What I've been reading

Cryptonomicon
by Neal Stephenson

"Cryptonomicon moves conspiratorially back and forth between two time periods - World War II and the present. Our 1940s characters are mathematician and cryptanalyst Lawrence Waterhouse, and US marine Bobby Shaftoe. They're part of Detachment 2702, an Allied group trying to break Axis communication codes while simultaneously preventing the enemy from figuring out that their codes have been broken. In the present-day, their grandchildren team up to help create an offshore data haven in Southeast Asia and maybe uncover some gold once destined for Nazi coffers."

This was recommended by a fellow blogger (Thanks, Aims!) It has been quite an effort to read - very thick, small print, and lots of detail, so it's taken an age to get through, but worth it in the end. I'd need to read it again to get the full story straight, but I don't think that's going to happen. The WWII sections are more interesting than the modern day plot about information and communication in the 21st century, although the theme through both periods is the need for cryptography to ensure that messages are secure and accurate. There's even a little factual appendix about how to create an unbreakable cipher.



Alias Grace
by Margaret Atwood

Narrated by Shelley Thompson

"In 1843, a 16-year-old Canadian housemaid named Grace Marks was tried for the murder of her employer and his mistress. The sensationalistic trial made headlines throughout the world, and the jury delivered a guilty verdict. Her sentence was commuted to life imprisonment, and Marks spent the next 30 years in an assortment of jails and asylums, where she was often exhibited as a star attraction. In Alias Grace, Margaret Atwood reconstructs Marks's story in fictional form."

This started slowly, but has become more gripping as the story progresses. It's slightly spoiled by the audio editing - gaps between sections are not long enough, so it's hard to tell the difference between a quotation at the head of a chapter and the text of the chapter itself. I don't think I've read Margaret Atwood before, but I'll try some more on the basis of this one. I've got 'The Handmaid's Tale' in my enormous pile of books that are waiting to be read.

In the garden

We had a pleasant Sunday at Lola Towers, in the manner traditional of country gentlefolk through the ages: Mr A mowed the lawn and I launched a frenzied attack on the shrubs.

I remember when we first moved in to the Towers; it was the first garden I'd been wholly responsible for, and luckily a manageable size. I thought the plants had grown quite a lot by the first autumn and needed some careful pruning, but I was aware of my previous experience indoors, where plants keel over and die if you don't tend them with the love usually reserved for newborn offspring. So I pruned gently, trying not to give these outdoor cousins any excuse for telling me later that they didn't have enough greenery to photosynthesise.

Obviously, the next year we could hardly see out of the windows for overgrown shrubbery. Ever since then, I have attacked the garden every autumn with barely suppressed mania.Yesterday I filled three bags with just the ivy that has grown since last year when I cut everything green off the plant in the hope it would die. It's been growing for ten years in a very small pot - it has to run out of nutrients eventually, doesn't it?

After the ivy came two of the plants at the garage end of the garden: forsythia and choisya. I'm attempting the strategy of sawing off a third of these each year in the hope that the remaining stumps will offer flowers in profusion on a small bush rather than encroaching ten feet into the lawn. In searching the web for the proper names for these plants, I discover that I should have pruned them after flowering in May, but it is possible to chop them both down to stumps.

Mr A kindly assisted with stuffing all the prunings into bags, which I'll take off to the dump today. We have tried many ways of disposing of the garden cuttings, but taking rubble sacks to the dump is the only practical answer. When I tried burning clippings, all the neighbours telephoned to make sure the house wasn't on fire. We haven't got enough space to compost all the unwanted garden greenery along with lawn clippings and excess kitchen waste.

That was only the first day of the garden campaign: there's much more to do. Ceanothus, berberis, clematis, the other choisya (which is flowering again), bay, more ivy, and aucuba. It will take quite some time, and we're hoping to go away at the end of this week, and then the new term starts. Oh well.

I do have one query - there's a large shrub right in the front of the border that I don't want there any more. I also have two mint plants doing quite well in pots (as long as I remember to water them). I wouldn't mind digging the shrub out and putting the mint there instead - is this a good time of year to do it? I'm quite aware of the tendency of mint to take over, but it would have quite a lot of opposition from the other plants there - you can see the rosemary and the sage peeking around the unwanted shrub. To tell the truth, we wouldn't mind if the mint did spread wildly, because we love it. Would the displaced shrub survive if I planted it in the shade where I've cut the choisya and forsythia right back?

Next semester

All the hospital workplace excitement is forgotten, and I'm back to the home workplace excitement. Mr A's feeling stressed about the business again, although he's sure we'll be able to take a few days off next week. I'm hoping it will stop raining by then. I've been doing routine home-based tasks that have been waiting a while. The cleaning continues, there's no way I can do it in one day, it's too boring. I have to spread it over the week.

I've had another look at all the modules available for next semester now that the timetables have been published. The GMO one that I wanted to sign up to clashes with a compulsory module, so I can't do it after all. I worked out a tortuous way of comparing the gaps in my timetable with Biosciences modules on offer, and there turned out to be remarkably few to choose from. Reproductive Physiology, Virology, Environmental IT, Plant Pathology, Food Commodities, Soil Science and Management Science (Food).

Reproductive Physiology sounded interesting until I realised that it was all about getting cows to produce calves and milk, and hens to lay eggs. Virology is a possibility, although I really don't like the lecturer who runs the module, and there's an element of group work that I'd like to avoid. Environmental IT: I thought the IT might be interesting, but the module description makes it sound very technical. Plant Pathology and Soil Science, well, I'm not that interested in the cellular and microbiological aspects of plant diseases or soil.

Food Commodities is the most likely choice at the moment, although the module actually has a bad reputation among the students from previous years, although I don't think the problem was the quality of lecturing (unlike our Food Safety module last semester). Management Science is the 'recommended' choice for dietitians, but it is based on a hypothetical new food product and covers market research, product design, budgeting and marketing, which all makes me want to hide under a rock. Lots of group work as well.

So it looks as though I'll choose Food Commodities, which covers cereals, oilseeds, fruit and veg, herbs and spices, eggs and milk; their chemical composition, storage and preparation for manufacturing, quality control and maintenance, and a little bit about trading. Best of all, there's no lab work, no group work, a multiple choice exam, and coursework involving a summary of papers, all of which suit me very well. I think I've talked myself into it. After all, while most students disliked the module in the past, I'm not a typical student (I like to think so, anyway).

I'm Ambassadoring at another two University Open Days tomorrow and Saturday, so I'll have a chance to run the idea past people who know a bit more about the options. And I'll find out what they've done to the gym membership this year - on the website it looks as though the cheapest annual membership has gone up from £65 to £90 with an additional fee to use the fitness suite. If that's the case, I'll have to find another way to meet the recommended 30 minutes of daily exercise.

I'm in two minds about writing about the fitness/weight loss ideas I've had after watching some qualified dietetic advice being given in weight reduction clinics. Suffice to say that it's based around very small daily changes that are easy to achieve, and writing down the things that work. Last years efforts resulted in absolutely no change whatever, so we'll see if this turns out any better.

Final stretch

Since I've been home I've been gearing up for the new term by cleaning the house. Four weeks away makes our usually grubby dwelling look much worse, especially as the mess doesn't seem to affect Mr A so he ignores it, or more accurately, contributes to it.

I'm ready now to end the story of the placement experience. The final days in Rotherham were OK, I didn't have much to do because I'd got all the workbook done already, and there was just the final review and feedback to receive before being allowed to go home. Both of us 'A' placement students were asked to come to the office at 10 am. This gave me the chance to get my second Hepatitis B jab and hand the keys of my room back to the warders before turning up.

I was at the office well in time, but nothing whatever happened until 11 o'clock, when the other student was asked to go in. When she emerged at 11.30, it turned out that the manager had another appointment, so would I wait? Only for 15 minutes, as it turned out, and it was my turn.

Unexpectedly, I was asked first what I thought my strengths and weaknesses were. I was expecting feedback from them rather than input from me, and made up something feeble as a strength and then couldn't think of anything at all to say in the weakness department. We moved on.

After some relevant and constructive criticism about my communication style, I started to smile when told that perhaps I should improve my cooking skills. At this point I was very keen to get out of there and go home, so I wasn't about to argue. The point was repeated a bit later in the interview, and again, I just smiled politely.

The manager said "Would you mind if I asked you something personal?"

I said I didn't mind. She asked me if I normally cooked for myself at home.

This was all because of the buffet I made. The requirement was to produce a lunch costing no more than £1.50 a head, based on the principles of healthy eating and the Eatwell plate. It should have a fat-reduced savoury option and a sugar-reduced sweet option, and these should be labelled with energy, fat, carbohydrate and protein content.

I asked lots of the dietitians if they had any advice or suggestions for what I should do, or could tell me what other students had done before. The main advice I received was "don't knock yourself out", "keep it simple", "the easier it is for you the better". So I'd decided I'd go for the quiche, salads and jelly that I wrote about before. Up until the last minute I was going to make quiches, but there was a '2 for £3' offer in the shop, so I bought them instead.

I told the manager that not only did I cook for myself at home, but I would never in a million years have served the buffet at home, but since I met all the set criteria I took the advice I'd been given, and made it easy on myself by buying ready made food rather than spending the weekend cooking.

"Who gave you that advice?" she asked.

"Several different members of the department," I said.

"Could you give me their names?"

I was slightly taken aback. I felt that if I gave any names, they would probably be targeted in some way, probably unpleasant. So I said no, I wouldn't give her any names.

She then asked if I would tell the dietetic assistant, who was also in the meeting with us. Of course I refused, and then she asked again.

"I'd like to know who gave you that information," she said.

By this time, I was quite enjoying myself. We'd touched on the uniform issue earlier in the meeting, when she'd told me that if I returned for one of the longer placements then there would be no compromise with the dress. So I thought she probably wasn't used to being contradicted or not getting her own way, and it was quite fun to carry on doing it.

"I'm not going to tell you who I talked to," I said. She looked fierce, but could do nothing more.

So that was it, they eventually let me go and I drove away with a song in my heart and a spring in my step, so to speak. Coming home was great, we treated ourselves to a glass of wine in Wilde's, dinner in Sushi Ya for the first time (it was good but pricey), then had a drink in the Cricketers (I haven't raved about the pub for a while, perhaps I'll do that again soon). Came back, watched QI then went to bed. A perfect evening.

Not much longer now

Only one day to go, my internment is nearly over. That feels great. Today I don't have anything to do except turn up for another student's buffet at lunchtime, and then go out in the afternoon to see something about an infant feeding programme. Tomorrow morning my workbook is reviewed, and I'm free!

My buffet on Monday went very well. I provided shop-bought quiche, made potato salads with standard and low fat mayonnaise, and a lettuce, tomato and cucumber salad. For the required standard and low sugar desserts, I bought ready made jellies in standard and 'no sugar' versions, and put a dollop of creme fraiche and a couple of segments of mandarin from a tin on top. They were horrible, but that wasn't the point.

Four of the dietitians reviewed what I'd done, and pointed out that my analysis of 1385 calories per 144g portion of potato salad was likely to be a mistake - true enough. We were fine on the rest of the review, although we agreed that the lunch overall was a bit high in fat. The budget came in at less than my allocated £1.50 per person, and there was food left over.

Apart from kicking myself for getting the figures wrong, my other buffet-related faux pas was to notice that one of the dietitians hadn't signed up for the buffet but was in his office, so I went to ask him if he'd like to have some anyway, seeing as there was plenty left. What I hadn't realised was that it was the first day of Ramadan.

The workbook was pretty much finished by Monday, so I wandered from person to person trying to get them to sign off the different sections. One section about the British Dietetic Association Code of Conduct ended up with the manager of the department, who'd given me such a hard time over the stupid uniform. She grilled me for half an hour on three pages of the workbook. She is actually a very good manager, and the department is run extremely well, but that business of the dress cast rather a shadow, particularly over the first two weeks of my time here.

This week I've sat in on a paediatric clinic, done a home visit, spent some time with one of the Dietetic Assistants, seen patients on a couple more wards, and attended the departmental service meeting. No new inspiration, although the meeting was very well managed and the time with the Dietetic Assistant was interesting. Her job covers two completely opposing topics: she runs weight management groups for people who want help losing weight, and advises on ways to lower calorie content of meals and control overeating behaviour. At the same time she's advising on nutritional support, usually for older people in nursing homes who are losing weight, including ways to boost the calorie content of every mouthful they manage to eat.

The referrals for the weight management groups come from GPs, and the rate of response is very low, maybe one in fifty. I read the letter sent to a new patient. It was like a slap in the face, a real piece of hospital-speak, including the phrases "If you do not respond to this letter within 4 weeks then we will assume you do not wish to change your lifestyle," and "We will inform your doctor of the outcome of this referral." I asked if it would be OK for me to draft an alternative, more sympathetic letter, which I did. I hope they consider using it.

The dentist

This has been the most expensive month in recent memory. I'm not looking for sympathy, funds are available, but the car service at the start of the month was a major one that included replacing the cam belt. I bought Mr A a birthday present of the second day of a paragliding course, food and drink for the party, and then I went to the dentist.

Visiting the dentist is one of the three most unpleasant experiences that I regularly put myself through, the others being cervical smears and blood donation, in case you were interested. Actually, blood donation isn't that bad. At least they give you a biscuit afterwards.

I have always suffered at the hands of dentists. The first visits I remember were as a child, when Uncle Leslie was our dentist. It was dentistry that is now obsolete - a mechanical drill that made that ominous high-pitched mosquito whine, no anaesthesia, that smell of the friction of drill against tooth enamel, and magical blobs of mercury rolling around on a little plate before being transformed into a paste that was forced into our teeth. Then when it was all over, the offer of some sort of treat, perhaps a small toy? My memory of that is vague. I remember that the drilling hurt, but not unbearably. I think I dislike the needles more.

After Uncle Leslie retired, the dentist wasn't such a long way away, but then he wasn't family either. I remember him as a grim-faced man who never smiled, never indulged in small talk, didn't care to put you at your ease with a kind word, just got on with the job. He's still my parents' dentist, and perhaps he is a very good one, but I didn't like him at all. And of course there were more fillings. Brushing my teeth was never an activity I looked forward to, unlike eating chocolate.

Then there was a period of about 8 years when I was treated at the Great Ormond Street Hospital in London, and I still remember Mr Mars, a lovely, kind man. Serious dentistry was required: my teeth were pointing in all directions except the right one. As well as removing four teeth to make space for the others, I had to have one removed that was coming through my palate. Mr Mars applied the sort of brace that produces an effect like James Bond's arch enemy Jaws, which is about as traumatic as it gets for a fairly insecure 13-year-old just starting to become obsessed with appearance. There isn't a single photo of me smiling in the whole of this period.

The first dentist I registered with under my own steam (rather than through my parents) was a revelation. He treated me as an intelligent person, talked about what was going on in my mouth, and had a camera and a screen so I could see what needed doing. I think there was even a mirror so I could watch the whole thing. Unfortunately, I didn't live there for more than a couple of visits. The dentist in Manchester was OK. Not as bad as the worst, but not as good as the best.

Now my dentist is Chris, and he's a happy, cheery soul. He and his wife were friends with the couple that we bought our house from, and it turns out he went to school with Smurf, the landlord of the pub next door, who Chris remembers as the cool kid in the class. It turns out that the most pressing need within my buccal cavity is not in Chris's department, but demands the attention of Laura, the Hygienist. No more caries, now I have pockets. Apparently these form between tooth and gum, harbour bacteria, and are the dental equivalent of War Crimes, Child Abuse, and Genocide combined. Pockets are Pure Evil, as they say in the film 'Time Bandits'.

Pockets are dealt with in a number of ways. The use of interdental brushes and anti-bacterial gel or mouthwash is one. But mainly, Laura gets out a variety of medieval torture instruments, puts me through an hour of excruciating discomfort, charges a small fortune, and then makes another appointment so she can do it again. She also has a pierced tongue - this labels her a masochist as well as a sadist. She masks these tendencies well in social situations.

As a full-time student, I am entitled to 100% free dentistry treatment on the NHS. To see Chris and Laura, I have to have private treatment, as they don't offer an NHS service any more. I suspect that I am likely to keep my teeth longer if I continue to see Chris and Laura, but actually I have no idea whether their advice is sound.

They have treated me for several years and have achieved definite improvements in eliminating the evil pockets, but there are two areas that are resisting all efforts to heal. I have an ache at the base of my neck in the mornings and signs of abfraction on a number of teeth, which suggests that I am grinding my teeth at night (bruxism). An appliance is recommended that should prevent the grinding and allow complete healing: only £350, and it will last indefinitely. Laura has one: she can't sleep without it any more. Oh, Lord.

If anyone has any expertise on the mysterious art of dentistry, feel free to share. Otherwise I'll just dose myself up with enough painkillers to numb my bank balance, and go for the recommended anti-bruxism appliance. Perhaps in a couple of months, when the car, the paragliding and the party have worn off.

Diabetes clinic

Apart from being away from home and in a hospital cell or library dungeon during the day and an isolation unit during the evening and night, it's been a bit less miserable and slightly more interesting recently. I'm getting used to the confinement and disempowerment and all that stuff, and it was curry day for lunch again. Only a week and a bit to go.

I went to a multi-disciplinary meeting of the Palliative Care Team at the local hospice yesterday. It wasn't a very long or interesting meeting, but loads of people were there, including doctors, specialist community and hospital nurses, the chaplain, clinical psychologists, social services, Macmillan nurses and the palliative care and oncology specialist dietitian. What essentially happened was that they talked about all the people needing palliative care who were in hospital, in the hospice, new referrals, and those that had died (the RIP's). The lady I wrote about two weeks ago when I was on the ward was on the RIP list. She had lasted three weeks from her admission to hospital, and she wasn't even aware that she had cancer when she went in.

The diabetes clinic last Friday was really interesting. I have a friend with diabetes so I thought I knew a bit about it, but I certainly had no idea of the complexity of the condition and its treatment and the dietary implications. Rotherham runs a specialist diabetes service that brings together doctors, nurses, dietitians and others who have expertise in the treatment and management of people with diabetes in the same building. Every so often (maybe once a month) they have a clinic specifically for 18-22 year-olds, as this is the time when the responsibility for managing diet, injections and everything else tends to move from parents to children. And there's a lot of responsibility, much more than I had known about before.

They now think that type 1 diabetes is an auto-immune disorder, where the body destroys the pancreatic cells that produce insulin. Insulin is the hormone that allows you to store the food you eat so you can use it for energy later on. Without insulin, all the carbohydrate that is broken down into glucose in your intestines goes into the blood, but doesn't get stored, and goes straight out in the urine. Before insulin was synthesised and purified, life expectancy was short following diagnosis because people essentially starved - no matter how much they ate, it all came out in the urine. The essence of treatment of diabetes is to replicate the insulin levels of someone who still has intact control of their blood sugar.

In most of us, a rising blood sugar level triggers secretion of insulin. After we eat, blood sugar levels rise as the food is digested, broken down and transferred into the bloodstream. Insulin allows the liver and other cells around the body to convert the sugar into fat. When blood sugar levels fall and we need energy, glucagon (also secreted by the pancreas) stimulates the liver to convert fat into glucose, off it goes into the blood and around the body to where it's needed. Nothing is wrong with glucagon homeostasis in most people with diabetes. They just need the right amount of insulin at the right time. Too little and the glucose isn't stored (and in the long term, too much glucose in the blood has other nasty effects); too much and the blood glucose level drops, the brain is starved of fuel and goes haywire - a hypoglycaemic attack, or 'hypo'. Interestingly, someone with untreated diabetes can't have a hypo, there's always too much sugar in their blood.

We only had two patients turn up at the clinic (and I was there ALL DAY.) Both of them were candidates for a new insulin regime. I hadn't appreciated just how many types of insulin there are, the differences being how long it takes before they act and how long they last. Previously, both the lads had been on a regime where they took intermediate acting insulin twice a day, which meant that no matter what, they had to make sure they ate enough at regular intervals to avoid a hypo. The insulin was in charge, they had to follow its direction.

The new regime involves a background dose of long-acting insulin, injected once a day, and then shots of quick-onset short-acting insulin, injected whenever needed, usually when having food or drink. Insulin has to be injected because it needs to get into the blood, but it is one of the hormones in the body that is a simple protein, like others we eat as food. If it were taken orally, it would be digested in the stomach and gut and wouldn't reach the bloodstream intact.

The disadvantage of this 'basal-bolus' regime is that it involves many more injections - two with the old regime, at least four with the new, and possibly more. The advantage is that the person is back in charge - they control the insulin rather than the other way round. They can eat what and when they please, as long as they calculate and administer the right amount of insulin. They can miss a meal, have a kebab, exercise as they please, and have a carbohydrate-free meal should they wish, all of which were difficult to manage before. There's a transition period even for this new regime while the patient works out how to manage the system, but once it's in place, it seems to work a treat. One of the patients who's been on the new system for five months whooped and punched the air when he got the results of the HbA1c blood test that indicates how good his blood glucose control has been over the last 3 months. He was pretty happy.

Anyway, I learned a lot about diabetes in that hour or so, and was also impressed by the maturity and self-possession of these two young men. I'm sure I didn't take anything like as much responsibility for my life and future health when I was their age. I'd tell you about it if my parents weren't listening.

I learned lots more than this - what happens when you're ill, the effects of alcohol, adjusting for exercise, 'carbohydrate counting', pregnancy and ante-natal care, when to take yourself to A&E, and the courses available for people to help them manage their condition. I heard about the results of a survey of clinicians, who were asked what the treatment for a hypo is. Only 20% knew what to do (short answer: administer glucose). The day didn't even touch on type 2 diabetes, the sort that is closely linked to overweight and obesity.

On Tuesday I went out to watch how the enteral feed regimes were reviewed for three patients in a nursing home. Yesterday I spent some of the morning with a Speech and Language Therapist (SALT) assessing dysphagia on the wards - that's anything to do with swallowing. There's remarkably little collaboration between dysphagia specialists and dietitians in the hospital. It seems entirely possible for the SALT to impose a 'nil by mouth' regime because of some swallowing malfunction, and for a referral to be made to a dietitian only when the patient has lost two stone after a fortnight on nothing but intravenous fluid. But perhaps I'm wrong and there are infallible mechanisms to ensure that nobody forgets that people need food in order to recover from whatever it is they're in hospital for.

Today I shadowed a dietitian in a brand new clinic for people with respiratory problems, common in this area where people worked in mining and steel and smoked forty a day in their time off. I learned a lot about how to use a dietetic consultation to build rapport and trust rather than to acquire useful information and provide dietetic advice. Very useful indeed, probably the best lesson I've learned in my time here so far.

Deputy Lola

As Lola I’s last post said, I visited her at the weekend. Now with her last words ringing in my ears - “I can’t believe I have to go back to prison camp tomorrow…”, I am guessing that the prison camp regime has completely consumed her(boom-boom!) and so blogging has had to take second place.

I once had a fortune cookie that read “It may be that your sole purpose in life is simply to serve as a warning to others”. If I had a Blog fortune cookie, it would probably read “It may be that your Blog entries in life are simply to make Lola I look good”.

So, the weekend. The number of things we managed to fit into a short amount of time is remarkable – amongst other things, getting a car washed, buying a pair of shoes, sausages & mash (an enormous wait but lots of gravy to make up for it), a visit to two shops looking for caustic soda (successful), a big box of herbs (successful), a paint pad (unsuccessful) and a lampshade (semi-successful). We took photos of glass dishes that we then emailed to Mum (doesn’t everyone?), watched Galaxy Quest on old-fashioned video with Mr A, watched a little bit of the Olympics, and made an obligatory visit to the pub.

But it wasn’t all play. Oh no, Lola had some homework to do. She had to complete more of her famous workbook. She had already looked at quantities and prices of certain supermarket food items on the internet, ultimately working out the nutritional value of them. Or something. Her mission (and she had no choice but to accept it) was to do the same in a non-supermarket shop.

Our first attempt failed. The shop assistant said he would get in trouble with the manager, since we could be from a supermarket wanting to compare prices. Next door at another shop, we overwhelmed the poor shop assistant with our enthusiasm and obvious student-like appearance. Waving the impressive chopped-down tree, otherwise known as the workbook, seemed to convince him that Lola really was a student and that there would be a hefty detention for her if we didn’t get this assignment done. Either that or he was scared of getting a life-threatening paper cut.

There was a fair division of labour. Lola read out the item we needed, I identified its location, prioritising our plan of attack so that we handled everything at the back of the shop first just in case the manager was to return and throw us out. I whispered weights, prices and mumbled helpful things like “You look at the jam, I’ll find out how much the peas are, do the sugar whilst you’re at it, but let’s not do the crisps until the end”. I’m sure to get a mention in her dissertation.

Eventually when we emerged into the bright sunshine with a bar of chocolate each (well it would have been rude not to have bought anything), it felt like being released out of neon prison. I imagine Lola is feeling like that in Rotherham every day…

The Placement Workbook

Turns out I did have some time to write a bit more that day. I'd done as much of my workbook as I could for the time being.

The workbook is the equivalent of the stroppy supervisor standing over me telling me what to do. It's a monster. 70-odd pages divided into sections covering the ward work, food analysis, shadowing dietitians and an Induction section at the start with questions like "How do you warn everyone else of a fire?" Actually, that's an easy one, a more challenging question was "Where is the Health and Safety manual kept in the department in which you are based?" I asked four or five people who had never heard of it; the fire officer didn't know, neither did two of the first aiders I asked, and finally the H&S rep said it was 'in the main office'. He didn't say which office (there are several), and I'd had enough by then, so that's what I put in the workbook.

The biggest single task in the workbook (and it's one of many tasks) is to analyse a day's food intake for energy, protein, carbohydrate, fat and two other nutrients (iron and calcium, say). Then work out the cost of the whole thing per portion if you were to buy the ingredients in a supermarket, and the same again for a smaller local shop. Then do the whole thing again, but with low sugar/low fat versions of everything: nutrient content and cost in a supermarket and smaller shop. Then, of course, comment on the findings.

Another big job is to create a 7-day meal plan for a family of four including parents and two children aged 4 and 7 who eat ready meals/convenience food 4 times a week - then price the whole thing within a budget of £40. Thankfully, I don't have to analyse the nutrient content of this one, unlike the Buffet Lunch task. For a budget of £1.50 per person, I have to create a real buffet for members of the department, making a lower fat version of one savoury dish and a lower sugar version of one sweet dish, and labelling these with energy, fat and sugar content per portion. I present it to the supervising dietitian, and am quizzed on the whole thing at length before it gets eaten. The workbook proudly states that I can use the facilities in the Dietetic Department Kitchen - this contains a sink and a microwave and no work surfaces, not even a table. I've scheduled my lunch for a Monday and I'll be doing any necessary cooking at home.

In the catering department I've been comparing the size of portions of hospital food with the 'standard' textbook portions, and looking at the different versions available for gluten-free, diabetic, pureed/minced and high protein menus. I tasted three different rice puddings, and none of them was very nice. It's not surprising that rice pudding gets a bad name - perhaps this is why I wouldn't touch the stuff for twenty years after leaving school. Properly made rice pudding is delicious; this was rather bland and tasteless, not even very sweet. I've got the recipe: you'll need 4 gallons water, 4 lb milk powder, 4 lb rice, 2 lb sugar and 2 tins evaporated milk to make some for yourself (and 199 friends). But I don't recommend it.

The dietetic department is quite big for a not-very-big hospital (around 800 beds.) The department is divided into different 'teams', but these seem conceptual rather than relating to the type of work undertaken. Some dietitians work in the hospital, some in the community, and some specialise in a field like oncology and palliative care, diabetes, and enteral feeding - that's when a liquid feed is put directly into the stomach, either via a naso-gastric tube or through a 'PEG' directly through the stomach wall. Yesterday I was shadowing a diabetes specialist. I might write about that later - the diabetes stuff was absolutely fascinating, but it was also the most annoying frustrating experience at the same time.

Most of the dietitians are friendly, but this seems directly proportional to their seniority. Perhaps the newer, younger ones remember more clearly how grim it was to be a student on a placement; the older ones are really rather snooty, and the manager is very fierce. Alyson is looking after me; she is a Dietetic Assistant, the lowest of the low. DA's can do quite a lot of the work of the registered dietitians, but not all, because they haven't done the degree I'm doing and aren't registered. Alyson is definitely the nicest of the lot, and the most normal of them all.

Being Saturday now, I'm home again for the weekend, including the Bank Holiday on Monday. Lola II is coming to visit, which makes up for the music festival that I was going to attend being cancelled, again. Last year it was flooded off, this time it's something to do with licensing. Maybe next year...

Week two in Rotherham

It is REALLY difficult to blog from here. First of all there's the times that the library is open in comparison with the times that I have available - the overlap is not large. The computers are a little sluggish anyway, plus the Internet filter messes with access and makes things more complicated. And now that I'm into the second week, I've got a feeling for the amount of stuff that I'm required to actually do, and then record that I've done, and then say how I felt about doing it and how I felt about recording that I did it, and how I felt about that.

On Monday I helped the Dietetic Assistant with stocktaking the food supplement store room. Does that sound thrilling? No, I thought not, and it wasn't.

I've been in the Catering department for the last three days - they prepare everything on site except the Halal food that is bought in ready packed. The chap looking after us wasn't very good at delegating, so most of the time I was standing around watching him do things. He couldn't seem to answer my questions at the same time as doing the job, so he started to get behind, so in the end I stopped asking questions.

Yesterday I helped on the conveyor belt that is used to assemble the patients' lunches from the menu cards they fill in - I was on gravy and parsley sauce. Again, not the intellectually challenging information-packed day I was hoping for.

Tomorrow the dietitian I was supposed to be with is off sick, and I was hoping (vainly) that I would have a bit of spare time. Doesn't look like it. I don't think I'll mind working with the dietitian, as long as there's something interesting going on.

It's a pity to let the blog opportunity pass, but I'm really not in the mood for blogging at the times when I can actually get to a computer, like now - I'm about to go to the hospital restaurant for lunch. It's curry day!