The £10 GP Charge

In an act of either smug self-importance, or epic trolling, Dr David Jones, a junior endocrinologist at  Worthing, has written to the BMJ stating that GPs should charge £10 a visit to prevent people wasting appointments. You'll note Dr Jones is not a GP, because any GP who has been practicing more than twenty minutes knows this would be disastrous.

First, how many patients do you think don't get their prescriptions filled because they can't really spare the £8.20? Loads. Way more than you'd imagine, because why else go to the doctor if you're not planning to use the medication you're obviously seeking? Many people don't go to the doctor for a cure, but for answers. If the answer is a medication they can't afford, well at least they know the answer. So, the country already has all these demonstrably unwell people not getting their medicine because of the cost. What's going to happen to all these demonstrably unwell people who cannot afford to go to the doctor's in the first place?

Then you have the people who can afford £10 to visit the GP, and therefore will assume it entitles them to special treatment. You see it all the time. People ask for a referral to the hospital clinic, find out the waiting time, and then decide they would like to go private because they envisage a system where they can be seen on the same day. Their optimism turns to rage when this mythical same-day-service turns out to be a two week wait. Bringing in a GP charge is unlikely to change patient turnover much at all in some areas, so instead there will be a crowd of furious people who have TEN WHOLE POUNDS AND EXPECT TO BE SEEN IMMEDIATELY! You already get this entitlement in the NHS. I cannot tell you how many times someone has huffed "I pay your wages" down the phone because I couldn't give them an appointment for three weeks, like that meant they owned the appointment system. Bring actual money changing hands instead of the invisibility of national insurance contributions and you have a recipe for a lot of upset patients, and stressed, threatened staff.
There would be people who, having paid their £10, would be furious because their three week cold is still a three week cold, and not pneumonia, demanding their money back on the basis of incompetence. And if the GP did get the diagnosis or treatment wrong, what then? Refunds?

Dr Jones seems to think the entire population of Britain has his medical knowledge and thus know when they should or should not seek a GP's advice. They don't. How many people can tell the difference between a viral infection and a bacterial infection when it is happening to them? Even people who are aware of the clinical differences between the two in presentation sometimes need it confirmed by a doctor. When you phone NHS Direct for PRETTY MUCH ANYTHING, they tell you to see your GP immediately or go straight to A+E, which does nothing to help patient anxiety. We have collectively lost our medical common sense in this country, partly as a result of being dependent on the NHS. We are told not to take painkillers for more than 3 days without seeing a GP. We are told to consult our GP before starting an exercise regime. We have to see a GP to be referred to hospital or for a blood test, even for longstanding complaints the GP is well aware of. Pregnant? See the GP, even though s/he will have absolutely nothing to do with your pregnancy care unless you're unwell.

What about when the doctor tells you to come back in a week? Do you have to pay another £10 just to be told you're better? Or when you have to see the GP for medication reviews on a regular basis? Chronic illness, already depressing and financially shite, could become very expensive. I had to have five injections in one week once - that would have been £50 just to stop me dying.

I strongly suspect that if the NHS introduced a £10 GP charge, the only change GPs would see would be a lot more people going to A+E (this already happens in massive numbers when people just can't get an appointment, like A+E give a shit about earache) and a lot more post-mortem reports coming through. Those who can afford to pay £10 for reassurance every time their elbow twangs will continue to waste GP time. Those who cannot afford to pay £10 when they're genuinely very ill will get worse and either overcrowd hospitals or die.

The whole point of general practice is that it's a gateway to medical help. Yes, if your arm is hanging off, you really do need to attend A+E, but what if your arm is just very swollen and painful at the elbow? And then it's your finger joints, your wrist, and then all your joints? And you have to pay £10 to be seen the first time, to have tests ordered, and then £10 to see the doctor again to be told the tests showed up rheumatoid arthritis, and then £10 again to see if the drugs (that you didn't get because you'd just spent your last tenner on the GP) prescribed last time actually worked, and then £10 a few weeks later to see if the drugs that you actually got last time have worked, and then another £10 because the GP forgot to refer you to rheumatology and just needs to check something again...and so on and so on.

GPs are massively oversubscribed, we all know that. If you don't believe me, ring up and find out how long you have to wait for a routine appointment. But GPs don't just deal with ill people and timewasters. It's not a dichotomy of the sick and the well.
They deal with people who are very sick indeed, but seem well. They deal with people who are physically fine, but full of psychosomatic illness because of anxiety or depression. They deal with people who are just lonely, who are slowly dying, who are actually dying right there in the waiting room. They deal with those who are absolutely fine but won't believe it, who seem absolutely fine but are definitely not. They deal with chronic illness, with acute illness, with tiny babies, and with centenarians.
So how to relieve the pressure? How about better patient education and empowerment in dealing with minor ailments? How about NHS Direct not telling absolutely everyone to go to the GP or A+E (down with NHS Direct!)? How about giving pharmacists and nurses more power?

The NHS needs to remain free at the point of access.

Twenty Six Months (And One Day)

In October 2013, I took Jimmy to see a GP about his mounting behavioural issues. He was referred to a paediatrican.
In January 2014, Jimmy was referred for an autism assessment following a provisional diagnosis of Asperger's-type autism. We were told the waiting list was 3-6 months, which I thought seemed suspiciously brief.
I was right to be suspicious - after 8 months, I phoned the clinic and discovered they had no staff. None. No autism team to do assessments. It wasn't just us, everyone in Peterborough has been waiting months for their child's assessment. In May 2015, after a particularly awful spate of school and home based episodes, me and Jimmy's dad both tried to get his appointment expedited. Jim was self harming, hurting people in the class, spending more time out of class than in it. And there was nothing the hospital could do except assure me they were reassembling a team and his name was quite near the top of the list when they did this.

Imagine my joy when I finally got an appointment...for exactly the same date and time as he was due to have a herniorraphy in Norwich. I had to cancel - surgery takes precedence over lifelong development delay. I was expecting to have to wait another six months for a new appointment, but they actually made me a fresh one for just three weeks later.

And the nerves kicked in. You see, the problem with having a child with reasonably high-functioning autism is that you doubt yourself. You doubt there's anything wrong with them. You think...what if it's just my shitty parenting? What if I'm wrong? What if he's normal and I'm the problem?
The whole of society are hell bent on either pretending autism doesn't exist or pretending everyone's a little bit autistic, ergo autism is nothing to worry about. You may detect a note of weariness here. You would not believe the amount of times I have come up against people who think autism is a childhood illness, or an excuse for bad behaviour, or a symptom of Munchausen's by proxy. The people who think that because they get a bit anxious in crowds or trying new things, they too are autistic. The people whose idea of sensory overload is annoying levels of noise rather than hideous distress.

Jimmy, as I've mentioned before, looks normal. Until he's lying face-down on the pavement because of a dog, or screaming bloody murder because you've asked him to put toys away, or biting himself because he's worried, or gouging at his friends' eyes, or walloping his little brother over the head with a wheelbarrow, or wandering around a moving bus like it's his bedroom, or shaking the baby all over the place because he thinks that will settle him, or just until you try and have a conversation with him when he doesn't want to. He is full of surprises.
I've been rebuked for referring to him in terms of normal and abnormal. The truth is, to consider autism as an abnormality allows the world to marginalise autistic people as subhuman and unimportant. They aren't. Let's not do that. Let's embrace neurodiversity, because autistic people and their 'abnormal' brains are capable of everything you are, and more.
But when you're talking diagnosis, you have to look at what isn't normal, what isn't standard, what is strange and weird and difficult. It is awfully depressing, because the way you cope with the challenges of raising an autistic child is to concentrate on what they can do, what they are good at, what they can excel in, and you have to reverse this way of thinking entirely for the purposes of all things medical and benefits.

The first part of his assessment was an ADOS assessment. This stands for autistic diagnostic observation schedule, and involves a 45-ish minute appointment between a psychologist and your child, but (if your child can speak) not you. That was a bit jarring. Jim was lost in a world of his own when she came to collect him, building patterns out of blocks. But he went off with her quite happily and without any anxiety. He's getting brave. I asked him what they did - talked about feelings, acted out a play and played with Batman apparently.

The second part of his assessment was a week later, and is called an ADI-R or autism diagnostic interview (revised). This one was just for me, and Alex who's too small to leave for three hours yet. The night before, I was a terrified wreck. I collated all the letters and school bumpf I had, wrote out a timeline of symptoms because my memory is dreadful in face to face interviews, and tried to lose myself in the dreck of X Factor. It made no odds, I barely slept and then the kids wouldn't get up so I was all of a mess in the morning.
But, thanks to my dad, I made it on time. The psychologist was lovely, and the interview took four hours. It is so long. SO LONG. You have to talk about behaviour now, at 4-5 and at 3, to do a backwards comparison. You have to talk about every little thing that you stopped considering odd years ago, and try and make sure the salient points are included. If you're reading this because you've got an ADI pending, fear not - they include EVERYTHING and ask for more stuff at the end. It was actually pleasant to sit and talk about him without any focus on "and how do we fix this" for a while. Everything ends up so goal focused in SEN that you sort of forget that there's a real person under it all.
At the end, she added up the myriad totals and told me the result. Jimmy scored highly on his ADOS, mainly due to communication difficulties. Jim is so very verbose that I forget that his communication is abnormal - he doesn't converse, he makes a speech at whoever listens.
His ADOS scores were
Reciprocal Social Interaction: 5
Communication: 3
Restricted and Repetitive Behaviour: 1
I don't know what the normal levels are, but this combined gave a score of moderate autism-related symptoms.

The ADI-R scores were as follows:
Social Interaction: 22 (normal is below 8)
Communication and Language: 29 (normal is below 10)
Restrictive, Repetitive and Stereotyped Behaviour: 9 (normal is below 3)

I was shocked. I knew Jimmy has problems, you would have to be without a head to notice them, but to have them spelled out in black and white was a strange, disorientating feeling. I have been waiting for two years for this. Two years of wondering what if I'm wrong, what if he's fine, what if it's just me, what if he's just made wrong. And then there it is.
Autism.
Not Aspergers, because his social and communication difficulties are quite profound. Moderate, because he can speak and function well within his own spaces. But otherwise, a textbook, classic autistic boy (her words, not mine).

I got home and I wept.
I wept for the six years I have spent worrying, advocating, fighting, shouting, wondering, hoping, hating myself for hoping, listening to bad advice, listening to good advice, listening to any bloody advice. I wept because I love him, regardless of how hard it is sometimes. I wept because I should be grateful he's not ill, and this isn't an illness, and he will be OK. I wept because it was a shock, even though it wasn't a shock.I wept with relief, and with pain, and with love.

Then I had a cup of tea and got on with it, because nothing has changed. Jimmy is exactly the same as he was a week ago, a month ago, a year ago. He was born autistic, he will die autistic, and he will live autistic. He is autism, autism is him. There is no separation. A label cannot change brain chemistry.
But now we can learn to cope with him better. He can get the help he needs in school. We can modify how we teach him things.We can help him

This is not the end of anything, although the journey to this point has been long, but the beginning of lifelong learning to help Jimmy.

Roast Chicken For Your Soul

When I am sad, and stressed, and wrung out like a filthy bit of kitchen rag, I make roast chicken. I made it yesterday when Jimmy came out of hospital. I made it on the first day Tom went back to work after the baby was born. I make it on Mondays, when everything sucks. I make it on Sundays, when everything will suck. I make it on Tuesdays because nobody likes Tuesdays. Tuesday feels like the entire week has risen up in front of you, defiant.. I make it because my children will clear their plates and I feel like I've done something right for once. I make it for no reason other than it tastes good and I feel better for creating something so quintessentially domestic.

My mother taught me to make a roast dinner, but she would spurn this as incomplete. Many people would.  Where is the bread sauce, the stuffing, the cauliflower cheese, the carrots, the mash, the proper roasties? BISTO GRAVY? Heathen. You can add all those things and more, and I do when the mood takes me, but this is not for then. This is for comfort; not the stress of a thousand things in the oven at once, of mashing, and mixing, and burning hot fat sploshing all over the place. This is the easy base from which all else can rise. This is for days when chopping things up is about all you can manage. And the washing up isn't too evil either. 

You will need a chicken, a lemon, some butter, some waxy potatoes, some garlic, some dried rosemary, some salt, some green vegetable and Bisto.

First, get your chicken. I would rather eat good chicken once a month than shit chicken every week, so I buy a free range one from a supermarket. It costs about twice what a battery chicken does, and it's not guaranteed to be twice as ethical, or even twice as tasty, but there is nothing more depressing than some poor pale creature that has lived out its six weeks of life up to its eyeballs in shit, crammed into a tiny space. If you are minted, buy an organic chicken. But try free range as a minimum. 

If you get your chicken from the supermarket, it will have the cooking time in minutes on the front of the packaging, if you cook it at 180 degrees. Note this. If you don't, there are sundry guides to cooking times on the internet. Preheat your oven. 

Get a roasting pan. I have two medium sized ones that are differently shaped, to accommodate chickens which are fatter or longer. Put a massive sheet of baking parchment in the bottom of the pan. This serves two purposes - it collects the juice, and it stops the chicken sticking to the bottom of the pan, which is a shitter to wash up.

Put the chicken in the baking parchmented-pan. Cut the string tying its little legs together, and untuck them from the cavity. The legs will spring open, like a birthing woman. Leave them there.

Get some salted butter. Cut a chunk off - how much depends on how sad you are - and blast it for five seconds in the microwave. Take it  into your paw and smear it about your chicken. All over the breast, the legs, the wings, the weird bits between the legs and breast. Wash your hands before you absent-mindedly wipe them on your jeans.

Take the lemon. Cut the lemon in half. Don't spray yourself in the eye as you do this. Take one half of the lemon and squeeze it all over your buttery beast. When that half is well emptied, shove it up the chicken's arse. Yes, you read that correctly. Keep the other juicy half; you'll need it later.

Sprinkle a little salt over the breast. I use a small amount of sea salt for this, because it makes the skin taste even more delicious. Saxa table salt is fine though.Don't overdo it.

Remember the cooking time for the bird? Stick your bird, uncovered, in the oven, and note (mentally or on your phone or on paper or whatever) what time it will be finished, and when it will be an hour from finished. 

Go do something else for a bit. A bath. A read. The telly. After half an hour, the house will begin to smell of chickeny goodness, and you will get hungry. 

About an hour before your chicken will be ready, get an ovenproof dish out, the sort you do pasta bake or cottage pie in. Get your waxy potatoes. I use Charlotte ones. They're a quid a bag from Tesco, but use whatever you like. Guess how many you might like to eat - we will generally eat a whole kilo between two of us. Adjust for numbers and greed. Chop them up. Doesn't matter how. I take the ends off, then slice them into rounds. Sometimes I do them as chunks, which tend to crisp up a bit better in the oven. However you do them, they need to be not-too-thin. Too thin makes the equivalent of crisps, and that is not what you want right now. Too thick and they don't quite cook through. Between a penny and a pound in thickness. When they are chopped, put them in the ovenproof dish. Slosh some olive oil over them. Squeeze the other half of the lemon over them. Sprinkle a little rosemary over; not too much or you'll just taste rosemary. Crush some garlic. How much garlic? How much do you like? One to two cloves gives a pleasant waft to the thing. Five gives a punch. Add that to the dish - I use a garlic crusher because then it melts into the potatoes and you don't get the nasty crunch of an unexpected slice. Add a good sprinkle of salt. Then mix it all up with your hands. Make sure each potato piece gets a bit oiled. If you think it's too wet, drain a little liquid into the sink. If you think it's too dry, add a little more oil. Cut the juiced lemon half into half again. It will be all sad and squidgy and dead, but it gives such life to the dish. Chuck it in. 

Put the dish in the oven. It will take between 45 and 60 minutes to cook, which should align with your chicken being cooked. Give them a stir if you think they're burning, but I always forget to check them, and they never do. Your hands will smell so good, you will want to eat them. Don't eat them. Wash them before you wipe them on your jeans. 

You have an hour-ish to kill. Go and do something relaxing. My god, your house smells amazing now, doesn't it?

I don't know what green vegetable you like. I tend to cook broccoli, green beans, peas, asparagus in season, or a mix of all of them. If you want them to be ready at the same time as the chicken, you'll need to be ready to cook them around 15 minutes before the chicken is done, but the nice thing about this is that unless you get stuck on the phone to someone or fall asleep or have an asthma attack, an extra ten or so minutes in the oven won't hurt. 

Is your chicken ready? You can skewer it to check - in the deepest part of the thigh, shove something sharp and then observe the juices that bubble forth. If they're clear, you're good. If they're pinkish, give it another five to ten minutes. I tend to trust the supermarket, and don't check. I deserve food poisoning. If your chicken is ready, remove it with a flourish, close the oven door and turn it off - you can leave the potatoes in there for a bit, they won't spoil. 

This chicken had twenty minutes longer than it should have, thanks to screaming children. Still tasted amazing. 

Leave your chicken on the side for a moment while you put a load of Bisto into a bowl. How much Bisto? I don't know. I like my gravy ludicrously thick, so I put in a fair bit. I don't think Bisto is really an exact science. 

To get your chicken from pan to plate is not necessary if you feel like just ripping the chicken off the carcass and shoving it into your face, and this chicken is so good, I wouldn't blame you at all. But I move mine out of the pan and onto a plate using a big spoon and a fish slice. I take the lemon out of the cavity, put the spoon in the cavity, and then use the fish slice to lift it from the pan onto the plate. Truly, I am an elegant genius. Should you drop your chicken on the floor...pick it up with a tea towel. You won't though. If I, clumsiest of women, can do this, so can you. You can put a foil tent over it if you don't think everything else will be ready for ages, but a cooler chicken is much easier to attack with hands and knife. 

You should now have a pan of delicious chicken juice and buttery lemonyness. Put some into your dry bowl of Bisto. No water yet, just juices and Bisto. It will look deeply unappetising and nothing like gravy. Fear not.

Mmm, slurry au Bisto avec jus de poulet!

Boil the kettle. While it boils, drain your veg and take the potatoes out of the oven.Give the potatoes a bit of a prod, to check they're cooked. They should YIELD. I love that word - yield. Give way. Fall to the sword that is the point of your little knife.

Your chicken should be covered in a golden skin, with speckles of crusty salt and generally look and smell beautiful. So beautiful it may be difficult to come to terms with the necessary carving. Do yourself a favour: rip some chicken skin off and eat it. Eat some more. Stab any wandering hands trying to steal your chicken skin with a fork. This is the definitive cook's perk. By the time you've eaten the skin, you should have a beautiful white breast looking up at you with a bone running down the centre. Put a sharp knife down either side of this bone. This parts the breast off the skeleton of the bird, making it far easier to carve. Men like carving on the bone, all knives and dead beast. I do not. Should this technique fail you, rip it off any which way you can. It all goes down the same way. 

Plate up. Chicken, potatoes, veg. Now pour just enough boiling water into your chickeny Bisto slurry to turn it into the consistency you want. In our house, that's basically meaty custard. Stir it vigorously with a fork. Pour it over your chicken, potatoes and veg. Eat it. Eat it all. Wonder why you ever feared roasting a chicken. It tastes good. It tastes safe, and comforting, warm and homely. It is balm. And you made it all by yourself. 

I have a confession. This chicken dinner didn't have gravy, I just lobbed some pan juices over it at the end because I was tired. And I made Ellabell Risbridger's amazing garlic kale instead of plain greens, but god it was good. It is always good. 

Leftover chicken mixed with mayonnaise and mango chutney make the best sandwiches I have ever had the pleasure of eating. You can also use them to make some sort of stir-in-sauce meal the next day. The leftover carcass, boiled in plain water for a few hours, makes the most delicious jelly of a stock. A chicken is a useful thing. But firstly, you get this meal, and that is always worth the effort. 

With thanks to Nigella Lawson's roast chicken in How To Eat, which is a must-read for food lovers, even if you have no idea how the oven goes on. 

Love Your NHS

I am not afraid of hospitals. In fact, they are almost a second home. The NHS has saved my life twice, mended me in various small ways since then, and also seen my three boys safely into the world. I worked for the NHS for eight years, in various administrative and minor healthcare roles. My degree's mainly focused on healthcare delivery. The NHS has been my lifeline, employer, coworker, chief educator, and friend.
I get exasperated by the NHS. Sometimes, I get thoroughly pissed off with it. But mainly, I adore it and think it's the greatest thing our country does.

My eldest boy, Jim, had his second ever surgery yesterday; a reasonably routine hernia repair. The hospital were completely amazing. Once admitted, the play therapist was on hand to run through the preop procedures with him, and then went off to find him colouring to do to distract him from his raging hunger and anxiety. His nurse then found him a portable TV to watch The Lego Movie on as his surgery was delayed for several hours, and a starving autistic kid does not a happy patient make. We were left alone to watch it, and as it finished, the orderly came to warn us it was almost time. The same orderly made going to the theatres fun, and held an ipad with Angry Birds up to Jim's face while he was cannulated and put under, so he would keep still. He then explained where to go, how long it would be, and gave me a pager to summon me at the end. The recovery nurses explained why he was in so much distress, answered my slightly-too-clinical-for-a-parent questions, and calmly gave him extra pain relief. One of the students made him four rounds of toast, which he declared the greatest thing he'd ever eaten. The handover to the main ward was smooth, and everyone was happy to wait long enough for Tom to come back with some food for me, and to let him stay with us until we were all ready for sleep. They turned a blind eye to me keeping Alex on the ward with us on account of breastfeeding. A HCA took Jim's cannula out this morning and he didn't even wince. Everyone asked us constantly if we were ok, if we needed anything, if everything was OK. And it was immensely, enormously reassuring in the circumstances.
And that's 'just' the nursing and support staff. The surgeon, anaesthetist and various registrars and house officers we saw were equally amazing. They took the time to ask if we had questions, to listen to those questions, and answer them. They had god-knows-how-many patients to cover, but they didn't seem rushed.
Doing anything out of the ordinary with Jimmy can be difficult and stressful, but this was astonishingly easy. Exhausting, and emotional for me, but not harder than it needed to be, mainly because the staff were so wonderful. The day was fairly standard, a child admission, a routine procedure, their daily bread, nothing unusual or exciting here. They could have been blasé about it. They could have been dismissive of our fears. They weren't, not once. We felt safe. We felt reassured. We felt OK about something parents generally find very difficult to be OK about.

I support the junior doctors strike absolutely. I would support a strike if every single clinician in the NHS was involved, because the NHS is the greatest thing we have, and the government seems absolutely intent on destroying it, through a carefully considered strategy of underfunding care and undermining clinicians.
Fight it. Support your healthcare network. Love your NHS.

Image via telegraph.co.uk

National Bigot Day

You don't need me to tell you how fucking indefensible the Paris atrocity is. Equally, you shouldn't need me to tell you that not all Muslim, immigrants and refugees are terrorists. Frankly, if you honestly cannot get your head round the fact that IS are to Muslims as Hitler was to Christians, and Stalin to atheists, then I don't want to be friends.

Because it's that merry time of year once more, when all your friends who you thought were reasonably rational, intelligent people out themselves as right wing bigots. Now, as any fool knows, for the average bigot, being CALLED bigoted is far more offensive than ACTUALLY BEING BIGOTED. The statuses abound with people stating a really nasty opinion ("Fucking Muslims should all be shot! Refugees are really terrorists! Close the borders or they'll come over here AND KILL US!"), being called out on it, and then getting upset and claiming it's their opinion and they have a right to state it.

And, my right leaning friends, you do. You have EVERY right to state it. One of the greatest aspects of Western society is freedom of speech.
However, that doesn't mean everyone has to agree with you. It doesn't mean you're right; factually, morally or ethically. It doesn't mean you shouldn't expect to have to defend that opinion. It doesn't mean everyone else has to listen to it without right to reply.

And people arguing with your opinion is not an attack on your right to free speech either. An argument on facebook is not akin to being flogged for a blog, or shot for wanting an education. It is literally people disagreeing with you, for a good reason, and you not being able to deal with that.

Over a hundred people going about their daily lives got killed for nothing on Friday night. They hadn't done anything to deserve it. They didn't know they were going to die. They were at a gig, out for dinner, having a walk, normal weekend activities. And now they're dead.
They're dead because a viciously bigoted organisation believe that there is only one right way to live, and anyone who doesn't subscribe to their viewpoint deserves to die. So as you weep over someone telling you why you're wrong on Facebook, remember that IS have taken that weeping and turned it into hate, into death, into control. They want you to hate all Muslims - it strengthens their us vs them message. They want you to view refugees with suspicion and alarm - they are the ones who drove them out in the first place. They want us to close our borders - it proves their point.

You are playing into their hands.

Anxiety

If I start to think, then I will die.
That's how it starts, how it always starts. I think about what's to come, whether it is a party, an appointment or just seeing a friend. And I become convinced that way lies death. Or illness. Or disaster. That nothing can ever go right again in this world, because doom.
It is not rational. If it was rational, I would not be unwell. I would be normal.

It started when the baby was born. It started when I found out I was pregnant. It started when we decided to get pregnant. It started when I got knocked out. It started when Jimmy was diagnosed. It started with the divorce. It started when Jack was born. It started when he left. It started when Jimmy was born. It started when I bought the old house. It started when I lost a baby. It started when I left school. It started when I started grammar school. It started when I was at primary school.
I can't put a date on it. It's only recently that I've realised fear has haunted me since I was a child. But there is a chasm of difference between a child's fear of monsters, of bullies, of loss, and an adult's all consuming terror of the vagaries in life.

I am frightened of tiny things, like the buttons you use to call a lift, and the postman's knock. I am frightened of massive things, like cot death, and accidents, and horrible life changing illness. I have daily intrusive thoughts about bizarre things; whole hideous scenarios play out in my head and I live them in a little side room of my brain.I haven't had a panic attack in over a month, and this is a major achievement. I feel like I am getting better, although sometimes I have a blip. I am currently having a blip.

I decided a while ago, that talking about anxiety and fear was BOUND to make the things I feared most come true. I kept it all inside. I thought, believed, knew that if I told anyone what I was afraid of, or discussed things I was looking forward to, everything terrible would happen. And I made myself ill. My anxiety manifested as burning joint pains, as terrible headaches, as weakness and exhaustion, because I wouldn't let myself express it. Being pregnant changed that, because my terror of losing my baby was a real fear I could talk about, and channel all the extraneous fear into. It was a rational thing to worry about, although the fear paralysed me at the end, making me angry, agoraphobic and terrified.

I felt like I was destined to have postnatal depression after Alex was born because of the all consuming terror of his pregnancy, but instead I have postnatal anxiety. And that is a very different beast. I had PND after Jimmy was born, and all I wanted to do was die. Or run away. Mostly die. I didn't feel anything towards my baby, myself, or anyone. I didn't have the energy to do anything about it, and eventually it lifted. Postnatal anxiety is much easier in some respects, because I love my baby. I interact with him. I take immeasurable pleasure from what he does, and cuddles, and feeding. I am able to function reasonably well, to get work and chores done and to look after the big boys as well. But it taints everything. It is like a sad gauze I have draped gently over everything. My mind runs at a thousand miles an hour, trying to sort the rational from the irrational. I try to talk it out when it's particularly bad, because other people can tell me the difference between legitimate fear and crazy fear.

This blip has been triggered by incoming essay deadlines, a surgery date for Jimmy, an appointment for my eye, socialising, Christmas, breaking my laptop-that-isn't-technically-mine, Jimmy's DLA form, parents' evening, the dentist, and a hormone shift, which are all legitimate worries that mount into one giant elephant in the brain, sitting on the sensible bit, squashing it flat.

And it feels like horror. A tight chest, breathlessness, getting too hot, visualising everything awful, wanting to stop everything, paralysing fear, no concentration, feeling snappy, guilty, angry and hopeless.

And it sucks. But it's getting better.

NHS Bureaucrazy

I am cross.
Last year, I had a head injury that led to concussion and whiplash. I had all sorts of terrifying symptoms at the time like slurring, amnesia, dizziness, nausea, night blindness, peripheral vision loss and anomic aphasia. I couldn't stand up for a week, but I was back to normal within a few weeks.
Except that I still have a small blind spot in my peripheral vision. At first, I thought I was imagining it, and ignored it. Then I went for an eye test a month ago, mentioned it, had all the tests done and was referred because I wasn't imagining it.
Normally, if you have a dodgy eye test, the optician refers you directly to the hospital, but (presumably because of the head injury) I had to go and visit my GP first and talk about it to decide whether to send me to ophthalmology or neurology. The GP thought it was either caused by damage to my retina, optic nerve or visual cortex. The initial injury was on the right side, but it's my left eye that's affected. She referred me to ophthalmology. This was early last week, because GP appointments are gold dust.

Now, the bit that's made me cross.
Today, I got a letter that looked suspiciously like junk mail. I get a lot of junk mail at the moment, thanks to foolishly letting the Bounty woman have my details in the hospital after Alex was born. So, I opened it, expecting yet another life insurance offer because PARENTS DIE, and instead found a letter from some random fucking 'care innovations' company who the LGC apparently employ to triage ophthalmology referrals. Obviously, GPs cannot be trusted to refer to the right people, so this company in Henley-on-Thames does it for them.
The letter told me I needed to be triaged by an optometrist, and gave me a list of four clinics to go to for triage. In order to select one, I had to either ring up and tell them who I wanted to be referred to, or go online and do it. WHY NOT JUST SEND ME TO THE NEAREST? WHY THE FUCK WOULD I WANT TO GO TO A CLINIC 30 MILES AWAY?
Ahem.
So, I did this, only to be told that my 'chosen provider' will send me an appointment in the post.
*jumps up and down in a rage*

In ye olden days of eye referrals pre-NHS-sell-off, you saw your optician, they sent a referral to your GP who passed it on to ophthalmology, who trusted their secretaries to triage it and send you a suitable appointment. The process took perhaps a couple of weeks. This has already taken a month.
Now, I don't talk about it much because it's evil, but I am suffering quite severe postnatal anxiety at the moment. The very IDEA of going blind, never exactly appealing in the first place, has been preying on my mind like a giant wasp that will not stop hovering by my face. All I really want is an appointment to be told what the hell is up with my eye, so I can work my flailing anxiety into something like a sensible approach to the whole thing. And now I have to go and see an optometrist, who will then probably send me to ophthalmology anyway, lengthening the whole process into one of months rather than weeks.

Not to mention how confusing this must be to people who are perhaps less computer savvy or presume the crappy junk-maily scam-ish letter is junk mail, particularly if their sight is poor. I mean, it doesn't even have anything visual to suggest it represents the NHS:

SEEMS LEGIT!

It's almost like they're trying to get people to ignore the letters so they can cancel the referral (she said, cynically).