Kates Journal

So, we spent a few days down at my mums, while viewings commenced on chez us in Slough. Most of the time was spent in a mixture of chilling out, doing paperwork for the new job and the agency job and attempting to coax the G-Wiz into life. Unfortunately, the G-Wiz is probably not going to go – one of the batteries appears deceased and UK batteries have tested it and declared it okay – so meh. I think it may have to go up for sale.

Anyhoo, we piled in the car and paused on the way home to view a house that we’ve been considering. So now we have to pause to consider do we want the insanely huge, utterly vast project with potentially really great returns and the production of a truly awesome house – or the marginally more sensible, probably much less difficult project with the production of a nice house that’s going to fetch much less money when we sell it. Or, of course, there’s the selection of much more sensible (in most senses), much less exciting, but far easier just need a bit of updating houses (which we’ve got a list of and need to organise viewing)

We’re trying to get some info from Bristol City Council – but they’ve not managed to give us anything yet – so we’ll be ringing them on Tuesday to find out whether our concept is even worth considering. We’re also trying to get more quotes from architects / timber frame places – because the costings we’ve had so far have basically given us: good case – easily affordable, bad case – vastly out of reach. I’ve found another timber frame place that’s quoting a vastly different per square metre price – closer to what I was expecting. And oddly, someone at work’s informed me that her uncle is a builder, in Bristol. This is handy :)

What’s not so handy is that the combined stress of court, job, house and MSc has made me go back to my IBSy rapidly needing the loo after eating state. Something I’ve not had for a very long time. Still, it’s handy for losing weight. It’ll be good when one of these stressors (at least) is over and done with though.

So, there’s been a fair bit going on at chez us, which I’ve not had a chance to post about, mostly due to being either incredibly tired or incredibly busy. In short, we’re moving to Bristol.

Well, most likely. I managed to get a new job in the Brizzle/Bath area doing exactly what I’m doing now, for exactly the same money; so we’re now hurled headlong into an effort to get moved. The only slight inconvenience being that I do have a CCJ against me (although I can get it struck out or at least marked as satisfied, which I think basically nullifies it because I met the conditions). I have to get that sorted because I’ve not yet got my inheritance through which means that I’ve got a wacking great temporary credit card (0% deal) loan – which I took out to pay for the minor, because when I got the nice letter saying ‘it shouldn’t be long until your inheritance comes through, just waiting on X’, I counted chickens and assumed that X would take less than a year.

As previously mentioned we’re both keen to do our project house, which would be great except for the teeensy tinsy problem that (a) we’ve not sold ours, (b) ours isn’t on the market, (c) we’ve no idea if the mortgage company will let us keep the current mortgage to build a new house instead of owning an actual house. Whilst I’d like to have a chat with them on the issue, I’d like to get the CCJ sorted first, really.

Also, just to throw into the stress-mix, I start my course next month which was (you guessed it) to be paid for by the inheritance. I’m beginning to think that once the CCJ is sorted the best plan is to take out a loan to pay for the car and the course, so as I at least know where my money’s going from – and to. Then when the inheritance does come through I can go *yaha!* and be done.

All of this is particularly relevant today as I’m going to spend a relaxing hour at the bank talking about, well, finances and how poor I am.

On the biting hand, Kathryn and I have been working incredibly hard to get the house finished – it’s repelling us to the best of its abilities; we painted the walls on the stairs – strange bubbles appear* – I’m hoping they’ll more or less disappear again. Kathryn’s been painting the doors (yes the gorgeous doors we stripped, which looked lovely, but a bit shabby-chic for Slough). We’ve repainted the back room and sorted the missing boxing around the central heating pipework. We’ve hung doors, we’ve moved furniture. And today we order carpet for fitting next week. The poor Dyson (DC-01) isn’t going to know what’s hit it – after 4 years of the odd bit of hoovering a rug it’s suddenly going to have two bedrooms and the stairs…

Anyhow, I must shower and find paperwork.

Catch you all later with a better post :)

* I’m assuming this is some reaction with the old paint – but it only seems to occur in random patches. It’s really a bit depressing (we’ve been leaving it a long time between coats to try and ensure that it’s well dried before we apply a second coat, but it does it all the same).

So, a week ago we dogsat for Nikki and Kate, and while we were there we spotted a house that we decided to have a little look at. Well, I say house. House is overstating it. We saw a building which, with some fairly substantial building work could be a fabulous place to live.

We almost certainly won’t get it, not unless many things fall in our favour. But all the same it’s been lurking in the back of my mind in a wholly interesting way. And Kathryn’s been using Sketchup to create a 3D model of the place – as we would like it…

It’s one of those things where while my brain is busy sorting out the practicalities of how we would do it and considering the possibilities of green roofing, SIPs, timber construction, prices… how much we’d need to do ourselves… Combined with the complexities of jobs, money, and so on, we’re well into things that can keep me awake and potentially prevent me getting enough sleep on nights. This is a ‘bad thing’. So now i’m going to go and try to sleep, again.

So, a while back, the ConDem government said they’d be getting rid of lots of health service targets. There are, of course, multiple ways to look at this. As someone pointed out to me, when they instigate one target, they don’t really know what effects it’s going to have on any other part of the system, nor the subtle ramifications of the target itself. They skew treatment priorities – for example, the four hour ’standard’ in the ED has meant that patients with more serious conditions sometimes end up waiting longer to be seen because we have to clear a backlog of minor injuries. And to ensure that gets done within the four hours, we’ll steal doctors from the ‘majors’ team.

Patient experience can be compromised as we push and push teams to accept patients they’ve not reviewed onto wards – with the intention that they’ll be reviewed there – because we need them out of our department within four hours. We do, or at least I do, only push for ’stable’ patients to have this done, and we do ensure they have analgesia – and often other medications written up. But still, it’s an effect that was probably not forseen when they were implemented.

We have a ’sepsis’ protocol which means that patients who meet the sepsis criteria should have antibiotics given within one hour of attendance, which sounds like plenty of time, but for patients who come through triage it’s a struggle. If you wait 15 minutes for triage, and 25 minutes to get an initial assessment done* another 10 to get antibiotics prescribed & mix them (and some of these are not the easiest to mix); get them checked and administered. For that hour you’ll often find you’ve got two nurses tied up ensuring that all that is done, and other patients just have to wait.

Staffing levels haven’t changed to take account of how much more we’re doing as an ED, and for nurses, how many more tasks we’ve taken on that used to be the doctor’s jobs.

So anyhow, wandered off from my point there. The main point I’m getting at is, as an ED nurse I’ve often argued that the four hour target is not always a great thing. Indeed, I’ve condemned it for skewing care, for making me feel pressured, for making me move patients who I’m not really 100% happy to move, etc. But the concept of losing the target completely worries me deeply.

Before the target came in, I spent an enjoyable 12 hours in the ED in Bristol waiting to be seen for my ‘back pain’ (this is before I was a nurse) which turned out to be a pyelonephritis. I was in loads of pain for those 12 hours, and quietly getting sicker and sicker in the waiting room. I’m one of those disconcerting people who goes quiet when their in pain. Really, really quiet. Which is not necessarily a good thing. I know nurses who vividly recall full EDs with patients not moving because the hospital was full. Patients from the previous shift were still there the next day, and ED nurses became pseudo ward nurses, complete with drug-rounds for patients who’d been there so long they’d otherwise miss their medication.

The four hour target forces the entire hospital to work hard at admitting and discharging patients. It means we’ve developed better methods of caring for people at home, and access to rapid input for social care. Not just that, it’s good to be able to say to a patient roughly how long they’re likely to be in the ED – and how long before they get a ‘proper bed’ – because ED trolleys are not comfortable.

It does, however, instill a level of patient entitlement which really winds me up. Yesterday I triaged someone at 20 minutes after arrival – who stropped about waiting so long for triage, then ranted about the concept of waiting 2 hours to see the doctor (for his day-old hand injury). Indeed, he ranted so much that I gave up on triaging him, because he kept stalking off when I tried to explain and so I never did assess his hand; just documented that he was aggressive, and that he had a non-specific hand injury that he wouldn’t let me assess. Another family (triaged at 10 minutes and advised that their child had broken their wrist (even I could see that on the X-ray they’d had in another department), and advised it’d be around an hour ’til they saw the doctor (offered analgesia for their child in the mean time), did the whole “How long?!”. This from people who’ve seen me triaging five-at-a-time (we have a minimal triage scheme for minor injuries which is, with the patient’s permission, performed in the waiting room**) to try and get through vast number booking in (seriously, I did five patients, came back, and found four more had booked in). As a side point, I asked if they’d had someone talk to them about the Xray – they said ‘no’ so I brought them in, I’m not giving out confidential medical information in the waiting room, just so as you know.

And while I can wax lyrical about how this culture of entitlement is (a) really annoying, and (b) inappropriate, and (c) really annoying. And I can go on at length about the patients who I’ve had to move at inappropriate times, or who’ve had their care interrupted, or the worst possible experience thanks to the four hour target, I think as a *target* it’s a good thing.

The problem is that this whole 98% standard forces staff, from us lowly RNs up to the senior management to behave erratically to try and meet something which isn’t necessarily appropriate for the individual patients. But remaining in place as some sort of moderated target? I think that’s appropriate and ‘a good thing’.

I’ll miss it when it’s gone, but I expect it’ll nicely cover the falling investment in the NHS. Because without the targets, and the figures**** that go along with it, the quiet disintegration of the NHS will be neatly undocumented.

* Observations, note that they meet the criteria, find a free ‘majors’ bay, changed into a gown, enough history to decide a most probable cause of infection, blood taken and cannulated (from multiple sites for individuals with existing access devices), perform a venous gas (same as an arterial gas but with venous blood. Lord help you if they’ve got ‘difficult’ veins and no existing access devices. I’ve got much better at cannulating people who’ve had chemotherapy (which often screws up your veins), but they’re still enough people that I struggle with.
** Yes, seriously. I am aware of the confidentiality issue here, but it’s policy, and for minor injuries – which is what it’s for, if the patient happily gives consent*** (even a brief hesitation leads to the ‘would you rather we talk inside’ offer) I’m reasonably happy to do it.
*** In general the questions I ask are “What’s brought you in today?”, and “Would you like any pain killers”. Sometimes it requires “Can I just see both wrists/ankles/hands”. And in some cases that leads to “let’s just get you inside for an X-ray”.
**** Lies, damn lies and statistics.

Well, in terms of updating I thought it was about time I did some. The house remains a hole, we’ve been working hard on getting it looking right for sale – and finally we overcame our fear and put up the wall paper. And I have to say, much to my amazement, it’s pretty damn good.

Not professional standard, and there’s a couple of spots which I wish were better, but all in all, it’s neat and it makes the wall – and by extension the room – look much better. Much more of a finished article. We’re now preparing to clean up, final few spots of paint, carpet, curtains and then dress the room. The most frustrating thing is we attempted to get away with just touching up the wardrobe doors (‘cos they were planed by the carpenter) and that’s not worked at all. The colour just doesn’t match quite right, which is incredibly frustrating. So we’ll have to put *another* coat of paint on them. I’ll be doing that in a bit, I suppose. I’m hoping there’s enough paint for that.

Other than that, though, it’s coming along pretty well. I spent a bit of time scrubbing at the floor like some mad cleaning lady, and got the excess tile grout off, and cleaned up the base of the shower where it’s been waiting for me to remove the excess tile grout for, uh, years. There’s just the wall-tile-grouting and cleaning to do, and ideally if I can locate the down-pipe’s chrome’d doojit, I’ll pop that on (rubber protector thing), and a bit of touching up on the walls, and that room is done. Then there’s just the back bedroom, the stairs, and some painting of skirting. And the door. I’d nearly forgotten the pain-of-the-doors. One of them is stripped, primed, filled and needs a bit of a sand and then should be good to paint. The other is mid strip and it’s taking ‘longer’ than is desirable.

In other news, we took the CRT to the storage unit yesterday (aren’t they so light and portable), and apart from freeing up a mountain of dust (well, that’s the problem with things you don’t move, eh) it’s improved the appearance of the lounge an awful lot.

It’s all getting there, but it’s painful. As are jobs.

I have not heard anything, which is not entirely surprising because applications to NHS positions tend to be quite slow to respond. But nor has Kathryn as yet. This is particularly difficult at this point – because we could really do with both of us employed, gainfully, before we shove off to Bristol. I could also do with my inheritance arriving right about now, because things are quietly niggling in the background about money. Sometimes they’re niggling quite loudly.

All of this notwithstanding, we went away for the weekend, up to Lauren and Chrissy’s, which was fabulous. We actually went to collect a prop, a 42″ dead plasma TV (specifically a Vision 4241), unfortunately, it’s lacking its stand, which is a bit of a pain, but we’ll have to see if we can come up with something – or more accurately, we’ll come up with something. It also came from a smoker’s house, which is a bit of a shame too. It’s currently sat in the back bedroom with the window open and hte door to the house shut – in hopes of it’ loosing that stale smoke smell fairly quickly. The CRT came from a smoker’s house and it took a little while, but became inoffensive quite quickly. And the breadmaker, similarly, stank when we got it and is now fine.

Anyhow, Lauren and Chrissy’s – so we saw their new house which has the potential to be excellent – it’s got really great bones and is in a lovely spot, complete with pretty views and a gorgeous old apple tree (which is incredibly productive) – and a eucalyptus tree which is a delightfully quirky addition :)

The whole place is being rapidly renovated by Chrissy and Lauren – putting our 3 year restoration to shame! We also spent Saturday basically chilling out (maxing, and relaxing all cool too, I suspect. We didn’t shoot any b-ball though) – a couple of hours wandering on the beach at Hunstanton was exactly what the doctor would have ordered, at least if we’d seen one. It was, to be honest, lovely to see old friends (and Jay-the-cat) and not really have to do anything (beyond collecting the TV).

On the TV front, if anyone wants to help me source parts for it, that’d be helpful. Online reports suggest the fault ties in with a dead ‘FMSD102A’ – which shorts and kills four resistors (surface mount, obviously, so that’ll be easy to fix – Kate calling John! We may need your microscope…) on the PC42V-PYS40-01 Y-Sus board. I’ve poked around the internizzle and not yet found any cheap sources of either the complete board or the FMSD102A, which is a shame, because yer man who we got it from reckoned that a place called maxsource could do them for $25 – which would be worth a shot. It is, incidentally (for anyone who feels like helping) a Vision PTS-4241, also sold under the brand name Conwa, and apparently the boards are made by Orion. None of this has so far lead me to success. When the house is done I’ll pop the boards out (it rattles, also, suggesting that previous owner may have attempted to fix it, and dropped a screw inside).

Searching for the board has lead me to a selection of people saying ‘it’s b0rked’, which isn’t helpful. I think I found a spares place a while back when I was thinking about getting it, but I can’t find it now – and they wanted £70 – which is a lot of money to spend on something where I’ve not actually looked for the fault. One doesn’t like to trust others judgements of what might be faulty when spending that much :)

Anyhow, I think at this point it’s time for me to shower and make some grout.