Three weeks. What have I learned?

It is just over three weeks since I started working in Rotherham.

It has been an interesting time.

There have been highs and lows.

Some confusion.

Soupcon of anxiety.

Even, disorientation.

Lesson 1

When I was younger, it was routine to change jobs every year – that was the rotation which was the core of my higher specialist training to become a geriatrician.

I last rotated 10 years ago and from memory, I used to enjoy the changes of scenery, the different environments, procedures. After a decade of constancy – with, albeit lots of gradual changes, the sudden, flash in the pan, unanticipated dowsing of new experience has been overwhelming.

What has it taught me?

Well, essentially, change is possible, it is just exhausting. And, likely, it contributes to neuroplasticity which in the event of a stroke or major brain injury could stand me in good stead.

Lesson 2

Many years ago, I adopted the Confucian idea, communicated via Bruce Lee of the lesson of the overflowing cup:

Courtesy of: http://bengtwendel.com/your-teacup-is-full-empty-your-cup/

You get the idea – leave your preconceptions at the door, prepare to learn new ways, don’t let past experience cloud your growth.

I’ve been thinking about that student frequently over the past few weeks.

It is interesting to see how readily we assume that our way is the way, and alternatives cannot possibly yield better outcomes.

Lesson 3

Amazing people everywhere.

This isn’t really a lesson as it was something I have always known, it was probably one of my reasons for becoming a doctor – the knowledge that no matter where you go, your situation, your vulnerability, there are always people with whom you can connect, empathise. Who see the world through a similar lens to you. Sure, we are all different and indeed, this can never be the majority, but those kindred spirits tend to stand-out from the crowd. Thank you for being so kind to me.

Lesson 4

The Man.

I never deluded myself into thinking that by moving from one big organisation to another, everything would be hunky-dory, a rose-garden of person-centred, kind, holistic empaths. People are people are… people. The Man is everywhere, controlling, manipulating, distorting peoples’ personalities and behaviours. The Man is not always the boss, they might not be the apex predator – their skills are sometimes more subtle, yet, they are there.

So, yes, the Man, the quintessence of hierarchical, organisational top-down coercion is a thing in Rotherham – nowhere near as bad as in Doncaster, but present nevertheless.

The Man is like the air we breathe; too little you’re are in trouble, too much you pop; let’s maintain a balance. Task and finish, process and procedure, all in their appropriate place.

Lesson 5

Side-rooms are hell everywhere.

Being isolated in a side-room is diabolical no matter the hospital.

On Mallard Ward we overcame this by utilising the dementia rationale – the psychological and physical harms of isolation are so much greater than the potential risk of MRSA colonisation, that, by taking special measures, people needn’t be locked-up. And, yes, our rates of infection were better than other places; that and our (successful) obsession at avoiding C. difficile.

I remember in Barnsley, Sheffield, and saw in Bassetlaw and Doncaster, and now, in Rotherham, the experience of predominantly older people, locked away in side-rooms because they either have or possibly have Norovirus, MRSA or C. difficile – the doors must be shut to prevent the bugs blowing-out, staff must wear tatty plastic aprons and blue gloves – if you are unlucky enough to be suspected of having the flu, folk are even made to don face masks.

This with no TV, radio, broadband; no decorations. Lonely, poorly; Argh.

Lesson 6

It is actually easier to discharge people from Rotherham.

Well, let me quantify this – the actual process of discharge decision, letter, take-home medicines, seems, to be many times more complicated than anywhere else I have worked, the actual ability to facilitate discharge, find someone to help the older person at home seems dramatically easier in Rotherham.

Perhaps the lesson here is that the systems can learn from one another.

Lesson 7

Measuring lying and standing blood pressure to investigate falls in older people is not yet a ‘thing’ in Rotherham… work to be done!

Lesson 8

Ward cleaners, in Rotherham are called Domestics, in Doncaster, Service Assistants. I know this might seem a trivial distinction, but, knowing an individual’s role, what they can and cannot do is important when working in a complex system. Who is it OK to ask for new hand-gel, who can remove a cannula, transfer a patient; sure, you can ask anyone anything, but I like to know what I am doing.

Lesson 9

Antibiotics – although the distance between Rotherham and Doncaster hospitals is only 19.2 miles, the antibiotic guidance for treating common infections is different. I can’t believe that the bacteria are that different from place to place, but, there you go.

Lesson 10

Rotherham folk seem to like Pregabalin and Gabapentin. These two drugs which are from a class called ‘neuromodulators’ are used to treat both epilepsy and neuropathic pain – that is, pain related to nerve damage. For nerve pain related to alcohol and diabetes they can be very effective, for other types of pain I am not sure; indeed, if you look at the list of side-effects, most people would be put-off, particularly those caring for older folk. Doncaster used to be known as the Gaba-capital of the country; perhaps those drugs are sourced from Rotherham – I have yet to determine.

*Yes, these are potentially ‘dodgy drugs‘ – they are great for some people. Never stop taking them without talking with your doctor.