Transition and technology

Vounaki, Greece, June 2014

I went to a study day last week, which has sent me into a spin. It was great, it was really interesting, there were loads of new ideas and people sharing their experience, and ever since coming back I have been vacillating between wanting to change the world, and wanting to keep my head down and just do my job.

In my previous career, I reached some people of influence, and feel that I made a bit of a difference in their thinking. That was on a few special occasions. The majority of the time I felt very much as though I was beating my forehead against a very solid brick wall. Not so much because of external resistance (although the resistance is always there), but because my own approach often missed the doorway, hence the brick wall. If I could only have found the way in, maybe I could have made more of a difference than I did.

It is a reflection of my own self-knowledge of what I am good at, and much more importantly, what I am not so good at. I am very good at remembering. I can do analytical thought. Give me a set of principles and I will derive pathways and outcomes, and I will make them practical, realistic and achievable. I will listen very hard, and make sure that people understand what they need to understand and try to ensure they feel supported and positive as they do so. My inherent pessimism lowers expectations, and rather than assuming "this will work" I imagine "what's the worst that could happen?" and try to make everything simple and failsafe.

But I am not a salesperson. I cannot spin the truth into a persuasive argument. I cannot achieve my own ends or the greater good by manipulating the listener out of their own entrenched position. I am no politician.

An example: the parking regime where I work has changed. Parking for 30 minutes is free; up to 3 hours is £1.60, 3 to 5 hours is £4.50 and more than 5 hours is £7.00. We run a course which lasts for about 6 hours, from 9 a.m to 3 p.m. or thereabouts. If you were coming on our course, how would you pay for your parking? Would you pay £7, or could you imagine an alternative payment option? Would you be keen to get away promptly at the end, or take the opportunity to linger to get the most out of the healthcare professionals who are leading the course?

From about 11.45 a.m. all of our course participants stop paying attention to what's going on in the room, and start thinking about getting out to their cars to avoid getting parking fines, and then up they get and excuse themselves one by one. This also happens to be the most intense period of the day, when we are covering the most difficult and yet important aspect of the subject. It's the part of the course that demands the most concentration, not the least. And at the end of the day they can't wait to get away, to make sure to avoid a parking fine.

I have spoken to the hospital management about how to avoid this disruption to our course. I have not yet found a way to convince them that it would be better for patient care to allow our participants to pay an acceptable amount in some other way. They have suggested that we restructure the course to build in a break at the critical time. I have lots to cover and little enough time as it is, and giving them a 15 minute break just makes everything run late. I haven't even been able to persuade my colleagues to support me in my one-woman campaign.

Anyway, this is just an example to demonstrate that my powers of persuasion are weak and ineffectual. Attending a study day that highlights all sorts of ways that we could improve our service just makes me tired, because improvement implies change, and persuading people to change is not what I do best. Add to that the fact that I haven't even been in my current job for a year, so am not yet 100% sure what it is that we do, let alone whether we do it effectively or in the best way that we can. I am also working with experienced professionals who have been doing their jobs for a very long time indeed, which means that they are fairly sure of themselves and somewhat more resistant to the upstart pushing for change than they might be if they were young and dynamic and a little insecure.

Peckover House, August 2014

The study day was about Transition, which is defined as a planned move from paediatric to adult services. This is a difficult time for young people with diabetes - not only are there many physical, emotional and social changes going on, but it is a time of rebellion and trying to fit in, hormones are raging, they may be changing schools, moving to university, getting a job for the first time, leaving home, having new experiences including sex, drugs, alcohol, tattoos, piercings, gigs and music festivals. Where does long term management of a chronic disease fit in? What is the role of the parent in managing or giving up control of blood glucose monitoring and insulin administration, and who is in charge - the adolescent or the parent? And what about leaving behind healthcare professionals you may have known all your life to attend appointments with a brand new team of complete strangers?

Let me be clear. I have no idea whether we run transition well or not in our service. I know that one of the Diabetes Specialist Nurses attends a transition clinic over at the main hospital, but I don't really know what goes on; I am not involved in any way. So should I be involved? One of the speakers made the valid point that those who are diagnosed as children may actually have a poor knowledge of their condition because most of the education and help was aimed at their parents. They may be going through a pretty tough time as adolescents, and are not likely to want to attract a whole lot of attention to a health condition that is difficult to manage at the best of times. So if we aren't helping them through this and we could be doing better, then surely we should try harder?

And then, I think, why don't I just do my job and keep quiet? Nobody will thank me for getting involved, I don't really know what I'm talking about, I don't even have two years of experience in diabetes and know virtually nothing about paediatric care.

As well as the technical aspects of the transition service, the day also covered a new approach to insulin dosage for Type 1 Diabetes based not only on counting grams of carbohydrate but also fat and protein. We heard about a project in Scotland which has developed some really interesting and useful materials for use in transition clinics. There was also a focus at this study day on the world of young people and the use of social media in the management of diabetes.

This social media and technology that young people are so comfortable with - well, the building where I work doesn't have wi-fi cover. We don't even have a mobile phone signal to speak of, and I don't have a work mobile phone. Our computers are so old that the operating system is no longer supported by Microsoft, and locked down so tightly that many useful websites either fail to display properly, or we are simply prevented from accessing them. The idea of using Skype or Facebook or Twitter or even text messages to improve the service we provide is laughable.

We were told that Pinterest and Instagram are the rage, Facebook is a bit old but Twitter can be quite useful. On the back of this, I have now set up a Twitter account and 'followed' a very select few diabetes-related people and organisations, but so far it has matched my expectations (which were very low). I haven't learned anything useful or gained insight into the lives of people with diabetes, but it's early days and I'm not even sure I understand what it's all about yet. And of course I can't do anything with it at work - it's blocked on the PC, and there's no mobile phone signal so I can't access it on my phone.

One of the diabetes consultants has been identified as an Innovation Champion for the Trust. That is the obvious place to start, talking to this doctor about what might be possible, realistic or necessary. But I am still in two minds. Perhaps I should just keep quiet and do my job.

Temperate House, Leamington Spa, October 2014

Kwells are my friends

September 2014

In case you weren't aware, and why should you be, 'Kwells' is the brand name for hyoscine hydrobromide, also known as scopolamine, and a remedy for motion sickness. And what's more, from my limited experience (one dose), it appears to work. After the unexpected but debilitating nausea I experienced during my first glider flight, I crowd-sourced suggestions via Facebook and was advised of the Kwells option. I don't much like taking medicines, but rather than endure prolonged nausea or forego a free flight, I decided to give it a go.

On my first visit to the gliding club with Lola II and Mr M, we were very much the honoured guests. We weren't made to do any work, we could sit around in the clubhouse or outside, enjoying the warm day and chatting to various people who wandered past and introduced themselves. This time, I was advised that I really should turn up at the start of the day and put my name on the list to fly and attend the morning briefing. So that's what I did.

Getting there at 9.30 I was among the last to arrive - many had already been there for more than an hour. They set up the airfield layout (which depends on the wind direction), sited the winch half a mile away across the field, got the planes out and checked them over, and probably did a load more things I'm not aware of. I was wearing trainers and it was strongly suggested that I'd need more waterproof shoes, so after the briefing I nipped home and changed.

I understood about half of the briefing - the bits where people volunteered for jobs and verified that they'd done the necessary checks and visitors were introduced and specific requests were made for assistance and people were asked to pay fees they owed. The technical stuff went right over my head - weather and wind forecasts and likely thermal activity and some more information that I have no idea about.

I was looked after by Phil, who is a most congenial character, and didn't hesitate to share the most scurrilous gossip about other club members. Like why the catering we had enjoyed at my last visit had changed to basic self-service - it was because of an argument about cake (yes, really) but nobody liked the member who had made all the fuss so nobody minded that the committee had judged him to be at fault, and his wife had withdrawn her catering services in a huff.

I was the only woman there except for a lady in the office who didn't seem about to do any flying. All of the members were extremely welcoming, and told me all sorts of stories at the drop of a hat. Some of them were decidedly peculiar (the people not the stories), but I'd rather feel welcome in the midst of some peculiar people than be ignored (cf. local Diabetes UK group). I found out a great deal about the technicalities of flying, including the advantages and pitfalls of using a winch for launching, a bit about how people are taught to fly, how instructors are trained, how the cables for launch used to be steel and are now synthetic, what can happen if the cable breaks during launch, and some safety procedures. I also found out a great deal about the personal lives of some of the members, local politics on motorised gliders, and how to acquire a large amount of wood for a Guy Fawkes bonfire.

When it was my turn to fly, Phil did a quick recap of the instrument panel and reminded me how to bail out, and we were off. The launch was as quick and violent as I remembered, and my stomach lurched ominously, but once we were up I felt fine, and was able to do a lot more this time. A couple of times Phil let me have full control, only taking control back when it was clear I was having a bit of trouble coping with the many different streams of information from the attitude of the plane to the instrumentation. As I said when we were back in the clubhouse and someone asked me how I got on: "I seemed to manage OK, and nobody died."

Conditions were not brilliant. The weather was grey, the wind was gusty, and Phil said that it was a difficult day for flying. Nobody was up for very long because there was no thermal activity at all. My first flight was ten minutes - the previous time it had been thirteen - and Phil gave me a chance to have another go but we only managed eight minutes airborne, mostly because he was letting me do a lot more of the flying that time and it takes more expertise than I possess to actually stay up for very long.

After the flying, I went down the field and had a look at the winch working, and then to the control tower (actually a computer on the top deck of a stationary double decker bus) where everyone's flights are logged. Nobody that day had flown more than 15 minutes at a time, so I didn't feel too bad about my efforts.

Although they all hoped I'd be back, I won't be returning, because there's just no time in my life for the commitment. It isn't the sort of hobby you can do in less than a day at a time, because there are a lot of jobs that need to be performed in order to allow people to fly safely, and it wouldn't be polite to turn up and expect to fly and go home again. Apart from all the setting up at the start of the day, there are at least five people needed for a launch: one to signal, one to hold the glider horizontal, one in the control tower/bus, one at the winch, and in my case, an instructor too. Someone also needs to drive the truck to bring the cable back after a launch and drive out to a glider once it's landed to tow it back to the start. Then all the kit and caboodle needs to be put away nicely at the end of a day.

It was a very interesting day, learning all about the technicalities of flying and many things I hadn't even considered before - trim, air brakes, flaps and rudders, wind speed, air speed and ground speed, waves and thermals. Maybe when I retire I'll come back to it.

She flies like a bird...

Gliding, September 2014

The last two weeks have been frankly, ridiculous. I don't know why everything had to happen all at once, but it did, and if I hadn't had a blog post about my reading in the pipeline last week you wouldn't have heard a peep out of me.

So, first, my glider flight. This was a birthday present from the lovely Mr M and Lola II, and replaced the one that had to be cancelled in Lincolnshire because of the high winds. Lola II and Mr M took me to a nearby airfield, and we were welcomed at the Clubhouse by all sorts of friendly people willing to share their stories while they addressed some sort of problem with the glider. There was another visitor ahead of me in the schedule, so we had to wait quite a while, but the weather was pleasant and warm and we could have a bit of a chat and watch the launching and landing procedures.

The gliders at this club are launched by a winch rather than being towed up by a plane, and it is quite spectacular to watch. In just a few seconds you go up at a 40 degree angle from zero to sixty miles an hour at 1200 feet. Barry gave me the safety talk and went through the instrument panel before I strapped on the parachute and climbed into the tiny cockpit in the front. It was all dual control, and the flight was designated a 'trial lesson' so in theory I would be given some flying to do, but Barry did ask me to keep my hands away from the controls while we took off.

So far, so good. From this point onwards, however, it didn't go so well. I was rather looking forward to the take off, as I have no problem with acceleration in normal planes or on motorbikes. Unfortunately, as we were thrown up into the air, my stomach somehow didn't go with us, and within just a few seconds after being launched I started to feel very sick. As we circled on a thermal, Barry talked a bit about what he was doing and I directed the fresh air blower into my face and tried very hard to think about something other than the nausea.

The scenery was pleasant but the sensation was not. Barry let me have a go at driving for a second or two, but very soon it was time to land, and to be honest, I wasn't sorry. With nowhere to throw up except on my own lap, I was really glad to have avoided that outcome. Barry marked up my log book - we had been in the air for 13 minutes, although it felt much longer. Lola II was ready to protest at the short duration of the experience, but I reassured her that it was fine, and please don't make me go up again...

I couldn't eat anything for the rest of the day. Advice via Facebook and from friends suggests I could have a go at using the very effective motion sickness treatments available over the counter, because the package includes a second flight within two months. We'll see.

Then the two weeks of mayhem started. Within these two weeks: I went to the Diabetes Education Club at Warwick University, where my colleagues gave a talk to a group of interested health professionals (Doctors, GPs, Nurses in GP practices and Dietitians) about the very low carb diet options that we offer patients; I spent two days in London being trained as a DESMOND educator; my oldest friends from school came to visit; I participated in a public meeting organised by the local Clinical Commissioning Group and Diabetes UK to consult service users about what they want from their Diabetes Services; I went to a comedy gig to see Marcus Brigstocke at Warwick Arts Centre; I attended a branch meeting of the West Midlands British Dietetic Association all about the gastrointestinal tract and various disorders that can arise; another friend came to stay before going to a show at the NEC up the road; I have played in a badminton match (we won!); I have been to see a film and done two runs of about 30 minutes each. I have also renewed the car insurance, and been to the optician. The car has also celebrated the milestone of reaching 200,000 miles by starting to act a bit flaky if it's left without being used for a day or two.

All of these things were worthwhile, satisfying and mostly enjoyable (except for renewing the car insurance, which is one of the most painful and frustrating tasks in the whole world). The one I was looking forward to the most was the optician, and over the next week or two I shall be trying out different contact lenses, followed by receiving my new, varifocal glasses. As an indicator of advancing age this step is unwelcome, but in terms of being able to read comfortably again, I am looking forward to it immensely.

What I've been reading

South Riding
by Winifred Holtby

narrated by Carole Boyd

"In this rich and memorable evocation of the fictional South Riding of Yorkshire are the lives, loves and sorrows of the central characters. They are the people who work together in the council chambers and backrooms of local politics. Alongside them, however, are the people affected by their decisions."

A long book, narrated beautifully, although Ms Boyd declines to use the suggested accents for the character known as 'Geordie' and one who's clearly Scottish. This is set in the 1930's and I've been reading it at the same time as Middlemarch, which is set in the 1830's, so some nice comparisons and clear changes in social mores during the intervening century, especially around gender roles and marriage.

Middlemarch
by George Eliot

"Named for the fictional community in which it is set, Middlemarch is a rich and teeming portrait of provincial life in Victorian England. In it, a panoply of complicated characters attempt to carry out their destinies against the various social expectations that accompany their classes and genders."

Oh my goodness this seemed to go on for ever. I think it was originally published as a series of books, and it did improve in terms of provoking interest as I progressed, but it also became a bit depressing towards the end. As a work of social history it provided much food for thought, and an interesting contrast with South Riding. I'm never going near it again, though.

The Corinthian
by Georgette Heyer

narrated by Georgina Sutton

"The accomplished Corinthian Sir Richard Wyndham is wealthy, sophisticated, handsome, and supremely bored. Tired of his aristocratic family constantly pressuring him to get married, he determines to run away after meeting the delightful, unconventional heroine Penelope Creed."

She writes such delightful heroines - ingenious and ingenuous, sparky and witty, and the heroes aren't bad either. For my taste, there isn't much leisure reading that can beat Georgette Heyer, but I'm sure my taste differs from other people's. I can relax while reading knowing that I am in safe hands, and that despite tribulations and an eventful journey, all will end as it should for the hero and heroine as well as the villains.

Nature via Nurture
by Matt Ridley

"Nature via Nurture chronicles a new revolution in our understanding of genes. Ridley recounts the hundred years' war between the partisans of nature and nurture to explain how this paradoxical creature, the human being, can be simultaneously free-willed and motivated by instinct and culture. "

A previous book by this author, Genome, is one of the best books I've read, and covers the basics of genetics and inheritance clearly and concisely in a highly readable way. This one is much more difficult to read and understand. It delves into the nature/nurture debate and shows that the relationship is circular: genes both affect and are affected by both nature and nurture. For me it reinforces the influence that environment has on the expression of genes, and reminds us that it is no longer believed that genes are immutable. While the DNA code does not change through an individuals lifetime, genes are continually being switched on and off in response to environmental cues as well as the physiological environment of the cell. 'Gene encodes protein' is just the starting point of the impossibly complicated dance within every cell in our bodies.