Friday, November 26, 2010

Not only... but also....

So-ho. You all though last post would be a flash in the pan didn’t you. Go on, admit it, you know you did. Well to be honest so did I a bit. You see you, well I, make these resolutions to try to do better, to stay more engaged, to put down just a few words each day until you get to something postable... and then real life chucks great dollops of stuff at you, well me, or your tiny little butterfly mind flits onto something else and here we are three weeks on and nothing to show.

Anyhow, in the flurry of quite unexpected, and stunningly over generous comments to my last outing, my friend Bendy Girl set me a sort of a challenge, which I shall now attempt to answer. If you’ve not met her before you owe it to yourselves to do so now. Go ahead, click the link and have a browse, I’ll still be here when you get back.

It seems our heroine has started a “revolution from her bed” as she says. And there follows a small contribution from your humble interlocutor about two friends of mine. As regular readers will know whilst the following stories are “true” they are composites of more than one individual’s experience in each case and reflect the “patient experience” rather than identifying an individual.

So with all of that said, first let’s meet Dud. Dud has worked in light industry all his life. Of course by light industry we only mean not building steam engines or other very very heavy things. He’s worked with metal in heat and dust and smoke for years. He’s also been partial to the odd fag, to be sure (American readers take note: Fag = cigarette in “proper” English like wot is spoke in Ambridge), and as a result of all of these factors he’s developed that persistent shortness of breath that is COPD. He needs three inhalers several times a day to get by. That hasn’t stopped him working well past retirement age, his skills being too valuable to the company to loose. A few months ago his chest took a bit of a nosedive, he started coughing a lot more and he ended up in hospital. While he was in the nice docs did a chest x ray and found a nasty looking “shadow” at the top of one lung. Dud put two and two together, decided he wasn’t liking the arithmetic and quickly persuaded them to let him home without a lot more testing and probing. He’s on oxygen, is comfy, and is looking forward to sitting up for nights on end to watch the test matches from Down Under. We haven’t talked about his diagnosis, because we don’t need to. In the end the only thing he’s worrying about now is how much his treatment is costing and whether he deserves it!

Pete lives in Penny Hasset, a stones-throw from Ambridge. He’s been barman, cleaner and general factotum to the Penny Hasset Working Men’s club for decades. Though never a smoker he’s worked around smokers for most of his working life. From quite an early age he was identified as having bronchiectasis. This, for the uninitiated, is a poorly understood condition of susceptibility to recurring destructive chest infections that slowly but surely erode the normal architecture of the lung, leaving in their wake cavities which fill with phlegm which in turn render the sufferer more susceptible to infection. Three years or so back Pete had a really bad infection—bad enough to warrant admission to hospital with pneumonia. While he was there he developed respiratory failure and came home with both oxygen and night time ventilation. Against advice he went back to work. He lasted six months before I prevailed on him to be signed off. He was gasping, and the lifting his job entailed was patently far too much for him. Three months after signing him off the benefit docs asked him in for a medical, where they asked him a few questions, got him to do a few trivial physical jerks, and passed him fit to return to work. This despite me filling in a form explaining his need for long term oxygen therapy and night time ventilation.

So Pete gamely struggled back to work. At least by now there was a smoking ban so his working conditions were a little better, but come the following winter he had another exacerbation, a long spell off work, and finally lost his job. Thus far I’ve been able to persuade him he really ought not be looking for another, and again thus far, the B.A. docs appear to have seen sense and have accepted my latest report and stopped hassling him.

So there you have it. Neither Pete nor Dud would have chosen to be where they are now, and neither has asked not to work when they were capable. Indeed both have rather struggled on when reason would have suggested they ought not. And I could name you a dozen others in a similar position. All present talk of making it more profitable to work than rely on benefit may sound very noble and high minded in the marbled halls of power, where hard graft means having a lot to read and a few late meetings to go to. It completely misses the enormous efforts made by the likes of Pete and Dud to keep going against the odds, and any move to impoverish them is little short of scandalous and should be relentlessly pointed out for the evil narrow minded bigotry it is. I sincerely hope this is not what Dave and his cronies are about to do, but somehow I'm expecting to be disappointed.

Wednesday, November 10, 2010

Crikey _ _ *

Well, blow me down, here we all are in November. We are all here, right? I mean it's not like I've neglected you at all is it? Well not *really* neglected. Well I didn't *mean* to. Er...

Perhaps I'd better stop digging now eh?

Would it help if I said I'm sorry to have been away for so long and that I never meant to. There were lots of times when I sat down to put finger to keyboard, but the words just wouldn't come. There were even a few when the words just wouldn't stay away, but there was no time to tap them out-- rather fewer to be sure, but a few. Anyhoo-- if there's anybody still out there just let me say again, and for the record, I'm sorry for not keeping in better touch.

So there you have it.

Now what was I going to say....

Oh, yes, crikey!

~Er, that's where we came in-- why doesn't he just get on with it? ~

~Don't ask me. I only stopped by to water the plants!~

~Shhh shhh shhh shhh, it looks like he's going to say something in a minute...~

~well it's about blooming time if you ask me...~

Sooo Mondays...

~What does he mean Mondays-- it's Wednesday isn't it?~

~Shhh, don't scare him off he's only just come back!~

... well perhaps more this past Monday, but in GP land Mondays are funny days. People save stuff up for Monday, or get sent up by the nice out of hours docs after an encounter at the weekend, or wake up at the start of a working / school week feeling a but the worse for wear, and need to be seen stat...

~ooh hark at him going all E.R. on us~

.. just in case it's the killer lurghi, or Green Monkey Disease or whatever. In a nutshell Mondays always loom that bit larger on the GP calendar, unless they are Bank Holidays, in which case the immediately succeeding Tuesday gets promoted to honorary "Monday-with-knobs-on" status.

And so it was two days ago the the gods of Mondayness struck and blighted the surgery with a cloud of despondency. The whole day was a catalogue of grief and woe. I should have known it was going to go ill when the first three patients all moaned bitterly about having their blood pressure checked. Now it's never entirely comfortable having your pressure checked in the vice like grip of the sphygmomanometer (500 points in Scrabble if you can position it right) but on Monday apparently not only was the cuff extra squeezy, it was also "too cold"!

Like the rest of the building.

No heat on over the weekend means it takes till Wednesday duty surgery for the building to thaw, and last weekend was a tad "Parky" as they say. (And yes this is a Wednesday duty surgery and I'm feeling far more toasty thanks for asking). In the end though parkiness was going to be the least of the problems presented.

After coffee a couple came in to talk about the death of their son. it was sudden and unexpected, and there is nothing to say in such a consultation that isn't, however well intended, a platitude. The best you can do is to make sure the bewildered, bereaved and struggling couple in front of you know that you really mean it when you tell them you'll be here for whatever, and whenever they need you. Not an easy sell now we're closed weekends and evenings.

We spent a half an hour going round the houses, with me trying-- vainly, and inevitably so-- to persuade them they have nothing to blame themselves for. In reality this is true, of course, but in the messed up milieu of "feeling" and "emotion" it is anything but. There are always a thousand "what ifs", easy to ask and impossible to answer. We covered a few, and we'll cover some more as time passes, but sometimes, even when it's inadequate "stuff happens" is the only response.

From here it's how you pick up the pieces that matters. We'll help as best we can, and they have family and a phone number to call that will open up the doors to more and better support that I can provide. And my door will remain open for them for as long as it takes, but it all feels so woefully inadequate.

The rest of the day plods on with a succession of intractable depressives, horrid sore throats and one comedy ailment-- a poor chap who pulled his back when he was jolted by the shock of poking himself too hard in the ear with a cotton bud. Now he knows why the ENT boys say never put anything in your ear that's smaller than your elbow (go on try it, you know you want to try putting your elbow in your ear-- not you Bendy Girl if you're still out there, you just might make it and then I'd feel terrible).

And then with grim inevitability, in comes a girl to talk about the death of her mum. Of course you have to bear in mind that in this context a girl is anyone more that five years younger than me-- what with me still being so youthful and all, but here even at forty-mumble she's still her mum's little girl and always will be, even with mum suddenly no longer here. The perspective is different, but the consultation is very much the same. Mum had been ill for some time, and her end was not perhaps quite so unexpected, but that hardly makes a difference as anyone who's been through this will tell you.

There are days when I feel barely adequate to the task. And somehow they are mostly Mondays.

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