News of Lola II and Mr M

Groombridge  Place, June 2013

When things are going well, when there is no catastrophe to report, when all trots along in a routine and mundane manner, I am happy. But I am also at a loss to find anything to write about. There is no scandal, nothing to complain about, no disturbing incident with a patient at work, or a colleague. So you lose out, because I have nothing to write about me and Mr A and Lola Towers.

Although it is not true that nothing exciting has happened. Lola II and Mr M staged their second annual Film Festival, with eight films over the course of one weekend (Mr A and I attended four and it was excellent), and shortly afterwards announced that they are getting married. So that's nice. I am surprisingly enthusiastic about the event, although I think that it is a very thin veneer of enthusiasm that may be eroded surprisingly easily. I am going to host a very modest hen party and Lola II has promised that she will try not to tax my endurance by becoming a wedding bore.

This is one of the remaining weddings in my life that I must attend - the others are those of The Boy and my nephews and niece, but I hope they all wait until they are as old as Lola II and Mr M because then if I am still alive I will not be allowed to go because of chronic infirmity or serious eccentricity. They will all be glad that ancient Aunt Lola isn't coming because "she would embarrass everyone by lying down in the aisle to look at the ceiling, or singing lewd songs loudly at inappropriate times." I am looking forward to a time when I am able to be freely eccentric, because let's face it, there isn't much fun to be had when you can't play badminton any more.

Talking of badminton, I mentioned my difficulty with seeing patients in the consultants' clinics to some of the new club. One member used to be a GP before she retired, and she came up with a splendid idea which I shall try out. It involves coming up with a few questions on a piece of paper that the patient can answer while waiting, and this ought to help make my dietetic consultation more appropriate and potentially shorter. Now I just have to think of the right questions.

To finish this brief report, Mr A has written a blog post for a skibike website, reporting on our recent holiday. I have to warn you that it contains explicit images of Mr A's bare legs, so perhaps not suitable for the faint-hearted.

I like my job

National Botanic Garden of Wales, May 2013

So far, I like my job.

I like the small team, the fact that we are mainly unsupervised and can do mostly what we like. I like the building, I like my office, I especially like the way that everybody comes together for lunch in the largest room. I can adjust 'my' heating, open 'my' window, and arrange 'my' furniture. I can always find somewhere to park on the site, even if not immediately outside the building. I can ask all sorts of people for all sorts of support, and so far they have not hesitated to do whatever they can to help.

Of course there are things that aren't so good. On Wednesday mornings I have to give up 'my' room to a renal Dietitian, but there are plenty of other places I can sit. We don't have any access to colour printing or copying in the building, but I believe we can go elsewhere if we really need it. These are small issues.

I have started to see more patients, and feel very pleased that I am almost keeping within the time limits allocated. One patient returned for a second appointment, and was extremely positive about how my advice had allowed him to make useful changes. There have been other patients who have not welcomed my input, but I have been content to leave them alone, and they may return for advice if they ever want it in future.

I've been given the job of reviewing the patient information leaflet that we offer on hypoglycaemia, and have included some of the great pictures that I produced last year. The draft leaflet is out with the rest of the team for comments at the moment; we'll see what they think.

A quick update on stuff outside work: no, there's nothing of any interest at all. I stupidly cut my finger on a tin can. I have a hurty arm, probably a result of the last wipe-out of the ski holiday and then exacerbated by badminton. My newest badminton club is very enthusiastic about the fact that I am eligible to play in matches; I am less enthusiastic, although I have said I will play if they are absolutely desperate. Mr A and I went dancing on Friday night; this is his latest plan to introduce some non-sedentary activity into his life. It was fun, but with two nights of badminton per week I'm not sure I will be accompanying him every time he wants to go dancing. The falconry centre has reopened after the 3-month winter break; it was interesting to see how the birds need reminding that they are expected to work for their living again. That's about it.

And it hasn't rained for two days!

Stuffed vine leaves

Ingredients

I don't think I've ever tried to show a recipe in one of my blog posts. For one thing, there are some great professional-looking food blogs that will make mine look very amateur indeed. But I did try to photograph my recent construction of stuffed vine leaves, thinking that it might be interesting. Let's see.

I took the recipe off a packet of vine leaves that I bought. It is slightly ambiguous, as I discovered when I attended a Vegetarian Society cookery course where they presented the same recipe. I decided that the rice should be raw; their version used cooked rice. I believe mine is the correct interpretation - cooking the rice inside the vine leaf wrappers swells and tightens the rolls nicely. Cooked rice just gets more soggy.

8 oz / 225 g vine leaves
8 oz / 225 g white rice
2 to 3 tomatoes, skinned and chopped
1 onion, finely chopped
2 tbsp parsley, chopped
2 tbsp mint, chopped
¼ tsp ground cinnamon
¼ tsp ground allspice
salt and pepper
¼ pint / 150 ml olive oil
¼ pint / 150 ml water
1 tsp sugar
juice of 1 lemon

The packets of vine leaves I used to buy in our local health food shop matched the recipe, but the jars I now get from Lola II's local Asian shop contain twice as much, so I doubled up the quantities above. You can use brown rice, but the texture won't be as good.

First stage is to mix everything in the list from the rice up to the salt and pepper. Then roll the filling into the leaves.

The leaves are usually packed quite tightly in brine, so I tend to float them in a big bowl of water and gently rinse and separate them at the same time. So as not to have loads of filling or leaves left over at the end, I tend to divide them both up into three or four sections, keeping any scrappy leaves for repairing parcels that threaten to fall apart. My calculations didn't work so well this time, but I had some green cabbage festering in the fridge, so the last few rolls were in blanched cabbage leaves rather than vine leaves.

To get a good tight roll, I try not to put too much filling in the middle of the leaf. I fold the lower lobes up first, then tuck the sides in, rolling up and tucking in the sides alternately.

After rolling I pack them tightly in the largest pan I have, which happens to be a pressure cooker. I put them on a trivet to stop them sticking to the bottom of the pan. I forgot to photograph that bit, but you can see the packing arrangement below in the finished version.

Mix the olive oil, water, sugar and lemon juice and pour over the parcels in the pan. Simmer for 1 hour, cool before eating.

It is a lot of olive oil, so sometimes I'm a bit stingy with the oil and make up the volume with water. The total liquid needs to be enough so it doesn't boil dry during the simmering. I actually use the pressure cooker to reduce the cooking time to about 20 minutes, but it's not necessary. Nearly all the liquid should be gone by the end.

So what do you think? More cooking blog posts, or should I stick to the diabetes and the odd adventure with Mr A and Lola II?

Week two

'My' office

The first day of my second week saw me thrown in well and truly at the deep end. I arrived bright and early, hoping to find time at last to get the room sorted, discover the contents of the filing cabinet, and look for all the official diet sheets or patient information or whatever I could find. Instead, I found a) a note from the main DSN saying she forgot to mention she and the other principal DSN wouldn't be around until lunchtime, b) a list of 23 patients who were due to be seen by the doctor that morning, of whom I could see as many or as few as I chose. I also found a small table had appeared in 'my' room, which was absolutely ideal for sitting with patients.

That was a difficult morning, because I didn't understand what was going on or what was expected of me. I tried to get an explanation from the Support Worker and the DSN working in the clinic, and they did tell me how the doctor worked and what all their roles were, but despite repeatedly asking for suggestions, I didn't get much help with what I was supposed to do. I did the best I could, and at the end I discussed how I'd found it a bit hard going, at which point the DSN said "Well, Dietitian X [one of my colleagues who comes over to participate in a joint renal and diabetes clinic] does it like [this], and it seems to work very well." That's what I wanted to know at the start of the day; I don't know why she didn't tell me then. It's all a very big learning curve.

Then on Wednesday I went to the meeting with four other Dietitians, three working in Diabetes in the big hospital and the community, and one working with obese patients. There are distinct differences in the services offered by this team compared with my previous team - for example, I used to offer support for a Very Low Calorie Diet (using meal replacements like SlimFast) to enable weight loss; this team advocates carbohydrate reduction and has two different programs to support this approach. My carbohydrate reference tables went down very well, but my hypo treatment illustrations provoked some discussion about whether the appropriate treatment should be 10g or 15g fast-acting carbohydrate followed by 15g or 20g slower acting carbohydrate.

The main problem through the meeting was that I had to interrupt them repeatedly to get them to explain all sorts of jargon and references to people, events, places, teams, programs and treatments that I wasn't familiar with. I didn't manage to get the full overview of the service that I was hoping for, but I can easily get back in touch to clarify and get more information at a later date.

I still haven't had time in 'my' office to get the hang of what goes on. I was looking forward to time on Thursday, when it didn't seem that there was anything scheduled. At the end of Wednesday, however, the DSNs mentioned that they wouldn't be around on Thursday because they were attending a study day on Type 2 Diabetes, so of course I asked if it would be suitable for me to attend, which it was. So that was where I went on Thursday.

It was a full day of talks from various doctors, nurses and researcher, but Ben Goldacre's views were thoroughly borne out when it became clear that the sponsor's products were featured heavily. It was useful to me anyway, because my knowledge of Type 2 and its features and treatments is a bit flaky. One of the strongest non-pharmaceutical messages that was delivered was that if you are diagnosed with diabetes and continue to smoke, then your risk of death is so enormously raised that if you understood the probabilities you would be thoroughly shocked. Maybe even shocked enough to stop smoking. I don't remember the numbers, but maybe I'll look them up when I get a spare minute. I have no idea when I will ever get a spare minute again.

I saw patients on Friday, which is my 'short' day, so I was home early. I had foolishly suggested to Mr A that we might go out on Friday night to a gig in which a friend was playing, and he was quite keen. I, however, had come to regret the suggestion and would have paid a considerable sum including body parts to be allowed to stay at home on the sofa. We went out, it was good, we came home very late indeed, and I slowly recovered over the course of the weekend. Then the working week started again...

What I've been reading

A Fatal Inversion
by Barbara Vine

narrated by William Gaminara

"In the long, hot summer of 1976 Adam, Rufus, Shiva, Vivien and Zosie are camping at Wyvis Hall. They don't ask why they are there or how they are to live; they simply scavenge, steal and sell the family heirlooms. Ten years later, the bodies of a woman and child are discovered in the Hall's animal cemetery."

I found this a rewarding experience, given my previous failures to choose suitable reading material (and I am looking warily at the last two books on my shelf from the 12 Books of Christmas from last year). The pace was good, it didn't confuse me with its characters or its flashback narrative, and I completely failed to anticipate what would happen. I had chosen it in the category of 'crime fiction', which I suppose it is, because you are told who the guilty parties are quite early on, it's just you're not sure exactly who's been killed and how. I'd certainly read another of hers.

How to be a Woman
by Caitlin Moran

"It's a good time to be a woman: we have the vote and the Pill, and we haven't been burnt as witches since 1727. However, a few nagging questions do remain. Why are we supposed to get Brazilians? Should we use Botox? Do men secretly hate us? And why does everyone ask you when you're going to have a baby?"

Most of this book was about stuff I'm not interested in reading about - what society thinks about what women are and aren't interested in: feminism, periods, shoes, childbirth... Even the chapter that nearly corresponded to my own feelings about weddings wasn't enough to redeem the whole, even though she has a good turn of phrase. I know I should be reading more of the Forsyte Saga, because that always restores my faith in the pleasure of good writing, but it is too heavy and long for my current holiday mood.

The Third Man
by Graham Greene

narrated by Martin Jarvis

"The British chief of police in a divided post-war Vienna is investigating the death of racketeer Harry Lime. Rollo Martins, a writer of Westerns, arrives in Vienna to visit his old school friend Harry, and gets inextricably involved in the mystery."

This only takes about twice as long to read than the film that was made of the story, a surprisingly short book, beautifully read by the master narrator Martin Jarvis. Audible only sells two Graham Greene novels, and it should get some more.

The Color Purple
by Alice Walker

narrated by the author

"As a young black woman living in 1930s Georgia, Celie faces constant violence and oppression. Her story is told through a series of letters written firstly to God, and then to her sister Nettie."

At last, an engrossing and diverting book of quality. I hesitated to buy a book narrated by the author, because while authors are good at writing they aren't always good at narrating, but this was outstanding. Beautifully written, beautifully read, a story including some terrible subject matter but told with respect, subtlety and positivity. A joy to listen to, and unlike so many books I have read recently, I was sorry when it ended.

Tuesdays with Morrie: An Old Man, A Young Man, and Life's Greatest Lesson
by Mitch Albom

narrated by the author

"Knowing Morrie was dying of ALS, or motor neurone disease, Mitch visited Morrie in his study every Tuesday, just as they used to back in college. Their rekindled relationship turned into one final 'class': lessons in how to live."

This is a really short book, and I'd read some very powerful reviews that prompted me to download it. Yes, it is good, but not THAT good.

Bad Pharma
by Ben Goldacre

"Doctors and patients need good scientific evidence to make informed decisions. But instead, companies run bad trials on their own drugs, which distort and exaggerate the benefits by design. When these trials produce unflattering results, the data is simply buried."

Dr Goldacre writes very passionately and persuasively about the subject, but it is one that I find very tricky. As well as outlining the shocking distortion and withholding of the results of clinical trials, he also describes how healthcare professionals ought to behave in respect of their relationships with drug companies - basically, to steer clear of them in most circumstances. It is a situation, however, where the journey from here to there seems too difficult. If I want to go to a conference, it is highly unlikely that my NHS Trust employer will fund my attendance, but one of the drug companies might. The author's proposition is that industry would not spend its cash on this type of thing if it did not prove profitable overall, i.e. produce higher sales of a company's products. However, I am not a prescriber and have very little influence on pharmaceutical spending, so perhaps I can take the money? There is a training course that I would have attended if I had not left my last job, but the fee is more than £2,000. My colleague RSB was funded by a pharmaceutical company; I applied to the hospital charitable funds as an alternative, so there is a way forward, I suppose. It's certainly a complicated situation, and the problems are so deeply embedded that it is unlikely to be resolved for a long time, if ever. A recent editorial in the BMJ suggests some progress in Parliament, though.

Swan Song
by John Galsworthy

"After years living in America with his mother Irene, Jon Forsyte is excited to be home and can't wait to show off his roots to his new bride. When Fleur Mont, his first love, hears of his arrival, she doesn't know what to feel."

I did return to the Forsyte Saga, which title I have found out refers to only the first trilogy; this second set of three books is officially called 'A Modern Comedy' and the whole thing including the third volume is 'The Forsyte Chronicles'. On holiday with time on our hands in the evening when the pistes are closed, I devoured it in no time. I don't think there's quite as much meat on the bones in this episode, but his description of Fleur's ambition and her devious plan is excellent. I have read that this is the end of the story of Soames and Fleur and Jon; the third volume deals with other cousins, but I'm looking forward to it nevertheless.