The Rants of Cherry Black

I haven’t blogged in a while, partly because I’ve been busy / exhausted, but also because I worry that if I blog about specific events, even with details removed, patients and colleagues may potentially be able to identify themselves if I write about it straight away, and that would be unfair and unprofessional. But mostly, I’m lazy and can’t motivate myself to write after a day at work.

So I’ve been working for 2 and a half months now, and honestly, I’ve really been enjoying it. There are some stark differences between working in Hampshire and London; most noticeably, budget. I’d mentioned before that the imaging equipment was different to what I’m used to, but it extends beyond that. The rooms in general could do with a refurb; the paediatric room is quite an intimidating place for an adult, let alone a 5 year old with a broken leg. There’s also a dearth of basic accessories such as positioning pads and cassette holders; this doesn’t necessarily affect patient safety or the diagnostic quality of the resulting radiograph (assuming that the radiographer is determined and caring enough) but it can affect patient comfort, and it can also make the task for the radiographer much more laborious and require some significant creativity.

That said though, having the newest fanciest kit doesn’t solve everything; our fancy DR system in Resus decided to stop working on the morning of the Vauxhall helicopter crash, when we were on standby for some of the casualties. It turned out to be a very quiet morning in the end, but nerves were certainly frayed when one of the A&E rooms packed in at the same time! This all happened during my fortnight’s “training” in A&E (I’m still rotating through the various modalities so I can get a basic understanding of equipment, protocols, and working practices). Unsurprisingly, this was my favourite time period so far, and I can’t wait to get back round there.

So far, my shifts have been nice and easy; 9-5 every day, no weekends, but that all changes this month. Luckily I’ve only got one evening shift, one weekend long day, and two weekday long days in February, but it steps up further in March with night shifts thrown into the mix too.

So… what other news? Well I received a dose badge, but then that expired and I wasn’t on the list for a replacement so now I’ve got a temporary one; my markers finally arrived from the USA but apart from my A&E fortnight I’ve hardly used them; and I’ve received half of my uniform (the trousers) and when I collected them my colleague, who accompanied me to find out about hers, demanded that they give me a plain white tunic to tide me over til my proper ones arrive. Hopefully this will mean fewer incidences of being called “The Student” by consultants.

After all this behind-the-scenes waffle you may be surprised to hear that I have actually encountered some patients in my 10 weeks of employment, so here are some anonymised excerpts of the ones who have, for various reasons, stuck in my memory:

The 6 year old who barely even winced when I moved his obviously fractured arm to a more lateral position- brave kids like this just make me even more annoyed at perfectly well yet uncooperative adults who scream the place down over a slight sprain or bruise.

The elderly lady with multiple myeloma who had been booked in for a skeletal survey (a long list of x-rays covering basically the whole body, to assess the formation of any lesions in the bones) who not only repeatedly apologised for taking so much time (!) but also told me about the horrible experience she’d had at another hospital. Apparently the radiographer there shouted at her when she misunderstood his instructions and she cried on the bus home. I hope I’ve managed to show her that those types of radiographers are in the minority.

The young teenager who came into Resus following a collision with a vehicle; she sustained several injuries (luckily none were life threatening) including losing all of her front teeth only a day after having her braces removed. She was understandably devastated and kept apologising to the trauma team for crying. I think she made a lasting impression on all of us.

The gentleman who refused to take his necklace off for his chest x-ray and got very aggressive at the mere suggestion of doing so, telling me that if he takes it off “and something bad happens, it’ll be your fault” whilst standing 6 inches away from my face. More on this in a future post.

The father of the tiny baby on NICU who was born so premature that her lungs had barely formed. I felt awful asking him to step out of the room while I x-rayed his daughter, especially as he cleared his throat and tried to hide the fact that he’d been crying when he returned.

I’ll try to be more regular with my updates in future; I’ve got a few radiology related posts to write on a number of different subjects which have been on my mind recently.

Photo courtesy of the Society of Radiographers

I’m pretty pissed off. So pissed off that on Saturday I marched through London with 150,000 other folk who are angry at the way this country is being treated by the government. And now I’m even more pissed off that we were completely ignored by both the media and those in charge. Is because we didn’t smash shit up? Because there was a football match that day? Or is it because 150,000 people closing roads in central London and marching past Downing Street just isn’t a big deal? After all, back in 2003 approximately one million people marched through London to protest the Iraq war, and that still happened.

The facts are fairly clear: the NHS is being privatised, but apparently, not that many people care. In 2007 the American Filmmaker, Michael Moore, made a documentary investigating the state of insurance-led healthcare in the USA, and comparing it to the socialised medicine available in France, Canada, Cuba, and the UK. While the film isn’t exactly unbiased, as a Briton I find the concepts covered in it as alien as Alien. Concepts such as: people with unrelated pre-existing conditions (such as thrush) being denied health insurance cover for cancer; patients being bundled into taxis mid treatment and abandoned outside charitable hospitals miles away, confused, disorientated, and still wearing gowns and ID wristbands; patients with severe respiratory illnesses contracted whilst volunteering in the clear-up post-911 having to pay hundreds of dollars for an inhaler; insured patients having to pay for ambulance expenses because the emergency response hadn’t been pre-approved by their insurer.

Nah, scratch all that, those examples are disgusting, but they’re also quite extreme. Personally, I find it abhorrent that in a developed country, with such national pride and a history of incredible achievements its citizens are treated with such contempt. Michael Moore seemed shocked that our prescription costs were so cheap and could cover so much. He was surprised to find that the only thing stopping a patient from leaving the hospital was the state of their health, rather than their bank balance. He was confounded by the idea that the cashier’s desk in an NHS hospital serves to reimburse travel costs to poorer patients rather than to collect payment. I am shocked that this is not the case over the pond, and I am even more disturbed that we’re starting to copy them.

Leaflet announcing the launch of the NHS

Moore spoke to Tony Benn to ask about the history of the NHS, talking about the motivation behind it, and the love that the British people have for it. There was, however, one part which was especially poignant today, where he compared the NHS with democracy, saying that taking away our healthcare would be as ridiculous and incomprehensible as removing the vote:

(See the full interview here)

Well where’s our bloody revolution? Seriously? The public reaction to the current dismantling of the NHS by the Conservatives has been, quite frankly, pathetic. Some people blame the media for the lack of coverage, but honestly I don’t buy that anymore. If there was a media blackout on the FA Cup, people would still find out the football results if they were interested; how can football be more interesting than your own health? There are even people working for the NHS who either don’t know or don’t care about the current threat to their employer; I know because I’ve spoken to them. I’ve had plenty of people ask me why I get so upset about this, and why I bother reading and writing about it. Well, I don’t know about you, but if I broke my arm tomorrow I couldn’t afford the bus fare to hospital, let alone the treatment.

People came up to us on Saturday’s march and (genuinely) asked what it was all in aid of (maybe they were illiterate, I dunno, we had plenty of banners). Back in March there were nationwide vigils and I went to one in Southampton and was disgusted with how few people turned up; I even grabbed the megaphone to express my disbelief.

Photo courtesy of Laur Evans

But honestly, what can we do? It seems that the only way to get media coverage is to destroy property, and that would be a wholly inappropriate response. I’ve tried telling people myself; I’ve blogged, tweeted, facebooked, accosted people in the street, written to my MP, attended events and rallies… what else can we do?

Answers on a postcard…

I arrived at Manchester Airport yesterday morning with plenty of time for my flight; I’d never been there before so didn’t know what to expect. It’s quite a large place with lots going on, so I figured it’d be easy to kill the hour before my flight. I had already gone through the rigmarole of separating my washbag so that all my liquids were in separate clear plastic bags, and I had my stuff all ready for inspection at the security area. When I got near the front of the queue I noticed that they had a fairly full-on security gate: there was a turnstile which let you through the initial metal detector, and once you’ve been checked for metallic objects, you are then presented with two glass doors surrounded by illuminated arrows; you then go through the door which lights up. One door leads you to your recently x-rayed belongings, and behind the other lurks a backscatter x-ray scanner. At this time I don’t know if this is a random allocation or if it’s due to Big Brother. Maybe if I’d been one place ahead in the queue I wouldn’t be writing this blog post.

So my turn comes and I go through the turnstile, through the metal detector, and stand in front of the doors, awaiting my fate, and hoping that the right hand door would light up and show me my freedom. Alas. I walked through the left hand door, where a kindly gentleman instructed me to place my feet on the marked circles. I calmly explained that I would rather not. He asked me to stay where I was and went to get a security officer (I’m not certain of her job title). She was a very friendly and not at all threatening lady, who walked over armed with information leaflets on the backscatter machine. I told her that I work with radiation, have spent the previous three years studying it, and that I had plenty of information on how the machines work and the radiation implications. Her body language changed slightly at this and she told me fairly dejectedly that unfortunately there was no alternative, as Manchester Airport do not allow passengers to opt out of the backscatter scanner. She asked me to email the Department for Transport and have it out with them; she said that maybe if enough people made a fuss, something might change. I’ll be honest and admit that I was so relieved to be met with someone so reasonable: I have never been on the wrong side of the law, and certainly never on the wrong side of airport security and I didn’t have the guts to get in trouble with both on this occasion. The conversation was very polite and considered, but she explained that the only way to avoid the scanner would be to not get on the flight. If I had the money I would have probably opted to take the train, but I’m still an unwaged student. I asked if they had any paperwork they could give me to prove that I had been scanned, but they don’t, which seemed odd; all she could give me were some leaflets on the machine itself. Maybe it’s part of the anonymisation process or something.

So I assumed the position, reluctantly. All the while very aware that I was being stared at by other passengers, as the entire charade was being conducted in a glass box in front of the security queue. It was quite humiliating to be honest, I know that assumptions were probably being made about why I was causing a problem, but I really don’t care. What worries me, is that there are no signs on the backscatter machine denoting what it actually is. It’s just two large black boxes which you stand inbetween with your arms in the air. At no point is it explained to you what the machine actually does or is. Is this because if they did, more people would refuse to enter it?

I’m going to do some more research, but for now I’ll leave you with these links:

http://www.bbc.co.uk/news/uk-england-manchester-15766544

http://www.bbc.co.uk/news/health-13990434

http://scrapthescanners.wordpress.com/2011/11/20/disgrace-and-debacle-euro-scanners/

No, not the apocalypse (do people actually believe that shit?).

This year will be the end of one way of life and the beginning of another, in theory.

If everything goes to plan, my final exam will be this Wednesday. The following day I’ll be celebrating the end of exams plus Portsmouth SitP’s first birthday (clicky for more info).

The next major milestone comes in March, which is when my dissertation is due in, and I am absolutely terrified. Shortly after is my final clinical placement, and hopefully the last time I’ll be working in a hospital without being paid.

And then that’s it. Finished. No more lectures, exams or presentations. No more staying up til 3am writing essays (I really can relate to Douglas Adams’ feelings on deadlines).

Apparently some people feel scared upon leaving academia; I wonder if this is because they haven’t worked before as I suppose that can be quite daunting. The scariest thing for me was starting the process. Giving up my job was the most unpleasant part of the whole affair, and I’m not just talking about losing a regular salary, although that was quite galling. There’s a certain safety in doing something you know you’re capable of, and you don’t tend to get that when you’re starting from scratch.

When I was learning how to use Linux for the first time, I did so at my own pace, and when it all got a bit much I’d retreat to the safety of Active Directory, something I could configure in my sleep (and frequently did so) which bumped my confidence back up.

There’s not been much in the way of safety or familiarity over the past 2 and a bit years; all of it (with the minor exception of the teeny bit of quantum physics in the first year) has been brand new to me, even down to certain aspects of essay writing (I put my name on the first essay I submitted, not knowing that this was an instant fail- oops!) so it’s been something of a journey.

The “working in a hospital” bit which comes next doesn’t worry me so much; from what I’ve seen, all newly quals start their first jobs like rabbits on a motorway, terrified about their first on-call or theatre case so I’m sure I’ll fit right in. The actual act of getting a job is pretty unnerving though. I had my first rejection last week for my “dream job” at King’s College Hospital. I didn’t expect to even be considered, but still. Sucks.

Anyway, I’m rambling. Back to revision.

On Friday I finished the practical aspect of a degree module called “Inter-Professional Learning” (IPL). For two weeks every academic year, healthcare students from Southampton and Portsmouth University are bundled together into groups of 10 and given a project to do. IPL “strives to improve communication and working relationships between professionals, and helps them deliver high quality services in increasingly challenging times.” The idea being that if doctors, nurses, podiatrists, radiographers etc work together before they qualify, it will hopefully enable them to work together even more smoothly throughout their careers.

Unfortunately my experience of IPL has taught me very little about other healthcare professions (except pharmacists, which I’ll come to later) and in most cases it has reinforced some stereotypes that I know aren’t true.

For example, all of the medical students I have worked with on IPL have been incredibly self important and made it very clear that they had much better things to do (as if the rest of the group desperately wanted to be there) and in a few cases they even went as far as not bothering to show up. The male med student in the first year showed up on day 1 and day 14, and spent the time in between playing rugby somewhere in Europe.

Until this year, all of the social work students in my group have been paranoid and defensive, an attitude which can’t have been helped by the introductory lecture we had at the beginning of the first IPL which basically reminded everyone that people always blame social workers when a child is hurt or killed. I’m sure this was meant to be helpful, but it put my group’s social work student into a really foul and indignant mood.

The nurse from IPL1 was an alt-med nutter who insisted that humans don’t need vaccines as homeopathy is a much more effective and safe method of protecting yourself. Terrifying.

So yes, I am cynical about the effectiveness of IPL in its mission to improve communication and attitudes within a multi-disciplinary team. Especially bearing in mind I had the best IPL-like experience anyone could wish for whilst living in the Pokhara house; working, resting and playing with healthcare professionals from all over the world. I learnt more about what nurses and doctors do in that month that I have done over the duration of my entire degree so far. I was hugely impressed by their knowledge, and I really enjoyed our dinner conversations about the day we’d just had.

Last year on IPL2 I did actually learn a fair bit about pharmacy, but it had nothing to do with IPL itself. It was in the car journeys to the placement site, where the pharmacist and I had many really interesting conversations about the legal side to the profession, as well as discussing the vast amount of mathematical prowess required.

I follow a few medics on Twitter; some are students, some are long-qualified, and some have only just registered with the GMC. They all regularly provide me with really interesting information about their profession and healthcare in general, and there’s even a Twitter journal club where papers are reviewed and critiqued by anyone with an interest.

I have never felt compelled to stay in touch with any IPL group member once the sessions have finished, but this weekend I’m driving over 500 miles for a reunion with my Pokhara housemates (those on this side of the Atlantic anyway).

I suppose what I’m saying is that healthcare workers and students need to be personally interested in engaging with each other, as no amount of forced role-playing or ice breaking sessions will achieve a truly cohesive working environment. It is a sad fact of life that some people are content to go through their lives with the bare minimum of effort and interest, and I guess that’s why IPL has to exist. But at least those people will never become public health bores like me.

:-/

And so begins my last week of working on the Isle of Wight, and I’m actually going to miss it. This placement in particular has been really good, I feel like I’ve learnt so much, and because of it, I’ve been made to feel like one of the team, which is fantastic.

But there have also been downsides: today had a couple of rather memorable ones.

The first one was really unpleasant and will probably stay with me for a while. A 90ish year old female patient (who I shall call Betty) was referred to the department for a lumbar spine x-ray. A message came through with her referral form telling us that she must be examined whilst lying down due to her mobility issues. We thought “fair enough, she’s in her 90s, no problem” and called her into the room. Her carer pushed her wheelchair over to the imaging table and we went through her details. Confirming her mobility issues, her carer agreed that she might be more comfortable lying down, but would be in pain anyway die to numerous previous fractures and her general frail state. Betty lay on the table on her side with her arm underneath her ribs so instead of getting her onto her back, we decided to attempt the lateral first, as she was obviously in a lot of pain. I asked her to move her arm forwards so it was clear of her spine, and when she moved it she screamed in pain. Both myself and the radiographer I was working with were really unhappy with continuing the examination this way, so we decided to ignore the earlier “advice” and perform the examination with the patient on her feet.

I helped Betty to sit up, and when she gave me her hand I noticed that the sleeve of her blouse was covered in fresh blood. I assumed that maybe a scab had been knocked off or something, but upon closer investigation, it turned out that her skin was so fragile that it had torn when she moved her arm. There was a three inch haematoma and open wound on her right elbow and it was bleeding a fair amount. We quickly continued with the x-ray whilst a colleague contacted A&E to get someone to apply a dressing to the wound.

Betty was much happier standing and the x-rays came out really well, although they clearly demonstrated her osteoporotic state. Personally I don’t agree with putting someone of her age and condition through such an examination; obviously the risks of the radiation aren’t a factor, but the pain and indignity are, and I really do doubt that the results of the x-rays will affect her treatment- it’s not like she’s going to be asked to lay off the skydiving for a few weeks so her back can heal.

After seeing her over to A&E, we filled out an incident form as is required following a patient suffering an injury whilst in our care. Whilst doing this, complaints started coming in about a leak in the waiting area, and sure enough, there was a torrent of water cascading down from the ceiling in the corner by the window. A few inco-pads were thrown down to absorb the water, but they couldn’t hold back the tide, and all they did was draw attention to the colour of the water. As suspected, it turned out that a sewage pipe in the ceiling had cracked, therefore making the flood slightly more unpleasant. Regardless of this, patients were still merrily walking through it, ignoring the warnings and traipsing it through the waiting room. One mother even walked past the cones that were used to block the area off and guided her son pretty much underneath the flow of effluent.

So I decided to take action and used some clinical waste bin-bags to set up a cordon, and mopped up the footprints and puddles in the waiting area. All the while dodging the waterfall which appeared every time someone upstairs flushed the toilet.

Luckily, shortly after lunch the estates department stopped the leak and arranged a clean-up. Let’s hope the smell is gone by tomorrow.

The residents of Cosham are bitching about the possibility of having their evening television viewing interrupted by the air ambulance. Yes, that’s right, some of the residents who choose to live next to a massive hospital are complaining about not being to watch Big Brother uninterrupted. Oh and apparently the downdraught knocks over their patio furniture too. Boo fucking hoo.

Currently, the air ambulance can only operate between 8am-6pm and a planning application has been sent in to make the service 24 hour, but some local residents regard their television viewing as more important than saving lives.

I’m assuming that in registering their complaints that they are also registering their ineligibility for airlift in the event of a serious illness or injury? Of course not.

If you live in the Portsmouth area and want to let the council know your opinion, the planning application can be found here or on the Portsmouth City Council website under Planning, and search for “helipad”.

Without wishing to labour the point too much, in countries like Nepal, if you are seriously injured and cannot afford the bus fare to hospital or don’t have anyone who can take you, you will die.  If you’re lucky enough to get back to your home, you will die there, if not, it’ll be an agonising, public death with no medical attention whatsoever.

Come on England, get your fucking act together.