When i was "done"yesterday i purchased a snack that included a refreshing cold drink.I read the label to see its sugar content,which is,in my opinion nearly always in numbers that are actually not as useful as they appear,with values relating to 100ml and 250ml,when the actual contents is 500ml,and where the "results"do not necessarily extrapolate easily.
Then my attention was taken from the numbers as i observed that all the wording was in French.This is odd,although i do not have any xenophobic,little englander response to it.My point rather,would be this:
To the best of my knowledge,in an economic system that has international,global reach many if not most transnational corporations have"local"footprints,companies they own in each territory.Most of the big soft drink manufacturers have such reach-producing their drinks in many countries and establishing partnerships or ownership of bottling plants,sometimes with local variations,where the product itself might vary and labels certainly do according to local regulations.
So why is it that in a city like London,i discover these drinks,and indeed other products,labelled as if it was produced in or for customers in Greece,or France or the middle east.If there are things like economy of scale an activity that such companies exploit,not least to reduce costs,and in turn to protect both profit and rate of profit-then how can this come about.Surely it cannot be some sort of simple error,that shipments end up somewhere other? If it is not a mistake,then what is it?Does this system still have quirks?
I know that such phenomena do not change the general sweep and dynamics of the broader sweep of the system,and the impact of this is probably peripheral but it is nevertheless peculiar!In this case,it makes little difference to the customer-who is not likely to be reading the label for complex guidance or instruction,but what if the description of the product"in the numbers"does not meet the requirements of local consumer law(i note that on products where there are multiple languages,any translation is not always direct-that what is described in one language,may not appear in another which i believe reflects variations,even across trade areas like the EU/European Union)
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Thursday 30 May 2013
Wednesday 29 May 2013
Analogies and Metaphors-Life just is....
When we think,speak,write,communicate it seems to me that humankind soon begins to explain the complexities and subtleties of thinks as analogy and metaphor,with metaphor probably being the extended form of analogy.The way it comes out is that anything can become anything else,everything is everything else which might,wrongly give the impression that nothing is differentiated,nothings has meaning but then that would miss the subtlety and complexity of what humankind does and is.
From that beginning,for me,it might be said that Life itself can be seen as a long winding,narrow path.I do not see it as a straight wide boulevard or tarmacked road but like a path through the countryside,through the grass across the fields,that many of us have made along with the animal lives we share our planet with across time.These paths are familiar to those who use or know them,but they are not always obvious.Part of living is that we have to rediscover,and sometimes reinvent those ways,and we also have to innovate and develop them.
It seems to me that,that for those of us who have an activist view of the world-that we can make and change it,that we are not simply bystanders,acted on,watching others act on us,then we have a similar situation in relation to our own activism.It includes the remaking and refinement,a re-galvanising and re-energising of our activity.
At present,as an activist in a number of campaigns,it seems to me to apply to my own level of activity in relation to CON/counter olympics network-that is MY problem,and in a different way to the CSFHC/Counihan-Sanchez Family Housing Campaign.
What follows then are MY thoughts.I claim nothing for them beyond that,although i hope they resonate for other people.I have no particular authority in these thoughts.I simply think and write them in the hope that i can continue to make a constructive contribution to the growth and development of the campaign......
(work in progress to be continued)
d1/290513
From that beginning,for me,it might be said that Life itself can be seen as a long winding,narrow path.I do not see it as a straight wide boulevard or tarmacked road but like a path through the countryside,through the grass across the fields,that many of us have made along with the animal lives we share our planet with across time.These paths are familiar to those who use or know them,but they are not always obvious.Part of living is that we have to rediscover,and sometimes reinvent those ways,and we also have to innovate and develop them.
It seems to me that,that for those of us who have an activist view of the world-that we can make and change it,that we are not simply bystanders,acted on,watching others act on us,then we have a similar situation in relation to our own activism.It includes the remaking and refinement,a re-galvanising and re-energising of our activity.
At present,as an activist in a number of campaigns,it seems to me to apply to my own level of activity in relation to CON/counter olympics network-that is MY problem,and in a different way to the CSFHC/Counihan-Sanchez Family Housing Campaign.
What follows then are MY thoughts.I claim nothing for them beyond that,although i hope they resonate for other people.I have no particular authority in these thoughts.I simply think and write them in the hope that i can continue to make a constructive contribution to the growth and development of the campaign......
(work in progress to be continued)
d1/290513
Friday 10 May 2013
Another admission to A&E-
Wednesday 9th May was busy for me.Apart from things to do at home,i attended an Atos Assessment Appeal at a Tribunal Court in central London with friends and comrades,before attending another busy and enthusiastic meeting of about 25 people at London SWAN(social work action network) in the evening.Whilst they are noteworthy,i will probably comment on them in another post but not this one.
Following that meeting,the evening took off in an unpredictable and frankly unwanted direction.I do want to write about it,from several points of view here.So now,i want to warn any readers of this blog,that it may well talk about material that is both possibly difficult and certainly intimate.I make no apology for either.
I am NOT writing this from I hope any egocentric viewpoint,nor in any belief that i am either special or important,in any other way than to assert that we are ALL important and special.Indeed,we all,i believe have talents that this sort of society under-develops and under-uses,but that too is another issue,the subject of another post.Indeed,i suspect as a man,that it is only men that would even think of putting those riders in,because i suspect that women have long had a way of talking about such issues that for men is at least much more problematic and ambivalent.I feel as one of those men,that we are only going to be able to challenge and change that sort of perspective if we do exactly that-to challenge and to change it.So this is an attempt to do so.
I want also to make clear that this is a very subjective and impressionistic piece.Whilst i brought my analytical and critical faculties to bear,i have not done further research nor have i approached this analytically,beyond my surprisingly still ferocious curiosity about my environment.I may have left social work,but social work has not left me-and on such occasions i still want to understand procedures and how things work,and again the sociology of it.
At the risk of pedantry,i admit i am going to talk about a health problem experienced by older men,so women would be less will to talk about it,though i suspect women tend to be more open to it,not least in their relationships with men,but also at the more general level of health and emotional issues,and indeed even in relation to men's health issues.I suspect that many of the campaigners include women.
I have unintentionally been mysterious enough,so let me be clear,what i am talking about as i describe the events of Wednesday night onwards.
Towards the end of the meeting i was in,i began to feel uncomfortable but that once able to address that discomfort at the end,it would resolve itself.It did not.I walked to the station with my woman friend and comrade,and we got on the tube together to return home.We talked largely about our political activities and plans over the next few days.This is frequently about activities in which we work together,or failing that,in which we have a common interest,backed by a close relationship as friends and comrades.
I admit that when i am feeling fragile or vulnerable,i often feel less so in her company or the company of other friends,companions,comrades.I may not talk about it long or in detail but i don't hide that,and it does make a difference to me and the quality of my life.
When i got home,i could still not get rid of the pain,which intensified and within a short time i was reduced to being naked and pacing about part of the house as a coping mechanism.It was not long before my partner was consulting the internet,and making contact with the relevant"arm"of the NHS.
Early information indicated i might have an infection.She tells me now that a check on the symptom checker on NHS Direct,indicated that we should call an ambulance to get to A&E(accident and emergency).I was not able to make that call,but knowing that the NHS Direct telephone helpline(an 0845 number had been shut down she called the new 111 number.Over the next 2 hours or so,we had 3 conversations with the same person,who asked the same initial questions and then more questions and gave us both advice about what to do.I won't repeat that advice in detail except to say that whilst it seemed useful,it did not work,although i intend no criticism here.We were both told that if things got worse,or the symptoms developed in particular ways,we should call back.During the 1st call,i was told that a doctor would call within and hour or so.As things got worse,as the pain intensified,we made a secnd call which ended with another sort of medical assistant(paramedic?)would call in less than 30 minutes.I think my partner was advised that we could call an ambulance,she did so although that call ended with a message that an ambulance may not come but that we may recieve andother call.The pain quickly became so unbearable that she made a 3rd during which we were advised to drive to some kind of clinic in the hospital,which was not for emergencies but for"out of hours events".This was impossible because nether of us drive or own a car.No taxi would take us due to health and safety/insurance and other issues-we did not even try,but my partner asserted our difficulty and my pain.She made a further request for an ambulance having reminded them of their own previous advice.
At 11.55pm an ambulance showed up.I experienced some relief,though no pain reduction being in the company of(broadly)medical and calm,competent staff.Some moments later when i was in their ambulance,we had received NO call backs from helpers,paramedics, nor doctors,nor ambulance service although we did now have 2 ambulances at our door!
After a few minutes to settle and undertake administrative tasks,we made the journey to hospital.I answered a number of probing,intimate,personal questions most of which i was happy to do,as precisely and concisely as i could given the"distorting"impact of pain and fear on me.If the calls were mildly reassuring the ambulance crew were very reassuring,calm and competent in both what they did and their attitude to us.
Partly because the pain "settled"though it did not reduce much,partly as a means of self distraction and partly because however ill i am on this or indeed other occasions,i am always surprised by my own analytic,curiosity especially in what might generally termed the sociology of it all-so we had a conversation along the way about their job as ambulance drivers.It became clear that busy or not such crews are constantly active,and that in a busy London A&E,like that night,they were already BUSY!This makes their breaks minimal in frequency and duration.One of them told me that there are now time limits of the time they can interact with patients!None of us had time to discuss some of the more"problematic"situations that the press/media like to report either as human interest stories or as disaster or"scapegoating"stories!
I commented that they worked for St.John's Ambulance Brigade.It seems that because LAS/London Ambulance Service cannot obtain enough staff,that it now"buys in"the service of at least 6 other organisations and companies,and that whilst no full time drivers for LAS,they had both started as volunteers for St.Johns and that they still were.I am NOT drawing the conclusion that LAS now relies on unpaid volunteers.Now am i challenging St.Johns as an exploiter particularly,although it is easy to see that this could provide further routes to the greater exploitation of labour.
I am guessing that volunteering for St.Johns is still about the provision of para-medical assistance on occasions when even in the best of times NHS services would only be applied in an emergency,such as at football matches and other public events.I think for example i have seen St.Johns staff at or near major political demonstrations although i cannot assert that.
To the best of my understanding St.Johns provide a service as a charity,which one way or another goes back to the MIlitary Orders of the Crusades,and to the Catholic Church.In decsribing it thus,i am at this juncture simply being descriptive,not critical although i might in another,and more informed context have criticisms.I am certainly NOT impuging the motives,commitment nor work of the 2 young men who took me to hospital.Indeed,it became clear these these men are trades unionists,dedicated public servants and to their professional tasks.It was a privelege to meet them,and to be in their care-and i do mean care.
Charm does not come naturally to me.I try to be good mannered.I also remain a shy man,but having long believed that good eulogies at gravesides/funerals have their place,and having long felt that often people do not appreciate each other,i always try to make a point of articulating what goes on inside my head when that is appropriate.I hope i appreciate labour,and service and commitment-and said that i appreciated the NHS in general and the work done by its"representatives"not as some abstract distant category,but as embodied in the real people i interact with.So,i will say here,and not for the 1st or last time-lets do everything we can to keep the NHS and to keep it free at the point of use.Lets go on to build it into an even better service,where every detail of"from each according to their ability,to each according to their need"applies.
This is not the 1st time into this A&E department for me.I think this is at least the 3rd time since 2009 for me.I had previously visited other styles of "out of hours"services too.My partner has i believe been to both at least once herself in recent years,and both/either of us took one or other of our two children when they were children.We also attended with emergencies during my partners pregnancies at 2 of the local hospitals.
I am familiar enough therefore to observe particularly what is similar each time,at least in my own direct experience.What comes across most powerfully for me is how there are no managers about,although there is a hierarchy of decision making command which at least at some levels make absolute sense.I am not an advocate of hierarchy but a Doctor IS more trained than a nurse,etc.Secondly,it all seems to operate as if it is both organism and machine-which fits in with my view based on Karl Marx that we are social beings,and that we are at our best when active at that level.I am sure that people.staff know each other and become familiar as colleagues and friends which hones this phenomena.There is always a busy calm.Not least,we the patients are at our most vulnerable,and possibly our most difficult.We are strangers to them and yet i have always experienced it as tender and sometimes intimate care by strangers of strangers.Unfortunately the NHS is NOT fully operative socialism,but there is a lot there,and indeed here in the specific situation i experienced that is very close to socialism(Please remember i am not being particularly analytical here.i am NOT writing sociology or Marxism here,this is a subjective piece,although another time or place i could probably defend analytically my view.)
I was handed over,and then had to wait over 4 hours for the attention i needed.I am not being critical when i observe,that whilst no-one rushed at anything all the staff i saw worked constantly and that standing about was either relatives or professional staff awaiting and usually doing something else manageable at the same time.Whilst there might be some unnecessary repetition,i believe that repetition to to check for mistakes or for security reasons.Mistakes and misunderstandings still occur-i saw though i am not sure i understood them,but this is in the nature of being human.
I am aware that at least for myself that it is often difficult to differentiate for example the "rational"experience of pain from psychological interpretation.Laying on a "trolley"eased my pain a little,being in the company or presence of medical staff at all levels was reassuring for me,and made the pain bearable most of the time but it reasserted itself.I found myself pacing again as i had at home,and i became increasingly desperate.I waited for over 4 hours for substantial relief with my treatment,which was radical in going well beyond tablets but did ease the problem.
Critical news coverage of the crisis of A&E both nationally and particularly in London indicates that 4 hour waits are not seen as acceptable,although bringing them down will not be easy,as it is not likely to be simply about money and resources.That said i do NOT want to cover up the problems nor the blatant destructive damage of austerity and cuts so far.
It seems that whilst "innovation"to provide GPs out of hours services,combined with other ways to deflect from A&E have had at best,it seems,ambiguous results,whilst others report an increase or surge of A&E referrals/activity of over 1m people/incidents.
From a place like Northwick Park which is reporting already an increase of something around 40% demand,a 4 hour wait can be nos surprise already.Planned cuts across A&E in this area of NWLondon seem increasingly absurd and unfair,although protest does not seem to alter the view of consultancies,consultations,authorities or anyone else in power to decide.
Again I can only argue subjectively ro analytically to keep the NHS,to keep it publicly funded and to keep it free at the point of use!
From what i could see,it seemed that all staff were working efficiently and expeditiously in so far as this is ever possible in the midst of human need.I was confident that staff were making legitimate and rational decisions about human needs in the health context.At no time did staff run away or even run to do something else.I ay not have recieved preferred answers but i did get answers.Only once did a doctor advice me to save my questions for a quieter time,as he had more acute problems to deal with.I had no problem with that answer,and my anxities were later more fully allayed.
After treatment a breezy young surgeon,responsible for urology during the night came to explain that i would be kept in for monitoring due to the problem identified.At around 6am I was taken to what i guess was a male general ward,and i probably fell asleep at around 6.30am.Before i left A&E i was tested for MRSA,which i think is one of those conditions that actually thrives in hospitals.This is not just an issue about ensuring their is adequate time,money and other resources to deal with it,but arecognition that the environment will inevitably be faced with such difficulties by the nature of the cause of such conditions(i apologise i cannt explian more fully,i am not a scientist)
I admit then that i was neither best pleased nor at my best when cheery,fresh hospital staff at the start of their shift wanted"wakey,wakey"at the start of new shift,new day or their routine tests.I co-operated but determined to otherwise stay asleep!I understand their needs too,in that regular tests is both monitoring and contact,neither of which is yet entirely reducible to being"management targets".In relation to myself it was directly related to monitoring my condition.It also facilitates contact with patients.
Yet this does raise some very real conundrums and difficulties in and for hospitals.There is a tension between the demands on A&E staff,and the emotional and practical needs of patients and friends and family with them.These do not fit easily together.I may return later or some other time to this.Hospitals do not seem so beset as in the days of more authoritarian structures-in those days health was done and delivered to us,these days we are increasingly seen as individually responsible perhaps in a way which replaces that previous authoritarianism with an equally unacceptable individuation.Instead the new routines,which are NOT the old ones disguised in my opinion,but are driven by regular monitoring of a diverse range of conditions,many of which might well be dealt with better,where once the crisis is over,in the community in at least notionally less disruptive as well as more economic ways.
When i did wake at a"more civilised"time in the morning i messaged a few people,tried reading,eat the food i had been carrying the previous day,and eventually fell asleep again after a visit from the Urology Team,and some further tests.A chance to allay my own fears with some questions,answered by a consultant who in manner and rank come across as authoritative,persuasive,trustworthy....It was agreed to my relief that i could go home when various processes were completed.Treatment would follow,along with further diagnosis.
Now,I admit that i'm from the question everything,trust no-one school which is NOT about trusting ordinary people in our everyday lives,nor doubting friendships but rather simply not taking on trust other sorts of knowledge,that claim to be fact-from advertising,to history,politics and especially not science.Incidentally whilst theology may have lost its rank as"absolute truth",i do NOT accept that science has earned or taken it,and is certainly not at the pinnacle of knowledge.I might accept that mathematics more closely replicates some of reality(though i could not articulate how,and i suspect that statement and admission both illustrate the very conundrum i am trying to articulate).If forced i would say that philosophy would occupy that pinnacle although that would still be based on a kind of relativism,in which it questions and posits that knowledge is socially constructed)
In banal,daily practice however,we do,i think have to take some things on trust.I found myself genuinely reassured by the presence of ambulance crew.It does not require me to rely on their knowledge in detail over my own,but it certainly has a psychological impact-in that my psychological experience of my pain was reduced at least partially with their arrival and presence.I did not know them but i associate their role with obtaning some kind fo reassurance.I know and trust my partner implicity,and yet no matter what i tell or ask her about my condition,nothing she says about this would give the same re-assurance.
I slept through most of the afternoon,though inevitably overhearing without intending to listen to other conversations.As an social worker,that comes as a kind of second nature.Part of that response is as an ever cuious social scientist and/or revolutionary socialist activist.
Another patient was a young man,usually a student at the local but very well know Public School.Usually i experience class not just filtered through my own experience but through those i mostly engage with as my clients in the past,through my political and social activist engagement through most of my life and not least through my own friendships and relationships.I also acknowledge that these overlap.Yesterday,i experienced at a distance,indirectly the other side of those class dynamics in observing someone of another class distancing themselves from what i guess is the ordinary and consciously or not"working class"of their immediate environment.I would not seek to judge the particular young man.I try not to be judgemental,and i do not know him.He seemed to wish to be obedient to his concerned father who was it appears on another continent.I picked up that his father wanted a more experienced/qualified surgeon.Despite reassurance from doctors and others via a woman who was both clearly in a position of authority over the youth but also of subservience to the father in relation to the school,it became evident that the father might be making assumptions that a free NHS might be an inferior service,as non-profit hospitals in say the USA might appear to be.It would seem to me that this view is both clouded by distance-i myself would not have a good hold on health services in Asia.Yet it might also illustrate another view too.
It is my view that the dominant ideas in society are the ideas of the dominant class.That does not make them either right,nor the majority view,simply the dominant view.Ideas also overlap and contradict.My impression from the way the media operate here is that they themselves are largely about the views and behaviour of their class.We,the others,the rest,the working class get told a lot about them,but"we"our class do not get the same coverage,and when we do,it is either when we are seem as"trouble"and stereotyped in various ways,or are quaint for our occasional ideas or for human interest stories.I think this comes down to,they really don't understand us.They just avoid,delete,don't understand us.Mostly we do not exist for them......I draw no firmer conclusions,yet.
Eventually but feeling a little fragile i got dressed to leave and was taken down to the discharge lounge,from where i made my escape and am glad to be home.I have heard of but not been in or used a discharge lounge,which i guess are marginally more comfortable places from which to arrange medicines,final instructions,follow up and transport.Staff and patients there were both very helpful.I felt a little disconnected by this time-fragile,sleepless,still anxious and in some discomfort.
I got home,and after trying to settle and get used to yet more medicine i went to bed where i guess i did some catching up,starting today even later than usual,getting used to the strange mild discomfort i am left with i trust temporarily,and reviewing the experience.
So i'm still talking to friends and my partner about it.I stand strong in my commitment to an NHS(national health service)that i believe should be even stronger and more socialist and should close out all the creeping as well as the obvious private/profit/capitalist input and exploitation.The irony is that the very treatment i have received,good so far in all respects might contribute to me NOT being present on the London wide demonstration on 18th May simply because i feel weaker,and more fragile.Otherwise,i will be there in spirit,eager for us to keep an NHS,free at the point of need,and growing stronger and more public everyday.
Many of us on the left and who are activists in the campaigns to defend/save/protect the NHS spend a lot of time considering why people don't see the urgency of the question.I don't have any magic answers,and without wishing to avoid the answer or searching for one i would firstly acknowledge its complexity.The experience of the last 48 hours or so has however reminded me of one thing,that although many people value and indeed love the NHS,on the other hand it offers services that we do not engage with unless we have need or problem,and that is actually part of the problem.I suspect those mostly involved in it,are those who one way or another are most directly involved in it.
Let me end with something personal:my partner joked that it was a good job that i had a male crew.Me and one of the crew men responded that i did not seem to be the kind of man who would be bothered.I'm not,and that was partly driven by my condition.Fear and pain.Having thought a little more,i would only add that it was good to be in the presence of men who made no negative hint of any kind when they saw that i was afraid,in pain and very fragile.That i hope is typical of ambulance men and ambulance crew
d1/100513
Following that meeting,the evening took off in an unpredictable and frankly unwanted direction.I do want to write about it,from several points of view here.So now,i want to warn any readers of this blog,that it may well talk about material that is both possibly difficult and certainly intimate.I make no apology for either.
I am NOT writing this from I hope any egocentric viewpoint,nor in any belief that i am either special or important,in any other way than to assert that we are ALL important and special.Indeed,we all,i believe have talents that this sort of society under-develops and under-uses,but that too is another issue,the subject of another post.Indeed,i suspect as a man,that it is only men that would even think of putting those riders in,because i suspect that women have long had a way of talking about such issues that for men is at least much more problematic and ambivalent.I feel as one of those men,that we are only going to be able to challenge and change that sort of perspective if we do exactly that-to challenge and to change it.So this is an attempt to do so.
I want also to make clear that this is a very subjective and impressionistic piece.Whilst i brought my analytical and critical faculties to bear,i have not done further research nor have i approached this analytically,beyond my surprisingly still ferocious curiosity about my environment.I may have left social work,but social work has not left me-and on such occasions i still want to understand procedures and how things work,and again the sociology of it.
At the risk of pedantry,i admit i am going to talk about a health problem experienced by older men,so women would be less will to talk about it,though i suspect women tend to be more open to it,not least in their relationships with men,but also at the more general level of health and emotional issues,and indeed even in relation to men's health issues.I suspect that many of the campaigners include women.
I have unintentionally been mysterious enough,so let me be clear,what i am talking about as i describe the events of Wednesday night onwards.
Towards the end of the meeting i was in,i began to feel uncomfortable but that once able to address that discomfort at the end,it would resolve itself.It did not.I walked to the station with my woman friend and comrade,and we got on the tube together to return home.We talked largely about our political activities and plans over the next few days.This is frequently about activities in which we work together,or failing that,in which we have a common interest,backed by a close relationship as friends and comrades.
I admit that when i am feeling fragile or vulnerable,i often feel less so in her company or the company of other friends,companions,comrades.I may not talk about it long or in detail but i don't hide that,and it does make a difference to me and the quality of my life.
When i got home,i could still not get rid of the pain,which intensified and within a short time i was reduced to being naked and pacing about part of the house as a coping mechanism.It was not long before my partner was consulting the internet,and making contact with the relevant"arm"of the NHS.
Early information indicated i might have an infection.She tells me now that a check on the symptom checker on NHS Direct,indicated that we should call an ambulance to get to A&E(accident and emergency).I was not able to make that call,but knowing that the NHS Direct telephone helpline(an 0845 number had been shut down she called the new 111 number.Over the next 2 hours or so,we had 3 conversations with the same person,who asked the same initial questions and then more questions and gave us both advice about what to do.I won't repeat that advice in detail except to say that whilst it seemed useful,it did not work,although i intend no criticism here.We were both told that if things got worse,or the symptoms developed in particular ways,we should call back.During the 1st call,i was told that a doctor would call within and hour or so.As things got worse,as the pain intensified,we made a secnd call which ended with another sort of medical assistant(paramedic?)would call in less than 30 minutes.I think my partner was advised that we could call an ambulance,she did so although that call ended with a message that an ambulance may not come but that we may recieve andother call.The pain quickly became so unbearable that she made a 3rd during which we were advised to drive to some kind of clinic in the hospital,which was not for emergencies but for"out of hours events".This was impossible because nether of us drive or own a car.No taxi would take us due to health and safety/insurance and other issues-we did not even try,but my partner asserted our difficulty and my pain.She made a further request for an ambulance having reminded them of their own previous advice.
At 11.55pm an ambulance showed up.I experienced some relief,though no pain reduction being in the company of(broadly)medical and calm,competent staff.Some moments later when i was in their ambulance,we had received NO call backs from helpers,paramedics, nor doctors,nor ambulance service although we did now have 2 ambulances at our door!
After a few minutes to settle and undertake administrative tasks,we made the journey to hospital.I answered a number of probing,intimate,personal questions most of which i was happy to do,as precisely and concisely as i could given the"distorting"impact of pain and fear on me.If the calls were mildly reassuring the ambulance crew were very reassuring,calm and competent in both what they did and their attitude to us.
Partly because the pain "settled"though it did not reduce much,partly as a means of self distraction and partly because however ill i am on this or indeed other occasions,i am always surprised by my own analytic,curiosity especially in what might generally termed the sociology of it all-so we had a conversation along the way about their job as ambulance drivers.It became clear that busy or not such crews are constantly active,and that in a busy London A&E,like that night,they were already BUSY!This makes their breaks minimal in frequency and duration.One of them told me that there are now time limits of the time they can interact with patients!None of us had time to discuss some of the more"problematic"situations that the press/media like to report either as human interest stories or as disaster or"scapegoating"stories!
I commented that they worked for St.John's Ambulance Brigade.It seems that because LAS/London Ambulance Service cannot obtain enough staff,that it now"buys in"the service of at least 6 other organisations and companies,and that whilst no full time drivers for LAS,they had both started as volunteers for St.Johns and that they still were.I am NOT drawing the conclusion that LAS now relies on unpaid volunteers.Now am i challenging St.Johns as an exploiter particularly,although it is easy to see that this could provide further routes to the greater exploitation of labour.
I am guessing that volunteering for St.Johns is still about the provision of para-medical assistance on occasions when even in the best of times NHS services would only be applied in an emergency,such as at football matches and other public events.I think for example i have seen St.Johns staff at or near major political demonstrations although i cannot assert that.
To the best of my understanding St.Johns provide a service as a charity,which one way or another goes back to the MIlitary Orders of the Crusades,and to the Catholic Church.In decsribing it thus,i am at this juncture simply being descriptive,not critical although i might in another,and more informed context have criticisms.I am certainly NOT impuging the motives,commitment nor work of the 2 young men who took me to hospital.Indeed,it became clear these these men are trades unionists,dedicated public servants and to their professional tasks.It was a privelege to meet them,and to be in their care-and i do mean care.
Charm does not come naturally to me.I try to be good mannered.I also remain a shy man,but having long believed that good eulogies at gravesides/funerals have their place,and having long felt that often people do not appreciate each other,i always try to make a point of articulating what goes on inside my head when that is appropriate.I hope i appreciate labour,and service and commitment-and said that i appreciated the NHS in general and the work done by its"representatives"not as some abstract distant category,but as embodied in the real people i interact with.So,i will say here,and not for the 1st or last time-lets do everything we can to keep the NHS and to keep it free at the point of use.Lets go on to build it into an even better service,where every detail of"from each according to their ability,to each according to their need"applies.
This is not the 1st time into this A&E department for me.I think this is at least the 3rd time since 2009 for me.I had previously visited other styles of "out of hours"services too.My partner has i believe been to both at least once herself in recent years,and both/either of us took one or other of our two children when they were children.We also attended with emergencies during my partners pregnancies at 2 of the local hospitals.
I am familiar enough therefore to observe particularly what is similar each time,at least in my own direct experience.What comes across most powerfully for me is how there are no managers about,although there is a hierarchy of decision making command which at least at some levels make absolute sense.I am not an advocate of hierarchy but a Doctor IS more trained than a nurse,etc.Secondly,it all seems to operate as if it is both organism and machine-which fits in with my view based on Karl Marx that we are social beings,and that we are at our best when active at that level.I am sure that people.staff know each other and become familiar as colleagues and friends which hones this phenomena.There is always a busy calm.Not least,we the patients are at our most vulnerable,and possibly our most difficult.We are strangers to them and yet i have always experienced it as tender and sometimes intimate care by strangers of strangers.Unfortunately the NHS is NOT fully operative socialism,but there is a lot there,and indeed here in the specific situation i experienced that is very close to socialism(Please remember i am not being particularly analytical here.i am NOT writing sociology or Marxism here,this is a subjective piece,although another time or place i could probably defend analytically my view.)
I was handed over,and then had to wait over 4 hours for the attention i needed.I am not being critical when i observe,that whilst no-one rushed at anything all the staff i saw worked constantly and that standing about was either relatives or professional staff awaiting and usually doing something else manageable at the same time.Whilst there might be some unnecessary repetition,i believe that repetition to to check for mistakes or for security reasons.Mistakes and misunderstandings still occur-i saw though i am not sure i understood them,but this is in the nature of being human.
I am aware that at least for myself that it is often difficult to differentiate for example the "rational"experience of pain from psychological interpretation.Laying on a "trolley"eased my pain a little,being in the company or presence of medical staff at all levels was reassuring for me,and made the pain bearable most of the time but it reasserted itself.I found myself pacing again as i had at home,and i became increasingly desperate.I waited for over 4 hours for substantial relief with my treatment,which was radical in going well beyond tablets but did ease the problem.
Critical news coverage of the crisis of A&E both nationally and particularly in London indicates that 4 hour waits are not seen as acceptable,although bringing them down will not be easy,as it is not likely to be simply about money and resources.That said i do NOT want to cover up the problems nor the blatant destructive damage of austerity and cuts so far.
It seems that whilst "innovation"to provide GPs out of hours services,combined with other ways to deflect from A&E have had at best,it seems,ambiguous results,whilst others report an increase or surge of A&E referrals/activity of over 1m people/incidents.
From a place like Northwick Park which is reporting already an increase of something around 40% demand,a 4 hour wait can be nos surprise already.Planned cuts across A&E in this area of NWLondon seem increasingly absurd and unfair,although protest does not seem to alter the view of consultancies,consultations,authorities or anyone else in power to decide.
Again I can only argue subjectively ro analytically to keep the NHS,to keep it publicly funded and to keep it free at the point of use!
From what i could see,it seemed that all staff were working efficiently and expeditiously in so far as this is ever possible in the midst of human need.I was confident that staff were making legitimate and rational decisions about human needs in the health context.At no time did staff run away or even run to do something else.I ay not have recieved preferred answers but i did get answers.Only once did a doctor advice me to save my questions for a quieter time,as he had more acute problems to deal with.I had no problem with that answer,and my anxities were later more fully allayed.
After treatment a breezy young surgeon,responsible for urology during the night came to explain that i would be kept in for monitoring due to the problem identified.At around 6am I was taken to what i guess was a male general ward,and i probably fell asleep at around 6.30am.Before i left A&E i was tested for MRSA,which i think is one of those conditions that actually thrives in hospitals.This is not just an issue about ensuring their is adequate time,money and other resources to deal with it,but arecognition that the environment will inevitably be faced with such difficulties by the nature of the cause of such conditions(i apologise i cannt explian more fully,i am not a scientist)
I admit then that i was neither best pleased nor at my best when cheery,fresh hospital staff at the start of their shift wanted"wakey,wakey"at the start of new shift,new day or their routine tests.I co-operated but determined to otherwise stay asleep!I understand their needs too,in that regular tests is both monitoring and contact,neither of which is yet entirely reducible to being"management targets".In relation to myself it was directly related to monitoring my condition.It also facilitates contact with patients.
Yet this does raise some very real conundrums and difficulties in and for hospitals.There is a tension between the demands on A&E staff,and the emotional and practical needs of patients and friends and family with them.These do not fit easily together.I may return later or some other time to this.Hospitals do not seem so beset as in the days of more authoritarian structures-in those days health was done and delivered to us,these days we are increasingly seen as individually responsible perhaps in a way which replaces that previous authoritarianism with an equally unacceptable individuation.Instead the new routines,which are NOT the old ones disguised in my opinion,but are driven by regular monitoring of a diverse range of conditions,many of which might well be dealt with better,where once the crisis is over,in the community in at least notionally less disruptive as well as more economic ways.
When i did wake at a"more civilised"time in the morning i messaged a few people,tried reading,eat the food i had been carrying the previous day,and eventually fell asleep again after a visit from the Urology Team,and some further tests.A chance to allay my own fears with some questions,answered by a consultant who in manner and rank come across as authoritative,persuasive,trustworthy....It was agreed to my relief that i could go home when various processes were completed.Treatment would follow,along with further diagnosis.
Now,I admit that i'm from the question everything,trust no-one school which is NOT about trusting ordinary people in our everyday lives,nor doubting friendships but rather simply not taking on trust other sorts of knowledge,that claim to be fact-from advertising,to history,politics and especially not science.Incidentally whilst theology may have lost its rank as"absolute truth",i do NOT accept that science has earned or taken it,and is certainly not at the pinnacle of knowledge.I might accept that mathematics more closely replicates some of reality(though i could not articulate how,and i suspect that statement and admission both illustrate the very conundrum i am trying to articulate).If forced i would say that philosophy would occupy that pinnacle although that would still be based on a kind of relativism,in which it questions and posits that knowledge is socially constructed)
In banal,daily practice however,we do,i think have to take some things on trust.I found myself genuinely reassured by the presence of ambulance crew.It does not require me to rely on their knowledge in detail over my own,but it certainly has a psychological impact-in that my psychological experience of my pain was reduced at least partially with their arrival and presence.I did not know them but i associate their role with obtaning some kind fo reassurance.I know and trust my partner implicity,and yet no matter what i tell or ask her about my condition,nothing she says about this would give the same re-assurance.
I slept through most of the afternoon,though inevitably overhearing without intending to listen to other conversations.As an social worker,that comes as a kind of second nature.Part of that response is as an ever cuious social scientist and/or revolutionary socialist activist.
Another patient was a young man,usually a student at the local but very well know Public School.Usually i experience class not just filtered through my own experience but through those i mostly engage with as my clients in the past,through my political and social activist engagement through most of my life and not least through my own friendships and relationships.I also acknowledge that these overlap.Yesterday,i experienced at a distance,indirectly the other side of those class dynamics in observing someone of another class distancing themselves from what i guess is the ordinary and consciously or not"working class"of their immediate environment.I would not seek to judge the particular young man.I try not to be judgemental,and i do not know him.He seemed to wish to be obedient to his concerned father who was it appears on another continent.I picked up that his father wanted a more experienced/qualified surgeon.Despite reassurance from doctors and others via a woman who was both clearly in a position of authority over the youth but also of subservience to the father in relation to the school,it became evident that the father might be making assumptions that a free NHS might be an inferior service,as non-profit hospitals in say the USA might appear to be.It would seem to me that this view is both clouded by distance-i myself would not have a good hold on health services in Asia.Yet it might also illustrate another view too.
It is my view that the dominant ideas in society are the ideas of the dominant class.That does not make them either right,nor the majority view,simply the dominant view.Ideas also overlap and contradict.My impression from the way the media operate here is that they themselves are largely about the views and behaviour of their class.We,the others,the rest,the working class get told a lot about them,but"we"our class do not get the same coverage,and when we do,it is either when we are seem as"trouble"and stereotyped in various ways,or are quaint for our occasional ideas or for human interest stories.I think this comes down to,they really don't understand us.They just avoid,delete,don't understand us.Mostly we do not exist for them......I draw no firmer conclusions,yet.
Eventually but feeling a little fragile i got dressed to leave and was taken down to the discharge lounge,from where i made my escape and am glad to be home.I have heard of but not been in or used a discharge lounge,which i guess are marginally more comfortable places from which to arrange medicines,final instructions,follow up and transport.Staff and patients there were both very helpful.I felt a little disconnected by this time-fragile,sleepless,still anxious and in some discomfort.
I got home,and after trying to settle and get used to yet more medicine i went to bed where i guess i did some catching up,starting today even later than usual,getting used to the strange mild discomfort i am left with i trust temporarily,and reviewing the experience.
So i'm still talking to friends and my partner about it.I stand strong in my commitment to an NHS(national health service)that i believe should be even stronger and more socialist and should close out all the creeping as well as the obvious private/profit/capitalist input and exploitation.The irony is that the very treatment i have received,good so far in all respects might contribute to me NOT being present on the London wide demonstration on 18th May simply because i feel weaker,and more fragile.Otherwise,i will be there in spirit,eager for us to keep an NHS,free at the point of need,and growing stronger and more public everyday.
Many of us on the left and who are activists in the campaigns to defend/save/protect the NHS spend a lot of time considering why people don't see the urgency of the question.I don't have any magic answers,and without wishing to avoid the answer or searching for one i would firstly acknowledge its complexity.The experience of the last 48 hours or so has however reminded me of one thing,that although many people value and indeed love the NHS,on the other hand it offers services that we do not engage with unless we have need or problem,and that is actually part of the problem.I suspect those mostly involved in it,are those who one way or another are most directly involved in it.
Let me end with something personal:my partner joked that it was a good job that i had a male crew.Me and one of the crew men responded that i did not seem to be the kind of man who would be bothered.I'm not,and that was partly driven by my condition.Fear and pain.Having thought a little more,i would only add that it was good to be in the presence of men who made no negative hint of any kind when they saw that i was afraid,in pain and very fragile.That i hope is typical of ambulance men and ambulance crew
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