Thursday, 27 November 2014

What I've been reading

Image of the book cover

Cat's Eye
by Margaret Atwood

narrated by Laurel Lefkow
"Elaine Risley, a painter, returns to Toronto to find herself overwhelmed by her past. Memories of childhood - unbearable betrayals and cruelties - surface relentlessly, forcing her to confront the spectre of Cordelia, once her best friend and tormentor, who has haunted her for 40 years."
After the experience of reading The Blind Assassin where I wanted to read it again as soon as I'd finished, this was a huge let-down. It's an account of a child growing up in Toronto, and there is no discernible story arc whatsoever. She goes to school, goes to college, has friends, marries, is a painter. Nothing to pique the interest, or hold any dramatic tension. Don't bother. And the audio editing is rubbish too.


Image of the book cover

The Island of Dr Moreau
by H. G. Wells

narrated by B. J. Harrison
"Adrift in a dinghy, Edward Prendick, the sole survivor of a shipwreck, is rescued by a passing boat which leaves him on the island home of the sinister Dr. Moreau - a brilliant scientist whose notorious experiments in vivisection have caused him to abandon the civilised world."
It's an oddly prophetic Victorian story that develops the theme of melding human and animal in a way that some consider similarly ethically dubious in our society - genetic modification. There's not much substance to the story, and in places it is pretty horrible in its description of animal cruelty and mutilation. The main character is pretty bland and the others seem exaggerated, but it's interesting for its insight into the imaginative thinking of the time.


Image of the book cover

Mystery Mile
by Margery Allingham

narrated by Francis Matthews
"Judge Crowdy Lobbett has found evidence pointing to the identity of the criminal mastermind behind the deadly Simister gang. After four attempts on his life, he ends up seeking the help of the enigmatic and unorthodox amateur sleuth, Albert Campion."
Quite a good story and very competently narrated. Not really up to the standard of Lord Peter Wimsey or Hercule Poirot, but good enough to keep me interested. I wish I knew of a contemporary crime writer who could write something in the proper 'whodunnit' spirit but without the violence and gore that seems to be compulsory for anything set later than 1950.


Image of the book cover

The Sum of All Kisses
by Julia Quinn
"Hugh Prentice has never had patience for dramatic females, and if Lady Sarah Pleinsworth has ever been acquainted with the words shy or retiring, she's long since tossed them out the window. But Sarah has never forgiven Hugh for the duel he fought that nearly destroyed her family."
A silly Regency romance because I couldn't face anything too heavy. All the others in this blog post are audio, which I listen to in the car. Actually concentrating on the written word at home seems too much like hard work at the moment.


Image of the book cover

Cat Out Of Hell
by Lynne Truss

narrated by Mike Grady
"A cottage on the coast on a windy evening. Under a pool of yellow light, two figures face each other across a kitchen table. A man and a cat. The man clears his throat, and leans forward, expectant. 'Shall we begin?' says the cat..."
I've read the author's non-fiction classic 'Eats Shoots and Leaves' and enjoyed it very much, and this novel was in a '3 for 2' offer so I thought I'd give it a go. It's fine, and I enjoyed it. Not a timeless classic, but so very few books are!

Saturday, 22 November 2014

Singing and parking

Rose on trellis with grey skies behind
Peckover House, August 2014
I am saying 'yes' to too many things.

I like doing all the things I do at work and in the evenings and weekends.

My house is not as I want it to be.

I am clinging on by my fingertips, as always.

But do not worry, I am calm. It will be OK.

There has been a lot of activity, days and evenings, evidenced by lack of blog updating. Three lots of badminton, a finance meeting one evening and a choir practice this week. I wrote the rest of this blog post a week ago, and rather than hang on to it any longer, I might as well press 'Publish'. Mr A and I are about to head off on a trip south, so no time in the rest of the weekend either - perhaps there will be time for a report next week.

The choir is just one more thing. I like to sing, and around this time of year there are some great opportunities to belt out some top tunes. In the Trust newsletter there was a call for volunteers to form a scratch choir for the festive season including a couple of concerts, and all finished by mid-December. I've been thinking for a few years about singing in a carol service, so a couple of weeks ago I found myself in a draughty room with a few other similar minded people and an old keyboard.

The person who came up with the idea and who's leading the group (and who owns the keyboard) is a member of a different choir, but not its leader. All credit to her for giving it a go, but there are little frustrations that are utterly unimportant, but niggling. She described an arpeggio as a scale. She counts us in at a different tempo to that of the music. She has chosen some carols and managed to print the music for us, but they are set much too high so that anyone who isn't a proper soprano can't sing them.

She is encouraging us to sing the harmony parts (especially if we can't reach the high notes) but she doesn't read music particularly well so is having trouble picking out the parts on the keyboard (I haven't let on that I can play the piano). The rehearsals are alternating weekly between two locations, both almost impossible to find. But I like her, and I like her enterprise and enthusiasm and positivity and tenacity, and I am happy to give my support and encouragement. I am happy to participate in an enterprise where the quality will be pretty poor (my prediction after three out of five rehearsals) but it will be fun. And you never know, it might turn out much better than I expect. Things often do.

At work, the great news is that at last my parking campaign has succeeded, and the top management has arranged exactly what I would have wished, so that course participants can pay for parking for the four specific days of the course at £3.20 a day. I am getting better at delivering the patient education courses too, but clinics (where I see patients one-to-one) are very variable. Sometimes I get a run of people doing well who are happy and grateful; sometimes clinics are filled with people who find it all too difficult and aren't doing so well. Just recently, it's been more of the latter.

Sunday, 9 November 2014

Tradesmen, employment and growing old

Monkey puzzle tree (araucaria)
Peckover House, August 2014 (photo credit: Lola II)
Tradesmen update: I have finally got hold of the electrician and we have agreed a date for the fuse box to be replaced, which will mean a day and a half without power. I have booked the day off work, and had some pleasant thoughts about doing some fun things like perhaps going off for a quick ski in the Snowdome to keep my ski legs trim - my ski holiday is now booked for February. Then I realised that this would be the perfect time to get the car serviced as I need it to get to work every other day. The car is up for a long service medal, as it has now completed more than 200,000 miles.

Employment update: Mr A has scored a full time permanent job and has now been employed for a week; so far he is enjoying it. Meanwhile, I have delivered half of my first DESMOND course for people newly diagnosed with Type 2 Diabetes, and the first day of my third course for people with Type 1 Diabetes. DESMOND is a national programme with quality assessment and a requirement to adopt a particular delivery style which includes much questioning of participants and withholding of answers unless they really can't work it out for themselves. The Type 1 course is not quality assessed or peer reviewed, which means that I am only really getting into my stride third time round.

Update on growing old: I have new glasses! and new (trial) contact lenses! I love the glasses, they are varifocals and it has taken me no time at all to get used to them. The contact lenses, on the other hand, are proving more challenging. What the optician suggested was to have two different prescriptions, so my dominant eye would have the lens set up for distance and the lens in my other eye would be for near sight and reading. They provided me with five pairs of two sorts of lenses so I could try them out for comfort. I've had a go at one type for a week, and I don't like it at all - instead of having clear sight for distance and near viewing my eyes seem to confuse the focus and I can't see clearly at any distance. So that's not such a success - but I'll try the other brand in case the problem is with the lenses rather than the prescription.

More growing old news - happy birthday mum! She and dad kindly hosted a very small celebration attended by Lola II, Mr M, myself and another friend during which we watched a film that was made for my school's 60th birthday in 1979. See the odd children! and their antiquated school uniform! Laugh at the teachers' 70s cars, outfits and hairstyles! The undisputed highlight was the orchestra, featuring your very own Lola I and Sister D, with me wearing the biggest specciest specs you can imagine. It was the 70s! Big specs were the fashion item! I still have the massive specs in a drawer, and they are so heavy that I'm surprised my teenage ears weren't pulled completely off.

Brief update on not growing old - badminton club no. 2 have suffered an early retirement by one of their veteran ladies, and asked me very nicely if I could play in a match, so I said yes. Then I found out it was for their 1st mixed team in Division 1 of the league. It wasn't as bad as I expected; I was only made to look like an amateur by their first pair and we managed to scrape wins in the other two sets, mostly because my partner ran around like a maniac picking up everything while I fannied about near the net doing very little. Good fun.

In other news, I combined the trip to London with a bit of time with Lola II and Mr M. They took me to Southall and fed me a delicious authentic Punjabi meal, and I was supposed to help with some household jobs, but I don't remember contributing very much at all. I have a load of jobs for them to help with when they pay a return visit, and I wonder if they will manage to get away with doing as little as I did?

Friday, 31 October 2014

Transition and technology

Blue thistles
Vounaki, Greece, June 2014
I went to a study day last week, which has sent me into a spin. It was great, it was really interesting, there were loads of new ideas and people sharing their experience, and ever since coming back I have been vacillating between wanting to change the world, and wanting to keep my head down and just do my job.

In my previous career, I reached some people of influence, and feel that I made a bit of a difference in their thinking. That was on a few special occasions. The majority of the time I felt very much as though I was beating my forehead against a very solid brick wall. Not so much because of external resistance (although the resistance is always there), but because my own approach often missed the doorway, hence the brick wall. If I could only have found the way in, maybe I could have made more of a difference than I did.

It is a reflection of my own self-knowledge of what I am good at, and much more importantly, what I am not so good at. I am very good at remembering. I can do analytical thought. Give me a set of principles and I will derive pathways and outcomes, and I will make them practical, realistic and achievable. I will listen very hard, and make sure that people understand what they need to understand and try to ensure they feel supported and positive as they do so. My inherent pessimism lowers expectations, and rather than assuming "this will work" I imagine "what's the worst that could happen?" and try to make everything simple and failsafe.

But I am not a salesperson. I cannot spin the truth into a persuasive argument. I cannot achieve my own ends or the greater good by manipulating the listener out of their own entrenched position. I am no politician.

An example: the parking regime where I work has changed. Parking for 30 minutes is free; up to 3 hours is £1.60, 3 to 5 hours is £4.50 and more than 5 hours is £7.00. We run a course which lasts for about 6 hours, from 9 a.m to 3 p.m. or thereabouts. If you were coming on our course, how would you pay for your parking? Would you pay £7, or could you imagine an alternative payment option? Would you be keen to get away promptly at the end, or take the opportunity to linger to get the most out of the healthcare professionals who are leading the course?

From about 11.45 a.m. all of our course participants stop paying attention to what's going on in the room, and start thinking about getting out to their cars to avoid getting parking fines, and then up they get and excuse themselves one by one. This also happens to be the most intense period of the day, when we are covering the most difficult and yet important aspect of the subject. It's the part of the course that demands the most concentration, not the least. And at the end of the day they can't wait to get away, to make sure to avoid a parking fine.

I have spoken to the hospital management about how to avoid this disruption to our course. I have not yet found a way to convince them that it would be better for patient care to allow our participants to pay an acceptable amount in some other way. They have suggested that we restructure the course to build in a break at the critical time. I have lots to cover and little enough time as it is, and giving them a 15 minute break just makes everything run late. I haven't even been able to persuade my colleagues to support me in my one-woman campaign.

Anyway, this is just an example to demonstrate that my powers of persuasion are weak and ineffectual. Attending a study day that highlights all sorts of ways that we could improve our service just makes me tired, because improvement implies change, and persuading people to change is not what I do best. Add to that the fact that I haven't even been in my current job for a year, so am not yet 100% sure what it is that we do, let alone whether we do it effectively or in the best way that we can. I am also working with experienced professionals who have been doing their jobs for a very long time indeed, which means that they are fairly sure of themselves and somewhat more resistant to the upstart pushing for change than they might be if they were young and dynamic and a little insecure.

Spotty purple flower
Peckover House, August 2014
The study day was about Transition, which is defined as a planned move from paediatric to adult services. This is a difficult time for young people with diabetes - not only are there many physical, emotional and social changes going on, but it is a time of rebellion and trying to fit in, hormones are raging, they may be changing schools, moving to university, getting a job for the first time, leaving home, having new experiences including sex, drugs, alcohol, tattoos, piercings, gigs and music festivals. Where does long term management of a chronic disease fit in? What is the role of the parent in managing or giving up control of blood glucose monitoring and insulin administration, and who is in charge - the adolescent or the parent? And what about leaving behind healthcare professionals you may have known all your life to attend appointments with a brand new team of complete strangers?

Let me be clear. I have no idea whether we run transition well or not in our service. I know that one of the Diabetes Specialist Nurses attends a transition clinic over at the main hospital, but I don't really know what goes on; I am not involved in any way. So should I be involved? One of the speakers made the valid point that those who are diagnosed as children may actually have a poor knowledge of their condition because most of the education and help was aimed at their parents. They may be going through a pretty tough time as adolescents, and are not likely to want to attract a whole lot of attention to a health condition that is difficult to manage at the best of times. So if we aren't helping them through this and we could be doing better, then surely we should try harder?

And then, I think, why don't I just do my job and keep quiet? Nobody will thank me for getting involved, I don't really know what I'm talking about, I don't even have two years of experience in diabetes and know virtually nothing about paediatric care.

As well as the technical aspects of the transition service, the day also covered a new approach to insulin dosage for Type 1 Diabetes based not only on counting grams of carbohydrate but also fat and protein. We heard about a project in Scotland which has developed some really interesting and useful materials for use in transition clinics. There was also a focus at this study day on the world of young people and the use of social media in the management of diabetes.

This social media and technology that young people are so comfortable with - well, the building where I work doesn't have wi-fi cover. We don't even have a mobile phone signal to speak of, and I don't have a work mobile phone. Our computers are so old that the operating system is no longer supported by Microsoft, and locked down so tightly that many useful websites either fail to display properly, or we are simply prevented from accessing them. The idea of using Skype or Facebook or Twitter or even text messages to improve the service we provide is laughable.

We were told that Pinterest and Instagram are the rage, Facebook is a bit old but Twitter can be quite useful. On the back of this, I have now set up a Twitter account and 'followed' a very select few diabetes-related people and organisations, but so far it has matched my expectations (which were very low). I haven't learned anything useful or gained insight into the lives of people with diabetes, but it's early days and I'm not even sure I understand what it's all about yet. And of course I can't do anything with it at work - it's blocked on the PC, and there's no mobile phone signal so I can't access it on my phone.

One of the diabetes consultants has been identified as an Innovation Champion for the Trust. That is the obvious place to start, talking to this doctor about what might be possible, realistic or necessary. But I am still in two minds. Perhaps I should just keep quiet and do my job.

Two colourful flowers
Temperate House, Leamington Spa, October 2014

Sunday, 26 October 2014

Kwells are my friends

On the ground waiting to launch
September 2014
In case you weren't aware, and why should you be, 'Kwells' is the brand name for hyoscine hydrobromide, also known as scopolamine, and a remedy for motion sickness. And what's more, from my limited experience (one dose), it appears to work. After the unexpected but debilitating nausea I experienced during my first glider flight, I crowd-sourced suggestions via Facebook and was advised of the Kwells option. I don't much like taking medicines, but rather than endure prolonged nausea or forego a free flight, I decided to give it a go.

On my first visit to the gliding club with Lola II and Mr M, we were very much the honoured guests. We weren't made to do any work, we could sit around in the clubhouse or outside, enjoying the warm day and chatting to various people who wandered past and introduced themselves. This time, I was advised that I really should turn up at the start of the day and put my name on the list to fly and attend the morning briefing. So that's what I did.

Getting there at 9.30 I was among the last to arrive - many had already been there for more than an hour. They set up the airfield layout (which depends on the wind direction), sited the winch half a mile away across the field, got the planes out and checked them over, and probably did a load more things I'm not aware of. I was wearing trainers and it was strongly suggested that I'd need more waterproof shoes, so after the briefing I nipped home and changed.

I understood about half of the briefing - the bits where people volunteered for jobs and verified that they'd done the necessary checks and visitors were introduced and specific requests were made for assistance and people were asked to pay fees they owed. The technical stuff went right over my head - weather and wind forecasts and likely thermal activity and some more information that I have no idea about.

I was looked after by Phil, who is a most congenial character, and didn't hesitate to share the most scurrilous gossip about other club members. Like why the catering we had enjoyed at my last visit had changed to basic self-service - it was because of an argument about cake (yes, really) but nobody liked the member who had made all the fuss so nobody minded that the committee had judged him to be at fault, and his wife had withdrawn her catering services in a huff.

I was the only woman there except for a lady in the office who didn't seem about to do any flying. All of the members were extremely welcoming, and told me all sorts of stories at the drop of a hat. Some of them were decidedly peculiar (the people not the stories), but I'd rather feel welcome in the midst of some peculiar people than be ignored (cf. local Diabetes UK group). I found out a great deal about the technicalities of flying, including the advantages and pitfalls of using a winch for launching, a bit about how people are taught to fly, how instructors are trained, how the cables for launch used to be steel and are now synthetic, what can happen if the cable breaks during launch, and some safety procedures. I also found out a great deal about the personal lives of some of the members, local politics on motorised gliders, and how to acquire a large amount of wood for a Guy Fawkes bonfire.

When it was my turn to fly, Phil did a quick recap of the instrument panel and reminded me how to bail out, and we were off. The launch was as quick and violent as I remembered, and my stomach lurched ominously, but once we were up I felt fine, and was able to do a lot more this time. A couple of times Phil let me have full control, only taking control back when it was clear I was having a bit of trouble coping with the many different streams of information from the attitude of the plane to the instrumentation. As I said when we were back in the clubhouse and someone asked me how I got on: "I seemed to manage OK, and nobody died."

Conditions were not brilliant. The weather was grey, the wind was gusty, and Phil said that it was a difficult day for flying. Nobody was up for very long because there was no thermal activity at all. My first flight was ten minutes - the previous time it had been thirteen - and Phil gave me a chance to have another go but we only managed eight minutes airborne, mostly because he was letting me do a lot more of the flying that time and it takes more expertise than I possess to actually stay up for very long.

After the flying, I went down the field and had a look at the winch working, and then to the control tower (actually a computer on the top deck of a stationary double decker bus) where everyone's flights are logged. Nobody that day had flown more than 15 minutes at a time, so I didn't feel too bad about my efforts.

Although they all hoped I'd be back, I won't be returning, because there's just no time in my life for the commitment. It isn't the sort of hobby you can do in less than a day at a time, because there are a lot of jobs that need to be performed in order to allow people to fly safely, and it wouldn't be polite to turn up and expect to fly and go home again. Apart from all the setting up at the start of the day, there are at least five people needed for a launch: one to signal, one to hold the glider horizontal, one in the control tower/bus, one at the winch, and in my case, an instructor too. Someone also needs to drive the truck to bring the cable back after a launch and drive out to a glider once it's landed to tow it back to the start. Then all the kit and caboodle needs to be put away nicely at the end of a day.

It was a very interesting day, learning all about the technicalities of flying and many things I hadn't even considered before - trim, air brakes, flaps and rudders, wind speed, air speed and ground speed, waves and thermals. Maybe when I retire I'll come back to it.

View of me and the instructor

Monday, 13 October 2014

She flies like a bird...

View from the cockpit
Gliding, September 2014
The last two weeks have been frankly, ridiculous. I don't know why everything had to happen all at once, but it did, and if I hadn't had a blog post about my reading in the pipeline last week you wouldn't have heard a peep out of me.

So, first, my glider flight. This was a birthday present from the lovely Mr M and Lola II, and replaced the one that had to be cancelled in Lincolnshire because of the high winds. Lola II and Mr M took me to a nearby airfield, and we were welcomed at the Clubhouse by all sorts of friendly people willing to share their stories while they addressed some sort of problem with the glider. There was another visitor ahead of me in the schedule, so we had to wait quite a while, but the weather was pleasant and warm and we could have a bit of a chat and watch the launching and landing procedures.

The gliders at this club are launched by a winch rather than being towed up by a plane, and it is quite spectacular to watch. In just a few seconds you go up at a 40 degree angle from zero to sixty miles an hour at 1200 feet. Barry gave me the safety talk and went through the instrument panel before I strapped on the parachute and climbed into the tiny cockpit in the front. It was all dual control, and the flight was designated a 'trial lesson' so in theory I would be given some flying to do, but Barry did ask me to keep my hands away from the controls while we took off.

So far, so good. From this point onwards, however, it didn't go so well. I was rather looking forward to the take off, as I have no problem with acceleration in normal planes or on motorbikes. Unfortunately, as we were thrown up into the air, my stomach somehow didn't go with us, and within just a few seconds after being launched I started to feel very sick. As we circled on a thermal, Barry talked a bit about what he was doing and I directed the fresh air blower into my face and tried very hard to think about something other than the nausea.

The scenery was pleasant but the sensation was not. Barry let me have a go at driving for a second or two, but very soon it was time to land, and to be honest, I wasn't sorry. With nowhere to throw up except on my own lap, I was really glad to have avoided that outcome. Barry marked up my log book - we had been in the air for 13 minutes, although it felt much longer. Lola II was ready to protest at the short duration of the experience, but I reassured her that it was fine, and please don't make me go up again...

I couldn't eat anything for the rest of the day. Advice via Facebook and from friends suggests I could have a go at using the very effective motion sickness treatments available over the counter, because the package includes a second flight within two months. We'll see.

Then the two weeks of mayhem started. Within these two weeks: I went to the Diabetes Education Club at Warwick University, where my colleagues gave a talk to a group of interested health professionals (Doctors, GPs, Nurses in GP practices and Dietitians) about the very low carb diet options that we offer patients; I spent two days in London being trained as a DESMOND educator; my oldest friends from school came to visit; I participated in a public meeting organised by the local Clinical Commissioning Group and Diabetes UK to consult service users about what they want from their Diabetes Services; I went to a comedy gig to see Marcus Brigstocke at Warwick Arts Centre; I attended a branch meeting of the West Midlands British Dietetic Association all about the gastrointestinal tract and various disorders that can arise; another friend came to stay before going to a show at the NEC up the road; I have played in a badminton match (we won!); I have been to see a film and done two runs of about 30 minutes each. I have also renewed the car insurance, and been to the optician. The car has also celebrated the milestone of reaching 200,000 miles by starting to act a bit flaky if it's left without being used for a day or two.

All of these things were worthwhile, satisfying and mostly enjoyable (except for renewing the car insurance, which is one of the most painful and frustrating tasks in the whole world). The one I was looking forward to the most was the optician, and over the next week or two I shall be trying out different contact lenses, followed by receiving my new, varifocal glasses. As an indicator of advancing age this step is unwelcome, but in terms of being able to read comfortably again, I am looking forward to it immensely.

Another view from the cockpit

Sunday, 5 October 2014

What I've been reading

Image of the book cover

South Riding
by Winifred Holtby

narrated by Carole Boyd
"In this rich and memorable evocation of the fictional South Riding of Yorkshire are the lives, loves and sorrows of the central characters. They are the people who work together in the council chambers and backrooms of local politics. Alongside them, however, are the people affected by their decisions."
A long book, narrated beautifully, although Ms Boyd declines to use the suggested accents for the character known as 'Geordie' and one who's clearly Scottish. This is set in the 1930's and I've been reading it at the same time as Middlemarch, which is set in the 1830's, so some nice comparisons and clear changes in social mores during the intervening century, especially around gender roles and marriage.


Image of the book cover

Middlemarch
by George Eliot
"Named for the fictional community in which it is set, Middlemarch is a rich and teeming portrait of provincial life in Victorian England. In it, a panoply of complicated characters attempt to carry out their destinies against the various social expectations that accompany their classes and genders."
Oh my goodness this seemed to go on for ever. I think it was originally published as a series of books, and it did improve in terms of provoking interest as I progressed, but it also became a bit depressing towards the end. As a work of social history it provided much food for thought, and an interesting contrast with South Riding. I'm never going near it again, though.


Image of the book cover

The Corinthian
by Georgette Heyer

narrated by Georgina Sutton
"The accomplished Corinthian Sir Richard Wyndham is wealthy, sophisticated, handsome, and supremely bored. Tired of his aristocratic family constantly pressuring him to get married, he determines to run away after meeting the delightful, unconventional heroine Penelope Creed."
She writes such delightful heroines - ingenious and ingenuous, sparky and witty, and the heroes aren't bad either. For my taste, there isn't much leisure reading that can beat Georgette Heyer, but I'm sure my taste differs from other people's. I can relax while reading knowing that I am in safe hands, and that despite tribulations and an eventful journey, all will end as it should for the hero and heroine as well as the villains.


Image of book cover

Nature via Nurture
by Matt Ridley
"Nature via Nurture chronicles a new revolution in our understanding of genes. Ridley recounts the hundred years' war between the partisans of nature and nurture to explain how this paradoxical creature, the human being, can be simultaneously free-willed and motivated by instinct and culture. "
A previous book by this author, Genome, is one of the best books I've read, and covers the basics of genetics and inheritance clearly and concisely in a highly readable way. This one is much more difficult to read and understand. It delves into the nature/nurture debate and shows that the relationship is circular: genes both affect and are affected by both nature and nurture. For me it reinforces the influence that environment has on the expression of genes, and reminds us that it is no longer believed that genes are immutable. While the DNA code does not change through an individuals lifetime, genes are continually being switched on and off in response to environmental cues as well as the physiological environment of the cell. 'Gene encodes protein' is just the starting point of the impossibly complicated dance within every cell in our bodies.

Sunday, 28 September 2014

Recent events

Deckchairs lined up in the snow with blue skies
Les Deux Alpes, March 2014
Having caught up with events from a month or two ago, it's time to return to the more recent past. A quick summary:
  • I went to the Food and Drink Festival
  • Two tradesmen have provided quotes
  • Domestic appliances continue to cause trouble
  • The hall is showing signs of water leakage at gutter level
  • My mobile phone had a fit in the night
  • The Tuesday community diabetes clinics are interesting
  • I attended a presentation given by a colleague
  • I attended a public meeting and had to do some facilitation
  • The second patient education course that I'm delivering has started
  • I had to prepare for an upcoming course
  • I had a 'trial lesson' in a glider.
The Royal Leamington Spa Food and Drink Festival was lovely, the weather was fine and warm and reports in the paper suggest there were 25,000 visitors. I can believe it; there were certainly crowds. I bought some lime pickle and chose a South African lamb curry for lunch on Saturday, and Caribbean jerk chicken with rice and peas on Sunday.

Tradesman report: The fourth carpenter I contacted actually came to see the airing cupboard, and has even followed up with a quote. I would ideally like to get a second opinion, which means finding a fifth carpenter. I am not optimistic, but I have another two phone numbers. The electrician has provided a quote for replacing the fuse box; the oven is working well on its fan setting after its repair, but the grill has now stopped working - I will do some research before calling in a repairman this time. And there is staining on the newly painted hall walls that suggest the guttering or leading might be leaking - this is a job for Alf. Lots to do in the house, as always. I won't even mention the garden, it is too distressing.

We had a disturbed night when, for no apparent reason, my mobile phone started to reboot itself over and over again at about 3 a.m. The battery is built in and can't be removed, so I took the phone downstairs and attempted to put the SIM card into a different phone. What with being half asleep I managed to lose the SIM completely, leaving me phoneless. Then there was the faff of having to find an alternative method of setting the morning alarm, and finding a way to take the phone into a shop to sort it out. It turns out that EE had made a mess of an automatic software update, so I met several other people in the shop with the same problem. It's fine now, and only cost a few hours sleep and a trip into town.

The main work news concerns the reason that I have now been employed on Tuesdays - the Clinical Commissioning Group in the area, which is responsible for making sure that all health services are available as necessary, has stumped up some money in order to try and address the backlog of patients waiting for their structured education on Type 2 Diabetes (called DESMOND). I will be trained to deliver this training next week, and have received the pack which requires me to observe a course before I do the training myself. There are none in the area to observe in the time available, so they have sent me three DVDs to watch, and some academic papers to read as well as some written homework.

My Tuesdays are now planned out until December, with community clinics to cover for a colleague who is on holiday and then to allow her to do some home visits, and then four DESMOND courses have been scheduled. The community clinics are very similar to my hospital ones, but there are a few different options around the edges for referral to local activity programmes and weight management groups. The biggest challenges were getting me physical access to the building, and electronic access to the computer systems. I still don't have a code to allow me to print, but when I do I will have access to the biggest fanciest printer/copier in the world.

My colleague's presentation was about the lower carbohydrate diets that we are facilitating for people with diabetes who want to lose weight, and she was very good. The public meeting was the first of two where Diabetes UK and the Clinical Commissioning Group have invited people with diabetes to respond to proposals for change to their services. There are various eminent personages who introduce themselves, then facilitated groups to provide the attendees' views about what they like and don't like about diabetes services, and then a panel of experts to answer specific questions. This time I was asked to facilitate the discussion on one table; next time I am on the panel of experts. It will be daunting. The first question to the panel this time was about the quality of hospital food, and there are no easy answers to that one.

The second course for people with Type 1 Diabetes has gone quite well. The team is very relaxed about my contribution, but I feel that I need a bit more rigour in my approach. This may be achieved by going on the DESMOND course - I have watched the DVDs, all six hours of them, and done my homework too. I believe that I will need to do lesson plans, and peer review, and will have to prove that I am competent before being let loose on real people. I'm hoping to follow the same process to improve my delivery of the the Type 1 education, but we'll see.

You'll have to wait for the account of my flight in the glider, and it may be a while. Next week is packed with extra-curricular events including the trip to London for the DESMOND training.

Wednesday, 17 September 2014

Wedding Presence - Part 2

Lolas on Trinity Bridge, Crowland, August 2014

Day 2


The first thing to happen on Day 2 was the bleep of a text message to Lola II, telling her that the glider flight had to be cancelled because of high winds. The flight couldn't be rearranged within the time available, so we had to abandon that plan, and after a breakfast of porridge we went to Kings Lynn instead.
Learning Point 5: Lynn Regis is very attractive and houses are very cheap (if you come from London). e.g. a 2 bed house for £86,000 ... and yes, by Lynn Regis I mean Kings Lynn but the old name is in my opinion much better.
Lolas I and II viewed through an archway
Learning Point 6: Shops and streets in Lynn Regis seemed to "tell it like it is". No messing about with streets imaginatively called "Saturday Market Place" and "Tuesday Market Place" and shops called "The Flower Shop", "The Tile Shop" and "High Street Hairdressers".
I think we all liked Kings Lynn, even though it wasn't very busy because of the fairly cold and windy day. The town is beautiful and has a good number of old and historic buildings, some dating back to the time when it was an important Hanseatic port, trading with Germany and Baltic states. We followed a walking trail around town, but the highlight was definitely a detour into a Polish shop where we discovered curd cheese ice creams
Learning Point 7: Frozen Cream Cheese makes a wonderful snack and can be found in Eastern European supermarkets across Lynn Regis (though not in London it appears).
Lunch was in an establishment that was quite posh, but Mr M's starter of beignets was still frozen in the middle, and no response was forthcoming from the kitchen when we mentioned it. I can't complain about my roast dinner, and Lola II's meat platter looked lovely, but they didn't get a tip. We walked about some more, and discovered that Captain Vancouver came from Kings Lynn and went on to have a bit of Canada named after him. Tea was in a converted warehouse, but more disappointment - there was no chocolate cake left, nor chocolate biscuits. Kings Lynn - you let us down. Although you partly made up for it by supplying those fantastic Polish ice creams.

Real bandstand and three drawings
Bandstand in The Walks park, Kings Lynn, August 2014
We did find a lovely park to walk through in the afternoon, with a bandstand and a band playing. The weather was just warm enough for us to sit down to listen, and Mr M distributed cards and pens, requiring each of us to draw a picture of the bandstand. The results are here, and I have blurred the respective authors' signatures. What do you think? Can you guess the respective artists?

Last noteworthy event of the day was the toast. Mr M had discovered a contraption designed to allow toast to be made on a camp stove, and was determined to try it. On the first day we had no bread, but now it received its maiden flight, and was a dismal failure. The bread warmed, and the toasting contraption went a lovely colour as hot metal things do, but we couldn't call it toast. Ever resourceful, Mr M 'adapted' it to remove much of the heat protection, and it operated much more successfully. My personal view is that camping is a time when we are relieved of the duties of toasting and frying, in the same way as we are unable to watch TV or sit in an armchair. Raw food and boiling will do for me. But respect for the effort.

Mr M also has quite a passion for wild food. He returned from a short walk with plums and blackberries that he had foraged.

Day 3


After having spent a couple of days in towns, we thought to make a change we would either do a walk or visit a garden. Walking was problematic - we hadn't brought maps, and anyway you may remember that the terrain was incredibly flat. Not a hummock in sight, let alone a hill or a cliff or even a slope. Walking would be easy, but views would be mainly sky, and the coastline was not reported to be very interesting. We could see lots of sky from wherever we happened to go, so we settled on a garden, and chose Peckover House, which turned out to be in Wisbech.

The house and garden do not open in the morning, so we stopped off in the town to buy provisions for a picnic lunch, and happened to come across an old-fashioned butcher's shop, with classic tiling and glass-fronted cabinets, selling all manner of cooked meat products as well as the raw stuff. Haslet, faggots, pies and cooked joints were on display and the butchers were most helpful in cutting each choice into three so it could be shared later. It was all delicious. Definitely a highlight of the trip.
Learning Point 8: There is a wonderful butchers in Wisbech on the Market Square (G W Frank) and we thoroughly recommend their local dishes (which I have forgotten the name of already).
The garden was beautiful, and the house interesting - from the Regency period with lots of relevant information inside as well as artefacts. It had been used as a bank when the owner's business extended into banking before reverting back to a family home. There was a very chatty attendant in one of the main rooms who showed us how one of the four curved doors in each (rounded) corner of the room was purely for decorative purposes, as the house had squared-off corners and behind the door was a small space between the square, brick, exterior shell and the curved interior wall.

The house and garden had been donated to the National Trust when its last occupant died, but the entire house contents had been auctioned off at the time, so it has been re-furnished with some original period items and some replica pieces. They had done quite a good job, but seeing an item and knowing it wasn't the one that had originally stood there was a bit of a shame.

Close up of centre of pink flower

After the obligatory tea and cake, we stopped off in a local pub for a drink before letting Mr M out of the car - his eagle eyes had spotted some more roadside blackberries, so he was up for some more foraging. He returned to the campsite in time for a pasta dinner followed by jelly and custard.
Learning Point 9: While picking blackberries, a lot of people seem to pull off the A17 at the road to Gedney Broadgate and wait for other people to pull in and then hand things over to them before driving off.
Our breakfasts included porridge & prunes, baked beans & meatballs (different breakfasts) and a dodgy attempt to make toast that resulted in, as far as I’m concerned, dry bread and a wasted gas canister. Our other dinner was pasta, tomato and cheese with obligatory olives, since I forgot to put them in the Moroccan chicken. Dessert that night was sugar-free jelly and custard, Lola I’s contribution to the gourmet adventure. She is clearly a classy camper with creative choices.
The campsite was fairly empty, but there was still a small party of three women, who had noticed that my tent was festooned with labels indicating that it had been at Cambridge Folk Festival several times. They invited us over to their spot for social singing, and they had even requisitioned wood and a fire pit to sit around. There was very little singing, but they were congenial company - two Scots and one originally Dutch but resident in Scotland. I heard the full story about Lola II's music group and the original composition they commissioned from a real life composer. It's worth a blog post of its own, you'll have to ask her.

Day 4


Last day, and we treated ourselves to a cooked breakfast at a cafe, then set off for Spalding to see whether there are any bulk flower outlets - there weren't. We wandered about a bit, found some more Polish cheese ice creams, eventually reaching the river and walking through some local gardens that had an sign warning of restrictions on anti-social behaviour in three languages. We thought about taking a trip on the river boat or watching a film, but the timings didn't work out.

Then we thought it would be nice to find a country pub for lunch, but because of the big breakfasts and the morning snacks we weren't that hungry. While we were discussing the situation by the river, one of the river boats arrived to let off its passengers, and I thought I'd ask the captain for a recommendation, and he gave us some directions out of town. He also argued (incorrectly) that jam and marmalade do constitute one portion of our 5-a-day, so I have lost all faith in Captains' knowledge of healthy eating. As I write this, I wonder why I ever thought they had any?
Learning Point 10: The river trip boat captain in Spalding is very knowledgeable and confirmed to Lola I that marmalade does count as a portion of fruit and veg. On the basis of this sound advice, we took his recommendation on where to eat. And got lost.
Yellow roses in front of the Abbey tower
Crowland Abbey, August 2014
We headed off in the vague direction indicated by the idiot Captain, found no country pub but ended up in a village called Crowland, which happens to have the remains of a very large abbey. We were welcomed inside by Arthur, who introduced himself as a volunteer guide, and showed us around both inside and outside the abbey. 
Learning Point 11: It can be quite good getting lost as this meant we discovered the wonderful village of Crowland which has an Abbey (part in ruins), a lovely tea shop and, best of all, the remains of a bridge with three walkways which meet in the middle. This bridge was over the junction of two rivers which have now dried up or now run underground. Strangely, they have a small alley/street called "Thames Tunnel" and it is very cheap (2 bed flat £78,000).
Crowland (or Croyland) Abbey was founded in 701 in memory of St Guthlac, a monk who became a hermit - in those days the Fens were more watery, and Crowland was an island. Although much water was drained from the Fens, in the 14th century there were still rivers through the town where now there are none. For this reason, the marvellous three-way Trinity Bridge now stands on dry land near the main road junction in the middle of town. It was one of the best features of the town, on a par with the lovely tea shop where we eventually had lunch before heading off in different directions to go home.

The last word goes to Lola II:
I love camping.
Mr M and Lola II sitting with their stove outside their tent

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)