Wednesday, 26 August 2015

Hospital: Doctor's orders: Have a big 50th birthday celebration

Uber to the zoom
For all the early planning I had done to get to the hospital on time, I barely had 20 minutes to hail a Uber taxi and make it out there. After exchanging pleasantries, I told the driver where I was going and he had the presence of mind to ask when my appointment was, we only had 15 minutes to make my appointment.
We made it in 17 minutes through no prompting of mine to take alternative routes or avoid traffic jams, for which I was quite grateful. Incidentally, patients can be sanctioned for missing appointments but medical establishments are rarely under obligation to meet the scheduled appointment time.
Mangled tardily
In most cases of my attending hospital appointments, I have rarely had the occasion of seeing my doctor or consultant on time and we all just accept that as the norm.
I registered and went to sit in the waiting room where there are five others in waiting, some 10 minutes later, I was called by an unforgivable mangling of my name, I swore under my breath at the lack of an attempt to do it well. Besides, my file already shows I prefer to be called by the shortened version of my first name than with that longish one that in the mouth of my mother spelt I was in deep trouble.
My weight as usual threw up numbers I could not bear to countenance whilst my blood pressure read the kind of figures that put me in my second youth. Three is work to be done about my gravitational displacement.
Called up
Returning to my seat, I chomped through my magazine waiting to be called in and at the 65th minute, I finally had my chance. Having seen many doctors in this unit, this was the first time I was meeting the main consultant. We had chatted before on my first visit, but only to hand me over to another to review my medical history and then when he provided a basic assessment of my situation.
Being in clinic today, he recalled that I was the very well-dressed man the first time that put all the other ward staff to shame and then ushered me into his office where he gave me a warm handshake and motioned to me to sit down.
Poring over my notes, we went over histories, analyses, results and prognosis within which I expressed my concerns about getting treated for a chronic condition that had not been addressed for over two years. He then suggested that I should consider the tough drug regime which would last 3 months instead of the original 12-month regime and that it is rather better tolerated now than it was in the early days.
All matters considered
I had my mind set on the alternative therapy and was really not prepared for this new piece of device that I felt I could not make a clear decision at this meeting. We then set a prospective time for 6 months hence whilst a new prescription note was filled in for the intervening period.
The bloods had their own story to tell, all reading good, a minor indication of my not fighting my condition as well as I used to and a slight inflammation without attendant discomfort. Not as good as I will have like things to be, but all within the limits of tolerance and expected responses medical opinion entertains.
Besides the essentials of this consultation, the meeting was warm-hearted with probably the most compassionate and empathetic concerns I have had from a doctor in a very long time.

Caring and nice
He asked at the beginning if I had found the love of my life, understood the angst and struggles in finding a suitable partner and was quite involved and personal when I asked about the consequences of the options I had before me in terms of treatment.
However, the deepest affection was shown to me when realising I will soon be 50 and I said I was unsure of what to do for my birthday; he said, having seen 50 and 60, the best thing to do is to go out and celebrate it well, have a party and be thankful for the joys of life. He also hoped by then I would have found the love of my life and be much fulfilled and happier when next meet in February.
On that note, we parted ways with a warm handshake and I feeling good at his wonderfully relaxing bedside manner despite the issues we needed to chat about.

Thursday, 20 August 2015

Opinion: On the pejorative of being 'white on the inside'

So he said
Steven Patrick Morrissey who is commonly known as Morrissey and really from my perspective might have been noticed for the fact that the name is recognisable but whatever he might have done and I am led to believe he sings in a band known as The Smiths whose music has had no personal recollection as to be forgettable, appears to have opinions.
Reading the Wikipedia entry as pertains this man suggests for an Englishman that he is apparently controversial as if I care a hoot.
However, I am drawn to comment on a view he expressed to Larry King in a somewhat candid interview, they say, when he surmised in the following words, “So is Obama, is he white inside? It’s a very logical question, but I think he probably is.
The pejoratives are many
I have never really been sure as how to respond to this kind of view, the many variants of this “white in the inside” pejorative is probably, ‘bounty’, ‘coconut’, ‘not one of us’, or ‘thinking like a Westerner’.
All of these I have been called at various times for having an opinion, standing by a principle, enjoying an interest, stating an objective or daring a particular conspicuousness of appearance.
It is a maligning form of slanderous condemnation borne of you not acting to a type or a stereotype, where your somewhat unique worldview is excoriated as a betrayal of the identity you are supposed to project and accept.
In this case, Morrissey was suggesting Barack Obama was not doing enough for black people in America especially after the globally significant incidents that have affected young black men in encounters with the police.
Barack Obama leads a nation
Maybe it is too much to say that Barack Obama is mixed race and was primarily brought up by his Caucasian maternal grandparents, even if he more or less identifies as black, his heritage is indisputable. Should one also say that he is the president of a very diverse United States of America, representing all peoples and in which the African American population does not number 20% of the total population?
Whilst again, he might have an affinity with fellow African Americans, the level-headedness with which he has addressed these issues is more what you will expect of a leader, he is not a controversial reactionary. In my view, he is not the reincarnation of Martin Luther King Jr nor a Moses that has come in the spirit of Exodus to lead a people away from a history of slavery depicted in the racism and the deprivation that has hallmarked the existence of the African American in the United States of America.
His job is to speak to reason, speak to hearts and minds and get people to contemplate what kind of country they want to live in that represents the theoretically attainable aims of freedom, of justice, of equality, of fairness and of liberty. He does that well and that is why he is also in his second term as president.
We refuse to be stereotyped
Yet, this whole matter harks to a kind of clannish politics of identity where you are expected to think and act in a particular way, hold up placards and lead protests within a stereotypical pigeonhole that you have been allotted but have refused to occupy.
In that, I remember when a friend asked that I give him an academic reference when we both knew I had never held an academic position, talk less of guaranteeing the academic nous of a friend; a serious conflict of interest and opinion. I countered and generously offered to write a character reference which I believed will be as good and any reference he might require.
I do remember that years after that, I did write a character reference for another friend seeking admission to a university and on the strength of that, the admissions officer called me to suggest I was also the kind of person they were looking for to attend their university. That is how I started a postgraduate programme with the University of Liverpool.
Race does not define virtue
Yet, my friend contemned me and abused me for refusing to give him an academic reference and ended his diatribe with calling me a coconut.
Rather than take offence, I understood his inference and responded, “It is not the exclusive prerogative of the Caucasian to be objective.” If I were in his close proximity, I might have been decapitated, but the self-same fact could not be ignored.
Race or identity does not determine virtue or character, and whilst experience and heritage might shape certain views, they do not have to rigidly define you that you become another example of a stereotype or be found to true to type.
Your character is the greater impression
Indeed, there are people who put it on, who have a particular mannerism with its affectations and there are others who are naturally who they are. By nature or by nurture, we are products of different influences that do not necessarily mean we cannot be liberal, be fair, be just, be honest, be true, be objective, be loving, be forthright and be much else.
Your race is not what decides whether you stick to the rules or not, that is a function of your character, the principles you espouse and the impression that you want to make either consciously or unconsciously.
I will not apologise for who I am or what I have become as a result of my life’s experiences, my pigmentation is a gift of nature, my attitudes, however, are not dictated by the colour of my skin, but by the strength of my character – even Martin Luther King Jr dreamt of a day when my colour will not automatically include me in a stereotypical straitjacket when I am just trying to be an understanding and a teachable member of the human race.
To Morrissey, one might be tempted to say, he is ‘blank on the inside’, but that will be to stoop to his primaeval level. Perish the thought.

Wednesday, 19 August 2015

Thought Picnic: From the midst of my considered mortality

A considered mortality
Three years ago yesterday, I boarded a plane from the Netherlands after a 147-month sojourn. I left a life completely shorn of everything but with a slight possibility, one of hope and some dignity, the little left.
Days before I left, I wrote an email to six of my closest friends, I also saw them as my pallbearers; about my plans to return to England, bruised, vulnerable and also with a dying wish, instructions given as to where I will like to be buried.
That last paragraph of that email was stark and shocking for some of my friends to read, some even thought I have completely given up. There were many reasons for giving up if I wanted to, I did not, I was 3 years after a cancer diagnosis and the long bushy tail of cancer was wagging the dog of my life. It was my considered mortality in the midst my particular reality.
A start again
Yet, in the contemplation of an end laid the possibility of a new beginning, how that would become I had no inkling of, but leaving the Netherlands was one that was forced upon me by circumstances well beyond my control.
I arrived in the UK, got a new phone number, updated my resume and posted it to as many agencies as I could find. Within 6 days of my arrival, I had interviewed for and secured a job that was to start in 3 weeks travelling to 26 countries in Europe and North Africa. It was promising, interesting and exciting.
The team met up at London Heathrow and made for France with schedules already in place for Germany and Switzerland. In the end, we only did 4 weeks in France before the whole project was canned. It was a hard blow and it took another few months before another good opportunity came.
That other untold story
The business of settling back in the UK was not easy, you need a proof of address to open bank accounts, to secure long-term jobs, to find a home and to do much else. One was in a Catch-22 situation because there is no template or manual for resettling back in the UK. If not for all sorts of technicalities, good fortune, familial and friendly support along with the story that had become one of the defining elements of my life, I might well have gone to make clear plans for eternal repose.
I reflect today on the story, of return, of jobs, of joblessness, of plenty and of lack, of shelter and the threat of homelessness, of brothers and sisters with large bosoms of kindness and compassion, of friends who never let a hair of my head fall to the ground, of a mentor, one of my six friends who has since passed on.
Thank you for a wonderful life
It was hard and difficult, yet I cannot deny, it is also a wonderful life. Even if I am nowhere near where I once was, I am grateful for mercies great and small, triumphs to whisper and ones to shout about, for where there is life, there is hope. Even is my spirituality leaves me with more questions than I have had answers, a little voice in me still cries out with Christian ululation – To God be the glory.
Thank you for being here, near and where I have needed help, support, encouragement, vision, comfort, advice, love and fun.

Tuesday, 18 August 2015

Thought Picnic: I don't know it all

Know why you do
In my line of work, I have variously found myself at loggerheads with others when it comes to problem resolution.
In context, it is important for me to understand why scenarios and circumstances present themselves before seeking a range of paths towards solutions that might resolve or eliminate the problem entirely.
A background in logic
There are many people who come from many walks of life and careers into the Information Technology profession taking up roles from design and architecture, through project and change management to support and much else.
It goes without saying that whilst many again are good at what they do when things are working like clockwork, the gaps in their fundamental knowledge of things begin to show when problems or emergencies arise.
There is a great user and support community out there from where one can get answers to a range of issues and problems. Yet, being able to craft a question properly or explain the scenario properly lends itself to other being able to visualise that setting and hopefully present ideas, opinions or clear solutions with steps to implement them to resolution state.
What an engineering mind gives you
My engineering background requires that there must be a purpose for any activity undertaken towards obtaining a solution. For me, it has to be logical, sensible, goal-oriented and capable of advancing knowledge and experience that any other similar scenario can literally use those steps as a template.
I do not work too well with trial-and-error, where purpose and goal are lacking that brawn rather than brain is used to hopefully get an unexpected outcome that then turns out to be the solution.
Because there is no particular method to trial-and-error problem resolution, stumbling upon a solution might well be fine, but you are left with whether you can backtrack and formularise those trial-and-error steps into a clear guide with full understanding of the problem, why the problem arose and what can be done to resolve it.
Reading the runes
I regularly peer through error logs trying to ‘divine’ from the logs what set of circumstances have presented the error observed from after. In doing that, I have to make more deductions over assumptions to begin to make headway.
In many cases, what the logs tell me gives me a sense of certainty about where things have gone wrong and possible insights as to how to right the situation. It is at this stage that I might become unpersuadable of alternative thinking if the logic and the reasoning is neither clear nor convincing.
In exasperation, I have sometimes walked away from a situation, though usually after I have shared my views and wait for the doubters to come to the conclusion that I might have been talking sense all along.
I don’t know it all
Yet, I have to be careful that this assuredness does not descend into intellection arrogance blinding me from other perspectives and perceptions. It is important to have a good idea of what knowledge you have, what knowledge you do not have and most pertinently be quick to retrace your steps where the absence of knowledge has precipitated into negligence or ineptitude.
Ignorance is fine if it means the quest for knowledge remains an ongoing pursuit with the view of mastering the rules established and then breaking new ground with new thinking and new perspectives.
Make allowances to learn anew
The constant quest for knowledge also limits the occurrences of negligence borne of not acquiring and using knowledge that is already available and the possible crime of ineptitude where wilfulness or hubris has made one almost too sure of a situation when it really is not the case.
Curiosity and a sense of precociousness are attributes one must always possess along with a questioning and challenging disposition. We can trust many things, but they should really only be trusted that much if they have also been verified as trustworthy – paraphrasing Ronald Reagan aphorism of “Trust, but verify.”
The inspiration for this blog came from Dr Atul Gawande’s first Reith Lecture in 2014 on The Future of Medicine, titled, Why Do Doctors Fail? [PDF Transcript]. In this lecture, he referenced an article Toward a Theory of Medical Fallibility [Subscription PDF], Samuel Gorovitz & Alasdair MacIntyre (1976) Published in The Journal of Medicine and Philosophy, 1976, Vol 1, No 1.

Saturday, 15 August 2015

Hospital: Between ancient and modern phlebotomies

Ancient and modern
I cannot say I look forward to this experience as I did when I lived in the Netherlands. Things are so different around here and it does leave a kind of psychologically negative effect on the mind.
Walk into any of the hospitals in the Netherlands and it is somewhat welcoming rather than foreboding; well-light, the open expanse of atriums, nature giving life to places where people visit to find cure or respite for their ills and sicknesses.
With note and with thanks
Our much vaunted NHS, the National Health Service, one of the largest employers in the world, probably in the top five and things are not just different, but quite noticeably different.
Now, for my expensive drugs that are covered by NHS system, I am more than grateful, I probably will not see another 3 months if I did not daily dose myself with these therapeutic and prophylactic formulations, that must be said.
However, at the point where you walk into the hospital as I did a few days ago, things are just not as they probably should seem. Asking for directions at the main reception, I could not help but notice that it was staffed by volunteers. Bless their hearts, there have been cuts everywhere that we have to depend on volunteers and charity to get around the hospital.
The charity that helps
In fact, there are many areas where charity and selfless service has been exploited at the expense of getting professionals to do the job. Yet, volunteerism allows for people to feel useful and relevant to their communities. Even the main shop serving tea and coffee with snacks was manned by volunteer pensioners too and in a way the profits from that shop might be ploughed back into helping the hospital in some little way, it is help all the same.
The directions to the phlebotomy waiting room were clear enough and I got there, Blood Room, it is called to find probably 20 people ahead of me, prey for the vampires we were, every kind of person was there from those you could look at with concern to those you caught a glimpse of and yet were afraid to take a second look and we were all there for the same thing, to get blood drawn.
Forget the comparison
The Dutch have a rather slick operation for phlebotomies, you present your form which lists the blood tests to be conducted and hence the number of vials of blood to be drawn. The nurse keys in the tests and a list of labels are spewed out of the printer with the date of birth, the number of vials, the colour coding of vials and a queuing ticket.
Within 10 minutes, you are called into a cubicle, private with the curtain screen drawn, a greeting, a verification of date of birth, maybe a conversation and then the phlebotomy.
In the UK, Florence Nightingale will not look out of place. For the billions spent on computer systems, it has not caught up with this section of the hospital establishment anywhere I have been. Things are as manual as they come and forget the privacy, we all go into an open plan room where we are just as exposed for the same thing.
After the confirmation of name and date of birth, the tourniquet is applied to the upper arm to help bulge up a vein on lower arm and the needle, the needle, steely and vicious, attached to a syringe-like plunger is inserted into the temple of body to draw life.
This needle is usually attached to a flexible tube in the Netherlands ensuring there is no discomfort with any movement especially when changing the vials. You can read from that, that it is different in the UK, our experience here is almost as Victorian as the old buildings that host these ‘modern’ hospitals.
This time, I even looked as the needle went in and did not flinch a bit as 6 vials of blood were drawn, the needle taken out and a bulb of cotton wool applied to the puncture wound which was held in place with plain masking tape. The sort that grabs your hairs in a painful waxing feeling when you are ready to take it off.
I cannot say where the vials went after that, but I can only hope that when the results are shared in a few weeks’ time, they will be from me. It goes without saying that I miss the sense of organisation and professionalism that I found in Dutch hospitals. Yet, when in the UK, we just have to make do with what we have got in the UK. C’est la vie.