Wilful Neglect

Although a nurse - I am indeed lucky to work outside of the NHS - for if not, I would feel very threatened, undervalued and unprotected.

I would bring your attention to this statement from the DoH which was briefly reported in the media and has now disappeared into oblivion.  It states that doctors and nurses should be charged with a new crime of 'wilful neglect' if they fail to look after patients.  Sounds fair to me

It also states that ".... ensuring that providers have sufficient qualified, skilled and experienced staff and patients are protected from the risks of inadequate nutrition and hydration."

I can't speak for doctors, but if nurses such as Nurse Anne go home in near tears, as she is terrified that she has made a mistake or killed someone, as she is stretched to the limit by dangerous (qualified) staffing levels - how will nurses cope when this becomes more widespread?

Nurses in hospital are natural scapegoats.  If a doctor makes a drug error and the nurse carries out his/her orders, the nurse is responsible and accountable for carrying out said orders.  If a cadet/HCA fails to assist a patient with feeding, come 'wilful neglect' the nurse will be responsible and accountable - even though she will be unable to supervise as she is carrying out doctors orders, doing meds rounds, attending to patients in difficulty and completing the mass of required paperwork

The Conservative Health Manifesto stated "We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line."    Aint happening.

If nursing levels sink even lower - patients are going to starve and become dehydrated (outside conditions where a patient declines food and hydration at end stage illness) and yes it does happen now due to dire staffing levels  - nurses will pay the price for something that will become increasing beyond their control.

Can anyone speak up for the medical and nursing professions please?   We meed more - not less!  Why can you not imagine they are forests/woodlands and raise Cain?

Anna :o[

Heartsink Doctors (revisited)!

We all know that feeling; we crawl out of bed in the morning, not quite full of the joys of spring but near as dammit, and then ten tonnes of reality drops on our head as we realise that we are on Dr Nasty's list that morning, and our heart sinks.  We are filled with anger, despair and frustration as the all pervading feeling of doom overwhelms us.  What should be a therapeutic encounter will be the exact opposite.  Why oh why was Dr Bubbly not available?

Oddly enough, Betty next door swears by Dr Nasty - one man's meat is another man's poison - and has elevated his status to that of a living saint and you begin to think is the problem me or has Betty got something wrong with her mind?

You arrive at the surgery and take your place in the waiting room.  Your anxiety levels rise and if you weren't hypertensive before you came - you certainly are now!  You are buzzed and make your way to his room - like a lamb to slaughter - and the consult was as awful as you thought it would be.  But was it a self fulfilling prophecy?  Was he the heartsink or were you his heartsink?

The following consults are based on appointments I have experienced.  Was I the heartsink or were the docs?  Dr Bubbly perhaps doesn't really deserve a place there - but he had his moments!

Dr Computer

Dr Computer is (in his own mind) a time management wizard and he can fit almost everything re logging data of a ten minute consultation slot into 10.5 minutes - the only thing that prevents him reaching 100% perfection is the damn patient!

He will be keying in info as you enter his room and doesn't acknowledge your existence for the run over thirty seconds.  "Ah and what are you here for erm, erm, Mrs Erm?"  He has no idea who you are or your history as he has just finished detailing his last patient - who coincidentally was also a Mrs Erm!

"Mrs Brown.  The hospital said I should visit you monthly to check on how my thrumbocritis (fictitious condition - but real for the purpose of this exercise) is progressing.  They said it's required to prevent deterioration."

"Don't know anything about it."

"But you referred me!"

"Did I?  Erm - just let me check the computer.  Ah!  Yes - so I did!  What did you say you've got?"

"Thrumbocritis."

"Never heard of it!  You'll have to tell me what it is!"

"Surely you'll have a scanned letter from the hospital on your computer?"

"Have I?  Hang on a minute... ah... yes I have!  But I still don't know what it is.  What is it ?"

"Why don't you Google it?"

"Google it?  That's a good idea!  Hang on!  Googles it and spends three minutes scanning.  "Mmmm... that's interesting - never heard of it.  Hang on a minute!"  Spends two minutes entering details of the consult on his beloved comp.  "Look, I'll have to read up on this!  How are you feeling?"

"Okay I suppose."  I'm not! - Why the hell am I saying I am?  Because I feel like I am intruding on his quality time with his damn computer!  "Should you not check something?"

All eye contact with me has now ceased and he is glued to his computer screen.  "Nooo: you look fine!  Tell you what; come back in a month and I'll have had a chance to read up on this.  Come back sooner if you think you must.  Okay?"

"I suppose so.  Thanks?"

"Fine Mrs erm, erm, Erm?"  He is still glued to the computer!  Little fingers typing away.  I leave feeling totally bewildered.  What was all that about?

Dr Nasty

As you enter his room, Dr Nasty engages you in his (I am not interested in you at all!) glare.  His facial expressions and body language betray all.  "What's the problem then?" he demands.

"The hospital said I should visit you monthly to check up on how my thrumbocritis is progressing.  They said... "

"Ah yes," he cuts in.  "The thrumbocritis lady!  I don't buy into it!  God!  They'll be medicalising burping as Postprandial Stress Disorder next!"

I can feel my hackles rising - determined to stay calm I smile pleasantly and ask "Pardon?"

"I don't buy into it.  It's anxiety!  Why don't you accept that?"

"Because I know it isn't.  I know me!"  Getting a little defensive but still smiling pleasantly, I add "And it's medically demonstrable, evidence based medicine and all that!"

"Oh - have it your way!  How are you then?"

"I feel awful."

Utter disbelief in his voice he says "How can you say you feel awful when you're smiling all the time?"

"I am smiling all the time because I refuse to rise to your bait and I refuse to adopt the sick role.  I am me - not my condition."  All said in a perfectly calm voice.

He shakes his head and his eyes roll.  "What do you want me to do then?" he demands.

"I have just realised I don't want you to do anything Dr Nasty.  I'm going now.  Goodbye."

Dr Nasty is the doctor who (apart from Betty) nobody, but nobody wants to see.  When you leave you think - What the hell did I do to deserve to be treated like that?

Dr Bubbly and Nice but sometimes Role Reverser

Most of the time Dr Bubbly is just bubbly and nice;  he makes you feel valued and comfortable and dammit - sometimes you just want to marry him and have his babies!  He is so lovely that I am sure that if you entered his room with depression - you would leave elated!  Sometimes though his dark side enters the consult - but it won't be obvious at the start and therefore takes you by surprise!  Really 95% of the time he is not a heartsink - but when his is, well, you leave very confused.  What did I do?

"Hello Mrs Brown!" he enthuses as you enter, "How's things?"

"Fine thanks Dr Bubbly!"  If someone is kind to me, why do I say I'm fine?  I am not a miserable sod perhaps?

"Mrs Brown, our thrumbocritis Lady!  Y'know, I am really excited.  I've read about it but never seen it before!"

There follows a general discussion about thrumbocritis, his favourite football team and his holiday in Bulgaria and life is tickety boo!  BP and heart rate checked.

"You'll need a new sick note then?"

"Yes please."

"You're quite tachycardic there!  The hospital suggest I up your meds if this happens.  I'll write you a script for Thrumbosolol 150mgs.  Okay?"

"I've still got a months supply of 100mgs left, so a months supply of 50mgs..."

"No!  I will write you up for 150mgs," he says harshly.

Thinking of the dire straits of the NHS, practice budgets,etc, I persist "But I have a months supply of 100mgs left, would it not make sense to... "

"No!  I will write you up for 150mgs!"

As this is the second time this 'change' has occurred during a consultation, I ask "Are you fed up with me?"  After all, I might be a heartsink and not realise it!

"No.  What makes you think that?"

"It's the second time you've become short with me, treated me differently.  I just wondered if you are fed up with me?"

"No - not at all; its just, well; I'm fed up with being put upon here.  I want to be a partner - but Dr Computer doesn't want a partner.  I want to make a difference to the practice."  He chats on about his unhappiness with his position and honestly - I don't mind - we all need to vent at times.  He finishes with "Did it come across?  I didn't realise."

We part as friends.  Often, when I go for my sick note we end up talking about him or he ends up talking about him really.  And I really don't mind but wonder who's seeing who?

Dr Bubbly finally left after achieving a partnership elsewhere.  Our practices loss is another practices gain.

Dr I Am the Doctor - You Are the Idiot

Dr I am the Doctor is a strange woman.  She is delightful with children and nobody minds making an appointment with her in this case.  With adults it is a totally different matter; she is very intimidating, very brusque and if she should visit you at home - when you have broken your toenail - she is able to diagnose from the door.  She has the propensity to make the happy depressed; the calm enraged and the sane mad.

"Yes!"

"The hospital said I should visit you monthly to see how my thrumbocritis is progressing.  They said it's required to prevent deterioration."

"Oh, they said, did they?  Well, I suppose they must  know what they're talking about."  She sighs and shakes her head.  "Well!  How are you then?" she demands.

"I feel awful most of the time - but I am adapting.  I am not going to let this rule my life."

"Bully for you!" she snorts.  "What do you want me to do?"  She is beginning to make me angry - I knew she would!

"I think it says in the letter that you should monitor my BP and heart rate."

"Oh does it now?" she sneers.  "Well, I'd better do it then!"  I am really getting hot under the collar!  "Arm!"  She takes my BP, twice, and then takes my pulse.  She writes out a script increasing the Thrumbosolol and shoves it across the desk.  "There!"

"Whats that for?"

"Well you must know you're tachycardic and your BP's through the roof!" she sneers, eyes widening by the second.  I'm not surprised my bloody BPs raised - I am surprised that steam is not coming out of my bloody ears!  I wouldn't dare mention the month's supply of meds that could be topped up with a month's supply of 50mgs!

I leave totally enraged!

All these doctors existed at the practice I attend several years ago.  No more - just them.  At this time I actually was on the sick and noticed the waiting room became emptier and emptier across the months.  Now perhaps the doctors' approaches led to patients not attending with trivial complaints - but I don't think so, as an ANYONE WISHING TO REGISTER AT THIS PRACTICE WILL BE ACCEPTED appeared on the board at the Health Centre entrance and remains there to this day.

Heartsink patients are the bane of a doctors life - but heartsink docs are the bane of a patients life too.  Do heartsink patients/docs really exist or is it about transference and counter transference - or simply the doctor-patient relationship, poor communications skills and a lack of shared understanding?  I realise that difficult patients exist and are a poor example of humanity - but difficult doctors exist too!

Anna :o]

Heartsink Doctors and Dr Google - a Patient Opinion

I am grateful to Dr Philyerboots for his post on "Heartsink" patients, for it opened my eyes.  I think most patients - if they know the term exists - regard heartsinks as the moaning hypochondriacs who plague a GP practice on a regular basis - I did, that is, think that, not plague a doctor!

But this is not only the case; a heartsink is also "...the most common one is of patients under my care who steadily deteriorate despite all that I and modern medicine can do", it is the "very few I object to on a personal level", it is "the patient that has consulted Dr Google before coming", it is "those who ask the same question, again and again an again.  It is as if they ask the question often enough that I will tell them that I have a miracle cure", it is "the insane", it is those "who seemingly just want a chat" or those "who have complaints about BGH, or about my colleagues or their GP..."

I think that most of us, as patients, regard doctors as super-human who are void of negative emotions.  If they are cool/cold with us - it offends us - it certainly offends me!  We are the patient - they are the doctor.  Forget the heartsink patient who is the eternal hypochondriac and let us think of ordinary Joe who visits the surgery with perhaps, a minor complaint.  He has a minor problem which he wants nipped in the bud.

Say Joe has not visited the surgery for three years - he is a seldom attendee - and he has a wart on the end of his nose and wants it removed.  Request over - he is met with a barrage of questions required to meet the QOF.  He is asked if he smokes - yes he does - but he thinks what the hell has this to do with the wart on my nose? and internally, becomes angry.  He then has his BP taken and it shows he is hypertensive (white coat and anger) and he is asked to return and have his BP rechecked and his bloods ta\ken.  He leaves the surgery in a state of angst.

After three visits to check his (white coat) hypertension he is commenced on meds and also meds for high (who says - Big Pharma?) cholesterol, and suffers side effects which are viewed as another problem and he is prescribed meds for this and that, and this no meds man suddenly takes home a carrier bag full of drugs from the chemist all due to the wart on the end of his nose.

But this entire aside, what if the patient is Jessie who has multiple comorbidities?  She likes Dr Smith for he is kind to her and treats her with compassion.  She needs to see a doctor, but the only doctor available is Dr Jones.  Nobody, but nobody wants to see Dr Jones, for he makes a patients heart sink.  Dr Jones meets the definition of a total w*nker!

Yes!  There are doctors that make a patients heart sink!  Whether in a GP or hospital setting,  patients leave thinking what the hell did I do to deserve to be treated like that!?

Then there is Janet who is also a seldom attendee who visits her doctor as she knows that something is not right.  She doesn't know what it is as she is not a doctor.  She has all the usual investigations and nil is found.  She is told she is anxious - for after all she is a woman - and is left on the outside looking in.  But she knows that something is wrong and consults Dr Google - for that is all she has left.  He does not listen - but he talks to her in the written word.  She is not stupid and discounts all that does not apply to her.  But then, she finds her illusive dx and consults her GP with a printout - bad move - for a sure sign of hypochondria!  She also takes a list of symptoms as NHS sites suggest that she should - but GPs and hospital docs hate lists and must take control of same and a list is another sure sign of hypochondria!  But months down the line - after much professional abuse (?) by doctors - she is proved right.

I need two pairs of hands to count the number of close family or friends who after routine investigations have been told there is nothing wrong with them, only to discover later down the line that there is - at times with terminal consequences!

Doctors are not perfect and neither are patients.  We need to meet in the middle!

Rant over!   I love doctors really!

Anna o]

The Broken of Britain

Head in the Sand.

One of the drawbacks of existing as an eternal optimist is that you are so content you fail to notice subtle changes in the world around you.  Or perhaps you do, but your why worry attitude makes you a willing procrastinator; manana is a very good word - it sums me up on issues I don't deem as important or pressing in the here and now.

There is much talk in my workplace re the proposed - but almost certain - end of the mobility component of Disability Living Allowance (DLA) for all state funded residents in care homes and the impact it will have on their lives; for it will indeed impact on their lives.

Several of our residents receive the higher component of DLA mobility and have a free bus pass which is a benefit of receiving it; some receive the lower - but not many.  The free bus pass is used as in wheelchair to bus stop - bus to town - go shopping, for a meal, pub, etc and then the return journey; this is a weather permitting activity.  Many residents cannot cope with bus travel and a taxi is the only viable alternative to getting round and about in day time hours.

We also provide our residents with trips and excursions such as air shows, theatre visits, and days out in the country or the seaside, restaurant visits, football matches and anything we or they can think of that will add quality to their lives.  Without their DLA mobility we could not do this.  We need to hire a coach or a taxi.

We have a residents fund.  The owner contributes towards it as do staff and grateful relatives.  But as many or our residents have no known next of kin - it is mainly financed by staff.  It might fund one or two outings per year - but that is it.

This article in The Guardian highlights the misconception that local authorities pay care homes to meet residents' mobility needs in the overall contract price - which is just not so;  thus residents (and care homes) are dependent on DLA to provide for transport needed to enrich the lives of the residents.

Here is the head in the sand bit - it was while reading the good Ned Ludds latest post today that a light switched on in the darkest recesses of my brain; it was over the filing cabinet that contained the 'Why Worry' and 'Manana'  folders, and I must confess, it was only today that I read the Disability Living Allowance Reform document in full.  In doing so, I now realise that the proposed changes will impact on my life too.

Mr A (hubby)  retired through ill-health over ten years ago, he has a chronic progressive condition. It is a fact that he cannot work and will never will be able to work again.  He has no choice in the matter and is not a malingerer.

DLA is all he receives.  In the first five years he received on average one or two letters a year inviting him to return to the workplace!  Every letter was a personal insult and a kick in the teeth.  It took the same amount of time - phone calls and letters - to put a halt to this after discovering he was just a NI number and not a name (with history), which is why these automatically generated letters were sent out to him.

Reading the DLA Reform document informs me that in 2013/14 this insult will begin again and he will be reassessed to see if he qualifies for what will then be a Personal Independence Payment (PIP), as it appears that the prime aim of the reform is to get everyone back to work!

Please read the DLA Reform document and also visit Ned Ludd, The Broken of Britain and One Month Before Heartbreak.

The disabled exist in our society and are generally unseen.  Let us all switch that light on to enable us to see how they are being treated by a Government that promised to look after them in their manifesto - but now, appear to be intent of robbing them of their freedom.  It is Deprivation of Liberty which will be enforced - not by the Mental Capacity Act - but by a financial stranglehold.  It is not right!

Anna :o[

"I Think I Have That Swine Flu!"

Sitting in the doctors surgery today with my worst half as he awaited his appointment, I overheard a conversation which inspired me to write this:

"I need to see a doctor"
The young gentleman said.
A thin fleece wrapped around him.
A bobble hat on his head.

"The problem is" he explained
"Is that I don't feel to grand"
As he munched on the sandwich
That he held in his hand.

The receptionist - a haughty one -
Eyed him with disdain.
Another damn patient!
Her displeasure was plain.

"Next Thursday, 11am, Dr Smith"
She said in a monotone voice.
"You can take it or leave it.
After all, it's your choice."

The young man looked worried
And said "I don't think that'll do
For the pig of it is -
I think I have that swine flu!"

She eyed him incredulously
And as some receptionists will,
Scanned for signs of influenza
That would indicate he was ill.

No obvious fever, cough
Or runny nose could she see.
My heavens she thought
He looks fitter than me!

"What makes you think that?"
The receptionist said.
"Well. I woke up this morning
With a pain in me head!

"I've also coughed once"
The young man explained.
"And I feel a bit nauseous
And I feel a bit drained.

"It feels like a hangover and
It might be the drink,
But reading of swine flu -
It just made me think

"That perhaps I could have it
And forgive my directness -
But I need to see a doctor
To see if I am infectious..."

"Okay!  Okay!  Okay!"
The receptionist hissed
"I'll just add your name
To today's triage list!

The doctor will phone later -
Is that okay?"
"That's topper!" said the young man
And he went on his way.

I hear doctors bemoan patients
Who worry about health.
But the worried well do exist.
Today, I saw it myself!

Anna :o]

Gaza Youth Breaks Out (GYBO)

I can't give this post as much time as I would like to as I have finished a night shift.  I am also working tonight so I must be sensible and go to bed soon.  In view of this I shall refer mainly to links.  Adding to and messing up the time limits I have put on myself before retiring - this damn computer insists on crashing, freezing, etc.

During my break I read this article in The Observer and it raised my spirits that there is indeed hope for this world.

It details a cyber-document written by young Palestinian activists who are disgusted with the tensions and rivalries that invade their lives in the Gaza Strip.  You can find the full document on Facebook which you can find by googling Gaza Youth Breaks Out (GYBO) Facebook - it won't permit a link.  This document was posted three weeks ago and has raised a groundswell of support with 7,804 readers giving it the thumbs up.

Further information can be found here at SHAREK Youth Forum.

I do so hope that it (GYBO) is genuine and the optimist in me says that it is.  In my younger days I was an activist and tried to change the world - but couldn't.   I only hope these young folk can!

Forgive any errors in grammar - but I need to go to bed!

Anna :o]

There May Be Trouble Ahead...

The Independent Safeguarding Authority.

After the sad murders of Jessica Chapman and Holly Wells by school caretaker Ian Huntley in 2002, legislation was put in place to prevent this happening again.  All people working with vulnerable children and adults are required to take a CRB check as part of Vetting and Barring requirements, thus denying those with a questionable background having contact with these vulnerable groups.  The Independent Safeguarding Authority (ISA) is the child of this original legislation.

This protection of the vulnerable is laudable, but yet again good intentions have fallen victim to almost impenetrable layers of bureaucracy leading to such situations as this and  this where everyone is presumed guilty until proven innocent.

CRB checks operate at farcical levels - more often than not, taking up to three months before completion.  This puts care homes - whether private or council run - under great financial strain as they have to rely on agency staff during this period which is expensive.  Despite what you might think, care homes are not pots of gold and in fact, unless fully occupied, they are money pits.  Any break in the links of the chain can lead to this and this.  It is a sad fact that councils generally axe elderly services during periods of financial constraints.

The ISA, as well as protecting care home residents from dubious staff, also operates to protect residents who are vulnerable adults from other residents who are also vulnerable adults; this is where it gets a little crazy.

My home (my, as in where I work - I don't own it) is an end of the road home; it is where residents come when other pretty purpose built homes cannot manage their behaviours (where decor is more important than dementia); where resident come with complex problems; a home where social workers, psychiatrists and psychogeritricians know that hard to place Henry will be welcomed.

It is a wonderful place and you can rest assured your Henry will be well looked after.  Due to the nature of the resident group - friction occurs on a daily basis - whether it is physical or psychological abuse - it does happen.  Please be assured that this is the resident group and not staff v residents; that said, if your Henry thumps me, I don't take it personally!

Our resident group is made up of those with enduring (often complex) mental health problems and dementia's where aggression is a key presenting feature; saying that, my home is not in a constant state of war with staff and residents dropping like flies in an eternal, bloody bun fight!  But, during any twenty-four hour period at least one resident will become annoyed with another.

Tom and Dick will have a bust up and punches will be thrown; both Tom and Dick have dementia and appalling short and mid term memories.  Why Tom hit Dick we will never know; after a few minutes neither will Tom and he and Dick will pass each other in the corridor with absolutely no recollection of the incident.

Dutifully we fill in a Safeguarding Vulnerable Adults Referral Form, highlighting the vulnerability of both Tom and Dick and send it off to the powers that be.  Within a few days we are informed that the incident will not result in any further action taken.

Harry - one of our residents - is a thirty-six year old man with complex enduring mental health problems and in the past he has resorted to drink and drugs as a coping mechanism.  He has lived with us for nigh on four months and does not want to be here.  I can understand this - for as much as I love working in my home, I wouldn't want to live here either.  However, his history dictates that he must.  He poses a serious risk to himself and others.

Harry will sometimes request that we call the police as he feels that he is held as a prisoner against his will.  In a sense this is true.  But the reasons for this are manifold and as the saying goes - they are in his best interests.  We explain to Harry why we cannot call the police, and although he accepts this - he is not happy.

Harry, at times, responds to auditory hallucinations.  These voices tell him to do things and he does.  Outside of these times and indeed during these times, he retains full mental capacity.  He knows what he is doing - even when driven by auditory commands - and will apologise for verbal abuse afterwards.  As yet, he has only presented with verbal abuse  but has a long history of physical abuse.  Whether driven by auditory commands or not - a punch is a punch.

As his frustration grows, one day soon, Harry will punch a fellow resident and as Harry has mental capacity, the police will have to be involved for it is a requirement of the ISA.  Harry will then realise that for his wish to talk to the police to be granted, all he has to do is a punch a fellow (equally vulnerable) resident.

His co-residents will view the above and learn too that now they can throw a punch with impunity and that staff are have now been rendered impotent to halt this; whereas in the past staff would diffuse a situation, residents could now vent their anger (physically) and just receive a verbal smack on the hand.  The ability to manage a situation will have been removed from staff and a free for all could ensue.

We had an occasion early last year when police were requested to visit for a specific incident.  They didn't want to come for their hands are tied and a friendly, but firm little chat is all they can offer.  What else could they offer - a totally inappropriate night in the cells?

Thus, the very tool to safeguard the vulnerable from each other can be used as a cosh to hit each other with!  Safeguarding resident/resident adults from each other has not been properly thought through and residents will suffer because of it.

I see trouble ahead....

Anna :o]

Happy New Year!

Happy New Year!

I must admit to being dull and boring as New Year is meaningless to me!  In the good old days when I was young and wanted to celebrate - we could never get babysitters as they were all young and also wanted to celebrate!  So we were stuck inside and accepted our lot!

So, New Years Eve, across time, has become  just another day, as have birthdays.  (Birthdays to me are just the day after yesterday - I am just one day older!)  This does not really mean I am dull and boring, as as an eternal optimist, I am happy 99.999% of the time

Nevertheless, I am aware, that folk put great stead in the beginning of a New Year!  The New Year is a time of renewal, of change and of hope that the dark side of the past year will not infiltrate the possibilities of a bright new beginning.  A new start.

So let us all start anew and accept the things that we cannot change and endeavour not be downhearted by them.  This is easy for me to say as a moronic optimist, for we all have our crosses to bear and my experience of life is not yours.  Whatever burdens you might carry - I hope they become lighter; reach out and touch those who can give help and guidance, or just comfort.  Give comfort to those who are less fortunate than you.

I sincerely hope that this New Year is good to you!

On a lighter note - things look good for me financially next year as my SPAM reports that there is over £3 million just waiting for me to collect!  Sorry, I must go soon as I have to provide my name, occupation, bank details, etc to collect this welcome booty!

I cannot recall meeting jung-c, w-moulder or e-puentes - but I must have made a hell of an impression on them - for they want to give me millions!  Yes!!!

Life is good!

Happy New Year!

Anna :o]

Asthma and cigarette smoking

I am sorry, I know this is flippant - but I was clearing out my 'My Pictures' and came across this:

I don't even remember saving it!  Times have changed and evidence based medicine has come to the fore - unless, that is, evidence is manipulated by Big Pharma and those in medicine with a particular agenda, .However, at least, those under six were protected!

Anna :o]

Dr Who and A Perfect Christmas Day

Dr Who and A Christmas Carol

What a wonderful Christmas Day this has been!  A lovely dinner - half an hour late as usual as I can never get the timing quite right!

My marvelous family are the most precious gift on this day.  Who needs material presents when you have your family?

And then, the best Dr Who Christmas edition ever!  Perfect!  Matt Smith and a wonderful cast of actors, complimented by the brilliant Katherine Jenkins.  If you missed it, see it here on iplayer.   You have until January 2nd!

This day has been perfect!

Have a great Boxing Day!

Anna :o]

Merry Christmas Folks!

Merry Christmas and a Happy New Year!

If you're going last minute shopping - don't forget the honey!

Anna :o]

Smokers to be denied routine surgery to cut costs.

I have admitted it before - I am one of those evil people, whose smoke drifts menacingly into every nook and cranny, polluting the atmosphere with its particulates from mainstream and drift smoke as I suck away on a cigarette.  I am the harbinger of death; my second and third hand smoke infiltrating the very core of the young and innocent.  I deserve the remarks I receive from passers by who are predominately middle class and middle aged males who feel they have the right to abuse me.

I do not doubt that smoking is damaging to health and it is estimated that one in six to one in ten deaths are related to smoking.  It is probable that this estimate is correct and equally probable that it is a gross overestimate depending on what research you read.

Science and research are wonderful things, that is, unless they deliberately mislead.  Most of my research is based on data provided by Scotland as England doesn't appear to have its finger on the button here.

We are led to believe (as science provides the figures) that since the smoking ban in Scotland (March 2006) that coronary heart disease (CHD) and heart attacks (MI) have continued to decrease in numbers year on year on; a 17% decrease in MI admissions in the year after the ban.

Now this is odd!  If you visit isdscotland and download Table MC2 you will see that CHD has continued to fall since 1995 year on year on.  Research would suggest that this decline could be attributed to effectiveness of cardiologic treatments and changes to risk factors (including smoking) prior to the ban; but of course after the ban, the decline is only due to the ban!

During my research I came across the Iron fist, velvet glove blog and with Chris's kind permission I have reproduced a graph which illustrates that MI's actually increased after the ban.  Please visit his site; Chris as you will see, is not a chain smoking half-wit! 

I have also researched respiratory disease, particularly asthma.  I don't have any respiratory problems nor to my sons, despite being raised in a smoking household.  I know that asthma is unpleasant  and frightening for the sufferer.  It has become more common in the last thirty years and scientists do not really know the cause, but believe it could be our change in lifestyles, i.e., central heating, carpeting and lack of ventilation in homes which provide an ideal environment for the house dust mite; less fresh food and less exposure to infections and of course exposure to cigarette smoking.  I do not doubt the latter.

It has been reported that childhood asthma admissions have dropped 18% per year since the Scottish ban, Chris has debunked this again.

You might think that I am a rabid smoker demanding my place back in the world, but I am not - I am just an ordinary person, saddened that research has been manipulated to give a false impression of health gains to suit a particular agenda.

The reason for this post is this article in Pulse.  It appears that smokers will be denied routine surgery unless they quit or complete an  NHS Stop Smoking course.  NHS Surrey has take the lead here.  Read it all, including the comments.

Smokers will contribute (as tax revenue) £10.5 billion into the coffers this year.  Source: HM Revenue & Customs.  This equates to 11.55% of the NHS budget for England (£110 billion).

Who will next become society's dog to beat - alcoholics, the obese, the elderly or you?

Anna :o]

Victims of Alcohol (Part Two)

Alcohol Related Dementia

At the end of my second year as a nursing student I had to give a presentation on a self-chosen topic related to health.  I chose alcohol.

In those days education was given in a school in the hospital grounds and also at a general hospital in a nearby city.  We had ward based - both in psychiatric and general hospitals - and community based placements, and gathered a great deal of practical experience there.  I overcame my dread of giving injections at a depot clinic in a day hospital.

My only observation of the old school v graduate nurse debate is that both produce excellent, good, mediocre or bad, indifferent nurses.  That is it!

We had hospital based libraries and much information could be found there.  Computers were very much in their infancy in the sense that it was pre-Wiki and the gathering of all the information that existed in the world had not begun.  And, I did not possess a computer.  My research then was purely library based and also involved contacting agencies and charities who focused on alcohol related problems.

My presentation was well received, but in hindsight, alcohol related dementia was not a part of it.  I never came across it in my research, nor was it mentioned by charities etc, nor was it highlighted that a relevant section and thus learning was missing from my project.  I do not recall any patients diagnosed with it during my time as a student nurse.

But, it existed.

After qualifying I worked in the community for many years and during the last fifteen years, in a nursing/care home setting.  I have worked in my present home for thirteen of these years and am proud to work there.  Initially our resident group was what you would expect of a nursing home, those suffering from age related dementia and a few with enduring mental health problems.

However, over the last five years or so, our resident group has changed; several of our residents have alcohol related dementia and the age at admission is getting younger and younger.  This change is also apparent in our sister homes across the country (we are a very small group and do not wish to become an uncaring chain).

What is Alcohol Related Dementia?

Alcohol related dementia is related to the excessive drinking of alcohol and affects memory, learning and other cognitive  functions.

Recent research suggests that moderate drinking may have a protective affect against Alzheimer's as against heavy drinkers or those who do not drink alcohol.  But is this information reliable?  We have to consider who is included in the research, who drops out and how dementia is identified.  Would some of the subjects in this research not develop Alzheimer's regardless of moderate drinking?

Alcohol has a serious negative effect on the central nervous system and can affect the brain directly as a neurotoxin.  Alcohol generally effects the brain as a result of malnutrition when the person does not eat properly, resulting in vitamin deficiencies (particularly Vit B1 - thiamine) or through alcohol  related liver damage.

Is alcohol related dementia a true dementia?  Evidence would suggest that in its early stages recovery is possible, especially in women.  Alcohol related dementia can present in the early thirties, but is more usual in the fifth to seventh decades.  For recovery to be possible, the person must abstain from drinking, improve their diet and receive vitamin  (especially B1) supplements.

What is Korsakoff's Syndrome?

Korsakoff's is very much like alcohol related dementia, same causes, but results in destruction of certain areas of the brain and changes in memory are the main symptoms.

Korsakoff's is usually preceded, but not always, by Wernicke's encephalopathy.  Wernicke's usually develops suddenly and presents with three main symptoms - although these are not always present.  These are involuntary jerky eye movements or paralysis of muscles that move the eyes, drowsiness and confusion and poor balance, a staggering gait or an inability to walk.

If Wernicke's is suspected treatment must be immediate, consisting of high doses of intravenous or intramuscular thiamine and most symptoms reverse in a few hours.  If left untreated or not treated early enough, brain damage occurs in the mid part of the brain resulting in severe short-term memory loss and is then considered as Korsakoff's.   Wernicke's is a giant alarm bell - it means stop drinking NOW!

This memory loss is filled by confabulation, which is an effort to make sense of the present by filling in the  gaps of the past.  Confabulation, although the reasons for it are sad, is an amazing thing and the stories (not lies) that our residents tell us and truly believe, are wonderful.

Our residents with Korsakoff's are the very same people they were before alcohol abuse took over their lives, mainly good people and sometimes, but rarely, bad.  They accept their situation, that is, living in a care home and rarely, if ever, question the reason for it.  I find them amazing and have a great deal of respect for them.

It is estimated that alcohol related dementia affect over 150,000 of our population; this may seem a small number, but it is probably only the tip of the iceberg, many sufferers being protected by their brave families, or street and hostel dwellers that do not come to the attention of the medical profession and are therefore unreported.

It is estimated that there has been an increase in reported alcohol related dementia - 20% today as apposed to 10% ten years ago - in those of early onset dementia, that is, before the age of 65.  My home would reflect that.

Why are most of us not aware of this alcohol related harm?  Most of us do not realise dementia can be a consequence of alcohol abuse.  Why?

It is not my intention to be a party-pooper as we near this time of festivity.  I drink alcohol myself and enjoy it.  But let us consider that Christmas and New Year will be very difficult for those families who have a alcoholic in their midst.  I shall delay my post re their plight until the New Year.

Anna :o]

Victims of Alcohol (Part One)

It is not my intention to preach here - just to make aware.   I like alcohol - I like the way it makes me feel; it makes me more creative; it is another guest when good friends visit.   It can add a warm glow to life or it can be the stuff of nightmares  You can control it or it can control you.

There are many quotes attributed to Churchill in regard to alcohol, such as "Always remember I have taken more out of alcohol than alcohol has taken out of me" and "My rule of life as an absolutely sacred rite smoking cigars and also the drinking of alcohol before, after and if need be during all meals and the intervals in between them."

There has been debate as to whether Churchill was an alcohol abuser and historians would contend that he was not so, but alcohol dependent.  Alcohol abuser or dependent - he was undoubtedly a great man and a great leader.

Alcohol has been a common feature in those that have occupied Number Ten.  Tony Blair confessed to using alcohol as a prop during his time as prime minister; Nye Bevan and Micheal Foot were hard drinkers; Harold Wilson was a bit more secretive about brandy consumption; Maggie liked her Scotch an HH Asquith - the last Liberal PM was nicknamed "Squiffy."  Other party leaders or deputies such as George Brown, Charles Kennedy and John Smith have/had problems with alcohol; Brown and Kennedy's careers being seriously affected by same.

Handel, Bach, Schubert, Brahms and possibly Mozart were all dogged by alcohol abuse and in most cases it was the death of them.  These were great men and think what more they could have accomplished without alcohol - or maybe, alcohol fired and enhanced their genius?

Other great alcoholics in the field of writing are Dylan Thomas, Ernest Hemingway and Brendan Behan; WC Fields, Richard Burton, Liz Taylor in the world of acting: Elton John, Eric Clapton and Robbie Williams in music and George Best and Paul Gascoigne in football - in both instances, alcohol ruining their careers and in Best's case, taking his life.

All of the above are people of great talent - but they are remote from us.  They may touch our lives with their music, their writing or we may love/hate them as politicians; but they are not part of lives as family, friends or neighbours.

In some of our lives, the effects of alcohol are close enough to touch a raw nerve.  We may be an overt/covert alcoholic ourselves; our partner might be one, our father or mother, our friend or workmate.  In some way, our life might be affected by alcohol abuse, and if so, it will probably be our unwanted little secret.

Alcohol can be a good companion or our worst enemy.  Out there, in that big wide world, there are many hidden victims and following posts will focus on their plight. 

Do you think alcohol can inspire and enhance genius?

Anna :o]

Christmas is coming....

Yay!  It's nearly Christmas!  I love Christmas!  Despite a (non oppressive) religious upbringing - I hold no religious beliefs - but still love Christmas!  Christmas is the time when there is the spirit of goodwill - although I do think 'it' and the magic of Christmas are fading; merriment abounds, families gather and all is well with the world.

Like many people, I am beginning to stock up on alcohol; this is the only time that stocks exist in my household; okay, there may be a few tinnies left over from last week - but that's about it!  There is the box of Liebfraumilch to be purchased for Christmas Dinner - I realise that this identifies me as a wine peasant as opposed to a wine connoisseur and indicates that I am stuck in the past - but me and my family like it!  I can only find it at the Co-op - God Bless the Co-op!  I must admit, that despite being a wine peasant, I do look down on those that drink Lambrusco - ugh!  There will be vodka for the eldest son and lager for me (spirits do not agree with me as I become, erm, well drunk - quickly!) and youngest son.  Apart from what we might receive as prezzies - that will be it!

I am not interested in celebrating the New Year and never have been.  I usually see it in with a cup of tea, that is, unless it falls on a Friday.  Friday is the night I drink alcohol (and a very occasional Wednesday) in the comfort of my home.  As New Years Eve does fall on a Friday this year, I may see it in with alcofrol or a cup of tea!   I may have finished imbibing before midnight!

Working as I do in a care home, I am aware of the devastating effects of alcohol (if abused), for there are some residents in my home with alcohol related dementia.  I found this while researching and am not surprised by it.  I think the general public are largely unaware of this aspect of alcohol related harm, which I find concerning.

So, what is it with us Brits and alcohol?  Do we have a national problem?  I think that probably we do.  Yes, some of us drink sensibly - but many of us don't.  Drinking (to excess) has become culture based; a rite of passage for the young that develops into a habit (dependence?) with some, particularly the middle classes.  This last fact always suprises me as I guess I am a bit of a snob, thinking that only those who exist on the peripheries of society might have a drink problem.

In the UK, it is estimated that 24% of adults drink in a hazardous or harmful way and alcohol related disease is a significant NHS burden.  In the UK there are approximately 5 million non-drinkers, 40 million social drinkers, 10 million "at risk" drinkers, 1 million problem drinkers and 200,000 dependent drinkers.

Hospital admissions relating to alcohol are rising on a yearly basis as are deaths related to liver cirrhosis related to heavy drinking.  It is estimated that each year, 5-10,000 people die prematurely from alcohol abuse.

In England in 2009, there were over 150,000 prescription items for the treatment of alcohol dependency.  This is an increase of 12% since 2008 and 49% since 2003.

The financial costs to the UK in respect of Health (£217 million spent in 2003-4 by PCTs and local authorities in support of alcohol treatment alone ), Work (absenteeism), Crime & Public Disorder and Family/Social networks (cost not qualified) runs into billions.  Source: Institute of Alcohol Studies  - download pdf 380kb.

So "Yes", I think we do have a problem, although it is said, that the country still thinks it is a "population of responsible drinkers".  You wouldn't say that if you saw my nearest city centre some nights!

In the days when I was young - which is too many moons ago than I care to remember - I was a regular social drinker, but I don't recall binge drinking; I did get drunk on occasion, the most memorable(?) being at a works Christmas 'Do' held in the furniture store where I worked in admin.  But I remember this because it was a rarity - would I recall this today if being drunk was a nightly occurence, which it seems to be for some of our young folk today.

But I might not be telling the whole story..... perhaps in the past, I have had an unhealthy relationship with alcohol..... perhaps I haven't!

Are some of us deluding ourselves that the UK does not have a problem with alcohol, as we know that we drink over the recommended (but arbitrary) limits, and do not wish to wear the label of a 'problem' drinker?  In today's criteria, as I drink my limit on one night - I would be classified as a binge drinker.  Do I think I have a problem?  No - but others might.

What do you think about alcohol consumption in the UK?

Anna:o]

Panorama - a narrow and unbalanced view

Pan-o-ram-a: a comprehensive presentation; a survey

"What Have the Drugs Done to Dad?"

I did not watch this programme at the time of its broadcast, nor was I aware that it was to be broadcast; I was only made aware of its existence by my manager, when (s)he reported that a few relatives had phoned the home, worried sick, in that their mum/dad were receiving antipsychotics and therefore believed that a drug induced premature death was imminent.

I have not long viewed same on BBC iPlayer.   I was alarmed by its almost sensational Daily Mail format, in that it only portrayed negative views of antipsychotic prescribing; Jeremy Vine stating: "...But perhaps worse of all. we know that 180,000 people with dementia are routinely being given powerful drugs, which in the  majority of cases harm them and which may actually shorten their life."

Cheryl Byrne reported on the sad case of her father who had been prescribed antipsychotics (while in hospital) and his apparent immediate decline.  It is a sad fact that hospitalisation (or care home admission) results in increased confusion, agitation and decline in mental status, as all that is familiar is suddenly taken away.  When our residents - with moderate to severe dementia - are hospitalised, upon their return, the decline is noticeable - but expected.  This is dementia.

Prof. Tim Kendall (RCoP) weighed in with his views of off licence prescribing, remarking that antipsychotics had a powerful sedative effect and were a chemical cosh, and should only be used after exhausting alternatives (I have never known antipsychotics being used as a first line treatment of aggression) and then only for a short while.

Prof. Sube Bannerjee (Inst. of Psychiatrists, King's College), put in his two pennyworth regarding antipsychotics shortening the lives of 1,800 dementia sufferers per year.  Costs, as in financial, were mentioned too - £80,000 million per year.  I wonder if this has anything to do with anything?

We visited the Spring Mount Care Home where residents were weaned of antipsychotics - as talking to people and interaction was a viable alternative. Methinks a little selective of residents here!  Could this be the only home where staff talk to their residents?  No!

Dementia is progressive whether receiving antipsychotics or not.

Before I continue, I should state that I am not an uncaring nurse who hides in a cupboard, drinking a secret bottle of vodka while reading Hello magazine; leaving the poorly paid and undervalued carers - which they are not - to deal with whatever the residents (who aren't drugged up to the eyeballs) care to throw at them.

Dementia has, and is, touching my personal life.  Ma, I can talk about - but the others still live.  I am not for unnecessary drug prescribing - I am against it!  But I am definitely for necessary drug prescribing!

Ted is one of the residents whose family phoned the home concerned about antipsychotics and possible premature death.  The move to our home is Ted's fifth!  His family were, in all cases, asked to find another home for Ted, due to serious 'Safeguarding Vulnerable Adults' issues.  There is no doubt that Ted is a vulnerable adult - but so were the quiet little old dears he punched on the face.  Ted is severely mentally infirm (yet very mobile) and to put it bluntly - there is not much going on upstairs.  He exists on auto-pilot, in that somewhere in the recesses of his mind - somethings strike him as not right.

It took four members of staff to prepare him for bed or assist him to rise in the morning - or change him after episodes of incontinence.  Ted would punch, kick, headbutt, shoulder, bite, slap, scratch, etc; staff did not take this personally, recognising Ted was not like this by choice, and realising that in his mind, he was defending himself.

Ted was prescribed antipsychotics and became calm - and dare I say it - HAPPY!  He was not heavily sedated, just carrying on before - but without the aggression; he ceased to be defensive during interventions, he slept well, ate well (admittedly while on the hoof) and didn't punch little old ladies on the head.

His psychogeriatrician succumbed to family pressure and halved his dose; Ted is no longer happy and the agitation and aggression is returning.  Observations are now required as Ted is a risk to others.  This is not fair on Ted or his fellow residents.

Ted is not alone in that he was given a certain level of peace and quality of life, that has now been taken away from him; others receiving the dreaded drugs are in the same boat.  Thanks Panorama!

As said in other posts, I would rather live five years of relative drug induced calm than exist for seven years in pure hell.  Wouldn't you?

Please note that I am reporting from my view of the world and accept that residents elsewhere may be over sedated.

Anna :o]

TO ANY DOC WHO MIGHT READ THIS AND WHO THINKS  I AM TOTALLY WRONG - PLEASE TELL ME.  TELL ME WHAT YOU SEE!  I AM NOT 'INTO' DRUGGING THE OLD DEARS IN AN EFFORT TO MANAGE BY SEDATION - AND IT DOESN'T HAPPEN IN OUR HOME.  PLEASE TELL ME IF YOU KNOW DIFFERENT.   I WANT TO LEARN!  CHEERS!

Care Homes and Drug Errors

Okay, I admit it, when it comes to adverse reporting on care homes - I am definitely hypersensitive, defensive and probably many more ' 'ives' than I can bring to mind at this moment in time.

I know that in the big bad world out there, there are indeed, many bad care homes - as, as is, dire care in hospital settings (I acknowledge some of the reasons - dangerous staffing levels, etc), but nevertheless, bad care exists there too.  There are uncaring doctors both in hospitals and GP practices.  But, whatever the wrongs outside care homes - it doesn't make bad care in care homes right!

The reason for this post - stuff I read in Pulse today.  It was "Call to reduce 'counter-productive' cardiovascular drug prescribing in the over-80s"  Video to watch at the bottom of this (Pulse) page too.  I have no problem with this and have also considered the chemical cocktails that the elderly receive.  I know I am not a doctor and therefore readily admit, I don't know what the hell I am talking about!  However, it appears to me, that even though drug A does not interact with drug B, or drug F does not interact with drug H (or even if it does - Flossy needs both of them anyway) - does a combination of A, D and E unknowingly interact with drug G?

Is polypharmacy a GP and/or hospital doc initiated (possibly fatal in the elderly - or anyone?) chemical cosh, that falls outside the care home initiated (in your dreams) chemical cosh of antipsychotics?

Nevertheless, I digress!  A bullet point in the aforementioned "Call to...." in 'Problems with care home prescribing' was "On any one day 7 out of 10 patients experienced at least one medication error" - Ooh, dear me(!), this sent the defensive hackles into overdrive!  I am not brilliant at stats, but easily worked out, that on an average day/night; I routinely gave (on my shift), 30% of my lovely residents, the wrong meds!  Am I thick!?  Would I not know?

Yes, on one (known) occasion, I did give a resident somebody else's meds (distracted by World War Three, for care home residents are not continually semi-comatose by home inspired antipsychotics!) - but I instinctively knew that I had!  I immediately consulted the BNF - thought "Oh My God" (possible bad drug interactions) and contacted the local A & E - for I would rather lose my job, than have somebodies death on my hands.  Given instructions on observations and luckily, everything was tickety-boo!

I have digressed again!  Further research at NHS Choices gave a wider view!  I am relieved!  It is not only care home staff, but pharmacists, GPs et al that produce the 7 out of 10 figures.  But will the general public see this?  No - they will not!  They will just see that care homes are dangerous places (and 'Yes', some of them are) and they will be so afraid.

I do remember Copperfield writing a post on this issue, earlier this year - but I cannot find it.  Yet again, Copperfield's understanding of this situation earned my respect.  I don't care that, at times, Copperfield  alludes to 'granny'stackers' for he/she/they are in touch with the real world.

In my experience, many GPs enter homes with a negative view - and the vicious circle continues - mistrust abounds.  The patient  (or residents)  interests are paramount - and we must remember this  For if not, we are doing the most vulnerable a great disservice.

Anna :o]

Rank Indifference

An Old Man.

Yesterday, I worked a night shift.  As per usual, I boarded a bus for the forty minute journey from the town in which I live, to the city in which I work.  The next part of my journey involves a ten minute taxi ride to my place of employment.

Prior to this second part, I usually enjoy my last fix of nicotine - and I make no apologies for being a smoker - as I stand (like a leper) in the street.

As I stood there, I became aware of a man some ten yards away, standing by and holding on to the guard rails (on the road side) that straddle the entire street - bar a pedestrian crossing - which lies between two bus stations.  This road also includes a taxi rank of which there are two points of access.  It is a busy road.

The man appeared to be talking to passers by who just ignored him.  As I neared him on my approach to the taxi rank, I became aware that he was saying "Excuse me.  Can you help me?"

He was a strapping fellow, over six feet tall; solid, but appropriate for his height.  Dress wise, he was ill-equipped for the presenting weather; wearing uppermost, just a T shirt on that cold, wet and windy night.  His right shoe was off, so on that side he stood barefoot on the ground.  He had also been incontinent and his jogging bottoms were wet and saggy.  He had a walking stick and he was old.  I am not skilled at judging ages, but would say, early to mid seventies.

Only when I was very close to him, did it became obvious that there was alcohol on his breath, but the folk who were ignoring his pleas would not be aware of this.  However, he was neither inebriated nor tipsy; he was fully coherent; he was old, cold, wet and vulnerable and was politely asking for help.

I asked him what was wrong and he told me that he just wanted to go home as he felt he might die, stuck where he was.  He told me that no taxi would entertain him as he had been incontinent.

Mindful now that I needed to set off to work - or be late, I told him I would ask the taxi driver to phone the police who could come and help him.  The taxi driver told me that the old man had already been 'thrown out' of one taxi for peeing on the seat and that he wouldn't contact the police.  I informed the driver that I was not prepared to abandon the old man and got out of the taxi and went back to him.

I offered to assist him to walk to one of the many empty seats in the bus station and I then would go into a shop and ask them to phone the police.  He attempted to walk, but cold and tired, he couldn't get himself moving.  I told him I would have to leave him for a while, while I attempted to find help.

I entered a major national department store and told the security guard of the problem and requested he phone the police.  He informed that it was not in his remit, so he couldn't do it (phone) as the problem was outside of the store.  After much badgering, he agreed to come out and see the old man.

The old mans wet jogging bottoms had by this time, fallen down, leaving him fully exposed.  Not a soul had offered assistance and the good people of the world were jeering at him, shouting "Pull your trousers up, you dirty old git!"

I attempted to pull the old mans trousers up - but to no avail as they had partially slipped under his feet, which he couldn't lift.  I asked the guard to help, but was met by the response of "I'm not touching him!"  The reason, I presume, to be the pee.

I implored him to contact the police.  He contacted his 'control' requesting that they send a private hire cab and stated that if the driver refused to take him, he would then call the police.

The cab arrive some ten minutes later and in that ten minute period, not one good citizen would help me pull the old fella's trousers up.  They had time however, to stand round in unconcerned little groups, uttering variations on the "Pull your trousers up!" theme.

The taxi driver agreed to take him, and after I had pleaded with him, he assisted me to walk the old fella to the cab as I could not manage alone.  So the old man - with his trousers still down - was finally going home.  I then took a taxi to work.

In today's Elf'n'Safety world, I should have carried out a mental risk assessment of every action I took - but I am pleased I didn't, or I would have thought of me first.

It appears to me, that in this risk assessment/risk aversion society that we now live in, we are losing our compassion, and becoming selfish and indifferent to the needs of others; we are beginning to lose our humanity.

What concerns me more is that, for that brief moment when I first sat in a taxi, I was more concerned about me and me being late for work, and thus was prepared to abandon that old man and attempt to pass the responsibility onto someone else.  That does really worry me.

Are we slowing becoming an uncaring, selfish society - or are we nearly there already?  What do you think?

Ann :o[

I am Dementia (Part Two).

Look at You!

Look at you!
I used to love you!
You loved and guided me
Through my childhood.
Ooh! That warm embrace,
The hug of hugs
That made wrong things right!

A hug:
A mothers elastoplast on
The wounds of life.
What skills you had!
A child cherished,
Wrapped in the comfort of
Unconditional love!

You gave me
All of you -
I took, but hope to God
I gave back.
I think I did.
I hope I did!

The pinny!
The cooking lessons!
Dusty flour on
My face (my nose!) and scuffed on
Everywhere imaginable!
That was life then
And girls were girls!

But life moves on
And things change.
You have changed
And no longer
Offer me hugs.

You are an empty shell!

I do not know you!
Who are you?
You have taken up residence
In my mothers body
But I don't know who
You are!

I hate you
For taking her away from me!
I hate you
For saying
"Look!, this is who she was
But I own her now!"
As you thrust
That empty shell
Of (who was) my mother
In my face!

Look at you!
You were my mother.
I idolised you!
But not now!
I no longer love you
And wish you would go
Away!

It is
So difficult
To gaze on someone
You loved so unconditionally
Who still lives
But no longer
Exists.

Anna

I am Dementia!

I am Dementia.
 I am not selective
When choosing my victims:
Doctors and nurses,
Politicians and plumbers,
The good and the bad,
The majestic or mediocre
Of intellect;
I welcome all to my world.

I slip quietly into your mind
(While you are not looking)
And slowly wreak havoc there.
My hallmarks of amyloid plaques and
Neurofibrillary tangles;
Multiple vascular lesions
Or abnormal proteinaceous
Cytoplasmic inclusions
Is all evidence of me!

Initially, you will not know I am there!
Then an odd thing forgotten
That should be remembered
Is dismissed as part of natural aging;
It happens again and again
And doubts are sown in your mind
That perhaps all is not well;
Or maybe you forget that you have
Forgotten
And unknowingly
Begin to walk down the path of
My journey
That I have gifted to you.

The form of dementia
I have gifted to you
Decides what happens
Next!

Failure of higher cognitive
Functioning:
Memory decline and
Difficulties in judgement;
Problems in spatial awareness:
Funny little thing that you are -
You even get lost in conversation;
You are losing everything that
Defines you as you
And you give all of your self to me!

Depressed or agitated,
Apathetic or aggressive,
Or just plain psychotic;
We shall see - for it is my decision!
Disinhibited (you take all your clothes off!)
As you wander aimlessly
In that private, terrifying world
You inhabit
That really belongs to me!

As you progress on your journey
Towards total loss of identity,
My ownership of you
Now extends to your family as
They are caught in the terror
Of my destruction of you.
You are strangers to each other
And they mourn their loss
While you still live and breathe.

You become a burden on society
And you are hidden away.
Friends have long ceased to visit
And your family feel guilty as
They can no longer cope with
This unbidden stranger.
You are not you!

I love the smug indifference of some
Who think they are immune to my grip.
To all -
Including some in the medical
And nursing professions,
Who presume that they are
Somehow excluded from my touch
And view my victims
With disdain -
I ask you to consider
That in time
I may select
YOU!

Anna