Gatekeepers

I'm always rather bemused that whenever I call the GP to try to make an appointment, there then follows the dance of the gatekeepers - what seems an ever-increasing battle to avoid actually giving an appointment to see a doctor. I do understand that they're really busy, and that the service as a whole is under-funded. But when the difference between "not a problem" and "this needs medication" can be ascertained with a very quick visual inspection (but only by that inspection), I'm not sure how to deal with the offer of a telephone appointment.

I was particularly amused recently by the question of whether I had been to the pharmacy first, partly because I hadn't had any opportunity, but also partly because if I needed anything beyond over-the-counter medicines, then access to those is blocked (for very good reason) by another round of gatekeeping - in particular, I'd need a prescription from the very person I was trying to see in the first place!

The whole system seems increasingly structured to stop people from using it. But, actually, not all people - basically, the less likely you are to need the service, the harder you'll find it to access on those rare occasions when you do need it.

Oh well. Hopefully it's all nothing.

Vaccination Day

I had my first dose of the Astrazenica vaccine this morning. So far, so good - my arm is a little sore, but otherwise fine.

I'm extremely glad to have reached this point - it seemed to take an age for the vaccine programme to get to me, but it has at last. Not that it makes a huge difference, as I was always in a low-risk group (due to working from home), and because I'm obviously still bound by the various restrictions. Still, getting the vaccine takes us all that little bit closer to herd immunity and therefore freedom, so it's all to the good.

#23: "A Murder of Quality", by John Le Carré

Surprise!

I haven't really had any time for blogging in the last week, so this is a rather belated post about a rather belated delivery. You wouldn't expect an overdue baby could end up being a massive surprise, but there it is.

It all started the evening I finished work. It was the weekend, and because of when LC was booked in to be induced we already knew I wasn't going to be back. That evening we had LC's parents over for dinner - a rather nice BBQ (our second of the year). LC was feeling rather uncomfortable, but at this point there was no real indication of what was coming, and so after the meal LC's parents went home, and we got started on our evening routine - LC took Funsize for a bath, while I started with the clean up and washing up.

The washing up was interrupted by LC crying out in pain. At which point I suggested she call the labour ward while I took over Funsize's bath. The advice was that things might be starting to happen, but we should stay home for now.

Next, Funsize was put in front of the TV while LC had a both to try to help with the pain, and I finished the washing up. Oh, and I called LC's parents to come back and collect Funsize "as a precaution at this time".

By the time the washing up was done, LC was out of the bath, but was crying out in considerable pain. I went upstairs to find that her waters had broken. What to do, what to do? (At this point LC snapped at me. Understandably, given the circumstances...)

The assumption at this point was still that we had plenty of time - last time there were hours between the waters breaking and the birth. Still, there was a need to be ready. So I headed downstairs, got Funsize into her shoes and jacket and made sure she had everything she needed. I also, crucially, unlocked the front door.

But I wasn't liking what I was hearing from upstairs, so now I called the Labour Ward...

As I was going through the routine "who are you" questions, I was heading upstairs and put on the speaker phone, whereupon the midwife noted that LC was already pushing, and asked if anything could be seen. "The head!" LC exclaimed.

The midwife then said two terrifying things. Firstly, that the baby was going to be born at home, and secondly that she was going to call an ambulance. Oh, and could I go get some cloths, towels, or similar?

So I did. Meanwhile, LC got down on all fours, and it was time for the midwife to talk us through the birth...

The next few minutes were not something I ever expected to experience. First the top of the head appeared. With the next contraction, the baby had a forehead and some eyes. Then a mouth and chin. "Your next contraction should be your last," said the midwife on the phone. Meanwhile, I was worried - the baby was a distinct purple colour...

At this point an unfamiliar voice came from downstairs. "Hello?" The ambulance had arrived!

I shouted, and up they came, and with enormous relief I moved out of the way to let the professional take my place. And seconds later, our son was born.

Once that was done, everything slowed right down. The ambulance crew moved on to helping LC, and our son was handed to me for some warmth (and to get us out of the way).

I'm not sure whether it was immediately before or immediately after the birth, but LC's parents had arrived by the time I went downstairs. Which had the nice consequence that they, but more importantly Funsize, were able to meet the new arrival right away. (There is a photo, but it's not the best - the baby is cute; me, not so much.)

And then it was off to the hospital. LC's parents took charge of Funsize, but also spent quite a lot of time collecting towels, clearing up, and generally putting the house back in order - by the time I got back home, it was all spotless.

From there, it was all remarkably calm. LC required some stitches, but was in remarkably good health. The baby was likewise entirely healthy (apparently, they're just that colour when first born), and big - 10 pounds, 8 ounces, and a bit. (And she did that with no pain control at all!) One day later, and we were all home.

A few things remain to be said: This was not at all how I expected to spend a Friday night, but it all worked out okay. Funnily enough, while it was all going on I actually found that I wasn't scared - there basically just wasn't time. I just had to do the next thing, then the next, and so on. But I was enormously relieved when the ambulance crew arrived. (When LC went for her bath, I very nearly joked about "The Worst-Case Survival Handbook" having a section on how to deliver a baby. I'm kind of glad I skipped that particular joke!)

I must also, of course, pay tribute to LC, who achieved something remarkable - to deliver at home, without any pain control, to such a large baby, and to come recover so well is extra-ordinary.

And I must also, once again, thank the medical staff involved - the midwifes in the hospital, and especially the one on the phone, and also the ambulance crew. All were brilliant, just when they were needed. Lots of people have congratulated me for my part in all of this, but the truth is that all I actually did was make one phone call at just the right time (and remembered to leave the front door unlocked). In the big picture, that's basically nothing.

Finally, of course, is that the new arrival needs a blog-name. I had been planning to go with Button, on the grounds that there aren't many types of chocolate smaller than a funsize. But under the circumstances another name seems more appropriate. Henceforth, he shall be Kinder Surprise, or just Surprise! (and KS for short).

Welcome to the world wee man!

LC Labours Long (and succeeds!)

Firstly, and most importantly, I have a daughter! Project Tadpole came to a successful end on Wednesday morning, and so she shall no longer be referred to as Tadpole - she has a real name, and also a blog name that I shall introduce later.

It was all a bit of a nervy time. LC had been due on the 9th of this month, but that came and went without incident. And when she went to see the midwife last week, it didn't go well - an attempted sweep was just too uncomfortable to complete.

So I had my last day of work on Monday, and then we were booked in for an induction on Tuesday morning. The first phase of which is the installation of some sort of hormonal pill, after which we went home.

Tuesday was a fairly uncomfortable day - LC was complaining about back pain all day, which seemed to get worse as the day went on. Which was pretty horrible. About 11 we went to bed, though it was unlikely we'd get more sleep. And that plan was to go to the hospital again the next morning for the second phase of induction, and a long wait in the hospital.

In the event, it was unnecessary - LC's waters broke just before midnight, we called the Labour ward, and off we went!

Five minutes later, we were at the hospital. We did make a mistake in going to the wrong ward initially, but were soon at the Labour ward, gained admission, and waiting for a room to be ready for us.

The theme of the next several hours was of waiting. LC did a lot of work - I tried to do what I could, but the reality is that that was very little. The midwife was great, but really it was LC who was magnificent. She didn't even use much pain relief - she took a paracetamol and some codeine early on, and then some gas and air for an hour from 1.30 (but then stopped because she was feeling nauseous), but that was all.

Things actually proceeded really fast, and just after 4 it was time to push. Alas, that was the end of the 'easy' bit. An hour later, and it was time for a doctor to be consulted.

The upshot was that our baby needed a bit of help to reach the world. There was also some concern that she might be facing the wrong way, which wasn't good - but the doctor couldn't be sure, as the examination was just too painful to perform. So the recommendation was for LC to have an anaesthetic, and then the examination would be possible. From there, a forceps delivery might hopefully be possible... if not, a C-Section might be needed.

Well... this was the point where I got really worried, because while I'm aware that these things are fairly routine these days and the risks are pretty minor, the fact is that the risks are non-zero. And even if the odds are 10,000-to-1, someone still has to be that one. And when you're talking about the two most important people in my life, that's a hell of a thing.

But, of course, saying any of that really isn't helpful. The key thing was that LC had done as much as she could possibly have done, and it was time to let them help her out. And then pray.

In the event, it all went as easily as could be hoped - as soon as the anaesthetic was applied, LC found she was no longer in pain (as you'd expect, really), which was a huge relief, it turned out that baby was the right way around, and so although forceps were needed a C-Section was not. And both came through okay.

Project Tadpole came to a successful end at 6.20am on Wednesday 21st Feb 2018. She weighed in at 9 pounds 15 ounces (and a bit).

As she was born, I had the great pleasure of informing LC of the sex of our child. That was quite a thing, because although we genuinely didn't know until that moment, we'd more or less convinced ourselves that we were having a girl. Not that it matters, of course - her first clothes (from us) were still an R2-D2 onesie, and she's still been watching Transformers with her Daddy. She's my little girl, but she's still my little geek. Until she rebels and grows up secretly normal.

The rest of the story is pretty straightforward - LC and baby were kept in for the rest of the day for observation, and then we came home on Thursday. We've since been having very little sleep, we've been enjoying a multitude of visitors, and have been very much imposing on Gran's willingness to do the ironing. And the nappies have been horrific.

Now, I said she now has a real name, which I'm not going to reveal here. However, she also now has a blog name, which is rather important. As you know (maybe), LC is short for Lady Chocolat. I therefore toyed with calling her Little Chocolat, since she is very much her mother's daughter, albeit much smaller in stature (for now). However, that would need to be abbreviated to lc, and that would just be confusing. Therefore, I shall name her after another form of little chocolate: Funsize (FS for short). Until someone in the comments points out that that's a really bad idea...

And now... sleepy. So very, very tired.

Oh yes, one more thing: we need to say a huge thank you to the staff at the hospital. You were fantastic from start to finish.

#8: "The Sorcerer's Daughter", by Terry Brooks

Nine-fingered Steve

I'm currently on holiday, and one of the tasks that I had set myself for this holiday was to restock the freezer - our supplies had run low, and so I was all set to cook up a batch of curry (or other food) each day, thus filling the freezer with all manner of wonders.

Monday's effort was a chicken jalfrezi, which begins of course with cutting up a whole load of vegetables. So, the onion was chopped, the chilli was sliced, the ginger was peeled and sliced, and the time had come for the garlic.

At this point, I reached for the knife, and I must have knocked it because it fell. Unfortunately, at this point reflex kicked in, and I rather foolishly tried to catch it. But our kitchen knives are spectacularly sharp, so all I succeeded in doing was getting a very nasty cut in the back of my thumb.

Which was rather sore, but rather more worrying was that there was a lot of blood. So, it was off to A&E (despite LC's initial reluctance).

At length, I got patched up. Fortunately, I had neither caused any nerve damage, nor had I nicked the artery. (I was simultaneously relieved and concerned to hear that - concerned because I hadn't even considered the possibility.) So, they patched me up with dressings rather than stitches, and sent me on my way.

It's rather unfortunate that the wound is on my right thumb - that's the worst possible finger to injure. Fortunately, although I'm not quite ambidextrous, several years of playing the pipes and working with computers has left me with good left-handed control. So working left-handed isn't too difficult. What's proving difficult is working one-handed. Still, I'm doing my best.

The most awkward thing, though, is that I'm under instruction not to let the dressings get wet for the next 5-7 days. Which is interesting. Still, with careful use of vinyl gloves, I've been managing thus far.

Ultimately, no serious harm has been done. Which is the main thing. Now I just need to let it heal.

More on PIP implants

The scandal of the fault fake breasts rumbles on. I must admit, I find myself incredibly concerned by it all - that a private company would so casually endanger the lives of so many is quite scary. And while the operation in question is mostly a matter of choice (some might say vanity), that doesn't in any way mitigate this - the women involved still had a right not to have their lives put at risk.

I still don't understand why there's so much hassle in getting this sorted out. As far as I can see, it should be pretty straightforward:

If the clinic that performed the surgery is still around, then any woman who has had the PIP implants should be free to have them removed (and, if desired, replaced) free of charge. There should be no debate over this, and no questions over whether or not there is thought to be any danger. At its most basic, they've been sold faulty goods, a recall should be underway, and so they should be contacting their supplier. And, as I noted before, those suppliers have to carry hefty insurances in case something goes wrong; something has gone wrong, and it's time to act.

The key exception to this is the case where there is an urgent threat to the health of women affected. Because arranging the required surgery privately will take time, the NHS will need to step in to remove the offending implants. It may (or may not) be appropriate for the NHS to also arrange replacements - that's a medical decision I'm not equipped to make, though my inclination would be "not". In any event, there should also be a mechanism for the NHS to get appropriate compensation from those same clinics for cleaning up their mess.

In the case where the clinics are not still around, it falls to the NHS to pick up the pieces. And here, my feeling is that the women affected should be able to have the implants removed if desired. Again, it may or may not be appropriate for them to also have the implants replaced. (In this case, there might be an argument for requiring proof of an actual danger before proceeding... but in general I'm a believer in preventative medicine, which suggests going ahead.)

As I noted in my previous post, if there is any hassle dealing with the clinics, there should be legal recourse to compel them to do the right thing. In cases where the clinics have disappeared, there should be recourse against the shareholders.

Finally, we need to tighten up the regulations to ensure that something like this cannot happen again. Further, we need to track down all those involved in making the switch (from the guy who actually did it, all the way up the chain to the guy who first made the call). They need to be found, prosecuted, and punished to the fullest extent of the law.

(Incidentally, this failure, in itself, is not an argument against privatisation in the NHS. The argument against privatisation in the NHS is that it's an incredibly stupid idea. But this is a failure of regulation, and could have hit the NHS just as it has private clinics. Indeed, given that not all such surgeries are cosmetic, it is possible that there are some women who have received the offending PIP implants on the NHS.)

#3: "Loving Against the Odds", by Rob Parsons

The trouble with haemodialysis

Apparently, le Welsh was quite excited by the thought that my post "The Trouble with HD" might be about haemodialysis, and rather disappointed to find it was actually about High Definition television. Although quite why I would post about such a thing is beyond me, but still... Anyway, not wanting to disappoint, here is my follow up.

The trouble with haemodialysis, at least from a blogging perspective, is that I don't really know quite what it is. Still, I do know the dialysis is something used for kidney failure, and that the kidneys are responsible for flushing toxins from our systems. Also, the prefix "haemo" implies blood, so I'll surmise that it's a process by which the blood is cleaned of toxins. Probably with an exciting machine that goes, "bing!" every so often.

A quick Google of the topic reveals that this surmise is broadly correct. Although wikipedia fails to indicate exactly what noise the exciting machine makes. I feel I shall have to investigate further.

It seems to me that the other fundamental problem with haemodialysis is that it actually does nothing to solve the problem. It does nothing to repair the failed kidney and so, fundamentally, is only of use to keep the patient alive until a replacement organ becomes available.

Clearly, what we need is some means to repair or replace a damaged kidney, preferably without being bound by the limited supply of donor organs. I can see three (maybe four) possible ways to do this:

• It might theoretically be possible to engineer some nanotech devices to enter a failed kidney, fix the damage, clear out the toxins, and therefore bring it back to health. (The possible fourth solution would be to do much the same thing with some application of stem cells. However, in reality I suspect neither the nanotech nor the stem cell solution would work in isolation. A combination of the two, perhaps...)
  
• We could perhaps construct a mechanical artifical kidney, in the same way we almost have a functional artifical heart. Essentially, this would be a very small-scale dialysis machine (probably without the exciting "bing!" sound, or whatever). It is likely that this would also be a short-term solution until a permanent solution could be developed, but it would probably be a step forward at least. I wouldn't be surprised to see this being the first solution implemented, and wouldn't be terribly surprised to see them in common usage by the end of the next decade.
  
• Finally, there exists the possibility of using stem cells to clone a new kidney from the patient's own tissues. This would dodge the issues of the shortage of donor organs, and remove the risk of organ rejection, both of which would be a good thing. And, as scientists seem to have found techniques to reprogram 'adult' stem cells to work like embrionic stem cells, the ethical concerns here need no longer apply, which is nice.
  

So, I think there is cause for hope. Of course, everything I have just written could be a load of utter tosh. Five minutes of research on Google while waiting for an email is hardly a substitute for actual expertise.

Ouch

Yesterday, I burned the back of my wrist in a lasagne-related over glove malfunction. This was not a good thing.

It hurts like crazy. I'm given to believe that this is actually a good thing - 'tis only a flesh wound.

Doesn't that just kill you?

Captain Ric's comment on the dentist post requires a longer answer than I can really give in a comment.

The question is this: given that I am paying for NHS services through taxation, and am now paying again by virtue of having a private dentist (not to mention having private health insurance through work), doesn't that just kill me?

The answer, of course, is both yes and no.

On the one hand, it is extremely galling having to pay twice for the service. It is especially galling when one considers that I would be right at the bottom of the NHS priority list for allocation to a dentist, being a single man with no dependents. And this despite the fact that I pay the same taxes as everyone else (as a percentage sum), or rather more than the average (as a raw numeric figure), and am a very low user of services (being a single man with no dependents, in full-time employment and in good health). One would have thought that, on principle, in those cases where I do need access to services, they really should be available.

(When it comes to allocation for a GP, I am rather higher on the priority list, working as I do in a high-stress sedentary occupation, being somewhat overweight, and with various elements in my family history that suggest that, statistically speaking, I died three years ago. As I mentioned in a earlier post that only Chris read, it is apparently the case that being married increases a man's life expectancy by some ten years, at the expense of his wife's life expectancy. Which is rather an impressive wedding present from her to him, I must say. Unfortunately, efforts to work this into my chat-up routine have thus far failed to bear fruit; I suspect I'm not phrasing it quite right...)

Anyway, on the other hand...

The NHS does not have an infinite pool of money available to it. With a growing and aging population, the strain on the system is evident, and will only become worse as time goes on. That being the case, a strong argument could be made that those who can afford private healthcare and private dentistry really should spend the money to avail themselves of these things, and thus reduce the burden on the public system.

Which is not to say I support the Tory notion of a few years back, that those who opt for private healthcare should therefore be able to recoup some of the costs from the NHS. This strikes me as rather defeating the purpose. And I dread the day when private health insurance becomes, effectively, a necessity of life, as it is in the US system. Sadly, I think that day is approaching.

(The only other fix I can see to the resourcing problems of the NHS is draconian methods towards those who represent an unreasonable burden on the system. To a certain extent, this already happens, in the form of extreme taxation on cigarettes. However, one could roll out a system whereby everyone has a certain credit in the system, which gets expended whenever you go in for 'preventable' incidents - including anything drug, alcohol, tobacco or obesity-related. Once the individual's credit runs out, they don't get treated. Of course, the problems with such a scheme are fairly obvious with only a slight analysis, and some of the outcomes are too monstrous to contemplate. So, I think I'm going to advocate "those who can afford not to overburden the system should not do so" as my solution of choice.)

Note to self: try not to think about politics; it's too depressing.

Thoughts, anyone?