Alice Meets the NHS Meets Bladerunner

Life’s lesson 6 on Chaos theory

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Grandpa was trapped in hospital, much as Alice got trapped down the rabbit hole. He needed a scan. They kept him in because the scan department was closed by the time we saw a doctor. (We had waited four and a half hours in A&E, this being the only route to get his day surgery checked out).

So there he was, in a hospital bed, fit as a flea, just waiting for a scan.  They put him on a drip, because when he arrived in the ward around ten at night he was dehydrated.  He was dehydrated because he’d been told not to drink when he first got to A&E, just in case he had to go to surgery. As soon as it was clear he wasn’t going to theatre, he started downing pints of water. It had been a very hot day. Made no difference, he was on a drip.

The consultant saw him at eight the next morning. He said he needed a scan. Grandpa phoned me at lunchtime. No scan so far. He phoned at three o’clock – no scan. By this time I realised there would be no scan that day. The department closed at five.

I set out for the hospital. Halfway there Grandpa rang. Could I bring his (extremely common) medication, because the pharmacy in this major London teaching hospital didn’t have it? Answer – no, I’m on the train!

When I reached the ward, I could hear a penetrating noise. Grandpa’s drip kept bleeping. It was driving everybody mad. A nurse had shown him how to switch it off, but every few minutes it still managed some piercing bleeps before he could reach it.

“Why is he on a drip?” I enquired, when she appeared to try and resolve the mystery bleeping.

“He’s dehydrated!” she said. He was drinking a cup of tea. I had read his notes.

“No, he’s not,” I pointed out. “Why’s he on it still?”

“I don’t know,” she said honestly.”I’ll check!”  She returned some minutes later, unplugged him and, much to everybody’s relief, removed the hypersensitive machine.

The next morning Grandpa saw three bright-eyed, bushy-tailed young medics. They poked his neck enthusiastically and said he needed a scan. By the time I arrived at 2 o’clock he was still waiting. I stood around the nurse’s station till somebody noticed me.

“When is he going for this scan?” I asked

“The doctor has to send in a request! Nothing to do with us!”

“Well, so far, three different doctors on three different days have said he needs to be scanned. Can you see from his notes if the request has been made?”

“No, I’ll need to talk to the doctor!”

“Then can you check with him please?” 

“I’ll give him a call. I’ll come and tell you.”

An hour later I started patrolling the corridor by the nurses’ station.

“He’s checking with Xray,” they said.  I continued my sentry duty.

In the end somebody got fed up and said “I’ll page him again. You speak to him yourself!”

Primed by Dr Kate Granger on Twitter, I introduced myself by name (staff nurse had just referred to me as ‘the wife’) and asked “Who am I speaking to?”

A polite young man told me who he was and also that the scan needed a specialist radiographer, who was shared by all five hospitals in the group. He was there that afternoon. He would check on Grandpa’s scan and get back to me.

An hour later Dr Bright-eyed&Bushy-tailed turned up, somewhat shamefaced. He looked just like my grandson. He was very sorry but Mr SpecialistRadiographer couldn’t fit Grandpa in.

“But what I can’t understand,” I explained, “Is why Grandpa’s in hospital in the first place.  If all he needs is a scan, why can’t he just stay at home and come in for his appointment?” Dr B&B looked thoughtful.

“Good point,” he said. “I’ll check!” And off he went to phone somebody senior.

Ten minutes later he came back.  “He can go home!” he said.”Come back to Xray tomorrow at 2 o’clock for a scan!”

That was the Alice in Wonderland experience.

So where does Bladerunner come into it?

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Do you remember the opening scenes in the street market in the city of the future, where everyone milled around and communicated in a kind of pidgin English?  Well, that’s what it’s like in our hospital group.  Since everything’s been reorganised and rationalised we can’t use our local hospitals any more.  They’ve been relegated to basic routine stuff, and have to refer us on for anything more complicated.

So everybody from all the many communities in a sizable chunk of London has to travel to one of these huge hub hospitals, like a massive hub airport.  We hang around, lost and confused, waiting for our slot in theatre, or x ray, or outpatient clinic, or transport, or for medication from pharmacy 

The switchboard is so overloaded it is almost impossible to get through on the phone.  Emails go unanswered, because they all go to one address for every outpatients’ department in the five hospitals and the backlog is unmanageable.  The lift system can’t cope with the sheer number of staff and patients. (When Grandpa arrived for his day surgery, he had to walk up six flights of stairs. None of the lifts were working).

I loved the first scenes in Bladerunner.

I just never expected to live in them!

All Human Life Is There

Life’s lessons 5  On patience being a much required virtue

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I had planned a nice relaxing week, but best laid plans and all that.

On Monday lunchtime,  when I came back from a nice TKMaxx dressing up session, I was greeted by Grandpa who had had minor day surgery a week ago. He thought it needed checking out. His neck looked a bit odd.

Off we set. We couldn’t go to our nearest local hospital, because their ENT had been moved to another hospital in the group. It was the furthest from us on the other side of a long traffic jam. (In London the moment the schools close for summer, a rash of major traffic works start.)

We went directly to the department where he was treated, but they said we had to go through A&E. This was at the other end of the large, confusing complex with no maps displayed to find your way. Various people helped.

When we got there it didn’t look too bad. Only one person was groaning in pain, while her friend patted her back with one hand and texted with the other. It was one of the hottest days of the year. There was a notice on the board apologising for the fact that the heating wasn’t working.

I couldn’t concentrate on reading to pass the time, but I didn’t need to. The girl next to me was on her phone. Her boyfriend was cheating on her. She had found out by going through his phone and had rung the number he had just been speaking to secretly in the kitchen. She said she had been very polite to the girl who answered, though I didn’t entirely believe her on this.

Her friend thought going through his phone was ethically questionable. I was with the friend on this. It was a bit sneaky. But she said the fact he was cheating exonerated her. I felt her reasoning was rather weak on this point. Anyway, he hadn’t been best pleased.  Perhaps that was why she’d ended up in A&E.

This saga got us through to the Triage nurse.

The next stage was waiting to see the doctor in another small seating area. The Chinese lady next to me was holding a sick bowl and a towel, but when her teenage son came in with some snacks and sandwiches, she cheered up and tucked in. There was a picnic atmosphere. He had to sit on the floor, next to the ten year old girl who was in with her mum and her mum’s friend. She had a tale to tell.

Her mum had a head wound. Every so often a passing member of staff would poke her and say “Don’t go to sleep darling!” It all had something to do with a fight. Ten year old was cheerfully recounting a blow by blow account of the altercation to Mum’s friend, covering what had led up to it and what the police had done. She also offered a detailed critique of the various social workers involved.

She appeared to have a confident familiarity with A&E. She helpfully showed me how to operate the water cooler. She could also negotiate the staff only route to the vending machine to which she made regular visits. 

Just when we had covered most aspects of the incident, further entertainment appeared in the form of two policemen and their handcuffed prisoner.  There was some discussion with hospital staff regarding his name, as the one given didn’t match their recent acquaintance with him. It was all very cordial. Everybody appeared to know each other.

Then a surprisingly cheery man with kidney stones turned up. The staff greeted him by name “Hello, Frank! You back again!” He told us all how he just popped in whenever he felt a new stone required attention. His local hospital couldn’t deal with that speciality any more, so he usually made a day of it.

Eventually at five minutes to eight we saw the ENT duty doctor. Grandpa was her last patient. Her shift finished at eight. It was five past nine before she managed to get away. She had to hunt down items of equipment she needed from distant departments and track down his notes. Everything was locked up and closed by this time.

I couldn’t help thinking how good natured everybody was considering the inconvenience of their workplace. The guy doing Grandpa’s blood test had to find him something to sit on and lay out his equipment on a plastic sheet on the floor.

And Grandpa? He’s still hanging around waiting for that scan 24 hours later. At least he’s healthy, apart from his odd looking op scar.

You need to tough to survive in hospital these days, as patient or staff!

Lesson 64. Goodbye to the Boys in the Band

Lesson 64 on Learning to be ashamed

The naming and shaming aspect of Ofsted prompted the teachers in Owen’s school to fret over different things.  With Mr TopJuniors it was his spelling.

Mr TopJuniors had been educated at a time when the systematic teaching of grammar and spelling had been deeply unfashionable. His talents and interests also didn’t lean towards these particular topics.  His great strengths were Maths, Science, Sport(in general) and Football(in particular). He was very much valued in school.  After all, just how often do good mathematicians opt for primary teaching?

When I was involved in teacher training, good maths and physics graduates were like hen’s teeth.  We did everything we could to lure them into the classroom.  We ignored government guidelines insisting graduates teach all three sciences and welcomed with open arms maverick physicists, who preferred to teach physics and maths. 

When this was finally outlawed, I would recollect the qualities of past students and regret the loss of the nonconformist. One of my favourites played in a band.  Everyone knows what this entails – staying up late on school nights and not doing your homework. Our experience, however, was that such individuals also tended to be interesting, creative people with a number of performance skills, useful in getting their subject across to reluctant teenagers.

My favourite was one of those.  At the end of his training year, he cheerfully phoned us from his interview at a prestigious independent school.

“Hi Anne, could you possibly spare a couple of minutes to speak to the headmaster? I can’t remember which part of the coursework I’ve got to resubmit, so can he have a word with you?”

What could I say? This young man is talented and confident. He loves his subject. He’s a team player, good in the classroom, but he doesn’t fit the government prototype of a model teacher? Of course the irony of the situation was that the independent sector didn’t have to care – they snapped him up!  It was only the poor old state system that lost out.

Mr TopJuniors fell into something of a similar category.  As a practitioner he was calm and constructive, taking difficult pupils and situations in his stride. His room was an orderly and cheerful place to be. His pupils made good progress. He just couldn’t spell. Everybody knew it.  Pupils and colleagues were happy to help.  He welcomed any corrections. It wasn’t a disgraceful secret.

But now he was worried sick about writing on the board during Ofsted week. 

He decided he would have to set about re-inventing himself.

Because, when he listened to the official naming and shaming rhetoric, Mr TopJuniors knew he came in the wrong packaging.

Lesson 63 There’s a Man Going Round Taking Names

Lesson 63 on The virtues of forward planning

Next door to Owen’s class was the reception class.  Mrs Reception was one of the best teachers I ever came across in my entire career.  She had trained for teaching later in life when her own children were young and she brought with her a rich store of practical wisdom.

Like almost all the teachers in Owen’s school she had been born in the area and had been brought up on one of the town’s many estates.  She had a keen sense of the social niceties of these.  Her own estate had been one of the oldest, but was towards the middle of the respectability spectrum.  She was warm in her childhood recollections.

“There was always something happening,” she would reminisce. “It was like Dallas without the money!” (Dallas being the popular soap opera of the time)

The estate where the school was situated, Mrs Reception assured me, was second from bottom in the town hierarchy.  There had been some staffroom disagreement as to which came bottom.

Mrs Reception was very concerned about Ofsted. This was her first post and she had only a few years experience, but she was a great one for organisation. Believing it best to leave nothing to chance, she soon had her plans laid out.  She would train her pupils to shine.  She was determined nobody for whom she was responsible would ever be named or shamed.

Central to her training regime was her special cupboard. In Mrs Reception’s cupboard was a truly marvellous treasure house of treats. There were biscuits in order of merit for rewarding whole class achievement, ranging from rich tea for completed but average work to chocolate hobnobs for excellence.  There were selection packs of small chocolate bars and suchlike for group awards and larger bars for outstanding individual achievement.

Every treat had to be earned, but there was an eclectic list of criteria for reward.  You could get a reward for not gurning and screwing up your face when you were in a bad mood.  You could be rewarded for taking your turn and not complaining. Not interrupting or shouting out for a whole afternoon could gain some individuals an extra biscuit.

The chief thing was that it was fair.  Mrs Reception knew her pupils’ individual strengths and weaknesses, and the whole class appreciated this.  People were rewarded for doing things they found difficult, whether this was school work or social behaviour.  Also the desired improvement had to be maintained over a period of time and Mrs Reception was ace at judging how long a period justified a reward.

The pupils in Mrs Reception’s class had few advantages in life, so she provided as many as she could in school, and not just of the confectionary nature. Everything was in her room was organised and secure. People knew what was going to happen when. Where many homes were insecure and chaotic, Mrs Reception gave pupils a safe, predictable place in which to learn. And my goodness, did they learn!

With regard to Ofsted, she knew her pupils were thrown by unexpected visitors, especially ones who looked like any form of officialdom. At the end of one day catching sight of me in the activity area with a notebook and Biro in my hand, she had a flash of inspiration.

” Now you know, children, that I’ve told you about the special visitors we’re going to be having.  Well, Mrs Wise is going to come in for our storytime just like one of them. She’s going to write down in her special book the names of who behaves and who doesn’t behave (looking pointedly at a few usual suspects) and then afterwards she will give me her special list.”

Put on the spot I assumed a proper gravity and stance to obey my instructions.  Pupils remembered their very best carpet behaviour and, mindful of the cupboard behind me, performed like little stars.

Desperate times call for desperate measures.