Moron

Fact: Richard Branson is figurehead of Virgin Health, a private health concern.

Fact: Richard Branson's daughter, who works in the same company (why help every patient when you can just help the rich ones who can afford it?) has recently been in the news in a positive light.

Fact: Richard Branson is advising the NHS.

All three of these facts resolve themselves into an big, fat truth, unfortunately. In the above story, There are two moronic, but quite funny, facts to pick up from the story. Firstly, Beardie complains government ministers mess around with health policy too much before... yes. Saying how he wants to fiddle with health policy. His grand scheme is to test (presumably by swab x3) every single person who works in the health service for MRSA. Not only would this be massively time consuming (compared to, I don't know, maybe HAND WASHING) it would also put a huge strain on the resources of microbiology. Saying that, perhaps Beardie would put the contracts out to tender. Perhaps Virgin Health would get them...

His second - most hilarious - point is that the health service could learn a lot from the airline and train industries. I don't know a huge amount about the airline industry, but - as any fule does know (or Private Eye reader, for that matter) Beardie makes large bags of cash from Virgin Trains. Most of this cash doesn't come from actually running the trains. It comes from contract negotiation and gobbling up appetising subsidies. Maybe that is his point, then. Perhaps the health service should be sold off to private concerns (at a snip, for them) and continue with massive problems in the infrastructure (whilst all the separate companies complain that beds aren't actually their problem) remaining unaddressed whilst the companies still grow fat off of massive public subsidies. Once they had their finger in this pie, they could justify increases in the cost of subcutaneous injections by whining about the price of oil, leaves on the lines of their delivery trains (private, of course) and, of course, the state of the economy!

Cunt.

Term Over.

Yes, indeed. Hark! The herald angels have thought it fit to see me through to the end of a term with my sanity intact. Or something like that.

Huzzah!

I've felt the past, compacted week has been something of a waste of time. Except for swapping experiences about placement, which only took about an hour, it was pretty benign. Two lectures were made worse by either: a lecturer not knowing how to use a computer properly, or a computer malfunction. One of these sessions basically involved watching 'Inside I'm Dancing' and reflecting on it. Which was certainly strange as a University experience.

Another involved debating nursing in relation to abuse of the vulnerable. To fence this into a 2 hour session seems a bit harsh, since it's a massive problem. Abuse by carers, professionals, other patients. Horrid subject matter, of course, but something that must be faced. By the end of it the lecturer, who is self-admittedly "old school" (but I like her), said she had faith in us as the subject got us all so upset. She said she still loved nursing after decades in the trade, and if that wasn't an indication of how burn outs don't always happen, nothing was. Useful session, perhaps, but over too soon.

And now it's the Christmas break. Eating, drinking, being merry and of course studying. I'll have to work on accomplishing all four.

The Right to Choose

It's not rocket science.

I've just came back from my morning lecture with an extended break, so thought I'd hit a few points that are on my mind. I'll go onto the ever contentious issue of abortion soon. A quick couple before, though.

The AM lecture was unfortunately cut short, but I'm quite glad. The course has tried to make a session on the massive problem of domestic violence into half a session, which I think is plain offensive. It would've been the arse end of the session, too, which is when most of the morons I sit in lecture theatres with are itching to stop learning and go for their second overpriced cup of coffee of the day. They don't have any money, obviously.

Staying on the point of the sections of my year group who don't seem to care much for the learning part of learning, I was quite amused to be sat in front of a row of girls (actually quite young, in respect to the average age of someone on my course) who talked all the way through the lecture. And I mean talk. Not whisper. And it's not even a big lecture theatre. It amused me more than it disturbed me, to tell the truth, as I can actually multi-task. But I feel bad for the lecturer (a person I quite like) who shouldn't really have to work with the behaviour generally reserved for a group of Year 11 girls sat at the back of a R.E. class. I've made a mental note to sit closer to the front, just in case. Anyway, the girls were shouted at (in hushed tones) by other colleagues, to much cringing and looking away. Funny old world, certainly. This afternoon's session is ran by someone with much more strength of character, shall we say? It should be interesting.

During the AM session, though, an idea came up. Can a nurse be an advocate if a patient is partaking in something they do not agree with? Should they feel guilty if they don't? The side of the room featuring me has to say a nurse shouldn't feel guilty, and we moved onto abortion. Boy, did I end up biting my tongue.

If someone doesn't agree with abortion on 'moral' grounds, or out of some other personal opinion, then fine. Feel free. But once, /especially/ as a nurse, you start to press your own opinions onto someone, onto someone's choices and treatments, you're so wrong it's untrue. I think smoking is a silly idea. Not a 'sin', or against the view of some great deity who may or may not existed, just silly. I do not, however, state clearly that I think someone should be denied treatment because of this choice (which will harm them and do very little good, so is almost against my stance on the 4 pillars of ethical practice) they've made. If someone has had an Myocardial Infarct and subsequently needed a CABG (a 'bypass') to repair it and yet continues smoking I would not deny them treatment, or deny them (in the above case) my advocacy. Nurses don't get to choose who they help in this country, and that's a good thing. Murderer, paedophile, terrorist - nurses should not be casting judgement which will influence their care and treatment on any patients who come their way.

EDIT: It was sad to see and hear most of the anti-choicers bringing out familiar old anecdotes from the Nadine Dorries school of fearmongering. Dead babies, floating in toilets and in kidney dishes, or maybe still alive, gasping for air. Same old biased bullshit, which does in no way reflect the wide range of cases, issues and types of abortion. And portrays abortion, as well as the woman who make such a choice, in a negative, prejudiced light. I was sad, but not surprised. Fear is a powerful tool.

My stance on abortion is similar to my standpoint on most life choices. Noone else matters except the person making the choice. I don't care if, in this example, a baby could survive outside the womb at 2 weeks. That's immaterial. It's the woman in questions right to choose. Not rocket science. The fact that I've met several student nurses who seem to think this isn't the case is downright wrong. Advocates, as it states we should be in the Code, nevermind ethical practice, they are not.

Update: Cretins

I have been told, officially, to not speaking to a colleague "as if they're stupid". This, as the previous post will back up, is incredibly difficult when they are, in fact, stupid. Call me old fashioned.

Basically, we were having a debate about blood pressure and it all boiled over (ho ho). A theoretical patient had a blood pressure of 80/60 and someone was implying that this was a sign of cardiogenic shock. I said his was bollocks (in a more polite way) as I've met patients who are quite lucid and /not/ in CGS with such blood pressures. Someone argued with me, which was a bad idea. I asked them, point blank: "What is hypertension?". I probably used the term 'high blood pressure', since they do not like big words. For which the above accusation was levelled.

I don't really care, anymore. The tutor backed up the opinion of a colleague and I - that is to say that such a blood pressure is not indicative of cardiogenic shock. I argued he had a history of hypertension and was medicated for it, which agreed with the above opinion. But, voracious as I was, I made few friends. M'bothered, am I? Not really.

These people I learn with, the people who don't want to hear big words, are one of the reasons nursing doesn't advance as it could and should do. Their attitude adds to negative views towards nurses, in my opinion, which is something along the lines of what this idiot believes. On top of this, I don't think it's my role to dumb down my own learning to a level in which I don't learn. This is the same group who I, being the only one with cardiology experience last year, offered supplementary sessions to. Out of the kindness of my heart, no less! Funny old world.

Cretinous...

... fuckwits. I worry about nurse education quite constantly, honestly. I have just finished a placement which, at times, may have been boring, but there was no shortage of learning opportunities. The staff themselves were constantly engaged in their own learning, as well as mine. Now I'm back to Uni? Ick.

In the past, student nurses I know have complained about the use of big words. A qualified nurse I worked with said working on a coronary unit involved "too much thinking". I shit you not.

I have just got out of a session (something I have to go back to) in which people I should respect espoused the idea that a Mentor (that is to say, a registered nurse who is guiding your learning on a ward) should teach you basic A&P if you're too pig ignorant to go out and learn it yourself. Sweet. Mentors are supposed to do this in between being overworked, overhoured and underpaid, apparently. Forget about independent learning, forget about guided learning. This is learning-on-a-plate. And here's me thinking that should've been left back in primary school.

N.B. A mentor should certainly assess your knowledge on a subject, and work from there. But if your knowledge is low, that is neither his/her fault, not is it his/her core responsibility to teach you what you don't know. My best ever mentor figure would ask me what a drug did. If I didn't know, I'd ask. She was fully prepared to answer, but would first tell me: "You know where the BNF is..." which is exactly the ways things should be done. My cretinous colleagues don't seem to realise this.

Absent

With Leave, as opposed to the other kind.

I went home to see my family, specifically my nephews. For the second time in a month my youngest ended up giving me a 24-hour vomit and malaise bug. Wrapping arms around the toilet at 4am on Sunday? Not fun.

As NHS doctrine dictates, I have to stay off until 48-hours have elapsed since the last symptoms. Since then, I've got better and then got bored. I should've done more studying today, when I've felt a lot better (thanks for asking) but didn't. I won't lose myself any sleep over it.

It's good, though, in a roundabout way, to be sick. I'm not sure nurses would be good at their jobs if they didn't have reasonably frequent reminders of how shitty symptoms can make you feel, as well as the repercussions. I originally got into nursing due to the fact I was ill when I was young. The reason I almost got into child nursing.

So, looking on the bright side, it's not all bad!

Health Promotion in Action

I've had an optimistic couple of days on the Health Promotion front. It's fun. This might have something to do with the fact that I finished before 1pm on each, but let's not be cynical.

On Tuesday I spent the morning with the team's Occupational Therapist (OT). Now, from the outset I'm pretty biased. I bloody love Occupational Therapy. I love the primary idea. It can be really basic, or really clever, and when it is facilitated well it can really improve people's lives. The OT I was with is very talented and experienced and we had a good chat about the ins and outs of OT within cardiology. We then went out - in the bloody snow, and I was already soaked through - to help a patient fit a bath seat. One of these zany electric things with suckers and whirring gears. That went smoothly, we had a chat and she expressed gratitude that we'd been able to help. A good visit, all in all.

Today I went to a real community setting, a church hall no less! Exercise classes for people post-MI go on there, at personal expense to the attendees. I'll vent on that later. The leader for the group was one of the most cheery, positive people I've ever met, which obviously helps things. Both groups knew each other, and on further questioning some of them had been attending for 12 years or more! No wonder, then. The exercise was pretty light, but given some of them were in their 80s that's no surprise. It is, rather cleverly, arranged into three levels, which makes it plenty accessible. Level One is quite sated, whilst Level Three generally uses whole body moves. It was an excellent learning opportunity, really. I got to speak to the leader about the classes and the reasons attendees value them, and then I got to check this out by speaking to the people themselves. They were all lovely, and told me the classes were both enjoyable and useful.

The major bee in my bonnet is the fact that they have to pay. These classes are bi-weekly, for an hour and a half each. One member of staff is required. The classes are in a church hall. I'm not seeing how they could be massively expensive. The classes are uber-useful. Not only do they allow people to exercise, warding off further MIs and other linked problems, but they encourage people to exercise outside of class. More importantly, the classes double up as a support group. People with similar problems getting together. Level Ones can find similar people to do the circuit with. If Level One A is a bit further down the road to recovery than Level One B they can talk about it. They get bloody enthusiastic about finding out about their conditions, which is one of the most important parts of Health Promotion!

And yet the PCT refuses to fund it. Good job, you cretinous fuckwits.

Concern

Is it going to take an epidemic to change things?

The above news story is quite saddening, as a nurse, a scientist and a person. Some very scared people once believed this man and his (at best) inconclusive piece of research. I'm not going to go too deeply into the specifics, but when everyone - including the research team at the time - said the issue (the link between autism and the MMR vaccine) needed further research and one person says: "No, it's conclusive" surely this hints at something. Then link it to the possible conflict of interests and you should have a doctor stripped of legitimacy.

Unfortunately, Wakefield used an oldie-but-goodie within medical/quackery circles. If you tug on the emotional heart strings hard enough, with an air of threat about you, logic goes out the window. People can't think sensibly, act irrationally. In this case they continue to give reverence to this debunked research.

Until this research and the fallout from it, measles was well under control in this country. Now, as the leading story reports, it has shot up. Because it has not been a problem for a decade or two, people have forgotten how horrible measles can be. Make no mistake: measles can kill. It does, and has in this country already for the first time in over a decade.

I hope Wakefield is happy with himself. I feel sorry for the scared parents, but in the same sense I don't consider ignorance an excuse in any situation. Especially when it could lead to misery, sickness and death. It's a bloody shame.

Going somewhere else

My course gives me a chance to venture into other clinical areas whilst on placement. They usually have to be connected and you need to justify why you'd want to do it. Thus: "Because this placement is boring," or "Because there's a staff nurse on there who's well fit" don't really cut it. In the same sense, it makes little sense to want to spend time in Orthopaedics if you're on a Cardiology placement, and so on.

My current placement, as previously detailed, is not the most exciting, in my opinion. As is prempting this, my mentors are somewhat pushing me out of the aeroplane to attend as many of these sidecar placements as possible. Problem is I don't really like them.

I turn up, introduce myself and firstly see if the people you're going to be watching and working with for the duration are much bothered. You find some to be gloriously friendly and helpful, some... not so much. Most of the time, I can pick up the vague impression I'm somewhat in the way of a day's work, really. One of the main reasons for my dislike. I prefer to be working, rather than standing around looking pretty.

Now, I hear you say - you can be observing! Yes, of course, and I do. But there's only so much you can learn from observing what happens to one or two patients. For example, I was observing echocardiograms today, which are very cool. I find them interesting, the technician was lovely and I understand the results of them more. But watching two can only do so much. Now, for example, if one of my patients was going down for one I would be happy to watch that single scan on it's own as part of the patient journey through the diagnostic pathways. But watching two scans of people I don't know from Adam? I don't find it particularly useful in itself. I do like EEGs, though. It's the same concept as doing that scan on a baby, but more interesting. You get to see the heart in all it's glory, the movements it's making and the rate it's moving at. A skilled technician then takes live feeds from different angles, recording them on a handy computer. The size of the chambers is looked at, as well as how much they're inflating and deflating. More importantly, one can observe all four valves, to see if they're leaking (regurgitation) or any other defects. Not only can one observe the heart in greyscale, it is also possible to bring in some colour. Specifically, it allows a technician to observe force moving away from the probe (usually in red) and towards the probe (usually blue) and anything in between. This is important to check if any blood is moving the wrong way, i.e. back through a valve. This is a bit naughty. There's also this awesome effect when you catch a decent glimpse of the Aortic Arch with both colours going in and out of each other. Fun. I like echocardiograms, then, yes. They're non-invasive, and a bit sci-fi. Only the former point is relevant to most patients, I'm sure.

I also witnessed a modified stress test, without the exercise component. Instead, the technicians administer a drug intravenously which makes the heart put a little more elbow grease in than normal, pumping effectively harder. This chemical is used in patients for whom even a gentle walk on the treadmill would be too much. The old and the very ill, in other words. The middle ground between these two absolutes (a full on exercise test and the chemical) is a more sedate time on the treadmill. The scores received are they modified, I believe, by another handy computer. The chemical test is pretty simple. A patient just lies there as it works it's magic. Reassurance is obviously key, as the chemical can cause an increase in temperature and - since it's a potent vasodilator - can lead to a drop in blood pressure, as well as the associated symptoms - dizziness, nausea and the like. The patient I witnessed was fine for the duration of the test, sat up well and just felt 'a bit funny'. Before sitting up, however, they are injected with a radioactive dye. The patient is then given a lovely meal involving milk and a (preferably fatty) sandwich. The Nuclear Medicine Department is not emulating the witch out of Hansel and Gretel, oh no. Instead, the idea is to activate the Liver and Gall Bladder, get them moving and, by proxy, move any radioactive dye that may have accumulated in either outwards. That way, there is more chance to recieve a better picture of the myocardium when the patient is being sent up for a Gamma Camera test.

The Gamma Camera test is pretty dull, from a patient perspective. It basically involves lying there are two cameras cycle around you, in jerky movements, to take a decent set of pictures of the heart. 20-20 style, although the cameras are arranged at angles of 72, 90 or 180 degrees to each other. So hardly like a human head. The gent in charge was nice enough to talk me through what the scans mean, so I can write it down here before I forget. The GCT is useful for a few reasons. The most important one is thus: Two sets of images are taken on two different ocassions. One after a stress test, so the pictures are of a heart working hard, and the other when the heart is at rest. This is the clever bit. If both pictures show nice swathes of white and red, therefore lots of perfusion of blood to the heart muscle, it's all good. If there are 'holes' in the stress test when compared to the rest test, then it is a strong indication of ischemia. That is to say, the heart is struggling to pump blood to itself when under increased exertion. If both rest and stress pictures are holey, this implies (but does not confirm) an infarct has taken place and most, if not all, of the non-perfusing tissue is dead.*

These are the tests I witnessed. I will now be able to speak of them to patients in a much more informed manner, which is a good thing, but I can't help feel a bit at a loss when it comes to time spent. I left before the afternoon began, as I didn't think there was much more to see. I, instead, will read about the above to increase my knowledge on the subjects. Additionally, I can't help looking forward to my next placement back on an actual ward, doing what I consider more valuable work.



* A different nuclear method, a Thallium test, can later give an idea how much of this tissue is fully dead, and how much of it is in hibernation.

Nazi Nursing

This is all at once saddening and maddening.

The four pillars of ethical practice and the views of far right, racist, nationalist politics do not mirror each other. In fact, they clash quite massively with each other. This idea that one could treat every person with dignity, respect and acknowledge their autonomy is somewhat ruined if, underneath, you want to unlawfully throw them out of the country for having skin that isn't white.

This is typical behaviour from the NMC. I am a constant critic of the lack of political opinions and stance from nurses in general, who seem to play the angel/martyr card as a get-out clause. But this is typical hands-off work by the NMC.

Political freedom is one thing. The freedom to believe in things which go directly against all nursing (and, to a point, the NHS) stands for is completely different. I believe in socialism, partly, and I definitely believe in trade unions. This political belief does not throw around slogans such as 'Rights for Whites' or does not involve violence and intimidation against it's opponents. It does not advocate hate or any other inequality. There's a fucking difference. No pity for fascists, no quarter for fascists. Just call me old fashioned.

Paternalism for Prostitutes

It's lovely to see that, even from women within the snake pit of national politics, patriarchal, paternalistic bullshit is still alive and well.

A sex worker on Channel4 News was not the first person I heard express dismay that the government commission - in its quest to make the world safer for sex workers - did not really talk to... sex workers. Shome mistake, surely?

Well, not really. It simply turns out that the idea of 'We Know Best' still reigns supreme. The ministers went on a tour of different countries to see how they handle the issue of sex workers. In Holland it's legal, as many anecdotes from just as many young men who go there for a dirty weekend will elude to. In Sweden it's completely illegal, etc.

The government chose to copy Finland with this new legislation. Legislation which has, to be polite, had a limited effect in that country. Legislation that sends out mixed messages. It doesn't appear to much protect the women it is designed to protect (and the personal opinions of sex workers I've read backs up this idea) and yet it - like most anti-prostitute legislation - force many sex workers underground.

People involved in the sex trade should be supported, in my opinion, and this new bureaucratic mess will certainly not do much to that end. KGM basically had DoubleH admitting she wanted prostitution completely banned, in theory. What else could be expected from a woman with such a goal?

Angriogram Duty

Today I have been observing angiograms, which is nowhere near as exciting as I thought it'd be. I got to wear scrubs which I'm sure some people might find exciting, but the (heeled - why?!) clogs that went with them were utterly irritating.

Not much to report, really. I'd already witnessed a nephrostomy back in the day, so it was pretty much the same thing.

The radiographers were snotty, the nurses were nice and the main consultant I observed was very helpful, talking me through and asking me questions (woo) on the scans the unit performed that day. Other than that, things were quite dull.

A massive ball was dropped, though. A rather rotund patient got all the way to the table before it became clear they would be too heavy for the mechanisms. So, at the eleventh hour, the whole procedure had to be scrapped. The patient was surprisingly good about it, but quite a mistake to be made.

On that note, another overweight patient was being scanned when the consultant noticed a quite horrific note in the patient file from a surgeon back in 1981. I paraphrase:

"Patient is embarrassingly overweight, with plump, reddened cheeks and presenting stinking of alcohol but appeared clinically sober."

It went on. How things have changed... I hope.

Anyway, I'm quite bored of my placement. And have yet 3 and a half weeks to go. Nil desperandum.

The Last Week

So, I spent some half days doing (what I know feel is) the same old Health Promotion business. Home visits with interesting people with interesting problems, which are very fun, really. But it's hard to ignore the fact that you're reading them the same check-list, over and over. The skill there, and the skills the people I work with really have, is keeping the procedure nice and fresh.

I spent Thursday and Friday on the Heart Care Unit, which was fucking awesomely out of this world. Critical Care really is my cup of tea, if this hasn't been made clear through my usual ramblings. And given my previous experience in Cardiology, it was a comparatively good deep end to dive back into. I had worried, over the Summer holidays and my current placement (involving few clinical skills) that I would be clinically void. Worse still, I feared I'd lost my edge communicating with and providing care for critically and acutely ill patients. But I haven't! That's exciting.

I had some really good experiences. I worked with the same senior staff nurse for both shifts, who was both a great nurse and a superb teacher. I impressed her with my knowledge, enthusiasm and willingness to get involved - another three things I'm glad haven't waned.

Yes, HCU was very good for me. Given I have an exam coming up about managing care for someone who has just suffered a cardiac event, it was a valuable education experience. The HCU in my current hospital is quite well staffed, which is excellent to see, and there is a more proportional population of men in the nursing side of things, a fact that fills me with optimism. Other than that, it simply reminded me of how much I *LOVE* the core.

This isn't to say it was easy. There were patients who had lots of things going on in their lives, and needed high levels of support on every level - social, spiritual, psychological and medical. This is one of the hardest parts of working in acute and critical care, but it's also one of the most important ones that I'm eager to learn more about, no matter how difficult.

This week I have to try and sort out some spoke placements, which is fucking awkward, especially when it comes to sorting them in other hospitals who are not 100% connected to my place of learning. I can't help but feel my current placement is eager to ship me off for as many away days as possible, which seems a bit besides the point, but we'll see. This week isn't all doom and gloom, though - oh no! Firstly, I'm going out on the tiles tonight to see one of my favourite ever bands. Second, I get to attend and observe some angiograms on Wednesday, which will be lots of educational fun. I look forward to it.

It's been a while.

So, yeah. Apologies for the lack of Mother and Baby conclusion. Although, truth be told it wasn't that interesting. I spent some time on the midwife-led delivery unit, and saw absolutely nothing, alas. A couple of baby examinations, that's about it. Not much that eluded to education and experience, but that's the way it goes, sometimes.

Dr. Crippen has been chronicling re: midwives/"madwives" recently, and it's certainly an interesting debate. Especially the comments.

I'd say the education of student nurses is quite biased towards midwives, in my experience. We share a council, obviously, which might effect things. But generally I don't mind them. They do a difficult job under often difficult conditions. Dr. Crippen has a big ying against Independent Midwives, with some good reasons, but it's not all that clear cut. It's not baddies VS. goodies or anything so simplistic.

The thing which I dislike is the view of the - ahem - feminists over at TheFWord. To state, quite simply, "we decide what is anti-feminist" is hilarious. Their arguments on 'medical rape' are also quite amusing. I seldom agree full on with Dr. Crippen, but his point rings true: Their arguments rely on eliciting emotion, overriding logic and good sense. They speak as if the waters are always clear in modern medicine and midwifery, and like decisions are typically easy to make. I am in no way condoning patriarchal, paternalistic, top-down care or anyone. That's bollocks. What isn't bollocks are the 4 pillars of ethical practice. 'Feminists' over at the F-word state that people in the medical and nursing professions aren't God, which is certainly correct. However, as any fule knows, sometimes judgement calls have to be made. Beneficence can overrule the three remaining principles. Worse still, in the case of pregnancy there are two lives to consider. Doctors, midwives and nurses have to make calls on these issues, often in split seconds, and I believe such decisions are a million miles away from the coffee table debates that concern these 'feminists'.

Mother and Baby Day Three

Third day down. Today was my first day spent with the community midwifery team, which was interesting. There were a quite a few women who didn't attend clinics or who weren't in when we called, which was educational in it's own way. Midwifery is difficult. I sat with the whole team, elements of which I will be working with for the rest of the week, as they had what is locally known as a 'natter'. There was a bit of bitchiness as well, but this is common in my experience of women grouped together.

The latter part of the day involved another clinic, a bit more well attended this time. Bizarrely, there was myself, the midwife I was with and two medical students. I'm sure some patients would be intimidated. But most were fine with it. The medical students (the female of the pair was actually quite doc-hot) were quite cute in asking if they could discuss issues related to the patient in their tutor groups. I just give them the respect of anonymity and get on with it, personally.

Pretty standard stuff, all in all. My midwife-of-the-day told me the story of a 16 year old pregnant girl who had had to give birth in hiding from her family due to death threats. Lovely world we live in, eh? Apparently the mother had been able to reconcile, but the rest of the male side of the family refused to. The baby is probably going to be put up for adoption. Shame.

Tomorrow I have elected to spend a late shift up on the Birth Unit. This is a midwife-led part of the hospital, reserved for normal births in which few to no complications are anticipated. There are no doctors involved primarily, which is a bonus. Far too many people think doctors are skilled at delivering babies, when it's really midwives who know the score in 'normal' births. I don't like late shifts, and I don't want to ruin my 100% awesome record at helping in births, but on the optimistic side I could end up keeping the record alive and helping out another little person come into the world problem-free. I'm not sure if my hand can take the squeezing from another stressed mother, but it's worth the risk.

Top Up Fees Are Rubbish

The government are planning on relaxing the rules on 'top ups' within the NHS. This is a stupid idea.

Let's forget about the inequity I've blogged on previously. These are more philisophical, I suppose.

Drug Companies are not good people. They're out to make money and they do it well. Given you have to speculate to accumulate companies spend more money on advertising than they do on research. Convenient, eh?

Making money and good ethics are seldom partners. If you want to sell things, you push them on people. If you want to sell pricey drugs which NICE have not yet certified as value-for-money, then what do you do? Advertise. Prey on people in very bad parts of their lives. Bad Karma from the Big Pharma. Although drug companies are not allowed to advertise directly to patients, as they are in the US of A and are restricted in advertising directly to GPs, the internet is a virulent tool. Such companies find other days of advertising their wares, and suddenly people are informed of treatments that their GP or other doctor didn't tell them about. They feel betrayed, even though the health care professionals were only trying to stay true to the four pillars of medical ethics:

# Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
# Non-maleficence - "first, do no harm" (primum non nocere).
# Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
# Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

Drug companies are not pinned down by such pesky ideas. They can promise people pretty much the Earth, with some presentational caveats (i.e. spin). Such freedom must be quite liberating. But is free market economics the way for the NHS to go? I think not.

Mother and Baby Day Two

Day Two turned out nowhere near as educationally exciting as Day One, I must say. Hence a shorter post.

From the outset, though, I got to see the mother, father and baby I made friends with yesterday. The two who could speak were very grateful, to which I had to play all modest (which I've learnt to do quite well, with practice) and honestly thank them for letting me play such a role in a massive experience in their lives. The mother expressed amazement when she found out it was my first birth, but her general happiness made the whole thing worth while. I didn't get to provide care for her and the baby on the ward, unfortunately, but seeing them was enough.

So. Post-Natal. A bit boring, really. It was interesting to see which kind of checks are done on both mother and baby on a daily basis, but not a day's worth of interesting. I got the strange privilege of feeling some contracting uterus' (externally, I should add) but other than that it was pretty procedural.

A note now about midwives. I have worked with two groups over two days, so this is in no way a big time judgement - just thoughts on blog-paper. A lot of the midwives I've met act as if they've seen it all, which a few might have. But sometimes this perceived expertise can come off as inconsiderate. For example, a mother was desperate to get home (for various reasons) but her baby still needed further tests. In this case, the midwives were worried about the baby's bilirubin levels. Too high can lead to jaundice which can, worse case scenario, lead to brain damage. This is a bad thing. But some of the midwives involved, out of earshot of the mother, were highly critical of her need to get home ahead of the needs of the baby. I can understand where they're coming from, but they were actually quite harsh about the whole thing when part of the problem could've been the distress of a new mother. This was not the only time something similar happened on the shift, and I personally felt it wasn't really empathetic practice. However, I'm just a student nurse, not a midwife, and so have no idea of the full picture.

An interesting day, then. I'm sitting here waiting on a call from the community midwives (who, I gather, are a completely different kettle of fish) to inform me of where to meet and what to do tomorrow. Interesting times continue.

Mother and Baby Day One

I have previously mentioned how I thought my Mother and Baby sub-placement, a week around and about the maternity and midwifery hotspots of the current Trust I'm working in, might be a waste of time. I feared this, and had images of me just stood prone not allowed to do anything, being both a man and a student on the wards for one day each. However, like most placements, it turns out it's what you make of the experience.

Today was an early shift up on the labour ward. After arriving in the wrong ward and rushing over the right one just in time, I was quickly assigned to a midwife and a pregnant woman, whose labour was in the earlyish stages, because I was more likely to see something there. Obviously, I will be keeping things ever vague to protect anonymity, but on asking the lady was glad to have me there, which is a lovely liberal attitude to hold in this day and age. I would it difficult to interact at first - asking if someone is alright when they're clearly not is just a silly idea. Generally, because her partner was unable to get onto the ward until later on, she was grateful for the support, if a bit standoffish since she didn't know me as of yet. And I was annoyed at myself for standing around very much in the style of a lemon for a bit, but then I remembered this was a total and utterly new thing for me. Maternity and midwifery is unlike standard nursing, and that's a lot to take. The midwife I was working under was equally lovely, and answered my myriad questions well, guiding me and talking to me about the issues involved. I think she was something of a (very skilled) rookie, having asked her superior for advice on a few occasions, but second opinions are important.

From starting at about 8am, the woman was in something of a state already, but still very calm, considering. She had requested no pain relief, and was simply annoyed at being linked up to machines. Things began to drag for her from there, as contractions slowly but surely gathered in pace and pain. I had found my nursing mojo and had been chatting to her by now, in between shadowing and helping the midwife. Some time later, due to somewhat suspicious clinical presentation, the midwife advised the woman to lie on the bed so we could track the heart rate of the baby and some other things more clearly. And this is when it began to kick off.

Pain and distress, although the woman was bloody well brave about it all, requesting no pain relief until much, much later down the line. The husband arrived soon, which helped, and gave us time to make some decisions. The midwife finally decided that, although it'd make the contractions hurt a bit more, a hormone delivered by IV would make them more consistent and prompt a smooth labour. The patient agreed and so off we went. Things accelerated from there - not quickly enough for the woman who was tired, in pain and generally fed up (but still immensely brave and doing everything right). I was crouched by the bed by this point, opposite her partner, having my hand squeezed in the vice-like grip only pregnant women manage to bring into play. After picking up on the things the midwife had been telling her, I took over the role of pregnancy cheerleader, helping her with her very light pain relief and the breathing she needed to be doing to 'breathe through the pain'. Once you've been an actor and learnt how to effectively improvise, this bit flows quite easily off the tongue.

Now, whereas she had not been near the 10cm of dilation necessary for delivery for the morning, the early afternoon was to herald some changes. She was the kind of woman whose status could change quite quickly and so I had half an eye on the tracing machine and the other one and a half on her, encouraging her along.

The one bad moment of the day came when a doctor came to examine her. To cut a long story short, he wanted to look and she was very sensitive. There was a point when he was inside her when she was screaming at him to wait, and I'm aware than sometimes we in the medical profession do things patients don't like and these things need to be done, in this case to assess the safety and health of the baby, but when you're being told to stop you really should. Just go away and document the patient said no, y'know? Anyway, I was close to actually speaking up when he stopped and got out of the way (and the room). Leaving the midwife, the husband, the woman and I.

From there things got really crazy from my standpoint of utter inexperience. After spending the past hour telling this lovely woman who was desperate to push NOT to push and to keep breathing, now she'd hit suitable dilation that she SHOULD push. I'm surprised she didn't smack us upside our collective heads, but she did excessively well in the push on. She was very concerned for most of the time before that the baby's head was nowhere to be seen (in the literal sense) but that soon changed. Cheered on by yours truly, primarily, the father more of the strong, silent type and the midwife busy getting things ready for what could be a quick crescendo, she pushed like a bloody trooper, and soon this beautiful little person was coming out of her. Just the head, then the face. The hard bit over, this baby was all out and the midwife was clamping off the cord, placing him right on his mother's chest. Silent at first, he soon piped up with some skin to skin contact and after a quick dry with the towel, and the woman was so relieved it's untrue. Smiles all around, despite the crying out of the lovely set of lungs of the newest person in the room. The father, elated, snapped some pictures and cuddled with the pair. The harder work over, I helped the midwife retrieve the placenta, which seemed relatively painless, and it was over. Just under an hour before the end of seemingly the longest shift I'd ever been on, and I was let go by the team, mission successful. And I felt good. The baby was absolutely beautiful, perfect even. The mother and father thanked me, to which I had to say it right back. It meant a lot to me to be involved in that special experience of their lives. I said goodbye to the baby, having a go in his father's arms after some very valuable skin2skin contact, and made my merry way home. A day of good work, indeed!

Earlier in the shift, the midwife asked me I'd considered midwifery. I said yes, but was put off by the job opportunities and difficulty getting onto the course. Asked the same question at the end of the day, the answer was still a resounding yes. I LOVE the core, even the midwifery one. They're not nurses and don't much like being associated with them, and I can see why. Their work is a world apart.

Less Excitement

What a difference a few days make. Well, not that much of a difference, truth be told.

My feelings are still mostly positive, but mixed. I very much like talking to patients, and can do so with confidence since I've the experience in cardiology. One of the downsides of the basis of the placement is the constant talks given to the patients. The talks are vital, but I just end up observing, which is dull. The same with exercise classes, which I'm pretty much pointless in, other than helping checking some pulses and blood pressures.

The former part of the job is very interesting, though. My mentor apologises that the interview/assessment part of the job is very much asking the same questions over-and-over. But she is very wise in the sense that she leaves half an hour to an hour for any one-on-one time with patients, which gives them a chance to talk through any problems. And that's all some patients need - a few open-ended questions and a listening ear - especially in community. That's where I could see getting the satisfaction out of working in the community, personally.

So yes, mixed experience. Tomorrow I spend the day with the dietician. An important role when it comes to cardiac rehab. There's a home visit involved, which will certainly be interesting, to say the least. And it sounds as if I might get off early, which will be lovely. As I get to go and dance.

I'm still waiting for some new shoes to be delivered. I have a suspicion my accommodation office are hoarding packages downstairs, since they should've been here by now. Such lack of shoes really are my biggest problem right now. It's fun.

Not my first first day.

I'm excited.

My new mentor, who I unfortunately won't be spending all my time with given the nature of community nursing, is great. She's only recently qualified, which means she has an idea about what student nurses mean and is generally lovely. The team itself seems sound, too, which is always good news.

The ideas involved in community nursing are certainly interesting, and there are lots of new challenges to face. In the real world, people are nowhere near as compliant as they are in a hospital bed, dressed in their pyjamas. I'm looking forward to learning how nurses work in such environments.

I attended an exercise class this afternoon, followed by a talk on healthy eating. I sat and chatted with the clients, as they should possibly be called within this environment, and it was lots of fun. Interesting, too.

I'd generally forgotten how much I love nursing in general. It's sad that university makes one forget one's love of the core.

Long time no type...

Yes, I'm alive. Like Flash Gordon, sort of thing.

Anyway, what's been going on? Well, I start my community placement tomorrow which will be very interesting. I spent the day in PCT mandatory training, which was a glorious waste of time but completely expected.

I feel quite nonplussed about the prospect of community care. I know - and am constantly told - that care is going to move much more into the community over the next few years and beyond, as per government "choice" policy. But I love ward work, and would like to stay in it. My mine, however, is wedged open and am looking forward to being surprised. This placement might make a community nurse out of me, yet!

Either way, I'll keep this blog of mine informed. In the casual, cuss-ridden learning diary sense it exists as, anyway.

Nursing and Poledancing

As (I think) previously mentioned, I pole dance in my spare time. I used to, anyway, and am just getting back into it with my highly talented teacher. I have performed (for fun, not cash) in the past and enjoy it very much. During a discussion on the dreaded NMC and professional conduct both in and out of work, I got to wondering whether anyone could have a problem with this. Pole dancing doesn't involve stripping or anything morally rude. And it's challenging physical activity. I just wonder whether the NMC would see it differently, if I was somehow or for some reason reported for it.

Funny old world, innit?

Suffice to say, for this reason and others I'm heading to join Unison. The RCN do very little for nurses, student or no, so I would rather be part of of one that does. Sounds simple, and is. I like it that way. Unison backed my dear old mum to the hilt when the government were trying to screw her over in employment, so I have faith.

The Second Year then...

It's a long time coming, but it's time to procrastinate about the second year of this wonderful Diploma I'm on. As previously mentioned, this module is split into two. The first module is all about Health Promotion, which means I struggle to stay awake during lectures and seminars and get into all sorts of trouble.

I have a few problems with this concept of Health Promotion. Don't get me wrong, it's important. Nurses should be nursing people before they get sick (even if this idea is not something I personally want to follow up in my career) for the first time or any concurrent occasions. No mean feat, but it is a noble goal. My main problem, however, is the idea that nurses have to work closely in line with local policies and government white papers they have little control over. Maybe it's just the socialist in me, but I'm against being used as a tool of the government. And we could debate how regular, hospital-based staff nurses are the foils of HMG, but those involved in Health Promotion are - in my opinion - more so.

Apart from that, the lion's share of health promotion theory is all too Humanist for my tastes. I'm a Freudian with lashings of Cognitive, Behavioural and ginger beer, thus generally lack faith in anything Carl Rogers would adore. Not that it is not without certain value to certain groups of people, it's just of little interest to me.

Speaking of which, the second module this term revolves around nursing people with acute and critical illness. This is where my passion lies, blatantly. This is where a nurse needs to be skilled both technically and personally (i.e. around and about people). To say it's cutting edge stuff is perhaps a bit insensitive, but it's true. It's where I would like to be.

My responses to each module have been quite predictable. I'm excited and interested in acute and critical care, seminars in which we speak and debate the technical skills and - more importantly - how they relate to patient care. There is this underlying, excellent reminder to keep your centre in mind. Don't go requesting a CT scan until you've had a chat with the patient (if possible) about how they're feeling. If a patient feels unwell, don't jump straight for the DinaMap until you've looked the patient over with your eyes and experience.

Health promotion seminars drone on about government initiative after government initiative which, if you look into it, haven't made much of a difference anyway (although we never get to debate this in seminar). "Saving Lives: Our Healthier Nation" for example has been recognised as not reaching it's aims. This is government-speak to say it failed. But instead of doing something radical, another document was producing, full of management speak and, as a respected colleague of mine has pointed out fancy collections of letters that are "just words". Words, of course, backed up with bureaucracy. This time, however, the ideas are constantly backed up with the idea of "choice". "Choice" being a byword for privatisation through the back door, another issue we don't get to debate. My anti-capitalist leanings aside, we spend very little time talking of nursing in the read world and instead speak in abstract, disconnected terms. I assume the essay I have to write on an issue related to health promotion will have to be full of such terms, too.

My next placement is within a cardiac rehabilitation environment, which should certainly be an experience. I shall, of course, end up doing my health promotion essay about issues pertaining to coronary heart disease. This is an easy option, but why make it hard for myself? The essay itself is pretty yawnsworthy. Discuss health promotion related to a certain issue, including primary, secondary and tertiary care/prevention. Given our other assessed piece of work is about CHD, I think it's wise to do it about that. If a little boring.

Anyway, the second year: a mix of beastliness (in the good sense) and boredom, so far. The jury is still out. I might like Health Promotion once I get into placement and see it in action, but for now I am more excited about my upcoming critical placement.

Troublemaker

I've always had a strong respect for authority and figures of said thing. I was brought up by a strict patriarch which I'm sure has contributed to this, but society in general ("back in my day" etc. Ha) is approving of structure and the like. That's fine. When I was younger my respect perhaps bordered on the unhealthy, but only for a little while. As I've grown up and gained a massive sense of self-awareness this respect has been altered. Figures of authority can still gain a large amount of reverence and respect from me, if there is some shown in return. Maybe I've been listening to too much Rage Against the Machine, but I don't follow authority blindly anymore.

Whereas there are currently subjects and lecturers I enjoy, engage with and certainly respect, there are definite bits I do not. One of the male lecturers at my University is highly approachable, likeable, professional and academic. This is the sort of nurse I want to be in the future hence: respect. He speaks about physiology with a level of expertise I haven't seen in other lecturers, but still reminds us that the patient is key. Other lecturers are less engaging in this sense, and so my respect ebbs away.

This can land me in hot water.

I am a doodler, and a multi-tasker. I can read or draw and listen at the same time. Especially like, as in the lecture this morning, the same basic information was being used as a 4x2 to smash us over the head with. If I hear the words Immunisation and Primary Prevention reminded to me one more time I may scream. Anyway, after this quite brutal piece of non-independent learning, the lecturer gave us a 35 minutes break (we'd been in for 45 so far). Then we came back to do the old presentation-lather-rinse-repeat. Not interesting, and not innovative. To me, anyway.

To cut a long story short, I was asked for the inevitable 'word after class'. I was told that reading during a seminar and presentations was rude. For once, I backed down and emulated apology, saying I'd try to pay more attention next time. Invigorated by such victory, the lecturer asked me how I would've felt if they read a newspaper during my presentation. The truth is: I'd be pretty nonplussed (in fact, the lecturer said they would've read the Daily Mail which would've been rude but for several other reasons), but I couldn't be arsed with an arguement. The lecturer argued the book I was reading (Essential Endocrinology) wasn't even relevant. I was tempted to retort that endocrinology is vital in the areas of diabetes and reproduction we were discussing from a Health Promotion point of view, but felt pretty hungry. Happy with perceived victory, the lecturer left and I realised I've made one more antagonist. Amusingly so.

Sadly, I don't really care. I'm a damn good student nurse. My essays are passable even when I put in little effort, my presentation skills are second-to-none and - to put an utterly self-indulgent point on it - I'm only doing this diploma for the free money.

These acts keep me amused, which in itself is pathetic. Like I told the lecturer about something completely different: "I'm trying to cut down, honest,".

But I'm intellectually unstimulated. And have to tow the line of looking interested in students who have previously asked, despite supposedly having done a week's research about Coronary Heart Disease: "What's ischemia?" So I modify my behaviour, bit by bit. I know now that sitting in front at a seminar, especially with this particular lecturer, I will now feign interest whilst secretly playing Empire Strikes Back in my mind, akin to Homer Simpson. I can live with it.

Quickie

I think this would be a good idea. If there's one thing that annoys me, it's overmedication of the population propped up with a lack of proper education. Why am I on these pills? What good and bad things do they do? When are they not working? These are questions people should have answers to, about themselves or their offspring.

Of course, this costs more money than simply packaging and distributing the pills does. So it's not taken up. Shocking, I know.

I'm fine, by the way. The first week is a bit hectic. Expect a larger post about the start of the second year soon.

Health and Gender, Inflexibility

Stories like this one are now, thankfully (in a roundabout way), quite common in the media. This overriding idea that conditions of ill health, and more importantly the people suffering from them, do not always conform to the written symptoms and law.

There is an arguement that parts of medicine are stuck in quite rigid 20th century thinking. The recent advent of circadian theory in relation to drug administration, especially chemotherapy for cancer patients, highlighted the fact that different individuals will feel the effects of certain medication better at specific times of day. Conversely, they will weather side effects with less stress. As the link above points out, there is this idea that young women may not exhibit the usual symptoms of Autism the books harp on about and therefore might slip under the radar. Harking back to a previous article, older books and sources on eating disorders may place little importance on the possibility of male sufferers.

The overall point is: people should be treated as individuals within the discipline of medicine. Which is kinda what modern nursing has been harping on about for a good while now, and rightly so. Obviously, there is little chance each patient (especially within the NHS) could have a personal retinue of doctors, nurses and allied health professionals studying their case 24/7, at the patient's beck and call. That's just silly. There has to be a middle ground somewhere between the two ideas, and in my experience there are some healthcare professionals who would rather tick boxes than open their minds. This idea of uniform treatment sometimes drives me crazy. Doctors who, despite the fact a patient might not be scheduled for surgery until 4pm on the next days list, don't think to alter a patient's Nil By Mouth setup and starve them from 6pm the day before like everyone else. Little things like that get to me, sometimes. On the other hand, I love it when I see some eyes open, questions asked and even far off possibilities explored. More of that, please.

Watered Down Megan's Law

I don't like it. One bit.

I am now old enough to count myself amongst the people who remember paedo-steria of the late '90s and early '00s. Many things came out of it, but the Brass Eye special was the only good one.

The new idea, if you haven't read the story yet, involves giving people the ability to find out if anyone (for anyone, read: men) in their lives have any history of child abuse/domestic abuse which would endanger children.

Why don't I agree? I could trot out the old arguement of how these kind of laws drive people with a history of child abuse underground. I could, and it does. But that's done. It gets to me because it goes against the idea of Justice in this country. The whole idea of going to prison and the like is based around the idea of rehabilitation. Rehabilitation links in to giving people a second chance, a chance to change. In this new pilot scheme, anyone who thinks a man might be a bit of a wrong 'un can check up on them and their past. And if there is anything there and this information comes out, their second chance of a life could be ruined. Again and again, in fact. I am in no way apologising for paedophiles, child abusers or any kind of criminals for that matter. However, this idea of possible persecution stinks of mob rule, and frankly makes me sick to my stomach.

Male Health Issues

Times are a'changin'. As this article shows. This article (and the issues therein) is not a shot out of the blue. Eating disorders have been on the rise in British men for years now, throwing into confusion some of the reasoning behind some psychological explanations behind bulimia and anorexia nervosa. It's the 21st century, for better or worse, and despite how I personally often feel that the link between men and their body images is often giggled at, ignored or even dismissed by society at large, it is becoming more important.

As I've also previously discussed, I think any cynicism towards John Prescott's admission of suffering from some form of bulimia was in poor taste (no pun intended. It's a minefield, this satire malarkey...) Seriously, though, eating disorders in men should not be snickered at like poor jokes in a poorer sitcom. I, personally, am sometimes unhappy with my own body image and so I'm pretty confident I could relate and care for a man suffering from similar anxiety and upset. I wonder if other student nurses, outside of my demographic, could say the same..

You can put lipstick on a pig...

... but it's still an anti-abortion, ignorant, nepotist and dishonest pig.

Haha. Seriously, though. I love this new Palin debate. She's an idiot and yet a brilliant idea. Anything said by anyone against her or the right-wing of the Republicans automatically gets lumped in with the rest of the 'left wing conspiracy' that has apparently been dragged out of some dusty wardrobe to be targeted against poor Governor Palin. And Americans will fall for it, as they typically do. Two terms of George Bush speak volumes of how a large section of Americans like tough-talking, somewhat bellicose leaders.

It's a sex debate, it's a race debate, however you like to spin it. And boy do those right-wingers like their spin, as evidenced by the adverts and supposed outrage of today. But the prejudice angle is something of a phoney war, since both candidates don't really push the interests of their demographic groups, per se. It helps, for example, that unlike Hilary Clinton (to a point) Palin stands for policies and ideas traditionally backed by men and patriarchy. That is to say - guns, anti-abortion, pride in the army, against sex education, etc. The fact that white women are apparently flocking to back her and the Republicans is quite pitiful. These are the issues that the Democrats are trying to tackle the Republicans on, and yet the messages are being twisted by the Repubs. They know very well that the comment was about financial policy, and yet use it to their advantage. All's fair in love and war? Unfortunately, this platitude isn't black and white. Whilst the right-wingers use quite open comments to their own advantage, the issues of racism go under the radar, implicit even.

Maestro

I'm slightly upset, on a quick note, that Goldie did not win the recent BBC2 series of Maestro. Although both finalists had music in their backgrounds, Sue Perkins (talented as she certainly was) had been lucky enough to be taught Piano to some Grade level when she was younger. This, unfortunately, costs money which some people don't have and stinks, debatably, of possible classism. Shame, really, since conducting and classical music is quite fun.

Anyway, where's all the nursing, you ask? I've been reading on and off all summer and will review the books and material soon. Especially when University starts again in two weeks time.

Freerunning

I like freerunning. Bunch of guys got together, started fucking around and jumping off of walls. It soon evolved into racing around big cities, using functional environments designed by other people for fun. With tonnes of risk, for fun. Excellent.

So tonight there is a freerunning tournament in London. Someone has built a cushioned course within a big warehouse and people are going to watch. I'm not a freerunner, but as an admirer I'm quite upset. No longer are these people invading and gloriously misusing cityscapes at great risk, but are coming together like competitive but performing monkeys. The warehouse is owned by someone else, rented out. The equipment is also owned by someone else and must be paid for by someone. It's selling out, plain and simple. Wait until Nike start sponsoring the special shoes. And when the stars, who started off their own backs, have to turn to the camera and say "Don't do this at home, kids," even though it's how they started.

I am a somewhat prolific graffiti artist, and this happens within the street art community. It's annoying and against some of the founding principles. Perhaps this is just another stage of the evolution of both forms, but it doesn't mean I have to like it.

Fiona's Story

In a move to annoy Male Rights Activists everywhere (like they need more excuses) the BBC have made and broadcast a drama programme about the story of a woman (Fiona, obviously) whose husband is discovered to be guilty of accessing child pornography. It's an interesting, if a little overdone, angle - the suffering female one, I mean.

From an actor's point of view (me being a red brick, classically trained actor and all. Heh) the role of Fiona is a doozy. Challenging, deep, limelight. Some people like that sorta thing. The whole idea is that Fiona is the greater, deeper victim and is being punished for essentially being good. Well, that's how I read it, anyways.

Being the protagonist, the story is obviously told from Fiona's point of view and it revels in the upsides and fails to avoid the associated pitfalls. Whereas the actress is more than capable, the directing falls a bit short. There are too many string quartet rising and falling in the quiet bits, were actors just look at each other/out into space and little else.

The story is a hybrid of standard slow-paced Brit thriller and American twist-drama. It's done well, but the process gets a bit old. Let me set the typical scene: Fiona thinks she knows something, and makes this assumption known. Suddenly someone or something comes down from the heavens to affect a big change and she is both shocked and saddened at the new turn of events. These events generally rely on her husband or someone else close to the plot revealing something. The shocks all lead to Fiona feeling more and more isolated. From her friends, children and obviously her husband. The crux of the drama is the family, and therefore Fiona-the-Mother plays a massive role. Again, I can't help but feel this idea, no matter how well performed, has been done. Not to death, perhaps, but done all the same.

But this leaves one big problem for me, personally. In the recent (and most excellent) BBC Drama Criminal Justice the protagonist was essentially painted as an innocent victim - like Fiona, in this case. But he was still a bit of a cunt. And you felt that. All the characters - none of them were particularly nice. And yet in Fiona's Story, she is righteous and everyone else is wrong, basically.

This unfortunately leads to the supporting cast being made up of two-dimensional characters. The actor who plays the husband is superb, but the character is a walking stereotype. Two-faced bastard, charmer one second, monster the next, all in all. And this process goes for the majority of the supporting cast, unfortunately. They trot out the generally heard of opinions of paedophilia, as if almost attempting to convey a balanced view.

The issue of paedophilia is tackled very well, it should be said. It is often the elephant in the living room, literally, being such a taboo subject. The 90 minutes does not draw too much on the controversial background, or too little, in fact.

All in all, for a one-off feature it is quite passable. I compare it to Criminal Justice, which had five episodes to tackle it's plot so this comparison is perhaps unfavourable. Regardless, I can't help but feel some of the ideas and themes have been done before and will be again. The forlorn female lead is by not means original, but Fiona's Story was never advertised as revolutionary.

Reflections of Drunken Adventures

5 day-long ones, even. I will switch to copy typing my notes:

I have, this end-August Bank Holiday weekend, discovered I am not suited to festivals. The main reasons can be summed up quite succinctly. Firstly? I don't like camping. Second? I don't like the festival music scene

[I didn't know this before heading off, of course. It's all about discovery - Ed.]

I scribble, rather than type, in one of the tiny notebooks I try to keep secreted about my person. To elaborate:

Camping is plain not my scene. I don't get a kick out of tents: either 'living' or sleeping in them. Although my cheap [8 squids] tent has been nothing but dependeable. And there's a great deal to say in favour of waking up in a piece of vaguely idyllic countryside every morning. Even if you were woken by an insistent sun turning your tent into a greenhouse. Great place to live, but I seriously do not want to live here. Like I have been doing [for 4 days]. Although I'm impressed with how well I've managed, living with insects and small arachnids as a matter of course is not sustainable. So yes, camping is not really my (sleeping) bag.

But festival life is much more disagreeable. Music-wise there is obviously a large variety, but it's a lot more impersonal compared to the small, local gigs I prefer. On that note, the epic magnitude of the event seems to bring out the worst in people. I will highlight but a few strong, reoccurring incidents:

* Men whacking their cocks out in the middle of a field and pissing into any nearby recepticle. This was, where possible, often followed by the apparently ever popular see-how-far-I-can-throw-this-cup-into-a-crowd-of-dancers-it'll-be-well-funny-even-though-loads-of-people-have-already-done-it-this-song.

* People with more money than sense and less sense than amoebas. Concequences of this being people passed out off theiir faces on a random substance and/or dressed in as much overpriced tack and merchandise as possible.

* People who will up music venues standing still. Now, I can't talk as I sit on the extreme end of the spectrum. I'd bop to a funeral dirge if it had a good beat. However, I would do so out of the way of people who wanted to be all stoic. I would not fight my way into a prime position to act like a slack-jawed yokel or concentrate on waving my large, pointless flag.

I am a self-confessed music snob, and proud of it. And I don't think my opinions are right, but they're mine which means they're pretty fucking good. I have no respect for people whom, during one of the two live gigs Rage Against the Machine will do this year (if not forever more) in this country, fail to dance. Or people who come to the bar. Or, even, sit down and watch. This is a paradigm busting, massive headliner of a band. If you weren't fully arsed about getting involved, I don't want to know you. And I am happy to rip you off for drinks, as a sign of that total non-respect.

I prefer smaller gigs, where the bands aren't stick figures and where I am not surrounded by thousands of people who barely care about the music. I was working behind one of the main bars for Queens of the Stone Age and then Rage Against the Machine, but I showed more enthusiasm than most people who had actually paid to come and see them. And that, more than anything, is why festivals don't do it for me.

Paxman Rides Again...

This story warmed me greatly as I was stuck at Leeds Festival, away from all idea of civilisation.

Paxman really does not give one solitary shit, which is highly respectable. And, given his background, is always careful to qualify his remarks which is vital.

MF shows the typical head-in-the-sand mentality associated with the feminine agenda in the media. That and, of course, misdirection. She points out Johnothon Ross, Ian Hislop, Paul Merton and Paxman himself. Essentially Paxman was talking about people in high up jobs within media, rather than personalities, and MF could come back with no real retort to this point, preferring instead to trot out the old platitudes. Women are oppressed in certain arenas, there's no doubt about that. But men face troubles, too, which is something MF and her ilk seem pretty hesitant to accept as a possibility.

I will be blogging my five days at Leeds Festival soon. Right now, I haven't slept in 28 hours. Priorities, priorities.

The Olympics

I don't like the Olympics. Period, really. That's not to say I dislike them very much, I just have a very strong lack of opinion for them. I probably don't like more the way in which the Olympics are viewed more than anything. I am vaguely miffed that winning a few medals in a four-yearly event can inspire national pride when the few actual good things we do cannot, but that's neither here nor there. And say what you like about football, but at least it's accessible. Some of the sports we're winning medals in are hardly something a bunch of kids can run out and get involved in. Sailing - expensive. Cycling - given mums and dads are worried almost full time about the welfare about their kids, they may be hesitant to let them go out and race around the surrounding roads on bikes. Obviously, the case of Mr. Foy (bought a old BMX, went out and won stuff, etc.) is tabloid inspirational, but it's not that clear cut, is it? Swimming - thanks to the past two governments, most of our indoor and outdoor pools have been gotten rid of anyway, as frequently pointed out in Private Eye. At least kids can still, more of less, go out with a ball and have a kick about.

The things which irk me about the current Olympics are the fact that the IOC are a bunch of impotent bastards when it comes to China's blatant promise breaking (although the mischief caused by Channel4 News has almost been worth putting up with the massive human rights abuses. See those IOCers squirm... ) and that the British success just adds weight to the 2012 Olympics, which have already run massively over budget and sucked up mounds of funds they weren't supposed to. I'm all for sports: partaking in them can promote well-bring; self esteem; happiness and sometimes even self-worth. But, in an Olympic context especially, they're not the be all and end all. As an ex-actor and still sometime-artist, I despair at the cash that will be snatched away from these disciplines to fill the Olympic void.

Panorama 18/08/08

Panorama today is about The so-called Post Code Lottery. And, by proxy, the good old NHS. Obviously, in this case, it is anti-NHS.

I've said it before and will say it again. I don't like bureaucracy. I hate it with a passion, in fact. Especially within healthcare. But, I don't necessarily agree with the programme. Whereas I think it's harsh that someone in one area of a city can get a certain treatment whilst another person elsewhere can not, this is not a black and white situation. It's local decision making at work.

Now, despite the fact that Panorama has been dumbed down a bit, it's still a good investigative journal. But today, I can't help but feel it's being rather tabloid. It takes headlines and blows them up. It takes young people with their lives ahead of them and turns on the waterworks and violins. It picks TV-OK examples and tries to warm - or chill, in this respect - the cockles of the heart. It's a bit of a cheap shot at a complicated issue.

NICE exists and is a necessary evil. And, although the people who work for NICE are not fully paid, you couldn't pay me to do their job. As any textbook will tell you, the NHS is a funny old game. Finite pot of money VS. masses and masses of problems. NICE try to make that work, somehow. But obviously, it filters down the system. And there are traps, sieves and gutters until it gets down to the people who matter: the patients. These traps, sieves and gutters actually count as the much trumpeted local-decision-making.

See, back in the day there was once a land of central decision making. And then people wanted to dissolve power to local authorities. And the-powers-that-be did so. And then, this happens.

I don't know what the perfect outcome is. Some people will complain if you give too much power to consultants, like Panorama suggested should happen. Some people will complain if you give too much money to mandarins. Some if you give it to politicians. The bottom line of this day and age seems to be: Your life is worth about £30,000 a year. And that's just economics. Medicine is economics, like it or not, and the NHS will never suit everyone.

Imagine if...

... we lived in a universe where the idea contained within this story could work out soon.

Any hope of a treatment for HIV/AIDs should be gripped with both hands, clearly (even if the more cynical among us would point out it would make Big Pharma even richer than they already are). The science behind it is, from a geekish point of view, fascinating and could even help make people ill with different diseases and disorders better, too. Hope does, indeed, spring eternal. Come on, science. Do it for the good guys...

More Rape Based News

Like the title says, more news. Anyone watching any sort of extended news broadcast today would've seen this story.

A rape victim who was told her compensation would be cut because she had been drinking before the attack has had the decision overturned.

I do so hate sounding like a bastard, but I do have a slight problem with the context of the story. I don't want to get into the rights and wrongs of compensation for crimes. This idea that: 'Well, we - the police - were not really around at the time of the crime, which is our fault, so here's some money to make up for it.' *

I have a number of thoughts about this case (only this one, as I don't know much more about the other 14). The story mentions the woman in question had been drinking 'excessively'. Whether this is over the typical 3 drink limit to make a binge, or whether it is actually excessive is not something I know, but it is at least hinted she may have had more than a swift half. Now, to say having a few drinks means the woman in question was 'asking for it' is fucking Neanderthal thinking and shouldn't be given the time of day, however; I'd be curious to see how 'excessive' alcohol consumption reflects on other compensation cases. For example, if someone had a few two many drinks and left their front door unlocked and only to have their home completely burgled, would they be penalised for that? Obviously these are completely different crimes, but legislation has to deal with this idea on an equitable basis. Consuming alcohol involves giving up a measure of control with your own consent. And although going out on the streets on a Saturday night may prove otherwise, this is not something to be taken lightly. There are plenty of risks attached in taking such a choice and unfortunately there are plenty of people to take advantage of people who take said risks.

I'm not really making any definitive conclusions or points, just noodling. But we have two people and one of this pair do something that makes them more vunerable and less in control of a situation, should that make a difference in how they're dealt with by the courts? I'm not sure.

----------------

* Obviously, I'm being glib. Things are more complicated than this, but the point still stands, no matter how lighthearted it may be.

Book Review

It is my adorably optimistic aim to read a book a week over these 8 weeks off. On average, since some weeks won't involve anything near a book.

Last week I finished:

TRANSCULTURAL CONCEPTS In Nursing Care: Second Edition (1995)by Margaret M. Andrews and Joyceen S. Boyle, J.B. Lippincott Company: Philadelphia

On the plus side I received this book as a gift, which means it's all mine. That gives me the option to underline, note and scribble endlessly in it, which is one of my guiltishly geeky pleasures.

So, what's it like? Well, it was a gift. I would not have bought this book, personally. It's old (most of the sources are from the 80s, making their reliability and relevance questionable) and American, which means it refers to processes and - more importantly - cultures and sub-cultures which are not very prevalent in this country. I am, for example, unfortunately not going to meet many Native Americans in my neck of the woods. Whereas I am statistically more likely to look after men and women of Arab descent, a culture not greatly covered in the book.

So it has it's down sides. Generally, if taken with a pinch of NHS salt the book is an interesting and valuable insight into the ideas behind transcultural nursing and does provide a few relevant examples that prove useful. Did you know, for example, that people of Asian descent find blowing one's nose to be rude, and consider sniffling more polite? Interesting stuff.

Would I recommend this book? To check out from the library, certainly, but not to buy. There may also be a later edition or even a British analogue out there which would be a much more sensible idea. Most certainly better than a kick in the teeth, though.

Magicoreligious Madness

The recent story of the Sikh girl who won the right to wear a piece of jewellery in opposition to school rules was always going to get a comment out of me.

As evident by the prominent link to a certain Church on my blog front, I don't hold religion is particularly high regard. Not to say I don't have faith, which I do, or I don't see a point in believing in something or than deterministic, reductionist science. I don't consider faith the be all and end all of existence in the same sense that science does not explain everything, however some people on either side of this invisible border between the two continue to have irritating effects on society. A society which is, apparently, looked after by a secular government.

The school in question was running a 'No Jewellery' policy. This in itself is not uncommon from schools I have both attended and worked in. I gather such policies are conducted for several reasons. Firstly, jewellery can cause jealous and envy, which have further follow on and side effects. Secondly, jewellery can cause problems with local health and safety policies (hoop earrings being pulled out - not pretty). Thirdly, some schools employ a uniform policy in an attempt to make children feel smart and equal to each other. Accessories put a dint into this, unfortunately. I don't agree with taking away people's individuality ala uniform policy, but it is a rule in many schools and was in this one, for (debatably) good reason. Rules are rules, and - made to be broken or not - are enforced, and should be if that's what the school board has agreed. Furthermore, the student in question signed a contract saying she would abide by said rules. I'm sure it wasn't a blood-legal document, but still an agreement.

Thus, she was breaking school rules. And anyone breaking rules is usually reprimanded. She continued to break the rules, she continued to be reprimanded. Until she went into the Court system and received what could be described as special dispensation to break the rules of the school. This special dispensation happened because what she was breaking the rules wearing is an accessory of magicoreligious importance. Despite the fact that it is going against the grain of all three of the above points of the rule.

This is particularly annoying. Schoolchildren comprise a diverse mix of cultures and subcultures who are different in physical appearance and psychological standpoint and belief, including any spiritual or magicoreligious standing. For some children, music is king. It's the most important thing in their lives. Listening to it, reading about it, following the tenets set out by the leading stars. And yet they are not allowed to express this through accessories on uniforms. Piercings and eyeliner, for one example, are disallowed. Yet a Sikh bangle has been given special dispensation (thankfully, the Fundamentalist 'SilverRingThing' was thrown out of the courts last year. I almost had a little party in celebration).

So, the crux of the matter is: where do we draw the line? This is not a secular society, so one belief should not receive more privileges than an other. Clearly, Sikhism has existed for a much longer duration and has a larger following than some Gothic music subculture, as hinted at in the example above. But does that automatically make it more important? What about a young black child who is celebrating his or her ethnic or racial links or roots by wearing a certain accessory to their uniform? Is this aspect of colonialism and it's aftermath less or more important than a religion. Where is the line drawn?

My standpoint is that mentioned above. As long as Britain remains a secular country then religion should not get any leg-ups. There are many schoolchildren who believe in fashions or trends just as vehemently as a religion, and yet they're not allowed to express themselves within the gates of a school. Their treatment shouldn't be so unfair.

New Laws

New laws, championed by Harriet Harmann and pushed by the British Law System, are attempting to liberalise the laws surrounding murder.

To be perfectly honest, I haven't researched this topic in an intense manner, but I have listened to various viewpoints and I am, perhaps unsurprisingly, against such a change. There are already bits and pieces within the law to allow defences like self defence to be used in the case or murder. And judges are, or should be, more than capable at managing these laws effectively.

The history of governments (and I know the supporters say this rule change has nothing to do with government, but that's bollocks) meddling with laws are dodgy at best. The recent decision to mess with anonymous witness schemes within murder trails hasn't helped one bit, now, has it?

Now, of course, we live in a "democracy". But there are plenty of people who haven't been voted into any seat of power who make decisions. And these men and women are the ones who annoy me most. That's an aside, I know, but a necessary one.

Anyway, what else is wrong with this law? I don't particularly like the wording. "Seriously wronged"? That could be taken in so many ways it's not even funny. Especially when you bring cultural, social and magicoreligious reasons. That's got trouble written through it like a stick of Blackpool rock.

Aside from that, the way in which the media is reporting the law is considerably biased towards to women suffering abuse. This is undoubtedly a problem, but just because female/male-on-male is statistically lower than the media published male-on-female domestic abuse doesn't mean it's any less important. And when one of the founders of a rather large Women's Refuge is criticising the government for gender bias and being both naive and short sighted, something's gotta be wrong.

Joined Up Thinking

This article made me giggle. The following paragraph in particular:

The areas that the audit has looked at include leadership (only four out of 35 British National Governing Bodies of sport has a female chief executive), media coverage (there is more than 50 times as much coverage in the media for men's sport than there is for women's, with only two per cent of articles and one per cent of images devoted to elite female athletes and women's sport) and investment in sport, which looks at the split in funding of men's and women's sports.

The concept of equal funding is a good and relevant one. The idea of somehow trying to influence the genders of sports leaders stinks of positive discrimination from the outset, but we'll see. My main problem is with the media point. Linking sexism to media coverage is spurious at best, bollocks at worst. Sport is a business. From the selling of equipment to the screening of matches/exhibitions on television, it's all about the money. Consumerism and shareholders etc.

Now, I could walk down a high street and run a quick survey on how much window space is given to male clothing vs. female clothing. I daresay the ratio would lie quite heavily in the female front. Are men being deprived of opportunities to express themselves through fashion? Perhaps. Why are these shops selling predominantly female clothing? Because it will make them more money. The 16-40 year old demographic probably spend more money on clothes than anyone. That's just capitalist good sense.

Open the back pages of a newspaper and you will probably be greeted with information (depending on the time of year) about football, rugby, cricket. Maybe some horseracing. Different times of the year will mean there is more coverage of certain sports. Cycling during Tour De France. Athletics during the Olympics or other big Championships. These subjects are clearly of interest of sports fans, otherwise they wouldn't get past the editor. Where does the big money lie in sport? Generally, lots of money is bet on horseracing, football and greyhounds. These fans, betting or not, also pay good money to watch their sports. Lots of people watch rubgy and cricket, additionally, and pay for the privilege. Greyhounds aside, the stars of these sports are all male. If the interest is in predominantly male sports, the money will go there, including in the media. This is simple consumerism, and I don't see how it relates directly to sexism in the sense they mean. If it does, then I hope to see a commission set up to tackle the discrepancies between male and female clothing choices on the average high street, too.

Just a quick one...

... about a fucking important subject. I cannot convey how delighted I am at the sight of more publicity for prostate cancer. Like cancer of the bowels, cancer of the prostate is not glamorous. There are no large-scale marathons of men in blue t-shirts running around to make money for the cause. Hell, ask a man in the street where his prostate is and he might reply like an American looking for Afghanistan on a globe. Despite the fact that Bob Monkhouse campaigned against the killer (from beyond the grave, to boot, bless him), not many - and not nearly enough - people know about this vicious strain of cancer. Or knew about it until the new stories of this new possible treatment for it came around. Now it has made it's way into the media spotlight, it's possible some men might actually think about getting themselves checked out for this horrible, despicable condition. And that, in my book, is a silver lining.

The Second Year

We had our first briefing for the second year and goddamn I am excited about it. Despite the fact that there's still going to be lots of happy-clappy-client Mental Health input (I'd say no offence to any Mental Branch readers, but there's no nice way to phrase my contempt for the way Anytown University handles our other branch exposure).

Firstly, we're no longer within Common Foundation learning, which means things are going to get more hardcore from now on. Welcome to big school.

Secondly, the assessments actually sound quite fun. One presentation, which should be a good giggle, and one unseen problem-solving-trigger-type exam. Varied, I like it.

The modules are a mix of exciting and twee. The twee one is all about Health Promotion, which is certainly interesting at points, but similarly quite wet and happy-clappy throughout. I'm not taking anything away from the role of the nurse as a health promoter, but I have a feeling the module is going to be similar to past ones. We'll see. The sister module is about acute and critical nursing, which is what I go to school for. The clinical skills classes should actually be interesting, the sessions are all about relevant skillsets and situations. Yes, we're actually going to be faced with theoretical clinical situations and instructed on relevant care and issues surrounding them. Something sorely lacking in the last few modules.

We have two weeks, one in placement, about Mother and Baby. Given I was close to being a midwife or child brancher, this will be very interesting, especially from a gender discrimination point of view. I think we're also due two days to drive around in an ambulance, which has me quite chomping at the bit.

I'm excited. But, to be prepared, this summer is going to involve a whole lot of reading. Given I'm going to be poor, that shouldn't be a problem. Woop.

Stating the Blinking Obvious (tm)

I am convinced that one day, in Anytown University somewhere I will accidentally walk into the wrong class. This hypothetical classroom is filled with old women. There is a quite normal person stood in front of them, unable to use the PowerPoint presentation they should be trained to use. Each old woman has an egg placed in front of her, and is being taught to suck it.

What has prompted this extended metaphor, you ask? Today we had a semi-lecture (which is like a lecture, but not in the safe, anonymous environment of a real lecture theatre where one can sleep/read/otherwise not pay attention. The seminar was about the important of spirituality in patient/client life. Firstly, given the guest speaker was from a hospice, I thought it might be stealth religion talk. But no, nothing so insipid.

It turns out that spirituality means... well... everything. Pretty stupid fucking definition, really. The importance of everything to the patient/client. Everything is, by definition, the be all and end all. This glorious definition kicked off a close to 2-hour extravaganza in which we were told many things.

Newsflash!: Some patients need a bit of company, and to be listened to.

Breaking News!: Nurses should be considerate.

I know. Revelations. Well, actually: no. These are things we were bombarded with through our first module. And ever since, really.

I'm not being funny, but if you don't know the basic parts of the nursing skillbase after three placements, you've either had a sheltered year or are as empathic as a plank of wood.

The whole pointless session was topped off by another repition of the poem by the Crabby Old Woman. For the non-nurses out there (it seems like the law of the land that students or workers of this caste called nursing must have it thrust in their faces every three months by my reckoning) this poem can be found: here. It's far too passée for me to copy and paste it onto my lovely blog. The context of the poem is obviously a sad one, but one reading is painfully sufficient.

Yes, I am being cynical. But I'm being clinical, too. In ages gone by, maybe nurses had time to sit all day with patients having a chin wag. The guest speaker was a hospice nurse, which meant they had this added time outside of a clinical environment. Modern, ward-based nurses don't have this luxury. On top of that, modern nurses are shouldered with delicious clinical skills and responsibility. Not to mention overworked. I appreciated the sentiment from twee and wet lecturers that we should never forget the patient in the job, but in a way it's quite offensive. If was ever close to being a box ticker of a nurse I'd get out of the job sharpish. The concept of forgetting that a person is a person is so arse-backwards, the fact that I'm being pre-emptively accused of it is insulting.