Surgery

I had an interesting conversation with a newly qualified doctor just recently, who is from Canada, studied in Melbourne, and spent time in London as part of her course. I think she has a solid perspective of what works and what doesn't work in health care.

As someone whose only experience with health care is in the UK, I found it to be an enlightening conversation to say the least. She stressed, for example, how poor the organisation of the NHS is from within, and how it affects various aspects of the business. In particular, she outlined how shocked she was at the work of the nurses. I recall various media reports on how nurses are overworked and underpaid. When I told her of this, her eyebrows disappeared into her hair line and she essentially said that from what she could see in the two hospitals she worked at in London, they do not deserve more. In fact, she said that due to the incompetencies that kept cropping up, if she had the power, she would have fired many of them on the spot.

When she was observing surgeries, she reported that the nurses were almost a hindrance. They had no idea about the process of various surgery routines, and no idea about the tools that were needed. When asked by a physician for equipment, they often handed over the wrong tools, or simply couldn't find them. When the latter occurred, they would have to go from the room, sometimes for ten minutes at a time, in order to collect the correct instrument. The surgeon and patient would be left waiting for that period. An inefficient use of time for the surgeon (and nurse) and dangerous for the patient.

She compared this to the process in Australia, and said that whilst the nurses were similarly seeking higher wages, they ran the show. Surgeons relied on them, patients relied on them, visitors relied on them. They know each and every patient in their ward, know where the files are kept, know where every bit of equipment is and know the details of every procedure in the operating room so that each detail can be taken care of. Think of Mad Men's Joan. She is the office equivalent of an Australian nurse. Wholly indispensable. In London A&Es, the nurses appear to have no clue where anything is, how it works, and they have no inclination to pro-actively introduce order. As far as I can gather, many seem to believe that it is a good thing to walk around the corridors looking rushed, stressed and overworked, lending the appearance of being a superwoman (or man), whilst in reality wasting valuable space.

The light of my friend's experience in London were the interns. She mentions one in particular that she shadowed, and saw something amazing. The interns "hold it all together", she said. This particular intern had been a qualified doctor for 2 years, but because there aren't enough positions available for qualified doctors, he has to hang around and wait for the opportunity to fully use his qualification.

She saw how harried he was, doing the job of the nurses because they allegedly had no clue where anything was kept, and appeared to have little medical training. One in particular that my friend asked a question to in relation to taking blood replied that she didn't know the answer because she'd never taken blood! A nurse had never taken blood! So student and intern proceeded to schedule various blood-taking dates into their diaries for the day.

On top of this, the doctor-nurse politics conflicted with the care of the patients. I understand that this is a documented problem in the UK, but she said that to experience it in the way that she did was disturbing and cringe worthy. A nurse, apparently, is ever conscious of the second hand reaching the five to clock off at the end of the day, never mind that there is still one more 20 minute procedure to fit in. Sure, we all have our scheduled work days, we have families and friends to go home to, but if your profession is to care, surely you... care? I stayed later at my place of work many many times, and I added apostrophes to words and reviewed customer feedback/complaints. Not exactly life and death.

Doctor and nurse will snipe because, I suppose, they disrespect each other. From one point of view, this seems to be understandable.

So A&E in London? Filled with a number of excellent surgeons, but surrounded by poor support, suspicious working conditions in old buildings that cannot possibly be sterile, and shocking organisation. Surprised?

George George George

How could I ever form an argument as remarkably well as this man can?

http://www.guardian.co.uk/commentisfree/2011/nov/07/one-per-cent-wealth-destroyers

What an excellent article by George Monbiot.

Go on, take a look...

Tailored?

The joy and the despair of people sharing experiences with polar opposite outcomes can be directly translated to this example.

A lovely friend of mine went on a long holiday this year (3 months in South East Asia), and within that time he went to Vietnam. He went to a town called Hoi An on the coast to have a suit tailored to fit him. Months later, I went to Hoi An. Tailored clothes were on the agenda, but so was relaxing and this seemed like the perfect place in which to do it. Hoi An is quietly situated on a river, with restaurants and shops lining the water. Lanterns softly light the town at night, but night time adventures tend to cease at around 10.30pm. A little sanctuary. 

This friend enjoyed Hoi An and had a great experience with his tailor of choice, so much so that he recommended the place to me. I went there and I can say with confidence that I will absolutely not recommend it. I still like the person who recommended the place to me, for how can I blame him for my own disappointment? Indeed, my experience was a colossal disappointment, but maybe my expectations were too high.

The place is called Kimmy's, and in fairness to them, I get the impression that they are not one-of-a-kind shit, they are one-of-most-if-not-all-that-are shit.

The prices are high. By saying that they are high, of course I don't mean that they are anything like what they would be in London, but everything is relative. A good price comparison is a packet of cigarettes: in Vietnam, expect to pay about 65p for a packet of 20 Marlborough Lights compared to the £6.20ish that you would pay in the UK.

Anyhow, Vietnamese workers get paid little, but they pay little for food (around 30p for a meal in a restaurant), little for fuel for their mopeds, for rent et cetera. So to get charged US$120 for a suit jacket and trousers that can be made within hours is quite obscene, particularly in light of the terrible quality of craftsmanship. 

I say that it is obscene mainly because it is unclear to me where the money goes. The cost of the fabric in Asia is next to nothing, but if you ask them how much a wool mix per metre costs, they don't know or refuse to say, but charge a solid $20 extra for a 'better' fabric for the item that you have asked for. You can get beautiful silk fabric in London for £3 per metre, so I was fairly confident that I was getting ripped off on the basis of the costs of the fabric alone. 

Do the employees who spend a couple of hours stitching together a few seams in their tried and tested methods get the moolah? I saw no evidence to suggest that there were countless wealthy Vietnamese people walking around.

The friendly employees of Kimmy's take your measurements (shoulder to shoulder, neck circumference, neck to waist, shoulder to wrist, under arm circumference, upper arm measurement, waist, hips, thighs, waist to knee, nostril to nostril...), but to experience your first fitting is a huge surprise. Every detail of your body that they write down is used as more of a general guideline than as a rule. And every design detail that you ask to be included in your jacket/shirt/dress will be ignored because they also seem to adopt a basic template with which to make a lady's jacket/shirt/dress.

Intuitiveness is certainly not something that a Vietnamese tailor can lay claim to and celebrate. It seems as if they are instructed on how to make a basic item and no more. To incorporate changes that you insist on as a result of the first fitting being so wrong, they disregard anything else that needs to be altered to in order to maintain a balance with the design. Buttons are sewn on unevenly, scorch marks will be left on your 'better quality' fabric, sleeves are sewn in poorly so that they don't sit comfortably and they look uneven, sleeve lengths are too short... Seams on trousers are wonky; straps on dresses are mismatched; lengths that you ask for are not provided; pockets are fake!

I stayed in Hoi An for nearly a week because I enjoyed cycling to the beach, eating the good food, and revelling in the comparative quietness. But going back to Kimmy's again and again and again for refit after refit because they don't know how to sew well was unexpected, and it added some frustration to my experience there. 

It was also very dull having to try on these disappointing items of clothing. If it had been cheap, I would have been less bothered. But the fact is that I could get all of the items from the high street for the same price, of better quality and superior fit, and without expectations of perfection. For surely that's what tailoring is? Working to achieve results of perfection. If only I had appreciated the merits of what was already available to me.

Please don't mistake this entry for someone with no perspective - I realise that in the grand scheme of things that can go wrong in life, this is going to have little impact on me or anyone else. No one has died. It's just really irritating. A disappointing clothing experience? A little shallow, I guess. But I really really like clothes, and I was so looking forward to being the owner of beautifully crafted, perfectly fitting fabric on my small frame. So not the end of the world, but a sad little let down for sure.

Short Tight Black Skirt: A Story

Teeny tiny little black stretchy skirts adorn the bottoms - just about – of the man-conscious young woman in Sydney. Style? Non. Fashion? Iffy… but perhaps it has been a brief member of the fashion club. But in my opinion, a person dressing fashionably is doing so with art in mind, as well as a desire to impress/stun their peers for their innovation and daring, and not as a way to promote drooling or possible wolf whistles.

These skirts are worn day and night. They don’t just seem to be the nightclub or bar uniform. During the day, a loose top and/or jacket is mock-casually thrown with it, with suitably tousled hair or an ever complimentary top-knot. At night? Anything goes really, as long is it is a relatively small anything.

At night it is particularly comical to see, as a throng of young women will walk three or four abreast with their very similar attire. You will see this a number of times in one evening. There may be a slight difference with the texture of the fabric – perhaps one is wearing a ‘body-con’ style dress/skirt, with thick synthetic fabric that squashes the contents in a little. Perhaps someone else is wearing stretchy jersey fabric that rides up much more easily. Perhaps another has gone crazy and chosen mauve.

It is the norm to not be wearing tights with them. Unfortunately, a high percentage of women suffer from water retention, and the evidence is clear. It just baffles me that they would choose to display the water retention evidence so visibly.

There must be an equation that identifies this look:

Short (usually) black skirt + boy/men = flirtation + boost in confidence + sexting (and beyond)

I’ll admit that I’m not certain of how to balance this equation. But there it is.

And there is nothing wrong with the equation except for its obviousness and the baseness. There’s always a place for baseness. I eat pork scratchings after all.

The positive is that I saw a kangaroo

After meandering through a few information streams first, I managed to arrange a stint pruning grape vine in Canowindra, New South Wales. Canowindra has a population of around 1,700 people. The final step was to give Tony a call. Tony will "set up [my] accommodation".

Tony was called, and my first impression of Tony was poor, as he answered the telephone with "yeah". But this is the man who makes the final arrangements for farm work, people do this all the time, so I suppose I need to pack away the now redundant expectations that good manners are normal. Asking if there was anything that I needed to know, he replied there was nothing except that I would be staying in the Canowindra Hotel and to call him when I'm close to arriving so that he could brief me on the work.

I arrived the following week at 8.30pm, called him when I arrived as there was no signal anywhere else on the journey, and he appeared to forget that I was due to arrive and that I was due to start work the following day. "Oh no - you're at the bus stop now?" he asked. "Why yes, Tony, as arranged last week, I am," I replied. "Oh no. There's no accommodation. I told the agencies to stop sending people." he said. "Right. But we spoke last week and arranged it," said I. "Oh no. You're at the bus stop now?"

He came to meet me at the bus stop, and described a story to me. This involved farmers not expecting a group of 14 people to start working 3 days previously, and the Canowindra Hotel overbooking so that grape vine pruners were unable to stay. 12 people were currently located in one room in one other hotel on a floor. As it turns out, I was one of the lucky ones to get a bed. This I shared with two strangers in a filthy room. As Tony sorted this room out for me, he said that he'd be back shortly to talk about the work etc. He didn't come back that night.

The following morning saw no improvements. He looked like shit with his hangover, but confirmed that I would be starting that day. I asked about payment, tax numbers, forms that I might need to fill in... Payment in cash on Fridays. No forms. We get on a bus that takes us to the farm. That's it. And what about the accommodation? That will be sorted today. Is there anything else I need to know? No.

Off to the farm. I was reassured later by a scatty Camelia, who it turns out organises all of the farm work and liaises with the farmers, that the accommodation would be organised. She is the one who condones what is bordering on slave labour. (I would have made around $6 an hour, if not less.) Of course, nothing else was mentioned about anything else.

The accommodation wasn't arranged and I spent a second night in the filthy bed and room.

The following day saw storms and nobody was allowed to work. The rest of the week saw the same forecasts. So there was a group of us who were expected to pay for filthy accommodation, in a town that sold food at twice the price you find in Sydney, with nowhere to go except for a single street. I couldn't justify spending any more time there. Short lived? Absolutely. I had expected to spend about 5 weeks there! But proper accommodation still wasn't arranged for the third night, despite repeated promises. The secateurs were left with Drunk Tony on Wednesday evening, and one of my room buddies, Judith, and I packed our bags ready to leave the following day. We both left our bank details and a thank you note for the initial chance to work on a farm. And left.

A week later, by text, I have been accused of stealing the secateurs, of not paying for the accommodation, and for not paying for the transport to the farm (?!). All of the information about extra costs were mysteriously not spoken of, and some wench has decided that she'd like to threaten me with the police and immigration department. Apparently, she is "sick and tired [of people] who constantly leave without being honest in paying what you have to pay". Right. Workers must be a little tired, too, of the disgusting conditions in which they clearly have to live and work. I'll see what happens...

Compatibility

"How long can you wait for a person to tell you that love is not enough? That all of the wonderful things that make a great couple are just too much? That energy, passion and opinions can't compete with cool, lovely and nice?

I suppose there must come a time when Defeat holds up its flag and tells you that you're pathetic, but also that you are more than what you are sinking into, and therefore you need to buck up and move on. Waiting to be discarded, or to be told that the energy is too much, that Love is too complicated and not worth a hop - let alone a leap - of faith is something that can kill any crevice of optimism and romance that a person may hold."

I wrote the above a little while ago as a way to explore a non-development. It's interesting to look at this now in a different context, feeling slightly more cynical. Or maybe it's not even cynicism, but rather realism.

I read something earlier today in Malcolm Gladwell's excellent 'The Tipping Point', which put an interesting slant on compatibility and perhaps why Failure must slap you in the face from time to time:

Perhaps most important, though, we store information with other people. Couples do this automatically... Wegner [Daniel, University of Virginia psychologist] argues that when people know each other well, they create an implicit joint memory system - a transactive memory system - which is based on an understanding about who is best suited to remember what kinds of things. "Relationship development is often understood as a process of mutual self-discolsure," he writes. "Although it is probably more romantic to cast this process as one of interpersonal revelation and acceptance, it can also be appreciated as a necessary precursor to transactive memory." Transactive memory is part of what intimacy means. In fact, Wegner argues, it is the loss of this kind of joint memory that helps to make divorce so painful... The loss of transactive memory feels like losing a part of one's own mind."

Practically, I think this can help to explain why some people just cannot work together. If you are so out of sync with each other, with completely different temperaments, alternative ideals and contrasting politics, then you are both likely to approach your environments in completely different ways. Although this could be a harmonious coupling, where each individual will remember what they are best suited to remember and bring different valuable things to the relationship, it could also be a source of frustration. Expectations are sometimes not met, and one half of the couple is left wondering why the hell the other has put so much weight on something they consider to be trivial, and consequently see the other as redundant. And vice versa.

The individuals will be left disappointed and frustrated, and expectations will not be met.

Perhaps this could be applied practically in a work scenario: you have spotted three recurring mistakes in a client's short automatic email. This email reaches hundreds of people per year and could have a negative impact on their business, and consequently your own. (See this BBC article as an indication of why easy business can be lost.) You'd like to advise them of their mistake but are unsure about how to approach it delicately, though you feel strongly that it is an appropriate course of action to contact them.

Just to be sure, you ask a colleague their opinion. Highlight the paragraph to them, and show them the three mistakes. Then ask them how they think the errors can be communicated. The colleague responds unexpectedly by saying that only two of the three mistakes should be highlighted, because in his opinion only two can really be noticed and the third is less important.

Perhaps he thinks that this approach is a softer blow to the person who has made the mistakes? To me, the colleague's answer is wholly stupid, and merely fuels ignorance. The fact is that there are three mistakes, and he is too much of a dolt to understand them all. However, if his partner of over two years asks him the same advice, she is likely to accept it as sound as they are so harmonious together. They bring different ideas and memory systems to the table in their relationship and get on brilliantly. In their world, their individual thoughts, opinions and memories are cohesive. In my world the ignorance - granted, of something relatively small - is unacceptable. Of course, we would never get on and never be able to build anything like a transactive memory system.

With this in mind, suddenly, thinking about relationships and compatibility makes more sense. You offer different things to the table so that you benefit each other, but each individual notices and appreciates the offering, making it clear that the offering is valued and applauded. This failure that sometimes happens? It's just a practical wake up call that you need, to encourage you to try something different.

Is this the best coffee in London, nay, the world?

Some people feel wretched if they have no access to coffee. If I am in the presence of one of these folk, I consequently feel wretched as they verge on being unpleasant. So if I can ply them with good coffee, or help with directions to good coffee, then I am more than happy to comply.

I love coffee, but do not consider myself to be an aficionado. I know the difference between very good and okay, but possibly not between very good and exceptional. Perhaps the difference between very good and exceptional lies in individual opinion anyhow. But how valid is the individual opinion if they frequent Starbucks et al?

The last time I drank a Starbucks coffee was after a friend highlighted that they now make flat whites. With respect, I felt that it was good. I would be inclined to venture in for another if I had a hankering for one and the store was convenient. Previously, though, I asked for a latte and it was vile. I asked them to make it again on account of it being watery and burnt. They duly made it again and it was the same shit. This was not a one off.

Could the same thing happen at Monmouth (coffee company)? Or in... Kaffeine? This is doubtful.

Monmouth has a tone of middle class country farm about it, despite being perched confidently in Covent Garden, London Bridge, and Bermondsey Street, with contrived communal heavy wooden tables, a style also exemplified perfectly in the popular and oh-so-pretentious coffee shop, The Town Mill Bakery, in Lyme Regis in Dorset, neighbour to the original place of Monmouth, from where I believe the coffee company gets its name. However, I think a pretentious place can embrace this title with something resembling pride if they can make it work. And both Monmouth coffee and The Town Mill Bakery work because the goods that they offer are really very good..

However, for something a little less twee, with a touch more elegance, Kaffeine could be the place that tops it. Coffee after coffee is a success, and although I think that Monmouth coffee is exceptional, the overall coffee-drinking experience is often let down by service with an attitude. Kaffeine has always been friendly without gushing and I always feel comfortable being there. I thank the friend who introduced me to it. Best in London? A definite contender. Others... Flat White? A bit tired... Macaron in Clapham? Delicious, delightful, indulgent - this is high on the list. 

But what makes a good coffee? Good beans, ethically sourced of course, because there's nothing worse than the taste of guilt; top-notch equipment; good skills. No burnt milk, not too much froth, a cup that is not too large (grande, anyone? I think not. A 5oz cup is just perfect), a smooth texture, a good consistency that is thicker than a glass of full fat milk but thinner than honey. Apparently, the Synesso Cyncra is "the holy grail of espresso machines", and is what is used to make the deliciousness as provided by Kaffeine.

A friend in Sydney is saying that it is the best place in the world for coffee, beating Italy and France. Apparently, a coffee movement is happening. Lots of new and previously uncommon techniques are being used to satisfy the needs of the common coffee aficionado. Perhaps I shall soon find out if he is boasting, deluded, or indeed spot on.

nom-nom