Being prepared

Adhsithana, July 2019

A lot seems to happen between each of my two-day working weeks, and going back to work on Monday after nearly two weeks away it felt like I'd been gone for a lot longer. Our Consultant was back to lead his multi-disciplinary clinic with me and the nurses, still by telephone, so we spent the  first part of the day going through the list and deciding who was going to contact which patient.

It felt good to have something constructive to do, because the edicts coming from the Dietetic department (often with the rider NO EXCEPTIONS) still forbade any outpatient clinics, leaving me with no patients and nothing else to do. And at lunchtime the doctor had brought in some games for us to play! He is a big games fan, so he brought three different types, each fun in itself but each with an educational purpose as well. One was about collaboration and communication, another about multi-tasking and working under stress, and the third was about interpreting non-verbal communication. It certainly made a change from the usual inane chatter about what has been on TV and the latest rumours about lockdown.

Occasionally a patient is allowed to come and see one of us in person, in which case we have to get fully togged up in uniform, mask, gloves and apron and everyone else keeps out of the way. Afterwards all the surfaces in the room and door handles in the building are wiped down. At lunchtime we sit as far from one another as possible. We are all still well, and our colleague who was stuck in India is still stuck in India.

On Tuesday I'd had enough of the enforced inactivity, and wrote a slightly terse note to my team leader saying that I was going to be telephoning patients whether she liked it or not, seeing as they still have diabetes, some of them still need a bit of help,  and I had literally nothing else to do. My colleagues still have their clinics, and when they identify someone who would benefit from a dietetic consultation it seemed quite wrong to tell them that I can't do it. Luckily this produced an acknowledgement that this did seem to be an appropriate use of my time, so I've got the green light for doing at least part of my job.

My uniform was delivered to the Ward Dietitian, and the Inpatient team identified that her Dietetic Assistant was off sick so I might actually be needed to support her. So I trotted over to pick up the uniform and find out more. She has no patients either and is as grumpy as me about all the outpatient appointments for cardiac rehab being cancelled. I'll give her a call on Monday to find out whether there's anything there for me to do by then.

With all the criticism I see online about arrangements within the NHS, it seems that the Trust where I work is relatively well prepared. I don't know about Critical Care, but elsewhere there is PPE and we are told that there is still capacity for the predicted surge in cases, and ventilators at the ready. There was a Panorama team at the main hospital who broadcast their documentary on Monday, which seems to support my impression of preparedness. And our photocopy room is full of boxes of donated pots of porridge, Snack-a-Jacks, Dorritos and Easter eggs.

Flattening the curve

Juma Lake Inn, Amazonia, April 2019

What with work only being two days a week, I have a lot of time confined to Lola Towers except for my one exercise break a day. I signed up to the zombie-based Couch to 5K programme and it's going pretty well, as it's quite easy to find time for a run three times a week, and on the zombie-free days I usually go for a walk somewhere local, especially in this lovely weather. That was fine for three weeks, then I unexpectedly discovered that you have to pay to continue so I have reverted to a different app. I do miss my zombies, though.

Shopping for fresh goods is no more than once a week, and for two weeks I had a HelloFresh food delivery. The first one was because they offered a hefty discount, and the second was because I forgot to cancel after the first. I'm still on the calorie-restricted diet, which has been quite tricky with the HelloFresh meals because they are pretty rich. I've had to divide their recipes for two meals into three and in one case into four to get them to fit into my daily calorie budget, but it is getting slightly easier to manage and I'm not feeling hungry absolutely all of the time, which I was at the start. Weight loss is only a paltry 1 kg in three weeks, but at least it's going in the right direction and I think it is sustainable.

Along with cooking and running there's been quite a lot of online activity with this great communication tool, Zoom, which nobody seemed to know about a month ago but now we are all experts. I've had Zoom meetings for dinner, three times for games, for several sessions of Buddhist meditation and discussion and team meetings, and for a tour of four paintings in the National Gallery led by Lola II. At one point I actually felt I'd had enough of this social activity and was longing for the old days when I could be properly anti-social. Now everyone knows where you are: at home.

Sometimes there's extra online time with mum now that our remote control system is working nicely. I'm still grappling with the task of changing my email address and passwords with about a hundred different people and organisations - alphabetically I've reached the letter M so still some way to go. I've got my DVD subscription and I'm also ploughing through all the episodes of Friends and ER, although I don't like sitting watching the TV for too long. And, due to my pestering mum about the food in her kitchen cupboards I found myself in possession of nearly a kilogram of out-of-date ground almonds, so I've made a couple of cakes and taken them to work.

But I'd say the Buddhism has taken up the most time, all via Zoom or YouTube. On Mondays our study group continues, on Tuesdays it's the local group and on Thursdays I can join a meeting with the Birmingham group if I want to. One weekend there was a day-long online retreat (we weren't online all day - that would have been exhausting). Another weekend there was a seminar for people like me who are involved in the organisation of groups, all about the different ways to take our groups online. And I also watched a public ordination, where an individual became a member of the Triratna Order and took on a new name, all within the confines of the current social distancing restrictions. And I'm meditating regularly, which helps with the confinement.

For the first time in ages my list of Things To Do is getting shorter rather than longer, and I've got out some old jigsaws. Of course what I ought to be doing is going through the stuff I put in the loft to get it out of my line of sight, which worked so well that I've hardly thought about it until now. Maybe next week. And there's the garden, which I thought would be so manageable with the help of a gardener, but I'm back on my own again and it just keeps growing.

Too much information

Rio de Janeiro Botanical Gardens, April 2019

So we finish another week of 'lockdown'. I'm not finding it difficult or stressful at all, but I seem to be a lucky soul in not getting anxious about things that are out of my control. And even things that are within my control don't bother me that much either. And I'm not exactly locked down, what with having to go out to work two days a week.

At work, I'm getting bombarded with information from all sides that changes almost every day. The Dietetic Department must be one of the most well-organised in the hospital. We have two joint Managers who are excellent, not that I see them more than once a year. From the first sign that arrangements within the hospital would very likely change dramatically over the next weeks and months, the whole department began to change in anticipation.

Face to face consultations stopped first in favour of telephone calls, shortly before all outpatient clinics were stopped. This had two benefits. Firstly there was less for the department to do which was helpful as some staff were already self-isolating,  Secondly, all those whose jobs included outpatient work were suddenly available, and they were put to work in formulating operational procedures in four strands: Critical Care, Non-critical Inpatients, Outpatients, and Community.

Everyone in the department was assigned to one of these teams . Except that I seem to be in two teams: Inpatient and Outpatient.

I had a call at home from one of the Inpatient leads, telling me that I would be required on the wards at the hospital where I work, which is not where all the Covid-19 cases will be. At my hospital we will be taking everybody who doesn't have the virus who has been displaced from the other hospital. I left my post on the wards about seven years ago with grateful thanks, but this is the situation now. It was agreed that I would need an update, so I arranged to go and meet the current ward Dietitian.

In the meantime, I successfully argued that there wasn't much I could do to help, so they might as well allow me to carry on doing my clinics (over the phone) until after Easter. But when I arrived at work on the following Monday, my clinics had been cancelled anyway. This left me with absolutely nothing to do, and then I was told that I was actually going to be in the Outpatient team, maybe as well as the Inpatient team. But there was still nothing for me to do, except for reading all the emails that contained all sorts of policies and procedures and spreadsheets and guidelines and drafts.

At the same time as all this, we were getting frequent updates from the top level Trust management team. The latest was a change in the policy for wearing Personal Protective Equipment (PPE) - a mask would now be required for any type of patient contact, even in outpatients. A few patients are still going to be coming to the Diabetes Centre in person - it isn't possible to start someone on insulin over the phone, for example. In case you were wondering, there's been no sign of uniforms yet. But we are all going to get an Easter Egg, so that's nice.

I spent an hour or two with the ward Dietitian, a young man that I didn't know who was covering for the usual Dietitian's annual leave. He had nothing to do either, so it didn't feel too bad to take up his time reminding me of the calculation for tube feeding, going through the specifications for different nutritional supplements, hospital policy on drug charts, menus, meals and snacks. Nothing significant has changed in the last seven years but a lot of the detail was different, and on the whole, better and more organised.

So I'm supposed to keep an eye on this torrent of emails while I have time off for the visit of a cousin who is now not coming, and after Easter I have no idea what I'll be doing. The Consultant's Diabetes clinic is still going ahead (by telephone) so my preference would be to do my actual job, but who knows if this will be allowed. The Consultant himself has been tested for the virus and found positive, but he has now recovered; there is talk that we might eventually be tested but we are low on the list of priorities so it won't be soon. So far, my immediate colleagues and I all remain well.

What I've been reading

The Mitford Girls: The Biography of an Extraordinary Family
by Mary S. Lovell

"Even if the six daughters, born between 1904 and 1920, had been quite ordinary women, the span of their lives - encompassing the most traumatic century in Britain's history - and the status to which they were born, would have made their story a fascinating one. But Nancy, Pamela, Diana, Unity, Decca and Debo were far from ordinary."

I now know a lot more about this interesting and privileged family. There was a son as well, Tom, who was killed towards the end of WW2; Nancy was unlucky in love, made her home in France and became an author, Pamela married happily and seemed to act as a bridge between politically opposed sisters. Diana's second husband was Oswald Mosley, leader of the British Union of Fascists, and they both spent many of the war years in prison; Unity was a close friend of Hitler and shot herself when war was declared because of her divided loyalties (she died a few years later). Jessica's politics were on the other end of the scale to her older sisters and she ran away to the Spanish Civil War with a cousin whom she married, and then made her life in America and joined the Communist Party, and Deborah married a man who became the Duke of Devonshire when his older brother died and devoted herself to the upkeep and running of Chatsworth House.

Why We Dream: the Science, Creativity and Transformative Power of Dreams
by Alice Robb

"Dreams aren’t just random events; they have clear purposes. In essence, we cannot learn without them, nor can we overcome psychic trauma. the author draws on fresh and forgotten research to show why dreams are vital to our emotional and physical health."

I bought this because dad has long been wanting to read about dreaming, plagued as he is by dreams that are often unpleasant. I didn't come away with much memorable information except what I suspected: that the brain carries on working while we're asleep and sometimes resolves issues that we were tussling with while conscious. The author is a little obsessed with lucid dreaming - it has clearly given her a lot of pleasure - and spends a little too much time trying to convince the reader to try it. I look forward to seeing what dad thinks when he's had the chance to read it.

Christmas Pudding
by Nancy Mitford

narrated by Kristin Atherton

"The formidable, fox-hunting-obsessed Lady Bobbin has put together a Christmas house party at Compton Bobbin, including her rebellious daughter, Philadelphia; the girl's pompous suitor; and an aspiring writer whose deadly serious first novel has been acclaimed as the funniest book of the year, to his utter dismay."

I've been trying to work out why I find Nancy Mitford's books so satisfying. She has a style slightly similar to others who were writing of the same period, whom I also like - P. G. Wodehouse, Evelyn Waugh - so maybe it's the period that I like? The principal character in this book is of humble birth placed among the upper class under false pretenses, but where Wodehouse would use this to build a tower of cards that threatens to topple at any moment with disastrous consequences which somehow are averted, here the character is happy to confess his status as a normal person would, which makes the plot much more realistic and her characters more relatable. Her books are not too long (less than 7 hours for this one), and she has a characteristic way of building the plot until there seems no time to straighten everything out, but she then ties off all the loose ends and winds it up in a single chapter. It was one of her early books and not as good as The Pursuit of Love or Love in a Cold Climate, but still well worth the time.

Gastrophysics: The New Science of Eating
by Charles Spence

"Why do we consume 35% more food when eating with one more person, and 75% more when with three? Why are 27% of drinks bought on aeroplanes tomato juice? How are chefs and companies planning to transform our dining experiences, and what can we learn from their cutting-edge insights to make memorable meals at home?"

The book promised more that it delivered, due to the slightly smug writing style and the strangely unengaging content. For example, I was interested in the idea of tomato juice being popular on aeroplanes, not least because that's my preferred choice on a plane, but despite having read the chapter I can't even remember what the conclusion was. It was all so forgettable that I can't remember anything at all of the contents a day later, except that the author is mates with Heston Blumenthal and likes to make sure we know it.

From the inside

Rio de Janeiro Botanical Gardens, April 2019

It seems there has been no topic of conversation other than Coronavirus and Covid-19 for a long time now. At work, even though we are not in the main hospital where cases will be treated we are closely involved in various aspects of the situation which is changing almost by the hour. And again I am sure things will be different when I complete this post compared with when I started.

Among the daily briefings, we are also reminded frequently of the social media policy, and the requirement not to spread rumour or misinformation. So I will be sticking to only those aspects that I have personally experienced.

The Monday after I came back from skiing was a day when we normally have a Consultant's clinic - about 30 patients are seen by Diabetes Specialist Nurses and the Consultant, and I pick out as many as I think need my input (or are brought to me by the team). The Consultant in question is only a part-time Diabetologist; the other half of his job is in Acute Medicine, and that's where he was needed that morning and for the foreseeable future. We managed without him - there were a few queries that he had to deal with afterwards, but subsequently it became clear that all face-to-face appointments would now need to be changed to telephone consultations.

My colleagues spent much of the rest of the week (while I wasn't there) phoning patients to tell them not to come in, and most patients were happy about that. This has been a huge administrative task, made more difficult by the fact that everyone in the hospital was having to do a similar job, which must have overloaded the phone system because it was taking two or three attempts to make a successful phone call, especially to mobile numbers. And nobody could get through to us - the phones just cut out. When I tried to contact the department I had to text my colleagues on their mobiles.

Many of those members of staff with chronic health conditions have been sent home. Many are working from home, or at home but not working, or coming in at odd hours in order to fit in with childcare. The Dietitian who does the other half of my job has asthma, and inexplicably (to me) she has been recalled to the other hospital (where all the cases are) rather than staying put in our deserted Diabetes Centre. The Dietetic Managers are putting out bulletins twice a day to keep us updated as things change.

Of course, nobody is calling for more Dietitians to deal with this crisis. Nurses who have long since left ward work or who have never worked on a ward are being asked to follow some online training to get them up to speed, and anyone with experience of Intensive Care is in great demand. But Dietitians do have a role in Intensive Care and on the wards, and it is possible that I will be required to re-learn the nutritional support role and be transferred over to help out. But thankfully, not so far.

Monday

We are a teaching hospital, and on Monday I had a student with me for my first day of telephone consultations. We don't have phones with speakers, but I improvised with a phone that is used for language interpretation services that has two handsets so she could listen in. It was better than nothing, but highly unsatisfactory because unlike when people come in person, we had no blood glucose results or food diaries to work with. And nothing that the student could possibly contribute to.

For most people I spoke to, the conversation went along the lines that either 1) they had enough on their hands with working from home with their children sent home from school and running wild around the house, or 2) I emailed them a food and insulin diary for them to complete and email back so that we would actually have something to talk about another time.

Tuesday

The next thing to happen was uniforms. In the Diabetes Centre most of us don't wear a uniform, and Dietitians don't actually have one. In the new world order we are to get some, and in the meantime we are to have separate clothing for work, changing when we arrive and depart, and washing the work clothes separately. On the first day of this regime I arrived at work in my civvies only to realise that I'd forgotten the bag with my work clothes at home. It didn't matter that much because all our patient contact is over the phone and nobody is actually supposed to come for appointments. It will matter more if I am called upon to work on the wards. And it will be interesting to see what the uniform will look like.

One of my younger colleagues (she's still in her 30's) was given a tunic and a dress when she joined the Trust, which she's never had to wear. The tunic is fine, but the dress is too long for her, so she brought it in and asked me to shorten it for her. I was happy to do it in exchange for a bag of pasta.

Wednesday

Blissful relaxing day off work, where all I have to do is record my meals and stay within my calorie allowance, achieve my step goal, blog, phone friends and relatives, and continue the brave plan to try and change my email address and password with the hundreds of sites that I am signed up to. I am trying to implement a more secure password system called LastPass, and am in the phase where it is much more difficult than my old memory-based and paper-based systems, but I expect it to become easier soon.

I had high hopes for TeamViewer, which is a remote desktop control package that I briefly used to link to mum and dad's computer to help them out before it refused to run any more on my old laptop. It worked like a dream on the new laptop - until the Powers That Be decided that I was a commercial user and stopped it working unless I paid a fee. I appealed, twice, and they relented, so I was able to renew the London Congestion Charge dispensation based on dad's Blue Badge.

Thursday

I get a message from one of my Diabetes Nurse colleagues - she's heard on the grapevine that all Dietitians were being told to work from the main hospital. I prepare a host of reasons why this makes no sense in preparation for a discussion with the Dietetic Manager, who tells me that this edict has not come from her and is not true. However, she told me that all outpatient clinics are being cancelled with immediate effect, even those that have switched from face to face to telephone consultations. I successfully argued that at people are still needing help with their diabetes, and anyway there really isn't anything else for me to do at the moment. I was given a two week dispensation, so my clinics are still running up to Easter.

Friday

A colleague texted me to tell me that I had to specify the size of my uniform today without access to the samples, and gave me a few hints on sizing - the tops come out big, the trousers small. I didn't realise I was going to get trousers; I thought we would be using our own. I have no idea how long it will take to arrive, but I'm looking forward to it - no more having to decide what to wear each day.

I heard that a colleague who worked a night shift arrived at a supermarket for the 'NHS worker' time slot in the morning where many non-NHS people were already queueing to get in. The NHS workers were heckled and abused as 'disease spreaders' and the police had to be called. She left without any shopping.

And so the week ended, and more has happened since, but I will keep that for the next thrilling instalment. I am well, my immediate colleagues are well, none of us has had to self-isolate yet, and we are only short of one colleague who went to India three weeks ago and hasn't yet been able to return.