Friday

Quietest  night for a long-long time, reminiscent of those dark days on 12b. Hindsight reveals them to have not been that dark after all.

But tonight is the quietest shift I feel I have worked since moving to 216 some fourteen months ago. You forget how hard it is to remain awake in these sort of conditions. It wasn't  helped by having a child with a terrible strider situated by the nursing station, who snored all night. The hypnotic rhythm of his laboured breathing made it very difficult to stay awake.

But all in all a very pleasant shift, I hope the remaining two are similar?

It couldn't last ...

Difficult Days

I always knew Tuesday would be difficult, how could it be anything else? The funeral of an auntie, the first of her generation (my Fathers generation) to die.

The day was horrible, but no more horrible than I imagined it would be. I had no words of comfort to offer my cousins. Although we know age has little relevance in such matters, the truth remains that she was my youngest Auntie and her children are my youngest cousins.

It was good that I made the effort to go, well timed within my week-off and appreciated no doubt. It was almost a full gathering of the Todd clan, obviously my 92 year old Nana didn't make the three hundred mile journey from Richmond and two of my cousins also didn't attend (one had a baby last week, a fair excuse)  

Returning back to the car following the wake, the plan was to drive Amy back to her new flat in Blackheath, make all the right noises, spend some time together and then head back to Stone the  following morning. 

Unfortunately my brother-in-law was unable to join us as he had a screening of a BBC drama he has a part in, more unfortunate still it appears that much of his performance has ended up on the cutting room floor.

Turning the ignition a message came on the sat-nav screen. "Enter code:"

This has never appeared before and no apparent code came to mind. Without the code I was unable to bring up the sat-nav, sound system, clock, parking sensors, reversing camera and it subsequently had an effect of the power steering and clutch assist. So in short it was like driving a car from the 1970's.

Calling the dealer we were simply told a code should have been given on purchase and could be found in the vehicle handbook, the vehicle handbook safely filed with all my paperwork back here at Huckleberry Heights. Liz was at school and there was no one else available who I could redirect to find it. Even if I could I wasn't entirely sure the code was in my documentation; I scrutinised that manual on collection and was sure I'd remember a code card.

After some discussion and explaining my predicament the dealership gave me a code to try, but on imputing it it immediately locked the system!

Consequently I had to drive from Horndead to Blackheath without the sat-nav, etc

It may sound dramatic but it was probably the most difficult driving experience of my life; driving through central London at rush hour with no clue of direction or route. Amy did her best from the passenger seat, but it was as difficult for her as it was for me I suppose?

Amy & Paul's flat is lovely, in a beautiful, picturesque and hip location; perfect for the pair and certainly a location they could put their hallmark on.

I remained stressed to the eyeballs so we ventured out into Blackheath to grab a meal, finding a quirky and rather stylistic pub in the centre of the town. Sadly I remained distracted about the whole car debacle and the prospect of another horrible drive the following morning   

Contacting Nissan assist later that evening they could offer no assistance, so the following morning once again I drove without any of the travel luxuries that I have become dependant on. Because I have had fourteen months without any technical issues I long ago discarded the batter road atlas that I had carried around in my boot for many years before.

I managed to pull up a route planner on my iPhone, so although without sound I was able to use the updated pictures as a rough guide to exit the city and head back north. It was horrible driving without music or radio distraction. So I just stuck my iPod on shuffle and fixed it to the band on the sun visor.

The drive back was better than expected, the drive from Amy & Paul's flat back to the Midlands is actually rather straightforward, going through the Blackwall tunnel a few miles from the flat and  accessing the M25 and then the M1 towards the North. Sadly it was tremendously busy for the three miles approaching the tunnel, and the ten or so on exiting. Desperate for fuel, running on fumes, scouring the roads for a service station or garage forecourt and worse still nearly exploding needing the toilet. I had visions of not only breaking down in roadworks because I'd run out of petrol  but also shamefully pissing and / or shitting myself in the drivers seat. Now embarrassing would that be when assistance finally arrived; stuck in a malfunctioning car, with no fuel, sitting in my own filth!   

When I returned home I collected all the Juke manuals and every item of paperwork given from initial purchase, to collection and on to recent service and every piece of written correspondence, nowhere within any of this documentation was there anything regarding radio codes or the like.

 In fact I am sure that I raised concern about the lack of code when I returned the car at purchase for the second tank of petrol? Knowing that I certainly didn't have a code, again I contacted the local Nissan dealership not content to be fobbed off this time.

I laid it on thick & heavy; the disruption it had caused, the situation prior to and following the system failure and my utter dissatisfaction at the level of care I had received from Nissan at all points. At which point they offered a full apology and admitted that we have never received a radio code at purchase, the code given the previous day was incorrect and once they realised this a note had been put on the system and this should have been relaid to me when I contacted Nissan Assist later that evening. 

Thankfully they gave me the correct code and on imputing it all issues were swiftly resolved. Now if only they'd given it me 24 hours previously I think my day would have been very different.

Dodgy Laces

Walking through the snicket to Stone earlier this afternoon,  I stopped to tie a wayward shoe lace. I don't know if anyone else has a pair of shoes which laces seem to constantly untie themselves, very frustrating?

I paused to retie them; because it was a bit damp rather than crouching down as I usually would, I leant against a fence. Only for the panel to topple like a card and for me to tumble after it into the rear of someone's garden.

This would have been embarrassing enough, had the family not been in their garden at the time as I very unceremoniously entered. They jumped out of their skin as their precarious panel suddenly fell and they were confronted by this lardy lad falling into their garden in a most undignified manner. I don't think anyone would expect that?

I rapidly gathered myself, apologised, righted the panel and swiftly went on my way.

First Visit

We received notification via email this morning that a social worker plans to visit us on the 29th May at 2.30pm to discuss our adoption application. 

That seems pretty speedy to me, nine days from postage to first official contact is significantly quicker than we imagined. 

Thankfully we can attend this meeting without any disruption or difficulty. Liz is off for half-term and I by utter chance am on a day off between two long days. We didn't want our very first contact with the service following completing the application to have any issue or problem, even at this early stage not wishing to highlight us as in anyway difficult or problematic. As if even saying that an appointment is inconvenient gives the impression that having children may not be your number one priority; that you're willing to put something else before it. 

An end in sight

Finally reach the last night of this dreadful run of off-duty.

I have briefly seen the wards managers over the last couple of days; very briefly across handovers. They say little beyond cursory enquiries of well-being, it appears they can barely look me in the eye at the moment. It is obvious that my dissatisfaction (unhappiness) has reached them, but no one has the courage to confront it ... and I don't have the inclination or energy to currently. I am comforted that I haven't actually done anything wrong, so blame can't be attributed to me in anyway. I'm not off sick. I'm not on maternity leave. I haven't made any outlandish off-duty requests. I don't make a fuss. I just keep my head down and keep going. I reached a point of dissatisfaction, but even then I haven't been unprofessional or laid responsibility unfairly.

We'll see how things are when I return in a week or so's time. Then my appraisal should happen and the discussions that have to take place will hopefully occur? Obviously I'm not holding my breath. I dare not say it but my off-duty when I return appears better, still a high percentage of nights, but better.

Wasn't really feeling it throughout the night, certainly didn't give bad care, just my mind appeared to be already on holiday a few hours before my body actually was.

Must admit that my handover this morning was pretty poor, dismissive even, not neglectful but nonchalant. By the time 7am came I was most concerned with getting away and getting away swiftly.

 The salient details of a child's history and health prior to admission, all seemed fairly unimportant, it's what their like now that really matters. Their lengthy health background can be caught up with as the shift allows. That catch all phrase to cover any neglected or missed areas ... "Read the notes"

When you come on shift, irrespective of it being a day or a night, the staff who are just starting are in no rush for the staff due to finish to leave. I wonder if we should have a longer cross over between the end of one shift and the beginning of another, when a double ratio of staff are present on the ward, even if it was for only thirty minutes? 

Perhaps I should keep quiet. Like many of my suggestions I know it wouldn't be popular with the majority of the staff, in the same way altering the mid-shift would not be. I feel it would be more beneficial is the mid-shift worked until 2am rather than midnight, meaning they'd start at 1.30pm instead of the current 11.30am. To my mind that would be better for all concerned, but I appreciate leaving at two o'clock isn't great.

We're all in this together ...

Perhaps one of the best shift skill mixes I've been on for quite a while; two current members of the ward senior team, two very experienced middle grades, two hardworking health care assistants and a fairly recently qualified (but enthusiastic) staff nurse on the mid-shift. 

The ward was certainly calmer than I recall it being on late when we arrived on shift, which boded well for a good night. It can turn very quickly, but on arrival the signs were very positive.

Our Quality nurse has recently returned to the ward following twelve months maternity leave, how she finds much of the ward on her return appears to be most unsatisfactory. I'm sure it is quite a culture shock after a year away, we have adapted and perhaps have become accepting of the ways of working. This doesn't mean that they are correct, far from it, but you have to make the most. Deal with what is thrown at you.

Yet, didn't she make a fuss.

I tried to explain that this is good, this is the best shift I've witnessed for ages, but still she moaned (in the nicest possible way) and redirected even easy admissions to our end 'cause they were swamped.

They weren't, in reality they were having a very good night. Yes they had a few demanding patients, that's not under dispute, but these patients have been just as demanding (more so perhaps?) in the care of significantly less experienced staff. 

Irrespective, I hope the legitimate concerns felt by the staff are communicated to the powers that be and a change occurs? Sadly I'm not sure there is an easy solution.

Personally I just desire some more sympathetic shifts and a sense of understanding. Certainly my dissatisfaction about my night to day shift ratio will be communicated at the next senior team meeting.

On arriving I was greeted by my Manager with ...

"Rupert, doesn't seem like I've seen you for ages!?!"

"I wonder why that is?!?"

I have perhaps laid it in a bit think regarding the implication nights have on my well-being, my home life and the adoption process. I can't feel guilty or dismissive about this, because it is truthful. I hope this will be addressed before it becomes an even greater issue?

Pox ridden

I'm tired and I have a sore c*ck. Some fungal infection caught from Liz, no doubt exacerbated by fatigue and sleeping all 'funny'. Woke up on Sunday morning feeling uncomfortable and it hasn't improved over the past few days.

Fungal makes it sound more dramatic than it really is, visions of mould and mushrooms, merely a touch of thrush. Uncomfortable, but bearable and treatable. I filched some cream from work, so hopefully it will clear up quickly?

Three to go

As I approach my final run of nights for a while

Just got to get through them and survive, I'm counting off the days, ticking them off the calendar. Please let them be okay, bearable, not too awful. Don't let me crumble or struggle, or get upset.

I've been reviewing and publishing some of the writing that I completed whilst on our Baltic cruise in August last year, a holiday diary really. It's not too bad, it certainly brings back memories of our bob along the Baltic sea. It provided a distraction and a necessary restful focus during our break. It has sat in my notes for the past nine months, seems stupid to not site it somewhere more permanent. 

It's all date specific, so scroll back and have a look. Whilst it's very much of it's time there's a few good bits and I haven't edited too heavily with the benefit of hindsight.

A revelation ...

Just to show how much more optimistic  I can feel after a decent sleep, perhaps all my recent anxieties can be put down to fatigue?

Thursday night was awful, the now all too traditional bedlam that often greets staff starting at 7pm rather than 9.20pm. The children are very much still awake and many jobs remain to be done, it's a full-on start to a shift. At best it usually doesn't calm until midnight, so I often have five hours of mania running from one child to the next and never really feeling on top. Frequently it never calms and you depart racked with anxiety at the things you've neglected or simply forgotten.

It's only now that I can write about the night; it felt so terrible at the time and I felt so betrayed that this is allowed to take place (that it's seen as acceptable) that I couldn't be rational in recording what was going on. 

I'd had minimal sleep in the day, sometimes you just can't catch it and the more you lay there not sleeping the more anxious you become ... and the less likely it is that you'll sleep (the vicious circle of day sleeping before the first night). 

So the ward felt utterly ferocious from beginning to end. It's hard enough staying awake all night after minimal sleep at the best of times, adrenaline carries you through initially, but when the ward calms down and those bursts of adrenaline reduce you really crash. 

I was utterly exhausted when I left in the morning, the drive home a bit of a blur, consequently when I got in I zonked out completely. I have a vague recollection of waking at midday (the alarm clock of a full bladder), concerned that I wasn't sleeping particularly well ...

Awoke with a sudden start at 4.30pm (pretty late for me) feeling utterly dreadful; disorientated, nauseous and anxious. It's hard to turn myself around in an hour and a half before a night; just to eat, shower, dress  and normalise. The night shift comes on me very quickly and I don't really feel prepared. Ideally I like to wake around an hour earlier, gather myself, sit around in my pants. 

Friday night was better; the ward was just as busy, the demands as great, the work load as heavy and the skill mix as poor, yet it seemed oddly manageable. I didn't get stressed and I didn't feel overtly anxious; I can only equate with this with me being rested and consequently coping with the stress and bedlam more adequately.

Pity

I know things must be bad when I receive pitying glances and sympathy from my colleagues.

"On nights again!?!?!" 

"Do you like nights then ...?"

Not particularly, no!

Originally I think they all found it mildly amusing, but now any element of humour has worn off. They actually feel sorry for me. 

Oddly as everyone seems to comprehend how difficult my recent shifts have been, they've been fairly relentless since returning from Cornwall, I appear to have become quite peaceful about them; perhaps past the worst now?

 I've broken them down into manageable chunks- Two nights / Two days off / Three nights / Twelve Days off. 

And this has somehow made them more copeable. I'm not enjoying them any more, but I can see an end in sight.

Adoption Form ...

Sent!

 

Adoption form ...

Completed!

 

Mow

First mowing of the lawn of 2013; it should have been done well before now but it has obviously been difficult after being practically nocturnal since the arrival of Spring. The weather hasn't helped either, last weeks weeding was done in very dodgy conditions.

Whilst it's nice to get out into the garden and have a potter, it is frustrating to be out there for three or four hours, survey your work and see minimal change. The brown bin is now packed with grass, cuttings, twigs, leaves,  weeds and assorted garden debris, so overall the garden looks tidier. 

 I don't think that the ground is particularly fertile or of a very high quality, digging about there's lots of rubble and masonry barely inches below the topsoil. So the garden of Huckleberry Heights has rarely been ablaze with colour or produced bountiful blooms since we moved in in 2010. Neither am I particularly green-fingered, lots of enthusiasm perhaps but minimal skill or aptitude 

Obviously I'm also a bit lazy, I want stuff you can plant then pretty much ignore but will explode in colour and fill the gaps. That's right I want miracle plants and I want them now.

Oscar nominated

Although I remain deeply unsure about the whole principle of Staff awards, I was quite chuffed to receive a nomination for 'Greatest Guy'

Throughout I have firmly believed that to reward one is to exclude all others, and that appears to me to be hugely divisive. To reward long service or innovation, or to have a ceremony's that is tongue in cheek would be okay, but sadly this all stinks of favouritism and is in fact more of a popularity contest than an award.

I don't expect to win or for any member of staff from Ward. 216 to win for that matter. Other wards, areas and teams were mobilised fully to vote; whereas we were a bit half hearted. An afterthought or token gesture, so if it's simply a matter of who polled the greatest number of votes it's unlikely we're going to succeed.

Despite everything I was actually annoyed with myself that I was pleased (proud even) to see my name feature on the nomination poster. Any recognition is better than no recognition at all; I should at least receive a certificate.

I certainly didn't intend to attend the awards evening at the Moat House, as I was so uncomfortable with the concept. But it seems important that each team is represented, and on returning home informing Liz of my nomination she also seemed keen. Yes I know I'm a hypocrite!

Pleased as ...

To be asked to be Harriet Elizabeth's Godfather.

I'm sure to be more activity involved in her development, upbringing and supervision than I am in my other two godchildren. I send regular gifts and hear from both occasionally but it's pretty one sided in terms of thank you letters and the like. Perhaps I need to up my game?

My first godchild was the second child of my ex-wife's brother, consequently I made the decision that my only involvement could & should be to be a mysterious figure that sends regular gifts, but beyond that is distant. To have any greater involvement seemed highly inappropriate.

My second is my cousins daughter, born the week following of the breakdown of my first marriage. I always though my appointment was a little bit of a sympathy vote to try and cheer me up at a low eb. My involvement is greater in her life certainly, but she seems to be succeeding without any input from myself.

Thankfully I am assured to be more involved with Harriet Elizabeth, just because we are very involved in the Biddlecombe's life and we live in close proximity. It was a bit of a surprise, C&R have always said they didn't want family to take on the role of godparents, and have previously appointed friends for the other two. Perhaps they haven't been involved as they had hoped or perhaps they have run out of close friends? Irrespective of the reasons, we are delighted. Pleased as punch.

Although we will treat HEB no differently than how we treat NVB & JJB already, we always felt we were their true godparents anyway just because if involvement and without having to stand at the front of the church to proclaim the fact. 

Despicable (not) Me

 

Terrible night

Terrible night, terrible terrible night. 

Worse than I had earlier imagined, of course it can always be worse still ... but this was still a bit of a doozey! Exacerbated by my own tiredness, a shitty skill mix, lazy /neglectful staff and general feelings of annoyance (... because of too many shifts & not getting my own way)

I feel there will probably be some ramifications from it all, there has to be.

I arrived to the now traditional utter bedlam, this has been made worse with the start time of seven o'clock when it is very much still going on. The children's surgical ward (217) next door were down to two qualified staff on the night shift, originally they were to be supported by PICU but this was retracted due to ITU admissions as sometimes happens. Help was then to be sent from NNU but that was then also subsequently retracted due to admissions there. Both these events took place prior to the arrival of the night staff. They then look towards us to support, which obviously we were unable to give without reducing staffing to dangerous levels considering the current dependencies of many of our children.

 217 felt that because they were down to two qualified staff and three HCSW’s they should close to admissions and the decision was made to redirect all trauma & surgical admissions to us, along with the usual medical admissions. Scrutiny revealed that they only had nine inpatients, a greater staffing ratio than we ever had on 12b for similar numbers of patients. Sometimes situations can not be rectified and you just have to take a deep breath, suck it up and get on the best you can. Throughout my career there have been numerous times when situations and staffing has been far from ideal; your upset and compromised  and feel you are providing substandard care but there is nothing further you can do in that moment.

We were busy; we currently have some fairly demanding children and their parents who are equally demanding. I think we would have been in an altogether better place had the mid-shift person remained but they were given time owing and allowed home at six o'clock (six hours before they were due to finish). I don't know who made the decision but I find it deeply unnerving that the decision is made before the arrival of the night staff on the ward (and before the evening admissions started to roll in) when it has such implication on the night staff.

 Of course the co-ordinator knew our staffing levels. Subsequently I had to justify a decision not made by myself to send the mid-shift home and its knock on effect to other areas within paediatrics; being unable to support 217, delays in swift admission of patients and ongoing difficulties . I believe the paediatric coordinator, based in the Children's Assessment Unit, contacted the manager on-call and the site manager to enquire about available staffing elsewhere, which obviously received short shift. Again deeply embarrassing & frustrating, and not my decision.

We supported 217 overnight as able, but in truth they required very little. It must be said that it's hard enough to manage the ward with four qualified staff without the addition stress caused by resolving & brokering other areas problems. I no longer have any management responsibility or am paid to deal with all this shit, yet it frequently gets laid at my feet.

I had to report it to my manager, sorry if I'm talking out of turn. I certainly wasn't telling tales or making waves, irrespective of who made it, the decision to send the mid-shift nurse home at 6pm was a really foolish one (... in my opinion)

B3

It may have been a difficult week but I always knew it would end on a high as my journey to become a Benevolent Uncle continues and we welcome the arrival of B3 (Biddlecombe Number Tree)- Harriet Elizabeth (9Ibs 4oz). She is beautiful in every way and I look forward to meeting her at Birmingham Heartlands Hospital tomorrow, prior to travelling over to Wolverhampton to see Dave Hause at the Slade Rooms. I don't even mind spending my day-off at another hospital. 

 

Weakest Link

I AM TIRED 

 Been slightly snappy the last couple of days; less patient with patients, off hand with parents & family members and short with colleagues ... although not colleagues on my working area (we're all in 'it' together) Those working on wards in close proximity, members of staff in the admissions area referring patients, those asking to borrow something or simply ringing for advice. 

Short. Not very nice. Verging on the horrible. Plainly not like me at all. 

Although I never actually said it out loud every utterance seemed to have a desperate and exacerbated "Oh for F*cks sake!" muttered under breath. I feel ashamed even admitting that.

One mother staying in one of the four bedded bays with her son expressed in the middle of the night "Children crying?!?!"  With hindsight this bullet statement was probably down more to her limited English and concern, than any complaint or criticism and my response of "It's a hospital, children are ill. What do you expect?" was neither helpful or particularly accurate. Children were crying, parents were unable to placate or were too concerned about their own sleep to try to sooth. Certainly not this anxious mothers fault.

So final night tonight, and the one I'm most concerned about. In their wisdom they have reduced the night staff from five qualified nurses to four, and do we feel it. Twenty six to four doesn't sound a bad ratio, but the way the ward is set out (and parents unwillingness to have their children cut in two)  doesn't make the devision of six and a half each very easy. We tend to divide the ward ten to two and sixteen to two.

It only takes one sick child to knock you off kilter completely, a single child and their family can occupy you all shift. And frequently you have more than just one of those children. We continue to offer a half-hearted high dependency service, whilst at the same time because we're the medical ward take the majority of admissions. There is minimal respite with only four staff, and each morning on leaving you rack your brain to imagine what you may have neglected to do or omitted.

Tonight is the shift I have been most concerned about, as I'm working with our perceived weakest link. She's a nice girl, clearly a bit troubled and a bit scatty. I don't believe she means to be neglectful but she's her own worst enemy. If you make a mistake or forget something, hold your hands up. If you don't know something or are unsure, ask. These are the most basic rules of nursing care, but rules she appears often to ignore. Replaced with a sense of back-covering and back-peddling.

I've always said anyone who criticises anyone for asking questions or seeking clarification is an idiot.

We are a hard team to breach, many very 'cliquey' (is it cliquey or clicky?) and she has always appeared an outsider (I'm probably an outsider, just an outsider that everyone knows) and hasn't made it easy on herself. A few months ago I was fearful that the pack would hound her out 

I feel sorry for her, I maintain her motives are good and she would be heartbroken to know how she is perceived by the majority of the team. I am our most even handed, the nicest perhaps, and even I'm unsure.

The other three staff nurse were working last night, consequently it's inappropriate to move staff to a different end. Wherever she is put it's potentially a problem; but as the nurse in charge, the most experienced and just because of how I am I will fall on my sword and work alongside her. It's only fair, it's only right ... ... ... or alternatively it's not fair, it's not right!

It does make for a stressier shift, not only do you have manage your own workload but you also have to supervise someone else's ... whilst at the same time not make that supervision too obvious for fear of causing offence. Consequently I am very concerned about tonight.

Final night, feeling tired, bit snappy, bit anxious and not probably firing on all cylinders myself; it feels like a nightmare to come.

Britain's Strongest Man

http://en.wikipedia.org/wiki/Eddy_Hall

Not something you can widely share but for the last four nights I have been looking after the young son of Britain's Strongest Man ... and his rather lovely wife.

Throughout his child's stay the mother has been resident, but Dad has frequently visited. I didn't realise his celebrity status(?) initially, silhouetted in the dark he just appeared to be a great bear of a man who was batting seriously above his average. Good on him I thought, living the dream for big fellas everywhere, the law of averages surely means that a chunker must pull a honey once in a while!?! 

It was only when I saw him in daylight that I became a little intimidated, sitting there with his top off, toned, tattooed  & mega-muscly. 

"Really fella there's no need! Although I realise with all that muscle you must be hot, it must be like wearing a puffa jacket inside!"

Early one morning Mum came to the desk saying she had to pop home briefly but Dad would be staying ... "Keep an eye on him, he's a bit useless!'

Normally you'd use this information to create a bit of banter, put the father at his ease, but in this case I decided to keep it to myself in case he ate me! He'd have to be jolly hungry it is true, but as part of his regime apparently he has to eat almost constantly, so it was a legitimate concern.