Monday, 13 February 2017

It's just my job, five days a week

Partha Kar, one of the #DocsOfGBDoc, caused quite a stir this week with this well-argued blog post about whether being a doctor is “just a job” or something rather more noble – a vocation. His post argued that being a doctor, even a consultant with multiple responsibilities and involvements like his, is for him a job, no more and no less than many other jobs, a conclusion that some might think somewhat at odds with his much-admired persona as a doctor who so obviously does far more than what he needs to. Surely, we might think, if ever we needed proof that Medicine is a calling, then we have it in the life and work of our Dr Partha.

Like all good blog posts, this one set me thinking. Is there such a thing as a vocation? As a teacher, married to a teacher, I am the son, grandson and great grandson of a teacher on one side and the son and grandson of a clergyman on the other. I am now father of an exceptionally dedicated teacher, a passionate recruiter of university students and a proud welfare assistant, so I have always been surrounded by people who work in jobs which are anything but nine-to-five, and which you often bring home at the end of every working day. Surely, I have seen people living out a vocation, and indeed I have lived out a vocation in a thirty six year career in teaching. I have never regarded devotion to work as anything other than the norm: my father often used to break family holidays to conduct funerals requested by the families of loyal parishioners, and in the days before safeguarding my mother often used to invite pupils from her school into our home for extra practice before important piano exams. 

As a teacher, I have always believed in doing what needs doing in my students’ interests rather than just doing what I’m paid for. I am also very conscious that I give off a very strong “teacher vibe”, and always have done. Strangers always guess what I do for a living, and I’ve probably been addressed as “Sir” more often than by my name over a lifetime. Former pupils, even when well into middle age, or even famous, still call me “Sir”. Some of the younger teachers at my school address me as “Sir”, not that I have ever encouraged it, and even some of my new friends on the #GBDOC use the term, despite having only met me as an equal, or in some cases not met me at all. I can’t shake it off, and I feel very much like the proverbial Mr Chips with a lifelong vocation in teaching. 

Yet the more I think about it, the more I agree with Partha. I’ve loved every minute of being a teacher. I’ve given it my heart and soul, and worked every hour God sends when necessary. But it’s just a job, and when I’m not doing it I’m very happy to forget all about it. 

Shock horror! Doesn’t he care? Of course I do. But the more I think about it, the more I feel that the whole idea of a vocation is flawed and potentially harmful.

Firstly, it carries for me the whiff of obsession, with the attendant risk of fatigue and burnout. I’m far from convinced that it’s healthy for either the individual or the profession for the former to be completely taken up by their job, and anyone who calls their job a calling risks seeing themselves as indispensable and losing a sense of perspective. I like people to have what is these days called a "hinterland": I always feel added respect for people who have an unexpected, unusual or incongruous interest – like trainspotting rock singers, wildlife-loving footballers, dancing politicians or rugby-playing doctors. I’m sure that a contrasting interest makes an individual more balanced, grounded and therefore more effective in the day job.

Secondly, and more importantly in my view, the idea of a “vocation” for medicine, teaching, nursing, the church, social work or whatever strikes me as rather arrogant and belittling towards other jobs. Surely it is possible to do any job with a sense of commitment, going beyond the call of duty and service, and I have to say I like nothing more than seeing another job well done. I’ve seen and benefitted from doctors, teachers, nurses, vets and clergy with an awesome sense of duty and commitment, but I’ve also had the pleasure of witnessing a true sense of vocation from car mechanics, waiters, chefs, painters and decorators, financial advisors, car salesmen and every job imaginable. The most dedicated professional in popular song is not a doctor or a teacher, but the eponymous Wichita Lineman.

I recently bought a replacement car battery from Halfords, and as I was very busy at the time, I elected to pay to have it fitted. I was so glad that I did so when it turned out to be an unexpectedly fiddly job because of badly corroded fastening clips, but I was even more glad that the job was done by a cheerful, resourceful and chatty young woman, whose manifest pride in a simple yet tricky job showed a true sense of....vocation. The fact that it was a woman doing a job traditionally associated with men was just an added bonus. Why should it not be a vocation to do anything and everything?

Of course saving and preserving lives matters more than changing car batteries or serving food. Of course teaching five year olds to read and write matters more than getting a smooth gloss finish, but we can’t all qualify to be doctors or teachers. What literally anyone can do is take pride in a job well done, give that little bit extra for no financial reward. And therein lies a vocation in which we all can share. "From each according to his ability, to each according to his needs" may be an unfashionable motto, popularised by the in some ways discredited Karl Marx, but it has always seemed to me to be a pretty good basis on which to build a decent society.

We are all “called” to do something, and that something is our job. It’s how we put a roof over our head and food on the table. I hope that I’m not being naive and idealistic when I say that to do your job with a sense of selfless pride and vocation means you’re more likely to enjoy it. But in the end, in the words of Elton John's Rocket Man, ”It's just my job, five days a week"

Saturday, 21 January 2017

The Boy in The Bubble

There’s been some talk this week on diabetes-themed social media about diabetes-themed social media. That might sound rather like navel-gazing, but in fact the conversation I saw was all about the limitations of social media in supporting people with diabetes, and the risk that those of us who use it a lot fall into the trap of over-estimating the size and scope of the SocMed bubble.

So are Facebook and Twitter here to stay? Are they essentials of patient care and peer support or are those of us who use them just a self-serving clique? Am I, a massive fan of Twitter and the #GBDOC, part of a genuinely valuable and valued group which helps people with diabetes to live well with their condition? Or am I  just an overgown teenager - The Boy in the Bubble?

It’s all about the bubble. I’ve had cause to question whether I’m in a bubble more than once over the past year. The Brexit vote and the Trump victory both seemed so at odds with what virtually everybody to whom I ever speak in the real or online world said that I had to conclude that I really did live in a rather limited world, full of people whose outlook and opinions are very close to my own. Self-evident in many ways: I’m a university-educated baby-boomer retired languages teacher, the child of a Liberal Christian clergyman and a schoolteacher, married to another languages teacher, living on a suburban road in a pleasant and reasonably prosperous market town. Hardly likely to be a Brexiteer or Trump fan, I guess, or to associate with those who are. Those of my generation and younger who were so shocked and dismayed by the Brexit vote should perhaps think what it feels like to be an elderly white Briton, brought up in the afterglow of the Second World War, believing that Britannia does indeed rule the waves, and finding your town swamped with people speaking a strange language. And before we guffaw too much at the election of an atavistic billionaire male chauvinist to the most powerful job on earth, we should perhaps imagine how it feels to be an unemployed factory worker from America’s rust belt, who has seen his work out-sourced to a Mexican factory, where labour is cheaper. I strongly disagree with both of these archetypal voters, yet can see why they might be attracted to such simplistic political solutions as those proffered by UKIP or Trump.

To an extent, we all live in bubbles, in comfort zones populated by people with whom we generally agree on a whole range of things. As a species, we are comfortable with the familiar, and gather together in bubbles of our own choosing, both in our real lives and now also in our online associates. We like to hear others say what we are thinking. But we should be cautious of over-estimating the size of our own bubble.

So what of the “Diabubble”? Well, I’m well and truly in one, but I’m aware that it’s actually pretty small. There are some 4 000 000 diabetics in the UK, and about 400 000 Type Ones. I “know” a few hundred on Twitter (I’m still a Facebook refuser for now) and regularly talk to fewer than 100, and wouldn’t presume to call more than maybe a few dozen “friends”. I’ve met around that number in real life, and found them without exception to be not only exactly like they seem through the filter of 140 character tweets, but also without exception the most delightful, friendly and supportive of friends. An online community linked only by a medical condition which is by its very nature random has led me to a circle of friends who are diverse, yet appear to share most of my core tastes and values.

Nobody is more surprised than me to find myself part of such a bubble. I am not by nature very gregarious, having always been very happy in my own company, yet I am sociable and interested in the lives of others. As a child, and indeed throughout my adult life, I have always tended to be friends with “everyone and no-one”, with no really close friends. When I developed diabetes in the late 90’s, I had no interest in getting to know others with the condition, indeed I actively avoided overtures from local “support groups”. I stumbled upon the #GBDOC sometime in 2013, by accident rather than design, having joined Twitter out of idle curiosity in 2011, and was certainly not seeking either friendship or knowledge about diabetes. Yet it has become a very big part of my life, and some of my diabetic friends have become valued and trusted sources of knowledge and friendship. They are also very good company, true friends both online and when I've met them in the real world, and I hope that the feeling is mutual.

Yet there are far more diabetics out there who either don’t know about the online community or don’t want to be part of it. So whilst it’s all very well for those of us who like and use the #gbdoc to pat ourselves on the back for being so knowledgeable and mutually supportive, it would be wrong for us to get carried away and think we speak for all diabetics. Just because we are helped, or even amused by tweeting pictures and tales of our (quite literal) ups and downs, doesn’t mean we should expect everyone to. We may be expert patients, but that doesn’t make us experts, and I know that there are people with diabetes out there who get annoyed by the constant stream of what one user colourfully terms "diabollocks".

Should we be evangelists for our community? For me, the instinctive answer is no. I have a deep-seated suspicion of evangelising: I am a practising Christian with a very particular take on faith (look elsewhere on my blog if you really want to know more), but I have no interest in converting others, let alone saving souls. I actively support my childhood football team, Bolton Wanderers, but fully understand that many other people support another team, or think that football is a futile and over-rated pastime. I love cats, but fully recognise that others love dogs. Each to his or her own.

We are all different, but those with whom we most readily associate are more likely to echo our own feelings and opinions. We can, and should, if asked, extol the benefits and advantages of what we like, do and belong to, but we should not assume that there is only one way to do things, only one way to think. And that applies every bit as much to diabetes and healthcare as to anything else. 

PS I haven't a clue what Paul Simon's song The Boy in the Bubble is about. It just satisfies my need to give every post a song title. Good song, though!

Tuesday, 3 January 2017

Ch-Ch-Changes: Thoughts for New Year

Turn and the face the change: a very apt title from the wonderful back catalogue left by David Bowie, one of the many unexpected and premature deaths that seem to have characterised 2016.

Many have branded 2016 as the “worst year ever”, citing in particular the Brexit vote and its aftermath, the election of Donald Trump to the US Presidency, multiple terrorist atrocities and the aforementioned celebrity deaths.

It is very easy to join in with this chorus of negativity, but two points come to my mind: firstly, I think that many of those who talk doom and gloom should perhaps consider swapping their lives in our comfortable Western democracies in 2016 with those of people in many other parts of our contemporary world, or indeed with those of British people in, say 1940 or 1916, before declaring their lives to be quite so shitty. However bad things seem, there are far worse places to live and for worse eras to live in. Secondly, I think we should be very careful about seeing everything through the filter of the hyper-connected and over-reactive world in which we live, rather than through our own response.  In other words, are we over-influenced by a collective response to what happens, rather than just forming our own reaction?

My memory of the elections of Margaret Thatcher as UK Prime Minister or Ronald Reagan to the Presidency in 1980 is that these were accompanied by similar ridicule, bewilderment and hysteria about imminent Armageddon, but there was not the same opportunity for mass reaction, and so that reaction was more muted, confined mainly to the traditional media, with no chance for hashtags and social media campaigns.

Yes, we may well feel that both of those figures of hate and fun from the 1980s inflicted much harm upon their respective countries and indeed the wider world, but we all survived. And we have all survived 2016, and will no doubt survive 2017 and beyond, albeit with plenty of hurt and sorrow along the way.

If 2016 can teach us two things, it is that nothing is more inevitable than change, and that we do not always get what we want. Many of us, myself included, are deeply unhappy and apprehensive about the changes that 2016 has brought about, just as we all get upset in our daily lives about all sorts of things: the new boss’s policies at work, refereeing decisions in football, winners of Strictly Come Dancing or Britain’s Got Talent - whatever may upset us at any given moment. Life isn’t fair, shit happens, and we don’t always agree with those who have power over us, but I always feel that we spend too much time wishing that things were otherwise. Turn and face the change.

I faced my own change in 2016, retiring from full-time work and in particular from a role which I, and only I, had undertaken for 25 years, as Head of Sixth Form, a position of considerable influence over the lives of the young people with whom I worked. Of course I miss it, and as I still work in the same school, I watch my old job being done by others, in a different way.

But as one door closes, others are opening. Over the past two years, I have become increasingly involved in the community of my fellow Type One Diabetics, and have found new opportunities, new friendships and new experiences which provide me with fresh challenges for 2017 and beyond. I hope to have the opportunity to help others, be it online or face-to-face, to live and flourish as I have done with a condition which is difficult yet manageable. I hope to use the skills and experience gained in a lifetime of teaching in new and different ways. Accepting that I am getting older and not in perfect health, I hope to have a life which is less physically demanding yet still busy.

My life is changing, the world is changing. Let’s stop moaning and get on with it.

Happy New Year!

Tuesday, 27 December 2016

You Have been loved: an appreciation of George Michael

Christmas Eve 2016. I was enjoying my family’s tradition of a pre-Christmas evening meal and, as always happens when we gather, conversations about music were inevitable. My 29-year-old son, a gifted, knowledgeable and dedicated choral singer, startled his two sisters, both also experienced, talented and committed choristers, by stating that George Michael was the best interpreter of rock and pop songs of his and any generation. His elder sister, never short of an opinion and never one to shirk a good-natured argument, was surprised that her brother, a rational scientist with a professed love of some of the great choral works should heap such an accolade on a rather unlikely idol. However, a brief discussion of the merits and scope of George’s work and technique led quickly to appropriately harmonious agreement. We listened to Last Christmas, reminiscing as so often before about that iconic video of the snowy Alpine holiday. 

Just 24 hours later, George Michael was dead, the latest of the so-called curse of 2016, triggering an outpouring of sadness and an unprecedented spike in downloads. Quite a 2016 bookend to the January demise of David Bowie. The media have, of course, had a field day, with his musical legacy and personal demons analysed to the Nth degree and celebrities and pundits all chipping in with words of tribute. It has become an all-too-familiar routine.

So just how good is George Michael? Is my son right? Or are we all getting carried away with the prevailing media-led sentiment? For me, the answer is that he is entirely deserving of the praise, regardless of the untimely death. And of course I now have the memory of that Christmas Eve conversation as proof that we are being led by genuine musical discernment, shared across two generations.

Perhaps that’s a good starting point. Any artist whose appeal can transcend different audiences and different eras is worthy of special attention, and of course Bowie passes that test as well. George Michael bestrides the turn of the millennium with almost perfect symmetry, from bursting on to the scene in the 80’s, all gleaming teeth, rolled up sleeves and highlighted hair, through the social activism and remarkable generosity to good causes of a mature rock star to a prolonged and troubled mid-life crisis with an all-too familiar end on Christmas Day 2016. Along the way, he has earned the admiration, either unbridled or at least grudging, of everyone from impressionable teenage girls to earnest gay activists to staid schoolteachers like me – and indeed my son, thirty years my junior.

George Michael was multi-talented: a songwriter, singer, multi-instrumentalist, producer and charismatic stage presence. But I think it is indeed, as my son suggests, as a vocalist, as an interpreter of his own and others’ songs, that he deserves the strongest praise. He could do joyful exuberance or profound melancholy with equal alacrity, and is one of the few singers who could take a song strongly identified with another artist and come up with a cover which improves on it.

Let’s take the joyful exuberance first: the Wham songs being endlessly replayed in recent days are so palpably full of life that it is unbearable to imagine their singer taken from us so relatively young and from such a manifestly unhappy life. Listen to Bad Boys, Wake Me Up before you Go-Go, Club Tropicana and Freedom and you hear fresh-faced youth singing for fresh-faced youth about fresh-faced youth. George’s voice smiles and sparkles like his teeth and the highlights in his hair, in a manner which is at once effortless yet crafted. Listen to any of the repeated lines (like “but you know that I’ll forgive you” in Freedom) and it comes out slightly differently each time it occurs, with delicate vocal twirls like the flourish of a master pâtissier icing a cake. Whether improvised or planned, I neither know no care; imagine those same lines sung with just the straight melody line and the song is immensely diminished in impact. The same remarkable vocal twirls are there before the lyric even starts in Last Christmas in that improvised “Oooh”. A superb example of the human voice as a musical instrument. You may not have noticed that vocal, but take it out and the song has lost something small but hugely significant.

Then there’s the profound melancholy. It’s there in Last Christmas, of course, but is all over his work, and of course a glaring sign of a deeply unhappy private life. Careless Whisper is the enduring favourite, loved by all generations with its recounting of the timeless and familiar theme of guilt after temptation. Everybody knows and loves that soaring saxophone riff and the chorus hook “I’m never gonna dance again” that could be the title but isn’t. But therein lies, in my view, a little touch of genius: the title is only heard once in the whole song, at the start of verse 2. Written by 17-year-old George, it is a hugely emotive yet restrained song, which tugs at the heartstrings as well as any lost love song ever written. Yet for me, the less often heard A Different Corner, from 1986, is an even better song. For a start, it repeats that subtle trick of the title being heard only once – such a clever and seldom used device in songwriting. But whereas Careless Whisper sounds like a tale of youthful indiscretion (cheating on your girlfriend at the School Disco?) and what might have been, A Different Corner sounds more like a divorcee’s lament for what very much was, with a more profound sense of loss. The aching sadness is again in the vocal: “Little By little, You brought me to my knees”, and the emotion that George conveys in his voice is simply awesome.

There are numerous other sad songs, of course, perhaps most famously Jesus to  a Child, written following the tragic death of his partner. Lots of great songs have been written about loss, but George Michael’s strking and daring choice of simile, unusual yet totally apt, is what makes the song so memorable. You have been Loved was not written as a tribute to Princess Diana,  but became one, whilst Don’t Let the Sun go down on me seems like a plea for a break from life’s woes. 

That song, in which its author Elton John, who had a big hit with the original recording, appears as a guest vocal, stands as an example of one of many where George takes an already well-loved standard and performs it with such respect and sensitivity that it arguably betters the original. He recorded a whole album of them in 1999 when he released Songs From the Last Century, and his rendition of great songs like Stevie Wonder’s As and Queen’s Somebody to Love shows his remarkable talent for interpreting the emotions of others. The former was a duet with Mary J Blige, one of several such collaborations which perhaps say something of his humility and generosity of spirit: in 1987, for example, he proved to be more than the equal of the legendary Aretha Franklin with the powerful Knew You were Waiting. And of course he had one of the key lines in the original and best version of Do They Know It’s Christmas?, which in just a few words exemplifies not only his gift for conveying emotion but also his ability to collaborate so effectively with others.

Much has been made since his death of George Michael’s extraordinary, and often secretive, generosity. That facet of his personality surely indicates, above all else, humanity and generosity of spirit, and that, together with the most beautiful of singing voices, has left us with a legacy which will long outlive him. Truly, George Michael, You Have Been Loved.

Friday, 23 December 2016

A Wombling Merry Christmas: an appreciation of Mike Batt

Among the Christmas hits that dominate the airwaves and form the soundtrack to any visit to a supermarket, garden centre or restaurant from mid-November onwards, one of the less commonly heard is Wombling Merry Christmas, which was a Top Ten hit in 1974, riding that year’s wave of popularity of the furry eco-warriors and their pre-news TV show. At one level, it’s just another identikit Christmas song of the sort that has been churned out over the years: a catchy tune, with cliché lyrics overlaid with sleigh bells. And of course in 1974, a 7” single was a perfect stocking filler for children who had fallen for the lovable litter-pickers and their music. It couldn’t fail at the time, but is now too often overlooked.

But listen again, or to any of those songs performed by a band of men dressed in furry costumes, and there’s a lot more to it than just a novelty song. Yes, it’s got all the Christmas clichés, but there’s more than a touch of class about the melodic progression, the orchestration and the production. It bears the unmistakable hallmark of the versatile musician Mike Batt, who wrote, produced and sang all those Wombling songs and a whole lot more besides. He’s one of those musicians whose versatility and breadth of musical skills mean that he risks being overlooked or regarded as a lightweight: not cool enough to be a respected rock musician, not serious enough to be a respected classical musician. This is a pity in my opinion, and his work over five decades merits more recognition than he gets. A bit like Wombling Merry Christmas.

Take those Womble songs for a start. Batt’s ability to write and produce songs in any style shines through: from the theme of the TV series came their debut single, The Wombling Song with one of the best melodic introductions I know, played on the French horn, hardly a staple instrument of pop and rock. He's fond of featuring more unusual instruments in his songs, a bit like another of my heroes, Roy Wood.

Batt followed that initial success up by cleverly exploiting the Womble craze while it lasted, with a series of pastiches of musical styles. Remember You’re a Womble with its violin hook, is a country square dance; Minuetto Allegretto dares to rip off Mozart of all people, while Wombling White Tie and Tails cleverly evokes the Hollywood of Fred Astaire and Ginger Rodgers. And of course there’s the already mentioned Christmas song. Novelty songs all of them, but a clear indication that their writer/ producer knows his music across a very broad range of genres.

Since that lot, we haven’t actually heard Batt much. He released one single in his own name, the theme song for a mid-seventies TV series Summertime Special - it's another “annoyingly good” song called Summertime City, but then concentrated on writing, arranging and producing. If you know your 70’s and 80’s pop, you’ll be familiar with all the songs, but you may be surprised to learn of Mike Batt’s involvement in at least some of them. In 1975, he turned a traditional folk song, All Around my Hat, into a big hit for folk band Steeleye Span, then in 1979 he wrote and produced Bright Eyes for the film Watership Down, giving Art Garfunkel his biggest solo success. Bright Eyes is the archetypal Mike Batt song, characterised by clever chord progressions that somehow tug at the heart strings and clever use of that most bitter-sweet sounding of instruments, the oboe. It always reminds me of one of my favourite French songs, La Montagne by Jean Ferrat, an achingly sad eulogy for the rural way of life lost in the late rush to urbanisation in post-war France. You don’t need to understand French to get this song, and even if like me you do speak French, you won’t understand all the lyrics, but you’ll get the feel of it. Like Bright Eyes, it just sounds sad and wistful.

Mike Batt certainly knows how to write a sad song. If you want to wallow in your misery after a failed relationship, try any one of these three Mike Batt compositions from the early eighties, all written for established artists: Please Don’t Fall in Love by Cliff Richard, A Winter’s Tale by David Essex and I Feel like Buddy Holly by Alvin Stardust. They won’t cheer you up, but they’ll put your sadness into music, never mind words, and assure you that however unhappy you are, someone else has been there as well and made a damn good tune out of it.

Talking of good tunes, you probably didn’t know that the main theme from Phantom of the Opera is in part a Mike Batt song. But it is, and in this case it was the lyrics, not the tune, that he co-wrote. And he also produced the Steve Harley/ Sarah Brightman version of that song, which served as such an effective trailer for the show.

Then there’s Katie Melua. Although her success is often rightly credited in large part to the late Terry Wogan’s championing of her work on his breakfast show, it was Batt who wrote much of, and produced her debut album Call off the Search. And the break-out single, still her best known song, Closest Thing to Crazy, is archetypal Mike Batt. It’s a sultry, jazzy song that sounded like a years-old standard as soon as it came out. One of those songs that you think you know the first time you hear it.

Perhaps that’s the thing about Mike Batt. In some ways, his music is a bit derivative, but what’s wrong with that if it’s done so well? He’s so good at writing in so many styles that he risks being seen as a jack of all musical trades, lacking in specialist talent or originality. He certainly deserves to be regarded as more than just “the man behind the Wombles”, but those songs alone deserve a lot of credit. I wish you all a Wombling Merry Christmas.

Monday, 19 December 2016

Life is a Rollercoaster: Diaversary Reflections

This is an update and re-edit of a post previously published as My Diabetes Story. Today (19-12-2016) is my diaversary, a term used by people with diabetes to "celebrate" the anniversary of the day when they discovered they were to live the rest of their lives with an incurable but manageable condition. I was diagnosed on 19th December 1997, at the age of 40, and here's the story.

Until that age, I had lived a life with minimal contact with the health service. I had a couple of standard childhood illnesses, leading to a couple of spells off school before the age of 10; I then managed an entire secondary school career without a single day's absence. I fell off my bike at the age of 13 on the first day of the summer holidays and suffered a straightforward arm fracture, which mended in the standard six-week time frame. And that was about it. Prior to my diagnosis with diabetes in 1997, I had worked for 17 years as a teacher with a total of four days off sick (two lots of two).

Moreover, I was a slim, healthy and active person: as a child I cycled to school, played football competitively and spent holidays fell-walking with my family. As an adult I cycled to work, tended an extensive garden and walked from my home to the local shops rather than driving. And I still do.

Then, as 1997 came to a close, with Robbie Williams' enduring classic Angels dominating the airwaves and the Tellytubbies bagging the Christmas No 1, I had a very bad case of 'flu in the week running up to the the Christmas break at school - a week's absence for the first time ever. No real cause for alarm: there was a big epidemic and a number of colleagues were off at the same time. Then, on the last day of term, after I had started to feel better again, my condition took a nosedive, and I went to my GP, alarmed at this apparent recurrence of an illness from which I had just recovered. I felt tired, thirsty and run-down, but just thought it was a hangover from my first real illness in years and a long, hard term's work. A routine urine test revealed very high blood sugar, and an alarmed GP (parent of three children whom I taught) informed me that she was pretty sure that it was diabetes, referring me to her colleague at the practice who was the specialist in diabetes. He told me to "cut out all sugary foods" and see if the sugar level fell. This puzzled me somewhat, as I have always had a famously "unsweet tooth"- there was little or nothing to cut down on. However, I agreed to do so, and came back a few days later - just before Christmas - to discover that my sugar level was higher than ever. "OK, said the doctor, we'll put you on medication" He was assuming, from my age, that I was Type Two. Looking back, I have to say this was a questionable diagnosis in the face of all evidence - I was slim, ate healthily and exercised plenty - but again, I went along with it and took the pills for a few days (including Christmas Day). 

It was only when I reported back with an even higher blood sugar level and no sign of feeling better that he finally wondered if it might be late-onset Type One. Off to hospital I went (only as an out-patient), where a consultant agreed it certainly must be Type One, and referred me to the clinic to learn the noble arts of injection and blood testing. I did all this without missing any days off work, despite feeling very tired. My school were very good to me, and as I live near to the school, I was able to come home for a rest at lunchtime and leave early when not teaching.

Two different insulins, two pens 
- my permanent companions.
Once the insulin started to have an effect (and that effect comes on almost instantly, as anyone with Type One will tell you), I was soon back to normal. By the Easter four months after diagnosis, I led my annual residential school trip to France with about forty pupils and five colleagues. I continued to do this every year whilst it remained part of my role at the school. By the June six months after diagnosis I was planning, setting up, organising and running the end-of-exams Ball for 200 Sixth Formers, a demanding job I undertake every year. In day-to-day terms over the 19 years since, I have continued to take on all that life and work throw at me, all with an unblemished attendance record in a very stressful job. I am certainly not a burden to anyone, and other than the cost of my insulin and test strips, the annual flu jab and my annual clinic review, I don't bother the NHS at all.

But let's not pretend it's easy. Living with Type One diabetes is a 24/7 challenge that we face on top of all as that we do in life, whatever that may be. You can never forget or overlook it for more than a few minutes. Every action, every piece of food or drink, every event needs to be thought through. Any departure from routine is potentially risky. And for me, the uniquely infuriating challenge is that insulin - the treatment that you self administer every day in order to preserve your life - is precisely what threatens to bring you down in day-to-day terms. I think is fair to say we have a love-hate relationship with it!

My Diabetes drawer - all the stuff we need to keep going

And yet it could be worse. Let us not forget that. It was a lot worse until the discovery of insulin therapy by Canadian Frederick Banting in 1922, when Type One was in effect a death sentence. It is a whole lot worse in many less fortunate countries where access to insulin is still limited or non-existent.

The 400 000 of us who live with the condition in the UK have good cause to be grateful to our doctors, nurses, designers and makers of insulin delivery methods and blood testing kits who enable us to live normal, active lives. I am particularly grateful that I discovered the FreeStyle Libre, a clever monitoring device which helps me to stay one step ahead of my blood sugar levels.

And then there's the silver lining to this cloud: my fellow diabetics. People with diabetes are remarkably supportive to each other and in recent years have used the internet to create a wonderful community, known as GBDoc in the UK.

What's the collective noun for diabetics?
In one of the best illustrations there is of the good side of social media, thousands of diabetic people of all ages, both genders and all backgrounds regularly support, help and encourage each other online in a spirit of togetherness and cheerful acceptance of a condition which can at times make its victims feel frustrated and lonely

It's no fun having Type One, although it is fun being part of a worldwide community of people who are very good at making the best of a cruel stroke of luck. I certainly feel that having diabetes has enriched my life and made me a different person with a more interesting life.

With diabetes, we are reminded every minute that Life is a Rollercoaster. We've just gotta ride it.

Tuesday, 29 November 2016

With a Little Help from my Friends

The reason for the title of this post will become apparent when you have read it. I am always very reluctant to use my blog or social media to be negative and critical, but I feel the need to pass comment on a matter which has already attracted much comment elsewhere. Diabetes Care.

I won’t bore readers who already know me with chapter and verse on my Diabetes story – it is in this post if you don’t know it. Suffice it to say that I have been most fortunate, in that I have lived for almost 19 years with Type One with minimal complications, good health and no significant impact upon my life and work. All I would say is that this is thanks in no small part to my own efforts, the care and concern of my immediate family, and in practical terms, the input of the health care professionals with whom I have dealt on a regular basis. Diabetes is hard work, all day, every day.

Six years ago, as a result of my consistently unproblematic condition, it was suggested to me by my hospital clinic that I should be discharged to the care of my GP practice. At the time, this was a welcome and appealing suggestion, which I willingly accepted. I had always found the six monthly clinics a nuisance rather than any help: I had to take an afternoon off work, which for a teacher means setting work for classes, travel to a crowded hospital with (at the time) appalling car parking problems, then sit for ages in a stuffy waiting room between various stages of a ponderous and inefficient process (one room for weight and height, one room for a BG tests, one room for seeing the doctor, another if necessary for seeing the nurses.) I always had a brief and frankly unnecessary chat with a consultant, who congratulated me on how well I was doing, exchanged a bit of small talk and sent me on my way. All very nice, but of no clinical value if the truth be told. The most meaningful and useful input was from the hard-pressed nurses, who scuttled from room to room, stopping to chat in the waiting area to check if I was OK for pens, was my meter OK etc.

The prospect of replacing all this with a convenient appointment at my local GP, ten minutes’ walk from home, was most attractive, and I took it. So for six years, I had this annual review, essentially just a standard GP appointment, but with a doctor who is designated a diabetes specialist in the context of the practice. I still had my twice yearly HBa1c test, annual retinopathy check, foot check and all the right questions from the doctor, so I was happy, and continued to have “good” control and a good HBa1c result (albeit creeping slightly upwards into the 8’s)

Then came the GBDOC. Again, no need to repeat the story – it’s here. But the GBDOC meant that I started to be able to “compare notes” on diabetes care with others. First of all online, then face-to-face with some, as I became more involved with the community. I was becoming more interested in my diabetes, not least with my children grown up and independent and my work life reducing to part-time semi-retirement. I started to realise that I was perhaps being short-changed on my care compared to others, and that perhaps I now knew more about diabetes than the experts who were caring for me. This suspicion was increased when in October 2015, after 6 months’ use of the FreeStyle Libre (which, needless to say, I had discovered via the GBDOC!), I presented at the GP practice with a sudden fall in HBa1c at my annual review. A clearly impressed doctor asked if I had been “doing things any differently”, and when I mentioned the clever little device that was enabling me to react to and control BG levels so effectively, he was stumped. He’d never heard of what many believe to be one of the most significant advances in diabetes management technology, and earnestly made a note of the name of the device. Fair enough, I thought. He’s a busy GP, not a consultant. And a nice guy, manifestly caring and conscientious.

I decided that it was time to see whether the hospital knew any better, so I ‘phoned the helpline to the nurses which I had been given back in 1997 and had never used. I also wanted to ask about a DAFNE course as a way of adding to my growing expertise in diabetes management. The helpline operates from 11-12 daily, is on voicemail until 10:59 and after 12:01 and engaged for the rest of the time. Have they heard of email? After repeated re-dialling, I got through, only to be told that as I was no longer a patient of theirs, I was ineligible for the DAFNE courses at their hospital, and whilst they could advise me over the phone in response to another query, namely about getting a new injection pen, they were really doing me a favour. I thanked them courteously and resolved to get referred back to the hospital.

And so it came to pass that yesterday, Monday 28th November, I went on a sentimental journey back to the clinic I had attended for all those years. Some things have improved: there’s a smart new multi-storey car park, with modest charges and loads of spaces. The hospital entrance has been rebuilt and extended, and feels like a provincial airport or a railway station, with well-designed waiting areas, big-screen TVs everywhere, and branches of Costa, WH Smith and M&S Simply Food. I actually knew of these changes, as I had been to the hospital for other reasons (most recently visiting a pupil newly diagnosed with diabetes as it happens!), but even the clinic had moved on….a bit. There was an automated check-in system, which worked. Someone had realised that it makes sense to do weighing, measuring, handing over the urine sample and testing BG all in one room with two people, rather than three rooms with three people. So far, so good. And having done all that, I was seen within 15 minutes of arrival, and starting to feel I had made a good decision.

But then I went in to see the doctor. A consultant, I presume, although not the named person on the appointment. No sign of #hellomynameis. He was a pleasant, courteous man, but he just asked how I was, waited 5 minutes for a screen full of data to appear, and told me what I already knew from my recent GP review, that I had “excellent” control, and enquired about how I managed my diabetes.  I told him that I had started using the FreeStyle Libre 18 months previously and proffered my tablet screen full of Libre data. He looked blank, then startled. He had clearly never heard of it. I repeat, a diabetes specialist in a large teaching hospital at a clinic had not heard of a device which has been the subject of worldwide interest and is widely thought to be a big step forward in diabetes management. His response suggested that I was extolling the virtues of some quack herbal remedy: he showed no interest in my screens full of data, didn’t ask to see the scanner or the sensor, and clearly wanted the conversation to end, and to move me on to the nurse who would discuss my request for a DAFNE course.

Fortunately, my time was not wasted. The nurse had heard of the Libre, readily agreed to refer me for DAFNE and agreed that as I now had so much data about the minute-to-minute progression of my BG, it made sense to try fully to understand the impact of different foods on levels.

I returned home mildly amused rather than annoyed, to be told by my daughter that there was a voicemail for me on the landline. It was the hospital doctor I had seen about an hour previously, asking me to phone back, giving a bleep number and saying “there was something he needed to talk to me about” but that I had already left the clinic. Yes I had left the clinic, because he and the nurse had told me to.

I was mildly concerned, my wife panic-stricken. A phone message from a doctor asking me to call back and bleep him, less than an hour after I had seen him. Surely a sign that something was amiss. What hideous complication had reared its head that needed such an urgent response? I needn’t have worried. He just wanted to know if I ever suffered from any hypos, if I tested before driving, if I had had retinopathy screening and a foot check in the past year.

Yes, I do have hypos, it’s what happens when you have diabetes, but fortunately I know the signs and deal with them. Yes, I do test before driving, it’s the law. (as well as testing 20+ times a day with this mysterious new gadget). Yes, I have just had retinopathy screening and a foot check – it should be on my records. And that was it. He had clearly forgotten some of the script, and needed to call me to get the answers rather than risk being accused of negligence. I put the phone down and reassured Mrs L that I was not suffering from some hideous life-threatening condition which had shown up as a result of a finger prick blood test and a sample of wee.

So there you go. My journey from hospital care to GP care and back to hospital care. I think I’ll continue to rely on the GBDOC for advice and information. There are several doctors there, including consultants, who are happy to tweet and interact with patients who aren’t even theirs. And there are hundreds of people with diabetes just a tweet away, all with their own experience and expertise, all of whom are there to help. In fact, I’ll just get by With a Little Help From My Friends

Oh, and I look forward to meeting DAFNE next year.