Another short story

Self portrait, 1970

This is from the same treasure trove of school reports and toddler artwork as the previous story, but was written a few years earlier, when I was 6 or 7. Again I am copying verbatim - spelling and punctuation left entirely unchanged, although I have substituted my blog name for my real name.

If a magician gave me one wish I would say "I will save it untill I went to have a holiday and I would try to be famous and I would ask for a pair of wings that will never never break and I would fly over the town and everybody would look up at me and say "look who is that up in the clouds. and I would shout It is me [Lola Blogger] with wings to fly with. Oh it is lovely up here. "I wish we were up there." the people will say.

I suppose I'm still trying to be famous, although in my world 'famous' means appearing on Radio 4 rather than being recognised in the street. And, of course, I still want to be able to fly.

Short story

Still life, 1971

While I was being Nurse Rosenberg I took all sorts of things from home to occupy myself, and one of these was a plastic bag full of my history - music exam certificates, school reports, some of my childhood art, a letter I wrote to my American cousins. A treasure trove.

Here is something I wrote for an English lesson when I was 12, in 1976 or 77. I have copied it verbatim without changing so much as a comma.

My Visit to the Past

It is now 1960. The weather is very gloomy and everyone around me is running. There is a shrill noise.

Everyone had gone by. A solitary woman was left, coming out of a shop door.

"That was better than usual," she remarked.

"What happened?" I asked.

"You got caught in the rush hour," she said. "You ought to know by now to head for the nearest doorway."

"Oh."

I carried on my way. The streets were now deserted, apart from a few early morning shoppers. I looked into a shop. It was a stationers. I wondered if the goods would tell me what time of year it was. Nothing. Not a firework. No Christmas cards. No Valentine cards. Not an Easter bunny in sight. This wasn't getting me very far.

A lady was standing admiring some notepaper. I asked her for the date. June 6th.

I started down a sideroad. Everything around me seemed much quieter. There were no babies crying out of 3rd floor flat windows. Then I realised what was really nagging me. The difference in our clothes. They were wearing two piece garments, at least, the men were. The women were sometimes in one piece dresses or dresses in two pieces. I wondered how they managed to get them on. Now, I was wearing the normal amount of jewelry, with all my rings, and a 5-piece suit, and it looked very advanced beside the primitive clothing of these people.

I heard another shrill whistle. Expecting another mad rush of people, I pressed back into a doorway, but I could only see one man coming towards me, dressed all in blue, with a tall hat, and brandishing what appeared to be a large metal or wooden stick. In his mouth was a little silver thing that was making the noise. He looked extremely fierce, and I just turned and ran, right back to my machine. Seconds later, I was safe again, back in my own time.

It's very strange to read your own composition more than 40 years later, but I find this so interesting. The story isn't much in itself, but the first four paragraphs hook the reader, make you want to know what's next. The rhythm of the writing - sentences, phrases, paragraphs, even the direct speech - I thought it was really cool that it was written by my 12 year old self.

What I've been reading

Death in Holy Orders
by P. D. James

"At St. Anselm's - an embattled, isolated theological college on England's windswept East Anglian coast - when the body of seminarian Ronald Treeves is literally unearthed from a suffocating pile of sand, a coroner's jury turns in a verdict of accidental death. Arms manufacturer Sir Alred Treeves, Ronald's adoptive father, questions the verdict and arranges to have Dalgliesh reinvestigate the boy's death."

Pretty good holiday reading. A short review today.

Clarity for Lawyers
by Mark Adler and Daphne Perry

"This unique book debunks the myth that legalese is precise. Using many before-and-after examples, this book explains how you can increase your efficiency, profits and client approval while making your documents more readable and reliable."

I have to declare an interest - this edition was co-written by Sister D. Despite this, or more likely because of it, I thought it was excellent. Of course it would be a great disappointment if a book about clear language was not well written, but I learned a few things even though I'm not a lawyer and know hardly anything about the law. The things I learned include how astonishingly convoluted legal language can be even when it is written clearly, but also the five (five!) different meanings of the simple phrase 'Time flies like an arrow'. Highly recommended to all, although probably most interesting to lawyers and sisters.

The Honorary Consul
by Graham Greene

"In a provincial Argentinian town a group of revolutionaries kidnap the wrong man. Their victim - Charley Fortnum, the 'Honorary Consul' - is sixty-one years old, living on whisky and his disputed status as British consul."

He is very earnest, old Graham Greene. You can feel the pain of his conflict with the Catholic Church in this novel, and the penultimate chapter is very fine indeed. But I'm still giving myself worthy books to read and I really should go for something more entertaining for a change.

Love Among the Chickens
by P. G. Wodehouse

narrated by B. J. Harrison

"The irrepressible scrounger Stanley Featherstonehaugh Ukridge and his jolly new wife Molly have identified Dorset as an ideal place to set up a chicken farm. They take with them the author Jeremy Garnet, who plans to swim and play golf alongside his writing, but finds life more complicated than he expected."

An early book in the author's career, but pretty successful as far as I'm concerned. I downloaded it in six weekly podcast instalments, and first it amused me that the American narrator pronounced 'Featherstonehaugh' as 'feather stone huff. Why on earth should he know about this ridiculous and archaic quirk of the English language? Then it amused me that by episode 6 he was correctly saying 'fan shaw'. How did he find out? Will he now go back and correct the early episodes too?

Writing for Pleasure and Profit
by Michael Legat

"Brimming with useful advice and tips, this guide to writing warns against common pitfalls and teaches you how to adopt a professional attitude towards your work."

Written in 1986, which is when I first thought about writing for a living. How times have changed! No need to pay a typist, or wait for a publisher's reply to come in the post, or hope that your bundle of paper will be returned so you don't have to type it again from the carbon in order to submit it to another publisher. No need to write to the BBC to ask for a copy of their guide 'Writing for the BBC' to be sent in the post. It would be interesting to discover how authors approach publishers and submit their work for scrutiny these days.

Nurse Rosenberg

Setenil de las Bodegas, Spain, November 2016

For the last few days Sister D and I have been standing in for mum at the parental manse, while she goes off to visit her brother in Seattle and then, of all places, Las Vegas. Lola II has gone with her, while Sister D and I have a full list of instructions that is seven pages long. So far, nobody has been murdered.

The campaign started when I arrived the night before the flight to find that mum needed help packing while dad reported a horrible dream about the plane being shot down by the King of Jordan and everyone dying in the resulting explosion. Over the next 12 hours the dream acquired the status of a premonition, and we all regularly had to withstand dad's heartfelt pleas for mum and Lola II to change their flight plans.

On the day of the flight I accompanied mum to the airport, which was not without its own stresses as we could find absolutely nowhere to park at the tube station and we were delayed by about 20 minutes while I drove about looking for a space. The train we boarded then changed its destination half way, but all's well that ends well and we got there in three hours. I returned by exactly the same route in less than two hours. Mum and Lola II were delayed three hours on the tarmac as someone on the plane was ill, but no mid-air explosions ensued. Since dad's premonition was been revealed to be false, he declared that he will no longer believe or tell us about any of his dreams. This resolution lasted less than 24 hours.

My responsibilities are few - I have to admit the carers in the morning and evening, admit the cleaner and do the laundry on Friday, supply meals and medications, and deal with any parental emergencies that arise. No emergencies have arisen, thank goodness, because I am supremely confident of my skills in opening the front door, the pill box and the fridge and working the cooker and microwave, but much less confident about dealing with emergencies. The main change I have instituted is to force dad to make his own breakfast, which he is perfectly able to do.

I also have a list of things mum would quite like done before she gets back, and a list of boring jobs that I would quite like to do before they get back (you know - insurance renewals, utility contracts, reviewing all the fancy multimedia hardware that Mr MHX specified last weekend) and altogether there isn't as much free time as I had anticipated. I have brought many toys, games, books and DVDs, and the fabric for the dress I promised Lola II about two years ago. When I spread it out on the table ready to go I discovered that and not enough had been supplied. I really should have checked at the time, but it's obviously much too late now to make a fuss. It will make a lovely top.

So I have spray painted the copper pipes to the new boiler in the kitchen, gone for a run (the first for at least a year), met two different school friends for coffee and hosted Sunday lunch with Sister D and Cousin Y. I had a look at the fan heater that had stopped working, squeezed into the cupboard under the stairs to have check the fuse box and discovered it was the old type and entirely unlabelled. So I went back to the fan heater to turn it on so I could tell from the light whether the power was off, and it spontaneously came back to life. Result. Next day the carer said yes, it works intermittently, so no result after all.

Visitors

Spain, November 2016

Another step has been taken towards the finished kitchen - Ilf has done all the required paintwork of kitchen and utility room walls, ceilings, doors, sills and skirting, put up a shelf and added a doorstop. He even reproached me for a mark I'd accidentally made on one of the freshly-painted doors, and repainted it for me. Now there's only tiling left to do, and I've started measuring and photographing so I'll be more prepared when I go to the tile shops. I also need to clean the windows now that everything inside is so clean and fresh. It is beautiful, and the sun came out and the kitchen is the brightest room in the house.

Lola II and Mr M visited just before the final wall colour went on. Those who know Lola II will be aware that she is, how can I put this, not altogether comfortable in low temperatures. She tends to avoid Lola Towers between the months of November and February. But mid-March, that should be fine, shouldn't it? Unfortunately no, the Second Coming of the Beast from the East meant sub-zero temperatures and many duvets and hot water bottles. She managed, just.

Due to the demise of the television we went out to the cinema on Saturday night to see 'The Shape of Water', which I think I liked more than Lola II or Mr M did. We took hot water bottles with us. Other activities included visiting a wool and accessories shop to feed Lola II's current obsession with crochet, and playing a new game that we were shown at New Year called 'Codenames'. It was lovely to be able to play in comfort in the kitchen.

Mr and Mrs MXF have also visited. Mr MXF is my multimedia consultant (and friend), and was very patient and repeated all the information many times until I worked out what it all meant. As far as modern technology is concerned I am apparently living in the Stone Age, which doesn't surprise me because in order to stay up to date one needs to own a teenager or work in the TV and Movie Bizniss like Mr MXF does.

Mr and Mrs MXF are very keen on voice activation, which I am resisting at the moment. There was an amusing interlude at Currys when a poor employee who looked about 15 years old tried to tell us that the voice activation devices do not store the conversation that they hear, and was very much put right on that matter. I now have many options to equip my house with the modern audio and video systems I crave. Mrs MXF is in a similar position to myself not only vis-a-vis modern technology but also in the way that she loves the work she does but not the people with whom she does it.

There has been lots of badminton, and work provides unusable blog material from the usual clinics and education sessions that I can't write about. We are, however, expecting a visit from the Care Quality Commission, which is the body that oversees good practice in healthcare institutions. Our last inspection revealed some flaws so we are being brainwashed with messages about Values, Pride, Safeguards, the Mental Capacity Act and rather a lot of other issues that don't apply in the outpatient department where I work.

As part of this focus on quality there was a three-line whip for all dietitians to attend a very important meeting about an issue arising from the death of a patient and subsequent investigation where nutrition played a part. I couldn't get out of a prior commitment, which turned out to be lucky because while it is true that lessons could be learned from the investigation, they were not lessons that had any relevance at all to my role.

I do stuff and stuff gets done

Trois Vallees, France, March 2018

I've been away and then very much over-committed in the evenings. Work is mildly annoying, skiing was great, badminton is similarly great, and meditation is OK (we've had a change of group leader and I'm having to get used to a different style). Ilf has varnished and painted a whole lot of stuff, plus he kindly switched my fridge door round and did a few other small jobs. He's due to be back again next week to finish the painting, after which there will be tiling. I have visited a tile shop and had a very entertaining conversation with one of the employees who I hope will be guiding my tile choices - now I have to measure the kitchen, which perhaps with hindsight I should have done before going to the shop.

That's all for now. Life is hectic.

February

Seville, November 2016

Another successful Gulloebl Film Festival has taken place chez Lola II and Mr M, with the usual high quality films and hospitality. My favourites this time: Grosse Point Blank (which was much more funny than I remember), and Best in Show (which was just as funny as I remember). My contribution was to drive mum and dad over to join in - the first time they have been to the house for quite a long time.

Meanwhile, the LRTP continues with Ilf varnishing stairs and kitchen doors and painting kitchen skirting, walls and ceiling. It all looks beautiful. I have, at last, felt able to just sit and read a book for an hour or two without the nagging feeling that I should be doing something. Of course there are still plenty of things I should be doing, but at least I can relax some of the time.

I have made an investment in buying a ski helmet and ski boots. The procedure for fitting the boots included measurements, a certain amount of trial and error, and experimenting with different manufacturers. Sadly the ones that fitted best were plain black and white rather than the blue and electric pink ones with furry lining. The inners were softened by heating and moulded to the shape of my feet. I've been wearing them around the house with rags tied around the bottom to protect my lovely floors, and the fit seems perfect. I'll be trying them out in the field next week on my second ski trip of the year.

The main thing bothering me at themoment is entirelymyown fault. In a distracted state I looked at my laptop keyboard and wasmildly dismayed at its filthycondition. So Iremoved the space bar and did a fair amount of cleaning witha small paint brush. Canyou see what has happened since then?

What I've been reading

Holes
by Louis Sachar

narrated by Kerry Beyer

"Stanley Yelnats has been unjustly sent to a boys' detention center, Camp Green Lake in Texas, where the Warden makes the boys 'build character' by spending all day, every day, digging holes: five feet wide and five feet deep."

It's a book for young adults but I enjoyed it hugely. I think I've been subjecting myself to works of quality for too long, so an easy read with a great story, good writing and plausible plot is unexpectedly pleasurable. All my reading should be fun; I have let it become too worthy.

The Sleepwalkers: A History of Man's Changing Vision of the Universe
by Arther Koestler

"A thought-provoking account of the scientific achievements and lives of cosmologists from the Babylonians to Newton."

I thought this would be an interesting history of astronomy from the viewpoint of someone writing in 1959, and I also remember finding it interesting when I read it in my teens. It is, however, dense, academic and enormous, covering the lives as well as the work of Copernicus, Tycho Brahe, Kepler and Galileo in immense detail but giving Newton not much more than a couple of paragraphs. I had a marathon journey home from Italy which gave me the chance to do some prolonged reading, otherwise I'm not sure I could have finished it.

The Assassin's Prayer
by Ariana Franklin

"The King of England has ordered his Mistress of the Art of Death - anatomist and doctor Adelia Aguilar - to accompany 10-year-old Princess Joanna on her thousand-mile journey to marry the King of Sicily. They must take with them the legendary sword Excalibur."

The fourth and last book of this series - last because the author died after writing this one. It's pretty good, but not as good as the previous ones, and there's much less of the anatomy and forensics which contributed a lot to the appeal of the first books.


Not much reading in two months, but my current audio book is an epic tome lasting more than 48 hours and I'm only half way through. Spending a week on holiday puts me in arrears with my podcast listening too, so books take second place until I've caught up!

Tuesday

Spain, November 2016

It's getting ridiculous how I spend my Tuesday off running around like a mad thing Getting Stuff Done rather than enjoying some time to myself with a book and a cup of tea. Not that there aren't plentiful cups of tea, but usually accompanying at least one other activity. Unlike Saturdays, when I try to have at least a bit of a break.

Last Tuesday felt particularly hectic:

• Set the alarm to wake up, because...
• Dropped the car off for an oil change and service, highlighting problem with tracking and/or steering
• Bought some milk and posted a letter on the way home
• Cooked mushroom and egg on toast for breakfast (this is a treat for a day off)
• Made four lunches for the rest of the week from interesting buckwheat pasta bought on holiday
• Contacted AEG customer support to enquire about certain operations of new microwave oven - did it over the web but should have phoned because response has not been forthcoming
• Phoned chimney sweeps and then realised this would have to wait because...
• Planning how to buy ski boots and this is more urgent than chimney sweeping
• Arranged to meet friend in Birmingham for lunch (less urgent than ski boots)
• Ordered ski helmet for collection at the weekend
• Lunch consisting of leftover soup and salads
• Garage called to inform me that one tyre was damaged to the point that I was fortunate it hadn't exploded
• Three more phone calls for various enquiries and appointments
• Started writing blog about insulin pump training day
• Cleared utility room ready for disassembly of cupboard in order to enable fitting of stopcock push-button valve
• Changed keysafe combination for kitchen fitters (I have a different combination when I'm expecting tradesmen)
• Scheduled future plans for replacing bathroom radiator
• Shopped for plastic tubs on the way to collect the car
• Came home and organised more kitchen stuff into new plastic tubs
• Drove to B&Q to buy a shelf for the kitchen
• Drove on to work in order to attend meeting for patients on insulin pumps who are not achieving their aims, but the time had been changed so I missed the first two hours
• Drove on to meditation with Buddhists. We are looking at the archetypes who comprise the Mandala of the Five Buddhas, and to be honest the discussion is not doing much for me, but the meditation is good and it's nice to have company for some of the day.

Not every Tuesday is this busy, but most of them are. I used to wonder how I managed to work full time, but I must have done all this stuff at the weekends. Since that Tuesday I've had a whole week followed by another Tuesday. Plumber Ulf came to sort out the stop tap business and while he was here he changed my bathroom taps and pipes so that it now takes less than a day to fill the bath. There's been badminton, I collected the ski helmet, and I've also done a lot of floor waxing and polishing so the living room is lethal when wearing socks. And at the weekend the soul of the television was stolen with a quiet 'pop' and faint smell of burning. It was about 15 years old, so fair enough.

In between all this I've still been going to work, but there's very little new to report on that front. Patients continue to be interesting but impossible to write about, I enjoy delivering the group education as well as the one-to-one consultations, but I'm always happy to go home at the end of the day.

Another insulin pump

Krakow Botanical Gardens, July 2016

There are a number of different insulin pumps available on the UK scene - unfortunately one fewer than there were last week, as one company (Animas) has withdrawn from the pump market. We support three different pumps in our service, although the majority of people use one particular brand (Roche). A training day was offered by Medtronic, one of our less used suppliers, and all three of our nurses, one doctor and I attended to learn more about how the pump is used and about some other associated products.

It's a 'tubed' pump, which means that a tube carries the insulin from the reservoir in the pump down to a cannula inserted subcutaneously. [Tubeless or 'patch' pumps (like the Omnipod) are mounted directly onto the skin with the cannula on the underside of the pump.] A blood glucose monitor communicates with the pump, and an insulin calculator is integrated into the pump rather than the monitor. The main consequence of this is that the pump has to be accessible for anything other than a preset bolus amount - the other brands we use can stay hidden under clothing as all their functions can be operated from the blood glucose monitor alone.

Aside from this one drawback, I like the Medtronic pump. It has potential beyond just being an insulin pump because it can be hooked up with an integrated Continuous Glucose Monitoring (CGM) system. This allows for anticipation of low blood glucose (hypoglycaemia) and the pump can actually suspend insulin delivery for up to 2 hours ('low glucose suspend'). It can do this automatically or with user input, with or without alarms, day or night. This has been shown to prevent hypos without leading to high blood glucose afterwards.

'Low glucose suspend' kicks in when blood glucose is within 3.9 mmol/L of a user-selected 'Low Limit' and predicted to drop to less than 1.1 mmol/L above the low limit within 30 minutes. So if the user selects a low limit of 3.4 mmol/L, insulin can be automatically suspended if 4.5 mmol/L is predicted when blood glucose is 7.3 mmol/L, as measured by the CGM sensor which is monitoring glucose levels through another cannula. Insulin is restarted either when the user intervenes, or when blood glucose is predicted to rise 2.2 mmol/L above the low limit within 30 minutes, or after a maximum of two hours. I started to argue about why the user-specified low limit couldn't be the actual prediction (4.5 mmol/L) rather than 1.1 mmol/L below it (3.4 mmol/L), but our tutor wasn't following my argument so I had to abandon that line.

We looked through the pump's menus, set up two basal patterns, set temporary basal rates, entered blood glucose levels, delivered different types of bolus and generally learned about all the different settings. We were shown different cannulas and inserters and stabbed ourselves with those, and then looked at the reports that can be produced, both with and without the associated CGM trace. They left this bit until the end, and I would have preferred a bit more time to work out what the reports featured, where the most useful and important information could be found, and a bit more practice at interpreting the tables and graphs.

The chap leading the training day was a healthcare professional who works for Medtronic and goes out to patients to start them on pumps, review, or troubleshoot. He also has Type 1 Diabetes himself, and uses a Medtronic pump. Occasionally he would throw in some personal experience about how he would manage a situation himself. Nobody, and I mean nobody that I have met through our diabetes service (or elsewhere) treats their diabetes in the way that he does. "But if I don't do it like this I'll have a higher HbA1c [i.e. worse control], so why wouldn't I?" he said. True, but he is in a bit of a unique position, understanding his diabetes and how the pump works as he does. And he seems more motivated to manage his diabetes than almost anyone I've met.

[For those who know about the numbers, he tested his blood glucose about an hour before lunch, it was 7.1 mmol/L with no active insulin on board and he gave himself a bolus of less than one unit of insulin. "My target is 5.5, I've got the technology, so why not?" he said.]

This company is aiming at development of the technology beyond the 'low glucose suspend' option. They have plans for a 'hybrid' system that will adjust basal insulin all the time according to CGM results, not just when blood glucose is dropping. Bolus insulin for food will still be down to the user, which distinguishes the hybrid from the 'artificial pancreas' level of technology (which does exist but is still too experimental for mainstream use).

At the end of the day we were also reminded of another bit of kit that the company produces, which consists of a cannula that can be worn for up to three days (like a pump or CGM cannula). This one, however, is designed for manual injections, so its function is to enable someone to give all their multiple daily injections for three days through the one device. The obvious benefit of this device is fewer skin-piercing injections; the downside is that by the end of three days the effectiveness of insulin injected in the same spot can fade a little, and the risk of developing lipohypertrophy ('lipos', or fatty lumps) is higher.

The sales pitch suggested that this is a device that would benefit everyone, but would it benefit someone who is doing well and doesn't mind multiple injections? Such a person would be moving their injection site around, wouldn't risk lipos and wouldn't experience the decrease in the effectiveness of their insulin. Balanced against that is the benefit of reducing the unpleasantness of multiple injections. It's difficult to judge the psychological strain of many injections compared with one cannula for three days, but so far I haven't started pushing this device to patients.