Wednesday, 29 February 2012

What I've been reading

Image of the book cover

Titus Alone
by Mervyn Peake

"Titus has set out from Gormenghast castle on his own, attempting to escape the monotonous rituals of his home, and ends up stranded in a big, bustling city. Now Titus, the deserter, the traitor, longs for his home, and looks to prove, if only to himself, that Gormenghast is truly real."
This guy really likes his adjectives, lots of them, and the more vivid and obscure the better. Having said that, I looked up 'scorbutic' and found that it means 'affected by scurvy', which perhaps I should have been able to work out. On the other hand, 'empyrean' is a word I doubt that I will need again ('heavens, sky, the apparent surface of the imaginary sphere on which celestial bodies appear to be projected'). An interesting trilogy, but too wordy and obscure for me. I can see the appeal to its admirers, though.

Image of the book cover

The Man of Property
by John Galsworthy

"London of the 1880s: The Forsyte family is gathered - gloves, waistcoats, feathers and frocks - to celebrate the engagement of young June Forstye to an architect, Philip Bosinney. Amongst those present are Soames Forsyte and his beautiful wife Irene - his most prized possession. "
This is astonishingly good considering it was written in the early 20th century, a period which I often find results in books that seem much more than a hundred years in the past. Behaviour is described exactly and precisely without being spelled out; the Forsyte family is almost mocked for its characteristics, some of which I recognise in my own family and others I know. Having seen the TV adaptation, it was also interesting to find that the source material is so much more economical with the story: where TV needed to act out a whole scene, Galsworthy summarises the entire episode in a sentence thus: "The morning after a certain night on which Soames at last asserted his rights and acted like a man, he breakfasted alone." There are nine books altogether in the Forsyte saga, and you can be assured that I will be reading them all.

Image of the book cover

Dark Matter
by Michelle Paver

narrated by Jeremy Northam
"January 1937. Jack Miller has just about run out of options. His shoes have worn through, he can't afford to heat his room, and he longs to use his training as a specialist wireless operator instead of working in his dead-end job. When he is given the chance to join an arctic expedition, as communications expert, by a group of elite Oxbridge graduates, he brushes off his apprehensions and convinces himself to join them."
A stab in the dark, this one, just on the basis of the description, gushing reader reviews, and because I was all out of audio books. Not bad, but not great, no arc to the narrative really, just one long description of being in the arctic after a short introduction in pre-war London, with a short post-script to tie up all the ends. It wasn't even scary. I didn't like it anywhere near as much as the reviewers did.

Monday, 27 February 2012

Training continues

Walk in the New Forest, Feb 2012
The job is so much better than my student clinical placements; I am hugely relieved. My dietetic colleagues are universally pleasant and helpful, and I am starting to become familiar with some of the staff on 'my' wards.

Most of the Dietitians don't wear uniforms, which is a shame, because I found the tunic pockets really useful. Some of the renal Dietitians wear a uniform, but it is a purple polo shirt and has no useful pockets. Uniforms that other professionals wear are really helpful in identification of the various species. Nurses are various shades of blue depending on seniority and specialism, Healthcare Assistants are burgundy, Ward Hostesses (the food service staff) are black, Physiotherapists are white with blue trim, Occupational Therapists are white with green trim. The most striking are the Speech and Language Therapists who wear bright crimson shirts, as vivid a red as you can imagine. It is a scary colour, and I can't imagine why they chose it. Doctors don't wear white coats any more (infection risk) but sometimes wear stethoscopes and harried expressions, and say things like "It's half past two, I've been working since seven thirty this morning and I haven't yet had a break." We all defer to the Doctors. They are the omnipotent rulers of the wards.

My patients are mostly uncommunicative. On the stroke ward they are usually either unconscious or have lost the ability to speak, understand speech or express themselves (dysphasia/aphasia). On the elderly ward they are often asleep, dysphasic, have dementia, or all three. One day I was delighted to be able to speak to two patients; by the time I visited the ward again one had already been discharged. I get the feeling that if they can talk, then the nurses can sort them out without the help of a Dietitian. This is a shame, because I would like to have a bit more interaction with the patients, but there's plenty of time for that once I've mastered this first stage of my professional life. I sat in on an outpatient clinic to see how things worked, and there was plenty of interaction between the patients and the senior Dietitian I was observing which went waaaay beyond the scope of my limited abilities.

There are many computer systems in use, including standard packages like Outlook for email, and specialised ones for clinical results like blood tests, x-rays and scans. I have done some small online training packages in order to be given access to other systems, but I had to attend a proper IT training session for half a day on something called iPM. About ten minutes of it was relevant, but I am now fully trained and authorised to operate the tracking system to request and log receipt of archived patient notes from off-site storage. This is a task that I will definitely, absolutely, never undertake. My second session of iPM training was shorter (it was one-to-one), and only took 40 minutes of which about 5 minutes was relevant, but I can show you the screen that will give you a list of patients that are expected to be treated on a day-care basis on a ward. Again, I will definitely, absolutely never need it again.

I've also had the first part of the training that will help us to supervise the Dietetic students we will be hosting on their placements. The B placement students have actually arrived in the department, but with me being so new I won't have to supervise them until later in their placement. The training was at the University associated with the hospital, and was very interesting. The first day was primarily about setting the scene and understanding the way that placements operate in this 'cluster', which is slightly different from the one where I studied. It was a welcome break from the unremitting pressure of patients on wards, as well as a chance to meet and share experiences with some other new Dietitians who are in a similar position to me. The second day of this training is this week.

In between writing and publishing this, I have had a lovely weekend with Lola II, which is why this post is late. It was actually ready on Saturday, but I was too busy cleaning the house to remember to click 'Publish'...

Wednesday, 22 February 2012

Replacing a windscreen - in pictures

Mr B's 'workshop', 2012
Last time we went to see Mr A's parents, I took my clarinet and his dad accompanied me on the piano. We both enjoyed it, and he was keen to do it again, plus Mr A's mum isn't too well, Mr A Snr is having to cope with that on his own, and they really enjoy going out for lunch. So we planned to visit again this weekend, combining the trip with seeing Mr A's sister and some other friends as well.

The first job was to pick up Mr A's sister, and then the three of us made our way to the next stop, where Mr A's dad and I produced our best efforts with Bach's Air on a G String and the slow movement of Mozart's Clarinet Concerto. We need some easier, shorter pieces than the Mozart, more like the Bach. Off to lunch, very tasty, then back to Mr A's sister's to drop her off and onwards to Mr B's windscreen workshop. My car windscreen recently received another hit from a flying stone, so along with the small crack and the huge star-shaped crater, there was a new crack that's been growing fr three weeks in a way that would have been imprudent to ignore.

Mr B has featured in my previous blog - he was the friend who arranged for Mr A to go with him on a charity rally from Plymouth to Dakar, meeting a group of random strangers on the way who have now become firm friends. I was quite interested in seeing the whole windscreen replacement operation, simply because I like finding out about things that are new to me. I tried to take a photo of the crack in the windscreen, but the lighting conditions were not suitable and my photographic skills were not up to it, so you'll just have to believe me that it was a big one.

I also tried to take a photo of Mr B's workshop, which is very large, and entirely filled with junk except for a space just large enough to accommodate a car whose windscreen needs replacing. The photo at the top doesn't do it justice, because it's impossible to stand far enough away to give a proper sense of how much stuff there is piled up in there. I know a few people who are reluctant to throw things away, but Mr B beats them all. Mr A gave Mr B an old car for parts or scrap in 1992, and twenty years later it's still buried in that workshop, covered with junk inside and out.

Anyway, back to the windscreen replacement. After taking off the windscreen wipers, all the plastic pieces that sit at the base of the windscreen, and the rubber seals around the sides, the next stage was to detach the existing screen by cutting through the bead holding it to the metal frame. Mr B had a special knife attachment that he could run around the screen, but the corners were a bit tricky, so he fed a sharp profiled wire through the gap made with the knife, and sawed away using that. Eventually the old windscreen could be removed, and the remaining bead material cut away. I was surprised at how much time and effort it took to get the old screen off.

The edge of the new screen and the frame were de-greased and primed, and then Mr B laid a new bead on the new screen with a very nice triangular profile, just like icing a cake. Together, he and Mr A gently placed the screen in the hole, adjusted it so it was exactly central, and that was it - no need for pressure or time to cure, the bead just solidifies over time and you can drive about while it does. The plastics at the base of the screen hold it in place. That part of the operation is surprisingly quick.

So then it was just a case of putting all the bits back on in the right order, saying thank you very much, and then going back to the B's for supper and chat. On Sunday we all went for a walk in the lovely New Forest, lunch and then home. Before you knew it, the weekend was over and I had to go back to work.

Sunday, 19 February 2012

Working life

Deserted hospital corridor stretching into the distance
Hospital corridor, 2012
The week ended well, even though I made the slight error of seeing my last patient in a ward that didn't have a clock, so I was late home on Friday. Then straight out for another badminton match, which we won. This full time work lark really leaves no time for much else, especially because this weekend we went south for visits to family and friends (I shall blog about that trip in due course). There is just NOT ENOUGH TIME.

As promised, however, here's some dietetic news, although it's still all about admin because I'm not risking writing about patients except in the most general terms. Believe me, I'm spending a lot of time seeing patients on wards as well as all this other stuff. I'll probably describe the job in more detail at some point.

Despite claiming to have finished all the necessary shopping for clothes, I had to do a bit more. This was because of the 'bare below elbows' rule on the wards, which is supposed to facilitate hand-washing and reduce risk of hospital-acquired infection. So now I've got a few more short-sleeved tops, and a serious problem with static when walking about the corridors. I now have the list of ingredients of the alcohol rub, but no answer from the Infection Prevention and Control department telling me what I should do about the fact that it contains one of the allergens that I react to.

My workplace is a brand new hospital built with the aid of PFI (Private Finance Initiative) money, whereby the capital funding to build the hospital came from the private sector. This means that there are some very hard-nosed commercial aspects to the infrastructure, like parking. Both patients and staff have to pay to park, and there is a waiting list for staff permits that is ranked by need and priority - on-call and night-shift staff along with people with disabilities are much more likely to get permits than perfectly fit Allied Health Professionals who work from 8.30 to 4.30 Monday to Friday. I haven't even bothered to apply for a permit, and I drive for about 25 minutes to a nearby housing estate, park there, and walk for about 15 minutes to the hospital.

This new hospital was built on the same site as the old one, which had a poor reputation in the city. With the new build it acquired a very clunky and long-winded new name, presumably in the hope that it would have the 'Sellafield effect' (when the nuclear reprocessing plant at Windscale acquired a new name in the hope that it would no longer be associated with safety concerns). I have no idea whether this worked, since I hardly know anyone who has needed treatment there except for our neighbours over the road who are going to have their baby there. I visited the old hospital only once, to play a badminton match in a gym with a ridiculously low ceiling.

Since my working day starts at 8.30 a.m., it should be possible to leave home around 7.45 a.m. Unfortunately, that pitches me into the heaviest traffic, so I leave half an hour earlier and spend the time in the hospital library catching up with my online life - emails and blogs and Facebook. I'd rather do that than get up a bit later but spend an extra 20 minutes in traffic. My actual job comprises 80% ward work, one half-day outpatient clinic and a bit of time for admin and professional development. I have been allocated to four wards: stroke, elderly medicine, and two others. Pretty much everything I do is about 'nutrition support' - helping people who can't eat or don't want to eat - through the use of modified menus, snacks, nutritional supplements and tube feeding.

That's all I've got time for at the moment - back to work tomorrow, badminton, work, and then maybe time for a bit more blogging. I'm hoping to put together a picture story similar to the 'Camping holiday - in pictures' post, but covering (among other things) the replacement of the car windscreen on our trip south. Watch this space...

Thursday, 16 February 2012

This new blog

A pier and boats on the sea with a pinky blue sunset sky
Sunset in Italy, 2006
Doesn't work take up a lot of TIME? Mr A has thankfully taken over the home catering during the week, but of course I'm not prepared to give up any badminton, so on at least two days a week (three days this week because I've been asked to play in a match) I've only had about an hour to do everything that isn't work or badminton, and my online life is being neglected slightly. Clearly, my aim to post every three days is a little ambitious.

I thought I'd share my excitement at having set up this new blog with its all-new design. I love it! Not that the other blog design was bad, but it remained essentially the same over nearly five years, and it's nice to have something a bit different.

For those who care about blogging and its arcane world, I tried to start afresh with WordPress. I've had a couple of attempts at WordPress websites, including the badminton club site which I think is quite smart and has brought us one or two new members. But Blogger won the day for my personal blogging, mainly because of the control it gives me over fonts and layout, which just weren't accessible in WordPress unless you are properly competent with HTML coding and layout using CSS, not an amateur like me.

The only downside of this template is that I couldn't quite manage to use my own background image, although I think if I had tried a bit longer I could probably have worked it out. The main issue was that the resolution of my image was too high, so the file was too big when I made it the recommended size to accommodate the biggest monitors that it might be viewed on. In the time available I couldn't be bothered to mess with the image to the required extent, and I doubt that I will bother now.

That's another thing where Blogger seemed to win - the number and variety of templates and colour schemes available, and their flexibility to be adjusted to exactly what I wanted. Anyway, I hope you like it, and any comments or suggestions would be very welcome.

More dietetics coming soon...

Sunday, 12 February 2012

The first few days

A shelf of cacti and succulent plants
RHS Wisley, in the arid plants area, 2011
For the last two days last week, induction was over, and I was finally in the Dietetics Office. With the Dietitians, of whom I am one. I don't yet feel like one, but that's just how it is. I have a bit of a desk and access to two drawers, office computers, a stationery cupboard, and filing cabinets full of dietetic stuff. Most of the time I have No Idea What's Going On.

My manager is the lead Dietitian on the acute team working within the hospital. Up until this point I didn't know anything about the conditions of my job, not even whether it is temporary or permanent. That has resolved itself: I have a permanent contract for two days a week, and a temporary contract for the other three days, so I am working full time at the moment. Many people are on maternity leave, or about to be on maternity leave, so it is likely that there will be other opportunities when the temporary part runs out.

I have patients allocated to me that I have now seen, and a bleep, although its clip has fallen off so I can't attach it to me. I thought I would like to shadow one of the more experienced dietitians, not so much for the treatment side of things, more about how the hospital works - how is food arranged, how are wards organised, what systems do I need to know about. In the end, I just asked for some patients of my own, and got stuck in - I will find out how things are done as I go along.

Access to some of the computer systems is still being arranged, and I haven't yet confirmed the ingredients of hand care products via Occupational Health. My colleagues seem very nice and friendly and helpful and supportive, so that's good, and I have even managed to remember several of their names. As for the patients: so far they are mostly old, uncommunicative, and being fed through tubes. I haven't been allocated my own wards yet, but I think that will happen fairly soon.

The best thing so far: the way that annual leave is allocated over the year and the rules about taking it means that I have more than a week's holiday that has to be taken by the end of March. The worst thing so far: an acute hospital Dietitian is just what I didn't want to be. But it is a very useful starting point, and being in a large hospital department should give me some access to a wide range of dietetic settings, with plenty of learning opportunities.

Thursday, 9 February 2012


The view of trees and plants from an Italian window
View from a window, on holiday in Italy, 2006

It's never what you expect. I had three days of mandatory induction - three days! - and feel about as induced as one could possibly feel, but I didn't anticipate which would be the stand-out presentations on each day.

The format was dry as dust for two days - a lecture theatre, Powerpoint presentations, a succession of speakers given time to do their thing and then move on. Values, policies, standards, guidelines, procedures, and "just call us if you need any more information." An overview of the Trust, an introduction to the NHS Constitution, Foundation Trust status, Fire Safety, Hand Hygiene, Blood Transfusion Theory (how to get units of blood when you need them - I don't), Fraud Awareness, Health, Safety and Risk Management, Environmental Management, Child Protection, the Library, the Faith Centre, Thromboprophylaxis (national rules about venous thromboembolism risk assessment), SBAR (a communications framework), the Mental Capacity Act, Dementia Awareness, Safeguarding Vulnerable Adults, Equality and Diversity, Information Governance, ICT and clinical systems. Oh boy.

Among all these, the only ones that had any sort of audience interaction were the Health & Safety and the Equality & Diversity sessions (and the hands-on ICT of course). All the rest - all of them! - were just delivered from the front, following the Powerpoint tradition. Given that the subjects are unlikely to delight a broad (and bored) audience of new employees, I was only thankful that each session was short. Health & Safety was a relief because we were invited to participate. Equality & Diversity was a whole hour, which I thought would be a bit much, and was more than any of the other speakers got, but turned out to be the best of all.

With my background working in disability, I wasn't sure what might be new to learn. Since I left my last job, the Equality Act has not only combined all the existing discrimination legislation into one place, but introduced three new anti-discrimination categories: pregnancy and maternity, marriage and civil partnership, and transgender identity.

The last was completely new to me, and raised some very interesting and, at times, heated discussion from the room. The essence of the law is that it applies from the day that the individual makes the decision that they wish to change their gender - if on Monday morning a colleague turns up for work and requests that s/he be treated as the other gender, then from that point onwards they are protected from discrimination. They should be addressed in the appropriate way, given use of the facilities appropriate to their chosen (rather than birth) gender, and generally treated in a way that respects their choice. The point was made that it doesn't matter what we think about this, it's the law.

Not only that, it is also an offence to disclose their transgender state to anyone else. The practical example was given of a woman being placed in a bed in a women's ward but who still retains some of the physical characteristics of a man. If the other patients complain, then alongside dealing with the situation, there is the question of how they found out, and whether a member of staff had carried out an illegal act by revealing confidential information. I also learned that at some point it is permissible to apply for a certificate of gender reassignment (this might not be the official name), at which point all records relating to a past where the gender was different may be removed, and disclosure is then only required in the circumstance of Criminal Records checking. And, apparently, wishing to become a member of the priesthood.

By this point the hour was up, and I was disappointed that we had so little time! Lots of issues were raised and not resolved, but there was certainly something new there for me to think about, and not at all where I expected.

Day three was a little more hands-on, with Manual Handling, Resuscitation, and Conflict Resolution. The bleedin' obvious was reiterated in handling of objects, including how to take a trolley safely through a doorway. I didn't have to stay for the patient handling session, but I thought it would be interesting, and it was. The newest technology to help nurses are Slip Sheets - sheets of fabric with one ordinary and one extremely slippery side. The sheets are placed in various orientations to allow patients to be moved where previously they had to be lifted using potentially back-threatening movements, e.g. patients are now moved from one bed to another by sliding rather than lifting. These sheets can be used in all sorts of circumstances, from moving a patient up a bed, helping them stand, sit and rotate into bed, and reduce the likelihood of damage to fragile skin by eliminating friction between the body and the bed (or other) surface. A great step forward.

The Resuscitation session found me and five nurses (all the other inductees in clinical roles were nurses except a few doctors, me, and one radiologist) taking turns to initiate CPR (calling for crash team/cart), doing chest compressions, squeezing the ventilating air bag thing (no mouth-to-mouth any more), and using the defibrillator. I was very surprised that even the nurses with years of experience behind them had never used the defibrillator or taken any sort of lead in resuscitation - they said that in the past, it was always the job of a doctor. It seems that in this Trust, it is thought worthwhile to start CPR before the doctors and the crash team arrive, which seems eminently sensible. I still hope that I don't have a patient going into cardiac arrest in front of me, despite the training.

I anticipated that Conflict Resolution would give us some tools to deal with conflict, stop a situation escalating into violence, that sort of thing. In fact, the session would more accurately have been called Conflict Identification And Communication Tools Theory, and the final part was focussed on contradicting the general view that we're not allowed to hit patients. The trainer assured us that we were definitely allowed to hit patients, or anyone else who is threatening us to the extent that we fear that we will be hurt. I don't think I'd have the courage to hit anyone in anger, but I suppose it's nice to know that I can.

Monday, 6 February 2012

A new beginning

Here we are at the start of the life of Dietitian Lola. There will be laughter, sadness, a soft diet and plenty of fibre. Thank you for joining me!
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