Today I am continuing a theme that I love: process, and the absence of its value when someone could have been left to use their brain instead. Don’t get me wrong, to paraphrase a quite brilliant fellow MBA colleague, process porn excites me just as much as the next Project Manager. I love the way it can enhance our lives when everything is there at the touch of a button. Then we call it “intelligence by design” or “user friendly” to avoid using the ugly word, “process”. But process is only dehumanising when it fails, raining absurd crushing blows on our heads, sending us internally spinning, and often into a lengthy British queue. I’m getting ahead of myself……………..

Recently, my husband and I spent one of those days juggling one kid off to a cub-scout day trip, one off to badminton club and with the third pair of hands, one kid went to the park to exhaust me. Never did I realise you could push someone on a zip-wire, for hours……..

Suitably exhausted I returned home to find number one girl curled up on the settee clutching her phone, looking particularly more emo than usual. This is the exact moment I learned at what age people start Googling symptoms to self-diagnose an illness. The answer is 11. Suspected appendicitis cannot be treated with painkillers or a hot water bottle for fear of rupture and instant death (I’m paraphrasing WebMD on her phone here). To be honest, if the lower right quadrant of your belly hurts like hell and the left side doesn’t, appendicitis was all I had to go on too, so off we went to the nearest A&E, time of arrival 3:15. Obviously, you can’t park near A&E. If you’re not ill enough to turn up with all sirens blaring in an ambulance you have a 20 minute drop off waiting zone (full) or the maternity car park half a mile away.

So, I’m trying to carry an 11 year old in my arms like a baby from the maternity wing car park. I get as far as the maternity wing (i.e. 10 metres) before I want to collapse, breathless and in agony. Looking not dissimilar to every other patient arriving at the maternity wing, I rush in, looking for a wheelchair. A saint of a porter appears out of nowhere and number one girl is chauffeured round to A&E, in the fetal position. There, she is rushed through as an emergency case for triage. Because a nurse says so, she also agrees to take some paracetamol. She is “overbooked” on the next available appointment at 4pm.

Here’s the first part of my process confusion, how do you get to the point where double booking an appointment is a normal process? Have they cloned the staff to be able to do this effectively? The waiting room was pretty much standing room only with loads of kids with suspected broken limbs, still dressed in football kit. One young girl was skipping with a bloody nose and a scraped knee. I can’t help thinking that perhaps a tube of savlon and some paracetamol was all many of them really needed, not a four hour wait sat next to a paranoid, anxious parent, hoping to be double booked over someone else’s suspected broken wrist.

Surprisingly at exactly 4pm, my girl is called through to see another nurse to go through exactly the same triage process as before, only with the addition of a urine sample request and without the paracetamol again. Also, I suspect because the nurses are fed up of documenting scraped knees on the computer system, our answers are first written on the back of an envelope (I kid you not) before being typed up after we leave that room. It’s a tricky process getting an unsteerable wheelchair alongside a toilet cubicle so that a girl bent double with pain can wee into a small pot inside, but we managed. Don’t ask me to repeat that task.

Second point of confusion, why not just copy the stuff from one form onto the next form? How are our answers going to differ from one hour to the next? Why even have a second form if it has all the same questions on it? One of the questions sounds like, “Is she known to cams?” If you understand this question, then you know it is actually “Is she known to CAMHS, which is the child and adolescent mental health services. If you answer this question, “no” rather than “what is cams?” no-one bats an eyelid or asks how you have come across the mental health services if it wasn’t for one of your kids. I was all ready to say “Oh, it’s our youngest son who’s clearly insane” but no, the box has been ticked, job done. Nurse number 2 seems very skilled and lovely, and “cannot rule out appendicitis” as the urine sample is fine. She’s “going to be assertive” and demand that a doctor sees my daughter. We’re sent round to the paediatric ward half an hour later, and ours not to reason why, but here’s the process on arrival, which in practice is about an hour after we arrive……………A nurse has a look at her, and asks ALL THE SAME QUESTIONS AGAIN, including the urine sample request. This time the urine test has a cardboard bowl to put under the toilet seat with a sterile packaged, plastic container insert inside, which has to be weed into, but only after opening it without compromising its sterility. I go and fetch another wheelchair………… Apparently, although the last nurse wrote up her notes from the back of an envelope onto the system, a) this did not include the results of the urine sample and b) they have big blue folders on the wall of the paediatric wards and you need to click paper in and out of these to look efficient, so to generate more paperwork, we have to start again.

It is now 5:30 and the nurse recommends taking a blood sample so that the results will be available to the doctor when they arrive to help their decision making. “That’s great” I say, “How long does it take to get the blood results then? What time do you expect the doctors to come round?” Here are the clues to the answers I’m expecting: How long = answer in units of minutes/hours; what time = something O’clock. The answers I actually got were, “oh, they come back almost immediately” and “she called me 15 minutes ago, so not long I imagine”. Right, let’s start with “they come back almost immediately” shall we? I distinctly remember weeping into many biochemical tests in a hospital based lab as a PhD student, so I have a little bit of experience with these.  It’s really very frustrating to spend two days carefully moving very small, and usually radioactive solutions from one type of tiny tube to another, only to discover that in your sleep deprived state, you wired up the terminals to the last machine in the process the wrong way round and now your samples are swimming in vast quantities of (also now radioactive) solution that you need to carefully clean up and pour down an appropriate sink somewhere. There were no tests that gave you results “almost immediately”. I understand that tests designed for the NHS have to be more robust than the ones I cocked up years ago, but still, the results are not coming back, “almost immediately”. I would bet my hospital parking fee on it. Moving on, how does the past event of “she called me 15 minutes ago” relate in any meaningful way to the arrival time of said doctor? She may live in Timbuktu, she may have 15 wards to walk round and 20 life-saving surgeries to perform before she gets to the blue folder filled paradise that is room 16.

So, sure in the knowledge that it is 5:30pm, but absolutely none the wiser on anything else, we watch anaesthetic cream being put on the back of my daughter’s hand, which will take half an hour to work, after which time, the blood test will be done.

6:35, blood test performed. No doctor around. She’s still nil by mouth and getting hungry. At about 7, dad turns up with the welcome distraction of brothers. As a new face on the scene, dad asks a nurse if there’s any danger of seeing a doctor or a blood test result any time soon. “The blood test results will take an hour” and “the doctors are on their way”. I bite my tongue. Eldest brother asks me why they can’t just X-ray his sister to find out if she has appendicitis. Grateful for the diversion, I discuss the use of X-rays with him and their ability to see bone, but not wiggly appendices, and the value of high resolution, but expensive imaging techniques like MRI and CT scans, versus cheaper, quicker, low resolution techniques like ultrasound.

8pm, we go wild and crazy and ask again if either a blood test result or a doctor are going to turn up any time soon. Miraculously the doctor appears and lets us know that blood test results take two hours to come back. He also asks my girl pretty much, all the same questions we have now answered three times already. However, this time we have brothers present, which livens up the process enormously. When asked if the previous day’s activity was normal, youngest son’s hand shoots up: boy does he know the answer to this one: “we cycled to the river where you can swim and I found a dead fish and a live mussel”. Unfortunately, this information has minimal clinical relevance and the doctor smiles politely. This is seen as a cue for eldest son (aged 10) to ask very bluntly, “Why don’t you just do an ultrasound to look at her appendix?” Gloriously shocked into action, the doctor informs us (in words of one syllable, despite the clear understanding that my son has of the situation, never mind his rather academically qualified parents) that this is exactly what they will do in the morning. Nil by mouth restriction is lifted and supper is offered to my picky eating number one girl. When I say supper, I believe the exact offering was “I think we have a cheese and tomato or egg sandwich in the fridge still?”  The look of horror on my girl’s face was enough to send me to the only thing open on a Sunday evening, a vending machine, so that she could eat an entire bag of Haribo Starmix (other types of carpet underlay are available). This can only be good for someone who has essentially had nothing to eat all day on top of severe bowel pain.

9:55pm, a surgical registrar comes to tell us that her blood test results are all normal, which is not strictly true as I pestered the nurses at 9pm and they said that “a couple of things are raised”. They’d like to keep an eye on her overnight before the ultrasound the following morning. My daughter is distraught as it has finally sunk in that she is definitely going to miss her maths test the next day. I drive home to get an overnight bag, incurring a £6 parking charge to leave the car park, even though this is the fee for anything over 5 hours, up to 24 hours. Although I am back within the hour there is no button to inform the machine of this and I start the whole parking ticket process all over again. I return to the ward with teddies and kiss my girl goodnight. Then I go to parents’ room 3 to sleep under the thinnest blanket ever manufactured, whilst ironically bearing a label that says “Imperial quality”; perhaps it was at the time Britain had an empire. I am reminded that your importance to the clinical care of the patient is directly correlated to the temperature of your surroundings. If you are the patient, you are placed in a room heated roughly to body temperature. If you are a mere parent, you are in an unheated room with draughty windows, where the curtains stop 6 inches short of the window ledge.

Any visible source of heating with apparent thermostatic controls is simply there to lull you into a false sense of warm security. I spend the night fully clothed, putting two threadbare towels on top of my imperial quality blanket in an attempt to remain warm blooded. Day 2 continues in the post below.

Don’t worry – it’s not that kind of blog, at least not yet, I will explain…….

Today I cycled into town. Before you get excited about this and start sending me information on Lycra and padded shorts and nutritional supplements to help me rehydrate/revitalise/recarb or reload protein or whatever you’re supposed to do; I am not about to threaten any government recommendations for getting fit just yet. Twice in a week is probably the most cycling I will ever manage and I can hardly lay claim to an energetic cycling style. In fact I suspect psyching myself up to do it burns almost as many calories as the cycling itself, and this is my main issue with exercise. Realising at half past midday that I hadn’t got any tuna for supper despite promising to do this, and having fully psyched myself to the max, I had to get a very quick lunch out of the fridge to give me enough time to cycle to and from town (and be back at the school gates, of course at 3:15 for the obligatory cake sale). I am sure this weekly extraction of money will pop up again in future posts, I digress. As my middle son is away on a school trip I realised I could could eat his carton of covent garden pea and ham soup (other liquidised green goo is available) and replace it before he got back. A whole carton – don’t pretend that half a carton is a serving, Covent Garden – has 270 calories. It’s positively skinny. So, how many calories do you burn cycling 10 km in total into and out of town along a very flat canal path? Well, mapmyride has 58 different bike ride options to select from when calculating this pressing issue, and thank god one of them is “hybrid cycling – shopping/errands”. It’s almost like they knew I was headed for Waitrose. Total estimated calories burned for a woman of a certain age (44) and weight is 329. I haven’t done the maths yet, but I’m pretty sure the white and milk chocolate chip brownie I ate as a result of being starving when I got home had slightly more than 59 calories in it. According to another site I found, if I keep up this level of cycling, (presumably without the brownies) I could get my BMI down by a couple of units into a more healthy zone in only one year. One year! I’m going to struggle to do this for more than one week. I’m not going to visit that site again.

So, once in town, I was intrigued to see a man outside Waitrose, standing by a Shetland pony shouting, “for local disabled kids”. Now, I wondered whether he had astutely realised (or read the metro on many occasions) that most people don’t give a monkey for disabled kids close to them, never mind ones far away; OR, that unless your disabled kid needed to be carried literally just round the corner and back, the pony wasn’t going to make it with those tiny legs. As a fully able person, the last time I tried to get on a Shetland pony as young (tall) girl, I half mounted, half stepped over it. The result was crumpled girl on the ground on the other side of a Shetland pony.

It turns out that this is a petting pony for disabled kids. Again, I have issues with this. Simply because you can raise money for something, stood next to a shrunken, fuzzy pet, it does not mean you should. Alternatively, at least work out what you are going to do with the money first. In reverse date order, my youngest disabled son has petted the following three animals in as many weeks:

1. Very flat, dead frog, found just outside the house. Begged me to take it home after showing it to all his friends at school and the teacher refused to keep its fragrant body in the classroom.

2. Slow worm in the garden: awepic (cross between awesome and epic). Conversation followed for hours about how much of a slow worm, or normal worm for that matter, you could cut off its owner before you got one or even possibly two slow worms to grow back.

3. A hissing cockroach at the zoo on the basis that it would probably feel nice, but in fact felt stickily and hissed (go figure).

My middle son, also disabled, pets our cat but drew the line at the hissing cockroach. He was probably hiding his disappointment that we had turned up hoping to see a scorpion and he was still waiting for an answer as to why snake skins, when shed, are not as colourful as the snakes they came from. Perhaps my sons have the wrong kind of disability for petting Shetland ponies? Perhaps you have to be wheelchair bound to feel a warm fuzzy glow from a warm fuzzy pony and have your world improved beyond measure for a brief moment. Now I know Shetland ponies are not the most expensive of horses to own (who’d have guessed? What did we do before Google), but I wonder how much net worth Mr shouty Shetland got for the kids today. He felt obliged to give me a sticker for capturing the photo above which I wore with pride, but this too must eat into some pretty meagre margins.

I can’t help thinking that Mr shouty Shetland could have spent the time helping every other disabled person I know fill out the appeal form for having their Disability Living Allowance benefit turned down, a lengthy process that takes 11 weeks for the Department of Works and Pensions simply to read your letter. Perhaps there’s something we don’t know about the reading age of DWP employees. It’s a great way of lowering the benefit budget, how long will it take to do something after they’ve read it I wonder? Anyway, helping with DLA admin may have been of some practical benefit, rather than roasting the poor animal in the sun for a few hours.

After all that I did check with my youngest son on the merits of petting a Shetland pony. It would be great he said, “better than a hissing cockroach”.