Traumatised.

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After years of not darkening the door of A&E, we’ve managed to chew through chunks of that scarce NHS resource twice in a month. I seriously misjudged my step near a flight of stairs in mid-December and still have a limb in plaster. A few days into the New Year, Grenouille’s flu-ridden Papa passed out in the bathroom, bounced his head off about five different hard surfaces, and was blue-lighted in with possible C-spine injuries, in a neck-brace and on a spinal ‘scoop board’.  

Both times, our local A&E staff have been superb, but the place is a nightmare.  It’s a maze of cramped corridors and cubicles, with people sliding sideways past one another.  Windowless, it feels oppressive even at noon, and I’ve never seen it but it’s rammed.  I don’t know how crowded it was when G’s Papa was taken in, in the wee small hours; I had to stay with G after the smoothly competent paramedics had assessed P, shot him full of morphine, braced and boarded him, got him round the awkward turn on our stairs and up the steep front path.  I know they managed to rustle up six competent pairs of hands to get him off the trolley and under the X-ray machine without jolting his neck and thankfully, after a period of worrying uncertainty when the initial films weren’t clear, he was given the OK.  But when I was in there, at ten in the morning, it was appalling.

Areas of the department seem to be under refurbishment.  I’m not sure if this is merely planned work to remedy some of the terminal shabbiness or whether they’re having to do emergency replacement of bits that have actually started fall down.  Either way, there are apparently random areas sheeted off with dust-coated polythene, behind which can be seen foggy outlines of construction workers; and the doctor treating me – Dr A, young, serious, neatly-pressed shirt starting to wilt – had to push me, on a squeaky-wheeled, brakeless trolley, to a half-demolished area. Here, he brushed sawdust off a computer terminal, in order to show me my X-rays and explain what needed to be done for my broken bones.  Back in the main area, en route for the plaster nurse, it was impossibly crowded. The doctor manoeuvred the trolley expertly, gently drifting it between scurrying bodies and round tight corners, without bumping anyone or anything, and parked me in a wider stretch of corridor. Around me eddied my fellow-flotsam: an elderly gentleman, slumped in striped pyjamas, whose only word, uttered dolefully at roughly thirty-second intervals, was ” ‘Ome!”; another woman with a leg injury who had brought in her knitting and her e-reader and was determinedly trying to block out her surroundings, though without much success, judging by her winces every time her neighbour foghorned his desired destination; a rather confused late-middle-aged lady who was having trouble communicating with staff. Parents cradled grizzling children and patiently repeated answers to repeated questions. In the distance, the doctor glided past at speed with another trolley, this one bearing an unconscious old lady, her scalp showing through her sparse hair, the same faded pink as the cellular blanket that covered her.  The phone on the nurses’ station rang constantly, but was seldom answered.  A nurse grabbed a water-bottle from behind the computer and gulped several swigs before flitting off.  Staff coalesced briefly around the desk and rapidly dispersed again.  Unlike the parked patients, they were in constant motion.

Suddenly, there was a buzz of bells and a trundle of trolleys moving from left to right, from the direction of the ambulance entrance towards the operating theatres.  Half the staff rose and moved off in a body behind them, as though the trolleys were surfing before a Severn bore of blue scrubs.

The confused lady became tearful and grabbed at a nurse for reassurance, babbling an incoherent account of her troubles, symptoms and worries.  “My heart… and I can’t remember which day, it’s… and then the stroke… I think I’m going to have one of my panic attacks, but the palpitations, it’s like when…”  The nurse squatted in front of her, talking to her as though she were a dim and rather naughty child.  “You’re hyperventilating!  Stop it!  Come on!”  She tapped the lady’s hand.  The lady breathed harder.  A female doctor came over:  “I’ve set up an ECG machine in the the office, I think she’ll be better in the quiet.”  “Come on,” said the nurse again.  “Let’s get you over there.” She stood up and put her hand under the lady’s arm.  “Get off!” shouted the lady, suddenly switching to indignation.  “You’ll make me fall!”  The nurse rolled her eyes.  “I’m just trying to help.”  “I have to… the stroke, it’s walking.  Take my time.”  She heaved unsteadily to her feet and shuffled off unevenly, muttering, between the two younger women.

Eventually, the plaster nurse came to find me. “Sorry about the wait. We’ve had a couple of urgent cases come in so Dr. A wasn’t available – he needs to observe this.”  She spun me round and set off for the workmen’s area again, acquiring Dr. A en route.  He watched as the nurse moved swiftly through her task, giving him minimal explanation and no opportunity to do anything himself.  I thought, fuzzily, that if this was the ‘see’ part of Dr. A’s ‘see one, do one, teach one’ training, I hoped he was a very quick study.  I was glad I was his first and not his second patient.  The nurse handed me a pair of crutches and helped me to transfer to a folding wheelchair that was even more decrepit than the trolley.  “Can you find someone to take her back to the front desk?” she said to Dr. A.  “I need to get this trolley back in circulation.”  She squeaked off, leaving the door open.

“I’ll take you myself,” said Dr. A, shoogling the chair’s handles until the wonky wheels were lined up enough to move.  “I haven’t seen a porter at all this morning. Still, you picked a good time to come in.  Earlier, it was really busy, and it’ll get worse again later on.”

I looked out at the heaving chaos in the main area and wondered aloud how much worse ‘worse’ would be.  Dr. A sounded amused.  “We’re jammy just now.  We’ve still got a spare operating theatre,” he said, turning down a corridor leading away from A&E, propping a door open with a crutch and deftly retrieving it as we passed through.  “No-one’s bleeding uncontrollably, or having a heart attack, or trying to take a swing at a member of staff.  And if you’ll kindly shift onto one of these banquettes in the foyer – if we prop your leg like this, is that comfortable? – I’ll have another seat for a patient who’s still waiting to be treated.”  He smiled, tiredly, wished me well and disappeared briskly, the wheelchair wobbling in front of him.

I called Eldest to come and pick me up, and tried to imagine what it must be like after fourteen hours of too few staff, in too small a space, juggling too many patients, including bleeders, vomiters, screamers, about-to-croakers.  If, as I believe, the quality of care depends on the nature of the relationship between carer and caree, how can you really care in those circumstances?  If you really care, how do you cope with having to do half a job much of the time: the bare minimum with no time for relationship, or even kindness?  How do you steer between the Scylla of callousness and the Charybdis of collapse?  How do you keep sane, knowing you have to do it all again tomorrow?

When E was in his final year at school, one of his friends was knocked down in the road.  A group of them had all been at an after-school ‘revision club’, and had stopped off at the local pizza place afterwards; it was winter, and dark, and the car came fast around a blind bend.  Milo went up on the car’s bonnet and was then hurled several yards down the road when the driver stood on the brakes.  E, who had completed St. John Ambulance emergency first-aid training, did all the right things.  He immediately ‘set a perimeter’, flagging down a couple of other cars and getting them to park with their hazard lights on so that Milo – and anybody helping him – was protected from the traffic flow.  He stopped a well-meaning passer-by from trying to move Milo.  He delegated calling the ambulance to someone else while he checked Milo’s ABC, kept him covered, kept him talking.  When the ambulance arrived, E was able to give the paramedics a comprehensive account of the number, nature and possible severity of Milo’s injuries.  His other friends agreed to wait for the police; E went with Milo in the ambulance.  He called me from there to explain why he was going to be late, and to ask me to phone Milo’s parents and tell them which hospital to go to.  No answer on the landline.  E didn’t have their mobile numbers, and Milo’s phone had got smashed in the accident.  I called E back and told him I’d keep trying.  He said that Milo needed to go into theatre immediately, could I speak to one of the doctors to explain.  E stayed with Milo right up until he was under anaesthesia, and then he went down to the main entrance so that when Milo’s parents finally arrived, they didn’t have to ask anyone where their son was; he could take them straight to the right place.  The surgeons were still operating.  E sat with Mr. and Mrs. Milo for another two hours.  Milo was still in theatre.  At 11.30, E got a cab home.

It was a long night.  Although E’s training had clicked in perfectly, and I was able to tell him, repeatedly, with absolute confidence, that what he had done had given Milo the best possible chance of surviving (given that he couldn’t make the car un-hit him), E knew that the injuries Milo had sustained were life-threatening. He was in shock, shaking and unable to sleep.  I called the hospital.  No information.  At some point after midnight, Milo was transferred to the regional trauma centre.  They were still more reluctant to say anything, even that he was a patient, but I managed to find out at 2 am that he was undergoing further surgery and was not expected to be out until 6 am.  At 6.30, Milo’s father called me to say that Milo had just been moved to resuscitation.  As E had suspected, there had been serious internal injuries and bleeding to sort out, but Milo was expected to make a full recovery*.  E fell asleep as though poleaxed; and I got Grenouille up and into the taxi, phoned E’s school to let them know why he wouldn’t be in that day, and retired for a kip myself.

It wasn’t the end of E’s difficulties, though.  He had nightmares and trouble sleeping for several days and I had to coax him to keep telling his story over until he had made his peace with it.  And so I am troubled about what we are asking of our A&E professionals at present.

Now, I know that there is a huge difference between a seventeen-year-old having to deal with an accident to a friend, and a healthcare professional dealing with patients as part of their job.  The HCP has far more training, more experience, more detachment.  But they also have more incidents, a closer view of the consequences of injuries, more people to deal with every day, more responsibility.  As long as E hadn’t actively made things worse for Milo, he would have done well enough; that he did considerably better than that was just icing.  A health professional’s first duty may be to do no harm, but they have to go a lot further, every working day, with every patient.  And then they have to complete the paperwork.  No chance for a proper debrief, let alone an extended one. Just eat, sleep and repeat.

Expecting them to do so, without breaks, on shifts that are nearly twice as long as the typical working day, in emergency departments that are under-staffed and over-crowded because the entire health system is deliberately underfunded for politico-ideological reasons, is diabolical.

*****

*Milo returned to school, in a jangle of supportive ironmongery, about 6 weeks later; got top grades in his A2s and, fully recovered as predicted, is currently doing very well indeed at university.

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In The Doghouse.

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Grenouille has been making a confection called ‘chocolate bark’, anent the forthcoming gift-giving season.  It’s two parts dark chocolate, to one part milk chocolate, to one part white chocolate. Each kind of chocolate gets melted in a separate bowl, then blobbed out randomly but contiguously onto a sheet of greaseproof paper. Next, G swirls the blobs into each other with a skewer to give the ‘bark’ effect, and dots a few cranberries, pistachios and chopped dried apricots over the surface, before cutting the resolidified sheet into triangles.

G’s Papa has become mildly addicted to the finished product.

“G, may I have some more of your chocolate rind, please?”

“Bark.”

“Woof!”

“Dad! It’s chocolate bark!”

“Sorry. Please G, may I have some more of your chocolate woof!

G gave him a look that channelled pure Victorian grandparent, at a pH of about 0.01.

“You won’t be getting anything at all unless you say the proper words.”

Grenouille Takes The Biscuit.

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An oldie from 2016.  Not sure why it didn’t get posted at the time…

Homework Club at the dining-room table.  Eldest is writing a history essay on European nationalism movements, while G is doing an assignment on baking for Food Tech.  Both are concentrating ferociously.

(to me): “How many b’s in Garibaldi?”

(obviously returning from some distant mental shore and looking bewildered): “Aren’t any bees in a Garibaldi.  They’re squashed flies, but they’re really currants.”

La Pacamiga Nueva.

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Usual stretching and squashing of respite over the summer holidays, with the happy result that we had a six-hour slot the other Friday evening.  With the children’s Papa’s birthday just round the corner, I offered him first dibs on deciding where we would go.  He came up with two alternatives: a gig by a Tex-Mex music outfit that I had never heard of, or an ice-hockey game.

We used to go occasionally to watch the ice-hockey, back in the far-off BC (before children) era.  We even took the kids a few times when they were tweens, but Eldest wasn’t desperately bothered, and Grenouille actively disliked the noise and fuss – the loud music, the shouts, the claps and semaphoring to a Queen drum-intro every time the home team scored: “WE will, WE will, ROCK YOU!” (boom, ba-ba-boom).  Grenouille doesn’t like popcorn (too dry) or ‘sodas’ (fizz up the nose).  When the ‘ordeal’ score outweighed the ‘enjoyment’ one, we gave up.   But the thought of a chilly hockey arena didn’t really appeal for a Friday evening.  A dose of synthetic southern sunshine sounded more like it.

“They’re called Los Pacaminos,” said P. “I’ve sent you the weblink.”

I had a look. The banner showed a baker’s half-dozen of middle-aged types in Stetsons and denim. ‘Tex-Mex, Border and Americana’ said the first line of the blurb on the home page.  Another page mentioned Ry Cooder.  That was me sold.  I love Ry Cooder: the jaunty bounce in the rhythm, the loping melodies, the swagger and the steel slide, the heartbreak and the sly humour in the lyrics, the gospel-inflected harmonies.

“Deal!” I said to P.

“Hmph,” he said, mock-grumbling.  “Just ‘cos you fancy Paul Young.”

This, Dear Reader, was a vile calumny.

“I didn’t realise Paul Young was in there!” I protested, flicking back to the home page and scanning the grizzled faces again.  It took me a while to recognise the erstwhile Mr. Wherever-I-Lay-My-Hat in the central figure.  “And anyway, I never fancied him, even thirty years ago.  Not my type.”  P cocked a sceptical eyebrow at me over his phone while ordering the tickets online, but it’s perfectly true: when it comes to southern-accented eighties rockers, my preferred visual aesthetic is a blue-eyed blond with with flowing locks and a razor-sharp jawline (thank-you and goodnight, Mr. Tom Petty), not a brown-eyed, round-cheeked, mulleted brun.

“Blimey, how long is it since we went to an actual gig?” I added.

“Apart from that Kate Rusby Christmas thing, about twenty years, if you don’t count Jon and his mates’ bashes.”

“Jon’s mates’ bashes definitely count. They’re excellent.”

Jon is a very accomplished guitarist who must have put in his 10,000 hours on fretboard and plectrum several times over, and my friend Ruthie’s husband.  Their sitting-room is decorated throughout with Jon’s guitars, hanging on the walls and propped on stands – Strats and Les Pauls, genuine and copies, solid- and hollow-bodies, an acoustic or two – in a dazzling variety of colours and finishes.   But the day-job pays far too well to give up, so Jon plays along to the telly and soundtracks conversations in the evenings, and if you go over at the weekend, you’re quite likely to find that he and some like-minded mates have dragged in amps and drum-kit and are spending a couple of hours messing around playing over old favourites, adding new numbers to their already enormous repertoire, improvising, and generally having fun.  Once in a while, they’ll play a party; and every so often, they’ll get a notion for a bigger audience and offer their services for a pub gig as a fundraiser for some local charity.  Classic win-win-win: Jon and pals are happy to be heard, the pub is happy to pull in extra punters and the charity is happy to make a bit of dosh: “Don’t forget to buy your raffle tickets!  We’ll be doing the draw after the next couple of numbers and it’s for an excellent cause!”

(Although performing brings its own puzzles:
“What shall we call ourselves?”
“We’re a pick-up band, so The Pickups?”
“Not sure I want to associate myself with pickup artists – sounds a bit sleazy, like that American slimeball who teaches coercive chat-up lines to creeps.”
“If you can find another beardie for the front line you can call yourselves ZZ Flop,” said Ruthie, irreverently.
“Don’t tell me, you’re going to say next that the ZZ stands for Zimmer Zimmer.”
“At hhome we would say, you are becoming a hheavy metal band,” said a visiting South American mandolin player.
“You what?” said Jon.  “We’re strictly rock and pop, not heavy metal!”
The visitor looked amused.  “No, is not the musical style, is the age.  It means: silver in the hhair and gold in the teeth!”
“Just as long as it also means: still got lead in your pencils,” said Ruthie, and nearly fell off her perch on an amp, laughing.
“More like ‘iron in the soul’,” muttered Jon.)

The parties and pub ‘dos’ are cheerful, relaxed affairs, as they romp through danceable classics down the decades: Johnny B. Goode, I Saw Her Standing There, Willie and the Hand Jive, She Loves You, I Feel Good, Mustang Sally, Ever Fallen In Love with Someone, I Knew The Bride, The Locomotion, and dozens of others, with the occasional guest vocalist or shout of ‘Round again!’ if there’s a particularly enthusiastic bop going on.

“Remember that time I got them to do the Q-Tips’ Keep Your Shoes On?  All those choppy chords and Whatisname pounding the piano, instead of the brass?”

The Q-Tips, for anybody who’s never heard of them, were a London-based R&B/soul band in the Memphis mould: guitar-bass-drums-keyboard, three-piece horn section, drainpipe trousers and drape jackets, covers of Stax and Motown classics, but also original material and more country numbers – one of their singles was a cover of the Boudleaux Bryant song, Love Hurts, which had featured in the canon of Gram Parsons and Emmylou Harris.  And their lead singer was one Paul Young, Esq., in a pre-mullet Beatles cut and velvet cuffs and collar.  

As a teenager, I saw the band live when they were supporting The Who and was fairly blown away by them, Stax being just as much my cup of tea as Mr. Cooder.  Their singer’s voice was phenomenal.  All dark-brown velvet in the middle and coffee-grounds roughness round the edges, it was totally my cup of, well, espresso. 

Keep Your Shoes On was my favourite track from their one album. A self-penned, authentically Stax-y sounding soul number, it had a lyric of almost music-hall Britishness, that encapsulated being young and trying to develop your sense of self and of style, in a place where it rained as often as not, and where the public transport you relied on stopped running at midnight.

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“If it is Paul Young, at least we know we’ll hear some excellent singing.”

Unfortunately, this turned out not to be the case.  Not because Mr. Young was in poor voice; I couldn’t really tell you whether he was or not, because the feed from his microphone seemed to be way too far back in the mix.  The only time I really heard him singing was when he swapped mikes with his guitarist/singer bandmate, Jamie Moses, adopting a wide-leg stance to lower himself to Moses-mike-height, while Mr. Moses stood on tiptoes and stretched his neck upwards to reach the muddy-sounding centre mike.  But I’m getting a bit ahead of myself.

The foyer at the venue was milling with people in cowboy hats.  The stage was crammed with serious kit: a row of microphones across the front, a pedal steel stage right, a keyboard stage left and a drum rostrum at the back. Two huge cowboy boots, each about three feet high, flanked the row of monitors across the front.  It all looked a bit earnest.  Then I spotted a Woody-from-Toy-Story doll sprawled on an amp.

“Do you get the feeling this might be rather fun?”

The house lights went down and the band threaded their way onstage, all wearing ridged cowboy hats and either plaid shirts, or cowboy ones with embroidered yokes.  Paul Young’s was of the embroidered variety and, to my amusement, was a darkish brown.  He’s definitely into his ‘heavy metal’ period, with a neat silver Imperial and thick steel-grey hair showing under the back of his hat, but if his middle, behind a hollow-body guitar, is rather more padded than it used to be (whose isn’t?), the legs underpinning his six-foot-three frame are still lean as well as long, and were displayed to advantage in dark-indigo slim jeans.  The rest of the lineup, read house left to house right, of bassist, pedal-steel player, guitarist, drummer, another guitarist, and keyboard player, were all several inches shorter and – how to put this kindly? – rather stockier, apart from the keyboard player, who had entered bearing a piano-accordion and was of the stick variety of build.

Young introduced the Pacaminos – “We started off as a practice band in 1992 and twenty-five years later we’re still going,” – then a siren-howl on the pedal steel heralded a pounding version of Red Simpson’s Highway Patrol.  After that, the evening careered, over-the-limit and frequently on the verge of going out of control, on a wild but hugely enjoyable ride through a medley of classics (the Cooder arrangement of Little Sister, Stoller and Lieber’s Saved, Eddie Deane’s Teardrops Will Fall), and some cracking lesser-known numbers, like Robbie Fulks’ acid-dipped I Told Her Lies, to numerous swerves via Pacaminos’ originals.

It was very like being at one of Jon’s sessions.  People swapped instruments while other people kept a rhythm going, there were pauses for banter and mild arguments, an audience member came up on stage and served a round of tequila slammers while being serenaded.  “Your turn!” called Moses as empty glasses filled the tray.  The tequila server necked her shot with panache.  “Style!” yelled Moses.  “It’s in her genes!”  shouted an audience member.  Moses grinned wickedly.  “You’ve been in her jeans?”  “It’s the genes, genetic!” shouted the heckler.  “How would you know, are you related?… You’re her Dad… Oh God… Inappropriate again!”  The other Pacaminos doubled up with laughter as Moses doubled up with embarrassment.  Although there was no raffle, there were reminders that albums and other merchandise were available for purchase in the foyer: “And we’ll see you out there afterwards!  You buy shit, we sign shit!” added Moses.

I liked the Pacaminos’ own songs just as much as the familiar oldies.  Poor Boys is a classic tale of a bank heist – that is on the brink of going unclassically wrong, if the cautious getaway driver can’t be persuaded to put his foot down.  The Pacaminos’ signature tune, Favourite Things, chugs along cheerfully on internal rhymes; The Girl From Tennessee has the same swing as The Girls From Texas but a different sly take on the battle of the sexes.  Then there are the drinking songs: Raised On Margaritas was inspired by the time Young’s then-two-year-old son did a boarding-house-reach across a restaurant table and swiped his mother’s cocktail.  Moses’ Battered and Broozed has the same lurching waltz-time as Drunken Nights In The City, but where Miller’s end-of-the-road drinker is all regret, self-recrimination and no redemption, Moses’ is still woozily, if deludedly, optimistic: “Tomorrow I’ll give up the booze/ If I can get sober/ I’ll drag my ass over/ And we’ll raise a small glass or two/ When I get my car back/ I’ll pick up a six-pack/ And drive myself over and drink it with you.”

It was a great evening.  Summoned back for an encore, “We’d like to play you the Tex-Mex National Anthem,” said Young, saluting smartly as the band crashed into La Bamba.  The audience was reluctant to let them go after that, but Moses demanded that the punters sing for the band, and while the crowd was bellowing “Los Pacaminos! Viva los Pacaminos!  Los Pacamiiiiinos! Oh, viva los Pacaminos!” to the tune of Guantanamera, the band slipped quietly away.

We couldn’t stay for the meet-and-greet, but we’ll be back next time “the Pacaminos are passing through”.  Probably sporting brimmed hats and Cuban heels, fully-fledged Pacamigos.  And I’m more than happy to recommend a dollop of “Pacaminos’ remedy” to anyone who finds it within reach.

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In the car going home, though, my linguist’s brain was niggling.  “I wonder where that name comes from?  I know my Spanish is as rusty as a newly-excavated medieval implement, but I’m sure pacamino doesn’t quite make sense.  Camino* means a walk or pathway, but that pa- prefix doesn’t fit in Spanish.  In fact, it doesn’t fit in any Romance language – it would have to be pan- or par- to mean something.”

“Mmph,” said P, who finds language fascinating on precisely no levels.

I lapsed into silence, and almost immediately, a mental movie started to play before my mind’s ear and eye.  A rehearsal room, a group of friends kicking tunes and ideas (and the odd beer or three) around, and eventually somebody saying, “You know, this sounds really good, I think we should take it out on the road.”

“What’ll we call ourselves?  Can’t be anything to do with Paul Young, if people think it’s the Paulie show, they’ll be miffed when they find out he’s doing Nashville and norteño stuff instead of his ballads.  They’ll all want their money back, extra-sharpish.  We’ll be the fucking Flying Exito Brothers.”

“Nah, they’ll love it.  We’ll be packing ’em in.  We’ll be Los Pack-em-iiin-os.”

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* (as all J4LB’ers will know) 

Meet Mr. Matty.

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Today, I have the honour to introduce to you, Mr. Matthew ‘Matty’ Brandon, aka ‘Mr. Smiles’.

Matty grew up in Saskatchewan, with a couple called Chris and Shannon Gardiner, who have looked after him ever since he was a small boy.  Matty has multiple disabilities, including cerebral palsy and autism.  He is non-verbal and needs his routines. So as he approached adulthood, Chris and Shannon devised a life for him where he could continue to live at home, attend a day programme, and get family-based respite care at weekends, to allow them to have a break and to broaden Matthew’s base of support. But in 2012, when he was 21, Saskatchewan Provincial government agencies decreed that as an adult, Matthew should move into residential care in a group living facility for people with intellectual disabilities.

The Gardiners fought long and hard to keep Matty out of the group facility, which they knew would not cater for his needs, and with which he would not cope.  But they could not stop the State juggernaut.  Matty was to be removed from the only home he could remember and dumped in unfamiliar surroundings with people he did not know and whom he could neither understand, nor induce to understand him.  However, after Matthew was injured, physically and psychologically, during the transition process, the Gardiners put their foot down and kept Matthew at home.

Saskatchewan responded by cutting off Matty’s funding.  The Gardiners, enmeshed in a bureaucratic nightmare, strapped for cash, but determined to give Matty a good life, began looking for ways to keep him occupied for free.  They also began building an online community for him, as well as an offline one.  They found their local library, which was good – interesting but not too noisy.  They set up a Facebook page to show all the things that made Matthew’s life enjoyable and worthwhile.  Then one day they discovered that their local Royal Canadian Mounted Police Depot Division – the RCMP cadet training school – held a ‘Sergeant Major’s Parade’ every Tuesday, which the public could view.  They were not sure if Matthew would cope with all the noise (the parade involves a brass band), but they gave it a whirl.  And Matty loved it.

Soon, the parade became the highlight of Matty’s week.  He would video it on his iPad and play the videos over and over.  Fair play to the detective skills of the RCMP, it did not take them long to clock that the same striking-looking, tall, burly young man was turning up to every parade and paying the closest of interest.  And having noticed him, they began to ask questions, then think about what they might be able to do to enhance his experience.  First, he was invited to meet individual Mounties.  Then, at the end of the parade, he was invited to tag along at the back, escorted by a couple of senior officers.  The Depot staff would give him occasional gifts of RCMP memorabilia. On his 25th birthday, bursting with incredulous pride and wreathed in the widest of his famous smiles, he was made an honorary cadet, with a full uniform specially tailored for him.

Then he got to meet the horses of the Musical Ride.  Not only has Matty been having a whale of a time, he has also, just by showing up and joining in, educated a generation of RCMP recruits about interactions with people with learning disabilities.  Like Steven Neary’s contribution to UK Human Rights law, Matty’s contribution to Saskatchewan civic life should not be dismissed or underestimated.

After several years of intense negotiation, the Gardiners succeeded in – well, I’ll let Chris tell you:

“Matty now receives SDF (Self Directed Funding), has his own agency and we were able to define and create delivery on what you see here on the page year round. Something “Person Centered” and a life plan that works for one of Saskatchewan’s most vulnerable citizens. We are thankful for this, only wishing it might have been easier a process in working with the system but are hopeful that the work put into Matty’s file makes it easier for others of similarity in the future to endure less trauma and challenge moving forward where transition planning occurs.”

With a framework of the predictable, Matthew is able to cope with the occasional surprise.  The Gardiners continue to introduce new experiences at intervals.  Matty has two friends, Sami and Nick, who take it in turns to host him in their homes at weekends, to give the Gardiners a break and to ensure that when the day comes that they have to step back from caring for him, there are other, familiar people around who can pick up the baton and run with it.  Matthew’s online community continues to grow, which is an important part of securing his future welfare, as in State care he would be subjected to a draconian ‘confidentiality’ regime that would obliterate him from view.  While the Depot parades have been a highlight of Matthew’s week, the regular posts about him, with photos and videos of him enjoying his time at the Depot, have been a highlight of mine for years now.  Do mosey on over and make his acquaintance here.  It’ll brighten your week too.

Matthew still needs all the support he can get.  Chris reports this week that:

“With Shannon away for a visit with her family/friends in her home town … and with me requiring a bit of focused time here at home with “must do” projects, our special man spent a couple extra nights away at his friend Nick’s. This time apart … replenishes all of our energy levels to a workable place and is why we designed it to be family focused, with us, or apart from us with friends he has built trust and harmony with. The goal is to make it so fluid that we all become interchangeable units of the same body, a transitional reality that needs to be in place in case any of us fall from ability to serve Matty’s best interests at any point in time. Both Nick and Sami have been along for the ride, a roller-coaster at times, and both have built beautiful trusting relationships with Mr Smiles, adding to this wonderful thing we have so carefully put in place together. Tonight I celebrate this irreplaceable effort but condemn a recent development which has created disharmony to it by an apparent policy glitch someone seems to have made their mission to see through. If they got their way, Matty would have to part ways with both Sami and Nick, an outcome that would be so very contrary to all the work both have put into the SDF project and Matty’s “Person Centered” program. As we have been through this before, we will not tolerate some arbitrary bureaucratic interference which ends in reckless harm where Matty is concerned and is why we are dropping this potential risk here with our many friends in case we have to fight back after it has gone too far. “

Sigh. It seems that Whistler’s Mother’s twin – or possibly clone – is alive, and well, and acting the interfering old trout in Saskatchewan.

The Death Decisions.

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Got to the point in Justice For Laughing Boy where the family are being asked if they ‘would…prefer burial or cremation for Connor’.

‘He.  Can’t.  Be.  Incinerated.’

I’ve never been involved in making arrangements after someone has died an orderly, expected death. When they’ve gone out, full of years and without too much pain, having made their wishes known.  I don’t know what that’s like, although I’m sure it’s still intensely distressing.  What I do know, is that after an unexpected and violent death, being asked ‘burial or cremation?’ is like being whacked on the ear with a lump hammer.  Dizzying, numbing, nauseating, causing black spots in front of the eyes.

When the children’s Papa and I were making our wills, the solicitor suggested that we put in them which of the two options we would prefer.

‘It helps relatives afterwards,” he said.

I hope so.  But – heads-up, E and G – you get asked anyway.  Not that it was a hard decision for your Grandad’s funeral.

“Burial or cremation?”  All our previous family funerals had ended at the crem, where the coffins of my grandparents and aunt had disappeared, three-odd decades previously, behind brocade curtains.

“Burial.”

We couldn’t possibly sit through a cremation. It would be like colluding in finishing off the job his illness started.

The Irresponsible Clinician.

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Revolting reminder yesterday of the complete lack of empathy and human kindness manifested by LB’s so-called Responsible Clinician, via her brief, at his inquest.

The psychiatrist, Valerie Murphy, is up in front of the GMC’s fitness-to-practice Panel this week and next.  Confusingly, the GMC has decided to refer to LB neither by his name, Connor Sparrowhawk, nor his nickname of LB, but as ‘Patient A’.  There’s probably a whole other blogpost in there about the effect and intentions of this depersonalisation, but right now I am busy with other things.

GMC Murphy notification

The full list of allegations runs to four pages (thanks and acknowledgement to George Julian for posting these).

GMC Murphy 2

GMC Murphy 3

GMC Murphy 4

On a first count, there are 55 separate allegations there, of which only the first does not allege misconduct.  But the effect of 7 (i) and 7(ii a-c) is to multiply the accusations in 7(a)-7(f).  Item 7 contains 24 separate allegations of misconduct, giving a grand total of 68 allegations of individual instances of Murphy’s care of LB falling below adequate standards.

Of those 68 allegations, Murphy has admitted 30, which are accordingly found proven, but contests the remaining 38.  Looking at the matters admitted to, they are either procedural failings (not arranging a best interests meeting, inadequate record-keeping) or related to Connor’s epilepsy.  The ones she is contesting are the mostly psychiatry-related ones: assessment, diagnosis, treatment and medication, including the whole of that multiplex Section 7.

The inference I draw from this is that she intends to assert that her treatment of Connor as a psychiatric patient was unexceptionable, that its poor documentation was down to faults in the system beyond her reasonable control, and that his physical health was not her responsibility.

At Connor’s inquest, she was already citing system chaos, for example on the morning of Day 6:

VM: I can’t remember what was seen or discussed at that meeting, but I remember it as quite chaotic..

11.05  AS asks who those minutes wld be sent to?  VM: Wouldn’t know.  AS: Do minutes of CTM meetings find themselves in patient’s medical records?  VM: Yes, they would.  AS: Would members of the team have a duty to ensure those records were accurate as medical professionals?  VM: It depends, we were struggling w RiO, the Chair would read and confirm them.  

(From @LBInquest tweets)

Now, I’m all for Southern Health management being made to shoulder their share of responsibility.  It was painfully obvious at Connor’s inquest, that the detached and indifferent nature of Southern Health’s oversight of Oxford services was itself probably well over the line of neglectful, leaving staff demoralised and demotivated.  But Southern’s flaws, however egregious, do not excuse a clinician failing in her direct duty to a patient.

The failure properly to treat Connor’s epilepsy is catastrophic on its own.  Psychiatrists are medical doctors, and all medical doctors are required first to train as generalists before they specialise.  Moreover, Murphy is a specialist in the psychiatry of learning-disabled people.  Given that epilepsy is commoner among learning-disabled people than it is in the general population, she should have been well aware of epilepsy in general. And, given the information that came into STATT with Connor and the subsequent additions to that information offered by his family, she should have focussed on epilepsy as a difficulty of Connor’s in particular.  Instead, she dismissed it, and continued to do so.

On Day 5 of LB’s inquest in 2015, she insisted that “there was no evidence of seizure activity during LB’s admission”, because “two instances that were explored as potential seizures….were ruled out”.  This was in spite of clear and urgent warnings, both oral and written from LB’s mother that she had seen signs of seizure activity – drowsiness and a bitten tongue – while LB was in STATT.  Now, it seems, Dr. Murphy has folded on the epilepsy in the face of the inquest findings, although, oddly, she still appears to contend that she obtained a history of Connor’s epilepsy that included whether seizures made him tired and need to sleep.

My general feeling for the other contested allegations is that these are areas where it is possible for Murphy to argue that she did the things she should have done; it is merely her recording of them that is defective.  Slap-on-the-wrist stuff, not striking-off material.  Whether those arguments will seem plausible, is likely to be largely down to the credibility of Murphy herself.  She needs to present herself as competent, knowledgeable  and benevolent, but overworked and harassed.

Hence, no doubt, the utterly disgusting hounding of Connor’s mother in front of the Tribunal yesterday.  The interactions of Richard Partridge, Murphy’s barrister, with Dr. Ryan, were not so much a cross-examination as an attempted crucifixion.  He did everything he could to portray Dr. Ryan as incompetent, ignorant, uncaring, shiftless and vindictive, in order to improve his client’s chances of appearing the reverse.  It was exactly the same strategy as the one used at Connor’s inquest by Murphy’s then-counsel, Alan Jenkins.  It failed then and it failed this time, for the same reasons as before.  Firstly, Dr. Ryan is a person whom it is difficult to impugn: she has always been shrewd, informed, capable, industrious and warm; and now she is showing tremendous courage in the face of loss and grief that would overwhelm most people.  I don’t think a Panel with even a modicum of intelligence is going to fail to notice the discrepancy.  The inquest jury certainly were not fooled.  Secondly, and far more importantly,  Dr. Ryan’s personal characteristics are completely irrelevant to the question of the adequacy of Murphy’s care of Connor.  Whether Murphy found Dr. Ryan’s outspokenness uncongenial, difficult or even frankly insufferable, that was still no excuse to ignore the information she contributed about Murphy’s patient, Connor.

That both Murphy’s briefs have taken this line of personal attacks upon the patient’s mother, suggests to me that the initial steer in that direction comes from Murphy herself.  It seems like a risky strategy.  It’s going to be hard for her to come across as competent when she has so seriously misjudged Dr. Ryan as well as Connor himself; or as benevolent when she has allowed her barristers to stick so many unwarranted knives of sneer and innuendo into a grieving mother, and then twist them.

The nadir yesterday came when Partridge read out Dr. Ryan”s impression of Murphy as ‘dismissive, arrogant and distant’ and told her it was ‘very upsetting for Dr. Murphy to hear any patient’s relative describe her as such’.  Dr. Ryan asked for a recess at that point:

‘Dr Murphy is upset by your evidence.’ Dr Murphy is upset. Upset. ‘Can I have a break?’ I was taken to a room alone. To howl…

Nevertheless, she returned to display the intellectual rigour that #JusticeforLB’ers have come to know and admire.   Pursuing an irrelevant line of questioning on the blog, Partridge tried leading his witness: ‘The tenor of the blog was critical, in a neutral term’.

“I don’t think ‘critical’ is a neutral term,” rejoined Dr. Ryan.  “The blog was an honest account of our experience.”

Partridge continued in a similar dismissive vein, referring to ‘the tongue-biting incident’.  When told by Dr. Ryan that it was not an ‘incident’ but a seizure, he went DefCon1 on the patronisation:  ‘I know that you feel it was a seizure.’

Dr. Ryan did not let him get away with that, either. “It was a seizure.”

I really don’t know what Murphy hopes to gain by permitting or requiring her counsel to act thus.  If anything could confirm the accuracy of Dr. Ryan’s negative summation of Murphy’s character, it surely has to be such a display of tone-deaf, compassionless persecution.  To  ‘dismissive, arrogant and distant’, most observers would probably add, ‘egocentric, devoid of empathy, disrespectful and cruel’; in short, thoroughly unsuited to being a consultant psychiatrist.

An irresponsible clinician.

Brief and Briefer : Justice4LB@GMC.

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The General Medical Council’s Fitness to Practise hearing into the conduct of Dr. Valerie Murphy (LB’s consultant psychiatrist – and Responsible Clinician – at the STATT unit where he died) began at 9.30 this morning. It’s taken over four years to get to this point; shortly after LB’s drowning in the STATT bathtub, Dr. Murphy upped sticks and headed back to her native Ireland, where she has continued to practise. 

I’m pretty uninformed about GMC procedures, but it appears that the Fitness to Practise Tribunal acts in a quasi-judicial manner.  Three people – one legally qualified, one medically qualified and one a lay representative – act as the judge-and-jury panel, while the GMC acts as prosecutor and the doctor as defendant. Parties complaining of being injured by the doctor’s actions are kind of off to the side as witnesses.

Both the GMC and the doctor get to instruct counsel.  Witnesses don’t; it is the GMC’s legal team who have to look after patients/complainants.  Fortunately, the GMC’s solicitor seems to have been entirely as considerate as one could wish of LB’s family, and one hopes that the GMC barrister will be equally considerate of LB’s mother, Dr. Sara Ryan, when she comes to give evidence.  One also hopes she will block the kind of disgraceful personal attacks on Dr. Ryan that Dr. Murphy’s inquest counsel indulged in, should anybody attempt to follow his example.

At today’s hearing, the Tribunal chair did introductions and housekeeping.  The GMC barrister made an opening statement outlining the case against Dr. Murphy: the events in STATT; the first Verita report; the inquest findings; and findings from the investigations of the GMC’s expert witness.

Dr. Murphy’s barrister corrected a couple of minor errors regarding designations and dates, and suggested that the Verita report was possibly irrelevant and unspecific.

The legal bundles of paperwork – two lever arch files apiece – were distributed to the Tribunal panel members, and they retired to read through them.  Evidence from witnesses will be not be heard until tomorrow.

And that was it. The public part of the hearing for today was all done and dusted in about an hour.  The briefs were brief indeed.  I hope the GMC solicitor had told Dr. Ryan that was likely to happen.

Imagine re-reading and re-re-reading all the evidence – the reams and reams of excruciatingly painful evidence – about your son’s death.  Imagine it having this effect on you.  Imagine psyching yourself up to do what was necessary, once more, to hold accountable the person who, above all others, could have put in place the precautions that would have avoided that death.  Imagine turning up at the Tribunal and seeing that person face-to-face again.  Imagine if you expected, that if you could hold it together until 5pm, your part would be all over. And then imagine being told, without warning: Not today; come back tomorrow.

I hope it didn’t happen that way.  I do hope that warning wasn’t omitted.

Love and Affection and Dirty Words.

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Read a couple of good blogs this week on love and social care.  In case you missed them, here are Damn – Forgot My Mantra from Mark Neary and The Saturday Boy from Rob Mitchell.  In both, ‘love’ and ‘friendship’ seem to be social-care dirty words.  Actually caring about somebody, rather than just doing care-tasks for them, is frowned on: inappropriate personal involvement.  I remember the former student at the 2014 LDS conference talking about how a gentleman for whom she undertook a direct-service rôle had referred to her as ‘a friend’ and she had corrected him.  She couldn’t, she told him, be a friend while she was paid to spend time with him.

I don’t think the attitude would be much of a surprise to the general public.  Second Youngest Uncle and his other half don’t have children (unless you count the half-dozen-plus canine ‘fur babies’ who have landed in their lives from time to time – rescue dogs all) but 2YU has had the idea of fostering and/or adoption in his head for the best part of twenty years.  And now that he and R are settled in their dream house – a six-bedroom former vicarage near the sea – they are in a position to offer the sort of home they would like to.  So the week before last, they went to an open evening at a fostering agency, to see what it entailed and whether they might be considered.

The lady running the evening gave a bit of a talk on how the process worked, and asked the participants – about 30 people, mainly couples – what they thought foster-children would need from them.  Structure, said someone.  Routine, said someone else.  Predictability.  A sense of safety, said a third. A healthy diet of foods they liked, suggested a fourth.  And activities.  The suggestions kept rolling in; but Second Youngest Uncle, he told me, was getting twitchier and twitchier.  All this talk of foster-parenting and foster-families and nobody was mentioning the most important thing of all.  Was it a dirty word?  Were people afraid that if they said ‘love’, it would be misconstrued?  If he said it, would he be given the bum’s rush out the door for inappropriateness?  But then he realised that if love wasn’t permitted as part of the deal, he wouldn’t want in anyway.  Eventually, he put his hand up and when the agency lady turned to him, he said, rather self-consciously and tentatively, “Affection?”

The agency lady flung her hands wide and practically shouted, “Yes!  Thank-you!  LOVE!  Children need LOVE!  They need hugs and pats-on-the-back and to sit on someone’s lap for a cuddle when they’re upset!  Now, you may be worried about what’s acceptable and what’s not, and certainly there are boundaries that you must observe, but we will teach you appropriate ways to demonstrate affection.  You will not need to keep your kids at arm’s length, quite the reverse!”

Later on, an experienced foster carer gave a warts-and-wonder account of his time as a foster-dad: the stomach-sinking feeling when things didn’t go well, and the huge joys when they did.  He spoke of his distress when one long-term foster-child was returned, despite his forcefully-expressed misgivings, to a precarious home situation; only to re-enter care fairly soon thereafter, for the same reasons as before, but carrying an even bigger burden of trauma.  If you are prepared to open your heart to children in need, you must, he warned, be prepared to have it broken at times.  On the other hand, several of his former foster-children have kept in touch after leaving care, and come back for big occasions and the odd Christmas, bringing girl- or boy-friends, then partners and even babies.  He never imagined he would end up with foster-grandchildren, and they are the most delightful bonus.

The day after Second Youngest Uncle had spent an hour debriefing over the phone to me about the evening, Grenouille’s Children’s Social Worker came to visit.  When we started in on the EHCP process, far too long ago, one of G’s expressed wishes was to be able to go out and about, maybe at the weekends, without having to drag Dad or Mum along everywhere. And, said G, I would like my helper to be a young person, like E (one of the medical respite carers, an early-twenty-something) not somebody middle-aged like my TAs.  So G now has a PA, very energetic and up for all G’s notions… but at least twice the age G was thinking of.

A second person needs to be recruited to cover all the assessed hours, so this time, said G, could it PLEASE be a young person?  T is great, but I want to feel like I’m going out with a friend, not a parent!

I did wonder if the f-word would give the CSW the collywobbles, but it did not appear to.  “Of course!”  said the CSW.  “Somebody your age doesn’t want to be going out with – well, not an old fuddy-duddy, it wouldn’t be fair to say that, but someone who is fuddy-duddy age!  I’ll speak to the recruiter and see if we can get a younger person for you.”

G smiled broadly and after a bit more chit-chat, the social worker asked to have a look at G’s bedroom.  I sensed my frown-muscles twitching, in much the same way, no doubt, as Second Youngest Uncle’s had been.

“Why do you need to see G’s bedroom?  The support workers won’t be working in there – they are for going-out, not staying-in.”

“Oh,” said the CSW, “It’s just a box-ticking thing – I have to see the child’s bedroom – not every time, I know G has a lovely room, but I have to check it at intervals.  Actually, G, I should say, can I see where you sleep,” – she turned to me, “…I once got a child to show me their room, but when I asked where they slept, it turned out to be in an old airing-cupboard.”

I felt my eyebrows rebound up towards my hairline.  “Would you like to inspect our airing-cupboard as well?  I guess it would be big enough for a bed, if it weren’t already full of hot-water-tank and linen-shelves!”

“Oh, no,” the CSW assured me.  “Just the bedroom.”

“Well, actually,” I said, abandoning sarcasm as a lost cause, “I think this bedroom-inspection thing is a bit of a cheek.  G is a child in need by reason of disability, not because there are child-protection concerns.  Given that, I don’t see why you need to go into the private areas of our house.”

“It’s literally so I can tick a box.  Seen the child?  Tick.  Spoken to the child?  Tick.  Seen where the child sleeps?  Tick.”

“I still don’t see why you need to go up there.  The medical respite carers are in there once a fortnight when they do an evening stint and put G to bed.  They have safeguarding responsibilities like any other professionals; do you not think that they would report it if there were anything amiss with G’s sleeping arrangements?”

“I don’t mind,” interjected G.  “It’s my room and I don’t mind.”

“Okay,” I said, reluctantly.  “It is your room, as you say.”

Inspection made, the CSW departed, but I still felt niggled.  “Not that you could have done anything about it,” said an acquaintance, when I voiced my irritation.  “If you’d refused, it would have been, obstructive mother, what’s she hiding?  Red flag on the file!”

Yes, I thought, that is what has got me so narked.  It’s the coercion behind the intrusion.  It may be G’s room, but it’s MY bloody house, and if I don’t want a damned social worker walking up MY stairs and along MY landing to inspect G’s room for no better reason than to tick a box, why can’t I sodding-well refuse permission without eliciting suspicion?  It may seem a relatively trivial reason to invoke them; but where, exactly, are my bloody Article 8 rights?

In our house, the dirty words are not ‘love’, ‘affection’ and ‘friendship’.

They’re ‘box’ and ‘tick’.