I’m sure I didn’t used to get so tired. My 40 something year old body just does not keep its’ charge as well as it used to. But it could perhaps be forgiven as it had to cope with 12 consecutive days at work with a 12 hour Sunday shift thrown in for good measure. There are well documented adverse health effects of working extended hours including: depression and anxiety; sleep quality; physical injury; coronary heart disease; and some cancers. There are also concerns about decision fatigue setting in by the end of a 12 hour shift. This has not been adequately studied, but it certainly feels true.
It’s not merely long hours that have contributed to my fatigue. The constant chaos of the NHS is draining, driving many colleagues to retire earlier than planned. I attended a Kafkaesque meeting in which the first half was spent discussing the dictat that we find ways to save money. We are provided with no data, no suggestions, no project management support. There is also zero focus on improving patient care. Just save money. The second half of the meeting was spent looking at recent staff survey outcomes which are the worst they have ever been, showing staff feel unable to provide high quality care, do not feel in control of their services, and do not feel supported in their improvement plans. We were asked to explain why we are so unhappy and what we propose to do about it!
Both domestic and international news are also exhausting, not least because they are simultaneously so predictible as politicians fail to wrestle with the real issues, and entirely unpredictable as to what flavour of chaos will be released on any given day. Trump appears to be intent on destroying any sense of safety and stability. Two weeks has flown by and I would struggle to summarise events for someone who had been living under a rock. Tuesday was April Fools Day but no one’s laughing when the news is indistiguishable from satire.
I was unimpressed when my sleep was interrupted by the local neighbourhod cats making loud noises, which sounded like a child crying. Apparently this is caterwauling, a noise made by female cats in heat to attract prospective mates. Cats have a surprising range of vocalisations; at least 21 have been described, but humans are not very good at reconising what cats are trying to communicate, and are prone to anthropomorphise cat behaviour and emotions. At 3am I was convinced the cats were scheming to keep me awake, as punishment for daring to shoo them away from my kitchen door.
It could be suggested that my tiredness is at least partly down to my tendency to say yes to everything. I gave an evening webinar to the Society of Acute Medicine on implementing the new BTS/SIGN/NICE asthma guidelines. The guidelines are a great step forward in asthma care and it’s important we get the message out. The webinar seemed to go well. It’s always a good sign if the questions are challenging.
I was on a panel at the The National Respiratory Medicines Optimisation Conference at the Royal College of General Practitioners. The panel was on “NetZero and Sustainability – How it is being tackled across the UK”. It was really interesting to hear from representatives of the 4 nations, and to share both successes and frustrations. The pace of change is woefully slow but we keep trying.
I also gave a talk to the Respiratory department on the physiology of altitude. A colleague suggested that this was just an excuse to show my holiday photos from Kilimanjaro, which may be partly true!
I found these articles useful and interesting reads.
- Taylor AT. High-altitude illnesses: physiology, risk factors, prevention, and treatment. Rambam Maimonides Med J. 2011 Jan 31;2(1):e0022. doi: 10.5041/RMMJ.10022. PMID: 23908794
- See Nuptse and Die. The Lancet, Volume 308, Issue 7996, 1177 – 1179
The Lancet article describes acute mountain sickness (AMS) as “vile at best, fatal at worst and an entity to be avoided“. I would agree! Having experienced AMS, I was reassured to learn it is even more common on Kilimanjaro than I realised, with a prevalence of 75% in one study of Finnish trekkers. The physiological mechanisms of acclimatisation, both short and long term, are really fascinating involving biochemical, neuronal and gene regulatory mechanisms, and I was once again amazed by the complexity and adaptability of the human body.
I attended a meeting with a company who claim to be able to solve our rota woes! Medical rotas are a nightmare as they have become increasingly complex over the years in order to accomodate EWTD, national and local rules on safe working for a workforce of diverse professionals, some of whom are to varying degrees of less than full time. Continuity seems all but lost, which is bad for patients, bad for training, and bad for Consultants who increasingly have to act down to be the necessary continuity on the ward. Managers and clinicians spend hours and hours trying to make all the rules work using excel spreadsheets and the last of their sanity. The output makes staff miserable as they can never get the leave they want without 5 swaps, despite asking months in advance.
I was told this was an AI solution, so arrived at the meeting with a number of questions. Rotas are a contraints solving exercise, which should be achieveable by standard computing and should not require AI. The water and energy requirements of AI are not justifiable for such tasks. I was impressed with the company, Lantum, and reassured that their software is essentially machine learning, therefore minimal energy and water use. Everything is called AI these days but it’s good to interrogate what that means beyond marketing. One of the people on the call was a clinician, which makes a huge difference when trying to translate the needs of the service into hierarchical rules and preferences that a computer can understand. I am hopeful that in this rare case computers may in fact save us.
Having forgotten I was working the weekend, and having been unable to swap it despite asking everyone in my phone, I was worried I would not be able to attend P___’s parents Golden Wedding Anniversary party. Thankfully my colleagues were very understanding and covered a couple of hours of my shift, allowing me to go. Good colleagues are gold dust.
It was a lovely party, with an excellent afternoon tea (vegan for us). 50 years is a long time and it’s always lovely to see people still happy together. It was particularly joyful given P__’s father’s recent health problems. He was on great form, which was not a given a year ago.
We also went to a performance of music not heard since 1669. Musica Antica were incredible as always, presenting on this ocassion Antonio Draghi’s L’Humanità Redenta, a gorgeous dialogue between humanity and hope. Appropriate subject matter for our times.
I watched a webinar from the Stand Up! Speak Out! series from Solidarity Knows No Borders. This is an annual series of free, online training to resist the Hostile Environment in public services. I really hate the way that the NHS is used as a tool of hostile immigration enforcement and try to resist whenever possible. There are more free webinars running until June. I’m looking forward to Asylum Support 101 and Community Organising for Health Justice amongst others.
I’ve been looking at examples of creative protest for ideas. Here are some of my recent favourites:
- Children’s shoes in Trafalgar Square to protest UK government subsidies of fossil fuel companies, destroying children’s futures
- Blood red dye in US Embassy pool to protest arms sales to Israel – Greenpeace UK
- 52 empty school buses in convoy representing 4,368 children who died due to gun violence in just one year in the US, targeting Ted Cruz, who receieved the most donations from the NRA
- Funeral march held by Cancer Alley activists to remember victims—overwhelmingly Black people—killed by petrochemical industry pollution and to demand that U.S. President Joe Biden declare a climate emergency and do more to stop deadly fossil fuel projects.
- Chris Packham’s recent subvertising campaign, featuring the faces of fossil fuel CEOs: Shell’s Wael Sawan, BP’s Murray Auchincloss and others, with the words: “Wanted for murdering life on Earth.”
My 12 day run at work finally ended. I celebrated by having friends over for dinner. I made recipes from Nisha Vora’s book Big Vegan Flavour featuring golden beets, pistacios, and a white bean stew. P__ made incredible fresh bread and the most luxurious beluga lentils. We had the folding doors open for dinner for the first time this year. We ate. We talked. We laughed.
I spent most of Saturday pottering in the garden and crafting in my garden office, sound tracked by Kate Bush, and enjoyed the sun and the lack of plans. I made some progress on my contribution to the collaborative quilted memorial banner representing every Palestinian life lost ‘an inch for each of the dead‘. I thought about how every square was a life. A life just as full and treasured as my own.
drlj 