Luckier than some

Munich Botanical Garden, December 2019

It's been more than a week and I feel the pressure to report in, but also resistance to writing a whole post about what I've been doing. It hasn't included anything that I imagine would interest anyone but me. Really, look away, there's nothing here, move on. But for the sake of my dedicated readers, who remind me how much they look forward to what I write, I feel bound to put something down.

I was on leave from the diabetes job for two weeks, and so had a bit of time for Mr MXF. In my first week I did some work that would actually affect one of his customers - not a real paying customer, but an organisation that Mr MXF supports on the side with website and email management. And it was successful! It still feels as though any success is more by luck and educated guesswork than knowledge and judgement, but still, it worked. Mr MXF reported back that I had received a vote of thanks at the Trustees meeting, which makes me feel even more of an imposter. In the second week I carried on my efforts to understand email hosting and servers, without noticeable success, which makes my triumph with the real customer even more surprising. 

I did another vaccination shift, where we had to use up 90 doses before 11 a.m. to avoid having to throw them away. So I contacted my diabetes team, and they all trooped over to help out. Which means that everyone except me has had their second dose - mine is due after Easter, but I might ask nicely at the end of my next shift and I should be able to have it then.

I had a big day of Sorting Out Stuff like renewing home insurance, reviewing my broadband contract (which ends in June), having an argument with my mobile provider about itemised billing, then investigating alternatives to find I could halve the monthly cost with a different mobile supplier on a month's rolling contract. Halving the cost only means saving £3 a month, but I'm giving it a try anyway - if it doesn't suit I don't have to wait more than a month to move to a different contract. The supplier I'm leaving got in touch, as they do when you threaten to move on, and told me that I'd been with them for 21 years. I was amazed. Can you believe mobile phones have existed for 21 years?

There's lots going on with the Buddhists, as always. I now have a meditation mentor who I chat to about twice a month, and so far has given me some good advice that I'm finding very difficult to follow. (Sounds familiar? I have managed to do the physiotherapy exercises more regularly, but it's still a struggle for motivation.) My regular Monday study group has finished the first whole year of the course in just a little more than a year, and we have settled down to a regular group of nine women via Zoom. The Tuesday group is still going and has maintained its Thursday study by choosing another book to work through together.

And as well as all that, I'm still pushing for expansion to our local group. We've managed to maintain our attendance for the last year despite not meeting in person, but without continually attracting more people the group is always at risk as people drift away over time. The difficulty is that we don't have an experienced practitioner to lead us on a regular basis, and for a number of reasons it's difficult to find one. I have some ideas, but I need to take the other members of the team along with me. So that's what I'm trying to do at the moment, which is occupying much time and thinking space.

I was very hopeful of finding a better venue to meet when we are ready to do so, and one of the group did make contact with somewhere that looked perfect. Unfortunately, when we were ready to get back to them we had lost the Tuesday evening slot. So unless something unexpected happens we'll probably have to go back to where we were meeting before, where there isn't WiFi. It's not an insurmountable problem, just a bit of a challenge.

And that's it for now. There's the exciting prospect of being able to do more and go places and meet people soon, but I'm trying not to raise my hopes because all this can be snatched away at a moment's notice if infection rates rise. But going out to work in two places, and having access to Lateral Flow testing, and seeing mum and dad a couple of times a month means I'm much luckier than some.

Vaccinating is exhausting

Coronavirus Vaccination Clinic 2 (the Portakabin), March 2021

You've had to wait for it, but the answer to the puzzle of what's in the bag hanging from my clothes airer relates to the fact that due to overconsumption and lack of willpower I had to go cold turkey on chocolate and snacks. I still had quite a large supply in the house and didn't want to throw them out, which meant that they had to be more inaccessible. Hence, hanging them up out of reach and out of sight. It worked quite well.

I've done a lot of reading in the last month as evidenced by the huge blog post last week, but there's also been a lot of other activity. The physiotherapist is suggesting that the longstanding issue with my hip is probably the source of the problem with my knee, and has changed my exercises. I am finding it increasingly difficult to motivate myself to actually do the exercises. And I have attended a very interesting Zoom webinar about the Libre 'Flash Glucose Monitoring' technology in diabetes, and I wonder if my colleagues already know about the things I learned.

I have been on annual leave from that job and signed up to many vaccination shifts, some of which were cancelled. We are doing far more work compared with that first session when I was shown the ropes - enthusiastic people are coming for their second dose as well as a few unenthusiastically turning up for their first.

We are now using iPads instead of paper forms to track our vaccinations, which I'm sure saves an enormous amount of data input, but relies heavily on our systems finding the individual. This means that the NHS number is quite important, name and date of birth being surprisingly unreliable. Obviously nobody knows their NHS number, but there is a website where it can be found, and so notices were put up asking people to type the long URL on their phones. This is quite difficult, so I suggested to the people doing the clerking that they could generate a QR code, at which they looked very blank.

I've only just started to appreciate the power of the QR code, which is the two-dimensional bar code that can be scanned by a phone camera and take you to a website. It was suggested to me for a diet sheet I was writing where I wanted people to have a look at a set of YouTube videos. The diet sheet would almost always be printed and provided to patients on paper so a clickable link would be useless, and even a shortened version of the URL would still be difficult to type, so I was just going to suggest that people searched on YouTube for keywords that would take them to the videos. A Young Person (now defined by me as someone under the age of 30) who has joined our diabetes dietetic team had the great idea of using a QR code, and it worked beautifully.

Reception in the Portakabin clinic

So I went off and produced some notices with QR codes for the clerks, and even laminated them (because: infection control), and handed them over on my next shift which was more than a week later (because: cancelled shifts). I think they made life a little easier - I wasn't in the same room as the clerks for most of the time so I really don't know how they were being used. But this picture of the reception area shows one of them on display.

Proximity alarms being charged

The other innovation is a proximity alarm worn around the neck, which vibrates and/or beeps when it is within 2 meters of another proximity alarm. These are given to patients when they check in and are supposed to make sure they stay 2 meters apart from each other. Obviously staff aren't wearing them because we can't vaccinate from 2 meters away, but we have extra face shields or goggles as well as masks and we test ourselves regularly using lateral flow kits.

The hardest thing about the shifts is the need to be standing up for six hours (with half an hour allowed for a break). The shift starts early and finishes at 2pm, then this week I had my weekly shop to do afterward, and needed to make some soup while I had time and before all the veg went mouldy. By the time I'd finished all that it was 5 p.m. and I was shattered, so I thought I'd have a nap. I became conscious again two and a half hours later, had some supper and went back to bed.

Pandemic contributions

30, 000 vaccines administered, March 2021

I've done a second vaccination shift in the Portakabin, which went OK. It was a bit hectic in the morning because between 8 and 9 a.m. we delivered as many vaccines as we had in the whole of my first six-hour shift. Word was that the other vaccination location in the hospital was closed for some reason, so everyone was redirected to us. Whatever the reason, we coped. At that point I was doing the 'reconstitute the vaccine checker' role, which involves checking everything that the person reconstituting the vaccine does, so I wasn't under as much pressure as some.

Halfway through the morning we had a visitor with a cake marking the fact that 30,000 vaccines had been administered by the Trust. Despite my contribution being in low double figures, I wasn't about to hold back on tasting the cake, which was very good. I also feature in the team photograph that was taken, although I was standing at the back with mask and visor so it's unlikely I'll be noticed.

Towards the end of my shift I was sent over to the other vaccination location in the hospital to be shown the new electronic version of the paper form that we've been using up to now. It runs on iPads and allows for more flexible updating of the questions asked, e.g. people's reported reactions to the first vaccine are now being collected when people rock up for their second dose.

Another Covid-related activity I've participated in has been a survey for which I have seemingly been picked at random by the Office for National Statistics. I completed one fairly long online questionnaire a little while ago for which I was given £15 for my trouble, and then I was asked if I'd do another. This time I was not only entitled to receive another £15 but was given an ONS-branded cloth bag as a gift. 

It was an interesting questionnaire all about how my life has been affected by the Covid restrictions - practical stuff about how often I go out and what for, how my work and social life has been affected, whether I'm likely to continue with some of the changes I've made, but also how I feel and how worried I am about various things, The first questionnaire also contained a whole lot of statements for me to agree or disagree with, many of which were the myths that have been circulating (e.g. 5G masts giving you Covid). It was an interesting glimpse into the Government's data collection strategy.

If you can guess what the bag contains and why it is suspended from my clothes airer, you will be awarded points. And we all know what points mean.

Nurse Rosenberg

Here we are at the end of February, and I feel pretty good about how the month has gone, despite the physiotherapy exercises having done very little to improve the knee situation. Other things have been very helpful in lifting my mood, including Zooming with at least four different groups of friends, walking with another friend and his dog, and some pretty inspirational online talks.

I have completed my first shift as a Covid-19 vaccinator. It started with me going to the location on the first floor of the hospital where the e-roster system indicated I would be working, to find the door locked and everything inside looking dark. So I returned to the Portakabin in the car park, only to find that locked too, but with someone waiting outside who let me into the secret of access to the first floor ward (knock hard on the door). So I went up there again and managed to get in, only to be told that I was actually going to be working in the Portakabin. A good start.

There were about ten of us working there as vaccinators plus about four doing reception and admin on my shift, which ran from 7.30am to 2pm. Reception and admin are about checking that people are who they say they are and are entitled to receive the vaccine, answering basic questions about the process, enabling them to avoid being charged for parking, supervising them for the 15 minutes they must wait afterwards in case of adverse reaction, and setting a date for the second dose.

There are three different roles for which I needed to be supervised and signed off. One is going through the protocol and ticking the boxes on the paperwork to establish entitlement to the vaccine and any contra-indications to be taken into account - for example, people with clotting and bleeding disorders are not necessarily disqualified but vaccinators need to be aware. The second is the process of diluting the vaccine and drawing it up into syringes for administration, and the third is checking paperwork before sticking the needle in. 

The paperwork role is pretty straightforward, the main skill being remembering to ask all the questions and providing the necessary information - it takes two weeks for the first dose to reach full effect, you can still catch Covid, you need to carry on taking all precautions. Reconstituting the vaccine is fiddly. There are many, many steps - drawing up saline, mixing with the vaccine in a particular way, then getting six doses out of one vial, and timing everything to make sure no doses are wasted. When I did the first part of my training a month ago we were only being asked to get five doses out of a vial, which is obviously much easier. I got the hang of it with a bit of practice.

Sticking needles into arms was obviously the most nerve racking for someone who has always been pleased that being a Dietitian does not require you to touch people at all, and certainly never expected to be performing this role! The supervisor was really good and took things just at the right rate, and my first victim was very calm - in fact, they all were, even the one who said she sometimes went a bit funny with needles. I did get some strange flashbacks later in the evening of needles going into arms, but nothing traumatic.

The most interesting experience came when one of my victims was sitting ready to be injected, and I was running through the information he'd provided on the form. In the place where you state your role in order to ensure that you qualify for our clinic (which is for health service and associated roles only) he had written 'Transport'. When I asked what sort of transport, he said 'Uber'. So I went off to fetch the supervising nurse.

I'd been warned that the taxi drivers of the area had found out how to play the system and were presenting themselves at the clinic despite not being entitled to a vaccine. This chap had got through the reception and the paperwork stage, where I would have thought his entitlement would have been challenged, and nearly got his jab. He was turned away unvaccinated. But it does expose the weakness of a fairly loosely defined protocol operated by well-meaning health workers who are reluctant to deal with conflict. Much easier just to let people get away with it than challenge their entitlement.

This decision was made more difficult because it was not very busy in the clinic that day. We are reaching the end of the wave of first doses, and second doses are about to become available at which point it will turn busy again. We only have a certain allocation of vaccines, so it's important not to give too many first doses otherwise we will run out of second doses - hence the criteria for entitlement. I was lucky to do my first shift when I did, because it would have been much more stressful if lines of people were forming outside and there was pressure to operate quickly. As it was I had time to practise and get things right in my own way. I've now booked a day a week for the next six weeks and two days on the weeks when I'm on leave from my main job.

The latest 'road map' out of lockdown has made me feel slightly better because of having an idea of how long things will take to change, and at the same time makes me feel slightly worse because of having an idea of how long things will take to change. There is a risk of raising hopes and expectations only to be disappointed. So I'm still trying hard to take it a day at a time, finding ways to tame my increasingly wild hair, and taking pleasure in music, in visiting mum and dad, in walking, in Zooming with friends, and in films. It's hard to remember what it was like to play badminton.

Vaccination

Great Dixter, July 2020

What a week it's been.

There was a massive low point, just after I wrote the last blog post. I felt terrible, everything was awful, I very nearly walked out of work but had the sense to talk to Lola II before doing anything foolish. I'm glad to say that my brain chemistry has reset itself and I'm feeling much better, thank you for asking. My Tuesday Buddhists saw the worst of it, and they and Lola II have rallied round like troopers to make sure that I'm OK. With chocolate, in Lola II's case.

I got vaccinated. I'm not over 80 or in a care home or in the NHS front line, but I am a healthcare professional and became eligible together with every clinician in the Trust. This Trust was where the first patient in the UK was vaccinated with the Pfizer vaccine, and the 'SODA' (Surgery on Day of Admission) ward has been converted to a vaccination centre, with another in a Portakabin out in the car park. We aren't running on the scale of those mass vaccination hubs in a sports stadium that you read about, but we're working towards a target of 850 vaccinations a day.

How do I know this number? Because I volunteered to support the vaccination programme within the Trust without knowing exactly what that would entail. After doing the online learning I heard nothing, and they are understandably a bit stretched in that department, so I managed to find out that I needed to attend a training session in person, and was I a Registrant or a Non-Registrant? These are new terms to me, but it turns out that I am a Registrant because being a Dietitian requires you to be registered with a professional body - the Health and Care Professions Council, which also regulates 14 other professions including paramedics, hearing aid dispensers and prosthetists.

So with my newly discovered Registrant status I turned up for the training, which is when I discovered that I might actually be the one behind the mask wielding the hypodermic and approaching your deltoid muscle (another new word for my vocabulary). You might be lucky enough to get the paramedic, which I for one would be happy with. Not sure about the hearing aid dispenser.

A slightly-too-crowded room full of masked-up nurses with a few imposters like myself were shown the whole of the job role, which starts with administering the screening questionnaire to check for pregnancy, bleeding disorders and other eligibility criteria. Then there's the preparation of the vaccine itself, which has to be reconstituted with saline very carefully to avoid damaging it, then drawn up into syringes for administration. 

A number of steps within the protocol caused the nurses in the room to make the noise that plumbers make when they have had enough of working for you, because we are required to - wait for it - re-sheath a needle after poking it through the vial bung, and then stick the same needle, not a new one, into the mark's arm. Apparently this has been outlawed for long enough to provoke horrified glances among the nursing Registrants. Of course, I'm happy to learn bad habits without a second thought.

The actual sticking-the-needle-into-the-deltoid practice was done using a pad clipped to the arm of my practice partner. It's quite a long needle, and my only question throughout the whole process was to ask how deep you stick it in? The answer is that you have to judge for yourself based on how fat the arm is. Not really what I was hoping for. My practice partner was a bit taken aback when I said 'ow' as she stuck the needle into the pad, but she soon saw the joke.

Now my paperwork goes through some sort of process which will lead to me being able to use some e-rostering system to book a shift, where I will be supervised doing the job. And then, presumably, let loose on the punters. You can be sure I will keep you up to date on progress.

A burst of enthusiasm

Great Dixter, July 2020

I was on retreat over the New Year. Sometimes these online retreats are fairly short and easy, with perhaps one meditation together and another session with some teaching every day. This one was full speed ahead, three sessions and sometimes four every day for a week, leaving little time for anything else - which is the point, really. It helps to keep you focussed on the Buddhist life.

I did manage a couple of other activities - a second trip to the tip with all the horrible thorny garden cuttings, a walk with a new member of the local Buddhist group and his dog, and a Zoom get-together with all the friends who would have been in the house in Devon if we had been able to go on the planned New Year holiday.

So when the retreat ended and I had a whole week of stuff to catch up with, I felt glad that I'm not at work until next week. I have spent a lot of time on the computer with that New Year enthusiasm that wears off so quickly. But I'll take advantage while it's there...

It's official - Flf the plumber didn't respond to my messages in the timescale I gave him, which leaves me with a usable but not quite finished wet room. New Year enthusiasm stretched to making a series of calls and emails to try and find someone to finish the job. I had the great idea of contacting Olf and asking him for a recommendation, and then while I was at it I thought I'd start on the next idea, which is to rearrange the bedrooms upstairs. 

One of the necessary steps is to make the wardrobe in the smaller room into something more than a clothes rail. Being an organised kind of person I went back to find the paperwork for the company that had installed the wardrobe in the bigger bedroom, which was 15 years ago. Not surprisingly, the phone wasn't answered, but a quick enquiry via Checkatrade produced a response from a different firm.

Then I was notified that my request to set up remote working had been actioned. This is more a precautionary measure in case I have to self-isolate, to allow me to phone patients from home. I need access to three specific systems plus my stored files and email, and it took quite a long time to follow all the instructions, installing an authentication app on my phone, then using that to log into a remote connection, then working out how to launch the systems that I need. Two of them won't work at the moment, one because it requires a keyboard where you insert a smartcard, and another because it doesn't work on Microsoft browsers. But we're halfway there.

I also responded to a call for volunteers to assist the vaccination programme. This has now extended to Allied Health Professionals like Dietitians, but it's unclear whether I'll be trained to actually give the vaccine injections or just support the team at the vaccination hub, perhaps with paperwork or helping patients. Anyway, the first step along the path has been to complete two extra training modules on anaphylaxis and core knowledge for vaccinators, which I've now done.

Another outlet for my enthusiasm this week included a trip to mum and dad who are defined in this third lockdown as my support bubble. Each time I find my time there fully utilised, finding out the progress of our attempt to switch mum's bank account (in summary - a right old mess), helping with all types of computer things, and this time, listening to a number of dad's stories after lunch. These tend to start with plausible memories (the friend with whom dad played violin duets at a school concert, the inspirational English teacher) and then progress to less believable detail (the friend's body was dug from his grave by wild animals). But some of the medical anecdotes remain fascinating all the way through. 

I managed to forget two things, though - one was the shopping that mum had asked for, so not only is she short of the specified items but I am now the proud owner of more margarine and soft cheese than I normally eat in a year. The other, which I have only just remembered, was to change my own email address in their Contacts list. Either that will have to wait for the next visit, or we'll arrange a time to go through it remotely.

Tier 3 lockdown shower

Munich, December 2019

The electrician came! And wired up the shower and the extractor fan, but couldn't hook the fan in with the light switch because of the tiling. If Flanders and Swann hadn't written their famous song I would have thought I'm the first to encounter this sort of difficulty. The electrician also told me a very interesting fact that Flf had neglected to mention: the cable to the shower was not incorrect and hadn't been replaced after all, because it was only powering the pump and not heating the water because the hot water comes from the tank upstairs.

There's no shower screen yet, but I had a careful shower and it was wonderful, but while the water is coming through OK, the knob that ought to adjust the power of the stream isn't working. Now all that needs to happen is for Flf to come back, sort out the power setting, the screen, the ceiling, the drains outside, and the tiling (which the electrician could probably have done himself but didn't) so that the electrician can come back and finish that bit of the job. But now that I can have a proper shower standing up he can take his time and finish up whenever he wants to be paid.

Doors & Windows Ulf came! With a sidekick, and we all climbed up to the roof of the kitchen, managed to avoid falling off despite the frost, and discovered that the leak is probably caused by moss prising apart plastic layers that oughtn't to be prised apart. So I'm going to need to get up there once or twice a year to scrape off the moss, which means I'm going to need some better ladders. But with luck, no more indoor rain.

I have done some more work for Mr MXF at last, and it is still as mind-stretching as before. But I can detect some progress in my understanding of how email works, and managed to send and receive email from an address using a domain that belongs to Mr MXF. If this makes no sense to you, and there's no reason why it should, then all I can say is that I have achieved something quite difficult and am rather pleased with myself.

It has definitely been a problem-solving week: the next problem to be solved is in connection with the bank switching service which failed to switch an account that I've been helping mum with. We think we may have tracked down the problem, but that is a long way from solving it. 

And the long confinement of Covid-19 continues, with Leamington in tier 3 lockdown, and nobody knowing exactly what that means, and the weather turning proper chilly. I keep myself pretty busy with the Buddhism (Sunday, Monday, Tuesday and Thursday in the past week) and watching films and writing blogs and family Zoom meetings and cooking and cleaning and 'gardening'. 'Gardening' means chopping everything down to shoulder or waist level and leaving it all on the lawn until I can be bothered to cut it up small enough to pack into sacks and take to the tip. Running has had to stop for the moment because my knee has started to complain.

Working at the hospital has been a bit hectic as I have been allocated a student for two weeks in succession during all-day busy clinics. I have also been given some 'instant' Covid testing kits that work a bit like pregnancy tests but with nasal swabs, but I haven't had the chance to try one out yet. Apparently a negative test can be accepted at face value, but after a positive outcome you have to go and get a proper test to confirm the result. I'll have a go next week.

Risks Must Be Assessed

Stilt walkers, Munich, December 2019

I've been on holiday again, and when I go away, blog continuity suffers. I'll do my best to remember what happened before my holiday and see how we go. This post is about work, and there ought to be another blog at some point about what happened outside work and on my holiday, which was significant.

There were two students. After a lull when students were withdrawn, they're back with a vengeance - we have four, but they can't all be accommodated in the dietetic office over at the main hospital. In fact the dietetic office at the main hospital has been transformed by the introduction of screens, a one-way traffic system and all sorts of other efforts to allow safe distancing without everyone having to wear masks in the office all of the time. I haven't been there, and I hope not to have to go there (ever), but I read the emails that come round. Anyway, students. I had a different one with me for two Mondays in a row.

What with my patients as always being on the complex end of the spectrum, there is never much opportunity for a student to do much more than observe. Now we've got no patients coming in person for face to face consultations either, so all they can do is listen. We use a telephone with two handsets that's designed to be used for the telephone interpreting service. To make it a bit more interesting I asked the other team members (Doctor, Nurse) if they would mind having the students spend a bit of time listening to their consultations as well as mine, and asked the student to write a piece about multidisciplinary working, or diabetes, or really whatever they like, I don't care (I didn't tell them the last bit). It's hard work, though.

Then along with all this there was a meeting - online, with my new headset and camera - to talk about Structured Education. The Clinical Commissioning Group and DSNs and Dietitians from three NHS Trusts are working together under the leadership of a Dietetic Manager (not from my Trust) to sort out the mess that is our Diabetes Education. Actually, our Trust is not in a mess, in fact the consensus has been to pretty much adopt all of our admin processes, educational materials and methods of delivery, which a) is flattering and b) means I don't have to worry about checking through everything to make sure that I agree with it. Although I'm pretty sure that I wouldn't have done that anyway, not now. I might have done a few years ago.

The meeting took two and a half hours, plus the time afterwards for me to do a few things I'd been volunteered to do, and then we had to arrange a smaller follow up meeting to tidy things up, all of which used up an enormous proportion of my two-day week and put me well behind with the 'talking to patients' work that I like to do. There were a number of other frustrations too, but I did manage to make the point to the Commissioners that it is all very well coming up with amazing ideas for delivering education, but we don't actually have the staff to deliver it (particularly Dietitians and admin). I've made the same point up my management chain and will just leave it there.

Since then I've managed to catch up with most of my clinical work, until today when I made the mistake of opening my mouth instead of keeping it firmly shut. Last week in the multidisciplinary clinic, the doctor was quite keen to talk about bringing some people in to the Centre to be seen in person, and we came up with a possible plan for the following fortnight. My mistake was to mention this to my Team Leader, who thought it would be fine until she mentioned it to her Manager, who said, "What about the Risk Assessment?"

So in order for me to see patients face to face, the risks have to be assessed and there are Procedures That Must Be Documented and Carried Out, I gather mainly around cleaning and PPE. Of course none of these risks has been assessed nor procedures documented or carried out, so I don't know what I'm supposed to do. If we all come down with Covid-19 and sue the Trust somebody will end up in trouble, but it would have been a great deal easier if I'd said nothing and just got on with it. Anyway, I told the DSN in charge that my Manager wants a Risk Assessment and Procedures, there was much rolling of eyes and then thankfully it was the end of my working week and I went home.

For the record, our Trust has two Covid-19 cases at present, both of them in the other hospital, and neither one in Intensive Care. We have to wear face coverings when patients are in the building (which they increasingly are), and add gloves and plastic aprons when patients are in the same room, and use hand sanitiser and/or wash hands a lot, and keep socially distanced from one another. When I finish on Tuesday I wipe down all the surfaces in my room as it's used by other people when I'm not there. There are many official signs up now with 2m markings on the floor and a perspex screen for reception, and some kind of classification of Green and Blue Zones which I confess I don't understand. Luckily the Diabetes Centre is a building in the car park so we don't get mixed up in the zoning and restrictions that are in place within the main hospital building.

So that's work. I'll try not to leave it so long before writing about Not Work.

Several types of progress

Brompton Cemetery, September 2019

Lockdown is ending, and my drive to work twice a week is clogged again with other traffic going about its business once more. More shops are open although I have no desire whatever to go inside them, nor will I bother with pubs, restaurants, theatres and cinemas. The easing on restriction about meeting other people in real life is quite exciting, so I went for a walk with a friend on the hottest day of the year so far. And camping is about to be possible again...

The main bonus of fewer restrictions has been my ability to get started on the LTRP again. Ilf finished painting the front of the house, garage door and gate - I decided not to bother repainting the other sides of the house, which meant we managed to use up the last of the specially mixed paint from 10 years ago without having to buy more. I've had a couple of plumbers in to have a look at turning the shower room into a wet room and solve some of the associated drainage issues, so I hope that will go ahead soon. My gardener returned, and I even managed to find someone to have a look at the damp at the base of the pub wall. The garden is still as wild as ever, but with fewer weeds, especially in the paving. I took the bags of excess greenery to the tip, which now requires online booking for a time slot. All went smoothly.

There have been all sorts of attractive offers in the last three months for your 'heroes' of the NHS. I feel a little guilty given that I have done none of the heroic jobs; all that's happened is that all our consultations are being done over the phone, which is difficult but by no means heroic. Yet I have succumbed to the lure of 10% off shopping in Morrisons with an NHS ID card, and another offer of £10 off a box of 12 different vegan pot meals from The Soulful Food Company for anyone with an NHS email address.

I've had indifferent experiences with various 'meals in a pot' before, but these ones looked so good on the website that I thought I'd have a go. Because there are 12 different types I decided to note down any that I particularly liked in case I wanted to buy them again. The first was delicious! I decided to give it the full five stars. The next was just as good - also five stars. By the time I'd had six of the meals I'd had to introduce a sixth star, and so far only one has fallen short and even that one was still delicious. I'll be buying them again, even without the £10 discount.

I had a bit of a blip with the weight loss plan when a friend came round and we each got a takeaway wrap from my favourite brunch spot in Leamington. It was delicious, and just proves that without the lockdown I would never have achieved my current status of 4.6kg (10lb) lighter. I'm back on track again, and finding it much easier to plan meals than I did at the start. It's still a pretty restrictive diet though, and I don't see any way round that. But I can fit into clothes that have lurked in the back of the wardrobe for six years.

Stasis

Adhisthana, July 2019

Very little going on again, making it difficult to rustle up blog content. The world continues in its crazy state where there is only one topic of news, and we muse over which politician and which country has got it right in the balance between economic disaster and mortality. Actually, since some police officers murdered a man in America there are briefly two topics of news.

I am still fine. All of a sudden, blood testing for Covid-19 antibodies appeared within the Trust, and even reached the Diabetes Centre. The result came back via text message a few days later to say that my test result was negative - no evidence of exposure. Obviously this makes no difference at all to anything, but the latest government guidelines allow for meetings of up to six people out of doors, so I felt a little reassured having driven down to meet Lola II and Mr M in mum and dad's garden.

The weather was not as warm as in recent weeks but we escaped the rain. We brought our own chairs and lunch and face masks and gloves and hand sanitiser, and wiped down the toilet when we used it. The best part of the day was borrowing dad's clippers and taking my hair down to a gentle fuzz, which delights me.

I have managed to get started on a couple of LTRP jobs. In the pub garden I excavated the footings of my adjoining wall. The pub had installed decking some time ago, and laid down gravel around the perimeter as well as putting up hanging baskets with an irrigation system on my wall. Having explored many other avenues I came to the conclusion that there was a strong possibility that this was attracting damp into my wall, and that now would be a good time to do something about it, given that the pub is not only shut because of lockdown but has no functional landlord or manager at the moment, and therefore could not object to me sorting things out for myself.

I also invited Ilf to start work on painting the roof-level woodwork (I can never remember the proper term for the fancy bits hanging from the gable end roof) and the front brickwork. It was a slight misjudgement to call upon Ilf, because he assumes that if he's asked to do a job then he'll do it badly rather than suggesting it's actually unsuitable and I should find someone prepared to utilise scaffolding. The ridge of the roof is beyond the reach of his ladders, so he has basically painted over whatever state the woodwork was in with a brush on a stick or some such device rather than washing it down and checking for rot etc. It will do for now, but I must remember to choose a different tradesman if I want that particular job done properly next time.

Other than that, there really isn't anything new going on. The doctor continues to bring amusing games with him every fortnight; I play online games with Lola II and other friends; I join in various events with the Buddhists; I observe the world going by on Facebook and the news and in satirical comedy shows on BBC TV and radio; I read and listen to books and podcasts. To be honest I am not occupying my time very productively at the moment, and each week I tell myself things will be different. Perhaps this week really will be different.

Still going to work

Adhisthana, July 2019

You may remember that one of my colleagues from work was stuck in India. She was there for two months all told, but finally managed to get a flight home. The plane was full - no social distancing, although everyone wore a face mask - and although health screening questions were asked at the Indian end, there were no checks or restrictions at all at Heathrow.

So we asked the Trust HR and Occupational Health Departments about self-isolation, given that travelling in a plane is notorious for spreading infections at the best of times. They advised that as long as she didn't have symptoms she could come straight back to work. This is surprising, to say the least, but all I could do was to stay as far away from her as possible - she came back on a Tuesday so we only had one day in the building together before I had the rest of the week at home. Her situation is slightly complicated by the fact that we were advised to record Covid-19 in the personnel system as the reason for her absence, which was taken to mean that she had been ill with the virus, and therefore would now be better... Luckily for all of us, she has experienced no symptoms.

In case anyone was wondering, none of us has been tested for virus or antibodies, nor has anyone suggested that we should be. This is reasonable as we have very little contact with the public, with patients visiting the centre only for the procedures that simply can't be done over the phone. We now keep the front door locked and we have a new doorbell and a perspex screen in front of the reception desk. When any stranger enters the building we all put on face masks and after they leave the receptionist wipes down all the surfaces they may have touched. If we have to be in the same room as the visitor we wear plastic aprons and gloves as well as face masks, and we ought to wear goggles or a visor too but those of us with glasses are omitting that inconvenience. So far we are not requiring the visitor to wear a face mask. We all work in separate rooms, and when we come together for lunch we sit 2 metres apart.

I have somehow escaped the order that has taken all Dietitian back to the main hospital to work on plans for the apocalypse. Fortunately the apocalypse has not come to pass, so there are a lot of Dietitians at a loose end - I have no idea how they are occupying themselves. Every fortnight I have a very busy Monday with the multidisciplinary clinic that used to allow people to see me and a nurse and a doctor all at the same visit. As a stopgap measure we are sharing out the telephone calls to patients between me, the doctor and two nurses, and it's working moderately well.

However, all the outpatient clinics for all the Dietetic services including mine have been cancelled except for one clinic for each service. That single clinic is filled with only the most urgent cases, so I have no means of booking follow ups for patients that I want and have time to see. I have resorted to keeping a separate diary - my own offline booking system - to get round the restriction.

On a Monday when I wasn't involved with the multidisciplinary clinic I was asked to do one of the sole bookable clinics for diabetes, and it was quite a challenge especially as I had one patient whose first language was not English. I worked hard that day, and it was just as hard to work out how to record what I had done and make plans to follow up that patient. There was no point putting them back into the general clinic because then it wouldn't be me following up, and it was too complicated to just pass the patient back and forth between different Dietitians. A little while later I got a call from the admin team querying how to record the follow up for the patient - the answer being "You tell me." It would have been perfectly straightforward if they hadn't cancelled all my clinics.

Most of the time, however, we are working less hard than before.

The local community is supporting their front-line workers by providing food, which has led to a situation becoming known in the Diabetes Centre as Pizzagate. Various local suppliers are sending food to the hospital - sandwiches, snacks, chocolate and pizza. These arrive at the management offices for distribution, but there are loud grumblings of inequity - the managers are accused of creaming the best off for themselves before distributing to the wards, and we in the Diabetes Centre receive nothing. I try hard to keep out of these discussions, not least because there is no way I can fit pizza into 1200 kcal/day, but it is getting as bad as back in the days when everyone was moaning about parking all the time.

The (first) peak in Covid-19 cases seems to have passed, and now the word from the top is all about how we re-start services. We are in a good situation at the moment - wards are so empty in our hospital that the opportunity is being taken to redecorate - and we have the chance to think about how we would like to do things differently. With this in mind I volunteered to send out a call to arms to our Diabetes doctors, asking them to contribute to a discussion. Not one has responded to me, but it seems they are thinking about it. I'm not holding my breath.

Still locked down

Adhisthana, July 2019

Here I am again, in my house, walking or running around Leamington's lovely parks, or at work in the Diabetes Centre. With a weekly excursion to a supermarket, that's it. But I'm thriving. I'm eating sensibly and losing weight very slowly, but unlike previous attempts at weight loss I think I can keep this up. While I hear most people talking about gaining weight at home, it's been relatively easy (after the first couple of weeks) for me to keep to my 1200 kcal limit, and even include chocolate every now and then.

I have mowed the lawn and pruned a load of shrubs, and then with the easing of the lockdown I have been in touch with the Lady Gardener to beg the favour of a visit (scheduled for June). I also contacted Ilf about external painting, and he's going to get back to me with an idea of when he might fit me in. Doors and Windows Ulf can do nothing about my front door at the moment because his suppliers aren't working, but Clf the Roofer may be able to help with my hall windows which he was so scathing about when he renewed the roof six months ago. Which then meant that I would need access to the pub garden, and the pub is most definitely still closed.

A sign in the pub window provided a phone number for the security firm responsible for keeping the site secure, and a helpful man even answered the phone. He disclosed a lot more information about the pub management than I was expecting, including the fact that the previous management is still responsible for the pub, but the interior has been stripped of all valuables and will need tens of thousands of pounds to restore it to a functional state. As well as this dire news he provided the combination for the padlock on the gates of the beer garden and told me that the lock is very stiff. So stiff that I haven't managed to prise it open yet - today I applied a load of penetrating oil and we'll see whether that helps.

Other activity at home includes jigsaws, games and socialising via Zoom, Buddhism three times a week at present (and a fourth time when I joined a thing at the weekend) and I re-started a tiny OU creative writing module online. I first started it about two years ago so had quite forgotten what I had done back then, and re-reading my own work after all this time was a delight.

So all is well for me in my little bubble, hoping for the lifting of restrictions on hairdressers while appreciating that such close proximity means I wouldn't be comfortable going to the salon even if it were allowed. The weather has been glorious with more sunshine to come, and the news reports tell of a reduction in the infection rate and mortality figures while warning of the seriousness of the recession to come. We certainly live in interesting times.

Nothing at all to report

Paraty, Brazil, April 2019

There's so little to say that it hardly warrants a blog post. I'm fine, working 2 days, idling 5 days, still keeping up the running and the Zoom games and Zoom Buddhism and not feeling much like working in the garden at all. Or getting the stuff down from the loft. At the end of a period of such idleness I should be able to look back and say "but at least I got xx done." Doesn't look like that's going to happen based on the last week's activity. But today, with a supreme effort, I have made a start.

At work, I got a call to say that the Ward Dietitian's Assistant was off sick, so could I liaise with her in case she needs help. She doesn't need help - there are more empty beds in the hospital than at any time anyone can remember - but she is finding that seeing people on the wards takes a lot longer than it used to, what with having to put on all the PPE and take it off again all the time. So she gave me a pile of telephone follow ups for cardiac rehab, which was most interesting. I managed to do five of them, not all that well I suspect, but good enough. It was particularly nice being able to tell someone without diabetes that they could have fruit juice if they liked.

And that's really all there is to report.

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.

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.

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.

Social distancing

Rio de Janeiro Botanical Gardens, April 2019

This is certainly the strangest period of time I have lived through. Nothing has come close to this level of disruption to ordinary habits that I previously took for granted.

Apart from the cancellation of all formal social activities and gatherings, the guidance on what we should individually do is making me think hard about my daily routines. I am more happy than most to spend time alone and avoid social contact, but I have been surprised by the extent to which I miss seeing people. Work is now the only place where I get to talk face to face, and so my work colleagues have become quite acceptable people to talk to where previously they were a long way down the list. I'll be writing more about work in a future post; there's a lot going on.

This period of social isolation has coincided with an interesting conversation with an old friend about an online weight loss program with which he has achieved amazing success (he's lost enough weight to reverse his Type 2 Diabetes). I was persuaded to give it a try, and have been restricting myself as it advises, to 1200 calories a day for the last 12 days.

There is an app, and you log your food and your steps and it gives you little pep talks every day based on evidence of what it takes to lose weight and keep it off. There is very little there that I don't already know, but it is the first time I've tried to log everything that I'm eating, and I have to admit that it works quite well to keep me on track. I still feel deprived - 1200 kcal isn't very much - but I have managed to save enough of my calorie budget to include some chocolate on a couple of days. The app is free for two weeks and then they propose to charge me an absolute fortune - my friend is on a much cheaper plan, perhaps because he had much more weight to lose. So I plan to unsubscribe, but if I keep on tracking my calories and steps using free apps I might actually achieve the change that I'm looking for.

Of course the other side of weight loss is calories expended in movement. No badminton! No unnecessary excursions out of doors! What am I to do?

Well, walking, cycling and running are all that's left while we're still allowed out of doors for our one form of exercise per day. I thought I would have another go at running, and a friend recommended an app for listening to while running that ought to make it a bit more interesting - it's called 'Zombies, Run!' It provides a story to accompany the tedium of running which, as you might guess, involves running away from zombies. I've only listened to the introduction and the first 'workout' so far, so we'll see how I get on. It lets you play your own music in the background as well, which is a great help.

Then there are my Buddhist groups which all shut down for a period of active online discussion about what we should do next, resulting in the use of various online methods. I've done my first two using Zoom and Skype and it's certainly better than nothing, but not as good as face to face meetings by a long chalk. All of the retreats I was so looking forward to in the spring and summer have obviously been cancelled, and the Leamington Peace Festival, and the cousin from Seattle's visit, and family weekends, and even a work study day that I'd somehow been allowed to book. I haven't given up on July and August yet, but I think the chances are slim that the restrictions will be lifted by then.

The C-word

Val Thorens, March 2020

My second ski trip was as successful as the first, after a rocky time leading up to the holiday when two people had to drop out - one woman because her husband had a stroke, and another man because he had damaged his knee. Luckily we managed to find two replacements.

We went to the same ski area as for my first holiday this year so I was slightly familiar with the runs and could make my own way round on the last day. The winter had been warm and spring had definitely arrived, so there was some rain and much melting of snow (also some fresh falls), but enough at high level to keep us swishing with satisfaction down the slopes.

We were a large group - 14 lovely people with varying experience and competence. Most of the time we split up into groups of similar speed and skill. One day was pretty cloudy but visibility was variable and I went out; the next day visibility was nil and it snowed a lot so I didn't ski. I had a wander around the town, some people went bowling, others sat in bars or had coffees, some stayed at the chalet and played cards. On other days we skied in bright, hot sunshine, which made conditions a bit slushy at low altitudes and at the end of the day.

With this many people in the group it helps to have a volunteer who makes decisions about the route and navigates as we go along. The main leader was the chap who had the thankless task of booking the whole holiday (and dealing with the consequences of those two people dropping out), but one of the others took over one day for an area that he was familiar with, and I even led for half a day to make sure we went to an area I wanted to ski. My period of leading didn't go as planned because one of the key pistes I was hoping to ski was closed and required a significant wait for a cable car and a major detour.

On the last day we had one of those situations when nobody particularly wanted to be in charge. There was also thick cloud in the valleys, so we started off at high level with all 14 of us together, stopping frequently to make sure everyone had caught up and to have long discussions about where we should go next which mostly went: "I don't really mind," multiplied 14 times. At one crossroads a decision was eventually made to go one way, and I decided to split off from the main group and go the other way because I couldn't bear the slowness and indecision, and also because there were a few runs I really wanted to ski.

I know when I'm skiing on my own that I need to make the time for breaks, so I did have a morning stop for hot chocolate and a lunchtime stop for my cheese roll. But I couldn't overcome my tendency to go for just one more run, and my legs were tired, and the unpisted run was lumpy even though not steep, and I fell over onto my shoulder just as I did a few years ago. Not serious, and it will sort itself out eventually, but last time it took about nine months and in the meantime my left arm is a bit restricted in its upward movement..

While we were out there in France we were all following various aspects of reporting on the Coronavirus pandemic. One chap had a friend who arrived in an Italian ski resort just as they closed the whole country down - his party was flown back to the UK the next day. Our chalet hosts (young men aged 19 and 22) were theorising on what might happen next week - there were 13 people due to arrive on the day we left. There were no particular restrictions in place and restaurants and bars were open as normal. We congratulated ourselves on a successful holiday as we arrived back in the UK on Saturday, and then on Sunday the news came that all French ski resorts would be closed with immediate effect.

The group after us would already have arrived at the chalet, including one guest who had booked only the previous day, to be faced with no skiing at all. We were all OK though. I had already started on my list of jobs - laundry, cooking, arranging the team for badminton matches this week - when news came through that one of our party had woken on Sunday with a high temperature.

So throughout Sunday messages were flying round - about his condition, about our different employers and their policies, about the guidance from Public Health England and the NHS 111 phone line. Those who could were going to stay at home rather than go into work, but my work can't be done from home and all the guidance said that you only self-isolate if you or those you live with have symptoms, not if people you happen to have been on holiday with have symptoms.

Since then things have moved fast, to the point that the situation is quite different while I type the end of this post compared with when I started. On the plus side, his temperature returned to normal after 24 hours. On the minus side, the panic buying, social distancing, daily updates from the hospital management, local, regional and national policies that change from day to day, the closure of my regular groups (badminton, Buddhism and music) and the cancellation of all of my spring and summer holiday plans. My diary has gone from a joyful mess of evening engagements, weekend breaks and longer holidays to a blank page with 13½ hours a week at work and the rest at home, save for the occasional shop for fresh and perishable foods.

I'm sure I will find more to write about the C-word soon. But I'm fine and so are my friends and family as far as I am aware, and we are all doing the best we can in the circumstances.