Getting on with it

National Botanic Garden of Wales, May 2013

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

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

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

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

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

Cycling to work

On a sunny day in the middle of August, I thought I'd record my journey to work in a series of photographs. Here is my photo-story.

The trusty steed - actually, not that trusty, being a very standard sort of low cost road bike. It could do with a few more gears, only having six, of which I mostly use five.

All is quiet at this time of the morning (sometimes not so quiet at 3 a.m.) Gentle uphill slope to start the ride, no problem there.

From this angle, you can't really see the gradient, but I would like to point out that we are above the roof level of the houses at the bottom. This is the killer hill that I have to climb on the way back. It does not look as menacing in the picture as it does in real life.

A short section where I ride along the pavement alongside a busy dual carriageway without the benefit of a cycle lane. So far, I haven't met a pedestrian along this stretch.

The cycle path alongside a different dual carriageway, this one not so busy. Cyclists who can keep up with traffic tend to cycle on the road, because the pavement is badly distorted by tree roots, and pedestrians often stray into the path of cyclists due to the rather narrow lanes.

We enter the university campus, with that helpful cycle path bypassing the barrier and keeping us cyclists separated from the nasty cars.

At this point, I leave the roads and cycle paths, and head down to the lake for the prettiest part of the route.

No separation of bikes and people, but there aren't many pedestrians at this time of day. There are a few more on the return journey, but we tolerate one another pretty well.

Ooh, isn't it pretty? A little bridge over a narrow part of the lake can be glimpsed through the trees.

An alternative route would take me up past this university building, which involves a fairly long uphill and then downhill section. I prefer the slightly longer route by the lake, which takes less effort, although I'm told by Mr M (who went to university here) that in winter the lake route is closed at dusk, so I may have to do the hilly route instead.

Back on the road through the university campus, and coming up to the road works.

The narrowest section through the road works, where cyclists are asked to dismount, but we rarely do. I just change down to first gear and ride at walking pace behind pedestrians, especially those who are wearing earphones. It seems more polite than trying to attract their attention by shouting.

Destination in sight now, but the biggest and busiest dual carriageway so far is in the way. No matter, the cycle path continues on the pavement for a few meters...

...to the traffic-light controlled cycle crossing across the dual carriageway.

And onwards goes the cycle path - carrying on straight ahead would take me all the way to the city centre, alongside the canal if I want to. But I turn left at this point, into the hospital grounds.

Last stretch towards the main hospital building.

There are several of these bike cages in different locations around the hospital, accessed by swiping an authorised staff ID card both in and out, and containing rails that bikes can be locked to. They also provide a bike pump, and I think there are some basic tools in there too.

And... relax. The journey to work seems to be very slightly downhill all the way, which means I arrive without too much fuss, but the way back is therefore very slightly uphill for most of the time, with that vicious hill at the end. My legs do seem to be finding it easier each time, though.

Cutting out the commute

Berlin, March 2013

There's been change at Lola Towers, in as much as I'm not at Lola Towers at the moment. I have found a room in a shared house which is just three miles from work, and I'm staying here for four nights a week, travelling up on Monday morning and back on Friday afternoon.

The quest for accommodation was not without its difficulties. Rather than traditional letting agents or small ads, I used the Interwebnets option. Landlords upload vacancies, potential tenants get in touch electronically, details are confirmed, viewings take place, negotiations follow and an agreement either emerges or it doesn't. I went through the cycle just twice - I was being fairly selective, and there are a lot of shared student houses in this city with two large universities very near to the hospital where I work. I didn't want to find myself in a house sharing with teenage students who are getting up just when I'm going to bed.

On Sunday I moved into a small single room in a house shared with two young professionals who seem to spend the majority of their spare time watching TV together. I am not a natural TV watcher, although for the sake of sociability I did join them on Sunday night for one awful hour of a British magician accosting holidaymakers in Las Vegas and foisting his magic tricks on them. I don't deny that the magic tricks were good, but while I watched I had the feeling of my life trickling down some plughole. The sociability was confined to commenting on the programme - we haven't yet had a proper conversation beyond "How was your day?" - and after a while I fired up the laptop and confined my attention to my online life. It's not so much more constructive than TV, but makes me feel more like an active participant in life.

The commute time to work by car is about 20 minutes - 15 minutes on one short stretch of road between the house and the first roundabout, and about 5 minutes for the rest of the journey. You will deduce that this equates to an average of 9 miles per hour, which is not much of a rate. My plan is to resuscitate my bicycle, which has been languishing at home, and is probably in a state of decay. The hospital has a very well-publicised 'Health and Wellbeing' team including a great deal of support for cycling, so I fired off an email to enquire about cycle storage and showering options. The response was that the person responsible is on holiday until 22 July, so I'd have to cycle quite slowly until then.

I have already been in touch with three different individuals regarding playing badminton, of whom just one replied. I went along to their club on Monday, and it was busy and very hot, but friendly and a similar standard to my usual clubs, whom I have now abandoned with some sadness. During the summer they play only once a week, but starting in September it should be twice a week, which is what I'm looking for. As I want to exercise twice a week (and spend as much time out of the house as possible), I'm trying to think of alternatives for another night of the week.

The cost of the accommodation including bills is about the same as the fuel I was using to commute, and other expenses will remain about the same, so I don't expect to be worse off financially than I was before. Of course there is weekday separation from Mr A, but we have methods of communication, and I gain sleep undisturbed by snoring while he gains life undisturbed by nagging. We'll see how it works out, and in the meantime my Team Leader has mentioned that discussions will soon take place over whether my contract will be extended or not.

A post that very nearly isn't about diabetes

Sculpture in Austrian monastery garden, October 2012

Anyone would think that the only things I get up to are work, reading and blogging. But there are a few other aspects to life, although I have to admit, they are mainly based around badminton and commuting.

I played in a one-off Ladies doubles handicapped competition, which means that there were teams of all standards playing one another with an attempt to even things up by giving one side lots of points to start with. We were given a head start of 12 (out of 21) and didn't do too badly, although we didn't win any prizes. Then there was the local badminton League dinner dance, which is a social evening that includes presentation of all the trophies for teams that have come first in their divisions and in competitions. Our club has won nothing this year, not even the plate for the friendliest club, but we occupied more than one table and more than our fair share of the dance floor. And just to follow up this enthusiastic participation, the club actually held an AGM this year (primarily because I am the club Secretary at the moment), and people were keen enough to attend, and even vote! And, even better, there are volunteers to attend the League AGM, which I would probably have had to do if nobody had volunteered, and which I hate.

Moving on to life that is not badminton, we have started to take steps towards resumption of house preservation and restoration. Not the most enthusiastic pair when it comes to DIY, Mr A and I have reviewed the battleground and made progress in attempting certain tasks ourselves while delegating others to the reliable Alf and a badminton-playing friend who has business cards calling herself 'Lady Decorator', which I find most amusing. Mr A is hoping to build a new door for the airing cupboard, while I will permanently shorten the curtains that I tacked up temporarily ten years ago, and attempt to descale all the bathroom fixtures and fittings. We have also performed some DIY support to Lola II and Mr M, who are similarly disinclined to do it themselves, and who also lack some essential skills. Mr A provided sawing, screwing and wood shaping support, while I made Lola II strip the wallpaper that was coming away from the wall rather than painting over it. Mr A made things look much better, and I made things look much worse, but I am confident they will be better in the long run.

In relation to work, I am finding the commute to be long but tolerable, especially when I have a good book to listen to, although the car is wheezing a little at the moment and will need some attention this week. I attended a talk given by our specialist obesity dietitian, which confirmed much of what I already know. The consensus of evidence seems to be that it doesn't much matter how one loses weight (as long as nutritional balance is not compromised), but the focus must always be how that weight loss can be maintained. And that it is almost impossible for most people to use exercise and activity alone to lose weight, because we simply don't have the time - but activity is highly effective in supporting weight loss that is achieved by eating fewer calories.

That's about it when it comes to stuff that isn't about diabetes. I can report that I attended another local Diabetes UK meeting, and Mr M has kindly donated some insulin pump supplies for me to stab into my fleshier parts as an experiment, because he is getting a new pump. I have commissioned a blog post from him and Lola II about the new pump, and some photos were taken at the weekend, but we'll have to wait and see whether they can find enough time to fulfil the commission.

Specialist Diabetes Dietitian

Sissinghurst, June 2012

Are your fingernails bitten to the quick? Is your breath bated? At last, I have more than two minutes to sit down and waste time on this blog, rather than running about like a mad thing. I have to admit that I didn't help myself by agreeing (having my arm twisted) to play in a badminton match on Tuesday, so that I didn't have more than ten minutes at home and awake and not in the shower between Sunday night and Wednesday evening on my first week in a new job.

So the new job started bright and early on Monday morning, when I reported for duty at Hospital B. The new employer is an NHS Trust which was formed from the amalgamation of two Trusts several years ago, and contains two large hospitals which I shall call Hospital A and Hospital B. My main place of work is Hospital A, but my direct line manager and her manager are both based at Hospital B, which is why I started there.

The first few days and weeks of a new job are always difficult, confusing, alternately crazy busy and tediously dull. Because you don't know anyone, are perpetually lost both literally and figuratively, constantly depending on other people for instruction/direction/advice/signatures on forms, there is very little that can be done independently. What I can do independently is deathly, and consists of reading about a million policies. And when I say 'reading', I mean 'skimming in the most cursory way imaginable'.

So far, then, subjects of particular interest are, in no particular order: commuting, parking, hospital navigation, and administrative paperwork.

The drive to and from work is taking a very long time indeed. Hospital A is nearer than Hospital B, but parking is more challenging, so I have been advised to try the (free of charge) Park and Ride service, which adds about 20 minutes to the journey time (including the bus trip to the hospital). Sometimes I have to travel between hospitals, which takes about 45 minutes on the (free of charge) shuttle bus, but may mean finishing the day at the wrong hospital, in which case it takes up to an hour to get back to the Park and Ride car park, followed by that long commute home. So I have applied for an on-site parking permit, which is reasonably priced but doesn't actually guarantee a parking place.

Hospital B is where I had my interview, and is an old site comprising buildings from ancient times that might have been workhouses, through to modern convention centres, with every era in between represented, and plenty of traditional lino-floored corridors. For just a moment one day, I caught an evocative whiff of that 'old hospital' smell of disinfectant and floor polish, transporting me back to the time when dad once took sister D and me to spend the day in Westminster Hospital while he worked there. The site containing Hospital B is huge, and the Diabetes department is in a separate building at the opposite end of the site from the main Dietetics department where the rest of the Dietitians live. It is probably a ten minute walk between the two.

In contrast, Hospital A is a purpose-built concrete monstrosity. I had to go there a few times for courses as a student, and found it confusing then, but now that I am expected to work there I am finding it almost impossible to navigate. Coming from my previous situation in a modern hospital with a completely logical layout and consistent ward numbering, this is a rabbit warren that makes no sense at all and has me utterly lost as soon as I turn a corner. I have learned just two routes so far: from the front entrance and from the nearest bus stop to the department, and even these are fairly flaky. If I go anywhere else, I have to be accompanied, like an idiot child or a convicted felon.

I am based in the Diabetes department, which is a different area from where the other Dietitians live. I share a room with the Dietitian who got the full time permanent job that I applied for, which is only fair as he had already been working there on the temporary contract that I now have. Our room is only just big enough for two, has no windows, and opens onto one of the main corridors. All around are corridors containing doors to rooms housing Diabetes consultants, registrars, their secretaries, Diabetes Specialist Nurses (hereafter abbreviated to DSNs), and the office containing two admin staff, a load of files and the kitchen/eating area. I have been introduced to a LOT of people.

I'm starting to see the end of the administrative paperwork phase. Apart from the contract and the payroll information, which I am obviously very keen on, there have been forms for the parking permit, the ID badge which doubles as a swipe card for getting through security doors, annual leave authorisation, occupational health forms, local induction, Trust policies and procedures, and - my favourite - my competency has been assessed and verified by signature of my line manager in the use of weighing scales and stadiometers (height measuring devices). Trust induction has been delayed, however, because there is no space for me to attend in February and the dates haven't been fixed for March. Let's hope I'm not involved in a cardiac arrest or have to lift anything heavy in the meantime, because I'm sure I wouldn't know what to do.

So far, so good. People are friendly, I can even remember some of their names, the other three diabetes Dietitians are lovely, and my room-share buddy (I'll have to think of a way to refer to him) even baked some delicious cookies and brought them to a meeting. I haven't even mentioned the job itself, but I'm looking forward to getting on with it with great relish.