generic downbeat

Another Icknield Way ride

It started as a trip up to my garage to search for my lost angle grinder. Once I had realised that it was not to be found (how can I have lost it?) I decided to work on my newfound confidence and ride the short section of the Icknield Way again. Its a short and not bad ride out there from Cambridge, through Fulbourn and Balsham, so why not? This time I wanted to record it so took my GoPro mounted on my helmet and another camera pointing more or less at me. I arrived at Balsham and turned everything on then set off, past the ‘Unsuitable for Motors’ sign (assuming that this didn’t actually mean ‘motors are prohibited). Things started off well. The track is gravelly in most places, straight and pretty flat. A little way down things started to get muddy with the the huge and soft tyre marks left by a tractor. I had one moment of instability on the slippy mud and then managed a climb. Further on, the muddy tyre tracks covered the whole track – apart from about 18 inches on the side that I only noticed afterwards. Heading across them at about 18 mph the bike quickly went into a slide and I ended up in the hedge and on the floor for the second time in as many months.

Unlike my fall in Wales, this time I wasn’t hurt and got up feeling optimistic I could pick up the bike and get going again. But for some reason the side stand had come down and was jammed in the mud. With a great deal of heaving I moved the bike out of the hedge but could not lift it enough to get the sidestand up. It was completely stuck despite some digging around it with my Leatherman blade. I did too much pointless heaving and tugging and pretty soon felt a sharp pain where I had broken my rib two months earlier and could not believe how stupid I had been to do all this.

I looked up and down the lane but it was clear very few people came down here. I started thinking about walking to the nearest house, but to ask anyone to come out and help me seemed a bit unrealistic, especially if they did not like the idea of people riding motorcycles on this route. Eventually I remembered my Cambridge based bike-riding friend. I hesitate before asking people for help but I could see little option. Luckily there was enough signal to reach him and kindly he agreed to ride out and help me. I was hugely relieved but while waiting for him I did more useless heaving. I thought about the advice not to ride potentially tricky terrain on a bike like this alone.

He came, and methodically helped get the bike into a position where we could both lift it and rode it up to a place where the ground was dry, then rode with me back to the garage where I surveyed the not-too-much damage on the bike.

GPX trace

The GPX file even shows my meeting with the hedge (yellow) followed by some moving around (red)

What is the moral of this little story? Don’t be an idiot. Get a lighter bike if I want to ride even these ‘easy’ tracks alone (I was looking at reviews of a Yamaha Serrow on the way home…). Yes the adrenaline of the first moments after falling can help you lift a bike, but it is good to survey the situation carefully before putting in unfruitful and potentially injuring efforts. Having a few friends is much better than having none. Another thought – which I am adding a few days later after having looked at the Icknield Way official websites – is that I should check on which stretches of the Icknield Way motors are allowed and which they are not. There are plenty of Youtube videos of people riding adventure bikes on tracks around fields claiming that they are riding the Icknield Way but if I were out walking I would certainly not want to meet up with a large motorcycle travelling at some speed and possibly in a group on these often narrow paths.

Last night I went up to Cambridge and dropped by the garage. It is very bleak on a cold winter night (it was Halloween). I had never been there in the dark before. I also saw that everything was covered with mud.

Can you see my angle grinder?

The contents of the flask were very welcome on a cold foggy night

Bodily or metal fatigue?

Every morning I cycle up the hill from Kings Cross station up to Archway. Since the New Year things have been getting tougher and I’ve been afraid that I’m getting less fit. From about this time I have been intending to bring the bike home to give it an overhaul.
This is what bearings are meant to look like and the deranged piece of metal is what I found once I opened up the bottom bracket.
photo

Granuloma trauma

Its always hard to judge what to make public and what is best kept to yourself – but if you search for granuloma on the net you find some informative personal stories – I nearly wrote personal traumas – of this condition so I am adding one. This year has involved a couple of traumas for me so far but the granuloma trauma is sufficiently distant to write about it. Granulomas are a skin growth that can emerge anywhere but sometimes, for the particularly lucky, they are on the face or lip. Mine started as what first appeared to be a herpes sore on my lower lip but then outstayed the normal 5-7 days and kept growing. After 3 weeks I took it to my GP who searched on Google images but could not diagnose it. He referred me to a maxilo facial unit and an appointment was scheduled for three weeks hence. Unfortunately between then and the appointment not only did this keep growing but I had an international conference which I was organising to attend and do a great deal of appearing in public. Though I never believed that this was malignant or there to stay, this was a sudden initiation into the experience of disfigurement, of people glancing twice or of me feeling they were, of avoiding a chat with my neighbour, of sitting with my hand over my mouth at meetings. I was shocked by how powerful and constant my consciousness of this minor disfigurement was. The conference involved lots of speaking to a full auditorium with my face projected twenty feet tall on a screen behind me. This was great timing. Some people would ask me about it but most ignored it. This growth had the habit of bleeding profusely if I drank a hot drink, and in the shower and my hotel pillow would be stained with blood in the morning. This was ghastly. The conference over and, uncharacteristically for me, I lobbied my GP to try to bring my appointment at the hospital forward. Even an extra week with this would be terrible. In the meantime, because it changed from being more like a large red pea (picture 1)

into a small crusty carrot shaped thing (picture 2),

I realised, using Google again, what it was – a granuloma. The clinic said they could fit me in early and I arrived before it opened and was prepared to camp there all day if necessary. I had sandwiches, a flask and plenty of work to get on with. I was seen before 10.30. Once in the chair I was told that it was not normal to have these removed at the first visit (I don’t know why).  Again, uncharacteristically, I insisted and they agreed. An injection of lignocaine and adrenaline in my lip turned it into a large flapping piece of liver approximately a foot wide then there was the slight sawing sensation as Mr Granuloma was being separated from me, and then some unimaginably neat needlework was done, three stitches in a little quarter inch wound. At this point I started to travel somewhere very strange and was given lots of glucose drops by the surgeon and her assistant. They encouraged me not to hurry out of the chair as the paperwork would take forever anyway. In the recovery room I talked to someone who had had her jaw broken and reset for a reason I did not quite understand. See picture 3 for the finished result (of my lip, not her jaw)

The Lone rider

This issue of Adventure Bike Rider has a few articles on riding alone and loneliness. The first is a rather eloquent account of Ben Owen’s ride through the ‘vast wilderness’ of British Columbia. He starts with the words of a friend who asked, uncomprehending, whether it is ‘a bit shit’ to travel alone. By the time he had reached British Columbia he already had ridden for two months in North America so this was a big trip, at least by my standards. The article chronicles the ups and downs of mood as he mostly travels alone through tough terrain and terrible weather. At times he is asking himself why he is doing this and occasionally a flash of landscape or a sudden achievement put the doubts at bay – for brief moments. It reminded me of similar honest moments in Ted Simon’s writing and of course of my own brief and usually unadventurous motorcycle trips. My trips are unadventurous in that they have not left Europe so far and mostly take place on tarmac but there are plenty of opportunities for anxiety and self-doubt particularly when the weather is bad and I get hopelessly lost. So this kind of writing speaks to me – much more than the matey accounts of trips with ‘grins’ and beers with a bunch of riders. Turn over the page and you get a column by chartered counseling psychologist Doctor Harriet Garrod who is currently taking referrals and charges between £250 and £400 for assessments. She says you need to mentally prepare yourself for going solo. One of her tips is to try imagining what everyone is doing back at home if you are tempted to head back early (as I have done at times). There isn’t a mention that some people may be temperamentally more suited to being on their own than others, strangely. I speak as someone who is at the end, the introvert end, of the Myers Brigs Introvert-Extrovert scale. Turn the page again and we get a less than gripping, but rather sad, account of a solo rider who found he wasn’t enjoying his 50th birthday treat of riding home to the UK from central Europe. He hated it so much that he rode home from the Adriatic in one go – 1400 miles in 25 hours. ‘The opportunity I’d created to celebrate my 50 years of life was tearing me apart: I sat next to the bike in some random European service station and cried’. Initially I was a bit dismissive of this article but this disappointment is quite touching. Perhaps he didn’t know himself well enough before he set himself this challenge. Someone said to me ‘don’t expect enjoyment, think of the journey as travelling not as a holiday’. I’ve found setting a target helps, getting to the top of Scotland, or Norway, getting to Slovakia. Then you aren’t looking for enjoyment.

My half of the debate

Earlier today I spoke in a debate about where researchers in nursing should publish their research. The other speakers were rather more focused on the motion that I was. Here’s the text of my talk:

For debate RCN Conference Cardiff, March 2009
I want to talk about ‘impact’ and about ‘nursing’. I want to suggest to you that we may have strongly felt and cherished beliefs about both but that the ‘truth’ about both is more complex than we would like to believe – and perhaps actually rather unpalatable. I’d like to suggest that we are living in a kind of ideological fog when we talk and think about them.
First I’d like to suggest that research may be less important than we think in an activity as complex as healthcare. In healthcare delivery what is far more influential on patient experience, on outcomes and on job satisfaction is the amount of work to be got through, how good the managers are, what our colleagues are like – and alongside every exemplary intelligent and highly motivated nurse there are a few who seem to use work as a kind of therapy sandpit to act out their problems with insecurity and resentment. Also having a huge influence on what happens in healthcare are the contingencies of daily unpredictability (people ringing in sick, agency staff who are lost, students who have fights with each other, medical consultants to be intimidated by, managers to be bullied by) not to even mention the constant distorting effects of a series of bizarre government targets that were invented not to make the health service better for anyone but to solve some short term media embarrassment for ministers. In this context, and yes, this is a negative picture but it it is the context, I think it is fair to say that compared with addressing some of these problems, the potential impact of research is small. We don’t need a stream of new knowledge constantly fed to nurses who are struggling with other factors at the bedside or in the community. Whatever we might like to think, its just not the priority.
Second, no-one can do much about research findings because procedures, assuming they are followed, are decided by organisational committees and handed out in the form of protocols and standard operating procedures. The nurse who wants to introduce anything new needs the skills not so much of understanding arcane research methodology but of political and bureaucratic nous and muscular survival. As one nurse said in a focus group run by a colleague of mine recently ‘If you don’t act by the protocol the repercussions come back on yourself and you stand alone’. The space of healthcare delivery is a space where subjectivity is almost entirely erased in a realm of procedures, where nurses and others crave to act and be seen to act in a way in which they are ‘covered’. Nurses are awkwardly suspended between science and witchcraft. Like the chorus of women in poet T. S. Eliot’s Murder in the Cathedral, their overriding concern is ‘in avoiding notice’, they are ‘Living and partly living’ or like those in the Laodicean church in the book of Revelation who are not passionate but lukewarm and are ‘spewed out’ of God’s mouth. Nurses have been wanting to be ‘covered’ for thirty years at least and the rise of evidence based practice merely provides a new backdrop and a different vocabulary for this fearful and masochistic desire for invisibility and annihilation. So, research, innovation, impact and nursing do not fit easily together without looking through half closed eyes.
I want to return to the particular expectations placed on research within healthcare and then within nursing because it can inform our debate and gives some explanation for why we are all here this morning. Since the 1940s when the medical profession was corralled into the National Health Service in this country, governments have become increasingly bothered by that profession’s ability to eat up whatever resources were thrown into the system. At the same time, roughly – perhaps rather later, a sociology of the professions has recast these apparently altruistic and knowledgeable groups like medicine but also others as self-serving elites who masquerade as motivated by the needs of their clients but whose chief concern is in building up their sphere of influence possibly even at the expense of these clients. Their call for resources – in the case of medicine from the national purse – has been made convincing by the profession’s secret body of knowledge and by the privacy and emotive power of their relationship with individual patients. In the UK, governments have tried a number of approaches to curb this expensive professional power: general management, market forces, for example, but current arrangements look to be the most successful: a nice mixture of inspection agencies, new levels of recording activity and outcome, guidelines for practice, readily available ‘evidence’ and incentives – or rather penalties. So research in the healthcare arena (apart from being a potential money-spinner in the form of turning the NHS into a research field for pharmaceutical companies) is a battleground where various professional groups can demonstrate their effectiveness and be seen to be concerned with issues like treatment and outcome variation.
One strong impulse for nursing to take up the drive for research and evidence based practice is connected to the profession’s ever-present desire for credibility and a little status in a healthcare world dominated by other powerful professions. As soon as talk of evidence based activity was out of the bag it became a currency that was not likely to go away. Back in the late 80s and early 90s in response to a rising managerialism and cost-containment, nurses and others were busy in efforts aimed at demonstrating their ‘value for money’. Then, later in the 1990s, they needed to show that they were acting from a reliable scientific basis. Some looked to ‘evidence’ quite explicitly as another vehicle for demonstrating the so-called ‘value of nursing’, the value of having qualified nurses on the staff. Yet strangely, in recent focus groups that I have run with nurses , the influence of research came very low down on the list of forces affecting practice and decision-making. Organisational protocols featured far more prominently. The strange thing was that the focus group members did not see this kind of circumscribed working as compromising their professional autonomy and image. Quite the opposite. Telling me that the protocols in force in their NHS trusts had been developed from specifically nursing research (rather than medical research) they saw the existence of these instructions as a sign that nursing had finally come of age and as proof of its professional status. These groups also told me repeatedly that when research did influence practice it was through formal decision-making bodies and channels that they were not privy to. Generally, instructions seemed to come down to use this kind of dressing rather than that. So, among a risk-averse and arguably not hugely powerful group, this is perhaps a procedure that suits everyone and has a built-in opportunity to complain a little about being disempowered while actually finding the lack of personal autonomy deeply reassuring because you are ‘covered’.
Finally I want you to entertain the thought that we might share a fond overestimation of the importance of research altogether. Could it possibly be that the whole research enterprise and our belief in its usefulness and its ‘impact’ is part of a pervasive but desperate fantasy? And the fantasy at its most basic is something like this: that we live and breathe and work in a rational world that we can largely take control of through rational examination, planning and action.
In nursing and healthcare this belief has a particular flavour – which I have talked a little about.
The main value of this story is in boosting our morale, as enlightened Westerners, by letting us feel for a moment or two that we are masters and mistresses of our collective destiny. The rational abilities of the human mind have had to take on the roles and responsibilities previously allocated to gods, or God. But what if human events in any realm are largely determined by forces that we are barely aware of whether they be unconscious, as Freud would argue, or ideological, as Marx or Althusser might say? These, just to take two, might be influencing what goes on in healthcare organisations and policy making – and nobody acknowledges it because its in most people’s interests to maintain this pretence that everything important is out in the open.
So, publishing in high impact places? well, not all research in nursing has anything directly to do with practice (and this is worth remembering) and those researchers that are involved in such work, if they have a choice of one or the other, would perhaps be better off spending their time trying to influence decision-making agencies and bodies rather than individual nurses. Of course there will always be some individuals in units that are the exception, but I would argue that the in an increasingly standardised health service, the role of any individual journal-reading nurse in innovating practice is in fact quite small.

Is it summer- is it autumn?

The sky is dark now at 9 o’clock and summer, that time that we all yearn for and want to cling on to, is edging into autumn, the time that school years begin but the time that blows the leaves off the trees and that reminds us of our own ageing and death. The earth’s season’s go round and round but we, obviously, have only one life, and once we are in its autumn, there is no waiting for the spring, just a savoring of where we are, finding new things in it, a way to inhabit it (or maybe we dye our hair).

A holiday without a holiday. Four weeks off work but without an expedition. Holiday’s aren’t always what they are talked up to be. The Proms end in the first week of September, then the summer is over. Bartok’s Bluebeard’s Castle is playing now on the radio. I know the story but don’t have a clue which door we are about to open, they are clearly doors into the unconscious. There is some passion and terror happening at this moment! O no, do not insist on opening that last door!