Thursday, 27 September 2012

In the respiration chamber

Nurse A showing me around
Intro by Nurse A

A few weeks ago, you may remember that I was measured in the BodPod in advance of taking part in some medical research. Today is the first day I spend in the 'respiration' chamber, a small room containing a flip-up bed, table complete with computer and phone (internal calls only), sink and toilet. I have intercom access to the outside world (well, to Nurse A) and to the next door cell, which happens to be occupied by a Dietitian colleague from the obesity service, who has also contributed to the research by formulating the menu. Before we were imprisoned, she said that she didn't even like the food on the menu that she herself had created.

The research is concerned with inflammation, measured through inflammatory markers in the blood - at least, I am assuming that is why I will have blood taken five or six times a day, via a cannula. I have never had a cannula before, and I don't much like it. But that is not the worst thing so far.

The worst thing so far is that I am very, very hungry. Somewhat ironically, today is the Day of Atonement, the Jewish holiday where one is supposed to fast until dusk, so it is perhaps fitting that I am hungry. My hunger is also a result of yesterday, which was a difficult day, and resulted in a lower dietary intake than usual, but perhaps I'll write about that later on.

Between 8 o'clock and now, I have had the cannula put in and a (large) syringe-full of blood taken, I have been sealed into the chamber and given a small snack of bread and salami, together with a thermos of hot water which I have used to make an Echinacea and Raspberry infusion (no caffeine today). I have caught up with some personal email and blog-reading (Ben Goldacre's new book is published today) and felt slightly guilty at not doing any work.


I have now done some work, so that's good. There's nobody policing me so I could easily spend the day watching iPlayer, but I've been given 'Study Leave' to help with this trial, which means I haven't had to take any Annual Leave or unpaid time, so I've brought some stuff to do.

So far I have reviewed the cards from yesterday's clinic, which has earned me the first Band 5 Dietetic Medal ever awarded - seven new patients, no breaks, no DNAs. Everyone turned up, some on time, some early, some late. It was terrible. One patient phoned to say that the air ambulance had come in so all the access roads were at a standstill and someone had driven into the side of his car. And he still came to his appointment. I mildly asked one patient if he'd had trouble parking, and let's just say he wasn't happy. By the last patient, who 'only' had to wait an extra half an hour for me, I was in a pretty poor state, and that patient brought a host of complex issues which I was in no condition to address effectively. And to cap it all, a patient needed ambulance transport home, which causes immense administrative problems.

Unlike most weeks, when I could easily have stayed to make sure the ambulance thing happened as it should, yesterday I absolutely had to go because I was giving a presentation in Nottingham in the afternoon, and had arranged to pick up an ex-colleague to do it with me. So the Dietetic Manager had to come and help me out, and in the process saw the state of my cards after that clinic, as I attempted to tidy up and complete all the admin before running away. I reached the room in Nottingham where I was giving the presentation at the exact time that I was due to start. So not exactly late, but it all added to my stress levels, and I reached home again at 6.30 p.m. having had nothing to eat and virtually nothing to drink since breakfast.

View of a fence and buildings
The outside window
So that's why I've been so hungry today, and why I have to finish up properly and write all the clinic letters before all the patients get muddled in my head. And I've just negotiated my first urine collection, closing the blinds to the main room and next door cell, successfully catching and decanting it all into the right containers, not even kicking it accidentally all over the floor, then realising I hadn't closed the blind at the outside window...


The first blood collection since I've been in my cell. I wondered how it would be done, given that I'm inside and they're outside, but the technique is surprisingly low tech. There's a plastic bag attached around one of the air lock ports, with a hole cut in the bottom. I put my arm in through the bottom of the bag and hold the plastic tight around my upper arm forming a seal. They open the air lock and fiddle with the cannula outside, then when they're done I pull my arm back in and they shut the air lock again. I thought I was going to have to do it all myself.

I've also had to fill in a couple of questionnaires about sleep and snoring, because I think there's something about sleep apnoea in the research as well. And every two hours I have to rate how hungry/satisfied/full I am, and how much I think I could eat. I am, obviously, still very hungry, and the next meal isn't until 1 p.m. It's due to be a big one, though.

Still doing research and writing letters associated with yesterday's clinic. I shouldn't have felt guilty about not doing work in here - I think this job on its own will take most of the day, and would have been really hard to fit in around the ward work I would normally have to do. Luckily, my colleagues report that yesterday was quiet on the wards, with very few referrals - let's hope today's the same.


Still no lunch. I am effing starving. One slice of bread and a bit of salami since 8 p.m. last night. I am drinking Echinacea and Raspberry infusion in the hope it will quiet the rumbling a bit, even though I will eventually have to deal with the consequences. I will definitely close the blinds properly next time, though.

Another setback - cannula not working for pre-lunch blood test, meaning another needle stick in the other arm. The researcher Dr P comments that this often happens before lunch, and he hadn't previously realised the effect of food on ease of blood-letting. So the cannula's still in, and we hope it will work at the 3 o'clock bleed.


I've had a large lunch, and I'm definitely not hungry any more, but feeling almost light-headed with the amount of fat consumed. We are being fed deliberately high fat meals - hence the salami first thing, and now lasagne and a chocolate eclair (mmm, my favourite). I ate my meal while watching the first episode of a new series of Never Mind the Buzzcocks, on iPlayer.

Now it's back to the clinic cards. It's taking ages, but that's probably got something to do with me breaking off every now and then in order to blog. And Facebook...


Nothing new to report. Still digesting enormous lunch, feeling sleepy now. No more blood taken yet, but clinic cards finished at last.


That was close - Dr P nearly couldn't get blood out of me via the cannula, and threatened to remove it and put another one in the other arm. But he managed it, the cannula's still there, and we'll see what happens at 5 p.m.

My afternoon snack arrived - a sliver of a pork pie, hardly worth the effort. I was still full from lunch, anyway. I wonder how they arrived at the quantities and the timing of the food? I saw my allocation written out before I came in, and it showed that I require only 1516 calories for a whole 24 hours of no activity. Obviously if I'm not imprisoned in a hermetically sealed room I can have more, but it's not very much, is it? It's actually exactly equal to one McDonalds Double Sausage and Egg McMuffin with large fries and a large milkshake, according to the McDonalds Nutrition Calculator.

I seem to have done very little in the way of work in the last hour. Where does the time go?


A thrilling new herbal infusion for the second half of the day - Blueberry and Apple. I'm starting to think I might be able to eat again, which is lucky because my second main meal is coming up at 5 p.m.

Having no mobile signal, and an internal telephone only, I have been maintaining contact with the outside world through Facebook and email - both highly asynchronous and unsatisfying. Then I noticed a Skype icon on the computer desktop - and bingo, I had a nice chat with mum, who was the only person online. With any luck there will be more options tonight.


Small plate of chicken korma surrounded by keyboard, mouse and telephone
The second main meal was a bit pathetic - chicken korma and rice, but a tiny portion compared with the huge 1 o'clock lasagne. These meals seem very unbalanced in terms of size and timing. I'd prefer something more substantial earlier so I didn't spend the whole morning ravenous. And this is the '5 meal-a-day' leg of the study; my second incarceration involves just two meals containing the same overall quantity as in my five meals today, with the first at 1 p.m. I shall definitely make an effort to eat more the night before than I did this time. During this supper I watched the first episode of the new series of The Food Hospital, which took a lot more time than eating the meal did.

The cannula just about performed its job at 5 o'clock, which I am relieved about. We think that on my next imprisonment we'll try the other arm.


It's actually 7 p.m. and I have no idea what I did in the last hour. Took my cardigan off. Had some more Blueberry and Apple infusion. Remembered to close ALL the blinds. Read a bit about diabetes from some of the uni notes I brought with me. Had a further half a chocolate eclair, the last food I'll see until tomorrow morning.

The cannula finally packed up, so I had to have a needle stuck in the other arm, but that vein wasn't playing along either so Dr P had to go for a third try. It seems my veins are single use only, but at least there's only one more blood test needed. I told Dr P I'd be a terrible heroin addict; he said that he reckons I would manage somehow.


Stopped reading about diabetes. Sat and stared at the wall, thinking about this and that. Checked Facebook. Checked email. Checked work email. Checked other email. Tried to Skype Mr A twice with no response but he's probably in the kitchen, so I've emailed him asking him to Skype me. More Blueberry and Apple infusion. Lola II, where are you? I'm a little bit bored now, but I've lined up the first episode of the new series of The Thick Of It on iPlayer. I've already watched more TV today than in the last six months.

Mr A Skyped me, but the initial conversation turned out to be very one-sided as he doesn't have a camera and his microphone wasn't working. I spent some time making rude signs at him, just because I could. Change of hard disk later (only a few minutes) and he's back, telling me about his day down in London on his first paying training job for ages. It went well. He torments me by suggesting he'll soon be sitting on the sofa and can help himself to drink and snacks.


Last lot of blood taken, best ever, using an old-fashioned syringe, took 10 short seconds rather than minutes of jiggling sharp implements in nervy flesh. Watched the episode of The Thick of It, and now I'm starting to feel hungry again. I definitely wouldn't run this meal schedule by choice.

Dr P has shown me the 'sleep machine', which sounds very sinister, but looks as though it will just be measuring my breathing rate and oxygen saturation. That's the end of his working day - I'm left to my own devices, with an emergency call bell to the nearest ward and the on-site Security telephone number. If there's a fire alarm or other emergency, I can just open the door and walk out, although Nurse A said she'd probably want to go into one of the chambers if there really was a fire. It's pretty bombproof in here.


Trying to sleep with a large box strapped to my chest (the sleep machine controller is about as big and heavy as a packet of four bars of soap), a strap around my waist, a finger-pinching monitor and nasal specs up my nose and around the back of my ears wasn't easy. Add to that the facts that it wasn't quite warm enough and I wasn't particularly tired, having done nothing but eat, read and type all day. I did sleep, and everything stayed in place except the finger monitor lead fell off the controller, but next time I need more blankets.

This morning first thing I followed the supplied instructions to provide a resting BMR measurement - staying awake but unmoving for a measured hour. I listened to a podcast, so that was no hardship. Now I'm waiting for the staff to get back to work and release me from my cell. I hope there's no more needling to do, but they have offered me a shower and I really need breakfast soon. Then it's back to the office and work - today I have a department meeting at lunchtime about student supervision and training, and clinical supervision in the afternoon when I present the difficult case from clinic in case anyone has any good ideas on how to manage treatment.


View through the window into the office
They didn't let me out until after 9 o'clock, but there were no more needles, and I saw the trace on the computer of my 24 hours in terms of oxygen, carbon dioxide and movement within the room, which is captured by sensors. They should be able to tell me more about my metabolic rate by the next incarceration event, which is in two weeks' time. Back in the office, the wards have been making up for lost time, and I had rather too many referrals waiting. Luckily, some of them turned out to be duplicates, one had already left hospital and another couple were for renal or oncology colleagues.

So what have I learned from my day in the tank? I enjoy solitude, don't like waiting for my meals when I'm hungry, miss my decaff tea, have veins that are not suited to repeated withdrawal of blood, need only around 1500 calories on an inactive day, and have a reliable bladder capacity of almost exactly 500 ml.


  1. Seems like a very harsh way of ensuring that your blog gets updated frequently... Hope it wasn't too bad and hasn't put you off the next one!

    LRM & BLx

  2. Doesn't sound like a nice test to me (I hate needles). When I was in uni we used to head over to the psychology department on a very regular basis to perform little tests (like reaction speed, sorting images, associations). We used to get 5 euros per test I think. It was a nice way to contribute to research, and to your own dinner. :)

    I hope the next test will be a little easier on you!


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