Moving on

My leaving cake, baked by a lovely colleague

My first dietetic job has now come to an end, and a new era is about to start with a specialist diabetes post. It's been almost exactly a year since my first day as a qualified working Dietitian, which has a pleasing feel to it, and I have learned an enormous amount in that year - maybe not as much as I learned during my degree, but still, important stuff. Most of all, my confidence has grown to the point that I now believe in my own abilities, and most importantly can tell the difference between things that I can definitely do and things that I need help with.

The last week at work was surprisingly quiet, which was wonderful. Added to that, it was also the last week for 'my' student, who was doing a tremendous job and took all the pressure off me, because she was just out on the wards seeing patients. She gave me a card and a present when I left, which was lovely. The quiet week made it easy for me to tie up loose ends and finish the job tidily (and on time!) on Thursday. But I had to phone the office on Friday, because I had been thinking about the patients I handed over and realised that I ought to have prescribed a different feed for one of them.

We had a little leaving presentation when I was given a cyclamen, some chocolate, and a voucher towards a new badminton racquet (which was what I asked for). A large number of people turned up at the pub after work for a drink and a curry, and I was hugged by more people than you could shake a stick at, which was many more people than I usually allow to hug me. It was hard to stop them, so I didn't.

What with my new post being temporary, and not quite full time, and a long way away, I can't rule out the possibility that I may have to return to acute dietetics on the wards at some point. But if I never have to offer another nutritional supplement or calculate and write up a regimen for an enteral feed, I won't be too sorry. In the last week, because it was a bit quiet, I stole some of the other Dietitians' diabetes patients and had some interesting conversations on the wards. But I also had to see the usual patients who are being tube-fed, mostly long-term, mostly for neurological reasons, although there were a couple of acute cases who had been through surgery.

We also had a professional development session on treatment of gastrointestinal failure, which can occur due to surgery, malabsorption (sometimes due to bowel being removed), or just a lack of peristalsis called 'ileus' which can also happen if the intestines are mucked about with or following any serious trauma or surgery. These are scenarios when parenteral nutrition (PN) is called for, and nutrition is given intravenously - it is a last resort, because the risks of infection and other complications are much higher if nutrients are supplied this way. In the meeting, we were all in groups and given the task of prescribing a feed. I was with a community Dietitian and a very experienced renal Dietitian, and found that their knowledge of ordinary hospital dietetics was somewhat poorer than my own, which was a surprise.

On another day, while I was on the endocrine ward, I listened in to one of the diabetes doctors explaining to a student some of the mechanisms used for differential diagnosis of diabetes - type 1 and type 2 and the tests that can distinguish them. The blood or plasma concentration of insulin is rarely measured, because it has a very short half-life in the system, so other indicators have to be used, of which the main one is C-peptide. Insulin is synthesised in the pancreas as a larger molecule which is split into two parts on release into the blood stream. Insulin disappears pretty rapidly, but the other component, C-peptide, doesn't, so it can be measured as a surrogate indicator.

If blood glucose is high and C-peptide is low, then it's either early-stage type 1 or late-stage type 2, because insulin-secreting pancreatic beta cells are being killed off, and insulin treatment is probably needed. If blood glucose is high and C-peptide is also high, then it's type 2 because the problem is not lack of insulin, but insulin resistance. There was a lot more to it, but that's just the bit I took away. He was talking pretty fast.

So all in all I feel very pleased with the prospect of moving forward into specialist diabetes dietetics, but also very privileged to have had the opportunity to see how a large teaching hospital functions. There was rarely a day when I wasn't thankful that I was able to walk away and go home, unlike those I'd left behind on the wards. And what wards! They all have particular challenges - my last batch were cardiac, neuro and vascular, and were as varied as any of the others. The vascular patients were particularly challenging; many had necrotic toes where their circulation had failed, gangrene, horrific ulcers, amputations, and the smell! The only worse smell I encountered was a patient who had very advanced cancer.

I have found the NHS to be a magnificent institution, staffed by people the vast majority of whom are genuinely trying to do their job well, and serving even the poorest without distinction. There are any number of reasons why this is sometimes impossible and we fail, but anyone who thinks that nurses, doctors and all the rest are just marking time and looking forward to the comfortable pension is mistaken. Of course, this has been my experience in this one hospital, and may not be the case universally - the recent history of Stafford hospital springs to mind.

My belief is that the culture within any department, profession or organisation is set by example rather than by rules or policies - if the boss picks litter off the floor and puts it in the bin, then others don't think it is beneath them and follow the example. I can compare the department I have just left with the three others that I met as a placement student - some aspects were better, some were worse. But as I may have written before, I don't think I have ever worked with such a supportive and congenial group of people as those I have just left.

The other difference between this set of colleagues and others is that my interests and passions are shared somewhat further than in any previous job. Of course, I still watch far less TV than most of my colleagues, but I can sometimes steer the conversation towards 'best restaurants in Kenilworth' or 'strangest foods we have eaten' without everyone getting bored. My lunch of celeriac gratin with walnuts is regarded as interesting rather than weird. At my leaving do we had interesting conversations about Michael Mosley's 'Fast Diet', nearest Michelin starred restaurants (Mallory Court), fancy restaurants where we have dined, and cake-making from the Hummingbird Bakery cookbook. I even half wished I'd watched the Great British Bake-off on TV, as it sounded like the least awful of this genre of reality shows.

Mr A has offered to treat me to lunch at the local noodle emporium, Wofon, so I need to get ready. More Lola Life to come in the next thrilling instalment - Specialist Diabetes Dietitian.

What I've been reading

Beseiged: Life Under Fire on a Sarajevo Street
by Barbara Demick

"Logavina Street was a quiet residential road in a city known for its ethnic tolerance and cosmopolitan charm. The book describes life for the residents of this street in Sarajevo during the siege of 1992-96. Often without heat, water, food or electricity, they evaded daily sniper fire and witnessed horrific deaths."

This is one of Mr A's books that he suggested I might read. According to this account, Sarajevo sounds just like any prosperous European city before war broke out, and the book provoked both Mr A and me to consider how we would cope if the same thing happened to us. Would we find shelter, food, water and ways to stay warm, would we run away, would we survive? There is no way of knowing, and I can only hope that we never find out.

The Lucky One
by Nicholas Sparks

"While in Iraq, U.S. Marine Logan Thibault finds a photo, half-buried in the dirt, of a woman. He carries it in his pocket, and from then on his luck begins to change. Back home, Logan is haunted by thoughts of war. Over time, he becomes convinced that the woman in the photo holds the key to his destiny."

The first of my 12 Books of Christmas prize from Judging Covers, and I think I did well to choose this one to start with. It's well written, kept me interested, not too long or too short, and although it is a 'boy-meets-girl' kind of story, it can't be described as 'chick lit' - a genre I really don't get on with. The only criticisms are that 50% of the story happened in the last two chapters, when the careful characterisation and steady narration in the majority of the book was substituted by unnecessary cinematic excitement. It was a good book, but would have been much better with a more considered finale.

Sleeping on a Cloud
by Joff Gainey

"Jake and Lucy are teenage twins, thrown into a world of mystery when they discover their seemingly unique gift. They can read each others thoughts. However this is not only confined to the two of them, for when they meet Lorna and William - Silver Liners - their journey begins to unfold."

This is the second of my 12 Books of Christmas, apparently self-published, and it is awful. The writing simply highlights how much I take for granted in published books: spelling, punctuation, grammar, realistic dialogue and believable characters. It is the first of a trilogy and ends with a cliff-hanger, and to give credit where it is due, the story so far is actually the best thing about it. I shall not be reading the sequels, however - this one was enough. I left it in the house we stayed in over New Year.

A Night Like This
by Julia Quinn

"Anne Wynter's job as governess to three highborn young ladies can be a challenge - in a single week she finds herself hiding in a closet full of tubas, playing an evil queen in a play and tending to the wounds of the oh-so-dashing Earl of Winstead."

The third of my 12 Books of Christmas, and I really enjoyed this one. It was silly, frothy, romantic and had a very unnecessary explicit sex scene, but apart from that last point it was just fun to read. I suppose it helps that I like Georgette Heyer's Regency romps (to whom the author is compared in the cover blurb), but it restored my faith somewhat that there are 21st century authors who can write something that I will enjoy reading. She's written some others, and a few are available through Audible, so I may be reading more at some point.

Hurricane Gold
by Charlie Higson

"As the sun blazes over the Caribbean island of Lagrimas Negras, its bloodthirsty ruler is watching and waiting. On the mainland, ex-flying ace Jack Stone leaves his son and daughter in the company of James Bond. But a gang of thieves lie in ambush – they want Stone's precious safe, and will kill for its contents."

I picked this out of the bookshelf at the house where we stayed for our New Year holiday - I'd only taken two books of my own to read on holiday, which was wholly inadequate. I would have borrowed one of Mr A's books, but he tends to read in parallel rather than serially, which meant he was still reading all of the books he'd brought. When I picked this one out, I'd forgotten that Charlie Higson writes the Young James Bond stories for teenagers - it was definitely aimed at children, but not a bad read for an adult either.

Handbook of Diabetes
by Gareth Williams and John C. Pickup

"This book has become the essential manual for all healthcare professionals involved in the treatment of patients with diabetes. It contains a wealth of clinical wisdom against a backdrop of clinical science that will be of help to every member of the diabetes care team."

This was loaned to me by the hospital diabetes Dietitian at the end of August, and has taken until now to finish - an inordinate amount of time. It is somewhat out of date, and contains a level of detail that makes it too general for an in-depth textbook but not readable enough for a generalist audience. Obviously there was interesting information that I wasn't aware of, but I won't be buying this one for myself.

The White Monkey
by John Galsworthy

"Fleur's marriage is haunted by the ghost of a past love affair, and however vibrant she appears, those closest to her sense her unhappiness. Michael, devoted to Fleur but not blind to her faults, is determined to stand by her through anything. He also finds himself caught up in the tragic and poignant story of a young couple struggling for survival in an age of unemployment and extreme poverty."

This is book one of part two of the Forsyte saga trilogy, or the fourth book of whatever a set of nine books is called. They've all been wonderful to read, despite their origins in the late 19th and early 20th century, or perhaps because of it. One imagines those days to be very different from our times, but I am sometimes surprised by the modernity of expressions and sentiments as well as everyday life. Clearly there are differences, and the gulf between rich and poor, the titled gentry and the common folk is significant, and I imagine being poor today in Britain is a great deal better than it was then. Those without any safety net (e.g. asylum seekers?) would probably recognise some of the situations described - I know very little about such lives, but the little I hear on documentaries makes me think so.

Catching up

Detail at the top of a column, Melk, October 2012

I have been back from our New Year holiday for more than a week, and have nearly caught up with blog posts waiting to be read, not helped by Stan Madeley who has started up again and has been posting loads of his letters that didn't get replies and so didn't get into his book, 'Second Class Male'. OK, plug over. Podcasts - well, I'm not sure I'll ever catch up, although when I start driving for 10 hours a week there may be some chance.

On Saturday morning I thought I would make a brief list of the few things I really must do this weekend. When I reached the bottom of the page I realised that it would be a busy time. Factors affecting work to be done during the weekend: parental computing woes; last weekend spent constructing a large bookcase and consequent rearrangement of crap in room; unexpected death of 'new' freezer. The last has prompted interesting meal choices - we are eating large amounts of thawed veg, yesterday was fish pie made with all the fish previously frozen (including fish fingers), today and tomorrow will contain vast amounts of meat, with leftovers providing all meals for the next week. Cereal for breakfast is forbidden; let them eat bacon. Not that we're complaining about that one.

Freezer death combined with my disorganisation over the past few months means that at present, neither Mr A nor I can find the receipt for the dead freezer, nor for the washing machine that we also bought recently. We suspect that they are hiding somewhere together, as it is unlikely that we would have thrown them out. Bank card statements will be of little use because both were bought with vouchers redeemed from TV-watching points. On the positive side, roast beef sandwiches for lunch were delicious.

There is little more to say about work that hasn't already been said. We were two Dietitians down last week but we had three nearly-qualified students helping out, and it wasn't too bad. I have just under two more weeks to go before the new job, when I imagine there will be much more to report. My last clinic: only four patients attended, of whom one was entirely fine, which made me feel like I should keep him talking because the journey to and from the hospital plus the pain of parking and then sitting in the waiting area takes a disproportionate amount of time and effort compared with the five minutes of a consultation.

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I wrote the above at the weekend, intending to publish before the week started. But I had a badminton match on Sunday and things were delayed and you know how it is. It's only Tuesday, but there have already been developments. The bad news is that Stan Madeley has given up his blog, through lack of readership. The good news is that the freezer has returned to its operational state, simply by pushing the plug back in. It must have been dislodged slightly by Mr A, whose bike equipment is kept in the cupboard where the electrical socket is. So the additional life-enhancing exercise of Mr A cycling a bit over the past few days has been negated by the enhanced saturated fat-filled intake of meat products. We lost out on some frozen veg and bread, but I think we've managed to consume everything else.

New Year holiday

A subset of the full group, at the top of a hill

I've been away - a whole week in Northumberland, with friends, most of whom I have known for nearly thirty years. Walking, eating, playing games, no phone signal, no Interwebnets, and the weather was kind as well. And as I don't have exams in January, this was the first New Year holiday for such a long time when I didn't have to do any revision, and could go walking whenever I liked.

As a group, we have clearly aged, and some of us have mellowed to the point that we hardly did any walking after lunch, and not all that much before lunch either. Just the highlights, then:

• Wonderful walks (with new gaiters)
• Having time to read three whole books in a week
• Playing duets with Lola II
• Meeting up with another old college friend
• Photo-charades (taking a still image to represent a film)
• Photo montage of the last 25 years of these New Year holidays
• Feuerzangenbowle
• Splendid food and drink
• A lecture on the LHC and its uses (courtesy of CERNoise)
• The Indian cafe on the way home.

Looking back on 2012, it has been quite a good year. I finally started working as a Dietitian, and I love the people I work with, even if the job hasn't been ideal. A few highlights of the last year include:

• Starting a job, which happily turned out to be full-time, although in a hospital rather than the community as I had hoped
• Becoming a Friend of the Falconry Centre - should I renew for the next year?
• My solitary holiday, which I am very tempted to repeat this year
• Two days in the respiration chamber (this experience supplied my favourite blog post of the year).
• The family river cruise
• Getting another job, this time in my preferred speciality area of diabetes.

I'm hoping that this year will be as good as the last.