Darjeeling tea

When Mr A gave up alcohol before Christmas he bought some nice tea to drink on the sofa of an evening, in place of beer. He's used up all the Earl Grey and started on the Lapsang Souchong, but there was a box of Darjeeling still unopened in the cupboard, and one evening this week I thought I'd have some of that.

It was the spookiest thing. I took a sip, and whoooosh I was back in 1986, sitting in Sas's living room in Jesus Lane drinking a cup of tea poured from a chipped old teapot while he drank a from a huge mug that held a whole pint. I could almost taste the plain chocolate digestive biscuit that we dunked in the tea. I'd never imagined that people dunked chocolate biscuits in tea until I saw Sas do it.

I lived with Helen in the house on Castle Hill. Sas lived in a house shared with other students that I never met. There was a notice on the front door by the doorbell illustrating different combinations of short and long rings: each occupant had a different sequence, so they could tell who needed to get up and answer the doorbell.

He was in a different college, but we were first introduced by a friend of mine who had gone to school with Sas. Another of my college friends knew him from the car club. We were all engineering students, and we met in lectures. Those were the days when the most hi-tech teaching aid was a continuous flexible blackboard mounted between horizontal rollers, which could be moved upwards to make space below for even more impenetrable equations, diagrams and graphs.

We got to see each other more in our third year. I can bring to mind hardly any visual memories of where we used to meet or what we did: Helen and I infiltrated the car club meeting at The Mill once or twice, Sas and I went to a ball at the end of the year... there must have been lots more, but I just don't remember. The taste and smell of the tea only brought back the teapot and that huge mug and the chocolate digestives.

I should like to write more about Sas, but it's personal and not really appropriate for this blog. I am somewhat tormented by certain memories of when I behaved rather badly towards him, but when I talk to him about it, he doesn't remember those things. At least, he says he doesn't. Water under the bridge.

I shan't be able to drink any more of that Darjeeling tea without being haunted by all those wonderful, painful, rose-tinted memories.

Coursework and practicals

It's been a hectic week. I did indeed spend the whole weekend working, except for a necessary trip to the supermarket on Sunday, but I did finish the whole stupid Metabolic Syndrome essay. On Monday I did the 'lay summary', tidied up the references, checked it for plagiarism, printed it, filled out the cover sheet and posted the damn thing in the coursework box. Thank goodness that's over.

Whenever anyone is crazy enough to ask me, I tell them how much I'm enjoying the course. At length. When they glaze over, pretend their mobile phone is ringing, remember an important prior engagement and start to walk away I realise they were probably just asking to be polite. If anyone had asked me how I'm enjoying the course at about 11 a.m. on Monday, they would have received a much shorter answer that included some terse Anglo-Saxon words. This is really the first time I haven't enjoyed a piece of coursework. Metabolic Syndrome is not very interesting.

It's not a proper disease, really, just a collection of symptoms that indicate a higher risk of developing type 2 diabetes (the type that's usually controlled by diet and drugs rather than insulin) and cardiovascular disease like atherosclerosis, angina, heart attack and stroke. There's no specific treatment except to treat the symptoms, and the main advice is to eat a healthy diet and lose weight. Duh! Like we didn't know this was a good idea. I am SO not interested in Metabolic Syndrome.

So Monday was full of this essay and then lectures and then badminton (hooray for badminton), and Tuesday was full of practicals. Cooking in the morning went well - preparing corned beef hash didn't take long in comparison to some of the dishes where other people were having to make pizza bases and chips and stuff. The afternoon was a bit different - we had a refresher session in Basic Life Support (CPR and ventilation), followed by the opportunity to measure blood pressure using the old-fashioned stethoscope and sphygmomanometer, stick a naso-gastric tube down a dummy's nostril, and (best of all) take fake blood from a fake arm using a real syringe and vacu-tube and everything!

Just for a change, I mingled in some other groups, and worked with some of the students that I've hardly spoken to before, which felt good because they turned out to be very nice. It's getting to the point, though, where I can't admit that I still don't know some of the names of the students on my course. Today I was slightly reassured, when another girl admitted that she didn't know everyone's names either.

It's been an exhausting few days, but I still like my course really. You'd get a medium-length answer if you asked me now - I'm pretty tired, and there's still loads of coursework to do, but on the whole, it's going OK.

Cooking at school

One of my modules this semester includes cooking. We have three tasks: to prepare a main course meal for someone who is diabetic, for someone with coeliac disease, and for someone who is either over- or under-nourished (my subject is undernourished).

In fact, we aren't assessed so much for cooking, it's more about the accompanying justification for our choices, and evidence of research. I suspect that the cooking has to be included because the majority of the class has only a year or two of cooking experience, having only left home a year or two ago. Some of them have surprisingly little interest in cooking, considering that they are training for a profession that has everything to do with food. One girl had never cooked an egg in any way until one of our practical cooking sessions last year.

The meals that I'm supposed to be adapting are corned beef hash for a diabetic, chicken pie for coeliac disease, and fortified macaroni cheese for an undernourished man.

• The food rules for diabetes pretty much match the healthy eating rules for the general population, although the limits for protein consumption should be more strictly applied. I'm cutting the amount of corned beef and adding extra vegetables.
  
• The chicken pie only has gluten in the pastry and a little flour for thickening the filling, which is easily replaced with cornflour. I made a test pie-crust out of polenta, and it worked pretty well - Mr A ate it without leaving any, so that really is a solid endorsement. It would have been even better if I'd grilled the top to make it even more crusty.
  
• Fortifying the macaroni cheese shouldn't be too difficult either, given the potential for adding cream, more cheese and even salami or other fatty meat.

Home news: Mr A's mood fluctuates with, well, something that goes up and down a lot. I got home late on Thursday after the Computing lecture was late finishing, and he was almost continuously on the phone right through until bedtime. Then he had such a high temperature that I thought I might wake to find just a blackened crisp in bed next to me (he's better now). On other evenings, he just sits opposite me on the sofa, often looking rather downcast.

My schedule of half day lectures every day and the whole day on Monday is making it very difficult to get the coursework done, given that I'm having to spend about 12 hours a week sitting behind a steering wheel. If I don't spend the whole weekend working, I'm going to be in trouble.

Photo taken through the SB library window

What I've been reading

Lord Peter Views the Body
by Dorothy L Sayers

narrated by Ian Carmichael

"Dorothy L. Sayers' aristocratic sleuth, Lord Peter Wimsey, is rarely at a loss when it comes to solving a seemingly insoluble crime. Whether confronted with a severed head in a bag, a particularly nasty case of blackmail, a sofa of horrifying origin, or even another Lord Peter Wimsey, the upper-crust eccentric retains his sardonic sense of humour while unravelling the most bizarre criminal conundrums."

This is a set of short stories featuring Lord Peter, and she makes a good fist of it even though there is so little time to set up the crime and the solution. You can usually work out where the plot is going as soon as all the characters are introduced, or maybe I've just read them before. Yes, I'm pretty sure I've read them before, but I like having stories read out to me.

The Life and Times of the Thunderbolt Kid

by Bill Bryson
narrated by Bill Bryson

"Using his old fantasy life as a springboard, Bill Bryson recreates the life of his family in the 1950s in all its transcendent normality. In a period that saw the inexorable rise of television, the opening of Disneyland, the testing of the atomic bomb, and the explosion of choice in everything from food to cars, Bill Bryson's days followed in reassuringly cosy succession, enlivened by modest triumphs and disasters."

He reads it pretty well too. Although I didn't grow up in that era, I recognise the feeling of nostalgia for a time when responsibilities were few and the days were long. It's a comfortable book to listen to, and just what I needed.

Sunday night thoughts from the sofa

Having a laptop means I can sit on the sofa, comfortable under a duvet, and tap away about life in the fast lane until Jeremy Paxman comes on to talk about Victorian Britain. Unfortunately, without a wireless modem, you have to wait some time for the blog post to appear.

It’s been busy, and it’s going to get more busy before things calm down again. I have ten separate deadlines between now and the end of term on 20 March. Four of these deadlines fall in one week. Not many are for pieces of work that are quick or easy.

But before I feel too sorry for myself, I have to feel sorry for Mr A, who continues to suffer all that the world can throw at him, knowing all too well that he has nobody to blame but himself. He also knows that I have nobody to blame but him. It really is hard on him. I don’t know how long it will take to get the business on a more secure footing, or whether he will throw in the towel and call it a day, and neither does he. He just has to endure each painful day, not knowing how or when it will end.

We have been for a few calming walks around town, through the park to the weir, stopping for a visit to the Temperate House in Jephson Gardens, then along the river and back again through the park. Or up Holly Walk to Clarke’s the vegetable shop and back via Tesco, the fishmonger and the cinema. We even went to see Slumdog Millionaire on Saturday, which was a real treat.

I still like my course rather a lot, and last week’s lectures were pretty good. Learning about disorders of metabolism such as galactosaemia and phenylketonuria and the consequences of missing enzymes in the metabolic pathways has been very interesting. It also makes me very grateful that all my enzymes are working as they should (as far as I know, anyway). We covered diseases of the cardiovascular system, and were given case studies to present to the rest of the class in workshops in a few weeks’ time: I’m in a group presenting a case of iron-deficiency anaemia in an infant.

Computing Techniques was a good choice of optional module, although it’s quite uncomfortable to attend because I’m the only one there older than 20, except the lecturers. I know a lot of things that you get to know simply because of living nearly 45 years and taking an interest in scientific subjects: how binary numbers work, chaos theory, why computers use approximation, what log tables are. I know a few things about HTML because of my hopelessly neglected website and this blog, and I know about referencing software because I took an interest last year. There hasn’t been anything too challenging so far in this module. Which is, quite frankly, a relief.

The most engaging subject this term by far has been the Communication Skills module. This week we started looking at how to conduct an effective face-to-face consultation with a patient or client – we have five weeks of practical sessions where we practise all aspects of the consultation. This first week we just covered the process from where we invite the patient into the consulting room, introduce ourselves, and start the conversation.

Again, being a little older is an advantage, and of course I’ve done this type of thing a great deal before. The difference is that previously I was not assessed or supervised or judged in any way, and more importantly, the language used is slightly different. The hardest thing of all will be trying to avoid responding with “Right,” or “OK,” which we are correctly discouraged from saying.

I'm finding it very difficult indeed to think at the same time as talking, and changing how I do things at the same time as doing them seems almost impossible. But I am reassured by the very fact that we are being taught this material with such skill and care. Getting the communication right between practitioner and patient is so important, and forging a relationship that enables difficult messages to be passed between the two is essential.

Belief versus the scientific method

This is an unusual post: I’m highlighting a bit of real life, an actual issue, and it isn’t even about me.

The full story is on Ben Goldacre’s blog, Bad Science, but the essence is that a presenter on LBC radio recently hosted a phone-in show, in which she perpetuated the (now discredited) view that the MMR vaccine causes autism in children. What is actually true is that unvaccinated children risk catching measles, mumps and rubella, all of which are non-trivial diseases that have the potential to cause serious permanent damage, up to and including death.

Dr Goldacre points out that the print and broadcast media have a lot of influence, and shouldn’t be allowed to present discredited theories or plain falsehood as fact. I haven’t yet read his book (Lola II is reading it at the moment; dad finished it in one sitting from the sound of it) but I thoroughly applaud his rigorous approach to the scientific method. The debate about Darwin’s theories of evolution by natural selection rather than intelligent design is in the news quite a bit at the moment too, what with Darwin’s 200th birthday and it being 150 years since the publication of the classic book: “On the Origin of Species by Means of Natural Selection”.

I won’t encroach far upon the subject of religion, but I’m quite happy for everyone to believe what they want. My great friend Dave once argued very persuasively that the moon landings in the 1960’s were faked, and plenty of people like to consult a tarot reader and go to religious services (although I suspect they rarely do both). That’s fine by me, because they presumably benefit spiritually at nobody’s expense, and support employment, the economy and some glorious architecture while they’re at it. Of course I disapprove of crusades or fatwahs or killing people who don’t believe what you do.

People are welcome to believe in dowsing, chakras, detox diets, life after death, reiki, ghosts, the power of crystals, leprechauns, homeopathy, or any other nonsense. That’s fine as long as they don’t try to persuade anyone to substitute the nonsense for evidence-based treatment when they have a real biological illness.

In one of our modules this term, we all looked at various magazine articles with the intention of analysing readability. The article we looked at in my group was from Good Housekeeping magazine, about the incidence of cardiovascular disease in women. From memory (this happened a few weeks ago) it mentioned the potential for the danger signs being missed. Because women before the menopause are somewhat protected by the presence of oestrogen, GPs tend to misinterpret the symptoms because they don’t expect young women to have heart disease. It was obviously written in a style intended to appeal to the readership of Good Housekeeping, subtlely portraying women as martyrs, undervalued by society, prone to misfortune and discrimination, and powerless to control their own fortunes. The Bridget Jones scenario. How I hated that book. (The film wasn’t too bad.)

Instead of analysing readability, I started to wonder about the credibility of the article. It was unattributed, so I doubt that it was written by any health professional.

“We need an article about some aspect of women’s health,” says the editor. “Men are always being told about heart disease – what angle could there be for women?”

“We could say that women get heart disease too, but the symptoms are different,” says hack #1. “That means that GPs could easily misinterpret them as depression – we’d be able to have a cheap shot at the medical profession at the same time!”

“Well done,” says the editor. “Off you go. No need to do loads of fact checking; just get some plausible stuff off the Internet, and make it up if you run out of time. 500 words by Tuesday, please.”

I have no idea whether the article was 100% accurate or entirely fabricated, or somewhere in between. I was actually shocked to realise that everything in the article really could have been wholly invented. I’ve never been that suspicious of the printed word before, or of the noble trade of journalism.

Nobody wants to read highly scientific accounts of trials that show inconclusive or equivocal results, which is typical of the research that I’ve had to read so far. Scientific papers are really hard to read, and even harder to interpret and analyse critically, and rarely offer clarity to the reader. It’s obviously impossible to police everything in the media, but I’m on Ben Goldacre’s side: if we want the scientific truth we have to challenge opinionated falsehood, and sometimes we’ll have a fight on our hands. I’ll be fighting the good fight on his side, that’s for sure.

Exam results come round again

On Thursday, the day when I took these pictures, the Nottingham Uni inter-site shuttle bus service was suspended, the campus library closed at 1 p.m. and at least one of my lectures was cancelled. I'm very glad I decided not to go in . 

By Friday morning the snow had pretty much disappeared, and there was no new snowfall, despite the forecast. So I went in to school on Friday, not only for the lectures but because that was the day that we could collect our exam results from Personal Tutors. I've done well again - all five of my module marks are Firsts.

I talked to my tutor about working on research over the summer, about options for our final year projects, and about PhD research opportunities. Still some time to go before these things get decided, but it was interesting to hear what possibilities there are. Then I treated myself to an evening off!

Delivering good presentations

Writing this post served to fill in time yesterday. I was showing people round the campus after lectures, and then meeting the IT staff to act as a student guinea pig for the networked Nutritional Analysis software that they are trying to get working.

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In the morning we had another session in the Communication Skills module. I'm finding this module extremely well taught, very interesting, and above all - relevant. It's difficult to find relevance in knowing the molecular structure of conjugated linoleic acid, but talking about how to do a really good presentation and critically analysing a research paper are both activities that are very pertinent to the role of a dietitian.

I always thought I was pretty good at doing presentations when I worked for RNIB. I tried to make them interesting, I had tons of enthusiasm, and people told me they enjoyed the sessions I did. Now I'm thinking hard about whether I've been a bit too confident, or even complacent.

In the first year of this course we had to do an assessed presentation, and my mark was on the low side - not a fail by any means, but not as good as I thought it could be. At the start of this year I did a mini-presentation to the new intake of mature students, along with two other final-year students. I was struck by how much better their delivery was compared with mine - again, I had bags of enthusiasm, but perhaps I lost a little coherence as a result.

I'm now looking back and thinking about how I could have done better. Being a student means that I watch presentations from different lecturers every day, and it's interesting to compare lecturers' styles of delivery and how they've structured their content. While the point was made this morning that teaching and presenting aren't the same, it's still possible to draw conclusions about what works in front of a critical audience, and what doesn't.

I know that I always need to prepare carefully - standing up and practising out loud always leads to changes in the structure of the 'storyline'. I find bits to add in and leave out, as well as settling on the actual words to use, and often, the words not to use. When I actually stand up in front of the audience, though, I enter a different state. It's a combination of nerves and adrenaline, and I think I rather let it drive me through the presentation, rather than controlling the energy and channelling it into good delivery. With a great deal of verve, I follow the routine I've practised, but I lose an element of self-awareness.

I once went on a course led by professional media types where we had the opportunity to deliver our message in a variety of forms, including to tape (for radio), to camera (like those correspondents who appear on a screen), and video recorded live in a studio with a real interviewer. I found it almost impossible to think quickly and speak fluently while having to maintain body language and social norms of appearance. The live video interview was the worst, speaking to camera was easier, and talking into a tape machine was by far the best. It seems I have to 'switch off' my body language and analytical thought processes in order to deliver a complex message under pressure.

In front of an audience one has to stand normally, gesture normally, and ideally, look at them properly. If there are questions, one has to think on one's feet. But to deliver a fluent message (especially with minimal notes), I can't manage all this. I can't be looking at them and aware of my own self at the same time as thinking about what I'm going to say and how I'm going to say it, and then respond to complex questions in a logical manner.

I can manage to sustain the correct level of eye contact in social situations, but as the complexity and importance of the message increases, my ability to simultaneously maintain social norms drops off. I'm sure this is one reason why I've been so comfortable with people who can't see too well - I can turn my eyes anywhere I like and sit back or lean forwards without prejudicing the communication channels.

What I need to do is try to be more aware of what I'm doing while I'm doing it - am I speaking slowly enough? Am I delivering the message as coherently and fluently as possible? Am I standing and gesturing in an odd way that I'm not even aware of? Am I really looking at the audience, or just facing in their general direction? I must practise on the next visit day, when prospective students come to the campus and I get to talk to them and show them round.

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Stop Press: We have snow! Proper amounts of snow this time, not just a sprinkling. Today I only have Computing Techniques in the afternoon, so I've written in to say I won't be there, and I'm staying at home - if I should have any car-related incident, it would be an utter disaster, so I'm not risking it today. It's a welcome opportunity to get a whole lot of work done without having to spend all those hours driving - but first I must take a few pictures of the virgin snow.

Snow!

Sunday was a garden marathon, after Mr A complained on Saturday that I spend all my time doing homework and we never do anything together. So we got to work on the garden, first moving a shrub that was in the wrong place, then I did a lot of clearing away dead leaves and overgrown bushes while he worked on fixing the trellis that the rose pulled over last summer when it had more flowers than the trellis could hold up. I finished all my pruning, went indoors to make some lentil salad for lunch next week, it started to snow very lightly, I went up to the shop to get some milk, and Mr A was still working on the trellis. He finished at about 5 p.m. Maybe we should revert to how we used to do less together... I had a badminton match after all that, while he soaked his tired muscles in a lovely bath.


And today, the snow continued. Not very much in Leamington, nor on the journey to Nottingham. But once I got there, it snowed pretty steadily all day. Beautiful, but potentially deadly. They cancelled two lectures, which gave me some time to do some research into the paper I'm going to present as a magazine article. By the time I was ready to go home, most of the roads that were icy in the morning had been gritted, and there wasn't a problem, even on the highest bit of the M1 where the outside lane was pretty much out of bounds with slush. There's not much snow here this morning, although I don't know about Nottingham. I shall set off anyway, with a thermos and a sleeping bag in the car just in case. 

I'm hoping to have time to take some photos today - I think snow is so beautiful, and the couple of pictures I hurriedly took yesterday aren't worth posting here. Look at this instead. I am finding, however, that the joy of snow is muted with age - instead of rushing out to build a snowman I shrink from frozen fingers and worry about falling over and breaking something. We do hope that it will last until the weekend, though, so we can use the toboggan again.

Working in the garden seemed to do some good; Mr A seemed almost cheerful on Sunday evening but he was back to normal yesterday. He's due to speak to the doc tonight, and with luck he may remember to ask which liver enzyme is raised and what the causes and consequences might be. I am starting to wonder whether it is simply the effect of 12 months of continuous stress, because I'm not sure he (or I) can take it for much longer. We have decided that if we don't see some improvement in the finances of the business by May, we shall have to Take Steps.