Category Archives: Week notes

Complicity

The world feels dark this week. Israel has prevented any humanitarian aid from reaching Gaza for almost 2 months. People are starving, as well as being under constant threat of bombing. Since January, 10,000 cases of acute malnutrition among children have been identified, including 1,600 cases of severe acute malnutrition. We can never say we did know. Pictures of skeletal children flood social media. “The blockade of aid is a breach of International Humanitarian Law, including Article 23 of the Fourth Geneva Convention, which mandates free passage of essential humanitarian supplies. It also violates international human rights law, including Article 11 of the International Covenant on Economic, Social and Cultural Rights, which guarantees the right to food.” Who will hold Israel accountable for these atrocities? Many countries are complicit in the genocide, including the UK, but the US is bankrolling the killing. In 2024 alone, the U.S. government sent Israel at least $17.9 billion. They could stop the horror by stopping the flow of money.

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we are not numbers

I had a relatively quiet week at work, off the wards, so tackled my to-do list. It’s a long list. I chose my least favourite task, writing the ward rota for the Respiratory Consultants. Why is a Consultant doing this tedious task, you may ask? This is a symptom of more than a decade of underinvestment in the NHS and the false economy of cuts, and more cuts, to a dwindling admin support team, resulting in more and more tasks being piled onto the clinical workforce. It would have been unthinkable to expect a Consultant to write a rota ten years ago. From a public and organisational perspective, it makes no sense to have employees who are paid well for their expertise and experience, performing admin tasks. Whilst I wrestle with excel spreadsheets, and attempt to solve hierarchical constraints problems, I am not delivering or improving patient care. Not only this, an undervaluing of admin in the NHS has led to low staff retention and poor patient experience. False economy is a feature of the modern NHS. Next time a politician talks about ‘cutting backroom staff’, remember that the work of the backroom does not go away, it just lands on the desk of the front line staff.

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Silence

It has been 5 weeks since my last post. My routine of reflecting each week was disrupted by climbing a mountain and it has taken until this weekend to feel that I am back to normal life.

5 weeks is a long time in the death throes of internationalist liberal democracy.

Newscloud (Chaos) 21 August 2018 Marc Quinn 2019
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The Mountain

In life we all face metaphorical mountains, but this week I am literally climbing a mountain. When a friend said she wanted to challenge herself for her 40th year and climb Mount Kilimanjaro, the highest peak in Africa, my impulsive response was ‘That sounds great!’.

A year of training (not enough) and worrying about mountain-worthy equipment (too much) and mountain sickness (probably the right amount) later and here I am, about to leave for the airport.

If the Kili blogs are anything to go by, I will return aching, but enlightened, as the mountain teaches us many lessons. We’ll see! Whatever happens, this experience has already reminded me that it’s good to do things that challenge and scare us, and to test both body and mind.

We have paid for the trip, and are raising money for 2 charities: the Samaritans and Women’s Aid. If you can add to our fund, please do. Every penny will go direct to these charities which do life saving work.

Hopefully I’ll be back in 2 weeks with pictures and stories, and hopefully the world will not have descended into World War 3 whilst I’m out of signal range. I know I’ll be looked after by this incredible group of women so make sure you look after each other too.

Hostile spaces

I had a stressful Wednesday. I was called to give evidence in person at an inquest, which was a surprise as my involvement in the patient’s care was peripheral. The court was tiny. We started very late, and had to wait for an hour in an unheated corridor between the door and the toilet.

All I could think about was every more useful thing I could be doing with this time. In my mind, my to do list is a pile of crisp bits of paper, each one with a task typed on it on an old fashioned typewriter, like the in-tray from a movie from the 1950s. This gets higher and higher, and then becomes an unruly mess, threatening to topple over and crush me. I had moved things around to be available all day, but could not move a webinar I was co-presenting in a 1 hour window at lunchtime. I asked to be released for this. After some discussion I was allowed to give my evidence first.

The Coroner’s court is supposed to be a fact-finding mission, rather than an adversarial or litiginous process, but this depends on whether there are lawyers present, and if so, what approach they choose. The questions were fair but challenging. It was a good experience, to have given evidence when I only played a minor part in the case. All healthcare professionals can expect to be involved in legal processes these days. We all find them very stressful.

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This is why we can’t have nice things

We’re a week into the New Year and already things are quite terrible. Here are a few lowlights:

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New year, new hope

It’s a New Year! January the 1st is not only the start of the New Year in the Gregorian calendar, but also the Roman and Julian, so if you’re still following the Julian calendar like the Amazigh people, then we’re in synch. There are of course New Years all through the year in different countries and cultures, and some New Years which move. This feels destabilising. I like the predictability of seasons and festivals. This week I learned that January the 1st is a feast day in the calendar of Eastern Orthodox calenders because it is the Feast of the Circumcision of Christ. I’m not sure this knowlege has enhanced my life. And now you can reflect on whether it has enhanced yours.

I did not stay up until midnight. I was pretty exhausted from work so had the most luxurious evening eating a lovely dinner and retiring to bed. My favourite thing about getting older is that I feel less and less need to do what’s expected and instead I do whatever I like! P__ stayed up but he’s a definite night owl, wheras I’ve had to accept that I’m more of a morning lark.

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Yuletide cheer

I had a lovely Christmas week, full of family and friends, and food, and thoughtful gifts. We had Mushroom Wellington and Maple Glazed Seitan Ham for Christmas dinner. It was super.

I was working for the days around the Bank Holidays. We rotate who does Christmas Day and, having done last year, I get a break for a few years. Hospitals are strange places at Christmas, a mixture of intense sadness and heart warming joy. Maybe that’s always the case, but Christmas somehow magnifies the contrasts. The people who remain inpatients at Christmas are those who are too sick to care or notice, and those for whom hospital is their best option. We’re always under pressure to discharge people and make beds, but to be honest, in the few days before Christmas I don’t discharge anyone who wants to be there. If home does not have something better to offer than a hospital bed then who am I to inflict loneliness, fear or sadness on anyone.

There is flu and RSV everywhere. People with chronic medical conditions are very sick. Even those who are usually well are strugling to shake off the persistent cough and fatigue. Vaccination rates remain much lower than pre-COVID. It’s hard to see how we’ll ever improve the situation and convince people of the benefits when there is so much misinformation and fear around vaccines.

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Chaos and conflict

The world feels chaotic and unpredictable. Just this week Syrian rebel group Hayat Tahrir al-Sham have taken Alleppo and Assad has fled to Moscow; South Korea’s President Yoon Suk Yeol declared martial law, before having to backtrack in the face of parliamentary opposition and mass protests; and United Healthcare CEO Brian Thompson was shot dead on the street in Manhattan. The images coming out of Palestine and Lebanon are relentlessly horrifying. I read an article which asserted that indeed the world is getting more violent. One in 6 people live in an area of active conflict. This is not what I expected as I grew up, with the promise of increasing democratisation and peace.

Data from: https://acleddata.com/conflict-index/
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Granny’s Garden

I spent most of the week at the British Thoracic Society Winter Meeting. It was a great mix of catching up with colleagues, discussing projects, and learning from the latest research. It’s an exciting time in the world of COPD with real hope for new treatments and a transformation of care over the next few years.

Medical conferences are not always comfortable spaces. I wrote about my ups and downs in a thread. Thankfully 2024 was a definite up.

I wrote this 🧵on the other place in the run up to #BTSWinter2024. The conference starts today, so I’m copying it over here. On belonging, joy, fear, imposter syndrome & how to enjoy medical conferences. 💙 1/n

[image or embed]— DrLJ (@drlaurajane.bsky.social) November 27, 2024 at 6:58 AM

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