Hair and head bogs

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Sometimes, Mum would wrap my freshly-washed hair around bits of toilet paper and tie them up at bedtime. She’d complete the effort with kiss curls; coiled strands just in front of either ear, pinned in place by two crossed Kirby grips. The photo is from my cousin Sarah, on the left here, showing the two of us in 1964 aged three, on the beach at Bude. See my ringlets! Mum used to say: we all must suffer in the cause of beauty. I can remember her in the same era backcombing her hair, layering it in spray, adding hair pieces and grips and big doughnuts like roadkill moles, the constructions needed to achieve the Dusty look. Sometimes I got the Audrey Hepburn topknot (hair covering the mole that was as big as my head, and wrapped beneath, skewered with curved pins into my scalp), or the dreaded ringlets, which meant a night with knots hurting my head, unable to get comfortable, and the tussle between those and the pulling of individual strands of hair was some kind of torture. And tonight, my first night home, l’m back there in that powerless state with my new dressing catching now dry hairs all over and irking the Hunt scar in a way it hasn’t been irked before. So I grab the dressmaking shears and cut through one side of my hair, releasing it as Mum shrieks. Finally, a rebellion. Relief, but the dressing’s fallen off from the top. Mum manages to re stick it using one of the new dressings, but when I press the feeling is horrible, a kind of squidge and bubble. I decide to ignore it, and get the dressing redone properly at the Minor Injuries Unit in the morning.

I sleep till 4.30 which is some kind of miracle, then wake and write. As an active resister of routine, at the moment it’s quite comforting to know that I have one. Meal times aren’t usually a feature of my life – I eat when I feel like it. But here at my parents’ home meals are eaten at the dining room table, and they’re planned. I have extras thanks to the steroids which give me a gut-gnawing hunger, and so I start with my first breakfast of oatcakes and cheese – at the moment I have a passion for cambozola – somewhere between 3 and 4am, with a mug of ginger tea. When Mum gets up to make tea somewhere between 6.30 and 7.30 I have my second breakfast of toast with marmite or peanut butter and a mug of builder’s tea with steroids on the side. Then at 9 ish I eat oats with chopped nuts, dates, live yogurt and banana, with a cafetiere of coffee and a glass of apple juice. A whole day’s food by 10. Then there’s the pre-lunch snack with steroids on the side again, the lunch, the pre-dinner snack, dinner and late night snack, and the other meds I take, two of which are tailing off at different rates. It’s hard to keep track. I’m going to be an elephant, anyway, but one with a routine.

Mum and I are sat in the tiny MIU waiting area in Tavistock. We hear the shuffle, a clop clop clop. He appears in the doorway, sheepskin coat, tween cap, walking stick and pointy-toed gait. We smile and say hello.

They don’t tell you about old age, maids, tis a bugger! I used to be able to leap a five bar gate, now I couldn’t jump a straw! He gesticulates low down. These legs is dreadful…

I reckon he could leap higher than I could today, the life force is strong in him.

What happened to your cap then? There’s a triangular singe mark across the peak.

Got im damp and dried him by the fire, and he caught a bit. People’s always mentioning it, telling me I should get a new cap; well I got two spares but this bugger’s got plenty of wear left in im, he’ll outlive me! 88 I am!

He’s a regular, in need of social contact and dressings.The thing I miss most about my job is the contacts like this one; chatting and laughing with people who’ve lived incredible lives often, lives that have seen so many changes and upheavals. He shuffles off with the nurse to get his legs dressed, waving and smiling, muttering Tis a bugger.

A few minutes later and the MIU HCA is looking at my scar which is excellent, and in a flash she’s replaced the dressing with one that I barely notice. I have been worrying, because of the head bog. I’m not minor injuries trained, although a number of paramedics now are. It’s a specialised area, assessing wounds and how best to treat them. My approach is the classic ambulance one – clean, cover with something sterile and big to prevent infection that ensures nobody thinks you’re a Johnner (St John Ambulance are known for their most beautiful bandaging) and send them off for a professional assessment. When it comes to more significant injuries, and in particular head trauma, there’s one sign that we all look for; bogginess. It took me some time to work out what that meant when I started in the ambulance service, but once you’ve encountered it you know. We all talk about head injuries, but bogginess hints at the real concern which is compromise to the skull and thus an underlying brain injury. A boggy head wound goes to the ED, no questions. Now I’m feeling boggy myself and it’s most strange.

One of our favourite wild swims is down the river Aune or Avon from Aveton Gifford to Bantham. We go on the high spring from towards the top of the tidal reach, and swim down the ria three and a bit miles with the ebb. The top stretch is silted mud, and the water is opaqe, greeny orange and brackish. Here when you swim you feel the silt, press with your hands and mould it, release bubbles from dwellers in river mud. I know there’s a world under that brown gloop, a deeper, chthonian world I’m brushing with my hands as I pass. Lower down as the salt water sinks beneath the less dense and cooler river, there’s an area where methane from rotting vegetation is trapped beneath sand layered lightly by currents. As you tread you feel your feet are on clouds and streams of bubbles rise as you move, tickling your legs as you sink back into the water. My head contains a mix of those sensations, and perhaps some Dartmoor mire; one of the places I used to take my nephews bog-trotting, where you run and the ground wibbles and undulates as you pass.

It started with a need to blow my nose. I did so gently, and was surprised by bubbles blipping up from the left nostril beyond my eye. Air in the sinuses. Then when I touched the top of my dressing, the bog in my head began to bubble and squish. Reading the information on craniotomy, the piece of skull is replaced with srews, but is prone to lifting and moving till the bone heals and I guess that’s what I’m feeling, along with the swelling from the op (although I’m happy there’s not much of that as I have no major symptoms). The brain and spinal cord are encased by meninges or membranes, which have beautiful names: the dura mater is the tough mother, the outer protection; the arachnoid mater (spidered with blood vessels) sits beneath; and then the pia mater is the soft mother, the membrane covering the brain itself. Between the latter two is the subarachnoid space, filled with cerebrospinal fluid (CSF) that acts as a protective buffer. Those membranes have been cut, and I hope restored. Something I’ll ask about later, how do they repair such fine entities? To notice fluid moving from within is most strange. The potential presence of CSF in the form of watery bleeding from the nose or ears particularly is one of the signs we paramedics look for in our trauma survey and I’ve seen it on a number of occasions. So it’s especially odd to be feeling it, although in such a controlled way. Still, as Mr Fewings says, yes it’s brain surgery but if it goes well it’s fine. I think it’s fine. It just feels odd.

 

 

 

 

 

 

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No Beds

1262504_10151822703488251_1557854932_oThe op date will be confirmed today and I might have 2 more days, or not. All action at home; we’ve moved the room around and there’s a desk space which was a key job to finish.

Honey aka Bun, has been behaving oddly, asking to go out at 1.30am and vanishing for ¾ an hour then lying on the frosty grass. While dogs are acutely sensitive to vibes, she is otherwise secure, has stayed here often since I got her, gets fed sausage and other delicacies (I once arrived to collect her after a run of shifts to hear Mum exclaiming: “Damn! I’ve overcooked Honey’s asparagus!”)  I’m concerned there’s something else going on. We go to the Vet’s and have her anal glands checked, finding that they are indeed full. That’s a relief for her and me.

Wandering up the footpath with my walking pole for security (I negotiated with Mum that I could go out alone provided she knows where I am and I have my phone) I feel horribly weak. I have a fine, internal tremor, one that I’m unsure is physiological. Sub-butterflies perhaps, combined with the general knock off in strength that I’ve been struggling with for several weeks. I ring Kari and as ever we end up laughing and she suggests we go off on a trip to Budapest’s thermal baths, and also Rekjyavik. Maybe in a couple of weeks? I tell her about chatting to my friend yesterday, discussing menopause symptoms. C had listed hers:

“And I think… is there something wrong? No, it’s just the menopause”.

“Or it might be a brain tumour.” I reply and we end up guffawing.

Taking the advice of my Macmillan supporter, I have accepted practical offers of help, and so a friend who’s an IT bod came with his partner and dogs for lunch, bringing fabulous cakes from Exeter including one called Ginger Dick. So voice recognition is now set up on the netbook, and I have extra memory on order to speed up the operation which M will put in next week sometime. We look at transferring all my Mac files from the Macbook, and I list all my passwords and email addresses attached to accounts in a notebook. Another massive relief. It’s as ever, lovely to chat about my stuff and gain another perspective, and also to talk of their lives and our dogs and swimming expeditions.

No call from neurosurgery, so I rang at 4 and was put through to Mr Fewings’ secretary who tells me she will call as soon as she knows, but that there are no beds.  They’re in a meeting now, trying to discharge some people, and there are six of us on the list this week to find beds for (along with emergencies, of course).

The NHS has been dropping beds since 2010 and the start of austerity. We have among the lowest number of beds per head in the developed world. By beds, I mean not just a bed, but also the staff and equipment to man it. This is related to cost, and it’s of course considered inefficient to ever have an unoccupied bed. But a hospital is not a Premier Inn; for the system to operate properly there must be resilience, some flex in the system, so that in addition to the unpredictability of acute illnesses and admissions, there is also the ability to contain people who cannot be discharged when expected.

This latter point is a huge one. Bed blocking is the result of massive cuts to social care budgets since 2010. The extra strain on the NHS makes a mockery of all those claims of ring-fenced budgets which are in any case misleading because there is no contingency for increased usage nor for inflation – Southwestern Ambulance Service’s usage rises 7% annually, and has done for years.

The average loss (devolved to councils so that the government can lay the blame with their budgeting rather than the 35% central cuts to local services) from social care budgets is between 30-35% since the coalition took over in 2010. Incidentally, Tory run councils including my own are receiving bail outs from government to protect some key services, while Labour run councils are not.

If there is no safety net when a vulnerable person (frail elderly being the most likely group to be in this situation) is discharged, then they can’t go home. Elderly people usually do not need to be treated as medical emergencies and it’s not in their interests either. I’ve taken many elderly people back in to hospital in the 24 hours after discharge, because they can’t cope. Local, community hospital beds play a huge role here, because they provide a place of safety where assessment and treatment can take place, in a location where friends and family can easily visit. These people need to be supported, to have their conditions managed, to be loved, not dashed through a system that’s there to try to cure them; there’s no cure for old age.

Community hospital beds are like gold dust, and ambulances are routinely forced take elderly, frail patients (“off legs” is the generic term used, meaning anything from a urine infection, to constipation, to heart failure) into the acute hospital which in this area might be 50 miles away. Often they’re confused, and on an inappropriate ward (surgical, oncology) where they become distressed and wander around. I once arrived on the AMU in the Royal Devon and Exeter to find a bank nurse specially employed for the task walking up and down the bays with a demented elderly woman who was wailing, and screaming that her husband had been killed. The other patients were clearly unwell and upset, as was this poor woman who had been sent in due to “increased confusion” from a residential care home, which clearly could not manage her.

In my area, Moretonhampstead wards were closed not long ago, on the basis that the Okehampton community hospital was ‘underused’. It most certainly would not have been underused had those beds been open – but they wer closed to save money. We could have filled them twice over, but instead all those people were being carted off to Exeter by an ambulance (25 miles rather than a local trip) which is then not available for 999 calls for well over an hour. And Exeter fills up, starts to breach the 4 hour ED targets, blocks at the AMU. Add to that the resultant travel concerns for elderly relatives who have to hike 16 miles by bus to visit patients who might well be end of life.

The justification for closing beds is always some combination of underuse/efficiency and the provision of social care in the community. The latter is often – but not always – a grand idea but it costs a lot of money to set up and run properly, and also requires huge support for carers. Imagine too living with a hospital bed in your sitting room, hoists along the ceiling through the doors to the bathroom.  It’s an ideal, but the impetus is key. Currently care in own homes is used to justify cost-cutting closures, when it’s anything but the cheaper option. The costs are moved elsewhere  (GP, ambulance service, emergency departments, acute medical units). And at the end of the line is someone like me, awaiting urgent surgery, but without a bed. Planned surgery will of course have already been cancelled. This is anything but efficient. It’s a massive waste of costly theatre time and all those massively expert staff who are now waiting around rather than doing their jobs.

So here I am in the wee hours, with no idea whether my op will go ahead this week at all.

Last eve my brother Iggy, sister in law Sarah and nephews Lee and Max arrived along with Lee’s gorgeous partner Louise. It was lovely to see them, though it felt rather like the last supper (with salty snacks rather than supper). I showed them my text from the DWP. Their faces said it all.

Reading over this post it sounds flat, and reflects I think a slight separation I feel from my soul. I’m off to Bantham today because I’ve been doing a job for the Outdoor Swimming Society helping to set up for an advert involving wild swimmers. I’m really going along for the craic, because I’m not up to a whole lot physically or emotionally, but I’m so looking forward to spending a day with the production crew and my friends. I guess in my head I’m floating down the Aune Swoosh, one of our favourite swims, and ahead of me is the estuary rip and the reefs and breakers of Burgh and Bantham. But I’m seeing and feeling it from the drone that filmed this swim last year, swooping overhead and in and out of different parts of the action, unable to quite hear the water, taste the salt or see the fish.

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