“We apologise for this late arrival...”

 So now it is 2025 and I have decided to return to a refreshed blog. The last year has been a trial of my (mainly physical) health. I needed steroids to dampen down polymyalgia rheumatica which brought on steroid induced diabetes.  I am now steroid free, the blood sugars on my low carb, full fat diet are much lower (see freshwell) and my weight has stabilised at what is about right for my height.  During all this I've awaited two relatively minor surgeries. The NHS is so good it is said when an emergency arises. The wait for non-emergency (elective) surgery, is often long which is frustrating, and at times costly, in terms of keeping comfortable and safe whilst waiting. 

In the last couple of weeks I have had my prostate reduced, it is expected to be cancer free but awaiting confirmation of that. It didn't go quite as expected so an uncomfortable week went by whilst I did my best to drink the world dry. All is beginning to get to get better now and for that I am very grateful. I had however to push to get the surgery done as I need a hernia fixing too. The local hospital was getting ready to do that but I had been told the prostate needing fixing first. There was no inter-departmental communication between surgical specialties that would have helped avoid the delays. This patient has had to do the organising. Given the level of computer based record keeping that exists it adds another layer of frustration.

So you can see why there's been an impact on what I call my mental health too. That being so the last 12 months have not been without bright spots too. There have been travels to see good friends, and taking forward my ambition to do more drawing and painting. Canada, New Zealand, France have been further destinations, while Brighton and Bath have been examples closer to home. In two of that list we saw friends who have since died. Whilst immensely sad about Tim and Chris, who are greatly missed, we were pleased to have spent time with them.

Even closer to home was a Garden Party at Buckingham Palace which on an warm sunny May day was most enjoyable. As ever though the joy of being granddad stands out. Making a den in the back garden, getting messy with flour while making biscuits, singing, train rides, and sharing stories are part of that picture.

Using stories to help understand death, dying, hospice care, and nursing is something I got used to. And a new development opportunity has arisen through the Anne Robson Trust. I have been recruited as a freelance trainer for the 'Simple Wisdom' course they offer. It‘s given me something else to look forward to, as I share examples from my life to help others develop confidence when death and dying arises in their lives. It's never too late to learn about these things, so it is timely unlike this blog piece that's taken too long to come along.

Heart Head Kindness and other influences

Tweeting away a couple of days ago I came across @WeNurses #nursestaketen  which encourages us to do something a little different, even if just for a short time. It made me seek my take ten moment, and as winter approaches I'll return to some creative activities in the darker evenings. The suggestions also included writing a blog from the heart; a prompt if ever I saw one as my heart has been a cause for concern in the last couple of weeks though thankfully the local rapid access cardiac team tell me I'm ok. My emotional heart has been touched by reminders to be kind to ourselves in David Gilbert's blog and being kind to others in Dr Dharmaraj Karthikesan's blog.

All very well beng chilled about kindness;  then I saw references to poor care home standards in the news; in particular what was evidence of an indefensible nursing attitude. The news piece flags up stereotypes of Care homes; whilst there are obviously concerns about the home mentioned it ignores the many excellent and simply good care home there are who can make a difference. 

It was the quoted, secretly filmed words of the nurse that struck home to my nursing heart and head. Immediate  to be "struck off" thoughts were the initial reaction; the attitude that allows uncritical use of medication for care givers convenience is wrong. But head says how did that person get to that place? Are they so isolated, denied training, supervision and support that they have lost that critical internal voice that says - "stop, think a moment" before you speak and act? I understand from the report the nurse has been suspended; I presume some disciplinary action will follow. 

Both heart and head say who was being kind to this nurse and their colleagues? Who was listening if they raised concerns? I suspect no one was. How can we reach out to our colleagues who find themselves in such conditions that they cannot "take ten"; maybe the act of kindness in seeking other professionals working in isolation and offering to share a coffee, tea and cake (nurses know the value of cake) and allowing them to take a break will avoid this kind of headline being repeated.

I realise I'm fortunate in being able to reflect on this from afar; I hope nursing and others will take heed of the calls for kindness not just to others but to ourselves; if we cannot do that our responses to those in distress, in need of kindness, will find no use of head and no gift of heart in those who are expected to care for them. 

70 degrees of separation

Many will be familiar with the idea that there only 6 degrees of separation between ourselves and others; there are only a few connections between us all whether famous or not. I'm talking about two different places I've visited where the temperature has been separated by 70 degrees Celsius.

It was early 1999 when I joined palliative care colleagues in a visit to Kemerovo in Siberia where one day the temperature was a challenging -35 degrees; currently I'm in Potchefstroom South Africa where I've been able to enjoy +35 degrees. The link is once again sharing my experiences in palliative and end of life care, recognizing I've worked in this area of practice for 25 years. 
So why here in Potch? My partner Megan has been invited here to be an Extraordinary Professor at North-West University Potchefstroom campus, in the School of Education. As her term of office begins we came here at the invitation of the Uni team. I was just going to be a hanger-on for the two weeks, reveling in the first two week break from work for some time. The Uni team had other ideas and recognizing I had my own area of expertise, in end of life care put me me in touch with the Education psychology and nursing departments of NWU. The upshot has been an opportunity to visit the local hospital and to deliver a presentation to two groups at NWU about ethics in end of life care as well as having difficult conversations. In between we have been able to share meals and time traveling in the area, visiting schools and a game park. All very interesting, though the game park details will have to wait another day. 
The two visits have taken place in places undergoing significant change, in political, cultural and social senses. In addition the organisation of resources for health and education has changed. For brevities sake I'll focus on our current visit, that's starting about 150km SW of Johannesburg.

We have experienced great generosity - time, food and drink, and travel. I hadn't realised just how big a country South Africa is. Our travels have included 3-4 hour drives and we have covered only a small part of one province. We're flying to Cape Town later; the time it takes would get us to the Mediterranean from southern UK. For many here though travel is a luxury with poor public transport; so travel from rural areas to the nearest healthcare provision is only undertaken when you're very sick. The result means many arrive at the state funded hospitals in towns like Potch (where there is no hospice) with advanced diseases and in need of end of life care. Being HIV+ is very common and so is tuberculosis, often going together. Getting people to understand the importance of maintaining the anti-viral therapies and the long  term TB treatments is an important priority. The message of changing behaviour about sex and HIV transmission is loud and strong yet some feel that the very strength of the message over a long  time is counterproductive.

The opportunities to meet students and colleagues at the university and hospital have been invaluable to help understand the joys and difficulties of life here. That people are trying to improve services is encouraging yet difficult given the differences of resource provision between provinces. This was highlighted in the difference in the number of educational psychologists in the Western Cape area approx 130, and the 4 in the North Western Cape where we are. Seeing the expertise and enterprise of North-West University in making links with Potchefstroom Hospital, to the benefit of patients and psychology students has been great to see. End of life care is a big part of what the hospital does so sharing my expertise and stories has been a pleasure and made this leave from work so much more rewarding. It has also helped me to appreciate the fund of examples and experiences I've had, as well as realise there is lots more for me to learn. I'm immensely grateful for the opportunities my career has thrown up; I never expected these travels. I am very pleased though that there is now far less than 70 degrees of separation between my understanding of what's happening in South Africa and my working life at home.

Headlines get in the way of a good read

This piece offers an interesting view on the treatment of cancer; the nature of cancer itself and adds comments about the language used when describing the relationship of cancer and attempts to deal with it. http://www.guardian.co.uk/world/2011/jan/15/cancer-stop-trying-cure?CMP=twt_gu

The author does not really ask if should we stop trying to cure cancer, rather seek to carry on trying to cure understanding that for many people a precise cure or incurable state, common only a few years ago, has been joined by a state of long term chronic disease. The author argues that whilst having cancer you may live to an old age and die of some other cause. The accompanying comments are worth going through for the diversity of stance and beliefs.