The First Trimester

So, we are having a baby in July, if all goes to plan. And this means I am (almost) through the dreaded first trimester.
You don't hear much about how crap this particular part of pregnancy can be because a lot of women prefer not to broadcast their gravid state until having had a scan. Personally, I prefer to LOUDLY BROADCAST my gravid state to people as I see them, and everyone else can find out later. Like a celebrity.

I found out I was pregnant way back in October, at 4 weeks. I didn't feel pregnant at this point, which meant the whole thing felt unreal and odd. At 5 weeks, we told our immediate families. Then my niece came out with slapped cheek, just after she'd given me slobbery kisses. Seriously, she screamed bloody murder at me for two years, but as soon as she gets a horrible virus, she's all over me ;-) You don't want slapped cheek when you're pregnant, as it can (in a small percentage of cases) cause miscarriage or birth defects. So, to the doctors I went for an emergency blood test. I hate having blood tests, not because I dislike needles, but because I am a fainter. It's not deliberate or phobic, I just do. So, I asked to lie down and the nurse said "Oooh, how are you going to have a baby if you can't manage a blood test?"
"ERM, I HAVE HAD TWO BABIES WITHOUT ANY PAIN RELIEF, SO QUITE EASILY I IMAGINE", I huffed. I didn't have slapped cheek, for the record.
I wasn't going to tell the children about the baby for a while, but then they started elbow dropping my abdomen and suchlike, so I told them I MIGHT have a baby in my tummy, but I needed an Xray to check. This provoked the wonderful comment: "Mummy, you must be VERY CAREFUL when you do poos in case the baby falls out."

Six weeks, no change, I started to get paranoid. WHYYY don't I feel pregnant? Except for my really painful boobs, and exhaustion, and weird hormonal dreams, and repeated positive tests. Why am I even bothered by this relatively symptomless pregnancy? Mainly because I had such hideous vomiting with my other two children, and I expected the same again. I looked at getting a private scan, and promptly balked at the cost.
Seven weeks, and I went to see the midwife, to tick lots of boxes, and be frowned at for being a bit fat (NB: I've always been a bit fat). I've been booked for consultant care because I have a tendency to develop quite severe B12 deficiency anaemia in the second trimester (oh yay for that again!) and need LOTS of B12 jabs, and had a moderate postpartum haemorrhage with my last baby. BUT despite this, as long as the consultant isn't bothered, I'm allowed another homebirth, provided the baby comes out before it's 10 days late. Otherwise, I'll be lectured. If you've read this, you probably know how much attention I'm going to pay to that.

Eight weeks, and HURRAH FOR VOMIT! My sister's wedding is an alcohol-less delight, and I'm not even sick on the bus ride to and from the wedding. There is dancing. There is about 12 hours travelling all told. It ruins me for a while.
Nine weeks, and I AM OVER THE VOMIT.

Ten weeks and, no, seriously, it's nearly Christmas, I have a TMA to write, and I would like to stop vomiting all the time now. Like, in the grass on the school run, and in any vessel available, including the toddler's pot. The baby is now the size of a kumquat. I have no idea how big a kumquat is and Google to find out. Apparently, a kumquat is the same size as a 10 week foetus. Thanks, Google!
Eleven weeks, and the emotions kick in. Oh gawd, do they kick in. Christmas is TOO MUCH. The assignment will NEVER GET WRITTEN. Nobody told me you produce LESS HCG at the end of the first trimester, and that's why my mad, reflexive pregnancy tests are coming back less pregnant instead of more. Panic ensues. Reassurance is given. I go back to fretting about the five million things I haven't done, and the state of the house since bending over makes me throw up. The baby is the size of a plum, or a festive sprout. This is at least something we can relate to better than a kumquat.

Twelve weeks, and it's scan day. First impressions are "wow, scan technology has improved a LOT in four years". The sonographer shows us our baby, its brain, heart and bladder. The baby is sweet, and kicks its legs at us. We breathe a sigh of relief, hang around in the antenatal unit for hours waiting for a blood test, and show the boys their new sibling. "WHERE'S ITS VAGINA?" asks eldest, on seeing this. And then the full burden of CHRISTMAS falls upon us gracelessly. I spend much of Christmas Day vomiting, because apparently the baby objects to me ever being full up.

With my first baby, I was working full time. With my second baby, I was working part time and had a toddler to look after. This time, I have two children at school/preschool, and an (almost) full time uni schedule. This pregnancy, despite the far lesser sickness, has been much harder than the previous two because of the sheer amount of STUFF I have to get done every day. This is partly because the sickiest time coincided with the Christmas run-up. I am so glad the Christmas season at school has finished now. Bloody plays, and church visits, and singalongs, and parties, and Christmas bastard jumper day, and extra money demanded here there and everywhere for everything. Ugh, it's been a bit much. But technically, things should start to get easier now. Until the dreaded anaemia kicks in. Hopefully, that won't be til around April. Meanwhile, university work beckons, and the thought of doing an exam at 36 weeks pregnant is suddenly a real and alarming prospect.

May 2015 be as good as 2014 has been!

STOP PRESS: Mothers are bad

There has been a lot in the press recently about mothers. Mothers, I think we can all agree, are pretty important. They produce the next generation, and do the bulk of caring for them (hopefully as part of a loving family unit) until said generation are big enough to take care of themselves. You could argue that parenting is the most important job in the world. However, the press has been resoundingly negative about mothers. Mothers are BAD.

First, we had the woman prosecuted for drinking in pregnancy, resulting in a baby with foetal alcohol syndrome. Now, current NHS guidelines say don't drink ANYTHING alcoholic, AT ALL when you're pregnant. When I had my eldest, it was 2 units max a week, when I had my second, it was preferably none, but not more than 1 to 2 a week. So, in the last six years, this has changed. When my mum was having me thirty years ago, there was NO recommended restriction on alcohol in pregnancy, and very little advice to stop smoking aside from perhaps to cut down a bit. However, we were not plagued with children born with F.A.S in the eighties and before. Foetal alcohol syndrome only happens when the pregnant mother is an alcoholic. Most pregnant women are not alcoholic.
Now, women who plan to breed should probably be glad that the woman prosecuted was not found guilty, because if alcohol consumption was illegalised in pregnancy, they might risk being arrested for having a solitary glass of wine at a wedding, or after work. And that would have opened the doors to smoking being illegalised in pregnancy (which would actually be kind of sensible since the link between smoking and foetal damage is better understood than that of mild/moderate drinking and foetal damage), but I'm fairly sure that most smoking women consider the sheer weight of expectation to quit in pregnancy is a sufficient deterrent.

Next, we had the great breastfeeding in public debate rear its ugly head. And I say ugly head, because there is nothing uglier than people trying to claim there's something obscene about feeding a baby. There really, really isn't. Babies need feeding, doesn't matter how you do it. When they are very tiny, they need feeding all the frickin' time, literally, for eight to twelve hours a day. It's not obscene for your baby to need feeding. It's not militant for your baby to need feeding. It's not exhibitionist of your baby to need feeding. Breastfeeding mothers still need to leave the house occasionally, and sometimes they may time it wrong, or have a baby that is teething, or ill, or growth-spurting and unexpectedly demand food. And when babies are hungry, they scream. They howl. They cry like they are being murdered, getting increasingly hysterical, and making people tut. The nice thing about breastfeeding is that the milk is there, ready to go. No "shit I haven't got a bottle" panic.This whole idea that WOMEN DO NOT NEED TO BREASTFEED BECAUSE FORMULA is the most ridiculous thing I have ever heard. Even the WHO call it bollocks. Formula has become the socially acceptable way of feeding babies, primarily because society is so freaked out by breasts.
I say 'society', as Farage has pointed out, it's mostly men. Urrrghhh, that woman's using her breasts for their biological purpose! Next thing, she'll be GIVING BIRTH FROM HER VAGINA, or something EQUALLY OBSCENE.
The fact is that it is illegal to ask a woman to stop breastfeeding in public. Trust me, as someone who has fed babies all over the place, from the living room, to the pub, to the party, to the shopping centre, if you are offended by seeing a curve of nipple for literal seconds, you need to perhaps re-evaluate your priorities instead of blaming breastfeeding women for making you feel slightly uncomfortable about society's preoccupation with SEXY BOOBIES. Or, you know, join the anti-Page 3 lobby.
 **

Finally, the terrible and tragic case of Charlotte Bevan. Now, until the inquest, it won't be clear whether she was suffering from puerperal psychosis or 'just' struggled to cope with new motherhood. I put just in inverted commas, because the immediate postnatal period is a time of exceptional stress and emotional upheaval in every single new mother. The leading cause of maternal death is suicide, which should be shocking, yet oddly isn't. It doesn't matter whether it's your first baby or your seventh. It doesn't matter whether you have a history of mental health problems or not. However, with your first baby it is a more pronounced shock, because you're unprepared for the bodyshock, for the odd new emotions, for the responsibility. The key to getting through it is support, and unhappily, many new mothers don't get enough, I've discussed this ad nauseum before. The provision of mental health care during pregnancy and perinatally is rubbish. I suffered very poor mental health antenatally with my second child and received essentially no help except for my understanding GP whose hands were tied. Thankfully, I got better when he was born, not worse. It is a gamble the NHS should not be willing to take.
The Daily Mail, spawn of Satan that it is, wrote an article on how she lived in A NICE EXPENSIVE HOUSE, and had been listening to R Kelly before she went missing. All the papers have suggested NHS maternity wards need better security. They already have good security to keep out baby snatchers, but women who have just had babies are not prisoners. They need help, they need support, they need a lot of love from their families. They don't need locking up like criminals, moreso if they WANT to go home. I had to self discharge to get off the ward with my eldest child, because there was not enough staff to observe me during the day and discharge me, and then when they tried to send my husband home, I freaked out. There is nothing lonelier than being left alone all night in an alien environment with a new baby, with your partner sent away. This was not a sign of incipient madness, just a sign that I badly needed to get away from a cold, unpleasant ward with no privacy (they kept opening the curtains when I was trying to sleep - how does ANYONE sleep on a shared postnatal ward?) and home with my family. Perhaps this should be a spur to improve postnatal care, rather than a reason to exercise medical authority over women who don't want to be there.

The media are increasingly happy to demonise mothers in pursuit of clickbait, with Charlotte Bevan being a particularly poignant case. Politicians are quite willing to attack public breastfeeding (the indignity!) in order to try and win votes from their conservative brethren, rather than encourage something acknowledged worldwide to be a Good Thing. People are quite happy to sit on their high horse, judging alcoholic mothers for inadvertently breaking their children, rather than wondering why there was nothing anyone could do to help. They judge women for daring to er...feed their baby in public without the protection of a niqab or something. They judge a mentally unwell woman for killing herself and her child, rather than wondering why she was allowed to get SO sleep deprived, and where her support was.

Mothers are important. Be kind.

**It makes me sad that I have to add this to every feeding-related blog I write so I don't get attacked as some sort of breastfeeding nazi, but please feed your baby however you want. This isn't an attack on formula feeding, but an attack on people who think breastfeeding is obscene.

Introductions and Conclusions

There are two common issues with TMA writing. The first, referencing, has been dealt with here before. The second is "how the hell do I write an introduction/conclusion?"

Now, the introduction and conclusion of your TMA bookend it. They demonstrate that you know what you're going to write, and that you can summarise what you've written about at the end. And they are vital, because most essay TMAs take them into account in the marking scheme.
So, how do you write them?

Well, first off, you don't have to write the introduction when you start, and the conclusion when you finish. I often write the conclusion first, before I write anything else. I may well totally rewrite it before submission, but it focuses my mind on what the final result should be. Conversely, I often write the introduction last, when I know what I've written about. You don't have to write your essay in order at all - I'll often write a few sentences that I want to get in, but I'm not sure where, and then ease them in at the end. Or not, if they turn out to be unnecessary. The important thing is to START writing.

It's times like this that an essay plan helps. I SCORNED essay plans when I started my degree. "I don't need them, they're a waste of time", I thought. But with time, I've come to value them, both as a template, and as a working frame of reference. If you have a vague idea of what you're going to write about, and in what order, before you start, half your problems of arranging the content in your head and on the page are solved. If you can work out how much of your word count you need to give to each segment, then you have an idea of how long each part needs to be.
An introduction and conclusion should not take up more than 20% total of your word count. With a thousand word essay, try and get your introduction and conclusion at around 100 words each. Any more, and you're probably waffling.

So, introductions. I tend to be pretty explicit in my introductions about what I'm going to write, and allude to the TMA title. For example (and I'm making this up as I go along, so I really hope it's not actually a TMA title), if your title is "Discuss Cordelia's motivation and actions in Act One of King Lear", then you need to mention in your introduction that your essay is about Cordelia's motivation and actions in Act 1 of King Lear. This may sound REALLY OBVIOUS, but you don't need to be Shakespeare to write an introduction.
"In the play King Lear, Cordelia is a central character. She is the youngest daughter of the eponymous king, and in the first Act appears only once, and greatly displeases her father. This essay will examine her actions, and discuss the motivation behind them."
And that's it. In under 50 words, Cordelia is introduced, and the reason for writing the essay is explained.

Conclusions are equally simple. You have, hopefully, done what you said you were going to do in the introduction and written an essay discussing the motivation and actions of Cordelia in King Lear, or whatever your essay title was. Now, you need to sum up your findings and signal this is the end of the essay.
"To conclude, Cordelia's love for her father is unsullied by greed, and Lear is unable to accept the simplicity of it, as he is so used to abundant, false praise. In trying to be honest, Cordelia is disinherited by her father, but her honesty wins her the King of France as a husband." 
And again, in 50ish words, the essay is rounded off neatly. All a conclusion does is state, briefly what you've written.
(I'm not an English Lit student, can you tell?)

So, don't fret about intros and conclusions. Fret instead about your essay argument, whether you're meeting the guidance (because if the guidance says read X, you better read X, and reference it, and quote from it if necessary), and whether or not you'll ever finish the horrible thing.

Good luck!

Limbo

Foundation year was hard work for Jimmy. The Early Years Foundation Stage framework suits 90% of children down to the ground. Freeform, learning through play, no desks, no books...it's all good. But not for Jim. Jim really struggled with the lack of structure, with the lack of routine, and with needing to share his time between activities. And because Jim struggled, the staff struggled to cope with him. It took six months for them to get the staff in place for him to attend full days. It was very difficult for me, because I was constantly told what he'd done wrong, what I should be doing with him, and felt to blame. It is difficult to accept a violent, difficult five year old's behaviour isn't solely because of the parents.

Summer holidays were also difficult for us all. The first couple of weeks were OK. We did structured learning every day at "Mummy school", which sounds massively pretentious but was just me trying to teach him to read. By giving it a name, a place and a time each day, he actually accepted it. Until the wedding. Our wedding somewhat knocked Jim off balance. He went to stay with his dad for ten days; the longest he's ever stayed with him, and he didn't settle back down afterwards. He didn't sleep, he didn't want to do anything except watch videos, he was violent to his brother, and to other visiting children. We took him out to Bewilderwood for the day (amazing place, thoroughly recommended for children) and he ran away, and threatened to cut a woman who came too close to him. He went feral at my brother's wedding, biting balloons and attacking children, until he wore out and asked to be taken home. He became increasingly 'locked in', and wild. His dad has been helping to put up a united front, regardless of whose house he's at, in terms of rules and reward. This mainly made Jim not want to be with either of us.

He went back to school last Wednesday. It's already apparent that the structure of year 1 suits him a lot better, although his actual performance is pretty low. He's going to take a few weeks to settle back into going to school, and the ringing cries of "I HATE SCHOOL" are probably something we'll be dealing with for years. I'm trying to find a decent wrist restraint I can use on him during the school run, to stop him running off. If anyone has any ideas, please let me know. To some, the idea of physically restraining a child is repellent, but I have seen Jimmy stop in the middle of the road to pick up a toy, and be deaf and blind to the car blasting it's horn inches from his back.

What has got us through the last six weeks of occasional garment-rending despair is knowing that he's on the waiting list for an autism assessment, and once he has that, he can get referrals to occupational therapy etc, as well as more input with the school. The school, for what it's worth, are being far more useful this year, and have managed to get him almost full time one-on-one supervision.
Today, I rang the hospital to ask how much longer the waiting list is. And alas, the answer is that they've lost a lot of staff recently, can't get locums to cover, and simply don't know.

I've asked to speak directly to the neurodevelopment team, just for some advice. I'm fairly sure Jimmy's sleeping problems are due to melatonin deficiency. He's been in the same routine for OVER A YEAR, with no improvement in time it takes to fall asleep (min 60 mins, max 3 hours) or how frequently he wakes up. I'm also sure his sensory overload is much worse when he's tired, which is almost invariably because of his sleeping problems. And he is so violent. He bashed his brother over the head with a wheelbarrow, and jumped knees first at his neck. He also scratched my godson to ribbons. Violence and coercion have become his favoured social tools.

It makes me wonder where I can find the cope to keep dealing with him, when it feels like everything I'm doing is wrong. Everyone has an opinion on what would work with Jim, and all I want is a professional opinion, which is the one I cannot seem to get.

Just Married

On 8th August, one of the wettest days of the year, me and my beloved Tom got married at Rutland Water.

It was perfect.

World War One

One hundred years ago today, World War One started. I don't know of much personal history in WW1. My dad's granddad lost his leg after a shrapnel wound, and one of my mum's granddads lost his mind. My family were not high status officers, or medal recipients, as far as I'm aware. Unlike World War Two, which is still in living memory for many, WW1 never really has been in my lifetime. It's almost a ghost of a war, as all wars end up being.

Last year, I went to France for the first time. We stayed in Verdun, which saw a year long battle in 1916 between Germany and France. When driving to Verdun along the A roads, we saw hundreds of war graves. Thousands even. Not in huge, formal cemeteries, but in small ones, just by the side of the road. And every single one is immaculate. Someone still cuts the grass. People still visit the gravestones. Bodies are still dug up every single year, and nobody knows who they are. In that area of France, WW1 is not a distant memory: it's living history.

Nothing drove into me the sheer horror of WW1 like seeing those small, unforgotten, cemeteries. Nothing drove into me the numbers of men who died like seeing the lines of white headstones. No TV footage, no worn memorial in a town centre or church, no amount of paper poppies can hammer home the scale of death like seeing the graves of the men who died. The endless sea of white on green.

Wars are happening right now. Terrible wars, wars for land, resources, religion. Wars where children are ripped to pieces alongside adults. And we shake our heads at the destruction, watch programs on the horror,  make infographics and pithy anti-war slogans, and write blogs about how awful it is. But how easily humanity forgets the slaughter, years down the line.

Some have condemned today's memorial services for celebrating the advent of World War One. But it's not a celebration. It's a commemoration of millions of lost lives, civilian as well as military. An acknowledgement of the millions more lives marred by war.

Just remember.

Understanding autism

Autism is difficult to understand. It is difficult for someone with normal brain function to fathom that someone's brain can be wired wrong, and yet still work. The brain is unfathomable to many, and the idea that neurological connections can go wrong but still create a working person is even more abstruse. Therefore, the idea that someone who looks normal, but has a messed up brain is difficult to swallow. The invisibility of autism is the root of most people's issue with it.

And HOW people take issue with it! There are plenty of folk who believe it is caused solely by bad parenting, linking it up with ADHD because it starts with the same letter and seems to affect children more than adults. There are plenty of folk who simply don't believe it exists, and that it's an excuse, a label to gain children special treatment. The idea that the only type of autism is the Rain Man stereotype is endemic.
The idea that autism occurs on a spectrum fuels the assumption that it cannot be real. The fact that most medical conditions exist on a spectrum passes most people by. Cancer manifestations can range from immediately deadly to an inconvenience. Even something as humdrum as hypertension occurs on a spectrum ranging from barely elevated to life threatening.

Then there is the debate of the causes of autism. The current best theory is that it is genetic. Some argue it is passed down the paternal line, but that may be because there is a higher percentage of male autists than female. However, other theories include the (somehow immortal, though wholly discredited) immunisation cause, and a variety of Daily Mail-esque causes related to maternal intake of Substance X in pregnancy. So, if you have a family member with autism, it can be difficult to accept there may be a genetic link. I don't know whether this guilt-denial is the same in other genetic conditions, like the breast cancer gene, or whether it's restricted to birth-onset neurological problems.

There is as much difference between autistic children as in any children. I personally know six autistic children other than my son Jimmy, and every single one presents differently. My son and godson are similar ages, both with ASD diagnoses and are completely different. The other autistic child in Jimmy's class is totally different again. The common threads of diagnosis are difficulty with social communication, difficulty with social interaction, and difficulty with social imagination. For Jimmy, this means that he struggles with normal conversation, turn taking, sharing, friends, playing, concentrating on things that don't directly interest him, and engages in risky behaviour because he simply cannot fathom danger. He won't look at you when you're talking to him most of the time, and very rarely makes eye contact. His emotional palette is very limited, and he doesn't recognise emotions in other people. He cannot grasp what other people think, or what behaviour is unacceptable. His lack of concentration holds him back at school, although his intelligence and ability to understand quite complicated concepts is exceptional. He has a small collection of people that he actually treats as people, and everyone else might as well be a plank of wood for all he cares. Some autistic children have a mix up in their wiring that means they process faces/people as objects, and that is very much Jimmy's thing. He also has some pronounced sensory problems, mainly with sound and proprioception (although autistic children can struggle with any combination, or all of their senses) and his main way of dealing with the resulting overload is to fight, to scream, or simply to withdraw. Jimmy falls on the aspergers end of the spectrum, which basically means his language problems are limited. Many autistic children either never speak, or take years to learn. Jimmy copies language all the time, but he is able to speak fluently and spontaneously. When he is mid-meltdown, he loses proper language, and become single-word-repetitive. Today, it was the happy word of diarrhoea, bellowed repeatedly, for some time. I'm sorry, neighbours. His social level is far lower than his brother's, and his brother is twenty five months younger.
There is a link between autism and ability to manufacture melatonin, which means many autistic children cannot fall asleep and stay asleep. Alas, this is very much Jimmy's thing as well.

This is just what he does: any other autistic child may do something completely different.

If you took each of his odd behaviours as a single entity, they could be explained away. Every child does something a bit odd that falls on the spectrum. But the collection of behaviours together is what leads you to the diagnosis of autism. It's not a diagnosis paediatricians make lightly, because in making it you are saying "this child will have social problems for the rest of their life". It is admitting the child is disabled. The idea that you can simply present your misbehaving child to a paediatrician, get an autism diagnosis and then live without guilt, or need for discipline for the rest of your child's education is a total misconception, but very popular in people who don't want to know more.

I was relieved when Jimmy was diagnosed. Not because I want him to be autistic, but because it meant there was a reason for the way he was behaving. I have felt since he was a baby that there is something wrong with him, and I finally got validation for those feelings after almost five years of being sidelined and ignored. But the reality is that he is significantly disabled by being autistic, and I have to be his advocate in everything. This is another thing that is generally overlooked by the Autism Is Not A Thing brigade - it is really hard work to be the resident parent of an autistic child.
There are lots of meetings where you're told what your child has been doing wrong, and it's your job to try and guess what insignificant thing has been the trigger, so you can avoid it again. There are meetings where you sit with clinicians and are told "this is what he's doing that isn't normal", and meetings where you sit with your child's headteacher because they want to exclude him for behaviour he can't control. There are meetings where you have to essentially put yourself in their shoes, and then walk around an area so you can spot things that might set them off, and then work out avoidance techniques, because there is no way the child has the self-awareness to do it themselves. I spent an hour and a half at Jimmy's school last week, looking at his new classroom, meeting his new teacher, meeting his new SENCo and trying to explain him, and even that wasn't time enough to give them all the information that might help. Then there's the strain on your personal life, the lack of time spent with your partner because your child needs almost constant supervision until he eventually goes to sleep around 9pm. The lack of spontaneous days out, when every potential venue has to be scouted for likely triggers. The general isolation of not being able to go out and see friends or family without weighing up the likely cost in terms of his sensory overload, because there's always a payoff in the evening, with the extended bedtime and the screaming. The worries about major events like weddings, wondering if he's going to be so uncontrollable that he'll ruin it. Trying to balance out his needs with the needs of his neurotypical brother without doing either of them a disservice. It's difficult sometimes to find the positives, especially after a bad week.

It's a constant, steep learning curve. So forgive me if I get annoyed when people tell me there's nothing wrong with my child, he just has a 'few problems' because the reality is somewhat harder, and more complex than that. It is a difficult condition to get your head round, and it is a complicated condition with many variables and an unclear aetiology, but finding out about it can only benefit you if you've got autistic people in your life.

If you'd like to know more about autism from a more objective point of view, I recommend the National Autistic Society's full and informative website.

Results

So, about six weeks ago, I sat some exams. And today, 8 days early, I got the results.

Hem hem.

For SK277 Human Biology, I got a PASS TWO.

And for A218 History of Medicine, I got...wait for it...

A DISTINCTION

I'm still BUZZING over that. I sat that exam in such a woozy haze of infection, I honestly thought I'd be lucky to scrape a pass.

So, I've finished level 2 completely now. I got a first, 2:1 and 2:1, so hopefully I might get an alright degree classification when I get that far.

For my next trick, I'm doing two modules together again. One is a 30 credit level one called SDK125: Introducing Health Science, A Case Study Approach. This is a free choice module, that I'm doing partly because I need that many credits, and partly because health practice is where I'm from and I'm looking forward to doing more of that sort of work.

My BIG module is K311: Promoting Public Health: Skills, Perspectives and Practice. That's a 60 credit level 3, with an EMA at the end. I really didn't want to do two exams together again. When I was working, I did a lot of public health type work. Not specifically in that domain, but general health surveillance, and trying to encourage people to come for health checks, and vaccinations, and finding out why people didn't come in. Public health is something I have an increasing interest in, and I'm really excited to learn more. Although I suspect I will end up ruing the day I thought it was a good idea.

BUT FIRST I'm getting married on 8th August, so I'll be someone's wife again by then. Eeek.

The Library As A Lifeline

My love of books is no secret. I learned to read when I was 2, and never stopped. I remember in year 4 being made to read the first line of every reading book they had to try and find something I couldn't easily read, and stopping at a year 6 book. I read every children's book in the house, and then moved on to my mum's books. I read the backs of cereal packets eating breakfast, and shampoo bottles in the bath. The idea of nothing to read still distresses me. I'm currently on bedrest with concussion and am not allowed to read much. I am so fed up.

We had very little spare money when I was growing up. I have six siblings, and with the mortgage and bills, we cost more than my parents earned. There was no spare cash for books. I used the school library constantly once I started high school. When I left, I began using the town library every week. I would go with my sister in her pushchair and fill the bottom of the pushchair with books.

I had a difficult few years in my mid teens. I was bullied, lonely, poor and bored. I babysat my sister as a job during the week and spent the money I got on visiting my boyfriend at weekends. My friends were still in sixth form. I didn't really belong anywhere. The books I got from the library were travel books; reading them sent me somewhere that wasn't a dead-end Lincolnshire town, where I was miserable.

And that is the value of libraries that is too often ignored by politicians and councillors trying to make cuts where privileged people won't notice. A book is a mental passport away from a situation. A book can provide the education needed to liberate oneself from inescapable difficulty. It can be a source of hope. Just the simple act of leaving the house to return books and fetch more can be a catalyst for independence.

I grew up in Lincolnshire and the way the library system is being systematically dismantled upsets me terribly. A library is far more than a simple repository of books. It can be a lifeline, and source of great pleasure for those who are less fortunate. The internet and Kindle have not removed the need for community libraries, and those who need them most are often the ones most excluded from the ebook revolution.

Save Lincolnshire libraries.
@savelincslibraries

Exams

I really HAVE finished level 2 now. Well, provided I pass, which I don't find out until 14th July. I'm not going to worry about that. THERE ARE RESITS.

My history exam was...fun. I got bitten on the hand by an insect on the Sunday, woke up very early Monday with a septic trail to my elbow and spent the day being prodded by a doctor, sleeping, taking head-fuzzing medicine, and then panicking about the exam. The exam, on Tuesday morning, was full of questions I didn't know the answer to. But I did my best, despite illness and hand-cramp.

The problem with doing two exams, two days apart, is that I didn't want to then go home and revise biology. So I didn't. I had an afternoon off. The afternoon stretched into the next afternoon.
Then I panicked and started reading through the notes, the books, everything. I spent the following morning panic-revising the essay question, and was just going through the practice questions in the text books when there was a sonic boom which scared the living crap out of the whole city and totally removed any ability I had left to cram.
I actually, and perversely, enjoyed doing a science exam. It made a nice change from endless three-hour, three-essay exams. The only thing I'd do differently (if I have a resit, which could happen), is to do the data handling question last. I realised, as I shaded in my beautiful bar chart, that I really didn't want to then sit and write a thousand word essay on sleep. I wanted to go and gad about in the sunshine, I was idly thinking about some gossip, I was not in exam-mode anymore. So, yes, a valuable lesson.

There is nothing more satisfying than putting away books and revision notes, but I do feel slightly lost now. However, I've signed up for various MOOCs and I'm getting married in eight and a half weeks, so there's that!

Level 2 draws to a close

It's finally, almost over.

This year has been HARD, for several reasons that were not apparent when I signed up last year.

1. Biology and history of medicine SOUND like they might be similar. One is human biology, one is how we got as far as acquiring that knowledge. Well, nope. Doing a science course is so utterly different to an essay based course, it utterly threw me to begin with. I also didn't realise how much chemistry content would be in biology, which was my own stupid naivety.

2. I got WAY less free time than I was expecting as my eldest didn't start full time school until Easter.

3. The spacing of TMAs was more of a struggle than I thought. I ended up spending several weeks on history, then two weeks on biology, frantically trying to catch up.

However, I'm done and these are my results:

SK277                                               A218

I'm a bit disappointed with that 72%, but it doesn't alter my OCAS, so I shall HOPE FOR THE BEST in my exam. SK277 doesn't care what my TMA scores are, it's all on the exam, which is...annoying.

My exams are on 3rd and 5th June, which is alarmingly close. It's easier to revise science than history, coz in history I'm going to have to reason and argue why I think things happened. At least science doesn't argue with you...often. So wish me luck!

ETA: My last TMA has been regraded to 77%, bringing my OCAS up to 80%. HUZZAH!

How To Save A Life - UPDATED

When I was five, I fell through a window and lacerated my arm really badly. I still have some problems with it, and have always been grateful to the wonderful NHS for preserving my hand function. However, when discussing the accident yesterday, I realised I should be equally, if not more, grateful to my dad and neighbour for the first aid they administered immediately afterwards. They held my arm up, to stop the blood pumping out, then carefully put the skin back and bandaged it in place, without disturbing all the glass in it. If my dad hadn't had industrial first aid training, or my neighbour not known how to dress a wound, the glass in the wound could have severed my artery and killed me, or irreversibly damaged the mechanics of my arm and hand requiring amputation. The use of sterile cloths and bandages probably stopped any infection getting in. As it is, my ulnar nerve is has some impairment and I get a lot of weakness, but I can use my hand and arm without noticeable disability.

On a less severe note, when my eldest son was 18 months old, he pulled a freshly poured cup of boiling water onto his head. I got him out of his clothes, straight under cold water and he didn't get a single blister.

First aid saves lives. I have been to a lot of first aid training courses, because they are mandatory when you work in a doctor's surgery, even for administrative staff. The first aid courses I have been on have focused on getting professional help as fast as possible, and CPR. As parents, you hope you will never have to perform CPR on your infant or child, but it is useful to know how to do it, in the awful event that it happens. Simpler first aid such as burn management, wound management, head injury management, knowing what to do in the case of a sudden collapse or seizure, is not generally taught. If I had my way, it'd be part of PSE development in secondary school, but I am not yet the leader of the free world.

As parents, we rarely plan to have to deal with a serious incident. We deal with small lacerations, bumps and bruises, superficial burns, occasional choking, and hope A&E can help if something worse happens. In our first aid kit at home, we have plasters of all shapes and sizes, rolls of bandage, micropore surgical tape, antibacterial wipes, a thermometer, some piriton (as my eldest occasionally comes out in hives for no reason), and all manner of painkillers. But having a well stocked first aid kit isn't enough if you don't know what to do with it.

If you don't know what you would do if your child was bleeding severely, unconscious, having a seizure, or not breathing, the NCT, St John's Ambulance, and The Red Cross all offer first aid information and courses for parents.

St John's Ambulance have also introduced a new campaign on choking. You can find information here.

Autism

Jimmy, my five year old eldest child, has Aspergers syndrome. Probably. He's definitely on the autistic spectrum, but needs to see the neurodevelopment team to have this made official and them to decide what to do next, in terms of school support and occupational therapy to teach him to deal with auditory processing problems.

We have been waiting for three months for an appointment, and it will probably be another three months before we get one. Meanwhile, we sit in limbo, waiting for the next thing to blow up.

This is Jimmy on his birthday:

He has the temerity to look normal.

And it's the normality that causes the problems.

See, mostly when people think of disabled children, the automatic thought is physical disability. It's very easy when dealing with an autistic child to forget they can't help it, to forget they aren't just throwing a fit to get their own way. I'll come back to this in a minute.

Until Jimmy started primary school last September, I convinced myself that it was my parenting that was the problem. I wasn't strict enough. I was too strict. I shouted too often. I gave in too easily. I wasn't good enough at maintaining a routine. He demonstrated problems at preschool, but they preferred to concentrate on what he could do rather than what he couldn't, which was GREAT because they had facilities and staff to have him on a one to one basis for as many hours as he needed. They never suggested he had autism, just asked me to get his hearing checked to make sure he wasn't ignoring them for no reason. The GP who did his hearing referral said he thought he had behavioural problems and I should bring him back for a referral to child development if his hearing test was normal. His hearing test was normal, and to my shame, I didn't take him back. I was sure it was me who was the problem, not him.

Fast-forward six months, and his first three weeks at school were hell. The first week, he kicked staff and was banned from having his dinner at school. The second week was no better, with added exhaustion from coming home for lunch. By the third week, he was on mornings only, and I took him to the doctors to get a referral. It was only at the very end of last term that he was able to start having full days at school, because they finally secured informal one to one support three days a week. The school managed to get an educational psychologist without formal referral, who has done a lot of work with his main teachers recently, and things have improved. But it's not been easy. I've formally complained once about their management, and had repeated meetings where I've tried to explain it from his point of view, and come away upset and angry that my little boy is perceived as such a monster.

Finally, at the end of January, I took him to see the paediatrician. The first words she said to me were "that's not normal" pointing at him, completely ignoring both of us. I explained him, she nodded and said he fit the diagnostic criteria for Aspergers, but the formal assessment would be made by the neurodevs. And therein we sit, in limbo, waiting.

His main problems are a total lack of social and emotional awareness, a frequent lack of spatial awareness - he does not realise people/things are there- very broken sleep and dysregulation. Dysregulation is one of my favourite words, and the reason we've been able to get him through the system relatively quickly. When something happens that deviates from Jimmy's internal plan, he goes NUTS. He screams. He fights. He kicks. He goes THROUGH people like they're not there. He cries huge tears. It is intensely annoying for most people to experience, and intensely upsetting for me to see him in such distress over so little. His default state is one of faint confusion and bewilderment.

But because he LOOKS normal, it is hard to explain to those who don't know him very well that... 

He ISN'T your average child. 

It is hard to explain that he has almost no empathy, that he doesn't care why you want him to do something, that he doesn't even realise you're there most of the time. It is hard to explain that although he's been asking to see you for the last 48 hours, he doesn't actually care once you're there. Or, that he cares too much and won't leave you alone. If you don't want him to repeatedly jump on you, he won't understand that without you physically removing him and explaining, and even then it's 50/50. He doesn't know when he's hurt you. He can't interpret your facial expression. He can sometimes tell from your tone of voice, but his expression-recognition is limited to happy, sad and cross. He won't look in your eye, unless he knows you really well. He sees no need for standard social convention.

On a broader family level, it's hard to explain to friends why you can't just pop round for a cup of tea with him, or why you can't have them round in the evening. It's hard to plan days out. It's hard when the school holidays come and he doesn't know what he's doing anymore. It's hard to go on the bus, and to go for a walk, and to nip to the shops. It's hard to go to parties, to plan for weddings and other social occasions, when you have to decide who'll be the one to take him out when he kicks off. It's hard to go on holiday, knowing he won't settle into the rhythm until it's nearly time to go home. It sucks when you can't even tell him he's going to his nanny's that afternoon because he will be angry and strange at school all day. 

There's a glitch in our Jimmy, and it happens when we change something. And we can't give him medicine or an operation to make it better, like we could when he had chronic tonsillitis. This is him.

He is autism, and autism is him. There is no part of his personality that is separate from it. It is how his brain is wired, it is who he is, and without it he would not be the son I know and adore. 

How To Write a TMA

I have written, in the last 25 months of OU study, nineteen TMAs, each once at least a thousand words.
Here is a brief guide to tackling them when you are horribly stuck:

1. Submit it. Even if it is the most terrible, horrendous, rambling shit in the world, submit it. You will definitely get 0 if you submit nothing, but you might get more than you think if you submit something. If your module has substitution applied, then so much the better, but something is better than nothing.

2. Read the question. This sounds so obvious, but many's the time I've skimmed the question, and think I've got it, only to realise I've missed two tiny vital words like "two sources" or "after 1800". So read it, and grasp what you're being asked even before you do the reading.

3. Read the guidance. Unless you're in an exam, the guidance tells you pretty much exactly what you're being asked, where to find the information and how to write it. Got to write a report and you've never done one before? Guidance! Source analysis? Guidance! The guidance will also tell you things like whether you need to include references (almost always yes, but check anyway), or diagrams.

4. Gather up your materials. There is nothing worse than being halfway through answering a question, realising you've left the relevant information upstairs, going to get it and then utterly going blank when you sit back down. The guidance should tell you what you need, as should your own common sense.

5. Answer the question. The way I approach TMAs is to read the question, and then give a short answer in my head. "Did the introduction of the Whatever Act of 2000 change things?" it might ask, to which I say "NO!" And then I have to decide why I've said no, and that's the basis of the essay. Tie every single point you make to the question.

6. Obey the word count. The word count is not an arbitrary sum the course writers have put in to annoy you; it's a very important clue to what to write. Give 10% of your word count to both your intro and conclusion. What's left is enough to cover everything. If you massively exceed it, you're either waffling, repeating yourself or going off on a tangent. If you come massively under, you're missing something.

7. Edit with extreme prejudice. If you can't bring yourself to, get someone to read through it and point out repetition, spelling mistakes and lost threads of argument. Leave it a few days, unless it's very last minute, so you're looking at it with fresh eyes.

8. Reference as you go along. I wrote a guide to referencing here, and do not understand why you would EVER wait to the end of an essay to reference it.

9. This is very basic, but check your full name, personal identifying number,the course code and TMA number are on every page. I set up TMA answer sheets at the beginning of the year and stick all identifying information in a header, and then never worry about it again.

10. Know when to stop. If it is 11:55pm on deadline day, and you're still staring at it blankly, hoping for errors to jump out, stop. If you are convinced you're going to fail and you haven't submitted because you're hoping for inspiration, stop. Submit it. Be kind to yourself. IF you get so it's two days before submission and something horrible happens, don't be afraid to ask your tutor for an extension. Just make sure you submit something before the extension expires.

11. SUBMIT! DO NOT FORGET TO SUBMIT! Check your deadlines, write them down EVERYWHERE, and do not forget to submit!

12. Relax. Even if you're so behind it makes you want to weep, and your next TMA is due two hours later. Give yourself a pat on the back, and a small treat (mine is usually a day stuck in a book unrelated to biology or medical history).

Divorce

Since my divorce was finalised a few weeks ago, I've been trying to write an entry about the whole experience. This is my ham-fisted attempt at putting the last three and a half years into words.

My marriage ended due to adultery. There is no way to make it less stark. He cheated on me, repeatedly, over several weeks, and when I found out, something inside me snapped. I knew immediately that I could not remain with someone who could do that. It explained much of his foulness towards me, which I had been willing to live with for the sake of our marriage and children, but adultery was the final straw. So, off I went to hide at my mother's.
Our son was 18 months old, and I was 15 weeks pregnant. Both our children were planned, which made the rejection much harder to bear. For the first twelve hours, I went silent. I tried to cry, but nothing came out. I tried to scream, but nothing came out. I smashed some pictures up. I stayed awake all night. I didn't eat or drink. I am eternally grateful to my parents, who put me on suicide watch, and my siblings who simply rallied round without question. The first twelve hours passed, and then came a difficult and painful phone call which I cried throughout. I asked all the horrible questions that I didn't want the answers to, to try and get the extent of the pain out in one go. When did it start? How long? How often? How did you meet her? Why her? How could you?
Why? Why? Why?
Funnily enough, I never really got an answer to the last one.
I was left with no real income (£500 a month from my job), and more than double that in outgoings a month. I had to go and see a solicitor, to make him pay the mortgage and give me money to live on. I couldn't increase my working hours because I had no recourse for childcare outside what I already had. Phoning the tax credit office to explain that I was now a single parent was horrible. Phoning the council tax office to say the same, equally awful. Not being able to tell them where he was living because I simply had no idea...awful. Somehow, I found the energy to do all the practical bits, to tidy up and make order out of chaos and at least guarantee me and my son had somewhere to live and something to eat.
Emotionally, I was a mess. For three days, I was simply convinced I would die. How could I survive pain like that? I couldn't. I would have to die. That was the easy bit.
Then I realised that I wouldn't actually just die. I would have to live or I would have to kill myself. This became a constant circular chorus in my head. "If I live, I'm not good enough to raise two children by myself, I should die. If I die, I fuck them up for life - I should live." Equally, I had the constant chorus of "I cannot take care of two children, I should have an abortion. If I have an abortion, I will not be able to live with the decision."
I chose to live. I chose to keep my baby. These were the most difficult decisions I have ever had to make, indeed it never really felt like I was the one making the decision.
I spent a week crying. I spent another week crying, with occasional smiles. In those weeks, I met up with my ex, which ripped me open. A pattern was established. Very light healing, and then dramatic ripping open of scabs. Eventually, I scarred up over the pain. It became part of me, something in my history that I cannot erase, but must live with.

After two weeks, I went back to work, couldn't hack it and took another week off. Certain members of staff were wonderful, and have my lifelong love and respect. Others could not understand my decision to continue to talk to my ex, or why I was keeping my child, or why I chose to move away from the area. Work became something I did to get me out of the house, and to bury myself in. At home, I was surrounded by 'our' things. It stopped feeling like home without him. I did small things like put up new pictures, and buy new bed linen, but it was a ghost of a home.
Pregnancy was awful. I didn't want the baby. I just didn't. I didn't want to be pregnant, I didn't want to have to give birth, I didn't want to find out what happened next. His 20 week scan was an utter blur, brightened by the sonographer assuming me and my best friend were lovers. After I hit 24 weeks, the cut off for legal termination, I became increasingly depressed and suicidal. My ex's family lived far closer to me than my family. They struggled, understandably, with the elephant in the room that was the unwanted foetus - the literal elephant as I got bigger and bigger. My ex disengaged completely from the pregnancy. He felt the baby kick once, and that was the sum total of his post-separation involvement. My pregnancy did not stop him causing me huge amounts of stress. We saw each other regularly, and it was horrible.
In March 2011, I went for a regular antenatal check. My midwifery team knew how I was feeling, and were supportive and kind to me. The baby, however, was a bit too small and apparently breech, so I went for a checkup. I saw him for the first time since the unhappy scan in November, and he was beautiful and looked like his brother and I wanted him. It took me five months to want him. Six weeks later, he was born (two weeks late) in the middle of the night, at home and completely naturally. When he was born, his cord had two knots. One knot is frequently fatal. My little boy had somehow survived all the stress, plus this murderous cord. I don't know how he did it.
However, life continued to be difficult. My ex was awol during the birth, and finally caught up with us some ten hours later. His contact was erratic and brief. I moved house when the baby was six weeks old, and had copious support from my family and friends, and felt free. Birth itself was tremendously cathartic. I felt like I was pushing out the pain, and the agony, and the grief.
I filed for divorce when my baby turned a year old. I felt it was time.

There was two shining lights throughout the whole experience. The first was my eldest son. My clingy, silly, giggly little mummy's boy, who stayed glued to my side throughout the whole thing, and who accepted his baby brother without flinching. He was very brave himself. It must be terrifying to see your mother go through such hell at such a young age. I had to be strong for him in turn. He gave me purpose where there was none.
The second was my Tom. I went to school with Tom, and he lost his job as I lost my husband. We connected over this shared life-ruinery. Our first date was four weeks after my ex left. FILTHY HASTE according to some, but I was on the rebound, and twanging around the dating possibilities like a pinball. He lived two hundred miles away for the first two and a half years: a safe distance. But he was a constant source of comfort, laughter and distraction. He made me laugh, continuously, when nobody else could. We are getting married in August, by which time we will have been together almost four years. These have been simultaneously the best and worst years of my life. I hope the years we have together from now on are solely the best.

Losing your husband (or indeed, wife) abruptly breaks you. My husband didn't die, but it felt like he had. I didn't recognise him anymore. We had been together for nine years, and literally grown up together. All our shared memories and experiences were gone. All our in-jokes, gone. Our friends didn't exactly take sides, but it was difficult for them to remain neutral.
As time has gone on, we've forged a relationship that works for the children, but it is nothing like our marriage. We are like distant cousins. It's not always a smooth relationship, but arguments are rare. We have to be in each other's lives for as long as our children need their parents, and that is more important than bellowing at each other over old bitterness.
When he left, my entire life up to that point dissolved. I had to find a new one, and that is impossibly hard. He went directly into a co-habiting relationship, straight into a life not dissimilar to the one he left behind. I could not. I had to learn independence, something I'd never required until that point.

It still hurts. I still get upset, because it is hard work parenting in this manner. It is hard work ensuring they get enough time with their dad and his family to build a lasting attachment. It is hard work assuming most of the responsibility for two other lives, and making sure they understand the concept of step-parenting. I expect many more issues will arise as they get older.

Am I a better person for having gone through this? Unquestionably. One thing you learn very quickly when something like this happens is who your friends are. I am a lot pickier about who I keep close to me now, and more ruthless about cutting people out if necessary. I discovered that I can live by myself, that I do not need a boyfriend or husband to make me whole. I also discovered that not all relationships are poisoned by inequality. I can say, without doubt, that I would not being two thirds through a degree if I hadn't been divorced. My ex would not have supported me studying. It is due to all these things that I do not regret the end of my marriage. Neither do I regret it happening in the first place.
However, I lost everything. I lost my home, my community, my job, my sense of personal security, my financial security, many friends, memories, and feeling like I belonged. I have gradually built all that back up again, but in a way that cannot be taken away from me on a capricious whim.

I have not lost my faith in marriage.

Should anyone read this, going through something similar, wondering if they will ever feel whole again, I can assure you that you will. It takes time, but you will.

Benefits Britain: A look from 1825

In 1825, ish, a doctor named William Turnbull wrote the following on the poor of Britain:

"Many a decent family, which has long been maintained in comfort by the exertions of the parents, has been brought to real misery by the sickness of the father or mother; or as is frequently the case, the earnings of the parents are all consumed in the means of cure, or in alleviating the anguish of child suffering [...] A poor family is driven, during sickness, to depend for the very necessaries of life upon their credit with their neighbouring Shopkeeper ; and a system is thus introduced, which, more than any other tends to degrade and demoralise the character.
The feeling of compunction which at first arises at running into debts, which they have no prospect of discharging, wears off by degrees; and when the possibility of supporting themselves creditably is gone; when hope, the great stimulus to exertion, is no more, all further effort is palsied, a sort of moral despair succeeds and they are contented to leave their debts unpaid, to forfeit all their independence of spirit, and idly to rely on a Parish for the future: thus they become useless, if not hurtful, members of the community."

Nothing really changes, does it?

Turnbull, W (1825) An Appeal on Behalf of the Intended Hospital at Huddersfield, Huddersfield Library

Halfway

It's been an age since I wrote about my studies. In that time, I've got divorced (huzzah), engaged (more huzzah), and my eldest has been diagnosed with autism. So, it's been a busy few months, but I have hit the halfway point on both courses.

A218, or history of medicine, is the bigger of the two courses. In the last few months, I've learned far more than I thought I would ever need to know about the rise of medicine from the Ancient Greeks to the Enlightenment, when things actually began to change. What interests me most is the way governments used the new discoveries and trends in health to keep an eye on the population (and pathology, but there's not been a lot of pathology thus far). This interest in public health has led me to elect to do a level 3 module in it next year. My TMA results have been solid - 80%, 79% (that would have been 86%, had I not gone massively over the word count) and 84%. I am really pleased with these marks. I wasn't sure if I was cut out for history, but I'm loving using sources to back up arguments in a way you can't with sociology.

SK277, or human biology, is the shorter of the courses, but by no means the easier. The biology is mainly framed as "This is the system, this is what happens when it goes wrong", which is fine but SO intricate. There is a lot more cellular level biology and biological chemistry than I was expecting. I started this course thinking "I know LOADS about anatomy and physiology" and I do...but not nearly as much as I thought. So far, it's covered cells, nutrition and the GI systems, neurology, skeletal system, muscles, the senses and my arch enemy, endocrinology. My TMAs have been really good - 83% and 88% - but don't contribute to my final mark. That's all on the exam. Eek.

It's been a challenge doing 90 credits, moreso since eldest still isn't in full time schooling because of his special needs, but I've found it rewarding and enjoyable, with the odd moments of despairing, hateful anxiety (TMA weeks, I'm looking at you). I can't wait to do the next half...except for the exams. I bloody loathe exams.