Watch out! - for the little things

I’m into week three of my induction period after joining an NHS acute trust. These days we’re all in a uniform of some kind or mufti; a big change since I was last working in such an environment is being bare below the elbows. Brought in as we became more conscious of infection risks ties have largely gone too.

So after several decades of wearing a wrist watch that habit has had to change too. “You can get the time from your phone” I hear you exclaim; but I’ve worn a wrist watch for much longer that digital timepieces were available, when analogue meant winding up the watch or clock yourself. And to get time from the phone meant dialling the speaking clock.

Why is this worthy of mention? The watch I’ve worn for some years now belonged to my late dad, and it was given to him after many years work as a teacher and head teacher in inner London. It’s served as a reminder of his commitment to education and those in his care; whose learning and development were so important.

It’s also reminded me of him as a person and father and of his love of public service and doing good things through that service. It’s been a little disconcerting not to have it handy to refer to. It’s meant I’ve had to develop a new ‘check my phone for the time’ thing though I still go to my wrist and wonder why there’s a gap. It’s made me reflect on loss and grief; another step away from him. It’s chipped at the inspiration the watch has provided as well as a sense of time. I always like to be just a little early and a watch is a quick way to check times progress. Now I have to rely on my phone, or the occasional wall clock, to be sure I’m timely.

Not having the watch has been a distinct loss that I wanted to mark through speaking up about it; it’s about the difference little things can mean to people. This was emphasised to me again this week listening to Chris Pointon speak about Dr Kate Granger and the build up and progress of the #HelloMyNameIs campaign. Do look the campaign up if you’ve not heard of it; even if you know about it, remember little things when left out or ignored can have an impact much bigger than we can ever realise.

Perspiration, inspiration, and poetry

Once again I find myself drawn to other sources of inspiration; social media has provided the contact method, using it has been key. That's what's led to the perspiration on my part, modest though that has been.

Dr Kate Granger with her husband Chris Pointon have through their sharing of Kate's experience of advancing cancer been a source of admiration and great ideas; the ultimate being "#hello my name is..." and I was amongst the audience on the last of the roadshows they did last year spreading the word. Out of that alongside my efforts to be more creative, came a poem about Kate and the "#hello my name is..." project. I am convinced more of us should make time for exploring other avenues of expression and outlets for thoughts. Blogs themselves can be a way to say what we're thinking; as I get older I'm keener to explore creative avenues that were not so well developed when I was at school though that is a whole different story. 

Instead I'd like to leave you with the poem I wrote after meeting Kate and Chris last year. Kate has seen the poem and this was the perspiring moment for me; I know now Kate is okay with what I've written. Not only do I want to share my thoughts through this poem, I hope it may inspire readers to explore other routes of expression for themselves.

Kate’s vision – “#hello my name is …” or The Wakefield Wonder

Standing strong
Staring life in the face,
 going only half the distance
Ambition defying the gravity pull of death.

Beyond the expectations of the 
‘experts’
Her medical skills are for others, yet
So needing others now.

Hello my name is – makes us
smile though that’s not
the whole intent.

Touch and calm,
Pace is mine, and your focus
on the person.

With Messiah like drive you push
onwards, touching lives
touching, us, 
Giving the lie to dying
for living still
You make your mark.

An imprint of a modern making,
a Twitter born legacy
that Must leave us 
better people.

Philip Ball, 
24/06/15 2205 hours

Being a target

Those who follow my tweets and those who access my Facebook page might have seen my posting about my health incident this last weekend. Enjoying a 'self-care' stay at a hotel near mum's prior to the UK Mothers Day, I became unwell during dinner, experiencing severe abdominal pain and feeling feint. Within a few minutes the kind and helpful hotel staff along with Megan decided help was required. The London Ambulance Service crew showed up a few minutes later and took control of the situation. I remained conscious and with my first aid and nursing knowledge realised the possibility of either an aneurysm or heart attack were high on their list of concerns. Dodgy food was  considered though no evidence was seen.

I was soon in the ambulance and wired up to the ECG machine, whilst the crew calmly went about checking me over. Without further discussion we set off for the nearest A & E where after a few minutes wait I was loaded onto a trolley. At this point I'm sure the ambulance reached me inside 8 minutes, and I was dealt with efficiently so the crew were on their way after handover.
It was relatively early on in the Saturday evening so the staff were fresh and not under too much pressure; my vital signs were recorded by a RN who used hello my name is, nice! A cannula was put in my arm and bloods taken; Megan was asking if there'd been anyone in the lab to process them. I was sure there was; some things have changed a lot and I expect there was machinery close by for doing the analysis required; there has to be to aid meeting targets.

I was put into a single room and vitals checked again; different RN and no ' hello my name is ...'. A cheerfully helpful HCA recorded another ECG, and gave me a gown and blanket with an apology for the lack of a pillow. He was another 'hello my names is ...' hero along with the doctor who saw me. The HCA insisted I put the gown on (I kept my trousers and shoes on all through my stay) though I'd have preferred to stay in my T shirt; a curious requirement and no reason from my perspective. Does wearing the gown help differentiate me from visitors and make life easier for staff? Is this a money saving opportunity missed? On a similar point why not have universal ECG stickers so the ambulance ones aren't pulled off and new ones applied at hospital?

My main question I suppose is around the need to transfer me without question to A & E? Would a wait a little longer at the hotel have reassured all concerned it was a one off and that resting in the room would have been ok? Maybe with my insight I would have been ready to take the risk that it was a one off episode and did not need hospital intervention. I suspect though that algorithms and risk averse targets played a part in driving my care rather then patient choice and perhaps an application of experience and common sense.

Treated with warm politeness at the hospital, privacy and dignity were only nearly there. Wearing a gown as one carried a sterile pot to the toilet clearly shouted - "he's a patient off to do his urine sample" - amplified by the evidence visible in my hands on the return journey did dent both privacy and dignity. As a nurse its ok to walk about carrying other people's bodily fluids; as a individual carrying ones own, its a whole different situation. Within about 3.5 hours I was allowed out after some IV fluids and pain killers, clutching my blood results sheet - though not sure why I was given it. We dutifully completed the Friends and family test card. So, I was treated and moved on from A & E inside the 4 hours and the ambulance team did their job too in that regard; I was a target met.

Was I safe, cared for effectively, in a responsive manner by a well-led team? Yes, so CQC-wise I have no faults to mention. I am still left questioning whether the expense of resources for me was a good use of what was available that evening. I asked the senior nurse who helped administer my IV medicines about the coming shift; it was clear that my case was a straight forward one; single episode of nasty tummy pain that passed off quickly and simply. Yet to come for the ambulance and A &E teams was an after midnight rush of drunken fighters and fallers, that required an increasing police presence. That makes those public servants targets of a different kind, and a group of people for whom I have the greatest admiration.

The times ahead...

Sharing Times

I have been reading recent news items and blogs all reated to end of life care; a recent blog update from Dr Kate Granger, @GrangerKate and via ehospice profile pieces. Kate Granger is no stranger to many social media users; her open door policy gives an insight into the kind of dialogue an individual can have with the cancer they have. Out of Kate's experience has come the '#hellomynameis...' campaign, encouraging everyone to introduce themselves as they deliver care. Just yesterday, while having a simple ultrasound the technician and consultant introduced themselves and asked a little about me as we got ready; the gel was nicely warmed too. I felt valued, and that my part of the preparation was appreciated making the procedure easier for all.
Reading a piece about the Buddhist approach to the end of life and death; an interesting refresher, I found myself wondering about the reality of mindfulness and meditation when thrust into the milieu of care provision. How far can our minds takes us to places of such self awareness that pain and discomfort are reduced? It was a salutory lesson; I am reminded that there are many people who have experiences very different to me yet our paths will cross because of a diagnosis and care system.
How we treat each other, and the room we give each other to hold our beliefs is critical to our future relationship and the benefit that sharing of our selves brings.