A plea to health care professionals, about pain.

When I wrote up the pain scales yesterday, I was aiming to make it as clear and easy to use as possible – both for those needing to describe and those needing to assess someone else’s pain. That meant that I left a lot of things out. Things that have often frustrated me about interactions with health care professionals.

I have no idea how much training is given to spotting someone in pain and assessing it accurately, or what form that takes, but if my own experiences are anything to go by then it’s variable, to say the least.

Asking someone how much pain they’re in on a scale of 1 -10, where 0 is no pain at all and 10 is the worst pain you can imagine, is completely useless. Especially if that person has lived with periods of intense pain for decades and has a vivid imagination. If you ask me that question then I’m never, ever, going to answer ‘10’. On the basis that I’m awake to answer, and I assume I’ll pass out when the pain gets that bad.

Also, calibrate your scale. Or ask the person to calibrate it for you. If you think that something commonly acknowledged to be extremely painful, such as childbirth, is 10, but the person in pain thinks it’s mostly 5-6, peaking at 7 at most, then you’re not ever going to have an accurate idea of how much pain someone is in. Yes, that has happened to me.

If someone doesn’t visit their GP for years on end except for hayfever meds, and then suddenly turns up week after week for more than 6 months, saying they’re in unbearable pain and by the way the painkillers they’ve been prescribed aren’t working and the pain is seriously impacting their ability to parent, then for the love of all that you hold holy, take them seriously. Investigate. Do not brush it off as something that will get better by itself. That kind of pain will not be a pulled muscle. Trust me.

Also, pain isn’t always shown by a patient rolling around and screaming. This is incredibly important.

The initial onset of pain may well make someone gasp, recoil, yell out. But when they have lived with it for nearly a year then they go quiet. Very, very, quiet. Withdrawn. Trying to not move. It can totally change their personality from smiley and bubbly to morose and monosyllabic. Yes, that was me too. Sorry.

If you’re a health care professional, then read the signs. Don’t dismiss a patient, just because they don’t look like your idea of pain. A good friend of mine risked losing her son because the doctors repeatedly dismissed her concerns of appendicitis, because he didn’t ‘look’ in enough pain. She took him in repeatedly with extremely high temperatures, but they kept getting sent home. He got very weak and seriously dehydrated as a result. It was only when they happened to be on a ward next to another mother and son they knew from school, that the hospital started investigating properly. The other mother took one look at him, and commented on how much his personality had changed. Fortunately this was overheard by a nurse. Before that, the medical staff had threatened my friend with investigating her for Munchausen’s by proxy, because she was so insistent something was wrong and she wanted them to investigate properly.

In the end the operation went ahead, and the appendix ruptured as they were taking it out, which was an incredibly close call. A few hours later and he could have had a severe case of peritonitis to contend with, in a very weakened state.

So please, if you’re in the position of assessing someone’s pain, do it properly.

 

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Pain scales

For @puncroaker, and anyone else who might find it useful.

Pain is an incredibly difficult thing to describe, and there’s always the worry that what seems obvious to you, may not mean the same thing to someone else, so I have my own way of describing pain levels, using fire as a scale. Why fire? Well, pain can be useful. Back when we lived in caves and slept around huge roaring fires to keep wild animals at bay, pain signals helped stop us rolling too close while we were asleep.

0 – You’re a safe distance from the fire. Close enough to benefit from the warmth but experiencing no discomfort whatsoever.

Pain – there is no pain. You’re fine.

1 – The heat is making your skin prickle a bit, but you can make it stop again by moving away.

Slight discomfort, but it’s not stopping you from doing anything, and may well stop if you rest and pace yourself.

2 – Intense prickling, to the point you wonder if you will singe hairs or damage the skin.

You can still carry out daily tasks but with a little difficulty, and the pain feels more permanent, doesn’t always go away when you rest. Occasional pain killer use that may or may not help.

3 – You’re now at the edge of the fire, and your clothes are starting to catch alight. (Side note: this is the sort of pain you might be prepared to put up with temporarily, to rescue a much-loved possession from the fire)

Daily tasks are now seriously impacted, you’re on painkillers almost all the time and they’re taking the edge off. (Side note: sort of pain you’d expect post-surgery, and can sort of put up with if you have to, so long as it’s temporary)

4 – In the outer ring of fire. You are now risking losing extremities. You need to be OUT NOW (Side note: You’d risk a quick run through to rescue someone who’s fallen in, but that’s it)

Childbirth without drugs level. You’d only do this voluntarily for the most desperate of reasons, and only because you know it will be over quickly. If you’re living like this, then you’re probably on all the drugs.

Painkiller example – daily doses of 8 x 30mg Dihydrocodeine at this point.

5 – You’re right at the heart of the fire. Everywhere you turn is fire. 

Pain now rules your life. Daily activities have stopped. You are housebound, pain is permanent with extra waves of super-intense pain if you dare move. The painkillers are helping to some extent, but you are zombified.

Painkiller example – daily doses of 8 x 30mg dihydrocodeine, plus 150 mg amitryptiline (for nerve pain), plus 4 x 5 ml oramorph.

6 – a huge rock from the roof has fallen and pinned you into the heart of the fire.

You start to worry that the pain itself will kill you, you wonder if your heart can cope with the intensity. You’re no longer functioning as a human being; you can’t eat, you can’t sleep, even with all the painkillers. You don’t even know if you’re thirsty or not.

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One mean-looking putto

One mean-looking putto
It was a complete accident. She’d read those twitter threads of people getting locked into bookshops, charity shops, and so on until rescued, and had thought that sounded more like fun than a disaster. Even so, this had been a genuine accident.
Janice had arrived at Capodimonte late in the day, one last visit before heading back to the hotel and back home on a late evening flight. The building had several floors, wrapping around the central courtyard, and she needed to find her way to the Baroque gallery before closing, so she headed on up and around, map in hand, to find the right rooms.
She was fascinated by the way you could see individual strands of hair, the grain of fabric, a pulled thread of lace falling from a ruffle in some works, whereas in others it was more of a smudgy mass. When you stood back and compared works side by side, it was obvious again which work was by the better artist. The figures looked as if they were about to stand up and walk out of some pictures, in others it looked like the artist’s models had been corpses. They looked stiff, unnatural, and very grey – surely no healthy person had skin that looked like that?
There was one painting, in particular, at this gallery that she had wanted to see – by Artemisia Gentileschi. She’d been fascinated by the woman’s story ever since she had learnt that she had been so good at painting, and so good at painting hands, that even the other artists had had to acknowledge it, and that the same men who had tried to keep her out of the profession, who thought she shouldn’t be there just because she was a woman, had come sneaking back to her, to ask if she would paint hands for them.
Since then she’d made it a point to seek out every Gentileschi painting she could, and couldn’t help looking at every other work around them, asking herself, ‘Did Artemisia paint these hands?’ Often the answer was a clear no – hands are difficult to get right, and there were some really bad examples out there as proof. She wondered if those artists had been too stiff-necked to ask Artemisia for help, too cocksure of their own abilities to even know they needed to ask, or if Artemisia had turned them down because, no matter how tight money might have been, she simply couldn’t stomach working for them?
The hands in Artemisia’s paintings often belonged to women, which wasn’t unusual by itself – most artwork of that era featured women somewhere – goddesses, mythical figures, and biblical characters were all popular subjects: women were allowed to be art, even if they weren’t allowed to be artists. Not so many of them were portrayed with clenched fists, though. Or wielding swords. Artemisia seemed to be very fond of sword-wielding women, although she was always careful to choose ‘approved’ subjects. Fortunately, the bible contained one story that was perfect for her purpose – Judith cutting off the head of Holofernes – and it was one that she returned to time and again.
In this piece, Holofernes was already dead. Judith’s maid is bundling it up, before they make their escape. Judith is standing there, still holding the sword but gazing to the side, shielding her eyes from the candle flame. As she looked up at the painting Janice was struck by how much this Judith looked like self-portraits of Artemisia herself. She was still pondering this when the security guard came around to clear the gallery, and tell her to move towards the exit.
The gallery was dark, as the winter light had faded long ago and all that was left were the lights illuminating the huge paintings on the walls. She hadn’t realised that he was there, until he was suddenly far, far too close. She tried not to panic, but he was far too close for comfort. She glanced around, but there was no one else there, which figured. If there had been anyone else left in this section, she would have heard the guard talking to them long before he reached her. When she looked at him she realised that it was the same man she’d seen earlier, as he stood guard in one of the other rooms.
She’d only half-noticed his round and babyish face, with curly blond hair, but there’d been nothing cherubic about his expression. What she’d fully noticed was the way he’d looked at her, the way some men do, a look that sent cold chasing to her stomach in worry. Her heart started racing, but when she moved on around the gallery as casually as she could manage, he’d stayed where he was – so she’d dismissed it as nothing. Until now. She started to look around her for anything she could use to defend herself. Could she pick up one of the metal stands carrying the rope that held visitors away from the artwork? She didn’t know, and she wasn’t yet sure that she’d need to. She moved away, towards the exit, giving him a conciliatory, ‘Look, I’m complying’ gesture.
She walked faster, listening out for his footsteps over hers, to see if they were getting closer or falling behind. Out of the room, turn right through the rest of the wing, and through the string of rooms that made up this side of the floor. It sounded like his footsteps had faded, and she started to relax, but when she reached the landing of the stairwell she realised that he had doubled back around in the other direction and was waiting for her. He stood so that he blocked her way to the doors through to the stairs and lifts. She hesitated, noticed that he was standing marginally to the left, so she went right. He moved to block her, with a stupid grin on his face, as if he expected her to find all this as amusing as he did.
She looked again, and all there was to help her were some more of those blasted barriers, to funnel visitors through from the stairs to the exhibition. She hesitated again, wondering what to do. She got her phone out, maybe he’d back off if he thought she was calling for help, but he came even closer and knocked her phone out of her hand and grabbed her arm with one hand, reaching round to try and catch the other. She lunged to the side and picked up the metal stand nearest to her and swung it at the backs of his knees, making a noise that she was sure would travel all the way to reception many floors below, as all the connected stands were dragged over onto the floor.
He let go of her, throwing his hands out to try to rebalance himself, but he went over like a cricket stump. His feet were swept up and he was flung over backwards, then dropped back down like a sack of blubber. As he landed she heard the echoes of her weaponry fading away, the thud of his head as it hit the floor and, weirdest of all, a scream of anger from behind her. She was pretty sure the screaming wasn’t her, in fact she was certain of it as she could now hear it coming closer, along with running feet – was that one pair or two?
She panicked, what if she’d killed him? What if the rest of the security guards were about to discover what she’d done? How much trouble was she about to be in?
Cautiously she peered over at him, edged a little closer, but still wasn’t sure if he was breathing or not – oh god, would it be better if he was dead or alive? She couldn’t make up her mind, she was in for a rough time whichever it turned out to be. Bloody idiot, why couldn’t he have just left her in peace?
He moved. She backed away. He rolled over and levered himself onto his knees, then to his feet, keeping her in his sights as he completed each manoeuvre. She stood there, unable to speak or move, the menace in his expression making her mind race with uncertainty – what on earth was she supposed to do now?
Those footsteps were really close now, but the screaming had stopped at least. Was that comforting, or not? Should she keep her eye on the guard, try to defend herself again, or should she find out who was behind her? She started to turn, but found herself being side-stepped by an astoundingly familiar figure. Judith, or was it Artemisia, took a swing with her sword and severed the guard’s head with such ease that it seemed as if she had been training for it her whole existence.
Gazing at the gore, unsure whether to throw up or not, she realised that the maid had followed Judith and was wiping up the bloodstains with her cloth, then bundling the head into it and twisting it closed before tying it to her belt. The stump of his neck had already been wrapped with another piece of cloth – how had she not seen that happen? Was she imagining all this, was any of it real, or was her mind in another place to protect herself from what was really happening?
Judith and the maid grabbed the body by the arms and legs. Judith spoke to her in Italian, but with such an unfamiliar accent that she couldn’t understand. Then she understood, she needed to help. He was quite a size, and it would take all three of them to manage him.
Still unsure of what the plan was, she took hold of his belt and heaved, and the three of them made their way back to room 88. There was no talking, all their strength was needed to shift the body. The weight pulling on her arms and shoulders sent pain signals back to her brain, and finally convinced her that she wasn’t imagining any of this. Besides, she thought, her imagination had never been this weird anyway. Unicorns she could imagine; hauling a beheaded guard through a deserted gallery with two figures who’d stepped out from a work of art – not in a million.
Finally, with many pauses to rest along the way, they were back at the painting. She hadn’t considered what she expected to see, a ripped canvas perhaps, but she wasn’t expecting it to look the same. Except, not exactly the same. The women left in the painting looked dulled, and flat, as if they’d been painted by an inferior artist.
The maid took the head from her waist and passed it to Judith, who unwrapped it and gave it a brief look of contempt, then threw it at the painting next to her own. Instead of bouncing off with a splat, it passed into the canvas, exactly where she had seen the disembodied head of a putto earlier. It was another Gentileschi work, The Annunciation, but she hadn’t paid it as much attention as the Judith and Holofernes. It wasn’t a subject she was that keen on, and besides, some of those putti looked mean. Cherubs were supposed to be, well, cherubic, but these looked anything but.
She looked closer, and realised that the guard had been a dead ringer for all the putti in that picture – had he been a painting escapee too? Now there was one that looked much less alive than before. His face seemed to be going dark, and his eyes rolling up into his head. Mean putto
She turned to Judith and the maid, but they were back in their own painting already. She looked, but there was no sign of the guard’s body anywhere – had they taken it in with them? She supposed they must have done, maybe that was what Judith was looking at, off to the left, beyond the frame?
With no trace of the guard or their….interaction….she guessed she was off the hook. Maybe they’d think he’d just had enough of the job and gone home? So, what now? Reluctantly, she reached for her phone and dialled for help. As tempting as it was to stay there all night and see as many paintings as she wanted to without crowds in the way, she was needed at home, and she had a plane to catch.

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The Domino Effect

‘Domino cloak, black silk velvet, lined with white silk satin, a little worn at the lower edge, style consistent with circa 1775.’ Vera muttered the words to herself as she lifted the garment out of the trunk that it had arrived in, then draped the cloak carefully over the inspection frame, filled out an index card with the details, and updated the museum’s database. Belt and braces as Cynthia, her supervisor, said. If one system fails, there was the other one as a back-up. It was the last item to be inspected and catalogued, after the donation’s arrival at the museum some months before.
It had been a surprise. Often such private collections were known about, their owners coming to the museum for advice on conservation, or on whether a prospective purchase was genuine, but this collection had come out of the blue. The result of a house clearance, apparently, where the owner had died, and the heirs were either unknown or not interested in the house contents. Oddly there had been nothing identifying the benefactor, just the firm of solicitors who had been the intermediaries – Poppinghole, Caldbec and Bourne.
She cast her mind back across the many weeks of inspecting and cataloguing the contents of the bandboxes, travelling cases and trunks that had turned up via DHL one rainy August afternoon. The conservation needed on some of the pieces had been quite extensive – they were obviously well-used – and she had begun to suspect that they had all been made for the same person at around the same time, rather than being a selection of garments and toiletries acquired over many decades by an avid collector.
She let her mind wander as she inspected the cloak for any other damage, and tried to imagine the original owner, as she had so many times before. Initially she’d thought that the owner must have been quite elderly, as it was unusual for the young to wear such rich fabrics at that time, unless very wealthy. Then as piece after piece was revealed, she had begun to think that the owner must have been quite young. The styles had been the height of fashion as the last quarter of the eighteenth century was just beginning, and the colours were pale such as an ingénue would wear, rather than the dark tones of a dowager. Except for this cloak, though. This was the only item of clothing that wasn’t bright and glittering.
The cloak was floor length, hence the wear on the lower edge where it would have brushed along the ground as the wearer walked. The hood was cut generously – even when worn over the huge, elaborate, hairstyles of the era the hood would have been loose. The cloak was full, designed so that the front edges met all the way down to the ground, completely covering the body. The velvet was soft, and so fine that she wouldn’t have been surprised if it would pass the wedding ring test. Not that she was about to attempt that, her supervisor would probably sack on the spot if she tried that.
Whoever it was must have been extremely rich: every single item of clothing was pure silk, even the undergarments and night gowns, and the cosmetics case was filled with crystal bottles with silver caps, solid silver hair brushes, all encased in a silk-lined box – everything of the finest quality that money could buy.
The colours were intriguing though, she thought. The underlying colours were fairly muted, but the fabrics had been adorned with crystals and gold thread to create a shimmering look that was dazzling in the bright lights of her basement laboratory. Still, definitely a young person from the style of the designs. Maybe 5’ 2” in height, and slight, even before the corsetry was applied. In fact, now she came to think of it, it had been odd that no corsets at all had been in the trunks. Every other item of clothing a fashionable young lady about town might require had been there, but no corsets.
As she tilted the Domino this way and that to look for wear and tear she noticed the occasional gleam from the lining. Putting the cloak down on a work bench for a better look, she identified thousands of specks spread over the red silk, which caught the light as the fabric moved. Using tweezers, she selected a sample and took it over to view under the microscope. What she saw horrified her – it was a piece of a moth’s wing. Insects could wreak havoc on the museum’s collection within weeks if there was an unchecked infestation, and she ran back to look at the trunk that the cloak had come in, to see if there were any signs of larvae. None, thank goodness, but she made a mental note to double check every item that had arrived in that consignment nonetheless. And to set the controls for the laboratory to flood the room with pesticide after she had locked up for the day.
Around mid-afternoon she had finished cataloguing the collection and decided to go up to the museum café for her break. Having missed lunch, she figured she was owed some extra time and a trip outside to get some fresh air, so she left by the staff entrance at the rear of the building, walked around to the front, and came in the main entrance like a tourist. Jo was there, as expected, and she was looking forward to having a chat as the queues were light at this time of day, but her old friend just stared at her, puzzled, as she walked up to the security desk.
Jo turned and looked out of the doors. ‘How come you’re so dry?’ Didn’t you get wet in all that rain out there?’ She turned and looked out too, and saw for the first time that it was tipping it down – which was hardly unusual for the last day of October, but she hadn’t noticed it at all. She had no answer – while inside her hermetically-sealed basement bunker she’d had no idea what the weather was like outside, and the rain hadn’t made any impression on her when she left. Jo turned her around and around. ‘Are you hiding an umbrella somewhere under that skirt? Or have you just invented rain-proof clothing down in that secret lab of yours?’
The answer to both was no, and yet she didn’t have any other answers either. Jo just shook her head and waved her through to the museum itself. As she walked through the remaining crowds to the café she wondered what she had thought she was doing when she’d tried the cloak on. She had intended it to be for just a moment, to test her theory that the original owner was her height and build, but she had almost forgotten she was wearing it and had nearly walked out of the lab with it still on. If she hadn’t caught sight of her reflection in the window of the door and realised in time, she would have exposed it to all that rain. The mere thought of having to explain her behaviour to anyone at all, let alone her pernickety and stickler-for-the-rule-book supervisor, made her blood run cold.
As Vera sat and drank her tea she watched the people moving in and out of the café. It was her favourite thing to do, trying to work out which half of the couple had wanted to be there, which half was there under sufferance, and which parent was in the dog house for letting the toddler run off and worry everyone, before being found hiding behind a statue. A sudden panic that her supervisor had walked in without her seeing, and sat down a few tables away, made her freeze mid-sip of tea, but the woman turned her head and she realised that it had been an illusion created by the way the light fell on the mask she was holding up to amuse a small child. Relieved, she decided to not push her luck any further, and head back to the lab.
Something was wrong. She could hear the whir of the ventilation grills closing as she walked down the corridor, and the sound of the machinery used to flood the lab with pesticide starting up just as she reached the door. There was a note on the window, from Cynthia, telling her that the settings had been changed to come on earlier, since she’d obviously finished early and gone home for the day. Damn. The woman had obviously dropped by, seen the cloak, and decided to step in, without thinking that she may have just stepped out for a moment. It made her blood boil, the woman seemed to think she wasn’t allowed to be human and need time to breathe and take a rest.
She looked through the window in the door helplessly as the gas filled the room, then stood there rooted to the spot as she noticed that the cloak, now hung over the inspection frame, was starting to unravel and disintegrate. Her mouth dropped open as it appeared to dissolve – she couldn’t imagine how or why it was happening, but she knew that she was going to be in the biggest trouble of her life if she couldn’t stop it. She tried to reach out for the door handle, but it was impossible.
She tried to look down at her arm, but realised that she couldn’t move her head either, she couldn’t move anything, in fact. She swivelled her eyes and saw that she was surrounded by moths. A cloud of them, no, a hurricane of them as they flew around her in tight circles. Silk moths, by the look of them, and they were binding her up in a cocoon as they flew around her in a swarm.
The moths had worked so fast, and the touch of the threads had been so light at first that she was almost completely covered before she realised what was happening, and by the time she had started to panic it was far too late. The moths worked on, stuffing her mouth, her nose and her eyes with silk, and hiding her face.
Struggling was useless, every movement bound her tighter, and the cocoon was complete. Her struggles tipped her over onto the floor, but she was no nearer to being able to break free. She felt herself growing warmer and then lost consciousness. The cocoon rippled and gurgled in the late afternoon light, as the contents rearranged themselves.
When Vera failed to turn up at Cynthia’s office in response to a terse email asking her to explain yesterday’s absence, the supervisor went down to the lab to see for herself. There was nothing to be seen except for a single item of clothing, which Cynthia picked up and placed on the inspection frame.
Damn, she thought, that’s another lab assistant just disappeared on me. Where do they go?
Weeks later, Vera’s replacement arrived, and picked up where she had left off. First item on the agenda was to re-check the item of clothing that had been found outside the lab door on the day of Vera’s disappearance.
‘Domino cloak, black silk velvet, lined with white silk satin, a little worn at the lower edge, style consistent with circa 1775,’ she muttered to herself as she turned the cloak this way and that, looking for any damage.

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GE17 – what a mess, eh?

You may not have noticed, but there’s something that’s going to happen tomorrow, Thursday June 8th 2017, that’s a bit of a pain, frankly. I hate being asked to choose my favourite, because it almost always depends on circumstances. I have no one favourite of anything, not even tea. Shocker, I know. But how do you choose an MP that will not only represent you for the next few years, but the party to set policy for the country as a whole? They’re all awful – how do you choose?
Let’s start with the basics – why bother to vote at all? While you might think that your vote won’t make any difference and that no-one in politics is listening to you, it does and they are. As more supposed information comes out about possible election fraud committed by the Conservatives in the last election, allegedly (is that enough caveats to keep the lawyers at bay, do you think?) the more it becomes apparent that even a few votes, in the right place, can have a major impact on a result.
Political parties keep an eye on what particular sections of society vote for, and don’t vote for, very carefully. If you never vote they can safely ignore any concerns you might have, because they know they’ll never be held to account for ignoring you – unless you vote. It’s not a coincidence that the biggest cuts to welfare have affected the young and the poor and that, while pensions haven’t been completely untouched, services aimed at pensioners have got off comparatively lightly. There have been U-turns. That’s because politicians, of all colours, know that the old are much more likely to vote than the young. They know that they lose votes when they change too much that affects pensioners in particular.
Maybe you think that politics isn’t for you, and that it doesn’t affect you in any way, so why should you bother? Unfortunately, that only applies if you have no plans to carry on breathing, eating and just generally being alive. Politicians influence pretty much everything that you experience, from air quality, food quality, to whether you’re allowed to work or not and how safe you are from crime.
So now what – just who do you decide to vote for?

The Ideological Vote – this is for the type of person who looks at the policies for each party standing in their constituency and decides which one is best for the country, as a whole. Look for policies that will benefit society as a whole, promote security rather than instability, that see people, the place where we live, and the economy, as things to be nurtured rather than exploited. Potential pitfalls: not every voter in your constituency will agree with you on which is the best party (I know, right?) so if you have a disastrous MP you want to vote out, you may need to vote for a party you think is second best, to avoid getting the worst option.

The Loyal Party member vote – if you’re a member of a political party then you’re probably going to vote for them come, what, May? (sorry, couldn’t resist). Potential pitfalls: if it’s some time since you read through your party’s policies then they could have moved quite a distance from what you think you’re voting for. It’s worth double checking. Policies of all parties move, over time, and there has been a general shift to the right over the past few decades. Policies that were once the preserve of far-right parties are now seen as mainstream by some. If you wouldn’t have been happy voting BNP back in 2005 then you might want to check some Conservative policies. Just saying.

The Self-interested vote – much like the Ideological vote, but you choose the party that’s best for you over some other section of society. You think you’ll get a better deal by voting for someone that puts your interests first. Potential pitfalls: these come in two main categories. Firstly, a government that promotes inequalities is not going to provide a stable society, and this will affect prosperity, no matter how much they pretend otherwise. Secondly, if a government can prioritise you over another section of society today, what’s to say they won’t prioritise someone else over you later? Remember that phrase Divide and Conquer? The really important thing to bear in mind is that their aim is always to conquer.

The Protest vote – you want to give the government a bloody nose and you’ll vote for pretty much anyone else. Yes, I get it, just make sure you’re not cutting off your own nose to spite your face. Choose wisely, and read the small print. Do not jump out of the frying pan into the fire.

The Tactical/Pragmatic vote – you have one candidate (quite possibly the current MP) that you want to prevent getting voted in if at all possible. The party that’s your ideological soulmate doesn’t stand a snowball in hell’s chance of getting elected, and the second choice is OK, you guess, apart from perhaps just one or two key issues that you fundamentally disagree on. This is where you have to decide – vote for a second choice to avoid the worst option, or stick to your principles. It’s a tough one and will probably depend on just how close the parties are in your constituency. There are some helpful websites that can show you which parties are contenders and which are no-hopers in each constituency, such as https://www.tactical2017.com/ It may also be worth remembering the principle of amelioration – will your vote help to take a step in the right direction, or will it take the country further away? You rarely get the chance to jump to your end-goal in politics, moving in the right direction can sometimes be all we can hope for.

The Lose Hope All Ye Who Enter Here vote – the sitting MP is awful, and you want rid of them, but they have such a huge majority that even if all the other parties clubbed together they still couldn’t beat them. In which case you might as well vote for the Monster Raving Loony Party (RIP, Lord Sutch). Interesting aside – did you know that quite a few of the original MRLP policies made it into law? All-day pub opening and passports for pets being a couple of examples. See, I told you they listened.

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Spinal Trap 4 – a bit of a Time Warp

When I woke up from the operation I was as cold as I can ever remember being and was immediately convulsed by body-shaking shudders and teeth that chattered so much I was scared I was going to bite through my tongue. There were people hovering around me and I remember my husband looking on anxiously as they got me settled back in my room. Someone went haring off to another room and when they came back they threw a plastic sheet over me which, when plugged in, churned out a blast of warm air over my body – it felt a bit like being under a hovercraft.
Eventually I warmed up and became aware that I was hooked up to more machinery than I could take in, and it became apparent that, while it had been a success, the operation hadn’t exactly gone as planned.
It was supposed to have taken a couple of hours at most, was supposed to have been keyhole surgery to remove the piece of protruding disc that was pressing into my spinal nerve and causing all the pain. Or so we had thought.
The operation had taken a lot longer than planned (hence the extreme reaction as I came to) because, as the surgeon explained afterwards, there had been an unexpected development. MRI scans are great, but they aren’t perfect, and it turned out that none of the MRI scans (2 or 3 at this point) had shown that there was another rogue piece of disc: one that had previously broken off from the herniated disc and glued itself to the spinal nerve column. All along my surgeon had said that the amount of disc he could see pressing into my nerve didn’t necessarily account for the amount of pain I was feeling, many people were walking around with greater disc bulges and less pain, but a protruding disc rubbing onto another piece of disc glued to my spinal nerve – well, that would do it every time.
He’d spotted it as he’d gently lifted the nerve out of the way to perform the microdiscectomy, and so the operation had turned into a much, much, lengthier one as he had carefully, painstakingly, shaved away the glued on piece of disc, one tiny sliver at a time.
I’m not sure how you would feel about someone wielding a scalpel that close to your spinal nerve column, but I can tell you that I’m very grateful that there were no untimely sneezes or twitches which could so easily have resulted in me living out the rest of my life in a wheelchair, probably doubly incontinent to boot. Every single time I think about that period of my life, which is getting less as time goes on admittedly, it’s something that I am grateful for.
The recovery from that operation was so, so slow. I got out of hospital within a few days, but I was weak from lack of sleep, lack of food and because I had a huge amount of muscle wastage from being almost completely immobile for weeks in the run up to the operation. I did recover, though, and with only the nerve damage that had been caused by the constant rubbing of disc on nerve.
The operation took place at the end of October, 2007. The incident that caused all the pain occurred mid-November 2006. There’s a lot I’ve not said, not described, but if you’ve ever experienced nerve pain you’ll know what living with those levels for nearly a year will do to you both physically and mentally, and that’s why I’ve jumped to this point before attempting to describe that. So that when you read it, you’ll understand what I’m telling you, and what the risks were of either having the operation or not having it.

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Spinal Trap 3 – These sequels are getting increasingly shitty.

You may well be asking what the good old NHS was doing all this time. For a good few weeks nothing at all. I had occasionally been referred to orthopaedic surgeons for various things but they had all dismissed me as Not Having A Problem. I had long decided that there was no help to be got from that quarter. Not for my back, at least. And still no scan. Every time I asked it was knocked back as an idea. Don’t get me wrong, I love the NHS and think it’s marvellous, but I’m not blind. It has pockets that can and need to be improved. (Side note; that improvement will not come about by starving it of funding, making insanely complicated management structures, or selling bits off to private companies. All of those are massively counter-productive.)

I’d been seeing a chiropractor for years and she had been marvellous at getting me back on my feet time and time again, so I went to her initially. Before I did that I did go to the GP, because I wanted them to see me as I was. So that if the chiropractor couldn’t do anything and I needed more help weeks later, I didn’t get sent away with ‘Let’s wait a week to see if it goes away by itself.’ I know why GPs do this, honestly I do, but occasionally they could give credit to those of us who are quite well-informed about things and have already done that week’s wait on their own. Anyhow, some weeks the treatment worked marvellously and I’d have a blissful few hours, but I’d always slip back. After 6 weeks of this the chiropractor told me to go back to the GP. She obviously wasn’t getting anywhere – she knew it, I knew it, it was time to get a scan and see what was really going on.

‘Let’s wait a week and see if it goes away by itself.’

Yes, really. I sat there just looking at my GP wondering if he’d even heard what I said, and remembered that I’d been in that surgery 6 weeks ago with the same problem. He figured I’d pulled a muscle in my buttock which was constricting the nerve. There needs to be a button on every GPs desk. When you press it they get to feel exactly what you do. Only for 5 minutes, I’m not a sadist. It would really help as a diagnostic tool. The fact that it might just stop some GPs being dicks would just be a side-benefit, honest.

So off I was sent to physio. I knew it wouldn’t work, but I recognised it was a stage I had to go through. The GP was only going to refer me to a consultant if an NHS physio said so. Hey ho. So after a good few weeks of this I was sent back to the GP, because nothings had worked. Surprise! Oh, a word about pain scales here. The physio wasn’t very impressed when I said the background pain was a 3-4, occasionally spiking to a 7 or 8. She asked me to rate it on a scale of 1-10, with 10 being the worst. As far as I was concerned 10 was when you passed out from pain, and I hadn’t quite done that. My husband told me I was an idiot, and under-estimated the pain levels, so he asked me where childbirth was on my own personal scale. I considered and reckoned a 4, mainly, spiking to 6, perhaps 7. I cleared up the misunderstanding next physio appointment. So, always make sure your pain scale is calibrated the same as everyone else’s!

So back I went to the GP. I wanted a scan. I needed a scan. The only way I was going to get a scan was through an orthopaedic consultant, which didn’t fill me with joy given previous experiences, but that was the deal. The only thing was, the GP was still reluctant. In the end we asked if we could do it through my husband’s corporate BUPA scheme. The GPs eyes lit up, he wouldn’t have to pay! That’ll do nicely.

No. I don’t know why we didn’t think of suggesting that earlier either. Brains were probably fried from pain and painkillers on my part and extreme exhaustion trying to keep up a 12 hour working day and look after 3 kids on my husband’s part. I’m physically useless at this point, remember?

Anyway, we’re off to a consultant. This is a breakthrough, so I’m happy.

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