Where I'm at

Today I was supposed to start what would at one time have been my dream placement - A and E at a big hospital which is the trauma centre for my city. Instead, Beanie and the rest of my year have started new placements today and I am at home.

At some point last week I realised that I have cried every day since we started back from summer break. There was so much to organise, and so many deadlines and forms, and so little support. The prospect of FPAS applications sneaking in on top of it all was quite dreadful and impossibility confusing. And then one evening I was talking to a friend and it suddenly seemed like the most senisble idea in the world. I take a year out to deal with a lot of the paperwork, to get used to life as a wheelie, to try and find myself some health again.

It was actually suprisingly easy to sort out. Although my disability advisor completely blew me off. I don't think she really gets me. Do most uni disability services have only non-disabled advisors? It's really difficult to work with...

It's starting to feel quite real, now everyone else is at placement, and I'm sitting here making plans for my time. My friend's have been generally quite positive and supportive, but I have a feeling that the med school will ignore me for a year and then continue to ignore my requests for reasonalbe adaptations. I'm keen that they don't see this year as me-getting-better so they don't have to sort anything out. Unfortunately when I tried to raise this I got the impression that this is exactly how they see it. Still, lovely pastoral care doctor is returning to work soon, so I hope to have an appointment pretty soon to discuss this. I'm starting to ponder whether threatening legal action would be an appropriate course of action if they continue to refuse.

They need to stop ignoring the concerns and needs of their disabled, sick and carer students. I just don't know how to make them listen.

Everybody dance now!

Yesterday I went to the wedding of two dear friends. It was a lovely experience from start to finish (except for the downpour I got caught in yesterday halfway down a hill in the wheelchair, which was slightly hairy!) and I used the chair pretty much the whole time.

Assistance on the trains was organised, and if anything slightly overenthusiastic (I'm sorry my love, but if you try and push me with one hand while also pushing the ramp, I will fall off the edge of the platform!), the accessible room that we stayed in had 3(!) emergency cords (all of which reached the floor I might add) and all the taxi drivers had huge boots (that is not a euphemism).

My favourite part of the day though was dancing at the reception. I normally hate discos, because I feel very self-conscious, and I can't stand up for long enough to meaningfully join in. (Plus in Scotland most parties have ceilidhs, and those are a spetacularly bad idea when your body isn't properly held together!)

Last night I danced for 4 hours straight - longer than anyone else - and, although I ache like hell all over this morning, it was well worth it. To start with, when I wheeled out on to the dancle floor, I had no idea, well, how. I mean, I've seen videos of Wheelchair Dancer in action, so I know it's possible - but I couldn't hope for those awesome standards the first time out! Add in that I wanted to dance with Beanie (to whom I was at boob height) and that the dancefloor was quite chaotic, and I was stumped.

It took a while to crack it, but plenty of being spun round at speed, giggling and a glass of Pimm's later, and I didn't care how silly I looked- I was having too much fun! I do believe video footage exists so I might give you a sneak peek. I wished that my GP could see me being so 'limited' by the chair.

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I was a little bit overwhelmed when Bendy Girl alerted me to the fact that my blog post had be mentioned in the Guardian Society Daily. I made a bit of a squeaky noise and shed a little tear.

On a related note, it's good to see more medics speaking out against NHS reforms - I know that there has been a lot of 'grassroots' opposition expressed on twitter, but most of the doctors I've raised it with on placement have barely known anything about it. I've been trying to spread the word a bit, but I just can't seem to find an angle that interests folk. The lack of awareness about the structures and politics surrounding the NHS among doctors is something that I find *really* difficult to deal with. I just want to scream "but how can you not care? RARRR".

I do wish that more of them would speak out against the welfare reforms as well. These are having a huge impact on the patient population, and I'm a bit confused as to why they're being so resoundingly ignored.

Systems can be changed

Firstly, thank-you all so much for the lovely comments about yesterday's post, and to those who published it more widely. It reminds me of how lucky I am to be trusted with people's stories, and how I can best steward those stories. My responsibility to my patient's can never stop at the ward door, even though the overwhelming pressure is to act like it. I am thankful every day for the friends - online and off - who remind me that justice is more than political correctness and that systems can be changed.

And just to make sure that I remember the wider justice issues within the NHS/social care system, today I read Max Pemberton's latest tome 'The Doctor Will See You Now' all in one greedy gulp (well, I did have a 4 hour train journey to kill...). This book covers his year after (what is now) the foundation programme as he starts the process towards specialising in old-age psychiatry. He covers many really important topics, and covers them very well - his passion for his work is evident, and he beautifully illustrates the unjust treatment of older people within the current system.

His book has given me some ideas for posts looking at other issues of justice within the NHS, including :

- The treatment of older people and those with dementia

- Food and the NHS

- The NHS and 'non-professional' carers

- Physical health problems in psychiatric patients

- Speaking out against injustice / whistle-blowing

- LGBTQ individuals and the medical profession

- NHS dental treatment

- Working conditions for auxiliary staff

I also have some public health geekery to throw your way! Don't worry, it's wicked cool stuff, and a good framework for some of these discussions.

Something I also want to explore further is the structure of the NHS. Do you know that the whole way through medical school, noone teaches you about the history of the NHS, how it is structured and governed and so on? I may be showing my cynicism when I tell you that I believe this to be deliberate. It's much harder to fight a system when you don't know what you're up against...

So tell me : where do you see injustice within the NHS? Do you feel you know enough about the NHS as an organisation? Do you know of any good resources for learning more about the NHS? I would love to hear your thoughts =]

Infection Control or "oh, I hadn't thought of that"

Would you believe me if I told you that infection control issues are some of the most challenging that I have to face in terms of access?

It's true, dear readers.

You see, at some point before I started medical school, the NHS decided to promote the use of alcohol hand gel before and after patient contact to reduce the spread of infectious disease. I'm sure someone has proved its effectiveness, and that can only be good, the fact that it has left a generation of staff with allergic dermatitis and that it is not effective against C.diff (which doesn't need any help to spread around) notwithstanding. Personally, I would rather there were more sinks, so that I could properly wash my hands around, but apparently people weren't using them or something.

I think it's good common sense to wash your hands between patients. Folk should wash their hands anyway. It's just nice, and not icky. But, here is my problem, as I explained to the last infection control nurse to teach me to wash my hands (I've been taught 11 times since I started med school...) :

I see a patient, I pick up my stick, I wash my hands, I pick up my stick, thus all the patient germies hang around.

She gave me a look that said "this is not on my algorithm", and then said that I should wipe my stick with a Tuffie wipe between each patient. This makes sense, except that Tuffie wipes all seem to come in tubs of 5 million (and with my stick I already have one less hand to carry stuff), that this means I take longer between patients than everyone else, and the ward round waits for no student, and that I would have to buy them out of my own pocket.

I explained what I had been doing - that is putting a surgical glove (which are all over the wards) over the stick handle each time I wash my hands. This seems an imperfect solution - it's really wasteful, the gloves aren't sterile (people will stick their hands in to the box to get a glove without washing first), and it makes me look silly...

She didn't like this idea (but couldn't explain why) and thought I should use Tuffie wipes. Which hasn't happened for aforementioned reasons.

The other option is to put gloves on every time I see a patient, taking them off before I pick up my stick. This combines two of the earlier problems - gloves not being sterile, and carrying something else around in my one free hand - plus the fact that I don't like making patients feel like lepers from the Bible. I found a newspaper article in the depths of the internet that said that this was the approach taken by a wheelie medic - but on wheels you have more capacity for carrying stuff around.

It's confusing and horrible to feel like I'm not perfectly conforming with a policy that people are so obsessed with. People also comment on it left, right and centre - either telling me off, or telling me I've found an ingenius solution.

That's the major IC issue, but there are others. "Bare below the elbows", brought in in Scotland in 2006, means that I can't wear splints, supports or bandages on fingers, hands or wrists. It's also caused problems for colleagues because of scarring.

I've shown here that I don't have simple answers to these problems, and I don't expect anyone else to - it's just that noone's thought about it. It seems assessing the equality and diversity impact of a policy only relates to patients and not staff. Noone has considered wheelies, or stick users, or splints etc. It's a really isolating feeling when everyone you ask double takes, and says "oh, I hadn't thought of that".