Category Archives: Change

Nothing wrong with MY pituitary, thank you

Just over one year on and I have an appointment with the neurosurgeon to review my latest MRI scan. The last time we looked at what was left after surgery there was too much debris in the void to make meaningful conclusions, although the surgeon was confident that nearly all of the tumour had been removed. This time the MRI was quite clear and we were able to see that only a tiny fraction remained, as was suggested immediately after surgery. The propensity for regrowth is low and it seems very likely that I will never need any further interventions (no Gamma Knife Surgery, for example).

I have spent the last year quite confident that the issue had been dealt with, at least so far as the actual adenoma was concerned, and was slightly surprised to find that a small residue of tension was released at this review. I walked out of the consulting room as if on air suspension, not just knowing intellectually (because my surgeon had told me so, and why should I doubt him) that the lump had gone but having seen the absence with my own eyes.

A further review in 12 months was set up alongside a further check of my visual fields (Goldman Test) and it seems that all we have to do now is keep an eye on hormone levels. Less than a month ago I had an review with the endocrine registrar and subject to a further blood tests and review 2 months from now all seems well.

So, to all intents and purposes, it’s all over. On 28th May 2015 I found out that I had a large pituitary adenoma and started this diary the day after. Today I am declaring it closed. It has been an ‘interesting’ journey, from the despair of those first few days when I thought I was living my last, through the totally avoidable administrative shambles, two postponements while I was at the hospital waiting for surgery, relief at waking up with family around me, delight at the lack of pain following surgery  and then the subsequent recovery and settling down back to life as normal. I know that others have had a much more challenging time than I with this particular problem and am relieved that it was caught before doing any serious irreparable damage to my eyesight or hormone balance. To the people at Biobank who discovered the adenoma incidentally, those of you who have ridden along with me, to those (Suzanne especially) who have held my hand and hugged me when I needed it (not very often, toughie that I am!), who have written notes of support and who have had me in your thoughts and not least to the hugely skilled surgeons I say “Thank You”.

And finally to anyone out there who has found out that they too have such a pituitary adenoma, good luck and remember to ask all those niggling questions you have in your mind for the doctors and nurses will be able to answer them and reassure you.

Retire – to what?

I want to start this piece by thanking Yorkshire Water’s pension scheme and HM Government for creating the conditions that allow me to write the post. Read on…

For many years I have spoken with people looking forward to retiring and for many years I have wondered what the word meant and whether or not I should succumb to thealleged temptations thereof

The first question I have tended to ask those looking forward to retiring is “retiring to what?”. They tend to know what they are retiring from, but the “to what” question is often more challenging. After all, there do seem to be a lot of people in jobs they don’t actively enjoy and I can hardly blame them for wanting to escape – but to what? The question often stumps my clients.

And now it may be stumping me.

Well, for some time friends and colleagues have been asking me if I am retired yet or when I am going to do so – and I have always replied along the lines of “It depends on what you mean by retirement”. After all, I am 66 and drawing both company and state pensions!

One definition of ‘retirement’ that I have used, and the one that seems to make the most sense to me, is the cessation of paid work – the ‘paid’ being important, because digging the garden is work, cooking is work, blogging is work… – and that’s the challenge that I face now. For the first time since I left my employment with Yorkshire Water 17 years ago I have no paid work in my diary. Moreover, I am not very motivated to do much about that. I’m happy to consider anything that comes my way, especially if it is short-term (coaching, training interventions – end of advert), but as we can get by (OK, a bit more than just get by) on my pensions there is not a huge financial incentive.

But the word ‘retirement’ brings baggage with it, as indeed does any word.

There is a folk myth that ‘back in the day’, when ‘men were men’ and physically wore themselves out doing manual labour for 50 years, the average life expectancy after retirement at 65 was around 2 years. (Actually I can’t find much evidence for this, back in the days when the state pension was first introduced  – the first pensions were  paid on 1 January 1909 to around 500,000 people aged 70 or more at the time only one in four people reached the age of 70 and life expectancy at that age was about 9 years.) Current life expectancy at age 65 is ca. 19 years. Now whether this myth is true or not, I can understand that as a piece of baggage it might inhibit some people from making that  jump to retired status – irrational yes but we are not rational beings.

So what other baggage might the word bring with it?

  • Feet up in front of the fire, slippers on, pipe lit, glass of whisky in hand, telly blaring out Eastenders…
  • or perhaps endless days on the golf course, watching cricket (neither a lot of cop in the winter unless you can afford to migrate to sunnier climes for 10 months of the year)…
  • or merrily frittering the day away babysitting those grandchildren who are the offspring of the children you spent so long encouraging to leave home…
  • or (over?) involving yourself in the Parish Council and getting frustrated with its inability to actually make any changes…
  • or ????

My point is that you are going to be ‘doing’ this retirement thing for, typically, 20 years so it might be worth giving the subject of how you spend those 20 years a bit of forethought. No employer is going to drive your day for you with this project and that, it’s up to you and me to find our own way to enjoy ourselves – for what is the point if we are not enjoying ourselves. I have a sign on our fridge that seems relevant here

“I do not intend to creep quietly through life only to arrive safely at death”

So my question to you, and to myself, is “What are you going to do that fills your soul, that you enjoy, that you will get out of bed for, that you will happily spout on about to your friends, that is your passion?”

Well?

Inspirational ripples

 I was wandering around my old files today when I came across this little piece that I wrote yet didn’t publish back in Autumn 2009.

I was thinking about how the little fountain I rested against offered a metaphor for change…

Market day in Tonneins – busy busy, hot hot, dusty dusty; lots of French (and a few English) locals, the usual North Africans, tourists, migrant workers for the plum/corn/sunflower harvests. The ‘ethnics’ all at one end with their brightly patterned and coloured clothing, their spices; the locals sifting through market stalls filling with fleeces and other autumn and winter clothing, picking the sweetest and juiciest tomatoes, melons, the first of the season’s prunes and the last of the haricots verts, jaunes et noirs.

It was an unprepossessing little fountain near the riverside ; no more than a piece of local rock about 6ft wide with a hole drilled through it and six 12” jets of water spurting from the top, splashing on the rock and into the pool around the rock. Still it offered a coolish resting place and the gentle tinkle of water on water. I sat on the surround for a brief rest, the fountain to my back. Drifting into some heat induced trance, I noticed the occasional wet spot appearing and disappearing in front of me, several metres away from the fountain. It’s not raining, no local child with a water pistol, they can’t be travelling so far from the little fountain – what’s going on?

Sherlock Holmes kicked into action – yes they were coming from the fountain after all, very occasional little splashes hitting the rock at just the right angle to reflect them out across the pool so far away as to seem improbable. The pool, and the ripples of the water splashes, had my attention…

As I watched, entranced by the ripples, I noticed that sometimes the surface was relatively calm, at others turbulent with the interactions of several ripples; sometimes small splashes, at others large blobs of water would disturb a great part of the pool – ever changing and always something happening, my attention gripped by the circles of light and dark as the ripples shed their shadows on the pool bottom. Always light after dark, the shadows fading as the ripple spread out across the pool, intersecting ripples throwing up sun-bright spots and night-dark shades.

I am sat focussing on the ripples and their shadows before my eyes, only just now noticing the contents of the pool – what was in the pool, on the bottom, floating on the surface, coming into eyeshot. Bunches of grapes, last night’s coke can, single leaves and leaves formed into mats solid enough to resist the charms of the water splashes, tiny tiny fish, gnarled rocks and smooth pebbles.

Suddenly a tsunami! Now the local boys had started playing in my pool, all the time they had been creeping up and now they struck coming from outside my viewpoint to change the whole pattern of my little ripples.

 

 

Well, I could sit here and philosophise or I could actually go get my pen and paper and record these thoughts – so I do so.

 

Coming back to the fountain I can see nothing, the glare of the sun on the ripples totally bleaches out everything. But as I walk around the pool to my starting place, the glare reduces as the angle of the sun changes until I can finally see all the original detail. It was worth coming back. I sit, I think, I write, I remember that 30 metres away from this mesmeric little pool, perhaps 3 metres across, flows the mighty Garonne River as wide as a bus and as deep as a house; strong enough to sweep away this little piece of rock without even blinking an eye. I notice again the hundreds of people going about their daily business all around whilst I muse on ripples and their metaphorical relationship to organisational change. I move on – if I stay I get damp or sunburned and neither of those is in your writer’s plan…

 

 

 

Inspiration from the most everyday objects – just let your attention flow…

 

 

 

Pay attention to the tiniest detail of your environment…

…to the unexpected…

“…there is something interesting going on here…”

…stick with it, investigate.

 

 

 

 

Never the same yet patterns of similarity

Some actions have little effects, some are more traumatic

 

 

Calm after the storm…just wait…

 

Sometimes you get the occasional really  difficult challenge

 

Don’t get mesmerised by surface noise – look below/through to see the deeper structure and/or what is not changing. Keep your eyes open for what is just out of and coming into view – it may be more important than your current focus; or it may temporarily make your current efforts pointless. Is what you are observing part of the underlying issue or is it an artefact – perhaps of someone else’s fiddling?

 

Take action – thinking never changed a thing, only actions change the world

Observation — Insight

Action — Change

 

Review the challenge from different angles – what may seem impossible with one set of eyes may not be through another.

 

Be aware of the wider world – you might be deeply embedded in your problem, others might not care less!

 

…and when it’s time to go. It’s time to go.

 

 

 

Infantile representatives

A few days ago MPs were heard to cheer when a Labour amendment to terminate the 1% cap on public sector pay was defeated. This post is not about the politics of that decision, but the behaviour itself. Behaviour that would and should be challenged in many ‘lesser’ institutions than the Houses of Parliament and which, in my opinion, devalues the House itself.

Politics is currently, like it or not, an adversarial process. I might wish otherwise. Perhaps a more collaborative, consensual, partnership…approach might be desirable (especially in a house with no inbuilt absolute majority) but that seems far away given the current predispositions of most of our politicians. Too many seem to have too much to win/lose, both personally and politically, to want to work with others to seek the best for the  country rather than the best for themselves or their party (which of course has the only correct answers tot he many challenges we face).

I think that thoughts on the adversarial system itself had better wait for another day, with the exception of the unfortunate behaviour that seems to be associated with ‘winning’ – namely this tendency to boorish (my judgement) behaviour towards the losers.

Not only do we have the Commons (OK, just over half of them) cheering when civil servants’ pay is restrained, but listen to almost any Parliamentary Questions (especially PMQs) and  the ‘yah boo’ brigade are out in force on both sides.

Behaviour that would not be acceptable in a school debating society has become the norm in arguably the most important debating chamber in the land.

The House of Commons has got so raucous in recent months that Speaker John Bercow was moved to warn MPs in November that he was receiving “bucketloads” of complaints from the public about their “low-grade, down-market and unnecessary” misbehaviour.

This quotation is from 2013 and despite the best(?) efforts of at least two party leaders little seems to have changed. If Speaker Bercow can unilaterally decide that ties are no longer required to be worn, then what’s stopping him making a rather more significant decision to clamp down on boorish behaviour? Parliament should not be a raucous side-show and a few well-timed remonstrations accompanied by threats of expulsion and/or refusing to accept questions from the relevant MP and/or closing the session would surely make a difference? If the party whips really want to ‘enforce’ the views of their leaders and create a more ordered Parliament then how about them enforcing better behaviour – they are quite happy to reward loyalty or toadying and to punish disloyalty, so perhaps punishing simple bad behaviour might also work.

But of cause, all of this requires MPs as a whole to actually want to improve!

Shattering memories – updated

Lefkada deserted village 2One day, while wandering around Lekfada Island (In the Ionian, in case you didn’t know), we came across this deserted village. Houses broken down and looking as if they might have been left in a hurry. We mused about earthquakes, displaced ethnicities, economic disaster etc and it was only  later that we found that the village had been hastily abandoned after a traumatic earthquake some years previously.

Now earthquakes are nothing new in this region and they are caused by three Lefkada deserted village 3tectonic plates which meet in the area of Kefalonia, Ithika and Zakynthos (Zanti). Apparently the plates, which are in constant motion are causing Greece to sink slowly into the Aegean. A major quake centred on nearby Kefalonia in 1953 was felt in Lefkada, but the real damage was likely done by one in Lefkada on August 14, 2003 – 50 years to the week after the 1953 quake.

I find it hard, if not impossible, to imagine such trauma. We regularly hear of earthquakes and other equivalent tragedies on the TV and radio, yet we are inevitably somewhat dissociated and insulated from them. Here I am so many years after the poor people watched and heard and felt as their word tumbled around them, not realising in the instant that they were witnessing the end of their village. The sadness was almost overwhelming, even so may years later.

As we wandered, we found NO evidence of the people who had probably lived here for centuries. Nothing, zip, zilch. Perhaps the odd bit of plastic suggesting that someone was trying, or had been trying, to keep the walls dry (essential if they are not to deteriorate beyond repair). A herd of goats could be heard tingling awaDeserted village in Lefkada following Earthquakes 1y at the far end of the village when we noticed the odd sign of regeneration starting. Was this one old owner returning? Was it the beginning of a complete rebuilding? Who knows? Whatever was happening, it was a sign of hope, a sign that perhaps this centuries-old village was not dead for all time.
Plagia starts to regenerate

UPDATE

Thanks to the wonder of Tripadvisor Forums I have found out more about this village. Firstly, that it is not on Lefkada but actually on the mainland just across the water and is called Palia Plagia. It is sometimes known as Old Plagia because the village has apparently been moved nearer to the coast after the earthquake that caused the devastation in the photos above. Here is a Google map of the location. 

Facebook Friend or Stalker

I love Facebook, it’s free, it’s simple, it allows me to keep in touch with family and friends (both ‘real’ and virtual) wherever they are in the world. Yes, it gets a bit full of adverts occasionally – but I have found a cool Add-In called AdBlockPlus that will block most of them as well as allowing configuration of lots of other potentially irritating features of FB. FB don’t like it and keep trying to get in it’s way, but so far ABP have managed to keep ahead of the programmers employed by Mark Zuckerberg, so give it a go.

So I use FB regularly, it is always on in both my phone and my laptop, I post several times a day and read my ‘Friends’ posts at a similar frequency. I rarely think about the consequences of my posts, having already paid a lot of attention to who I accept as a Friend, who I include in the various audiences allowed to read my posts, what I post etc… I work on the basis that, despite my best efforts, everything I post will probably be available to anyone with sufficient expertise anyway and so avoid posting photos of various bits of genitalia or being gratuitously offensive.

But a recent conversation has got me thinking about those ‘Friends’, one of who has admitted to reading posts but never posting anything themselves. My first, and admittedly rather extreme, thoughts were that this practice is in the same territory as stalking and that I would UnFriend the individual. Clearly it is not stalking, but I’m still very uneasy about someone who sucks stuff in about others’ lives but never gives anything out. How would I respond if a physical friend spent their whole time listening to my conversations, looking at my photos without ever speaking themselves or showing off their own family snaps? How long would I keep accepting that person into my house or inviting them to the pub? Would I question their motives for the apparent friendship? Isn’t friendship about a mutual exchange of information?

One part of me is interested in what lies behind this behaviour, another part thinks that even if I knew, what would I do with that insight and would it make any difference to how I feel?

So what would YOU do in these circumstances and why? I would really value your insights into the situation – please comment below. I promise I will share all comments (unless you specifically ask me not to).

Bursting my bubble

As an experiment and in an attempt to get out of my bubble and seek to understand some of the thinking, I committed myself to reading some of the right-wing media supporting Trump – in particular Brietbart as it seems to be perceived as the source of much of the thinking and supportive comment.
I don’t know if I want to continue.
The bile, the hatred, the racism, the conspiracy theories (one today being that ‘they’ are letting in “TB ridden” refugees so they can infect the true Americans and in turn collapse the country) are overwhelming and horrendously alien to my own mindset and values. Some of it makes the Daily Mail read like pink fluffy liberalism.
I guess that the real worry is that the publishers and many (most?) of their readers truly believe all this stuff, much as the relaitvley uneducated (by which I mean ‘do not really understand how the media works’) left and right in this country believe their own mouthpieces. The Guardian is no more ‘correct’ than the Telegraph.
Having been involved with the media over the years I believe that I do understand how most channels will represent even the most innocent story in a way which suits their agenda. Just think of the headlines and stories written about HS2 (not that HS2 is necessarily an ‘innocent’ story, it’ just a very good example of my point):
  • “Billions invested in UK jobs”
  • “Billions to be wasted on foreign trains”
  • “Trade and industry helped by faster journey times”
  • “Thousands of homes blighted”
  • “Property values near route rocket”
  • “Hedgehogs tunnels to be built”
  • “Lesser Spotted Winklewort habitat under threat”

You buys your paper and you takes your choice. None of the above are ‘wrong’, just different views on the self-same scheme. But unless the promoters of a scheme seek to understand the positions of other stakeholders the chances of accommodation are almost zero.

So it is with Trump, Brexit etc – bile in response to their bile just generates and even stinkier swamp, hatred in response to hatred just sets parties at war with each other, denial of positions closes down any possibility of change. As Stephen Covey said in his “7 Habits of Highly Effective People”, ‘Seek first to understand’. And you can only ever understand if you are willing to risk bursting your own bubble and investigating those things with which you disagree.

My pituitary journey

For those who have not really been following my journey over the last 18 months, this is a summary recorded by Leeds Teaching Hospitals Trust and shown to an internal conference. Watch and learn!

Due to unforeseen circumstances…

 A few days ago I received a text confirming an appointment at the hospital – this was news to me as I had not been advised of the appointment that was now being confirmed. OK, no problem the letter is likely to be in the post. Unfortunately there was no way I would have been able to attend the appointment without MAJOR disruption and rearrangement and as I know there is nothing significant outstanding I opted to text them back (as suggested) to postpone the appointment. Great stuff.

Even greater was someone ringing me later to rearrange the appointment and offering me another only 3 weeks away. Great stuff.

Today I got a letter:

“Due to unforeseen circumstances your appointment has been rescheduled. Please accept our apologies for any inconvenience caused.”

I haven’t yet had a letter about the original appointment and it would be slightly churlish to comment on the rearrangement. So I am going to be slightly churlish. It’s a minor thing, but the wording suggests that the hospital had to reschedule and are apologising for that. No, I rescheduled and I would simply suggest a small tweak (an additional letter) worded appropriately for the situation.

It’s in no way life-threatening but it is yet another, admittedly minor, example of not really being as patient-focussed as is the expectation. To be fair, this little exchange gets 9 out of 10 (which is MUCH more than some earlier exchanges) but the extra point is the one that makes the difference. Good stuff could easily be a bit better.

Getting better all the time

I have been delighted to spend most of today in the highly pleasurable company of 25 committed people working in the opthalmology team at Leeds Teaching Hospital Trust. We were working on how to improve the patient experience in their department, with me volunteering my time to the process as a patient representative.

I was delighted to be involved, having been fairly vociferous about the weaknesses (whoops, improvement opportunities!) that I came across during my recent journey through their system (not opthalmology though). Not being one to just complain (and I nearly lodged a formal complaint at one time, before realising that complaining would only lead to effort being committed to investigating my complaint rather than actually making improvements), I offered my services as both a patient and someone who claims to know a fair bit about organisational change and process improvements. That offer was taken up and so far I have been filmed telling the story that is contained in previous blogs, I have helped redesign some customer letters. Now the real hard work starts.

LTHT is one of just five trusts in the country chosen to pilot an approach to process improvement imported from Virginia Mason Hospital in Seattle. In turn they have adapted The Toyota Way – a highly structured approach to continuous improvement. LTHT are putting the patient at the forefront of their efforts in the belief that by getting this right, other things (including costs) will fall into place. That they are taking this philosophy to heart was evident by the warmth with which I was received and the attention that was paid to my observations and suggestions.  From my perspective, ‘patient first’ is a major shift and challenge in an industry that has traditionally been medic-led and where the stereotype (and all stereotypes are rooted in some reality) is of patients being called for the convenience of the staff not the patient.

A further aspect of the methodology (now branded “The Leeds Way”) is expressed as ‘Inch wide, mile deep’. Rather than looking widely across a process (‘mile wide’), they choose relatively tiny little areas (‘inch wide’) where improvements would have a big effect and study them in huge detail (‘mile deep’). So today we had a look at the core of the outpatients process (in their jargon – Pathway), searching for those few inches that needed deep study. We found them, and what was a delight was to find that the key areas of study related to minimising patient waiting times. The data was compelling – for new patients, they would typically spend around 90 minutes in the department, only 30 of which were actually spent with the specialists they had come to see; so of my 90 minutes in the department I spend a whole hour waiting for something to happen! Definitely room for improvement.

Lots of detailed investigations needed before further review by the team. However, my purpose here is not to delve into the detail of the improvement process so much as to praise the approach. Not only the approach of the improvement team and their methodology but perhaps even more the openness, creativity and enthusiasm of the range of people in the room (ranging from me and a volunteer through to General Managers, Clinical Directors and no less than the Deputy Chief Executive/Chief Nurse). Worthwhile and sustainable  improvements tend to be made by those directly involved in the processes and I feel that people left the room enthused, committed and somewhat more empowered than they arrived. Job well done.