Friday, 29 January 2010

The Wakefield Experience And What Should Be Learnt From It

When I was completing the final course for my BSc (Hons) I decided to apply to study with the OU for an MSc. My acceptance was reliant on me getting my Bachelors degree, and having achieved it I had to decide what courses I would take for the MSc. I have always been interested in how science is presented to the public so this guided me towards the courses that I later chose to study.

The first course I took was called Science and the Public and was based on a series of fairly high-profile cases from the 1980s and 1990s. While studying these cases it became obvious to me at a fairly early stage that the media can be very undiscerning about what data they use to report a story. Not everyone can be a scientist, and not everyone can understand science, so it is very important that journalists who write stories about science should not only have a good knowledge of the subject but also be able to explain things in terms that any reasonably intelligent would be able to understand.

The final part of the course required the submission of a dissertation based on one of the stories that had formed the basis of the course. I chose to analyse the impact of newspaper reports about the MMR-autism link put forward by Dr Andrew Wakefield. I originally intended to look at all UK daily newspapers, but it soon became apparent that there was just too much to sift through so my dissertation proposal was refined so that I would look at what was written in three newspapers (including their Sunday versions). This still presented me with a lot of data to work my way through, but it was more manageable, and I decided that for key dates in the long-running saga that I would compare what was said in all UK newspapers for those dates.

It is as a result of this that I have had a more than cursory interest in the case before the General Medical Council, the results of the first stage of which were delivered yesterday. I should say at this point that I have absolutely no axe to grind. I do not have children, so I have never faced the dilemma of whether or not to allow them to be given the MMR vaccine. Nor am I a scientist, but I do have an analytical mind and analysis of data was a major part of my work when I was in employment.

The thing that struck me very early on in my study of the MMR-autism story, was that there really was no evidence that there was a link. The paper that was published in the Lancet did not mention a link, it was at the press conference that was called by the authors of the paper (a very unusual event for this sort of research paper) that the first mention of this link was made by Dr Wakefield. There can be no doubt that even at this early stage Wakefield was working to a hidden agenda which most of the other authors of the paper were not aware of.

My analysis of the reports in the newspapers at the time that this story of an MMR-autism link was running showed a great disparity in the quality of reporting. I had chosen the newspapers that I looked at based on their availability online, and by the type of their readership; those I looked at were the Times and Sunday Times, the Daily Mail and the Mail on Sunday, and the Sun and the News of the World. I hoped that this would give me a fairly representative sample of reporting on this subject.

Lots of tables were drawn up and entries made in them, there were word counts, there were lots of dates, there were details about the authors of the articles, there were references made to the qualifications of the writers of the articles and to the posts that they held at the paper. A lot of hours were spent gathering the data and then writing my analysis of it all. At the end of it all I was able to say that there was a significant difference in the quality of the reporting, the quantity of reporting, and the reliability of the information presented in the articles.

Throughout the time period that I was looking at it was interesting to note that the length of the article seemed to be related to the perceived interest that the article would attract in each of the papers. Those in the Sun and News of the World tended to be of few words and there was certainly no evidence of analysis of the data. In the Mail and the Mail on Sunday there were likely to be not only the actual report of whatever had occurred but also a long piece that in effect said that Andrew Wakefield was a saint and should be thanked by one and all for alerting us to the risk of one's offspring developing autism as a result of receiving the MMR vaccine, particularly if said piece was written by Melanie Phillips. The Times and Sunday Times tended to have measured pieces, which not only reported the facts but also regularly reported that no-one had been able to replicate the results that Dr Wakefield claimed to have produced. The one area where all of the papers seemed to produce very similar stories was the question of whether Leo Blair had or had not received the MMR vaccine.

Brian Deer was the reporter who eventually managed to investigate so deeply into the whole affair that he uncovered the evidence of unethical practices concerning how children were selected for the study, how Wakefield had received huge sums of money from the Legal Aid Board, and a multitude of other wrongdoings. If Deer had been writing in the US press he would have undoubtedly won a Pulitzer prize for his investigative reports.

There is no doubt that many of those mothers who decided that they would not allow their children to receive the MMR vaccine did so because they believed every word that reporters such as Melanie Phillips wrote. It is almost criminal that newspapers are allowed to print the kind of unsubstantiated drivel that she wrote on the MMR-autism link. She would regularly write about scientific evidence that did not actually exist, and never wrote about the evidence that did. It would not matter to reporters such as her how many studies were carried out showing that the link did not exist, in her mind Andrew Wakefield had shown that the link existed and that was it as far as she was concerned.

The fact that most of the charges against Drs Wakefield, Walker-Smith and Murch have been found to be proved, that unnecessary invasive tests were carried out on children, that much of the research that they carried out was unethical and irresponsible all show that there have to be serious concerns about their fitness to practice medicine. It now remains to be seen whether they will be struck off the medical register. But we should not forget that there have been many children, and some adults, who may have suffered as a result of Wakefield's irresponsible claims about the safety of the MMR vaccine and the subsequent drop in take-up of the vaccine. What does he say to the pregnant women who had miscarriages or gave birth to babies who were deaf because they came into contact with children suffering from German Measles? What does he say to the parents of the children who died or suffered serious complications because they got measles? Some of these children may not have been able to have the MMR vaccine because of serious medical conditions such as cancer.

One would hope that lessons have been learnt as a result of this long-running story. If such an event were to occur again, it should be hoped that the scientists would be very careful about what they said and that the evidence that they put forward have been achieved through properly conducted trials on a truly representative population sample rather than the 12 children that were in the original study. If such a thing were to arise again we should be able to expect that our politicians would be honest with us and not try to hide behind a sudden desire for privacy when they are keen to get whatever publicity they can at other times.

The problem is, that I know that this will not happen. We have already had another health scare in this country caused by someone who should have known better. This time it was swine flu and the villain of the piece was another doctor, Sir Liam Donaldson, the Government's Chief Medical Officer. His prognostications about the likely number of deaths that could be expected from what was only flu after all, was so far off what has actually occurred that he has become a laughing stock. However, he is not the first senior Government scientist to have made an announcement of massive death tolls that have not materialised. One has only to look back to the 1990s and the suggestion that there would be tens of thousands of cases of vCJD in the population as a result of BSE infected cows getting into the food chain, to see that it doesn't matter how many degrees you may have, or how may senior posts you may have occupied, or how much great work you have done, you can make a prediction that turns out to be so far wide of the mark that it will become the only thing that you are remembered for.

Out To Lunch

It was another bad night for sleep although I'm not at all surprised. I am planning an early night for later which will have all the things that should ensure a good night's sleep; hot bath, hot chocolate and sleep medication.

I have decided that it was just not worth my while busting a gut to get the final assignment of my OU course done for midday. I tried several attempts at writing the required short story, but nothing was very good and all were far short of the word count required. I just have to accept that I did the course at a bad time. How was I to know that I would have a mammoth period of depression which would delay me starting the course and as a result I have never been able to tackle it with anything like the enthusiasm that was required.

So, in order to make sure that I don't just sit here moping all day I have phoned Lily and we are going to meet up for lunch. This will make a change from our usual cup of tea and it means that I can have a long chat with her. I can get up to date with how her current placement is going and what she is going to be doing next. I will probably also get an update on what the ferrets have been up to.

While I was trying to pass the hours when sleep would not come I started work on another post in the Tackling the Mental Health Minefield series and another one on a subject that I have never covered before but which is pretty topical at the moment. Hopefully they should both be published later today.

Thursday, 28 January 2010

The Day After

I don't expect that it will come as much of a surprise to anyone that I didn't sleep last night. By midnight I had been crying pretty much non-stop since I had received the phone call and I had a headache that felt as though it was going to split my head open.

Today I have managed some sleep and the headache has now gone, but I still feel like sh*t. I still have to finish my final submission for my OU course so I am going to have to burn the midnight oil tonight in an effort to at least have something written to send off before midday tomorrow.

I have managed to eat one meal today; I had a couple of rolls with chicken in them as a late lunch at about 2.30pm. It was easy to prepare and it didn't need an lot of effort to eat. It has been much more difficult to stop myself from opening the gin bottle. Vodka is my tipple of choice but I don't have any of that. The gin was bought as duty free the last time that I went to Canada and has remained unopened since then. I know that having a drink is the wrong thing to do, but it doesn't stop me wanting to use it as a means of escape from how I am feeling at the moment.

I shall be sensible, however, and the alcohol will stay untouched. I shall eat a bar of chocolate instead. The calories are a pain, but it tastes good and for a few minutes I will be able to forget how awful I am feeling.

Wednesday, 27 January 2010

A Black Day And The Black Dog

I would be lying if I said that I am okay about not getting the job. I am absolutely devastated and more than that I am questioning my ability to do anything successfully and whether there is much point in carrying on with life. I think that what makes it worse is the fact that I was the person who suggested the creation of this post in the first place. I have not had any feedback, just a phone call to let me know that I didn't get the job.

The depression which landed me in hospital last October had been receding over the last couple of weeks but now I find that the world looks very black again. I am supposed to be writing a short story as my final submission for the OU course that I am doing at the moment (it needs to be submitted by midday on Friday) but the likelihood of me managing that is extremely remote now. I will try to get it done tomorrow but it is not going to be easy. My ability to concentrate on anything has gone completely and it is going to take a great deal of concentration to write something that includes all of the things that are required.

I also have to now consider whether I want to carry on doing the presentations about patients having access to their medical records. I have not received any payment for any of the presentations and I have to pay my own travelling expenses too. I am not rich, I live on pensions from my service in the RAF and the Civil Service. They are not large sums of money but they are sufficient to ensure that I get no financial help from the government. Working for six months would have given me the wherewithal to be able to have a holiday, something that I have not had for two years now.

I would like to say a really big thank you to all of you have taken the time to wish me luck and, more importantly today, to commiserate on my news. I will try to keep blogging but I am sure you will understand if I find it difficult to do so.


I have NOT got the job.

Tuesday, 26 January 2010

Now All I have To Do Is Wait

Job interviews are horrible but waiting to hear whether you have got the job or not is probably even worse.

I managed to get up when the alarm went this morning although I would have loved to go back to sleep, get myself ready, and then leave the house in the time frame that I had set for myself. It seemed very strange getting myself dressed in a suit for the first time in about four years and I felt the cold as soon as I left the house to walk to the bus stop. During this cold winter I have been wearing thick tights and thick trousers on my bottom half and a T-shirt, jumper, and fleece on my top half and on top of all that wearing a nice thick padded jacket when I went out of the house. This morning it was just a blouse with my suit, although I did have some thickish tights on under the trousers, and my padded jacket. I forgot to pick up my gloves as I left the house so it didn't take long for my hands to get really cold and waiting for the bus, the cold really got to my core.

I knew the way to the GP practice where the interviews were being held having looked at the Transport for London website, but I find that it can still be very difficult to judge how long it is going to take you to walk from the bus stop to wherever you are aiming for. As it turned out it didn't take as long as I thought to walk that last bit of the way and I arrived at the practice building at just after 8.30am for my 9am interview. As usual I was there early, and after having reported to the reception, explained that I was there for an interview and then taken a seat in the waiting room, the extra time did mean that I could start to thaw out a bit before I was escorted upstairs by 'B' to the room where the interviews were being conducted.

As we climbed the stairs, 'B' told me that there were a couple of problems. The first was that 'M' who was supposed to be doing the interviews with him (she was from the PCT) was unable to be present so he had seconded a member of staff from the practice to be the second interviewer. that didn't seem to be much of a problem to me. The second problem could have been far more of a concern. 'B' said, "Have you brought your presentation on a memory stick, by any chance?" Well, of course I had. Didn't I say that I was a belt and braces person the other day? I was able to reply in the affirmative and 'B' was not at all surprised because he knows that I usually have my presentation on a memory stick when we go anywhere, even if we had already emailed them to wherever we were doing our double act.

The interview involved lots of questions, but then that is obvious. They ranged from what was your last/current job, what did you enjoy about it most and what did you like least. These were pretty easy for me seeing as I have really had only one job during my working life because I did the same thing both in the RAF and the Civil Service. Then the questions started about the job that I was being interviewed for. I have to be honest and admit that the questions probably played to my strengths and even the one about what I would do if I was at a practice and all the GPs except one were in favour of giving their patients online access to their medical records but as it was the senior partner who was against it they wouldn't say anything to try to persuade him to change his mind. This is where the gentle art of persuasion comes into play and I said as much. But if such an occasion was to arise, the final thing that can be used to persuade the recalcitrant senior partner is the fact that patients actually have a legal right to see their medical records and it would actually be easier to allow this to happen online than it would be to have patients regularly turning up at the practice to see them.

After about 20 minutes of questions I was asked to go through my presentation. This was the easy bit as far as I was concerned because I was only having to present to two people something that was a lot simpler than I would normally have to present. The fact that I am actually quite passionate about the subject probably helps, so at the end of it all I was reasonably pleased with how things had gone. As is normal at the end of an interview, I was asked if I had any questions for the interviewers, but I couldn't think of anything at the time, and I'm not sure that even now I can think of anything that I could have asked. The interview ended with me being asked if I was to get the job when I would be able to start. That was the easiest question of the lot. I said that I had psychotherapy on a Tuesday morning and that I was already booked to do the lecture at one of the London universities at the beginning of March, but really I could start any time that was acceptable to both parties.

'B' accompanied me back downstairs to the waiting room and we chatted a little about our visit to the House of Commons next week for the round table discussions. We still have not heard anything more about this so I may have to contact the Shadow Health Secretary's research assistant for details of where and who we have to report to.

After leaving the practice building, I made my way to the bus stop so that I could get the bus to the hospital for my psychotherapy appointment. I had time for a cup of tea before my appointment and I really enjoyed it as I was rather dry in the mouth after all that talking and nervousness. When my psychologist came to collect me for the session I commented on being a bit overdressed (in comparison to how I am normally dressed for my appointments) because of having just attended a job interview. When I saw him last week I hadn't received the invitation to the interview so he didn't know anything about it.

What was really great about today's session was that instead of dealing with my emotions and getting me to let them out as is the normal pattern of the session, we talked about how the interview had gone, about the fact that it is only a 6-month contract and if I got the job how I would feel when it was over, about my previous psychotherapy and how I had felt when it ended, and lots more things about my life and my feelings of abandonment. It was a good session and I think that it was just what I needed after the interview. I think that it allowed my psychologist to learn a lot more about me and how I can best be helped. He definitely feels that I need to be referred back to the main hospital where I had the earlier psychotherapy because I need long-term psychotherapy and if this is successful that it is likely to reduce my relapses into depression and should mean that I will never need to be be hospitalised again.

I guess that the only way that I can finish this post is to say a very big thank you to all of you who have sent me good luck wishes for the interview. I truly appreciate your comments and wishes and it only remains for me to say what a truly nice bunch of people bloggers are. I'll let you know whether I have got the job as soon as I hear anything.

Fingers Crossed

I'm just about to set off for the most terrifying day in my life for a very long time.

Monday, 25 January 2010

Ready For Bed

I went off to the CMHT this morning via the local Tesco Express so I could buy plenty of tissues for my cold. My nose seems to be constantly running one minute and then a few minutes later I am completely bunged up. And I don't think that I have sneezed so much for a long time. This is a real humdinger of a cold and it couldn't have come at a worse time.

I arrived at the CMHT at 9.45am for my 10am appointment, and was told that the HTT team were running a bit late and that I wouldn't be seen until about 10.15am. It wasn't anything more than a bit of an annoyance as I didn't have to do anything else today. A member of the HTT that I had not met before came to see me in reception and said that he just wanted to read through all my notes before we had a chat.

Normally there are only one or two other people with appointments at that time on a Monday morning, but today there were about a dozen and it meant that rooms were at a premium. We went in one and were then asked to move out of that so we had to go to another room, this time in the annex at the back of the main building. We settled down for our chat and talked quite a bit about my interview tomorrow and what the job will involve. Most of my appointment ended up being on the subject of patients having access to their medical records and how this should and could be achieved. Then we discussed all of the other presentations that I have done on this subject and who they were for and then passed on to my trip to the House of Commons next week. We did eventually get on to the real subject of my appointment, which of course, relates to how I have been over the last week and how I am coping with life in general.

The end result of all this is that I have been discharged from the HTT/Crisis Team and I now have an appointment with my new consultant psychiatrist next Monday. I haven't met him yet but I have been told that he is very nice and quite young. So next Monday morning I shall be making my way over to the CMHT again, but this time not to see the HTT, it will be the first of what I am told will be regular meetings with my new consultant psychiatrist. So watch this space.

When I had set out from home this morning it had been a very grey morning. By the time that I left the CMHT a fine drizzle was falling and it was sufficient for me to get cold and damp on my walk to the bus stop. Fortunately, almost every bus stop in my part of London now has a shelter associated with it so I could at least stand in the dry while I waited the few minutes before the first of my buses home arrived. When it became time to change buses it was raining even more but the stop that I alighted from was also the stop where I had to wait for the second bus for my journey home. I had to wait about five minutes before my bus came, but again I was under a shelter and by the time that I arrived at the bus stop nearest home, the rain had stopped, so the short walk home didn't mean that I got any wetter.

Once home, I slapped a pasta ready meal into the microwave, zapped it for the required four minutes and then sat down to enjoy my nice hot meal. then I wrapped myself up in a couple of blankets and laid down on the settee to half watch television and play Mah Jong on my Nintendo DSi. I may have dozed off for a few minutes a couple of times, but other than that I have been awake all day, which is a bit of a surprise as I only had one hour of sleep last night.

Now I am ready for bed and I plan to get myself snuggled under the duvet and read for a while before trying to get to sleep. I'm not sure how successful I will be as I am definitely suffering with this cold and my anxiety level is very high. Having a job interview, followed shortly afterwards with a psychotherapy session is not what I would normally plan for my day, but it has to be done and I'll have to do my best. The alarm is set for the indecent hour of 6am so that I can get myself up, showered, dressed and make sure that I have everything that I need for the day, before leaving the house between 7.30am and 7.45am. Whether I have the time, or the inclination, for any breakfast remains to be seen.

I shall report on how my day went tomorrow evening, when I may even resort to an alcoholic drink or two to get over my taxing day.

Not At My Best

I've managed about an hour of sleep and I'm feeling rather rough this morning. I now have a streaming cold and my first port of call this morning, before I even go to the bus stop, is to call into Tesco Express to buy a box of tissues.

My nose is bunged up and constantly streaming at one and the same time and it really couldn't have happened at a worse time. It is probable that I have been feeling so down over the last few days because this cold was developing. Knowing my luck it will be in full flow tomorrow morning when I have my interview.

I shall have to get myself out of bed soon and the thought of getting out of a nice warm place so that I can get myself dressed and go out into the cold morning is not one that is particularly appealing but it needs to be done. My trip to the CMHT to see the HTT will be about all that I can manage today. Fortunately I only have to get the paperwork that I need to take with me to the interview together when I get back home and then I shall probably just wrap myself up in the duvet and climb into bed for the rest of the day.

I shall dose myself with paracetamol, find a book to read (something that is not too taxing) and hopefully drop off to sleep for a few hours. My clothes are ready for tomorrow, and all I will have to do is make sure that I set the alarm so that I am up in plenty of time and then get myself ready to leave the house by shortly after 7.30am to walk to the bus stop to get the bus to the GP's surgery where the interviews are to take place.

Having a streaming cold is not what I would have wanted when I am about to undergo this ordeal, but it will hopefully elicit a little sympathy from the interview panel. The rest is up to me.

Sunday, 24 January 2010

Presentation Prepared

I had another one of those nights where I didn't need medication to help me sleep; what I needed was something to wake me up this morning. It took me until nearly midday to get to a state where I knew what I was doing. I popped round to the local Tesco Express to get a few essentials and then came home and heated up my lunch in the microwave.

This afternoon I have spent my time moving from one computer to another to get the screen shots that I needed for my presentation. It's a real pain when you don't have the same applications on each computer and this is something that I must remedy in the near future.

I have now managed to get everything together on one computer (thank goodness for USB memory sticks), completed the PowerPoint presentation, including adding a couple more slides to round up the presentation and I have emailed it to the person indicated on the letter inviting me to interview. I have also loaded it on to one of my USB memory sticks and put it in my handbag so if there are any problems with the emailed version I still have a copy of it that can be loaded on to a computer.

Tomorrow I just have to finish getting all the paperwork together and then I will be ready. Well, as ready as I can be.

I am now thinking about getting myself something to eat again. I have decided that soup fits the bill with a bread roll to dip in it. I've decided on soup because I have got a cold starting and a nice big bowl of mulligatawny soup, which is both filling and spicy will hopefully help to drive the cold away. I just don't need a runny nose at the moment.

Tomorrow I have to go to see the HTT first thing in the morning, well 10am actually, so I should be home by midday and I aim to have a relaxing afternoon before having an early night in preparation for the dreaded interview.

Saturday, 23 January 2010

Tackling The Mental Health Minefield Part 8 - OT? What OT?

(This post continues the story from Tackling The Mental Health Minefield Part 7 - The GTN Story)

Having to spend a long period in hospital, and these days anything more than a week can be considered a long time, means that there can be a lot of empty hours to fill. When that hospital is a mental hospital then one can expect to be mobile and the empty hours can seem interminable. Mental illness can make it difficult to concentrate, or to be able to do something for a long period of time. My experience of mental illness is depression and I have tried many things to deal with the hours of the day. I read, I study, I do crossword puzzles, I knit, I do embroidery and I make cards. Sometimes I can't do any of these things for more than an hour at a time and sometimes I can spend all day on one of these activities as long as I don't encounter any problems. Problems are very difficult to deal with and so I end up putting whatever it is I am doing aside until I am feeling a little better and can deal with the problem.

During my stay in hospital, life soon settled into the routine so loved of such organisations. Breakfast would be served at about 8am, meds and obs at 9am, lunch served at about 12.15pm, meds at 1pm, dinner at about 5.15pm, meds at 6pm and night-time meds at 10pm. I expect that it is pretty much the same in any hospital.

Visiting hours were 2pm to 5pm and 6.30pm to 8.30pm. The difference between visiting hours in a mental hospital and an ordinary hospital is that there are very few visitors; most patients have no-one visit them from their admission to the day that they are discharged.

So what do patients do during the rest of the empty hours in a day? Well, there are of course ward rounds, but while these may take a considerable time during the day, the patient only attends ward round for a limited time. Most of my visits to see the consultant psychiatrist and whoever else was in the room (see Tackling the Mental Health Minefield Part 6 - Throwing The Christian To The Lions) were no longer than about 10-20 minutes twice a week.

While I was on the admissions ward there was nothing organised for us to fill the empty hours. As is common to most accounts of time sent on mental wards, we were expected to spend most of our time in the communal areas. These were the TV room and the dining area/day room. During my time on the admissions ward I went in the TV room twice; both occasions being for ward meetings. The dining area/day room had tables and chairs sufficient for 12 people, but the ward could take up to 16 patients, which meant that if the ward was full it was impossible for everyone to be able to sit down together at meal times or during other periods of the day. So I spent some time in the dining area/day room particularly when I had made myself a hot drink or for meals, sometimes I would read a book or doing sudoku puzzles. I had always found sudoku puzzles impossible to do even though I understood the requirements for completing them because I have number dyslexia. However, one of the patients that I was on the admissions ward with spent time explaining how to do them and I became hooked. Most of the rest of the time I spent in my room trying to catch up on sleep that I wasn't getting at night or reading. There were no organized activities for us to take part in.

When I was on the second ward, there was an activity semi-organised for each morning (Monday to Friday) between the hours of 10-11am but these rarely took place. The two which did seem to be regular events were a session of creative writing on a Tuesday morning and a group psychology session on a Thursday morning.

The first Tuesday that I was on the ward (I had been on the ward for five days then and in hospital for two weeks) two occupational therapists approached me when I was in the main corridor of the ward walking from the laundry room with my arms full of the washing that I had just done, and tried to get me to join in with the creative writing. I took my newly laundered clothes back to my room and went to the OT room to wait for the OTs to round up any other patients who could be dragged along. They were unsuccessful, so there I was sitting in a room with two OTs and all they could suggest to me was that I might like to write about what had led to me being in hospital. Now maybe I was just being over-sensitive, but I really didn't think that was a very good thing for me to be doing at that time. So I thanked them very much and left to go back to my room to read my book.

I was absent from the ward on the following Thursday morning as a result of being on my first attempt at home leave. I arrived back on the ward at lunch time so I missed the group psychology session. The following week however, I was persuaded to join three other patients from the ward and one of the nurses at the group psychology session and spent an hour away from the ward with one of the psychologists and his trainee psychologist. Each of the patients were given time to talk about how they ended up on the ward, the other three having been present at the previous week's session they went first and then it was my turn. I was asked a number of questions which I have to admit I answered only briefly and then I was asked about my depression and how long I had been suffering from it and how I had ended up in hospital. I answered at length and what I had to say somewhat surprised the other patients who had no idea that I had been suffering for so long or that this was my first admission to hospital.

Then we began to talk about life on the ward and I raised the subject of the 'protected hour' that we were supposed to have everyday between 11am and lunch. As this is going to be the subject of another post in this series I won't go into too much detail here, but from being someone who pretty much kept to myself on the ward although I did talk with a number of the other patients, I suddenly found that I had become a spokesman for not only those patients at the group psychology session but also those who weren't.

So, at the end of this post I go back to the subtitle that I used. OT? What OT? I know that some things that traditionally come under the title of occupational therapy involve cost and money is something that seems to be in short supply in mental health services, but the significant lack of anything that could be termed as 'helpful' in making the empty hours pass more quickly for the patients was alarming. The wards had televisions, and a small supply of books, but nothing much else. The result was that some patients spent most of the time in their rooms and socialised only at meal times. It is probable that the nurses wrote up their notes on the patients on each shift and commented that the patients didn't seem to do much, but it has to be said that there really wasn't anything to do. I would have loved to be able to do some knitting, but knitting needles were not allowed on the ward. I understand that they could be used as a weapon if used in public areas, but if I was to knit in my room and return the knitting to the staff when I had finished for the time being would certainly have helped me considerably.

I was lucky: I was only in hospital for a month but by the time that I left I was desperate to do some knitting or something other than read a book and do sudoku puzzles. As far as I am concerned this is an area what definitely needs something done about it. I know that some patients probably wouldn't want to partake in anything but there are definitely some who could almost certainly be helped considerably if there was something to help to pass the time in an environment that is not always conducive to improving one's mental health.

Taking A Nosedive

I didn't write a post for this blog yesterday. Okay, so that's not a big thing but since the start of the year I have been trying to write something every day. I have been trying to finish the eighth part of Tackling The Mental Health Minefield this afternoon and I hope to have it published some time today, but it isn't easy as my mood has taken a bit of a nosedive over the last couple of days.

I went to bed early Thursday night as I found that I couldn't keep my eyes open any longer. I was asleep by 8.30pm, woke again at about 12.30am and took my night-time medication (minus sleep medication because I didn't think that I was going to need it), fell asleep again almost immediately and then didn't wake until about 10am. I got myself something to eat, took my morning medication and went back to bed again. I then managed to sleep again although this time it was only for a short time.

I didn't get much done during the afternoon and while I was playing Mah Jong on the Nintendo DSi I actually managed to drop off without being aware that I was feeling tired. It was only momentary because I woke with a jerk when my head fell forward as I was sitting on the settee. I was finding it difficult to focus on anything for longer than about five minutes so I settled down to spend the evening sitting watching television but by 9pm I knew that I would have to head back to bed again.

I woke today at 11am having slept for more than 12 hours. This is often the pattern that occurs when I am starting to sink into depression again and having had a few days of feeling reasonably well I am rather annoyed that I seem to be sinking into depression again so quickly.

I'm not sure what has caused this to happen. It may be that the anxiety about the interview on Tuesday is causing it, but I hope not. I don't need the additional pressure of feeling absolutely sh*t through depression on top of the anxiety about performing at my best. I know that I can do this job, after all what I will be required to do is something that I have been doing for some time already. I am quite passionate about patients having access to their medical records and I believe that a patient is the best person to persuade the doctors of the benefits that can accrue from this, particularly when it is done online.

So, this afternoon I am not going to think about the interview. I still need to put the finishing touches to my presentation but that can be done tomorrow. Instead I am going to spend time completing another post for this blog about my time in hospital and then do a bit of reading before going to bed at a reasonable time. Then tomorrow I shall get up early, finish the presentation, get all the paperwork together, get my clothes ready for Tuesday, and when I have done all that I shall spend some time doing whatever I want to. Maybe it will be some knitting (I haven't done any for quite a few days now), perhaps it will be playing a game on the Nintendo, perhaps it will be a bit of reading.

I just need to stop thinking about the interview and concentrate on making sure that I am feeling as good as possible for Tuesday. Easier said than done, I know, but I shall do my best.

Thursday, 21 January 2010

Preparing For The Interview

I know that I still have to finish my presentation, and it's still quite a few days until my interview but worrybones that I am means that this afternoon I have been making sure that I have done all the things that I need to do.

Over the last hour I have managed to confirm that I will be attending the interview. This was relatively easy in that it just required me to go to the NHS Jobs website, login to my account on it, and then mark the confirm interview box. Not exactly rocket science but it needed to be done. I have made a list of the documentation that I need to take with me. Tomorrow I will have to fire up the printer so that I can get my academic summary from the OU website because I am not going armed with my framed degree diploma, and I must sort out three items for identification. This seems a little bit silly as one of the interview panel knows me so I couldn't send someone in my place if I wanted to.

I have also logged on to the Transport for London website to check how I get to the place where the interview is being held. I knew which bus I needed to get already but I needed confirmation of where I had to go when I got off the bus. I will have to make an early start from home on Tuesday morning so that means that I will have to make sure that I get to bed early on Monday night.

Tomorrow morning I will sit down at the computer again to finish the slides for my presentation and write the notes. Then I shall print the relevant pages out so that I have them to refer to if necessary. I also have to email the PowerPoint presentation to one of the interview panel by 3pm on Monday, so if I am happy with everything I will do that tomorrow too.

That leaves just sorting out what I am going to wear. This should be fairly easy as I have just invested in a new suit for the occasion so I should only have to check that it is pressed and ready for me to put on, that I have all the necessary other items (shoes, blouse, handbag) placed conveniently, and this is something that I shall do on Sunday.

I think that covers all that I need to do and by having made sure of what was necessary a few days in advance I shouldn't be running around like a headless chicken when Monday arrives. I have to go to see the Home Treatment Team on Monday morning for my weekly appointment with them and it is important for me to have as easy a time as possible for the rest of the day so that I don't get more anxious than is necessary. I am reasonably calm at the moment because I have taken it easy over the last few days; now I just have to maintain that level of calmness until Tuesday. The only problem is that it is easy for me to say that but how things turn out in reality could be something completely different.

Creating A Presentation

I have been good. I have actually sat down to work on the presentation that I have to give at my interview next week. Talking for 5-8 minutes is not normally a problem for me once I get started but that is when I know the subject well. The subject for the interview is not one that I would normally tackle.

I could create stunning PowerPoint slides but fail to get my message across. So I have decided to go for something fairly simple. Some of my slides will have screen shots on them of things that I want to talk about; others will consist of words alone. It's always a problem trying to get the mix just right but I hope that I will achieve this with the presentation that I am creating.

One mistake that many people make when creating presentations is that they fill the slides with words. No-one can take in the information if it is given in this way; it's always easier to understand something that you have heard in a presentation rather than trying to get the information by reading a slide that will have gone from the screen before you have finished reading it.

The old saying 'a picture speaks a thousand words' can be very true when you are trying to get information across to an audience in what is usually a time frame that is not long enough for you to do the subject justice. I am used to having at least 20 minutes when I am doing my presentations about patients having online access to their GP records. This means that I can tailor my presentation to the audience. If I am talking to an audience of doctors I know that I have to spend far more time telling them about the benefits that I believe accrue from having this access. If the audience is made up of practice manages then I have to emphasize the time that can be saved through not having phone calls asking if test results are back yet. If I am talking to an audience of patients the emphasis is on what online access can mean to them; an example would be that links could be available to take you to relevant, reliable, good quality information about a condition that they may suffer from.

It is never possible to create a presentation that will sort every audience, but if you know your subject well that need not be a problem. I often do my presentations live. By that I mean that I use the online access system that my GP surgery uses, not as a series of screen shots but by using the Internet and a real patient record (mine). The benefits of this can be amazing because it allows you to show your audience that it is not difficult to use and that it does not require doctors to change what they are already doing when compiling your medical record at an appointment.

Creating a presentation is not a 5-minute job. It requires you to have some idea of what you are going to say during the presentation so that you can ensure that your slides are relevant. There is no point in creating a lot of slides and then not being able to use them because they don't 'answer the exam question'. So with that in mind I have looked at what I have been asked to talk about; I have selected what I think are the most important points to make on the subject; and all I have to do now is finish creating the slides and write the notes to accompany each of the slides. With a bit of luck I can manage that today and then I can relax a little knowing that it is done.

But I will still be worrying about the interview itself!

Wednesday, 20 January 2010

A Brief Update

After a few nights of not sleeping particularly well and a certain amount of anxiety over my psychotherapy session and the forthcoming job interview, I took my sleep medication last night and I slept. Admittedly it was nearly 2am before I dropped off but it was definitely the medication causing the sleep because I just could not keep my eyes open a moment longer and I literally fell asleep as soon as my head hit the pillow.

I woke up at about 10.30 to answer a call of nature and then climbed back into bed and instantly fell asleep again until nearly 3pm. this means that I have pretty much lost my day, but I do feel completely rested and while it means that I probably won't get any work done on preparing my presentation for the interview today, I will feel better tomorrow and can get to work nice and early and hopefully complete it then.

I went to see my GP yesterday afternoon and I had a lot to tell him. We talked about my being in the mental health loop now after my stay in hospital and how I seem to be getting the help that I need. Then we talked about how the news about Mr Smiley had affected me. My blog was the next subject of conversation. I told him about the Mental Nurse TWIM Award and how my readership has increased dramatically since starting to write the Tackling the Mental Health Minefield posts. Then we talked about the job interview and he wished me luck. Eventually we actually got to the reason that I had gone to see him. Over the last few weeks I have been getting occasional pains in my right leg. They can occur at any time, are excruciatingly painful and last for just a second. The pain is very sharp and feels as though it is in the bone rather than being muscular. "Shin splints" he said and had a look at my leg and the place where I was feeling the pain. So with a weight off my mind knowing it wasn't anything too serious I said that I needed a prescription for most of my medication. We went through the long list of things that I take on a regular basis and apart from GTN spray and the cream for my eczema I needed everything. The prescription printed out and signed and then I was on my way to the chemist to get the prescription filled and walked home with a carrier bag full of pills.

I think that it was the first time that I have been to see my GP for many months and not cried at some point through the appointment. I see this as a good thing because it is a real indicator of how my mood is improving. Now I have to hope that my confidence will start returning so that I can do well at my interview next week. And while we are on the subject of the interview, I would like to thank all of you who have sent me good luck wishes. I really appreciate the fact that you have taken time out of your day to read my blog and send me a comment.

Tuesday, 19 January 2010

Now I Can Get REALLY Anxious

I haven't written in this blog much about it, but I have applied for a job. It's just a temporary one on a 6-month contract. I'm not sure that I could, or even want to, work for longer than that. That may sound a strange thing to say but I live on pensions (four actually, two for my service in the RAF and the Civil Service, and two widow's pensions from the same organisations for my husband's service) and if I had a permanent job with a decent salary the tax man would take so much money from me that I would need to consider whether it was worth the effort to work.

But this job is different. It was tailor-made for me mainly because I am the person what actually suggested its creation. If I get it, then its mean being paid for 6 months to do something daily that at the moment I do on an irregular basis for free. That is, talking about why it is important for patients to have online access to their medical records and the benefits that can be accrued by it.

This morning I received an email inviting me for interview for the post. I have to go armed with a mass of paperwork proving who I am and that I have the qualifications that I claimed on my application. I can't really go armed with my degree diploma because it is framed, but fortunately my home page on the OU website gives me access to my academic achievement with the OU detailing what I studied for my degree and the qualification that I have as a result of that study.

That part doesn't worry too much, but I also have to dream up a 5-8 minute PowerPoint presentation to give at the interview and which has to be submitted the day before the interview. The subject of the presentation is obviously geared towards the job and worries me a lot more. It's not something that I have thought about and so I am going to have to put on my thinking cap over the next few days so that I can create something that shows off my talents with PowerPoint and that covers the question posed for the presentation.

Perhaps the thing that worries me most of all about all of this is that I have only had two job interviews before. The first was nearly 38 years ago when I applied to join the RAF, and the second was 18 years ago when I applied for a job with the Civil Service. I had a couple of promotion interviews while I was in the Civil Service, but that is not quite the same. So you can see that I am not exactly experienced in the job market and I don't deal with interviews very well.

I become a physical wreck. I get so nervous that I become nauseous and have been known to have to make a dash to the loo to throw up before an interview. I physically shake and the anxiety of what is to come builds daily while I am waiting for the interview to happen and then it doesn't dissipate until I have had the results. The thing that is making me anxious about it already is that the interview is next Tuesday, that I am the probably the first person to be interviewed because it is at 9am, and that after the interview I have to go for my psychotherapy session.

So, readers of this blog, I am asking a favour of you all. Will you all keep your fingers (and toes) crossed for me and send me positive vibes so that I can win this job? I really would appreciate it.

Monday, 18 January 2010

Anxiety Relieved

My walk to the bus stop this morning was not alone as would be the norm; just as I stepped off the drive my next-door neighbour (actually she and her husband and kids live behind my house because I live on a corner of the road and their house is in the road that joins my road) came out of the house on her way to the local newsagent to pick up a newspaper. It was nice to be able to have a chat with someone as I walked along the road. I was lucky this morning (or unlucky depending which way you look at it) because the first of the two buses that I have to catch to get to the CMHT arrived almost immediately and when I changed buses I had only to wait for a minute after getting off the first one for the second to arrive. The net result of this was that I arrived 35 minutes early for my appointment with the HTT.

I didn't see the usual nurse this morning although the one I saw today I have seen before. He is much better than the nurse I normally see at getting the information that they need to ensure that I am keeping well and it doesn't seem like answering questions by rote. It was actually much more like having a proper conversation. This meant that I probably gave more information because we talked around the subject. They are very pleased with my progress and I was told that I should give myself a pat on the back for all that I have achieved since leaving hospital.

When the appointment was over (I was in there for an hour and yet it seemed like five minutes) I walked down the road to catch the bus to take me to the hospital so that I could attend my psychotherapy session. By the time that I went into the psychologist's office I was suffering terrible anxiety and I really didn't want to be there. We got to work immediately and, though it was very difficult for me, it was a good session. I know it was a good session because at the end of it I felt as though I had been put through a wringer, but as I walked along the road to the shops after leaving the hospital I realised that all the anxiety had gone and I was much more relaxed. It really is just the anticipation of what I know is going to happen that makes me so anxious.

By the time that I got to the main shopping area I realised that I was very hungry; it was about 1.15pm and I hadn't had anything to eat since last night so I got myself some lunch and then did the little bit of shopping that I needed and then headed for the bus stop to get the bus home. The nice postman left my parcel at the back door so I don't have to go to the sorting office to collect it tomorrow so I now have a couple of knitting books and three new games for my Nintendo DSi to look at this afternoon.

After a night with only a couple of hours sleep and the rigours of the therapy session I am going to relax for the rest of the day. I shall probably try for an early night tonight, I will definitely take my sleep medication, but before that happens I am going to look at my new books and play my new games. Then tomorrow I must sit down and write the short story for my final assignment on my OU course.

High Anxiety (Apologies To Mel Brooks)

It's been another night with little sleep. I didn't dare take the sleep medication because I had to be up early this morning to go to see both the HTT and my psychologist. I know why I didn't sleep; it was the overwhelming feeling of anxiety that started to come over me yesterday evening. This morning I am like a coiled spring and I feel that I am likely to explode at any moment.

This complete irrationality about talking about how I have been feeling over the last couple of weeks to the HTT ( I chickened out of last Monday's visit) and what is to come later when I am with psychologist is what makes my mental health problems so draining on me both physically and emotionally.

The silliest thing about the state which I find myself in is that I know exactly what is going to happen. It's not fear of the unknown that worries me but anticipation of what is about to occur.

Sunday, 17 January 2010

Computer Games

I use a computer a lot, I used them to do my work when I was in employment, and I use them still for many things including my studies with the Open University, online shopping, and writing this blog. I have never been 'into' computer games although I have been known to play the odd game of Spider when I can't sleep.

My husband loved computer games and he would have been amazed at the complexity of the games that are available now; things were still pretty simple in comparison to those available today when he died in 1998.

It is with some amazement that I should do such a thing that I have to say that I have just bought myself a Nintendo DSi. It was one of the parcels that I eventually managed to pick up early in the week. I only have a couple of games for it at the moment, one of which is Mah Jong. Mah Jong is a very old Chinese game and I have to say that it rather lends itself to being a computer game.

The game for the Nintendo DSi has two modes; one allows you to play various game formats, one at a time, while the other mode is more like an adventure. Yesterday afternoon I played a few of the solo games and started to really get into it trying to increase my high scores as I played. Today I have had a go at the adventure mode. I'm hooked. I read the little booklet that explains the game before playing but like so many of these things it didn't really explain some of the levels that well, but what the heck I'm reasonably intelligent and by playing a few times I have managed to work out what is necessary to get through those levels, by trial and error admittedly, but I am getting there.

This afternoon I have been playing the game so much that I have exhausted the battery in the game console. Unfortunately, I was well on my way to actually completing the game when the console switched itself off. I had noticed that the red light was on that should warn me that the battery power is low, but I was so engrossed that I didn't realise that it had turned to a flashing red light indicating that I had to either to save the game and exit or attach the power cable to it.

I bought this particular console because I wanted something small that I could put in my handbag for when I am travelling and need something to pass the time. I didn't really think that I would get hooked on it but I am beginning to wonder why I didn't buy myself one long ago. I have ordered a couple more games for it and they should be arriving tomorrow, but I am going to be out most of tomorrow so I will probably have to go to the sorting office to pick them up on Tuesday.

Who says that you can't teach an old dog new tricks?

Lasagne For Breakfast

I didn't sleep very well last night. That's nothing new but although I did take medication to help me sleep, I was still awake at about 2am and when I did finally drop off I was awake again by 6am. I knew that I needed more sleep but when I tried to get settled again I couldn't because I was feeling hungry.

Hungry is not something that I do very often. Depression robs me of my appetite and also the will to actually make an effort to cook for myself. I'm a reasonable cook, so it's not as though I can't cook, just that it seems such a lot of effort for one person. This means that I rarely have a roast dinner anymore, and that is definitely one of my favourites. There is nothing like some really rare roast beef accompanied by roast potatoes, and roasted vegetables such as parsnips, carrots, courgettes, and aubergine; and there should be Yorkshire puddings and a good dollop of horseradish sauce too all served up with a good helping of proper gravy made in the tin that the meat was roasted in.

When I am well I can be quite inventive too. I make a really lovely dish which comprises diced potato, diced sweet potato, diced aubergine, diced onion, garlic, ginger, salmon, salt and pepper for seasoning, a good squeeze of lime and a healthy handful of dill to finish it off. It takes longer to prepare the vegetables for the dish than it does to cook it.

I might not be ready to start experimenting with my cooking at the moment but I am starting to enjoy food again. It's been a long time happening so I'm not well stocked up with things to experiment with. So at 7am this morning I was standing in front of the microwave waiting for it to heat up a lasagne ready meal.

I admit it's not something that I have ever had for Sunday breakfast before, but it certainly tasted good and I now feel that I might actually be going to buy some raw ingredients for a few meals over the coming week. This has to be another sign that I am at long last coming out of this horrendous period of depression that I have been enduring since the beginning of last August.

Friday, 15 January 2010

Buying A Suit And Afternoon Tea With Lily

I don't have any work-type clothes. It's almost three years since I had to give up work and I'm afraid that none of the clothes that I used to wear to work fit me anymore. This wouldn't be too much of a problem if it weren't for the fact that I have applied for a job and I know that I am going to get an interview for it because they sent me an email earlier in the week asking if I was still interested in the job because I was a very strong candidate for it based on my application form.

It's best not to turn up for an interview wearing jeans and a T-shirt which is pretty much what I am dressed in most of the time. I do have a couple of pairs of decent trousers, and some reasonable blouses and jumpers that are fine to wear to work, but I know that it would be best to wear a suit for an interview. And yesterday's email from the Shadow Health Secretary inviting me to round table discussions at the House of Commons means that I ought to be dressed in something half decent on that day too.

The answer was a trip to my nearest shopping centre with a Marks and Spencer so that I could see what they had that might be suitable. It didn't have too much difficulty finding a jacket and trousers in the right sizes so I now have a nice navy blue suit, and three new blouses to wear with it too (one white, one blue, and one pink which is not a colour that I wear often).

I bought a few more bits and pieces (not clothes) that I need in some of the other shops in the shopping centre and then it was off to the cafe to wait for Lily as we were going to meet for afternoon tea. We spent nearly two hours in each others company, drank two cups of tea each, and chatted non-stop. Lots of the talk was about plans for her wedding, but we also talked about what she has been learning about at uni this week. There were a few laughs when she was talking about medical students who are embarrassed by the lectures on certain parts of the body and how they are functioning, and one can't help wondering how these students are going to react when they are doctors and have to talk to patients about slightly embarrassing things. Surely they've thought about it before they went to medical school, but perhaps they haven't.

I am now back home and thinking about getting myself something to eat before sitting down for the evening with my feet up and maybe doing some knitting while I watch television. And just in case you hadn't realised, yes I am feeling a bit better today.

Thursday, 14 January 2010

Strange Emails

Like everybody who has an email account I get my fair share of spam. The gmail account that is associated with this blog gets about 30 spam emails each day, but as it automatically sifts them from real emails its not a problem. It's somewhat different with my personal email account which fortunately doesn't get anywhere near as much spam but has had a lot of bogus emails about my bank account and new security measures; these get removed immediately without being opened because it is obvious that they are phishing because they purported to come from banks where I don't actually have an account.

This evening I received an email that invited me to take part in some round table discussions. It seemed to be from someone who had an email address that seemed to be in the Houses of Parliament. I guess that I can be excused for being a bit wary about this email, after all it's not every day that I get an email asking me to take part in discussions in the House of Commons. Yes, that's right. I have been invited to the House of Commons to talk about patients having online access to their medical records.

It seems that I am really getting to some interesting places to talk on this subject.

Things May Be Starting To Get Better

Yesterday was pretty much a non-day for me. Having not got to sleep until the early hours of the morning I eventually ended up sleeping through the whole morning and part of the afternoon. I'm not too worried if I don't have any appointments when it happens because I obviously sleep because my body, and my mind, need it.

Having gone without breakfast I got myself some lunch and then picked up my knitting. I actually completed 11 rows before I put it done, which was pretty good considering how little I seem to be accomplishing at the moment. Later on I sat down with a crossword puzzle book and half-heartedly worked my way through some puzzles while also half watching television.

It was quite late when I went to bed, not surprising really considering how late it was when I got up, but it didn't take me very long to fall asleep. This morning I woke at about 8, eventually forcing myself up to get up about 10 and having got myself dressed I went round the corner to buy some bits and pieces. Once home again I made myself some brunch and having eaten that I picked up my knitting again.

I've managed to knit four rows so far today, and I am about to start a new pattern block which I will have to repeat twice. This pattern is the longest of the eight which make up this shawl comprising as it does 24 rows so it will be some time before I report that I have finished it and moved on to the next pattern.

The fact that I have managed to pick up my knitting and work on it for several hours is perhaps an indicator that I am starting to feel a little better. I still find it difficult to concentrate on anything for longer than a couple of hours but I am finding that I am able to do things that I haven't been able to do for several months.

So, this afternoon I will do a little more knitting, perhaps try to read for a while and undoubtedly try my hand at a puzzle or two. Now all I need is for it to warm up sufficiently for the snow to melt completely (much of it has already gone and the rain and warmer temperature are doing their bit to get rid of it) so that I can start going out for my walks again without fear of falling over, and also get some work done in the garden which should have been done in the autumn but which didn't get done because I was in hospital.

Tuesday, 12 January 2010

It's All About Psychology

Much as I am always very anxious before going for psychotherapy I know that it is the right thing to do. This morning I didn't want to get out of bed but I managed to get myself up and out of the house in plenty of time to be able to catch the bus to the hospital. I walked along to bus stop somewhat relieved that the thaw has continued and that much of the snow has now disappeared or turned to dirty grey slush so that there was no chance of me slipping over today.

I arrived at the hospital early (as usual but I can't help it) so got myself a cup of tea from the little kiosk and sat outside in the garden to drink it while I had a cigarette. It might have been cold outside but it was quite pleasant watching the squirrels running backwards and forwards along the fence. When it was time for my appointment, I made my way indoors and headed for the lifts. There are two lifts but only one of them goes to the fourth floor where the psychological therapies department is situated. I usually have to wait ages for the lift to arrive but this morning it was actually down at the ground floor when I pressed the button for it and the door opened immediately. It was straight up to the top of the building and into the department to await my psychologist.

Last week's session was different to normal in that we spent the whole session talking about how the devastating news about Mr Smiley had affected me. It was nice to be able to talk to someone about it and not just have it whirling about in my brain. This week, however, it was back to the usual work in the session and all that entails. I have to steel myself for what is to come and the effect that it will have on me and it is making a difference but I know that there is a long way to go yet.

We work at my emotions and in trying to stop me putting a lid on them all the time. I learnt at a young age that I had a temper and that I was likely to want to hit out if I got angry. The problem is that I have now been controlling these urges for so long that it is difficult to express them and this is doing me damage. It seems strange to have someone who is actually a very nice person deliberately trying to make me angry. This morning there were a couple of occasions where I could feel the anger rising in me to such an extent that it was causing me to shake as the emotion was overtaking me and for it to cause spasms in my body as the anxiety of the situation overcame me.

While I was in hospital I got angry and frustrated on a number of occasions and the only way that I could deal with it was to sit and scratch at my hands. The problem was that I kept scratching at the skin on the back of my hands until I had removed patches of it and I ended up with horrible areas of bleeding. Some of these got infected, somewhat unsurprisingly, and it took a long time for them to heal up. Even now the areas are apparent, particularly so when it is cold, so they are obvious at the moment as I sit typing this post.

As each week passes I find it easier to feel anger during the therapy sessions and I am slower to put a lid on it and bring myself under control. It may seem a strange thing to be trying to achieve but it is considered important that I should stop trying to keep myself under control as it is one of the things that is making it so much harder for me to deal with the depression. But it's very difficult to change the habits of a lifetime and learn new behaviour to a situation.

At the end of the session we talked about how much longer these sessions should carry on for. My psychologist is proposing that we carry on until Easter with these one-to-one sessions and he is going to refer me back to the psychotherapy services at the headquarters of the mental health trust (where I have already had a year of psychotherapy) for further long-term therapy. He is not sure whether this should be on a one-to-one basis or whether group therapy would be better. It will undoubtedly mean further assessment appointments to allow the decision to be made.

I was asked if I could change my appointment for next week to Monday at midday. This will actually suit me very well as it means that I can see the HTT at 10am and then instead of going home, head for the hospital for psychotherapy. I will be getting all of the difficult things over with in one day and then have the rest of the week to do whatever I want.

Monday, 11 January 2010

A Bit Of A Thaw

I eventually managed to get out to get my parcels from the local sorting office this morning. I needed to get some food too, so I couldn't put it off any longer. I knew that it was still cold out so I made sure that I was well wrapped up and that I wore a hat and some gloves and equipped with my shopping bag and walking stick I set out. Most of the snow at the back of the house had gone but there was still much on the road and pavements at the side of the house.

As I stepped off the drive onto the pavement I put my foot down somewhat gingerly but I needn't have worried. The surface that last week had been so slippery was today quite soft. There had been a little more snow over the weekend but the real reason that it was much safer underfoot was the fact that the snow was actually melting. We are having a bit of a thaw at the moment and even though it is still very cold it is possible that by the end of the week most of the snow on the pavements will have disappeared.

I made it to the sorting office without a hint of a slip and then made my way to the supermarket for life's essentials. I now have bread and milk as well as a few other bits and pieces and I should be fine until the end of the week now. I decided to travel as much of the way home as I could by bus because the shopping was quite heavy and I really didn't want to come a cropper if I did mange to find a patch of icy pavement. In the end I made it home quite safely and once indoors I started to warm up a little.

I managed to get to sleep last night without the aid of medication and somewhat unbelievably actually managed to sleep in this morning too. I was supposed to go to see the HTT this morning at 10am, but I was still asleep then. I eventually woke at about 10.30 and knowing that I had other things to do that were far more important than going to see the HTT I decided to phone them to apologise for not being there owing to my having overslept. I had a brief chat and when asked when I wanted to go to see them I persuaded them that as I had a lot to do this week, especially having to get my assignment in to my tutor by lunchtime on Friday, that I not call in this week but go to see them next Monday. This was accepted by them and so I have a reprieve for this week.

Tomorrow I am off to see the psychologist again and I am already beginning to get anxious about it. Last week's session was less psychotherapy and more an opportunity to talk about how the news about Mr Smiley has affected me. Tomorrow it will be back to the real work and we will also be discussing how many more sessions I will be having and whether I am to be referred for long-term psychotherapy. I believe that this is quite likely, but the fact that I am being referred by one of the mental health trusts psychologists rather than by my GP will hopefully mean that I don't have to wait too long for the therapy to start.

Now I have to decide what I am going to do for the rest of the day. Do I have a go at writing the 1500-word story for my assignment? Or do I sit and do some knitting? Or should I sit down to write another post in the Tackling the Mental Health Minefield series. Making decisions is very difficult at the moment.

Saturday, 9 January 2010

Tackling The Mental Health Minefield Part 7 - The GTN Story

(This post continues the story from Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions)

In one of the earlier posts in this series (Part 2 - The Admission Process) I wrote about many of my possessions being taken away when I was admitted to hospital. One of these was my GTN spray, which is prescribed for me because I have Prinzmetal's angina. Prinzmetal's is also known as variant angina and is relatively rare in comparison to the other forms of angina. The pain is caused by one of the arteries in the heart going into spasm, and can occur at any time, even when at rest, and is not caused by exercise and a cardiac stress test cannot be used to diagnose it. I had suffered from its symptoms for a number of years before it was diagnosed and since then daily medication has kept it pretty much under control although I do still have occasional attacks and I always carry a GTN spray to reduce the pain. No matter how hard I argued with the nurse that I should keep the GTN spray, he would not accept that and I was told that if I had an attack that I was to go to a nurse who would get my GTN spray out of the drugs cupboard in the Clinic Room.

I had been in hospital about six days when, early in the evening, I had an angina attack. I was in the communal/dining area, so I walked calmly to the office at the end of the corridor and having knocked on the door and it been answered I explained that I was having an angina attack. The nurse who had answered the door immediately picked up the keys for the Clinic Room and for the drugs cupboard and ran to open up while I calmly walked to meet her. By the time that I got into the Clinic Room she had my GTN spray out of the cupboard and ready for me to use. After taking the usual two puffs under the tongue I sat down on the chair for a couple of minutes to make sure that the GTN spray was doing its work. One of the side-effects of the spray is that it can cause one to become light-headed or occasionally very dizzy, so it is always advisable to sit down for a few minutes after using it.

After about five minutes I was feeling much better and the pain had gone so I went back to the communal area to rejoin the three patients that I had been sitting with. Sometimes after having the angina pain I have a repeat attack about an hour or so later and that is exactly what happened on this occasion. This time one of the other patients went to the office to call a member of staff and the process was repeated. After the second attack, I went to my room and laid down for a while. I was fine, and the next day things were back to normal.

A couple of days later I was moved to my permanent ward and before I left the Admissions Ward I had to make sure that my GTN spray was removed from the drugs cupboard and made the move with me. Once again during the admission process to the new ward I asked that I be allowed to keep the GTN spray with me. Once again the answer was no, but to make matters worse the nurse had to ask what it was for.

Life on the ward continued with no further attacks until the day that I was supposed to be having a couple of hours home leave. This was the occasion when I had an argument with the staff about what my consultant had said about me having home leave (see Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions). I'm not sure that it was the argument with the staff that caused me to have an angina attack, or whether it was just one of those coincidences that happen occasionally.

After lunch I was sitting quietly in my room doing a crossword puzzle when an angina attack started.
My room was just a matter of yards from the ward office so I made my way there, knocked on the door, and the nurse who was in there answered the door and I told her I was having an angina attack and that I needed my GTN spray. The clinic room with the drugs trolley was next door to the office, but the nurse headed off along the corridor towards the communal area rather than going to the clinic room. When I shouted at her that I needed the spray immediately, she said that she needed to find another nurse because there had to be two of them to dispense drugs. I'm afraid at this point I really lost my temper and shouted so loudly that patients and staff came running from all directions.

At this point the nurse decided that perhaps she had better get the spray for me so I followed her into the clinic and waited while she fumbled with the keys to the drugs trolley. Then there was the problem that she didn't know what she was looking for, so I just snatched it from the trolley myself and sprayed twice under my tongue. I sat down on the chair which was used by the patients when obs were being done, laid back and closed my eyes for a few seconds while I waited for the GTN to take effect. Of course there was rather a large audience for what followed and the nurse was still more interested in finding a second nurse than in ensuring that I was okay.

The ward SHO had heard all the noise and came out of her office to see what was happening. Seeing everyone standing around the clinic doorway at a time when no medication would normally be dispensed alerted her that something untoward may have occurred and that she may be needed so made her way along the corridor (I was told about this later by one of the other patients). The SHO came into the clinic and asked what had happened and the nurse said that I had come to the office complaining of chest pains and that she had tried to find another nurse so that they could get my GTN spray together. The doctor was appalled, and proceeded to ask the nurse whether she would have gone looking for another nurse if she had found me lying in the corridor and not breathing. It being a question which did not need an answer, the doctor continued by saying that in the event of something like this happening then the nurse should ignore normal procedures and give an angina patient their GTN spray immediately.

While this was going on, I was just sitting in the chair waiting for the pains to stop. After about 10 minutes, with me still experiencing pain and being monitored by the doctor, it became necessary for me to use the spray again. This time it seemed to do the trick because a few minutes later I was feeling much better and was able to stand and walk back to my room after having had the spray again locked up in the drugs trolley. The SHO came to see me about half an hour later and asked me to go along to her room so that she could carry out an ECG. this turned out to be another farce. First of all, the ECG machine belonging to the ward was not working so one had to be borrowed from another ward. One this had been procured I climbed onto the examination couch and the doctor proceeded to attach the sticky pads to my body and the various leads to the sticky pads. It was a bit like watching someone trying to put together a piece of flat-pack furniture. The doctor stood there with the instruction manual in one had and was attaching everything with the other hand. Every time she attached a lead, one of the sticky pads on another part of my anatomy would come unstuck. Eventually she managed to get all 12 pads attached to my body and all 12 leads attached to the pads. Then she pressed the 'Go' button on the ECG machine ...... and nothing happened. After about half a dozen attempts she decided that it was all far too difficult for her and decided that I seemed to be recovering quite well and the ECG could wait.

The decision was made that because of the angina attack I should not go home on leave that day and the situation would be reviewed in the morning. I asked that I be allowed to keep my GTN spray with me and the doctor agreed, but the nurse wanted it written on my medical records and as the doctor failed to do this she would not give it back to me.

The next day arrangements were made for me to have an ECG in the main hospital, the grounds of which the mental hospital was sited. The ECG was done immediately and I went back to the ward to collect my belongings and my medication so that I could go on my overnight home leave. Although this leave was for one night only I was required to take all of my belongings with me. As I said earlier in this series of posts, and in a post at the time, the home leave was not a success. I didn't sleep at all that night and when I reported back to the ward at lunchtime it was to find that someone had been put into the room that I had been occupying.

At ward round that afternoon it was decided that I was not fit to be discharged and that I was to stay in the hospital. At the same time, the consultant said that I was to retain my GTN spray so that I could administer it myself immediately if I needed to and asked only that I inform the staff that I had used it. I had two further attacks while I was an inpatient, both of which I was able to control immediately because I had my spray.

What the episode of the GTN spray taught me was that you really don't want to be in a mental hospital if you also have a non-mental illness. I would hate to be an asthmatic having a serious attack, or someone having a heart attack, in a mental hospital because if it were staffed with nurses of the calibre of the one who I had the misfortune to encounter, your chances of surviving the attack could be severely compromised.

To be continued.

Friday, 8 January 2010

Staying In

I didn't sleep very well last night. It was about 2am when I eventually fell asleep and then I kept waking up because of the pain in my knee.

After my little mishaps yesterday when I managed to thump my right knee against the cold hard ground twice, it is swollen and severely bruised. I'm not surprised about the bruising because I take aspirin daily and I have always bruised easily.

I was supposed to be picking up my parcels today and then going to meet Lily (Student Doctor Diaries) for tea this afternoon. At about 9.30am, after limping around the house for a while and managing to bang my knee three times on different pieces of furniture (yes, I am clumsy) I decided to phone her and suggest that we postpone today's meeting as I really didn't fancy trying to walk to the bus stop along the pavements that I had fallen onto twice yesterday.

When Lily answered her phone there was a very hoarse little voice talking to me. Poor Lily had woken up this morning and found that she had lost her voice. My suggestion that we postpone our meeting was greeted with some relief on her part, I believe.

So my opportunity to see her engagement ring and to talk to her about her wedding plans has been put on hold for the time being. However, we will probably manage a meeting either next week or the week after, so I can catch up on all her news then.

After phoning Lily I suddenly came over very tired so I decided that as I wasn't going to go outside today, there was no reason why I couldn't go back to bed for a while. And that is what I did. When I woke up about four hours later I felt a bit better and so I have spent the rest of this afternoon trying to do a bit of studying. I didn't do as much as I had hoped, but at least I have broken the back of the stuff that I still have to read before I settle down to write my 1500-word short story.

This evening, I am going to get out my knitting and try to do a few rows of my lace shawl. When I did some the other day I actually managed to complete 8 rows, which was about 6 rows more than I thought I would do. I have just eaten my evening meal so once this post is published I can get myself comfortable and with a knitted afghan over my knees and another round my shoulders, armed with a bar of chocolate, I shall seat myself in front of the television and see what I can manage tonight. I should finish the pattern block that I am working on at the moment and then do the 4-row divider before starting the next pattern block. This shawl is a bit like a sampler would be in embroidery; it is composed of a number of different lace patterns worked up to the centre of the shawl and they are then worked in reverse for the second half of the shawl. With a bit of luck it should be finished in time for next winter.

Thursday, 7 January 2010

Slipping And Sliding

I had to venture out of the house this morning. There were the parcels to collect and I was in dire need of certain necessities. I wrapped up well in multiple layers of clothes, put on my sheepskin lined boots, a hat on my head and gloves on my hands, and armed with a shopping bag and my walking stick (I'm having problems with my hip again at the moment).

I left via the back door (it's the one I use most) and marched across the snow-covered lawn. Actually, it was a bit more of a shuffle that a march. It only took me the few yards to get to the pavement to change my mind about picking up the parcels, but the shopping was absolutely necessary so I continued on my way to our local Tesco Express.

The pavement of the first road that I had to walk along was still fairly well covered with powdery snow so there were no real problems. I turned the corner and things became a lot more scary. Where the pavements had been well-trodden they were very slippery but there was some soft snow at the edges so I tried to stick to them as much as possible. I managed to get along this road without any mishaps and then I turned into the road where the Tesco Express is located. There had been much more pedestrian activity here so it was almost like walking on clear pavements.

Once in the shop it was apparent that they have not had deliveries of certain basics such as milk, although there was a good selection of bread. But this didn't cause me too much of a problem. I did need some milk and there was sufficient for me to be able to get some, but it was in one pint containers rather than the larger size that I wanted. I also managed to get a couple of tins of soup, and the loo roll that was an absolute necessity.

On leaving the shop |I made my way down the road and then turned the corner. I knew that it was going to be much more difficult to get home without a mishap because I was now carrying a full shopping bag rather than the empty one that I set out with. I was right to be concerned for I managed to slip over twice.

The first time wasn't too bad because I felt myself slipping and I managed to catch hold of the railing running along some one's front garden. Even so, I went down on one knee and gave myself a bit of a shock. I was helped up by a young lady who made sure that I was alright. I slipped for a second time about 30 yards further on. This time it was a full-blown slip with me falling face down to the ground. I banged my already bruised knee hard as I fell and felt my chin and nose make contact with the icy ground. This time I was not so quick to raise myself because it the fall had really shocked me. Fortunately, two ladies were walking along the other side of the road and saw me fall and came to my rescue. They helped me up and made sure that I was okay. I thanked them both and warned them that both pavements along this road were very slippery.

I only had a few more yards to walk before I turned into the road that leads to my house. By trying to walk in untrodden snow as much as possible I managed to make it home without further mishap.

The shopping is now unpacked and put away, and I am consoling myself with a bar of chocolate. I'm hoping that it will take my mind off the painful knee as I wrap myself up warmly under a blanket and watch a DVD for a while before settling back down to my studying.

Wednesday, 6 January 2010

Procrastonation Rules

Despite having taken my night-time medication, including something to help me sleep, at about 10pm yesterday evening, it was well past 2am before I got to sleep. I woke at about 7am to answer a call of nature, then climbed back into my nice warm bed and instantly fell asleep again. Sleep is always the first thing that suffers when I am depressed but I am reluctant to use the sleep medication too often because of all the other medication that I have take.

Having had extra sleep I feel a little better than I have done for a few days. But by the time I had roused myself and got dressed it was past midday, and it was snowing, so the parcels have not been picked up. However, another day in the sorting office won't hurt.

I should be doing some studying and getting myself in the frame of mind to try to write a 1500-word story for my final assignment of the course that I am working on. I still have 10 days in which to do the work but I would like to get it completed early if at all possible. Fifteen hundred words is not a lot really. Many of my posts on this blog are at least that length, but for them I can write whatever I feel like saying at the time. Having to write a piece of fiction, including at least one of a number of items, is a little more difficult.

Procrastination has set in and I really can't be bothered to pick up the folder that contains the course material and sit down to read the sections that I have not yet looked at. Perhaps I will feel a little more like doing that later this afternoon or this evening, and I am not yet working myself up into a frenzy about it.

I feel that it is more important that I am comfortable with sitting down to several hours reading than forcing myself to do something that I am just not in the mood to do. So, while I may be procrastinating I am also thinking about my wellbeing and trying to ensure that I do nothing to make me feel lower than I do already. I have other things that I can do to occupy myself. I need to write a letter to Mr Smiley, and I have my knitting too.

I am sure that I can leave the studying until tomorrow, for as Scarlett O'Hara says, "Tomorrow is another day."