Triggered by Anonymous

The recent Christmas party video, filmed during lockdown in December 2020, which emanated from 10 Downing Street, filled me with rage. I watched the people involved, who weren’t socially distanced or wearing masks, drinking, dancing, singing and laughing in the workplace far removed from the measures that others were held to. I couldn’t believe the blatant disregard for the rules and even the mocking of them as if they were insignificant.  It seems that the horrors of covid had affected me and continue to affect me more than I ever realised they had.

Working in CCU at that time my own reality, and that of my colleagues, was very different. I remember the very odd calm before the storm, just waiting for the first covid+ patient to be admitted. I remember the unit being prepared and stocked with PPE and half of the unit being sealed off to accommodate covid+ patients. I remember my first shift in the, ‘covid end’, removing all the personal items from my pockets and sealing them in a bag, putting on all the necessary PPE over my uniform, sterile surgical gown, gloves with a second pair worn over them and sealed to the gown at the wrist with tape, surgical cap, mask, eye protection over my specs and then a visor and a plastic apron.  I remember I was assigned my first covid+ patient who was chatting away to me on admission but sadly deteriorated and slipped away a few hours later, frightened and alone save for the PPE clad pair of eyes holding his hand. This same desperately sad scenario was repeated with the admission of my next patient on that shift also passing away soon after the first. Despite all the best efforts of the staff and medics, and without any specific treatment at that time, patients were dying in our unit and in other healthcare settings all over the world. I’ve never witnessed so many instances of death and so much heartbreak, frustration and despair in my entire 30 odd year NHS career.

I remember the staff who were drafted in to the unit to help. I remember once thinking that a colleague was taking a long time to tie up the back of my gown (it’s just easier!) and when I looked round it was because their hands were trembling. I remember having to give the news no one ever wants to receive to relatives via phone, or by video call, and hearing the last words exchanged between them and their loved ones. I don’t think those words will ever leave me. I remember we had our names written on the front of our gowns so we could identify each other, a small glimpse of humanity in a blue sea of PPE.

There is a floor to ceiling window in CCU which looks out over the entrance to the ED. During the first wave of covid, on a Friday night, we heard a piper and went over to that window. Outside there was indeed a piper along with firefighters, police and ambulance staff looking up at us. We quickly wrote, ‘thank you’ on a piece of paper and stuck it to the window. When the piper finished playing the emergency personnel saluted and applauded up to that window to which we all applauded back down to them. I always tend to get emotional when I hear the bagpipes but never more so than that night.

Returning home from work was another time consuming routine. Taking off clothes I’d worn to work in the garage, sorting my worn uniform and bagging it, straight into the shower without touching anything at all and a litany of other precautions I took to protect my wife, kids and wider family. I would never have forgiven myself if they had become ill because I hadn’t acted appropriately and flouted the rules.

Initially, I only put this down on paper in an effort to get the aforementioned rage out of my system, I think it has. I certainly didn’t write it to garner sympathy or far less, praise. There are many staff who worked on the ‘front line’ during the pandemic for longer than myself. My experiences are in no way unique and will be familiar to a lot of NHS staff. Without getting into the politics of it (those who know me know where my allegiances lie) there is a possibility that some of the people who appeared in the ‘partygate’ video may be honoured and we often hear that we should ‘just move on’ or ‘get over it’. I saw honour in December 2020, I also saw dignity, respect, camaraderie and sacrifice, none of these qualities are apparent in the Downing Street video. I’m afraid I’m not ready to ‘just move on’ or ‘get over it’, not just yet anyway.

Dignity in Continence Care- Working Together by Chris Wallace

The theme of this year’s World Continence Week is ‘ Commitment to Collaboration in Continence Care’ and is a timely opportunity to highlight the excellent work that goes on locally, largely unnoticed, ensuring that patients and their Carers receive appropriate treatment, therapy and care in relation to their bladder or bowel health problems. 

This is only effective because of partnership working- Specialist Bladder & Bowel Nurse Practitioners and administrators, Community Nursing, our general and mental health colleagues in all acute wards and specialism’s, Social Services staff, Allied Health Professionals, Cottage Hospital teams, Community Rehab Team, Paediatric Teams, Ontex Health Care- our current pad provider, Care and Support Workers, Care Home staff, Consultants, GP’s and Primary Care Teams , Carers Centre, Prescribing Teams, National Procurement, catheter companies –the list is endless, all collaborating and communicating , with our patients and their Carers at the heart of their decision-making. 

‘So what!’ you may say. ‘Isn’t that what should be happening?’  Definitely, but nationally, continence care has never been under such significant pressure. With proactive promotion of the service leading to a rise in referrals alongside reduced clinical resources, the increased cost of incontinence products due to Brexit alongside the rising cost of raw materials, and people living longer with life-long incontinence, the focus is understandably on ‘What can we do better, cheaper, slicker?’ and  ‘What can we stop doing altogether?’

What we can do better is never accept incontinence as an inevitability- of hospital stay, of neurological impairment, of mental illness, of being a child with additional needs, of getting older.  

We need to continue to change our culture to one of openness where we are comfortable and confident talking about bladder and bowel dysfunction and possible solutions,  and uncomfortable every time someone automatically views a pad or a catheter as the only possible outcome for someone with new bladder or bowel symptoms.

With a wealth of solutions- focussed resources, these should be a last resort.                            

An Animation on Urinary Incontinence – YouTube

                                                                                                                                                              Also, speedier engagement with patients and their carers when an incontinence issue needs assessed. This is a real challenge when all services are stretched.  However, when continence care breaks down, it can impact catastrophically on all aspects of peoples’ lives, and often precipitates an admission to care homes

Finally, across all our health and social care services, we must promote a healthy bladder & bowel lifestyle, and ensure that people have the right support at the right time to maintain continence.  Only by sensitively asking the awkward questions will we get to the heart of the problem

What we can do cheaper is focus on reducing our spend on pads and other continence appliances  by referring  people with new symptoms- excluding red flags-at the earliest opportunity to our clinics, and reduce waste by ensuring accurate assessments before using containment pads.

What we can do slicker is engage patients and their Carers in self management, sensitively negotiating solutions. That doesn’t mean telling them ‘the continence service say you’re not getting pads’ L  

When people contact us as soon as symptoms occur, there is far more likelihood of a cure or a reduction in the impact of symptoms.     

What we can stop doing altogether is treating incontinence as a taboo, an inconvenience and an unsolvable issue.  Having the confidence to label the use of underpads as an undignified way of managing incontinence, to question why a patient is being discharged with a urinary catheter, which was inserted due to urinary retention, without a trial without it, and to ask when did it become acceptable that ,between care visits, ‘people will just have to use a pad’.

Maintaining continence is complex. Anyone who has ever been severely constipated or had diarrhoea as a result of a change of food, routine or environment, or had the stress of trying to attain toilet training with a child, will have some insight into how difficult it would be to live with this challenge every day of their life.

We have a duty to ensure the right treatment, care and products at the right time for every child and adult living with bladder or bowel dysfunction.

Thankfully, things have moved on a bit since Billy Connolly’s incontinence pants J

Chris Wallace, Service Manager- Community Bladder & Bowel Health Team/ Team Leader- Community Rehab 

Bonding Before Birth by Anna Robson

No one can prepare you for the joys and challenges of parenting and they start long before baby is even born. The love, playfulness, happiness, worry, guilt, pain and sickness start for mum and for baby in the womb. This is a journey you are on together.

I remember the excitement and joy when I discovered I was pregnant for the first time and the pain when it ended in miscarriage. I remember the excitement and joy the second time but also the worry and apprehension, would it be ok this time or would it end in tears again. But then the relief at the 12 week scan, ‘a heartbeat’, ‘a baby’, ‘our son/daughter’.  From that moment, for us, they were a little person growing inside of me, another member of our family who we couldn’t wait to get to know.

And get to know them we did. Even in the womb they showed preferences to music, to food, to times of day. Once I could feel them moving I started to notice patterns. During pregnancy they were always very active before lunch. A pattern which continues now, always getting a bit restless when they are hungry or ‘hangry’ some might say, not too dissimilar to me. 

Through-out my pregnancy I listened to my favourite song most nights before going to sleep, to help me relax. I swear they remember hearing it in the womb and that sense of calm it gave us both back then. Because it always calms them down now when they are getting upset and they too will ask to listen to it before bed when it has been a tough day.

‘Everything grows rounder and wider and weirder, and I sit here in the middle of it all and wonder who in the world you will turn out to be.’ Carrie Fisher, American Actress

My husband was convinced he could hear their heartbeat when he placed an ear on my tummy. As a result he spent much time lying with his head resting on my bump. I didn’t have the heart to tell him it was probably my digestive system. He also stopped telling me about his day, preferring to tell them. I’m not sure if the kicks to his head were a good or a bad thing but I could already tell they were feisty.

Then at 37 weeks my waters broke!!! They just couldn’t wait to meet us and we felt the same. This is a personality trait which has continued, always enthusiastic and impatient, however also a little ambivalent. After going from 0-90 or should I say 0-8cm dilated in a matter of hours they appeared to change their mind. Maybe reconsidering whether they really wanted to leave the only world they had ever know. It’s warm and dark, they never go hungry or thirsty, and they have constant physical contact with you, already their favourite person. They already know your scent, your voice, your favourite music and your favourite food. However after 2 hours of persuasion they arrived. We had a few potential names, boys and girls. But without any conferring with my husband I knew who they were the moment I saw them, ‘Hello Tessa!!’

This was our journey and everyone’s is different. Lots of things can impact on parent’s ability to connect with their baby before birth. Was the pregnancy planned, is the pregnancy wanted, was it the result of a positive relationship? Is it the result of trauma or does it trigger a past trauma? Has this pregnancy come after a series of lost pregnancies or babies or attempts for a baby? Has it come after experience of having a baby on the Neo Natal Unit? Does it feel too scary to believe this baby might make it to full term and arrive safe and sound? Are you juggling the prospect of a baby with a physical illness? Are you managing your own physical or mental illnesses? Is life already stressful? Do you have a supportive partner? Do you have any support? You might be juggling a stressful job, other children, or the role of a carer, poverty, inadequate housing, relationship problems and the list of potential stresses can feel endless. However what I know is that no one commits to the decision to become a parent without wanting to do the best they can. But at this pivotal stage in life we all need a little extra support so it’s important to know where you can get that support from. If you are struggling with your emotional wellbeing during pregnancy talk to you Midwife, Health Visitor, Family Nurse, Obstetrician or GP to discuss support options.

Anna Robson is a Clinical Psychologist at NHS Dumfries and Galloway