contribution. The other two did quite a lot of washing up.

The other notable highlights of the holiday:
- The three male members of the party had become friends through their participation in various off road motorcycle events and rallies. They found it impossible to walk down any street without stopping at least 1000 times to look at and discuss some form of motorised transport. A seemingly ordinary conversation about, e.g. the merits of a hat could suddenly veer off into tales of foolhardiness on some desert rally in Africa.
- I found a Factor 50 suntan spray (called P20) that doesn't contain poison, doesn't smell like rotting vegetable matter, and works so well that on a day when my arms were exposed to the Ionian sun for the full eight hours I still looked as though I'd spent an overcast day walking in Scotland. I am tempted to write to the manufacturer. It was the day we rented scooters and whizzed about on the island of Ithaca: great fun. The disadvantage of the wonderful P20 is that weight for weight it costs more than gold.
- Greek salads. Every day. And lots and lots of reading.

Table and chairs on the sea front

Thursday, 19 June 2014

What I've been reading

Image of the book cover

One Day
by David Nicholls

narrated by Anna Bentinck
"She peered up at him through her fringe as he leant against the cheap buttoned headboard and even without her spectacles on it was clear why he might want to stay exactly this way. Eyes closed, the cigarette glued languidly to his lower lip, the dawn light warming the side of his face through the red filter of the curtains, he had the knack of looking perpetually posed for a photograph."
Unusually, it's been a while since finishing this book before writing my review - but there's been a lot going on. It was interesting enough, and I enjoyed the concept of relating the events of one day over a period of years - a lot can be implied and you don't have to hear the detail, it certainly maintains the pace of the story. But in the end the characters weren't drawn sympathetically enough, and I didn't much like either of them, so it felt a bit shallow. Not bad though, and much better than my choices over the previous month.


Image of the book cover

Let's Explore Diabetes With Owls
by David Sedaris

narrated by the Author
"A guy walks into a bar. From here, the story could take many turns. A guy walks into a bar and meets the love of his life. A guy walks into a bar and finds no one else is there. When this guy is David Sedaris, the possibilities are endless, but the result is always the same: he will delight you with twists of humour and intelligence."
I like David Sedaris, and that's all that's needed for this collection of readings, some live to an audience, others narrated in the studio. There isn't much diabetes in it - in fact I don't remember any - but I do remember the owls, which are stuffed. He appeared live in Leamington Spa in March, and I would have gone to the show, but I was away skiing.


Image of the book cover

The Mask of Dimitrios
by Eric Ambler

narrated by Tony Gardener
"English crime novelist Charles Latimer is travelling in Istanbul when he makes the acquaintance of Turkish police inspector Colonel Haki. It is from him that he first hears of the mysterious Dimitrios - an infamous master criminal, long wanted by the law, whose body has just been fished out of the Bosphorus."
A title from my list of 'Classics' but from an author I hadn't heard of before. It's a historical thriller in the mould of John Le Carre, but written earlier last century, and includes historical detail about the politics of Eastern Europe between the wars that was wasted on me. A quality read, though, and worth the time spent.


Image of the book cover

The Alchemist
by Paul Coelho

narrated by Jeremy Irons
"Here is the magical story of Santiago, an Andalusian shepherd boy who yearns to travel in search of a worldly treasure as extravagant as any ever found. From his home in Spain he journeys to the markets of Tangiers into the Egyptian desert where a fateful encounter with the Alchemist awaits him."
Another book that appears on the 'Classic' list, quite short and poetically written, although that might be down to the translation. I think there is a sub-text in the story, but I'm too dense to pick it up - parables are not my thing. On the surface, a straightforward tale with a likeable hero and a happy ending.


Image of the book cover

Counselling People with Diabetes
by Richard Shillitoe
"This book takes you through the steps in the helping process; forming a relationship with the patient, agreeing goals for care, giving advice and information, supporting patients and families and helping them through difficult times."
This is a library book from work, not all that recent, but reiterating messages that are only refined and improved in newer textbooks. I'm attending the level 2 Behaviour Change course next week, so this has helped to remind me of the areas that I'm aware need more attention.


Image of the book cover

Relics of the Dead
by Ariana Franklin
"Medieval Glastonbury - human remains have been uncovered. Are these the bones of King Arthur and Guinevere? On hearing of this momentous discovery, King Henry II demands evidence that the legendary Arthur is dead. So he calls upon his Mistress of the Art of Death, anatomist Adelia Aguilar, to examine the bones."
I like the way this writer puts her mysteries together, making for a book that I end up reading at a wild gallop, reaching the end, and thinking, "I should have read that more slowly, I'm sure I would have enjoyed it even more." But when there's a plot to untangle I can't slow down - one reason that audio books are so satisfying for me: they make me read at a pace that forces me to absorb every word without skipping through.