PQRST

Sinus rhythm that's called. That familiar wave shape we see on a hundred hospital dramas. The shape you should get when wired up to a three lead ECG which is a relief, as that's mine.

There's a whole new world of hypochondria which opens up to you when you are studying a healthcare degree. If you are already prone to health anxiety then the whole thing is a minefield. I spent a lot of last year having type two diabetes, alternately writing essays on it and fretting that the slight thirst or wooziness I felt was A Sign. For the back half of last year and again this year it has been various cardiac complaints. A lecture from the specialist pregnancy cardiac doc was fascinating but the symptoms she described... that's me I thought as she listed this or that sign that someone was about to drop down dead.

So being wired up to an ECG twice over the last week was a strange experience. A moment of dread that it would show something awful, there in the university's skills lab in front of all my peers. It is an occupational hazard. One fellow student had her hypertension discovered when we were messing about learning to take manual blood pressures (the trick is to use the stethoscope the right way round by the way). Another had the highest blood pressure I've ever seen, including in pregnant women admitted to hospital for treatment in case they have fits. It turns out she has white coat hypertension. I had a moment of fear when we tried testing our own urine. Oh dear lord, there was BLOOD in it. And signs of infection. Was I secretly harbouring some dreadful bug that was going to strike me down? Turns out it was the university harbouring the world's oldest dip sticks. They were well past their use by date and throwing out mad results.

I've never been a science person. My first degree is in English and Philosophy, nearly 20 years ago now. I had no end of arguments with science types about the relative merits of our fields of study. Mine was properly important I said, not just the spoddy messing about with teeny tiny particles or things that go bang but the hearts and minds of people, the stuff that makes us human. I still believe that by the way. Studying literature does involve a whole load of posturing around and carrying slim volumes of Sylvia Plath's poetry around in your bag (cringe) but it tells you about people. Stories are important and the Shakespeares and Dickenses and Plaths of the world have given us a shorthand to try to explain the messy stuff about feelings, motivations and desires. However, I now have to concede that it all comes down to the science. More specifically it comes down to the teeny tiny particles and the things that go bang, or don't.


Such small things can have a devastating effect on a human body. A little imbalance in this or that, sodium and potassium in cardiac muscle cells for example, and that's game over. All the wandering lonely as a cloud and what-not is over for that collection of walking bone, muscle and nerves. It's frightening but it's also incredible. We all start as two cells which crash together against unimaginable odds. Then, from three layers of cells you eventually get one of us. I find that reassuring. The chances that any of us got here safely are so small, let alone to survive every day heartbeat by heartbeat. That's amazing. And yet we carry on doing it, growing babies, being born and living to write poetry, blog nonsense or just sit on the sofa staring at the ceiling. What are the chances?

We'll never have it so good (again)

These are the hands

These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed.

These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip.

These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab.

And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.
(Michael Rosen - "These are the Hands" written for the NHS 60th birthday celebrations)


There's been a bit of fuss recently about this new NHS/social care bill. It's in the news a bit but more prominent on social media like twitter, facebook and forums. There's been a sense that people – especially health professionals – are getting more and more anxious about it. Doctors I speak to have raised their concerns about it, the Royal Colleges have come out against it.

If you're not clear as to why, you should probably read this


What this bill will do, when it becomes law, is to change the NHS forever. When I say change, I mean dismantle. And once it's in bits it will be impossible to put it back together again.

Does this matter? You can get sentimental about it but the NHS needs change, doesn't it? It's an unwieldy beast of a thing that lumbers along significantly behind the cutting edge leaking money from every orifice, isn't it?

Well.

Look at the way the change has been presented. Efficiency. A drive to focus on patient care by cutting bureaucracy. I've heard people complain about how NHS hospitals are full of administrators. Or, as I prefer to think of it, full of people doing essential jobs which allow clinical staff to do their essential jobs. Someone has to order the stuff, make the phone calls, write the letters and the people who pay for the NHS (that's us, folks) should get value for money. Which is the right person doing the right job. When you take the administrators away, their jobs don't go. Stuff still needs ordering, phone calls need making, letters have to be generated and sent. Behind all the people in scrubs crashing through doors and shouting incomprehensible stuff about being in VF and wanting things STAT that you see on the telly, the real life everyday things need doing.

The Nash is far from perfect and we all complain about it. Like a long term partner or a family member, we can get irked by the little things because we're absolutely sure that we're in this relationship for life.

Except suddenly we're not. The effect of this bill is that things we have grown up taking for granted might not be there any more. Medical care free at the point of need, available to all. The National Health Service.

If the critics are right then GP commissioning is the first stage and it's not meant to work. Give it a bit of time and it won't be your friendly local GP in charge of who gets what and how, they will be relegated to the odd meeting with Healthcare for Profit PLC who have conveniently offered their expertise. My GP is a fantastic doctor but I have no idea if she has the skills or inclination to become a heathcare commissioner as well. It's a bit like asking your expert plumber if they fancy doing a bit of town planning as well, isn't it? A totally different job. Both skilled and both essential but different.

Fortunately there are well established groups who do just that. Like Healthcare for Profit PLC. When the new bill abolishes the requirement for care to be universally available, Healthcare for Profit PLC will be able to concentrate on the things that make money for their shareholders. Things which won't generate money or are too costly in terms of risk won't appeal. Unprofitable things like elderly relatives, long term sick or disabled people, my friends and relatives who have suffered from mental health issues. Obstetrics.
In midwifery the picture isn't quite so straightforward. There are lots of midwives who are looking for an opportunity to practice in the way they want rather than being kept within a hospital system. Caseloading midwifery (think “Call the Midwife”) is a model that many would love to see more widespread. Midwife led units being actually led by midwives not looked at askance by the management who just don't get what it's all about.

But at the cost of the NHS? At the cost of knowing that my children will always get health care regardless of our income? At the cost of wondering what will happen to us as we get older? Call me an old romantic but I'd rather stay in this relationship and carry on tweaking it than cut loose and get a system like the one in the US where a disabled child or a long-term illness can ruin a family financially.

I got my marching boots on earlier this year with a load of fellow feisty women (or “harpies” as we were branded on Twitter) to shout about the erosion of women's reproductive rights. This is a much, much bigger picture and trust me I'm eyeing up my boots again. Meanwhile I'm blogging, I'm writing to my MP, I'm signing petitions and waiting for my 38 degrees posters to display. I'm 18 months away from qualifying as a midwife and I want my dark blue dress to have NHS embroidered on it. I want us to be able to carry on grumbling gently about the food, the funny smell of hospitals, the odd disorganised clinic safe in the arms of the Nash.

View from the Playground

This is what you can see if you look over the fence from Isaac's school playground. Fields and sheep and hills and stuff. Apologies for the crappy photo, I snapped it on my phone just before I left after the parents' lunch which the school held last week.

I have to say I was secretly thrilled when the invitation for the school lunch arrived home amongst the usual detritus in the book bag (twigs, Biff Chip & Kipper book, one glove). School sponge and custard? Oh yes. Mr M was overtly thrilled that it was for a day when I'd be at home so he didn't have to go. For him the prospect of school custard (good) was far outweighed by the prospect of going back to the hall where he was forced to eat his own primary school dinners (bad). As we queued in the corridor I got the chance to look at the yellowing newspaper photo of Mr M and his classmates dressed up as morris dancers sometime during 1981.

I love it that Isaac is at the same school his dad and auntie went to, the school where he has cousins in older year groups. He can tell his friends that his Grampy helped build the block their classroom is in. It's a real village primary school, for all the good and bad that brings. There is, to my knowledge, only one non-white child in the school.

I'm doing a lot of compare-and-contrast with Isaac & Eva's childhood compared to my own but also to Dan's. That's the funny thing about having a big age gap between children, it's almost as if they're a different generation. Right now I'm sitting on my bed with the laptop trying to type this while the two smaller children are running between their room and mine, dragging Buzz Lightyear and a selection of soft toys around as part of their complicated game together. Meanwhile Dan has arrived home for the weekend and wanders about looking like an emo Arthur Dent, all sardonic comments and smoker's cough.

So, Isaac and Eva have each other but Dan had me all to himself for a decade. He grew up in multicultural schools and moved to different areas, they are rooted in the same area that Mr M's family has lived for years. There's a real sense of guilt that their experiences will be so very different but then isn't there always guilt? That seems to be the one abiding feature of parenting, whatever the circumstances. Guilt and school custard, some things never change.

Been quiet here, hasn't it?

It's not like I'm expecting anyone to be tapping their fingers and at a complete loose end, thinking "where's that Mrs M with her incisive and witty ramblings?" But there is a sense of guilt about not blogging for such a long time.

I'm one of nature's blabbermouths. I've always been someone who has to gob off about stuff incessantly. I know I've always made up stories, and that I make things that happen into anecdotes to make sense of them.

Recently I've been on a midwifery placement that I can't really talk about. It's not top-secret midwifery or anything like that. Not MI5-wifery. Just an area where confidentiality is even more important than in other places. I've had a head full of the things I've been doing and nothing else has seemed to be able to come to the surface past it.

It's difficult, when you see things that put trivial worries into perspective. Helpful in a way, but then it makes you impatient with other people's problems which actually are serious and need sympathy. Just because someone's leg has fallen off it doesn't mean your ingrowing toenail doesn't hurt after all.

But now the year has turned and I'm off to catch babies again and hopefully I can get closer to the target of 40 which I need in order to be a real, proper midwife and qualify for a darker blue dress. There's nothing to be said for the uniform, by the way. I do wonder why we still have this kind of uniform, a version of an old fashioned nurses' dress which is impractical, uncomfortable and not entirely flattering. Some people like the uniform because it looks professional and it identifies you as belonging to a particular group of people. I don't like it for the same reasons really; it is divisive, a way of pulling rank over some ("do as I say, I'm in a uniform") and being subservient to others ("yes, doctor").

I do sometimes hanker over a swishy cloak and a starched hat though. Good for keeping things under.

Waiting for the news

Waiting for exam results sucks. Especially when they aren't yours. It is A levels day, the sun has risen and we are into the last few hours where they are like Schrodinger's cat, in a state between good and bad where all possibilities are still in play.

I remember my A level results day. That whole summer seemed to go on for years - I know, a dreadful cliche. I finished my last exam and walked home all the way from Muswell Hill, probably a good 5 or 6 miles, through the park where we'd played as children and sat on the swing. I remember that day so clearly because it seemed to me that everything changed then; my sense of myself, my friendship groups, even what I wore and where I went. The Day The Results Came was sunny and I had to wait for the postman as the results came directly to candidates. I sat downstairs and watched bits of "The Wall" on video repeatedly until the post clattered through the door.

My results were all wrong. One grade higher than I'd expected - insanely good for the effort I'd put in (none). But the grade for English was too low, not the A I needed to get into my first choice of University. So I wandered out of the house, not entirely sure where I was going, and went down the road. Carried on for a bit and got to the tube station and so to Colchester, where I sat in that park on my own taking it all in.

I think I'm more nervous this morning. D and I were talking last night, he complaining that he was the last one left out of the loop; his school, his university choices and UCAS know by now what his fate is but we don't. Somewhere someone has put a tick or a cross by his name and that will affect everything from his eventual qualification and employability down to how much petrol we burn in the next few years.

My role as mother today is to be on immediate alert for lifts to school to get results and to give advice when asked but otherwise to stay Sssssssshhhhh and let him get on with it. As one of life's fixers, this is hard. My instinct in any situation is to suggest something, do something, not just nod and smile. I'm far better at it than I used to be; being at births teaches you a lot about the value of just waiting. As one of our lecturers says "don't just do something, stand there!"

So that's what I'm doing, mentally rehearsing reactions good, bad and indifferent. Having my car keys in my pocket and my hand near the TV remote for when the inevitable reports of how easy A levels are start polluting the airwaves.

At least I didn't have that to contend with, the media scrum around A level and GCSE results days. The endless TV shots of comely independent school children opening their envelopes, screaming and hugging. The pundits on the breakfast telly sofas and the newspaper columns talking about how easy it all is. I've taught GCSE and A level, and they're not easy. You know, they are really not that easy. And waiting for those results for someone else is also hard.

I'll go back to fretting now. The sun is a little higher in the sky and the UCAS website could update any time now; the words "confirmed" or "rejected" next to his offers telling him what he really wants to know ahead of the actual numbers and grades. At least he's not waiting for the post because in these degenerate days there isn't an early post and I don't think any of our nerves could stand waiting to see Postman Pete striding down the hill in his GPO issue shorts at the crack of 3pm.

Camping it up

As good ideas go, maybe this wasn't. It remains to be seen. There is a bit of pre-holiday excitement building up but for me and Mr M it is definitely tempered by a sense of foreboding.

We are going camping. In August (usual season of typhoons, floods and other biblical plagues). With a total of six children and one dog. Granted there will be six adults, and not just any old adults but the ex-door neighbours and their eldest daughter and son-in-law, so good times are guaranteed. But still. My friend K and I are making increasingly anxious phone calls to each other about the logistics, I have emailed the campsite and double checked that we can use wind breaks and a gazebo around our tents. They have agreed but whether our planned stockade will be frowned upon is another unknown.

The campsite has a 10.30pm curfew, which is exactly what we want. Having been camping in places where people find it amusing to play music and shout and holler into the small hours I have a deep-seated loathing of noisy campsites. But Eva's current sleeping habits make me worry that we will be turned off the field, a noise abatement notice pasted to the side of our tent after a night or two of her waking up and yelling every couple of hours.

I have a love-hate relationship with camping holidays. In theory, I love them. I suspect that in practice I mostly love them too. Just in the days and weeks immediately beforehand I get decidedly cheesed off with the whole prospect. Insecure accommodation and escaping children - eek. No electricity - and no internet - pah. Twenty minutes to make a cup of coffee which you have to drink from a plastic mug - meh.

My first brush with camping came courtesy of the BBC's "Holiday" programme, which showed a sunny paradise that was camping in Norway. My parents and our cousins felt that this would be a good wheeze so off we went. To be fair I think we enjoyed it; by "we" I mean the four children. I know the adults were less enthralled to the point that my cousins' family bailed out after one too many nights of tinned meatballs and sheeting rain and went home. We spent the last night or two in a hotel. After a respectful interval the gigantic frame tent was sold and it was Never Spoken Of Again.

I think the next outing for me was a Guide camp, complete with trying to cook over an open fire (we had sandwiches) and about as much fun as a gang of pre-adolescent girls under canvas sounds, complete with bitchiness, tantrums, hormones and all.

So, what will this trip bring? Who knows. We are preparing for the worst, with a car full of wellies, umbrellas, colouring books and an ipod loaded up with Maisy Mouse and Peppa Pig episodes. Secretly hoping for the best. We'll see.

different hats

I've been thinking about this a lot recently, about all the different roles we inhabit. Specifically for me at the moment I'm mulling over my midwifery hat and my NCT hat - which you can see was made for me by one of my student midwife colleagues when I was in the slightly odd position of guest lecturing to my mates about the NCT.

Part of it is that I am cursed always to see other people's point of view, or almost always. (I struggle with "he's different, throw chairs at him!" or similar). But it's rare that I can't see where people are coming from even if I disagree with it. I remember Cherie Blair getting in bother for saying that she could see suicide bombers' points of view. I was surprised that a lot of the reaction was so negative because to me it's a no brainer; of course one can see how a particular set of stresses on top of a certain world view can lead to blowing yourself up. But perhaps not.

So I almost always get stuck on the fence when I'm between two points of view about pregnancy and birth. I'm totally passionate about antenatal education but I accept the evidence that it doesn't actually *do* much by measurable standards (perhaps we're not looking at the right things?) After all, why should antenatal education lower rates of epidural use? It's a perfectly valid choice after all, to decide that in the full knowledge of the potential downsides you're requesting that at the first opportunity. Is that a failure of antenatal education? I don't think so.

Then I start thinking that maybe it is, when I go into a room with a woman with no epidural or other drugs on board and see her birthing her baby in SUCH a different way.

Not that I feel that strongly about epidurals by the way. Except when I'm with someone who does when I immediately start seeing exactly why they're passionate...

So why do I need a midwife hat (starched, white) and an NCT one, hand knitted from lentils and hairy string. After all we want the same things, don't we? Similarly my friends who are doulas - professional birth companions. Why is there a tension between midwives and doulas? I'm mulling that one over too. Why would midwives feel threatened by someone else being there to provide a level of support which hand on heart rarely happens in an NHS labour ward? But then, why should someone without any requirement for training or regulation be in a position to advise a pregnant woman when a midwife has studied for years to do just that, and has a regulatory body to answer to if deemed to have acted improperly.

Don't know. In the meantime I'll keep giving myself a headache trying to balance multiple hats.