The plumbers - episode four

We have had the plumbing brothers back in to finish off all the remaining plumbing jobs. I shall remind you of the history of our previous encounters:

Visit 1 - to replace bath, toilet and basin plus taps in upstairs bathroom. All seemed to go well, although the brand new bath taps and associated pipes didn't seem to deliver water at an adequate rate.

Visit 2 - to install a wonderful new insulated hot water tank to replace the previous ancient copper one. It was discovered that in the process of draining the header tanks, polystyrene balls were drawn into the hot water and heating system, and this is what may have been causing the impaired flow to the taps. We are left without heating or hot water for the weekend.

Visit 3 - Monday morning following visit 2, with the plumbers due to return to restore our hot water any minute, a leak from supply pipes under the bath results in a large hole in the living room ceiling. Hot water is restored, but over the ensuing weeks, we confirm that the flow to the bath is still compromised. We also discover that the bath overflow leaks - more water dripped through the living room ceiling after overfilling the bath, and one of the radiator taps in the downstairs shower now leaks very gently into a puddle on the floor.

Visit 4 - last week - to resolve the issue with the bath taps, fix the bath overflow and leaking radiator, and finally install the bathroom towel radiator. Obviously the header tanks must be drained again, and this time the ballcock sticks so that when water flow is restored, the tank in the loft overflows through the ceiling of Mr A's office and the upstairs hall (the overflow drainage pipe has somehow become disconnected).

No significant damage has been done - the ceiling didn't come down and seems to have dried out OK, although there appears to be a fine crack which we shall investigate. While we are fairly certain that our plumbing brothers are properly qualified, there are a number of other possibilities:
- we have a ramshackle old house where unexpected things can happen, and/or
- our plumbers are not very good at anticipating the worst and covering all eventualities, and/or
- they are very, very unlucky, and/or
- they are incompetent cowboys.

I think the first two options are the most likely. It is a great shame, because they were recommended by Alf, whom we trust and so far has not let us down. They are likeable chaps, and reliably answer the phone and turn up when they are supposed to. It is very difficult to find a good plumber, but I don't think we can trust them any more - each visit has caused some additional problem, and it is clear that even if they are entirely competent, they are not equipped to deal with the unexpected challenges that our house provides.

* Picture was taken from Hadrian's Wall, December 2004

Homework: seven things

It's been a while since it last happened, but I've been tagged for some homework. It's not too onerous, so here are Seven Things I Haven't Mentioned Before On This Blog. Some of them are not very interesting, though.

1. I really like lentils: orange, green, brown, whatever. Most people have an aversion from early exposure to badly-cooked tasteless brown glop, much the same as school tapioca did for me. But mum always made a wicked lentil soup, and it was one of the first recipes I asked her for when I went to university. I have progressed beyond soup, onwards and upwards to lentil salad, seasoned with a vinaigrette or spiced up with some chilli. Dhal - loverly.

2. Before Lola II and I were called Lola, we shared a house in Manchester, which had a very stained carpet in the living room. Mum sent us a bottle of 1001 carpet cleaner (that had a price sticker in shillings and pence). The instructions were to rub the stains with the liquid, and then dab the area dry. While I reclined on the sofa, my sister did the hard work of vigorous rubbing, then I leaned over and lightly dabbed the area with a cloth. "Over to my assistant, Lola," she said, parodying some TV show of the time. You really had to be there to understand how funny this was, but we both liked the name so much that we adopted it. That was in 1991.

3. I have just been contacted via Facebook by my very first boyfriend. I can't remember how old I was, but still at school, possibly aged 15 or 16. He was very nice, made me laugh, and we must have gone out for, oh, maybe six weeks if memory serves. Two months? Three? It seemed like a long time back then. I wrote him a letter saying I didn't want to go out with him any more, and walked all the way to his house and back one day (and he lived a long way away) to deliver it. I don't think we ever met again.

4. Lola II and I once went to the Good Food Show in Birmingham, and volunteered to be guinea pigs in a cooking demonstration area, led by a presenter with a proper chef and a small audience. We were each given stickers to write our names on. As the demonstration proceeded, we all followed instructions at our workstations, mixing this and heating that. The presenter wandered around, talking to each participant, and was astonished to find not one, but two Lolas in her group. "What are the chances of that?" she said.

5. I have neither owned nor wanted either a pet or a child since I was old enough to be responsible for one. Actually, I'm not sure I'm old enough now.

6. After she'd finished university, Lola II signed up to a programme that took her to Japan for a year, to help out with teaching English at a secondary school, and I went to visit her out there.* I'd travelled for an eternity by plane and train, and finally reached her apartment in the early evening local time. I was completely exhausted by the travelling and the time difference. Lola II wanted to celebrate my arrival and catch up on everything, but I just needed to sleep, and she was most disappointed that I needed to go straight to bed.

I woke up in the night, completely disorientated, but needing the toilet. It was dark, I didn't know the layout of the apartment, I staggered out of my room and tried one of the doors, which turned out to be Lola II's bedroom. She woke up, delighted, thinking I'd now recovered from the journey. I was still asleep, just wanting the toilet, standing there in the wrong room in a stupor, trying to find the complex mix of words of reassurance to thank her for her concern, that I would be better later but just now I still needed to sleep but still appreciated her welcoming gesture, and I was actually looking for the toilet.

What I managed to say was, "Shut up!"

In the morning, after I had apologised as best I could, she told me that I had pulled the door shut over the telephone cable, wedging it so hard she could hardly open it next morning.

7. I have just seen the most extraordinary music video - apparently one of several by the same artist, Lior Narkis. Don't worry too much about the lyrics, it's just an ordinary bland pop song ("You're sweet, I want to hug you"), and stay with it even though it seems rather tasteless - it all gets very surreal just after 2 minutes.


* This is what has fuelled my passion for sushi ever since. I'm not sure that any non-Japanese sushi can match that perfect mixture of rice, fish, vinegar, wasabi, soy: all the flavours melding together and hitting the tastebuds in perfect harmony for the first time.

Artificial nutrition support

Well, a couple of people have asked, "How did it go?" The simple answer is that I really, really don't know. Just two exams and loads of time to revise should be a recipe for confidence, but it didn't work out like that.

I've written before that I didn't really like Health Promotion much, and it was a difficult subject to revise. I like facts that I can remember and connect together to build up a picture - a biological system, or cell functions, or some other physiological process. With research I can make more of the whole than the simplified parts we are given in basic lectures, so in an exam I can usually show some insight or original thought, which I believe is what gets particular credit in that setting. With Health Promotion it didn't to seem to get more sophisticated the more I looked at it. I didn't manage the time in the exam very well, so the last question was very rushed, and I probably only managed one original thought in the whole thing.

The second exam was Diet Therapy. The subject is actually very interesting, and extremely relevant to what I'm hoping to do at the end of the degree. About half of it is about accumulating facts, and the other half is applying those facts to a situation with a patient in it - making deductions, drawing conclusions, appreciating limitations. The main problem was that it was a double module - twice the amount of material to learn, but only two hours for the exam.

I went into the exam fairly confident of my knowledge, but there was absolutely no time to think or consider a question; it was about reading the paper as quickly as possible and then launching straight into an answer. Given that real, qualified, experienced dietitians would probably have more time to consider a situation presented to them, it seems harsh to expect us novices to work so quickly. I was careful to manage the time allowed, but it was almost impossible to put anything other than basic information in there - no time for original thought, and plenty of scope for making mistakes. So maybe I wrote what was wanted, but maybe not. I really can't tell.

I haven't written about the content of the course for a while, so perhaps this is a good opportunity. The Diet Therapy module covered some aspects of professional behaviour: ethics, proficiency and standards of conduct. There was material on trauma, surgery and burns, all of which produce a similar response in the body. We looked at specific conditions including Motor Neurone Disease, Parkinson's Disease, Multiple Sclerosis, dementia, HIV/AIDS, cancer and stroke, all of which have the common consequence of undernutrition at some point. Dysphagia, a problem with swallowing, is also a frequent symptom, sometimes caused by the illness, sometimes a side effect of treatment.

The rest of the material was about undernutrition - how to recognise it, assess the situation, plan a nutritional intervention and monitor results. We learned about nutritional support of various kinds, from food fortification using everyday foods, supplements on prescription or over-the-counter, and artificial nutrition support, via tubes into the stomach or intestines, or intravenous. Palliative and end-of-life care was also included, since one of the issues might be withholding or withdrawal of artificial nutrition and hydration, e.g. for permanent vegetative state or end-stage dementia or cancer.

That's quite a lot, isn't it? It all has to be evidence-based as well, so I know what the National Institute for Health and Clinical Excellence (NICE) says about most of these conditions, as well as Dietary Reference Values suggesting how much of different nutrients ought to meet our requirements. Given that I learned pretty much the whole thing, it would have been nice to be able to show off a bit more in the exam.

[If you're not fond of my treatises on complex dietetic subjects, then you might prefer to stop reading now - see you next time!]

For example. I could tell you the procedure for inserting a fine-bore nasogastric (NG) tube, and what the potential complications are. This is a short-term feeding option (less than 4 weeks), but if the patient is unconscious, it might be better to use a Ryles tube, which has a wider bore but is less well tolerated if the patient is awake - it's often used in critical care and burns. A longer term option is a gastrostomy - a tube that goes directly through the skin and stomach wall into the stomach. It can be put in place using an endoscope down through the nose into the stomach to make sure the incision is in the right place (a PEG), but for someone with MND who needs constant respiratory support, it can be placed radiologically (a RIG). And there are other types.

One of the problems of feeding directly into the stomach is the risk of aspiration, where the stomach contents are regurgitated and enter the lungs, and if this happens (perhaps because of vomiting), then feeding into the upper part of the small intestine (jejunum) past the stomach's pyloric sphincter might be indicated. This can be a short term nasojejunal tube, an extension via a PEG into the jejunum, or directly into the jejunum (a jejunostomy). Another reason for post-pyloric feeding might be gastric stasis, when the stomach isn't doing its job, and food just sits there without being moved on past the pylorus.

This is all very well if the only problem is that for some reason not enough food and fluid can be taken through the mouth to meet requirements - maybe the patient is unconscious, can't swallow safely or has an obstruction in the upper GI tract. If the lower GI tract is accessible and functional, it should always be used - it is thought (but not certain) that the microorganisms in the gut are kept in check somehow by food coming through and being digested and absorbed. If that isn't happening, one hypothesis is that gut bacteria are somehow 'translocated' across the intestinal barrier and cause trouble in the body.

Sometimes it can't be helped, and the gut is simply not working well enough to absorb sufficient food to meet requirements, whether the food is coming orally or through a tube (enteral nutrition). Maybe the blood supply to the gut is insufficient (ischaemia), or there is an obstruction (perhaps from a tumour), or a critical section has been removed (e.g. Crohn's disease), or the absorptive structure of the gut has been destroyed by radiation enteritis as part of cancer treatment, or there is a risk of losing too much fluid through a stoma (ileostomy or colostomy), or the pancreas or liver aren't secreting digestive juices for whatever reason.

Then we have to consider parenteral nutrition, which is intravenous feeding. The difficulty with this is that our bodies are designed to absorb food through the gut. Any absorbed carbohydrate (mostly glucose) goes straight from the gut to the liver via the hepatic portal vein, and the liver only releases a little at a time into the systemic circulation. Arteries and veins other than the hepatic portal vein aren't used to high glucose concentrations, and don't like it - this is the source of some of the problems relating to diabetes.

I suppose that artificially feeding into the hepatic portal vein isn't a viable option, so the best alternative must be the largest vein possible, so that lots of blood flows past and quickly dilutes the intravenous glucose. For long-term parenteral nutrition a 'central line' does this, but it's not a trivial procedure to put one of those in, so often a peripheral vein is used. Nutrients can only go in very slowly, and with lots of fluid to make sure concentrations aren't too high and cause phlebitis, which is inflammation of the vein. Too much fluid can also cause problems, and that's aside from the risk of sepsis (used to be called blood poisoning) because you're putting stuff directly into the bloodstream.

So NICE best practice evidence-based guidance tells us to use the oral route for feeding if at all possible, then enteral feeding, with parenteral nutrition as a last resort.

And I didn't have the opportunity to write any of that in the exam.

We win a badminton match

I played in a badminton match on Monday, with a new and enthusiastic (young) partner whom I shall call Ginger Graduate. That's a picture of him there, at the recent Christmas do. He used to play badminton for his university, and joined our club when we moved to the new venue, but this was the first match he'd played for us. It seems that grown-up league badminton is a bit different from the student experience, where they offer loud encouragement, sledging, and various other forms of vocal and physical gamesmanship intended to put off the opposition.

I had to take him aside, and confide to him that shouting "Keep it up, Jo" and "Fantastic shot, Nicky" were not the sort of thing that we are used to. We occasionally say "Oh, good shot," just loud enough for the closest players to hear, and perhaps clap quietly when really crucial points are won. While it's perfectly acceptable within the rules, his behaviour would meet with disapproval with most of the league teams, who are composed of ladies and gentlemen like myself, well past the flush of youth. We are fiercely competitive, but do not like to show it so overtly. We are very old-school British.

Anyway, I'm hoping that he becomes my regular partner, because we won the match, with GG and me winning two of our three games (and the third was very close). This should be put in perspective - the first season I played League matches with this club, we didn't win a single one. I barely won any games within the matches. The second season, I reckon we might have won maybe one or two matches, and with a change of partner I managed a few more games. I don't think we have risen above the bottom position in the League tables, ever. But that's fine, I really like the people and the club, and playing badminton is nearly always good fun whether we win or lose, as long as people are friendly.

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Today brings my second and last exam of this session, and I'm feeling a bit better about it than the other one. It's still going to be unpredictable, because the module is huge - it took two sessions a week last term - and there is a compulsory question in which they can ask absolutely anything. But in a few hours' time it will be over, and I can get on with having fun for two whole days before lectures start again, 9 a.m. Monday morning.

The plumbing brothers are due to turn up at home today as well, and I have left Mr A with a list and instructions to help him remember what needs doing, in order of priority. Mr A has been a boon over the revision period, especially in comparison to this time last year when he was stressed to the eyeballs in a failing business. He's been hoovering and cooking and shopping and washing up, being (mostly) considerate and looking after me. I've promised to treat us to a meal out tonight, and I'm looking forward to it already.

Now, must stop wasting time, and get on with reviewing my copious revision notes.

Building works

Great news! Alf has visited a couple of times, and we now have a finished loft access hatch and bathroom wall where the radiator is to go. The plumbing brothers are due to call later in the week, because the situation with the polystyrene balls in the hot water system has not miraculously resolved itself, and the hot water flow to the bath taps occasionally reduces to a trickle. And they will fit the new radiator, so we can carry on constructing the rest of the bathroom.

Alf travels from quite a distance, and doesn't want to make the journey for just an hour's work. Our solution has been to compile and send him a two-page list of everything we want doing, in three priority categories. He can choose jobs he'd like to combine into a satisfactory day's work, and we get a bit further ahead with our essential maintenance.

So far he has fixed the hole in the living room ceiling, as well as the loft and the bathroom wall, and patched another hole in the porch with 'brown' which will need skimming (I know all the terminology now). His next job will probably be the front door - replacing the rotting frame and patching up the door itself before repainting it, and then there's the airing cupboard that contains our new hot water tank... and much, much more.

I am still revising, although I am finding it more difficult than previous years. I am not optimistic about the exam I did last Monday, but it's impossible to tell, really. The second and final exam is on Friday.

The photo at the top is from a couple of weeks ago - at last the snow is gone, although it was replaced by a flood warning on the River Leam. The water level did get quite high, but would need to be significantly higher to pose a risk to us.

New house

I am now seriously concerned about my second exam. I need to work a lot harder than I am. But you need to know that Lola II has moved house. Despite the exam season, I volunteered to help, so I journeyed forth to icy West London and on Tuesday night was found, alone in Lola II's old flat, surrounded by an assault course of cardboard boxes.

Why was I alone? Well, before all the house moving dates were organised, Lola II signed up to a 10-week wood-carving course, and the first session was Tuesday night. So she was off learning to carve wood, while my responsibility was to pack anything that isn't on the dining table, unless I'd rather not. Of course I'd rather not - packing is boring, horrible and dirty, so I was mostly blogging instead. As has been the case so many times before, Lola II's loss is your gain. As long as you consider my bloggy outpourings to be a gain. (I did some packing in the end. There was so much packing to do.)

On Wednesday morning, the Big Day, Lola woke me up quite early. "What would the worst sort of weather be like for a day when you move house?" she asked.

"Rain," I said.

"OK, what would the second worst sort of weather be like?"

It had snowed overnight, quite a lot, and was still snowing. We started packing the last few things, and then the removers turned up before we finished and started taking out the first boxes while we carried on packing, and then we gave them all cups of tea to slow them down a bit while we carried on packing more boxes. In the end we finished packing boxes just in time so they didn't have to hang around.

Sister D and brother-in-law J turned up just as all the packing was nearly done, but they cleaned up the empty flat while we made sure nothing had been missed. They came by public transport rather than by car because of the snow, and then we realised that four of us plus the boxes of breakable things and valuables and cleaning equipment and hoover and doormat and kettle, teabags, coffee, sugar, milk and mugs and my overnight bag would all have to fit in a small car if we were to travel to the lovely new house together. We did it, but Lola II was the only one who could move any limbs once we were all packed in, which was useful because she was driving.

I should mention that the removal men were very nice. Very, very nice. Art, Leo and Todd were cheerful, helpful, thanked us for putting books and papers only in the smallest boxes, and gave us 7 out of 10 overall for packing and organisation. Lola II was pushing for 8/10, but I think we lost that chance when she couldn't decide which room they should take the very heavy piano into while they stood holding it between them.

When it was all done, they posed for a photo and we said goodbye very fondly. Then Lola II and I managed to hang one curtain, unpack a very few things, and I set off home, where I am now going to get stuck into Diet Therapy revision. Definitely.

Pen

I have been enjoying writing with the ink pen I found. Revision is a painful torment, but I love the act of writing, and this pen with the purple ink was really helping - until it broke when I was changing the cartridge. It is beyond repair - the plastic disintegrated.

I fashioned a temporary bodge out of tape, but was ready to go out and buy a new pen. I thought I'd just check in the tin where I found that one, where I keep all sorts of fancy pens. And sure enough, hiding in there was an even older fountain pen, the one I used at school, with my name scratched in the side.

The sight of my hand holding that pen and writing with it brings back a very strong visual memory of school. It writes beautifully, still, despite being about 35 years old.

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The first exam is nearly upon us, and I'm just about ready. The subject, Health Promotion, has not engaged my interest very much, which makes revision that bit more difficult. It is about the ways that public health workers try to make us more healthy, whether by diet and nutrition, sun safety, physical activity, cutting down smoking or whatever, and the reasons why we tend to resist their efforts.

We've looked at partnership working, community development, Health Needs Assessment and evaluation of interventions, use of the media and the 'settings approach'. There are tens of official documents from the World Health Organisation, the UK Dept. of Health, the Health Development Agency (now incorporated into the National Institute of Health and Clinical Excellence) dating back to the WHO conference at Alma Ata in 1978.

The main problem with it all is my past work experience. All the policy papers and initiatives and academic theory are all very well and good. It should be possible to plan, implement and evaluate successful interventions to improve some aspect of health based on sound theory and cast-iron evidence. It's just that in real life, stuff gets in the way.

There's a project you think will really work, but the funds are only available for something else, or the partners aren't that committed, or the timescale doesn't work, and you will definitely have to fill in a soul-destroying 20-page form. As soon as it is given the go-ahead, one of the identified members of the project will announce she is pregnant and another key individual will change jobs.

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Anyway, the snow conditions have been much less severe than was anticipated, and I'm tucked up in a student room on campus, ready for a short walk rather than a freezing drive to the exam venue tomorrow morning. I have a hot water bottle, and I discovered and activated the 'boost' button for the small room heater. I brought a thermos of tea and food for tonight so I don't have to venture out unless I want to. I shall run through my notes one last time, perhaps attempt a couple more questions from past exam papers, and that will be that.

Cold weather

Monday

The weather is extraordinarily cold, but still no snow for Leamington Spa, despite tales from the north of impassable roads and travel chaos. Mr A had to use the car in the morning, after it had been sitting immobile for at least a week. Aside from the difficulty opening the iced-up doors, there was ice on the inside of the windscreen.

When I needed the car for badminton in the evening, I had to scrape the windows down again (thankfully outside only), and again two hours later when I came out of the hall to drive home. At least I was warm - running around wildly for two hours is good for generating heat, as well as mental well-being.

The car thermometer said the outside temperature was -3.5 ºC when I got home. Normal for some places, maybe, but very unusual for us.

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Tuesday

Snow! But not very much, and not for long. A dusting only. I am wishing for snow because it looks nice and makes everything quiet. If roads are impassable next Monday, however, I will not be able to get to my exam, which is at 9 a.m. sharp.

Without the inclement weather, when it comes to travelling to an exam I allow more than two hours for the one hour journey, in case of trouble. If there is serious risk of proper snow and ice, I will have to consider travelling up the previous night.

We have been very generous with the heating while we are both working at home, but today I decided on extreme measures. I am fully dressed for skiing: no gloves, hat or goggles, but including salopettes, ski socks and all thermals. So far, it is working.

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Wednesday

It snowed all night, and we have a lovely few inches of silent white quilt covering everything. Mr A proposed a tobogganing outing, and I considered carefully before agreeing. I've got to the stage where I'm nearly scared enough to work really hard on the revision and not consider doing anything else, but it is only Wednesday and there are still four full days in which to panic.

It was a good thing we decided to walk rather than drive across town, because the road leading up to Newbold Comyn and the sports centre and golf course was an ice rink, and the police were there trying to sort out the cars that couldn't get out. There was only time for a few runs, all pretty tame really except for an inadvertent dive into a bunker. The golf course doesn't have much in the way of mountains compared with the Alps or the Pyrenees. It put a smile on my face, though.

I've contacted the accommodation office on campus, and I shall probably travel up on Sunday and stay overnight. The forecast shows continued cold weather, so even if it doesn't snow any more it will be a nasty journey up the M1 motorway early on Monday morning. Much better to travel on Sunday afternoon nice and slowly during daylight.

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Thursday

No more tobogganing excursions for me. It's revision all the way now.

A Happy New Year

The New Year's Eve party at the Cricketers was a real treat. We were joined by the same friends that we were with at the Millennium New Year event 10 long years ago. Mr A cooked roast pheasant for dinner - there's a definite 'game' trend at Lola Towers since we discovered what good value it is. Then some dressing up happened, taking far too much time. I was ready in two minutes and sat down reading the paper for the next half hour while the boys faffed about with their unaccustomed finery.

Numbers were limited so that we wouldn't be too crowded in the pub, and Smurf had arranged various drinks and entertainments, starting with a quiz. The prizes were awarded to all teams by a lottery ticket system, regardless of ranking, so despite getting our traditional pasting in the music round we ended up with a very respectable prize of a bottle of Cava.

There was a singer, and although some people danced we decided to play a game. We were tucked away in the back of the pub, and had a lovely time, disturbed only by Smurf letting us know that a) there was a snack waiting, and b) it was coming up to midnight and another glass of fizz was in order. We finished our game in time for the walk to the dance venue.

The Assembly has been open for about 18 months, and you may remember that we went to a gig there to see Alabama 3. It is still great, the music was fine, we danced, I drank water, we danced more, and were there when they turned the lights on at the end. My acclimatisation plan worked beautifully - we'd been staying up past midnight for the last week just to make sure that we wouldn't fall asleep and miss the fun.

Next day went very slowly. After a late breakfast our visitors departed, and despite our best intentions both Mr A and I fell asleep on the sofa for long stretches of the afternoon. Acclimatisation doesn't take account of two hours of vigorous dancing.

Dressing up

In preparation for the glorious New Year's Eve party event, Mr A and I thought we had better have a bit of a practice with the clothes, what with it being Black Tie and everything. Good thing that we did - Mr A's dress shirt (which he must have worn last for the Millennium party we went to) turns out to need studs rather than buttons, and was a bit grubby around the collar. His trousers came nowhere near to being done up, with probably a three inch gap at the waistband (again, last worn around the turn of 1999). The jacket was passable, although a little tight under the arms.

My planned outfit didn't work at all - I need to lose an inch from my bust and waist. A standby plan was brought into effect, which was fine, and I even found the watch I'd been looking for for ages, inside my 'best' shoes (the ones that Lola II found for me in the charity shop). These best shoes are the only ones I have with heels, but are not in the least glamorous, and have rubber soles that make dancing a bit sticky, but it's those or walking boots (or sandals, slippers, flip flops or wellingtons). I went with the unglamorous but comfortable shoes.

Mr A sallied forth to investigate the world of charity shops, and returned with a pair of neat black trousers for £5 and news that a set of studs in the gentlemen's outfitters cost a fortune, and double that for cufflinks as well. I can't imagine how he has ever worn this shirt before, given that I have never seen cufflinks among his belongings and I don't even know what shirt studs look like.

After some discussion and investigation of my sewing bag, he ventured out into town once more. At the ethnic haberdashery he bought eight buttons which he proceeded to sew together to make four very attractive studs. He looked good to go: the shirt and tie were laundered, we had means of fastening front and cuffs, trousers ironed. The cobwebs and Millennium mud had been brushed from the patent leather shoes (which also had not seen the light of day for 10 years) and cleaned with Windolene - don't ask me why, but Mr A chose it in preference to shoe polish.

We thought it would be a good idea to assemble all the features of the shirt in situ, and again it turned out to be worth doing. The home-made studs and heritage cufflinks (retrieved temporarily from the family treasure) were fine, but we hadn't tried doing the shirt up before, and had overlooked the possibility that Mr A's neck no longer fitted the collar. I was called upon to move the button, but it still placed considerable stress on the Adam's apple. What a performance this was turning out to be. It had better be a good party.

The last hurdle placed before us was the tying of the bow-tie, which was overlooked in the previous dry runs and was only attempted in the last minutes of the lead-up to leaving the house. I had assumed that the clip-on version would do, but no, the dress shirt has a sticky-up collar that requires proper tying. After several attempts, I managed to produce something that bore a passing resemblance to a proper tied bow-tie. We were ready to roll.

If I can get around to it, I'll blog about the party itself. If I can't be bothered, then I should just mention here that it was a fantastic night. Here's to 2010!