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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Salt water

A non-exhaustive list of things that have made me cry this week:

Fast and slow

I seem to have lost a week in a blur of christmas parties, overflowing inboxes, overbooked clinics, carols and mince pies. And I am harbouring yet another Respiratory virus. They are persistent this year, with coughs lasting weeks. I was asked if colds last longer as you age. I can’t find any evidence this is the case. Illnesses last longer in those in poor health and at the very extremes of age but there’s no reason for differences in illness duration of 40 somethings vs 20 somethings.

Nutrition is of course a major determinant of health and immune funcion. A plant based diet is associated with a lower risk of hospitalisation in COVID-19. Plant-based diets provide micronutrients, including vitamins A, B6, B12, C, D, E, and folate; trace elements, including zinc, iron, selenium, magnesium, and copper; and the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid, which play vital, often synergistic roles at every stage of the immune response. Plant-based diets are also anti-inflammatory, and support a healthy microbiome. There is little data on diet pattern and viral illnesses other then COVID-19, an area that needs further study. Despite having grumbling illnesses for weeks I’ve not had a single day off work. I’m convinced it’s the plants!

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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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A Tranquil Space

P__ and I went to Turn Up for Gaza at The Colour Factory. The venue is very cool. The line up was great, hosted by Jen Brister, and including JJ Bola, the repeat beat poet, Rozi Plain, Robyn Rocket and more. A highlight was Donna Thompson who made magic with her voice and a looper. And of course, my all time favourite Hollie McNish, who made me cry, as always. The event was in support of All Our Relations, supporting families displaced by conflict and violence, providing them with the financial, organizational, and emotional aid they need to rebuild their lives with dignity. I hope the event raised a lot of money. You can donate here or use the QR code.

There has been heavy rainfall in Khan Younis and other areas of Gaza. Osama tells me that conditions have deteriorated. There is no infrastructure. There is no shelter. Everything, everywhere is cold and wet. They worry that tents will be flooded and destroyed. I got paid, so I sent his family more money. Please help with whatever you can. I am matching all donations between now and Friday* so whatever you give will be worth double!

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Impatience

I was recently asked what my primary emotion is, and I answered, without hesitation: impatience. This is both a blessing and a curse. It drives me to work hard try to change the problems I see everywhere, every day, and makes me very productive. But it also makes me a bit of a nightmare to work and live with. I struggle to slow down and to accept the slow pace of change that is a common reality. I tell others to remember their sphere of influence and not to expend energy on things way outside it, as this way burnout lies. I often fail to take this advice myself. This week I have felt very impatient.

COP 29 is happening. At least 1,773 fossil fuel lobbyists have been granted access to the summit in Baku. In an open letter, a group of international experts have stated that the UN Climate talks are no longer fit for purpose, and called for reform. Global emissions continue to increase, carbon sinks are being degraded and we are headed for more than 2.9°C of warming by 2100. I respect those who continue to participate in COP but I would not have the patience or diplomacy required.

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The other side of hope

NHS IT is universally acknowledged to be a nightmare. The promise of technology is always that it will save time and make us more efficient. But the reality is that staff feel like slaves, feeding the ever-ravenous monster of the electronic health record with more and more data, more and more time. Time stolen from patients. Worse still, the monster never regurgitates the promised useful data.

It therefore felt like a huge win this week when I managed to get multistep voice commands working in Dragon and EPIC. This has dramatically reduced the time it takes me to do frequent routine tasks, and reduced my risk of RSI. A year after implementation I finally feel like EPIC might make my job easier, as was promised. The beast is not dead, but it has been tamed somewhat.

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Haunted

Since October 4th, at least one child has been killed and 10 injured daily by Israel in Lebanon. Fifty children were killed in Northern Gaza yesterday. Gaza’s children are not merely ‘collateral’ which would be horrific enough, but are targets of genocide, of erasure, of extermination. The Palestinian people have been so completely dehumanised that the world continues to stand by, spectators to the horror show. I sent more money to Osama and his family in Khan Younis, but they need much more than I can give. Osama is one of 8 siblings. His youngest sister Haya is just 11 years old. She has been robbed of her childhood. His father Sobhi has diabetes, and a deep foot ulcer, as well as heart disease. They cannot afford the escalating price of medications and there is no functioning health service.

It is too awful.

There was some hope this week as Barclays divested from Elbit systems after a direct action campaign. Until recently, Barclays owned over 16,000 shares in Elbit Systems, Israel’s largest weapons company, worth over $3,400,000. For over a year, Palestine Action activists have targeted Barclays premises, smashing branch windows and spraying them in blood-red paint. This has put Barclays sites out of operation for weeks, raising the costs associated with dealing with Elbit. Palestine Action’s broader campaign against Elbit systems and its’ financial and industrial partners aims to make the cost of dealing in genocide, occupation, and apartheid exceed the potential to profit from it. 

The CEOs of these corporations have no conscience, but hit their bottom line and they act.

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This meeting could have been an email

I spend more of my life in meetings than I would like and often think “this meeting could have been an email.” But this week I have been in several short and very effective meetings. It is amazing what can happen when there is a clear shared purpose and the right people are in the (virtual) room. There has been research into the psychology of work meetings, and the impacts for organisational outcomes and culture. I wish everyone would be more critical of meetings and ensure they always had a clear purpose that could not be achieved by another communication method. I for one commit to pausing before sending any future diary invites!

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