It has started

The big day has arrived: Ulf and his henchmen are labouring in the garden, taking drinks with two sugars and devouring many, many biscuits. I am very pleased that I thought of buying the biscuits. I am also going to have to buy a bag of sugar.

It started at 7.30 with a phone call - they were already outside and were wondering why I wasn't answering the door. They'd been using the knocker rather than the bell so I hadn't heard them, but at least I'd paid attention to the casual message "See you at 7.30-8.00" and was up and dressed. On my day off. At 7.30 a.m.

By 10 a.m. I was shattered. Not that I'd done much except make tea, but the early start on a Tuesday after badminton on Monday night was harder than I had anticipated. I'd worked hard to clear the kitchen but they started outside, pulling up the brick paving in preparation for digging foundations. The henchmen are doing most of the work, and I have decided to name them both Sons of Ulf - one of them is actually Ulf's son and the other might as well be because I can't tell the difference. They were introduced to me at the same time and I will probably never work out which name belongs to which, but they seem cheerful enough. There was a small cheer when I mentioned the biscuits.

I met another man who supplies the roof lantern and the external doors and windows. It turns out that it will be a 'sky pod' rather than a roof lantern (Google if you want to know the difference) which will be handy if I ever want to do any space travel. Although a sky pod is actually much less exciting than it sounds. I was even offered a choice of colours, but making any more choices may tip me over the edge into insanity. So it will be white.

The skip has been a bit of a problem. Normally by mid-morning the road is pretty clear of parked cars as everyone goes to work. Not this morning - all the closest parking spaces are filled with cars. Where to put the skip? We decided to put it in front of my garage for the time being. The full skip was due to be replaced by an empty one the next day, so I talked to my neighbours about leaving a free space.

Ulf and Sons of Ulf left at around 4 p.m. and I went to bed and slept for an hour before going off to this new Buddhist class. Of which more later.

Day 2 (there won't be this level of commentary throughout the project) and I have realised that it is foolish to consider £25 too much to pay for an extra parking pass when the whole project is costing tens of thousands. However, when I ring the authorities it isn't so simple. Each resident can only have one £25 visitor pass. Further parking dispensations are available per day, per week and per month, but permits are associated with particular vehicles, so not transferable to the electrician or plumber or whoever. So I think we'll be stuck with having to shuffle vehicles around in the middle of the day to avoid charges.

Days 3 and 4 proceeded with me at work, punctuated by text messages in the evening clarifying various things like whether the fridge was broken when they moved it (it was actually just the bulb). Someone came to measure up for the stairs while I was out, as well as the foundations being dug, concrete poured, and foundation blocks being laid. Unfortunately a pipe was found which has turned out to be very expensive as it belongs to Severn Trent. This means that if in future it is found to be damaged the builder may be liable, so it has to be inspected during the build to certify that it is in perfect condition before and after. And this costs hundreds of pounds, due to me being in no position to decline their kind offer of inspection.

Lots of photos, then. These are the stages of the foundations so far (you can see the expensive pipe in the second and third pictures):

And the stages of the kitchen demolition:

There's an interesting lintel and bricked-up opening exposed in that last picture, which is behind what is now the fireplace in the living room. At one point this would have been the rear wall of the house which might then have been the pub, but I can't imagine what its purpose would have been.

So we're four days in and much progress has been made. Biscuit consumption: Bourbons: 90%, Hobnobs 10%, Digestives 0%. I have bought more Bourbons. Maybe I'll try them on custard creams next.

Matters arising

April 2017

After the parking episode described recently, I think I have not written about my other parking issue, because parking is one of the least interesting and most discussed issues of modern times. Outside my garage there is a white line to indicate that parking is not permitted across the entrance. As we have seen when it was removed by the re-surfacing works this line served a useful purpose, but it was only just long enough, and cars parked legally would slightly obstruct the garage entrance, but not enough to stop me getting in and out. I wrote about this briefly in a previous post, and eventually did contact the council's white line department to ask if it could be lengthened, to which they said 'No'. However, after the re-surfacing work the line was re-painted at the longer length that I had been asking for. So that's interesting. Or, more accurately, it isn't. Enough with the parking already.

I went to a local meeting. Some money has been allocated to be spent on improvements to the park at the end of my road, and the council thought they'd ask the locals what they would like. There was already a prototype group to ask, because the Friends of the Park had been convened when the park was threatened with being taken over by cars, caravans and motor homes during the National Bowling championships in the summer. It was a good meeting, and surprisingly good humoured and constructive. The main problem seemed to be the newly installed skate park, which is very popular and attracting swarms of local 'yoof', but is also attracting their litter despite the many litter bins in the vicinity.

The yoof in attendance were polite and well-spoken and made good points. There were also representatives from the bowling club, the tennis club, local dog-walkers, parents and runners who are the main constituency of park users, as well as all the candidates for the local election taking place a couple of days later. It looks as though the most likely purchases may be outdoor gym equipment (but there is a separate pot of money that may fund this anyway) or a refurbishment of the under-used tennis/cricket pavilion to make it more usable for e.g. a cafe. My previous local councillor who I can no longer vote for was there, and I took the opportunity to thank him and express my regret that he would no longer be representing me.

Work news: I delivered the 'short carb counting course' pilot. Prizes are available for anyone who can come up with a better name - my best shot at the moment is Candi, which stands for Carbs and Insulin. This comprised four hours about carb counting extracted from our usual four days about Type 1 Diabetes, to deliver to people who can't spare four days and maybe don't have Type 1 Diabetes. We had five attendees and I think it went well. I have yet to look at the feedback sheets.

We also had a small meeting attended by our business manager, two doctors, three nurses and me. It was supposed to discuss the future of the insulin pump service, which is set to expand by about 10% every year. As usual the meeting was utterly pointless and did not result in any useful discussion or conclusions, but it was quite a nice social event within the department. We are having a follow-up meeting with just three of us, which may be more constructive. All I actually want from the meetings is to understand how our service is funded and managed. It doesn't seem much to ask, but so far I have failed to achieve even this small advance.

Two CPD courses for me last week as well - the first about Clinical Audit presented by one enthusiastic and knowledgeable man and one girl whose presentation style was simply to read out loud the text written on each Powerpoint slide. I tried to be constructive in my feedback, but she was terrible. I discovered quite a lot about Clinical Audit, including the fact that what I planned for evaluation of the short carb counting course isn't Clinical Audit at all, it's Service Evaluation. The other course was a compulsory three-year update on DESMOND, the Type 2 patient education product. Also very interesting, and delivered in the same rooms of the same hotel as the first big Techshare conference that I helped to launch and run in the 1990's.

Much leisure activity to report - the music group continues, with the prospect of me being the sole baritone saxophonist at the July concert because my fellow saxophonist has a previous engagement. There are significant exposed baritone solos in the pieces we are playing, and I am not at all confident of successful delivery, seeing as how I'm really not very good at playing the beast even though it is enormous fun.

I also spent a whole day with the Buddhists at our usual venue - a nearby village hall - and the weather was lovely and we did some meditation, some chanting, some discussion and another 'puja' ritual. I still don't think I'll be joining in with the rituals any time soon, but for the first time I really felt that I had made progress with the meditation. It's been so gradual that it's hard to detect, but it feels easier to do and in my everyday life I am employing some of the positive behaviours that it's supposed to promote, and and feeling better for it.

The LTRP took a step forward with the rebuild of the airing cupboard, which looks lovely and needs only to be painted. While they were here the carpenter and his mate were kind enough to carry my filing cabinet upstairs to the new office, about which I am disproportionately excited. I also went back for a second meeting with the woman from the alternative kitchen supplier who has very strong views on her products and doesn't mind sharing them, and who speaks very loudly. I am trying not to be too influenced by these factors and to focus on the content rather than the style of delivery.

Shopping, touring and parking

Borough Market, May 2016

Sometimes I don't have much to say, but at the moment I'm almost driven to the keyboard to let off a bit of steam. Actually, the pressure has dissipated a bit because I've told most of the hairiest stuff to Lola II and Mr M on the phone already, but writing it down can help too.

While you've been enjoying the niceties of diabetes technologies, activities at Lola Towers continue unabated. I think I am actually unable to lessen the quantity of stuff going on because I'd rather have too much than too little to do. Accepting that this is true may help me to stop moaning about how busy I am.

I have had a bit of a shopping spree - online, of course. With some actual camping coming up, and also with the prospect of being without a kitchen for a while over the summer, I decided to get a move on and decide on what sort of camping stove to get, followed by actually buying it. So that's one thing crossed off the enormous 'To Do' list.

The building where I work is fairly relaxed but the hospital as a whole is trying very hard to make sure that quality standards of all sorts are maintained, and the latest standard to be addressed has been the one about uniform: bare below the elbow and hair above the collar. The Dietetic Manager sent an email round to highlight this, and I have had to accept that if I am caught transgressing now it will be rather more of an issue than before we were specifically told to abide by the rules.

Keeping hair tied back is fairly easy and I can manage fine without a wristwatch, but I do find that the wristband Fitbit pedometer has helped me to carry out a bit more activity and a few more steps every day, and I was reluctant to give that up. So I also rode the wave of rare shopping motivation to try and use up all the remaining TV-watching points on a Fitbit device that clips to clothing so I wouldn't have to wear it on my wrist. Unfortunately after I'd ordered the TV-watching vouchers it turned out I couldn't use them to buy this gadget, but I bought it anyway with real money. Within a week I had gone and put it in the washing machine. [It has a surprisingly effective rubbery jacket, so it survived unscathed!]

Local elections came and went - constituency boundary changes meant I had to choose a new candidate to vote for, and I am glad that the incumbent Green Party candidate was elected - small patches of Green and Lib Dem yellow appear among the sea of blue in this county. I am dreading the General Election. Each time there are more hateful personalities and policies among the distorted propaganda, political bickering and biased media, and less integrity, honesty, generosity and truthfulness. It has become a choice between wasting a protest vote, or tactical voting for the least detestable party that stands a chance of ousting the most detestable. Sometimes democracy is a burden.

Lola II and I went to Shrewsbury for her 'birthday' weekend this year. It is rather a nice city, with river, hills, interesting independent shops and many many coffee shops and churches. I bought a rug! It was a bit of a surprise but maybe this shopping thing I seem to have acquired is seasonal. There was a rug shop in the market, and we had a bit of a think about how to manage a rug purchase when we were spending the day wandering about and staying in a B&B, but the vendor agreed to deliver it to the B&B. The rug is red and black and very striking. I like it.

Other things we did in Shrewsbury - a rather interesting guided walk looking at buildings all round town from medieval to modern times. Particularly interesting was the half-timbered building faced with brick to fit in with the style of the newer Regency buildings around it. We were also shown a modern frieze on a building, including a small plaque containing two faces, and asked who they were. Lola II guessed one as the Queen, and rather flippantly I said the other looked like Michael Heseltine. My guess turned out to be right, and the other face was Margaret Thatcher - the frieze was a reference to the introduction of the Poll Tax. We ended Saturday with a local theatre company performing 'Anything Goes' which was a delight.

On Sunday Lola II and I did a lot of walking and talking and had a Japanese lunch, which made me happy. And during the weekend my ebay sales record was broken by a postcode promotion leaflet much like all the others, except that it featured Sherlock Holmes on the front. It was clearly Sherlock fans rather than the more sober philatelic collectors who bumped the successful bid up to a frankly ridiculous £16. I was even more delighted because I happened to have two of the same leaflet, but the person whose offer of £15 was outbid must have come to his or her senses, because they failed to take up my Second Chance offer at that price.

The only other recent event of note was on a Friday when, most unusually, all my clinic slots were full and I was expecting seven people in the morning. Out of the front door as usual in the morning I was confronted with a car parked right in front of the garage, completely preventing me from getting the car out.

The road was resurfaced a few days ago so all the road markings were missing, and this might have contributed to the situation. No matter why, the question was, what do I do? A few neighbours were out and about but none knew whose car it was, so I phoned the police non-emergency number for advice. A friendly woman took the details and asked if I had knocked on any neighbours' doors. I caught the hint and asked if it would be worth my while - could she perhaps give me the address that the car was registered to? No, she couldn't tell me the address, but yes, it would be worth my while to try a few doors. Meanwhile, she would pass my case to 'Despatching' who would send someone over when they had the chance.

I really didn't fancy knocking on doors at 8 o'clock in the morning, so I waited. At work, my colleagues had started to contact the patients who were booked in - unfortunately a couple turned up anyway because they hadn't checked their phones. An hour later I phoned the police again to see if I should just cancel the whole morning's clinic, and got the distinct impression that nothing was going to happen very quickly. Another hour later I did get a phone call, and this time the policeman told me which house the car owner lived in, but there was nobody at home, so I put a note through the door. At this point I tried contacting the council parking enforcement department, who also said they would send someone round although we agreed that there was very little that could be done.

After a further hour (now it was after 11 o'clock) the police controller called me back to see if anything had changed. I didn't see how any policeman could help me unless they could track down a mobile number for one of the occupants of the house, and it didn't seem like that was something they were going to do. She said she'd send someone round anyway because they might be able to move the car, which would have been really interesting to watch.

At 12.15 p.m. there was a ring at the door - the neighbour had returned from a very unimportant trip into town and was distraught at the trouble she'd caused. She hadn't noticed the garage, she was busy telling the kids off when she'd parked - it was hard to be angry at a genuine mistake and she acknowledged how it had really messed up my day. We did agree that it was unlikely that she'd do it again.

Tedious parking issues

Krakow Botanic Garden, July 2016

I'm still spending many spare minutes engaged in eBay trading, and my Canadian buyer is still keeping the boat afloat. Meanwhile other members of the family are busying themselves with other aspects of dad's collected material, with limited success. The past weekend contained a trip to The North West, where the weather was cold but the welcome was warm. Part of the reason behind the trip was to stay with old friends I hadn't seen for more than five years, but on the way there and back I offered to assist with the further clearing and emptying of goods currently stored in basement rooms. Just the threat of my presence was enough to prompt the requisite activity - I hardly had to do anything, and even acquired a certain proportion of said goods, some of which I have passed on to Ilf.

Yes, Ilf has paid another visit, and the upstairs spare room is looking even better with its final coat of paint. Next it will need curtains, a bedside table, the clothes rail that returned with me from The North West, and I'm thinking of sanding and painting a wooden chair that is currently in the garage looking very sad. That will complete the bedroom half of the spare room; I haven't thought too much about the office half yet. I made the follow up trip to the kitchen design shop to talk through some changes, and the plan is nearly finished. I'm still feeling good about the progress of the LTRP.

At work the talk has been of parking for a very long time, and is becoming extremely tedious. The Trust has two hospital sites; the one where I don't work (Hospital A) has insufficient parking for both staff and patients, leading to much stress. When I used to do a clinic there, patients occasionally phoned the reception desk from the car park, and more than once it was to say they were not coming to their appointment simply because there was nowhere to park. The hospital where I do work (Hospital B) has plenty of parking space.

Parking passes used to be allocated to staff at Hospital A on some arcane basis that probably had a lot to do with historical precedent and seniority. When I worked there, I used to park on a nearby housing estate that is 20 minutes' walk away from the hospital site. Since I stopped working there, the housing estate has introduced residents-only parking, so staff would park in the Tesco car park, which is 25 minutes away. Tesco is now limiting its free parking to exclude such visitors, and I really don't know what staff do any more.

It was decided that a fairer system needed to be introduced, so all staff are being invited to re-apply for parking passes which will be awarded on the basis of need, taking account of the requirements of the job role and public transport options. These are not free passes, but they cost less than the daily parking charges that patients pay. They used to be charged at different rates depending on pay grade and hours worked, so part-timers and those on low pay grades paid less. The new system is a flat rate for all from part-time cleaner to Chief Executive.

Throughout the extended period of time when details were slowly being made available to staff, it was never made clear whether these changes would apply at Hospital B, where there is no parking problem. The main grouse in my department was the unfairness of changing from proportional pricing to a flat rate, but parking raises such high emotion that barely a day went by without someone complaining afresh about the unfairness, which usually set someone else off, sometimes on an unrelated course, usually about the changes to the retirement pension entitlement. Parking, pensions, more parking - most lunchtimes descended into dissatisfied whingeing.

At last the day came when we could finally apply for a new pass under the new, 'fairer' guidelines. My goodness, the complaining escalated to unimaginable heights when it was discovered that anyone living nearer than two miles from Hospital B was going to be denied a parking pass on principle. Emails were fired off like cannonades - secure bicycle parking was going to be needed, husbands were going to set up lift sharing services, people couldn't be expected to walk all that way at their age, and what if it snowed? I felt like saying that I would love to work within walking distance of my home and not have to pay for parking or petrol at all.

Things calmed down when one member of staff was informed that there had been a mistake, and the two mile limit was supposed to apply to Hospital A only, given that parking capacity at Hospital B was adequate for all who wanted passes. But the price increase would still apply at Hospital B. And this is where we stand at present, and I hope they will all stop moaning about it soon.

In other news, my aspidistra is flowering!

Singing and parking

Peckover House, August 2014

I am saying 'yes' to too many things.

I like doing all the things I do at work and in the evenings and weekends.

My house is not as I want it to be.

I am clinging on by my fingertips, as always.

But do not worry, I am calm. It will be OK.

There has been a lot of activity, days and evenings, evidenced by lack of blog updating. Three lots of badminton, a finance meeting one evening and a choir practice this week. I wrote the rest of this blog post a week ago, and rather than hang on to it any longer, I might as well press 'Publish'. Mr A and I are about to head off on a trip south, so no time in the rest of the weekend either - perhaps there will be time for a report next week.

The choir is just one more thing. I like to sing, and around this time of year there are some great opportunities to belt out some top tunes. In the Trust newsletter there was a call for volunteers to form a scratch choir for the festive season including a couple of concerts, and all finished by mid-December. I've been thinking for a few years about singing in a carol service, so a couple of weeks ago I found myself in a draughty room with a few other similar minded people and an old keyboard.

The person who came up with the idea and who's leading the group (and who owns the keyboard) is a member of a different choir, but not its leader. All credit to her for giving it a go, but there are little frustrations that are utterly unimportant, but niggling. She described an arpeggio as a scale. She counts us in at a different tempo to that of the music. She has chosen some carols and managed to print the music for us, but they are set much too high so that anyone who isn't a proper soprano can't sing them.

She is encouraging us to sing the harmony parts (especially if we can't reach the high notes) but she doesn't read music particularly well so is having trouble picking out the parts on the keyboard (I haven't let on that I can play the piano). The rehearsals are alternating weekly between two locations, both almost impossible to find. But I like her, and I like her enterprise and enthusiasm and positivity and tenacity, and I am happy to give my support and encouragement. I am happy to participate in an enterprise where the quality will be pretty poor (my prediction after three out of five rehearsals) but it will be fun. And you never know, it might turn out much better than I expect. Things often do.

At work, the great news is that at last my parking campaign has succeeded, and the top management has arranged exactly what I would have wished, so that course participants can pay for parking for the four specific days of the course at £3.20 a day. I am getting better at delivering the patient education courses too, but clinics (where I see patients one-to-one) are very variable. Sometimes I get a run of people doing well who are happy and grateful; sometimes clinics are filled with people who find it all too difficult and aren't doing so well. Just recently, it's been more of the latter.

Transition and technology

Vounaki, Greece, June 2014

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

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

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

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

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

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

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

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

Peckover House, August 2014

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

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

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

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

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

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

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

Temperate House, Leamington Spa, October 2014

A few steps forward

Brixham, August 2012

Into week two I go, forging ahead with getting more of the policies under my belt (Arson Prevention Policy, anyone?) and still observing other people at work rather than doing any proper work myself. I spend a happy couple of hours walking around the hospital with floor plans, discovering a deserted Cyber Cafe, the ID office, the car parking and security office, and registering with the medical library. I can nearly find my way to most of the important places now.

My parking pass arrives, and mystifies me by being entirely paper with a small hologram, and no accompanying explanation. Given that the car parks are 'pay to exit' with barriers, I can't understand how it would work. I pay a visit to the car parking and security office, which I now know how to find, and they explain that some of the car parks would now accept my swipe cards, while others operated by numberplate recognition. Having made sure to clean my numberplate, I am recognised successfully this morning.

I have decided to call my Room-Share Buddy 'RSB', which can equally represent 'Really Supportive Bloke'. He is proving a delight to work with, and although I am not moving forward towards independent working as fast as I would like, he is reassuring about my progress. We have discussed which clinics I will cover, and agreed a start date of 11 March, when I will be on my own. It is unfortunate that this date is my first day back after a week's holiday that I have planned with Mr A, and is the start of two weeks when RSB won't be around. So I really will be on my own, except for the DSNs, who I'm sure will help if I need it.

On Friday, by coincidence, RSB was scheduled to deliver a talk to Dietitians from the main department, so I joined the merry throng. We were split into three groups and given tasks to complete: one group was looking at medications for Type 2 diabetes, I was in the group categorising different types of insulin, and the third group was sorting out various hypo treatments. We made a dog's dinner of the insulins, highlighting again that I still have much to learn. I have found a checklist designed to ensure that different types of patients are given all the information they need, but it will prove useful for me to indicate how much I don't know.

I attended another CPD session led by the specialist obesity Dietitian, all about obesity in pregnancy - how much weight a pregnant woman might gain, healthy eating advice in pregnancy and whether weight loss should be encouraged for obese women who get pregnant. It was very interesting although not very relevant, as I won't be covering the ante-natal diabetes clinic unless I am called upon due to unforeseen circumstances. More relevant was a session delivered by a rep from one of the companies that sell insulin - more on this in another post, I think, along with a report on the 'structured education' that I have been attending, aimed at people with Type 1 diabetes and delivered one day a week for four weeks.

I had a long discussion with a very congenial chap from IT, and we took about a quarter of an hour to find suitable times for training on three essential systems, after which I still had to move my Occupational Health appointment (again) and send apologies for a meeting that I can no longer attend. I'm sure that computer systems will feature again on these pages before long. I have many strong opinions already about the state of the IT to which I have so far been given access.

Part of the difficulty of scheduling the IT training is the number of meetings that have been deemed appropriate for me to attend. Being part of two separate teams (Diabetes and Dietetics) doubles the number of team meetings, and the Diabetes team seems to have a lot of other meetings, including education and updates from reps aimed mainly at the medical team, and sponsored by pharmaceutical companies. I've been to two of these, but they were rather dry and focused on the presentation of lots of clinical data to support the prescription of their products, and the speakers were soundly heckled by the doctors, seemingly as a form of sport. It does mean a free lunch one day a week (although of course there is no such thing as a free lunch).

We have a large and important Diabetes meeting tomorrow, which all ranks and grades and specialties are required to attend, and which will 'debate' the future convergence of the Diabetes service, potentially onto one site rather than over the current two sites where it is presently located. I am not looking forward to this meeting one bit - it will be highly political, I won't know any of the background and locations and services and personnel, and while I would prefer the future location to be Hospital A because that is easier for me to get to, I have no relevant arguments to support this in terms of quality of service outcomes. The meeting is also scheduled to end more than an hour after the end of my work day, so I will be trying quite hard to sit near the door and leave as inconspicuously as possible.

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.

Working life

Hospital corridor, 2012

The week ended well, even though I made the slight error of seeing my last patient in a ward that didn't have a clock, so I was late home on Friday. Then straight out for another badminton match, which we won. This full time work lark really leaves no time for much else, especially because this weekend we went south for visits to family and friends (I shall blog about that trip in due course). There is just NOT ENOUGH TIME.

As promised, however, here's some dietetic news, although it's still all about admin because I'm not risking writing about patients except in the most general terms. Believe me, I'm spending a lot of time seeing patients on wards as well as all this other stuff. I'll probably describe the job in more detail at some point.

Despite claiming to have finished all the necessary shopping for clothes, I had to do a bit more. This was because of the 'bare below elbows' rule on the wards, which is supposed to facilitate hand-washing and reduce risk of hospital-acquired infection. So now I've got a few more short-sleeved tops, and a serious problem with static when walking about the corridors. I now have the list of ingredients of the alcohol rub, but no answer from the Infection Prevention and Control department telling me what I should do about the fact that it contains one of the allergens that I react to.

My workplace is a brand new hospital built with the aid of PFI (Private Finance Initiative) money, whereby the capital funding to build the hospital came from the private sector. This means that there are some very hard-nosed commercial aspects to the infrastructure, like parking. Both patients and staff have to pay to park, and there is a waiting list for staff permits that is ranked by need and priority - on-call and night-shift staff along with people with disabilities are much more likely to get permits than perfectly fit Allied Health Professionals who work from 8.30 to 4.30 Monday to Friday. I haven't even bothered to apply for a permit, and I drive for about 25 minutes to a nearby housing estate, park there, and walk for about 15 minutes to the hospital.

This new hospital was built on the same site as the old one, which had a poor reputation in the city. With the new build it acquired a very clunky and long-winded new name, presumably in the hope that it would have the 'Sellafield effect' (when the nuclear reprocessing plant at Windscale acquired a new name in the hope that it would no longer be associated with safety concerns). I have no idea whether this worked, since I hardly know anyone who has needed treatment there except for our neighbours over the road who are going to have their baby there. I visited the old hospital only once, to play a badminton match in a gym with a ridiculously low ceiling.

Since my working day starts at 8.30 a.m., it should be possible to leave home around 7.45 a.m. Unfortunately, that pitches me into the heaviest traffic, so I leave half an hour earlier and spend the time in the hospital library catching up with my online life - emails and blogs and Facebook. I'd rather do that than get up a bit later but spend an extra 20 minutes in traffic. My actual job comprises 80% ward work, one half-day outpatient clinic and a bit of time for admin and professional development. I have been allocated to four wards: stroke, elderly medicine, and two others. Pretty much everything I do is about 'nutrition support' - helping people who can't eat or don't want to eat - through the use of modified menus, snacks, nutritional supplements and tube feeding.

That's all I've got time for at the moment - back to work tomorrow, badminton, work, and then maybe time for a bit more blogging. I'm hoping to put together a picture story similar to the 'Camping holiday - in pictures' post, but covering (among other things) the replacement of the car windscreen on our trip south. Watch this space...