13 December 2021
Hello everybody, sorry it’s been so long. I’ve been a bit busy, but I imagine so have you. Busy enjoying your freedom perhaps, while we still have the chance. But it’s December already and, looking at my calendar, if a blog is to be written in 2021, I have a window of opportunity that started an hour ago and will end in 77 minutes.
And I’ve already wasted the first hour drinking coffee, checking my emails, being uncharacteristically responsive to June’s needs and staring at Twitter. I’ve had an ambiguous relationship with Twitter ever since doing Zoe’s “How to win at” course last year. Sometimes I think it’s harmless banter, this morning I think it’s the greater enemy of promise than any pram in the hall. 70 minutes left.
I started 2021 looking for reasons to be cheerful and loving my scrubs. I have new scrubs now, North American, dead expensive, but worth the investment, and a hoody as well – essential for the Hartcliffe winter. Ellie, our great new practice manager gives us regular email status reports on the perilous and constantly evolving condition of the premises. In the last week the headers of these have been increasingly alarming, “Bad smell in corridor” and “Leak in reception – update”. Fixing our building has always been a Sisyphean project – you push that bloody boulder up the mountain, knowing it’s just going to roll down again. But in that absurdity there is dignity and occasional happiness – bit like the last year.
More pandemic, a European football tournament that we all lost, eventually (you’re not Italian, are you? if you are – Well Done – enjoy it while it lasts). Then even more bloody pandemic, the most yet down here, even though it was all meant to be over. It caught us a bit on the hop to be honest, Bristol and the Southwest racing from the relegation zone to the top of the Covid league table with all the attendant chaos and misery. How did this happen? Who knows – except it had nothing whatsoever to do with a dodgy lab in Wolverhampton telling us all we were PCR negative when we weren’t. And in the middle of all this, FREEDOM, which did feel a bit like another word for nothing left to lose.
In a supermarket toilet the other day I noticed that someone had written on the wall,
“In a time of universal deceit, telling the truth is a revolutionary act”
Apparently, this is a famous misquotation that George Orwell never actually said. So what? Words always have their own life, beyond whoever writes them. I’ve been considering the troubling concept of truth a lot recently, like when reading “From harm to hope: A 10-year drugs plan to cut crime and save lives” (don’t get me started, seriously just don’t) or watching Allegra Stratton say sorry.
You want to know the truth? The truth is that ARC West are awesome, all of them, every single one, through shared and personal hardship, visible and invisible, still delivering the goods. One of my best 2021 memories is our ARC picnic in Queen’s Square on a sunny evening in August. My wife June, my daughter, and granddaughter came along. Walking from where we’d left the car, sandwich and crisp laden basket in hand, I thought I better quickly explain what ARCs are.
“People tell us their problems and we do projects to solve them”, I let this sink in for a bit.
“How many projects?” says June, typically cutting to the chase.
“Loads” I say vaguely (what? Am I meant to be in charge or something?)
Luckily, five minutes later, Liz is on hand with facts at her fingertips:
“Over 60 live at the moment.”
“Wow” says June “that is loads.”
A buff guy in black shorts and nothing else is doing his exercise routine right next to us – totally unnecessary, he could have done it anywhere in Queen’s Square.
“You used to look like that” says June, wistfully and completely inaccurately. We eat and drink, we congratulate Loubaba on her engagement, we don’t play bowls (this to Jan’s disappointment – she has lugged her bowls set down on the bus and is now contemplating lugging it back again) because late summer sun and inertia have overtaken us. We head home around 9. “I never thought the people you work with would be so nice” says my daughter. “Me neither” I say.
Our ARC picnic was an odd, lovely moment. There were other nice moments in 2021. Long overdue promotion successes for Jeremy and Sabi, progressions for Tim and James, Pippa is now a Chief Operating Officer, and Zoe also successfully starred up through the labyrinthine, impenetrable and, above all long, UHBWT regrading process is now “World Queen” (or something, she rewrites all of this).
A glut of reasons to be cheerful came in late Autumn. June and I both got boosted, an extra £750K to support our mental health research, the email arriving during an Operations Group meeting (like opening your exam results in front of your parents). I was actually in a good mood already, because a day earlier I’d been sat on the back of a boat heading out of Seaton, right next to the twin Selva 115 horse outboards, a rainbow in the spray, past a school of tuna feeding on mackerel; and a day later I saw the Nightingales at Rough Trade, one of the very few bands from my long lost youth who are still consistently brilliant, as opposed to an embarrassing tribute act to their former selves. I was so excited that I bought June a pink tote bag that said “Post punk crybaby” – perfect. We’d also had our official feedback letter on the Annual Report the week before.
“We thank you and the ARC staff for a tremendous year’s work, and we would like to thank all staff for their contribution to delivering the work programme over the year.”
In NIHR terms this is effusive praise, they’re not known for hyperbole. Treat ‘em mean, keep ‘em keen, always seems to be their motto. I forwarded Pippa the letter from NIHR (with the single word covering note “Phew!!”), she sent a “Well done team” email to everybody and for a few hours we relaxed in relief.
Next time you’re relaxing check out our website. I just did and reminded myself of some other highlights: Anna Mulvihill our ARC West nursing intern winning 2021 Nursing Times Student Learning Disabilities Nurse of the Year; two volumes from Policy Press edited by our own Michelle Farr and others on “COVID-19 and Co-production in Health and Social Care Research, Policy, and Practice” and a thoughtful report from the CoMMinS project and the PPI team on long Covid in children.
I was one of the GPs interviewed for this report and acknowledged our ignorance of long Covid in general and the inadequacy of what we can currently offer patients. Accounts in the report from children experiencing long Covid and their parents seemed to reflect this. Clinics in Hartcliffe, and I imagine everywhere else, are very busy again. Days in clinical practice have reverted to their pre-pandemic length – longer perhaps. In my last surgery, more patients were seen face to face than any other way. It takes longer, both because of persistent PPE needs and the fact that most people understandably bring a list of things they’ve been saving up. So far, one thing we don’t seem busy with is the anticipated tsunami of long Covid. That could have lots of explanations, including patients not believing that we have very much to offer them.
So, Christmas is coming and 2021 has at least had the virtue of going so fast it feels like last Christmas was last week. Liz, Lucy and Katie are spearheading plans to spread festive cheer throughout the ARC team. So, there will be a lunchtime walk round Ashton Court (a stroll to Liz, she runs marathons). And there will be a quiz, as there must be (on Zoom again) and despite cheating shamelessly my team will lose and be berated by quizmaster Jon.
I’ve also got a list of New Year Resolutions. Mainly in the realm of “personal development”, the ostensible product of my annual appraisals. Being joint NHS and University employed I must endure two of these every bloody year which seems cruel and unusual. My appraiser is typically exasperated by my personal development goals,
“These are all a bit aspirational” he complains “I mean, ‘Be a better person’ – it’s not exactly SMART is it?”
Of course it’s not SMART, if it was SMART you’d be able to tell whether I’d achieved it or not – duh!!
Here’s the list.
No really, you can do it – in the past 12 months my feelings have oscillated between “This is the best job you have ever done, the pinnacle of (what passes for) your career – you are amazing” and the despair of “It’s all an endless sea of shit, and it’s all your fault”. In the latter circumstance I generally seek reassurance from my colleagues, who, being kind, dutifully deliver. Sabi and Pippa in particular have learned to tolerate my insecurities: active listening, loads of empathetic nodding and “mmm”s – , if they added “negotiating children’s mental health referral pathways, spotting cancer and making unhappy people happy” to their skill-set they could be GPs any day of the week, solve the workforce crisis.
June I see more as a neurosurgeon – practical, unsentimental, useful. I was a neurosurgeon once, on the head injuries unit at the old infirmary in Edinburgh, drilling holes in people’s skulls as the sun came up over Lauriston Place. I hadn’t met June then. I’d seen her once, on a stage.
“What’s the matter with your face?” is her typical response to my latest existential crisis.
“It’s just all so awful” I wail. “You know like that frozen moment when everybody sees what’s on the end of every fork.”
“Oh man up for fucksake” she says.
In 2019 my Christmas present from my GP was the revelation that I have ‘pre-diabetes’ – great! This is the sort of news we give patients all the time and expect them to just deal with it.
“So am I diabetic?”
“No but you’re at higher risk of being diabetic one day.”
“When?”
“No idea – maybe never.”
“What do I need to do?”
“Lose weight and get some exercise – OK are we clear?”
On losing weight the only 100% effective strategy I can think of is amputating both my legs (got to be a couple of stone there) though this might impair my capacity to meet the other imperative. Anyway, I’m now on my second exercise bike. The first one died so I had to return it to Amazon. What a palaver, the Hermes lady looking at it and shaking her head – “that’s never going in the back of the Skoda” – but eventually it did. And shout out to Hermes, and all the folk delivering the stuff that lets us stay safe at home.
The most inflammatory Twitter poll I’ve seen in the last year is the one on “Who or what annoys you the most?” Provocative question, can’t decide on my answer and I would never vote in one of these polls in any case. The twitterati are less reticent, and they have spoken. Number 1 – Hermes delivery drivers, Number 2 – GP receptionists. This seems so completely depressing and wrong – so Twitter, in fact.
I’m not entirely sure why but I always see Twitter as a mainly middle-class thing, like Waitrose, the only supermarket where they routinely ask you:
“And did you find everything you were looking for sir?”
The ‘sir’ is a nice touch but honestly what a ridiculous question,
“Actually no, but I’ll never, ever stop looking.” Better to travel hopefully than arrive I always say.
And GP receptionists!! I know you want an appointment, I know it’s urgent, and I know it can be disheartening (because I’ve done it) to phone your GP and eventually get through to the appointments option to be told “You are – number 23 – in the queue” but don’t take your completely understandable frustration out on the receptionists. They’ve got a shit job with shit pay and they’re doing their best – try being grateful. In Hartcliffe our reception team are colossal, right up there with the cleaners. Just an example: back in July we had a Hartcliffe night out, Stacey and Terri, front desk legends both of them, were late. They were late because, stopping at the Spar shop on Parson’s Street to buy fags, Stacey found herself in the middle of an armed robbery. I can imagine the scene, Terri sitting in the motor outside, impatiently drumming her fingers on the dashboard till Stacey reappears, slightly breathless.
“Where’ve you been Stace – you were taking ages!”
“Yeah there was an armed robbery, I had to sort it out.”
“Yeah but did you get the fags?”
“Oh fuck, I knew there was something else – gimme a minute.”
Those armed robbers are probably still in therapy, and I’m currently keeping a low profile with Stacey – in case she ropes me into Secret Santa.
£750 grand sounds like a lot of cash doesn’t it. But then you put it in the context of improving the mental health of a region where two and a half million people have just lived through their second year of a pandemic, that’s about 30p each. Too bad, we need to JFDI, as we used to write in the “indications” box of our spurious CT scan requests. What we’ve said we’ll do is add value to our existing programme, extend it to address additional unmet need, consolidate and build our evaluation and implementation capacity and capability and increase our impact. There you go, that SMART enough?
Before we all got pandemicked Bristol had been about to ban diesel cars from the city centre – great news for the planet, less great for me and my 10 year old Beamer and the 25 mile commute from Weston. I’ve been thinking of getting another motorbike. Mike Bell has a motorbike and if Mike’s doing it, you know it probably makes sense.
I last bought a motorbike in 1994. I needed an immediate mobility solution to the problem of home visits as a GP in Muirhouse; more immediate than the four attempts it would eventually take me to pass my driving test. But I still had my bike licence, if no bike. June and I went to the motorbike shop on the Pleasance.
“What is it you’re looking for then?” asked the predatory sales girl.
“Umm, I’m not sure, something flash and black that looks the business.”
A look of “this is going to be even easier than I thought” flitted across her face, she steered me towards this huge, ridiculously expensive Ducati Monster, straight out of Bologna, black as the ace of spades.
“There you go” says the sales girl “but I’m warning you, she’s a bit of a beast”.
About then June lost her patience, muttered “Jesus!!!” under her breath and told me “I’m going outside for a fag, I’ll leave you and Penelope Pitstop to get to know each other.”
I eventually left with a second-hand Kawasaki, not black, not a beast, sold a year and two broken arms later. But maybe now is the time to get back on the iron horse – born to lose.
This may be the least realistic and most aspirational. Dad’s story is just another tale of the pandemic. In Summer 2019, around my sister’s 50th, he started to feel more ill than usual. In October, just as ARC West was starting, he started chemo for Hodgkin’s Lymphoma, his haematologist making it clear it was palliative. He thinks some junior haematologist told him he had six weeks. He survived a few bouts of sepsis and two broken hips. If you can haul a net full of cod in a force 12 onto the deck of an 80-foot otter trawler hundreds of miles from nowhere in the North Atlantic, a bit of E. coli’s not going to faze you. When I was a kid (clueless about the demons he was struggling with) I thought he was indestructible. He’s not. He was discharged just in time for lockdown and full-on shielding since he’s got a blood cancer which, despite his doctors’ gloomy predictions, appears to be quiescent. Unfortunately, his dementia isn’t. He’s in hospital again, fluorescent pink pot on his left elbow following his latest mishap enroute to the toilet. “Everything’s falling into place” he told me.
“That’s great Dad,” I said. “We should go fishing again when you get out of this dump.”
“Yup”, he says, “We should go river fishing”.
I’m thinking of the Amazon.
So, my uber-resolution will be “keep trying to always look on the bright side of life.”
Somebody called me a “Pollyanna” the other day. I wasn’t sure what they meant – it didn’t feel like a compliment. But I had a vague memory of Pollyanna from the telly of my childhood – the girl with curly blonde hair who was glad all the time. So, I googled it and it all came back. Pollyanna is a kid in the public care system of early 20th century North America. Following the death of her parents she is placed in what would now be called a kinship care arrangement (popular with local authorities, cheap) with her loaded but mean-spirited Aunty who proceeds to come up with imaginative ways to make her life miserable. But Pollyanna is a survivor, and undaunted she plays the “glad game”, which involves finding something positive in every situation, no matter how objectively awful the situation is. You see this sometimes in kids in care – especially the younger ones, before they become angry adolescents (then they’re just like all angry adolescents – x 106). Like our own Pollyanna (that’s not her real name by the way) who came to us 11 years ago on a Friday evening in March. We were the last drop off, her siblings having already been deposited at their own, separate, foster placements – belongings in black plastic bags, no paperwork. She says she can’t remember it, but I can. Her shy, completely disconcerting cheerfulness – despite her predicament and the nits crawling through her curly blonde hair. She knocked on our bedroom door at around 6 on her first Saturday morning.
“Come and feel my bed” she said, “it’s dry”. She was beaming from ear to ear.
And at a later Christmas, we bought her first mobile phone (bottom of the range Samsung from Tesco – she’ll only lose it we figured). We hid it on the mantlepiece so we could ring it at the right moment, after she’d finished opening the contents of the sack with her name on it. She virtually cried happy tears (except she never cried – three times in over ten years max).
“All my dreams have come true” she said, without a hint of irony.
She’s still doing it, 21 years old now, locked down in a care home in the New Forest for the last 18 months. We’re still not allowed in her bedroom, but we took her out for a pizza in Lyndhurst two weeks ago, her and the new love she has found. They’re clearly nuts about each other which is so great even if it doesn’t last. And it might last forever, who knows. She has done her Ready2Shine course, and they have agreed to be patient, till the boy has done his.
“Then we have our risk assessment” she explains, “before we can do what we need to do.”
Risk assessment, I wonder what risks they’ll assess. All the usual ones I guess, misunderstandings and mismatched expectations, disappointment, dishonesty, unkindness, anger, violence and cruelty, age and its ravages, offspring. What a bloody minefield, why on earth do we do it – because of all the good bits I suppose. And the good bits are what they’re anticipating, savouring the imminent excitement, like Christmas Eve.
People as confused as me (there must be some) have clearly been on Google before because,
“Is Pollyanna a bad thing?” appears on their FAQs with the answer,
“Although the tendency to be optimistic and find the silver lining is no doubt a desirable trait—and one that imparts benefits to our health and well-being to boot—to be a “Pollyanna” is generally not considered to be a good thing… “
I disagree, in fact I think I’m going to get a t-shirt printed with “Pollyanna and Proud”. I’m going to wear it under my new Figs scrubs (so cool, so comfy – you could wear them to a Nightingales gig, I intend to – Robert Lloyd will be impressed). And at the appropriate time, maybe following some clinical triumph – like curing someone (“Cured anybody today?” my daughter used to ask me) I will rip off my scrubs to show my t-shirt, like Andres Iniesta in 2010, running to the touchline having just won the world cup – imagine doing that – ripping of his number 6 shirt to reveal the message for his dead friend,
“Dani Jarque, siempre con nosotros”
I bet he thought the mandatory yellow card was worth it.
Happy Christmas everyone, may all your best dreams come true in 2022.