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.

Training continues

Walk in the New Forest, Feb 2012

The job is so much better than my student clinical placements; I am hugely relieved. My dietetic colleagues are universally pleasant and helpful, and I am starting to become familiar with some of the staff on 'my' wards.

Most of the Dietitians don't wear uniforms, which is a shame, because I found the tunic pockets really useful. Some of the renal Dietitians wear a uniform, but it is a purple polo shirt and has no useful pockets. Uniforms that other professionals wear are really helpful in identification of the various species. Nurses are various shades of blue depending on seniority and specialism, Healthcare Assistants are burgundy, Ward Hostesses (the food service staff) are black, Physiotherapists are white with blue trim, Occupational Therapists are white with green trim. The most striking are the Speech and Language Therapists who wear bright crimson shirts, as vivid a red as you can imagine. It is a scary colour, and I can't imagine why they chose it. Doctors don't wear white coats any more (infection risk) but sometimes wear stethoscopes and harried expressions, and say things like "It's half past two, I've been working since seven thirty this morning and I haven't yet had a break." We all defer to the Doctors. They are the omnipotent rulers of the wards.

My patients are mostly uncommunicative. On the stroke ward they are usually either unconscious or have lost the ability to speak, understand speech or express themselves (dysphasia/aphasia). On the elderly ward they are often asleep, dysphasic, have dementia, or all three. One day I was delighted to be able to speak to two patients; by the time I visited the ward again one had already been discharged. I get the feeling that if they can talk, then the nurses can sort them out without the help of a Dietitian. This is a shame, because I would like to have a bit more interaction with the patients, but there's plenty of time for that once I've mastered this first stage of my professional life. I sat in on an outpatient clinic to see how things worked, and there was plenty of interaction between the patients and the senior Dietitian I was observing which went waaaay beyond the scope of my limited abilities.

There are many computer systems in use, including standard packages like Outlook for email, and specialised ones for clinical results like blood tests, x-rays and scans. I have done some small online training packages in order to be given access to other systems, but I had to attend a proper IT training session for half a day on something called iPM. About ten minutes of it was relevant, but I am now fully trained and authorised to operate the tracking system to request and log receipt of archived patient notes from off-site storage. This is a task that I will definitely, absolutely, never undertake. My second session of iPM training was shorter (it was one-to-one), and only took 40 minutes of which about 5 minutes was relevant, but I can show you the screen that will give you a list of patients that are expected to be treated on a day-care basis on a ward. Again, I will definitely, absolutely never need it again.

I've also had the first part of the training that will help us to supervise the Dietetic students we will be hosting on their placements. The B placement students have actually arrived in the department, but with me being so new I won't have to supervise them until later in their placement. The training was at the University associated with the hospital, and was very interesting. The first day was primarily about setting the scene and understanding the way that placements operate in this 'cluster', which is slightly different from the one where I studied. It was a welcome break from the unremitting pressure of patients on wards, as well as a chance to meet and share experiences with some other new Dietitians who are in a similar position to me. The second day of this training is this week.

In between writing and publishing this, I have had a lovely weekend with Lola II, which is why this post is late. It was actually ready on Saturday, but I was too busy cleaning the house to remember to click 'Publish'...