Getting on with it

National Botanic Garden of Wales, May 2013

I left you at the end of induction, and I have now been in the Diabetes department for a few days. I wasn't expected to start clinics straight away, although I did see a patient on day 2, which was fine. I really need to get the hang of what patient information I can give out, and find out where things are in the building and in the hospital. There is a meeting scheduled with the three other Diabetes Dietitians in the Trust, who are based at the other hospital and in the community, and I am hoping to get a better picture from them of how the service operates.

The hospital where I am working is pretty small. It doesn't have an Emergency Department, maternity, or paediatric intensive care, for example. There is a walk-in centre for 'urgent' cases, but anything needing proper hospitalisation will go to the big hospital where I used to work, so it is unlikely that I will see many newly diagnosed diabetic patients. I have met the two Dietitians who cover the five wards in the hospital, and my manager has suggested that I may need to help out on the wards from time to time. I have made it clear to all involved that while I would be very happy to chip in when times are tough, ward work is something I would very much like to keep to a minimum.

The hospital was first opened at the end of the 19th century, although obviously it has been modified since then. The Diabetes department is in a separate building on the site and was built within the last ten years, so it is pretty modern. I have a whole big room to myself, with adjustable heating and a window! I am quite excited about the things I can do now that I have somewhere to store resources in the same room as seeing patients, although I am not the only one to use the room so I can't make it exclusively my own. The main thing it lacks is a table so that I can draw and write easily during consultations - at the moment the desk faces the window and we can't sit around it.

There are just two Diabetes Specialist Nurses (DSNs) based there, along with a clinical Support Worker and some admin staff. Doctors come and go, and there is a big meeting room where we all have lunch and where courses are held. It is so light and airy compared to the cupboard off the hospital corridor where I spent the past year. The Dietitians I am replacing are long gone, and the room had accumulated a whole lot of stuff, so I have started to sort through the legacy and dispose of old and irrelevant material, keeping some things that look like they might be useful.

Lastly, commuting to and from work takes 30 minutes, but the sort of 30 minutes that is almost a pleasure to drive. It avoids all the bottlenecks, is mostly through countryside with farms and animals, A and B roads but no motorways, and once I've left Leamington there is only one set of traffic lights. I'm almost looking forward to the journey!

Induction number 3

Cardiff, May 2013

I've been enduring a third episode of workplace induction, to celebrate the start of my third year as an employed Dietitian. It has been uninspiring and tedious, but has also highlighted some important differences between the two Trusts that have employed me.

I'm back at NHS Trust #1, and induction has changed considerably in the two years since I last went through it here. It is much better - I did not have to sit through the wholly irrelevant and inappropriate session about how to order and collect blood for transfusion, for example. We had a practical handwashing session including UV lighting to highlight deficits in technique. There is a whole lot of e-learning to support topics like manual handling, infection control and 'Health and Safety Awareness' where previously these were all live presentations.

In terms of IT, I got my Smart card and ID card within the first two days; my email account and network access were working almost immediately, and as an added bonus my email address is the same as it was a year ago. During induction, the emails I failed to delete before leaving were still there, as were 470 emails received in the 12 months since I last used the account. I even received my own email thanking me for my leaving presents. Unfortunately, on Thursday when I tried to log in, the system told me my account had been disabled, and when IT support got it back, all my emails and files had disappeared, together with all the messages I had been sent that week about where and how to retrieve various documents and details of meetings.

We still had to sit through quite a lot of Powerpoint, though. Welcome from the Executive Managers, the fire officer's lecture stating the bleedin' obvious, Information Governance (which mostly means confidentiality and data protection), an introduction to the Library, a slightly too-graphic presentation about Safeguarding Children, and Conflict Resolution. Oh, how bored I am of hearing about Conflict Resolution. It gets a lot of time in the programme, probably because of national guidelines, but has not changed in two years. Of course we must try to provide respect and dignity to colleagues, patients and the public, and must try to prevent and mitigate conflict, but oh! the endless acronyms and six stages of this or that and don't forget how we are allowed to defend ourselves and use reasonable force to prevent a crime, and what exactly is the definition of Assault, and should it be reported as clinical or non-clinical?

The highlight of the induction two years ago was a presentation on Equality and Diversity, which has now sadly been changed to an e-learning module - the only one in which I scored 100%. I have learned a great deal more about the incidence, prevention and treatment of venous thromboembolism than any Dietitian needs to know. The latest defibrillation machine is pretty snazzy, and it can even tell you whether you are doing your chest compressions correctly.

All in all, having three compulsory days at the very beginning of a new job is a comprehensive, timely and efficient method of ensuring that statutory and mandatory training is done, especially compared with NHS Trust #2. In that Trust, despite my best efforts, I didn't manage to complete my induction and mandatory training in the 11 months I worked there. And the relief of having modern computers with up-to-date software again is only slightly dented by the loss of all those emails and files.

Other good news: parking at the hospital was arranged swiftly and effectively, and I have been given extra hours on a permanent basis, making 27 hours a week over 4 days. Still ten and a half hours short of full time, but much nearer, and I think the end result will be very similar to what I was getting paid in the last job, if you take account of not needing so much fuel or accommodation costs.

New job tomorrow!

National Botanic Garden of Wales, May 2013

Not much to say of any interest - I haven't been at work, so no new diabetes news; I've been doing quite a lot of reading, so the next book blog will be a bit longer than usual. I've renewed the house insurance, done my income tax return at last (I've never left it this late before, almost time for the next one), and been to London and to Manchester.

In London I saw mum and dad, did some computer maintenance for them, sealed up a leaking kettle, met an old school friend and had a walk in the forest, stayed with Lola II and Mr M, had a tour of BBC Broadcasting Centre (old and new bits), replenished my supply of Japanese ingredients, met another old school friend and watched her do some of her radio show, travelled to Manchester along with mum and Lola II to visit H&B, played with Lola II's music group, replenished my supply of vine leaves and various other goodies at Lola II's local Asian supermarket, and cooked up a feast for Lola II and Mr M. It was a busy week.

Back home I find there isn't much preparation to do for the new job, because the first three days are corporate induction (again) and the next couple will be local induction. It will be predominantly the same as before, so maybe I can report any changes since the last time, two years ago. I have been told that my contract of three permanent days a week is likely to be extended by one further day, but it is likely that I will not be working on Tuesdays. At first I was disappointed, but on reflection this does give me scope for doing all sorts of different things, both work-related and nothing to do with work. I have some ideas, but we'll see what happens.

Ski/bike holiday

Ellmau, January 2014

I'm guessing that one or two of you are interested in our holiday - it was fun, I gradually remembered how to ski with the help of one lesson on the second day, the weather was horrible on the first day but improved after that, Mr A absolutely loved his snow bike.

Ellmau, 2014

We went to Ellmau, in Austria. The resort is sadly lacking in snow, and it appears this is generally the case across Europe at the moment. In the olden days skiing would have been impossible, but thanks to snow generating technology the pistes were fine. Down in the town and anywhere off-piste, there was nothing, which meant a bit of ski removal and walking to the lift stations at the bottom.

This was the seventh ski holiday that Mr A and I have undertaken, and all have been very different.

Macugnaga, 2004

The first was to Macugnaga in Italy, a very small resort, but perfect for first-timers. Mr A hadn't skied before and I hadn't skied since university, so we had some lessons before going out and joined group lessons when we were there. This also meant we made friends with another family and could do a bit of socialising in the evenings. The highlight of this trip was the evening meal at a mountain restaurant, which we reached with our skis on by hanging on to a rope trailing from the back of a skidoo. There were two skidoo drivers; mine went at a terrifying speed and traumatised all his passengers, while the other one was beautifully sedate and its passengers were bemused as we staggered into the restaurant.

Soll, 2005

Next time we went to Söll in Austria, taking The Boy and his girlfriend with us. They had snowboard lessons and we improved further in our ski lessons, although Mr A was already starting to have trouble with his knees. The third trip was very interesting - we went to Ruka in Finland, not noted for its downhill skiing. It certainly had nothing to match the Alps or the Tirol, but we were self-catering with four other friends in a cosy log cabin with a sauna and had a jolly good time.

Ruka, 2006

The fourth trip was to Champoluc in Italy, where the hotel was adjacent to a piste and only yards from the main ski lift station. This was a huge benefit - no need for ski buses or long walks to get started in the morning or to get back to the hotel in the evening. Mr A had invested in some highly expensive personalised ski boots, but it was becoming clear that even these didn't provide sufficient relief, and this was when he had his first go at snowboarding. This holiday was particularly memorable because at the end of the penultimate day, we went for a walk and I fell over and broke my leg.

Champoluc, 2007

Mr A decided to abandon skis and try snowboarding for the next holiday, which was in Meribel, France. I thought I'd try it as well, and blogged about it twice. This was the least successful holiday in terms of snow-based activity, but we were in a chalet with nice people and went to a comedy gig.

Galtür, 2011

Then there was a gap of three years before our next trip, to Galtür in Austria with our friends J+C, which I also blogged about. This one was notable for the food, and because I finally abandoned my attempts to learn to snowboard and returned thankfully to the skis. Mr A also decided that his arthritic knees couldn't cope with the stress of snowboarding either, despite the more comfortable boots.

So, how did Ellmau compare? The hotel was quite a long way from the town up a steep hill, which would have been bad for après ski activity had we been able to stay awake later than 8 p.m. As it was, there was a piste nearby so we didn't have to rely on the infrequent ski buses, and on the few occasions that we walked up the hill, it just felt like an extension to the exercise we were getting anyway through the day. I had a great time on the slopes once I'd remembered how to ski; Mr A had the time of his life as soon as he got on his bike. We had chosen Ellmau purely because of the presence of snowbikes for rental, and now Hans the snowbike man is one of Mr A's best friends.

Apparently, there are two types of snowbikes: both have ski runners instead of wheels, but with one type you stand on pegs in your ordinary boots, and the other type, which is what was available here, you have short skis on your feet and sit down to ride. This meant Mr A still had to wear his incredibly uncomfortable ski boots, but there was hardly any strain on his knees, and for the first time he could actually get some speed up and do some work. The disadvantage to this was that he is still wearing motorbike gear rather than ski gear, and he described it as "spending the day in your own personal sauna." His jacket and trousers now need some serious deodorising, as well as the rucksack he stored them in.

I didn't quite manage to leave work behind, in as much as I occasionally pondered the enormous challenge that such a holiday would be if you had Type 1 Diabetes. You'd have to test loads, have snacks constantly on hand in case of hypoglycaemia, all the food is unfamiliar so estimating carbohydrate would be difficult, and all that exercise would affect your sensitivity to insulin so you might have to reduce the amount you inject by a proportion you can only guess at. And in the evening, you don't actually know what dinner will be. Without an insulin pump you'd either have to give yourself an injection per course as the food arrived (up to four injections), or take a guess at the start, count as you go along and correct at the end (two injections), or wait until the end (one injection but you'd have to endure post-meal high blood glucose).

Anyway, I've still got a week to play with before having to go back to work, and I've spent a whole day on unpleasant tasks like house insurance and self-assessment for income tax. Tomorrow I'm off to spend some family time; we'll see if there's enough time for blogging too.

An interlude

Groombridge Place, June 2013

Christmas has come and gone, the New Year celebrations passed, and I have left one job behind and am looking forward to a different one. But in the meantime, it has been by turns restful and hectic.

I was working on the Monday and Tuesday before Christmas Day, and Mr A was in charge of preparations. He did a great job, and we had a delicious seafood medley for Christmas dinner, plenty of sitting on the sofa in front of the fire, watching DVDs, reading some books and even watching a couple of TV programmes. I was back at work on the Monday and Tuesday before New Years Day, but those were my last two days there. I had scheduled patients, but most of them didn't turn up. The most reliable were those with Gestational Diabetes, for obvious reasons. A year ago I enjoyed the predictability of the ante-natal clinic, but ended up tyrannised by the inexorable progress of pregnancy.

We had no plans for New Years Eve until the very last minute. I had anticipated quite a long and busy last day at work, but it wasn't like that at all. The Diabetes Specialist Nurses told me that sometimes it can be crazy busy, but for some reason this year there were few referrals, and we even had time to spend a break together in the hospital coffee shop. I cleared my computer, cleared my drawers, cleared my desk, cleared the room and managed to get away mid-afternoon.

Mr A suggested that we try and gatecrash the party at the Pub Next Door, by pulling rank as Very Important Neighbours. Their ticket-only party had been advertised for a while, but I had thought I would be too tired from the working and the driving, so we hadn't signed up. We found, however, that the party wasn't happening after all, and it was to be a fairly normal night at the pub, so there was no need to call in any favours, we could just go next door as normal customers.

Of course, Smurf couldn't let an opportunity pass for some sort of mischief, so he was dressed as Elvis, in a white shiny outfit and big wig that must have been awfully sweaty at the end of the night. He and the other bar staff were downing shots at a rate that made me wonder how they could still stand up by the end of the evening. Towards midnight they turned the music up and Mr A and I were first on the dancefloor, the traditional countdown to New Year took place, there was a bit more opportunity for dancing and then Mr A and I went home. We have managed to avoid the staid married couple story of 'can't be bothered to stay up until midnight' for several years now, in various interesting and enjoyable settings.

My new job starts in a couple of weeks, and I have Plans of all sorts for the intervening time. I started with planning a trip to London and another trip north, but mentioned to Mr A that it would be a perfect opportunity for a snow holiday. He took up the challenge with gusto.

Mr A has now admitted defeat with both the skiing and the snowboarding. His legs, both broken in his mid-20s, were poorly set and his feet and shins cannot be comfortably accommodated in ski or snowboard boots with any success, even in the boots that were ludicrously expensive because they were moulded to the shape of his legs. But always optimistic, he started looking into the possibility of renting a type of ski bike that we had seen on the slopes during our last snow holiday.

With less than a week's notice, we are now booked for a week in Austria. Since I have a day or two at leisure, I spent a couple of hours practising at our 'local' SnowDome, which was a very good idea indeed. I progressed from just about remembering how to snowplough right through to parallel turns in the space of two hours, which has made me a million times more confident, and means I'm looking forward to our holiday a great deal more.

So I will be absent from this blog for a while, but with any luck Lola II may fill the hiatus. She was planning a blog post a while ago, and she has been on holiday as well, so maybe she will surprise us!

No idea why this is in one of the hospital corridors - the caption is 'Negev'