Saturday, 16 March 2013

I am on my own

Mr A on a bridge in the mist
Bridge to Esztergom, October 2012
It's been... HOW long? Anyone would imagine that I didn't love writing these posts. I really do, but I haven't even managed to get to badminton this week, so it must be serious. And last week we were on holiday, in Berlin and Munich. Maybe there will be a post about that, but I somehow doubt it.

My colleague, RSB, was away last week, and will still be away this coming week. So I returned from a week's holiday to a proper caseload, with real patients to see in real clinics, and no safety net. There are plenty of people to help out if I needed help, but they are at the end of a telephone. And it was fine.

I'm starting to relax with the job now, a little more confident in my ability to deal with whatever walks in the door. I've got used to asking before anything else in a consultation: "What is it that you want to talk about?" and finding that it isn't at all what I expected. There have been two patients with eating disorders, several others who have cried, and some who haven't. The most satisfying have been where the patient has said "I didn't know that" after I've told them something, and that's happened twice. Because I'm pretty new at this game, and some of them have had diabetes for all their lives, I feel very glad if I manage to pass on some of my acquired knowledge.

I have been working on a document that is called "All About Diabetes". It is both for reference, and a learning tool, so that I can be sure that I not only know about everything I need to, but can also explain it when I need to. My first Gestational Diabetes clinic was on Friday, so now I am pondering about how I can cut down the amount of time it takes to do all the necessary explaining to a woman who is more than 26 weeks pregnant and has been told earlier the same day that she has diabetes. I need to cut it down because I ought to be spending about half an hour with each patient, and on Friday there were only three patients and I was an hour and a half late home. Although it didn't help that the last patient was an hour late.

So this is what I need to cover:
  • What diabetes is
  • The patient's normal diet
  • Which foods contribute to blood glucose, and which don't
  • Which foods should be avoided altogether and why
  • Any questions
It doesn't sound much, but the 'Any questions' section can go on for a long time. And the patient may have a partner or family member there who also has questions, and their first language may not be English, and the mum-to-be may be in floods of tears as well. I've worked with all of these already, and that's probably why I'm feeling at the moment like I can manage whatever is thrown at me. I'm sure there will be days when it is clear that I can't.

There are other aspects to the job outside the consultations with patients. I have now been to a meeting involving all dietitians within the Trust, and discovered that there are absolutely loads of them, and also learned more than I currently need to know about intestinal failure. I am still getting to grips with the admin, and the computer systems, and finding my way around the hospital and between sites - at the end of one day I wasn't paying attention to which staircase I went down, and managed to get so lost that I couldn't find my way out of the building. I have also managed to arrange a large service and MOT for the car, which felt like quite an achievement. But I haven't managed to go to badminton, so there is still room for improvement.


  1. What fraction of women who are diagnosed with diabetes during pregnancy get better as soon as the baby is born? Do the tests allow you to distinguish the woman who has developed diabetes related to being pregnant from the woman who's had the bad luck to get her other-sort-of-diabetes diagnosis while pregnant? How much does pregnancy-related diabetes affect the outcome of the pregnancy? (All leading questions, which if the answers are comforting might help the pregnant woman in floods of tears....)

  2. Answering these questions is the responsibility of the specialist diabetes midwife, who generally sees the patient before me. She also breaks the news that they will have to prick their fingers to test their blood glucose levels SEVEN TIMES A DAY UNTIL THE END OF THEIR PREGNANCY. I try to stick to the food-based subjects, but will give vaguely reassuring answers if called upon. It's slightly worrying that in future clinics I may be seeing the patients before the midwife - we'll see how that goes.

    p.s. Do you actually want to know the answers? I might be able to produce some facts in a future post, but the vaguely reassuring answers are:
    Generally no
    Very little if well controlled.

    The less reassuring factoid is that having been diagnosed with gestational diabetes, there is a significantly increased risk of being diagnosed with type 2 diabetes later in life, even if the diabetes goes away at the end of the pregnancy.

  3. Well, I was vaguely curious about how often it just gets better, rather than just making an assumption. But mostly just burbling, and wondering which aspects were most likely to be provoking the floods of tears. Seven times a day is a lot.

    (Why are the "prove you're not a robot" words so very difficult to read? (rhetorical))


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