You cannot understand someone until you’ve walked around in their shoes

Harper Lee’s famous line from To Kill a Mocking Bird.  I’ve had some wonderful things said to me in my time from friends who don’t think the diabetes is a big thing to men who just don’t want the responsibility.  It is a responsibility: when you love someone seeing them in pain is horrible.  If you don’t love them, it’s embarrassing.

When you really love and care for someone, you do just deal with it.  But it’s always there, 365, 24, 7: never a day off, never a break.  You do relax round it but you don’t get the chance to forget.

I don’t blame the friends who’ve backed off when I have been hypo round them.  Or if I’ve been in a stinking mood when I’ve been high because it does hurt, having blood sugar above 11mmol/l physically hurts - imagine the worst headache ever in your legs and arms and even your stomach.

There’s great excitement today because a new device has cleared a trial in administering drugs through the skin (subcutaneous doesn’t seem the right phrase here) and no doubt some bright spark will see this as a way of treating diabetes mellitus.

Because it’s the injections that hurt!

Eh? What’ya on about?

When people adopt new skills they go through four stages: unconscious incompetence, conscious incompetence, conscious competence and finally unconscious competence.  I think good examples highlighting this are learning to walk, speak a new language and learning to drive.

Software use is similar and the Amiga managed this migration really well by understanding there were actually three levels of user: absolute beginner, intermediate user and expert users.  Every time you loaded new applications you got asked where you rated yourself and then guided you through at the right level.  This enabled you to move on to the next level too.  It was a really great way to manage the relationship between app producer and the end customer.

OK, but I still don’t get where you’re heading to…

Patience, dear friend.  I like Web 2, it allows experts like me to throw things together quickly and easily.  I get the choice to dip in and out really easily and I get what can and can’t be discussed.

I belong to a couple of forum’s too, based around my pump.  Forum’s have two types of contributor, the experts providing answers to the questions asked by the rest of the community.  I also felt this didn’t support the intermediate users but the good forums provide a wealth of answers and a view to a user base.

Forums have not been so successful in terms of telemedicine. I know a couple of good ones focusing on type 1 diabetes, but they are often hampered by the very thing that enables forums to work: they are asymmetric not real time.  People dip in and out of them.  They can also be a little scary: there are a lot of unhappy people out there.

So…

Many healthcare professionals are hoping to use Web 2 tools (blogs, wikis, mini-blogs as well as UGC sharing sites) to bridge this gap.  They hope that the sites will enable healthcare workers and patients to share experiences and hopefully some serendipity.

Sounds great

OK, but just like I don’t necessarily want me mum to see me drinking in the local disco, I don’t necessarily want my healthcare person, who let’s face it signs my ability to drive, to know Friday night is Indian night, Saturday I like to watch footbal with my mates and have a couple of pints and Monday that I’ve had a big falling out with my boss.

The great thing about FB and twitter is that I know what I put up there will be around forever for people I care about to see how things are going.

Am I really going to allow my doctor to crawl all over this?

There must be some advantages…

Well yes, what would be great is a sympathetic ear when things are not going well.  Sometimes things are not as easy as they should be and having someone who understands would be good.  But once I’ve got back on track, I wouldn’t want this any more than I want a beginners pump any more, I’ve got to the unconcious competance on the pump and now just want to go with it.

Help for me and my family at 3am in the morning when it’s not working out the way it should be would be really useful.

I don’t know if the “prime minister debates” have really livened it up for me or whether the interesting policies - reform over tax, parliament and of course access to the manifestos through the Internet mean anyone and everyone can really delve in to the real essence of the current party politics.

Yet, I am torn.  I totally agree with removing the 1% increase on National Insurance.  This is a terrible way to raise revenue as only the employed and employers are taxed this way.  Given the recession (and yes, I am using that word even though I do believe it’s a depression we’re currently experiencing in Europe and America), I feel that gaining that 2% from every worker is wrong.  It’s hard to collect, ambiguous who is potentially eligible and effects people earning lower wages much more than it effects higher earners.  Essentially, it’s not a great way for the redistribution of wealth or a way to fund the running of the country.

But I also believe the £10K earning right is terrific, this should work whether there’s an economic crisis going on or not - much better than a minimum wage in insuring every man, woman and child has the ability to a high standard of basic life.  Cheap to collect, very fair, elegant.

Yet universal suffrage does not allow me to express these beliefs in the ballot box.  I need to make a choise by the 6th May.

That’s not going to be an easy choice.  Should we be able to vote for policies rather than individuals?

Well, I finally took my advanced motorcycling test and passed and I am finally taking some piano lessons. The skiing trip went well and I finally have enough skill to fake being confident on even quite high mountains and even enjoy myself while doing this

I’ve finally done it and bought an SLR; having spent my late teens carefully borrowing my mum’s Yusika I have bought myself a Nikon D5000.

As a gadget freak, this camera hits most of my check list, but the thing I really enjoyed about using the Yusika semi-automatic (one of the first semi-automatic SLRs) was its simplicity.

The Nikon is not simple. The user manual seems obvious enough, there are enough controls on the aperature and shutter length to allow me to capture most things really well. But there are a lot of things I can control and I don’t really see myself being able to remember all this when the time comes!

So, I have options:

1. Buy a course - book, CBT or tutor led
2. Experiment like mad until I understand the thing backwards.
3. Use this as an opportunity to meet a new group.

I’ll let you guess which I do…

The nurse caught my face and twigged what was going through my brain: “no, you drink this one :-)”

I laughed and downed the syringe that was handed to me.  Morphine would definitely either make me not care it was hurting or would stop the pain.  That sounded great to me.

“Twenty minutes, half an hour then we can dose you up with some local and relocate the radius.  It is almost certainly going to hurt very badly and you are going to hate me, but hopefully it will mean you don’t have any problems later on.”

Jon was back from the car, having checked on our son too and I lay my head on his lap.  Hopefully we’d be home in an hour.  Relocate, plaster, x-ray, home.  Easy, right.

As one of the oldest and best performing forms of analgesia morphine does knock me out.  When the nurse came back and did the injection for the local anaesthetic, I didn’t really feel the needle go into the gap between the ulna and radius.  I happily moved to the room where the nurse would try to realign my bone and got comfortable though I had this nagging thought that despite the painkiller the next 10 minutes of my life were going to be excruciatingly painful.

The nurse treating me had found a buddy, nearly twice the size of the original (I thought babushka and thought this is not the time to laugh), he looked concerned at my husband.  “You’re not going to like me: this is going to be really horrible to watch,” which Jon shrugged off

So the big guy holds me by the upper arm, fixing my elbow.  The other nurse held my wrist firmly and pulls and twists until there really is a popping sound.  When that happened, he put the arm onto a back board and starts to plaster it up.  When the plaster is dry, they’ll check it with a x-ray but all being well I should be on the home straight.  After the plaster is on, I realise it didn’t hurt - man those were good painkillers!

The x-ray showed it was a great realignment, which the nurse was really chuffed about.  There was a 19:20 chance it would dislocate itself while healing, apparently this doesn’t happen with pre-teens and the under 70s.  If it stayed put, two to four weeks and I should be right as rain.  Two weeks would mean I could take my bike down to France for the holiday I had booked - nothing like having something to aim for to help the healing process

Come back in on Tuesday for an x-ray and keep up with the pain killers.

My husband took my son to one side and pulled his skates off, he took my shoes and my bag out to the car.  Lots people then came over to try and help.  I kept my hand on the floor, I figured keeping it as stationary is possible was the best thing I could do.  I knew it was broken though I am not sure how; I’d always thought there’d be a snapping sound if I ever broke anything and there was nothing like that.

The manager came out to check the situation and a sling and some ice were presented.  Jon had gone back home to get our family car.  Everyone asked if there was anything they could do and almost like a proper parent, I finally worked out I was heading to hospital and what on earth were we going to do with our eight year old for the duration.  Casualty (ED) on a Saturday afternoon was probably not going to be a fun place for him!

The parents of the birthday girl oftered to take our son home at the end of the party, which was fantastic.  All I had to do was cope with the pain and wait for Jon.

Oh, wait, I came to the sports centre on my motorbike: what on earth was going to happen to that?  When the manager came over to check I was OK, I got him to promise not to clamp my bike - the sports centre had a locked down car park, and he was fairly happy with the arrangement.  The manager then took a lot of persuasion not to call an ambulance, in my bike gear I didn’t fancy taking up their time as this was completely my fault and while was really painful but let’s face it, not life threatening.  Also, while they might get me some very decent pain relief (yes, I was thinking about that) my fingers had circulation, so waiting for Jon was the best course of action.

While I am always happy to see my husband, the elelation I felt allowed me to get back on my feet; strangely the pain made me feel really naucious.  I was still shoeless, but the car was going to get me to people who would help so that was fine.  The sling was now really soggy, but I was so grateful I had it: as a means of allowing you to move a broken arm the sling is awesome.

So we drive to hospital: I felt every bump, the people who decide the emergency department should have speed ramps before it our saddists: especially if there is no speed over which you can cross them without moving the car.  Jon dropped me off and I checked in with reception.

I got triaged and some pain relief, and then was sent back to wait for the xray.  The pain relief took the edge off but it was still insanely painful.  The swelling hadn’t increased which agian was comforting.

Casualty is all doors, you do get help, but it is a lot quicker if you ask for it.  You go from being almost comfortable in the waiting room through to the queue for the xray, whcih is where Jon caught up with me.  It was so good to see him again.  The xray was taken and I asked to have a look.

There wasn’t an obvious break!  I couldn’t quite believe it but both arm bones from the lateral view: fantastic, I have never been so grateful to be wrong.  This meant the arm would heal without too much intervention and pain would be short term :-).

So, feeling a bit confused about why my arm was still very painful, I returned to Jon with half a smile on my face: I was going to be fine.  I was just waiting to be sent home.  Jon had gone back out to extend the parking ticket time, I was waiting for someone to tell me I could go home.

The nurse who was treating me came back out and didn’t look as relieved as I was feeling.  He asked me to come and look at the x-rays.  I’d only seen the lateral view which was completely aligned: the AP wasn’t.  I had a dislocated distal radial fracture, while I had almost certainly saved a lot of problems by pulling it straight it would need to be relocated along the anterior–posterior axis.  This was not an easy job, but he was one of the best trained people in the hospital and he could do it.  First job would be some pain relief.

I am diabetic and am used to injections: when the nurse came back with a huge syringe and a massive needle and began drawing up the brown liquid my colour faded!  Jon was no where to be found and this looked like it was going to hurt before it got better…

Sir Terry would like to be able to petition for assisted death.  I think that is an awful thing to ask someone else to do for you; even to be asked make the decision about someone else.  Sir Terry is currently healthy enough to commit suicide: like almost everyone else on the planet though, he would like to delay dying as long as possible. In fact, so long, that he needs someone else to do the job for him.

I don’t think that is a reasonable thing to ask.  It’s different for someone who has been hit by a car or been involved in an accident where one second they are fine and the next not.  Indeed, motor neuron disease is such that you get some warning.

Last year, I was involved in a car accident caused directly by the incurable condition I have.  I was exceptionally lucky in that no-one was hurt apart from me and I only got bruising.  But I could have been left with someone’s death on my conscience and that hit me very hard.

There were moments in the following 48 hours I really couldn’t cope: distraught is possibly the best word for it.  Something I had guarded against for such a long time had happened.

The thing that kept me vaguely together was my family.  It took a lot to get back behind the wheel of a car and I’m still not confident, even though the policeman who dealt with the accident supported me and encouraged me to drive again.

Knowing what I went through, at the possibility of having end another’s life, I do not think I could ask someone to help me die.

One of the things soldiers are trained to do is kill but it has a cost.  The subject is discussed in length by various detective novels: taking a life changes you forever.

No-one is asking Sir Terry Pratchett to not enjoy his life, so how can he ask another to take his away from him?

Largely, it has remained corruption free with the few instances of any MPs corruption being publicised and discussed openly.
Our MPs are not given a terrific amount of money but the financial package was such that there was little advantage to be had from taking money in order to influence votes and bills. The cost was too high.

Which is why I am not looking forward to next year.

Would I much rather the public purse was recompensing MPs for the life styles they need to function on the job 24 hours a day than seek finance from anyone with a view to buy an MP? Hell, yes!

Other European countries are renown  for this happening - indeed it is almost given a blind eye. In the UK this hasn’t happened as the civil service understood how people function (and MPs are still people) and accommodated it. The package was wrapped up so everyone benefited including the UK public: we had a government that was hard to corrupt.

Who knows what we’ll end up with post 2009.

Yet, by the nature of the mathematicians work, this stereotype must lack merit.  The letters between Isaac Netwon’s and Gottfried Wilhelm von Leibniz are possibly the best known recorded discussion on how integral calculus should work and two minds working together on the problem, steering each other to very similar conclusions.

Pythagoras was almost certainly a group of philosophers discussing how geometry should work which almost certainly makes the formulation of mathematical language one of the earliest recorded theories reached by a group and not an individual.

The language of maths itself proves that it must be uniquely defined as a purely team activity or else why would a language have been formulated to express its ideas so eloquently?

I’d like to know who first established the idea of the solitary mathematician?  How did this stereotype come to be so readily accepted?

Being diagnosed was great, insulin made the pain go away.  32 years later, I still feel that way.  Insulin works: it lowers my blood sugar and enables me to use my food. Insulin is marvellous.

Insulin has problems though.  It’s not smart, it has no way of knowing how much I need.

Hypo heat rash

Having high blood sugar hurts, having low blood sugar hurts. The photo is the rash I often get when my blood sugar is low (I am told this is quite unusual, normally half an hour after my levels rise the rash will ease).

My insulin pump is a glorified syringe, it’s not much more, but it means no high lasts more than 8 hours and likewise with a low.  The pump doesn’t stop the variance, it just helps to control it.

Yet most people think the injections (and the pump) are the problem, because it’s needles and must hurt.  The fact that my injections really don’t isn’t considered by most people.  I have to say, needle technology has come a long way. 

So the needle going through the skin is not the issue.  It’s the fact the insulin is dumb is the issue.