I watch movies so you don't have to

Mr A and I have a subscription to the mail order DVD library that is LoveFilm. Here are reviews of all the movies we have watched in April and May, written when I really should have been revising for tomorrow's final exam. I really haven't enjoyed this last stretch of revision - I'm not learning anything new, and I'm very preoccupied with what happens next - how will I earn a living? Do I really want a standard entry-level NHS Dietitian job? If not, then what? Answers on a postcard, please.

Alice in Wonderland
Not the original Lewis Carroll story, but the recent version with Johnny Depp - my choice, of course. Mr A wasn't interested so I watched it on my own as a treat one afternoon in the slack time when I'd got back from GNT before school work started again. I liked it, especially the choice of actors to voice particular roles - Matt Lucas as Tweedledum and Tweedledee was particularly inspired. 8/10.

Made in Dagenham
Quite good, but all the ladies are extremely good looking and therefore rather unrepresentative of women in Essex. Miranda Richardson was a brilliant Barbara Castle, though. I compared this with my time working in Dagenham as a student sponsored by Ford more than 10 years after the strike, and failed to draw any comparisons because I didn't get to see the sewing machine area and didn't meet any females at all back then. There are some short clips of the actual women who were involved at the end of the DVD, which was fascinating. 8/10.

Hunger
A harrowing story of the 1981 IRA hunger strike in the Maze prison in Northern Ireland, showing much of the spirit of the hunger strikers, and some of the brutality towards them by the authorities. It was a pretty balanced commentary, and left it up to the viewer to decide whether they were right or wrong. 7/10.

The Other Guys
I saw this in the cinema with Lola II when it came out, and had mixed views at that time because we made the mistake of sitting too close to the screen. We enjoyed it more when thinking back afterwards, so I thought I'd give it another go, and it was better this time. Mr A even laughed out loud a couple of times: Mark Wahlberg's mystified expression at the loveliness of his buddy's wife was a particular highlight, along with the really quiet fight at the funeral. 8/10.

The Blind Side
This is the movie that won Sandra Bullock her Oscar, and she does a good job although it's not that great a film. Based on a true story, it's firmly based in the US culture of (American) football and the college scholarship system, which made some of the references a little obscure to us. Mr A wasn't that impressed, I liked it, but not excessively. 7/10.

Christiane F
I watched this without Mr A, based on my having seen it first at an impressionable age, and wanting to see why it had remained with me ever since. It's not an easy film, depicting a decline into heroin and prostitution for the very young lead character, albeit with a 'happy' ending, for her at least. One of the most striking aspects was the absence of any allusion to HIV/AIDS, which was only just emerging into society in 1981 when the film came out. 7/10.

Four Lions
This is described as a black comedy, which I suppose is accurate because there are amusing elements within it. In most black comedies, however, nobody is actually portrayed as blowing themselves up - usually there's some hilarious explanation and everyone's still alive at the end. After the laughs, I found myself considering the possibility that the idiocy portrayed may not be too far from reality, which is a sobering thought indeed. 7/10.

Perrier's Bounty
This very much reminded us of In Bruges, which was one of my rare 10/10 films (most get 7 or 8 out of 10). Some of the actors and many of the gangster characters were very similar, but unfortunately they were much less sympathetic, and often just stupid or unpleasant without any redeeming features. I was sorry to see some of the bad guys meet a sticky end in In Bruges, but not here - I didn't even care much for the hero. 7/10.

(The Tragedy of) Macbeth
Mr A specialises in choosing these difficult yet 'classic' films for us to watch. Mostly I let him get on with it and watch them without me (especially while I was away at GNT) but I thought this would be educational. It's directed by Roman Polanski and produced by Playboy Productions, so there's gritty bloody realism along with gratuitous witch nudity. Not bad, but at 2 hours 20 minutes it would have been better if he had made it a bit shorter. 7/10.

Sherlock Holmes
Now this one really did go on too long. At one point the DVD got stuck, as they sometimes do, and usually we try all sorts of techniques to continue from the same point onwards. This time we jumped to the next scene without even trying. It would have been an excellent film at 90 minutes, with a nice relationship between Holmes and Watson, and lots of 'reveal' at the end. But at over 2 hours it only gets 7/10.

Avatar
We managed to avoid all the hype and didn't see it at the cinema, in 3D or anything else. I'd heard it was quite long, but it didn't seem to go on as long as Macbeth or Sherlock Holmes, despite checking in at 2 hours 42 minutes. Really good CGI, story not bad, could have done with a bit less fighting, but then I think we're unusual in finding the battle scenes boring. Overall, I liked it. 9/10.

What I've been reading

Mindless Eating: Why we eat more than we think
by Brian Wansink

"Every day we make around 200 decisions about eating. But studies have shown that 90% of these decisions are made without any conscious thought. Brian Wansink lays bare the facts about our true eating habits to show that awareness of our patterns can allow us to lose weight effectively and without serious changes to our lives."

This is a fascinating subject, explained with adequate references to properly-executed research on the type and amount of food that we eat, and why we eat it. It all matches perfectly with my recent and ongoing experience of weight loss: eating and stopping eating is very rarely related to physiological hunger or satiety, but most of the time is driven by thoughts, feelings, habits and the sensory experience of food - sight, smell, taste. The main thing that I am hoping to embed, in order to make it more comfortable to eat less for ever, is the belief that a small amount of food will be 'enough'. Deliberate behavioural and visual techniques are my weapons: a small plate has been a good start.



Why does E=mc²? (And why should we care?)
by Brian Cox and Jeff Forshaw

"Explaining and simplifying notions of energy, mass and light, while exploding commonly held misconceptions, they demonstrate how the structure of nature itself is contained within this equation."

This is a tough read. Mr A had a go first, and was in trouble because he stole it off my huge pile of books to be read, rather than the equally large pile of books I've already read. As it was, his course demanded too much mental energy to allow him to take on even more in leisure reading, so I took over. The first half is straightforward, especially as I already had some basic grasp of how special relativity works. The second half takes us on to the explanation of why spacetime is defined as curved - in the same way as we perceive the earth's surface to be flat, but two people walking on parallel paths will eventually meet. I might have another go at the second half again at some future time, to see if it gets any easier the second time.



The Three Hostages
by John Buchan

"England is at peace after the end of World War I. Richard Hannay is enjoying the country life with his wife and young son at Fosse Manor. However, Hannay's peace is shattered when a dangerous criminal gang kidnap three children of important national figures. The deadline for searching for the hostages is midsummer."

We're back to form in this fourth story of the John Buchan anthology that I bought ages ago. It builds up properly, with suspense, a number of simultaneous threads to the story, some threat but not too much, and a pretty tidy ending, although the effort he makes to tie up all the loose ends makes it a bit long.

Bird update

It is Blog Day again today, and would I let you down? Would I? Well, yes, actually, I probably would, on another day. But not today. Despite the fact that very shortly (after all the cars with people going to work have finished) I shall travel to the second ordeal of three at the university campus, I have a lovely little blog post for you.

Mr A has become a little overexcited by 'his' offspring, the baby robins. He did indeed go out and buy live mealworms for them, and I can report that opening the fridge to be confronted by a plastic tub of squirming worms is disconcerting.

It reminds me of when I was younger and mum worked in the school biology lab. We had to be careful when opening tubs of margarine, in case they contained maggots, or locusts, rather than margarine. I seem to remember dead rats in the freezer, but that might be apocryphal. We were certainly interrupted during dinner times to watch locusts shedding their skins in a glass-fronted box, until mum discovered that something about the creatures was giving her respiratory problems and they were given to someone else to look after over the holidays.

The bird table disappeared from the garden one day last week, and Mr A admitted that he'd put it in the garage for the robins. The fledgeling robins left the nest soon after that last blog post, but were heard cheeping from odd corners of the garage, and we can only hope that they all made it outside and we don't find tiny bird corpses in corners behind motorbike tyres and planks of wood.

The bird table is back in the garden now, complete with additional fat balls that have attracted blue tits, who also love the worms (they eat more than the robins, anyway). The blackbirds scavenge around the foot of the table where the worms end up if they escape, and Mr A has also seen and identified a goldfinch. I have requested no more live worms in the fridge, so he has now bought some dried mealworms. We'll see if they are as popular as the live ones were.

University work continues in the background to this ornithological obsession, both for Mr A and for me. Mr A has now submitted his last assignment before his two exams in June and is moving on to revision, and I have now completed one out of three of my final assessments. My presentation about a Stroke case study went well, and the next activity will be something practical that will involve coeliac disease, although none of us knows exactly what will happen. Some of my student 'Friends' on Facebook are going a little bit crazy trying to imagine what we will have to do, but I'm just tired of the whole assessment thing, and will be very glad when it's all over. I'm not entirely sure what I will do then, but rest assured, blog readers, you will be among the first to know.

Rampton

I may have mentioned that during my placement in GNT I was offered the opportunity to visit the dietitians at Rampton, which is one of only four high-security hospitals in the UK. Patients there have personality disorders, learning difficulties or mental health issues that mean that they present a serious risk to themselves or others. It is also a national centre for treating women and deaf people. As I understand it, the main aim of treatment is to reduce this risk and enable patients to be transferred to a lower security facility. Despite this, the average stay is around 6 years, with some staying much longer.

I spent the day with two of the three dietitians who work there, and it was a fascinating and challenging experience. The environment is pleasant for both patients and staff - light, clean, airy rooms with plenty of windows - but large, thick, heavy, locked doors. Many, many locked doors, and high fences. The majority of work for dietitians is around healthy eating and obesity, but there are a few other chronic conditions. I was particularly interested in how people who have insulin-dependent diabetes are looked after. Obviously they are not freely given insulin and hypodermic syringes, but after a long process of risk assessment and care planning there is one patient who is using an insulin pump. There isn't anyone needing dialysis at the moment, but there was a recent case of possible coeliac disease.

The main difficulty in dietetic treatment seems to be that you can't be sure that the patient is telling the truth, either because of learning disability or because patients can be highly manipulative, especially if they can see an advantage to behaving in a particular way, for example. Claiming to need a 'special' diet would probably relieve the monotony of the normal food, and a hunger strike was described as 'typical attention-seeking behaviour'. The other difficulty is motivation - is losing weight or any other aspect of physical health going to be a priority when there are many other pressing mental health issues (this is a hospital, after all), and a prolonged period of incarceration lies ahead?

Having said that, I observed two consultations, both concerning surgery for weight management, one before surgery and one after. What struck me, apart from the unusual setting and heightened security awareness, is that both consultations and both patients were nothing out of the ordinary, just the same as any other patients that I had seen in GNT. In fact, if there had been anything out of the ordinary, the nurses caring for the patients would have advised that it wasn't appropriate for the consultations to have gone ahead.

Setting aside the one-to-one aspect of the dietitians' job, there are some good examples of work that has been done within the hospital to address aspects of food service and the 'obesogenic environment' that research has shown to be a factor in the obesity epidemic in society at large. As well as indicating the 'healthy' choices on the menu that are low in calories, they have produced photographic menus and labelled those as well. There is a limited daily allocation of milk, bread and butter, and the dietitians also work with the shop to try to discourage unhealthy food purchases.

As I found during my previous visit to a secure mental health hospital, the dietary handicaps for patients are the level of inactivity particularly in the evenings, the relatively large amount of disposable income that patients have, and the availability of the high fat, high sugar snacks that cannot be prevented. And because it's a hospital and access to the grounds is restricted, none of the patients is allowed to smoke, which must be quite a challenge for them and those around them when they are first admitted. Inevitably this leads to weight gain, especially when the health condition and medications used to treat it may also contribute to the effect.

Such a small exposure to such a complex setting often raises more questions than answers. But in terms of dietetic input, it is very little different from treating patients in any other hospital setting, and there are a number of advantages - the nurses are much more inclined to talk to you, the patients and their notes are always available and notes are legible, and there is much less doubt and vagueness about the patients' care or their dietary intake. I think I would prefer to work there than in an ordinary acute hospital.

Word-botcher

Mr A is turning into a bit of a twitcher. It was the robins that started it, when we noticed that a robin was probably building a nest in the garage. Then he found the nest, and took a series of pictures of the developing chicks. He's now put up a bird table!

The history of the bird table goes back to at least 1990, when I was travelling around Australia and was smitten by the variety and colour of the birds there. I thought I might carry on birdwatching when I came home, but I found that the vast array of sizes, shapes and colours of Australian birds was not matched in the UK, where birds are, almost without exception. small and brown. The books said they often had to be distinguished by their call, or the shape of the eye, or some other impossible aspect of mating behaviour.

I joined RSPB anyway, and they gave me a self-assembly bird table as a free gift. It has remained unassembled in its cardboard box for more than 20 years, travelling with me to each place I have lived, and has been sitting here in the kitchen for about 10 years. Until this week, when Mr A put it together.

He's also been looking up useful facts about robins on the Internet, finding out that they fledge within 2 weeks and the pair may have another clutch of eggs in the same season, and they will eat mealworms, which are quite expensive to buy. The bird table has not been an immediate success with the birds, probably because there's quite a lot of other food around at this time of year, but Mr A has been cutting up tiny pieces of salami and putting them out anyway.

The title of this post comes from an anecdote told by the great Humphrey Lyttleton, who was once interviewed on a local radio station. At one point, the interviewer said "You're a bit of an orthinologist, aren't you?" Humph described how he was on the motorway on the way home before he thought of the perfect answer: "Not so much an orthinologist, more a word-botcher."

Conference

I had a great time at the BDA conference, although it differed quite a bit from my expectations. There were fewer delegates than I was expecting, and based on my experience running conferences in the past, the budget was a great deal larger than ours was. There was more sitting and listening to eminent dietitians and less up to date and relevant practical information from the field.

To open the conference they had Martyn Lewis, who used to be a TV newsreader and whose appearance fee is probably comparable with the entire budget of the conferences that I used to be involved in. He 'interviewed' a couple of luminaries in the world of dietetics about the history of the Association, now in its 75th year. We also listened to a talk about Elsie Widdowson, who in the late 1930's helped to compile the comprehensive tables of the chemical composition of food that we still use in their sixth edition.

One of the two breakfast briefings I attended was about the benefits of probiotic bacteria: the sort that are found in yogurts and yogurt drinks. It turns out that a) there actually is evidence for benefit in prevention/treatment of bloating in Irritable Bowel Syndrome and diarrhoea associated with antibiotic treatment and C. diff infection, and b) the strain of bacteria matters, so different products benefit different conditions.

During the main part of the second day there were sessions on the theme of 'Outcomes', which feature prominently in the plans for the future NHS as a way of evaluating the quality and value of input by the different healthcare professionals involved in delivering patient care. Establishing valid and positive dietetic outcomes will help to minimise the risk of dietetic services being cut in the next inevitable round of cost savings.

The third day was more practical, and included a terrific presentation about an audit in Oxford that reviewed the use of nasogastric tubes and gastrostomies during treatment of head and neck cancer. I also found out more about how the dietetic profession tries to ensure continuous professional development among its members, but glazed over when a management consultant talked about the future of commissioning within the NHS.


My poster time was on Wednesday. Each presenter had 2 minutes to talk about the research behind their poster, and there was time for a question or two. Because my session was right at the end of the conference, and there were only four posters (and only three presenters turned up), I was lucky that my tutors and lecturers and fellow students rallied round for me, so we had a decent crowd.

The main benefit of being there was networking, which was surprisingly easy, and I had very informative conversations with all sorts of experienced dietitians as well as those just starting out. One ex-student from Nottingham has been engaged in a full time PhD for three years, and thinks that this is enough to prevent him from going back to clinical dietetics. A freelance dietitian advised me that it takes 3 or 4 years of clinical dietetics before a dietitian really has the baseline knowledge and experience to branch out into freelancing. Another told me that she had taken every temporary short-term job that was available until eventually she found something full-time. I asked everyone whether they thought that the department where they worked was likely to be recruiting graduate dietitians, and all were fairly pessimistic about budgets, especially while the NHS reforms were still under review and nothing was certain.

I met the editor of Dietetics Today, the professional journal of the BDA. She was thinking of writing something about students or from a student perspective, so we talked about that for a bit. I mentioned that I don't live very near the university, so she asked where I live, and it turns out that a) she lives less than 5 miles away from my home, and b) she walked past our Royal Wedding street party to go to the park with her family. Then I sat down with a dietitian working in Coventry who lives even nearer to my home, and we even found that we have a mutual friend. It's a small world.

A final highlight: Lingering around the registration desk, I was invited to a forum to discuss the involvement of Kelloggs, the cereal company, in the provision of information for dietitians and their patients. Despite being a student with zero experience of actual independent dietetic practice beyond two supervised 12-week placements, I was still given a £25 voucher for my troubles. Result!

I have come away with a few key messages. Jobs are going to be hard to find, and I will probably have to accept that I may have to accept a short term post and work away from home, at least at first. On the other hand, I have a few other ideas which may occupy some of my time while hunting those elusive jobs, and may even bring in some income.

The next three weeks are going to be fully occupied with revision, assessments and exams, and I had actually forgotten how dull and frustrating revision is. Oh well, not long now.

Follow up

It turns out there are consequences of my little swooning fit. The National Blood Service has now followed up my case, and is threatening to withdraw my donation privileges, because I had already left the centre when it happened. I am strangely disappointed that I may not be allowed to endure the nuisance and boredom of giving blood in future, mainly because I know it to be one of the most worthwhile activities at no cost to me beyond a couple of hours every four months and the occasional bruise. Anyway, because the reason is fairly clear, and because I was in a hurry and left the centre before I normally would, they are going to discuss my case and get back to me.

I have travelled south now, and am ensconced in Lola II's parlour, watching the resident garden robin bouncing and pecking about in an amusing way. It has been warm enough to sit outside in the afternoons over the weekend and admire what Mr M is doing with the garden.

Lola II and I were out in London during Saturday, unfortunately accompanied by my wheeled suitcase of baggage for the conference. We still managed to complete a number of tasks, including the compulsory Japanese meal, and we visited the shop where Lola II had bought her flute so that they could advise on a small problem she was having. She was very impressed when the nice man immediately started taking the flute apart, fixed the problem, put it together and didn't charge her for it. Proper customer service.

On Sunday we thought long and hard about whether to go for a walk, paint the skirting board, buy me some trousers that fit, or go to the London Transport museum. In the end Lola II started preparing for painting the skirting, Mr M applied a bit more creosote to the fence, and I was given the job of creating a ring tone for Lola II's phone using free audio editing software that I can only just use. After all that we still had time for the walk, so we did that too.

The weekend ended with an episode of Dr Who featuring David Tennant, only the second episode I've seen since watching Jon Pertwee and Tom Baker wander around rickety sets while I was hiding behind the sofa. It was pretty good, but nowhere near as scary as the original stuff. Either that, or I'm now braver than I was at the age of 10.

Of mice and men

Well, the best laid plans can go awry, and on Thursday I was driven home in an ambulance! The activity I did that day plus the ongoing attempts at weight loss all led to what the lovely paramedics recorded as a 'vaso-vagal episode' - I fainted on the way home after donating blood. Big style, passed right out on the pavement. A guy who saw me go down came over to check I was OK, then he insisted on going back to the blood donor centre and hauling out a couple of nurses. They tried to get me back to the centre, but every time I sat up all the blood drained away and I had to lie down again, so eventually the ambulance was called.

On the plus side, I've never been inside an ambulance before. The two paramedics wheeled me in on a trolley, and I now know I'm not diabetic (blood sugar was 6.1 mmol/l), ECG was normal, but blood pressure was obviously low - the first measurement was 107/68, but it rose to 111/71 when I started to feel better (I have no idea what my 'normal' blood pressure is). Because they didn't have any other calls and I didn't live far away, they even took me home.

I felt well again pretty soon, but with bruises coming up nicely on both elbows, which clearly hit the ground before the rest of me. I couldn't go on to play at the new badminton club, though, so I spent the evening trying on clothes for the conference. I appear to have dropped one size, which is nice, but makes my smartest clothes look a little bit baggy. Then I had a go at some of the lovely clothes that I bought at one point in my life when I might have been described as thin, and it was clear that I haven't dropped two sizes. Not too far off, though.

Future plans

Another long weekend has passed, but I had a few things that needed doing - that haircut, and the pulley rope. I needed to get the Conference Poster finalised, but to do that I needed to find the guidelines, and to do that, I had to go through all of the junk paperwork I brought back from GNT in rucksacks and briefcases and boxes. It has taken a while. Then there was the press release, which I'd like to have ready before the Conference. And the hinge on my toilet seat broke, so I bought a new one - more than 50% of the cost of a brand new toilet seat - and fitted it successfully.

So I've been doing a fair bit of work, although without too much pressure, and with one or two opportunities to go outside, where the weather has been beautiful.

The plan for the coming month is as follows: a bit more work around the house this week, vote in the local elections and the AV referendum, blood donation, an evening trying out a new badminton club, a social visit to the Association for the Blind who helped with my research. Then the British Dietetic Association Conference next week, when I will be staying with Lola II, so there will be Fun. After that there is a week of lectures and revision, and we each have to do a presentation, although the details are not yet available. The following week I will have some sort of practical examination, and I'm guessing it will be a consultation with a pretend patient, and then there is the final written exam.

After that, assuming that I pass, I can send off for registration with the Health Professions Council, pay the fee, and I become a qualified Registered Dietitian (RD). It is a protected title, which means anyone calling themselves a Dietitian without registration can be prosecuted. Unlike nutritionists, who are not required to have any academic qualification whatsoever, and can write any old clap-trap in the papers and magazines if they want to. Reliable sources will choose a nutritionist with at least a Nutrition degree, but Gillian McKeith doesn't have any relevant qualifications, and look how far she went with her rubbish.

Anyway, June will probably contain job applications, although that very much depends on jobs being advertised, and the locations. If at all possible, I obviously want to be able to commute from home, but there are no guarantees of suitable jobs coming up in this area. I just have to wait and see.

What I've been reading

The Gargoyle
by Andrew Davidson

"The nameless narrator is driving along a dark road when he is distracted by what seems to be a flight of arrows. He crashes into a ravine and wakes up in a burns ward. One day Marianne Engel, a wild and compelling sculptress enters his life and tells him that they were once lovers in medieval Germany."

One of Landlady Lola's books, and fairly graphic in its exposition at the beginning of the treatment of a burns victim, but given that I did a case study on the subject, it covered old ground. The book as a whole feels a bit like the author really wanted to write short stories, but then managed to tie them together with a tenuous plot. Not too bad really, a bit weak at the end.



The Constant Princess
by Philippa Gregory

"Katherine of Aragon is born Catalina, the Spanish Infanta, to parents who are both rulers and warriors. Aged four, she is betrothed to Arthur, Prince of Wales, and is raised to be Queen of England. But when the studious young man dies, she is left to make her own future: how can she now be queen, and found a dynasty? Only by marrying Arthur’s young brother, the sunny but spoilt Henry."

I think I read this too soon after the other book by the same author - this one covers the era following the death of Henry VIII. It's quite good, and puts forward a version of the rationale behind Henry marrying his brother's widow - a mixture of envy, dishonesty and ambition on both sides. I think I've had enough of Philippa Gregory for the time being, though.



And Now on Radio 4
by Simon Elmes

"What this book intends to do is take you on a journey through that distinctive, instantly recognisable Radio 4 world. I hope that through the programmes I've featured and the voices I talk about, as well as the generous contributions from the many Radio 4 people - presenters, producers, controllers - who've spared the time to talk to me, some sort of coherent picture of the phenomenon that is Radio 4 will emerge."

It's a bit of a mess, to be honest, a mish-mash of verbatim quotes from various luminaries that haven't even been tidied up for grammatical accuracy, jumping here, there and everywhere around the past 40 years of the station. It's a lot less formal and more readable than the serious academic history of Radio 4 that I read a while ago, but where that was very thick porridge, this is thin soup, and ultimately unsatisfying. So there's still a gap, waiting for the perfect book to illuminate my favourite radio station. Step up, Stephen Fry...